I have been seeing alot of discussions about EMS being referred to as "ambulance drivers" and noticed that some are getting pretty upset at the idea that they are not viewed as a skilled provider. I started thinking what makes an emt or paramedic a taxi driver/ambulance driver. I would love to know what people think the difference is between a skilled provider and a taxi driver and what kind of things have you done lately to keep from falling into that category??
There are a few reasons and they all stem back to providers themselves rather than anyone else
1) Type of Jobs EMS responds to evidence supports that 90% of EMS calls do not require a qualified paramedic to attend and could be dealt with by other healthcare options such as walk in clinics
2) Education of providers does not match that of other healthcare professions such as not having university based training as standard. We churn out ambulance staff on a conveyor belt and standards of underpinning knowledge is poor
3) Professional regulation, paramedics in general avoid change or regulation. Advance Practice Roles tend to fall away because understaffed and overwhelmed agencies see responding to emergency calls within the target time as priority over getting the right skills or care to the patient.
So most of the jobs are simply just collect and transport and paramedics feel that they do not practice their profession rather just shuttle people back and forth from hospital.
This is definitely an issue EMS providers have struggled with for a while. We just ran an article in JEMS about ways providers can inform the media about the 'ambulance driver' epidemic and push for change. Check it out here: http://www.jems.com/article/providers-can-do-their-part-combat-ambul
What really makes the difference between Ambulance/Taxi driver and Professional EMT is largely the providers attitude towards the profession; not to mention the patient. If for example someone becomes an EMT and just got by in school, only does the minimum CEU's to re license (at the last minute), and has the attitude that anything short of running a code is 'not an emergency' then that person is, as I see it an ambulance driver. If; by contrast, they studied hard in EMT school, does regular ongoing CE's, looks to continually expand their knowledge base and help mentor others than that person is a Professional EMT. Two people, same license, different attitudes.
So, when providers start belly aching about being called 'ambulance driver' they should first look in the mirror and ask "does my appearance/ demeanor exude professionalism?" Things as simple as having a clean, pressed uniform and a clean rig inside and out can help differentiate between the former and the latter
I recently discovered a press release from our local city police department with the title "Man dies after crashing SUV into parked car." in the press release it stated that "the victim was driven by ambulance to (xyz) Medical Center where he was pronounced dead." So even other agencies can be guilty of the degradation of the EMS profession. I have, after reading the JEMS article on this subject contacted the PIO for the local law enforcement agency to complain about the way the victim was described as being conveyed to the hospital
So, in order to combat the "ambulance driver' mentality we need to start, as a profession to raise the bar on EMS personnel. We need to support the national registry and their efforts to institute uniform EMS standards, we need to demand that initial EMS training occur at a minimum at the community college level (part of that includes premium pay for providers who hold an EMS degree), and we need to continue to work at integrating evidence based medicine into EMS.
Also, Neil I disagree partly with your assessments about '90% of calls not requiring a qualified paramedic and AP roles falling away because agencies see responding to calls within the time frame a priority over patient care' here in Texas at least we are really focusing on providing the right stabilizing care on scene then transporting to the most appropriate facility. It used to be that we would just ' bag and drag' to the ER especially with pediatrics now the protocols are better, allowing more clinical judgement to take place and educational standards are being tightened. At least in our corner of the planet. We'll see if national health care changes that, if that's what nationalized health care has done in the UK, all the more reason why we need to repeal it here, just say'n
Justin Poland A.A.S., NREMT-P, EMS-I
The types of calls...
When 90 percent of my daily call volume consists of nursing home runs, because the CNA's are too lazy to drive the pt to an appointment in a wheel-chair van and my "care" consists of making sure the pt can fog a mirror during the drive across town.
Happens more and more these days.
Calen, if that is the service that your employer provides, how does that change your status as a professional? If you signed up for the job, you have an obligation to do it professionally, to the best of your ability. If you don't like the job, find another. Compassionate transport of those who require it is one of the things that EMTs and paramedics do!
Don't get me wrong. I am not saying that I am not up to running such calls. Merely replying to the topic question "what makes us taxi drivers" and citing a local example.
I try to be a professional with all public contacts.
Perception is 9/10ths of reality. "If that's the service the employer provides," then those who refer to the Calens in this business as "ambulance drivers" and "taxi drivers" rarely (if ever) get to see "skill" in the "professional." All they see is a professional taxi driver with an EMT patch. What else is there to see?? What's so "skilled"(in either the Emergency or the Medical sense) about that, other than being helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, tucking in their shirt-tails and only wearing black socks with black shoes? Oh, and getting there on time and in one piece. Is it any wonder that such a moniker has stuck? It seems rather obvious to me. But, perhaps, that's just me.
Again, the question here is the difference between the "skilled professional" and the "taxi driver." We don't need to get into semantics about how anyone doing anything can be a professional. The context of the term in this thread is a given. If I'm wrong about that, then will the OP please step up and correct me?
Though it's off the topic, I couldn't agree more with you: "you signed up for the job.....If you don't like the job, find another." And, that is why I no longer work in a service such as Calen's. That is entirely why 4 years ago, "Rambo Ambo CCT Service" went minus one more "skilled professional." :)
Skip Kirkwood said:
Calen, if that is the service that your employer provides, how does that change your status as a professional?
As the original poster i appreciate all those that have joined the discussion. I think you all have valid points representative of your backround in EMS. When I hear the term ambulance driver from someone outside of our profession it doesnt bother me one bit. The general public and other healthcare workers are not aware of the specific levels of certifications that we have earned and have adapted the "ambulance driver" title for us. On the other hand, i have used this term to describe a select coworker(or two) that provide substandard care or are just plain lazy. We all know the type i am referring to. The clueless medic that has a "drive fast and do nothing method to treating critical patients". I also refer to those types as "fed ex drivers" b/c they act as if they are delivering packages and not patients in need of interventions. Whether in a private service or 911 provider we all respond/transport to a fair amount of "BS". After a 12 hour shift of hauling multiple patients with not one who truly needed to go to the hospital it is easy to view yourself as a "taxi driver". However, when you do come across a sick patient where your actions can make a postitive impact on their outcome it is time to play paramedic again. One aspect of the topic I have not seen covered yet is the "what have you done to keep from being called a taxi driver/ambulance driver?"
Thanks, Brennan, for the clarification. My point of view on your original post mostly is from a perspective of those on the outside of EMS looking in. Amongst our own, I have to say that I've never looked at an EMS provider or co-worker such as you describe and regarded them as a "fed/ex" or "taxi driver." I've simply regarded them as lazy and/or ignorant EMS providers who act in a manner that is less than professional. In that respect, and with your clarification, I think Chief Kirkwood could not have hit the nail more on the head with his description of an EMS provider's obligation to duty.
To answer your question in the clarified context of your latest post, I would say that:
a) I make it primary to uphold the duty I swore to do when I got my very first EMT card and uphold my
professionalism and integrity. At times, it can be hard to do. So....
b) I make sure I TAKE A BREAK. That means I have a life outside of EMS that has nothing to do with
EMS. I don't have a scanner. I don't chase ambulances. I have days off.
c) I try to round myself out. Fourteen years in a 12'x8'x6' box isn't healthy for the sanity, the physical
health, or the career. There comes a point where you hit the glass ceiling. I LOVE riding the box,
I still do it to keep my feet on the ground, but, it's amazing how your perspective widens when you
step outside the box. I transferred out of the field into Education and Training. Now, I'm involved in
planning, organizing, staffing, training, and other aspects of EMS which have allowed me to maintain
involvement, increase my knowledge, have a positive effect in many areas of EMS, and, most of all,
not lose my compassion and spiral downward into apathy.
d) I've also (in the past) quit 2 jobs with which I was neither satisfied with how they were being run,
or how they treated their employees, the standard of care and training they propagated, nor how
they utilized their resources. One of those organizations folded up shop and left town. The other one
still exists, but is no longer the same organization it was when I got there, and has problems
recruiting and retaining the caliber of employees it once had. And, I'm still, quite sane. I think!!
For what I've done, there ya have it!!
I am still amused at how so many EMS providers get so bent out of shape over a harmless term. Ambulance Driver? That is so bad? Oh for goodness sake there is more important things to gripe about.
On that note, if you drive the ambulance, you are an ambulance driver. If you attend to the patient, you are an ambulance attendant. Just descriptive terms. Stop whining.
Now, I will say that the disparaging connotation that so many EMS providers find in that term, is the manner in which they practice. I have worked with so many partners who only insist on driving, and little else. God forbid they get in the back and care for the patient and let someone else drive when the required level of care is appropriate. How can you not call these folks ambulance drivers? Everyone has worked with folks like that at least some time in their career, usually in a private for profit ambulance service.
And Skip, as much as admire you, I feel you may slightly be off base in your rebuke of Calen. EMS providers are trained to provide EMERGENCY medical care, and most get into the field for that reason. Then providers get a job with a private for profit service whose only goal is moving people for a fee like UPS moves packages. In these services, the EMS provider is nothing more than a traditional 'ambulance driver', by simply picking up a person from point A and delivering them to point B, without causing them harm. Little of their training is utilized. The same even holds true for many urban EMS providers who are faced with simply providing often a free service of transporting people who do NOT need an ambulance, let alone an ER visit. This is often frustrating to the average EMS provider, regardless of how 'professional' they are. There is plenty of literature out there showing that workers need to be challenged and want to utilize their skills and education. Sometimes, that makes up for low pay. But when they are not challenged and not paid well, it negatively effects their psyche.
There is ample enough professional peer reviewed literature to support the notion that boredom and under utilization of skills leads to decreased morale, apathy and typical effects of job related stress. I see this phenomenon so apparent in EMS. It is easy to reprimand someone who expresses the effects of this type of job related stress when sitting in the EMS ivory tower. It should be too easy to see how EMS providers with low pay and significant job stress become frustrated and seem to forget about the concept of compassion. It is easy to tell someone to get another job, and often, that may be an option, but other times, but for others, it may not be that easy, at least not right away.
Often when I see folks at transport services or abused urban services, I cannot help but wonder how they don't slip into a self-fulfilling prophesy of becoming just an 'ambulance driver'.
Right those EMT's who hate the 'Ambulance Driver" label need to stop whining when its a BLS patient and the Medic drives while they ride the call. For example I once had an isolated ankle injury, pain was 3/10, with splinting and cold compress was 1/10. EMT didn't want to ride it cause they thought pt needed analgesia, I'm like "hmm No!" Pt stable, vitals all WNL, no neurovascular deficits, likely sprained all pt needed as a comfortable ride to the ER and a set of vitals.
Now I still believe that work that is unstimulated, unchallengeable, and underutilized skills causes stress, burnout, apathy and other negative effects on the psyche, but I don't discourage new EMTs from working for transport services for many reasons and I tell them to make it a learning experience and the job will be what they make of it. They can learn all of the hospitals, nursing homes, personal care homes, etc. within their region, learn the streets and geography, learn a lot about medications and pathophysiology, etc. from reading the patient's charts, and learn how to even write reports based upon how RNs and MDs writer their nursing notes and H&P. They can learn how to interact with the geriatric population, as well as those with disabilities, especially special needs children, as well as the home health care equipment they use. They can learn to do vitals in the ambulance, and how to assess patients if they do it on every patient, and can find some abnormal findings that may have been missed by the nursing home staff.
The problem is, most people who end up in jobs like this tend to quickly evolve into being just ambulance drivers or basic attendants. They simply look at transporting patients as 'materials handling', or just moving people or objects, from point A to point B. They rely on the referring facility vitals, and don't take any more, and almost never do an assessment. They only look at the chart to simply transcribe the information for billing or the PCR.
A problem with EMTs who want to push everything on the medic may be simply "ambulance drivers" or lazy, but many are so used to ALS providers taking most of the calls, they simply feel uncomfortable taking a BLS trip. Many areas see BLS crews calling for a medic when in fact, they could transport the pt. BLS where it is warranted, and often can get the patient to the hospital quicker than waiting for a medic to arrive. That is a whole other issue.