# Low call volume 911 vs Transport work



## SeeNoMore (Aug 16, 2009)

I have unfortunately exhausted the local possibilities for 911 employment, applied but did not get the jobs. I am currently on a 911 volunteer squad with a very very low call volume. I am considering moving to a city and working transport. I was wondering if those EMTs who are doing this could speak to the benefit, or lack, of working non emergency as far as clinical skills. 

I am trying to weigh whether working a very few emergency calls at a BLS level is better than many calls that are non emergency, but I get to take lots of vitals and assessments, become familiar with various medical conditions, get a lot of experience driving a rig etc.


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## EMTinNEPA (Aug 16, 2009)

My service does both.  Benefits of IFT work for an EMT-B include:


The opportunity to practice obtaining vital signs and performing patient assessment.

The opportunity to see the effects of various diseases at various stages.

The opportunity to read patient paperwork and familiarize themselves with the names of different medications, diseases, conditions, treatments, and surgeries.

All in a non-emergency environment.

It may not be "exciting", but it's informative.

Either you do that, or you volunteer and do nothing but hand things to the medic while hurting the profession.


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## emtech419 (Aug 16, 2009)

I currently work for two different emergency services, but I spent about six months earlier in my career working for a transport service, and here is what I have found:

When you are working for a 911 service, the crazy things that happen, as the previous poster mentioned, will almost always be handed off to a medic.  When working for a transport service, however, the EMT-B tends to be highest level of care.  Don't get lulled into thinking that NETs are always routine - things go wrong all the time.  I had a 6 separate patients have full blown strokes in my ambulance within a 1 month period, all while working for a transport service.

I gained more confidence during my time at the transport service then I ever did during my OJT stints at 911 services, and while I adore my job and will never work for a transport service ever again if I can help it, I am very glad that I had the experience.

The big piece of advice I would give is be very, VERY, choosy about the service you work for.  Ask around to find out the transport service's reputation.  I say this because transport services tend to be, and god help me if I offend anybody by saying this, more concerned with making money than they are about patient care.  This is not to say that there aren't caring individuals in the management of transport services, but just be careful about who you work for.


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## Jon (Aug 17, 2009)

Why not do both?


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## 46Young (Aug 17, 2009)

You may need to move to find a good dept. Where do you live?

Also, if you do go IFT for the time being, make sure and work with a medic. That's the only way I ever learned anything during my first six months of IFT. You will learn some from the in-hospital environment, but you'll really hone your BLS skills in a 911 environment. You'll need to exercise critical thinking, fast hands, street smarts, etc. IFT is too controlled of an envirnment for you to learn to perform at optimal speed and efficiency. Go find a good, grimy ghetto to get your skills together. You'll be tight in no time.

NSLIJ CEMS was my ideal next step, as they have both a NYC 911 shifts (EMT-EMT, or Medic-Medic), and IFT shifts. Great place to get experience all around.


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## EMTinNEPA (Aug 17, 2009)

I disagree.  IFT provides you with the opportunity to practice these skills and become proficient in a controlled environment.  That way, when it's imperitave, you'll already be proficient.  Learn how to do it right before you learn how to do it fast, because if you can do it right, you'll do it fast.


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## Akulahawk (Aug 17, 2009)

SeeNoMore said:


> I have unfortunately exhausted the local possibilities for 911 employment, applied but did not get the jobs. I am currently on a 911 volunteer squad with a very very low call volume. I am considering moving to a city and working transport. I was wondering if those EMTs who are doing this could speak to the benefit, or lack, of working non emergency as far as clinical skills.
> 
> I am trying to weigh whether working a very few emergency calls at a BLS level is better than many calls that are non emergency, but I get to take lots of vitals and assessments, become familiar with various medical conditions, get a lot of experience driving a rig etc.


 



EMTinNEPA said:


> My service does both. Benefits of IFT work for an EMT-B include:
> 
> 
> The opportunity to practice obtaining vital signs and performing patient assessment.
> ...


 I pretty much agree with the above. IFT may not be "exciting", but it'll help give you a MUCH better understanding of the medical side of things. EMT's are taught to deal mostly with Trauma and to recognize that a medical problem exists that needs immediate transport or call ALS. The EMTs that then get jobs doing IFTs are woefully inadequately trained for that environment. It's not a slam against EMTs... but more against their training that they're required to get. 


46Young said:


> You may need to move to find a good dept. Where do you live?
> 
> Also, if you do go IFT for the time being, make sure and work with a medic. That's the only way I ever learned anything during my first six months of IFT. You will learn some from the in-hospital environment, but *you'll really hone your BLS skills in a 911 environment*. You'll need to exercise critical thinking, fast hands, street smarts, etc. IFT is too controlled of an envirnment for you to learn to perform at optimal speed and efficiency. Go find a good, grimy ghetto to get your skills together. You'll be tight in no time.
> 
> NSLIJ CEMS was my ideal next step, as they have both a NYC 911 shifts (EMT-EMT, or Medic-Medic), and IFT shifts. Great place to get experience all around.


 I would have to disagree with this. EMTs learn TONS by doing assessments, reading the charts, learning what various medical conditions look and present like, what meds often go with those conditions, and so on. They get this from doing those IFTs. The EMT learns to do those assessments the same way every time, until it becomes automatic. 

I DO happen to agree that doing IFTs is NOT good for developing speed and efficiency. In areas where EMTs end up providing the bulk of prehospital EMS, they also learn LOTS about doing Prehospital EMS. It's in that arena where they're on EMT/EMT staffed units that they learn the speedy & efficient ways to do things. 

One of the services I used to work for had a good mix of IFT and private emergency calls with the occasional 911. The EMTs that went on to become good Medics later learned to assess patients as if they were 911 patients every time. On those IFT's, they'd sometimes find patients that went sideways and the transport would be cancelled or diverted to an ER. Their on-scene time would be as quick as the facility would allow. When it came to doing private emergency and 911 callls, they didn't have to think about doing their assessments quickly... that was a given. They knew how to do it. These people could easily transition from one end of doing BLS to the other and do it well. 911 was easy. IFT was easy. 

I would DISAGREE with the idea that being on a 911 unit, being partnered with a Paramedic will get your EMT skills up to par. Won't happen. The stuff that you could learn from is handled by the Medic. Many times the EMT is treated simply as a Gopher. THAT IS WRONG, but it happens. All you get to do is hand stuff to the Medic or take vitals or hold stuff. You get to Drive. A lot. 

Of course, the above is MY opinion... based on MY observations over the last 8-10 years...


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## marineman (Aug 17, 2009)

My company does both 911 and a few IFT's. I find the IFT work to be the most educational. On 911 you really just operate within your protocols based on what you see in your patient. You can learn from 911 calls and you should learn at least something every time your ambulance leaves the garage but the opportunity to learn is huge on IFT's. On 911 calls it is harder to follow up on your patients and if you do, you usually only get minimal information. 

For me after I do an IFT I will go back to station and spend an hour or two researching anything I can about the patients condition, what I could do if I had a 911 patient that presented with that condition etc. The opportunity is all what you make of it, if you look at IFT and say all it is, is taking vitals every 15 minutes until you get there then you will not learn anything. Become active in furthering your education and they are great learning opportunities.

To answer your question I would take any job that I could get but I like money.


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## Akulahawk (Aug 17, 2009)

marineman said:


> My company does both 911 and a few IFT's. I find the IFT work to be the most educational. On 911 you really just operate within your protocols based on what you see in your patient. You can learn from 911 calls and you should learn at least something every time your ambulance leaves the garage but the opportunity to learn is huge on IFT's. On 911 calls it is harder to follow up on your patients and if you do, you usually only get minimal information.
> 
> For me after I do an IFT I will go back to station and spend an hour or two researching anything I can about the patients condition, what I could do if I had a 911 patient that presented with that condition etc. The opportunity is all what you make of it, if you look at IFT and say all it is, is taking vitals every 15 minutes until you get there then you will not learn anything. *Become active in furthering your education and they are great learning opportunities.*
> 
> To answer your question I would take any job that I could get but I like money.


 That is the key to becoming a better EMT or Paramedic. The other thing is actually being the guy in the back that gets to _DO_ the stuff. The times I worked for a company that staffed it's units EMT/Paramedic, I was the Medic... I had my EMT do as much of the work being the GIB as possible because they learn from _doing_ more than they learn from _watching_. I did the ALS calls, and we swapped off doing BLS calls. It worked out well. Those that wanted to learn, did.


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## SeeNoMore (Aug 17, 2009)

I am actively becoming more educated, and plan on attending paramedic school in a year. I want to go to school in Philadelphia, but the companies I have looked into are not 911/IFT but just IFT. There is no way Philly Fire will hire me with less than a year 911 experience. 

Thanks for the advice though all.


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## firecoins (Aug 18, 2009)

BLS IFT rigs do nursing home emergencies.  There are alot of stuff to learn there.


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## csly27 (Aug 18, 2009)

I am a few weeks into a new job working IFT, I thought it was gonna be boring but quite the contrary. I have a new found respect for older people not that I didnet respect them before. It is amazing to me to see all the diffrent health issues out there, and to learn all the diffrent medical terms. I really wanted to start out doing 911 calls but I am thankful to be starting out IFT. I am gaining confidence and experience everyday. although still a little weary of breaking some of them, some are so fragile that I think they will break if I go to take vital, any suggestions for getting over that one?


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## kymtgpro (Aug 18, 2009)

Just remember, if they were at a nursing home to begin with, they have their vitals taken routinely.  At least they should.  If they havent been broken by now you should be in the clear.  And get as many vitals as possible.  The elderly are great for perfecting the BP.  If you can get their weak thready pulse and BP younger pts shouldnt be a problem.  

oh yeah, do it manually.


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## MrBrown (Aug 18, 2009)

EMTinNEPA said:


> My service does both.  Benefits of IFT work for an EMT-B include:
> 
> 
> The opportunity to practice obtaining vital signs and performing patient assessment.
> ...



Agreed; sometimes the most boring jobs or calls are the most informative


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## Tiberius (Aug 18, 2009)

I started doing IFT before doing 911...I became proficient due to starting out IFT. I now work for a service that does both. When I work with a medic, I do plenty of 'gofer' stuff, but I also learned/am learning why things are done as they are.


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## Hoofguy (Aug 21, 2009)

It took me about a month of doing straight transfers to realize I didn't want to be a basic anymore. While you can learn a lot it is also a lot of repetitive BS and will burn you out. 

When your slinging you normally get worked harder and have less downtime than 911, now while that's cool at first you don't want to be stuck doing that forever. There are very few opportunities for rescue as a basic in my area, so I went on to medic


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## harkj (Aug 22, 2009)

mostly in arkansas there are ALS trucks which include a medic and emt the company i work for i work on an ALS truck with a medic so i run alot of emergency calls and we also do transfers as well. we run from 8-16 calls in a 24 hr shift which is mixed with both emergencies and tranfers so everything that a medic gets to see and have fun with i do too!


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## ds15 (Sep 1, 2009)

The company I'm working for right now is a private service that does no 911 work, but provides emergency and non-emergency services to nursing homes, urgent cares, and hospitals in our area.  It seems like our company is a little unusual given the volume of emergency trips that we do, which apparently is a lot more than other private services in our area.  The last figures I heard was that about 60% of our runs are "emergency" runs (in that they terminate at an ED), while 40% are pre-scheduled dialysis trips, discharges, doctors appts, etc.  It all breaks down to about 50/50 ALS vs. BLS.

Point is, don't write off transport services just because they don't provide 911 service.  In the past several months, I have treated acute MIs, CVAs, CHF and COPD exacerbation, severe hypoglycemia, and cardiac arrests.  I've intubated, cardioverted, defibrillated, inserted IOs, CPAPed and more.  When talking to friends who work in 911 services, they are frequently surprised at the extent of what we have the opportunity to do working for a non-911 service.

Working in this type of service can also hone your assessment skills - the overwhelming majority of our patients are geriatric, with a long list of chronic conditions.  Differentiating between chronic and acute conditions is a major part of what I have to do when working with this population.  For instance, differentiating COPD vs. CHF vs. pneumonia can be challenging, but is a skill you'll get a great deal of practice with.

Of course, we don't get a lot of variety - probably 90% of our emergency calls are nursing-home based.  Also, the majority of our patients are geriatric, so not a lot of age variety either.  So, we don't see much trauma, no MVAs, and very few pediatric patients.  Also, between emergency calls we have to do pre-scheduled trips, IFTs and discharges, which can get boring, repetitive and monotonous.  Of course, that's still an opportunity to practice taking vital signs and assessments.

Bottom line, don't write off non-911 services.  Sick people are sick people, regardless of whether they're calling 911 or a private service.  So working for a few months for a non-911 service can be a great way to gain some experience in assessments and treatment, determining who is sick and who is _sick_, driving non-emergently and emergently, etc.  Don't be quick to write it off.


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## 46Young (Sep 5, 2009)

EMTinNEPA said:


> I disagree.  IFT provides you with the opportunity to practice these skills and become proficient in a controlled environment.  That way, when it's imperitave, you'll already be proficient.  Learn how to do it right before you learn how to do it fast, because if you can do it right, you'll do it fast.



When I was working BLS, and later ALS, my skills/assessments didn't improve a whole lot when working IFT. The opportunities to do something other than vitals and routine diagnostics were few and far between. My learning curve and general proficiency were greatly improved with a high frequency of legit 911 pts. My pt interview was sharp, and appropriate questions were asked without any delay. My thought process was fast. My hands also moved rapidly when performing skills, almost like I'm on autopilot. Critical thinking in real time is developed, as you need to make a provisional diagnosis to plan a treatment course. In IFT, the Dx has already been given, you just need to know what to look out for regarding Hx, labs, current drips, etc. Granted, the high call volume in NYC and ALS units only getting ALS call types definitely helped.

IFT is definitely a whole other, legitimate side of EMS. It's beneficial to see pts in various stages of the disease process, and also to see the benefits/consequences of our actions during prehospital Tx. however, the opportunities to use your critical thinking (and other) skills pale greatly in comparison to a busy high acuity 911 system such as NYC ALS 911 and other like systems. I will concede that critical care paramedicine is a whole other ballgame. They actually get to use their training more often, and to a greater extent than the garden variety medic.

I had the best of both worlds working in NY. If others want to have the same experience, then get your NYS card, your NYC REMAC card (for medics) and apply to either NSLIJ CEMS, or NY Presbyterian. At either place you can work a dedicated NYC 911 shift, or a dedicated IFT shift. Certain PICU's, most baloon pump jobs, vented/sedated pts won't require a team. Maybe a second medic, but that's it.


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## 46Young (Sep 5, 2009)

Akulahawk said:


> I pretty much agree with the above. IFT may not be "exciting", but it'll help give you a MUCH better understanding of the medical side of things. EMT's are taught to deal mostly with Trauma and to recognize that a medical problem exists that needs immediate transport or call ALS. The EMTs that then get jobs doing IFTs are woefully inadequately trained for that environment. It's not a slam against EMTs... but more against their training that they're required to get.
> 
> I would have to disagree with this. EMTs learn TONS by doing assessments, reading the charts, learning what various medical conditions look and present like, what meds often go with those conditions, and so on. They get this from doing those IFTs. The EMT learns to do those assessments the same way every time, until it becomes automatic.
> 
> ...



My EMS (BLS) career started at an IFT company (Hunter Ambulance-Ambulette Inc.) per diem for around 6 months prior to getting into a 911 hospital. I'll agree that it's a good learning opportunity to read charts, match meds with the pt's Hx, do assessments on truly sick pts. The learning curve flattens pretty quickly with that after a short time, though. I made sure to pick up shifts with medics only, so that I would see some good stuff occasionally. 

NYC 911 has the benefit of having EMT-EMT BLS units, and medic-medic ALS units only, no EMT driving a medic, who dominates pt care. I've come to find out that much of the country runs EMT/medic ALS rigs. It cheats the EMT out of developing their critical thinking skills. Perhaps in the future an EMS degree will take one straight to medic, no more varying levels of education and scope.

A few months in an IFT company as a basic is beneficial IMO, but then it just becomes monotonous and mind numbingly boring. Complacency may also set in. A good BLS tech with solid 911 experience is more likely, in general, to pick up a change in pt condition than an IFT tech only, due to complacency.

I've personally witnessed IFT EMT's bring in a deceased pt in rigor in a stair chair on a NRB. I've witnessed a pt being "bagged" via NRB. I've seen CPR done on a pt with semi-fowler's positioning. They should know better, but it would be beneficial for someone with experience to shoe them the way. when I started, I had two weeks on, maybe about 40-50 hours on the job, and was partnered with a brand new tech. I'm glad nothing serious went down. That, along with wanting to see more acutely ill pts, caused me to seek shifts driving medics only.


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## Akulahawk (Sep 5, 2009)

46Young said:


> My EMS (BLS) career started at an IFT company (Hunter Ambulance-Ambulette Inc.) per diem for around 6 months prior to getting into a 911 hospital. I'll agree that it's a good learning opportunity to read charts, match meds with the pt's Hx, do assessments on truly sick pts. The learning curve flattens pretty quickly with that after a short time, though. I made sure to pick up shifts with medics only, so that I would see some good stuff occasionally.
> 
> NYC 911 has the benefit of having EMT-EMT BLS units, and medic-medic ALS units only, no EMT driving a medic, who dominates pt care. I've come to find out that much of the country runs EMT/medic ALS rigs. It cheats the EMT out of developing their critical thinking skills. Perhaps in the future an EMS degree will take one straight to medic, no more varying levels of education and scope.
> 
> A few months in an IFT company as a basic is beneficial IMO, but then it just becomes monotonous and mind numbingly boring. Complacency may also set in. A good BLS tech with solid 911 experience (or a 911 medic) is more likely, in general, to pick up a change in pt condition than an IFT tech only.


Doing IFT's (acute care facility to SNF) can be incredibly boring. It is, however, a good way to see how many disease processes present themselves. When I started, about 1/2 of the calls we ran were from home or from SNFs to an ED. If you don't do those types of calls... you'd be amazed at what they call BLS transport for... and what is actually going on with the patient when you get there... and find out that the facility should have called 911... The company I worked for was quite proficient at running 911 calls. Generally, better than the BLS component of the 911 contractor...

Complacency can be a problem, if you let it. I've seen many PCRs done by EMTs that have become complacent in doing care.... It's sad.


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## 46Young (Sep 5, 2009)

Akulahawk said:


> Doing IFT's (acute care facility to SNF) can be incredibly boring. It is, however, a good way to see how many disease processes present themselves. When I started, about 1/2 of the calls we ran were from home or from SNFs to an ED. If you don't do those types of calls... you'd be amazed at what they call BLS transport for... and what is actually going on with the patient when you get there... and find out that the facility should have called 911... The company I worked for was quite proficient at running 911 calls. Generally, better than the BLS component of the 911 contractor...
> 
> Complacency can be a problem, if you let it. I've seen many PCRs done by EMTs that have become complacent in doing care.... It's sad.



Recently, at the IFT company I work at per diem, I had an EMT-I ride along (this employer requires you to clear BLS precepting prior to ALS). His PCR was worse than some BLS techs out there. No physical assessment noted, he circled alert and oriented (to what? no mention), wrote that the pt was "lethargic" without mentioning that it was normal for that pt per the sending RN.


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## Akulahawk (Sep 5, 2009)

46Young said:


> Recently, at the IFT company I work at per diem, I had an EMT-I ride along (this employer requires you to clear BLS precepting prior to ALS). His PCR was worse than some BLS techs out there. No physical assessment noted, he circled alert and oriented (to what? no mention), wrote that the pt was "lethargic" without mentioning that it was normal for that pt per the sending RN.


I do NOT tolerate that kind of documentation. That's one of the few things I have a very low tolerance for. When one of the EMTs I was responsible for did that... a real quick lesson in as to why each report is done completely usually solves the issue. If I see it happen again, that person gets re-taught how to write the reports all over again... and a third time, they're heading for a suspension... We expected nothing less than good patient care and documentation from our crews. In general, we got it.


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## 46Young (Sep 5, 2009)

Akulahawk said:


> I do NOT tolerate that kind of documentation. That's one of the few things I have a very low tolerance for. When one of the EMTs I was responsible for did that... a real quick lesson in as to why each report is done completely usually solves the issue. If I see it happen again, that person gets re-taught how to write the reports all over again... and a third time, they're heading for a suspension... We expected nothing less than good patient care and documentation from our crews. In general, we got it.



Agreed. On the floor, I asked this individual and the basic to hook up my pt and get a set of vitals for me while I do ppw (after speaking with the pt). They moved him to the cot, attached a pulse ox only, then they both walked away from the pt! I was watching them, and immediately went to the pt, and told them that someone must be with the pt at all times. On another call, the pt had a sinus with 1st degree AV block. The EMT-I handed me the strip with a puzzled look and said "do what you want with this". WTF? The negative QRS deflection apparently puzzled him or something.

We had a "stat" call to the floor for an xfer for a pt w/CHF secondary to an aortic valve malfunction with tricuspid regurg. She was awaiting surgery at the receiving facility. I found the pt to be reasonably stable in fowler's on 4lpm O2. No drips or anything. Oh yeah, this was about 2000 hrs, the pt was admitted x 2 days, and surgery was scheduled for tomorrow afternoon. I found this out after calling the receiving RN. She agreed with me that running this pt hot was wholly unneccesary. The basic kept trying to convince me that we still should light it up because the sending MD requested it. I shared several accounts of co-workers and acquaintances that were killed or severely injured while txp lit up. I explained that it's unneccesary to put ourselves and the public in danger for no good reason. If we crash, it's really my fault for allowing code 3 txp.He still didn't get it, he seemed annoyed that I killed his chance to drive hot.

I was on duty this day and responded to this call...... http://www.postandcourier.com/news/2008/mar/26/fatal_collisioncar_ambulance_crash_kills34947/

http://cms.firehouse.com/web/online/In-The-Line-Of-Duty/Paramedic-and-a-Volunteer-Killed-in-Ambulance-Crash-on-Long-Island/39$41502   I used to work with Bill.
Good thing that I have experience at a top of the line 911/IFT hospital. Those that are new may learn things the hard way.


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## WannaBeFlight (Sep 19, 2009)

I am currently doing my EMT-B in my medic program now. By January I would be able to work Routine Transport for a Level II hospital. I am intrigued by this type of work for these reasons: Experience with stretchers, patients, assessment and emergency vehicle driving. It would also serve me well in getting my foot in the door at that hospital, considering they have the Helo I want to work on in the future.

My main question is this:  Can anyone tell me about working for a Hospital based RTS? Thanks.


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## 62_derick (Sep 25, 2009)

I work with a company that also does both IFT and 911 calls. I am a new emt (still wet behind the ears as some medics say) only 3 months into it. I have found out that I enjoy working the 911 calls more then the IFT calls but even just like someone else said that if you get something good it will most likly go to the medic but I still like being in the back assisting the medic. 

I like doing both I dont really know what I like better, I enjoy the laid back days of IFT trips cuz it less crazy. We also run wheelchair calls and ambuletes there good but I really dont get to practice my skills. 

I was once told by a friend when I was going through school that he recomends new emts getting into a BLS squad that way you can improve you skills and such. 

Good luck hope everything works out.


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