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In Your Opinion, What Is Holding USA EMS Back?

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Great topic. One that can go in circles forever, unless action is taken beyong us talking about it here and in other forums.

So far I agree with most of the comments. But..

No vollys

how about no volunteers on 911 calls , unless

1. it's out i nthe sticks where volunteer Ambulance crews back up the paid, health professional paramedic / emergency care proactitioner ( i.e. advanced practice paramedic /PHRN)

2. it's solely as COMMUNITY first responders and strict no whacker / wanker rules over POVs

No EMT, EMT-I, EMT-CC etc. - One license, One Level - Paramedic

doesn't work - paramedic or other Pre-hospital specialist Heal;th professional on every call, other roviders are there to act under his /her direction

also a single license mentality limits the possibly of developing advanced practice

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Having separate level providers EMT, EMT-I etc is one of the problems in EMS.

How can we expect to get licensed when someone goes thru a 120 hour course to be an EMT?

This also confuses the public, they don't know what to expect when they call 911. Some guy with an oxygen tank or someone with a mini ED.

I also feel that by promoting one level and therefore one standard of training. It will be much easier to pursue the cause of making EMS it's own entity and get that license and standard of education and care implemented.

By having all these separate levels, you would have to approach it with

an EMT can do this but not that

an EMT-I can do that but not this

an EMT-CC is allowed to do almost this but still

cannot do that.

Imagine someone with no clue about EMS looking at us and trying to figure all that out and give support to the goals we have.

I've been in EMS for over 16 years and my own family still doesn't understand what I do.

It's a hard sell IMHO.

When you have a system that is so all over the place, what needs to be done is practically breaking it all down and starting from scratch.


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To summarize the multi problems in the U.S. EMS in one word.. it would have to be .. OURSELVES!

There are multiple problems as addressed and I agree, but realistically we are the source of our own demise. What is the difference between any other successful profession and ours? Compare ourselves with nursing, it took them years to finally decide enough was enough and change their profession drastically. We can and should learn off other medical professions as well. Respiratory therapists, physical therapists all changed and not only demanded more from their profession, demanded more from themselves.

All successful professions became actively involved in the legislative process. They defined themselves as professionals and would not allow anyone to lower their standards and in fact would increase them more and more. Quite the opposite from EMS. Some reason we implore the fast and quick and half-ass methods than to ever do things the right way.

Even though we attempted not to mention education, we cannot discuss progression without it. Again, comparing other successful medical professions, we have to acknowledge one of the first requirements was to increase the education requirements. As well, with that as an ace in the hole; they were able to lobby and campaign for higher reimbursement rates.

I am surprised EMS is not in worse shape than it is in. I am also surprised that Medicare pays as much as they do for a 20 minute taxi ride. In comparison with other medical professions we are lucky to get what we get.

It is not atypical to send a person that has a first aid type course and then be able to transport a patient to the hospital, and collect $200 to $300; that is not too bad. Especially since most of the treatment is rarely more than palliative, and few patients get more than the basics, and very little treatment really provides changes in outcome. As well our profession is very limited, we continue to only "lock" ourselves and limit our education and skills to "emergency" scenarios and situations, especially since we know that those specific areas do NOT pay, and to be realistic emergency calls are rare and few.

Those that are really in medicine know whom causes the real changes. One would wish it was physician and health practitioners; it would make sense. However; ask a physician if they can admit anyone that really needs it or whom they personally believe needs treatment... and you will find they are restrained.

The controller of medicine and EMS is the payers of services rendered. Medicare and insurance payers. They set the standards by what the reimbursements or payments is made (how much, when and how). Again, we need to turn and look at other medical professions and see how they increased their reimbursement rates. By doing so increased their professional benefits (pay, respect, and longevity). Again, one thing in common was they increased their education requirements so they could justify themselves to the payers.

So until EMT's really become involved to become shakers and movers, not whiners and moaners, nothing will improve and yes things could become worse. We will see how important this so called profession is to all.

If you do not work upon and support changes, then you are part of the problem... short and simple.

R/r 911

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also a single license mentality limits the possibly of developing advanced practice

How do you figure?

MDs/DOs have a single licence system, yet that doesn't seem to stop them from becoming brain surgeons.

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Scott 33 hit a few good points that I'd like to expand on...........

Lack of Autonomy:

I have found that most services that have a higher level of autonomy, have it because of limited government interference. In Texas, the physician decides what a medic can and cannot do, not someone sitting in the state capital. I see many states that have "State protocols" and I have to say, I'm not impressed. Most are way behind the 8 ball.

Professional status:

1 level for primary 911 response..........PARAMEDIC. Create an equal level of professional responders who are dedicated enough to complete this course of education. Stop hiring the 120 hour first aid wonders who are looking for a side hobby. Most currently do it because it a) is extremely easy and quick to obtain and B) offers an immediate gratification and increase in adrenaline release. Neither of which are remotely a decent excuse to be on an ambulance..............


4 year undergraduate degree preferred or at least a 2 year A.A.S. degree. Get rid of all these "Sally Struthers" programs and fire based programs. The FD only wants medics for one reason, to increase their budget.


Get rid of 'em or start regulating them. I'm not going to get too deep into the whole devaluing of employment that occurs with volunteers, but all too often , the volunteers are allowed to do what ever the hell they want to. They should be held accountable to the same standards and policies that a paid employee is. That alone will take care of most of them since many will no longer want to volunteer.


RAISE IT! Communities and administrators listen up! We are performing a service, bill for it! Tax for it! Stop with the excuses, stop saying that the "community won't approve it". If they don't want to pay, then don't use our service. If they truly need it and cannot pay, then we can work with them. But this belief of entitlement in today society has to stop. You want quality service, then you will pay for it. Believe it or not most citizens ARE willing to pay a premium for quality, too bad the powers that be fail to recognize it.................

As always, just my humble thoughts and opinions............. :lol:

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Private ambulance companies.

And especially AMR.

AMR just cares about making their shareholders happy. Because they do such a terrible job of serving our community (not staffing units, not trying to retain experienced employees, hiring 19 year olds), they are destroying the image of EMS in the public's eye. Professionalism is obviously a huge problem for EMS, and AMR is helping to make it worse. And of course that makes it easy for the fire department to step in and take over.

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New level of training, requiring a degree. Not sure if Associates or bachelor. Call it Pre-Hospital Care Provider. PHCP. This would be at least Paramedic level. Maybe more so that the PHCP would have more latitude in field to be able to treat and release.

Get EMS out of fire is my other thought.

But what do I know, I am just a volunteer EMT-B.


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I figure most here would not remember Bill Mauldin. He was a cartoonist in the "Stars and Stripes" military newspaper, back during the Second World War (not that old, myself, but I read a few of his books).

One comic panel he had in his book, "Back Home", showed a couple reading a newspaper, which every headline was Veteran this or Veteran that. One comments to the other, "There's a story of a triple ax homicide on page 17, no veterans involved!"

Figure it this way. After the old adage, "If it bleeds, it leads," for garnering a headline, even so-called "union friendly" newspapers go after public servants, as "they failed to maintain their 'higher standards' BECAUSE they were public servants, and tarnished the image we, the public, have of them." The wording is mine, but you get the idea.

I have one of his books. If you look at some of the comics, you will see that some of the patches on some of the soldiers match my avatar, for he was a Thunderbird.

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