RocketMedic
Californian, Lost in Texas
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*repost of a conversation on Paramedics on Facebook that I started.*
I know that this is going to be controversial, but here goes: I think that the volunteer services in EMS need to be phased out across the nation.
Why, that's heresy! It's tradition! Volunteers are the backbone of America and have served admirably for decades, but we are rapidly approaching a point in funding our industry that will require us to justify our necessity and our position within the health care continuum. As a profession, we have been quite successful at popularizing emergency medicine with the population (to the point where Americans expect an ambulance post-haste if they call 911), but we have been far less successful with delivering a comprehensive, standardized or even really effective service across the nation. Volunteers are, quite simply, not 'reliable' from a systemic viewpoint (this is not a criticism of individuals, but of systems as a whole). They are generally not as trained as well as full-time personnel, they are less likely to be familiar with modern advancements in medicine, and the vast majority of volunteer services operate at a BLS or ILS level.
We have extremely low educational standards for entry into this field at all levels, and I would be a fool to argue that paramedic school is some sort of crucible or defining experience. However, every call to increase educational standards, to provide more services to the public, and even to add additional skills to our prehospital arsenal is lamed by the fact that a majority of our members are professional hobbyists. When people cite the length and expense of paramedic school as a reason for their department to remain a BLS service or use 'tradition' and 'field experience' to justify archaic, harmful practices and operations policies, we lose credibility as a profession. How can an EMT in Anytown reasonably ask their medical director for permission to start an IV or use medication when their peers advocate publicly for more skills with little or no formal training? I am not claiming that full-time staff are immune from this, but volunteers are notorious for a very real lack of education and possible care. Would you accept 'volunteer doctors' at your hospitals who 'may' show up? What about volunteer policemen or volunteer garbage collectors?
Let's also look at the differences in service. In my region, the cities are covered by aggressive, all-ALS agencies with relatively aggressive, 'standard' protocols. Our agencies are constantly adding and refining treatments and therapies, adjusting and testing theories and generally provide good care to most of our patients. It is not an exaggeration to say that you will probably be treated appropriately for a life-theatening event by a professional EMS crew arriving in a timely manner and will be transported to an appropriate facility. Several towns, however, have BLS volunteers alone. BLS may be appropriate for many patients and boast similar mortality statistics, but at what point are we viewing relief of pain and suffering as essential? This ignores the spread of technologies like BiPap and the development of new treatment regimes- how many people still backboard everyone? It is not an exaggeration to say that the difference between receiving pain management, definitive treatment of symptoms and a fairly accurate working diagnosis with appropriate triage and transport in a timely fashion from a professional paramedic and receiving a Stare of Life and an uncomfortable, highly-oxygenated ride to the 'designated' ER is location alone.
I understand that many of the members of this board will protest that their communities cannot 'afford' paid personnel. To them, I call shenanigans. Your communities employ police officers, garbage collectors and city personnel. There is no good reason that a person (who realistically expects police intervention if needed) should not receive paid EMS service if requested. Unless your community's garbage is managed by volunteers, you can afford paid EMS. If needed, fire departments can remain volunteer (low-use/high-acuity assets, at least for suppression), and/or fire departments can continue to cover EMS in their communities- but do it with professionals, for wages. I would encourage our new members that come here every day to not volunteer. Your time is worth something, even as an EMT, and you can find a job that pays. Volunteers, by definition, make the time of professionals less valuable. If you take your profession seriously, practice it for pay.
Yes, I am aware this is controversial and will result in a fair number of undereducated people shouting that I am wrong. I would encourage every reader to think about why we have responsibilites far in excess of compensation, problems gaining trust and respect from our peers in health care, and training that can be completed by eighth-graders while you read through the broken English and sentence fragments of those who disagree. Just remember, the volunteer EMT who complains that he can't start an IV on 'there' arm and spouts platitudes like 'treat the patient' and 'BLS before ALS' as answers to questions might be the reason that we make less than that trash collector.
I do not think it arrogant to point out that we as a profession must adapt. The days of showing up, looking cool and driving around really fast are ending, and we are trying to carve ourselves a defined, permanent and professional role. Are we really arrogant enough to think that medicine will remain static and that we will be continued to perform as we have in the face of a graying population, increasing calls for education and changes in funding?
For those who do not see a problem with volunteering, from an economic standpoint, what would you say if someone volunteered at your full-time job? What if your employer could simply page in a free and equally "qualified" substitute whenever they felt there wasn't money in the budget for pay?
Money is available. It may not be in volunteer departments or county budgets, but it is available. I personally think we will see an increase in the number of hospital-based EMS agencies and increases in federal and state support for health care as more Boomers start needing EMS. Rural medicine and impoverished areas will be a problemish until the residents of those areas decide to do something about it. Some contract a private company, others simply take risks and go with mutual aid, others take volunteers. I am simply proposing a minimum government (likely Federal) floor on EMS levels of care. If the vollies in Anytown can meet the standard, carry on. If not, then it's time to let professionals who can take over. The sticking point comes from the fact that this "standard" would be unattainable without actual training. Personally, I'd set minimum criteria at AEMT.
Doctors volunteer for personal reasons, but hospitals don't count on volunteer doctors to operate. Lawyers volunteer for personal reasons, but courts do not rely on volunteer lawyers to operate. Police reservists may volunteer for personal reasons, but they do so as a supplement to paid personnel and are not the primary law enforcers.
If volunteering is so great, justify it. Make doctors, lawyers, pilots, and whatever everyone else does for a living volunteer too. Convince me that it's worth keeping our medical practices in sixth grade and our thirty calls a year people on the same professional level as everyone else. Convince me that EMS is somehow an exception to the rule of "more standardized education = more pay and respect". More importantly, convince yourselves and our doctors and our taxpayers.
Look at the military. We have well-developed active-duty branches and a "trained" reserve component. The active component sets a minimum standard of competence, outliers notwithstanding. Reserve components, when activated for actual military missions, go into months of retraining to simply do the same jobs that they were already trained on when initially accepted into the Armed Forces and are paid as active-duty members are, to the point where they are effectively active-duty. If volunteering were able to maintain proficiency and progression of tactical and technical training, wouldn't their volunteer drill time alone be enough to let them do everything an active-duty unit does? The experts at warfighting have decided that that is not the case, and thus spend billions to train and retrain reservists before they deploy.
Would they do this if volunteers were ready to go to war?
Why is EMS (or fire suppression) different?
I know that this is going to be controversial, but here goes: I think that the volunteer services in EMS need to be phased out across the nation.
Why, that's heresy! It's tradition! Volunteers are the backbone of America and have served admirably for decades, but we are rapidly approaching a point in funding our industry that will require us to justify our necessity and our position within the health care continuum. As a profession, we have been quite successful at popularizing emergency medicine with the population (to the point where Americans expect an ambulance post-haste if they call 911), but we have been far less successful with delivering a comprehensive, standardized or even really effective service across the nation. Volunteers are, quite simply, not 'reliable' from a systemic viewpoint (this is not a criticism of individuals, but of systems as a whole). They are generally not as trained as well as full-time personnel, they are less likely to be familiar with modern advancements in medicine, and the vast majority of volunteer services operate at a BLS or ILS level.
We have extremely low educational standards for entry into this field at all levels, and I would be a fool to argue that paramedic school is some sort of crucible or defining experience. However, every call to increase educational standards, to provide more services to the public, and even to add additional skills to our prehospital arsenal is lamed by the fact that a majority of our members are professional hobbyists. When people cite the length and expense of paramedic school as a reason for their department to remain a BLS service or use 'tradition' and 'field experience' to justify archaic, harmful practices and operations policies, we lose credibility as a profession. How can an EMT in Anytown reasonably ask their medical director for permission to start an IV or use medication when their peers advocate publicly for more skills with little or no formal training? I am not claiming that full-time staff are immune from this, but volunteers are notorious for a very real lack of education and possible care. Would you accept 'volunteer doctors' at your hospitals who 'may' show up? What about volunteer policemen or volunteer garbage collectors?
Let's also look at the differences in service. In my region, the cities are covered by aggressive, all-ALS agencies with relatively aggressive, 'standard' protocols. Our agencies are constantly adding and refining treatments and therapies, adjusting and testing theories and generally provide good care to most of our patients. It is not an exaggeration to say that you will probably be treated appropriately for a life-theatening event by a professional EMS crew arriving in a timely manner and will be transported to an appropriate facility. Several towns, however, have BLS volunteers alone. BLS may be appropriate for many patients and boast similar mortality statistics, but at what point are we viewing relief of pain and suffering as essential? This ignores the spread of technologies like BiPap and the development of new treatment regimes- how many people still backboard everyone? It is not an exaggeration to say that the difference between receiving pain management, definitive treatment of symptoms and a fairly accurate working diagnosis with appropriate triage and transport in a timely fashion from a professional paramedic and receiving a Stare of Life and an uncomfortable, highly-oxygenated ride to the 'designated' ER is location alone.
I understand that many of the members of this board will protest that their communities cannot 'afford' paid personnel. To them, I call shenanigans. Your communities employ police officers, garbage collectors and city personnel. There is no good reason that a person (who realistically expects police intervention if needed) should not receive paid EMS service if requested. Unless your community's garbage is managed by volunteers, you can afford paid EMS. If needed, fire departments can remain volunteer (low-use/high-acuity assets, at least for suppression), and/or fire departments can continue to cover EMS in their communities- but do it with professionals, for wages. I would encourage our new members that come here every day to not volunteer. Your time is worth something, even as an EMT, and you can find a job that pays. Volunteers, by definition, make the time of professionals less valuable. If you take your profession seriously, practice it for pay.
Yes, I am aware this is controversial and will result in a fair number of undereducated people shouting that I am wrong. I would encourage every reader to think about why we have responsibilites far in excess of compensation, problems gaining trust and respect from our peers in health care, and training that can be completed by eighth-graders while you read through the broken English and sentence fragments of those who disagree. Just remember, the volunteer EMT who complains that he can't start an IV on 'there' arm and spouts platitudes like 'treat the patient' and 'BLS before ALS' as answers to questions might be the reason that we make less than that trash collector.
I do not think it arrogant to point out that we as a profession must adapt. The days of showing up, looking cool and driving around really fast are ending, and we are trying to carve ourselves a defined, permanent and professional role. Are we really arrogant enough to think that medicine will remain static and that we will be continued to perform as we have in the face of a graying population, increasing calls for education and changes in funding?
For those who do not see a problem with volunteering, from an economic standpoint, what would you say if someone volunteered at your full-time job? What if your employer could simply page in a free and equally "qualified" substitute whenever they felt there wasn't money in the budget for pay?
Money is available. It may not be in volunteer departments or county budgets, but it is available. I personally think we will see an increase in the number of hospital-based EMS agencies and increases in federal and state support for health care as more Boomers start needing EMS. Rural medicine and impoverished areas will be a problemish until the residents of those areas decide to do something about it. Some contract a private company, others simply take risks and go with mutual aid, others take volunteers. I am simply proposing a minimum government (likely Federal) floor on EMS levels of care. If the vollies in Anytown can meet the standard, carry on. If not, then it's time to let professionals who can take over. The sticking point comes from the fact that this "standard" would be unattainable without actual training. Personally, I'd set minimum criteria at AEMT.
Doctors volunteer for personal reasons, but hospitals don't count on volunteer doctors to operate. Lawyers volunteer for personal reasons, but courts do not rely on volunteer lawyers to operate. Police reservists may volunteer for personal reasons, but they do so as a supplement to paid personnel and are not the primary law enforcers.
If volunteering is so great, justify it. Make doctors, lawyers, pilots, and whatever everyone else does for a living volunteer too. Convince me that it's worth keeping our medical practices in sixth grade and our thirty calls a year people on the same professional level as everyone else. Convince me that EMS is somehow an exception to the rule of "more standardized education = more pay and respect". More importantly, convince yourselves and our doctors and our taxpayers.
Look at the military. We have well-developed active-duty branches and a "trained" reserve component. The active component sets a minimum standard of competence, outliers notwithstanding. Reserve components, when activated for actual military missions, go into months of retraining to simply do the same jobs that they were already trained on when initially accepted into the Armed Forces and are paid as active-duty members are, to the point where they are effectively active-duty. If volunteering were able to maintain proficiency and progression of tactical and technical training, wouldn't their volunteer drill time alone be enough to let them do everything an active-duty unit does? The experts at warfighting have decided that that is not the case, and thus spend billions to train and retrain reservists before they deploy.
Would they do this if volunteers were ready to go to war?
Why is EMS (or fire suppression) different?
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