Paramedic Job Description:
There are three recognized levels of Emergency Medical Technician - Basic, Intermediate, and Paramedic. EMT-Paramedics work primarily in the traditional role of emergency responders, providing medical care at the scene of an accident or illness and transport to an appropriate medical facility.
In recent years, the role of paramedics has broadened significantly, and today paramedics may be found answering 911 calls, doing inter-facility transports of high-acuity patients, working in hospital Emergency Departments, and serving on offshore oil platforms, to name just a few.
"Critical Care Paramedic" is a fairly new designation, one not recognized in all states. Critical Care Paramedics typically handle inter-facility transports of high-acuity, technology-dependent patients such as those with invasive hemodynamic monitoring, chest drainage, mechanical ventilation (breathing), and mechanical cardiac support devices (heart). In my case, I utilize that expanded skill set in an Emergency Department.
Your paramedic job is in Louisiana, were you in New Orleans when Katrina hit?
I was in north Louisiana during Hurricane Katrina. Actually, I left the EMS Expo, a national EMS conference held in New Orleans that year, a day early to avoid the hurricane. Since I had been on vacation for the days prior to Katrina, I was put on duty in my service area to provide care for evacuees and medical patients flown in from the hurricane-stricken areas. Katrina and Rita have driven a large number of doctors out of southern Louisiana.
Many of them saw their patient base leave with the evacuees. Others have seen their practices suffer due to the shortage of available hospital beds. The area we see it the most is in finding specialty coverage for local Emergency Departments. Orthopedics and neurosurgery, two specialties already in short supply, have become especially hard to find.
What steps did you take to become a paramedic?
To become a paramedic, one must first be an EMT-Basic, a certification that requires roughly six months of formal education and training in basic life support, airway management and oxygen administration, wound care, splinting, automated defibrillation and other resuscitation techniques.
The paths to a paramedic certification vary widely between states. The educational curriculum is set forth by the National Highway Traffic Safety Administration (NHTSA), and all states are bound to meet that minimum educational standard. Many states choose to exceed the minimum standard, so paramedic practice in the United States is hardly uniform.
The provision of Emergency Medical Services is ultimately a local issue, and municipalities typically adopt a system that meets their local needs, including the education level of the providers in that system. The difference in education and scope of practice between paramedics in rural Texas and urban New Jersey may be radically different. Different settings dictate different needs in an EMS system.
Typical paramedic education takes 18 months to 2 years, in addition to the prerequisite EMT-Basic education. It involves a classroom component, hospital and ambulance clinical rotations, cumulatively a minimum of 1,000 hours or so. Some programs require three times that amount. Some states require paramedic education to be at the minimum of an associate degree.
Can you recall any humorous or memorable moments during your paramedic job?
Never ask a paramedic that question. All of us with any experience in the field can recount instances of foreign objects stuck in various bodily orifices or odd medical conditions that stand out from our usual fare. EMS personnel often employ gallows humor to deal with the things we see on a daily basis, and often what we find funny, others would find shocking or disgusting.
For me, the oddest call I ever ran was one where a male ostrich attacked and killed two people. It was truly horrific, but again, rather funny experience that I wrote about on my blog.
Do you have any advice on how to become a paramedic?
Be sure EMS is for you. The average career expectancy of a paramedic is five years. Many use EMS as a stepping stone to other health care careers such as nursing or physician's assistant. If you are entering EMS for the adrenaline rush and the excitement, you will be disappointed very quickly. This profession involves a great deal of back-breaking drudgery and interminable boredom, and precious little opportunities to save a life.
A common refrain is that the typical ambulance shift involves twelve hours of boredom, interspersed with infrequent moments of pure terror. We actually don't get the opportunity to save many lives. What we can do is alleviate pain and suffering, stabilize the patient and hopefully deliver them to the hospital in good enough condition that the ER staff can finish the job.
Occasionally, if we're very good or very lucky, we can save a life all by ourselves. It's a good feeling, but it's not the norm. The sooner new paramedics realize that, the more satisfied they'll be in their chosen career. If you like people and thrive in crisis situations, EMS may indeed be your calling. It pays a living wage, and it gives you a front row seat to the pageantry of countless lives.
What is the outlook for paramedic jobs?
There is currently a nationwide shortage of paramedics. As the baby boomer generation grows older, the health care system will be increasingly taxed by their medical needs, and more paramedics will be needed. Health care in general has a fairly stable employment outlook. People will always get sick. The graying of America will only increase that.
What is worrisome is the overwhelming cost of it all. Lack of primary care physicians, emergency departments inundated with non-emergency patients seeking free medical care and the declining government reimbursement has our health care system teetering on the brink of collapse. There will always be a need for paramedics, the question is, will we be able to pay for them?
What factors affect the salary of paramedic professionals?
Typically, larger taxpayer-funded municipal EMS systems offer the highest wages. Private, for-profit ambulance services also pay fairly well, but the salary of paramedic professionals varies widely. Smaller municipalities and privately-owned ambulance services cannot compete with the larger systems, in terms of salaries. They simply don't have the call volume to justify the expense.
In fact, the majority of EMS care in this country is performed by volunteers, often for no fee at all. While the altruistic nature of volunteers is in keeping with the ideal of EMS to provide the best care possible without regard to ability to pay, it does tend to suppress salaries. After all, why vote in a tax to pay for a needed service, when people are willing to do it for free?
Ambulance services often have to lower salaries, cut equipment and fleet maintenance costs, or rely on taxpayer subsidies to make up the shortfall. In summary, it is indeed possible to earn a living wage as a paramedic, maybe just not in your town.
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