Win a T-Shirt: contribute your thoughts on EMS: Success, Failures and Future Challenges

1. What do you feel the greatest successes EMS has had? The advancements in ems education. This is enableing EMS to be reconized as a profession rather than a bunch of "wackers".

2. What have been the greatest failures? Not being reconized as professionals in the past by the medical community. Also the political barriers between ems services that seperates us from our common goals of good patient care.

3. What direction would you like to see for the future? A county wide based service with better wages, benifits, so provides can only work one Job to make a good living!!

1. What do you feel the greatest successes EMS has had?

The creation of EMS, enabling those in need to access pre-hospital care has been the greatest success of all.

2. What have been the greatest failures?

I don't see anything about this system as a "failure." Any "faults" or "deficiencies" that have been in the past, and the present, are all tools to better the overall system.

3. What direction would you like to see for the future?

I would like to see a more stable EMS environment that is governed and managed by one body, such as countywide services. This would be beneficially in many ways. You would not have the political fighting between privately owned services. EMS personnel would be able to work better together because everyone would work for the same "team." Government funding would go to one service to distribute to their stations based on need. This would also eliminate some of the areas where there are several services close together that one service can efficiently cover, thus saving money and resources.

1. What do you feel the greatest successes EMS has had?

The advancement in equipment and skill levels.

2. What have been the greatest failures?

Deficiencies are more like it. A great deal of EMS workers do not look or act professional while working; the EMS evaluation system, especially for EMTs and EFRs, is very lax; those in leadership positions are appointed for the wrong reasons, i.e. favoritism, default

3. What direction would you like to see for the future?

Consolidation of EMS agencies, possible a county wide system. Move to an entire tax based system, as all public safety should be. Maybe it's just a pipe dream, but it's an idea.

1. What do you feel the greatest successes EMS has had?

The greatest success in EMS has been the ability to physically take the Emergency Department/ ICU to the patient. This was first done by visionaries (LOCATED IN PITTSBURGH) who believed in the abilities of non-professionals to be trained in the delivery of this specialized care.

Since the middle-60's, EMS continues to make positive strides in equipment, education, pharmacology and oversight which result in improved prehospital patient care and outcome.

2. What have been the greatest failures?

I believe the greatest failure in EMS has been our inability as EMS professionals and practitioners to establish the profession as a necessary part of the medical arts.

Those of us who work in EMS have failed to change the perception that that the public and the healthcare community as a whole have of us. Unfortunately we never established it to begin with. The perception that "their only ambulance drivers" or "emergency service workers" is the key issue in our profession not being completely accepted. We have allowed others to label us and have done little in promoting EMS as something more than a janitorial and transportation position, to clean up after the ill and injured and haul them away. I believe we have failed to legitimize our profession. As a group, we have neglected to take charge of our careers and have allowed people to ignore our singular purpose.

3. What direction would you like to see for the future?

I would like to see EMS become MORE recognized as the life saving practitioners we've become in 40 + years. I would like to see equality in public safety and receive the same respect and recognition for our profession. I would like to see equity in employment that our brother and sisters receive in the police and fire services. Lastly, I would like our profession to take advantage of the many opportunities to provide an expanded scope of practice. This can only happen when we begin to solve our own recognition issues.

1. What do you feel the greatest successes EMS has had?

I feel the greatest advancement in EMS recently has to be the state finally stepping in and coming up with state wide protocols that make it much more uniform for everyone.

2. What have been the greatest failures?

I'm not sure failure is what I would use either. There are some defeciencies in EMS.
I believe EMS as a whole wants to be accepted as professionals but in EMS as a whole we fail to do that because there are no uniform dress codes, no codes of conduct, etc. Any service can make up their own rules instead of banding together and having uniformity amongst EMS as a whole at least in the county or hopefully the state. Also too many different command structures to comply with in EMS. There should be one command structure that all hospitals abide by so all of EMS can be on the same page and avoid tremendous overlap in requirements, repeated trainings, etc.

3. What direction would you like to see for the future?

I would like to see the county step in first of all and stop all mutual aid agreements leaving it up to county dispatch to call in the closest agency instead of politics being involved at the service level enabling a faster response in most emergency situations. I too would like to see consolidation of smaller EMS agencies with others to make them stronger and more viable for the future like some of the Police departments have done in the past. I would also like to see more outreach involving EMS and the residents of the areas that we serve. Last I would like to see destination command be utilized by all hospitals so you are speaking with a doc that will actually be seeing the patient you are transporting making the transfer of care that much more efficient.

1. What do you feel the greatest successes EMS has had? Early Defibrilation and improved trauma rescusitation.

2. What have been the greatest failures? Injury prevention and community education.

3. What direction would you like to see for the future? I would like to see further injury prevention and community education. In my opinion, before we can be taken seriously as a profession, we must stop patting ourselves on the back and prove our worth by being more proactive. We in EMS like to say that we need parity with Police and Fire, but the those other 2 components of public safety have also worried less about "what are we getting" (especially for EMS week)and been more active in promoting safety and what they can do for their citizens. I believe that we must shadow them in this particular fashion.

1. What do you feel the greatest successes EMS has had?

The greatest success EMS has had is the people who do this job. Without us, EMS would have been lost long ago. The willingness of those people to learn to care and treat those in need of care in a pre-hospital setting make this a very successful and important part of the process of the sick and injured to begin to heal.

2. What have been the greatest failures?

I don't see any "failures" in EMS. EMS is very dynamic. With advancements in science and technology, EMS can only get better. Better equipment and techniques to treat the sick and injured. Better vehicles to transport those sick and injured patients to hospitals. As science and technology advance, EMS will follow this trend and will be ready for any situation with trained professional who can handle any call.

3. What direction would you like to see for the future?

I would like to see EMS continue in the direction of science and technology. We, as professional, strive for the best in any pre-hospital situation. Continuing education and advanced skills keep us up-to-date with this everchanging profession. Patient care and providing the best for them is always a goal for those who care enough to risk their lives for the sake of a stranger.

1. What do you feel the greatest successes EMS has had?

The ability to advance with all of the changes in our field. The acceptance of the sick and injured to let us into their homes and let us practice our craft as professionals.

2. What have been the greatest failures? The public relations perception of our profession. Although most folks we deal with are appreciatve of our efforts, the news outlets just cannot get our job figured out, despite the huge "billboards" on our vehicles and uniforms. Its frustrating that they do not recognize us as a profession as paramedics, etc.

3. What direction would you like to see for the future?

Being able to take care of pt care at their homes. Being able to give flu shots, treat ear aches, dispense tylenol for fevers and such that doesn't need an ER visit, but we transport anyway because familes have no other way to get care. I would also like to see better dispatching triage to save valuable medical services being sent for frivolous, non-emergency care problems that wear out providers and their equipment.

1. What do you feel the greatest successes EMS has had?
Continual growth. From "push one of the 'red boxes'" to ALS Notification & 12-Lead EKG interpretation. In my 'just 14 years' in EMS I have seen miraculous improvements in technology and interventions that we now bring curb-side that used to be only available in a hospital setting. The pioneers and current leaders in EMS from the small municipal services to the large urban services are always looking for how we can improve our service to our community and improve continual decrease in morbidy and mortality.

2. What have been the greatest failures?
Acceptance as a profession. Unfortunately a small percentage in our profession do not realize how important image and attitude impact the publics vision and impression of EMS in general. This 'small percentage' impacts the entire profession. RN's in ER's STILL call us Ambulance Drivers! We need to prove we are professional and deserve to be considered in the same league as our acute care colleagues, not just expect it because we passed our EMT or Paramedic test!

3. What direction would you like to see for the future?
EMS becoming more of a home safety net with expanded scope protocols and procedures. Paramedics can be doing home health care to an extent. This could creat an entire new 'specialty' in prehospital medicine.

Bringing CPAP to BLS providers has been one step for the future, there are still other 'advanced' procedures that EMT's can complete with proper training. EMT-I's would be one step that seems to not get beyond discussion.

We need to hold accountable those who 'go through the motions' and do not provide a COMPLETE 7 days a week/24 hours a day full ALS unit IMMEDIATELY available. The days of responding form home to the station to pick up the unit and then meet a partner is no longer acceptable. That was the 1970's and early 80's! If we are to be concidered professionals, we need to staff like it.

1. What do you feel the greatest successes EMS has had?

a. The fact that EMS is even around and sustaining as a profession is an accomplishment. Since it's birth we have seen fairly rapid progression into a service which can provide swift and potentially life saving interventions, or at the very least palliative care. We are also an extremely versatile group, able to practice in the field or in the hospital.

2. What have been the greatest failures?

a. Specific to western Pennsylvania, EMS saw rapid growth, but now we are stuck in a plateau, while other states pass us by. As one of the pioneers of EMS, I think it is shameful that we are not still on the bleeding edge of EMS research and protocols.

b. The statewide protocols released recently no doubt brought some regions a step or two forward, however, many of us took a few steps back as far as autonomy in the field. Also, I notice an inverse relationship between skill levels and location relative to a hospital and call volume. It seems the most experienced personnel and best equipped services are those in urban/suburban areas who could almost throw a patient to the nearest facility. In the rural areas you have services that average a call a day or less, have less equipment (are sometimes BLS) and a very long transport time, sometimes as long as 20-30 minutes.

3. What direction would you like to see for the future?

a. EMS education needs to change, and all EMS providers need to unite, much like the nursing profession did decades ago, if we are ever going to progress from a tradesman to a professional.

b. ALS/BLS skills need to be re-evaluated. There's no reason things like glucometer use should be ALS only skills. Most people consider states like West Virginia to be behind the times, yet their BLS protocols allow for glucomoter use, ASA administration and Combitube placement (and have done so for many years).

c. Review approved medications and the protocols that go along with them. With the new protocols, you need to call command to give pain medication for anything other than an isolated extremity trauma. If you are that worried about narcotic use without command, then give us something like Toradol to use instead. Paralytics would also be nice. Some areas don't have a 5 minute ride to the hospital, and it's a waste of resources if you have to call an aeromedical service just to knock someone down and tube them. As I mentioned above those in rural areas really need some options, as they are sometimes a good 30 minutes from the nearest level 3 facility and perhaps an hour or more from a level 1 trauma facility. What happens when those services can't rely on aeromedical because of inclement weather?

d. In the long term, after EMS education changes and we are recognized for the highly educated professionals we are, I would like to see even more autonomy in the field. As we all know, emergency medicine isn't always an emergency. People are using EMS and the emergency department for complaints that were traditionally handled by a family doctor. Such use often puts a strain on EMS and emergency departments, as we all have seen. Ideally, with more education, perhaps close to a CRNP or PA, we could provide care in the home, without transporting to the ED. This would get people in non-emergent situations time to be seen by their regular doctor. These would be the people who have been sick for a week and decided at 5am on a Saturday they just couldn't take it anymore. In some countries (the Netherlands, I think), the EOC determines whether your condition warrants EMS. In a litigious country like the US, I don't know if we could get away with a system such as that. What seems more plausible in a non-emergent situation, would be to have EMS respond and after evaluation and confirmation that there is no life threatening emergency, consult with a physician, who could then call in an RX in addition to what we could give ourselves to buy time until the Pt could see his or her own physician. The legal hurdle with this scenario might be insurmountable, however at some point in the future, especially if we end up with socialized healthcare it might be something that needs to be entertained. We should be preparing for such eventualities by emphasizing education and skill retention and portability of those skills into the hospital or even clinic setting.

e. No doubt that some paramedics won't want to be subject to more education or provide more advanced skills. It probably would be a good idea to create another level of paramedic, EMT-P2 perhaps, which would require more education, but would have the advantages of being able to provide more advanced care and have higher pay grade. It would then be up to the individual to attain that accreditation and become employed at a service which utilizes the EMT-P2.

1. What do you feel the greatest successes EMS has had?

It has evolved into a proffesion that requires quality education and common sense. The technology available is now producing tools made for EMS, not adapting something to "make it work"! Our scope of practice has expanded well beyond what was ever envisioned. We are saving lives and making a difference with a far greater frequency, which should make us very proud of who we are and what we do!

2. What have been the greatest failures?

Differentiating ourselves from the media tag of "other rescuers". We are well educated, professionals whom the media and the majority of the public view as ambulance drivers. We need to sell ourselves better, we need to be as visible as the fireman down the street or the cop around the corner. We need the public to understand that we bring the ER to their home. That if it was not for the ALS interventions, the 12 leads that are sent to the ER, the life saving medications we have at are disposal, they might not see the ER. EMS is beyond its infancy, we need to be in the forefront beside other public safety agencies, not behind as the other responders!

3. What direction would you like to see for the future?

Increased training requirements. Increased scope of practice. More stringent requirements on local governments forcing them to fund adequate ALS coverage, not settle for BLS with ALS backup from a distance. Major PR push on a local,regional, as well as a national level showing what EMS does, what it can do, and what it takes to get it done. With proper recognition of the hard work the EMS providers provide, we would be able to get the pay that is deserved as well as get an increase on the number of raw recruits wanting to join us in taking EMS to the next level.

1. What do you feel the greatest successes EMS has had?

I feel that the one of the greatest success in EMS was the creation of state wide protocols. I feel this was important because it has stopped medical command systems from competing for EMS services. I remember the days then command A would promise a EMS service their new protocols would be better then command B protocols. I feel it should go one further steps with a state wide medical command system. I think these days it is crazy that a paramedic still has to have multiple medical command privileges to practice the same state wide protocols.

2. What have been the greatest failures?

The greatest failure of EMS is the acceptance as a profession. This not only goes for being accepted by other medical professions but farther. EMS works on the streets just as fire and police but are not covered by the heart and lung act when they are injured on the job. This is an act that then a paid firefighter or police officer is injured on the job they get 100% of their salary tax free. I also feel it is a failure that EMS has to beg medical insurance for payment and have to has subscribtion drives. Why can't EMS be a tax bases service just like fire departments and police departments. I know there are some tax based EMS services but they are very limited. This is the only way EMS employees will get better pay and benefits.

3. What direction would you like to see for the future?

I would like for PA to look at what other states to see what their standards of care and protocols are. I worked in Florida as a paramedic/firefighter for three year before moving back to PA. I worked there in the mid 1990 and our protocols back then allowed for greater patient care. It seems that PA is always slower to come to the times. I would like to see the EMT-I be set in place. If you are interested in seeing the protcols I used google Martin County Fire/Rescue of the City of Stuart Fire/Rescue.

1. What do you feel the greatest successes EMS has had? I think the greatest success has been the expansion of paramedics scope of practice. I first became a medic in 1987 and had very little pre authorized standing orders. With todays protocols I feel we are truely trusted with the care and treatment of our patients. The medical directors that I have worked with have the utmost respect for what we do. I believe that from what I have seen the patients of our region recieve the best possible prehospital care available.

2. What have been the greatest failures? That's easy. Politics and teritorial boundries. I think it is a public health crisis when volunteer BLS services will not have an appropriate ALS service dispatched along with them on ALL high priority calls.

3. What direction would you like to see for the future? The day of free prehospital care is over. I am against raising taxes as much as any other tax payer, however I can not see any other option for underfunded and understaffed EMS services. We are grossly underpaid. There is no insentive to draw young people into EMS. We have to work 80 plus hours a week in order to pay our bills. Our legislators need to get off their butts and realize that third party billing is no longer providing enough funding and begin providing assistance to the EMS system.

1. What do you feel the greatest successes EMS has had?

I feel one of the greatest sucesses is the implication of C-PAP in the prehospital setting, I personaly have had multiple uses where it has saved from intubation and long term hospitalization.

2. What have been the greatest failures?

I would have say injury prevention and physical fitness is a downfall in most ems systems.

3. What direction would you like to see for the future?

I would like to see EMS become county run systems, I think this would alocate resources better and provide better care to our communities, while providing a better work environment and more compatibility between employees.

What do you feel is the greatest success EMS has had?
EMS has had quite rough time gaining "credit" in this world. I personally have only been in EMS almost 6 years now. an EMT for 4 and a medic for just under 2. Ive knowtice from working in two different states and several different areas. In all areas the EMS system has greatly gained the trust of civilians. from EMS first starting in the "mother, jugs and speed" days it had progressed in to a "cant live without" nessisity. EMS does exactly what it should, prehospital care and treatment of patients. Now EMS provides in the field can identify a STEMI and get the ball rolling on the cath lab. We can call stroke alerts and "raise the dead". EMS is the best way to get people the treatment nd care they need. most of these treatments require immediate intervention by the paramedic inorder for the patient to have a better chance of survival. 60years ago the mortalilty rate was higher because we used to be "ambulance drivers", now we have evolved into Paramedics, EMTs, PHRNs and Critical Care Medics. The success that EMS has had by increasing the survival rate of the ill and dying is excillent. even though the save rate my be small in the long run you have to take a look at the big picture in the fact that almost everybody EMS has to medically intervene on will have a grater chance to heal and live.

2. What have been the greatest failures?
One large failue of the EMS is the lack of trust in some medical systems. From having worked in several different EMS systems i can say that the lack of trust in the medical system in the greater pittsburgh area is huge. Ive only been working in the pittsburgh area for 5 months now but i have seen that the faith doctors have in EMS is less that other systems. (please do not take this as an insult to the EMS system of this area, this is just info for your speech if nessicary, i love this area and am origonally from pittsburgh and love my job in this area, this is no insult by any means.) EMS in ohio is very gung ho and trusting. Paramedics fresh out of medic school do not follow the provisional command system, they are given the preverbial blessing and sent on there way. the protocals are very aggressive involving surgi-crics, RSI, bougies, and a very large array of medications that medics carry. in PA a new medic must call the command doc and get orders for just about anything. the command docs a very good and very lienent and know what is going on. the protocals can use a change, take the lasix for example, any medic needs to call for orders to give lasix. from what i heard was the reasoning behind this is that too many medics were misdiagnosing CHF and giving puenmoina patients lasix. this in my opinion goes to a great failure of EMS and that is training. Too many prehospital providers dont have the knowledge to differ between a puenomnia and CHF. This can be fixed in many ways through training and expirence. Between training and "faith in EMS" we are doomed never to evolve into nothing more than "the bastards of medicine" . Yes i know it goes hand in hand in that protocals are so so so nonagressive due to the fact that certain EMS providers dont have the knowledge and skills to effictivly treat patients. The training and knowledge of certain provediers needs to be increased to the point where EMS protocals can become more aggressive. dont punish everybody for one persons mistakes.

3. What direction would you like to see for the future?
i would love to see the stem of abuse in the EMS system. too many people call an ambulance for sore throats, stubbed toes and leg pain. These nonemergent calls tie up EMS units and were not tthere when a real emergency comes in. yes i know that sometimes when we show up on what is suspected to be BS it turns out to be a "good" run. But EMS providers in the area need the ability to triage in the field. if some one has a sore throat and just needs a ride to the ER because they dont have a car and dont want to pay for a taxi EMS should have the means and ability to give the "sore throat" a free taxi voucher for a ride to the ER so that they dont tie up valuable EMS. if we could do this it would reduce the amount of BS that the ER directly sees. yes the patient will ultimatly end up in the ER but by the patient coming in POV the ED can force the sore throat to wait until the resources are availiable to deal with them. EMS is EMS, not a taxi even though its treated as a taxi everyday. EMS needs to be able to triage patients in the field do reduce the BS flow and free up units. Cities like Pheonix and Dallas have the ability to hand out free taxi rides. The city of Dallas paramedic can refuse to transport a patient if they find no reason that the patient needs to go to the ER. If the patient has a reason but it is nonemergent the medic can give out a taxi voucher. thats just freaking sweet! along with the taxi issue for the future i would like to see what i wrote above about the more aggressive protocal. i had to have the PACER unit RSI my patient one day because i didnt have the means to do it myself. i find that insulting and im sure many others out there do too. If need bee put on a special class for the RSI and once you complete and pass the course then your able to RSI. dont let just anybody out there be able to RSI because frankly there are some people out there i wouldnt want to have the ability to RSI. make it a special privilage if you (as doctors) dont think that "a special skill" is for everybody. me persoanlly i would take every class nessicary to make me a better paramedic in the long haul. i do this job for one reason and thats the people. if i had more weapons in my arsenal to do my job i know that would just make my day and patients day a little bit better.

THESE ARE ALL PERSONAL OPINIONS AND IN NO WAY THE VIEWS OF MY COWORKERS OR MY EMPLOYER, FORGIVE THE SPELLING

1. What do you feel the greatest successes EMS has had?

Most wouldn't know it, but there are a handful of EMS advocates out there with nothing more than a paramedic certification who have educated themselves and done great things for EMS. Others have advanced degrees and do amazing and difficult research for the betterment of EMS. These individuals share a common devotion to EMS. The fact that EMS has grown these individuals to advocate for itself is an amazing thing.

2. What have been the greatest failures?

The in-fighting amongst the interest groups. Without a cohesive voice, we fail.

3. What direction would you like to see for the future?

The industry learn how to support itself. Industry sponsored research that is open and transparent. Not industry-product sponsored research, but local agencies donating a handful of dollars to a big pot to fund research the government can't or won't fund.

The greatest success is in the reduction of mortality and morbidity to the public especially in rural areas with no close access to hospitals. This has enabled many people to have the ER come into their homes that in the past would have not had access to.

The greatest failure and I dont just blame this on service managers but insurance companies, the economy, the goverment etc but the evolution of EMS into the non emergency transport and wheelchair van service world. I know not all services do this but im a strong believer in that a 911 EMS service provider is to provide the citizens of the areas they serve with a crew ready to respond to emergencies first and foremost which has not been my experience where ive worked. This had put a greater emphasis on getting paid and stripping townships of emergency crews. Dont get me wrong there is definetly a need for this service and I have nothing against 911 services doing them but not at the expense of the citizens you ve sworn to serve.

The direction I would like to see EMS take is a greater role in its own destiny down the road, continue to push for its own federal chair in a dept. more fitting then the NTSB, more lobbying the fed and state govt. for greater reimbursements that match the level of service that we provide, to continue to evolve EMS as technology continues to bring more advancements to the field.

1. One of the biggest advances has been 12 lead EKG transmission. Also real time CPR feedback.

2. Attitudes need to change in EMS. EMS is not all about lights and sirens and driving fast. We have failed in our ability to retain providers, losing them to other areas of medicine including physicians, nursing and PA's to name a few. The number of ambulance accidents and fatalities. We do not hold providers to a high enough standards. For the difficult situations we face, the wages do not match.

3. EMS needs to move more into chronic disease management. Policy changes are necessary so an expanded scope of practice is reimburseable. There is often "down time." This time needs to be put to better use for training and other revenue streams. EMS needs to become more recogized in the media.

1. What do you feel the greatest successes EMS has had?
The change from only being in the field to being able to have jobs inside hospitals and dr's offices. We no longer are limited to just ems with our certifcation.

2. What have been the greatest failures?
Not moving the skill level of a emt-b to what other states let them practice. We could be doing so much more.

3. What direction would you like to see for the future?
Better communication between emsi and emt/paramedics. The lack of attention to more details in the certifcation and recertifcation is unbeliveable.
We also need to push for better safty when it comes to running calls. The need for scene safty has gone to the way side with the years.

1. The care that can be provided to a pt in the prehospital setting. Example 12 lead transmit a pt today was sent to Presby that was having an acute MI, because of the 12 lead the pt was going straight to the table. The C-Pap that is cutting down on pre hospital intubations and shorter stays at the hospital. The KINGS that ANY E.M.S. provider could place. Over all the care has came a long way from the days that we were held back from doing any care and were just AMBULANCE drivers.

2. Some of the failures in E.M.S. that I have seen are the rivalries between services and the way they act toward eachother, losing sight that we are all out their trying to do the same JOB. (To help someone that been injured or sick, or if some one just needs to know that there are people out their who do care about them.) The way some look down on the people that we treat. The lack of training with neighboring companies. The fact that we have lost sight of the COMMON GOAL THAT WE STARTED WITH, to help the sick and injured !!!!!! No matter what time of the DAY or NIGHT it is. One last thing, the lack of care that we are all capable of doing, however not aloud to do.

3. I would like to see the E.M.S. field open the scope of practice up as to the treatment that can be provided by E.M.S.. The working relations between the services, as well as the training that is offered to the E.M.S. providers. I also would like to see providers more involved with the community. I also belive that if the E.M.S. providers were to spend more time in hospital they could see how their treatment does affect the pt's out come.

1) Success in EMS has been ALS/BLS standard protocols trying to get everyone on the same page finally. 12 leads and ASA in the field. CPAP getting away from intubations. Better training , improved skills. Computer based PCR's. Agenda for the Future of providing and becoming a better instructor. Actually seeing the new CPR work and treating patients with hypothermia , better survival rates from this. Putting AED's into the hands of First Responders and EMT's . Allowing EMT's to admit some medications and airway devices plus the greater use of the Epi-Pen . Becoming more standard across the board finally.

2) FAILURES No standard uniforms to look professional. NO STANDARD WAGES to keep the professional in the profession ( Why go to Paramedic school and come out making $ 9.00/hr while a fresh out of high school person can go to McDonalds and be a manager and make much more). Along the same line some services decrease pay for the field staff but the top person makes $ 80,000.00 or more. Not enough community education or respect for the profession ( I have RN's still calling me the Ambulance Driver when most of us know and can do more than her.) Abuse of the 9-1-1 system by just about everyone including dispatchers ( dispatching you bravo for 20 y/o with a simple headache because they have no other way to ER, which is also abused itself. ) The system is broke or broken and it needs fixed. ie transport of non emergency 201 and 302 patients. Lack of local , state, and federal funding for the system. Poor reimburement for services not only medicad, but medicare and other insurance . The fraud by some companies such as put the monitor on the injured toe patient and the medic has to ride the back.Lack of Accountability on our people the fire service does it why cannt we. The is a big safety issue. The poor working relationships in some places between fire and EMS we are all one Public Safety ( Police, Fire, EMS, 9-1-1, ) FIRE and EMS need each other so it helps to be crossed trained. Lack of a state wide retirement fund some will have nothing when they retire with 20-30 years in the profession. Basically we are being crapped on by the same people we put in office all the way around . Poor ambulance standards killing most of our brothers and sisters, even with EVOC still nobody knows how to drive and we run lights and sirens more than we have to.

3) THE Future : Able us to treat and release , give Flu-shots and Tyenol ,immunizations , ( we carry alot of other medications that are more fatal) The mass admit of Antibotics and the greater training for the Mark I kits. Suturing in the field ( again treat and release) Maybe Video to the ER doc's for treat and release. Better dispatching ( hold non-emergencies or give persons a taxi token, if all they need is a ride, Allow us to down grade calls if they need a wheelchair van or some other assistance ( office on aging , handicap, etc.. ) Do better to utilize staff keep more units available. Quit transporting the same patient every day for the next seven when they do not even need us. Greater cooperation between FIRE and EMS and POLICE and other agencies. Better equipment expanded scope Ultra sound in the field , more advanced training on mass casualties, triage, haz-mat, WMD, Bombs etc.. A more safe ambulance , better cleaning and disinfecting products .better lifting devices our patients are not getting lightier , they are getting huge, so a better standard on our health and safety have you noticed some of us are heavier than our patients and we should practice what we preach.

The greatest success?
Clearly the advances in technology such as 12 lead EKG, CPAP and wave form technology are the greatest success in EMS.

The greatest failure?
This is the conundrum of education, professionalism and salary. Expanding the scope of practice for EMS will always be limited by a technology based education when an academic based system is necessary. Increased educational standards bring increased wages but the system in this area limits itself by perpetuating volunteers and small services. Where to start? The small services need to swallow their pride and merge into bigger services which can pay a decent salary. 24 hour shifts are dangerous but are only used because it allows people to work multiple jobs in order to support their families. Improved professionalism starts with the individual. Comb your hair, shave, tuck in your shirt, don't wear a baseball cap and for pete's sake learn to speak and spell correctly. You won't be respected if you look and talk like a hick.

Direction for the future?
We need more involvement from our medical directors. We can't grow if the only time we see our MD's is when we go into the emergency room. I have known MD's that didn't even know the location of their services. But this is a two edged sword. If we expect our MD's to come to our base to teach and run calls we need to pay them. You get what you pay for and we are getting little because we don't value the input of our MD's enough to pay them for their time and expertise.

1. Greatest Successes? I think having a national curriculum is a great success. To have everyone nation wide trained with the same material provides consistency throughout the US.

2. Greatest Failures? There are many!

To begin with the lack of recognition of professionalism. This comes from having so many various agencies run so many different EMS entities. IE: EMS based, paid and volunteer; Fire based, paid and volunteer; Hospital based; Community based; For profit services; Politicians...etc. This has created a lack of consistency from community to community; state to state; county to county. Some areas are paid and some are volunteer. Some are all ALS and some have no ALS and minimal BLS. There is no consistency as to who or what is at the helm. How can we as a profession ask to be recognized as more than an ambulance driver when some services roll into an er looking like they just crawled out from under a rock!? Remember the negative actions of a few have more impact than a million good actions of many. So we need to clean up our act.

Secondly the national curriculum is taught however everything that is taught does not necessarily mean you will ever use the skills one has learned. This is because of the lack of nation-wide consistencies in the whole emergency care system. Many services are limited by what their medical director deems necessary.

Third, The quality of education we receive. Despite the national curriculum the quality of instructors are not there. Some do not even understand what they are teaching. "Those who cannot do teach" Guest speakers come in for training days and have no idea what we do.

Fourth: We have become social services on wheels. There is a serious lack of education of the public on when to call 911. We need to correct the "have a problem call 911", mentality. The "Lack of planning on your part does not constitute an emergency on my part" occurs on a hourly basis in many EMS systems. When the dispatchers do not know who to send or have no one else to send, they send EMS. In our service almost every Fire call is an EMS call, many police calls are an EMS call as well. We have become a ride for everyone who's Dr. cannot see them when they demand. Many days we are an expensive taxi service. We are called to transfer people from a chair to a bed; fill water bottles; cook a meal; explain medicines....the list goes on and on.

3. The Future?

We need to educate ourselves, the public as well as the media. We need to develop a system of checks and balances of ourselves and monitor ourselves better.

Greatest success? When I started in the business, we took traumas to the local hospitals where they often died, strokes were a sentance to lingering disability or death, and heart attacks were treated with bed rest. Therefore, I would say that our ability to incorporate the dramatic advances in treatment that have been made into our practice and the refining and defining of our role in the patient care continuum as our greatest success. We now respond quickly with high tech equipment and well trained personnel, initiate advanced treatment and rapid transport, and insure that the patient is delivered to the most appropriate facility in a timely manner. 33 years ago, patient outcomes were dismal. Now we see excellent patient outcomes on a regular basis, and to me, this makes it all worth while.

Greatest failures? The lack of acceptance as peers in the health care community. This is in a large part our fault, because we still cling to our current fragmented EMS systems. We will be considered true health care professionals when we, as a body, act like health care professionals. Runner up for the failure award is the unfortunate tendency for some of our weakest practitioners to rise to the top as administrators. Many of our so-called leaders would not last a minute if they actually had to run a large EMS operation AS A VIABLE BUSINESS. The most experienced and knowledgeable people are either actually running EMS organizations or are on the trucks. They are either too busy or too tired to become training instructors or get involved in organizations such as ACEMS or PEHSC. Thus, the rules are made by those who have the time to go to the meetings...not the most qualified.

Direction for the future? 1. Consolidation. By transitioning EMS into larger, professional services we will lose the stigma of being a rag tag bunch of yokels. Furthermore, as consolidation takes place, everyone will begin to work together (as other health care professionals have done long ago)and begin to gain acceptance as health care professionals. This will also result in improved pay, benefits, and most importantly, quality of service delivered to our communities. One caveat: There are many EMS systems out there that are not viable. Future designs should think outside the box and see what works. A bloated, inefficient system that eats up ever increasing amounts of tax dollars is not in anyone's best interests. 2. Expanded scope of practice. The public should think of EMS as essential players in the health care system. We should be able to treat and release, rather than transport patients to our already overcrowded emergency rooms. We should be doing home health, giving vaccinations, health screenings, and a host of other services. WE SHOULD GET PAID FOR THIS! In the long run, we can fill an essential role in health care that ultimately will save money and improve the health of the general public.

1. What do you feel the greatest successes EMS has had?

I think the greatest success EMS has had definitely has to be the Advancements in treatment and technology over the years. The way we as providers have been able to develop and use new technologies to help us treat our patients is incredible. The fact that we have the ability to transmit 12 lead EKGs wirelessly to physicians is simply amazing. The integration of tools such as CPAP and the IO drill and even the new hypothermic treatments for post cardiac arrest patients allow us to further treat our patients in ways that would have never been thought possible a few years ago. The integration of GPS in many ambulances has enabled faster and safer response times. GPS also has allowed dispatchers to locate the closest ambulance to the emergency enabling much faster response times. It is advances like these that truly show we are successfully improving treatment and care with advancements in technology.

2. What have been the greatest failures?

I think EMS has several major failures that are keeping us from advancing further. The first failure of EMS that came to mind was the lack of public awareness of who we are and what we really are capable of. Unfortunately to the public eye the general consensus seems to be that we are "ambulance drivers" and nothing more. The fact that the public does not know a lot about us actually causes several other major problems.

Today many ambulance services are closing or are struggling to survive because of money or the lack there of. Insurance companies are not reimbursing adequately forcing cuts to be made and stations to close. Millions of dollars are given out by the Federal and State Governments each year for public safety. Unfortunately EMS seems to receive little or none of this money at all as a vast majority of it seems to go to Fire and Police.

The third failure that came to mind is Recruitment and retention (or the lack there of). Unfortunately I think the two failures above stem directly into this problem. If the general public knows nothing about EMS how can we recruit them? How are they going to want to choose a profession they know little about? How can we expect to recruit people to this profession when someone right out of high school can walk into a fast food restaurant and get a job requiring little or no training making equal or more money than the average EMT and Paramedic? Providers currently working in EMS are leaving the field all the time to seek higher paying jobs because they cannot make ends meet.

3. What direction would you like to see for the future?

There are many improvements and changes that I think should be made to EMS. If we correct some of these problems I think many other problems EMS is experiencing will be self corrected. For example, If we increase public education and awareness of EMS we might have an easier time obtaining funding through the State and Federal Governments because they will have a better understanding of what we do and why we need more money. With more funding going to EMS wages will increase. Public education/ awareness and wage increases will help with recruitment and retention. If public is taught about EMS and if working in EMS has good pay I think more people will show interest in this profession. Higher pay will also increase retention making current providers think twice before leaving this field. Increased funding will also enable further research and development of new technology and equipment for us to use in treatment of our patients.

Another direction I would like to see in the future for EMS is increased training and requirements for education. I would like to see a move form certifications to Licensing and requiring degrees for EMS providers. Increasing the education requirements for EMS will only improve EMS. It will allow more advanced treatments to be performed by providers and it will also improve the general publics respect for us as EMS professionals. The general public will have to think twice before calling us "ambulance drivers".

I did not become an emt until I was 46 years old. It is incredible experience I am getting. My biggest regret is not getting into it sooner. I can say one good thing, I know my knees and back are still in great shape, unlike the others my age in this field.

EMS as a business is great...for the ppl in the front office or board room. EMS went in the toilet the day when the started to run dialysis pt's all over this earth. The dialysis Pt gets more respect and more resources than the actual 911 or county calls. I know dialysis pt's pay the bills, but as soon as I get my medic, I am flying the coop for a big city service THAT DOESN'T DO TRANSFERS!!!!!!

1. What do you feel the greatest successes EMS has had?

EMS in 40 years has definitely made a difference in pre-hospital care. The days of someone showing up with a gurney and taking you to the hospital without any care. Or even the days of no pre-hospital care system has made a big difference in survival rates from different ailments. We have come from days of "Ambulance Drivers" to "Pre-Hospital Care Professionals."

2. What have been the greatest failures?

That as much strides as we take to make ourselves professionals, we still do not get paid what we deserve, and maybe that is the results of certain things that we allow to happen such as the abuse of the insurance companies. It shouldn't be allowed for a Dr. to sign a medical necessity for someone to get a return trip from a hospital and once you pull him or her out of the back of the bus they get up and walk the steps. That I feel is one of the biggest failures.

3. What direction would you like to see for the future?

That we continue to make strides to progress our selves with training and education, to continue to gain the public's respect as Pre-Hospital Care Professionals.

1. What do you feel the greatest successes EMS has had? we are the first step to patient care before the hospital gets the patient due to our training and the equipment we carry we can start the treatment tp help the patient . with out these thing all we would be is first aid taxi drivers.
2.What have been the greatest failures?
the idea that the ambulance is a taxi for people who does not have a life threatning illness . while we are busy dealing with them we could prolong our responce to someone who needs us more . and defantly the pay ,we are all under paid for what we deal with and the advance training we haft to have to keep our certs. or to get them in the first place .
3. what direction would like to see for the future? more training , better pay, and a better understanding from the hospital and the public that we are there for emergencies not for rides to the hospital if they have they have a cold or have been ill for a couple of days or for all the other non emergencies they have and that the hospital wants them to leave they call us to give them a ride home .