A Slap in the Face for Medics? How about a Wake-up call

Thank you everyone! Yesterday when I posted “A Slap in the Face to Paramedics Everywhere?” I recorded my biggest traffic day ever by at least one thousand visitors. I’m honored. Thank you for coming and reading this and thank you for caring about EMS. Especially, thank you those who left such intelligent comments and added to the debate. We who care about our profession need people who are passionate, intelligent, and who are ready to work alongside of us to improve who we are and what we do. By participating here and in the wider EMS blogosphere, you’re helping spread the ideas that we need to spread. Read, Talk, Learn, and Think. Make this the profession you want it to be.

I’m going to repeat that above statement: “Make this the profession you want it to be”

And there lies the true meaning of what I wrote yesterday. Sure, I was mad about the perceived encroachment by nurses onto our professional “turf”, and sure I played my anger up into what I thought would be something to fire you up as well, but there was a message there that not everyone may have gotten.

I know that there are good nurses out there that know a lot about a lot of stuff. A lot of them do a great job in the field within their scope and their experience in such things as neonatology, pediatrics, and critical care has proven invaluable to me on a lot of occasions. Yes, like each and every medic out there I can speak volumes about the times I’ve seen and worked with nurses who seem to be lacking vital chromosomes, but I’ve seen members of every profession that seem to have written their final exams in crayon. It’s no different when I am staffed alongside an idiot partner of the EMT persuasion… give me a smart nurse in their place any day.

However, my beef is this: Why is it necessary that a nurse need ever step into the field? The times I’ve had to carry one in the back of my rig have been mainly because of protocol deficiencies, where the EMS system I was working in at the time didn’t allow me to transport a specialized piece of equipment that was attached to a patient or to administer medications that were beyond the normal scope of the field. Now days, my EMS system allows me to transport pretty much anything and I’ve personally taken the steps to educate myself on the less-common things that I see. However, I’ve grabbed a nurse on occasion when called to transport multiple uncommon medications along with unfamiliar equipment. I’ve never been too proud to ask for help when I wasn’t fully confident in my abilities to fully handle possible eventualities with the patient. It’s not about my ego, it’s about patient care. I live by that motto. However there is no reason, in my opinion, that a paramedic cannot take the education necessary to become experts in any and every aspect of out-of-hospital care. It’s our bread and butter and the thought that our skills are lacking causes me concern. Whatever you call it: inter-hospital, pre-hospital, field, or other care… Paramedics are supposed to be the experts at that in my opinion and I want us to take the steps to ensure that we are so.

If you were angered by the actions of this ambulance service plastering their truck with the phrase “Staffed by Nurses”, that’s good. You should have been. Be angry at the management of that service for existing in a system that they haven’t changed for the better so that they don’t have to use nurses for things that paramedics should be doing. Be angry at their EMS system and their state for limiting their paramedics’ scope of practice and education so that they cannot be used to adequately staff the truck. Then, be angry at each and every one of us for not taking the ownership of our profession so that we can step up and dictate what is best for the patient’s we serve.

Is that petty “turf preservation”? Maybe. However we need some of that. For us to have pride in our profession we need to take the steps necessary to own what we are supposed to own. If we can see our profession lacking the necessary educational background, skills, or just plain old gumption to fix a problem, then we have to band together to do the work needed to fix it. The fact that this service and this system are thinking that having and advertising a “special” truck, “Staffed by Nurses” is a good idea is representative of a bigger problem, and that bigger problem must be handled by our people stepping up and handling our deficiencies so that we can solve the problem. We must improve the education, improve our skills, and improve our public perception so that people trust us beyond just the feel-good perception we have as “life saving” “ambulance drivers”.

You’ve heard me, Justin “the Happy Medic” Schorr, Mark “Medic999” Glencorse, and many, many others talking about EMS 2.0 over the last year. Well, this is part of it. My version of EMS 2.0 involves us paramedics taking ownership of problems like these and taking the necessary collaborative steps to fix them. We have to do just that if we want to advance. Now is the time for us to analyze the problems, dissolve the political boundaries, do the necessary work, and collectively grow up as a profession.

And fixing management philosophies that view us as contemptible morons is first.

One last comment, I got a link in a fascinating article by the Nursing Show ran by my buddy Jamie Davis. You should read it, it’s a good way to see how the nurses take this.

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Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”

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  • http://www.theemtspot.com Steve Whitehead

    I guess I'm just not seeing what I'm supposed to be so offended about here Chris. I've worked along side a PA in a critical care transport rig for over a year. I thought we made a great team. We did market the idea “staffed by PAs” to the hospitals. (we didn't write it on the side of the rig… but it was a marketing angle.)

    I had a great experience working on that rig. I learned a bunch from my PA partner. We never had any scope of practice issues on inter-facility transports. We ran 911 calls and he learned about field medicine from me. We ran ICU calls and I learned about drips and pumps and vents from him. When things went down hill, I tended to manage the airway and ACLS issues, he managed advanced meds. We gave great care. I thought the idea was innovative and unique. I wish we had found a greater market for the out-of-hospital urgent care component, but I think it was just too unique for our systems docs to wrap their brains around.

    Nurses, PA's and doctors could all help to change peoples perceptions of the capabilities of EMS systems. I don't think we serve EMS by creating barriers of entry to other types of practitioners. Instead, I think we should look at those nurses who want to come explore the ambulance environment and say, “huummmm… How could we use them?”

    Creating the future that we want in EMS is going to require us to be a little fearless about who shows up to help.

    How can we invite these newcomers to help us create the future EMS that we want?
    How can their knowledge, experience and extended scope of practice benefit us?
    What new ideas in EMS 2.0 might be more palatable to the medical industry if RNs were a part of it?

    I see an opportunity here.

    Thanks Chris

  • http://www.theemtspot.com Steve Whitehead

    I guess I'm just not seeing what I'm supposed to be so offended about here Chris. I've worked along side a PA in a critical care transport rig for over a year. I thought we made a great team. We did market the idea “staffed by PAs” to the hospitals. (we didn't write it on the side of the rig… but it was a marketing angle.)

    I had a great experience working on that rig. I learned a bunch from my PA partner. We never had any scope of practice issues on inter-facility transports. We ran 911 calls and he learned about field medicine from me. We ran ICU calls and I learned about drips and pumps and vents from him. When things went down hill, I tended to manage the airway and ACLS issues, he managed advanced meds. We gave great care. I thought the idea was innovative and unique. I wish we had found a greater market for the out-of-hospital urgent care component, but I think it was just too unique for our systems docs to wrap their brains around.

    Nurses, PA's and doctors could all help to change peoples perceptions of the capabilities of EMS systems. I don't think we serve EMS by creating barriers of entry to other types of practitioners. Instead, I think we should look at those nurses who want to come explore the ambulance environment and say, “huummmm… How could we use them?”

    Creating the future that we want in EMS is going to require us to be a little fearless about who shows up to help.

    How can we invite these newcomers to help us create the future EMS that we want?
    How can their knowledge, experience and extended scope of practice benefit us?
    What new ideas in EMS 2.0 might be more palatable to the medical industry if RNs were a part of it?

    I see an opportunity here.

    Thanks Chris

  • stevnlisjones

    I do not agree with the message being plastered to the side of the rig. But if EMS does not include paramedics, EMT's, nurses, doctors, and first repsonders working together not claiming turf like a gang things will never get better. We must remember we are here for the patients that need us not to claim ground. Each and everyone of us can bring our stengths to the table to better the outcome for our patients. I am proud to be an emergency room nurse that works hand in hand with all staff under the EMS title. In our county we do not fight over turf between in hospital and out of hospital care. I would hope each and everyone of us are in it to help others and that includes each other. Lisa

  • fire

    I am a firefither and NREMT-B in a small state, I may be out of my league and i do recognize this but when have you known a fireman not to offer his opinion, even if he is wrong. I do believe paramedics belong in the “field” if by field you mean 911, emergency dispatch, i have suddenly stopped breathing I need help, field. Yes paramedics do belong in that field. this looks like this is a transfer unit ran by a hospital or private ambulance company. I dont know about you guys but when i get called to do a transport companny's job and someone down the street from the place i just left collapses and they have to send an ambulance from across town and a medic unit that is 20 miles away to help, I feel some way about that. I feel dr.'s, nurses, phd's, resident's, whoever, you do the facility transports that require long term (most likely invasive) care. Let us handle the acute care. Like you said they are seperated for a reason. Really put what you want on your unit, put staffed by the highest quality nurses ever found in the history of nurses, or staffed by cute little puppies and kitties. I do not care. I don't think we need a wake up call. The public knows who will come when they call 911. EMS.

  • fire

    I am a firefither and NREMT-B in a small state, I may be out of my league and i do recognize this but when have you known a fireman not to offer his opinion, even if he is wrong. I do believe paramedics belong in the “field” if by field you mean 911, emergency dispatch, i have suddenly stopped breathing I need help, field. Yes paramedics do belong in that field. this looks like this is a transfer unit ran by a hospital or private ambulance company. I dont know about you guys but when i get called to do a transport companny's job and someone down the street from the place i just left collapses and they have to send an ambulance from across town and a medic unit that is 20 miles away to help, I feel some way about that. I feel dr.'s, nurses, phd's, resident's, whoever, you do the facility transports that require long term (most likely invasive) care. Let us handle the acute care. Like you said they are seperated for a reason. Really put what you want on your unit, put staffed by the highest quality nurses ever found in the history of nurses, or staffed by cute little puppies and kitties. I do not care. I don't think we need a wake up call. The public knows who will come when they call 911. EMS.

  • Hillary

    As a liscenced paramedic for the past ten years I am not offended by the statement staffed by nurses on the side of a hospital based ambulance company. First of all not all paramedics are CCT (critical care transport certified). Some pts. may need a portable vent, a baloon pump, or other advanced equipment that few street medics may not be familiar with. Also most floor nurses have no desire to do transports. Ten to one those “nurses” that staff the ambulance are formed paramedics and or field nurses from the military. Don't be so quick to judge the person. I am all for paramedics furthering their education, just because you are a parmedic, this does not me you can't also be an RN or LVN. I have known several in my time, and I am also one of them. ~Hillary EMT-P, LVN~

  • Hillary

    As a liscenced paramedic for the past ten years I am not offended by the statement staffed by nurses on the side of a hospital based ambulance company. First of all not all paramedics are CCT (critical care transport certified). Some pts. may need a portable vent, a baloon pump, or other advanced equipment that few street medics may not be familiar with. Also most floor nurses have no desire to do transports. Ten to one those “nurses” that staff the ambulance are formed paramedics and or field nurses from the military. Don't be so quick to judge the person. I am all for paramedics furthering their education, just because you are a parmedic, this does not me you can't also be an RN or LVN. I have known several in my time, and I am also one of them. ~Hillary EMT-P, LVN~

  • Ed

    It is truly sad how this article paints a picture of 'us vs them'. This seems to be the never ending feud between 'what ever fields'. When we think we have a brain in our fields, we always want more, more, more. You boast that you like to 'educate yourself'; Then go back to school and get educated. Become the enemy and be an RN. Wow, what a concept! Then you would be a paramedic and a nurse. Huh, sounds like the best of both worlds. How would I know this, I am one. Hold degrees in both professions. The sad part is, I have held both for numerous years. Why? Because know I have the knowledge of the field and critical care. Now that seems to me like I can deliver the best possible patient care. What do you think? But, if medics want more, then why can't I have more 'skills' in the hospital. I should be able to do what I want. Oh wait, that's what doctors get to do! What a concept. See the trend? You are correct that we need to be proactive with our profession, but we must hold ourselves to standards first. We have to many 'monkey' medics. They hold us back. Until that is fixed….'Fire' (from small state), you simply haven't got a clue. Perhaps some education for your is required. When you get an understanding of ALS (that's ADVANCED Life Support), then you might get it. But wait!! I must apologize, you are a FIREFIGHTER!! Your the hero! Last time I checked, most departments these days run about 85% EMS. Probably the only reason you have a job, but it's not about serving the community is it? I am a certified firefighter too, and that mentality was the whole reason for me getting out of the fire service. To many small minds that think they are somebody, when last I checked, it was about serving the community. Luckily for my family and I, we live in a big state, so it wont be you I call for help to save us during a medical emergency. Wouldn't want to inconvenience you since were not on fire.

    Ed, RN, CEN, NREMT-P

  • Jill

    You guys seem to be pretty pissy about this post. All I want to say is…everyone posting here, you are heroes to me. All I ever did was work the front desk of a Trauma Center for five years….before said hospital (after I quit) decided to take the advice I gave them and put a medically trained person at the desk. I mean, I had a triage nurse in the office behind me, but if she was in the back, I had to slap a pulse ox on a diff breathing patient in order to know whether or not to bother the folks in back. (Because if I ran someone back there, they looked evilly upon me…after all, I was BOTHERING them sometimes). I had to help stroke patients into wheelchairs…and then wheeee….we went to the back….and I was looked evilly upon…while I said…”Left-sided weakness!” I had to plead with some nurses from the back to PLEASE help a guy in the toilet who was bleeding out in the lobby. (He really WAS bleeding out…)

    I don't know HOW many times I may have saved a life. And you all talk so expertly that I imagine you would shit me out of your extraordinarily educated pants…just because….

    OMG…You are much more educated.

    You are. You guys are my heroes. So quit bitching and fighting.

    It's frustrating. I am the person who brings food to the (whatever emergency location) when you have to be there on the holidays.

    I am just a soul. I sat at the front desk of a Trauma Center for five years and took crap from some nurses (sorry, nurses…my mom was a nurse…but you guys can be brutal)…I took crap from doctors…(when I was alone and freaked because a diff breathing came in and was a frequent flyer)….and I didn't know it was a panic attack…

    I used to love it when the paramedics came in. That's why I had my candy jar. On a terrible day, when some medics came in and were waiting for their paperwork, and hell on earth was happening in the lobby…it wasn't the nurses who helped….it was the paramedics who had my lonely back.

    I love you all…but quit yer bitchin'. You think you are special…Win twice on Jeopardy, then get back to me.

    I had ZERO training.

    ZERO…when the local hospital put me at the front desk of the Trauma Center.

    You can imagine all the things I saw, right? You can imagine the terribleness of having a patient in front of you that

  • Jill

    Continued – DIED later? And you had to have them wait for the nurse? Even though you knew that something bad was happening?

    You had already called for help and the ER was so busy, you couldn't GET help? And you just stood there with the patient.

    And you tried to catch a nurse's attention….saying, “Hey!” and the nurses looked at you like, “What? I'm busy?

    Again…you are all my heroes….but for heaven's sake…get it together

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  • fire

    never asked to be a hero, thats not what im saying, and my college degrees are in community service, and a masters in public administration, and homeland security. I am not a professional I am a volunteer because i do care about the community. If you have some pent up aggression about firefighters you should have that checked. I do agree there are too many people that think they know what they are doing that really don't. I am saddened that you had a bad impression of the fire service and quit. it is a true shame when the fire service loses people who are “certified.” to simply dismiss my comments because i am just a “firefighter” is very egocentric, and down right rude. Don't lump me into a preconcieved category of what you think simply because we wear the same uniform perhaps that could be a source of the division right there. you automatically assume i have barely a high school education, and am missing my front teeth simply because im a “firefighter.” I commit one night every week to riding the ambulance for 6 hours, and i recognize this as the growing trend among the fire service. I just find it fun and enjoyable to help people wether its on a fire truck, ambulance, trash truck, or my gov't window office at work. With those remarks i hope you don't catch on fire in your big town, they might be too stupid to put you out.

  • fire

    never asked to be a hero, thats not what im saying, and my college degrees are in community service, and a masters in public administration, and homeland security. I am not a professional I am a volunteer because i do care about the community. If you have some pent up aggression about firefighters you should have that checked. I do agree there are too many people that think they know what they are doing that really don't. I am saddened that you had a bad impression of the fire service and quit. it is a true shame when the fire service loses people who are “certified.” to simply dismiss my comments because i am just a “firefighter” is very egocentric, and down right rude. Don't lump me into a preconcieved category of what you think simply because we wear the same uniform perhaps that could be a source of the division right there. you automatically assume i have barely a high school education, and am missing my front teeth simply because im a “firefighter.” I commit one night every week to riding the ambulance for 6 hours, and i recognize this as the growing trend among the fire service. I just find it fun and enjoyable to help people wether its on a fire truck, ambulance, trash truck, or my gov't window office at work. With those remarks i hope you don't catch on fire in your big town, they might be too stupid to put you out.

  • Andy

    Hillary – In fact you are correct…the first several nurses who were hired to staff these units were already employed with the company as a Paramedic long before the IFT RN business came along.

  • ShogunofHarlem

    It's all about triage. Sometimes it is hard to understand and sometimes people fall through the cracks. It is sometimes impossible to help everyone. Maybe we can get some real health care reform and fix this problem. As long as we have businessmen deciding what is an appropriate number of health care workers staffed, whether they be paramedics or nurses, the community loses.

  • ShogunofHarlem

    Very perceptive. This article is a huge whine fest regarding a huge gap in pay and education between nurses and paramedics at a particular company. The nurses make roughly double the paramedics pay. Also, this ambulance is apparently “decked out with all the bells and whistles”. There is a lot of jealousy and going on.

  • ShogunofHarlem

    It's all about triage. Sometimes it is hard to understand and sometimes people fall through the cracks. It is sometimes impossible to help everyone. Maybe we can get some real health care reform and fix this problem. As long as we have businessmen deciding what is an appropriate number of health care workers staffed, whether they be paramedics or nurses, the community loses.

  • ShogunofHarlem

    Very perceptive. This article is a huge whine fest regarding a huge gap in pay and education between nurses and paramedics at a particular company. The nurses make roughly double the paramedics pay. Also, this ambulance is apparently “decked out with all the bells and whistles”. There is a lot of jealousy and going on.

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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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  • Comments
    mr618
    Welcome to the Club
    Well said, Chris. We can't save everybody, but the ones we don't save tend to stick around a lot longer than the ones we do save.
    2014-10-18 14:40:00
    Steel City Medic
    Welcome to the Club
    Particularly appropriate for me this week. Thanks.
    2014-09-23 21:46:00
    DiverMedic
    Welcome to the Club
    Very well done, Chris.
    2014-09-17 22:15:00
    DiverMedic
    My Blogroll
    One of these days you'll figure out where my blog is... :)
    2014-09-17 22:11:00
    emtterri123
    Six Tricks You Can Use Today to Improve Your EMS Narrative Report
    The first and best way to get people reading you to think that you are an idiot is to pepper your writing with spelling and grammatical errors. It makes you look dumb. - Me thinks this should have been restructured as it does not flow and caused me to reread it several times. lol :)
    2014-09-17 08:27:00
    Taking It With You
    Taking It With You
    Night at the Movies
    Night at the Movies
    A REAL Emergency!
    A REAL Emergency!
    What is Experience?
    What is Experience?
    Streets: Nine and a Half D
    Streets: Nine and a Half D

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