Flight Paramedic, Ask Me Anything

Carlos Danger

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Well I work because I have bills and need the check so I guess you can say I do it for the money.
Considering you do exactly the same as the nurse but get paid less does seem a but unfair but that is what I suspected.
I asked because I am considering just doing nursing but I still want to fly (eventually maybe) and am curious what the difference would be, not much from what you all are saying.

It isn't the least bit unfair; it is basic supply/demand economics. For numerous reasons, it isn't uncommon to have 25 or 50 or more applicants for a single flight paramedic opening, and maybe 5 applicants for a flight nurse opening at the same company. Flight RN's are a much scarcer resource, so they are more valuable than flight paramedics and are thus paid more.

What's the real attraction to flight? There are many ground services that have the same, if not better protocols, do the exact same calls and don't have the risk of the airship crashing.
Many ground CCT medics also receive excellent pay and benefits packages.

Is the just "the helicopter" that makes it attractive? I'll admit, when I was younger, the excitement of seeing Hartford Hospital LifeFlight do a scene call was pretty cool, after becoming a medic and running a large number of calls, the excitement and allure of the flight job wore off pretty quickly.

You could ask that about any career choice. Why is a trauma surgeon attracted to that instead of just doing non-emergent ortho or general surgery? Why do EM physicians choose that rather than family practice? Why does a criminal defense attorney or prosecutor do that instead of corporate regulatory law?

When I got into HEMS early in my career, there was a huge difference between HEMS and ground EMS in terms of protocols, educational and training opportunities, patient acuity, etc in my region. The difference between being a ground medic and flight medic was like the difference between working for a private ambulance company that does mainly dialysis transfers and working for a really high-speed, progressive 911 only service. It's still like that in many areas. I even got paid a little more and when I wasn't on a flight, I got to sleep in a bed rather than posting on street corners in the ghetto.

Along with all that does come some status, and if I said that often being treated like the rock stars of the medical world had nothing to do with my attraction to the job I'd be lying.....but it really was only part of why I liked it. I never was one of those types who wore my flight suit out in public as much as possible so that everyone would know what I did. It was mainly the better training, better protocols, higher expectations, lower volume but much higher patient acuity........what's not to love about that? Even if you could somehow have taken the status away completely, I'd still have liked flying much better than ground.

Anyway, it didn't take long before I learned to truly enjoy the work for the sake of the work. A lot of people find trauma to become boring; I became more and more interested in it. I developed a true interest in prehospital airway management and analgesia. I learned to love helicopters and aviation. Working for a HEMS program that covered a huge rural area, I got to routinely do and see some really interesting stuff over the years that I very well may never have working ground, or maybe would have only a few times in a whole career.

HEMS is substantially different than ground CCT, so it's entirely possible to really enjoy one and not care much for the other. As far as safety, HEMS definitely has some important issues to work out, but I'm not sure that it's statistically that much more dangerous than working ground 911.

Anyway, I think I'm reminiscing and rambling more in this post than I am providing a coherent answer to the question. So I'll finish by saying that the industry has changed a lot since I first got into it 15 years ago. I'm pretty sure I wouldn't find it nearly as satisfying getting into it now.
 

CANMAN

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I completely echo every single one of Remi's points, and many of those are the reason I left my full time FD job. I was burned out and over the 911 calls, and had always enjoyed the acuity that came with critical care transport. In my area the ground services protocols are no where near the same levels HEMS is in the area. The education and training is top notch and much more frequent with my program. I also enjoy the people I work with more then any other job I have ever had. Everyone is held to the same standard, truly, and if you can't cut the mustard after sufficient training then your cut. It's nice to truly be able to count on your partner and know they have a minimal competency level, and you know exactly what that is. I never found that within any EMS or transport job. There were always the "bottom of the barrel" providers, if you will, who somehow always just scraped by, and the was tolerated.

Most of all I wanted a change in scenery but also wanted to continue to do something I knew I was good at. It had nothing to do with ego, or looking cool, I have had much cooler jobs earlier in life, and I put my pants on like everyone else, however I wanted to be in a new environment with new challenges.

I make it a point to learn something new about the aircraft or weather each shift, and now I see my interest for aviation maybe turning into a career later down the road. As Remi pointed out, and I agree, operational challenges are present and you may have to learn of different ways to do things, or take a more proactive approach and worry about the "what ifs" vs. just 5 more minutes to the ER in 911. I also completely agree that sadly (for ground ems) we are treated like gold everywhere we go vs. treated like dookie the very next day when I work part time fire department. Good question DEmedic
 
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Carlos Danger

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Rockstars? Its a flying IFT truck.
Is that still true when 80% of your calls are scene flights and your protocols are well above and beyond the ground protocols in the region?
 

Household6

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I've seen one of our HEMS crew push nurses aside in the ER and take over their crash cart.. Even though they *do* get paid a lot less for the same job, our air crews really command respect from HCPs. Probably because they walk into the ER like dis:

maverick-and-goose.jpg


My FTO did HEMS for a long time but switched back to ground full time. Our service separates seniority lists between Air and Ground. He wanted to get seniority.. But my stars, he's brilliant. Protocols and skills are the same for him, and he was a good resource for their equipment. Vents and pumps are different on the chopper, during pt transfers he's able to pull his probies in the bird and run through their set ups. Greatest FTO ever.
 

TXmed

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as far as the protocol thing goes. its not that HEMS has so much different protocols, its that what they can do they do well. there are plenty of services that can hang multiple pressors, RSI, vent management and all that good stuff but typically HEMS crews do it more often and have more practice & training at it.
 

CANMAN

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Our STEMI protocols are greater than Starflight's

So you're talking about one program, and comparing your protocols to them...... Is your ground service also doing fire supression, rescue swimming, and hoist evolutions, because STAR Flight is.... They are also doing FAST exams and ultrasound guided line placement, is that in your scope? Every program will have variations in the protocols and care they are providing. What is so advanced about your "STEMI Protocol" that they aren't doing? This isn't a "who has the most aggressive protocol" thread. It was a thread for people that had legit questions. We have already established that in some regions the protocols are the same, and in others, like mine, our HEMS protocols are way more advanced then the ground services we provide to. So I am not exactly sure what your point is?
 

teedubbyaw

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Calm your tits. I was giving one example in regards to a previous post.

ATCEMS has rescue medics that have a ton of training in different areas, but their medical protocols still suck.

You may go be seated back on your throne.
 

akflightmedic

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Wowsers...someone has "non-ego" issues...
 

TXmed

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Calm your tits. I was giving one example in regards to a previous post.

ATCEMS has rescue medics that have a ton of training in different areas, but their medical protocols still suck.

You may go be seated back on your throne.

Wow... Just because there protocols aren't as aggressive as others doesn't mean they suck. It's about how you use your protocols.
 

Handsome Robb

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It's never been a secret that their medics aren't trusted to do much. Lol

One of our TEMS and Flight guys went to STARFlight in February. He's a certified badass both medically and in everything else he does.

His partner was the RN who died this year unfortunately. He was off that night though.
 

teedubbyaw

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One of our TEMS and Flight guys went to STARFlight in February. He's a certified badass both medically and in everything else he does.

His partner was the RN who died this year unfortunately. He was off that night though.

You know I was talking about ATCEMS, right? Starflight rocks.
 

Tigger

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I like this thread. In effort to keep it rolling, I've removed some posts that have nothing to do with the topic at hand. Try being civil, you (all) just may like it.
 

triemal04

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Rockstars? Its a flying IFT truck.
If you can ever find a flight medic/RN, sit down with them and get them to be honest, it can make for an eye opening conversation for a lot of people. Rotary-wing EMS is unregulated (aside from the FAA and the occasional state that requires a company show "need" before opening a base; though "need" is a loose term usually) and far, far, far overstaffed. As a helicopter and crew are not cheap to maintain, this leads to companies flying for every patient they are called about, advertising themselves as available for any type of patient, and sometimes flying in weather that they shouldn't. Which in turn leads to patients being flown who don't actually have a need for a helicopter, let alone any type of critical care. Which may or may not even be available, depending on the specific company. Find a flight provider who is being honest and without an ego, and that's what they'll tell you; most patients who are flown don't need it and don't get much more than standard care.

Now believe me, there are exceptions to this; as large as the US is, plenty of exceptions I'd guess. It'll depend a lot of the specific geography, population density, and the available medical resources that are found in each specific area.

And I'm sure that all the people here only worked for one of the exceptions.
 

Carlos Danger

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If you can ever find a flight medic/RN, sit down with them and get them to be honest, it can make for an eye opening conversation for a lot of people. Rotary-wing EMS is unregulated (aside from the FAA and the occasional state that requires a company show "need" before opening a base; though "need" is a loose term usually) and far, far, far overstaffed. As a helicopter and crew are not cheap to maintain, this leads to companies flying for every patient they are called about, advertising themselves as available for any type of patient, and sometimes flying in weather that they shouldn't. Which in turn leads to patients being flown who don't actually have a need for a helicopter, let alone any type of critical care. Which may or may not even be available, depending on the specific company. Find a flight provider who is being honest and without an ego, and that's what they'll tell you; most patients who are flown don't need it and don't get much more than standard care.

Now believe me, there are exceptions to this; as large as the US is, plenty of exceptions I'd guess. It'll depend a lot of the specific geography, population density, and the available medical resources that are found in each specific area.

And I'm sure that all the people here only worked for one of the exceptions.

Over-utilization in HEMS has always been an issue - just like it is with ground ALS - and it has gotten much worse since the early 2000's, when the American HEMS fleet has roughly tripled in size (with the majority of the newer HEMS bases concentrated around urban centers, FWIW).

It is also true that a majority of transports are not life-threatening; this has been proven in the literature repeatedly. I've commented numerous times on this forum about the lowering of "average patient acuity" and thus experience levels among both HEMS crew members and ground paramedics due to increasing numbers of paramedics and helicopters.

That said, the type of really underhanded practices alluded to here are really only common among a few (albeit large) community-based, corporate programs. A majority of programs don't operate that way. That's why in any of the numerous other threads on this forum where I replied to questions about getting into HEMS, I always say that it's very hard to get into a quality program. It's not necessarily that hard to get a job with one of the bottom-feeders.

And I'm sure that all the people here only worked for one of the exceptions.

I always love the snipes from the sideline experts. Contributes so much to the discussion.

Maybe Epipusher and triemal04 should just start a thread called "Never Been a Flight Paramedic, But Still Ask Me Anything."
 
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