Why doesn't the US EMS revise their system from the ground up?

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Ricky_Rescue

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I've been looking at the Canadian/Australian EMS system, and it's pretty sad when you compare it to the US system. First off, they're paid FAR better than we are here...I'm not talking about a few thousand more, I'm talking sometimes 3 or 4 times more than a regular EMT Basic here. A PCP (EMT-B) equivalent here, depending on where they live can make anywhere from 60,000 to 75,000 performing relatively equivalent skills.

Really? We're here making 8 dollars an hour if we're lucky.

I say we change the system entirely, make EMT-B's take 2 years of schooling like PCP's do in Canada, and make it a real, well-paid trade as opposed to the currently shat-on one we have here in America.

Thoughts? Am I crazy?
 
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Simple answer IAFF... :D
 
What exactly is the IAFF doing?
 
Volunteers, not enough education, for profit services, take your pick. The truth is that we are neither Canada nor Australia and that neither of those systems is perfect either.
 
The public doesn't know, and even less care.
 
Under what standard is an EMT-B the same as a PCP?
 
And while on some level they do get paid more, very rarely in any of these links is the cost of living or taxes discussed.

Both are higher in those countries than the USA. Then that leads to the discussion of what they get for those taxes but at the end of the day it is still less in your pocket for most.
 
JPINFV said:
Under what standard is an EMT-B the same as a PCP?
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Thanks for pointing that out. I think the only way PCP and EMT-B are the same is that it is the lowest level to work on an ambulance (at least in Ontario where we don't have EMRs). The education is completely different, and generally from what I understand the PCP skill set (though limited) is comparable to EMT-I.

I don't think the IAFF can be blamed entirely, though surely it doesn't help the situation for American EMS providers. The IAFF wants to keep fire in EMS so they will want to keep the education standards low so that they can relatively easily have EMTs on fire trucks. Imagine if they had to send someone away for a four year degree in paramedicine to work as an EMT-P on a fire truck. That is a cost that fire departments don't want.

The IAFF can hardly be blamed for all of the problems though. To the OP, I would ask who in the American system has the power to make a change like that? Is there an organisation that has enough buy in that it could say that by 2015 all EMT-B programs must be run out of community colleges and must be at the AS level? I don't know about professional representation in the US, but I suspect not. My other big question would be whether there is actually consensus among American EMS providers that that type of change is needed. Remember that this forum is surely not representative of the profession as a whole.
 
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akflightmedic said:
And while on some level they do get paid more, very rarely in any of these links is the cost of living or taxes discussed.

Both are higher in those countries than the USA. Then that leads to the discussion of what they get for those taxes but at the end of the day it is still less in your pocket for most.
Click to expand...

This.


Sent from my iPhone using Tapatalk
 
akflightmedic said:
And while on some level they do get paid more, very rarely in any of these links is the cost of living or taxes discussed.

Both are higher in those countries than the USA. Then that leads to the discussion of what they get for those taxes but at the end of the day it is still less in your pocket for most.
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We'll leave taxes out of the discussion, since as you mentioned these are then used for services that don't need to be paid out of pocket. Let's just look at trying to compare EMS provider income between Canada and the US, specifically looking at Ontario and Michigan.

In 2001, average personal income in Michigan was $29,788 (according to this, I didn't see more current numbers than this, but presumably it has increased since then). In 2008, median personal income in Ontario was $29,700 (according to this). So let's just say that the median personal income in both Ontario and Michigan is somewhere in the ballpark of $30,000.

So what does an EMS provider in Michigan make? My completely unscientific source (Indeed.com) says $36,000 for an EMT and $56,000 for an EMT-P. And what about a PCP in Ontario? At $33 an hour, it would end up being around $66,000, and more for an ACP.

So even if we forget everything else and just compare the EMS provider wage to the average for the area, it looks like Ontario paramedics are doing better. I am not trying to rub this in anyone's face or anything like that, but the issues of cost of living, taxes, etc. are often raised when comparing American to international EMS wages and since I did a bit of digging I thought I would share. Obviously this is just using whatever numbers I have found and they may or may not be entirely accurate.
 
The Canadian PCP is not equivalent to US EMT.
(use Wikipedia to find "Paramedics In Canada")

Primary Care Paramedic is more like the Advanced EMT as described in the Scope of Practice documents.

I disagree with Luno's blaming a national firefighter labor organization for keeping ems provider pay down. Labor focuses on job protection, pay and benefits.

INCREASE EDUCATIONAL LEVEL OF CAREGIVER

If we follow our colleagues in nursing and the health care sciences, we need higher levels of formal education for providers, a "body of professional knowledge" and an academy of credentialed educators.

Nursing has moved from a vocational training program to, generally, requiring an associate degree. Supervisors, managers and specialists have a Bachelor of Science in Nursing.

You can get nursing masters and doctorial degree. No PhD in EMS (yet).

About half of the physician assistant programs have gone from bachelor degree to master degree.

Oh, and the physician remains the boss.

INCREASE FORMAL EDUCATION FOR EMS EDUCATOR

The CoAEMSP requirement that the lead instructor in a paramedic program possess an earned bachelor degree by 2013 is identified as a hardship in about a fourth of the existing accredited paramedic programs.

I needed a master's degree to run a fire science associate degree program. That requirement was the college's interpretation of the regional accrediting organization's regulation.

EXPAND JOB TASKS

With increased critical thinking capability comes an opportunity to perform more clinical skills. In a variety of venues. Some EMTs in my area became emergency department technicians, applying 12-leads, using ultrasound, etc.

Staying with the health care science model, we need to be doing tasks that are billable to Medicare. Someone will have to pay for the services.

Which makes us competitors with our health care science colleagues, like the battle between Nurse Practicioners and Physician Assistants.

JOIN THOSE LABOR SAVVY PUBLIC SAFETY WORKERS

In many urban areas, there are increased educational requirements for firefighters and cops if they want to be supervisors, managers and administrators. Along with some type of civil service promotional process.

A firefighter/emt provides the municipality with an "all hazards" capability, which translates to higher pay (THAT is what the IAFF is involved in).

ECONOMICS DETERMINE WHAT A WELL-PAID JOB IS

There are folks with Master degrees in journalism and social work that have bleaker job prospects than someone with a National Registry paramedic credential.

Unfortunately, having an EMT-Basic remains a ticket to get you in the door, not to fortune and fame.

Mike
 
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mikeward said:
I disagree with Luno's blaming a national firefighter labor organization for keeping ems provider pay down. Labor focuses on job protection, pay and benefits.

INCREASE EDUCATIONAL LEVEL OF CAREGIVER

If we follow our colleagues in nursing and the health care sciences, we need higher levels of formal education for providers, a "body of professional knowledge" and an academy of credentialed educators.

Nursing has moved from a vocational training program to, generally, requiring an associate degree. Supervisors, managers and specialists have a Bachelor of Science in Nursing.

...

INCREASE FORMAL EDUCATION FOR EMS EDUCATOR

The CoAEMSP requirement that the lead instructor in a paramedic program possess an earned bachelor degree by 2013 is identified as a hardship in about a fourth of the existing accredited paramedic programs.

I needed a master's degree to run a fire science associate degree program. That requirement was the college's interpretation of the regional accrediting organization's regulation.
Click to expand...


...which is funny since the USFA doesn't think that EMS providers need a college education until they become a supervisor and the IAFC thinks that college educated paramedics are swell, provided the requirement isn't applied to the fire service (Middle of page 3).

Admittedly, though, the IAFC, IAFF, and USFA are all three distinct organizations.
 
Money.
 
JPINFV said:
...which is funny since the USFA doesn't think that EMS providers need a college education until they become a supervisor and the IAFC thinks that college educated paramedics are swell, provided the requirement isn't applied to the fire service (Middle of page 3).
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Nice pyramid. Developed the "EMS Professional Development Model" when I was the chair of the National EMS Management Curriculum Subcommittee.

Follows the fire service model of a bachelor degree for manager and administrator level officers, a master's degree at the executive level. In some systems, these are required before sitting for a promotional exam.

In the two "town hall" style meetings we held - at EMS Today and EMS World - it was clear that those in attendance wanted the associate degree to cover paramedic training and the bachelor degree to cover EMS Management.

As you probably know, CoAEMSP expanded their definition of academic affiliation in 2010 to facilitate fire service academies.

When EMS was formally included in the mission of the US Fire Administration, it is clearly restricted to fire-based ems organizations.

Mike
 
mikeward said:
When EMS was formally included in the mission of the US Fire Administration, it is clearly restricted to fire-based ems organizations.

Mike
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Why should the taxpayers care about that? If the standard should be an associates degree as a minimum (where the standard should be, based on what is appropriate to ensure an appropriate command and ability to apply both the foundational sciences and EMS applied science, is not necessarily where it is now), why should the fire service be exempt? It's akin to requiring private hospitals to staff their EDs with physicians board certified in emergency medicine while the county hospitals can just use any physician they want.

As someone who currently lives deep in fire-based EMS territory, shouldn't I feel at least a little concerned that the fire service doesn't think that paramedicine requires a degree?


Also, I'm much more concerned about what comes out of committees than necessarily who's on them.
 
mikeward said:
As you probably know, CoAEMSP expanded their definition of academic affiliation in 2010 to facilitate fire service academies.
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Which is bothersome in and of itself. It's hypocritical of me to think this (I'm not a degreed medic) but if the paramedic certification doesn't come with a degree from an institution accredited by an academic organization, I don't think you should be allowed to sit for NREMT exam. Similar to NCLEX.

What hasn't been mentioned is that since EMS is regulated by state agencies (not boards made up of members of the profession, such as nursing and medicine) it get's very difficult to put forward a nationwide change, especially when there's a very strong competing interest (certain fire service entities, private services, medic mill schools) in a particular area.
 
The problem of restricting USFA/NFA work to fire-based ems organizations is that it ignores ems providers from hospital, municipal, non-profit and ems-only volunteer organizations.

The success of the fire side of the Fire and Emergency Services Higher Education (FESHE) initiative is that they have been inclusive, including industrial fire brigades and fire alarm/fire sprinkler industry.

The current community college paramedic educational model does not "ensure an appropriate command and ability to apply both the foundational sciences and EMS applied science."

Under the old National Standard Curriculum there was barely enough time to met the minimum general education requirements of an associate of applied science or technical degree. These are terminal two-year degrees.

Students coming from those programs often need to complete 9 to 12 additional semester hours to meet the general education requirements of a two year associate degree that is aimed at transferring to a bachelor degree program.

Adding Anatomy and Physiology is a help, but if we were to construct a Scope of Practice paramedic degree program to cover the foundamental sciences and EMS applied science it would need to be a four year program. Like the programs run by Pittsburgh and University of Maryland Baltimore County.

Mike
 
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usalsfyre said:
What hasn't been mentioned is that since EMS is regulated by state agencies (not boards made up of members of the profession, such as nursing and medicine) it get's very difficult to put forward a nationwide change, especially when there's a very strong competing interest (certain fire service entities, private services, medic mill schools) in a particular area.
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Au contraire. Medicine is regulated by state agencies (the board of medicine is a state agency). It's just that the multiple agencies and organizations that run medicine (AMA/AOA=NAEMT, NBME/NBOME=NREMT, LCME/COCA=CAAHEP, Board of [Osteopathic] Medicine= what ever state agency licenses EMS). It's that they seem to get along better, are less dysfunctional, and there's a lot less internal debate than in EMS. Also, the concept of "professional responsibility" to the average physician is different than to the average EMS provider.
 
JPINFV said:
Au contraire. Medicine is regulated by state agencies (the board of medicine is a state agency). It's just that the multiple agencies and organizations that run medicine (AMA/AOA=NAEMT, NBME/NBOME=NREMT, LCME/COCA=CAAHEP, Board of [Osteopathic] Medicine= what ever state agency licenses EMS). It's that they seem to get along better, are less dysfunctional, and there's a lot less internal debate than in EMS. Also, the concept of "professional responsibility" to the average physician is different than to the average EMS provider.
Click to expand...

But the state BOMs are generally made up of physicians. When was the last time you saw a state board of paramedics? For that matter, when was it you last saw a state EMS agency that had a significant paramedic presence among its policy makers?
 
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