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Occupy EMS

A few months back, I engaged in a bit of trollery on Facebook and here on the blog when I asked readers to defend or refute the following statement:

"Nobody in EMS is paid what they're worth. 25% are paid far less than what they're worth, and 75% are paid far more than what they're worth."

The statement was in response to one of those pointless Facebook threads wherein EMT's bitch about how little they make. As usual, every argument once again made the rounds.

"If we increase educational requirements, better pay will follow."

Actually, I happen to agree with this one.

"Why should I strive for better education? Going to college doesn't make you a good paramedic. I've been a medic for [insert number of years] and my class only lasted [insert number of months], and I've done just fine!"

Maybe so. Then again, maybe he's one of those medics with one year of experience, repeated twenty times.

"If you got into this for the money, you're in the wrong profession."

Ah, a dose of realism. Then again, why should we have to choose between rent and job satisfaction?

"Making more money is simple. Go to work for the fire department. We make great pay!"

Yep. Then again, more and more cities are questioning whether they're getting any value for all that pay, expecially with dwindling tax revenues making budget shortfalls commonplace. And while your unions might get you better wages and benefits, they also make you a big target for some politicians.

"If I wanted to run into burning buildings, I'd have joined the fire department long ago. I just want to be paid a fair wage for being a paramedic. Besides, fire departments provide really shoddy care."

Two fair sentiments, followed by a gratuitous slap at others in our profession. Not exactly constructive.

"How can I go to school for more education, when I already work for three private ambulance companies just to pay the bills?"

Brother, do I feel your pain. Then again, if you saw how paltry the reimbursement is for ambulance transport, the low pay starts to make more sense.

"See, that's why I won't work for private EMS. They're all just a bunch of mercenaries, getting rich off sick people while paying their employees chump change. I VOLUNTEER my services, because that's just the kind of altruistic sonofagun I am."

Except, of course, that those wages come from a finite revenue pool of Medicare and Medicaid reimbursement that runs about 30% less than the actual cost of providing the service. And that reimbursement was derived from some arcane formula calculating the average cost of providing EMS services across the country… including the volunteers who provide the service for free. So, thanks for doing your part to keep EMS wage levels in the toilet, Mr. Noble Volunteer.


I used to engage in these discussions. But after you've seen the same ignorant statements a thousand times, maybe dropped a few ignorant statements of your own, you grow weary of such things. The signal to noise ratio in such threads makes it tiresome. So instead, I skim it, maybe drop a verbal grenade, and move on.

Some of you took up my challenge. Happy Medic proclaimed himself a member of the 75% of us who are overpaid, and told us of the choices he had to make to get there. If you don't understand what he's saying there, I can 'splain… no, ees too much. Let me sum up: Challenge yourself, seek professional growth, and get out of your comfort zone. It pays off.

TOTWTYTR chimed in with a sentiment I've heard him express for years:

"There is no shortage of paramedics. What there is, is a shortage of paramedics who are willing to work for the low pay, high call volume, crappy or non existent benefits, sitting in an ambulance for 8-10-12 or more hours, not able to even go to the bathroom without asking for permission, lowest common denominator medicine, that is EMS in much of the country."

He's right, but he misses my point. So did Happy Medic.

Silicon Valley Redneck hit closest to the mark, when he correctly interpreted my statement to be a variation on Sturgeon's Revelation, which states, "Ninety percent of everything is crap."

Change the professions around and the percentages might change, but the law holds true. Mediocrity reigns.


That fact is sometimes easy to forget, especially here in this insular little world of the Internet. My EMS readers here are passionate about their profession. The EMS blogs I read are written by people who are passionate about their profession. I can look around and see great medics and EMTs, people who are a credit to their profession. They're easy to find because, by and large, we surround ourselves with those kinds of people.

I don't teach nearly so many EMS classes as I used to. It's been over seven years since I had a paramedic student, four years since I taught anything longer than a refresher. And the vast majority of my students have been talented and dedicated kids who are passionate about their chosen profession.

But the reason I see so many of them is because they sought ME to teach their classes.

For every student I get who takes the education I provide and runs with it, there are a dozen more who sought their education elsewhere, because I demanded too much, or charged too much, or graded too hard, or required them to think and not memorize. A dozen more who didn't want an EMT education, just an EMT card.

And if you look hard enough, you can see beyond your circle of like-minded people and realize that you're outnumbered by the turds of our profession, the ones who are satisfied with good enough. They're all around you. They outnumber you at least three to one.

For a variety of reasons, this post was back-burnered until I could find the time to give the subject its due. And yesterday, I discovered that now I don't have to, because Tracy Loscar wrote it for me. For me, the money quote was:

"In short, you are required to metabolize, but nowhere does it say you must evolve."

You need to read the whole thing, but that one sentence, to me, sums up what is wrong with EMS.

So no, Happy Medic isn't one of the overpaid 75% he claims to be. He's just the opposite. He's the underpaid 25%, because you can't put a salary value on what he does for the profession. Ditto for TOTWTYTR, Rogue Medic, Steve Whitehead and others.

The good news is, even though we're outnumbered 3:1 by the turds of our profession, those are not overwhelming odds. The 75% aren't doing anything to actively advance our profession, but then again, they're too apathetic to do it much harm, either. Less than 3% of the American colonists actually took up arms in the American Revolution. Less than 10% actively aided them with arms, shelter or materiel. Perhaps only another 20% were favorable to their cause.

And yet, they were able to throw off the yoke of the most powerful nation on the face of the Earth.

Imagine how we can transform EMS if we manage to shift the ratio even a few points in our favor.


Comments - Add Yours

  • Andrew D

    Kelly, I can agree with 99% of the piece you have here.  The only thing I want to put on the table is that maybe we need to find a way to make the volunteer in Texas or Rural Alabama or Backwoods New Hampshire not be the devil against the Full-time tech in Boston or Lowell or Austin or Albuquerque. 

    MediXXXX pays too little, regardless of what part of health care it deals with, but maybe if some transparency was put forward it would help, e.g. where do all these costs come from and where is the money coming from. People don’t think of emergency services until they need them (and then you’re too slow), and they don’t realize that insurance pays pennies on the dollar for their care, so the numbers they can get from the doctor for prices are nowhere near what is actually expended and received, so they think the hospitals actually get $100 for a dose of Tylenol.

    The needed reforms are not merely monetary, but until the assumptions in the system (insurance payouts). One size does not fit all, particularly in a ~ 3000×1000 mi country.  Maybe we need to get the ticks to learn that first.

    For most cities, private or fire-based EMS work well, but for places
    where you have either tiny towns or widespread towns, it can’t be
    financially sustained.  Add in the fear from small towns that a service
    will just up and drop the service or significantly increase fees once
    there was no other options (both of which occur) and I doubt that Volley
    services will ever disappear completely.

    Perhaps what’s best for a city of 500,000 doesn’t work for a town of 10,000…maybe one size fits all anything needs to be looked at

    • Ambulance Driver

      No one said that volunteer EMS is the devil, nor is private EMS, or fire department EMS, or any other system model.

      But volunteers don’t get to play the altruism and nobility cards without accepting their role in what is holding us back. Can’t have one without the other.

  • Scott Brown

    Tell me again what makes you a “turd”? You lost me in there someplace. 

    What…precisely…would you have me do to “advance the profession?” The other day, I patted a kid on the head and applied a Band-Aid to a skinned knee after coming >< that close to being a statistic while responding to meet an arbitrary, unscientific response time criteria to said skinned knee. Skip Kirkwood challenges me to join the NAEMT to "advance the profession" yet he, who is actually in charge of a respected service, doesn't pay his people what they are worth. 

    You write this awesome blog…is that the answer? I'm halfway to a masters degree, own a license, have 17 years Fire/EMS experience in high volume, high acuity systems, a proven track record as a leader, own a myriad of wicked little card courses with bitchin' acronyms…hell, I even spent a year getting shot at for sport to see what "remote medicine" was all about. I've played this game a LOOONG time, been just about everywhere, jumped through all the hoops and beat my head flat against the wall. I've won some battles and lost a whole lot more…and we're still running in the same circles for the same reasons. 

    Am I evolving or merely metabolizing? I'd love it if I could get to wave my magical wand and fix everything…if I had that power, I'd be the most popular guy in the history of pre-hospital medicine, but thusfar, nobody has seen the obvious wisdom of that course. I've been "occupying" this sumbitch for going on 18 years now…what more does it require of me to avoid turd status?You just point the way Magellan, and I'm your huckleberry….

    • Ambulance_Driver

      A turd is someone who just gives the bare minimum to his profession.

      The fact that you’re halfway to a masters with all your merit badges and your passion for the profession demonstrates that you’re already headed the right direction.
      Now we just need less turds and more people like you.

      I’m not preaching to people like YOU. I’m preaching that people like you keep trying to influence the rest if them who aren’t engaged in the profession beyond showing up for their pay checks.
      Wasn’t that obvious?

      • jalzate

        Unfortunately, the people you are preaching to are not the ones reading posts and information about EMS. Those people are to busy sleeping, drinking or bragging about how good they are and how they save lives for a living. 

      • Scott Brown

        I’m asking 2 questions…where is the crossover point for “advancing the profession” v. just being a paycheck player…and what is your suggestion to further “advance the profession”? 
        My not that estimable view is, it’s not the “turds” who hold us back…there are turds in every profession on earth, yet the professions they reside in are clearly further advanced than ours is. 

        Let me just make this one point, and see what you think. 

        Lets say that I wanted to swap gigs and come play in your service. What would I have to do? What happens in every other professional endeavor if you want to level up or sideways? 

        There’s a bunch of hoops to jump through…tests, skills, interview boards, psych evals…right back to the bottom of the ol’ pile. Some kid with 1/3 my education and experience is going to ask me why I think I’m good enough to ply my “profession” at their service? Really? They do that to doctors and nurses…PAs and RTs? Or do they ACTIVELY RECRUIT them? Professional industries SEEK talent, nurture it and attempt to retain it. EMS acts like the first time I’ve ever seen a monitor or worked a code is right then…shit my own department does it. Some guy with my experience pops up, I have to see if he knows how to use an axe…it’s insane, and just one of the MYRIAD of things that the “industry” does that holds us back. 

        I’m running a service, the FIRST thing I do is start mining talent. We are our own best headhunters, and the ones who know how to write a good CV, you ought to BEG them to come work for you…maybe even offer…oh I dunno…ENTICEMENTS as opposed to an outdated 100 question “entrance exam” that still has the dosage for bretyllium on it. 

        Do we even pretend to be professional in how we recruit and retain? 

        Pfffftttttt…the list just goes on and on and on and on of the completely backwards way this “profession” operates. 

        I do what I do because I enjoy it. The “paycheck players” are a symptom of the disease, not the cause. Our cart is 45 miles out in front of our collective horse. 

        We pay squat, we manage like crap, we do EVERYTHING we can think of to drive talent into other endeavors, in a crazed 180 degree out of phase orgy of how NOT to do things…then sit around and wonder why we are where we are? 

        So….we’re back to…what MORE can I do? Somebody vote me EMS king, and this is all a bad memory…until that happens…what would you like me to do?

        • Ambulance_Driver

           One, most of those professions are a good deal older than EMS. We are still in our adolescence, if indeed we can yet be called a profession instead of a trade.

          You don’t think nursing went through these growing pains? They did, and still are. Most of the stuff we’re arguing about – and resisting – they did a couple of generations ago, and reaped the benefits from it.

          Any yes, my agency does recruit, nationally. Go to the Texas EMS Conference or any of the big national trade shows, and they’ll have a booth up.

          And when you’re tendered a job offer, your starting pay is based upon certification and experience. Ours caps at 10 years, but you will definitely be paid more than a 2 year medic, even if he’s got 10 years of seniority on you as a new hire.

          And there’s no test, either. There’s a field internship of usually 12 shifts (less if you catch on quickly), before you’re cut loose, and the purpose of that internship is more to see that you’re familiar with company policy and procedures than to test your competency as a medic.

          No, it’s not perfect. We have turds that slip through, and we have great medics that just aren’t a good fit. But it beats what you’re describing.

          And my ex-wife has taken jumped through exactly the same hoops you’re talking about when changing employers as an ED nurse.

          So, your statements may not necessarily apply to the profession as a whole, but only to the agencies *you* are familiar with. But I agree with you – there’s a lot of that shit out there.

          But where I disagree with you is that your arguments are more like the McDonald’s mentality – why should I do more, when none of it is recognized by my employers or prospective employers? Why should I work harder and apply myself, when I’m already paid and treated like shit.

          Actually, it’s just the opposite. If they worked harder and applied themselves, they’d be a friggin’ district manager in five years.

          And I don’t think you believe the arguments you’re making yourself. Otherwise, you’d be marking time, collecting a paycheck, showing up at the minimum number of CEU sessions and doing what *only* what is required to get by, like 75% of our co-workers, because after all, what’s in it for you?

          But instead, you’re working on a masters degree, maintaining a wallet full of certs, and arguing with me on an EMS blog and in the comments on my EMS1 column.

          How many of your colleagues, do you think, actively subscribe to trade journals? Read EMS blogs? Go to conferences? Seek out any continuing education that isn’t already mandated? Go back to college? Read any medical research on their own?

          I’m betting it’s damned few.

          Changing things isn’t going to be accomplished by some magic wand, and you’re never going to be declared EMS King, just like my legion of flying monkeys is never going to complete my quest for world domination. None of the things we want to see changed is going to happen overnight, man. Hell, it may not even happen before you or I retire.

          But all it’s going to take is enough voices dissatisfied with the status quo, and stubborn enough to actually DO something about it, to change the institutional inertia of EMS.

          Hell, it ain’t even rocket science on how it’s done. You already know what we’re doing *wrong*, and I’m betting you’ve contemplated finding some little service with potential that you could run, in the way that *you* think EMS should be run.

          So you find that service, and do those things. And if you’re successful enough, the services surrounding you all start losing their best people and business to Scott’s EMS Utopia, they either have to start stealing pages from your playbook to compete, or they’ll have to close the doors and let Scott’s EMS Utopia  take over.

          And right now, I’m betting you could think of a long list of EMTs that you *wouldn’t* hire at that service.

          There’s your definition of turds, man.

          • Scott Brown

            No, I’m not really just letting it all ride…but I am for SURE not as enthusiastic as I once was about the INDUSTRY…I am enthusiastic about my small part in it, but I’ve become resigned to the fact that after approaching 20 years, I’ll be using my education and skills in another field…and no matter which way you try to slice it, THAT is the crux of the issue. This is not a field that attracts, and retains talented people…for the whole litany of reasons we’ve all named countless times through the years. 

      • ab9302

        most people in most lines of work just do the minimum to get by….EMS is not unique in that.

  • Joe Paczkowski

    “Imagine how we can transform EMS if we manage to shift the ratio even a few points in our favor.”

    …and that’s why I keep fighting the good fight. If the first 9 times engaging with a turd ends up with us banging our head against a wall and the 10th time (same turd or different, it makes no difference) we get through to one, and as long as EMS is worth fighting for, that 1 time is worth it.

  • Jetcptr119

    Seems whomever wrote this article missed a point. What about the PTSD that some of us (namingly me if you would like) go through after responding to a DUI crash involving a vehicle vs. pedestrian? Oh, did I mention that the pdestrian was my father and that ,y partner and I were the first medisc there?

    • Ambulance_Driver

      What does anything Tracy said in her article, or I in my blog post, have to with your PTSD?
      Or anyone else’s?

    • mpatk

       That’s a nightmare scenario for anyone, and I can’t imagine what you’re going through; but what does that have to do with the blog post?  The “turds” he’s talking about are the ones who (1) became EMS with minimum effort and qualifications and (2) continue to ride that “minimum qualification” line and let others pick up the slack for them.  In other words, the lazy bums that are present in every job but happen to be making EMS more difficult.  I doubt like hell he meant any of his critique for someone in your position.

      That said, prayers for your dad and I hope you got any support you needed from your EMS family.

    • Bobball

       A nightmare case to be sure. However, if you’re suggesting that PTSD be allowed to be an excuse for doing shoddy work or having a bad attitude, I’d disagree. If, despite therapy (and medication if prescribed) someone can’t re-engage and be a positive member of the profession, then it’s time to leave.

      It may sound crass, but if I’m having an MI, or my mother is sick or whatever; I’m not going to care one lick about the trauma you faced before…because I’m facing my own trauma and it’ll be far easier for me to face with the help of compassionate professionals.

  • tammbamm

    If you really look at it (now I can only speak about the EMS system that I use to work for) We would start our shift at 8 am after we would check off the truck we were able to lay down until a call would come in. with an average of three calls a day (at that particular station) we would get payed a LOT for sleeping20 out of the 24 hours on duty. I got payed 14 an hour time and a half after 40 hours)laying on my butt most of the time or watching tv taking time out to eat or shop. So yes the people I worked for and with got payed a lot if you broke it down to the actual calls we did in a 24 hour shift. None of us went into this proffesion thinking we could get rich. Stop complaining or find an other job!!!!!

    • Midwest Medic

      First of all it’s not necessarily the work load that people are paying us for, we’re being paid to be ready in the event someone needs us quickly. Second, checking the truck and going to sleep immediately after, or tending to personal tasks all day does nothing for anyone. What about training between calls? Doing con-ed, homework for classes one is taking, reviewing SOPs, familiarizing oneself with the equipment one doesn’t use very often? Using the job as a chance to sleep all day, or do personal stuff and then bragging about it is exactly why people don’t take us seriously. Don’t get me wrong, I’ve done personal, non job related stuff on shift too, but I also make sure I’ve done at least something to keep myself sharp every day too.

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  • MedicMarch


  • mpatk

    Ambulance Driver,

    Thank you for writing that post; and especially for linking to Tracy Loscar’s article.

    Much as I hate to admit it, I was embarrassed while reading Ms. Loscar’s article.  A few of the things she mentioned hit home for me.  I’ve let my tiffs with management affect my attitude; and in retrospect I probably ended up setting a rather poor example when I had the occasional newbie partner.  I’ve had a particular problem with stopping saying “It’s OK” (as Ms. Loscar says); probably the biggest reason that I’m no longer a supervisor.  On bad days, I’ve found myself lowering to the level of “the 75%” rather than trying to bring them up to a higher level.  I’m not one who wants to be everybody’s friend; but I find it tough to end up on the outside for criticizing “stuff that everyone does”.  But you know what?  The damn job is tough as well.  If I can handle the wrecks, frequent fliers, codes, psych transfers and the rest of it, I should be able to handle telling someone (constructively) things they need to fix or improve.

    Again, thank you for writing something that has woken me up to a part of my job that I need to improve.

  • Berlin

    Get ready to hate me but, private service wages are kept crap my management.  Management salaries are up 100’s of percents while employee salaries are down 10-15% from 20 years ago.  Management lines their pockets over the employee more and more.  The market pool is over-saturated, which makes us very replaceable.  The solution is to unionize.  Enter into bargaining units and speak with a voice of many instead of just your own, there is more leverage there.  You don’t have to be a “greedy” “union thug” either.  

    • Ambulance_Driver

       No, the private services *you* are familiar with are kept crap by management.

      Where I work, if you looked at the salary of the supervisors in the two tiers directly above me versus the hourly wages paid to paramedics, the pay is only marginally better, and sometimes worse.

      And I won’t disagree with you that unions and collective bargaining agreements may indeed be a solution in some areas, but they’re not a catch-all solution, either.

      Their approach to pay parity, for example, is often just that – parity. The shitty medics get paid just as much as the great ones, based solely on seniority and very little on ability.

      I’ve got quite a few friends who work as medics in unionized shops. Some of them like what the union does for them, and others believe, probably correctly, that the union’s first priority is to take care of the union – not the workers it represents.

      • Berlin

        I’ve got quite a few friends who work in “private” shops and they hate it.  You must not work in Ohio.  There may as well be a revolving door on the front of those private services because all they do is turnover their employee rosters.
        I’ll agree that unionization is not a catch all.  Pay can be the same for everyone, even the shitty medics.  However, the good medics usually further their skills and certs, which comes with it’s own pay benefits.
        One thing is for sure here.  Everyone wants to “further the profession” and “earn what they believe they are worth.”  In order to do that the private companies need to stand together.  I think it’s pretty clear what standing alone has gotten most of you.
        As far as unions only looking out for themselves and not the employees, that’s where good leaders come in.  Not to mention that unions ARE employees so I don’t get that comment people throw around.  
        You obviously don’t have the need of one but you are in the minority of private ambulance employees.  I hope you continue to thrive in this business.  

        • Ambulance_Driver

          I have a couple of friends who work for private EMS in Ohio. From what they have told me, the situation there truly is dismal, so I can understand your frustration.
          Just realize it's not that way everywhere.

  • Kave

    It is not for those trying to advance the profession to alienate and condemn the “turds”. It is up to those trying to advance the profession to embrace the turds, teach the turds, help the turds float to the top. If you can help one turd float, and that turd helps another turd, think about all the turds floating, helping each other. Turds helping turds. That’s the world I want to live in.

    • Ambulance_Driver

      Turds cannot be polished (Okay, according to Mythbusters they can.)

      Turds can only be flushed.

      But there is all likelihood that a small percentage of them are unpolished diamonds that only smell like feces because of the people they surround themselves with.
      Those are the ones we aim for.

    • Ernie Sharp

       The problem is that many of the turds don’t want to improve. How many times have you heard “I don’t need to know that.” or  “So what, it won’t change my treatment. I still have to follow protocol.” or my personal favorite: “You are a know it all, stop trying to be a doctor.”
      The reason that medics don’t make much money is that the overwhelming majority of them don’t deserve to.

  • Bobball

    Awesome post by you…and by Tracey!

  • crs224akameema


    “Except, of course, that those wages come from a finite
    revenue pool of Medicare and Medicaid reimbursement that runs about 30% less
    than the actual cost of providing the service. And that reimbursement was
    derived from some arcane formula calculating the average cost of providing EMS
    services across the country… including the volunteers who provide the
    service for free. So, thanks for doing your part to keep EMS
    wage levels in the toilet, Mr. Noble Volunteer.”

    Ah, AD, ya got me again. 
    I swore to myself after the gun debacle that I wouldn’t run the risk of
    all the dissention by commenting, but as a volunteer with our local rescue
    squad for over 35 years, I gotta take you to task on this one, and run the risk
    of getting shot down yet again.  Volunteers
    are not doing what they do to bring down wages for paid services.  Volunteers are doing it because they are a
    necessity for both EMS and fire services.  In many areas across our country that’s all
    there is.  That’s all there is because
    given the many factors that include location, tax base, potential revenue and operating
    expenses make having a paid service out of the question.  And let’s not even go in to finding trained
    people in some of the areas, never mind keeping them trained. Then there’s the
    whole thing about how even if there were enough trained people to go around,
    would any of them want to pick up and move to the isolated areas that depend on
    the volunteers for whatever help they have?  We’ve got a lot of places like that here in New York State,
    and I know you must in Louisiana,
    too. Look them over and ask yourself if they’re better off without the
    volunteers, without any help at all, or should they wait for a paid service to
    arrive from an area many, many miles away – if that service would provide the
    coverage.  The county I live in now has five
    rescue squads.  Every one of them started
    life as part of the all volunteer fire department and eventually branched off
    on their own, and now we all have career staff 24/7/365.  Ours operate out of two stations to cover
    roughly 150 square miles.  But we
    thankfully still have volunteers who help those crews when things get busy. The
    EMS system the country knows today is founded
    on what volunteers provided for decades. 
    Please don’t put down what your predecessors did, and what thousands of
    us still do – yes, for no pay except the satisfaction that we’re helping our
    neighbors and often our own families.  For
    whatever reasons, we couldn’t go get the training and make it our life
    work.  But please don’t make us the scapegoat
    for what’s wrong with the system.  And
    don’t make it sound like getting rid of us would solve the problem.  I doubt it will, especially not in my lifetime. 

    Thanks for at least reading the other side, even if you don’t
    agree.  I will now put on my armor and
    wait to be blasted with your response – and no doubt that of others. 

    • Ambulance_Driver

      “Volunteers are not doing what they do to bring down wages for paid services.”

      I never said they were. All I said was that factoring volunteer expenses into the reimbursement model by CMS was one of the major factors in bringing down wages in EMS. It said nothing as to motive for volunteering. I simply pointed out that a volunteer doesn’t get to paint for-profit EMS as mercenaries without accepting the responsibility for their part in keeping reimbursement so low.

      “Volunteers are doing it because they are a necessity for both EMS and fire services.  In many areas across our country that’s all there is.”

      I’m well aware of that. And believe me, so are the communities you serve. You don’t see police, nurses and doctors giving away their services as volunteers, yet EMS does. While saying “Why buy the cow when you can get the milk for free,” may seem overly callous, it doesn’t make the statement any less true.

      “But please don’t make us the scapegoat for what’s wrong with the system.  And don’t make it sound like getting rid of us would solve the problem.”

      Nobody’s making you a scapegoat for what’s wrong with the system. Look at what I said before.

      And I’m well aware that EMS couldn’t survive without volunteers. The problem is that it should.

      As to how to make that happen, I haven’t an answer.

      • crs224akameema

         As I was reading your response, I was also hearing on the radio an ad that’s part of a campaign here in NYS (and maybe other places as well) to recruit more volunteer firefighters-part of the draw they are offering is free training. Fire departments get the press, the funding, the glory.  EMS needs something, somehow, to raise awareness that we are just as important to them, just as needy – make that more so – I’m sure we’ve all said variations of “What is more of an emergency: your shed is on fire or you’re having a heart attack?”   How to do it?  Can enough of us get together to create (or enlarge if there already is one) a lobbying group?  Can we create a regional or national promotional campaign?  Those are things needed, but can it happen?  Another thing there is no easy answer to.  We’re doing our damndest to raise awareness of who we are and what we do in just our own coverage area, and it ain’t easy.  As to whether EMS should be able to survive without volunteers, I’ll disagree, for the reasons stated in my original post.  With permission of the original writer I’ll amend that to “… should be able to survive without using the volunteers’ necessary services as a means to lower payment throughout the entire system.” 

        • Ambulance_Driver

          No, it should be able to survive without EMT’s having to give away their services for free. Period.
          But that’s not possible right now, hence EMS needs it’s volunteers to survive.
          You’re telling me that, *if* a mechanism were in place to assure that every volunteer EMT in America were fairly compensated for their services, you’d still do it for free?
          Because that’s the difference between “should survive” and “could survive.”

          • crs224akameema


            Agree with your first two sentences – yes it
            “should” be able to but no it “couldn’t”.  Would I
            take money if it were made available?  No doubt.  However that’s
            hardly something that will happen in my lifetime (given that I’m fast
            approaching 70).  Volunteerism is a necessity in many fields – the
            not-for-profit organization that pays my salary “could” not survive
            if we had to pay for all that our many volunteers do.  Sadly, volunteers
            are dropping like flies in EMS (and fire service) as people’s lives and the
            training needed to stay qualified get more complex; another reason more
            agencies are going to paid staff.  Meanwhile, the public protests the
            higher taxes that are levied to pay for these services – we’ve had people say
            “I’m not paying to ride in the ambulance, I pay $86 in taxes for that!”  Again, a major effort is needed to make it
            different.  Ideas?  Help with that?  Somebody? 

            o.  Volunteers are also
            dropping like flies in EMS (and fire service)
            as people’s lives get more complex.  Meanwhile, the public protests the
            higher taxes that are levied to pay for these services – we’ve had people say “I’m
            not paying to ride in the ambulance, I pay $86 in taxes for that!”  Again, a major effort is needed to make it
            different.  Ideas?  Help with that?  Somebody? 

          • Ambulance_Driver

            Well, the first step is educating the public that their tax dollars are NOT paying for that ambulance ride.
            Their tax dollars are paying for the CAPABILITY for the ambulance to arrive to give you that ride early enough to do you some good.
            We suck at public education.

          • crs224akameema

             That we do, AD, that we do.  but, as many of your posts make note of, all too often the public cannot be educated.  We’re trying, in our little corner of the world here, but it’s an uphill battle all the way.  More power to all who are trying.

          • Bobball

             This is an important thing for them to know…of course depending on the community, their tax dollars don’t go to EMS at all. In our area, if EMS isn’t part of the fire service, it’s generally not part of the local direct tax financing at all. Read: we get paid only by reimbursement…just like the other health care providers.

          • crs224akameema

            In our county the squads are not part of the fire service and do get some money directly from the towns we cover.  Many of the people do not know this, or think that’s their ticket to ride.

  • Too Old To Work

    You’ve got a nice heated debate going on here. I think I’ll help you out by throwing some Kerosene on it.

    It’s a vicious cycle we’re dealing with. Educational standards are a joke, because a lot of different entities want them to be a joke. If EMS education, especially ALS education were comprehensive, then the NAEMT wouldn’t make a ton of money peddling merit badge courses. If EMS education was comprehensive, people who volunteer because it’s fun to drive around with lights and sirens wouldn’t volunteer and there would either be no EMS  or paid EMS in a lot of places. Mostly no EMS because most volunteer areas can’t afford to pay for EMS. If EMS education was comprehensive (I’m putting the Nomex on now) many fire based EMS systems would fall apart because their people wouldn’t bother becoming paramedics so they could become fire fighters. If EMS education was comprehensive, then a lot of private companies would fold because someone who had to go to school for a year or more FULL TIME would decide that the paltry pay wasn’t worth it and would go to nursing school.

    We’ve made it entirely too easy and cheap to become a paramedic, let alone an EMT. Twenty or so years ago a friend encouraged me to go to paramedic school because EMTs were “a dime a dozen” and the only way to stay in the profession. Now, paramedics are a dime a dozen and EMTs are about a penny per bushel.

    Of course I have to through in my gratuitous slam at the 1994 basic EMT revision which dumbed down an already insufficient BLS curriculum. Which in it’s turn affected the ALS educational system.

    It’s a mess, but it’s a mess of our own creation. The time to fix this was in the late 1980s and early 1990s. By now the cycle of insanely easy education and insanely cheap labor is so engrained in the system that I don’t see it ever improving.

    • mpatk

      Before we can improve the educational requirements, we need to standardize what a “paramedic” can do. It’s bad enough when states differ; but it’s asinine to have different COUNTIES in the same state with drastically different scopes of practice. Once there is reasonable standardization of the scope of practice, then work can be done on improving the education/training for that scope; trying to improve all the disparate levels separately is about as effective as herding kittens.

      I agree about the factors trying to maintain the status quo of low educational requirements (and would add AHA for starting the whole “merit badge” concept. Maybe combining NAEMT with NREMT would help that: have the people who devise the curriculum be he ones who verify compliance. Or it could make it worse, you never know.

      The mess will eventually be fixed, one way or another. The question is whether the current system can be fixed, or it is necessary to “blow up” the current system and start from scratch.

  • Scott0762

    May I ask where are the advancements there is no upward position.
    Paid to much three jobs to pay rent and afford a modest vehicle.
    There are to many in it for the lights and sirens and not to do the job. There are to many that want to step on a coworkers head than help to get to the imaginary boss spot. Just saying on passing.

  • Jacci5

    I am a volunteer emt. Id still volunteer if I had millions, I do it because I love it.

  • a medic, burning out…

    I am a paramedic, and I care about the work that I do and the image of my industry.  I am slowly being ground down by the people who don’t give a damn, though.  I am surrounded by EMT’s and medics who don’t tuck in their shirts, interact poorly with patients and other medical people, and never do more than the bare minimum necessary (and sometimes not even that).  I have tried to set a good example, and I’ve tried to cajole, persuade, entice, bargain, browbeat, bully, threaten, or trick the lazy ones into doing the right things.  Almost nothing works.

    Do you know why?  Because EMS MANAGEMENT rarely gets involved.  I’ve complained to bosses and supervisors about malingering, unprofessional partners and co-workers, and I’ve typically gotten answers like:

    1)  Well, what are you gonna do?

    2)  It’s your word against his (hers).

    3)  That patient was a gork/skell/prisoner/pain in the ass anyway.

    4)  Do your own paperwork, and mind your own business.

    5)  Nobody cares about that.

    When EMT’s and paramedics get the message from their management that “anything goes”, standards go right out the window.  And then people wonder why nurses, doctors, and the public don’t respect us, and don’t want to pay us more…

  • CCmedic9813

    I’ve been saying it for a long time that the difficulty of getting into EMT/paramedic school needs to be raised… Or created for that matter. Anyone that is able to come up with tuition is a candidate to get into EMS, but yet RN school requires at minimum an associates degree and you have to prove yourself before you can even get into the actual nursing program. If you don’t have at least a 3.0 or greater then you can pretty much forget about getting into RN school as a brand new medical care provider. Obviously the bridge program is different. I’ve been in EMS for nearly seven years and the trend that I’ve noticed over the last few years is that the quantity of EMT student third riders has increased, but the quality has significantly decreased!  A very large percentage of the students that ride with me couldn’t care less about learning or taking initiative to do patient care. They just want to get in, get their hours, and complete their check off sheets. I actually spend a good amount of time with my students and it’s insane how little they will know or lack there of, and they couldn’t care less about it.  I began to think to myself, “no wonder most people don’t take us seriously.”  Not only do I love learning about medicine, but it’s obviously very important because we are dealing with people’s life’s and I think that’s what most people fail to realize. They just automatically assume that “someone else on scene will know what to do.” Medicine is my hobby as well as my passion and it’s unfortunate that it’s rare to see that in this field.  As an EMT I was taking ACLS/PALS classes, teaching myself how to read EKG’s and 12 leads, and learning pharmacology. Obviously I wasn’t able to perform those skills as an EMT, but it made me a better EMT to my paramedic partner and when I did move on to become a paramedic, I had a much easier time than 90% of my classmates did. The more I learn, the more confident I become, and the more resourceful I am for my patients…. With that being said, the more I learn, the more I realize how much I DON’T know, especially while I was studying to become a critical care medic.  I think Kelly’s 75/25 rule is spot on and if they don’t raise the difficulty to enter these programs and/or make the programs more difficult then that rule will always apply. 

  • ab9302

    Interesting post, Kelly. I can’t say I disagree with a single word of it…..

    There’s always a lot of discussion among the more intelligent and professional members of the EMS industry about how to “advance the profession”: “If we had more education, the pay would follow”…..”we have to evolve/advance as a profession”……”too many paramedics aren’t interested in education”…..etc, etc.The question that always comes to my mind and that no one seems to have the answer to is this: What do want the profession to EVOLVE to? What does that even MEAN? To be completely honest, I’m not sure there’s a whole lot of “advancement” left for EMS. People get sick, they call 911, we go pick them up and take them to the hospital, rendering treatment throughout the process as indicated and as our training allows. We’re paramedics; that’s what we signed up for and that’s what we’re trained for and that’s what we do. Some of us are very professional; some are less so. Some are highly competent; others are less so. Some employers are great; others suck. You could say those same things about ANY profession. How is paramedicine any different than any other line of work in the fact that many or most are satisfied with mediocrity? What do we WANT TO DO as paramedics? To hear some talk, you’d think that with less than an associate’s degree worth of education, we ought to be functioning at the NP/PA or even MD level, in terms of the clinical decision making and interventions they think we should be able to provide. To hear others talk, we should all make as much money as clinicians with master’s level degrees or higher.A lot of the discontent, in fact, seems to come from the fact that paramedics don’t have the same professional status as their much more highly educated counterparts, or have the hero-worshipper/groupies that cops and firefighters do. Of course it’s deeper than that for many, but I think that’s really a root source of much of the discontent that I see among us.  Pay: We all want to make more money. Many in EMS, unfortunately, do earn very little. But – and I know this is going to offend some, but I think it’s a reality that we have to face – how much is what we do really WORTH, economically speaking? Keeping in mind that the value of something is determined by what the market is willing to pay for it, not necessarilly what we WANT to be paid for it. Seriously….most of the people we take to the hospital aren’t even sick in a way that requires any prehospital treatment whatsoever, or even an ambulance ride, for that matter. Many of the treatments that we DO perform have not been shown to positively affect outcomes. Most of what we do could be done just as well by a taxicab. Think about it: if someone wanted you to pay them to do something that wasn’t even necessary most of the time, to do things that haven’t been proven to add any value, how much would you be willing to pay them for that service? Unfortunately, that’s pretty much how the market looks at EMS. Don’t shoot the messenger; I’m just pointing out an economic reality. But what are we really looking for? What do we want? To be PA’s? To be firefighters? If we don’t want to do what paramedics do, for the pay that paramedics earn, why don’t we find something else to do? I know, I know…..”paramedicine is a young profession; over time it will evolve and things will improve”. Maybe. I hope so. But I don’t see why that’s considered a given. How much has police work “evolved” over the decades? Firefighting? Medicine? Professionals in those fields are doing pretty much the same exact things they were doing when those professions were invented…..even in medicine, which obviously has changed DRAMATICALLY over the years due to scientific and technological improvements, I think the general nature of a nurses’  or physician’s work is pretty much the same that it always was….. Of course interventions and protocols will evolve as medicine advances and technology improves. Of course roles will naturally evolve to some degree. Better & more standardized education for paramedics would be a good thing for everyone. But I wouldn’t hold my breath or bang my head against the wall too much over “advancing and evolving”. No one even seems to know what that means, or how or even why it should happen.I guess the point of this rambling is this: every time I hear someone intelligently discuss the profession, It’s all about finding ways to dramatically change the job, or at least the compensation and recognition that comes with it. And I don’t really understand that. A doctor is a doctor. A pizza delivery guy is a pizza delivery guy. A cop is a cop. A paramedic is a paramedic. If you are one of those things and think your profession is so lacking, why not find something else to do?I just got home from a busy 12-hour shift in a noisy, hot helicopter, so I’m tired in addition to already being pretty buzzed. So please forgive me if the preceding makes little sense.

    • Ambulance_Driver

      What would I like to see EMS *evolve* to?

      Education on a par with BSN, and pay parity, except that we would have a prehospital focus to our training.
      And with *that*, field triage and treat and release and community paramedicine becomes nationally viable.
      And because we have the education and capability to make no- transport decisions, we have the means to lobby for an overhaul of the CMS fee-for-transport reimbursement model.
      And when we’re no longer locked into the system of giving expensive rides to people who don’t need it, to expensive Emergency Departments when there are more appropriate and far less expensive treatment options…
      … we can have fewer paramedics, and our smaller cadre of medics will be far better trained than our current ones…
      … and most prehospital care will be rendered in tiered response systems with EMT’s providing the bulk of the care…
      … and since they’ll be providing far more direct patient care, they’ll make better seed corn for growing new paramedics…
      …. and since we’ll have better EMT’s, we can do away with this silly and inefficient practice of medics clustered in cities with a major hospital a few minutes away in any direction, where the most effective treatment is a rapid diesel bolus…
      … and put all our EMT’s in the city to run those calls, and put our medics in the rural areas and outlying communities where ALS is more likely to be of benefit…
      … and we can replace ALS intercepts with BLS intercepts, and rotate our community medics back to the city on a regular basis to keep their skills sharp.
      And as soon as my legion of flying monkeys completes my quest for world domination, by God, we’re gonna do just that.

      • ab9302

        I agree all of those things would be nice. They would all contribute to making EMS a more rewarding profession and more attractive to motivated, professional-minded people.

        But, I just don’t see much of it happening on a large scale. Sure, you’ll have municipal systems (who have taxpayer money to burn, though that’s becoming rarer and rarer) play with such concepts here and there, but I just don’t see such sweeping changes supported by market forces, medical necessity, or even public demand. If they were, the changes would already be happening.

        I hate to say it – but I think for the most part what a paramedic is today, is what a paramedic is always going to be.

  • Geoffrey Horning

    Great points all for the most part, as far as volunteers though IMHO I’m a lot more supportive of reserves who can back fill when needed than I am of volunteers.  Though as has been said before, as long as a community also has volunteer police, volunteer engineers, volunteer road crews, electrical crews and volunteer groundskeepers as well, who am I to say that Paramedics and Firefighters should be paid? 

    Back in the old days when I was still in the military I received 2 questions more frequently than any other.  What service are you in? and what are you going to do when you get out?  Never mind the fact that I was a highly trained professional Marine who could shoot expert every time and walked around at 6% body fat, it was considered a job, not a profession.  Shamefully EMS isn’t much different.  I came in to EMS 12 years ago from the Fire side of the house  (I know, I know its not done that way).  As a firefighter the questions and comments I got were “wow you’re brave” and “are you single” and “my brother/son/husband/boyfriend wants to be a firefighter what does he have to do?”.  When I became a paramedic however, I was and am more generally asked questions such as “why not a doctor or nurse?” or “my sisters a nurse and she said you should take G-ma to the hospital” or my very favorite “hey you’re pretty smart, why didn’t you go to college?”

    The fact that I spent 9 years of my life in a structured academic setting, (tech school, college, grad school), has no bearing on my status as a paramedic or as a professional for one reason and one reason only.  WE don’t care.  In this case WE the profession have failed to define ourselves as a profession…its a job.  It always will be a job until we get our collective heads together, lock the doors and refuse to come out until we know what we are, what we do, who’s in charge and where were going.  Then we have to go one step further and spread the word.  Doc’s do, Nurses do, Police Officers do, Firefighters do, EMS? Nah…

  • Old_NFO

    Things have NOT changed since the 70’s… And my personal opinion, it’s pretty F’ing sad when garbage men make more than EMTs/Paramedics… Just sayin…

    • BH

       Actually, it’s completely predictable economics.  Lots of people want to be EMTs, and are willing to accept any amount of money- including not any- to be an EMT.  Not too many people are willing to pick up garbage.  In order to attract and retain people who are, management is forced to compensate fairly. 

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  • Fire Medic

    Great post. What I find amazing is that the turds are turds no matter the pay. All the rest of us can do is strive to be better. I’ve found that in trying to be better medic and trying to provide better service I’ve been able to swing a few of the almost turds back into caring EMTs and medics. Like you said, we’re a small in numbers, but mighty.

  • Devoted85

    Some of the comments make me think of a poem I recently read from Og Mandino…or at least a portion of the poem.

    The prizes of life are at the end of each journey, not near the beginning; and it is not given to me to know how many steps are necessary in order to reach my goal.  Failure I may still encounter at the thousandth step, yet success hides behind the next bend in the road.  Never will I know how close it lies unless I turn the corner.  Always will I take another step.  If that is to no avail I will take another, and yet another.  In truth, one step at a time is not too difficult.

    I will persist until I succeed.

    Henceforth, I will consider each day’s effort as but one blow of my blade against a mighty oak.  The first blow may cause not a tremor in the wood, nor the second, nor the third.  Each blow, of itself, may be trifling and seem of no consequence.  Yet from childish swipes the oak will eventually tumble.  So it will be with my efforts of today. 

    I will be liken to the rain drop which washes away the mountain; the ant who devours a tiger; the star which brightens the earth; the slave who builds a pyramid.  I will build my castle one brick at a time for I know that small attempts, repeated, will complete any undertaking.

    I will persist until I succeed.

    I enjoyed the post, and agree that many things must be done for us to advance the profession.  Many of the comments are valid points in and of themselves.  However, we all have to keep trying our best, everyday, despite the hardships and repeated slaps in the face by low wages and “turds” to advance our profession.  There’s no question there. 

    We can’t give up just because others don’t care to try.  It may not benefit us immediately, or in our lifetime.  But eventually, we can make a difference.

    WE must persist until WE succeed.

    • Ambulance_Driver

      Well said!

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  • Bob Sullivan

    Overheard on my ‘bolance:

    “She looks really emancipated.”

    I think the field supervisor of that BLS service meant emaciated when he said this.  I did not correct him.  That is a symptom of a much bigger problem we have, and doing so would do nothing to fix it. 

  • mastermedic

    You know, this is a great post. Every one of the comments posted I can relate to 100%. We as fantastic medics, who have risen above the Mr. Hanky status, have experienced every emotion possible in our jobs whether or would like to admit it or not. But while all the comments posted have managed to evoked emotions, productive or not, there is one that caused me to laugh out loud! Why? Because as mastermedics this is really how we feel ~ “LET’S BURN THIS MOTHERFUCKER DOWN POOKIE! WOOOOOO”. Awesome!

    • Ambulance_Driver

      He is an articulate sucker, ain’t he? ;)

  • ASG29

    So this is a little bit late but I thought I would add my two cents for what it worth.
    I think the breakdown is probably closer to 50/50 as far as people getting paid more or less than they are worth, but I also think that what percentage group we fall into changes, it can change month to month, day to day or call to call. Any one who has spent any time around EMS types has listened to the complaints of long hours spent running nonsense calls for a paltry wage and little in the way of benefits. I am also sure that most of us have had days spent on the rig that we wish we could do over, calls where we provided less than stellar care and patients we wish we would have treated better, The trick to advancing our profession is to be just as loud about our own short comings as we are about how “unfairly” we are treated.

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