As some of you probably know, last weekend I went to the Fire Department Instructorsí Conference (FDIC) in Indianapolis, IN and I spent a great deal of time wandering the convention floor, looking at cool things and talking to cool people. There were plenty of great things to see and great new things to learn about and I immersed myself in doing just that. One of the things Iím always interested in is looking at the new trends in ambulance design and the manufacturers always have their coolest new vehicles on display to feed my interest. However, while walking the conference floor, I came across an ambulance that did more to tick me off than it did to promote their new vehicle design. Seriously, it was like someone slapped me in the face. Hereís the picture I took from my phone:
Does anybody see anything wrong with that picture? I was immediately ticked offÖ †Iím talking a level 7 hissy fit. I was livid for quite a while and if you follow my twitter feed, you probably saw the three or four times I TwitPicíd it.
I mean really? They had to put ďStaffed By NursesĒ in six inch high script on three sides of this thing?
I blocked out the name of the service that runs the ambulance and in all fairness to the manufacturer, this truck is awesome. I would be quite happy to work in this truck although being that it has no bench seat, its usefulness as a 911 truck is hampered by its inability to carry more than one patient at a time. However, I would flatly refuse to work in this truck or for the ambulance service that puts it on the street. I happen to know the service that bought it and Iím trying to avoid naming them directly, but they serve a midsize city in Illinois.
Before you go all West Side Story, whip out your switch blade and zip gun, and prepare to have a dance fight with the nurses out there, realize that Iím not mad at them. Sure, mostly theyíre well-paid and have climate controlled jobs inside of well-lit buildings, but they didnít do this to us. My beef is with the management of this particular ambulance service.
So, letís say that youíre the manager of this particular ambulance service. Obviously, sitting there in your office you must think that your paramedics and EMTs are contemptible morons who live simply to cause you problems. Furthering your view of the world, you probably think that the rest of the medical profession and the members of the general public in your area view them the same way and simply donít trust them to provide medical care when itís like *really* complicated and stuff. You probably feel that everyone would feel safer knowing that their patient or loved one is traveling via the companionship of ďnursesĒ whom you must view as actually being like actually *Competent* and stuff.††
And thatís what this rolling billboard to your contempt of your employees and their profession says about you. Itís a slap in the face to the good men and women you have working for you and there is flatly no excuse for it.
Hereís a tip, anonymous ambulance manager person (AAMP). There isnít a need to have your precious ambulance be ďstaffed by nursesĒ when you have sufficiently equipped and prepared paramedics working in it. Paramedics are acute care specialists. Weíre also experts in mobile medicine. Our education, training, and experience prepare us for the unique environment that we create when we move patients from one place to another. Critical Care Paramedics have the intensive Care experience, training, and background needed to operate in a critical care ambulance environment, nurses do not. Sure, ICU and ER nurses are great at Critical Care. However you shouldnít regularly staff a critical care nurse in the transport environment for the same reasons that you wouldnít put a critical care paramedic inside of the ICU. The professions are like in a lot of ways, but theyíre separate for a good reason.
And you, AAMP, donít respect that. Perhaps itís because youíre burnt out. Perhaps itís because youíve beaten the system youíve created into such a pulp that nobody wanted to staff your new Critical Care Truck. Perhaps itís because of a lot of reasons, but itís certainly not because you wanted the best in patient care or to show that your employees are capable of operating your shiny new ďspecialĒ ambulance. No, you wanted ďnursesĒ to ďstaffĒ that truckÖ and not only did you want the medical people youíre contracting with to know this, you wanted everyone who saw the truck to know it as the 6 inch high letters stating that fact clearly show. Do you think that the public views your crews as incompetent? If so, do you think that furthering the notion by advertising that your ďspecialĒ truck is ďstaffed by nursesĒ will help that situation?
If your protocols are so draconian that even critical care certified paramedics cannot be allowed to staff that truck, then your protocol system is in the Stone Age. If your educational system isnít up to the challenge of preparing your most experienced medics to staff it, then fix that problem. I know that there are great medic/nurse combos out there and I know that flight nurses have garnered quite a bit of respect out there in the worldÖ and heck, Iím not knocking them for doing it. However, this is the time for Paramedics to step up and claim our turf. This ambulance clinched it for me. AAMP, your shortsightedness has caused me to lead a revolution of sorts here. Youíre contempt for your staff has indicated to me that now is the time for paramedics and EMTs, such as the ones that work for you, to stand up and start claiming what is rightfully ours. Frankly, AAMP, your ambulance and your attitude is ridiculous and thinking like that must be stamped out right now by the good medics among us.
And I should also say this to the nurses in the audience before you start skewering me for knocking you: Have you looked at the debates in your circles concerning the use of paramedics in the ER and in other hospital units? Have you ever seen the term ďUnlicensed Assistive PersonnelĒ? Well I have, and itís what the upper nursing echelon calls me and my professional colleagues. †Itís offensive, but heyÖ our jobs are different. You have the hospitals and the fixed facilities. Thatís what you do. We have the field. Itís what we do. Thereís a line, respect it. If you want to do EMS, go through a real paramedic program. If we want to do nursing, we should go to nursing school. Really, itís that simple. The transport environment is difficult and requires the use of specialized personnelÖ which we have, theyíre called paramedics. The medical care we provide is close to the care that you provide, except we have autonomy that you do not and we are use to working independently in the environment in which we operate. Your focus is different than mine. †You may be the best transport nurse out there, but even though you personally may be awesome, my profession needs to have people as awesome as you working on our side. Thatís what this is about, not to knock your transport nursing skills, but to kick us paramedics in the shorts and get us to step up and maintain ownership of what we should own.
The responses I got back on Twitter show me that there are a lot of like minded individuals out there. Perhaps some of them might work for you, AAMP. You better take that into consideration because if I have my way the paramedics are going to get the notion that weíre not just a bunch of contemptible morons and weíre soon going to take control of our own profession. On that day, managers like you will be obsolete. Perhaps you can get a job managing nurses.
Here is my personal Ďthumbs downí for the graffiti against my profession that you had someone slather on your shiny new truck, AAMP. My advice? Take it off and reconsider your staffing patterns. What youíre doing is bad for my profession. It affects me negatively, it affects my profession negatively, and it shall not go unanswered.
What do you think?
Be sure to check out the follow-up to this post “A Slap in the Face? How about a Wake-Up Call?”
Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”