Here’s a great example of what’s wrong with EMS. This morning, I was looking at the webpage for the EMS For Children Improvement and Innovation Center project being administered by Texas Children’s Hospital. The webpage identified twenty-eight staff members assigned to the project.
Of these staff members, only one of them is identified as a paramedic and he’s actually a full-time employee of the state EMS office. The majority of those identified with healthcare backgrounds were either physicians or nurses. We need to quit letting EMS be defined and controlled by people who aren’t in EMS. This is the equivalent of having a bunch of paramedics define oncology care because they do transports.
The truth is that there are EMS professionals with the educational background to be involved in developing the future of EMS and determining our professional identity. There are paramedics with master’s degrees in a variety of fields ranging from the hard sciences to education to public health to administrative fields like business administration, public administration, and healthcare administration. The National Registry even funds two EMS professionals per year to get a graduate degree in an EMS related field. There is NO reason not to have more than a token EMS presence on committees that define who we are and what we do as a profession.
Instead, through a combination of our own apathy and aggressive encroachment by other fields (cough, nursing, cough), we allow our profession’s path to be charted by those without a real stake in EMS and not necessarily with EMS’s best interests in the forefront. The nursing advocates regularly say that EMS providers shouldn’t do anything that approaches nursing and believe that nursing represents a higher level of education and skill sets. However, these same nurses readily encroach on the EMS field and insert themselves on almost every committee that determines EMS education and practice. Try advocating for an EMS professional to even have a seat on a committee regarding the hospital emergency department or the ICU and prepare for the wailing and gnashing of teeth.
A lot of really smart people in EMS regularly advocate for EMS being represented within the US Department of Health and Human Services. Personally, I believe this will continue the trend of EMS having little, if any, voice of its own. After many years as a government lawyer, I’ve realized that those who call the shots in the health and human services bureaucracies usually have a nursing and/or a public health background. I can virtually guarantee that putting EMS in the health and human services system will ensure that nursing and public health controls who we are and what we do. An EMS office within the HHS bureaucracy will be little more than a token voice that will be run over roughshod by the nurses, public health professionals, and various other “stakeholders” that truly have no stake in EMS.
We have got to control our professional identity and that begins with paramedics being involved in the administration and development of our profession. It’s time to demand that those that define and determine what EMS is at least have an idea of what happens on an ambulance.
There are lots of committees and advisory boards that have a questionable method of selection. Too many times, unless you sit at the ‘cool kids’ table, you are not going to be a part, period. Every day I see instances of people who have no real interest in nothing more than keeping the status quo, or nothing more than advancing their own resume, being placed in positions of influence over various aspects of EMS. I am at the point that I do not think there is really anything that we can do to prevent the encroachment of nursing. That is, unless we allow for the encroachment into EMS by the IAFF.
Once upon a time, when EMS was newly conceived, the presence of those physicians and nurses were necessary, as there weren’t experienced, educated EMS providers to lead the profession.
I really expected that over time, EMS providers would grow, gain education, and step up to fill those roles. But we – the EMS community – have worked hard to keep our profession – our education – our standards at the minimal level of the 1970s. And we have refused to join – and thus empower – EMS organizations that could push us collectively forward.
This is all on us – not on nursing or anybody else.
Part of the problem, from just my vantage point, is that some of the existing organizations and boards do not share information, nor do they get around to see people.
An organization cannot expect rank-and-file staff to join without seeing some sort of benefit or presence. As an example, I have never met anyone from the NAEMT hierarchy, even at EMS Today. There have been several incarnations of the state paramedic association over the years and I never heard of any initiative that they pushed forward that would benefit….anyone. There is an administrators association, as well. I know they play golf, but still, what else have they done that would get the folks out and support them? …..crickets…..
Do EMSers need to get on board? Sure. But these organizations need to show value. And in reality, they have not. I used to be a member of NAEMT. I could not convince myself to keep sending them money. I used to be a member of the state association, but then I just quit hearing from them.
In reality, the only organization that I got anything out of was IAFF, but then this is NC, so that is not going to do much, either. Especially when everyone shouts “unions are bad?”
I began EMS in 1974. We were cutting edge then and fought against the funeral homes with their obvious conflict of interest and others who accused us of “playing doctors”. We persevered and through the 1980’s and 1990’s EMS was very forward moving. Unfortunately, as my generation has aged yet remained in EMS in leadership roles, WE have become the same people that we fought against over 40 years ago. The good news is that, just like the dinosaurs, my generation is dying out. The bad news is, I don’t know if EMS can survive until the worst of us is gone.
I have served on the State EMS advisory committee that reviewed rules and policy. But while there I saw first hand the limited impact EMS providers would have. The board had 21 members 8 nurses 6 physicians multiple other angency/professional representatives (“rehabilitative services”) and one paramedic. The nurses compromise was the ENA rep was a “Nurse/paramedic” and guess which way that went?
No one is interested anymore. Too much time and effort spent tilting at the windmills have left EMS providers with the ability to recognize the writing on the wall: go to nursing school.