Will EMS ever hold nationwide status as a separate entity, but equal to law enforcement and fire/rescue?

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It depends on your point of view.

In my environment, EMS is not only equal to law enforcement and fire rescue, but EMS is the larger jurisdiction.  In our state, EMS has county-wide jurisdiction, while police and fire do not.  Only the Sheriff and the Board of Education have border to border jurisdiction.  Starting salaries for a recruit deputy sheriff, a recruit big-city firefighter, and a recruit paramedic are the same, +/- a few dollars.  Retirement is identical, except that the cops have a slightly better deal because they are better organized politically.

I think the "status" issue in EMS is one of our own creation.  EMS people do not, as a rule, demonstrate pride and professionalism; they do not value education or higher standards; they complain about working for their whole shift (what other profession gets to sit around and watch TV waiting for something to do); they treat patients who "aren't sick enough" poorly; and they encourage and support people who are willing to do their job "for free," showing that they place little value on their own profession. 

The solution to this problem, if it is a problem, lies within our own ranks.  Where firefighters and law enforcement have a "better deal" it is because they all joined the IAFF or the FOP, they paid dues to support political campaigns, they worked on getting candidates who support them elected to local, state, and national legislative bodies.  They pushed for their own higher standards.

We can do those things to, IF our colleagues cared enough to put their money, their time, and their effort toward doing so.  Yet we don't.  Questions back at you - why DON'T we do these things?

In most of Canada, EMS has largely outgrown the phenomenon whereby the police and fire services look down their noses at us, and depending on the locale our compensation is usually competitive with the fire service. Therefore, I think it's certainly possible.

That said, I think there's a significant drag on the amount of respect which EMS gets in the States vis-a-vis the police and fire service because the entry level barriers are so low compared with those organizations. When I got certified as an EMT-B card in New York, I might as well have had an advanced first aid course, and as long as I had a card and a pulse I could probably get a job. To get licensed as a Primary Care Paramedic (PCP) in Canada, I had to get roughly as many hours of education as an EMT-P gets in a lot of states, and the school was highly competitive to get into, as are the jobs when you graduate. In Ontario there's actually a program where they're graduating PCPs with four-year bachelor's degrees to go out and do Basic Life Support. Ultimately, the comparatively low barriers to entry in the US mean lower wages and lower quality workers: things I saw EMS providers get away routinely with in NY would get you summarily ejected from the profession here, and toxic attitudes which just wouldn't be tolerated by the Canadian professional peer group were commonplace there.

Thus, while I mostly agree with Skip that the respect problem has to be solved within EMS's own ranks, I also think that as long as the standards for joining those ranks are so low, they won't be up to solving the problem.

Jason Merrill

Interesting question; surprised that there aren’t more comments.  But, it is the weekend.

I will have to agree with much of what Skip has said.  We are our own worst enemy.  We continually shoot ourselves in the foot through our convoluted image of self as practitioners and “professionals”.


We attend our marginal and basic training programs as EMTs and paramedics and come away with the delusion that ‘we’ve got this’.  We interact with other emergency service personnel (police, fire, dispatchers, nurses and physicians) with a chip (substitute ego here) on our shoulder disguised as our hyper inflated opinions of our knowledge and skills.


We whine and moan about any additional training that we should attend; mandatory or suggested.  We take minimalist refresher programs designed to make recertification as easy as possible that do not provide any real furthering of our knowledge or skills.  We blindly follow a cookbook of protocols thinking that as long as we do nobody can question the outcome while never really understanding why we do these things and how not all situations fit cleanly into each  peg hole.


We read our trade journals but seldom look at a scientifically based research publication.  And when we do, we are ill prepared to understand methodology, statistical significance and the results because our minimal education never taught us to understand this complex process and analytical reasoning.


We fight change, actively and passively, because we get stuck in habits and opinions that leave little room for the possibility that maybe, just maybe, there is a better way.  We make decisions on current practices that we feel are cumbersome and are there just to make our life more difficult but have, in our opinions, little real significance on what we do.


We will not commit to anything beyond ourselves.  We will join a party but will not be part of the planning or clean up teams.  We expect to be served because we think we are due and entitled.  We scoff at those few amongst us that do get involved and at every opportunity undermine their commitment and dedication with our surly comments and our backstabbing.


We treat our patients inconsistently based solely on our mood and our tainted personal opinions of just how sick they are.  We look for short cuts and ways to circumvent while justifying in our own minds that the patient doesn’t deserve the very best that we can do.  We forget the person that is our patient and all the complexities that may exist in their life that led them to call us for help.  We opt to take a few seconds to deride them and to be curt with them thinking that it will make them think twice about calling again, when a few extra minutes of listening and communicating could lead to answers and solutions.


The state of EMS is fraught with ignorance and arrogance.  Why?  Because we think “we’ve got this”.  When nothing could be further from the truth.  We are at a crossroads.  We can either be our own champions or wait until things get worse, then let others force a transition that will not be much to our liking.

Having been involved in EMS over the past 36 years, there is much to be said about the pride and honor of being part of such an elite profession. I have experiencing many positive changes toward the betterment of the ems arena.

However, it should also go without emphasizing our diversities from within have been our own worst enemy toward achieving identical status of fire and law enforcement. It should also be mentioned, in comparison of years established, we are still in our infancy.

For many years, EMS has been attempting to find its own identity. Doe we belong in the healthcare arena or the public safety sector? Until a total agreement can be achieved, we will continue to flounder. Furthermore, internal strife regarding paid vs volunteer, vs municipal vs nonprofit has also caused much disruption in achieving a higher status. Regardless of our status, we all are fighting for the identical goals toward providing high quality prehospital patient care, and fighting the challenges of increased expenses and lower reimbursements.

We are attempting to approach this issue in our company, with our focus being on creating a better atmosphere of comraderie between our EMTs.  Skip Kirkwood is right, there is definitely an unspoken lackadaisical attitude that is generated by the profession at times, and we hope to guide that in a different direction.  Great question, Nicole!

Hows that Dandruff coming along David?

Well at least where we are in Australia, we are moving to a National Registration Body under Federal Government, of which Doctors and Nurses are already part of.

It's not about whether you are public health or public safety but that are are an entity on your own right. Not part of another qualification life fire or even police. You need to be county size or bigger so that your presence is significant.

Most importantly raising the bar on minimum standards in education is everything.

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