IAmA Emergency Medical Technician (EMT)

Have you delivered a baby?

I have. Full term healthy boy delivered on scene.

Did they name it after you? Do you have your own name for him regardless?

They had a name picked out. I'll sick with that

What is the most ridiculous reason/non emergency you've been called out to?

Its hard to pick just one. Here are a few: - My insurance won't pay for my taxi/bus fare. - My elbow itches - My eyes are jiggling - I'm trying to get to [location] near [hospital]

Emt here. Got a call at 3 am for a kid who was sitting down for an hour in a pretzel leg position and thought he had DVT. Like really?

Why do kids know about DVT? Probably read about it on some crazy site named redit or something.

Have you seen this? I'm a police officer in WA and find this hilariously true. (Ps. No disrespect, my brother is an EMT and I respect what you do.) http://youtu.be/0HAGMb_jAdU

We actually watch that in every EMT course I participated in!

There's a great video I just stumbled across last night while on sure of an officer who preformed cpr on a child who had drowned and brought him back. That's worth three cheers in my book.

I had recently had the worst panic attack of my life and had an ambulance called as I thought my throat was swelling up and I was going to die.

I ended up being completely fine, but my question is; How often do you get calls from people having panic attacks?

Its not uncommon. Panic attacks can definitely progress into a full blown episode. I believe there is more to patient care than just medicine and have no problem talking a patient down if that is the best medication for them, which often it is.

I shattered my tooth, half of it is still in place all black, dead, should i pull it out or let it rot and maybe eventually fall out? i am 3000 km away from any medical assistance(island in south pacific ocean, internet trough satellite), i do not want to return to civilization as i just started my cruising journey trough world in a yacht, i dont care about pain, just afraid infection can go wild and get into the jaw or something? or i will be fine? i always think about all those mentawai tribal people in indonesia where they sharpen they teeth and shit and never have any tooth care and live fine... so with that in mind will i be ok?

I am in no way a doctor or dental specialist, but its true, infection can spread and cause you to lose your jaw or your life!

I'd have it looked at...

Have you ever been threatened or attacked by a patient or bystander?

It happens more often than you might think. I've never SUCCESSFULLY been assaulted (or battered) but I've had attempted kicks punches and bites. Usually I can't hold it against them as it's usually caused my some form of delirium as a result of their condition.

How did you go about getting your training/certification?

Where do you work, and do you get paid? What do you think is the starting salary for an EMT?

I really want to get certified and make it a career for myself.

How did you go about getting your training/certification?

Most areas will have a community college that offers an EMT course. You can also find for profit courses but I recommend those held by a local college.

Where do you work, and do you get paid? What do you think is the starting salary for an EMT?

I work in central California but have also worked in Los Angeles County. I am paid, well paid for an EMT in California. Starting pay for most EMTs nation wide is $8-10/hr with some making $20 or more (not common). There are a large number of volunteer services throughout the country.

I really want to get certified and make it a career for myself.

Go for it! Don't get discouraged if you find it difficult. It is.

Thanks for the advice.... 8-10$ seems lower then I was expecting, was hoping it would be more like 12$/hr, but I guess there is overtime and stuff too right?

Also, another question.... do you remember your drug test? Do you know if they used a 5, 10, or 12 panel testing cup? Reason is that I take suboxone, or bupenorphine, and worried that it may come up on a drug test and I can't join. It's given to me by my doctor, but I don't wanna tell them about it.

I am planning to sign up thru my local fire department, get training, volunteer one night a week and work the rest as a paid EMT.

Thanks for the advice.... 8-10$ seems lower then I was expecting, was hoping it would be more like 12$/hr, but I guess there is overtime and stuff too right?

Pay varies by region, but don't expect much. EMS is notoriously underpaid.

Also, another question.... do you remember your drug test? Do you know if they used a 5, 10, or 12 panel testing cup? Reason is that I take suboxone, or bupenorphine, and worried that it may come up on a drug test and I can't join. It's given to me by my doctor, but I don't wanna tell them about it.

That will depend on your company, department and state levels. You can pass an employment drug screen if you tell them about prescriptions that may pop up as long as they don't endanger your job duties (like sleep pills and a truck driver). However our state requires us to have a medical examiner's certificate to allow us to drive. That may not pass. Don't hide it. I'm sure I'll be okay.

How do you compartmentalise? You must see some pretty awful things at work, how do you keep them from affecting your home life?

We do. It's hard. Jokes help (as rude as that may sound, of course always AFTER the fact) as a sort of deflection method. Talking it out helps as well.

I struggle with this a bit. My dad was an EMT/firefighter before I was born and he is well...kind of my hero. I expressed wanting to be a paramedic and he warned me about some things he can never unsee. He said he would go back and do it all again no question but there are 2 instances where he just never got over them. One being a baby that they tried and tried to resuscitate and could not (having had my brother at the time it really got to him) and the other being most terrifying to me he got to a truck accident where the truck had caught fire and the guy was pinned inside. My dad got there in time to watch the man literally melt/burn to death as they tried to extinguish the fire. He said it haunts him. I'm sure I would see horrible things like that but I kind of still want to do it do you have any advice for coping with seeing the most awful things? I still want to go for it, but I would love some advice.

Bad things happen. Bad things happen to good people.

I do what I do because I love it and I'm good at it (not to toot my own horn). When someone under my care dies like that, I have to reassure myself that I know I did everything I could possibly do. I did everything right. There was nothing to be done. It was too late.

Unfortunately 9 times out if 10 that's. It enough. I lay awake at night after calls like that thinking "why didnt I try this.. What if I hadn't gotten stuck behind that truck... What if... What if.."

But untimately it always comes around to "but I did do everything."

There are plenty of good times too. I too ran a cardiac arrest on a baby. We got her back. Several weeks later I met the mother. I introduced myself and she almost broke into tears. Her baby is alive, fighting, struggling, but alive. Her dad is holding her again, she's opened her eyes and looks up at them again. They almost lost that and we gave that back to them. There is no greater reward I can ever ask for than the hug from that mother.

Hey, just wanted to say hi! I'm an Advanced care paramedic (ACP) in Canada, keep fighting the good fight and stay healthy. PTSD is pretty big lately with us and we've had a string of first responders committing suicide in our province. People are pretty ill informed that our job has the highest rate of PTSD above all other jobs and it might be worth talking about here on reddit?

http://m.vice.com/en_ca/read/canadian-paramedics-are-the-most-likely-citizens-to-develop-ptsd

I have heard. I am sorry for your string of losses. It's hitting the EMS news down in the States pretty widely and our hearts are with you, Brother. Stay strong. Stay safe.

Do you think North Melbourne will find their consistency leading into the finals series?

Thanks in advance.

Yes.

What's the rudest thing a patient has ever said/done while trying to help them?

A patient once asked my nurse (on the ambulance) if he trusted me to drive because I have shifty eyebrows!

They called me shifty for months.

If that's the rudest thing a patient has said to you then, my friend, you have the best zone in the country.

Lol its probably not. I just can't think of it right now. I've had them say rude things to partners!

Is being an EMT a career job, or a stepping stone to something else?

Both any people view it as a stepping stone, which is great for them however it can result in high turnover in an industry with an already high burn out rate. My company seeks out career employees and retains them with abnormally good benefits, pay, and conditions.

In response to your "my company" bit, how are medical service companies mandated? Do state hospitals hire EMTs out? How do your jurisdictions work?

Most ambulance services in the US are either 1) A private for profit company 2) A fire dept based ambulance service 3) a municipal service just like PD and FD.

Don't think you can dodge a bill by living somewhere with a government run service, they bill too!

There are some hospital based ambulance services as well, and most of these are managed by ambulance companies.

I'm not sure on the specifics but in my state ambulance providers are regulated by the highway patrol and federally by the DOT. EMTs are certified at the state level by the department of emergency medical services.

Have you ever found yourself in a situation where a common person tried/wanted to help before your arrival on the scene and ended up making the situation worse?

Yes. And you know who is surprisingly guilty of this? Doctors.

Most doctors have a specialty in something other than emergency medicine so their only emergency experience in from their ER rotation in med school.

Once responded to a cardiac arrest at a heart convention (Yes. Oh the irony) patient was surrounded by doctors, they started CPR which was great, but they were all so concerned about the cause and treating the underlying cause that they all forgot to get the AED off of the wall a few yards away.

Sorry if this comes off as a little blunt, but have you ever had a case where the patient died before reaching the hospital? Did you ever feel like it was your fault and if so, what did you to to get back into a functional mentality? Thanks for the AMA!

Yes. And sadly there wasn't a thing anyone could do. The patient had a dissecting aortic aneurysm. In laymen's terms the largest artery in the body was getting ready to pop. And it did. The patient bleed out internally in seconds.

I imagine at least for the first few times, it would be rather traumatic. Were you just able to naturally compartmentalize it, or did you have you learn along the way?

There's nothing natural about it. It's just something we learn to adapt to.

Have you ever been on a call where you knew the victim?

Thankfully no. I do know 2 coworkers who did though. One transported his grandfather, the other a family friend.

How do you stay calm in an emergency?

Training. We are taught steps and lists so we don't forget anything. Everything happens in an order. We have to remember it's not our emergency, its theirs, and we are here to fix it. If we panic, nothing gets done.

We have a saying "Slow down, were in a hurry."

Is there any place to read up on these steps/lists?

If you go to NREMT.org they have skill sheets. These are the "lists" most EMTs are taught from. They have lists for everything from Medical Assessments, to splinting. We also use a lot of algorithms at higher levels, for example the American Heart Association has many algorithms for Advanced Cardiovascular Life Support

Is it possible for a 19-year-old to get a summer job as an EMT? What is the on-boarding process like? I live in NYC, if that helps.

Thanks for your service :)

Sure! I started at 18 which is the youngest you can start in CA. Some commercial insurance carrier make it expensive or don't allow hiring of persons under 21 years old which can make getting a job hard at some places. I recommend finding a local EMT program (college based if you can) and speaking with a director or instructor to get started.

How often do you see suicides compared to other accidents or murder?

Accidents are much more common.

On average how many false alarms do you get? By false alarms I mean non emergencies.

Over 90% of 911 calls are nonemergent. Not that they don't require transport or medical treatment, but that an actual emergency doesn't exist.

Now I'll redefine false alarm to mean a call where no medical condition exists. I would say 10% or less. However there is a large ground between "false alarm" and "emergency" where people who could go to a doctor, or urgent care call an ambulance instead. I end that by saying anyone feeling like they might be having an emergency should always call 911. If its not an emergency oh well. Maybe we treat you and you go home maybe we treat you and you do to the hospital. But is rather that happen then someone not call because they think it's nothing when its definitely something.

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I'm confused by your reply. While there are some true ambulance drivers out there, they are the vast majority. As an EMT you have much more training than just driving!

Also, thank you for your service.

I'm confused by your reply. While there are some true ambulance drivers out there, they are the vast majority. As an EMT you have much more training than just driving!

Minority...

Hello and thanks for answering questions! My wife is currently taking the EMT-basic prep class at our local CC. Recently they've been discussing triage and prioritizing patients on a scene. She has really struggled with the concept of not helping someone who would be considered beyond help but still alive (the example she told me was a woman with a slow pulse, rr, and an open brain injury). How do you cope with making that call? Do you feel like there's ever been a time where you made a call like that but were wrong?

Its a hard decision. I haven't had to make that hard call yet thankfully. But I can sympathize with your wife. Its hard. I've been in similar situations. You have to step back and look around. There's nothing wrong with making that person comfortable if you have time (if you REALLY have time) but chances are that person may not even be aware of what is going on at that point. You have to realize that they are beyond saving. But the next person may not be. You can do good there.

First of all, nice username!

Best call and worst call?

Do you have a SO? If so, how do you share your work experiences with them? Do you ever feel uncomfortable telling stories in too much detail?

Best call: don't have one. I've connected with a under or patients. Those are always the most rewarding. Worst: suicides of kids

What was the funniest/most memorable dispatch call you ever received?

The dispatcher said "blah blah blah for a person laying on the ground unable to be aroused"

Someone behind me muttered "is that in your scope of practice" making a sexual joke out of it.

What is one of the grossest things you've seen on the job?

People who have been in bed way past sun rise (like weeks or months..)

No bathroom breaks, just right there, in bed. And we have to pick them up out of it and get them out of the house

How do you stand looking at wounds? You're very brave. Hell, I couldn't even bear holding my grandfather in my arms while he was having a seizure.

Some people can some can't. Its hard to explain without experiencing it, but when you are in the moment looking at something gross, you forget its a person. All you see is a wound, you know what to do and you do it. Very task oriented. Not that we don't care about out patients and treat them non human, but it helps us to isolate ourselves.

How often do you get called because of strokes or heart attacks?

When I was working with a nurse on a Critical Care Transport unit, pretty much daily.

In the 911 setting a true heart attack or stroke may be every one or two weeks.

How often do you respond to 911 calls? And what do you do in the downtime between calls?

About 6-10 per 12 hour shift. Between calls we attempt to devour food before the next call. Maybe read a face book post. If things are really slow we might read an article. If its dead a nap might get squeezed in :)

Hello. Firefighter here. Just wanted to thank you for all the stuff you guys do and put up with on a daily basis. You guys typically work hand in hand with us, and although we make fun of your funny looking pants and suspiciously lunchbox shaped vehicles, we love you guys. But in all seriousness, what's with those pants?

Thank you! We have a great relationship with our FD which we did not have where I used to work!!

The pants allow us to carry snacks, scissors to open snacks, and tape to seal snacks... Like you have room to talk, banana pants ;)

Do you prefer cheese cake or mud cake?

What kind of cheese cake

Hi! I'm in high school right now and am starting an EMT class in about 2 weeks. Do you have any tips for me?

Edit: Also, what should I expect? Is there anything in particular I should pay attention to or do?

Listen to how the paramedic talks and the questions he asks.

Any advice for someone who's signing up for an EMT course in September?

Persevere. Invest in a kurieg.

First of all I want to thank you for what you do.

1. What do you think of the different systems of emergency medicine between the US and Europe? It is my understanding that in the US the idea is to get the patient to the hospital ASAP (golden hour) while in Europe they often have doctors with them and try to stabilize the patient then move.

2. Do you think EMT-B's should be taught more before going to the field or do you feel that they are generally prepared for their assigned duty?

3. What are a few things that you wish paramedics could be trained to do, that they are not trained to do currently, in order to further their life saving treatment en-route to hospitals?

1. What do you think of the different systems of emergency medicine between the US and Europe? It is my understanding that in the US the idea is to get the patient to the hospital ASAP (golden hour) while in Europe they often have doctors with them and try to stabilize the patient then move.

There are some VERY different systems in place around the globe. From what I've read Australia has a model system in place.

The US has had a difficult time with EMS as a whole. Currently EMS is administered under the Department of Transportation. We have evolved well past transportation into medicine. There is currently a bill in front of Congress (forget which house at the moment) that proposes EMS move to the Department of Health and Human Services. This would be monumental in changing the mind set that EMS is a taxi, and not an ER with wheels.

The golden hour specifically applies to traumatic injuries and as far as I know is ghr gold standard (ba-dum-ch) around the world for trauma. There are systems that like to "load and go" on most cases however we are seeing the benefits of "stay and play" more and more. I recently read an article where a county changed its protocol to keep paramedics on scene of a cardiac arrest instead of immediate transport. Return of Spontaneous Circulation (ROSC) increased by 30%. I definitely see the value of treating on scene when feasible. There are someb areas where that doesn't make sense obviously. If you have a 45 minute drive to the hospital like some areas here, let's load up and work enroute. Except for cardiac arrests as studies show CPR in a moving vehicle is less than optimal to be generous.

There is a new movement commonly called Community Paramedicine. The idea is to have special paramedics interface with medically needy patients (recent discharges, elderly, etc) in a non-emergency setting to ensure continued health through out of hospital followups, and education. There are pilot systems in place across the US and have been mostly successful. One such system studied CHF patients after discharge and with community paramedicine that patient had an ER readmission rate drop by 90%. Very exciting proactive medicine

1. Do you think EMT-B's should be taught more before going to the field or do you feel that they are generally prepared for their assigned duty?

Its important to have varied levels of care, like EMT and Paramedic. However it would be nice to fix some of the obvious vacancies. For example its not uncommon for an EMT not to be allowed to check blood sugar. A simple procedure anyone can do at home. Just last week I had an ER nurse get mad at me because I gave a patient a tube of oral glucose with out checking the blood sugar first. I can give sugar (and per my protocols correctly did so) but I can't check it. Until recently I couldn't use pulse ox either. Asprin for heart attacks was also recently added to my scope of practice.

I have noticed in the past few years the NREMT HSS upped its clinical education standards.

3 What are a few things that you wish paramedics could be trained to do, that they are not trained to do currently, in order to further their life saving treatment en-route to hospitals? I can't say that they aren't trained to do these things because there are areas where they can. However I wish they were more common...

• RSI
• IV Pumps
• Beta blockers would be great
• iStat or other similar mobile lab testing and associated simple treatments (electrolytes)

Among other things

Have you and your partner ever had to force a patient to walk outside to the stretcher...when the patient's chief complaint was being unable to stand? (Possible reasons: patient's weight was 205 pounds. House was a mess with not much space to maneuver. There were 6 steps up to the porch.)?

Have you and your partner ever had to force a patient to walk outside to the stretcher...when the patient's chief complaint was being unable to stand? (Possible reasons: patient's weight was 205 pounds. House was a mess with not much space to maneuver. There were 6 steps up to the porch.)?

Not acceptable by my standards. I've moved entire time of furniture for patients. I can carry a patient is a sheet, on a stair chair, what ever it takes. If they can't walk is my job to get them out. I wouldn't settle for a shamrock shake if I ordered medium fries.

(Actually I really like shamrock shakes so I might)

Do you think it would be a good idea to become certified as an emt, and volunteer while pre-med? Or would it be a career, that requires full dedication?

Doesn't matter how much time you dedicate to working as long at your heart is in it.

How hard was the certification exam (not the practical) when you took it? Because I failed the nremt exam once due to the fact that it had questions way beyond what our bls ability is...

Its hard. I passed on question 83 the first time and 85 the second when I renewed the first time.

The NREMT may not follow your local scope so be sure to study a NREMT study book. These days they really stress diagnosing.

Hey man I'm in intermediate right now and taking the registry in September. Any tips on what to study?

The new NREMT stresses differential diagnosis. Understand pathologys, signs, symptoms, etc.

EMT for several years? How long is that paramedic waiting list?

Until I felt I was ready. I should be entering a program this spring. I'm only going to paramedic school once. I want to do it right the first time. I work with many 10, 15 and even a 40 year EMT vet.