Proud of my profession….paramedic

What is a Paramedic?

“Next To Creating A Life The Finest Thing A Man Can Do Is Save One” — Abraham Lincoln.

A paramedic is the closest thing to a doctor the public will ever see outside the hospital. Lets face it; doctors don’t do house calls anymore. Besides, they don’t teach doctors or nurses to deal with the chaos and limited resources of the streets. Being a paramedic is 25 % rescue work,25% social worker, 25 % street smarts, 25% medicine, and 100% being quick and adaptable.

It takes (average) about two years to be a paramedic. First you have to be an EMT. An EMT does basic care, administers a few limited drugs (oxygen, adrenalin [we call it epinephrine] for allergic reactions and others) and has some basic knowledge of common medical conditions. The paramedic does all that and a lot more. We do “physician level” emergency skills, give emergency drugs, and have extensive knowledge for common medical conditions. But there is a saying…every good paramedic is a great EMT. Meaning without the basics, the fancy stuff will not matter.

Why be a paramedic?

A lot of people ask me why did I become a paramedic, instead of a nurse. On the average, nurses (sometimes) make more than a paramedic. But I am not a person who can sit still for very long. People often think its an “adrenalin rush”. Not for me, besides that’s a myth after the first year…it’s the “challenge rush” the challenge of figuring things out, solving problems, all at three AM in a ditch or cold apartment, and knowing you did the job better than any other profession could have in that situation.

Its also, as a friend of mine said about answering a “Call to duty”. I think everyone has that need to be part of something greater than them, something that means something beyond computer code, financial reports, or what ever. For some it’s a “call to arms” (the military) for others it’s a “call to teach”, some answer the need by doing charity work, coaching football, being a “big brother”. For me it was a “Call for help”. I like the fact that when other people are in a time of crisis, when it’s something that they cant handle, its me they call for help. They are crying, afraid, upset, sometimes drunk, abusive, or what ever, but its still me that comes in and “puts order to chaos” and tries to do some good. Does it always work? Heck no, but it sure feels good when it does!

Paramedics, Nurses, and Doctors:

A lot of fellow professions (Nurses mainly) look down on paramedics. Part of its jealousy, because we do many skills they cant, part of it is just human nature. Some of it is that the average paramedic is truthfully, quite full of himself. Often it is brought up that Nursing programs are 4 year degrees an Paramedicine is not.. Well now more and more paramedic programs are as well. And many are two-year programs, just as there are many two year nursing degrees. A simple way to look at the two professions is this. Paramedicine is where the nursing profession was thirty years ago. Struggling for acceptance. Now Nursing is a recognized profession with unions, lobbies, good pay, etc. Paramedicine in well along that path. Pretty good considering modern Nursing has been around since before the civil war, and modern EMS only for about 35 years.

Paramedics and Doctors, while not always getting along, generally go hand in hand. A paramedic operates under the delegated authority of a doctor who is a “medical director”. This medical director writes down the things a paramedic can do in certain situations, called “standing orders”. This is similar to the “doctors orders” a nurse needs to do something in the hospital, only these are written down in advance. A good medical director takes personal pride in his paramedics, and often is directly involved in their training, giving lecturers, reviewing calls, etc. He takes up for the medics when other people have questions. He educates his medics, when they don’t perform to standard. A bad medical director may give his license, but is only seen when something goes wrong.

Dr. R Adams Cowley

Speaking of good doctors, paramedics owe a lot to the father of trauma medicine, Dr. R Adams Cowley. Dr. Cowley was by all accounts the complete a** hole perfectionist every truly worth wile profession needs to get the job done. This is a plug for a man I never met, but sure do respect, as should all medics. He founded one of the first civilian air medical systems, founded the very first trauma system, and took on every body, I mean EVERYBODY (even other doctors, and politicians) to push good medical care in the field.

It had been while Dr Cowley was an Army surgeon just after World War II in Europe that he first began developing his ideas about quick treatment of the seriously injured people. Dr Cowley developed the idea that there is a “golden hour” just after a serious injury, during which prompt and coordinated medical treatment can save lives. He began with a two-bed research unit at the University of Maryland Hospital in 1961, and worked to build his dream, living to see the opening in 1989 of the eight-story Shock-Trauma Center in Baltimore, which was named for him.

He died October 27, 1991, at the age of 74 at his home. The services were videotaped so they may one day be seen and appreciated by Dr Cowley’s infant son, R Adams Cowley 2nd, who was a month old at the time. He was buried at Arlington National Cemetery in Virginia.

At his funeral he was called “one of the greatest figures in modern medicine . . . around the world.” He was a visionary “decades ahead of his time.” People, who had been credited with intervening to bring Shock-Trauma into existence, testified to Dr Cowley’s unique qualities. “He was arrogant, determined, stubborn and difficult to get along with,” but he had to be, one admirer said, to see his dream through. Another said he was thinking as he peered from his car window on the way to his funeral that “there will be an accident somewhere today, and a life will be spared,” because of the system that Dr Cowley set up. “He was a driven man, a perfectionist,”

Types of paramedic services:

A common misconception is that all ambulance services are alike. Many people will only have come in contact with one or two, or have just seen them on TV, and think that all ambulance services are alike. Here are the most common types, but there is wide variance in how good the service is.

Fire Based: These guys may or may not also be fire fighters, but they are employed by the fire department. They are usually union, and typically have good benefits and pay, as well as a career ladder. These guys sometimes work off of a fire engine with medical equipment as well. The down side is sometimes the medicine comes second to the fire fighting side.

Hospital Based: These paramedics often are employees of a particular hospital. Law prohibits them from restricting transport to just one hospital, but usually they prefer to transport back to their sponsor. These medics often work in the emergency room as well. Benefits and pay vary widely, but they usually get to see a wide variety of things in the ER.

Private services: These paramedics have work for a private company that is usually contracted to provide a service for an agency or government body (like a city). While there are exceptions, there generally is very little pay, poorer benefits, and a lot of instability. These companies run for profit first, patient care second, and employees last. The most well known examples are Rural /Metro and American Medical Response (AMR)

Third Service/Public Utility: Basically governmental department that is separate from other agencies, similar to a fire department or police department, to cover a geographical area. The benefits, pay and quality vary widely, from very good to very bad, depending largely on tax base of the county or city, but stability is usually decent.

Others: there are still some (rare) police based services, funeral home based services, services that are attached industrial companies, as well as other unusual types. These all are very uncommon.

Paramedic options:

There are a lot of options in being a medic, after you get experience. There are paramedics who train to go into special rescue situations (mountain rescue for example), paramedics who go with the swat teams, there are medics who work in very isolated areas (like oil rigs, ships, etc), that function with a lot of independence. There are critical care paramedics also. These used to be mainly flight paramedics, but more and more these teams are working on ground units too, so “flight” doesn’t really apply anymore. Paramedics, in many places also may work in the emergency room, working similar to nurses. There are paramedics who now do nothing but teach EMT and Paramedic courses. There are paramedics who are safety officers for large companies.

Choosing a paramedic program:

First and foremost, you want a degree. That means a college or university. That is the way this profession is heading, at least a two year degree. You also want an accredited program, that has been teaching paramedics for at least 3 years. You want them to provide you a list with clinical sites, as the ones with clinical sites at the better hospitals and larger ambulance services generally have their act together. Also, check with the state board of EMS to see if there is any action pending against the program you are looking at.

There are 9 month and 6 month programs, just like 30 years ago there were non degreed “diploma: programs for nurses. Stay clear of those. No one can teach you what you need to know to be a good paramedic in 6 months.

Also look at where your final “field internship” will be. Sometimes courses will set up internships across the country at large services like Las Vegas, or Galveston. This is usually a very good sign, but be sure it isn’t because all the local services have black balled the program.

My personal history:

I am a Paramedic. Pure and simple. I have been involved in EMS (Emergency Medical Services) for about 11 ½ years, as a paramedic since 1995. I was always the geek kid in school with only a very few (but close) friends. If someone told me then I would be a paramedic today, I would have thought they were smoking dope. Now, I cant see myself doing anything else. When I got out of High School, I was most attracted to being a cop, so I went to college for a criminal justice degree. On taking the courses, I found the material to be boring, I wasn’t interested, my grades were falling. So I took an EMT class to raise my GPA. I was instantly hooked. I joined the army a short time after, to “get my act together”. Well I was a “combat medic” in the U.S. Army, among other places I served with the 101st Airborne Division at Fort Campbell Kentucky. In addition I since I had my civilian EMT certification, and I volunteered at several civilian departments as well. So even though I was a combat medic , I got a lot of “non combat” experience in medicine too. (The point to be taken home is that what ever position your in, don’t just sit around, be pro-active, always try to further yourself) As a result of this, I was sent to paramedic school (long story, but the meat of it is that this is a very uncommon thing for active duty outside of special forces). Eventually I got out of the army, and worked the civilian market, tried to build up my resume. Well, there is an old adage about Army buddies and a small world… Basically I had a fellow “combat medic” who also went to paramedic school with me. He moved back to his hometown, and three years later he convinced me t come out and take a look. That was almost 4 years ago.

Currently I am the “ALS Education Coordinator” for Ada County Paramedics. That is a fancy term for coordinating the educational needs for field paramedics. ALS stands for Advanced Life Support, which has to do with everything a paramedic or an EMT does, as opposed to “BLS” (Basic Life support) which is the foundation of ALS and is more closely associated with EMT’s. This does not mean I am a “Desk Jockey”, Besides teaching classes, coordinating other classes, and doing special projects; I still work as a field paramedic once a week (or more) to stay “Sharp”. It’s hard to be respected teaching a topic you are not fresh and good in it. This is especially true in EMS (and public safety in general, and in the military) because there are so many high-energy personalities in this field. In order to qualify, I had to be an experienced and educated field medic, and have proven myself as an educator as well. This is more difficult than it sounds, I know many excellent medics who don’t do well teaching others. It is not a poor reflection on them. I am sure we all know many good teachers who couldn’t apply their knowledge outside of the classroom. Then there are those who do good at both.

Why I enjoy this job:

The job is always interesting, the technology of the industry is always growing, the stuff we did even five years ago is different from what we do today, or what we will do in another 5 years.

The people I work with are all pretty different , there are no set “type” although they are , usually, not shy or meek. As a result even if I have a quite shift, it is usually fun.

What I dislike about my Job:

Well, sometimes it is bothersome when others (the public) take your hard work for granted, as if anybody could do your job. Learning the academics is difficult but by no means impossible. It’s the mentality, the “go getter ,do anything with nothing in the dead of night” attitude; The “testicular fortitude” that you cant teach people. One person put it that a good paramedic is like a green beret. No matter bad things are, he still gets the job done, and done well at that.

Another thing that bothers me has to do the calls. Its not the children, although that too can be rough, it’s the sneaky calls. “Sneaky”, you say, “I wonder what he means.”. Well basically I mean the calls that sneak up on you and stay with you a while. It may not be a tough call, just one that gets past your professional wall and strikes home. Like the little old lady who has no one in the twilight of her life, who lives on a fixed income, but who still has her silent dignity, if nothing else. The little 5 year old who is delighted at the 1 dollar stuffed toy you just gave him , because it’s the best toy he ever received. The family living in a car. Being a veteran , I sometimes ask the stories of some of the older vets we pick up. So many lost stories of friendship, family, war. If you want a generation to look up to, look to the WWII generation. They really did save the world from evil.

Off Time:

What a paramedic does off duty is as different as the paramedic himself (or herself).

Personally, I do a lot of reading, movies, etc. I spend time with my significant other, and I teach a lot.

I know a lot of people who get spend their off time with their family, or go hiking, or are rafters, climbers, hikers, bikers, etc. Its important to have something just for you, or you can burn out quick.

Women in EMS

Often it is assumed that females can’t be good paramedics, or can’t have families, or what ever.

At my particular service we have aprox. 30-40% of our field staff are female, they are all very feminine. It’s true that some are very athletic, but not all. Some of the best medics (you know who you are…) I have ever known are women.

While it is true that it is harder (be comparison) to have a relationship in this line of work, I think it has to do with having a supporting significant other. Many of our females have families, and some are involved (married or dating, or somewhere in between) with other medics (or other related professions – doctors, nurses, cops, fire fighters) themselves!

In Summary

Gone are the days of the “big dumb ambulance driver with a strong back and weak mind” I am proud of my profession, it is my career. It is not for everyone, it is not easy, but if it was, it wouldn’t be worthwhile.