It is a tough choice, to pick something worth fighting for and to stay with it. Unfortunately, I am almost at a lost of what to do from here on out. So I am going to propose my idea of what EMS 2.0 should look like. The Emergency Medical Service should be a profession that lives up to the standards of excellence that we all expect of it. There are a few things that I want to see happen in order for this to happen.
First, take the idea of “for-profit healthcare” completely out of the equation. We all (at one point or another) got into this job to help people. Our motivations for business models should be based off of smart business decisions which provide fiscal responsibility, while keeping our main motivator being clinical excellence and patient satisfaction. If you make the majority of business models “non-profit” then that will turn a lot more cash flow over to the organization as a whole for advancement in many areas such as operations, or fleet. By investing more money in gadgets, newer fleet, or bonuses to employees (not sure of the legality of bonuses with non profits) this will show to your employees that they are a valuable part of your organization instead of just a line item on the payroll budget.
Next I would like to see us get away from certifications. Relax, I am not advocating for the total deregulation of EMS. I am saying lets elevate the responsibility of the care on the employees. Lets make Paramedics, maybe even EMT’s, licensed. Licensing will allow for more personal responsibility on behalf of the provider. The National Registry of EMT’s defines these hallmarks of certification:
- Voluntary Process
- By a private organization
- for the purpose of providing the public information on those individuals who have successfully completed the certification process (usually entailing successful completion of educational and testing requirements) and demonstrated their ability to perform their profession competently.
On the contrary, the NREMT’s defines the licensing process:
“the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice. Under the licensure system, states define, by statute, the tasks and function or scope of practice of a profession and provide that these tasks may be legally performed only by those who are licensed. As such, licensure prohibits anyone from practicing the profession who is not licensed, regardless of whether or not the individual has been certified by a private organization.”
Certification and Licensure are often used interchangeably and they cannot be. For example, the American Heart Association is the private entity that certifies you in BCLS, ACLS, PALS, and so on. Whereas your State OEMS is the government agency that allows you to function as either an EMT or Paramedic. I hope this clears up the misconceptions that are out there with certification vs licensure. It did for me believe it or not.
Whats next on the list? Let’s take the idea of patient disposition out of the protocols and lets put it in the hands of the on scene Paramedic or EMT. Right now, in Massachusetts our protocols are riddled with phrases such as “transport to the closest appropriate facility,” or “follow appropriate Point of Entry protocol.” I laugh every time I read it because it seems like they feel we won’t transport to the closest hospital, or transport to a location other than what would be in the best interest of the patient.
Also, if you want us to act like professionals, pay us like professionals. While money certainly is not everything in this life, I would like to make more money than the manager at my local McDonald’s restaurant. In order for us to get more money, reimbursement from insurance agencies and medicare also need to increase. Lord knows that isn’t going to happen any time soon, but hey…A guy can dream right?
Finally, give us a future. The biggest reason that Medics, or EMT’s move onto other jobs is because of retirement options. Often times municipal departments offer some form of gaurnteed benefit retirement plan instead of some 401(k) plan offered by a private company. The other option to consider is promotional path or special team options (critical care, tactical EMS, Disaster Response, etc). Having more defined options allow for employees to feel less trapped and more secure with their career path instead of always looking for that greener grass on the other side of the fence.
This is clearly not the entire picture to solve how to bring the EMS industry into the next generation, but it is a start. Lets get it together, are you working towards the EMS 2.0?