Why are Paramedics paid so little?

[VentMonkey]

I think there is nothing wrong with a Basic applying a 12-lead then transmitting the telemetry to the ED and allow the on call DR to look it over while we're en-route. As a basic rig, we don't need to interpret considering there is little we can do in the field aside from O2, ASA, assist with nitro, rapid transport, making interpretation less important. And, most of our medication interventions require online med control approval.

Here's a perfect example why, as of now, you (EMT's in general) have no business carrying cardiac monitors. If anything it makes interpretation that much more crucial with a time-sensitivite injury/ infarct, yikes.

This post is one big contradiction, IMO.

 

[NysEms2117]

I mean, in an ALS-heavy system like mine, that's basically what I am - I run the BLS side of things (vitals and set up for medic procedures) while they get venous access or get a more detailed history/exam going, then I drive. No reason to not make EMTs --> "EMR" in name.

I get that, i'm a Basic on a CCT rig, so my job is to literally try and read my medics mind, and get what he will need + call in whatever he needs/sees ect. I'm also not a fan of EMR's, because they technically can work on an ambulance, but have no place being there a rename to driver only, or paramedic assistant is necessary IMO. I feel that a paramedic should be having most of the patient contact, just as a PCP has most of the patient contact when you see them. I(as well as most people, I would assume) want the highest trained person available providing care to me, or my loved one.
To me i don't understand why people would want to be given the tools to do something, but not why. Personally if i was a CC-EMT, i'd be petrified to intubate, sure they taught me how, but i dont want to end up being a "well i'll figure it out as i go" kinda thing. I also learn better knowing why i'm doing something, but hey i'm a weird person i guess?

I also think a thing we would need to watch out for and this is more of @EpiEMS field then mine, but if we do all of these educational requirements, how are the patients going to pay, if they can't already? Sure we bump up paramedics salary and EMT(paramedic assistant i think you called it), but if the patients can't pay, it does nobody any good.

 

[Giant81]

so is there no value at all in allowing a provider to apply, acquire, and transmit a 12-lead to the ED ahead of their arrival? Especially when considering a 20min transport time in a rural area, and the additional lead time needed to call in the needed personnel for the Cath-lab if required.

I'm certainly not trying to start a fight or anything, I'm just trying to figure out how providing the ED with more information about the PT's before arrival is a bad thing. Unless the Basic acquired 12-lead is looked at as inaccurate.

 

[EpiEMS]

how are the patients going to pay, if they can't already?

Well, in some sense, we've answered that question forever - they won't/don't.
The reimbursement model for EMS is such a mess - and dependent on cross-subsidization from those who can pay.

We all need to be very aware of the following:
- Not everybody needs the highest level of care.
- Providing the highest level of care to everybody is expensive, and not everybody needs it (or can afford it).

@Giant81, on the subject of BLS 12-lead acquisition...sure, it's fine and dandy to transmit, but the inability to interpret could lead to gross overtriage (or, perhaps worse for your patients, undertriage).

 

[VentMonkey]

Unless the Basic acquired 12-lead is looked at as inaccurate.

This right here. So again, even many paramedics interpretation of properly and accurately identifying NSTEMI's, for example (think NOS LBBB in the face of several co-morbid factors absent "classic" ACS/ AMI s/s) are faultered.

Even at the ALS-level in an urban/ suburban environment with fairly short transport times to PCI capable hospitals you have folks down playing the severity of the NSTEMI who oftentimes may have sat on it just as long as the "classic tombstone" STEMI with crushing chest pain, but because it isn't slapping Mongo the Medic directly in the face, the patient can be under triaged only to find out their cardiac markers are just as, if not more so, through the roof than the acute MI.

Again, this all falls back on better education at every level in order to take the seriousness of the more vague complaints with a bit more than a grain of salt. I just don't realistically see an future EMT curriculum being afforded that kind of luxury.

Now, if they did, I would argue that they need a full understanding of basic A&P as well as in depth cardiology module review that mimics some of the better paramedic programs, or surpasses them entirely, which would also call for the same if not more with future paramedic education.

Again, it all circles back to more education. Along those same lines, and while many provider in the streets may not care, what is the cost-burden for an over-triaged falsely identified STEMI alert patient?

This too effects even prehospital providers, but again without an all encompassing approach to EMS there's no room for this when we as a whole continue to call for more "tools in the toolbox" sans proper understanding and education, let alone actual EBM, which collectively, EMS sucks at.

 

[MikeC]

https://www.ems.gov/pdf/education/N...l-Guidelines/EMR_Instructional_Guidelines.pdf

Interesting read. Definitely the EMR looks to be sufficient for the role of Ambulance Driver/Patient Transport tech to help with transfers.

 

[EpiEMS]

what is the cost-burden for an over-triaged falsely identified STEMI alert patient?

It's yuuuge. We're talking in the 5-figures, and that's even before we talk about societal burdens (like lost productivity).

https://www.ems.gov/pdf/education/N...l-Guidelines/EMR_Instructional_Guidelines.pdf

Interesting read. Definitely the EMR looks to be sufficient for the role of Ambulance Driver/Patient Transport tech to help with transfers.

As is a taxi, generally speaking.

 

[MikeC]

That's what EMTs (more or less) do, we show up, treat immediate life threats (which is a rare thing to have to deal with), and (almost always) transport...sounds more or less like patient transfer/IFT to me.

There is a list of things that the EMT-B is trained on currently in addition to transporting and identifying/ treating life threats to ABCs.

EMT-B teaches how to assess diabetic emergencies, which are extremely common it seems, and provide appropriate treatment for hypoglycemia . Local protocols look to implement the use of Glucometers for BLS crews. So in the event of a hypoglycemic diabetic emergency, the EMT-B can assess the various s/s, history taking, obtain a glucometer reading, and administer oral glucose / food or drink allowed via local protocols. If the pt is conscious with a gag reflex, no ALS would be required unless there was no response within 15 minutes of administering treatment. If unconscious, ALS could be dispatched to provide D-50/ Glucagon.

The NREMT-B is trained on assessing for potential stroke via the Cincinnati stroke scale and GCS. In the event of a wnl glucometer reading, the crew would suspect potential stroke and load and go to the most appropriate trauma center to receive treatment via thrombolytics. Medical command could be contacted for any further instructions or advise.

I think many services could greatly expand the role of the EMT-B, especially the NREMT trained in my opinion.

Also when I stated "transfers", I was referring to the various transfers from nursing home to hospital, hospital to hospital, etc

 

[EpiEMS]

I think many services could greatly expand the role of the EMT-B, especially the NREMT trained in my opinion.

Sure, and they do. But that doesn't really add very much value to the discussion.

 

[VentMonkey]

It's yuuuge. We're talking in the 5-figures, and that's even before we talk about societal burdens (like lost productivity).

Sorry, again, my vague attempt at rhetoric fails.

 

[Eden]

In Israel, we face quite the same difficulties. We are in the process of turning the profession to acdamia-based. Currently 66℅ of the paramedics working in the field have a degree (b.ems or other relevant degree).
But the problem still exists, the job is hard and medics are overworked. The last research showed that 50℅ of the medics leave the field after 5years.
So yea you guys are not alone lol.

 

[Eden]

In Israel, we face quite the same difficulties. We are in the process of turning the profession to acdamia-based. Currently 66℅ of the paramedics working in the field have a degree (b.ems or other relevant degree).
But the problem still exists, the job is hard and medics are overworked. The last research showed that 50℅ of the medics leave the field after 5years.
So yea you guys are not alone lol.

And now academic paramedics with 5 years of experience can go on and become PA's. So tons of good medics leave.

 

[EpiEMS]

Sorry, again, my vague attempt at rhetoric fails.

No, no - I understood your rhetorical point, I just wanted to add some color on the literal statement.

 

[Giant81]

This right here. So again, even many paramedics interpretation of properly and accurately identifying NSTEMI's, for example (think NOS LBBB in the face of several co-morbid factors absent "classic" ACS/ AMI s/s) are faultered.

I feel like we're getting bogged down with the possibility of over or under triaging a cardiac emergency based on a 12-lead. This can't happen. I can't triage anything using a 12-lead. I don't obtain a 12-lead until after I've traiged the PT. Once I've made my transport decision and possible diagnosis based on evidence I'm allowed to interpret, and treated as appropriate per my protocols, THEN I apply, acquire, and transmit a 12-lead.

There is no way I can interpret a 12-lead incorrectly, since I cannot and do not interpret them at all. They are only a tool the local hospitals would like us to obtain and send them while enroute to give them a better picture of the PT's condition before we arrive at the ED.

I can completely understand where you're coming from and how even a paramedic can end up mis-interpreting a 12-lead. They are not simple to read. There's quite a bit of information on them, and I can understand how some things may not be straight forward. I've done a bit of research on trying to identify what I'm looking at. Not so I can interpret, but so it can hopefully help identify artifacting and ways to minimize it so I can obtain the best information possible for the ED to treat the PT.

I guess there may be some argument on whether or not a Basic is competent enough to obtain a 12-lead, but it's not that difficult to apply the proper electrodes to the right places, and acquire the strip. Reading it is the hard part, and that is left to someone with a lot more knowledge and time in doing that sort of thing than I am.

As far as why paramedics make so little, I can't say. On the one hand, I believe a paramedic degree is an associates or the equivalent of a 2-year college degree. While the initial entry requirements are not large, and may not facilitate a higher salary, the fast-paced OP tempo, constant requirement for ongoing education, responsibility for PT's lives, and high burnout rates would (I feel) tend to possibly suggest a higher pay than your normal 2 year degree trained tradesman. Though, public service isn't known to be a terribly lucrative industry. Sure, the equipment makers can make bank, but the EMS companies and providers don't tend to make much. Some are municipality based systems funded partly with tax money. These systems aren't going to pay much either.

I guess there are some places that pay pretty well don't they? Wasn't Denver, CO and a couple other markets pretty well paid in comparison to national averages? I guess it's like anything police/fire/ems related. You do it because you like to help people and be a part of the community, if you're doing it to try and get rich, you'll be sadly disappointed very quickly.

 

[SandpitMedic]

I vote changing the name from Emergency Medical Services to something along the lines of Prehospital Medical Services.

You want to be PMS?!

 

[EpiEMS]

You do it because you like to help people and be a part of the community, if you're doing it to try and get rich, you'll be sadly disappointed very quickly.

Nurses don't have this problem. Physicians don't have this problem. (Why? They have more education and more professional unity, which circles back to the education - they raise the barriers to entry, magically cutting down on the possible supply.)

 

[SandpitMedic]

Enough with the cardiac calls. That's nothing to do with why we are paid minimally, and nothing to do with increasing the educational standards at the Paramedic level.

Let's be realistic, if these changes are going to occur at all, they are going to be minimal. The least common denominator is an Associate of Science degree. If we can move from a certificate based model to an AS model we'd be taking the smallest largest step forward.

Jumping straight into the Bachelor of Science arena is biting off more than EMS can chew. It also is not feasible. Starting with the AS allows the market to catch up, and allows the physicians who devise our protocols a chance to catch up...

The implementation is to be in steps not in leaps. Eventually, I hope to see the top field Paramedic level being, at baseline, equivalent to a CCT Medic with a Bachelor of Science Degree... in several years.... for now, the minimum barrier being an AS will self correct a lot of the problems we face, and better EMS providers. We will always be a hands on, first line, skill set driven employee; supplemental education in CCT skills and academia are what we need as a baseline.

 

[SandpitMedic]

Nurses don't have this problem. Physicians don't have this problem. (Why? They have more education and more professional unity, which circles back to the education - they raise the barriers to entry, magically cutting down on the possible supply.)

Exactly, as I said the answers to most of our issues has been staring us in the face for years. You want to be like them? Act like them? Follow suit. Raise the education standards.

 

[VentMonkey]

It was merely an example as someone suggested that EMT scope should include cardiac monitoring with limited educational backgrounds.

That was my relevance to the thread topic regarding education, pay, and lack there of.

You all know how us (EMS) folk are easily side tracked...oh! A penny!!...

 

[agregularguy]

While I agree on the bumping up of education, standards and all that- I think we're missing something right now. I believe EpiEMS brought it up earlier in the thread.

Where is the money for our pay raise coming from?
If you're in a smart, publicly funded third service/municipal/fire based EMS, you're paid through taxes supporting your agency as well as reimbursements for care.
But if you're with an agency like AMR, or other private services which cover a vast, if not majority of America at this point, where is that increase in money going to come from? How about volunteer agencies, who remain volunteer out of either stubborness or complete inability to actually pay for providers?
AMR for example, literally pays the cities near me to be the 911 (and hospital) coverage provider. They make the most money off of IFT's near me, as I'm in a poverty stricken area and Medicare is what's paying most of our 911 bills. Medicare doesn't cover the full amount for services though. They can only reimburse up to X number of dollars. Exceed that amount in providing good patient care, and you're taking a loss for that extra amount of $. I don't have the exact figures off hand, but if you're bringing in a complicated ALS patient with multiple medications, cardiac monitoring, intubation, there's no way that they reimburse the full amount.

So we can talk all we want about increasing our standards, our education, and what we can provide for our patients all day. But the fact is that as of right now, where is that money going to come from?