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Call him Ishmeal, just not “EMS Worker” – a thought on EMS1.com’s captioning

Quick! What is the difference between an electrical engineer and an electrician?

Or the difference between a general contractor and a foreman?

Who cares?

You should because the public has no idea the difference between EMT and Paramedic and it’s our own fault.

Over at EMS1.com there was a ruffling of feathers about the site using the term “EMS Worker” to describe an EMS worker who had been injured in an accident and they knew not the name or the level of certification.
I saw no problem in it, but the alphabet soup supporters went into overdrive.
“We are NOT EMS WORKERS!!!!!” one person wrote.

Aren’t we?
Driving past a construction site I could care less which of them is the electrician, the carpenter or the unskilled laborer, but when I need one, I know who to call. Their roles are clearly defined across cultural and political boundaries.
But EMS is hopelessly shattered into fiefdoms who demand their own training and certifications. As mentioned in the EMS1 article by Skip Kirkwood, we all need to come together and decide what we are and just go with it.

However, which governing body do we choose to make that decision?  The National Association of EMS Officials?  The National Association of EMTs?  What about the International Association of EMS Chiefs?  the International Association of Firefighters?  Egads there are as many little organizations as there are levels of EMT.  No wonder we can’t get on the same page.

As Mr Kirkwood mentions, the term Ambulance Driver actually is rooted in our history, so don’t go too insane when someone calls you that, especially if all they see you do is drive it there, load someone up and drive away.

A Policeman is not a police car driver and a mechanic is not a tow truck driver, but we have a long way to go before we can kick that ambulance driver label.

But what label will remain when we do?

Paramedic?  EMT?  EMS Worker?

A PA is not an MD, but I still say I’m going to the Doctor.  Perhaps we could learn from that and expand on it.

I suggest adopting the title of Paramedic, as does Mr Kirkwood, but only because EMT drags behind us.  First responder CPR providers may not be considered Paramedics by us, but they sure are by someone who’s husband just slumped over dead in a cafe.

Many different levels of Paramedic will still exist and, unfortunately they need to, because each community will need to train their responders differently based on the needs of that community.

For example, training me and my co-workers in grain silo extrication and farm emergencies may be a waste of time and money whereas a rural community will probably not need high rise training.

So where do we draw that line?  When does a technician become a Paramedic?  It really is just a name, just a title, just a way to separate ourselves from the others we work with.

The common citizen may not know the difference between a Paramedic, an EMT and a CPR First Responder until someone more qualified arrives on scene and can do more.  Then they may notice a distinction, much like when I call for a plumber and a carpenter arrives.  If he never tells me he’s not a plumber all I see is a work truck, tools and someone doing something to help.  Only when the plumber finally arrives will I take note of the limited abilities of what I thought was a plumber.

What’s in a name?  Everything and nothing, all at once. (Thanks Green Day)

Leave a comment over on the EMS1.com article to get in on the discussion.

Respectfully,
Justin Schorr – Paramedic

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10 Comments

  1. Joe Paczkowski December 4, 2010 8:18 pm

    It’s nice to see this discussion expanding. I blogged about it about a year ago and now it’s just starting to heat up over at JEMS Connect, and now apparently at EMS1. It seems like only EMS has this issue. Physicians are physicians. No one gets upset on either side of the isle if you drop the “osteopathic” designation for a DO. A fire fighter is a fire fighters, regardless of if they’re on a specialty unit, an ambulance, ladder truck, engine, or somewhere in the administration or prevention. If they’re a uniformed member, then they all have equal claim at the term “fire fighter.” Same goes for the police and many other professional, paraprofessional, and technical workers. Until we can decide on a single name to describe us and accept that it’s unreasonable for non-EMS providers to be able to identify the level of all providers from a picture, we lose the right to decide what unified name the public calls us. Don’t get mad at people for calling us “ambulance drivers.” Get mad at ourselves for not providing a better alternative.

    “When does a technician become a Paramedic?”

    However, the reverse needs to be asked. When does the average paramedic (I have trouble believing that the average person who posts or blogs online about EMS represents the average paramedic) cease to be a technician and become a professional?

    • the Happy Medic December 5, 2010 12:53 am

      “When does the average paramedic (I have trouble believing that the average person who posts or blogs online about EMS represents the average paramedic) cease to be a technician and become a professional? ”
      The $64,000 question indeed. We’ve all been writing about this for years, finally the trade publications are catching up. With more and more bloggers writing for the JEMS and the EMS1s hopefully we can get more timely content out there.
      I did interviews in Dallas in September that have yet to be available to watch online (Not filmed by Ted Setla, hence why you didn’t see them THAT DAY.)

      We do seem to be the only ones having this problem, and the billing/for profit problem, and the morale problem…

  2. Joe Paczkowski December 4, 2010 8:18 pm

    It’s nice to see this discussion expanding. I blogged about it about a year ago and now it’s just starting to heat up over at JEMS Connect, and now apparently at EMS1. It seems like only EMS has this issue. Physicians are physicians. No one gets upset on either side of the isle if you drop the “osteopathic” designation for a DO. A fire fighter is a fire fighters, regardless of if they’re on a specialty unit, an ambulance, ladder truck, engine, or somewhere in the administration or prevention. If they’re a uniformed member, then they all have equal claim at the term “fire fighter.” Same goes for the police and many other professional, paraprofessional, and technical workers. Until we can decide on a single name to describe us and accept that it’s unreasonable for non-EMS providers to be able to identify the level of all providers from a picture, we lose the right to decide what unified name the public calls us. Don’t get mad at people for calling us “ambulance drivers.” Get mad at ourselves for not providing a better alternative.

    “When does a technician become a Paramedic?”

    However, the reverse needs to be asked. When does the average paramedic (I have trouble believing that the average person who posts or blogs online about EMS represents the average paramedic) cease to be a technician and become a professional?

    • the Happy Medic December 5, 2010 12:53 am

      “When does the average paramedic (I have trouble believing that the average person who posts or blogs online about EMS represents the average paramedic) cease to be a technician and become a professional? ”
      The $64,000 question indeed. We’ve all been writing about this for years, finally the trade publications are catching up. With more and more bloggers writing for the JEMS and the EMS1s hopefully we can get more timely content out there.
      I did interviews in Dallas in September that have yet to be available to watch online (Not filmed by Ted Setla, hence why you didn’t see them THAT DAY.)

      We do seem to be the only ones having this problem, and the billing/for profit problem, and the morale problem…

  3. Joe Paczkowski December 5, 2010 1:33 am

    “We do seem to be the only ones having this problem, and the billing/for profit problem, and the morale problem… ”

    However it’s very interrelated.

    Why is there morale problems? Handful of reasons. First off, the technicians and the professionals don’t get along when forced to work together. The technicians like the cookbook and the professionals like to think, but you can’t have it both ways. The tension between the two groups (especially if there’s a difference between management and field providers in this regard) decrease morale and drive good providers on both sides out. I would have loved to have stayed as a street provider (and definitely would have gone to paramedic school if I did), but I have a hard time arguing for a larger scope and liberal medical control given the current requirements in addition to it being EMT-B, or EMT-P, not EMT-Joe (that saying doesn’t work too well with the new level names).

    When you’re on the low end of the education scale compared to other health care providers, and the subsequent expectation for clinical performance, the interaction between other health care providers changes. It’s easy for an individual to point at themselves and say, “Hey, I act as a professional, therefor we deserve the utmost professional respect,” but then you realize that they may deal with only 1 or 2 EMS professionals for every EMS technician they deal with. So now the interactions with the bitchy physician or nurse who sees you (generic “you”) as an EMS provider (which are often technicians) instead of an individual drags down morale.

    Low pay drags down morale. However how much more should insurance reimburse companies for a service that is defined by the majority of those that practice it as transport only and provided by providers who often have 110 hours or 10000 (if that) hours of post secondary education/training. Often without any college credits? This doesn’t take into account the low barrier to entry that floods the field and drags down the supply vs demand equation.

    I personally don’t find ‘for profit’ to be an issue. There are plenty of for profit health care services outside of EMS and every department has to make a “profit” (take in more than they spend). The only questions are where do those profits come from (tax payers? Insurance? Service fees?). Are there other services that EMS agencies can offer besides transport or emergency response? However this comes back to education. It’s easier to expand on a solid foundation than expand a house without a foundation at all.

    My personal opinion is fix the education issue and everything else will work out. Higher barrier to entry, demand starts to rise relative to supply, and so will wages. Increase the bar and the technicians go elsewhere and the brain drain stops (another issue). Of course once morale increases, the “that’s my name, not yours” regarding the term “paramedic” or “I’m not an Ambulance Driver” is finally realized for what it is, silly. Which, of course, paves the way to making a real identity for ourselves.

  4. Joe Paczkowski December 5, 2010 1:33 am

    “We do seem to be the only ones having this problem, and the billing/for profit problem, and the morale problem… ”

    However it’s very interrelated.

    Why is there morale problems? Handful of reasons. First off, the technicians and the professionals don’t get along when forced to work together. The technicians like the cookbook and the professionals like to think, but you can’t have it both ways. The tension between the two groups (especially if there’s a difference between management and field providers in this regard) decrease morale and drive good providers on both sides out. I would have loved to have stayed as a street provider (and definitely would have gone to paramedic school if I did), but I have a hard time arguing for a larger scope and liberal medical control given the current requirements in addition to it being EMT-B, or EMT-P, not EMT-Joe (that saying doesn’t work too well with the new level names).

    When you’re on the low end of the education scale compared to other health care providers, and the subsequent expectation for clinical performance, the interaction between other health care providers changes. It’s easy for an individual to point at themselves and say, “Hey, I act as a professional, therefor we deserve the utmost professional respect,” but then you realize that they may deal with only 1 or 2 EMS professionals for every EMS technician they deal with. So now the interactions with the bitchy physician or nurse who sees you (generic “you”) as an EMS provider (which are often technicians) instead of an individual drags down morale.

    Low pay drags down morale. However how much more should insurance reimburse companies for a service that is defined by the majority of those that practice it as transport only and provided by providers who often have 110 hours or 10000 (if that) hours of post secondary education/training. Often without any college credits? This doesn’t take into account the low barrier to entry that floods the field and drags down the supply vs demand equation.

    I personally don’t find ‘for profit’ to be an issue. There are plenty of for profit health care services outside of EMS and every department has to make a “profit” (take in more than they spend). The only questions are where do those profits come from (tax payers? Insurance? Service fees?). Are there other services that EMS agencies can offer besides transport or emergency response? However this comes back to education. It’s easier to expand on a solid foundation than expand a house without a foundation at all.

    My personal opinion is fix the education issue and everything else will work out. Higher barrier to entry, demand starts to rise relative to supply, and so will wages. Increase the bar and the technicians go elsewhere and the brain drain stops (another issue). Of course once morale increases, the “that’s my name, not yours” regarding the term “paramedic” or “I’m not an Ambulance Driver” is finally realized for what it is, silly. Which, of course, paves the way to making a real identity for ourselves.

  5. Benoit Vaillancourt December 5, 2010 1:11 pm

    Up here in Canada, as said in the article, every EMS worker is a “paramedic”.

    The lowest certification, Primary Care Paramedic, is somewhere near the EMT-I. The Advanced Care Paramedic is the EMT-P. It’s way more simple this way, as we speak both english and french.

    Here in Québec (french speaking), we are “paramédic”, but still sometime use the terms “ambulancier” and “ambulance technician”, the latter tending to disappear. I still have “Technicien ambulancier” (ambulance technician) on my shoulder patches, but my official work title is Primary Care Paramedic, and my employee card only say “paramédic”.

    Ben – Primary Care Paramedic

  6. Benoit Vaillancourt December 5, 2010 1:11 pm

    Up here in Canada, as said in the article, every EMS worker is a “paramedic”.

    The lowest certification, Primary Care Paramedic, is somewhere near the EMT-I. The Advanced Care Paramedic is the EMT-P. It’s way more simple this way, as we speak both english and french.

    Here in Québec (french speaking), we are “paramédic”, but still sometime use the terms “ambulancier” and “ambulance technician”, the latter tending to disappear. I still have “Technicien ambulancier” (ambulance technician) on my shoulder patches, but my official work title is Primary Care Paramedic, and my employee card only say “paramédic”.

    Ben – Primary Care Paramedic

  7. gwalter December 7, 2010 10:45 pm

    I’d never thought of letting go of my pride and allowing EMTs to be called paramedics. I think that is a great step forward. Thanks for that thought.

  8. gwalter December 7, 2010 10:45 pm

    I’d never thought of letting go of my pride and allowing EMTs to be called paramedics. I think that is a great step forward. Thanks for that thought.

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