Do you think EMS should be paramilitary?

[medic417]

I should have placed a poll I guess. Seems based on responses most including myself oppose paramilitary style of EMS.

I do agree with the need to be in shape but that can be done w/o acting like we are military. I have heard of a service that requires you to exercise 1 hour per shift paid. Your ambulance is sent to the gym and you are allowed to work out. Others have actually had contests to motivate. And there is nothing wrong with saying if you are to out of shape to do the job you will be fired, if that doesn't motivate nothing will.

As to the we've always done it this way it has been shown in many topics that much of EMS is based on traditions that have continued despite scientific evidence against. For example back boarding all trauma, proven bad yet many still argue it is better to err on side of caution.

 

[46Young]

PT is important. Show up early to get it in, or do it after your shift ends. Charleston County EMS has a paramilitary structure. So does Fairfax County FRD. CC has a Sarge or Lt. Fx has a Lt. riding the seat(that's changing with the new one & one initiative). If you're both medics, having someone dictate care without input from the other provider is fundamentally wrong. Your card is at risk along with theirs. The court won't care about ranks when malpractice is in question. Pt care is not compatible with a paramilitary structure. all you need is a lead provider for guidance, and a field supervisor. I never had to deal with my partner dictating pt care without my input in NY. Luckily, at my station, I'm treated as an equal in regards to pt care.

 

[Summit]

I honor those that chose to enter the military. I chose not to. Should respiratory therapist, public health nurses be paramilitary as well? Could you see home health or hospice nurses being such? Again, why should EMS?

We are NOT public safety. We are NOT enforces of anything! Even the badge is ludicourous, as it has no authority at all.

Should we be in shape to perform our job, should we demonstrate professional traits such as a sharp clean uniform, being organized, a definite yes. Do we have infrastructral ranks?... Yes, supervisors, FTO's, Directors, etc.. Should we stand at attention or have PT (who has the time on duty?) for inspections, or salute or have the hazing usually associated with such organizations? No!

We should be medical professionals. My peers are just that. Peers. They are not my brothers, sisters, cousins, etc... When they get injured or die I mourn, but it is because of the individual not his/her job choice. Should we honor their service to EMS? Yes, but alike any other professional.

Look at this way. The Oklahoma Highway Patrol (OHP) has one of the most Paramilitary Patrol Academies in the nation and models itself as a paramilitary organization. Is it working for them? ......

R/r 911

end of thread

 

[reaper]

PT is important. Show up early to get it in, or do it after your shift ends. Charleston County EMS has a paramilitary structure. So does Fairfax County FRD. CC has a Sarge or Lt. Fx has a Lt. riding the seat(that's changing with the new one & one initiative). If you're both medics, having someone dictate care without input from the other provider is fundamentally wrong. Your card is at risk along with theirs. The court won't care about ranks when malpractice is in question. Pt care is not compatible with a paramilitary structure. all you need is a lead provider for guidance, and a field supervisor. I never had to deal with my partner dictating pt care without my input in NY. Luckily, at my station, I'm treated as an equal in regards to pt care.

Most agencies do have rank structure for supervisors. That does not mean that they outrank you in Pt care, if you are both medics. I have never had a supervisor tell me how to treat a pt!

 

[medic417]

Most agencies do have rank structure for supervisors. That does not mean that they outrank you in Pt care, if you are both medics. I have never had a supervisor tell me how to treat a pt!

I have seen very few EMS only systems that use rank like Sarge or Lt, Capt, etc. Yes you have a supervisor but you do not salute, stand at attn. Seems only fire and volunteer systems that use them and act that way.

 

[reaper]

Every EMS only system I have ever worked for used Capt, Lt, and Sgt. No, you do not salute or stand at attention for them. It is a ranking of supervisor levels.

As I stated, they do not dictate pt care to other medics.

 

[el Murpharino]

I will quote two of the three Air Force core values, which is about as militaristic as EMS should be:

Integrity First
Excellence in All We Do

(For those that care, the third is service before self....but I'm not putting EMS before Me or my family)

If one adheres to those two values, regardless of what capacity you function in, you will easily be head and shoulders above the status quo.

 

[LucidResq]

Also, on the education side of it, I think there should be a certain amount of thought put into how you prepare students for stress and emotional trauma. The army is well versed in such matters.

Really? You're referring to the US Army?

Army's monthly suicide toll may surpass Iraq, Afghanistan combat deaths

'Tell somebody,' if you're thinking of suicide, says general

The 101st Airborne's senior commander in effect ordered his soldiers Wednesday not to commit suicide, a plea that came after 11 suicides since January 1, two of them in the past week.

"If you don't remember anything else I say in the next five or 10 minutes, remember this -- suicidal behavior in the 101st on Fort Campbell is bad," Brig. Gen. Stephen J. Townsend told his forces. "It's bad for soldiers, it's bad for families, bad for your units, bad for this division and our army and our country and it's got to stop now. Suicides on Fort Campbell have to stop now." ...

But Townsend's message -- called a Second Suicide Stand-Down event -- is likely to be ineffective, said Dr. Mark Kaplan, a professor of community health at Portland State University in Oregon, who has researched veterans' suicide and served last year on a Veterans Administration blue-ribbon panel on suicide risk.

"It sounds like an order," he told CNN in a telephone interview. "I'm not sure that a command like this is going to alter the course of somebody who is on a trajectory of self-harm."

Army mental-health providers in Iraq often unlicensed in war's early going

 

[LucidResq]

Should we stand at attention or have PT (who has the time on duty?)

I think some kind of organized PT would actually be highly beneficial. Not saying you should have people lifting weights between calls, but some kind of physical fitness standard that is evaluated continuously, not just at hiring, in addition to an agency-facilitated group fitness program would be a good thing.

A) We all know people in EMS who are so grossly obese and/or out of shape that it clearly affects their ability to provide quality patient care.

B ) Exercise relieves stress. Period. Especially regular exercise.

C) A simple weekly or monthly game of capture-the-flag or ultimate frisbee could facilitate group bonding. Playing team sports fosters... get this.. teamwork!

 

[46Young]

Most agencies do have rank structure for supervisors. That does not mean that they outrank you in Pt care, if you are both medics. I have never had a supervisor tell me how to treat a pt!

This goes on with some old time Lt's at Fairfax. Providers that have experience in other agencies know better than to let this fly. Those that have never worked for a 911 agency think that this is normal. It depends on the Lt. Some say "I'm a medic, and you're a medic". Others treat you like you don't have a clue, other than taking care of interventions as directed by the Lt. Some tried that crap with me. I put an end to it real quick.

 

[mycrofft]

If by paramilitary you mean hoorah and sidearms...Nope. However:

If you mean a system of regulations, rank/promotion based on training, time in service, and merit, with esiprit d' corps, then maybe yes.

Nothing forbids a private or public service from going that way, but in practice it seems most are pretty dependent on individual managers' integrity and smarts to make it any good on an organizational level.

I think our existent Guard and Reserve troops should get mre real world practice and doing real world EMS is one way to do it.

 

[reaper]

This goes on with some old time Lt's at Fairfax. Providers that have experience in other agencies know better than to let this fly. Those that have never worked for a 911 agency think that this is normal. It depends on the Lt. Some say "I'm a medic, and you're a medic". Others treat you like you don't have a clue, other than taking care of interventions as directed by the Lt. Some tried that crap with me. I put an end to it real quick.

Exactly, They have no more power over your treatments, then a bystander. They are your supervisor over operational standpoints. You were right to nip it off fast. As long as you are equal in your license, then you work together as a team. If they have more experience then you, then by all means accept their advice.

 

[Shishkabob]

Again, how could you guys not want to carry around flashbangs in our jump kits?!


Narcan make your overdose aggressive? Throw a flashbang at him!

 

[thrilla82]

this is an interesting thread. i find myself having trouble on the civilian side of the house, not with rank but with treatments. being on a second deployment as a medic in the infantry, ive seen my fair share of traumas but dont understand why the civilian side of the house doesnt adopt some of our sop's (tc3). i know the main argument will be the transport time, your not with the patient long enough but heres an example. how many times have you brought a pt to the er with a bleed that a pressure dressing is having a hard time controlling but sop's are too afraid of a tourniquet. why not use the tourniquet to stop the bleeding, pack the wound with kerlex (or a hemostatic agent depending on the bleed) and wrap with an ace wrap. as time goes by and you keep doing your ongoing assessment, you can loosen the tourniquet if need be ( or the doctor, to see what hes working with). to me, it beats holding pressure and elevating the whole time.

curious to see the replies on this.

 

[medic417]

this is an interesting thread. i find myself having trouble on the civilian side of the house, not with rank but with treatments. being on a second deployment as a medic in the infantry, ive seen my fair share of traumas but dont understand why the civilian side of the house doesnt adopt some of our sop's (tc3). i know the main argument will be the transport time, your not with the patient long enough but heres an example. how many times have you brought a pt to the er with a bleed that a pressure dressing is having a hard time controlling but sop's are too afraid of a tourniquet. why not use the tourniquet to stop the bleeding, pack the wound with kerlex (or a hemostatic agent depending on the bleed) and wrap with an ace wrap. as time goes by and you keep doing your ongoing assessment, you can loosen the tourniquet if need be ( or the doctor, to see what hes working with). to me, it beats holding pressure and elevating the whole time.

curious to see the replies on this.

That is now the way we do it and PHTLS teaches. NREMT even now tests with tourniquet being way to control bleeding.

 

[reaper]

Yes, we have Tq's in our protocols. But, there is no way the trauma team would allow hemostatic dressings. They are fine in the battle field, but have been shot down in a lot of civilian areas, due to the thermo action of them.

 

[Bloom-IUEMT]

I think it should be less paramilitary. I've noticed a lot of people at my service come from military background and not even a military medic background sometimes. I'm curious as to why the cross-over. Why does EMS attract the same type of people as the military does? I'm not saying its bad, although there are some guys who are kind of terse and militaristic and I'm not sure why then even like dealing with patients.

 

[EMTrainer]

With Great Respect, No Sir

Are there things we can learn from the military, definately Yes.
Should we seek to become like the military, definately No.

There is no argument that war and other military functions have contributed greatly to our EMS system, from the first use of modern triage to some of the most current technology coming out of our ongoing operations in the Middle East. We have also inherited some technology from NASA. Doesn't mean I want to be an astronaut.

:usa:

Thank you to everyone who serves or has served in the military of the United States and our allies. You have my undying gratitude and respect.

 

[Ridryder911]

Ironically, when I first started I was with primarily those that served in Vietnam as medics. They were quite the opposite of wanting paramilitary within EMS. Yes, alike discussed upon the professionalism but in regards to true paramilitary style, they were quite the opposite in what I have seen of the recent medics that are or were military.

R/r 911

 

[Melclin]

Really? You're referring to the US Army?

A thousand times no. I was ganna say something about the US army but I thought I might end up starting something. I mean't in my the case the Australian army.

And not to adopt their practice straight up, I just think they can be learned from. I thought it would be interesting to consult them, see if they know something we don't.