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MedicalI am a Paramedic serving a diverse area from very rural to large cities. AMA!

Sep 26th 2016 by AOx3 • 16 Questions • 308 Points

I am a Paramedic working in California, USA, serving a large area that covers everything from desert, to mountains, to cities. I've been doing this job for 5 years and I look forward to coming to work every day.

My job is far from routine. I start off the day like any other, checking the ambulance and the equipment. After that, all bets are off. It could be car accidents, medical aids, or cliff rescues.

It's occurred to me that many people don't actually know what we do on scene, or in the ambulance. We are much more than just a ride to the hospital. Health care starts the second I walk up to you.

I know there are good questions out there so AMA!

Side note: Don't ask "what is the worst thing you've ever seen." I won't answer that.

Proof: https://imgur.com/8AX8ogT

This is a repost with adequate proof.

Q:

Maybe he got a call?

A:

It depends. Not all of our responses are the same. We have a priority tiered response. Meaning a 911 can be a priority 1, 2, or 3. A priority 3 has been a maximum 20 minute response time, where as a priority 1 response has a maximum 8 minutes. This ensures the highest priority patient gets the closest ambulance, even if they are already enroute to a lower priority call.


Q:

Which for Ontario at least is nearly fully covered. A ride in an ambulance will send you back around $45.

A:

In the United States you often receive a bill from the ambulance unless the specific service has free service they subsidized through taxes or something. Expect anywhere from $800-1500 for an ambulance ride. These rates are high because a majority of ambulance patients have government insurance, which has a very low reimbursement rate ($100-500) which is below the cost to operate. The remainder of the unpaid bill is transferred to the next patient in the form of a high bill.

We do not collect insurance prior to providing service and our billing department deals with it later. Also, some forms of government insurance for low income people prohibit us billing the patient for any amount that their insurance left unpaid.

In the end, the bill sounds scary, but there's not a good chance you'll ever be faced with actually be paying the whole thing.

Also, medical bills are treated differently on credit reports in the States, and don't hurt you as much if unpaid.


Q:

Thanks for the reply! Good to hear that you don't have to take insurance into account when meeting the patients.

Sorry for the crappy spelling - phone autocorrect can be a bitch

A:

No problem! I wish we didn't have to charge for service, because patients bring it up all the time. I'd prefer if my company could get tax money instead and offer free service (after billing any available insurance).


Q:

This job almost certainly is not what you think it is. We work terrible hours for mediocre pay. You will almost certainly sustain at least one serious injury while working here. You almost never run calls that are "worthwhile." You rarely respond to calls where people actually need the skills you went to school for. It's almost always the drunk who has wet their pants and their friends didn't want to deal with them any longer. You're personal relationships will be strained, often past the breaking point. Your eating habits, your health, will most likely fall by the wayside as you suck down whatever gas station hot dog you could grab in the moments between calls. Large portions of the populace will look down at you like you are some sort of servant they are entitled to use as they see fit.

You can try this job, but it's a near certainty that you won't make it. Then all you are likely to have for your trouble is wasted time and unpleasant memories.

A:

I love the job. Do some ride along and see if you like it. It's guaranteed to be different than you imagine. Training is minimal at the entry level.


Q:

I was always taught it is best to maintain speed limit and move to side for any emergency vehicles so if something prevents overtake the emergency service can at least maintain speed. Is this best or would you prefer a pullover and stop?

A:

Pull over and stop when safe. Usually by the time you stop were already past you, so just try to slow down. Use your blinker so we know you see us and we don't think you're oblivious. Don't go through a red light. In California it is illegal for emergency vehicles to "push" (encourage) cars to go through a blocked red light. This is not so everywhere, but is should be. If your are at a red light, wait until it is green and safe before going forward. We can wait, or go around.


Q:

Think it must be a bit different in the UK, officially the rule is what I was taught and I believe the logic is that in the UK not even ambulances can pass over a solid white line in the middle of the road and more often than not on most single carriageways there isn't enough room to pass safely even if someone is pulled to the side. But that being said it's more common for people to pull over and mount the kerb.

A:

That could be. I don't know if it's true all over, but I've always been told that roads in the UK are narrow due to how old (read as historic) the infrastructure is. Most roads here are wide, like our citizens, and we don't have laws against where we can drive, we just have to drive with "due regard". Basically, you can do what you want, but you will be held responsible for your actions.


Q:

OP when will you start answering questions? Why is this AMA void of OPs responses?

A:

When I wake up. It was reposed because original proof was not adequate.


Q:

Almost always. Early and effective CPR is key to a cardiac save. Which means that bystander intervention is key to a pt survival since typical response times are about 8 minutes in metro areas and in rural areas typically about 15 minutes. And cardiac arrest patients need CPR almost immediately to have a good chance of survival. Learn CPR and get your friends to do it too! It's very easy but extremely important and helps our jobs out a ton!

EDIT: I remember a statistic I think in Rochester Minnesota where the Mayo Clinic is the survival rate for out of hospital cardiac arrest patients is about 70% because they put so much effort into teaching the community CPR. Whereas the rest of the country has about 15% survival rate.

A:

Hardly ever, because most 911 calls are not actual emergencies. In the event there is an emergency, we usually arrive before it's "too late."

In the event if a sudden cardiac arrest, however, we are almost always not soon enough. We can still improve outcomes, but the real key here is bystanders CPR.


Q:

Did you ever pass out seeing something?

A:

Not yet.


Q:

Actually it does happen more often than not! I worked in a semi rural larger city area also. We get posted to different areas thought out the county. Sometimes we get posted to another city and we miss a call or something like that.
2) rarely does anyone do first aid. I am quiet surprised that it still occurs. I responded to many calls where people are dying and have died because no one started cpr or managed to put an AED.

A:
  1. It's rare for me. We typically run calls back to back. I think it may have happened once in the last 2 years for me.

  2. Almost none. However very few calls require immediate interventions.


Q:

My goodness. I made $5.50/hr when I left my EMT Advanced job in 1988 long before EMT-P

A:

We are 911 and transfer. We are the only ambulance company in my area, also we are the only ALS provider. Fire is all BLS.

Starting medics are at about $16/hr on a 12h, $20/hr on an 8 and $15 on a 24


Q:

What was your post secondary schooling like, furthermore how much from school do you use on a day to day basis?

A:

Paramedic education is the US is lower than many parts of the world.

The requirement is only a high school diploma prior to entering vocational training. Training requirements vary by state. In California EMT Basic training is generally about 500 hours, and Paramedic is a minimum of 1,090.

There is currently no widespread degree requirement, however it's becoming more mainstream. The college I took my school from has transitioned to a degree based curriculum and several of us are going back to apply for the credits to get the degree retroactively.


Q:

Do you consider severley broken bones an emergency or waste of ambulance time? I once broke ulna and radius clean in half so my arm was very floppy in the middle. My friend called an ambulance for me before I could refuse. Do you view that as a waste of ambulance time (e.g. I could have gone myself with some help and some kind of homemade splint)?

A:

That's a perfectly reasonable thing to call an ambulance for, and for several reasons.

  1. We have pain meds.
  2. Not all hospitals are equal, we will get you to the right one.
  3. There is a chance with broken bones, that circulation beyond the break can be compromised. We can attempt to restore this blood flow. If the blood flow cannot be reestablished, that constitutes a true emergency. We can alert the hospital to the situation. Where I work, if someone has vascular compromise to an extremity they are a trauma patient. We call the hospital early, and the ER pages trauma doctors to prepare the surgery suite for emergency surgery.

Q:

Australian medic here. What kind of skill set do you have over there? We are just rolling out thrombolysis in our state which is a big step up...

A:

Compared to Australia, most of the United States is lacking, especially California which is notoriously slow to adapt best practices.

We don't have thrombolysis, but I wish we did. We don't even have RSI in California (yet).

There is a TXA trial in the process to add that to our protocols.


Q:

RRT here, just curious I guess. Do you prefer Mac or Miller blades?

A:

I preload my laryngoscope with a MAC 3. Some people say they prefer a 4 because it's easier to have more blade than needed, than not enough. But I've found a a MAC 3 to work for me 90% of the time.


Q:

13 year medic here. Job is stressful and does have a high turnover rate. I had to leave since my knees and back were starting to hurt. People are getting heavier and my knees aren't any younger. I also got burned out with being held over 1-3 hours after my off time!!! I loved the job, not the pay and holding over. Most people leave for other jobs or wonder into firefighting jobs. Here in California paramedics don't get paid well since most are private ambulance medics. The real money and benefits are in the government sector working as firefighters and medics.

A:

I'll stay here as long as I can. I love my job, however you're right, it's hard to retire in. I expect that once I'm older I'll move into an administrative or educational position.