GreenHat

07, I understand your situation as i was only 20 when I started in EMS. I had to work as a vehicle service tech for my former company until I turned 21, then I immediately switched on my 21st birthday to a car (I had already finished all of my training+EVOC prior to my birthday) and it worked well for me. I am now employed by AMR(much larger company) and we have drivers under 21, but most of them are at least 20. It is, however, possible to be insured at 18 (at least in AMRNW). My recommendation is to get some schooling out of the way before you start applying to medic school. Here in Oregon, you receive an AAS degree for your trouble, but in most states you are certificate only. You need something to show for your schooling in case it doesn't work out.

I work for AMR in Portland right now and after working for a different EMS agency in the area, I love it... of course, we are union and that really keeps AMR in line. AMR is a great company for me and it really fits here, but it could be different there, just depends on management.

I myself am an EMT-B in the great state of Oregon, and we require both a 12 hour ride along and 12 hour clinical rotation (still wildly insufficient, but they do exist) for EMT-Bs and a basic can do quite a bit on a scene. we are trained in paramedic assist protocols ie spiking bags, combi tubes, drawing drugs, etc. and within our scope are able to assist in interventions, but the paramedic supplies the knowledge and expertise for patient care, then we transport (and yes, I do drive most of the time). However, many many patients are only BLS patients even on 911 calls, so I do take patient care. I have found this extremely helpful as I am a paramedic student (in one of the few degree paramedic states) and I have learned much from my paramedic partners. Also, you only learn about half of what is necessary to be a good paramedic in class, the rest comes in the field and I have been afforded the opportunity to jump start that training before I finish my paramedic. I am very much aware of my narrow scope of practice, but it is a necessary to maintain in order to take the paramedic exam... all in all, it is a good position for somebody entering EMS to get their feet wet in patient care and get a job with a company where they can continue their education.

Ace wrote: Just FYI, If you ever tried to use your signature line with ANY of the OB's I've worked with or know they would promptly use their speculum with 'wide spread' action on your anus...Most of them have forgotten more in their undergrad years about emergency patient management than you may ever know. Furthermore if you had chosen a non-intensive critical thinking specialty like say..DERM.. I may not say this, But OB?!?!?! WTF? Food for thought before you go saying that to anyone!! I use that as my signature because my old partner actually had to pull out that line on an OB-GYN who had been treating a patient in an emergency on an airplane and was unwilling to surrender patient care upon landing... it worked then, but you do raise a good point, it was just a funny situation I have been in though.

we do Have several trauma centers within a close area in Portland, but there are virtually no hospitals for hundreds of miles around so life flight tends to be activated when we are in the boondocks. I am stationed in clackamas county which is half city and half frontier, so it's basically both here... big city with more than enough hospitals and in places you are hundreds of miles away... there are 8 hospitals in the greater metropolitan area and only one further out, it is a level 2 trauma center, but it has to service quite a large area. any appearance at backpedaling there was just my attempt to better explain our situation, in some areas, you have your choice of several hospitals and in others you have only one choice.

That is very true and we normally only use life flight during rush hour in urban areas, but it is important to remember that Clackamas county, our largest county area wise that has EMS service has no level one trauma centers and only 3 Er's (where I would not allow myself to be taken, by the way) to service more land. Much of this area is classified as frontier and our response time is 4 hours or whenever we make it. In these areas, we tend to activate life flight more often, and also to transfer from other states as the next closest trauma center is 5 hours away to the north, 14 hours to the south, not sure on the east, but we do take several flights in from states to the east of us, and nothing on the west side. We have 2 mountain ranges that are more than an hour from any hospital code three after you make it to The freeway, and several other rural areas that have need of our life flight. We only put them on standby until we have assessed the patient (that is EMS or fire as all of our fire crews are paramedic crews) due to the plethora of false calls where life flight went to a scene where the 911 caller was panicked and said the call was much worse than it was in actuality. It is an imperfect system, but it works in our area, especially since flight craft are only ever about 10 minutes away from any of our urban calls. Again, not perfect, but it works... Also, it puts health care decisions in the hands of *gasp* health care professionals, not Joe public.

I was quite distressed upon reading this topic. This patient, in my honest opinion should have been transported to the nearest trauma center... level two as she was A/Ox3 and life flight should not have been activated. What we do here in Oregon is put them on standby until we arrive on scene then activate after we have done an assessment, but conscious patients almost never require life flight... of course, we have two level one trauma centers within 5 miles of each other and a 3 level two's within 10 miles, so we really have plenty of hospitals to take people to. Based on MOI and possible head trauma and the possible ETOH, there is no excuse for allowing this patient to refuse transport, they needed to go to the hospital for assessment and ongoing care just to rule out internal head injury. Also, what is your cert level? We have paramedics on all rigs and both partners are medics in Multnomah County (our highest population county) so these decisions would have been made by a medic. Also, why would you listen to police about whether this person needs to go to the hospital or if they can put them into temporary custody? Remember, you are the medically trained person on scene and as far as patient care goes, the buck stops with you and it is your responsibility to be a patient advocate even if they are unwilling...