To Stay or Not to Stay....

I've made comments in other posts about my service being shorthanded when it comes to Medics. This has become an understatement. I have only worked for 2 EMS services. The first was a Basic transport service. It started out like many others, a small Mom and Pop operation where the owner still ran calls on the truck. Eventually, sadly, they got a little too big for their britches and forgot about the little people that made them what they were. I left them for several reasons, the major being an increase in my education and I couldn't use it there. Other reasons included several disagreements with the management and the overall day-to-day grind of the place. It just wasn't what I signed on for. So I left.

Now I have been with my current service, an ALS service, for about a year and a half. Not that long by many standards, and I completely agree. But my seniority is quickly growing. This is due to Medics leaving and leaving quickly. In that year and a half about 15 senior Medics have left. And I'm not talking about Medics that have been here for a year or 2. I'm talking about 5-15 year Medics. Some left because of Nursing school, we all know that Nurses on average make a hell of a lot more money, so I can understand that to some degree. Others leave because of personal disagreements with the management, which is inevitable, first rule of management should be that you can't make everyone happy. But the rest? I don't really have a clue.

We have lost a lot of people to "Big City EMS" just down the road. They pay a little more, not much, but a little. Their call volume is 2-3 times greater, they have 3-4 times as many employees and they have the availability of 12 hour shifts instead of 24. They can have a call completed from dispatch to return to quarters in less than an hour. They have a major hospital inside the county and that is where they transport everything, so their turn around time is quick. To me this is a bad thing, you don't get a chance to be a Medic. They vary rarely even start an IV because they can load and go and have the patient inside the ED so quick, there is rarely any point. I can see why some Medics like this. The ones who are lazy or don't know what they are doing and the ones that are burnt.

I'm not downing the urban EMS service. The basic service I worked for was in an urban setting and we ran the basic 911 calls. I have some good friends that work in the urban setting, and I know several great Medics that also work in the big city. It's not for me, but someone has to do it.

Back to the original question.....why do people leave? Maybe it's just me but I was raised to have pride in my work and loyalty to that place. Sometimes things piss me off and I bitch a little, but I'm not going anywhere. I love my job and I love my service. I try to recruit whenever I get the chance. I don't think others think like me in this way. I don't think that loyalty ever comes into play for some people. For me EMS is a career, a lifestyle if you will, not just a job. I may sound corny or pathetic or like a greenhorn, but that's just the way it is for me. I don't live and breath EMS 24/7. I take my time off and I try to leave my work at work and not bring it home with me, but EMS is my passion, I don't know how to say it any other way.

My service is comparable in many ways to other services. We are on average with other services as far as pay. We still work the 24/48 schedule. Time off is great, we generate about 24 hours a month for new employees and that goes up with your vested time in. Other benefits are on par with the area as far as insurance and all that. Depending on which station you are at you could have between a 30 and 90 minute transport time, and that's emergency traffic. Our call volume is fairly low. An average day is 3-6 calls. Each call will take about 2-3 hours from start to finish. Due to our long transport times, we have excellent protocols with a lot of freedom and flexibility. We also have a full drug box with RSI and thrombolytics. I know this sounds like a pitch for employment, its not, just trying to give the reader a sense of my service.

So why is it that Paramedics leave? Is it because of the money? different scenery? different type of service? I'm at a loss on this issue.

Another problem that we along with other services are having is hiring. From the little info that I can glean from out training officer we have very few applications coming in and even fewer who can pass the entrance testing. This is a statewide thing. I have heard that the director of our Office of EMS said that there is a shortage of 2-3,000 Paramedics across the state. Why is that? When I went for my test, there were over 300 people in the room. They broke us up and all of the people testing for Intermediate and Paramedic filled only one classroom which was less than 40. Forty out of 300! That is proof to me that there just isn't that many people going for the Paramedic patch.

I think I'll end my rant here and pick up later after a few comments.

First time...hopefully the last.

Up until this point this has been an EMS blog. My EMS blog. I have been careful not to put too many personal things and experiences in this blog. I'm pretty sure that I am still anonymous, no one has contacted me in an effort to try to ascertain my identity and I want to keep it that way. I have seen too many bloggers, mostly EMS ones that get into loads of trouble all because of not being careful. That being said, I am going to write about something that happened to me today, my day off. This is not an EMS post.

I was at Wal-Mart today. Just nosing around, picking up a few wants and a couple of needs, nothing special. I paid for my things and made my way out to the truck. About halfway there this guy walks up to me and says hi. At first I figured he wanted to sell me something, but his clothes were not that of a salesman. He didn't seem to be homeless, but he did have a bag over his arm. He asked for money. Now usually I don't give money away, I work hard enough for the little I got. But today I was feeling generous. I said sure, I reached into my pocket and pulled out what I had, about $1.30 and handed it to him. He looked from his palm to me, back to his palm and to me again. Then he said "That all?" I just walked away. My truck was in sight and I just wanted to get to it and get home. I heard the crunch of his shoes on the asphalt as he turned. I glanced over my shoulder and he was just standing there looking at me.

At this point my "oh-shit-o-meter" just perked up a few notches. Using my ears as my eyes behind me I just kept walking towards my vehicle. About the time I open the back door to put my bags in I heard him walking towards me. Now, don't get me wrong, I am no coward. But I believe that it's better to turn the other cheek and keep your head down than go looking for trouble. In my experience, enough trouble will find you that you don't have to go looking for it. But if that trouble does find you, be ready.

I opened the drivers door, got in and shut it. I put one hand on the key to start the truck and the other underneath the seat. When the door opened (I had a feeling it would at any minute), I was ready. It was yanked open and there he was, the same motherfucker that I just gave money to. I yanked my peace and stuck it about 1/2 inch from his beady little eyes. It's amazing the amount of white that I could see. I don't remember the color of his eyes, but I do remember the acres of white as he stared into the barrel of my 40 cal.

I wished I could have come up with something catchy to say. Something like Bruce Willis or Clint Eastwood would have said. But this is the real world and I am not afraid to say that I was scared shitless. The only thing I could say was "I don't want any trouble".

He backed up, turned around and walked away. I sat there, put the safety back on and shivered until I had to grab hold of myself so I wouldn't fall out of the truck. When I had pulled myself together enough to form a rational thought I picked up my phone and called the cops. The rest is just a blur. The cops came, I gave a statement. They left. I drove home.

I'm not sure what his intentions were. Maybe he intended to do harm, maybe not. Maybe he just wanted to ask directions. I don't know and I don't care. If he had wanted something, he should have asked when I gave him the money. If someone jerks open my door, either my vehicle or my house, I feel that my life and my family's life may be in danger and I will act accordingly.

For the record: "I am a gun-toting, card-holding NRA member, I also have my conceal-to-carry license and they can have my guns when the pry them from my cold dead hands." There that said, if I offended any of you, just re-read the above paragraphs and put yourself in my shoes. As I said, I don't know what his intentions were, but if they weren't just to ask where the local 7-11 was, then what other reason would he have to follow me and then yank open my door? What if? What if he wanted to take my truck, or just off me right there in broad daylight in the middle of a Wal-Mart parking lot. It happens, just watch the local news any night of the week if you don't so.

So all of you gun-haters out there, you can kiss my ass. This was the first time I have ever pulled a weapon on anyone and I hope that I never have the opportunity to do it again. But I am glad that I have it. I am glad that I had it with me. The only reason it wasn't on my person today was that the Wal-Mart I visit has a no-weapon of any kind, concealed or otherwise sign on the front door. I left it under the seat because of it. I am a law-abiding, gun-owning citizen and I will protect myself and my family if I feel threatened....

This was the first and only time. Jesus, I hope that I never have to again.

Irritated.....

The other day I was sitting in the dayroom and overheard a conversation. There was this medic who just got back from vacation and he was talking to another medic about his return flight being delayed. Now this in of itself wouldn't be a problem. Anyone who has flown more than a few times can sympathise with being delayed, held-up or otherwise postponed at the airport. At this point my interest wasn't peaked.

Needless to say, if I am writing this, eventually my interest was peaked....

I couldn't help but overhear, this particular guy has a very loud "indoor" voice, added by his conviction of how badly he was wronged by the delay. He went on to say that at first everything was fine. The flight was on time and he boarded as usual. The plane took off and everything was hunky-dory. Then he said that about an hour into it he was "rudely" awaken by one of the stewardess asking if he was a doctor or nurse. He said no. Then he asked why? She said that there was someone in first class that was in need of medical attention.

Now at this point, I would have stated that I was a Paramedic and would like to help if I could and then let the staff decide if I was what they and the patient needed/ wanted. Maybe it's just me and maybe I'm just naive, but I would like to think that any card holding EMT, no matter what level, would have stepped up and offered their help. That's just what we do.

But not this guy. He was napping for God's sake! Asshole, I say. He just said no and went back to dreaming whatever dipshits like him dream about. I personally hoped it was that one where he was falling and wakes up screaming and pissing himself.

Anyway, he goes on to say that captain of the plane decided to make an emergency landing to get this person some help. Apparently there was no other person on board with medical training or like him, there was no one willing to step up to the plate and at least try to help. So he was delayed for about 7 hours while the plane waited on the tarmac.

Eventually he found out what had happened. An elderly woman was having a heart attack. Full, classic symptoms: crushing chest pain, shortness of breath, pale, cool, sweaty, nausea and feeling like she was going to die. The kicker was one of the stewardess noticed it and asked her. The patient denied it at first, said she didn't want to bother anyone. That didn't last long because she eventually passed out!

Now this was the point I just had to say something. This is sort-of out of character for me. You see, I am new at this Medic stuff. The ink on my card isn't even dry yet and this guy has been around for about 5 years or so. Not an old-timer by any means, but he's been around longer than I have. I usually try to follow the old rule of "seen and not heard." Someone once told me that God gave you 2 ears and 1 mouth, which do you think you should use more? Plus he was one of the cocky types. You know the ones, the guy who thinks he's King Shit of Turd Mountain, a "Para-God".

But this wasn't the time for that. I put down the JEMS magazine that I was pretending to read and turned to face him. He noticed my piercing glare and asked "What?"

"What?" I said. "How can you wear that patch on your arm and call yourself a Medic?"

"What the hell are you talking about?"

I then proceeded to tell him my thoughts on his actions in a decidedly heated fashion. We ended up nose to nose. My supervisor picked that very moment to walk in. He got between us and split us up and asked what in the hell was going on? I just walked out. He came after me in a few minutes and I told him what the other guy had said and the fact that it pissed me off and I couldn't hold my tongue any longer. I was sorry that I caused a scene, but I wasn't going to apologize to that asshole. He leaned back on his haunches and squinted at me, then grunted and walked back inside.

I got in my rig and waited on my partner. He eventually came and we drove off. He was laughing. I asked him why. He said that our supervisor had come back in and the other medic was still ranting and raving about me and the fact that I had the nerve to open my mouth in his presence and all that bullshit. Well the supervisor told the asshole in question that he should maybe close his mouth and listen to the "kid" then walked out leaving that particular fuckstick with his jaw hanging somewhere down around his knees. It's also both funny and irritating that I am still referred to as the "kid", even though I am almost 5 years the elder of the asshole. But that's another post altogether.

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On a side note, I have heard that airplanes carry full ALS gear on board in the event that someone has a need for it. But there is no one that can use it and that is why they ask for someone with medical training. I am not sure about this, but if anyone who is reading this knows, please leave a comment and let me know.

New Partner....

For the past 4 months or so I have been without a permanent partner. We, like so many other services, are short-handed on Paramedics and I have been with part-timers or my supervisor. I am finally out of the "round-robin" of part-time partners. The higher-ups have deemed it necessary to give me a semi-permanent partner. I say semi because he is on loan from another shift. We are together until I am cut loose to function on my own. Then I will be put with an Intermediate or Basic partner, which are much easier to come by for hiring.

I used to give over my keys to the rig to him every morning, but other than that I know very little because he has not been with the service for very long. We are the same age, but he has been a Medic for about 5 years or so. We have been together for about 2 shifts and have only ran 5 calls. We have been really slow as of late. He does his calls and I do mine, with little talk between us.

The one call that had anything to it was a chest pain. Not sure what his intentions were but he kinda stood back and let me do all the work; O2, IV, monitor and treatment. It was my call, but I am used to working as a team and doing things accordingly. With 2 Medics, you can get things done a lot faster if one is doing one thing and the other is doing another. Maybe he was trying to see how I do things or if I could do them. Either way it got done, I don't think that the patient was having a heart attack anyway, but I treated him like he was. Partner meanwhile just stood there watching then got up front and drove.

I don't necessary think he's lazy. Maybe he's just pissed at being moved against his will, even if it is for only 6 months or less. It took about 3 months for me and my first partner to get to know each other and work well together. He was really quiet at first, then I couldn't get him to shut up. Hopefully the same will be the case with the new partner...

Ratings....

Interesting, I would have thought it would have been at least PG-13...

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The Calm...

A recent commenter posted that this lull I'm having was just the calm before the storm. Well, if the length of the calm has anything to do with the severity of the storm, I'm in for it. For the past several shifts, I have done almost nothing. A few routine transfers, fire stand-by's and one chest pain.

But that one I could do absolutely nothing for. She had major peripheral edema, but her lungs were clear. She has so much edema and her extremities were so swollen, that despite me and my partners repeated attempts, we could not get an IV in place. She had substernal chest pain that radiated to her back and to her left arm. the monitor showed A-fib, a new onset as far as we could tell, with a few PVC's thrown in to boot, other than that her 12-lead was OK. We had her on O2, but that was pretty much the extent of our treatment. She already had her aspirin about 2 hours before our arrival, so that was out. With our protocols, we can not give nitro without an IV in place, so that was out as well.

She made it to the ED, not sure how she fared there, but I hope that she's OK. I wish I could have done more for her pain. I felt pretty useless just sitting there holding her hand all the way to the hospital. Everyone said that I did OK, there was nothing else I could do. But they didn't have to see the pain in her eyes for 35 minutes.

Imagine that.....