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I am a Kern County paramedic.
We do almost everything based off of protocol and standing orders. We rarely if ever make base contact. If a paramedic does make base contact, it is for something that is outside of protocol such as using Versed and Valium to facilitate intubation, which MDs will often let you do if you call and present your case to them.
We have more medications than most CA counties (Verapamil, Pitocin, Mag Sulfate, etc) and actually get to use them. We do run paramdic/EMT staffing on ambulances so the paramedics here get experience on every call. Because of the long transport times, we use more medications and have first, second, and even third line drugs. For example, Albuterol, EPI 1:1000 and Mag are our first, second, and third line respiratory drugs here. We also have multiple drugs for the same condition in case someone has an allergy (i.e. we carry valium and versed, as well as lidocane and amiodarone, etc). We have more options in our drug box.
We also have more procedures than many CA counties such as gastric lavage, nasal intubation, peds intubation, etc.
We also cover an extremely diverse area. Our county alone covers 8,000 square miles. We also cover around 1,000 square miles of Tulare, Inyo, and San Bernardino counties on an auto aid basis and use Kern County protocols on those responses. Kern County Paramedics (working for Hall, Liberty, Kern, and Delano ambulance companies) cover a city with close to 500,000 people, the Mojave Desert, the Kern River Valley and Upper Kern River, part of the Sierra Nevada Mountains, the China Lake Naval Weapons Station, some of the the largest oil fields in the US, and some of the richest farmland in the US. Therefore our protocols are wide open so we can account for the diverse situations we face. One paramedic might be running a shooting in inner city Bakersfield while I might be on a hike in rescue at 7,000 feet in the show at the exact same time.
We also have very nice equipment by private company standards. Where I work in the mountains, we have lifted 4WD type I ambulances, Lifepack 15s, IV warmers, over the side equipment, cold weather gear, etc.
Fire and EMS (GASP!!!!) for the most part play nicely here. Fire is almost entirely BLS with the exception of two stations in extremely rural areas. Fire has some excellent EMTs. They carry and use King Airways when they beat us to cardiac arrests and are extremely helpful ready to help out wherever needed.
Overall our EMS system is not perfect, but I feel it is very good. Our county EMS administration lets us do our jobs as paramedics, does not micro manage us, but still reviews our PCRs and holds us accountable. Because we are a 100% EPCR county, county EMS gets all of our PCRs very quickly and reviews them.
Hall? I'd move back to CA for Hall or Liberty.
I miss Ridgecrest and the Lake. My dad managed Liberty for a while, from 2003-2007. How's the pay now?