# KCM1 Now Hiring



## KingCountyMedic (Nov 15, 2016)

http://www.kingcounty.gov/depts/health/emergency-medical-services/medic-one/employment.aspx


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## RocketMedic (Nov 15, 2016)

Interesting, but a few questions: 

Do your ALS units/supervisor/etc carry vents? RSI? Field ABX? Blood products?

What is the workflow (standing orders for all, medical control, mother-may-I, etc?)

What opportunities exist for an experienced, college-educated provider in your system once the "repeat paramedic school" box is checked?


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## ExpatMedic0 (Nov 15, 2016)

I am just curious, how many applicants do you generally receive when spots open up?


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## EpiEMS (Nov 16, 2016)

ExpatMedic0 said:


> I am just curious, how many applicants do you generally receive when spots open up?


For context, they have 26 ALS units (I'm quoting from their 2014-2019 Strategic Plan). I couldn't find a number of staff figure.

Also, interesting info in their 2016 Annual Report.


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## ExpatMedic0 (Nov 16, 2016)

They are looking to hire 3 people from what I read, just curious how many people apply


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## SandpitMedic (Nov 16, 2016)

EpiEMS said:


> For context, they have 26 ALS units (I'm quoting from their 2014-2019 Strategic Plan). I couldn't find a number of staff figure.
> 
> Also, interesting info in their 2016 Annual Report.


According the link posted, the info on their website states they only have 9 ALS units.


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## NomadicMedic (Nov 16, 2016)

SandpitMedic said:


> According the link posted, the info on their website states they only have 9 ALS units.



This is a job posting for King County Medic One, the third service that serves King County south of Seattle.


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## SandpitMedic (Nov 16, 2016)

Also looks like you have to be the best of the best to be hired.
Pretty tough. And limited vacancy.


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## SandpitMedic (Nov 16, 2016)

DEmedic said:


> This is a job posting for King County Medic One, the third service that serves King County south of Seattle.


Yes, the guy above stated 26 units.
That's incorrect for the company that is hiring.


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## Handsome Robb (Nov 16, 2016)

SandpitMedic said:


> Yes, the guy above stated 26 units.
> That's incorrect for the company that is hiring.



I was going to say that 26 sounded like a lot. 


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## VentMonkey (Nov 16, 2016)

DEmedic said:


> This is a job posting for King County Medic One, the third service that serves King County south of Seattle.





SandpitMedic said:


> According the link posted, the info on their website states they only have 9 ALS units.





Handsome Robb said:


> I was going to say that 26 sounded like a lot.


This has to be one of the more convoluted sounding EMS systems to non-WA paramedics such as myself, or perhaps I am truly that spee-shull...

Is this the MedicOne that responds to/ with the Seattle FD? Forgive my ignorance.


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## NomadicMedic (Nov 16, 2016)

VentMonkey said:


> This has to be one of the more convoluted sounding EMS systems to non-WA paramedics such as myself, or perhaps I am truly that spee-shull...
> 
> Is this the MedicOne that responds to/ with the Seattle FD? Forgive my ignorance.



No. That is SFD Medic One. Remember, "medic one" is the brand name for paramedics in Washington. King County Medic One = king county paramedics. Seattle Fire Medic One = Seattle Fire Department paramedics. And so on. 

KCMO is the only true third service in King County. Not fire based, although they're in red apparatus, based in fire stations and are represented by the IAFF.


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## NomadicMedic (Nov 16, 2016)

They also believe (as I do) that fewer paramedics make for better paramedics. Less skill dilution, a higher incidence of high acuity calls seen by each medic and fewer wasted resources.


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## VentMonkey (Nov 16, 2016)

DEmedic said:


> No. That is SFD Medic One. Remember, "medic one" is the brand name for paramedics in Washington. King County Medic One = king county paramedics. Seattle Fire Medic One = Seattle Fire Department paramedics. And so on.
> 
> KCMO is the only true third service in King County. Not fire based, although they're in red apparatus, based in fire stations and are represented by the IAFF.


Makes complete sense (says the guy from the county that still practices "Johnny & Roy medicine")


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## VentMonkey (Nov 16, 2016)

DEmedic said:


> They also believe (as I do) that fewer paramedics make for better paramedics. Less skill dilution, a higher incidence of high acuity calls seen by each medic and fewer wasted resources.


Oh, so do I; another reason ALS intercepts while somewhat unpopular in the eyes of some just makes sooo much flippin' sense, IMO.


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## SandpitMedic (Nov 16, 2016)

DEmedic said:


> KCMO is the only true third service in King County. Not fire based, although they're in red apparatus, based in fire stations and are represented by the IAFF.



Not convoluted at all. 

From their testing process, requirements, and vacancies I'd say it's easier to become a contractor overseas than to get juiced in at King County Medic One.
Seems like a tough sell, but then again, they are clearly looking for the best of the best...
... 6 months with an FTO... Then 6 more on probation. Plus retraining as a paramedic. 
Takes a lot of dedication, are they at least all baseline CCT?! I'd hope to be dropping chest tubes with that stringent of a training/recruiting process.

Plus you have to not screw up anything for nearly 2 years or risk it all being a wash.  Tough sell, as I said. Maybe I'll go for USAF Pararescueman instead. Seems easier 

Good luck to those who apply.


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## SandpitMedic (Nov 16, 2016)

DEmedic said:


> They also believe (as I do) that fewer paramedics make for better paramedics. Less skill dilution, a higher incidence of high acuity calls seen by each medic and fewer wasted resources.


That, I love.


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## VentMonkey (Nov 16, 2016)

SandpitMedic said:


> Not convoluted at all.


Like I said...speee-shull.


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## EpiEMS (Nov 16, 2016)

SandpitMedic said:


> According the link posted, the info on their website states they only have 9 ALS units.


You're right -- sorry. 26 is the number of ALS units throughout the county (across all the services, I think).


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## SpecialK (Nov 16, 2016)

Outside of the USA we're told Medic One is the "best" of the USA, particularly due to their very high survival from cardiac arrest.

Does anybody know if it is true in regards to the "rest" of what they do; considering cardiac arrest is like 1% of workload.


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## SandpitMedic (Nov 16, 2016)

EpiEMS said:


> You're right -- sorry. 26 is the number of ALS units throughout the county (across all the services, I think).


No way... 26? That can't be right for a place the size of King County. 

Do some fact checking.


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## Handsome Robb (Nov 16, 2016)

SpecialK said:


> Outside of the USA we're told Medic One is the "best" of the USA, particularly due to their very high survival from cardiac arrest.
> 
> Does anybody know if it is true in regards to the "rest" of what they do; considering cardiac arrest is like 1% of workload.



From my understanding they suck at symptom management and turf a lot of calls to BLS crews that shouldn't be sent BLS.

However, that's hearsay and I have no evidence to back that up. 

I know their survival rates look good because, if I remember correctly, they only include witnessed VF/VT arrests in that number but I may be wrong. That's not to say they aren't great at resuscitation but that's only a fraction of the arrests we see. The biggest reason their save rate is so high is the "MedicTwo" program which is the massive push to train every day people in CPR and lots of access to AEDs. 


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## ExpatMedic0 (Nov 17, 2016)

If your looking to settle down for the rest of your life at one agency and do EMS as a career, this is a top one.  One of the best pay rates and benefits in the entire country. Otherwise, some big challenges. As a paramedic you'll need to repeat your entire paramedic program at medic ones program in harbor view. The good news is that your paid. It's over 3000 clock hours compared to the national standards of around 1000_1300.


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## Gurby (Nov 17, 2016)

ExpatMedic0 said:


> If your looking to settle down for the rest of your life at one agency and do EMS as a career, this is a top one.  One of the best pay rates and benefits in the entire country. Otherwise, some big challenges. As a paramedic you'll need to repeat your entire paramedic program at medic ones program in harbor view. The good news is that your paid. It's over 3000 clock hours compared to the national standards of around 1000_1300.



Get paid to sit in class for 3000 hours?  Sounds more like a "pro" than a "con" to me at least...

"Training is approximately 11 months long. The cost of your training is paid for by the Medic One Foundation. During this time, employees have full benefits – medical, dental, vision, and contribution to a state pension plan (LEOFF 2). Employees are paid an hourly rate while in school that ends up grossing approximately $50,000 for that year."

Sounds friggin amazing.


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## Carlos Danger (Nov 17, 2016)

Gurby said:


> Get paid to sit in class for 3000 hours?  Sounds more like a "pro" than a "con" to me at least...
> 
> "Training is approximately 11 months long. The cost of your training is paid for by the Medic One Foundation. During this time, employees have full benefits – medical, dental, vision, and contribution to a state pension plan (LEOFF 2). Employees are paid an hourly rate while in school that ends up grossing approximately $50,000 for that year."
> 
> Sounds friggin amazing.



Yeah, I wouldn't view that as a downside, either. 

A big waste of money for King County perhaps, but not a negative from the paramedic's perspective.


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## ExpatMedic0 (Nov 17, 2016)

I can see it as both a pro and a con. A huge pro if you're an EMT basic. Also, a pro if you want to spend the rest of your life living in Seattle working at medic 1. Another pro that the training is paid and it's probably pretty good training, at the very least its 2-3 times more hours than a standard paramedic program so we all could probably stand to learn something and refresh on things regardless of our provider level.  A con is it is a very intense year worth of training. For comparison, 40 hours a week times 52 weeks equals 2,080 hours a year. 3000 hours is much more than a fulltime job and thus the salary offered for training is not very good when analyzed from an hourly perspective. Secondly the 3000 hour program is vocational training, it is not recognized any more than any other 1300 hour paramedic program if you ever leave the small bubble of Seattle. It also does not result in any type of degree or transferable credits toward a degree more than a standard paramedic program does.  Another con is if you're already an experienced provider and a paramedic with a degree who is willing to go through something like this there are other options. For example, PA school is also a 1-year intense classroom program, followed by 1 year of clinical...  and your salary and working hours are better than even Medic 1.  Just playing the devils advocate a bit...


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## EpiEMS (Nov 17, 2016)

SandpitMedic said:


> No way... 26? That can't be right for a place the size of King County.
> 
> Do some fact checking.



It looks like 26...per the 2014-2019 Strategic Plan for the whole of King County, as promulgated by the county's EMS office -- "There are 26 ALS units located throughout King County which are strategically placed for optimal response times" (see pg. 12). This is 26 ALS units covering the whole county -- operated by six agencies (Bellevue Medic One, King County Medic One, Redmond Medic One, Seattle Medic One, Shoreline Medic One, and Vashon Medic One). Their model is explicitly based on medics only responding to ALS calls...they only respond to a quarter of calls (per pg. 8 of the 2016 King County EMS annual report).

King County Medic One, which covers the southern half of the county only operates 8 units, with 73 paramedics.

For the county, it's split between 19 ALS units covering the county ex-Seattle, and 7 ALS units covering Seattle. BLS units are not included in this count.


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## SandpitMedic (Nov 17, 2016)

26 units for 2 million people?!

Everyday we have about 100 911 responding ALS ambulances that are transporting units (that doesn't include fire trucks). Plus about 20 or so CCFD ambulances (rescues) that are capable of transport. Add another flex of about 20-25 area wide for large scale events and holidays

That's for about 750,000 residents of Las Vegas, and a transient population of another 100,000-200,000 travelers depending on what's going on at any given time.

So, 26 ALS transporting 911 units for a population of 2.1 million (according to the latest data) seems to be a little underwhelming when we can put over 100 ALS 911 transporting units for half the population size.

Either they are taking the "fewer medics makes better medics" mantra way too seriously, or your research is off somehow. It would seem to me that would leave a large amount of the population underserved with limited to no access to prehospital ALS transport.

It is also true that what works for one system may not work for another, and that my perspective is simply altered because of my own experiences. But I've worked in a lot of places, and I still say that numbe seems low.

I suppose if we only responded to true EMS calls we'd only need half as many units, which is a double edged sword. Would be nice to only respond on only ALS calls, no doubt. 

And can someone answer why they're all tagged as "Medic One?"


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## VentMonkey (Nov 17, 2016)

SandpitMedic said:


> And can someone answer why they're all tagged as "Medic One?"


I think (thought) Boston EMS had a similiar ALS to BLS unit ratio, but could be completely wrong. I was under the impression that KCM1 ALS units only responded to/ transported ALS level patients and were cancelled the rest of the time; could be completely wrong.

As far as the name, @DEmedic breaks it down really well, and shares a link to their history in this thread. That's what threw me off as well initially.

http://emtlife.com/threads/central-skagit-wa-paramedic-opening.44733/


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## Tigger (Nov 17, 2016)

SandpitMedic said:


> 26 units for 2 million people?!
> 
> Everyday we have about 100 911 responding ALS ambulances that are transporting units (that doesn't include fire trucks). Plus about 20 or so CCFD ambulances (rescues) that are capable of transport. Add another flex of about 20-25 area wide for large scale events and holidays
> 
> ...


Did you read the report or are you going to tell him to keep doing more research? A direct quote has been provided from the King County government. Some systems may be different than yours. Peak ALS ambulance staffing in the city of Boston is five, plus two paramedic lieutenants and a deputy superintendent paramedic. There might be a few other "semi-clinical" paramedics floating around. There are 21 BLS ambulances and a myriad of privates providing backup, mostly staffed BLS. The estimated daytime population is over a million.


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## SandpitMedic (Nov 17, 2016)

Tigger said:


> Did you read the report or are you going to tell him to keep doing more research? A direct quote has been provided from the King County government. Some systems may be different than yours. Peak ALS ambulance staffing in the city of Boston is five, plus two paramedic lieutenants and a deputy superintendent paramedic. There might be a few other "semi-clinical" paramedics floating around. There are 21 BLS ambulances and a myriad of privates providing backup, mostly staffed BLS. The estimated daytime population is over a million.


That's wild. I concur, there's more than one way to skin a cat, but as I stated, my estimation is that leaves a lot of folks underserved. That's my own opinion. It's a hard thing to study and quantify. Are their success rates so high for OHCA because they are performing above average, or because they run fewer because it takes them longer to get there leaving the patient in a state where efforts are futile? 

I did say it could just be my perspective. I have never worked in a system where BLS was the only responding unit to a 911 call in a major metropolitan area.


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## SandpitMedic (Nov 17, 2016)

VentMonkey said:


> I think (thought) Boston EMS had a similiar ALS to BLS unit ratio, but could be completely wrong. I was under the impression that KCM1 ALS units only responded to/ transported ALS level patients and were cancelled the rest of the time; could be completely wrong.
> 
> As far as the name, @DEmedic breaks it down really well, and shares a link to their history in this thread. That's what threw me off as well initially.
> 
> http://emtlife.com/threads/central-skagit-wa-paramedic-opening.44733/


Thank you.


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## Handsome Robb (Nov 17, 2016)

SandpitMedic said:


> 26 units for 2 million people?!
> 
> Everyday we have about 100 911 responding ALS ambulances that are transporting units (that doesn't include fire trucks). Plus about 20 or so CCFD ambulances (rescues) that are capable of transport. Add another flex of about 20-25 area wide for large scale events and holidays
> 
> ...



We cover half a million people plus 250k commuters with 17 dual medic ambulances, a single medic squad, three paramedic commanders and are never holding calls or use privates for backup....

How many calls are y'all running daily? 


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## Summit (Nov 17, 2016)

I believe the primary reasons for their super hi OHCA survival are massive ammounts of bystander CPR faciliated by huge education drives and public access AED, plus a bit of selective stats.

Is KCMO still doing old school stuff like starting central lines in the field?


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## ExpatMedic0 (Nov 17, 2016)

Beautiful city, though, if I ever move back to the Pacific Northwest it will be Seattle. Strange Thunderdome of an EMS system they have, but a great city


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## RocketMedic (Nov 18, 2016)

I wonder how they do at everything that's not cardiac arrest?


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## Grozler (Nov 18, 2016)

RocketMedic said:


> I wonder how they do at everything that's not cardiac arrest?


They do everything the same as any medic everywhere else, there are no magic bullets out in Seattle. (The earlier posts about what OHCA they specifically study as well as public access to AEDs and bystander CPR are definitely true.) The only catch is they have to contact a doc every call. Now they are not asking for permission/Mother-May-I as much as telling them what they are going to do and giving an ETA. But a lot of medics get bent out of shape about contacting a doc every call, which I can understand. 

The training program is set up like boot camp for a reason. Three thousand hours in 11 months is designed to break you down (and boy do they break you down; the Seattle medics can be extremely delightful to deal with in the context of being a medic intern), and build you back up in the Medic One way. It is what it is and I know two friends who have gone through that program. Both they and their spouses were told ahead of time that it would be the hardest year of their lives and it absolutely lived up to that. However it is like any medic program: if you can juggle school with the rest of your life, you will make it. Some of the dumbest knuckle dragging hose jockeys you could imagine make it through that program. Trust me, you can make it through too.


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## FLMedic311 (Nov 21, 2016)

Hey all! So I thought I might take a second to chime in here.
So I am currently employed here at KCM1 in the 3rd month of my FTO period, I was hired late in 2015 and finished school at the UW Harborview Paramedic Training Program July of this year.  I was Born and raised in Florida and at the time of hire I was working full time as a FF/PM with 9.5yrs experience and also working part time as a Flight Paramedic (Rotary Wing/Helicopter).  I can honestly say that as I applied for the position I did so without the expectation of getting to any significant stage of the hiring process, much less a job offer.  So when I got the call and said Yes it would be a understatement to say that I was extremely nervous about what I had just gotten myself into.  Going back to school, that was well known for being not only intense but not afraid to send people they didn't think were cutting it home packing.  Now just over a year later I can easily say that it was more then worth it!  School had it's challenges, but the learning and clinical opportunity were second to none.



RocketMedic said:


> Interesting, but a few questions:
> Do your ALS units/supervisor/etc carry vents? RSI? Field ABX? Blood products?
> What is the workflow (standing orders for all, medical control, mother-may-I, etc?)
> What opportunities exist for an experienced, college-educated provider in your system once the "repeat paramedic school" box is checked?


Vents-No; RSI-Yes; ABX-Not for the Pt's, only for providers S/P Exposure/WMD; Blood- No, Maybe coming...
What opportunities are you referring too?  We have Helicopter Medics, MAT-Medical advisory team, Truck Team, Regional Disaster Team, Forestry Team, and Your typical opportunities to promote




RocketMedic said:


> I wonder how they do at everything that's not cardiac arrest?


Clearly my opinion at this point would be deemed bias, I would recommend you come do a ride along and make a determination for yourself!



Summit said:


> Is KCMO still doing old school stuff like starting central lines in the field?


Yes we have the training and ability to do central lines, we also have IO Sternal, Humeral and Tibial.  I like to think of it more as having a extra tool in your tool box!



ExpatMedic0 said:


> 3000 hours is much more than a fulltime job and thus the salary offered for training is not very good when analyzed from an hourly perspective. Secondly the 3000 hour program is vocational training, it is not recognized any more than any other 1300 hour paramedic program if you ever leave the small bubble of Seattle. It also does not result in any type of degree or transferable credits toward a degree more than a standard paramedic program does.  Another con is if you're already an experienced provider and a paramedic with a degree who is willing to go through something like this there are other options. For example, PA school is also a 1-year intense classroom program, followed by 1 year of clinical...  and your salary and working hours are better than even Medic 1.  Just playing the devils advocate a bit...


There is a lot to this one but I felt the need to address it so you can have the full story of what the first year really entails..
During training your Hourly wage is 16.82, based on a 40 hour work week.  Meaning that any time worked beyond 40hrs per week is 1.5x Pay, with this you also have full Medical, Dental and vision benefits for you and your family (They are excellent BTW)
All your training hours are transferable to Central Washington University
As Far as working hours, well I don't know anything about a PA's Shifts  What I do know is that it is estimated that the Mean salary for a PA is 96k
We work 24on 24off 24on 5 Days Off with 10 Debit Days for a total of 102 shifts per year, (Also start at 10 Vacation annually)
The work week is based on 40hrs, Pay starts at 32.4479/Hr and by Year 4 you will be making 42.1616 this does not include any bargained COLA.  OT is very available and Mandatory typically will not happen more then 2 12hrs shift per year

Any how as your probably can tell I am very enthusiastic about KCM1.  I write this because I believe in what we do here and want people with love for medicine to know how great this department is.  I am excited for the opportunity to work with anyone that brings the same passion/drive for medicine and taking care sick people!  Please feel free to PM me if you have a detailed question you have or just want to chat for that matter!


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## VentMonkey (Nov 21, 2016)

FLMedic311 said:


> Yes we have the training and ability to do central lines...I like to think of it more as having a extra tool in your tool box!


Howdy, welcome, and thanks for the insightful post.

Out of curiosity, what would really be the reason to perform a central line in the prehospital setting? I understand you guys work very closely with your ED docs, but given the various IO choices I am of the "I would rather have a tool(s) in my toolkit that I can justifiably use with a fair amount of frequency and practice that is backed by EBM" variety.

From what I know a central line placement is a sterile procedure and can be quite time consuming without experience, are you guys being remediated if you don't meet your quota for the year like your ETI's? 

Also, I think the vent in the prehospital setting has more significance than CLP, but alas, I too have my biases.

-VM


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## FLMedic311 (Nov 21, 2016)

VentMonkey said:


> Howdy, welcome, and thanks for the insightful post.
> 
> Out of curiosity, what would really be the reason to perform a central line in the prehospital setting? I understand you guys work very closely with your ED docs, but given the various IO choices I am of the "I would rather have a tool(s) in my toolkit that I can justifiably use with a fair amount of frequency and practice that is backed by EBM" variety.
> 
> ...



Fair question!  I can say that the current emphasis is on IO first, some reasons that they are preformed in the field could include poor performance of IO and the lack of IV access in a critically ill Pt.  Also the need for extended duration of a vasopressor "Levophed" without IV access (anecdotally they are not as effective IO).
We use the Arrow kit via seldinger technique (same used in the ER) with sterile technique.  Yes we do have a quota of 2 per year or remediation.
I also agree and I think I would find a Vent very usefully, alas that is not something we have been able to obtain as of yet


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## Summit (Nov 21, 2016)

FLMedic311 said:


> Fair question!  I can say that the current emphasis is on IO first, some reasons that they are preformed in the field could include poor performance of IO and the lack of IV access in a critically ill Pt.  Also the need for extended duration of a vasopressor "Levophed" without IV access (anecdotally they are not as effective IO).
> We use the Arrow kit via seldinger technique (same used in the ER) with sterile technique.  Yes we do have a quota of 2 per year or remediation.
> I also agree and I think I would find a Vent very usefully, alas that is not something we have been able to obtain as of yet


Anecdotally you think that norepi is less effective in an IO? You would use a failed IO as your justification to start a CIV in the field instead of another IO despite the well documented complication from CIV starts in suboptimal/substerile conditions with providers who start a whopping 2 CIVs per year? Would you also delay transport for this?

What percentage of your medics get two CIV field starts and what percent remediate?


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## EpiEMS (Nov 21, 2016)

FLMedic311 said:


> So I am currently employed here at KCM1 in the 3rd month of my FTO period



Thanks for your great reply - very informative!

I wanted to inquire: What has been your sense of the nature of your interaction with the medical control physicians? Do you find that you have to call them more often than you'd like, or is it not much of a burden? My understanding is that you must call before you perform most (all?) ALS procedures. Is that correct?


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## DrParasite (Nov 21, 2016)

FLMedic311 said:


> Going back to school, that was well known for being not only intense but not afraid to send people they didn't think were cutting it home packing.  Now just over a year later I can easily say that it was more then worth it!  School had it's challenges, but the learning and clinical opportunity were second to none.


Do you know what percentage of their new hires don't pass the reeducation process?  and how many graduates of the reeducation process don't complete their FTO time?


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## ExpatMedic0 (Nov 21, 2016)

Interesting, I am sure it's a great place to work. However, coincidentally I have my bachelor's in paramedicine from Central Washington University. From my understanding unless you take CWU's program on campus, all other accredited paramedic programs are accepted at the same amount of transfer credit as a " advanced standing" policy. This is regardless if they exceed the national standard. So in that regard, any NREMT paramedic from a nationally accredited program will get the same amount of transfer credit, unless you took seperately classified and accredited college credits in separate subject matter. For example, a full anatomy class for college credit as part of your program. Otherwise it's all vocational training at most universities. Not to steal your thunder, I am sure it's a stellar agency with great pay and a good reputation


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## FLMedic311 (Nov 21, 2016)

Summit said:


> Anecdotally you think that norepi is less effective in an IO? You would use a failed IO as your justification to start a CIV in the field instead of another IO despite the well documented complication from CIV starts in suboptimal/substerile conditions with providers who start a whopping 2 CIVs per year? Would you also delay transport for this?
> 
> What percentage of your medics get two CIV field starts and what percent remediate?



I am going to start with I fully respect your opinion on this matter, and have nothing against your thoughts on CIV access.  With that said I am not going to try and sway your opinion or defend our current practice.  



EpiEMS said:


> Thanks for your great reply - very informative!
> 
> I wanted to inquire: What has been your sense of the nature of your interaction with the medical control physicians? Do you find that you have to call them more often than you'd like, or is it not much of a burden? My understanding is that you must call before you perform most (all?) ALS procedures. Is that correct?



To be honest I only have my last job as a FF/PM in Florida to compare too and I do not feel it is much different.  We have standing orders in which we operate under and they cover most all things you can think you may need to do in an emergent situation.  There are few times in which we are calling for "Orders" and most of those times it is warranted do to it being a complex Pt.  The "mother may I" system is not in place here and I think the thoughts behind it mostly stem from what you have to do in school while with SFDM1.  So no it is not a burden at all!



DrParasite said:


> Do you know what percentage of their new hires don't pass the reeducation process?  and how many graduates of the reeducation process don't complete their FTO time?



I can't honestly say I know and exact # but it sounds like it does not happen often as the hiring process itself is set up pretty well with regard to hiring canidates that are going to be successful in school and a good fit for KCM!


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## Amberlamps916 (Nov 21, 2016)

SpecialK said:


> Outside of the USA we're told Medic One is the "best" of the USA, particularly due to their very high survival from cardiac arrest.
> 
> Does anybody know if it is true in regards to the "rest" of what they do; considering cardiac arrest is like 1% of workload.




Medic One is always looked upon as the gold standard for cardiac arrest survival but for some reason, other systems with relatively high survival rates are rarely mentioned.

For example, Santa Barbara County in California (go figure) has very high sudden cardiac arrest survival rates, 52% as of 2015 (file uploaded for verification).

This can be attributed to bystander cpr programs, a strong emphasis on resuscitation, pit-crew cpr, and county AED programs.

It's interesting to see Medic One's cardiac arrest survival rates but I'd like to see statistics on patients where treatments are performed in the Medic One system utilizing methods most providers in America can't use.


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## FLMedic311 (Nov 21, 2016)

ExpatMedic0 said:


> Interesting, I am sure it's a great place to work. However, coincidentally I have my bachelor's in paramedicine from Central Washington University. From my understanding unless you take CWU's program on campus, all other accredited paramedic programs are accepted at the same amount of transfer credit as a " advanced standing" policy. This is regardless if they exceed the national standard. So in that regard, any NREMT paramedic from a nationally accredited program will get the same amount of transfer credit, unless you took seperately classified and accredited college credits in separate subject matter. For example, a full anatomy class for college credit as part of your program. Otherwise it's all vocational training at most universities. Not to steal your thunder, I am sure it's a stellar agency with great pay and a good reputation



This could very well be true! I honestly do not no the fine details. As far as my thunder, admittedly it is just my opinion and it is not to say this is without a doubt the best place to be a medic in the world. I just think it is!


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## VentMonkey (Nov 21, 2016)

FLMedic311 said:


> admittedly it is just my opinion and it is not to say this is without a doubt the best place to be a medic in the world. I just think it is!


Undoubtedly disputable.


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## SpecialK (Nov 21, 2016)

Addrobo said:


> It's interesting to see Medic One's cardiac arrest survival rates but I'd like to see statistics on patients where treatments are performed in the Medic One system utilizing methods most providers in America can't use.



CPR and defibrillation are not available to most American ambulance personnel?

That's the only two things which have ever been proven to increase survival.

IV drugs, mechanical CPR, endotracheal intubation, pre-hospital hypothermia: absolutely none of them have shown a positive impact on survival.


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## VentMonkey (Nov 21, 2016)

SpecialK said:


> CPR and defibrillation are not available to most American ambulance personnel?
> 
> That's the only two things which have ever been proven to increase survival.
> 
> IV drugs, mechanical CPR, endotracheal intubation, pre-hospital hypothermia: absolutely none of them have shown a positive impact on survival.


I think he was referring to things such as central line placement, which also has zero benefits, particularly in an urban-EMS environment; to answer your question, yes early CPR and defibrillation is readily available here.

Some cities, such as Seattle, do a phenomenal job at educating the public and supplying them with the training and equipment (public access defibrillators), thereby improving their overal OHCA survival rates.


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## EpiEMS (Nov 22, 2016)

FLMedic311 said:


> To be honest I only have my last job as a FF/PM in Florida to compare too and I do not feel it is much different. We have standing orders in which we operate under and they cover most all things you can think you may need to do in an emergent situation. There are few times in which we are calling for "Orders" and most of those times it is warranted do to it being a complex Pt. The "mother may I" system is not in place here and I think the thoughts behind it mostly stem from what you have to do in school while with SFDM1. So no it is not a burden at all!



Ok, that makes sense. I think I saw the "mother may I" in a slide deck for SFD MedicOne. So do you have to call for orders, say, for procedures like IOs or ETI?



Addrobo said:


> It's interesting to see Medic One's cardiac arrest survival rates but I'd like to see statistics on patients where treatments are performed in the Medic One system utilizing methods most providers in America can't use.



This is a really good point!



SpecialK said:


> CPR and defibrillation are not available to most American ambulance personnel?
> 
> That's the only two things which have ever been proven to increase survival.
> 
> IV drugs, mechanical CPR, endotracheal intubation, pre-hospital hypothermia: absolutely none of them have shown a positive impact on survival.



Well, maybe not in LA County...but yes, they are widely available - I think there is still an attitudinal adjustment needed in American EMS, where we tend to think more is better, even when the evidence is just not there (especially for neurologically intact survival and cost per QALY).


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## FLMedic311 (Nov 22, 2016)

EpiEMS said:


> Ok, that makes sense. I think I saw the "mother may I" in a slide deck for SFD MedicOne. So do you have to call for orders, say, for procedures like IOs or ETI?


No, most emergent procedures you would not. Situations like if you wanted to use Procaine for a SVT, or Metoprolol during a STEMI.


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## EpiEMS (Nov 22, 2016)

FLMedic311 said:


> No, most emergent procedures you would not. Situations like if you wanted to use Procaine for a SVT, or Metoprolol during a STEMI.


Gotcha, thanks. I really appreciate your helpful answers on this - very interesting to learn about this system!


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## Bullets (Nov 22, 2016)

SandpitMedic said:


> Not convoluted at all.
> 
> From their testing process, requirements, and vacancies I'd say it's easier to become a contractor overseas than to get juiced in at King County Medic One.
> Seems like a tough sell, but then again, they are clearly looking for the best of the best...
> ...



I was told i should apply, but with all this, its just easier to go be a PA. Do you even get an AS on the way out with all this work?


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## SandpitMedic (Nov 22, 2016)

Bullets said:


> I was told i should apply, but with all this, its just easier to go be a PA. Do you even get an AS on the way out with all this work?


I wouldn't quite say it's easier to be a PA, yet it does seem highly competitive.
Great question- about the degree. I ASSume you would since it's a university program. However, what if you already have your AAS in EMS? What if you already have a BS in EMS?

Take one step backwards to take two forward? Sounds like some heavy personal decision making processes. Is it worth MAYBE getting hired to jump through all the hoops if you've already jumped through other hoops Such as academic, EMS, reciprocity, FPC/CCT, relocation, etc. just to be a paramedic in King County.

Not a swipe at "still" paramedics, but you'd think one would prefer career advancement over transferring "slightly up" or even "slightly down" if you're a practicing FP-C or CCT medic. Again, a personal choice and personal perspective.

For me, it's simply not worth it at this stage in my life. If I were early 20's I would attempt it. Late 20's... Not for me. I'd rather work on PA or Med school. What they offer to me is not worth wasting 2 years of education & probation that could otherwise be spent pursuing higher education, and career & life advancement.


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## EpiEMS (Nov 22, 2016)

Bullets said:


> I was told i should apply, but with all this, its just easier to go be a PA. Do you even get an AS on the way out with all this work?



If this is still accurate, I don't think you do. However, it seems like they provide 88 college credit hours, and they have an agreement to transfer those credits to Pitt for their bachelors' program.

Becoming a PA is definitely more academic work, especially if you don't have the prereqs -- and also because that's two years of graduate school versus circa 10 months of paramedic school.


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## SandpitMedic (Nov 22, 2016)

ExpatMedic0 said:


> I can see it as both a pro and a con. A huge pro if you're an EMT basic. Also, a pro if you want to spend the rest of your life living in Seattle working at medic 1. Another pro that the training is paid and it's probably pretty good training, at the very least its 2-3 times more hours than a standard paramedic program so we all could probably stand to learn something and refresh on things regardless of our provider level.  A con is it is a very intense year worth of training. For comparison, 40 hours a week times 52 weeks equals 2,080 hours a year. 3000 hours is much more than a fulltime job and thus the salary offered for training is not very good when analyzed from an hourly perspective. Secondly the 3000 hour program is vocational training, it is not recognized any more than any other 1300 hour paramedic program if you ever leave the small bubble of Seattle. It also does not result in any type of degree or transferable credits toward a degree more than a standard paramedic program does.  Another con is if you're already an experienced provider and a paramedic with a degree who is willing to go through something like this there are other options. For example, PA school is also a 1-year intense classroom program, followed by 1 year of clinical...  and your salary and working hours are better than even Medic 1.  Just playing the devils advocate a bit...


This. I should have read the entire thread before my previous post. I concur with you 100%

Inshallah!


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## RocketMedic (Nov 22, 2016)

This would be a pretty substantial clinical downgrade from what I do now. Having to call in for pain management and stuff....it's not terrible, but it's not exactly a lot of trust placed in the medics either.


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## FLMedic311 (Nov 22, 2016)

SandpitMedic said:


> Take one step backwards to take two forward? Sounds like some heavy personal decision making processes. Is it worth MAYBE getting hired to jump through all the hoops if you've already jumped through other hoops Such as academic, EMS, reciprocity, FPC/CCT, relocation, etc. just to be a paramedic in King County.


So I am 33y/o with two kids, I have my FP-C and was a practicing flight paramedic with a great set of protocols!  I do not feel I have taken a step backwards at all.  Once again, I appreciate this may not true for others.  Honestly though, I am a bit surprised about the thought of going back to school to equate to being a step backwards..


RocketMedic said:


> Having to call in for pain management and stuff..... not exactly a lot of trust placed in the medics either.


So I feel like I failed to paint a good picture on our ability to act and our relationships with our MDs.  I don't know how I could word it better without having to answer to every possible situation, all I can say is that we have a great deal of autonomy, trust and relations with/from not only or MPDs but our receiving physicians as well.

BTW, thank you all for the great reception, I really appreciate all you have been able to provide to EMS as a whole through these forums.  I have been reading through and there is a lot of great stuff on here and hope to try and contribute.  I just want to say that I get that KCM1 is just one of many wonderful EMS systems, that I would also be fortunate (if I was ever able) to be part of as well.  And that list grows more and more day by day.  I do not wish to try and sway all the opinions on our dept and/or our practices, I simply would like to minimize rhetoric and give the fair opinion of someone who is there. Thanks again so very much for your excellent questions and curiosities, and I encourage you to keep them coming!  Thanks Again!


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## FLMedic311 (Nov 22, 2016)




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## RocketMedic (Nov 22, 2016)

FLMedic311, I don't know much about the workflow there at KCM1 (for obvious reasons). I've really only seen the Medic 1 hype video (which didn't exactly impress) and seen anecdotes online from AMR, Trimed, Olympic, etc personnel that highlight patients that "should have been ALS but weren't". 

Does M1 do things like medicate abdominal pain?


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## FLMedic311 (Nov 22, 2016)

RocketMedic said:


> FLMedic311, I don't know much about the workflow there at KCM1 (for obvious reasons). I've really only seen the Medic 1 hype video (which didn't exactly impress) and seen anecdotes online from AMR, Trimed, Olympic, etc personnel that highlight patients that "should have been ALS but weren't".
> 
> Does M1 do things like medicate abdominal pain?



I can totally dig that, I was there myself!  As far as your question it is kinda vague..  Like abd pain I have been vomiting all night or I think this guy is having a AAA?  The first is going to go Trimed, the second we will take and treat, anything in between is kind of a grey area depending on the medics that respond, the pt's vitals, S/S, and system status..


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## VentMonkey (Nov 22, 2016)

RocketMedic said:


> FLMedic311 said:
> 
> 
> > I can totally dig that, I was there myself!  As far as your question it is kinda vague..  Like abd pain I have been vomiting all night or I think this guy is having a AAA?  The first is going to go Trimed, the second we will take and treat, anything in between is kind of a grey area depending on the medics that respond, the pt's vitals, S/S, and system status..
> ...


What about the patient that isn't a "hot belly" AAA, but an acute appy, or chole? Tearing, tachy, hypertensive, etc.?...


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## FLMedic311 (Nov 22, 2016)

VentMonkey said:


> What about the patient that isn't a "hot belly" AAA, but an acute appy, or chole? Tearing, tachy, hypertensive, etc.?...


Not intentionally trying to be vague or dodge your question but to be honest this sounds like it falls in that grey area..  I can personally say there have been some of these that I have transported and others I sent AMB..  Under the setting of all that you stated tearing, tachy and HTN I can say I would def take and most people I have met I believe would probably as well.  Sorry I can't give you a more black and white answer


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## RocketMedic (Nov 23, 2016)

FLMedic311 said:


> I can totally dig that, I was there myself!  As far as your question it is kinda vague..  Like abd pain I have been vomiting all night or I think this guy is having a AAA?  The first is going to go Trimed, the second we will take and treat, anything in between is kind of a grey area depending on the medics that respond, the pt's vitals, S/S, and system status..



See, that right there is why I would _not_ be a successful KCM1 medic. To me, the first patient you suggested is an ALS patient until otherwise proven, one who would get some sort of antiemetic/pain management/etc as indicated and needed. It's not that the KCM1 approach is wrong, it's just not the way I like to practice.


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## ExpatMedic0 (Nov 23, 2016)

EpiEMS said:


> If this is still accurate, I don't think you do. However, it seems like they provide 88 college credit hours, and they have an agreement to transfer those credits to Pitt for their bachelors' program.
> 
> Becoming a PA is definitely more academic work, especially if you don't have the prereqs -- and also because that's two years of graduate school versus circa 10 months of paramedic school.


It says 39 transfer credits in the document you posted. This is how much any standard paramedic program is worth which meets the minimum national standards and hours to become accredited.  Where do you see 88 university credit hours? Most accredited universities have a cap of what they can accept from vocational training programs for advanced standing students. Sometimes vocational training will not transfer at all and they get around it with a loop hole for "experiential learning", which is normally severely capped.


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## ExpatMedic0 (Nov 23, 2016)

Here is The University of Washington PA program (MEDEX) classroom portion. http://depts.washington.edu/medex/pa-program/curriculum/didactic-year/  I realize it is intense but no more of a time commitment than medic 1's 3000 hour 11 month paramedic program. In fact, it has less "clock" hours if you convert the credit hours to clock hours. It's a little unfair to compare since I am not including the 2nd year which is clinical ( http://depts.washington.edu/medex/pa-program/curriculum/clinical-year/ ) but I imagine after medic 1 training you are probably mentored or have an FTO which is also something to consider. In my case, I am 35 years old, I have over 10 years on the job, I have a bachelor's degree with most of the prereq's required by the PA-C program. It's also worth noting I am not the only one... So in my opinion, If I was going to commit to an incredibly intense year of training... repeating my paramedic program  or becoming a PA would be a no brainer. You are a higher level provider as a PA, the salary is better, PA-C is good outside the very small community of King County, Washington, opening up 99% of the country, plus you get a masters degree out of it.


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