If I were the boss of EMS....

Linuss said:
To get said pay.




Honestly, what I make isn't BAD. Not what it should be, not what I'd like it to be, but I know people older than me who work in retail who make less.
Click to expand...

I could live modestly on what I make, hell, I do. With the hours I'm working now I make good money really. But 171 hours a pay period isn't sustainable when your UHU is above 0.5.
 
A poster earlier wanted us to be able to perform a lot of intensive care. Time consuming work. With equipment that is rare in EMS.

Why not professionalize our existing profession before we become nurses?
 
Rocketmedic said:
A poster earlier wanted us to be able to perform a lot of intensive care. Time consuming work. With equipment that is rare in EMS.

Why not professionalize our existing profession before we become nurses?
Click to expand...

Much of what we do already is considered critical care in other parts of medicine.

EMS needs to get over comparing itself to nursing. I practice medicine of limited scope. Nurses practice nursing. Both are different, but important parts of the system.
 
Paramedics share a lot more in common with physicians than with nurses.
 
I'd paint all the trucks in bright pink.

Sent from LuLu using Tapatalk
 
usalsfyre said:
At some point the impetus has to be on us, as stewards and guardians of the field, to push change and recognize that education may not pay divedens now, but will in the future.
Click to expand...

This.

If we want EMS to become a true profession then we need to push the standards and quality of practice forwards. Professional behaviour is more than polishing your boots, checking the unit first thing every shift, and avoiding swearing. It also includes a responsibility to increase your personal knowledge, so that you're better able to take care of your patients.

This has worked out quite well for nursing. I doubt there's many nurses today that would say moving towards a Bachelor's degree entry to practice has been a bad thing for them.
 
To elaborate on my earlier post, its unnecessary for our field to expand as far as giving long-term care in a prehospital environment. We work on the basis that 30 or so trucks can cover a city of millions. That model doesn't hold water everyday as-is in terms of response times or finance, and some would have us remain on scene for hours to manage electrolyte derangements and such? Why not transport them? Yes, we could perform all care that's likely at home, but its not smart to show up, push a bunch of meds, and leave, and its not feasible to quintuple every services size.

We need to stop worrying about scope and arbitrary educational levels. I meet plenty of EMs and Paramedics from the reviled online courses or academies- myself included - and for the moat part I feel like I learned enough to function. I'm getting better with every run. In the end, all any certificate gives you is the knowledge of how little you know.

Pushing a mandatory Bachelors isn't going to solve our problems, nor will expanding the scope. We just need to unite as as a profession, standardize what we are, and fix the semi-broken funding system.
 
Rocketmedic said:
To elaborate on my earlier post, its unnecessary for our field to expand as far as giving long-term care in a prehospital environment.
Click to expand...

I agree. There's already home care and palliative care to fill those roles. But what EMS should be able to do, is show up to a home care, palliative care or long-term care patient, provide an initial assessment, liase with the physician and health care team that are looking after this person and determine whether transport to an ER is in their best interests. I'm not advocating that EMS should try and take over those areas where functioning system exist, just that we should develop clinical pathways that don't end in "stat to the trauma center".

If we encounter a senior who's fallen, we should be able to assess for probable injuries, and if this seems unlikely, refer they for a home-care assessment. We should be able to assess an isolated extremity injury and see if it meets criteria for radiography, e.g. Ottawa ankle / knee rules. If that person's still mobile, perhaps some po analgesia, and a referral for x-rays and a family physician examination would be more effective than dumping them in a crowded ER at 3am, on the basis of "we don't diagnose".


We work on the basis that 30 or so trucks can cover a city of millions. That model doesn't hold water everyday as-is in terms of response times or finance, and some would have us remain on scene for hours to manage electrolyte derangements and such? Why not transport them? Yes, we could perform all care that's likely at home, but its not smart to show up, push a bunch of meds, and leave, and its not feasible to quintuple every services size.
Click to expand...

I'm not advocating we start providing ICU care in an urban setting with the aim of avoiding transport. If someone's that sick, then the hospital is where they need to be. This level is designed for critical care transport; ground or air. There's plenty of areas where the nearest hospital with a CT might be 5+ hours by ground or an hour by air. This is where this level would be most useful. Or potentially working in a rural ER augmenting a family physician that lacks a comfort with emergency care.

A large part of what we are going to do in any future system is likely to be transport. I'm just not sure that the default options need to be ER, cathlab and no transport. I think there's some efficiencies to be gained by referring less acute patients to other services.

I agree that many of our current EMS systems are completely understaffed and over-utilised. This is something else that also needs fixing. But perhaps if EMS can provide savings by directing patients at contact to other services, the money saved to the healthcare system could be redirected towards EMS.

We need to stop worrying about scope and arbitrary educational levels. I meet plenty of EMs and Paramedics from the reviled online courses or academies- myself included - and for the moat part I feel like I learned enough to function. I'm getting better with every run.
Click to expand...

I'm not saying paramedics who went to a shorter or on-line(?) course are bad people. Or that they don't care about their patients. Or that someone who has gone to school for four years for a degree is going to automatically be better. I'm just saying that if you extend the training time the level of the average provider is going to increase. It's hard for me to see why it wouldn't.

If you look at what we do in the field, we have a huge amount of responsibility. We choose when to RSI people, or when to do medication facilitated intubations. This should be a very difficult decision, as it comes with incredible risk to our patients both with the initial procedure, and the long-term management. We're treating tachyarrhythmias, bradyarrhythmias, running cardiac arrests (as futile as this may largely be). Doing conscious sedations. Interpreting 12-leads and diagnosing infarcts, providing lysis or referring patients to PCI.

There's no where else in the health care system that people are doing this with 2 years of education. This barely gets an LPN any more, or a lab technician.

In the end, all any certificate gives you is the knowledge of how little you know.
Click to expand...

And that's a good thing, right? And so if a little education gives you a better understanding of the risks of what you're doing, and a little more respect for how little you know, doesn't it follow that a longer education might gives you a better understanding of these risks? And perhaps ensure that while you'll be aware that there's more things you don't know, at least the things you don't know are now a little more complicated?

Pushing a mandatory Bachelors isn't going to solve our problems, nor will expanding the scope.
Click to expand...

It would go a long way to solving our educational problems.

As to scope, are the public going to care? Probably not. Are other health care professions going to care? To the extent that they feel threatening, which realistically, isn't going to be much. If you talk to the average person and tell them a paramedic makes too little, they're not going to care whether you can do a CABG using a coat hanger, upside down in a ditch in car half filled with water while being attacked by mutant ninja dinosaurs with lasers for eyes -- they're going to ask, "well how long does it take to become a paramedic?". And they're going to compare the income to similar professions with a similar training time. A lot of the time that doesn't work out too great.


We just need to unite as as a profession, standardize what we are, and fix the semi-broken funding system.
Click to expand...

I agree that we need to do all these things. But I also believe that a major step in that direction is increasing our educational standards, and that these are currently too low -- particularly at the BLS level, but also at ALS.
 
Most education in EMS is on-the-job. If we start pushing a 2 or 4 year degree to even start working, we either need to massively increase payroll or get ready for a shortage.
 
Take it back to the Drawing Board

Everything has changed.

EMS started as a movement to send trained personnel to the scenes of accident or injury; to essentially take the ER TO the patient.

Unfortunately, when we got there a whole bunch of other people hopped into our ambulances!

We became an OUTLET, and in many areas, the outlet of choice (theirs, not ours!)

Today, EMS is a reflection of the ABSENCE of viable alternatives for the patient. We need to have places to bring a lot of these people to. Right now, we take the poor into overpriced facilities that make people poorer and don't necessarily get the job done; primarily because there's no follow-up to PREVENT more rides to the ER.

We need to make this a profession. That means, IMHO:

#1) Deal with the burnout issue -- until that's tackled (and if you really look you'll see that many of the issues around it are a direct result of the crazy-making behind so many people to treat with only one place to send them), the transience of our personnel will doom us to eternal purgatory.

#2) Medics need to be trained in the Art of Handling Humans. That means a much more broad education on servicing the people we actually service. That means a minimum Associate's level to get on the rig.

#3) We need mid-level facilities (like sub-specialty pediatric and elderly evaluation and "holding" facilities) to bring people to.

#4) ...or, preferably, a system set up where emergency ambulances are not tied up in the transport of minor ailments.

#5) Staffing must reflect the needs of our population such that as first response, trained medics get there but have the TIME to appropriately make sure the patients get to their next level of care.

#6) THEN let's get to the life-saving stuff and make sure there's at least a Bachelor's degree involved, and...

#7) the system is designed into tiers. Until a better way is found, or intermediate facilities established, the more highly trained medic needs to be first response and the decision for a lower tier to transport must be made. In that sense, EMS needs to be re-designed so that rapid, safe response occurs first, evaluation done on-scene (with life-saving measures immediately initiated) and THEN appropriate transport arranged.

I guess that's just for starters.
 
Rocketmedic said:
Most education in EMS is on-the-job. If we start pushing a 2 or 4 year degree to even start working, we either need to massively increase payroll or get ready for a shortage.
Click to expand...

I think OTJ education is massively important in EMS. However, without a solid foundation to start from, the OTJ education component isn't really education. It's not about the "why" in EMS. When you get trained on the job, it's all scenario based. A patient presents a certain way and you are shown how to deal with the presentation. But rarely does this lesson seem to include why a certain intervention is actually taking place. All you get out of this style of education is "the patient looks like this so I do that." That isn't going to further EMS, I don't think.

Most healthcare degrees include a significant degree of patient contact during the program. However, no one ends up practicing in the field until they have a solid background in education. The clinical time in EMS education needs to come on line with the rest of the medical world as well. The idea that a provider's clinical time is based around only performing a minimum number of procedures and interventions is inherently flawed. I would like to see clinical time move towards a more flexible timeframe. Dropping five tubes during clinical time does not indicate with any degree of certainty that a provider is proficient at intubating does it? Instead, it would be nice if a preceptor type person could make the call when a person is proficient in a certain skill.

I don't have much experience in internships and residencies, but I know that in dietetics programs that the internee is constantly being evaluated by a preceptor figure, and that person determines the intern providers competency, not a check sheet.

I would also like to see higher level classroom education occurring in a more informal degree during the internship phase so that students could receive critical and constructive feedback about their performance in the field while not actually in the field.
 
Rocketmedic said:
Most education in EMS is on-the-job. If we start pushing a 2 or 4 year degree to even start working, we either need to massively increase payroll or get ready for a shortage.
Click to expand...

Here in Canada namely the province of Ontario In order to work in an ambulance you need to be a Primary Care Paramedic. The education required is a 2 year college diploma. There in even a 4 year Bachelor of Science degree in Paramedicine, and that only lead to BLS level. If you want to work ALS then it\'s another year of school above an beyond the Primary Care Paramedic programs. As well in Australia and I believe New Zealand You need at least a bachelor degree to work in an ambulance.
 
Last edited by a moderator:
fortsmithman said:
Here in Canada namely the province of Ontario In order to work in an ambulance you need to be a Primary Care Paramedic. The education required is a 2 year college diploma. There in even a 4 year Bachelor of Science degree in Paramedicine, and that only lead to BLS level. If you want to work ALS then it\'s another year of school above an beyond the Primary Care Paramedic programs. As well in Australia and I believe New Zealand You need at least a bachelor degree to work in an ambulance.
Click to expand...

Almost correct, some states in Australia still employ paramedics with a diploma (equal to half a bachelors degree) I am going through the diploma program, however I already have a BSc and a Masters not related to health. Very soon it will be degree level minimum for paramedic, with post-graduate qualifications for intensive care paramedic (already)
 
Another flaw in our education system is the tremendous ease with which many programs drop students. Miss a test day? Goodbye. Miss a payment? Goodbye. We need to build our system to allow people to learn and retain some flexibility.

Another recurring problem is funding. In the US, its becoming increaingly clear that the economy and federal spending cannot continue to expand, and new taxes are difficult both fiscally and politically. Why expand funding so massively for EMS on the governments dime?
The best way to improve our profession is to keep EMS as an organic, easy-to-enter arm of medicine. I joined the Army to afford paramedic school at CSN Las Vegas, but lucked out and earned it in El Paso. Having to make that choice sucks. We will do ourselves a disservice if we drastically increase the entry requirements.
We need to standardize who we are on a national level. Concurrently, our employers need to partner new medics with experienced medics whenever possible- say, make an initial recertification involve a reasonable amount of calls and an honest evaluation by a senior medic preceptor and or medical director.
we should modestly increase time requirements for education- 600 hours or one year for EMT and 4000 and three years or so for paramedics. We will need to provide scholarships or financial aid for the paramedics unless pay goes up a lot.

Call me dumb, but I think the current system works pretty well. We don't do this for money. More would be nice, but I'm doubtful that the same things nursing used to secure better wages will work for EMS...nor should it. On some level, a lot of us need to accept that we will be unable to provide service if our customer communities can't support us. We need to determine what our communities can pay before we set these education requirements.
 
Rocketmedic, to respectfully disagree, the LAST thing EMS, and especially EMS's patients, need to be is an easy to enter arm of medicine. EMS, at the paramedic level, is very often far more autonomous than say nursing or respiratory therapy. In fact, we have more in common with mid-level providers such as PAs and NPs than other allied health providers. If you look at the Webster's definition, we practice medicine. Granted, it's of very limited scope, but it's still the practice of medicine. No other arm of medicine would dream of placing providers in this position with as little as 700 hours of didactic training.

Again, we need to stop relying on the government and other parties for professional improvement. The push needs to come from within, and we need to take control of the profession. As for the salary, my gut says a needed contraction of paramedics would take place. Put "primary" paramedics on the transport trucks and save the four year medics for high level responses and primary care type decisions.
 
It does not take two years to learn BLS, nor should it take 4 years and a batchelors to run as a primary care paramedic. I'm all for increases in scope requiring educational increases- but I am warning against setting the baseline for entry as high as some want it.
 
I agree with upping the standards. However, we can't go from nothing to a Bachelor's with the snap of a finger.

I can see an AAS required for ALS, then eventually a BS, but it's not something thats going to happen overnight. Possibly something similar to an AAS for ALS then a year-long, paid internship at the ILS level before being promoted to an ALS provider if that makes sense.
 
You must log in or register to reply here.
Back
Top