Category Archives: Ins and outs


Indeed, many of our patients are full of crap for calling 911 for the things they call for, but it doesn’t bother me much. As long as their reasonably nice I’m willing to do anything for them.

What does bother me are my co-workers who call in sick all the time, and you know they’re not sick. It’s always the same people too. Can’t get the day off ahead of time? Just call in sick. Nice day out? Sick. Don’t like the partner you’re working with? Sick. Busy last shift? Sick. Plenty of people don’t even have the decency to give sufficient notice before calling in sick. Quite a few simply don’t show up.

And not a day goes by without someone going home sick mid-shift. Sometimes it’s not even mid-shift. More like mid-hour. The people who are at work end up working harder because fewer units are in service and running calls.

Does my employer do anything about this? No. What employer tolerates this kind of behavior? Clearly it would help if my employer took a stand. That being said, the fact of the matter is simply this: my co-workers lack of any semblence of any sort of work ethic because they’re just lazy and irresponsible. I hate them.


Hi, I’m a paramedic in a poor urban area with a high call volume.

The county’s EMS (Emergency Medical Service) agency has immediate local oversight of all of its different EMS providers. All of the fire departments in the county have ALS (Advanced Life Support) engine and truck companies. A few of them have ALS ambulances. The primary ambulance service provider operates the majority of the ALS ambulances in the county for the EMS system.

An ALS fire unit carries at least one firefighter-paramedic, and an ALS ambulance carries at least one paramedic. Firefighters trained as emergency medical technicians (EMTs) make up the rest of the fire unit, and one EMT works with the ambulance paramedic. Sometimes there are more than one firefighter-paramedic on a fire unit, just like there are dual-paramedic ambulances.

When a person dials 911 on a landline, the call is routed to a PSAP (Public Safety Answering Point). If the call is for medical assistance, the PSAP dispatcher transfers the call to an Emergency Medical Dispatch (EMD) center, where an EMD dispatcher obtains the nature of the call and other relevant information, provides pre-arrival instructions in certain situations such as CPR, bleeding control, etc., and dispatches the appropriate personnel and equipment. Fire units are “toned out” from their stations, station-based ambulances are called via landlines, and flexibly-deployed ambulances are dispatched via radio.

In general, a code 2 response simply consists of an ambulance response without lights and sirens. A handful of fire departments send a crew on these code 2 calls. A code 3 response consists of a fire apparatus and an ambulance, both lights and sirens. A fire crew is known as the first responder, and they turn over patient care to the arriving ambulance for transport. On more serious calls, the firefighter-paramedic accompanies the ambulance crew during transport. The Base Hospital is available to crews for medical consultation via telephone or radio. In some cases, air ambulances are utilized, usually in more remote parts of the county or during rush hour.

Most transports are code 2, no lights or sirens. The Emergency Department (ED) at the Receiving Hospitals is notified with a brief report prior to arrival. Patient care is transferred to the ED staff, and a Patient Care Report (PCR) is submitted if time allows.

Time to go available.