EMS, a romantic notion.

[ExpatMedic0]

Brandon,
Perhaps you misunderstood me. I can understand why some people leave the job or move on. I can also share your frustration over many of the things you mentioned. As you can see I have been a member of this forum for 7 years and I have been involved with EMS for several years longer than that.

I believe we do deserve better but I believe we also deserve a better education and training. That is something we ourselves need to change in order to reap the benefits of.

*Devil's advocate*

I think that Medics/EMS are paid appropriately. What makes you think they deserve more? What do other similar jobs, non-degree vocational trained, pay? And maybe they will be recognized as a true profession when they actually become a profession.

*Let the hating begin

You must be speaking about the USA? I have been working abroad as a medic now for 3 years. Perhaps you should speak to some of our comrades from any of the common wealth country's and the majority of the EU. I am sure they would be delighted to brag about there mandatory undergraduate and graduate degree's,
a long with there pay,respect, and working conditions compared to ours.

But back to the good ol US of A:


around half of my paramedic class had undergraduate degree's, furthermore 2 states require at least an AAS to even be certified as a paramedic and other states require it to be "licensed" rather than certified. I understand that is far from the entire country, but what about those people? Do they deserve more?

What about a paramedic with an AAS in EMS or undergraduate degree in Paramedicine, EMS, Biology, Chemistry, does he/she deserve more? What about states, agency's, and medical directors that have raised the minimum standard? Seattle's Paramedic program is over 3000+ hours long vs a Firefighter Paramedic from Texas who completes a 600 hour training course (in some areas) deserves vocational pay, but not everyone. Its not a one size fits all kind of situation right now.

How are providers supposed to go about improving things? There is so much resistance from so many different interests trying to keep EMS down.

We further our education beyond what the current minimum standard is, we work on raising the bar, we become more proactive in organizations and advocacy groups that help advance our profession. We looks at models in other country's where the Paramedics are of a higher minimum standard.



Its not something that is going to happen overnight but its never going to happen if we just bend over and continue quietly taking it in the @ss and chasing the good people we have away.

I can see why some people leave, they have my full support and understanding. However, what I do not understand is people who do not leave and would like to or should.

I am just another pawn in the system right now. I am not claiming to be the best Paramedic in the world nor am I claiming to have any easy solution to the mentioned problems. I am just someone who likes what I do and I am taking the self initiative to be a professional for my own self and for what I enjoy while advocating others to do the same.

 

[ExpatMedic0]

As a medic, I agree with chase.

I bet you do, since your both nursing students ;-) Good luck to both of you.

 

[sir.shocksalot]

Thats my point, the responsibility falls on the medic. Responsibility does not fall on the nurse.

This is not true. Nurses are responsible for their patient. If a nurse fails to recognize and treat changes in the patient's condition they will be held accountable for that, and probably far harsher than a paramedic will because there is a BON who is more than willing to reprimand/admonish or take away one's nursing license.

Paramedics are responsible for knowing and following protocols, nothing more. I understand why you would think that paramedics are far more responsible since we have no physician in house holding our hand, but neither do most nurses. When you have seen a good paramedic troubleshoot a medical problem, arrive at a treatment plan and implement it without ever consulting with a physician, it does start to look pretty impressive. However this is only possible to do while following the very algorithmic protocols. Many paramedics throughout the country rely on said protocols to form a treatment plan because they lack the knowledge of medicine to form a plan of their own.

I guarantee that 90% of the paramedics on this board probably would do fine without protocols, but this is in no way representative of the actual population of paramedics. As long as paramedics operate in a protocol driven care system with a lack of education we will always be considered as "unlicensed assistive personnel" by nurses. It sucks for all of us who choose to better ourselves but we will always be weighed down by those among us who choose not to put forth the effort to educate themselves and better themselves as a healthcare provider.

This is the bed we have made for ourselves as a profession... now we get to lie in it.

 

[VFlutter]

You must be speaking about the USA?

around half of my paramedic class had undergraduate degree's, furthermore 2 states require at least an AAS to even be certified as a paramedic and other states require it to be "licensed" rather than certified. I understand that is far from the entire country, but what about those people? Do they deserve more?

What about a paramedic with an AAS in EMS or undergraduate degree in Paramedicine, EMS, Biology, Chemistry, does he/she deserve more? What about states, agency's, and medical directors that have raised the minimum standard? Seattle's Paramedic program is over 3000+ hours long vs a Firefighter Paramedic from Texas who completes a 600 hour training course (in some areas) deserves vocational pay, but not everyone. Its not a one size fits all kind of situation right now.


We further our education beyond what the current minimum standard is, we work on raising the bar, we become more proactive in organizations and advocacy groups that help advance our profession. We looks at models in other country's where the Paramedics are of a higher minimum standard.

I am indeed talking about the US. EU/AUS EMS is on an entirely different level and what I would consider on par, if not exceeding, nursing education. But you can not even being to compare that to the US.

That variability is what is killing EMS. IMO, those with degrees should be paid more. But there needs to be a national minimum level of education which should be a degree.

I bet you do, since your both nursing students ;-) Good luck to both of you.

Shhh keep that on the down low

And I will only be a student for 6 more weeks

 

[NYMedic828]

I bet you do, since your both nursing students ;-) Good luck to both of you.

Lol while I appreciate the well wishes I would hardly consider myself a nursing student. I have taken all my liberal arts requirements for a BSN and am doing my sciences now. Have not touched a single nursing class. Haven't decided yet if it is in fact the road I wish to walk.

Mind you if a bachelors in Paramedicine was a requirement in the US and the pay and scope of a paramedic reflected that, I would sooner be aiming for that that then nursing.

 

[VFlutter]

This is the bed we have made for ourselves as a profession... now we get to lie in it.

Don't worry we can still cuddle. My nursing bed is much more comfy

 

[errey]

sorry to get a little off topic but it will just help me grasp what you guys are talking about and referring to. what is the level of education for EMS workers in the states from EMT-B, EMT-I, EMT-P how much schooling is there? cheers

 

[ExpatMedic0]

http://www.ems.gov/EducationStandards.htm

But off the top of my head minimum national standards in clock hours are around 1200 for paramedic and 120 for EMT-B which is required before Paramedic. This is not exact just as best that I can remember.

I think most medic programs complete this in 12 months and EMT in 3 months. However standards vary wildly (especially for intermediate which I am not even mentioning)

Some areas have paramedic programs that are as little as 600 hours in a few months, others that are 3000+ hours and require A&P as a pre req, and yet others that require mandatory degree's.

 

[NYMedic828]

The fact that some places require 3000+ hours is AWESOME.

The problem is, that is not a systemic standard. If it was we would be golden.


The 200 hour EMT programs are very geared to the schedule of a weekend warrior who only wants to volunteer. Everyone can become an EMT for very little money and minimal time devotion.

Paramedics generally intend to work professionally as a provider but the programs are often far too easy and completable without taking the plastic off your texts.

If an AAS or better yet Bachelors was the minimum standard, the incompetence and Ricky rescues would be extensively weeded/pushed out. Mind you all professions even physicians have complete morons, there would be FAR less. Probably 80% less.


Every problem with USA EMS stems ultimately from our educational standards.

 

[errey]

http://www.ems.gov/EducationStandards.htm

But off the top of my head minimum national standards in clock hours are around 1200 for paramedic and 120 for EMT-B which is required before Paramedic. This is not exact just as best that I can remember.

I think most medic programs complete this in 12 months and EMT in 3 months. However standards vary wildly (especially for intermediate which I am not even mentioning)

Some areas have paramedic programs that are as little as 600 hours in a few months, others that are 3000+ hours and require A&P as a pre req, and yet others that require mandatory degree's.

thanks for the reply, so I'm guessing based on that amount of training that once you become a paramedic you receive a certificate?

 

[ExpatMedic0]

thanks for the reply, so I'm guessing based on that amount of training that once you become a paramedic you receive a certificate?

Yes, however most states offer an optional 2 year degree, some even a 4 year degree, but this is not a requirement(except in 2 states)

So at a national level we are certified .

 

[errey]

Yes, however most states offer an optional 2 year degree, some even a 4 year degree, but this is not a requirement(except in 2 states)

So at a national level we are certified .

ok thanks for clearing that up, and i can imagine as stated before that if those degrees are not required everywhere a lot of people would not take them. I agree that is not a very high standard and can see how nurses etc. might not view EMS up to there level. I would still call it a medical profession in my opinion. you said earlier you have/are working abroad? whereabouts?

 

[ExpatMedic0]

ok thanks for clearing that up, and i can imagine as stated before that if those degrees are not required everywhere a lot of people would not take them. I agree that is not a very high standard and can see how nurses etc. might not view EMS up to there level. I would still call it a medical profession in my opinion. you said earlier you have/are working abroad? whereabouts?

Most recently I was working for an Australian company a long side Paramedics from Australia, Canada, South Africa, UK, Ireland, Sweden, and the US near Dubai in Abu Dhabi. Before that I was on a contract in Saudi Arabia working mostly with Australian and South African Paramedics but also some Germans and UK medics. Currently I am in Denmark while I complete my undergraduate degree I am on an "on call" roster for some international flight work but have yet to see much action.

Meeting so many Paramedics from so many country's and working a long side them has really opened my eyes to the bigger picture.

 

[DMT]

The bottom line barrier for a true professional EMS system is you get what you pay for. I know a lot of great guys in EMS, but most of the time you're not going to get many top notch professional people when the pay is peanuts. $40k a year is NOT a 'career' IMO.

To me, everything revolves around that. If you argue that people should need more education and you want people to have a degree to be a medic... Why the hell would I go to school for 4 or even 2 years to get a job that pays $13-$15/hr? Not a chance. Too many other options with no college needed, and too many better paying gigs out there for people who have degrees. So unless the $$$ outlook changes, it will always be a lose lose situation.

 

[Veneficus]

Moderating again...

There are many threads on the education of EMS.

I did not intend for this to be another one.

I would like to discuss the culture of EMS. Mostly so I can figure out for myself how to remain active in it.

Real fast, I hear a lot about the pay argument.

I don't know about most of you, but for myself and everyone I know in EMS in the whole world, I cannot think of one person who said "EMS is a decent paying career, I think I will do that."

I have never heard anyone say "I don't have a degree yet, so this would be a good vocational job until I qualify for something better."

I have heard many people say that they would like to work in EMS as either their primary career, because they need to for their primary career, or who wanted to be paramedics.

I don't know anyone who thinks they make enough for what they do.

We see good people intentionally go into EMS. We see most of the best people move on to something else. The only logical conclusion is that something EMS is doing or not doing is causing this.

Yes, EMS leaders largely push to keep education low. Many providers don't want to advance their education because it will not change pay immediately. But if US providers do not raise their education, certainly pay will not increase to a level comparable with their international collegues.

People in EMS get pissed when they are refered to as an ambulance driver. But that is what you are paid to do!

Do nurses or doctors get paid for milage on every patient they see? Do their treatments always end in "transport to the hospital"?

I wouldn't say I left EMS. I wouldn't even say I moved on. (probably a lot of people wish I would, not last of which are my colleagues who feel I am wasting my time with it) I advanced my education because that is what I had to do in order to get away from protocol driven treatments (I wouldn't even call it medicine) and not be paid to drive people to the hospital.

I suspect many on this forum fall into the same category.

Of all the physicians and nurses I know who are former EMS or "also" EMS, knowing, doing, recognized as more is universal. Not the pay. (But it certainly doesn't hurt)

So let's get back to culture of EMS. Let us look at it from an anthropological point of view the way we would study ancient Greeks or Egyptians. Because if we figure out how the clock actually works. They we can start to change it.

While this may sound strange, last year I read a book by a anthropologist on the culture of surgeons. The book (which is a study) was commisioned by surgeons in order to help them work out their problems.

As I read it, I was nodding my head every paragraph thinking "I see that everyday."

But I still have to figure out what I can do. Being the old guy sharing experience and knowledge doesn't seem to have much benefit.

 

[RocketMedic]

Vene, I do think a lot of problems stem from pessimism and the burnout of some. Granted, US EMS does a lot wrong, but we do do some things right, and there are legitimately lives saved by EMS daily. Not to be romantic or look at things with rose-colored glasses, but we should strive to remind people that we do indeed make a difference, even if it's only a rare, rare occasion.

 

[Veneficus]

Vene, I do think a lot of problems stem from pessimism and the burnout of some. Granted, US EMS does a lot wrong, but we do do some things right, and there are legitimately lives saved by EMS daily. Not to be romantic or look at things with rose-colored glasses, but we should strive to remind people that we do indeed make a difference, even if it's only a rare, rare occasion.

Just my observation and certainly you have a good point, but I wonder about the growing of the seemingly unofficial requirement of volunteer service in order to secure employment.

That is not something found anywhere else in healthcare. Volunteer as a doctor before you get a paid position? How about a nurse? RT? PA? CRNA? the list goes on.

I am thinking the low entrance requirements to be in EMS have attracted a high number of "johns" (aka punters or hobbyists) looking for a way to make themselves feel like they make a difference and getting a fast and cheap thrill from it.

They then form volunteer councils and other political bodies in order to make sure their hobby is not made illegal.

Together, these 2 components seem to be squeezing out professional minded and dedicated people.

As I have said many times, and we have agreed upon, saving lives is not the measure of value of a professional EMS provider.

 

[paccookie]

While this may sound strange, last year I read a book by a anthropologist on the culture of surgeons. The book (which is a study) was commisioned by surgeons in order to help them work out their problems.

As I read it, I was nodding my head every paragraph thinking "I see that everyday."

But I still have to figure out what I can do. Being the old guy sharing experience and knowledge doesn't seem to have much benefit.

What was the title of the book you read?

 

[mycrofft]

Pre-Hospital EMS Culture is the subject

This thread could support a whole website and each subthread a category.

Second metacomm, Vene: if you are on the forum for long, things are brought up time and again and again as new folks come on board (especially new to the profession...yes, I said it) so it seems there is never any traction. Actually, it is largely just addressing each new wave of grads and website discoverers.

How many of us had our attitudes and practice shaped significantly by a mass-medium like a website forum? In my experience, at least initially, I was formed (some say warped) by significant individuals among my mentors, my coworkers, and my patients. So don't get discouraged beyond the usual variance.
=============
Metacommunicational rant over, I'm watching so many good comments and common shibboleths fly by....

Here's one. "EMS" (whatever that is) has to crash soon. Malarkey. We are experiencing a generalized loss of humanity and individual competence throughout American medicine, why not prehospital EMS (PHEMS) also? Witness the medical practices, especially PEMS, in many other countries which are not failed countries or frontiers but culturally and economically have basically no PHEMS. Snatch and run, no spine board, often no "gurney", maybe oxygen. (Not pointing fingers, but parts of Turkey and subsaharan Africa are right there; after the fall of the Politburo, Russian hospitals had to lock patient rooms to stop theives from stealing the linens and drugs, what little they had). We can fall alot farther.

Here's another, and it is an observation. If you want to make more decisions on the spot (versus taking everyone back for a diagnosis) you have to start seeing them sooner (before they crump; these are your "taxi" cases sometimes) and you need to learn a lot more than the vestige taught to technicians (not clinicians) known as "emerency medicine". Things such as how to recognize rashes; what the likelihoods are for complaint X to be problem Q,R,or S; communicable diseases; the pharmacy of common prescription and over the counter meds besides the ones on the crash cart; how to spot a dental abscess versus a broken mandible. In other words, primary care. Our educational system fails to impart this well to many practitioners of many sorts, and a tech cannot and will not progress with this learning unless they do it individually; this frustrates them because their job cannot let them use it openly.

There is a valuable place for a tech in the field. Just try not to adopt the Ricky Rescue/Crusader Rabbit attitude, and keep learning, even going so far as maybe nursing or medical or other degree program. We need more mentors. Step up, folks.

PS: It can still be ok to party after duty and get all redneck over watching tractor pulls on tv between calls, etc.

 

[Veneficus]

What was the title of the book you read?

http://www.amazon.com/The-Scalpels-...ds=the+scalpel's+edge+the+culture+of+surgeons