The Profession that is EMS

(Attention: I edited this post heavily. I think that my ADD was in full effect when I wrote it. It’s better now, I think)

The results are in: the bloggers, posters, commentators, columnists, partners, colleagues, and other people even passively involved in EMS have spoken. It seems that EMS ain’t much of a profession these days.

Dang it. I wanted this to turn out to be a real career. I thought that it would. I needed it to.

You see, I have wanted to be a paramedic since I was about 14 years old and didn’t really know what a paramedic truly was. It’s my father’s fault. He was the volunteer fire chief in the small town where I grew up. And I mean really small here. There were (and still are) about 400 people on a good day if everyone was home with their families and there were a couple tour busses rolling though. The town was Edgington, IL and dad was the chief of the Andalusia/Edgington Vol. Fire Prot. Dist. I’d say that there is where I got my passion for this stuff. It was the kind of department where everyone was a farmer and I got pulled up into a truck to go to my first house fire when I was only 14 years old. I was a body and they needed all the bodies they could get. I was hooked and had to continue. It made me want to know more. I wanted to be a firefighter and EMT so bad when I was a young teenager that I tried to get the state to let me challenge the EMT class before I was 18. I worked very hard to get them to bend the rules for me, but they didn’t let me. I know now that they were right. I should have spent those formulative years doing something productive like learning math or biology or picking stocks or something. Instead, I spent those days carrying around a copy of “Emergency Care and Transportation of the Sick and Injured” that my dad gave me from when he took his first EMT course. I treasured that book. It was my bible. I was a young EMS Geek.

When I turned 18 I signed up for my first EMT-B class and joined the local vollie squad. It was a very rural service with a huge area. We covered 275 square miles of rural territory providing only Basic Life Support (BLS) care. Not much has changed there since then. They’re still an all BLS squad. After a few years I became a paramedic at the age of 20. With that, I became an Advanced Life Support (ALS) provider and was licensed to do all these cool new things but the vollie squad didn’t change for me and I couldn’t do all those cool things with them. This disconnect between my licensure level and my career path lead me to obtain employment at an ALS service. It was interesting being a Medic at 20… I could give complete strangers schedule “A” narcotics but I couldn’t go have a beer after a hard day’s work spent scraping up humanity. Man was I young and dumb. I had no idea what I was getting myself into. There was quite a few times where my bravado got smashed into my face. Luckily I had many, many mentors along the way who took the time to give me their best and train me in the arts and sciences that are the Emergency Medical Services. Without those dynamic individuals, I shudder to think of how some of the calls that I’ve had would have turned out.

Thanks to everyone who has helped me along the way.

However now as I reflect upon the decade or so that has passed since then it brings some things to mind. It is debatable whether this next statement deserves a “fortunately” or an “unfortunately” in front of it. I wrote it both ways but neither word seemed to fit the statement. So here it is stripped of any adjective. Most of those people who mentored me are still on the street with me or have moved out of EMS altogether. While this could seem almost normal in some other professions it could go both ways in EMS. A lot of those people were veterans in the service at the time I met them and were where I am now in the profession. They had around ten years on the job and were at the top of their game as far as providing care was concerned. I don’t want to have such gaul as to say that I am as good as my mentors were even though I have worked very hard to be so… but I have given my all so that I can say I can hold my own with dang near any medic out there. The problem is, I feel like I peaked at 20… as some of my mentors may have peaked when they got their licensure. The ones that are still on the street are getting tired. It’s extremely hard on the body to do this emergency stuff every day for twenty or thirty years. It tears you up. But they’re still doing it. They’re still in the thick of things with me in the same job. They’re still slogging through the blood and the mud and the tears fighting for their pay checks and living their lives working multiple jobs being a slave to overtime shifts. They’ve proven that there is precious little career advancement. The others who left the profession, well they’ve gone on to other jobs taking their lifesaving experience with them. Teaching those of us that are left in the trucks that our income potential is limited if we stay here in the field. We may be saving lives, but we’re hurting our families by working jobs that don’t pay squat.

Sure, there are some good EMS jobs out there. There are EMS jobs that pay well, have great hours, and have a well defined career path. Unfortunately that’s not even close to being the norm. We need every EMS job to be like that but most aren’t.

I don’t say the names or exact locations of where I work on here for a few reasons, like I never want to cross patient privacy guidelines or HIPPA laws. That and I don’t want my comments to be associated with my employers. My opinions are my own and nobody else’s. With that said, some time ago I took advantage of the family package being offered by a member of the opposite sex. This changed my life in ways that I couldn’t imagine. (as a matter of fact, I have to take a “read me a story” break in the middle of writing this) One of the ways that I couldn’t have imagined was that one of my jobs became nearly incompatible with family life. I work for an agency that responds to disasters in a governmental way that I won’t name here in the hopes that google won’t pick it up. With that job I had been making enough money to support a house, a couple of cars, and a good existence. However, being gone 6 months out of the year isn’t good when one has a 4 year old. Because of that, I decided to stay closer to home most of the time and make my fortunes solely as a paramedic again, after spending a few years splitting my time between my busy ALS-Providing Volunteer Fire Department (around 3k calls per year) and travelling around the country for my other job.

With that decision I’m back to being a wage slave and an overtime hog. I work three jobs and I’m gone a lot. I make the same exact pay rate as do the new medics right out of the school. While I’m expected to help mentor the others I’ve found that the program is really only lip service at the full-time place where I work. I do my best because I really, truly care about the patients, the people I work with, the community, and the service (in that order). But I fear that I’m going to end up like my mentors have… still stuck in a truck making very little pay while being so concerned about the patients who need me that I can’t leave them for the sake of my family. Or in an entirely new profession that I don’t love and am not passionate about.

It’s precisely that dilemma that prompted me to start writing about EMS.

I want EMS to be a profession that I can be proud of. Not a job that anyone can do with a moderate amount of education, but a career that spawns true professionals that can make a living doing this and progress up a true career ladder.

Here are two suggestions I have on to do this:

First, we need to make the educational requirements hard. The more we learn and master, the more useful we are. While I don’t want to leave my mentors behind, I don’t think that any idiot out of high school should be able to take an EMT class and hav
e my position… like I did to my mentors. The volunteer services won’t like this statement, and neither will the IAFF or the IAFC or the ENA or the (insert acronym here)… but I believe that the MINIMUM STANDARD to become a PARAMEDIC should be an associate’s degree. Perhaps even a Bachelors degree should be required for a PARAMEDIC.

Secondly, EMS needs new revenue streams. The fee for service model doesn’t work. Neither really does taxation (and I’ll get into both of those in another post). We need to capitalize upon and monetize our current skill sets while developing additional skill sets that will bring new sources of revenue into our services. I believe that the cost of an ambulance shouldn’t be a barrier for someone to call 911 for a life-or-death situation… however I also believe that I deserve a fair wage. With additional revenue streams, both of my ideals could be optimized.

For further consideration, read these:

http://medicscribe.blogspot.com/2009/04/profession.html#comments – Peter Canning’s Blog on the same topic

http://tooldtowork.blogspot.com/2009/04/rant.html – Too Old to Work, Too Young to Retire’s blog on the same topic

http://www.communityparamedic.org/ – A new program that I really think shows promise

 

  • Pat

    Well written. I remember . . .

  • http://www.lifeunderthelights.com Ckemtp

    This is an older post that I hope to give a bump to my new wider audience by commenting on. It's an early look at EMS 2.0

  • http://twitter.com/DG_Medic Daniel Green

    I can agree with most of this, but it is moving both ways. I mean EMT-B is becoming easier, while Paramedic becomes more difficult(in my State at least.) For example in Kansas there is more then one High School where EMT-B is an option for Juniors & Seniors who will be 18 at test time, while an A.A.S. in required before taking the State Board exam for paramedic(or MICT here.)
    But nothing after that. Which I agree leaves little to no room for advancement, sure I can be like every other Paramedic I know in my state and bridge to an RN so they can get paid more, but If I wanted to be a nurse I would have gone to nursing school and not be getting my ass kicked and never seeing my family by being in a Paramedic program. Luckily Paramedics can make a living wage here due to the cost of living in most counties.

    One question for you, what about Stand alone fire services? Here in Kansas MOST EMS services are stand alone County-based. In Wichita (where I live, the largest City) Fire responds to most EMS calls. EMT-B in a min for the Fire Dept. If you make EMT harder educationally do you run the risk of back-lash from fire services that supplement EMS? Do you hurt the volunteer services who are already having a hard time finding people willing to do something for nothing, much less spend $1000 and and a college semester doing an EMT-B class to get paid nothing?
    Not that I disagree, just curious of your thoughts.

  • http://twitter.com/DG_Medic Daniel Green

    I just re-read that and I want to clarify… I'm not saying Firefighters are dumb. I'm referring to a Fire services' commitment to CE classes and initial training for firefighters who have EMT as a requirement of their department if those educational standards rise. As with any thing, if standards rise, the cost probably will as well. Hope that makes sense.

  • http://twitter.com/DG_Medic Daniel Green

    I can agree with most of this, but it is moving both ways. I mean EMT-B is becoming easier, while Paramedic becomes more difficult(in my State at least.) For example in Kansas there is more then one High School where EMT-B is an option for Juniors & Seniors who will be 18 at test time, while an A.A.S. in required before taking the State Board exam for paramedic(or MICT here.)
    But nothing after that. Which I agree leaves little to no room for advancement, sure I can be like every other Paramedic I know in my state and bridge to an RN so they can get paid more, but If I wanted to be a nurse I would have gone to nursing school and not be getting my ass kicked and never seeing my family by being in a Paramedic program. Luckily Paramedics can make a living wage here due to the cost of living in most counties.

    One question for you, what about Stand alone fire services? Here in Kansas MOST EMS services are stand alone County-based. In Wichita (where I live, the largest City) Fire responds to most EMS calls. EMT-B in a min for the Fire Dept. If you make EMT harder educationally do you run the risk of back-lash from fire services that supplement EMS? Do you hurt the volunteer services who are already having a hard time finding people willing to do something for nothing, much less spend $1000 and and a college semester doing an EMT-B class to get paid nothing?
    Not that I disagree, just curious of your thoughts.

  • http://twitter.com/DG_Medic Daniel Green

    I just re-read that and I want to clarify… I'm not saying Firefighters are dumb. I'm referring to a Fire services' commitment to CE classes and initial training for firefighters who have EMT as a requirement of their department if those educational standards rise. As with any thing, if standards rise, the cost probably will as well. Hope that makes sense.

  • http://twitter.com/DG_Medic Daniel Green

    I can agree with most of this, but it is moving both ways. I mean EMT-B is becoming easier, while Paramedic becomes more difficult(in my State at least.) For example in Kansas there is more then one High School where EMT-B is an option for Juniors & Seniors who will be 18 at test time, while an A.A.S. in required before taking the State Board exam for paramedic(or MICT here.)
    But nothing after that. Which I agree leaves little to no room for advancement, sure I can be like every other Paramedic I know in my state and bridge to an RN so they can get paid more, but If I wanted to be a nurse I would have gone to nursing school and not be getting my ass kicked and never seeing my family by being in a Paramedic program. Luckily Paramedics can make a living wage here due to the cost of living in most counties.

    One question for you, what about Stand alone fire services? Here in Kansas MOST EMS services are stand alone County-based. In Wichita (where I live, the largest City) Fire responds to most EMS calls. EMT-B in a min for the Fire Dept. If you make EMT harder educationally do you run the risk of back-lash from fire services that supplement EMS? Do you hurt the volunteer services who are already having a hard time finding people willing to do something for nothing, much less spend $1000 and and a college semester doing an EMT-B class to get paid nothing?
    Not that I disagree, just curious of your thoughts.

  • http://twitter.com/DG_Medic Daniel Green

    I just re-read that and I want to clarify… I'm not saying Firefighters are dumb. I'm referring to a Fire services' commitment to CE classes and initial training for firefighters who have EMT as a requirement of their department if those educational standards rise. As with any thing, if standards rise, the cost probably will as well. Hope that makes sense.

  • http://twitter.com/DG_Medic Daniel Green

    I can agree with most of this, but it is moving both ways. I mean EMT-B is becoming easier, while Paramedic becomes more difficult(in my State at least.) For example in Kansas there is more then one High School where EMT-B is an option for Juniors & Seniors who will be 18 at test time, while an A.A.S. in required before taking the State Board exam for paramedic(or MICT here.)
    But nothing after that. Which I agree leaves little to no room for advancement, sure I can be like every other Paramedic I know in my state and bridge to an RN so they can get paid more, but If I wanted to be a nurse I would have gone to nursing school and not be getting my ass kicked and never seeing my family by being in a Paramedic program. Luckily Paramedics can make a living wage here due to the cost of living in most counties.

    One question for you, what about Stand alone fire services? Here in Kansas MOST EMS services are stand alone County-based. In Wichita (where I live, the largest City) Fire responds to most EMS calls. EMT-B in a min for the Fire Dept. If you make EMT harder educationally do you run the risk of back-lash from fire services that supplement EMS? Do you hurt the volunteer services who are already having a hard time finding people willing to do something for nothing, much less spend $1000 and and a college semester doing an EMT-B class to get paid nothing?
    Not that I disagree, just curious of your thoughts.

  • http://twitter.com/DG_Medic Daniel Green

    I just re-read that and I want to clarify… I'm not saying Firefighters are dumb. I'm referring to a Fire services' commitment to CE classes and initial training for firefighters who have EMT as a requirement of their department if those educational standards rise. As with any thing, if standards rise, the cost probably will as well. Hope that makes sense.

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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