How to improve EMS professionalism

[ERDoc]

For all those who are saying "My town can't afford...", lets break it down at a community level. Someone quoted to me that the cost of running a 24 hour ALS response ambulance staffed by two paramedics is around $1,000,000 a year. I think that may be a little high, especially since the person was talking about in the greater NYC area where prices of everything increase substantially. But lets use $1,000,000 a year for round the clock ALS service and transport. Okay, so if we broke it down evenly over a populace, which of course given tax rates wouldn't be the case, but lets say we break it down evenly over a populace, in a city of 20,000 people, the cost per person per year is $50.00. Yes, $50.00, or 13 cents a day per person to have round the clock, professional advanced life support at your beck and call, and that doesn't even take into account the fact that unlike a police or fire department, EMS can actually generate some of the revenue back. Certainly not $1,000,000 a year, but enough to defray a good portion of the funding. For instance, if you averaged 3 calls in a 24 hour period, your call rate for the year would be 1,095 calls for the year. If you billed $500.00 for each transport and only half the people or their insurance company ponied up the dough, you would generate $273,750 dollars a year. This leaves your operating costs at $726,250, or $36.31 per person per year for the ALS service, or roughly ten cents a day. Now, I ask you, is it really all that expensive to go paid ALS? And to be perfectly frank, if a town of 20,000 people doesn't want to pony up ten $.10 to $.13 cents a day to have me risk my damn neck, wreck my knees and back and leave me with a headful of bad memories, then honestly, f--k them. If they want something for free, I will gladly say "I told ya so!" afterwards.

Oh, and as Lt. Columbo would say, just one more thing sir. I have never understood this. If you don't want to be a paramedic and do all you possibly can to treat the sick and injured, why exactly did you get into EMS? I mean, if you have true desire to help others by providing prehospital emergency care, wouldn't you want to be able to do all you possibly could for your patient? Doesn't it bug you just a little that your patient may be suffering or even dying because of your lack of skills? This really isn't a slam against EMT's. It's honestly something I never quite got.

Asys, maybe you should head out to Suffolk County and show some of these numbers to the tax payers. The volley system out there is so overburdened that they could use a little help, but the volleys are too proud to open their eyes (despite the fact that most of them are already paying people). There are companies that run 3-4 calls/day and still have budgets over $1,000,000. You also have coompanies that have a huge membership, lots of ambulances and still are being overburdened by the call volume (CI-Happaugue, Brentwood to name a few). If the county went to a paid or even a paid/volley system, but consolidated everything they could probably save so much money and help ease the property tax burden that has caused so many people to leave.

[ERDoc]

Asys, maybe you should head out to Suffolk County and show some of these numbers to the tax payers. The volley system out there is so overburdened that they could use a little help, but the volleys are too proud to open their eyes (despite the fact that most of them are already paying people). There are companies that run 3-4 calls/day and still have budgets over $1,000,000. You also have coompanies that have a huge membership, lots of ambulances and still are being overburdened by the call volume (CI-Happaugue, Brentwood to name a few). If the county went to a paid or even a paid/volley system, but consolidated everything they could probably save so much money and help ease the property tax burden that has caused so many people to leave.

Sorry about that post. I guess it is a little to "local" to be of any use here. My appologies.

[emaxray]

...you think a town/city of 20k can run one rig, staffed by two ALS providers for .13 cents a day. I live in a town of 30k and it takes two services running 5 rigs each to take care of the assistance load 24 hours a day. On rig and one crew dont work in a town of 20-30k and you know that to be true. Thats just a worthless suggestion. That would bring us back to 40 minute response times. And if you dont want to hurt you back and your neck, and if you cant handle some unpleasant memories, then be a florist. Thats what EMS is about. If you work in NYC or Dynamite Springs, BFE, these things are going to happen. Is your back any less hurt or your memories any less disturbing for 45k/year than for a lesser amount. Pheh! and minus 10 for faulty reasoning and figures not based on fact. The fact is that even you, in your "infinite wisdom" couldnt provide adequate service to a town of 20k with one rig...and its not like it wold be one crew running 24/7/365...you would probably need something more like 3 crews to covers time off, sick leave, family emergencies. The city of 30k I live in has 3 extra crews on each service just to cover such eventualities. And if you have that one rig and its on its way to say, an acute MI call, and it gets hit going through the intersection....how much cardiac muscle will your patient burn when there is no back up. There are enough holes in your plan to drive that rig through. And even if it worked...do you honestly think they are at the communities "beck and call." Double Pheh!

First I read it as, for 13 cents a day one rig (to continue the implied it seems, 26 cents a day get 2 rigs, 39 cents a day...) basically meaning it really would be all that hard or as expensive as the people who say it would cost too much. Maybe one rig couldn't do it, but it isn't as far fetched to think there couldn't be enough provided.

Second, yeah, both parties back are hurt, yeah both have bad memories, but only one was paid to do it and can afford therapy from doing it, etc, etc.

Third...eh...I read only an example of how a system can be affordable.

-5 for not being able to read between the lines.

[NREMT-Basic]

Perhaps, just perhaps, you could run a paid ALS service this way. I doubt it. What I would like to see is where the magical problem solving numbers come from. It always make me doubt the accuracy when someone gives a statistic and says something like 'a friend told me.' Anyway, we are now all guilty of massively hijacking this thread.

-15 to all those who participated in knocking this thread off the rails (including myself).

Now if you'll excuse me, I just found .13 cents in the couch cushions...Im going to go start an ALS service.

[Asysin2leads]

You assume that everyone who gets into EMS wants to become a paramedic...the Paragod complex rears its head. Thats like saying that every person who goes to nursing school to work in an ER actually wants to be a trauma doctor. And you think a town/city of 20k can run one rig, staffed by two ALS providers for .13 cents a day. I live in a town of 30k and it takes two services running 5 rigs each to take care of the assistance load 24 hours a day. On rig and one crew dont work in a town of 20-30k and you know that to be true. Thats just a worthless suggestion. That would bring us back to 40 minute response times. And if you dont want to hurt you back and your neck, and if you cant handle some unpleasant memories, then be a florist. Thats what EMS is about. If you work in NYC or Dynamite Springs, BFE, these things are going to happen. Is your back any less hurt or your memories any less disturbing for 45k/year than for a lesser amount. Pheh! and minus 10 for faulty reasoning and figures not based on fact. The fact is that even you, in your "infinite wisdom" couldnt provide adequate service to a town of 20k with one rig...and its not like it wold be one crew running 24/7/365...you would probably need something more like 3 crews to covers time off, sick leave, family emergencies. The city of 30k I live in has 3 extra crews on each service just to cover such eventualities. And if you have that one rig and its on its way to say, an acute MI call, and it gets hit going through the intersection....how much cardiac muscle will your patient burn when there is no back up. There are enough holes in your plan to drive that rig through. And even if it worked...do you honestly think they are at the communities "beck and call." Double Pheh!

Oh where to start, where to start... Okay, let's start with the paragod complex thingy. Its a sad, trite arguement, but I'll bite. First of all, a nurse's job and a physician's job are completely different. A nurse's job is to care for the patient and make sure they recieve the appropriate treatment that has been prescribed for them, among other things. A physician is a scientist who specializes in the human body and its processes. A better arguement would have been "Not all nurses want to be nurse managers or nurse practioners," and to that I would say if we brought the lowest level of provider in EMS up to the standard of RN, I would not ever complain again about people not wanting to go further. Seriously though, and I hate being put in the position of saying this, because I have many friends who are EMT's and I respect them, but being an EMT is lifting, driving, CPR, first aid, and vital signs taking. In the grand scheme of professions, it is harder to get your CDL then it is to get your EMT. So in that aspect I am very suspect if someone's major accomplishment in life was passing the EMT course and then they want to settle in to that for the rest of your life. If you never had the ambition to go further than EMT, than usually ambitions such as quality assurance, going the extra mile, and keeping the ambulance tidy usually go right along with it. If its Again, this isn't a slam against EMT's, this a personality profile of the typical person who is a career EMT. Generally speaking if it's "Screw being a paramedic, I'm getting paid as an EMT" then usually, "Screw carrying the cardiac patient, I'm getting paid anyway" goes right along with it. If you think there is a flaw in this reasoning, please, feel free to share it.

Okay next, you attack my reasoning about the toll it takes on a person doing this job. If you never have the joy of slipping a disk and then finding out exactly how the community you worked so hard to help will turn their back on you, be grateful, because I know a lot of people who thought being a volunteer firefighter or EMT was the greatest thing until they got injured and now survive on welfare. If you've never been through physical therapy, then don't even try to give me the pseudo tough guy "go be a florist" crap. Oil workers are well compensated and the physical toll of their job is taken into account. People need oil just like they need EMS, so I don't see why anyone who does this job shouldn't be protected the same way.

My model of course took many liberties and was used just to illustrate a point, that all things considered, professional, paid ALS is not that expensive for a community. I have also said there are communities that would benefit from volunteer first response as opposed to nothing. However, most communities that utilize volunteer services could well afford paid EMS, such as Long Island, as ERDoc noted, and the only reason they don't is because of stubborn, arrogant volunteers who's need to be a hero outweighs the health and safety of their community.

[brock8024]

Sorry for any spelling errors!!!! I am human

I hope that a lot of people who are on here calling others names and thinking they are better than others look at the title of this thread. The senior members on this board so far have been very respectful of everyone and the ones with the hot heads are being unprofessional.

Now how to fix the whole ems problems? Get young people who are willing to fight for better ems along with the older people of ems. We should stand together and make a difference in our profession.

I go to the only national recognized paramedic school in oklahoma. It is not a easy road to get through by any means, but I chose the road. I could have picked a 11 month course or school with less standards but I am DAMN proud of what I am about to accoplish. I am not saying that others are not better or harder but come and see what we have to do to get our A.A.S. I have talked to other EMT students and they do not know near what I will know or my classmates. Hell some do not even know how to do a 12 lead which I find scary. Here is what I am tested on affectively

Integrity,empathy, self motivation, appearance and personal hygiene, self confidence, communitcation, time management, teamwork and diplomacy, respect, patient advocacy, careful delivery of service.

I have other student tell me that I have to do way to much stuff to get through medic school but I do not care. I like knowing that when I walk across that stage and get my degree that I have gotten probly the best education in the state.

As far as the whole Volley thing goes, I will have to agree that they hurt the rest of us. I mean they pay everyother city offical there and probley pay them more than they are worth. Trust me if all the volleys stopped working and that mayor's wife ro kids got hurt the would find a way to have a ambulance. Why can they not make a deal with other towns and put stations between the towns? Or hell increase their water tax or something to make money for a ambulance. I think it is funny that there is no money for a ambulance but they will pay for joe blow to go to school to be a EMT B. There is no money for a ambulance but they can have picnics, parades, all the city officals they do not need, but do not want to pay for a ambulance. WTF

What is wrong with our world. I got into EMS for one reason and that was to help people. I chose to be a medic so I could make the choice. I did not want to be that EMT I or EMT B that gets on these boards bashing the medic because "THEY" would have done it different. I mean get off your butts work a little harder to get through a good school and be a professional. Stop gripping about everyone else and take the steps to make your community a better place, not getting on here throwing stones at others because you community is in trouble.

Brock

[emt322632]

I would have to agree that the whole "Volunteer vs. Paid" argument definitely hurts EMS professionalism, mostly because we're all so busy arguing amongst ourselves that most of the time we forget why we're here: the patient.

Example: The volly squad that serves in the area where I work is grossly understaffed when it comes to ALS. When I work, they generally do not have ALS available, but refuse to dispatch us because they have a problem with 1 person on our staff.

We don't suffer because they won't call us, they don't suffer...ultimately the patient does because a higher level of care could have been delivered quicker, and wasn't...

Volunteer squads really do, in a way, hinder EMS...after all, if you're selling something, and someone else can come along and do it for next to nothing, wouldn't you accept it?

I've seen the same suggestions to improve U.S. EMS here that I would have made...

Increase education requirements :move away from teaching "technicians" and move toward training "clinicians".

Increase pay : a happy employee is more than likely going to love their job, and show it when they work their job.

Decrease volunteers: Volunteers are great, but hey, sometimes they can't get out quickly or at all...

Just my .02

[mediccjh]

Last night, while working my part-time ALS gig, we got dispatched 4 times with the jolly-volly BLS crew for jobs.

4 times they did NOT get out.

How professional is that?

Back on track now.....

If we can all hold hands, sing kum-bay-yah, and share milk and cookies, that would be the first step to improving professionalism in EMS.

[PRPGfirerescuetech]

If we can all hold hands, sing kum-bay-yah, and share milk and cookies, that would be the first step to improving professionalism in EMS.

ummm, how long have i been promoting kum-by-yah? Amen to the thought friend.

[Laura Anne]

Psst, Mediccjh?? Can we have chocolate chips cookies, please? They're my favorite.....

On a more serious note, I feel a true professional is not someone who has a higher level of training, but someone who shows their expert knowledge at the level that they hold. Next, I see a true professional as someone who wants to better themselves by continuing to expand their knowledge. A true professional does not do it for the amount of pay, but for the desire and love of the career. In my eyes, someone who shows they're a professional does not use scape goats, excuses, or bash another person in the same 'family' to make themselves look better. HELLO? Exactly who are you trying to impress by name calling? Certainly not anyone who takes this career with pride because by name calling and picking fights, you only make yourself look like a less of a professional. Last, I would see any medical responder of any level be considered a professional if their compassion shines through. This is not only for the patient, but for any family/bystanders as well as co-workers you come in contact with. Fire and Police consider themselves a 'family'.

Why can't we all just get along????

Ahem, sorry a bit Rodney King there.....