How Can EMS Get Parity?

[FF402 133]

I'm curious what steps could be taken to give EMS the parity it deserves with Police, Fire, and EMS.

If you look back in Fire and PD history, the pay, benefits, and working conditions haven't always been that great at all. It's the unions- specifically the IAFF and PBA and their predecssors, who have brought the compensation and working conditions to where they need to be. Same with unions for nurses, hospital workers, ironworkers, etc. Why can't EMS do the same?

If EMS workers- especially when they work for private industry- don't want to band together stand up for themselves- then they are going to be stepped on.

And EMS shouldn't be privatized. We never would privatize Fire or PD- even DPW, so why do we contract out EMS to commercial providers? EMS also needs to be clearly seperarated from the medical transportation sector of things.

Nothing's ever handed to you.

[Guest]

It’s easier said than done. EMS has always been the bastard child of the emergency services. Why? I have no idea; maybe it has to do with the fact that the concept of EMS is only 30 something years old? A lot of the problem is EMS isn’t even given a fighting chance in the bigger municipalities, which are the trend setters. The move away from NYC*EMS and to FDNY*EMS was probably not a good one for EMS. Look on the NYC website, you’ll see that FDNY*EMS employees are considered “civilian†employees of the fire dept. and despite them being classified as civil service they are not granted the title of uniformed service! Heck, the sanitation workers are a uniformed service for crying out loud! Hell, Scopetta was quoted as saying something to the effect of “this city has a great group of ambulance drivers†when referring to FDNY*EMS’s Paramedics and EMTs. When you have a system which is relatively unfamiliar with EMS running an immense EMS system you’re only looking for problems. Similar issues were encountered across the country when the LA County Fire took over EMS operations. I think a lot of the problem has to do with a general “ignorance†(for lack of a better term) of what EMS really is, what we do, and how important we really are – which I think could be, in part, contributed to the young age of the service. When talking about municipal EMS, I agree and think it’s probably your best bet. However, you have to understand that EMS is extremely expensive. Just to have an ambulance respond can cost roughly 600 dollars, and then depending on the level of care you’re providing, BLS or ALS, you’re looking at a few more hundred plus upwards of $10 a mile just to have a medic onboard. Add the cost of units, equipment, maintenance, fuel, salary + benefits, medications, training, and a host of other things you’re looking at a nice chunk of money. A lot of places just don’t have the tax base to provide that type of service and thus rely on a volunteer BLS provider, which may “soft†bill, and a contracted or municipal ALS system. Highly populated metropolitan like NYC have the ability to generate far more tax revenue than say Westchester County as a whole does.

[92DLt 0]

66ALPHA, I agree with you totally. It's funny that governments will say running EMS costs too much money. How much does it cost to run full crews with all apparattus to a fire call? Probably a whole lot more than it costs for an ambulance run especially since EMT's and Medics typically make far less than your average firefighter. It's sad that with the increasing demand for EMS with the changing population demographics etc. that more municipalities don't realize the need for a professional (not that the volley's aren't) EMS service. Civil Service status would do wonders for the status of EMS providers. Unfortunately, to too many people we are just ambulance drivers. As an aside, ever notice how on the news or in the papers Police and Firefighters are always mentioned during an emergency or a disaster but EMS just gets relegated to "other emergency workers." The sad truth is that people don't understand or appreciate what it is we do until they need our help. Good thing none of us got into this for the recognition huh?

[WAS967 97]

The simple fact is we're not really the bastard step children. We're just that, we're the children of the Emergency Services. How long has EMS been around and commonplace? 30 years? 40 maybe? (Please don't tell me about the Horsedrawn ambulances at Vinny's and the whole Civil War thing - I know). We celebrate Fire Departments that have been around for 100 - 150 years. Police Departs probably around the same time. We haven't existed long enough to garner the respect that the FD and PD services have.

IF the respect and pay and benefits given the FDs and PDs are due to unions like the IAFF and the PBA THEN the problem would seem to be that EMS just doesn't have a universal union that represents thier needs. (And don't tell me about the IAEP as they are hardly universal and effective).

I can't say I agree with seperation of the EMS and Transportation sides of things. For many reasons but it would bring us WAY off topic.

It remains a mystery why the governments (local and otherwise) will spend millions on Fire and Police service yet balk at spending half a million on a paramedic truck. Or 1 million on a full service ALS ambulance. It just boggles my mind.

ook on the NYC website, you’ll see that FDNY*EMS employees are considered “civilian” employees of the fire dept. and despite them being classified as civil service they are not granted the title of uniformed service!

Weren't FDNY EMS workers granted Uniformed status last year?

[Guest]

WE ARE OUR OWN WORST ENEMY........ we dont stand up for our selves, We need to do something We need to show the powers that be that the answer is not sending an engine the answer is sending another EMS crew, We need more EMS personel . Nothing personal but if i am doing a cardiac arrest I dont want cops I dont want ff's I want an EMT or a MEDIC, I mean what would a cop want for back up? what would fd want if they need assistance on a structure fire. The answer is a county wide E-M-S system, 1 system working together, every agency should be a participating WESTCHESTER COUNTY EMS PROVIDER. 1 central dispatcher,KDT's in the bus and each agency is responsible for providing a crew and unit for each tour. It can be done if WE do it together that means that profit goes on the back burner and peoples little fiefdoms do also alot of people dont want to give up thier thrones .Just think about it it would really work WE have to GITERDONE ................................I AM NOT ANTI-ANYONE I AM PRO-EMS..........BE SAFE

[Guest]

Not to nitpick, but if EMS wants to be treated as professionals (this goes for FDs too) then they need to act and appear as such.

How serious do you think people will take EMS providers if they show up at a scene or in an ER in jeans and a t-shirt? Or with a bunch of juniors and other non-essential personel runng around their house when they are suffering a medical emergency?

Presenting yourself professionally goes a long way in the publics eyes. No matter volunteer or career, EMS is a profession, not a hobby, and we all need to work together to reinforce that.

[Guest stephentyler20]

I'd like to add something to this conversation, which is probably the most frequently discussed topic around any ems "station" or equivalent. In a way, EMS has a vicious cycle going. Everyone says we need representation, people to stand up and shout to the politicians and the public about ongoing ems problems and ways to solve them, becoming municipal where not, getting tax support, etc. etc. The problem is, the most likely leaders to do so frequently won't be found in a field that doesn't give them the respect, courtesy, challenge, and frankly cold hard cash that they deserve. I'm not saying that most "good" clinicians out there can't stand up for their rights and their business and try to make a difference. But those who are well educated and potential out-criers, who could make a huge difference, are probably in the process of leaving EMS for something bigger and better, and therefore won't dedicate the time towards an albeit worthy cause.

I strongly encourage those in the business to do whatever it takes to fix the problems with EMS, but I firmly believe that a good way to do this is for those who are already in leadership positions (DO's, chiefs, etc.) to seek out and employ individuals who are bright, educated, and can make a difference behind the scenes, if not on the warfront. By enticing such people to stick around and participate actively, and create a respectable knowledgebase in the biz, the EMS community increases its likelihood of having those that matter listen to its problems. I could be talking about doctors, nurses, or even paramedics who have not only been around a while but are active in their communities and care about the job as something more than just a whimpy paycheck. It's not what you know, it's who you know, and the politicians and the public need to see that we're utilizing competent and well-rounded leaders in order to take us seriously.

[mikeinet 37]

Not to nitpick, but if EMS wants to be treated as professionals (this goes for FDs too) then they need to act and appear as such.

How serious do you think people will take EMS providers if they show up at a scene or in an ER in jeans and a t-shirt?  Or with a bunch of juniors and other non-essential personel runng around their house when they are suffering a medical emergency?

Presenting yourself  professionally  goes a long way in the publics eyes.  No matter volunteer or career, EMS is a profession, not a hobby, and we all need to work together to reinforce that.

←

No offense... but vol. fire depts are the exact same way... firefighters have gear to cover the jeans and tshirt :0) How often do you see a chief walking around in plain clothes at a 'lesser' fire call... or even in some sort of dept identifier (ie: polo...tshirt)...

I absolutly agree.... but its public perception - EMS crews are smaller and yes you might have a jr or non-essential person running around during a call - but FDs are the same way, but FDs have bigger apparatus that present a different perception that it 'needs more people' and therefore its' ok for people to be running around.

[Guest alsfirefighter]

If this ruffles any feathers I'll partly apologize now, but those who know me, know I speak from a common sense approach.

You want parity in EMS. Tell private companies to stop worrying about the bottom line and allow their employees to make competitive rates along with other emergency services and stop abusing them. The turnover rate of providers going from company to company or even working full time at one and then part-time at another is phenomenal. Private companies should not be in the 911 business, as I've said in the past I am super pro FD based EMS, but that would be extremely difficult in Westchester with the system that is currently in place and the handcuffing of common sense approaches to the overall Fire/EMS status due to statutes, ego's and selfish pride. Take the private companies and have them train employees to all be critical care medics and worry about interfacility transports. The transports I've seen numerous companies pull 911 units out of service for to cover, leaving 911 contracts to the bare bone. How about education. Anyone want to bring up the subject of licensing again? Or how about getting rid of less desirable EMT's and Medics all together instead of shoving them in slow areas, or on transport buses or doing the slow steady squeeze of forcing them out of one company to another, where their bad skills continue and they hop from company to company for work.

What do I want in a cardiac arrest. Well trained individuals who want to get in and help a person who is ill. Do I want a firefighter, absolutely, because where I work they are almost all EMT's and Paramedics except for a handful and even those guys are CPR trained and I'll put them to use. No different then when I have used bystanders when I've been by myself for several minutes on an arrest and need a hand.

FD's are the same way with large apparatus with a perception that they need more people running around?

Its not a perception. Its a fact we need more people on the fireground. I don't know where you are, but if they are running around thats a problem. Laws and regulations aside concerning 2 in/2 out rules. Firegrounds are just plain dangerous and in order to complete many of the functions needed for both civilian safety and property conservation it comes down to staffing.

The bottom line is this, when a fire truck pulls up its the fire department and you can get quite a few firefighters operating around in whatever color gear they wear and that's the way it stays. The "firefighters" are here. But in EMS we have the opportunity to have direct 1 on 1 patient contact. We are not wrecking things, throwing things out windows we've just broken. We are getting personal interaction with our patients and in less then 5 minutes have the potential to impact someone's lives. Why we do not allow this to transgress into getting parity and more respect for the job is beyond me. But it is difficult when you always have the 10% out there, not performing good skills. Racing to the hospital code 3 for a ankle sprain or taking 20 minutes to get to a call and the patient and the family say "thanks for coming." Nevermind it took you 20 minutes to get here and I can't breathe, but thanks for showing up when I called 911.

[Guest]

I must say, that I am disgusted with "ALSFIREFIGHTER"'s last post. It's that mentality that causes the rift in the EMS community, therefore never allowing parity.

Let me start out by saying I am firmly against ALS fire departments. I just came from a system that was a tiered response system, with fire departments providing ALS first response. With that said, I will say that I was witness to some of the shoddiest, most backwards EMS care I have ever seen. I have worked throughout the state, in many systems, and I have found that the best care comes from private EMS. Before you rant...allow me to explain.

First...Fire departments get into EMS for one specific reason..to generate calls, and therefore generate revenue. some years ago, someone realized that paid departments were putting themselves out of work, due to the advent of fire retardant building materials, better apparatus and training, and better notification systems. Realizing that their calls were numbered, someone said "hey...lets go on medical calls!!" Calls went up, and budgets were beefed up. Fire departments figured it was a good thing. It was not.

Second...Show me a paid, civil service fire department with ALS...and I will pick out the clause in the union contract that MANDATES a probationary firefighter become a paramedic, and maintain his/her certification a prespecified time, some as long as ten years. Now, take a second and think back to when you were young. your parent made you do something you really did not want to do. You did it half-assed..just enought to get by. Such is the case with paid departments. 99.99999 percent of the firefighters have one goal in mind....bidding the truck company, and ride in the BRT, dragging cats out of trees. They have no real desire to get out of their racks at 0-dark-thirty to get Mr. Drunk who just pissed in the cop car.

Lastly, I did not go to school to do shuck grandma, or to do the "cath runs". I am a highly trained professional, with twenty years of "front line" EMS experience in both urban and rural enviroments. I (and the other highly trained medics and EMT's in the private world) deserve the respect ot the medics in the civil service world... because we do the job, not for the money, but for the love of it. you want to do EMS....do the whole job. you do the shucks. You do the BS runs. instead of buying the new flat screen TVs tor the houses, go get a few ambulances. I don't do your job (although I did...6 years in a truck house and on a FAST team) and you don't do mine.

Like church and state...they should be separate. I have respect for the firefighters...but not when you try to do my job just to save your own.

with that said....I will gladly sit back and revel in the replies

[ny10570 745]

I am a huge fan of FD and EMS being united. First, there are many things we in EMS could stand to learn from fire as far as brotherhood, teamwork, and taking care of our own. While forcing FF's to handle EMS is a bad idea, FD response with EMS to certain call types can be hugely productive. Ideally you can keep the two as separate entities within the same organization. In calls with the greatest threats to life seconds count and a two man crew is never enough. Throw a couple of FF's trained at least to CFR or even better EMT-B on the scene and they are an extra set of trained hands. Because lets face it there never has been and there never will be enough EMS units on the road. There are also many situations where ff's have their hands on our pt's before we do(MVA's, Fires, Collapse's, etc) FF's with at least an awareness of what to do to care for the sick an injured makes our job that much easier.

[heyu 0]

I am a huge fan of FD and EMS being united. First, there are many things we in EMS could stand to learn from fire as far as brotherhood, teamwork, and taking care of our own.

Touchy subject here.

Just my opinion, I DO NOT need to learn anything from from any other fire agency, especially ones who have not received proper credentials, education, and training. I appreciate the help and initiative, on a job, of qualified individuals who are not looking for the "pat on the back" but can recognize when to step back on an EMS call and let me do my job with as little confusion as possible. Brotherhood, teamwork, and dedication should be AUTOMATIC.

[Guest stephentyler20]

I don' think we need to rag on commercial services either, but don't we think that EMS would be better off as a municipal service, in general? I DON'T mean firehouse base, as I'm not a huge fan of that idea either, I'm talking about just EMS but in a municipal setting. What could be wrong with that? I have tremendous respect for many of the medics and emts that have been with the commercial services for long periods of time, but at the same time I am so morally opposed to some of the standards these services uphold I can't in my right mind endorse their continued right to provide EMS care in many circumstances. This does NOT apply to ALL commercial services, of course!

[Guest alsfirefighter]

Your not the first person who's ever said I disgusted them. I'm going to address your comments first and then get back to the real issue which I feel I covered nicely by discussing the EMS system overall.

Second, nice stereotype statement that "first, fire departments get into EMS to generate calls." Then how do you explain the first fire departments who started EMS and the first ALS system was LA County FD? I'm sorry you worked in an area where you saw some shoddy work. My motto is this, if your gonna do it, do it right. Let me be the first to tell you that some of the private companies I've worked part time for and have been around, I've seen Paramedics whom I wouldn't let them touch a manakin in the classroom again before a patient. So guess it depends on what area you are in. You want a ALS system to look at, come look at mine...no clause. The road of EMS is paved with high quality FD based EMS. You don't want to do both, go find another job, you want to work in a area where they provide EMS then you better get use to it. Because if you have a supervisor like me, then your gonna do it right or your gonna have problems. The majority of the issues of fire departments that provide EMS is not getting the politicians or fire commissioners to give the appropriate staffing to keep the providers fresh instead of abusing them. Not keeping up with turnover rates, the same problems private companies often have as they keep expanding or to cover existing contracts. Perhaps now you can explain what it is in any of my comments that causes any more of a rift in the EMS community then of your statements? And mine were exactly that, comments, you made bold, half-baked statements about fire departments that have been cried about now for nearly 20 years. I'm sorry you feel all fire departments are out to just get more call volume. For the majority of us its about getting out there and helping people and giving the best professional and compassionate care out there. Perhaps we should revert to sucking in more and more territory instead of our muncipalities, so we can make a bigger bottom line for the company.

If so many are in for the love and not the money, then stop crying about parity and how hard it is to live off the salaries. We all know every job has its 10% and thats about how many I've ever actually seen who are in it for the love of the job and won't complain about salaries and so on.

2 seperate entities is not the answer either depending on how the management is. Which is the only thing that stops every fire department EMS system from either being one of the best or one that myself and other Fire/EMS colleagues just shake their heads at. It all starts at the top and how it is implemented.

[ny10570 745]

Touchy subject here.

Just my opinion, I DO NOT need to learn anything from  from any other fire agency, especially ones who have not received proper credentials, education, and training.  I appreciate the help and initiative, on a job, of qualified individuals who are not looking for the "pat on the back" but can recognize when to step back on an EMS call and let me do my job with as little confusion as possible. Brotherhood, teamwork, and dedication should be AUTOMATIC.

←

Too bad they're not. EMS consistantly ranks tops in all jobs for Post Traumatic Stress (far above even combat soldiers) near the top for suicide, and amongst the bottom for years served in the field. Our brothers and sisters burn out at an extrordinary rate. At the end of the day FF's are together at the house talking, shooting the s***, whatever. There is also no one out there that can even come close to the back patting and atta boys handed out by ff's. Add to that the blind faith they have to have in eachother and you wind up with a very close group that works hard to care for their own. Sadly, in EMS we spend our entire day posted out in the middle of town stuck with our partner. And if we work with any onter crews its for a few minutes before we takeoff with our Pt and back into isolation. Then come the end of the day we clock out and we're on our way home. We don't have the opportunities fire has to just talk with each other. Until we find a way to eliminate that isolation we will continue down the same path we currently follow.

[Guest]

als and fd do not mix I'm sorry how can you become a good medic on an engine? you can not get the proper exposure to achieve good clinical judgement any medic would agree that being with the patient a few mins till the bus comes just dosent cut it. The perception you get from a FD run system is that EMS is secondary to the primary job role of FF, Not every system was started by FD's the bigger ones were run by HEALTH AND HOSPITAL. Every one of the top guys in NYC*EMS were opposed to the hostile takeover this is first hand knowledge not rumor. for profit is NOT the answer, tacking EMS on to an existing agency is not the answer. The powers that be in EMS in this county are the ones that should fix this system nobody wants to give up their thrones. We all no how political the climate is. There have been many articles written as of late that say the merging of the two is not working. Lets wake up just because we LOVE our chosen proffesion dosent mean we are putting down another, and i would still rather have an EMS unit back me up nothing personal why is it everytime some one in EMS has pride in what they are people say they are knocking someone else it's so they dont voice an opinion that is not what some want to hear.............BE SAFE.........I AM NOT ANTI ANY ONE I AM PRO EMS

[Guest alsfirefighter]

Ped, I see your point. But I am not pro ALS engine to a degree. I believe in normal tiered response of BLSFR engines with ALS ambulances or flycars. How can you be good at anything you do? By applying yourself. If you don't have good skills, you just don't have good skills. I've also had the argument stated that you can't be good at both and I think that is hogwash. If that statement was true then volunteerism would be a non-point in any argument.

This is a great topic with great discussion, lets keep it rolling.

[Guest]

ALSFIREFIGHTER brings up a GREAT many valid issues that infact plague our EMS system as it currently stands. I believe that their aren't enough people in the private sector that refuse to band together and unionize simple because of fear of reprecussions from superiors. Right place, right time, not enogh band of brothers.

As to ALS's reference toward ALS/FD's, it never hurts, only benefits the patient. That's what ultimately counts. The comment made that FD's respond to calls purely to generat run numbers is rather ludicrous. LAcoFD was the first FD to implement ALS response in this country. On the local level, the gradual progression of FD's responding to aided cases is FOR THE PATIENTS BENEFIT. Yes, it generates a few extra bucks in the annual budget. Yes it ups their runs numbers. But it solidifies that FD's play a reasonably important role in prehospital patient care. Should FD's have medics here? Why not. With such short staffing of private companies, delayed response times, etc. It narrows the time for appropriate intervention.

Should towns and cities start dropping their contracts with private firms to provide EMS? It's a case by case discussion in which local governments need to address on their own and weigh in the pros and cons.

Here in Westchester, our level of care/response is equivalent to the stature of West Coast EMS from ten years back. We are behind the times here and need to step things up a notch if we are to survive.

From a personal view point, I don't care where the medic comes from. Private or Municipal. As long as they get to me fast and take care of me and my family well.

Let's not turn this into another pissing contest. ALSFIREFIGHTER has a GREAT many years of experience in this matter. He's not here to bash. He's here to educate.

[Guest]

IF I remember right wasn't it jacksonville that was first? anywho I dont want it to be a pissin contest that is not my goal the point is to have good clinical judgement you need to do many ALS calls start to finish to achieve this, spending a few mins till the bus gets there does not give you the proper exposer to be able to make a life or death decision, difficulty breathing secondary to CHF requires a differant approach than difficulty breathing secondary to COPD. Does this patient who is in a SVT require adenosine? or diltiazem? is it junctional tachycardia or multifocal atrial tachycardia, The point I am trying to make is that being a Paramedic is important enough to be a PRIMARY job role, not secondary. As for a tiered system i could live with it but the tiers should be BLS then ALS (on the ambulance). Paramedicine is a serious technical proffesion. I AM NOT ANTI ANYONE I AM PRO-EMS..........................

[PC414 0]

So, I've got a question. Be patient, if you can, with some loose definitions. Teach me ... don't "burn" me

From my limited perspective (volunteer FF w/20+ years experience, EMS experience limited to driving the ambulance and basic first aid/CPR a couple of times; Advanced EMD 9-1-1 dispatcher), it appears that EMS is sort of the "bastard step-son" of emergency services. PD is certainly a municipally-supported branch and in most ways, I think, fire suppression is, too (even at the volunteer level - although "subscription services" and Scottsdale, AZ(?) may be notable exceptions). Of the three "branches," isn't EMS most generally dependent on private services and lacks most some kind of tax-based support (again, with some exceptions - most notably with FD provided EMS)?

My question is simple. Why the argument over which is best given the current system (i.e, private services versus FD-based)? When I dream of an "ideal" municipally-based EMS system, I don't personally think of FD-based ALS but of a separate, equally-funded system wherein Police, Fire and EMS all have the needed tax dollars to provide the very best and same quality emergency services to the residents of a community.

This is NOT to imply that private medics and EMTS don't or can't. Don't read that into my poorly-worded essay here 'cause nothing is further from my mind (or the truth). I just don't get why the history/tradition of emergency services gives tax dollars for needed services like PD and Fire, while letting EMS go without.

This is not a "vollie-vs. paid" issue (see paragraph 2, above). The people of my volunteer Fire District contribute a tax which goes toward fire protection, approve bonds when new engines are needed, etc. Their taxes help fund both a County Sheriff's Office and the New York State Police. Why is the BLS ambulance replaced by fund raisers and donations? Why is ALS dependent upon who can be hired by a private agency which constantly must struggle between legitimate profit for the principals, the need to invest in personnel and equipment, etc.?

I personally suspect EMS got "thrown" to the FD not to generate call volume but because some "genius" who doesn't understand the issues said, "Hey, let's make/give these firefighters something to do between runs 'cause we're paying 'em anyway to just sit around between fires."

While I don't have figures available to quote exactly, my understanding is that the good people of Putnam County pay more for garbage pick-up then they actually would see as an increase in taxes if the County were to fund a viable, County-based ALS system for the residents.

Because my involvement with EMS is more peripheral, I may not understand the issues well. Can someone explain to me what it would take for EMS to achieve some kind of better parity with police and fire in a municipally-supported sense?

Thanks!

PC414

[Guest]

I think oftentimes a fully supported EMS service may get a bad rap. Many towns pride themselves on having volunteers able to staff their own ambulances and the community supporting them through donations. They should get some funding, yes, but a community supported EMS service is better than one that is only supported byt the town government

[Guest paramedico987]

HERE IT IS... MY SIMPLE LIST OF WHY THINGS DON'T CHANGE!

1) You call for an ambulance and it comes... no matter what it comes.

it may take for-fricken-ever, and may come from out of county or out of state,

but it WILL come. If there aren't FD's people notice because the whole city burns

down. If there aren't police people notice because they get robbed and shot.

But if it just takes too long for the ambulance the only people who notice are

those directly impacted (i.e. the patient and their family)

2) People lived for thousands of years without us and they did alright... If tomorow

there were NO AMBULANCES then people would start taking taxis or walking

to the hospital, or better yet not going at all. Our resource is expendible in

in reality. As a paramedic I would estimate that 75%-85% of the ALS jobs I

go on are just expensive cab rides to the hospital with an extra salt-water

hole in your arm.

3) We share a dual role and fit imperfectly into both... We are healthcare

providers on one hand and a public service utility on the other. If we fit into

the hospital system then we are the bastard child of the hospital that just goes

away every time we go on jobs. If we're a public service then our quality of

care goes down the drain as statistics are more important to politicians than

people.

[ny10570 745]

paramedico987 has hit the nail right on the head. More importantly points one and two. If you were to look at it in a cost vs reward scenario(EMS, PD, and Fire), EMS would lose out every time. We are irreplaceable to a very small segemnt of society. To everyone else we're not necessary. PD and Fire have a much broader affect on society.

[Guest]

I have always felt that EMS should have parity with nurses. Medics provide professional healthcare in the field without ancillary support that is found in the hospital. They are able to make patient assessments and treat based on those findings. Unlike the hospital the medics and EMTs do not function under ideal conditions with labs,xrays, CAT scans, RTs, MDs, RNs, at the bedside ready to assist. Unfortunately the general public does not have a clue. I agree that EMS should be separated from transportation and maybe then medicare will recognize the difference between transport and providing care at the scene. As it is now if a patient you have helped RMAs Medicare does not reimburse...only if you transport can you bill. They don't recognize assessments and care provided at the scene.