Looking for some advice

[Foxbat]

When evaluating this advice, it is important to know exactly who is giving it. That means it is important to differentiate between real "educators" and those who are just common "instructors".

One of the people I got this advice from was our department's former training officer is a medic with a MS degree in biostatistics. I know he's an EMT instructor, but I don't think he teaches medic class.
Unfortunately, for me the question "to wait or not to wait" is irrelevant. I got my EMT about a year ago, and by the time I graduate I will have been EMT for a while anyways. And even then I doubt I'll go for a medic. You see, I'm planning to stay a volunteer because I see people struggling to make a living as medics (let alone EMTs) and for me a medic's wage would be a painful step down from what I get now on my college internships, let alone the wage after graduation. That means I will have little pt. contact, and will lose what I dont' use, and I'd rather be a good EMT than a bad medic. EMT skills should be much easier to retain.

 

[AJ Hidell]

And even then I doubt I'll go for a medic. You see, I'm planning to stay a volunteer because I see people struggling to make a living as medics (let alone EMTs)...

Is there any chance that you see the irony in that statement?

Put differently, do you realise that YOU are the reason why people struggle to make a living in EMS?

And do you care?

 

[Foxbat]

I volunteer for a combination department with a paid crew 24/7. Volunteers, like me, are used:
a) as an additional, third, member of crew;
b) to staff multiple ambulances in case of MCIs or multiple calls in the same time;
c) when paid staff calls in sick, has a day off, etc.
d) stand-by events.

I am not taking anybody's job. If I stop volunteering, nobody benefits.

 

[medic417]

I volunteer for a combination department with a paid crew 24/7. Volunteers, like me, are used:
a) as an additional, third, member of crew;
b) to staff multiple ambulances in case of MCIs or multiple calls in the same time;
c) when paid staff calls in sick, has a day off, etc.
d) stand-by events.

I am not taking anybody's job. If I stop volunteering, nobody benefits.

Actually then they would hire a third person and possibly a fourth so they could staff 2 ambulances.
But why buy the cow when the milk is free?

 

[Foxbat]

Actually then they would hire a third person and possibly a fourth so they could staff 2 ambulances.
But why buy the cow when the milk is free?

No service that I know of uses a paid 3rd person. Relatively little benefit for a big increase in budget. As of two ambulances - the general call volume is pretty low as it is... Events which require 2d truck are not common enough to justify hiring 2d crew.

 

[jrm818]

Is there any chance that you see the irony in that statement?

Put differently, do you realise that YOU are the reason why people struggle to make a living in EMS?

And do you care?

Seems to me by that same logic that every EMT or medic who is currently employed for a low wage is just as bad (I bet almost every one of the paid people on this board thinks they're underpaid, and that EMS is in general). The logic of "volunteers hurt paid people" is that if there were no one to work for free, the ambulances would be forced to pay people.

well...if there were no-one to work for the current low wages in EMS, ambulances would be forced to pay more.

The real issue is that people (including me) can volunteer. If you want EMS to be a paid gig the value of EMS to the population needs to be increased, the value needs to be conspicuous, and it needs to be harder to get into EMS.

You see less volunteer doctors because the requirements to become a doctor are much higher and they are valued more. Thus there are very few people willing to work for free, and people aren't as reluctant to pay.

Of course it is an interesting idea that EMS is the only profession with volunteer professionals. Ever hear of a free clinic, or a lawyer working pro-bono? More rare perhaps, but I dont hear anyone claiming pro-bono lawyers are the downfall of the lawyering profession. If you want to place the blame for the low EMS wages somewhere, there are more important places to look than volunteers.

It hasn't escaped me that the people lambasting volunteers also advocate for increased education....which is all fine and well. I would argue that scapegoating volunteers are the "root" of the problem is counterproductive...takes focus off the issues of the value people assign to EMS and educational standards. It is not the case that simply eliminating volunteers will raise the standards in EMS. It is probably the case that raising the standards will minimize the number of volunteers, except where volunteers are truly needed. keep the horse in front of the carriage...

 

[medic417]

Of course it is an interesting idea that EMS is the only profession with volunteer professionals. Ever hear of a free clinic, or a lawyer working pro-bono? More rare perhaps, but I dont hear anyone claiming pro-bono lawyers are the downfall of the lawyering profession. If you want to place the blame for the low EMS wages somewhere, there are more important places to look than volunteers.

...

That is like comparing grapes to to a Texas black diamond watermelon. The minor amount done free is basically none compared to the amount given away in EMS. All those willing to work in EMS for free do hold it finacially back. In fighting to get pay raises it is often thrown in our face that this community or that one is handled by volunteers.

Yes education needs to increase to make it harder for people to enter the field and give away their services free.

 

[ffemt8978]

That is like comparing grapes to to a Texas black diamond watermelon. The minor amount done free is basically none compared to the amount given away in EMS. All those willing to work in EMS for free do hold it finacially back. In fighting to get pay raises it is often thrown in our face that this community or that one is handled by volunteers.

Yes education needs to increase to make it harder for people to enter the field and give away their services free.

And when you make it harder for people to volunteer, many communities will lose what little access they have to these services...or have to travel farther/wait longer for them.

How many small towns have lost their local doctors offices in recent years? How many of these communities still have some type of EMS, either in their community or relatively close?

How will making EMS an entirely paid profession bring rapid medical care to these communities? How many medics will have to be trained to provide care to every community that currently has volunteers?

How many educational programs will have to be created to train all of these medics, so that we can avoid the medic mill and have truly educated people? And who is going pay for it all?

It's easy to say that the local communities can fund EMS if they truly want, but who is going to fund the educational programs required to train all of these people? If you make the students pay for their education before they even get a job, they are going to expect higher wages from the community that employs them to offset their educational costs. At some point, the community is going to draw the line and say enough is enough.

 

[Ridryder911]

..Your child is severely injured, and you await in the local Emergency Department. Finally the awaited "expert" arrives. The neurosurgeon enters the door. He apologizes for the delay; he exclaims that his delay was because "he was working his real job" at Best Buy as a computer technician. He profanes " I do this every so often because the hospitals get so busy and I feel that I could help out; some way". You ask about credentials and explains how when he attended a foreign medical school that from start to finish it was a grilling two years long; but hey he passed the same boards as the others!.. "that's all that matters; right?" Now; let's get your child into the O.R. and start drilling!

Sure, this would never occur for several reasons. The same reasons it should NEVER occur in EMS.

R/r 911

 

[AJ Hidell]

well...if there were no-one to work for the current low wages in EMS, ambulances would be forced to pay more.

Completely separate issue, which you bring up later, which is education. For now, most people in EMS are getting paid exactly what they are worth, if not more, for the "education" they have. Until they elevate the educational level, asking for more money is a joke. And before we do that, we first have to establish that we are worth any money at all. Volunteering is the primary stumbling block to that seminal step.

The real issue is that people (including me) can volunteer.

That highlights two other problems. First, that too much of EMS is done simply because, "I can". And second, because too many people in EMS think it is all about them, and not the community or the patient.

You see less volunteer doctors because the requirements to become a doctor are much higher and they are valued more. Thus there are very few people willing to work for free, and people aren't as reluctant to pay.

"Less" is a pretty significant understatement, don't you think? But yes, if we had an entry level educational requirement that took more than three weeks to complete, there would be a LOT fewer people willing to volunteer.

Of course it is an interesting idea that EMS is the only profession with volunteer professionals. Ever hear of a free clinic, or a lawyer working pro-bono? More rare perhaps, but I dont hear anyone claiming pro-bono lawyers are the downfall of the lawyering profession.

That's because, as often as this stinker is tossed out there, it is simply not even close to a valid analogy. Professionals who volunteer is very different from volunteers who play professional.

If you want to place the blame for the low EMS wages somewhere, there are more important places to look than volunteers.

Wrong. Volunteers comprise over one half of all EMS providers. That means more than half of the people in the field are telling America that we have no value. Spin it how you like, but there is no more immediately significant problem facing the profession.

It hasn't escaped me that the people lambasting volunteers also advocate for increased education....which is all fine and well. I would argue that scapegoating volunteers are the "root" of the problem is counterproductive...takes focus off the issues of the value people assign to EMS and educational standards.

Wrong again. I expect that the people with the intelligence and vision to move the profession forward have the ability to walk and chew gum at the same time. There is no reason why multiple issues cannot be addressed simultaneously.

It is not the case that simply eliminating volunteers will raise the standards in EMS. It is probably the case that raising the standards will minimize the number of volunteers, except where volunteers are truly needed. keep the horse in front of the carriage...

Best observation so far. And the volunteer issue will indeed have to be solved through education. We are not going to talk any of these selfish people into giving up their hobby for the good of society, anymore than you can convince Michael Vick that dogfighting is wrong. I simply maintain that we do not have to limit ourselves to one issue or one avenue of resolution at a time. They all tie together.

 

[medic417]

And when you make it harder for people to volunteer, many communities will lose what little access they have to these services...or have to travel farther/wait longer for them.

How many small towns have lost their local doctors offices in recent years? How many of these communities still have some type of EMS, either in their community or relatively close?

How will making EMS an entirely paid profession bring rapid medical care to these communities? How many medics will have to be trained to provide care to every community that currently has volunteers?

How many educational programs will have to be created to train all of these medics, so that we can avoid the medic mill and have truly educated people? And who is going pay for it all?

It's easy to say that the local communities can fund EMS if they truly want, but who is going to fund the educational programs required to train all of these people? If you make the students pay for their education before they even get a job, they are going to expect higher wages from the community that employs them to offset their educational costs. At some point, the community is going to draw the line and say enough is enough.

The medics are out there. With pay more would be willing to make themselves available.

Other medical professions pay for their own education either out of pocket or education loans/grants. Why should EMS be different?

Communitys get prioritys straight no matter how poor an area and EMS can get funded. If you already have the equipment for volunteers all you are added is salarys. So it is not near the leap so many say.

 

[medic417]

..Your child is severely injured, and you await in the local Emergency Department. Finally the awaited "expert" arrives. The neurosurgeon enters the door. He apologizes for the delay; he exclaims that his delay was because "he was working his real job" at Best Buy as a computer technician. He profanes " I do this every so often because the hospitals get so busy and I feel that I could help out; some way". You ask about credentials and explains how when he attended a foreign medical school that from start to finish it was a grilling two years long; but hey he passed the same boards as the others!.. "that's all that matters; right?" Now; let's get your child into the O.R. and start drilling!

Sure, this would never occur for several reasons. The same reasons it should NEVER occur in EMS.

R/r 911

Excellent illustration. If a person can not get the point of that illustration they are just ignoring it on purpose or ignorant.

 

[ffemt8978]

The medics are out there. With pay more would be willing to make themselves available.

Other medical professions pay for their own education either out of pocket or education loans/grants. Why should EMS be different?

Communitys get prioritys straight no matter how poor an area and EMS can get funded. If you already have the equipment for volunteers all you are added is salarys. So it is not near the leap so many say.

Not entirely true. Just because you have equipment for volunteers doesn't mean you have the equipment/infrastructure necessary to support paid medics. Most volunteer agencies don't have sleeping quarters therefore you would need to spend money to remodel/acquire a base for them. Most volunteer agencies are not ALS, therefore you would have to spend the money to get the necessary equipment like 12 leads, drugs, intubation equipment, etc...to allow them to do their job correctly. So you're adding a lot more than just salaries, and that is not even taking into consideration things like unemployment insurance, insurance coverage, pensions, and the like.

And do you truly believe that there are currently enough medics out there to provide paid ALS coverage to every part of the country, and that all that is holding them back is salaries? :wacko:

 

[medic417]

Not entirely true. Just because you have equipment for volunteers doesn't mean you have the equipment/infrastructure necessary to support paid medics. Most volunteer agencies don't have sleeping quarters therefore you would need to spend money to remodel/acquire a base for them. Most volunteer agencies are not ALS, therefore you would have to spend the money to get the necessary equipment like 12 leads, drugs, intubation equipment, etc...to allow them to do their job correctly. So you're adding a lot more than just salaries, and that is not even taking into consideration things like unemployment insurance, insurance coverage, pensions, and the like.

And do you truly believe that there are currently enough medics out there to provide paid ALS coverage to every part of the country, and that all that is holding them back is salaries? :wacko:

Look at the numbers of certified Paramedics nationwide and compare that to how many are working in the field. Yes there are a lot that have left the field to support their familys. Also I know several hold out volunteer services that are staffed entirly by volunteers so if they went paid theres even more available.

Sleeping quarters could be a cot in the station. Most stations have a bathroom. Then slowly upgrade using the paid people while waiting for calls.

As to supplys Many bigger citys give away or will sell cheaply the older but still good working equipment. Drugs for the most part are not that expensive. Take morphine less than $0.30 a vial. There are only a couple of have to have drugs that are expensive. Honestly you could upgrade any BLS ambulance to ALS with about $20,000. Would not be MICU but would be a huge improvement.

Salaries include those related expenses. Also salary could be phased in.

 

[AJ Hidell]

Sleeping quarters could be a cot in the station. Most stations have a bathroom. Then slowly upgrade using the paid people while waiting for calls.

Or they could use the intelligence and common sense that God gave them to be a little creative and figure out that, just because the firemen work 24 hour shifts does not mean that we have to continue that tradition. Work out a shift arrangement that doesn't require sleeping quarters. How hard is that?

As for the money, don't get me started. Did you see the budgets that were just passed by the Congress to address pig odors and Frisbee golf courses? Don't tell me this country lacks the funds to pay for EMS. It's a lie. And don't tell me your community doesn't either. They manage to pay the teachers and school bus drivers, the city hall janitors and mechanics, the water department and street department workers without volunteers. Nobody picks up garbage for free in your community. So puhleeze... it's all a lie.

 

[PapaBear434]

I guess I don't have a huge deal with EMT volunteers. Medics have far to much training and education, though, that I don't think they should only be able to find Volunteer gigs. And this is speaking as a current EMT and future medic. I can draw that line, because to me it's like someone volunteering at a children's hospital while working on their RN in order to get experience (as my wife did, for instance.)

And as mentioned, there is no way you'd be able to staff all-medic crews outside of major metropolitan areas. Hell, even cities are being hit hard right now.

Here is the big issue, and I hope you guys, volunteers and paid medics alike, can agree; The biggest problem with getting paid, and what led to people feeling the NEED to volunteer, is because of the nature of our business. The public tends to not think about us, firefighters, or police until they need them. It's easy to not think twice when it comes time to slash the budget to go ahead and take from emergency services, because people have this idea that we don't do that much and they'll never need us.

The people in charge would rather spend money better spent on us on things like flowers along the freeway, because beautification projects are more widely seen by the public than the paramedic that shows up at five in the morning to deal with someone's grandma after she fell down the back steps.

After 9/11, fire and police got federal funding like they've never seen before in the form of federal grants (I have no idea if EMS divisions got anything substantial.) Unfortunately, that "hero" thing only lasted for so long, and soon the budgets began to get slashed almost worse than they were before. People don't think about it until they need it. It's a flaw in the human condition, really.

Problem is, when it IS needed, and there is no one there, you are left in the lurch. People started noticing that, but not many. Just a few that noticed that people were dying because of the simple lack of access. So people started volunteering to cover that gap.

Of course, then you had municipalities all over the country saying "Hey, wow, this is cool. We don't even have to pay them!" And the condition got worse as they slashed the budget even more.

Yes, my and others volunteer activity may hurt the overall situation concerning payment. But the alternative is that entire areas of the country would have little to no EMS coverage, and that would simply be unacceptable.

Thus the catch-22. Paid medics hate the fact that people volunteer because they can't make a decent wage and more quality people aren't attracted to the profession. Conversely, volunteers are not willing to let areas go uncovered because cheap jerks in charge won't reallocate funding from tourism advertising or whatever local idiocy is siphoning the funds.

Volunteerism isn't the cause so much as it's a symptom.

 

[medic417]

Bear the problem with your theory is that the public sees an ambulance and they do not realize that the volly BLS is any different care than the Paramedic MICU. So yes EMT's as volunteers lead to lower wages for all levels.

You mention Paramedics not really vollunteering well in my area until our revolt almost everyone that volunteered were Paramedics. But guess what just informing the community that there was about to be no coverage led to multiple communitys and countys finding the money. Now my area is one of the highesy paid areas with even basics making at least $13.

The money is there, my area is one of the most poverty stricken nation wide but well shifting prioritys they found he funds needed.

Now what has been the affect of paid service? Much quicker response times because we are at the station not coming from home. So patient outcomes have drastically improved. Another major ripple effect has been that paid services that already existed went from making barely above minimum wage now pay a good wage. Some are now paying Paramedics over $25 an hour with great benefits. So low and behold just doing a way with volunteers has led to decent wages.

Now if education comes into play we can see even better wages.

Oh and guess what most of these former volunteer services only staffed 1 ambulance. Now that they are paid they have more ambulances. 1 county that had 2 ambulances when volunteer now staffs 5 spread around the county staffed ALS 24/7. So again non lost ambulances and most actually increased coverage.

 

[PapaBear434]

I'll concede that if you make a big public display of "no coverage," the public outrage will be enough to ride into a paid job. But hear me out here.

My service has been all volunteer since the early 40's. They pride themselves on being not only one of the oldest organized EMS services, but the oldest volunteer service out there. The deal that they usually do is that if you go to medic, they'll pay for your schooling, all of it, in exchange for 4 shifts a month. They give benefits around the city in the way of discounts at stores and restaurants, equipment reimbursement so you can buy your own, and other little perks. Yeah, it's not much, but four only four shifts a month it's not a bad deal.

Now, there are others that do more than that. Like me, going to school and trying to get all my proctor hours in, I tend to do more than that.

The service has paid medics, however, to ensure that every single ALS call WILL have a medic on hand on either the ambulance itself or via a zone car that is dispatched at the same time as a Basic unit. To date, I have never had an ALS call where a paid medic or at least a volunteer EMT-I (on their way to medic, usually) has not been on hand for the patient. And if all that is on hand is an EMT-I, the medic is usually enroute too baring some major case somewhere else.

The medics... Well, I'm not sure WHAT they get paid. But it has to be decent for four twelve hour shifts a week and they don't work any other job.

I'm just saying there are ways to balance out the volunteers that just want to help and pad the numbers that the lack of Medics leave, and the educated medics that can truly take care of the big problems.

 

[AJ Hidell]

Yes, my and others volunteer activity may hurt the overall situation concerning payment. But the alternative is that entire areas of the country would have little to no EMS coverage, and that would simply be unacceptable. <snip> ...volunteers are not willing to let areas go uncovered because cheap jerks in charge won't reallocate funding from tourism advertising or whatever local idiocy is siphoning the funds.

Okay, you seriously think that if there were no volunteers, the community leaders would simply throw up their hands and say, "Oh darn! I guess we just won't have EMS anymore"? You don't really believe that, do you? Come on, man!

What did you just say they do when they need money for something? You said they take money from EMS. Well guess what; when they suddenly need money for paramedics, they will find it the very same way. Or they will throw down with surrounding communities or the county to jointly fund a service. Or they'll find a federal grant. Or they'll raise taxes.

Ever seen someone who hasn't made a car payment in three months and hears that the tow truck is on it's way to his house? He finds money really fast! He hocks his television and stereo, he borrows from his dad, or he gets a payday loan. But he gets that money because the urgency of the situation suddenly inspires him to get creative and do so. Your community will do the same. They always do.

 

[PapaBear434]

Yeah, I'm sure they'd get a paid paramedic service. It would be inadequately paid, funded, and staffed, but they'd be paid.

It amazes me that we can decry the populace because no one cares anymore, but when you DO find an area where people just want to help we still find ways to say that they're destroying civilization as we know it.