Advancing EMS & Paramedicine

[triemal04]

<stops episode of hypergagging> There. Now maybe something constructive can come out of this instead of the sameoldsameold. Want to change EMS for the better? The solution is real easy; it's implementing that solution that is the hard part.

1. Mandate that all state's adhere to a national standard for levels of EMS providers, preferably not more than 3 and maybe even 2, at least initially. Benefits to this is it would allow people to move from one area to another without the difficulties we currently have, allow for more federal funding/reimbursement since it'd be much easier to understand what we are/do.

2. Raise the educational standards and enforce them at the state and national level; 3-yr AAS degree as the entry level for a paramedic. Benefits would be people in it for the thrill would be weeded out, and, with everyone having a degree the ability to get a higher reimbursement rate from medicare would become a reality.

2.5 Raise the pay for paramedics to an appropriate level. More education equals more responsibility, and more education can, as seen above, equal more federal money which could be turned into higher wages. Benefits would be people would stay for a career instead of leaving for better pay.

3. Create both a union for paramedics, and a national body that also works for the advancement of the profession; think IAFF (union) and NFPA (nat'l org). Both have done wonders for the fire service...think maybe it could also be done for EMS? Benefits would include the ability to lobby at the state/national levels, have people actively working to advance and protect EMS, and have the ability to bargain for contracts and be protected as an employee.

4. Remove non-emergency transports from being associated with EMS in anyway; use it as a 911 service and emergency transport service only. Benefits would be, again, people would be able to understand what we do without the current fragmentation, people starting out would not be exposed to things that burn them out and turn them into poor providers, and the various levels of providers would be used in the appropriate way.

Those are just the most obvious, and all have many more benefits that I've listed here. Unfortunately, as I've said, it's not coming up with a solution that's hard, it's implementing it.

 

[triemal04]

An RN making only $30/hr? It is time to raise their education standard since the PTs, OTs and SLPs have passed up the RNs and RRTs, who only hold a mere Associates, in wages and bonuses. This is the reason why the RRTs have already petitioned for expansion of scope privileges, as it pertain to reimbursement, in other areas outside of the hospital such as clinics.

As an aside, and playing a bit of devil's advocate, but do you think it's appropriate for someone fresh out of school to be making $30/hr (last RN I met started at $32)? With everyone involved in healthcare wanting, justifiably or not, to make great money and have a high paying job, how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?

 

[VentMedic]

As an aside, and playing a bit of devil's advocate, but do you think it's appropriate for someone fresh out of school to be making $30/hr (last RN I met started at $32)? With everyone involved in healthcare wanting, justifiably or not, to make great money and have a high paying job, how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?

New RRTs and RNs start at $28 - $32/hour in my area. On the West Coast, specially in CA, they can start at $45/hour.

how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?

I still don't make anywhere near what my techie or accounting friends make.

If you believe that contributes to the high cost of health care then why support advancing the education of Paramedics and unions? The increase in pay will eventually follow. Are you also in favor of Paramedics walking off the job for every little labor dispute? Everytime the RNs and RRTs walk off their jobs in CA for a union called strike, some RNs/RRTs from the other states get an all expense paid "vacation" to CA to make some incredible wages for 10 days. How does that save money if Paramedics were to do the same thing for their strikes? I sure there will be just as many wanting to do coverage for the bonuses just as the have for previous strikes in some areas.

A strong national organization would be most appropriate. I linked a couple of organizations earlier that could easily expand if EMT(P)s took an interest and they already have established links in government.

 

[reaper]

I agree.

A National Organization is best. No need for a union.

 

[triemal04]

New RRTs and RNs start at $28 - $32/hour in my area. On the West Coast, specially in CA, they can start at $45/hour.

I still don't make anywhere near what my techie or accounting friends make.

If you believe that contributes to the high cost of health care then why support advancing the education of Paramedics and unions? The increase in pay will eventually follow. Are you also in favor of Paramedics walking off the job for every little labor dispute? Everytime the RNs and RRTs walk off their jobs in CA for a union called strike, some RNs/RRTs from the other states get an all expense paid "vacation" to CA to make some incredible wages for 10 days. How does that save money if Paramedics were to do the same thing for their strikes? I sure there will be just as many wanting to do coverage for the bonuses just as the have for previous strikes in some areas.

A strong national organization would be most appropriate. I linked a couple of organizations earlier that could easily expand if EMT(P)s took an interest and they already have established links in government.

There's loads more jobs that pay more than anything in healthcare, but this isn't about them right now. I don't really know how much, if any the high pay contributes to the high cost of healthcare, like I said, a lot of this is devil's advocacy; I want to know what others think. And I'm for increasing the pay for paramedics because it's not at appropriate levels, and, if educational standards were increased it'd definitely not be at an appropriate level (for many places, not all currently). But, be honest. If it was shown that the compensation paid to healthcare workers was high enough that it contributed to the high cost of healthcare, what would you suggest doing?

Personally I'd like to see EMS run the same as fire/police; as a publically funded service. Of course, that generally entails them being prohibited from striking, but...oh well. That type of thing is a last resort anyway, and, in this line of work, would do more harm than good. There's better options to explore before even considering that.

Yes, things like NAEMT would be able to do more...if they had more support. But like I said, coming up with the solution isn't the hardest part, it's implementing it. And really, before anybody was to even consider lobbying at the national level, EMS needs to become a standardized group, which...could be an issue.

 

[VentMedic]

Yes, things like NAEMT would be able to do more...if they had more support. But like I said, coming up with the solution isn't the hardest part, it's implementing it. And really, before anybody was to even consider lobbying at the national level, EMS needs to become a standardized group, which...could be an issue.

Advocates for EMS and the physcian/state officials/educators organizations have decent representation.

With any luck the new education levels will chop away at the 50+ certs among the states.

I just wish some would show more interest at the state and national conferences. These conferences might even attract more heavy hitters for the legislative issues. However, unless placed on the main floor of the conference rather than an obscure break out session as some are now and often in the managerial track, the attention is not there.

I also believe the education level for instructors should be increased before anything else. There will of course need to be educators with higher education if standards are ever increased. The lack there will be what may hold EMS back from obtaining the goal of a 2 year degree.

 

[triemal04]

Advocates for EMS and the physcian/state officials/educators organizations have decent representation.

With any luck the new education levels will chop away at the 50+ certs among the states.

I just wish some would show more interest at the state and national conferences. These conferences might even attract more heavy hitters for the legislative issues. However, unless placed on the main floor of the conference rather than an obscure break out session as some are now and often in the managerial track, the attention is not there.

It's not just having people sign up, but having the ability to get your voice heard and effectively lobby people/groups at all levels that makes an organization effective, having people out working on it; once it's determined that you do represent the group you claim to, do know what you are talking about, and are working to better not just your constituents but laypeople as well, it get's much easier; look at the NFPA.

I have been following along what happens in EMS at the state level, and, (I will almost guarantee that this will apply to many states as well) the new EMS standards won't fix a damn thing. There is nothing that mandates that the new standards are followed; as long as a state doesn't care about NREMT status, there is nothing to prohibit them from keeping their own levels. Personally I think a better way to have done this was make it so that medicare/Medicaid would only reimburse services that followed the new levels (course currently you'd have to allow exceptions for states that exceed the new standards) and that federal monies for EMS would only go to states that followed the standards. That's a pipe dream though.

Anyway. Not trying to be a ****, but I am curious. Do you think that the high payrates for healthcare employees contributes to the high-cost of healthcare? And if so, what should be done to fix it?

At this point the thread is so fragged it might as well go anywhere...

Edit: Yeah, whoever is doing the teaching should be at least one step up on who they are teaching, that goes with increasing educational standards. Want to teach an AAS course? Better get a BA. Teach a BA course(s)? Get a masters, and so on.

 

[VentMedic]

Anyway. Not trying to be a ****, but I am curious. Do you think that the high payrates for healthcare employees contributes to the high-cost of healthcare? And if so, what should be done to fix it?

That is difficult to say especially with the U.S. health care system. As well, the wages for RNs, RRTs and FFs in parts of FL and CA are barely a living wage even though they seem ridiculously high for some. Health care professionals still can not always afford the nice homes that their accountant has. But then, the accountant entry level education is no less than a 4 year degree and usually a Masters. Paramedics with SFFD make about $75K to start. This is just at a minimum living standard in that area. Those that work with lower paid services commute from areas less expensive.

I would like to say yes but then I know that what the front line workers are making such as the RNs, RRTs, PTs, EMT(P)s is just a drop in the bucket compared to what others that control the companies they work for are making along with the many perks. Health care is no different than the financial industry which benefited some but not the front line employees who sank with businesses.

 

[MrBrown]

I agree.

A National Organization is best. No need for a union.

Sure there is; industrial employer/employee relations are seperate from any national regulatory body; for example here the Police and Professional Firefigters Association's (police union) is seperate from the Police and Fire Service, respectively.

I also believe the education level for instructors should be increased before anything else. There will of course need to be educators with higher education if standards are ever increased. The lack there will be what may hold EMS back from obtaining the goal of a 2 year degree.

I agree. You won't find an instructor on the paramedic degree here who doesn't have at least a Masters and often most have a PhD.

 

[Level1pedstech]

As an aside, and playing a bit of devil's advocate, but do you think it's appropriate for someone fresh out of school to be making $30/hr (last RN I met started at $32)? With everyone involved in healthcare wanting, justifiably or not, to make great money and have a high paying job, how much do you think that contributes to the problems we have today with healthcare; the high cost of it I mean?

Just for the record the new grad RN I was speaking of started at 30.00p/hr working in a small level 3 ER in a semi rural area between Eugene and Portland where the wages are historically lower. The cost of living is much less than it would be in the Portland or Seattle are. She seemed very happy with the money and the chance to work as an ER RN right out of school in the area where she wants to live, I call that a win/win situation. New grads are finding it hard to find any work and the chances of landing a position in the ER right out of school does not come up everyday.

 

[Level1pedstech]

I skipped over the meat of your last post, as will I this one, because in my opinion it does not even deserve a response. I am a patient advocate first. I am currently a few months away from an A.S. in paramedic studies, and will probably be applying to Loma Linda's B.S. in Emergency Medical Care. I do this with the full knowledge that it by itself will not increase my salary.

After having a AS and BS in EMS, I will make just as much as the guy with the certificate paramedic school education, who started working when I did.

Also, what does any of this have to do with adding public health responsibilities to southern california fire paramedics who make over 100,000 a year to sit at a station?

I'm sorry you don't consider my questions and concerns worthy of your response. This is a discussion board and your participation although welcomed is of course not mandatory but for the record I do value your input. Try as you may you have nothing to offer and I make an arguement that you cannot break. Let me take a stab at what I think you have in mind and lets see how close I get.

In your world there should be a certain segment of the population that are willing to step up and put two to four years (or more) of time and money into their EMS education. After spending all the time and money they should in the name of patient advocacy accept what at least in the current market are far from family friendly wages. I mean if you really care about your patients why should you worry about providing a decent standard of living for yourself or your family. In the mean time while were waiting for all these "patient advocates" to step up and accept the challenge the system further deteriorates and quality of care sinks to an all time low. Once again its a solution that puts the horse before the cart and will not work.

I have tried several time to get someone to provide some answers to the low wage question but all I see is "we need higher levels of education" and of course the few who have to chime in with "it's not all about money". Both camps are living in a dream world and I suspect are made up largely by a segment of the population that are very young and have no real world experience. I am very careful to point out that I know there are some "seasoned" people that contribute here and I respect and highly value their opinions. I admit there will always be people who are willing to do the job for less money for whatever reasons but you will not be able to attract the large number of high quality providers you need unless you come up with an answer to the the low wage question. I'm sure you will not find any of this worthy of your response, I understand you you have no answers but thanks for being a good patient advocate.

On the subject of adding public health duties to the fire service. You say you hang out at LA County fire stations, have you brought the subject up with the guys around the kitchen table? I bet I know the answer to that one. It has taken years for the fire service to accept any type of "nurse" work, there are places where fire is fire and many believe there is good reasons for that but we don't want to start beating that horse now do we. I don't see it going over very well when you inform the line guys that they are now in the clinic business and will be "nurses" when their not running calls, I would love to be there when you present that idea to a room full of hardcore firemen. Nice try but I think not and I hope your able to run and run fast. Why do you have a problem with fire making 100,000 a year anyway, don't you think there are times when that money is truly earned like when their pulling one of those poor taxpayers out of their burning house or any of the many duties that put them at risk. I forgot we should all be advocates and should be happy doing what we do for as little as an employer is willing to offer, pass the free government cheese please!

 

[VentMedic]

I have tried several time to get someone to provide some answers to the low wage question but all I see is "we need higher levels of education" and of course the few who have to chime in with "it's not all about money".

This has been answered many times in many different threads. You also seem to make it sound like the Associates degree is equivalent in time to med school. It is just 2 years...not 4, not 6, not 12 years.

Once a standard of education is established, EMS can petition to be reimbursed as a professional rather then general tech level. This is what the other professions have done rather successfully. Right now with 50+ different EMS certs varying in a few different "hours of training" there is not concrete definition to even give legislators as to who or what EMS providers are since it can vary from one county to the next for what a Paramedic is even called or what test is recognized for certification.

making 100,000 a year anyway, don't you think there are times when that money is truly earned like when their pulling one of those poor taxpayers out of their burning house or any of the many duties that put them at risk.

Due to improved construction, the numbers of fires have decreased dramatically over the past few years. Thus, FDs are scrambling to fine other ways to fill the void. Some leaders in the FDs actually see a time where some FDs may be slimmed down much more due the advancements in equipment and construction.

 

[Level1pedstech]

This has been answered many times in many different threads. You also seem to make it sound like the Associates degree is equivalent in time to med school. It is just 2 years...not 4, not 6, not 12 years.

Once a standard of education is established, EMS can petition to be reimbursed as a professional rather then general tech level. This is what the other professions have done rather successfully. Right now with 50+ different EMS certs varying in a few different "hours of training" there is not concrete definition to even give legislators as to who or what EMS providers are since it can vary from one county to the next for what a Paramedic is even called or what test is recognized for certification.



Due to improved construction, the numbers of fires have decreased dramatically over the past few years. Thus, FDs are scrambling to fine other ways to fill the void. Some leaders in the FDs actually see a time where some FDs may be slimmed down much more due the advancements in equipment and construction.

I want daedalus to give me my answer, he seems to have the whole thing figured out. I do know the years involved with the various degrees and what a person should expect in the way of (fair) compensation. Asking for people to spend four years in school and then expecting them to work for 15.00 p/hr is a joke. You will never get the privates to pony up the wages at least not without union representation. I do know of a few privates with good city contracts that pay a livable wage but they had those contracts negotiated by the teamsters. Like the union or not they do get results..

I was told by daedalus earlier in this thread to quit while I was ahead, whats that supposed to mean. Is he going to pull out the books he sitting on to reach the keyboard and start throwing them at me. I have grown tired of the condescending tone that comes with many of this "patient advocates" posts, I know there are others that feel this way but they don't have the stones to step up. Listening to someone with a head full of fresh text book material and very little real world experience drone on about how much the system needs fixing and what suffering our patients must be enduring due to our lack of education is just unbearable. I don't have as many years in as you vent but I have enough to know how to deal with people in a tactful and nurturing manner. Talking down to people with less education than you is rude and really unproductive. Not everyone is in the position to spend 2-4 years in school especially those in the volunteer ranks. If he is so bothered about the lack of education with us EMT's and the possible negative effects it could have on our patients maybe he should stay off this board and go to a site that's more accommodating to his educational pedigree. I have paid compliments to daedalus and I applaud his efforts and wish him no ill will but no one tells me to quit while I'm ahead especially not some snot nosed rookie.

 

[triemal04]

Well this has gone downhill in a huge hurry and is leading up to yet another episode of hypergagging due to the same old BS that comes around again and again. But before that happens-

Level1pedstech- Yes, I do agree that having a union to represent the employees is definitely a way to help increase pay, benefits, safety, standards, etc etc; wouldn't belong to one if I didn't. But, while increasing educational standards isn't the only thing needed to change pay rates, it will help. Continue for more.

Say the standard for a paramedic becomes a 2-yr degree (nationwide). With that requirement, people will most likely not be willing to work for lousy wages; if a service doesn't have any prospective employees, then eventually the wage will rise. Not overnight, but it will happen. Look at Oregon; while the average starting pay isn't where it should be, it's higher than in many places, and many of the places starting at low rates are tiny services.

With a degree as the minimum education it'll become easier to get full reimbursement from medicare for services rendered; right now the average is medicare paying between 30-40% of the bill nationally. That's not good, especially when medicare accounts for a huge (roughly 75% in my area) part of how pt's pay. More money coming in means there is more ability to pay medics more; right now a true 911 only service doesn't make a lot of profit.

With a degree it becomes easier to demand more money from larger corporations/services; the whole "we know more thus do more thus deserves more argument." Easier to back up when you have some letters after your name.

These are just a couple of examples, there are more out there. Is that a bit clearer?

 

[jgmedic]

BBQ and watch movies, is that what you really think?. I should probably stop now but what the hell, you need some educating. Do you have any idea what goes on at a firehouse in the course of a twenty four hour shift or do you and the others just tow the anti fire line. Maybe try a ride out and you will see that alot gets done before downtime activities like BBQ's and movie watching. Training,drilling,house duties and PT are just a few things that come before downtime activities. By the way during the day the public is always welcome to pop in for a BP check. It would be hard to have the fire department function as a walk in clinic and do more public health duties because they have to be able to do this little thing called responding to calls. I don't think leaving a house full of public health recipients while the crew responds to a call is going to go over real well with the white shirts.

I know you want more education and that's great,you can increase standards and education for prehospital providers all you want but who is going to do the job for 15,00 p/hr. Your never going to get the pay or respect out of the privates. Why do you think scab outfits like AMR manage to hold on, its because they are able to function mostly with medics that cant get on with fire. Why would you work for 25,000 p/yr with a private when you could work for 60,000 plus with fire. I'm sorry I just don't get it, maybe you could explain to us how your going to get the privates to step up and offer decent wages and benefits (like fire) to these folks after they get this great education you are proposing.

I understand not everyone wants to go fire but many would if they could do something as simple as passing the physical ability portion of the process. If chairman maobama and the rest of his party have their way and succeed in destroying our health care system, you after spending all those years in school might find yourself begging for a job as good as a firefighters. I will close by saying I think your a sharp kid and I know your going to go on and do great things but you and the other higher education folks really need to think things through and figure out how you are going to reward people for putting in years of education..

Dude, really? you think that AMR pays so low because they can function with medics who CAN'T get on with fire. Come on, they function at low pay because of all the medics who use it as a stepping stone to fire, which I totally understand, being as that is where the good pay and benefits are, but typecasting private medics as a bunch of fire wannabes is ridiculous. The privates don't have to pay because they know a majority of their employees are looking for the first way out.

 

[Level1pedstech]

Over the last ten tears I have seen many medics rotate through my departments ALS transport agency as well as through the doors of the ED. Looking back at what I have seen I think I am comfortable with my statement. What about you, how many years have you been following trends in EMS. Have you ever talked to any AMR medics or maybe your an AMR medic and know I speak the truth. I never type casted anyone and am well aware that there are medics that are happy being private service medics but at least in my dealings they have been the exception not the rule. If you want to throw into the equation a handful of people that move on to better paying medic jobs that's fine.

Not all fire service medics have fire suppression duties (the reason most folks avoid fire), there are agencies that have separate EMS divisions that offer the same great pay and benefits but you still have to get by that pesky PAT or its watered down little sister the CPAT. Have you ever tested out with any medics, they are a group that in general are not the picture of health and fitness. Its been several years for me so maybe things have changed but I doubt it. So yes I do think agencies like AMR are able to function in large part because they have many people who would move into fire if they could but for whatever reasons cant or wont make the transition.

 

[daedalus]

I want daedalus to give me my answer, he seems to have the whole thing figured out.

You place too much faith in me, sir. You asked for a response, and one you shall receive:

Fire Departments will be slimmed down and streamlined to be able to provide at least some sort of response to most areas of their districts. I would imagine most departments would lose around 90 % of their workforce and operational capacity under the daedalus-all-figured-out-plan. I would fire the fire fighters. EMS would take direct control of remaining fire operations, and the firefighters would be under the command of a paramedic with no cross training. Eventually we will phase out the fire operations altogether and just put fire extinguishers on all ambulances instead. After the firefighters are all finally laid off, I would bring a massive lawsuit against all of them to require them to pay back all wages earned plus interest back to the public, and use most of this money to hire new paramedics.

 

[firetender]

A Dinosaur's Perspective

Nursing is an old profession. It has been around for a long time. EMS has also been around for a long time, longer than some/most of the other allied health care professions. What was it that got nursing and those other professions going like gang-busters to increase their educational standards and professional recognition?

I've been waiting for a good topic to chime in on for my 500th post, and this is a big BINGO! I've read every post in this thread, though not every word, but let me start with the above.

Modern day nursing was established by Florence Nightingale in 1854 during the Crimean War. That is generally acknowledged as the starting point of the profession.

In 1909 the first BS program for Nursing was established by the University of Minnesota. That's 55 years of development to get to that stage!

The first paramedic programs were established during (roughly) the early 1970's. Emergency Medicine for M.D.s did not become a specialty until 1979; YES 9 years AFTER paramedics were in business!

When Florence Nightingale began, "nurses" were lower caste women doing remedial care (gruntwork; though sanitarily which changed the course of ALL medicine) and often, in order to make ends meet, prostituting themselves on the side. The first wave of paramedics (on the East Coast, anyway) were "hacks" usually initially employed as hearse drivers who, as a "courtesy service" had to pick up the occasional live transport.

The first wave of medics, of whom I was one, were societally marginal at best (the book will be out within a month), as well.

PARAMEDICINE IS IN ITS INFANCY!

I would imagineour history now is not much different than the early history of Nursing: It really wasn't a profession. Most of the people involved were transient due to rotten working conditions and lack of respect by other agencies. There was neither a career track (as in specialties to pursue), nor equitable pay.

We actually got BS programs off the ground within about 20 years, which ain't bad, but still, there hasn't been a strong enough movement (spelled d-e-s-i-r-e) to actually BUILD a profession WITH each other to make it stick.

PARAMEDICINE IS LIMITED IN SCOPE

Let's face it, the vast majority of our calls are relatively routine transports and a couple or a few times a day we dip into our bag of tricks for about a half-hour and then, we're spent! We are FIELD based and all about TRANSPORTATION to a facility where, well, the Nurses take over (under direction of the Docs, of course!).

Even there, most of what the R.N.s do is maintenance, but because it's much more long-term involvement, the scope of knowledge and application of it is much more complex.

And, as the name states, most of what we are are Emergency Medical TECHNICIANS. We are prepared to be Flesh Mechanics, and we can get pretty good at it, but to do what must be done in the limited amount of time it takes to get someone to the hospital in STABLE (not healed) state, honestly DOES NOT require that much sophistication.

THE NATURE OF THE WORK = BURNOUT

And that's the biggest part of the problem in my point of view. The educational and physical challenges of the profession are secondary to the intangibles of learning how to manage yourself as a human being amidst all the assaults you're subject to. People don't quit because of lack of knowledge; they quit because they can't "take it" anymore.

Look at this site. How many people who were here in 2005, when I first got involved, are still here? Many, many people are interested and enthused in the beginning, but what is the proportion of people who have ten years under their belts? Five years? One year? The math speaks for itself.

Paramedicine is as intense a job as you can find. The stakes are life and death. It is largely meant for young people, full of piss and vinegar, who can give everything they have for a couple years and then move on.

Why? SELF-PRESERVATION. You have to be an extremely unusual individual to both subject yourself to and work with the steady assaults of the profession; let alone maintain your functionality. (You read the posts on this site from the people who've been around for years and you will find out just how much work they had to do and continue to do to stay involved!)

PARAMEDICINE IS LARGELY AN INDUSTRY

I'm not current with the numbers, but I imagine that most EMS services are still businesses. They COUNT ON the transience of their workers; that's what they are to them, replaceable drones.

Some comments were made about Unionization. I was part of the team that established (to the best of my knowledge) the first Union for EMS personnel West of the Mississippi (1983 - California Paramedic's Association, Santa Barbara, CA; affiliation with Local 399 AFL/CIO). This was the logical conclusion of five years of battles with the County and their contracted companies to provide some sort of stability to the burgeoning profession.

My biggest hurdle was overcoming the apathy of the medics to get involved. I honestly do not believe they saw (nor do I believe today that they see) themselves as "in it for the long term".

I think that's why people like Guardian and Ris and VentMedic feel like they're driving themselves nuts trying to get people to even LISTEN to their insistence on professional development.

Those groups banded together, acknowledged that they needed to increase their standards to improve their level of care, and here's the kicker: they also formed/became powerful lobbying groups to get the State Legislatures to write laws and regulations to more specifically define their scopes.

In this Akulahawk is right on the money! But what I'd like to see included in this thread is conversation about how YOU see yourselves IN the profession. Is this short or long term? What do you see around you?

Once we come to terms with that we can begin to decide if we have what it takes to mold this into a true profession as opposed to what it is now, a Technical Job Description.

 

[atropine]

You place too much faith in me, sir. You asked for a response, and one you shall receive:

Fire Departments will be slimmed down and streamlined to be able to provide at least some sort of response to most areas of their districts. I would imagine most departments would lose around 90 % of their workforce and operational capacity under the daedalus-all-figured-out-plan. I would fire the fire fighters. EMS would take direct control of remaining fire operations, and the firefighters would be under the command of a paramedic with no cross training. Eventually we will phase out the fire operations altogether and just put fire extinguishers on all ambulances instead. After the firefighters are all finally laid off, I would bring a massive lawsuit against all of them to require them to pay back all wages earned plus interest back to the public, and use most of this money to hire new paramedics.

Hey cool guy, LA City used to use single role medics and then phased them out, because it's cheaper to cross train for staffing reasons. You are too much, but funny non the least stay cool.