# Wis. city to hire more paramedics; some EMTs take offense



## VentMedic (Oct 31, 2007)

*Read all of the article and all of the comments made before typing a response. There are valid arguments on all sides. *

http://www.ems1.com/products/ambulances/articles/317351/

*Wis. city to hire more paramedics; some EMTs take offense*

By Kay Nolan
The Milwaukee Journal Sentinel
Copyright 2007 The Milwaukee Journal Sentinel

NEW BERLIN, Wis. — In one fell swoop, by juggling city funds this year — and counting on voters to approve future tax increases — the city is about to upgrade its rescue services to rival that of larger urban areas.

If the 2008 municipal budget, tentatively adopted last week by city officials, is finalized, the city will dramatically increase the number of full-time paramedics in its Fire Department. 

Fire officials believe this reflects the public's expectation to have top-level emergency responders with paramedic certification.

http://www.ems1.com/products/ambulances/articles/317351/


> *quote from article*
> 
> But Don Hunjadi, executive director of the Wisconsin EMS Association, says New Berlin fire officials "owe the EMT basics in the state a huge apology."
> 
> "Don't get me wrong. I completely support and advocate that New Berlin should be at the paramedic level," said Hunjadi. "But to say that anything but that is just substandard, or that anything but that is just a fast ride to the hospital is just not true. While paramedics may be able to do more things, there's a lot of life-saving skills that an EMT basic can supply. Somebody having a huge, anaphylactic reaction to a bee sting or something they ate can have their life saved by an EMT basic. Someone having cardiac arrest can have their life saved by an EMT basic."


http://www.ems1.com/products/ambulances/articles/317351/


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## triemal04 (Oct 31, 2007)

Oh baby, and the first shot of the newest EMT vs Paramedic war have just been fired.  Duck and cover!  :lol:

Far as I'm concerned, if they want an ALS service, then they should do it; with a population of 38+ thousand it's warranted, though having 27 full-time medic's is going to be a bit much I'd say.    

For the rest...the comments about EMT's may not have been the nicest, but there is a lot of truth to it.  Granted the Chief should have been just a wee bit more tactful in what he said, but it's still valid.  Sorry.  

Now I'm going to watch the fireworks.  :beerchug:


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## AZFF/EMT (Nov 1, 2007)

I am an EMT in an als Fire/Rescue system and do not take offense at all. We run 5 rescues with emt/medic teams and 2 ALS engine company's in a comm. with a much smaller population than this town. having 27 medics in a 38k town i not unreasonable at all. ou can run BLS engines with ALS(2medic rescues) like some area's do. Or run ALS engines with BLS rescue's, and on ALS calls a medic rides into the hospital like some cities do. Phoenix does both of the above. Or Run ALS or ILS engines with ALS/ILS rescues. The EMT/Medic team works very well in my opinion. You both ave your roles and ALS calls the medics attends and BLS calls the Basic attends. In a way we are second rate care if it is a true ALS call the patient should have ALS care especially in a rural/semi-rural area with long transport times. We have the same issue with some volunteer's in my area who are firast responders or EMT's. Oh well times change and ALS/BLS tiered systems are a must.


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## Flight-LP (Nov 1, 2007)

triemal04 said:


> Oh baby, and the first shot of the newest EMT vs Paramedic war have just been fired.  Duck and cover!  :lol:
> 
> Far as I'm concerned, if they want an ALS service, then they should do it; with a population of 38+ thousand it's warranted, though having 27 full-time medic's is going to be a bit much I'd say.
> 
> ...



I think the time for tactfulness is over. Professional providers are starting to stand up and speak out; I for one applause them. There will be more to come, guaranteed. The public wants the best quality of service and care available. That is ALS, period. I think this will also serve as a wake up call for many services too. Perhaps they will give more consideration to educational assistance so there EMT's can better themselves and advance their knowledge and certification.........................


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## VentMedic (Nov 1, 2007)

Growing pains.  Almost every community will experience it in some form sooner or later.

I did not post this news article to incite an EMT vs Paramedic fight. There is something to be learned with good manners, tactfulness and from the mistakes of others.  Reading some of the comments on other threads, I would hope that if any one of you are ever given the opportunity to publically express themselves they will excercise diplomacy and respect for others. There's more than just yourself involved when you work in EMS. 

I grew up in South Florida. The area that now looks like one big city covering 3 counties used to be many small communities with small ambulance and fire companies (volunteer, paid, mixed). Everybody was considered a neighbor and if you needed an ambulance, chances are you knew the EMT or their family.  The FDs were strickly fire.  Many communities also had Public Safety LEO/EMTs. 

In the late 1970s and early 1980s more paramedics were graduating from the local 2 year degree programs and a few State tech or college certificate programs.  The PDQ Medic Marts came in the mid 1980s. The fire departments started running ALS response vehicles with the BLS ambulances transporting. Eventually the FD started to transport their own ALS patients. 

All of South Florida experienced a population boom. The tax base and structures were changing at the local, municipal, county and state levels. Paid ambulance services started to replace the volunteer services.  Corperate ambulance services started to move in. Even one of the nation's biggest private service (Schaefer - LA was one of the largest at the time) was feeling the effects of EMS coming of age. Although, it was still a special treat for me to still see a couple of Cadillac's in the yard that had been active until the mid 1970s. The photos of a fleet of cadillac ambulances responding the the 1972 Eastern Flight in the Everglades are incredible.  This ambulance service has now be sold to AMR also.  The end of many decades of service by a family owned company. 

The local FD gave way to "THE COUNTY".  ALS was the buzz word. Times were changing and quickly. For a while in the late 1980s, South Florida EMS was more 'potluck' for its variety of different services as it was developing.  

Florida is still growing and changing.  However, tt is still nice to remember how it started. Too quickly we forget the heated debates that took place in the town halls and Fire Stations throughout the region. Too many young people are not aware of how their systems came about.  

In 1980, if someone had told me I would be working in Flight Medicine, I would have been thoroughly insulted. At that time that was one of the worst means of transport. Nothing glamorous or high tech about it at all.  I just saw the Vanderbilt Flight video. We have come a long way.  

I do hope that this little town in WI gives the EMTs a chance to advance their education. This could actually be a lucky break if they can get their paramedic education paid for with time allowed on the clock to do so. This may be the incentive needed to move on.  The town would be wise to retain the experience these EMTs have in some way. 

Change is inevitable for many areas. Although, there will still be the very rural  regions where you can call anybody that lives within 5 miles of you a neighbor. In many ways we are still lucky to have them and the values they possess.


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## Summit (Nov 1, 2007)

BLS care is not in and of itself substandard.

BLS care is substandard care for a patient who needs ALS care.

If BLS is all you have then it is all you have and you do the best you can with what you have, but an ALS patient care standard is ultimately not being met.


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## firecoins (Nov 1, 2007)

Being an EMT-B is a pre-requisite for being a medic.  Usually a year is required,


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## VentMedic (Nov 1, 2007)

firecoins said:


> Being an EMT-B is a pre-requisite for being a medic.  Usually a year is required,



Work experience as an EMT-B or to even be certified as an EMT-B is not a pre-req for Paramedic classes in some states.  Most states and educational programs would prefer you have an EMT-B card when you start classes. But, not having the card may not keep you from enrolling.  You may need it just prior to paramedic clinics. 

Many of the private tech schools offer the whole educational experience in one "easy to pay package deal".


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## firecoins (Nov 1, 2007)

VentMedic said:


> Work experience as an EMT-B or to even be certified as an EMT-B is not a pre-req for Paramedic classes in some states.  Most states and educational programs would prefer you have an EMT-B card when you start classes. But, not having the card may not keep you from enrolling.  You may need it just prior to paramedic clinics.
> 
> Many of the private tech schools offer the whole educational experience in one "easy to pay package deal".



It is a pre-req here in NY and should be a pre req everywhere.


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## BossyCow (Nov 1, 2007)

In my county ALS is the exception not the norm.  And in one particular district, after loss of an EMS levy, they went from ALS to a BLS provider.  Be wary of determining what is a trend in an urban area as the norm for everywhere.


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## Flight-LP (Nov 1, 2007)

firecoins said:


> It is a pre-req here in NY and should be a pre req everywhere.



I have to disagree with you. If you look traditionally at many EMT's, you will find that delaying their education onto the Paramedic level is a prime cause of their career stagnation in remaining an EMT, sometimes for life. Plus it affords an EMT to develop bad habits only to have to fight them once in Paramedic school. I too thought that experience was the key to success, now I am not a believer, as I have seen to many bad habits, bad attitudes, and what I willl term an "inferiority God complex". Go all the way through, get the education, provide the highest level of care you can. Don't short-change yourself, you may regret it later in life..........................


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## Ridryder911 (Nov 1, 2007)

What do you have? 
Basic EMT that works for five years as a Basic then attend Paramedic school, graduates= rookie Paramedic

Student goes through Paramedic school, graduates and gets five years experience= F.T.O. or Supervisor of the former EMT. 

All will get experience on the job. Performing basic care is not rocket science, is experience nice- you bet! Is it essential- NO! 

Too many place too much emphasis on the basics is so complicated, there called basics for a reason. It is just part of the care of the patient. In reality, there is no basic or advance, just treatment. 

R/r 911


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## Guardian (Nov 2, 2007)

Great post Vent!  I’m pleasantly surprised they knew the difference between ALS and BLS and were willing to demand and fund it.  I hope to see more of this in the future.





firecoins said:


> It is a pre-req here in NY and should be a pre req everywhere.




Most experts disagree.  This is an antiquated way of thinking.  NY EMS is very bureaucratically antiquated in their way of thinking about EMS and everything else.  There is a misconception (from laymen and New Yorkers especially) that NY has a great EMS system.  The rest of the world who know anything about EMS, know this isn’t true at all.  I don't mean to bash any particular system, but when I see a misconception, I am compelled to speak out.  “You should do _____ because NY EMS does it” is a horrible reason and actually discredits your opinion or argument.


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## reaper (Nov 2, 2007)

This one blows my mind even more!

http://m.greenvilleonline.com/news.jsp?key=121123&rc=op

This is what you get when bureaucrats get involved.


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## Guardian (Nov 2, 2007)

reaper said:


> This one blows my mind even more!
> 
> http://m.greenvilleonline.com/news.jsp?key=121123&rc=op
> 
> This is what you get when bureaucrats get involved.



They are approaching this problem from a practical standpoint.  They are not thinking about our profession's future and employee moral, etc.  I would love to advocate 100% double paramedic ambulances.  But then I think about how well my P/B system works, especially in the urban environment.  I can't make up my mind.  I would love to read other input on this subject.


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## firecoins (Nov 2, 2007)

Guardian said:


> Most experts disagree.  This is an antiquated way of thinking.  NY EMS is very bureaucratically antiquated in their way of thinking about EMS and everything else.  There is a misconception (from laymen and New Yorkers especially) that NY has a great EMS system.  The rest of the world who know anything about EMS, know this isn’t true at all.  I don't mean to bash any particular system, but when I see a misconception, I am compelled to speak out.  “You should do _____ because NY EMS does it” is a horrible reason and actually discredits your opinion or argument.



This makes no sense at all. I never said anything about NYS systems versus other systems.  I commented on education not on NYS systems. NY has many different systems based on locality to boot. You see it makes no sense to compare many different NY systems to where ever you are.  Which NY system is good, bad or better than yours?  The medic programs all require you be an EMT for a year but they care if you got the experience in AZ, FL, Il, MA or elsewhere.      

Being an experienced EMT greatrly advances one's knowledge.  I get more out my rotations than an inexperienced EMT is still learning the basics while I am mastering them.  I don't have to waste time on the BLS skills because I have them down pat.  I have have had the excperience of working alongside medcs where an inexperienced medic. How does being from NY discredit this?  It doesn't. Programs in NYS require this and they should everywhere. Not because its doen in NY but because it improves the quality of the medics graduating.


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## firecoins (Nov 2, 2007)

> The difference between EMTs and paramedics is simple: Paramedics are able to administer some medications and perform advanced life-saving procedures such as intubation and cardiac procedures, while EMTs are not. But seldom, if ever, are two paramedics from the same crew required to perform those tasks on a given call.


The person who wrote this never worked a code.  Its always nice to have 2 medics on a code.


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## Guardian (Nov 2, 2007)

firecoins said:


> It is a pre-req here in NY and should be a pre req everywhere.



I feel like I'm always explaining myself, and here we go again...

Lets break down your original post.  You start off with "it is a pre-req here in NY"  Why would you put NY into your sentence?  Why not just say "it is a pre-req where I live" or simply "it should be a pre-req everywhere."  You put NY into your sentence because you were trying to give your opinion some much needed legitimacy and authenticity.  You were trying to put some weight behind your opinion.  By putting NY into your sentence, you were implying that "NY does it, so you'll should too, because we all know how great NY EMS is"  I simply wanted to point out, that most ems experts look down upon NY EMS in general.  Notice, I didn't point out a specific town/county/city.  Just, in general, their systems suck (for the reason I gave in the last post) and we all know it.  Now, what specific areas were you talking about when you wrote the original sentence?  Hope this made more sense to you.  Whenever you need something broken down, just let me know.


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## firecoins (Nov 2, 2007)

Getting experience should be a prerequiste everywhere as it is in NY.  Not because NY is better but because experience is better.


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## VentMedic (Nov 2, 2007)

firecoins said:


> Getting experience should be a prerequiste everywhere as it is in NY.  Not because NY is better but because experience is better.



The work experience as an EMT varies from employer to employer and with the initiative of the employee.  Too often, as evidenced by some posts, EMTs do not take advantage of the potential experience they could get even doing routine transports. Too often, EMTs enter Paramedic school and still can not properly take a BP or get an adequate history.

I would like to see the Paramedic student being taught in a structured curriculum that allows students to utilize skills as they get them.  If the Paramedic program was a 2 year degree, there would be the opportunity to do 4 - 6 semesters of clinicals. Whereas, the Paramedic program now on an average in the US is approx 1100 hours total. This is the number for just the clinicals in other professions.  Some professions, after the degree graduation, require an extra semester of supervised interning at a facility before they receive  permission to sit for their boards.  Structured clinicals would better ensure experience is gained at all the levels and not depending on the hit and miss of work experience.


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## firecoins (Nov 2, 2007)

VentMedic said:


> The work experience as an EMT varies from employer to employer and with the initiative of the employee.


yes, as oppossed to having only an 8 to 12 hour shift required from EMT-B class.   Any experience is a plus.



> Too often, as evidenced by some posts, EMTs do not take advantage of the potential experience they could get even doing routine transports.


Your correct. Many of us hate transports. But transports are good experience.  



> Too often, EMTs enter Paramedic school and still can not properly take a BP or get an adequate history.


 This is the fault of a horrible EMT class.  It stengthens my point on experience. People with good experience will learn to do these things.  



> I would like to see the Paramedic student being taught in a structured curriculum that allows students to utilize skills as they get them.  If the Paramedic program was a 2 year degree, there would be the opportunity to do 4 - 6 semesters of clinicals. Whereas, the Paramedic program now on an average in the US is approx 1100 hours total. This is the number for just the clinicals in other professions.  Some professions, after the degree graduation, require an extra semester of supervised interning at a facility before they receive  permission to sit for their boards.  Structured clinicals would better ensure experience is gained at all the levels and not depending on the hit and miss of work experience.


  Paramedic programs often have a very low admissions criteria allowing anyone into the program who has them money.  I love the rotaions I do for my paramedic program.  Wish I had more of them.


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## Ridryder911 (Nov 2, 2007)

When describing having experience is really pointless. If one describes having experience, what does that really mean? One would have to evaluate the type of service, run volume, type of calls, progressiveness of the service, etc. For example, I know of many that work on metro units that respond to 15 calls in 12 hours, yet have poor experience, basically all load and go. The opposite in some rural areas that one may have to perform multiple drips, etc.. or maybe in rural are with little exposure. So stating one has experience means nothing. 

I suggest residency requirements after graduating from Paramedic school, similar to physicians. NREMT used to have provisional requirements (6 months)at the level one tested for before receiving certificate, patch, etc. Shame that was removed. If one had a residency requirement of being supervised under a Paramedic after graduation for a year, then would we see a change of gaining experience and implementing their knowledge and skills. 

As well, many EMS companies now prefer to hire those with no prior experience. I know of many. They much rather "mold" their employees, and have those without previous baggage or "bad" habits. 

Personally yes, I can detect those without experience and those with in a classroom and in the field. Is it crucially essential one has it before Paramedic school? Recommended but not crucial. There has been thousands that have graduated from programs that went straight into the field without difficulties. 

I much rather see that requirements such as science, reading, mathematics be installed than experience. All will get experience when they become employed. Being a Basic for a certain amount of time, without specific criteria does not change anything. 

R/r 911


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## firecoins (Nov 2, 2007)

Here is what I was asked:  How long have you worked as an EMT?  Volunteer or paid? What was you call volume?  Was it 911 or transport?  Can you get a letter from your employer verifying this? It isn't hard for a paramedic program to gage you experience.  The several medic programs in my general vicinity all require a minimum of a year of one kind or another.  They are looking for people who have had the opportunity to run calls of one nature or another above and beyond having taken the EMT course. I think we all agree that 1 12-hour rotation is not enough to be an EMT-B.  So all EMS experience is good.  

I don't see any problems with adding science requirements on.  A&P I & II were requirements.  Medical terminology is a co requiste for some programs.  Bio I and Inorganic Cehm I should be requirments.  College Algebra, Precalclus, Stats could arguably be added.  Legal writing would be a nice class.  Criminal Investigations can be added.  Fire Science/Haz Mat classes would be nice as well.  A nice mix of classes can arguably be added pre-req or co-req.


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## BossyCow (Nov 2, 2007)

From an administrative point of view, looking at it from a fiscal and risk management perspective, an EMT-P can do BLS and ALS.  An EMT-B can only do one of them.  So, having a purely ALS response eliminates the possibility of having a BLS rig respond to a call that turns out to need ALS.  This can happen in multi-tiered response agencies.  

Having the highest level of care available to all is definitely the optimum.  However, due to the requirements of ALS being fully staffed 24/7, those outlying rural areas may not see it anytime soon. 

I get to see this from both sides, being a volunteer EMT-B with a rural response agency, but married to a civic career FF/EMT-P. Staffing levels at the civil agency are the biggest concern at every union contract negotiation. 

I agree the trend should be towards a higher standard of care for all.  But, until then, I will keep renewing my EMT-B and doing what I can.  I guess I just can't quit my day job!


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## Ridryder911 (Nov 2, 2007)

I believe that we allow too many into the Paramedic programs. I realize some areas have "entry requirements: however; that is an exception. Usually, as long as one has the $$ and has completed Basic EMT, they are generally accepted. 


I would think having a harder entry point, one would see a change in the type of student we have and the type of Paramedic we produce as well. A point system based upon variable requirements one could have accomplished. Experience would be a number, additional complimentary courses would be additional points, etc. Anatomy and physiology (collegiate level) should be mandated before entry into advanced level courses, as well upper level scores on pre- health occupational exams such as HOBIT, Briggs, Nelson Denny, etc. 

Any program not requiring such is asking for failure from students. Understanding the base levels of reading, science, comprehension helps instructors know about their students needs. Instead of teaching physiology and anatomy should be a review in Paramedic class, thus allowing more time to teach and study patient care. 

Ironically, if EMS was union or had more political action, similar to other health care professions, the cities would never even consider or reducing the number. 

R/r 911


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