It occurs to me that I have never described how my current EMS System works and without that it may make understanding my job more difficult.
The EMS System that I work in now is pretty different from what I have done in the past both in configuration and operation. I work for a regional combination ALS transport emergency service. That's a whole lot of words that to someone outside of EMS may or may not mean much.
We cover three towns one of which includes a large state run university with close to 12,000 students during the school year.
Our staffing is a combination of paid and volunteer. Paid staff primarily are to handle administrative functions and each has an assigned role. I am the operations officer while another is the membership officer, another manages our community CPR education programs, and so on. The paid staff are the primary ambulance and paramedic crews only when volunteer staff is not available. This primarily puts the administrative staff on weekdays. There is a paid EMT-Intermediate on duty for a 12 hour shift on weekdays and paid paramedics on call for the day and evening shifts 7 days a week. Nighttime and weekend EMT-B and EMT-I coverage is by volunteers with nighttime paramedic coverage being by on call paramedics who are paid a stipend and then an hourly rate while actually on call. Most of the paramedics also serve on the paid staff either full time or in a per diem capacity.
We operate three ambulances and one paramedic intercept unit. The ambulances are all capable of operating at the paramedic level as well as the paramedic intercept unit. We can, for major events, have three paramedic staffed ambulances in addition to the intercept unit if needed but usually the ambulances operate at he EMT-Intermediate level and only take the paramedic with them if needed. This also allows us to send our paramedic to If staffing is such that there is only one person assigned to the ambulance for the shift the duty paramedic is simply detailed from the intercept unit to the ambulance to complete the crew.
Because we have such a large college campus nearby and also run 5 separate EMS courses (3 EMT-Basic and 2 EMT-Intermediate courses) every year there are always opportunities to teach in formal classes as well as informally in small groups or one on one. This also means that we draw almost half of our volunteers from the college student body. There are always other classes being offered and training being done for refreshers and members preparing for promotion.
Our closest hospital and most frequent destination is 20-30 minutes away depending on where in our service area we are coming from and is a pretty capable community hospital with a pretty good cardiac cath lab. There are no trauma centers within reasonable distance to us so we end up transporting our trauma to the nearest hospital or, less often, flying them to large teaching hospitals about an 60-90 minutes away by ground. Up until recently we did not have a helicopter within 30 minutes flight time but that changed recently and now we can usually get a helicopter within 20 minutes weather permitting.
We don't do routine transports with any regularity except from campus health services and most of those are actually classified as emergencies because of their nature.
The organization itself is run differently than any I have worked for in the past. This is both good and bad. The paid staff are overseen by a general manager who is also a paramedic. The manager is overseen by an elected committee of officers which oversee the organization as a whole. This does cause some difficulties in my job. As I oversee day to day operations I am still answerable to the manager as well as the vice president of operations, currently held by a young EMT-I with limited experience. This can cause some problems as my decisions can, and often are overruled by either of the two positions who oversee my work. It is frequently less than clear what I an responsible for making happen and what I need to "kick upstairs" for authorization. A problem that causes me many headaches and much distress at times.
Our first responders are quire varied as well. We have one career fire department who has a paramedic on some of their shifts and the rest EMT-Intermediates. One combination department with some EMT-Intermediates and the rest EMT-Basics and one volunteer department with almost all EMT-Basics. The police departments sometimes go to medical calls but almost never provide any medical care. Occasionally we see Marine Patrol or the Coast Guard if the call is on the inland waterway in our area but those calls are few and far between.
What don't we have that I had before we moved? Limited access highways for one, occasionally we have a road with three or four lanes across for some of it but mostly it's just one lane each way. The other thing that is missing is the sea. We're close, 15 minutes to the shore but nothing in my service area and anyone who read my blog in the early days knows that one of my most stress relieving places was the seawall within sight of the lighthouse.
Do I wish we were busier than the 1500 calls a year we do now? You bet. Do I want to be working somewhere else? Not really, as frustrating as the internal politics can be sometimes this is a good place to work and I enjoy both the calls that we do and the opportunity to pass on what I have learned over almost 30 years to a new generation.
