City vs. Town

[JohnnySynthemesc]

thanks for those who helped me out (I'm gong to keep up on them, just hopefully they don't get pissed). I have another question too, I was wondering, for someone new to EMS, which route is better: To work in the city (my case Boston) or in a smaller town? (although its weird because Weymouth is considered a city, but its more like a town) I want to so badly work in Boston, but there are people who tell me "wait until you get more experience" and then there are people who tell me "that's how you get your experience". But I think its time to ask the real professionals. How do you feel about that and what was your experience? Haha i also hear that city EMS really dislike young newbies...

thanks.

-john

[medic001918]

The decision of where to work is yours. It depends more on the service than the location as far as being new goes. The biggest thing that i could recommend would be to work somewhere that you are geographically familiar with if possible. There isn't much wose than needing to be at a hospital with a patient that demands my full attention and having to give directions at every intersection, stoplight, stop sign, etc. The cities tend to have more call volume, but they also tend to do more calls that don't amount to much...drunks, cold and flu, etc. These calls are valuable though to someone new to the field in that it's a chance to improve your patient interaction and assessment skills. So once again, there's a value there.

As far as city employees not liking "young newbies," it has nothing to do with being in a city. It has everything to do with the person. Your attitude will go a very long way towards how your coworkers percieve you. Ask questions that are pertinent. Don't get into a game of comparing war stories. Be open to criticism. The criticism should be of the constructive variety though, not the degrading kind. Be open to suggestions. Ask how you can improve. If my partner is new and takes an active interest in learning, I don't mind teaching them. If my partner is new and comes in with an attitude that they have seen and/or done it all, or the attitude that they already know everything they need to know...then they are in for a large reality check. I'll go out of my way to help you if you desire the help. If you're going to ask and not listen, I'm not going to waste my time. Be honest about your experiences (or lack of), and you'll find that you are rewarded with more assitance then you know what to do with. Lie and find out how quickly you get left with just enough rope to hang yourself. It has the potential to be a vicious field. While most calls are not life threatening, there are those that are and it's not the time to deal with someone's attitude unless they can 110% back it up.

Keep an open mind and a thick skin and you'll be fine. It's more how you act than your physical age.

Good luck,

Shane

NREMT-P

[Dustdevil]

I want to so badly work in Boston, but there are people who tell me "wait until you get more experience" and then there are people who tell me "that's how you get your experience".

Newbies have no business in a rural system. Urban is where to get your best experiential base. You won't necessarily make more serious runs than a rural service, but you will make more runs total than at a rural service. Quantity is extremely important in developing and perfecting your style of practise. Also important is working with a variety of people and working for a very structured organisation with a good education department and close supervision. Usually, you will find none of those things in a rural service.

Once you have established a routine and are comfortable in practise, then you are set to move to a rural service where you are more autonomous, have significantly greater patient contact time, and perform a lot more pre-hospital care. It is just not an ideal situation to be thrust into a rural situation as a rookie. In the city, you have lots of backup, first responders, and resources. In the country, it is frequently you and your partner, and that is it. If you don't already know what you're doing, you are not an asset. You're a hindrance. And the slower pace, as well as the lack of educational resources, will significantly delay your professional development.

From what I can tell, Boston EMS is full of bad attitudes, so I think you can probably expect that attitude as a rookie. Of course, not everybody is the same. And you are certainly likely to find bad attitudes in a rural service too. It is not uncommon to find bad attitudes in the country because many of the people who end up there are either burnouts who fled the big city, or losers who are bitter because they never could get hired in the big city. And a lot of jerks in EMS simply enjoy shitting on those with less experience than themselves, regardless of where they work. So I wouldn't assume that it is really any better in either situation.

Bottom line: if you can work city EMS first, do it. It is best for your overall development.

[medik8]

Hmmm....I kinda do both. Personally, I would try to get the City job if I were you. You see a lot, but as Dust said, you are close enough to most hospitals and resources that even though you can have some pretty hairy deals, they are somewhat short-lived.

Rural....as mentioned...do not do as a newbie. When I work in the country/county, there are times that my calls take 2 hours EACH. Only a very small portion of that is response time and time on scene. The rest of it is spent en-route to the hospital with the patient. Meaning, you'd better be comfortable being in the back of that ambulance with that patient who is VERY pre-code looking or that you may have already had to tube, or going down the tubes...whatever the case may be. There's no calling for help. You're it. Sink or swim. Not a position I'd want to ever be in if I was new. Trust me. It's scared the crap out of me a time or two. Get some experience and then move to an area that's more challenging. You'll enjoy it more because you will feel more in control, and you will be better at your job in the long run. Just my advice...

xoxo

8

[Dustdevil]

I had been in EMS for thirteen years before I went to a rural county service. Even with that experience, it was a rude awakening! I had to increase my game. I had to dive back into the books and gain a much better, more advanced understanding of what I was doing. Had I not already had significant hospital experience, I might have panicked. Without that experience, most medics have no idea what to do with a patient after the first fifteen to twenty minutes. You definitely do NOT want to be learning your operational basics in a rural setting. Learning at the expense of your patients (and partners) is not a good thing.

[chbare]

Dustdevil and Medik8, I also agree that rural EMS has very unique challenges. (Long transport times/more autonomy) Working at a rural hospital is very similar. If we have a sick patient we need to stabilize them and prep them for transport. The closest cath lab is over an hour away and the closest level I trauma center is an hour and a half away, so we can't just send the patient to OR or the cath lab if they start going down hill. In addition, family practice docs and internal med docs cover the ER, not to say internists or FP's are bad, but their training and continuing education does not focus on emergency medicine. As a health care worker, you need to really stay up on current treatment recommendations and changes regarding emergency medicine so you can help the docs out. On the other hand, I do not get exposed to hemodynamics and advanced procedures as much as I would in a large hospital. (art lines, Swan_Ganz lines, IABP's, etc) Then, you have the business of transporting these sick patients to definitive care. Luckily our area has a service that specializes in inter facility transports and they work real hard at providing a paramedic crew or paramedic nurse crew. Unfortunately, most of the EMS crews are BLS or ILS crews and I have seen patient care suffer greatly because they did not have access to ALS.

Take care,

chbare.

[AZCEP]

There is little worse than watching someone come out of a class ready to save the world, and have to sit on their hands because they don't get to run many calls.

Go to the city. Learn what the sick look/sound/feel like, then move to the country. I've found that the types of calls are identical in the two areas. The only difference is volume. The sick people in the country tend to wait a bit longer before calling for help. The city units run more calls, and make up for it with more of the BS as well.

[PRPGfirerescuetech]

This answer is variant on your goals.

Do you want to learn how to become a killer provider? Elevate your game? Do you want a higher call volume?

What do you want, will answer this question.

[Arachne]

I worked in a rural/volunteer setting for 5 years before starting in more urban, full time EMS about a year ago. It's a bit of a beating to your ego to find out that those years don't amount to much. I found that I was frequently relying on my partners to guide/train me in situations that were beyond my previous experiences. It was almost like being completely new. Having been out of my EMT class for 5 years didn't help either.

Like everyone else has said, it's about call volume.

[strippel]

Going with Dust on this.

I started at a rural service, only because that is where I was. I was lucky enough to learn rapidly. I was able to mature in EMS, mostly because I wanted to learn. There were many co-volunteers who just drove, or sat in the back and smiled. We were 30 minutes to the nearest hospital on a good day, usually without ALS. If I wanted my patient to survive, I became aggressive.

After a year or two, I started working for a small private. (Had to pay for school). Mostly routines, but they were back-up for the city. Back then, that city government was pretty messed up, and we ran more 911 calls than city fire. When you run the projects, shootings, stabbings ODs on a BLS truck, you learn fast. Back then, there were no classes on scene safety. You rapidly learned to watch your back, and your partners. We rarely had police. If the city sent us, there was no ALS.

What I have learned there, made me the quality EMT I am today. In a matter of weeks, I got so much experience on so many levels, far too much to explain.

I now work for a small city service (bastard hospital/non-profit). I see and help train many new people. You'd be surprised how many come in, fresh from EMT class, knowing everything. They don't, and many leave. Those who stay are kick-ass EMTs and medics.

Recently oriented a volunteer EMT with 13 years experience on a small town ambulance. She also taught EMT class. She was lost the first 2 weeks. It was funny, everyone got high-flow O2, and it turned out she only wrote a handful of PCRs in her 13 years.