EMS Stagnating?

[MMiz]

Another thread got me thinking about my career over the past 20 years and how much (and little) it has changed.

What about EMS? Treatment protocols haven't changed much in 20 years. Ambulance design philosophy hasn't changed, nor have we seen significant advancements in technology. Education standards have seen incremental improvements.

I thought by now ultrasound would be a thing, community paramedics would be the norm with a greatly expanded protocols, and street corner System Status Management would be something we joked about.

Have we stagnated as a profession?

 

[Aprz]

Absolutely. We are a very traditional profession. Even at my current job, we got video laryngoscopes, and people will act like the video laryngoscope are crutches discouraging using them. Our intubation success rate overall is appallingly low. At another company I worked for, people FOUGHT for non electric gurnies! It's so weird how resistant to change we are.

 

[E tank]

Did a search on the interweb and found the average paramedic is in that job for 5 years. Have no idea how accurate that is but I don't guess it's too far off. With that kind of turnover, its pretty difficult to get traction on change.

 

[DrParasite]

EMS, in general, has a couple of problems, that prevent it from growing. the best and brightest in EMS leave for higher education or other careers in healthcare. We treat newcomers to the profession pretty poorly, so they don't stay long. we have a poor track record of training and developing leaders, and it shows... the metrics that we use to evaluate a "good" EMS system suck (response times is one of the big ones). There is no financial incentive to innovate in EMS, not much EMS research being conducted to better EMS, and we are still primarily thought of as a transportation system, instead of as medical professionals, by many others. And we don't have the funding from the AHJ to actually improve, only to continue with what we have been providing for decades. And the education standards for existing providers is woefully inadequate, and many have no desire to rectify that.

There are some up and coming EMS leaders who are pushing for improvements, but a lot of old farts who aren't willing to put forth the effort to get those improvement implemented, because "back when started, we didn't need xyz, so why waste money on this new toy that we didn't need then, and don't need now?"

 

[E tank]

EMS, in general, has a couple of problems, that prevent it from growing. the best and brightest in EMS leave for higher education or other careers in healthcare.

Hate to admit it, but IMO, if EMS is supposed to make meaningful progress, the future is in fire departments. Seems like that's the only place that provides the means for someone to stay in the job for 20+ years. That, I think, is where the long term framework is going to be. As far as a forward looking, progressive mindset in a fire service...that might be another conversation.

Further divorcing EMS from the established medical milieu of a metropolitan area's medical community is not a good thing, but as far as career sustainability goes...its the FD.

 

[FiremanMike]

Another thread got me thinking about my career over the past 20 years and how much (and little) it has changed.

What about EMS? Treatment protocols haven't changed much in 20 years. Ambulance design philosophy hasn't changed, nor have we seen significant advancements in technology. Education standards have seen incremental improvements.

I thought by now ultrasound would be a thing, community paramedics would be the norm with a greatly expanded protocols, and street corner System Status Management would be something we joked about.

Have we stagnated as a profession?

I don't know about the last 20 years.. I feel like we've changed a fair bit.. I do feel like the last 2-3 years have seen almost no appreciable protocol changes (at least here)..

 

[Summit]

Did a search on the interweb and found the average paramedic is in that job for 5 years. Have no idea how accurate that is but I don't guess it's too far off. With that kind of turnover, its pretty difficult to get traction on change.

I remember that 5 year factoid 15 years ago...

 

[DesertMedic66]

Hate to admit it, but IMO, if EMS is supposed to make meaningful progress, the future is in fire departments. Seems like that's the only place that provides the means for someone to stay in the job for 20+ years. That, I think, is where the long term framework is going to be. As far as a forward looking, progressive mindset in a fire service...that might be another conversation.

Further divorcing EMS from the established medical milieu of a metropolitan area's medical community is not a good thing, but as far as career sustainability goes...its the FD.

That is definitely an option that very well could work however in my experience EMS will still be treated like black sheep. There are a few fire departments that I know of who place great pride on their EMS/transport side but the vast majority do not and the employees who are on those ambulances are just there until a coveted spot on an engine opens up at which time their pay, benefits, retirement, and everything else greatly increases.

I also don’t believe that private for-profit or even non-profit is going to be a good option. This really just leaves hospital based systems or a third service. While I have no personal experience with either of these systems I have heard great things about the third service model where EMS is a county wide department.

 

[mgr22]

I think evidence of stagnation is judging success by the protocols we have and the tools we use. Evidence of anti-stagnation is community paramedicine, but I'm still not sure how qualified we are to do that.

 

[FiremanMike]

There seem to be a few third service agencies that do it right, offering advancement, full focus on EMS, and a general feeling of being a career job and not just a “until I get...” job..

They seem to be in the minority and most of them are still far underpaid.. If I’m a medic working in such an agency and realize that getting my RN on my off days will lead to double my salary, its no wonder turnover is high..

And the FD isn’t all rose bushes either, a good chunk of folks only stay because of the ball and chain that is the pension system..

 

[Summit]

Look, this forum in particular has been a hotbed of progressive EMS ideas and advocacy since I joined it in 2004. Many of the conversations go in circles because change comes slowly. There are many multipage threads over the years talking about this. Many are worth reading and they involve US and non US EMS, Fire, PAs, MDs, RNs, etc... the full breadth of the membership of this place.

If you look at what makes EMS progressive and a long career in other nations, it generally functions as a government third service and requires vastly higher education requirements, typically 2, 3, or 4 year degrees to be ILS with additional university education yielding higher responsibility, scope, and pay to include BS or MS degrees including pathways into additional fields. Look at Canada, NZ, Australia, and parts of Europe (many of which may also incorporate RNs and MDs into EMS).

Pinning EMS to Fire guarantees that EMS will be considered a secondary function of FD, a stepping stone within FD. Yes there are a handful of departments that are EMS Fire instead of Fire EMS, but most do not think EMS first and never will. Increasing education requirements will not be permitted to occur because Fire doesn't want that. Fire wants degrees to be in Fire when people go for officer after they do their requisite **** duty on the bus. Pushing Fire as EMS's savior means making EMS just a higher paid version of what it already is for most: a temp job in career that is not ultimately EMS.

Volunteer EMS creates a similar issue, specifically East Coast volly depts in areas that could absolutely support professional departments. Low entry requirements and people doing the job for free will keep anyone from raising the bar for entry and education which drives scope and role which drives pay.

EMS is a small, fractured, and isolated component of healthcare and has an identity crisis frequently confusing itself with public safety (Fire/PD). For EMS to progress it has to identify with its actual field of focus, and that is MEDICAL services in the prehospital environment. We ought to rename EMS to PHS: Prehospital Healthcare Services.

EMS gains career paths when people stay in it. Career paths open when EMS providers are educated professionals rather than stone steppers and interchangeable cogs. Some pathways are dead ends: hospital work is silly because the hospital is full of niches that are already filled! Advocating for cheaper and less educated paramedics to be interchangeable with higher educated higher paid healthcare workers inside the walls of a hospital actually works against EMS progression because it confirms the idea that EMS is exactly those things that are holding it back: technician level, lower education, cheap. Community paramedicine is one of those pathways of true progression but it truly should be the role of an educated professional rather than another 40 hours cert course. More broad education makes it far easier for medics to transition. it is why RNs can jump specialties far easier. They start as generalists. EMS are specialists from the start. Broad education is found in degrees.

Things have gotten better, and they could get better still. Change has been incremental because all the education reform is always pared back by intrasigent interests working against ultimate EMS progression. Eyes on the prize! Associate Degree in Paramedicine as the minimum to become a medic, no exceptions, grandfathered if you have 5 years of medic experience, otherwise you have 5 years to get it or you get dropped to AEMT. Intermediates get 5 years to transition and EMT-Cardiac and the like all go the way of the dodo. Do that modest thing, and changes start.

 

[FiremanMike]

Look, this forum in particular has been a hotbed of progressive EMS ideas and advocacy since I joined it in 2004. Many of the conversations go in circles because change comes slowly. There are many multipage threads over the years talking about this. Many are worth reading and they involve US and non US EMS, Fire, PAs, MDs, RNs, etc... the full breadth of the membership of this place.

If you look at what makes EMS progressive and a long career in other nations, it generally functions as a government third service and requires vastly higher education requirements, typically 2, 3, or 4 year degrees to be ILS with additional university education yielding higher responsibility, scope, and pay to include BS or MS degrees including pathways into additional fields. Look at Canada, NZ, Australia, and parts of Europe (many of which may also incorporate RNs and MDs into EMS).

Pinning EMS to Fire guarantees that EMS will be considered a secondary function of FD, a stepping stone within FD. Yes there are a handful of departments that are EMS Fire instead of Fire EMS, but most do not think EMS first and never will. Increasing education requirements will not be permitted to occur because Fire doesn't want that. Fire wants degrees to be in Fire when people go for officer after they do their requisite **** duty on the bus. Pushing Fire as EMS's savior means making EMS just a higher paid version of what it already is for most: a temp job in career that is not ultimately EMS.

Volunteer EMS creates a similar issue, specifically East Coast volly depts in areas that could absolutely support professional departments. Low entry requirements and people doing the job for free will keep anyone from raising the bar for entry and education which drives scope and role which drives pay.

EMS is a small, fractured, and isolated component of healthcare and has an identity crisis frequently confusing itself with public safety (Fire/PD). For EMS to progress it has to identify with its actual field of focus, and that is MEDICAL services in the prehospital environment. We ought to rename EMS to PHS: Prehospital Healthcare Services.

EMS gains career paths when people stay in it. Career paths open when EMS providers are educated professionals rather than stone steppers and interchangeable cogs. Some pathways are dead ends: hospital work is silly because the hospital is full of niches that are already filled! Advocating for cheaper and less educated paramedics to be interchangeable with higher educated higher paid healthcare workers inside the walls of a hospital actually works against EMS progression because it confirms the idea that EMS is exactly those things that are holding it back: technician level, lower education, cheap. Community paramedicine is one of those pathways of true progression but it truly should be the role of an educated professional rather than another 40 hours cert course. More broad education makes it far easier for medics to transition. it is why RNs can jump specialties far easier. They start as generalists. EMS are specialists from the start. Broad education is found in degrees.

Things have gotten better, and they could get better still. Change has been incremental because all the education reform is always pared back by intrasigent interests working against ultimate EMS progression. Eyes on the prize! Associate Degree in Paramedicine as the minimum to become a medic, no exceptions, grandfathered if you have 5 years of medic experience, otherwise you have 5 years to get it or you get dropped to AEMT. Intermediates get 5 years to transition and EMT-Cardiac and the like all go the way of the dodo. Do that modest thing, and changes start.

This is actually the first time I got behind a "paramedics need degrees" argument. I totally agree..

One of the questions from my first week in RN school is "what makes nursing a profession" and the answer is essentially education, professional accountability, and career opportunities. EMS can start with education and then potentially grow in the other areas.

With that said, I suspect EMS will always suffer from the fact that the best and the brightest simply aren't going to be content with stopping at Paramedic and will want to move up..