A Slap in the Face to Paramedics Everywhere?

Sounds jealous and whiny.

I find this “slap in the face issue amusing.” There are two points I would like to make since I was one involved in the design of this truck and concept. First, the lettering on this vehicle clearly indicates the main purpose of this vehicle is inter-facility transfers, calls which paramedics btich about taking and sight as a reason for hating their jobs. Yet design a truck that helps relieve this “inconvenience” on the paramedics and “it’s a slap in the face.” It proves one of my axioms of life: “You can change things that people hate in life, but you can't change someone who hates their life.” Also, inter-facility patient care responsibilities are governed by EMTALA Laws. It might be beneficial for those of you outraged by this vehicle to Google EMTALA before you continue to demonstrate further ignorance.

As somone who live in the town that that rig operates, someone who worked his way through college as a medic, and someone who is not finishing up residency in that same city, I have to say that without a doubt you are overreacting to this. I come from a medic family, my dad has taught EMS for 15 years, I taught it for 4 years. I agree that in general medics get little to no respect for what they do. But to take offense to a rig designed for transfers being staffed by nurses is ridiculous. I've done the medic training, Ive helped teach it. Everyone can agree it is designed for “pre” hospital medicine, which this rig is not. Some have given examples of how nurses freak out under pressure, I would argue that I know nurses, and ones in this city, that can handle more pressure than any medic I have ever met. This is a good service you are bad mouthing. I agree with the person above about taking a look at you life if you have such a problem with a couple of letters on the side of a rig.

“There are those that look at things the way they are and ask, Why? I dream of things that never were and ask, why not?” – Unknown (and no, it wasn't JFK)

Those of us that look at the profession of paramedicine and seek to change it for the better face an uphill challenge. EMS is made up of little kingdoms in every locality where people break down into personal attacks and vitriol when their way of doing things comes under scrutiny. I don't mind, honestly because I didn't start writing about EMS with a thin skin. However, this issue isn't black and white. This post created a firestorm of opinions across the internet. I've seen all of the comments here, on twitter and facebook, and the ones that have been emailed to me. Thousands of people have read this post since it came out and thousands more will. Each one will form their own opinion. Some people will put thought into forming their opinion, and some won't. Some will see me as a shallow, bitter medic, and some will see the company as evil and wrong.

Honestly, there is a point to this article. It's much bigger than the service this truck functions for and it's bigger than the small town it runs in. It deals with the role that EMS sees itself filling now and in the future. Do we as paramedics and EMTs wish ourselves to staff the most difficult clinical roles? Do we wish ourselves to be in the management positions? Where do we see ourselves? Is it as solely 911 providers who leave patients who we decide are “beneath us” to the “transport trucks” and whomever is on them? Or do we see ourselves as being professional enough to go out there and educate ourselves so that we can fit into the most challenging of field roles? Do we as a profession collaborate and dictate where EMS goes in the future? Or do we allow our profession to languish under the control of the political and special interest groups who now dictate where we are placed?

This issue bothers me on many levels, but none of them are as egocentric as I have been accused of being. I am bothered because I hear multitudes of paramedics and EMTs when they talk of “furthering their education” or “advancing their career”. When those people talk of this, it invariably leads to them leaving the profession. When these experienced, intellegent, professional men and women leave our profession for greener pastures they take their experience and knowlege with them. When an experienced field provider leaves the field, not only are they immediately impacting patient care but they're also eliminating the chances they would have had to mentor the next generation of paramedics and EMTs. When enough of our experienced people leave, our new generations lose their heritage and the new generation begins again.

While staffing this truck with nurses may indeed be the most expedient thing to do under the protocol system and reimbursement structure that this truck functions within, it eliminates yet another avenue for the experienced medics to rise to when their careers reach the “I want to advance” stage. This is a problem that is systemic to EMS and it holds back the advancement of our profession when one looks at the broader picture of what this mindset represents. My anger was based upon yet another door being closed in the face of long-time field providers and paramedics in general. This is yet another gust in the wind that pushes the best and brightest among us away from the profession.

And that is why I take issue. If you work the truck and you took my anger as being directed personally at you… well then please take a look at why I must take the position I've taken. I have written hundreds of articles about EMS and most of them are right here for you to read. I do not wish to offend dedicated people personally but I am passionate about the profession and I will do what I feel is best to see to it's improvement. Whether you agree with me or not, if you feel the same way about improving EMS I invite you to keep coming back for the dialogue that we have here with like minded professionals.

Your opinions help make us all stronger. My job is to get us all thinking and talking. This issue has sure done that. Please keep it up.

Thank you to everyone who has commented, I deeply appreciate it.

If you want to be “educated” enough to do nurse transfers…go to nursing school and stop whining. It's really simple.

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.

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.

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.

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.

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.

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?

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.

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.

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.

Thankfully my area worked thru these issues long age. A paramedic is a known skill set in an ambulance environment. RN could be just about anything, and it is very rare that a RN will have the skill set of a paramedic. I’ve held both. High speed level 1 trauma hospital ICU experience helps when a transfer has an ICP device, balloon pump, ECMO, PA catheter, 7 drips…the medic in me knows what that stuff is, but only my ICU RN self can operate/adjust it to hospital standards. Hopefully there is strong MD control…field crews stridently proclaiming what they will and won’t do need it.  

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