Dear Sirenhead: I don't think you went far enough in your response to Matt S. in "Ribbing Over Cribbing" (August 2001). His partner was 5' 8" tall and weighed 250 lbs. Even if they did have training and the proper tools to stabilize the overturned vehicle, it's doubtful his partner would've been physically able to help him.
Doesn't this highlight the need for at least minimal physical fitness standards for EMS personnel? We don't need to pass the same tests as firefighters, but we should be in good enough shape to help our patients.
-J.E., Washington
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Requiring minimum physical fitness standards could wipe out 30-40% of the EMS workforce. A lot of rotund rescuers work the streets. Problem is, we sit in our trucks too much and only wheel our patients around 75% of the time. After we do work our butts off-lugging Mrs. Jones down 14 flights of stairs-we go to Burger King and wolf down a double-double cardiac burger, fries and a chocolate shake.
For our own health, and the safety of our patients, our profession should have some physical fitness standards. It's embarrassing to see an EMT or medic in worse respiratory distress than the CHF patient they carried down just eight steps.
Instead of posting providers near street corner hot-dog vendors, our bosses should wake up and allow us to shoot some hoops, run on a Stairmaster somewhere or pump some iron. That way we'd be happy, and they'd have fewer back-injury claims to process.
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Dear Sirenhead: While on an extended vacation recently, I traveled throughout the United States and did ride-alongs with various EMS agencies. Five were fire-based, two were hospital-based and four were private systems. It was a great experience for me.
As I left each agency, they wished me luck on my next ride-along and several said they'd love to hear how they compared with the others. While I wouldn't want to compare the agencies, I felt compelled to write to you about several of my observations.
1. The fire-based, public systems appeared to have the best-maintained equipment and a more stable workforce. Several of the people I rode with had been on the streets for more than 15 years with the same agency. These crews worked together like well-oiled machines. Where I come from (a non fire-based service), that's not the case. People here often move from service to service.
2. Hospital-based EMS providers came across as the most contented and knowledgeable people I encountered. I felt it was because the hospitals in which they work treat them more like professionals. They also appeared to have the tightest control on medication distribution, medical control, chart review and quality-assurance practices.
3. The personnel in the large private systems didn't appear to be long-term employees. Those who were hold supervisory, training or management positions. The field personnel seemed unhappy with their pay and envious of the vehicles and equipment their neighboring agencies-fire- or hospital-based-had.
4. Some of the EMTs and paramedics I met in small, private firms were longtime employees. Several told me they were happy where they were and had no desire to go elsewhere.
Am I off base with these impressions or am I on to something?
-Carl J., Massachusetts
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I think your observations are right on. I often compare the little appliance store and Sears with the small private services and ambulance companies who trade on Wall Street. A small appliance store has no major investors or taxpayers supporting it and can't buy supplies in bulk or replace their delivery vehicles every five years. So you'll often find their delivery vans are a little older and rustier than the Sears fleet, and their employees probably earn less and don't get dental benefits. It costs them more to operate, so they pay their employees less to turn a profit and remain in business. The folks in the field get financially screwed.
But that doesn't mean the people who work for the small ambulance companies offer lower quality care to their patients. I've found some of the brightest and most caring EMTs working in Hometown, USA, for the only private firm around. Sure, they could pick up and move to the big city. But then who would care for the family members and friends they have in the community? They stay because that's where their roots are.
Hospital systems tend to treat their employees with more respect because they're integrated into the medical staff. This higher respect requires EMS crews to get involved in more chart reviews, patient care audits and continuing education. As an added bonus, I know a few hospital-based medics who've gone on to nursing or medical school-often paid for by their hospital in return for service to their facility after graduation.
Fire-based systems have the benefit of public funds, annual apparatus upgrades and quality retirement plans to keep their employees longer. But as I'm sure you saw during your ride-alongs, almost every station has a useless longtimer they'd gladly trade in for one of those dedicated home-town EMTs (or a Dalmatian) if they could.
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