Progressive EMS systems?

[NomadicMedic]

well shoot, I'll throw my application in. Thanks for the tip! Why'd you leave? Whats their initial training program like?

I left because a mentor of mine got me back into my previous field. It was a bad mistake. But, what doesn't kill us makes us stronger.

The hire process has changed a bit, I've heard. It used to be scenario and panel questions from FTOs and leadership. I hear they added a written test to weed out the zeroes.

The clearance process is long and involved. It's basically the FTEP process, all competency based. It used to be very difficult to complete successfully, but I think they washed out too many candidates. It can take anywhere from 6 weeks to 6 months, depending on your skill level and how well you learn their systems.

It's a great place. It has downsides,like anywhere... But if I were just a medic,looking to start a career with an agency,I'd go back in a heartbeat. Unfortunately they don't hire for anything other than medics, so someone with lots of experience still starts brand, new at the bottom. And the promotional process takes seniority into account.

And it's Delaware. So, there's that. It's a bit insular and slow. (it's why they call Sussex county "slower lower" Delaware )

Anything else, just ask.

 

[DrParasite]

The "cliff notes" version (in case it hasn't been updated) of the agency is that we run approximately 3000 calls a year between 911, IFT between two hospitals, vehicle extrication, Haz-Mat, and Rope rescue. We cover an area of approximately 10,000 square miles and roughly 20,000 people, currently with two full time crews and a supervisor, with most of the staff living in town with call back ability if needed. We have 3 primary 911 ambulances, a "Rescue Ambulance," a heavy rescue, and a dual stretcher transfer rig as well as 8 or 9 additional semi- or unstocked rigs we use for Burning Man or if we had a significant MCI.

OK, so you staff 2 911 ambulances and a supervisor.... who staffs the rescue ambulance and the heavy rescue? off duty staff? the supervisor takes the rescue wherever it needs to go? if there is a MVA, does one crew respond in the ambulance, and the other put the 911 truck OOS and take the rescue? Are most staff paramedics, or a mix of EMT and paramedic?

 

[NPO]

OK, so you staff 2 911 ambulances and a supervisor.... who staffs the rescue ambulance and the heavy rescue? off duty staff? the supervisor takes the rescue wherever it needs to go? if there is a MVA, does one crew respond in the ambulance, and the other put the 911 truck OOS and take the rescue? Are most staff paramedics, or a mix of EMT and paramedic?

The rescue is cross staffed. They have 2 stations, one hasn't been staffed pretty much since it opened other than a fly car sometimes.

Ideally, the rescue ambulance and 2 ambulances are staffed. But that hasn't been the case in a long time.

It's a mix of EMT/EMTA/Medic.

 

[Barsa]

Heavy rescue is call back, almost entirely for Semi crashes or super technical rescues. The Rescue Ambulance is the primary rescue rig, since it can also transport, and will be staffed by one of the crews. So, yes, one crew brings a "normal" ambulance and one Rescue. Each of our 911 ambulances also have a saw-zall and battery powered combi-tool if rescue is committed or delayed to get started.

Right now, we have most of the full time crews as AEMT and Medic, but there are a few that are basic/medic with the EMT working on completing the written for NR-AEMT. @NPO is right about the other station, it has not been very busy historically, so the current hospital admin has trouble justifying it.

 

[NPO]

Heavy rescue is call back, almost entirely for Semi crashes or super technical rescues. The Rescue Ambulance is the primary rescue rig, since it can also transport, and will be staffed by one of the crews. So, yes, one crew brings a "normal" ambulance and one Rescue. Each of our 911 ambulances also have a saw-zall and battery powered combi-tool if rescue is committed or delayed to get started.

Right now, we have most of the full time crews as AEMT and Medic, but there are a few that are basic/medic with the EMT working on completing the written for NR-AEMT. @NPO is right about the other station, it has not been very busy historically, so the current hospital admin has trouble justifying it.

Glad to have you on board. You'll have better insight into HGH than I.

 

[Barsa]

I appreciate it! I have contemplated joining a few times over the years, so much useful knowledge and experience on the boards here!

 

[GMCmedic]

My agency is progressive, but isn't a metro area. We are a mix of rural and urban. We get busy in the summer from tourism, then slow way down in the winter.

We have 6 ALS trucks on during the day and 4 at night. That is augmented by up to 5 ALS fly cars. No BLS ambulances. ALS units are a mix of BLS/Medic and Medic/Medic. Everyone from our Chief down is a working paramedic.

We have evidence based protocols that are updated at least every year. We get a lot of our changes from the Eagles Conference every year.

We RSI, we have vents on every truck, Lucas on every truck, ultra sound, and unique treatment protocols like Esmolol for refractory VF, a "no medication" traumatic cardiac arrest protocol, IV nitro for CHF, and carry everyone's favorite drug, Ketamine (push dose and drip protocols). Only 1 or 2 of our medications require medial control.

All but one fire department are volunteer, and are mostly EMR level meaning you're medic in charge always. Our supervisors go on many calls to help, but never take scene control from the transporting medic. We often send 2 ambulances to support difficult calls, like cardiac arrest, maternity with imminent delivery, or lift assists.

We do some small rescue stuff, like low angle ropes. We carry extrication clothing as we are expected to be involved in extrication and patient care on scene of MVAs, not sidelined waiting for a patient.

Our paramedics are the highest paid public safety personnel in the county, we have the best benefits, and we are the only full-time county-wide agency. This puts us in a unique position where other agencies call upon us for help, not the other way around.

Man, I was pushing hard for IV nitro right before I left my ground gig. Never could get the medical director on board. I did manage to get them finger thoracotomy as a going away present.

 

[NPO]

Man, I was pushing hard for IV nitro right before I left my ground gig. Never could get the medical director on board. I did manage to get them finger thoracotomy as a going away present.

It was on my list of things to push for, but wasn't at the top. Our medical director beat me to it.

 

[CANMAN]

After doing this for a while, things like RSI and progressive medicine have become less important. I’m far more interested in a great culture, work schedule that allows for work/life balance, promotional opportunity, decent retirement and a fair compensation package. Doing good medicine is important, but being paid well for it is also valuable.

I still recommend Sussex County Delaware as a stand out for all of the above.

Couldn't agree more on this point. You really want to find a good balance of total package. Early on I wanted all the high speed things and was willing to (and did) compromise on the pay and work life balance. I ended up working a full-time and two part-time jobs to make the money I wanted to make. After about 5 years I had enough, and although felt like clinically I was on the tip of the spear, that in an of itself wasn't enough to keep me where I was at. As I got older things that were once important to me were now not as important, and supporting & spending time with family rose a bunch of notches.

With that being said, don't make a move strictly based on finances. I left a program I was overall really happy flying for because of low wages, which factored into the work life balance obviously. For the last 3 years I was flying for a lesser know, lesser quality, and crap culture place, and really regretted my decision to leave my previous job. Thankfully I can report they revamped their entire wage and program structure to include a clinical ladder, and I recently accepted a position to come back as a manager starting next week.

Moral of the story is don't be guiding or pulled in a direction by one or two items and really evaluated the entire package. Great point Nomadic!

 

[Peak]

I would add that what makes a good progressive system is more than just what advanced protocols or procedures are in place.

Does the system allow for changes in protocols to be presented/made to the medical director by the line medics, nurses, and RTs?

What is the process for QA/QI? Does the service have a professional and organized peer review process? How are errors handled, does leadership actually have just culture training?

 

[medichopeful]

Also hear good things about New Britain EMS in CT which @medichopeful can chime in on I believe.

I can indeed chime in on them. Hands down the best EMS service I've ever worked for. In fact, I'm so happy there that I'm still there part-time even after picking up my full time flight job.

A quick run down of the service:
-Not-for profit, VERY heavily supported by the city (basically, we're a third service in everything but pension and benefits. Benefits are good from what I understand, I don't have my health insurance through them but they very much take care of you)
-911 only (with the exception of the occasional stand-by for some sporting events and larger events), no posting, very nice base
-All box trucks with the exception of some SUVs (supervisors), a pick-up truck, and a Gator. Powerlift/Powerloads on the majority of the frontline trucks, the rest are being installed in the near future
-Amazing working relationship with fire, police, and the hospital(s) in the area
-Protective equipment issued for all employees: helmet, extrication gear, and traffic vest. Ballistic vests are available to check out at the beginning of the shift if you want, or they can help you buy your own
-Management truly cares about us, and they take our well-being and safety extremely seriously. For example, if there's a tough call, it isn't uncommon for the on-duty supervisor to buy dinner for the entire on-duty staff
-Standing order RSI, vents on every truck, Lucas on every truck, King Vision on every truck, and LP15s which get replaced fairly frequently
-Excellent QA/QI program that is non-punitive with a dedicated QA/QI lieutenant
-Excellent FTO program that is broken up into 4 stages, and can be altered based on past experience. All FTOs have at least 1 year of experience, and have to interview and test for the position
-When there isn't a pandemic, we have students with us all the time so there's plenty of opportunity to teach, even if you are not an FTO

It's a busy system, but you'll gain a ton of experience. Unfortunately, it isn't the easiest to get hired because it's one of the top services in the state, but if you're a paramedic you should have a much easier time.

I actually grew up in Connecticut and took my EMTB course through NBEMS academy! I've applied to NBEMS three times over the past 4-5 years, never got a call back. I commute to work 48's at a smaller third service in Tolland county just to get some actual experience while I apply around and just got medical control clearance. I would stay in MA or CT but its just way too expensive, and I want to know what a winter is like not worrying about waking up extra early to clean 2 feet of snow off my car

We're currently hiring part-time paramedics, which would be a foot in the door should you decide you wanted to stay in the area and go full-time if a position were to open up. If you're interested or have any questions just let me know!