Good choice. Too bad you couldn't defer to a later hiring date, like you can do in other places. Make sure that you get your NR-P. You'll always have the option of moving out of state to work if you get tired of all the NY BS (cost of living, quality of life, traffic, realizing that you'll retire poor, etc.)
New York is a tough city to get work in.
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Good choice. Too bad you couldn't defer to a later hiring date, like you can do in other places. Make sure that you get your NR-P. You'll always have the option of moving out of state to work if you get tired of all the NY BS (cost of living, quality of life, traffic, realizing that you'll retire poor, etc.)
I miss working with him. Did you take the CCP or FP-C class with him?
We missed each other by a couple of months. I know little Yvette too.
I miss the job too. You have to see these all ALS systems. As a medic, you're running everything and anything, and as an EMT, they don't teach you anything, you're just a skills monkey, and are not generally allowed to exercise any indepandent thinking. I see maybe 2-3 good jobs a month if I'm lucky. The working conditions and quality of life are much better here.
Oh, you might also know Serge F. He's a tall Ukraninan dude. IDK what tour he worked on 46Y. He finished our fire academy a couple of months ago. Like the other four of us from N. Shore who left for here, he said that he got tired of sitting on street corners for not enough money and no career ladder to speak of.
Why did you leave?
I think it was the PNCCT a couple of years back.
I remember when he took it. I had a hook with him for PHI based in northern VA, but it's too far for him to travel. They got rid of their per diems a while ago, the ones that couldn't commit to full time. Later on, they realized that they couldn't fill their slots unless they had per diem people. So, they're hiring per diems again.
northernnhmedic
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I left because I was getting sick of the city life. I was born in raised in small town USA, and moved to Bayside for the job when I was 19. I thought it would be this big great thing, so on and so forth. I enjoyed working down there, both as an EMT and a medic, and I made some great friends that I go to visit when I can. But the city life was getting to me for the worse, and I realized I needed to get out of dodge, and fast. So I found a gig back in NH and moved back home. I miss the urban EMS environment, particularly working the NYC 911 system. In hindsight, I should have found a mutual partner, done the double/double/single and commuted back and forth.
Nah, the traffic, tolls, and fuel costs would make it not worth it, especially on a FDNY EMS salary. Factor in mandations and if your mutual partner changes, and you're screwed.
You would have been better off applying as a per diem for one of the hospitals. I would do that right now if I was single. EMS in Virginia is not very challenging.
northernnhmedic
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I realize that now. It would have been barely do-able. As much as i have to work 80 hour weeks now, im enjoying it, and Im happier than I was down there. I tried to commuting to and from Manchester (NHs largest city with approximately 120,000 people and 2 hours from me) for about 6 months, but even that got old, so im stuck working per-diem at a few squads up here til a full time slot opens up.
abckidsmom
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Hey!WTH?
Fixed that for you. I challenge you to go out to the Warren/Page County line on a night with no HEMS available and run a sick trauma patient....
It's like anywhere else, some places it's challenging others not so much.
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abckidsmom
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Put your station anywhere that's an hour from the hospital, and you bump into that problem all the time. I had a sick asthma kid a couple of weeks ago that I had long enough to see the mag help him. Very fun, rural EMS.
I'm referring to the frequency of true emergencies. In NYC, even though the hospitals were very close, we still needed to work the patients in their apartments, since getting them outside could take 5-10 minutes depending on logistics (we were typicaly by ourselves) and having to do walkups of several flights, having to make our way through the projects, Co-ops, etc. Typically in the poorer neighborhoods, the pt is already behind the 8-ball for a good while before we even get there, so there's no getting them out to the bus and then going to work.
We also saw a much greater frequency of high acuity patients. What you're walking into and what was called in to 911 can be two different things, but with FDNY EMT's and medics as call takers, the accuracy is much better than the non EMS EMD cookbook call takers you find elsewhere. In the NYC 911 system, medics don't get dispatched for a single Sz, abd pain, sick jobs, the intox, a diabetic that can follow commands, major or minor injuries, MVA's unless their pinned or are a multitrauma, CVA's, EDP's, or unknowns such as medical alarms. We're only running cardiac arrests, diff breathers, cardiac conditions, the unconscious, inbleeds, stat ep, multitraumas, and that's about it. As such, my number of pt contacts that are truly sick is much greater than I've seen in VA. Much of the time, if I was called for a diff breather, it's an APE full up, or a tight asthmatic. The cardiac is someone sweating bullets and clutching their chest. It would take me 10-12 years to get the experience I had in two years as a medic in NY.
I understand that with long txp times it can be cowboy time, but I got a taste of that in South Carolina (Awendaw, McClellanville, Kiawah, John's Island), and I still found urban EMS in a system that eliminates the less acute calls to be much more stimulating and challenging.
I don't mean to sound arrogant, but I feel that a medic's time is wasted running MVA's, injuries (call for us if pain management is needed), sick jobs, EDP's drunks, etc. These are good calls for basics to gain experience on, along with jobs where you're backing up medics. My three years as BLS in NYC were a great learning experience.
I'm a big advocate of a tiered system, obviously. I feel sorry for medic students here who can go through four or five 12 hour ambulance ride-a-longs and not see a single pt that they can go to work on. I used to see 2-4 a day, and drop at least a tube a week, most of the time. What are you learning in this environment? How to throw on a monitor, 12 lead, and pulse ox? The learning curve for field medics is equally slow. 10-15 monitor/IV/O2 pts to every sick one isn't going to allow you to get good very quickly. Maybe 5% of my calls are somehting that I can sink my teeth into. Perhaps this is why my county likes to barf 3-4 medics on most calls. Collectively, someone will know what to do.
This is why I say that EMS here is not challenging. 90% of my patients are V.O.M.I.T (Vitals, O2, Monitor, IV, Txp) at best. Although, a guy I work with is a per diem medic in Morgan County WV, and he says he runs bad traumas, heroin OD's, etc all the time, so that may be an option for me if I miss running real jobs. Still have to run a bunch of BLS, though.
It's just that EMS here bores me to tears. Great work environment, but we're really not doing much of anything past good customer service most of the time. It's a good career, but not very stimulating.
See my last post. I remember you saying asomething about mixing "street dobutamine" by juggling dopa and ntg. That's quite creative, and those long distance train wercks can be both stimulating and challenging. But, how many of those are you running on a regular basis? We can fly them out if necessary, depending on the weather.
I understand. I had that type of environment in Charleston County.
In NYC, some buildings are grandfathered in where they don't have to have elevators even though it's a six floor walkup. Some projects are maze-like. Elevartors don't always work, either. Even though the closest appropriate hospital is 5-10 minutes away, from pt contact to arrival at the ED can be 30-40 mins or more.
northernnhmedic
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Wow 46Young, you did hit the nail on the head. Granted i was only in FDNY-EMS for 3 years, i do feel the same way. When i worked in Queens, my volume was higher, and the majoroty of it was truly sick patients. Now that Im back in NH, im wishing I was back in an urban EMS environment. Granted people are less likely to call for B.S. and more likely to call for Oh.S., there is still nothing else like it. Here im doing everything, even if it is minor, which I dont mind, after all, I am happy doing the job i love, but I dont feel challenged here. Not like in NYC where i was working at least 1 arrest a week, and cardiacs and diffbreathers all day long. Dont get me wrong, rural EMS has challenges of its own, but urban EMS is its own beast that can be just as challenging as any other EMS Environment.
northernnhmedic
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Oh and 46Young, medics on traumas there? Until the advent of "RescueMedics", and even after the RMs came around, ALS was never much of a thought on most traumas. Unless it came in as an uncon or an arrest, it was my experience that medics didnt roll on traumas, and the BLS didnt call for medics as much as they did when I left.
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I can attest that in NYC you can spend alot of time with your patients when you must "extricate" them from their apartment and its a 6 story walk up.
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Now if I could only get the bosses to understand that this why on-scene times are so long on 911 calls in Boston. First you have to stabilize the patient enough to move them, and then figure out how to move them. If we're going to start treatment onscene, we might as well just get it all done at once, and just monitor/adjust on the way to the hospital.
Are triple deckers common in NYC? Those are the buildings I hate the most, along with buildings with elevators that are so small that you still have to use the stairchair to get to street level.
Where I work now, it's a fire based dual role system. We have ALS engines back us up on many calls. The dispatchers are typically not EMT's, just lay people. They go by the EMD cookbook, and cannot further clarify the situation with questions outside of the script. As such, most of our calls are typed as ALS. For example, someone could have dropped a bowling ball on their foot. The dispatcher will ask if they were short of breath, and the caller may answer yes, since the pain made them hyperventilate for a little while. Boom! It's now ALS for toe pain. All of our buses are ALS except for only four BLS. We have 15 double medic units, and 22 "one and one" medic units. We run pretty much everything.
Back in the days of Queens West, we weren't dispatched on virtually any traumas. The BLS would call for ALS if it made sense, but we would buff anything that sounded good. We also listened to the PD frequencies, so we would get the jump on a good shot, stab, ped struck, etc. and get "flagged" for it as we "happened to drive by." You know how it is.
I had to be broken of that mindset after I moved out of the city. Here, it's quick vitals, O2, strip, pulse ox, and do the rest in the bus. It's easy to do when you have six people and you can run the cot right into the house with maybe two steps to get over, with the pt on the first floor. These patients tend to take better care of themselves, have insurance, so they're not waiting until they're practically dead to call us, and walking them from the living room to the cot that's in the front hallway is usually not a problem. If I tried that with the "real" ALS patients I was used to in Queens and Brooklyn, there's a real chance they will be dead before I make it to the bus.
Basically, in an urban environment, in particular one with a poor socioecnomic clientele, it's do everything in the house, get to the bus, and leave right away. In other systems, the mindest is to get the pt into the bus real quick since it's a more stable environment, do a few things onscene, then leave (or leave right away if it's a long txp). It helps here that probably 85-90% of our patients would have had the same outcome whether they called us, or went to the MD/ED via POV. I see more sick people with my IFT per diem job than I do with 911 it would seem.
Well, it's easy money I suppose.