Increasing Education from a perspective of system management

[actualparamedic]

Wow. Sounds like a really dedicated bunch of professionals to me. Definitely the sort of wankers I want working on my mother or child. To price EMS out of the budget of wankers and make it a professional service of value and worth that people understand they have to pay for. Okay, suddenly you are no longer talking about rural volunteers and first responders anymore. Now you're talking about EMS at large. First of all, less than half of those Bs are actually in EMS, so whatever they do or don't do is of no consequence to the profession. Those who downgrade to first responder will be out of a job. And if the job meant so little to them that they would do that, then good riddance. I am very happy to see them go. And again, that is the very point of elevating the profession. To get rid of those whose heart and soul isn't in the profession and create a professional atmosphere that will attract and retain people of intelligence and commitment to EMS.

First of all, I want to make clear that I am not talking about rural volunteers, I was definitely talking about EMS at large. There are more EMT-B's in metropolitan/suburban areas than rural areas (on fire departments, working for tranfer services, and paid-by-the-call personnel).

All of your rebuttal points are valid in their own right, but you ignore the reality. EMT-B's by and far still make up the backbone of EMS in the United States today - more than 70% based on that study from 1993. And while paramedics and EMT-I's are plentiful (and even over-concentrated in some states) they are a scarce commodity in other states. Your original post says to do away with EMT-B's and make EMT-I the new minimum standard, and that will never happen.

You haven't substantiated your tossing out of the fact that more than half of the licensed/certified EMT-B's aren't actually in EMS. Where do you come up with that number? I haven't seen any literature or studies affirming that or even suggesting that.

Making EMS a paid venture isn't just a consideration of dollars and cents. In some cases, compensating EMS providers leads to not professionalism but rather an atmosphere of complacency and entitlement. What about the thread on this forum regarding the decline of volunteers in New York State - down many thousands over a decade. Creating a paid EMS infrastructure will cost taxpayers according to the article some $7 billion. Talk about a taxpayer revolt! Do you think folks in metro NYC and collar counties are going to shoot this hypothethical referendum down at the polls since it addresses a need most urgent in central and upstate New York?...you betcha!

I'm guessing you live in metro D-FW from some of your previous posts -- how would you feel about a $125.00 property tax levy on your house next year to support EMS down in Brazoria County or somewhere in Hill Country or maybe west Texas if it doesn't directly benefit you.

If EMS was such an easy fix following this path then why hasn't it been implemented before? Also, you seem to have been around the block enough in multiple disciplines to know that functioning at a higher EMS level doesn't necessarily translate to better care for a community. Example: a dedicated, active provider who had marginal BLS skills to begin with is suddenly forced to transform into an EMT-I, passing his written and clinical exams by the skin of his teeth. He just isn't cut out to be an intermediate life support provider and after 14 months leaves EMS altogether because he can't do it well. There are no EMT-B's so he has nothing to fall back on. Good riddance? You just forced someone out of a job who was dedicated to EMS, and that won't be lost on his co-workers/co-volunteers/family.

Remember, every provider level has their place in working cooperatively to effectively deliver EMS even if it's not the way or at the level you think it should be delivered.

While this forum is all about exchanging ideas, spirited debate, and expressing opinions...you're shooting from the hip on this one. The suggestion of eliminating EMT-B's with a forced national upgrade to EMT-I is on the periphery at best. The logistical, training, and provider compliance issues not to mention implementation burdens by each individual state is a decade-long proposition.

Plus, how will you pay for this sweeping national EMS practice reform? Don't think for even a minute the federal government will be pitching in anything!

[Dustdevil]

EMT-B's by and far still make up the backbone of EMS in the United States today - more than 70% based on that study from 1993.

So what? Horses used to make up more than 70 percent of transportation in this country too. Do you miss them? Did their demise inconvenience you? Did you shed a tear for all those dedicated farriers and stable boys who lost their jobs to the horseless carriage? And how did we ever pay for all these horseless carriages anyhow?

You see, times change and society matures and progresses, nostalgia for a simpler time be damned. That is the answer to all of your questions.

Your original post says to do away with EMT-B's and make EMT-I the new minimum standard, and that will never happen.

Just to clarify, that was meaning for EMS AMBULANCE personnel. I would not apply that standard to first responders or non-emergency ambulance personnel. And first responders and non-emergency ambulance personnel comprise the largest portion of registered EMS personnel.

You haven't substantiated your tossing out of the fact that more than half of the licensed/certified EMT-B's aren't actually in EMS. Where do you come up with that number? I haven't seen any literature or studies affirming that or even suggesting that.

Have you looked? Most states keep statistics on these things. Texas statistics show that a huge chunk of registered personnel are not active in EMS. They left the field for a real job or they were never in the field in the first place. While I admit to having never sought statistics from other states, common logic and knowledge of the EMS field says they remain similar to Texas. Pennsylvania's big recruiting push for medics includes a campaign to send letters to thousands of inactive EMS personnel and ask them to return to the field. If those people didn't comprise a significant block of personnel, they wouldn't have bothered with that.

Creating a paid EMS infrastructure will cost taxpayers according to the article some $7 billion. Talk about a taxpayer revolt! Do you think folks in metro NYC and collar counties are going to shoot this hypothethical referendum down at the polls since it addresses a need most urgent in central and upstate New York?...you betcha!

Screw New York. They have not yet found the problem that they couldn't overbureaucratize to the tune of billions and STILL not even come close to solving. They could easily eliminate half of the BS programs in that state and afford to train paramedics for the rest of the country with the leftover money.

There is the problem. Too many people get myopic with the costs and think only in terms of finding extra money when all they have to do is restructure their priorities. And trust me, when EMS disappears because it is no longer a freebie, they WILL find a way to fund it. Even in New York. Maybe instead of volunteer ambulance services we can pay EMS and have volunteer librarians, bus drivers, janitors and lawn mowers.

I'm guessing you live in metro D-FW from some of your previous posts -- how would you feel about a $125.00 property tax levy on your house next year to support EMS down in Brazoria County or somewhere in Hill Country or maybe west Texas if it doesn't directly benefit you.

Braziora County can raise THEIR property taxes for THEIR EMS service if they need to. What makes you believe that the cost needs to be spread statewide? Incidentally, what you suggest is actually what they are doing with education in this state. They take money from rich districts and send it down to the poor districts. And yes, nobody likes it and it is being challenged in court.

If EMS was such an easy fix following this path then why hasn't it been implemented before?

Simple, because nobody is eager to pay for something they used to get for free. Especially when it is something they really know nothing about and have never themselves even utilized. The public has to be educated that EMS is not just a ride to the hospital anymore, and that it has to be funded and operated professionally just like any other medical service. The good 'ol days are over for good. Pay or die.

Also, you seem to have been around the block enough in multiple disciplines to know that functioning at a higher EMS level doesn't necessarily translate to better care for a community. Example: a dedicated, active provider who had marginal BLS skills to begin with is suddenly forced to transform into an EMT-I, passing his written and clinical exams by the skin of his teeth. He just isn't cut out to be an intermediate life support provider and after 14 months leaves EMS altogether because he can't do it well.

The example you give does not show EMS functioning at a higher level, and therefore does not illustrate your point. Functioning at a higher level is more than semantics or a patch. Functioning at a higher level does indeed translate to better care for a community. Does it translate into decreased mortality and morbidity for every patient? No. Not every patient needs ALS and not every patient presents with a survivable condition, regardless of care. But there is no patient who does not benefit from being evaluated and cared for by an educated medical professional over a basic EMT. The ability to be professionally examined by a person capable of determining your condition and potential need for advanced care is in and of itself a benefit.

There are no EMT-B's so he has nothing to fall back on. Good riddance? You just forced someone out of a job who was dedicated to EMS, and that won't be lost on his co-workers/co-volunteers/family.

Tough luck. Aren't you the one who decried the sense of entitlement earlier? Nobody is owed a job in EMS. You earn it. And if you fail to earn it, you may lose it. That's business. That's quality assurance.

Remember, every provider level has their place in working cooperatively to effectively deliver EMS even if it's not the way or at the level you think it should be delivered.

Absolutely. But an EMT-B's place is not in charge of an emergency ambulance. Period.

While this forum is all about exchanging ideas, spirited debate, and expressing opinions...you're shooting from the hip on this one.

I have considered and reconsidered most every aspect of the profession from most every point of view for thirty years. I stopped shooting from the hip on EMS probably well before you even considered joining EMS. If and when you ever match that experience, I am confident you too will see things closer to my way.

The suggestion of eliminating EMT-B's with a forced national upgrade to EMT-I is on the periphery at best. The logistical, training, and provider compliance issues not to mention implementation burdens by each individual state is a decade-long proposition.

Interesting theory. However, that's what they said about two-year nursing schools and four-year medical schools. Guess what; both of those proposals came to pass. And guess what else; the healthcare system didn't collapse.

Your suggestion that those providing emergency medical services shouldn't be at least as well educated as the guys doing x-rays, urine tests, and breathing treatments at the hospital is on the periphery at best. I really don't see how you can defend it.

Plus, how will you pay for this sweeping national EMS practice reform?

Already asked and answered multiple times.

[Ridryder 911]

I too agree with Dust.. Why buy the milk, when the cow is free"... Yes, there are areas where volunteers will always be needed and used. But, for the most part, cities that I have heard complain are usually over 30k to even a million people. Some even admitted that they use freight-liner ambulances and have 5 medics in the back of the rig.. ( I guess this is the reason for the big rig?) Then they try to tell me that the city can not afford professional EMS...

Just like any other health care profession, we too have to progress and change. Just like all the others there will biting, gnashing of teeth, & clawing as we try to improve the system and the profession. Hopefully, we can learn of nursing profession and not take 150 years to change.... so far we have 40+ and still holding onto what we have. I have mentioned this before but really think about it... when Johnny & Roy ; Emergency was on t.v. 35+ yrs ago... they are doing more advanced EMS care than a lot of EMS units are still today.... now tell me, if that is not disappointing and SCARY !

I agree with Dust and had been almost crucified here long time ago, when I described that until we truly hit the public where it hits the most we will never be appreciated or treated like a profession. It took disasters for the fire department to receive attention for the public to appreciate their role in rescue. what will it take for EMS. Again, as long as someone will do it for free and there is at least someone there... no one cares...In most people eyes we are a luxury or "just there". There is no real deterrent foe not having ALS units other than death... with Police they are required of crime & dangers, with the F.D.they are required because of the I.S.O. ratings .. but EMS... try to justify us. Other than loosing a loved one, which usually is thought as "well, death happens"....don't believe me ? look at how many AED's versus fire extinguishers... now think how many full arrest you work in those same buildings versus the number of fire's they have....

Something to think about ....

R/R 911

[Nate]

I have to agree with Ridryder and Dustdevil here. I truly don't think that people understand thae difference between EMT-B and paramedic. After all to most of them we are "ambulance drivers" in their eyes. Most are shocked we even do anything in the back of that little box.

[PRPGfirerescuetech]

I have to agree with Ridryder and Dustdevil here. I truly don't think that people understand thae difference between EMT-B and paramedic. After all to most of them we are "ambulance drivers" in their eyes. Most are shocked we even do anything in the back of that little box.

I wholeheartedly agree with you there. Thats a whole additional public education issue to discuss....

[Nate]

Most of the volunteers that I've worked with as a paid paramedic have told me the reason why they don't "go paid" is because they would take a pay cut and they don't want to lose their ability to do EMS. My old volunteer fire department had a lot of paid union guys that volunteered there. They flat out said they would volunteer until the department went paid because they didn't want to see their community do with out.

As a result that department is headed towards paid full time and I think most of them will leave HFD and continue on there.

[actualparamedic]

Dustdevil - why don't you create a draft of your plan to establish a sweeping new EMS system and send it to NHTSA, NAEMSA, NREMT, congressional/senatorial reps, and all 50 state EMS directors and see how well it is received? A well written proposal won't be turned away by any of these organizations, especially if you have a viable funding solution in place.

Don't want to send it off to all of them? Create a website with your proposal and send request for review to your targeted audience via emails and snail mail. I would be interested to see if the wheels begin to turn. If nothing else, you can create a united front with more folks who support your ideas and get them out and circulating.

Just because Penna has sent out letters to "dormant" EMS providers doesn't imply that 50% of their EMS providers are not actively employed or volunteering. As a sidebar, Penna has spent a great deal of their 9-11 Homeland Security money tackling some of the very issues this thread contains. Lots of money spent on blue ribbon panels, grass roots EMS involvement/input from career and volunteer agencies - and no concrete solutions, just ideas and an honest internal assessment of the state's ability to deliver essential emergency services on all fronts. The mailing campaign and EMS recruitment website you spoke about are just two of many ideas.

[actualparamedic/quote]Plus, how will you pay for this sweeping national EMS practice reform?

[PRPGfirerescuetech]

Dustdevil - why don't you create a draft of your plan to establish a sweeping new EMS system and send it to NHTSA, NAEMSA, NREMT, congressional/senatorial reps, and all 50 state EMS directors and see how well it is received? A well written proposal won't be turned away by any of these organizations, especially if you have a viable funding solution in place.

Don't want to send it off to all of them? Create a website with your proposal and send request for review to your targeted audience via emails and snail mail. I would be interested to see if the wheels begin to turn. If nothing else, you can create a united front with more folks who support your ideas and get them out and circulating.

Just because Penna has sent out letters to "dormant" EMS providers doesn't imply that 50% of their EMS providers are not actively employed or volunteering. As a sidebar, Penna has spent a great deal of their 9-11 Homeland Security money tackling some of the very issues this thread contains. Lots of money spent on blue ribbon panels, grass roots EMS involvement/input from career and volunteer agencies - and no concrete solutions, just ideas and an honest internal assessment of the state's ability to deliver essential emergency services on all fronts. The mailing campaign and EMS recruitment website you spoke about are just two of many ideas.

[actualparamedic/quote]Plus, how will you pay for this sweeping national EMS practice reform?

[Dustdevil/quote]Already asked and answered multiple times.

[BrianG1984]

pyroknight- It is true that well trained auto mechanics make more than emt-b's not paramedics. I am currently making 11/hr plus on a commission program where I make around 13/hr average. EMT-B jobs with alot of the private providers in my area pay anywhere from 8.00-10.75/hr. However the company in my hometown which is a municipal ALS only service starts paramedics at 48k per year.Granted I know that is on the higher end of the spectrum.ASE certification does not take any investment any moron can pay 20-60 dollars and take an ASE exam. What cost me a fortune was the associates degree in Automotive Technology. That cost me $30,000. My tools are valued around $20,000. So in the longrun an EMT-B would actually make more money that they get to keep than a well trained technician.My point is simply that a low initial investment is a very attractive component of EMS. The investment is not that low compared to other areas of public service out here to go to Paramedic school it costs 6-10k depending on where you go to school. Th police academy is only 3k, and I think the fire academy is 5or 6k(not quite sure on that figure).

Dustdevil- A smart person would not stay at the lowest rank in a field, but more mature, older professionals could enter a career in EMS if the initial investment is low and then move up from there, that was my point in my earlier post.

[pyroknight]

I think you're making my point for me Brian. Paramedics are starting to earn decent money because you can't get a paramedic license in six months anymore. Nearly every paramedic program in the country is now a two-year, associates degree program. If EMT-Bs had to have an associates degree, the entry level pay for EMT-Bs would have to bump up accordingly. If paramedics moved to a four-year degree, they would also see a corresponding increase in their wages. If physical therapists can do it, EMS can too. It is going to require a decision on the part of the industry as a whole that we are willing to make the sacrifices and worthy of the pay.