Stepping into the future, backwards

[firetender]

Lately there has been a lot of focus here on BLS vs. Paramedic Services, Two ALS partners or One ALS and One EMT, the neverending debate (to be charitable!) about being EMT and going straight to paramedic or gaining experience and then, of course the ongoing question "Why aren't we a REAL profession?" Oops, almost forgot the very telling quarrels between those who'd stop for an accident while off-duty and those who wouldn't.

So here's a simple thought for you. When there was no paramedic program and when First Aid started to be made available to the public, a Brand NEW! idea was brewing and it went something like this:

We are amongst the most advanced of all the civilizations that have been on the earth. Now, our level of sophistication is growing such that we can soon be in the position to offer every one of our citizens professional intervention in the event of a medical ot traumatic emergency. Expert emergency medical care for the sick and injured can be a Universal thing, let's do it!

The notion that began growing was the idea that we could get more trained professionals out there to intercede in emergencies. Our populace DESERVES the BEST when it comes down to Emergency Intervention. That was the guiding light that got you here.

THAT is the "profession" that I thought I was getting in to; one where, as our technology and medical knowledge grew, it would be Standard Operating Procedure that those committing their working life to the cause would be able to grow with the profession and be able to make those advances available to the populace.

So much for adolescent dreams!

That would mean making sure that even if the heavy duty tools and protocols weren't used much, the medics that showed up to your house knew how to use them and could if they needed to. The idea was to plug as many holes in a leaky patient as quickly and efficiently as posssible.

What I hear now is:

We're learning so many of our advanced procedures don't do all that much good for long-term recovery, so, really, how much do you need ALS? Why bother having two paramedics on board when the evidence shows that for most of our patients, Load and Go will suffice? Hell, most of our calls are about IFT, what kind of training do we REALLY need? Take the risk of getting infected with something off-duty? What are you, nuts?!

It almost seems like we're seeking reasons to minimize our impact on our populace, as if we're just waiting for the final straw to lay on the camel's back that says:

Really, if you do a cost-benefit analysis, the paramedic program doesn't pay! Let's get by with the minimum service we can get away with.

What happened and what can YOU do to change this?

(I will probably expand on this thought on my Blog.)

 

[DrParasite]

Lets look at this another way.....

what would we need to get this done? first off, lets get the FD and every other non EMS agency out of EMS; you want to do EMS, join or work for an EMS agency.

second, lets get rid of the privates in the 911 system. every EMS agency should be paid 24/7, funded 100% by taxes. They can be government employees too, that way people have pensions so they can retire after 25 years.

third, all emergency calls go to the 911 service. routing calls can go via IFTs, but if the patient is sick, they go via 911. similarly, all emergent calls that are given to IFT companies are referred to 911 agency.

forth, all paramedics must have associate degrees, from an accredited college. all supervisors must have bachelors. all coordinators must have masters. all agencies must provide tuition reimbursement, as incentive for their staff to gain advanced degrees. raising education levels, and you give people a career path.

fifth, EMT class is 200 hours, 50 of which are clinical time on a 911 truck where students are evaluated and must pass. prerequisites for EMT class are a HS diploma, 6 credits of college level A&P, 3 credits of english, math, and psychology. The course isn't increased too much, but the prereqs are increased, raising the entry standards.

sixth, fix the EMT program. and I don't mean lengthen it, but if what is being taught is wrong, STOP TEACHING IT!!!! if you tell everyone is school NRB for everyone, LSB and collar for every trauma, is it really fair to say they are wrong when they do what they are taught?

seventh, no more SSM, and every EMS system has enough units to answer all calls within 10 minutes and doesn't need a first responder to "stop the clock." And when units are not on assignments, they are assigned to stations, not street corners. and they are staffed 24/7 to cover surge volumes, and during off peak, you still have extra units to handle the calls.

either, most focus on research, and more incorporating of research into existing practices. if the research says hard plastic doesn't help anyone, why are we still doing it day in and day out?

lots of stuff that could make us better, but we need more money, fewer special interest groups, and more legislative support to get it done. that and we need to raise our own internal standards.

 

[Veneficus]

Having been involved during the time of the transition, I think that while we still try to save as many as possible, at least I do, using the most sophisticated knowledge ad technology available, many things have changed.

Most importantly, we have realized there are things worse than death.

There was a time when we got a pulse back and delivered this person to the ER (not ED, as it was usually a room) if that person sat in a medically induced vegatative state until they either died of pneumonia, sepsis, or a court or family finally pulled the plug, it was a win.

Not because the person might wake up or live again, but we wanted and perhpas as humans needed to prove we could defeat death with science and our will.

We are now realizing how foolish that notion is.

Society has changed.

Many of us old folks grew up in a society of helping your neighbor and your neighbor would help you. For no other reason than you were neighbors. A community pooling together to survive and prosper.

Now the US is an "every man for himself" society. Even the very possibility of the common good is considered distasteful and an antithesis to the very values of the US.

It is one thing to risk your life and health for somebody who might watch out for you or your kid. Let you borrow a cup of sugar, or help you in a nonmedical way if you needed.

It is quite something else to take such a risk for a person who would shoot or stab you for "not doing enough" or at least threaten to sue you for all you had. If they outright didn't just to make the whole event profitable for themsleves or their lawyer.

Biology has changed.

Over time, new viruses and bacteria have evolved. Being up to your elbows in blood (literally, even surgeons were not using gloves) or putting your lips on a stranger for mouth to mouth meant you were no more likely to get something that you didn't already have.

But things are different, now you can get diseases that you cannot see or feel but will not only kill you, but degrade your very life to torture doing it.

Taking away from me.

At one point, the idea of these responding providers, was a community investment. They collectively paid a little for a service they may need. They valued that piece of mind, insurance, if you will.

The idea of everyone benefitinng was something they were willing to sacrifice for.

Now if you are sick, it is your problem, why should I have to sacrifice to help you? With no promises of a positive outcome?

Our understanding of disease has changed.
(some are slower than other to catch on)

We thought people suddenly and unpredicatably suffered from things like heart attacks.

We know now most diseases are neither sudden nor unpredictable.

With the management of chronic disease, including things we used to simply attribute to "getting old" sometimes by the time EMS is called to intervene, the person is well beyond the help of modern medicine.

We spent money we didn't have, on things that didn't help.

We mandated care, even if people could not pay, without setting up a way to make this sustainable.

It not only caused some people/groups to take impossible losses, but it drove up the costs for everyone else.

We also try to make substantial profits off of other people getting sick. It literally benefits somebody if somebody else is not well.

Finally, we lost sight of what medicine is supposed to be.

A helping hand when things go wrong.

Now we destroy ourselves with our diets and activities and think medicine is simply resetting to the beginning as opposed to help in living with whatever we did.

Like belief in the divine, we now believe in the miracle of medicine. At the very least we want to.

 

[Asclepius911]

I believe that we are still in the evolution of EMS. People are unfamiliar with the role of an emt/b/p. Even among ourselves there are many interpretation. I am not to familiar with other countries health care system, however I feel that countries such as Australia, and UK are heading in the right direction with EMS. Australian medics are not fire fighters, they are their own branch, and must go to school for it, not just a HS degree and less than a quarters worth of training. Aussies go to school to become a paramedic because they want to work in helping others as a medical practitioners, unlike the US where people want to become medics just to become a firefighter.

I strongly agree with veneficus America is loosing its unity. We have people suing for attempting to help, we have people who instead of looking for the greater good are looking for getting rich regardless of anyone around them. This is why responding to a TC while being off duty is an issue.
And we lost sight of our own awareness, we don't listen to our bodies or to others, all for indulgence of a quick reward as oppose to long life prosperity. This can go to those being ambitious in making money (those who sue/stress), those whom gorge in high carbohydrates and fats (high cholesterol/ HTN/CAD), and or those who can't control their sexual impulses without thinking (sti/uti).

What society need are educators to promote all field of health; nutritional/mental/physical/spiritual /social.

Although it's a farfetched idea, I feel that when I become a Dr I can help EMS grow as a renounce profession in the US and help strengthen other aspects of our community.

 

[MrJones]

Although it's a farfetched idea, I feel that when I become a Dr I can help EMS grow as a renounce profession in the US and help strengthen other aspects of our community.

It's not so far fetched. Dr. Frank Hubbell started as an EMT, then Paramedic then Medical school, and look what he has accomplished in the field of wilderness emergency medicine; both in developing protocols and gaining recognition for the legitimacy of the field.

 

[Veneficus]

" those who can't control their sexual impulses without thinking (sti/uti). "
I must vehemently disagree with this statement.

Despite what conservative America thinks, sexual health is as much a part of health as any other aspect.

Humans and dolphins are the only creatures on earth that have recreational sex.

High order primates actually practice sex before onset of fertility. (humans are high order primates if nobody knew)

In the most faithful and exclusive pairs, uti in females can be a regular occuance after every intercourse.

Vaginitis, the most common diagnosis of an sti can be from normal flora or fungus.

Both have pathophys based in upsetting normal vaginal ph and flora.

Condom use not only protects against the really nasty stuff, but also these common causes.

Not to mention sex stimulates the same CNS dopamine receptors as smoking, video games, shopping, and gambling with less cost and serious health effects.

Please save the puritansim. You ever notice that sexually liberated societies don't worry about buying guns for a zombie apocalypse or blow themselves up in the name of god?

what a coincidence...

 

[mycrofft]

Sexually liberated society as in Sub-saharan Africa?

=====================================================
Firetender this thread is too big for me to get my head around or start on.

Just let me say ignorance, a rescue mentality, and rewarding people for being intimidating creates hostile and confrontational patients, and that the profit motive for private EMS providers and the demonizational scapegoating of civil service by certain politicians guarantees prehospital EMS will be an urban ghetto and undervalued/supported rural asset for the foreseeable future.

 

[Asclepius911]

Allow me to clarify, by sexual impulses, I was referring to acting without thinking. Not the act of sex, however the lack of protection and knowledge/background from a partner. Controlling sexual impulses by thinking about safe sex practices in hope of preventing the transmission of Aids/HIV, along with syphilis, chlamydia... Etc, is what I was hinting at.

 

[firetender]

Don't forget...

Humans and dolphins are the only creatures on earth that have recreational sex...

our closest primate relative, the Bonobo chimp.

When stress occurs, either to an individual or to the group as a whole, it's a sexual free-for-all and the tension disappears. All the rest of the time I guess they keep just as busy in the same way to make sure the tension doesn't appear!

Something about "Make Love Not War"

 

[AngelMedic360]

LoL dude, are we relating dolphin sex with human sex?

 

[Veneficus]

LoL dude, are we relating dolphin sex with human sex?

This may come as a shock, but humans are not some magical type of organism.

We share characteristics with many different species. That's what happens when biodiversity evolves from common ancestors.

 

[Jambi]

This may come as a shock, but humans are not some magical type of organism.

We share characteristics with many different species. That's what happens when biodiversity evolves from common ancestors.

Embryology comes to mind as great example of this...

 

[Sultan of Swing]

I'm a brand new basic, so my experience could charitably be called "limited". Having said that:

I've already noticed there are techs and medics who treat EMS as a profession and those who don't. Those who do take pride in the quality of care they provide and take it upon themselves to increase their general fund of knowledge, both through independent study and formal education. They enjoy working in EMS because of the incredibly diverse experience it offers, be it simply being a bright spot in the day of a dialysis patient or managing multi-system trauma. They seem to make up about 30% of those I've met. I'd be willing to call those basics and medics "Professionals".

The other 70% are there for the paycheck, period.

I think the basic problem with EMS is funding. When services (both private and municipal) can only afford to pay their techs $9-$11 / hr, and their medics $15-$25 / hr, you're going to attract people who's employment prospects aren't at the "professional" level. When you can fairly easily transition from a job paying $15-$25 an hour (EMT-P) to a job which pays twice as much (RN) you're going to have a hard time hanging onto your best and brightest. As much as some people love working in EMS, I've already met several who are transitioning to other professions in the medical field because of the financial obligations they have to meet.

When you increase the salary you're willing to pay your EMTs, you can also increase the education you require of your EMTs. There are way, way more MDs than EMS providers. Why? Because the vastly more grueling, time consuming, and expensive education required to be an MD is offset by the financial reward of completing that education. I'm not saying that EMS providers should be educated or compensated at the same level as doctors, but there has to be a happy middle ground. How can it be that it requires a masters degree to be a Nurse Practitioner and diagnose & treat upper respiratory infections & sinus infections, but it requires less than an associates degree to, at least initially, "diagnose" & treat an MI / full arrest / tension pneumo / hemo thorax? How can you pay the person who, under the watchful eye of a pharmacist, counts Rx tablets / capsules the same as you pay the person who, with no direct on site supervision, is going to come to your home and attempt to resuscitate your spouse / child?

The low pay of EMS providers also means that, at least in my area, there is a fairly severe shortage of EMT-Bs working on a truck, let alone EMT-Ps. Having cruised a number of EMS forums / Blogs / Podcasts in the last few months, I know that in some areas newly minted Basics have a hard time finding employment. That is not true here. The major municipal 911 service has a hard time recruiting Basics. They're currently hiring EMT-Bs with still-wet ink on their EMT-B cards. The major private service (who does more than a bit of 911 response themselves) is in even worse shape. This means they're willing to hire more or less anyone with current EMT numbers. Which, given the relative ease and availability of education, at least at the Basic level, means that you're going to get plenty of people who's other prospects for employment include flipping burgers and operating cash registers. Or, in the case of EMT-Ps, supervising those who flip burgers and operate cash registers.

firetender's question was "what can YOU do to change this?". My answer is "very little". I am not capable of changing the way in which EMS is funded. I am not capable of changing the way in which EMTs are educated. What I can do is provide the best patient care I'm capable of, and work to increase that capability by furthering my own education, both formally and otherwise.

I can strive to ensure that, at least on my truck, you're treated by a professional.

Oh, and on the subject of dolphin sex: That's just hot.

 

[Veneficus]

I'm a brand new basic, so my experience could charitably be called "limited". Having said that:

I've already noticed there are techs and medics who treat EMS as a profession and those who don't. Those who do take pride in the quality of care they provide and take it upon themselves to increase their general fund of knowledge, both through independent study and formal education. They enjoy working in EMS because of the incredibly diverse experience it offers, be it simply being a bright spot in the day of a dialysis patient or managing multi-system trauma. They seem to make up about 30% of those I've met. I'd be willing to call those basics and medics "Professionals".

The other 70% are there for the paycheck, period.

I think the basic problem with EMS is funding. When services (both private and municipal) can only afford to pay their techs $9-$11 / hr, and their medics $15-$25 / hr, you're going to attract people who's employment prospects aren't at the "professional" level. When you can fairly easily transition from a job paying $15-$25 an hour (EMT-P) to a job which pays twice as much (RN) you're going to have a hard time hanging onto your best and brightest. As much as some people love working in EMS, I've already met several who are transitioning to other professions in the medical field because of the financial obligations they have to meet.

When you increase the salary you're willing to pay your EMTs, you can also increase the education you require of your EMTs. There are way, way more MDs than EMS providers. Why? Because the vastly more grueling, time consuming, and expensive education required to be an MD is offset by the financial reward of completing that education. I'm not saying that EMS providers should be educated or compensated at the same level as doctors, but there has to be a happy middle ground. How can it be that it requires a masters degree to be a Nurse Practitioner and diagnose & treat upper respiratory infections & sinus infections, but it requires less than an associates degree to, at least initially, "diagnose" & treat an MI / full arrest / tension pneumo / hemo thorax? How can you pay the person who, under the watchful eye of a pharmacist, counts Rx tablets / capsules the same as you pay the person who, with no direct on site supervision, is going to come to your home and attempt to resuscitate your spouse / child?

The low pay of EMS providers also means that, at least in my area, there is a fairly severe shortage of EMT-Bs working on a truck, let alone EMT-Ps. Having cruised a number of EMS forums / Blogs / Podcasts in the last few months, I know that in some areas newly minted Basics have a hard time finding employment. That is not true here. The major municipal 911 service has a hard time recruiting Basics. They're currently hiring EMT-Bs with still-wet ink on their EMT-B cards. The major private service (who does more than a bit of 911 response themselves) is in even worse shape. This means they're willing to hire more or less anyone with current EMT numbers. Which, given the relative ease and availability of education, at least at the Basic level, means that you're going to get plenty of people who's other prospects for employment include flipping burgers and operating cash registers. Or, in the case of EMT-Ps, supervising those who flip burgers and operate cash registers.

firetender's question was "what can YOU do to change this?". My answer is "very little". I am not capable of changing the way in which EMS is funded. I am not capable of changing the way in which EMTs are educated. What I can do is provide the best patient care I'm capable of, and work to increase that capability by furthering my own education, both formally and otherwise.

I can strive to ensure that, at least on my truck, you're treated by a professional.

Oh, and on the subject of dolphin sex: That's just hot.

And already you have mastered EMS...

Time to go for a higher level of healthcare provider.

 

[DrParasite]

The low pay of EMS providers also means that, at least in my area, there is a fairly severe shortage of EMT-Bs working on a truck, let alone EMT-Ps. Having cruised a number of EMS forums / Blogs / Podcasts in the last few months, I know that in some areas newly minted Basics have a hard time finding employment. That is not true here. The major municipal 911 service has a hard time recruiting Basics. They're currently hiring EMT-Bs with still-wet ink on their EMT-B cards. The major private service (who does more than a bit of 911 response themselves) is in even worse shape. This means they're willing to hire more or less anyone with current EMT numbers. Which, given the relative ease and availability of education, at least at the Basic level, means that you're going to get plenty of people who's other prospects for employment include flipping burgers and operating cash registers. Or, in the case of EMT-Ps, supervising those who flip burgers and operate cash registers.

wait.... low pay of EMS workers means there is a severe shortage? I think you have that backwards; usually when you have a shortage of the supply, the demand (and the pay) increase. Similarly, if I have 20 people who are all applying for a job that pays $9 per hour, then why do I need to raise wages? after all, I have 20 people willing to work for $9 an hour, and I am only looking to hire one of them.

Out of curiosity, where is this area you are in that is hiring EMTs with the ink still wet on their cards? most people are looking and never finding anything.

 

[Sultan of Swing]

wait.... low pay of EMS workers means there is a severe shortage? I think you have that backwards; usually when you have a shortage of the supply, the demand (and the pay) increase. Similarly, if I have 20 people who are all applying for a job that pays $9 per hour, then why do I need to raise wages? after all, I have 20 people willing to work for $9 an hour, and I am only looking to hire one of them.

Out of curiosity, where is this area you are in that is hiring EMTs with the ink still wet on their cards? most people are looking and never finding anything.

In simple free market terms, you're right. When demand outstrips supply prices, or in this case, wages, should increase until things are in equilibrium. But EMS does not exist in a vacuum. Medicaid/medicare/insurance reimbursement rates, coupled with the fact that EMS is a service made available to those who can't afford to pay for it (un/under employed and uninsured patients) make true EMERGENCY medical service a money looser, requiring a public subsidy to make it profitable, in the case of private services, or simply sustainable in the case of municipal services. Unfortunately many municipal and state governments are experiencing a severe income problem, given the havoc current economic issues have wreaked on their tax base. They can't AFFORD to pay more. This is a common problem in the world of municipal & state services such Fire, EMS, Police, & Public Education.

And I'm in Louisville KY. Louisville Metro EMS is currently hiring brand-new basics, as are the two largest privates in the area which, while primarily IFT services, do end up running a fair percentage of the 911 calls. One contributing factor to the EMT-B shortage around here is the fact that all three of the aforementioned services run tiered-response, so most of their trucks are staffed by two basics, and their ALS trucks are staffed by a basic and a medic. It seems to work pretty well, but that's a different discussion in a different thread . Another problem is that, while Louisville Metro government is having some budget issues, our local economy was in relative terms fairly unaffected by the current economic woes, as Ford, UPS, Yum! Brands (KFC/Taco Bell/Pizza Hut), Papa Johns, Anthem, and Humana, the major employers in the city, are doing OK. People don't have a hard time finding a job. It may not be exactly the job you want, but you can always find a gig. But, again, the unique way in which EMS is funded means that services are unable to bring their wages up past the point where, at least in terms of EMT-Basics, one can make the same money working as a Starbucks "barista", server at Applebees, or package sorter at UPS. Moving into EMS is actually a pay cut for me, at least in terms of base 40hr/week pay, and my previous job was in no way "professional" grade. Gotta love overtime.

 

[Tigger]

I'm a brand new basic, so my experience could charitably be called "limited". Having said that:

I've already noticed there are techs and medics who treat EMS as a profession and those who don't. Those who do take pride in the quality of care they provide and take it upon themselves to increase their general fund of knowledge, both through independent study and formal education. They enjoy working in EMS because of the incredibly diverse experience it offers, be it simply being a bright spot in the day of a dialysis patient or managing multi-system trauma. They seem to make up about 30% of those I've met. I'd be willing to call those basics and medics "Professionals".

The other 70% are there for the paycheck, period.

I am here for the paycheck first and foremost. However, I also happen to greatly enjoy my job for the reasons you have described. Being a professional and putting compensation first are not mutually exclusive, you just have to think a bit harder while working, which is admittedly too much to ask for many.