What is the lifestyle in EMS like really? (maritime WFR thinking EMS)

[SailorMed]

I gather this is a community largely centered around medical student information sharing? But I think this particular forum has a bunch of career EMS folks posting so I thought I'd ask some stuff here even though I'm not at any point in the med student progression.

I'm a sailor. I work with high school students in non-traditional education programs like Outward Bound and semester at sea. I recently received my Wilderness First Responder training and was really impressed and interested with emergency medicine.

Now I am considering entering EMS as a career and I could use some insider knowledge.

Firstly the dummy newb stuff that I couldn't find on the FAQs, stickies or searches:

What are all these ALS, BLS, ADLS, etc. acronyms?

Second, as a sailor I typically alternate between 4-6 months at sea/4-6 months on land. It seems easy enough to get an EMT-B between voyages. But what about the job? I've worked seasonally my whole life but can you picture an EMT fitting into that schedule? How would your outfit take that?

Once I get my own perspective on the job, I am totally open to changing careers to full-time EMS and leave the rotation behind. But thinking long-term like that what am I really getting into? I am seeking to leave sailing because it is so disruptive to my personal life (I basically die every 6 months as far as all my relationships and friends are concerned). So I have to ask, what is working for EMS really like, lifestyle-wise? What are the hours and rotation schemes? How do you find it impacting your life? I work in harsh conditions at sea, so that doesn't seem too new.

I'm in Chicago. From what I gather here, as an EMT-B I could either be doing transports if I worked suburbs, "blood and guts" super fast paced if I worked in the rougher neighborhoods on the southside or probably a mixture of both if I worked in the more affluent northside. Does that seem like a reasonable eval? How does the fire dept. over-lap with EMS in urban centers do you find?

Lastly--thanks for reading this far--how do I really enter the field? I read a lot of accounts of people getting an EMT-B cert with no prior field experience and not finding work, is that the case? Where should I look as a place to start and what should I expect from: private ambulance services, hospitals, and the Chicago Fire Department?

Considering my highly non-tradition background as a sailor with only a WFR cert and a successful sinusitis field diagnosis and treatment under my belt (yah thorough patient history! lol), what do you think my prospects and misconceptions about starting out as in EMS might be?

Thanks so much.

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[SailorMed]

What are all these ALS, BLS, ADLS, etc. acronyms?

Oh! I finally got it! Basic Life Support and Advanced Life Support right?! Not that I know what that means, but that's what it stands for right?!

 

[jkelly2]

Have you considered Med PIC?

 

[dogpython]

I'll try to help you out a little with the acronyms if I can, take these with a grain of salt as I am writing stream-of-though here

BLS - basic life support (CPR + basic first aid)
ALS - advanced life support
ACLS - advanced cardiac life support
PALS - pediatric advanced life support
BTLS - basic trauma life support
ATLS -advanced trauma life support
PTLS - pediatric trauma life support
CPR - Healthcare provider/heartsaver

most of these are courses that are offered through AHA (American heart association) with various requirements, prereqs, and lecture times

also there are levels of EMT

NR - National registry (many states require this certification/test to certify you in their state)
ECA - Emergency Care Attendent
EMT-Basic/Intermediate/Paramedic
LP - Licensced Paramedic
CC - Critical Care

As far as differences there are many. Basically EMT-B does BLS, EMT-I does BLS + ALS (IV/intubations/a few meds), Paramedic does BLS + ALS + ACLS + BTLS etc...

As far as the work, it will vary service by service. Some are 24on48off, some are shifts, some are 8/12/24hr or any variation. It all depends are the service. Keep in mind some city/county services require their medics to all be Fire Fighters, you just have to see what is required in your area. As far as where to find work, the easiest place is probably a transport service, but it truly does just depend on your specific area and availability. It also depends, as you stated, on the pace and patient population you want to work in (911 vs. transfer vs. combo).

It can be a lot of fun and a rewarding experience. Hopefully I answered some of you questions.

Anyone else feel free to correct me as I am sure I have made a mistake somewhere!

Good luck!

 

[SailorMed]

Have you considered Med PIC?

Yes I have considered Med PIC (medical person-in-charge certificate that satisfies international conventions for medicine at sea, from BLS to minor surgeries to long-term care, IVs, catheters etc.). It looks like an interesting body of emergency medicine covered in the course. As professional development however it doesn't make a terrible amount of sense. The biggest misconception with US Coast Guard licenses is that many people think a cert like MedPIC guarantees employment as a medical officer on a wide array of ships and offshore installations (oilrigs). The reality is that only a narrow range of ships are required to carry a licensed MedPIC. Of that narrow range, the USCG MPIC only applies to US flagged vessels. So in most cases you are over qualified when they are accepting former nurses into the position. Or you are under-qualified since you don't have the addition health experience many oilrigs and the like are looking for.

In my case, the ships I've sailed with designated medical officers were staffed by either former nurses(!) or in one case an EMT-B. So MedPIC while fascinating in its scope, is expensive and overkill in practice in my experience.

Also I worry about redundancy with any EMT training I might do as well. EMT-B and Med PIC both seem to run about $1000-2000 and the courses take 120(?) and 80 hours respectively. So in my mind while MedPIC offers more diverse and in depth medical training, EMT-B is cheaper and actually applicable to land jobs.

If anyone has run into similar overlaps in training, let me know if you just had to eat it or if some kind of credit was administered.

And thanks dogpython, you did answer some of my questions. I guess my big lingering question would be this. Since it really does seem to vary so much by service, being in a service yourself, how would you say is the best way for an outsider to evaluate a service in terms of these questions (shifts, what tasks correspond to which certs, is being a fireman mandatory, etc.)? That was an awkward sentence... basically how do I get to know how EMS works in my community?

 

[jkelly2]

From my observation, the depth of knowledge of the PIC is no deeper than the EMT-B but the skill set is broader. I think there might be a way to test out of the first week of MPIC, so you might be able to take EMT-B and then test out of half of MPIC. The more experience you can gather before handling a medical emergency by yourself at sea, the better. Have you ever been to MITAGS?

 

[SailorMed]

No I haven't been to MITAGS. Yeah, I don't really know much about either MedPIC or EMT-B as to which is more in-depth. And yeah, I'd love to have the most possible medical experience before treating people, especially alone at sea. Right now though I think I'd rather get on the job experience and perspective into the EMS world ASAP. And I think EMT-B will let me do that.

I mean, as far as I know now, I could just not be able to stand the sight of blood or something. My big question at the end of the day I suppose is what's the best way I get in an ambulance and start figuring out how my place int he EMS world? Let me just ask, since it's an assumption I've been making, but with just Wilderness First Responder, I can't even volunteer on an ambulance service, especially in a city like Chicago?

 

[fiznat]

You may not be able to volunteer, but chances are you could to do some "ride along" shifts with the services in your area. It has been getting harder to do this lately because of federal privacy requirements, but it definitely still happens.

I guess I would want to ask first about what exactly attracted you to EMS? I understand that wilderness medicine course interested you, but I think it is important to articulate your expectations so that we can maybe offer you some better advice. A lot of people who get into EMS do it because they think it is going to be exciting all the time, full of blood, guts, and drama. The truth is, 90% of what we see is really frustrating bull****. ...People who don't need to go to the hospital, people who abuse the system, or people who make it impossible for you to do your job well (or at all). We VERY rarely "save lives," and it honestly isn't all that often that I can feel like I really made a "difference" with my patients. You will be the lowest man on the totem pole in a system that revolves around hierarchy, and you will frequently be reminded that your knowledge is at the very tip of a giant iceberg of which you have no real understanding. The pay isn't great, there is usually no pension, very little opportunity for advancement, and if you get hurt you're screwed.

That said, there are a lot of good things about this job as well. You get to be out and about on the streets all day, away from an immediate supervisor and largely in control of your own small world. What happens in your ambulance is pretty much up to you, and I think there is some satisfaction and pride that comes from this ownership of your work. No two days are ever really the same, and at any moment a call can show up that changes your perspective on everything. Things frequently go wrong, but when they go right I'm not sure that there is any experience quite like it.

Hope some of that helps.

 

[SailorMed]

That's a a really good post. The best question I can ask really.

I think it comes down to this for me, even if like 90% of the job is more routine and drudgery, the rest is just a huge challenge. You are put on the spot to be responsible for life-altering decisions in an adverse environment with incomplete information under a severe time crunch. And like you say, this is a unique opportunity in life where you can nearly single-handedly 'own' that moment of importance. I think that challenge would add meaning to the job.

Now I understand that with both feet on the ground all that looks different. Long hours of waiting and drudgery and admin BS etc. in ****ty weather. It sounds like disillusionment in the system in which you operate is a problem too. But I don't think it'll be "ER"-style "CRASH CART, STAT!!" 'saving lives' all the time.

But the simple mundane work of the job seems interesting to me. Working with your hands putting on a dressing for the thousandth time. Or even better the mental problem-solving under time constraints. Tell me, I mean, even if you get a fair share of routine calls that you aren't surprised by and can treat in your sleep, I imagine like at least a quarter to half involve some head-scratching diagnostic skills.

I'm grounded insofar as I realize that this is a job with drudgery and it isn't all 4th quarter hail-mary life-saving. But I do still think you are right to ask, and I am right to worry, that I do have severe misconceptions about my role in most calls and in the larger medical system.

I'd welcome you breaking down how much of your time you spend doing what and what kind of service you work in although I understand that might not be a terribly good use of your time.

Really, the big thing that is really just seriously scarying me off right now is the shift schedule. I keep reading about Chicago FD medics doing 24 hour shifts without sleep because of the call volume. That kind of shift schedule is something that gets old on ships and is part of the reason I am looking to switch careers. Anyone have any insights about that or if there are EMs opportunities that don't require such shift work?

Honestly I'm even curious why they have crews do such long shifts. What's the need? What is it about EMS that keeps it from working on a standard 3 shift schedule with an understood amount of flexibility in overtime if a call warrants it?

 

[jbar]

Almost the only people who work 24 hour shifts are fire department based, where they sleep at the station between calls. If you aren't a FF don't worry about it. Almost all pure EMS crews work either 8s, 10s, or 12s.

 

[MediumDef]

Almost the only people who work 24 hour shifts are fire department based, where they sleep at the station between calls. If you aren't a FF don't worry about it. Almost all pure EMS crews work either 8s, 10s, or 12s.

Worry about it. There are many variations including private services that work 24hr shifts. Generally there is more flexibility in straight EMS as the scheduling is often done in 8hr or 12hr blocks (or 10hr days 14hr nights) but there are definitely places where full time is 2 24hr shifts.

 

[jbar]

yes, there are some places that work 24s. But MOST don't, like I said.

Also note that the people who work 24s usually only work 10 days a month. And it depends where you work, there might be nights were you are running all night, but often you get to sleep.

I wouldn't worry about going into EMS because you don't want to work 24s. In straight EMS it is the exception rather than the rule.

 

[fiznat]

I don't know any EMS agencies in this state that do 24 hour shifts. Like another poster said, I think this is more of a fire house thing although I'm sure there are exceptions to the rule.

I work for a private, for-profit EMS agency in a medium sized city (the capital of my state) and the surrounding towns. We answer all the 911 calls in the area as well as do (yuck) interfacility transports to pay the bills. I work 12 hour shifts three or four times a week and my partner and I usually run about eight calls in a day. We split those calls evenly unless it is an "ALS call," which I take because my partner is an EMT-B. Usually of the four or five I take, If I'm lucky, one will turn out to be a call that requires any thought at all.

I live for those calls you described. The head scratching, time constrained, critical patients who require my immediate attention and quick, accurate decisions. They don't happen all that often as I said earlier, but another point I should make is that they pretty much never came when I was working as an EMT-B. Not only will you likely get sent to fewer of these critical calls, but if you do, your ability to handle them will be significantly less than that of an ALS provider. When I finished my paramedic and started working on the road, I remember thinking that it was like a different job entirely (in a good way). I am still at the tip of that iceberg I mentioned before, and I realize even more how little I know in the face of medicine, but even still: I am SO much better prepared to perform prehospital care as a paramedic. If you are making a plan to start EMS as a career, work paramedic school into there somewhere (after you get some experience).

 

[SailorMed]

Thanks these are really good viewpoints to have access to.

Based on what you said about how different the job was between when you were a medic and an EMT-B, I wonder what your calls mainly consisted of as an EMT-B? It seems like what I was envisioning was what you experience as a Medic. I had assumed as an EMT-B that I would be partnered with a Medic to assist them while they work. So i figured I'd seem the same calls if only in an auxiliary role. So would I be likely to work without direct supervision as an EMT-B doing transports? What else could I expect to be doing as an EMT-B?

I think after what you've said, I'll just start Googling and calling down the list of private EMS agencies in the phone book and asking about training and employment outlook. I'm leaving for sea in 10 days for a 5 month service. So if I can enroll in a program that starts when I get back(intentionally timed to be at the end of August) then I should be in good shape to get some work experience before I return to sea, probably next January.

I mean if an EMS agency in my area is open to it, I could get an EMT-B or EMT-I and work for a bit. Million dollar question, if you guys have any input from your experience (long shot), is there an EMS agency in the world that wouldn't laugh in the face of someone looking to get trained and hired all within a 4 month time-frame?

 

[ArkansasRanger]

Almost the only people who work 24 hour shifts are fire department based, where they sleep at the station between calls. If you aren't a FF don't worry about it. Almost all pure EMS crews work either 8s, 10s, or 12s.

I was a part-timer, and I still worked 24's, lots of 48's, and some 72's. I was a high school science teacher at the time so I did this on weekends, spring break, summer, (refused to do it at Christmas lol), and miscellaneous three day weekends.

I was an EMT-P, but after working four years of that (off and on) I realized that I never liked transfers and all the down time. Also, I didn't like having a part-time job (which I felt obligated to have as a paramedic after enduring two years of classes and clinicals) on top of a full-time job. Soooooooo I gave up the paramedic certification, ACLS, and the others, AND National Registry status to go back to EMT-B here in Arkansas. Really, I only kept that because it's handy in what I do now as we Rangers do a lot of first responder stuff. My 4x4 includes among other things oxygen, a 25 pound jump bag, and AED.

Briefly, I entertained the thought of going thru a paramedic - RN bridge program, becoming an RN, and then going on to CRNA (nurse anesthesia).

 

[Blahblahologist]

Couldn't help but notice you're looking at courses that run a couple thousand bucks. That's on the steep side. If you're looking for EMT-B, check out the community colleges in you area. I did mine for something like $75, plus another $100 for books. I lucked out and ended up with a great instructor and highly motivated class.