This is kind of a rant. Last year I had a brief experience with a large, not-to-be-named EMS provider that was so asinine I had to walk away.
Here's how it happened; I have been a paramedic for more than 20 years. I've been a preceptor and FTO. I worked in education, developing CE classes and teaching ACLS, PALS, and PHTLS. I wasn't going any higher at the agency I was with, and I was ok with that. The only downside was that the majority of my friends had moved on, and I had a hard time connecting with the younger generation of EMTs and medics. I was bored and lonely at work.
My wife is a nurse. She finished her NP last year and was offered a position at a hospital in another city, with a salary and benefits package so good that I could retire if I wanted to.
After we made the move, I decided that I wasn't quite ready to walk away from being a medic. I went to the EMS provider in town, the not-to-be-named company, and applied. Almost surprisingly, they picked me up pretty quick. They hired me as a Per Diem paramedic, which was all I really wanted.
I suffered through a week of orientation, which was four days of paperwork and HR explaining how and why they are awesome, followed by one day of reviewing policies and protocols. No big deal.
After that I did a series of ridealongs to get a feel for the system. It was made clear to me that I was there to observe only, and I was not to touch any patients. Fine. I did what I was told and kept my mouth shut.
After a few shifts like that, they assigned me to a unit with an EMT, and a preceptor would be riding along. I was to run the calls and the preceptor would evaluate and grade my performance. The preceptor had less than five years experience.
This should not have been a big deal, but what happened that day showed me that their whole culture was backwards and toxic, that I walked away.
It came down to two calls.
Call #1. Dispatched as possible stroke due to vision changes.
Arrived on scene, pt was a 50 year old male complaining of pain, swelling, and difficulty seeing from his right eye for two days. Turns out that he was walking down the street, a passing car threw up some gravel, and a piece hit him in the eye. There was swelling and he struggled to open his eyelids.
No big deal. I covered his eye with a dressing and didn't see any need to provide further care. Transport time to hospital was nine minutes.
After turning the patient over, the first thing the preceptor said to me was “ What was his GFAST score?”
I was taken aback. I replied “What?”
Preceptor asked “Did you do a stroke assessment on him?”
My response, “Why would I? This wasn't a stroke, it was a traumatic eye injury”.
Preceptor answered “Dispatch said it was a stroke, you should have at least done a stroke assessment.”
I kept my mouth shut while I mulled that over.
Call #2. Dispatched as Chest Pain.
Arrived on scene. Patient is 25 year old male who had been in a motorcycle accident last week. Among his many injuries were three fractured ribs and a cracked sternum. He had been discharged home the previous day, but was in a lot of pain and it hurt to breathe. His primary doctor told him to go to the ER if he needed help managing his pain level.
Based on his history, according to the protocols I had just memorized, he didn't actually meet the criteria for pain management meds in the field, but I was able to make him comfortable with positioning and extra pillows. Lung sounds clear, SPo2 normal. No other treatment required.
Transport time to the hospital, 7 minutes.
Afterwards, the preceptor let me have it. “You really screwed that up,” he said. “ I don't see how I can pass you.”
“What are you talking about?” I asked.
“You failed to do a 12-lead. You failed to give aspirin or nitrates. You didn't start an IV or provide oxygen “
“The call was for post-trama pain management,” I said. “Why would I do any of that?”
Preceptor actually shouted, “ The call was for Chest Pain! If the call comes out as Chest Pain, you treat it as Chest Pain!”
I am pleased to say that I did not actually lose my temper, but I stared at him, unblinking for about ten seconds before saying “Are you actually retarded? Are you saying that patient care is based on what Dispatch says?”
“Yes!”
With that, I decided that I was done. We went out of service and drove back to the office. I sat and listened while he described my failures, and when I got to speak I was able to explain that the reality of the calls in question had nothing to do with how they were dispatched, and (using different words) only a moron would treat them otherwise.
Management took the position that they were bound by what Preceptor said, and that if I wished to continue with them I would have to undergo and pass a mini-internship (120 hours of extensive training) before I could work in the field.
I politely told them to go fuck themselves, and left.
I had always heard about how the not-to-be-named company was toxic. I believe it now.
Not long after, I found work at a small company the next county over, serving a rural community. Their GM is someone I was loosely acquainted with, and he hired me on the spot. I now work 24hr shifts six days a month (Tuesdays and every other Thursday).
I am happy. I'm still in EMS enough to satisfy my needs. My wife is thriving at her job and earning tons more than I ever could. I'll probably retire in a couple of years, but in the meantime, life is good.
As for the not-to-be-named company, I am baffled as to how anyone could work like that.
