How often do you get to use your skills???

Considering all of the skills I was trained in as an EMT (and before that, actually) there's only a very few that I haven't ever done and only a small list larger than that that I've rarely/never done. Back then I worked a BLS ambulance that regularly responded to 911 calls in addition to "private" emergency calls where the reporting party declined to call 911.

Let me see... of the skills you listed, OP, I've done them all. In the field, I've never had to place a traction splint, MAST pants (they were on the way out anyway back then), nor use a SAM splint. I've only dropped an NPA twice. Ever.

The other skills? Pretty darned familiar with them...

Now then I did a LOT more thinking than most of my peers. Frequently, because of all the work in my head, and what I've found, I used to be asked why I didn't do some ALS intervention. My answer was that I was BLS and not allowed and that (this is unfortunately true back then) ALS wasn't available so it was faster to transport than wait. So, the critical thinking skill was utilized most of all and this usage continues to this day.
 
As a volunteer with the local fire dept, I have used my skills at least a couple times a week. Sometimes it ranges from the simple abdominal pains to the overdoses.
 
The insights shared here were really helpful....I guess the big takeaway is that if I want to actually use the skills I’ve learned and hope to develop further I should steer clear of Orange County....that’s ok it’s too expensive here now anyway.
 
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Akulahawk said:
ALS wasn't available so it was faster to transport than wait. So, the critical thinking skill was utilized most of all and this usage continues to this day.
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That is really the biggest skill I use, and one that I find is often lacking among EMTs who work on a paramedic EMT ambulance. Doing a thorough assessment, knowing what is going on with the patient, being able to think through what is going on and anticipate what the patient will need, and being able to do it all without a paramedic telling you what to do. Not that they aren't great paramedic helpers on the ambulance, but if you take that paramedic away, and all the paramedic toys and they are like a lost puppy without any idea of what to do next.

There are a couple of skills that I have yet to do, but really really want to: drop a king airway (state protocol says we can, medical director won't let us), administer narcan and wake the dead. Every thing else (BVM, OPA/NPAs, traction splint, extremity splint, suction etc) is pretty common, but it's also location specific on how much you will actually do. in NJ, we did everything other than stuff involving needles, advanced airway, meds, and cardiac monitoring. But the biggest thing we did was do a proper assessment, and differentiate what patients needed ALS, and what patients didn't. And if the patient needed ALS and they weren't on scene yet, we learned to start making out way to the ambulance, and either meet ALS line of sight or go directly to the hospital, giving them a heads up on what we had.

There are plenty of horror stories about SoCal and LA Co EMS on these forums. With the high cost of living in that area, I'm surprised anyone can afford to live there and work on EMT wages anyway.
 
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Other than MAST pants I can't think of any skills that I haven't used, and those were on the way out anyway.

@EMT Rookie if you want to use your skills you probably need to find a system where the engine company isn't running the show. Find an agency that is 3rd service, where EMS and fire actually work together, where fire is EMR/BLS only, a fire department that runs their own ambulance service, or something like that. Anywhere that fire runs the show will range from fire running some to all of the show with variable levels of rudeness.

Back when I was on fire I was on a pretty small department but we were ALS and ran out own ambulances. We would occasionally get get requested for mutual aid into the city when AMR was level 0.

Some of the city fire guys (they had scene control as part of their contract with AMR) wanted to dictate care when we showed up (especially for dumb things on bls patients), I would tell them that I have different protocols and that if they want to keep control that they could wait for AMR and I would go back to my district. This certainly wasn't all of city crews but it was enough for me to give my spiel multiple times. Unfortunately for the AMR crews that had to deal with that nonsense every day, and it certainly did limit what they did with the patients.

I should also add that when we would mutual aid fire or rescue calls with them that they respected us as firefighters, but for some reason when we came down in the ambulance they then treated us like we were below them.
 
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Peak said:
Find an agency that is 3rd service, where EMS and fire actually work together, where fire is EMR/BLS only, a fire department that runs their own ambulance service, or something like that. Anywhere that fire runs the show will range from fire running some to all of the show with variable levels of rudeness.
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This must be specific to California, or places that have private EMS as the ambulance service; This type of behavior wouldn't be tolerated ANYWHERE where I have worked. Then again, I have never worked in a system where Fire runs the EMS system, so it might be a cultural thing ingrained in fire-based EMS systems. IDK.

When I was on the ambulance, if I had an engine as my first responder, they did their thing, and when I showed up, I asked for (and usually received) a patient report from the captain, then they stood back and while I did my thing. If I needed something, I asked for their help, and they usually assisted. Now that I'm on the engine, in another state, it's the same way: I do my thing, when EMS shows up, here is my report, I'm going to let you do your thing, and get out of your way. I mean, it's EMS (Emergency Medical Service), not ETS (Emergency Transport/Taxi Service), right? so EMS is responsible for the patient care; I'll gladly go back to whatever I was doing, and they should know what they should be doing regarding patient care.

I did briefly work in one fire based EMS system in NJ: it was pretty much the same thing, but the full time FFs had 0 desire to be on the ambulance, and would rather just play on the engine (and I don't blame them, it's way more fun).
Peak said:
Some of the city fire guys (they had scene control as part of their contract with AMR) wanted to dictate care when we showed up (especially for dumb things on bls patients), I would tell them that I have different protocols and that if they want to keep control that they could wait for AMR and I would go back to my district. This certainly wasn't all of city crews but it was enough for me to give my spiel multiple times. Unfortunately for the AMR crews that had to deal with that nonsense every day, and it certainly did limit what they did with the patients.

I should also add that when we would mutual aid fire or rescue calls with them that they respected us as firefighters, but for some reason when we came down in the ambulance they then treated us like we were below them.
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That's because they treated you just like they treated AMR. It had nothing to do with you personally, they see you on the ambulance and see "idiot private EMS service who works for us." When you show up on the fire truck, your an engine company, not a private ambulance service. It's one of the reasons I avoid private EMS services like the plague.
 
DrParasite said:
This must be specific to California, or places that have private EMS as the ambulance service; This type of behavior wouldn't be tolerated ANYWHERE where I have worked. Then again, I have never worked in a system where Fire runs the EMS system, so it might be a cultural thing ingrained in fire-based EMS systems. IDK.
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Definitely not exclusive to california, since I've never worked there. I think has a lot to do with fire departments that contract out their ambulances.

In my current area fire is BLS (there are a handful of medics and nurses but they are limited to BLS interventions based on the department structure) and EMS is a 3rd service through the county hospital. Fire and EMS have a pretty good relationship, and the patient gets better care because there isn't as much politics at play.

We occasionally get patients from 911 outside of the city where a lot of the suburban departments contract out their ambulance services and it's the exact same as I've seen before with that setup.

One department just east of us particularly loves to just treat their ambulance service like dirt, and their care is pretty poor. I think my favorite was the firemedic who brought me a COPD exacerbation who he had done essentially nothing for, and his bunkers reeked of structure fire/MVC fluids (not in a fresh way, in the I don't believe in cleaning my gear way). This is also a department and ambulance service that gets brought up all the time with people looking for jobs...

There are also a small number of fire departments up here that run their own ambulances, and from my experience those medics have been very professional and have given great care.
 
DrParasite said:
That's because they treated you just like they treated AMR. It had nothing to do with you personally, they see you on the ambulance and see "idiot private EMS service who works for us." When you show up on the fire truck, your an engine company, not a private ambulance service. It's one of the reasons I avoid private EMS services like the plague.
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I work part time for a fire department in the same system. I have no idea how they can think we are AMR when I show up in a red ambulance that says "FIRE" on it and I'm wearing bunker pants. Many of the fire crews on the outlying areas of Colorado Springs are salty to anyone that shows up. When we run mutual aid in the engine with them, we get the same crap attitude too. Just organizational culture...
 
I work in the SF Bay Area as a paramedic for a private ambulance company. I feel like I've done a lot of things like OPAs, splinting, etc. I've tried delegating it to my EMT, so she has a lot experience doing it too. Although most of our fire departments are ALS, I feel like a lot of them wait for us to show up for us to do ALS things, particularly IV and intubation. Fire tends to be focused with doing IO right away to give ACLS drugs quickly. My partner and I like working in a very urban/downtown area, so we tend to be even on who makes it to calls first since it is so small and busy. It is my goal to beat fire to calls to cancel them as soon as possible. I personally find it easier to run calls without the fire department. I kind of wish I could cancel them on cardiac arrest calls too since they get too amped up, freak out, but also do the most lousy chest compressions that even scrawny me and my partner can do much better chest compressions, but I am sure I would get in trouble for cancelling them unfortunately. I jokingly say to students/ride alongs that it is BSI, scene safety, make the patient safe from the fire department by moving the patient away from the fire department... I know there are some good firefighters/paramedics, but I think most should just stick to what they are interested in, fire supression and looking cool.
 
HFD is wildly variable in terms of care, but the average is terriblad care.
 
In the US Coast Guard, I have used my EMS skills during boating season such as answering SAR alarms, assisting with medevac off the islands. Working on getting Aircrew qualified to work with Air station Cape cod.
 
Kavsuvb said:
In the US Coast Guard, I have used my EMS skills during boating season such as answering SAR alarms, assisting with medevac off the islands. Working on getting Aircrew qualified to work with Air station Cape cod.
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What EMS skills do you utilize while assisting the medevac?
 
DrParasite said:
What EMS skills do you utilize while assisting the medevac?
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Working along with the Rescue swimmers in my AOR, which is 1st district USCG, we have a busy summer boating season and often times encounter fisherman who had their hands/fingers amputated. Boaters who happen to have a heart attack. Other is interfacility between the islands of Nantucket, Cuttyhunk, Block island and Fishers Island. Medevac can happen a lot in the USCG because the Island hospitals are not equip for curtain things and often time request the USCG because most flight teams will not fly in bad weather.
 
Prehospital - depends on where you are. I’m working Zone 5, that’s Huntington Park, Bell and Vernon (mutual aid), Compton + Watts are McCormick but we do occasional border incursions. It’s a busy area with plenty of radical stuff, and there’s enough hands on. Back in OC I used to do Zone B (Los Al, Seal Beach, Cypress, Stanton etc) and it all depended on the crew we were running with. Same applied to Santa Ana, Fountain Valley, Westminster & Garbage Grove.

Hospital - above and beyond. Anything that the team needs, and then some. I believe that the only things that I’m not doing in the ER are the absolutely-our-of-scope, otherwise - once the rapport is established and the team trusts you - they happily delegate.
 
Depends on the day for us. I'm permanently stationed for the year and our area tends to be a mixed bag of lower level calls, MVAs with refusals and the odd streak of legit calls. Past 2 days we've had 2 arrests and a pedestrian struck...
 
Ground 911 ambulance: it’s your usual run of the mill stuff. IVs, fluids, splinting, pain medications, etc.

Helicopter: usually all the very simple skills such as those I listed above are already done on the patient. We tend to use more advanced skills (RSI, chest tubes, expanded medications) and because of that our call volume is also a lot less.
 
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