EMT's are we going by the wayside

[calhobs 110]

was wondering what you all think, been checking out many job postings. As far as 911 system goes do you think EMTS are out of the picture. many places want Medics, you really just dont see to many EMT jobs for 911 system. was wondering what you all thought. are we a dying breed?

[GAW6 66]

I certainly hope not - I guess people are forgetting "BLS before ALS".

[STAT213 332]

I have a couple of thoughts on this topic. I think you see more EMT-P openings because of the true lack of paramedics out there right now. Its a lot of time for not a lot of $$$. Basics can take a short class and be in the workforce fairly quickly with a fair return on the investment, dollar wise.

To answer your question directly, are EMTs going by the wayside, and do people want them to...

I would honestly have to say "No" they are not going by the wayside, but "yes" I wish they would. (That should get some folks jumping-but let me explain)

I am not trying to be a jerk, but trying to prove a point, so please read this whole post before the hate emails come flying. And, let 'em fly. A little controversy is a good thing!!! There are many of us out here in EMS land who feel we are not respected and are not treated as professionals like we should be. Part of this is because there are people out there who cannot spell, cannot talk and cannot carry on a conversation with a nurse or a physician using words with multiple syllables, let alone medical terminology.

When someone thinks of an ambulance, they don't separate the incredibly well read, experineced practioners from the total yayhoos. I don't like this. I don't want to be associated with those people, because they give EMS a bad name, and they are why I make what I make.

Paramedic should be the ONLY level of EMT to be on a 911 or CCT bus. EMT-I should be the ONLY level for First Responders. And, the cirriculum needs to be re-written so that we teach useful things. Its sad that we allow someone to take a 120 hour class and then go play on an ambulance.

So, its probably a good thing I am no longer practicing in NY, cause all the basics down there might hate me now. That's ok, if you hate me, just understand me and where I am coming from. I have always enjoyed working with ALL levels of provider, and if you have worked with me, you know that having fun and giving good care is paramount to me. This whole thing is a philisophical point, not one I carry around on the streets with me. If I did that, I would have exploded with angst and hatred by now. And that is just no way to live.

[ems-buff 81]

there's one thing you forget to become a Paramedic

one must first become a EMT so with out EMT'S there really can't be Paramedics

[calhobs 110]

what is funny though in my 15 plus years as an EMT, I have worked with pleanty of the Medics stat described. Look there are yahoos on both sides we all know that as the medics have stories so do we. Lets just remeber that we all have our job to do so lets play nice

[mikeinet 37]

I have to agree with calhobs... we are all here to help people ... why are we fighting as to who can give the better care and who should be the only ones around?

THANK YOU VOLUNTEER BASICS, INTERMEDIATES, AND PARAMEDICS. No matter what level, everyone helps and everyone should be thankful that SOMEONE with AN AMOUNT of medical training responds to a 911 call.

[STAT213 332]

I am trying to start dialogue here, controversial as it may be. I apologize for some grammatical and spelling errors. I am at work, and got dinged on a call, thus I did not re-read my post for correctness. Very good point though. How can I suggest one thing and not do it? My oops. Thanks to MGMedic for pointing that out, because if I was reading the post, that would have been one of the first things I would have noticed.

Ok, to answer some of the points about why I don't want anyone but medics on the trucks. And, college educated ones at that.

EMS Buff reminded me I was once an EMT. Yup, very true. And, as someone out there to save lives on an ambulance, I sucked. Worse than sucked. I was a dumb college kid with a patch. My EMT class prepared me for nothing I would see in the field. Nada. So, go learn more, right? Off to Intermediate Class. Whew, lots more knowledge. Now I know it, right? I am an ALS provider. So, I get into paramedic school. Thinking I know enough to survive, I am happily confident in my skills. Wrong again, jacko. I did not start to have a clue about what was going on with my patients and how to take care of my patients until well into my paramedic class. In fact, I can tell you the call when it clicked. Lights went on, angels sang, the whole bit. And, it was because of my education, and the experience of being mentored by some amazing medics that got me there.

Now, some would say that I imply through all this blathering that I am discrediting the work that good EMT Basics do in the field. Well, I just might be. Honestly, what do good basics do? What can they provide - other than some basic airway management, some oxygen and a backboard - that was not provided when EMS was run from a hearse? How far have we come? Is that the shining example of prehospital care? Sorry, but I really don't think so. And, that is why I want 911 EMS to be about educated folks performing a profession, not a vocation.

This does raise the point about EMS and research. There is very little to prove that what I am proposing will make any difference at all. Interestingly enough, the best research shows that rapid transport. is about the only thing we really need. I would argue though, that many of the interventions we perform make a difference.

I hope I haven't pissed everyone off. That is not my point or what I am trying to do. I am mostly trying to get a viewpoint out there and a hope for what professional EMS could and should be. And, in my dream world (and thankfully, where I work is pretty close to that) there just aren't ambulances without skilled paramedics. Its what the people here pay for, and its what I give them. If they wanted simple BLS care, they would vote for that in their budget.

In addition to the point that EMS Buff made about becoming a paramedic, Doctors do not first become PAs or RNs. They go to school to become Doctors. We should do the same for medics.

[Guest ksneubec]

In addition to the point that EMS Buff made about becoming a paramedic, Doctors do not first become PAs or RNs.  They go to school to become Doctors.  We should do the same for medics.

Can you clarify this point for me? I'm not sure I understand what you mean.

[mikeinet 37]

He's saying that doctors do not go to school to "become a RN" then when they feel like it go to med school... they start out in med school. Trying to make the point that instead of going EMT->Paramedic people should just become paramedics.

STAT - You have pushed me a bit - You have to remember, ambulances are NOT hospitals on wheels... they're to provide emergency care, in the field, to get someone hopefully still somewhat alive to a hospital.

I still stand by the fact that if you call 911 and only get a basic, that's a hell of a lot better than getting a lay rescuer who can't even do CPR correctly.

I feel like in general most paramedics I know look down on EMTs because "they can't do what we can" - is it cockiness? I don't know... but I don't see much backing for a lot of the reasoning... sure it'd be awesome to have a parmedic who can dispense quite a handful of drugs on a rig, but they're few and hard to come by in terms of training verses a basic... so if you have someone there who can at least do basic airway mangament, give an epipen, give albuterol... that's a huge step forward.

no world is perfect, but bashing those below you isn't the way to fix it.

just my $0.02.

[STAT213 332]

Mikeinet,

Thanks for the reply. What I am trying to point out mostly is that IF we removed the EMTs from the system, and made it so that paramedics - college educated paramedics (with initials after their name, because that is what many folks seem to recognize) were the only ones providing care in the field, the profession would be elevated. Look at what nurses did for their profession about 20 years ago. They went from being doctor's helpers to health care professionals.

I want people to stop saying its ok that all we can get out on the street is a basic EMT. I want that mind frame to change.

While it may seem that I am bashing those below me, that is not my intention. Its just that as long as they exist, and are viewed on the same level as paramedics, paramedics will always be ambulance drivers and not pre-hospital professionals. And its not what we can do. We can't do all that much. Its what we KNOW, and how we can begin moving a patient down the right pathway for the best possible care from the beginning.

And, looking back on that statement, it would seem to be pretty clear that I am bashing those below me. I do not bash their work, their energy. Do ED techs expect to be given the same level of respect as MDs just cause they work in the ED with them? Nope. Its a different level. But until we differentiate (sp) ourselves from the masses with something other than a Gold Patch from the Regsitry, we'll be little more than that ambulance driver with the flip flops and metallica T shirt everyone is thanking for just showing up and performing CPR a little bit better than the lay person.

I think its great that I have pushed you. I enjoy doing that on these forums. And, I will stand by the fact that as long as we think its ok that all we get is a basic emt when we call 911 we will never advance this profession a lot further than we have already.

I know I sound like a cocky bastard who hates EMTs. I really don't. Ask those I've worked for, with and around. I enjoy being a medic, teaching those around me and learning from those around me. It is all about teamwork and fun. I am not a hard guy to work with or get along with (mostly!). But, these forums give a good chance to vent and discuss how we could make the world better (even if in our own minds.)

Rob

[Guest mediconpatrol]

As a paramedic I have nothing but respect for the EMT's that I work with and as an RN I have nothing but respect for the nursing assistants I work with. Frankly, I have found in the past anyone trying to use words with multiple syllables are trying to hide what they dont know using big words. Even doctors are taught to use simple words so that whoever they talk to can understand. Many of the words used are open to an interpretation.....for example: Heat Exhaustion vs. Heat Stroke....Isnt that part of the reason why they changed some of the protocals to say "heat emergencies" and you describe the skin condition.

EMT's are the basic level that emergency services are based on. It is the stepping stone for some people to decide if this is the right profession for themselves. For others it is truly because they want to help, usually because they were helped in the past. Granted some EMT's are have poor spelling...but, look at it this way..some are lawyers, some are businessmen, and some are garbagemen. They come from all different economic, racial and ethnic backgrounds, and..they all come together for a common cause. It is rare that you will ever find this mixed group of people come together. And, if this is what it takes to make us come together...then it gives me another reason to be thankful for EMT's

[x635 4,066]

Just some of my random thoughts...

This is my profession, something which I have INVESTED a lot of time,energy,and pride into, and something which I make a living off of. I have been in EMS for 8 years, 4 as an EMT, 2 as an EMT-I, and 2 as an EMT-P. So I'm quite familiar with all ranks in this field.

Respect with EMT's for me is not automatically given, it is EARNED. (Same goes for firefighters and cops and ESU Officers) When I started as an EMT, in a busy urban high volume system, I was automatically assumed incompetent by my peers until I proved myself otherwise, and found that to be the case in most systems.

I fully agree in medicine their is a pecking order.

As far as the "big words" comment, where I was trained as a medic, and where I did my rotations, I was always taught speak professionally, get treated professionally. A paramedic is a medical professional, and should use proper medical terminology. It also gains more respect from the MD's you are working with.

Yes, ALS ambulances ARE hospitals on wheels....they are an extension of the Emergency Department. In general, an ALS provider can typically provide the care found in the first 15 minutes of an ED visit.

Another thing is EMT's using the lame excuse that their skills are detiorating because of Medics being there!! That is a load of CRUD!! You get what you put into it! If you show intiative and are ASSERTIVE, you will get to use your skills and your will learn. I was taught this early on as an EMT, and I learned so much and got to use all my skills, even when working on an ALS bus.

Also, most Paramedics I know show up in uniform. Many VAC EMT's show up in all kinds of casual clothing. Nothing is meant to offend, but IMO, not only does this present an unprofessional image, but it is hard for the Paramedic to differentiate who has what training. In addition, you have EMT's doing non-emergency medical transportation, which degrades the image of an EMT.

And to answer the question that started this thread, their are still plenty of EMT jobs out there. Just gotta know where to look. Also keep in mind there are a large number of volunteers providing EMT's, so that is another reason why job oppurtunities on the EMS side may be limited.

EMT's are a important part of the EMS team. Howver, I foresee their current role changing greatly over the next couple of decades.

And BTW, just because someone has a different opinion than yours, or thinks differently, does not make it "bashing".

I don't care if I offended anyone. I love my profession, and I want the best image for it. I love the EMT's I work with, and I always do my best to use my position to educate them and set them in the right path for this profession, just like my medics did for me when I was an EMT.

[Guest]

Stat,

I agree that EMS, much like all other fields, stands to improve greatly. There is much inefficiency throughout the system in research, training, and care. With that said, allow me to respectfully disagree with some of the things that you have said.

I will preface my arguments by mentioning that I am about to be a college freshman, and have been volunteering at my local VAC for quite some time (I am an EMT).

First, you insist that paramedic should be the only level of EMT on a 911 ambulance. As I am sure you realize, this is extraordinarily inefficient. What is the point of dispatching two paramedics to a kid who broke his arm when all he needs is the BLS care that the current EMT-B curriculum encompasses? Alternatively, take Mr. Doe who has a heart attack and needs ALS support quickly. My VAC usually has 3 people on the ambulance: a driver/EMT-B, an EMT-B, and an assistant. I assure you that even with the presence of a medic and police, fire, etc., the extra man power has never gone to waste when moving 400lb. Mr. Doe down 3 flights on a Reeves. You get my point.

Second, you ask what good can basics provide in the field. With most of America overweight, lifting and moving sounds like a start. You mention backboarding and basic airway management – but why discredit them? This could make a difference.

Third, you mention studies (I have also seen them) that conclude that rapid transport is often most highly correlated to positive patient outcome. However, you also argue that “many of the interventions†that you perform make a difference. I agree that they do, but don’t you think that the aforementioned scientific studies should influence your theory – namely, that BLS isn’t BS?

In my opinion, it is clear that medical care in this country is most practical and efficient when it is usefully tiered. If someone gets hurt at a pool, a lifeguard can help the patient with basic first aid. If that doesn’t work, then more advanced first responders, EMTs, etc. can step in. They can call for further resources like ALS, STAT flight, and the like. Eventually, the patient ends up in the care of an M.D. Each of these links is vital, and should not be removed. There is no point in having all lifeguards become EMTs. There is equally little use in having all 911 responders be paramedics – just as there is no point for all 911 responders to be M.D.s. This last point puzzles me the most, as it seems to me that you are arguing for the highest possible credentials on an ambulance. So, why not doctors?

The answer is simple: it’s inefficient. The only efficient system is the practical one: the tiered one.

[pjtm4 4]

Hey Stat213,

If you did away with all EMT'S we would have to change the name of this web site to Paramedic.Com LOL

[Guest WCDES636]

Stat,

I'm still trying to figure out how BA after a name makes a better paramedic!

[RU 911 0]

Stat you seem to have created some friction in here, or as you put it "I am trying to start dialogue here, controversial as it may be".

I have been a Paramedic for 15 years and EMT for 3 years before that. It has been my experience that those who invest some time at the basic level and then go to Paramedic class enter the realm of Paramedicine as better Medics. Those who take an EMT class and jump right into a paramedic class are for the most part "BOOK SMART" and cannot apply that knowledge to a patient. Something gets lost between the brain and the hands "Experience". We all know them and have seen them on calls.

I do think you touched on something though. We need to address the education so that the EMT-B, EMT-CC and EMT-P (even here NYS calls us EMT-Paramedic) can learn more in class instead an understanding of some basics and then on the job training. We really learn from our partners and other EMS people how to be good EMT's and Paramedics. The class just prepares us for that lesson.

Although every Nurse in the region would love the patients to come into the ED IV plugged in and bloods drawn, for most patients that is unnecessary.

Good BLS is always the best.

just my 2 cents

[WAS967 97]

Those who take an EMT class and jump right into a paramedic class are for the most part "BOOK SMART" and cannot apply that knowledge to a patient.

I can tell you from my own experience, that this is very true. I went right from EMT class, into Medic class less than a year or two later. I was indeed book smart and had trouble making it all come together in the field. My suggestion for ANY EMT is to wait a bit, get some experience, THEN do medic class. Or even upgrade through EMT-I first.

[Guest]

EMT's going by the wayside? Does anyone remember the venerable First Aiders and First Responders? Show a little love to the FA's/FR's. A small memorial service perhaps.

[Guest alsfirefighter]

This is a bit long but I hope many read it, I feel I have valid points and opposite opinions to some of you that are valid (and we need a good convo on here lately)

I have to agree with STAT. I feel that all Paramedic programs should be a 2 year program thatmuch like other medical profession degree programming. No requirement to be an EMT, you go to college, you get educated and you get a degree to become a Paramedic. Then perhaps we can knock of the bull$hit and become licensed providers versus just certified which would cause a rebound of more stable pay for those whom work for EMS only agencies and would also open up many other possibilities as far as occupations that could be filled with a license. Nursing shortage? License your medics and allow them to fill LPN spots. We can already do more skills then LPN's can. Noone is saying that you sit in a classroom for 2 years and then you go out in the field. Do nurses and doctors do this? Nope. You build up experience over 2 years with clinical rotations much like is already performed in a medic curriculum. If EMT was so good and important, why would you need this and why do you do some prior to learning advanced skills?

How does having BA after your name make you a better Paramedic?

It may not make you a better street medic, but can make you a better professional. With good writing, communication and person skills, not to mention a higher thought process. I'm all for college education requirements for civil service exams. Better education requirements, equals better police officers, firefighters and will mean better ems providers.

Second, BLS isn't BS, but good advanced care in conjunction with BLS is what makes a big difference. One study that said rapid transport vs advanced airway was just argued against in a recent article. You can have all the BLS in world and guess what...mortality rates will climb.

Third...and ambulance isn't just for emergency care to get someone to the hospital "somewhat alive." Majority of my patients make it to the hospital very alive, very well treated and feeling better or completely reversed from whatever condition they were suffering from. Mikeint, I think your way off on that comment. If your stance was true, I'd have half the medication and skills that I have and we wouldn't aggressively treat persons who are not critically ill, only when they are beyond the point of no return. Reducing door to door time is going to become more and more critical in this area as the hospital funding and crowding issue continues to grow. Many things good paramedics perform is the same as in the ER and no dig to ER's quicker then they would if they walked in.

ANON..What's the sense of having 2 medics on a call? About the same as it is to have that medic driving the ambulance with a tech in the back because its BLS. What difference does it make if its a 1 plus 1 (2 medics) or a 1 and 1 (1 medic, 1 emt). Many systems ride the 1 and 1. They both have their ups and downs. 2 medics equals faster ALS skill deliverence. One can draw meds and do other things that speeds up diagnosis and treatment. Instead of starting an IV, then drawing up meds all while asking questions. It can also hide a weaker skilled medic which I don't like. I understand your taking it from a VAC point of view from what I interpret from your post. But I'm taking it from a ambulance staffing point. Why we still live in a soceity that has no problem with waiting for a ambulance to arrive is beyond me and sometimes even the FD.

This profession will fail to grow and evolve until those who are worried about and feel threatened by what may come stop lobbying to hold it back! No one is saying EMT's will go to the wayside, what some are saying is that Paramedic education needs to be changed and perhaps EMT's should become BLSFR only and staff all areas with paid, ALS ambulances!!!!

[WAS967 97]

What is the difference between certified and licensed?

In CT, it means you pay, what? $70/year for your card?

In NY, we pay nothing.

What other difference is there?

I don't see how a change in a word is going to stabilize pay and open up other opportunities for medics.

I'm all for further education. I always try to take classes to expand my knowledge base and would love to get my Bachelors Degree. Too bad I have to work 80 hours a week to support my family. Part of the 2 year program idea is this: Like the nursing profession, medics are in short supply. And the problem is getting worse. If they make Paramedic a mandatory 2 year degree then it will further limit the pool of people coming into the profession. EMS isn't seen by most as a career. Many use it as a stepping stone to other things. Be it nursing, law enforcement, fire services, etc. Why would anyone want to go to school for 2 years to make $43,000/year when they can do any number of other things and make much more.

The problem is paramount and I won't pretend to have answers to any of it. It's easy to say, "well, we should get paid more". With medicare cutting rates, insurance rates tripled after 9/11, gas prices at an all time high and growing at the worst rates ever (yes, adjusted for inflation), the cost of running an EMS agency is through the roof. It's easy to say, "just make EMS a part of the fire service. it works for California!". Well thats great. But good luck getting it past the taxpayers. Just mention a tax increase and people start to riot.

You know what kills me? Last I checked municipalities are required to provide certain services to thier citizens. Law Enforcement and Fire Protection I believe are two of them? Is Emergency Medical Service? Uhm, no? Does anyone see a problem in this?

[Guest NYTruckie]

In CT it's $75 each year, due the month your birhday is in.

You are on the CT "Health Care or Environmental Health Professional's License Status" web page with the following info,

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

License Type: Paramedic

License Number:

Name:

Expiration Date:

Granted Date:

License Name:

License Status: Current

Disciplinary Action: None

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

Can you look up a New York State Certification to see any Disciplinary Action?

I don't know

[ems-buff 81]

You know what kills me? Last I checked municipalities are required to provide certain services to thier citizens. Law Enforcement and Fire Protection I believe are two of them? Is Emergency Medical Service? Uhm, no? Does anyone see a problem in this?

WAS can you explain that to me better? i don't understand what you mean

[WAS967 97]

WAS can you explain that to me better? i don't understand what you mean

I don't know how I can explain it any better. Perhaps someone else can?

[Guest NYTruckie]

WAS can you explain that to me better? i don't understand what you mean

<{POST_SNAPBACK}>

Last I checked municipalities are required to provide certain services to thier citizens. Law Enforcement (POLICE)

Fire Protection Fire Department

Is Emergency Medical Service? Uhm, no? (Ambulance)

Does anyone see a problem in this?

So the law says the municipality you live in must provide you with a Police Department, and a Fire Department. But they DO NOT have to provide you with an Ambulance.

Does this help?

[antiquefirelt 994]

Nothing says professional medic like a fat AMR parmedic out of breath on the second floor landing. Or sitting on the street corner with his/her feet on the dash sipping a 96 oz DIET Pepsi.

We have a bunch of career medics, EMT-Is and a few EMT's: all are expected to be professional at all times. Over my career I 've seen many excellant volunteers from every level and many crappy ones. I also have the pleasure of having had EMT's become EMT-I's then Paramedics in our dept. Most of these medics are gung-ho-let me at 'em professionals, for a couple of years. Then they burn out and turf all but the best calls to the EMT-I's and EMT's. They want you to believe that they are the end all, but don't want to be asked to prove it. There are a few exceptions that really are great, but few is the key word.

Becuase a medic has a uniform on vs. a volunteer in shorts and a t-shirt says nothing about professionalism. Heck, the maytag man wears a uniform. And college educated medics are even higher on themselves than others.

A recent study of our state's system, says that our EMT-I's can do 98% of the ALS calls that medics do. In fact, other than some of the obscure drugs and crikes, our EMT-I's can do everything the same with online medical control.

Paramedics with attitudes that they are the end all hurt EMS in general.

Edited September 14, 2005 by antiquefirelt

[ems-buff 81]

Last I checked municipalities are required to provide certain services to thier citizens. Law Enforcement  (POLICE)

Fire Protection Fire Department

Is Emergency Medical Service? Uhm, no? (Ambulance)

Does anyone see a problem in this?

So the law says the municipality you live in must provide you with a Police Department, and a Fire Department.  But they DO NOT have to provide you with an Ambulance. 

Does this help?

yes it does thank you truckie

[Guest alsfirefighter]

Difference between certified and licensed?

Nursing assistants are certified, how is their pay and what they can do on a medical facility? Sometimes things are in a name. If someone is sick or injured on a medical facility they are supposed to only be treated by a licensed medical provider.

You have to start somewhere. If it wasn't such a bid deal then why has nursing unions in NY state fought hard to prevent Paramedics from becoming licensed providers over the years?

[WAS967 97]

Sometimes things are in a name.

Yup. And it drives me nuts. Why should we be less able or looked down upon simply because we are certified and not licensed?

If someone is sick or injured on a medical facility they are supposed to only be treated by a licensed medical provider.

Does this mean we can tell all the nursing homes to stop calling us and to take the patient to the hospital themselves?

[Guest alsfirefighter]

I educate nursing homes as often as possible about calling a private company for transports where it would have been warranted. I had one tell me they thought by calling the VAC's number, lol.

Can you tell them no when they call...of course not.

But they call a doctor first normally and they make the decision of calling an ambulance. So that is the licensed medical provider or the nursing supervisor for acute problems. Plus I would have to find out if an extended care facility would fall under that. That is one of the complications we would run into when I worked at the VA and have emergencies on campus and we would respond along with their "medical team."

[Guest]

This Is my first time on so be nice. I think Some EMT's as well as some Medic's give us a bad name by not acting the way they should on a call. I also have to say That some EMT's are Nurse's and Doctors. So how can you say that EMT's do not know how to assess there Pt. I know I can assess just as good if not better then some Medics. I also know as a Nurse in a nurseing home my Pt. get great prehospital care from me.

I think to say that only Medics should be doing 911 is crazy..I was an EMT before we even had medics. I think because of that I am a stronger EMT then the new ones who rely on a Medic being there. I am also a Lab Instructor and I can assure you that our students do get real life senarios and are NOT taugut to a book. We do not teach them to past the test we teach them to be awsome EMT's.

I am also not one of those anti Medic EMT's. I am the first to call for a Medic when I need one and the first to cancel when I dont. all of you that know me know this is true. I have been an EMT for 18 years. I am a volunteer, did paid for a while ( Not my thing) and then became a Nurse. I am also a volly Fire Fighter I started in 1987. I am still active (not old lol) Just my 2 cents for now..