Rant about how much volunteers are hurting our profession

[Ridryder911]

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

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

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

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

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

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

Yeah, thought so.

R/r 911

 

[medic417]

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

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

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

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

 

[scottyb]

From an insurance definition website:

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

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

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

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

 

[medic417]

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

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

 

[scottyb]

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

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

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

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

 

[emtjack02]

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

 

[Ridryder911]

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

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

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

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

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

R/r911

 

[PapaBear434]

Yeah, thought so.

R/r 911

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

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

 

[akflightmedic]

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

Yeah, thought so.

R/r 911

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

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

What if they did it for free as Rid mentioned?

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

So why do we?

 

[Ridryder911]

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

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

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

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

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

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

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

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

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

R/r 911

 

[PapaBear434]

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

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

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

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

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

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

 

[mycrofft]

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


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

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

Money. Can't afford it.

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

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

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

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

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

Rant over.:blush:

 

[PapaBear434]

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

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

What if they did it for free as Rid mentioned?

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

So why do we?

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

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

 

[PapaBear434]

"Flying Fig Newton Club"

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

 

[mycrofft]

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

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

 

[akflightmedic]

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

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

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

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

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

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

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

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

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

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

 

[medichopeful]

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

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

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

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

 

[medichopeful]

Disregard.

 

[PapaBear434]

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

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

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

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

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

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

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

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

 

[medichopeful]

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

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

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

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

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

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