Best Rural Gigs?

Lo2w

Forum Captain
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Just curious, pretty well set where I am for the time being as I work to gain experience, complete my Medic cert and some other schooling. I just love to keep my options open.

Looking to see what others consider some of the better career rural services, primarily in the Mountain West as I'm loving it out here. Just in terms of progressive protocols, advancement opportunities, community paramedic programs etc.
 

NPO

Forum Deputy Chief
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I work in rural SW Missouri. Our largest town has 10,000 people and a total county population of 50,000 over 560sq miles.

We are competitive in pay (like actually, when other services raise their pay, we match it). Health, vision, dental, life, and disability insurance is paid 100% by the employer. We have a fantastic pension plan. We are an all ALS service, with many double medic trucks.

Protocol highlights, if you think of these things as progressive: Ketamine drips, Esmolol, TXA, Ultrasound.

Good education. Advancement opportunities and professional development including paid conferences with travel and reimbursement for college though your Masters.

Great atmosphere. We're a rural service with a high speed feel. You get the best of both here.
 

FiremanMike

EMS Coordinator
858
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I work in rural SW Missouri. Our largest town has 10,000 people and a total county population of 50,000 over 560sq miles.

We are competitive in pay (like actually, when other services raise their pay, we match it). Health, vision, dental, life, and disability insurance is paid 100% by the employer. We have a fantastic pension plan. We are an all ALS service, with many double medic trucks.

Protocol highlights, if you think of these things as progressive: Ketamine drips, Esmolol, TXA, Ultrasound.

Good education. Advancement opportunities and professional development including paid conferences with travel and reimbursement for college though your Masters.

Great atmosphere. We're a rural service with a high speed feel. You get the best of both here.
What’s your indication for esmolol and how do you guys use ultrasound?
 

NPO

Forum Deputy Chief
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What’s your indication for esmolol and how do you guys use ultrasound?
Esmolol is for refractory VF. 500mcg/kg bolus followed by 50mcg/kg/min drip.

Ultrasound is currently limited to assessment of wall motion (for determining if PEA is true or not) in cardiac arrest. In the future we will be adding other POCUS exams.
 

E tank

Caution: Paralyzing Agent
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Ultrasound is currently limited to assessment of wall motion (for determining if PEA is true or not) in cardiac arrest. In the future we will be adding other POCUS exams.
....wow
 

CarSevenFour

Forum Crew Member
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When Los Angeles and ORCO became too much to handle with all the traffic, smog, and violent calls, I moved to Bellingham, WA. It was a nice gig up there working for a small family-run ambulance service with 2nd hand but well-maintained, decent rigs. Most of our ambulances were Type II Ford and "Euro" vans, which are no fun to drive in the frequent crosswinds, due to the slim wheel track on the ALF converted Mercedes vans. The Type-II Mercedes vans were definitely "tight" in back. I preferred the Fords. Now the company rigs are exclusively Type-III ambulances that were purchased from AMR as used surplus. Our company was close-knit with AMR, which may be good or bad depending on your outlook. They did our night dispatching and eventually took over full dispatch responsibilities.

Medics for IFTs were contracted individually, dependent on need (on a per-call basis). One of the owners was an RN with deep ER and ICU experience and he kept the medical side of training running smoothly (along with our medical director who was an ER doc in Bellingham).

If you want a cool place to live, Whatcom County is tough to beat. Skies are beautiful and deep blue in spring and summer, it rains a lot, but that's what keeps it green and the streams/rivers flowing with the best salmon you'll ever eat. The rivers and streams flowing into the upper reaches of Puget Sound are fed by glaciers running from Mt. Baker, it truly is a beautiful place to live, if you don't mind the local politics which run radically left these days.

The county seat is in Bellingham which features great museums, art galleries, and a nice theater hosting top-line performers who stop off in Bellingham on the circuit from Seattle/Tacoma to Vancouver, B.C., where they try out their new music for an appreciative local audience. One of my partners was a concert violinist for the local symphony. You met a lot of interesting and artistic people working in the ambulance! I think the old Thrice song, "Artist in the Ambulance" definitely applied here.

I collect and repair old telescopes, Nikon film cameras, and clarinets as a hobby and often found good stuff at the many antique stores and junk shops in Bellingham, usually at reasonable prices. Do you like books? Bellingham had the most new and used bookstores of any place I've ever called home. I wouldn't exactly call this cultural gentrification, it was just a cool and vibrant community.

Like the area I left (Orange County, CA), running 9-1-1 calls as a medic was strictly Bellingham or Ferndale fire departments. The pay in private service was good, unionized, and you had the option of working either full-time or part-time. Uniforms were provided gratis and were professionally dry cleaned. If you wanted strictly wages, part-time was the way to go as it was based on a higher rate of pay due to not having benefits as part of your P-T compensation package. I saved every timecard copy and paycheck stub just for fun. Most of my P-T shifts were pre-scheduled. As a part-time EMT, I worked a lot of shifts and had a good relationship with dispatch, so I could request local city coverage when coming in to cover for a crew going on a long IFT. If the destination looked interesting or I was up for a "roadtrip," I could conversely opt to handle the call so the duty crew could remain local.

During that time (2004-2012) most of our IFT ambulance calls were long hauls as the trauma center in Bellingham was often a 1 1/2 hour run to Harborview ER in Seattle. FD BLS ambulance runs were at least 20 minutes to the local trauma center from our fire station located in the northern part of our county south of the international border with Canada. When the bird wasn't flying due to weather, the only option was ground transport via private ambulance. It made for long emergency runs going to a higher level of care in the big city. We'd have either an RN or paramedic responding with us and relations between our company and the local hospital were very good. (If we could not get a medic or RN from our roster, the hospital would detach a specialty nurse to run the call with us). The fire department relations, not so much, same as ORCO, even though many crew members were also volunteer FF/EMTs for local departments in the county. For instance, we were never included in county-wide disaster drills held by the local authorities, the resentment from the BFD toward private ambulances was palpable.

IMO, the psych care for individuals suffering from mental health crises was abysmal, never enough beds or specialty MH care locally, but that's a problem that can be best handled at the state level. We would routinely run patients from our ER to Seattle and even across the state to Spokane and as far down as Tacoma. That's a long time to be in 4-point restraints for the patient on a 72-hour hold.

We would also handle runs for transport out into the Sam Juan Island Archipelago via Washington state ferries on a last-on, first-off basis. The view from the ambulance sitting right on the bow was spectacular on a beautiful day, not so good when the storm swells were running high, but it was interesting.

So, if you're looking for a high quality of life, surrounded by green forests and beauty, Whatcom County, WA is a wonderful place to call home. I left the area after retirement in 2016, and headed for the desert. A lot can change in just a few years, so your mileage may vary.
 

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