# Best state and county to work as a paramedic! ?



## jonathan carreto (Dec 11, 2014)

Hey ems  ! I was wondering  some of your guys' opionion's and thoughts on some of the best areas to work in the US as a paramedic/FF . Good pay? Good protocols ? Alot of action!? I am a Medic student at the moment in caifornia. I love california and everything about but this awesome state but it can get alittle expensive here lol so with that being said,  my paramedic program  is based on national standards. So im considering moving out of state. Any thoughts would be greatly appreciated!


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## STXmedic (Dec 11, 2014)

Fire based? Look for almost any major city and you'll get good pay. You'll also get plenty of "action" in a big city. Just realize that action typically means "My tummy feels upset, I might throw up." All of the glamorous P1 trauma stuff is pretty uncommon no matter where you go, except maybe somewhere like Flint/Detroit- but then there goes your pay...

Texas has a lot of systems with good protocols, both fire based and single role.


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## jonathan carreto (Dec 11, 2014)

Thks stxmedic! My dream department  is LA City Fire department.  But then Again i gotta leave my options open! Thks bud


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## RocKetamine (Dec 11, 2014)

I might be biased, but if you want progressive medicine and low cost of living Texas would probably be the best place.


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## wanderingmedic (Dec 11, 2014)

RocKetamine said:


> I might be biased, but if you want progressive medicine and low cost of living Texas would probably be the best place.



Yep. Texas all the way. MedStar in the DFW area has a great reputation if you need a company to look at.


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## EMT11KDL (Dec 11, 2014)

I know a lot of Colorado is Fire Based EMS. at least on the western side of the state.  I guess better question is do you want to be a 5 minute medic or a 911 transport medic? If you just want to do fire/ems and not transport than pretty much any where in the Northwest.


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## FF-EMT Diver (Dec 13, 2014)

Texas and North Carolina both seem to have very progressive services.


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## Christopher (Dec 15, 2014)

FF-EMT Diver said:


> Texas and North Carolina both seem to have very progressive services.


I second this sentiment (and am wildly biased pro-NC). The palindrome States MN and NM also appear to value clinical judgement over protocols. Idaho has some progressive services as well. DE has wonderful services as well. Just know that there are many, many different delivery means and you may want to find a State whose model matches your goals. For example, if you want firefighting AND EMS, then NC is not your State; there are precious few FD's that deliver ALS care.

I think you'll find there are great places to work in every State.


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## Angel (Dec 18, 2014)

How difficult is it to get hired at some of these places?


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## EMT11KDL (Dec 18, 2014)

Angel said:


> How difficult is it to get hired at some of these places?


 
I do know the northwest is very competitive, normally like 30-40 people testing per position


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## Angel (Dec 18, 2014)

See I'd like to work in texas, but at the time don't want to spend hundreds of dollars getting certified in states where there's really low chances or opportunities to work. Hence the problem


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## EMT11KDL (Dec 18, 2014)

I heard a rumor that Ada county is testing in March for paramedics (Idaho)


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## TransportJockey (Dec 18, 2014)

Angel said:


> See I'd like to work in texas, but at the time don't want to spend hundreds of dollars getting certified in states where there's really low chances or opportunities to work. Hence the problem


If you have your NREMT, a lot of areas in TX don't mind you applying with the stipulation that you must get your TX card before you can start orientation and work. I know WilCo and ATCEMS are like that.


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## Angel (Dec 18, 2014)

Good to know!
I'm gonna give some of these places a call. Cant hurt.


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## wanderingmedic (Dec 18, 2014)

Angel said:


> See I'd like to work in texas, but at the time don't want to spend hundreds of dollars getting certified in states where there's really low chances or opportunities to work. Hence the problem



Most places in Texas are not super selective. For the most part, I think Texas is feeling the paramedic shortage like the rest of the US. Since TX licenses are good for 4 years, you get pretty good bang for you buck. When I got reciprocity in TX a while ago, all I needed was my NR card and a paper signed from my current state EMS office and ~$125 (can't remember how much money it was exactly).

Acadian ambulance appears to be offering a $10,000 bonus for new employees right now...but I have no idea what the stipulations on it are. Does anyone have details?

Also looks like Medstar is hiring. If I could go anywhere in the world to work, it would be to Medstar. Highly progressive system, great protocols, good pay $16-$21/hr, and the standard of living in DFW is high, while the cost of living is not.


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## Angel (Dec 18, 2014)

These are all 911 companies with EOA? Acadian is confusing to figure out where they do 911 not just IFT or back up


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## TransportJockey (Dec 18, 2014)

Acadian in beaumont and se texas.does 911. Medstar is primary 911 in Ft Worth. Linus works.there I think


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## bizzy522 (Dec 18, 2014)

EMT11KDL said:


> I heard a rumor that Ada county is testing in March for paramedics (Idaho)


Really, that surprised me... they just tested last month?


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## bizzy522 (Dec 18, 2014)

azemtb255 said:


> Most places in Texas are not super selective. For the most part, I think Texas is feeling the paramedic shortage like the rest of the US. Since TX licenses are good for 4 years, you get pretty good bang for you buck. When I got reciprocity in TX a while ago, all I needed was my NR card and a paper signed from my current state EMS office and ~$125 (can't remember how much money it was exactly).
> 
> Acadian ambulance appears to be offering a $10,000 bonus for new employees right now...but I have no idea what the stipulations on it are. Does anyone have details?
> 
> Also looks like Medstar is hiring. If I could go anywhere in the world to work, it would be to Medstar. Highly progressive system, great protocols, good pay $16-$21/hr, and the standard of living in DFW is high, while the cost of living is not.



Acadian offers 10,000 bonus with a 2 year contract. You get 5k on your first paycheck and 5k on your 1 year. They do BOTH 911 and IFT in SE Texas (Beaumont, Port Arthur, Orange, Nederland, Port Neches, etc.). Be careful, If you want to do 911 don't go to Houston, Acadian only does IFT there. HFD does the 911.
Given the chance Id recommend Medstar. Nice area with good protocols. My friend works up there and enjoys it.


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## TransportJockey (Dec 18, 2014)

Im tempted by Acadian. I liked the Beaumont area when j drove through


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## STXmedic (Dec 18, 2014)

TransportJockey said:


> Im tempted by Acadian. I liked the Beaumont area when j drove through


I wouldn't...  They don't offer 10k sign ons because they have people beating down the door to work there. I know RM is sorely underwhelmed by his experience with them so far. @RocketMedic


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## TransportJockey (Dec 18, 2014)

STXmedic said:


> I wouldn't...  They don't offer 10k sign ons because they have people beating down the door to work there. I know RM is sorely underwhelmed by his experience with them so far. @RocketMedic


I know talking to KElly he hasn't been too upset with them, but it might be like the evil empire and vary by division...


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## bizzy522 (Dec 18, 2014)

STXmedic said:


> I wouldn't...  They don't offer 10k sign ons because they have people beating down the door to work there. I know RM is sorely underwhelmed by his experience with them so far. @RocketMedic


Absolutely.
I agree 100% SE Texas is not for everyone and a culture shock. I moved here from Boise Idaho. I went from beautiful mountain and 4 seasons to oil refineries and humidity.
Acadian IN MY EXPERIANCE is a all in all good company.. You are in a system status private EMS company that mixes 911 and IFT so you WILL have issues arise from time to time. But that's the name of the game.  I guess it comes down to you.. what do you want? Do you just want a change for a years? Do you want to find a service to retire at? I can tell you for me personally I will only be here until the paramedic program is finished Ill be moving on

@TransportJockey if you have any questions shoot me a message.


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## STXmedic (Dec 18, 2014)

TransportJockey said:


> I know talking to KElly he hasn't been too upset with them, but it might be like the evil empire and vary by division...


I could certainly agree with that. I'm just wary of companies begging people to come work for them. WilCo doesn't offer sign on bonuses because they're a quality system and have people knocking down their door. ATC. Montgomery. Schertz locally. They don't need to beg and bribe because people actually want to work there and don't often leave once they get there. Like bizzy said, would be a good place for some experience. That's not something you really need...


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## RocketMedic (Dec 22, 2014)

If I had known what I know now, I would have  followed up more with Medstar or stayed at Pafford (which, despite the "Cleveland steamroller" model of employee compensation,  was clinically pretty decent). I'm about 60% finished with the onboarding process and I'm already pretty done. Sorely, sorely underwhelmed by Acadian. 

It's not that Acadian is a bad service. They're not. The pay is decent (ish), the schedule is decent. Equipment is nice. 2/2/3 schedule for every other weekend off. Benefits are bc/bs, day one effective. You start participation in their esop at one year.

..and then it gets subpar.

The HR policies seem to come from some weird Cajun/Midwestern glutton-for-punishment model. PTO is not accrued,  it's given in week-long blocks at the one-year anniversary of employment...something like 44 hours a year for the first three years. Sick time is accrued separately,  but they don't pay the first sick day off for three years or something.  They do offer "Lagnappie" days that let you take sick time as pto, but not for a while. Pay isn't bad, I'm at $16.61 an hour and make almost exactly what I did in Oklahoma. 

The medicine is fairly shoddy in my opinion. You can download our protocols on the PPP app, but so far, I'm not terribly sold on this place. They are highly conservative and risk-averse, but even worse, it seems that cost of treatment is strongly considered. QI preemptively read us the riot act on fluids (verboten for most patients), we account for IO needles like narcs (because apparently the company vice presidents want to get rid of them for cost reduction). They push nasal intubation aggressively (don't mind) but they explicitly discourage aggressive airway management. The pain management protocol is a joke. Acadian is explicitly not a "pain-free" organization. 

Morale-wise, I've been on their trucks for three weeks and it's the same as most places. I keep hearing it gets better, but I dunno. I sense this is a job to hold until I can find something that is better. Looking at a few alternatives in Texas. 

I don't know much about other places, but the transfer vs 911 ratio here in San Antonio is about 50/50. Meh.


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## triemal04 (Dec 22, 2014)

In all seriousness, have you ever worked for a department that, at the time you were there, you actually liked and considered a "good" department?


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## RocketMedic (Dec 22, 2014)

TransportJockey, I would love to work Pecos if it wasn't a week at a time.


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## NomadicMedic (Dec 22, 2014)

triemal04 said:


> In all seriousness, have you ever worked for a department that, at the time you were there, you actually liked and considered a "good" department?



Sussex County DE is excellent is almost every respect. Good to great medicine. Very decent pay. No IFT, all ALS chase cars. Nice stations. Excellent equipment. 

Not one bad thing to say about the service, and if I wanted to live in DE, I'd go back in a second.


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## triemal04 (Dec 22, 2014)

DEmedic said:


> Sussex County DE is excellent is almost every respect. Good to great medicine. Very decent pay. No IFT, all ALS chase cars. Nice stations. Excellent equipment.
> 
> Not one bad thing to say about the service, and if I wanted to live in DE, I'd go back in a second.


Sorry, I should have been more clear; I was specifically referring to the poster directly above my post.


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## Chewy20 (Dec 22, 2014)

TransportJockey said:


> If you have your NREMT, a lot of areas in TX don't mind you applying with the stipulation that you must get your TX card before you can start orientation and work. I know WilCo and ATCEMS are like that.


 
@Angel like TJ said you can get hired on with ATCEMS as long as you have another state cert. You just need to have a TX cert by the time you graduate from the academy. If you already have NR then all you have to do is apply and pay the $125 fee. If you do not have NR you just have to take the written portion nad pay same fee.

Apparently the same for WilCo and others!


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## NomadicMedic (Dec 22, 2014)

triemal04 said:


> Sorry, I should have been more clear; I was specifically referring to the poster directly above my post.



Hahaha. Gotcha.


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## Angel (Dec 22, 2014)

To anyone who knows, and I will call but they are close now so...
How will fingerprints work? It looks like they also want fingerprints and although I've had them done several times here in Ca, I know agencies don't share that info. 
(Unless of course I'm reading it wrong)


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## triemal04 (Dec 22, 2014)

Angel said:


> To anyone who knows, and I will call but they are close now so...
> How will fingerprints work? It looks like they also want fingerprints and although I've had them done several times here in Ca, I know agencies don't share that info.
> (Unless of course I'm reading it wrong)


In this area at least you just go to the the police (probably have to be one of the more main stations) and for a fee they'll either fill out a fingerprint card, or if they use it, use livescan or another electronic verrsion.


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## TransportJockey (Dec 22, 2014)

Angel said:


> To anyone who knows, and I will call but they are close now so...
> How will fingerprints work? It looks like they also want fingerprints and although I've had them done several times here in Ca, I know agencies don't share that info.
> (Unless of course I'm reading it wrong)


Texas uses a specific vendor. They might have a place near uou that works for that vendor. The DSHS site has a link in the reciprocity packet


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## RocketMedic (Dec 22, 2014)

triemal04 said:


> In all seriousness, have you ever worked for a department that, at the time you were there, you actually liked and considered a "good" department?



No, I have yet to find my unicorn. 
I started my career at friendly little hospitals without much full-time potential. I am not going to live at work.
I found EMSA to be a case of untapped potential wasted by complacency and shortsightedness. They didn't want progressive medicine or positive change, they wanted asses in seats and non controversial standard care. 
I found Pafford EMS to be everything I wanted in an EMS provider, but without the attendant sustainability I need to justify working there. I think I made a mistake leaving Pafford from a job-satisfaction point of view and I certainly think Pafford's medicine was better, but I am happier with my personal life as it is here in San Antonio. I would rather have a pacific personal life and accept work flaws than I would have the reverse. 
I find Acadian to be a holding pattern for the time being. It's not bad, but it isn't what I want it to be either. I feel like Acadian is the most "private" of any service I've ever worked, and although that's not bad, it's not where I want to spend my career. 

I want a unicorn job. Fire-like job security and benefits, good medicine, real promotional opportunities and within a twelve-to-fifteen hour arc of El Paso, and close enough to a decently-sized city or nice locale where my wife and I both have employment, recreational and educational opportunities. I want a living wage without living at work.

I know you and others look at me as a whiny, cocky, arrogant elitist, but I am not terribly eager to accept mediocrity.


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## teedubbyaw (Dec 22, 2014)

Angel said:


> To anyone who knows, and I will call but they are close now so...
> How will fingerprints work? It looks like they also want fingerprints and although I've had them done several times here in Ca, I know agencies don't share that info.
> (Unless of course I'm reading it wrong)



Most here in Texas use FAST. May see if they have any locations outside of the state. 

If you have any questions on agencies in central Texas, let me know. We've got some really great services here.


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## RocketMedic (Dec 22, 2014)

Teedubbyaw, I'm looking for exactly that- a great agency in Central Texas. Proximity to San Antonio a plus. Any advice?


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## triemal04 (Dec 23, 2014)

RocketMedic said:


> No, I have yet to find my unicorn....
> 
> ......I want a unicorn job. Fire-like job security and benefits, good medicine, real promotional opportunities and within a twelve-to-fifteen hour arc of El Paso, and close enough to a decently-sized city or nice locale where my wife and I both have employment, recreational and educational opportunities. I want a living wage without living at work.
> 
> I know you and others look at me as a whiny, cocky, arrogant elitist, but I am not terribly eager to accept mediocrity.


If I recall correctly there were quite a few more than you listed, going all the way back to your time in the Army.  And if I further recall correctly the typical mantra was "this place is terrible...but that other service is great...no, actually this other service is terrible and the last was better...no, it's really terrible too..." and so forth.  I'm not bringing this up to be insulting but so that other's reading this can be aware of this problem:

Good, very good jobs in EMS are not "unicorn jobs."  They exist, and in much greater numbers than many people think about.  The reason that people may never be hired by one or even know about one are because of what's involved in getting them; 2 very specific things.

You need to go to the job; which may include moving, or creating a long commute for yourself, but also actively seeking these places out and finding out when they hire.  At least a fair number that I know of really don't advertise that much; they don't need to and someone who takes the initiative to go to them will often end up being the better hire.   In essence, you have to do your due diligence, which a lot of people in EMS can't, or won't do.

You need to have the right attributes that they are looking for, be that work experience, education, background, personality, interpersonal skills, or most likely, a combination of all of those things.  If you don't have these things, you need to figure out which is lacking and, if possible, fix that.

But, all to often in EMS, many people are not willing or capable of doing either one, or both of these things.  Or unwilling to look objectively at the situation.

A good department is a good department.  Not a "unicorn job."

(all those were a general "you" as well)


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## Angel (Dec 23, 2014)

teedubbyaw said:


> Most here in Texas use FAST. May see if they have any locations outside of the state.
> 
> If you have any questions on agencies in central Texas, let me know. We've got some really great services here.



I do! I'm open to all possibilities right now. I just dont know much about texas or where to begin looking besides what is mentioned on here.

ETA: yea i can get a live scan done easily. ill check and see if theyll accept that. I have to go through the packet a bit more thoroughly


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## RocketMedic (Dec 23, 2014)

triemal04 said:


> If I recall correctly there were quite a few more than you listed, going all the way back to your time in the Army.  And if I further recall correctly the typical mantra was "this place is terrible...but that other service is great...no, actually this other service is terrible and the last was better...no, it's really terrible too..." and so forth.  I'm not bringing this up to be insulting but so that other's reading this can be aware of this problem:
> 
> Good, very good jobs in EMS are not "unicorn jobs."  They exist, and in much greater numbers than many people think about.  The reason that people may never be hired by one or even know about one are because of what's involved in getting them; 2 very specific things.
> 
> ...



Aware of this, but disagree. A "good" job is one that fulfills most of the criteria. A unicorn job is one that fills them all. Some good jobs may be unicorns, not all good jobs are worth it.
I have moved from several places because I wanted betger. Hasn't failed me yet.


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## Chewy20 (Dec 23, 2014)

@triemal04 yes I believe I work for a good department. One of the biggest if not the biggest 3rd role agency in the country. Boston may be a little bigger volume wise.


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## TransportJockey (Dec 23, 2014)

Chewy20 said:


> @triemal04 yes I believe I work for a good department. One of the biggest if not the biggest 3rd role agency in the country. Boston may be a little bigger volume wise.


I think new Orleans mIght have y'all beat 
Actually, never mind...Lol I forgot how small no really is


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## RocketMedic (Dec 23, 2014)

New Orleans is, by many accounts, a high-speed cool-lookin' all-paramedic BLS+ service in the vein of Houston Fire.

Austin/Travis County would be cool if it wasn't for "years as a basic".


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## STXmedic (Dec 23, 2014)

RocketMedic said:


> Austin/Travis County would be cool if it wasn't for "years as a basic".


And average protocols


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## Chewy20 (Dec 23, 2014)

STXmedic said:


> And average protocols


 
STX hates ATC don't listen to him 

Average or not, theres not to many non-fire based EMS agencies that will pay you a 100k base salary after around 10 years if you promote right.


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## Burritomedic1127 (Dec 23, 2014)

Chewy20 said:


> @triemal04 yes I believe I work for a good department. One of the biggest if not the biggest 3rd role agency in the country. Boston may be a little bigger volume wise.



Boston runs about 350 calls a day with about 12-14 trucks. Mostly BLS trucks and I believe 3-4 ALS trucks. A lot of employees are medics working as basics waiting for a promotion to Boston's paramedic school. They do have more progressive protocols (RSI) compared to other companies in the state. But good luck on waiting, spoke with a BEMS employee the other day and he was saying people are quitting like crazy. Yeah they get paid more and have a pension but it evens out cause you have to live in the city for 10 years with roommates to survive. On top of the fact of picking up psych and ETOH pt's all day/night. I don't have any bad blood I just wouldn't work there unless I was eighteen and straight out of EMT school. Move out of the city at 28 start saving money starting a family and hope to get promoted. IMHO.  

Side note, you know something's wrong when BEMS employees have to had out flyers at the ER to other EMS providers when they are hiring.


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## triemal04 (Dec 23, 2014)

Rocketmedic...you really didn't understand a word I said.  Carry on though, not my concern.


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## RocketMedic (Dec 23, 2014)

I don't think BEMS is a great model for medicine. I think every patient deserves an ALS assessment when needed, adequate pain management and shouldn't need to wait a long time for it.

You can't tell me with a straight face that every hip fracture, dyspnea or "unknown medical" in Boston gets that treatment.


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## Chewy20 (Dec 23, 2014)

Burritomedic1127 said:


> Boston runs about 350 calls a day with about 12-14 trucks. Mostly BLS trucks and I believe 3-4 ALS trucks. A lot of employees are medics working as basics waiting for a promotion to Boston's paramedic school. They do have more progressive protocols (RSI) compared to other companies in the state. But good luck on waiting, spoke with a BEMS employee the other day and he was saying people are quitting like crazy. Yeah they get paid more and have a pension but it evens out cause you have to live in the city for 10 years with roommates to survive. On top of the fact of picking up psych and ETOH pt's all day/night. I don't have any bad blood I just wouldn't work there unless I was eighteen and straight out of EMT school. Move out of the city at 28 start saving money starting a family and hope to get promoted. IMHO.
> 
> Side note, you know something's wrong when BEMS employees have to had out flyers at the ER to other EMS providers when they are hiring.


 
Nevermind we run more calls than that. I can see what youre saying about them though. Used to talk to them when I worked in the area.


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## Burritomedic1127 (Dec 23, 2014)

RocketMedic said:


> I don't think BEMS is a great model for medicine. I think every patient deserves an ALS assessment when needed, adequate pain management and shouldn't need to wait a long time for it.
> 
> You can't tell me with a straight face that every hip fracture, dyspnea or "unknown medical" in Boston gets that treatment.



Not a chance. Major traumas, codes, chest pain, or anything "spicy" enough to put on their alerts, I'd assume would get ALS in Boston


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## Tigger (Dec 23, 2014)

RocketMedic said:


> I don't think BEMS is a great model for medicine. I think every patient deserves an ALS assessment when needed, adequate pain management and shouldn't need to wait a long time for it.
> 
> You can't tell me with a straight face that every hip fracture, dyspnea or "unknown medical" in Boston gets that treatment.


 
It isn't. If I wanted ALS while working for a private there it was either coming from own company or not at all. 

Peak of six ALS trucks during the day, drops to three at night.


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## RocketMedic (Dec 23, 2014)

I don't see that as being a good system, 8r even something to emulate.


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## Burritomedic1127 (Dec 23, 2014)

I know some of their emts pride themselves on having a special project waiver for albuterol and narcan at the BLS level. I've seen them bring in hypotensive pts BLS or diff breathers with albuterol administered BLS. If any ALS medication is given (based on state protocols) that Pt should be ALS. Yeah you can train emts to use albuterol and narcan but what about cardiac wheezes, no response to meds, and the such?


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## Chewy20 (Dec 23, 2014)

Burritomedic1127 said:


> I know some of their emts pride themselves on having a special project waiver for albuterol and narcan at the BLS level. I've seen them bring in hypotensive pts BLS or diff breathers with albuterol administered BLS. If any ALS medication is given (based on state protocols) that Pt should be ALS. Yeah you can train emts to use albuterol and narcan but what about cardiac wheezes, no response to meds, and the such?


 
Albuterol and narcan are not statewide ALS meds in MA, if that's the state you are talking about. I worked for a private and we carried both on our BLS trucks.


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## Burritomedic1127 (Dec 23, 2014)

Chewy20 said:


> Albuterol and narcan are not statewide ALS meds in MA, if that's the state you are talking about. I worked for a private and we carried both on our BLS trucks.



Yeah I know. Mass companies that are under a special project waiver allow their BLS to carry albuterol and narcan. I don't know it's been awhile but I'm assuming there not teaching albuterol and narcan in EMT class, but they do teach those meds in medic school.


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## Chewy20 (Dec 23, 2014)

Burritomedic1127 said:


> Yeah I know. Mass companies that are under a special project waiver allow their BLS to carry albuterol and narcan. I don't know it's been awhile but I'm assuming there not teaching albuterol and narcan in EMT class, but they do teach those meds in medic school.


 
Oh I see what youre saying. I do remember being taught those things when I was in EMT school. Not sure if that was the norm or not.


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## STXmedic (Dec 23, 2014)

Chewy20 said:


> STX hates ATC don't listen to him


I think my gripe with ATC comes from most (not all, you aren't there yet Chewy  ) ATC medics I know being exceptionally arrogant and cocky. They think their **** doesn't stink, they're god's gift to paramedicine, their system is the best in the country, and every other system is garbage. Even with that attitude, I have only considered one of them a truly good medic (albeit my standards are set pretty high), and I don't think as a system they do anything special or ground-breaking. The Kool-aid there is exceptionally potent, and undeservedly so. 

I don't think they're a bad service by any means. They do some things I'm not a fan of, but I can see how those things would work for others. If every medic there wasn't so damn arrogant, or could at least back it up, I'd probably like ATC much more. It's primarily the attitude I don't like, which comically changes as soon as they leave (and they almost all leave).


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## teedubbyaw (Dec 23, 2014)

STXmedic said:


> I think my gripe with ATC comes from most (not all, you aren't there yet Chewy  ) ATC medics I know being exceptionally arrogant and cocky. They think their **** doesn't stink, they're god's gift to paramedicine, their system is the best in the country, and every other system is garbage. Even with that attitude, I have only considered one of them a truly good medic (albeit my standards are set pretty high), and I don't think as a system they do anything special or ground-breaking. The Kool-aid there is exceptionally potent, and undeservedly so.
> 
> I don't think they're a bad service by any means. They do some things I'm not a fan of, but I can see how those things would work for others. If every medic there wasn't so damn arrogant, or could at least back it up, I'd probably like ATC much more. It's primarily the attitude I don't like, which comically changes as soon as they leave (and they almost all leave).



A lot of them are incredibly cocky, for sure. Then the other half are incredibly jaded and/or burnt out. 

My biggest gripe with ATCEMS is that they are a politically governed body that does not make their decisions on what is in the best interest of their medics, but rather, what makes them look good as a whole. They do not stand behind their medics, as reflected with their incredibly limited scope of practice. Not to mention, their hiring process is a load of crap.


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## Burritomedic1127 (Dec 23, 2014)

Chewy20 said:


> Oh I see what youre saying. I do remember being taught those things when I was in EMT school. Not sure if that was the norm or not.



Went to EMT school in NH were basics can use combitubes, albuterol, narcan but thats standard in their state protocols. Not sure in mass though. Not to go too far off topic but there are some things basic should be able to use like glucometers


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## Chewy20 (Dec 23, 2014)

teedubbyaw said:


> A lot of them are incredibly cocky, for sure. Then the other half are incredibly jaded and/or burnt out.
> 
> My biggest gripe with ATCEMS is that they are a politically governed body that does not make their decisions on what is in the best interest of their medics, but rather, what makes them look good as a whole. They do not stand behind their medics, as reflected with their incredibly limited scope of practice. Not to mention, their hiring process is a load of crap.


 
Whats your gripe with the hiring process? Not coming at you, just wondering as I just finished with it a couple months ago.


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## TransportJockey (Dec 23, 2014)

Burritomedic1127 said:


> I know some of their emts pride themselves on having a special project waiver for albuterol and narcan at the BLS level. I've seen them bring in hypotensive pts BLS or diff breathers with albuterol administered BLS. If any ALS medication is given (based on state protocols) that Pt should be ALS. Yeah you can train emts to use albuterol and narcan but what about cardiac wheezes, no response to meds, and the such?


I keep forgetting narcan and albuterol aren't bls drugs everywhere


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## teedubbyaw (Dec 23, 2014)

Chewy20 said:


> Whats your gripe with the hiring process? Not coming at you, just wondering as I just finished with it a couple months ago.



It's not so much the process as it is the people behind it. It's all about politics, and even if you rank #1, outperform everyone in every aspect of the hiring process, they'll find a way to screw you over if they can. Having a psychologist dictate whether you get hired or not is amusing. They should just make it pass/fail based on the written. 

I've been through it with no issues, but close friends have been screwed. 

But hey, if you're a basic, you can't beat the salary, updated equipment, and being able to run 911. Medics, on the other hand, don't want a 30 year retirement.


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## Chewy20 (Dec 23, 2014)

teedubbyaw said:


> It's not so much the process as it is the people behind it. It's all about politics, and even if you rank #1, outperform everyone in every aspect of the hiring process, they'll find a way to screw you over if they can. Having a psychologist dictate whether you get hired or not is amusing. They should just make it pass/fail based on the written.
> 
> I've been through it with no issues, but close friends have been screwed.
> 
> But hey, if you're a basic, you can't beat the salary, updated equipment, and being able to run 911. Medics, on the other hand, don't want a 30 year retirement.


 
Not to sure what you mean by that to be honest. Its civil service, you either pass the steps or you don't. Everything is pass fail except for the written test which is what your ranking is based on. The oral board I can see getting a lot of people. But plenty of departments, not just in EMS require you to pass a psych doc interview.


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## teedubbyaw (Dec 23, 2014)

Chewy20 said:


> Not to sure what you mean by that to be honest. Its civil service, you either pass the steps or you don't. Everything is pass fail except for the written test which is what your ranking is based on. The oral board I can see getting a lot of people. But plenty of departments, not just in EMS require you to pass a psych doc interview.



It's pass/fail up until psych. Very few agencies require a psych interview in Texas. 

They refuse to look at you as a whole or how good of a medic you are. Again, one of the few agencies that does that. Perhaps that's why they have so many medics with poor customer service skills.


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## Chewy20 (Dec 23, 2014)

teedubbyaw said:


> It's pass/fail up until psych. Very few agencies require a psych interview in Texas.
> 
> They refuse to look at you as a whole or how good of a medic you are. Again, one of the few agencies that does that. Perhaps that's why they have so many medics with poor customer service skills.


 
Like I just said, its all pass fail except for the very first test. You take a huge psych questionnaire then have a psych interview with the doc. If it were just based off the questionnaire than I probably would have not been hired. The interview is where they got to know me.

You pass you are hired, if you slip by the oral board and psych interview then you may get weeded out in academy or FTO phases. That's how civil service works. Show me a civil service department of any kind that does not have a psych part to it and I would be surprised.

Sorry just don't see what the issue is. Civil service usually has a lot of hoops to jump through.


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## Tigger (Dec 23, 2014)

Chewy20 said:


> Like I just said, its all pass fail except for the very first test. You take a huge psych questionnaire then have a psych interview with the doc. If it were just based off the questionnaire than I probably would have not been hired. The interview is where they got to know me.
> 
> You pass you are hired, if you slip by the oral board and psych interview then you may get weeded out in academy or FTO phases. That's how civil service works. Show me a civil service department of any kind that does not have a psych part to it and I would be surprised.
> 
> Sorry just don't see what the issue is. Civil service usually has a lot of hoops to jump through.


Agreed, sounds like a standard civil service setup to me.


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## teedubbyaw (Dec 23, 2014)

Chewy20 said:


> Like I just said, its all pass fail except for the very first test. You take a huge psych questionnaire then have a psych interview with the doc. If it were just based off the questionnaire than I probably would have not been hired. The interview is where they got to know me.



Um, so how is that pass/fail if you have a chance to speak for your answers on the written psych eval?

You are right in that a lot of aspects are pass/fail, which is a poor way to hire medics. Watching the FTO's throw a fit because they keep hiring 18 year old kids with no life experience, straight out of basic, and DQ'ing the overly qualified people who would be a phenomenal addition to their system is amusing.

Regardless, it's just my opinion. Basics get a great job, medics get the short end of the stick.


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## Chewy20 (Dec 23, 2014)

T


teedubbyaw said:


> Um, so how is that pass/fail if you have a chance to speak for your answers on the written psych eval?
> 
> You are right in that a lot of aspects are pass/fail, which is a poor way to hire medics. Watching the FTO's throw a fit because they keep hiring 18 year old kids with no life experience, straight out of basic, and DQ'ing the overly qualified people who would be a phenomenal addition to their system is amusing.
> 
> Regardless, it's just my opinion. Basics get a great job, medics get the short end of the stick.


 
The doc either thinks you are fit for the job or doesn't. Pass fail.

Once again it doesn't matter your exp or anything like that. CIVIL SERVICE. Not saying anything more, you are not getting the simple concept. Right or wrong that's the way it works.


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## teedubbyaw (Dec 23, 2014)

RocketMedic said:


> Teedubbyaw, I'm looking for exactly that- a great agency in Central Texas. Proximity to San Antonio a plus. Any advice?





Angel said:


> I do! I'm open to all possibilities right now. I just dont know much about texas or where to begin looking besides what is mentioned on here.
> 
> ETA: yea i can get a live scan done easily. ill check and see if theyll accept that. I have to go through the packet a bit more thoroughly



Marble Falls and Hays county are more central to Austin, both growing systems with great team dynamics. Awesome protocols that give medics ample opportunity to practice medicine. The downside, is that they most always hire PRN then promote within. Not ideal if you're out of state and need the income.

Williamson county is phenomenal. The system backs their medics like no other, and expects that you perform to a high standard in return. Great benefits and retirement. A lot of competition in trying to get in with them.

Fayette county and Washington county are great systems as well. Washington having similar benefits/retirement as Williamson county, if I remember correctly.

Acadian does 911 in rural Bastrop county. From what I've heard, you can't specifically sign on with that district, but may get to do rotations out there. Everything else they do here are IFT's. I doubt either of you would be interested in the private companies here -- they're mostly IFT or medical standby and low pay.

Scott & White runs 911 in Temple (50 or so miles north of Austin). Don't have much info. on them as it's run by a hospital.

Georgetown Fire Department just recently (as in last month) took over the town for EMS, which was ran by Williamson County EMS. Very new system, but may be worth looking in to.

That's all I got. STX may know places closer to San Antonio.


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## teedubbyaw (Dec 23, 2014)

Chewy20 said:


> T
> 
> 
> The doc either thinks you are fit for the job or doesn't. Pass fail.
> ...



I get it just fine. You obviously haven't been behind the scenes of their hiring process.


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## Chewy20 (Dec 23, 2014)

teedubbyaw said:


> I get it just fine. You obviously haven't been behind the scenes of their hiring process.


 
Lol you're right I haven't. My job was to get hired, not hire people.


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## Tigger (Dec 23, 2014)

teedubbyaw said:


> I get it just fine. You obviously haven't been behind the scenes of their hiring process.


You seem to have some sort of agenda here...


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## RocketMedic (Dec 23, 2014)

Thanks, Teedubbyaw. I am already fairly unimpressed with Acadian.  Just not my cup of tea.

Washington County looks pretty cool. 

Austin/Travis County honestly seems like a system to attract the young (brand-new), the submissive and the very, very patient. To me, as a somewhat-seasoned medic, the purpose of the ATC process is to filter out people like me with my own experience and workflow and instill the ATC Way.


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## wanderingmedic (Dec 23, 2014)

teedubbyaw said:


> Scott & White runs 911 in Temple (50 or so miles north of Austin). Don't have much info. on them as it's run by a hospital.



Scott & White is partially owned by the hospital and partially owned by Community EMS. I don't know how similar Scott & White is to other Community operations, but the Community EMS companies I have seen are pretty typical services. Nothing really notable.


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## JDEMT18 (Feb 4, 2015)

If you are an EMT-P in the US preferably a state with a large scope of practice work in the UK or Australia. They have a great mindset to prehospital care and are so ahead of the U.S. If you want to see where the US is in 10 years look at the UK or Australia. Also the naming in the UK an AU is misleading because if you are an EMT-P you can work as a critical care paramedic in those countries. When just paramedic in the UK and AU is the US equivalent of a EMT-I99 or AEMT-CC. 1 or 2 US states use the UK/AU style of naming where AEMTs are medics and EMT-P are Mobile Intensive Care or Critical Care Paramedics. Also if you like rescue and special op stuff both countries have EMT-P Hazmat, USAR etc teams rather than an FD. Those countries FDs do that stuff but if you are on these teams you can work as MICP and also work with them on calls with basic Hazmat/USAR/etc duties or due ALS treatment in those areas rather than PD FD brining patients to you. So you get to preform a lot of advance care in different places with a good salary and a lot more ALS experience.


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## ZootownMedic (Feb 16, 2015)

I started my career and came up here in Colorado so this is all I know but from my experience here and knowledge of other states/counties protocols we have it pretty good here. I have worked in Arapahoe/Douglas/Denver counties (greater Denver area) and currently work in El Paso COunty (Colorado Springs) and it rocks. EMT's here can do IV's, D50, narcan and ODT zofran and are about to get IO's at my agency and have them at many others already. As a paramedic I dont remember the last time I called in for an intervention or med. Pay is ok, pretty busy systems. I have been in the private industry for the past 5 years and got hired on with a small FD just in the last few weeks. We run 15-20 calls in a 24 with 2 medic units and 20-25 min transport times. Great mix of urban and suburban setting, stretches of highway for decent MVA's/TA's, and a wide variety of medicals and traumas. I have heard great things about texas but if CO is on your radar give it a shot. Aside from the great EMS work environment we have an outdoor paradise....and the best beer around


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## DrParasite (Feb 16, 2015)

STXmedic said:


> I think my gripe with ATC comes from most (not all, you aren't there yet Chewy  ) ATC medics I know being exceptionally arrogant and cocky. They think their **** doesn't stink, they're god's gift to paramedicine, their system is the best in the country, and every other system is garbage. Even with that attitude, I have only considered one of them a truly good medic (albeit my standards are set pretty high), and I don't think as a system they do anything special or ground-breaking. The Kool-aid there is exceptionally potent, and undeservedly so.


I would wage you would get the same attitude from every "best EMS system in the nation" whether it be Wake EMS in NC, Seattle Medic One, or Ada County in Idaho.  Of course, Miami Dade & LAFD could be even worse, but when you are regarded as one of the elite in the country, you start to believe your own hype.


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