Brace yourself, this is going to be a long one... Back to my EMS roots; I worked for roughly two years at FREMS during the drama.
My first EMT gig was at Wirst Responder-Sac Ops. Working for Tom Arjil... The man, the myth, the legend, the millionaire. We used to have a running joke that as EMTs our title actually stood for
Earning
Money for
Tom.
Once, I transported a lady from the health department who was eager to be transported home, until I walked in and she saw the words "First Responder" on my shirt... Haha. Her smile turned sour real quick. I remember her asking if I worked for Tom and obviously I had nothing to hide. She made small talk and then while transporting her she asked if I liked Tom... In my head, I thought: “Tom, who gave me my first job? The charismatic businessman who seemed to always remember my name? That Tom? Tom is awesome.” So, I replied in the affirmative, something to the tune of, "He is okay, like any other manager..."
She reached into her purse on her lap, as I scribbled that old paper chart as we bounced down the road, and pulled out a business card. While I can't remember her title, she was some big-wig political person from the EMS branch of the County Health Department. She proceeded to tell me not to be fooled by Tom, that he was a snake in the grass, hungry for money and nothing else. She told me he was a cheat and a liar, a circumventer of the law, and that I should be wary about working for him for too long....
Ooooooooh.... Dramatic!
I just remember thinking, "Tom is so nice though"... So naive I was. In the end, that unknown woman's words rang true for myself and many of my colleagues. Anyways, back to the beginning:
I believe I started at $9.12/hr on a 12 hour night car with time & 1/2 after 8 hours. Therefore 10.64 per hour
if I worked 12 hours; there was no night differential. Not too shabby. (My previous job had paid $15/hr as a security guard.) The rigs and equipment were mostly old junk... It was a BLS/ALS company, doing dialysis runs, "gurney van transports," 5150 Txrs, and the typical hospital to hospital shuffle. (I’ll talk about the ALS side later) I remember sitting in my first day of orientation watching people walking around in their navy blue t-shirts that said EMT in big red letters on the back... Oh man... I couldn't wait! I was so ecstatic to start saving lives and kickin' butt... And then they put up the Medicare/Medi-Cal slides on the PowerPoint and started talking about transferring patients to lower acuity facilities and hospital to hospital transports...
... And I thought.... "What the whole wide world is (bleeping) going on here?!?!? MEDICARE??? I don't give two ***** about Medicare? What the hell is Medicare anyway?!"
And then as I sat there quietly stirring in my head and registering all this I thought, "Hospital to SNF?! What in the world is a SNF???!!!!..... Screw that mumbo jumbo! I'm here to save lives and put everyone who sneezes on an oxygen mask!"
Tom came in, and had his business philosophy up on the screen... His five goal posts... I don't recall them all. But being honest was his number one thing. If you set a rig on fire, and told him the truth about it, you wouldn't be fired. On the flip side, if you took a pen home, and lied about it- you were dead to him.
He also mentioned patient care, and not letting complacency get ahold of you, or your chart writing. After all, he couldn't get paid if your charts sucked. –There was a whole lot of coaching on how to write charts, such as words that must be included in the narrative. Lines such as "non-ambulatory; requiring max assist from bed to gurney via draw sheet; unable to self-monitor O2 due to lack of manual dexterity; unable to stand/pivot." Etc, etc, etc. Basically, key words every chart needed, even if the patient could walk or turn on their own oxygen. This was in order to be reimbursed; even if they could walk, the policy was to move them from bed-bed. At the time I didn't know it, but that is called fraud.
But at the time, in my head, I thought it sounded legit, and if they required an ambulance then you're gonna get an ambulance! “Darn right I'll turn your O2 on for you! Besides, you don't know how many liters you need; I went to school for 3 months to do this!"
Complete F!N!G!... 100%, guns ablazin', just happy to be here.
What an idiot. After about a week working IFT I realized that this whole thing was a huge scam and that less than 5% of these folks truly needed an EMT and an ambulance. Whatever, who was I to make waves? I was a 20 year old EMT, lusting after that fire service job, just like everyone else. So I had to do my time, I had to pay my rent, and I had go with the flow.
In short order, I realized that I was surrounded by a wealth of knowledge, and had so much information at my fingertips with access to nurses and other healthcare folks. (Not doctors though, I was very intimidated by the doctors as a young pup in the game.) Reading these peoples' charts actually taught me a lot too. I learned a whole lot. I touched humans, performed assessments, listened to lungs, was thrust into emergency scenes, was unconvinced at meal time, learned long hours of shift work, got comfortable with patient care and the fundamentals of this industry. It was like... Little League, teaching the foundations. It was my gateway to medicine.
I enjoyed it, aside from making pennies in a high cost-of-living city and having rigs that were duct-taped together, and being under-valued and over-ran... It was a great experience. It taught me about the industry and about myself. Even though I shuffled grandma around, the public didn't know that- to the public eye I was in a position of authority and public trust. As an EMT (medic, fireman, whatever) I could walk in to
your residence and tell
you what to do, and you'd
do it, most of the time. That's because you called me to help you.
Day-to-day, I didn't even think about Tom or management... I just did my job the best I could and gained experience. We had fun, played pranks, made friends and networked.
After 6 months of IFT, you could take a one day class and upgrade your position within the company--- to ALS EMT. It was a highly coveted spot that only a few were invited to apply for. The Holy Grail. You could be upgraded and assigned to a 12 hour ALS unit or a 24 hour ALS station (a station was generally a crappy one or two bedroom apartment in the cheapest ghetto location they could find.) Ooooooh man! So exciting. As an ALS unit (EMT/Paramedic) you could now be assigned to run "scene calls" at local SNFs that had contracted with First Responder…
And then you could also continue to run BLS and gurney van transports, then whine about it because this was the major leagues baby!!! ---Hot Call---Grandma in the dementia ward is a little more confused than normal and won't eat breakfast?? OMG! The RN on site has no clue what to do?! Medic 504, it's morphin’ time!!! Lights and sirens- ENGAGED!!!!
Pft… Weaksauce.
I remember we had a Paramedic who wore the Batman style get up belt with all types of stuff he’d never use in 911, let alone responding to SNFs. He used to go into full on trauma activation mode if some poor old lady fell out of her chair while reaching for a new stamper in the bingo room. Bilateral 16G IVs, full C-spine, complete neuro check, EKG, BGL… the whole nine yards. I was a newb, but I knew that he was the amateur. On an aside, common sense will go a long way in this job.
All jokes aside, we did run a few true emergencies because we were called for everything, even Codes. That was due to the facilities not wanting to call 911 because they didn't want the dings in their reports to their governing/licensing body. (Every time 911 gets called they get a mark; too many marks=gov’t shut you down-
or at least make you change your name and business license.) So, they call Tom or Medic or NorCal, their boys will do the same thing as 911.
Anyways... When Tom wanted to start an ambulance company he needed some help. So he went up North and wheeled-and-dealed with an established company: First Responder, Chico Ops - an IFT/911 contract agency. To get his company off the ground
cheaply, Tom struck a deal with Byron (FR Chico CEO) so that Tom's company would have the same name and therefore Tom could buy Byron's hand me downs for under market value. He also got his degree in how to make money from insurance companies and Medicare/Medi-Cal. So now you had two companies, with two separate tax IDs: First Responder EMS Chico, and First Responder EMS Sacramento.
A baby was born, but there was another catch to the deal... Tom's stake in his baby was only 49%. His co-owner Byron owned 51% of the company, but let Tom be the shot caller. Years went by and this made Tom rich; scamming insurance companies and paying low wages and buying the cheapest equipment and uniforms, stations, etc. yielded Tom record profits. They even failed to pay folks double time if they worked over 12 hours on a scheduled 12 hour shift, violating the California Labor Code. If you were good at hustling and making Tom money he would leave you alone; make too many waves or ask questions and you were out! You could always engage the smooth talking folks in Tom’s upper management circle, that included a guy named John. These guys were a gang of smooth talking hustlers who had been rumored to have been fired from other ambulance companies, including Tom himself, for things like sexual harassment and using drugs on duty. Or there was Brent, the shop guy who could duct-tape anything. I wasn’t there during those times, and can’t speak to the accuracy of that, only that I had heard the exact story from multiple long-timers.