Anyone else in a system like this?

[Gatewayhoward]

I have been a paramedic for almost a year now. I move from a mixed volunteer and career department in the East coast to a private EMS company in Phoenix. The standing orders are great, you can do just about any skill or med without having to talk to a physician and only have to tell the hospital you're coming. Unlike the east, where you had to patch for half your skills and meds and lacked about five or six meds.

But the way the system is set up is so terrible that it's making me consider giving up the road or atleast working there part time and working at a hospital. As medics, we are tought to be aggressive and function as leaders on scene. In AZ an engine or ladder truck HAS to be on scene before the ambulance. Okay, in the east, fire would be there half the time and stabilize the situation, and once the ambo gets there, it's their medical scene. In this jurisdiction, the fire crew has two medics that take charge the entire time. you will wait and assist the crew while they order you and your EMT partner what to do, and where you're taking the patient.
We're looked at as just the transport. We have no real authority on scene. If it's an ALS call and the fire medics don't know you, they will always ride to the hospital with you and they continue to take charge. Most of the skills you'll do would consist of IV's and meds.
Okay, I'm super aggressive and I get in there and tell them what I'm going to do, so it's not as if I'm being timid on scene.
It seems that they run so few fires here that to justify all their nice equipment, they have to be the EMS heroes on EVERY CALL. So we're looked at as just the private EMS transport that assists them. And we have to fight to get any real experience, like those fabled sink or swim moments we crave as agressive providers.
To add to all of that, I get constant gripes from ER doctors and nurses on how bad fire medics are and how they're so cookie cutter. So it's funny how us 'gourney jockeys'

My question is this: Are there other jurisdictions in the US this terrible? Or is this a trend in the private EMS world?

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[sentrosi]

Dude man...that is a horrible horrible setup. Though, a lot of FD don't have enough fires to justify their existence...which is why most of them have expanded to EMS to some degree. Sounds like the department you work with went to the extreme.


I actually volunteer with all student staffed, all student run EMS service at my university (MIT). We are BLS only. Yet, whenever we show up on the scene, it almost immediately gets handed over to us. Sometimes ALS (if needed) even looks to us for whatever...because their might be whatever bizarre stuff going on in labs or because we know the campus a billion times better. And the thing is, the service is made up of almost exclusively EMT-Basics with less than 2 years of volunteer experience (our minimum is 50 hours a semester, plus monthly drills). Of course all crews are required to have one experienced EMT as a crew chief. Still, we manage to command the respect at our scenes.

 

[Gatewayhoward]

.

 

[Gatewayhoward]

That's something I left out, in this system, they hate EMT's. They only drive and assist the medic. THe medic always has to ride in the back. So EMT's here get not real experience. So basically, fire are the real EMS heroes here. I'm just wondering if other jurisdictions have a set up this bad cause I want out. To go be a REAL medic.

 

[Apollyon]

In the area I used to live and work in, there is one set of municipal paramedics, and I could swear that you were talking about them. The company I worked for has a dedicated BLS ambulance for them, but, on occasion, an ALS truck would go out. I got myself in a little bit of heat for calling these idiots on their ****ups. One notable screwup was one day in the winter. I was in med school at the time, but didn't let on. These idiots had a patient that had slipped in the slush. I don't recall if they noted or not that the patient had no distal pulses in his left LE, but they said he could "go BLS" (even as I was a paramedic). I disagreed, and went "on the deuce" to the hospital, where this guy got to the OR with vascular surgery in less than an hour, after dislocating his knee. Because of ME, and NOT them, this guy didn't lose his leg.

There were a few times when the paramedics tried to dictate to us that we could not go "code 2" to the hospital, and our response was legion - "you can always ride and we'll do it your way". I got a secret joy when these guys had done something STUPID and not gone to their regular hospital, and, on arriving at the receiving hosp, had their asses CHEWED - they are noted for disappearing after their mismanagement and leaving the BLS crew to the wolves.

There is a newer cadre of more modern paramedics (most of whom were on the opposite side of the fence before getting the job, so they know what it's like), but there remains a core of substandard idiots that leave the bad feelings of yesterday lingering in the air.

 

[DropkickMurphy]

One of the reasons I want to become a medical director after completing my residency is to weed out these idiots from the EMS ranks.

 

[a_ditchdoc]

One of the reasons I want to become a medical director after completing my residency is to weed out these idiots from the EMS ranks.

Weeding them out is no fun. Keeping them around so you can torture them slowly, now that's fun....

 

[DropkickMurphy]

Who said anything about weeding them out without torture? Slowly knock them down the ladder from paramedic to EMT-I to EMT-B to driver only.

 

[sentrosi]

One of the reasons I want to become a medical director after completing my residency is to weed out these idiots from the EMS ranks.

I was kind of thinking the same thing. It would be cool.

 

[QuikClot]

There are lots of great fire medics out there, and lots of inferior transport medics. I would give transport medics the edge in most cases because of greater patient experience. Still, there's no justification for vilifying one while deifying the other. We all have good days and bad days.

I wonder if part of the OP's problem is that he is "super aggressive" and doesn't see himself as a "real medic" unless he is running the call. People like that on my scene make me uneasy. I tend to mistrust their decision-making process, since their satisfaction comes not from good patient outcomes but from giving orders and doing proceedures.

Maybe if he calmed down, learned to function in a supportive role, and showed respect rather than disdain for his colleagues, they would be more apt to support him in the leadership role he wishes to occupy. Whatever the protocols say, in my experience leadership on scene usually devolves on experience, maturity, and is underpinned by mutual respect.

 

[DropkickMurphy]

There are lots of great fire medics out there, and lots of inferior transport medics. I would give transport medics the edge in most cases because of greater patient experience. Still, there's no justification for vilifying one while deifying the other. We all have good days and bad days.

I wonder if part of the OP's problem is that he is "super aggressive" and doesn't see himself as a "real medic" unless he is running the call. People like that on my scene make me uneasy. I tend to mistrust their decision-making process, since their satisfaction comes not from good patient outcomes but from giving orders and doing proceedures.

Maybe if he calmed down, learned to function in a supportive role, and showed respect rather than disdain for his colleagues, they would be more apt to support him in the leadership role he wishes to occupy. Whatever the protocols say, in my experience leadership on scene usually devolves on experience, maturity, and is underpinned by mutual respect.

The above should be required reading for all EMS personnel.

 

[leviathan]

There are lots of great fire medics out there, and lots of inferior transport medics. I would give transport medics the edge in most cases because of greater patient experience. Still, there's no justification for vilifying one while deifying the other. We all have good days and bad days.

I wonder if part of the OP's problem is that he is "super aggressive" and doesn't see himself as a "real medic" unless he is running the call. People like that on my scene make me uneasy. I tend to mistrust their decision-making process, since their satisfaction comes not from good patient outcomes but from giving orders and doing proceedures.

Maybe if he calmed down, learned to function in a supportive role, and showed respect rather than disdain for his colleagues, they would be more apt to support him in the leadership role he wishes to occupy. Whatever the protocols say, in my experience leadership on scene usually devolves on experience, maturity, and is underpinned by mutual respect.

Quoted for truth.

 

[sentrosi]

Teamwork is important but that doesn't mean that you are there just to drive the patient to the hospital. If that was the case, you could get almost anyone to do that.