So it’s no big secret that I’m an EMT, right?  Have been for over 13 years.  In the course of those years I have met a lot of people, seen a lot of things, and done a whole lot more than I think I will ever completely remember.  EMS as an industry is a relatively young one, really only about 30-40 years old.  There are a number of issues facing EMS today that I have very solid stances on.

I am pro-uniformization of organizations.  I think everyone below a Vice-President or Deputy Commissioner in an organization should wear a uniform.  We are not an industry of one man shows, we are an industry of teamwork.  Uniforms help develop the sense of belonging and assist in team building.  Of course, I am also for individualism when it is tactfully done within a guideline.  In other words, I am for allowing people one or two spots on their uniforms for custom patches whether it be a unit patch or a commemorative patch to help raise the morale of those who have achieved or done something… and to give others something to strive for.

I am pro-Medicare and Medicaid reform so that ambulance organizations can actually get reimbursed for the cost of the trip as opposed to paying EMTs a salary that places them at or below the poverty line and the city/company STILL loses money on the transport.  Since they are the two largest payors of EMS services, to continually drop the payment rates as costs continue to rise will result in a severe shortage of first responders when a disaster strikes and they are needed most.  While there will always be the argument about municipal organizations vs. private companies, municipal organizations that rely on tax dollars currently lack the ability to fund and staff a response outside of their primary service area without negatively impacting their performance.  Private organizations who do the bulk of inter-facility transports and scheduled appointments currently have that ability as evidenced by the 225 private ambulances sent to New Orleans from around the nation during the Katrina and Rita hurricanes in 2005.

I am against mandatory protocols.  Every patient is an individual.  They all have individual histories, individual circumstances, and individual situations.  To require protocols to be followed by the letter would require an inordinate amount of time to be able to compile them to cover every possible situation.  We would then be forcing people to study a tome the rough equivalent of the Encyclopedia Britannica. Doing so also removes the human element from the equation and will further handicap responders from being able to make decisions when things do not necessarily go as planned.  Protocols should be guidelines, not law.

As in any industry there are challenges that need to be met and overcome both from the inside and from the outside.  One of the challenges from the outside is the perception the public has of our industry as being nothing more than “Ambulance Drivers”.  The truth is we spend a lot of hours in both our initial training as well as in Continuing Medical Education (CME) classes.  Our CMEs usually last 3 hours or more and are generally done on our own time, unpaid.  The physical demands of the job are also generally greater than any other job with the “driver” description.  We carry patients from the fifth floor with no elevator, we move patients from one bed to the next, and we are often lifting our own body weight if not more to get them into the actual ambulance.  Most people with a “driver” description at most have to carry some bags.  We carry people.

Since every state differs from another in how it regulates EMS, and every city and town within a state differs in the type of systems that they have, another thing lacking in the industry is consistency.  It is because of this inconsistency that there is a lack of definitive industry leadership.  One of the things that does bind us together is The Journal of Emergency Medical Services (JEMS).  It was in JEMS that I read what I consider to be one of the absolutely most ridiculous columns I have ever come across.  Allow me to present to you both the author of that column, and some excerpts with my own input into the matter:

About The Author

David S. Becker
David has been a paramedic for 30 years, holds a master’s degree in Health Service Management and is a graduate of the National Fire Academy Executive Fire Officer Program. He is the EMS program director at Sanford-Brown College in St. Louis, Mo.

From the column:

But to be looked at as professionals, we need to use professional terms for our equipment, including our mode of transportation. I say enough already with using the slang term “bus” for an ambulance. Can we try to show that EMS is a profession and not just a bunch of cowboys?

My response:
So by using a slang term, you’re saying that we aren’t going to be looked at as professionals?  If someone is bleeding in the middle of the street, I come over and yell at my partner, “Bring the bus up!”, do you think the guy bleeding is going to think ”Hey what’s this bus?  What kind of guys are these?  Do I really want them to stop my bleeding?” No.  He’s going to probably scream, “Oh my God I’m dying!  Help me!” Suits and ties don’t always save the day ya know… some time it takes the rough and tumble approach of a cowboy to make the impossible happen.

From the column:

I know that people in at least one part of the country call their ambulances by this slang term, and I won’t try to change them. But my goal is to make sure that we call an ambulance an ambulance in the rest of the country, even the rest of the world.

My response:
I know you’re talking about New Yorkers… or specifically those of us from New York City.  This is where the term started, with origins a bit cloudy, and it was “popularized” by Third Watch.  Don’t be all pissy if the only thing that show’s producers got right was the term we use for an ambulance.  There are other worse terms ya know?

From the column:

The Department of Defense uses the term “ambus” to refer to an ambulance bus, and perhaps that reference has been made in movies about World War II, the Korea War or the Vietnam War. But I hope future television shows and movies will use the proper terminology for an ambulance. When they don’t, we (EMS) need to call them on it.

The term “ambus” is because the new military vehicles can carry up to 8 patients at a time.  Show me a commercially available ambulance that can do that, and maybe then you’d have an argument on that one.  Again, the producers of Third Watch got the term right.  Don’t blame them for your ignorance as to the culture of the setting of a show or movie.  Perhaps becoming better educated as to that culture would reveal the TRUE inaccuracies.  (Heh… ambulances in a firehouse… right.)

From the column:

I know that in some services ambulances are called “Rescues” or “Medic Units,” and I’m OK with those terms. They still indicate a public safety or medical aspect that applies to the service delivery of emergency medical systems. Even in most of these cases, the vehicles have decals with the word “ambulance” on the sides.

My response:
So calling an ambulance a “Rescues” is okay, even though there are no rescue tools onboard and grammatically it is a plurality indicating more than one.  Calling any ambulance a “Medic Unit” is okay, even though it may be staffed with only EMT-Basics.  Do you want to purposely mislead the public?  Your approval of these terms endorses just that.  What about the terms “Rig”, “Ambo”, “Lance”, or “Truck”?  Are those okay… or should they join “Bus” on the banned list?  As a major point of fact, all New York State ambulances have the word “Ambulance” on ALL sides of the vehicle.  That’s front, back, driver’s side, and passenger’s side.  It is written in English and depending on where the vehicle is stationed, may additionally be written in Spanish, Russian, Chinese, and Polish.  Where there is not a proper translation for the word “Ambulance”, the word “Emergency” or “Emergent” and “Medicine” are used… because all languages do not necessarily have a word for “Ambulance”… which kind of proves that goal of yours in the beginning is a little bit more than unrealistic.

Thus concludes my ranted response on this column.

I find it incredible that the guy with the master’s degree could find no other issue than the slang term for a vehicle worthy of writing about when there are so many other challenges facing us from the inside.  It is too common that I find suits like him are so disconnected from the issues at hand on the front lines, proving industry leadership is a fallacy we cannot rely on to address our immediate needs.  I find it disheartening that JEMS, the great unifier, would give time to this drivel instead of where it obviously belongs… on a blog somewhere for industry suits to bow down and worship as gospel which they often do for any piece professing to make us “more professional”.  Perhaps if the time and effort they spent chastising people for terms used was spent on making sure those people could live above the poverty line, then those people would be more willing to make changes along the lines of this so called “professionalism”.

The last time I checked, when someone called 9-1-1, it was the cowboys who showed up to stop the bleeding and start the breathing.  I prefer to be a cowboy… which is why my preferred ride is a “bus”.