EMS In Crisis

[46Young]

Then by all means, because the providers are lazy arses, lets not do it!

Sorry patients, we were too lazy to go to school! Our bad, but you gotta suffer with some warm pulse patch factory medic who couldn't be bothered gettin the edoomukashin.

Biggest fail ever.

You're right about the lazy part. Evidence of this would be patch factories and anyone who chooses to do the EMT-I program rather than a paramedic program. Her, in Virginia, the EMT-I and the EMT-P are considered virtually the same. They can practice with virtually the same scope, with the EMT-I having but a fraction of the education. At least NVCC requires their EMT-I students to have human biology and pharm prior to application.

Anyway, what I was speaking of earlier is that the field turns over it's workforce way too rapidly to allow any effective organization. Meanwhile, few are willing to make the educational investment (when easier alternatives are available) when the benefits and payoff aren't there. The EMS employers aren't going to lobby for more education, either. It's not just about being lazy, the field just doesn't appeal to those that expect a decent return for their educational investment, for the most part.

 

[Trayos]

EMT as in the concept of prehospital providers or EMT in contrast to a paramedic?

As in the concept of prehospital providers. It makes me kinda sad when people go "oh, the guys who drive the ambulances? Whats so important about that?"
Most know what a paramedic is, at a rudimentary level.

 

[Veneficus]

S*** rolls downhill

In the 1960s there was a realization that our healthcare system was broken. You could only get care when you got to the hospital. The days where a physican was part of or entered the community were coming to an end.

The paramedic was born. For no other reaon than to fill the hole that was left.

Shortly after I became an EMT, paramedics were being hired to work in emergency rooms. With the inability to recruit nurses for a variety of reasons, after the nursing lobby displaced ED techs, a hole was created, the paramedic was then asked to plug this hole.

From amuzement parks, to zoos, (A to Z get it?) whenever a low cost medical provider is needed so desperate is the situation, EMTs of all levels are thrown in to plug the hole. Some specialize in their hole. call it wilderness, industrial, whatever.

With the breakup of the family unit and society in the US, the care of the elderly had been institutionalized. Another hole, somebody had to get these people from point A to B and back. Somebody who was part of the "medical system." EMS providers were again put into a failing situation.

For many years in public safety and medicine we have been witnessing the total collapse of our society. As the number and types of people that need a safety net increased, EMS (mostly in the way of public safety) and by extension the EMT (of all levels) was called upon to help by transporting to the hospital. This stop gap worked for a while, but it was simply the finger in the dyke. The "abuse" many of us witnessed in our EMS career by "patients" was really the manifestation of our failed social and medical systems.

EMS providers are thrown into the impossible situation now. The hole is so big it doesn't matter how many you throw into it, you cannot fill it. You cannot slow the leak. The problems are social and not medical. It is why even after you take the pt to the hospital, you wind up taking the same frequent flyer again and again for the same thing.

The providers get frustrated. They came to help to make a difference. They hoped to make a living at it. EMS providers get "burnt out" or frustrated because whether they realize it or not, deep down somewhere, they know they are just spinning their wheels. The record is broken and there is no satisfaction in it anymore.

I have explained the economics of service professions ad naseum, I'm not doing it again.

In order to "help" people EMS providers need more education. Whether you like it or not, get a pay raise or not, or any other lazy excuse I have heard over the years, it remains. But the education is not all medical in nature. You have to learn what social programs are available, how to get people nvolved in them, what you can do at the social level so that it doesn't become a plea for help by dialing 911. If you want to make a difference, if you want to save lives, do some good, or whatever idea brought you to EMS, you have to perform the task needed, not the task you want to, only on the people you want to or feel are deserving. Instead of jumping in the hole trying to fill it, you need to form a chain around it and stop people from falling in.

Everyday in this world, somebody has a "real" emergency. No matter what is done they may not survive, they will never be the same if they do. They are discharged alive and functional if they make it. They have chronic issues forevermore until the body can't cope. The damage done accelerates the bodies natural breakdown even if it is latent for years. Defiant as you stand before nature, before that which mankind does not understand, you will be overwhelmed. You don't have a chance. Tangible, needed, desired, help is that which precludes crisis. Stopping a minor lac from being infected is where lives are saved. Getting an old person a walker so they don't fall and smash their skull will save more peoples lives than every neurosurgeon, critical care surgeon, and Emergency physician combined.

One of the things I have learned is that we really don't know the names of most heros. They are not the ones on TV or who went above and beyond once to save a life. They go above and beyond everyday. They come early, they stay late, they do the undesirable tasks for years, they give of thier time, their money, and every measure of value you can think. They save more lives and make a bigger difference than we will ever know.

This semester I had the opportunity to meet a physician who specializes in microbiology.(not somethig I want to specialize in) Her team (which spans 4 countries) is working on vaccines for bacterial STDs. During her presentation, she talked of life and death in numbers that look like they came from wall street.

She had pictures of camps in Bangledesh where some of the brightest physicians in the world built toilets without running water and emptied and cleaned them by hand. So little was the money they could not hire nurses. They could not find volunteers. They built them so people could come for treatment during the annual cholera outbreaks after the monsoon season. They estimate they saved more than 100,000 people in a few months. They had vaccinations, some IV fluids for the most desperate cases, the treatment for cholera, and whatever they could find locally on the cheap. They make a difference. Would you like to make a difference like that?

My current and future role is extremely focused. The days of my EMS involvement are less than 1000. I share my insight and experience so that maybe those that are still involved can make the required changes. So you can go home proud that you did make a difference. Save a life. All of those things.

Burnout in EMS isn't required, but if a provider is not satisfied, no amount of money or prestige is going to change that. You are never going to be happy replaying the same broken record day in and day out. You will never be a professional without knowledge.

I was told once: "There are only 2 types of people in the Navy. People whos lives it makes better and people whos lives it makes worse." EMS is the same way. If you came to EMS to help people, start by learning what that means. It is rarely a trip to the hospital.

 

[medic3974]

Good post Veneficus and Asst. Chief. I believe this system needs its own hero. Someone with the political savy and smart enough to surround themselves with the right people to designs a EMS system that could work. A system that would provide more rights to the employees of the system and some better accountability to the tax paying citizens who fund medicare and medicaid.

 

[Trayos]

It seems to me like what the system needs is a face, something the public can flash to when they hear "EMT".
People already have set ideas about what a police officer, or a firefighter does/looks like. There is very little other then a blue uniform with the star of life that comes to mind when EMS is mentioned. Until it reaches that sort of recognition in the public consciousness, it will always be downplayed and under-supported. The only way to achieve that recognition is through toughing it out through the worst of times, and doing the hard work.

 

[Veneficus]

It seems to me like what the system needs is a face, something the public can flash to when they hear "EMT".
People already have set ideas about what a police officer, or a firefighter does/looks like. There is very little other then a blue uniform with the star of life that comes to mind when EMS is mentioned. Until it reaches that sort of recognition in the public consciousness, it will always be downplayed and under-supported. The only way to achieve that recognition is through toughing it out through the worst of times, and doing the hard work.

The trouble is EMS and EMTs are so many different things.

For example, I was a firefighter when our the department decided everyone had to be an EMT. But even after certification my title was still firefighter. It still said firefighter on my helmet etc. EMT wasn't even mentioned. When people asked what I did I was a "firefighter."

The same can now be said for any level of EMT. They work so many places besides ambulances. The jobs don't even resemble the training. There was not "industrial health day" in paramedic class.

Many EMS people can't even agree what EMS is. Is it public safety? Public health? Medicine? a hybrid? The answer depends soley on who you ask.

Now many of the people who have been around awhile and many nations abroad see the roles EMS and its people will play in the future, but then we hit a wall of people telling us what EMS is today and see no reason or have an interest in making sure it doesn't evolve.

The only common ground I have discovered as I detailed is EMS workers are people with some level of medical training that fill in gaps in the healthcare and social safety net systems. (often as low cost as possible) But again, there is no consensus or even majority.

 

[MrBrown]

Anyway, what I was speaking of earlier is that the field turns over it's workforce way too rapidly to allow any effective organization. Meanwhile, few are willing to make the educational investment (when easier alternatives are available) when the benefits and payoff aren't there. The EMS employers aren't going to lobby for more education, either. It's not just about being lazy, the field just doesn't appeal to those that expect a decent return for their educational investment, for the most part.

I don't want to turn this into the education debate again but I will say this at the risk of sounding snobbish (which I am not).

Having the Bachelors Degree and working with people who do not makes me appreciate how helpful the depth and breadth of knowledge and ability to "see the big picture" those who are Degree educated posses is.

There are advantages to Degree education and there are equally important advantages to the old "on the job" style education you cannot get on the Degree.

 

[46Young]

I don't want to turn this into the education debate again but I will say this at the risk of sounding snobbish (which I am not).

Having the Bachelors Degree and working with people who do not makes me appreciate how helpful the depth and breadth of knowledge and ability to "see the big picture" those who are Degree educated posses is.

There are advantages to Degree education and there are equally important advantages to the old "on the job" style education you cannot get on the Degree.

Don't get me wrong. it would be a great thing for EMS in the States to have the level of education that other developed countries enjoy. I'm completing my EMS AAS at the moment, at least it's a start. I'm disappointed at the lack of further clinical education for the paramedic past the AAS in the US. My next step is to become an RN, then chip away at a BSN, so I'll get the additional clinical knowledge there, since it doesn't yet exist in the American EMS educational system.

I simply don't see how EMS educational standarde will improve if there's no significant organization and/or funds to work toward that change.

What I'm trying to say is that I don't see how EMS here will be able to bring itself up to the standard of other countries, for the reasons I've stated earlier.

 

[MrBrown]

I simply don't see how EMS educational standarde will improve if there's no significant organization and/or funds to work toward that change.

Thats a good point, something we have seen here in New Zealand.

In 1975 the first Telethon was used to raise nearly a million dollars for the development of the National Ambulance Officers Training School.

Almost forty odd years later the Ambulance services are again collectively working together (something of a first) to make the Bachelors Degree and Post Graduate qualifications mandatory for Paramedic and Intensive Care Paramedic.