# EMT and Ambulances in the US **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [June 17, 2023, 4:46am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660 "2023-06-17T04:46:07Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [June 21, 2023, 10:02pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/41 "2023-06-21T22:02:38Z")
One of the key things about the USA is that local provision & local funding means there’s a vast difference between what rural areas, suburban areas, and urban areas can afford. The low population density in ruralia means long distances, slow response times, and few people to pay much. And much of ruralia is rather poor. The opposite situation obtains in urban areas. I’ve lived in upper-middle class suburbia or in an urban center in several different states for most of my life and have never had anything other than well-funded highly professional fire, paramedics, and EMTs. It’s also the case that most states have 1 to 3 major cities / conurbations that house most of the populace. With the result that the median EMS provider is one of the underfunded semi-trained tiddlers out in the country, while the median EMS customer is somebody in the 'burbs served by a large good quality good department. @kambuckta explains how another (much smarter) country handles the disparity between urban and rural. It can be done. You just need to get away from local funding and local control being the Prime Directive. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [June 21, 2023, 10:11pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/42 "2023-06-21T22:11:03Z")
> [@echoreply](#): > > I left a message with the billing company, and we’ll see if they ever get back to me. I assume I’ll get to dispute it with collection companies and the credit bureaus. What fun. You might want to keep an eye out on your various accounts in case there’s some identity theft going on. Someone might have duplicated your insurance card or worse. Regarding fire / ambulance services in my county (as noted, there are county-run stations AND volunteer stations both within a couple miles of our house; we are in a relatively affluent county). About a year back, we saw smoke in our furnace room. Got out of the house, called 911, and five - yes FIVE - fire trucks showed up, and eventually an ambulance despite our not claiming any injuries of any sort. A bit of overkill!! We did not receive a bill for that ambulance, fortunately. I am guessing it was a slow day and they were bored. May all days be so boring!!! ---
**Author:** ![echoreply](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/echoreply/32/3641_2.png) [@echoreply](https://boards.straightdope.com/u/echoreply)\ **Post date:** [June 21, 2023, 10:52pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/43 "2023-06-21T22:52:41Z")
> [@Mama\_Zappa](#): > > You might want to keep an eye out on your various accounts in case there’s some identity theft going on That’s one of the worries. It’s my wife’s name, and she knows she has doppelgangers out there with the same name. Did somebody with the same name happen to be transported in our state to a hospital that is part of the same network we use? That is certainly possible. The ambulance was affiliated with the city’s fire department, not the hospital, though. Insurance refused coverage, which is why we got the bill. I’m not seeing any denied claims on our insurance, so my guess is if it is identity theft it is in name only, and not our insurance. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [June 21, 2023, 11:05pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/44 "2023-06-21T23:05:04Z")
Since it didn’t go to your insurance , I’m going to guess it’s not identity theft at all. I mean, check your credit reports etc, but it’s probably just some sort of clerical screw up like the hospital screwed up the address for one of the doppelgangers , tried to look it up and found your wife’s. An identity thief would have tried to use your wife’s insurance - and if it was the doppelganger’s identity that was stolen, they would have used her address. ---
**Author:** ![Loach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/loach/32/350_2.png) [@Loach](https://boards.straightdope.com/u/Loach)\ **Post date:** [June 22, 2023, 12:12am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/45 "2023-06-22T00:12:21Z")
> [@Dr\_Paprika](#): > > I understand what you are saying. Doubtless you are right, but you could say most situations dealt with by professionals are more often mundane than requiring all their skills. This is much less true of emergency responders than most other professionals, so more training is often better than less. The reason for less training is entirely due to costs. > > If I did a full medical exam on someone using every little used thing I know (see Sapira, The Art Of Bedside Diagnosis, etc.), it would literally take hours. In practice, this is never done and you only do what is required for a specific situation. That does not make the esoterica not worth knowing. I’m sure what is frustrating to outsiders is the lack of uniformity from state to state and town to town. I can only tell you how things worked in the town I worked in. Services are divided between BLS (basic life support) and ALS (advanced life support). ALS is the fully trained paramedics. BLS consists of EMTs. For years they ran only with a volunteer BLS service in my town. Due to lack of participation coverage went partially through a paid service and now 24 hour coverage with a paid service. That’s not a bad thing. The volunteers were sometimes excellent and sometimes shoot me before they can lay a finger on me. The paid crews were almost always good while I was working. On top of that the police all had O2, narcan and defibs in their cars and are trained to use them. The ambulance company was paid a relatively small fee per year and also charged insurance. Anything above what insurance paid was not billed to the patient. The EMTs are not paid well but their needed certifications and training are not that advanced. I can’t say enough about paramedics. They are highly trained and are the next best thing to having a trauma specialist doctor at a call. For anything not involving surgery they can pretty much do it all at the scene. They get paid double what an EMT makes but it should be much much more. Who gets sent to the calls is up to dispatch protocols. Anything with chest pains or difficulty breathing gets ALS along with BLS. BLS is tied to a town and ALS is centrally dispatched so BLS is usually there first and can call off the paramedics if they feel it’s not warranted. I once was put on a helicopter and flown from one hospital to another. I later got a bill for $12,000 above what my insurance paid. I made a few phone calls trying to get it reduced then forgot about it. I never talked to anyone that could help me. They never attempted to get the money from me. I guess they were hoping that someone would be stupid enough to send a check but they were ok with the insurance payout. ---
**Author:** ![ZipperJJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/zipperjj/32/211_2.png) [@ZipperJJ](https://boards.straightdope.com/u/ZipperJJ)\ **Post date:** [June 22, 2023, 1:39am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/46 "2023-06-22T01:39:25Z")
> [@Mama\_Zappa](#): > > About a year back, we saw smoke in our furnace room. Got out of the house, called 911, and five - yes FIVE - fire trucks showed up, and eventually an ambulance despite our not claiming any injuries of any sort. That’s pretty good service! Firefighters definitely like to come out to fires. I asked my Chief one time why they sent out a big ol fire engine when my elderly neighbor fell. He said since all our firefighters are EMTs, the closest EMT crew happened to be on fire engine duty that day so they came in the vehicle they were in. Eventually an ambulance came for further treatment and transport. You’d think there’s a lot of fires in my town with all the fire engines tooling around but no they are still mostly doing EMS calls. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [June 22, 2023, 4:03am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/47 "2023-06-22T04:03:20Z")
> [@Mama\_Zappa](#): > > About a year back, we saw smoke in our furnace room. Got out of the house, called 911, and five - yes FIVE - fire trucks showed up, and eventually an ambulance despite our not claiming any injuries of any sort. Forgot to mention: there wasn’t even a fire! Something had malfunctioned in the furnace’s blower (which also circulated the air conditioned air), and some insulation had melted, causing the circuit breaker to trip. The smoke was from the melted insulation. ---
**Author:** ![Common\_Tater](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/common_tater/32/13846_2.png) [@Common\_Tater](https://boards.straightdope.com/u/Common_Tater)\ **Post date:** [June 22, 2023, 1:29pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/48 "2023-06-22T13:29:52Z")
> [@Johnny\_L.A](#): > > think my EMT training was something like six weeks. Ringer’s Lactate and D5W, what else would anyone possibly need to know?? ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [June 22, 2023, 3:12pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/49 "2023-06-22T15:12:31Z")
> [@Common\_Tater](#): > > Ringer’s Lactate and D5W, what else would anyone possibly need to know?? At my EMT training, we were NOT taught anything to do with IVs (nor intubation). Only thing we could have done with Ringer’s was to offer the patient a refreshing drink! ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [June 22, 2023, 5:46pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/50 "2023-06-22T17:46:39Z")
Well, which fluid would you give to a two year old toddler? If an EMT/paramedic gets a medical call, in an ideal situation the patient would only come to hospital if required. This is not always possible to know, and the American schema means being hauled if called since this funds the ambulance. I’m not sure what percentage of callers are hauled in Canada, for legal reasons it is probably higher than it should be. But say one responds to fifteen calls a day. Ten get transported to hospital. My guess is two to four would benefit from some immediate intervention which might worsen outcomes if delayed. These numbers might be garbage, but it is a big enough difference to justify a moderate increase in salary and education at least on a societal benefit level. ---
**Author:** ![Little\_Nemo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/little_nemo/32/3120_2.png) [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)\ **Post date:** [June 22, 2023, 5:56pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/51 "2023-06-22T17:56:14Z")
> [@Dr\_Paprika](#): > > I assume EMTs require significant education and have commensurate costs My understanding is that not only does it require significant education, it’s also an ongoing process. EMTs have to keep taking new classes to remain certified to work. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [June 23, 2023, 2:29am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/52 "2023-06-23T02:29:07Z")
> **[Starting pay for NYC EMS workers will soon be less than food app delivery...](https://nypost.com/2023/06/22/nyc-emt-workers-will-make-less-than-food-delivery-drivers-union/)** > > The starting pay for New York City emergency medical technicians and paramedics first to treat sick and contagious coronavirus patients during the peak of the outbreak is now less than app-based fo… ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [June 23, 2023, 3:06pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/53 "2023-06-23T15:06:40Z")
> [@doreen](#): > > > [@Dr\_Paprika](#): > > > > The reason for less training is entirely due to costs. > > Absolutely - but that’s always going to be the case. Otherwise there would be an ER doctor on every ambulance. I remember hearing on a news story that staffing ambulances with doctors is the practice in France; the [Wikipedia article](https://en.wikipedia.org/wiki/Emergency_medical_services_in_France#SMUR) say some advanced ambulances include doctors. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [June 23, 2023, 5:48pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/54 "2023-06-23T17:48:45Z")
Ambulances with doctors are sometimes used in Canada for transfer between hospitals. But not at private residences or before initial assessments. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [June 24, 2023, 5:18am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/55 "2023-06-24T05:18:10Z")
AFAIK, in the UK ambulance services do sometimes send out a doctor as well, depending on what the despatchers have been told. Most commonly it would be a specialist in accident & emergency (I believe that’s usual for air ambulance teams), but I’ve also seen ambulance-branded ordinary cars with a physician on board. Also, the ambulance service (at least in London) might send out whatever grade of first responder on a specially-equipped motorbike (or in central London a push-bike), again all depending on how the call has been categorised (in digging into this, I gather there’s a standard categorisation protocol that’s widely used internationally). > **[Who will treat you - London Ambulance Service NHS Trust](https://www.londonambulance.nhs.uk/calling-us/who-will-treat-you/)** > > As soon as we have enough information from callers and have assessed whether the patient requires immediate medical treatment, we will send help. We can respond in a number of different ways: Life-threatening emergencies In life-threatening... As for organisation and funding, ambulances are organised regionally and funded from national NHS budgets, with charitable supplementation for some additional services. Obviously service levels will be different in remoter rural areas from those in big cities, but different localities don’t have to fund services from local resources. ---
**Author:** ![crowmanyclouds](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/crowmanyclouds/32/19884_2.png) [@crowmanyclouds](https://boards.straightdope.com/u/crowmanyclouds)\ **Post date:** [June 24, 2023, 7:39am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/56 "2023-06-24T07:39:56Z")
> [@Common\_Tater](#): > > Ringer’s Lactate and D5W, what else would anyone possibly need to know?? Ringer’s when Dr. Brackett is on call and D5W when it’s Dr. Early… or is it the other way around? ---
**Author:** ![Common\_Tater](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/common_tater/32/13846_2.png) [@Common\_Tater](https://boards.straightdope.com/u/Common_Tater)\ **Post date:** [June 24, 2023, 8:57am UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/57 "2023-06-24T08:57:39Z")
> [@Dr\_Paprika](#): > > Well, which fluid would you give to a two year old toddler? I might have missed that episode, so I can’t say for sure. ---
**Author:** ![Superdude](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/superdude/32/13450_2.png) [@Superdude](https://boards.straightdope.com/u/Superdude)\ **Post date:** [June 24, 2023, 12:40pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/58 "2023-06-24T12:40:05Z")
During my 8 years as an EMT, we were not allowed to check someone’s blood sugar unless a medic was present, or if the patient was alert (in which case, we “assisted” them with the glucometer). The reason why? The pinprick to obtain the blood droplet broke the skin, and so was considered invasive. And when I first got on an ambulance, back in 2008, we were paid $8/hr. ---
**Author:** ![Loach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/loach/32/350_2.png) [@Loach](https://boards.straightdope.com/u/Loach)\ **Post date:** [June 24, 2023, 5:05pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/59 "2023-06-24T17:05:14Z")
> [@Little\_Nemo](#): > > > [@Dr\_Paprika](#): > > > > I assume EMTs require significant education and have commensurate costs > > My understanding is that not only does it require significant education, it’s also an ongoing process. EMTs have to keep taking new classes to remain certified to work. What do you mean by significant? An EMT basic is a relatively short certificate program and they are prohibited from doing anything advanced. They do have to maintain their certifications by going to refresher courses. In the police academy we were trained in what they could do in a couple of days. The easy days at the very end. Paramedics are entirely different. They have significant training to include pushing medicine, intubation and advanced trauma care. > [@Dr\_Paprika](#): > > Ambulances with doctors are sometimes used in Canada for transfer between hospitals. But not at private residences or before initial assessments. I have seen ER docs riding with paramedics as part of their continuing training. It may be an hourly requirement. It’s not really needed though. The only difference is that some things the paramedics have to get permission for over the phone the doctor can do in person. There are certain standing orders for medicine that the medics can push but some they need to call in. Paramedics also pronounce people dead at the scene with a doctor remotely seeing the telemetry. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [June 24, 2023, 5:11pm UTC](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660/60 "2023-06-24T17:11:21Z")
Most jurisdictions in Canada seem to have basic or advanced level paramedics. These are sometimes referred to as “EMT”, perhaps in error or due to American influences. But they are better trained. Basic level paramedics certainly take heart tracings, check blood sugars, start IVs, administer defibrillation (maybe if recommended by machine) and so forth, and they do these things often. Advanced paramedics can intubate patients, do more things, and administer more medications, usually after consulting a doctor designated to advise them. In Canada, many firefighters have CPR and basic life support training. This may not be particularly arduous. But skills like IVs and intubation certainly require practice. I have taught paramedics who are generally very interested in learning more medicine, ECG interpretation, using ultrasound, and the like. It seems reasonable for police and firefighters to have more basic skills since it is not their primary thing (though they should certainly give naloxone and be treated very leniently as “Good Samaritans” for doing so). But if bothering to send anyone under a medical impetus it makes sense to have a higher level of skills even if not always needed, since being needed often is reason enough. [Previous page](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660.md?page=2) [Next page](https://boards.straightdope.com/t/emt-and-ambulances-in-the-us/985660.md?page=4)