In the comments to Getting Our Panties in a Bunch Over Being Called Ambulance Drivers Turbosinaboy writes –
In my case (and all my buddies) being called ambulance driver is like being called ‘school bus driver’ or ‘taxi driver’. Need to say we actually live in Mexico, and maybe the context is not the same. There are actually ambulance drivers; people whose only job is to drive the ambulance, no more. In our case, sometimes we are called the equivalent of ‘stretcher bearer’ (people whose only job is to move patients from one stretcher to another and to drive patients through the hospital, not even nurses). The matter is not about asking for respect to our/my trainning and education, is something more. We are EMT’s and we perform a job that has some value in caring for patients, and that job is a part of a chain of actions. When somebody calls me ambulance driver I am not the only one affected; that means the MD at the ED believes we just pick up the patient, put them in a strecher and ran to the hospital while we watched them, like if the patient would have been dropped from a cab in front of the hospital; that leads to think the care of the ill and injured begins in the ED, and everything before is useless or nonexistent.
Watching the patient is the most important part of the job.
Assessment and reassessment and more reassessment and even more reassessment – until we arrive at the hospital.
I have to correct some partners who put the monitor on the back of the stretcher facing the back, rather than the side. Am I going to sit behind the patient and just be an ECG Tech, or am I going to continually assess my patient?
The people who disrespect EMS are those of us who will sit behind the patient, only able to see the top of the patient’s head, without the ability to assess anything other than what is visible on the monitor. They might as well ride up front with the monitor up there. The cables should reach.
Then, when the ECG Tech gets to the hospital, he disconnects the monitor and rolls the stretcher in to the ED (Emergency Department). It appears almost coincidental that there is a patient on the stretcher. We might as well be delivering a package, rather than a patient. How is that ECG Tech going to assess the patient’s rhythm, sat, and pressure? This person has just demoted himself from ECG Tech to stretcher pusher.
If we want respect, we need to behave in a way that is deserving of respect.
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We have been called sometimes when people is very ill and even so the wife/husband/mother asks us not to do anything (not even IV) until the ED, as if they were not confident to let the ‘taxi driver’ and his pal to stick a needle in their loved one.
I try to explain to the person why I think it is important, or I ask them to sign a refusal form and explain to me in clear language that demonstrates that they understand the risks and benefits of refusing treatment.
Nurses and doctors are faced with the same problems. The patient who wants the doctor to start the IV, not the nurse. The patient who will only talk with their doctor, not the emergency physician. This is certainly not specific to EMS.
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Asking for not being called ambulance driver is far beyond asking for respect. I believe it’s a way to get the public educated, through a simple name, in what that guys who arrive in an ambulance can actually do for their health and life.
And while we are at it, we could make sure the public only calls for true emergencies, but I don’t see that happening.
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I believe Emergency Medical Vehicle Operator (EMVO) is more appropriate.
But that’s only the opinion of somebody who can hardly figure out the true perception of being called ambulance driver in a different language.
Essentially my disagreement is with “demanding” and “earning” respect.
I do not demand respect. There are people do not respect me, possibly due to their ignorance of my abilities. That list includes about 7 billion people. Will I change any significant portion of those minds? They do not know me and they probably do not care that they do not know me.
If I tell someone that they must respect me, they may realize that their behavior was disrespectful, they may realize that their behavior was misinterpreted as disrespectful, they may decide to argue with me over this demand for respect, or something else. Rarely will this improve the care of that patient.
A conflict with a doctor may lead to worse care of patients after this patient – “I’m not giving any orders to that arrogant medic demanding respect after only a thousand hours of school. My hairdresser has more education!”
I only try to put things in the perspective of whether something is good for the patient. “You can call me whatever you want, but this is what should lead to the best outcome for the patient (for your family member).”
In order to get appropriate orders for my patients, I try to demonstrate to the doctors that I understand the possible complications as well as the benefits. There are a lot of medics who do not have a good understanding of this. Many paramedic programs do not appear to have a problem with graduating medics like this. The certification exams do not screen out these medics.
If we want any respect, we must raise our standards.
As long as we tolerate mediocrity, we do not deserve respect.
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“I have to correct some partners who put the monitor on the back of the stretcher facing the back, rather than the side. Am I going to sit behind the patient and just be an ECG Tech, or am I going to continually assess my patient?”
I sit in the jump seat for transport quite often, with a couple of caveats:
1. It’s the safest seat for me to be in during transport.
2. All my interventions are done.
3. My inner ear tells me weird things when I am sitting sideways and moving forward, all while scribbling a report. Spewing on your patient is considered bad form. Seating in a rear-facing seat where I am less affected by the sway of the rig helps keep my cookies untossed.
3. My rear rig windows are reflective, and I work at night. So I can still see the patient’s face and upper body, and they can see mine.
But you’re right. Sitting in the jump seat where you cannot interact with your patient is bad form.
Excellent illustration of how assessment and reassessment requires linking at the patient and not just the instrumentation.
EMS Outside Agitator put it very well at the end of most recent posting: “Something I might have missed, and re-reading Kelly’s R-E-S-P-E-C-T blog it dawned on me that I wasn’t thining in terms of Correcting anyone when they called me an ambulance driver. I was thinking in terms of making the effort to correct that image in the public’s eyes so I wouldn’t have to any more.”
The place to get the public to refer to us as medical professionals is NOT by correcting an agitated patient or relative, and NOT by getting in an argument with a frazzled ED nurse or MD at the end of a long shift. We need to change the perception by public outreach (such as teaching hands-only CPR at county fairs, or helping staff free screening clinics for the elderly). We change the public’s perception win our everyday interactions with them. And yes, we change the public’s perception by keeping up with medical advances and raising the bar wih regards to education and continuing education and research.
Unfortunately these debates about nomenclature or terminology too often get bogged down in emotional responses and hackneyed images and perceptions. i am wholeheartedly in favour of addressing the issues from the perspective of effective communications. I also speak on my own behalf as a professional (non-paramedic) who has worked in the public and private sectors as a professional dealing with policy issues and more recently health and paramedic practice for many years. It helps to take an objective, outside view of what works and what doesn’t.
You can talk as much as you like within the occupation and EMS sector but you will continue to have difficulty getting appropriate recognition of funding needs, training and clinical practice until you reach the ears of the decision makers and alter the perceptions of kindred health professions and the public. In terms of healthcare I also commonly imagine myself as a patient – the only person who is in the journey the whole time – and I analyse what happens and marvel at the silos within health, and the common disconnect between people who should be working as interconnected professionals.
And to bring about change let me assure you that language is extraordinarily powerful. You need to analyse the ‘triggers’ that motivate people and their perceptions of role and that involves language.
You need to get paramedics into positions of policy development both locally and nationally and you need to develop a stronger sense of inner strength and professional ethos and ‘own’ the profession. (My perception for what it is worth) That’s what the national professional body in Australia has been doing for some years – and it works! It takes time but a promoting a coordinated consistent message does have an impact.
What needs to be appreciated is that paramedics also carry the skills and competencies that create a class of out-of-hospital health care professionals whose skills and knowledge are able to be used in a variety of settings; as extended care practitioners in community healthcare and industrial site roles; as emergency room practitioners in association with nurses and physicians; and most obviously through their principal employment roles for various EMS and crisis care providers.
When it comes to the employment of the paramedic in an ambulance (EMS) service it takes
but a small step to realise that it is the paramedic who provides the care and interventions
to the patient – supported by the great resources of the mobile clinic and transportation resources
provided by the infrastructure provider. That is similar to a medical practitioner who works within a hospital setting supported by the hospital and diagnostic infrastructure.
Just as a hospital (per se) has never treated anyone, neither has an ambulance. But they are both vital parts of the infrastructure of healthcare that enable the practitioner (in this case paramedic) to perform his/her role.
So the role of a paramedic needs to be envisaged as a healthcare professional working in a
symbiotic relationship with the communication and infrastructure resources created by
the particular service provider(s) and as a participant in inter-professional practice. That’s my call for what I want as a patient at the centre of it all.
That will only be possible if you use appropriate terminology that properly describes the role and scope of your practice. Use the throwaway terms at your Saturday home barbeques, but be consistent and professional and earn your stripes (or respect) by your demonstrated competence in healthcare delivery described in terms that match the role.
[Sarcasm]
All of those points aren’t important as long as people who aren’t in any power to change anything are calling us “ambulance drivers” Until John Q Public, who has no real ability to advance or regress the field, stops calling us “ambulance drivers,” we’ll never have the respect that our 1000 or 140 hours of trade school training deserves!
[/sarcasm]
Well, as someone who has undertaken public education programs I suggest that every person has the capacity to bring about change. That means every one of us and every citizen who has a vote.
One of the more effective ways I have used to bring about change is to monitor the media and then engage the program producers, directors, scriptwriters and journalist who help to shape the public opinion. Politicians will soon respond to that because most of them want to stay in their positions.
Now note that such activities are outside the immediate EMS sector (but don’t forget that as well). It means communicating with politicians regularly and not just once a year with a visit ‘on the Hill’; It means being part of the health community so the professionals in other fields get to know you. It means proactive engagement in a positive sense and promotion of higher education and relevant research. It means having a strong professional body that can establish and promote effective policy positions nationally. If you have that, then that’s great- but my suggestion is that if you don’t, then look into becoming more unified and think of the profession as a whole and not as disconnected units. Perhaps leaven the hero image somewhat by adding a little more health into the mix. But in the end it’s your choice how you play it – I’m merely an observer, potential patient, and member of joe public.
My theme is simply that you must go about any change management program as an exercise in communications; and in that respect, even the nuances of a particular word can have powerful connotations and affect public perceptions.
When was the last time you voted on a Medicare fee schedule?
When was the last time you voted to change the education requirements for EMS?
When was the last time you voted to influence or produce research regarding EMS?
The actual problems facing EMS are not the problems put up to a popular vote and are not the issues that are commonly on the radar of elected officials.
Regardless, even if all EMS providers were recognized 100 percent of the time at their actual level (which would be impressive given the bastardization of levels that some states have) by everyone everyplace, none of that actually changes the issues listed above.
Not being called “ambulance drivers” doesn’t change the state of the research.
Not being called “ambulance drivers” does not change reimbursement schedules or rules such as the transport requirement.
Not being called “ambulance drivers” doesn’t change the education requirements to align with the breadth and depth actually needed to provide prehospital emergency medical care.
Now I do agree that particular words have powerful connotations, but I don’t care what the public thinks or uses. I care what the legislatures use. I care what the fine people at the Centers for Medicare and Medicade Services use. I care about what language academia uses. However, if the people in these categories are more than just passing involved with EMS, I expect that they should know the difference because they should be educated in the areas that they are regulating, legislating, teaching, and researching. Activities that the average John Q. Public isn’t involved with.
G’day Joe,
A it happens I have had considerable contact with the relevant legislatures at State and National levels and that has had a very substantial impact on the recognition of paramedics for undergraduate and postgraduate scholarships and continuing professional development support alongside other health professionals,
Similarly paramedics are now part of the advisory committee for professionals on the national health workforce planning commissions and there are paramedics now being appointed to regional hospital governing boards.
And one doesn’t have to get things to a vote to achieve progress. Many changes are feasible through the bureaucratic and policy levels.
That progress has come from a focused and dedicated program of awareness-building, multiple submissions on EMS and healthcare policy and a pervasive presence across the health landscape. It has come from targeted discussions with advisory staff and Ministers and Secretaries of State legislatures and close liaison with healthcare lobby groups and health reform groups. It has come from sponsorship of university academics and winning of teaching and learning grants. In other words, strong advocacy and forward thinking in policy terms rather than looking behind and smarting from perceived omissions. One must look ahead, because that’s where we’ll all be spending the rest of our lives.
So I’ll end my contributions here with the comment that in my view communication is the key to understanding and change, and words and language are the foundations. Images are terribly important too, but I’ll not go there right now. Thanks for the discussion.
We do a lot of “educating the public” about what we do.
Most of them have no idea whatsoever of the different levels of certification, or the difference between the rescue squad and the ambulance, or why it may or may not be better to go in an ambulance than a personal vehicle. Regardless of what they call people, they still don’t know anyone’s job, really.
So we tell them.
As a non-transporting agency, we tell them that we are there to take care of them until the ambulance gets there.
If there’s time- meaning if we don’t have other things that need to be done at that moment- we’ll tell them what will happen once the ambulance is there, and what level of care they will be getting. When the ambulance arrives, we introduce the patient to the medic and transfer care.
We often explain to families what the level of care is in the ambulance. Around here, I’d rather be in the ambulance than in the ER. One-on-one immediate care, no waiting, and the quality of care is equal or better until the patient needs something that neither the medic nor the emergency room docs can provide. It’s like bringing the ER to you, for the most part.
I think that the level of respect we show for the medics helps the patient understand that they aren’t just drivers, if they had that misconception. Likewise, the level of respect the medics show for us helps the patients feel comfortable and cared for by professionals, even if we are “just volunteers.”
A caveat: I’m speaking very specifically about the interactions of myself and my crew, and the medics we often work with, not necessarily for anyone else anywhere, let alone near here. I’ve put a LOT of effort into building my relationships with the medics and am aware that not everyone does that.
Call me whatever makes you feel good, just don’t call me late for dinner.
Seriously, does it really matter that some little old lady called you an “ambulance driver”? Hell, I get more upset about being called a fireman.