Occupy EMS

It is not the fault of a generation, or a system, an economy or a government that we do not get the compensation we feel is warranted


Tracey Loscar is a featured speaker at the 2012 EMS World Expo, scheduled for October 29–November 2 in New Orleans, LA. For more information, visit EMSWorldExpo.com.

“Remember upon the conduct of each depends the fate of all.”

—Alexander the Great

On April 23 of this year, popular EMS author Kelly Grayson posted this on his blog:

Your Homework Assignment for the Day:

“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.”

—Kelly Grayson

If you happen to agree with the statement, tell us what we as a profession should do about the 75%. If you disagree, tell us why.

This referenced a quote Grayson had made in a social media thread discussing why EMS is so underpaid as a profession. Like many of those who read it, it gave me significant food for thought. Though you do not want to come out and say the percentage is that skewed, in all reality and based on personal experience, that statistic is probably dead-on when you look at prehospital providers on the whole.

I am not talking about small clusters or departments that work constantly on performance improvement or those who don’t just have CQI as an acronym on a piece of paper to maintain a certification. I am talking about the breadth of providers, EMTs and paramedics as they practice across the country. People get into this field for vastly different reasons, and it is reflected in the type of care they deliver and perpetuated in a professional culture as a result.

EMS is a minimum competency field, and whether you graduated with honors or squeaked in by the skin of your teeth, the patch on your arm will look precisely the same and carry with it the same life-threatening responsibility—regardless of whether you barely passed pharmacology or can read a 12-lead ECG with any accuracy.

With those of us for whom this is a career choice, our livelihoods rest on maintaining those slips of paper. To do that, we rely on continuing education, which really has a twofold purpose: It is meant to refresh us in those low-volume topics and skills that happen infrequently but are critical when they do, and also to teach us emerging trends and treatment modalities. Changes in protocols (one hopes) reflect evidence-based practice and a foundation in sound research.

Yet there is a problem with a lot of continuing education out there: You are required to attend, but you are not required to pay attention. You must demonstrate that your body sat in that seat for the prescribed amount of time, but in many cases there is no parameter that proves you’ve processed the material and can now incorporate it into your clinical practice. If you can manage to stay vertical, be polite and manage the basic life functions such as gas exchange for a few hours at a shot, you too can have a certificate that says you’re entitled to those CEUs.

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

We know you do not have to evolve. We have all worked with (or are) those members of the prehospital Cretaceous period whose basic evolutionary design allows them to arrive on scene and put forth the minimum amount of care required—who have mastered those techniques that allow them to proceed unimpeded by either protocols or progress. They meander forth, enjoying relative job security and employing the mantra of, “This is the way we’ve always done it.”

It is not always a matter of age; the dinosaurs are only part of the EMS ecosystem. Much like baby ducks, the brand-new EMT or paramedic will imprint from their first partner, the first service they come to. With no sound work habits of their own, they look to their peers and elders to develop their professional processes. They will imitate what you do, so the question is, what are you teaching them to be without even realizing it?

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