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What the hell? We loved you when you were here, we've missed you for being gone. But the, "If I'm not wanted, I'll leave?" has got to go. What evil new whiny bullshit is this? When you posted regularly you were one of the strongest members here...enough with that crap, ok? If I'd left every time I wasn't wanted I'd have missed out on being the medic that I'm becoming. And I've actually come to respect that medic pretty well. When I tried to work with the vollies (Not volly bashing, I know of some that are amazing) I was sumarily hated by nearly everyone despite my best effort to be supremely positive and gentle. ( And by normal standards I mean, not just mine.) But man, I couldn't make it work. I believe that the service is much diminished with me gone, but the service is much happier that way. Stop focusing on the ass kicking you may have taken and be grateful for the experience that you gained. You now know much better where you don't want to be, what you don't want to do, and the places that you actually do have the power to make positive change. You know of some approaches that won't work, and others that will...And that's no small thing. Good to have you back Brother. I'm excited for you to be here. But straighten your friggin' knees, stop looking at your shoes, take a deep breath and get back to the business of being who we've always known, ok? Because that guy friggin' rocked and was a force to be reconned with.

A mixed system with EMS-based BLS first response along with BLS (EMT/EMT) and ALS (paramedic/AEMT) ambulances as well as Community/Advanced Practice Paramedics and supervisors in fly cars dispatched as requested by providers on scene or according to call type: Omega: first response only Alpha/Bravo: first response + BLS ambulance Charlie: first response + ALS ambulance Delta/Echo: first response, ALS ambulance, C/APP C/APP's do Community Paramedic work between emergency calls, ALS ambulances hand over care to BLS units if the patient doesn't require ALS capabilities. Also have some trucks dedicated to BLS/"light" ALS transfers (AEMT/EMT), as well as some critical care capabilities (CCP x2 + EMT) for critical care inter-facility transfers. Have an ALS:BLS ratio of about 4:10, target highly educated, highly trained paramedics and put them through an intense "on boarding" academy. Six months probationary period under an experienced paramedic. For vehicles, my picks would be: Chevrolet Suburban for BLS first response and C/APP's Type II Sprinter for BLS and ALS ambulances Type III Sprinter for critical care ambulances All hi-vis yellow with green battenburg patterns. Blue lights. No bench seats, all should have forward-facing chairs instead with a "stand" in front with drawers and a monitor mount; keep the radio and the bulk of vital equipment on the provider side to avoid providers having to get up during transport. Scrub tops (durable with a radio mic clip sewed on the front), EMS pants. No patches, just agency logo over left breast and name/cert over right. Make the uniforms ANSI compliant (a safety vest you can't forget to put on). Alpha/bravo/charlie responses, no lights and sirens. Delta/echo, lights and sirens as deemed safe to do so by crew. Lights and sirens transport by clinical supervisor order only. Entry level payscale EMT: $34,000 AEMT: $38,000 Paramedic: $45,000 C/APP/Supervisor: $50,000 Requirements EMT: Valid certification. 3 month academy + 3 months probation/field training AEMT: Valid certification. 3 month academy + 3 months probation/field training Paramedic: Associate's degree minimum. 3 months academy + 6 months probation/field training. C/APP/Critical-Care Paramedic: Bachelor's degree minimum and/or Associates + CP/CCP certification and/or Medic + RN. 3 months academy + 6 months probation/field training. Supervisor: C/APP equivalent or relevant management/administrative education. Capabilities EMT: Same as state regs. AEMT: Same as state regs. Paramedic: Supraglottic airways only. C/APP: ETI, (maybe) RSI, wound care (simple sutures), port/cath maintenance, limited dispensing, etc. CCP: Vent management, IV drips, IABP monitoring/management, etc. On-boarding academy be a mix of online and in person lectures as well as skills lab and would include: Medical foundations (bio/A&P/patho review for both BLS and ALS) Pharmacology review (not just EMS meds) Protocol/guidelines Operational guidelines and policies Equipment familiarization EMS defensive tactics (something like DT4EMS, not guns and tasers and all that stuff) EMT's and AEMT's operate under protocols or paramedic direction. Paramedics and up operate under guidelines with options for alternative care pathways available to them. C/APP follow-ups for high-risk refusals or patients targeted as "at-risk" by call review or internal/external providers. 12-hour shifts rotating between busy and slow stations every month. An X-box and a copy of the original Star Wars trilogy in every station.