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EMS as a Profession?

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Here is a hot topic for you – Should EMS be a profession? Some have even dubbed it EMS 2.o (originally coined by The Happy Medic according to the comments) as if the future is in the works and testing needs to be completed.

If you look around the EMS blogosphere you will see a lot of writing about it recently.

They are using a very broad brush to paint the picture of just some of the issues with Pre-Hospital care. Some of these guys/gals work in EMS and others in Fire based EMS. Either way, it matters! It matters because it is what we do.

I admit it; I like the EMS part of my job. I don’t like it as much as the Fire side of things but I came to terms a long time ago that EMS is a large part of my job.

I am not a Medic, still something I struggle with not doing but I don’t have any reason to now. I won’t get paid any extra for it because I am ranked. It would be a personal achievement, but it isn’t worth it to my family. I don’t see them enough already. Maybe down the road…someday.

I work in the Fire based EMS side of things (City w/ population 100k). I have worked in an EMS only system (RAA) which was actually part of a review by the NHS (.pdf doc here) and a hotbed for medics doing ride alongs to see how Richmond Ambulance Authority does it.

Back to EMS 2.0.

This is my thoughts on just one part of it after reading some of the posts…

  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.
  2. At what point will this increase in overall medical knowledge require higher paying salaries?
  3. At what point will these increased salaries be realized as waste for taking nose bleeds (BS calls) to the hospitals?

One thing that a Battalion Chief I know (and all around philosophical being) always likes to bring up for discussions sake is the need for EMS prevention. Similar to the model of fire prevention, EMS prevention would educate people on when to call, what to call for, and what is an emergency.

This EMS prevention MIGHT decrease BS calls. It won’t stop them. The realization of a free ride to the hospital for people who can’t afford to pay the actual costs usually outweighs any education on whether or not it is a real emergency.

One other thing is prioritized dispatch and then some. The Richmond Ambulance Authority’s dispatchers are all Paramedics (who are/were field paramedics and know the job). This cuts down on the amount of ambulances running lights and sirens to calls. It doesn’t cut down on BS calls though, because the RAA bills for transports and also takes care of the majority of non-emergent transports in the Richmond area. The BS calls might be culled to transport agencies if you don’t do non-emergent transports.

What do you think?

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Posted by firecritic on October 20, 2009 • Filed under: EMS Topics, News, Training & Development • Tagged: , ,
  • I think that there are some agencies doing the EMS prevention you describe. The problem is that too many people are afraid of the lawyers. What if somebody doesn't call 911 and dies? The hospitals have the same problem, since all of the non-emergent patients are going to the hospital. This is a big problem. It is also a problem for the much higher paid nurses, PAs, and doctors.

    There are some systems that do tiered response. Paramedics are only sent to some of the calls. They have much fewer medics, but they seem to be much better skilled than the medics in systems that send a medic on every call.

    We have too many medics. Not enough of the medics are skilled enough. To me, this seems like a two birds/one stone problem. Unfortunately the clueless politicians are not likely to see things the same way.
  • totwtytr
    We have BS calls because we spent the past 35 or so years telling the public "If in doubt, call 9-1-1 for EMS." We've succeeded beyond our wildest expectations and now people call us for everything and nothing. The police call us when they have a situation they don't want to deal with. The public calls us because we have vehicles that can bring them to the hospital. The fire calls us (in many systems) because they want the run volume but not the work or responsibility of actually doing EMS. Clinics call us when they have someone that is more sick than they are set up to handle. Schools call us when they have a problem child they don't want to deal with. Need I go on?
  • My department runs on a ton of BLS calls where the person easily could have hopped into the car and drive to the hospital, maybe even just the doctor and by perfectly fine. Most are thankful, some rude and not too cooperative. Then we have the people who are knocking on death’s door, but were too embarrassed to call 911. The whole time treating them they are apologizing and felling bad they called us. Anyone else find this to be the case?

    When I got into the fire service I was very unsure of how I would like the EMS side. I like the fire side better, but I get more action on the EMS side. I think the increased schooling and training for EMS can be a great thing. However, EMS needs to be paid like a career and respected like one. Otherwise, EMS will continue to be a stepping stone to respectable careers like a RN or a PA.
  • First off, thank you FC for the mention. EMS 2.0 was originally coined by the Happy Medic as the reinvention of EMS. I look at it as the maturing of our profession out of the adolescent trade phase and into a grown-up profession. It's going to be a tough road to travel, and if the issues we were facing were easy someone would have thought up solutions by now.

    There's a lot of people I respect that are already here, FC, TOTW, and RM, you've all got excellent opinions and are going to be leaders in the movement. However, I have to respectfully disagree with you all on a point. Smitty touched on this in the above comment while I was writing this (My computer crashed... Thanks Windows!).

    I don't believe in BS calls. There, I said it. Sure, in the decade or so that I've been doing this I've ran more than my share of hangnails and even a "lost condom" or two. However that is a small price to pay for trying to avoid what it is that really bothers me... and that is when people having true medical emergencies don't call us when they could really benefit from our care.

    Look for my expanded ideas on this in a post that I'll get up later today. However, the salient point is this: EMS cannot be angry when our customers (patients) choose to use our service in a way that we don't want to be used. It is our responsibility to adapt to how the public chooses to use our services. What other business model (and yes, healthcare reform must look at the fact that all healthcare is indeed some form of a business) would launch sweeping and angry diatribes on the fact that more customers are coming than they want to come? Any other business model would adapt, overcome, and improvise to meet the challenges and onslaught of new business. We can't... yet. because we're not nimble and we're bound by lots of regulation and pressures from other interests.

    I wouldn't chase customers away from my hamburger stand simply because they enjoyed my hotdogs. I'd change it to a Hotdog AND hamburger stand. Today's EMS would continue to try and sell hamburgers and would get ticked off everytime they sold a hotdog.

    Onward and upward.
  • ryan6236
    We aren't a business though bud, at least not where I work. We're a municipal service, funded by taxpayers... and everytime I run a homeless guy to the hospital because its cold outside or carry a seeker to the ER because their hydrocodone or xanax ran out, I'm not doing anyone a favor, least of all the public.
    We aren't generating revenue, we aren't helping these people, we're being abused by them. And everytime I miss a Chest pain/breathing difficulty, Code Blue, Shooting, Stabbing or whatever because I'm driving back spasms lady to the hospital for the second time in ONE DAY it really drives home the fact that something is broken.
    I don't know the fix.
  • Thanks FC for the mention on the movement. EMS 2.0 was origionally born on the floor of the Univeristy of new mexico graduation ceremony where 4 Paramedics stood arm to arm with the graduates from the Medical School with their Bachelor's in EMS.

    EMS 2.0, as I first envisioned it, was the ability of the on scene practitioner to access other elements of the system other than the ER.
    I respectfully disagree with CK about the "No BS calls" and using his hot dog analogy, most of my customers are coming to the hot dog stand looking to buy frozen dinners.

    EMS will always be activated for reasons other than an emergency, but we need to give those who encounter these folks more options. Along with tthat will be completely new training to identify the situations when people don't need an ambulance.

    No matter your views about what is wrong, we all need to bring solutions, like CK and others in the movement are doing.

    I too will expand when I have more time. I snuck onto the classroom computer and everyone is reading along.
  • FC,
    Just to add some info about the end of your post:

    "One other thing is prioritized dispatch and then some. The Richmond Ambulance Authority’s dispatchers are all Paramedics (who are/were field paramedics and know the job). This cuts down on the amount of ambulances running lights and sirens to calls. It doesn’t cut down on BS calls though, because the RAA bills for transports and also takes care of the majority of non-emergent transports in the Richmond area. The BS calls might be culled to transport agencies if you don’t do non-emergent transports"

    I have mentioned on my blog in the past about the system for disptach we use called 'NHS Pathways'. This is a brand new 'first of its kind' traige system for Ambulance Services, that provides the EMSO (Emergency Medical Services Operators) with the option to inform the patient that they do not need an ambulance, could be seen by a more appropriate provider of a service, make there own way to hospital or a walk in centre or just refer them on to one of our clincal supervisors for phone advice.

    It took some getting used to and initially the safeguards were set very high, and it was more likely that a patient got an ambulance than not for something minor, however, with training and experience it seems to be working really well.

    More information can be found here:
    http://999medic.com/2009/03/06/nhs-pathways/

    Im excited to see where EMS 2.0 can go. As I have mentioned in my last post, I really think that it is a world wide concept, not just for the U.S. We have alot to learn from each other, and forums like this can only work to enhance international co-operation to help push our profession to where it needs and deserves to be.
  • CBEMT
    Sorry FC. Should it become necessary, I want my family taken care of by someone who eats, breaths, and sleeps pre-hospital medical care. Not a firefighter who has "come to terms" with EMS being a necessary evil of the fire service whose only useful purpose is to justify BRTs.

    Nothing personal.
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