How important can it be?
Original Post Date: 5/4/08
No, they don't stop bagging. Well, they rarely do it themselves. But the point is that they see that it is continued. Why is that, anyway? Does it have something to do with the proven need for artificial respiration in the non-breathing, or does it have more to do with an accepted level of competency among EMS personnel? Simply put, it's hard to screw up a bag valve mask, and it is hard to miss the indications for positive pressure ventilation, so the assumption that paramedics can bag a patient that clearly needs it is pretty well supported. But what if the treatment is CPAP, or vasopressors, or antihypertensives? Then how important can it be, really? Or, how likely is it that the paramedic really knows what he's doing at all? Evidence and perception would say not very. Facing facts, the common holding behind the ER doors is that paramedics know how to bag, compress and drive. So, by extension, there is no need to continue any treatment beyond those three things if the EMS crew started it.
Take CPAP, for example. CPAP is still in its infancy when it comes to EMS and thus is largely scoffed by the hospital. Some physicians actually feel we do these patients a disservice by precluding the need for intubation. I would be more inclined to believe we're cheating doctors out of skills, but I digress. This sort of poison-pen attitude spills over into the nursing staff, promoting the notion that this treatment, on which some patients are DEPENDANT when they present is unnecessary and not worth continuing. To complete the vicious circle, when the patient decompensates after treatment is stopped, whatever EMS did must be to blame.
Part of this, I agree, is about personalities. Personalities are largely born from experiences, and many of the nurse's first experiences with EMS were long ago when EMT's did little more than drive and CPR. And, they listen to paramedics talk, unfortunately supporting the idea that they aren't terribly bright. I'm not sure I would listen to a doctor who told me a patient was FUBAR, so I don't think I can blame them for feeling the same way. Perhaps the most damning piece of evidence is the frequent incidence of EMS patient mismanagement, or at least perceived mismanagement.
A bigger component, perhaps the biggest, is a system wide educational failure. Everybody: physicians, nurses, respiratory therapists, paramedics and EMTs just stop learning. Professionals who are taxed so heavily at work rarely feel inclined to study or read after hours. This leaves them believing that whatever they learned in school is still current, no matter how long ago that was. Enter a handful of current, cracker-jack providers who read and study and review new information almost daily, brining that knowledge to the bedside. Imagine the audacity—challenging 20 year-old ideas and outdated theory with newly PROVEN interventions. How Dare They! What better way to deal with unfamiliar knowledge but to ignore it?? Paging the emperor: Your new clothes are ready!
A paramedic friend of mine transported a patient the other day with a bifasicular block on 12 lead. He reported this with the proper gravity to the receiving facility and they said "What's that?" Imagine, education that (should be/is)part of initial paramedic training is a complete mystery to an experienced nurse. Is that necessarily the individual's fault? Not completely; maybe you could argue (I'm sure the nurse would) that the facility should teach them better. Most likely though they would say it's not important for them to know because it's not written on the ER Flow sheet. What the fact is; however, is that everyone is responsible for their own education and, by extension, the lack thereof.
The larger medical community believes we, EMS, don't have the capacity to manage these complex treatments. Medics should know that we can't afford to be without it.
Next: PRIDE
That Dog Don't Hunt.
Original Post Date: 4/20/08
Like any service, one that I know has bumps in the road; obstacles. Like many, a chief problem with this one is the local hospital. If it isn't C Spine it's IV's, if it's not IV's it IO…always something and nearly always something manageable.
Well, when this week's "something" came up I asked one of the bosses at this service about it, and he agreed that his field personnel were right and that they should approach hospital administration about a policy change on their end. Then, he said something that brought all my delusions of adequacy crashing down.
"With the personalities over there, I don' think anything will change." Wow.
So, and stop me if I got this wrong, if a policy is suggested, adopted by management and put into practice, it can all be negated by "personalities" in the Emergency Department?
Just so we're clear, this isn't an IV KVO. What we're talking about is a treatment that is started in the field and must be actively continued in the hospital to remain effective. Yet, for whatever reason, the hospital staff takes the call from EMS but will not arrange for the treatment to be waiting upon the patient's arrival. Then, they act surprised when either EMS stays in the ER to maintain care or the patient gets worse when the treatment is abruptly stopped. How is this anything but a continuity of care issue? Since when must patients foot the bill in suffering for the wages of pride?
Next time: They don't stop bagging, do they?
Original Post Date: 4/20/08
Like any service, one that I know has bumps in the road; obstacles. Like many, a chief problem with this one is the local hospital. If it isn't C Spine it's IV's, if it's not IV's it IO…always something and nearly always something manageable.
Well, when this week's "something" came up I asked one of the bosses at this service about it, and he agreed that his field personnel were right and that they should approach hospital administration about a policy change on their end. Then, he said something that brought all my delusions of adequacy crashing down.
"With the personalities over there, I don' think anything will change." Wow.
So, and stop me if I got this wrong, if a policy is suggested, adopted by management and put into practice, it can all be negated by "personalities" in the Emergency Department?
Just so we're clear, this isn't an IV KVO. What we're talking about is a treatment that is started in the field and must be actively continued in the hospital to remain effective. Yet, for whatever reason, the hospital staff takes the call from EMS but will not arrange for the treatment to be waiting upon the patient's arrival. Then, they act surprised when either EMS stays in the ER to maintain care or the patient gets worse when the treatment is abruptly stopped. How is this anything but a continuity of care issue? Since when must patients foot the bill in suffering for the wages of pride?
Next time: They don't stop bagging, do they?
What’s it worth to you?
Original Post Date:April 13, 2008
For the scientific among you, here's an experiment:
Find a paramedic. This might be the hardest part because, if s/he isn't running calls, s/he is probably at a second or third job, but that's a post for another day. Assuming you find one, ask him how much money he makes. Record that answer, then ask how much he should make. Jot that one down, then search the answers for a single word that you will almost surely find, most likely more than once.
Nurse. Or the plural thereof.
Finally, talk to a nurse who either used to be or began as a medic. These are pretty easy to find, so don't fret. Ask them why they went to nursing school. The word you'll be searching for on this page is…
Money.
Paramedics love to talk about their knowledge and skills, and that conversation is almost always either prefaced or followed by a negative comparison with nursing and the pay disparity that exists between the two. Those medics who have completed nursing school almost universally site money as the driving force behind that decision. All of this back-and-forth feeds two predominant illusions:
· Nursing is a promotion from EMS, and
· The only valid comparison for paramedic pay is nursing pay.
Each of these lines of thought is fraught with its own misconceptions that lie at the heart of the career paramedic debate.
During an instructor trainer course I attended recently, I the facilitator apologetically told us that the hospital paid part-time instructors $xx.xx/hour. I joked that I would love to make that kind of money every day because, in fact, it was more than my salary. A paramedic-turned-RN in the class looked at me with a smirk and said "Go to nursing school." Once my flash of anger dissipated, I recovered, smiled and said to him, "Just because you got a raise, don't think for a second that you got a promotion." That is really the crux of the argument that nursing or EMS is inherently better than the other: the idea that they are the only valid counterpoint to one another. News flash—they are entirely different jobs carrying different responsibilities and focused on different, if similar, goals. For reasons beyond my ability to articulate, nursing jobs have been in greater demand and thus have commanded higher wages, but this should never imply that a nurse is worth more. The honest truth is that we shouldn't have compared these careers in the first place.
I don't think anyone will say that he is paid all of what he's worth. Where this conversation goes awry with a paramedic is when the same guy says "I should make as much as a nurse". What they should say is "I should be paid what I'm worth" with no comparison to any other job because no logical comparison exists.
EMS is a funny business because there is no production quota or minimum order. We run the calls we're dispatched to and treat the patients we see. In short, we really are paid for what we know and the relatively few times we're called to do it. Therefore, it can be difficult to convince local governments, who usually pay us, that we should be well compensated for watching TV, eating and sleeping. Of course they don't see thousands of hours of education and shift after shift with no rest that supports or depends on what we know. A county commissioner suggested to me one time that paramedics should staff the county landfill during downtime to make better use of taxpayer money, but I digress. Point is, no one else does what we do. Not nurses, not physicians, not plumbers; so how can we compare any of their jobs, or pay, to ours. Can't. What you can do is recognize that and calculate the value of what we offer. Furthermore, this must be done in an articulate manner with measured data. Hyperbole is the language of the angry and theatrical, and neither of them is of any use to those writing the bottom line.
The sad truth is that most local governments simply lack the resources to pay EMS professionals a wage commensurate with their value and they know it. Rather, they take advantage of our love of the game, as it were, to keep us satisfied and getting back on the truck, or the aircraft.
The aircraft…that brings up perhaps the only valid comparison of nurse and paramedic pay: Critical Care Transport. In most CCT programs that employ nurses and medics side by side, the scope of practice is virtually the same, many times exactly the same. Yet, in these cases the pay is not. RN's still outpace medics on payday by as much as 50% and intangibly more so when it comes to promotion opportunities. However, the answer is still the same. We as professionals must define our own value and make the administrators answer for failing to compensate us at that level.
Or, you could always go to nursing school.
Original Post Date:April 13, 2008
For the scientific among you, here's an experiment:
Find a paramedic. This might be the hardest part because, if s/he isn't running calls, s/he is probably at a second or third job, but that's a post for another day. Assuming you find one, ask him how much money he makes. Record that answer, then ask how much he should make. Jot that one down, then search the answers for a single word that you will almost surely find, most likely more than once.
Nurse. Or the plural thereof.
Finally, talk to a nurse who either used to be or began as a medic. These are pretty easy to find, so don't fret. Ask them why they went to nursing school. The word you'll be searching for on this page is…
Money.
Paramedics love to talk about their knowledge and skills, and that conversation is almost always either prefaced or followed by a negative comparison with nursing and the pay disparity that exists between the two. Those medics who have completed nursing school almost universally site money as the driving force behind that decision. All of this back-and-forth feeds two predominant illusions:
· Nursing is a promotion from EMS, and
· The only valid comparison for paramedic pay is nursing pay.
Each of these lines of thought is fraught with its own misconceptions that lie at the heart of the career paramedic debate.
During an instructor trainer course I attended recently, I the facilitator apologetically told us that the hospital paid part-time instructors $xx.xx/hour. I joked that I would love to make that kind of money every day because, in fact, it was more than my salary. A paramedic-turned-RN in the class looked at me with a smirk and said "Go to nursing school." Once my flash of anger dissipated, I recovered, smiled and said to him, "Just because you got a raise, don't think for a second that you got a promotion." That is really the crux of the argument that nursing or EMS is inherently better than the other: the idea that they are the only valid counterpoint to one another. News flash—they are entirely different jobs carrying different responsibilities and focused on different, if similar, goals. For reasons beyond my ability to articulate, nursing jobs have been in greater demand and thus have commanded higher wages, but this should never imply that a nurse is worth more. The honest truth is that we shouldn't have compared these careers in the first place.
I don't think anyone will say that he is paid all of what he's worth. Where this conversation goes awry with a paramedic is when the same guy says "I should make as much as a nurse". What they should say is "I should be paid what I'm worth" with no comparison to any other job because no logical comparison exists.
EMS is a funny business because there is no production quota or minimum order. We run the calls we're dispatched to and treat the patients we see. In short, we really are paid for what we know and the relatively few times we're called to do it. Therefore, it can be difficult to convince local governments, who usually pay us, that we should be well compensated for watching TV, eating and sleeping. Of course they don't see thousands of hours of education and shift after shift with no rest that supports or depends on what we know. A county commissioner suggested to me one time that paramedics should staff the county landfill during downtime to make better use of taxpayer money, but I digress. Point is, no one else does what we do. Not nurses, not physicians, not plumbers; so how can we compare any of their jobs, or pay, to ours. Can't. What you can do is recognize that and calculate the value of what we offer. Furthermore, this must be done in an articulate manner with measured data. Hyperbole is the language of the angry and theatrical, and neither of them is of any use to those writing the bottom line.
The sad truth is that most local governments simply lack the resources to pay EMS professionals a wage commensurate with their value and they know it. Rather, they take advantage of our love of the game, as it were, to keep us satisfied and getting back on the truck, or the aircraft.
The aircraft…that brings up perhaps the only valid comparison of nurse and paramedic pay: Critical Care Transport. In most CCT programs that employ nurses and medics side by side, the scope of practice is virtually the same, many times exactly the same. Yet, in these cases the pay is not. RN's still outpace medics on payday by as much as 50% and intangibly more so when it comes to promotion opportunities. However, the answer is still the same. We as professionals must define our own value and make the administrators answer for failing to compensate us at that level.
Or, you could always go to nursing school.
And I Care Why?
Original Post Date:April 06, 2008
Why, I wonder, does the EMS educational system frustrate me so when I'm a part of it? Maybe I hope that I'm different. Maybe I'm afraid that I'm just the same as those I complain about. Maybe, and most likely, I understand that our profession is at a crossroads between where we can go and where we can go back to. It would be terribly easy to return to the days of "treating with diesel" in the back of a Chevy van, and the only thing that stands between us and that inevitable end is broad based improvement in our educational programs.
I'm confounded because I like what I do, and I like doing it at the level I've grown accustomed. Recently, state EMS governing agencies across the country have proposed EMS rules changes that would make all EMS systems statewide work from and use the same protocols, thus taking clinical decision-making away from the local level. There are ulterior motivations at work behind this that don't bear discussion, but one of the biggest motivations for this "generalization" is our demonstrated lack of ability to balance basic care with newer, advanced treatment. Many cutting edge interventions these days require intense education and training to learn the science and application, and our teaching systems continuously fall short of these expectations. Our providers then go out into the field improperly equipped to make the necessary judgments prior to attempting these new treatments and often do them wrong.
I care because, as educators, I honestly feel like we hold the future of the business in our hands, and our students are asking for it. It is up to us to give them everything they need, not just what we think they want.
Original Post Date:April 06, 2008
Why, I wonder, does the EMS educational system frustrate me so when I'm a part of it? Maybe I hope that I'm different. Maybe I'm afraid that I'm just the same as those I complain about. Maybe, and most likely, I understand that our profession is at a crossroads between where we can go and where we can go back to. It would be terribly easy to return to the days of "treating with diesel" in the back of a Chevy van, and the only thing that stands between us and that inevitable end is broad based improvement in our educational programs.
I'm confounded because I like what I do, and I like doing it at the level I've grown accustomed. Recently, state EMS governing agencies across the country have proposed EMS rules changes that would make all EMS systems statewide work from and use the same protocols, thus taking clinical decision-making away from the local level. There are ulterior motivations at work behind this that don't bear discussion, but one of the biggest motivations for this "generalization" is our demonstrated lack of ability to balance basic care with newer, advanced treatment. Many cutting edge interventions these days require intense education and training to learn the science and application, and our teaching systems continuously fall short of these expectations. Our providers then go out into the field improperly equipped to make the necessary judgments prior to attempting these new treatments and often do them wrong.
I care because, as educators, I honestly feel like we hold the future of the business in our hands, and our students are asking for it. It is up to us to give them everything they need, not just what we think they want.
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