I'm going to go ahead and throw in my own comments for good measure. My experience and personal observations are actually consistent with what daedalus has reported. I started out as an EMT working for a private ambulance service that operated in both LA and OC, so I got to see how both counties operated. I did both BLS IFT's and 911 response with fire medics with this company, and what I saw happen daily was hard for me to fathom. I saw so much negligence that after a while it was no longer a mystery to me why the medics here are on such short leashes. I got BLS'd patients with chest pain, shortness of breath, altered LOC, even trauma criteria patients on a near daily basis by both LA and OC fire medics. Shocking that this occurs without fail every day and little to nothing is done about it.
Now that I'm a paramedic and working in LA this system has me tearing my hair out over how upside-down & backwards it is. FD medics here for the most part do not care about the thing which basically justifies the fire service's existence & budget, which is EMS. What a bizarre mentality, that it's considered such a burden to the service. Like daedalus said earlier, most guys get their medic license just as a vehicle to get on a department; and, once they do they just bide their time on the rescue or squad until they can move to the engine or truck at which point they let their license lapse. Many people here who are involved with EMS/Fire will look at you like you've got three arms growing out of your head if you state an interest in being a medic for any other reason than to become a firefighter. Why on earth would someone want to do such a thing? It's no wonder then, that paramedics in LA/OC operate on what is likely to be the most restricted scope of practice in the entire country. No interpretation of 12-leads, no pediatric intubation, no needle cricothyrotomy, no needle thoracostomy (Orange County), a med box that consists of about 14 medications, and a list of procedures that may be performed prior to base contact that fits on a single piece of paper (OC medics, for example cannot even give repeat doses of albuterol without an order). Speaking of base contact, like daedalus said, when you call base you speak to a MICN who gives you his/her blessing to continue down the remainder of a pre-established protocol that is very basic yet you can't complete it without this permission. MICN's become very nervous when you request some sort of variance, and usually you'll just get the, "Hmmm, you said you're 5 min. out, just hold off on that and bring them here" line. Also, when you make base contact it doesn't consist of a patient's age, chief complaint, and your ETA. No, in the LA/OC little slice of paramedic heaven base contact consists of a long, drawn-out, detailed report of everything you've found in your assessment, what you've done so far, and what you'd like to do. It's basically a way for the MICN to play 20 questions with you to make sure you haven't killed your patient. There is such a lack of trust afforded to paramedics by hospitals due to terrible performance that this is what the system has come to. It's so bad that many ED's don't even utilize the IV line that the paramedic started in the field - they start a new one once the patient is in the ED and they might use the field line to draw labs or sometimes they even just remove it.
It's true that every year it seems that some other procedure or something is set to be pulled from the field. Sometimes, however, there are these shocking instances of trust extended to medics from medical directors that defy explanation and are subsequently ruined by field personnel. For example, Orange County paramedics used to carry streptokinase (a potent thrombolytic synthesized from streptococcus bacteria). So, despite all of the above OC medics were - for a short time - engaged in pre-hospital thrombolytic therapy. A few years ago, however, this was pulled from the field but not for the reasons one would expect. Medics weren't using it on hemorrhagic stroke patients or administering it horribly incorrectly or otherwise misusing it in any way. So, why did it get pulled from the field? Because they weren't using it at all. It was drastically underutilized in the field. Here they were, engaging in some seriously progressive prehospital medicine, and they just sat on it. All this streptokinase just sat in med boxes collecting dust until its expiration date. So, the county was tired of paying for this med when it wasn't being used, and now it doesn't exist in OC protocols any longer. Nice work everyone.
Unfortunately, it isn't just the prehospital aspect of our EMS system that is messed up. The ED's have their own bizarre antics as well. For the most part, if you're prehospital personnel, the only way a nurse will give you the time of day is if you wear yellow pants (that is, you're an FF/PM). Private ambulance paramedics are looked upon by ED nurses and other staff as slightly above the guy who's there to fix the HVAC system, but still more of a nuisance. Since I've only ever worked for private ambulance, I can say that I have never felt like I've been acknowledged as a fellow medical professional in this area. Never. The idea that any hospital staff personnel would listen attentively to what I have to say, trust me to make clinical decisions, and treat my like a professional is a foreign concept to me. Many of my friends have left the LA/OC microcosm to be paramedics in other parts of the state, and from what they all say it's like night and day. It took me a long time to accept the sorry state of EMS in this region, and this realization has often caused me considerable anxiety and doubt about my role in EMS. It has also made me seriously consider leaving the field for a different role in medicine (PA school, specifically). Furthermore, I am absolutely 100% certain that I will not take a job in EMS in LA or OC (even if it is for a FD); pretty confident about leaving the state; and, even desiring to leave the country.
It's such a shame that this is the way it is here, because southern California is such a great place to live and work, and there is an excellent variety of calls. It could be such a progressive system, but I can't really see things ever changing for the better. Anyway, I've already said too much as it is so I'll put a sock in it for now.
