EMS as a Profession.

Fire blogger Fire Critic has made comments in the past about the mission of the modern fire service.  Heck, that’s most of his coverage.  I respect his views and check his site daily for news, advice and ideas to make my career safer and better.

He recently posted a question that has been being kicked around ambulance bays for a years. “Is EMS a Profession?”  In the post he made 3 main points about the EMS 2.0 concept that is gaining shape and attention.  I made a comment there, but wanted to expand on them in my own forum.

Just a quick note on EMS 2.0.  It does not belong to me, but to us all.  Anyone who wants to improve the way EMS is delivered is included.  Each community needs a different system, so there is no single answer to the number of problems we face from salary to education to resources available.  I prefer to focus on the system designs and transport options as opposed to advanced practice, which I think CKemtP covers far better than I.

Back to Fire Critic’s notes:

1. At what point in advancing more in-depth treatments, on scene surgical protocols, more advanced medicine treatments, and all around increase in skills will the Paramedics be required to go to longer schooling? This longer term in schooling might mean that many decide to go the route of a PA, Nurse Practitioner, or MD.

There is a lot in there, so let me see if I can cover each point fairly.  CK may disagree with me on this because we work in separate systems and parts of the country, but I think we need to focus more on increasing our education first rather than adding skills first.  I think our patients could certainly benefit from in-field suturing, basic wound treatment and diabetic or respiratory treatments without a transport to the hospital, but as a young profession, we still have most of our brothers and sisters far below the training level needed for these treatments.

Paramedics in the near future should be at least an Associate’s degree, but even then 2 years is barely enough schooling for what we’re being asked to do.  If you want to take a one year program and get paid a ton of money just because you “got your medic” just quit now.  If you want to get paid better, get schooled and get on the road.

I have to disagree about more education leading to Paramedics wanting to go the route of a PA or MD.  If we want to make a difference on the street, a PA or MD will not help us.  Those who do decide to continue on in their education get my full support, but we still need better training than we’re giving now.

As Mike Ward mentions in his apparently ever growing post “The next Paramedic Shortage” the focus seems to be on getting undergraduate and graduate degrees.  I agree 100%.  if you think taking public speaking and statistics at a college won’t help you in the ambulance you are wrong.  a strong educational base teaches us decision making, how to learn and time management, not to mention the obvious benefits from classes like Advanced Assessment, Clinical Research and Systems Design.

A high school diploma and an EMT-P certificate means you have done the absolute minimum in our profession. (EMT-Basic aside, of course.)

2. At what point will this increase in overall medical knowledge require higher paying salaries?

As your Paramedics are better trained not only in their skills, but in how the system should operate, they are a move valuable resource to their employers.  They anticipate patient care issues, are constantly looking to self improve and understand they are a part of a larger system.  This will lead to fewer errors, better patient outcomes and a more successful company.  That should be something companies are willing to pay more for.  How much more is hard to say and will obviously vary by region.  Would you pay an office worker who does the minimum the same as the next guy with the degree and better results?

3. At what point will these increased salaries be realized as waste for taking nose bleeds (BS calls) to the hospitals?

When your higher educated practitioners recognize that a nosebleed is not (in most cases) in need of an ambulance, they can direct that person to a proper care facility or agency instead of the automatic default transport or refusal.  This is the situation that drives me today.

Our pal CK often writes that everyone deserves an ambulance and I agree to a point.  I think everyone deserves to have an ambulance available in case of an emergency.

Another pal Steve Whitehead did a popular post about the patient being the one that defines what is an emergency.  I disagree with this post.

If I call an electrician and tell him what to do with no regard for what he can and can’t do, then demand he do what I say, chances are he’ll leave.  If a person calls 911 and I respond for a stubbed toe, the person who called decides what level of service they get, not the highly trained expert that responded.  Why is that?

Paramedics, even the minimum requirement ones, know the difference between an emergency and something that is not.  We operate a service that has become all encompassing and people have noticed.  A higher trained work force can gain the respect and trust from proactive medical directors who can authorize their crews, who have been trained, to redirect that stubbed toe or bloody nose to the proper care, not the ambulance.  The number of non emergency calls that people think are an emergency will not change in the near future.

One of the major problems, as FC notes in his post, is the lack of EMS preventative care.  The American Fire Service has worked very hard to educate the public about fire safety, almost to the point that they are struggling to prove their services are needed.  EMS preventative care includes a lot of things people don’t want to hear.

Stop smoking. – I can smoke if I want, it’s a victimless crime.  Until you develop emphysema and call an ambulance every 3 days when you can’t breathe anymore.

Eat right. – I’ll eat what I want, Medic boy, you’re not a doctor.  True, but you’re wheezing just from lifting that triple cheese burger.   Eat right and your heart won’t have to work so hard.

Drive safely. – Shut up, I’m late.  And you’ll be forever late when you run that yellow light without seeing the kid stepping into the crosswalk.

Don’t stress. – You have no idea what I’m going through.  I do actually, since I got all that fancy training in college.

It’s a hard sell.  Making builders add sprinklers to a school is an easier sell than getting those builders to stop smoking, eat right, stress less and drive safely.  These things are seen as “liberties” or “rights” and something that no one should be forced to change.  If they can’t see the benefit to living a healthy life, how will I ever convince them that doing so will mean hey live longer and run less of a chance of being in my ambulance?

So when Fire Critic asks “EMS a Profession?” I say “Yes.”

The future of EMS is wide open.  The Fire Service is struggling to stay fully staffed and equipped as the non EMS calls are dwindling away and the EMS staff is overworked, understaffed and underfunded in most places.

Some claim we need less Paramedics to keep skills up, while others think putting a patch on everything painted red is the answer.  I think instead of looking at us, we need to look at them, our clients.  Clients are persons who knowingly activate the 911 system without an emergency.  Let’s get some of those people to stop calling us by getting them alternate solutions.  When we stop taking them, but they actually get results from the options we suggest, everyone wins.

Also on The Happy Medic…

• Liability – Part I – April 6, 2010
• Liability – Part II – May 21, 2010
• EMS Week happenings CoEMS style – May 9, 2010
• That does it, I’m changing this thing – March 16, 2009