I am a Paramedic serving a diverse area from very rural to large cities. AMA!

Op hasn't answered a single question in 5 hours. No point asking anymore. Just in case though.

What is your average response time in the more populated areas you cover?

It depends. Not all of our responses are the same. We have a priority tiered response. Meaning a 911 can be a priority 1, 2, or 3. A priority 3 has been a maximum 20 minute response time, where as a priority 1 response has a maximum 8 minutes. This ensures the highest priority patient gets the closest ambulance, even if they are already enroute to a lower priority call.

Hi. I work as an EMT in Norway (Europe). We have free healh være to all, so getting picket up by the ambulanse does not cost the patient anything. I've heard it is different in the states. What do you do if the patient does not have insurance, and can not afford the trip?

In the United States you often receive a bill from the ambulance unless the specific service has free service they subsidized through taxes or something. Expect anywhere from $800-1500 for an ambulance ride. These rates are high because a majority of ambulance patients have government insurance, which has a very low reimbursement rate ($100-500) which is below the cost to operate. The remainder of the unpaid bill is transferred to the next patient in the form of a high bill.

We do not collect insurance prior to providing service and our billing department deals with it later. Also, some forms of government insurance for low income people prohibit us billing the patient for any amount that their insurance left unpaid.

In the end, the bill sounds scary, but there's not a good chance you'll ever be faced with actually be paying the whole thing.

Also, medical bills are treated differently on credit reports in the States, and don't hurt you as much if unpaid.

Thanks for the reply! Good to hear that you don't have to take insurance into account when meeting the patients.

Sorry for the crappy spelling - phone autocorrect can be a bitch

No problem! I wish we didn't have to charge for service, because patients bring it up all the time. I'd prefer if my company could get tax money instead and offer free service (after billing any available insurance).

How many of your calls are accident-related? Would it be a majority?

Edit: Also, what is something people can do to make your life easier, something that people often don't realize?

A majority of calls are chronic medical problems. Very few calls are actual emergencies, and a fraction of those will be accident related.

Carry a list of medications you take. Most medications are common, and we can deduce your medical history from that.

OP when will you start answering questions? Why is this AMA void of OPs responses?

When I wake up. It was reposed because original proof was not adequate.

I have heard ambulances are prone to explosions. Have you seen anything crazy like that? Something about the oxygen you carry on board?

Do you often find people reluctant to cooperate when the police are involved? I would wager you both cross paths now and again.

Is there any truth to ambulances growing in size to accommodate obesity?

Yes, ambulances explode. Not spontaneously, only when they catch fire, which is more often that the average car because if how much extra wiring is in ambulances. Once they catch fire, keep back. They will blow. We had one at a ambulance company I used to work for that blew up.

Not often, but it happens. Once you get them in the ambulance and close the doors, they usually start talking.

Yes and no. Ambulances have grown since the 70s, but not because of obesity.

What's the best job you've ever responded to? What keeps you going when you've got a bad call?

Well, "Best" is subjective. Often "best" for me is bad for the patient, because it means theyre more sick.

If by best you mean rewarding, we recently had a sudden cardiac arrest survivor come back to the station to meet with us. After he recovered, before he came and saw us, he celebrated his 21st birthday.

Fellow Paramedic here. How does it feel to have the sexiest job ever? ;)

Pretty damn sexy.

I'm looking into being an EMT.

Would you recommend EMT work?

What training/education did you need?

I love the job. Do some ride along and see if you like it. It's guaranteed to be different than you imagine. Training is minimal at the entry level.

I was always taught it is best to maintain speed limit and move to side for any emergency vehicles so if something prevents overtake the emergency service can at least maintain speed. Is this best or would you prefer a pullover and stop?

Pull over and stop when safe. Usually by the time you stop were already past you, so just try to slow down. Use your blinker so we know you see us and we don't think you're oblivious. Don't go through a red light. In California it is illegal for emergency vehicles to "push" (encourage) cars to go through a blocked red light. This is not so everywhere, but is should be. If your are at a red light, wait until it is green and safe before going forward. We can wait, or go around.

Think it must be a bit different in the UK, officially the rule is what I was taught and I believe the logic is that in the UK not even ambulances can pass over a solid white line in the middle of the road and more often than not on most single carriageways there isn't enough room to pass safely even if someone is pulled to the side. But that being said it's more common for people to pull over and mount the kerb.

That could be. I don't know if it's true all over, but I've always been told that roads in the UK are narrow due to how old (read as historic) the infrastructure is. Most roads here are wide, like our citizens, and we don't have laws against where we can drive, we just have to drive with "due regard". Basically, you can do what you want, but you will be held responsible for your actions.

How often are you too late ?

Hardly ever, because most 911 calls are not actual emergencies. In the event there is an emergency, we usually arrive before it's "too late."

In the event if a sudden cardiac arrest, however, we are almost always not soon enough. We can still improve outcomes, but the real key here is bystanders CPR.

Did you ever pass out seeing something?

Not yet.

What about vomiting?

Nope. A few dry heaves occasionally. And not even from the really gross stuff. That doesnt seem to bother me. Stagnant urine gets me though.

What do people not understand about your job or what you're capable of?

Most people (including some hospital staff and healthcare workers) think we are just medical transportation, or an express ride to the hospital.

In reality, we are highly trained in the skills needed to recognize and treat not only life threatening illnesses, but chronic illness and acute injury.

Sometimes it may not look like we're doing much, but 90% of what we do is assessment, and the majority of that goes on inside of our head and in the form of seemingly innocent questions.

When you're in a rush to a scene or back to the bay how close to the speed limit do you stick to? If it's a 50km'h area (which is residential) would you go far over 60?
My mum told me when you see an ambo with lights on and going slow, does that mean you're working in a tricky condition ?
Broadly speaking if you're coming to my home or work site (not for me) how can I set you up for success / help you?
Finally how the god damn heck do you not get personally involved with every person you serve (and switch off at the end of the day)?

In my area we are permitted to go 15 MPH over the posted speed limit. It is true, if you see an ambulance driving slowly with lights and sirens, chances are there is a patient in the back who is in bad condition. We drive slower with patients so that the paramedic can work safely in the back.

Clear access to the building (handicap ramps) and large doors are the best way to get in. Having someone meet us who can guide us in is a big help. In hallways move items away so we can get the gurney through. The gurney needs room to turn and lamps, trash cans, cabinets, etc make it more difficult.

On average how many snake bites do you treat?

3-4 per year company wide. It's not that common here, even though we have a lot of rattlesnakes.

How long do you plan on staying in this profession?I've heard it's hard staying in this career till retirement, is this true?

Because I'm very keen on switching careers and doing a degree in paramedicine .

If you have time to answer I'll appreciate it. Thanks.

I'll stay here as long as I can. I love my job, however you're right, it's hard to retire in. I expect that once I'm older I'll move into an administrative or educational position.

How important are health care services in rural areas?

Extremely. Most rural areas are populated with people who live at, below, or near poverty, which means they do not get the medical care they need. Often times ambulances and the ER service as these peoples' primary Healthcare.

Not sure if this ama is still open? But if it is thank you for your service! I am just curious if you ever had trouble with stuff like body fluids or " the General human body"?

What do you mean? Like grossing me out? No. Not generally. Sometimes stale urine gets me dry heaves.

That and the things like blood? I imagine it's not too uncommon in your work. I just curious if it grosses you out or causes anxiety? Thanks for the reply :)

No, it's a normal part of my job. I frequently have to tell people to poop or pee themselves in the ambulance. Not because I'm mean, usually because they're not 100% with it and there is a medical problem that needs addressing.

I will always make concessions for bathroom use when reasonable.

How do you not lose your sanity?

You get used to it. Last time I told someone to poop themselves he was drunk and had just rolled an ATV at 45MPH. He had a brain injury, which only made him more confused on top of the alcohol.

What is the best thing a junkie has ever said to you?

In order to refuse treatment from us, you have to answer some basic questions that test your long and short term cognitive function... Name, place, year, and what's going on.

Once a junkie barely alive, jumped up, rattled off all of the answers, yelled "no Narcan" and fell back down.

what is Narcan and why would a junkie refuse it?

It blocks opioid receptors and kicks out the opioids already there. In laymen's terms, it's reverses their high and wakes them up.

... and they hate you for that. Tanks for the AMA !

No problem!

Fellow medic here, how much are you making entry level to your service? Are you 911 only or do you also do transfers?

We are 911 and transfer. We are the only ambulance company in my area, also we are the only ALS provider. Fire is all BLS.

Starting medics are at about $16/hr on a 12h, $20/hr on an 8 and $15 on a 24

I'm an aspiring Paramedic, what's your advice for me?

Have a plan. Whether it's stay as a Paramedic or move on to something else. Know what you want to do and do it.

Be realistic. EMS is not glorious. Long hours, low pay, no heroism. But for those that love it, it's rewarding in and of itself.

What was your post secondary schooling like, furthermore how much from school do you use on a day to day basis?

Paramedic education is the US is lower than many parts of the world.

The requirement is only a high school diploma prior to entering vocational training. Training requirements vary by state. In California EMT Basic training is generally about 500 hours, and Paramedic is a minimum of 1,090.

There is currently no widespread degree requirement, however it's becoming more mainstream. The college I took my school from has transitioned to a degree based curriculum and several of us are going back to apply for the credits to get the degree retroactively.

Do you consider severley broken bones an emergency or waste of ambulance time? I once broke ulna and radius clean in half so my arm was very floppy in the middle. My friend called an ambulance for me before I could refuse. Do you view that as a waste of ambulance time (e.g. I could have gone myself with some help and some kind of homemade splint)?

That's a perfectly reasonable thing to call an ambulance for, and for several reasons.

1. We have pain meds.
2. Not all hospitals are equal, we will get you to the right one.
3. There is a chance with broken bones, that circulation beyond the break can be compromised. We can attempt to restore this blood flow. If the blood flow cannot be reestablished, that constitutes a true emergency. We can alert the hospital to the situation. Where I work, if someone has vascular compromise to an extremity they are a trauma patient. We call the hospital early, and the ER pages trauma doctors to prepare the surgery suite for emergency surgery.

Australian medic here. What kind of skill set do you have over there? We are just rolling out thrombolysis in our state which is a big step up...

Compared to Australia, most of the United States is lacking, especially California which is notoriously slow to adapt best practices.

We don't have thrombolysis, but I wish we did. We don't even have RSI in California (yet).

There is a TXA trial in the process to add that to our protocols.

RRT here, just curious I guess. Do you prefer Mac or Miller blades?

I preload my laryngoscope with a MAC 3. Some people say they prefer a 4 because it's easier to have more blade than needed, than not enough. But I've found a a MAC 3 to work for me 90% of the time.

My little brother has some very severe allergies, namely to beestings. My parents always told us, if he gets stung by a bee, we need to administer the epi-pen, and we need to call 911. Nowadays, we are both of driving age. Would you still consider this an emergency that requires calling 911 and having them send an ambulance, or would you recommend we simply drive him to the hospital (~15 mins)? I understand the severity of the situation, but I wouldn't want to pull an ambulance away from another potentially life-saving situation for something that may merely require observation.

Yes, that's still an emergency. The Epipen will wear off, and you don't want to be sitting in the ER waiting room when that happens. Ambulances carry additional doses of epinephrine to give your brother, as well as other medications to help him fight the reaction quicker and better.

Saw something I personally have never seen today, was at a gas station and saw an ambulance pass well over the speed limit with sirens running but no lights? Why is that?

Some ambulances can have the siren on without the lights. It's a flaw, but sometimes people forget to turn on the lights. My ambulance format let the site come on unless the lights are on.

1. I know there is not "average day" but how often will you have a day with no calls?

2. About what percentage of calls has someone already initiated first aid?

1. It's rare for me. We typically run calls back to back. I think it may have happened once in the last 2 years for me.

2. Almost none. However very few calls require immediate interventions.

How bad is it when drivers don't make way for the ambulance, or use it as a chance to overtake people? Can it mean life or death? or is it just an inconvenience?

Either way those people have a very special place in hell I'm sure.

Mostly, it's just an inconvenience. It's become such commonplace that it's pretty much expected. One car simply not pulling over isn't the real problem, it's wren drivers fail to pull over, then block the last open late at a red light, which means now we have to wait a few minutes for it to turn green. If they did this at every light we would be very delayed.

The other problem is when people don't pull over, or worse do suffering drastic like pull into oncoming traffic or stop in the middle of an intersection. This can cause accidents which is Anso obviously not good.

HI AOx3 !

I'm going to graduate with a B.A. in Biology in December and plan on taking an EMT course when I go back home (Southern California). The plan is to EMT, Paramedic, end hopefully Fire route. I've had a year previous experience as an EMT but that was about five years ago. Naturally, I am unlicensed.

My questions are: Do my prior hours count towards my paramedic school requirements?

Is it a sound idea now, especially with how competitive it is now? I remember they filled up Angels Stadium for a few Fire openings.

The fire sector in southern California is extremely competitive. Personally, I have no interest in joining the fire dept, so I might not be the best person to ask.

As far as prior hours, they might accept them, but they might not since it's been so long. Best to ask the school you plan on attending.

How much money do yall see per year?

I make $50-60k depending on overtime.

What isn't the best thing you have ever seen?

I once saw a minor car accident with no injuries. It was NOT the best thing I've ever seen.