ambman142

Hey Scratrat :munky2: , I usually need a forklift to carry me, but you already know that. As for appearances, I din't mean my good looks . BTW, it's 80 up here too......this week! :wink: Keep in touch. you have my email. Always great hearing from you! :angel5:

Thank you. Have a lot of respect for Dustdevil though. I read a lot of his other posts and he is passionate about EMS and his advise is well thought through & on the mark, (I guess those 8 years really do make a difference) :wink: . I Just don't agree on the volunteer vs. paid professional thing or the Transport vs. Street provider thing, but he has many good points. I have to admit that my first impression was less than luminous, although I also have to admit that I agree with Dustdevil more often than not. I still stand by my beliefs that paychecks do not make you a professional, but giving you services away for free does lessen the value of the service that is provided by those of us that have chose this career path and strive to make it a recognized profession. I can not for the life of me figure out why people will pay someone to pick up their trash, but do not want to pay for EMS. Where are their priorities? I also have to agree that many stellar pre-hospital providers may have never been a transport jockey, but again I have to re-emphasize the 3- dimensional aspect. Anyway, I guess that's what this website is all about; providers expressing their opinions whether they agree with each other or not.

#1 I acknowledge your 34 years experience, but a have to reemphasize that receiving a paycheck doesn't make you a professional. How you carry yourself in relation to your patient, their family, your employer, your peer, and the public is going to either increase or decrease their perception of you and our profession. If you have been a provider for 34 years than you must have seen you share of volunteers that provided equal or occassionally better patient care that their "paid" counterparts. I can not see how receiving a paycheck has any bearing on professionalism. #2 While on the subject, it's not about false appearances, it about first and foremost "patient care". Other's impression of our profession, is directly related to appearances, like it or not, people making judgements based on appearances. Unfortunately, some who act like pompous asses tend to represent all of us in EMS in that capacity, although some us can not help being what we are. The point I was attempting to make is: If our actions instill confidence in our patients, etc. it reduces anxiety and the healing process can begin. #3 Although I run mostly in the 911 arena, with an occassional overtime transport shift. I stand by my original statement that no one ever became a nurse without wiping a few butts and no "Fire Monkeys" as you call them ever started in the fire department without wrapping up a few lines. Health care is 3 dimensional (pre-hospital. in-hospital, & post-hospital). Transports allow the provider to be more well rounded, with the realization that there is health care beyond the emergency room. letting the provider see patient outcomes through rehabilitation and possible Long Term Care facilities. Nurses have it 2/3 correct with in hospital and post-hospital care, but fail to realize that care begins prior to arrival in the ED. I am not saying that there are not many good medics out there that have never did transport. What I am sayng is that in private ambulance services, transports pay the salaries of us 911 providers. If course if it's municipal, then your salary is dependent on tax dollars and transports are not in the equation. I do feel that saying we are better than our transport counterparts is being an elitist. I know many transport providers that I would have as a partner any day over some 911 "trauma junkies". So, there is my rational for that particular statement. #4 As for my helping to hold back "our people" & profession in the 1970's. My reply to that is: The only way to move our profession ahead is to increase others perception of us and "our people" & that includes "all" of us (emergency & transport), because in case you don't realize it not many (even other healthcare disciplines), know the difference by just looking at us.

Where do I start? As an EMS veteran of 26 years of both paid & professional services, I have to state it is not a matter of whether or not you are paid or not that makes you a professional. It is in fact, how you present yourself to your patients and their families, the general public, your employer (paid or volunteer), and you co-workers. As for not wanting to & being to good do transports, that's nonsense. As the quote says, you think that you're too good to dig ditches. Well. that is not the profession that you chose. A master plumber doesn't dig ditches anymore either, but he had to start somewhere. Transport is the the way most ambulance companies pay their bills, like it or not. You have to look at it as a professional, a neccessary part of the job. Use it as a learning experience. Learn how each piece of equipment operates, how the senior EMTs interact with other health care professionals, how they interact with their patients. Transports can teach you a lot, if you have the right teacher. It will also teach you one more important thing, humility. Although, the glory of street EMS may be great, the act of holding a hand & truly caring for someone, who may not have anyone else or in a hopeless situation, is really what it is all about. If it isn't, then you might want to reconsider why you chose EMS as a career in the first place. It's not about the glory, it's about helping someone, when they are in the middle of a crisis, and making the situation better. Remember that EMS isn't all about being Johnny & Roy. As for the resume, list education & experience, both paid & volunteer. Be concise and do not overelaborate as to what duties you perform. Any employer will already know what duties are required. Better is to show a willingness to do what is required to get the job done and to further your education. Too many EMT are satisfied with just having the basic credentials to satisfy the state's requirements for the position instead of attempting to be the best healthcare professional that they can be. This in effect makes EMTs nothing more than horizontal taxi driver, that take blood pressures. Feel free to express your opinions, I have a thick skin.

Finally someone who gets it! I am in complete agreement with you on hospital based ALS versus municipal based. I have been saying that the hospital based system was the way to go all along. First let me restate the fact that a hospital based system is better able to provide Medical Direction, Quality Assurance/ Education, Pharmacological Rotation, and Skill Retention/ Competency. I As for EMT-Intermediates, I personally think that if a EMT-B/D is competent enough to attaining a EMT- Intermediate level of certification, then it wouldn't be detrimental for the patient to receive that level of care. Although, I agree that it will never happen again in New Jersey, it does work in other states. As I explained the 3 county Pilot Program was a way to provide at least a ILS level of care to patients that only had a BLS level of care accessible. This was due to the fact that an ALS CN was awarded with a population based criteria. This is not the case anymore and ALS is available for every resident in the State of New Jersey. I do have to respond to you comment that If you have a legitimate BLS patient, that starting a IV & running fluids was not providing any greater patient care than a EMT-Basic. You are right in that statement. but they can provide a greater level of care to patients that require more care than the EMT-Basic can provide. In fact let me remind you that we are all EMT-Basics first & foremost, and build on that certification to the ALS level. The fact is, a EMT-Intermediate can start a IV & run fluids and provide limited pharmacological intervention, when ALS is unavailable. They can also better assist the paramedic, when they arrive, due to a broader Scope of Practice than a EMT-Basic. Yes, a basic provider does provide basic care and a intermediate provider provides intermediate care, and a advanced provider provides advanced care. No one was saying that a EMT-B provide intermediate care. The statement that was made was that an EMT-Basic that was competent enough to attain EMT-Intermediate certification, provide intermediate care. This works in other states, why not in New Jersey.

I don't want to always respond in the negative, but private companies are also not a possibility, due to the fact that they could not obtain a CN from the state to provide street ALS. This in conjunction w/ the fact that a private company would in fact be less able than municipalities to fiscally maintain the availability of staff, pharmacological rotation, & skill retention.

Living in Cape May, I agree that Blackwood is quite a distance. I believe that AtlantiCare is working w/ ACCC on developing a cirriculum, but I haven't heard of a timeframe. I was speaking w/ a mutual friend of ours that happens to be a MICP and he added that municipalities could also could not support ILS/ALS due to not being able to maintain skill retention by the provider.

Although your heart is in the right place. As I mentioned, the State of New Jersey has already attempted to run an EMT-I pilot program within the 3 counties and apparently that system did not come to fruition as the NJ DOH OEMS had hoped. I don't believe that anyone could convince them to attempt at reviving the program. I am all for patient care and sometimes regret not being an ALS provider, although life's situations have precluded that for the time being. I do however think that the only solution is to have more ALS personnel in the field. What is needed is a paramedic cirriculum in ACCC, so the people at the shore don't have to drive to Blackwood. In the interim, the only solution is to be the best EMT-B/D that yopu can be. I know that it dosen't substitute for being able to intervene in patient outcome through pharmacology, but until the National Scope of Practice is finalized and adopted by the NJ DOH OEMS, we have to work with what we have.

My apologies, I wasn't trying to ascert that you didn't know where Medic 7 was stationed, only clarifying that their station is by history not the busiest medic unit in the sysytem. In fact at one time when Medic 7 was stationed @ Mainland, it was referred to as the "Country Club" because they were the least busiest unit in the system. With the population increase in the southern New Jersey the current system is getting busier. Cape May County currently has 2 Medic Units from 07:00-19:00 Sunday through Thursday and 07:00-01:00 on Fridays and Saturdays. Although the this additional Medic unit has alleviated some of the strain on Medic 9, it is still as usual for EMS, a hit or miss situation. Either both units are not busy at all, or both units are running non-stop and additional units are being dispatched from Atlantic County. This unfortunately is the case with EMS, you can not adequately predict call volumes accurately, even with System Satus Management. As for EMT-Intermendiates in New Jersey, I'm all for it. Although the State of New Jersey might disagree with us. As I mentioned in an earlier post, 3 counties in New Jersey were in a Pilot Program in the 1980s due to these counties being unable to obtain a population based CN for full ALS units. These counties were Salem, Cumberland , & I believe Essex Counties. I do not know all the particulars, not being from any of those counties, but apparently the program didn't work. In 1989 the EMT-Is from Salem & Cumberland Counties, that were able, went through the Camden County College Paramedic Program sponsored by Underwood Memorial Hospital & West Jersey Health System and were certified as MICPs. The rest reverted back to EMT-As when the Intermediate certifications expired. I fully agree that SOME EMTs of a higher calibre should have an expanded Scope of Practice, but other than the proposed changes at the national level of the same title, there are no plans that I know of to expand on the basic EMT's role in the EMS system.

Medic 7 is stationed in Galloway Twp. covering the northern end of Atlantic County. Medic 6 in Atlantic City & Medic 8 in Somers Point, covering sothern Atlantic County & Northern Cape May County including Ocean City are by far busier units, especially since Medic 10 now covers the western end of Atlantic County. As for municipalities doing ALS, the fact remains, if you make it possible for some municipalities, potentially all municipalities cound TRY. As for finding a medical director, hospitals are better suited, since the have a staff for quality control, as to not overtax the medical director of the program. Then there is rotating expensive, sometimes rarely used medications, so that they don't expire. This is better suited for a hospital based system, so they can be rotated through pharmacy to hospital floors or to other medic units in the system that may use them more frequently. The system that is currently in place in New Jersey works. Can you imagine the cost involved when the NJ DOH OEMS tries to regulate ALS at the municipal level. Let's try to focus on something that can change things for the better instead of trying to fix something that isn't broken.

The point that I am trying to make is. With volunteers, even though they have the certification, you have no recourse if they don't cover their duty night or break squad rules, etc. Oh, you can suspend them for not making a call on the duty night, but that only hurts the person who has to cover their duty both for the infraction and for the suspension. It doesn't hurt them where it counts, in their wallet. I'm also saying that you can require a higher calibre of provider, if you're giving them a paycheck. I realize that volunteers do it because they love it, but sometimes loving it isn't enough. There has to be a degree of professionalism, if we're ever going to earn the respect of the rest of the medical community. Desire is not a direct reflection of compentency. With professional personnel, you can require uniformity. Many volunteer squads takes calls in civilian attire because they were living their lives,which doesn't lend any credibility to their service and dosen't give the patient the sense that they are being cared for by a professional. As for professional providers not caring, that's BS. If we were only doing it for the money, then we would do something that pays better. I do it because I love it, but I still need to pay my bills. You pay someone to fix your car, pick up the trash, and deliver your mail, but the general public expects EMS to get out of bed @ 03:00 in the freezing cold rain to pull someone out of a wrecked automobile after they have been drinking. All this for free, and the volunteer still needs to get up & go to work in the morning. If you have paid staff, they are already there working, with a duty to act and it doesn't infringe on their regular job, because it is their regular job. On top of that, volunteer rescue squad has to stand on the road and beg for donations for much needed equipment. I don't understand this train of thought at all. Lastly, I have worked in both hospital & municipal EMS system and most municipalities do not have enough allocated money to support a proper ALS system. As previously mentioned, most municipalities are more concerned with keeping tax dollars down, while hospitals have reputations to think about, so in turn require better patient care. Hospitals are also have a better grasp of the cost of medical equipment and following State Dept. of Health regulations.

OCFD does employ MICPs, but not as MICPs, but as EMTs. OC can not run ALS calls because they do not have a CN and no Online Medical Control. The Medics than are employed by OCFD are top notch and work for AtlantiCare as Medics.

It's not the volunteer squads that are short sighted or greedy. The volunteer squads can not run ALS, because they can't obtain a Certificate of Need. ALS Cert. of Need can only be held by a hospital based system. As for hosp. based ALS, such as Monoc, Virtua, UMDNJ, AtlantiCare, etc., they are better suited to run the ALS programs, since they provide the medical control, Q&A, etc. Municipal squads can not afford to to even attempt to do this much less volunteer squads. Some of the vollys bearly can afford to equip a BLS ambulance. As I mentioned before, having paid personnel gives you the opportunity to be more selective in who staffs your rigs. Whether it be BLS or ALS, and most municipalities can only afford to provide BLS. Most of the calls are of a BLS nature anyway.

I wouldn't have called it a bidding war, but AtlantiCare did submit a bid for the Atlantic City 911/ EMS contract. The contract however was awarded to Exceptional Medical Transport for another 3 years.

Although I agree that NJ municipalities need professional EMS. I'm not in agreement that they need to be ALS providers. Many municipalities don't have the budget to support the number of ALS providers to fully staff their stattions. In addition, many calls are BLS in nature and ALS providers would be overkill. What we need is professional BLS providers, that have made EMS a career choice and not rely on volunteers to be our primary responders. With volunteers you get what you pay for. This is not their profession. They have other jobs and responsibilities and can not continue to fullfill the training requirements and the duty schedule to meet the municipalities needs. With paid personnel, you are guaranteed to have someone manning your stattion and have the proper credentials ( or they don't work). You also can hold an employee to a higher calibre than someone who does it for nothing. I've heard the story before that a volunteer has a higher level of community. That's hogwash, I've been a professional EMT for 25 years and it's always been about patient care, no matter what community I was providing service in.