What makes an agency "the best?"

[triemal04]

This came up in a recent thread and, even if it has been discussed before, it's probably time it was again.

There is lot's of talk, both here and in real life about how such-and-such an agency is "good" or "one of the best" and how others are "bad." Being able to see what makes an agency "bad" or "good" on the surface is relatively easy, but more should go into it than that But there are lot's of different departments that are continually referenced as "the best."

Why? What is it that makes some of these places get that reputation, desirvedly or not? If "one of the best" agencies has a massive yearly turnover, are they really the best? If they have a great PR machine is that what does it? Is it their history in the community? What is it?

What really should be thought about before labeling a group "one of the best EMS agencies in the US," and what are people actually thinking about?

Is it the money and job titles?
Base salary?
Benefits?
Retirement?
Wage increases?
Promotional ladder?
Number and type of non-line paramedic jobs?

Is it what the paramedics can do?
Calls run per shift? Per year?
Procedures performed? Number performed successfully? Initially successfully? Appropriately?
Procedures available?
Medications available?
Medications rountinely given? Given appropriately?
How accurate are the field diagnosis?
Amount of trauma/stroke/STEMI activations?
Amount of accurate trauma/stroke/STEMi activations?
Number of intubations per paramedic per year?
The number of appropriate and initially successful intubations?
Ability to RSI? Do it correctly?
Autonomous care or calling for everything? Calling for some things?
Refuse care/transport?
How much of their own discretion can they use?

Is it the working conditions?
Fixed vs dynamic posts?
Lots of down time?
Good equipment?
Defined disciplinary steps?
Having a current contract?
Appropriately promoted supervisors?
Mangament who will stand with you?
Are people who need to be fired/disciplined fired or disciplined?
Is there a remediation process?
Do people stay for their career, or routinely leave?

Is it the medical director?
How involved is he/she?
How much authority do they have?
How can/do they change how things are done?
Will they stand up for their paramedics when appropriate?
Do they have QA/QI setup for all thier paramedics?

Is it the system?
Is it because they aren't fire-based?
Do they have a PR setup and PIO? Do they use them?
Do they overuse their PR setup?
Is it how other local agencies feel about them?
Is it how area hosptials feel about them/interact with them?
Number of medical studies they contribute to? Perform?
Is the the cardiac arrest save rate? Overall or Utstein?
Is it being a tiered system or taking everything?
If it is tiered, how set are those rules?
Do other services duplicate what they do?
Dose the system track what they do and make decisions using that data?
Is it that they are trying new things? Or only doing what is tried and true?

Is it how people are hired?
Is there an involed testing process that looks at paramedic-level knowledge? Knowledge above that?
Is it having an initial training period?
An FTO period? The length of it? What is done during it?
Is the the number of applicants?

Are any of these what people think about when deciding to label an agency "one of the best" or "a top system?" Should any of these be considered? Do people just look for buzzwords and what others are saying now, or actually think about it for themselves?

 

[Veneficus]

When you love your job and the people you work with and don't have to constantly worry about money your agency is great.

 

[RocketMedic]

This came up in a recent thread and, even if it has been discussed before, it's probably time it was again.

There is lot's of talk, both here and in real life about how such-and-such an agency is "good" or "one of the best" and how others are "bad." Being able to see what makes an agency "bad" or "good" on the surface is relatively easy, but more should go into it than that But there are lot's of different departments that are continually referenced as "the best."

Why? What is it that makes some of these places get that reputation, desirvedly or not? If "one of the best" agencies has a massive yearly turnover, are they really the best? If they have a great PR machine is that what does it? Is it their history in the community? What is it?

What really should be thought about before labeling a group "one of the best EMS agencies in the US," and what are people actually thinking about?

Is it the money and job titles?

Same at this agency as any other, but with some paramilitary twists. Meh.

Base salary?

Better than regional competitors, but still lacking. Hits the "keeps the lights on" perfectly.

Benefits? Meh.

Retirement? Hah. 401k.

Wage increases? Stingy and small.

Promotional ladder? Long, but meaningless.

Number and type of non-line paramedic jobs? There's quite a few available, but I'm not sold on the availability.

Is it what the paramedics can do? Average, but fairly conservative.

Calls run per shift? Per year? Approx 6-10/12hrs, 192,000 and counting on the year.

Procedures performed? Lots. Number performed successfully? 75% Initially successfully? 65% Appropriately?...honestly? Closer to 40-50%

Procedures available? See above

Medications available? Standard stuff.

Medications rountinely given? Depends on the medic. Given appropriately? Really depends on the medic, although agency QI is aggressive on medication errors.

How accurate are the field diagnosis? "We don't diagnose."

Amount of trauma/stroke/STEMI activations? Lots.

Amount of accurate trauma/stroke/STEMi activations? Lots less.

Number of intubations per paramedic per year? 2-3/year.
The number of appropriate and initially successful intubations? I'd say 80%
Ability to RSI? Do it correctly? No, unless you're counting the Versed Bolus of Fate.

Autonomous care or calling for everything? Calling for some things? Pretty much autonomous.
Refuse care/transport? Possible, frequently used, but requires FOS consult. We always want to take people.
How much of their own discretion can they use? 0%.

Is it the working conditions? Average SSM.
Fixed vs dynamic posts? Dynamic to fixed points.
Lots of down time? No.
Good equipment? Top-rate.
Defined disciplinary steps? Ish...
Having a current contract? Yes.
Appropriately promoted supervisors? No.
Mangament who will stand with you? See above.
Are people who need to be fired/disciplined fired or disciplined? Depends on who they are, but generally they'll find a reason.
Is there a remediation process? Yes.
Do people stay for their career, or routinely leave? $10k bonus...retention is a problem.

Is it the medical director? He's OK. Conservative but OK.
How involved is he/she? Very.
How much authority do they have? Lots.
How can/do they change how things are done? No real changes immediately, but they do work pretty hard at it.
Will they stand up for their paramedics when appropriate? Yes.
Do they have QA/QI setup for all thier paramedics? Yes.

Is it the system? Sort of.
Is it because they aren't fire-based? No.
Do they have a PR setup and PIO? Yes, Do they use them? Ineffectively.
Do they overuse their PR setup? No
Is it how other local agencies feel about them? No. I think other agencies pity us.
Is it how area hosptials feel about them/interact with them? Good interaction.
Number of medical studies they contribute to? Perform? This. So this.
Is the the cardiac arrest save rate? Overall or Utstein? Utstein, 40%ish.
Is it being a tiered system or taking everything? Takes everything.
If it is tiered, how set are those rules?
Do other services duplicate what they do? Not really.
Dose the system track what they do and make decisions using that data? Yes, but no.
Is it that they are trying new things? Or only doing what is tried and true? 1989...

Is it how people are hired? No.
Is there an involed testing process that looks at paramedic-level knowledge? Knowledge above that? No.
Is it having an initial training period? Yes.
An FTO period? Yes/ The length of it? 3 weeks initial. What is done during it? Highly dependent upon the FTO- there's a lot of new blood in both sides of the equation.
Is the the number of applicants? No.

Are any of these what people think about when deciding to label an agency "one of the best" or "a top system?" Should any of these be considered? Do people just look for buzzwords and what others are saying now, or actually think about it for themselves?

 

[RocketMedic]

When you love your job and the people you work with and don't have to constantly worry about money your agency is great.

I've got...none of those right now.
The job I love. The operation I already have misgivings for.

 

[NYMedic828]

When you love your job and the people you work with and don't have to constantly worry about money your agency is great.

Does such a place of fantasy exist?

 

[RocketMedic]

Does such a place of fantasy exist?

I'd argue yes. Exposure to where I thought I wanted to be is showing me that I was there all along.

 

[Achilles]

Does such a place of fantasy exist?

That movie absolutely SUCKS. :excl:

Kind of what Vene said but I actually have a quote from a

“Choose a job you love, and you will never have to work a day in your life.”

-Confucius

 

[NYMedic828]

That movie absolutely SUCKS. :excl:

Kind of what Vene said but I actually have a quote from a


-Confucius

Yea, Mr. Depp should stick to playing Capt. Jack.

[youtube]GI6CfKcMhjY[/youtube]

 

[46Young]

This forum is comprised mostly of people who are employed or are tring to get hired into an EMS job. So, I feel any discussion about what is "the best" EMS agency should prioritize the benefits to the employee.

Given that, the primary consideration is retirement. That is paramount. Is it a 401k or 403b? What is the match, and what funds are available? Hybrid? Defined benefits? What is the multiplier, years of service, and is there a DROP?

Pay is obvious. "Love" of the job doesn't pay the mortgage and keep your family fed. Step increases or merit based increases? What is the top-out, and how long does it take to get there?

Next is benefits. How much paid time off? What is the premium for the medical plan, and are there deductibles? Disability benefits? Do they supplement your pay up to your base rate if you're military and get deployed?

Schedule? Forced OT? Are you able to use your leave, or do they make it prohibitively difficult to do so?

Is there a real career ladder and positions available away from field pt transport?

Arddress all these concerns, then get into protocols, deployment, equipment, etc.

 

[Veneficus]

This forum is comprised mostly of people who are employed or are tring to get hired into an EMS job. So, I feel any discussion about what is "the best" EMS agency should prioritize the benefits to the employee.

Given that, the primary consideration is retirement. That is paramount. Is it a 401k or 403b? What is the match, and what funds are available? Hybrid? Defined benefits? What is the multiplier, years of service, and is there a DROP?

Pay is obvious. "Love" of the job doesn't pay the mortgage and keep your family fed. Step increases or merit based increases? What is the top-out, and how long does it take to get there?

Next is benefits. How much paid time off? What is the premium for the medical plan, and are there deductibles? Disability benefits? Do they supplement your pay up to your base rate if you're military and get deployed?

Schedule? Forced OT? Are you able to use your leave, or do they make it prohibitively difficult to do so?

Is there a real career ladder and positions available away from field pt transport?

Arddress all these concerns, then get into protocols, deployment, equipment, etc.

I will point out.

Both my father and my grandfather died at work. So will I. Retirement comes with a headstone.

When you are the best at what you do, you dictate your terms. I love what I do and I can't believe I get paid for it. I would do it for free if I didn't need the money. I keep getting told the money is coming, but I have yet to see it.

Having said that, what is best for you is determined by you. There is no "best EMS company or department."

If you are willing to live in poverty in order to put in a chest tube then that is your happiness. Especially if you don't want to go to school in order to do it.

If retirement is your aim, then obviously a dept with the best retirement is best.

As for "does such a place exist?" My philosophy is you can either choose your own life or submit to having it chosen for you.

Shakespeare once wrote a passage about whether tis nobler to suffer the slings and arrows of outrageous misfortune or to take up arms against it.

There is just as much knowledge in art as there is in science. You do not find your fantasy. You make it or accept not having it.

 

[abckidsmom]

I will point out.

Both my father and my grandfather died at work. So will I. Retirement comes with a headstone.

When you are the best at what you do, you dictate your terms. I love what I do and I can't believe I get paid for it. I would do it for free if I didn't need the money. I keep getting told the money is coming, but I have yet to see it.

Having said that, what is best for you is determined by you. There is no "best EMS company or department."

If you are willing to live in poverty in order to put in a chest tube then that is your happiness. Especially if you don't want to go to school in order to do it.

If retirement is your aim, then obviously a dept with the best retirement is best.

As for "does such a place exist?" My philosophy is you can either choose your own life or submit to having it chosen for you.

Shakespeare once wrote a passage about whether tis nobler to suffer the slings and arrows of outrageous misfortune or to take up arms against it.

There is just as much knowledge in art as there is in science. You do not find your fantasy. You make it or accept not having it.

:like:

Retirement is important, or at least a back up plan in a job that requires your physical capability. You never know what freak accident will come up and destroy your career.

But all of us live on the edge of that bubble. Who is to say we are not going to pop an aneurysm today and get our headstone tomorrow?

Enjoy life, and have plans B and C waiting.

 

[46Young]

I will point out.

Both my father and my grandfather died at work. So will I. Retirement comes with a headstone.

When you are the best at what you do, you dictate your terms. I love what I do and I can't believe I get paid for it. I would do it for free if I didn't need the money. I keep getting told the money is coming, but I have yet to see it.

Having said that, what is best for you is determined by you. There is no "best EMS company or department."

If you are willing to live in poverty in order to put in a chest tube then that is your happiness. Especially if you don't want to go to school in order to do it.

If retirement is your aim, then obviously a dept with the best retirement is best.

As for "does such a place exist?" My philosophy is you can either choose your own life or submit to having it chosen for you.

Shakespeare once wrote a passage about whether tis nobler to suffer the slings and arrows of outrageous misfortune or to take up arms against it.

There is just as much knowledge in art as there is in science. You do not find your fantasy. You make it or accept not having it.

I agree with you. It's just that in this line of work I''ve often responded to the elderly, so I''ve seen first hand how people end up when not preparing properly for retirement. It's truly sad. They don't have two nickles to rub together, have to alternate meds every month, etc.

 

[46Young]

:like:

Retirement is important, or at least a back up plan in a job that requires your physical capability. You never know what freak accident will come up and destroy your career.

But all of us live on the edge of that bubble. Who is to say we are not going to pop an aneurysm today and get our headstone tomorrow?

Enjoy life, and have plans B and C waiting.

Exactly right. I plan on getting an Emergency Management degree, doing time in the Fire Marshall's office hopefully become a Fire Marshall, definitely finish the EMS AAS as well and build on that if necessary for a post retirement job.

 

[NYMedic828]

Exactly right. I plan on getting an Emergency Management degree, doing time in the Fire Marshall's office hopefully become a Fire Marshall, definitely finish the EMS AAS as well and build on that if necessary for a post retirement job.

Fire Marshall is my end goal someday as well with FDNY.

That or Rescue.


Both easier said than done.

 

[46Young]

Fire Marshall is my end goal someday as well with FDNY.

That or Rescue.


Both easier said than done.

Got a letter of interest in for the next TROT school right now.

 

[NYMedic828]

Got a letter of interest in for the next TROT school right now.

Nice man best of luck.

Does being a medic help you? I know its different since you can be a firefighter paramedic in fairfax.


For FDNY being a medic looks real good on your application to a rescue company and whatnot since few fireman are medics. Granted you can't operate as a medic, they still want to have someone with the training.

 

[46Young]

Nice man best of luck.

Does being a medic help you? I know its different since you can be a firefighter paramedic in fairfax.


For FDNY being a medic looks real good on your application to a rescue company and whatnot since few fireman are medics. Granted you can't operate as a medic, they still want to have someone with the training.

Thanks!

Actually, being a medic works against you somewhat. Medics get less spots since a TROT orHazmat Tech promotion lets a medic drop their ALS cert if they want.

One guy who works here went through the next academy class after me. He worked some Zebra unit near LICH or NYM before leaving for our FD. He got dissed for Hazmat school, so he took it somewhere else, so now He's Hazmat. We have eight Heavy Rescues, four TROT and four Hazmat specialty.

 

[Veneficus]

I agree with you. It's just that in this line of work I''ve often responded to the elderly, so I''ve seen first hand how people end up when not preparing properly for retirement. It's truly sad. They don't have two nickles to rub together, have to alternate meds every month, etc.

One more reason I will not be moving back to the USA.

 

[NYMedic828]

One more reason I will not be moving back to the USA.

Don't worry, Obama is fixing it... It's just going to take 4 more years than the first 4 years he guaranteed us it would be fixed.

 

[jemt]

My agency is probably one of the best in the tri-state area for a EMT-B.

We have the best equipment,best buildings,online medical control, and constant free classes.....................BUT we are also one of the lowest paid in the tri state area.


Gotta take the good with the bad.