Questions about EMS in the Old Northeast and Mid-West

RocketMedic

Californian, Lost in Texas
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So, I've been having some silly thoughts lately, and was wondering what sort of EMS they've got in upper New England (VT/CN/MA/RI/NH/ME), particularly with regards to pay, schedule, work/life balance, etc. I'm also curious as to the regional approach to challenges like RSI.
Also, same question set, but for Michigan.
 

EpiEMS

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I can speak to the more populated parts of CT, where we are very medic heavy and have a mix of commercial services (BLS and ALS), municipal services (largley BLS, some have ALS, and most contract for ALS with a hospital or commercial agency), and hospital services (ALS dominated).
The more rural areas of CT are served largely by volunteer BLS agencies, but have seen the usual transition to more and more paid providers. In some cities and municipalities, EMS is fire-based. Some of the agencies have the LA model of ALS non-transporting fire with BLS transporting commercial services...personally one of my least favorite operating approaches.

CT protocols allow for RSI, most of the services I'm aware of have it (but going to be "sponsor hospital" dependent).I don't believe there is a 2 medic mandate for RSI.

CT has essentially no AEMTs anymore, it's all EMT and Medic (minimal exceptions).

Compensation in CT EMS agencies seems to be on the upswing - medics are typically $35 plus.
 

akflightmedic

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Maine....low wages, lot of volunteers, HUGE shortage, 25 years behind the times, limited protocols as compared to other states I have worked in, lot of rural towns to cover. Most Medics I know, work one full time job and then 2-3 per diem gigs. Outside of the established cities (which are few), there are tons of towns, and each town likes to maintain control as opposed to consolidating or sharing resources. Many fiefdoms where it has always been done this way and they do not want to give up control. The state just approved I think 25M to be released to EMS to help with falling revenues, loss of staff, and to prevent some of the towns from losing their services (you know the ones they would not lose if only they worked with another town).

Can have some very long transport times with no air support due to weather. My longest (5 hours from start to receiving facility) was a septic shock patient, lived way back in the sticks, took me 40 minutes to get to him, on scene was about 50 minutes due to house layout (home made elevator, big dude, paraplegic, and acuity), stairs, weather, then got stuck in the snow, waited on back up, then of course a fleet of volley FFs, nice dudes all with big trucks....they eventually made their way and then chained the ambo out of the snow bank, up an ice hill and then to main road where we could continue our journey. Meanwhile I am in back giving fluids after fluids, pressors, aggressive airway, had to do IO, it was a crap show.

I did work for one service which I would recommend for many reasons if interested. Its a non-profit that formed from 11 towns agreeing to consolidate.

Leadership is good, many "old" medics on department, meaning a ton of experience and wisdom to be shared. Recently went Union (teamsters) which I had a significant part in their negotiations. Wages and benefits are above average. They invest in equipment, do have decent protocols and are upgrading their fleet.

Only major challenges is everything of significance has to go before the board which is comprised of people from the various towns. Many of the board members are old school Mainers, sitting on a ton of wealth but counting every penny, and many of them are 65+ and completely out of touch with reality. This was evident during negotiations; however, I did get through to many of them by breaking it down. They are definitely confused as to what it costs to live. :)

Not long after negotiations were finalized, I moved on. Job done. :) Only took a little over 14 months or so. And many aggressive meetings...I was the token bad guy, but was one who was informed, able to stand and present, and able to speak in their language. The department was being railroaded until I intervened and yes I am tooting my horn because I helped all existing and future staff there by laying down a darn good first union contract. Part of the problem is all the staff NEEDED their job so no one wanted to make waves. IDGAF, so I was the arsehole.
 

johnrsemt

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Seems like most places are medic heavy in cities, and few and far between the farther you go out of town, the places that you need medics there aren't any
 

EpiEMS

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Outside of the established cities (which are few), there are tons of towns, and each town likes to maintain control as opposed to consolidating or sharing resources. Many fiefdoms where it has always been done this way and they do not want to give up control.
Totally agree, I think this is a (if not *the*) major systems challenge in the northeast, especially in rural or exurban areas. (Local control can be great if you have the resources to back it up, even if it is inefficient. )

Seems like most places are medic heavy in cities, and few and far between the farther you go out of town, the places that you need medics there aren't any
Yup. This is consistent with what I've seen in the areas I'm familiar with (CT, NH).

old school Mainers, sitting on a ton of wealth but counting every penny
The one thing I'll say for this is that it is indeed classic New England small "c" conservatism!
 

DrParasite

The fire extinguisher is not just for show
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CT has essentially no AEMTs anymore, it's all EMT and Medic (minimal exceptions).
don't they have FFs who are AEMTs? or is that RI?
 

EpiEMS

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Rhode Island has the ”cardiac tech.” Paramedic scope without requisite education.

Like the old NYS EMT-CC, minus the medical control consults.
 

PotatoMedic

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RocketMedic

RocketMedic

Californian, Lost in Texas
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Rhode Island, Vermont and New Hampshire sound very interesting indeed.
 

Tigger

Dodges Pucks
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Some musings in no particular order:

In 2010 there were less than 250 paramedics in all of Vermont and there was no paramedic school in the state. This has since changed but the provision of paramedics in the state is pretty new, relatively speaking. EMS is more regional in VT and the state guidelines are pretty good, which I think is unusual for statewide guidelines? There is RSI and transport ventilator options available. Incidentally I broke my back skiing in VT in 2012 and there were no paramedics available—it was a long ride with no meds.

I don’t have much to add about Maine. I’ve investigated working for Portland FD and departments around there and I thought the pay was rather low. Granted it’s a four platoon schedule so your work week is only 42 hours, so I imagine that’s nice compared to the three platoon, 48/96 I work now which is a 56 hour work week. Also seems like Maine is more pro community paramedic than the rest of New England. My parents live in Portland and are always sending me articles about how Maine’s EMS is failing and there are too many non regionalized tiny services.

I think the reputation that Rhode Island has is correct. I worked in southeast MA for a while and only saw paramedics in RI doing IFT. In general the attitude appeared to be that paramedics were unnecessary.

I worked for Brewster in Boston from 2011 to 2013 when I was not in school. There are a few hospital and third service entities practicing progressive medicine but for the most part the state guidelines are restrictive. Lots of fire based ALS transport in the suburbs with pretty good pay and the same four platoon schedule. Private places seem to pay alright compared to industry standard. I don’t think I would return to MA to work as a paramedic though, just feels behind the times.

I know very little about NH and CT.
 
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