EMS in Los Angeles: One Year LaterSo, I've been back in Los Angeles County (namely West Hollywood) for over a year now after moving back from New York (state, not city) last October. When I left CA about four years ago I had no EMS experience, when I came back I had about 4-years full-time 911 response experience under my belt.
Since moving back I've been looking for a decent EMS gig (I'd even take volunteer)...just something that lets me actually TREAT patients and not play second fiddle to fire union-based operations. What a frustrating year it has been!
Nearly every private EMS company I contacted pretty much played the role of a glorified taxicab, with the management of most being sleazy at best. A lot of cut corners, questionable practices, and providers who seemed to think this was normal. And--of course--the low and insulting wages.
A year of Los Angeles EMS and my desire to make a career as a paramedic has been all but destroyed, and I find myself finally considering a medical school path. Perhaps as an EMS-friendly MD I could actually make a difference in our sorry EMS system?
Does it not upset any of us here that despite being the creators of modern EMS, California is now some 15 years behind the curve compared to most of the country? The amount of sheer incompetence that I have witnessed in my "ambulance driver" and "special event standby" roles over the past year has been mind blowing. No wonder the medical director doesn't think EMS providers are capable of learning advanced procedures and techniques!
My question is...why do we as providers allow this to continue? Why do we just accept this as the way things are? We all bitch and moan about how EMS isn't atken seriously as a medical profession, etc., etc., etc., but are we really doing anything to change those attidues? How many of us subscribe to and read JEMS regularly? How many of us go out of our way to further ourselves as providers beyond the classroom?
There seems to be a huge disconnect between what EMS providers want and what EMS providers are doing to bring about change. There is absolutely no reason why the current Los Angeles County Medical Director should say to me that he has chosen to remove certain protocols because Los Angeles County providers have been unable to demonstrate competency, rather than raise the bar. (I have the emails of him saying just that regarding a handful of procedural differences that I observed).
I understand that in Southern California EMS is seen as a stepping stone to or a necessary evil of becoming a true hero....a firefighter. But take a look around....look what's being done in other places. No, it's not true that the hospitals here are too close together. What's true is that early interventions, regardless of hospital proximity save lives (as long as they are performed competently). Heck, traffic in Los Angeles makes the distance irrelevant anyway (even when going Code 3).
Are any of us ready to start questioning and acting, rather than just accepting what we've been led to believe the role of the EMS provider is in the grand scheme of public safety? Do we really want OUR family members being treated by individuals who are largely doing the job because they were forced to....not because they want to. What kind of care to you get on average when the job of paramedic is being filled by someone who was forced to go through the paramedic program because the fire department they work for couldn't justify their job if they relied solely on actual fire calls. (Heck, I think last year LAFD reported 94% EMS call volume relative to 6% fire volume which included calls such as odor of natuarl gas, etc.)
Now I know we've heard this before, but I'll say it again (as unrealistic as it is due to the union and political situation): THREE SERVICES. Fire, EMS, Police. Fighting a fire is NOT the same as treating an anterior wall MI or resolving acute flash CHF.
Let this be the start of a productive discussion that goes beyond fire service bashing (despite the tone that I likely have set).
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