Thursday, August 11, 2011

RANT: Let's be completely CLEAR on this subject

I just came across a blog that more or less said this, "paramedics that work for a private sector or company are only working there because they couldn't get on a fire department, and are therefore not as good as fire department affiliated medics."

First I have a few choice words for this person, but I will keep them to myself.  I also have several questions to ask of anyone who thinks the same.

Have you ever worked for a private ambulance service?
How long have you been a paramedic?
How many calls do you average a day?  A week?
What kind of calls do you get?
Do you have any special training above and beyond your paramedic license?
How many paramedics do you have on a call?

I must say, when I first started in the field, I heard this sort of thing a lot.  When I was in EMT school everyone's goal was to get on a fire department and people were constantly debating which private ambulance service is better than the other.  It took me some time, but I came around.  I'll be the first one to admit it.  I didn't want to work in the private sector.  At all.  I wanted to be full time on a fire department.  End of story.

Once I started doing ride time and clinical time I spoke with a lot of paramedics that worked for private ambulance companies, and I saw first hand what they brought into the ER.  I also heard of some of the crazy calls they got.  I wasn't convinced, but I gave it a shot.  And I've been doing it for nearly 8 years now.  Sure, fire departments are great.  I'm not going to deny that.  I was on one for several years.  It was fun.  I loved being a firefighter and I want to stay current with my certification.  But I noticed some major differences in how "private ambulance medics" and "fire department medics" do their job and what they know.

I'm not here to say either side is bad, as I've done both, but to people that have comments like the one above, I would like to say a few things to clarify the differences.

People will typically say that "on a fire department you'll see patients of all ages, all medical conditions, a lot of trauma, you get more action, etc."

and that on a private ambulance, "you're basically a taxi driver, you just cart old people around."

That, simply put, is a JOKE.  First of all, on the fire department, yeah you'll get your trauma, you'll see an assortment of ages and medical conditions.  But not how some may lead you to believe.  Running traumas (outside of a broken hip or minor MVCs, and simple trauma) isn't all that common.  Maybe if you're in a very urban area you'll see the stabbings and gunshot wounds, etc.  In the suburbs, not so much.  Of course it's bound to happen eventually, but it's not an everyday thing, as I was told in school.  Age wise, you're looking at mainly elderly people, with young adults and adults mixed in occasionally, and the rare child or infant.  As far as medical conditions go, you'll see people with chronic problems like diabetes and emphysema and heart problems.  I'm definitely not denying you will see any of these things, as anything is possible.  At a fire department, the amount of calls you get varies constantly, and when you run a call you always have extra sets of hands, it's typically not just two people on a rig.  

Now, for working on a private ambulance.  Yes, you will do some calls where you're taking a patient for a dialysis appointment or a psych transfer, and some of them are boring.  That's just how it works no matter if you're working in public or private.  Trauma, no, we don't see a lot of live action trauma like the car wrecks you see on TV.  We get the broken hips, the falls, the lacerations.  What people don't seem to realize is that the people that DO have major trauma are commonly not taken to a hospital that can care for the patient.  Guess who takes them?  That would be a private ambulance.  Age wise?  We see a lot of old people.  But we also see a large mixture of all ages groups, ranging from neonatal transports on up.  Medical conditions...if someone has it, the privates have dealt with it.  We get the calls for people that are young with acute problems, people with chronic problems of all ages, and desperate emergencies that, guess what?  Fire department medics aren't trained to deal with.  I don't know any fire medics that are trained in peritoneal dialysis treatment, trach emergencies, LVAD devices, chest tubes, ventilators, or balloon pumps.  I could list a hell of a lot more but I think I've started to make a point...

If you hand the same list of medications to a medic in the fire service that has never worked for a private service, and one that has worked primarily in the private sector, I can tell you who would know the medications and could figure out the patient's medical history from it.

The people that I work with are AMAZING medics.  We can get a call, talk with the patient (and staff if necessary), take a look at their medications, review their symptoms, and have an extremely good idea what is causing them-NOT just treating what you see, but having the knowledge behind the cause and being able to treat the patient more definitively.  We also have the capability to take a patient to the most appropriate hospital, even if it's further away.  We are required to stay current (I can't speak for 100% of private sectors) on PEPP/PALS, ITLS, ACLS, and monthly continuing education.  A great deal of us are trained in ventilator operation and tracheostomy emergency care.  We also are required to be fluent in protocol for more than one system as our jurisdiction varies widely.  Call wise?  I would say an average day would be 5-6 (granted some of these calls can last hours due to where the patient is being transported), and there are some days where 12+ wouldn't be shocking.  And the amount of people you have to do these calls? TWO.  You and your partner.  One driving, one in the back with the patient.  Try running a full arrest all by yourself, now that's what I call fun.

The top dogs of the paramedic food chain?  Those trained in critical care.  Not only are they trained in all of the paramedic basics, they are trained to work ventilators, to manage chest tubes, run IV medications on pumps, care for critically ill neonates, operate an LVAD to keep a patient's heart beating until they get a transplant, and transport patients that are so unstable they literally need EVERYTHING to keep them alive.  They have to do additional continuing education, keep up with NRP standards, read and treat patients based on 12-lead EKGs and transport them to definitive care-skipping the ER to go straight to cath lab, along with "regular" emergencies.  Even with all of these extra things they do, they still do almost the same amount of calls as regular ALS paramedics.  And can you guess how many of them are on the ambulance at once?  You guessed it.  TWO.  One drives, one is with the patient.  Nurses very rarely accompany patients as the protocol allows more freedom.

I've worked on both sides.  I have a lot of respect for paramedics on both sides-fire and private sector.  I've seen some pretty crazy stuff on both sides too.  But I can tell you this, I've learned a hell of a lot more being on the private sector than I did with the fire department, because I was constantly exposed to conditions day in and day out.

I have seen amazing medics on both sides, but I must say, I am biased.  The medics I work with, especially the critical care paramedics, I have mad respect for, and I would trust them with my life.  They are trained in so many different areas and have so much knowledge base.  I feel it's an honor to work with them, to have my partners by my side, and to be part of a critical care team.  They are my family.

To anyone that thinks private sector medics aren't "good enough" for a fire department, I tell you to take a closer look.  Live a day in the life, a 24 hour shift on a private ambulance, and your perspective will change drastically.  You just have to look beyond the surface and get over the fact that we don't have "FIRE DEPT" written across the back of our shirts.

END OF RANT.

for now.
 

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