# EMS systems similar to FDNY



## lukgiel (Feb 21, 2014)

Hi there all.

What kind of cities offer EMS jobs similar to FDNY? As in, it's city (no privates), maybe part of a FD, offers 20, 25 or 30 year pension retirement with a chance to move up as in Lt, capt, chief etc and have a civil exam or similar to get in?

I am exploring my options.

Thank you.


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## Jim37F (Feb 21, 2014)

If all you're interested in is city run EMS, come to southern California, can't throw a rock without hitting a dozen (or more) FDs that run their own ambulances. The rest all run the first in Paramedics, a private is merely their BLS transport.


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## lukgiel (Feb 21, 2014)

Jim37F said:


> If all you're interested in is city run EMS, come to southern California, can't throw a rock without hitting a dozen (or more) FDs that run their own ambulances. The rest all run the first in Paramedics, a private is merely their BLS transport.



thank you that is just what I was looking for and its warm at that so best of both worlds huh I have to see how everything works out With fdny but I will keep Southern California in mind how do you like working there and how do you get it is it first come first serve or civil exam


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## NomadicMedic (Feb 21, 2014)

Not for nothin', but I couldn't think of a worse place to work in EMS.


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## lukgiel (Feb 21, 2014)

DEmedic said:


> Not for nothin', but I couldn't think of a worse place to work in EMS.



Please explain. Do you mean FDNY or a EMS system merged with a FD? Thanks


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## exodus (Feb 21, 2014)

lukgiel said:


> Please explain. Do you mean FDNY or a EMS system merged with a FD? Thanks



He means So-Cal.


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## NomadicMedic (Feb 21, 2014)

Southern California, really not a great place for EMS. FDNY is not great place for EMS. Fire based EMS is certainly not great for EMS.  All in all, it's a bunch of bad ideas, all wrapped up in one. 

However, some people REALLY want to work in these places and/or want to be firemen ... So, good luck.


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## lukgiel (Feb 21, 2014)

DEmedic said:


> Southern California, really not a great place for EMS. FDNY is not great place for EMS. Fire based EMS is certainly not great for EMS.  All in all, it's a bunch of bad ideas, all wrapped up in one.
> 
> However, some people REALLY want to work in these places and/or want to be firemen ... So, good luck.




well I do not plan on being a firefighter maybe a rescue medic but the reason I like fire based SMS is because its city its not private and I have better money Than in the privates and  you retire in 25 sure I can go to the hospital and get more moneybut have to work until I'm 65 to get social security . at a fire based EMS even with its bull:censored::censored::censored::censored: I can just do 25 years like at fdny and get out with full benefits and a steady pension I can't get that working for a hospital or a private. Salary isnt as important ad retirement is, having worked transport I see seniors deciding between medications and food on the table. In fdny you get 70000 as a medic plus ot, meal money etc, that isn't that bad.

why do you think private hospitals are better if that's what you meant


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## TransportJockey (Feb 21, 2014)

lukgiel said:


> well I do not plan on being a firefighter maybe a rescue medic but the reason I like fire based SMS is because its city its not private and I have better money Than in the privates and  you retire in 25 sure I can go to the hospital and get more moneybut have to work until I'm 65 to get social security . at a fire based EMS even with its bull:censored::censored::censored::censored: I can just do 25 years like at fdny and get out with full benefits and a steady pension I can't get that working for a hospital or a private. Salary isnt as important ad retirement is, having worked transport I see seniors deciding between medications and food on the table. In fdny you get 70000 as a medic plus ot, meal money etc, that isn't that bad.
> 
> 
> 
> why do you think private hospitals are better if that's what you meant




I think he meant single role government agency. As in ems only


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## lukgiel (Feb 21, 2014)

TransportJockey said:


> I think he meant single role government agency. As in ems only



Ah, getcha, thanks


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## VA Transport EMT (Feb 21, 2014)

lukgiel said:


> Hi there all.
> 
> What kind of cities offer EMS jobs similar to FDNY? As in, it's city (no privates), maybe part of a FD, offers 20, 25 or 30 year pension retirement with a chance to move up as in Lt, capt, chief etc and have a civil exam or similar to get in?
> 
> ...


Virginia beach ems. Fire runs calls and may ride in when the situation presents itself. They only hire medics but there are plenty of neighboring counties that have paid rescue squad members. Vbems full time members ride in a supervisor car and respond upon request of ambulance crew/fire or when the call sounds als. Great system, great ppl to work with, huge budget, the downside that I saw during my two rideouts were that medics are assigned to a certain zone and nearly everyone else is vollie. I'm not a SME but can answer a few questions such as the VB area (places to rent,eat,etc) and the system.


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## Jim37F (Feb 21, 2014)

Also, there's Hall Ambulance in Kern County. Yes it's technically a private company, but the president is also mayor of Bakersfield and they cover something like 85-90% of the county (a service area bigger than some states)  I've heard someone say before that Hall practically is the Kern County Third Service EMS Agency. 

They have an outstanding reputation, and pride themselves on being a company whdre EMTs and Medics stick around for 10+ years. Idk their retirement benefits and whatnot, but I'd be surprised if they were subpar, everything else they do is superb from everything I've ever heard.


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## lukgiel (Feb 21, 2014)

VA Transport EMT said:


> Virginia beach ems. Fire runs calls and may ride in when the situation presents itself. They only hire medics but there are plenty of neighboring counties that have paid rescue squad members. Vbems full time members ride in a supervisor car and respond upon request of ambulance crew/fire or when the call sounds als. Great system, great ppl to work with, huge budget, the downside that I saw during my two rideouts were that medics are assigned to a certain zone and nearly everyone else is vollie. I'm not a SME but can answer a few questions such as the VB area (places to rent,eat,etc) and the system.



Sounds great. So if medics ride in supervisors car, its the fire guys who respond in ambulances or only bls rides in ambulances?


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## lukgiel (Feb 21, 2014)

Jim37F said:


> Also, there's Hall Ambulance in Kern County. Yes it's technically a private company, but the president is also mayor of Bakersfield and they cover something like 85-90% of the county (a service area bigger than some states)  I've heard someone say before that Hall practically is the Kern County Third Service EMS Agency.
> 
> They have an outstanding reputation, and pride themselves on being a company whdre EMTs and Medics stick around for 10+ years. Idk their retirement benefits and whatnot, but I'd be surprised if they were subpar, everything else they do is superb from everything I've ever heard.



I just checked them out,  they offer great benefits and they have nice ambulances. Only thing I don't like it is, they are technically private, and they offer 401k.
I only want to do 25, 30 years tops, get my pension and retire.  I don't want to do ems until I'm 60, I'll be too old and that's too many years of lifting and a high stress job.

Thank though. Sucks its on the other side of the states. I work for a private now and a hospital per diem in NYC


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## 9D4 (Feb 21, 2014)

Phoenix Fire dept staffs rescues. Never looked into them as far as benefits and such, but most of the Phoenix guys are pretty good. A heeellll of a lot think they're God's gift to the Earth, also, though. Never heard one whine about Phoenix, though.


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## lukgiel (Feb 21, 2014)

9D4 said:


> Phoenix Fire dept staffs rescues. Never looked into them as far as benefits and such, but most of the Phoenix guys are pretty good. A heeellll of a lot think they're God's gift to the Earth, also, though. Never heard one whine about Phoenix, though.



Haha, doesn't every medic think he's God's gift to earth? 
Thanks though


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## TransportJockey (Feb 21, 2014)

Let's see... Wake County EMS, Durham County EMS (both NC), Austin/Travis County EMS, Williamson County EMS (both TX), New Orleans EMS, East Baton Rouge Parish EMS (Both LA), Denver Health Paramedics (CO), Richmond Ambulance Authority, MEDICS, etc... There is not shortage of third service agencies.


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## TransportJockey (Feb 21, 2014)

lukgiel said:


> Haha, doesn't every medic think he's God's gift to earth?
> Thanks though



I'm not gods gift to earth. I am God.


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## lukgiel (Feb 21, 2014)

TransportJockey said:


> I'm not gods gift to earth. I am God.





I apologize
*awkwardly stares at floor*


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## NomadicMedic (Feb 21, 2014)

All three counties in Delaware.


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## StudMartin (Feb 21, 2014)

*MA fire*

Most of the fire depts. in MA (and CT) cover ALS/BLS.  And those that don't are typically transitioning into that role.


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## lukgiel (Feb 21, 2014)

DEmedic said:


> All three counties in Delaware.



Thanks.
Do you work for one od those systems? How hard is it to get a job? Considering you have both transport and city 911 exp?


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## lukgiel (Feb 21, 2014)

nikc12 said:


> Most of the fire depts. in MA (and CT) cover ALS/BLS.  And those that don't are typically transitioning into that role.



Cool, is that where you work?


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## lukgiel (Feb 21, 2014)

For anyone's respective depts,  how's the tattoo policy? I have two sleeves,  being in NYC, FDNY has no policy on tattoos as long as its not offensive, and hospitals and privates don't care


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## Handsome Robb (Feb 22, 2014)

TransportJockey said:


> I'm not gods gift to earth. I am God.




False. 

Because I'm god. 

And Robby Awesome.


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## STXmedic (Feb 22, 2014)

Robb said:


> False.
> 
> Because I'm god.
> 
> And Robby Awesome.



False. You're Robby Dispatch.


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## lukgiel (Feb 22, 2014)

So we have two gods?

I always thought I was a god


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## 9D4 (Feb 22, 2014)

STXmedic said:


> False. You're Robby Dispatch.


:rofl::rofl::rofl: Hey, don't anger the dispatch Gods!


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## terrible one (Feb 22, 2014)

Jim37F said:


> If all you're interested in is city run EMS, come to southern California, can't throw a rock without hitting a dozen (or more) FDs that run their own ambulances. The rest all run the first in Paramedics, a private is merely their BLS transport.



Horrible advice. CA EMS is literally as bad as it gets. If you have no interest in fire departments stay as far away as possible from CA.
Good luck getting a pension retirement, those are fading quickly. 
Third service systems, look at Texas, NC, SC, and Delaware.


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## VA Transport EMT (Feb 22, 2014)

lukgiel said:


> Sounds great. So if medics ride in supervisors car, its the fire guys who respond in ambulances or only bls rides in ambulances?



Everyone else is a volunteer rescue squad member. They have little staffing problems.


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## AtlasFlyer (Feb 22, 2014)

Indianapolis EMS (IEMS). Under the city of Indianapolis Department of Public Safety, the IEMS is a sister agency to the IFD and the IMPD. Municipal service, 911 response. Indy has a very reasonable cost of living. Plenty of opportunity for advancement and retirement. 

http://www.indianapolisems.org


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## MrJones (Feb 22, 2014)

lukgiel said:


> So we have two gods?
> 
> I always thought I was a god



And _that's_ the difference between God and Paramedics.....


God doesn't think he's a Paramedic.


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## lukgiel (Feb 22, 2014)

terrible one said:


> Horrible advice. CA EMS is literally as bad as it gets. If you have no interest in fire departments stay as far away as possible from CA.
> Good luck getting a pension retirement, those are fading quickly.
> Third service systems, look at Texas, NC, SC, and Delaware.



By fading quickly,  do you mean in ems or everywhere in general? I know in some pd's and fd's they raised it from 20 to 25


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## lukgiel (Feb 22, 2014)

AtlasFlyer said:


> Indianapolis EMS (IEMS). Under the city of Indianapolis Department of Public Safety, the IEMS is a sister agency to the IFD and the IMPD. Municipal service, 911 response. Indy has a very reasonable cost of living. Plenty of opportunity for advancement and retirement.
> 
> http://www.indianapolisems.org



Nyc has a very high cost of living, thats offset by our medics making the Most out of many places


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## NomadicMedic (Feb 22, 2014)

But, making 70k in NYC certainly isn't a lot of money. The cost of living is so high, that's 40k everywhere else.


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## lukgiel (Feb 22, 2014)

DEmedic said:


> But, making 70k in NYC certainly isn't a lot of money. The cost of living is so high, that's 40k everywhere else.



A lot of medics live in either long island or NJ, and if your spouse also has a good job, it's not that hard to live comfortably, you won't be rich but will live comfortably


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## Handsome Robb (Feb 22, 2014)

STXmedic said:


> False. You're Robby Dispatch.




Not a for sure thing. But if I get it you're lucky you're not in this system cause you'd be central coverage all day!  



lukgiel said:


> So we have two gods?
> 
> 
> 
> I always thought I was a god




I think that puts us up to three now :lol:



MrJones said:


> And _that's_ the difference between God and Paramedics.....
> 
> 
> 
> ...




That one never fails to make me laugh. :rofl:


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## STXmedic (Feb 22, 2014)

Robb said:


> Not a for sure thing. But if I get it you're lucky you're not in this system cause you'd be central coverage all day!


You'd be my favorite dispatcher, then! I volunteer for that crap!


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## terrible one (Feb 22, 2014)

lukgiel said:


> By fading quickly,  do you mean in ems or everywhere in general? I know in some pd's and fd's they raised it from 20 to 25



In CA the current pension systems are unsustainable. Cities and Counties are always trying to reform them because they simply can't afford them. Pensions are on the decline, or being reformed in most other states as well.


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## Handsome Robb (Feb 22, 2014)

STXmedic said:


> You'd be my favorite dispatcher, then! I volunteer for that crap!




I do too until I get down a couple charts then I get pissy. 

Nice part about dispatch if I end up in there while the shoulder heals? Wayyyyy less paperwork lol.

Definitely going back to night shift if I end up in the spatch I think. Best part is I'm not gonna be bottom of the list either...I'll be ahead of whoever I get hired with and then at least one if not two of the dispatchers that are in there already.


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## lukgiel (Feb 22, 2014)

terrible one said:


> In CA the current pension systems are unsustainable. Cities and Counties are always trying to reform them because they simply can't afford them. Pensions are on the decline, or being reformed in most other states as well.



I know thw situation is bad in CA, with the over saturation pf emts and medics, it's getting harder there to get a good paying job with good benefits


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## lukgiel (Feb 22, 2014)

Robb said:


> I do too until I get down a couple charts then I get pissy.
> 
> Nice part about dispatch if I end up in there while the shoulder heals? Wayyyyy less paperwork lol.
> 
> Definitely going back to night shift if I end up in the spatch I think. Best part is I'm not gonna be bottom of the list either...I'll be ahead of whoever I get hired with and then at least one if not two of the dispatchers that are in there already.



How do you like dispatching?


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## chaz90 (Feb 22, 2014)

Robb said:


> I do too until I get down a couple charts then I get pissy.
> 
> Nice part about dispatch if I end up in there while the shoulder heals? Wayyyyy less paperwork lol.
> 
> Definitely going back to night shift if I end up in the spatch I think. Best part is I'm not gonna be bottom of the list either...I'll be ahead of whoever I get hired with and then at least one if not two of the dispatchers that are in there already.



Let it be known that "spatch" sounds far dirtier than it was meant (I think). Just imagine being in said "spatch" all night...

Feel free to send me to central coverage too  Winter is dragging on and I could use a few extra calls!


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## Jon (Feb 22, 2014)

TransportJockey said:


> Let's see... Wake County EMS, Durham County EMS (both NC), Austin/Travis County EMS, Williamson County EMS (both TX), New Orleans EMS, East Baton Rouge Parish EMS (Both LA), Denver Health Paramedics (CO), Richmond Ambulance Authority, MEDICS, etc... There is not shortage of third service agencies.




Many of these are good services.

Are you ALS? There are also the 3 DE County-based ALS services. Are you willing to do fire too? Look at MD/Metro DC. Fairfax is always hiring medics, and PGFD (MD) is hiring right now.


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## lukgiel (Feb 22, 2014)

Jon said:


> Many of these are good services.
> 
> Are you ALS? There are also the 3 DE County-based ALS services. Are you willing to do fire too? Look at MD/Metro DC. Fairfax is always hiring medics, and PGFD (MD) is hiring right now.



Thats guys,  I will deff check those out. 

I'd you're asking me,  I'm an EMT, will soon go to medic school or do it through Fdny.


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## DrParasite (Feb 22, 2014)

lukgiel said:


> What kind of cities offer EMS jobs similar to FDNY? As in, it's city (no privates), maybe part of a FD, offers 20, 25 or 30 year pension retirement with a chance to move up as in Lt, capt, chief etc and have a civil exam or similar to get in?


FDNY's EMS system sucks.  It is commonly regarded as one of the worst in the country.  If you don't believe me, check out this site http://www.fdnyemswebsite.com/  I know many former NYC EMTs and paramedics; many left NYC for NJ for better pay and less BS (and found the same BS but more $$$).

Personally, i am looking at relocating to either Wake or Durham County EMS.  Also looking at Johnston County in NC if Wake and Durham fall through.

Lots municipal and county EMS agencies in the US.  Where are you looking to go?  anywhere?  Personally, I would avoid SoCal, I have heard nothing good about that area (other than there are too many medics to treat the population).

Many places in MD and Va are hiring medics, but they are mostly fire department based (either as FF/PM or single role PM).  Personally, i am not a fan of fire based EMS, and prefer municipal 3rd service government systems.  with fire based, you tend to be used to run numbers and not get enough staffing or funding, because it all goes to the supression side.

good luck with your exploration


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## 46Young (Feb 23, 2014)

lukgiel said:


> Hi there all.
> 
> What kind of cities offer EMS jobs similar to FDNY? As in, it's city (no privates), maybe part of a FD, offers 20, 25 or 30 year pension retirement with a chance to move up as in Lt, capt, chief etc and have a civil exam or similar to get in?
> 
> ...



I did five years in the NYC 911 system with North Shore-LIJ, and I  worked at Hunter Ambulance before that for a short while (Inwood). 

You're not going to find a municipal tiered system like FDNY EMS anywhere else that I know of. King Co. Medic One in Washington State s tiered, but it's completely different.

As you search, you need to realize a few things:

The vast majority of municipal systems have regular schedules in excess of 40 hours/week, typically 48 or 56 hours/week. When you see a posted starting salary, your hourly rate (and OT rate as well) will be much lower than you may have anticipated. For example, I worked briefly for Charleston County EMS in SC. My starting pay was $38k/yr, but my hourly was only $11.25/hr or so. That was for medics, BTW. Don't get tricked! I work for the Fairfax County FRD, outside of DC. Our firefighters start out at a little over $50k/yr, and their hourly is only $17-something, which is the same as a 40 hour employee making $35k/yr. Just keep that in mind. As far as pay, good luck finding a single role EMS employer that can give that to you. Many places start medics out at $35-$45k/yr if you're lucky.

Many systems outside of NYC have what's called an all-ALS system, which means that every ambulance is at least medic/EMT. What this means is that you'll go from running only high priority ALS job types (NYC) to running anything and everything, which means that most of your calls will be minor, non-acute (to say it nicely) BLS. You'll be running minor injuries, Allstate-itis MVA's, and frivolous sick jobs most of the time, and only see true diff breathers, unconscious, cardiac conditions once in a blue. It gets real boring real fast. I'm largely indifferent to EMS as a result. For example, the only two sick people I've seen all month occured last night - a peds stat ep and a critical COPD exacerbation. My typical calls in this all-ALS system include nursing home falls, flu/vomiting/feel-me-bads, minor MVA's, and psychs. I'm glad that I got my experience back in NY, because we run mundane stuff that typically doesn't need an ambulance or an ED.

Realize that in the NYC 911 system, the protocols are very restrictive when compared to the more progressive agencies. This is because there are so many voluntary providers (the hospitals) participating, and the FDNY has no control over their hiring standards and has little control over their QA/QI processes. MY OMD regards our protocls as guidelines, and will back us up if we can justify our deviations. We also have a lot of stuff on standing orders that the NYC medic would have to call OLMC for. We also have really good equipment and all of the tools needed to be effective EMT's and medics. The problem, again, is that we hardly ever need to do anything past vitals, ECG, and maybe a 12-lead and a line 90% of the time. I've gone more than a month without opening my drug box. It's really sad.

But, in my fire based system, we're very well taken care of with pay, benefits, and retirement. When I'm riding lead on a medic (called "teching" back home), I rarely have to lift a patient, since we get ALS engine companies on most of our calls, which gives us a total of six providers onscene. With our pension, we also have a three year DROP, which is where you retire, but keep working, and you collect pension checks in deferred comp until you really retire. South Carolina used to have that, but they got rid of it. This was referred to as a TERI, same as the DROP.

Realize that the average tenure in EMS is only 7-10 years, due to burnout from call volume/low pay/lack of career advancement opportunities, or leaving for a more satisfying and respected healthcare careere (nursing, PA for example). Many firefighter/EMT's and medics stay on until retirement. If you want to be comfortable, your best bet is with a fire department.Fire departments may give ALS incentives to attract medics, where a single role EMS employer is just EMS, so there's no justification to add differentials above the hiring rate. For example, when I started here in 2008, my base was $53k/yr, on a 56 hour schedule. My hourly rate was $19-something (FLSA laws mandate that the first 53 hours of a FF's schedcule are straight time). We get a $5,000 ALS incentive bonus automatically, as well as $3/hr to ride the ambulance, and $2/hr to ride the engine as an ALS provider. My real yearly salary was $71k/yr when adding these incentives. Now, five years and a promotion later, my base is in the mid $80's, and we missed a few raises due to budget shortfalls.

The pay in the Carolinas, most of Florida, and in Virginia south of Richmond drops off precipitously. There's no money in the southeast. I'm not about working for $10-$14/hr as a medic, working 56 hours/week as my regular schedule. There's a number of departments all around DC in both MD and VA that pay well, and hire medics quickly (in a year or less). CA and TX pay well for the most part.


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## FiremanMike (Feb 23, 2014)

terrible one said:


> In CA the current pension systems are unsustainable. Cities and Counties are always trying to reform them because they simply can't afford them. Pensions are on the decline, or being reformed in most other states as well.



States where pensions are still separate and self-contained don't seem to be having these problems.  States where bureaucrats can put their grubby, greedy little hands on the pension funds, borrow against them for use on their own special interests, those are the states that have issues.

I get sick and tired of hearing misinformed people blaming public safety for bankrupting this country while completely ignoring the actions of our politicians.


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## STXmedic (Feb 23, 2014)

FiremanMike said:


> States where pensions are still separate and self-contained don't seem to be having these problems.  States where bureaucrats can put their grubby, greedy little hands on the pension funds, borrow against them for use on their own special interests, those are the states that have issues.
> 
> I get sick and tired of hearing misinformed people blaming public safety for bankrupting this country while completely ignoring the actions of our politicians.



Amen. We control our own pension here, and our pension is one of the strongest in the country (and I'm not talking about just fire department pensions). So Exactly what Mike said.


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## lukgiel (Feb 24, 2014)

46Young said:


> I did five years in the NYC 911 system with North Shore-LIJ, and I  worked at Hunter Ambulance before that for a short while (Inwood).
> 
> You're not going to find a municipal tiered system like FDNY EMS anywhere else that I know of. King Co. Medic One in Washington State s tiered, but it's completely different.
> 
> ...



Thank you, that was very informative.  When I was younger,  I wanted to be a firefighter,  and I still do, I might even take the FDNY promotional, who knows.

Reason I like FDNY is, as I'm sure you know, tours are 8hrs, sure you get a late call, but you learn to work the system. I have friends who are rescue medics, make around $75000, pick up some transport tours and come out to $100000 a year, which isn't so bad.

I also see fdny emts who are in their 40s and they are still working, I'm surprised they haven't moved up to medic, haztac, lt, capt etc, but that is not my business, 

For me, for some reason, I'd love to wear the FDNY patch, I figured do like 30 yrs and retire to a small town,  nyc is a great place to live, but when you're young.


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## lukgiel (Feb 24, 2014)

DrParasite said:


> FDNY's EMS system sucks.  It is commonly regarded as one of the worst in the country.  If you don't believe me, check out this site http://www.fdnyemswebsite.com/  I know many former NYC EMTs and paramedics; many left NYC for NJ for better pay and less BS (and found the same BS but more $$$).
> 
> Personally, i am looking at relocating to either Wake or Durham County EMS.  Also looking at Johnston County in NC if Wake and Durham fall through.
> 
> ...



Thanks, I do agree, stand alone 3rd tier ems systems are the best, here in long island, ems is part of the pd


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## lukgiel (Feb 24, 2014)

@46young

I forgot to mention,  I do not agree with you saying that nyc protocols are strict,  on the contrary,  they are very lax. Here, it is up to the medics discretion as to the administration of medications, in other places, Especially where transport times are long, you have to call medical control for everything


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## STXmedic (Feb 24, 2014)

lukgiel said:


> @46young
> 
> I forgot to mention,  I do not agree with you saying that nyc protocols are strict,  on the contrary,  they are very lax. Here, it is up to the medics discretion as to the administration of medications, in other places, Especially where transport times are long, you have to call medical control for everything



Places that have to call for everything are extremely uncommon. The only places I've even heard of like that are a few systems in CA (and I'm not even sure if that's still the case). So no, being able to give medications without calling does not mean NYC does not have strict protocols. There was a fairly intelligent medic for FDNY that used to post here that was beyond frustrated with how strict the protocols were, and how bad most of his partners were. So while that's only one account- from his side and 46young's personal experience, I'd have to agree with 46young. I've certainly never heard of NY being on anybody's list of progressive areas...


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## lukgiel (Feb 24, 2014)

STXmedic said:


> Places that have to call for everything are extremely uncommon. The only places I've even heard of like that are a few systems in CA (and I'm not even sure if that's still the case). So no, being able to give medications without calling does not mean NYC does not have strict protocols. There was a fairly intelligent medic for FDNY that used to post here that was beyond frustrated with how strict the protocols were, and how bad most of his partners were. So while that's only one account- from his side and 46young's personal experience, I'd have to agree with 46young. I've certainly never heard of NY being on anybody's list of progressive areas...



I work ALS, and I have responded to many "emergencies" (I use that term lightly since those are nursing home emergencies" such as hypo/hyper glycemia, chest pain, hypo/hyper tension, syncope etc I've assisted my medic partner in the administration of many medications and not once has he called medical control, I think only once for morphine if I am not mistaken. Granted, I am not a medic and I am not that familiar with their protocols.  I don't know how it is on the 911 side, but while doing 911 and we called for als for a heart attack, the medic was on the phone before administrating calcium, epi's and shocking like 5 times.


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## STXmedic (Feb 24, 2014)

Whether or not he was required to call or just felt more comfortable calling, I don't know as I have no idea where/what system you're referring to. Regardless, that is extremely uncommon.


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## chaz90 (Feb 24, 2014)

lukgiel said:


> I work ALS, and I have responded to many "emergencies" (I use that term lightly since those are nursing home emergencies" such as hypo/hyper glycemia, chest pain, hypo/hyper tension, syncope etc I've assisted my medic partner in the administration of many medications and not once has he called medical control, I think only once for morphine if I am not mistaken. Granted, I am not a medic and I am not that familiar with their protocols.  I don't know how it is on the 911 side, but while doing 911 and we called for als for a heart attack, the medic was on the phone before administrating calcium, epi's and shocking like 5 times.



What STXmedic was saying is that this is how it works in the vast majority of systems. Very few places have to call for the vast majority of meds administered by paramedics. I sure hope this medic you refer to didn't call anyone prior to defibrillating or administering epinephrine to a cardiac arrest...

Where I am, we have many of those long transports you referred to in an earlier post. Contrary to your suggestion that those with long transports have to "call for everything," there is a very small list of requirements to call medical control prior to acting. RSI, calcium chloride, Labetalol, and magnesium are the only ones I can think of off the top of my head. Of this list, I call for RSI most frequently and have never been denied. Many of our docs trust us enough that all they need ro hear in a quick initial report is that Medic X is calling for RSI and they grant the order. In each of these cases, there is the disclaimer that if we are for some reason unable to get in contact with medical control and the situation is time critical, we are able to do what is needed and contact the doc ASAP.


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## lukgiel (Feb 24, 2014)

STXmedic said:


> Whether or not he was required to call or just felt more comfortable calling, I don't know as I have no idea where/what system you're referring to. Regardless, that is extremely uncommon.



Nyc, hospital 911


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## lukgiel (Feb 24, 2014)

chaz90 said:


> What STXmedic was saying is that this is how it works in the vast majority of systems. Very few places have to call for the vast majority of meds administered by paramedics. I sure hope this medic you refer to didn't call anyone prior to defibrillating or administering epinephrine to a cardiac arrest...
> 
> Where I am, we have many of those long transports you referred to in an earlier post. Contrary to your suggestion that those with long transports have to "call for everything," there is a very small list of requirements to call medical control prior to acting. RSI, calcium chloride, Labetalol, and magnesium are the only ones I can think of off the top of my head. Of this list, I call for RSI most frequently and have never been denied. Many of our docs trust us enough that all they need ro hear in a quick initial report is that Medic X is calling for RSI and they grant the order. In each of these cases, there is the disclaimer that if we are for some reason unable to get in contact with medical control and the situation is time critical, we are able to do what is needed and contact the doc ASAP.



We had 4 emt's and 2 medics on scene, we were bagging and shocking,  medic one was administrating some medicine while the other called medical control.

Whats RSI?

Thanks


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## STXmedic (Feb 24, 2014)

lukgiel said:


> We had 4 emt's and 2 medics on scene, we were bagging and shocking,  medic one was administrating some medicine while the other called medical control.
> 
> Whats RSI?
> 
> Thanks



What were they calling medical control for? What was the request? I call quite frequently on cardiac arrests to cease resuscitation efforts; I can't think of anything else to call for during an arrest, it would have to be something completely out of the norm.

RSI is rapid sequence induction/intubation. It's a means to rapidly sedate and paralyze somebody to gain control of their airway (intubation).


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## lukgiel (Feb 24, 2014)

STXmedic said:


> What were they calling medical control for? What was the request? I call quite frequently on cardiac arrests to cease resuscitation efforts.
> 
> RSI is rapid sequence induction/intubation. It's a means to rapidly sedate and paralyze somebody to gain control of their airway (intubation).



Thanks, how often do you get to do that?

Resuscitation efforts weren't ceased, as chest compressions were done enroute to a hospital, closest cardiac center which wad maybe 5 minutes away, the guy died in the er.

I have no idea what it was for, maybe for calcium?  Or the fact that he did shock like 5 times.


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## STXmedic (Feb 24, 2014)

lukgiel said:


> Thanks, how often do you get to do that?
> 
> Resuscitation efforts weren't ceased, as chest compressions were done enroute to a hospital, closest cardiac center which wad maybe 5 minutes away, the guy died in the er.
> 
> I have no idea what it was for, maybe for calcium?  Or the fact that he did shock like 5 times.



Me? Never. Though that may change in the next 6 months or so. Chaz would be the better person to comment on that.

My guess (how I could see it playing out here) is that they called for an opinion for a refractory VF patient, and med control advised to continue resus and transport. Purely speculation, though. It may just be a really crappy system where they have to call for common interventions on dead people.


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## lukgiel (Feb 24, 2014)

STXmedic said:
			
		

> Me? Never. Though that may change in the next 6 months or so. Chaz would be the better person to comment on that.
> 
> My guess (how I could see it playing out here) is that they called for an opinion for a refractory VF patient, and med control advised to continue resus and transport. Purely speculation, though. It may just be a really crappy system where they have to call for common interventions on dead people.



It was a fun call nonetheless.  My first cardiac call, and one of my first calls. 

Why do you think that'll change in 6 months?  Are you switching jobs?


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## NomadicMedic (Feb 24, 2014)

Could have been for the calcium. Or bicarb. Or mag. Or to stop wasting everyone's time. 

FWIW, Seattle Fire Medics call for everything. The orders are very seldom denied, but even for a simple ACS patient, they have to call, present the patient to the medic one doc and ask permission for ASA, Nitro and morphine. Every time.


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## lukgiel (Feb 24, 2014)

DEmedic said:


> Could have been for the calcium. Or bicarb. Or mag. Or to stop wasting everyone's time.
> 
> FWIW, Seattle Fire Medics call for everything. The orders are very seldom denied, but even for a simple ACS patient, they have to call, present the patient to the medic one doc and ask permission for ASA, Nitro and morphine. Every time.



How is it wasting anyone's time, that's the turn the discussion took


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## chaz90 (Feb 24, 2014)

lukgiel said:


> How is it wasting anyone's time, that's the turn the discussion took



Continuing efforts on a non-viable corpse=Wasting everyone's time.

"Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."


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## lukgiel (Feb 24, 2014)

chaz90 said:


> Continuing efforts on a non-viable corpse=Wasting everyone's time.
> 
> "Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."



I'd still shock once more to be on the safe side:rofl:


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## STXmedic (Feb 24, 2014)

chaz90 said:


> "Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."



Okay, this made me chuckle.


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## TransportJockey (Feb 24, 2014)

I can count on one hand the amount of times I have had to call for orders in my rural 911 setting.  Basically everything we do is on standing orders. .. And our scope is not narrow by any stretch of the imagination


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## NomadicMedic (Feb 24, 2014)

lukgiel said:


> I'd still shock once more to be on the safe side:rofl:




And that's why you carry the bags...


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## lukgiel (Feb 24, 2014)

DEmedic said:


> And that's why you carry the bags...



It was a joke
Oh,  and the bags are always on the stretcher,  not much carrying.


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## 46Young (Feb 25, 2014)

lukgiel said:


> @46young
> 
> I forgot to mention,  I do not agree with you saying that nyc protocols are strict,  on the contrary,  they are very lax. Here, it is up to the medics discretion as to the administration of medications, in other places, Especially where transport times are long, you have to call medical control for everything



I looked at the 2014 REMAC protocols. They are restrictive compared to other areas like Wake Co. NC, just to give one example. 

IDK if things have changed, but when I was a medic in the NYC 911 system from 2005-2007, we had to call to get permission to "jump" protocols if we needed to treat a patient with several things going on. Also, we were restricted to just the OLMC options listed after we run through the standing orders.

Here, our protocols are guidelines - we can give or withhold a medication/intervention so long as we can justify why, we can pull from several protocols at the same time when needed, we can call OLMC for anything within our scope appropriate for the pt, not just what's listed as options, and we have a lot more stuff as standing orders when compared to NYC REMAC. for example, we don't need to call to run Dopa, give additional benzos for Sz, repeat epi IM for the anaphylaxis or asthma (we can start an epi drip as well for anaphylaxis), our choice of fent or MS for pain mamagement, we have Ketamine for EDP's, we don't need to call for peds IV access for asthma, anaphylaxis or resp. arrest, CPAP is not resticted to just APE pts, and we also have the Lucas II, KingVision, and we can do field Cricothyrotomy, not just neede cric.

I feel that we have a lot more lattitude to do what we need to do, with less hassle, so long as we can give a good reason why we did what we did (or didn't do) afterwards. 

The 2014 NYC REMAC protpcols are much better than what I had to make do with when I last worked in the system, but there are many other systems that have much more freedom.


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## lukgiel (Feb 25, 2014)

46Young said:


> I looked at the 2014 REMAC protocols. They are restrictive compared to other areas like Wake Co. NC, just to give one example.
> 
> IDK if things have changed, but when I was a medic in the NYC 911 system from 2005-2007, we had to call to get permission to "jump" protocols if we needed to treat a patient with several things going on. Also, we were restricted to just the OLMC options listed after we run through the standing orders.
> 
> ...



So it seems like remac protocols are getting to be more up to the medics judgement which is good, even though there are medics who I wouldn't want touching me haha.

For the bls protocols, I think they are adding two new medications in 2014 Protocols


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## Jon (Feb 25, 2014)

chaz90 said:


> Continuing efforts on a non-viable corpse=Wasting everyone's time.
> 
> "Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."



You sir... you win the internet today.


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## Jon (Feb 25, 2014)

lukgiel said:


> So it seems like remac protocols are getting to be more up to the medics judgement which is good, even though there are medics who I wouldn't want touching me haha.
> 
> For the bls protocols, I think they are adding two new medications in 2014 Protocols



Actually, it sounds like REMAC is just coming into what I've had in PA for the last 10 years (and that's STATEWIDE, and you're not even there yet), in that I can do MUCH without orders, but I still have protocols I must follow, and times where I need base command.

The problem of "there are medics I wouldn't want touching me" is a HUGE problem in your system. FDNY isn't alone in that, by any means, but thats a big deal. You need competent providers, and a good QA/QI system to ensure they are.

Are you seeing that perhaps FDNY isn't as awesome as you think?


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## lukgiel (Feb 25, 2014)

Jon said:


> Actually, it sounds like REMAC is just coming into what I've had in PA for the last 10 years (and that's STATEWIDE, and you're not even there yet), in that I can do MUCH without orders, but I still have protocols I must follow, and times where I need base command.
> 
> The problem of "there are medics I wouldn't want touching me" is a HUGE problem in your system. FDNY isn't alone in that, by any means, but thats a big deal. You need competent providers, and a good QA/QI system to ensure they are.
> 
> Are you seeing that perhaps FDNY isn't as awesome as you think?



I'm not thinking that FDNY is the best thing since sliced bread,  but it is where I want to work, out of the many companies and hospitals here, it's the best option for me.

My goal is to not be a medic like that, but be the best damn medic and patient care provider, as I'm sure so does everyone on this forum, which is why we're here, to un wind, learn and ask questions


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## 46Young (Feb 25, 2014)

lukgiel said:


> So it seems like remac protocols are getting to be more up to the medics judgement which is good, even though there are medics who I wouldn't want touching me haha.
> 
> For the bls protocols, I think they are adding two new medications in 2014 Protocols



NYC REMAC is definitely getting better from what we had in 2007. Looking back, it was like being in the stone age. 

Advantages that NYC has over most other systems is that it's tiered, and that there are a lot of poor people that do not take care of their health. The result is that medics get to see a lot of critically ill people on a regular basis, use their protocols a lot, and the BLS can also handle a lot of stuff on their own, and also be able to start treatment on ALS patients if they're greater than ten mins. away.

Outside of NY (and a few NJ systems), the BLS don't do much more than drive the medics, and the medics run mostly BLS and just start lines and run a few 12 leads here and there. If I had to choose, I'd go with restrictive protocols and a lot of critically ill patients, rather than an all-ALS system with good protocols and an affluent, healthy population that I have here. 90% of my transports are VOMIT - vitals, O2, monitor, IV, txp. I've never been so bored with EMS in my life. I got my best experience in NY, but I'm making mountains of cash now haha


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