Kelly Grayson gives an excellent interview about his career as a Paramedic.  You can find Kelly at www.ambulancedriverfiles.com.  You can also follow him on his Twitter feed found in the sidebar of this interview.

What do you do for a living?

I’m a critical care paramedic for Acadian Ambulance in southwest Louisiana.

How would you describe what you do?

Long hours of boredom and drudgery, interspersed with occasional moments of sheer terror. Okay, maybe “terror” is too strong a word. How about, “tense and thrilling interludes?”

What does your work entail?

I answer 911 calls for sick and injured people in my service area, assess them and provide stabilizing treatment, and bring them to the local Emergency Departments for more definitive care. Anything from helping little old ladies off the floor to doing CPR, shocking people, sticking needles in their chests, drilling needles into their bones to give them lifesaving fluids and medications, to just giving mildly sick people rides, I do it.

In between 911 calls, as a critical care paramedic, I bring very sick people from one hospital to another hospital with greater capabilities. Typically,  they’re patients who are on multiple medication infusions and machines to keep them alive, and need a level of care beyond what a regular paramedic can provide.

What’s a typical work week like?

I work 12-hour shifts, three days one week and four days the next. I get to my station, check out my rig and restock what it needs, and go into service. For the next 12 hours I don’t see my station again. They keep us moving, parking on street corners in between calls, theoretically to keep us closer to areas of high anticipated call volume. I eat when I can, pee when I can, and poop when I can – and quite often don’t get to do any of those. Emergency calls take precedence over everything else, even your meal and bathroom breaks.

The area in which I work has some good hospitals, but at least once or twice a week, I am asked to transfer patients to the very best hospitals around, which are all three or more hours away. So, I’m the only one taking care of the patient for that three-hour trip, and some of these people have medical conditions that are very difficult to manage. Think of it as a rolling ICU, only smaller and noisier, and I’m the nurse, doctor, respiratory therapist, and aide all rolled into one.

Since my company covers a very wide area, once my patient is dropped off at the receiving hospital, I’m back in service again, often at a city 200 miles from the one in which I started. I’ve resuscitated cardiac arrest patients in my home city, then transferred them from the local hospital to a bigger one 200 miles away, then resuscitated another cardiac arrest in that city not ten minutes later – all in one shift.

How did you get started?

I was a professional retriever trainer, believe it or not. I had burned out on training dogs, and my intention was to go back to college and try to get into medical school. Since I had student loans to pay off, I enrolled in the local community college to start the nursing program, intending to work as a nurse for a couple of years while I paid off student loans. There turned out to be an 18-month wait for the nursing program, so I enrolled in a program called Emergency Medical Technician instead.

That was almost twenty years ago, and I’ve been doing this ever since.

What do you like about what you do?

I love the fact that it’s so unpredictable. You never know what you’re going to do next. It doesn’t happen that often, but occasionally we get to touch someone’s life in a way that they will remember long after we’ve forgotten their faces or names. So many people spend their careers watching life go by, stuck at a desk on the sidelines, wondering if what they do really matters.

EMT’s don’t have to ask that question. We’re out there every day, tired, muddy, bloody and overworked… but we know that, at least to the person we’re working on, it matters more than anything else in the world.

What do you dislike?

System abuse. One of the biggest drains on my job satisfaction is the sheer number of people who abuse the service I provide. Roughly 75% of the people I transport don’t even need to be in a hospital Emergency Department, much less an ambulance to take them there. I get people who call the ambulance to save gas money and cab fare, which makes no sense unless you consider the fact that they never intend to pay an ambulance bill anyway, so they’re essentially getting a free ride. I have people who fake illnesses and request a certain hospital, only to refuse further care and walk away as soon as they arrive, because their friends happened to live around the block. I was just a convenient taxi. I get people who call 911 several times a day, going to the hospital each time, because their feet have hurt for six months. I get women who fake abdominal pain, so they can get a free pregnancy test in the Emergency Department.

Luckily, so far the 25% of my patients who do really need my help make up for the 75% who abuse the privilege.

How do you make money/or how are you compensated?

I’m paid hourly, every two weeks. Quarterly, I also get a stipend for all the critical care transports I’ve done in the previous three months. I also get a yearly Christmas bonus, and can sell back unused vacation or sick time to the company, if I wish.

Ambulance services usually make most of their revenue from Medicare or private insurance reimbursement, with Medicare making up the bulk of their income. From that reimbursement, they must pay salaries of the medics and support staff, fuel, equipment and training costs, vehicle and liability insurance, and so on.

The problem is, Medicare only reimburses at about 66% of what it actually costs to provide the ambulance transport. It’s very hard to even break even as a for-profit ambulance provider without running a large number of the more mundane, non-emergency transfers.

The larger cities that have ambulances that only run 911 calls, are usually funded by local taxes. If they only relied on revenue generated from insurance reimbursement or Medicare, they couldn’t function. They’d go broke.

Actually, over half of the Emergency Medical Services in this country is provided by volunteers who don’t get paid at all. They usually live in small towns where there isn’t enough run volume to support a full-time paid ambulance, so they volunteer their services for their home town, while working at their full time career to pay their bills. Many EMT’s work for pay in larger cities far from home, and volunteer during their days off to support the EMS system at home.

How much money do Paramedics make? (comment on salaries, ranges of income,  etc that you’re familiar within the industry)

Salaries vary widely, and much of it is deceptively high or low because the numbers don’t reflect the cost of living in those areas. For instance, paramedics at San Francisco Fire Department may start at close to $100k/year, but the cost of living in San Francisco is very high, so that salary doesn’t go as far as it would elsewhere.

If you live in a small town in middle America, you may not even get paid at all, because the ambulances in those areas are often staffed by volunteers.

Right now, I make close to $60k/year at my full-time job, and an additional $20k writing and teaching. In the area I live, $60k/year will provide you with a fairly comfortable standard of living if you manage your money well.

How much money did/do you make starting out as a Paramedic?

At most places, salary increases with experience and additional certifications. I started out making less than $30k/year 18 years ago, working twice as many hours as I do now. So effectively, I’m making 4 times as much as when I started. Sadly, there are medics still making as little as $30k/year in many parts of the country.

What education, schooling, or skills are needed to become a paramedic?

First, you need to become an EMT, which is typically a six month course. EMT certification requires that you be at least 18 years of age, in reasonably good physical shape, and have a high school diploma or GED. Once you become an EMT, paramedic training is typically another 18 months to two years, and 2 and 4 year college degree programs are becoming increasingly common.

What is most challenging about what you do?

It’s not dealing with blood or gory stuff, I can tell you that. When you’re working, you’re usually far too busy to be affected by the sight of blood and gore. And actually, those things are easy to deal with: air goes in and out, blood goes around and around, and any variation in that pattern is something you need to fix.

What I find most challenging are the patients with complex medical problems. Trauma is easy, but medical patients require critical thinking skills, good detective work and some creative problem solving. They’re an intellectual challenge.

What is most rewarding?

Getting a “thank you” every now and then from a grateful patient. Believe it or not, no matter how good you are, that doesn’t happen very often.

But when it does, it’s enough to make up for the 100 calls you ran before that when you got no thanks at all.

What advice would you offer someone considering this career?

Don’t get into it thinking it’s going to be exciting, or that you’re going to make a lot of money, because you will be sorely disappointed.

In fact, the better you are at your job, the less exciting EMS is. After a while, the adrenaline rush wears off and is harder to come by, and the calls that used to make your heart race barely even warrant a yawn any more.

When that happens, you’d better have a genuine love of people and a desire to help them to fall back on, or your career in EMS will be short and unpleasant.

It is possible to make a good living as a medic, but it may take some time, and it may not be possible in your home town. But if you do decide on EMS as a career, you’ll be paid in job satisfaction just as much as money.

How much time off do you get/take?

For the first year with my current employer, I qualified for 72 hours of vacation time, which, if you take the days off during your short week, amounts to a week’s paid vacation. After two years, that number went to 96, and now I get 132 hours paid time off each year, the equivalent to three weeks paid vacation.

In addition, I accrue 2.75 hours of paid sick time every pay period, which equates to 71.5 hours of sick time a year. Once you have banked more than the minimum number of sick hours, you can either take the excess as paid time off, or sell it back to the company for cash.

What is a common misconception people have about what you do?

That it’s all life and death emergencies, all the time, and that we save lives every day. Sometimes that happens, but mainly it’s just helping people. The possibility that the life-and-death call is just around the corner is what keeps a lot of us doing it, though.

The best way I can describe EMS is that we’re the special teams of emergency football. We don’t score touchdowns (save lives). We take the ball (patient), and advance it as far as we can, to give the offense (Emergency Department) the best chance at scoring a touchdown (saving a life).

Occasionally, if we’re very good or very lucky, we can score a touchdown all by ourselves, but those moments are few and far between. That’s not the same thing as saying what we do isn’t important, however. It’s very important.

Just ask a football coach how hard it is to score touchdowns if the offense is constantly handicapped by poor special teams play.

What are your goals/dreams for the future?

Within the next 10 years, I’d like to be an Emergency Nurse Practitioner, either working in an Emergency Department, administering a college EMS education program, or running a small ambulance service with lots of potential somewhere.

What else would you like people to know about your job/career?

We need more hand-holders. I’d much rather teach a hand-holder how to deal with stress and emergency calls, than teach an adrenaline junkie how to be compassionate.

We have far too many adrenaline junkies and hero wannabe’s as it is.