I laugh when people tell me that EMS is a profession. Yes, there are professional EMS providers. I was one for pretty much my entire adult life. Still, although I worked in EMS full time, was paid well (especially by EMS standards), had a great set of benefits, and got to retire with what some people refer to as “an overgenerous pension”, I’m smart enough to know that my career was not the norm across the spectrum of EMS. Other systems, not all that much different than the one I worked in, have crappy pay, worse benefits, and a pension that requires their employees to work almost to the point where they become a patient before they can retire. That’s more the norm.
With a few exceptions, the only “good” jobs in EMS are not in EMS. That is to say, EMS is not the only (or in many cases) the primary focus of the job. Which generally means working in EMS as part of the fire service. I’m not knocking the fire service, but in all too many fire departments becoming and EMT or paramedic is mainly an entry path to the “real job” of being a firefighter. For most departments, that still means responding to EMS calls, but not actually doing patient care, transporting, or writing reports.
Since the late 1960s, the fire service overall has done a great job at reducing the number of fires, the number of injuries and fatalities from the fires that still do occur, and improving fire prevention and alerting (smoke detectors). The downside for the fire service is that it ran a serious risk of putting itself out of business. At which point the fire service in the form of the International Association of Fire Fighters and the International Association of Fire Chiefs, decided that EMS (the meat wagon) was going to be the savior of the fire service. You probably know the rest.
To quote Larry Fine, “I’ll go, but my heart ain’t in it.”
That’s changed some, especially in smaller departments which would still be mostly part time or call if not for the volume (and revenue) brought in by EMS calls. As the older generation of fire fighters retires out, the younger guys mostly understand where their livelihoods come from.
So, there is one reason that EMS is not a profession.
Another is the low education standards we’ve accepted in order to appease the fire service and the volunteer contingents.
Oh boy, am I going to hear about that!
Back in 1994, when the last major revision of the BLS education standards came along, the original plan was to add hours to the EMT course and include more theory and detailed information. That was derailed because the volunteer contingent was afraid that making it take longer to become and EMT people would decide not to become volunteer EMTs. I understand that, but it set back professionalism in EMS by decades. Two to be precise and I don’t see an end.
In England, it takes four years to complete the paramedic program. In the US, if you go full time you can be done in about a year. Two years if you go part time. Of course in England there aren’t a lot, if any volunteer, paramedics. They mostly work for one of the National Health Service regional trusts. Which means they get good pay, benefits, and so on. They also, like EMS providers just about anywhere, work very hard for that pay and benefits. While the fire service in England makes periodic noises about taking over EMS, there doesn’t seem to be any serious consideration of that.
Canada is similar in that regard.
At the BLS level in the US, it can take as little as six weeks to complete an EMT course. Which means that just about anyone can do it if they stay awake, read a bit, and pay attention. That’s not necessarily a good thing, because it means that EMTs are a dime a dozen. Which at the least depresses wages, but even more insidiously means that very few people think of EMS as a career, let alone a profession.
A friend of mine, who has been an EMT instructor since the late 1970s related a story about one of her students. He is in his mid 30s, unemployed because of a “disability” and yet was able to enter her program. He told her that he smokes Marijuana for medical reasons (legal in her state) and asked if that would be a bar towards taking the certification test. As it happens, it is not (she checked with the state), but she also told him that it might discourage services from hiring him. His response was that he has a lawyer on retainer for circumstances such at his and would sue under the Americans with Disabilities Act (ADA) if they didn’t hire him. He also told her that her teaching style needed to change because he wasn’t learning what he needed from her.
Sounds like an ace of a fellow, doesn’t he? Yet, he’ll likely pass the test (maybe) and get a card that says he’s an EMT and meets the minimum standards of the profession.
During my brief tenure with a paramedic program, I ran into a similar chap. He failed to comply with the requirements in the student handbook. He signed a contract attesting that he had read the handbook, understood and agreed to the terms, and would abide by them. Only he didn’t on multiple occasions. We finally had to terminate him from the program at which point the fun began. He called and threatened to sue because “We were costing him a chance at a fire job.” The requirements, you know, the ones that he agree to, were unreasonable and unfair. He finally just dropped off our radar and nothing came of any of his threats.
Neither of these students were kids. They had worked in other fields before deciding to enroll in EMS programs. One would think that they would understand how the world works. Maybe they understood how THEIR world works and expected us to conform. I don’t know, I’m just glad that at least one of them isn’t in the field.
I wish I could tell you that I had a solution to this, but I don’t. If we raise the standards for EMS education, then we’re going to lose a lot of potential providers. That might be good in that we’ll get better candidates. Of course the problem is that the people who pay for EMS services are pretty cheap overall. I mean the government and private insurance companies. People who have been transported in ambulances frequently complain about the bills. They don’t realize, or more likely, don’t care how expensive it is to maintain an ALS ambulance and pay for a crew. The people who actually pay the bills do know, but they mostly don’t care. They expect EMS to run on the niggardly amounts that the insurers are willing to pay.
All of which means that there isn’t likely to be a path out of the current state of EMS. Which means that there likely won’t be a “profession” of EMS or even a trade. Some fortunate few will have long, productive, and even profitable careers in EMS, while most will work for a few years until something better comes along. Education in EMS will mostly lag behind other areas of medicine, as will protocols, standards of care, and career paths.
Maybe someone will figure it out, but I’m not hopeful. The entire problem revolves around funding, which affects training and education, which affects career opportunity, which drives people away from the field, which affects the long term prospects for professionalizing the field… And on and on.
Some people have proposed requiring a two or four year college degree as a requirement to become a paramedic. I don’t see that as viable as if someone is going to invest that much money in a college education, they are going to expect a much better return on investment than is likely in EMS.
So, you can see the scope of the challenge and the difficulty in finding a solution. Maybe someone out there has a better idea. I’d love to hear it.