Private EMS Masochists: Thank You Sir, May I Have Another?

Like so many others, my first EMS experience was in private EMS.  I began my career at a large--very large--private ambulance company that provides interfacility transports, private EMS, and 911 response for a large midwestern, city. The city in which I worked is poverty-stricken and segregated. I travelled from my nice suburban home to the city, spend 24 hours responding to calls, then leave for the safety and green lawns of the outskirts.

Private EMS is a unique amalgam of low priority calls, interfacility service calls, and every once in a while, a genuine patient with actual injuries or illness in real need of ambulance transport. Private EMS requires the ability to apply the power of positive thinking that Norman Vincent Peal himself would struggle to generate. The stories we all have of the ridiculous reasons people call an ambulance are familiar, but amplified in a community that has recently been named the fourth poorest city in the country. The people who call our ambulances privately are either manipulative enough, or simply grew up expecting, to have the "magic medicaid" card that is a free pass to a ride to the emergency room. So the abdominal pain with an onset of six months ago that requires a 4:00 AM ride to a hospital across the county, past four other hospitals because "my doctors are there" is commonplace. I chuckle at the efforts of some of the newer guys who spend their time arguing with the patients about where they should go, or whether they should go, while the wiser among us realize that if you just take them to the hospital you can get back to bed sooner. And you're not fixing the system by refusing one transport. No one is learning a lesson by being "educated" by a 24 year old EMT who doesn't want to encourage abuse.

Then there are the nurses who have a patient to discharge and just want an empty bed in their ER. They could do the right thing and call a wheelchair van for the patient who spends their days in a wheelchair, or is ambulatory but a little weak. But that requires effort and planning. On the other hand, if they just fill out a simple medical form stating that the patient requires ambulance transport--even if that statement is a lie--two EMTs will appear in fifteen minutes or so and take the patient off their hands. The fact that they had to engage in Medicare or Medicaid fraud to do this doesn't faze them a bit. They justify the fraud by focusing on the fact that they now have an empty bed for the next patient in need, and isn't that more important? They turn an indifferent shoulder to us when they see the look on our faces after we read "patient unable to ambulate, requires immobilization, poor endurance, debilitating condition" on their certification form while we watch the patient get out of bed, put on their clothes, and walk out to the ambulance. We're not going to fix the system by arguing with them, either.

Then, there's the workload. It's private EMS. It's a business. And businesses turn a profit or they cease to exist. They don't schedule a crew and an ambulance unless it's going to be used. So my typical 24 hour shift begins with punching in at 7:00 AM. The phone rings shortly after I punch in and a dispatcher usually tells me I have a call. If I'm lucky, I get to inspect my ambulance and re-stock it. Usually, I wind up running calls right away and maybe, if things slow down, I'll be able to re-stock it later that day. I run calls consecutively for the next twelve to fifteen hours. CONSECUTIVELY. That means when I hit the "available" button on my MDT, another call appears on my screen immediately. Possibly, instead of another call, an instruction telling me to stage the ambulance in a particular location will appear. It means I get a chance to sit for a few minutes. I don't get to pick something up to eat, I don't get to leave the ambulance, I get to sit and listen to the radio for a few minutes. I wait for a call, and it always comes. Somewhere around eight or ten at night, I'll get sent to a station--maybe. Maybe not. Some nights I don't see a station until three or four in the morning. But I might get back as soon as eight or ten. Now, if there's someone in line ahead of me, I can sit down or lie down and relax, The phone rings, another call, and I'm out the door again. This continues until four thirty or five. Perhaps, if the gods are with me, I get to sleep until six am, when the dispatcher calls with my wake up call. That's a reminder to get up, clean the ambulance, and pray we don't get a late call. We watch the clock until seven AM comes, and punch out as soon as it strikes seven and walk out the door just in case a call comes in--that's going to be the next crew's call, I'm out of here. Total calls run for the shift, anywhere from fifteen to thirty. Not all of them were transports, but most were.

What's the reward? Once or twice that shift something really funny happens. Something really stupid happens. Someone really interesting needs an ambulance. Just once or twice, but it's enough. Every couple of shifts a patient will come along that was in genuine need of emergency medicine. Their chest pain was real, their respiratory distress severe, their injuries severe, their psychological crisis acute. A child is raped or beaten, a driver strikes a windshield, a man is assaulted and robbed, someone tries to kill themselves--these are the challenges that keep me going.

The nurses, they treat us with disdain for the garbage calls we bring them. The firefighters who call us in, treat us like second class citizens who aren't worthy of their respect. Our bosses treat us as disposable assets because we are disposable--there are hundreds of job applicants willing to begin their EMS careers here if I choose to leave and they can start tomorrow.

So what makes it worth it? Well, we have each other. And that next call, well it might be the one...

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