Where is the best EMS system?

DPM

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Hello EMT Lifers!

I'm becoming more and more disappointed with the state of EMS here in California. I don't live under a rock, I know that California is the bottom of the barrel, so I don't mind moving.

So here is my question; where is the best EMS system in the USA? Seattle King Medic 1? Somewhere else? I'm looking for a busy system, that pays at least Ok, with good protocols.

If you have a suggestion, please elaborate on why you like a system. I'm all ears!

Thanks in advance
 

VentMonkey

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Hello EMT Lifers!

I'm becoming more and more disappointed with the state of EMS here in California. I don't live under a rock, I know that California is the bottom of the barrel, so I don't mind moving.

So here is my question; where is the best EMS system in the USA? Seattle King Medic 1? Somewhere else? I'm looking for a busy system, that pays at least Ok, with good protocols.

If you have a suggestion, please elaborate on why you like a system. I'm all ears!

Thanks in advance
It's all subjective. What's your cert level? In California you're correct your options are limited, but as far as "the best", that is entirely up to you to decide. What do you want most? For me a career ALS intercept agency with good retirement and benefits would be something I would strongly consider in regards to relocation.

So, my top picks would be one of these types of agencies---with SCEMS being at the top of my list---followed by a solid Texas-based EMS third service such as Wilco EMS. Denver Health (EMS) seems interesting as well.

I also wouldn't mind working for a hospital-based service that utilizes full-scope paramedics in the ED when not responding to calls (bonus if they're CCP+911 deployment).

As you can see, there's hardly a clear cut answer, but that being said I am pretty content with my current (California) agency.
 

EpiEMS

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The best system? Probably not one in the U.S. - I'd say NZ or AUS are probably more like where you want to be. Or Canada!

The best system in the U.S., well, that's up for debate - depends on your criteria. You've identified preferences for a
busy system, that pays at least Ok, with good protocols.
. I'd interpret that as an urban system paying more than $40,000/annum, and with (ideally) good retirement. For "good protocols", I'm going subjective on ya, so I'll ignore it for now.

You didn't specify good system design -- so I have to leave all-ALS staffed ambulances, fire-based EMS, and similar problematic designs in, but I do it with chagrin ;).

Here are some classics cited on this site: King County Medic One, Seattle Medic One, Boston EMS, Wake County EMS, Austin/Travis County EMS, Denver Health EMS, Sussex County (DE) EMS, and New Orleans EMS, Worchester EMS

My picks are going to be more northeast-skewed, and more urban. I'd argue that, despite my distaste for dual medic staffing, Boston EMS has a lot of advantages - plentiful BLS units, lots of good hospitals, and fairly high compensation (circa $60k for EMTs starting, I'm told?). I am also a fan of Pittsburgh EMS, if you like maritime matters or heavy rescue. If you like to ride dual medic and do intercepts, New Jersey has some offerings (University Hospital Emergency Medical Services), too, as do some services in CT (Stamford EMS, for one).
 
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DPM

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Those are the kind of things I was thinking about. I'm a Paramedic, and I've worked all over the Bay Area (SF and San Jose mostly).

You're hitting on the types of things I was talking about, but I also kept it pretty vague to see what other people like about their systems.

Which SCEMS are you talking about?
 

VFlutter

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Detroit EMS
 

VentMonkey

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Detroit EMS
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DPM

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The best system? Probably not one in the U.S. - I'd say NZ or AUS are probably more like where you want to be. Or Canada!

The best system in the U.S., well, that's up for debate - depends on your criteria. You've identified preferences for a . I'd interpret that as an urban system paying more than $40,000/annum, and with (ideally) good retirement. For "good protocols", I'm going subjective on ya, so I'll ignore it for now.

You didn't specify good system design -- so I have to leave all-ALS staffed ambulances, fire-based EMS, and similar problematic designs in, but I do it with chagrin ;).

Here are some classics cited on this site: King County Medic One, Seattle Medic One, Boston EMS, Wake County EMS, Austin/Travis County EMS, Denver Health EMS, Sussex County (DE) EMS, and New Orleans EMS, Worchester EMS

My picks are going to be more northeast-skewed, and more urban. I'd argue that, despite my distaste for dual medic staffing, Boston EMS has a lot of advantages - plentiful BLS units, lots of good hospitals, and fairly high compensation (circa $60k for EMTs starting, I'm told?). I am also a fan of Pittsburgh EMS, if you like maritime matters or heavy rescue. If you like to ride dual medic and do intercepts, New Jersey has some offerings (University Hospital Emergency Medical Services), too, as do some services in CT (Stamford EMS, for one).

Thanks! I'm leaving the fire based systems in just to hear if there is an outlier that works well, but I agree with you about the issues that these systems present.
 

Summit

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In my imagination ;)
 

EpiEMS

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VentMonkey

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Sussex County EMS (as referenced above) - forum user @DEmedic worked there (please do weigh in, DE!).

They're fly-car based dual-medic staffed, and intercept for BLS transporting agencies. I believe they have a pension plan (25-year) and they seem pretty good as far as protocols go.
Honestly between him, and @chaz90 I think it would be best to PM them directly (assuming they're ok with it; I know chaz is pretty open to it, can't speak for DE at this point regarding SCEMS), and/ or do the research independently via threads posted (there's more than one), and the interwebs.
 
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DPM

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I left SCEMS 2 years ago and I still think it might be one of the top 5 stupidest mistakes I've ever made. It is the job that all other paramedic jobs will be judged against.

Mind if I DM you?
 

SpecialK

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In no particular order:

London
Queensland
New Zealand
Canada (I hear BCAS and AHS are good)

You can go be an international in London if you like, they're hiring.
 
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DPM

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In no particular order:

London
Queensland
New Zealand
Canada (I hear BCAS and AHS are good)

You can go be an international in London if you like, they're hiring.

Do you have first hand experience with LAS? I've heard some not so great things from people going from the US to London, particularly in regards to the scope / level that a US paramedic will be accredited at.
 

SpecialK

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Do you have first hand experience with LAS? I've heard some not so great things from people going from the US to London, particularly in regards to the scope / level that a US paramedic will be accredited at.

There's only one level in the UK (Paramedic) which internationals are assessed against so I'm not sure what you are referring to?

The "thrust" in England at least is to have a Paramedic on every ambulance and then to specialise from there; for example Specialist Paramedics in HART (CBRNE), critical care, or primary care. Each trust is also slightly different from each other in terms of how they seem to be implementing the higher tiers because it is up to their discretion I guess owing to the HCPC only broadly registering "Paramedics" in general terms as a professional; a bit like how all the various "advanced" nursing roles are still in the regulators eyes a "Registered Nurse".

Personally I wouldn't go to work in London because I don't want to leave where I am now, but for some people who are a bit younger and want the experience I'd say go for it.
 

TransportJockey

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I would love London. But for the US, I would say any of the good third-service (municipal or county based) agencies here in TX (I work for a decent one right now), Delaware, Denver Health, Ada County Paramedics, Wake County, Orange County, or Durham County EMS. That's pretty much my short list right now. Florida is interesting in that they have some decent single role fire medic positions and some of their third service systems have their own rotor teams too
 
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DPM

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There's only one level in the UK (Paramedic) which internationals are assessed against so I'm not sure what you are referring to?

The "thrust" in England at least is to have a Paramedic on every ambulance and then to specialise from there; for example Specialist Paramedics in HART (CBRNE), critical care, or primary care. Each trust is also slightly different from each other in terms of how they seem to be implementing the higher tiers because it is up to their discretion I guess owing to the HCPC only broadly registering "Paramedics" in general terms as a professional; a bit like how all the various "advanced" nursing roles are still in the regulators eyes a "Registered Nurse".

Personally I wouldn't go to work in London because I don't want to leave where I am now, but for some people who are a bit younger and want the experience I'd say go for it.

Specifically it was the reciprocity for me. I'm hoping to expand my scope, at it looks that a move to LAS would limit it further. I think I'm correct in thinking I wouldn't be able to start IV's or give any IV meds, intubate etc until I was an Advanced or Specialty Care paramedic.
 

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