# Rant about how much volunteers are hurting our profession



## medic417 (Aug 23, 2009)

*Well here it is folks. Please place your educated responses as to why vollys are hurting the progress of ems. This has the blessing of the mods per the qoute above. I'll post mine as I have time.*



> Today, 08:10 PM    #13
> MMiz
> Community Leader
> I put the M in EMTLife
> ...


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## Pudge40 (Aug 23, 2009)

I feel the mods are crontradicting themselves. They say they want everyone to be respectful of each other but yet then say that you can make a post that belittles volunteers. They need to get their act and story straight.


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## ffemt8978 (Aug 23, 2009)

Pudge40 said:


> I feel the mods are crontradicting themselves. They say they want everyone to be respectful of each other but yet then say that you can make a post that belittles volunteers. They need to get their act and story straight.



No, we allow civil discussion and disagreement...as long as they remain civil.  Just because somebody doesn't agree with you, doesn't mean everything they post belittles you.

Feel free to prove the OP wrong using fact, logic, reason and debate...as long as you can remain civil about it.


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## usafmedic45 (Aug 23, 2009)

> Just because somebody doesn't agree with you, doesn't mean everything they post belittles you.



What he said.  If your stance is worth taking, you should be able to gut the other person's argument like a trout.  Otherwise, why do you bother holding an opinion you can not defend?  BTW, this goes for both sides of this or any argument.


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## Shishkabob (Aug 23, 2009)

Police have volunteers as well, and they aren't viewed as any less professional.




Maybe we're doing something else wrong...






/end devils advocate


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## Sasha (Aug 23, 2009)

Back on topic. I feel volunteers harm the profession because there is little regulation and uniformity. There is no compensation. Compensation is many people's motivation to do a good job and maintain their current status. Without that incentive people are likely to slack off, there is no crippling loss if they lose their position.


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## JPINFV (Aug 23, 2009)

Are the volunteers (I'm assuming you mean civilian patrols and auxiliary) uniformed and armed in most cases (note: retired police volunteering in small town is a different scenario than most volly EMS agencies)? Are the standards set for for police officers set, in part, to be able to attract volunteers? Do the locals hold the services to a lesser standard because they are volunteers?


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## Shishkabob (Aug 23, 2009)

Reserve Officers.

Depending on the city, they can be just crossing guards, or they can be fully uniformed sworn Peace Officers with all the power of paid officers.  All still (non monetarily paid) volunteers.


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## VentMe∂ic (Aug 23, 2009)

Several of the EMTs in my former service were uniformed, armed, paid auxiliary members of the local PD.


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## 8jimi8 (Aug 23, 2009)

The only place that I have heard anything negative about volunteers is on this forum.

Call my organization.  They absolutely love us.  Honestly, the only way you can tell a difference between a volunteer and an employee is if you ask the person.

Everyone at BSBEMS has to do extensive ride outs w/ an FTO and gets evaluated by everyone that they ride out with.  We are all held to the same standards, protocols and procedures.  

BSBEMS only hires from their volunteer pool.  So in the case that Sasha brings up about a lack of motivation to provide good care, is not an issue where I volunteer because everyone there is trying to show how good they are, so they can get a job.  

Personally I volunteer for the experience and because i just freaking love EMS.  I sure do wish that Paramedics made more money, because then i'd do that full time and work as an RN pt.  I really really do love being out in the field WAY more than being in a hospital.

You wanna know what the real problem is?


E G O


stop taking yourself so seriously (not at anyone in specific)

if you are mad because i'm holding you back because I volunteer, then you just need to get better.  Then you'll have a job, patients will benefit and my volunteering won't bother you.


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## Luno (Aug 23, 2009)

*8jimi8*

I'm going to differ with you, you state that the only real "problem" is EGO, as you put it, yet fail to provide facts backing your assumption.  But rather than dismissing it as baseless opinion, I'm going to argue that it isn't ego at all, because there as you put it, there are no differences between professional EMS providers that are either career or volunteer.  That negates your point of ego.  However there is a far more basic reason to believe that volunteer EMS hurts EMS as a career field.  For every volunteer that responds on a call, there could be a career responder, and that in and of itself can be viewed as detrimental to EMS.  The townships, cities, other agencies are saving money by using volunteers instead of paying EMS providers their worth, and circumventing career EMS.  The issue isn't professionalism, or ego, the issue is that for everyone providing a service that isn't compensated to the level of a career EMS provider, it diminishes that potential for a career EMS providers to make a living in that community.  Let's just another analogy, if someone started offering free taxi cab service, wouldn't the charging taxi cabs start to feel threatened?  I don't think the answer is all career, or that volunteers are absolutely right, I feel that the answer is somewhere in the middle, and local government needs to be held accountable.


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## 8jimi8 (Aug 23, 2009)

Well said.

I appreciate your points.  


Is it really the case that some places don't hire EMS because of volunteers, or is it that there is no money to pay, thus volunteers are allowed to have some real responsibility?

I mean r e a l l y...  volunteers are causing people to have less money and jobs?

Where I volunteer, they NEVER have enough money to fully staff every shift with a paid employee.  BSBEMS is responsible for 3 cities.  I know they would hire more people if they had the funding and again, volunteers are doing nothing more than filling in the roster gaps when a paid employee can't make shift.  (and we do get compensated... $20 for a 24 shift + $10 for every transport, but we are not paid employees)

I guess i'd like to see some hard data on your points as well.    

As for me, my proof is in my post.  I have ONLY encountered the "volunteer phenomenon" on this site.  I don't really need to give you hard data because in my experience there is nothing tangible.


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## usafmedic45 (Aug 23, 2009)

> I feel volunteers harm the profession because there is little regulation and uniformity.



The same problems exist in paid services.  I used to oversee quality for several operations- both paid and volunteer- and there was no dire difference between the volunteers and the paid personnel in terms of quality or oversight.  It's not a matter of volly vs. paid that leads to lack of oversight, regulation or uniformity; it's a matter of poor medical control oversight which is by no means unique to volunteer organizations. 



> There is no compensation.



You understand the concepts of a strawman argument and circular reasoning right?



> Compensation is many people's motivation to do a good job and maintain their current status.



Those "many people" are also not the kind who tended to give up their free time to act as volunteers.  



> Without that incentive people are likely to slack off, there is no crippling loss if they lose their position.



As the saying in legal circles goes, "relies on facts not in evidence".  A lot of us who are volunteers could care less about getting paid.  Hell, most of the volunteers I know made more money doing their day jobs than you will ever make as a paramedic even if we got rid of volunteers completely.  If they are living comfortably and do not need the money and find gratification by helping their neighbors, then who says money is the sole motivator?  And you call me burnt out and jaded....girl, please.... :glare: :lol:


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## JesseM515 (Aug 24, 2009)

Volunteers might hurt the profession but what about the patients? I have a full time job and I am looking forward to volunteering while finishing up my military enlistment.Im interested in EMS for helping people and I like the idea of being able to do that to the best of your ability without worrying about a paycheck.


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## Ridryder911 (Aug 24, 2009)

It is not that I am against volunteerism, just that it should be performed as an initial act and not regarded as professional care. Sorry, emergency medicine is hard enough to maintain proficiency and be educated to provide the very best. Place the role where it should be as in first response. 

The main problem is that those associated volunteers is the ones with ego problems. Many communities suffer today not because of lack of funding but do to tradition. Again any community that could afford a professional EMS unit should even more so than some other city services. 

Again, I have never been against the volunteer themselves as I have taught & worked with many for decades but the problem arises when such organizations demand and then change the outcomes of programs and services associated with EMS. Most medics are not involved with the "system" of EMS, to really know what is involved at a State and National level. What happens politically in sub-committees and action groups that can and has changed the scope of all levels in EMS. This is where I draw the line volunteer or paid. Patient care is patient care, paid or not. The disease or injury process does not care whether you could afford to obtain a degree or if you make 20 calls a day, you better be the best for the patient and no excuses.

Unfortunately, I have seen what many large number of volunteer groups had done to change and restrict the educational level. As well, I have seen communities not provide ALS care all because tradition; now whose ego is really being displayed. 

As more and more progress will be demanded, time will take care of those that cannot provide care. Regionalization and consolidating is the way of the future as the only viable means to continue the service. 

R/r 911


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## PapaBear434 (Aug 24, 2009)

Not to question the all knowing moderators and their infinite wisdom, but is there really a point to this?  I mean, really, both sides have more than said their peace on this, no one is going to be convinced otherwise, and it always ends up with someone getting their feelings hurt because someone gets a little too overzealous defending their "point" and the thread gets shut down.

Why do we want to keep going around on this crazy train?  Why can't we just respect all of us, EMT, Medic, Nurse, Doctor, students, volunteer and paid alike, as medical professionals?  All this topic serves to do is stroke one's own ego by attempting to crush another's.  We're all guilty of it, myself included from time to time.  And anyone who says otherwise is a liar.  

Why not stop running head long into this brick wall and just agree to disagree, and attempt to just try to make each other and ourselves better providers rather than trying to draw lines in the sand and stand against one another?


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## ffemt8978 (Aug 24, 2009)

PapaBear434 said:


> Not to question the all knowing moderators and their infinite wisdom, but is there really a point to this?  I mean, really, both sides have more than said their peace on this, no one is going to be convinced otherwise, and it always ends up with someone getting their feelings hurt because someone gets a little too overzealous defending their "point" and the thread gets shut down.
> 
> Why do we want to keep going around on this crazy train?  Why can't we just respect all of us, EMT, Medic, Nurse, Doctor, students, volunteer and paid alike, as medical professionals?  All this topic serves to do is stroke one's own ego by attempting to crush another's.  We're all guilty of it, myself included from time to time.  And anyone who says otherwise is a liar.
> 
> Why not stop running head long into this brick wall and just agree to disagree, and attempt to just try to make each other and ourselves better providers rather than trying to draw lines in the sand and stand against one another?



Simple


> We don't intend to censor messages based on the opinions expressed within posts, but we will enforce the policies outlined both here, on the Guidelines page and on the Forum. We reserve the right to remove, modify or move posts at our discretion and without explanation.



We will let the discussion continue until such time as it violates our guidelines and rules.


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## PapaBear434 (Aug 24, 2009)

ffemt8978 said:


> Simple
> 
> 
> We will let the discussion continue until such time as it violates our guidelines and rules.



Of that I have no doubt.  But I'm willing to bet that you could search for one of a million former threads on this topic, cut-and-paste the results into THIS thread, and  you would be hard pressed to tell the difference from what is going to result in the end.  Sure, one or two of the usual players may be replaced with fresh new faces that have not seen the hell about to be unleashed and don't know any better.  But for the most part, it's going to be the same thing, same argument spewed by the same people until the same insults are eventually thrown.  

It just seems so idiotic to draw borders between us all at a time in our relatively young field of practice when we should be a united front.  Most people still don't know what we are or what we do, and most people in the medical field look at us as adrenaline junkies whether we are paid or not.  

Maybe we should stop the infighting and just concentrate on becoming better at our jobs and becoming more respected as a field of medicine.

And now, that last part was NOT a shot at Vollies.


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## MrBrown (Aug 24, 2009)

Volunteers hurt EMS because they will always be the lowest common deominator that standards are watered down to please.


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## PapaBear434 (Aug 24, 2009)

MrBrown said:


> Volunteers hurt EMS because they will always be the lowest common deominator that standards are watered down to please.



I rest my case.


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## usafmedic45 (Aug 24, 2009)

> Volunteers hurt EMS because they will always be the lowest common deominator that standards are watered down to please.



I don't know about that....you've obviously never dealt with TransCare ambulance out of Terre Haute! :lol:  Also, let's try not to paint diverse groups with broad brushes.....not all volunteer agencies (hell not even most) have lower standards than their local paid services.  The two tend to follow one another in terms of recruiting standards and often share personnel.


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## firefighter170 (Aug 24, 2009)

I feel that they hurt us by offering less than quality service and they do not want to get more education or newer better equipment, most of the the vollies around here are stuck in the mind set of this is how granddaddy did it and we are gonna do his way even though its outdated.


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## FireResuce48 (Aug 24, 2009)

I volunteer in a big combination department in the DC suburbs. Without the volunteers in this county the citizens would be screwed.
They don't have enough money for the paid firefighters/emt's they have.

We have to keep up with our certs do annual refreshers on certain things. 

We log more training hours then our career staff in a year. 

I read allot of the threads that are written here.

There is some good info on this site but there is a whole bunch of threads that just are full of big headed responses on how someone's way and thoughts are better than everyone elses. This place would be more enjoyable if it was easier to wade through the crap.

And i noticed a misplaced my letters in my username. Don't I look intelligent. 

But apparently I am just a worthless job stealing tic so all is ok in the world.


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## usafmedic45 (Aug 24, 2009)

> I feel that they hurt us by offering less than quality service



Have any evidence to back that up?  Like so much in EMS, that claim is based on supposition and politics with no scientific data that I've ever seen to support either side conclusively. 



> they do not want to get more education or newer better equipment



You've obviously not spent a lot of time around any number of volunteer departments other than the handful in your area.  Ever heard of a selection bias?  I've worked in four different states (including the same area that FireResuce48 is talking about) both paid and volunteer and the volunteers have always been the ones going for as much training and education as they can get into.  The paid guys- especially on the combination departments (read as "unionized fire departments")- tend to rest on their laurels/"disco patches" and not want to do any more than the bare minimum to keep their certs.  

BTW, while my stance is that an all paid profession would be a great ideal, I don't see it happening any time so instead of *****ing about how much volunteers "suck" or deliver "substandard care", work on addressing those issues.  Trust me, _if you have evidence_ that they are screwing up in a significant way, you can take that to the state EMS agency, the county board, the city council, the medical director or (as a last resort) the news media and effect change that way.  Whining about perceived issues on a forum, mostly without any credence to the claims you are making, is not going to do anything for anyone including the ones who need it the most (the patients). 



> most of the the vollies around here



That's a key phrase that causes your argument to look like nothing more than sour grapes.  C'mon people...let's not get petty.  If you actually believe something and really want to push the profession forward, have the stomach to actually prove your beliefs and not just waste your time and everyone else's by comparing the size of your genitalia to those of the department down the road.


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## Luno (Aug 24, 2009)

FireResuce48 said:


> I volunteer in a big combination department in the DC suburbs. Without the volunteers in this county the citizens would be screwed.
> They don't have enough money for the paid firefighters/emt's they have.
> 
> We have to keep up with our certs do annual refreshers on certain things.
> ...



See, here's where I think the difficulties lie, the problem I have isn't with volunteers, they have way more dedication and drive then I do.  I don't think that I would do this for free.  That being said, my issue isn't with the volunteers dedication, training, motivation or desire.  There are volunteers that are slackers, but there are career personnel that are slackers as well, the difference is that the volunteers aren't paid, the career slackers are stealing from the system.  My issue is simply that there are fewer groups abused more than EMS volunteers.  "They don't have enough money for the paid firefighters/emts they have."  If enough people die, local government will find the money, either to pay lawsuits, or they will decide to be proactive.  I've been able to work with volunteers who are very well trained, so I don't think the system has been dragged down for them.  I think the system has been brought to lowest common denominator for several reasons, to blame that only on volunteers lacks factual evidence.  I'd also like to clarify that I don't see volunteers as a "worthless job stealing tick" but rather the victims in a game where someone is trying to get something for nothing.  I appreciate all the volunteers that I work with, and I tell them the same thing.  In my opinion, "They are being taken advantage of."


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## usafmedic45 (Aug 24, 2009)

> If enough people die, local government will find the money, either to pay lawsuits, or they will decide to be proactive.



Trust me, it's not quite that simple.  It's too easy to brush those numbers under the rug since they occur in ones and twos for the most part.  Unless you can prove a great deal of negligence (which is not as easy to do as people think), it's still going to just be cheaper to pay the lawsuit off than to pour at least a million dollars a year into a paid EMS operation.  You can argue it _*might*_ save a few dozen lives per year, but I can guarantee the average taxpayer is not going to care that much since they can say "Oh, I don't plan on dying/being in an accident/getting seriously ill" and all they will ask is "How much are you going to raise my taxes?".


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## SanDiegoEmt7 (Aug 24, 2009)

I don't understand the big deal with volunteer services.

If you think they are badly organized:  Change their oversight

If you think they are of lesser care:  Require them to have to same certifications, or again change their oversight

If you are pissed because you feel they lower your earnings: understand where they are coming from.  Many EMTs I know are volunteers at FDs that cannot afford to hire new FT employees,  they use the volunteer program to gain experience at that fire department so that when there are positions available they can be more qualified to apply.  In Southern California job competition is fierce.  You can't be angry at someone for seeking skills/experience to get a job.

I don't even feel that firefighter/medics are underpaid.  For a job that only requires one year of education and a fire academy I think that earning 50K+ is a pretty good deal.  EMT earnings aren't relevant.  You can't take a first aid course and expect a career.

Education is key.


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## Ridryder911 (Aug 24, 2009)

PapaBear434 said:


> It just seems so idiotic to draw borders between us all at a time in our relatively young field of practice when we should be a united front.  Most people still don't know what we are or what we do, and most people in the medical field look at us as adrenaline junkies whether we are paid or not.
> 
> Maybe we should stop the infighting and just concentrate on becoming better at our jobs and becoming more respected as a field of medicine.



The problem is those within EMS know very little to nothing of the profession. Very few know what national and even state standards are and how they are placed. Unfortunately, ignorance is not always blessed as we just can stand back and look at our profession in whole. 

The old saying could never be more true of asking_...."Is what we are continuing to do working?"...._ An absolute no, would be the answer. So why do we want to continue to do this? 

As you pointed out many posts are repetitive, and I don't know how many assume after taking a few week course they have became experts in EMS. Which is ironic, when many ask on how to renew or how the workings of the profession occur. Again, something we fail to teach at all levels. So the repetitive posts occur because newbies assume that they are the first to post or ask. 

Very few that posts here are really active within EMS as a profession other than riding in the truck (albeit paid or volunteer) or have any idea what is occurring in the profession outside their local city. For example, anyone know what is occurring at a special meeting at Florida at this time? .....


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## upstateemt (Aug 24, 2009)

Volunteers save lives.  

Not every community is large enough to provide paid services, to expect them to do so is to place an unfair financial hardship on them. 

As a volunteer with a small town agency I maintain the same educational requirements expected of the paid service 30 miles down the road.  In fact, our training and skills testing far exceeds that required by NYS.  With 2 Paramedics, 4 Critical Care EMT's and 2 Basics my squad answers 340 calls a year, many life threatening emergencies that would result in a far poorer outcome if the patient were waiting the 30 minutes required for the paid service from the city. 

I am also a Registered Nurse (of greater than 20 years) and I can say without hesitation that the time and training involved in maintaining my EMT Certification is far greater than my RN. 

I don't know why this question keeps coming up, it's baseless and ridiculous. It's time for the paid people to GET OVER THEMSELVES.


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## Sasha (Aug 24, 2009)

> Maybe we should stop the infighting and just concentrate on becoming better at our jobs and becoming more respected as a field of medicine.



Some people won't let go of their old way without a fight. How can you get respected when many people still treat the profession as a hobby?


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## medic417 (Aug 24, 2009)

OK here is a brief response from me the OP.  It's a shocker.  I have seen and actually was a part of a volly system that put to shame most paid services.  They took education serious.  They held educational classes, they did training as well.  In an emergency I would trust them with my life.  I actually did twice but that is another story.  On scene they could out perform any paid service I have seen.  They actually knew the what, why, what to expect etc for everything they did.  These volly Paramedics were are the best.

Now after saying that these same great Paramedics have caused much harm to payroll.  In my area when we approach the city and county for pay raises they always throw it in our face that people do this for free, so why should we pay you more.  Sadly the community of those Paramedics is in a better financial shape to pay than any of the other services I am involved with.  You know the reason they have not gone paid?  They are high paid professionals that use volly EMS for a tax write off.  So because they insist on staying volly I and all the other professionals get lower wages so they can have their tax write off.  That is not fair. 

Now as to all the comments about if no vollys there would be no ambulance as their area can not afford.  I call BS.  With a shift in priorities money can be found.  No you may not be the highest paid but you can be paid.  I think I will start a new topic for input on how it can be done.  If you can't wait go into my posts and you will find many ideas to make your volly service a paid one.  

I'll be back later for more.  Please keep this respectful so this does not get locked.


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## upstateemt (Aug 24, 2009)

The analogy that because a person is a volunteer they treat EMS as a hobby is totally absured and faulty logic.  Your attitude is what a previous poster was talking about when they discussed Ego issues in EMS. 

You get a pay check, big deal. 

I take the refresher classes right along side the paid EMT's. I test out right along side the "paid professionals" and I have to say that far more "paid professionals" fail their skills testing than the volunteers.  The conferences and CEU lectures I attend are the same ones attended by the "paid professionals".  

The flip side of your argument could very well be that volunteers are more dedicated that the professionals BECAUSE we are doing it without compensation.  INDEED, when is the last time a "paid professional" missed an important family event, cancelled social plans, or had to go to their "paid job" with one hour sleep simply because they were trying to help their community. 

I would much rather have someone take care of me because they wanted to be there than someone who was just doing it for a check.

There are good EMT's and bad EMT's on both sides of this issue, whether you are getting paid or not has nothing to do with it.  One of the most incompetent Paramedics I have ever encountered works full time as a "paid professional".  Her inability  to provide even the most basic of care has nothing to do with whether she gets a pay check or not.


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## Melclin (Aug 24, 2009)

I think the problem is that the EMT-B level requires so little education that it can be accessible to volunteers. 

We have vollies for the same reasons as I suppose you all do: to fill low call volume areas. They have the same education as you might expect an EMT-B to have, sometimes more. Nobody considers it a profession, just a bunch of socially minded people helping their community in their spare time. And nobody is whining in the ambulance service, because all the paid professionals have real educations and practice at a level far beyond volunteers. 

You can hardly go off too first aid class for 15 seconds, then wine about not being considered a professional and complain that volunteers can usurp you.

Nothing wrong with volunteers practicing at a volunteer level and augmenting the professional system. What you need are higher educational standards for paid EMTs.


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## Ridryder911 (Aug 24, 2009)

upstateemt said:


> Volunteers save lives.
> 
> Not every community is large enough to provide paid services, to expect them to do so is to place an unfair financial hardship on them.
> 
> ...



Would you still perform nursing full time if you were no longer paid? .. Yeah, that's what I thought. 

R/r 911


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## upstateemt (Aug 24, 2009)

Melclin said:


> I think the problem is that the EMT-B level requires so little education that it can be accessible to volunteers.
> 
> We have vollies for the same reasons as I suppose you all do: to fill low call volume areas. They have the same education as you might expect an EMT-B to have, sometimes more. Nobody considers it a profession, just a bunch of socially minded people helping their community in their spare time. And nobody is whining in the ambulance service, because all the paid professionals have real educations and practice at a level far beyond volunteers.
> 
> ...



WHAT THE H#LL???????????????????????  I don't know what state YOU practice in but in my state and in the states I am familiar with the education and testing are the SAME regardless of whether you are paid or not. 

In NYS the EMT B is a TWO SEMESTER COURSE followed by the same testing for all.  My CC certification consisted of 16 ADDITIONAL credit hours and over 300 hours of clinical.  Paramedic is another year with hundreds of hours added clinical.  NO DIFFERENCE BETWEEN PAID OR VOLUNTEER. 

You are totally wrong in your view of "volunteers" we practice at the same level of professionalism as ANY paid person.  Because we have a "social" conscious in addition to being professional is a PLUS and an ADDED benefit.


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## upstateemt (Aug 24, 2009)

Ridryder911 said:


> Would you still perform nursing full time if you were no longer paid? .. Yeah, that's what I thought.
> 
> R/r 911




Yes, I would and I do.  I volunteer my Nursing services with a local Hospice.   Your question makes no sense however since like most people I need a paid profession in order to live.  No one is faulting paid EMT's for using that skill to make a living we are simply saying don't call us substandard because we chose to volunteer as EMT's rather than be paid.


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## ffemt8978 (Aug 24, 2009)

Don't let the student tag fool you...some people here intentionally choose that as an indicator that they feel they are always a student in EMS.  Constantly learning.


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## medichopeful (Aug 24, 2009)

upstateemt said:


> INDEED, when is the last time a "paid professional" missed an important family event, cancelled social plans, or had to go to their "paid job" with one hour sleep simply because they were trying to help their community.



Seriously?


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## upstateemt (Aug 24, 2009)

medichopeful said:


> Seriously?



seriously.
perhaps I should add the caveot, "and not gotten paid for it".


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## medic417 (Aug 24, 2009)

upstateemt said:


> seriously.
> perhaps I should add the caveot, "and not gotten paid for it".



One actually could argue that paid people care more for their community's because they are willing to be away from home.  That they want to make sure response times are short.  That they refuse to leave their community w/o the best in care.  etc etc etc etc etc

You could also argue that vollys are selfish.  That they do it for personal glory and satisfaction rather than doing whats best for the patient.  That they want to be able to put lights etc on personal cars to draw attn to themselves.  etc etc etc etc etc

Do I need to go on?


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## Medic744 (Aug 24, 2009)

Where I am volleys are not treated any different or looked down upon in any way.  On scene they wear the same uniform that we do and you cannot tell the difference in any of us.  I respect them more for being there when they don't have to and aren't getting paid for it.  On both the EMS and Fire side there is a paid crew and volleys to fill in.  I have never met a group more dedicated to being there.  The EMS volleys are held to the same standards and expectations as the paid crews, including keeping up with training and time put in at the station.  I dont believe they are hurting the profession as a whole but think that it may be that some volleys are not the caliber that they need to be.  I may be a little biased too since I started here as a volley before going paid and they hold a special place in my heart.


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## upstateemt (Aug 24, 2009)

Medic744 said:


> Where I am volleys are not treated any different or looked down upon in any way.  On scene they wear the same uniform that we do and you cannot tell the difference in any of us.  I respect them more for being there when they don't have to and aren't getting paid for it.  On both the EMS and Fire side there is a paid crew and volleys to fill in.  I have never met a group more dedicated to being there.  The EMS volleys are held to the same standards and expectations as the paid crews, including keeping up with training and time put in at the station.  I dont believe they are hurting the profession as a whole but think that it may be that some volleys are not the caliber that they need to be.  I may be a little biased too since I started here as a volley before going paid and they hold a special place in my heart.



Thank you.

I'm heading back to my mostly lurking status.  It's threads like this that make me wonder why I bother reading this forum at all.  It should, perhaps be renamed "Paid" EMTLIFE.    Interesting to note that very seldom does a volunteer start a thread "what's wrong with paid EMT's", generally it's the paid folks looking to tell us that we are inferior. 

I cannot get it through my volunteer head WHY you paid people are so threatened by us.


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## Ridryder911 (Aug 24, 2009)

upstateemt said:


> Yes, I would and I do.  I volunteer my Nursing services with a local Hospice.   Your question makes no sense however since like most people I need a paid profession in order to live.  No one is faulting paid EMT's for using that skill to make a living we are simply saying don't call us substandard because we chose to volunteer as EMT's rather than be paid.



If money is nothing, then go to EMS full time and nursing as a volunteer nurse? Volunteering occasionally, and not being able to make a livelhood due to a sector is another thing. So you would have no problem of allowing Paramedics to perform in the role of a RN at half the salary and reducing the shortage of need? Replace every other ICU/CCU nurse with a Paramedic at half the cost. You would not mind taking a furlow or having your pay reduced due the need would not be there? .. 

Sorry, I have been an RN for over twenty years and I know the uproar anytime there is any discussion of anyone moving in on their turf. So let's be realistic that we as nurses are secure due to our profession fortunately has the fortitude to see that there is a supply & demand to ensure pay. 

Talk is cheap. 

R/r 911


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## wyoskibum (Aug 24, 2009)

medic417 said:


> *Well here it is folks. Please place your educated responses as to why vollys are hurting the progress of ems.*



What is hurting EMS is those in the field that are unprofessional.  Being professional has nothing to do about collecting a paycheck.  It has everything to do with being the best that you can be.  It is about making the effort to continually learn and advance your knowledge.

I've seen some very professional Volunteer and Career people in EMS.  Unfortunately, I've seen some very unprofessional people as well.

I think it is easy to blame volunteers became so many do this for the wrong reasons.  They are in it for the adrenaline rush, to be able drive with lights and sirens, etc...   Any volunteer who has said "I'm just a volunteer" should get out of EMS and do something else.


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## medic_texas (Aug 24, 2009)

I agree with Rid's last point.  

I know several volunteers that "triage by address" and won't answer up for calls unless it's something "good".  I've had to respond to several calls because non of the volunteers would answer up or were unavailable.  I know there are several volunteer EMS agencies that are excellent.  I worked for one as the "paid paramedic" while I was in nursing school, and that service had their stuff together.  However, it was the leadership that made that service great and the volunteers were very committed to keeping their city covered when they were on call.  They were very selective on who they would allow on the service and would turn people away, rather than having someone ruin their reputation.  

But on the other hand, they were reimbursed very well.  They were paid 25 dollars a call, free uniforms, jackets, training, etc.  I'm still on-call there just because of the people and the professionalism.  Those places still exist, but yet they DO pay and they are progressive.          


EMS needs to change at the top with uniform standards across the country.  I think there is a need for volunteers in many rural areas, but too many suburbs take advantage of their near-by paid EMS service and have them run the calls when their vollies are "busy".  This has been happening in my area for years.  

I think EMS would be a better career if volunteer services were limited to a minimum and held to a higher standard (or even had a set standardization for training, response times, documented contact hours, etc).  Most full time agencies have certain requirements and have continuing education on a regular basis.  

Just a drop in the bucket for changes that EMS needs to make, IMO.


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## upstateemt (Aug 24, 2009)

Ridryder911 said:


> If money is nothing, then go to EMS full time and nursing as a volunteer nurse? Volunteering occasionally, and not being able to make a livelhood due to a sector is another thing. So you would have no problem of allowing Paramedics to perform in the role of a RN at half the salary and reducing the shortage of need? Replace every other ICU/CCU nurse with a Paramedic at half the cost. You would not mind taking a furlow or having your pay reduced due the need would not be there? ..
> 
> Sorry, I have been an RN for over twenty years and I know the uproar anytime there is any discussion of anyone moving in on their turf. So let's be realistic that we as nurses are secure due to our profession fortunately has the fortitude to see that there is a supply & demand to ensure pay.
> 
> ...



Sorry, I fail to follow your logic.  You are saying I would be more "professional" if I were a paid EMT and a volunteer RN?  I happen to make about twice the going local salary of a Paramedic as an RN.  I also  have about twice the education, well actually more than twice since I'll be completing my Master's this fall than,  a Paramedic has.  In NYS many Paramedics do not even hold a degree, they complete an 18 month course and test out.   Shame on me for earning a decent living and being educated. 

I don't understand your statement about allowing Paramedics to function as Nurses in the ICU...... where did that come from?  A volunteer EMT in NYS has EXACTLY the same education and testing as a paid, there is no difference.   In the two states I practice nursing in; NY and PA Paramedics are not hired in the ICU.   Are you suggesting they should be?

If I am secure in my position it is because of 25 years experience and my education.

Volunteer occasionally?  The majority of the volunteers in my agency, and I can only speak for my agency, spend as many hours a week volunteering as they do at their paid positions.   I spent 48 hours last week covering ambulance shifts, every hour spent at the Fire House.  During my 4-12 hour shifts I responded to 8 calls.  Not an overwhelming number indeed, but hardly what I would call "occasional". 



I am sorry, I simply don't understand what you are saying.


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## medic417 (Aug 24, 2009)

wyoskibum said:


> What is hurting EMS is those in the field that are unprofessional.  Being professional has nothing to do about collecting a paycheck.  It has everything to do with being the best that you can be.  It is about making the effort to continually learn and advance your knowledge.
> 
> I've seen some very professional Volunteer and Career people in EMS.  Unfortunately, I've seen some very unprofessional people as well.
> 
> I think it is easy to blame volunteers became so many do this for the wrong reasons.  They are in it for the adrenaline rush, to be able drive with lights and sirens, etc...   Any volunteer who has said "I'm just a volunteer" should get out of EMS and do something else.



"A professional can be defined as: 

a worker required to possess a large body of knowledge derived from extensive academic study, with the training almost always formalized. 

Professions are at least to a degree self-regulating, in that they control the training and evaluation processes that admit new persons to the field, and in judging whether the work done by their members is up to standard. This differs from other kinds of work where regulation (if considered necessary) is imposed by the state, or where official quality standards are often lacking. Professions have some historical links to guilds in these regards. 

Professionals usually have autonomy in the workplace—they are expected to utilize their independent judgement and professional ethics in carrying out their responsibilities. This holds true even if they are employees instead of working on their own. Typically a professional provides a service (in exchange for payment or salary), in accordance with established protocols for licensing, ethics, procedures, standards of service and training / certification. 

The above definitions were echoed by economist and sociologist Max Weber, who noted that professions are defined by the power to exclude and control admission to the profession, as well as by the development of a particular vocabulary specific to the occupation, and at least somewhat incomprehensible to outsiders 


So an EMS professional should have education, be able to work w/o immediate supervision, have to attain and maintain certification as required by a group other than government. 

Obviously changes are needed for us to meet that definition. 

So what is professional EMS? Only a dream. "

http://www.emtcity.com/index.php?showtopic=10124&hl=


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## JonTullos (Aug 24, 2009)

Threads like this used to kindda get me going because I am a volunteer in addition to (now) having a paid EMS gig.  However, no matter what's said, everyone has their minds made up and there's no changing them.  This is nothing more than a pissing match.

Have fun with it... I'll be in other threads.

Jon


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## medichopeful (Aug 24, 2009)

upstateemt said:


> A volunteer EMT in NYS has EXACTLY the same education and testing as a paid, there is no difference.



They may have the same amount of training, but a paid EMT has much more "on-the-job" experience (which is technically "education") as it is their primary job.


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## upstateemt (Aug 24, 2009)

medichopeful said:


> They may have the same amount of training, but a paid EMT has much more "on-the-job" experience (which is technically "education") as it is their primary job.



Yup, lots of experience with inter facility transfers and wheel chair gigs.


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## scottyb (Aug 24, 2009)

JonTullos said:


> Threads like this used to kindda get me going because I am a volunteer in addition to (now) having a paid EMS gig.  However, no matter what's said, everyone has their minds made up and there's no changing them.  This is nothing more than a pissing match.
> 
> Have fun with it... I'll be in other threads.
> 
> Jon



I am with you.  Too much poo flinging be productive.  Minds are made up and there is going no where but arguments between the two sides.  I am a volunteer and this is kind of crap is starting to make me want to skip stopping by emtlife.com.


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## medic417 (Aug 24, 2009)

scottyb said:


> I am with you.  Too much poo flinging be productive.  Minds are made up and there is going no where but arguments between the two sides.  I am a volunteer and this is kind of crap is starting to make me want to skip stopping by emtlife.com.



Well you did not have to open this thread as it was clear based on my title that it is anti volly.  Please don't let the internet hit you on the way out.


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## Chimpie (Aug 24, 2009)

medic417 said:


> You could also argue that vollys are selfish.  That they do it for personal glory and satisfaction rather than doing whats best for the patient.  That they want to be able to put lights etc on personal cars to draw attn to themselves.  etc etc etc etc etc
> 
> Do I need to go on?



So there's not a single volunteer that is there for the patient?  Are you sure about that?



upstateemt said:


> Thank you.
> 
> I'm heading back to my mostly lurking status.  It's threads like this that make me wonder why I bother reading this forum at all.  It should, perhaps be renamed "Paid" EMTLIFE.



Are you only reading the posts from those who are paid?  There have been several pro-volley comments made in this thread.


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## scottyb (Aug 24, 2009)

medic417 said:


> Well you did not have to open this thread as it was clear based on my title that it is anti volly.  Please don't let the internet hit you on the way out.



Nice.  You are exactly what I am talking about.  You think you're witty, well done, very respectful.  It is not just this thread.  Paid personnel interject their paid vs volly crap into everything on this site.  I was commenting on the fact that this thread is not constructive. Maybe you should read my thread before you comment on it.   Volunteer's have been around for pretty much as long as EMS, maybe you should have thought about that before making your career choice.  It is nice to know that us volunteers are so well respected by our paid counterparts.  I am sorry you feel that our good will is taking money out of your pocket, but get over it.  It ain't changing anytime soon.


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## scottyb (Aug 24, 2009)

Chimpie said:


> Are you only reading the posts from those who are paid?  There have been several pro-volley comments made in this thread.



And I realize it is not all the paid, but a special chosen few.


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## medichopeful (Aug 24, 2009)

upstateemt said:


> Yup, lots of experience with inter facility transfers and wheel chair gigs.



You do realize that that is valuable experience, correct?  The more experience in the medical field, the better.  

Someone who just volunteers part time will have a lot less experience than someone who does the job as their career.


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## cbjfan (Aug 24, 2009)

In my area there are some agencies that one could easily tell are vollies. Then there are those, mine included, where you can't tell the difference between the vollies and the paid. As far as vollies not providing a good level of care, well in our county there are 3 ALS departments, 1 paid and 2 vollie (including mine). There is also another paid that is BLS. So that means 2 vollie agencies provide higher care than a paid department. Oh my the world is going to end.


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## medichopeful (Aug 24, 2009)

scottyb said:


> Volunteer's have been around for pretty much as long as EMS, maybe you should have thought about that before making your career choice.



Are you saying it shouldn't change?  Even if it is for the better?


----------



## scottyb (Aug 24, 2009)

medichopeful said:


> Are you saying it shouldn't change?  Even if it is for the better?



I am just saying don't bad talk the type of people that led the way for your chosen profession.  It seems counter productive. At least be thankful as a provider that there are people willing to provide care, even though substandard in some people's eyes, to a community (including mine) that can not afford a 24/7 paid department.  I don't see this type of bickering between firefighters, at least not to these degree.  maybe because there is some tradition and brotherhood there.  And they realized they all have a job to do, whether they get paid for it or not.  Maybe EMS needs to establish some tradition and gain some sort of sense of brotherhood first.  I know some think that is blasphemy, comparing EMS to FD's.  Well it is a natural comparison since in most communities they operate hand in hand, out of the same bases in many cases.  Like it or not, even though a health care professional, you are still an emergency responder.  Maybe it is time to accept that fact instead of bucking it and trying to carve your own little niche by stepping on the heads of good people.


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## medichopeful (Aug 24, 2009)

The only time I will be volunteering is when I am in college, where I will be volunteering with the campus ambulance "company."  During the summers, I will be going paid (if everything works out).  Once I get out of college, it's full time EMS for me.

Volunteering is the only feasible way for me to work as an EMT in college.  Not saying it's great, but it's life.  The more experience, the better.
When I can, however, I will make it my career.  No more volunteering once I am out of college.  I want to dedicate my work time to EMS and EMS alone.


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## medic417 (Aug 24, 2009)

Chimpie said:


> So there's not a single volunteer that is there for the patient?  Are you sure about that?
> .



Way to take it out of context.  I was replying to her statement that vollys are better so I showed how it could also be reversed.  Guess I stepped on your toes to.


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## emtgurl21 (Aug 24, 2009)

I not sure about the states your from, but in the state of Arkansas there alot of rural communties and most ems and fire personal live in the rural areas and commute to work. Most of the rural areas do not have ambulances, so the ambulances that do respond from the bigger towns have a 30 min response time or more. So the volunteers in most of these areas can get there and start providing care. If it werent for the volunteers the outcome could be worse. And the last time i checked the reason we come emts and paramedics is to help people not draw a check.


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## medic417 (Aug 24, 2009)

scottyb said:


> .   Maybe EMS needs to establish some tradition and gain some sort of sense of brotherhood first.  .



Actually that holds EMS back more than vollys do.  We do to much based on tradition rather than scientific proof.


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## scottyb (Aug 24, 2009)

medic417 said:


> Actually that holds EMS back more than vollys do.  We do to much based on tradition rather than scientific proof.



Please provide an Example?  Here in NY, our protocols are always changing.  Yes, as a volly, I am promptly trained on those changes.  These changes keep us update as best they can with the best patient care while staying within our scope of practice.


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## medic417 (Aug 24, 2009)

scottyb said:


> Please provide an Example?  Here in NY, our protocols are always changing.  Yes, as a volly, I am promptly trained on those changes.  These changes keep us update as best they can with the best patient care while staying within our scope of practice.



Do you still back board?  Do you still place shock patients in the "shock position"?  That is just two quick examples.  Many more of our practices nationwide have no scientific merit.


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## scottyb (Aug 24, 2009)

medic417 said:


> Do you still back board?  Do you still place shock patients in the "shock position"?  That is just two quick examples.  Many more of our practices nationwide have no scientific merit.



This must be due to the stupid vollies and them not wanting change.  We are apparently to busy trying to ruin your career to learn new protocols.  OR, our state has not changed it.  So the MD's in charge of emergency medicine in NYS DOH decided not to change it.  That is clearly our fault.  Sorry to be the anchor that is dragging down your overly buoyant intellect. 

Maybe we should train all medics to the MD level and carry some diagnostic equipment, like x-rays and CAT's so we don't have to go through the frivolous practice of trying to maintain spinal integrity as best we can in a dynamic environment of an emergency scene.  

Or you can be just accept the fact that not everybody can be a paid paramedic and is gonna do the best they can within their training.  If our state DOH really thought it was not beneficial to backboard any more.  I am sure they would.  They just recently changed the protocol for immobilization.  Allowing for us to skip the immobilization if there is no suspicion of a spinal injury.

From the state training I received for the change: 

When using the Suspected Spinal Injury protocol, a positive mechanism of injury is not considered means to necessitate full immobilization …
BUT…
should be used as a historical component that may heighten a provider’s suspicion for a spinal cord injury.

I know you are gonna key in on the "historical part to try to prove your point.  You can't equate, I don't think, a protocol based on historical data of injuries incurred via a given MOI with tradition that is holding back EMS.

Sorry, as an EMT-B in NY, the shock position is pretty much all I got.  I know that it is shown not


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## medic417 (Aug 24, 2009)

scottyb said:


> This must be due to the stupid vollies and them not wanting change.  We are apparently to busy trying to ruin your career to learn new protocols.  OR, our state has not changed it.  So the MD's in charge of emergency medicine in NYS DOH decided not to change it.  That is clearly our fault.  Sorry to be the anchor that is dragging down your overly buoyant intellect.



Dudette chill out.  You said EMS needed tradition and I said it was more the problem than Vollys.  You asked for proof now you throw a tantrum.  

As to needing equipment for selective spinal immobilization all you need is education.  It is implemented and has been proven to work in the field.


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## scottyb (Aug 24, 2009)

medic417 said:


> Dudette chill out.  You said EMS needed tradition and I said it was more the problem than Vollys.  You asked for proof now you throw a tantrum.
> 
> As to needing equipment for selective spinal immobilization all you need is education.  It is implemented and has been proven to work in the field.



You attack me with you internet hit on the way out comment and then you don't understand why I am upset.  I just showed you that we have selective immobilization.  I didn't mean tradition in care or practice, but in how you carry yourself and having respect for those that came before you and paved the way.  You could try to accept vollies as equals and blame the system instead of trying to put us down as inferior care givers.  And it is DUDE.  Try not let the normal gender of the name Scott kick your butt.  Could we expect you not to feel attacked in a thread if it was just about bashing paid guys.


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## medic417 (Aug 24, 2009)

scottyb said:


> You attack me with you internet hit on the way out comment and then you don't understand why I am upset.  I just showed you that we have selective immobilization.  I didn't mean tradition in care or practice, but in how you carry yourself and having respect for those that came before you and paved the way.  You could try to accept vollies as equals and blame the system instead of trying to put us down as inferior care givers.  And it is DUDE.  Try not let the normal gender of the name Scott kick your butt.  Could we expect you not to feel attacked in a thread if it was just about bashing paid guys.



Was no attack, you complained despite having read the title.  If you don't want to read don't click. 

So you want me as a long time person in EMS to accept the hazing traditions.  The pranks that have harmed many.  And no vollys are not are history paid funeral homes are our tradition.  

Yes we should know our history.  In fact any that fail to know their history are doomed to repeat the same mistakes.  HMMM seems we keep seeing the same mistakes happening in EMS decade after decade.  Maybe you new people need to listen to us old farts.  

You are welcome to make a rant against paid in fact it would be more appropriate than hijacking my thread.  In fact per the mods recent notice you technically should get a warning for this hijack.  

And I have started a post that shows how any service can go paid.


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## scottyb (Aug 24, 2009)

medic417 said:


> Was no attack, you complained despite having read the title.  If you don't want to read don't click.
> 
> So you want me as a long time person in EMS to accept the hazing traditions.  The pranks that have harmed many.  And no vollys are not are history paid funeral homes are our tradition.
> 
> ...



Hijack your thread?  So now actively discussing a topic you started is considered hijacking.  I am saying goodbye.  Go ahead and warn me.  I won't be returning to a site that allows discussion as long as you don't rock the boat.  Volunteers in all capacities are what keep this country going.  Keep talking down to them.  Without volunteers this country would grind to a halt in many respects.


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## FireResuce48 (Aug 24, 2009)

Luno said:


> See, here's where I think the difficulties lie, the problem I have isn't with volunteers, they have way more dedication and drive then I do.  I don't think that I would do this for free.  That being said, my issue isn't with the volunteers dedication, training, motivation or desire.  There are volunteers that are slackers, but there are career personnel that are slackers as well, the difference is that the volunteers aren't paid, the career slackers are stealing from the system.  My issue is simply that there are fewer groups abused more than EMS volunteers.  "They don't have enough money for the paid firefighters/emts they have."  If enough people die, local government will find the money, either to pay lawsuits, or they will decide to be proactive.  I've been able to work with volunteers who are very well trained, so I don't think the system has been dragged down for them.  I think the system has been brought to lowest common denominator for several reasons, to blame that only on volunteers lacks factual evidence.  I'd also like to clarify that I don't see volunteers as a "worthless job stealing tick" but rather the victims in a game where someone is trying to get something for nothing.  I appreciate all the volunteers that I work with, and I tell them the same thing.  In my opinion, "They are being taken advantage of."



I just don't appreciate people trying to me that my station and its members are stealing jobs. We provide a service to our community with agreesive firefighting and up to date ems tactics.
I don't think the county goverment is finding any money to pay anybody to staff anything anytime soon. They owe a bunch of money in back pay cause of furloughing. And we have a bit of corruption going on up top.

Volunteering is something I will always do even when I do get hired onto a paid department.


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## rescue99 (Aug 24, 2009)

Volunteers in all capacities are what keep this country going.  Keep talking down to them.  Without volunteers this country would grind to a halt in many respects.[/QUOTE]

He's right. Volunteerism is a lot of what makes this country so great.


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## 46Young (Aug 24, 2009)

rescue99 said:


> Volunteers in all capacities are what keep this country going.  Keep talking down to them.  Without volunteers this country would grind to a halt in many respects.



He's right. Volunteerism is a lot of what makes this country so great.[/QUOTE]

Amen! Well put.


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## 46Young (Aug 24, 2009)

To the OP, it sounds like you could really use a union to force a wage increase. Hahahahahahahahahahahahahaha!

I can see that your organization being "at will" is really working out for you.

All you can do is rant on the internet, as you and your fellow employees appear powerless to cause any positive change to the situation. Given your poor attitude towards volunteers, I don't feel sorry for you in the least.


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## medic417 (Aug 24, 2009)

46Young said:


> To the OP, it sounds like you could really use a union to force a wage increase. Hahahahahahahahahahahahahaha!
> 
> I can see that your organization being "at will" is really working out for you.
> 
> All you can do is rant on the internet, as you and your fellow employees appear powerless to cause any positive change to the situation. Given your poor attitude towards volunteers, I don't feel sorry for you in the least.



Actually I work for one of the highest paying services in the USA when you include benefits and cost of living.  So no union is going to do anything but hurt us like it has you.  

The vollys keep the area services from getting better pay.  If a union moved in you would still have low pay plus another monthly payment so actually you would lose money.


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## medic417 (Aug 24, 2009)

scottyb said:


> Hijack your thread?  So now actively discussing a topic you started is considered hijacking.  I am saying goodbye.  Go ahead and warn me.  I won't be returning to a site that allows discussion as long as you don't rock the boat.  Volunteers in all capacities are what keep this country going.  Keep talking down to them.  Without volunteers this country would grind to a halt in many respects.




Again bye, thought I already told you bye before.  If you do not want to read my opinion you should not click a discussion that makes it clear it is what I am going to discuss.  You were welcome to make a counter rant elsewhere but you are not supposed to hijack a thread as I have been warned not to do thus my rant subject.  If they allow you to hijack my thread they have to let me hijack any thread I want to, that won't happen.


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## 46Young (Aug 24, 2009)

medic417 said:


> Actually I work for one of the highest paying services in the USA when you include benefits and cost of living.  So no union is going to do anything but hurt us like it has you.
> 
> The vollys keep the area services from getting better pay.  If a union moved in you would still have low pay plus another monthly payment so actually you would lose money.



how exactly has our union hurt us? I'm puzzled by that statement.

If a union moved in they would require management to change your current situation for the better through a contract.

In the same post you stated that you work for one of the highest paying services in the USA, but you'll still have low pay if a union moves in? Once again, if you feel that you deserve higher wages, and management is using the volunteer excuse, you're powerless to change that without collective bargaining. Explain to me why I'm wrong about that, if you can. If you and your fellow employees wre able to cause any change, you'd have your wage increase and this thread would never exist. Strength in Solidarity!

Also, have you worked for a union shop? You seem to be thoroughly convinced that a union will ruin your agency, but you offer no plausible reasons as to why.


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## medic417 (Aug 24, 2009)

46Young said:


> how exactly has our union hurt us? I'm puzzled by that statement.
> 
> If a union moved in they would require management to change your current situation for the better through a contract.
> 
> .



Please start a union thread rather than hijacking everyone elses threads.


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## scottyb (Aug 24, 2009)

46Young said:


> how exactly has our union hurt us? I'm puzzled by that statement.
> 
> If a union moved in they would require management to change your current situation for the better through a contract.
> 
> ...



Be careful.  Arguing against them is futile, and will be labeled as hijacking as now you are talking about unions.  They are right.  Let them have their thread to bad talk the vollies. I came here to learn and discuss EMS topics, actual techniques and perspectives.  That is all I am going to do from now on.


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## medic417 (Aug 24, 2009)

scottyb said:


> Be careful.  Arguing against them is futile, and will be labeled as hijacking as now you are talking about unions.  They are right.  Let them have their thread to bad talk the vollies. I came here to learn and discuss EMS topics, actual techniques and perspectives.  That is all I am going to do from now on.



Again feel free to make your topic as the rules say to do.  Welcome back again.


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## 46Young (Aug 24, 2009)

medic417 said:


> Please start a union thread rather than hijacking everyone elses threads.



Done, and don't forget to answer my questions as above, on post #79.


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## Melclin (Aug 24, 2009)

upstateemt said:


> WHAT THE H#LL???????????????????????  I don't know what state YOU practice in but in my state and in the states I am familiar with the education and testing are the SAME regardless of whether you are paid or not.
> 
> In NYS the EMT B is a TWO SEMESTER COURSE followed by the same testing for all.  My CC certification consisted of 16 ADDITIONAL credit hours and over 300 hours of clinical.  Paramedic is another year with hundreds of hours added clinical.  NO DIFFERENCE BETWEEN PAID OR VOLUNTEER.
> 
> You are totally wrong in your view of "volunteers" we practice at the same level of professionalism as ANY paid person.  Because we have a "social" conscious in addition to being professional is a PLUS and an ADDED benefit.



Take a second....read my sidebar next to my post....I'm from MELBOURNE, AUSTRALIA. The difference between paid and volunteer is very great. As I said a short course for the vollies, just like your EMT-Bs and a degree for the paid pros. With a 100 or so hours of training, nobody thinks the vollies are pros. So why are people whining about EMT-Bs not being considered pros? 

I'm ganna reiterate my point. you can't go off to any two bit class for a few minutes and expect to become part of a profession. 

*Whining EMT-Bs:Get a real education and vollies won't be a problem. It's not the vollies fault that there isn't much too your job*


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## JPINFV (Aug 25, 2009)

Easiest way to end the volly mess? Require college level courses in anatomy, physiology, chemistry, and physicis (at least mechanics) prior to taking the entry level certification. There's a reason why there are very few volunteer registered nurses (and by volunteer, I mean, work as a nurse on the side of a "real" job outside of health care).


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## Melclin (Aug 25, 2009)

JPINFV said:


> Easiest way to end the volly mess? Require college level courses in anatomy, physiology, chemistry, and physicis (at least mechanics) prior to taking the entry level certification. There's a reason why there are very few volunteer registered nurses (and by volunteer, I mean, work as a nurse on the side of a "real" job outside of health care).



Precisely my point.


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## TransportJockey (Aug 25, 2009)

JPINFV said:


> Easiest way to end the volly mess? Require college level courses in anatomy, physiology, chemistry, and physicis (at least mechanics) prior to taking the entry level certification. There's a reason why there are very few volunteer registered nurses (and by volunteer, I mean, work as a nurse on the side of a "real" job outside of health care).



This is what I would like to see! I'd love to require an AAS or BS for entry level into EMS


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## Ridryder911 (Aug 25, 2009)

I used to get upset in regards to vollies. Not any more. The bar has been raised and will continue to do so. Vollies do have their place, as I have always stated. That being in very rural America and first response units only. 

I chuckle when reading most posts here. Most of the posters will ever get involved in EMS is the chili cook off or a CPR class given. Responding to more than 15 emergency calls a day (even while in a rural area) would cause a mind struck; never mind discussing adult education and methodologies of teaching EMS. Requiring states to update and mandate additional education, as insurance (Medicare, BC/BS) will require states to offer more and more aggressive treatment. 

It still saddens me though to read so called medics describing to treat protocols rather than have an educated hypothesis and treat the clinical problems. In other words the patient and not the protocol. Sorry, I don't treat protocols or do I make them fit within a protocol to be able to treat. 

The remainder of the medical community is getting tired of EMS lame excuses. Patient care is more and more initiated by what is determined in the field setting. Good accurate thorough examination provided by those that have a formal education (yes, degree) along with several hundreds of clinical hours and preceptorship. 

Most involved in this site is very lacking of what is really occurring within the profession of EMS. Lack of interest past responding with l/s or simple training does not mean anything to them. Very few are participants within National, State or Local development of the system itself other than being stretcher fetchers. 

I and many others have always provided and encouraged others to participate if they were truly interested within the profession. It appears some have listened, as there are some major changes on the way. 

I do doubt that most of those that volunteer will find time to return back to school for the gap or bridge course, that will be required. Doubt that many will want to take college academic level courses such as anatomy/physiology and statistics to be in a Paramedic program. Clinical arrangements have to be made with on site preceptors to verify not just numbers but actual patient contacts and procedures performed (gone are the coffee clinicals). This will not just affect vollies but those that just want to "skate by". 

One of the major focus now, is requiring degree entry level. The profession as a whole is asking for it for multiple purposes, many do not understand or lack to have an interest to. 
So podt. voice and yell, describe tradition and how things ought to be..... time and progress will resolve it. 

R/r 911


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## Seaglass (Aug 25, 2009)

My opinions on this subject are pretty mixed, just like the volly places I'm with.

Something I haven't noticed anyone mention is that some "volunteer" departments are actually compensated fairly nicely. I'm with one that provides free training, a health insurance option, partial tuition reimbursement, retirement, and a whole slew of other good things. You only get them if you put in enough time, and they're very careful about making sure records aren't falsified. 

Professionalism at that one is pretty good. We run ALS, and becoming a medic is very strongly encouraged. About half the volunteers have other jobs in medicine, either in career EMS or nursing. Paid people make up a little under half the department, and relations are very good. We train with them, bunk with them, and so on. Experienced volunteers get preferential hiring.

Same training requirements and protocols for everyone who wants a qualification, career or not. The career people tend to be more highly qualified, as they can devote their entire working time towards it--but they tend to focus way more on fire and technical rescue. We only have a handful of volly hazmat specialists, and not too many career medics. But that's the whole EMS vs. fire thing. And we're too rural for separate departments, or more paid people. 

I'm also a part of another volunteer service that frustrates me. Training requirements are way lower than local fire or third service, and some of the lapses I've seen supervisors turn a blind eye to really bother me. Professionalism? Depends on which crew you get. Entitlement? You bet. Patient care is acceptable, or we'd have been shut down, but it really could be so much better...


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## PapaBear434 (Aug 25, 2009)

medic417 said:


> One actually could argue that paid people care more for their community's because they are willing to be away from home.  That they want to make sure response times are short.  That they refuse to leave their community w/o the best in care.  etc etc etc etc etc
> 
> You could also argue that vollys are selfish.  That they do it for personal glory and satisfaction rather than doing whats best for the patient.  That they want to be able to put lights etc on personal cars to draw attn to themselves.  etc etc etc etc etc
> 
> Do I need to go on?



You misunderstand what a lot of volunteer systems are.  







We are a squad of over 120 members, we have five ambulances, a squad truck and a support/extrication truck, and a 4x4 fire/rescue support truck.  We have a chain of command, board of directors, budgetary meetings and concerns and a regular schedule filled out by us that allows us to have two ambulances on the street at all times, contributing to our umbrella system's (Virginia Beach Rescue) 12-16 ambulances that are on the street at any given time, day or night.  

Over half of us are already medics, and almost all the rest are in the pipeline TO medic thanks to Virginia Beach's policy to pay for our schooling in exchange for our services. 

Our call volume is about 8-12 patients per ambulance per twelve hour shift.  We keep ourselves busy.  

Our system employs 40-50 paid medics who ride in "zone cars," covering various areas of the city, to ensure that if by some chance a truck only has two basics that there will always be ALS on any call that requires it, or accessible backup to any major call that needs it.

I will agree that a lot of rural vollie systems have their issues with wannabes just slapping wig-wags on their trucks and considering themselves rescue workers, but don't classify all vollies as worthless.  We all aren't cut from the same cloth.


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## FireResuce48 (Aug 25, 2009)

Va Beach has a good volunteer system. I lived down there for a year. 

Most of the people I talked to in the system seemed to know what they were doing and liked doing it.


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## medic417 (Aug 25, 2009)

PapaBear434 said:


> You misunderstand what a lot of volunteer systems are.
> 
> 
> We are a squad of over 120 members, we have five ambulances, a squad truck and a support/extrication truck, and a 4x4 fire/rescue support truck.  We have a chain of command, board of directors, budgetary meetings and concerns and a regular schedule filled out by us that allows us to have two ambulances on the street at all times, contributing to our umbrella system's (Virginia Beach Rescue) 12-16 ambulances that are on the street at any given time, day or night.
> ...



You misunderstand the point of my comment you qouted.  It was in response to  the statement that vollys were more dedicated.


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## rescue99 (Aug 25, 2009)

> I will agree that a lot of rural vollie systems have their issues with wannabes just slapping wig-wags on their trucks and considering themselves rescue workers, but don't classify all vollies as worthless.  We all aren't cut from the same cloth.


Is this a part paid service? I love volly services personally but, sometimes we confuse paid and volly. If there is compensation beyond a tiny stipens which might cover fuel costs, it's a part paid department. My husband for example, worked volly for years. He was given a quarterly stipens of very little (maybe 200 bucks) for his service along with all of the time he donated to all other responsibilities involved. He did everything from train rookies, to being an officer, to respond to servicing their trucks.


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## catskills (Aug 25, 2009)

Wow this forum has some real stuck up paid EMS employees.  I made a list of those who think because they get paid they walk on water and because volunteers don't get paid they provide inferior patient care.  Let me very clear about what I am about to say.  

*If you think just because your paid you are better than a volunteer, then I do NOT want you providing me or anyone in my family medical assistance.  *  You got that.  I am very serious abut that statement.  Read it again and then go take a hard look in the mirror.  It may be time for you to get off your high horse and find another profession.


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## subliminal1284 (Aug 25, 2009)

8jimi8 said:


> The only place that I have heard anything negative about volunteers is on this forum.
> 
> Call my organization.  They absolutely love us.  Honestly, the only way you can tell a difference between a volunteer and an employee is if you ask the person.
> 
> ...



Quoted for truth!


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## Level1pedstech (Aug 25, 2009)

Finally someone stands up and makes a clear no BS statement against this continued bashing and outright disrespect aimed at this country's volunteers. Who I will restate out number the paid folks,don't like that statement then prove me wrong or stand down. I have been holding back at making any statements because I really want to be a positive influence and offer my experience to those that are in need of guidance or help and getting into a pissing match with you paid folks seems a bit infantile. My volunteer crew will run circles around your paid crew and that's a fact. Thank you catskills and if this thread goes the way I think it might Ive got your back my brother (or sister).

 If any of you non volunteer types are ever in my area and need my assistance I will be there let not your heart be troubled. I am an equal opportunity provider and help all who are in need whether you can pay your bill or not. Should you require paid assistance it will be on scene in around 30 minutes so maybe you could begin your own treatment(because your so superior to me) and hope for the best. Are you really going to have all this bias at that point in time and refuse treatment from what you all consider as your less than equal counterpart.


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## JB42 (Aug 25, 2009)

Why is it just us volunteers who are hurting EMS... I think the system itself is hurting EMS paid and volunteer, basic and paramedic, and everything in between. We should develop a system similar to SAMU in France. Doctors and Nurses with "Techs" to assist. A true mobile ER. h34r:


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## Sasha (Aug 25, 2009)

Level1pedstech said:


> Finally someone stands up and makes a clear no BS statement against this continued bashing and outright disrespect aimed at this country's volunteers. Who I will restate out number the paid folks,don't like that statement then prove me wrong or stand down. I have been holding back at making any statements because I really want to be a positive influence and offer my experience to those that are in need of guidance or help and getting into a pissing match with you paid folks seems a bit infantile. *My volunteer crew will run circles around your paid crew and that's a fact.*



That's actually an opinion.


> If any of you non volunteer types are ever in my area and need my assistance I will be there let not your heart be troubled. I am an equal opportunity provider and* help all who are in need whether you can pay your bill or not. *Should you require paid assistance it will be on scene in around 30 minutes so maybe you could begin your own treatment(because your so superior to me) and hope for the best. Are you really going to have all this bias at that point in time and refuse treatment from what you all consider as your less than equal counterpart.



As will paid providers. We don't discriminate who gets services and who will not just because we draw a paycheck from EMS. Also, unless I missed it somewhere, the only one I've seen list that they will refuse service based on people being paid or volunteer is catskills.

I wandered over to the license plate thread and saw one specifically for volunteer ambulances. I'm wondering why, if volunteer ambulance personnel want to be seen as equal many insist on setting themselves apart.


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## akflightmedic (Aug 25, 2009)

JB42 said:


> Why is it just us volunteers who are hurting EMS... I think the system itself is hurting EMS paid and volunteer, basic and paramedic, and everything in between. We should develop a system similar to SAMU in France. Doctors and Nurses with "Techs" to assist. A true mobile ER. h34r:



Ask William and Harry how that worked out for their mom...Diana


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## Level1pedstech (Aug 25, 2009)

I have seen the anti volunteer brigade suggest that if you force agencies to  go paid that people will have no choice but to go along or risk losing service. Sounds to me like no pay no play or unless were paid we dont show up.


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## JB42 (Aug 25, 2009)

akflightmedic said:


> Ask William and Harry how that worked out for their mom...Diana



I expected that comment. 

I wish I could come up with some publicized situation where the level of care SAMU provides saved a life that would have otherwise been lost with a system such as that in the US. I just can't seem to find anyone as obscenely famous being in a situation that merited news coverage of not only the incident but the care provided. Obviously mistakes were made in that situation, but I think it is safe to say mistakes have been made that have caused patient death in the US system as well.

My point was that since everyone here is complaining about lower standards and less education and less pay because of volunteers why not take that to the next level. If there is a system that is successfully putting a Dr. on every truck why aren't we. Only the absolute highest level of care right? All communities should be able to afford it, it's a BS excuse to say otherwise.


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## medic417 (Aug 25, 2009)

Level1pedstech said:


> . Who I will restate out number the paid folks,.



Can you provide proof of that statement please.

And for everyone else please stop the thread hijack.  The mods have made it clear we are not allowed to do that thus I had to make my own topic rather than reply where I wanted to.


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## Sasha (Aug 25, 2009)

Level1pedstech said:


> I have seen the anti volunteer brigade suggest that if you force agencies to  go paid that people will have no choice but to go along or risk losing service. Sounds to me like no pay no play or unless were paid we dont show up.



Links please.


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## PotatoMedic (Aug 25, 2009)

Since everyone wants data here is my two cents:

Until someone provides me with DATA and STUDIES with information stating that volunteers hurt an organization, I will always support volunteers and career personnel.  As long as they meet or exceed the standards that they are required to meet.  (EMS, FIRE, POLICE, RED CROSS, SAR, etc.)


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## andydrumm05 (Aug 25, 2009)

Don't know if this point was already made. 

I'm a volunteer. We sit through the same classes. The same number of hours. Are held to the same standards as far as obtaining our certification. We have to pass basically the same test. We learn the same skills. We all have to get CEU's in order to renew our certifications. It doesn't make any sense. an EMT is an EMT, no if's and or buts. Just because it could take vollys longer to respond to a call because we don't man a station 24/7, doesn't mean that we are bringing the profession down. The same thing happens with paid crews as well. What if all their crews are out and receive a call? What will they do then? Same thing with Volly crews. Would I like to get paid to do this? I wouldn't turn down the offer, but that's not why I went into EMS. I like helping people, and what better way to help people than helping them in a time of need. I know of basics on paid crews with private ambulances, and they are nothing more than a glorified driver. Their medical director drastically limits what a basic can do. They also volunteer, and if they didn't volunteer, they wouldn't be able to keep current on their skills. And yes, there is a lot of ego within these smaller volly departments, but at least with the case of my department, we do hold our members responsible for what runs they go on and what they did to help the patient, and did they follow their scope of practice?  I do see some of the points from the other side. There are a lot that can be done to improve volunteer departments, but there are also a lot that can be done to improve some of the paid departments as well, at least those paid crews in my area.  But I go back to my first statement, we are all EMT's. We all go through the same training. And as someone else had mentioned earlier, the only difference between a paid EMT and a volunteer is if you ask them. That's it. Plain and simple. I worked hard to get my license and will continue to work hard to keep it. And I know a lot of volunteers who are the exact same way. I know in my area, I feel safe with the volunteer crews we have.


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## medic_texas (Aug 25, 2009)

First of all, you have a certification not a license.  

Secondly, someone who performs as a EMT(any level) on a fulltime basis tend to be more experienced, competent, and educated (most EMS services require education on top of their CEU's that are required for recert) than a volunteer.  

I like helping people too, that's why I'm in health care but I don't do it for free.


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## Ridryder911 (Aug 25, 2009)

FireWA1 said:


> Since everyone wants data here is my two cents:
> 
> Until someone provides me with DATA and STUDIES with information stating that volunteers hurt an organization, I will always support volunteers and career personnel.  As long as they meet or exceed the standards that they are required to meet.  (EMS, FIRE, POLICE, RED CROSS, SAR, etc.)



I offerred data and referrences. What more do you want? 

R/r 911


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## EMTinNEPA (Aug 26, 2009)

Level1pedstech said:


> Finally someone stands up and makes a clear no BS statement against this continued bashing and outright disrespect aimed at this country's volunteers.



Why is it that the only people who consider the statements in this thread to be infantile, disrespectful bashing are the ones being directly criticised?



Level1pedstech said:


> My volunteer crew will run circles around your paid crew and that's a fact.



As Sasha mentioned, it is an opinion.  And an unfounded opinion, since you have no idea what kind of additional training our paid services require.



Level1pedstech said:


> Thank you catskills and if this thread goes the way I think it might Ive got your back my brother (or sister).



Catskills is *NOT* your brother of sister just because they're also a volunteer.  This "brotherhood" nonsense is a remnant of the fire service and has no place in EMS.



Level1pedstech said:


> I am an equal opportunity provider and help all who are in need whether you can pay your bill or not.



What a coincidence... so is my for-profit service.



Level1pedstech said:


> Should you require paid assistance it will be on scene in around 30 minutes so maybe you could begin your own treatment(because your so superior to me) and hope for the best.



Actually, if I required treatment I could count on the paid service to be there within a few minutes.  The only time I would have an extended wait time for them would be when I'm in a volunteer BLS company's coverage area and they fail to crew (as they do very often).



Level1pedstech said:


> Are you really going to have all this bias at that point in time and refuse treatment from what you all consider as your less than equal counterpart.



For the vast majority of them... yes, I would.


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## EMTinNEPA (Aug 26, 2009)

catskills said:


> Wow this forum has some real stuck up paid EMS employees.  I made a list of those who think because they get paid they walk on water and because volunteers don't get paid they provide inferior patient care.  Let me very clear about what I am about to say.
> 
> *If you think just because your paid you are better than a volunteer, then I do NOT want you providing me or anyone in my family medical assistance.  *  You got that.  I am very serious abut that statement.  Read it again and then go take a hard look in the mirror.  It may be time for you to get off your high horse and find another profession.



How immature.  You would deny medical care for yourself or a family member because somebody has the audacity to collect a paycheck?  And you're telling me to find another profession because I want my profession to be a profession?  Think about it...


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## JPINFV (Aug 26, 2009)

andydrumm05 said:


> I'm a volunteer. We sit through the same classes. The same number of hours. Are held to the same standards as far as obtaining our certification. We have to pass basically the same test. We learn the same skills.


I made the comment before, but since this response keeps poping up, I'll post it again.

How many volunteers would you have if the EMT-B education required college level anatomy, physiology, chemistry, and physics (minimum of mechanics)? Why do you think that the 1994 EMT-B curriculum was set at 110 hours? 


Yea, EMT-B training is EMT-B training regardless of professional vs volunteer. The problem is that it's because of the volunteers that the training is so pathetically low and simplistic.


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## PotatoMedic (Aug 26, 2009)

Ridryder911 said:


> I offerred data and referrences. What more do you want?
> 
> R/r 911



I must have missed them.  I'll go back and try to find them.  Thank you.


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## Ridryder911 (Aug 26, 2009)

andydrumm05 said:


> Don't know if this point was already made.
> 
> I'm a volunteer. We sit through the same classes. The same number of hours. Are held to the same standards as far as obtaining our certification.



Doubtful. Did I see you in my chemistry or anatomy cadaver lab? I must have missed you at the Pediatric Burn Unit or while I was scrubbed in OR doing intubations or maybe during the psychiatric lock up clinical we must have missed each other? Where you getting coffee while they were awarding the degree after three and a half years of studies? 

So, please don't compare yourself or your "training" versus my education, unless you really want to go toe to toe. 

How many patient contact do you make a day? Five, ten, fifteen more? How much studies do you actually perform in improving yourself a day, a week, a month? When was the last time you read the _New England Journal of Medicine, JAMA _or _Trauma_? Do you know your percentages of correctly diagnosing/clinical impressions? Would you like to compare the results? When was the last time you discussed the emperical data findings of STEMI AMI with a cardiologist or how to decrease ICP in the first few minutes of a TBI in a major trauma patient with a neurosurgeon?

You see, I am a *professional*. This is not a hobby or a community need I fulfill. 

I am a health clinician, educator, professor and EMS promoter. I take my profession very damned serious. Just alike the physician or practitioner you see when your ill, I have focused my life work around mastering and  what I and others do. 

So please, don't even try to compare your charity work which maybe admirable but may not always be in the best interest for everyone if you really don't know the facts. 

Just because someone shows up with a patch does not mean that person is the best qualified or is better than nothing. Filling a space that is there does not mean the problem has been resolved. In fact, placing a band-aid on spurting wound is much more dangerous as the wound is still bleeding but is hidden. 

The cause and affect that volunteers is tremendous. Much more than some realize. Large lobbying groups has set us back decades in moving forward in EMS. Again, look at the studies and programs that was developed all for saving volunteers. 

Why do you think that EMS programs continue to be watered down or the number of hours have been fought against? The largest protest against increasing EMS education have and continually is from the volunteer sector. Lobbying organizations protesting that it is already difficult to obtain and maintain their membership. 

So patients must continue to suffer because the system is broke? All of the system must then lower national standards because some communities cannot get their act together? 

Amazing, in all other areas of medicine they are treated equal. A physician in the reservation of Arizona recieved the same degree and minimal education level as those working in downtown Chicago. No emphasis or curtailing of curricula was made because of where that person might practice. The same is true for professional RN or Respiratory Therapist, Laboratory Technologist. Something, we cannot say within our profession. 

So those that want to compare themselves with professionals. You would not mind then to be required to obtain your degree within EMS to continue your volunteerism if mandated? 

If your state described within three years, you have to had to complete an accredited academically program, would you do so? If not, then really who and what are you in this for? 

R/r 911


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## daedalus (Aug 26, 2009)

JPINFV said:


> I made the comment before, but since this response keeps poping up, I'll post it again.
> 
> How many volunteers would you have if the EMT-B education required college level anatomy, physiology, chemistry, and physics (minimum of mechanics)? Why do you think that the 1994 EMT-B curriculum was set at 110 hours?
> 
> ...



I second JP's challenge. Can the volunteer advocates on here *please answer* our question? How many volunteer EMTs would there be if getting your EMT meant taking chemistry, biology, anatomy and physiology, microbiology, and physics all at a college? Providing medicine means taking these classes before starting to learn pathology and its treatment. 

A volunteer advocate here mentioned he/she would not let a paid EMS provider touch his family. I put forth that EMS is a division of medicine and public health, and every other part of that machine collects a paycheck here in the United States.

By the way, and as Rid/Ryder will tell you, we are moving on without you guys. I speak of the people who insist that EMTs are effective volunteer medical providers. We have changed what will be taught in future EMT and Paramedic classes, a small step to be sure, but one in a positive direction. I plan on continuing to raise the bar until it will be impossible to become a prehospital provider just by taking a semester long night school class.


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## daedalus (Aug 26, 2009)

Ridryder911 said:


> I used to get upset in regards to vollies. Not any more. The bar has been raised and will continue to do so. Vollies do have their place, as I have always stated. That being in very rural America and first response units only.
> 
> I chuckle when reading most posts here. Most of the posters will ever get involved in EMS is the chili cook off or a CPR class given. Responding to more than 15 emergency calls a day (even while in a rural area) would cause a mind struck; never mind discussing adult education and methodologies of teaching EMS. Requiring states to update and mandate additional education, as insurance (Medicare, BC/BS) will require states to offer more and more aggressive treatment.
> 
> ...



Post of the year. Rid, I can't wait until our colleagues are all medical professionals with degrees.


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## PapaBear434 (Aug 26, 2009)

rescue99 said:


> Is this a part paid service? I love volly services personally but, sometimes we confuse paid and volly. If there is compensation beyond a tiny stipens which might cover fuel costs, it's a part paid department. My husband for example, worked volly for years. He was given a quarterly stipens of very little (maybe 200 bucks) for his service along with all of the time he donated to all other responsibilities involved. He did everything from train rookies, to being an officer, to respond to servicing their trucks.



Kind of.  As I said, the city employs 40-50 paid medics to make sure there is always ALS available.  But the rest of us are volunteers.

They don't give us any pay or stipend to cover fuel, as our own personal vehicles are never used for a response.  It's not like a lot of rural systems where a call comes in, everyone gets a call at home, rushes to the station and mans up the truck and goes to the site.  

We actually put on a uniform, go to the station, and we are there for an entire 12 hour shift (thought it ends up more like 13-16 some days).  We have a lounge to sit, play on the computers, BS and watch TV.  We have a bunk room with about eight beds to rack out when we need to.  But the call comes in over the PA and we just walk the 200' to our truck bay and we're off.  

As far as compensation, the city pays for any schooling related to EMS in exchange for your service.  So as long as you are going with the goal of medic, they'll pay for the classes and books involved so long as you maintain a "B" average.  So far, I have a 4.0, so here's hoping THAT keeps up.

It's a sweetheart deal for the city, because it costs less than having to train AND pay people, only to have them leave for a better job later.  The individual stations pay for everything equipment wise, right down to our trucks and other apparatuses, and all the city pays is for fuel, insurance, and repairs.  As an independent station, we qualify for a lot more federal and state grants as well, so we end up better funded than the city would be able to provide too.

The other kicker that as far as our resume goes, we are listed as city employees, not "volunteer" status.  That means that as far as any future employer is concerned, you were a city employed EMT/Medic for X amount of years in a high population, high call volume, diverse population tourist town like Virginia Beach.  And that looks pretty good wherever you go.


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## JB42 (Aug 26, 2009)

daedalus said:


> I second JP's challenge. Can the volunteer advocates on here *please answer* our question? How many volunteer EMTs would there be if getting your EMT meant taking chemistry, biology, anatomy and physiology, microbiology, and physics all at a college? Providing medicine means taking these classes before starting to learn pathology and its treatment.



Not as many, but I would still be there and volunteer along with many others at my service. Of course in a perfect world EMS would be compensated reasonably and I would be a paid full-time EMS professional instead of a cube jockey/EMS volunteer. 

There are a lot of unfair generalizations being tossed around in this thread. I am well aware that some volunteers are not up to snuff and unwilling to help EMS move forward, but some of us are. No, I cannot possibly keep up with Rid and others in terms of medical education and continuing ed. The anti-volly group has that right, full-time paid EMS just has more time and opportunity for education. (Although that could be up for debate since in order to survive with EMS as a career it seems that you need to work two full time jobs.) That doesn't mean there isn't a place for volunteer providers, at least right now.

As the situation stands right now there is a need for volunteers in some areas of the country. There need to be other changes in EMS before volunteers are no longer necessary, changes that are not being held back solely because I volunteer in some small town in NH. Education standards need to increase, scope of practice for paramedics really needs to be increased to that of a true practitioner (this is secondary to higher education standards), pay needs to be reasonable, and burn out prevention really needs to be addressed. All of that can be done while working along side volunteers. As volunteers disappear due to lack of interest in keeping up with new requirements paid people will have to take their place. Then you can have what you are striving for.


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## Level1pedstech (Aug 26, 2009)

For anything above an EMT-B I am with you on the education but I think you give a little to much credit to most basics. All I hear is what a joke the training is and how quick a person can go from being  a lay person to a certified EMT-B. Did you ever think maybe its called a basic for a reason, I'm not expecting an ER doc or PA when I call 911. I want someone who can respond and safely and methodically work their way through the ABC's. Why must you keep fighting such a simple concept, one that sure was developed and refined over time with the lay person in mind. Do you really think most EMT-B's are practicing medicine? I think that's a bit of stretch and I will gladly put my ten years of service behind that statement. The material and the skills are BASIC so that people can offer BASIC life support. I know someone will offer what they think is a valid argument but please explain what you don't understand about basic life support provided by an emergency medical TECHNICIAN.

  I think the theory to work with is lets have as many people as we can that provide care at the EMT-B level. CPR,ABC'S and BLS do not require advanced college level studies and fight as you may they never will. Whats next a two year community CPR class. In regards to anything above a basic I am with you 100%, I think change has already begun with more states making paramedicine a degree program with the same educational requirements as nursing school. I think this is a step in the direction you want to take pre hospital medicine.

 I do agree it would be next to impossible to recruit my fellow community members if the education requirements were that high for a person wishing to provide aid at an entry level. So I ask again what is my family going to do when there is no one to respond? Keep in mind we have paid ALS that will respond but they are 30 minutes out on a good day. I have made this statement before but I guess it fell on deaf ears. Start with your local system and leave mine alone until you can provide adequate first response care for my family. You are really pushing hard and you may not like what results you get. So go back to your books and life on campus,become super educated and stand in line to change the world. Some of us who work close to 80 hours a week would love to be in your position but college is not always an option for the working man. Are you getting any of this!

  Once again my system is not broke stop trying to fix it,you are messing with the health and well being of my family and many others who rely on the aid provided by first response EMTs paid or not. I have spent the last four years working part time in a level one trauma center that acts as a teaching hospital. I have had the opportunity to interact and be around on a regular basis some of the brightest and most promising students from EMT's to MD's and I can tell you there is no shortage of well educated people waiting to get out there and affect change. Lets give them a shot and stop trying to force your educational ideals on providers that for the most part are here to do one thing and that is help their fellow man. Remember its called BASIC for a reason.


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## bunkie (Aug 26, 2009)

In reading this thread, it seems to me that in general people seem to be more against the B level of care as a whole, not necessarily if its a paid or volunteer member. I can understand the thought that patients need a higher level of care that comes from a higher level of education. But I know that in *my* area, you have to be a B for at least a year or be working for a FD or local EMT around the area before you can even get into their paramedic program. So where does that leave people, either at the paid EMTB level or volunteer because they have no choice but to gain those hours so they CAN get to that higher level of education. What is your thought on that then? Should the year experience and/or sponsorship from an agency be waved to get into paramedic school, or should they not have that stepping stone of education and experience before they get there? Not to mention, after a year of it, you tend to weed out who really wants to be there and who doesn't. Or why the hell else would people go through any of this?


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## JPINFV (Aug 26, 2009)

Level1pedstech said:


> Why must you keep fighting such a simple concept, one that sure was developed and refined over time with the lay person in mind. Do you really think most EMT-B's are practicing medicine? I think that's a bit of stretch and I will gladly put my ten years of service behind that statement. The material and the skills are BASIC so that people can offer BASIC life support. I know someone will offer what they think is a valid argument but please explain what you don't understand about basic life support provided by an emergency medical TECHNICIAN.


If a provider is making any sort of judgment based off of an assessment, then yes. They are practicing medicine. I don't care whether it's a question of back board or not, provide supplemental O2, and if so at which flow rate and by with device, whether or not to call paramedics, or any other judgment, then they are. Most systems do not have a single protocol for all patients, require basics to backboard every single trauma, and administer oxygen to every single patient and a lot of the systems that do probably don't rigorously enforce that strict of a protocol. EMS isn't cookbook medicine in most areas, even for basics.

Besides, lay people have no business responding to a medical emergency as the person in charge. I want someone who feels that they are a medical provider, not a lay rescuer playing weekend warrior. 



> I think the theory to work with is lets have as many people as we can that provide care at the EMT-B level. CPR,ABC'S and BLS do not require advanced college level studies and fight as you may they never will. Whats next a two year community CPR class. In regards to anything above a basic I am with you 100%, I think change has already begun with more states making paramedicine a degree program with the same educational requirements as nursing school. I think this is a step in the direction you want to take pre hospital medicine.


Then we need to take basics off ambulances and use them only as first responders. 



> I do agree it would be next to impossible to recruit my fellow community members if the education requirements were that high for a person wishing to provide aid at an entry level. So I ask again what is my family going to do when there is no one to respond? Keep in mind we have paid ALS that will respond but they are 30 minutes out on a good day. I have made this statement before but I guess it fell on deaf ears. Start with your local system and leave mine alone until you can provide adequate first response care for my family. You are really pushing hard and you may not like what results you get. So go back to your books and life on campus,become super educated and stand in line to change the world. Some of us who work close to 80 hours a week would love to be in your position but college is not always an option for the working man. Are you getting any of this!


All of your physicians, registered nurses, and midlevel medical providers all went to college, right? There aren't any physicians or PAs that are practicing from Billy Bob's Accelerated Night School of Medicine. Yet, somehow you have physicians in your area, right? 



> Once again my system is not broke stop trying to fix it,you are messing with the health and well being of my family and many others who rely on the aid provided by first response EMTs paid or not. I have spent the last four years working part time in a level one trauma center that acts as a teaching hospital. I have had the opportunity to interact and be around on a regular basis some of the brightest and most promising students from EMT's to MD's and I can tell you there is no shortage of well educated people waiting to get out there and affect change. _Lets give them a shot and stop trying to force your educational ideals on providers that for the most part are here to do one thing and that is help their fellow man. Remember its called BASIC for a reason._



So it doesn't matter what the training requirements are as long as the soul is willing?


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## TransportJockey (Aug 26, 2009)

bunkie said:


> In reading this thread, it seems to me that in general people seem to be more against the B level of care as a whole, not necessarily if its a paid or volunteer member. I can understand the thought that patients need a higher level of care that comes from a higher level of education. But I know that in *my* area, you have to be a B for at least a year or be working for a FD or local EMT around the area before you can even get into their paramedic program. So where does that leave people, either at the paid EMTB level or volunteer because they have no choice but to gain those hours so they CAN get to that higher level of education. What is your thought on that then? Should the year experience and/or sponsorship from an agency be waved to get into paramedic school, or should they not have that stepping stone of education and experience before they get there? Not to mention, after a year of it, you tend to weed out who really wants to be there and who doesn't. Or why the hell else would people go through any of this?



That requirement to spend at least a year as a basic is an old myth that you couldn't be a good medic unless you had street experience. It to should be done away with. No other profession makes people stop at each level on the way up. 

And I've seen it work. My medic class' best student was someone who had never been on an ambulance a day until he started doing his internships. Hell, the only reason I spent some time working as a basic was cause the job paid better than what I was doing. I jumped straight into medic school as quick as I could get the pre-reqs done right after I finished my basic


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## JPINFV (Aug 26, 2009)

bunkie said:


> What is your thought on that then? Should the year experience and/or sponsorship from an agency be waved to get into paramedic school, or should they not have that stepping stone of education and experience before they get there? Not to mention, after a year of it, you tend to weed out who really wants to be there and who doesn't. Or why the hell else would people go through any of this?



Physicians don't have to be PAs. RNs don't have to be CNAs (heck, there are entry to nursing MSN programs out there). If paramedic schools provided quality education, then there wouldn't be a need to 'require' people to work at a lower level first.


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## medic417 (Aug 26, 2009)

JPINFV said:


> Then we need to take basics off ambulances and use them only as first responders.



+1
10charcrap


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## Medic (Aug 26, 2009)

Lets say you have 15  calls par day per ambulance in your area in a single 12 hour shift, you have 5 ambulances on call in that shift.

 All ambulances can be on a call at any given time and you then start getting a back log of calls. 

There could be a few P1's(most critical pt) not sure what you call it in the states, in that back log with lets say a blocked air way and unconscious, or a huge trauma and needs help asap.

you might have to ask other services to help out which is not all ways a option.

 This is where a "weekend warrior" can respond in his personal vehicle or how ever to stabilize a pt until a rig is free to come and transport a pt to a hospital. This can save lives I know where I live it can.

I dont see an issue with having a vollie on call for those emergencies a paid rig can get to. A full time vollie on a rig is a totally different story.

Thats my view on the situation.


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## Seaglass (Aug 27, 2009)

Medic said:


> This is where a "weekend warrior" can respond in his personal vehicle or how ever to stabilize a pt until a rig is free to come and transport a pt to a hospital. This can save lives I know where I live it can.
> 
> I dont see an issue with having a vollie on call for those emergencies a paid rig can get to. A full time vollie on a rig is a totally different story.
> 
> Thats my view on the situation.



How do those vollies get enough experience and practice to know what they're doing?


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## Level1pedstech (Aug 27, 2009)

Seaglass said:


> How do those vollies get enough experience and practice to know what they're doing?



 Where do most people get experience and practice? For most of us paid or not its by running calls and attending drills,obtaining CE's and furthering our level of knowledge by searching out every opportunity to better our level of education. I do believe that most providers want to improve their education regardless of what the pointy headed, book throwing, everyone needs a degree to provide BLS, anti volunteer brigade seems to think. What percentage of the nations Fire/EMS personnel work in systems where they run hard all through their shift. I guess if you work in a slow system your just not as qualified and lack the training and hands on patient contact. If you work off that theory your not getting the big picture. I worked at a combination paid volunteer department that provided service to a small municipality and the surrounding rural communities,we sometimes would go a whole 24 hour shift without a call. During the day we always had some type of drill or class and were ready for whatever came our way. Does a situation like that where we did not actually run a call make us any less qualified and to be honest it happened quite often. Its a double edge sword, at my all volunteer department if we had the call volume we could justify staffing paid personnel. It has been stated before that most volunteer agencies take classes and test at the same level as their paid counterparts. Most states have oversight of certified medical responders (FR,EMT's) so if members don't keep up with CE's and skills maintenance they are unable to apply for recertification.  I don't know of any departments that have no oversight or training plan in place and just let untrained people respond on calls. Most agencies paid or not train for the worst possible scenarios that their crews may be involved in.

 I still think people are missing the whole concept of the basic in EMT-B. I realize the above mentioned pointy headed brigade just hates the way EMT-B's are shuffled through the  mills ( for the record my WA state basic class was 156 hours with 24 hours of ER time) but they are fighting a long uphill battle. I just wish I could get a straight answer from the brigade on the need for all the college level courses when you will never use the material at least not until you advance to medic school. Once again to respond to a call then safely and effectively follow the ABC's(at the basic provider level),package and prepare for or transport that patient to the appropriate facility for advanced care does not require advanced college level knowledge of A+P or biology. I have said before any thing above a basic and I am with you 100% but come on give me some situations where any of this would play into the daily routine of your average basic. I know that there may be a time when that advanced knowledge would be of use but that's not the norm and you know it, so no oddball once in a lifetime trick medical scenarios please. I'm thinking about your average IFT or BLS basic that works with a system that has average protocols and expects their basics to be basics.


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## Medic (Aug 27, 2009)

Volunteer on a on going bases if you vollie every weekend with a paid crew or who ever,, if  the vollie is all ready a Emt of any sort,they will gain experience quite fast.. A vollie with a bit of experience who is certified is better than a first aider or no one at all. 

There is good in this whole argument. You just finding or looking for the bad.

Maybe a person has a job and cant quit but really wants to help out and the only way is to vollie, this is not a train smash. Grow with change you cant fight it. 

Take what i say with a pinch of salt. It's my opinion.


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## Seaglass (Aug 27, 2009)

Medic said:


> Volunteer on a on going bases if you vollie every weekend with a paid crew or who ever,, if  the vollie is all ready a Emt of any sort,they will gain experience quite fast.. A vollie with a bit of experience who is certified is better than a first aider or no one at all.
> 
> There is good in this whole argument. You just finding or looking for the bad.



No... I'm just curious because I know nothing about how the South African system works. From what you said originally, it seemed to me like the vollies were only responding when paid crews weren't available, which sounded rare, not also volunteering with paid crews.

I'm a big fan of drills and CE. But I think patient contact is essential, because it's a lot more stressful when everything's for real. A lot of people who are great at drills and textbooks stumble in the field because they aren't used to handling the chaos and adrenaline rush. If call volume is limited, I can't blame the provider for not getting experience on calls. But if systems are designed to keep some providers from getting frequent patient contact, whether by calls or some other method, I suspect that errors are going to go up when those EMT's wind up alone on scene.

As for college courses, I don't think they're essential for basics. Instead, they're part of going above and beyond, which is something to be encouraged. But I think the "brigade's" argument is more that everyone should train up to medic.


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## Achromatic (Aug 27, 2009)

MrBrown said:


> Volunteers hurt EMS because they will always be the lowest common deominator that standards are watered down to please.



Always? Great stereotype. Our county does its BLS training in-house. Whether you are volunteer or career, you a) have to compete for the same spots in the EMT-B course (our last intake had 45+ applicants from the paid and volunteer staff for 30 spots in the course, and intake was determined based on practical and written exam from the AHA CPR curriculum), and b) are held to the same standards in regards to ongoing education, discipline, and functionality.

But hey, just continue to belie we're a bunch of clowns that need our hands held to get through any training.


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## JPINFV (Aug 27, 2009)

Level1pedstech said:


> I have said before any thing above a basic and I am with you 100% but come on give me some situations where any of this would play into the daily routine of your average basic. I know that there may be a time when that advanced knowledge would be of use but that's not the norm and you know it, so no oddball once in a lifetime trick medical scenarios please. I'm thinking about your average IFT or BLS basic that works with a system that has average protocols and expects their basics to be basics.




Any time the basic is deciding whether the patient needs paramedics or not. 

Any time that the complaint involves a patient on dialysis or with abnormal labs. 

There's two right there.


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## Ridryder911 (Aug 27, 2009)

Achromatic said:


> Always? Great stereotype. Our county does its BLS training in-house. Whether you are volunteer or career, you a) have to compete for the same spots in the EMT-B course (our last intake had 45+ applicants from the paid and volunteer staff for 30 spots in the course, and intake was determined based on practical and written exam from the* AHA CPR curriculum*), and b) are held to the same standards in regards to ongoing education, discipline, and functionality.
> 
> But hey, just continue to belie we're a bunch of clowns that need our hands held to get through any training.




You will have to do better than referring to such courses as anything relevant for a screening process. 

I believe that I and others doubt that anyone is against the Basic or now called EMT level. It is rather that I feel that it is no longer acceptable as an entry point and YES it is just above the first aid level. (prove me wrong - hint...compare the curriculum with that of ARC Advanced First Aid... I have). 

It is an excellent program for the first responder/ first response but not qualified to actually assess and perform medical procedures that is needed in todays health care. A 120-150 clock hour course is not sufficient enough to meet the demands to be the sole care-giver provider on the EMS unit. 

*WARNING:* Anyone that spouts off protocols is in danger of looking like a fool. Remember, we should be treating patients individually not as a protocol! Protocols are and should be *only* used as guidelines ! Truthfully, what is it the EMT level would need a protocol for (other than oxygen and epi-pen (activated charcol has been removed in the new standards)? 

R/r 911


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## Achromatic (Aug 27, 2009)

Ridryder911 said:


> You will have to do better than referring to such courses as anything relevant for a screening process.
> 
> I believe that I and others doubt that anyone is against the Basic or now called EMT level. It is rather that I feel that it is no longer acceptable as an entry point and YES it is just above the first aid level. (prove me wrong - hint...compare the curriculum with that of ARC Advanced First Aid... I have).
> 
> ...



Oh, definitely - don't mistake me as thinking that an EMT-B is anything beyond that acronym of the rig they are in - 'basic. life. support.'

"Know what you know. And know enough to know what you don't."

For me, my plan is to be a paramedic within the next three years, with at least an AAS.

The reference to the AHA courses etc was more to draw a contrasting opinion to the person who claimed that "volunteers bring us all down because standards will have to be lowered and watered down for them" when point in fact in our county at least is that there is zero differentiation in training (though not in what is unabashedly extremely valuable, experience, by virtue of hours clocked) between a paid EMT-B and a volunteer. We are assigned shifts, are expected to be at station, in uniform, etc, and respond to all calls - actually, one thing this thread has shown me is that it seems at least from my perspective that I'm in probably one of the better areas in the country in terms of the 'volly experience' - I've not once heard people discussing what lights they want to run on their POV, and if a crew on shift was to even attempt to avoid a 'boring' call, the med. director and county would rain a sh*tstorm down on them.

And you, Mr Rider, I wish to thank - reading these forums over the last couple of weeks has given me a lot of insight into this change in my profession (although I started in college studying biomedical science, I got sidetracked by healthcare IT, and now at the age of 31 am looking to get back into 'practical medicine' - with all caveats acknowledged, that I realize EMT-B is not a medical practitioner certification!) - though blunt at times, I respect that you have a lot of beliefs and opinions that have been formed through a lot of experience - even on a more general level, being willing to "know what I don't know" and take those on-board, even if I disagree, is one of the keys to becoming a better medic. That, and "the patient's best interest should always be the #1 priority".


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## Level1pedstech (Aug 27, 2009)

JPINFV said:


> Any time the basic is deciding whether the patient needs paramedics or not.
> 
> Any time that the complaint involves a patient on dialysis or with abnormal labs.
> 
> There's two right there.



 On deciding whether to continue ALS your joking right?

 With regards to a patient on dialysis or with abnormal labs, I must be missing something can you offer a little more for me to work with in regards to the basics responsibilities and how college level courses fit into the treatment plan at the basic level. Maybe we should consider your first statement and at least consult with a higher level provider.


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## JPINFV (Aug 27, 2009)

...because, you know... every situation is completely cut and dry. There's no gray area at all when dealing with patients. 

Also, who said anything about 'continuing.' Not every patient is going to get an initial paramedic response for a variety of reasons.


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## Medic (Aug 27, 2009)

In SA a BLS medic gets paid pea nuts. They can barley live on there salary, it sickens me an its no different in our police or fire. they have to work extra shifts and jobs to pay for a house and food putting aside school fees. 

In my eyes thats what scares people from working in our amazing ems system. I'm sure in the states you wont get 15-20 calls per 12 hour shift on a average day not even talking about a busy day thats experience in a nut shell.

Thats why people will vollie on weekends or some weeknights and keep there 8-5 job. Both to help out the services and do what they love. I belive SA  needs a hell of a wake up call because we losing our medics to over seas where there better paying jobs. Who will replace all these leaving medics in the mean time vollies are helping quite a bit, and vollies willing to give up time are few and far between but play a roll. Full time medics on the road vollie on choppers or sea rescue or mountain rescue. 

Im not degrading any SA medic leaving or any service its just we have a world cup around the corner and we have to import medics for the event, what message is that leaving you?

So you complaining bout a vollie stealing your call well if that happened here it would snow and it does not snow here. We need staff here.


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## 8jimi8 (Aug 27, 2009)

Before I answer this questions i must ask my own.
Is the only reason that you don't like volunteers because of how easy it is to become a basic?

I'm all for raising the bar on education to be an EMT.  I have never argued against that.  Yah its easy to be an EMT.  I took mine online during while it was in school full time for nursing.  Requiring that type of education as a baseline to get into practice will not stop me from volunteering.  It may hugely cull the ranks of incoming basics and stop a great many people from volunteering.  The only other problem that I foresee with raising the bar to entry level is that everyone who actually takes those courses will eventually continue on, or possibly immediately start paramedic education.  You aren't gonna have any people at just the basic level after a while.

So why not just eliminate basics altogether.  Maybe make the baseline of entry EMT-A.  No more bls units?  Is that all i have to say to get you to agree that volunteering is not the reason that EMS is held back from other allied healthcare?  Do you REALLY think its the volunteers faults?  Seems most of the employed people on this site are negative towards volunteering, is that really an accurate depiction of EMS as a whole, across the nation?  Does everyone REALLY hate volunteers?

I have never been one to downplay the education hoop jumping.  When i get my red patch, i will probably get the one with gold letters.  Not sure if i want to... cause it really just costs more money to re-cert. I will probably not ever be a paid paramedic on an ambulance, not in the area where I live.  No one pays enough.  Eventually I will be trying to fly either as a nurse or a medic, and i'm sure that i will always volunteer.  Nothing feels better than helping someone who needs it.

So yah, up the education, just don't blame volunteers because you in your professional wisdom and experience (that somehow makes me inferior) haven't done it yet.  




daedalus said:


> I second JP's challenge. Can the volunteer advocates on here *please answer* our question? How many volunteer EMTs would there be if getting your EMT meant taking chemistry, biology, anatomy and physiology, microbiology, and physics all at a college? Providing medicine means taking these classes before starting to learn pathology and its treatment.
> 
> A volunteer advocate here mentioned he/she would not let a paid EMS provider touch his family. I put forth that EMS is a division of medicine and public health, and every other part of that machine collects a paycheck here in the United States.
> 
> By the way, and as Rid/Ryder will tell you, we are moving on without you guys. I speak of the people who insist that EMTs are effective volunteer medical providers. We have changed what will be taught in future EMT and Paramedic classes, a small step to be sure, but one in a positive direction. I plan on continuing to raise the bar until it will be impossible to become a prehospital provider just by taking a semester long night school class.


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## EMTinNEPA (Aug 27, 2009)

Volunteers lobby to keep the educational standards low.  Volunteers are also the reason that professionals usually need one and a half jobs to get by.  Educational standards are low and people are willing to do it for free... hmm, why should we pay you a livable wage?


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## 46Young (Aug 27, 2009)

EMTinNEPA said:


> Volunteers lobby to keep the educational standards low.  Volunteers are also the reason that professionals usually need one and a half jobs to get by.  Educational standards are low and people are willing to do it for free... hmm, why should we pay you a livable wage?



Lack of political organization by EMS workers is by far the major reason why EMS professionals need one and a half jobs (or more) to get by. This has been addressed previously at the EMS and unions thread.

So, you get your way and vollies disappear. Now, you go hunting, skiing, camping, or whatever up in the mountains. Your car goes off the side of the road. The nearest paid EMS is greater than 30 minutes away, on a good day, as the tax base can't support full time medics. your golden hour comes and goes, and now you're taking a dirt nap. Or the elderly gentleman with an MI who needs an interventional cath lab. Pt contact and txp is delayed by 30 minutes or more due to lack pf resources, and he expires. Additionally, in both cases, air txp is not an option due to weather.


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## EMTinNEPA (Aug 27, 2009)

46Young said:


> Lack of political organization by EMS workers is by far the major reason why EMS professionals need one and a half jobs (or more) to get by. This has been addressed previously at the EMS and unions thread.
> 
> So, you get your way and vollies disappear. Now, you go hunting, skiing, camping, or whatever up in the mountains. Your car goes off the side of the road. The nearest paid EMS is greater than 30 minutes away, on a good day, as the tax base can't support full time medics. your golden hour comes and goes, and now you're taking a dirt nap. Or the elderly gentleman with an MI who needs an interventional cath lab. Pt contact and txp is delayed by 30 minutes or more due to lack pf resources, and he expires. Additionally, in both cases, air txp is not an option due to weather.



I'd say "Welcome to Pennsylvania" because you're looking at that situation anyway once three separate vollie BLS companies fail to crew, which happens quite often.  If these services were paid (which they aren't largely due to tradition) we wouldn't have that problem now.


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## ffemt8978 (Aug 27, 2009)

jtpaintball70 said:


> That requirement to spend at least a year as a basic is an old myth that you couldn't be a good medic unless you had street experience. It to should be done away with. No other profession makes people stop at each level on the way up.



Actually, some areas and programs do make it a prerequisite to have at least one year of experience before you can even apply for the paramedic program.  Just because it's that way where you are does not mean it's that way everywhere.


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## ffemt8978 (Aug 27, 2009)

EMTinNEPA said:


> Volunteers lobby to keep the educational standards low


About as much as fire departments in Florida...



> Volunteers are also the reason that professionals usually need one and a half jobs to get by.  Educational standards are low and people are willing to do it for free... hmm, why should we pay you a livable wage?


Care to offer proof for that one?


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## EMTinNEPA (Aug 27, 2009)

ffemt8978 said:


> Care to offer proof for that one?



Average salary for a paramedic in this area fresh out of school: $29,120
Cost of living: $50,000
Number of paid services in this county: 2
Number of volunteer services in this county: 6

How many volunteers are there in PA?  Tens of thousands of people... doing my job for free.

Why do nurses make more?  They have more education.


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## ffemt8978 (Aug 27, 2009)

EMTinNEPA said:


> Average salary for a paramedic in this area fresh out of school: $29,120
> Cost of living: $50,000
> Number of paid services in this county: 2
> Number of volunteer services in this county: 6
> ...



That doesn't mean you would be paid more if there were fewer volunteer agencies.  You might think it would, but voters can be unpredictable when it comes to raising their taxes to pay for something that they may or may not use, or even understand.

Look at it from this perspective...If the vollies were done away with in your county, that would mean that more personnel would have to be hired to provide the same coverage.  That means more money spent on CE's, equipment, training, retirement, insurance, unemployment insurance, facilities, etc...  Do those 6 communities have the tax base to support the increase in costs, or would the burden be shared throughout the county?


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## 46Young (Aug 27, 2009)

EMTinNEPA said:


> I'd say "Welcome to Pennsylvania" because you're looking at that situation anyway once three separate vollie BLS companies fail to crew, which happens quite often.  If these services were paid (which they aren't largely due to tradition) we wouldn't have that problem now.



Funny that you should bring that up. I don't know if this has been addressed before, as this thread is quite long winded - I've observed that volunteer FD's and ambulance squads on Long Island NY have been 100% volunteer there, with the exception of Nassau County PD EMS. NCPD staffs their EMS division with consideration to the availability of vollie EMS. Suffolk County had no prior fire based or PD based professional EMS. 

Over the past decade or more, the vollies have had increasing difficulty in staffing their EMS units, particularly in the daytime, since members need to work a job or two to stay afloat nowadays. The volunteer FD's have been adding paid medic fly cars, and the Town of Rockville Centre has a contracted out a 24/7 dedicated 911 ALS unit with the North shore LIJ CEMS. The town guarantees the CEMS a certain amount of revenue. Any shortcomings in billing will be offset by the town. Any revenue over the agreed upon amount goes to the town. Not a bad deal, something for some areas to consider. I'm not sure if any other vollie FD's have any paid rigs, but it will come to that sooner or later. 

My dept was 100% volunteer at one point. Now it's like 1%. Other surrounding counties started out the same way, but have been progressively shifting from vollie to paid by varying degrees. I know that our systems are fire based, but I'm sure that similar scenarios are in progress with vollie single role EMS.

So, it appears that these vollie organizations are actually providing paid positions in a progressive fashion. Dur to financial constraints, the community will typically staff only what's needed with paid personnel. 

This increasing shift towards paid personnel is likely the norm across the country. so, vollies aren't stealing anyone's job. declining participation in many areas will ultimately result in replacement by paid personnel. 

Stop whining about vollies stealing your jobs. these individuals are willing to help their communities basically for free, and ask little in return.


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## Foxbat (Aug 27, 2009)

ffemt8978 said:


> That doesn't mean you would be paid more if there were fewer volunteer agencies.


I do not have data for percentage of career vs. volunteer EMS service by state, but I do have such data for fire departments.
I put this data into Excel and here's what I got.
Each datapoint represents a state. X axis is percentage of all-volunteer FDs in this state. Y axis is average yearly wage of career firefighters in this state.
Graphically, I do not see how one is dependent on another. If anyone would like to analyze it numerically, I can send you the entire spreadsheet.


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## TransportJockey (Aug 27, 2009)

ffemt8978 said:


> Actually, some areas and programs do make it a prerequisite to have at least one year of experience before you can even apply for the paramedic program.  Just because it's that way where you are does not mean it's that way everywhere.



I never said it doesn't exist, I just said it should be done away with. I said it's a myth, which tends to be perpetuated in 'tradition' bound depts


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## catskills (Aug 27, 2009)

EMTinNEPA said:


> Volunteers lobby to keep the educational standards low.  Volunteers are also the reason that professionals usually need one and a half jobs to get by.  Educational standards are low and people are willing to do it for free... hmm, why should we pay you a livable wage?


I hear your pain.  I am all for people earning a wage they can live on.  Its obvious EMT-B is not a job one can live on.  

That said, I don't think forcing the volunteers EMT-Bs to be paid EMT-B is going to solve the problem of low pay for EMT-B profession.  If anything all those volunteer EMT-Bs will be forced to find part time EMT-B jobs where they get paid.  As noted here there are 100s of 1000s of volunteer EMT-Bs that would be looking for a paid EMT-B job if they could not volunteer.     I personally don't think this scenario is going to help the EMT-B low salary problem.  

Also note that myself and many volunteer EMT-Bs that I volunteer with have taken many college level chemistry and biology classes.   I have a BS degree in Electrical Engineering.  I volunteer with a Math professor, Mechanical Engineer, Dentist, and RNs.  These highly educated people enjoy doing part time EMT-B work.  If these professionals start looking for part time EMT-B paid jobs, they may end up taking away existing full time paid EMT-B jobs that have less education.  :sad:


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## medic417 (Aug 27, 2009)

catskills said:


> I hear your pain.  I am all for people earning a wage they can live on.  Its obvious EMT-B is not a job one can live on.
> 
> That said, I don't think forcing the volunteers EMT-Bs to be paid EMT-B is going to solve the problem of low pay for EMT-B profession.  If anything all those volunteer EMT-Bs will be forced to find part time EMT-B jobs where they get paid.  As noted here there are 100s of 1000s of volunteer EMT-Bs that would be looking for a paid EMT-B job if they could not volunteer.     I personally don't think this scenario is going to help the EMT-B low salary problem.
> 
> Also note that myself and many volunteer EMT-Bs that I volunteer with have taken many college level chemistry and biology classes.   I have a BS degree in Electrical Engineering.  I volunteer with a Math professor, Mechanical Engineer, Dentist, and RNs.  These highly educated people enjoy doing part time EMT-B work.  If these professionals start looking for part time EMT-B paid jobs, they may end up taking away existing full time paid EMT-B jobs that have less education.  :sad:



If they quit volunteering the places they volunteer at would go paid.  Thus more jobs would be created.  Thus the pay grade would be higher.  At this point when a city/county works to make a pay decision they include what each service in the region pays.  Every volly organization shows up as zero.  Then the city/county leaders take that low average and say what are you complaining for you are paid higher than the average emt or Paramedic.


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## Ridryder911 (Aug 27, 2009)

In my area it is a rarity to see EMS as a volunteer although there is more volunteer Fire Departments, as well very few true EMS that are associated with the fire service as well. As being a state that not only that population is less than rural rather considered frontier (look those stats up) I can say bullish on describing EMS cannot be done with professionals. 

I have never said that volunteers should be done away with. I am all in favor of first response first responders; however in the majority.. (not all) a professional EMS with Paramedics could rendezvous within minutes to a workable time. 

What I do get angered with is communities that continue to utilize volunteer EMS that can afford professional care. Any community that will be utilizing Paramedics that obtain their "training" from a sub par trade school with very minimal clinical exposures (albeit paid or volunteer). Cook book medicine from any service where patients are regarded as protocols and one only knows treatment regime as step by step from set guided algorithms. For some reason, many communities still assume that they have to have their own EMS instead of regional or interacting vollie intercepting with professional EMS. 

Sorry, if I had my choice of knowing that my person has the possibility of being monitored and being fired for any problems, I would chose the later. As well as the physician that performs a procedure every week to one that performs one a year, that would be closely monitored and had proven academically that they are educated and demonstrate expertise in clinical performance I would want those in EMS to have the same foundation. 

Again, I don't think anyone is ignorant or naive to describe that volunteers will not be needed or should be used. It is that their role and methods that will be drastically changed. It is happening, it is not a "possibility" or "if" it is a fact. Within the next two to five years EMS will have a drastic over haul, even affecting those that are paid. We will see who will last and endure those changes as many will be filtered out. 

I have just reviewed some new national changes that are coming out and very excited about the future. There are projects underway that will shape EMS in the near future. Unfortunately, I am not at liberty to go into detail at this time but I can describe that I am finally seeing EMS come around after 40 years. It's about time. 

R/r 911


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## emtjack02 (Aug 28, 2009)

Once again so many good points brought up.  I honestly don't know what it would cost to run a full time ambulance for our coverage area, or what a private full time would charge/bid to contract it.  I encourage any of the business savey to come and get a pd service going.  We currently tax about 10/hr.  
The OP must be right, if I didn't volunteer they would have a pd department.  Their education would be so much better. And their experience...wow..the call volume that they'd see would be...well not much at all. 
While volunteers may be adrenaline junkies. Or not the most highly educated they are providing care in places that I believe could not afford a full time ALS ambulance.  
We may be behind the times or caught with older equitment but that is not neccessarly the doing of the crew.   
Should I still bring my questions here...or would you rather I not bring you down more.


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## Ridryder911 (Aug 28, 2009)

emtjack02 said:


> Once again so many good points brought up.  I honestly don't know what it would cost to run a full time ambulance for our coverage area, or what a private full time would charge/bid to contract it.  I encourage any of the business savey to come and get a pd service going.  We currently tax about 10/hr.
> The OP must be right, if I didn't volunteer they would have a pd department.  Their education would be so much better. And their experience...wow..the call volume that they'd see would be...well not much at all.
> While volunteers may be adrenaline junkies. Or not the most highly educated they are providing care in places that I believe could not afford a full time ALS ambulance.
> We may be behind the times or caught with older equitment but that is not neccessarly the doing of the crew.
> Should I still bring my questions here...or would you rather I not bring you down more.



Questions are always appreciated if one has attempted to already seek answers (we have found many attempt too many short cuts i.e. reading). One can learn many ways as the old saying of "skinning a cat" even may learn the cat does not be skinned...lol 

As in EMS, I also believe in nursing, etc. it does not matter the size or location of where you provide care at. I have worked in a 1 bed ER and in one of the nations largest Level 1 trauma center and seen good and bad care at both. One of the best & most aggressive services I worked at was at a very rural area with < 6,000 people. We did RSI, central lines, thrombolytic & 9 lead (12 lead monitors for EMS was not invented yet) and this was in the mid 80's so it can be done if the desire and determination and of course good medical direction. 

I believe it is more difficult to work in such areas. Sure, our call volume was only about 2 calls a day but our transport time was always > than a hour + and we bypassed the local ER due no real services available. So we carried numerous medications as we often seen patients either worsen or improve with treatment alike within a ER. As well due to the low volume we had to maintain our skill level to be sharp. So we instituted a high level of studies and clinical performance. This meant performing IV therapy at the hospital and quarterly intubations in OR and ECG reviews with the hospital visiting cardiologist. We made up special training such placing a KED on blind fold or who could place on a traction splint the fastest to prevent skill deterioration. Again our statement was because we were rural or small did not mean we were stupid or provided lower care. 

This carried on at one of the ED's I managed was a rural 8 bed ED. We recognized our limitations for hospital services but I enforced that the patient could be packaged and stabilized the best we could do and provide before leaving hospital grounds. That means emphasizing early recognition of injuries and illnesses as soon as possible so no further delay can occur. 

Again, it can be done. It is very hard work and the main emphasis is to think outside the norm. Look at systems such as Canada, South Africa and Australia that provides good quality medical care in many remote areas. Modifications and collaboration may have to occur; but that is okay as long as the patients best interest is always the key factor and main point. 

R/r 911


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## medic417 (Aug 28, 2009)

emtjack02 said:


> Once again so many good points brought up.  I honestly don't know what it would cost to run a full time ambulance for our coverage area, or what a private full time would charge/bid to contract it.  I encourage any of the business savey to come and get a pd service going.  We currently tax about 10/hr.
> The OP must be right, if I didn't volunteer they would have a pd department.  Their education would be so much better. And their experience...wow..the call volume that they'd see would be...well not much at all.
> While volunteers may be adrenaline junkies. Or not the most highly educated they are providing care in places that I believe could not afford a full time ALS ambulance.
> We may be behind the times or caught with older equitment but that is not neccessarly the doing of the crew.
> Should I still bring my questions here...or would you rather I not bring you down more.



Lets see I am involved to some extent with several ambulance services, all in small remote poor areas.  All are paid.  One of them just hit 70 report numbers for the year, yet station is staffed 24/7.  And that 70 is misleading as to number of calls as actually many of the calls involved multiple patients.  Probably safe to say this station has only had about fifty 911 calls for the year.

How did this and other poor areas go paid?  They got their priorities right.  See the topic I started a few days ago on changing from volly to paid.


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## Achromatic (Aug 28, 2009)

EMTinNEPA said:


> Volunteers lobby to keep the educational standards low.  Volunteers are also the reason that professionals usually need one and a half jobs to get by.  Educational standards are low and people are willing to do it for free... hmm, why should we pay you a livable wage?



I assume you have actual evidence for these assertions, rather than claims based on your perceptions...?


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## emtjack02 (Aug 28, 2009)

If I am taking your jobs..come get them.  Don't expect me to try to change things so you can have a job.  Thats up to you.  I would love for our department to be full time but I know the trustees...they are old firemen that dont care about EMS.


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## medic417 (Aug 28, 2009)

emtjack02 said:


> If I am taking your jobs..come get them.  Don't expect me to try to change things so you can have a job.  Thats up to you.  I would love for our department to be full time but I know the trustees...they are old firemen that dont care about EMS.



Then vote them out.  EMS is not about tradition it is about what is best for the patients.


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## PapaBear434 (Aug 28, 2009)

emtjack02 said:


> If I am taking your jobs..come get them.  Don't expect me to try to change things so you can have a job.  Thats up to you.  I would love for our department to be full time but I know the trustees...they are old firemen that dont care about EMS.



That kind of confrontational attitude isn't helping anything.


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## emtjack02 (Aug 28, 2009)

Telling us that we are bringing you down doesn't really help much either.  And I would love to vote them out.  One problem, I dont live in our district so I can't run or it or vote against them.


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## Sparky79 (Aug 28, 2009)

emtjack02 said:


> If I am taking your jobs..come get them.  Don't expect me to try to change things so you can have a job.  Thats up to you.  I would love for our department to be full time but I know the trustees...they are old firemen that dont care about EMS.



I tend to agree with this statement. If you *CHOOSE* to make a career doing a job that thousands are willing to do for free, what do you expect? I would bet that even the oldest, most experienced medics that have been doing this for their entire career knew when they made the decision to get into EMS that there were thousands of volunteers doing this "job". Now these people complain that "volunteers are ruining this job". I have read on this forum in the past statements like "would you volunteer to pickup trash, pave streets, or other menial jobs"? No, nobody wants to do those jobs for free, so the town has to pay someone to do it. That argument is comparing apples and oranges. People will do EMS/firefighting for free. You knew that going in, so stop complaining and deal with it!

If you don't want to compete with volunteers, or are upset that volunteers are keeping wages down, you should have chosen a different career path, one people don't want to do for free. I'm an electrician. Nobody wants to do my job for free (aside from a DIY homeowner who will end up calling us anyway to fix their mistakes afterwards). Actually there are less people entering my field every year than people retiring, meaning eventually there will be an electrician shortage driving both prices and salaries higher. Most people don't want to do my job at all, which is fine by me. It's a dirty, physical job with no glory and very little respect, but it pays well and I can make as much money as I want by doing side jobs and such. I love it!

EMS/Fire/Police have a never ending line of applicants, all of whom will do anything to get the job including working for peanuts. As we all know there is a very high turnover at the lower levels of EMS, and an unlimited labor pool for employers to pick from to replace those leaving. This is due to the amount of education required to enter the field, it's a joke even at the paramedic level never mind the basic level. That is what is stopping the professional from progressing, not volunteers. Increase the education levels across the board and let the chips fall where they may.

I have read on this forum people questioning if there would still be volunteers if the educational standards were increased, probably, but I'm sure the number of volunteers would drastically decrease. I'll be honest, if the education requirements were a lot tougher I would probably not do this. I'm not a volunteer, we're paid oncall, but the money I make doing ambulance calls would definitely not convince me to make a whole lot more of an investment in education to continue. I have enough to do to maintain my electrical licenses both in license renewal fees and continuing education requirements (both of which are much more intensive than that required to maintain my EMT cert.).

Increasing the education requirements for all levels would not only affect the number of volunteers, but would also eliminate the number of "wannabees" who aren't really serious about a career in ems but get into it because it's "easy money".

To say that volunteers are bringing down the profession gives way to much credit to all of the lazy providers at every level, both paid and vollie, who do the absolute minimum to get by in this field. There are plenty of so called "professionals" who show up, do their shift, and get paid. They do no more than what is absolutely necessary to keep their job. They don't go on websites such as this to learn from others, they don't research topics to learn any new things, they don't take extra classes to better themselves. They show up for the paycheck, period.

So all of this volunteer vs. paid stuff is BS. If you want to better the profession - great! Increase initial education requirements, increase continuing education requirements, make the testing more difficult. There might be some volunteers who will still do this no matter what the requirements are, and so what? As long as the requirements are the same across the board for both paid and vollie that is all that should matter. Volunteers were doing this before you came, and will be doing it long after your gone. Deal with it!


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## taporsnap44 (Aug 28, 2009)

Sparky79 said:


> Increasing the education requirements for all levels would not only affect the number of volunteers, but would also eliminate the number of "wannabees" who aren't really serious about a career in ems but get into it because it's "easy money".



Hopefully this will be in full swing soon. With the new paramedic curriculum going into effect, and the possible updates to scope of practice requiring a bridge for existing paramedics. This is hopefully the first step in getting existing persons out of this profession that have no other reason then the "glory".


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## EMTinNEPA (Aug 28, 2009)

Achromatic said:


> I assume you have actual evidence for these assertions, rather than claims based on your perceptions...?



Read.
10 characters.


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## Ridryder911 (Aug 28, 2009)

Sparky79 said:


> I tend to agree with this statement. If you *CHOOSE* to make a career doing a job that thousands are willing to do for free, what do you expect? I would bet that even the oldest, most experienced medics that have been doing this for their entire career knew when they made the decision to get into EMS that there were thousands of volunteers doing this "job". Now these people complain that "volunteers are ruining this job". I have read on this forum in the past statements like "would you volunteer to pickup trash, pave streets, or other menial jobs"? No, nobody wants to do those jobs for free, so the town has to pay someone to do it. That argument is comparing apples and oranges. People will do EMS/firefighting for free. You knew that going in, so stop complaining and deal with it!
> 
> If you don't want to compete with volunteers, or are upset that volunteers are keeping wages down, you should have chosen a different career path, one people don't want to do for free. I'm an electrician. Nobody wants to do my job for free (aside from a DIY homeowner who will end up calling us anyway to fix their mistakes afterwards). Actually there are less people entering my field every year than people retiring, meaning eventually there will be an electrician shortage driving both prices and salaries higher. Most people don't want to do my job at all, which is fine by me. It's a dirty, physical job with no glory and very little respect, but it pays well and I can make as much money as I want by doing side jobs and such. I love it!
> 
> ...



Take away the badges, l/s on their POV's, and T-shirts/jackets with block letters on the back and see if there would not be a shortage alike electricians. Require real education with a formal degree before entering alike all other health care professionals and again then compare the line... 

R/r 911


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## medic_texas (Aug 28, 2009)

Don't take away my blinky things!!!


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## scottyb (Aug 28, 2009)

Ridryder911 said:


> Take away the badges, l/s on their POV's, and T-shirts/jackets with block letters on the back and see if there would not be a shortage alike electricians. Require real education with a formal degree before entering alike all other health care professionals and again then compare the line...
> 
> R/r 911



All Healthcare professionals do not require degrees.  For example, CNA's.  I understand, that there are mostly bathers, shavers, movers and wipers.  But, they do work in the health care profession.

Making a case for greater education is great.  But most of us volunteer's are basic's, at least in my area.  A degree required for basics, come on.  Paramedics, yes.  I would tend to agree with you.  Unless you feel all ambulances should be ALS, and there is no room for basics in health care.  Can you really see Paramedics in a rural setting having to respond to band aid call after band aid call for the pay they would get when they can probably get paid a little more and have some calls where they can use that ALS education that they paid and worked for.


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## Ridryder911 (Aug 28, 2009)

scottyb said:


> All Healthcare professionals do not require degrees.  For example, CNA's.  I understand, that there are mostly bathers, shavers, movers and wipers.  But, they do work in the health care profession.
> 
> Making a case for greater education is great.  But most of us volunteer's are basic's, at least in my area.  A degree required for basics, come on.  Paramedics, yes.  I would tend to agree with you.  Unless you feel all ambulances should be ALS, and there is no room for basics in health care.  Can you really see Paramedics in a rural setting having to respond to band aid call after band aid call for the pay they would get when they can probably get paid a little more and have some calls where they can use that ALS education that they paid and worked for.



Sorry, you do not know what a health care professional is defined as. Yes, I do and we have Paramedics that treat all  areas albeit in rural, urban or metro. First aid does not cut it and unfortunately the curriculum of the EMT level is just a little above that. Before your blood pressure rises I forewarn you to read both curriculum's to even attempt to debate.

Basic level is just that. Utilize them as they are designed to do for first response and to assist Paramedics. I wont argue against that at all, great asset and wonderful idea but to place a patients life solely in the hands of person that has less per hour training in their profession than a manicurists is ludicrous. 

I am sure you would not allow a electrical journeyman to perform just a few 8 hours of clinical  and few night school classes before wiring a house or business but to deal with a persons life it is okay? Yeah, not even close to being rational. 

So what would your opinion be if we were to eliminate the journeyman or master requirements and have a simple few week elcetrician course and those individuals that passed could wire homes & business for free? Why not? Place them in small ommunities that need homes re-wired, shelters, schools, churches, etc All of those that are on tight budget and look at all that could benefit from it. I mean really, if electricians really wanted to help the community they would take a cut or offer their services free all the time to those areas not all projects really need an electrician..... right? 

Yeah, thought so. 

R/r 911


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## medic417 (Aug 28, 2009)

scottyb said:


> All Healthcare professionals do not require degrees.  For example, CNA's.  I understand, that there are mostly bathers, shavers, movers and wipers.  But, they do work in the health care profession.
> 
> Making a case for greater education is great.  But most of us volunteer's are basic's, at least in my area.  A degree required for basics, come on.  Paramedics, yes.  I would tend to agree with you.  Unless you feel all ambulances should be ALS, and there is no room for basics in health care.  Can you really see Paramedics in a rural setting having to respond to band aid call after band aid call for the pay they would get when they can probably get paid a little more and have some calls where they can use that ALS education that they paid and worked for.



Actually the rural areas need Paramedic level response more than the citys.  Why?  Because often patients are a long way from a hospital.  An educated person actually knows that in real rural areas you actually get to practice medicine, you get to see that what you are doing works.  In the city's you probably are at the hospital before you get the drugs out of the cabinet many times.   I work very rural in fact it is called frontier.  We are paid.  

As to basics, no they should not be on ambulances, they should be first responders only.


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## scottyb (Aug 28, 2009)

From an insurance definition website:

A physician or other health care professional *licensed, accredited, or certified* to perform specified health services consistent with State law.
Examples include but are not limited to the following: medical doctors, doctors of osteopathy, psychologists, nurses, physical therapists, and occupational therapists.

I agree, you may have a different definition that you can find that supports your opinion.  There are plenty of different sites out there will word the meaning differently.  But I believe this the definition most of America will think of when asked, again, my opinion.

That is great for you, you are paid and work in a frontier.  But that will not always work.  Public opinion will prevail.  Tell them you want more money for something they already have and will probably never use.  Not a happy public.  And a politician that pushes it, probably not gonna have another term, at least where I am.  As far as no EMT's on an ambulance, a BLS rig is just that, _basic_.  And in rural areas can intercept with ALS, but at least the ABC's are being maintained, albeit by an inferiorly trained person.

I was simply stating that try finding a qualified and certified, with a degree paramedic for every rural emt spot in america at pay they will like and the community can afford without raising taxes, taking things away that they actually think they will use, or causing others to lose their jobs.  I think this is a slim possibility, especially with the current state of the economy.  To think otherwise is not realistic.  While it would be great to have the greatest level of care in every nook and cranny of the country, it is just not gonna happen in any of our lifetimes.


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## medic417 (Aug 28, 2009)

Scott any community can with proper priorities go paid Paramedics.  Your right won't happen while people are doing it for free.  Sadly it takes telling the community you can no longer properly staff and on such and such date we will be closed.  Here are the options we have that will provide continued care for our citizens.  You present some options highlighting the good and bad of each.  Give them a few ideas how to adjust the budget and surprise especially once the blue hairs hear no ambulance those in power can make adjustments and usually do.  I have seen this work multiple times.  I did see one community say no so guess what they had no ambulance.  After a couple of 911 calls the public outrage forced the area leaders to shift money and now they have EMS again, fully paid.  

As the old saying goes if you can get the milk for free why buy the cow.


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## scottyb (Aug 28, 2009)

I understand your plight.  You can see the possibilities of the field and what it could be.  Any profession would want that.  

I was blinded by the sheer anti-volunteer atmosphere for the first couple days of this thread.  I don't think going the way of no care instead of volunteer provided care to promote public outrage is the way to go.  

If it is all about patient care, how many lives are okay to promote the paid ambulance personnel and the desire of the public to fund it?  If I am misunderstanding your post, then please correct me.  

A good politician or group, I don't think, would put his constituents in that situation to gain support for paid ambulance.  But, maybe I live in a dream world, unions and lobbying can be powerful tools.


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## emtjack02 (Aug 29, 2009)

No sarcasm...
So we(the ALS provider) that volunteer should all get together and say we are no longer going to take time and force them to either down grade to BLS or close?  
The ideas about Basics not being on an ambulance is nice... 
Would you view a basic rig that gets a paramedic fly car (and assessment) as satisfactory?


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## Ridryder911 (Aug 29, 2009)

emtjack02 said:


> No sarcasm...
> So we(the ALS provider) that volunteer should all get together and say we are no longer going to take time and force them to either down grade to BLS or close?
> The ideas about Basics not being on an ambulance is nice...
> Would you view a basic rig that gets a paramedic fly car (and assessment) as satisfactory?



In some systems a Paramedic fly car make better sense but in reality it is as cheap to place the Paramedic in a EMS transport unit. I have no problem of being downgraded upon certain calls where it is obvious a minor situation, but I have read posts where states allows the basic to determine CVA'a, chest pain and shortness of breath; which all concerns me. Again, I am not naive or ignorant that I do recognize, there are remote areas that will have to depend upon what they have on hand but that number should be limited. 

I have reviewed the new standards and the EMT level will have require more knowledge than previously. I am uncertain exactly upon how much clinical assessment will be required. Maybe with the increase of education more responsibility could be placed upon them to be able to make better triage decisions. 

Again, as a first response and initial care nothing could be better but should be followed up as much possible by Paramedic assessment to ensure accuracy. 

Don't worry, I am just as mad about Paramedics programs that are producing lousy and inadequate providers. Hopefully, once we have better uniformed guidelines and most states will have to follow them; possibly we can see a change. 

R/r911


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## PapaBear434 (Aug 29, 2009)

Ridryder911 said:


> Yeah, thought so.
> 
> R/r 911



Much like the above poster I responded to, your smugness in this matter doesn't help anyone.  We get it, you think you are above all this.  

Experienced, yes.  Educated, yes.  But you negate your entire point by coming off like an insufferable jerk because no one wants to listen to you besides those who are already inclined to agree.


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## akflightmedic (Aug 29, 2009)

Ridryder911 said:


> Basic level is just that. Utilize them as they are designed to do for first response and to as
> So what would your opinion be if we were to eliminate the journeyman or master requirements and have a simple few week elcetrician course and those individuals that passed could wire homes & business for free? Why not? Place them in small ommunities that need homes re-wired, shelters, schools, churches, etc All of those that are on tight budget and look at all that could benefit from it. I mean really, if electricians really wanted to help the community they would take a cut or offer their services free all the time to those areas not all projects really need an electrician..... right?
> 
> Yeah, thought so.
> ...



Sure seems smug when you eliminate what the quoted text was referring to...since I have now included it, can you dispute it? It is a very relevant comparison and if it were done like he proposed, everyone would be up in arms about it.

Imagine if electricians were only required 120 hours of education and they could go straight to work...what would happen? People's lives are in their hands, literally. We would have people getting electrocuted in their showers, in their kitchens when flipping a switch, it would be insane. 

What if they did it for free as Rid mentioned?

No homeowner, renter, business, or insurance company would tolerate it..period!

So why do we?


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## Ridryder911 (Aug 29, 2009)

PapaBear434 said:


> Much like the above poster I responded to, your smugness in this matter doesn't help anyone.  We get it, you think you are above all this.
> 
> Experienced, yes.  Educated, yes.  But you negate your entire point by coming off like an insufferable jerk because no one wants to listen to you besides those who are already inclined to agree.



We have sugar coated and disguised the truth for over 40+ years. Has that method worked? No. 

If you think my smugness is awful, apperantly you have little to no medical experience as most of those in medicine take their career and delivering patient care very damned seriously. Wait until a seasoned EMS veteran or physician proceeds to deliver their opinion; my attitude here is very tame. I guess I could drop the candor and just simply explain, do it right or get the hell out of my profession. Who do you really think you are disguising yourself as a medical provider? But my sole attempt was to let the poster see in comparison that their profession had standards in place to ensure safety and as well allow financial compensation for acquiring the needed training and experience and mainly responsibility of their work. No difference in emphasis than in EMS. Something unfortunately you were not able to get the point.  

At first I too was the nicey and sweet caring poster and guess what it did not work. I have found EMT's have to be awakened and shaken to be made to think. Unfortunately, all through their training they have been groomed to be like sheep as followers and never to have to defend their actions or ideas. Going outside the safe box of the 150 hour level night course was never thought of. Every action, treatment and intervention should be defended by means for scrutiny. If you can't defend it; chances are you do not know the why's and how's of your actions. 

Now, have you ever consider why most national and high level EMS professionals do not post on EMS forums? I can tell you, many consider the majority of those that post are idiots or ignorant of the profession or system. Other than Dr. Bledsoe that periodically peeks in other forums, rarely is another true national EMS leader seen or heard from. Why do you think that we don't see State EMS Directors &  popular EMS authors and so forth. Especially since hot topics as "what boots is the best" or "how dare you down grade my 150 hour course" when that person in power probably has multiple degrees and decades of experience. In fact most would find humorous if it was not real.  

Seriously, do you think a person that is attempting to design national or state level EMS programs, systems and criteria would ever try to defend their actions with a person that has the highest level of EMS education is a 120 hour course and maybe performed one clinical? Then they would have to defend their action(s) to this person? Really how absurd. 

I know I get asked routinely of why do I waste my time on any EMS forum. Truthfully, to educate and because I have seen people explorer their profession. With others that have credentials and professional experience that routinely post I have seen a change in the mind set. In less than three to four years ago, majority that posted here was anti-education and primary volunteers. Medical discussion and topics was rarely posted. One of the other factors that I have enjoyed is along the way I have made many friends and still receive many daily IM's on career pathways and other related discussions. 

So if I offended you, so what? It's just a forum, if I made you think..... just a little and to be able to defend your thoughts... then it was worth it. 

R/r 911


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## PapaBear434 (Aug 29, 2009)

Ridryder911 said:


> Bunch of arrogant, self righteous, self important ranting.
> R/r 911



Look, dude, all I was doing was calling for civility.  Just like I did at the beginning of this thread.  I knew where this was going to lead, and the usual cast of characters that I mentioned most definitely included you.  It was just a matter of time before you let your ego flag fly.

I know you consider yourself one of the nations foremost experts in the field, but everyone is entitled to an opinion.  I respect yours, as a long time provider and having a high level of education.  But your "impact" is greatly diminished when you end over half your posts with a dismissive "Yeah, I thought so" or similar valley girl-esque comment.  

All I am saying is that there are ways to get your point across without letting your obvious arrogance run wild.

Myself, I have no real horse in this race.  I plan on being a paid nurse/medic in the near future, but for now my education is being paid for via a volunteer system.  I'm riding the fence here.  But seeing the vast amount of opinionated and self righteous idiocy on either side... It's just doing our profession more harm than good.

Just keep it civil, Rid.  I know I have no power here, that my pleas will fall upon deaf ears should you choose to disregard my statements here and that the mods will likely side on your behalf anyway.  But I ask you, as one EMS provider (whether you like it or not) to another, keep the level of maturity up a bit.


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## mycrofft (Aug 29, 2009)

*I won't post about this in this thread again, so this is long....heh heh*


First off, you cannot, *cannot*, equate "EMS" in Emerald Nebraska with "EMS" in Miami, or even Omaha. 

Ultimately why don't we have paid and fully supported paramedics (heck, _why not MD's_?) standing by every quarter mile with engines running waiting to zoom out and perform definitive treatment on the scene?

Money. Can't afford it.

So let the marketplace decide? What do you think has caused so many of the little local hospitals (including base hospitals on CONUS military installations), and inner-city hospitals of any size, to fold up or stop inpatient care? What has led to the conglomeration of small ambulance companies into a few big ones leaving lots of underseved areas with long response times and low care levels? These places often offered services which were vital, but no one could keep them going in the economic and political climates.

Without volunteers many rural areas would be served worse than they are, maybe not at all. Trouble is that there are both a financial "critical mass", and a "horizon event" effect at work; you can't get it going at all without a certain concentration of will, money, people and expertise, and you can't keep it going if you fall below a level of these ingredients which happens to be much higher than the "critical mass".

Government "EMS Departments" (like many positions on school boards) are often sinecures for politically-minded firefighters, paramedics and minor politicians;they are usually  underfunded, and concentrate (when they do anything) upon "setting standards" and playing "gotcha" with EMS services they aren't buddies with. They ought to be working to get money then fund and upgrade EMS where it is needed most, not a blanket approach, and that includes another push (like the one which created "EMT" 's) for the organization and medical control of volunteer services, and the creation of profesionally *paid* positions where possible and necessary.

"Paid" does not equal "professional" and vice versa. The large numbers of people willing to do EMS for little or no money hurts those who want to make a career out of it below the management level, and it makes it more difficult to bring quality to the table. It supports certificate mills. But without them, and the other "little guys", many areas will not be served at all.

1. START WITH THE KIDS: motivate them and teach them first aid. Give them role models. Use them municipally through CERT, Red Cross or "Flying Fig Newton Club" or whatever, but get them involved early and spot out the talented ones. 
2. Make first aid and basic public health/safety part of education throughout the educational carerer, and part of certification for appropriate professions like teaching, barbering, pest eradication, scout-mastering or troop-leading, etc etc. Flood the country with first-aiders, or at least people with some indoctrination.
3. Use tax clout and government certification to spread it. You want to do ambulance in Chicago and Los Angles? Then you have to do ambulance in underserved areas as well. You can't afford medical school? Get a paid ride through your prereqs and a paramedic license (not certificate) at the govenment's nickle but you will, WILL, work and learn in a clinic or EMS on a reservation, in a military setting, or a County clinic during part or most of your sumnmer break. You want to be a volunteer paramedic or EMT? Get your license, either after attending an accredited certificate class or getting a degree.
Oh, and stop with making up a zillion different types of "emergency responders" because it lets you make more money or it's convenient. Go back, go back....EMT-A means "ambulance", EMT-P means "paramedic", no more "EMT-I-Wanna-Do-Airways-Only" horseapples.

Rant over.:blush:


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## PapaBear434 (Aug 29, 2009)

akflightmedic said:


> Sure seems smug when you eliminate what the quoted text was referring to...since I have now included it, can you dispute it? It is a very relevant comparison and if it were done like he proposed, everyone would be up in arms about it.
> 
> Imagine if electricians were only required 120 hours of education and they could go straight to work...what would happen? People's lives are in their hands, literally. We would have people getting electrocuted in their showers, in their kitchens when flipping a switch, it would be insane.
> 
> ...



As much as paramedics hate to admit it, though, most EMS calls don't really require their expertise.  Your general "accident with minor injuries" doesn't really need a medic unless someone is having trouble breathing or has a decent head wound.  But for your average busted arm, slip and fall in a supermarket, abdominal pain from constipation...  Yeah, the person will be fine until a Basic gets them to the ER.  Meanwhile, the Basic is acting as a pre-hospital triage, getting a base set of vitals, gathering information about allergies, medications, past history, demographic info...  All that stuff that the hospital is going to need anyway.

Basics, when used properly, aren't going to kill anyone.  As Rid pointed out, they are little more than basic first aid.  In cases that require that, you're fine.  It's when they are being used for more than that, like being the only unit dispatched to a difficulty breathing call, that the problems arise.


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## PapaBear434 (Aug 29, 2009)

mycrofft said:


> "Flying Fig Newton Club"



Just so you know, I have interest in this club and expect to receive a pamphlet or a newsletter at some point.


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## mycrofft (Aug 29, 2009)

*Papabear, you haven't like LICENSED the name yet....?*

....I hope....:blush:


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## akflightmedic (Aug 29, 2009)

PapaBear434 said:


> As much as paramedics hate to admit it, though, most EMS calls don't really require their expertise.  Your general "accident with minor injuries" doesn't really need a medic unless someone is having trouble breathing or has a decent head wound.  But for your average busted arm, slip and fall in a supermarket, abdominal pain from constipation...  Yeah, the person will be fine until a Basic gets them to the ER.  Meanwhile, the Basic is acting as a pre-hospital triage, getting a base set of vitals, gathering information about allergies, medications, past history, demographic info...  All that stuff that the hospital is going to need anyway.
> 
> Basics, when used properly, aren't going to kill anyone.  As Rid pointed out, they are little more than basic first aid.  In cases that require that, you're fine.  It's when they are being used for more than that, like being the only unit dispatched to a difficulty breathing call, that the problems arise.



I usually stay out of these threads cause it is the same year after year and Rid has a bit more patience than I do.

Having said that, I disagree with your opening statement. All medics I have known including myself know that the majority of the calls do indeed result in BLS level of care. Having said that, do you think it is NOT in the patient's best interest to let a medic determine that first with an ALS assessment? We do it backwards...a medic should see them first and then downgrade if necessary, not the other way around. You can not compare this to a hospital setting either and tell me how a nurse sees the patient before the doctor, because in that setting, the doc is right there and the nurse is an educated professional...so no relevance to this discussion.

EMS is its own entity and can not be compared to those standards, we have to set our own precedence. Now will you still disagree with my position, do you think the patient should see a basic first then medic, or a medic then downgrade to a basic?

Regardless, I do not mind BLS calls because I am here to provide patient care. My skill set and knowledge is NOT divided into BLS or ALS, all I know is patient care. I perform whatever intervention is needed, be it from a soothing voice and calm atmosphere to intubating and providing pain relief. My "expertise" which you stated is not needed the majority of times shows either the lack of knowledge (ignorance) on your part or an overly inflated ego.

I am here for the patient, not hobbyists, not do gooders feeling good about themselves, but the patient and their needs. I think one of the most overlooked "skills" that a paramedic performs is PAIN RELIEF or CONTROL. Many, many "BLS calls" would benefit from some sort of pain relief, yet because this is not in the knowledge or skill set of a basic provider, they neglect to call for intercept and opt to transport the patient for whatever distance because they got that splint on and distal pulses are present.

Average busted arm : Pain relief
Average slip and fall: Pain relief or opt to utilize selective spinal immobilization protocol...also rule out or recognize underlying medical conditions that may have contributed to a slip and fall/just cause they are by a Wet Floor sign does not mean that is why they fell
Abdominal pain from constipation: how do you know it is constipation..regardless, yet again PAIN relief, ALS assessment for underlying conditions since Abdomens have about 1000 differentials

Do you see the recurring pattern? If you were the patient, would you not want an ALS assessment first and then a downgrade? Wouldn't you want pain control during that 10-20 minute ride to the ER?

Of course you would!! But this would be because you know higher level of care exists or pain relief could be available. The general public is ignorant of these facts. They see an ambulance and assume paramedics are on board. If something is not done, they are unaware it was available. This is where we step in...we take the initiative and go a step beyond. We do not want the patient to have to request or demand better care, we should provide it because we are professionals whose sole aim is to give every patient the best care possible from the start.


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## medichopeful (Aug 29, 2009)

Sparky79 said:


> I'll be honest, if the education requirements were a lot tougher I would probably not do this. I'm not a volunteer, we're paid oncall, but the money I make doing ambulance calls would definitely not convince me to make a whole lot more of an investment in education to continue. I have enough to do to maintain my electrical licenses both in license renewal fees and continuing education requirements (both of which are much more intensive than that required to maintain my EMT cert.).



I see a MAJOR problem with this statement.  It seems as if you're saying that you want to just get by with the least amount of education possible.  Is this correct?

You state that one of the reasons you want to do this is because of the money issue.  It seems (I could have read it wrong) that you want to put your other job in front of EMS.  Am I right?  If this is the case, drop EMS entirely.

I mean, seriously THINK about what you just said.  You said you don't want to spend money on EMS, because you are already spending it on your regular job.  You need to make a change.  Either A.: drop EMS and spend your time on your electrical job; or B.: drop your electrical job and do a job where lives are at stake correctly.  Get education in the field.  Don't do EMS as a hobby, without dedicating yourself to advancing your education on it.  That's not fair to the people you come into contact with.


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## medichopeful (Aug 29, 2009)

Disregard.


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## PapaBear434 (Aug 29, 2009)

Well, *AKflightmedic*, you have to judge it by what the patient says.  If they are speaking fine, don't seem out of sorts, and just said that they fell and need some help getting up, why should you send a medic for it when there is something far more important going on somewhere else in town?  If they say that they've had constipation for the last three days, why worry about rushing a medic over there?

Not saying that I'd be opposed to medics being on every truck, or even having everyone required to be medics.  But until you convince the local governments around the nation to pay for it, we have to deal with what we've got.



> Regardless, I do not mind BLS calls because I am here to provide patient care. My skill set and knowledge is NOT divided into BLS or ALS, all I know is patient care. I perform whatever intervention is needed, be it from a soothing voice and calm atmosphere to intubating and providing pain relief. My "expertise" which you stated is not needed the majority of times shows either the lack of knowledge (ignorance) on your part or an overly inflated ego.



Treading dangerously close to arrogance yourself.  When I was a Basic, I knew my place as a provider that did a base minimum:  Transport, low level intervention, information gathering and assisting medics in treatment.  Now, I am going through Intermediate qualifications, and I strangely have yet to act like a lot of ALS providers and go all "paragod" on the basics.  I am not offended by their being there, as you seem to be.



> Average busted arm : Pain relief
> Average slip and fall: Pain relief or opt to utilize selective spinal immobilization protocol...also rule out or recognize underlying medical conditions that may have contributed to a slip and fall/just cause they are by a Wet Floor sign does not mean that is why they fell
> Abdominal pain from constipation: how do you know it is constipation..regardless, yet again PAIN relief, ALS assessment for underlying conditions since Abdomens have about 1000 differentials



I guess this depends on your protocols, because we don't give pain relief meds to anyone for anything short of a severed limb.  The hospitals would have a fit if we gave pain meds for a broken arm or a bruised butt from a fall.  Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted.  That's a pretty basic skill.

Far as the abdomen pain goes... Well, if they haven't pooped in four days, it's pretty safe to say it's constipation.  Now, basics can't tell WHY they are constipated.  It may be a side effect of narcotics, it might be an impaction.  Guess what, medics are rarely able to tell either, since we don't do ultrasounds or other diagnostic procedures.   Even if we do know what it is, such as the narc SE or such, we are limited in what we can do for it. We certainly are not going to provide a laxative or an enema on scene.  Besides, if they have been hurting for four days, they are not likely to keel over today in the course of a fifteen minute ride to the ED.

Now, I'm going to exit this thread, because it's getting away from "all paid vs. volunteer" and moving quickly toward "Medics or nothing, the rest of you are worthless."  That, and I have already disregarded my own advice about staying the heck out of it from the beginning because this is exactly where I said it would lead.  Just please, keep the egos out of it.


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## medichopeful (Aug 29, 2009)

PapaBear434 said:


> As much as paramedics hate to admit it, though, most EMS calls don't really require their expertise.  Your general "accident with minor injuries" doesn't really need a medic unless someone is having trouble breathing or has a decent head wound.  But for your average busted arm, slip and fall in a supermarket, abdominal pain from constipation...  Yeah, the person will be fine until a Basic gets them to the ER.  Meanwhile, the Basic is acting as a pre-hospital triage, getting a base set of vitals, gathering information about allergies, medications, past history, demographic info...  All that stuff that the hospital is going to need anyway.



I'm not in the field (yet), but I know that many times calls come in to 911 that don't really relay what is happening at the scene.  A MVC with minor injuries could be much worse.  Injuries can also worsen.  What presents as one thing can degrade into another.  Why put somebody who was just in a traumatic accident or has an illness with a caretaker who doesn't really have the training to save their life if something goes horribly wrong?

And how can you know if something is because of something else with 100% certainty while out in the field?  It might just be constipation, but it might be something worse as well.  Though a paramedic can't diagnose with certainty in the field that it's one thing, they will be much better prepared than an EMT Basic if it isn't what they thought and something goes wrong.

A person will not always be fine until they get to the hospital.  There is such a thing as asymptomatic and other conditions.

Why not let the basic get the information, like you suggested, while the paramedic provides the care?  Unless it's a minor issue; then let the basic provide the care with the paramedic supervising and ready to take over.  

If EMS does what you suggest (let the basic just take vitals, etc.), it sounds more like a taxi service than a medical service.


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## EMTinNEPA (Aug 29, 2009)

PapaBear434 said:


> Look, dude, all I was doing was calling for civility.  Just like I did at the beginning of this thread.  I knew where this was going to lead, and the usual cast of characters that I mentioned most definitely included you.  It was just a matter of time before you let your ego flag fly.
> 
> I know you consider yourself one of the nations foremost experts in the field, but everyone is entitled to an opinion.  I respect yours, as a long time provider and having a high level of education.  But your "impact" is greatly diminished when you end over half your posts with a dismissive "Yeah, I thought so" or similar valley girl-esque comment.
> 
> ...



Look, _dude_...

I see no lack of civility.  Sometimes the truth hurts.  I used to think Rid was a self-important ego maniac.  Then I stopped deluding myself into believing that volunteer EMTs were doing the profession a favor.

You want to be a nurse?  Get out of my profession.

You may want every EMS provider the world over, vollie, paid, fire-based, etc., to hold hands and sing a rousing chorus of "We Are The World", but others want to make progress.  Others want to advance the profession to its full potential, make every EMS provider a skilled, knowledgeable, educated patient care professional.  And providing EMS for free with minimal educational requirements is *NOT* the way to do it.  You may think by doing it for free and not billing what your services are worth that you are doing your patients justice, but you aren't.  How can you be a true patient advocate by not being all you can be?


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## medic417 (Aug 29, 2009)

PapaBear434 said:


> I guess this depends on your protocols, because we don't give pain relief meds to anyone for anything short of a severed limb.  The hospitals would have a fit if we gave pain meds for a broken arm or a bruised butt from a fall.  Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted.  That's a pretty basic skill.



Wow your service needs to get out of the dark ages.  It is never right to allow a patient to suffer.  If your hospital complains must be because someone in your service screwed up royally multiple times probably.  

If the above is how your area does volly they really need to quit.  Even volly organizations must do it right by the patients and allowing suffering is unethical. 

And no basics are not qualified to use selective spinal immobilization.


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## medichopeful (Aug 29, 2009)

PapaBear434 said:


> Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted.  That's a pretty basic skill.



I don't really know about this.  Should somebody with so little education really be ruling things out?  I mean, things that are not hugely obvious?


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## medichopeful (Aug 29, 2009)

EMTinNEPA said:


> I used to think Rid was a self-important ego maniac.



Actually, he is.  But at least he has some good points.

 I kidd (about the ego part)

I was actually the same way.  Now I have begun to learn a lot from him and others.


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## akflightmedic (Aug 29, 2009)

Just give it time mate...I have watched many over the years come to the "dark side" after advancing their education and actually doing this as a profession. The attitudes and thought processes change and we witness a shift for the good.

One at a time, unfortunately it takes the same thing being said over and over, year after year.

I can not wait to speak to Mapabear (misspelling intentional since he didn't take the time to get my name right after bolding it)after he becomes a nurse and medic and works for a year or two.

**Edit: Papabear, since he is still reading and went back and corrected my name.***

It is hard to convince them it is not about ego, I have been doing this long enough to know an ego is not a good thing. As a 19 year old paramedic, yes I had ego at the time, but I was also scared to death because I realized how important me knowing my stuff had just become.

As I now enter my 15th year of paid EMS as a paramedic, I can say beyond a shadow of a doubt it is all about the patient. Hurting others feelings or taking away their hobbies is of little concern to me, especially if it is me or my family on the receiving end. I want dedicated professionals not weekend hobbyists.

It is with this desire in mind that people like myself and Rid continuously support higher education and push for more stringent standards. We know it will not happen over night, we know there are funding issues, but we will continue to push.


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## EMTinNEPA (Aug 29, 2009)

PapaBear434 said:


> I guess this depends on your protocols, because we don't give pain relief meds to anyone for anything short of a severed limb.  The hospitals would have a fit if we gave pain meds for a broken arm or a bruised butt from a fall.  Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted.  That's a pretty basic skill.



Uh oh... so you follow protocols to the letter?  No critical thought of your own?

Around here, we give pain relief for fractures all the time.  Our command physicians actually trust us!  And they also realize that we aren't doing right by our patients by allowing them to remain in pain.  As medic417 said, time to come out of the Dark Ages!  It's time to stop being a taxi ride and start being medical professionals!

And basics are NOT qualified for selective spinal immobilization.  They just don't have enough anatomy under their belt to notice not-so-obvious injuries or perform a neurological exam beyond "A&Ox3".  The few that are have educated themselves through study or were taught by a medic.  You think just because spinal immobilization is considered a "BLS" skill that a BLS provider is more qualified in it than an ALS provider?  Next time a medic tells you to board somebody, tell them no and claim to be more qualified.  See how far THAT gets you.


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## scottyb (Aug 29, 2009)

If I decide not to board somebody (Which I am allowed to do per NYS DOH) based on my findings during my size up (MOI), assessment, and what the patient tells me based on strict guidelines and a higher certified person, EMT-P, CC, P tells me to board any way.  Do you think I wouldn't?  Of course I would, they are more qualified than me and have the ability to make that call above me.  But, they would also be explaining to me why they directed it, not because I want to question them, but because I want to learn.


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## PapaBear434 (Aug 29, 2009)

Ok, one last post, since I have raised so much ire.  Feel like I owe you guys a response.



> Actually, he is.  But at least he has some good points.
> 
> I kidd (about the ego part)
> 
> I was actually the same way.  Now I have begun to learn a lot from him and others.



You have no education, nor practical experience by your own admission.  I don't see as you have much of a perspective on this.  I will warn you right now, though, if you keep this attitude you have before you have ANY training, you are going to be the guy that everyone talks about behind your back as the "paragod."  Your patient care will suffer, because you will be so sure of yourself you won't consider anything anyone else has to say.  



> Wow your service needs to get out of the dark ages. It is never right to allow a patient to suffer. If your hospital complains must be because someone in your service screwed up royally multiple times probably.



We are never more than fifteen minutes with no l/s from a hospital.  I have only given pain meds once, when a guy had a crush injury to his right hand.  We (the medic I was riding with) administered a nerve block.  

It's one of those things that we'd rather get them to the ED than take the extra time in the field to give them pain meds that will take just as long to take effect as they do to transport.



> If the above is how your area does volly they really need to quit. Even volly organizations must do it right by the patients and allowing suffering is unethical.



Nothing unethical.  Just practicality.  I would understand if it was a huge area where it was half and hour or more ride to the ED.  But if it's something that extreme, I think the patient is better served with a five minute ride to the ED.



> I don't really know about this. Should somebody with so little education really be ruling things out? I mean, things that are not hugely obvious?



Take C-Spine control > Ask > "Does your neck hurt?  How about your head?  How does your back feel?"

If the answer to all of these is no, examine patient.  Observe no step up/down, bruising, odd shapes or deformities.

Ask the patient if they lost consciousness.  Answer is no.  Ask a witness if any of this stuff happened.  Answer is no.  

Did the patient fall from a significant height, or just off a chair?  Is the patient an elderly person, or a healthy teenager who tripped off a step going into the school?

A lot of factors, I'll grant you.  But a reasonable person can rule this out with basic training. 



> I see no lack of civility. Sometimes the truth hurts. I used to think Rid was a self-important ego maniac. Then I stopped deluding myself into believing that volunteer EMTs were doing the profession a favor.
> 
> *You want to be a nurse? Get out of my profession.*



You may want to look at Rid's education list again.  Being a trauma nurse can only help be a better EMS provider.  After all, aren't you all clamoring for higher education?  RN's have higher educational standards than medics, do they not?  I plan on being a paramedic, but being an RN opens my occupational opportunities a bit more.



> You may want every EMS provider the world over, vollie, paid, fire-based, etc., to hold hands and sing a rousing chorus of "We Are The World", but others want to make progress. Others want to advance the profession to its full potential, make every EMS provider a skilled, knowledgeable, educated patient care professional. And providing EMS for free with minimal educational requirements is NOT the way to do it. You may think by doing it for free and not billing what your services are worth that you are doing your patients justice, but you aren't. How can you be a true patient advocate by not being all you can be?



You see me as idealistic, that's fine.  But I also think that your "All Paid All the Way" as a bit of an idealistic goal too.  An admirable one, one that I partially share.  But again, until you are able to convince the majority of local governments country wide to switch, you have to work with what you've got.  Yes, having all volunteers stop service immediately might convince them after enough people go without care, but you are also sacrificing how many people going without care to achieve that goal.

As most volunteers get into the gig to help folks, they probably would not be willing to do that.  Again, I ride the fence in this regard.  I got into EMS because I wanted to help folks, but I do the volunteer thing out of the fact that they provide me a resume bullet point and a paid for education. 



> If EMS does what you suggest (let the basic just take vitals, etc.), it sounds more like a taxi service than a medical service.



Welcome to EMS, friend.  Whether you are a medic, basic, or just some scrub on a truck, this is what you are going to feel like the majority of the time.


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## akflightmedic (Aug 29, 2009)

scottyb said:


> If I decide not to board somebody (Which I am allowed to do per NYS DOH) based on my findings during my size up (MOI), assessment, and what the patient tells me based on strict guidelines and a higher certified person, EMT-P, CC, P tells me to board any way.  Do you think I wouldn't?  Of course I would, they are more qualified than me and have the ability to make that call above me.  But, they would also be explaining to me why they directed it, not because I want to question them, but because I want to learn.



I appreciate your response and I have this to say:

You have done what many others have done in similar debates concerning these issues. You/they tend to bring the argument home...meaning they personalize, they compare it to their own bubble and personal experiences which is very limited in most cases.

When you step back and evaluate the system as a whole, you will realize why changes need to take place because although you may have a stellar group of exceptional people who go above and beyond regardless of their level, we have to apply the argument/facts to the entire group.

When examined from that perspective, your eyes will be opened and you will realize why this argument exists and why it needs to be rectified.


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## Ridryder911 (Aug 29, 2009)

PapaBear434 said:


> But untilTreading dangerously close to arrogance yourself.  When I was a Basic, I knew my place as a provider that did a base minimum:  Transport, low level intervention, information gathering and assisting medics in treatment.  Now, I am going through Intermediate qualifications, and I strangely have yet to act like a lot of ALS providers and go all "paragod" on the basics.  I am not offended by their being there, as you seem to be.



If you are not an Intermediate yet, you still are a Basic Level sorry but you are not advanced yet. 



PapaBear434 said:


> I guess this depends on your protocols, because we don't give pain relief meds to anyone for anything short of a severed limb.  The hospitals would have a fit if we gave pain meds for a broken arm or a bruised butt from a fall.  Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted.  That's a pretty basic skill.
> 
> Far as the abdomen pain goes... Well, if they haven't pooped in four days, it's pretty safe to say it's constipation.  Now, basics can't tell WHY they are constipated.  It may be a side effect of narcotics, it might be an impaction.  Guess what, medics are rarely able to tell either, since we don't do ultrasounds or other diagnostic procedures.   Even if we do know what it is, such as the narc SE or such, we are limited in what we can do for it. We certainly are not going to provide a laxative or an enema on scene.  Besides, if they have been hurting for four days, they are not likely to keel over today in the course of a fifteen minute ride to the ED.



Well, I don't know what country or era your hospital & medical community works upon but pain control as in National Standards have been a high priority for about a decade, albeit being in the prehospital or in hospital phase. JCAHO has been closely monitoring patient pain level and control for about 15 years. 

You should had stopped while you were ahead. Describing patients and describing  "not likely to keel over" is a great illustration of the type of ignorance we are describing and attempting to emphasize. The infarcted bowel resulting by being fecal impacted or sepsis by an bowel obstruction; that itself does have a high mortality even though they may appear to be initally stable. Again, lack of education and medicine is why it is essential to have the highest level to describe stability or not. 

As you describe that your hospitals would have a "fit" in regards to analgesics; I wonder if it is because of the providers that would be performing this in lieu of the procedure or treatment modality itself. Something to consider and explorer. 



PapaBear434 said:


> Now, I'm going to exit this thread, because it's getting away from "all paid vs. volunteer" and aiming quickly toward "Medics or nothing, the rest of you are worthless."  That, and I have already disregarded my own advice about staying the heck out of it from the beginning because this is exactly where I said it would lead.  Just please, keep the egos out of it.



Anytime logic and reason with the discussion of being able to defend one's position; many people will bow out and take the "ego" route. Again; justify of not just your position but again how it would relate to be in the best position for the patient and the EMS System. That it is not called ego; rather it is called formal discussion. 

R/r 911


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## PapaBear434 (Aug 29, 2009)

akflightmedic said:


> **Edit: Papabear, since he is still reading and went back and corrected my name.***



I corrected my post approximately three seconds after posting and noticing that I screwed up your name.  No disrespect was meant, so I corrected it.  I didn't even see your... attempt... at an insult with "MaBear".  

Calm yourself, I'm not going to lower myself into the dregs with you.


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## akflightmedic (Aug 29, 2009)

PapaBear434 said:


> We are never more than fifteen minutes with no l/s from a hospital.  I have only given pain meds once, when a guy had a crush injury to his right hand.  We (the medic I was riding with) administered a nerve block.
> 
> It's one of those things that we'd rather get them to the ED than take the extra time in the field to give them pain meds that will take just as long to take effect as they do to transport.



Mate, this comment alone displays your lack of understanding in regards to pain control.

Extra time in the field?? In less than 5 minutes, an IV can be placed and fetanyl or morphine administered. In our system, we utilize nasal fetanyl, so that is really fast.

However, the comment about how it would not even take effect before you got them there is inaccurate. In short, you are wrong.

Also think of the continuum of care, total patient care. By this I mean put yourself in the patient's shoes.

Injury occurs
Delay to call 911 2-10 minutes depending on situation
Ambulance arrives 6-12 minutes later.
Assessment performed 3-5 minutes
Load in ambulance Few minutes
Transport  15 minutes
Hand over pt care  2-5 minutes
Pt reassessed  few minutes
Doc orders  few minutes
IV placed few minutes
Pain meds given few minutes
Pt relief ****Possibly up to an hour post injury***

Do you see where you could have made a difference?


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## PapaBear434 (Aug 29, 2009)

EMTinNEPA said:


> Uh oh... so you follow protocols to the letter?  No critical thought of your own?
> 
> Around here, we give pain relief for fractures all the time.  Our command physicians actually trust us!  And they also realize that we aren't doing right by our patients by allowing them to remain in pain.  As medic417 said, time to come out of the Dark Ages!  It's time to stop being a taxi ride and start being medical professionals!
> 
> And basics are NOT qualified for selective spinal immobilization.  They just don't have enough anatomy under their belt to notice not-so-obvious injuries or perform a neurological exam beyond "A&Ox3".  The few that are have educated themselves through study or were taught by a medic.  You think just because spinal immobilization is considered a "BLS" skill that a BLS provider is more qualified in it than an ALS provider?  Next time a medic tells you to board somebody, tell them no and claim to be more qualified.  See how far THAT gets you.



Of course there is critical thought.  But since I am not a fan of loosing my certifications before I even get all the way to medic, I don't disregard protocols.  

Figure that I should probably at least be a qualified medic before I try to fight "the man" and change the rules.  

Oh, and I never said that basics (which I am NOT, mind you) were more qualified.  I said that they were qualified to rule on it.  If a medic says otherwise, well, the medics are the ones running the call and get the final say.  

Now...

You know what, never mind.  Nothing I say is going to make this civil.  You guys have your opinions, right or wrong, and the false feelings of self importance to back it up I guess.  

You guys (yes, I see that Rid has posted to me again, I have yet to read it, but I am sure it's positively SCATHING) are holding back the profession just as much as any volunteer.  You are just too busy screaming at the trees to see that the forest is being cut down around you.

The metaphor broke down a little at the end there, but you get what I'm saying.

Enjoy your little ego stroking session, guys.  Both sides of this debate are getting plenty of it.


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## medichopeful (Aug 29, 2009)

PapaBear434 said:


> You have no education, nor practical experience by your own admission.  I don't see as you have much of a perspective on this.  I will warn you right now, though, if you keep this attitude you have before you have ANY training, you are going to be the guy that everyone talks about behind your back as the "paragod."  Your patient care will suffer, because you will be so sure of yourself you won't consider anything anyone else has to say.



So I am going to be a cocky "paragod" because I stated any opinion that said that people who don't have a lot of training should not be put into a position where lives are at stake?  Could you explain why I will be a paragod a little better, please?  Because I clearly don't have the education to be able to see at your level.


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## Ridryder911 (Aug 29, 2009)

PapaBear434 said:


> Of course there is critical thought.  But since I am not a fan of loosing my certifications before I even get all the way to medic, I don't disregard protocols.
> 
> Figure that I should probably at least be a qualified medic before I try to fight "the man" and change the rules.
> 
> ...



I ask then for clarification. If you are not a Basic and not an Intermediate or Paramedic then upon what national level would you be? 

Second, the forest is growing. The trees are being rattled and the leaves are falling down.... I was in a two hour meeting yesterday in regards to national pilot study programs that will be introduced. Something I and many those within professional EMS will be pleased with. I am not at liberty to discuss at this time but I can assure you things are changing and dramatically so. This will be from the National level down; yes states will have the option to opt out (if they want to refuse Federal funding; like that will happen). 

Again, ego's hmmm.. _"but I do the volunteer thing out of the fact that they provide me a resume bullet point and a paid for education".... _" You are supporting a side because they are padding your resume and benefits that is not considered self ego? 

You are correct, probably will not convince you until you have finished formal education and have more clinical experience. Come back in five years after practicing in patient care as an advanced level and then let's compare notes. 

R/r 911


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## EMTinNEPA (Aug 29, 2009)

PapaBear434 said:


> We are never more than fifteen minutes with no l/s from a hospital.  I have only given pain meds once, when a guy had a crush injury to his right hand.  We (the medic I was riding with) administered a nerve block.
> 
> It's one of those things that we'd rather get them to the ED than take the extra time in the field to give them pain meds that will take just as long to take effect as they do to transport.



So fifteen minutes isn't enough time to administer pain meds?  Even if they don't take effect immediately, you're still saving time since the ED won't administer pain relief until they've done their own assessment.



PapaBear434 said:


> You may want to look at Rid's education list again.  Being a trauma nurse can only help be a better EMS provider.  After all, aren't you all clamoring for higher education?  RN's have higher educational standards than medics, do they not?  I plan on being a paramedic, but being an RN opens my occupational opportunities a bit more.



I'm clamoring for higher education for paramedics, not replacing paramedics.  If you want to be a paramedic and have more occupational opportunities, become a CCEMT-P.



PapaBear434 said:


> You see me as idealistic, that's fine.  But I also think that your "All Paid All the Way" as a bit of an idealistic goal too.  An admirable one, one that I partially share.  But again, until you are able to convince the majority of local governments country wide to switch, you have to work with what you've got.  Yes, having all volunteers stop service immediately might convince them after enough people go without care, but you are also sacrificing how many people going without care to achieve that goal.



Why do the governments need to fund it?  Bill for your services!  Even if you want to charge your patients less than warranted, there are plenty of ways to have paid staff.  Work out a deal with a local paid ALS service to staff a paramedic while you provide a paid or volunteer driver.  Have two paid EMTs from a private service staff your truck and let volunteers go on calls if they want.  These are just a few ways that vollie services in my area have gotten around the financial difficulties and still staffed their ambulances 24/7.  It is possible if you don't let tradition and weekend warriors who don't want to lose their favorite hobby get in the way.


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## PapaBear434 (Aug 29, 2009)

Ridryder911 said:


> I ask then for clarification. If you are not a Basic and not an Intermediate or Paramedic then upon what national level would you be?



I'll answer your questions.  Right now, I am about two semesters away from getting my degree in paramedic medicine, going to expand it to RN.  I am only certified in my system as EMT-Enhanced, a stupid middle-level between B and I in Virginia that allows for IV's, certain drugs (Narcan, Dextrose, breathing treatments under medic supervision, antihistamines, stuff like that) and intubation.  Anything more advanced like cardiac is the realm of a medic.  It's called "Shock/Trauma" in some places, if that helps.  It's one of those things I agree with you on, that we need a universal certification/license to practice qualifications and random letters in the mix is just confusing everyone.  But hey, it allows me to operate.  

That's when I am not running with my proctor, who is a twenty five year veteran and qualified flight medic.  Under his supervision, I do pretty much everything that an Intermediate or Medic does.  Over half my shifts are run with him, until I get my quals out of the way and am allowed to operate on my own.

Furthermore, I'm not going to deny a little selfishness on my part.  Yes, I love doing EMS, and it makes me feel good to do it.  Yes, I want to get compensated for it someday.  Hell, I'm being compensated for it now, via getting my schooling to medic (and as it turns out, most of the way to RN) paid for.  I'm not going to feel bad for that.  The fact that it also pads my resume isn't bad either.  Most places in a crowded field want experience.  So, yeah, I'm not going to shy away from marking this as experience just because it was an unpaid, volunteer gig.


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## Ridryder911 (Aug 29, 2009)

Don't blame you at all. Appears to be good for both you and the system at the time. Good luck in school and again, let's re-visit this discussion in about three years. 

R/r 911


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## Chimpie (Aug 29, 2009)

This topic, again, has gotten off topic.

Thread closed.


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