EMS, a romantic notion.

[mycrofft]

1. Not particularly
2. My fiancé thinks so
3. I had to look this one up, sadly, and it depends.

I was your age when I took my EMT class. And an Airman on active duty. And married for two years-plus. THAT's multitasking.

 

[11569150]

So were talking about EMS being a "medical profession" and not just "any old profession."

And sorry to open up the black hole but I couldn't resist.

 

[Veneficus]

What about a community Paramedic, or a fly car paramedic which is authorized to treat and release, how about an FP-C or CCEMT-P working in an advanced system, what about a paramedic working occupational health or remote medical?

Those examples do not get paid by medicare/medicade/insurance for BLS/ALS transport like 99% of all US EMS.

The community paramedic/treat and release is usually either local funding or an attempt by an agency to control costs.Money is saved by not always having to staff equip and dispatch an ALS ambulance.

CCT has its own funding source which as aeromed discovered is well higher than it it is worth. Which is why everyone and their brother decided to get into the airmed business.

I also have worked Oc. health as a medic, that was paid for by the institution because it was a cost saving/controling measure.

Remote medicine is also another animal, one where paramedics are often less useful then they think they are. I have quite a few war stories of having to clean up after FOB medics who think ibuprofin and antibiotics solve all ills.

I even have a great story about a guy who fell down a flight of stairs, fractured his clavical, dislocated his humerus, and despite the obvious deformation was given 800mg ibuprofin 3x day with 7 days bed rest note.

I have worked most of the above mentioned positions (excluding critical care) and I would say I have to disagree with your statement because I was never a transporting unit unless I was riding along.

As I said, your funding source was not BLS/ALS transport.

 

[Veneficus]

At Veneficus, about the anthropology, basically you're saying that most people who do EMS in the US are meat heads who do it for the glory and stuff like that? (not being confrontational just confirming)

I think I would agree. How would you describe the culture/personality of the majority of EMS providers in other places like the EU?

The EU is a large place. There are multiple systems within it. Even within the same country sometimes. Here there are paramedic only ambulances and there are physician ambulances. The 2 simply do not equate nor function in a similar way. However, the paramedics here are degreed healthcare providers. They can get a mastersor even PhD in EMS. If they want a leadership role they certainly will.

(one of my friends here is the director of emergency service and response for the equivalent of a state and he is a paramedic. Who wrote his PhD in EMS on the differences between European and US EMS systems.)

Limiting my answer to just the EU paramedics I have encountered, most are very professional minded, all are educated. The Europeans as a common culture place a high value and emphasis on education.

I have yet to meet one I couldn't hold a medical discussion with who I first needed to explain ineffectiveness or cardiac arrest drugs or overoxygenating.

I will disclaim I have not seen all systems in the EU and there may be a few of those out there.

I do see a lot of EU paramedics in different countries who constantly try to demonstrate to physicias they are expert and worthy of what they do as they transform from physician based to medic based EMS.

But they don't do it by comparing themselves to physicians at 60mph, they do it by demonstrating their academic qualifications and performing studies that define and shape their treatments.

They basically use the same established system among doctors to define and change practice while demonstrating value.

I believe that AU and NZ use a similar format.

 

[Frozennoodle]

They can get a mastersor even PhD in EMS.

Assuming a setup similar to nursing where 2 years is the minimum and 4 is the standard how would you pay to deploy those highly skilled and knowledge paramedics? I'm not arguing against education. I'm truly wondering how bankrupt cities and states will afford to deploy them. I'm lucky to make 21.18 here but that's essentially the ceiling. I work for the highest paying service in the region. When I advance my education and eventually go to grad school who will pay me that PA salary in the field? Probably no one. My service might allow me to work as a PA in a sprint car but I doubt they will pay me much more than a medic.

How do we change the culture of EMS and get the money to make it worth peoples time? People already balk at the idea of paying a 1500 dollar ambulance fee.

 

[Jon]

Those examples do not get paid by medicare/medicade/insurance for BLS/ALS transport like 99% of all US EMS.

I'll amend that and say "for now".

It's always bothered me that Medicare sees EMS as a transport provider, not a clinical provider. I have a feeling that's going to change in my lifetime, though.

 

[Veneficus]

Assuming a setup similar to nursing where 2 years is the minimum and 4 is the standard how would you pay to deploy those highly skilled and knowledge paramedics? I'm not arguing against education. I'm truly wondering how bankrupt cities and states will afford to deploy them. I'm lucky to make 21.18 here but that's essentially the ceiling. I work for the highest paying service in the region. When I advance my education and eventually go to grad school who will pay me that PA salary in the field? Probably no one. My service might allow me to work as a PA in a sprint car but I doubt they will pay me much more than a medic.

The deployment model is rather simple. The "advanced" medics are deployed just like any other. (though usually they are supervisors or officer of some type) For example, the firend I described has his normal 9-4 director duties then picks up OT shifts as a "regular" medic. But he is always payed the rate of his qualification.

If you call 911 in this city, you will either get an ambulance with 3 medics or an ambulance with a driver(basically EMT or medic working OT) nurse and a doctor. It will depend on the severity of the call as decided by dispatch. The medic unit can aso call for a physician unit as back up.

In less severe calls the physician is dispatched as basically a house call. Obviously for advanced procedures and knowledge in more severe calls.

In areas where there are no physicians working, usually smaller cities/villages, then a paramedic ambulance will arrive.

No matter what you get, it will cost the equivalent of $125 USD. They will show up with the same lifepack 12 or 15 in the US, with a much more amazing jump kit. (aka equal or better equipment.)

None of the citizens or residents pay out of pocket, they have state mandated insurance. (which is also paid for by the state if they can't afford it) But if you are a tourist or other visitor, $125 for an ambulance isn't a bad price.

There are many benefits to state level EMS systems and national level healthcare systems. (a few drawbacks too, it is not perfect)

In the US, if you are working as a PA, you bill as a PA, not as an ALS ambulance or fly car. That fee for service is submitted to medicare/medicade/insurance as PA service, not medical transport.

If you work as a PA and accept a medic rate while your company bills a t a higher rate, that is your business.I don't suggest it. I wouldn't accept less than a percentage of that collected.

How do we change the culture of EMS and get the money to make it worth peoples time? People already balk at the idea of paying a 1500 dollar ambulance fee.

Once EMS providers have an education, they can leverage the value of service they can provide to increase funding for it.

But don't be fooled, EM physicians make a considerable amount of money because EMS transports all patients to them. They are often medical directors. So you are literally up against the financial interests of your medical director.

The first step is for EMS to advance education to at least a bachelor's where the medical "director" is really an advisor and paid for such. That is a vital part of being a profession. Setting your own rules.

No matter how professional EMS behaves. It is like having a sex change.
They look like a profession, they act like a profession, but they are only in appearance.

(in a similar manner as a man undergoing cosmetic gender reassignment will not have a uterus, ovaries, etc.)

 

[Veneficus]

I'll amend that and say "for now".

It's always bothered me that Medicare sees EMS as a transport provider, not a clinical provider. I have a feeling that's going to change in my lifetime, though.

I hope it does. But the only way I can see that happnening is with increased education requirements.

That is the route everyone from nursing to RTs to PAs, and DNPs took.

I have no idea how EMS could go about it a different way.

 

[ExpatMedic0]

I have been living in the EU for a year, it is in no way shape or form the same in every country here. Just like how every country has there own language they also have drastically different EMS education and systems.

 

[mycrofft]

Sidetrack: follow the money.
OK. Pt's can't afford rides and care, municipalities can't afford to pay a prehospital medical service AND a full FD, taxpayers can't afford to pay for anything, supply/medicine/equipment/vehicle suppliers can't afford to reduce their prices, insurance can't afford to lower its rates to anyone (or even to pay out on an honest policy). Tech's can't afford to go back to school and become a MD, PA, FNP.

So where the hell did all the money go*? Or are we each either too lazy or too avaricious or both?

The best one could do in such circumstances (and they are not uniform throughout the land) is to start early on your professional journey, don't settle and stay as a tech unless you fail further advancement, use all the resources you can muster to better yourself, and if you make it, don't try to get rich by gouging those behind you.


*PS: hint: corporate legal companies; nonessential surgeons and other practitioners; software magnates; oil cartels; war materials suppliers; and all the toys we need to live in modern middle to upper class America. Etcetera, etcetera, etcetera. So sez me.

 

[46Young]

No, that is unfortunately where you are mistaken. I can put countless hours into certifications and education but 99% of the time it is only for personal benefit. I will see no promotions or increased pay or even a good job for what I do. Mind you I do it anyway but regardless, it is otherwise a wasted effort.

As far as living within your means, sure, it's more than possible. Personally I like driving a decent car ($20-40,000) and I would like to own a modest home some day and be able to provide my children with the things they want.

Living in NY, more specifically Long Island @ 23 years old I live within my means comfortably. If I had to pay a mortgage, I would be in substantial debt. My $60,000 a year supports myself fine but a family? Not a chance.

$60,000 a year simply won't do that. Not even close.

...Which is why I left Queens NY with my family to a fire based EMS system. This is one of the reasons why so many leave single role EMS systems for fire based, just like you're doing by "back door-ing" (what they call it on the firehouse.com FDNY threads) into FDNY fire from FDNY EMS.

For the record, it isn't only EMS that's used as a stepping stone. I know a few DOC CO's, cops, parks dept workers, and garbage men that took those jobs just to start on their 20 and out retirement with their sights set on FDNY. This occurs in a lot of other places as well. EMS just happens to be a convenient way to pay the bills or get into a retirement system until you get the career you really want.

EMS just doesn't pay well most of the time. To me, $40-$60k/yr isn't sustainable for the long term unless you choose to remain single with no children and don't care about your retirement at all. Eventually, many young EMS workers mature and realize that the job is dead-end and working 2-3 jobs for 60-80 hours a week isn't desireable for the long term.

 

[Veneficus]

many young EMS workers mature and realize that the job is dead-end and working 2-3 jobs for 60-80 hours a week isn't desireable for the long term.

Well said.

A dead-end job is not a profession.

 

[46Young]

While I concur with you that the many "Ricky Rescues" are not helping our profession, its a double edge sword.

How about all the burned out EMSers? Every time I visit this forum I feel as if half the people who post here need to either get out of EMS and accept it as a "lost cause" or get off there @ss and do try to do something about it. I disappear from this forum now again because I get so sick and tired of hearing the same old complaints about EMS. Don't like it? Fair enough, move on to something else that YOU ENJOY.

I see there being a TWO types of people destroying the future of EMS advancing.
1. Under educated buffoons who want to play hero with a couple hundred hours of training, along with the "advanced providers" who advocate "meat head medicine"
AND
2. Burned out providers who instead of being proactive about improving things simply tell new up and comers to "be a nurse" or discourage furthering of ones education in the name of EMS.

Really, what kind of career ladder and retirement is there in EMS? EMT > medic > maybe supervisor, of which there are very few positions? Maybe there's a lateral to dispatcher or support services, but that's about it. My dept: FF or FF/medic, Technician, Master Technician, Lt, Capt I, Capt II, BC, DC, AC, Fire Chief. Each promotion is a 5-10% pay increase. We have numerous positions in EMS Admin/education, the Fire Marshalls office in Investigations, Prevention, the Fire Academy, Peer Fitness/CPAT, as well as numerous office positions.

What if you need light duty in EMS? If you're lucky, there's a dispatcher spot or maybe one or two office spots. Otherwise, you're out of luck. I know places that make pregnant EMT's work on the bus until they're seven months pregnant or worse.

I'm absolutely going to recommend that the young EMS professional seek a better career, usually in a fire based system or in a better paying healthcare field, and maybe do EMS on a per diem basis afterward, so they can have the best of both worlds, which many people do. When I worked at my former ospital based EMS dept, I worked with a few FDNY FF's, several nurses, a banker, a few retired people, etc.

I've worked per diem at one local hospital in the area for more than a year and a half. Many, like myself, are FT in a FD and work here per diem. At least a dozen others are planning on or are actively seeking employment in a fire based EMS service. One guy just graduated our last recruit school. There are some full timers that have been here for ten years or more, or are retired from their careers (typically fire/EMS) but they are the minority, and this place happens to be top-of-the line IMO. That's just how it is. In EMS, full timers generally come and go, and others work EMS per diem while having a different career, because an EMS job is usually easy to get.

 

[46Young]

*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

We work nights and weekends, typically for no differential pay in most places. We often lift dynamic loads (people) in dangerous positions and terrain. We have to sit in a seat for a long period of time, which further pre-disposes us to injury. We deal with the diseased and sometimes violent pt. We work roadside where emergency responders get killed every year. Municipal schedules are often a 56 hour workweek, where you need to make $12/hr just to make $40k/yr. As a rule, our breaks are often delayed, interrupted, or omitted altogether. Late calls and mandatory holdover are more the rule than the exception as well.

I know plenty of burned out EMT's and medics that went down with a career ending injury, or cannot take the pain of their chronic injuries caused by the field. I know a few people that caught HIV, HEP, etc. from working in the field.

For these reasons I feel that we should get paid more, but because the barrier for entry is so low, and every Tom, ****, and Harry applies for EMT work nowadays, anyone is willing to do the job, so employers have no reason to pay more.

Really, anyone who agrees to work for substandard pay is part of the problem. But, if you refuse to work, someone else definitely will.

So, even though it was never my original intent, I used EMS as a stepping stone to a better career, and continue to use EMS as a second source of per diem income (because I still enjoy the work, and per diems make more than most FT'ers).

It's popular to say that we should get off our butts and "change EMS," but I have no intention to martyr myself financially, with an uncertain payoff.

How much do truck drivers make? Administrative assistants? Roofers (legal)? Highway workers? Personal trainers? Bouncers? They all make more than $10/hr, with little to no education, and usually on the job training to some extent.

 

[46Young]

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.

+1

I understand that nurses increased their education first, advertised that the pts benefit from this, and then worked towards better pay. I don't see this as a reasonable course in EMS, though. It's a tough sell to ask someone to go to college for four years just to make $12-$20/hr with a crappy retirement in most cases. Not enough people will be willing to do this unless employers give weight to degrees or just require them. Almost all private EMS, hospital based EMS, Third Service EMS, and fire based EMS are equally to blame in this regard. Most places have requirements such as a pulse, patch, a decent driving record, no felonies, and maybe some experience. I must have missed where they ask for a degree, IDK. Really, go on any municipal hiring page, or any hospital beasd hiring page for that matter, and you'll see no mention of a degree, or perhaps a 2-3% stipend at the most.

 

[46Young]

Really, when I tink about it, EMS in the USA is not a profession, it's just a job. It's appropriate for the short term, maybe 3-5 years, while you go to college or something, and then you leave or stay on per diem for some extra $$$. The lack of job security, lack of a career ladder, and lack of a decent retirement in most cases just shows that EMS is not intended to be a career. Besides the long term financials, many people get injured on the job, and most people don't like being woken up several times a night and posting on a street corner for 25+ years, not to mention all the mandatory weekends and holidays worked, etc.

 

[ExpatMedic0]

Really, when I tink about it, EMS in the USA is not a profession, it's just a job. It's appropriate for the short term, maybe 3-5 years, while you go to college or something, and then you leave or stay on per diem for some extra $$$. The lack of job security, lack of a career ladder, and lack of a decent retirement in most cases just shows that EMS is not intended to be a career. Besides the long term financials, many people get injured on the job, and most people don't like being woken up several times a night and posting on a street corner for 25+ years, not to mention all the mandatory weekends and holidays worked, etc.

So why are you still in EMS, why did you not only stay in EMS but advance to the paramedic level? What have you done to fix anything or make your life in EMS better ? Whats the point of all this for you?

 

[Jon]

I hope it does. But the only way I can see that happnening is with increased education requirements.

That is the route everyone from nursing to RTs to PAs, and DNPs took.

I have no idea how EMS could go about it a different way.

I'm entirely OK with that. I'm not trying to bash EMS-based fire suppression agencies, but they are going to have the biggest issue with it.

The problem is the brain drain that is occurring until such standards are raised. We are loosing many of the very providers that would love such a system. We are loosing them to other professions (how many members of the forum, including yourself, Vene, will still be in EMS in 2 years, in 5, in 10?).

Until the education standards are raised - our great minds of EMS will continue to leave and go to nursing school, or medical school, or going into other office jobs.


Who's doing the biggest fighting against the new national standard for EMT's? Volunteers in some areas, sure - but the big city FD's that are only IN EMS because there's money, that's who.

 

[Veneficus]

The problem is the brain drain that is occurring until such standards are raised. We are loosing many of the very providers that would love such a system. We are loosing them to other professions (how many members of the forum, including yourself, Vene, will still be in EMS in 2 years, in 5, in 10?).

I suspect I will always be involved in some capacity.

I have my moments when people in EMS really piss me off, but after a little break I usually come back.

Until the education standards are raised - our great minds of EMS will continue to leave and go to nursing school, or medical school, or going into other office jobs.?

Maybe it is just my perspective, but I don't think it is the education standards. I think it is the lack of career opportunity. Ifyou look at fire service medics, they usually stay in for the long haul. But they have many more opportunities for advancement and lateral transfer. Even the best US EMS systems, like Wake County, cannot compete with the fire service.

Who's doing the biggest fighting against the new national standard for EMT's? Volunteers in some areas, sure - but the big city FD's that are only IN EMS because there's money, that's who.

It has always been that way. But i am starting to think volunteers are becomming a much larger problem than the fire service.

FDs I think are discovering it is not the cash cow they once had. Increased costs, static revenue. I would not be surprised to see some FDs try to divest themselves from it in the next 5-10 years.

 

[46Young]

So why are you still in EMS, why did you not only stay in EMS but advance to the paramedic level? What have you done to fix anything or make your life in EMS better ? Whats the point of all this for you?

This is a little long winded:

When I was 26, I decided that I needed to do more than work off the books as a Snapple delivery man and a bouncer. I wanted a decent career with benefits and retirement. I thought about what career could fit that criteria. I recalled that two of my cousins worked FDNY EMS, so I talked with them, and decided that EMS was a career I would enjoy, and the money was decent ($14-$20/hr for EMT's at NS-LIJ, $22-$30/hr for medics). I worked per diem for a private at $9.50/hr just to build a resume and got hired by the hospital seven months later. About two years in, my wife and I were expecting our first child, and we were barely getting by bill-to-bill.

So, I had to decide between nursing school and medic school. 3 years vs 13 months, for the same money if I just pulled two extra tours a month. The plan was to do FDNY EMS, but while in the process one of my former co-workers came up to visit from Virginia where he was hired as a FF/medic. He told me all about it, so I lost interest in FDNY EMS and began the process down South. I really didn't see myself sitting on street corners getting my stones busted by the conditions Boss for 25 years for not enough money and 25% less pension than FDNY fire. The hospitals are all 401k or 403b, so screw that.

I failed one poly and thought I failed the second (they do that routinely as a tactic to illicit confessions), so took a job in a Third Service in SC while my wife was still agreeable to leaving NY. That place was undesireable to me. All of the burnout issues were present there. About three months in, I received a job offer from my current employer, so I left after five months or so in SC.

$53k in the academy, $71k after clearing ALS internship, now a $84k/yr base four + years in with a promotion already obtained, excellent benefits, 25/55 pension w/ a 2.8% multiplier, and a three year DROP. I had always wanted to do fire as well as EMS, so this just worked out perfectly. My employer supplies me with all the tools necessary to do my job in EMS well, and I ride the bus typically two days out of every three. Last year I grossed $128k w/OT and another few grand from my per diem hospital based medic IFT job, and I'm paced to hit $140k this year.

THAT's why I've stayed in EMS. Excellent working conditions with ample benefits and pay. At this point in my life, with a wife, two children, a mortgage, and a retirement to fund, addressing these needs is the point, addressing these needs is of paramount importance. I still enjoy EMS work, at least the acute cases and patients that are truly appreciative,but 10+ years in I'm sure that I would have burned out had I stayed either in the NYC 911 system or in SC.

You see, I had no intention to financially martyr myself for the good of EMS. I decided that if I wanted to stay in the field, it would need to be with an employer that would take really good care of us. So, I sold out and went fire based. I still do the exact same job I did previously at least two days out of every three, with top of the line equipment and decent protocols/guidelines, and I also have an engine full of people to carry my equipment and the pt as well. No more six floor walk-ups with just me and my partner, humping all our equipment and then taking all of that back down along with the pt. I can ask questions and gather info while other people do vitals, package the pt, and deliver them to the back of my bus, where I can go to work. I can do this for 40 years if I want to.

Capiche?

Edit: Almost forgot, in addition to the money, I wanted to be able to do more for my patients - that was of equal importance to the pay, truth be told. I'd felt handcuffed as an EMT-B - I have a reasonable idea what the pt needs, or maybe I would like to know so that I could help them, but don't have the education or diagnostics, so I give them air and chair until someone that can actually help shows up. Like I said, I still enjoy paramedic work when it actually makes a difference. Frivolous calls kill my motivation and job satisfaction, but the working conditions at this career definitely mitigate that. Where else do you get to sleep and exercise on duty, and knock out degrees OTJ?