question: emt job in the big city

[disheveled_dave]

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Hi all,

I am a premed, planning on taking a year off after graduation (2006) before med school (2007). I would like to use that time, and perhaps some of this upcoming school year, to work as an EMT. I've wanted to work this job for years, and I will finally be getting the cert either this autumn or winter, and will plan on looking for a job immediately after.

My question deals with the practicality of finding EMT work in a big city. I am in Seattle, and I was speaking to a rural doctor about this question. He told me that big city EMT's tend to be people who are in it as a career, and finding part-time or temporary (1 year) work would be next to impossible, as the job force is pretty much dominated by the career-types. However, I've also talked to some of the MA's and docs in the Seattle ER where I volunteer who say just the opposite. Does anybody have any input as to who is more correct? Thanks in advance for any help

PS, I can honestly say that the EMT work and emergency medicine is a genuine interest of mine, and not just for application-padding. I wouldn't get the cert and not do anything with it, nor would I take on a job I don't want just for the credit. Just wanted to clear that up in case anyone was wondering 😉

 

[Jambi]

I don't think is should be difficult to find an EMT job. You can either find a "ER Tech" job or a job working on the ambulance. Of course everything depends on the local job market but I've never had trouble finding a job.

Regarding the Big-EMT jobs being taken by career types, I've experienced the opposite. I feel that an EMT job is more of a stepping stone to other careers.


Good luck.

 

[ockhamsRzr]

You may want to look outside the city for another reason: skills.

Generally speaking EMTs in the city are bus drivers. For example in Boston, you are NEVER more than 5 miles from any hospital and so the kinds of interventions you can do compared to an EMT in rural New Hampshire or other places with less hospital density is far less.

Medical protocols reflect this and as such you'll be allowed to do more in the sticks than in the city.

I don't think is should be difficult to find an EMT job. You can either find a "ER Tech" job or a job working on the ambulance. Of course everything depends on the local job market but I've never had trouble finding a job.

Regarding the Big-EMT jobs being taken by career types, I've experienced the opposite. I feel that an EMT job is more of a stepping stone to other careers.


Good luck.

 

[leviathan]

Hi all,

I am a premed, planning on taking a year off after graduation (2006) before med school (2007). I would like to use that time, and perhaps some of this upcoming school year, to work as an EMT. I've wanted to work this job for years, and I will finally be getting the cert either this autumn or winter, and will plan on looking for a job immediately after.

My question deals with the practicality of finding EMT work in a big city. I am in Seattle, and I was speaking to a rural doctor about this question. He told me that big city EMT's tend to be people who are in it as a career, and finding part-time or temporary (1 year) work would be next to impossible, as the job force is pretty much dominated by the career-types. However, I've also talked to some of the MA's and docs in the Seattle ER where I volunteer who say just the opposite. Does anybody have any input as to who is more correct? Thanks in advance for any help

PS, I can honestly say that the EMT work and emergency medicine is a genuine interest of mine, and not just for application-padding. I wouldn't get the cert and not do anything with it, nor would I take on a job I don't want just for the credit. Just wanted to clear that up in case anyone was wondering 😉

Your friendly neighbours up north (Vancouver BC) only employ paramedics in the metropolitan area who have been working part-time on-call shifts up north for at least 5-6 years. In other words, people who are dedicated and in it for the long haul are the only ones who seem to find positions as they open up down in Vancouver and surrounding areas, as they are the only ones who are willing to stick around for several years working for low wage and few hours per week in a northern rural city. So I guess it can vary from state to state / province to province. Good luck though!

 

[niko327]

You may want to look outside the city for another reason: skills.

Generally speaking EMTs in the city are bus drivers. For example in Boston, you are NEVER more than 5 miles from any hospital and so the kinds of interventions you can do compared to an EMT in rural New Hampshire or other places with less hospital density is far less.

Medical protocols reflect this and as such you'll be allowed to do more in the sticks than in the city.

Taxi drivers?, that really hasn't been my experience. Though probably not the best first job, big cities are the best places for experience. There's alot more serious trauma, and just about everything else because of sheer volume, especially in lower socio-economic areas. Rural areas can go several hours without calls, so as far as experience is concerned, a major metropolitan city is the best place. Only problem is, city EMS jobs are typically more difficult to get because they tend to go with experienced providers. So your doctor friend is quite right. Working in a big city is probably not the best place to start out as a new EMT, because it's not the most forgiving place to make rookie mistakes. Rookie mistakes are a part of life when we all start out, I made them, you'll make them, and just about anyone who's been an EMT for any appreciable amount of time has made them.
Why don't you try volunteering your time in a community EMS system, or working for a private ambulance company or maybe contact the major EMS system in your area for a ride-along, if you spend a week doing ride alongs you'll quickly see what I mean. Anyway, best of luck.

PS. I saw that your post said you're in Seattle. Seattle has got MEDIC One as their major EMS provider if I recall. They are probably the best system in the country! If you can get a ride along with their ALS (Paramedics) you're gonna friggin love it, they've got great latitude and one of the best reputations out there. Seriously, try and get a ride along with them, it'll be well worth it.

 

[deleted6669]

the medic -1 guys are top notch....they have protocols for everything, even tpa and subclavian lines in the field. I took atls at harborview a few years ago and the medic guys helped out with the scenarios. nice folks.

 

[disheveled_dave]

Taxi drivers?, that really hasn't been my experience. Though probably not the best first job, big cities are the best places for experience. There's alot more serious trauma, and just about everything else because of sheer volume, especially in lower socio-economic areas. Rural areas can go several hours without calls, so as far as experience is concerned, a major metropolitan city is the best place. Only problem is, city EMS jobs are typically more difficult to get because they tend to go with experienced providers. So your doctor friend is quite right. Working in a big city is probably not the best place to start out as a new EMT, because it's not the most forgiving place to make rookie mistakes. Rookie mistakes are a part of life when we all start out, I made them, you'll make them, and just about anyone who's been an EMT for any appreciable amount of time has made them.
Why don't you try volunteering your time in a community EMS system, or working for a private ambulance company or maybe contact the major EMS system in your area for a ride-along, if you spend a week doing ride alongs you'll quickly see what I mean. Anyway, best of luck.

PS. I saw that your post said you're in Seattle. Seattle has got MEDIC One as their major EMS provider if I recall. They are probably the best system in the country! If you can get a ride along with their ALS (Paramedics) you're gonna friggin love it, they've got great latitude and one of the best reputations out there. Seriously, try and get a ride along with them, it'll be well worth it.

Thanks to all for the replies. I do agree with ockhamsRzr about the possibility of "doing more" as a rural EMT based on more relaxed protocol, but when I was shadowing the docs at a clinic for a 3,000-person town, their ambulance crew got only one call the entire day I was there. I know my one day at the rural clinic may not be representative of the life of a rural EMT, but needless to say, they were very bored, and what I'm looking for in the next year or so is as much experience as I can get.

Thanks again to all, and any new advice regarding the original post is much appreciated! 😎

 

[fiznat]

Yeah, I disagree with the conclusion that rural EMT's/Medics have better skills because of longer transport times. I work in a fairly large city (Hartford, CT) with a very high call volume, and I have to say that the amount of calls we get and the types of things we see/do are leaps and bounds above what I used to do as a more rural EMT in my home town. True, transport times are sometimes shorter (although not always), but any good EMT or Medic will have a certain amount of stuff done before getting to the hospital regardless of how long the transports are. Even in some of my longer transports back home, Assessment/IV/Cardiac monitor/Bloods/Glucose/etc and whatever meds needed to be pushed was pretty much all that got done. The EMT, even paramedic scope of practice isnt so wide that it really takes (or should take, rather) any extremely long length of time in the back of the rig. Quite the opposite, actually: I've found the the most highly skilled EMS personnel are able to get things done quickly and efficiently on short transports, not spread things out and take forever.

As far as finding work in a large city, I doubt it is much of a problem. I am pre-med as well (post bacc), and I had NO trouble picking up a job in Hartford. The volume is so high in big cities that the companies are usually constantly hiring... and while you may get some crap for being a premed from your partners, I have found EMS EXTREMELY rewarding, both for experience/skills as well as for giving me examples every day why it is that I want to keep on this path towards EM.

Go for it!

 

[bennyhanna]

Experience.

I am a certified but not praciting EMT. I practiced in rural WY for 2 years and in Phoenix, AZ for 2... I can say, the more rural, the more experience.

However, in the big city, it is not uncommon to find an EMT ER position. This would be where you could get a vast amount of experience without having to taxi drive.

Since you are pre-med, you may also consider woking as a Nure Aide... it is good for future doctor's to have respect for all professions, and what better way to learn it than at the bottom?

However, I've noticed that if you're looking for a cocky attitude, then EMS is your place.

If you do get a job, please realize that your training or the EMS/EMT myths that they really are "doctor like" and "better than nurses" are just that, myths. (some (many) do have this outlook, and some do not, I realize, so save your posts).

EMS is a good 'hands on' experience, but you can teach a monkey to intubate, start an IV, etc. Good patient care skills come from good patient contact, which you can find in the ER, or as a hospital CNA.

bb

 

[southerndoc]

Couldn't agree more with Benny... good patient care skills is what you should focus on as an EMT, not trying to learn additional technical skills.

 

[Doczilla]

I have to agree with several of the above posts. As an EMT in the city, you will get more call volume and thus be exposed to more stuff. On the other hand, you will frequently be relegated to simply "driving the bus" on any ALS call. At the same time you will get good exposure to seasoned ALS providers and will be able to learn how they handle scenes and deal with patients, bystanders, random weirdos on the street. You will also learn how they prioritize patients, how the patient condition affects their line of thinking, and how they sort the truly sick from the relatively stable with subtle signs. If you're looking toward medical school, this will be far more valuable than learning how to splint an arm or administer nitroglycerine.

Rural services have less call volume, but you may find yourself in more of a BLS environment. Thus you may have more opportunities to manage the scene yourself. Nothing like being out there on your own to quickly find your deficiencies in scene management. This may help you to learn the all-important skills: adapt, improvise, and overcome. The longer run times also give you the opportunity to hone your patient relations skills.

ER tech jobs will get you familiar with some of the nitty-gritty of patient treatment and management, but may not really get you close enough to the thought processes that will be valuable to you as a physician. Depends on where and with whom you work.

All of the above is fairly meaningless, however, if you can't get a job. EMT jobs are a dime-a-dozen (and about that much per hour) for transport services, but be prepared to haul people back and forth to dialysis all day. ZERO learning value there. Getting on with a decent emergency service might be more difficult, but put in your application. If there are volunteer agencies in your area, apply now so you can get oriented and go out on runs as an "observer" or "assistant" prior to getting your EMT cert. This will also afford you the opportunity to get to know the crews and the service. It may also save you some time in the long run. Few services will hire you or take you on as a volunteer for only a year (non-emergency transport services being an exception), so I would withhold that information. Hey, you never know, you might like it enough to do it for a few more years before med school.

Hope this helps. Good luck to you.


'zilla

 

[bennyhanna]

Don't forget to add the extended down times, the possibilty of having a shift with no calls, few ALS calls etc... 'seasoned' paramedics can be of help in learning some tricks but still the patient care aspect really isnt there. Patient contact is 5-30 minutes, and you're done. (sometimes longer). Though, it might be good to see how EMS interacts with other healthcare providers for a future doc to better understand interbuisness relationships.

I tend to think from my personal experience that many medics feel themselves to be 'doctor-like', and better than many other healthcare providers, especially nurses. And, sometimes vice-versa.

Regardless.... working as a medic will get you skills (which you will learn in your specialty anyway), working a more patient oriented facility will get you bed side manner, something that will benefit you beyond technical skills.

 

[Siggy]

There is always a flip side to doing interfacility transports. I started working a couple months ago with one of the larger private ambulance companies in Southern California. All we do is inter-facility, and yes, I've had plenty of days of going to and from Gambro or Davita dialysis clinics. On the other hand, we get a fair number of con-home ER calls. This being said, the term "Skilled Nursing Facility" in my area is an oxymoron, so we get a fair number of calls that should be ALS calls.

Here is the trick. County policy is to transport if medic ETA and assessment is less then the time to a hospital as long as you have enough people to transport (i.e. full arrests, etc). So, 78 y/o female, full code, with a BP of 50/30, pulse of 100 and very irregular, unresponsive, acute onset rhonchi that is audible at the door, as well as the nurses reporting that Pt. spO2 is anywhere between 60-82 ON 15 LPM via NRB is not only MY patient, but since we're only 7 minutes away from the nearest hospital code 3, we're within protocol to transport without medics.


Is all of our calls like this? No, but they do happen on a regular basis.


Essentially, here is how it is in my area:
Interfacility Transport:

Pro=EMT-B on scene first on all ER calls, makes decisions in regards to transport and Tx, including paramedic intercepts.

Middle: BS ER calls.

Con=Dialysis, hospice, discharge transports. Nurses getting bitchy because you didn't call medics when you were 0.1 miles away from the hospital.

911 calls:

Pro: More true emergencies. Get to see ACLS interventions more. Get to see places other then Con homes, dialysis clinics and hospitals.

Middle: Extended downtime depending on area (hey, study time).

Con: Medics arrive first about half the time. Always playing second fiddle to medics.

As far as Tx protocols. Yea, it sucks being limited to O2 only. The county doesn't allow for Epi pens, Nitro sprays (both have to be pre-prescribed) nor oral glucose or activated charcol.

 

[Jambi]

the term "Skilled Nursing Facility" in my area is an oxymoron,

I've started referring to them as "UNSF," unskilled nursing facility.

As for the rest of what what siggy said is true, at least in this area (SoCal). When I worked for a private BLS ambulance company I had run into similar situations, they where very few and far between (YMMV). I wouldn't count on it for experience. By far the best experience I got was from a 911 service provider, there is no two ways about it, even if you end up driving most of the time you still get some great experiences.

 

[slb]

So how hard is it to get an ER tech job with an EMT-B cert? i am thinking about getting certified next semester with an eye toward the ER tech job. I live in Chicago. I would guess that it might be do-able to get the job, but that the pay might be crap. i won't be going to MS for 4 yrs probably so i need to work for awhile... be nice if i could afford rent...

 

[bennyhanna]

So how hard is it to get an ER tech job with an EMT-B cert? i am thinking about getting certified next semester with an eye toward the ER tech job. I live in Chicago. I would guess that it might be do-able to get the job, but that the pay might be crap. i won't be going to MS for 4 yrs probably so i need to work for awhile... be nice if i could afford rent...

Depends on where you are, the location of your hospital, and their need. I applied at my hospital (Ft Collins, CO),for 2 years as an EMT, and got hired as a hospital wide nurse aid (which I don't mind as it dispelled severall of the myths I learned in EMT school and from fellow EMTs about the inferiority of nurses, and you get to deal with and learn much more about medical devices and equipment that you'll never see as a medic). But at least I've got my foot in the door.

I would suppose its a more difficult job to get (and it may help if you know someone in the ER) because you actually get to preform your EMT skills, you're not taxi driving, the down times are negligable compared to street EMS, and in many cases (depending on your state, local and city laws), you get to do more as delegated by your supervising physician(s)... so, for many it has many pro's over the street EMS job(s) for about the same pay.

 

[Cocosiss]

I am interested in taking an EMT-B course and, Just to get the feel of things just get my certif in Emergency Vehicle Operator (Just be the driver). Or do you think it's a good idea to just get straight to the EMT course?

Also is the EMT course really stressfull, does it have a whole lot of the medical tech?

 

[sanford_w/o_son]

there is another flipside to the interfacility transports. I've been working as an EMT at a private in Chicago for almost two years. We have some part-timers from the CFD. I was working with one one day, griping about not doing emergency calls, when he reminded me that in doing interfacility transports you get to observe and learn about (through dealing with pts and seeing their charts) the "chronic disease" side of medicine. Since chronic conditions reign supreme in 21st century illness, this could be good learning experience for a pre-med (especially if you're not thinking about EM).

i also agree that my skills in dealing with pts has gone up considerably. Never before have I felt so adept and salesman-like in talking a hostile psych pt into coming along for an involuntary commitment. I've also had to bring a 22 year-old with lung cx and his family to a hospice, and when someone's elderly mother asked me if she was going to "another hospital" from the ED I had to talk to her daughter on the side and try to help answer this stranger's question about whether she was doing the "right thing" by sending her mother to a hospice (I also had to make my own ethical decision about what to tell this dying pt with dementia about where we were taking her).

It is also the case here that we do "emergency" calls from nursing homes and residences (especially those who want to go further than where the CFD will take them--the closest hospital), but it's quite often not a "true emergency" (usually psychs or those who are stable after a fall) and the emergency calls rightfully tend to go to the medics.

CFD has a monopoly on 911 dispatches here, and it's such a long enough waitlist for people wanting a career on CFD to get a job that I really don't think they would want someone with non-career goals.

slb, getting a job on one of the many privates with no experience is very easy. ED tech job is more difficult. Many want paramedics and it usually comes down to connections anyway. Another good thing about a private, I suppose, is that you can get to know job connections--er, um, staff--at EDs across the city . . .

but despite the overlooked positives, I would want to work 911 only any day.