Cypress Creek (Houston) is Hiring

[RocketMedic]

If I recall correctly, we start brand-new Paramedic I's at something like $17.85 an hour, plus 100% health for you and 90% for your whole family. On a 24/72 (42-hour week, 3 48-hour weeks and a 24), you're looking at something like $47k a year, before OT. Rent around here for nice places is around $800-1200/month in the metro. There's a lot to do, and we have every culture on Earth here. There is a lot of variety and anything is in easy commuting range. Lots of traffic here and in Austin.

Clinically, Creek is pretty aggressive- certainly moreso than ATCEMS!

Field blood

 

[RocketMedic]

Transfusions, rsi (albeit with supervisors present), all-911, ketamine, good equipment and stuff, and a very busy area with something like 700k people in 188 square miles. Plus you can be a paramedic from the start here (we do have a tiered system, but some folks come in at a P2 rate. I was a P1 for about an hour before I promoted.)

Average call volume is 10-15 for a 24 hour shift. We've got everything from mansions to homeless camps.

Also, we are starting a community paramedicine program, have a separate tactical medic thing, and run our own EMT and Pmed courses.

 

[RocketMedic]

Now, on to the important questions:

1) Yes, we take new medics. All three take new medics, without experience; Creek takes new Basics without experience as well. This is because we want to teach you the Creek Way, we need people, and there's nothing really special about experience from somewhere else that you have to have to get hired. Experience is a double-edged sword and if you look like you know what you're doing it helps, but if you try and bluff your experience into success everywhere, experience will actually become an impediment (hence the ALS academy, which I think of as "putting all the Legos together the way on the box"). With that being said, for a new medic, I think Creek is the easiest of the three to get hired onto, especially if you are excited about getting to learn and develop as a professional medic.

2) Hiring process is pretty simple: apply, an electronic test with a minimum score to proceed, a personality assessment, practical scenarios, and a panel interview. Takes a day or so at Creek; reckon it's similar everywhere else. It's not like a week-long ordeal like some departments.

3) Working in Texas: This is the big one, so it gets its own reply below.

Working EMS in Texas is wildly dependent upon where you're doing it. This is because we have a very loose state regulatory body (Texas DSHS) that essentially dictates who can provide services, what is required to provide services, and acts to remove persons/groups who cannot provide services for whatever reason from practice. That's it. There is no state scope of practice, no state EMSA or medical control, and no state-level force to say 'no'. Additionally, Texas allows physician medical directors to direct, either on-line or via standing orders/protocols, paramedics to do anything, with requirements and restrictions as they see prudent and necessary. This means that medical directors don't have to clear protocols with county or state bureaucracies. We do have state-level coordination, resource-allocation and training bodies (the Regional Advisory Councils) and state-level disaster-response teams, but as far as medical direction and operations go, it's defined by your medical director and your organization. Texas is a huge state, with a large population and six distinct climates, so we get some really wild variability. In West Texas, medicine ranges from primitive "some dudes in a van might show up" to screamingly-advanced "let's get the brainwave scanner to monitor how sedated they are" depending on where you are (@TransportJockey, @Wes, @TXmed). In other parts of the state, you might find generic EMS, lesser-care-than-average, or screamingly-advanced "let's transfuse blood into you" EMS, sometimes separated by a single alley (the difference between HFD's BLS-heavy approach and Creek). There's no California-style uniformity, nor do we have to ask permission or call elaborate reports for every patient (depending on where you work).

The Houston area is pretty wild, because there are so many high-functioning departments in a relatively compact area and everyone learns and cribs from one another. HFD is handicapped by size, budget and lack of motivation, but the standalone EMS services that serve most of the metro mostly display an unusual interest in progression beyond the standard. Part of it's competitive spirit, part of it is a desire to innovate, and part of it is a desire to do better than the minimum necessary, and I like that most of all. When I go to work, I can expect that someone is looking at what I do and trying both to make it better and to determine what could be done better, on a systematic level. We didn't settle for "they're pretty screwed" for people who needed blood- we did the work to put blood in the field. Is it the most-right answer? I don't know yet, but at least we're asking. To me, that makes it a better place to work than a lot of other places and states, where the questions aren't asked or where change is too hard. Additionally, I really like the area because Texan medicine and Houston in particular seems to be willing to swing for the fences in a way that I reckon a lot of the USA isn't. When field ECMO works itself into the USA, I reckon it'll roll out in the Houston metro long before it hits the streets of Bakersfield, CA (for example). I reckon that working Houston EMS is a lot like working tech in Silicon Valley- the innovation happens here a little more than elsewhere.

Additionally, if you're interested in experience, it'll come fast here. We're a pretty high-performance operation, and I'd put our people right up with MedStar, ATCEMS, EMSA, etc in terms of numbers of patient contacts, etc. I think we'll run something like 60k EMS calls this year?

 

[RocketMedic]

Cypress Creek, Cy-Fair VFD, Northwest EMS (Tomball), Harris County ESD-48 and HCEC are cut from the same cloth- both are fairly high-functioning, 911-only organizations. They are operated as 501c(3) nonprofit corporations, so there's not the overarching drive to profit; although both operations are cost-conscious. Structurally, this means that the organization 'exists' in essentially the same market space as any other non-municipal service provider, but Texas has what it calls Emergency Services Districts, which are special taxing entities that levy sales and/or property taxes to support emergency services within specific areas. Cypress Creek serves "ESD-11", the area defined on our website; Tomball is ESD-8, Cy-Fair is ESD-9, HCEC is ESD-1, etc. Basically, instead of supporting the money-losing business of 911 with transfers, we're supported by tax dollars from the ESD that contracts us and what we recover in billing. The ESD effectively replicates a city government, or augments it (in the case of Tomball).

This means that we get treated a lot better than private ambulance workers, and are generally roughly equivalent to county and Fire in terms of pay and benefits. A common thread between most of the Houston area's 911 EMS is that we're making better money than most of the nation for about the same work, and with some exceptions, all we do is 911. For example, I'll make around $58k gross this year with minimal overtime (even counting Harvey), which is low-average for area medics. Pay in this area tends to run in the very high teens to low twenties per hour, with generous benefits packages. Creek pays 100% of our health insurance premium and 90% of our entire family, Cy-Fair and HCEC are similar with high-but-not-as-high percentages for family but more bonus opportunities and Kelly schedules as opposed to Creek's 24/72. For Creek, I think we start our brand-new "P-1" new medics at like $17.85, but I hired on at a P2 rate and rocketed through the orientation and credentialing process. Currently, I'm at $22.15 an hour, which isn't terrible at all (one year as a P2). It makes it really hard to move anywhere else. Part of that is regional cost of living, part of it is being a non-profit, and part of it is because our admin really does try and do the right thing by us all. It's not the kind of place you see management rolling around in Maseratis off of the fruits of your labor.

Operationally, since all we do is 911, you'll have to get that mindset (no call is BS, everything is someone's emergency, etc). All of the agencies in this area are pretty progressive and focused on patient experience and outcome. Everyone has a slightly different approach. Creek runs P2/B, P2/P1 or P2/AEMT on trucks; P1s can run ALS calls but all trucks have a P2 aboard who is trusted to 'run' the truck. However, we can triage calls to our partner (B, AEMT or P1) based on the specific call and complaint, and this allows everyone to get good experience. P1s are fully credentialed paramedics and are able to do everything in our scope of practice as allowed by protocol, but they're also developmental levels so it is the discretion of the P2 as to what they should or shouldn't take. The P1 is intended for new medics to gain familiarity with the role and isn't a punishment- I rather like the way it's implemented here and plan on replicating it when I eventually run somewhere. HCEC is mostly P/P, as is MCHD and Cy-Fair (although Cy-fair does have a considerable number of EMTs as well). The credentialing process at Creek is as follows: NEOP + driver's training (concurrent), then "Basic-in-charge" for everyone, and ALS academy (2 weeks of really, really good training on the Creek Way, totally worth it), then you test for P1. Depending on management's opinion of your abilities, you might find yourself at P1 for a while to develop or be ushered straight through to P2. I think that's totally fair, because P1 isn't treated as a penalty, it's a developmental post. I was a BIC for like a day and a P1 for a few days I think? The levels aren't as stratified as some other organizations and the timelines at Creek are flexible. Clearance is a test, scenario/talk with the medical director, and a review of your perceived abilities. To their credit, Education also proactively works to develop you, and there's a lot of opportunities to do that (EMT/Paramedic classes, classes in general, community relations, etc). We're also starting a community medic program and have the tactical medics, so those departments exist too. Communications is its own separate world where medical training isn't strictly necessary, of that I know little. Cy-fair has a similarly flexible NEOP and clearing process. HCEC and MCHD are lengthier, drawn-out, with more testing, scenarios, more reviews, etc. I've heard the minimum is six months at either to fully clear as an attendant, and for most new medics, you're probably at least a year in training to in-charge status. All three agencies have a 'tiered' medic system with what we call "P3" or critical-care or supervisor or whatnot as well. At Creek, supervisors carry blood products, vents and some really rarely-used items on their trucks and they (or a P3) has to be physically present for RSI to be attempted, although who does what is up to the P3 and the crew. Other places have slightly different takes on it, but I think it's the same at HCEC (I know they have to ask for ketamine, we can give it autonomously). I initially chafed at this, but it's nowhere near as obtrusive or irritating as I thought it would be, and I think it does improve patient safety and workflow to have an extra highly-trained medic on-scene on something complex.

MCHD and HCEC both have pumps and vents on every truck, and they're actively fielding Powerloads. We'll start eventually. Our vents come with supervisors, so it's not like we don't have them- we just don't use them enough to justify buying one for everyone. We use X-series Zolls, LUCAS, etc. That's pretty common across the fleets, although HCEC uses mRX and Cy-Fair uses LP-15. Everyone up here has video laryngyscopes, EZ-IO, RSI, etc. It's probably the best-equipped EMS region in the nation.

Schedule-wise, we run a core 24/72 (oxxxoxxxoxxx) out of thirteen stations, and we're very busy. Stand-up 24s or nearly-sleepless nights are common and we do pull trucks from slower stations to post in the Vortex frequently. Honestly, I'm not a fan of the 24-hour schedule, but that's a different argument, so I work the "peak truck", which is exactly what it sounds like- we cover peak hours and try to intercept calls for the 24-hour trucks. We work a 12-hour shift, and they're trying to add more peak trucks to the schedule- currently, we've got one near-permanent (mine) and one staffed on weekends (sometimes). Peak trucks don't have a station, we post at hotspots and run calls all day. There is flexibility within the schedule and our scheduler is awesome- for example, I am pursuing a Master's degree and it is far easier with her help and my opposite's cooperation. The peak truck's base schedule is a 42-hour workweek, which really means a 4/3 3/4 or a 2/2/3 schedule (2 48-hour weeks and 2 36-hour weeks). ESD-48 also runs 24/72. HCEC and Cy-Fair run a Kelly schedule mimicking HFD with debit days, and MCHD is on a nine-day rotation of some sort. Functionally though, it's all the same- generally 24-hour station-based shifts in busy urban/suburban EMS.

@TransportJockey , @RocKetamine , @TXmed

 

[RocketMedic]

@LACoGurneyjockey .


Also, those of you with RN SOs....Texas Medical Center is a thing and the region is growing explosively. Nurses here are not short of work.

 

[RocketMedic]

So we got raises. 22.15 to 25.75 an hour. I am very happy with this. I think our new no experience medics are now at 24 an hour. EMT s are at like 14.50-15 I think.

 

[FoleyArtist]

what's yearly salary after OT? how's it calculated; is it paid straight 24 or theres daily ot? is there additional OT opportunity? what type of living does this salary afford you and if which part(s) of Houston area?
are you able to answer those questions for the other ESDs like as above? thanks

also would you happen to know what RN salary is out there? thanks

 

[RocketMedic]

Scheduled yearly salary is like 59k right now. All hours after 40 are OT. Paid for all time clocked in. THe make around 85k starting I think

 

[mrhunt]

Well you Definitely Sold me on that one Rocketmedic. got a hard on Just by reading about that company compared to all the ones in california.

Im in medic school now and wont be done until Mid to late 2019 (its a part time program). So once im finished with it (or fail out, who knows) I'll definitely be perusing this.

 

[RocketMedic]

https://www.paycomonline.net/v4/ats/web.php/jobs?clientkey=B4B00350EC0495C22E2FBC77252981A3&jpt=

Hiring basics and AEMTs, would not say no to a paramedic either.

 

[PotatoMedic]

I really wish I could have convinced my wife that Texas was ok...

 

[RocketMedic]

Just inform her that it will happen lol. People hate it until they get here, then wonder why they ever didn't come.

 

[PotatoMedic]

I promised her 5 years here before we move again.

 

[RocketMedic]

It's pretty awesome here.