# Anyone working in ca?



## kkhartzog (Jul 15, 2009)

if anyone is working in so-cal can you post your company's website^_^ it would be greatly appreciated


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## VCEMT (Jul 16, 2009)

I cannot say which company I work for, we aren't into advertising. All three companies get about the same amount of applications that a fire department gets and there might only be one opening. Though, you will not get the opportunity to do what we do in L.A. County, unless you're LAFD.
http://portal.countyofventura.org/portal/page?_pageid=953,1299886&_dad=portal&_schema=PORTAL


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## Sapphyre (Jul 16, 2009)

I work in So Cal, and, like VC, I'm not going to post my company's website.  Will tell you, it wouldn't help anyway, we're not hiring.  And, if you thought about it, for a few minutes, you probably know who we are anyway.


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## JPINFV (Jul 16, 2009)

Listing of services in Orange County (note: ranges from primary service area to rarely to never seen in OC).

http://ochealthinfo.com/medical/ems/ambulance.htm


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## AnthonyM83 (Jul 16, 2009)

VCEMT said:


> I cannot say which company I work for, we aren't into advertising. All three companies get about the same amount of applications that a fire department gets and there might only be one opening. Though, you will not get the opportunity to do what we do in L.A. County, unless you're LAFD.


What do you mean?



To original poster:
Some 911 private ambulance providers in Los Angeles are:
AMR
Care Ambulance
Gerber Ambulance
McCormick Ambulance
Cole-Schaefer Ambulance

There has been a recent thread that discusses them if you search around.


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## VCEMT (Jul 17, 2009)

AnthonyM83 said:


> What do you mean?



Medics are on ALS rigs only. Here in Ventura county, we have Ds and medics on a rig. From what I know about L.A. County, which I don't know much, EMTs just do IFTs. A few months after I was hired by my company, I was working ALS. Even before that, I was already running calls on a BLS rig.


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## Sapphyre (Jul 18, 2009)

VCEMT said:


> Medics are on ALS rigs only. Here in Ventura county, we have Ds and medics on a rig. From what I know about L.A. County, which I don't know much, EMTs just do IFTs. A few months after I was hired by my company, I was working ALS. Even before that, I was already running calls on a BLS rig.



Sorry, your information about LA County is wrong....

:this post brought to you by a BLS 911 ambulance, rocking a random parking lot, somewhere in LA County:


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## JPINFV (Jul 18, 2009)

VCEMT said:


> Medics are on ALS rigs only. Here in Ventura county, we have Ds and medics on a rig. From what I know about L.A. County, which I don't know much, EMTs just do IFTs. A few months after I was hired by my company, I was working ALS. Even before that, I was already running calls on a BLS rig.



What level is EMT-D? Last time I checked, the levels in California were EMT-I, EMT-II, and EMT-P.


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## daedalus (Jul 18, 2009)

JPINFV said:


> What level is EMT-D? Last time I checked, the levels in California were EMT-I, EMT-II, and EMT-P.



In Ventura County, we have EMT-Ds. They are EMT-1s who are hired by one of the three ambulance services here and put through a special class to assist paramedics on a split 911 rig. They are authorized to push the shock button on the lifepak when the medic tells them to...


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## EMT007 (Jul 18, 2009)

daedalus said:


> In Ventura County, we have EMT-Ds. They are EMT-1s who are hired by one of the three ambulance services here and put through a special class to assist paramedics on a split 911 rig. They are authorized to push the shock button on the lifepak when the medic tells them to...



Let me add a slight correction that D's can do whatever their medical director authorizes them to do with a defib, and that policy is unbelievably restrictive.... only when the medic tells you to? (as they are presumably two feet away) Good grief, whats the point? I was a D, and we got to do (completely independant of medics) semi-auto defib, 3-lead, 12-lead, sPO2, etCO2, and (more restrictive) trans-q pacing.


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## JPINFV (Jul 18, 2009)

daedalus said:


> In Ventura County, we have EMT-Ds. They are EMT-1s who are hired by one of the three ambulance services here and put through a special class to assist paramedics on a split 911 rig. They are authorized to push the shock button on the lifepak when the medic tells them to...



Ah, so it's an EMT-1 with THAT specific optional skill. I've always found that optional skill really stupid. That said, you're still an EMT-1, just with an optional skill package.


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## JPINFV (Jul 18, 2009)

EMT007 said:


> Let me add a slight correction that D's can do whatever their medical director authorizes them to do with a defib, and that policy is unbelievably restrictive.... only when the medic tells you to? (as they are presumably two feet away) Good grief, whats the point? I was a D, and we got to do (completely independant of medics) semi-auto defib, 3-lead, 12-lead, sPO2, etCO2, and (more restrictive) trans-q pacing.


Trans-q pacing? I'd love to see that protocol. Technically the vast majority of AEDs are really semi-auto. Push one button, it analyzes. Push another and it shocks. That is the textbook definition of semi-auto. Technically, I can see your medical director throwing 3, 12, SpO2, EtCO2 as "obtaining vital signs," especially if you aren't interpreting them. Doing things like 3, 12, SpO2, etc under a medic shouldn't require any sort of authorization. 


Alternatively you're medical director is authorizing things outside of California law or I'm missing something in my reading of it.


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## EMT007 (Jul 18, 2009)

> Doing things like 3, 12, SpO2, etc under a medic shouldn't require any sort of authorization.



Nor should defibrillation.



> Alternatively you're medical director is authorizing things outside of California law or I'm missing something in my reading of it.



What law would that be?

Like I said, the trans-q pacing protocol is quite restrictive and I'm sure it is within the county policies. It required an MD (or DO, of course, as I see you're on your way to) or paramedic's orders.


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## JPINFV (Jul 18, 2009)

EMT007 said:


> What law would that be?


Here is the legal state wide scope of practice for EMT-Is.

http://www.emsa.ca.gov/laws/files/reg2.pdf


As far as defibrillation, there's a difference between manually defibrillating a patient and using an AED/SAED.


Edit: Here is Ventura County's specific scope of practice for basics:

http://portal.countyofventura.org/p...0_EMT-I_SCOPE_OF_PRACTICE_0410_AS_15OCT04.PDF

It mentions the "manual defib" optional skill, which is manual defib under direct observation of a paramedic and I see no mention of pacing as being in the EMT-I SOP.


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## EMT007 (Jul 18, 2009)

JPINFV said:


> The legal scope of practice for EMT-Is.
> 
> http://www.emsa.ca.gov/laws/files/reg2.pdf
> 
> ...



One's medical director can specify "optional skills" that surpass the standard scope, as long as proper training and competency is verified. There are also provisions for medical trials and studies into new procedures that allow EMT-I's to exceed the standard CA scope. I'm not sure which one of those this policy falls under (if it even does - as I said, it is not an independant skill, as we required the orders of a higher medical authority in the form of a physician or paramedic), but again, I'm quire sure it is well within both state and local policies.


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## JPINFV (Jul 18, 2009)

So, where is the authorization for for basics to pace? The section covering manual defib is on page 11 and is the first skill package covered under the optional skill heading. Still, though, outside of studies, medical directors can only designate skills covered under statute, unlike paramedics who have an "unlimited scope of practice" since anything that their SOP is anything that their medical director and state EMSA signs off on.


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## EMT007 (Jul 18, 2009)

JPINFV said:


> So, where is the authorization for for basics to pace? The section covering manual defib is on page 11 and is the first skill package covered under the optional skill heading. Still, though, outside of studies, medical directors can only designate skills covered under statute, unlike paramedics who have an "unlimited scope of practice" since anything that their SOP is anything that their medical director and state EMSA signs off on.



Like I said, there doesn't need to be a specific authorization for pacing, as there are multiple mechanisms for it to be approved otherwise. And as I mentioned, this skill for us was more akin to daedalus' example of being able to push the button with the authorization of a higher medical authority. My point in mentioning it was that this is a more valid example of a skill that basics should be able to do (with proper training) under the direction of a physician or paramedic, not simply pushing the button for defibrillation. So with that, I bow out of this off topic sidetrack.


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## daedalus (Jul 18, 2009)

As it stands now, there is no way my basic will be doing any of those things when I become a paramedic. I am not sure if EMT007 had a "relaxed" paramedic partner, but doing any of the other procedures he listed (transq pacing) are firmly in the paramedic scope. 

JP, EMT-D is an internal county designation. It is authorized by the state. The EMT-D is just an optional add on for EMT-1s. It is shocking for some Orange county EMTs to find out about because compared to them, Ventura county is pretty progressive. The only additional things I know they are allowed to do push the shock button when the paramedic tells them to, set up ALS equipment, preform but not interpret 12 lead, etc.


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## JPINFV (Jul 18, 2009)

daedalus said:


> JP, EMT-D is an internal county designation. It is authorized by the state. The EMT-D is just an optional add on for EMT-1s. It is shocking for some Orange county EMTs to find out about because compared to them, Ventura county is pretty progressive. The only additional things I know they are allowed to do push the shock button when the paramedic tells them to, set up ALS equipment, preform but not interpret 12 lead, etc.


Personally, I'm more shocked that any county would use that optional skills package (this isn't the first I've heard about it, so don't go assuming that just because I worked in Orange County that I think OC is THE system). I've just always figured that there was no real point to have a basic manually defib when under direct supervision of a paramedic, RN, MD/DO, or (I think at least), an EMT-II. I also don't really considered being allowed to push a button under direct supervision something to be excited about or "progressive."


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## daedalus (Jul 18, 2009)

JPINFV said:


> Personally, I'm more shocked that any county would use that optional skills package (this isn't the first I've heard about it, so don't go assuming that just because I worked in Orange County that I think OC is THE system). I've just always figured that there was no real point to have a basic manually defib when under direct supervision of a paramedic, RN, MD/DO, or (I think at least), an EMT-II. I also don't really considered being allowed to push a button under direct supervision something to be excited about or "progressive."



I know how much you love the OC system  It is so evident in your posts! Haha

I too, do not see the point. However, by progressive, I mean the VC protocols in general for ALS are far superior to LA and OC. Our paramedics can transport STEMI patients from an ER to a cardiac center with multiple drips without having an RN in the back. We also have pages of standing orders and do not have to call base to start pacing and other things like that.


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## JPINFV (Jul 18, 2009)

daedalus said:


> I too, do not see the point. However, by progressive, I mean the VC protocols in general for ALS are far superior to LA and OC. Our paramedics can transport STEMI patients from an ER to a cardiac center with multiple drips without having an RN in the back. We also have pages of standing orders and do not have to call base to start pacing and other things like that.



...in other words Ventura County let's paramedics be, I dunno, paramedics?


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## VentMedic (Jul 20, 2009)

daedalus said:


> I know how much you love the OC system  It is so evident in your posts! Haha
> 
> I too, do not see the point. However, by progressive, I mean the VC protocols in general for ALS are far superior to LA and OC. *Our paramedics can transport STEMI patients from an ER to a cardiac center with multiple drips without having an RN in the back. *We also have pages of standing orders and do not have to call base to start pacing and other things like that.


 
But can these Paramedics set up or titrate the drips? There are a couple of counties in the Northern part of the state that will also allow them to transport drips but it is a look and don't touch situation. The ED gives whatever sedation meds and sets up the pumps. It is always a dilemma if a ventilator is involved since they only use an ATV. So, a CCT with an RN is usually utilized.


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