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Here is a good website about the origins of paramedicine.

http://www.pioneersofparamedicine.com/

Video:

So each individual county holds its own accreditation process then? Presumably to align you to their protocols? Does that include training in things that perhaps I haven't seen with my UK training- Naso tracheal intubation for example.

I don't mind becoming a firefighter, certainly I care more about the EMS side of things and patient care. In my mind it seems an odd match outside of an RTC to pair the two but then it would coming from the UK system. I know over here fire service jobs go in an instant and there is massive demand (sitting around getting paid seems to be popular)... is it similar over there or am I likely to be more sought after as a Paramedic already? I know there are companies such as AMR which will hold me over until I can get a job with the fire service.

Yes, each county or regional EMS agency handles their own accreditation process. Each county has their own medical director who establishes their own policies and protocols (via committee). For the most part, protocols are very similar but some counties may have certain meds or procedures while other counties do not.

The fire service basically started EMS in California so it has been within the fire service from the beginning. Of course, there are all types of EMS systems in California with public and private providers.

http://www.youtube.com/watch?v=mnYeUHyZv_o

Sorry, we don't "sit around getting paid" around here. Your chances of getting hired as a firefighter increases if you are a paramedic. There are less candidates for the job of firefighter/paramedic as there are for firefighter/EMT.

That's only if you count Los Angeles and Orange County as "California."

Exactly

As I understand it, the NREMT is the national licensing body and i'll have to complete their exam? (Tried a practice one and passed but am I likely to struggle without knowing protocols/specifics to US?)

You will need to take and pass the National Registry test. I haven't taken it because I became a paramedic before it was required and I am grandfathered in so I don't have much information on it. If you haven't already, go to http://www.nremt.org for more info.

California has a crazy system. Once you are done with the state license (nremt etc.), you have to be "accredited" within the county you want to work. You take your state card to the local EMS agency and go through their hoops. It shouldn't be as bad as the state hoops. The local EMS agency won't issue you a card until you have a paramedic job within that county. Once you have a job, you can start the process of being accredited. Your employer will know what to do.

I've been told I need 40 ALS contacts as part of my UK training, ALS for us is essentially various securing an airway and administering cardiac drugs during an arrest. Speaking to a US para training school I get the impression these 40 contacts are any para intervention or drug over that of an EMT-B? Is this correct? Aspirin and glucose monitoring form this list?

Basically, you are correct. You need 40 ALS contacts during your internship/training. An ALS contact is any invasive procedure. IV/IO access, drug administration, defib/cardioversion, intubation etc... I think you get the idea. The only ALS skill that doesn't count is cardiac monitoring. That could be abused as every pt could potentially be placed on the monitor whether they need it or not. Question 11 on the link below talks about reciprocity from the California EMS authority.

http://emsa.ca.gov/paramedic/files/FrequentlyAskedQuestions.pdf

Whats the job market for Paras in the US/Cali, am I going to struggle getting a job?

In my experience, hiring seems to come in waves. 6 months of no hiring followed by 6 months constant hiring. Like any medical field, there are is a shortage of paramedics. The economy seems to have slowed down that shortage. It could be hit or miss with you. Southern California has more fire department based EMS then the rest of the state so it will be harder to get a job. Please, unless you are 14 years old, it is California and not Cali.

Am I best getting basic fire training (community college?) and working from a fire station in order to get a decent wage?

This is up to you. Do you want to be a firefighter? It is not required as there are private ambulance paramedics that are not associated with the fire department. If you do, then a firefighter I academy is a good idea. Generally speaking, firefighter/paramedic makes a better living then a private ambulance paramedic and the working conditions are better. I think as a private ambulance paramedic, you can make a decent wage depending on where you work but you will have to watch your pennies a little more.