How to evolve EMS

[WolfmanHarris]

Honestly I think your biggest problem is high cost, profit driven private health care. How can your pursue more appropriate assess, treat and refer type care if reimbursement is based on transports? How can you provide integrated out of hospital health care when every organization has motivation to stay in their silo? In an era of austerity and a manic obsession with low taxes at all costs a progressive agency pursuing high standards and good medicine could be gone next year becuase a private company doing the bare minimum and focusing on coverage response times and reimbursement rates can take over.

Granted I'm watching from the outside so my view on how your system works might not be accurate BUT all the advances we've made in community Paramedicine in just the last 5 years in my province have come from a combination of forward thinking leadership at the service level and a Province looking for novel solutions to improve the health care system that at all levels from family medicine, to public health to EMS to hospitals is paid for by the Province.

 

[Qulevrius]

Honestly I think your biggest problem is high cost, profit driven private health care. How can your pursue more appropriate assess, treat and refer type care if reimbursement is based on transports? How can you provide integrated out of hospital health care when every organization has motivation to stay in their silo? In an era of austerity and a manic obsession with low taxes at all costs a progressive agency pursuing high standards and good medicine could be gone next year becuase a private company doing the bare minimum and focusing on coverage response times and reimbursement rates can take over.

Granted I'm watching from the outside so my view on how your system works might not be accurate BUT all the advances we've made in community Paramedicine in just the last 5 years in my province have come from a combination of forward thinking leadership at the service level and a Province looking for novel solutions to improve the health care system that at all levels from family medicine, to public health to EMS to hospitals is paid for by the Province.

US can't switch to that model, because once people are told their taxes will hit 20%+ bracket, there will be riots. And the flip side of a socialist model medicine is that it has to be all-embracing. The dreadful Obamacare was trying to build on a transition from private to public healthcare, and we've seen (or rather, suffered from) the result. And there's also the nuance of having a very limited access to specialists. Long story short, it's not going to happen here.

 

[EpiEMS]

MORE money.... lol For example you can't afford people like my bosses pensions in EMS... 98% of top 5 years at 200k+. +health... again that won't be everybody, but my uncle who's a fire chief in WNY, won't even be near that... he's going to be close percentage wise, but not even close in the realm of salary.

On this matter, it seems as affordable to PD and FD to pay generous pensions as it does for EMS - it's not: the taxpayer (especially future taxpayers) will bear the burden. Unless you operate public pensions like private ones (hint hint, there are very few private pensions anymore) where assets need to match liabilities (GASB vs. GAAP-driven), you're going to be able to have generous pensions for some amount of time going forward.

Honestly I think your biggest problem is high cost, profit driven private health care.

I'd argue the opposite - I think the biggest problem is people not paying for their own care. And in the U.S., there's a large evidence base suggesting that more coverage (especially more public coverage) increases service utilization.

 

[NysEms2117]

I'm going to try and ask to shift back to ideas for change? if thats okay with everybody?

 

[luke_31]

I'm going to try and ask to shift back to ideas for change? if thats okay with everybody?

While you came up with an excellent topic, the fiscal side for healthcare should be included as it will have a direct bearing on how change is implemented or not. But you are correct that talking about pensions is off topic and should have its own discussion in its own topic.

 

[akflightmedic]

But that is the opposite of what a tier system is designed to do. Let BLS handle BLS calls, and let ALS handle ALS ones. You have done the paramedic no favors when they spend most of their time dealing with BLS patients. That will make them good at dealing with BLS patients, but when they get a really sick patient, when are are all used to BLS patients, how sharp will their skills be?

Very over reaching and still flawed. As I stated, the paramedic with the higher education is the one best to determine if their resources should remain or if they should hand off to BLS unit who was responding at same time but in slow capacity until told otherwise. The medic is NOT transporting BLS patients. It is higher utilization of the paramedic and ensuring if/when those higher skills/knowledge base are needed, then they are there first.

Who is more important in this scenario? The paramedic seeing extra BLS cases or the ALS patient needing certain interventions sooner rather than later?

A medic if lacking in skill usage can always make rounds at local hospitals and do procedures....but again didnt we discuss earlier how all of this should be about more education as opposed to skills? Skills are just that and very similar to riding a bike.

So it absolutely makes sense to put the more skilled diagnostician/clinician in the patient's face first and then downgrade as necessary.

 

[DrParasite]

I'd tend to think that, all else equal, given current levels of education and practice, entry level EMS compensation should match PD and Fire (perhaps "prorated" for EMTs, since EMT-level educational requirements are quite a bit lower than PD and Fire). This is not usually the case, nationally, based on the data I've seen.

Considering most big city departments put both their PD and FD recruits through an academy, I think it's fair to say that the entry level requirements to get the job are actually lower than in EMS, where you need to be certified to get hired.

And while more departments are requiring certifications prior to hiring, there are still plenty of departments that will hire someone with a high school diploma, and no other experience or education, and pay for them to become certified to their agency standards.

 

[EpiEMS]

Considering most big city departments put both their PD and FD recruits through an academy, I think it's fair to say that the entry level requirements to get the job are actually lower than in EMS, where you need to be certified to get hired.

And while more departments are requiring certifications prior to hiring, there are still plenty of departments that will hire someone with a high school diploma, and no other experience or education, and pay for them to become certified to their agency standards.

I don't know about standards overall, but I would say that regardless of the paid education folks in PD and FD are getting, the average quality input to the process, if you'll pardon my suggestion, may be higher. Not to mention, many PDs require a certain level of academic achievement (e.g. NYPD requires 60 credits or 2 years of military service) - I don't see much of this in EMS.

 

[NysEms2117]

Considering most big city departments put both their PD and FD recruits through an academy, I think it's fair to say that the entry level requirements to get the job are actually lower than in EMS, where you need to be certified to get hired.

I disagree whole heartedly. The Police academy is longer then an EMT class, longer then an EMT-I class... 26 weeks of training, 28 if you are advanced EVOC.
Direct quote "To graduate a recruit must successfully complete 1,095 hours of training provided by certified law enforcement professionals and members of the New York State Police." - This is not including field training for 10 weeks.
EMT class is 200. + be generous and give EMT-I class 500 (varies between 350-450, from what i found).

**the above information was for New York State**
***My personal training varied slightly***

 

[DrParasite]

I disagree whole heartedly. The Police academy is longer then an EMT class, longer then an EMT-I class... 26 weeks of training, 28 if you are advanced EVOC.
Direct quote "To graduate a recruit must successfully complete 1,095 hours of training provided by certified law enforcement professionals and members of the New York State Police." - This is not including field training for 10 weeks.
EMT class is 200. + be generous and give EMT-I class 500 (varies between 350-450, from what i found).

**the above information was for New York State**
***My personal training varied slightly***

I disagree whole heartedly. Are most of the people in the police academy already have jobs waiting for them when they graduate? or are they in the academy, with the hopes of getting picked up by a department?

I agree that the in house training by both PD and FD are significantly longer than for EMS..... but many departments (including the NYPD) do not require you to complete a police academy prior to starting.

So as I stated before, the entry level requirements (Ie, to get hired by ABC department where they send you to the academy) is still much lower, since they require no training or experience, because they are going to send you through the academy after they offer you the job.

 

[NysEms2117]

I disagree whole heartedly. Are most of the people in the police academy already have jobs waiting for them when they graduate? or are they in the academy, with the hopes of getting picked up by a department?

I agree that the in house training by both PD and FD are significantly longer than for EMS..... but many departments (including the NYPD) do not require you to complete a police academy prior to starting.

So as I stated before, the entry level requirements (Ie, to get hired by ABC department where they send you to the academy) is still much lower, since they require no training or experience, because they are going to send you through the academy after they offer you the job.

This is false for my job, I needed a bachelors and 3 years work experience or explicit direction of a bureau chief. My job has one of the highest starting requirements in all of corrections. Also some people go through the police academy to be put on a reserves list because no jobs are currently open... But I'll agree to disagree.

 

[EpiEMS]

I agree that the in house training by both PD and FD are significantly longer than for EMS..... but many departments (including the NYPD) do not require you to complete a police academy prior to starting.

Most require prerequisite education that is much more costly and much more time consuming than EMT or AEMT, and in many cases, more than paramedic-level training. That being said, your point below is well founded, insofar as that entry level requirements might be lower if training/experience prerequisites are less than a one semester/two semester/four semester (or whatever metric you like). I'm not sure how often this is the case, though.

So as I stated before, the entry level requirements (Ie, to get hired by ABC department where they send you to the academy) is still much lower, since they require no training or experience, because they are going to send you through the academy after they offer you the job.

 

[DrParasite]

NYPD's requirements from http://www.nypdrecruit.com/#hiring-process
ACCREDITED COLLEGE CREDITS WITH A 2.0 GPA 60
YEARS OF FULL-TIME MILITARY SERVICE IN U.S. ARMED FORCES 2

for FDNY http://www1.nyc.gov/site/fdny/jobs/career-paths/firefighter-eligibility-requirements.page
Education/Military/Work Experience Eligibility
By the date of appointment, have a four-year high school diploma or its educational equivalent.
Have at least 15 college semester credits earned at an accredited college or university.
OR, for applicants with a military service background, must have full-time military service with an honorable discharge.
OR, six months of full-time, satisfactory, paid work experience.

Fayettville Fire Department http://fayettevillenc.gov/government/city-departments/fire-emergency-management/employment
Career Opportunities: Must be at least 18 years of age at the time of application

• Must be a U.S. Citizen or a Lawfully Authorized Alien Worker
• Must present original birth certificate (or notarized copy)
• Must be a High School graduate and present original (or notarized copy) of diploma, transcripts, or GED certificate meeting minimum state standards to include scores
• Veterans must provide proof of military service (DD214) member copy #4; if you are currently in the military, you must have an official letter from the military indicating your ETS date
• Possess a valid North Carolina driver's license appropriate for vehicle operating within 30 days of employment
  Must have been licensed to drive for a minimum of one year, with no loss of license within the past year and an acceptable driving record in accordance with the City of Fayetteville Driving Standard. Click here to view the City of Fayetteville's driving standard.
  
  • Must have no felony and limited misdemeanor convictions

Seattle (WA) Police: https://www.governmentjobs.com/care...44/police-officer-entry-level-january-14-2017
Qualifications
Be at least twenty and half (20.5) years of age.
Hold United States citizenship.
Attained a high school diploma or a certificate of high school equivalency (GED).
Individuals may not have been discharged from military service under dishonorable conditions.
Applicants must meet all eligibility standards by the exam date.

Austin Texas : https://www.austincityjobs.org/postings/57178
The minimum qualifications include:

• Between 20.5 and 45 years of age at time of application.
• US Citizen, born or naturalized.
• Have a valid Driver’s License.
• HS Diploma or GED.

And that was what I found on policeone.com

You can agree to disagree all you want, the reality is many police departments require a HS diploma only to get hired. Are there jobs that require an associates, and bachelors? absolutely. And many departments do want people to already be certified, with experience, especially the higher paying ones. I remember working for an EMS agency where most of us has bachelors degrees, and one person had her masters. Of course most of our degrees had nothing to do with our jobs, an almost every paramedic had an associates in EMS (although exceptions were given for out of state transfers and those who had the director's approval).

for PD and FD, the barriers to entry are low, but they also train you (if you are selected) for several months. Most EMS agencies couldn't afford to operate like that, which is why they require you to be trained and certified before you start. It might also contribute to why police and fire and considered careers, while to many EMS is just a job.

 

[EpiEMS]

@DrParasite, do you think it'd be sufficient to have such a low barrier to entry? This might undermine us with respect to other healthcare fields. For example, I don't know of any nursing programs that have such minimal requirements.

 

[NysEms2117]

Is there a statistic showing that for states such as New York State? Not city. New Jersey? California? I think you can understand what I'm getting at. I also was talking more at the state/county level, due to the fact that's how I feel ems should be run. Also those are minimum requirements your a knowledgeable and smart individual, you can understand that often times minimum means you won't get hired the first time around.
As well as good luck even getting hired for NYPD with a bachelors... I'm in federal contention and still not even remotely close to NYPD.


Sent from my iPhone using Tapatalk

 

[akflightmedic]

In Florida, you have to attend a proper state sanctioned academy (usually hosted by the community colleges) and be licensed as a firefighter or a police officer BEFORE applying for a job.

This is almost standard across the state...I say almost cause I have heard of a few rare programs where a Fire Dept will hire a Paramedic and then put them through the academy....however the academy IS through the college.

 

[EpiEMS]

@NysEms2117 and @DrParasite

I found the data I was looking for thanks to the Bureau of Justice Statistics (of the US DOJ)!

As of 2013 (this is the latest data on the matter, as far as I can tell), it looks like 84% of all police departments require a HS diploma, 4% require "some college" (less than an associates' degree), 10% require an associates degree, and only 1% require a bachelors degree. However, for departments serving populations over 1MM people, 64% of require a HS diploma, 7% require "some college", and 29% require an associates degree, but no require a BA/BS.

Haven't seen anything for fire yet, but I'll keep looking.

 

[NysEms2117]

not that i'm disagreeing with statistics, however as of recent(past 5 years) police departments, sheriffs departments, and state police have all pushed for more education. As well as higher minimum restrictions. In 2013(when that report was done), we were on the front end of this "reform" which I know in my neck of the woods has been successful to a certain extent. I'd be curious to see what 2017/2018 brings, i'd venture higher numbers under the "associates degree, or some college experience" categories.

 

[DrParasite]

Is there a statistic showing that for states such as New York State? Not city. New Jersey? California? I think you can understand what I'm getting at.

The Mendham Township Police Department is currently seeking candidates for the possible position(s) of a Full Time Probationary Police Officer. Following are the requirements of the position:

Be a citizen of the United States of America
Be a resident of the State of New Jersey at time of appointment
Be more than 21 and less than 35 years of age at time of appointment
Be sound in body and of good health sufficient to satisfy the Board of Trustees of the Police Recruitment System of New Jersey that such person is eligible to membership in the retirement system
Be able to read, write and speak the English language well and intelligently
Be of good moral character and must not have been convicted of any crime involving moral turpitude
Possess a current and valid New Jersey driver's license
Possess a minimum of 60 College Credits towards a degree in police science or a related field.
Candidates must be in excellent physical condition and have the ability to complete a Basic Academy Recruit Class at a NJ PTC Certified academy if necessary.
Candidates need not be PTC Certified

EpiEMS found the actual stats.. I didn't know the DOJ even kept track of stuff like that

I also was talking more at the state/county level, due to the fact that's how I feel ems should be run. Also those are minimum requirements your a knowledgeable and smart individual, you can understand that often times minimum means you won't get hired the first time around.

I used to think that county wide EMS was the way to go..... now that I have worked in a county wide system, my opinion has shifted, because I have seen the coverage holes that are created. And I agree with you, just because you meet the minimum requirements doesn't mean someone who exceeds those requirements might get hired more quickly.

 

[DrParasite]

In Florida, you have to attend a proper state sanctioned academy (usually hosted by the community colleges) and be licensed as a firefighter or a police officer BEFORE applying for a job.

This is almost standard across the state...I say almost cause I have heard of a few rare programs where a Fire Dept will hire a Paramedic and then put them through the academy....however the academy IS through the college.

Yes, but even 15 years ago Florida was doing that...... they still seem to be the only state where they want all your fire and medical training completed before you get hired, and they still have 1000 applicants for every 1 position. and when i was looking they only accepted florida training, out of state stuff didn't cross over.