# I really want to work for AMR



## Goofy (Mar 20, 2011)

I just got my NREMT; my state and county certification; my ADL and now I am really anxious to begin working as an EMT. I just picked up a few applications from many ambulance companies, but I am very interested in getting employment with AMR. 

Is there anyone on this forum that is working with AMR? Any pointers? What should I expect upon turning in my application? Is it difficult to become employed?

Please no sarcastic comments about lousy pay and no recognition; that's useless information. Oh what the hell; go ahead. But if anyone can sincerely offer a few pointers I'd greatly appreciate it.


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## DesertMedic66 (Mar 20, 2011)

Goofy said:


> I just got my NREMT; my state and county certification; my ADL and now I am really anxious to begin working as an EMT. I just picked up a few applications from many ambulance companies, but I am very interested in getting employment with AMR.
> 
> Is there anyone on this forum that is working with AMR? Any pointers? What should I expect upon turning in my application? Is it difficult to become employed?
> 
> Please no sarcastic comments about lousy pay and no recognition; that's useless information. Oh what the hell; go ahead. But if anyone can sincerely offer a few pointers I'd greatly appreciate it.



The process changes from area to area. When I did my application this is how i had to do it: fill out an application, take a written test, if you pass then turn in the application, wait for a call to set up an interview, take a skills test, if you pass then you go in for an interview, then wait for another phone call letting you know if you got the spot, then do a drug test lift test background check etc, then 2 weeks of orientation, then a day of orientation at your division, then 10-20 shifts with a FTO. That's just for where I applied tho. It could be different for your area. I'm still waiting on the phone call to let me know if I got the spot.


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## CAPilot55 (Mar 20, 2011)

First off welcome to the world of being an EMT..Let me just tell you I am from the same area, and I recently got invited to my first interview with AMR,  I had my application in with them since last March, Almost an exact year since they called me for an interview.  But just keep looking.


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## aaron911 (Mar 20, 2011)

I work for AMR. The only thing I can tell you is make yourself stand out from the others. From what I have seen each division hires more than 1 at a time and there is a lot of applicants. Confidence is important as well. Good luck!


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## Ewok Jerky (Mar 21, 2011)

Yeah, around here (N ca) amr waits until they have multiple positions open then they dig up all the applications they received since last time they hired. 

Highlight your customer service experience as amr in northern california has had contract issues and they are looking for friendly employees.


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## beebers (Mar 21, 2011)

aaron911 said:


> I work for AMR. The only thing I can tell you is make yourself stand out from the others. From what I have seen each division hires more than 1 at a time and there is a lot of applicants. Confidence is important as well. Good luck!



does AMR always keep there job openings updated? i'm in the houston area and they currently have no EMT-basic openings right now. should i still apply now or hold off til i see a current posting?


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## DesertMedic66 (Mar 22, 2011)

beebers said:


> does AMR always keep there job openings updated? i'm in the houston area and they currently have no EMT-basic openings right now. should i still apply now or hold off til i see a current posting?



Apply now. I applied 3 months ago when there were no openings. As soon as they get spots opening they will start hiring. AMR is a rather large company so they have alot of applications and normally don't post job openings.


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## Hal9000 (Mar 22, 2011)

Do try and set yourself apart.  My application process (back in the day) was different.  I filled out the app, emailed it in, and had a phone call at 0700 the next morning.  Next I went in for an interview, and then immediately did a scenario.  This was followed by a job offer and a written test, which they assumed I'd pass (hint: a monkey could pass), so I walked out the door with my drug and PAT scheduled.

I just applied for another job with a new, better company (making much more than before, but I'm leaving the industry for good soon) and also got a phone call the next morning, followed by an interview and hiring on the spot the day after.

Make yourself stand out!


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## Goofy (May 3, 2011)

Thanks a lot everyone. I put all these pointers into practice and I am happy to say: I got a job! 

No. Not with AMR. Someday I will. For now I am employed with Priority One Medical Transport and I love it.


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## Acetone (May 10, 2011)

I'll post in this thread since it's on the topic of AMR. 

AMR in LA county is now opening up applications.  I completed my app and am scheduled to take a written test next week.  Currently, I am an EMT at an IFT company, dealing mainly with dialysis, so it gets pretty routine.  If I miraculously make it through all the loops to get hired by AMR, how different will my experience be as an emt?


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## DesertMedic66 (May 10, 2011)

Acetone said:


> I'll post in this thread since it's on the topic of AMR.
> 
> AMR in LA county is now opening up applications.  I completed my app and am scheduled to take a written test next week.  Currently, I am an EMT at an IFT company, dealing mainly with dialysis, so it gets pretty routine.  If I miraculously make it through all the loops to get hired by AMR, how different will my experience be as an emt?



If AMR is only picked up as a BLS/IFT company out there then it will pretty much be the same thing. If AMR gets or already has the 911 contract then it will vary. You will have 911 (code 3) responses mixed in with your IFT transports.


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## Juarez (May 11, 2011)

Hey fire how much did you start off at AMR and what kind of calls do you run I'm hearing a variety of things from people saying not to go to amr because pay is around 9 they aren't flexible with hours and finally that you start off doing ift with another emt until a spot with a medic opens up. Just curious so can you fill me in or anyone for that matter thanks!


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## thisismikedee (May 11, 2011)

firefite said:


> If AMR is only picked up as a BLS/IFT company out there then it will pretty much be the same thing. If AMR gets or already has the 911 contract then it will vary. You will have 911 (code 3) responses mixed in with your IFT transports.



AMR LA county is 911 contracted, we run the san gabriel valley, antelope valley, santa clarita valley
Source: current employee

to put other things to rest, AMR LA county is NOT hiring, we just shifted to full 24 hour shifts with 20 stations through out our coverage areas. we are always accepting apps though. you will run code 2's mixed in but you will mostly run code 3 response at a ratio of approx 13:1. we do NOT pay around 9, the starting pay is 12.47, we are fully unionized and have a very good relationship with our local fire stations we cover. No IFT company or other code 3 is going to pay you as well as we do, despite propaganda. and our benifits are AMAZING, for a full family with kaiser is approx 13$ per pay check, the rest is company paid. our most expensive insurance option is a bluecross PPO that covers Armageddon for like 50 a pay check. vision and dental are virtually free. You are not treated like a number, you get paid the full 24 if you work a 24 hour shift, overtime is ENDLESS, and all supervisors and employees are top notch. the average emt that picks up a lot of overtime can make approx 60k a year, assuming you have no other commitments (medic school, rn program, etc)


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## Juarez (May 11, 2011)

Wow thanks that was very in depth! I appreciate that. The reason I ask is because I work for an IFT company, and everyone I speak foreworns me of everything mentioned above. But the reason I asked is because last night I was on a CCT and I was asking the nurse (which previously worked for AMR as a RN) if AMR fits my goals of going into an RN program the beginning of next year. He told me that they will give me whatever hours they want and whatever days they want and they won't work with you and your schedule. So understandably that made me weary.


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## thisismikedee (May 11, 2011)

If you are trying to go into an RN program in general you will have a hard time at any ambulance company. The cool thing about AMR is that at any time you can wave your full time status (at the cost of your seniority) and go part time. Part time, in the LA county operations at least, allows you to work whenever there are over time shifts paged out (OT is endless) all you have to do is pick up a minimum of 3 shifts a month. you can work full time as a part timer by just picking up whenever you are available.

thats the most flexible company i've ever heard of lol.

anyways, you will have to set aside some time at the beginning of the employment process for things like EVOC, Orientation, etc. (which at AMR are very in depth) and you will need to set time aside for your FTO shifts etc, but after you have a month of two under your belt, just go part time and work when you want, but remember, minimum of 3 shifts a month you have to work in order to continue employment. 

dont let people shy you away from AMR, the reality is, every IFT company wishes they were us :]

plus, its not every day you get to be a badass and actually save a life instead of take grandma home after dialysis


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## Juarez (May 11, 2011)

Hahaha thanks I appreciate it, I understand what your saying and yeah I don't mind putting in the work before I get to go part time. Well see where end up,CARE called me to interview and test for them but I'm not sure if I should stay at my IFT company and wait until AMR or go to CARE(possibly).


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## thisismikedee (May 11, 2011)

Care is wack lol, last I heard they are only allowed to respond code 2 to all 911 calls unless FD specifically requests code 3 upgrade.

Care is weak sauce.

They got all mods though, which is nice and roomy and is great for the occasional full arrest where u need all the space you can get


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## JPINFV (May 11, 2011)

thisismikedee said:


> Care is wack lol, last I heard they are only allowed to respond code 2 to all 911 calls unless FD specifically requests code 3 upgrade.


If responding with lights and sirens only saves a few minutes and the first responder unit from the fire department has the paramedics (since the transport ambulance is only staffed with EMTs), then there's no need for the ambulance to respond with lights and sirens since it's not needed in the first 5-10 minutes of care anyways.



thisismikedee said:


> They got all mods though, which is nice and roomy and is great for the  occasional full arrest where u need all the space you can get


The size of the ambulance is irrelevant for cardiac arrests as cardiac arrests shouldn't be transported anyways absent of ROSC or specific special circumstances.


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## Death_By_Sexy (May 11, 2011)

thisismikedee said:


> plus, its not every day you get to be a badass and actually save a life instead of take grandma home after dialysis



This made me laugh. I work in LACo for AMR too, and let's not kid ourselves. "Being badass and saving a life" is not the same as being an EMT. Driving to the scene, not doing/needing to do any assessment, putting the person on the gurney, and driving to the hospital with the medic is our SOP. Maybe I'm jaded from working in a first in county prior to this, but LACo is a transport county, being County fire's little helper elf isn't being a badass, or hero.

But on topic, I agree, for LACo, you're best bet are any of the 911 providers. I have people in my medic class from McCormick, Schaefer, and Care, none complain about their companies. I don't know their hiring status.


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## DesertMedic66 (May 11, 2011)

Juarez said:


> Hey fire how much did you start off at AMR and what kind of calls do you run I'm hearing a variety of things from people saying not to go to amr because pay is around 9 they aren't flexible with hours and finally that you start off doing ift with another emt until a spot with a medic opens up. Just curious so can you fill me in or anyone for that matter thanks!



My starting pay is $10.21/hr. My division is a non union. During my FTO time I am on an ALS rig running mostly 911 calls with some BLS calls. Once my FTO time ends then I will be placed on a BLS rig until a ALS EMT spot opens up but still at the same pay. I was originally hired part time. I would only have to work a minimum of 3 shifts per month. But I just got a full time position so I work 3 12 hour shifts one week and then 4 12 hour shifts the next week. Since we are not union we make 4 hours of overtime per shift. And anything over 12 hours in the same day is double time. We always have shifts open so there is alot of overtime and double time. If they really need a shift to be covered they will offer incentives (pick your partner, $100 plus your normal pay, $500 plus your normal pay, overtime pay, double time pay).


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## Juarez (May 11, 2011)

Do they tell you what days you have to work or are you able to choose as a full time?


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## DesertMedic66 (May 11, 2011)

Juarez said:


> Do they tell you what days you have to work or are you able to choose as a full time?



For part time you get to choose. For full time we do what's called shift bidding. You pick a partner and add up your points. Then you place a bid on up to 3 shifts that you want. If you have been with the company for a long time then it's really good because you can literally pick what shift you want. If your fairly new to the company then you pretty much get the shifts that are left over AKA the shifts no one really wants.


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## thisismikedee (May 11, 2011)

JPINFV said:


> If responding with lights and sirens only saves a few minutes and the first responder unit from the fire department has the paramedics (since the transport ambulance is only staffed with EMTs), then there's no need for the ambulance to respond with lights and sirens since it's not needed in the first 5-10 minutes of care anyways.
> 
> 
> The size of the ambulance is irrelevant for cardiac arrests as cardiac arrests shouldn't be transported anyways absent of ROSC or specific special circumstances.



Umm, who are you? Lol

Okay...here we go

The point of code 3 response is to get to whatever is happening right? Alright, so for example (and this is very common down in the AV since Fire Station 33 is the busiest in LA County):

Code 3 for a cardiac that just so happens to be down the street from a posting ambulance. Where I'm from it's very common that we beat FD on scene by approx 3-5 minutes. An ambulance not being able to respond code 3 to something like that can mean the difference between life and death, especially when the earlier the defib the higher chances of life. All you paramagics should look at the statistical save rates for ALS then take that number and look at what is most crucial for preservation of life, and no, it's not cardiac drugs and intubation, it's early defib and hard fast compressions (all emt skills) 

Paramedics are over rated, every credible source says there is no replacement for EMT skills and rapid transport. I've loaded and gone and have met squad en route numerous times, I don't need the fire dept to replace standard protocol. Many squadies down here have even loaded pediatric drownings in their squad and have booked it wo ambulance becuz we took too long (and we respond code) 

I know ur not supposed to transport pulse less, but I've had patients code on me with a medic follow up and it's hard to get all the stuff set up with minimal space. Ask any FD medic and they will tell you the space in the Care Mods is second to none


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## Juarez (May 11, 2011)

So let's say starting out as someone new is it possible to pick your days or is it just whatever day is left?
Also if your part time can you pick up more than 40 hours?


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## DesertMedic66 (May 11, 2011)

Juarez said:


> So let's say starting out as someone new is it possible to pick your days or is it just whatever day is left?
> Also if your part time can you pick up more than 40 hours?



Not really. If your part time then yes you get to pick. If your full time you pretty much get what the other employees don't want. 

Yes and no. It all depends on the division and the time of the year. I know part time guys who have picked up 60+ hours per week.


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## thisismikedee (May 11, 2011)

Juarez said:


> So let's say starting out as someone new is it possible to pick your days or is it just whatever day is left?
> Also if your part time can you pick up more than 40 hours?



If you are hired on as part time at AMR you get to choose what days you work and u can work as many hours as you please so long as the overtime is available and your able to do so. Usually they don't hire as part time first, in la county AMR will hire you full time and give you the option of going part time later


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## DesertMedic66 (May 11, 2011)

thisismikedee said:


> If you are hired on as part time at AMR you get to choose what days you work and u can work as many hours as you please so long as the overtime is available and your able to do so. *Usually they don't hire as part time first,* in la county AMR will hire you full time and give you the option of going part time later



that all depends on your division. My division will only hire part time. Your FTO time will be a full time position but after that you are placed on part time. You can put in a letter to go full time but we (my division) will not hire full time.


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## thisismikedee (May 11, 2011)

firefite said:


> that all depends on your division. My division will only hire part time. Your FTO time will be a full time position but after that you are placed on part time. You can put in a letter to go full time but we (my division) will not hire full time.



My apologies, I assumed we were talking about the Los Angeles county division. What division are you?

Representing North Los Angeles County ops! Lol Antelope Valley station 106


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## JPINFV (May 11, 2011)

thisismikedee said:


> Umm, who are you? Lol
> 
> Okay...here we go
> 
> ...



If you're just down the street from a call then you won't save any time anyways. Think about it. If it takes 2 minutes to respond without lights and sirens, it's going to be, at best  what? 1:45 with lights and sirens? Do you think 15 seconds is going to matter? The fact is that lights and sirens response doesn't save that much time. 

Yes, compressions and defibrillation is what saves cardiac arrests. However the vast majority of calls are not cardiac arrests, nor should all calls be treated as cardiac arrests until proven otherwise. Ok, you're on scene of a chest pain patient for 5 minutes. Are you planning on intiating transport sans paramedics? Can you give acetylsalicylic acid? Nope. You can give oxygen, but the benefits of oxygen are in question to the point that the standard of care is changing away from every patient receiving a non-rebreather mask (see AHA Emergency Cardiac Care 2010 guidelines). So, instead you're going to package the patient (which still needs a 12 lead EKG to be done to determine destination and cath lab activation), and then stand around waiting for fire to show up. 

Oh, and sweet! I've been promoted to paramagician? Let me put on my robe and wizard hat!. 



> Paramedics are over rated, every credible source says there is no replacement for EMT skills and rapid transport. I've loaded and gone and have met squad en route numerous times, I don't need the fire dept to replace standard protocol. Many squadies down here have even loaded pediatric drownings in their squad and have booked it wo ambulance becuz we took too long (and we respond code)



OPALS definitely cited benefits from paramedic level care in medical patients. Additionally, US EMS levels do not exactly match up with Canadian levels. To most of Canada, our EMT level is their first responder level. I can also cite studies that shows that transport by POV results in better outcomes for trauma patients than transport by ambulance. 

Also, you can't compare pediatric drownings to a standard EMS patient. 



> I know ur not supposed to transport pulse less, but I've had patients code on me with a medic follow up and it's hard to get all the stuff set up with minimal space. Ask any FD medic and they will tell you the space in the Care Mods is second to none



What's more common, though, patients coding in the ambulance, or patients coding someplace outside of the ambulance. If the patient isn't in an ambulance when they go into cardiac arrest, then there's no reason to move them to the ambulance.


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## thisismikedee (May 11, 2011)

JPINFV said:


> If you're just down the street from a call then you won't save any time anyways. Think about it. If it takes 2 minutes to respond without lights and sirens, it's going to be, at best  what? 1:45 with lights and sirens? Do you think 15 seconds is going to matter? The fact is that lights and sirens response doesn't save that much time.
> 
> Yes, compressions and defibrillation is what saves cardiac arrests. However the vast majority of calls are not cardiac arrests, nor should all calls be treated as cardiac arrests until proven otherwise. Ok, you're on scene of a chest pain patient for 5 minutes. Are you planning on intiating transport sans paramedics? Can you give acetylsalicylic acid? Nope. You can give oxygen, but the benefits of oxygen are in question to the point that the standard of care is changing away from every patient receiving a non-rebreather mask (see AHA Emergency Cardiac Care 2010 guidelines). So, instead you're going to package the patient (which still needs a 12 lead EKG to be done to determine destination and cath lab activation), and then stand around waiting for fire to show up.
> 
> ...




Again, it's always better to assume the worst than under treat. Although my examples do not happen often, they do happen, and you never know, 15 seconds could mean the difference between life and death. I've personally seen a difference of up to 3 mintues in responding code and responding code 2. There are also many sources that are citable that show that there is a fine balance between prehospital care and hospital care. I'm sick of seeing the FD take a million years to do their 12 lead...only to find out that our possible ALOC stroke patient is NSR with no ectopics, this ruling out process takes too long and is almost always repeated at the receiving hospital anyways. Again, the need of paramedics? We don't need your epi, atro, ami. Don't care for your bicarb, or your dopamine drips. Benadryll? Yeah I agree w that. About the only thing I see use for is d50 IV, only cuz it saves me a hosptial trip. Your airways are overrated. Paramedics are constantly losing skills to legal battles and questioning of pre hosptial necessity. Again, bringing them closer to EMTs. All we are is people movers, getting to the hosptial is still of up most importance. If my squads not there and I see that rapid trans is more important I'm gonna go and I don't care, my patient is more important than a medic practicing his skills. Medics are just EMTs with needles. I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.


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## jgmedic (May 11, 2011)

thisismikedee said:


> Again, it's always better to assume the worst than under treat. Although my examples do not happen often, they do happen, and you never know, 15 seconds could mean the difference between life and death. I've personally seen a difference of up to 3 mintues in responding code and responding code 2. There are also many sources that are citable that show that there is a fine balance between prehospital care and hospital care. I'm sick of seeing the FD take a million years to do their 12 lead...only to find out that our possible ALOC stroke patient is NSR with no ectopics, this ruling out process takes too long and is almost always repeated at the receiving hospital anyways. Again, the need of paramedics? We don't need your epi, atro, ami. Don't care for your bicarb, or your dopamine drips. Benadryll? Yeah I agree w that. About the only thing I see use for is d50 IV, only cuz it saves me a hosptial trip. Your airways are overrated. Paramedics are constantly losing skills to legal battles and questioning of pre hosptial necessity. Again, bringing them closer to EMTs. All we are is people movers, getting to the hosptial is still of up most importance. If my squads not there and I see that rapid trans is more important I'm gonna go and I don't care, my patient is more important than a medic practicing his skills. Medics are just EMTs with needles. I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.



Wow. 1. No, 2. You work in LACo, where paramedics are barely more than intermediates, anyways, why don't you step outside of your bubble and see the way EMS can be run in systems where mommy doesn't have to tell you what to do on every call.


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## cstiltzcook2 (May 11, 2011)

hey why don't you go  p rick  off on some nursing board mikedee. this is a family you are pissing on, and it doesn't look like you are trying to contribute anything positive.


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## JPINFV (May 11, 2011)

thisismikedee said:


> Again, it's always better to assume the worst than under treat. Although my examples do not happen often, they do happen, and you never know, 15 seconds could mean the difference between life and death. I've personally seen a difference of up to 3 mintues in responding code and responding code 2.



15 seconds won't mean the difference between life and death. If it did, then EMS responders (including the fire department) should be forced to sit in their vehicles, engine on, ready to respond at all times. After all, how much does turnout add to the response time? Similarly, 3 minutes is highly unlikely to change the outcome either under the same reasoning. 




> There are also many sources that are citable that show that there is a fine balance between prehospital care and hospital care. I'm sick of seeing the FD take a million years to do their 12 lead...only to find out that our possible ALOC stroke patient is NSR with no ectopics, this ruling out process takes too long and is almost always repeated at the receiving hospital anyways.


You know what takes longer than the fire department doing a 12 lead to check for STEMI? Having a non-PCI hospital find the STEMI and then arrange for a transfer for the patient to a hospital with PCI. Also, just because something is repeated at the hospital doesn't mean its a waste of time to do it prehospitally. The hospital repeats a history and physical, therefore should EMS just skip taking a history and physical? 



> Again, the need of paramedics? We don't need your epi, atro, ami. Don't care for your bicarb, or your dopamine drips. Benadryll? Yeah I agree w that. About the only thing I see use for is d50 IV, only cuz it saves me a hosptial trip. Your airways are overrated. Paramedics are constantly losing skills to legal battles and questioning of pre hosptial necessity.



No epi? What are you planning on doing to reverse the immediate side effects of anaphlaxis?

No atropine? What are you planning on doing for an organophosphate poisoning?

Amioderone? What are you going to do with a patient in a tachyarythmia? 

What about albuterol? What about pharmacological pain management? What about pharmacological (chemical) restraints? 

The ironic thing about your list is D10 has been shown to be better at managing hypoglycemia than D50.  Oh, but wait. You only care if you have to transport, not about patient care. I gotcha now. 



> Again, bringing them closer to EMTs. All we are is people movers, getting to the hosptial is still of up most importance. If my squads not there and I see that rapid trans is more important I'm gonna go and I don't care, my patient is more important than a medic practicing his skills. Medics are just EMTs with needles. I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.



I feel sorry that you look down so much on paramedics. Hopefully nursing school will show you that in plenty of medical cases prompt diagnosis and initial care can change outcomes. Not always mortality, but morbidity as well as providing earlier relief. 

PS. If you become a MICN, feel free to just pass all of your patients to me when I'm on duty as the base hospital physician.


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## thisismikedee (May 11, 2011)

Death_By_Sexy said:


> This made me laugh. I work in LACo for AMR too, and let's not kid ourselves. "Being badass and saving a life" is not the same as being an EMT. Driving to the scene, not doing/needing to do any assessment, putting the person on the gurney, and driving to the hospital with the medic is our SOP. Maybe I'm jaded from working in a first in county prior to this, but LACo is a transport county, being County fire's little helper elf isn't being a badass, or hero.
> 
> But on topic, I agree, for LACo, you're best bet are any of the 911 providers. I have people in my medic class from McCormick, Schaefer, and Care, none complain about their companies. I don't know their hiring status.



this is true, we do run 98 percent bull:censored::censored::censored::censored:, but when you get a cardiac save pin or a commendation, or a letter from family thanking you for what you did, it makes it all worth it. Compared to all other non 911 companies, we are bad ***, think about it...
jaded is correct


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## JPINFV (May 11, 2011)

thisismikedee said:


> this is true, we do run 98 percent bull:censored::censored::censored::censored:, but when you get a cardiac save pin or a commendation, or a letter from family thanking you for what you did, it makes it all worth it. Compared to all other non 911 companies, we are bad ***, think about it...
> jaded is correct



Wait, so the fact that you got a pin is more important than the fact that you saved a life (assuming your definition of cardiac arrest save is survival to neurologically intact discharge and not simply ROSC)?


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## thisismikedee (May 11, 2011)

JPINFV said:


> 15 seconds won't mean the difference between life and death. If it did, then EMS responders (including the fire department) should be forced to sit in their vehicles, engine on, ready to respond at all times. After all, how much does turnout add to the response time? Similarly, 3 minutes is highly unlikely to change the outcome either under the same reasoning.
> 
> 
> 
> ...



*no need to bother a doctor, i'll just give my orders like i'm supposed to*


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## thisismikedee (May 11, 2011)

JPINFV said:


> Wait, so the fact that you got a pin is more important than the fact that you saved a life (assuming your definition of cardiac arrest save is survival to neurologically intact discharge and not simply ROSC)?



negative, the fact that what we do should not be undermined by potentially burnt out employees. 

yes neurologically intact discharge is a requirement for commendation in our operation.


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## thisismikedee (May 11, 2011)

jgmedic said:


> Wow. 1. No, 2. You work in LACo, where paramedics are barely more than intermediates, anyways, why don't you step outside of your bubble and see the way EMS can be run in systems where mommy doesn't have to tell you what to do on every call.



yes, paramedics cant do anything here, which may lead to my biased opinion, but again, working in a system like this i can see that the people that might need medics in other more advanced counties, are probably gone anyways...i've seen medics here mess things up quite horribly, and I have rarely seen them make interventions that me and my partner can do with a set of feet, a gurney, and basic emt skills...in a different manner that is


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## JPINFV (May 11, 2011)

thisismikedee said:


> *all the hospitals i deal with on a daily basis are stemi recieving facilities.*


Which is not characteristic of all of the hospitals in LA County. Additionally, early notification allows for preparation to began sooner.




> *asist vents and move fast, most people with known anaphalatic reactions have epi pens, which tada, are emt skills*


*

*Epi-pens won't help out when you need a second dose. Ventilation is going to be difficult as angioedema sets in. 



> [organophosphates] [arrhythmia]
> *rapid transport*


*
*
Why rapid transport when you can begin treatment in the field? Preventing cardiac arrests is much more important than reversing cardiac arrest. 


> *oxygen asisted vents, rapid transport, who needs pharmacological  restraints when i can just throw a spit mask over them and strap em down*


*

Why assist ventilation when you can reverse the underlying problem? Sure, assist until the albuterol sets in, but assist + albuterol is better than assist alone. 
*
For pharmacological restraints, pharmacological restraints are better for the patient than a set of leathers and a surgical mask. Why not provider a superior level of care to patients with acute psychiatric issues?





> *d50 only thing allowed besides glucagon in my county, and i care  about if my patient really wanted to go to the hospital or not (they've  probably had diabetes for years and easily manage it on their own, they  usually just forgot to eat after taking their insulin this will  potentially save them a FAT unwanted hospital bill and ambulance bill,  which in turn is actually caring about my patient... by not caring about  transport) anyways, 98 percent of the time the d50 brings em back and  they tell us they made a mistake and would like to just eat some food  and go on with their lives. im not going to impose a uneeded transport  on my patient which could cause unneeded finical burdens to people that  need all the money they can get to pay rising health care costs. *



The issue with D50 vs D10 isn't about which works better at reversing hypoglycemia, as both will do that. It's about which will cause a smaller overshoot in BGL and which one will cause less problems with maintaining a proper BGL in the immediate future. 

...and yes, I agree that known diabetics who make a mistake shouldn't be forced into a transport.



> *prompt diagnosis after prompt transport to the hospital where  the diagnosis can be treated instead of wasting time diagnosing then  re-diagnosing...saves time, saves patients money, saves hospital systems  money, saves tax dollars, saves lives, makes health care more  efficient, which makes health care better . *




So, basically there's no point in providing any sort of physical exam or most treatments prehospitally? Just put them on the gurney and run lights and sirens to the nearest hospital?


*



			no need to bother a doctor, i'll just give my orders like i'm supposed to
		
Click to expand...

*Why do I get the feeling, though, that you're the type of person who would deny most requests for treatment orders?


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## jgmedic (May 11, 2011)

thisismikedee said:


> yes, paramedics cant do anything here, which may lead to my biased opinion, but again, working in a system like this i can see that the people that might need medics in other more advanced counties, are probably gone anyways...i've seen medics here mess things up quite horribly, and I have rarely seen them make interventions that me and my partner can do with a set of feet, a gurney, and basic emt skills...in a different manner that is



Tell that to the AMI in bigeminy that needed Lido(which we wouldn't have seen without a 12L), or the CHF'er in acute pulmonary edema who because we CPAP'ed them, now isn't on a vent.


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## thisismikedee (May 11, 2011)

jgmedic said:


> Tell that to the AMI in bigeminy that needed Lido(which we wouldn't have seen without a 12L), or the CHF'er in acute pulmonary edema who because we CPAP'ed them, now isn't on a vent.



those treatments seem like they are from a county that lets you do something, let us not forget we were arguing LA County, the original poster of this thread was referring to LA county. CPAP is an amazing thing, but remember that oxygen powered, flow restricted ventilations devices are in a nationally registered emt b's scope, essentially a CPAP machine. Lido is not given in LACo


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## thisismikedee (May 11, 2011)

cstiltzcook2 said:


> hey why don't you go  p rick  off on some nursing board mikedee. this is a family you are pissing on, and it doesn't look like you are trying to contribute anything positive.



im only trying to have a good conversation, its only a debate. last i looked this is a place to where EMT and EMT-P can talk about things, haha, im not trying to make anyone mad, just trying to give the otherside of the opinion. I have already said i am biased to LACo medics, i have not worked in any other county so i dont know how it works. the original poster of this thread was referring to working AMR near LACo, thats the only reason im baggin on LACo Medics. All you norcal folks are fine in my books, progressive EMS systems do work, LA county is stuck in the era of johnny gage and squad 51


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## thisismikedee (May 11, 2011)

JPINFV said:


> Which is not characteristic of all of the hospitals in LA County. Additionally, early notification allows for preparation to began sooner.
> 
> 
> 
> ...


*

i am not that kind of person, i merely like setting up a good debate. this is never done at work, or when patients are involved because i do understand fluid work enviroment will do better for my patient than any ems interventions. thats fine, but i do like questioning the norm because there is another side to all of this.*


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## medichopeful (May 11, 2011)

thisismikedee said:


> I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.



I'm also a nursing student.  And I'm a little bit shocked that someone who is in the same field as me is seriously saying that medicine more advanced then "OXYGEN AND DIESEL!!!!!" is useless :wacko:


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## medichopeful (May 11, 2011)

thisismikedee said:


> who needs pharmacological restraints *when i can just throw a spit mask over them and strap em down*



You can't be serious h34r:


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## thisismikedee (May 11, 2011)

medichopeful said:


> I'm also a nursing student.  And I'm a little bit shocked that someone who is in the same field as me is seriously saying that medicine more advanced then "OXYGEN AND DIESEL!!!!!" is useless :wacko:



medicine is in fact more important than oxygen and diesel, wasting time with statistically useless paramedical treatments is in fact, not. 

PARA from the latin root meaning "NEAR" medicine is self explanitory

NEAR medicine, but not medicine. im not trying to beef up being an EMT-B either, im just saying lets get these patients to the hospital asap and waste less time lollygaggin on scene, i'd trust my grandma in the hands of an experienced cardiologist before i trust her with a bunch of needle happy god complex commando medics.

this does not refer to ALL PARAMEDICS, only to those that think they can be a medic without being an EMT first and foremost. remember, its EMT followed by the P
emt-p


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## reaper (May 11, 2011)

All this comes from never seeing real medicine at work.


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## thisismikedee (May 11, 2011)

reaper said:


> All this comes from never seeing real medicine at work.



real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine. EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course. 

experience trumps cool names and fancy equipment.

Hospital Care > EMS care on ANY level


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## HotelCo (May 11, 2011)

thisismikedee said:


> real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine. EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course.
> 
> experience trumps cool names and fancy equipment.
> 
> Hospital Care > EMS care on ANY level



ACLS


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## JPINFV (May 11, 2011)

thisismikedee said:


> real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine.


I think you're selling yourself short. Proper pain management, including appropriate liberal use of pharmacological pain management, means the world to that patient. Chemical restraints of an acutely agitated psychiatric patient means the world to everyone. Albuterol means the world to the patient with reactive airway disease even if it doesn't change the ultimate outcome. NTG and CPAP means the world to the patient with acute pulmonary edema.

None of these will normally change the ultimate outcome. However, even when medicine, including prehospital medicine, can't cure the disease, we can at a minimum relieve suffering. Sure, the asthmatic patient will probably survive another 5-10 minutes while struggling to breath, but I'm willing it's a big relief to them to not feel like they are suffocating. While, at best, EMS treatment is equal to hospital treatment (and for initial care, a lot of it is), temporally EMS provides early intervention, which is a plus in ways that are not as easily measured as mortality rate. 




> EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course.
> 
> experience trumps cool names and fancy equipment.
> 
> Hospital Care > EMS care on ANY level


Again, don't sell yourself short. Care for a cardiac arrest, for example, is the same prehospitally and in hospital. Chest compressions don't care whether it's an ER tech, paramedic, or EMT providing it. Vasopressers don't care if it's pushed by a RN on the order of a physician or pushed by a paramedic understanding orders. However, chest compressions do care whether the gurney is moving relative to the ground (be it the gurney itself moving, or locked in a moving vehicle. 

Yes, EMS providers shouldn't be spending an hour with the patient, but an appropriate assessment and initial treatment should often be completed on scene in most cases (especially medical patients in contrast to trauma patients), even if it delay transport by a few minutes.


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## medichopeful (May 11, 2011)

thisismikedee said:


> real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine. EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course.
> 
> experience trumps cool names and fancy equipment.
> 
> Hospital Care > EMS care on ANY level



Yes, there may not be a replacement for hospital-based medicine in many cases.  However, that does not mean that EMS should provide nothing but a ride to the hospital.  The purpose of an EMS system is to BEGIN CARE.  What an EMT-B does, with very few exceptions, is transport.  Any care they provide, again with few exceptions, is minimal medicine, if you can even count it as medicine.

You do bring up the valid point of a 6-month medic course, but for now let's say that that is the exception and not the rule.  Let us say that the paramedic responding has at minimum a 2-year degree, for the sake of discussion.

A paramedic, with their knowledge and skills, will be able to start care IMMEDIATELY.  Is that not what is being aimed for by EMS and, if I remember correctly, by yourself?  You stated that you have had times where you drove Code 3 to a call to save time.  Time until what, the hospital?  Although a paramedic will not be able to do everything a hospital can, guess what?  They're doing SOMETHING.  They're not (hopefully) just throwing the patient on the stretcher and going to the hospital.  No, they're assessing, gathering information, and then treating.  And that treatment they are providing is the beginning of care.

Again, I'm not disagreeing that the hospital can do a lot more than an EMS system can in many cases.  Rather, I'm saying that it makes sense to get medical started ASAP.  That's not something an EMT-B and a ride to the hospital can necessarily do.


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## JPINFV (May 11, 2011)

thisismikedee said:


> *if i am not mistaken, i think it is better to rapidly transport,  if the patient codes en route, then at lest we are already  rolling...wasting time setting up a line (most of these patients veins  are shot from excessive medical history) drawing up the drugs and or  shock cardioverting just means more time wasted on scene, my AED can  cardiovert all day. *



I believe you're confusion cardioversion and defibrillation. I've yet to see an AED (under automatic mode for the ones with an override) that is able to synchronized cardioversion, much less detect when it is needed. Additionally, if the patient codes during transport, you're going to have substandard compressions due to issues with the ambulance moving. As you mentioned, the most important thing during a cardiac arrest is compressions and defibrillation. 





> *im sure this is correct, but case in point then, why not a stick  of Oral Glucose then? Blood glucose level overshoot wont really affect  the experienced diabetic*


If the patient can take oral glucose, then sure, go for it. However, there's evidence that points to D10 being superior to D50 for treating hypoglycemia when IV dextrose is indicated. 

Example... I'm sure there's more. http://emj.bmj.com/content/22/7/512.short


*



			i am not that kind of person, i merely like setting up a good debate. this is never done at work, or when patients are involved because i do understand fluid work enviroment will do better for my patient than any ems interventions. thats fine, but i do like questioning the norm because there is another side to all of this.
		
Click to expand...

*I think the problem is, intentionally or not, that you're currently in the position of supporting LA County's EMS system design. I can't speak for others even if I don't feel alone in this position, but I view the issue of the 9 month paramedic, 1-2 month EMT (I think the old EMT-II or new AEMT would be better suited as the base level (EMT level) should be at in scope, albeit more education than is currently required at that level), the paramedic's reliance on the machine interpretation, and LA's limited standing orders and strict requirements for base hospital contact as being quaint and backwards. Sure, there's short transport times, but a viable patient in cardiac arrest (which is, arguably, rare) who gets transported in cardiac arrest has essentially had their death warrant signed due to a lack of quality compressions. Similarly, (as mentioned in my last post), that 10 minutes of distress for the patient in respiratory distress or pain is going to be an eternity. Similarly, when in a part of LA that isn't surrounded by STEMI centers, the 12 lead prevents a huge delay with setting up a transfer.

It's not that a lot of people here are Ra-Raing paramedics, it's that there's a lot of people here who view Southern California as a whole as a good case study on how not to design an EMS system.


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## ffemt8978 (May 11, 2011)

This thread has gone WAAAAYYYY off topic.  Get back on topic, or it will be closed.


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## RanchoEMT (May 15, 2011)

Goofy said:


> Please no sarcastic comments about lousy pay and no recognition; that's useless information. Oh what the hell; go ahead. But if anyone can sincerely offer a few pointers I'd greatly appreciate it.


Why is this useless? The Pay is Horrible! Unless your gung-ho about getting hired, gaining experience and plan on leaving to go do something better, I think you ota' know, it's *HORRIBLE*. Just above minimum. Your spending money will be made in overtime, and you won't have time to spend it as you will be working all the time.  When you work, You will be sitting in a 90 degree chair for 12 hours, driving back and forth to post all day, you will not be able to keep a consistent diet or sleep pattern. Whatever sleep you lose you will gain back in pounds. You will see things you could've lived without seeing.  You will take calls home with you. You will work with egocentrics. You will stop talking to non EMS friends, and slowly shift to you work buddies. You will become callous and egocentric yourself. You will curse dispatch, fire, supervisors and trainees. You will wave to cops, and they will just look away. As if the paycheck wasn't enough, You will constantly be reminded of how uneducated and low on the totem-pole you really are when working with medics, nurses and doctor's alike.  
--There's nothing sarcastic about it, Be Advised.

My Sincere Pointer: *Unless your going to do Fire, DON'T*.


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