Is EMS designed to attract dramatic people?

[EpiEMS]

I'll say this, I am a much better provider at 25 than at 21...and it's not anything to do with knowledge.

Barriers to entry are the universal answer to increasing wages (and arguably - on average, anyway - quality).


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[DesertMedic66]

I keep saying it... barriers to entry.

Higher educational standards.

Even then, it will not be eliminated. (Case and point: RNs.)

It will reduce the occurance though, dramatically....
^see what I did there^

Let me preface this by saying I do not work in an ED but my girlfriend is a ICU trauma nurse and there is way more drama in her unit than I have ever seen in EMS. These are all nurses that have at a minimum their bachelors and several with masters. It might just be because they deal with each other all day and I only have to deal with my partner everyday.

 

[SandpitMedic]

Let me preface this by saying I do not work in an ED but my girlfriend is a ICU trauma nurse and there is way more drama in her unit than I have ever seen in EMS. These are all nurses that have at a minimum their bachelors and several with masters. It might just be because they deal with each other all day and I only have to deal with my partner everyday.

Right! No more women in EMS...
Check!

(Kidding)

 

[NysEms2117]

@SandpitMedic I agree with you completely, just playing a bit of advocate here. How should EMS tier so there are more opportunities for advancement.
Example: LE has municipal->county->state->federal, with ranks/jobs A-Z in between. Do you see anyway to incorporate that level of variety that in EMS?

 

[DesertMedic66]

Right! No more women in EMS...
Check!

(Kidding)

Actually around half of their nursing staff, RTs, and techs are male. The CNA staff are all female.

 

[SandpitMedic]

@SandpitMedic I agree with you completely, just playing a bit of advocate here. How should EMS tier so there are more opportunities for advancement.
Example: LE has municipal->county->state->federal, with ranks/jobs A-Z in between. Do you see anyway to incorporate that level of variety that in EMS?

I don't feel that necessary for EMS.
It's not that complicated; we don't need diabetes detectives and federal GFR agents.

The farthest that should be pressed is distinguishing roles in effective management, teachers, and training officers. Including instructors and field training officers, hospital and agency liaisons, and ancillary office folks. Similar to most models, but with an actual incentive (other than getting off the streets) such as increases in requirements and salary.
Similarly, critical care medics and flight medics.

Additionally, community health paramedics may be as far as I'd like to stretch it.

We don't need tiers of agencies and medical enforcement. We are not law enforcement, we have a completely different mandate and require different structure.

 

[EpiEMS]

Credentialing for FTOs, "officers"/field supervisors, that couldn't hurt


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[VentMonkey]

I'll just leave this here as some more insight. As an aside, I would like to see where he leads ATCEMS over the next few years.

http://mlnetwork.heart.org/blogs/22/95

 

[E tank]

I'll just leave this here as some more insight. As an aside, I would like to see where he leads ATCEMS over the next few years.

http://mlnetwork.heart.org/blogs/22/95

Good intentions, but really over thought. It doesn't matter what field of patient care you're in or your level of responsibility/stakes in the interaction, the further away from the terminal care (the final authoritative, not end of life) provider you are, the less money, "prestige" (whatever that means) and hierarchical standing you will have.

So, generally speaking, surgeon makes more than the anesthetist, anesthetists make more than the RN's, RN's make more than the scrub techs, scrub techs make more than the EMT's that brought the patient in alive in the first place.

Even if you were the person that placed the IV and gave the epinephrine that made the difference between the patient dying and walking out of the hospital, it is the physician (or PA/NP) that decides when the patient is fit to walk out of the hospital after having his life saved by you.

Fair or not, that 25 minutes you spent with the patient is not as "valuable" as the hour or more the doc spends looking at labs, getting consults, ordering tests and making a decision. But he wouldn't have had a patient were it not for you, or at least it would have made him work a lot harder to keep the patient from dying.

In the US, that is the reimbursement system. Has little to nothing to do with ability, enthusiasm or intelligence.

 

[VentMonkey]

Good intentions, but really over thought. It doesn't matter what field of patient care you're in or your level of responsibility/stakes in the interaction, the further away from the terminal care (the final authoritative, not end of life) provider you are, the less money, "prestige" (whatever that means) and hierarchical standing you will have.

So, generally speaking, surgeon makes more than the anesthetist, anesthetists make more than the RN's, RN's make more than the scrub techs, scrub techs make more than the EMT's that brought the patient in alive in the first place.

Even if you were the person that placed the IV and gave the epinephrine that made the difference between the patient dying and walking out of the hospital, it is the physician (or PA/NP) that decides when the patient is fit to walk out of the hospital after having his life saved by you.

Fair or not, that 25 minutes you spent with the patient is not as "valuable" as the hour or more the doc spends looking at labs, getting consults, ordering tests and making a decision. But he wouldn't have had a patient were it not for you, or at least it would have made him work a lot harder to keep the patient from dying.

In the US, that is the reimbursement system. Has little to nothing to do with ability, enthusiasm or intelligence.

I am completely perplexed by your reply, are we reading the same link?

 

[E tank]

EMS must work hard to create opportunities for advanced EMS providers in the field. Like nurse practitioners, the “paramedic practitioner” is a level of paramedic that’s desperately needed to create a career path for our industry that combines increased education with increased autonomy and pay.
Having the pinnacle of clinical care that involves a salary that’s higher than livable wage without working 80 hours a week increases the prestige of the entire field. This will in turn improve perceived career longevity and will help recruit and retain talent. This is the process that nursing began in the 1950s, which resulted in vast improvements in their workforce.


Yep...this is the link I read. My point is that creating a new mid-level paramedic practitioner brings paramedics no closer to the terminal provider, whether that is a doc, an NP or a PA. There is no "desperate need" for this new kind of provider. They already exist and the money isn't there in pre-hospital care to justify their being there now, otherwise they'd be on ambulances already.

Making "uber-medics" would bring so much more to the table, both for the profession as a whole and for some patients. But broad deployment is just unsustainable and impractical because of the amount of resources outside of the hospital, the amount of time medics spend with the patient and the finite amount of money counties and states want to spend on pre-hospital care.

There is only so much value that can be wrung out of a pre-hospital encounter relative to the amount of money available to spend. A PA level paramedic is still way down the food chain, only now he costs way more.

 

[VentMonkey]

EMS must work hard to create opportunities for advanced EMS providers in the field. Like nurse practitioners, the “paramedic practitioner” is a level of paramedic that’s desperately needed to create a career path for our industry that combines increased education with increased autonomy and pay.
Having the pinnacle of clinical care that involves a salary that’s higher than livable wage without working 80 hours a week increases the prestige of the entire field. This will in turn improve perceived career longevity and will help recruit and retain talent. This is the process that nursing began in the 1950s, which resulted in vast improvements in their workforce.


Yep...this is the link I read. My point is that creating a new mid-level paramedic practitioner brings paramedics no closer to the terminal provider, whether that is a doc, an NP or a PA. There is no "desperate need" for this new kind of provider. They already exist and the money isn't there in pre-hospital care to justify their being there now, otherwise they'd be on ambulances already.

Making "uber-medics" would bring so much more to the table, both for the profession as a whole and for some patients. But broad deployment is just unsustainable and impractical because of the amount of resources outside of the hospital, the amount of time medics spend with the patient and the finite amount of money counties and states want to spend on pre-hospital care.

There is only so much value that can be wrung out of a pre-hospital encounter relative to the amount of money available to spend. A PA level paramedic is still way down the food chain, only now he costs way more.

I don't know that he was implying a mid-level equivalent of an NP, or PA; that isn't what I walked away understanding from it.

My point with regard to posting the link was to re-rail my initial question, and the topic at hand of A) getting rid of the stale image portrayed by the loudmouthed, complacent "heroes", and B) moving forward with a different image altogether.

If you took it as a direct threat to replacing mid-levels as they stand, that wasn't my intention, nor was it what I was implying by posting the link. As it stands now, I agree, if you want to be a PA, or an NP be a PA, or an NP. A mid-level medic is overkill.

I'm not advocating "uber-medics", I'm advocating being a paraprofessional and as he mentions an extension to the physician out of the hospital. This ties into increasing standards, and entry-level requirements, not taking away anyone else's job. It focuses on more of what we're already actually doing vs. what we "prepare for" and don't do as often.

Much like the fire department, and what @akflightmedic had mentioned in another thread it implies, and emphasizes prevention. Why shouldn't that be our goal?

Right now it's nothing more than it has been for decades. The band-aid box, or meat wagon. Respectfully, I could care less who gets credit for what. Heroics are like beauty...in the eye of the beholder, and that will never change.

 

[VentMonkey]

So I almost created a new thread, but felt it's somewhat pertinent to this thread, and worthy of a bump so what the hell...

How many of your peers and co-workers do you find want to run every "good call", and only those kind of calls? I mean the types that come to work really, genuinely, wholeheartedly feeling like they're going to "save a life today at work".

Do you guys think if we embraced this culture less now, and start feeding the newer, and next generations of prehospital providers more of the "a call is a call" approach this would be a cost-effective way of decreasing burnout amongst younger providers? Not to mention a more lighthearted approach to a falsely perceived heroic job.

Perhaps telling them that the next guy, the proverbial "black cloud", is often the same person who's left half of their trauma patients volume on the floor of their ambulance. In other words, things aren't always as they seem.

Instead of embracing "trauma, trauma, trauma" we can one day hope for a paramedic curriculum that includes shadowing trauma coordinators, and surgical attendings as they round on these "cool", and "wicked gnarly" calls only to find an 18 year who now has to spend the rest of their life being fed through a straw, and will need around the clock care.

Maybe even have them assist transport coordinators in helping to put together discharge orders for the 25 year old who is now nothing more than a vessel, but that the family just "can't let go of".

This isn't intended as forum burnout, it's meant to invoke and solicit insight so that the new comers can consider changing their approach to care. After all, trauma care is actually like every other kind of medicine, a lengthy approach to a single individuals (hopeful) road to recovery.

 

[DesertMedic66]

I most hear about EMTs wanting "the good calls". It seems as if the majority of medics view a call as a call. I've never really been huge into trauma calls. I prefer the complex medic calls that make you think and plan out treatments.

 

[MMohler]

Maybe it is worthy of a new thread @VentMonkey. Your post kind of hit a good spot in me! I mean a good spot. I think every person who starts in EMS (including myself, guilty) glorifies it as a career of happiness and rainbows at first. I think I have a better understanding then most "rookies" because I grew up with a parent who is in EMS (BC with CalFire now). I understand the lifestyle a bit more then others would. Just hearing some of these crazy *** stories over the years has given me more of an insight.

This by no means qualifies me more then the guy/girl who has 0 experience like myself. I do think that it has benefited me to be exposed to some of the crazy stuff that goes on and I still wanted to pursue it so here I am lol. I am pretty sure I have a good understanding that this isn't grey's anatomy anymore it is real and it will turn sideways quickly.

Thanks for the wisdom as always vent keep it up.

 

[VentMonkey]

Thanks @MMohler, admittedly I'm being somewhat lazy. I think it's still pertinent to the thread topic at hand. In all honesty, I welcome your novice views.

We have a local EMT educator known more for telling his war stories than teaching the curriculum (IKR? You don't say??). I have had dozens of his underlings, and have seen the misconceptions. Sure he's a nice guy, but that's completely beside the point.

I spent nearly a decade chasing flight paramedic jobs across the state only to finally land one in my own backyard. I can tell you now, this job is nothing like, say the EMT instructor I am describing (and have firsthand heard him tell his students) would have you believe.

Honestly man, it's really disheartening to me, why? Because I was once that young foolish kid who battled through years of burnout. Why would I want that for the next generation? Why wouldn't I want to see this field grow?

The mark of a professional is striving to see that their profession grows beyond their own years.

 

[MMohler]

You mean an EMT can actually do the skills he/she is taught. No, it couldn't be!

I really just want to get my hours and get into medic school. Fire/LEO is the end goal, I have a passion for both. Maybe FF just a taddddddddd more . I am not so much excited to go out and save lives, all of a sudden I am superman kind of thing. More looking forward to be able to help people in some dark hours of their life. I was shown the same professionalism when I was younger(bad accident when I was younger, big wheel vs. SUV, should have lost my leg below the knee) so I have always been drawn to this field on top of growing up with a FF parent. Gotta be cliche here and say I was sort of groomed for it lol.

 

[VentMonkey]

I really wish others such as yourself would peruse these sorts of threads. I'm sure there are older threads that are similar made by posters long gone with experience light years beyond myself.

I really just want newer folks to understand what it really means to do this for a living. First, it is just that, a living. Second, in order to be good at it you do have to enjoy it, even just a little. You can think that you're the ultimate badass, but I guarantee if you fall prey to the infamous "EMS ego" as so many do, I assure you your medicine will suffer.

I can go on, and on, but I really want to hear from new EMT's and paramedics, or anyone really. @DesertMedic66 I'm the same way about running complex medicals (you might enjoy critical care), but the fact remains that there are so many whackers out there. EMR, EMT, paramedic, etc. it's just good to know that not alls lost, and as a friend of mine recently put it still worth "fighting the good fight".

 

[GMCmedic]

Not even 4 years into EMS and barely 6 months after getting my Medic, I was burnt out. I realized that it was those once a month calls between the taxi runs that kept me going.

Then I went to a service that cares about its employees. Once I was no longer writing 13 reports a day I began to appreciate why I got into EMS, to help people. Not the save every life I encounter help, but the fluff a pillow, treat an old ladies nausea, hold a hand and comfort help.

Sure, I still get excited when i get to do fun stuff. My first decompression (bilateral at that), I didnt shut up about it for a week. I still like fast paced trauma, but trauma is easy. I enjoy the complex medicals more the longer I do this.

Ive been fighting the "way weve always done it" mentality at my service. Its a service full of people who have made EMS their life (bumper stickers and personal medical bag type people). I get a lot of resistance but I am slowly making progress.....except for thiamine, for whatever reason I cant get rid of thiamine lol.

The short version is, if people made EMS their job and not their lifestyle, I think they would be better providers.

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[OREMT]

As a newbie I can't say I've got much wisdom to offer, but I'd like to share an early EMT experience that ultimately made me much wiser. Sorry if this post is too long.

I am a brand new EMT, just certified last August. I found A&P fascinating, was interested in healthcare, and wanted to work outside, so I started down this path in the hopes of becoming a career paramedic. I can't say I was ever really drawn to the gore and promises of "heroism," at least not at first. But as my EMT class progressed, and as I heard more and more war stories from veteran medics, I really started thinking, "Hey, this is kind of a badass job." When we did practice scenarios in class, we often pretended to be responding to extreme situations - lots of GSW's, serious MVA's, and tricky "scene safety" scenarios involving drug houses and nightclubs. Though much of this was tempered by conversations with actual EMT's in the field about transferring dialysis patients and running syncope calls, I nonetheless found myself feeling more and more like a future action hero when I went to class.

When it came time for me to do the first of my few required "clinical experience" shifts in the local emergency department, I was foolishly hoping for a cardiac arrest to come into the trauma bay. You can't do much in the hospital as an EMT student, but you can do chest compressions, and I wanted my chance to play the hero. By this point, I knew many of the medics working that night and as they brought in patients I kept jokingly asking them to bring me a cardiac arrest (just so you know, I'm cringing as I write this.) Codes are "good calls," and I wanted to see a "good call." At around 5:00 AM a guy in cardiac arrest following three gunshot wounds to the chest came in, and I had my chance. In between my compressions the trauma doc tried needle decompression; it was all very bloody, and the doc called his death within a few short minutes. I felt stupidly satisfied that I had seen a "good trauma."

No sooner had I taken my gloves off than I heard another arrest coming in, this time to a pediatric bay. A mother had woken up to find her 6 year old son in cardiac arrest in bed. I rushed to the bay, but it became instantly clear that this was no place for an EMT student to get "hands-on" experience, so I just watched the situation unfold. They worked the kid for maybe 10 minutes before they had to call it. As I watched, I didn't see any "heroes" defending this boy from the reaper. Rather, I saw a highly skilled team of professionals working together and doing their job. There was no bravado, no magic, and no drama, save the real-world drama of comforting a grieving parent.

I cannot tell you how instantaneously I realized what a supreme a**hole I had been for hoping someone would go into cardiac arrest, just so that I could feel like a big deal. That man whose gore I thought provided a "cool experience" had a family too. This, more than most anything from my EMT class, was my real learning experience. After that I realized that yes, there is drama in the field of EMS. There is in fact plenty of real world drama - enough to make it so that there should be no room for dramatic EMS providers, no room for self-centered, wannabe heroes.

I think EMT education has a lot to do with how this job is perceived by newbies and by the public. It can be a dangerous job, so EMT classes (or at least mine) seem to overemphasize the danger, to the point where one assumes that you must be some sort of action hero to do the work. I think this mentality can be reversed through more actual experience in the field, more opportunities to see what the day-to-day job is really like. I also think EMT classes should have students spend more "experience" hours in places that care for the elderly (be it nursing homes or acute care in the hospital), because EMT's spend far more time responding to elderly patients with chronic conditions than severe traumas.

Once I got my first EMT job working a wheelchair van I believe I saw much more of what the prehospital environment is like in real life, though I still have a hell of a lot to learn. Now that I've gotten over my whacker phase, I hope to keep maturing into a healthcare provider. Funny thing is, I found I really like the patient interactions I have on the wheelchair van, and many times when I've mentioned that to other EMS folks, they'll say, "Maybe you should think about nursing school..."