While reflecting on the events of the past week, I thought about what I really wanted for EMS Week. I really enjoyed reading the various blogs, articles, comments, status updates, and all that other stuff people posted during the week. I refrained from an EMS Week post for various, unimportant reasons.
I generally think a week dedicated to the awareness of our profession is a good idea. It gives us the opportunity to present ourselves to the communities we serve, so that they may understand exactly what we do. Most of the public has no idea what it is we do, and we get to give them a glimpse into the life of an ambulance driver EMS provider.
So, several things I wish could have been accomplished, changed, or whatever during EMS Week:
A real EMS journal
I read lots of journals, and contrary to popular belief, we, EMS, don’t have one. We have a magazine that happens to have helpful articles smashed between layers of fluff pieces and advertisements for ambulance manufacturers and knives. I certainly don’t sit on a review board for the EMS “journal,” but I question how much legitimate peer review is actually happening. I can’t imagine our “journal” as having a respectable impact factor. I would really like to see a move away from the magazine format, and towards a medical journal format.
There is nothing scientific about a dog being able to recognize an impending seizure.
Nationwide standards for entry
I will readily admit that I am a proponent of National Registry. I believe NREMT has the best interests of EMS at heart, and wants to improve our profession. The easiest way (in my opinion, of course) to begin improving our perception is national standards. I can’t imagine the rationale behind my certification not being “good enough” to work in a neighboring state. If I take the same test as a guy in Seattle, and a gal in Boston, and a dude in Omaha, then we have all met the same standard. Nurses are “registered” and we should be as well. I believe that National Registry should be a national standard, and a requirement.
Before you get all up in arms, suggesting that NREMT is just there to “collect money,” ask yourself how much money you pay to them versus your state. Registry takes 20 bucks every two years. I pay 175 to my state for the same time period.
There are also opponents of the computer-based testing model that Registry uses. “How does passing a test assure competency?” is one of the arguments I’ve heard. If you happen to think that way, then I would ask for your solution to ensuring the competency of paramedics entering our field.
A National EMS advocacy group
Yeah, NAEMT just ain’t gonna cut it. And they haven’t been for a long time, either. We need an organization that advocates for EMS. Period. Not one that supports the IAFF position that fire-based EMS is the best way to go. It is my personal opinion that the IAFF desires to overtake EMS because they see EMS as a cash cow (both for revenue and membership numbers) with no cohesive leadership. We shouldn’t be forced to capitulate to IAFF simply because we have no leadership.
This is not an indictment of those in the fire service at all. I have immense respect for firefighters. I don’t think firefighters should be forced to cross-train to provide EMS, and I don’t think EMS providers should be cross-trained to fight fire. Fire and EMS have completely different missions, and they need different methods of leadership to function at their best.
“The fire department is a budget looking for a mission. EMS is a mission looking for a budget.” as someone much smarter than me said once.
More EMS 2.0
I am tired of asking people if they’ve heard of EMS 2.0. “Dowhatnow?” is the usual response. I don’t know where the apathy comes from, and I really don’t know how to fix it. I think it comes from a perception of EMS as more of a hobby or a job, as opposed to a career. Admittedly, I could do more.
I do post articles and blog posts on the bulletin board at work. Rogue Medic is a favorite. I enjoy starting discussions about new ways of thinking with my coworkers.
Frankly, I don’t know how else to push EMS 2.0. It seems that not too many people care about the future of EMS. You, the reader, obviously do, since you are reading this instead of watching TMZ. Perhaps those who aren’t reading want the best for our profession, but just don’t know what to do next.
Let’s get them involved. Help me do it, and I’ll help you.
The slogan this year was spot-on. This is a calling. It’s not just a job. It takes a special person to dedicate themselves to this field. As always, I’m honored to be a member of such a group.
There are more things I want for EMS, but my fingers are tired now.
Nicely said. I agree 100%. I particularly like the EMS journal idea and I’d like more information about EMS 2.0. I’m not familiar with that term and I don’t quite understand what it implies. More! More!
EMS 2.0 is by no means my idea. Many smarter people have cultivated the movement.
Have you read Interventions? http://frnmagazine.com
Yes, I have been reading Interventions.
I think you guys are doing fantastic work, and sure hope you keep it up.
Over the years, there have been several serious journals written for EMS. Sadly, none have succeeded. Back about 10 years ago, there was even one that was written on line only. That one failed too, but it drove JEMS to develop an on line presence.
Sadly most people in EMS seem to think that JEMS and EMS World are just ducky. Cartoons, preachy editorials, condescending articles, and even poetry. As a former co worker of mine said, “How can you take an EMS magazine that includes poetry seriously.” I’ve never seen poetry or cartoons in the NEJM or JAMA.
I don’t quite agree with you about the NREMT, although as you point out it is cheap enough to maintain certification. I’ve referred to passing the NREMT exam as the “Bunny Slope” of EMS. All it certifies is that you’ve passed an entry level exam. It’s your ticket to start your real education in EMS.
You’re spot on with the NAEMT. I know some very earnest and bright people who have tried to work from within to affect change, but to no avail. It’s the old boy’s network that has expanded to include some old girls as well. “Round up the usual suspects.”, as Captain Renault once said.
Finally, while I’m grumping; Before we start on EMS 2.0, we have to make sure that everyone is up to the EMS 1.0 standard. They aren’t and from what I see, it’s getting worse not better.
I’m glad that we see eye-to-eye on most of my points.
You are absolutely right about NREMT being the bunny slope of EMS. I can’t imagine that changing anytime in the near future though, especially with the shortage of EMS providers we are facing. I wholeheartedly support using NREMT as a national standard of sorts, however. Perhaps we need to raise the initial standards while we are at it, but I believe Registry is doing what they can to advance our profession.
Having read what I have on EMS education in other countries, I certainly believe we can do much, much more. Australia, The UK, and Canada are prime examples. I would really like to see a paramedic license come with a bachelor’s-level education. Such a standard would open up opportunities for further advancement, perhaps through Master’s-level, or maybe even Doctorate-level. Nurses can do it; why can’t we?
Adopting Registry as a nation-wide standard would be a good place to start with EMS 1.0. Making sure everyone is on the same page across the country should be a priority.
Nurses make much more money than we do, by and large. The problem with a bachelor’s level paramedic certificate is that there is no Return on Investment. Services are not going to pay enough to justify a four year education to be a paramedic.
What I’ve recommended is that people who want to advance in EMS put their money into degrees in fields such as business, public administration, or (yech) public health. The first two will prepare the person for management, but more importantly, are fairly portable skill sets.
If paramedics want to determine the future of EMS, then a number of them are going to have to stop being field providers and get into positions where they can be policy makers. That’s not going to happen with a bachelor’s degree in IVology.
As to the shortage of EMS providers, there is no such thing. There are plenty of EMTs and paramedics out there. What there is a shortage of is people trained to be EMS providers who will put up with the low wages, craptastic benefits, horrible working conditions, and disdain by their employers. Not when they can go into other fields.
“What there is a shortage of is people trained to be EMS providers who will put up with the low wages, craptastic benefits, horrible working conditions, and disdain by their employers. Not when they can go into other fields.”
If I could just find someone who’ll take me, I’ll deal with it!!!
You would for a while, but it would become old very fast. Chances are as soon as you could find another job, you’d leave. That’s not a personal reflection on you, it’s just the way the industry works.
We seem to be largely on the same page across the board.
FWIW: EMS does have 2 “serious” journals; Prehospital and Disaster Medicine and the Journal of Prehospital Emergency Care. I wrote a short piece for PDM some years ago.
Ultimately, EMS has to be able to define itself. If we want to be a “profession”, then people need to start reading (and subscribing to) the serious journals. Only then (when money talks) will we be able to put more provider-level material in there. Of course, if we want to be a “trade”, then the existing journals/magazines are fine. Neither answer is right or wrong. What’s wrong is lacking a true accepted definition. Nursing is only now climbing out of there. Some of their written works (Journal of Emergency Nursing, for example) are well-done professional journals; rival to their medical counterparts. Others are “magazines”.
Otherwise, you’re spot on…
I’ve read PEC, and get it whenever it is published, since I am a member of NAEMSE. The NAEMSP website says that PEC is the “official journal of the…National Association of EMTs (NAEMT). I was unaware of that fact. Looking on the member benefits page of NAEMT, joining gives you a free subscription to EMS World Magazine, but only half off of PEC.
I would think if PEC was the “official journal” of such a group, the subscription would be free. I’ve been getting Air Medical Journal for years now as a member of the IAFP. I think that shows where the priorities of the respective groups lay: NAEMT wants to sell advertisements and comics, while IAFP wants to give away knowledge.
I wouldn’t make such an assumption. Most scholarly journals have pretty slim ad runs. As such, the cost of publication becomes heavily put upon the subscribers. Our EM physicians are board certified…but their organization doesn’t pay for journals (though they get a discount). JEN isn’t free either…even for CENs.
The long and short of it is that if providers aren’t willing to subscribe to the scholarly journals of our profession, we have only ourselves to blame. Professional Journals (perhaps with the exception of the Air Medical Journal) are not cheap.
As for the trade magazines, I don’t for a minute disagree that the content is often lacking…or simply a rehash of existing material. This has been an issue for some time.
A group of us tried to unseat that idea some years ago with an attempt at an e-journal (Prehospital Perpectives). Subscriber base was so-so. Ads were non-existent, and frankly we grew weary of being the same 5 – 8 people writing every month…for free. While it did push JEMS to improve their online presence and boosted/started many of the other EMS sites now online…it didn’t work. Too much serious stuff, not enough cartoons and ads.
EMS Week. Yes.
It is said that the AARP has devolved into an insurance company advocating for liberal causes that enable it to sell more insurance. That is, the thing is not what it asserts itself to be. EMS Week is a time for hospitals to serve up BBQ and be nice in an attempt to get EMS providers to bring patients to them.
To hospitals: we would rather you actually be nice and listen to us when we actually do bring you a patient than feed us BBQ once a year.
As far as CCC’s wants (which he ain’t gonna get any time soon):
A real EMS Journal. Yes. Sadly, as was pointed out by someone else, attempts at a more serious EMS journal has been tried unsuccessfully. Why? Unfortunately, most EMS providers are either not intelligent enough or not literate enough to grasp high-level writing and not interested in learning how to understand serious matters. So look at the pretty pictures, people. It’s what the market will bear.
Nationwide standards for entry. Yes. That would be nice. I began my EMS career about the time the national registry came into being. At the time they urged us to sign up though I don’t remember what the entry requirements were at the time. I asked a simple question: what will it get me? Will I be able to go to adjacent states and use my “national” registry in order to be licensed? Nope? Why would I be interested? I’m still not. I don’t think as much of the registry as CCC. I think they’re a lot like the aforementioned AARP. They are a private company trying to take control of certification nationwide in order to provide their principals with large incomes and a subset of their representatives (testing employees) a salary. In no way do I believe that these people have the best interests of EMS at heart. Would I be interested in some sort of nationwide entry modality. Absolutely. I’d like there to be a nationwide gun carry license as well but I’m not going to get that either.
National EMS advocacy group. Yes. I agree completely with everything CCC has written here. The problem with any organization is how it is governed and managed. The state EMS organization my home state is a shill organization for interests that a small clique of people who control everything else in EMS in the state desire to promote. It is essentially a lobbying organization that allow state employees who are not allowed to lobby to influence legislation. Fortunately, the people of my state are sensible enough to have rejected some of the self-interested initiatives of the organization. In any case, both state and national organizations are worthless when pitted against the bureaucracy of both the legislative arms and the regulatory arms. The state regulations in my state are poorly organized, poorly written and poorly administrated.
EMS 2.0. It’s an idea. A concept. There may be others but this is the one that has been put forth that seems to have attracted the most attention and support from intelligent EMS providers. Unfortunately, as CCC points out, most EMS providers don’t know what it is. What he may have a hard time accepting is that most EMS providers simply don’t care about it and wouldn’t if they knew about it. They would prefer to be inactive members of state and national “advocacy” organizations that promote the interests of the organizers rather than active in attempting to substantively improve the practice of prehospital medicine. They like the nice little card they can carry with them.
The regulation and future of EMS is in the hands of bureaucrats and self-interested people looking to line their pockets with our money. In that respect, it is not unlike most of the rest of medicine.
If it mattered to me, EMS Week would be depressing. As it is, it’s just another week. With free BBQ. The free BBQ is why it’s not depressing.
You get BBQ? Dang, all we get is pizza. Other than that EMS Week is the same here.
Seriously. I want some BBQ too.