Rant about how much volunteers are hurting our profession

[EMTinNEPA]

Look, dude, all I was doing was calling for civility. Just like I did at the beginning of this thread. I knew where this was going to lead, and the usual cast of characters that I mentioned most definitely included you. It was just a matter of time before you let your ego flag fly.

I know you consider yourself one of the nations foremost experts in the field, but everyone is entitled to an opinion. I respect yours, as a long time provider and having a high level of education. But your "impact" is greatly diminished when you end over half your posts with a dismissive "Yeah, I thought so" or similar valley girl-esque comment.

All I am saying is that there are ways to get your point across without letting your obvious arrogance run wild.

Myself, I have no real horse in this race. I plan on being a paid nurse/medic in the near future, but for now my education is being paid for via a volunteer system. I'm riding the fence here. But seeing the vast amount of opinionated and self righteous idiocy on either side... It's just doing our profession more harm than good.

Just keep it civil, Rid. I know I have no power here, that my pleas will fall upon deaf ears should you choose to disregard my statements here and that the mods will likely side on your behalf anyway. But I ask you, as one EMS provider (whether you like it or not) to another, keep the level of maturity up a bit.

Look, dude...

I see no lack of civility. Sometimes the truth hurts. I used to think Rid was a self-important ego maniac. Then I stopped deluding myself into believing that volunteer EMTs were doing the profession a favor.

You want to be a nurse? Get out of my profession.

You may want every EMS provider the world over, vollie, paid, fire-based, etc., to hold hands and sing a rousing chorus of "We Are The World", but others want to make progress. Others want to advance the profession to its full potential, make every EMS provider a skilled, knowledgeable, educated patient care professional. And providing EMS for free with minimal educational requirements is NOT the way to do it. You may think by doing it for free and not billing what your services are worth that you are doing your patients justice, but you aren't. How can you be a true patient advocate by not being all you can be?

 

[medic417]

I guess this depends on your protocols, because we don't give pain relief meds to anyone for anything short of a severed limb. The hospitals would have a fit if we gave pain meds for a broken arm or a bruised butt from a fall. Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted. That's a pretty basic skill.

Wow your service needs to get out of the dark ages. It is never right to allow a patient to suffer. If your hospital complains must be because someone in your service screwed up royally multiple times probably.

If the above is how your area does volly they really need to quit. Even volly organizations must do it right by the patients and allowing suffering is unethical.

And no basics are not qualified to use selective spinal immobilization.

 

[medichopeful]

Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted. That's a pretty basic skill.

I don't really know about this. Should somebody with so little education really be ruling things out? I mean, things that are not hugely obvious?

 

[medichopeful]

I used to think Rid was a self-important ego maniac.

Actually, he is. But at least he has some good points.

I kidd (about the ego part)

I was actually the same way. Now I have begun to learn a lot from him and others.

 

[akflightmedic]

Just give it time mate...I have watched many over the years come to the "dark side" after advancing their education and actually doing this as a profession. The attitudes and thought processes change and we witness a shift for the good.

One at a time, unfortunately it takes the same thing being said over and over, year after year.

I can not wait to speak to Mapabear (misspelling intentional since he didn't take the time to get my name right after bolding it)after he becomes a nurse and medic and works for a year or two.

**Edit: Papabear, since he is still reading and went back and corrected my name.***

It is hard to convince them it is not about ego, I have been doing this long enough to know an ego is not a good thing. As a 19 year old paramedic, yes I had ego at the time, but I was also scared to death because I realized how important me knowing my stuff had just become.

As I now enter my 15th year of paid EMS as a paramedic, I can say beyond a shadow of a doubt it is all about the patient. Hurting others feelings or taking away their hobbies is of little concern to me, especially if it is me or my family on the receiving end. I want dedicated professionals not weekend hobbyists.

It is with this desire in mind that people like myself and Rid continuously support higher education and push for more stringent standards. We know it will not happen over night, we know there are funding issues, but we will continue to push.

 

[EMTinNEPA]

I guess this depends on your protocols, because we don't give pain relief meds to anyone for anything short of a severed limb. The hospitals would have a fit if we gave pain meds for a broken arm or a bruised butt from a fall. Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted. That's a pretty basic skill.

Uh oh... so you follow protocols to the letter? No critical thought of your own?

Around here, we give pain relief for fractures all the time. Our command physicians actually trust us! And they also realize that we aren't doing right by our patients by allowing them to remain in pain. As medic417 said, time to come out of the Dark Ages! It's time to stop being a taxi ride and start being medical professionals!

And basics are NOT qualified for selective spinal immobilization. They just don't have enough anatomy under their belt to notice not-so-obvious injuries or perform a neurological exam beyond "A&Ox3". The few that are have educated themselves through study or were taught by a medic. You think just because spinal immobilization is considered a "BLS" skill that a BLS provider is more qualified in it than an ALS provider? Next time a medic tells you to board somebody, tell them no and claim to be more qualified. See how far THAT gets you.

 

[scottyb]

If I decide not to board somebody (Which I am allowed to do per NYS DOH) based on my findings during my size up (MOI), assessment, and what the patient tells me based on strict guidelines and a higher certified person, EMT-P, CC, P tells me to board any way. Do you think I wouldn't? Of course I would, they are more qualified than me and have the ability to make that call above me. But, they would also be explaining to me why they directed it, not because I want to question them, but because I want to learn.

 

[PapaBear434]

Ok, one last post, since I have raised so much ire. Feel like I owe you guys a response.

Actually, he is. But at least he has some good points.

I kidd (about the ego part)

I was actually the same way. Now I have begun to learn a lot from him and others.

You have no education, nor practical experience by your own admission. I don't see as you have much of a perspective on this. I will warn you right now, though, if you keep this attitude you have before you have ANY training, you are going to be the guy that everyone talks about behind your back as the "paragod." Your patient care will suffer, because you will be so sure of yourself you won't consider anything anyone else has to say.

Wow your service needs to get out of the dark ages. It is never right to allow a patient to suffer. If your hospital complains must be because someone in your service screwed up royally multiple times probably.

We are never more than fifteen minutes with no l/s from a hospital. I have only given pain meds once, when a guy had a crush injury to his right hand. We (the medic I was riding with) administered a nerve block.

It's one of those things that we'd rather get them to the ED than take the extra time in the field to give them pain meds that will take just as long to take effect as they do to transport.

If the above is how your area does volly they really need to quit. Even volly organizations must do it right by the patients and allowing suffering is unethical.

Nothing unethical. Just practicality. I would understand if it was a huge area where it was half and hour or more ride to the ED. But if it's something that extreme, I think the patient is better served with a five minute ride to the ED.

I don't really know about this. Should somebody with so little education really be ruling things out? I mean, things that are not hugely obvious?

Take C-Spine control > Ask > "Does your neck hurt? How about your head? How does your back feel?"

If the answer to all of these is no, examine patient. Observe no step up/down, bruising, odd shapes or deformities.

Ask the patient if they lost consciousness. Answer is no. Ask a witness if any of this stuff happened. Answer is no.

Did the patient fall from a significant height, or just off a chair? Is the patient an elderly person, or a healthy teenager who tripped off a step going into the school?

A lot of factors, I'll grant you. But a reasonable person can rule this out with basic training.

I see no lack of civility. Sometimes the truth hurts. I used to think Rid was a self-important ego maniac. Then I stopped deluding myself into believing that volunteer EMTs were doing the profession a favor.

You want to be a nurse? Get out of my profession.

You may want to look at Rid's education list again. Being a trauma nurse can only help be a better EMS provider. After all, aren't you all clamoring for higher education? RN's have higher educational standards than medics, do they not? I plan on being a paramedic, but being an RN opens my occupational opportunities a bit more.

You may want every EMS provider the world over, vollie, paid, fire-based, etc., to hold hands and sing a rousing chorus of "We Are The World", but others want to make progress. Others want to advance the profession to its full potential, make every EMS provider a skilled, knowledgeable, educated patient care professional. And providing EMS for free with minimal educational requirements is NOT the way to do it. You may think by doing it for free and not billing what your services are worth that you are doing your patients justice, but you aren't. How can you be a true patient advocate by not being all you can be?

You see me as idealistic, that's fine. But I also think that your "All Paid All the Way" as a bit of an idealistic goal too. An admirable one, one that I partially share. But again, until you are able to convince the majority of local governments country wide to switch, you have to work with what you've got. Yes, having all volunteers stop service immediately might convince them after enough people go without care, but you are also sacrificing how many people going without care to achieve that goal.

As most volunteers get into the gig to help folks, they probably would not be willing to do that. Again, I ride the fence in this regard. I got into EMS because I wanted to help folks, but I do the volunteer thing out of the fact that they provide me a resume bullet point and a paid for education.

If EMS does what you suggest (let the basic just take vitals, etc.), it sounds more like a taxi service than a medical service.

Welcome to EMS, friend. Whether you are a medic, basic, or just some scrub on a truck, this is what you are going to feel like the majority of the time.

 

[akflightmedic]

If I decide not to board somebody (Which I am allowed to do per NYS DOH) based on my findings during my size up (MOI), assessment, and what the patient tells me based on strict guidelines and a higher certified person, EMT-P, CC, P tells me to board any way. Do you think I wouldn't? Of course I would, they are more qualified than me and have the ability to make that call above me. But, they would also be explaining to me why they directed it, not because I want to question them, but because I want to learn.

I appreciate your response and I have this to say:

You have done what many others have done in similar debates concerning these issues. You/they tend to bring the argument home...meaning they personalize, they compare it to their own bubble and personal experiences which is very limited in most cases.

When you step back and evaluate the system as a whole, you will realize why changes need to take place because although you may have a stellar group of exceptional people who go above and beyond regardless of their level, we have to apply the argument/facts to the entire group.

When examined from that perspective, your eyes will be opened and you will realize why this argument exists and why it needs to be rectified.

 

[Ridryder911]

But untilTreading dangerously close to arrogance yourself. When I was a Basic, I knew my place as a provider that did a base minimum: Transport, low level intervention, information gathering and assisting medics in treatment. Now, I am going through Intermediate qualifications, and I strangely have yet to act like a lot of ALS providers and go all "paragod" on the basics. I am not offended by their being there, as you seem to be.

If you are not an Intermediate yet, you still are a Basic Level sorry but you are not advanced yet.

I guess this depends on your protocols, because we don't give pain relief meds to anyone for anything short of a severed limb. The hospitals would have a fit if we gave pain meds for a broken arm or a bruised butt from a fall. Oh, and by the by, basics are MORE than qualified to provide spinal immobilization, and should be able to rule out if it's warranted. That's a pretty basic skill.

Far as the abdomen pain goes... Well, if they haven't pooped in four days, it's pretty safe to say it's constipation. Now, basics can't tell WHY they are constipated. It may be a side effect of narcotics, it might be an impaction. Guess what, medics are rarely able to tell either, since we don't do ultrasounds or other diagnostic procedures. Even if we do know what it is, such as the narc SE or such, we are limited in what we can do for it. We certainly are not going to provide a laxative or an enema on scene. Besides, if they have been hurting for four days, they are not likely to keel over today in the course of a fifteen minute ride to the ED.

Well, I don't know what country or era your hospital & medical community works upon but pain control as in National Standards have been a high priority for about a decade, albeit being in the prehospital or in hospital phase. JCAHO has been closely monitoring patient pain level and control for about 15 years.

You should had stopped while you were ahead. Describing patients and describing "not likely to keel over" is a great illustration of the type of ignorance we are describing and attempting to emphasize. The infarcted bowel resulting by being fecal impacted or sepsis by an bowel obstruction; that itself does have a high mortality even though they may appear to be initally stable. Again, lack of education and medicine is why it is essential to have the highest level to describe stability or not.

As you describe that your hospitals would have a "fit" in regards to analgesics; I wonder if it is because of the providers that would be performing this in lieu of the procedure or treatment modality itself. Something to consider and explorer.

Now, I'm going to exit this thread, because it's getting away from "all paid vs. volunteer" and aiming quickly toward "Medics or nothing, the rest of you are worthless." That, and I have already disregarded my own advice about staying the heck out of it from the beginning because this is exactly where I said it would lead. Just please, keep the egos out of it.

Anytime logic and reason with the discussion of being able to defend one's position; many people will bow out and take the "ego" route. Again; justify of not just your position but again how it would relate to be in the best position for the patient and the EMS System. That it is not called ego; rather it is called formal discussion.

R/r 911

 

[PapaBear434]

**Edit: Papabear, since he is still reading and went back and corrected my name.***

I corrected my post approximately three seconds after posting and noticing that I screwed up your name. No disrespect was meant, so I corrected it. I didn't even see your... attempt... at an insult with "MaBear".

Calm yourself, I'm not going to lower myself into the dregs with you.

 

[akflightmedic]

We are never more than fifteen minutes with no l/s from a hospital. I have only given pain meds once, when a guy had a crush injury to his right hand. We (the medic I was riding with) administered a nerve block.

It's one of those things that we'd rather get them to the ED than take the extra time in the field to give them pain meds that will take just as long to take effect as they do to transport.

Mate, this comment alone displays your lack of understanding in regards to pain control.

Extra time in the field?? In less than 5 minutes, an IV can be placed and fetanyl or morphine administered. In our system, we utilize nasal fetanyl, so that is really fast.

However, the comment about how it would not even take effect before you got them there is inaccurate. In short, you are wrong.

Also think of the continuum of care, total patient care. By this I mean put yourself in the patient's shoes.

Injury occurs
Delay to call 911 2-10 minutes depending on situation
Ambulance arrives 6-12 minutes later.
Assessment performed 3-5 minutes
Load in ambulance Few minutes
Transport 15 minutes
Hand over pt care 2-5 minutes
Pt reassessed few minutes
Doc orders few minutes
IV placed few minutes
Pain meds given few minutes
Pt relief ****Possibly up to an hour post injury***

Do you see where you could have made a difference?

 

[PapaBear434]

Uh oh... so you follow protocols to the letter? No critical thought of your own?

Around here, we give pain relief for fractures all the time. Our command physicians actually trust us! And they also realize that we aren't doing right by our patients by allowing them to remain in pain. As medic417 said, time to come out of the Dark Ages! It's time to stop being a taxi ride and start being medical professionals!

And basics are NOT qualified for selective spinal immobilization. They just don't have enough anatomy under their belt to notice not-so-obvious injuries or perform a neurological exam beyond "A&Ox3". The few that are have educated themselves through study or were taught by a medic. You think just because spinal immobilization is considered a "BLS" skill that a BLS provider is more qualified in it than an ALS provider? Next time a medic tells you to board somebody, tell them no and claim to be more qualified. See how far THAT gets you.

Of course there is critical thought. But since I am not a fan of loosing my certifications before I even get all the way to medic, I don't disregard protocols.

Figure that I should probably at least be a qualified medic before I try to fight "the man" and change the rules.

Oh, and I never said that basics (which I am NOT, mind you) were more qualified. I said that they were qualified to rule on it. If a medic says otherwise, well, the medics are the ones running the call and get the final say.

Now...

You know what, never mind. Nothing I say is going to make this civil. You guys have your opinions, right or wrong, and the false feelings of self importance to back it up I guess.

You guys (yes, I see that Rid has posted to me again, I have yet to read it, but I am sure it's positively SCATHING) are holding back the profession just as much as any volunteer. You are just too busy screaming at the trees to see that the forest is being cut down around you.

The metaphor broke down a little at the end there, but you get what I'm saying.

Enjoy your little ego stroking session, guys. Both sides of this debate are getting plenty of it.

 

[medichopeful]

You have no education, nor practical experience by your own admission. I don't see as you have much of a perspective on this. I will warn you right now, though, if you keep this attitude you have before you have ANY training, you are going to be the guy that everyone talks about behind your back as the "paragod." Your patient care will suffer, because you will be so sure of yourself you won't consider anything anyone else has to say.

So I am going to be a cocky "paragod" because I stated any opinion that said that people who don't have a lot of training should not be put into a position where lives are at stake? Could you explain why I will be a paragod a little better, please? Because I clearly don't have the education to be able to see at your level.

 

[Ridryder911]

Of course there is critical thought. But since I am not a fan of loosing my certifications before I even get all the way to medic, I don't disregard protocols.

Figure that I should probably at least be a qualified medic before I try to fight "the man" and change the rules.

Oh, and I never said that basics (which I am NOT, mind you) were more qualified. I said that they were qualified to rule on it. If a medic says otherwise, well, the medics are the ones running the call and get the final say.

Now...

You know what, never mind. Nothing I say is going to make this civil. You guys have your opinions, right or wrong, and the false feelings of self importance to back it up I guess.

You guys (yes, I see that Rid has posted to me again, I have yet to read it, but I am sure it's positively SCATHING) are holding back the profession just as much as any volunteer. You are just too busy screaming at the trees to see that the forest is being cut down around you.

The metaphor broke down a little at the end there, but you get what I'm saying.

Enjoy your little ego stroking session, guys. Both sides of this debate are getting plenty of it.

I ask then for clarification. If you are not a Basic and not an Intermediate or Paramedic then upon what national level would you be?

Second, the forest is growing. The trees are being rattled and the leaves are falling down.... I was in a two hour meeting yesterday in regards to national pilot study programs that will be introduced. Something I and many those within professional EMS will be pleased with. I am not at liberty to discuss at this time but I can assure you things are changing and dramatically so. This will be from the National level down; yes states will have the option to opt out (if they want to refuse Federal funding; like that will happen).

Again, ego's hmmm.. "but I do the volunteer thing out of the fact that they provide me a resume bullet point and a paid for education".... " You are supporting a side because they are padding your resume and benefits that is not considered self ego?

You are correct, probably will not convince you until you have finished formal education and have more clinical experience. Come back in five years after practicing in patient care as an advanced level and then let's compare notes.

R/r 911

 

[EMTinNEPA]

We are never more than fifteen minutes with no l/s from a hospital. I have only given pain meds once, when a guy had a crush injury to his right hand. We (the medic I was riding with) administered a nerve block.

It's one of those things that we'd rather get them to the ED than take the extra time in the field to give them pain meds that will take just as long to take effect as they do to transport.

So fifteen minutes isn't enough time to administer pain meds? Even if they don't take effect immediately, you're still saving time since the ED won't administer pain relief until they've done their own assessment.

You may want to look at Rid's education list again. Being a trauma nurse can only help be a better EMS provider. After all, aren't you all clamoring for higher education? RN's have higher educational standards than medics, do they not? I plan on being a paramedic, but being an RN opens my occupational opportunities a bit more.

I'm clamoring for higher education for paramedics, not replacing paramedics. If you want to be a paramedic and have more occupational opportunities, become a CCEMT-P.

You see me as idealistic, that's fine. But I also think that your "All Paid All the Way" as a bit of an idealistic goal too. An admirable one, one that I partially share. But again, until you are able to convince the majority of local governments country wide to switch, you have to work with what you've got. Yes, having all volunteers stop service immediately might convince them after enough people go without care, but you are also sacrificing how many people going without care to achieve that goal.

Why do the governments need to fund it? Bill for your services! Even if you want to charge your patients less than warranted, there are plenty of ways to have paid staff. Work out a deal with a local paid ALS service to staff a paramedic while you provide a paid or volunteer driver. Have two paid EMTs from a private service staff your truck and let volunteers go on calls if they want. These are just a few ways that vollie services in my area have gotten around the financial difficulties and still staffed their ambulances 24/7. It is possible if you don't let tradition and weekend warriors who don't want to lose their favorite hobby get in the way.

 

[PapaBear434]

I ask then for clarification. If you are not a Basic and not an Intermediate or Paramedic then upon what national level would you be?

I'll answer your questions. Right now, I am about two semesters away from getting my degree in paramedic medicine, going to expand it to RN. I am only certified in my system as EMT-Enhanced, a stupid middle-level between B and I in Virginia that allows for IV's, certain drugs (Narcan, Dextrose, breathing treatments under medic supervision, antihistamines, stuff like that) and intubation. Anything more advanced like cardiac is the realm of a medic. It's called "Shock/Trauma" in some places, if that helps. It's one of those things I agree with you on, that we need a universal certification/license to practice qualifications and random letters in the mix is just confusing everyone. But hey, it allows me to operate.

That's when I am not running with my proctor, who is a twenty five year veteran and qualified flight medic. Under his supervision, I do pretty much everything that an Intermediate or Medic does. Over half my shifts are run with him, until I get my quals out of the way and am allowed to operate on my own.

Furthermore, I'm not going to deny a little selfishness on my part. Yes, I love doing EMS, and it makes me feel good to do it. Yes, I want to get compensated for it someday. Hell, I'm being compensated for it now, via getting my schooling to medic (and as it turns out, most of the way to RN) paid for. I'm not going to feel bad for that. The fact that it also pads my resume isn't bad either. Most places in a crowded field want experience. So, yeah, I'm not going to shy away from marking this as experience just because it was an unpaid, volunteer gig.

 

[Ridryder911]

Don't blame you at all. Appears to be good for both you and the system at the time. Good luck in school and again, let's re-visit this discussion in about three years.

R/r 911

 

[Chimpie]

This topic, again, has gotten off topic.

Thread closed.