Very interesting replies.
Okay, here is my ideas.
1. Are people entering for the right reasons?
As pointed out they maybe entering programs, but are they entering to be an EMT? Yes, most Fire Services require such to even be considered an applicant. This was to eliminate and decrease the number of applicants. This itself has harmed the profession of EMS. Over abundance of EMT's has made the demand and supply non-realistic. The problem again, many of those have no desire to be an EMT. Some will take a job until a F/F position opens. As well with the abundance of EMT's this has watered down the possibility of salaries for those really wanting to be a professional EMT.
Should every firefighter be an EMT prior to entering a Fire Service? Why? Should it even be a requirement to be an EMT as a Firefighter? Seriously. Sure they should have first aid or MFR training being a firefighter, but does every truckie needs to be a medic? How much training is really kept up after receiving their accreditation? How often does each Firefighter put on a hare traction, KED, perform a thorough assessment before professional or more advance care arrives.
Would it not be more feasible and more prudent to teach a thorough MFR course within the Fire Academy? A percentage or at least one designated EMT on a truck or medics on a squad. Is requiring all firefighters to be an EMT an overkill? What was the main purpose of doing so? By doing this, has the objective been met?
I much rather have a well trained MFR with limited knowledge, than a so called EMT that has not kept up and presumes that they know it because they passed an EMT test, or will not participate in care at all.
2. Should there be a screening process to help eliminate those that expectations are not that of the career?
Do we allow everyone to enter medical school? Dental hygienist programs or even become a firefighter? Why should we allow everyone to enter EMS programs?
According to the NREMT less than 50% that enter EMT programs finish them. Worse many of those that do finish EMT programs never take the certification test to become EMT's and less than 50% of those that do pass their certification never enter the health field.
So apparently those that entered programs never really understood what an EMT or what EMS is, or never really planned to be an EMT. The expectation of the student was not what the course or occupation is in comparison.
We want our profession to be a profession? We want better salaries, more demand, to be respected? Then we will have to earn it.
Only the best and the select should be allowed to enter. Give validity and credibility to this profession.This means one will have to be able to read and write. (this job really does require it, if you do it the right way). Have basic mathematical and above average science knowledge. Go through a psychological test to detect if one is mentally healthy as much as physically healthy. The job demands as much mental stress as it does physical.
Place requirements alike other real professions do. Reference letters, display of intent and demonstration of interest. Demonstration of an understanding what the job and focus of what an EMT does and a full understanding the course is NOT and does NOT teach one to be a firefighter, nurse, physician, helicopter pilot, etc. This course is designed and solely to teach one to be an entry level into EMS to provide prehospital care in an ambulance. Nothing else. What one does with it, is up to them, but this is what they are going to be taught and it should NOT be considered a "stepping stone". If you want to go to that profession do so, don't waste time being an EMT. There are plenty of other temp jobs out there.
3. Should we allow anyone to enter?
Again, NO! EMS is not for everybody! Nor should it be. We have attempted to say it is by allowing volunteers, and opening the doors for every Tom , **** and Harry. See the results?
You can define success by evaluating if it is working or not. Obviously, it is not. Time for a change.
Life is not pretty. Not all us get to be what they want to be. Not all can be firefighters, astronauts, doctors or police officers. Not everyone can be in EMS. There are factors that may prevent individuals from being the "best" in that profession. This does not make them bad.. but, not the best suited for that profession.
We attempted to be so politically correct, it has now caused change within the medical profession. Even to the point, changing the outcomes of patient care.
Compare ACLS to that of even twenty years ago. Doubtful, that ten percent of Paramedics today could pass such examination of what knowledge was required. Oxyhemoglobin curve, acid base balance, nosocomial infections, cardiac assessments. True emergency and cardiac care. Again, it was presented and known that one had to have such knowledge to provide adequate care. Not everyone was going to be able to or even should. Where and when, did we decide it was okay to be mediocre?
4. Was emphasis placed during the educational process, that majority of our job is NOT technical, rather humanistic?
I recently started teaching a Basic EMT course. I have to admit, this is the first one in sometime. I usually teach advanced or critical care courses.
What I started out describing is that our main job is not just providing care. Really, that is NOT what most call 911 for. People call 911; because they do not know what to do!
If most citizens knew what to do during an emergency crisis, there would be very few responses made. We are there to take over their life during this crisis mode, to ensure them we have it under control and for them not to worry about it.
This maybe medical, psychological or what ever the case maybe.
EMS author Karen Hauffman, wrote many years ago she did not believe there was as much "burn out" as the expectation of the EMT was unrealistic and not that of what the job was really about. Many assume that they know what being an EMT is, and assume that what they learned in class is what they will be doing. In truth, it is very rare to see a sucking chest wound, delivering a child, placing a hare traction on.... in reality and per percentages of dealing with grandma with a terminal disease, transporting dialysis patients, hearing and seeing personal matters of poor financial problems, lack of money for medications causing exacerbation, or abuse of medicines in general poor personal health care. Yet, our curriculum does not even address what our true job is or sees on a daily basis.
How many would had continue if they were told it would be very doubtful that they would ever perform a 10th of the procedures they learned? Yet, in case they did see such occurrences they would have to be above proficient and perform it flawlessly.
I have emphasized that this is a CARING business. Providing physical care is just one of part of caring. One has to be able to deliver both.
5. Are we producing EMT"s and Paramedics with unrealistic expectations?
As I described; yes. Most exit the programs without a clue of what the real job is. That is why forums have became popular.
Unfortunately, many want to argue and vent of what they want in lieu of listening to what it the profession truly is. Again, attempting to make the job or situation to fit them instead of them fitting the profession. This has even slid over to medical care. I now see medics treating based solely based upon protocols. Making the patients fit their protocols instead of treating upon what the patient solely presents. Example, IV lifeline. Will this patient need fluid or medication enroute? If not, why the IV? This usually comes from shake & bake training, thus cook book protocols are developed to "CYA" as much as possible.
Would it not be better to really inform students of what the "real" job is and develop a curriculum based to teach from that? That in-depth A & P, psychology, even social services is as much of our job than treating a tension pnuemothorax. The likelihood of seeing a diabetic being non-compliant of diet and med's is higher than seeing an eviscerated bowel.
This does not mean, we should have to lessen our teaching of emergency care. That emergency care has to be taught well and in-depth. Also critical care should be taught to Paramedic level students, recognizing the distinction that it is NOT the same as emergency medicine.
We have to abolish the BLS vs. ALS distinction mentality. There is NO such thing in the world of medicine. Either you can perform the procedure or you cannot. Not wrong, just the way it is.
It is unfortunate that most in EMS want someone else to do things for them. One of the reason we have so many multiple levels. We are always full of excuses instead of taking actions. The same reasons there is 5,000 EMT's for one position and the pay is sometimes below minimum wage.
Who's fault is it, really? ....
R/r 911
