Paramedic advocacy

[daedalus]

Medical Doctors have the AMA, Nurses have the ANA, PAs have the AAPA. What do Paramedics have, the NAEMT? I don't like them.

I think that there should be a professional organization for Paramedics dedicated to advancing the profession, protecting paramedics from god-awful employers and low wages, promoting education, lobbying congress, etc.

I have been talking to many PAs lately because it may be a path I will take, and they have a wonderful attitude about professional advocacy. They are all united and whenever a newspaper or other form of media makes a mistake like calling them medical assistants, etc, they jump on. Hundreds of emails are written in hours. The public is educated.

Paramedicine has stagnated for quite a long time, and we cannot use the excuse that we are a young profession anymore. I see a future where we refer out to outpatient care, provide community welfare checks and staff health fares, champion for public health, and provide emergency care and transport to emergency rooms. We have the potential to blunt to ER crisis around the country, to expand our education and professionalism, and to really ask what can we do for the public. Plus, we can use this all as a platform for public education.

EDIT: EMTs are out of this equation. If we are to actually become a health profession, EMTs are not going to be seen as equals or substitutes to Paramedics.

Thoughts?

 

[VentMedic]

They are all united and whenever a newspaper or other form of media makes a mistake like calling them medical assistants, etc, they jump on. Hundreds of emails are written in hours. The public is educated.

I would hope the PAs are not so petty to be worried about what they are called in a newspaper unless it was a major boo-boo. However, they do have some excellent promotional video available.

http://www.aapa.org/

They are have a powerful political machine that is constantly working for healthcare reform. Along with the AANP http://www.aanp.org/AANPCMS2 for nurse practitioners, they have joined forces to make things happen in terms of EDs and clinics to reduce overcrowding. EMS is still flapping its jaws at the station house thinking how they could rule this situation but don't want that education stuff or pay the fees or be associated with any association that might put FFs or private Paramedics on the same side. In other words they want everything that other professionals have but haven't found the right shortcut to get there.

And then you have some that confuse unions with professional associations. Some use the unions as an excuse not to belong to another association or to pay more fees.

The other difference is in attitude. When other professions present their arguments for increased standards, they do it in a way that puts the patient first. EMS has managed to give them impression of being self-serving in some way. "We want more money." "We don't want the hardship of more education...unfair." "We want more respect." "We want the public to know who we are." "We don't want a hard national test."

Even the national association for RTs www.aarc.org addresses the public's interest in every reform they push for the profession. That gives them a good end result and it is more difficult for members of the profession and legislators to agrue against lower quality care.

 

[ResTech]

Its been and currently is a slow climb as EMS is still coming out of its infancy. But currently workgroups and task forces are working to bring EMS on a level playing field. It takes time. Things like a National EMS Scope of Practice and the EMS Education Agenda For The Future are moving in the right direction. In addition to the NAEMT.... the American Ambulance Association, and the NREMT advocate for EMS.

 

[VentMedic]

It has been a very long infancy and it is time to stop using that excuse. EMS is well over 40 years old so it is more like middle aged.

The American Ambulance Association has their own agenda which doesn't always coincide with the future for Paramedics.

The NREMT is an advocate but for testing purposes. Other health care professions also have their own national testing organization but do not rely on it for all aspects of planning the future of a profession. If they did, the testing fees might be alot higher than they are. Some states might also get disgruntled as they are now with the NREMT and not all states use the NREMT for their state exams. There needs to be a national association to help bring the needs of all states together to see there is one test that is fair to all.

The NAEMT probably has many more EMTs than Paramedics. Their issues read more like a union statement with basic labor concerns without much mention of advancing education.

The Advocates for EMS is another organization that has members of other established associations for educators, physicians and State EMS Officials.
http://www.advocatesforems.org/

 

[Shishkabob]

media makes a mistake like calling them medical assistants, etc, they jump on. Hundreds of emails are written in hours. The public is educated.

I wouldn't go so far as to say the pubic is educated. I had no clue what a PA was until I got in to EMS. Heck, vast majority of the public don't know the difference between CNA, LVN, and an RN or NP.


Just because you have a national agency doesn't mean the public will be any more aware of what you do.




Do I wish there were one? Sure. Do I expect it to make much of a difference to the general public? Nope.

 

[daedalus]

I wouldn't go so far as to say the pubic is educated. I had no clue what a PA was until I got in to EMS. Heck, vast majority of the public don't know the difference between CNA, LVN, and an RN or NP.


Just because you have a national agency doesn't mean the public will be any more aware of what you do.




Do I wish there were one? Sure. Do I expect it to make much of a difference to the general public? Nope.

Understand that the AAPA creates educational materials for the public, while we do not. It is time to stop fooling the public, and let them know that the ambulance responding to their kid may not even be able to give epi, and the EMTs probably do not know what a mast cell is.

 

[Shishkabob]

Which is more a problem with education standard of EMS, is it not?


Who gives a darn if the public is educated. There will always be an ignorant public. We need to worry about making ourselves educated first.

 

[VentMedic]

Who gives a darn if the public is educated. There will always be an ignorant public. We need to worry about making ourselves educated first.

Excellent statement!

Although I wouldn't necessarily call the public ignorant. Most just have their priorities for what information they want to retain. You don't hear other professions, of all types medical or not, calling their potential clients names.

To push your profession's acceptance it should be what can the public do for us but what can we do for the public.

We must eliminate the title confusion. Right now when legislators are presented with proposals from EMS, they get 50+ different cert levels to sort through and many variations of which service is best for EMS.

A national organization with state affiliates should work with the State EMS department of each state to achieve some consistency. In addition, they can coordinate with the other EMS organizations such as those for educators and physicians.

There are many successful professions that the public knows very little about or may not even have heard of. Most of these professions have managed to achieve a well organized professional structure in under 20 years. But, they know who they are and do not suffer the same identity crisis that EMS does.

Almost everyone knows to dial 911 in an emergency and have seen enough newspaper articles, TV shows and real life MVC or medical incidents with EMS involved to get a general idea that EMT(P)s are there for emergencies. They do not have to know your entire job description to know what you are about.

 

[daedalus]

Which is more a problem with education standard of EMS, is it not?


Who gives a darn if the public is educated. There will always be an ignorant public. We need to worry about making ourselves educated first.

Because we cannot even all agree that we need more edcation, we are not demanding it for ourselves. The public may have to demand it for us.

 

[Shishkabob]

They haven't in the past 30 years, and I don't foresee it any time soon.


Let's work on us, by us, before we worry about the public's education about us.

 

[silver]

So here is my thought. These threads always come up about better education, better pay, and more respect. Everyone has their comment, but I have yet to hear anyone say, "I sent a letter to congress" or "I am lobbying" or "Creating/joining a non-government organization for the betterment of EMS."

Just something to think about, but really what do I know; I'm just an EMT-B...

 

[VentMedic]

Because we cannot even all agree that we need more edcation, we are not demanding it for ourselves. The public may have to demand it for us.

We are actually lucky the public doesn't know how little education some EMS providers have. I often see a little elderly lady looking up at one of our FF/medics and telling him he must be as smart as a doctor. Of course the patient was essentially BLS'd in and the FF/Medic was graduate of one our notorious medic mills that allowed ALS engine sleepovers for clinicals and couldn't get a hospital to allow them to do intubations.

People examine the credentials and education of their stockbrokers, accountants, Massage Therapists and hairdressers closer than they do with EMT(P)s. Some just believe or have faith that if you are dealing with life and death situations you must have a good eduation. Thus, we have been running a pretty decent scam by talking a big talk on the Public Safety commercials or those the FF unions put out frequently.

 

[daedalus]

They haven't in the past 30 years, and I don't foresee it any time soon.


Let's work on us, by us, before we worry about the public's education about us.

The same argument can be made against us. We haven't budged either.

 

[daedalus]

We are actually lucky the public doesn't know how little education some EMS providers have. I often see a little elderly lady looking up at one of our FF/medics and telling him he must be as smart as a doctor. Of course the patient was essentially BLS'd in and the FF/Medic was graduate of one our notorious medic mills that allowed ALS engine sleepovers for clinicals and couldn't get a hospital to allow them to do intubations.

People examine the credentials and education of their stockbrokers, accountants, Massage Therapists and hairdressers closer than they do with EMT(P)s. Some just believe or have faith that if you are dealing with life and death situations you must have a good eduation. Thus, we have been running a pretty decent scam by talking a big talk on the Public Safety commercials or those the FF unions put out frequently.

Somehow I think if the public found out the scam we pull over their heads and the amount of their trust we violate with all this un-needed code 3 and the like, it would be a catharsis for EMS after the witch hunt

 

[ResTech]

I agree educational standards need to be raised a bit but to insinuate EMS is full of dumb providers and we are "scamming" the public is going a bit far.

I hear stories of RN's who are fired because of incompetency and stories of RRT's who aren't allowed to work the critical care areas of hospital's because of their competency level. Its simply not just EMS...

 

[daedalus]

I agree educational standards need to be raised a bit but to insinuate EMS is full of dumb providers and we are "scamming" the public is going a bit far.

I hear stories of RN's who are fired because of incompetency and stories of RRT's who aren't allowed to work the critical care areas of hospital's because of their competency level. Its simply not just EMS...

We are scamming the public. Allowing EMTs who receive just a little more training than First Aid for Boy Scouts to run calls is wrong.

 

[ResTech]

I agree that the current EMT curriculum is very weak indeed. And I also agree that all ambulances should have some form of ALS capability and not simply an EMT as the highest level care provider regardless of call priority.

However, there is not an easy and uniform fix which is frustrating. EMS services across the country are so diverse in their populations, demographics, economics, and available resources that it's impossible to blanket one standard for all. And this is why more then one level of EMS provider level has been created for right or wrong.

It would be great to have degreed Paramedics on all primary EMS units but they're are many logistical aspects that sometimes prevent this. EMS isn't like a hospital or other medical facility where they are pretty guaranteed to have their bills and staff salaries paid. EMS in a lot of communities is self supported by Bingo and Chicken BBQ's. Municipalities and the Federal government want to get by as much as possible without paying anything for EMS services yet expect top notch care. And the public is just as guilty. They want top notch EMS service but heaven forbid we raise their taxes to cover the cost of providing it.

How do you staff an all volunteer station that runs a few hundred calls a year with degreed, critical care Paramedics? That's a serious question that I would like to hear plans of how you would accomplish that with funding coming from bingo, the chicken BBQ, and maybe an annual carnival. And if you are a Paramedic, would you work at a station like this? How well would your skills be with only one or two calls every week?

EMS is very dynamic and presents unique challenges and cannot always be compared to other medical professions. It is a specialty of its self and is recognized as such. Some medical school's are offering physician specialty in Pre-Hospital care the same as Cardiology, Pediatrics, etc.

It's great to spout off education, education, education... nobody is disagreeing with that. Wouldn't it be great to have physician's staff EMS units? When is enough, enough for pre-hospital education to be considered adequate? I think that is the real question. When does it become overkill if ever? Think of what the primary mission of EMS is and what specifically is adequate to carry it out? Do we need physician's onboard to be adequate? You say no, so why not? Again, when is enough enough to stabilize and rapidly transport patients within a coordinated EMS system to definitive care?

 

[djmedic913]

It would be great to have degreed Paramedics on all primary EMS units but they're are many logistical aspects that sometimes prevent this. EMS isn't like a hospital or other medical facility where they are pretty guaranteed to have their bills and staff salaries paid. EMS in a lot of communities is self supported by Bingo and Chicken BBQ's. Municipalities and the Federal government want to get by as much as possible without paying anything for EMS services yet expect top notch care. And the public is just as guilty. They want top notch EMS service but heaven forbid we raise their taxes to cover the cost of providing it.

I agree that everyone wants but no one wants to pay. I live in New Hampshire and they just paced a state law mandating public kindergarten. Well the town I live in filed against it and won, so they do not have to offer public kindergarten. And the reason they fought it was because the tax payers would have had to pay for it. So there answer of course was I don't have kids, why should I pay. These are the same tax payers who tried to condemn the school board for giving teachers a raise. they stated how dare they get a raise when the economy is bad and people are getting laid off.

Everyone wants everything but wants everyone else to pay for it. This 1 major reason universal health care will not work in this country because everyone is still ME, ME, ME!

How do you staff an all volunteer station that runs a few hundred calls a year with degreed, critical care Paramedics? That's a serious question that I would like to hear plans of how you would accomplish that with funding coming from bingo, the chicken BBQ, and maybe an annual carnival. And if you are a Paramedic, would you work at a station like this? How well would your skills be with only one or two calls every week?

There is a paid/per call/volunteer service I used to work per diem for. They pay great. That towns tax payers said they will pay for the FD/EMS. but their call volume barely exists. there were some weeks that 'one or two calls' did not even happen that week. There is only 1 of the full time medics who works at my much higher call volume company per diem so he CAN keep his skills up. But, the other medics don't work anywhere else. And since it is FD run EMS, EMS education takes the back seat to FF training.

It's great to spout off education, education, education... nobody is disagreeing with that. Wouldn't it be great to have physician's staff EMS units? When is enough, enough for pre-hospital education to be considered adequate? I think that is the real question. When does it become overkill if ever? Think of what the primary mission of EMS is and what specifically is adequate to carry it out? Do we need physician's onboard to be adequate? You say no, so why not? Again, when is enough enough to stabilize and rapidly transport patients within a coordinated EMS system to definitive care?

As for MD's on the ambulance...that is the absolute perferred way to handle EMS..BUT, we know that will never happen. 1 reason for EMS in the 1st place was because there was not enough Dr.s to make house calls, respond to MVA. The mere definition of Paramedic is 1 : a person who works in a health field in an auxiliary capacity to a physician . I found many variations of this, but we assist the Dr. Since it is not possible to get a Dr on every ambulance call, Paramedic are still needed. I agree the more eduation we have the better we can assist the MD and the Pt.
I heard of medics in the middle of nowhere, USA [can't remember where], that are doing suturing in the field and calling a Doc to write the antibiotic script.

Where is EMS going? this is something we need to figure out. We may be certified or licensed, but we still work under a Doctor's medical License. So, we need to convince the Doctors who let us practise and the Doctors who write our protocols we can do these things.

I currently work in a state with very progressive protocols that give the medic a lot of freedom to treat their patients with out med control. I have also recently posted threads about NJ Paramedics and their protocols and their protocols are very limiting with contacting med control.

Our state protocols are written by this Dr.s who think we are incompetent and would rather not see basics or medics but just ambulance drivers [like it used to be].

I agree we do need more education after school, but what? I agree we need a true EMS advocate in Washington, like FD and PD. Did you know many of our representatives did not realize that EMS could be private and NOT run by FD. There are definite issues between private, municipalities, and fire based EMS. None of them can look at the other as an equal...

What do we do? how do we grow? Where do WANT EMS to go in the future?

[I apologize for the lengthy post. And ResTech this is not an attack on anything you said...actually I agreed with most of it]

 

[46Young]

Restech, I couldn't have said it better myself. I'm interested in hearing the rebuttals to this post.

 

[46Young]

DJ, excellent questions. I'd like to know how we would best spend our resources to further the field collectively.