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5 things EMS must do in 2012

EMS1.com News

December 28, 2011


EMS News in Focus
by Arthur Hsieh

5 things EMS must do in 2012

Let's all try to work toward progress and the maturation of our industry

By Arthur Hsieh

In a seeming blink of the proverbial eye, 2011 is coming to a close.

Is it me, or do the years seem to be getting shorter? It feels like we move from one headline story to the next, hardly pausing to consider the impact of such events to our current or future situation.

The presidential race is already in full swing, our military is drawing down its troops in Iraq while still grappling with the issues in Afghanistan, and the economy is still bruised and battered by four years of recession.

In EMS, we spent another year without a federal home, saw increasing interest in community paramedics, and crashed our ambulances on an alarming basis.

Social media still made bad moral decisions stand out like sore thumbs. I can definitely go on with our profession's foibles; some days I just shake my head and wonder how we persevere.

But, being a glass-half-full kinda guy, I'd rather work toward progress and the maturation of our industry. Here are some ideas:

1) Let's get education on track. Paramedic should be an associate's degree. EMTs and Advanced EMTs should require more anatomy and physiology.

Educators should know more than the book, and be trained to teach, in order to push students to a higher standard. Not everyone can be successful in EMS, and that's okay.

2) Push for a living wage. That would include a working environment that doesn't require 60-80 hours a week in order to make ends meet. EMS providers have families, take vacations, save for retirement. Don't all of us deserve that?

3) Be more than what we are. The only constant in life is change. EMS is no different. To not evolve is to perish. We can do more to benefit our community, to be more meaningful and have a more effective mission.

I hate to disappoint some of you, but we have been around long enough to have our own dinosaurs. Johnny and Roy have been gone a long, long time. Why do we still think in that paradigm?

4) Be the master. EMS exists at the nexus of public safety, public health and health care. The overlap of function varies from one region to the next, but the general premise is clear: we are a jack of all trades, and master of none. This cannot continue to exist; we need to be masters of all we do.

5) Commit to service excellence. We would all like to think we provide the highest quality service. Fact is, most of us provide the best service we can, given the circumstances. The two concepts do not mean the same thing.

Quality Excellence is an active process. It never happens naturally, but mediocrity does. That's why we call the middle of the bell curve "average."

To really be excellent requires real courage to ask what we can do better, even when things don't appear broken.

It means questioning the paradigm, even when everything seems "normal." To not ask these fundamental questions is to promote the status quo, to reinforce tradition.

For me, I'm going to be more deliberate in asking these questions through this column in 2012. You may not agree with me … and I hope you'll let me know.

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
Comments
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Greg Friese Greg Friese Friday, December 30, 2011 4:47:11 AM Mr. Hsieh, I look forward to the conversation continuing in 2012. Thanks for your excellent contributions to EMS1 (EMS EMT Paramedic Ambulance).
Tim Erskine Tim Erskine Friday, December 30, 2011 5:07:01 AM "...we have been around long enough to have our own dinosaurs. Johnny and Roy have been gone a long, long time. Why do we still think in that paradigm?" The people who designed the current systems were brought up on a diet of Station 51 and Rampart General. But those people are now starting to retire - I was 11 years old when Emergency! debuted and I have now been in EMS for close to 30 years. The KMG-365 paradigm can be allowed to fade away, or it can be shown the door. I'm opting for the latter. So, here's a New Year's resolution for EMS1.com: Never again allow publication of the phrase, "EMS is a young profession" or anything synonymous with it. It's time we constantly look forward, not back. It's OK to stand proudly on our heritage, but we have to think of that as history, not precedent. It's something to be learned from, not a model to follow.
Catie Holstein Catie Holstein Friday, December 30, 2011 6:55:59 AM I'll be thinking about how to implement these on a micro level. Thank you for the inspiration!
Michael Norris Michael Norris Friday, December 30, 2011 11:16:28 AM Some very salient points. In the Johnny and Roy days (shortly before I got certified), medic school was 4-6 months total and focused mostly on prehospital cardiac care. Now the curriculum is much more technical and comprehensive thereby needing to be affiliated with an associate degree. As a faculty member in a paramedic program we constantly run into "kids" who cannot read, write or perform basic math skills which cripples not only the student but slows instruction to a crawl at times. Yet the college refuses to make college math, English comp and a basic reading comp class a prerequisite. Another issue with education is that we should be doing psychological testing on students before admission. Many of them are not cut out to be EMS providers and yet occupy space in classes only to be washed out of programs or terminated for character issues in their first couple of years of employment. Living wage is essential. For the amount of responsibility non-fire and non-third service EMS providers qualify for food stamps and other welfare programs. Much of this is due to corporate overhead greed. But the question is...how do you change that paradigm? I like and agree with Tim's last paragragh.
Alexander Kuehl Alexander Kuehl Friday, December 30, 2011 2:19:26 PM I really liked the article. If you include your comments about accident avoidance and "barefoot community providers" on your list, you have nailed most of the issues I stressed in the NAEMSP Textbook.One other issue that I stressed in those heady days after 9/11 was the future need to become more efficient as resources were likely to become scarce.Among my thoughts were cheaper vehicles, single paramedic units, more non-transports, and education better tailored to common conditions with proven treatments. To me that meant more local medical oversight and fewer national, statewide or large regional mandates. Unfortunately many providers, leaders and states continue to resist those changes. Keep up the good work.
Van Fenix Van Fenix Friday, December 30, 2011 10:25:33 PM We also need to create a stronger affiliation and rapport between pre-hospital and emergency department providers.
James Dinsch James Dinsch Saturday, December 31, 2011 9:10:19 AM Thanks for calling it as it is, Art. May 2012 be the year for change.
Steve Jacobi Steve Jacobi Saturday, December 31, 2011 4:09:06 PM 1) The new national curriculum has been published and there are no increases in education but rather just a renaming process. It has been 15 years in the making and will be arriving in 2012. If you wanted higher education standards for 2012 you are a little late. Numbers 2 - 5) See number 1. Until education is beyond a 6 month tech certificate don't expect much more money or for the EMT or Paramedic to be more than an add on cert for Fire and Law. Nothing like the last minute to realize what has been happening all along in the profession with no one having tme to pay attention since they are too busy whining rather than finding a way to participate in the changes at have been anticipated for 15 years.
Robert Balsan Robert Balsan Sunday, January 01, 2012 9:09:26 AM I must agree with this for the world itself and the medical world are constantly changing, meaning we must change with it and not stay with the past. As for the Paramedics, yes they should be given an associate's degree, and the EMTs should be given college credit toward that degree, since there is talk about making the RNs have a bachelor degree.
Dinky Naylor Dinky Naylor Sunday, January 01, 2012 9:11:24 AM Just after Christmas my brother was almost dead at a bar. they knew he was a binge drinking & wasn't breathing on his own blood alchole was.40 that you for all your help keeping him alive.from the friend who called 911 to the day he was released.
James Gray James Gray Sunday, January 01, 2012 10:11:02 AM I believe that in most college or university E.M.S. education programs, things go so fast to the point where many students have trouble retaining much of what they need to learn. So many students have to juggle a job, family and other relationships, as well as other things while I school. Many students who aspire to become E.M.S. professionals begin without relationships with experienced providers who could mentor them and give them the guidance they need. We have so many new people in the field who have the desire and ability to provide top-level patient care but are seldom given the proper tools they need and they must figure things out on their own because there are experienced people out there who might tell them a couple of things here and there, but never really share much of their knowledge and experience with them. We definitely need an overhaul in our E.M.S. education system in the worst way.
Jon Danger Pornstache Jon Danger Pornstache Monday, January 02, 2012 11:38:06 AM I think those are excellent points, most of which can be achieved by making paramedic an Associates degree. Mandatory. It is time we stop catering to the fire service and require them to go beyond the bare minimum.
Michelle Mic Williams Michelle Mic Williams Monday, January 02, 2012 7:45:41 PM I really agree with your points in your article. The biggest thing is education and making paramedic an associate degree. But before that can be done, we must get more universities and community colleges on board. Here in Memphis, TN, there is only one local community college offering the courses. There is no competition and it is not ran appropriately. I was blessed to obtain my education from UAB, one of 5 schools in that area that offer the paramedic classes and certification. Hence, competition gave me a great education. I was surprised when I moved home and began working with paramedics here. Many of the really good ones have trained themselves. We need a better education system here before living wage can even be discussed.
Chuck Scott Chuck Scott Monday, January 02, 2012 8:56:55 PM I agree on most points. However, english classes and how to love your neighbor would not help. These are classes required to get an associates degree. Paramedic classes are up to three times longer than when I took it. They aren't learning anything extra. If the curriculum doesn't give more real life information, it would be a waste of time. This is a tech job. Also, the idea of mastering all is ludicrous. The reason people see doctors is that the doctors are paid ridiculous sums to know how to direct care to find a solution. More training? Yes. A living wage? Yes. Nexus of medical care? No.
Jon Danger Pornstache Jon Danger Pornstache Monday, January 02, 2012 9:44:27 PM I would say master everything on your truck. How many medics give meds, use vents, etc with just a bare minimum of knowledge. They know just enough to be dangerous.
Jonah Thompson Jonah Thompson Monday, January 02, 2012 11:26:57 PM What other "comparable" medical field licenses folks without at least an undergraduate level foundation in basic English, math, and science? Respiratory therapists, lab/rad techs, *gasp* nursing? If you can't read well enough or understand the math and science required to study then we are forced to rely on rote memorization without comprehension. Training isn't the problem - EMS has lots of that. Many paramedics are missing the education that allows us to advance as a profession. We have somehow come to rely on the didactic component to provide "everything". What it should be providing is an academic foundation so you can benefit from the clinical component. That's the point of an internship. Taking the baseline knowledge you have, giving you experiences with the benefit of both a mentor (preceptor) and enough understanding to conduct self-directed study into the practicalities. Run a call, do your follow-ups, dig up the literature/look up the drugs/ask questions of the receiving staff, maybe write it up as a case study, repeat.
Manuel Corky Heredia Manuel Corky Heredia Wednesday, January 04, 2012 9:05:09 AM Here in our neck of the woods we have integrated our fire deptarment EMS system, with our main hospital and our medical director and our local community college EMS program. Our chief has apporved a dedicated QA/QI coordinator between our department and the hospital as well as between our three shifts. Our EMS training division has been mandated to establish a stronger presence within the EMS program and so we pay our seasoned medics who have the desire to teach overtime to instruct at the community college. EMS is on the cusp of change, and we will be asked to provide our services as a higher level than ever before. The smart and progressive EMS system will do well to be ahead of the game through providing advanced training and a strong QA/QI process that can identify the needs of the frontline personnel, the community and keep them accountable to their medical direction.
Steve Kimsel Steve Kimsel Thursday, January 05, 2012 2:47:18 PM The educational component would help move this to fruition. Maybe the stereotype would move from EMS being trained monkeys to educated providers. Taking EMS from the fire service, adding education, and increasing liaison between the EMS and ED are great steps. Too many of those "trained monkeys" still out there...critical thinking and understanding of the treatment modalities used in your profession and local system should be the norm; not the rare exception...
Linda Gregg McGlaun Linda Gregg McGlaun Saturday, January 07, 2012 11:32:43 AM Agree with education, but must realize people in rural areas are not able to acquire those with the education. Those who have the education move to areas of pay. This leaves the older people in small rural areas without help. As you travel I-40 interstate in Texas be prepared for no ambulance coverage thanks to regulations beyond small community abilities.
Michael L. McCullough Michael L. McCullough Saturday, January 07, 2012 12:18:01 PM I'm and Emergency Medical Responder in Northwest Arkansas. Most of our EMS services are deployed from fire stations, throughout this state. We do have a few, groups that run EMS services from a corporate stand-point, but overall, the standards I have seen so far, from the DOT, are lacking. DOT handles the trucking, and logistics of freight movement around this country, why has there not been a division started in this country, that handles nationwide EMS services. We need better oversight from the top down, and yes, many of my friends are in the Emergency Service field, be it nurses, surgery techs, or the occasional M.D. I know that during my EMR training, my instructors were both Paramedics, and two of the best at their job from what I understand. I have nothing but praise for those two gentlemen, because they took time out of their day to come to the community college to enlighten me, train me, and educate me. I am hoping to go forward with my EMS training this spring and continue on, once I've been in the field for a time. Trained Monkeys are not what I see, I see individuals doing what they can, within a system that is outdated and over-taxed by its current duties to the logistics of freight, and the infrastructure of American roadways. I still believe that if we want a better system, for a Nationwide EMS service, then it has to start at the governmental level. They need to take EMS services, out of the hands of "truck drivers" and hand it over to Medical Professionals up in D.C., and have them start coordinating guidelines. See, everyone in medical systems, and medical care, are in the customer service industry. You are the face of the local fire department, the hospitals, and medical as a whole as most people see us. And thus, we need to have more training in A&P, Customer Care, and overall medical standards, but I fear this won't happen until a "Department of ___________", is created at the National level. I do apologize for the rant, but I see it more everyday, and can only hope for better standards of care, for both the public, and EMS services.
Steve Glauer Steve Glauer Sunday, January 08, 2012 9:15:24 AM Simply well stated.
Chris Manion Chris Manion Sunday, January 08, 2012 11:01:33 AM Agreed in all respects.
Alexander Kuehl Alexander Kuehl Saturday, January 21, 2012 12:56:56 PM Steve Kimsel You canotn design an education system for EMS until we decife the evolutionary goa. AS I wrote elsewhere, there is confusion about what model is best, It may well be that LOCAL jurisdictions will evolve differrently...bad for the profession, but good for the locality.l
Alexander Kuehl Alexander Kuehl Saturday, January 21, 2012 1:01:46 PM After reading this thread, I would like to focus on the "nexus vs model" approach to public health, public safety and medicine. Perhaps we cannot be the master of all as Hsieh suggests, rathe rperhaps each locality(state?) must decide which model to use as a template and then master that.
Stuart William Cox Stuart William Cox Tuesday, March 20, 2012 4:34:45 AM Need a national standard of care and scope of practice like nursing.

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