# EMS In Crisis



## medic3974 (May 15, 2010)

I`ve had it with this job. It was a career and a profession, now it has turned into the largest sanatation company in the USA. Government let it fail by not educating citizens how and when to call 911. Private EMS folks were looking to get rich so transport everything. Fire Departments attempt to stop the bleeding and take over EMS only to find themselves over their head in a system they have no understanding of. Working 24 hour shifs, sleep depervation, starving to eat because your on the 16th call and the truck got fuel but you didnt.Senior Parmedics 5 years in the field because most wont last past that after all the abuse. Work for a slower service only to be punished monitarly for running fewer calls. Yep the citizens will finaly get what they diserve very soon a red cross first aid trained person because that is all you will find because paramedic school is 2 years and nobody wants this anymore.


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## medic417 (May 15, 2010)




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## Veneficus (May 15, 2010)

*I'm on a roll tonight.*



medic3974 said:


> I`ve had it with this job. It was a career and a profession,.



When was that? If it was I'd probably still be on a truck. 




medic3974 said:


> now it has turned into the largest sanatation company in the USA. Government let it fail by not educating citizens how and when to call 911.



Why is it the government's responsibility? In a government of the people, for the people, by the people. Doesn't that make it our responsibility and not that of some ambiguous entity?

It was EMS people who told the public to measure effectiveness by the amount of people raised from the dead, the volume of paramedics in the system, and response times.



medic3974 said:


> Private EMS folks were looking to get rich so transport everything.



Every type of agency does. The worst offender i ever worked for was a municiple 3rd service that measured how good of a paramedic you were by how many runs you could do in a day.



medic3974 said:


> Fire Departments attempt to stop the bleeding and take over EMS only to find themselves over their head in a system they have no understanding of..



That is an over generous estimation.



medic3974 said:


> Working 24 hour shifs, sleep depervation, starving to eat because your on the 16th call and the truck got fuel but you didnt...



True that sucks.



medic3974 said:


> Senior Parmedics 5 years in the field because most wont last past that after all the abuse.



I once heard a joke that the only smart marine was an ex marine. But when medics used to simply switch services to get a new environment to avoid burnout, organizations started not hiring them refering to them as "gypsies" and "not worth the investment" so you could no longer recruit somebody with more than 5 years experience. Meanwhile services (all services are guilty) didn't want to spend the money to offer a career laddrer for people to stay. Again our fault. There was a time a union could have helped, but I think it is past that.



medic3974 said:


> Work for a slower service only to be punished monitarly for running fewer calls. Yep the citizens will finaly get what they diserve very soon a red cross first aid trained person because that is all you will find.



They will get what they are willing to pay for. No less, certainly no more.




medic3974 said:


> because paramedic school is 2 years and nobody wants this anymore.



Do you promise!!!?

Then there wouldn't be 10,000 patch and pulse providers without a clue and the demand will outstrip the supply. Ask any economist what happens then!


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## Outdoornut (May 15, 2010)

*hmmm*

Hmmm,

You know I think it might be worth it to look back at the history of the 911 service. I have to admit that I don't know that much about it at all...but it is a *great* concept. Unfortunelty,it is being abused...and a lot more than I think a lot of people realize (check out this article http://money.cnn.com/2009/08/24/news/economy/healthcare_911_abuse/index.htm). I think it definitly has gone from a luxury mindset to a call on demand service...think about it really...how fortunate are we to be able to dial three numbers and have other people, who really have no obligation to help us...yet are trained, come and give aid. Unfortunetly the mindset has gone from that to "of course they came*...I called them*! And they *should* have been here faster...now...*why* haven't my fries been brought yet??"  <_<

There was a little situation one of our expedition groups had a couple years ago. About 3 days out in the back country...broken ankle...no cell service (and where they were satalite phones were about useless...but they did have a WEMT with them  In any case they had to send to people to higher ground to call 911 for an ambulance...they had to call 24 times before they got a dispatcher because they kept being put on hold because all of the lines were busy. Later they were told it was because there were several non-emergencies that had taken up the phone lines...rediculous!! 

It seems to me that there should be a better way to educate people on when to and when not to call 911....reminds me of that movie quote:

"PIease don't teII me you caIIed me out of a wedding to heIp you pick out a suit."
"You ran out of a wedding? That's horribIe!"
"You said it was an emergency!  Didn't I memo you as to what constitutes an emergency?"
"Yes. Large meteor, severe Ioss of bIood and what's the third one again?"
"Death!"
" And you're not dead."
"No"

But despite all of its greviences...and let's face it no job is perfect...keep in mind that to those who *really do* have an emergency...you're heroes. I have yet to decide if I will continue my training and possibly work within the urban context as an EMT so speaking as someone who is not currently one...I have to say I respect all of you, and what you do, a lot....hope that wasn't too sappy for you all


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## TraprMike (May 15, 2010)

this is why I enjoy volly services.. do a differant thing then regular job, community support. big plus 1 on volly services.


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## firetender (May 16, 2010)

medic3974 said:


> I`ve had it with this job. It was a career and a profession, now it has turned into the largest sanatation company in the USA.



Nice of you to visit. Happy to see you reflect many views that people can relate to.

Now...how can we be of assistance?


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## Trayos (May 16, 2010)

Nobody is holding a gun to your head, your life is your own.
Do with it what you think best.


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## mycrofft (May 16, 2010)

*OP seems ambivalent...*

Other places aren't as bad, some maybe worse. As long as young single warriors with death keep flinging themselves in, it will continue.
Move. Hone your skills. Get another job. Some games are best not played at all.


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## mycrofft (May 16, 2010)

*Veneficus, free market effect doesn't work with EMS.*

Too much regulation built in at many levels (legal, civil, governmental at many junctures), cost too high without subsidy for most people.
In fact, EMS is an excellent example on one hand of why civil service and government functions are needed (to carry out stuff no one can or wants to do for private profit), and on the other how and why it fails (operational considerations are political, expectations constantly inflated, and results tainted by inflation and mudslinging.

PS: someone (OP?) said public needs educations as to how to use EMS. Most have no alternative because EMS sucked public health dry years ago, or they think they deserve a cadillac ride and emergency dept care when all they really need is a short wait at a well-run clinic and a ride home because they are sick.


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## 8jimi8 (May 16, 2010)

what's next?


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## medic417 (May 16, 2010)

http://ems-safety.com/index.htm


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## medic417 (May 16, 2010)

medic417 said:


> http://ems-safety.com/index.htm



OOPs posted this in wrong topic and did not realize until to late to edit.  Sorry.


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## EMSLaw (May 16, 2010)

Cynical much?  Anyone in EMS for any length of time gets jaded, but if you hate it that much, it's time to move on to something else.  When I started feeling this way about the practice of law, I realized that my mental health required an exit strategy, even if it was in the long term.


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## SeeNoMore (May 16, 2010)

Yup. EMS sucks.


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## 46Young (May 16, 2010)

medic3974 said:


> I`ve had it with this job. It was a career and a profession, now it has turned into the largest sanatation company in the USA. Government let it fail by not educating citizens how and when to call 911. Private EMS folks were looking to get rich so transport everything. Fire Departments attempt to stop the bleeding and take over EMS only to find themselves over their head in a system they have no understanding of. Working 24 hour shifs, sleep depervation, starving to eat because your on the 16th call and the truck got fuel but you didnt.Senior Parmedics 5 years in the field because most wont last past that after all the abuse. Work for a slower service only to be punished monitarly for running fewer calls. Yep the citizens will finaly get what they diserve very soon a red cross first aid trained person because that is all you will find because paramedic school is 2 years and nobody wants this anymore.



Don't hold back, tell us how you really feel. Just kidding.

Seriously, this attitude is why I don't see clinical EMS progressing past the EMS AAS, or even achieve that level as the minimum. There aren't enough in our field that are willing to make the 2-4 year degree commitment and then have to accept the conditions that you rant about. 

Ventmedic has advised of those nursing and other professions collectively becoming educated, taking the position that it's mainly for pt benefit, then organizing and lobbying for all that they have now. That model obviously worked, for them, but doesn't mean that the same model will work for EMS. No guarantee.

Unless employers require degrees as condition of employment and/or significant political organization/lobbying takes place, the outlook for the future of EMS is grim. If things remain unchanged, the way I see it, the fire service will eventually achieve an overwhelming majority (or even complete)control of 911 EMS txp, nurses will do most IFT, with the privates left with simple, non emergent IFT at best. I'm suprised that the nurses haven't attempted to take over EMS IFT at large thus far by exposing the inadequate education of the EMT and paramedic. With their level of education, perhaps the hospitals would be able to bill for IFT at a higher rate using nurses, and needing to have nurses at the minimum due to the inadequacy of the paramedic's education.


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## JPINFV (May 16, 2010)

46Young said:


> Ventmedic has advised of those nursing and other professions collectively becoming educated, taking the position that it's mainly for pt benefit, then organizing and lobbying for all that they have now. That model obviously worked, for them, but doesn't mean that the same model will work for EMS. No guarantee.




What type of health care education is described by the following system:

Any Tom, ****, or Harry could open up a school.

Almost no standardized education requirements. 

Admissions and graduation requirements decided by the schools with high variability from institution to institution. 

The ability to observe or participate in patient care ranged from none to a virtual run of the place. 

Lab facilities (both clinical skills lab and educational labs) varied from non-existent to high levels.

Instructors were who ever could be found to volunteer time.


Give up?



Medical education in the US circa 1910. Isn't it kinda of scary what medical education consisted of just a relatively short 100 years ago? I've said this before, and will continue to say it. Probably the best way to advance EMS education standards at this point of the game is through a Flexner style report that shames the EMS community to demand higher standards and reform education.


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## 46Young (May 16, 2010)

JPINFV said:


> What type of health care education is described by the following system:
> 
> Any Tom, ****, or Harry could open up a school.
> 
> ...



Not disagreeing with you. The Flexner style report is a great idea, but would require organization, along with an extensive media and lobbying, of course. 

Who's going to do that? 

That was what I was getting at with the last post. EMS doesn't have enough like minded people to fight the good fight. The issues of having a poor work environment, poor pay, poor career advancement, and a transient work force are difficult to overcome when the goal is to retain motivated EMS professionals that will be properly educated, and will organize/lobby.


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## medic3974 (May 16, 2010)

8jimi8 said:


> what's next?



Good question. We ran a call this morning that is a perfect example of what EMS is all about. Female patient c/o pink eye. Demanding to be transported to an already over burden ER. She was full of all the usual dramatics. Towel tied around her head to cover her eyes and the slow painful death march to the unit. I know people who have committed find another job and no one is holding a gun to your head, yea, your the ones that get the stairchairs or stretcher and carry them to the truck. So, I am talking to you folks that have been out of school and have been doing this for awhile. Anyway, I mentioned to the patient waiting a couple of hours untill a clininc opens. I explained to her that the ER was busy and she would save herself the cost of a ambulance and ER bill. She told me "thats what my medicaid is for". Oh yes she got transported and will set in triage forever. But, she will sit their for ever patiently. She will suck everything she can out of the system.


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## SeeNoMore (May 16, 2010)

Sadly I can't see such a report working. 


The media is content to look at EMT's and Medics as heroes that save lives. Most EMT'/Ps  are content to buy into this and all the myths of EMS. "This is the street. It seperates the men from the boys"

In all likliehood nothing will change. Whackers will stick around, and anyone with any sense will get out.


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## mct601 (May 16, 2010)

46Young said:


> Don't hold back, tell us how you really feel. Just kidding.
> 
> *Seriously, this attitude is why I don't see clinical EMS progressing past the EMS AAS, or even achieve that level as the minimum. There aren't enough in our field that are willing to make the 2-4 year degree commitment and then have to accept the conditions that you rant about.
> *
> ...





Let me get a degree to make $14/hr. Yep, that makes sense.

Paramedics need more education, and more pay. Restructure how they're educated, and then they should get compensated for that.


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## 46Young (May 16, 2010)

mct601 said:


> Let me get a degree to make $14/hr. Yep, that makes sense.
> 
> Paramedics need more education, and more pay. Restructure how they're educated, and then they should get compensated for that.



The problem is, who is going to advocate for this restructuring? It's in the best interests of EMS admin (fire, private, hosp based and muni third service alike) to keep the EMS applicant supply cheap and plentiful. This is evidenced by the fact that most employers don't even ask where you got your P-card, let alone require a degree or even give preference for one at the entry level position. The EMS employers certainly aren't going to buck up and donate funds for lobbying and such, so that leaves the EMS professionals.

Many on this forum do advocate for higher educational standards in EMS, but what percentage of EMS professionals outside of this forum feel the same? I'm betting not many since quite a few come and go from EMS for various reasons, and have no vested interest in advancing the profession for the long term.

Restructuring education alone won't automatically benefit the profession. You need lobbying and organization. You need a workforce that's not transient to accomplish that.


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## Shishkabob (May 16, 2010)

mct601 said:


> Let me get a degree to make $14/hr. Yep, that makes sense.
> 
> Paramedics need more education, and more pay. Restructure how they're educated, and then they should get compensated for that.



Problem is, what comes first? 


Who's going to want to spend a lot of money on a degree that they can't recoup easily in their career?

On the same token, who is going to want to pay for a more educated person, when they can get the same thing from less educated?



Texas attempted compensating degreed medics with their "Licensed Paramedic" level.  Problem is, LPs typically get no more (or very little) pay than a certified Paramedic, have no further advanced protocols or freedom of choice, and have to pay more to get re certified every 4 years.  Only difference between an LP and a certified Paramedic?  LPs have golden letters on their medic patch.


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## mycrofft (May 16, 2010)

*Well, just invent another type of EMT.*

Works in California, has since they invented EMT's. Just invent an EMT who can also start IV's. And an EMT who can defibrillate. And an EMT who can prescribe drugs.


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## CAOX3 (May 17, 2010)

medic3974 said:


> i`ve had it with this job. It was a career and a profession, now it has turned into the largest sanatation company in the usa. Government let it fail by not educating citizens how and when to call 911. Private ems folks were looking to get rich so transport everything. Fire departments attempt to stop the bleeding and take over ems only to find themselves over their head in a system they have no understanding of. Working 24 hour shifs, sleep depervation, starving to eat because your on the 16th call and the truck got fuel but you didnt.senior parmedics 5 years in the field because most wont last past that after all the abuse. Work for a slower service only to be punished monitarly for running fewer calls. Yep the citizens will finaly get what they diserve very soon a red cross first aid trained person because that is all you will find because paramedic school is 2 years and nobody wants this anymore.



Can you say vacation!


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## mct601 (May 17, 2010)

46Young said:


> The problem is, who is going to advocate for this restructuring? It's in the best interests of EMS admin (fire, private, hosp based and muni third service alike) to keep the EMS applicant supply cheap and plentiful. This is evidenced by the fact that most employers don't even ask where you got your P-card, let alone require a degree or even give preference for one at the entry level position. The EMS employers certainly aren't going to buck up and donate funds for lobbying and such, so that leaves the EMS professionals.
> 
> Many on this forum do advocate for higher educational standards in EMS, but what percentage of EMS professionals outside of this forum feel the same? I'm betting not many since quite a few come and go from EMS for various reasons, and have no vested interest in advancing the profession for the long term.
> 
> Restructuring education alone won't automatically benefit the profession. You need lobbying and organization. You need a workforce that's not transient to accomplish that.





Linuss said:


> Problem is, what comes first?
> 
> 
> Who's going to want to spend a lot of money on a degree that they can't recoup easily in their career?
> ...



You're both right- I'm not saying its easy.  I'm not sure how to get there, but I wish we could work towards it. I love EMS but unfortunately this is not my career because of the current state its in. I plan to attempt to get into medical school, or at least a BSN degree because I crave more medical knowledge.


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## rescue99 (May 17, 2010)

mct601 said:


> You're both right- I'm not saying its easy.  I'm not sure how to get there, but I wish we could work towards it. I love EMS but unfortunately this is not my career because of the current state its in. I plan to attempt to get into medical school, or at least a BSN degree because I crave more medical knowledge.



 Anyone can get a degree and still be a Paramedic but one has to _want_ to be a Paramedic to really stick with the job. Some folks love their career and still crave more education. Some love being agood  medic and that's enough for them. If the people in EMS want more pay and more respect as professionals they will have to lobby for themselves. PD did it. FD did it. Nurses did it. Even Physicians had to make their profession  happen lest they  continue to settle for chickens. We cannot simply say we have a higher education degree therefore deserve more. We have to make it happen by organizing and demonstrating a little support and strength, a little solidarity as an organization. I've discovered people in EMS are deathly afraid to organize and have yet to figure out why.


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## dudemanguy (May 17, 2010)

The grass is always greener. If youve never done anything except EMS or the medical field, try something else. You might be in for a rude shock or you may find something else you love. I've lasted a couple years at a job that was so wretchedly bad illegal aliens wouldnt even do it, why? Because my situation was such that it was that or try being homeless for a while(also tried that and didnt care for it much). 

Point is everyone thinks they got it bad until they see what bad really is.


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## LanCo EMT (May 17, 2010)

I'm just gonna put my opinion out there....


EMS is a job in which if you don't truly love the job or at LEAST like it, it's time for you to quit.


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## TgerFoxMark (May 17, 2010)

huh. on the training bit... I like a radically different style... you hire in, untrained, and then they train you.  
needed to be hired, have a CDL-B. you start as a driver and are taught basic first aid, CPR, O2, and triage
Spend 6 months doing this.
then offer to be trained to EMT I. add in ECG 3 lead at this point.
18months service from that
EMT-II. IV starting, nothing more than NS. Teach to do Oximitry, and take a glucose reading. Psyhcology training, bring in wildland training as well.
24 months
EMT III
Basic Drugs, Pharm. Bring in the real schooling, A&P. 12 lead, Manual Defib, Extracation.
24months.
EMT IV
Advanced Drugs, more like todays Paramedic.
24months.
EMT V Trained higher than Nursing. Some Sugical Skills. Can Suture in the field
24 months.
EMT VI Highest Level. 
Trained to ER Doc + Trauma Surgon level. Full interventions, has own medical liscense to practice under if needed. is considered a doctor. can work as a doctor or surgon. Can run a clinic. Full Perscribing abilities. 

Yes its a LONG road. that time is needed. we need people who can do more advanced interventions, perscibe meds. 

if we could send out a rig with people on it who can complete the entire mess on scene, it would help the ER's, help the pt more, cost less overall. 

People will disagree with me. It happens. something more along these lines makes this a true profession. 
Keep in mind, i wrote this in 5 min or less. no, not everything is thought through. my spelling and grammar stink.


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## firecoins (May 17, 2010)

You can require a Master's degree. Medic will get $14/hr.  That is how much the job is valued at. Fixing how well the medics are educated will not get you higher pay.

We aren't firefighters or cops.  We lack the hero status. IN NYC, people come out to protest the closing of a firehouse due to a slower response. They protest cop layoffs. These same people have no idea how long it takes to get an ambulance which is something they will more likely need. We do not get their support simply because the general public is unaware. They expect they will get an ambulance quicky but are less involved than with cops or firefighters.


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## Trayos (May 17, 2010)

Sad but true, I have to explain what an EMT is to most people I bring it up with.


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## JPINFV (May 17, 2010)

Trayos said:


> Sad but true, I have to explain what an EMT is to most people I bring it up with.



EMT as in the concept of prehospital providers or EMT in contrast to a paramedic?


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## MrBrown (May 17, 2010)

46Young said:


> Seriously, this attitude is why I don't see clinical EMS progressing past the EMS AAS, or even achieve that level as the minimum. There aren't enough in our field that are willing to make the 2-4 year degree commitment and then have to accept the conditions that you rant about



Then by all means, because the providers are lazy arses, lets not do it! 

Sorry patients, we were too lazy to go to school!  Our bad, but you gotta suffer with some warm pulse patch factory medic who couldn't be bothered gettin the edoomukashin.

Biggest fail ever.


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## emtstudent04 (May 17, 2010)

medic417 said:


>



hahah thats so funny.


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## medic3974 (May 17, 2010)

Why is it when you put it out their, the whole truth and nothing but the truth, about this job people always come up with you need a vacation or you need a new job. To answer the question's, yes I would love a vaction and yes it is time for me to move on. Not for the reason of being burned out. The reason is EMS as we know it now is broken. You to will become burned out and will be just like me one day. I know right now you want to save the world and you carry all of your eqipment to the patients side and follow all of your company's SOP but one day you will get tired of hearing my stomach hurts at 03:00am with every kid in the house up watching TV. So with that said you will be left with mostly non experience medics with less that five years or a few like me who just keep their head down hoping one day it would change. Wouldn't be nice if someone would come up with a plan to fix it. I'm not sure if it can be fixed. There is a few people getting rich on the backs of EMT's and Paramedics. So, there is alot of folks who are happy not to fix it and keep it the way it is. What kills me is that patient care is not first nor will it ever be.


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## firecoins (May 17, 2010)

When was EMS not broken?  It was always broken.


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## TransportJockey (May 17, 2010)

Education most likely will need to come first. Start mandating that all providers need a minimum of an AAS. It's not that hard to attain. Pay will eventually start increasing as education has already increased then. We are the only 'healthcare' provider that already doesn't require at least that. 
And you wonder why hospital staff doesn't take us seriously? Those of us who have worked in hospitals can see exactly why when certain medics walk through the doors with a patient.


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## medic3974 (May 17, 2010)

I use to like being better than some other paramedics. It use to feel good when I would come in to a call that was going to hell in a hand basket and everyone would feel a sense of relief when I would walk in. I think education is a lot of it. I agree, how will anyone take us seriously when you can get your paramedic certification out of a ceral box. Most students now arent allowed to touch a patient in the O.R. so they have no real intubation experience when they hit the field. Hospitals dont let students do anything in any department unless they know you in the ER and even then the student is not going to get to do much. I remember a time when meical professionals in the hospital respected us enough to at least teach us someting while we were in paramedic school. I also remember a time when Er Dr's would pull you to the side and talk to you like a normal human being and tell you something you did wrong or right. Now they dont care. Dr's sign my trip reports all of the time and never ask what their signing for. Just let me sign and dont bother me. Education cant change everything but it would be a good start.


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## firetender (May 18, 2010)

*The Root Problem*

*Our OP exemplifies the root problem of most everything that has been discussed re: EMS in crisis. It is, but not in the way he thinks. It is in crisis because HE is in crisis.*

There had never been the continuity of employed crusaders in the profession to effect change for one reason; the turnover rate is sky high due to burnout. Burnout is sky-high due to the fact that NO ONE FACES IT.
*
Burnout is the poop in the living room that everyone is in denial about.*

If there's a chance, as I see it, for EMS to grow as a profession the very first thing that must be put in place is something that allows active medics to MOVE THROUGH the emotional, psychological, moralistic, spiritual and psychic traumas they experience in their work. The people to set that up are medics themselves. Everyone else who's tried to do it has failed because they are not living within those conflicts themselves.

Nursing and other medical professionals have been able to organize because turnover doesn't begin to really accelerate until burnout takes hold, usually after ten or more years in the field; and then, because exposure is doled out in increments, it takes another five or so years before the individuals pull the plug on their careers. And yet, because there is a solid profession there they can actually extend the suffering somewhat comfortably for years more because they're paid well to do it. This is not a good thing for anyone, especially the patient, but Hey! It pays the bills!

With medics, the burnout period is massively accelerated, largely because of the steady exposure to intense and unrelenting trauma. I'm not talking about gory crashes or children dying in your arms, I'm talking de-sensitizing yourself to the human condition by "having" to transport human shells back and forth to the Nursing Home being the essence of the work along with dealing with human beings who now have degenerated into "abusers".

Most medics hit one or more of these walls and in the absence of an outlet to process, come to terms with and then move on WHOOSH!! they're gone. I don't know what the stats are for average burn out today, but if you look at them one level deeper you'll see that the first three years have the biggest proportion of turnover. 

The "culture" of the medic is still in an infantile Macho stage. *I'll betcha a buck most of the medics on this site showing no pity to the OP will be gone within 3 years themselves!*

Those who last much longer are essentially gluttons for punishment (and damn good medics) *and *too drained to have the energy to organize; especially since the biggest proportion of the people who they have to organize are not ready to dedicate themselves to the field by doing such things as getting educated. This "wait and see" attitude limits growth.

It's a numbers game and we ain't got the numbers to effect change. We don't have a profession because FNG's come in, get burned out fast and there is always the need to have warm bodies in the ambulance. It's relatively easy to get new blood because there are so many wanna be FNG's who are hooked on the "idea" of Johnny and Roy and about the third time the reality really slaps them in the face; Bye Bye!

The systems depend on this turnover to be cost-effective. They're not employing professionals, they're filtering through wanna-bes, the smallest majority of whom stick to it, really become medics and then, they'd just as soon that THEY leave because, well they gotta give them a raise every year!

It's quite the vicious circle, isn't it?


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## 46Young (May 18, 2010)

firetender said:


> *Our OP exemplifies the root problem of most everything that has been discussed re: EMS in crisis. It is, but not in the way he thinks. It is in crisis because HE is in crisis.*
> 
> There had never been the continuity of employed crusaders in the profession to effect change for one reason; the turnover rate is sky high due to burnout. Burnout is sky-high due to the fact that NO ONE FACES IT.
> *
> ...



That sounds about right. Sad and frustrating indeed.


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## 46Young (May 18, 2010)

MrBrown said:


> Then by all means, because the providers are lazy arses, lets not do it!
> 
> Sorry patients, we were too lazy to go to school!  Our bad, but you gotta suffer with some warm pulse patch factory medic who couldn't be bothered gettin the edoomukashin.
> 
> Biggest fail ever.



You're right about the lazy part. Evidence of this would be patch factories and anyone who chooses to do the EMT-I program rather than a paramedic program. Her, in Virginia, the EMT-I and the EMT-P are considered virtually the same. They can practice with virtually the same scope, with the EMT-I having but a fraction of the education. At least NVCC requires their EMT-I students to have human biology and pharm prior to application.

Anyway, what I was speaking of earlier is that the field turns over it's workforce way too rapidly to allow any effective organization. Meanwhile, few are willing to make the educational investment (when easier alternatives are available) when the benefits and payoff aren't there. The EMS employers aren't going to lobby for more education, either. It's not just about being lazy, the field just doesn't appeal to those that expect a decent return for their educational investment, for the most part.


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## Trayos (May 18, 2010)

JPINFV said:


> EMT as in the concept of prehospital providers or EMT in contrast to a paramedic?


As in the concept of prehospital providers. It makes me kinda sad when people go "oh, the guys who drive the ambulances? Whats so important about that?"
Most know what a paramedic is, at a rudimentary level.


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## Veneficus (May 18, 2010)

*S*** rolls downhill*

In the 1960s there was a realization that our healthcare system was broken. You could only get care when you got to the hospital. The days where a physican was part of or entered the community were coming to an end. 

The paramedic was born. For no other reaon than to fill the hole that was left.

Shortly after I became an EMT, paramedics were being hired to work in emergency rooms. With the inability to recruit nurses for a variety of reasons, after the nursing lobby displaced ED techs, a hole was created, the paramedic was then asked to plug this hole.

From amuzement parks, to zoos, (A to Z get it?)  whenever a low cost medical provider is needed so desperate is the situation, EMTs of all levels are thrown in to plug the hole. Some specialize in their hole. call it wilderness, industrial, whatever. 

With the breakup of the family unit and society in the US, the care of the elderly had been institutionalized. Another hole, somebody had to get these people from point A to B and back. Somebody who was part of the "medical system." EMS providers were again put into a failing situation. 

For many years in public safety and medicine we have been witnessing the total collapse of our society. As the number and types of people that need a safety net increased, EMS (mostly in the way of public safety) and by extension the EMT (of all levels) was called upon to help by transporting to the hospital. This stop gap worked for a while, but it was simply the finger in the dyke. The "abuse" many of us witnessed in our EMS career by "patients" was really the manifestation of our failed social and medical systems.

EMS providers are thrown into the impossible situation now. The hole is so big it doesn't matter how many you throw into it, you cannot fill it. You cannot slow the leak. The problems are social and not medical. It is why even after you take the pt to the hospital, you wind up taking the same frequent flyer again and again for the same thing. 

The providers get frustrated. They came to help to make a difference. They hoped to make a living at it. EMS providers get "burnt out" or frustrated because whether they realize it or not, deep down somewhere, they know they are just spinning their wheels. The record is broken and there is no satisfaction in it anymore.

I have explained the economics of service professions ad naseum, I'm not doing it again. 

In order to "help" people EMS providers need more education. Whether you like it or not, get a pay raise or not, or any other lazy excuse I have heard over the years, it remains. But the education is not all medical in nature. You have to learn what social programs are available, how to get people nvolved in them, what you can do at the social level so that it doesn't become a plea for help by dialing 911. If you want to make a difference, if you want to save lives, do some good, or whatever idea brought you to EMS, you have to perform the task needed, not the task you want to, only on the people you want to or feel are deserving. Instead of jumping in the hole trying to fill it, you need to form a chain around it and stop people from falling in. 

Everyday in this world, somebody has a "real" emergency. No matter what is done they may not survive, they will never be the same if they do. They are discharged alive and functional if they make it. They have chronic issues forevermore until the body can't cope. The damage done accelerates the bodies natural breakdown even if it is latent for years. Defiant as you stand before nature, before that which mankind does not understand, you will be overwhelmed. You don't have a chance. Tangible, needed, desired, help is that which precludes crisis. Stopping a minor lac from being infected is where lives are saved. Getting an old person a walker so they don't fall and smash their skull will save more peoples lives than every neurosurgeon, critical care surgeon, and Emergency physician combined. 

One of the things I have learned is that we really don't know the names of most heros. They are not the ones on TV or who went above and beyond once to save a life. They go above and beyond everyday. They come early, they stay late, they do the undesirable tasks for years, they give of thier time, their money, and every measure of value you can think. They save more lives and make a bigger difference than we will ever know. 

This semester I had the opportunity to meet a physician who specializes in microbiology.(not somethig I want to specialize in) Her team (which spans 4 countries) is working on vaccines for bacterial STDs. During her presentation, she talked of life and death in numbers that look like they came from wall street.

She had pictures of camps in Bangledesh  where some of the brightest physicians in the world built toilets without running water and emptied and cleaned them by hand. So little was the money they could not hire nurses. They could not find volunteers. They built them so people could come for treatment during the annual cholera outbreaks after the monsoon season. They estimate they saved more than 100,000 people in a few months. They had vaccinations, some IV fluids for the most desperate cases, the treatment for cholera, and whatever they could find locally on the cheap. They make a difference. Would you like to make a difference like that?

My current and future role is extremely focused. The days of my EMS involvement are less than 1000. I share my insight and experience so that maybe those that are still involved can make the required changes. So you can go home proud that you did make a difference. Save a life. All of those things. 

Burnout in EMS isn't required, but if a provider is not satisfied, no amount of money or prestige is going to change that. You are never going to be happy replaying the same broken record day in and day out. You will never be a professional without knowledge.

I was told once: "There are only 2 types of people in the Navy. People whos lives it makes better and people whos lives it makes worse." EMS is the same way. If you came to EMS to help people, start by learning what that means. It is rarely a trip to the hospital.


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## medic3974 (May 18, 2010)

Good post Veneficus and Asst. Chief. I believe this system needs its own hero. Someone with the political savy and smart enough to surround themselves with the right people to designs a EMS system that could work. A system that would provide more rights to the employees of  the system and some better accountability to the tax paying citizens who fund medicare and medicaid.


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## Trayos (May 18, 2010)

It seems to me like what the system needs is a face, something the public can flash to when they hear "EMT".
People already have set ideas about what a police officer, or a firefighter does/looks like. There is very little other then a blue uniform with the star of life that comes to mind when EMS is mentioned. Until it reaches that sort of recognition in the public consciousness, it will always be downplayed and under-supported. The only way to achieve that recognition is through toughing it out through the worst of times, and doing the hard work.


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## Veneficus (May 18, 2010)

Trayos said:


> It seems to me like what the system needs is a face, something the public can flash to when they hear "EMT".
> People already have set ideas about what a police officer, or a firefighter does/looks like. There is very little other then a blue uniform with the star of life that comes to mind when EMS is mentioned. Until it reaches that sort of recognition in the public consciousness, it will always be downplayed and under-supported. The only way to achieve that recognition is through toughing it out through the worst of times, and doing the hard work.



The trouble is EMS and EMTs are so many different things.

For example, I was a firefighter when our the department decided everyone had to be an EMT. But even after certification my title was still firefighter. It still said firefighter on my helmet etc. EMT wasn't even mentioned. When people asked what I did I was a "firefighter."

The same can now be said for any level of EMT. They work so many places besides ambulances. The jobs don't even resemble the training. There was not "industrial health day" in paramedic class.

Many EMS people can't even agree what EMS is. Is it public safety? Public health? Medicine? a hybrid? The answer depends soley on who you ask.

Now many of the people who have been around awhile and many nations abroad see the roles EMS and its people will play in the future, but then we hit a wall of people telling us what EMS is today and see no reason or have an interest in making sure it doesn't evolve. 

The only common ground I have discovered as I detailed is EMS workers are people with some level of medical training that fill in gaps in the healthcare and social safety net systems. (often as low cost as possible) But again, there is no consensus or even majority.


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## MrBrown (May 18, 2010)

46Young said:


> Anyway, what I was speaking of earlier is that the field turns over it's workforce way too rapidly to allow any effective organization. Meanwhile, few are willing to make the educational investment (when easier alternatives are available) when the benefits and payoff aren't there. The EMS employers aren't going to lobby for more education, either. It's not just about being lazy, the field just doesn't appeal to those that expect a decent return for their educational investment, for the most part.



I don't want to turn this into the education debate again but I will say this at the risk of sounding snobbish (which I am not).

Having the Bachelors Degree and working with people who do not makes me appreciate how helpful the depth and breadth of knowledge and ability to "see the big picture" those who are Degree educated posses is.

There are advantages to Degree education and there are equally important advantages to the old "on the job" style education you cannot get on the Degree.


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## 46Young (May 18, 2010)

MrBrown said:


> I don't want to turn this into the education debate again but I will say this at the risk of sounding snobbish (which I am not).
> 
> Having the Bachelors Degree and working with people who do not makes me appreciate how helpful the depth and breadth of knowledge and ability to "see the big picture" those who are Degree educated posses is.
> 
> There are advantages to Degree education and there are equally important advantages to the old "on the job" style education you cannot get on the Degree.



Don't get me wrong. it would be a great thing for EMS in the States to have the level of education that other developed countries enjoy. I'm completing my EMS AAS at the moment, at least it's a start. I'm disappointed at the lack of further clinical education for the paramedic past the AAS in the US. My next step is to become an RN, then chip away at a BSN, so I'll get the additional clinical knowledge there, since it doesn't yet exist in the American EMS educational system.

I simply don't see how EMS educational standarde will improve if there's no significant organization and/or funds to work toward that change.

What I'm trying to say is that I don't see how EMS here will be able to bring itself up to the standard of other countries, for the reasons I've stated earlier.


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## MrBrown (May 18, 2010)

46Young said:


> I simply don't see how EMS educational standarde will improve if there's no significant organization and/or funds to work toward that change.



Thats a good point, something we have seen here in New Zealand.

In 1975 the first Telethon was used to raise nearly a million dollars for the development of the National Ambulance Officers Training School.

Almost forty odd years later the Ambulance services are again collectively working together (something of a first) to make the Bachelors Degree and Post Graduate qualifications mandatory for Paramedic and Intensive Care Paramedic.


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