Very good questions. I will do the best I can to answer them.
1) I started EMS in 1985 as an EMT. I worked then as a Nurses Aide in a nursing home. I volunteered for a municipal ambulance service while I continued to work in the Nursing Home. Within two years I was pursuing my Paramedic. I was offered work by the chief of my volunteer service in 1987 as one of two paid personnel to cover days. I took that with a pay cut because I felt that EMS was so important and vital. In 1988 I was advised I would have to go commercial [private] to complete my Paramedic because of Medical Control matters so I went commercial. I graduated as a medic in late 1988, and my commercial ambulance association began. At that time medics were scarce and they were kept available for the serious calls and they were respected as providers of advanced care by all.
2) To be honest, there are so many it is tough. Not only where I am concerned but with other medics I am proud to call colleagues. I recall a child choking call that came in, in which my colleague Jim was right around the corner from as he was heading toward a transfer he had been given and he was denied diversion requests repeatedly followed by the all too familiar "are you refusing to do the call you were given" BS by the dispatcher, their attempt to catch him in an event of insubordination. He did the transfer. I specifically, was denied diversion to a seizure I was three minutes from in which it was reported that the patient was not breathing. Denied outright to transport a dialysis patient who was already ten minutes late to her appointment.
3) In many areas there are intercept Paramedics that are employees of my commercial service. These are closed shifts and given to the cronies of the managers. They are not subject to the shift bid process. We just lost a service area to a newly established municpal service whose genesis was on the grounds of what I am asserting, that we are not available for their emergencies or cannot meet the demand because of our primary focus on transfers. We are never available because of our companies disregard for the importance of being available for emergencies and their focus on the dollar generators. We serviced this area for 14 years. It didn't happen over night. The history was evident that we were not focused enough on the emergencies predominately for years and the municipality established its own service with that recognition and unchanging reality.
4) Yes, I have thought many, many times of changing my career, Nursing, P.A., Fire Fighter, but I was ignorant and lazy. I wasted time on hopeful vision. I am a long time smoker, started when I was 12. I kept convincing myself I couldn't make the fire department because of that. My longevity is related to a small amount of selfishness. The transition of commercial EMS, if it was a transition, was slow for medics. Medics were revered when I started. EMS may have had the same focus I see today that is disturbing to me, but I was exempt because I was a "medic". As time progressed, the lack of reverance became more and more pronounced as the ranks of medics grew. A slow growth, a slow progression of unimportance crept into my professional life. Soon I was nothing along with many of my colleagues with as many years. We were relegated to transfers as we lost our service areas to other services [commercials that publicly professed better service but we knew better in the rank and file] and to newly established fire based and municpal based services who were tired of hearing "no medic available".
5) Well you might have guessed that already. I was not satisfied working indoors after a while. When I began providing volunteer EMS service as an EMT I loved the "field" concept. The ability to float around and get outdoors. The pride that we felt in riding in our ambulance around the roads I grew up on appealed to me. The true, heartfelt senasation that we mattered. That we made a difference. The pursuit of EMS stemmed from a friend who worked with me in the Nursing Home and she urged me to join the EMT class with her and I agreed. She said I was great with patients and had something to offer so I joined. That was the very beginning. Well I have said way, way too much. I hope this answers your questions.