Hard Questions About EMT Life (Part 2)
Continued …
Today we wrap up this round of reader questions. I can’t tell you how much I enjoyed mulling these over and I look forward to your comments.
8. When do you know you are no longer meant to be an EMT?
Dave Konig via blog
The day you find that you have no more compassion left, it’s time to go. Skills deficits, knowledge deficits, life challenges, addictions, injuries, interpersonal issues all can be overcome. But compassion and a willingness to help others (without being a jerk) is prerequisite. If you don’t have it, or you loose it, it’s time to go.
Perhaps I should qualify that statement. If you don’t have it, and you have no desire to try to cultivate it again, it’s time to go.
9. Why do EMT schools spend so much time and energy on people who are not putting in the effort?
@gfriese via twitter
I think we put too much emphasis on passing a large percentage of students, instead of passing the right students. I know in our EMT class we have an unusually high pass rate, but we also have an unusually high drop rate. Almost a third of our students drop before the midterm.
We are very blatant in communicating to students who are not performing up to standards, if we think they are not putting in the effort needed to pass. For the students who are on the fence, we offer them lots of resources, but we try to keep the resources student directed They need to put in the effort to find and use our additional support.
Still, toward the end of class, I find this same dynamic occurring even in our group. It’s difficult to fail a student in the last few weeks, or the last day. But we do it every class.
10. What is the difference between a good paramedic and an exceptional paramedic? Both do the job well, but what can someone do to make themselves ’shine’ amongst a crowd of peers?
Medic999′s wife via blog
These, certainly, are very arbitrary and subjective terms, so it is a matter of opinion. Every experienced provider will draw the line somewhere different, but I’ll tell you where I draw my line.
For me, great paramedics have exceptional knowledge and skills. They understand what to do and they understand why they should do it. They have confidence in their skills and their confidence is bolstered by their competence. But exception paramedics take that skill and take it across the human barrier.
Exceptional paramedics have a calming effect on their patients and the crews they work alongside. They develop almost instant rapport with people in the midst of the most stressful situations. They make real connections with people who are having the worst days of their lives and they make it look easy.
For me, paramedic excellence isn’t achieved through medical knowledge and skills. Medicine is a human endeavor and those who excel at the human element are the true great ones.
11. Do we have any prayer of getting American EMS to where it should be from where it is today? Or will volunteers, fire departments, Generation Y, and the American tendency towards mediocrity doom us all?
CBEMT via blog
Well … I have to take issue with several preconceived ideas in your question. I don’t believe medical mediocrity is related to volunteer vs. paid services or private vs. public agencies. Nor is it a product of human tendencies that are strictly American or strictly confined to a generation. But there is, indeed, a problem with medical performance in prehospital care.
And all those things you mentioned can be contributing factors to some degree or another. But the problem with all of those observations is that they are divisive. I do think we will gradually improve as a profession. I’ve seen so many amazing advances in my career so far and I expect that will continue.
But one of the things we need to accomplish is dropping the divisiveness. We point to the stuff that we don’t want to own and claim it as the problem. We all own the problem. We’re not just visitors here. This is our industry. We own it.
Instead of standing against volunteerism or firefighters or generation-Y or lazy Americans or whatever you’re standing against, stand against incompetence and rally for competent caregivers and higher standards. Shout it from the rooftops. Model what it’s supposed to look like every day. And then things will start to get better.
12. Have you ever had to tell someone that they were not going to make it? if so when?
Ryan via Facebook
Ryan I’ve never said that to anyone and I can’t imagine a scenario where I would. I’ve encouraged people to hang on and fight, but I can’t say when someone’s going to die. And if I could I don’t think I’d tell them.
When I am managing a set of injuries or an illness and I get a sense that the person might not survive I try to be very present – if that makes sense. I might ask them if there’s anyone I can contact for them. I’ll listen closely if they want to talk. I’ll make certain they know they’re not alone. I’ll try to make them comfortable … sometimes that’s just not going to happen.
And, of course, I manage their condition and prepare for an imminent cardiac arrest.
13. Some say that you shouldn’t become emotionally involved with patients, however, how can you truly care for your patients without having that intimate connection?
Medic999′s wife via blog
You can’t, not authentically. People having medical emergencies are keenly aware of what is real and what is fake. Medical emergencies realign our priorities and give us tremendous clarity. You can’t fake it. And You Can’t Give Away What You Don’t Have.
I believe that you can treat people with great effectiveness and still connect with them on a personal, human, deeply compassionate level. And I think the people who say you shouldn’t let your emotions be involved are only correct to the extent that we shouldn’t ever let them compromise our effectiveness as caregivers. Beyond that it’s a bunch of hooey.
14. Which EMS models produce faster response times and better outcomes? All ALS, or BLS / ALS combo.
Yitz via blog
I may be misunderstanding your question Yitz. Forgive me if I am. I don’t see how having an ALS or a BLS responder on a rig would affect response times. If we’re looking at time to ALS interventions then there are effective ways to use either model. The response time is far more dependent on system factors than the level of training of the personnel on each rig.
There is also scant evidence that time to ALS interventions is a critical factor in having better outcomes. In fact, research seems to keep suggesting the opposite. To many ALS providers in a system can decrease ALS competency. ALS providers on scene can overlook critical BLS interventions and inappropriately delay transport. Until we make a real link between ALS response times and “better outcomes” the question is a mute point.
15. Should BLS providers be trained and allowed to administer (not assist) some drugs without Medical Control?
Yes. But it should be system dependent, not part of the national scope of practice. The ability to give medications on standing order is well within the grasp on many EMTs working in systems all around the world. But there are also many systems where the standards of care and oversight are just not adequate to allow this.
That’s why we have medical direction. Your medical director should be able to authorize some EMT medication administrations on standing orders. (In my humble opinion.)
Now it’s your turn: So, those are all my answers, but more importantly, what are your answers? Where do you think I’m right and where am I dead wrong? It’s time for you to leave a comment and put in your two cents? I’d really like to hear what you think.
Related Articles:
6 Reasons Why You Should Be A Better EMT
You Can’t Give Away What You Don’t Have
In response to Yitz’s question in number 14- see “Resuscitate!” by Dr. Mickey S. Eisenberg who notes that in patients who present with vfib, having a two tiered system in which the closest BLS unit responds followed by ALS yields both the fastest response times and the greatest rate of survival.
Instead of standing against volunteerism or firefighters or generation-Y or lazy Americans or whatever you’re standing against, stand against incompetence and rally for competent caregivers and higher standards.
That’s all well and fine and PC. Guess who’s against higher standards?
@anonymous I agree that Dr. Eisenbergs book is worth looking at and considering. Readers can find it here if they are interested:
Resuscitate!: How Your Community Can Improve Survival from Sudden Cardiac Arrest (A Samuel and Althea Stroum Book)
Thanks for the contribution.
@CBEMT I think you’re determined to bring this interaction around to blaming a certain model of EMS delivery as the root cause of EMS industry challenges and I just patently disagree.
I think that divisive judgments like that are myopic and overly simplistic. Especially when we take what we see happening in our own community and decide that it must apply to all communities everywhere. It just doesn’t.
Worse yet, as long as we spend our time drawing lines between our agencies and pointing fingers across them, we stand no chance of accomplishing the things you asked about.
You’re asking a question that is enormous in scope and you’re looking for an answer with a microscope.
Sure, I suppose we could all try to hold hands and sing Kumbaya, like NAEMT seems to think we can.
Let me know how that turns out.
@ CBEMT OK. And you go on building walls between yourself and the agencies around you. Point your finger at the other guys and tell them that they are the problem. Make sure you try to make them look bad whenever possible.
Let me know how that turns out.
@11
Stating that someone that has volunteered for 10 years is somehow less capeable than someone who has been paid $10 an hour for 1 year, is laughable at best. There are plenty of “Great” volunteers and plenty of “Great” paid staff. The ability of the person is in no way tied to their compensation level.
I run with an all volunteer (BLS) crew, when we need assistance we call in ALS from one of several paid areas (and sometimes we get volunteer ALS). Either way, the problems that exist have nothing to do with how much money the responder makes. Somehow paying to have an ambulance crew sit around 24/7 to take the fairly low amount of calls we get is going to make them better?
@cbemt -What’s your answer to your question?
RE: #9 “Why do EMT schools spend so much time and energy on people who are not putting in the effort?”
A couple of reasons I’ve observed:
Because pass rate on the NR exam is bragging rights for a school. Schools in Texas are notorious for requiring 80% to pass the class, and will do whatever it takes to ensure a student–good or bad–passes EMT-B school and is pushed to the NR exam, which is–to be blunt–quite a bit easier than any of the major class exams. Once that person is out of class s/he is no longer the school’s problem, but their success on the NR exam is to the school’s advertising/student draw benefit.
And, it’s emotionally easier on the instructor to push a poor student to barely pass than to wash that student out. Some of us just don’t have the stomach to break a kid’s heart when it needs to be broke (we need more Simon Cowell types). We fail to realize that that kid may end up treating someone we love one day…
@CBEMT: Go spend some time in your billing office, see what your last year’s worth of runs were billed out at and see what was actually paid.
The problem is not volunteer vs career and standards. The problem is this is what the job pays, and the government (through Medicare and Medicaid), and insurance companies dictate what the job pays by their re-embursement rates. As well, when the “light-pays” and “no-pays” are factored in, where is your agency is supposed to get more money to pay you. (Light pays are the curtosy checks an ins. co. may send because Ms. Jones called you for a hangnail and demanded transport.)
Liscensing is hogwash, and quite honestly a complete waste of our efforts to pursue. It sounds really slick, but in the end, it doesn’t help anything, the job will still pay what it pays, which is determined by factors beyond our control.
Regardless of how high we set the standards, they will still be the minimum standards.
This job will never make a person rich because of the inherent desire in those of us willing to do it to help our fellow man.
Would you rather have a $10/hr medic working on your loved one because he wants to help them? Or the $20/hr medic that only took the job because it pays well?
Here’s a hint: the reimbursement rates will never change unless our education does. IE, until we deserve it.
It’s how nursing got their pay, it’s how RTs got their pay, hell its how X-ray techs got their pay.
Make nice with other services all you want- I’m not suggesting open warfare. But at the same time, you need to face facts-that the IAFF, IAFC, and NVFC have fought increased educational standards at every turn.
Of course there will always be a “minimum” standard. Everything has a minimum, that was a stupid argument. Without BETTER standards, our reimbursement isn’t going anywhere, and neither is our pay.
For many services, pay scales are pretty simple. Why pay somebody $20 an hour when plenty of people will willingly do it for $10?
Or, why pay somebody $10 an hour when somebody else will do it for free?
CBEMT,
Your original question:
“11. Do we have any prayer of getting American EMS to where it should be from where it is today? Or will volunteers, fire departments, Generation Y, and the American tendency towards mediocrity doom us all? ”
Where is your assumption of where it should be today?
You make the argument that Volunteers/Gen X/American tendencies and Firefighters all contribute to the problem we have today.
I personally am searching for your solution. From the way you sound you want no more volunteers and you expect small rural counties to pay people to be on call 24/7 (well paid professionals who will not lose any skills by the lack of calls in rural areas). You also expect the volunteer and paid staff firefighters to step aside so that the citizens of said county can wait for you (or said well paid people who happen to keep their skills up by waiting for 600 calls a year) to show up (between 3 shifts).
While you may feel that the raised taxes/fair costs associated are well spent and they should all shut up and pay it, I do not. When my core transports someone it is a small fraction of what they pay when we call for commercial agancies (we are all volunteer). However when jail time becomes the norm, they are on their own and they can trust in people like you (who have shown distrust for people like their fathers/uncles etc) giving them the care that will be picked through like a fine tooth comb.
@CBEMT – What standard would you change, and how would that change make anything better?
(I’ll tell you I think would make it better, but it wouldn’t increase our pay: one should not be allowed to progress passed EMT until s/he can demonstrate a minimum of 2-years of field experience as an EMT. And I would consider that one would have to have an employer sponsor to go to medic as well.)
And I would consider that one would have to have an employer sponsor to go to medic as well.
The problem with that is it would put the employee at the mercy of the company. A company wouldn’t sponser without a written commitment. That would force the medic to stay with them, even if a better opportunity comes up.
I didn’t mean company paid for the class–although that is certainly not an unreasonable option. In that case, both backs are scratched here, and if the company pays for it, then by all means the company can require a “continued employment or pay us back” agreement such as MedStar in FW has.
“one should not be allowed to progress passed EMT until s/he can demonstrate a minimum of 2-years of field experience as an EMT. ”
Why aren’t doctors required to be a PA for 2 years first? Why aren’t RNs required to be an LPN for 2 years?
Because every other field in medicine has recognized that a solid educational foundation is necessary before any field exposure can be absorbed.
Instead of forcing a 120-hour Basic into the field utterly unequipped for what they may encounter, how about we make an Associates degree the minimum entry requirement? Two years in the field making horizontal taxi runs or, just as bad, running 911 calls while learning from other under-educated individuals, or, at best, chauffeuring a paramedic around, is not a valid basis for higher education.
There’s no where else in the free world that allows an individual with as little education as an American EMT-B to be the sole decision maker on an emergency ambulance. Think about that. In fact, most of those places don’t even allow such providers on an ambulance, period.
I have a family member teaching Medical Assistant classes- the people taking vitals, running rapid strep tests, and giving IM injections at most Primary Care Physicians offices.
They spend more time in school than most paramedics. I’ve seen the curriculum, and they spend more time on medical terminology than Basics do on the entire human body.
Your BARBER spent more time learning to cut hair- which could kill exactly no one- than most paramedics learn how to intubate, push dangerous medications, and perform invasive surgical procedures.
Only in America have special interest groups kept EMS as far down as we are.
I’ve got acquaintances staffing paid double paramedic ambulances 24/7 in a town generating no more than 200 calls per year. Pay is somewhere north of $20/hour. Skills are an issue, yes, which is why they also work at busier services.
The point is, it CAN be done.
CBEMT:
168 Number of hours in a week
336 Number of hours in a week X 2 paramedics
6720 Cash a week at numbers X $20.00
349,440 Cash paid a year strictly in compensation/not meds/insurance/maintenance/base/gas/uniforms etc.
$1,747.20 Cost each of the 200 calls, strictly in compensation for the paid staff. This does not include costs for anything except the 2 paramedics waiting.
I don’t know if your corp can send bills that high (plus all the extras) per call, but it would never fly in my area.
I’m not saying or trying to imply that getting paid better can’t be done, or isn’t worth persuing. I said pursuing licensing is a waste of our efforts.
Docs serve a long internship.
I don’t disagree that two-years may or may not be enough, depends on the call volume. What benefit would an associates degree add?
I don’t think that 120-hours is enough, and I know the additional clinical hours are way too low as well.
What is the survival rate in other countries EMS vs the US?
What are the system similarities/differences between us and other countries (transport times, level of truck care and hospital care)? I think that we would agree that just because something takes longer in another country doesn’t mean its better.
What about pay versus cost of living between us and other countries? Which when we get right down to it is what the real issue is: pay…
Med Assistants, barbers, cosmetologist minimum standards are set at the local and state level. No doubt you know this next part, but for the reader that doesn’t, EMS minimum standards are established by the Federal Government via DOT. (State and local government can make them higher.)
It’s a bad argument to compare a barber or cosmetologist’s education with EMS. Especially when you consider the history of the development of local/state regulations for the barber or cosmetologist…(IMHO the state should only regulate sanitation/safety for these businesses, not methods and how this style is cut…). (Coincidentally, a local air ambulance pushed this argument in the news media a few years ago in an effort to get field intubations outlawed for all except their aircrews…)
“Outlawed” is the wrong word. I should have said “in an effort to get field intubations to be veiwed by the public in an extremely negative light in order to hammer a very well respected–and competing services–Medical Director.”
Tundra- I confess to not knowing the particulars, just that he works there, gets paid well, and the town is still standing.
S. Cook- “I think that we would agree that just because something takes longer in another country doesn’t mean its better.”
Best example I’ve seen so far is the Netherlands. A Paramedic course is a 1 year Master’s Degree equivelant, open via an application and selection process to BSN-equivelant nurses that have a minimum of 2-3 years ICU experience.
If you’re going to suggest that a 6 or 9-month US paramedic is “better,” (to say nothing of EMT-B classes that can be complerted in 2 weeks at some schools widely advertised in trade publications) well, I think we’re done here.
CBEMT: I didn’t suggest one was better than the other. I asked you.
Now, since you mentioned it, is it your opinion that US paramedics should be nurses?
CBEMT,
If you’re going to suggest that a 6 or 9-month US paramedic is “better,” (to say nothing of EMT-B classes that can be complerted in 2 weeks at some schools.
I guess this is where my ignorance flows. I am in NY and out Paramedic course is 18 months (1 semester shy of a Nurse). Our EMT-B course is 3 months. NY isn’t part of the National registry and does not recognize it. While it kind of sucks that I could not go elsewhere and volunteer, I suppose it does have it’s advantages. I was unaware that one could become a paramedic in 6-9 months elsewhere or an EMT-B in 2 weeks.
Thanks for the clarification.
S. Cook- here’s what I wonder. Are patients in the Netherlands sicker than Americans? I highly doubt it. So what do they (the people who made these decisions) know that we don’t?
The nursing to paramedic thing, obviously we couldn’t just create that right now, out of nothing. I’m not that blind. I’d be interested to know what their progression was to that point; I honestly don’t know. But I bet we could learn from it.
The IAFF would scream bloody murder, you can bet the farm on that. But then, they do that every time somebody tries to make American paramedic education more than it is.
Tundra- I think any paramedic course that isn’t measured in semesters is not something we should be doing. You can’t get a license in Oregon right now without an Associates degree (not sure how reciprocity works). I hope that spreads, it can only bring good things to our patients.
Lots of really great discussion on this one. I’m glad you’re all willing to chime in. All of your experiences and opinions certainly add to the original post immeasurably.
@Tundra “There are plenty of “Great” volunteers and plenty of “Great” paid staff. The ability of the person is in no way tied to their compensation level.”
I will completely agree with the first half of that statement.
@CBEMT “There’s no where else in the free world that allows an individual with as little education as an American EMT-B to be the sole decision maker on an emergency ambulance. Think about that. In fact, most of those places don’t even allow such providers on an ambulance, period. ”
I don’t know about “no place else” but I hear you. And it is a very good point. It is worth thinking about.
@Scott Cook “I don’t think that 120-hours is enough, and I know the additional clinical hours are way too low as well.
What is the survival rate in other countries EMS vs the US?”
I agree as well. And I think we should start by looking toward systems that do a better job already for answers.
@CBEMT “Tundra- I confess to not knowing the particulars, just that he works there, gets paid well, and the town is still standing. ”
I suspect that if you knew the particulars you might not be so convinced that there are simple solutions to paying EMS providers more money.
But I commend your willingness to hold EMS providers to a higher standard. I think your on the right side of the fight.