I only had a minute to do my last post concerning Mayor Charles Lombardi of North Providence’s idea to staff town rescues with “fifteen dollar an hour no benefit” employees for ambulance rides that the town could profit from. In case anybody is wondering what is so wrong with that, please follow this link:
http://happymedic.com/2009/08/08/ems-2-0-starts-now/
I’m nearing the end, possible have even reached it, of my career in fire/EMS. The system is a catastrophe, plain and simple. I often wonder if the rest of society is held together by broken strings and mirrors, or if we as emergency providers are the only ones. I’ve been on the outside looking in for a little while, and from an outsiders viewpoint things seem to be working okay. If people only knew how close to collapse this system actually is they would be appalled.
Society finds it perfectly acceptable for some folks to earn great salaries selling trinkets and widgets while others, EMS providers among them, struggle to earn a living. Capitalism works, the system of entropeneurship and private growth providing us who happen to be fortunate to be alive during this moment in history comfort and luxury only imagined in prior generations.
The market is flooded with EMT’s. A lot, if not most of those EMT’s take the courses and learn the craft hoping to do some good and earn a decent living. Private companies that provide ambulance services pay thier employees anywhere from ten to twenty dollars an hour, with few exceptions. Comparatively speaking, that doesn’t amount to much, career wise. Not bad for a part time gig, but not enough to provide for a family, or even have a decent lifestyle comparative to other, similarly trained professionals.
Municipalities offer the best chance for an EMT to earn average wages and benefits. The best of those jobs are in fire department based EMS. Problem is, a lot of EMT’s want nothing to do with firefighting. As a third public safety department joining the fire department and police department, EMS could solve the problem but not many want to see it happen, cost being one hurdle to overcome. To sum things up, a lot of EMT’s are EMT’s hoping to get hired by a fire department. It’s a lot of work and a slim chance of success. While waiting for a well paid position, a pool of hungry applicants wait to be exploited by ambulance companies.
The mayor of North Providence reportedly has friends who own an ambulance company. Now he has an empty fire station in the middle of his town. Now he slips in privatizing EMS services in his community.
I am the biggest proponent of free market capitolism there is, but some restrictions need to be in place. Life and death top my list. Life and death for profit makes no sense to me. Maybe I’m crazy, but this whole thing stinks.
I couldn’t agree with you more, Mike. I worked for hospital-based systems for a lot of years before making the switch to a fire department. My hospital-based colleagues were talented and committed and excellent paramedics, but we were all working for employers who paid us as little as the market would bear, put us in unsafe equipment and treated us as third-class employees to whom paying a salary was a nuisance. I miss the medicine, I don’t miss the hijinks. Fortunately, it turns out I find the firefighting as engaging and exciting as the medicine, so I feel like I have the best of both worlds, but even if I didn’t I can’t imagine trying to make a living as a paramedic in Massachusetts for anything other than a municipality.
Mike,
I agree that in many areas, it is a system held together with baling wire. Part of that is because EMS, like so many governmental services, has been expanded far past what it was intended to provide.
EMS was never designed to be a triage service, a primary care provider or a stop-gap measure for a failed social services system. It was designed to provide rapid medicine for emergent situations. When 60% of your EMS call volume is non-emergency, the burden is too great to bear and systems collapse.
Again, it is what we have created.
I also believe that we have seen the pinnacle of fire and EMS quality of life. Compensation will degrade to that only slightly above clerks and laborers make.
I’m glad I was here at the peak.
Good luck Mike, I wish you the best.
Mr. Schmoe has some great points here. EMS is a victim of it’s own success. In our early days, in desperate attempts to garner business and maybe some respect, we told people to just call 9-1-1 and let us respond to figure out if a real emergency exists. They’ve finally listened to us and now we complain that we are being abused and wasted.
Can’t have it both ways, folks.
totwtyr — I couldn’t agree with you less. In fact, I really have no idea what the heck you’re talking about.
True, private ambulance companies have done some shameless things to drum up transfer business in nursing homes and hospitals, but that has nothing to do with 911 abuse.
I’d love for some specific examples from you because I can’t for the life of me recall anyone trying to drum up 911 business.
IMHO, EMS is crumbling because we don’t have the ability to say “no” — not to the frequent flier who wants a bologna sandwich at the ED to go with his nightly drunk, not to the visiting nurse who wants to get rid of the patient with the UTI because she’s already late for her next 3 appointments, not to the doctor at the hand clinic who wants to close for the night but had a patient get out of a procedure late, not to the family with the 4 Volvos in the driveway who insist you take Nana to the hospital for her chronic elbow pain because she’ll get seen faster if she goes by ambulance.
We didn’t ask for any of these things or the other hundred injustices we have to suck up every day on an ambulance, but here we are. You’ll have to indulge me and my complaining a little bit.
I think it would be a great first step to fixing this system if EMS had the ability to tell people that we’re not a taxi service, or a public convenience. We’re here for emergencies.
Of course, if we only went to emergencies a lot fewer of us would be employed….
Ted, indeed TOTW has a point I see. An entire generation, almost 2 has been told to call 911 for anything they think might be an emergency. How many times have you called somewhere and the recorded message begins “If this is an emergency, hang up and call 911.” We encouraged folks to call and let us check them out, but somewhere along the lines they stopped listening to us.
Indeed we need to be able to say no. But first we need to disconnect the need for profit from the decision to transport.
So long as companies need transport revenue to survive, we will never see Paramedics free to give the patient the honest truth that they don’t need to go.
“Free market capitalism” is a dream. The free market allows child labor, lead paint on toys and doesn’t require ambulances to be inspected. We need to get away from the business model in EMS, isn’t it clear by now it has failed? So many companies and municipalities scrounge to make ends meet because of decreases in reimbursements. If 75% of Americans are insured, then where is the problem? The abusers are always going to abuse the system, driving up costs for the rest of us, so why not stop the bleeding now? I’d rather see a 10% tax increase and not have to pay out of pocket for care than the 26% “tax” I am paying to Blue Cross just so I can pay out of pocket later. That would be a 16% RAISE in salary for me on day one, not to mention no more copays.
This entire economy is held together by bailing wire, string and mirrors Lt. Expensive string and top of the line mirrors built in China and made with Iraqi oil, customer support in India and delivered by a guy from Mexico. All because we want to pay $.99 instead of $1.29 for a trinket.
Our best days aren’t over, they’re still to come. I’ve got 23 years left in my planned career and I’m not letting it get worse. Quite the contrary. We’re building a new generation of EMS Professionals who will not only demand a better salary and system, but EARN it.
Mike, the only thing I disagree with in your post, as far as I can see, is the assertion that what Lombardi wants to do with his private transport truck is “EMS.”
Shlepping somebody from Goldencrest to dialysis and back 3 days a week is not EMS. Never was. Neither is dragging someone from Fatima to Hopkins Manor, Rhode Island to Bannister, Kent to Riverview, etc etc etc. At the moment, it may be done in an ambulance, and done by EMTs. But its not EMS. I did it for years, I know what I’m talking about.
I vote that EMS 2.0 take up the idea that we separate the EMS profession from the horizontal taxi industry. All in favor?
HappyMedic — I agree with ALL your points, but I don’t agree with totwtytr’s assertion that somehow we’re just getting what we asked for.
That kind of thinking is fatalistic, in my view, and suggests that there’s no hope or possibility for change.
Clearly, from reading your blog, you don’t feel that way, and neither do I.
And let me also say, lest anyone think I’m a grouchy SOB looking to start a flame war — may everyone on here have a safe and happy 2010!!
We have a lot of work to do to right the HMS EMS! I think TOTWTYTR has it right in the big scheme of things: WE meaning society, not us as individuals. I blame Captain Kirk and his silly foray into that other show, EMERGENCY 911.
One of the saddest things I’ve learned from years on the streets is the majority of people in this country don’t give a hoot about anything but themselves. I’ll never forget the aftermath of 9-11, leaving the station, 24 hour news on the TV, obsessed with the attacks, and responding to peoples homes for bellyaches while they watched the Jerry Springer show on cable.
HM, I know how you feel about free market capitolism and hold little hope of changing your views, but remember that without freedom of choice just who will provide this medical care? Surely not the state mandated doctors whose passion for medicine was forced upon them for the common good. As soon as we assume somebody will take on the responsibility of becoming a doctor, specialist, surgeon , researcher or whatever for any reason other than self advancement we have condoned the slavery you speak of, only much more insipient.
Brandon, what would we do about these transports? You can’t have half an EMT doing transports. It’s all or nothing in this world we work in. Maybe another branch of the DOT can be created, disabled transports or something, without the liability.
Anyway, thanks Ted, TOTWTYTR, Brandon, HM and Capt. Schmoe. You guys are the cream of the crop in this industry, and I appreciate not only your stopping here, but your thought provoking commentary as well.
Mike,
That makes two of us getting out. As much as I love being a paramedic (most nights), I’m getting married this year. I want to be able to raise my future family comfortably without working 80+ hours a week to live from paycheck to paycheck. This is why I hope to be leaving in the next 2 years to operate a subway train, where I’ll be starting close to $30/hr.
Hello Michael and Happy New Year, whether you like it or not!
I for one am not a proponent of dialing 911 in an emergency or otherwise. This system , to me, is a waste of time and resources in a town as small as the one I work in and the surrounding towns on Cape Cod. How many precious seconds are wasted by the separate departments that must transfer those calls. Night after night I monitor the radio for the Fire Department across the parking lot and night after night the same addresses come through with needing help back into bed, getting to the bathroom, stomach ache, toothache, cramps from menstruating. This is ridiculous! I have seen the station empty and a true emergency come in and they have to tone it out to ANOTHER department in the next town!! How is that helping anyone? It is not even fiscally helpful! But because of out suit happy country and politically correct tongues, we are helpless to tell them to call the VNA or their children or a neighbor instead of the FD unless its a true emergency. Those recordings of “if this is an emergency, call 911″ need to go. Those with a true emergency know who to call! And now with all phones being equipped with caller ID, and cell phones with GPS, the time of the 911 system is almost obsolete!
I know your cause is much deeper than what I am speaking of but I wanted to add my 2 cents worth to all the very intelligent people who posted before me!
Take great care, Michael!
Gia
Still got a seat warm for you Mike, just say the word and you will be eating like a king for the rest of your career.
Until people get some (ba%%s) and use the proper dispatching system. EMS is going to crumble under the pressure of the nonsense calls. We live in a litigous society and everyone is worried about being sued but at what cost to the system as a whole. 911 response and ambulance response both have a place in the system. Everyone must work together to resolve this mess. One problem that has happened is EMS is under the Department of Transportation. It doesn’t have its own place like Fire (US Fire Administration) or Police (Department of Justice). We also are the new kid on the block of emergency services (about 45 years old compared to police and fire) try getting a piece of the public budget with those giants in the room, not going to happen. All this internal bickering, private vs public, paid vs volunteer, ambulance vs 911, fire vs 3rd service all defeat our universal goal. What is best for the patient. We just need to work together to strengthen EMS. JoeEMT799
Thanks for that, Gia, its good to hear from you! You know best how the system is abused, being the first to hear the call. i hope all is well.
Joe, Al…message received, standing by.
Mike- all that has to happen is for someone important to realize that those kinds of transports can easily be done by two people trained to use a stretcher, do CPR, and use an AED.
I know a guy in CA that works a private ambulance company that does basic transports with a wheelchair van outfitted to hold a stretcher instead. He still has to staff it with two EMTs because of state law, but why? They don’t have any EMT equipment except for an O2 tank.
The privates would love it, because they won’t have to pay EMT wages for non-EMT transports. It would save the government money, by creating a different level of reimbursement besides BLS transport. Instead of grandma back to the nursing home getting paid the same as a BLS agency working a code with no ALS backup.
It may even (eventually) reduce the number of EMTs overall, which in a supply and demand model should theoretically raise pay. And that’s even before we start talking education.
Any ideas what you will do – of course I don’t understand the politics but all does not seem well or fair!
Wishing you everything good for this decade Micheal