STARofLIFE
Union County, NJ
Male, 24
I have been a certified Emergency Medical Technician (E.M.T.) for over 6 years. I am the true "first responder" and have been dispatched to over 1,000 calls including medical, trauma, and psychiatric emergencies. How do I handle the stress and what goes on in my mind when YOUR life is on the line? Find out by asking me anything!
Yes, we treat anyone and everyone. We are a volunteer squad and run entirely off of tax-deductible donations. The real issue is with the MICU (Mobile Intensive Care Unit) Paramedics. These are emergency health care providers who are dispatched by the hospital and can provide a much greater level of care than the EMT. As soon as the Paramedics begin an examination, a large bill (around $1,000) is generated. Now, Paramedics would never deny treatment based on insurance needs in the field. To the best of my knowledge, the patient is billed and must pay out of pocket. The patient could apply for charity care or work something else out.
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This is a question I am always asked. Generally, I would say burns or car accidents are pretty horrific and gruesome. However, my most traumatic call involved a construction worker putting up a ceiling fan in a new house. The worker lost his balance and fell off his ladder. He managed to catch his wrist on an jagged piece of porcelain sink. He cut through both his radial and ulnar arteries (the arteries in the wrist suicide victims use). He literally was pumping blood out of these arteries every time his heart beat. I quickly elevated his arm and applied direct pressure to the wound. However, the injury was so severe that we could not control his bleeding. At this point, the floor of the ambulance was covered in blood, as were my pants. I could actually smell the iron from the hemoglobin as the blood clotted on the floor. That's how much blood this guy was losing. On the way to the hospital, the paramedics started two IV fluid bags and I still was squeezing the patients forearm. We drove him to the state level 1 trauma center and rolled him right into the OR for the vascular surgery team to begin to save his life. Unfortunately, I never found out if this patient lived or died. This is the nature of EMT work.
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Yes, you are absolutely correct in your last statement. We get many 911 calls from nervous parents or elderly patients who are not having an acute medical emergency. This certainly doesn't mean that they don't need treatment. It's just that they don't need the ambulance to transport them immediately. Here's how transportation works. We cannot legally force someone to go the the hospital with us. This would qualify as kidnapping or false imprisonment. Note, this does not hold true for minors without parental consent or psychiatric patients. Any patient who is over 18, coherent and not a threat to themselves/other can sign an RMA (refuse medical attention) form. This form states that they would not like to be transported with us the the hospital. We can still treat the patient and the patient has the right to call us back whenever they fell the need to.
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Let me put it this way. You could either be riding around in fully stocked, state-of-the-art ambulance or a mid-range Ferrari. Although, I don't think patients would appreciate a Ferrari showing up during their heart attack. Don't quote me on these numbers but the ambulance body itself costs about $70,000. The real cost is all the expensive equipment which makes it a life saving vehicle and not just a van. A fully stocked ambulance includes a high powered radio system, lights/sirens/air-horns, oxygen delivery system and a high powered vacuum for airway suction to name a few. Next, we need to decal the ambulance with our town colors and name. Finally, we need to add all of the medical equipment such as cardiac defibrillator, portable oxygen tank and radios, portable suction, stretcher and tons of bandages, band-aids, gauze etc..... When it's all said and done you're looking at a cost of $175,000 to $250,000 per ambulance. One more thing, these things are fuel guzzlers!
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EMTs cannot pronounce a patient dead. There are, however, two exceptions. These exceptions are when obvious death (decapitation) occurs or severe rigor mortis is seen. Therefore, if we think a patient may have just expired before our arrival or en route to the hospital, we will continue life saving measure (CPR, cardiac defibrillation, mechanical ventilation) until we arrive at the hospital. This scenario changes when we are working the the MICU (mobile intensive care unit) Paramedics. The paramedics have a much advanced level of training and are certified to pronounce death in consultation with a physician over the phone. If the paramedics pronounce a patient on scene, we are not allowed to transport the patient in the ambulance. The medical examiner must come before we are released. If a patient expires while in the back of an ambulance, we would either continue on the hospital or pull over and wait for the medical examiner to claim the body.
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There are opportunities for both paid and volunteer EMT positions. The distribution varies by state. Let me give you an example of how it usually works in New Jersey.... In the state of New Jersey, most squads are volunteer based. In my town, when a call comes in and we don't have a crew to respond, a county EMS squad is dispatched. This county EMS squad is paid to respond to any town in the county who is short on EMS crews. There are also EMT companies, MONOC and On-Time in NJ, who hire paid EMTs. These companies mostly do transports of patients to and from private residences and between hospitals. These companies don't do emergency calls. MONOC is contracted by the state to provide EMS for large scale functions, such as concerts at PNC Bank Arts Center.
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I don't have statistics on this (even though they certainly exist). Off the top of my head, I'd say our average response time is between 5 and 7 minutes. This would obviously vary based on the location of the call and traffic. Yes you heard me correctly, traffic. Even though we have the red lights and sirens, traffic still requires us to slow down and navigate it slowly and safely. Luckily, our squad building is right smack in the middle of town. This cuts down on average response time across the whole town. When a call comes in, I'm immediately out the door! You wouldn't believe how many of my EMT colleagues take their time out the door. Sometimes, we are dead asleep, or in the shower or in the middle of dinner. On any given call, we make take a little longer to get going but this usually doesn't grossly effect our response time.
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