As some of you probably know, last weekend I went to the Fire Department Instructors’ Conference (FDIC) in Indianapolis, IN and I spent a great deal of time wandering the convention floor, looking at cool things and talking to cool people. There were plenty of great things to see and great new things to learn about and I immersed myself in doing just that. One of the things I’m always interested in is looking at the new trends in ambulance design and the manufacturers always have their coolest new vehicles on display to feed my interest. However, while walking the conference floor, I came across an ambulance that did more to tick me off than it did to promote their new vehicle design. Seriously, it was like someone slapped me in the face. Here’s the picture I took from my phone:
Does anybody see anything wrong with that picture? I was immediately ticked off… I’m talking a level 7 hissy fit. I was livid for quite a while and if you follow my twitter feed, you probably saw the three or four times I TwitPic’d it.
I mean really? They had to put “Staffed By Nurses” in six inch high script on three sides of this thing?
I blocked out the name of the service that runs the ambulance and in all fairness to the manufacturer, this truck is awesome. I would be quite happy to work in this truck although being that it has no bench seat, its usefulness as a 911 truck is hampered by its inability to carry more than one patient at a time. However, I would flatly refuse to work in this truck or for the ambulance service that puts it on the street. I happen to know the service that bought it and I’m trying to avoid naming them directly, but they serve a midsize city in Illinois.
Before you go all West Side Story, whip out your switch blade and zip gun, and prepare to have a dance fight with the nurses out there, realize that I’m not mad at them. Sure, mostly they’re well-paid and have climate controlled jobs inside of well-lit buildings, but they didn’t do this to us. My beef is with the management of this particular ambulance service.
So, let’s say that you’re the manager of this particular ambulance service. Obviously, sitting there in your office you must think that your paramedics and EMTs are contemptible morons who live simply to cause you problems. Furthering your view of the world, you probably think that the rest of the medical profession and the members of the general public in your area view them the same way and simply don’t trust them to provide medical care when it’s like *really* complicated and stuff. You probably feel that everyone would feel safer knowing that their patient or loved one is traveling via the companionship of “nurses” whom you must view as actually being like actually *Competent* and stuff.
And that’s what this rolling billboard to your contempt of your employees and their profession says about you. It’s a slap in the face to the good men and women you have working for you and there is flatly no excuse for it.
Here’s a tip, anonymous ambulance manager person (AAMP). There isn’t a need to have your precious ambulance be “staffed by nurses” when you have sufficiently equipped and prepared paramedics working in it. Paramedics are acute care specialists. We’re also experts in mobile medicine. Our education, training, and experience prepare us for the unique environment that we create when we move patients from one place to another. Critical Care Paramedics have the intensive Care experience, training, and background needed to operate in a critical care ambulance environment, nurses do not. Sure, ICU and ER nurses are great at Critical Care. However you shouldn’t regularly staff a critical care nurse in the transport environment for the same reasons that you wouldn’t put a critical care paramedic inside of the ICU. The professions are like in a lot of ways, but they’re separate for a good reason.
And you, AAMP, don’t respect that. Perhaps it’s because you’re burnt out. Perhaps it’s because you’ve beaten the system you’ve created into such a pulp that nobody wanted to staff your new Critical Care Truck. Perhaps it’s because of a lot of reasons, but it’s certainly not because you wanted the best in patient care or to show that your employees are capable of operating your shiny new “special” ambulance. No, you wanted “nurses” to “staff” that truck… and not only did you want the medical people you’re contracting with to know this, you wanted everyone who saw the truck to know it as the 6 inch high letters stating that fact clearly show. Do you think that the public views your crews as incompetent? If so, do you think that furthering the notion by advertising that your “special” truck is “staffed by nurses” will help that situation?
If your protocols are so draconian that even critical care certified paramedics cannot be allowed to staff that truck, then your protocol system is in the Stone Age. If your educational system isn’t up to the challenge of preparing your most experienced medics to staff it, then fix that problem. I know that there are great medic/nurse combos out there and I know that flight nurses have garnered quite a bit of respect out there in the world… and heck, I’m not knocking them for doing it. However, this is the time for Paramedics to step up and claim our turf. This ambulance clinched it for me. AAMP, your shortsightedness has caused me to lead a revolution of sorts here. You’re contempt for your staff has indicated to me that now is the time for paramedics and EMTs, such as the ones that work for you, to stand up and start claiming what is rightfully ours. Frankly, AAMP, your ambulance and your attitude is ridiculous and thinking like that must be stamped out right now by the good medics among us.
And I should also say this to the nurses in the audience before you start skewering me for knocking you: Have you looked at the debates in your circles concerning the use of paramedics in the ER and in other hospital units? Have you ever seen the term “Unlicensed Assistive Personnel”? Well I have, and it’s what the upper nursing echelon calls me and my professional colleagues. It’s offensive, but hey… our jobs are different. You have the hospitals and the fixed facilities. That’s what you do. We have the field. It’s what we do. There’s a line, respect it. If you want to do EMS, go through a real paramedic program. If we want to do nursing, we should go to nursing school. Really, it’s that simple. The transport environment is difficult and requires the use of specialized personnel… which we have, they’re called paramedics. The medical care we provide is close to the care that you provide, except we have autonomy that you do not and we are use to working independently in the environment in which we operate. Your focus is different than mine. You may be the best transport nurse out there, but even though you personally may be awesome, my profession needs to have people as awesome as you working on our side. That’s what this is about, not to knock your transport nursing skills, but to kick us paramedics in the shorts and get us to step up and maintain ownership of what we should own.
The responses I got back on Twitter show me that there are a lot of like minded individuals out there. Perhaps some of them might work for you, AAMP. You better take that into consideration because if I have my way the paramedics are going to get the notion that we’re not just a bunch of contemptible morons and we’re soon going to take control of our own profession. On that day, managers like you will be obsolete. Perhaps you can get a job managing nurses.
Here is my personal ‘thumbs down’ for the graffiti against my profession that you had someone slather on your shiny new truck, AAMP. My advice? Take it off and reconsider your staffing patterns. What you’re doing is bad for my profession. It affects me negatively, it affects my profession negatively, and it shall not go unanswered.
What do you think?
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Be sure to check out the follow-up to this post “A Slap in the Face? How about a Wake-Up Call?”
Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”
If you want to be “educated” enough to do nurse transfers…go to nursing school and stop whining. It's really simple.
If you want to be “educated” enough to do nurse transfers…go to nursing school and stop whining. It's really simple.
CKEMTP, your thoughts are well written and I understand your views. However, why are you not just as outraged by situations in other cities where before you can function as a paramedic you must first earn your tade as a firefighter? Aren't the firefighter unions just as gulity as the RNs?
you must be a nurse
CK, you nailed it, thanks for putting my feelings into words. As I mentioned above, the direction of said company was only one reason why I left. Furthering my education in “my” profession was another. I did not, do not and most likely never will want to be a RN. I'm a Paramedic, plan and simple.
CK, you nailed it, thanks for putting my feelings into words. As I mentioned above, the direction of said company was only one reason why I left. Furthering my education in “my” profession was another. I did not, do not and most likely never will want to be a RN. I'm a Paramedic, plan and simple.
Attacking RNs only weakens your argument, especially when you resort to such low brow means as referring to bedpans and the like; it is on the same level with calling all EMTs and medics “ambulance drivers.” It is petty and unnecessary. EMS personnel and hospital-based nurses have entirely different roles. Getting nasty about it will not change the problem. It seems the issue here is the management advertising transport by nurses, not the care delivery. Inter-facility transfers are the bane of everyone's existence, but are a necessary evil. Using nurses in this role makes more sense to me than taking an experienced paramedic out of service for a routine run.
Perhaps part of the issue is a distinct lack of public (and professional) education about the roles? Would this be as offensive if the other rigs read “MICT” or “Paramedic Unit” or “EMT & MICT” on the side? What if they advertised with a message that nurses rode transport so medics can cover the emergency calls? There are some areas where nurses are trained in EMS to run calls as well. Are these folks any less a part of the team?
“Starting an IV at 80mph” is a ludicrous comparison for jobs. I am certain that skill did not come to anyone on the very first day on the job. There are going to be good and bad apples out there in all professions. Judging an entire profession by one or two people totally out of their element and in a critical situation is entirely unfair and childish. Were you uber-medic on your first day in the back of the bus? I find it doubtful, and I would not expect you to be. What I expect is professionalism and a selfless dedication to public service, regardless of what some detached manager thinks is best for business.
Divisiveness in EMS only serves to splinter the public perception. Television perverts every profession it demonstrates; “Nurse Jackie” is only the latest piece of trash out there. I did not base my views on EMS on “Emergency” from the 70s, nor do I expect “Rescue Me” to do anything other than entertain. Yelling and screaming about how unfair something is will not change it. Take a diplomatic approach. Ask for rationale behind the wording. Propose adding “Paramedic Unit” to other rigs. Take an approach that this is an opportunity to educate the public. I urge you to remain professional about it and keep a level head. Yes it is a ridiculous thing to have on the side of a rig, but you have to tackle it in a calm, professional manner.
Good luck and God bless.
Former medic and EMT
You have every right to be upset as was I when I read that. However, after some introspection a couple of things occurred to me:
1. Perhaps the public needs to be more aware of what it means to be a Medic. I hold a couple of post grad degrees and medic school rivaled in intensity and depth what I found in my Masters Programs. A paramedic is not an ambulance attendant but a highly trained emergency medical provider. Our marketing department needs to take a note from the nurses union.
2. There are situations in transport of certain patients where having a nurse specialist is value added. That being said, nurses by and large have no place in the field. I have met some awesome ER nurses that would lose their minds having to deal with what we do in the field. Why an EMS organization would pay more for less value is beyond me and in all probability this is a company that is not long for the world or they are a strictly a transport company that the closest they come to a 911 call is the sticker on their telephone.
3. We tend to be a silent service. Until we are willing to open our mouths and let people know who we are, what we do and what it means to them, we will continue to see this kind of public sleight. Why a police officer with a high school diploma and 12 weeks of training commands a starting pay of $45K and a medic with a year of training who has a greater impact on peoples lives than the cop ever will makes $25K is our fault and no one else.
http://themictstudent.blogspot.com/2010/05/staf...
Well i'm kinda curious, about something. What about the EMT's that are supporting the paramedics, on the regular ambulances? All they say is paramedic unit. Let me tell you, i have worked with a variaty of different medics/nurses in my time, and without EMT's to support, get the equipment, or checking the equipment, or actually just being there, then there would be alot more dead people in the world. I'm not saying all paramedics/nurses are stupid, i work with alot of great nurses, and paramedics, but we need to remember the EMT's also. About the truck, who cares if its staffed by nurses, theres always an EMT driving it. Everything i have said is just an opinion, and i love the medics, and the nurses that i get to work with. People please remember, we are all in this for the same reason.
Maybe they put it on the side to warn the public that there is only nurses on board and don't call them in a real emergency? Now don't get me wrong I am a paramedic, married to a Nurse. I feel we are both important, but people we have to remeber just about (note I did not say all) every nurse I have met after 5 years don't want to be a nurse anymore, and they only got into it because they thought it would be easy or because the pay is great. But just about (note the just about not all) every EMS worker enjoys going to work and we do it because we love it. So I say big deal give the nurses one little thing to make them feel better about themselfs. We as EMS workers have way more pride
Did you Paramedics know that after you drop that critical care patient off and your transport is done, the patient still requires care? Or lets talk about this, how are these critical care drugs excreted? How do they work, what organs react to them and how? Will your care send a previously healthy person into renal failure because all you know is the protocol of the drug and not how the drug itself works??!! How about the 2-3 weeks of recovery after Multiple Organ Dysfunction due to an arrest situation? The list goes on and on honey…
Please don't insult me as an ER nurse if you don't want the feedback…
Buck up, sometimes patients need nursing care. Stop being a cry baby.
Try NJ, where *only* RNs with at least a year of ICU, CCU or ER experience are allowed (by law) to staff an ambulance for the purpose of interfacility (referred to as Specialty Care Transport) trips. Thank the Nurses' Associations for this – the more you lobby, the more you get. It's the same reason that Paramedics in NJ must ride two-per-truck and are specifically prohibited from transporting (again, by law). Thank the Volunteer First Aid Council for lobbying that into existence.
Try NJ, where *only* RNs with at least a year of ICU, CCU or ER experience are allowed (by law) to staff an ambulance for the purpose of interfacility (referred to as Specialty Care Transport) trips. Thank the Nurses' Associations for this – the more you lobby, the more you get. It's the same reason that Paramedics in NJ must ride two-per-truck and are specifically prohibited from transporting (again, by law). Thank the Volunteer First Aid Council for lobbying that into existence.
A-fucking-men!
-Sean (Critical care nurse AND paramedic)
Let me comfort you.
1. I am a nurse and would not know what to do in an ambulance, or the first thing to do outside of my safe little world in the hospital: except maybe BLS till the paramedics could come.
2. As an artist and former graphic artist lettering trucks: That script sucks, the whole design is crappy.
Seriously?? Have you looked at the Paramedic Curriculum? Not to mention you pretty much stated what everyone was saying “after you drop that critical patient off…..the patient still requires care”. No knock to ER nurses, or any other nurse for that matter……just in the field, I beleive is what people are tring to say.
First I agree with the discussion as far as I have read. Where I come from protocols are written so that a nurse and paramedic compliment one another, not placing one higher then the other. However I do find myself wanting to play devils advocate. The fact that the amblance reads “Staffed by Nurses” may not mean that one is trying to place a nurse above a medic. For example there are amabulances that are clearly marked as BLS and others as Paramedic. Does that mean that we as medics are going to put our value higher then an EMT-B? Granted we can do more interventions but, depending on the system it often times would not work without BLS units, there are many interventions we can do that would be ineffective without the smaller more trivial BLS interventions being done at the same time. Perhaps now medics are able to feel the same way EMT's have felt about markings on an ALS unit. Just something to think about, I still agree that an RN should be in a hospital where they were trained to be in and there is a shortage of them, why spread them even thinner when we already have educated professionals to staff the ambulances?
I can fully comprehend the last part of your posting concerning how some RN's act or regard Paramedics. I just completed 8 clinical hours for re-licensure here in Illinois & I wasn't treated rudely, but was not made to feel welcomed either. I said at the end of my hours 'I felt like I was more in the way & a swollen thumb' !
Kelly,
People like you are exactly the problem. You belittle paramedics and assume we know nothing but protocols without actually being familiar with the paramedic education process. Yes, there are some three-month medic mill programs out there, and they are deplorable. But let's not forget the two-year associate degree programs that expose the student paramedic to over 2000 hours of clinical experience. Let's also not forget the paramedics who take advanced college-level pharmacology and/or anatomy and physiology courses. I know several paramedics with bachelor-level education, and some even have a master's degree. So before you go shooting your mouth off about “those derned ammalance drivers”, take a moment and educate yourself on the reality of the situation. Realize that EMS is no longer what is was in the days of Johnny Gage and Roy DeSoto on Squad 51, and it most definitely isn't like on Trauma. If you want to keep taking potshots, I'm sure I could bring up some of the more embarrassing things I've seen members of your profession do… like the nurse who stared at me with a dumbfounded look on his face when I explained to him the difference between ventricular tachycardia and supraventricular tachycardia… or the nurse who stated matter-of-factly that you should never touch the insertion site when starting an IV due to risk of infection, then proceeded to tape the IV down with tape that had been stuck to her sleeve before she even thought about applying a tegaderm… or the nurse who blew both ACs in a patient before I calmly stepped in and put an 18 in the gentleman's hand. I'm sure we could both site humiliating examples from either's profession, but please, do not make assumptions that have no basis in fact or else you will end up making yourself look like an idiot. More specifically, an idiot who cannot do anything but make an argument that is the philosophical equivalent of “You suck you suck nanny nanny poo poo I can't hear you na na na na naaaa naaaaa…”
All the best.
Please forgive any grammatical errors… it's early for us night shifters!
Kelly,
People like you are exactly the problem. You belittle paramedics and assume we know nothing but protocols without actually being familiar with the paramedic education process. Yes, there are some three-month medic mill programs out there, and they are deplorable. But let's not forget the two-year associate degree programs that expose the student paramedic to over 2000 hours of clinical experience. Let's also not forget the paramedics who take advanced college-level pharmacology and/or anatomy and physiology courses. I know several paramedics with bachelor-level education, and some even have a master's degree. So before you go shooting your mouth off about “those derned ammalance drivers”, take a moment and educate yourself on the reality of the situation. Realize that EMS is no longer what is was in the days of Johnny Gage and Roy DeSoto on Squad 51, and it most definitely isn't like on Trauma. If you want to keep taking potshots, I'm sure I could bring up some of the more embarrassing things I've seen members of your profession do… like the nurse who stared at me with a dumbfounded look on his face when I explained to him the difference between ventricular tachycardia and supraventricular tachycardia… or the nurse who stated matter-of-factly that you should never touch the insertion site when starting an IV due to risk of infection, then proceeded to tape the IV down with tape that had been stuck to her sleeve before she even thought about applying a tegaderm… or the nurse who blew both ACs in a patient before I calmly stepped in and put an 18 in the gentleman's hand. I'm sure we could both site humiliating examples from either's profession, but please, do not make assumptions that have no basis in fact or else you will end up making yourself look like an idiot. More specifically, an idiot who cannot do anything but make an argument that is the philosophical equivalent of “You suck you suck nanny nanny poo poo I can't hear you na na na na naaaa naaaaa…”
All the best.
Please forgive any grammatical errors… it's early for us night shifters!
It’s a nice truck, but it creates a lot of resentment inside AMT among the EMTs towards the nurses. Although the nurses that staff it are very nice people and good at what they do, they do seem to get “special” treatment from administration and get their way on issues. However for me
the biggest problem with the truck is that it has that script on the side advertising the use of nurses.
Nurses have always been in the field. Many moons ago, paramedics were authorized to practice in their county only. This meant, if they rolled across county lines, they were no longer authorized to practice. Theoretically, those “lines” went straight up into space. Physicians, Nurses and Respiratory Therapists are licensed by the State; they could practice in any county. The State EMS Authority didn’t exist then. CCT crews, both flight and ground, were MD/RN/RT staffed and came from the receiving facility to pick up the patient. In the late 70′s to early 80′s, the Field MICN staffed with an EMT worked the streets and did transfers. Counties began Paramedic Programs *yeah* and this began to change.
Direct online medical radio control was provided by ED Physicians. That too was given to the RN. As Paramedic training/education expanded, so did their diameter of service. Counties formed Regions to share the training and coordinate expenses. The EMS Authority was born, providing medics with the ability to practice state-wide. Protocols expanded to what they are now. Most counties no longer have direct online medical ratio control anymore. Medics use field protocols. Some DCF’s still delegate who goes where for multiple counties, but by and large, medics practice very autonomously here in California.
CCT is a huge revenue generating ticket. Even documentation reimbursement in hospitals must state “1:1 critical care begins now” and then “1:1 critical care ends now” for reimbursement purposes! *blech* It’s about money. Plain and simple, folks. Higher “level of skill” = higher educational degree = higher reimbursement.
As far as skills go, ANY skill can be taught..it’s monkey see, monkey do, if you ask me. Skills are important, you can’t get shit done if you can’t DO. But what really makes a good practitioner is knowing HOW to think critically, not just what cookbook to follow. Not one profession is without their duds, EMT, Paramedic, Nurse or Physician. I’ve been around long enough both the street and in house to have seen some pretty clueless folks in ALL services. Personally, if you don’t have strong BLS skills, I don’t care what degree or license you have…nothing else matters.
Working the field is a unique environment. Many of my Paramedic students over the years failed miserably once they hit their field internships; they were EMTs but had never worked an ambulance; therefore, had no clue on how to manage a scene, much less delegate and lead one. The Paramedic Program I am very proud to have been a part of provided an Associates Degree. Our medics scored in the high 90th percentile, first time pass, National Registry. They are employed in some of the most hard-hitting cities of California. Lucky Cities! Some RNs wanted to crossover as medics and some failed during field internship for the very same reason. Some, rocked it up and are terrific CCT flight/ground staff.
My advice to you: Get organized. Require at least an undergraduate degree for your profession. Lobby for yourselves. Once you do that, you can advocate at the federal level for acknowledgement of your CCT skills. Nurse Anesthetists can now practice autonomously and bill on their own without having to do so under an MD. Why not Paramedics? Paramedicine = Para(llel) Medicine. Stop sniping at nurses…we have an ugly job nowadays..lol