How do you compete, and what are the next steps to ensure that you will be able to care for yourself professionally, your family financially, and your future securely?

Paramedics have struggled for years to establish themselves as professional, skilled clinicians, who deliver patient care in impossible situations and against almost insurmountable odds. We have gone from ‘load and go ambulance drivers’ to professionals that are part of the primary patient care system, but that is only the beginning. Peter O’Meara (2009) advises, “… the future development of the profession has been the progressive move from a vocationally based training system to university based undergraduate education, with Bachelor degrees as the entry-level qualification.”

Speak with any of your contemporaries and you will hear stories related to ‘going back to school’. The days of getting settled into a job and retiring at that same level 30 years later are gone. Aside from keeping current on professional practices and literature, we need to continue to grow and learn beyond mandated Continuing Education for licensure and certifications. Not taking that next step may cost you; rationalizations of why you cannot improve your education and marketability will decrease your competitive edge. Managing money, time, stress, academic challenge, and sheer exhaustion is not easy, but doable.

So what are your options?

Actually, they are almost limitless; we have more choices today than ever before. For those who wish to stay in direct patient care but come out of the uncontrolled environment of the streets, there are several options for becoming a registered nurse, including bridge programs for Paramedic to RN transition. For those whose professional exposure sparks a desire to handle crisis from a managerial perspective, there are bachelor and master’s degree programs in Emergency and Disaster Management, EMS Management, Public Safety Administration, Public Personnel Management, and Disaster Medicine Management.

Which one do you choose? Talk to your coworkers; ask if their networking includes anyone who has already completed a degree program in which you are interested for experiential insights. Perform online research to see what is required of each program, as some requirements may be far more (or less) interesting to you personally. Ask your employer about educational reimbursement; sometimes they will pay only if the program directly relates to your current job description. You also want to know about employer-paid maximum dollar amounts (and in what time period) for your educational compensation package.

Inquire about the fit of your desired degree program to your workplace or community structure. If you are debating between programs, talk to the university’s enrollment advisor (online programs have them, too), and include a conversation with the university’s financial advisor regarding student loan information if you will not receive an employer contribution. Network with local emergency management groups; they may offer personal and historical perspectives to gauge the need for the types of programs that interest you.

Your future depends on your marketability in an economic downturn. Do your homework. Find a program that suits you, and take control of your future before the economy or your lack of education makes that decision for you. This paramedic RN is completing an undergrad program (online, Bachelor of Science in Management) and will soon enter a graduate program (online, Health Psychology) which are hardly predictable degree programs, but evidence of innumerable choices. The road is far from easy, there are always challenges, but where will you be if you do nothing? I once had a coffee cup that provided daily motivation in addition to caffeine. It read, “Take charge of your life, you can do what you will with it.” And you can.

Be vigilant and be aware. Never take things for granted, and never let yourself believe that “It can’t happen to us”.

We will NEVER forget.

Are you prepared?

This is the question that NPM asks. It also asks that employers, civic groups, homeowners, agencies, webmasters, and anyone that has the ability to play a role in educating and teaching about NPM to help spread the word and to play their part in National Preparedness Month.

A simple way to find out if you are prepared is to ask yourself a few easy questions.

1. No matter where you are, do you have a soft plan of action in mind for a disaster?
2. Do you and your family have a plan in place at home? Even such things as Home Disaster Kits, and a well thought out escape route or route to safety.
3. Does your employer have a plan in place, and are you and your co-workers familiar with the plan?
4. Is your important information preserved? Think of fire safe boxes, or even backing up computer files.
5. What would happen at this instant, if a disaster should happen in your area?

Being prepared is the most crucial step in surviving a disaster. This September, let’s all take every step possible to prepare ourselves for the event of a disaster striking in our area.

What can you do?

If you would like more information on National Disaster Preparedness Month, please go to the official Ready Campaign website. Become a member of the NPM Coalition, and help to do your part in aiding FEMA in their campaign to educate everyone about NPM. Go Here to Become a Member.

Want to help by sharing some of your ideas and actions with us? Leave a comment!!

Does this story sound a bit ridiculous? It should, but the sad fact is that it is a true story. Every single day, thousands of people that do not require any type of emergency or even basic medical care use ambulances for transport. You may be asking yourself, “How do people afford to pay for these transports?” The simple answer is that in almost every instance, the “patients” carry Medicaid for payment.

Medicaid, sometimes referred to as “The Gold Card” by medical service professionals, was designed to help make sure that even those that cannot afford health insurance receive needed medical treatment. Though Medicaid is funded by a joint effort between state and federal programs, the costs are ultimately placed upon taxpayers.

What is a paramedic?

Paramedics are among the most highly tried emergency medical professionals, outside of a hospital. Their training is centered on providing treatment to critically ill and injured patients. Due to the amount of time and effort required to complete the paramedic program, they are also some of the most sought after emergency professionals. Most cities employ only a small number of paramedics in comparison to other levels of responders. In most cases, especially in small to medium sized cities, there will only be one paramedic on duty that is responsible for providing coverage to their contracted area.

The training required to become a paramedic is rigorous. Aside from classroom hours, paramedics are also required to volunteer long working hours at hospitals and on ambulances under the guidance of mentors or preceptors. Their training allows them to utilize advanced airway systems, provide cardiac monitoring, applying various pharmaceutical treatments, and performing advanced trauma care. They are masters at treating patients in any type of emergency situation, and are often called upon, even by skilled doctors, to use their skills to start difficult IVs or obtain compromised airways. Many medical professionals, such as nurses and doctors, will freely admit their admiration for a paramedic’s ability to perform such techniques in the back of a moving ambulance with such precision.

Although there are a great many “career” paramedics, many others are using their experience as a paramedic to help propel and guide them into advanced emergency and medical careers. Some go on to become doctors, while others move on to advanced careers in Emergency Management. Paramedics often proceed to become nurses, utilizing a paramedic to rn program.

So why do people so often use a paramedic ambulance as a taxi for non-emergent transports?

There is no simple answer as to why so many paramedic ambulances are used on non-emergent, or convalescent transports. If you ask a paramedic, he will probably tell you there are a few reasons.

• Often times, the person requesting the transport cannot afford to drive themselves, or may not own their own transportation. It simply becomes too easy for them to pick up a telephone and schedule the ride.
• Many ambulance providers see these types of transports as “guaranteed money.” Since Medicaid is funding the transport, the provider is guaranteed payment. That means the provider will rarely have to worry about using the legal system to obtain payment.
• The system Medicaid has in place, allows providers to simply complete the needed paperwork, and then file the payment request online. Most times, this means that the request for payment and processing is made on the same day as the transport. Quite simply, it is fast, easy, and guaranteed money.
• Many times, the people abusing the Medicaid system lack the sort of responsible decision making skills that prevent others from doing the same.
• Medicaid continues to allow this type of abuse. Since it is considered a covered expense, many are more than willing to take full advantage of it.

The scenario described earlier in this article is not the only one of its kind. Each day, paramedics are called for emergency responses only to find patients openly abusing the system. While talking with Jerry, the paramedic noted at the beginning of this article, he began to tell me of other instances.

Jerry recalled a response recently where he was called out during the middle of the night for an unconscious male patient lying on a sidewalk. Upon arrival, jerry noted that the patient was a “frequent flyer”, a patient who calls often and sometimes daily for creative reasons. On this occasion, Jerry noted that his patient first complained of chest pain. After providing basic treatment, the patient refused more advanced care. Jerry loaded the patient in the ambulance and proceeded to transport him to the hospital.

After arriving at the hospital and turning the patient over to hospital staff, Jerry began to complete his documentation. Shortly after starting his documentation he noticed the patient was no longer in his hospital room. Upon inquiring with hospital staff, jerry found out that the patient had signed himself out of the hospital without any medical treatment given. It was then Jerry realized that the patient had a new address, and was now living across the street from the hospital. Jerry could only surmise that the patient had simply used the ambulance as a means of transporting him across town, so he could be closer to his home. Since then, the patient has made many more calls for similar reasons. All of the calls end in a similar fashion. It is now obvious to Jerry and his co-workers that this patient uses the ambulance service, and Medicaid, as a means to gain transport from one side of town to the other.

Why is this abuse of Medicaid allowed to continue?

Medicaid abuse occurs because current laws protect those who abuse it. Using the patient above that uses Jerry’s ambulance as a means of getting across town, let’s imagine this scenario. Suppose this same patient would call for an actual emergency. Is it really feasible to allow the paramedics to refuse treatment or transport? The scenario brings forth a sort of “Boy who cried wolf” situation. If the paramedic refused transport, the patient could suffer dire consequences and possibly even die as a result. This is just too much of a liability and no paramedic or ambulance provider is willing to take that risk.

Patients willing to abuse Medicaid also have rights that protect them from being refused. Currently, it is unlawful for a patient complaining of an emergency symptom to be denied medical care. According to Medicaid, ambulance transport is included into the scope of “medical care.” And, since Medicaid providers are required to perform all medical interventions covered by Medicaid, they risk losing the ability to charge for Medicaid covered services.

How can we stop the blatant abuse of our Medicaid system?

The current economy in the U.S. dictates that we must find ways of improving our government expenditures. Finding ways to curb government spending, thus putting money back into the pockets of Americans, is the only way to recover from the current financial situation. If we want to ensure the financial security of our great nation, we must find ways to stop frugal spending and outright abuse that has caused so many problems.

Some possible ways of eliminating or reducing Medicaid abuse and fraud are:

• One of the first things that could be used to stop Medicaid abuse is a comprehensive audit system. Although there is currently a system in place to perform audits on Medicaid spending, the system is obviously failing.
• Create a closer working relationship between Medicaid, and providers of Medicaid services. There is no doubt that online filing and billing systems have streamlined procedures between providers and Medicaid, but they have also lessened the contact between the two. With such a robotic system in place, contact between them has been diminished.
• Stop the current “blanket” coverage that Medicaid currently has in place. By forcing all treatments to first be audited, before being approved for payment, fewer people would be willing to risk having to pay the bill themselves.
• Enforce consequences to those found to abuse Medicaid. The more people realize the consequences, the greater the chance they will resign themselves from abusing the system.
• Create a county level Medicaid audit system that can interact with providers. Leaving all of this to a system that is often hundreds of miles away from a provider causes problems.

As long as there are people and options, such as Jerry and Medicaid, there will always be those who try and abuse them. As time goes on, people become smarter and more effective in their endeavors to cheat and abuse the systems that are in place. Only by due diligence and persistent measures can we hope to combat these types of abuses. We have a responsibility to our children’s future to help create a secure and stable financial system for them. We must constantly adapt to needed changes, and stay educated in the means it takes to prevent things like Medicaid abuse.

As for Jerry, he says that he plans to retire as a paramedic. Doctors, nurses, and paramedics alike, have all voiced their concerns with the healthcare system in the United States. But, despite his frustrations with a broken health care system in the U.S., Jerry claims that he still truly loves his job. He says that the personal satisfaction he gains from helping those that need him will always outweigh any political and social problems that medical professionals face each day.

Share your thoughts on Medicaid abuse.

The food was nothing short of spectacular, and the shopping in the area was designed to bring out the child in any adult. I had my first Po’ boy sandwich on that trip and I also was tempted to try the popular crawfish cuisines, but the Indiana country boy in me said “no”.

My second time in New Orleans was three years ago. Having been less than just two years after the hurricane, the results of the devastation were still very evident. There was still mud left over from the flood waters. Condemned buildings, still waiting on insurance claim settlements, were still standing all over the city and surrounding areas. A few businesses were open and seemed to be thriving, but many were closed up. Even if you had never heard of Katrina, you could not help but know that something disastrous had recently happened.

I remember my wife noting that there appeared to be an extremely high amount of homeless people in the city. Poverty seemed to be the norm, rather than the exception. The streets were home to countless construction and demolition vehicles, and the semi-trucks were making continuous trips in with building supplies.

In the aftermath of the storm, many people moved away from New Orleans. Much of the normal housing and commerce revenue had been lost with this outflow of population, and the city struggled to rebuild its economy. My wife and I had discussions over the rebuilding process. We wondered how they would ever make a complete reform. To us, it seemed unrealistic for the area to make a full comeback. I mean, why anyone would move back there after such devastation is something that confused me. Why rebuild a home in an area that could very easily be destroyed during any upcoming hurricane season.

A City Returning to Normal

Earlier this summer my wife and I, along with my parents, made a trip down to Slidell and the New Orleans area. We were scoping out possible campgrounds that we could use as a destination for an upcoming trip in our RV. While in route, it dawned on me that the question I had pondered only a couple of years before, could be asked of me now. “Why go there, if the area is in ruin and a storm could pass through with such destruction?” It was then that I had an answer for my own questions.

New Orleans is a place of festivity. It is a place of a carnival atmosphere, and a place to celebrate any time of year. It is a place that even the residents enjoy life and giving up just because of a little ole’ storm is certainly something that does not fit the profile.

As we drove through New Orleans on this trip, I was stunned by what I saw. It was the same city I had remembered from my trip 8 years earlier. As we drove down Bourbon Street, we could listen to the jumble of music coming from numerous Blues bars on the street. Small shops had their doors wide open and awaiting new customers. Novelty shops selling beads, and even traditional voodoo items were open and seemed to be doing quite well.

As we drove through the city, the smells of the local restaurants came through our car windows to entice us to come inside for lunch. We stopped at a local favorite for some soft-shell crab, and I got to introduce my father to a Po’boy. My wife and my mother made us stop for Beignets to take back to the hotel with us. Well, maybe they did not have to “make” us stop. After all, you really can’t go to New Orleans without having one.

Home is Definitely Where Your Heart Is

Leaving New Orleans made me realize something. People have been fighting and giving up their lives to protect their “home” since the beginning of time. Home is something that is as near and dear to us as our own family. There isn’t a person alive that does not have a strong connection to the place they call “home.”

Experts had been making predictions of the results from a direct hit by a hurricane in New Orleans for years. The devastation and loss of life that occurred was no surprise. A coastal city that is built below sea level could not expect any other outcome. Yet, those that call New Orleans home stayed. Those same people are still there, and have rebuilt their home. New Orleans is now back to its old self, and still serves as home to some of the most resilient people in America.

As I was leaving New Orleans on this last trip there, I could see the city in my rear view mirror. I could see the skyline, the traffic, and the businesses that people love. Although I was heading back to my own home in Indiana, I knew I would return to New Orleans again someday.

After all that has happened, New Orleans is now something more than just a place to visit. Just as Ground Zero in New York City, New Orleans is a symbol for Americans. It is a symbol of the same things our fore fathers fought for years ago. It represents “home”, and nothing will ever force an American to give up their home.

On this fifth anniversary of hurricane Katrina, Americans should stop to remember what we stand for: Freedom, Liberty, and the right to allow our hearts to determine our home.

When your husband needed chemo three times a week, I was the one that took care of him during the four hour trips.

I am more than just an ambulance driver

When your 13 your old son decided to drive his four wheeler into a barbed wire fence, I was the one that came to his aid and kept him alive until he reached a hospital.

When you were chasing a fugitive for two hours through the country, I was the one that was following you, and then saved your life after being shot and crashing your cruiser.

I am more than just an ambulance driver

When your 16 year old son crashed his car on the interstate, I was the one that was immediately there to stop his bleeding and keep him from dying.

When your wife developed a blood clot in her lungs, I was the one that began to breathe for her. I was the one that helped to give you and her a longer future together.

I am more than just an ambulance driver

When your 15 year old daughter decided to give birth to her breech baby in her bedroom, I was the one that came and finished the delivery and saved your grandchild from suffocating before it could have a chance to live.

When your father decided to stab your mother, I was the one that was there to keep her alive. I was the one that got her to the hospital in time to have emergency surgery done.

I am not just an ambulance driver

When your wife and her friends were struck by a semi truck, I was the one that tried to save them, and I am the one that still wonders if I could have done something different to save them all.

When you decided to drive drunk and flipped your Volkswagen: I was the one that was there, holding your four year old daughters hand until the fire department could lift the car off of her chest. I was the one that she last asked for help, and I was the one that saw her take her last breath.

I am not just an ambulance driver

When you are sick, or injured, or even just frightened, I will be the one to come to your aid. To comfort you, to treat your injuries, and to do everything in my ability to save your life.

When you are old and lonely, and just want a friendly face to talk to in the middle of the night, I will be the one that will come to reassure you. I will be the one that will hold your hand and tell you that everything is alright.

When your loved ones leave the house, I will be the one that is ready to respond at a moment’s notice. I will be the one willing to drop anything I am doing, and come to your aid. I will be the one to risk my own life, so that you or your loved one can live to see another day.

I am much more than just an ambulance driver. I am an EMT.

Let’s start of by acknowledging that inner child in all of us that wanted to be a policeman or fireman when we were little. That is exactly what the Kids Firefighter blog is. It is a blog by a child that absolutely loves everything having to do with fire service or firemen.

I really liked this blog from the first time I visited, and have gone back many times to see what 5 year old Mathew was up to. Now obviously Mathew gets help writing his blog, but hey, the thought is there and I think that a blog for kids is an awesome idea.

Examples of some things written in Mathew’s blog are a Donald Duck Fireman Video, which really is fun to watch as an adult too, and Fire truck pictures. The Kid’s Fire Fighter blog even takes the time to publish reminders of upcoming events and fire recognitions. As a parent, I really respect the parent/s of this young blogger, and I wish more families would be this involved in what their kids do and view on the net. Kudos!

Up next, we get a bit more serious with The Average Jake Firefighter blog. Though this blog is not a very “old” blog, I like to read the updates because the writer incorporates a lot of fire fighting and training tips. He also adds in a few fire fighting related product reviews and even a few personal opinions. As long as this blogger can keep finding things to post about, I believe he will be a great resource and interesting read.

And now, we get into a bit more “hard core” fire fighting blogs. The Kitchen Table takes business serious, and it is one of those blogs that you could lose a lot of time in and before you know it, you have been there for hours. Put together by several writers, this blog has pretty much everything you could want. From tactical information, to standards and regulations, to articles of inspiration, I think anyone interested in fire service would like this blog.

Anyone that reads the blog here at publicsafetydegrees.com, should also know how much I appreciate good stories and accounts of real life incidents. In fact, I think I would have to say that personal blogs are my favorite, especially if I can read and identify with the story being told. So, blogs like Into the Fire are definitely blogs I frequent a lot. Although there are posts extending back a few years, I actually wish there were more. There are stories about electrical fires and even a post about a fellow firefighter death. Blogs like this actually inspire me to keep on writing my own stories.

I saved my favorite for last. The Fire Critic is my favorite fire related blog, and I know I am not alone in this thinking. The Fire Critic’s blog is way too in-depth for me to just single out a couple of posts, and say, this is what the blog is about. The blog covers everything, and I really mean everything. However, a couple posts that ring out in my mind are a topic about tunnel vision, which we can all associate with. The top ten lists, featuring this firefighter dance video, and some very personal topics covering fallen fire fighters, memorials, and even discussions about aging, in the Line of Duty category. The Fire Critic is a “must read” for anyone seriously interested in fire/ems, and I highly recommend it.

So, those are some of my favorites. I could only hope to put out the quality of content that many of you do. I do try, but I must also give recognition to those that inspire me, such as the ones I have mentioned here. Keep up the good work fellas!

For the next year I volunteered my time. On almost every shift I volunteered, I was placed on a truck with just myself and a tech. I loved it, and learned the ropes of EMS along the way. It did not take long to realize what I wanted to do for the rest of my life, and I enrolled in the first EMT course I could find.

Becoming an EMT

In late 1990, I completed my EMT-Basic course. Although I did not immediately get hired into the department I had been volunteering at, I had no problems finding work at other departments. It seemed that almost every EMS department around was in dire need of EMTs, and having any kind of experience was something that none of them cared about. I took a full time position and without any type of “warming up” period, I was now beginning my new career.

The new service I was working for was much like the previous. I had a certification, and that was enough. Despite my lack of experience as an EMT, my partners often had even less. While no issues ever came up, I knew even then that something in the system was flawed.

Becoming a Paramedic

Just 1 year after becoming an EMT, I began to look for any Paramedic programs that had openings. In 1992, I was accepted, and by mid 1993, I was a full-fledged Paramedic that was ready to jump into my new position.

I was immediately hired back on to the county 911 service I had originally volunteered at. The training process was little more than riding a few hours with an experienced Paramedic to prove I was capable of handling things on my own. In fact, I had only ridden a total of 24 hours, when an emergency came in while we were short staffed. I was immediately cleared to function on my own, and was now cleared for “solo” duty.

I spent many of my adult years working as a Paramedic. Along the way, I met some really brilliant Paramedics and EMTs. However, I also met many more than I knew really had no business working on their own. The problem is that guidelines must be followed, and until someone makes a serious mistake, there really is not anything that can be done.

A mistake: What does that mean when dealing with the lives of patients?

Why I feel modern EMS is broken

I retired from EMS in 2006. I have to say that I truly loved the career, and to this day, I am still pro-active in supporting EMS. However, I do believe that changes need to be made, as NOTHING seems to have changed since I first started driving ambulances in 1989. Here are some examples of my views and opinions.

1. Training processes at all levels of EMS need some serious reconsideration: Every instructor I ever had or met was brilliant. The problem with EMS training lies in the requirements for completion, and even more, the requirements of various providers on releasing EMTs and Paramedics onto the streets. At every stage in the process, there are entirely too many people that have the ability to make subjective decisions on whether or not an EMT or Paramedic is capable of being released to work on their own. It leaves too much room for error, and even worse, it leaves too much of a margin of error. It also leaves too much leniency for liability.What needs done: Training requirements need to be more standardized. A person should NEVER be released to perform patient care without being fully trained and proven to be able to provide it in a more prudent manner.
2. Liability: If a cleared Paramedic is right out of school and is working the streets, then who is liable for his/her actions? During my career, I never met, or heard of, a Paramedic carrying liability insurance. It was just assumed that we would either never be held liable, or the service we worked for carried it for us. This is not the case. In fact there are some gray areas in laws that are taken advantage of when it comes to liability. Sure, the service we worked for carried liability insurance, but only to protect them. Had I ever made a serious mistake, I would have been held liable for my actions without having any type of malpractice insurance coverage to protect me. There is no requirement for it, and there should be.What needs done: There needs to be clarity on liability of EMS professionals. There should not be any gray area around this topic. We live in a world that includes people who are willing to sue, just to try and get rich. With the current situation, a frivolous lawsuit upon a Paramedic or EMT would not make anyone rich, but would perhaps ruin the career and financial security of a great person.
3. There was a time when I thought I might like to work in another state. Surprised to find out that the state I wanted to work in required licensure for their Paramedics. This meant that my current Paramedic certification was nearly useless, if I wanted to move. The reciprocity procedure would have required me to pay some money, take some tests, and then take an additional course to become “updated.” Huh? I thought I had already taken all the tests needed to be a Paramedic. Am I to believe that a sick person in Tennessee gets different treatments than a sick person in Indiana?What needs done: training of all EMTs and Paramedics in the nation needs to be more standardized. It also needs to be governed by a single body that outlines proper procedures. This is something that is detrimental to patient care, and should be a top priority in insuring that ALL EMS professionals are trained in the same patient care techniques and receive the same updates, across the country.
4. There is a National Registry of Emergency Medical Technicians, but why? If you ask them who they are, they will absolutely deny that they set any kind of standards or regulations. All they will claim to be is a group that does testing. Many states require a NREMT certification to become certified in their state, but yet they do not require you to keep the NREMT cert updated. In the state I worked in, I carried 2 certifications: One for the state, and one for the NREMT. After I was tired of paying the $45 re-certification fee to the NREMT, I stopped re-certifying it. There was no need. It was not a requirement to maintain in my state, and it did not really help in reciprocity to another state, so why even bother with it? Also, a Paramedic or EMT can let their cert expire for many years, yet only be required to take a very short refresher course to become certified again. There is no way that a person can retain enough information after such a long downtime that a ‘refresher’ course can get them back up to speed.What needs done: I feel that the current situation regarding the National Registry is a joke. There really is no other way for me to say it. I do not think we need an entity like the NREMT to “just do testing”. I think what we need is someone like the NREMT to handle teaching, testing, and governing, all done by one single entity. For lack of better words, EMS needs to have fewer “hoops” to jump, so that the focus can be primarily on training, and not on legalities.
5. While talking to a Paramedic from another state, I was shocked to find out that Paramedics in their state were not allowed to intubate. What? Isn’t intubation a staple in the Paramedic’s lifesaving care that is the top priority of all Paramedics? After all, the first thing they teach you is the ABC’s: airway, breathing, and circulation. Intubation is often required to maintain a clear airway. Why is it that some states allow Paramedics to do some skills they have been trained to do, while other states do not? Should a paramedic be a Paramedic, regardless of where they are?What needs done: Treatment of patients by EMTs and Paramedics across the country should only change when it is necessary for environment or region. In other words, providing oxygen to a patient in Alabama is no different to providing it to a patient in Missouri, so why do the treatments vary so much?
6. Documentation is extremely flawed. While chatting with a Paramedic from another department, after a mutual aid run, I was shocked to see that their paperwork was a mere 3 forms to fill out. The service I worked for had a whole bundle of paperwork that needed completed after each run. Why is it that requirements for details and patient information are different, depending on the service and location? Also, it is my belief that documentation protocols are directly related to how easy we can make it on the billing secretary of the provider. The most time consuming part of paperwork is done for billing purposes, and has nothing to do with the transfer of important patient information between health care professionals.What needs done: Paperwork and documentation procedures need to be the same across all EMS platforms. One service should not be required to gather different information than another. Too many times, we see that a volunteer service that does not bill patients are required to only document patient care, yet other services spend thousands of dollars a year on documents that help billing purposes.
7. Protocols are something that are created in tandem between the sponsoring hospital and the service provider. However, protocols vary widely between one service and another. This is wrong, and we have known it for years. Obviously certain treatment protocols are bound to vary a little, depending on the treatment guidelines of each hospital, but why are Paramedics in some services given the “go ahead” for multi-dose Epinephrine, while others are required to use bare minimums. Why do some services promote the “stay and play” philosophy, while others emphasize “load and go”?What needs done: the way protocols are currently in place, leaves too much variance between providers. When involved in a mutual aid run, there should not EVER be a reason for the two departments to argue “My protocols say we get to sit on the scene and stabilize the patient”, while the other states “our protocols say we have to load the patient and get them to the hospital quickly”. The idea of scene time is only the beginning of the arguments on why protocol procedures need changed, but in my opinion, it is a good start.
8. Supporting certifications are additional certifications that can be obtained by EMTs and Paramedics. Examples are, ACLS, BTLS, PhTLS, PALS, etc… Not all services require the same supporting certifications. In fact, many only require their state’s minimum. In the state I worked, the only supporting cert. we were required to carry were CPR and ACLS. However, many other providers required a whole different set.What needs done: All EMS providers should require the same set of supporting certifications among EMTs and Paramedics. The only variance on this would be to suit environmental or regional needs. An example would be that if a Paramedic is working for a pediatric hospital, then PALS would be required. However, in my opinion, there is no reason why the basic supporting certifications should not already be included in a Paramedic program, and re-certified automatically by completing re-certification for your Paramedic cert. Examples of the basic supporting certifications would be: CPR, ACLS, and PALS. Having all of the current supporting certifying bodies does nothing but offer a means for those governing bodies to make money from courses and re-certification processes. A Paramedic should know how to perform CPR, and it should be the most basic requirement for Paramedic certification each year. We do not need the American Heart Association or the American Red Cross to be separate certification options. Pick one as the standard for a Paramedic cert. include it in the EMT or Paramedic program, and include the re-certification in the annual or bi-annual re-certification or licensure for the Paramedic, not a separate cert.
9. If you really stop to think about it, the job of a Paramedic is really a “dead-end” job. Because of the extreme differences between states in requirements, there is no real way for a Paramedic to insure his/her future in medicine. Some states require certification, others require licensure. Some states require NREMT certification, while others do not. Some providers are beginning to require college level education, while other never will. All this does if blur the lines of whether or not an EMT or Paramedic is a legitimate profession, and offers no real means for a Paramedic to advance. Because of this, pay rates for EMS are nearly frozen in time, as providers know that there are so few choices.What needs done: Currently, the only viable options for EMTs and Paramedics are: Using their experience to get one of the few jobs at a fire department, which may offer more alternatives in the future. Taking advantage of the few actual college programs, such as the EMT to EMS Management or the Paramedic to RN. EMS training needs revamped to give EMS professionals a long standing future. The current design, for lack of better words, is designed for young people that can afford to spend some time in EMS before moving on to a new career which would provide for a family. Training needs to be designed so that it provides a means for EMS professionals to advance.
10. Lastly, let’s discuss patient care. Patient care is the single most important factor in why we are even on the streets. Why is it that there has never been a standard in how QA is performed among providers? QA/A&R is an integral part in ensuring that proper patient care is always being performed. It COULD be a way that EMTs and Paramedics learn from medical directors and peers. Instead, in many providers, it is simply a way that other EMTs and Paramedics can subjectively pick apart another’s patient care or documentation. Rarely do Paramedics and EMTs get “Official” treatments that are new. In other words, I cannot recall a single time in my career where my certifying body contacted all Paramedics to say “We have discovered something new that all EMTs and Paramedics need to learn.” Instead, once you receive a certification, the knowledge you gain from then on is left up to you and your sponsoring hospital. This makes it difficult to stay up to date on new patient care techniques, and to maintain the ability to provide the very best care to our patients.What needs to be done: QA/A&R should be a requirement across all providers, and not just an option. It should also be redeveloped into a standard format that is provided as a learning tool, and not as a tool that can be used as a contest between EMS crews. I once overheard the crew from one shift bragging about how only 2 of their run reports had been pulled for A&R; while the crew from another shift had 4 of theirs pulled. This is a detriment to patient care, and it only serves to either boost the egos of some or derail the confidence of others.

The rest of the story

In 2006, I not only retired from EMS, but I also allowed my certification to expire. I have since remained active in the EMS community. I love the career I had. In fact, I would say that I am extremely passionate about it. I loved every aspect of it, including the people I worked with, the patients I had the pleasure of meeting, and even the training I had to undergo. However, it saddens me to see that nothing really changes. Many brilliant people fought so hard to carry EMS from the 1960s to what it is today, yet nothing has really changed in the past 20 years. Sure, new equipment, new trucks, better radios, better ways to diagnose (oops, did I just use the “D” word while talking about EMS?), but has anything really changed?

I will forever be happy that I had the opportunity to be involved in such a remarkable career. It taught me things about myself, and about “the ways of the world” that many people live sheltered from. I had the opportunity to be part of a “brotherhood” that will forever remain in my heart. I love what I was able to do for patients, and how I may have affected the lives of countless people in the world. But most of all, I like knowing that I may have saved the life of someone who may someday save the life of another.

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Have some given up fighting illegal immigration?

These days, it is difficult for the average American to understand just what constitutes being an “illegal alien”. In fact, there are states in the U.S. that even grant a driver’s license to undocumented individuals. In 2003 California Governor Gray Davis even signed a bill that would have given these individuals the “RIGHT” to obtain a drivers license, and auto insurance. Arguments in favor of this bill claim that it would make our streets and roads safer by having more licensed and insured drivers. Those against argued the obvious. Why give someone a driver’s license if they are not supposed to be here to begin with?

It seems to me that by giving a driver’s license to those individuals in the U.S. illegally, it is more like saying “Since we cannot enforce the laws, let’s just try and make them safe drivers.” Isn’t that the same as just giving up? Have we really gotten to a point that our laws have gotten so complicated that they cannot be enforced, and the only reasonable thing left to do is to co-exist instead of enforcing the laws that were designed to prevent this? Obviously, the fight against illegal immigration is about a great deal more than just driver’s licenses, but it is just one example of how skewed many laws have become in fighting it.

Why should we be so stern on border security?

For years, we have been fighting against terrorism. Long before the attacks on 9-11-01, we were dealing with terrorist attacks in our homeland. In fact, the World Trade Center has been the focus of terrorist attacks in the past. The reason for these attacks has never been over oil, money, religion, or even land. The reason is because of hatred by others over our freedom. The very freedom we cherish most about our country. Stronger border security may have easily prevented many of the attacks within the U.S., but the flaws in our system continue to allow this to be a very real possibility. The irony of the 9-11-01 attacks on the World trade center is that our own flawed immigration system allowed these terrorist to live in our country. We even trained them how to fly the very planes they used in the attacks!

Each and every day, our country’s law enforcement agents fight crime and risk their lives to protect citizens. In fact, crime has seen a significant decline in almost every area, except illegal drug sales, possession, and usage. Some may argue that drug use would exist no matter where it came from, and they would probably be correct. However, our country’s law makers should be ashamed of the fact that the vast majority of illegal drugs bought and sold in the U.S. came across the borders we should be protecting. I find that it is an absolute travesty that while encouraging our law enforcement officers to risk their lives on a daily basis to find and arrest those involved in illegal drug trade that we put so little emphasis on preventing it from coming across the border in the first place.

Recently, the President of the United States allowed 3000 American troops to be placed along our southern border. Let’s put this into prospective. The city of New York employs over 34,000 police officers. The city of Phoenix, Arizona employs more than 3500 officers. I think it tells a bit about how much emphasis our government has placed upon border security, and stopping illegal drugs from entering the country.

Some of the latest jobless rates estimate that nearly ten percent of Americans are unemployed. Obviously recent financial problems within the structure of U.S. corporate have a great deal to do with those numbers, but there is also another large contributing problem. According to the Center for Immigration Studies (CIS), more than 35 percent of America’s farming and custodial building maintenance industry is made up of illegal immigrants. Also, almost thirty percent of America’s construction workers are in the country illegally. We have to ask: If almost ten percent of our nation is unemployed, why are we continuing to allow large numbers in some of our core workforce areas to be consumed by people that are not even suppose to be in the country?

Some will argue that the employers of these people should be held accountable, and they would be correct to argue that point, to a degree. However, we also have to realize that it is because of our flawed immigration laws that it is allowed. In some states, it is completely legal for illegal aliens to be employed! It seems like a sort of paradox that we claim that they are here illegally, but it is illegal for us to prevent them from taking American jobs. Recently, the town of Fremont, Nebraska passed a law to prevent the hiring of illegal immigrants by businesses and the renting of housing to them by landlords. Would you believe that Nebraska is now coming under fire and the law is being contested by such people as the Civil Liberties Union? It seems that by stopping illegal immigrants from illegally prospering, we are somehow violating their civil rights. I do not claim to be a genius by any means, but doesn’t the Bill of Rights grant those rights to legal citizens of the U.S., or is this yet another part of the law that is now so far blurred that we can no longer enforce it? It raises the question: If you are not a legal citizen of the U.S., are you still protected by the same Bill of Rights written by Americans, for Americans?

How do we stop this madness?

Recently, the state of Arizona took a huge stance on illegal immigration. I will not agree or disagree with SB 1070, but I will say that I applaud the state for at least putting up a fight. I do think that it is the responsibility of the Federal government to create and enforce these types of laws, but the fact that they have not, leaves little else for a state like Arizona to do, except fight it themselves. I feel that at some point, the U.S. has to take a strong stance and put a stop to all of this. The fact that the country is being terrorized, jobs are being taken, and legal citizens of the country are paying the high price is nothing less than an outrage.

America needs to be tougher on illegal immigration. Obviously, we cannot stop all illegal aliens from entering the country. That would require a soldier at every square inch of the entire U.S. border. But, what we can do is make it simply not worth it for people to try and live and prosper in our country. We can do this by putting a stop to the laws that protect them from being rejected for employment, housing, and anything gainful, until they have provided legal documentation that permits them to live and work here. Do we give them a driver’s license to help keep our roads safe? NO! What we should be doing is arresting them at the DMV when they try! When a person is pulled over or arrested on our streets, they should be required that they provide documentation of U.S. citizenship.

One major reason for the rejection of the SB 1070 law of Arizona is the fear of racial profiling. I do agree that this law would be very difficult to enforce, without a certain degree of profiling, and to deny it we would just be kidding ourselves. However, there is a way to enforce such a law that is not bordering on discrimination. Force every American to always carry ID that proves their legal status. It could be a driver’s license, or even a simple ID card. Now, some will argue that an ID such as this can be easily forged. I say that notion is crazy, and with the technology we have in the U.S. today, it can be done.

Ever notice the black strip on the back of new driver’s licenses that is similar to that of a credit card? Why is that not being used by law enforcement? I was recently pulled over on an interstate for speeding, and yes I was guilty and I paid the price. But, while I was sitting there, the officer simply ran my driver license number, but never scanned the card. Perhaps he did not have the technology to scan it, but that is not the point. If an officer had this technology, and was require to use it with every single interaction, it could be used to detect whether or not a subject was a legal U.S. citizen. It would be a tool that could make a huge difference in the number of people that are undocumented and illegal in the country.

Protect our liberty

The U.S. was founded on a basis of liberty and the right to prosperity. It is this notion that attracts illegal immigrants to live in our country, and the same notion that attracts terrorist to try to destroy our country. It is not only our right to protect our freedom, but it is also our responsibility. We have a responsibility to help preserve this great nation for our children and grandchildren.

The United States of America began as immigrants, and will forever be “A country of immigrants”. However, it has to be a country of legal immigrants, and one that does not give asylum to those who wish to do harm to it. We have to find a way to enforce strict immigration standards, while continuing to grant freedom and liberty to those who live here as legal citizens.

It is the duty of our Federal government to provide the means for Americans to protect what is sacred in our lives. Laws preventing illegal immigration need to be solid, and not the transparent laws that allow them to be left to a matter of interpretation. Tying the hands of our law enforcement, yet asking them to die in the line of duty protecting our borders is simply unfair and unjust.

I firmly believe that the party lines of our country’s law makers take a front seat when it comes to creating and enforcing laws on immigration. We elect our politicians on the basis of ideas and beliefs, and by what our country needs, yet it seems that when the time comes, it is a party line that makes the deciding vote. Democracy is a wonderful thing, but when abused by the strict division of parties in the face of what is actually good for the nation, democracy will fail.

It’s my right to write

I am but an average person in the U.S. I am not a politician, nor a scholar, but I am one thing for certain: I am an American. By being an American, I have the right to express my opinion and I have the right to protect my liberty and freedom. I do not have the right to break the law, and I do not have the right to impose on the rights of another American. Because I am an American, I have the right to say this: If you want to live, raise a family and prosper in this country, become an American or get the hell out!

By James C.

“I went to nursing school due to my desire to move forward and be more productive with my knowledge and skills. I love being a medic, but I also enjoy both ends of the spectrum. Both positions keep me sharper in regards to the other; they are a good mixture for me.”

John chose a bridge program from paramedic to ADN through a local campus, but for his BSN, John is going to school online. Having weighed all of his options against a grueling schedule, John found the convenience of online education too perfect to pass up.

“Online courses have allowed me to continue my education. With the combination of my busy life and lack of time or ability to attend the brick and mortar (conventional) setting, my education would have been stalled.”

Andy Wiegand is another firefighter-paramedic, 31 years young, and considering nursing school. Andy was my paramedic student protégé nine years ago in a Detroit Trauma Center. I shared my best tips and secrets, and Andy’s older sister Tracy, a RN in the same ER, reinforced the value of education. Andy wants to expand his knowledge base and proficiency, but is also concerned about two things we all ponder at one point or another: more money, and better job security. The median nursing salary last year was $62, 450.

“There are budget cuts happening in the township where I work. They are laying-off nine people. I’m not one of the nine, but if they lay off more, I could be in line to be cut.”

Paul Sorrell, a paramedic for 25 years, is preparing for a medic to RN transition program. Working several years for a private ambulance company in Southfield, Michigan, Paul completed 2.5 years of a traditional nursing program 20 years ago before leaving due to professional conflict.

“The clinical coordinator was a lady who felt that men did not have a place in society as nurses, and I was getting sub-par evaluations on clinical rotations. I would do the exact same stuff as other students, the same way, and get much poorer marks.”

A man in emergency medicine does not translate exclusively to either paramedic or doctor anymore; more men these days are nurses. These changes have encouraged those who have served many years as paramedics, like Paul, to continue to do what they love in a related branch of medicine.

“I want to get into an ER and get back to some real patient care, and Online courses have allowed me to continue my education…with the combination of my busy life and lack of ability/time to attend the brick/mortar setting my education would have been stallethen complete my BE (bachelor’s in education).”

Being an educator has been part of Paul’s life for almost as many years as he has been a medic. As we spoke, Paul was conducting a paramedic refresher course. The dual-licensure of paramedic and RN opens up a world of opportunities for educators with a strong background in emergency medicine.

There is a growing trend for paramedics to expand their knowledge and level of licensure. When I completed that path 15 years ago, paramedics whispered among themselves about going to nursing school. Now more paramedics view nursing as a logical next step.

“We have had two other FF go to nursing school after me; seems as though a trend is emerging. Though the online transition from paramedic to RN can certainly present challenges, the rewards of furthering your education can only benefit you as a professional, and those you care for and serve.”

There is never a convenient time to fit school into one’s schedule. Nobody knows what tomorrow may bring, so working toward a better future, and becoming more marketable while enhancing skills and professionalism now as opposed to later, is imperative.

John’s last words to me prove my point. Ending the interview, John said, “Gotta go: CPR in progress.”