Where I’d Like to Work

A good friend at work quit last week.  He’s not going far – instead of 911 calls he’s going to do critical care transfers at the mother-ship health system in our region.  It was a hard decision for him, but he wants an opportunity for him to learn more and work in a different environment.  This made me think about why it has to be in a different environment, and what an ideal EMS workplace would look like.

Where I work now, we only respond to 911 calls in ALS quick response units with one of 22 independent BLS ambulance services.  I the past I have worked for services that did only scheduled, non-emergency transfers, another that did critical care, NICU, and PICU transfers.  Experience gained in each of these settings left me better prepared to care for patients in the others.

Many EMS organizations fall into one of two extremes. Some have a narrow focus, where the job people sign up for is the only one they’ll ever do. For others, the focus is so broad that they don’t do any one thing particularly well.  Think McEMS.

Now compare this to law enforcement.  Officers start on patrol after graduating from the academy, but have opportunities to specialize in other things later.  Some become homicide detectives, some become K9 officers, and others are content doing street patrol their entire career.   If a surge is needed, officers in specialty positions are temporarily assigned to patrol.

Nurses also have opportunities to specialize, even within the setting they choose to work.  ED nurses specialize in caring for sexual assault patients, collecting evidence on trauma patients, and doing research, in addition to being assigned patients as they arrive.

So after looking at the best aspects of different organizations I have been with, here is some of what my ideal EMS workplace would look like:

1. New EMT’s would perform non-emergent interfacility transports.

2. Seasoned EMT’s would be partnered with paramedics to go on 911 calls and ALS interfacility transports.

3. Critical care paramedics would work out of QRV’s.  One organization would be responsible for transferring critically ill patients between hospitals within the region.  CCP’s would ride on an ambulance with another paramedic for critical care transfers, and respond  to the most serious 911 calls.  They would be the only ones authorized to perform several low frequency/high risk procedures.

4. Special operations teams would partner with other public safety organizations, such as  HazMat, USAR, large scale special event coverage, and SWAT teams.

5.  The organization would be affiliated with a college or university, like many hospitals are, for initial and continuing education.  It would also be responsible for quality assurance and continuing education of the entire system, including dispatch and first responders.

So what do you think? I’m interested in learning what your ideal EMS organization would look like.



  1. Evan Tsurumi says:

    The problem you are going to run into continually is revenue and tax base. Most major cities depending on their fiscal health will balk at creating a system which provides more services, especially critical care services. For a private hospital to fund such a system with a large population is going to be difficult especially with a lack of reimbursement from health insurance companies. I doubt that until we address reimbursement issues from health insurance/medicare that many developing programs will go forward. At least not in major cities.

    I’d love to have worked for a municipal EMS system in a small to medium size city which provided the services which you described above. The municipal system which is third service either under Public Health or Department of Health for a county/city would help with retirement, benefits, and funding which would be necessary for such a large endevor. I think that the idea of partnering with the areas hospitals or any city hospitals is an excellent idea which provides the paramedics with continuous quality improvement and training.

    Even more important is to give the EMS professional avenues to advance in the medical field if so inclined. NYC EMS used to partner with NYC HHC to provide scholorships for paramedics to advance to PA and nursing schools while paid their salaries. This was a home run for the retention and morale of the paramedics who wanted to advance their careers and provide the city with trained and motivated personnel.

    So if I had to pick a system, it would be one in which Paramedics operate in fly cars staffed with dual medics in a 911 system. I would concentrate on the continuted education and retention/development of those paramedics with monthly paid CME and mandatory paid hours in the OR and ER as well as annual ACLS/PEP refreshers. Also along with the teaching hospital/university I’d create special programs for paramedics and EMT’s who wanted to take classes to advance into the nursing and PA fields.

    If you find such a system in bizarro land for me please let me know as I will gladly quit my job now and go there. Basically there would have to be a physician running the system which happens rarely.

    • emspatientperspective says:

      I realize paying for such a system is a problem. Much of how EMS is funded is an accident of our evolution. I never learned about interfacility transports in my EMT class, but that was much of what we did, because that’s what insurance companies would pay for.

      Some may say I’m a dreamer, but I’m not the only one. I’m just trying to figure out what is best and then find a way to pay for it.

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