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Long hours, low pay: So what do we do?
As field providers, we have to grow up and escape the chains of the past
By Art Hsieh
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Editor's note: Ambulance crews in N.M. have been assigned 72-hour shifts. Art Hsieh argues that such working conditions, along with pay, training and other issues, can't improve until EMS can show its effectiveness as an industry. |
"Wanted: EMS providers to work for an ambulance service. Must be able to stay awake for long periods of time yet still function at peak efficiency. Must be able to work for low wages. No experience necessary. Rapid seniority is possible."
I'm sure this is not how the service advertises for new staff. But unfortunately, reality usually overshadows good intentions. I suspect the issues that plague this service are chronic and not unusual. The inability to recruit and retain EMS staff has been an issue for as long as I've been in the industry, and it's merely symptomatic of the big issues that we haven't been able to solve.
Why is the pay so low? I'm sure you have some ideas; here are mine:
- Low reimbursement rates by government and private health insurance (since we can't demonstrate our effectiveness as a whole)
- Large regions of the country where people do it for free (I'm not slamming volunteers, but it's hard to justify reality-based wages when people pay for the privilege of providing EMS)
- Lack of recognition of the training and preparation EMS providers need to perform the job
- Self-enforcing perception of the stepping-stone nature of the industry
- Inconsistent spheres of influence at state and national levels
What is happening in N.M. and elsewhere across this great country won't change until these issues are resolved. As field providers, we have to grow up and escape the chains of the past.
We're not simply emergency care providers, and we never have been. Our jobs are multi-faceted, and to do all of the tasks well requires significant training and experience, neither of which we typically have.
Experience won't come until working conditions allows for job stability, family and health.
Working conditions won't improve until reimbursement does.
Reimbursement won't rise until we can demonstrate our effectiveness as an industry beyond cab rides.
And so on.
Challenging? Yes. Insurmountable? No.
As I've said before, this is an all-hands situation. Everyone needs to be on board for this. Other countries have worked to make this happen, and we can too.
It will eventually trickle back to the service in N.M., which will be able to retain quality staff and serve its community well.
Comments
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Aaron Mishler Thursday, April 19, 2012 4:18:33 PM It's a pretty simple solution. Unionize! Then Fight for it, no one is going to give you these things, you have to take them 
Skip Kirkwood Thursday, April 19, 2012 4:22:01 PM Unionize doesn't do it - most unions have no interest in EMS (SEIU, AFSCME, Teamsters) and just take the medics' money. Pay is so low because supply of cheap labor is plentiful. If you want salaries in EMS to increase, support increased educational standards. When employers have to compete for employees, salaries go up - nurses, physicians, lawyers, architects, physical therapists, you name it. Those willing to work cheap or for free, who fight for the lowest educational standards in the civilized world for EMS, are making the problem worse. 
Mark Chambers Thursday, April 19, 2012 4:33:31 PM Spot on. We have to educate ourselves as professionals and conduct ourselves in the same manner if we want the benefits. It's not an easy solution and it wouldn't benefit everyone because there are different interests at stake but it would benefit EMS, EMS pay, and most of all the patients. 
Skip Kirkwood Thursday, April 19, 2012 5:04:47 PM Chris Kaiser Thanks, Chris. What do I have to do to change the sermon in to reality? Or am I destined to simply develop a flat spot on my forehead from banging my head on the wall???
Jim Dinsch Friday, April 20, 2012 4:20:28 AM Absolutely true. Cheap is even an understatement. Often, it's free. Professionalizing thru education is definitely the answer. 
Bruce A Mills Thursday, April 19, 2012 4:39:31 PM With the opportunities for advancement limited why not get more education and be a PA or RN . Skip Kirkwood Thursday, April 19, 2012 5:03:52 PM Why not get more education and change EMS so that there are more opportunities for advancement in EMS? Getting out of EMS is not advancing your career in EMS!
Robert Martin Thursday, April 19, 2012 6:00:12 PM Because I love this job, helping people, big trucks with flashing lights, problem -solving, and interaction with people. My goal is to work for Skips company or one like it and train new medics in the field in 30 years.
Charles Phillips Thursday, April 19, 2012 6:00:23 PM IAFF does organize public ambulance services in this part of the country and they do stand up for the rank in file members. So saying that all unions are bad for our business is a myth; some unions are bad.
I can't believe that the State of New Mexico has not come down hard on this service. They are endangering their staff and the public (a personal injury attorney's dream!). In my state they would be in big trouble for requiring their employees to work 72's. Are these folks paid overtime for work beyond 40 hours/week? If not the service would probably be in violation of state and federal wage and hour laws.
Skip, education has nothing to do with what employees are paid. It's licensing. If the employee is a state licensed paramedic, there has to be a minimum level of education/skill certification. A degree is nothing but a piece of paper that says you spent so many years in college and met the requirements to be awarded a degree. It has nothing to do with mental and physical skills.
I have been in the business for 34 years and I will never be desperate enough to work more than 24 hours at a time. Life's too short to be married to your work. Skip Kirkwood Friday, April 20, 2012 4:18:05 AM It is not licensing. Cosmetologists are licensed, barbers are licensed. Increased pay does not come with licensing - it comes with increased education and professional standards. A degree is a barrier to entrance - people who don't care to invest the time don't get in. This results in reduced supply, causing salaries to rise. Economics 101, which comes with a degree program. Charles Phillips Friday, April 20, 2012 6:38:03 AM Skip- It takes a certain level of education and practical knowledge to qualify to obtain that license, correct? A degree is not an end all. It does not teach the critical thinking skills or the manual skills needed to perform a paramedic's duties. A college degree prepares you for life, not a career. Friday, April 20, 2012 7:36:07 AM Charles: Would you rather someone with a higher level of knowledge of the human body, pharmacokinetics, pathpphysiology etc. care for you or a loved one? Or someone who spent some time in a trade school, learning how to bandage and splint? There are MANY treatments that we consider in the field that can change the hospital stay for many patients. We need to have a thorough understanding of our patients, and the human body as a whole. ANYBODY can be taught how to place someone on a stretcher, place an I.V. and airway, not everyone can be taught how to properly CARE for and TREAT a patient. Should we go back to the days when physicians attended trade schools? Or when nurses did not have to have degrees to become licensed? I have been in the EMS field for over 20 years, I have seen the transitions in EMS, we have made strides in improving, but many more need to be made. I am no way a proponent of socialized medicine, but if you look at countries like Canada, their Paramedics are DEGREED PROFESSIONALS and are paid quite a bit more on average than we in the U.S. The days of cookbook medicine are and should be over.
Thom
Jake Stein Friday, April 20, 2012 9:09:38 AM Charles Phillips
What exactly is a Paramedic degree? The ones in existance now teach everything a cert program teaches but also will teach why and when to more effectively use critical thinking skills. If you have more than just the basic cert training to consider, it broadens the ways you utilize critical thinking and look at being a Paramedic beyond a few skills. The degree is for the career minded and not just those who want a job with easy entrance at the votech. Charles Phillips Friday, April 20, 2012 3:17:07 PM t_derkowski- You're comparing apples to oranges. Most paramedics go beyond just bandaging and splinting. You don't need a formal education to learn how to read a 12 lead EKG or recognize when a patient needs RSI. It takes common sense and good critical thinking skills. I'm all for EMS personnel getting formal degrees but unfortunately there are very few programs in the US and almost none in rural areas. I've been around for a very long time and I don't need some diploma to tell the world I'm "qualified" to care for the critically ill or injured, I have earned my "degree" through years of training and experience.
Art Hsieh Friday, April 20, 2012 4:00:07 PM Charles, I have to respectfully disagree. Your experience and school of hard knocks helped you to develop you critical thinking skills. The degree, in addition to getting you to question key assumptions and reason through complex problems, also provides the tools to write more clearly, complete calculations more quickly, argue more persuasively. It is alo the tool to allow progression through an EMS career or any other "profession". It allows the possibility of thinking outside the box. Experience in and of itself is not enoilugh to overcome society's perception of a profession. Charles Phillips Friday, April 20, 2012 6:02:01 PM Art- I'm not dissing those who can and will get a degree. In my case, however, it would be a waste of time and energy as I'm in the twilight of my career (and some would say life!). It would be great if EMS degree programs were available nationwide but this is not the reality. And for those of us who live and work in the "outback of America", it's not practical. As for writing skills, some of the worst writers I have seen in my life have been those with degrees (some of them have trouble with grammar and spelling!!). My level of experience (34+ years) has given me all of the respect from my peers, other medical professionals, and the public that I need. And just because you and some others think that you need B.S. after your name does not mean that you're any better than those of us who have worked hard, studied hard, and paid our dues. My experience has been my best teacher but I have also been trained by some great physicians, nurses, respiratory therapists, and paramedics at the University of Missouri, which does not have an EMS degree program and never has (if it did I would have been going for it when I trained in 1979). Anyway, I encourage those who can get a degree to go for it and those who can't to not stop learning. Respect is earned and as for those who choose to work for poor salaries and poor working conditions have nobody to blame but themselves (they obviously have trouble with self respect). Skip Kirkwood Monday, April 23, 2012 3:43:53 PM PS - the whole licensing discussion is a red herring. A piece of paper from a government that lets you practice a trade, occupation, or profession is a license no matter what they call it. "Certification" comes from a non-governmental organization. There is a great legal opinion, by the top expert on professional licensing, on the NREMT's web site, that explains it in great detail. Skip Kirkwood Monday, April 23, 2012 3:45:38 PM Charles Phillips I've got a bunch of college degrees. They teach critical thinking, true, but they also teach technical skills that you need to function in a profession. On the other hand, trade schools teach only the technical skills, without the breadth that is needed to create a professional (rather than a tradesman). Charles Phillips Tuesday, April 24, 2012 10:16:37 AM Skip- What about us who attended a University that did not award degrees for didactic/technical training? I didn't need a degree to get my National Registry certification and I didn't go to a trade school either. This whole discussion about "you must have a degree" to get a decent paying job is load of BS.There are thousands of people out there with advanced degrees (like a law degree), who can't find a job. The point I have been trying to make while it would be great to have a degree based profession, but it's not reality.
Bill Anderson Monday, July 16, 2012 3:32:55 AM Charles, you are dead on correct. You cannot learn street smarts in a classroom. Look at cops. Some of the best cops I have known had no degree, but with years on the streets they had more sense than any degree could give you. If you study instead of party in college, then you might learn something. A good head on your shoulders and knowing how to use it are more important. Like my paramedic instructor said, "There are clinical medics and practical medics. Which one do you want taking care of you in that overturned car in the rain at 0300?" BS also has another term too.....Having the knowledge and being able to apply it are the most important tools we have. Acing the NR exam doesn't mean you will be functional in the field.
Eric Young Wednesday, November 14, 2012 11:50:51 AM I disagree 100% it's not about education, or supply. Look at police for example. In Massachusetts, every time an exam is given there are over 200,000 applicants for less than 100 jobs. More than enough supply, yet their starting pay (with just a high school diploma) is more than double the starting pay of an EMT. The real issue is that police and fire are government agencies, while EMS is predominantly privately based. The few government run EMS agencies are generally much better paid (though still usually less than police and fire). The fragmentation and privatization of EMS is the real problem and is what is holding us back. We have no real identity, are we healthcare providers, or public safety? If we ourselves can't agree, then how can the public? We're the bastard step children of a union between healthcare and public safety. Bill Anderson Thursday, April 19, 2012 9:16:38 PM Bash me if you want to, but part of the problem with pay is the owners of some companies. They may have well established, sometimes profitable services, but pay their people low wages so they can have that new BMW or high society lifestyle. They could pay better but their lifestyle is more important.
If Ocommiecare goes through we can kiss EMS as we know it goodbye. Reimbursement will bottom out since anyone over 65 will have to be approved for transport. And what age group uses EMS more often? Senior citizens. 
Kee Llewellyn Thursday, April 19, 2012 10:03:54 PM Oh bull crap. "Obamacare" has nothing to do with it. It's the insurance companies that stiff us the most. Especially the volly corps, who get screwed on charges every day.
Health Care Reform relies on insurance company policies. No matter what happens, the insurance cos will try to cram down reimbursements until we get paid nothing.
Stop mindlessly bashing Obama. Bill Anderson Thursday, April 19, 2012 10:44:18 PM Who's mindlessly bashing Ocommie? If he has his way HE will control everything from private insurance to Medicare. And I bet you believe he's not muslim. If it walks like a dictator, talks like a dictator, and acts like a dictator, then it must be a dictator. Better read up on your world history there kiddo. Charles Phillips Friday, April 20, 2012 2:57:33 AM Bill Anderson- Spare us the right-wing rhetoric! You obviously have never lived around a totalitarian dictatorship (like Nazi Germany, Stalinist Russia, or Mao's Red China) because your assessment of our country's government is way off base! Those governments slaughtered their people and I don't see any Americans being slaughtered unless it's by a bunch of gun toting thugs. We live in a corporarate plutocracy, meaning the rich people have the power. Big money talks and BS walks. Skip Kirkwood Friday, April 20, 2012 4:20:24 AM Bill - employment is a consensual relationship - a private contract. If you (or anybody) don't like the terms of the contract (what the company pays you, versus what the owner keeps for himself), don't work there! Nobody is forcing you to accept the deal - that went out with the end of the Civil War! Kee Llewellyn Sunday, April 22, 2012 8:46:25 AM Bill Anderson You're clearly insane. Obama is neither a commie nor a socialist. That too many on the right have no idea what those words even mean, nor care to educate themselves says far more about them than it does Obama. Not to mention, so WHEN has Obama EVER done anything to make you think he wants total power? Oh right, it was when he combined all the national security agencies into one intrusive, all snooping organization. Oh wait, that was Bush II. Was it when he started two idiotic wars that spent three trillion dollars and gained us NOTHING? Oh, right, that was Bush II, too. all your bizarre, delusional fantasies about Obama are nothing more than projections of what Bush did, and what Romney promises to do if he gets (ha, ha) elected. Charles Phillips Sunday, April 22, 2012 11:05:36 AM Kee- You're spot on. What I don't understand about those who are FOX News educated is that they have terrible memories about Bush's gas prices in '05 & '08, Bush's secret bank bailouts, and the 2 idiotic wars that have screwed a generation of young people with PTSD due to numerous deployments (I'm a Vietnam vet and could not imagine going to Vietnam more than once). This doesn't even get into the health problems of EMS, fire, and police screwed up by the recovery efforts at the World Trade Center. We could do much worse than Obama. Bill Anderson Tuesday, April 24, 2012 1:03:42 AM Ya know, if it wasn't for you brainwashed, intellectually challenged, sheep, this country would not be in the shape it's in. So take yer buddy Ocommie and pray to mecca. THAT IS ALL!!!!!!! Charles Phillips Tuesday, April 24, 2012 10:20:20 AM Bill- You're an incredible bigot! How do you deal with minorities in your work? And where do you get the idea that the President is a Muslim? Oh I know, you put on your tinfoil hat and you hear it on FOX News. Bill Anderson Sunday, April 29, 2012 8:28:25 PM Where do I get the idea the Moron in Charge is a muslim? He's admitted it several times in speeches. I'm not a bigot, I just call them as I see them. His color has nothing to with his inability to run the country. He would suck no matter what his race is. You sir, are the bigot by bring the race card into the discussion. You were the first to mention it, Archie. Charles Phillips Monday, April 30, 2012 1:37:19 PM Bill Anderson- You're just spewing the same tired BS based rhetoric that the birthers have been spewing for the last 4 years. The President has said he is a Christian, (remember Rev. Wright, a Christian minister) and he never said he was Muslim. His grandfather was a Muslim but the President was raised in his white grandparents home in Kansas and they are Christians. So get over it! Your arguments about the President are race based and so by your own comments, you sound like a bigot. Kee Llewellyn Thursday, April 19, 2012 9:57:12 PM Part of the problem is fragmentation. Police and fire see themselves as a family. When there's an issue that affects fire fighters or police on the state docket, 1,000 police or fire fighters show up to support or oppose it as they see their interests best served. When something affects EMS, a handful of people, at best, show up. We need solidarity and cooperation. But this is hard when the paid services are all cutting each other's throats over contracts and the vollys all want to be tiny little dictatorships on their own.
The fact that most of the public still thinks of EMTs and paramedics as "ambulance drivers" doesn't help.
After 9-11, police, fire and EMS services were heroes nation wide. But EMS got dropped as one of the "hero" groups pretty darn fast. When was the last time you saw a 9-11 memorial image that included EMS? Police and fire, yes, EMS, not so much.
We need a nation wide push to remind people that EMS is their first link to healthcare when they are the most sick or injured they'll ever be. When they call 911, it's highly trained EMTs and Medics who show up at their door, their car, their job, or wherever.
Both EMTs and Medics need to be trained better. EMTs should all be trained up to EMT-I at a minimum. Medics should all be equivalent to CCs or better, maybe even equivalent to a PA or NP. Medic should be a full undergraduate degree program, like nurses. Doctors and nurses would respect us more and patients would be better served.
And face it, employers would stop thinking of us as "the guys who lift people for $9.00 an hour" if we were better trained. Bruce A Mills Friday, April 20, 2012 4:23:17 AM If you recall EMS was never called that 911 and post 911 We were " EMT's and First Responders" not once was the word Paramedics mentioned as a profession only as a work class for those effected. I have been in EMS since 1979 we have come a long way and there are many miles to go. I agree education can help but until compenstaion improves the pay will stay low. We have to keep opening doors and getting the word out. Bitching on blogs and snipping each other makes us look worse Skip Kirkwood Friday, April 20, 2012 4:23:22 AM Good point, Kee. NYC has one police department, one fire department, and many EMS organizations, who more often than not bash each other instead of working together. Same country-wide. The national police memorial is in our nation's Capitol, and the national fire memorial is nearby on a campus that is a major center for the national fire service. Our EMS memorial is far off the beaten path - what's that? Again, a small group doing what it wants.
David Slifka Sunday, April 22, 2012 11:53:01 AM Over 90% of EMS personnel responding to the Pentagon on September 11th were non-fire affiliated services. They were comprised of private and non-profits. Very little mention was made. If you will notice, the media either referred to those involved in te twin towers as "firefighters" and police officers. Very little mention of paramedics and EMT's. Also remember that the EMS industry does not have the lobbying power as does fire and police. Many believe that the fire service is overshadowing or attempting to swallow up the non fire-related EMS agencies in order to justify the retention of personnel and funding. 
Patrick Fahrenbruch Friday, April 20, 2012 5:41:35 AM While unions would provide a legitimate option in order to be heard, I am also cognizant of the reality that if issues are not handled with respect and care...a union could essentially end being the same nightmare we are already facing, just in a different uniform. I have certainly had days, sometimes entire weeks full of rage and brooding about how disappointed I am regarding policies and practices, and that I am not alone in saying that I feel powerless and defeated at times. EMS providers inherently have an unwavering sense of pride about our occupation, but pride doesn't pay the bills, folks. Not one person chose to be involved with EMS for the money, but now the very people who live and die for EMS are abandoning their passion in order to have a better way to provide for their families financially. Understandably, budgets are being slashed across the nation at this very moment, but why should that affect our ability to be at our best when our patients are at their worst? It doesn't. Money won't solve the problems that lay ahead. The heart of any EMS service is the people on the streets, you and me...sleep deprived, dirty, hungry, and often disheveled....but never at any moment would anyone of us hesitate to jump back in the truck for the umpteenth call of the shift and perform our duty to the public. With all of the politics surrounding EMS these days, we seem to be caught in the middle of very big decisions being made by individuals that have little or no idea about what we actually do. Well, I feel that my rant has now run it's course...but please remember this, those of you desk dwellers out there that feel content to contribute to our hardship....the more you take away from us and the smaller you make the hoops we must jump through....the more aware we become everyday of how many hours are in your shift and how much you seem to accomplish. Had any good calls lately? :) Stay safe out there. 
Richard Young Friday, April 20, 2012 6:37:37 AM To get higher wages, reimbursement must be increased for ambulance services from Medicare, Medicaid and private insurance companies. Currently it is way below what it costs to operate an ambulance service. We are a very fragmented group we have no clear voice in Washington DC, we have no lead agency to fight for us. Until we all stand together to show we are a profession with high education standards we will always be left out. But we all must stand together as one. Skip Kirkwood Monday, April 23, 2012 3:38:10 PM Not so. FIRST, we have to limit the supply of medics, through advanced educational standards. When they can't provide the service for what people will work for, THEN reimbursement will rise. You are right that we are so divided that we can't get anything done. Jake Stein Friday, April 20, 2012 8:52:12 AM "Lack of recognition of the training and preparation EMS providers need to perform the job".
Ever think that might work against you if the public actually know the number of "hours" especially as compared to other professions who are in the reimbursement battle. California requires a mere 1070 hours to be a Paramedic. The program is so watered down that it is easy for FDs to require all of their FFs to become a Paramedic regardless of interest.
"Self-enforcing perception of the stepping-stone nature of the industry".
If your interests are now broader than the narrow focus of prehospital medicine, then yes you could see EMS as a stepping stone. Those who want to expand in EMS will seek out an education or put higher education to work towards more opportunites which are out there. Unfortunately, the mentality in EMS is to wait for the opportunity to come to them or what the public can do for them rather than taking the initiative. But, as far as a stepping stone, you can see it however you want but if another profession offers more opportunites to advance your knowledge and experience in that area, go for it rather than whining about why a Paramedic can't do it all with a 1000 hour cert.
The industry is still too fragmented and still does not know whether it is even a medical profession. Surely Art you can see this in your own backyard with all of the turf battles in California.
To further complicate things, more titles (CCP, CCEMTP, CP, APP) are added with just a few hours of training but still no definitive minimum amount of education to solidify the states into become a defined profession acceptable to the insurers and legislators. 
Kevin Hanes Friday, April 20, 2012 1:44:40 PM Wow, I see a ton of great and good ideas! Personally I think we need national training standardization for every state. We need one common voice, from organizing. That is usually best done with a union. We need to become more professional as a whole. We need to be held accountable for everything we do. We need for our companies to stop being so greedy, and treat their employees fairly and equally regardless of level of care. Like I said we need most of everything mentioned by all to succeed and to be seen as the true resource that we are! 
Carolyn Anderson Friday, April 20, 2012 4:16:51 PM Kevin your on the money. I started in EMS in 1973, but became and RN. After working 20 years as a nurse, I certified as a Paramedic to work on the streets again. Then My husband who is also a Paramedic and I moved to where we could both work full time for the same company, I became a CCTRN and did ground transport and backed up the helicopter service. I was also involved in the management and billing part of the company. We worked hard to increase our education level and also try and change the image of we are not just Ambulance Service with mixed results. learn to fight with medicare for payments, and unfortunately the private insurance followed Medicare especially for the Elder and disabled. That has been almost 16 years ago and unfortunately I still do not see much change. I left EMS and returned to ER nursing but still had a lot of contact with EMS. Unfortunately I saw a lot of nurses who just think EMS is just ambulance service. I hope with the change in the EMS education and Licensing available, the profession with finally get the recognition that is deserved. Also that EMS will get organized maybe a union or professional organizations like the Nursing associations. Best of luck to those that willing to get those changes through for everyone. God bless all of you that still work the streets!!
Jake Stein Friday, April 20, 2012 5:29:20 PM Carolyn Anderson
Hospital Nurses go under a different budget and does NOT bill Medicare directly like some services (OT, PT, RT) in the hospital and transport business. When nurses get a raise, usually another service or group of employees is sacrificed to pay for it. Last time the local nurses went on strike the Biomed department got outsourced to find the money to pay for the RNs' demands. Not a good way to keep others in support of you or the public's respect.
But, I also have not seen EMS go to battle for other bills which support patients in many different health care settings including home health. In fact, EMS and Fire are going again nurses, RT, PT, OT, PAs and NPs to put CPs and APPs in their place. The recent legislation passed will cut a few RN jobs in favor of Paramedics. So Paramedics do have strong political allies but only for battles of their own specific agendas with something to gain which usually is not in the best interest to all. But then that should sound familiar to you and the nursing unions. Bill Anderson Monday, July 16, 2012 3:36:28 AM Trust me, she gave no slack on QA/QI. We had our share of after work discussions on why me or my partner did something.
Eric E Brors Saturday, April 21, 2012 8:09:20 AM There is not another field where you have to be something before you get to where you want to go. A Nurse does not have to be a Nurse Basic before becoming a nurse. A Doctor does not have to become a Doctor Basic before becoming a doctor. A Poice Officer does not have to become a Police Basic before becoming an officer. Increase education and standards for the proffession. I recently lost my NREMT certification because I did not affiliate with an agency, and that is required. So, I have to work for free, or at minimum wage, where I am unable to pay bills, or eat, just to be in EMS? Charles Phillips Saturday, April 21, 2012 8:29:38 AM Eric- I work for a unaffiliated agency and have never had a problem with maintaining my National Registry. You can't apply online but you can maintain your training, print the application, get the required signatures, attach training certificates, pay your dues, and send it in. There's no reason to not maintain your National Registry. Sorry to hear you can't get a decent paying job. My advice would be to get your application in the mail and apply for some paying jobs. Bill Anderson Monday, July 16, 2012 3:49:42 AM Eric, i don't know where you live, but Texas has different levels for police and firefighters. Police have basic, intermediate and master levels. Firefighters have FF1, 2, intermediate, and master levels.
Mike Sullivan Saturday, April 21, 2012 1:09:08 PM Wow, definately some interesting ideas on the subject...might as well add my.02... First, although I am 100 percent behind improving the quality of our EMS Education, I do not think this is the answer. It is hard to convince someone to spend the time and effort to go through all of the current requirements, based on the pay... After all they can be a (Nurse/LabTech/XRay Tech) pick one... with about the same amount of school, and financial investment. I think our first step towards improving our pay... is educating the PUBLIC, and by that I mean everyone from John Q Citizen, to Jack Q Councilman. Lets face it, when we compare ourselves to Fire/Police/Nurses.... there is one big difference, we have been around only about 50yrs.. We are totally misunderstood by the public, and the politicians...and how can we expect them to support something that they do not understand? I don't know about other areas, but I know that I get asked roughly once a month by a member of the public "Do you have to go to school to be an EMS?"... If people had anyidea of what we REALLY do, and CAN DO.. perhaps they would be willing to support more money for EMS. Once this began happeneing, then I think we would not only attract more people to the profession, but retain the good ones we have.. If this worked in the municipal services, the private services would eventually have to follow suit in order to attract and retain staff...
In closing, I will also say that although more money would be nice... I can't complain too much, I have a job I love, with people I adore at a service that I am PROUD to be a part of..
Mike Sullivan,
Education Coordinator
Laurens County EMS.
www.lcems.net Bill Anderson Monday, July 16, 2012 3:46:23 AM I think we are our own worst enemy. Public education is lacking all over the country. No one bothers to explain when and what to call an ambulance for. No one tells the public they won't be seen sooner if they go by ambulance. No one tells them a cut finger or stubbed toe is not a reason to call an ambulance. No one tells nursing homes and social workers that ambulatory does not mean needs to go by ambulance. But pity the poor, tired, on his 8th call in 6 hours, hungry, wet, cold/hot, medic that slips up and tries to educate one of our 'customers.'
Folks, we have done this to our selves by taking for granted the public knows what to do. Educate the population first.
Daniel Hart Saturday, April 21, 2012 2:43:31 PM Nice that some causes can be identified.
Where are the solutions? No point in presenting the problems without suggesting solutions.
I do not have any off the top of my head, and I am not familiar with N.M.'s solutions. 
Jake Stein Saturday, April 21, 2012 5:52:57 PM @Mike
How can you educate the public when EMS does not know who or what it is? There are probably over 40 different titles in the US for EMS providers. The titles used can vary from county to county as well as state to state. The states can't even agree on what to call the Paramedic/EMT-P/MICT/MICP etc. Not all states want to use the NREMT tests and its levels. Some states continue to keep making more levels like CCP, APP and CP without any increase in the base education. Most of these extra certs or levels require only a few hours of training much like the EMT-I does and we know how that became a joke as a pseudo or Almost a medic title. When EMS bases its titles on "a" skill or less hours than most trade professions like hairdressers or nail professionals, then there is a problem. When EMS relies one nifty titles like "advanced" or "critical care" without the actual advanced or critical care education, training or experience, what trust can you expect to instill in the public, the insurers or the legislators? What answer can you give the insurers, the legislators and the public when they ask for a simple definition of the EMS levels and get more than 50 answers. Some of the certs like FP-C and CCP-C can be obtained fresh out of Paramedic school by passing a test and there are Q/A books out there to give you most of the test just like for the NREMT. You also have alot of confusion within the EMS community by not knowing what the NREMT is. Others have no clue about what is going on in their own state and are oblivious to changes and requirements just to maintain their own "professional" license.
The next question which is also an article published recently pertains to being medical or public safety.
The Paramedic or the beginnings of ALS has been around for 50 years. There have been various forms of EMS around for centuries. Nursing has been around for a long time but didn't achieve professional recognition until the 1970s when it raised its education level. Many other professions have been around for only 20 years and came with the technology advancements. But, their profession recognized immediately the need for education and had no problem integrating into the health care systems. Only EMS is reluctant to change to keep up with the fast paced world of medicine and try to keep uping excuses like "we're only 50". MS Windows NT has been around for under 20 years and look at it. That also includes the way medicine has grown with the internet.
You can also ask EMS providers to list 5 different health care professionals commonly found in the ED and most will not know the correct titles or education involved. Most couldn't tell you anything about nurses except for things like ass wipers and order takers who are too dumb to think on their own. 
Doug Smith Sunday, April 22, 2012 5:55:21 AM We need to increase reimbursement. We will only do so when we can do two things. One, prove we make a difference. Two develop a clinical career path that requires time commitment, educational commitment, a reimbursable service to the community as a whole, and a draw that keeps good people in this profession. 
Kim Calvin Piesik Sunday, April 22, 2012 7:00:28 AM I agree, Doug. Now that it's a done deal, I hope accrediting our medic programs helps us move in that direction.
David Slifka Sunday, April 22, 2012 8:37:28 AM Accrediting our medic programs and entire operations is a great start. Another plus is the fact that we are now submitting data, which in turn will help in supporting our cause for higher reimbursements, equipment, training, etc. However, we also have to shed our dysfunctional actions within the EMS industry, i.e. volunteer vs paid, vs hospital-based, vs private, vs profit, vs non-profit. Inspite of these we need to become more unified in our goal toward providing the highest quality of pre-hospital patient care. There remains much turbulance of mistrust and arrogant egos within the system, especially in the fact that larger services continue to expand their geographic regions. In many cases, there is no other choice, however, I have witness many occasions where this is a demonstration of a "take-over," rather than help. Many ambulance services have worked hard to care for their constituents, and along the way, build up pride and autonomy.
Brigitte Blackburn Monday, April 23, 2012 10:49:36 AM With five years in EMS, lost my job last week because the private ambulance service refussed to agree to a contract with a established private insurance company to except $89.00 flat rate for all trips. So, another private ambulance picked the contract up. Private insurance company's are expecting to pay the same as medicare, and medicaid flat rates for transprort, when the private insurance company's are charging high monthly rates, patient pays for the transport anyways......Private Medical Insurance Companys are only in it for the profit, and the want us to work for nothing. 
Tammie Sneed-Newsom Monday, April 23, 2012 12:56:13 PM The same kind of thing happened to me this past January! They took me in a room and said we are letting you go. I have never been written up. I always got good reviews. When a company decides to let one go they just let ya go!! Ohio laws suck!
Vicky Ctown Wednesday, April 25, 2012 2:11:02 PM Brigitte, did you lose your job? I've been jobless for quite a while now....Returned from major surgery, day after FMLA was over, they let me go...Ohio and I'm sure many other states have the 'right to work' law which translates to 'mess over your loyal employees for your bottom line'...
