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How EMS physicians became recognized and rewarded

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How our physician colleagues got respect

To follow up on last night's discussion on compensation, a board-certified emergency medicine physician with five to ten years experience earns an average of $258,000 per year, or $124/hour. (2009 data)

It was not always so. Forty years ago emergency medicine was a low-pay, low-prestige side job. The mom-and-pop community hospital with a dozen beds maintained a poorly equipped "Emergency Room" staffed by part-time or fill-in physicians.

Defining a Profession:

Medicine considers five factors in defining a specialty:

  • Unique body of knowledge
  • Professional association
  • Peer-reviewed vetting of knowledge acquisition
  • Testing of competence
  • Institutional training: internship, fellow, clerkship

Three organizations have pushed emergency medicine and EMS physicians into the light.

1968: American College of Emergency Physicians (ACEP)

The first professional organization, established Annals of Emergency Medicine in 1972 as their peer-reviewed scientific journal.

Establishing a scientific journal is a major component in establishing a specialty, from the Annal's website:

Annals is the emergency medicine journal most frequently cited by authors and has the highest impact factor over the years of all 19 journals in the emergency medicine category of the SCI (Science Citation Index). The impact factor (the average number of citations per published article) is the commonest measure of journal influence; the 2010 impact factor for Annals was 4.14, placing it in the top 12% of all 8,005 science and medical journals tracked by the SCI.

Not only is Annals most frequently cited, but it is cited more promptly and longer than any other emergency medicine journal (9.5 years, 83% longer than its nearest competitor). In the past 5 years, more than1,200 different journals in the ISI science journal database cited an article in Annals, and in a typical year, Annals articles are cited by more than 400 different scientific journals, most of them from a broad range of specialties outside of emergency medicine.

In 1979 Emergency Medicine becomes the 23rd specialty recognized by the American Board of Medical Specialties.

1984: National Association of Emergency Medical Service Physicians (NAEMSP)

One hundred emergency physicians established NAEMSP to define the needs and specialties unique to an EMS Physician. The first effort was a task force started in 1992 to establish EMS as an emergency medicine subspecialty. Their efforts moved the ball forward, but not enough to achieve recognition. The task force disbanded in 1996.

In 1997 Prehospital Emergency Care (PEC) was created as the scientific journal for emergency medical service physicians.

From the 2011 NAEMSP annual report:

In July, PEC received its third Impact Factor, which increased to an impressive 1.889. This Impact Factor placed PEC as the 8th most oft-cited Emergency Medicine journal out of the 23 that are currently rated by the ISI Web of Knowledge.

PEC had an even more impressive Immediacy Index, which indicates how rapidly articles that are published in PEC are cited in the same year. PEC had an Immediacy Index of 0.533.

This ranks PEC 4th out of the 23 EM journals that are ranked in terms of being rapidly cited. PEC continued to be placed ahead of such well-established journals as Journal of Emergency Medicine, Pediatric Emergency Medicine, Journal of Emergency Nursing, Emergency Medicine Clinics of North America, and European Journal of Emergency Medicine.

PEC is also the official journal of the National Association of State EMS Officials (NASEMO), the National Association of EMS Educators (NAEMSE) and the National Association of EMTs (NAEMT).

1998: United States Metropolitan Municipalities Medical Directors Consortium

Known as the "Eagles," this group is comprised of most of the jurisdictional EMS medical directors for the nation's largest cities 9-1-1 services. Read more about them HERE (510 minutes that shape EMS: The Eagles speak in Dallas)

Establishing a unique body of knowledge

By 2005 the professional, peer-reviewed literature was sufficient to make a second effort at establishing EMS physicians as an emergency medicine subspecialty.

NAEMSP members wrote a four volume Emergency Medical Services Clinical Practice and Oversight publication that covered four areas:

  1. Clinical aspects of prehospital medicine
  2. Medical oversight of EMS
  3. Evaluating and improving quality in EMS
  4. Special operations medical support

The books were published in 2009.

The content and organization of EMS Clinical Practice and Oversight matched the proposed curriculum for the EMS subspecialty fellowship.

EMS was recognized as an emergency medicine subspecialty in 2010. You can go HERE (How medicine approaches EMS credentialling) for details of the ems physician fellowship. The first board exam is anticipated in late 2013.

You get what you invest in.

I appreciate Skip Kirkwood's response to yesterday's article. It provides an appropriate conclusion to today's example:

My frustration comes from the failure of, or the unwillingness of, so many EMSers to "engage," to spend even a few minutes or a few dollars to advance their profession.  MANY are willing to speak, but a willingness to speak without the willingness to WORK on what you are speaking about is just whining.  And as a kid I learned (whap!) that there are few things worse than a whiner.

My second source of frustration comes from the "What's in it, or what's easy, for me" focus. Improving the stature of EMS in our communities, and improving the lot of EMTs and paramedics, is not rocket science. It involves improving educational standards, becoming active in political regulator affairs, and stepping up to take control of our profession and our work environment. Unfortunately, the response seems to be "If they're not going to pay me more, up front, I'm not going to make any additional effort in this arena."

Folks, you make the investment first, then you get the dividend. It works that way in the stock market, and it works that way in the economic, political, and academic environments.

Mike "FossilMedic" Ward

Posted by on May 21, 2012 • Filed under: Administration & Leadership, EMS Topics, Training • Tagged: , , , , , , , , , , , , ,

Keep Yourself Safe!

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Another excellent music video from Farooq Muhammad (KingFarooq Productions)

from FireEMSRescue:

A music video showing the potential hazards EMS professionals face on a day to day basis. It emphasizes the importance of safety while working under these dangerous conditions.

Blauer provided the funding for this project and is a huge supporter of EMS, Fire and PD all around the country. Please visit www.blauer.com for more information on their wonderful products and services

Mike "FossilMedic" Ward

Posted by on May 21, 2012 • Filed under: EMS Health & Safety, EMS Topics, Training, Videos • Tagged: , , , , , ,

Is EMS REALLY a calling?

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How do WE get engaged?

This video shows how a population was motivated to participate in their first free elections.

YouTube Preview Image

The Return of Ben Ali. On January 14th 2011, we chased former Dictator President Ben Ali out of Tunisia. Since then many had lost interest in politics.

After many uneffective attempts to push Tunisian people to go out and vote for the upcoming elections, a new campaign was set up in La Goulette, to the shock of residents.

Their reaction was filmed. Results: On October 23rd, there was 88% turnout when 55% were expected.

EMS: More than a job (??)

This year's theme selected by the American College of Emergency Physicians is: EMS: More than a Job, a Calling

If you have been following the posts by National EMS Management Association President Skip Kirkwood, you may have a different observation. He is not a snarky pundit, but someone who has been doing heavy lifting for EMS. I would say he is a little frustrated.

Working conditions for many paramedics are grim, near minimum wage.

The US Department of Labor identified 2010 median pay for 226,500 "paramedics and emts" at $30,360 per year ($14.60 per hour).

As a contrast, the 310,600 firefighters 2010 median pay is $45,250 per year ($21.76 per hour). Police and detectives make more than firefighters.  Registered nurses even more than police and detective, at $64,690 per year ($31.10/hour).

I appreciate that this year's theme is:

… reflecting the idea that EMS practicioners don't choose this field for big salaries, comfortable working conditions, or 9-to-5 hours; they have a true calling to help and care for others in their hour of need.

Over the same 38 years, physicians dedicated to the practice of emergency medicine have significantly improved their compensation and professional status within the universe of medicine.  Nurses have transformed their profession.

Why are medics still near minimum wage? Why are some single-role ems providers engaged in 9-1-1 service without the same worker compensation presumptions that fire and police have?

Celebrating working for free does not pay the rent

My three passions; teaching, writing and emergency service, are not known as wealth builders.

When I went to work full-time as a community college fire science program director, I was making less money than the rookie firefighters I was teaching … with a master's degree and a dozen years experience as a part-time college instructor.

At the beginning of every academic year, one of the college leaders would celebrate that a retired federal worker was teaching for free. After four years I left the college because of poor pay and threadbare resources.

This week we are going to look at issues affecting the profession of out-of-hospital care that will probably make you annoyed or uncomfortable.

Mike "FossilMedic" Ward

Posted by on May 20, 2012 • Filed under: Administration & Leadership, EMS Health & Safety, EMS Topics, Videos • Tagged: , , , , , , , , ,

Ambulance Red-Light Rollover

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A LEIPZIG, GERMANY, AMBULANCE WAS INVOLVED in a traffic accident on Thursday night that left the ambulance laying on its side and four people injured.

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The ambulance was responding to a hospital with a patient when it entered a controlled intersection against the red light.  An automobile traveling with the green signal failed to notice the ambulance in time to avoid a collision and struck the unit in the rear section, causing it to roll over.

The 71-yr.-old patient and his companion were both seriously injured.  The “orderly” and the emergency doctor, who were both also in the rear, suffered minor injuries.  The 26-yr.-old driver of the car and the ambulance driver escaped injury.

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Firegeezer notes:  Look how well the cot was anchored.

Mitteldeutscher Rundfunk has the story and a VIDEO HERE.

Hat tip:  Christian L.

Posted by on January 9, 2010 • Filed under: ambulances, EMS Topics, Vehicle Operation & Ambulances • Tagged: , , , , ,

LODD In Germany – Ambulance

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WHAT MAY BE THE NEW YEAR’S FIRST LODD occurred early this morning in the Kitzingen region of Germany.  A 1st-responder emergency ambulance/rapid response car was responding on a call at 2:30 am local time when it collided with an automobile at an intersection.

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The RR car can be seen on the left in the field in this photo by Berthold Diem

The 28-yr.-old driver of the “smart car” rapid response vehicle was killed immediately and his 20-yr-old partner was critically injured.  Police say that the RR car had its emergency lights on, however the car that it struck was in the roadway that normally has the right-of-way at the intersection.  The driver of the second car was uninjured and his wife suffered only a minor injury to her left leg.  They are both age 34.

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photo by Berthold Diem

There is no report yet on any charges from the police.

Radio Gong 106.9 has the story, more photos and a video report HERE.

Hat tip:  Christian L.

Posted by on January 1, 2010 • Filed under: ambulances, Line of Duty, Vehicle Operation & Ambulances • Tagged: , , , ,

Drunk Drives Head-on Into Ambulance

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A DRUNK DRIVER STEERED HIS CAR DIRECTLY INTO a head-on collision with a Grainger County EMS ambulance near Knoxville, Tennessee, late Friday night.  WVLT-TV reports that:

It happened around 8:30 p.m. while the ambulance was traveling south on N. Broadway. It had just stopped in the turn lane to continue onto Mineral Springs Avenue when a black Chevrolet Impala headed north crossed the center line and ran head-on into it.

Officers confirmed the driver of the Impala was drunk. He was arrested for several charges including fourth offense DUI, driving on a revoked license, refusing to take a field sobriety test, failure to maintain his lane, disorderly conduct and resisting arrest.

Nobody was injured and the ambulance only suffered minor damages.  The police said that the driver’s female passenger was also arrested for public intoxication and disorderly conduct.

Posted by on November 22, 2009 • Filed under: ambulances, EMS Topics • Tagged: , , , ,

Missouri Ambulance Damaged in Hit-and-Run Wreck

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A CAPE GIRARDEAU, MISSOURI, AMBULANCE stopped at an emergency scene early Sunday morning was struck from behind by a pickup truck that immediately fled the scene.

The ambulance owned by the Cape County Private Ambulance firm had just pulled up to the location and had its emergency lights flashing when the gray pickup rear-ended it.  The driver of the truck then backed up, pulled away and drove down a side street.  The collision occurred just moments before the medics would have been at the rear unloading the cot.

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KFVS-TV

A report from KFVS-TV includes the ambulance dash-cam video HERE.

Posted by on November 16, 2009 • Filed under: ambulances, Vehicle Operation & Ambulances, Videos • Tagged: , , , ,

Secondary Wreck Flips Ambulance

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A JACKSONVILLE, FLORIDA, POLICE OFFICER was conducting an accident investigation at an I-95 ramp in the city Tuesday and an ambulance was stopped at the scene while the medics checked the passengers.  While they were doing their tasks, a delivery truck failed to clear the wreck scene and crashed into the back of the ambulance, ramming it into the barrier and then flipping it on its side.  The truck continued farther and ended up demolishing the rear end of the police cruiser.

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WJXT-TV

Five people, including one of the police officers, were taken to the hospital for non-life threatening injuries.

WAWS-TV has this video report from the scene:

WJXT has the details HERE.

Posted by on November 11, 2009 • Filed under: ambulances, Vehicle Operation & Ambulances, Videos • Tagged: , , , ,

Ambulance Crashed Into by Drunk Driver

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A HOUSTON, TEXAS, AMBULANCE WAS STRUCK BY A DRUNK DRIVER early Thursday morning while transporting a patient. 

KRIV-TV reports:

Witnesses told investigators that the driver of the Honda was traveling southbound on South Dairy Ashford Road at approximately 80 mph when an ambulance was leaving a shopping center with a pregnant woman inside the van [sic]. The woman, who was 8 months pregnant, was involved in another accident on Westheimer Road and was to be taken to West Houston Medical Center.

Investigators say the Honda driver saw the ambulance too late and the car slid and struck the side of the ambulance….

KHOU-TV has filed some raw video from the accident scene:
(stick with it, some shots of the amb. show up near the end)

The police say that the driver of the car was highly intoxicated, unable to stand up, failed a field sobriety exam and refused to finish taking the exam.  He was arrested.

Posted by on October 30, 2009 • Filed under: ambulances, EMS Topics, Vehicle Operation & Ambulances, Videos • Tagged: , , ,

Another Stolen Ambulance

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FROM VANCOUVER, WASHINGTON, COMES A REPORT on still another stolen ambulance.  This time it was an AMR unit that was outside of a residence while the crew was inside tending to their patient.  A passing Vancouver firefighter had stopped in to assist and he saw the ambulance suddenly drive away.  He notified the crew and they called for a backup unit, then notified the police.

The missing ambulance was abandoned about 10 minutes later several miles from the scene.  Neighbors believe it was snatched by a local street bum that they recognized and the police are searching for him.

WKPTV Ch. 12 Portland has this video report:

Posted by on October 30, 2009 • Filed under: ambulances, crime, EMS Topics • Tagged: , , ,

Pay Me Now ….. Or Pay Me Later

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FAYETTE COUNTY, GEORGIA, DECIDED TO meet the economic downturn by not replacing three of their four 10-yr.-old ambulances.  Their original schedule had called for buying three new ambulances, one this fiscal year and two more in FY2010.  Earlier this year the County Commission approved $156,000 to purchase one vehicle, but they decided to hold off on the other three.

Those plans have now changed as the old vehicles are reaching a point of non-performance.  They are breaking down constantly and causing a drain on the fiscal resources anyway, so the commission voted 4-0 last week to solicit proposals to replace the other three.

The Fayette County News has the STORY.

Posted by on October 26, 2009 • Filed under: ambulances, EMS Topics, Funding & Staffing • Tagged: , , ,

Phantom Medic Earns $53,000

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A WOMAN WHO HANDLED THE PAYROLL for  the Bath County, Kentucky, EMS is in jail this morning after being charged with embezzling over $50,000 from the agency.  Angel Masterson, 36, worked for a private C.P.A. firm that maintained the payroll account for the ambulance agency and she set up a scheme to generate paychecks to herself.

When the EMS sent her this payroll list of employees and number of hours worked, she would  compile the wages earned and send the information to the bank where direct-deposits would be sent to the employees’ accounts.  Masterson simply added in a fictitious name along with her own bank account number which created paychecks to herself.

The scheme fell apart after she was fired from her job for poor work performance.  Her boss who had taken over the payroll account noticed the missing money immediately and notified the police.

WKYT-TV has the story and a video report HERE.

Posted by on October 22, 2009 • Filed under: ambulances, crime, EMS Topics • Tagged: , , , , , ,

Morning Lineup – October 21

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Yesterday’s story on the head-on crash with an ambulance (Firegeezer HERE) and a pickup truck that killed a grandfather was a sad story in its own right.  But for me it raised some questions about what was going on with the patient care.  The man’s legs were crushed beneath the dashboard, trapping him in the truck.  He was conscious and seemingly alert with no other apparent injuries, yet he died a few hours later in the hospital.  I’ve got a couple of things to ask about this, so please help me out here.

First of all, this is a classic case for using the shock-trauma pants.  They were designed for just this sort of trauma care.  Naturally, the news reports didn’t mention anything about that, and I wouldn’t really expect them to.  But the outcome of the event is exactly what happens with these things.  The inflatable trousers are ideal for stabilizing extreme leg injuries as well as serving the function of returning the patient’s blood back to his heart and brain.  Like I said, a classic case to use them.

But as I’ve said before, I haven’t peeked inside an ambulance in quite a while and I’m wondering if anybody even carries them anymore?  Have they been “disallowed” and removed from ambulances?  Have they been shoved out of the units to make room for newer devices and expanded equipment inventories?  Perhaps the shock-trauma pants are just not carried on AMR units.  If that’s the case, what a shame.  Let me know if you’re allowed to use them anymore.

The other item that started me thinking is in the newspaper story that we linked to in the posting.  They are reporting that during the extrication, the patient (Hager) pulled out his cellphone and called his family to tell them what was going on, right in the middle of the evolution.  They tell:

Vickory (a relative) said Hager called his wife while he was pinned inside the truck to tell her what had happened.

Vickory and three other family members converged at the scene and watched the rescue operation.

As half a dozen Tampa Fire Rescue workers ripped the top of the truck off and finally broke Hager free, Vickory yelled “He’s out,” and they rushed to see him, following as he was taken to the ambulance.

Welcome to the Wireless Age.  This strikes me as so strange an event.  It got me to thinking of how I would have reacted if I was doing an extrication and the victim whipped out his cellphone and started calling people.  I think my own personal reaction would have been to gently discourage his actions and insist that he not do that.  My justification would be that his fiddling with the phone is a major distraction to the life-saving activities going on around him and the need to keep him in communication with US rather than someone far away.  Priorities, you know.

But having hindsight available to us now, I suspect that some people would claim that the family benefited from the call because they got to see and talk to Gramps, giving him some final moments of pleasure before he passed away.  Knowing what you know now, what do you think you’ll do if you are faced with something similar?

We had better get this equipment checked out now.  I’ve got to get  the coffee started and then in a little while we’ll get together in the day room talk over the best action to take if our patient wants to describe his last moments to the folks back home while we’re working on him.

Posted by on October 21, 2009 • Filed under: ambulances, Fire Rescue Topics, morning lineup • Tagged: , , ,

Ambulance Gets a Cow

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AN AMBULANCE IN CENTRAL KENTUCKY WAS TRANSPORTING A WOMAN to the hospital in Lebanon ended up with three patients, the woman and the two EMT’s.  The Associated Press is reporting:

Kentucky State Police said the ambulance struck a cow in the road early Tuesday on Ky. 433, one mile south of Willisburg.

The 71-year-old patient, Virginia Lewis of Mackville, was belted into place. She was admitted to Springview Hospital in Lebanon, but for her illness – not a crash injury.

Troopers said the ambulance driver was 45-year-old Donald Milburn of Springfield. The EMT in the back with the patient was 50-year-old William Hagan of Lawrenceburg.

Both men were released from the hospital after treatment.

Posted by on October 20, 2009 • Filed under: ambulances • Tagged: , , ,

Head-On Crash With Ambulance Kills One

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A 64-YR.-OLD TAMPA, FLORIDA, MAN DIED THIS MORNING after an ambulance crashed head-on into his pickup truck Monday night.  The man was carrying his two grandsons home from a Boy Scout meeting and had stopped for some milkshakes at a fastfood restaurant.  As they were continuing their journey home, an AMR emergency ambulance was approaching in the opposite direction.  When the ambulance came upon a traffic backup, the driver noticed it too late and, jamming on the brakes, he pulled into the oncoming lanes to avoid rear-ending the stopped cars.

Unfortunately, Jerry Hager’s truck was in the lane and the heavy collision smashed the dashboard into his legs, pinning him in the truck.  Tampa Fire Rescue responded and extricated him  with two crushed legs.  At the time, he was conscious and talking and when he was taken to the hospital he appeared to be in a non-life threatening condition.  But less than nine hours later he died in the hospital.  His two grandsons, ages 11 and 13 are being treated for broken bones.

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St. Petersburg Times

Tampa Fire Rescue said that the AMR ambulance was responding to a call at the time, but the police have not confirmed whether the ambulance was running lights and siren or not.  The ambulance driver has been cited for careless driving.

The St. Petersburg Times has the complete STORY.

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Tampa Fire Rescue photo

Posted by on October 20, 2009 • Filed under: ambulances, Vehicle Operation & Ambulances • Tagged: , , , , , ,

Electric Ambulance Debuts

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THE ISLAND COMMUNITY OF TERSCHELLING IN the northern Netherlands is using itself as a testing place for methods of achieving a “CO2 neutral” environment.  So it was only natural for the tiny island of 4,700 residents to choose an all-electric car for ambulance duty.

Norwegian EV maker Think has adapted its Think City electric car into an ambulance configuration, but notably without transportation capability.  The UMCG Ambulance Service that provides EMS care for the island will be using the Think City as a first responder and only if transportation is required will they then send the regular ambulance.  Since there are only 12 miles of paved roadway on the island, range and response times are not a problem for the electric car.

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Think issued this press release:

The concept of electrical ambulances is not new. In fact, in the early 20th century ambulances were powered by electricity. Nowadays however, an electrical ambulance is a rare sight. The Dutch company, UMCG Ambulance Service is keen to demonstrate its environmentally responsible ethos, so has decided to complement its fleet of ambulances with an all electric Think City.

With a range of 180 km, the Think City is well suited for the distances covered on the island of Terschelling. Fully equipped with life saving medical equipment, the ambulance gives good support to the other ambulances and is very well suited for giving first aid.

Terschelling is located in the northern Netherlands and is one of the West Frisian Islands. A large part of the island has become a nature reserve and the municipal of Terschelling is working hard to reduce emissions to become a CO2 neutral island. The Think City electrical ambulance is making a vital contribution to achieving this goal.

AllCarsElectric.com has more HERE.
Think auto makers WEBSITE.

Posted by on October 19, 2009 • Filed under: ambulances, EMS Topics, Vehicle Operation & Ambulances • Tagged: , , , ,