controversial- what leads you to believe we are in a "legitimate profession"?

[Lifeguards For Life]

While the question staged above is not necessarily my views on EMS all the time, I still think it deserves some intelligent debate. What leads any of us to believe EMS to be a legitimate profession?

A profession can be defined as a vocation requiring knowledge of some department of learning or science. I believe we satisfy that particular requirement. I have long heard many members of the forum rallying to promote advancement of the profession, a profession that is not regarded as a hobby, a profession that can be done with minimal amount of training on nights or on the weekends. Some point to Volunteers as the root of our professionalism dilemma. But I think that view in itself is self limiting to our said profession and as far away from the true basis of our problems as possible.

I am of the belief that our problems stem from the first day one walks into EMT school. Even at the Paramedic level we have Instructors with out degrees teaching "advanced skills", who would not be qualified to teach elementary school art. I'm sure some of them are wonderful paramedics, but can hardly be called educators. My EMT class was alot of scare tactics, about how not everybody can do this every day, the instructor told alot of self glorifying stories, and passed people i wouldn't trust with my mechanical pencil, let alone my life. The NREMT was a joke at best, it took 17 minutes to complete.

I've nearly completed my first semester of paramedic school, and have not been impressed or challenged thus far. I can also say the number of paramedics i have met on numerous clinicals that i felt confident in their abilities, I can count on 2 fingers. I've seen "great" paramedics treat patients like dirt. I've seen the "sweetest, most caring medics you'll ever meet" make disasterous decisions and lose their patches.

This thread is not meant to offend anyone. “I am of the opinion that my life belongs to the whole community and as long as I live, it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work the more I live.” As of late, I am beginning to wonder if prehospital emergency medicine is the way to go. Can someone please explain to me what makes this a "real" profession. Can someone please account for all the shortcomings that I'm sure many of you see in the field on a day to day basis.

Maybe I'm just in a flawed system. Maybe I'm just sleep deprived as i havent slept through the night since friday. Maybe I'm just goin off on a poorly though out rant (probably).But I'm not trying to instigate anything, hopefully someone can make EMS make some sort of sense again.

 

[Shishkabob]

Do you consider being a Peace Officer a profession?

 

[Lifeguards For Life]

sure? i guess what i am getting at is at the moment it seems like way too many incompetent(well meaning or not) people have somehow gotten through the system and are now providing mediocre care. I'm sure there are people in all professions making similar claims, but i have no experience in those fields.
I'm fairly frustrated with the system in my area, and recently read a few threads here mentioning "this is not helping to advance our profession", "this does not make us seem like a legitimate profession" etc.
What are they seeing that I am missing that even hints at being a "legitimate profession"?

 

[VentMedic]

I am of the belief that our problems stem from the first day one walks into EMT school. Even at the Paramedic level we have Instructors with out degrees teaching "advanced skills", who would not be qualified to teach elementary school art. I'm sure some of them are wonderful paramedics, but can hardly be called educators. My EMT class was alot of scare tactics, about how not everybody can do this every day, the instructor told alot of self glorifying stories, and passed people i wouldn't trust with my mechanical pencil, let alone my life. The NREMT was a joke at best, it took 17 minutes to complete.

Unfortunately you are in an EMS education system ran by instructors, not educators, who probably don't have enough education to teach the material. Thus, they waste classroom hours with tall tales of heroic activities which are usually embellished much like fish stories.

I've nearly completed my first semester of paramedic school, and have not been impressed or challenged thus far. I can also say the number of paramedics i have met on numerous clinicals that i felt confident in their abilities, I can count on 2 fingers. I've seen "great" paramedics treat patients like dirt. I've seen the "sweetest, most caring medics you'll ever meet" make disasterous decisions and lose their patches.

Does this surprise you? You have been around the EMS forums long enough to read the many threads bashing patients. There have been numerous "BS" this and "BS" that to how many times some lazy arses had to leave their recliner to run a call that they already decided should get a refusal form long before arriving at scene. I hate to say it but it isn't just in your system. Until standards are raised and some are held to some type of accountablity, you will continue to see this in EMS. And, what is really unfortunate, when a medical director such as the one in Collier county attempts to hold some to being accountable for their knowledge and skills, those so call professionals go on a rant in public to thrash their medical director in an attempt to justify their own stupidity.

Thus, after 30 years, I have come to some of the same conclusions you have. It is sad that the ambulance services and FDs that do EMS really well and those dedicated to quality medical care get over shadowed by broken systems (including the ESM education system) full of people not qualified to wear an EMT(P) patch and care for patients.

 

[Melclin]

The definition of profession must also include a requirement for a unique body of academic knowledge. Something that is included in most definitions of professionalism and that we are building here in Australia.

Here in Australia at least, the paramedic uniquely combines components of many different health care profession's (Emergency/ICU Dr/Nurse mostly) but often applies it in situations that require a singular ability to multitask and prioritize. We assess, triage, treat and transport, often all at the same time, without direct medical oversight. As such the normal application of these skills, equipment and the knowledge to back them up, that belongs to those other HCPs, have to be uniquely adapted to paramedic practice. This new body of skills/knowledge, and the responsibility for it, belongs to the paramedic and the paramedic alone. As such, their is room to have dedicated paramedicine experts, paramedic academics and investigators with teaching and research developed around a university base (such as those suggested in the National EMS Research agenda).

Here, there is a strong separation between professional paramedics (who make up the entirety of the emergency services, doing emergent IFT when needed) and those who participate in Non-Emergency Patient Transport (NEPT officers). Paramedics and Intensive Care Paramedics (our equivalent of BLS and ALS) must start with a 3 year bachelors degree, and must gain experience in the field and return to university for post graduate studies to become an Intensive Care Paramedic. This puts us on par educationally with nurses and ICU nurses. The idea that we should have anything less boggles the mind, given that we have significantly more personal responsibility that our nursing companions and greater clinical scope of practice, especially at the ALS level.

With a bachelors degree (with honors depending on whether or not you want to write a thesis) and post graduate qualifications; PhDs and Professors teaching new students; and a unique body of knowledge both practically and academically, who on earth would consider us not to be professionals.

The importance of moving to a professional model lays in the improvement of pt care as well as the efficiency of the health care system, at least in part, making up for the extra expense of education (both in training and the higher wages required for university educated paramedics).

 

[mycrofft]

Yes and no. "No" because there's no "No".

Unique body of knowledge...perhaps. Certainly some aspects. Arguably an excrescence of "medicine" (MD's).

However, the body (in our case NREMT is closest thing to it) has no way to control or even influence the discipline, unlike the AMA, ANA, etc. Any state can create a new category of tech anytime it wants and it will be valid...within that state. Likewise it could decertify a category of tech on a whim, or legislate to ignore any national or interstate certificates issued by any body. EMS as a group can't say NO, and can't even agree on what EMS means.

There are supremely professional individuals, but EMT's are hired guns, merc's.

 

[EMTim]

Unfortunately you are in an EMS education system ran by instructors, not educators, who probably don't have enough education to teach the material. Thus, they waste classroom hours with tall tales of heroic activities which are usually embellished much like fish stories.

.

For now, all I have to contribute to the topic is this: while that is prevalent, that is not the case with all schools. The educators in my school are all paramedics with higher education including a PhD, a MS, 2 with a BS, a CCEMT-P (probably the most intelligent of them all), and a host of guest lecturers with varying degrees/levels of higher education.
They definitely had a thorough understanding of the material, and were able to answer just about any question thrown at them. And more importantly, they were able to explain the applications of the material due to their experience as paramedics.
I wouldn't expect any less from the school I paid to attend, which is why I didn't compromise.

 

[VentMedic]

For now, all I have to contribute to the topic is this: while that is prevalent, that is not the case with all schools. The educators in my school are all paramedics with higher education including a PhD, a MS, 2 with a BS, a CCEMT-P (probably the most intelligent of them all), and a host of guest lecturers with varying degrees/levels of higher education.
They definitely had a thorough understanding of the material, and were able to answer just about any question thrown at them. And more importantly, they were able to explain the applications of the material due to their experience as paramedics.
I wouldn't expect any less from the school I paid to attend, which is why I didn't compromise.

I was only commenting on the post by the OP. To be educators, a solid education foundation is required and one should know how to teach rather than tell tall tales.

Now for thee CCEMT-P "cert" you mentioned, that is also part of the problem in EMS. Hopefully that instructor has much more than just a Paramedic cert with an additional "CCEMT-P" on his title. That title can be given out with as little as a 2 hour inservice in the back room of an ambulance company. Only about 5 states have a recognized level and that also varies greatly from each of those states. The CCEMTP at UMBC is a mere overview of an overview of a few critical care concepts consisting of just about two weeks and does not adequately prepare on to care for critical care patients without extensive additional training. Unfortunately too many believe that is all there is and just "wing it". These put the patients into serious danger because the "CCEMT-P" may truly not know what they don't know.

 

[johnrsemt]

Also: you state that you have finished your first semester. How many doctors are truly challenged in school in their first semester? wait till you have gotten past the basic groundwork of your classes before you start saying how easy it is.
If you are one of the ones that school is easy for you, make it harder on yourself. Dig deeper and find out more details on how and why drugs work, and what all of the blood gases mean for the patient: it may not help you in class, but it can make you a better paramedic (both for you and more importantly: for your patients).

 

[EMTim]

I was only commenting on the post by the OP. To be educators, a solid education foundation is required and one should know how to teach rather than tell tall tales.

Now for thee CCEMT-P "cert" you mentioned, that is also part of the problem in EMS. Hopefully that instructor has much more than just a Paramedic cert with an additional "CCEMT-P" on his title. That title can be given out with as little as a 2 hour inservice in the back room of an ambulance company. Only about 5 states have a recognized level and that also varies greatly from each of those states. The CCEMTP at UMBC is a mere overview of an overview of a few critical care concepts consisting of just about two weeks and does not adequately prepare on to care for critical care patients without extensive additional training. Unfortunately too many believe that is all there is and just "wing it". These put the patients into serious danger because the "CCEMT-P" may truly not know what they don't know.

I knew this was coming. You picked one out of 5 people I mentioned and are trying to tear it down. I'm sorry you're so jaded to EMS..
Also, the blanket statements you are known for are not applicable to everyone or everything.

 

[cm4short]

The problem in prehospital care comes from the top and trickles downhill. It's all a numbers game and the primary goal is to make money. The service we provide is based on quantity and not quality. FD's depend on volume of calls ran to justify their budgets and private calls depend on number of patients transported to increase income. They employ the undereducated majority and keep us blinded from what's really going on. They few that oppose the current system and are trying to make changes are going to hurt a lot of people's wallets, especially in high places. So, in order to challenge them, you'll not only need to be in a higher place, but have more pull than them.

The easiest example is; how many calls were you on and you had to choose between the right thing to do, and what your company/employer wants you to do. Now, given this, which one makes who more money?

 

[JPINFV]

How many doctors are truly challenged in school in their first semester?

Are we talking first semester of undergrad or first semester of medical school? If you're talking about first semester of medical school, the answer is going to be 90%+.

 

[JPINFV]

The easiest example is; how many calls were you on and you had to choose between the right thing to do, and what your company/employer wants you to do. Now, given this, which one makes who more money?

I always assume that my company wants me to do the correct thing. Have I had to justify my actions to management, up to and including the general manager? Yes, but that's why you always do the right thing and be able to defend your actions.

 

[46Young]

I noticed pretty early on in my now 7 year+ EMS journey that it's laughably easy to get into the field (EMT) and also quite easy to get your medic cert as well. When I was in EMT school, a medic told me that becoming a medic is the quickest way to make money without having to go to college. You'll make almost as much as an RN with only a fraction of the workload. Sad but true.

The truth is that for every individual that goes the paramedic degree route, or goes RN>challenge medic>work EMS FT, there are maybe ten (or much more, I'm sure) that go the cert route for the fast, easy bucks. That describes me. It's not that these individuals aren't serious about their job, but see no financial benefit in spending the extra time in school as well as the monetary opportunity cost in lost revenue/401k contributions from not working while completing a degree, as well as the additional cost, money that could be invested instead. After all, it's not so much about how much you invest, but for how long you invest. Tuition of 6k vs 20-40k (or whatever, I don't know the actual costs for an assosciates currently, OK?), plus time lost gaining tenure in your chosen agency and a year or two in salary. Compound the difference in tuition plus what you would have contributed into deferred comp plus the employer match. Compound that by 8-10% annually (on average, go agressive, as in equities but diversified, and use percentage based portfolio rebalancing to ensure that you're always selling high and buying low and greatly reducing volatility to boot) for 30 years without even making any new contributions (for argument's sake), and see what the degree route REALLY costs you.

I knew that staying in this field, in it's current state, was not financially sustainable in the long run. Things may change, or they may not. Go fire based, or get a legit degree in another healthcare field, and then decide which one you want to do FT and do the other one on the side for extra cash.

 

[RyanMidd]

it seems like way too many incompetent(well meaning or not) people have somehow gotten through the system

As I am currently pursuing a career in law enforcement as well, many acquaintances immediately inform me that LEOs are jerks, :censored::censored::censored::censored::censored::censored::censored:s, and crooked people.

Obviously, this is false, but what I'm trying to point out is that every profession, no matter how noble or service-oriented, has bad apples. There are people that slip through the cracks and end up in law enforcement. There are people that slip through and end up in the church.

Similarly, everybody has to start somewhere along any given path. Where are the most mistakes made? At the beginning, of course. Maybe the bigger mistakes are made later on, but that results from a strange alchemy of overconfidence and knowledge.

Ultimately, I guess I don't want you to be discouraged by the seemingly chaotic threads that make up the EMS profession, since each and every thread has the potential to be a paragon of paramedicine, or a crooked caregiver. Everybody has to get into the building on the ground floor, and no matter WHAT you do, there will never be ideal proportions for heart, smarts, and intent.

 

[46Young]

I always assume that my company wants me to do the correct thing. Have I had to justify my actions to management, up to and including the general manager? Yes, but that's why you always do the right thing and be able to defend your actions.

Doesn't matter. If you don't do the company's bidding, as in pt steering, or being pressured to not use supplies, they'll get a paper trail going to get rid of you as quick as possible, or punish you with undesireable shifts, no pay raises, and such. If they want to get rid of you, they'll find a way, unless there is a legit progressive discipline process and grievance process in place.

 

[VentMedic]

I knew this was coming. You picked one out of 5 people I mentioned and are trying to tear it down. I'm sorry you're so jaded to EMS..
Also, the blanket statements you are known for are not applicable to everyone or everything.

The other letters you mentioned were college degrees and not a weekend cert. One should know the difference.

I was just explaining how the CCEMT-P cert can be obtained. This has been discussed many times and why some have felt there is a need for some standardization in this area. It is bad enough to have 50+ different levels for EMT A - Z in the states but then to have another 50+ versions of CCEMT-P "cert" just muddies the water and credibility for EMS all the more. The fact that there is little standardization to that cert just gives one more reason to question the abilities of someone who uses those letters.

Wanting less fragmentation and more credibility is definitely not being anti-EMS. The only way for this profession to grow is to gain credibility through less fragmentation and to stop some from just becoming patch collectors who don't have the education/training to support the letters.

 

[White Fang]

I read all the replies and we have to agree to disagree, i also still in emt school and i have gone through several careers in my life and to answer your question lifeguard for life is yes EMT is a career and my personal opinion is because you get trained, and you can advance in life to develop and or refine your skills. know as other pots they mention quick money??? I dont know about that you want to make fast easy money they are easy jobs other than drugs and prostitution, be a broker (mortgage, stock, insurance ETC) thats not a profession thats a easy way to make money not even going to college i was a mortgage broker/loan officer and let me tell you i made 100K a yr with out a sweat on the books plus more on the side plus bonus and incentives i did nothing what so ever seating in my arse all day. know the reason i went this path is because i realize that i lost track of why i became in the first place a loan officer and notary public to help the one who was in trouble, and that is why i choose to go back to school and become something better in life to provide help to those one in need do the things that a few would do. Dont get me wrong they are some out there that they are RATS and dont need or should be there in the first place, but thats life and you will find them every where in every profession. My EMT class is awesome here in NJ the instructors (not teachers) are knowledgeable and they been around since the 70's and they are hard on us and they dont brag about there accomplishments nor stories they go and do what they like to do best and the only thing that you can do is to be good at what you like to do. Every chance you have to make a person feel better or secure and you do all whats in your power and in reach to make that person secure trust me you are a professional!

 

[mycrofft]

Don't need the shin kicking, and about the education matter...

does NREMT certify EMS instructors? If they did/do, can they sue or file criminal complaint against a school not meeting their standards/ Would an employer using non NREMT accredited graduates be subject to sanctions by their state?

If doctors were regulated the way EMT's are, no MD (or nurse, pharmacist, even veterinarian) from anywhere in the world would be refused a license on demand as long as they could pass that state's certification hurdles, no matter how low, and as long as they paid their license fee for that state.

 

[EMTim]

Wanting less fragmentation and more credibility is definitely not being anti-EMS. The only way for this profession to grow is to gain credibility through less fragmentation and to stop some from just becoming patch collectors who don't have the education/training to support the letters.

I totally agree. Being that the 'profession' is so young, this will obviously take time. So who/what entity that currently exists has the potential to get the ball rolling? Or is it already underway? What types of things can be done at the bottom end?