EMS Apathy

After spending most of yesterday in recovery from a near-sleepless night at the EMS, I logged on to Twitter today and noticed an interesting tweet from Chris Kaiser (@ckemtp on Twitter – an all around good fellow and follow, by the way).  It was a link to an article about apathy in EMS.  The article, entitled “Apathy in EMS is Pathetic” asks some hard questions that all of us in EMS should be asking ourselves:  “Do EMS providers really care about EMS, or is it just a temporary job until something better comes along? Is it just a young person’s game? Do EMS providers really care about the profession as a whole and worry about its future?”  Often I wonder the same things that Dr. Bledsoe asks in his article.  Why do so many EMS people seem to apathetic when it comes to their field?

When it comes to people in my area, I can’t help but think that a lot of them don’t speak up more for positive changes because “it’s just the way it is and the way it always has been.”  Evidently they’re not alone.  A survey conducted by JEMS indicates that, despite safety concerns, the average EMS shift in the cities surveyed in their 200 City Survey remains at 24 hours and a lot of that seems to stem from tradition.  Could you imagine what EMS would be like if we kept our protocols the same just out of tradition (and, to a degree, I’d speculate that some do).  Accepting the status quo is not always in the best interests of ourselves and certainly not in the best interests of our patients.  However, many of us do and a lot of that is because of the “it’s just always been that way” mentality.

I don’t know about you but I’m all for bucking tradition (whenever and however possible).

I wrote about EMS 2.0 in my last post and it’s very much inclusive of some of the issues that possibly lead to EMS apathy.  One think CK and I discussed earlier was the need to have better pay for EMS crewmembers and treatment that actually makes a difference.  I agree 100%.  Part of the overhaul of EMS will be addressing the factors that make EMTs and medics want to jump ship.  I know of several people who are working in EMS and in school for areas of study that have little, if anything, to do with EMS.  A lot of people see EMS as a stepping stone or as a means to collect a check while they’re in school.  If that’s what they want, that’s fine.  I’m not going to fault them if it’s really what they want.  However, I think we have too many people with that mentality and we need to do all we can to reduce those who will let their licenses lapse after they graduate from school.  We need to increase the number of people who truly care about EMS, its future, about making it better and, just as important, who are in it for long-haul.  We need people whose long term career plans are to stay in EMS for as long as they possibly can, be it on the front lines or in EMS education.

The pay thing is an important factor to address as well.  The last salary survey that JEMS performed is very telling.  Did you know that even within EMS itself there are big salary discrepancies?  The average EMT makes just over $28,000 and the average medic makes about $38,000 (the medic making more is understandable since they have more education than a Basic).  However, if you continue on to support staff, an IT manager makes about $68,000.  Wow.  Now, I’m not downplaying the training and long hours that IT people put in and they are very important to what we do.  However, I don’t like the huge gap in pay between those on the front line and someone who essentially works behind the scenes.  Those who are directly responsible for patient care should be paid better than they are.  Remember, these numbers are averages and many don’t make as much as the survey claims is the median.  Especially in settings like mine, a medic may not make even over $30,000 a year.  The lower pay is a slap in the face of those who are on the front line and who work long hours and spend so much time away from their families, compared to others who make more and work 9-5 Monday-Friday.

Changes will happen but it will take time.  It took nurses decades to get the respect and pay they have.  However, they earned their respect and higher pay.  Simply put, they insisted on more education and more accountability in their profession.  They demanded that they be allowed to give better patient care overall and they proved that they deserve what they’ve achieved.  I’m not saying that us in EMS haven’t earned respect but we, as a profession, haven’t done enough in the areas of education and accountability.  EMS 2.0 is a great step in the right direction but implementing it is going to take some doing.  We have to make it attractive to the decision makers in order to truly make this successful.  We can push for it all we want but we have to get our higher-ups on board in order to make it happen.  That’s where we take pages from nursing’s playbook and act accordingly.

What do you think can be done in order to combat apathy within EMS?  What can we do to improve our working conditions, pay and our ability to care for our patients?  How can we make EMS a legitimate career and profession rather than a stepping stone to something else?  Please feel free to leave your thoughts as a comment or you can email them to me (you can leave your name off if you wish).  I may use the ideas in another post in the future.

Rural EMT-B

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Psych Patients, Trauma and EMS 2.0

As I write this, I don’t have my Word Press dashboard open so I have no idea how long it’s been since I’ve written something.  I know it’s been a good minute.  For some reason anytime I sit and try to write I get some kind of weird writers block.  I’ve had blogs before (and have a couple of others now) but it’s been happening no matter what I’ve been wanting to write about.  It’s been the strangest thing.  I sure hope it goes away.

At least let me get through this post.

My last shift was rather interesting.  I hauled a psych patient to a facility that is better equipped to handle the case.  The medic had our passenger calm during the whole ride, which was great considering that the PT had threatened to kill the E.R. doc before a transfer for a psych eval was arranged.  It seems the pt also was suicidal and had made at least a few attempts.  All in all, it was an uneventful transport and the pt even slept part of the way to the other hospital.  Now, my EMS brethren might be thinking “so? I do this everyday.”

Was your last suicidal and homicidal patient a peds case?

My pt was under 10.

How in the world does this happen?  There are a lot of conspiracy theories but who knows what’s really going on.  I just couldn’t believe that a kid, so young, would be in that state.  It made me somewhat sad but also made me wonder if some of those conspiracy theories might be true (one involves a relative having custody of him and turning him that way so she could get a check off of him).  That thought made me mad.  Regardless, I hope he’s getting help and that it’s not too late.  Otherwise he might just be a good candidate to be one of these people who are locked in the padded room for the rest of their lives.

I was chatting with an old friend the other day and we were doing the usual catch up stuff.  He asked what I’m doing these days and I told him that I’m an EMT and hoping to get into medic school this fall.  “Oh, so you’re an ambulance driver.”  I tried to explain to him that there was a difference but his opinion is that of so many people around us.  You know the opinion that all we are is a fancy taxicab with loud sirens and pretty red lights.  It’s sad that people don’t see us as real medical practitioners but that’s going to take some time.  That’s why I wholeheartedly support the project known as Chronicles of EMS.  It’s a show that follows medics and EMTs while they’re doing their jobs.  This is a reality show, not some piece of garbage like Trauma on NBC (more on that in a minute).  It shows EMS for what it is and that doesn’t give in to the stereotypes that the fictional shows give (and thus is believed by Joe Public).  If you haven’t checked it out yet, I highly encourage you to do so.  It’s all part of the EMS 2.0 movement, one of the many steps in the process.  This is the step that seeks to educate the public in what it is that EMS does and helps them to see that, yes, we are real medical practitioners.  It will be nice when the day comes that we’re seen as a legitimate part of the medical community and not just a transport service.

Now some thoughts on NBC’s Trauma:  Trauma is a fictional (yes, I know it’s meant to just be a show) that follows some fictional members of an EMS in San Francisco.  It not only shows them “in action” (you’ll understand why I call it that in a moment) but it shows all the stuff in between (their personal lives).  I have no problem with that; in fact I think that’s a good point of the show.  That said, a lot of the stuff they show while the characters are on duty is just plain insane.  Numerous times they show sex in the back of the truck or in the station and all types of unprofessional behavior (including letting some poor dispatcher have it for a problem that’s beyond her control).  Some of the medical practice they show is dodgy at best and a lot of the things the characters do would get licenses revoked in a lot of cases.  The worst part: At the end of one episode they had the audacity to show the following message just before the credits:

“Dedicated to the men and women of Emergency Medical Services.”

Honestly, I was somewhat offended by that.  They just got finished showing an episode full of unprofessional and outright reckless conduct by the characters and yet they want to dedicate that garbage to us?  I was floored.  Again, I realize this is “just a show” but think about how police officers feel about shows like Law and Order and how doctors feel about Grey’s Anatomy.  These shows make them look just as unprofessional and I know of a lot of people who don’t like those shows for those reasons.  That’s how I feel about Trauma… they make us look like loose cannons and then have the nerve to say the show is dedicated to us.  It’s unreal and it’s degrading.

I mentioned EMS 2.0 a few minutes ago and lots of people wonder about it.  Pretty much, it’s a grassroots movement by EMS people themselves to improve our neck of medical practice from the ground up.  That’s everything from dispatch to protocols to QA.  It also calls for education and licensing (yes, licensing, not certification) standards to be increased at all levels of EMS.  It also includes demanding better working conditions and much deserved respect.  Better patient outcomes, more options for the EMT or medic as far as treatment goes and, ultimately, the recognition of EMS as a real profession and not a trade.  As the name suggests, EMS 2.0 is a complete overhaul (or reboot if you want to keep with the computer metaphor) of EMS as a whole.  The system isn’t dead but it could stand to be improved.  What needs to be done is keeping and improving that which works, throwing out what doesn’t work and giving us even more tools.  One of the things I’d love to see is the ability for a paramedic to use his clinical knowledge (gasp!) and make a determination on whether or not the patient really needs to be transported to the hospital, if the patient can be treated right where they are or if alternate transport to the patient’s primary doctor or other appropriate medical service can be arranged.

I’m all for anything that can make EMS better and where I can be of more use.  I’m hoping to start paramedic school this fall because I want to be the most use to my patients that I possibly can be.  I also plan to continue my education further after paramedic but I haven’t decided exactly what I want to do just yet.  The betterment of EMS is something that everyone, including those in EMS and the general public, should strive for.

Rural EMT-B