Wednesday, October 29, 2008

Why Don't I Get Paid What I'm Worth?

I wanted to get started with a question that plagues EMS folk all across the country. Why don't we get paid what we are worth? It's an easy answer, but a complicated fix. If your employer is anything like mine, they will tell you tales of Medicare reimbursements and inability for people to pay for the services, but the answer is much less complex than that. I will agree that Medicare keeps tightening the noose around reimbursements and there is no good way to ensure payments from people when they cannot afford, but need an ambulance, and I could argue those points. The real reason Paramedics/EMTs don't get paid what they are worth is pure and simple, education.

If most Medics are like me they obtained their education from a technical school. Technical school education is one of the main reasons why our profession is lacking in monetary compensation. I have nothing against technical schools, I believe they serve a valuable purpose with professional trade training. My problem is that I view a Paramedic's profession as collegiate, not technical. In my state all you need to be a medic is to be 18 years old and have a high school diploma or GED. That is it, no college foundation courses or anything. Granted I believe it's changing a little to where anatomy and physiology are now a pre-requisite, but in my opinion, that is not enough. We think we are on the same level or better than nurses, but we aren't required to have the same education as they? How can we be better or even comparable? We cannot! Granted, nurses have a choice of just an RN or BSN, but I think you would find that most are BSN or attempting to get their BSN. Paramedics do not have anything like that. If we are to be taken serious about wages, or even professional, we need to up the ante on our education. Not only would it start to secure better wages for our brothers and sisters, but we would start to see better quality medics out in the field, instead of the cookie-cutter, get them out as fast as you can medics.

There is a problem with the idea of better wages for higher education. No employer in their right mind would hire a medic with a BS at $30-40k a year (starting) when they can get a technical school medic for only $20k a year. The only way to bypass that obstacle would be to make it mandatory for all medics to have a BS. Only then would employers find that they can no longer hire medics at ridiculously low wages, there would be a shortage, and wages would increase to lure people into the field. I know it is more complex than that, but it's a start. Educational requirements could be similar to nursing requirements, but with emphasis on Emergency Medicine and Triage. With this kind of educational background, medics can start taking over the ERs like we need to be doing, instead of leaving it to the nurses. I am not anti-nurse, but I do believe that Medics belong in the ER, not nurses.

Hopefully in the coming years as the need for more medics increase so will the educational requirements at obtaining a Paramedic license. Only by increasing educational requirements will our pay be increased as well. We need to take control of our profession and make it clear that minimal pay is not acceptable anymore. I have left a lot of my arguments out because of the length of this blog already. There is so much more reasoning and many more complex issues that need to be ironed out, I just want to start people thinking about it. Have any questions or criticisms please feel free to ask.

Be Safe,

Monday, October 27, 2008

We'll leave the light on for ya!

No, my name isn't Tom Bodett but sometimes I feel like my ambulance could double as a Motel 6. This is my first EMS Taxi post so let me take a moment to introduce myself. I've been a volunteer EMT-B for about 8 years, I'm currently studying to become an EMT-Enhanced which just means I'll get to start IVs and give a few more medications. I volunteer in a small town next to a big interstate.

The interstate is where I ended up yesterday during my shift. Things have been really quiet in our county lately so when I heard the printer start whirring I couldn't help but jump up from the couch in excitement. This excitement left my rookie very confused because he hadn't heard the printer and I'm pretty sure he thought I had finally gone around the bend. I grabbed the "rip and tear" and headed out to where my driver was already sitting in the ambulance. A medical call on the interstate, the patient is having stomach pain, is sweating and is shakey.

Our first due area on the interstate is about a 12 mile stretch and the patient was just on the edge, almost into the next county so it took us a few minutes to get there. Upon arrival I note that the patient has vomited a few times, is very pale, sweaty and says he is having a hard time breathing. Due to our location on the shoulder I had the engine company shut down a lane so that we could get him into the ambulance quickly. As soon as we are in the unit I asked my driver to get a baseline set of vitals because dispatch wanted to know if ALS was needed. The first set looked good so I told them no, we would just go ahead and transport. (At that time we would have had to wait approximately 20 minutes to get an ALS unit there, about the time it would take us to get to the ER.) The patient said he was having no trouble breathing at all, his stomach was fine and he just didn't feel well.

The rookie hopped up in the back with me as we began making our way to the ER, he has only been on a few EMS calls so he is still getting the hang of it all. I asked the patient a question to which I received no reply. I asked my question again and the patient didn't move. Just as I am about to switch from "easy ride" to "get me there!" mode I noticed him pushing his pulse ox off of his finger very slowly. I asked him another question, this time even louder, and he opened one eye, looked at me and said "I am very sensitive to noise, would you shut up?"

The rookie looks at me with "WTF?" written across his face. I tell the patient I will talk quietly to him but that I need him to answer my questions. I ask medical history and I am told he is "sensitive to light, noise, smells temperature and people in general." He asked me to turn off the light, he told me the oxygen smelled horrible (we'll look past the fact that he probably hadn't showered in a few days...) he told me I talked way too loud, even when I whispered, and that the ambulance was too bumpy. Then he fell asleep and started to snore. In our 20 minute ride he woke up every few minutes to complain about the light, the smell, the bumps, the weather, the color of my hair (yes the color of my hair), the Redskins game, the fact that we wouldn't go an extra 20 minutes to his favorite hospital, and the equipment I had on him. If I asked him a question he would tell me that talking required too much effort but if I said nothing he would complain about one of the above. He would remove the cord from the blood pressure cuff that was hooked to our Lifepak 12, then he would remove his pulse ox every time I put it back on and he would do this without ever opening his eyes.

When we transferred him into the hospital bed he curled up into the fetal position, told the nurse to go away and then asked her to bring him water first. When the nurse asked him what exactly was wrong he said "my back hurts and I'm tired. I just need sleep. Can't I just sleep and you come back in a few hours?" He never told me his back hurt (even after I asked specifically) and told her he never had nausea/vomiting and that I was just rude. The nurse and I smiled at each other, you know the smile of "I'm sorry, I can't help who calls 911 and isn't he a fun patient?" I went back in to his room about 10 minutes later to drop off the cigarettes he had left in our ambulance, there he was snoring loudly. The nurse told me he said he just needed a place to sleep. The worst part? He was only 3 miles from home when he called 911.

Motel 6, we'll leave the light on for ya!

Saturday, October 25, 2008

My First Call....

I searched my closet for a light blue shirt, and dark pair of pants. Until I finished my required training period, I wouldn't be assigned a uniform, but still needed to look the part. Wincing at the bright orange of the "trainee" coat, that screamed FNG from a mile away, I packed the pockets with pens, paper, gloves, my wallet, my cell phone, more pens just in case, tissues, trauma sheers....anything I thought I could possibly need during the 6 hour shift.

Totally gung ho, ready to "save lives" and "do good in my community," I bounced my chipper bubbly self into the firehouse all full of smiles, agreeableness, and interest. I was secretly trying to hide the fact that I was terrified of what I might see, and that I would kill someone.

5 hours later, all I had done was spend an hour and a half inventorying the rig, and gone out to dinner. The perkiness was starting to falter. The nerves were starting to win. The rest of the crew sat in the day room, and watched TV as calmly as you please. Outwardly I was watching with them, but inwardly I was having self doubt. Is this all you do on a volunteer ambulance?? Watch TV and go out to dinner?? What have I gotten myself into?

Beeeeeeeeep-BEEEEEEEEEEP-beepitdy beepitdy BEEEEEEP....the tones dropped 15 minutes before the shift was supposed to end. The sound echoed off the walls of the bay, and reverberated in my stomach. This was it. My very first call on an ambulance. All fatigue cleared away, my adrenaline started racing. I was holding my breath in anticipation, just waiting for the dispatch to come back with details on the call.

My crewmates slowly disengaged themselves from the couch, muttering under their breath, since it was so close to time to leave. Most calls in this town average about 2 hours, between the ride to the hospital and back, and scene time. They wouldn't see their beds for a few hours, and weren't happy about it.

"Dispatch to MVEMS, respond Priority 1 to 15 All American Street for the cardiac arrest, possible DOA"

17 words that made my heart almost stop, and my stomach find it's way to my throat.

Wait. It's my first call EVER. Can't we start with something easy, like a broken arm or like, a kid falling off a skateboard?

The drive to the house goes by in a blur. The driver is talking to me, calmly, and gently. He can sense my fear. I'm trying to hide it by acting totally calm and natural...asking what size gloves everyone would like, what did they want me to carry, making idle conversation. But my hands are shaking.

When we arrive, PD has confirmed the DOA, and just wants someone from the service to come in and pronounce. We cancel the medic, one EMT goes in with PD to do the dirty work, and PD asks the rest of us to hang tight, to not mess up their crime scene.

Then a family member runs out another door: "My mom just fainted!!! You have to help her! The shock was too much for her!"

The rest of us go inside, where a very nice family has just received the news. Their brother or their son was found dead in his own bed in the apartment off the family's house. His brother went out to the apartment tonight to ask him something, and found him. His family is overcome with guilt and mourning.

The mom of the deceased sits on a couch. She is supported by her daughter-in-law. The trainer tells me to get vitals. I step up, and gently ask her if I can take her pulse and blood pressure. She looks at me with sad eyes, and agrees. She begins to cry again, as I try to talk gently to her. My hands shake again, trying to take her blood pressure. The trainer becomes inpatient with me, telling me I'm taking too long. She grabs my arm, and drags me back, and takes over.

The trainer turns her back to me, effectively cutting me out of the entire evaluation. I have been dismissed. I stand there, and try to send comforting smiles to the family, completely unsure of what I should do now. I feel like a fool.

I'm worried. I'm thinking that I've failed at EMS, since the trainer snapped at me.

We leave the main house, and the trainer tells me that I need to see the DOA, so that she can review the steps for DOA's. I'm dragging my feet. At this point, I shook during a blood pressure. She must think the worst of me. It's not that I don't think I can handle a DOA, its that she is making my nerves freak out, because I think she's thinking I'm a moron.

She brings me over to a cop, tells them in a brusque voice "She's never seen a dead guy before, so I'm bringing her in" The cop looks startled. OK, so maybe it isn't just me that she's short with.

The gentleman is lying on his bed, sprawled out, face down in a pile of vomit. The smell of booze fills the air, as we see bottles of beer laying around the room. At least the alcohol is kind of masking the other smells. It's a summer night, and the air conditioner doesn't appear to be on in the place.

He's been gone for a while. The family reported that the last time they saw him was on Friday. It's Sunday...whoops, technically Monday now. He very well could have been gone all weekend. The trainer walks right up, grabs my gloved hand, and forces me to touch him. "That's what rigor feels like, and see that? That's lividity" and she begins to cover our DOA protocols.

My first call taught me a lot of lessons. The biggest one was that I will never ever be that kind of trainer. I will never ridicule my students, or make them feel humiliated for being scared. I understand the lessons she was trying to teach me, but I will never repeat them in the same way for anyone else.

Since that day, I hold a special place in my heart for the newbies. You can spot them a mile away, in their hideous orange coats, and from the nerves written on their face. We've all been brand new at this at one point or another. Remember your first call?

Friday, October 24, 2008

Too Drunk To...

Circa mid-1990's

The tones knifed through the quiet air of the squad building. It was the beginning of summer and I was enjoying the warm night air with my a few of my compatriots, when the call came in.

"It's been quiet all day." Jake replied, walking to the dispatch phone to acquire the info for the call.

"Too quiet for a Friday night in fact," I replied, "I hope you didn't just start something when you said that."

Pausing for a second to note the sarcasm in my voice, Jake wrote the call information on the board and made his way over to the rig.

"So are you going to tell us what and where, or do we have to guess?" Bill questioned, some agitation behind his voice.

"Sorry, MVA, lower main. Car into pole." Jake responded, now picking up his pace. It was as the seriousness of the call now dawned on him as he heard his own voice.

"What?!" I blurted, falling in behind the two senior members as they made their way to the rig.

It was my second year as a member. And even though we were a small town rescue squad, I had been apart of some serious and heartbreaking. Even with a year of calls under my belt, I could still feel the rush as I climbed in the back before the old gas powered battle wagon, pulled out. The once quiet small town night now disrupted by the whine of the siren.

"PD is backed up so they'll be a little late getting there." Jake said, grabbing the portable radio and the jump bag.

No one thought this unusual. A large portion of our calls went with PD back up. Even when the officers assistance was needed.

The trip was short. Two lights and several blocks later, we arrived on the scene of lower Main Street. Unlike upper Main, littered with its well lit houses and stores, lower Main was dedicated more to industry and had no real illumination. Hosting a sand and cement company, this road was always full of large trucks speeding by. Making work on this part of Main Street, very dangerous.

Jake called on scene and the wreck came into sight. There was indeed a car into a pole. Smoke gushed from the now mangled hood and the telephone pole leaned precariously to one side, taking the full force of the impact.

"2 is out. Requesting PD and fire for the assist. Will advise further." Jake relayed over the radio.

Soon the air was filled with the sounds of the fire department overheads. Signaling the membership of the need for their services.

Jake reached over and began to open the door when the driver of the car fell out of his door and ran over to the ambulance!

"Here we go!" Bill shouted, jumping out from behind the wheel to intercept this bloody mess of a man.

By the time I reached the group, they were walking back to the rig. Jake gave me the, "this is a wast of time", look as he passed. Followed by the strong smell of alcohol.

Sitting the man down on the stretcher, the senior members began the usual assessment of the patient. After a minute of sluridly answering their questions, the patient sat bolt upright and began to scream!

"Oh My God!!!! I hit someone!!" Blood now pouring from his open wound on his forehead.

Jake and Bill looked at each other before Bill asked, "You hit someone? Where?!"

"They were standing right in front of the pole! It might have been a child! They seemed close to the ground!"

Without another word, the three of us ran from the back of the rig to the smoking mass of metal!

"Chris, shine the light here." Jake ordered, trying to look under the front of the hood.

After a minute of looking, Jake emerged with a red rage that was pinned between the car and the pole.

"That's not a shirt from some kid is it?" I asked, a lump in my throat beginning to form.

After a second, Jake began to laugh. I must admit I was dumbfounded as to what part of this situation was funny.

"Aaa, I take it that's a no?" I asked, not sure whether to follow along or prepare myself for something gruesome. Or perhaps Jake was getting burnt out.

"Chris, this rage has been hanging here for as long as I've been a member." Jake relieved.

Relief now passing through my body, I was able to take a deep breath once again. "You think he's just so drunk he thought it was a shirt?"

"That sounds about right to me."

The senior guys continued to laugh and made they way back to the truck. I stood up, careful to make sure that my shaking knees would still support me.

Jake and Bill returned to the back of the truck and the now sleeping patient on the cot. After seeing that they were back, the driver sat up again and, in a concerned voice, continued to ask how the kid was.

"Sir, Jake began, with obvious trouble attempting to contain his laugh, "it wasn't a kid. You hit a pole with a rage hanging from it."

After a second of silent thought, the driver began to cry.

"Oh my God, I can't believe I killed a kid!!!"

Stunned the three of us exchanged bewildered glances, not sure how to respond.

"I guess he's too drunk to understand." Bill said, voice full of conjecture.

"Services him right. Shouldn't be drinking and driving anyway," Jake spat.

"Maybe, he'll learn his lesson." I said, shrugging my shoulders.

Other than me, the names of this memory have been changed to protect the innocent, lol.

Thursday, October 23, 2008

The Proposal

"Sir! Sir, can you hear me. Open your eyes for me." I have to shout for my voice to carry over the roaring of the generator.

"Leavesss me alone! I'mmmm ffffine."

The overpowering smell of alcohol pours out of his mouth and assaults my nostrils. I have to turn my head to gasp for a fresh breath of air before I heave. After a few deep breaths, I lean down to fit my head, helmet and flashlight under the bed of the truck.

"Sir, you just flipped your truck like a pancake and now you are pinned underneath. Does anything hurt?"

"Hellll no. I'mm sdrunk asss, assssss... you know. Datsss amnimal."

"Right. I can tell. We are going to get you out of here as soon as we can? What's your name?

"Isssss... itsssss, Shawn."

"Okay Shawn. I'm Bernice. I'm going to put some oxygen on you until we can get you out of there." I am praying it will cut down on the amount of toxic waste coming out of his mouth as well.


"Yes, Shawn. What's wrong? Does anything hurt now? Are you feeling nauseated or light-headed?"


"Okay. Are you sure? Do you need something? Are you cold?"

"No. I wantss sto know ifff youssis marry me. Yous is perty,"

I hear Eddie cough in a vain attempt to cover his laughter.

"No Shawn. I can't. I'm already married. In fact, my husband is the one cutting apart your truck."

My polite decline is rewarded with a string of profanity that would make my Marine brother blush. His tirade also brings forth another cloud of staink. I gasp for another breath of air only to find diesel fumes have permeated my clean air. Great, which is better diesel, or alcoholic gingivitis face?

I spend the next ten minutes asking all the pertinent questions and getting nowhere. I feel like a dog when chasing it's own tail - it is fun, but pointless. I get the nod from the firefighters that we are ready to slide him out. Thankfully, Shawn has decided to put a belt on this morning. At least he has done something to make this easier for me. Greg grabs hold of c-spine and Eddie grabs his shoulders. We rhythmically count and anticipate a smooth transition to the back board. On three we all pull, but nothing happens. I look under the truck to find his hands neatly folded together on his chest.

"What is he stuck on?"

Three men in black and reflective tape army crawl under the bed of the truck to find me an answer.

"Nothing. He's free. Go ahead."

We count again and again are met with resistance.

"What the hell?" Now I'm getting pissed. "Jeremy, get under there and tell me what he is stuck on."

"He's not stuck on anything Bernice. You are clear."

This time we don't count out loud. And low and behold, he moves. That is until he gets a hold of the bed of the overturned truck.

You dirty little rat! "Shawn! Let go!"

"I ain't goinnng to no hoschpitalll."

"You really don't have any choice Shawn. We can do this my way, or the hard way. And trust me, you don't want to do it the hard way."

"Itscch okay. I like itsch rou-tough. Rough? Tough? Yeschh, pleasche hurt me."

By this time, Eddie is in a full blown laughing fit. And so it half the department.

Thankfully, Shawn was far too amused with himself to remember he was trying to stay under his broken Dodge as long as possible and with one swift motion he was removed from the twisted metal. He decided to behave himself for the remainder of the call thanks to the man with the shiny star on his chest looming over him.

Sometimes being an EMT is scary but this has put a whole new deinition to the term. But hey, at least I know I make turnout gear look good, even if it is through beer goggles.

Wednesday, October 22, 2008

House of Horrors

The house was ready for Halloween. A graveyard decorated the front yard, a mummy hid in the bushes, a scary black cat waited for us on the porch, next to a zombie locked in a cage. The side door was open, the house dark. The door creaked when I pushed it. There was some commotion coming from the upper floor, I started toward the stairs. My old partner, Renato appeared at the landing, a forty year old woman dressed in pajamas at his side.

"She ate Dominican Rat poison," said Renato. "Her kids are upstairs."
"Get her to the truck," I said, Renato and my new partner, Rob walked her out of the house. I went upstairs. Two kids were there, with Miles, the officer of Engine Co. 11who had been called to assist and had arrived on scene a few moments before Rescue 1.

"I'm on the phone with her husband," said Miles. "Trying to get the package. Take Renato if you need him, we'll meet you at the hospital." The kids father had been with friends a few streets away. The woman went there, and there she ingested the poison, then drove home to her children. Oliver, the third firefighter from Engine 11was with the kids, a boy about twelve and his ten year old sister. They tried to be brave but tears flowed freely down their faces. Their parents have been "having problems," their mom said she's had enough and decided to "end it."

I walked out of the home, school papers stuck to the refrigerator with cheerful magnets, family pictures on the walls, certificates of achievement framed and displayed. Dinner dishes sat in the sink, waiting to be cleaned and put away. Everything here looked to be in order, but something was terribly wrong.

In the truck, Renato and Rob had the patient on oxygen, an IV established and were running an EKG. Although her vitals were stable, 128/72, HR 70, sp02 98%, the poison was starting to take hold. She was diaphoretic, foaming from the mouth and started convulsing. Her breath smelled like insecticide.

Rob drove to Rhode Island Hospital, Renato comforted the patient as best he could and I contacted the ER. A room waited for her when we arrived. The ER doctor "Googled" Dominican rat poison and came up with a treatment plan, Atropine and a lot of it.

We did all we could, then left her in the ER. Her prognosis is not good. She may be gone in twenty-four hours. I drive by her home on the corner often. I hope I don't have to add it to all the others I avoid. After seventeen years on the Providence Fire Department, I'm running out of happy places.

*Update, 2300 hrs., Wednesday.

I just talked to the RN and doctor who treated our patient. The poison she ingested is called Tres Pasitos ("Three Little Steps.") Shortly after we transported her to the ER her convulsions and abdominal pain increased, she was unconscious, incontinent and eventually went asystolic. 40 units of Atropine were administered in the ER. She is now stable in the MICU.

My old partner, Renato, who is actually doing quite well as a firefighter on Engine 11 helped considerably with his Spanish language skills. Had the patient been treated for "normal" rat poisoning, which are anticoagulants such as coumadin and their long acting derivatives, she in all likelihood would have died.

I love a happy ending and hope the patient gets all of the help she needs.


Hi, I'm Sheri, and I run with a tiny volunteer agency in Southwest Virginia. We average about 700 calls a year, and the majority of those are "I stubbed my toe, take me to the ER". I wish I had the funny, crazy stories that I love to read, but the reality is, the last month of night calls for me have been nothing but a great nights sleep.

So why am I posting today? Because last night at our building we got the best laugh out of the new song released by Brad Paisley. Now, whether or not you're a country music fan, if you're in EMS, you have to be a fan of at least the title. Oh, what is it you ask?

Cluster Pluck. 'Nuff said.

Monday, October 20, 2008


After a really long 12 hour sift yesterday. I had some time to sit and reflect on some of the calls that we responded to. At first glance, they weren't anything out of the norm for an EMS crew to respond to. First was the DOA (Dead On Arrival), followed by several refusals, two MVCs and then one poor gentleman with leg pain. It was this gentleman that tied it all together for me. Now the following description might make some people sick to their stomachs, so you might want to skip ahead.

We were dispatched for leg pain and we walking into an elderly man living with his developmentally challenged older son and his neighbor who was just there to help clean him up out of the goodness of her heart. The sad fact of the situation was that this man should really be under supervised care. He is bed ridden and covered in sores.

As we walked in, we discovered that he was unable to speak so the only way he would get people's attending was to demonstrate what he needed. At the time of us walking in, he needed to be changed and to get everyone's attention he decided to throw his feces at everyone in the room. Now barring the cleanup before we packaged him up for transport to the hospital, the rest of the trip went smooth.

After the shift was over and all things settled down, I began to think about how alone these people must be. My DOA was found in a field, face down against a fence in the cold. Covered in blood and not a soul around. My elderly gentleman was in a warm bed and still alone in a room full of people.

Most days are like this, seeing people at some of the worse moments of their lives. And some days it just reminds you that in the end, we all die alone.

Sunday, October 12, 2008

Am I The Only One?

I had to take a vacation from work. Life on the ambulance was overtaking every other aspect of my life. I was thinking about work constantly. Being woken up in the middle of the night, heart racing, sweating, because I was dreaming about work. It's my full-time job that does it to me, though. I only have nightmares about that place. I only act like a raging lunatic when I'm at that place. I'm calm, collected, and almost zen-like at my part time job. Am I crazy, or is the environment where I work that toxic?