Good Colorado EMS agencies?

[jdemt]

I'm about to graduate P-school. I've been working in the Aurora system for three'ish years (Rural Metro and Falck). I'm not particularly happy with this system, and don't really want to work there as a medic.

I really like the urban EMS model of street corner posting, 12 hour shifts, etc. I'm looking for an agency that has progressive protocols, street corner posting/12-hour shifts, and would prefer MDT assisted mapping. I've thought about DG, but I'm concerned about the attitude. For example I spoke to a DG medic about one of their patients and happened to ask about the patient's MAP. They said, "we take real blood pressures". This is a bothersome attitude. I'm also concerned about their strict mapping requirements, and the similar attitude of, "we just know where to go". What is the problem with technology?? I've looked into PVH, and they seem really cool, but I don't know that it would be considered an "urban" system, and I'm not sure that Fort Collins is a fun place to live. Thompson Valley looks awesome but I don't like that they only have 24 hr shifts, and it seems like a slower system. Does anybody have any input? EMS only.


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[VentMonkey]

Yes, you're a 21-year old paramedic with little life experience and no paramedic work experience. If you're put off by comments one or two paramedics made, and are assuming that all of their medics function this way, I highly doubt that this is, in fact, the case.

Any, and every agency will have somethings you don't like about it, some will have many things you won't. It is ultimately up to you where you are willing to work and what you are willing to work with, and whether or not the job itself and its positives outweigh its negatives. Afterall, it would not be work if there weren't things to gripe about.

I am by no means encouraging this type of behavior, but merely pointing out the facts of life. Also, @Ensihoitaja, and @captaindepth can probably elaborate about DG. I did a course with a couple of DG medics last year and TBCH they seemed like cools dudes, and were very squared away.

Perhaps some self-reflection may be in order? //shrugs//

 

[jdemt]

Thank you for your input ventmonkey. I understand that there are things with every agency that I may not like. I hope I didn't convey that I think DG is bad place to work, as I really know nothing about them, besides what I've heard from people here and there. With that said, I don't want to work somewhere that would mold me into the type of medic that I don't want to be. Aurora being a prime example (even though there are fantastic providers in the system). I would love to here from the DG folks and have by no means judged the entire agency based on a couple comments.


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[RocketMedic]

Have you looked at Colorado Springs or Texas? Medstar is a good outfit.

 

[captaindepth]

I'm about to graduate P-school. I've been working in the Aurora system for three'ish years (Rural Metro and Falck). I'm not particularly happy with this system, and don't really want to work there as a medic.

I really like the urban EMS model of street corner posting, 12 hour shifts, etc. I'm looking for an agency that has progressive protocols, street corner posting/12-hour shifts, and would prefer MDT assisted mapping. I've thought about DG, but I'm concerned about the attitude. For example I spoke to a DG medic about one of their patients and happened to ask about the patient's MAP. They said, "we take real blood pressures". This is a bothersome attitude. I'm also concerned about their strict mapping requirements, and the similar attitude of, "we just know where to go". What is the problem with technology?? I've looked into PVH, and they seem really cool, but I don't know that it would be considered an "urban" system, and I'm not sure that Fort Collins is a fun place to live. Thompson Valley looks awesome but I don't like that they only have 24 hr shifts, and it seems like a slower system. Does anybody have any input? EMS only.


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So I'm trying to figure where to start. As an "almost" new paramedic you want to work in a busy, urban, and progressive system but are mainly concerned about mapping and attitudes? Seems like there needs to be some adjustments in your priorities and figure out what are hard & fast deal breakers for you.

The comments regarding a "DG" medic and MAP is out of context and I doubt you asked about Mean Arterial Pressures and the medic simply responded "We take real blood pressures." Do we have NIBP at Denver Health? No. Are we clinically aware of the importance of accurate blood pressures and the correlation of MAP and patient presentation/outcome? Absolutely. I'm not sure where the "bothersome attitude" comes from.

Being concerned about the "strict mapping requirements" is a legitimate source of anxiety but hundreds of paramedics have figured it out in the past and hundreds more will in the future. The city is based on a simple grid, memorize the street rotations, major hundred blocks, and common addresses. It's really no big deal. When you run 1,000-1,500 calls a year the mapping aspect becomes second nature. I never feel hindered not having a mounted MDT in the ambulance.

If you live in the Denver Metro area than both PVH and Thompson Valley can be a pretty rough commute and I'm not sure if those systems require previous paramedic work experience. Denver Health usually only hires new paramedics when they graduate from the Denver Health paramedic school in good standing with recommendations from their P-school preceptors, otherwise paramedics generally need a few years experience in a busy 911 system before getting hired.

From what I have heard/seen EMTs and paramedics coming fro the Aurora system can have a tough time adjusting to the Denver system due to the MAJOR differences in scene dynamics and medical control on scene. Denver Health paramedics run the call from start to finish and DFD is all BLS, very different from Aurora fire medics s****ing all over what ever private medics/EMTs are on scene.

There are a lot of pros vs. cons to consider for any job and especially with the variability of EMS. I think the major things to consider are location (of the job), pay, call volume desired, protocols, schedule, advancement opportunities, and system dynamics ( i.e. fire ALS vs. BLS ). Think about what your wants vs. needs are as a career paramedic and try to check off as many as possible.

 

[jdemt]

Colorado Springs looks pretty awesome! I've talked to a couple people from there and it seems like a really progressive system. Can you tell me any more about them. I'll look into Medstar. Thank you so much!


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[jdemt]

Thank you captaindepth. I was a little more negative than I intended to be regarding "bothersome attitude". I think part of my negative prospective is coming from my time as an EMT with Pridemark. My FI was a former Denver medic and I didn't particularly enjoy my time with this (particular) individual. "You will never work at DG if you use a GPS to get to calls". I understand that they probably only had the best of intentions, but it definitely left a sour taste with me. With that said, I have worked with a couple other former Denver medics and they were very cool. Being an "almost" new paramedic I'm torn between getting experience anywhere that will hire me or finding the "perfect" place to be a career paramedic. Thank you so much!


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[luke_31]

Thank you captaindepth. I was a little more negative than I intended to be regarding "bothersome attitude". I think part of my negative prospective is coming from my time as an EMT with Pridemark. My FI was a former Denver medic and I didn't particularly enjoy my time with this (particular) individual. "You will never work at DG if you use a GPS to get to calls". I understand that they probably only had the best of intentions, but it definitely left a sour taste with me. With that said, I have worked with a couple other former Denver medics and they were very cool. Being an "almost" new paramedic I'm torn between getting experience anywhere that will hire me or finding the "perfect" place to be a career paramedic. Thank you so much!


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Forget perfect place, there isn't one. Get some experience as a medic first, then look for an agency you like in an area you would want to live in.

 

[Tigger]

I'm a part time AMR Springs medic. If you want to be on a busy 12 hour street and sit on street corners (well you won't because it's too busy to actually post but in theory), then it might be for you. Protocols are pretty good, relationship with Springs Fire is pretty good, equipment is decent. Haven't had MDTs in three years and they sucked when we had them, but we're supposed to be getting new ones. In fact we've owned them for a year but they just sit in the bay.

It is not my ideal place to work and I would choose all the other places you've listed as places to be first. I keep it at as a part time job to keep my abilities up, work a busy system for experience/vibes, and the pay is alright. But AMR can't hold on to people right now and running 14 calls with 10 transports in 12 hours is not sustainable for me.

 

[jdemt]

Thank you so much Tigger! That actually sounds pretty ideal for what I'm looking for. I may message you when I'm closer to being done with school.


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[Tigger]

Thank you so much Tigger! That actually sounds pretty ideal for what I'm looking for. I may message you when I'm closer to being done with school.


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For sure. They put a pretty good shine on things and you'll get experience. But it's busy private EMS and there's some big downsides that come with that. But when you have no experience, it's kind of what you got.

 

[RocketMedic]

DG doesn't use technology? Not even NIBP? Are y'all Luddites or something? Do you at least have power cots? I don't see why you wouldn't have CAD, data terminals or GPS, there's really no reason not to in 2017.

How do you even find monitors that don't have NIBP?

 

[Summit]

I used to have a chief who said "the first BP will be manual, then you can use the machine" like 13 years ago. Yea... was useful because it gave you a baseline in an environ where road vibrations could give you a spurious read.

In SAR we only have manual... but that might be changing (better for the patient to not open the packaging for every BP and more frequent BPs done if small portable NIBP used).

In the hospital, manual BP cuffs exist and are for when the machine is broken, won't read, or you need extended tq for IV starts, blood draws, therapeutic phlebotomy... NIBP for everything else. It doesn't take much experience to spot a misread or struggling machine and suspicious providers palp while the machine reads.

What is the hate for NIBP by DG?

Also.. "DG." In the hospital side it is mostly DH. Also, after all her efforts and transformation of the system, Gabow couldn't get EMS to stop calling it DG after TWENTY YEARS.

I learned to call DH "DG" 6 years after the transformation.

Well, some still call SAH "SAC" oh well... I guess it has only been 6 years.

 

[Tigger]

DG doesn't use technology? Not even NIBP? Are y'all Luddites or something? Do you at least have power cots? I don't see why you wouldn't have CAD, data terminals or GPS, there's really no reason not to in 2017.

How do you even find monitors that don't have NIBP?

Can't really say that the lack of an MDC really affects my ability to work.

 

[captaindepth]

DG doesn't use technology? Not even NIBP? Are y'all Luddites or something? Do you at least have power cots? I don't see why you wouldn't have CAD, data terminals or GPS, there's really no reason not to in 2017.

How do you even find monitors that don't have NIBP?

A frequent saying around the division goes something like this, "Some of the best things about "DG" are the traditions, and some of the worst things about "DG" are the traditions." It's true, we definitely have our way of doing things but it works, and most people are happy to get on board with it, others not so much.

We have LP 15s with NO NIBP attached (I don't think we even have those cuffs laying around the garage), its all manual BPs all the time.
No power stretchers either, just the old manual Ferno "prams."
No real need for the data terminal. We get dispatch (EMS, DFD, and DPD) notes on our laptops, have wifi in the ambulance for uploading files from the laptops/monitors, and we are all used to navigating the city without one. The city and county of Denver is pretty much as developed as it can be, very few new neighborhoods, it follows a simple grid, and in the further outlying areas of the cities we will use GPS on a cell phone to hone in on obscure addresses.

I guess it sounds crazy but it works. I worked in Colorado Springs for AMR and the mapping systems on those data terminals was spotty at best and lots of mapping errors occurred when solely relying on those things.

@Summit I hear ya on the DG nomenclature, I don't think its going anywhere. I try to only call it "DG" in certain circles and don't use it to identify my unit when calling other hospitals. In a professional setting we are Denver Health Paramedics, but at the bar we are "DG medics," (that even feels weird to type). Again it goes back to the culture of the division.

 

[RocketMedic]

I mean, the MDT can certainly get annoying with its placement and all, but if you get call notes on the ePCR, that's essentially what I mean. Then again, I work in unincorporated county, where the only constant is that there Is No Plan and developers have gone to work with all sorts of winding, twisting roads where fields and farms once were, so for us at Cypress Creek, the MDT (a mounted Toughbook with Responder360) is a totally-vital necessity. MDTs also make it easier to add functional providers to the system without having to worry about the minutia of mapping and routing.

That you can have "spotty" mapping in this era of Google Maps blows my mind, Responder360 and Zoll RoadWhatever literally integrate Google mapping into their software and work flawlessly as long as Verizon has signal (and there's an offline mode for when they don't). I've experimented with key mapping our calls, and it's a huge pain here, the company can't really keep up with the pace of development.

Not having power cots makes me cringe, people are not getting lighter and I'm not a Ferno manual cot fan. Not having NIBP is just plain weird, I'd love to hear the logic behind it. My personal opinion is that not having NIBP leads to fewer vital signs, less-accurate vital signs for patients, and isn't quite as safe as NIBP (since it's harder to take a seatbelted manual pressure than press a button).

 

[captaindepth]

I mean, the MDT can certainly get annoying with its placement and all, but if you get call notes on the ePCR, that's essentially what I mean. Then again, I work in unincorporated county, where the only constant is that there Is No Plan and developers have gone to work with all sorts of winding, twisting roads where fields and farms once were, so for us at Cypress Creek, the MDT (a mounted Toughbook with Responder360) is a totally-vital necessity. MDTs also make it easier to add functional providers to the system without having to worry about the minutia of mapping and routing.

That you can have "spotty" mapping in this era of Google Maps blows my mind, Responder360 and Zoll RoadWhatever literally integrate Google mapping into their software and work flawlessly as long as Verizon has signal (and there's an offline mode for when they don't). I've experimented with key mapping our calls, and it's a huge pain here, the company can't really keep up with the pace of development.

Not having power cots makes me cringe, people are not getting lighter and I'm not a Ferno manual cot fan. Not having NIBP is just plain weird, I'd love to hear the logic behind it. My personal opinion is that not having NIBP leads to fewer vital signs, less-accurate vital signs for patients, and isn't quite as safe as NIBP (since it's harder to take a seatbelted manual pressure than press a button).

I can see the mapping software being useful in a rural area with new and expanding neighborhoods/roads. But here in the city, all the roads that are going to be built are already built and not changing any time soon. No nearly as useful here as the scenario you described.

I agree that not having power stretcher is a bummer but it is nice having such a lightweight stretcher to move around instead of a 200lb power stretcher. I heard we were going to upgrade the ambulances with power stretcher systems but haven't heard any progress on that front in about 6 months.

I don't know if a NIBP vs. manual BPs is a worthy debate at this point but I have a feeling one is brewing (.....again). I disagree that manual BPs are less accurate, it's a skill that if practiced on a regular basis is quickly and easily obtainable. I trust my manual BPs over NIBP any day. I regularly see inaccurate NIBPs in the ED and at our main hospital they frequently double check the monitor pressures with a manual pressure. I have been to some other EDs in the area where ER nurses don't carry stethoscopes and literally will say "I haven't taken a blood pressure since nursing school, I'm not even sure I remember how to do it." That is crazy to me!!! I also think they are faster to get then letting the monitor cycle through its NIBP. Also when I auscultate a BP I can hear the beats, their quality, regularity, ectopic/dropped beats, and easily transition into other assessments/treatments (Lung Sounds and IVs using the cuff as a tourniquet for example). Again its a system wide thing we do and what we are all used to. I'm not sure if there is any "written" reason why we only do manual pressures but I think we would all have a similar arguments as to why we do.

 

[RocketMedic]

Stryker power cots weigh 125lbs, and with the power-load, there is literally no lifting.

 

[Ensihoitaja]

My friend captaindepth covered this pretty well.

Depending on what you mean by GPS, we do have AVLs on all the ambulances that the CAD utilizes. We don't have a route-finding MDT or anything like that.

As far as "strict mapping requirements," yeah that's true. It's also a good thing. Google Maps and the like are great, right up until they're not. What are you going to do when the software tries to take you down a street that's closed for construction? Or when the software doesn't know those 2 streets don't really connect? Or when it's going to take you through a police perimeter or across a parade route? What if your patient's at the park down by the river across from McDonalds? Google Maps also doesn't know that if you go 2 blocks over you'll give your hip fracture patient a much nicer ride on smoother pavement.

Denver's not that hard a place to get around. Memorize the downtown streets and the street rotations and you can get damn near anywhere.

It's also worth noting that overreliance on GPS mapping can mess with your brain
Are GPS Apps Messing With Our Brains?
Do Our Brains Pay A Price For GPS?

 

[Ensihoitaja]

Interestingly, I came across this right after I posted that: Jamming GPS Signals Is Illegal, Dangerous, Cheap, and Easy