I am a Paramedic working in California, USA, serving a large area that covers everything from desert, to mountains, to cities. I've been doing this job for 5 years and I look forward to coming to work every day.

My job is far from routine. I start off the day like any other, checking the ambulance and the equipment. After that, all bets are off. It could be car accidents, medical aids, or cliff rescues.

It's occurred to me that many people don't actually know what we do on scene, or in the ambulance. We are much more than just a ride to the hospital. Health care starts the second I walk up to you.

I know there are good questions out there so AMA!

Side note: Don't ask "what is the worst thing you've ever seen." I won't answer that.

Proof: https://imgur.com/8AX8ogT

This is a repost with adequate proof.

Comments: 207 • Responses: 38  • Date: 

Legofdragon24 karma

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?

AOx33 karma

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.

Treelover2321 karma

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?

AOx34 karma

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.

Treelover231 karma

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

AOx32 karma

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).

_Thom205 karma

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?

AOx33 karma

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.

LydJaGillers3 karma

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

AOx31 karma

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

adismail3 karma

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?

AOx31 karma

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.

PsychedelicDoc2 karma

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

AOx32 karma

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.

SithLord132 karma

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

AOx32 karma

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.

mtjh2 karma

Did you ever pass out seeing something?

AOx31 karma

Not yet.

mtjh1 karma

What about vomiting?

AOx32 karma

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.

bravo02 karma

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

AOx32 karma

Pretty damn sexy.

cool_but_not_cool2 karma

I'm looking into being an EMT.

Would you recommend EMT work?

What training/education did you need?

AOx31 karma

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.

Elitenoob892 karma

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?

AOx32 karma

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.

Elitenoob891 karma

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.

AOx31 karma

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.

DebuggedRobot2 karma

How often are you too late ?

AOx32 karma

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.

Accountforpoopshower1 karma

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

AOx34 karma

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.

Gabriel_is_Satan1 karma

what is Narcan and why would a junkie refuse it?

AOx31 karma

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

Gabriel_is_Satan1 karma

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

AOx31 karma

No problem!

crumbbelly1 karma

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

AOx31 karma

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

108noKitsune1 karma

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"?

AOx32 karma

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

108noKitsune1 karma

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 :)

AOx32 karma

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.

108noKitsune1 karma

How do you not lose your sanity?

AOx32 karma

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.

jack-kn1 karma

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.

AOx32 karma

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.

leclittoris1 karma

How much money do yall see per year?

AOx31 karma

I make $50-60k depending on overtime.

SonofHackett1 karma

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.

AOx31 karma

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.

yompk1 karma

  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?

AOx32 karma

  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.

Type_ya_name_here1 karma

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)?

AOx32 karma

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.

anythingbutbroke1 karma

On average how many snake bites do you treat?

AOx31 karma

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

jordossmillan1 karma

How important are health care services in rural areas?

AOx31 karma

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.

MrMathius1 karma

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.

AOx31 karma

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.

herp-derp-herp-derp1 karma

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.

AOx31 karma

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.

Oquela301 karma

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

AOx31 karma

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.

Jethrojones1 karma

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...

AOx31 karma

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.

natz9941 karma

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)?

AOx33 karma

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.

cwilde20161 karma

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

AOx31 karma

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.

AscendToOblivion1 karma

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

AOx32 karma

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.

Slayeraustin1 karma

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?

AOx31 karma

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.

stupiloose0 karma

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

AOx31 karma

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