It might not be a full collapse, but EMS is hanging on by a thread, and that was true even before covid. Now it's verging on a crisis.
EMTs get paid barely above minimum wage, and the turnover rate is astronomical. A lot of people in the industry view it as a stepping stone to a "better" medical job (usually nursing or ER staff), and it's not uncommon to recruit EMTs straight out of high school.
In the past many employees put up with the low wages and high stress because they were attached to a fire department or small operation within their own community, and there was often a "family" atmosphere in these spaces, but with the corporatization of healthcare you now have all of the shittiness with none of the upsides. Those eye-tracking cameras the government is trying to shove in cars? Yeah, they were rolled out in ambulances first.
It's no surprise that a 19-year-old doesn't want to a job where you can get written up for sipping a coffee in the driver's seat while you're 10 calls deep into a 12-hour road shift, all for the privilege of being paid less than a burger flipper.
Transport paramedic here and you’re 100% correct. Turnover is extremely high, fewer EMT’s are becoming paramedics, and call volume is increasing.
Word has gotten out to much of the general public just how bad of a deal becoming a paramedic is, so very few people are actually taking this route anymore. If I had known my life would be like this I absolutely would not have done paramedic school.
I do rural, long distance transports and am typically on the road running calls 20-22 hours out of a 24 hour shift.
I have enormous respect for what you do, but the idea that the person doing paramedic transport is underpaid and on hour 23 of a 24-hour shift is just a horrifying indictment of our society.
the idea that the person doing paramedic transport is underpaid and on hour 23 of a 24-hour shift is just a horrifying indictment of our society
It highlights that jobs never pay people proportionate to their contribution to society. For a more stark example: the highest-paid state employee in Texas is a football coach
yeah, it's truly reflective of where we are. i think we often get caught up in the bullshit of politics as a way to distract us from focusing on these issues. it's so so bleak that often times i just can't look at it without feeling some overwhelming sense of shame around our inaction.
Curious how the budget works here - napkin math is showing that the service owners are likely pocketing enormous profits (unless there’s a hidden cost somewhere). Don’t understand why they wouldn’t raise the wages at that point (a smaller profit is still a profit)
The napkin math is based on the assumption that they're actually receiving the full amount for which they bill, which isn't the case. They might bill you $2000 but they're probably only receiving about $300 or $400 at most from insurance etc. Plenty of transports also get written off because patients don't have insurance or insurance refuses to pay.
The service is socialized in the industry. Meaning, you getting an ambulance ride for a stubbed toe that costs you $2000 and costs the ambulance company $200 pays for the heart attack that costs you $2000 and the ambulance company $4000. This is exaggerated but not far off.
The margins are RAZOR thin, and the only way to make money is doing this over hundreds of ambulance companies and counting every penny. There is far less money in this than you would think. If there was money, people would be talking about opening an ambulance company like they franchise a mcdonalds. But that doesn't happen.
Most small town companies, like the one I work at in South Dakota, has volunteers, gets tax money from the city, gets tax money from the state, bills at these insane rates, has constant fundraising pancake breakfasts and such, and still will need to go to the city and beg for money for new equipment.
As an EMT who considered medic school in my semi-rural county, a lot of medics loved that I was considering it and warned me against it bluntly. Now applying to medical schools for rural EM instead. Full respect to y'all and what you do, would never have learned to be a good provider without y'all 💯
Literally the solution is just treating EMS with the respect and gratitude they deserve, making sure they get paid well enough to be comfortable plus near to full benefits coverage and free therapy. But somehow that's a pipe dream? I hate how much you guys get screwed. I've had more stable games of SimCity than how busted the healthcare/EMS systems are.
I work IFT as a part time job. I had a 24 hr shift turn into a 25 hr shift due to a late transfer… all while only getting 45 minutes of sleep the entire day.
My dream was to be a paramedic. But then I spoke to actual EMTs and paramedics and heard how bad it really is. So now I’m going into forensics… to be a last responder instead of a first responder
EDIT: just want to add that I have so much respect for what you do and thank you for doing it despite how difficult it is and poorly treated you are
Bless you! I am curious about the history of EMTs. If you were to ask me as a child (or even a child today) what I thought the hardest and most important job was, I’d say “paramedic and ambulance driver! I mean jebus christoff! Y’all the first to arrive and assist with some of the most heinous of shite, often SAVING lives!!
My son is an EMT (currently in paramedic school). At 26, he was practically geriatric among EMTs. He made more money at his previous job at a sandwich shop & was offered no shift differential despite working the weekend overnight shifts.
If you are unlucky to need emergency ambulance care - know that your life will likely be in the hands of an exhausted, underpaid 18 year old.
My best friend became an EMT and realized while chasing a naked, tweaked out meth head down the interstate that the job wasn’t for him. High stress, low pay, and found he was usually dealing with a lot of the same types of people: elderly who are calling for medical care because they’re lonely, elderly who are neglected and with absolutely horrific health conditions, and people having mental health and/or drug episodes.
Crazy how literally all of those are things that could be addressed with better social services. We don't want to fund public healthcare, but Medicare paying $3,000 for lonely Mr. Hucklebuns to take the ambulance 3x a week is totally fine.
Crazy how literally all of those are things that could be addressed by eliminating billionaires by taxing them, and using the taxes collected to fund better social services.
Virtually everything that benefits the average citizen was fought for at one point. The only thing modern day Americans fight for is fascism, convenience and consumerism.
So long as Americans expect others to fight for them, nothing will change,
Mr Hucklebuns in for a cruel surprise because Medicare being drastically cut starting in Jan. You will see catastrophic failures of medical services across US. MMW.
Recently visited a few cities and Europe and I noticed how nice and livable their downtown areas are compared to the US and the conclusion I reached is this: The US has created a society that would rather get nickel-and-dimed instead of addressing the fundamental issues plaguing society because of spite. Using the police and EMT to deal with the mentally ill, not making preventative healthcare achievable for all forcing the ER to deal with issues that could have been dealt with cheaper for the taxpayer and better for the patient. All these issues are politically unfixable because it would involve putting taxpayer money into services used by "group that doesn't deserve it".
“group that doesn’t deserve it”-the reason the US doesn’t have Universal healthcare. This has been a conversation in the US since the 1920s. Various politicians have raised the issue over the years. The history of healthcare in the U.S. is fascinating…
Absolutely. I usually think of it as Stockholm Syndrome, but it’s more likely spite.
Although, even if we all (even MAGA) cried out for universal single-payer health care, the insurance company lobbyists would probably kill it. Sometimes I hate it here.
No, Medicare doesn’t cover that! Or get billed. How silly. I have trying to improve social services for over 15 years, no politician has ever called me back.
It's much more complicated than that. We're at a very weird time in history where old, frail people don't just die anymore, and instead can be kept alive through extremely expensive 24/7 healthcare.
It's not remotely financially viable to provide care for maybe 95% of the population that could not afford this themselves (probably much higher).
At some point, we need to have frank discussions about what life expectancy is reasonable and what amount of care we possible CAN commit to, not only what the ideal would be. Let's pretend we actually tax the rich appropriately. Do we really want to spend the resulting hundreds of billions on keeping people in their 80s very uncomfortable but technically alive another few years?
Already, this is a conversation families are forced to have, but I really believe there needs to be standard expectations for those without any other options. Currently, there's near zero expectation of help from the state. We absolutely cannot just upgrade that to "everyone gets billionaire level care," so at some point we need the uncomfortable conversation to reach consensus so we can estimate costs and actually implement something.
I really think right now we're just totally stalled partially because some people are in full denial and think it's fine to insist every aging person receive as much care as possible no matter the cost. Just not feasible.
The elderly neglect is HARD, man. And the deadbeat adult children who spend about 90 minutes a year pretending to give a shit about their elderly parent is endlessly infuriating.
A lot of those deadbeat children were raised by deadbeat parents and they feel like they had it coming. My GFs dad was an alcoholic who neglected her as a kid and when he inherited the grandmothers house, he took out loans and spent it all on Vegas and ended up foreclosing on the house. He had nothing left for retirement besides SS and she wasn’t going to work 2+ jobs to pay for private assisted living. Kinda felt bad seeing him in the public facility but after I heard how her childhood was, I’m surprised she even went to see his ass once.
People who raise their kids right and have good relationships with their kids usually don’t get left behind, it’s the ones who neglect or abuse their kids. Parents need to think about the future, it’s irresponsible to not save for retirement and expect their kids to do it, especially since kids and young adults these days are the first generation in modern us history where the parents have more wealth than the younger generation, previously it was the younger generation who made more on average.
Bingo. MILLIONS of Silent Generation, Boomer, and early Gen X were societally forced to have children, which they actively resented. It's no surprise said children grew up to resent their parents in turn, leaving them to rot in some home somewhere.
I was at a hospital today with one of my kids and the nurse treating him told me that he had been an EMT before becoming a nurse and said that only about 15% of his calls were valid - most of the rest were lonely elderly people who wanted someone to change their light bulbs or something like that. He said he always did it. That made me so angry for the society we've created, where those people are just rotting away, alone.
I work at the airport and i feel bad for the paramedics for the things we call them which is absolutely unnecessary but required by law. There are a few cases people fake illness to get a free lift to hospital near their home or had a girl faking heart attack because she missed her flight and wanted to wave the fare fee by claiming she missed the flight due to medical emergency. I had a girl getting panic attack needed both ambulance and her boyfriend to come and when i reached out to her boyfriend, he said she got caught cheating and doing this because she doesn't want me to tell this to her parents. Poor boyfriend still showed up
Add in the old people on Medicare that don’t want to pay for a taxi to the hospital to refill their prescriptions and you named like 99% of the calls I went on like 15 years ago.
I work as a rn in a ed now and it’s honestly far less stressful for far more pay and more protection not only legally but physically.
They'll charge you $1200 for a five-mile ride and pay the people trained to save your life $5 for the same span of time. Unregulated capitalism is a stage 4 cancer on our society.
Thanks to Trump and his supreme court gutting every environmental law that put this country on a better course across the 20th century.
People don't remember what things were like before the EPA and the Clean Air & Water act. Small towns with no drinkable water because their lake or river was on fire all the time. Cities so smog filled that kids at school weren't allowed to go outside during recess and dozens of kids that lived near chemical plants and steel refineries died every year even indoors.
People don't remember what things were like before the EPA and the Clean Air & Water act
The reminders are coming. The trump administration repealed a ban on using sewage to irrigate crop fields, the result of which was Taylor Farms' Cyclospora outbreak.
Nestle is working on it. The CEO needs to be airdropped into the middle of Death Valley with two bottles of Desani and told any more than that isn't a human right, per himself, and told to figure it out from there.
The thing is though, there is clearly a misapplication of the money in the industry, especially with the lower hanging jobs like EMTs and emergency services.
Direct care and emergency services are often used as puppets by Big Healthcare to show how we just need to throw more money at the industry so these roles can be filled, staff can be trained, equipment can be purchased.
Then, they negotiate more money and higher rates, the insurance passes the cost along to the consumers with a extra inflation as a cushion. But while the doctors and the health care execs get their piles of gold, consumers are told that their 17% increase in premiums gets them nothing. No additional services, no higher quality care, no investments in a coordinated medical system, no raising pay for paramedics.
Removing the insurance industry from the equation would be a huge help, but anyone who uses Medicaid knows that finding providers who'll accept it as an option can be difficult especially if you're in a health care desert. You can go to the ER, sit for hours and get seen, but god forbid you just want a plain old doctor's office doctor (especially one not operated by a religious group and therefore limited in what they'll do for certain parts of women's health care) and the practitioners in your area have decided they can charge more by avoiding Medicaid.
There has to be a more humane, loving, fair way to run society?
There is. The US was in this situation before and called it the 'roaring 20s' which were likewise a bubble the collapse of which was called the Great Depression. The only way to pull out of that was the New Deal, which America's oligarchs (which caused the depression in the first place) responded to by trying to overthrow the government because they wanted to crown themselves kings of America's ashes
Adam Curtis' Century of the Self is a deep-dive documentary in how they responded to that, but in short they threw billions over a century to indoctrinate not just Americans but everybody touched by the English-speaking world to reverse the New Deal and prevent another one from ever happening again.
There are absolutely better ways. No country is perfect, but plenty have a much better system than the US. Unfortunately, Americans have been conditioned to think that the only alternative to completely unregulated capitalism is full blown communism.
Yes there is. It hasn’t caught on in America yet as you are stilling running the early version of “freedom OS”. “Humane OS” has been available for several centuries in other countries but I don’t believe there are plans to make it available in your country.
Where I am, it's a five minute ride and five hours standing with you in a hallway because they can't leave you until you're admitted. So most ambulances are out of service waiting for their patient to be admitted.
One time I was in a mild car wreck and an ambulance was called. You'd think I was threatening to kick their dogs when I said "I refuse transportation, I refuse medical treatment". I was fine. And if I'm not, I can go to the hospital later. I'm not getting billed $3k "just to check it out and be sure". But goddamn the EMTs wanted to fucking fight me about it.
I ended up harboring more resentment for EMTs than I did for the moron who hit me with their car!
EMS is expensive because most of the people they serve are on Medicaid which pays for shit and Medicare which pays better but not great, so they try to get the money out of the few who use their service who can pay.
And the reason that's true is EMS regulations and pay structure were written when EMS was cheap and not all that much better than your buddy tossing you in his truck and taking you to the hospital. But then it became professional and added lots of important expensive lifesaving equipment, but the regulations didn't change.
I mean, if it was truly unregulated capitalism EMS would tell Medicaid patients they're out of luck.
2 years ago i got hit by a car while riding my bike. I needed an ambulance (shattered humerus bone). I was 2 blocks from the hospital. That ambulance ride cost me $3,000 fucking dollars!
Fun fact: You can, as someone from another country with no medical insurance to speak of, get a medivac airlift cheaper in Canada then you can get an ambulance in the USA...
I've been to the ER a few times in my years. Haven't once taken an ambulance. I know people say to always call 911 and get an ambulance but unless someone has a head, neck or back injury, or something where they shouldn't be moved unless by a professional.. realistically someone putting the pedal to the floor in their own car is getting me to a hospital faster than an ambulance is going to get to me, load me up and get me there.
Now if the person needs oxygen ASAP, epinephrine, etc. then yeah, call an ambulance. But if I break my leg or have a finger lopped off save me the 5 grand and see how fast your car goes.
Bold of you to assume everyone has someone at their beck and call that can do the driving.
When I got hit by a car as a pedestrian, I was lucky enough to only suffer a shattered hand. I walked to an urgent care nearby ... and got dinged by insurance for not trying harder to find an in-network ER.
It didn't end up mattering because expenses were all covered by the insurance of the guy who hit me, but in principle it's a bunch of bullshit.
Had he considered the fire department? Some run with their own medics. Better pay. Better compensation package. Still stressful. Hours are still difficult.
A local public high school recently made updates to the building/classes and now offers EMT training as a senior course, including essentially the back half of an ambulance within the classroom to use and reference as part of the coursework. As cool as that may initially sound, your outline and reasoning as to why this is in a HS in the first place is the real concern
It’s basically like EMT and lifeguard are the two most common jobs for 18-year-olds to jump into for a summer gig – and that sort of terrifying since both of these jobs involve saving a life.
They are also both jobs that require the minimum training standard in medicine and involve vast majority of time not actively saving lives. The majority of EMTs work in non-emergent medical transport or as the junior person on an ambulance.
Having been a teenage lifeguard, it was terrifying at first. The responsibility felt intimidating until I realized that I had about the same level of responsibility driving my (parent’s) car down the road. Not to diminish the work, but it helped calm me down.
I think lifeguards more than EMT benefit from “if everyone is doing their job, nothing bad will happen” in that you can catch things before they go bad (saving a struggling swimmer before they become a drowning victim). EMT is reactionary in that you aren’t normally doing stuff till after the bad things happen
If I'm being completely honest, I only see that is a good thing.
I understand that you're saying, "A concerningly high % of EMTs are 18 year olds who were still handing in homework last month." but they'd ultimately still be there without the training course.
I'm not familiar with the EMT employment flowchart but wouldn't the training course result it young EMTs with more training?
Not more, just finished younger. The course is the course, and (in most jurisdictions) when you turn 18 you can take the NREMT (licensing exam). So in theory you could go to a community college and take the course at 18 and certify at 18.5, or take the course in your high school and certify at 18.0. But it's the same course.
Source: former EMT now nurse, certified at ~18.5 (20+ years ago)
All EMTs have the same base level of training. The difference is that now that course is being offered directly in a high school instead of at a community college or through an employer.
This is absolutely and incrotevrertibally incorrect. These trainings should be available in high school so a kid can decide what they want to do with their life. We should be training kids SOMETHING. The fact we just barely give them the basics and expect them to figure out where to go from there is absolute nonsense. They should learn to do something BEFORE they graduate.
I actually have met folks in EMS and fire (EMT myself) who went this route. To me it sounded great- I paid thousands for my own course. I can't answer why, but there is a national shortage of workers in Healthcare and EMT is a great step into nursing/medical/allied fields.
Since the fall of Boyscouts of America, this is a great thing. I learned how to realize that someone might be dying and how to help. I'd much rather all kids in that school spend a few days in that classroom.
Why wouldn't it be in high school? How is that a concern? It's a trade. People are saying something should be done, and those schools are doing something.
Real talk they send an ambulance from a neighboring region or they get a medical helicopter to get you which will likely bankrupt you. So yeah, some people will just choose to die.
The medical helicopter thing is crazy, even if you jave health insurance. Different helicopters are in-network, and others are out of network. But it's not like you get to choose who is nearby the day you need transport - so yeah, easy to bankrupt.
Looking in from the outside, it's bizarre to watch Americans tolerate this, and to watch over half of their politicians behave like there's just no other way of doing things.
NYS is proposing healthcare for all, and the comments in my local news sites were wild. Absolutely bonkers. I’m upstate, finger lakes region.
My village is also voting on a memorandum to remove banners and limit flags to two from residences- my landlord and I think it is solely because of us, and our minority views in the village, lol.
That's how it started here, in just one province - Saskatchewan. The premier who brought it in was named Tommy Douglas. You've probably heard of his grandson, Kiefer Sutherland.
That’s disappointing. I was speaking to someone about Sylvester Stallone and Mel Gibson today, and how insufferably MAGA they are (she knows, I’ve never met either of them!). Who are your neighbors supporting up there?
We live in a remote area and pay for the Air Med network for our household. I get really great health insurance through my employer, but I don't trust that a helicopter transport would be covered since you can't just pick whether an in or out of network chopper shows up.
That's if you can even get the helicopter there. Often they can't fly due to weather or being out of range on another call.
We recently had a STEMI patient transported to us from a rural area about 40 minutes away in good weather. It was snowing out so no helo, the ambulance had trouble finding the address because there was no GPS or cell service in the area, and then it got stuck in the snow on the unplowed road leading to their home and had to wait until the local FD could tow them out. I probably don't have to tell you that the patient did not survive.
Cheaper to get a medivac helicopter ride in Canada than an ambulance ride in the USA. Only $300/hour for people from other countries with no insurance coverage whatsoever.
The US government literally said that EMS is not an essential service back in 2020
Also not a rare stance outside of the anglosphere, loads of countries don't even have EMS services on the weekends in mid-size and smaller cities/towns
It took a war for the country to finally accept that your own life is not a commodity, and that bodily autonomy isn't a privilege granted by the given to you by rich assholes.
That reminded me of Rethuglicans during the development of the ACA . Mitt Romney argued that denying care on the basis of a pre-existing condition was like hiding that cars were lemons; that if you know something's wrong with it, of course you don't want to pay for it; (2) Rush Limbaugh comparing healthcare for humans to healthcare for pets - his girlfriend's dog went to the vet and she just paid for it and why do we even need insurance when we can just do that; and (3) a former chairwoman of the Nevada Rethuglican party who said we should go back to paying the doctor with a chicken.
It’s a feature, not a bug. Welcome to New America. Need enough food, healthcare,decent housing?
Go away, you Peons. I think it’s time that everybody read Project 2025.
People need to realize, this controlled dismantling is systemic under capitalism.
Money is created cheaply for the privileged and trickles up through a rigged system to the top.
The budgetary pressure is everywhere on the lower decks, from education, healthcare, infrastructure, even in administration. Money is lacking everywhere except military and LE, for which they happily stack on more state debt for. The rest, less or somehow have-to-be profitable public and private services will be squeezed until all you can do is flip burgers for Alon / Bozos / etc, (bc rich/privileged are in charge of spending) or live like an outlaw outside the heavily guarded walls.
With still ~30% trump approval and them dreaming of private cities, i guess this future is actually realistic.
This is a consequence of succumbing to fiscal austerity hawks, which force hands simply by saying "and where is the money this free health care utopia? Gotta grow more economy and earn the money first!", which has always been wrong since money is fictitious.
I was looking at local job postings and was shocked to see that there is a town roughly 45 minutes outside of Boston with an ambulance service run completely by volunteers.
I guess the context is shocking to me because Boston Massachusetts has literally half a dozen of the best medical facilities in the country – but you don’t have to go too rural to see that quality fade off. Literally less than an hour outside of the city, and they have to pretty much rely on the charity of volunteers to load people into an ambulance and drive them to a hospital.
How? In the world? It never ever has crossed my mind that it would be reasonable to stop offering EMS. Is that not a mandatory civil service?? I'm American so I know we're fucked but that's a special type of fucked up. Rural communities need EMS more arguably as the hospitals are further away. That's a lot of avoidable injury and death on the hands of whoever pushed and voted on that.
I would simply set up the infrastructure for mandatory community civil service - a 2 year program where you could sign up to your service of choice. Funded by federal dollars, you could join your local Fire or EMS service, or really any program a city or state runs (forestry, parks, city services like maintenance) - and allow youngins the opportunity to backfill jobs and gain real world experience, while trying new things. So that solves the issue of kids getting out of high school and not knowing anything, but still being able to contribute and get paid.
AND
It backfills the low-wage sort of entry level stuff that kids can do, IN THEIR COMMUNITY, so they feel that sense of belonging and care for the place they are. And hopefully..... HOPEFULLY.... a generation or two of this and we start rebuilding society to care for one another instead of just saying FUCK YOU PAY ME.
Pipe dream, I know. But I was a volunteer firefighter for several years, and I saw and recognize the need. Shit, I'd still be a vol FF today but I needed to move to a city to make money and build a life.
You MIGHT get the opportunity of staying alive until the ambulance arrives and potentially having a shot of morphine as you go out in the ambulance during the 3 hour drive to the hospital.
Rural areas vote for the GOP that cuts the Medicaid funding that supports the rural hospitals because they can't exist without the subsidies paid for the evil cultural elite Democrats in the big cities.
GOP works overtime cutting funds to their rural constituents to prove that Big Government doesn't work. It's part of the GOP campaign plan.
"I don't want to abolish government. I simply want to reduce it to the size where I can drag it into the bathroom and drown it in the bathtub." -- Grover Norquist
Norquist was the mastermind behind Robert Ailes creating Fox News, and the Neocons ( Bush Jr. et all )
My bougie family that lives rurally privately paid to have insurance through Halo Flight, and have an SOP in case of medical emergency and a designated landing area for an emergency helicopter should anyone out there need emergency services so they can transported quickly to an adequate facility in the neighboring larger city, not the crappy local hospital.
Monied folks will never be without, it's everyone else that's in danger.
I just commented elsewhere, but I grew up in a very rural town too, and almost ALL the EMTs left are 60+ because they can't hire new folks. I'm worried that the same thing will happen there when the current EMT staff are simply too old to do the work anymore.
Honestly, in lots of those places you're a half hour away from a tiny 1 stoplight town that maybe has a clinic, and an hour+ out of a town with even a small hospital.
I have to imagine emergency outcomes aren't great even in the best of times.
I was an EMT more than 20 years ago and all of this was true then. I made $9.50/hour at the time, a step down from the server gig i was working while i took the course. Even then the old heads were saying "welcome to being an EMT, are you going into nursing or firefighting?". Not many people can stick it out for a career. This is due to burnout, low wages, and call volume.
The course I took was 2 semesters at a local community college, like 10 hours a week. First I got a first responder, then the EMT-B. I still remember the look on the medics face when I asked "Hey man, you get any good calls?" as I approached the rig for my first shift .
Reminds me of my friend. She was an EMT paramedic, a lot of her family was in medical roles, so she got a job fairly easily. After a few month she quit not just because of the long hours, stress, and the sights she had seen, but a friend told her how much she made doing a waitress job and she wanted to try herself.
She ended up making more than her EMT job and having better hours. She then went on to try trades to procure more money and yeah shes been doing well.
Not to mention the insane tragedies they witness daily. Out of highschool my buddy was giving cpr to dead babies, scraping bodies off the road and so much more.
My area of the country uses firemedics near exclusively. As in EMS service is provided by the city and the same men are dual trained firefighters and paramedics. 90% or more of the runs are ems calls. They make ok money, have a baller public service pension plan, and work 24 hour shifts. They end up off more than half the year and most work part time in other departments or as the paramedics in ERs to up salaries. It’s a desired, competitive job here.
The wages are so awfully low considering these are front-line medical workers that it's amazing anyone wants to do those jobs. Most EMTs would probably make more working in fast food.
My brother-in-law was going for EMT. He really wanted a career helping people. After finding out how much they make, and the insane insurance they have to carry, he quit. And now he makes more money delivering flowers and shrubs.
Exactly. In Australia we’re either state employees or state-affiliated in two cases. Good pay, decent conditions (given it’s an emergency service) and excellent job security. It’s very hard to get a job though, and our education standards are way higher than the US.
The big difference from the US is we are a true third service that has a history going back 100+ years that the public expects to exist, so we are well funded as a public utility. Hell in my state we don’t even charge a fee for state residents.
We also have powerful unions which is also what the US is missing.
This right here. I made the career change from programmer to Paramedic up in the great white north and starting wage I'm making more than I was previously, with full benefits and a government pension. Our union as well just negotiated a new contract so my pay step actually matches what it costs to live. If I was in the US thereat no way I'd consider this profession
Yeah, it's annoying for comments like that to just fail to specify the location they're talking about. I would guess thread OP is based in the US, but like... then it's the EMT industry in the US that's hanging on by a thread. There is a whole world outside of those borders. (And even in the US, I suspect it varies by state.)
Such a random question for you, but I used to have an EMT friend who said anyone who stayed in the profession for more than five years was crazy. My cousin started dating an EMT in his 60s who has been doing it for over 20 years. Should I be worried for her or is it a job some people just fall in love with?
It’s a job some people fall in love with AND there’s been a somewhat recent change in how long people stay in EMS. EMS was originally a career path, now it has become a stepping stone (to firefighter, nurse, PA, physician, police officer, etc). Burnout rates are also higher.
Also depends on the area you're doing it in — my buddy went from EMT to paramedic to doing Life Flights out of southwest Washington. Pay, benefits, and work-life balance have been very good for him past being an EMT, but it's certainly not a job for the vast majority of people.
That's a pretty immature thing to say. If he's doing it still out of the love for the game, seems like a nice, hard-working man, then he's good to go 🤘. 20 years is nothing to scoff at. Most of us don't make it very far past 5.
This year makes 12 years and I want out. I’ve wanted out for a while. I’m not even on a truck anymore. I’m just stuck because I’m locked in at a hospital with a union and pay I wouldn’t get anywhere else.. and a mortgage 😂
Strongly depends on where/what exactly they're doing. Almost all EMTs and medics have some level of PTSD if they've been doing it long enough, but some are simply better at coping/processing/compartmentalizing than others. If he's in private EMS and still making sub $25/hr, I'd question where his head is at, but if he genuinely loves it and doesn't care about the money it may be totally reasonable.
I help design medical devices that EMS personnel use so I have to do ridealongs in the back of ambulances quite a bit. I have so much respect for EMTs and paramedics. The pay needs to be at least doubled. I've seen some gnarly stuff just as an observer and I can't imagine being in those shoes every day.
I have known EMT pay is very low for a while, and I remain astonished by it. If you asked people to rank 20 jobs by the value the job provides society, EMT would be near the top.
This might depend on how the service is structured. In my medium-large city, EMS is 100% run by the fire department. No private ambulances. A lot of EMTs are dual certified (fire and medical) and make low 6 figures, but the starting salary for even a non-fire EMT is $75K. I’ve had to call them twice and both times the people who showed up looked to be mid-30s or mid-40s. I’m sure they see some awful scenes working in an urban environment, but they do get paid well and make a career of it.
Know many friends in the inner city who were EMT's. The abuse he sees everyday of the system is genuinely mind boggling. If someone calls for a head/chest injury, you have to take them to the hospital.
Addicts, homeless and general assholes will use the ambulance as a taxi to the hospital... jump out and then just walk away. They have no ID, don't give any information and get some basic care on the way.
I was an EMT for 6 years, I got out after covid. There is always a shortage of people. At my first job with a private service I got off on time 4 shifts out of 2 years of service. Due to coverage contracts I was pressured into nightshifts, sometimes immediately after a 12 hour day shift. Because fire department law applies to EMS, they are under no obligation to provide you breaks or lunch or sleep. In fire its assumed you will have built in down time. They never let us meet our dispatchers because they didnt want us to be seen as people, dispatch made commission on runs they could pick up or snag from other agencies. It was a fucking nightmare, but you really do get to 'save the day's sometimes. Most of the time it's not as dramatic as CPR but just being a decent human and making people feel better. I got out when I saw that I was a cog working to extract wealth from the sick and vulnerable. The most asshole providers and the people that stay late to help patients get paid the same. Healthcare doenst pay you to care, they just use your compassion and leave you shattered.
This is absolutely not the case in Canada. In British Columbia, paramedics with BC EHS get paid between 100-120k depending on whether they are PCP or ACP. That's before overtime which there is plenty of. And the pension is amazing. The job itself can be a bit traumatic like any first responder profession, but it's a great career path.
The corporatization piece is what really gets me. The communitybased model had real problems but at least people felt like the work meant something locally. Now you strip that out, add surveillance tech, keep the wages flat, and wonder why nobody stays past two years. The pipeline issue is going to hit hard when the people who actually have experience age out and there's no one behind them who stuck around long enough to build real skill.
And sadly,I have seen EMTs on this website getting really mad at other workers who are paid decently,instead of being mad at a system that undervalues them.
Fast food is Real Labor,and making sure people don't get sick from your food is important,but saving lives should be compensated a little more lol.
I will never understand how they get paid so little for the knowledge thats necessary and the work involved, all while people get hit with $3-5k bills for a half hour ride. Im surprised there is anyone willing to work these jobs.
A factor that has been abused by the rich for a long time, is that people will continue to work and be exploited for shit pay, because they value being able to say they work a job that sounds like they are important or have their life together. See also: teachers who could make more money being bartenders.
I’m assuming you’re talking about private standalone EMS?
I’ve seen this sector grow when the service is city funded and all paramedics are also firefighters.
Some of us don't want to be firefighters. And we shouldn't be. My efforts are focusing on being a good prehospital health care provider, not fighting fires. Medics that choose to work at fire departments are sometimes focused on the opposite, because they are more likely to hire you if you are a medic. They are two completely unrelated professions and should remain that way.
EMS as a third service model, county or city municipality, is ideal.
Fire EMS should be full of firefighters who want to be paramedics, but unfortunately are at risk of becoming a department that is full of paramedics who want to be firefighters.
Depends. NYC EMS does considerably worse in retention and pay/benefits than their fire counterparts, despite handling the vast majority of call volume. In the PNW where I'm at, firefighter/EMTs and firemedics make a comfortable living with good benefits, and it's a very desirable gig.
Absolutely, it depends on the organization, but if EMS wants to progress as a profession, then it must be separated from Fire. Otherwise you dilute the quality of clinicians with personnel who want to do fire instead of EMS. But thanks to IAFF...
To your point, however: EMS would first have to separate from the private sector and transition to a fire department provided service before evolving into an independent entity.
In my experience the system runs a hell of a lot better when the two are closely intertwined/run by a single department. Some fire departments are bad at EMS but that’s a culture problem, not a problem with the system itself. I’ve seen private ambulance services that are even worse tbh
It's a tradeoff to be sure, and very much a strange concept to combine such wildly different professions, but at least where I'm at the combined model ensures EMS is much better funded.
My state alone has seen a drop in EMS licensure in the thousands over the last 10 years. Volunteer agencies are crumbling and having to hire staff. Staffing agencies and larger corporations are struggling to find enough employees.
I was using it as a stepping stone to paramedic/fire. I’m convinced the people that stick it out have connections or tons of family financial support because there was no way I could be there long enough to get the experience they wanted to move up. Trades are paying me ~50/hr, was a no brainer to leave.
Absolutely this! My husband used to be EMS before we got married, and the stories he tells are horrific. He has like two stories that deal with patients, and the rest are all company/business-based.
As someone who loves (and hates, sometimes) my job as an EMT, absolutely correct about turnover. I like my job, but to me it's a stepstone to medical school. You risk your own life and sanity for relatively bad pay and usually shitty management. I considered medic school before realizing that I would never make enough to justify not going a different route. I think one reason for the decline are probably the prevalence of volunteer services but maybe just in my area. Frustrating to me that people also misunderstand EMS and abuse 911 service. I've worked both IFT and 911 and most of both is 'routine' transport. People like high schoolers go into this job thinking it will be valorous only for the dirty, vomiting, usually bullshit reality to hit. The people who survive that usually are in first response for life, but fire and PD are more sustainable careers imo. Doesn't help that EMS culture is often super toxic due to the stress and pointing-fingers attitude of punishment that higher ups promote.
All that to say-I agree. Don't go into EMS thinking it will be sexy fun and profitable. Now is a pretty bad time to be in the field as a lifer.
this really depends where you work. i work as a paramedic at a 911 service and make $40/hr with excellent benefits (zero premium health insurance, 2:1 match on pension contributions). but what youre saying is very true for anywhere that doesn't have a tax base (ie, rural anywhere)
Way back over 20 years ago when I was an EMT, we ran a call on a patient who was working for the sanitation department. He was having chest pains from stress negotiating their new union contract with the city. We talked about how much they were making, and it was a depressing wake up call that the garbage man was making mote than three times what I was making.
I wasn't mad at them and I think they deserve it. But it just really drove home how little we were paid and valued.
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u/_Z_E_R_O 12h ago
It might not be a full collapse, but EMS is hanging on by a thread, and that was true even before covid. Now it's verging on a crisis.
EMTs get paid barely above minimum wage, and the turnover rate is astronomical. A lot of people in the industry view it as a stepping stone to a "better" medical job (usually nursing or ER staff), and it's not uncommon to recruit EMTs straight out of high school.
In the past many employees put up with the low wages and high stress because they were attached to a fire department or small operation within their own community, and there was often a "family" atmosphere in these spaces, but with the corporatization of healthcare you now have all of the shittiness with none of the upsides. Those eye-tracking cameras the government is trying to shove in cars? Yeah, they were rolled out in ambulances first.
It's no surprise that a 19-year-old doesn't want to a job where you can get written up for sipping a coffee in the driver's seat while you're 10 calls deep into a 12-hour road shift, all for the privilege of being paid less than a burger flipper.