# Where is the best EMS system?



## DPM (Dec 5, 2016)

Hello EMT Lifers! 

I'm becoming more and more disappointed with the state of EMS here in California. I don't live under a rock, I know that California is the bottom of the barrel, so I don't mind moving. 

So here is my question; where is the best EMS system in the USA? Seattle King Medic 1? Somewhere else? I'm looking for a busy system, that pays at least Ok, with good protocols. 

If you have a suggestion, please elaborate on why you like a system. I'm all ears! 

Thanks in advance


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## VentMonkey (Dec 5, 2016)

DPM said:


> Hello EMT Lifers!
> 
> I'm becoming more and more disappointed with the state of EMS here in California. I don't live under a rock, I know that California is the bottom of the barrel, so I don't mind moving.
> 
> ...


It's all subjective. What's your cert level? In California you're correct your options are limited, but as far as "the best", that is entirely up to you to decide. What do you want most? For me a career ALS intercept agency with good retirement and benefits would be something I would strongly consider in regards to relocation.

So, my top picks would be one of these types of agencies---with SCEMS being at the top of my list---followed by a solid Texas-based EMS third service such as Wilco EMS. Denver Health (EMS) seems interesting as well.

I also wouldn't mind working for a hospital-based service that utilizes full-scope paramedics in the ED when not responding to calls (bonus if they're CCP+911 deployment).

As you can see, there's hardly a clear cut answer, but that being said I am pretty content with my current (California) agency.


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## EpiEMS (Dec 5, 2016)

The best system? Probably not one in the U.S. - I'd say NZ or AUS are probably more like where you want to be. Or Canada!

The best system in the U.S., well, that's up for debate - depends on your criteria. You've identified preferences for a 





DPM said:


> busy system, that pays at least Ok, with good protocols.


. I'd interpret that as an urban system paying more than $40,000/annum, and with (ideally) good retirement. For "good protocols", I'm going subjective on ya, so I'll ignore it for now.

You didn't specify good system design -- so I have to leave all-ALS staffed ambulances, fire-based EMS, and similar problematic designs in, but I do it with chagrin .

Here are some classics cited on this site: King County Medic One, Seattle Medic One, Boston EMS, Wake County EMS, Austin/Travis County EMS, Denver Health EMS, Sussex County (DE) EMS, and New Orleans EMS, Worchester EMS

My picks are going to be more northeast-skewed, and more urban. I'd argue that, despite my distaste for dual medic staffing, Boston EMS has a lot of advantages - plentiful BLS units, lots of good hospitals, and fairly high compensation (circa $60k for EMTs starting, I'm told?). I am also a fan of Pittsburgh EMS, if you like maritime matters or heavy rescue. If you like to ride dual medic and do intercepts, New Jersey has some offerings (University Hospital Emergency Medical Services), too, as do some services in CT (Stamford EMS, for one).


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## DPM (Dec 5, 2016)

Those are the kind of things I was thinking about. I'm a Paramedic, and I've worked all over the Bay Area (SF and San Jose mostly).

You're hitting on the types of things I was talking about, but I also kept it pretty vague to see what other people like about their systems. 

Which SCEMS are you talking about?


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## VentMonkey (Dec 5, 2016)

DPM said:


> Which SCEMS are you talking about?


http://emtlife.com/threads/sussex-ems.43269/#post-607320


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## VFlutter (Dec 5, 2016)

Detroit EMS


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## VentMonkey (Dec 5, 2016)

Chase said:


> Detroit EMS


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## DPM (Dec 5, 2016)

EpiEMS said:


> The best system? Probably not one in the U.S. - I'd say NZ or AUS are probably more like where you want to be. Or Canada!
> 
> The best system in the U.S., well, that's up for debate - depends on your criteria. You've identified preferences for a . I'd interpret that as an urban system paying more than $40,000/annum, and with (ideally) good retirement. For "good protocols", I'm going subjective on ya, so I'll ignore it for now.
> 
> ...



Thanks! I'm leaving the fire based systems in just to hear if there is an outlier that works well, but I agree with you about the issues that these systems present.


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## EpiEMS (Dec 5, 2016)

VentMonkey said:


> [Best Baby Meme Ever]


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## Summit (Dec 5, 2016)

In my imagination


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## EpiEMS (Dec 5, 2016)

DPM said:


> Which SCEMS are you talking about?



Sussex County EMS (as referenced above) - forum user @DEmedic worked there (please do weigh in, DE!).

They're fly-car based dual-medic staffed, and intercept for BLS transporting agencies. I believe they have a pension plan (25-year) and they seem pretty good as far as protocols go.


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## VentMonkey (Dec 5, 2016)

EpiEMS said:


> Sussex County EMS (as referenced above) - forum user @DEmedic worked there (please do weigh in, DE!).
> 
> They're fly-car based dual-medic staffed, and intercept for BLS transporting agencies. I believe they have a pension plan (25-year) and they seem pretty good as far as protocols go.


Honestly between him, and @chaz90 I think it would be best to PM them directly (assuming they're ok with it; I know chaz is pretty open to it, can't speak for DE at this point regarding SCEMS), and/ or do the research independently via threads posted (there's more than one), and the interwebs.


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## NomadicMedic (Dec 5, 2016)

I left SCEMS 2 years ago and I still think it might be one of the top 5 stupidest mistakes I've ever made. It is the job that all other paramedic jobs will be judged against.


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## DPM (Dec 5, 2016)

DEmedic said:


> I left SCEMS 2 years ago and I still think it might be one of the top 5 stupidest mistakes I've ever made. It is the job that all other paramedic jobs will be judged against.



Mind if I DM you?


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## NomadicMedic (Dec 5, 2016)

DPM said:


> Mind if I DM you?



Sure.


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## SpecialK (Dec 5, 2016)

In no particular order:

London
Queensland
New Zealand
Canada (I hear BCAS and AHS are good)

You can go be an international in London if you like, they're hiring.


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## DPM (Dec 5, 2016)

SpecialK said:


> In no particular order:
> 
> London
> Queensland
> ...



Do you have first hand experience with LAS? I've heard some not so great things from people going from the US to London,  particularly in regards to the scope / level that a US paramedic will be accredited at.


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## SpecialK (Dec 5, 2016)

DPM said:


> Do you have first hand experience with LAS? I've heard some not so great things from people going from the US to London,  particularly in regards to the scope / level that a US paramedic will be accredited at.



There's only one level in the UK (Paramedic) which internationals are assessed against so I'm not sure what you are referring to?

The "thrust" in England at least is to have a Paramedic on every ambulance and then to specialise from there; for example Specialist Paramedics in HART (CBRNE), critical care, or primary care.  Each trust is also slightly different from each other in terms of how they seem to be implementing the higher tiers because it is up to their discretion I guess owing to the HCPC only broadly registering "Paramedics" in general terms as a professional; a bit like how all the various "advanced" nursing roles are still in the regulators eyes a "Registered Nurse".

Personally I wouldn't go to work in London because I don't want to leave where I am now, but for some people who are a bit younger and want the experience I'd say go for it.


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## TransportJockey (Dec 5, 2016)

I would love London. But for the US, I would say any of the good third-service (municipal or county based) agencies here in TX (I work for a decent one right now), Delaware, Denver Health, Ada County Paramedics, Wake County, Orange County, or Durham County EMS. That's pretty much my short list right now. Florida is interesting in that they have some decent single role fire medic positions and some of their third service systems have their own rotor teams too


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## DPM (Dec 5, 2016)

SpecialK said:


> There's only one level in the UK (Paramedic) which internationals are assessed against so I'm not sure what you are referring to?
> 
> The "thrust" in England at least is to have a Paramedic on every ambulance and then to specialise from there; for example Specialist Paramedics in HART (CBRNE), critical care, or primary care.  Each trust is also slightly different from each other in terms of how they seem to be implementing the higher tiers because it is up to their discretion I guess owing to the HCPC only broadly registering "Paramedics" in general terms as a professional; a bit like how all the various "advanced" nursing roles are still in the regulators eyes a "Registered Nurse".
> 
> Personally I wouldn't go to work in London because I don't want to leave where I am now, but for some people who are a bit younger and want the experience I'd say go for it.



Specifically it was the reciprocity for me. I'm hoping to expand my scope, at it looks that a move to LAS would limit it further. I think I'm correct in thinking I wouldn't be able to start IV's or give any IV meds, intubate etc until I was an Advanced or Specialty Care paramedic.


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## SpecialK (Dec 6, 2016)

DPM said:


> Specifically it was the reciprocity for me. I'm hoping to expand my scope, at it looks that a move to LAS would limit it further. I think I'm correct in thinking I wouldn't be able to start IV's or give any IV meds, intubate etc until I was an Advanced or Specialty Care paramedic.



Many Paramedics in the UK no longer intubate.  This is largely because they cannot maintain competency.  Remember, in the UK, Paramedics are professionally registered with standards of competence set by the HCPC and the accountability is with the individual practitioner at the end of the day.  The other reason is well, it doesn't really help and there is good evidence to show this.  Indeed I think here we are only averaging about one intubation a month per Officer. 

You can start an IV as a Paramedic and give some IV drugs yes. 

Because of the professional HCPC registration you have very wide scope in what to do with patients and this seems quite nice; i.e. you are a registered professional who can exercise your own clinical judgement (and on the flip side are responsible for it).  Australasia is slowly moving towards registration and it's at least one to two years away.  While we have similar practices it would be nice to have some legal weight behind it. 

I seriously investigated moving to London, and I have personally been to London a couple of times.  It is an incredible world city with absolutely amazing things to do and see and that is not even considering the wider England, UK or Europe.  Auckland is an up-and-coming world city but I think we are still five years away from truly being there.  I'd go back to London in a microsecond, but I just do not want to move there to work.

If you are young and want some experience I can't see why you wouldn't go especially considering the LAS is actively seeking internationals?

Do a Google for the BBC series "Ambulance" and have a squiz; it's on some streaming site somewhere probably.  It's three or four very recent episodes that will give you a bit of an insight.


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## EpiEMS (Dec 6, 2016)

SpecialK said:


> If you are young and want some experience I can't see why you wouldn't go especially considering the LAS is actively seeking internationals?



LAS, that's a great option! It'd be a great experience to live abroad, for sure!


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## DrParasite (Dec 6, 2016)

DPM said:


> So here is my question; where is the best EMS system in the USA? Seattle King Medic 1? Somewhere else? I'm looking for a busy system, that pays at least Ok, with good protocols.


Define busy..... define pays at least OK, and define good protocols...

There is no system that is the best... Take London Ambulance: http://www.bbc.com/news/health-38077409 for everyone who says it's great, there is always another side of the coin.

If I was looking for an EMS career, I would look at agencies that offered the following: offers positions that doesn't involve me being on the ambulance, so when I get bored/hurt/sick of the ambulance, I can transfer to a different position and not have to change companies, an ability to retire and collect a pension, reasonable cost of living compared to my salary, either a 24/72 schedule or 12 hr shifts, without a frequent flip from days to nights, enough independence to do my job, but the resources are available should the situation require more help, and to have an agency culture of people who want to be there to do the job, not who are just there to collect a paycheck and are miserable but get paid too well to go elsewhere.

As I said, it all boils down to what you want, and if that particular agency is able to provide you with what you are looking for.


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## DPM (Dec 6, 2016)

DrParasite said:


> Define busy..... define pays at least OK, and define good protocols...
> 
> There is no system that is the best... Take London Ambulance: http://www.bbc.com/news/health-38077409 for everyone who says it's great, there is always another side of the coin.
> 
> ...



Do you know of any systems that fulfil those criteria that you listed?


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## Handsome Robb (Dec 6, 2016)

I'm surprised Williamson County EMS hasn't been thrown in this mix. Station based, dual Paramedic 911 service with good protocols, involved medical direction, 55k a year base salary, one of if not the outright best retirement plans in the nation and in a decent location. 

Might not meet your definition of busy but not slow either.


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## VentMonkey (Dec 6, 2016)

VentMonkey said:


> So, my top picks would be one of these types of agencies---with SCEMS being at the top of my list---followed by *a solid Texas-based EMS third service such as Wilco EMS*. Denver Health (EMS) seems interesting as well.





Handsome Robb said:


> I'm surprised Williamson County EMS hasn't been thrown in this mix. Station based, dual Paramedic 911 service with good protocols, involved medical direction, 55k a year base salary, one of if not the outright best retirement plans in the nation and in a decent location.
> 
> Might not meet your definition of busy but not slow either.


Ahem...


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## EpiEMS (Dec 6, 2016)

Seems like Texas has a relative profusion of good services -- is it a matter of flexibility for SOP? Or is it more related to local flexibility for organization? Or maybe...relatively low cost of living and a decent tax base for third services?


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## Handsome Robb (Dec 6, 2016)

EpiEMS said:


> Seems like Texas has a relative profusion of good services -- is it a matter of flexibility for SOP? Or is it more related to local flexibility for organization? Or maybe...relatively low cost of living and a decent tax base for third services?



Delegated practice helps a lot. We can do anything our MD wants provided the can show we've been sufficiently educated for it. 

Also we have a professional association in the Association for Texas EMS Professionals that lobbies for legislation supporting EMS. 

No state income tax means more property taxes and what not which in turn provides more county/city tax base for third services if I understand it correctly as well. 


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## Handsome Robb (Dec 6, 2016)

VentMonkey said:


> Ahem...



Ahh missed that one. 

Lo siento señor! 


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## SpecialK (Dec 6, 2016)

If you want busy, go to London.  They average 5,000 calls to 999 per day and I think on average generate about 4,000 responses.  This is for a population of say 8 million people.  On average, for a population of 1.5 million we do about 500.


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## dutemplar (Dec 7, 2016)

Let me say that Qatar is certainly world-class and a very interesting system, particularly for experienced providers.


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## EpiEMS (Dec 7, 2016)

Handsome Robb said:


> Delegated practice helps a lot. We can do anything our MD wants provided the can show we've been sufficiently educated for it.
> 
> Also we have a professional association in the Association for Texas EMS Professionals that lobbies for legislation supporting EMS.
> 
> No state income tax means more property taxes and what not which in turn provides more county/city tax base for third services if I understand it correctly as well.



That third one is awfully appealing 



dutemplar said:


> Let me say that Qatar is certainly world-class and a very interesting system, particularly for experienced providers.



Do you have any suggested reading materials on Qatar's EMS system?


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## Handsome Robb (Dec 7, 2016)

EpiEMS said:


> That third one is awfully appealing



I've honestly never known anything else. You do make up for it in property taxes though if you're a homeowner. Average in my area ranges from 6-10k/year for a 200-350k home.



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## TransportJockey (Dec 7, 2016)

Handsome Robb said:


> I've honestly never known anything else. You do make up for it in property taxes though if you're a homeowner. Average in my area ranges from 6-10k/year for a 200-350k home.
> 
> 
> 
> Sent from my iPhone using Tapatalk


It's a nice little pay bump. Coming from NM,  which has state income tax, to TX,  which does not,  was a nice little pay bump. 

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## NysEms2117 (Dec 7, 2016)

I know i'm gonna get slaughtered for this, but where I work PDM is actually a really good place to work. I work at the Albany county sheriffs office EMS unit. Albany area is a great place to live, _low taxes for being in NYS,_ there are taxes, but not bad! Pay is great 40k+ EMT 50k+ paramedic(i think, my CC-P partner is well above 50k, but he's also been here a long time). 
An excerpt: "The Albany County Sheriff Office's EMS Division is actively seeking Paramedics and EMTs for part-time positions. This includes both County and non-County residents.
BENEFITS: EMTs = $14.05/hr, Paramedics = 21.29/hour, All 911 System, Paid Time Off, Longevity, Uniforms, Training, Monthly Scheduling, Paid Holidays"

few links to show a bit about. I also understand facebook is not a reliable source.. 
http://www.geocities.ws/45peter/NYalbanyCo.html
http://www.albanycounty.com/Government/Departments/CountySheriff/EmergencyMedicalServicesUnit.aspx
https://www.facebook.com/Albany-County-Sheriffs-Office-EMS-Division-143143805843470/


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## DrParasite (Dec 7, 2016)

NysEms2117 said:


> I know i'm gonna get slaughtered for this, but where I work PDM is actually a really good place to work. I work at the Albany county sheriffs office EMS unit. Albany area is a great place to live, _low taxes for being in NYS,_ there are taxes, but not bad! Pay is great 40k+ EMT 50k+ paramedic(i think, my CC-P partner is well above 50k, but he's also been here a long time).
> An excerpt: "The Albany County Sheriff Office's EMS Division is actively seeking Paramedics and EMTs for part-time positions. This includes both County and non-County residents.
> BENEFITS: EMTs = $14.05/hr, Paramedics = 21.29/hour, All 911 System, Paid Time Off, Longevity, Uniforms, Training, Monthly Scheduling, Paid Holidays"


wait a second... someone here is using that funky common core math..... 14.05 an hour doesn't come close to 40K a year for EMTs.....


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## NysEms2117 (Dec 7, 2016)

DrParasite said:


> wait a second... someone here is using that funky common core math..... 14.05 an hour doesn't come close to 40K a year for EMTs.....


14.05 was based on an old model. As an EMT-B working on a CCT rig, im at ~$17+-10 cents. They also base that off of 40 hours a week due to the fact they are seeking "part time positions". However, they are hiring for both PT and FT.


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## EpiEMS (Dec 7, 2016)

NysEms2117 said:


> Pay is great 40k+ EMT 50k+ paramedic(i think, my CC-P partner is well above 50k, but he's also been here a long time).



We're talking about around ~2,850 hours a year for $40k as an EMT -- is that typical?


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## NysEms2117 (Dec 7, 2016)

EpiEMS said:


> We're talking about around ~2,850 hours a year for $40k as an EMT -- is that typical?


no sir, 40 hours is what they are basing that on as said above. so generally 48 hrs a week is not "unreasonable". 8 hours at time and a half, lowers that down exponentially. if my mental math is right 40 hours a week is about 2100 hours. So i'd venture around 2150? It really is nothing super unrealistic, there are people that do full time EMT work there and are reserve sheriffs in the off time, and make 40k+ and still maintain a personal life.


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## dutemplar (Dec 7, 2016)

EpiEMS said:


> Do you have any suggested reading materials on Qatar's EMS system?



https://www.hamad.qa/EN/Hospitals-and-services/Ambulance-Service/Pages/default.aspx
http://www.qscience.com/doi/abs/10.5339/jemtac.2016.icepq.106
http://www.emsworld.com/article/12032139/improving-prehospital-care-abroad
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938867/
http://dohanews.co/qatar-motorists-to-get-alerts-on-the-radio-when-ambulance-approaches/
http://www.qatarisbooming.com/tags/ambulance-service
https://emergencytrauma.wordpress.com/
http://www.nhsq.info/app/media/1190
http://www.medichealth.com/early-warning-score-system-for-ambulance-service/
https://en.wikipedia.org/wiki/Healthcare_in_Qatar
https://www.esri.com/~/media/Files/Pdfs/library/brochures/pdfs/qatar-enters-a-new-era.pdf
http://nricafe.com/qatar-installs-new-devices-to-help-emergency-vehicles-cross-signals/
http://naedjournal.org/content/first-middle-east

Plus the usual JCI, etc...

..some older articles and studies.  They are research and pretty aggressive in terms of equipment and science based upgrades.


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## EpiEMS (Dec 7, 2016)

NysEms2117 said:


> no sir, 40 hours is what they are basing that on as said above. so generally 48 hrs a week is not "unreasonable". 8 hours at time and a half, lowers that down exponentially. if my mental math is right 40 hours a week is about 2100 hours. So i'd venture around 2150? It really is nothing super unrealistic, there are people that do full time EMT work there and are reserve sheriffs in the off time, and make 40k+ and still maintain a personal life.



I definitely am OK with 48 hours/week, myself (heck, 60 is fine too), I just didn't think about time and a half...oops! Thanks for clarifying! 



dutemplar said:


> They are research and pretty aggressive in terms of equipment and science based upgrades.



Much appreciated! So is Hamad a private company, or is it some sort of state enterprise?


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## NysEms2117 (Dec 7, 2016)

EpiEMS said:


> I definitely am OK with 48 hours/week, myself (heck, 60 is fine too), I just didn't think about time and a half...oops! Thanks for clarifying!


All good  glad I can help


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## FLMedic311 (Dec 11, 2016)

So to everyone's dismay I am going to jump on in here and drop my bias opinion of KCM1, having been here for just a little over 5 months (and the year of school) I love it.  Great Pay, Benefits and Scope.  It has been one of the better decisions I have made thus far...  With that said I really do agree with everyone else in that everyone is different, and you are going to have to go out and see what sounds best for you!  I can't say I have first hand knowledge but hear great things of Wake, Sussex, Shands Cair, MCHD, Austin-Travis just to name a few.  When thinking about making a big move, where you want to live geographically should be a big part of it.  At the end of the day work is just that work, and when you clock out at the end of your shift if your not happy with where you are then it is going to start to wear on you.  Good Luck with the search!


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## VentMonkey (Dec 11, 2016)

I am beginning to realize, I think I know exactly where the _best EMS system_ is...

In my head.


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## DPM (Dec 11, 2016)

VentMonkey said:


> I am beginning to realize, I think I know exactly where the _best EMS system_ is...
> 
> In my head.



This was my concern too. I know that I'm in Cali, which is bad already, but I'm having a really hard time finding any systems that I would consider great. 

You might get OK protocols and OK equipment, but the pay will be bad, with no room for promotion. Or you can get paid well to do glorified BLS... or you can have ok pay and protocols but have a low call volume...


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## NysEms2117 (Dec 11, 2016)

VentMonkey said:


> I am beginning to realize, I think I know exactly where the _best EMS system_ is...
> 
> In my head.


is that system hiring????


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## NomadicMedic (Dec 11, 2016)

Nobody has mentioned Hennepin for a while...


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## VentMonkey (Dec 11, 2016)

DEmedic said:


> Nobody has mentioned Hennepin for a while...


@cruiseforever any thoughts? I know you're not there specifically.

I could have sworn there was a poster from Hennepin EMS at some point. It definitely sounds doable.


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## NomadicMedic (Dec 11, 2016)

VentMonkey said:


> @cruiseforever any thoughts? I know you're not there specifically.
> 
> I could have sworn there was a poster from Hennepin EMS at some point. It definitely sounds doable.



Yeah, @WestMetroMedic is a Hennepin guy, and they're currently hiring. Sounds like a decent system. there's been a few posts about it here.


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## luke_31 (Dec 11, 2016)

Over time my definition of a great system has changed from looking for great protocols, good call volume, great pay, and benefits.  I think that liking the area you are working in, enjoying your coworkers, and not having to worry about losing your job if the organization loses a contract is more important. Of course I started in IFT, moved to contract work, and then found a great government job as a paramedic which has hit practically everything I've ever wanted. So if you spend the time and try a few places you will eventually find what you are looking for.  13 years in I never would have even dreamed of ending up where I am now.


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## DrParasite (Dec 11, 2016)

FLMedic311 said:


> So to everyone's dismay I am going to jump on in here and drop my bias opinion of KCM1, having been here for just a little over 5 months (and the year of school) I love it.  Great Pay, Benefits and Scope.  It has been one of the better decisions I have made thus far...  With that said I really do agree with everyone else in that everyone is different, and you are going to have to go out and see what sounds best for you!  I can't say I have first hand knowledge but hear great things of Wake, Sussex, Shands Cair, MCHD, Austin-Travis just to name a few.  When thinking about making a big move, where you want to live geographically should be a big part of it.  At the end of the day work is just that work, and when you clock out at the end of your shift if your not happy with where you are then it is going to start to wear on you.  Good Luck with the search!


You know, if I was younger, single, renting an apartment, with nothing holding me down, I would be applying to KCM1.  Now that I'm married, and looking to start a family, moving across the country for a job that has a relatively high failure rate just doesn't appeal to me anymore.  Moving my family away from everything they know,and starting over for a great job is one thing..... but knowing that 25 to 50% of those who get accepted don't make it past a year after day 1 of the new job (for many reasons, many valid), well, it's one thing if it's just me living out of an apartment, it's another when you have a family, nice furniture, roots and if it fails, you are all kinda of screwed.  Moving is expensive, and if the new job doesn't work out (for whatever reason), then what are you going to do?


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## NomadicMedic (Dec 11, 2016)

I think anyone who wants to work for KCM1 should have to do 6 months on a TriMed BLS rig first. Then let's talk about the vast dichotomy of EMS in King County.


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## WestMetroMedic (Dec 11, 2016)

VentMonkey said:


> @cruiseforever any thoughts? I know you're not there specifically.
> 
> I could have sworn there was a poster from Hennepin EMS at some point. It definitely sounds doable.


Hennepin EMS Community Paramedic here indeed (at least for the next 3 weeks). Hennepin is a great place to work. Minneapolis is a great place to practice, as well as live. We have a very aggressive wage scale ($21 to ~$34 after 15 years, plenty of overtime if that is your thing (not mandated to work more than 40 hours a week), Police and Fire pension (20 year vesting), generous uniform allowance, great medical benefits, and decent PTO plan. We are a union shop, but we are not affiliated with a large national union.

UHU's are a bit high right now (IIRC ~0.45), but we have an amazing fleet that gets replaced every three years. PowerLOAD in all vehicles (except bariatric truck), LUCAS2, King Vision, Zoll X-Series, Android based ePCR system, closest unit dispatch via our own PSAP, Radios that always work. NO INTERFACILITY TRANSFERS. We have a Community Paramedic program, and we are the EMS provider for MN Timberwolves, MN Twins, MN Vikings, MN Lynx, U of MN Gophers, and about 105 other special events a year (all overtime opportunities).

Medical Protocols exist, but our medical directors firmly believe that if you can reasonably justify what you did, they will support you. We have a great dynamic with all of our first response agencies in the 14 municipalities that we serve. We are affiliated with a Level 1 Adult and Pediatric Trauma Center with great and collegial relationship between EMS and ED staff. Alwyas have some sort of research project going on (doing TXA now, but i've been involved in resuscitation research, thoracic ultrasound, Seizure studies, and more).

It is far from a perfect place, but i have always felt that the people that complain don't appreciate how much better we have it than nearly every other agency in the nation. 

I am leaving at the end of this month to pursue an opportunity in the Community Paramedic world, but I am very sad to be leaving. I am very proud to have worn brown for the past nine years.

http://www.theatlantic.com/magazine/archive/2015/03/the-miracle-of-minneapolis/384975/


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## VentMonkey (Dec 11, 2016)

DEmedic said:


> I think anyone who wants to work for KCM1 should have to do 6 months on a TriMed BLS rig first. Then let's talk about the vast dichotomy of EMS in King County.


Indeed there are two side to every coin. I can only compare this to my time as an AMR "gopher" to the majority of the LACoFD's paramedic squads.


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## RocketMedic (Dec 12, 2016)

DEmedic said:


> I think anyone who wants to work for KCM1 should have to do 6 months on a TriMed BLS rig first. Then let's talk about the vast dichotomy of EMS in King County.



Do tell!


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## PotatoMedic (Dec 12, 2016)

RocketMedic said:


> Do tell!


Oh the memories.

Well there was the time I brought in a NSTEMI.  Signs and symptoms were "same as my last heart attack". Oh how the nurse was pissed because the medics wanted to go back to bed.  Yeah the 12 lead was clean but when the pt says it is the same... You listen.  Just stuff like that all the time.


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## RocketMedic (Dec 12, 2016)

The best system ever!!!!!!


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## EpiEMS (Dec 12, 2016)

WestMetroMedic said:


> Hennepin is a great place to work. Minneapolis is a great place to practice, as well as live.


Looks like a solid system! Are all units based out of the hospital?


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## TransportJockey (Dec 12, 2016)

EpiEMS said:


> Looks like a solid system! Are all units based out of the hospital?


I kinda wanna go there. Lol I bet I could deal with the snow and cold for that. 

Sent from my SM-N920P using Tapatalk


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## WestMetroMedic (Dec 12, 2016)

EpiEMS said:


> Looks like a solid system! Are all units based out of the hospital?



It's full system status management style deployment. All posts are physical locations you can go into. Cable, recliners, microwave, and usually an actual garage at most. Most are at fire or police stations. 

Central reporting point at the hospital downtown.


Sent from my iPhone using Tapatalk


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## WestMetroMedic (Dec 12, 2016)

TransportJockey said:


> I kinda wanna go there. Lol I bet I could deal with the snow and cold for that.
> 
> Sent from my SM-N920P using Tapatalk











Sent from my iPhone using Tapatalk


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## Scott33 (Dec 12, 2016)

WestMetroMedic said:


> Medical Protocols exist, but our medical directors firmly believe that if you can reasonably justify what you did, they will support you.



I like that idea. Medical oversight instead of medical _control_



> I am leaving at the end of this month to pursue an opportunity in the Community Paramedic world, but I am very sad to be leaving. I am very proud to have worn brown for the past nine years.



The community paramedic aspect of my job is probably one of the more satisfying things I do. You won't regret it.


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## WestMetroMedic (Dec 12, 2016)

The community paramedic aspect of my job is probably one of the more satisfying things I do. You won't regret it.[/QUOTE]

Yeah, I've been a community paramedic for 4 years now and love it. I actually had the opportunity to drive the pilot program here and also got some really cool projects started including basing in a homeless shelter to cut down 911 use and enhance primary care access. It's been an amazing time.


Sent from my iPhone using Tapatalk


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## DrParasite (Dec 12, 2016)

WestMetroMedic said:


> It's full system status management style deployment. All posts are physical locations you can go into. Cable, recliners, microwave, and usually an actual garage at most. Most are at fire or police stations.
> 
> Central reporting point at the hospital downtown.


So it isn't full system status management style deployment, it's more like system status management station deployment.  I don't mind being "posted" as long as we are posted in an actual building with proper amenities, and I understand that move ups will need to happen to ensure proper coverage.  

Posting in a street corner, that's a different topic, especially in extreme heat or cold.


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## WestMetroMedic (Dec 12, 2016)

DrParasite said:


> So it isn't full system status management style deployment, it's more like system status management station deployment.  I don't mind being "posted" as long as we are posted in an actual building with proper amenities, and I understand that move ups will need to happen to ensure proper coverage.
> 
> Posting in a street corner, that's a different topic, especially in extreme heat or cold.


sure *shrug*. SSM and its variations are a lot like Arby's sandwiches. Pretty much the same thing, just a different bun.


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## TransportJockey (Dec 12, 2016)

WestMetroMedic said:


> Sent from my iPhone using Tapatalk


That looks evil...  How is MN reciprocity? Lol 

Sent from my SM-N920P using Tapatalk


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## EpiEMS (Dec 12, 2016)

@WestMetroMedic Do you have 4x4 ambulances? Or do you find that snow tires and chains are sufficient?


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## WestMetroMedic (Dec 12, 2016)

TransportJockey said:


> That looks evil...  How is MN reciprocity? Lol
> 
> Sent from my SM-N920P using Tapatalk


Easy Cheesy. our EMSRB allows full national reciprocity, no charge for your credential. occasionally Lauren takes a couple days to get back to you, but otherwise it is easy.

@EpiEMS 
No 4x4 or chains. We do just fine.  He have grain transfer shovel and a coffee can full of salt and sand. Winter is a pain in the rear, but it isnt bad.


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## VentMonkey (Dec 12, 2016)

@WestMetroMedic I know you've touched on the pay scale in an earlier post, but is it DOE negotiable? 

What's turn around like with HCEMS? Thanks.


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## WestMetroMedic (Dec 12, 2016)

@VentMonkey 
wages are set in stone due to being union. shift diff for nights and weekends / FTO pay, student pay, etc.

like hospital times? 15-20 minutes to complete chart and clear.
typical 12 hour shift is 8ish transports, usually about 45 minutes start to finish.


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## NomadicMedic (Dec 12, 2016)

What's the pathway to become a community paramedic? Tuition reimbursement?

I just submitted an application.


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## VentMonkey (Dec 12, 2016)

DEmedic said:


> What's the pathway to become a community paramedic? Tuition reimbursement?
> 
> I just submitted an application.


Good luck, DE.


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## TransportJockey (Dec 12, 2016)

I have a basic friend asking how much basic pay is. 

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## WestMetroMedic (Dec 12, 2016)

TransportJockey said:


> I have a basic friend asking how much basic pay is.
> 
> Sent from my SM-N920P using Tapatalk



We run dual paramedic units as mandated by Hennepin county ordinance. We employ basics in our communication center and also we use them to staff special events at US Bank Stadium. we don't do and interfacility work, so no BLS units


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## WestMetroMedic (Dec 12, 2016)

DEmedic said:


> What's the pathway to become a community paramedic? Tuition reimbursement?
> 
> I just submitted an application.



In Minnesota, Community Paramedic is a recognized and required certification level. There are two programs in Minnesota.

Tuition reimbursement is$3500/year.


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## VentMonkey (Dec 12, 2016)

WestMetroMedic said:


> like hospital times? 15-20 minutes to complete chart and clear.



[QUOTE="VentMonkey, post: 629696, member: 30261"][USER=16634]@WestMetroMedic What's turn *over* like with HCEMS? Thanks.[/QUOTE]
Sorry wrong word, my mistake.[/user]


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## TransportJockey (Dec 12, 2016)

Does Hennepin have any special teams? Just curious  I'm rtempted


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## MassEMT2012 (Dec 12, 2016)

Im biased but Boston EMS is one of the best in the country, and great pay....starting EMT-Bs at $26/hr from what I've heard.  But they are very competitive and hard to get into


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## EpiEMS (Dec 12, 2016)

MassEMT2012 said:


> starting EMT-Bs at $26/hr from what I've heard


Any idea if they pay for medic school?


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## DPM (Dec 12, 2016)

MassEMT2012 said:


> Im biased but Boston EMS is one of the best in the country, and great pay....starting EMT-Bs at $26/hr from what I've heard.  But they are very competitive and hard to get into



I'm interested to hear what it is about Boston that you like so much, If you don't mind.


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## TransportJockey (Dec 12, 2016)

EpiEMS said:


> Any idea if they pay for medic school?


Why would they? They have a ton of medics working as basics until one of their few ALS spots comes open. 

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## VentMonkey (Dec 12, 2016)

MassEMT2012 said:


> TransportJockey said:
> 
> 
> > Why would they? They have a ton of medics working as basics until one of their few ALS spots comes open.
> ...


That was the impression I was under as well. I don't know a whole lot about BEMS, but from the wonderful job producers did on that show they had a year or two ago, it didn't seem like it would be a good fit for me, nor I for it; cool looking city though, and I still like that accent.


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## EpiEMS (Dec 12, 2016)

TransportJockey said:


> Why would they? They have a ton of medics working as basics until one of their few ALS spots comes open.



Ah, I forgot about that! Whoops!



VentMonkey said:


> That was the impression I was under as well. I don't know a whole lot about BEMS, but from the wonderful job producers did on that show they had a year or two ago, it didn't seem like it would be a good fit for me, nor I for it; cool looking city though, and I still like that accent.



The city is pretty cool, but I really can't stand the layout, it makes no sense! Also, their trucks, they are way too big for that city, though it looks like they're downsizing to Type I units?


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## Handsome Robb (Dec 12, 2016)

DPM said:


> I'm interested to hear what it is about Boston that you like so much, If you don't mind.



They have a TV show...duh! 


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## WestMetroMedic (Dec 12, 2016)

TransportJockey said:


> Does Hennepin have any special teams? Just curious  I'm rtempted


We have three medics attached to the Minnesota US&R Task Force 1 (not a FEMA team), of which I am one. No tactical medicine stuff, but we do have a volunteer CSO/Paramedic program with one of the rural sheriff's offices that our medical director is a part time and fully licensed deputy. MN DMAT-1 has a number of HEMS folks, but isnt affiliated. 
We also have line staff involved in technology, quality assurance, media production, and i am unsure what special stuff will pop up when Minneapolis hosts the 2017-2018 season Super Bowl. When we had the Republican National Convention in 2008, we had a number of special details built.

@VentMonkey 
The turnover is a bit complex.  I started 9 years ago and was #110 out of 112 total medics. Now I am #53 out of 163. We have four 30+ year retirements over the next month. Bit of the old guard leaving, but we also have turnover (not unlike everyone else) among the bottom 1/4th. People leave for Fire, Cop, and RN gigs usually, but people certainly stick around too.


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## MassEMT2012 (Dec 13, 2016)

EpiEMS said:


> Any idea if they pay for medic school?



No Idea, I do know from the info on their website that they do not directly hire paramedics.  Boston EMS only hires EMTs, and then they promote EMTs with Paramedic certification to paramedic once they have enough experience and positions within the department open up.  So Boston EMS does have some EMTs who are actually licensed Paramedics that are just practicing at the BLS level until an ALS spot opens up for them.


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## VentMonkey (Dec 13, 2016)

MassEMT2012 said:


> No Idea, I do know from the info on their website that they do not directly hire paramedics.  Boston EMS only hires EMTs, and then they promote EMTs with Paramedic certification to paramedic once they have enough experience and positions within the department open up. * So Boston EMS does have some EMTs who are actually licensed Paramedics* that are just practicing at the BLS level until an ALS spot opens up for them.


TMK, that is the majority of their EMT's that they hire, who await the oh so coveted ALS promotion. I'm sure @Tigger or another former, or current Bostonian could enlighten us though.


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## MassEMT2012 (Dec 13, 2016)

DPM said:


> I'm interested to hear what it is about Boston that you like so much, If you don't mind.



Really because I am from the Boston area and am a die hard Masshole.  I just love my homes culture and attitude, as well as the fact that we have some of the most advanced and widespread of trauma centers and hospitals in the country, if not the world.  I know people come from all over the world to see certain doctors in Boston, so its kinda cool feeling like you're a small part of that large machine that is Boston healthcare. Boston EMS itself has a 6 month academy you have to pass once you are hired before you actually come off probation and get your badge. (Yes they have badges because they are technically a government organization, not a private company.)  So the ****ing academy for BEMS is longer than the entire training course to even get the EMT license in the first place!!!!!!!!!!!!!!! That is because of the crazy amount of extra training they give both about EMS skills/knowledge, as well as info related specifically to Boston and managing any disaster that may happen (I.e Boston Marathon Bombing in 2013, which had an excellent response from city officials and helped saved a lot of lives.)

Bottom line: Patriots, Bruins, Red Sox, the culture, revolutionary/colonial history, best healthcare (MassGeneral, Brigham and Womens, Beth Israel, Childrens, Boston EMS, and education (Harvard, MIT, BU, BC, Tufts, etc.)

WHATS NOT TO LOVE BABY?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!? #BostonStrong

(Only downside is the fact that we are in the middle of the largest heroin/opiate epidemic in out nations history, you drive around outside some of the Boston hospitals in the south end area and see people nodding off and OD'ing in broad daylight which ****ing sucks =( ****, we have alot of sick people who need alot of help and compassion and care and a second chance.) #BostonStrong


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## TransportJockey (Dec 13, 2016)

Just saying, just cause you're a govt agency doesn't mean you HAVE to have badges. Most of our municipal and county agencies around here (mine included) do not issue badges. Some of the big ones (WilCo, ATcEMS) do, though.


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## Ensihoitaja (Dec 13, 2016)

TransportJockey said:


> Just saying, just cause you're a govt agency doesn't mean you HAVE to have badges. Most of our municipal and county agencies around here (mine included) do not issue badges. Some of the big ones (WilCo, ATcEMS) do, though.



We have badge numbers but not actual badges.


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## cruiseforever (Dec 13, 2016)

I would encourage people that would look at Hennepin to also look at AllinaHealth Emergency Medical Services.   It's a progressive service that is always looking at ways to improve it's self and the services they provide.


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## VentMonkey (Dec 13, 2016)

"Bajesss, we don't need no estinkin' bajesss..."


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## Handsome Robb (Dec 13, 2016)

TransportJockey said:


> Just saying, just cause you're a govt agency doesn't mean you HAVE to have badges. Most of our municipal and county agencies around here (mine included) do not issue badges. Some of the big ones (WilCo, ATcEMS) do, though.



Badges are new for us in the last few years and there's more than a handful that aren't happy about it. I'm indifferent about it but when I wear my jacket I get mistaken for a cop constantly.

We have metal badges for our dress uniforms and some wear them on regular duty but most have sewn on ones. 

Each promotion you get a new badge with your title. SMO/LT and above are good instead of silver. At 5 years you're given a metal badge with your badge number on it that you get to keep even if you promote, if it's before your 5 years a promote you have to return your old badge. Every promotion puts stuff on your collar as well. 


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## VentMonkey (Dec 13, 2016)

Wilco's patches are pretty spiffy, not sure if the badges are the same or similar. 

@WestMetroMedic you've definitely piqued my interest regarding HCEMS. If or when I am ready to return to the ground you've helped bump HCEMS higher up on my list.


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## hometownmedic5 (Dec 13, 2016)

Since the advent of EMS, we collectively have been hunting for the "perfect system". To date, no such animal has been located. For sure there are systems where people can be happy, but every system has flaws and they must be taken into account. 

Take for example Boston EMS, much discussed on this thread. Most of the information here is actually quite accurate, but one detail(a detail that is extremely crucial) has not been given just attention. In a word, residency. 

In a lot more words, you must attain residency within city limits within six months of your date of hire, and maintain it for ten years. There are absolutely people who do not, but do you want your city job to be twisting in the wind because you decided to try to scam the system?

Once you factor in cost of living, the money isn't very attractive. Sure, it's BLS 911 in big flashy trucks in the big bad city, but you're not going to get rich doing the job. People frequently scope lock on the 25 bucks an hour(or whatever badged pay is these days) and overlook what it's going to cost you to live in a neighborhood where you don't need a handgun and body armor. 

BEMS isn't a bad place to work, but it isn't Mecca. I flirted with the idea when I was a basic, but after careful analysis decided the juice wasn't worth the squeeze. To each their own


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## VentMonkey (Dec 13, 2016)

hometownmedic5 said:


> Since the advent of EMS, we collectively have been hunting for the "perfect system". To date, no such animal has been located. For sure there are systems where people can be happy, but every system has flaws and they must be taken into account.
> 
> Take for example Boston EMS, much discussed on this thread. Most of the information here is actually quite accurate, but one detail(a detail that is extremely crucial) has not been given just attention. In a word, residency.
> 
> ...


Good first post, welcome to the forum.


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## hometownmedic5 (Dec 13, 2016)

VentMonkey said:


> Good first post, welcome to the forum.



Thanks. The place looked interesting from the highway.


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## NomadicMedic (Dec 13, 2016)

cruiseforever said:


> I would encourage people that would look at Hennepin to also look at AllinaHealth Emergency Medical Services.   It's a progressive service that is always looking at ways to improve it's self and the services they provide.



Does Alina and North Memorial do 911 as well? Is the pay structure and benefit package similar?


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## PotatoMedic (Dec 13, 2016)

hometownmedic5 said:


> Thanks. The place looked interesting from the highway.


Just keep driving.


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## medichopeful (Dec 13, 2016)

MassEMT2012 said:


> WHATS NOT TO LOVE BABY?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!? #BostonStrong



Driving around in the city is something I don't love! 

I love Boston too, and still love visiting it.  But good lord is it a horrible city to drive in or navigate


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## VentMonkey (Dec 13, 2016)

medichopeful said:


> Driving around in the city is something I don't love!
> 
> I love Boston too, and still love visiting it.  But good lord is it a horrible city to drive in or navigate


I picture cobblestone streets and oystee bars galore. Am I an ignorant west coast sonofagun or what? Oh, and I thought it was pronounced "Baaa-stin"??


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## medichopeful (Dec 13, 2016)

VentMonkey said:


> I picture cobblestone streets and oystee bars galore. Am I an ignorant west coast sonofagun or what? Oh, and I thought it was pronounced "Baaa-stin"??



Nah that's actually a pretty accurate description of some areas! 

It's funny, I grew up about 30 minutes from the city, and I still don't know the "correct" pronunciation!


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## WestMetroMedic (Dec 14, 2016)

DEmedic said:


> Does Alina and North Memorial do 911 as well? Is the pay structure and benefit package similar?



Yeah, pay scales are very similar. Hennepin and Allina health are union. North and Allina health have a great dichotomy of urban and rural even in their metro service area. All three have great equipment and vehicles. Hennepin has the police and fire pension which is probably the biggest difference.

That being said, my departure from Hennepin at the end of the month is for North Memorial. 

And for the badge conversation, Hennepin wears badges. Probie shield for 6 months and then you are issued your permanent shield. 


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## Tigger (Dec 14, 2016)

MassEMT2012 said:


> No Idea, I do know from the info on their website that they do not directly hire paramedics.  Boston EMS only hires EMTs, and then they promote EMTs with Paramedic certification to paramedic once they have enough experience and positions within the department open up.  So Boston EMS does have some EMTs who are actually licensed Paramedics that are just practicing at the BLS level until an ALS spot opens up for them.





TransportJockey said:


> Why would they? They have a ton of medics working as basics until one of their few ALS spots comes open.





VentMonkey said:


> TMK, that is the majority of their EMT's that they hire, who await the oh so coveted ALS promotion. I'm sure @Tigger or another former, or current Bostonian could enlighten us though.


While there certainly some paramedics working as EMTs for BEMS, most of the EMTs are just EMTs (or at least that's how it was when I lived there). They do a paramedic class when they have openings, though I am not sure if you have to go back through if you already are a medic. There are only six (I think) double medic ALS ambulances during the day plus some medic staff, so promotions are pretty rare.



MassEMT2012 said:


> Boston EMS itself has a 6 month academy you have to pass once you are hired before you actually come off probation and get your badge. (Yes they have badges because they are technically a government organization, not a private company.)  So the ****ing academy for BEMS is longer than the entire training course to even get the EMT license in the first place!!!!!!!!!!!!!!! That is because of the crazy amount of extra training they give both about EMS skills/knowledge, as well as info related specifically to Boston and managing any disaster that may happen (I.e Boston Marathon Bombing in 2013, which had an excellent response from city officials and helped saved a lot of lives.)


While I am happy that Boston EMS actually puts there new people through a well thought out academy and field training process, they are still primarily serving the city of Boston with EMTs. Now with hospitals in such close proximity, that's maybe ok, but let's be clear, they are are still EMTs. 3 month academy aside, their skill set is still that of an EMT with some added assessment knowledge. Also, they strive to be an all hazards organization, so a lot of the academy time goes towards that as well.


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## EpiEMS (Dec 14, 2016)

Tigger said:


> their skill set is still that of an EMT with some added assessment knowledge



I'd wager for most urban calls, national EMT scope plus Mass protocols permitted skills (see pg. 176 of the protocols) like an albuterol breathing treatment would be more than sufficient. Yes, I said it, EMT scope is "sufficient" for something .


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## DrParasite (Dec 14, 2016)

Tigger said:


> Also, they strive to be an all hazards organization, so a lot of the academy time goes towards that as well.


What do yo mean, all hazards organization?  What do they prepare for that other urban ems systems don't?


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## Tigger (Dec 14, 2016)

DrParasite said:


> What do yo mean, all hazards organization?  What do they prepare for that other urban ems systems don't?


Probably nothing different really. But they do give all their new members hazmat ops, some basic rescue stuff, basic "tactical EMS" things, things like that. Nothing exciting, but all their new people go through it, not just team people.


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## hometownmedic5 (Dec 15, 2016)

EpiEMS said:


> I'd wager for most urban calls, national EMT scope plus Mass protocols permitted skills (see pg. 176 of the protocols) like an albuterol breathing treatment would be more than sufficient. Yes, I said it, EMT scope is "sufficient" for something .



What makes the primary BLS model work so well in Boston isn't the training the BEMSs guys receive, its the scoop and screw short transport times to the world class hospital conveniently located on every corner. If you couldn't be at a harvard or tufts affiliate in 3 minutes, you'd probably see a much higher medic : emt ratio. 

Again, not dogging BEMS at all, but they aren't super EMTs or anything. They do the same job as every other 911 EMT in the state. Absolutely they receive much more training than your average IFT basic. On the other hand, the training they get is specialty stuff, not BLS medicine.


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## EpiEMS (Dec 15, 2016)

hometownmedic5 said:


> What makes the primary BLS model work so well in Boston isn't the training the BEMSs guys receive, its the scoop and screw short transport times to the world class hospital conveniently located on every corner.



I don't disagree at all, this helps, but even in an urban area without world class hospitals nearby, just your run of the mill Level II or Level III trauma center less than 5 minutes away, say, BLS measures are more than enough for most calls.


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## hometownmedic5 (Dec 15, 2016)

Very true, but how far do you want to carry it? For the majority of the calls I respond to, any one of the cars I have to maneuver past in the driveway are sufficient...


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## VentMonkey (Dec 15, 2016)

So I just watched a "seasoned medic" on that BEMS show ask their tech to "grab a curb" so that their paramedic partners could get an IV on a (presumably) hypotensive patient while transporting "hot" to a "world class" hospital.

I get showbiz editing and what not, but the quote that came out of the paramedics mouth being something to the effect of "that's what this job is, getting IV's and not losing them" made me cringe and look over at my wife. Lol, my poor wife she knows all too well whaf will come out of my mouth with these shows, but they're like the tabloids for folks like me. 

#Bostonwrong?


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## PotatoMedic (Dec 15, 2016)

Wrong thread


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## DrParasite (Dec 16, 2016)

VentMonkey said:


> So I just watched a "seasoned medic" on that BEMS show ask their tech to "grab a curb" so that their paramedic partners could get an IV on a (presumably) hypotensive patient while transporting "hot" to a "world class" hospital.


Sadly, I know of too many EMS agencies that have their ALS patients transported "hot" as a matter of routine practice, who wait until they get the IV to leave the scene (even if in the back of the ambulance), as well as several providers who think if they don't get the IV in the field, they have failed their patient, especially when the ER complains about the lack of IV access.


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## NomadicMedic (Dec 16, 2016)

DrParasite said:


> Sadly, I know of too many EMS agencies that have their ALS patients transported "hot" as a matter of routine practice, who wait until they get the IV to leave the scene (even if in the back of the ambulance), as well as several providers who think if they don't get the IV in the field, they have failed their patient, especially when the ER complains about the lack of IV access.



I work at one. I always get the quizzicality tilted head when I tell the driver to turn the lights and sirens off and drive with the flow of traffic. 

And aside from working an arrest on scene, getting a 12 lead in the house or fixing immediate issues, I'll do my interventions in the truck please. While we're driving. At a NORMAL rate of speed.


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## NomadicMedic (Dec 16, 2016)

VentMonkey said:


> So I just watched a "seasoned medic" on that BEMS show ask their tech to "grab a curb" so that their paramedic partners could get an IV on a (presumably) hypotensive patient while transporting "hot" to a "world class" hospital.
> 
> I get showbiz editing and what not, but the quote that came out of the paramedics mouth being something to the effect of "that's what this job is, getting IV's and not losing them" made me cringe and look over at my wife. Lol, my poor wife she knows all too well whaf will come out of my mouth with these shows, but they're like the tabloids for folks like me.
> 
> #Bostonwrong?



Is this as bad as the guy on nightwatch cardioverting a septic patient? Or any of the other cringeworthy things that happen on that show? (If a person on my truck ever put the end of a IV cath or needle cap in their mouth to pull it off with their teeth, I'd come unglued.)


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## RocketMedic (Dec 16, 2016)

DEmedic said:


> Is this as bad as the guy on nightwatch cardioverting a septic patient? Or any of the other cringeworthy things that happen on that show? (If a person on my truck ever put the end of a IV cath or needle cap in their mouth to pull it off with their teeth, I'd come unglued.)


#Nightwatch


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## VentMonkey (Dec 16, 2016)

DEmedic said:


> Is this as bad as the guy on nightwatch cardioverting a septic patient? Or any of the other cringeworthy things that happen on that show?





RocketMedic said:


> #Nightwatch


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## DrParasite (Dec 16, 2016)

DEmedic said:


> (If a person on my truck ever put the end of a IV cath or needle cap in their mouth to pull it off with their teeth, I'd come unglued.)


you mean there is a better way to remove the needle cap?  Does it look as cool?  I have been doing it wrong all these years!!!!


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## VentMonkey (Dec 16, 2016)

Are you're telling me that night shift supervisors at NOLA EMS _don't_ just jump every "rad" call and "drop lines" in patients hands and leave?

Clearly, BEMS and NOLA are the best systems there are, hands down, bar none, coolest medicine ever.


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## NomadicMedic (Dec 16, 2016)

It's just like anything else. It's a TV show. Creative editing can make even the most boring call look good. Lots of jump cuts of trucks flashing lights and profile shots of strong jawed paramedics.  Add in some random radio chatter, concerned bystanders, an NRB and Motorola squawks and all of a sudden even an IFT can look like an MCI


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## WestMetroMedic (Dec 16, 2016)

DrParasite said:


> you mean there is a better way to remove the needle cap?  Does it look as cool?  I have been doing it wrong all these years!!!!



I like to think of my hot breath as a final autoclave cycle.


Sent from my iPhone using Tapatalk


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## VentMonkey (Dec 16, 2016)

DEmedic said:


> It's just like anything else. It's a TV show. Creative editing can make even the most boring call look good. Lots of jump cuts of trucks flashing lights and profile shots of strong jawed paramedics.  Add in some random radio chatter, concerned bystanders, an NRB and Motorola squawks and all of a sudden even an IFT can look like an MCI


Agreed, but I still can't help but wonder how much of what they say is ad-libbed, scripted, or just the cheesiest "Reaper Racing" crews that they have.

I guess it's quite possible it's a combination of all of the above mentioned. Every service has these types, which is exactly what pulls in ratings. So, yaaay, keep encouraging the people who mimic this behavior learned on TV to continue to act as such because, well, TV never lies, and is never wrong. I mean come on people look how real, and down-to-earth the Kartrashians are??

I have noticed an increase in even the crews at my service going "code" to the local hospitals from the time I started until now. It's questionable as I am not the one running the calls, but when you chop, cut, and edit every call to be an emergent ride to the ED whilst you smile, laugh, and joke with your patient all the way there this sure encourages these actions, and all but obliterates the need to use clinical insight, judgement, or crtical thinking as tools to decide mode of transport. After all, what does it matter what we're taught in school? Clearly, every other profession was taken seriously based solely on how high they scored on the "coolness factor" meter.

I know it's often discussed on here, but I have never gotten the chance to voice my opinion so please bear with me. I did look over to my wife mid-show and told her how sad it makes me that even in this day and age with all the pissing and moaning about us being a profession this is what is continually shown to be "what we do". The folks on the show, the producers themselves, and everyone involved really does nothing to show the intelligent side of some of the better clinicians I've learned from both on this forum, and over the length of my career. 

When you have one of these "cool racer reaping medics" on 'Nightwatch' bellow how the first thing that comes to mind with a 30 year old anxious patient (in spite of them being pale, cool, diaphoretic, tachycardic, and not grabbing a room air while the patient was in the position found) is a panic attack, you're going to leave the wrong impression to many newer folks. And let's not forget the layperson who now compares them to us.

Will I still watch these shows? Probably, it's still very much like a bad car wreck, hard not to look...even harder not to critique.

Thanks all for letting me share my zero-two...


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## cruiseforever (Dec 16, 2016)

DEmedic said:


> Does Alina and North Memorial do 911 as well? Is the pay structure and benefit package similar?



At Allina medics start at 20.67 and max out in 12 years at 32.84.  EMTs start at 15.16 and max out at 25.85 in 12 years. We do 911 and cover around 100 communities  with a population around 1 million.  The cities range from the inner core suburbs to rural community approx. 50-75 miles from the metro area.   Allina also has CCT and BLS ambulances.  With an increase in pay for the CCT.

There are 3 metro central bases, most covering is done from fixed bases with an occasional street corner.  There a 4 rural bases.  If you decide to work the rural bases you will be required to do some call time besides your regular shift.  All 911 ambulances can be used to do BLS and IFTs when needed. I enjoy doing the different types of runs. We also contract with a local fire department and provide medics to staff their ambulance. 

The ambulances are staffed medic/medic or medic/emt depending on the area they cover.  It usually takes a newer person a year or two to figure out what area they want to work in.  Shifts can be 8, 12, 13, 16 hours in length.


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## StCEMT (Dec 17, 2016)

VentMonkey said:


> Clearly, BEMS and NOLA are the best systems there are, hands down, bar none, coolest medicine ever.


While as low on the totem pole as it gets for things about a place of employment, I am a bit (very) jealous they can rock the beards. Medic school was a sad sad time without one.


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## VentMonkey (Dec 17, 2016)

StCEMT said:


> I am a bit (very) jealous they can rock the beards. Medic school was a sad sad time without one.


So can Denver (EMS) General/ Health. IMHO, a much more respectable service based solely on what I have seen from a cultural standpoint.

That's also not to say there are not solid providers at the other two services.


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## StCEMT (Dec 17, 2016)

VentMonkey said:


> So can Denver (EMS) General/ Health. IMHO, a much more respectable service based solely on what I have seen from a cultural standpoint.
> 
> That's also not to say there are not solid providers at the other two services.


Denver sounds like a cool place to work. Got a friend out in CO, beautiful state. I think I could do just fine in a place like that.


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## DrParasite (Dec 18, 2016)

While it might be a cool place to work, i do hear that is very expensive, and not always feasible on a paramedic's salary


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## CALEMT (Dec 19, 2016)

StCEMT said:


> Denver sounds like a cool place to work. Got a friend out in CO, beautiful state. I think I could do just fine in a place like that.



To bad its the next CA... just sayin'...


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## StCEMT (Dec 19, 2016)

CALEMT said:


> To bad its the next CA... just sayin'...


Eh that's true. I mean I am all for people rolling a blunt if that makes them happy, but there are a few other things I don't mix well with come to think of it. Maybe Montana instead...


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## nwhitney (Dec 19, 2016)

I work in a busy urban system in Portland, OT. I think a new medic starts at 51k. Benefits are good too. Our protocols are fairly liberal and progressive. Feel free to PM for additional info.


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## aquabear (Dec 19, 2016)

Williamson County EMS. In terms of progressive scope and evidence based medicine, it doesn't get much better. Great pay and retirement doesn't hurt either.


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## EpiEMS (Dec 19, 2016)

aquabear said:


> Williamson County EMS. In terms of progressive scope and evidence based medicine, it doesn't get much better. Great pay and retirement doesn't hurt either.


Looks like a great system - management seems good. How do you like them?


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## aquabear (Dec 19, 2016)

EpiEMS said:


> Looks like a great system - management seems good. How do you like them?


There's no such thing as a perfect system, but there are certainly more positives than negatives at Wilco. In terms of patient care, our medical director likes to be as close to the cutting edge as possible. We are given a large scope of care, but in return a high degree of competency is expected. We have quarterly training and every year our SOCs are updated to keep up with the latest medicine. 

Operations wise, I can't complain. I wish we had union representation (I came from a union shop EMS system), but since Texas is a "right to work" state, it probably won't ever happen. If you want any more info, shoot me a DM.


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## Tigger (Dec 21, 2016)

DrParasite said:


> While it might be a cool place to work, i do hear that is very expensive, and not always feasible on a paramedic's salary


Certainly getting more expensive, but DGs wages are doing a decent job keeping pace I think...

@Ensihoitaja


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## Ensihoitaja (Dec 21, 2016)

I think Denver Health has done a good job of keeping up pay-wise.

Job/salary info is here https://careers.peopleclick.com/car...getJobDetail&jobPostId=26205&localeCode=en-us

Starting pay is about $47,000 a year ($22.58/hour not including any shift differentials), and the only people who get that are people starting fresh out of paramedic school. We get evening shift differential of $2.42/hour and night shift of $4.65/hour. Max pay is a little above $72,000 (note that it's higher than the max starting salary).

Cost of living wise- from this 2015 study (PDF) http://nlihc.org/sites/default/files/oor/OOR_2015_FULL.pdf- at bare minimum starting you'd be above the hourly income needed to rent a 2-bedroom apartment.


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## TheBuffOP (Dec 21, 2016)

Houston has a lot of companies to work for. Texas has a low living cost. If you have your paramedic, then you can try to work for Harris County Emergency Corps, Cypress Creek EMS (EMT-B, AMET, and Paramedic), and MCHD. All of those companies are emergency only calls.


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## TransportJockey (Dec 22, 2016)

TheBuffOP said:


> Houston has a lot of companies to work for. Texas has a low living cost. If you have your paramedic, then you can try to work for Harris County Emergency Corps, Cypress Creek EMS (EMT-B, AMET, and Paramedic), and MCHD. All of those companies are emergency only calls.


One county South also has some ok options.  City of League City EMS, Galveston County EMS, ****inson EMS are decent systems. Ft Bend County EMS is a good system too. 

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