Professionalizing EMS

[niko327]

Another user asked a question about EMT-P going straight to CCRN on another thread, and it got me thinking about why this would never happen.

Many can clearly see the parallels of critical care paramedic work with the work of the CCRN, but that similarity will never be recognized by the nursing profession. And that's fine because that is what a good profession does to protect its professional interests; it actively limits free access to it's profession by outsiders and set up hurdles that everyone must pass to become a member. That's why nursing is a much higher paid profession than EMS, with far more advancement oppportunity. The Nursing profession has got it figured out, there are alot of reasons why nursing is a recognized and respected health profession and why paramedics are still called ambulance drivers.

EMS should really take a page out of their book, here's a few things to get the ball rolling.

1. Get rid of these RN to Paramedic challenge programs or any other Paramedic Challenge Programs.

2. Set up uniform professional National certification (a national board certification) that makes you eligible for LICENSING in your respective state.

3. Make the EMT-B an associates degree and the EMT-P a Bachelors Degree Program.

4. Phase out volunteerism. When you no longer have people willing to do the job for free, it suddenly becomes valuable.

5. Food for thought.....How great would it be to link the Paramedic Bachelors degree to the PA profession, another 2 years will get you a Masters Degree in Physician Assistant Studies, and voila senior experienced providers have an outlet profession and the PA profession gets well qualified applicants.

I'd really be interested in hearing what other EMS providers/hopefuls think as well as our fellow nursing colleagues, physician and PA friends. Any thoughts about the above? Any other ideas?

---

Members don't see this ad.

 

[jonb12997]

4. Phase out volunteerism. When you no longer have people willing to do the job for free, it suddenly becomes valuable.

Some of your ideas are good, but I'll say that I'm not usually very agressive on here, but I've got real problems with this idea and need to say something... there are many small towns that can barely afford a used 15 year old ambulance with 150k miles on it, let alone paying a paramedic and staff keep it running. heck, most of them have trouble even getting any basics to even volunteer. Getting rid of volunteerism is all good and well in a big urban/suburban area, but in a more rural area, there is NO way that would fly.

 

[Gatewayhoward]

I agree with everything. Small towns do need volunteers though.

 

[Jambi]

2. Set up uniform professional National certification (a national board certification) that makes you eligible for LICENSING in your respective state.

The NREMT fulfills this role already, though not each state accepts it universally.

Have you seen the national scope of practice document? The earlier drafts were more aggressive, but the final is at least a step forward. Getting everybody on the same page would be a great help in regards to the profession.

 

[viostorm]

I agree with everything. Small towns do need volunteers though.

I completely disagree. Small towns often have money for several police officers, yet they do not pay EMS. They pay garbagemen but they don't pay EMS. They pay school teachers yet they don't pay EMS.

Now the specifics of who gets paid in small towns may vary, but the fact is that small towns do pay employees but don't pay EMS. Why would they if people will do it for free?

 

[deleted6669]

5. Food for thought.....How great would it be to link the Paramedic Bachelors degree to the PA profession, another 2 years will get you a Masters Degree in Physician Assistant Studies, and voila senior experienced providers have an outlet profession and the PA profession gets well qualified applicants.

"I'd really be interested in hearing what other EMS providers/hopefuls think as well as our fellow nursing colleagues, physician and PA friends. Any thoughts about the above? Any other ideas?"

I would be in favor of this but what I would like to see is this:
bs emt-p program followed by 2 yrs work as a 911 medic.
work hx + a reasonable gpa say 3.2 guarantees you an interview at the pa program.

about volunteers. I have to agree. I have worked with some good volunteers but I have worked with more really awful volunteers. with some of these folks it would be better if grandma just threw grandpa in the station wagon and drove him to the er for his big mi.
if you weigh 350lbs and are 5'6" tall and run 1 als call a month you are a disaster waiting to happen....and happen it does....every month......

 

[jbar]

about volunteers. I have to agree. I have worked with some good volunteers but I have worked with more really awful volunteers. with some of these folks it would be better if grandma just threw grandpa in the station wagon and drove him to the er for his big mi.
if you weigh 350lbs and are 5'6" tall and run 1 als call a month you are a disaster waiting to happen....and happen it does....every month......

What about people who aren't sure that they want to work on an ambulance? There are staffing probs as it is, volunteering gives people a chance to get involved without having to make the commitment to work as an EMT full time. I think that gives you much better full time people down the road becuase they are more likly to have made the decison to enter EMS with their eyes open rather then just guessing that it is what they want to do full time. I don't think I would be working on an ambulance now without the volunteer ops that I had in the ED, on ski patrol, and on SAR.

 

[docB]

Just a few points to ponder:

The benefits of some degree of volunteerism will continue to outweigh the drawbacks for the forseeable future. It is a necessity (though not always done) to have those volunteers supervised by and given con ed by experienced professionals.

The fire depts who think they are going to make $ by demanding some of the EMS transports in a given area and then force some reluctant firefighters to become disgruntled paramedics are hurting everyone involved. Either do it well with a motivated force or leave it alone.

We need a national standard and cert body for all EMS levels. I can't believe I'm saying that because I don't like increased power at the federal level but in this case that's what I advocate. NREMT doesn't go far enough. If we had nationally recognized certs we would eliminate a huge amount of effort wasted on retesting, challenges and so on. It would increase pay because there would be national competition for people and or jobs, ie. if one state is paying more EMS providers from across the country could go there to benefit from those jobs without a lot of hassle.

 

[emtcsmith]

Another user asked a question about EMT-P going straight to CCRN on another thread, and it got me thinking about why this would never happen.

Many can clearly see the parallels of critical care paramedic work with the work of the CCRN, but that similarity will never be recognized by the nursing profession. And that's fine because that is what a good profession does to protect its professional interests; it actively limits free access to it's profession by outsiders and set up hurdles that everyone must pass to become a member. That's why nursing is a much higher paid profession than EMS, with far more advancement oppportunity. The Nursing profession has got it figured out, there are alot of reasons why nursing is a recognized and respected health profession and why paramedics are still called ambulance drivers.

EMS should really take a page out of their book, here's a few things to get the ball rolling.

1. Get rid of these RN to Paramedic challenge programs or any other Paramedic Challenge Programs.



2. Set up uniform professional National certification (a national board certification) that makes you eligible for LICENSING in your respective state.

---NREMT, my understanding is the RN lobby is the reason why the first national scope was gutted to what it is now. Ask one of my profs that is a nurse and he'll tell you if Docs, Nurses and PA's are not willing to go out into the street and do this stuff then someone is going to have to and they will need to get out there or back down.

3. Make the EMT-B an associates degree and the EMT-P a Bachelors Degree Program.

---And see numbers drop even more. EMTB needs to stay that and you can't make it into a two year program. I can see making the change overall from a medic cert to degree but talk to me more and you'll see there are only 16 places you can do that in a University and will be 15 if Drexel gets its way.


4. Phase out volunteerism. When you no longer have people willing to do the job for free, it suddenly becomes valuable.


---see others comments, just can't do.

5. Food for thought.....How great would it be to link the Paramedic Bachelors degree to the PA profession, another 2 years will get you a Masters Degree in Physician Assistant Studies, and voila senior experienced providers have an outlet profession and the PA profession gets well qualified applicants.

People want to get there medic in 15 months and not two or four years, and see what I said before about how hard is is to find those type of programs. When people start paying medics what they are worth then mabye programs that cost so damn much will become more popular. But ask someone why they would go to school for four years to graduate and make only $15-$20 an hour. I don't want to be a nurse so thats why I'm not going to nursing school but we deserve more for what we do.

 

[DropkickMurphy]

I completely disagree. Small towns often have money for several police officers, yet they do not pay EMS. They pay garbagemen but they don't pay EMS. They pay school teachers yet they don't pay EMS.

Now the specifics of who gets paid in small towns may vary, but the fact is that small towns do pay employees but don't pay EMS. Why would they if people will do it for free?

How do you define "small town"? My hometown doesn't have police (our only law enforcement comes from the county sheriff's department) and our only paid EMS is out of a town 30 minutes away under ideal conditions. The problem is not with volunteers- the problem is with weeding out lousy volunteers which while they don't happen with great frequency, they do still happen.

 

[psychbender]

The problem is not with volunteers- the problem is with weeding out lousy volunteers which while they don't happen with great frequency, they do still happen.

And there are also some really terrible paid providers. The GOB (Good 'Ol Boy) network doesn't just exist with volunteers.

On the topic of challenging, there are a number of people in my area that are going to try to implement a challenge to avoid getting screwed over by the system. In Virginia, we had a certification called Cardiac Technician, which was identical to NREMT-Intermediate 99. To come in line with national standards, they're requiring all Cardiacs to essentially RETAKE their entire class again, for a horizontal transfer (no change in protocols, and can't just recert to I with CE...must use the state's transition modules). I know some ER RN/CTs that are trying to use a roundabout manner to get their medic by using the states that have RN-->medic challenges.

I am going to also implement a challenge in another year. In Virginia, third/fourth year medical students who are currently Virginia ALS providers (CT/I, maybe ST/E) can challenge for paramedic, and take the national registry exam if they can demonstrate sufficient knowledge of prehospital medicine (getting an ER doc to sign off on you). It won't change what I do in the field, as there is very little difference in protocols between a paramedic and an intermediate in my region, but lay people (and EMS providers from out of state) will have a better idea of what I am, and I can get more money if I'm still working.

 

[viostorm]

How do you define "small town"? My hometown doesn't have police (our only law enforcement comes from the county sheriff's department) and our only paid EMS is out of a town 30 minutes away under ideal conditions. The problem is not with volunteers- the problem is with weeding out lousy volunteers which while they don't happen with great frequency, they do still happen.

Like I said, the specifics of who gets paid in your town will vary. I would be surprised if you didn't have a paid garbageman or city employees to keep up with the local park. But, maybe you are just screwed. I have lived in towns of 1500 and they had 2-3 paid police officers, and over $2 million in fire engines. EMS just isn't a priority.

People in rural america make the decision that in exchange for their isolation, they won't have an ambulance and fire services at the same level as urban populations. There are some farming communnities that you could put a fire station at the end of every one of their driveways and they wouldn't be within the NFPA goal of 4.5 mins.

I disagree with "The problem is not with the volunteers" ... to me EMS is not a hobby and should never be. The technical competence is too high and risks are too great. The problem *is* with the volunteers ... volunteers are not unpaid professionals as they claim, they are amateurs.

In the birth of EMS where patients were merely loaded into the ambulance which drove to the hospital, managament could be done successfully as volunteers. Expectations have changed and tolerance of mistakes has changed.

Even working part time now ~12-24 hours / week while in medical school I find my skills are insufficient to make lifesaving interventions at times (just recently, it took me 10 mins to get an IV on a code, and guess what ... he died and he wasn't that tough a stick). I am in a reasonably busy system and spent 2-3 years as a full time paramedic running 10-15 calls/shift. Just like others have commented, throw in the guy who does 1 ALS call a month and it is a disaster, it would be better just to BLS the patient.

 

[viostorm]

The GOB (Good 'Ol Boy) network doesn't just exist with volunteers.

I was a volunteer for 5 years in Virginia ... the GOB network is the reason volunteers are still alive in that state. The rural county "board of supervisors" have strong relationships with their volunteer EMS. Volly EMS agencies are often sources of huge political power in rural Virginia. It allows malpractice like I have never seen before. Often times members of the "board of supervisors" are on the volunteer rescue squad.

On the topic of challenging, there are a number of people in my area that are going to try to implement a challenge to avoid getting screwed over by the system.

CT and NREMTI/99 are a horrible idea, so is challenging. If you want to interpret rhythms and treat people in cardiac arrest I suggest you become a paramedic. There is a huge problem with ALS outcomes in this country, and I think weeding out mid-level practictioners would be a step in the right direction.

 

[niko327]

---NREMT, my understanding is the RN lobby is the reason why the first national scope was gutted to what it is now. Ask one of my profs that is a nurse and he'll tell you if Docs, Nurses and PA's are not willing to go out into the street and do this stuff then someone is going to have to and they will need to get out there or back down.

Why does the nursing lobby have power over national scope in EMS,we don't practice any sort of nursing? Maybe its because of huge political power and a well organized profession. If anything we should be seeking input from the American college of surgeons, american college of cardiology, anesthesiologists etc... but nursing???? And no, I do not hate nursing, its just not right that EMS is subject to some much political influence from an unrelated profession.

---And see numbers drop even more. EMTB needs to stay that and you can't make it into a two year program. I can see making the change overall from a medic cert to degree but talk to me more and you'll see there are only 16 places you can do that in a University and will be 15 if Drexel gets its way.

If numbers are so low to begin with (i'm not neccessarily disagreeing with you), why do you think that this profession is as grossly underpaid and undervalued as it is? I recently saw job advertisements that pay $9.00/hr for paramedics, wildly inappropriate or what the market will bear??

4. Phase out volunteerism. When you no longer have people willing to do the job for free, it suddenly becomes valuable.

---see others comments, just can't do.

I agree that it maybe difficult, but I don't think its impossible. Viostorm brings up a great point about paying for garbage services. What would happen if towns said that we no longer have the money to pay for sanitation?? Public outrage maybe? People would find the money pretty damn quick. But if there were a bunch of selfless citizens out the who just love to pick up garbage for free and cart it landfill sites or their own backyard, I could see the the scramble to find the money slow down considerably. Sanitation is vital to public health, is EMS as vital?

People want to get there medic in 15 months and not two or four years, and see what I said before about how hard is is to find those type of programs. When people start paying medics what they are worth then mabye programs that cost so damn much will become more popular. But ask someone why they would go to school for four years to graduate and make only $15-$20 an hour. I don't want to be a nurse so thats why I'm not going to nursing school but we deserve more for what we do.

$15-$20 an hour, I agree is pretty low, and you said it yourself: "we deserve more for what we do." Unfortunately, we are simply not valued by the allied health professions, why do you think this is? We've got people who will do this job for free in varying states of professional competency, and we have people who are against educating themselves. Collect all the certifications that you want, unfortunately none of them will turn into college degree, none of them will turn into a professional license, and none of them will give you credibility to professionals that have degrees and licenses.

 

[viostorm]

$15-$20 an hour, I agree is pretty low

OMG Niko! I just worked last night 12 hours for $75.00! That is $6.25 / hr. No benefits!

Let me see ... I'm a licensed paramedic, NREMT-P, CCEMT-P, PNCCT, and PALS instructor ... omg I'm getting depressed.

$15/hr! Think of the lifestyle I could be living!

Yay for the paramedic market in West Texas!!!!

 

[niko327]

OMG Niko! I just worked last night 12 hours for $75.00! That is $6.25 / hr. No benefits!

Let me see ... I'm a licensed paramedic, NREMT-P, CCEMT-P, PNCCT, and PALS instructor ... omg I'm getting depressed.

$15/hr! Think of the lifestyle I could be living!

Yay for the paramedic market in West Texas!!!!

Dude, are you seriously working as a Paramedic for $6.25? That's SLAVE labor. I am so sorry. Do paramedics in West Texas believe that $6.25 is even remotely acceptable?
I am disgusted and outraged for you. Where the hell do they get off thinking that's an appropriate wage. I wish I could walk into your operations manager's office and puke on his desk. Where is the rest of the money going?

 

[niko327]

NYC, not less than $20/hr, even if you are brand spanking new. $25/hr if you have a year or two behind you. That's why I said $15-$20 is a pretty low. I mean $6.25, Arrrgh WTF?????????? Why not quit and work at the mall? So much less responsibility and probably more money. No wonder people can't conceive of volunteerism disappearing. This is exactly why EMS needs to be professionalized, $6.25 for BLS is disgusting, but for ALS, I don't even have the words to describe it. Let me just stick my fingers in my ears and close my eyes and say everything is just fine. Pass the Kool-Aid.

 

[viostorm]

NYC, not less than $20/hr, even if you are brand spanking new. $25/hr if you have a year or two behind you. That's why I said $15-$20 is a pretty low. I mean $6.25, Arrrgh WTF?????????? Why not quit and work at the mall? So much less responsibility and probably more money. No wonder people can't conceive of volunteerism disappearing. This is exactly why EMS needs to be professionalized, $6.25 for BLS is disgusting, but for ALS, I don't even have the words to describe it. Let me just stick my fingers in my ears and close my eyes and say everything is just fine. Pass the Kool-Aid.

Yes, it is absolutely horrible. If I wasn't at school here I'd be gone and somewhere with a better job market. There are so many paramedics here almost all of the trucks in the area are dual medic. Lubbock, Texas is a horrible place to move to as a paramedic.

The only reason I tolerate it is because:

* they work with my school schedule, I do every 6th night shift from 7P->7A
* it turns out to be about $300 / month which is my motorcycle payment so I'm not putting my Harley on school loans.
* It keep me working as a paramedic.

I feel so bad for this one guy out there, they schedule him 36 on, 36 off at $6.25/hour. He has two kids and a wife.

Oh, and they don't pay overtime either.

It is not uncommon for people out here to work 48 on, 24 off. Usuallly they work 24 at EMS, 24 at fire, 24 off.

 

[viostorm]

Don't you love it when you are full time and your family qualifies for WIC?

Yay for paramedicine!

 

[leviathan]

It's $36.00/hour for ALS medics in BC, with full benefits, retirement at 55, good overtime pay, etc. That's $31.50 US dollars.

 

[niko327]

It's $36.00/hour for ALS medics in BC, with full benefits, retirement at 55, good overtime pay, etc. That's $31.50 US dollars.

Now that's more like it.... I think medics are somewhat better educated and trained in Canada, right?

 

[leviathan]

Now that's more like it.... I think medics are somewhat better educated and trained in Canada, right?

I'm not really familiar enough with the US system to compare.

We have two main levels: primary care paramedic (PCP), and advanced care paramedic (ACP). There is also critical care but they are for ICU and aeromed transfers. The PCPs do mainly BLS stuff but they can also start IVs and give a few drugs like insulin, narcan, D5W, etc. It is a 2 year program in most regions. The ACPs can do all of the ALS stuff like intubation, cardiac drugs, ECG interpretation, needle decompression, etc., and is an additional year of education and clinical training.

However, in BC the PCP is only a 4 month program (albeit 60-70 hours/week of combined didactic and clinical training), and the ACP is about another 12 months of training on top of that. Wages are comparable for ACPs across the country.

They are funded by the government, so maybe that has to do with the higher wages? I'm not sure. I know lots of ACPs that pull in 90k/year with overtime pay, so they are definitely happy with their wages.

 

[Underachievment]

It's $36.00/hour for ALS medics in BC, with full benefits, retirement at 55, good overtime pay, etc. That's $31.50 US dollars.

Per the last CUPE bulletin- that's top step. Starting is 31 loonies. Upwards of 3-4 years training before you're hired and only if you're willing to wk the lower mainland for a decade.

Given no outcome change- your posse's banger is still the cheapest bling for the transport bang.

 

[Underachievment]

One way to professionalize EMS is to institute fitness tests...

 

[Underachievment]

Then again, you'd lose 80% (90 CAN) of the workforce.

 

[Underachievment]

I suppose you could narrow the crew quarter's openings.

 

[jonb12997]

in my original EMT class I was always the patient for backboarding and lifting practice, I think it was because I was at that point a senior in high school on the track team, 5'9'' 145lbs... (oh to be in that good of shape again)... :/

 

[DropkickMurphy]

Hey Vio.....do you have a problem with your arms going numb?

 

[jbar]

Given no outcome change- your posse's banger is still the cheapest bling for the transport bang.

what does that mean? I speak three languges (English, Spanish, and bad english) and I'm at a loss.

 

[viostorm]

Hey Vio.....do you have a problem with your arms going numb?

Ok, I'll bite .... no.

Why?

 

[leviathan]

Per the last CUPE bulletin- that's top step. Starting is 31 loonies. Upwards of 3-4 years training before you're hired and only if you're willing to wk the lower mainland for a decade.

Given no outcome change- your posse's banger is still the cheapest bling for the transport bang.

Oh, is it $31 starting? The ACPs I know are making top wages, then. And not many people want to work OUT of the lower mainland (pop = 2,000,000), so it works out well for everyone. There's not much demand for ACPs out in rural areas like Boston Bar that might not even see a single call in a day.

 

[leviathan]

what does that mean? I speak three languges (English, Spanish, and bad english) and I'm at a loss.

Hahaha, I'm not quite sure if I understood him either. For what I take it, he was saying it isn't all what it's hyped up to be.

In regards to fitness exams, we do have a fitness test that applicants must undertake in order to be accepted to the paramedic program. I can't imagine it's very hard, but it involves long distance running, carrying weights over long distances, some basic weight lifting, sit-ups, push-ups, etc.

 

[Underachievment]

Given that a vast degree of outcomes are not determined by who does the transporting- it's faster and cheaper to hop into a "car" as long as the destination is appropriate (e.g. no vet or chiropractic offices).

 

[Underachievment]

Fitness is akin to inertia. A body in motion.... A body at rest...

edit: annual fitness tests.

 

[DropkickMurphy]

Ok, I'll bite .... no.

Why?

Because the chips on your shoulders should be giving you thoracic outlet syndrome.....

 

[emtcsmith]

They can't not pay you overtime...there are these things called labor laws. I have a hard time saying we have to go away from vollies being one as a Basic but I do see where you are comming from. I know mabye one or two volly medics and will not be one myself when I get through my program.

Oh and no other group should have power over us but when the Nusing Lobby gets together they have from what I understand. They are just afraid of giving us to much powere on the street. Like I said until Nurses, Pa's, and Docs get out on the street then we will keep doing what we do and more as time goes on.

 

[viostorm]

They can't not pay you overtime...there are these things called labor laws.

I read quite a bit on labor laws after your post, and I agree with you paramedics involved in 911 services are likely non-exempt employees and overtime pay is required.

For example local hospital will pay overtime if you are working in the field, but will not pay overtime if you are working extra shift as a tech in the ED.

Secondly, so here a dilemma, keep taking the $6.75 / hour without OT (I rarely break 40 hours because I usually work about 28-30/week) or make a problem for my employer, maybe lose my great every 6th night shift, and probably never get a raise.

EMS is a very small community here, so it is unlikely I would be hired by another place because word would get out that I was causing trouble and costing agencies money.

-------------------------

FLSA exemption exclusion for the following jobs.

Police, Fire Fighters, Paramedics & Other First Responders
The exemptions also do not apply to police officers, detectives, deputy sheriffs, state troopers, highway patrol officers, investigators, inspectors, correctional officers, parole or probation officers, park rangers, fire fighters, paramedics, emergency medical technicians, ambulance personnel, rescue workers, hazardous materials workers and similar employees, regardless of rank or pay level, who perform work such as preventing, controlling or extinguishing fires of any type; rescuing fire, crime or accident victims; preventing or detecting crimes; conducting investigations or inspections for violations of law; performing surveillance; pursuing, restraining and apprehending suspects; detaining or supervising suspected and convicted criminals, including those on probation or parole; interviewing witnesses; interrogating and fingerprinting suspects; preparing investigative reports; or other similar work.

 

[viostorm]

Because the chips on your shoulders should be giving you thoracic outlet syndrome.....

I'm glad you noticed I'm obviously very bitter and have very strong opinions about EMS.

I hope my attitude doesn't bring the forum down too much. I really enjoy the discussions we have. But please someone let me know if I'm out of line.

 

[emtcsmith]

I see where your comming from but don't look at it as "making a problem" your not asking for anything that isn't the law. If I work 22min overtime at my job then they are required to pay me 1.5x my rate for those 22min. Don't forget the first rule of EMS. You come first, your partner, and then anyone else.

 

[DropkickMurphy]

I'm glad you noticed I'm obviously very bitter and have very strong opinions about EMS.

I hope my attitude doesn't bring the forum down too much. I really enjoy the discussions we have. But please someone let me know if I'm out of line.

You're not out of line.....a little jaded, but not so far out of line that I really feel the need to put you in your place.