Your opinion on the future of EMS

[SeeNoMore]

I am interested in getting a feel for the general impression people have of the future of EMS. We are faced with cities and towns with less money to spend, gaps in the even dispersal of quality EMS education (as in differences in the quality of specific programs by region/state), questions on the use of ALS in many situations, questions of how/whether to integrate with Fire etc

It seems to me the two most likely possibilities are that money and effort will go into expanding what EMTs and Paramedics can do, how well we are trained and educated to ensure our use and perhaps take some burden off the health care system by having some ability to treat minor injuries out of hospital or prescribe some medications. This would have to be coupled with ongoing money for research, training and technology along with having degree requirements, greater national cohesion and oversight of EMS.

or

The reversal of front loading of Paramedics and the widespread filling of those positions with EMTs, except perhaps in very rural areas. I've read of some towns already starting this, or proposing it sometimes out of concern for the use of ALS/BLS sometimes just out of financial concerns. This could also include a reduction in Paramedic scope of practice, or perhaps if there were fewer ALS providers per region would result in more use of specific skills, and therefore an expansion of practice.


To be clear, I don't have an opinion on how EMS should be in the future, but am trying to become informed enough to have one. I find people not on this forum are very reluctant to discuss the situation, so I am hoping this will result in some fruitful discussion.

 

[spisco85]

I'm leaning towards A. Once the paramedic education requirement is held to at least an associates you'll see much more in terms of open ended protocols and treating and releasing in the field, advising people go to clinics or specialty services that sort of thing.

 

[Sasha]

I would like to see this...

It seems to me the two most likely possibilities are that money and effort will go into expanding what EMTs and Paramedics can do, how well we are trained and educated to ensure our use and perhaps take some burden off the health care system by having some ability to treat minor injuries out of hospital or prescribe some medications. This would have to be coupled with ongoing money for research, training and technology along with having degree requirements, greater national cohesion and oversight of EMS.

But I really don't see it. Some people on this forum have been fighting for higher educational standards and to get EMS accepted as a profession, and not just a hobby, for longer than some of us have been alive. However, they've made little progress. From some attitudes I've seen here and elsewhere people say they want it to be a profession, but really don't want to put in the effort. They want to know just enough to get by, want to continue to volunteer and run around with their sirens in their POV, they want to continue talking about sirens and light bars and not patient treatment. I don't see other professions comparing the types of IV needles they use or parading around with T-Shirts that talk about heroism and/or sexual innuendos. (I actually saw one "Practice Safe Sex, Sleep with an EMT".. Really? Is that the image we want to project?)

It just doesn't say "profession" and I don't think it ever will.

Hey, I may be wrong, and I may be a pessimist. But the future of EMS doesn't look too bright.

 

[46Young]

I would like to see this...



But I really don't see it. Some people on this forum have been fighting for higher educational standards and to get EMS accepted as a profession, and not just a hobby, for longer than some of us have been alive. However, they've made little progress. From some attitudes I've seen here and elsewhere people say they want it to be a profession, but really don't want to put in the effort. They want to know just enough to get by, want to continue to volunteer and run around with their sirens in their POV, they want to continue talking about sirens and light bars and not patient treatment. I don't see other professions comparing the types of IV needles they use or parading around with T-Shirts that talk about heroism and/or sexual innuendos. (I actually saw one "Practice Safe Sex, Sleep with an EMT".. Really? Is that the image we want to project?)

It just doesn't say "profession" and I don't think it ever will.

Hey, I may be wrong, and I may be a pessimist. But the future of EMS doesn't look too bright.

+1. for every one individual that represents the profession well, advocates and works for greater educational requirements, there are 10 (100?) that could care less, and only use the job as a stepping stone, or an "in" for a FD.

When I was in EMT school, a medic told me "getting your EMT and then your medic is the quickest way to make good money without going to college. You could begin with no more than a GED. My base is a little over $60,000/yr (NYC, summer of '02). It's almost as much as an RN here, and any medic school will accept you". Three years and a few months after we had that conversation, I began working as a new medic, and grossed over 85,000 that year off of a 55,000/yr base. Easy money. It would appear that the medic had it spot on.

The question is, will employers, be it municipal, hosp, private, whatever, be willing to compensate at a higher rate if educational requirements are increased? Will they make do with less medics in favor of BLS? Everyone's already crying poverty, so I don't envision a substantial rise in medic salary/benefits with more schooling.

 

[46Young]

Adding to my last post, consider this scenario: 17 y/o gets their EMT cert, turns 18, goes to a medic mill for 3 or 4 months, receives their P-card, gets hired as a firemedic here at Fairfax, and is making about 65,000/yr base less than a year out of high school. I realize that's a fire based job, so..... same scenario, but the medic gets hired at Charleston County EMS and is compensated at a rate of 45,000/yr after 6 months, where RN's are quite lucky to get 25/hr. This is in the deep South where your dollar gets greater mileage.

It's disturbingly easy to become a medic and quickly find a decent paying job, if you know where to look, and are willing to relocate.

While playing Devil's advocate with these last two posts, let me ask - with a P-card being the golden ticket to prosperity (firemedic, medic-RN bridge, muni third service, numerous venues for PT work) what would be the motivation to draw the process out to 2-4 years? Also, how many of you speaking out for greater educational requirements are already on the job (I got mine!) and as such wouldn't be affected by any changes to the educational requirements, other than maybe having to take a class or two?

 

[TransportJockey]

What I want to see in the future is a requirement of a BS to gain entry into the field of EMS as a paramedic. I would love to see every truck a dual medic truck. The other things I would love to see is the splitting of EMS from fire and the doing away with volunteer organizations.

I'll even take an AAS as the entry requirement for EMS. But medic should be the entry, not EMT

 

[atropine]

I don't think much of anything is going to change in the future of ems. At least where Iam from if it ain't broken why fix it?, sure there are some fire haters out ther, but this is how it's been for 30+ years and the citizens don't seem to mind or care one way or another. As far as eductation is concerned I don't think a two year or four year degree is going to matter when you can get an RN, or Rt two year degree and make way more, with those kinds of options turn over is still going to be high, and wages will be low. Far as Rx and releasing minor injuries and illness good luck with all that find a medical director to sign off with all that liabilty out there.

 

[SeeNoMore]

I agree that conflict with Fire Departments is silly. We should view each other as essential parts of Emergency/Rescue. I will say though that I think having EMS be it's own entity, and not part of Fire Department seems like a better idea to me.

As for volunteer EMS, I do not think it is a problem. It exists in places that need EMS but have no paid services, and can be every bit as professional as paid EMS. In fact, where I live most of the volunteer squads higher trained members are working currently in paid positions elsewhere. In addition, if an area becomes busy enough, the squad will usually begin to have some paid members, or transfer to paid entirely.

 

[Fireguy]

the doing away with volunteer organizations.

Do not label all volunteer services as awful. After all, if a volunteer/combination service can get awarded the Departmentof Health's EMS Agency of the Year for thier perticular state then I would say that they are very professional. As for the HOBBY comment, many volunteers dedicate thier lives to the service they work for(but cannot take a pay cut to work on a paid unit). You guys said it yourself that many use EMS as a steping stone and dont even want to be there. Volunteers are there because they want to be.
With that said. there is a few bad apples that have no place in EMS but of course that is just about anywhere you go.

 

[marineman]

Also, how many of you speaking out for greater educational requirements are already on the job (I got mine!) and as such wouldn't be affected by any changes to the educational requirements, other than maybe having to take a class or two?

I have my P ticket and am working. This coming fall semester I am finishing my last 2 classes for my associates degree. I am a huge advocate for a minimum of an associates for paramedic licensure. In fact I wouldn't mind if they required an associates and left our pay where it is for a while, think of how quickly we would get rid of all the bottom feeders. I am not required to have an associates degree but I believe in what I do and want to be great at it. So no, if they increase the education requirements I probably won't have to go back to school but I have put in the work when I didn't have to and I don't get paid any differently for it.

 

[46Young]

What I want to see in the future is a requirement of a BS to gain entry into the field of EMS as a paramedic. I would love to see every truck a dual medic truck. The other things I would love to see is the splitting of EMS from fire and the doing away with volunteer organizations.

I'll even take an AAS as the entry requirement for EMS. But medic should be the entry, not EMT

The odds of EMS splitting from fire are about the same as me hitting the winning Lotto numbers.

In rural areas, if you would abolish volunteer organizations, who is going to run EMS there? The tax base would certainly fail to support any EMS in the area, let alone ALS.

Also, as far as requiring a BS to be a medic? I have a better idea. Have a PA enter an agreement with a medical director where they have a degree of autonomy and basically function on an ambulance as a field MD like times past. Some MD's already have PA's handle their NH pts, and do assessments/Tx plans in the ED for them (after review of course), so why not on an ambulance? We could do away with the whole "para"medic thing altogether! I would think that a PA's education would easily trump that of a BS in paramedicine, for roughly the same salary (compensating for 4 years of education).

 

[Ridryder911]

The odds of EMS splitting from fire are about the same as me hitting the winning Lotto numbers.

In rural areas, if you would abolish volunteer organizations, who is going to run EMS there? The tax base would certainly fail to support any EMS in the area, let alone ALS.

Also, as far as requiring a BS to be a medic? I have a better idea. Have a PA enter an agreement with a medical director where they have a degree of autonomy and basically function on an ambulance as a field MD like times past. Some MD's already have PA's handle their NH pts, and do assessments/Tx plans in the ED for them (after review of course), so why not on an ambulance? We could do away with the whole "para"medic thing altogether! I would think that a PA's education would easily trump that of a BS in paramedicine, for roughly the same salary (compensating for 4 years of education).

Do you even relatively know what your talking about? Better look at P.A.'s salary again... They usually start out at a 6 figure salary, as well the majority are graduate to post graduates (PhD). I know of very few that would want to play ambulance driver and have to lift, move, enter hazard areas and increase their liability and litigation risks in the field setting. Not that they could not, rather they are much smarter than that, they would not. Again, why?

Far as Fire Department having EMS, it may be become a thing of the past. Actually maybe it should be EMS with fire trucks .. since the majority of the Fire Service responses are 70-85% EMS calls. With the economic situation, maybe it's time to start discussing privatization of Fire Services just think of the money cities that could be saved and the reduction of needless manpower. At the least, EMS can and does make money to pay for itself if managed right. Many other services are being contracted out and managed much better.. why not fire service? Their primary responses are decreasing each year, yet the manpower increases. Any other business would have to reduce and cut overhead or simply close shop...


R/r 911

 

[atropine]

Far as Fire Department having EMS, it may be become a thing of the past. Actually maybe it should be EMS with fire trucks .. since the majority of the Fire Service responses are 70-85% EMS calls. With the economic situation, maybe it's time to start discussing privatization of Fire Services just think of the money cities that could be saved and the reduction of needless manpower. At the least, EMS can and does make money to pay for itself if managed right. Many other services are being contracted out and managed much better.. why not fire service? Their primary responses are decreasing each year, yet the manpower increases. Any other business would have to reduce and cut overhead or simply close shop...


R/r 911[/QUOTE]
Why this maybe true, try taking it to the voters. Again at least in my area, fire has been runing ems for 30+ years and nobody's seems to be to have any heartburn about it.

 

[Ridryder911]

Why this maybe true, try taking it to the voters. Again at least in my area, fire has been runing ems for 30+ years and nobody's seems to be to have any heartburn about it.

Until, they have no income or taxes to support system that could be ran cheaper or even free. When it comes to money (taxes) and loyalty, I would not place my bet on loyalty.

Look at cities already laying off public service.

R/r 911

 

[Level1pedstech]

I think its pretty unrealistic and bordering on disrespectful to all those that serve to even consider doing away with volunteer agencies. Do you realize that volunteers are the majority in this country and folks who don't have the luxury of a paid service rely on their fellow citizens to be there in a time of need. I don't know why someone would even make such a suggestion on a board that has a large number of dedicated and well trained responders as members. If you think doing away with volunteer agencies is a good idea you need to provide an alternative. I can save you the trouble, in many areas mine included there is no alternative.

As to running multiple medics on an engine, more than one medic on an engine is overkill. I have heard talk of running four man medic engine companies, could you imagine that, there would be no room in the cab with all the ego's. I have worked as a member of an engine company with one medic/officer and one EMT-I and two basics and we got along just fine. The only way I could see a benefit from dual medics on an engine is in an operation with no ALS ambulance service but how would you transport.

 

[medic417]

I think its pretty unrealistic and bordering on disrespectful to all those that serve to even consider doing away with volunteer agencies. Do you realize that volunteers are the majority in this country and folks who don't have the luxury of a paid service rely on their fellow citizens to be there in a time of need. I don't know why someone would even make such a suggestion on a board that has a large number of dedicated and well trained responders as members. If you think doing away with volunteer agencies is a good idea you need to provide an alternative. I can save you the trouble, in many areas mine included there is no alternative.

As to running multiple medics on an engine, more than one medic on an engine is overkill. I have heard talk of running four man medic engine companies, could you imagine that, there would be no room in the cab with all the ego's. I have worked as a member of an engine company with one medic/officer and one EMT-I and two basics and we got along just fine. The only way I could see a benefit from dual medics on an engine is in an operation with no ALS ambulance service but how would you transport.

First any area can go paid if priority's are right. Search my posts and I give many ways your area can do it. Can you back up that volunteers are the majority in EMS?

As to more than 1 medic on an engine, I agree as I feel there should be 0 medics on any engine. But on an ambulance having a fellow Paramedic to trade calls with and to bounce ideas off would be great. The equal education/certification means if one misses something more likely the other can catch it. If with a lower level partner all the pressure is on the Paramedics shoulders.

 

[daedalus]

If the paramedicine educational process was improved, there is no reason we could not be the equivalent of a PA, but operating in the out-of-hospital environment. Both professions have the same premise, they are physician dependent practitioners of medicine (although currently this cannot be said about many paramedics).

In california, a PA license requires around two years of community college or university time gathering the pre-reqs which include chem, bio, english, math, and microbiology. They than enter a roughly two year program to become licensed PAs, and can complete and optional one year residency afterwards. I do not see why we cannot mirror this educational process for ourselves...

It is important for me to add to this post, I have no intention on EMS ever stepping on the PA profession's toes. I imagine us doing public health clinics in community fares, and providing home welfare checks and injury prevention visits. I imagine us closing simple lacs in the field and referring to primary care, and doing what we do right now, emergency first response. PAs will continue to be the preferred midlevel in clinics, ERs, private offices, and hospitals.

 

[Level1pedstech]

I did not say anything about EMS being majority volunteer, I have always been a fire/ems guy. Most volunteer agencies require thier firefighters to have a minimum of CPR so when you put togeather fire and medical responders the volunteer agencies far out number the paid ones. We do have a paid ALS transport agency in our district but with a minimum response time of 20 minutes its really important to have volunteer responders with at least BLS skills (CPR and AED). With a yearly call volume under 200 its just not possible to fund paid first responders.

I do agree with your thinking on dual medics for ambulances that are designated ALS transports. Its the future weather basics want to admit it or not. In the ideal situation three would staff a rig, two medics and a basic, who would act as an extra set of hands and drive leaving both medics in charge of patient care. It would be a great learning experience for a basic to function as a PMA for two medics.

 

[Sasha]

But on an ambulance having a fellow Paramedic to trade calls with and to bounce ideas off would be great.

I think that would oversaturate the area.

 

[medic417]

I think that would oversaturate the area.

Nope it actually benefits the patients and also helps lower the stress of being the only Paramedic on scene.