# EMS, a romantic notion.



## Veneficus (Oct 31, 2012)

I have again over the last few days noticed and interesting pattern in the types of posts being debated.

One of the often lamented aspects of EMS is the lack of professional, or for that matter, any respect in the healthcare community.

What I have noticed is that there seems to be a growing level of romanticism in EMS providers.

Riding in on the blazing steed to singlehandedly combat death and aid one's fellow man in time of need.

EMS joins volunteer fire with being the last bastion of modern society where minimally trained and medically uneducated people can fulfl some childhood dream of making a difference.

There seems no shortage of providers who would like or maybe need to believe EMS is something other than what it is. 

Afterall, where else can less than 200 hours get you a front seat ticket to be something more than another corperate cube organism, physical laborer, or fast food guru?

You can't even be a barber with such little training.

This "hero" perception is further perpetuated by elected leadership, who constantly laud "first responders" despite not being able to secure funding for adequete response or even to provide a standard level of care to most of the country.

I call attention to this because I see it as yet another step away from an EMS professional in the US. 

I don't know about you, but in my family, we have a few relatives who  are big in heart and short on brains.  

That is basically the mentality new EMS providers seem to be shifting to.

I will confess that when I started I thought I was going to save the world. At least everyone in it. 

But here is the rub. I was fortunate to be mentored by some very capable and professional people who took pride in what they really did. Not what they wanted to believe they were doing.

They tempered or rather preempted my enthusiasm by making it clear in order to be a part of their group, things like a light bar on the POV were unquestionably unacceptable.

They taught me safety as a proactive culture, to scrutinize everything I did to either be better, safer, or demonstrate my value.

But as more and more capable providers leave EMS, the only ones left and its new generation of leaders have no idea or want of these virtues. 

They believe their ignorance and passion is just as, if not more valuable than experience and education. They are vollies, weekend warriors, tinkerers, or in a more brutal term, hacks.

With no pretense of even understanding what they are doing, it now seems popular for them to label as out of touch or burnt out any who do not agree with their romantic notions. 

They cite personal feeling and N=1 experiences they cannot understand as obvious fact. 

It is almost the EMS equivalent of "teach the conflict" of intelligent design.

With both a population and culture shift away from the "hardcore" difficult to replace professional minded, I suggest that the possibilities of a professional US EMS provider is a lost future.

I think I must re-evaluate my efforts and value to advancing EMS.

Is there a solution to this disturbing trend?


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## NYMedic828 (Oct 31, 2012)

The answer to your question is no. There is no future
for the current model of EMS with 9/10 newer generation providers. Everyone at my volly house calls me Mr. Negative. I tell them I'm a realist. I hold an EMS review, no one attends because "the state said I'm good for 3 years." They just want to play with lights and sirens and tell war stories at the table.

It will go on this way for a little longer maybe 5-10 years but the economy is not improving and the costs of healthcare are rising. The system of you call we haul and charge $1400 is simply not going to survive.

Ultimately it falls onto the educational standards. My making an EMT class 1400 hours, or even making paramedic the minimum standard, you deter most of the people who only want to save the world and not actually do their job how it was meant to be done.

When, not if, healthcare needs to take a hit, the bottom of the food chain will without question be first.

I believe the sole reason EMS has even survived this long in its present state is the societal expectation of what they get when they dial 911. They would be appalled if a transport van with only a pair of orderlies showed up to take them to the hospital. If they actually knew what it took to be an EMT, let alone what you are even capable of doing then they may not care so much. Eventually, word will get out...


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## ExpatMedic0 (Oct 31, 2012)

While I concur with you that the many "Ricky Rescues" are not helping our profession, its a double edge sword. 

How about all the burned out EMSers? Every time I visit this forum I feel as if half the people who post here need to either get out of EMS and accept it as a "lost cause" or get off there @ss and do try to do something about it. I disappear from this forum now again because I get so sick and tired of hearing the same old complaints about EMS. Don't like it? Fair enough, move on to something else that YOU ENJOY.

I see there being a TWO types of people destroying the future of EMS advancing. 
1. Under educated buffoons who want to play hero with a couple hundred hours of training, along with the "advanced providers" who advocate "meat head medicine" 
AND 
2. Burned out providers who instead of being proactive about improving things simply tell new up and comers to "be a nurse" or discourage furthering of ones education in the name of EMS.


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## NYMedic828 (Oct 31, 2012)

schulz said:


> While I concur with you that the many "Ricky Rescues" are not helping our profession, its a double edge sword.
> 
> How about all the burned out EMSers? Every time I visit this forum I feel as if half the people who post here need to either get out of EMS and accept it as a "lost cause" or get off there @ss and do try to do something about it. I disappear from this forum now again because I get so sick and tired of hearing the same old complaints about EMS. Don't like it? Fair enough, move on to something else that YOU ENJOY.
> 
> ...



I tell people to be a nurse PA or MD instead of a paramedic on the sole basis of having a better future.

I don't discourage education in the name of EMS, but that goal is only realistic for someone who has money in their pocket to remain in EMS, which is almost no one.

I do not feel right in steering a young mind in the direction of struggling to pay the bills and living one paycheck at a time.


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## Handsome Robb (Oct 31, 2012)

I'm going to hold my tongue on this one...

I do agree with Schulz though


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## epipusher (Oct 31, 2012)

EMS is just like any other job where you get out of it what you put in. A person can be comfortable with a Paramedic's pay as long as you live within your means, which is the same for just about any pay. As far as being burnt out, that is a choice one makes. Change your attitude,and if that doesn't work, change partners, change stations, change locations, change city's, or change states. A person has options.


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## NYMedic828 (Oct 31, 2012)

epipusher said:


> EMS is just like any other job where you get out of it what you put in.



No, that is unfortunately where you are mistaken. I can put countless hours into certifications and education but 99% of the time it is only for personal benefit. I will see no promotions or increased pay or even a good job for what I do. Mind you I do it anyway but regardless, it is otherwise a wasted effort.

As far as living within your means, sure, it's more than possible. Personally I like driving a decent car ($20-40,000) and I would like to own a modest home some day and be able to provide my children with the things they want.

Living in NY, more specifically Long Island @ 23 years old I live within my means comfortably. If I had to pay a mortgage, I would be in substantial debt. My $60,000 a year supports myself fine but a family? Not a chance.

$60,000 a year simply won't do that. Not even close.


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## VFlutter (Oct 31, 2012)

schulz said:


> 2. Burned out providers who instead of being proactive about improving things simply tell new up and comers to "be a nurse" or discourage furthering of ones education in the name of EMS.



_How_ are providers supposed to go about improving things? There is so much resistance from so many different interests trying to keep EMS down.


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## Brandon275 (Oct 31, 2012)

Schulz, 

we all get burnt out at times.  I'm not sure what sort of system you work in but I am sure it is something worthy of this knowledge.  The reason people in EMS get burnt out is not always because of their attitudes.  It is the low pay, the lack of respect we get as a profession and the lack of job security we have in EMS.  


How many of us have bounced around to different companies?  I have been in EMS for 6 years in a busy 911 system and I have already worked for two companies because my previous company lost the city 911 provider contract.  Who knows how long this current company will have it.  


I firmly believe if medics and other EMSers were paid what they deserved and were recognized as a true profession and had some sort of job security and as mentioned wouldn't have to work 60 hours a week to make ends meet then I don't think you would have such a high burnout rate in EMS.  The reality of this profession is that in the longterm there is only so much money you will make in EMS and there is only so far to go.  It is what it is man.  I absolutely love EMS and I love taking care of people who need my help.  But the previously mentioned issues at times outweigh the love I have for the profession.  It is not about love and passion, its about longterm career sustainment.


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## VFlutter (Oct 31, 2012)

Brandon275 said:


> I firmly believe if medics and other EMSers were paid what they deserved and were recognized as a true profession and had some sort of job security and as mentioned wouldn't have to work 60 hours a week to make ends meet then I don't think you would have such a high burnout rate in EMS..



*Devil's advocate* 

I think that Medics/EMS are paid  appropriately. What makes you think they deserve more? What do other similar jobs, non-degree vocational trained, pay? And maybe they will be recognized as a true profession when they actually become a profession. 

*Let the hating begin


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## Hunter (Oct 31, 2012)

Brandon275 said:


> Schulz,
> 
> we all get burnt out at times.  I'm not sure what sort of system you work in but I am sure it is something worthy of this knowledge.  The reason people in EMS get burnt out is not always because of their attitudes.  It is the low pay, the lack of respect we get as a profession and the lack of job security we have in EMS.
> 
> ...



+1

And this



NYMedic828 said:


> ...I can put countless hours into certifications and education but 99% of the time it is only for personal benefit. I will see no promotions or increased pay or even a good job for what I do. Mind you I do it anyway but regardless, it is otherwise a wasted effort.
> 
> ...My $60,000 a year supports myself fine but a family? Not a chance....


Unfortunately this is the main reason a lot of people leave EMS, I love EMS, I study more than most of my co workers even though i'm done with school. I read blogs, articles, attend extra classes, medical directors meetings, ect. None of that has gotten me any closer to getting a promotion from EMT-B to Paramedic at work, Annual raise I got just as much as everyone else I was hired with, regardless of weather i show up 30 minutes instead of 15 minutes early to check my truck or write more detailed PCRs, treat my BLS Hospital Discharges with just as more dignity than my co-workers do. To management i'm just as good as the guy who shows up late, barely cleans the truck at the end of the shift, treats his patients like :censored::censored::censored::censored: because he's bitter that he doesn't work 911 yet.

The system is broken completely, but it's not just the management or everyone else's view about us that makes it broken, it's also how most providers view the system. Most providers don't behave like professionals, they don't like hoe doctors nurses and everyone else treats them, but they wont do anything about it. Like it has already been stated most people in EMS are either a "Rescue Randy or Burnt out.


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## usalsfyre (Oct 31, 2012)

ChaseZ33 said:


> *Devil's advocate*
> 
> I think that Medics/EMS are paid  appropriately. What makes you think they deserve more? What do other similar jobs, non-degree vocational trained, pay? And maybe they will be recognized as a true profession when they actually become a profession.
> 
> *Let the hating begin



It could be said that nursing is probably overpaid considering the majority of their task boil down to tech level stuff and in the US don't particularly have a strong independent body of knowledge....


That said, I agree with Kelly Grayson's theory that 75% of EMS is far overpaid and 25% don't make nearly enough...


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## Hunter (Oct 31, 2012)

ChaseZ33 said:


> *Devil's advocate*
> 
> I think that Medics/EMS are paid  appropriately. What makes you think they deserve more? What do other similar jobs, non-degree vocational trained, pay? And maybe they will be recognized as a true profession when they actually become a profession.
> 
> *Let the hating begin



Medics/EMTs are paid appropriately, if they want better they they need to improve their own standards.


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## Brandon275 (Oct 31, 2012)

What makes me think they deserve more?  Really dude, lets see, first off Medics and other EMS street providers are required to think for themselves and make clinical choices based off their experience and their training meaning all the responsibility falls on them this is especially the case with the paramedic.  A nurse for example that makes much more than the paramedic is instructed to do things by the ER physician in terms of emergency medicine.  They do not make their own choices nor are they ultimately liable, the physician is.

Second, I think Medics have just as good if not better assessment and practical skills than any hospital provider has because we have to constantly use them.  I am an Intermediate, way below a nurse and a medic and I have had many patients tell me that EMS are better at IV's and overall care than most of the RN's they encounter.  I have also helped the hospital with difficult sticks that they had a lot of trouble with even with their little light they use.  

Third, the profession is not recognized as a profession because EMS are not appreciated by the Hospitals, FD, the police or the public in general.  I have had patients in total shock because of the things we can do in the back of the ambulance because they had no idea we have the capabilities to do the things we do.  


The public still refers to us as ambulance drivers, that is how little the public knows and appreciates EMS, sorry but your comment is totally off base.  EMS are at a high stress with the long hours and nights we work without any shift differential.  The profession will be recognized as a profession once we are appreciated and recognized instead of being forgotten by our own medical counterparts and the patients we take care of on a daily basis.


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## VFlutter (Oct 31, 2012)

usalsfyre said:


> It could be said that nursing is probably overpaid considering the majority of their task boil down to tech level stuff and in the US don't particularly have a strong independent body of knowledge....
> 
> 
> That said, I agree with Kelly Grayson's theory that 75% of EMS is far overpaid and 25% don't make nearly enough...



I think nursing pay is on par with other enters level degree jobs. I would not considered it overpaid but I am not complaining either. Eh I will agree that certain subsets of nursing or as you described but not the majority. And I would argue nursing is still better off then EMS in both regards.


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## NYMedic828 (Oct 31, 2012)

usalsfyre said:


> That said, I agree with Kelly Grayson's theory that 75% of EMS is far overpaid and 25% don't make nearly enough...



Now there is a statement I can agree with.




Side note to anyone who thinks physically working hard is a grounds for higher pay, it isn't. Education is.


I would add more of my opinion but I already see this thread going down the same route as the other 100 threads that get into these debates.


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## VFlutter (Oct 31, 2012)

Brandon275 said:


> What makes me think they deserve more?  Really dude, lets see, first off Medics and other EMS street providers are required to think for themselves and make clinical choices based off their experience and their training meaning all the responsibility falls on them this is especially the case with the paramedic.  A nurse for example that makes much more than the paramedic is instructed to do things by the ER physician in terms of emergency medicine.  They do not make their own choices nor are they ultimately liable, the physician is.
> 
> Second, I think Medics have just as good if not better assessment and practical skills than any hospital provider has because we have to constantly use them.  I am an Intermediate, way below a nurse and a medic and I have had many patients tell me that EMS are better at IV's and overall care than most of the RN's they encounter.  I have also helped the hospital with difficult sticks that they had a lot of trouble with even with their little light they use.
> 
> ...



Yes dude, really. First off I think you are seriously over exaggerating the ability of the average medic and seriously lacking understanding in what nurses actually do. So you can make independent decisions on your own without medical control and outside of protocols? Secondly, again I think your view is skewed. And third, that is the least of the problems of why EMS is not a profession.


And...We are ambulance drivers. Get over it. Getting upset about the term just shows your lack of understanding of where EMS is in big picture of health care.


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## Brandon275 (Oct 31, 2012)

I don't think I am overly exaggerating abilities of medics at all.  I think Medics are highly skilled and highly unexaggerated.  Yes, we have protocols but it does not mean there are not bad medics out there that don't get in trouble for messing up.  Thats my point, the responsibility falls on the medic.  Responsibility does not fall on the nurse.  So you tell me, why is EMS not recognized as a profession, since you clearly don't see EMS or medics as professionals.


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## VFlutter (Oct 31, 2012)

Brandon275 said:


> I don't think I am overly exaggerating abilities of medics at all.  I think Medics are highly skilled and highly unexaggerated.  Yes, we have protocols but it does not mean there are not bad medics out there that don't get in trouble for messing up.  Thats my point, the responsibility falls on the medic.  Responsibility does not fall on the nurse.  So you tell me, why is EMS not recognized as a profession, since you clearly don't see EMS or medics as professionals.



Actually responsibility ultimately falls on the medical director but I get your supposed point. And nurses do have the responsibility, legally, for their patients. If a nurse walks out and quits it is patient abandonment. If a nurse makes a clinical decisions and it results in a poor outcome they are responsible. I don't see what you are trying to get at. 

I will save that for its own thread. It would require way too much typing and really will have no point. I never said medics are not professionals but that does not make EMS as a whole a actual profession.


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## NYMedic828 (Oct 31, 2012)

As a medic, I agree with chase.

While my physical scope of practical skills may ultimately outweigh a nurse my baseline knowledge does not. And that is what matters in providing good medical care.

In a perfect world, paramedics and nurses would have the same educational standards geared for their work environment. If paramedics had a BSN requirement to do their job then they would get the respect and pay everyone thinks they deserve.


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## ExpatMedic0 (Oct 31, 2012)

Brandon,
Perhaps you misunderstood me. I can understand why some people leave the job or move on. I can also share your frustration over many of the things you mentioned. As you can see I have been a member of this forum for 7 years and I have been involved with EMS for several years longer than that.

I believe we do deserve better but I believe we also deserve a better education and training. That is something we ourselves need to change in order to reap the benefits of.



ChaseZ33 said:


> *Devil's advocate*
> 
> I think that Medics/EMS are paid  appropriately. What makes you think they deserve more? What do other similar jobs, non-degree vocational trained, pay? And maybe they will be recognized as a true profession when they actually become a profession.
> 
> *Let the hating begin


You must be speaking about the USA? I have been working abroad as a medic now for 3 years. Perhaps you should speak to some of our comrades from any of the common wealth country's and the majority of the EU. I am sure they would be delighted to brag about there mandatory undergraduate and graduate degree's,
a long with there pay,respect, and working conditions compared to ours.

But back to the good ol US of A: 


around half of my paramedic class had undergraduate degree's, furthermore 2 states require at least an AAS to even be certified as a paramedic and other states require it to be "licensed" rather than certified. I understand that is far from the entire country, but what about those people? Do they deserve more?

 What about a paramedic with an AAS in EMS or undergraduate degree in Paramedicine, EMS, Biology, Chemistry, does he/she deserve more? What about states, agency's, and medical directors that have raised the minimum standard? Seattle's Paramedic program is over 3000+ hours long vs a Firefighter Paramedic from Texas who completes a 600 hour training course (in some areas) deserves vocational pay, but not everyone. Its not a one size fits all kind of situation right now.



ChaseZ33 said:


> _How_ are providers supposed to go about improving things? There is so much resistance from so many different interests trying to keep EMS down.


We further our education beyond what the current minimum standard is, we work on raising the bar, we become more proactive in organizations and advocacy groups that help advance our profession. We looks at models in other country's where the Paramedics are of a higher minimum standard.



Its not something that is going to happen overnight but its never going to happen if we just bend over and continue quietly taking it in the @ss and chasing the good people we have away.

I can see why some people leave, they have my full support and understanding. However, what I do not understand is people who do not leave and would like to or should.

I am just another pawn in the system right now. I am not claiming to be the best Paramedic in the world nor am I claiming to have any easy solution to the mentioned problems. I am just someone who likes what I do and I am taking the self initiative to be a professional for my own self and for what I enjoy while advocating others to do the same.


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## ExpatMedic0 (Oct 31, 2012)

NYMedic828 said:


> As a medic, I agree with chase.



I bet you do, since your both nursing students ;-) Good luck to both of you.


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## sir.shocksalot (Oct 31, 2012)

Brandon275 said:


> Thats my point, the responsibility falls on the medic.  Responsibility does not fall on the nurse.


This is not true. Nurses are responsible for their patient. If a nurse fails to recognize and treat changes in the patient's condition they will be held accountable for that, and probably far harsher than a paramedic will because there is a BON who is more than willing to reprimand/admonish or take away one's nursing license.

Paramedics are responsible for knowing and following protocols, nothing more. I understand why you would think that paramedics are far more responsible since we have no physician in house holding our hand, but neither do most nurses. When you have seen a good paramedic troubleshoot a medical problem, arrive at a treatment plan and implement it without ever consulting with a physician, it does start to look pretty impressive. However this is only possible to do while following the very algorithmic protocols. Many paramedics throughout the country rely on said protocols to form a treatment plan because they lack the knowledge of medicine to form a plan of their own. 

I guarantee that 90% of the paramedics on this board probably would do fine without protocols, but this is in no way representative of the actual population of paramedics. As long as paramedics operate in a protocol driven care system with a lack of education we will always be considered as "unlicensed assistive personnel" by nurses. It sucks for all of us who choose to better ourselves but we will always be weighed down by those among us who choose not to put forth the effort to educate themselves and better themselves as a healthcare provider.

This is the bed we have made for ourselves as a profession... now we get to lie in it.


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## VFlutter (Oct 31, 2012)

schulz said:


> You must be speaking about the USA?
> 
> around half of my paramedic class had undergraduate degree's, furthermore 2 states require at least an AAS to even be certified as a paramedic and other states require it to be "licensed" rather than certified. I understand that is far from the entire country, but what about those people? Do they deserve more?
> 
> ...



I am indeed talking about the US. EU/AUS EMS is on an entirely different level and what I would consider on par, if not exceeding, nursing education. But you can not even being to compare that to the US.

That variability is what is killing EMS. IMO, those with degrees should be paid more. But there needs to be a national minimum level of education which should be a degree. 



schulz said:


> I bet you do, since your both nursing students ;-) Good luck to both of you.



Shhh keep that on the down low

And I will only be a student for 6 more weeks


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## NYMedic828 (Oct 31, 2012)

schulz said:


> I bet you do, since your both nursing students ;-) Good luck to both of you.



Lol while I appreciate the well wishes I would hardly consider myself a nursing student. I have taken all my liberal arts requirements for a BSN and am doing my sciences now. Have not touched a single nursing class. Haven't decided yet if it is in fact the road I wish to walk.

Mind you if a bachelors in Paramedicine was a requirement in the US and the pay and scope of a paramedic reflected that, I would sooner be aiming for that that then nursing.


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## VFlutter (Oct 31, 2012)

sir.shocksalot said:


> This is the bed we have made for ourselves as a profession... now we get to lie in it.



Don't worry we can still cuddle. My nursing bed is much more comfy


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## errey (Oct 31, 2012)

sorry to get a little off topic but it will just help me grasp what you guys are talking about and referring to.  what is the level of education for EMS workers in the states from EMT-B, EMT-I, EMT-P how much schooling is there? cheers


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## ExpatMedic0 (Oct 31, 2012)

http://www.ems.gov/EducationStandards.htm

But off the top of my head minimum national standards in clock hours are around 1200 for paramedic and 120 for EMT-B which is required before Paramedic. This is not exact just as best that I can remember.

 I think most medic programs complete this in 12 months and EMT in 3 months. However standards vary wildly (especially for intermediate which I am not even mentioning) 

Some areas have paramedic programs that are as little as 600 hours in a few months, others that are 3000+ hours and require A&P as a pre req, and yet others that require mandatory degree's.


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## NYMedic828 (Oct 31, 2012)

The fact that some places require 3000+ hours is AWESOME.

The problem is, that is not a systemic standard. If it was we would be golden.


The 200 hour EMT programs are very geared to the schedule of a weekend warrior who only wants to volunteer. Everyone can become an EMT for very little money and minimal time devotion.

Paramedics generally intend to work professionally as a provider but the programs are often far too easy and completable without taking the plastic off your texts.

If an AAS or better yet Bachelors was the minimum standard, the incompetence and Ricky rescues would be extensively weeded/pushed out. Mind you all professions even physicians have complete morons, there would be FAR less. Probably 80% less.


Every problem with USA EMS stems ultimately from our educational standards.


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## errey (Oct 31, 2012)

schulz said:


> http://www.ems.gov/EducationStandards.htm
> 
> But off the top of my head minimum national standards in clock hours are around 1200 for paramedic and 120 for EMT-B which is required before Paramedic. This is not exact just as best that I can remember.
> 
> ...




thanks for the reply, so I'm guessing based on that amount of training that once you become a paramedic you receive a certificate?


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## ExpatMedic0 (Oct 31, 2012)

errey said:


> thanks for the reply, so I'm guessing based on that amount of training that once you become a paramedic you receive a certificate?



Yes, however most states offer an optional 2 year degree, some even a 4 year degree, but this is not a requirement(except in 2 states)

 So at a national level we are certified .


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## errey (Oct 31, 2012)

schulz said:


> Yes, however most states offer an optional 2 year degree, some even a 4 year degree, but this is not a requirement(except in 2 states)
> 
> So at a national level we are certified .



ok thanks for clearing that up, and i can imagine as stated before that if those degrees are not required everywhere a lot of people would not take them.  I agree that is not a very high standard and can see how nurses etc. might not view EMS up to there level.  I would still call it a medical profession in my opinion.  you said earlier you have/are working abroad? whereabouts?


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## ExpatMedic0 (Oct 31, 2012)

errey said:


> ok thanks for clearing that up, and i can imagine as stated before that if those degrees are not required everywhere a lot of people would not take them.  I agree that is not a very high standard and can see how nurses etc. might not view EMS up to there level.  I would still call it a medical profession in my opinion.  you said earlier you have/are working abroad? whereabouts?


Most recently I was working for an Australian company a long side Paramedics from Australia, Canada, South Africa, UK, Ireland, Sweden, and the US near Dubai in Abu Dhabi. Before that I was on a contract in Saudi Arabia working mostly with Australian and South African Paramedics but also some Germans and UK medics. Currently I am in Denmark while I complete my undergraduate degree I am on an "on call" roster for some international flight work but have yet to see much action. 

Meeting so many Paramedics from so many country's and working a long side them has really opened my eyes to the bigger picture.


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## DMT (Nov 1, 2012)

The bottom line barrier for a true professional EMS system is you get what you pay for.  I know a lot of great guys in EMS, but most of the time you're not going to get many top notch professional people when the pay is peanuts.  $40k a year is NOT a 'career' IMO.

To me, everything revolves around that.  If you argue that people should need more education and you want people to have a degree to be a medic... Why the hell would I go to school for 4 or even 2 years to get a job that pays $13-$15/hr?  Not a chance. Too many other options with no college needed, and too many better paying gigs out there for people who have degrees.  So unless the $$$ outlook changes, it will always be a lose lose situation.


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## Veneficus (Nov 1, 2012)

*Moderating again...*

There are many threads on the education of EMS. 

I did not intend for this to be another one.

I would like to discuss the culture of EMS. Mostly so I can figure out for myself how to remain active in it. 

Real fast, I hear a lot about the pay argument. 

I don't know about most of you, but for myself and everyone I know in EMS in the whole world, I cannot think of one person who said "EMS is a decent paying career, I think I will do that."

I have never heard anyone say "I don't have a degree yet, so this would be a good vocational job until I qualify for something better."

I have heard many people say that they would like to work in EMS as either their primary career, because they need to for their primary career, or who wanted to be paramedics. 

I don't know anyone who thinks they make enough for what they do.

We see good people intentionally go into EMS. We see most of the best people move on to something else. The only logical conclusion is that something EMS is doing or not doing is causing this. 

Yes, EMS leaders largely push to keep education low. Many providers don't want to advance their education because it will not change pay immediately. But if US providers do not raise their education, certainly pay will not increase to a level comparable with their international collegues.

People in EMS get pissed when they are refered to as an ambulance driver. But that is what you are paid to do! 

Do nurses or doctors get paid for milage on every patient they see? Do their treatments always end in "transport to the hospital"?

I wouldn't say I left EMS. I wouldn't even say I moved on. (probably a lot of people wish I would, not last of which are my colleagues who feel I am wasting my time with it) I advanced my education because that is what I had to do in order to get away from protocol driven treatments (I wouldn't even call it medicine) and not be paid to drive people to the hospital. 

I suspect many on this forum fall into the same category. 

Of all the physicians and nurses I know who are former EMS or "also" EMS, knowing, doing, recognized as more is universal. Not the pay. (But it certainly doesn't hurt)

So let's get back to culture of EMS. Let us look at it from an anthropological point of view the way we would study ancient Greeks or Egyptians. Because if we figure out how the clock actually works. They we can start to change it.

While this may sound strange, last year I read a book by a anthropologist on the culture of surgeons. The book (which is a study) was commisioned by surgeons in order to help them work out their problems. 

As I read it, I was nodding my head every paragraph thinking "I see that everyday."

But I still have to figure out what I can do. Being the old guy sharing experience and knowledge doesn't seem to have much benefit.


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## RocketMedic (Nov 1, 2012)

Vene, I do think a lot of problems stem from pessimism and the burnout of some. Granted, US EMS does a lot wrong, but we do do some things right, and there are legitimately lives saved by EMS daily. Not to be romantic or look at things with rose-colored glasses, but we should strive to remind people that we do indeed make a difference, even if it's only a rare, rare occasion.


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## Veneficus (Nov 1, 2012)

Rocketmedic40 said:


> Vene, I do think a lot of problems stem from pessimism and the burnout of some. Granted, US EMS does a lot wrong, but we do do some things right, and there are legitimately lives saved by EMS daily. Not to be romantic or look at things with rose-colored glasses, but we should strive to remind people that we do indeed make a difference, even if it's only a rare, rare occasion.



Just my observation and certainly you have a good point, but I wonder about the growing of the seemingly unofficial requirement of volunteer service in order to secure employment. 

That is not something found anywhere else in healthcare. Volunteer as a doctor before you get a paid position? How about a nurse? RT? PA? CRNA? the list goes on.

I am thinking the low entrance requirements to be in EMS have attracted a high number of "johns" (aka punters or hobbyists) looking for a way to make themselves feel like they make a difference and getting a fast and cheap thrill from it.

They then form volunteer councils and other political bodies in order to make sure their hobby is not made illegal.

Together, these 2 components seem to be squeezing out professional minded and dedicated people. 

As I have said many times, and we have agreed upon, saving lives is not the measure of value of a professional EMS provider.


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## paccookie (Nov 1, 2012)

Veneficus said:


> While this may sound strange, last year I read a book by a anthropologist on the culture of surgeons. The book (which is a study) was commisioned by surgeons in order to help them work out their problems.
> 
> As I read it, I was nodding my head every paragraph thinking "I see that everyday."
> 
> But I still have to figure out what I can do. Being the old guy sharing experience and knowledge doesn't seem to have much benefit.



What was the title of the book you read?


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## mycrofft (Nov 1, 2012)

*Pre-Hospital EMS Culture is the subject*

This thread could support a whole website and each subthread a category.

Second metacomm, Vene: if you are on the forum for long, things are brought up time and again and again as new folks come on board (especially new to the profession...yes, I said it) so it seems there is never any traction. Actually, it is largely just addressing each new wave of grads and website discoverers.

How many of us had our attitudes and practice shaped significantly by a mass-medium like a website forum? In my experience, at least initially, I was formed (some say warped) by significant individuals among my mentors, my coworkers, and my patients. So don't get discouraged beyond the usual variance.
=============
Metacommunicational rant over, I'm watching so many good comments and common shibboleths fly by....

Here's one. "EMS" (whatever that is) has to crash soon. _*Malarkey*_. We are experiencing a generalized loss of humanity and individual competence throughout American medicine, why not prehospital EMS (PHEMS) also? Witness the medical practices, especially PEMS, in many other countries which are not failed countries or frontiers but culturally and economically have basically no PHEMS. Snatch and run, no spine board, often no "gurney", maybe oxygen. (Not pointing fingers, but parts of Turkey and subsaharan Africa are right there; after the fall of the Politburo, Russian hospitals had to lock patient rooms to stop theives from stealing the linens and drugs, what little they had). We can fall alot farther. 

Here's another, and it is an observation. If you want to make more decisions on the spot (versus taking everyone back for a diagnosis) you have to start seeing them sooner (before they crump; these are your "taxi" cases sometimes) and you need to learn a lot more than the vestige taught to technicians (not clinicians) known as "emerency medicine". Things such as how to recognize rashes; what the likelihoods are for complaint X to be problem Q,R,or S; communicable diseases; the pharmacy of common prescription and over the counter meds besides the ones on the crash cart; how to spot a dental abscess versus a broken mandible. In other words, primary care. Our educational system fails to impart this well to many practitioners of many sorts, and a tech cannot and will not progress with this learning unless they do it individually; this frustrates them because their job cannot let them use it openly.

There is a valuable place for a tech in the field. Just try not to adopt the Ricky Rescue/Crusader Rabbit attitude, and keep learning, even going so far as maybe nursing or medical or other degree program. We need more mentors. Step up, folks.





PS: It can still be ok to party after duty and get all redneck over watching tractor pulls on tv between calls, etc.


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## Veneficus (Nov 1, 2012)

paccookie said:


> What was the title of the book you read?



http://www.amazon.com/The-Scalpels-...ds=the+scalpel's+edge+the+culture+of+surgeons


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## VFlutter (Nov 1, 2012)

Veneficus said:


> People in EMS get pissed when they are refered to as an ambulance driver. But that is what you are paid to do!
> 
> Do nurses or doctors get paid for milage on every patient they see? Do their treatments always end in "transport to the hospital"?



This should be copy and pasted as a reply every time someone starts getting pissy about it. 

For some people in EMS the feeling of power or prestige is addicting. How many people, especially new or young, "love" cardiac arrests? They love the idea of saving a life. Ask a cardiac arrest survivor about their experience and many will say "The EMTs saved my life , they are heroes". It creates this idea that the job is superior or prestigious. Or they love to wear their uniform in public just because of the attention. 

Also I feel that some (most) EMS providers lack even a common understanding of medicine or how healthcare works. The constant comments such as "We are independent providers, we dont have a doctor telling us what to do, we make our own decisions", etc just show little they understand. Their thought process ends at the ER doors, they do not understand what will happen to the patient or what their interventions may have caused or complicated once they get to a unit.


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## ExpatMedic0 (Nov 1, 2012)

What about a community Paramedic, or a fly car paramedic which is authorized to treat and release, how about an FP-C or CCEMT-P working in an advanced system, what about  a paramedic working occupational health or remote medical? I have worked most of the above mentioned positions (excluding critical care) and I would say I have to disagree with your statement because I was never a transporting unit unless I was riding along.


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## NYMedic828 (Nov 1, 2012)

When's the last time any of you saw a physician wearing a shirt that read

"Medicine, more than a job, a calling!"

Or 

"Doctors, fending off the Reaper"


Nonsense like that is the attitude of EMS. And until these delusional Ricky rescue :censored::censored::censored::censored:tards get out of the way (90% of EMS) then we simply cannot advance.

I really don't see any more too it than the simple fact that EMS is a hobby. Paramedic is a START but being an EMT is a damn hobby it is not a career.


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## VFlutter (Nov 1, 2012)

Or better yet "Doctors...Doing the same :censored::censored::censored::censored: as medics just not at 60mph"


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## RocketMedic (Nov 1, 2012)

NYMedic828 said:


> When's the last time any of you saw a physician wearing a shirt that read
> 
> "Medicine, more than a job, a calling!"
> 
> ...



Sadly, I think that many of my agency's problems are rooted firmly in this attitude. I think this is actually the same problem that we'd see across the nation.


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## Tigger (Nov 1, 2012)

Veneficus said:


> I have never heard anyone say "I don't have a degree yet, so this would be a good vocational job until I qualify for something better."



I have said that, and will continue to do so.


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## NYMedic828 (Nov 1, 2012)

Tigger said:


> I have said that, and will continue to do so.



People do that all the time?

Essentially anyone working as an EMT while in school is doing that whether they blatantly say it or not...


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## Tigger (Nov 1, 2012)

NYMedic828 said:


> People do that all the time?
> 
> Essentially anyone working as an EMT while in school is doing that whether they blatantly say it or not...



Yea I didn't think I was the only one. Granted I don't work with many people that are getting their bachelors at the same time, but hey it is a good job for a student. If you have nothing but an HS diploma it offers better working conditions than the alternatives and gives you healthcare experience if you want to go that route. 

People whine about the pay, but I made less money delivering snow blowers than I do on the ambulance and I work a lot less so I am not complaining.


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## JDub (Nov 1, 2012)

Tigger said:


> I have said that, and will continue to do so.



Same here. My plan is to get my paramedic certification which will allow me to have a job I enjoy while I pursue my bachelor's degree and attempt to get into medical school.

I like EMS, but I don't see myself liking it if I was forced to do it for 40+ hours a week for the next 20+ years.


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## waaaemt (Nov 1, 2012)

At Veneficus, about the anthropology, basically you're saying that most people who do EMS in the US are meat heads who do it for the glory and stuff like that? (not being confrontational just confirming)

I think I would agree. How would you describe the culture/personality of the majority of EMS providers in other places like the EU?


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## NYMedic828 (Nov 1, 2012)

oogemsquagger said:


> At Veneficus, about the anthropology, basically you're saying that most people who do EMS in the US are meat heads who do it for the glory and stuff like that? (not being confrontational just confirming)
> 
> I think I would agree. How would you describe the culture/personality of the majority of EMS providers in other places like the EU?



When your minimum standard requires a collegiate level degree, you tend to weed out a vast majority of undesirables.


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## waaaemt (Nov 1, 2012)

NYMedic828 said:


> When your minimum standard requires a collegiate level degree, you tend to weed out a vast majority of undesirables.



Oh yeah, true that. I found an interesting summary of Euro EMS here:
http://www.euro.who.int/__data/assets/pdf_file/0016/114406/E92038.pdf

So it looks like their lowest level is paramedic with 5 years of school. If anyone wants to get hurt, the EU looks like the place to do it! 

I think a problem is how hard the US system makes this kind of thing to be done. For instance, Seattle's Medic One program requires you be a FF/EMT for i think 4 years before you can even be nominated to take the course.

But as for the US EMS, so far it has done what it has to do for the most part. I think a lot of the people who do it to look good in a uniform and be called a hero are the ones who get burnt out in a few years cause they don't get the respect they except and get sick of it. Am i right or wrong?

But then what do you guys think the culture/attitude should be? Anything other than the hero wannabes or something specific?


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## mycrofft (Nov 2, 2012)

*My swing was a miss.*

I posted:

"EMS" (whatever that is) "has to crash soon". Malarkey

Sounded a little like "they can't fall", but what I was trying to say was it can and will have the potential for falling all the way to rock bottom unless the culture changes and medical professionals working for medical professionals take charge of raising standards and enforcing them.


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## mycrofft (Nov 2, 2012)

About meatheads;

Many new trainees are YOUNG. Today's media culture rewards and models behaviors not designed to be mature and dependable, but hip, sexy, and insouciant. Thug chic. Abercrombie and Fitch cool. So, maybe we DO need a medical boot camp, six weeks of deprogramming and reporgramming?

Many "meatheads" are salvageable.


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## Wheel (Nov 2, 2012)

mycrofft said:


> About meatheads;
> 
> Many new trainees are YOUNG. Today's media culture rewards and models behaviors not designed to be mature and dependable, but hip, sexy, and insouciant. Thug chic. Abercrombie and Fitch cool. So, maybe we DO need a medical boot camp, six weeks of deprogramming and reporgramming?



This is interesting. Where I trained and now in the place I work I am much younger than most of the people I work with (I'm 23.) Everyone kind of assumes I'm too young to be a medic.


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## mycrofft (Nov 2, 2012)

Wheel said:


> This is interesting. Where I trained and now in the place I work I am much younger than most of the people I work with (I'm 23.) Everyone kind of assumes I'm too young to be a medic.



Well, are you hip, sexy, and insouciant?


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## mycrofft (Nov 2, 2012)

Wheel said:


> This is interesting. Where I trained and now in the place I work I am much younger than most of the people I work with (I'm 23.) Everyone kind of assumes I'm too young to be a medic.



Well, are you hip, sexy, and insouciant? 





PS: I place the fall of western euopean cultural world dominance firmly at the feet of Ferris Bueller.


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## 11569150 (Nov 2, 2012)

Having only read the first 3 pages of this thread (forgive me its very late and my ADD is kicking in) I've got a clarifying question: what would it actually take to consider EMS a profession?  Maybe I'm in the minority here, but I get paid a comfortable liveable wage that supports me and my family, I have a retirement package, insurance benefits for my family and I (including our little one until he is 26 thank you Obama!), and an awesome management team who treats everyone fairly and is extremely understanding.  Combine that with a 2 day on 5 day off schedule and getting to do my part for the community, seems like a pretty good "profession" to me...maybe I'm not looking at the right aspects to understand everyone's point.  Granted I also work seasonally for a FD which has better benefits that I use instead, but that's besides the point.  I could easily live off the EMS wages alone but I just plain enjoy both jobs too much to let either one go.  Anyway, trying to stop rambling here, I guess my point is this: a vehicle mechanic is considered a profession, waste management is a profession, a tow truck driver is a profession, why not ambulance driving (I know I know "were not ambulance drivers were life savers" blah blah blah)?  All jobs albeit are blue collar, but still considered professions.  What's the difference?


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## Wheel (Nov 2, 2012)

mycrofft said:


> Well, are you hip, sexy, and insouciant?



1. Not particularly
2. My fiancé thinks so
3. I had to look this one up, sadly, and it depends.


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## mycrofft (Nov 2, 2012)

11569150 said:


> Having only read the first 3 pages of this thread (forgive me its very late and my ADD is kicking in) I've got a clarifying question: what would it actually take to consider EMS a profession?  Maybe I'm in the minority here, but I get paid a comfortable liveable wage that supports me and my family, I have a retirement package, insurance benefits for my family and I (including our little one until he is 26 thank you Obama!), and an awesome management team who treats everyone fairly and is extremely understanding.  Combine that with a 2 day on 5 day off schedule and getting to do my part for the community, seems like a pretty good "profession" to me...maybe I'm not looking at the right aspects to understand everyone's point.  Granted I also work seasonally for a FD which has better benefits that I use instead, but that's besides the point.  I could easily live off the EMS wages alone but I just plain enjoy both jobs too much to let either one go.  Anyway, trying to stop rambling here, I guess my point is this: a vehicle mechanic is considered a profession, waste management is a profession, a tow truck driver is a profession, why not ambulance driving (I know I know "were not ambulance drivers were life savers" blah blah blah)?  All jobs albeit are blue collar, but still considered professions.  What's the difference?



This is one of EMTLIFE's deepest darkest Black Holes from which few threads ever emerge. 

Me, I think there are many professional EMTs and Paramedics and etc etc, but look up the formal definitions of "profession" then see how many protocols are written by EMTs, and how many medical controlers are EMTs, and THEN decide if prehospital EMS is a "Profession" or a gig.


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## mycrofft (Nov 2, 2012)

Wheel said:


> 1. Not particularly
> 2. My fiancé thinks so
> 3. I had to look this one up, sadly, and it depends.



I was your age when I took my EMT class. And an Airman on active duty. And married for two years-plus. THAT's multitasking.


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## 11569150 (Nov 2, 2012)

So were talking about EMS being a "medical profession" and not just "any old profession."

And sorry to open up the black hole but I couldn't resist.


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## Veneficus (Nov 2, 2012)

schulz said:


> What about a community Paramedic, or a fly car paramedic which is authorized to treat and release, how about an FP-C or CCEMT-P working in an advanced system, what about  a paramedic working occupational health or remote medical?



Those examples do not get paid by medicare/medicade/insurance for BLS/ALS transport like 99% of all US EMS.

The community paramedic/treat and release is usually either local funding or an attempt by an agency to control costs.Money is saved by not always having to staff equip and dispatch an ALS ambulance.

CCT has its own funding source which as aeromed discovered is well higher than it it is worth. Which is why everyone and their brother decided to get into the airmed business.

I also have worked Oc. health as a medic, that was paid for by the institution because it was a cost saving/controling measure. 

Remote medicine is also another animal, one where paramedics are often less useful then they think they are. I have quite a few war stories of having to clean up after FOB medics who think ibuprofin and antibiotics solve all ills. 

I even have a great story about a guy who fell down a flight of stairs, fractured his clavical, dislocated his humerus, and despite the obvious deformation was given 800mg ibuprofin 3x day with 7 days bed rest note. 



schulz said:


> I have worked most of the above mentioned positions (excluding critical care) and I would say I have to disagree with your statement because I was never a transporting unit unless I was riding along.



As I said, your funding source was not BLS/ALS transport.


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## Veneficus (Nov 2, 2012)

oogemsquagger said:


> At Veneficus, about the anthropology, basically you're saying that most people who do EMS in the US are meat heads who do it for the glory and stuff like that? (not being confrontational just confirming)
> 
> I think I would agree. How would you describe the culture/personality of the majority of EMS providers in other places like the EU?



The EU is a large place. There are multiple systems within it. Even within the same country sometimes. Here there are paramedic only ambulances and there are physician ambulances. The 2 simply do not equate nor function in a similar way. However, the paramedics here are degreed healthcare providers. They can get a mastersor even PhD in EMS. If they want a leadership role they certainly will. 

(one of my friends here is the director of emergency service and response for the equivalent of a state and he is a paramedic. Who wrote his PhD in EMS on the differences between European and US EMS systems.)

Limiting my answer to just the EU paramedics I have encountered, most are very professional minded, all are educated. The Europeans as a common culture place a high value and emphasis on education.

I have yet to meet one I couldn't hold a medical discussion with who I first needed to explain ineffectiveness or cardiac arrest drugs or overoxygenating.

I will disclaim I have not seen all systems in the EU and there may be a few of those out there.

I do see a lot of EU paramedics in different countries who constantly try to demonstrate to physicias they are expert and worthy of what they do as they transform from physician based to medic based EMS. 

But they don't do it by comparing themselves to physicians at 60mph, they do it by demonstrating their academic qualifications and performing studies that define and shape their treatments. 

They basically use the same established system among doctors to define and change practice while demonstrating value. 

I believe that AU and NZ use a similar format.


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## Frozennoodle (Nov 2, 2012)

Veneficus said:


> They can get a mastersor even PhD in EMS.



Assuming a setup similar to nursing where 2 years is the minimum and 4 is the standard how would you pay to deploy those highly skilled and knowledge paramedics?  I'm not arguing against education.  I'm truly wondering how bankrupt cities and states will afford to deploy them.  I'm lucky to make 21.18 here but that's essentially the ceiling.  I work for the highest paying service in the region.  When I advance my education and eventually go to grad school who will pay me that PA salary in the field? Probably no one.  My service might allow me to work as a PA in a sprint car but I doubt they will pay me much more than a medic.  

How do we change the culture of EMS and get the money to make it worth peoples time?  People already balk at the idea of paying a 1500 dollar ambulance fee.


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## Jon (Nov 2, 2012)

Veneficus said:


> Those examples do not get paid by medicare/medicade/insurance for BLS/ALS transport like 99% of all US EMS.


I'll amend that and say "for now".

It's always bothered me that Medicare sees EMS as a transport provider, not a clinical provider. I have a feeling that's going to change in my lifetime, though.


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## Veneficus (Nov 2, 2012)

Frozennoodle said:


> Assuming a setup similar to nursing where 2 years is the minimum and 4 is the standard how would you pay to deploy those highly skilled and knowledge paramedics?  I'm not arguing against education.  I'm truly wondering how bankrupt cities and states will afford to deploy them.  I'm lucky to make 21.18 here but that's essentially the ceiling.  I work for the highest paying service in the region.  When I advance my education and eventually go to grad school who will pay me that PA salary in the field? Probably no one.  My service might allow me to work as a PA in a sprint car but I doubt they will pay me much more than a medic.



The deployment model is rather simple. The "advanced" medics are deployed just like any other. (though usually they are supervisors or officer of some type) For example, the firend I described has his normal 9-4 director duties then picks up OT shifts as a "regular" medic. But he is always payed the rate of his qualification. 

If you call 911 in this city, you will either get an ambulance with 3 medics or an ambulance with a driver(basically EMT or medic working OT) nurse and a doctor. It will depend on the severity of the call as decided by dispatch. The medic unit can aso call for a physician unit as back up.

In less severe calls the physician is dispatched as basically a house call. Obviously for advanced procedures and knowledge in more severe calls.

In areas where there are no physicians working, usually smaller cities/villages, then a paramedic ambulance will arrive.

No matter what you get, it will cost the equivalent of $125 USD. They will show up with the same lifepack 12 or 15 in the US, with a much more amazing jump kit. (aka equal or better equipment.) 

None of the citizens or residents pay out of pocket, they have state mandated insurance. (which is also paid for by the state if they can't afford it) But if you are a tourist or other visitor, $125 for an ambulance isn't a bad price. 

There are many benefits to state level EMS systems and national level healthcare systems. (a few drawbacks too, it is not perfect)

In the US, if you are working as a PA, you bill as a PA, not as an ALS ambulance or fly car. That fee for service is submitted to medicare/medicade/insurance as PA service, not medical transport. 

If you work as a PA and accept a medic rate while your company bills a t a higher rate, that is your business.I don't suggest it. I wouldn't accept less than a percentage of that collected. 



Frozennoodle said:


> How do we change the culture of EMS and get the money to make it worth peoples time?  People already balk at the idea of paying a 1500 dollar ambulance fee.



Once EMS providers have an education, they can leverage the value of service they can provide to increase funding for it.

But don't be fooled, EM physicians make a considerable amount of money because EMS transports all patients to them. They are often medical directors. So you are literally up against the financial interests of your medical director. 

The first step is for EMS to advance education to at least a bachelor's where the medical "director" is really an advisor and paid for such. That is a vital part of being a profession. Setting your own rules.

No matter how professional EMS behaves. It is like having a sex change. 
They look like a profession, they act like a profession, but they are only in appearance. 

(in a similar manner as a man undergoing cosmetic gender reassignment will not have a uterus, ovaries, etc.)


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## Veneficus (Nov 2, 2012)

Jon said:


> I'll amend that and say "for now".
> 
> It's always bothered me that Medicare sees EMS as a transport provider, not a clinical provider. I have a feeling that's going to change in my lifetime, though.



I hope it does. But the only way I can see that happnening is with increased education requirements.

That is the route everyone from nursing to RTs to PAs, and DNPs took. 

I have no idea how EMS could go about it a different way.


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## ExpatMedic0 (Nov 2, 2012)

I have been living in the EU for a year, it is in no way shape or form the same in every country here. Just like how every country has there own language they also have drastically different EMS education and systems.


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## mycrofft (Nov 2, 2012)

Sidetrack: follow the money.
OK. Pt's can't afford rides and care, municipalities can't afford to pay a prehospital medical service AND a full FD, taxpayers can't afford to pay for anything, supply/medicine/equipment/vehicle suppliers can't afford to reduce their prices, insurance can't afford to lower its rates to anyone (or even to pay out on an honest policy). Tech's can't afford to go back to school and become a MD, PA, FNP. 

So where the hell did all the money go*? Or are we each either too lazy or too avaricious or both?

The best one could do in such circumstances (and they are not uniform throughout the land) is to start early on your professional journey, don't settle and stay as a tech unless you fail further advancement, use all the resources you can muster to better yourself, and if you make it, don't try to get rich by gouging those behind you.


*PS: hint: corporate legal companies; nonessential surgeons and other practitioners; software magnates;  oil cartels; war materials suppliers; and all the toys we need to live in modern middle to upper class America. Etcetera, etcetera, etcetera. So sez me.


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## 46Young (Nov 2, 2012)

NYMedic828 said:


> No, that is unfortunately where you are mistaken. I can put countless hours into certifications and education but 99% of the time it is only for personal benefit. I will see no promotions or increased pay or even a good job for what I do. Mind you I do it anyway but regardless, it is otherwise a wasted effort.
> 
> As far as living within your means, sure, it's more than possible. Personally I like driving a decent car ($20-40,000) and I would like to own a modest home some day and be able to provide my children with the things they want.
> 
> ...



...Which is why I left Queens NY with my family to a fire based EMS system. This is one of the reasons why so many leave single role EMS systems for fire based, just like you're doing by "back door-ing" (what they call it on the firehouse.com FDNY threads) into FDNY fire from FDNY EMS.

For the record, it isn't only EMS that's used as a stepping stone. I know a few DOC CO's, cops, parks dept workers, and garbage men that took those jobs just to start on their 20 and out retirement with their sights set on FDNY. This occurs in a lot of other places as well. EMS just happens to be a convenient way to pay the bills or get into a retirement system until you get the career you really want.

EMS just doesn't pay well most of the time. To me, $40-$60k/yr isn't sustainable for the long term unless you choose to remain single with no children and don't care about your retirement at all. Eventually, many young EMS workers mature and realize that the job is dead-end and working 2-3 jobs for 60-80 hours a week isn't desireable for the long term.


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## Veneficus (Nov 2, 2012)

46Young said:


> many young EMS workers mature and realize that the job is dead-end and working 2-3 jobs for 60-80 hours a week isn't desireable for the long term.



Well said.

A dead-end job is not a profession.


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## 46Young (Nov 2, 2012)

schulz said:


> While I concur with you that the many "Ricky Rescues" are not helping our profession, its a double edge sword.
> 
> How about all the burned out EMSers? Every time I visit this forum I feel as if half the people who post here need to either get out of EMS and accept it as a "lost cause" or get off there @ss and do try to do something about it. I disappear from this forum now again because I get so sick and tired of hearing the same old complaints about EMS. Don't like it? Fair enough, move on to something else that YOU ENJOY.
> 
> ...



Really, what kind of career ladder and retirement is there in EMS? EMT > medic > maybe supervisor, of which there are very few positions? Maybe there's a lateral to dispatcher or support services, but that's about it. My dept: FF or FF/medic, Technician, Master Technician, Lt, Capt I, Capt II, BC, DC, AC, Fire Chief. Each promotion is a 5-10% pay increase. We have numerous positions in EMS Admin/education, the Fire Marshalls office in Investigations, Prevention, the Fire Academy, Peer Fitness/CPAT, as well as numerous office positions.

What if you need light duty in EMS? If you're lucky, there's a dispatcher spot or maybe one or two office spots. Otherwise, you're out of luck. I know places that make pregnant EMT's work on the bus until they're seven months pregnant or worse.

I'm absolutely going to recommend that the young EMS professional seek a better career, usually in a fire based system or in a better paying healthcare field, and maybe do EMS on a per diem basis afterward, so they can have the best of both worlds, which many people do. When I worked at my former ospital based EMS dept, I worked with a few FDNY FF's, several nurses, a banker, a few retired people, etc.

I've worked per diem at one local hospital in the area for more than a year and a half. Many, like myself, are FT in a FD and work here per diem. At least a dozen others are planning on or are actively seeking employment in a fire based EMS service. One guy just graduated our last recruit school. There are some full timers that have been here for ten years or more, or are retired from their careers (typically fire/EMS) but they are the minority, and this place happens to be top-of-the line IMO. That's just how it is. In EMS, full timers generally come and go, and others work EMS per diem while having a different career, because an EMS job is usually easy to get.


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## 46Young (Nov 2, 2012)

ChaseZ33 said:


> *Devil's advocate*
> 
> I think that Medics/EMS are paid  appropriately. What makes you think they deserve more? What do other similar jobs, non-degree vocational trained, pay? And maybe they will be recognized as a true profession when they actually become a profession.
> 
> *Let the hating begin



We work nights and weekends, typically for no differential pay in most places. We often lift dynamic loads (people) in dangerous positions and terrain. We have to sit in a seat for a long period of time, which further pre-disposes us to injury. We deal with the diseased and sometimes violent pt. We work roadside where emergency responders get killed every year. Municipal schedules are often a 56 hour workweek, where you need to make $12/hr just to make $40k/yr. As a rule, our breaks are often delayed, interrupted, or omitted altogether. Late calls and mandatory holdover are more the rule than the exception as well.

I know plenty of burned out EMT's and medics that went down with a career ending injury, or cannot take the pain of their chronic injuries caused by the field. I know a few people that caught HIV, HEP, etc. from working in the field. 

For these reasons I feel that we should get paid more, but because the barrier for entry is so low, and every Tom, ****, and Harry applies for EMT work nowadays, anyone is willing to do the job, so employers have no reason to pay more.

Really, anyone who agrees to work for substandard pay is part of the problem. But, if you refuse to work, someone else definitely will.

So, even though it was never my original intent, I used EMS as a stepping stone to a better career, and continue to use EMS as a second source of per diem income (because I still enjoy the work, and per diems make more than most FT'ers). 

It's popular to say that we should get off our butts and "change EMS," but I have no intention to martyr myself financially, with an uncertain payoff.

How much do truck drivers make? Administrative assistants? Roofers (legal)? Highway workers? Personal trainers? Bouncers? They all make more than $10/hr, with little to no education, and usually on the job training to some extent.


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## 46Young (Nov 2, 2012)

DMT said:


> The bottom line barrier for a true professional EMS system is you get what you pay for.  I know a lot of great guys in EMS, but most of the time you're not going to get many top notch professional people when the pay is peanuts.  $40k a year is NOT a 'career' IMO.
> 
> To me, everything revolves around that.  If you argue that people should need more education and you want people to have a degree to be a medic... Why the hell would I go to school for 4 or even 2 years to get a job that pays $13-$15/hr?  Not a chance. Too many other options with no college needed, and too many better paying gigs out there for people who have degrees.  So unless the $$$ outlook changes, it will always be a lose lose situation.



+1

I understand that nurses increased their education first, advertised that the pts benefit from this, and then worked towards better pay. I don't see this as a reasonable course in EMS, though. It's a tough sell to ask someone to go to college for four years just to make $12-$20/hr with a crappy retirement in most cases. Not enough people will be willing to do this unless employers give weight to degrees or just require them. Almost all private EMS, hospital based EMS, Third Service EMS, and fire based EMS are equally to blame in this regard. Most places have requirements such as a pulse, patch, a decent driving record, no felonies, and maybe some experience. I must have missed where they ask for a degree, IDK. Really, go on any municipal hiring page, or any hospital beasd hiring page for that matter, and you'll see no mention of a degree, or perhaps a 2-3% stipend at the most.


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## 46Young (Nov 2, 2012)

Really, when I tink about it, EMS in the USA is not a profession, it's just a job. It's appropriate for the short term, maybe 3-5 years, while you go to college or something, and then you leave or stay on per diem for some extra $$$. The lack of job security, lack of a career ladder, and lack of a decent retirement in most cases just shows that EMS is not intended to be a career. Besides the long term financials, many people get injured on the job, and most people don't like being woken up several times a night and posting on a street corner for 25+ years, not to mention all the mandatory weekends and holidays worked, etc.


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## ExpatMedic0 (Nov 2, 2012)

46Young said:


> Really, when I tink about it, EMS in the USA is not a profession, it's just a job. It's appropriate for the short term, maybe 3-5 years, while you go to college or something, and then you leave or stay on per diem for some extra $$$. The lack of job security, lack of a career ladder, and lack of a decent retirement in most cases just shows that EMS is not intended to be a career. Besides the long term financials, many people get injured on the job, and most people don't like being woken up several times a night and posting on a street corner for 25+ years, not to mention all the mandatory weekends and holidays worked, etc.



So why are you still in EMS, why did you not only stay in EMS but advance to the paramedic level? What have you done to fix anything or make your life in EMS better ? Whats the point of all this for you?


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## Jon (Nov 2, 2012)

Veneficus said:


> I hope it does. But the only way I can see that happnening is with increased education requirements.
> 
> That is the route everyone from nursing to RTs to PAs, and DNPs took.
> 
> I have no idea how EMS could go about it a different way.



I'm entirely OK with that. I'm not trying to bash EMS-based fire suppression agencies, but they are going to have the biggest issue with it.

The problem is the brain drain that is occurring until such standards are raised. We are loosing many of the very providers that would love such a system. We are loosing them to other professions (how many members of the forum, including yourself, Vene, will still be in EMS in 2 years, in 5, in 10?).

Until the education standards are raised - our great minds of EMS will continue to leave and go to nursing school, or medical school, or going into other office jobs.


Who's doing the biggest fighting against the new national standard for EMT's? Volunteers in some areas, sure - but the big city FD's that are only IN EMS because there's money, that's who.


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## Veneficus (Nov 2, 2012)

Jon said:


> The problem is the brain drain that is occurring until such standards are raised. We are loosing many of the very providers that would love such a system. We are loosing them to other professions (how many members of the forum, including yourself, Vene, will still be in EMS in 2 years, in 5, in 10?).



I suspect I will always be involved in some capacity. 

I have my moments when people in EMS really piss me off, but after a little break I usually come back.



Jon said:


> Until the education standards are raised - our great minds of EMS will continue to leave and go to nursing school, or medical school, or going into other office jobs.?



Maybe it is just my perspective, but I don't think it is the education standards. I think it is the lack of career opportunity. Ifyou look at fire service medics, they usually stay in for the long haul. But they have many more opportunities for advancement and lateral transfer. Even the best US EMS systems, like Wake County, cannot compete with the fire service. 



Jon said:


> Who's doing the biggest fighting against the new national standard for EMT's? Volunteers in some areas, sure - but the big city FD's that are only IN EMS because there's money, that's who.



It has always been that way. But i am starting to think volunteers are becomming a much larger problem than the fire service.

FDs I think are discovering it is not the cash cow they once had. Increased costs, static revenue. I would not be surprised to see some FDs try to divest themselves from it in the next 5-10 years.


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## 46Young (Nov 2, 2012)

schulz said:


> So why are you still in EMS, why did you not only stay in EMS but advance to the paramedic level? What have you done to fix anything or make your life in EMS better ? Whats the point of all this for you?



This is a little long winded:

When I was 26, I decided that I needed to do more than work off the books as a Snapple delivery man and a bouncer. I wanted a decent career with benefits and retirement. I thought about what career could fit that criteria. I recalled that two of my cousins worked FDNY EMS, so I talked with them, and decided that EMS was a career I would enjoy, and the money was decent ($14-$20/hr for EMT's at NS-LIJ, $22-$30/hr for medics). I worked per diem for a private at $9.50/hr just to build a resume and got hired by the hospital seven months later. About two years in, my wife and I were expecting our first child, and we were barely getting by bill-to-bill.

So, I had to decide between nursing school and medic school. 3 years vs 13 months, for the same money if I just pulled two extra tours a month. The plan was to do FDNY EMS, but while in the process one of my former co-workers came up to visit from Virginia where he was hired as a FF/medic. He told me all about it, so I lost interest in FDNY EMS and began the process down South. I really didn't see myself sitting on street corners getting my stones busted by the conditions Boss for 25 years for not enough money and 25% less pension than FDNY fire. The hospitals are all 401k or 403b, so screw that.

I failed one poly and thought I failed the second (they do that routinely as a tactic to illicit confessions), so  took a job in a Third Service in SC while my wife was still agreeable to leaving NY. That place was undesireable to me. All of the burnout issues were present there. About three months in, I received a job offer from my current employer, so I left after five months or so in SC.

$53k in the academy, $71k after clearing ALS internship, now a $84k/yr base four + years in with a promotion already obtained, excellent benefits, 25/55 pension w/ a 2.8% multiplier, and a three year DROP. I had always wanted to do fire as well as EMS, so this just worked out perfectly. My employer supplies me with all the tools necessary to do my job in EMS well, and I ride the bus typically two days out of every three. Last year I grossed $128k w/OT and another few grand from my per diem hospital based medic IFT job, and I'm paced to hit $140k this year.

*THAT's why I've stayed in EMS. Excellent working conditions with ample benefits and pay. At this point in my life, with a wife, two children, a mortgage, and a retirement to fund, addressing these needs is the point, addressing these needs is of paramount importance. I still enjoy EMS work, at least the acute cases and patients that are truly appreciative,but 10+ years in I'm sure that I would have burned out had I stayed either in the NYC 911 system or in SC.

You see, I had no intention to financially martyr myself for the good of EMS. I decided that if I wanted to stay in the field, it would need to be with an employer that would take really good care of us. So, I sold out and went fire based. I still do the exact same job I did previously at least two days out of every three, with top of the line equipment and decent protocols/guidelines, and I also have an engine full of people to carry my equipment and the pt as well. No more six floor walk-ups with just me and my partner, humping all our equipment and then taking all of that back down along with the pt. I can ask questions and gather info while other people do vitals, package the pt, and deliver them to the back of my bus, where I can go to work. I can do this for 40 years if I want to.

Capiche?

Edit: Almost forgot, in addition to the money, I wanted to be able to do more for my patients - that was of equal importance to the pay, truth be told. I'd felt handcuffed as an EMT-B - I have a reasonable idea what the pt needs, or maybe I would like to know so that I could help them, but don't have the education or diagnostics, so I give them air and chair until someone that can actually help shows up. Like I said, I still enjoy paramedic work when it actually makes a difference. Frivolous calls kill my motivation and job satisfaction, but the working conditions at this career definitely mitigate that. Where else do you get to sleep and exercise on duty, and knock out degrees OTJ?*


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## NYMedic828 (Nov 2, 2012)

46Young said:


> This is a little long winded:
> 
> When I was 26, I decided that I needed to do more than work off the books as a Snapple delivery man and a bouncer. I wanted a decent career with benefits and retirement. I thought about what career could fit that criteria. I recalled that two of my cousins worked FDNY EMS, so I talked with them, and decided that EMS was a career I would enjoy, and the money was decent ($14-$20/hr for EMT's at NS-LIJ, $22-$30/hr for medics). I worked per diem for a private at $9.50/hr just to build a resume and got hired by the hospital seven months later. About two years in, my wife and I were expecting our first child, and we were barely getting by bill-to-bill.
> 
> ...


*

Stories like these are the kind people just don't understand. Your phrasing could not be more dead on. It isn't wise to martyr yourself for the good of EMS. It's that simple. EMS is not out to save me, I'm going to look out for myself and my future family before all else.


I debated applying for fairfax Virginia but il make
Firefighter in January so it isn't worth it at this point.*


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## 46Young (Nov 2, 2012)

NYMedic828 said:


> Stories like these are the kind people just don't understand. Your phrasing could not be more dead on. It isn't wise to martyr yourself for the good of EMS. It's that simple. EMS is not out to save me, I'm going to look out for myself and my future family before all else.
> 
> 
> I debated applying for fairfax Virginia but il make
> Firefighter in January so it isn't worth it at this point.



Good luck! Best job in the world!

I'll have to do Savannah GA one year for St. Paddy's Day. It's popular with firefighters. I used to do Olympic Weightlifting at Lost Battalion Hall off Queens Blvd, and Joe Triolo was my coach (OTJ w/ FDNY). He used to mention that he goes to Savannah for St Paddy's. I should give him a call.


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## NYMedic828 (Nov 2, 2012)

46Young said:


> Good luck! Best job in the world!
> 
> I'll have to do Savannah GA one year for St. Paddy's Day. It's popular with firefighters. I used to do Olympic Weightlifting at Lost Battalion Hall off Queens Blvd, and Joe Triolo was my coach (OTJ w/ FDNY). He used to mention that he goes to Savannah for St Paddy's. I should give him a call.



Been with FDNY EMS nearly 4 years come January. All waiting for the promotional to firefighter.

It hasn't been a terrible experience but if presented the option again I assure you I would be sitting at a desk in school instead of staring at the dash board getting yelled at by bosses for no apparent reason.


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## abckidsmom (Nov 2, 2012)

Way to sum it up, 46Y.  I am a fan of the fire-based system too.  I love being crossed-trained, I don't think that general-purpose firefighting is all that difficult to learn well, and it makes a nice diversion from running just EMS.

I agree 100% with your post, only make it a state retirement plus city pension, 90 mile commute, and 5 kids' (4 daughters') start to their lives to fund.  I love the NOVA salary on the central VA cost of living.


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## NYMedic828 (Nov 2, 2012)

I wish FDNY was a little better in the cross trained division.

It's really quite silly. A solid 1/4 of FDNY fireman if not more are EMTs, medics, RNs, NPs and PAs. Every FDNY firefighter is only permitted to function as a CFR, essentially a worthless title.

I believe the main reason is a union issue between EMS and Fire. We have two separate unions. The EMS one is worthless.


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## mycrofft (Nov 3, 2012)

46young, I'm rooting for you, especially the OJT stuff. Keep swimning upstream because on the job injuries can take you out if all you have are street skills. Your post brightened my day.


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## ExpatMedic0 (Nov 3, 2012)

46Young said:


> Capiche?



Ya I get you. I would not say you sold out simply because you work in a fire based system right now. It is what it is. However those systems are still a part of EMS. It sounded by your previous quote your being bit hypocritical though? It seems as though you are quite happy with your career as a Paramedic right now.


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## NYMedic828 (Nov 3, 2012)

schulz said:


> Ya I get you. I would not say you sold out simply because you work in a fire based system right now. It is what it is. However those systems are still a part of EMS. It sounded by your previous quote your being bit hypocritical though? It seems as though you are quite happy with your career as a Paramedic right now.



Because he makes a livable wage.

He makes $140,000 being classified as a firefighter paramedic. Mind you his title is firefighter with paramedic as a supplement to his training.

I make $60,000 as a paramedic. Sorry, forget that.


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## Handsome Robb (Nov 3, 2012)

NYMedic828 said:


> I make $60,000 as a paramedic. Sorry, forget that.



Must be tough. I net 40k after taxes as a paramedic with no OT, albeit I make more than that because I choose to work OT....


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## VFlutter (Nov 3, 2012)

NYMedic828 said:


> Because he makes a livable wage.
> 
> He makes $140,000 being classified as a firefighter paramedic. Mind you his title is firefighter with paramedic as a supplement to his training.
> 
> I make $60,000 as a paramedic. Sorry, forget that.



Just curious, how much do RNs in NYC make? I will be making around $50K as a new grad whereas non-fire medics around here make 30-40K. I am sure the cost of living is way cheaper here.


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## 46Young (Nov 3, 2012)

abckidsmom said:


> Way to sum it up, 46Y.  I am a fan of the fire-based system too.  I love being crossed-trained, I don't think that general-purpose firefighting is all that difficult to learn well, and it makes a nice diversion from running just EMS.
> 
> I agree 100% with your post, only make it a state retirement plus city pension, 90 mile commute, and 5 kids' (4 daughters') start to their lives to fund.  I love the NOVA salary on the central VA cost of living.



Same deal, only it's under an hour's commute for me


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## 46Young (Nov 3, 2012)

NYMedic828 said:


> Been with FDNY EMS nearly 4 years come January. All waiting for the promotional to firefighter.
> 
> It hasn't been a terrible experience but if presented the option again I assure you I would be sitting at a desk in school instead of staring at the dash board getting yelled at by bosses for no apparent reason.



Good to do it (college) while you're young. It's when you have kids, a mortgage, and other bills that the EMS job plus OT becomes vital, and there's no time to go back to school. That's the EMS trap - the money is just good enough, with OT or per diem work added, to keep you from going back to school. Next thing you know, you're 40 y/o and still living bill-to bill with little to no retirement savings. That's where people that say "you can survive on a medic salary if you just live within your means" get burned.


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## 46Young (Nov 3, 2012)

mycrofft said:


> 46young, I'm rooting for you, especially the OJT stuff. Keep swimning upstream because on the job injuries can take you out if all you have are street skills. Your post brightened my day.



I appreciate it. Every day I do a mobility drill I learned from a Mike Mahler Kettlebell Workshop, and do CrossFit/Paleo.


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## Veneficus (Nov 3, 2012)

46Young said:


> and I'm paced to hit $140k this year.



Can you get me a job there?


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## 46Young (Nov 3, 2012)

schulz said:


> Ya I get you. I would not say you sold out simply because you work in a fire based system right now. It is what it is. However those systems are still a part of EMS. It sounded by your previous quote your being bit hypocritical though? It seems as though you are quite happy with your career as a Paramedic right now.



I'm happy because I can work as a medic with state-of-the-art equipment, enjoy desireable working conditions, and also be financially secure.

When I first came here, I thought having an engine run with us on all ALS calls and MVA's was overkill. It still is, but now I like it that there's 5-6 people to provide pt care, carry bags, carry the pt, turn my rig around, etc, rather than just two of us most of the time. I used to take pride in the fact that my partner and I could get ALS interventions onboard really quick, and be out to the hospital in no time, just by ourselves, but having the lifting and other tasks spread aout over 5-6 people makes the job more sustainable for the long term. My body's taking maybe 1/5 the abuse it was taking on the streets of NY, maybe less, since we don't post on street corners and can exercise at the station.

The flip-flop from medic to engine, and the availability of lateral positions such as EMS Admin (education), Fire Investigations, Prevention, Peer Fitness Trainer, Fire Academy Instructor, etc, keeps EMS txp from becomeing stale, which makes for a long, happy career.

I've heard the figure of 7-10 years as being the average timeframe for burnout in EMS, and I believe that's accurate. That 7-10 years gets stretched way out where I work by dividing the labor, and performing functions other than EMS ground txp all day, every single day, for one's entire career. It's not so much that EMS 24/7/365 is boring and frustrating for the long term in it's own right, it's just that many of us need variation in our job functions. I find that particularly with A-types, doing the same thing day in and day out gets painfully boring after some time.

If EMS had a real career ladder, with ample promotional opportunites (even merit positions like ranks below officer), and more lateral positions like vehicle extrication, Swift Water, Hazmat, something like the FD's Peer Fitness, Community medics (like Wake's ACP's) and such, with fire's pay scale and retirement, I probably wouldn't have entertained the thought of leaving NY. But, that type of system doesn't exist, as far as I know, unless it's a combined fire/EMS department.


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## 46Young (Nov 3, 2012)

NYMedic828 said:


> Because he makes a livable wage.
> 
> He makes $140,000 being classified as a firefighter paramedic. Mind you his title is firefighter with paramedic as a supplement to his training.
> 
> I make $60,000 as a paramedic. Sorry, forget that.



That's a big part of it. I look at career selection from the opposite angle that many others do - I decide that a career must pay well, good bennies, etc. etc. Then, I choose from the careers that fit my criteria. It happens to be that EMS was something I thought about for a long time, and so was fire, so it just worked out perfectly. Even with all of EMS' faults, I'd still rather be on the road doing my thing rather than in a hospital, though that may change as I get older. 

When I retire from the FD, if I can't get a Chief's spot in another dept, or an OEM position, I'll try for EMS Supervisor in a Third Service or hospital. If that doesn't happen, I would be okay with being a per diem IFT medic just to keep a little busy.


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## 46Young (Nov 3, 2012)

NVRob said:


> Must be tough. I net 40k after taxes as a paramedic with no OT, albeit I make more than that because I choose to work OT....



Yes, but $60k/yr doesn't go too far in NYC where I'm from, or in LI where NYMedic lives.

You pay local taxes in addition to State and Federal in NYC, car insurance is astronomical, so is fuel, a 2 BR apartment that's not in the ghetto costs from $1500/month to well over $2000/month in even a lower middle class neighborhood. Forget about owning a house unless you go in with family for a 2-family plus rented basement, like a lot of foreigners do, where all the adults work FT while the grandparents provide free child care. Property taxes in LI can and do run north of $10,000/yr as a rule. Some property tax bills run the same as the mortgage on my $330,000 house here in VA!

$60,000/yr is practically welfare wages in NY unless you're single and living in a studio apartment in the outer boroughs.


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## 46Young (Nov 3, 2012)

ChaseZ33 said:


> Just curious, how much do RNs in NYC make? I will be making around $50K as a new grad whereas non-fire medics around here make 30-40K. I am sure the cost of living is way cheaper here.



IIRC, back in 2006-2007, it was around $35/yr inside the city, and it dropped the further out you went on LI, and I remember Stonybrook Hospital (NYS facility) offering $65k/yr.


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## 46Young (Nov 3, 2012)

Veneficus said:


> Can you get me a job there?



That's with a 56 hour/week work schedule, and maybe 20 hours/week OT/per diem work. Easy OT though, most of the time. Go in for the evening half (12 hrs), PT, run a call or two, and sleep.

The FLSA rules are where we really make out - The threshold is 212 hrs in a four week pay cycle. If I do the OT early in the pay cycle, those hours count towards that number, so I hit time and a half much sooner, sometimes 60-70 hours sooner or more. That's 1/2 time x 60-70 hours. You do the math. My last FLSA bonus was more than $1400 on top of my regular pay and OT. It all adds up nicely. Good tradeoff for getting straight time 53 out of 56 hours/week, on the average.


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## Veneficus (Nov 3, 2012)

46Young said:


> That's with a 56 hour/week work schedule, and maybe 20 hours/week OT/per diem work. Easy OT though, most of the time. Go in for the evening half (12 hrs), PT, run a call or two, and sleep.
> 
> The FLSA rules are where we really make out - The threshold is 212 hrs in a four week pay cycle. If I do the OT early in the pay cycle, those hours count towards that number, so I hit time and a half much sooner, sometimes 60-70 hours sooner or more. That's 1/2 time x 60-70 hours. You do the math. My last FLSA bonus was more than $1400 on top of my regular pay and OT. It all adds up nicely. Good tradeoff for getting straight time 53 out of 56 hours/week, on the average.



Like I said, I'll take. You can put me on a heavy rescue and never hear a complaint from me.


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## Handsome Robb (Nov 3, 2012)

Veneficus said:


> Like I said, I'll take. You can put me on a heavy rescue and never hear a complaint from me.



Time out. You don't get to jump straight to Rescue right outta the gate! Oh wait....disregard


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## Veneficus (Nov 3, 2012)

NVRob said:


> Time out. You don't get to jump straight to Rescue right outta the gate! Oh wait....disregard



I have experience. I am not right out of the gate.


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## Handsome Robb (Nov 3, 2012)

Veneficus said:


> I have experience. I am not right out of the gate.



I know, sorry poor attempt at a joke. I need to go to bed.


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## RocketMedic (Nov 3, 2012)

Heck, I'd love to move there.


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## mycrofft (Nov 3, 2012)

46Young said:


> Yes, but $60k/yr doesn't go too far in NYC where I'm from, or in LI where NYMedic lives.
> 
> You pay local taxes in addition to State and Federal in NYC, car insurance is astronomical, so is fuel, a 2 BR apartment that's not in the ghetto costs from $1500/month to well over $2000/month in even a lower middle class neighborhood. Forget about owning a house unless you go in with family for a 2-family plus rented basement, like a lot of foreigners do, where all the adults work FT while the grandparents provide free child care. Property taxes in LI can and do run north of $10,000/yr as a rule. Some property tax bills run the same as the mortgage on my $330,000 house here in VA!
> 
> $60,000/yr is practically welfare wages in NY unless you're single and living in a studio apartment in the outer boroughs.



A strong point about comparisons. Your NY dollar (or San Fancisco or Los Angeles dollar) goes far shorter than your Omaha, Portland or Bangor dollar. (And social security/medicare/insurance companies don't take that into account).
The campaigning "reformers" say all civil servants make too much. Hope they need a TOledo ambulance solmetime.


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## NYMedic828 (Nov 3, 2012)

mycrofft said:


> A strong point about comparisons. Your NY dollar (or San Fancisco or Los Angeles dollar) goes far shorter than your Omaha, Portland or Bangor dollar. (And social security/medicare/insurance companies don't take that into account).
> The campaigning "reformers" say all civil servants make too much. Hope they need a TOledo ambulance solmetime.



A top pay FDNY firefighter with some overtime here as there usually makes about $100,000 a year. Bosses and specialty companies usually do $120-160,000 a year.

In any other state that would be great wages but in NYC/LI it's enough to be comfortable assuming your wife helps pay the bills.

I pay $200 a month in car insurance alone... A one bedroom apartment in someone's basement would run me $1200 a month. Hence why I still live with my folks.


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## 46Young (Nov 3, 2012)

NYMedic828 said:


> A top pay FDNY firefighter with some overtime here as there usually makes about $100,000 a year. Bosses and specialty companies usually do $120-160,000 a year.
> 
> In any other state that would be great wages but in NYC/LI it's enough to be comfortable assuming your wife helps pay the bills.
> 
> I pay $200 a month in car insurance alone... A one bedroom apartment in someone's basement would run me $1200 a month. Hence why I still live with my folks.



Not to mention that you have to wash your clothes at the laundromat as well in most cases.


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## 46Young (Nov 3, 2012)

mycrofft said:


> A strong point about comparisons. Your NY dollar (or San Fancisco or Los Angeles dollar) goes far shorter than your Omaha, Portland or Bangor dollar. (And social security/medicare/insurance companies don't take that into account).
> The campaigning "reformers" say all civil servants make too much. Hope they need a TOledo ambulance solmetime.



This is why I say that all things being equal, try and work for the better paying department with a higher cost of living. Saving 10% of $100k is better than saving 10% of $60k. Same thing for pension multipliers. It's all about the best retirement. You can always relocate to a locale with a lower cost of living afterward.


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## 46Young (Nov 3, 2012)

Rocketmedic40 said:


> Heck, I'd love to move there.



You can. We hire from all over the country, medics preferred. We get a lot of NY, Ohio, and Florida refugees.


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## 46Young (Nov 3, 2012)

Veneficus said:


> Like I said, I'll take. You can put me on a heavy rescue and never hear a complaint from me.



There's no age restrictions here, just sayin'


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## RocketMedic (Nov 3, 2012)

whats your agency called?


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## usalsfyre (Nov 3, 2012)

Rocketmedic40 said:


> whats your agency called?



Not to step on his toes, but it's Fairfax County Fire and Rescue


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## NYMedic828 (Nov 3, 2012)

I have a pretty set plan at this point.

I was hired early enough to avoid the hits that were taken by NYC police and fire pensions. I am grandfathered into the old system that still has a 20/50 retirement with benefits for life. 75% pension untaxed if I am injured and put out. As far as my future goes, I am set. I will have just shy of 4 years in EMS come January which I can buy back by paying more into my pension and I can retire at 39 if I so choose to.

Anyone hired after me is not in the same boat unfortunately but it is still worth while.


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