Leadership Vacuum

At one end of the EMS spectrum we have Community Paramedicine.


Not a bad idea, probably a great idea for areas that are underserved by our present health care system and have underutilized resourses, ie. medics hanging around waiting for calls.

At the other end we have Tactical EMS.


During active shooter incidents where innocent people are in harms way, trained medics will be available to assist and treat, and save the lives of the wounded. Great idea.

In the middle, we have people like me. EMT's who are over whelmed with calls, do their best to stay out of harms way while responding to shootings perpetrated by drug and gang wars, have no desire to enter active shooting scenes, and while not content with the status quo simple cannot imagine an expanded role in EMS, not from lack of vision, motivation or desire; rather from first hand knowledge that trying to do more will ultimately lead to having to do more with less.

Perhaps our EMS leadership can develop a nationwide strategy that dissects our current EMS force into groups with detailed responsibilities.

We need "boots on the ground" to continue providing emergency medical services to those who need it. Rather than a tactically trained medic assigned to some SWAT teams, ALL SWAT teams should have medics trained in tactical operations. Medic first, soldier later I say, wisdom gained from a friend; an accountant/FBI agent who told me it is eaisier to train an accountant to be an agent than to train an agent to be an accountant. The same holds true in EMS, I believe.

Expanding our role where it is needed as Community Paramedics will work only if those Community Paramedics are not the same medics who are "waiting" for emergencies. The job growth potential is enormous if done properly, without jeapordizing the integrity of the current EMS system. When given the opportunity to exploit resourses, our political leaders will take every opportunity presented to them.

At present, it appears that EMS has lots of leaders swinging for home runs. We need a team approach here, before these good ideas are implemented without proper planning, and become drains on a system that is already in crisis due to lack of direction, cohesion and definable leadership.

So, exactly who is in charge of EMS? I've been doing this for two-plus decades and have no idea.

That needs to change.




  • Rusty Lee says:

    "Expanding our role where it is needed as Community Paramedics will work only if those Community Paramedics are not the same medics who are "waiting" for emergencies."  Alas, therein lies the problem because, in every instance I am familiar with where "community medicine" has been implemented……..it has been on the backs of those medics "waiting for emergencies". For NO additional pay. More responsibility, more work…………no compensation. Can you say morale problem?

  • Stephen Menchaca says:

    Is it odd that I am interested in pursuing both options?

    At 33 I still have a lot of Hoo Rah left in me.  In an emergency, you want a medic at your 6.

    Community based paramedicine is logical step for underserved communities.  As the author implies, we are the most suited to do the most with the least. The ability to adapt and overcome is the hallmark of the medic.

    True, I am looking for a second degree as a BSN in order to provide for my family, however, in my heart, I am a paramedic.

    • Michael Morse says:

      Thanks Stephan, I believe we have a chance of making a program like community paramedicine work as long as it is the EMS leadership, of whom that is I have no idea but we had better figure it out quick before other interests do, that takes the lead.

    • Dave B says:

      Personally if I feel that Paramedics should evolve to Prehospital Nurses. In my oppinion this would improve patient care and lead to better utilization. It would also open up a vast number of options in the event a change is needed, With out the inconviences associated with retuning to college. It would also bring the pay scale up to that of Nurses.

  • Julie says:

    Excellent insight into a situation that has the potential for numerous benefits, but can also turn into a nightmare of problems.  Leadership, clear and objective leadership, will make all the differnce.

    • Michael Morse says:

      Thank you Julie, that was the point of the article that more than a few people missed judging from some commentarry of the JEMS Facebook page.

  • CJ Ewell says:

    I will tell all of you in EMS land that the funding for the community paramedic services could disappear in a heartbeat. You need to understand that these services were provided by home health and community nurses until the funding dried up 10-15years ago. Then people did without. The situation was terrible. People did without needed healthcare due to poverty, isolation, and so on. Now, community paramedicine is positioning to provide services to those people. They will run on grants for pilot projects. It will be great. Health will improve. People will be happy. And then, the funding will disappear. The cycle will repeat. Be warned.

    • Michael Morse says:

      Thank you for the insight, CJ, unfortunately, I agree with you 100%. I guess we have both been around long enough to lose hope.

  • Too Old To Work says:

    Tactical medics are not there to treat the wounded civilians. They are there to support and treat wounded or injured tactical operators. In some agencies, they are shooters in addition to medics. That's the flaw of thinking that you can depend on tactical medics to respond to active shooter incidents. By the time they assemble and gear up, the shooting is generally going to be over. FEMA, IAFF, and the IACP haven't thougtht this through at all. At an active shooter incident, the medics who initially respond and the survivors who are on scene are going to be the deciding factor in who lives and who dies.

    The interest in community paramedics is likely a response to the impending cuts in Medicare home health services under Obamacare. Organizations are going to be looking for cheaper (not better) alternatives to using Visiting Nurses and similar services to contain costs. It's just cost shfiting, nothing more.

  • Michael Morse says:

    Thanks TOTWTYTR, it is the expected role of the tactical medic that worries me most, you are correct, they are there primaraly to treat tactical operators, the first time that the tactical medic doesn't go into a hostage situation or sniper attack or whatever to help the citizenry all hell will break loose. At worst, the drug war casualties will expect medics to run to their side during a gunfight. You have seen it, I have seen it, a lot of us have seen it- people screaming at the staged companies to deliver their friends, relatives or complete strangers from their situation with no regard to our own safety. And, I absolutely despise the idea of community paramedicine, not because i don't think it could be a good idea, rather because I know it will be abused and misused until it collapses.

    • Too Old To Work says:

      The first time? It's happened any number of times and hasn't been a scandal because the media is too dumb to understand the dynamic. It happened at Columbine, it likely happened at the recent LAX shooting, and 100 times in between.

      It's not what they are trained and intended to do, pure and simple.

      • Michael Morse says:

        It's a good thing nobody knows what the F we are supposed to do, are required to do or are legally obligated to do. The press doesn't know, the public doesn't know, heck, most of us don't even know.

  • emtannie says:

    All the comments here are valid… I would like to add my two cents.  In my area, we are trying community paramedics, and as Rusty said, it is falling on the backs of medics already waiting for calls, so staff are juggling dual roles.  As well, part of the problem in my region (and I have been saying this for 20 years) is that EMS supervisors and management are medics who have moved into management roles mostly because they have been around long enough to get there.  EMS is like hockey – just because you were a fantastic player, doesn't make you a fantastic coach.  Just because someone was a great medic, doesn't make them a great supervisor or manager.  Then these ideas of where EMS could expand to are made without the business planning required, and front lines end up being guinea pigs for the project of the month.  I have been on the front lines of some of these community projects, and they have been nightmares.  I have seen excellent staff throw up their hands and leave the profession, because they became so frustrated with the politics and the lack of leadership.  I don't know about other areas, but here, another part of the reason that these expansion roles are so difficult to get to work, is the opposition from other medical professionals.  We are seen as "scab labor" taking away employment from nurses and nursing assistants and other staff, and a danger to their current employment, that someday we will be taking over their jobs as well.  CJ said it well, that the funding dried up.  Here, it is a case of the funding just coming from a different pot, until some supervisor decides to change that as well.  EMS could expand into additional roles, but the current methods of doing that aren't working.

  • Redskull says:

    Definitely interested in CP. After all that’s what my background is in, however who are these medics that are just waiting around for calls? Private company medics are usually doing transfers when not responding to 911 and Fire company medics are usually busy learning how to fight fires, rescue and such.I see a lot of potential in this new role, but only if they hire medics that want to do health promotion and disease prevention and provide them with specialized training to undertake this new role as opposed to forcibly volunteering medics that just want to do the emergency-flashing lights part of EMS, to do it.

  • Jason Stewart, A.S., NRP says:

    EMS will never grow until the problem facing public service is addressed and corrected. Emergency response is, by nature, unpredictable, equally dynamic as America’s cultural and geographical diversity. A national model can only work at standardizing training to ensure qualified paramedics possess skills necessary to preserve, not only life, but quality of living. Too many variables exist in this country from county to county, state to state, even household to household, to apply a national model for system providers. Plus the breakdown of moral values corrupts the industry by failing to employ the best candidate through misguided selection process. Until there are vaccinations against human pride and greed, the growth of EMS will be Carcinogenic in nature. The possibility of success, in either program Is relative to the needs of the community it serves. Overall efficacy is key to sustainability of any given emergency service provider that unfortunately has become undermined by the misconception of profitability.

  • B says:

    Community paramedicine proprely executed, wil be completely impossible without greatly increasing EMS educational requirements.  The IAFF has been a national leader in preventing anything of the sort.  

    We can't advance until they get the hell out of the way.

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