Allow me if you will to allude to some Roman history here. I know that itís a little heavy for an EMS blog but if you would please search the dusty recesses of your memories to think of the Roman Emperor Nero, it would help this post. You know, the one who ďfiddled while Rome burnedĒ
I am way oversimplifying this, but the way that I remember the story was that Rome was being swept by the ďGreat Fire of RomeĒ that burned for days and decimated the city. Popular legend has it that Nero, unconcerned with the plight of his citizenry, played the fiddle while the city was burning.
†(Although, the MOST TRUSTWORTHY SITE ON THE INTERNET *Other than Mine* has this on the subject: http://en.wikipedia.org/wiki/Great_Fire_of_Rome)
Recent events and some things that Iíve been reading lately have brought some EMS issues to light in my mind, and thoughts about good olí Nero have popped into my head.
Are we Fiddling while Rome Burns?
Thereís a few competing EMS system design models out there that have various people in their camps. Mention the virtues of one over another and you will get passionate and snarky responses from the various members of these camps. Trash Fire Based EMS and youíll get a ton of people that will take a break from lifting weights and will bombard you with reasons while Fire Based EMS is awesome while wearing their T-Shirts emblazoned with ďFIRE RULES!!Ē. Mention that 3rd service and not-for-profit EMS may have their downfalls and the EMS Chess Club will bring forth obscure research that shows how much better they are for the patients than everyone else is. Trash Private-for-profit EMS and um, the employees thereof will trash it right along with you and their management will be too busy putting out fires to care.
Try as you might to convince me that one is better than the other and Iíll agree with you on some points and disagree with you on others. I will only endorse what I call ďEMS based EMSĒ, which is EMS provided by truly dedicated caregivers who base their decisions and actions simply upon what is best for their patients and their communities. I have my beef with fire based services that place protecting firefighter jobs and the ďfunĒ stuff involving spraying water on things that happen to be on fire over solid patient care. I have my beef with private-for-profit services that always default to the bottom line, and admittedly, I have a bias towards third service and not-for-profit EMS agencies. However, no one system has ever proven to be a good fit for every community, none are inherently evil, and other professions find their fit within lots of configurations.
If the system design models out there are really locked into a competition for the soul of EMS then theyíve all got a lot of work to do. In this piece, Iím going to ignore patient outcomes, efficient use of tax money, and all of the stuff that I usually talk aboutÖ and focus on one thing and one thing only.
The way EMS people are treated by the competing systems will probably decide this debate weíve got going on here. The model that treats the paramedics the best will win and will take over the industry. Why wouldnít it? What paramedic with half of a brain would continue to work in a service model that didnít pay and treat them the best?
Here in Northern Illinois, there are very few options for a paramedic that doesnít want to do Fire Based EMS for one reason or another. The few options that there are donít pay nearly as well as the fire-based groups and this creates an endless revolving door of young paramedics entering the system, working the ďprivatesĒ for a while, while trying to get a ďreal jobĒ with a fire department. The private services suffer for it, and the fire based services reap the benefits while fostering a system that (gulp, here it comes) focuses less on the healthcare and more on the fun stuff.
So I challenge the private, third-service, and not-for-profit services out there with my next statement.
Youíre fiddling while Rome burns.
If you arenít out there doing your absolute damndest to treat your employees well and pay them what they deserve, youíre failing. You push your employees away. You push the best and brightest into other professions and into fire-based EMS which hands down has the best pay and benefit structure. Your lack of interest in caring for your caregivers is killing our profession. You fiddle whilst complaining about decreased reimbursements and failing to do anything about it. You fiddle whilst focusing on minutia like stupid rules and regulations that degrade the dignity of the adults who work for you. You fiddle while worrying about protecting your jurisdictional boundaries and contracts while theyíre eroded away by the constant stream of departing employees.
Nero could have been an ambulance manager in some of the services Iíve been to, worked for, and observed from the outside. Could he be you?
You have got to find a way to pay your people better. I donít know exactly how itís going to happen either, but it has to be priority #1 for every ambulance manager out there. Trust me, if you donít do it you will find that your capital city has burned to the ground. You will lose your empire and it will not come back. If you arenít out there doing every possible thing you can to keep your employees as happy as you can get them, youíre fiddling, and youíre failing our profession.
This blog has a lot of content on it that explores new revenue sources for ambulance organizations already. Coming soon: Ways for each individual EMS professional to take control of our own income potential, own our profession, and improve our care to our patients. Iíve said it before and Iíll say it again folks, hang on cuz itís going to get fun.