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February 2005 Letters

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Mail: EMS, 7626 Densmore Ave.
Van Nuys, CA 91406-2042
Letters may be edited for clarity and to conform to space requirements.

Volunteer EMS Providers

I am writing, somewhat belatedly, to express my dismay with respect to your disparaging comments regarding volunteer EMS providers in The Low-Pay Lowdown in the March 2004 issue. I would be willing to compare the volunteer services provided by the department where I serve (Bethesda-Chevy Chase [MD] Rescue Squad) with any career EMS service.

Although your story is written in terms of perceptions, it conveys a message that volunteer providers must be inferior to career providers. There is no attempt to counter that perception.

More than 100 volunteers, providing both BLS and ALS service on thousands of calls every year, staff the Bethesda-Chevy Chase Rescue Squad. Our apparatus and equipment, all of which is provided by the community through charitable donations, is state-of-the-art. We require a greater level of initial training for our volunteers than is required of the paid EMS personnel in neighboring departments.

Volunteers bring unique strengths to the EMS system through their professions and other outside experiences. For example, our department’s volunteers include many who are nurses and other medical professionals. Those volunteers who come from other professions offer a broader perspective than might be available to those whose only professional experience is EMS. Additionally, a volunteer department is an expression of a community’s commitment to caring for its neighbors. Undoubtedly, many paid EMS providers care about their profession and their patients, but there are many for whom it is merely a job and a paycheck. That attitude is never present in a volunteer station.

I urge you to take a serious look at the important contributions made by volunteer EMS departments like ours. You will then understand that there are good reasons why “EMS is still delivered by volunteers.” Volunteer EMS providers bring special strengths to the system and are not merely a relic of the unknowing past, such as is implied by your statements.

Indeed, I would invite you to visit our department and see this for yourself. Then I hope you will write a more balanced piece about volunteer providers that accurately reflects both our special strengths, as well as our challenges.

Steve Blackistone
Kensington, MD

John Erich, author of The Low-Pay Lowdown, responds: Thanks for your letter. In reviewing the article, I believe the crux of the issue you raise was my use of the word “still” in the sentence, “Part of the perception problem may be that in so many areas, EMS is still delivered by volunteers.” This may have been interpreted as suggesting that the volunteer delivery of EMS is a bad thing, or should change.

This was not my intention. We here at EMS Magazine are acutely aware that quality prehospital medical care is delivered on a daily basis across the country by highly trained, immensely skilled providers who are not compensated monetarily for their time and efforts. Volunteer services can and do provide EMS that is just as good as, and sometimes better than, that provided by paid professionals.

The point I was attempting to make (and perhaps could have worded differently) is that the volunteer delivery of EMS can have an effect on other people’s perceptions of providers’ value. That is, those without direct knowledge of the industry—lay persons and even decision-makers and government officials—may see EMS delivered by volunteers and assume it is less difficult or of less importance than other emergency services: “If they let volunteers do it, how hard can it be?” It’s plenty hard, as you are well aware, but those not involved in EMS may simply not know any better. And if that perception exists among government officials in communities with paid systems, they certainly won’t be fighting to increase the salaries of their EMS providers. However good volunteers may be, the very fact that EMS is delivered in some places by volunteers may unintentionally contribute to keeping pay low. That’s not the fault of the volunteers, but it’s probably a fact of life.

While countering that perception was outside the range of the story (which simply looked at reasons why EMS pay is low), I’m happy for the opportunity to do so now. We know you guys are good, and we’re grateful for what you do. And if I’m ever in Maryland, I’ll take you up on that offer.

Standing Up for Medics

I was somewhat surprised to read about one of our agency’s former employees in your August 2004 article, Turning Paramedics into Firefighters by Jeff Price. Our former colleague, Charles (Chaz) Gross, and a number of other paramedics were singled out in the article as “attitude problems” by the author. I can assure your readers that Charles was among the most dedicated and skilled members of our EMS team in Summit County, CO.

As an EMS employer who actively encourages our paramedics to contribute to the improvement of our service, I was left with an impression that the author was scolding paramedics in general for not fitting into the paramilitary and often macho culture of the fire service. I was further appalled that the author assumed single role EMS agencies would not train employees on such topics as media relations, personnel safety and the handling of emergency situations.

I hope the author would more appropriately focus future articles on the positive aspects that can be gained from both cross-training and the merging of EMS and fire service cultures to the betterment of those we serve. Clearly, it is not the objective of fire service employers to hire well-qualified employees only to minimize their contributions. An experienced paramedic is a great resource to the community, not simply an attitude problem and training headache to be controlled at all costs. Perhaps it is the trainers and the author who should re-evaluate their attitudes?

Sean Caffrey, Director
Summit County Ambulance Service
Frisco, CO

I’m a firefighter in Massachusetts. I started out as a volunteer firefighter/EMT-B and EMT-I while attending college in Vermont; I’ve worked in private EMS as a paramedic and in municipal EMS service in Boston. Jeff Price’s article, Turning Paramedics into Firefighters in your August 2004 issue, was incredibly offensive and opinionated. It completely lacked any scientific comparisons and failed to describe anything except an individual’s ignorant generalizations of an entire group, based on a couple of recruits.

Price seemed to emphasize some theoretical “attitude” problem with this group of recruits who happened to be medics. A problem he described was a “lack of respect” for not standing when an officer entered the room, or questioning authority when given an order (whether it was an order pertaining to a life-threatening situation or an insignificant request wasn’t clarified). I am sure the command staff was appalled at the “paramedic’s defiance,” since the author led the reader to believe that no other “non-paramedic” had ever failed to stand when a position of authority entered the room or questioned an order.

Price mentioned the fact that medics tend to be older than most other recruits, but doesn’t admit that any non-paramedic older recruits ever display such disruptive behavior. Maybe he needs to open his eyes and refrain from his biased conclusions without examining the entire picture.

Let’s face it, the fire service is an expanding field. Even in the article’s North Metro Fire Rescue District (Denver, CO), EMS calls made up 71% of their call volume. That’s more than half. The sad reality is that it took the fire service 200 years of history and tradition to realize they needed to hire recruits with some experience and qualifications for the majority of the job.

Ironically, the conclusion of the article describes how these paramedic recruits performed well in the final weeks of the academy during the live burns. Imagine that. These recruits didn’t question orders that dealt with life safety; they remained calm during an emergency setting; and they did their job well. I would like to ask Price if the paramedic recruits were still not smart enough to stand when the officer walked into the room or the burn building.

The point of this letter isn’t to further divide the fire service, but to make others think about what they write before they generalize about any group entering the brotherhood, whether it be paramedics, minorities, females or homosexuals. Any good instructor will tell you that every recruit and every recruit class needs to be approached differently. The ability to see and overcome these challenges separates the good instructors from the bad. Unfortunately there will always be instructors who excuse their incompetence because a recruit is a paramedic or a female, etc. Let’s just hope they aren’t allowed to spread their biased opinions. Thanks for taking the time to see the other side.

Fred Lorenz
Winchester, MA

Troubled Times

Year after year we see the number of EMTs and paramedics fall to an all-time low. Once upon a time, ambulances were staffed from the abundant EMS volunteers across the nation. Volunteerism has all but disappeared in many places, leaving the pool of resources virtually dried up.

This forces paid ambulance services to put much more focus on training issues. The experience and caliber of the new employee has changed dramatically. New people are walking in the door just out of high school, with little or no experience—not ready for the tough job of street EMS.

When volunteers provided a majority of the EMS coverage, many folks would enjoy the work so much that they would become full-time EMS providers at professional ambulance companies. For-profit agencies reaped the benefits of having these seasoned, experienced people working for them.

Individual states are continually raising the criteria for—and expectations of—EMS providers. Paramedics are expected to be the universal problem-solver, able to handle all situations they encounter. This includes, but is not limited to, responding with other agencies, demonstrating superior skills, as well as all aspects of emergency vehicle operations. It could take six months to train a person on the job, not counting the time invested on initial training. It takes a great investment in time to get a person ready to work; compare that to the time it takes the same person to end their career in EMS.

Low pay and lack of competitive retirement are the leading causes for this huge manpower shortage. How many high school kids are planning on being paramedics? If a study were conducted, I’m sure we would find the number very low. Today, I think it’s more likely for people to get involved with EMS by accident than on purpose. It starts as a hobby, and suddenly people find themselves working 60–80 to 100 hours per week.

Professional and volunteer services use the same limited number of personnel to get the job done. Paid EMTs also volunteer in local communities when off-duty. Often EMTs and paramedics will work for several agencies—working a shift at one service, then driving to the next and working some more, only to return to the first agency the next morning. This is a recipe for disaster. EMS providers become overworked, exhausted and burned out. Then they get out of EMS altogether, sometimes never to return.

This is a national problem and I see no end in sight. Where will we be in 10 years? I’ve said that for five years now. We’re halfway there, and it’s looking ugly. Pick up a phone and call your local EMS provider and ask them about their staffing. You’ll be shocked.

The problem is too great for ambulance companies to battle alone. The federal government needs to get involved and develop a plan for employees in the private sector to get state retirement, higher wages and more comprehensive benefits. This problem is not going away. It’s getting worse every day, and people need to do something about it. Your lives and the lives of those you love may be at stake!

Those protected by municipal fire and EMS should be concerned as well. Guess who backs them up? Private ambulances, and they do it a lot. It’s typical for smaller cities to have one or two fire ambulances out on calls, which leaves the private ambulances there to back them up.

In the time it took you to read this article, how many EMTs and paramedics ended their careers in EMS, and how many took their place? No one seems to know.

Ken Thompson, CCEMT-P
Ithaca, NY

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