I almost missed EMS Week. Missed in the sense that I forgot about it, not in the sense that I felt a sense of loss because I didn’t get any of the valuable prizes and goodies that come with EMS week. I can go down the street and buy mediocre pizza if I feel the urge.
My good friend The Ambulance Chaser (he really isn’t) wrote a superb EMS week post which he titled EMS Week Resolution. Some of the points he brings up have been brought up before, including by yours truly. Even with that, his post brings up some excellent posts. In EMS, we are our worst enemy.
There are reasons for that, which AC amply points out. We are disorganized as a group. It’s no coincidence that the highest paid EMS providers work for municipal services, mostly fire departments. It’s no coincidence that the fire service lobby (IAFF and IAFC) saw EMS as not only a viable option for keeping jobs, but easy pickings for taking from volunteers, private companies, and even some municipal agencies. They’re organized, EMS is not. It’s the same dynamic AC talks about with nurses.
Speaking of nurses, if “community paramedicine” is successful AND gets a consistent funding source, EMS can kiss it good bye as nurses lobby to change state laws and regulations to make them the “community medicine” providers.
Have I depressed you enough? No? Try this on for size.
Fast food counter help will get their $15.00/hour wage while entry level EMS providers in the same markets will still be making in the sub $10.00/hour range. Oh, and they’ll get the state legislatures and local governing agencies to make using automated equipment too costly so that their jobs have some degree of protection.
Yeah, fast food counter help will have better wages and working conditions before EMS.
There are two reasons for this.
First, very, very few people in EMS see EMS as the the pinnacle of their career. Many, if not most, are using EMS as a stepping stone to something better. That’s pervasive at the BLS level and only slightly less so at the ALS level. I worked a full career in EMS at an agency that paid pretty well, had good benefits, and a retirement system. Despite all that, during that time I saw hundreds of my co workers leave for other fields. Some went on to be doctors, some went to law school, a lot of them became police officers or fire fighters, and some just went on to “normal” jobs because the pressures of EMS, the lousy schedules, or even the nature of the work just became more than they could stand.
Second, we are not organized. I stopped wasting $40.00/year on NAEMT dues a few years ago. Even friends of mine who are NAEMT supporters and members can’t tell me what NAEMT does for field providers. Offering merit badge courses to make up for a deficient national standard curriculum is not really a benefit to members. Long ago, back in the early 1980s, the NAEMT made a decision not to be a lobbying agency, let alone a union like agency. The cops have unions for the most part, as do the fire fighters. There is no equivalent organization for EMS. Nor do I expect there ever will be. If you want a reason for that, go back to the previous paragraph. No organization has taken as it’s mission creating a professional identity for EMS. Being an EMT isn’t a profession and it’s not a trade. It’s a skill set, which any other trade or profession can co opt for it’s own ends. As the IAFF has pretty much done already. Being a paramedic is one step closer, because the educational bar is higher, but again, it’s not a trade or a profession and it’s vulnerable to being co opted. Most fire departments, even ones that don’t provide EMS transport, see 70-80% of their run volume being EMS calls. Big department, small department, doesn’t matter. While the total number of runs varies widely, the percentages don’t.
Despite that, just about every paramedic I know who is also a fire fighter identifies themselves first as a fire fighter and then as a paramedic. This despite the fact that around here fire department drill school (or academy if you prefer) is less than three months while paramedic school is well over a year. I don’t care if you tell me that drill school is full time while paramedic school isn’t. Run the numbers, you’ll see which requires more time and education. EMS is just something that fire departments do to keep from having to lay off fire fighters. Some small departments with which I’m familiar would have four people working per shift if not for EMS. Others would be all volunteer or call. Major city fire departments would probably have to lay off up to 25% of their field staff.
With all of that said, they get more public recognition for fighting the very few fires they see each year than for all of the EMS work they do.
It’s even worse in fire departments that have their EMS service as a “civilian” component. The EMS providers are second, or maybe third, class employees, who despite being the major source of revenue generation get less money, have older vehicles, and often inferior facilities. If you doubt me, go look at this website.
Until at least one dynamic I’ve listed above changes, EMS will remain essentially what it is and the best providers will for the most part see it as a way point, not a career destination.
Happy EMS Week.