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The firefighter instantly climbed into the back seat and held the patient’s head straight. He was well trained, too.

The walrus firefighter approached us and took charge of the situation. In a few minutes, we got the girl out of the car and onto a backboard. Another ambulance transported her to a nearby hospital. I returned to my truck to take the family from the other car.

Fortunately, the baby was okay, but another female was also attached to a backboard, like the girl from the Honda Civic.

We took everyone to the hospital, cleaned the gurney, tidied up the back of the truck, grabbed some snacks from the medic room, and went on our way. I don’t know what happened to any of the people involved in the accident, but I did know absolutely that I was in love with my occupation, that neither death nor incapacitation would take me from it. Ultimately, a few detestable ambulance companies would disenfranchise me from the EMS field. As it happened, I only lasted two years.

The next couple of months were incredible. I was working more advanced life support than wheelchair shifts; I got to work with excellent paramedics and gained great experience. I picked up all the extra hours I could. I was the go-to guy, especially during a massive snowstorm that shut down half of Portland. I couldn’t have cared less about the money I was making. I loved my job.

Many of the partners I worked with told me about issues they’d had with the company. There was the negative manner with which management treated paramedics, the refusal by the owner to invest money back into the business, the exodus of several paramedics who had had enough. A coworker once overheard the company’s CEO refer to the paramedics as “a dime a dozen.”

After the economy began to slump, my company was forced to tighten things up. ALS was no longer available to me, and I was sent back to the wheelchair division. I couldn’t even beg my way into a 911 shift. The warnings about management I’d received from my previous partners became a sad reality.

I grew tired of the monotony of the wheelchair division, of squabbling with my managers and my live-in girlfriend. It was as frustrating as the incessant Oregon rain. One day, I arrived for my 4:00 a.m. shift only to have the dispatchers tell us that, after our first call — which took no longer than an hour and a half — we were to clock out. We’d have to sit in our vans, unpaid, until the next call, which didn’t come until 8:30 a.m. I couldn’t take it anymore.

I decided to move back to San Diego and try my luck with a different company. With only $1103 in my bank account, I said goodbye to the gloomy Northwest. I packed only the stuff that fit into my Toyota Tundra and got on the southbound I–5.

To become a paramedic in California, a student must survive an intensive 18-to-24-month program, EMT-basic school, three to six months of EMT experience in the field, plus another two semesters of additional classes. The cost for paramedic school alone in San Diego is $2500 at a community college and about $12,000 at a technical school. The starting pay for a paramedic at a private ambulance company is between $9.38 and $10.56 an hour. As an EMT-Basic, you start out making between $9.56 and $10.00 an hour.

I hooked up with a new company in San Diego. During orientation, the training manager had a stack of paperwork for me to sign. When we got to the hourly wage agreement, he placed the document on the conference room table and slid it over.

“Nine dollars and sixty-five cents, huh?” I said.

“Sorry to ruin your day.” He pointed at the solid black line where I should sign.

The difference between an EMT-Paramedic and an EMT-Basic is like the difference between playing for the Padres and the Lake Elsinore Storm. Paramedics are pros who respond to an emergency call and provide the treatment necessary to get a patient to a hospital alive. EMT-Basics don’t have as much training. They can perform simple procedures, such as administering oxygen and taking vitals, but in an emergency, their greatest life-saving apparatus is a cell phone with which to call 911.

Of the 13 private ambulance companies in San Diego, there are 3 that provide emergency services; the rest provide basic life-support measures. These BLS units provide transportation to and from various medical facilities, such as hospitals, skilled nursing facilities (SNFs, pronounced “sniffs”), and doctors’ offices.

Between the boring sniff calls and pointless paperwork, basic life support soon lost its luster for me. The dialysis appointments were the worst.

Patients with renal failure, having to go to three dialysis treatments a week, were subjected to so much misery while their overall condition continually worsened. Some would be missing limbs the next time I saw them. I pretended not to notice the body parts gone AWOL. What could I say? “Hey, Bob, they took the other one, huh?”

Running dialysis calls bored me to tears, but my aversion to this routine developed into outright moral objection. Like other health-care outlets, most dialysis centers are privately owned; profits depend on the flow of clientele. The product does not offer a remedy to the patient’s health issues, nor does quality of life substantially improve. These people are sold on the idea that they need this treatment. A majority of the patients are Medicare or Medi-Cal recipients, and the companies are assured of guaranteed income. It struck me one day — as three other EMTs and I lifted a gurney with a man too obese to walk on his own — that I had become a part of the broken medical system so many decry.

Much like a predator picking off the weak and half-dead, many ambulance companies prey on patients. Once, while tripping over a wheelchair as my partner and I lifted a lady from her bed to the gurney, I realized that there was no reason this person needed two EMTs and an ambulance. Too many dialysis patients, with wheelchairs sitting next to their beds, were going to their treatments by way of my glorified taxi service. One lady, who lived 1.4 miles from her dialysis facility, had to be lifted out of her wheelchair and onto the gurney to transport. For a routine, non-life-threatening appointment, people should be taken by wheelchair van.

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Sdemt Jan. 13, 2012 @ 3:37 p.m.

Excellent written article. May I remind you though, that in a life threatening emergency its quite unfair to assume that an EMTs only tool is the cell phone with which to call 911? I don't need to enumerate the interventions an EMR can make as it seems you are aware of those but it seems you have forgotten your BLS basics in that a well trained EMT is worth their weight in life saving measures regardless if their scope is elementary, as it seems, to you. Anyone can call 911. Anyone can flip burgers. And burger flippers get paid more than most EMTs. So show a little respect for us little people. In a crisis we are watching out for the paramedics or nurses back while helping for the best patient outcome. I feel sorry for any EMT who works with you and all they get to do is call 911, instead of doing what they were trained to do.


AliPal June 22, 2012 @ 2:52 p.m.

I really enjoyed reading this! I've often wondered what it was like to be an EMT and I am appalled to see how little they are paid! I had no idea, but if it were up to me, I'd double it and I hope someday companies like the one you wrote about will be more concerned with efficiency and patient and employee care than their bottom line. Thanks for sharing and I'd buy you a Venti if I could!!!


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