Bringing Out the Dead

How do paramedics work? Are they run by private companies? Or are they all volunteer? Paid by the salary or by the rescue?

How do you get get trained to be a paramedic?

How does one get to be a “captain” and set up his own “unit”? Any experianced paramedics out there? People who have experience in this area only please.

Paramedics can be volunteers, a private company, or paid members of the fire department or other similar organization. If they’re paid, it’s usually a salary.

In our area, we have all three. The city of Schenectady has both private companies and the fire department providing coverage (and you should see quibbling that entails, with each side trying to make the other look bad). Outside the city, there are volunteer ambulances and a few private companies, though the volunteers tend to drive out the private companies because they charge less (or nothing).

You need to go through special training to be a paramedic. There are two levels – one that lets you do general first aid, and the second, which lets you make more complex medical decisions.

I’m not a paramedic, but my brother is and he won’t stop talking about it…

Training: the first level mentioned is “Emergency Medical Technician” (EMT). After you’ve gained some experience as an EMT, you can go back to school and train to be a full-fledged paramedic. As RC mentioned, the difference between the two lies primarily in the decisions that can be made. As an EMT, my brother was pretty much restricted to transport (nursing homes to hospitals, etc.) or–in a trauma situation–had to do what the paramedic he was riding with told him to do. As a paramedic, he can actually make more decisions, insert needles, etc. He trained through a hospital in Dallas that took three or four months for the EMT and (after a year of being an EMT) several more months to be a paramedic. Several community colleges also offer at least EMT training. Plus, to be an active paramedic, you’ve got to keep up with some schooling each year.

Jobs: As I’ve understood it, he’s worked in basically three types of jobs. As an EMT he mostly worked with a private company that did transports (already mentioned). When he worked for Dallas Children’s Hospital, it was also to do transports. Later, as a paramedic, he’s both worked as an “Emergency Room Paramedic” (his words)–meaning he assisted in the hospital and didn’t run around in ambulances and for various cities around the Dallas area either for private companies that provide emergency services or for a fire department as a paramedic (which is what he’s doing now). The only time he’s ever volunteered is when it comes to working on holidays for double pay.

I’m sure I’ve schlocked some of the details; when he starts talking about his latest encounter with entrails, I usually start tuning him out.

I’m not an EMT, but I had to sit through my older brother becoming one and lecturing the family incessantly on the rules and regulations of FDNY rescue stuff. The information I’m giving isn’t very deep, but I’m fairly certain of its accuracy.

EMT, EMT-3, AEMT, and Paramedic are various levels of achievement and training in the business of emergency life-saving. The basic level, EMT, is pretty much just advanced first-aid. Technically, they can’t administer meds, intubate, or use defibrillators (they often do anyway, especially if there is a higher-level medic on the bus who wants the junior to get experience). You gain more knowledge and more clearance to do stuff to people on up through Paramedic, which is about as close to “mobile trauma surgeon” as you can get without an MD. Every state has different rules for how this works, but all levels require certification. The levels are indicators of training, not just experience – you don’t get promoted to AEMT. In New York State, you’re supposed to have 2 years of field experience before you can try to get into Paramedic school. You can “challenge” the State certification test for any of these, i.e. take the test without going through the official training.

There are private ambulance companies, but they generally hire only State-certified people. They are all salaried – there is no bounty on rescues. In the NYC boroughs, the Fire Dept. is the “official” EMT organization but there are private companies. NYC residents are probably familiar with Hatzolah, which is run by Orthodox Jews and caters to that community and their needs (mostly Talmudic/Torah stuff that reform Jews like me don’t care about).

Some states have reciprocity with other states for certification. I don’t know which. If you want to work in a state where your cert is no good, you have to challenge their exam.

I’ll shut up now.

–Da Cap’n

Short answer: depends on where you are.

As was previously stated, some places have a have a private ambulance company (AMR, and Rural/Metro being the two largest) do their transports. Some are large companies (AMR), and others are very small, non-profit companies (such as the one we work with). Most of Connecticut does this. The local fire department may respond and begin treatment while the ambulance is on its way. Which may take a very, very, very long time (ask Hartford, CT). Others, such as our ambulance, is very prompt with their responses and we don’t have to do anything.

In other places, the fire department runs the ambulance. Thats kind of self explanatory, I think. Its also a very common arrangement.

Then, you have places like Boston, where the ambulance is a seperate municipal department (Boston EMS).

Or, Be like Fairhaven, MA, where the police department runs the ambulance.

As for staffing, it varies from volunteer where the EMTs have to respond to the station to get the ambulance, to paid where someone is with the ambulance all the time. Every variation you can think of in between is used.

Levels of EMS (very generalized):

  • First Aid/CPR: Duh.
  • First Responder: What I am. Everything in first aid/CPR, plus I can give oxygen, and tie people to longboards. Thank god I don’t have to do it often. My class time was about 24 hours.
  • EMT Basic: First Responder plus the ability to transport. Class time: 100 hours
  • EMT Intermediate: Basic plus you can stick needles in people. Can’t put stuff in the needle, but you can stick people (at least thats what I understand of it). Class time: not sure, but its a goodly amount.
  • Paramedic, aka Advanced Life Support (ALS), or EMT-P: Everything short of surgery, but nearly everything has to be OKed by a doctor (Medical Control). You can reaad ECG strips, push all sorts of fun drugs, and shock people. Class time: a few years of experience as an EMT plus like 600 hours of classes (or some obscenely high number)

EMS isn’t my thing, but I do know a bit about it. I’m sure someone who knows it a bit better than I can fill you in more.


I can think of no more stirring symbol of man’s humanity to man than a fire engine - Kurt Vonnegut