Recently the Federal Interagency Committee for Emergency Medical Services (FICEMS) released the 2011 National EMS Assessment Report. At 550 pages, there is ALOT of data. In the first few pages I noticed an interesting trend that I want to highlight.
The assessment describes the current conditions for:
- 19,971 EMS Agencies
- 81,295 EMS Vehicles
- 826,111 EMS Professionals
Of the 826,111 EMS Professionals:
- 64% are EMT-Basics
- 24% are EMT-Paramedics
- 6% are EMT-Intermediates
I’m not sure what the remaining 6% are. Possibly Emergency Medical Dispachers (EMD), locally certified First Responders, or non-certified personnel thrown into the mix. The important number to note is that almost 2/3 of EMS Professionals are EMT Basics. If that’s the case, why are the vast majority of continuing education, seminars, and conference content skewed heavily towards advanced providers? Why do we provide one path for Basic providers, that of becoming an Advanced provider, for advancement within EMS?
EMS education and the “big” conferences aren’t the only ones guilty of this. Most blogs are also skewed towards the advanced provider. While The EMT Spot, and Everyday EMS Tips offer content applicable for all levels, the majority of blogs also lean towards the advanced provider. EMS Basics and Ambulance Junkie remain (to my knowledge and in my opinion) the only real basic centric blogs out there.
Is being an EMT ranked the 6th worst job because of what we ourselves are failing to do?
Do you wonder why we can’t advance ourselves as a profession? Maybe its because we ignore or minimize 2/3s of our providers. We fail to engage them at their level to keep their current interest and help their progression. Is that a recipe for success? I think not.
Insanity: doing the same thing over and over again and expecting different results.
-Albert Einstein
In order for EMS to truly change, we need to rethink about how we go about things. The first step should be to stop tailoring to the minority and address the needs of the majority. Perhaps that takes the form of a change in how we advance basics, how we design continuing education, the type of conference sessions we promote, and the type of content we bloggers create. I view these as the fundamental building blocks of the industry and until we change the development of the foundation, we’ll be unable to change either the design or the delivery.
In order for a change in EMS to be successful, we need to get back to the basics.
Download the 2011 National EMS Assessment Report here (BIG PDF)
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I obviously agree with you in principle. But just to play devil’s advocate, I think part of the problem truly is demand, not just supply. While there are high-quality, professional, engaged, passionate Basics out there, many times they end up being “too good” for the position and (at best) quickly turn into high-quality, professional, engaged, passionate paramedics. Or nurses, docs, electrical engineers, massage therapists, whatever. So even moreso than for the medics, it’s a job category that can’t hold onto good people (I would like to see the average time spent at this level), and that means fewer of the Basics around are interested in really developing themselves and their work. Many of those who WOULD be end up as medics by the time you can blink, and then they’re just adding to the pool of dedicated folks on that side of the fence. Which is nice, but kind of a brain drain for us! There are a small number of systems out there that believe in and promote the idea of serious BLS (Boston is an example), but without someone making that explicit effort, there’s just little reason for anyone with potential to stay. It’s masochistic and there are greener horizons.
I have to say I am an EMT-B. I love working on the ambulance but I am now in Nursing school….I know that money is not everything BUT I also can not imagine going to school for 2 more years just to make a buck more…NO WAY!!!!…where I live I will start as a nurse making what a paramedic caps at…That is why there are no Paramedics.
I think there is a stigma that all basics want to be ALS and there for much of the content, like you touched base on, is geared towards that idea. Or there is no need to address critical thinking skills with basics if they can’t preform them. The rational does not support the advancement of EMS, we force young minds into advance classes to fuel the desire to learn yet we undermind them with shorting them on experience and fundemental skill set’s they would rely on as a medic. This may be a surprise but an assessment has and always will be a basic skill to which advance skills are applied.
Just my basic perspective, and thanks for the mention.
Bravo! and Thank You!
I started as a volunteer EMT and was lucky enough to have it turn into a career after my old one disappeared 10 years ago. I say lucky because I actually work in my home community, taking care of my neighbors. It’s why I signed up to begin with. Over the years I have helped four partners through medic school. One of whom, after hearing me say I didn’t want to go with him, told me he understood how at my age I could settle ( for “just being a basic” ) It’s nice every once in awhile to know that there are people out there, like yourself, who realize I didn’t.
I think, as a basic, a BIG part of the problem is everything these days are more geared towards ALS. Being an advanced provider has changed so much. The training now-a-days is to call ALS (if it is dispatched as an ALS call or additional leads you to think it will be an ALS call), the protocals are more in favor of ALS treatment, and the con ed we receive, again favors ALS by telling us to call them or training us as ALS. I mean I went through PHTLS and had to think as an ALS provider, ended up not doing so good because I second guessed myself, WHY? because I am not an ALS provider. The target audience is ALS and with that comes more responsibilities for the lack of pay they receive. We have already established that we as EMS providers are underpaid, so as a medic, would you want to be doing twice the work for half the pay? The other reason is, like stated before, the good medics who do their jobs well deserve a higher rate of pay and doesn’t get it, which deters the EMT-B’s from advancing. We know what we see. The other reason for EMT-B’s being at the higher population is fire personnel have also been going through the basic courses only for the certification to go along with their certification as a firefighter.. not all but most have no intentions on furthering themselves. Another Factor, I think (from what I have seen), is there are people who get into EMS for all the wrong reasons and do not last long. They imagine it being this great job where they get to be a hero to the pretty girl and they get crazy rescues with bad car wrecks and, clearly, that’s not what we are about. Those people keep their certs for so long before they run out…and never advance to medic. Those are just a few of my opinions..
I find these statistics quite interesting. EMT Intermediates could also include EMT with IV Certifications, where they are basic EMT’s with endorsements to start IV’s on patients. Some EMT’s also have defribulator certifications but not allowed to start IV’s, which would place them as an EMT Intermediate as they are above basic EMT level, but below Paramedic levels.
First responders usually are below an EMT Basic certification, and have limited functions compared to an EMT Basic. Each state has their own rules, such as California does not recognize and EMT intermediate while others do. In California, they were known as EMT Basic, EMT -D (EMT basic plus Defib cert) and Paramedic. Other states have EMT Basic, EMT Intermediate and EMT-P (Paramedic).
Hope this helps clarify what an Intermediate EMT consists of.
I am probably speaking for a small group here, but still felt the need to share my opinion just the same. Where I am from we are all volunteers and when I say all, I don’t just mean the town I live in, but also all the surrounding areas as well. I would love to continue my education in the EMS field and continue my growth in education; however, and I believe I speak for all of us out here, there just isn’t enough time. Our volunteer work is strictly that, we don’t get a penny for anything that we do. That’s ok, because that’s a choice we made to begin with and we weren’t doing it for the money, nor will we ever expect to. So, we were able to take those first steps in order to become productive with our volunteer departments, but we all must work full time jobs. We somehow managed the 4 months it took to become EMT basics, but with life continously being in fast mode at all times, to be able to go through more classes just isn’t practical. Where we are at out here we are focused on getting more EMT basics and not so much on advancing the basics that we already have. My department alone, we only have 3 EMTs and we all have full time jobs. Most runs that we go on consist of one driver and one EMT. We consider ourselves lucky to be able to have that.
Improve basic EMT education by lengthening the course and including more knowledge and skills. That would go a long way towards improving the image and performance of EMTs.
That won’t happen because even more so than at the ALS level EMT is seen as a skill set, not a profession or even a trade. How many people do you know that are something else “and an EMT”?
Between fire fighters who have a ticket only so they can get more money, volunteers who treat EMS as a hobby, and those who are EMTs while they wait for a “real job” to come along, there is a problem with what we call EMT. That extends to a lesser extent at the ALS level, but because it’s longer, harder, and more expensive to become a paramedic than an EMT it’s less obvious.
Of course I blame a lot of this on the dumbing down that occurred way back in 1994.
Sadly I have to agree that EMS WON’T see an improvement in EMT course content, and that EMT level is seen only as a skill set, yet I worry of the eventual top heavy structuring of the industry if improvement to the fundamental base is not made. We can not expect to further advance ALS if we don’t also advance EMT’s at some level.
Now maybe it is only a small step and a boring one at that but adding some more A&P into the education or Build on the assessment skills of an EMT would only help later as a medic. I learned most of what I know and apply in my assessments from my 8yrs on the street, like most of us, I picked it up from some “Old Timers”. With less and less of them remaining the knowledge gained and applied from them for advancement is dwindling and so is the strength of EMS. Creating less seasoned and knowledgeable providers is a perpetual motion to create less seasoned and knowledgeable providers.
Too old to work, this is true. EMT’s often are stepping stones for something else, at least in California, there are high EMT turnover rates and such low pay (at least in So. Cal). They only work as an EMT to get experience then move on to something else. I’ve also worked with some EMT’s (former FTO) that had no business being in the field, and not sure how they passed their tests. I also believe, the instructor makes a major impact on their learning the skills. I’ve seen instructors who just are there for a check, and don’t really care whether someone succeeds or not, while others have it in their hearts to ensure every student is capable of the job and offers extra to ensure they are taught properly. I’ve had the honor of helping a friend teach an EMT course, and he’s one of the few who give his best to ensure his students are successful.
Another major issue, at least in California, is the high cost of EMT training compared to 5 years ago. While I am not working as an EMT currently, I thought about retaking the course again, but $1000 for EMT is a little pricey, compared to 5 years ago when I paid $25.
I live in mo and paid 2200.00 for my emt lic….I had an excellent instructor and after being in the field for a while did not realize how much extra I was taught…But again…I know the reason most around here will not advance is because of the pay! It is nuts to even think about going to school for a dollar raise!
I know from my experience and i’ve been at this for about 11 years as a basic. Its a handful of reasons that I will not go onto paramedic level. First of all. the pay isn’t worth the time I will have to invest into the education. The pay isn’t worth the time I will loose from spending with my family and the pay doesn’t offset the cost for any medic to keep up with their licenses. We are the “unsung” heroes I understand this but shesh!!! Must we be as wellt he underpaid and over charged?
I agree with alot of the opinions and realize that this is a national document, but I have to wonder at the validity of these stats. Are the basics EMT-I’s that got a basic # as part of their program prior to completion, and are all of these providers still active in their field? 6% just seems a bit low for Intermediate counts. And with most courses being geared towards ALS, while there may be significant coverage of ALS content, alot of courses actually harp on “good basic skills are better than crap advanced ones”. Take ACLS for example, what does the AHA state as the only two therapies to make the greatest chance towards meaningful recovery? CPR and defibrillation, both of these are basic skills/something a layperson could do. While im not saying basic providers are the equivalent of laypersons, but the interventions that show the greatest improvement are basic maneuvers…. For the instructors out there, do your students seem to respond more when you teach them something a little “advanced ” for their position, or when you tell them, “that’s als stuff, you wouldn’t understand”? Just my 2 cents worth.
I’m in a situation I haven’t seen anyone mention yet. I volunteer for a small, non-transporting fire dept. I am technically an Intermediate, but I function as a Basic for a couple of reasons. One is that the agency doesn’t really support anything beyond Basic, even though it is certified as an ALS (ILS, really) agency. We don’t yet have capnography, so I can’t intubate. We don’t have the paperwork filed so that we can check blood glucose. (That’s actually a Basic skill, but we still can’t do it.) And really, the opportunity to do anything beyond BLS is rare because we have an excellent ALS ambulance company that is our automatic back up and transporting agency. I don’t often have very much time on scene before they arrive, and the calls where I’d need to start an IV that quickly are fortunately rare.
When I joined the dept, there was one person who was in the same position I am now- technically Intermediate, but for all practical purposes, working as a Basic. He has now let his certificaiton lapse entirely. Before that, years ago, the dept used to have medics, BUT that was back when EMS was first getting sorted out here. When ended up happening was that people either quit the dept, or dropped back down to a Basic level of certification. There is just little reason to maintain a higher level of certification out here.
What this means for me, personally, and for the other EMTs out here (what few we have) is that we need to have excellent BLS skills. Some of that is focusing on and practicing all the stuff that EMT-B covers. Part is extending knowledge into some understanding of “what comes next” so that everything makes more sense. The more I understand about what higher level providers will need to do, the better I can support that. Becoming an Intermediate actually made me a much better Basic.
Anyhow. I agree with what some folks have been commenting, about how most really good Basics tend to move on, and who can blame them? It’s endlessly fascinating and rewarding. Even so, I think there are a lot of smaller agencies like mine, where all that is really needed is good BLS, so it’s important to encourage those providers, and make sure they understand their role in the big picture.
We are fortunate here that the ambulance company that comes out here is excellent, and their employees are wonderful to work with, and appreciate what we do. I have read many stories of places where that isn’t the case, where Basics get treated poorly, and am glad we don’t have that experience. I’m sure there are a lot of Basics who either quit or move on if they get treated like crap, whether that is from someone devaluing their skill level, or from not getting paid enough to live on, if it’s their day job.
Hilinda, you have some good points in here. Being an EMT, we must obey our protocols issued by the county. Here in California, Every county has different protocols. In Orange County, you are limited on what you are allowed to do as an EMT, while Riverside County, you’re allowed to do almost everything in your scope. For example, In Orange County, EMT’s are not allowed to issue glucose paste, while Los Angeles and Riverside County, and EMT can assist a patient with gluecose paste. The combitube is allowed to be used by an EMT in Riverside County, but Orange County and Los Angeles County does not allow an EMT to use this. As an EMT, it can be frustrating when you operated in various counties, as to your scope being limited in each county you provide service too. Another good example, is in Orange County, the only paramedics allowed to operate paramedic protocols are those hired and working for fire departments, where other counties, private paramedics can operate as a paramedic. Politics play a role in our protocols in which EMT’s and Paramedics are allowed to provide.