A Paramedic's Life: Street Grit, Saving Lives -- Job Can Be Difficult And Stressful, But It Has Its Rewards

After thousands of calls, some cases seem like only yesterday:

Bob Block still remembers when he delivered a baby on a ferry - "I tried to get the mother to name the baby after me, but she didn't like the name Roberta" - and the time he found a man who had been reading the Bible at home one night and had interpreted literally the passage, "If thy hand offends thee, cut if off, if thy eye offends thee, pluck it out."

The 18-year Seattle Fire Department veteran has experienced everything in his eight years as a paramedic with the department's Medic One, including being shot at and assaulted on a call. "You have to watch everything that's going on and get out of there as quickly as possible, not only for your safety but the patient's," he says.

Chest pains are the most common paramedic call, followed by respiratory problems and seizures, says Lt. Rick Newbrey, a medical services officer with Seattle's Medic One, which was established in 1969, one of the first such services in the nation. Medic One paramedics are dispatched by 911 operators to provide emergency advanced life support in the field. In 1992, Medic One responded to about 22,000 calls.

Seattle's Medic One is an independent operation; Medic One services elsewhere in King County are affiliated with King County EMS, a government oversight agency, and administered by local fire departments, said Battalion Chief Mario Trevino, medical services administrator for Seattle's Medic One.

In Seattle, there are three levels of mobile medical response:

-- Six Medic One units, staffed by paramedics, primarily handle life-threatening emergencies.

-- Six aid cars, equipped just like Medic One units but staffed by emergency medical technicians (EMTs), provide basic life support in lower-priority calls not requiring a Medic One response.

-- Private ambulances, used for non-critical situations.

Many paramedics also firefighters

There are 60 Seattle Medic One paramedics, who in addition to being EMTs are all qualified firefighters, and are expected to function as firefighters as required.

To be hired as a Medic One paramedic in Seattle, an applicant must have three years of experience as an EMT and one to two years working in one of Seattle's six aid cars, Newbrey said.

Seattle Fire Department EMTs may be promoted to paramedic only after completing 120 hours of basic life-support training, available either in-house, through a twice-yearly King County class or through college instruction. (A three-semester EMT program at North Seattle Community College and two-year paramedic programs at Tacoma Community College and Central Washington University each result in state certification.) EMTs must recertify after three years and complete 10 hours of state-mandated continuing education each year.

Unlike Seattle, King County's Medic One service hires paramedics without firefighter experience, from the ranks of respiratory therapists, nurses, civilian ambulance technicians, volunteer firefighters and military medics, Newbrey said. King County Medic One also employs first responders - EMTs with 40 hours of basic life-support training - in its 100 aid cars.

Training is intensive

Medic One candidates throughout the Puget Sound area must complete a paramedic training program run by the University of Washington's School of Medicine at Harborview Medical Center. The course's 3,000 instruction hours give candidates the equivalent skills of a fifth-year resident in emergency-room care, Newbrey said.

"The majority of people we employ come from a fire-service background," said Bill Marsh, operations manager for South King County Medic One and a former paramedic, EMT and firefighter.

South King County Medic One, a separate entity from King County Medic One, prefers applicants with two years of first-response experience, including experience in aid cars and ambulances. The county is looking for "people who could demonstrate lots of hands-on patient care at an EMT level," Marsh said.

Like firefighters, King County paramedics and EMTs must be able to meet certain physical requirements, such as being able to carry two 35 pound kits up stairs, carrying a one-person stretcher with a 160-pound load or dragging a body 50 feet.

Only about five paramedic openings occur annually in Seattle, Newbrey said, and all are filled by firefighters.

King County usually experiences little turnover among its 46 paramedics, Marsh said. Over the past five years, only one to two positions has come open each year.

Hiring patterns in the program have changed dramatically over the past decade, Marsh said. Formerly dominated by white males, the field has lately seen the entrance of increasing numbers of women. However, hiring of minorities has lagged.

"We have a few (minority employees), but very few blacks apply," Marsh said. "I don't know why; maybe they have no exposure to these kinds of jobs. We send paramedics to job fairs to recruit, but few of the people who apply have the field experience."

Stress and street smarts

Stress studies indicate that a paramedic usually burns out after five years, Marsh said. "Having been on the street for about 15 years, you do begin to feel the pressure. We can't rotate (to other jobs) like firefighters."

Advancement opportunities for EMTs can be limited and competition fierce. "People who come for the wrong reasons - like the flashing red lights and sirens - don't last long," Marsh said. "The motivated caregivers - dedicated professionals - are the ones who last." Most people leave for other career opportunities, some going on to more advanced paramedic training, he said.

"Where people fail miserably in paramedic training," Marsh said, "is in being streetwise" - assessing patient and environmental conditions in the field that aren't encountered in clinical settings.

"Street sense is considering what the scene tells you about patients," he said. "Like at a disaster scene when trains or planes crash, (it's) how you assess and prioritize treatment of multiple victims. Working in a street environment exposes you to all aspects of life: You may work in a home worth $8 million and have to treat a street person next. You have to have a . . . rounded knowledge of things that go on in the street, and you can't be shocked by what goes on."

On the plus side

Although stress is an inevitable occupational hazard, being a paramedic has its attractions. Seattle Medic One personnel work 24 hours on, then 48 hours off, followed by another 24-hour shift and four days off - a total of only nine work days monthly, Newbrey said.

King County Medic One personnel work 24-hour shifts for an average of 48 hours weekly.

To become a firefighter in Seattle, an applicant needs only to have a high-school education, be 18 years or older and gain EMT certification. Rookie firefighters earn $35,484 a year; the EMTs who staff the aid cars ear 20 cents more an hour, said Fire Department Chief Gregory Dean.

After two years, a firefighter can be accepted as a paramedic, be given all the training needed and be earning $38,868 within 18 months. Paramedics with five years of experience are paid $48,996 (15 percent more than other firefighters). Like all unionized firefighters, paramedics receive benefits, pensions and automatic cost-of-living adjustments.

"We give them the best tools and supplies to work with and a healthful, clean (work) environment," Marsh said. "The nature of the work can be extremely negative, so we have to provide a positive environment."

Private ambulances

Stress is only a small consideration for most ambulance technicians, said Brant Butte, public information officer for Shepard LIFEFleet in Seattle. "I worked on cars for nine years and never felt close to burnout," he said.

The nation's largest private ambulance company, Shepard employs 200 EMTs and former paramedics in the Puget Sound area and responds to 100,000 calls annually.

Fire Department and Medic One restrictions mean Shepard ambulance technicians can't work as paramedics in King County, Butte said. "The bulk of our business is basic life support - that means two EMTs in an ambulance, so we don't need paramedics," he said.

Ambulance personnel do much more than just drive vehicles; they may help the Fire Department extricate victims, put on splints, backboards and cervical collars, perform oxygen therapy or write up hospital patient reports. About half the time, technicians will have to intervene and be active in patient care during transport, Butte said. "You can't just pick up somebody from a paramedic as if they've waved a magic wand and expect that (the patient will) make it all the way to the hospital without anything going wrong," he said.

The length of shifts for Shepard ambulance technicians varies, equivalent to 10 24-hour shifts monthly, Butte said. New hires are paid $16,000-$22,000 depending on their shift, he said. Most drivers stay an average of almost five years, and many leave to join the Fire Department.

Ambulance technicians must have a state EMT certificate and a current driver's license. "We like for people to have some experience in emergency medical service," Butte said. "A medical background helps. Many drivers are . . . military reservists and many have been Army medics."

Shepard employs an estimated 20 women and about 30 minority drivers locally, Butte said. "We do very little recruiting. . . . Most people come to us. Since we're the largest, we get pretty much the pick of most of the EMTs out there."

Locally, Shepard hires about three ambulance technicians monthly, Butte said. Together, Shepard and four other local ambulance companies field about 325 nurses, EMTs and ex-paramedics in the area, he said.

The growth of managed health care in the state seems to have had a slight but negative affect on the EMT hiring picture. Managed care has led to "a little drop-off in transport volume," Butte said, which "very well could have an impact on hiring." Although he doesn't expect the drop-off to continue, Butte projects the local ambulance industry will experience flat employment. "Our applicant pool is pretty stable, and not growing. There's a fair amount of EMTs out there not working as EMTs. As the economy changes and less and less jobs (are left), we might have a larger pool to pick from."

Many people begin in ambulances because it's the first step to becoming a paramedic. Others enjoy being part of the medical industry, helping people and getting paid for it. "Some people think there will be a certain amount of glamour and excitement - red lights and sirens, or rappeling off bridges and saving babies," Butte said. That doesn't happen, "but it's a pretty rewarding job, being able to help people in pain, and people look up and thank you for that."

Steven Spenser, president of Praxis Communication, is a former journalist with The Associated Press and The Seattle Times.