If I were the boss of EMS....

[fortsmithman]

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.

I agree with the above statement.

 

[systemet]

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.

This should be fixed, as well, I agree. I think that part of the problem is we have too many private training academies providing instruction. They don't have to be as transparent or accountable for how they do business.

If we move training programs away from private enterprise and into technical colleges or universities, I think this situation will improve.

The other thing that needs to change to support this, is the mentality of many EMS providers. It seems like a lot of us believe that some people simply "don't have what it takes" to be an EMT / Paramedic, and others do. Usually the ones that do are the ones we think are most like ourselves. While I accept there's a percentage of people who aren't going to enjoy or thrive in a high stress job, I think most people are capable of becoming good EMTs or paramedics given the right support and training.

Any time a preceptor or mentor feels it necessary to fail a student, they should take this as a personal failure to provide them with the necessary training. Admittedly, sometimes this is the fault of the training institute for not giving the student a good enough base. And sometimes it's practicum/employer policies that don't allow a preceptor or mentor to extend a student's training beyond a certain fixed time. But I think sometimes we're too quick to throw away good people.

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.

I think that's a difficult issue. It seems like there's no support for increasing the tax rates, despite the US being one of the least-taxed industrialised nations, and that healthcare funding is particularly divisive. I'm sure it's hard in the current climate to argue taking funding dollars away from the armed forces and directing it to EMS.

Why expand funding so massively for EMS on the governments dime?

I'd assume this would work if the majority of people in the states were willing to accept a trivial tax increase to pay for better health care. Perhaps they are, perhaps they aren't. I've always lived in countries with universal public healthcare, so I've never had to experience the public-private debate personally. Right now though, isn't the US EMS system primarily funded at a municipal, not a federal level?

If we're going to increase EMS service levels then someone has to pay. Perhaps more people in the US would prefer to see taxation in the form of user fees instead of income tax. I don't know. I think there would be some cost savings if we can direct people through the healthcare system in a more efficient manner, but whether they'd cover the cost is another matter.

For what it's worth, the cost of EMS for a given city is usually trivial compared to costs for fire, police services, parks & rec, city works, etc.

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.

I don't think I follow, why would this be bad?

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.

I think this is a good idea. One of the places I worked used to give a 2-3 week academy (all classroom), then 4 tours (192hr) on the road for an EMT with a mentor, or 8-12 (768 hr), before you could work with another new hire. Other places just showed you where the narcs were, gave you a map, and let you learn the hard way. I preferred the first method.

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.

I'd support that. Right now, any increase in the standards is an improvement. I see a bachelor's degree paramedic as a decent goal, you might not. But 3 years is an improvement on the current situation.

I only paid about $3,000 / year for my medic program, but this was a while back. I worked full-time as an EMT while I did my medic(2 year program, M-F 8 hrs a day; 1200h am practicum, 400 hr hospital) and took loans from the bank for another $12,000. Paid it all off within a year. I was lucky.

Perhaps the issue I'm not getting here is how expensive university education is in the states. I've had free education for the last few years, but when I did my BSc. I paid around $5,000-$6,000 / year. It wasn't easy, but it was probably a lot cheaper.

Call me dumb, but I think the current system works pretty well.

I think I've seen a continuous improvement in the time I've been in EMS. I don't think it's always felt like things are moving forwards. Often the change has been managed very poorly. But if I look over time periods of a couple of years, the end result has been an improvement in the medicine.

I'm not sure if I can say that the working conditions have got better. I'd argue in the last place I worked in that they were getting worse.

However, I definitely think there's a lot of room for improvement. It's a young field. I think we've all benefited from those who've come before us, but at the same time we have a responsibility to keep pushing things forward.

We don't do this for money

I do. Or at least I did, and will again (I haven't worked in EMS for the last couple of years). It has to pay my mortgage, it has to support my wife working less than full-time, and it has to support my daughter, and hopefully future children.

Right now, for me, it's where I can make the most money. I know a lot of people here think that medics don't make much, but I felt I was pretty well paid. I know people with PhDs in hard scientific fields making $37,000 / year after 10 years of university. I made that some years as an EMT. Perhaps the area I worked in paid paramedics very well, and I should be grateful for that. I felt I was well paid. Perhaps even overpaid.

I was never able to understand the general dissatisfaction with salary where I worked. We make 10-20% less than the RNs. About the same less than the cops. More than fire at the bottom end, but less at about 5 years. The major problem was a lack of career mobility. This is slowly improving, but it's not even close to those fields. I thought that we made a lot of money for the amount of training hours we had.

[I should point out, in fairness, that I did EMS primarily for the satisfaction of helping people, the feeling of doing a job where I was having a positive impact on my community, making a difference in people lives, the changing workplace environments, and because of a deep interest in medicine. I've missed those things, and look forward to going back. It wasn't just about money, but at the end of the day, it does have to pay the bills.]

. 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.

Why? What do you think is different? Why do you think increasing the education requirements allow the nurses to professionalise, but won't help us?

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.

Are you sure that's the right way around? Isn't the responsibility more for us to prove that we're worth paying more?