Problems in EMS

[daedralarsa]

ok well for my class we have to identify a problem in ems. however i was just wondering if any of you with years of experience have seen problems in your areas. it can be any problems that you know of locally to nation wide. any ideassss???????

 

[skyemt]

lack of standardization... not only between states, but counties as well...

there are too many different levels, and even at the same level, say basic, emt's can do many different things in different areas...

i think it is confusing to the public.

 

[MMiz]

1. Lack of qualified personnel
2. Lack of strong national and local lobbying forces
3. Traditional view of EMS as transporters instead of treaters.
4. Lack of funding for EMS, opposed to police and fire.

I hope that helps!

 

[Katie]

Public views of ems are a big issue. People having such a wide range of expectations.
Standardization is one of the problems in ems. Universal minimum standards of training like those set out by national registry are a good start. Stardardized minimum levels with some variation would help as regards to confusion. Standardization is a tricky issue though simply because I think that one size fits all usually ends up fitting no one. In some areas there really is a need for an emt to be able to do more skills than in an area where hospitals are easily accessible and transport times are short. Needs differ dastically from place to place.

 

[Ridryder911]

Actually giving the good points about EMS would be more difficult.

1. Lack of good education
2. Lack of good education
3. Lack of good education
4. Lack of EMS instructors that are really educators qualified to teach adult learners
5. Professionalism (lack of)
6. No career ladder after achieving Paramedic
7. No screening of applicants to enter EMS
8. BLS services are still considered good enough for patient care
9. No incentives to go forward (maybe a time limit on being an Basic)
10 Did I mention.. Lack of education?

R/r 911

 

[VentMedic]

There are 48 different certifications and licenses with varying education requirements and various names designating EMS providers in the U.S.

Education is expressed by the number of "hours" and "skills".

Schools are not always accredited by CoAEMSP and/or CAAHEP.

 

[Jon]

Actually giving the good points about EMS would be more difficult.

1. Lack of good education
2. Lack of good education
3. Lack of good education
4. Lack of EMS instructors that are really educators qualified to teach adult learners
5. Professionalism (lack of)
6. No career ladder after achieving Paramedic
7. No screening of applicants to enter EMS
8. BLS services are still considered good enough for patient care
9. No incentives to go forward (maybe a time limit on being an Basic)
10 Did I mention.. Lack of education?

R/r 911

What he said.

PLUS:

Lack of funding
Lack of adequate equipment (vehicles, etc).
EMS playing second fiddle to FD in a "combination" department
Standardization (an EMT should be equal to an EMT anywhere, same for Paramedic)

Hospitals... the lack thereof, as well as Trauma Center problems, etc.

 

[Ops Paramedic]

I can not help you out with topics for local EMS. There are congnital problems as it seems.

1. Lack of proper remuniration for our level of education compaired to doctors, as we are specialist in our field
2. To many "chiefs" and to little "indians"
3. The authorities who set up the rules and regulations, have no idea as to what is happening on ground level
4. Bridging the gap between training instutions and industry
5. Not only the lack of good education, as per rid, but also the lack of certifeid training instutions
6. Tertiary education vs short courses

There are plenty of identified problems posted on this thread already for, it is up to you highlight a particurlar one (as the opertunity exists) and to action it.

 

[JPINFV]

To add what has been said (especially education), fire service activling fighting against more education.

http://www.iafc.org/associations/4685/files/ems_NtlEMSeduStandardsSectionComments070731.pdf
(bottom of page 3 for their fight against required degrees for paramedics and increase in class hours).

 

[firecoins]

i think it is confusing to the public.

I don't think there is much we can do about the general public. Its not something they think about until they need it.

Medical staff also have no idea. As a BLS provider we don't carry pulse oxs and glucometers but nurses and doctors ask me for that info all the time because they get it from ALS providers.

 

[el Murpharino]

Medical staff also have no idea.

This is a great point! We had a patient the other day who we gave dopamine to, and upon arrival at the ER the doctor questioned our use of it without contacting medical control. We explained to her that dopamine is a standing order for paramedics, after which she promptly and rudely told us to get out. There was never a question that the patient needed dopamine...

I understand that doctors make the protocols, but not all ER doctors that we interact with don't know our protocols. As a result, our agency extended an offer for the ER docs to do a ride along with us for a shift. Not all of them did it, but the ones that did have a much greater appreciation for what we do. I mean doctors don't have to wade through an inch of filth or extricate a 400 lb. patient down 4 flights of stairs. Additionally, it has led to much better relations between us and those doctors.

 

[EMTIA2-7747]

Lack of proper funding has to be on top of the list. Most services here in the north country can't afford to pay EMTs what they are worth. I am a career EMT (over 120Hrs a pay period), and have to hold two other part time jobs to keep afloat. Equipment and supplies cost too much, and insurance companies pay too little.
We also have a lack of funding for proper training, ie real life like scenarios and seminars.
This, I believe, still stems from the fact that we are yet to be recognized nationally as professionals. The fire service is nationally recognized, the law enforcement service is nationally recognized. we have the NREMT, thats it.

 

[Ridryder911]

Hmm.. Do we see a trend here? Maybe, we are the major problem (source)?

Really, how much PR education do we really perform? In the case of pay, how much education do we require to demand more pay? How much legislation and requirements we place onto the community to have to have EMS?

We may ask for it, but doubtfully we want to have to pay the price to stop those problems. Do you participate in associations and organizations for the betterment of EMS? Do you think LEO and FD received such without some work? It just didn't happen.

Like politics. Unless you participate to change, then one should not complain about it.

R/r 911

 

[firecoins]

The idea of police and fire department are old. Police deparetments existed in for centuries and fire for almost as long. EMS is quite new.

Between EMS and fire there are plenty of EMTs and medics do it for free.

Fire uses EMS billing to finance fire dept activity. This pisses me off.

 

[AlaskaEMT]

So we've diagnosed the problems in EMS... how do we resolve them?

What organizations are fighting for us? Who is responsible for EMS funding? (congressman / governor / mayor?)

 

[el Murpharino]

Fire Departments and Law Enforcement have unions and lobbyists who can speak on their behalf. We don't really have a national-level group or level that inform our elected officials of the perils of EMS. In fact, I'm not even sure if that is being taken care of at the local level. EMS is like the stepchild of public service. It is not regarded as a long-term profession with the long-term benefits of those in the fire service or law enforcement (unless you work for a municipal department, but even then EMS is usually a stepping stone, not a goal). But on the other hand, fire departments and police agencies are not private agencies that work for profit...

 

[Niftymedic911]

1. Lack of Education
2. Existence of "Volunteerism" and "EMS based Private enterprise"
3. Lack of Public Relations/ Professionalism
4.TOO Many Cert levels
5. Lack of Funding
6. Fire based EMS oppression
7. No standardization for agency to agency

 

[firecoins]

2. Existence of "Volunteerism" and "EMS based Private enterprise"

We have an excellent private service providing ALS fly cars Rockland County, NY and work for another providing ALS fly cars in Northern Westchester. But I am biased.

Two private companies providing service to Yonkers and White Plains, NY privide excellent emts and medics but are poorly managed. FDNY EMS is also poorly managed in my opinion.

Private companies do provide an importamt services of interfacility transfers, stand bys at private events and non-emergency calls that would overwhelm 911 systems.

6. Fire based EMS oppression

In general I am against this. However because ambulance service can be billed, we finance both EMS and fire based operations. I hate being a tool for fire service who views us as the band aid squad but wouldn't have job without us.

5. Lack of Funding

Cops make a high 5 figure salary in my community. 6 figures with overtime. Any government based EMS system will demand the same for EMS civil serve workers. Community already finances 4 volunteer corps and 2 private ALS fly cars. It would a tough sell for an independant EMS agency. If the volley corps fold, the police will most likely take over the service.

FDNY just made EMTs and Medics civil service positions a few months ago.

7. No standardization for agency to agency

Impossible. Each agency has a different situation. Each region has a different set of protocols. NY medics have standing orders where NJ medics have to call for medical control.

 

[MSDeltaFlt]

"2. Lack of strong national and local lobbying forces"

"1. Lack of good education
2. Lack of good education
3. Lack of good education
4. Lack of EMS instructors that are really educators qualified to teach adult learners
5. Professionalism (lack of)
6. No career ladder after achieving Paramedic
7. No screening of applicants to enter EMS
8. BLS services are still considered good enough for patient care
9. No incentives to go forward (maybe a time limit on being an Basic)
10 Did I mention.. Lack of education? "

If you have strong local and national lobbying forces, the rest should be a little less difficult.

 

[firecoins]

We should study the history of nursing, fire depts and police depts. See what's good and what's bad.

Definately need a strong lobbying forces. We need to get in with ER doctors, trauma surgeons, cardiologists and neurologists. Between MIs, CVAs and trauma, we are the first line of medical care. We need to to get them behind us.

As for adult learning. I am in a medic class right now. The head teacher is great but there is much room for improvment. Many of the instructors, MDs too, really don't know how to teach. I found that other programs in the area suffer the same problems.