I thought I'd bring this topic out from the "Paramedic versus Trooper" threads for discussion.

Many have lamented that "We don't get the respect that we deserve" and talk about how we should "demand" that respect. They talk about how the trooper is always referred to by title (Trooper Martin) while the paramedic, if he gets named at all, is "Mr. White" or "the ambulance driver." I don't like that either ("ambulance driver" and "police, fire, and emergency workers" are like fingernails on a chalkboard or an out of tune bagpipe for me).

But....you can't DEMAND respect. Respect is earned. It is earned by professional conduct, professional appearance, professional demeanor, and self-imposed professional standards.

You can't DEMAND it, but you can COMMAND it, by demonstrating the professional attributes I've just named. Unfortunately, because many in our profession do not demonstrate those attributes, I think we ask for the "disrespect" that we get.

First, our titles. The Canadians have got this one figured out and done. Everybody is a PARAMEDIC - what we call an EMT is a Primary Care Paramedic, moving to Advanced Care Paramedic, Critical Care Paramedic, and a few others. We in the US insist on being an "Advanced EMT 4" or "EMT-Basic/Defib/EOA/IV, or some such nonsense that nobody can understand, comprehend, or even remember. So, we can't expect the media, etc., to call us by a proper title. I'd vote immediately to adopt the Canadian scheme, but when I've raised this subject the ego of many US paramedics (who think of them selves as "real paramedics" and can't bear the thought of some lesser being sharing the title) won't have it. It would be a shame to put the good of the profession ahead of the personal ego!

Second, forms of address. Hang around on-duty LEOs enough and you will hear them refer to "Officer Smith," "Deputy Jones", Sergeant Smith, Lieutenant James, etc. How often to you hear medics refer to each other in such a professional manner? Answer? Damn near never! Personally, I try to do this whenever I'm referring to a member of my staff in an official capacity, but even the person I'm trying to show respect to often demurs, because it makes them "feel funny." If we won't use formal, respectful forms of professional address (in business or in public settings, not in the day room), why should we think that outsiders like the media will even know what they are? We've also resisted standardizing our ranks and titles, again for reasons that I can't begin to fathom.

Third, many of our members don't present themselves in a manner tha commands respect. Why do you think that state troopers (in most all the states) wear meticulous uniforms, moreso than their city counterparts? Because they often operate alone, without backup, and they know that a flawless uniform sends a message that the wearer is competent and professional. Yet much of EMS insists on being as casual as we can get away with, again putting our personal comfort ahead of the professional considerations. Now I know somebody will immediately talk about how physicians dress. First, everybody knows about their 8-12 years of formal education and training and will respect that. But second, not every attending physicians turns out in scrubs (unless doing surgery). Locally, our ED attendings mostly wear dress shirts and ties while working in the hospital, as do my internist and my neurosurgeon - so don't just pick the examples that suit your fancy.

OK, what do you think? Have I lost my mind? Or if we want the media, the public, etc., to take us seriously and respect the "office" of paramedic as much as they respect the office of state trooper or police officer, do we have to do the work and exhibit the behaviors to command that respect?

Once again, examples of us being our own worst enemies!

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I disagree. I believe the reason Police officers are more respected than paramedics across the board is because they all work for a municipality. EMS has a huge variety of models and no government representation like police and fire. Working for a private company often offers low pay and no public service type pension. Private EMS doesn't really seem to be a public service as much as it is a customer service provided by whichever company bids the lowest amount to that city/county/state. In private EMS the customer is always right, where as I believe you are given more benefit of the doubt with things like complaints if you work for a municipality. Furthermore, it appears private companies will hire anyone with a license and throw them out on the street to make money. This is not the same in any police or fire job where the jobs are very competitive. So pretty much what I'm trying to say is working for a private ems company shares more in common with working for McDonald's than it does with other public safety jobs. If you look at private security guards, how well are they respected? They are the closest thing to a private company police officer. Truthfully from what I've seen they aren't really that respected regardless how professional they look.

Plus if you think about it the lack of respect isn't usually from the public but from the government. Most of the public appeared to be outraged by the police officer attack on the paramedic. However, the laws nor the government officials are willing to stand up for a paramedic because it isn't a government position. If he would have been a firefighter/paramedic this would be a completely different story. The Fire Chief would have backed him and it would be a completely different situation. Look at the outcome from the police officer arresting the fire officer for not moving his fire truck. He lost his job and the fire fighter won a huge amount of money for wrongful arrest.


As far as the titles, police is much more paramilitary than EMS, especially private EMS. I'd prefer my partner not call me Paramedic Justin all the time lol. Even if you make up paramilitary titles(Sergeant, Lt. etc) for a private company it is kind of corny.

And for uniforms, you have to remember that many of us are in the uniform for 24 hours straight. If my uniform looks a little wrinkled at 2 in the morning it is most likely because I had to sleep in it. Uniforms should look professional but not to the point that they impair functionality. It is much easier to keep a uniform looking nice for an 8 hour shift than it is for a 24 hour shift.
I believe you both have valid points. Regarding the uniforms, its true that at 2 in the morning its a little harder to look perfect than it is if you only work twelve hour shifts. As for getting respect, that comes from all the poorly trained, horribly dressed, downright stupid people that slip through the cracks in our profession. Lets face it, its very very easy to become an EMT and in some places not really that hard to become a paramedic. Until that changes we will not get much respect. It makes me soo mad when someone wearing the same uniform (EMS) shows they are incompetent because they do not simply reflect on themselves but also on all the rest of us wearing that same uniform. I feel the root of the problem lies in not acting professional and not performing professionally. Lets face it, all it takes to become an EMT in most places is a GED and a year or less of free time. I strongly support adding additional general education classes and making EMT an AS. Make Paramedic a BS with classes like chemistry, A and P, Microbiology ect. Until we make it, (in the eyes of the general public) respectable, we will not gain respect. I know that's probably going to irritate a lot of people on here but Im all for making it harder to get that patch than it is. Im tired of stupid, or ignorant, or simply unprofessional colleagues giving the rest of us a bad name.
Sorry for the strong words but Im very passionate about this subject. Im proud of what I do, of what all of us do every day. I want it to become more respected and hey, while we're at it, better paid!
I agree with what you are saying. In a way EMS needs acceptance from both the public safety side and the health care side. To get acceptance with the public safety side we need EMS representation in the government. To get health care acceptance we need increased standards. An associates degree minimum would be a great start. Furthermore I think we need more studies and evidence to support our existence and practices. We need definitive proof that ALS has better outcomes than BLS(if it does). We need proof that pre-hospital intubation and other ALS procedures are good or bad for the outcomes of the patients. Realistically I think an associates degree would be the most fitting entry degree with continuing education available into a bachelors degree. The bachelors degree could be maybe for management or teaching.

If I had it my way the associates degree would be like this:

A and P 1 and 2
English 1
Medical Ethics
Medical Terminology
Microbiology
A chemistry overview class specifically for paramedics that gave a general explanation of acids/bases, the citric acid cycle etc

and then the Paramedic curriculum. But I think the paramedic classes should be more in-depth. I also don't think you should have to be an EMT-B first.



nathan said:
I believe you both have valid points. Regarding the uniforms, its true that at 2 in the morning its a little harder to look perfect than it is if you only work twelve hour shifts. As for getting respect, that comes from all the poorly trained, horribly dressed, downright stupid people that slip through the cracks in our profession. Lets face it, its very very easy to become an EMT and in some places not really that hard to become a paramedic. Until that changes we will not get much respect. It makes me soo mad when someone wearing the same uniform (EMS) shows they are incompetent because they do not simply reflect on themselves but also on all the rest of us wearing that same uniform. I feel the root of the problem lies in not acting professional and not performing professionally. Lets face it, all it takes to become an EMT in most places is a GED and a year or less of free time. I strongly support adding additional general education classes and making EMT an AS. Make Paramedic a BS with classes like chemistry, A and P, Microbiology ect. Until we make it, (in the eyes of the general public) respectable, we will not gain respect. I know that's probably going to irritate a lot of people on here but Im all for making it harder to get that patch than it is. Im tired of stupid, or ignorant, or simply unprofessional colleagues giving the rest of us a bad name.
Well this is a good discussion on a subject that I believe is going to take a long time to resolve.

As far as respect from the public, I agree that we need common titles that the public can call us. In my area we are still the ambulance drivers to alot of pt.'s and families, and that is irritating but what are they to call us when we can't decide what to call ourselves.

As far as the low standards, yes, it very, very frustrating to watch people who do the bare minimum and get by. I don't know the solution, but here's the problem as I see it. In my area, at least, there is such a shortage of paramedics, that anyone with the patch, regardless of how lazy, unprofessional, uneducated, and uncaring, are swallowed right up by the services. The service I am at now is the largest and most professional in the area, and you can tell for the most part, as they are more selective and not just anyone gets in the door. However, even they have suffered from expansion and the need to fill larger rosters than in the past. Why? Because they are taking over services that have gone out of business. My county has gone from 7 to 3 services since I started in the business in 2003, and 1 of the remaining 3 is getting ready to merge with us, and the other is in serious trouble. Those 2 currently remaining services have some horrendous medics, because they need them to put a body in the truck. It's a sad state of affairs, and again, I don't know the solution. I'll throw this out there, and maybe it's something for another thread entirely, but I've worked for 4 services (some at the same time), and I've seen one thing that seems to affect the quality of personnel and subsequently the quality of care, unit maintenance, policy adherence, etc. etc. That is this.....the 2 services that were non-union didn't seem to deal with slap-sticks, they were out the door when they proved to management that they were unable or unwilling to meet the standards. The 2 with union representation seemed to have a much harder time getting rid of the scumbags, and it's unfortunate because bad care, bad attitudes, and laziness seem to be more contagious than any disease.

Also, I think alot of our problem is the mindset that we're not a real profession. So few people I see around me have enough pride in EMS to look presentable or act presentable. And that effects all of us. Maybe, as Nathan said, if we made it harder to get into these positions, then although we'd have a smaller workforce, it would be a higher quality workforce. Bigger isn't always better, and I think most big changes happen by means of small groups of highly motivated people. Maybe it is time for a thinning of the herd, but I don't know how to go about that either.

I really don't have any solutions to these big problems, but I agree that overall, we in EMS are our own worst enemies.
Unfortunately I think we deserve the low level of respect that we get. We respond to calls in dirty trucks with our shirts untucked. Some of our managers are just happy that someone showed up at all, and argue against increasing education standards because it will hurt staffing. Then we go argue with cops, firefighters, nursing home nurses, triage nurses, and doctors. So why would anyone resect us.

Compare us to the nursing profession. Nurses have associates degrees, even the lowly nursing home nurses that we think we're so much better than. There are bachelor and masters degree programs for nurses. Each comes with more money and increased responsibility. Unlike EMS, the high demand and low supply of nurses has lead to more money for them.

So compare the nurses working today with the ones seen on Emergency! (except for Dixie), who answered "yes doctor" to whatever was barked at them. No one handed nurses the respect they get now. They earned it themselves, and EMS would be wise to learn from them.
Robert, Asys might disagree with you. After all, he is offended by the fact that some firefighters refer to EMS providers by perjorative names. Those names can't possibly be earned by the EMS providers, can they?
Justin,

Much, if not all, of what you say is true. Well it is true in some services there are others though that do not quite fall into these problems. Your analogy of security guards is actually quite accurate. However just like the private security company’s there are certainly different types of private ambulances. There is a far difference between a private security guard who does parking lot checks for a factory and private security firms who provide escorts and protection to foreign diplomats, movie stars, etc.

But for the sake of this conversation let’s assume that the vast majority of the private ambulance services fall into the first category and not the second.

I am interested in reading your, or anybody’s for that matter, opinion as to why?


Justin said:
I disagree. I believe the reason Police officers are more respected than paramedics across the board is because they all work for a municipality. EMS has a huge variety of models and no government representation like police and fire. Working for a private company often offers low pay and no public service type pension. Private EMS doesn't really seem to be a public service as much as it is a customer service provided by whichever company bids the lowest amount to that city/county/state. In private EMS the customer is always right, where as I believe you are given more benefit of the doubt with things like complaints if you work for a municipality. Furthermore, it appears private companies will hire anyone with a license and throw them out on the street to make money. This is not the same in any police or fire job where the jobs are very competitive. So pretty much what I'm trying to say is working for a private ems company shares more in common with working for McDonald's than it does with other public safety jobs. If you look at private security guards, how well are they respected? They are the closest thing to a private company police officer. Truthfully from what I've seen they aren't really that respected regardless how professional they look.

Plus if you think about it the lack of respect isn't usually from the public but from the government. Most of the public appeared to be outraged by the police officer attack on the paramedic. However, the laws nor the government officials are willing to stand up for a paramedic because it isn't a government position. If he would have been a firefighter/paramedic this would be a completely different story. The Fire Chief would have backed him and it would be a completely different situation. Look at the outcome from the police officer arresting the fire officer for not moving his fire truck. He lost his job and the fire fighter won a huge amount of money for wrongful arrest.


As far as the titles, police is much more paramilitary than EMS, especially private EMS. I'd prefer my partner not call me Paramedic Justin all the time lol. Even if you make up paramilitary titles(Sergeant, Lt. etc) for a private company it is kind of corny.

And for uniforms, you have to remember that many of us are in the uniform for 24 hours straight. If my uniform looks a little wrinkled at 2 in the morning it is most likely because I had to sleep in it. Uniforms should look professional but not to the point that they impair functionality. It is much easier to keep a uniform looking nice for an 8 hour shift than it is for a 24 hour shift.
One carries a bigger gun :) in all seriousness though the diplomat, body guard type security is more akin to a critical care transport team. Comparing convalescent EMS to Critical Care Team is kinda like comparing apples to oranges.

Gul Dukat said:
Justin,
Much, if not all, of what you say is true. Well it is true in some services there are others though that do not quite fall into these problems. Your analogy of security guards is actually quite accurate. However just like the private security company’s there are certainly different types of private ambulances. There is a far difference between a private security guard who does parking lot checks for a factory and private security firms who provide escorts and protection to foreign diplomats, movie stars, etc.
But for the sake of this conversation let’s assume that the vast majority of the private ambulance services fall into the first category and not the second.

I am interested in reading your, or anybody’s for that matter, opinion as to why?


Justin said:
I disagree. I believe the reason Police officers are more respected than paramedics across the board is because they all work for a municipality. EMS has a huge variety of models and no government representation like police and fire. Working for a private company often offers low pay and no public service type pension. Private EMS doesn't really seem to be a public service as much as it is a customer service provided by whichever company bids the lowest amount to that city/county/state. In private EMS the customer is always right, where as I believe you are given more benefit of the doubt with things like complaints if you work for a municipality. Furthermore, it appears private companies will hire anyone with a license and throw them out on the street to make money. This is not the same in any police or fire job where the jobs are very competitive. So pretty much what I'm trying to say is working for a private ems company shares more in common with working for McDonald's than it does with other public safety jobs. If you look at private security guards, how well are they respected? They are the closest thing to a private company police officer. Truthfully from what I've seen they aren't really that respected regardless how professional they look.

Plus if you think about it the lack of respect isn't usually from the public but from the government. Most of the public appeared to be outraged by the police officer attack on the paramedic. However, the laws nor the government officials are willing to stand up for a paramedic because it isn't a government position. If he would have been a firefighter/paramedic this would be a completely different story. The Fire Chief would have backed him and it would be a completely different situation. Look at the outcome from the police officer arresting the fire officer for not moving his fire truck. He lost his job and the fire fighter won a huge amount of money for wrongful arrest.


As far as the titles, police is much more paramilitary than EMS, especially private EMS. I'd prefer my partner not call me Paramedic Justin all the time lol. Even if you make up paramilitary titles(Sergeant, Lt. etc) for a private company it is kind of corny.

And for uniforms, you have to remember that many of us are in the uniform for 24 hours straight. If my uniform looks a little wrinkled at 2 in the morning it is most likely because I had to sleep in it. Uniforms should look professional but not to the point that they impair functionality. It is much easier to keep a uniform looking nice for an 8 hour shift than it is for a 24 hour shift.
Nathan,

Certainly I understand what you are saying and I somewhat agree. However I still believe the analogy stands.

Just like there is a vast difference between a security guard who checks for I.D. tags at a gate and a security firm who provides security escort services in Iraq. There certainly is a vast difference between a private Ambulance service who only provides dialysis transports and a private provider who provides 911 services to municipalities.

Both are private Ambulance services yet each is very different from one another.

But the point of the entire discussion, as I understood it, was respect for E.M.S. providers as a whole. To which Justin expressed his thoughts that private Ambulances were, in large part anyway, responsible for this. He listed reasons as to why.

I am not disagreeing with him at all I am just asking him (or again anyone for that matter) why? Why are most private Ambulances the way they are?
My opinion is that private EMS is like it is because of it's main goal, to make profit. Now granted there are some non-profit models and etc, but the main ones I'm talking about are the for profit private ambulance company. It is profitable to not pay your employees a fair wage. It is profitable to not offer retirement programs on par with other public safety positions. It is profitable to transport dialysis patients who can go via wheel chair van by ambulance and bill medicare for it. A police officer and firefighters roles are not to bring in a profit. An EMS provider's role at a private ambulance company is to make the company money. I understand this is how capitalism works, however people obviously don't want everything to work like this. Why can't I start my own "private" police or fire department? Probably because the public wouldn't trust someone who's main intention was to make money as opposed to protect the public.

Gul Dukat said:
Nathan,

Certainly I understand what you are saying and I somewhat agree. However I still believe the analogy stands.

Just like there is a vast difference between a security guard who checks for I.D. tags at a gate and a security firm who provides security escort services in Iraq. There certainly is a vast difference between a private Ambulance service who only provides dialysis transports and a private provider who provides 911 services to municipalities.

Both are private Ambulance services yet each is very different from one another.

But the point of the entire discussion, as I understood it, was respect for E.M.S. providers as a whole. To which Justin expressed his thoughts that private Ambulances were, in large part anyway, responsible for this. He listed reasons as to why.

I am not disagreeing with him at all I am just asking him (or again anyone for that matter) why? Why are most private Ambulances the way they are?
Hello all. i have been a Paramedic for about 32 years, all but the last 5 911. In the Military as an Indepndent Clinician as well for 20 years.
Item 1. "We", meaning EMS Providers "are the way we are" because of compassion for our patients. That is the underlying rythm. Ask the average (not all) 911 Medic/EMT if they would like to transport "Geriatric" patients... Those that answer privately "No!" will not visit thier grandparents when they are in need of 24 hr Skilled Nursing Facilities either. The same ones do this work for two things, "Sirens, Hurst Tools, and the highest wages."
Item 2. Making an Honest Living, while making a difference in the lives of others is honorable, be it 911 or Private.
all others, we hope the offices (DHEC, Federal Law Enforcement etc.) that govern innappropriate EMS practice in their States NAILS them. Because those of us who do it for a LIVING, the right way, suffer when those that do not are allowed to continue.

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