How Paramedics Work

we don't hate ourselves? Do we tell me? I need to know? No? Okay, so it depends on the day. I didn't want to hate myself. Sometimes I want to punch myself. Does that count? No? I know exactly what you mean, man. Sometimes is I'm just like, I am so sick of myself? Is that? Is that what you're talking about? That was a good song? Remember that song? No,

it sick of myself? No, that was Matthew Sweet. Oh yeah, wow, that's weird that this is going on right now because Matthew Sweet just popped up like randomly in the last couple of days and like an article I was reading. I was like, I forgot about him, haven't heard about him in twenty years, and then bam, bottom mine off. Here he is again. Well he's still around. He's an Atlantic guy. You know, I didn't know that. Well that's cool, Yeah, I know. I think I think that's like the way

it goes. Just because you had one hit in the world came and like listened to you and then moved on doesn't mean like you're like, Okay, well, I guess I'll go bury myself alive now in my own backyard. Usually usually the artist like keeps going. You know, yeah, he had two hits stuff. I know, girlfriend and then the other one. You're just talking about girlfriend. That's a

great song. Yeah, that's a good song. Okay. So obviously what we're talking about today are paramedics, para medicine really is what we're talking about, which is, um it's actually a pretty interesting topic because you kind of look into it, You're like, oh, these these people save lives. That's great. Um, here's some of the life saving techniques that they do. Fantastic.

But there's like actually so much more too. It's got a really interesting history, it's got a it's one of those things where it's way worse off than it should be as far as like funding and and and like UM logistics and stuff like that goes. I just find it interesting. It's it's interesting to kind of poke into a topic and then find that, oh, this is even more interesting than I thought, and have it poked back

yep with forceps. So I guess we should say right off the bat that the word paramedic para means alongside, so alongside medicine, I guess, which I'm not quite sure what that means. So what I think it means is as follows Charles, these people paramedics. They are not doctors, but they work with an alongside and really honestly um as an extension of a doctor and empty. So that's what I think it means, because it's not like what

they're doing is a different type of wacky medicine. Like they're actually doing the same type of medicine that an E R doctor and E R nurse would be doing, and e R they're just doing it out in the field. Could you imagine how disconcerting it would be to be like on the ground and have a paramedic come up and like blow green dust in your face. You're like, what are the chicken bones for? Man? Oh man, blow green dusty. I don't know, it would depend on what

the effect of the green dust was. So, um, I think that's what paramedic means. Right, we can go we can go further back actually and and and describe what ambulance means. We know that one for certain. Yes, Uh, that came around in fifteenth century Spain during the Inquisition. They clearly had a lot of need for medical work. Uh. And they actually had field hospitals that were called ambu lancias. Right. It was just basically like a mass unit out in

the field. Um. And then eventually the the French shortly after, I think under Napoleon, they innovated on the ambulance and said, well, that's great, that's neat that we have these things out in the field, But there's some guys way over there who are injured, and they probably wouldn't die if we could get them to these ambulances, these field hospitals. Right.

So they came up with basically mob ambulances um, which is the this idea of a flying or a moving ambulance, which is like a little medical facility that they would put the people into and move them away from battle to go patch them up, rather than waiting for the battle to end. Well yeah, and before that, even during the Crusades, and they also had a great need for medical care. Uh, there were the Knights Hospitaller. Hospitaller I think hospitalier. Oh whoa is there an extra I might

be putting an extra syllable in there. Well, I'm known to do uh nights hospitaller. That's what I'm gonna say of the Order of St. John of Jerusalem. And they were the first kind of the first people to practice emergency medicine on the battlefield. And they even invented the what we now call the stretcher, although it's still called a litter in some circles. Yeah, it's pretty intuitive thing, but it's it works. Someone had to think of it. A couple of sticks with some canvas stretch between them.

Throw a person on there, you can pick them up. Two people can pick them up and get them off of the battlefield lickety split. So yeah, So this is the idea of emergency medicine grew basically exclusively out of warfare over the centuries. Well, yeah, But what's remarkable to me is that from that time, I have the right idea,

let's get these people out of here quickly. It took about a hundred and thirty years all the way until the mid to late nineteen sixties until they said, hey, wait a minute, if we actually put trained medical people in these things and weren't simply driving people to a hospital,

we might have even more luck. Yeah, that was the late sixties and then amazing it is And at the time it was so a lot of medic It was practiced through house calls right, including emergencies like if there was an emergency and you could get ahold of a doctor, the doctor was expected to go out to that emergency

and do what they could. But more often than not, either the cops um or local morticians were tasked with basically was called like a scoop and scoop and run, scoop and carry, where you just basically get the person out of that car wreck or um from the bottom of that ladder or whatever just happened to him, throw them in the back of a car, a cop car, or a hearse. I would looked it up the ECTO one the ghostbusters, um ambulance is a modified Cadillac Hearse,

so um, they would dress the sinking feeling. It really was for a mortician to show up in a Hearse and be like, I'm gonna take you to the hospital. Depending on what happens, you may be back in the same car. Yeah, and talk about a conflict of interest, you know what I mean, that's a good point. Hopefully not, but yeah on paper, yeah right, or they just you know, casually put their hand on the person's nose and mouth

in the backseat. Dry. Um. The thing is, though, is whether the mortician or the cops were getting you to the hospital. Even when you got to the hospital. It's not like there was such a thing as an e er room. E Arston come about really until like the mid seventies, where you could find them in in fair abundance around the United States. Like e r just didn't exist. It was here you go, doc. I know, you just delivered a baby and you um treated somebody else for Angelina,

but now you've got to put this person's head back together. Yeah, And it was all just medicine at the time. So yeah, the idea of getting somebody to a hospital and having a medical person a professional in the car that's transporting them. It came out of Ireland, I think, right yeah, big shout out N seven to Dr J. Frank Pantridge of Belfast.

He had a study. He published a study that said, hey, you know what, we have more success saving people's lives when our mobile units have a physician or a nurse inside. And everyone went, huh, I never really thought about that, but there it is. There's a study. Pretty cool. So he definitely um set the stage for this. And then the year before there was a report I think it was a year earlier, right, the one from Congress in

America a couple of years sixty five. I think it was like the National Academy of Sciences or somebody basically got together with another group and said, let's let's study accidents.

And what they came up with was this idea that there was like this um overlooked disaster that happened, like accidents were a huge, major leading cause of injury and death in the United States, and the this inquiry determined that we weren't doing much about it, and specifically a lot of people died who otherwise wouldn't have if there had been something like an emergency medical service to attend to them at the accident scene and on the way

to the hospital, and then having the hospital actually know what they were doing as far as emergency medicine goes. Yeah, it's just it's just staggering to me. It seems so intuitive and I can't believe it took that long for this to happen, you know. Uh. And in fact, the Emergency Medical Systems Act was signed in nineteen seventy three, which basically said, we need a standardized system here, Yeah, nationwide. That was after that paper came out in nineteen sixty six,

many years later. I mean that's the speed of government, I guess. Uh. And then in nineteen seventy seven the publication of the first very first national standard Curriculum for e m T s and Paramedics seventy seven. Yeah. And then so alongside this para this, um, they they there were people like around the country, at universities around the country and around the world, who, um, we're kind of all recognizing all of this. At the same time that there were there's a lot more that could be done

for people who were injured in accidents. Um. And so you had the people at Pitt University of Pittsburgh taking up the cause. Yeah, they started UM. Is it the Panthers? Huh, they started UM creating some of the first curriculum for paramedics, some of the earliest tests for paramedics. Uh. The University of Cincinnati came up with the first curriculum for training physicians in e er medicine. I think the University of California was an early entrant into the world of of

UM teaching paramedicine. And I think they were the first one to be accredited in nineteen eight, Like they had their operation going for years, but they were the first one to say, hey, somebody take a look at this and make sure we're kosher, and then we can say we're an accredited training facility for paramedics. It is. It is pretty amazing. And then the problem is this, So the federal government got into the act in nineteen seventy

three with the Emergency Medical Services Act. But bye, there was an omnibus budget that said we're out, We're done, We're not funding emergency services anymore. And then from that point forward, the emergency service system in the United States, whatever had been developed to that point, broke into patchworks of state, local county programs, sometimes multiple ones within a

single county. I think there's a county in Michigan that has like eighteen different emergency services UM and that has kind of created this where we are now, which is people doing the absolute us they can in what what amounts to a broken system in a lot of ways. Should we take a break, all right, when we come back, we will put the broken system behind us momentarily. Talk about e m t s and paramedics change to change,

all right. So if you want to ride in an ambulance or drive an ambulance and get on the scene and help someone out who's in need, there are a couple of ways you can do it. UH. You can be an empty emergency medical technician. And this is the UH. This is the person who has has undergone about between about a hundred and twenty and a hundred and fifty hours of course work. They're they're well trained and all

kinds of life saving procedures. If you need CPR, if you need oxygen administered, if you were having some bad allergic reaction, that your life is in jeopardy. But there are limits to what they are allowed to do. So one thing they cannot do even in the case of giving shots, is they can't break the skin, right, which is super interesting. I never knew that. No, I didn't know that either. But you can consider an e m T like an entry level paramedicine professional, right, that's where

you would start. And in fact, I think you have to start as an e m T to go on to the next level, which would be paramedic. Yeah. So if you're a paramedic, you have about ten times the amount of coursework and schooling under your belt by the time you're a paramedic. And I think you do have to have about s months at least of prior immediately prior e m T experience to start um becoming a paramedic as well, which I'm sure is the way most

people go. As you start out as an e m T and then you you know, move on to the next level, which is paramedic. Yeah, which, like you said, ten times, so that's about anywhere from hours depending on your state or your municipality to get certified. And this is where the real action can happen. Um, you can give an i V. You can if someone's having a heart attack, you can deal with that. You can operate uh, defibrulator, fibulator, fibrillator. It's fun to say. Once you master it. They should

have just called it the the clear machine. Yeah, the uh. But it's a it's a lot of work in a lot of hours. And one of the people that they interviewed in this article said that, you know, it's really grueling, and when you're in paramedic training in school and doing your coursework basically for a year or two, you can just say goodbye to your friends and family. Yeah, I

saw that too. Stuff. So, um, the paramedic is actually they operate under the license, not just like like under the direction, but under the license of a physician in their locale. Right, there's a couple of ways that you can do it. And and as you'll start to see, like I saw a quote that um it said, if you've seen one emergency medical system, you've seen one emergency medical system. They're all just so different and the whole

thing is so patchwork. But um there is a national standard, which I think is the National Emergency Medical Technician Registry Exam. That's like the national exam, and then you may have to pass like a state and or local exam to depending on where you live. But there is like a national accreditation and national coursework. But then how the system functions and runs is what's the the patchwork part of it. Yeah, and it will cost you. I mean it depends on

where it is, of course, and what program. But the the example they used in art article is the u c l A Center for Prehospital Care. Uh, and they quoted about ten grand for just tuition. And then of course, like any college or coursework, you're gonna have to pay for books and equipment and uniforms and stuff like that. That's exactly where they get you the plaid skirt. Uh. And then after that, though, the good news is is that you have a really good chance of getting work.

I get the impression that if you have gone through all of your paramedic training, you're not sitting around like there's usually a job waiting for you somewhere. Yeah. I saw that as well. And actually, um, it doesn't necessarily pay super well people. So if you ever see a paramedic, be extra nice to them for sure, because not only are they running around saving people's lives, they're not getting

rich off of it at all. Um, They're doing it because it's something they care about um, but they're just bite that despite the mediocre pay um, it's I saw it's gonna be one of the most in demand jobs over the next like ten to fifteen years. I really wish I could remember the statistic exactly, but I think they're like expecting another like fifty three thousand e m T jobs or paramedic jobs to be added to the American economy over the next decade maybe. So it's definitely

a growing, growing um career for sure, growing profession. Yeah, and you mentioned the pay. If you, uh, if you go to the US Bureau of Labor Statistics to kind of find a mean salary or something, they do it. It's not really they should separate it out, but they lump in e m T s and paramedics, when of course e m T s don't make the kind of money they're paramedic would. But they had a mean annual wage of about thirty one dollars a few years ago. Uh. And if you're in the top ten percent, it's about

fifty four thousand. And apparently this to Washington is one on the higher side. They you can get as high as seventy one grand in the state of Washington, but I mean, you know, that's a that's a good living and a decent living. But it's not like like you said, they don't go into this because like, oh man, you know that thirty one grand year. It's sort of like being a school teacher. It's a I feel like it's

a calling in a lot of cases for sure. For sure um as I was saying about the license that they operate under, right, So if you're a certified paramedic when you are um depending on the state you're in, you may be operating under the license of the state medical director, like that's where you have your license, or you could also be operating under the license of a local physician, like that physician's license covers you, covers the

physician's assistant, basically everything working for everyone working for him or her. So you might be operating under that physician's license, or I didn't know this man during an ambulance ride. So remember how just adding like a trained medical professional to the ride from an accident scene to the hospital improves outcomes. And we've done that since nineteen sixty six at least they've figured out that if you can communicate with a doctor, an e er physician en route you

could also improve outcomes even more so. During these um this transportation from an accident to the hospital, the paramedic is probably in touch with an E R doctor who is instructing UM and advising and consulting with the paramedic to figure out the best course of action, the best course of treatment, and then how to carry that out. And from what I understand at that time, the paramedic is operating under that physician's license in that state. Would

that make you feel better or worse? What that the paramedic was getting instruction from a physician, Like if you're here here this going on, I don't know. I would say. Part of me is like better because it's a doctor telling you that, But the other part of me is like, don't you know? And you would hate to hear like the doctors say, we'll get the something something and for the paramedic to say the what you're right, I don't know what that is. I've never seen this before ever.

Have you ever had to take an ambulance ride for yourself? No, thank goodness, I didn't think I had either, But then I did. Remember UM, when I was thirteen or fourteen, my brother was sixteen, or seventeen, we were in a car wreck. There were eight people in a jeep, my and my brother's jeep that was once my dad's cheep, and that was definitely not safe to do to begin with. But we were going to a movie after church on

the Sunday night. A bunch of kids in youth group piled and my brother's cheap wasted now just kidding, um, completely sober wasted on the Lord we were and it was raining really hard and uh, you know at at Ponts ponstantly on Avenue here in Atlanta. Everyone that doesn't live Atlanta probably laughs that we pronounced it that way instead of pulse dadion. Uh. But on Ponts where it kind of um, if you're leaving from Atlanta, it's that big curve where you go over that large stone archway. Yes,

kind of headed toward Intdicator. We were coming down that way nowhere near North Lake Mall where we were supposed to be headed. We were lost and my brother we hydroplane hit a curb and turned the jeep over on its side and I ripped through the canvas ceiling or whatever it's made. Man, you got thrown. Oh yeah, we were scattered all over the street. You are lucky. I know.

It's the only time I think that I've been knocked unconscious, and I just remember waking up, you know what would have been probably seconds later, in the pouring rain, and looking around and seeing my friends like scattered within like twenty ft of each other in various places. Man, that is scary stuff. It was scary so uh. In the end, the good news is no one had like I think the worst injury was like a broken collar bone. I broke my finger. There were little cuts and scrapes, but

nobody was hurt bad. Uh. But I do remember this. My brother doesn't listen to this one. In the ambulance on the way, my brother was just sort of catatonic, and they said they were trying to get information, and they asked what his name was, and he said a whole. He said a hole, he said the real world. Yeah. I think he was just sort of out of it and felt terrible. And he didn't curse at all at the time. It still doesn't even curse much, but it was just it's weird that that is what stands out

of my mind. I wonder if he remembers that. Actually, well, that's a big one. Especially you didn't curse. You're not so funny man, that's a that's you were a great storyteller. Was that a good story? Yeah? I was like, I was seriously, well, you kept like going off on tantons. I'm like, no, We've got to get back to the story. What happened to the cheek? I know you looked a little nervous. Yeah, so, um wow, Okay, should we take a break. Oh yeah? And also I forgot to mention

the one guy that was tragically killed. Right, You're like, but did I mention? I also broke my finger. No, nobody, nobody was hurt. Everybody's too bad. Everybody was good. Everybody's good. I think my brother broke his foot. Yeah, it was just stuff like that. Heck of a story, chuck, heck of a story. Thank you? Uh yeah, let's take a break and regroup, shall we. Yeah, let's do okay, check, Okay, we're back. I'm not reeling quite as much as I was.

But that was a good story. Again, I feel like we should mention even though it's kind of silly that emergency TV show Oh yeah, for sure from the seventies, because it seems like it definitely like actually played a part in ramping up ambulance services. Yeah. So this is I think n Or seventy two and it premiered and um, remember the Emergency Medical Services Act wasn't passing until nineteen seventy three. That white paper had come out in nineteen

sixty six. So this idea of like this new type of medicine, this new type of like healthcare worker was really on America's mind. But one of the ways it got there was from that TV show Emergency, in part because it was shot like documentary style. People played themselves on it, like there were real dispatchers on the show acting as dispatchers. Um, it just captured America his imagination. Yeah, I remember watching it, see I I don't think I ever saw an episode of it. Yeah. It was an

emergency with an exclamation point in Mantle seventy seven. And uh, it was mainly two dudes, uh to firefighter characters is what the story centered on. And one of them was a young Kevin tig Ortigue. He was did you eversee Roadhouse? Yeah, he was the owner. He's a character actor, he's been in he owned the Double deucee. Yeah, he's great. Yeah, I can't remember what else it's you. I've seen him young before. I wonder if it was Emergency now that

you mentioned it. Maybe, huh, maybe I have, because I'm gonna for sure it did. I'm a Jack Web fan, and I think he produced or created it. You're big Jack Web guy, are you not. I don't know. Uh, he's the dude from Drag Night. He Sergeant Friday. Yeah, I guess I need to think about that. Yeah, he's awesome. I'll let you know, man, if you go back and watch like old episodes of drag Now, Oh my god. Yeah that was a good show. Yes, it was. And I think Emergency maybe Adam twelve is like the direct

spinoff of Dragnet. Maybe that's what I'm thinking of. But I swear I know exactly what you're talking about with um fatigue fella from the Roadhouse and then wasn't Dragnet Colonel Potter, Yes, Harry Morgan, right, we had a Emilina had a long conversation about Match the other day and how that was I was a mash nut, and how that show was one of the few to survive like major cast changes. Oh yeah, like three of them. Yeah, they certainly didn't like like big stars, like co stars.

I think one of the few people who made it through was Alan Alda, Right, he was there the whole time. Yeah, and like Hot Lips I think was the same, Um and a few others. But they had like Radar and Clinger. Yeah, they co existed I think. But eventually Radar left and Clinger took his job. They Potter took over for what's his face, the original guy, I don't remember, but he wore the fishing hat. Yeah, he was a man, the

saddest ending ever for that one. What when he left? Yeah, I remember he got his papers to go home and everyone's all excited and then he was killed in a helicopter crash or a plane crash. I don't remember that this way out. Uh. And then of course Frank Burns left and was replaced by Winchester, and then Trapper left and was replaced by Honeycutt. Right, but it just it was still great, Well, I got it wasn't as great

at the very end. I don't know. Man, Goodbye, Farewell and Amen was one of the all time best last episodes. That true for sure, Um, But you're saying they pulled it together at the at the last episode. I think I remember the last couple of seasons, it was a little bit like, you know this, maybe it did run its course, but that was a very discerning twelve year old viewer. Yeah, like they've really onto the hoo gin

joke too many times this episode. It is funny though that, like, little twelve year old me thought, like the funniest thing in the world was war surgeons. Drunk war surgeons, right, drunk philandering war surgeons. Alright, I really got off track there. Yeah, maybe we should take a third break. I don't think so. I don't think we should either. So we're talking about paramedics today, believe it or not. And um, one of the things we talked about was the idea that that paramedics, well,

let's talk a little bit more about their job. Right. One of the things that paramedics are sometimes criticized for is, um that they don't run to the scene of an emergency. I've never thought about that. Once you have it, I I really hadn't either, But then I started thinking about I'm like, yeah, I could totally see that. Um. Apparently, for some people who are at an emergency scene and see the paramedics kind of walk up, they appear a little too casual, and they want to know, what are

you doing? Why aren't you rushing to this scene? And paramedics, I think we saw a question answered on course Cora or something like that, and um, a paramedic explains, there's actually a number of really good reasons why paramedics why you don't see them running to the scene. First of all, they're gonna park as close as they can't, so that running is only going to shave a couple of seconds off.

But really the number one reason, or one of the top reasons, is that they are supposed to be they're supposed to bring with them to this scene of catastrophe, catastrophic panic, basically calm and professionalism and being in control. Yeah, I get that, Like I think it would be a little disconcerting if I was injured and I saw a paramedic burst into the room like breathing heavy, like, oh my god, what's going on? What's going on? Is everybody okay? Yeah?

Plus they might get hurt running, that's another one. And they're usually you know, or not usually, but I would say probably a lot of times. It's not like they're walking through a you know, a perfectly laid pathway, like they could be running upstairs or through a house of hoarders, or you know, through the woods, like you don't know what's going on. You gotta be careful on your way there. Yeah, and you have to be going slow enough that you can assess what the risks you're walking into our as

you're walking into them. Sure, then running into it and being like, oh, the guy who shot you still here waiting for me. You know now that I've run into the scene. I know that, but it's terrible. Um. It's also kind of hard to run from place to place, depending on the equipment that they're carrying with them. Those stretchers get heavy. Um, the e k G machines get heavy, the defibrillators get heavy. All that stuff gets heavy. So there's a number of reasons why you won't see a

paramedic rushing to the scene. You will see him rushing to the scene in the ambulance though, and from what I understand that driving in the ambulance or riding in the ambulance is the most dangerous part of the entire job. Yeah, and here's another tip. Aside from being nice to your e M. T Or paramedic is. Don't call them ambulance drivers, yeah, because that's part of their job. Uh. And it's a

weird thing too that there. It's not like they hire a driver who's super skilled at that and then they have other people in there that do the work like they do double duty. They have to learn to drive like that. And I mean, while they're e m T s are paramedics. Yeah, And so you know, if you've ever seen an ambulance going through an intersection, they're gonna

slow and and maybe even stop and then proceed. They still get broadsided very frequently by people going through the intersection because they they have a green light and they're not paying attention. They'll they'll hit an ambulance like t

bone an ambulance. And the drivers probably okay, or I should say the paramedic driving is probably okay, But the paramedics in the back they probably aren't um lashed down in any way, shape or form because they're working on the patient and they're getting thrown around and can get injured and killed themselves that way. So that's the most

dangerous aspect of the job from what I've seen. Yeah, another interesting thing that I saw from that list you sent was that if you're in a big city, a lot of times they even have divided up between e MT and paramedic for different cases. So like if if there's a scene of trauma going on, like a car accident, then you're more likely to get an e m T. Whereas if you're at home and you're like my husband's having a heart attack, where my child's having a seizure,

then you're more likely to get a paramedic. Yeah, which is interesting. Yeah, And um, if in cities as well, if you're a paramedic, you're probably once you get into your ambulance, you're basically stationed at the ambulance for the rest of your twelve hour shift. Um, you're you don't go back to the firehouse or to the ambulance clubhouse or anything like that. You're you're you're like on a desk, neated street, corner, parked waiting for your next call. Um

probably killing time somehow, but you're you. There's there's not

very much downtime. And like in a in a city especially, the opposite is true for more rural um e m T s and paramedics, and that there's a lot of downtime so much so that this guy who was actually one of the consultants on that show Emergency years back, Uh, he became a Minister of Health I think in Nova Scotia, and he UM he created this program for rural e m S workers UM to use their downtime in much the same way that like a country doctor would have

made house calls. Yeah, so they're like, it wasn't the idea that they would go to places and sort of help train like regular citizens on how to avoid getting hurt and stuff to begin with, right, Yeah, like like doling out preventative medicine, like making sure that people are taking their med since correctly, teaching CPR classes, UM, teaching leading exercise classes for like seniors at a senior center, like doing all the stuff to reduce the number of

calls that they have to go on anyway, so it cuts down on their downtime, which I think is actually very much appreciated by paramedics because there's really nothing more boring than sitting around constantly, and then they're actually doing something and and also UM making their community a healthier place. Yeah. I thought it was funny when they were talking to some real on the ground paramedics about the downtime, They're like, well, HBO goes kind of awesome, right, yeah, Like, oh, well,

I guess you got a past of time. It's better than Nicolas Cage and bringing out the dead. What did he do? Because I remember that movie, but I don't remember all the details of Well, it wasn't that great. Um, I liked it. He did tons of drugs. Oh okay, that's why or something I got you. Yeah, yeah, he kept to be fired, right, I don't remember it very very well at all. Actually, I think he did, like

that was his stick. He'd be he begged to be fired. Um. So one of the things about those that downtime the community community preventative medicine initiatives that have kind of spread from Nova Scotia out through around the country. Um, when you see a paramedic doing that, they're they're not being paid or at the very least their unit or their county or their city is not being paid for that, which is a huge problem. Yeah, this is where I

got a little confused. The way I was reading this was Medicaid and medicare and stuff in insurance companies will reimburse only if they have transported someone to a hospital. Yes. So in other words, if you go as an ambulance in a paramedic or e n T to a place and you actually can just help and treat someone there and they don't need to go to the hospital, then it's a freebee. Or did they send a bill to the people? As from what I understand it's a freebie.

I don't probably since it is such a patchwork of systems all around the country. I'm sure that you could live somewhere where you the person would get a bill for that. I think as a matter of fact, you do no matter where you live. But um Medicaid and

Medicare won't pay for it. Um, So there is there is a substantial reason to say, keep working chest compressions on a person who is obviously dead all the way to the hospital so that you can like bill Medicaid for that transport or getting somebody to go to the hospital even though they don't need to, so that you can build Medicaid for that that as well. And the problem is that that leads to other problems as well, like hospital e ers are very much overcrowded and understaffed

and overworked. Right, so when you show up with another person. That's one more person they have to deal with, and apparently it creates a bit of a conflict. Yeah, there's a cultural conflict between the people the paramedics and the e m t s bringing people to the e R and the people who staff the e ER and are accepting these people, and so much so that there's it's become kind of common for e ER rooms to um to issue ambulance diversions saying don't bring anybody to our

e ER, go somewhere else. And on a really bad night in a really populated city, you might find every single uh e ER room like with that diversion alert on and you've got to take somebody out to like a country hospital that doesn't know anything about trauma, and it takes forty five minutes to get there. Um, and you're they're not going to get the care they could receive at a good trauma center in the city. UM. So that's a real problem. Yeah, and it isn't too

in terms of pay. And we need to hear from people on the ground because this it's surprisingly confusing when you research this on how it all works. Uh. And maybe that's the point, but um, it seems like it's also a fixed rate. There's no difference between I treated a kid for an allergic beasting reaction to I brought a guy back from the dead who had had a heart attack or heart failure. Yeah, is that right? Yeah, so long as you transport both of them to the hospital,

that you're gonna get. I think I saw as low as twenty five bucks from medicaid in some places. I don't understand this is the numbers just do not add up. I don't get it at all. I know that some places, some counties and cities fold their e M t R E M S workers under their fire departments so that they fall under the fire departments funding, which I think fire departments tend to be way better funded than any kind of E M S service. So I think that's how.

That's one way that it happens. But I just I don't I don't get how this how this actually works money wise, because it doesn't add up. It doesn't make sense. Yeah, I mean, it's not often that we're a little stymied. UM, So we're gonna follow up for sure with some emails. But I think it's also going to vary from place to place. Because the other thing that I got really

confused about was private the privatization of ambulance services. Uh. And as best that as I can tell is in the seventies and eighties there were a lot of small private ambulance companies, but then they merged into more regional things, and that these days there's just a few, like big multinational companies that are the most dominant in the industry. Right. But I don't get how that works, Like if they're private, are they like working with only private hospitals or can

they go to a state hospital. I think that they can get a contract from the state, they can be they can have a license to operate within a state AID or a county or wherever. Um, And I think they go wherever they're called to. I know that there can be like competition among them, so like multiple ambulances

will show up at a scene. Sometimes it's just it's it's it's kind of a bit of a cluster um as far as competing with the local E M. S services, And I think it's on the decline from what I've seen. But when you call nine one one, do you have a choice? So what you can do? I think it's kind of like Uber, where like they the nine one one dispatcher has a log of companies or services like public funded or private services that that it can be issued too, and they send out the alarm and whoever

takes the call goes and gets it. Interesting. So the problem is I saw a Las Vegas Review Journal article about this. Las Vegas was debating whether to just totally privatize their e M S services, and their e M S is like went berserk there like no, like this is this doesn't work? Um, the private companies are late. I think they were late like ten thousand plus times in one year in Las Vegas. Um, their response time tends to be less than the actual fire department e

M S is. Um, it's just not as it's just not as preferable. And the reason why ambulance private ambulance services came about or became widespread is this this idea that you should just privatize everything and then that competition will keep everything going. And that hasn't necessarily panned out to be the case. And from what I see, New

York is actually scaling back on their's right. Yeah, I think Juliani is one of the people that really tried and of course, you know, no surprise given his politics trying to privatize the industry. Uh, but apparently a lot of those had gone out gone bankrupt basically. And and then during the um, during the housing boom, the financial collapse, strangely, or maybe not straight asually because I don't understand it, a lot of private equity firms started buying up ambulance services. Yeah,

that's there, you go, there's the downfall. It's just so interesting. I know that this is one of those where someone's gonna knock our socks off with a great email. Yeah. I think Also, um, one more thing about the private ambulance services, it's not like they're just a bad idea all around. In a in a locale that is underserved, if a company wants to come and set up ambulance services, that would be great for that area because they have a far you know they have. They can get places

faster in an ambulance than they could have before. In a place where you've got your E m S overstretched and the county's like, no, we're not hiring a single additional E M S worker. The company that sets up shop can actually take up the slack like there are good aspects, so like, it's not just like some terrible idea, but in practice that hasn't worked out as well as as one would hope from what I understand. Yeah, em mess workers like email us like explain this because I

really like you. I do not get who's footing the bill has to be insurance companies, and then if you don't have insurance, it has to be just the person the individual. Yet, and I think we have. We waded into the waters of doing a podcast once and didn't. Didn't that correct because it was I mean, we'll do it at some point, but I remember thinking, oh, that's a good, easy ish one and it ended up like being super convoluted. Yeah, I think I think we should do that. We should also do um just e ers

in general too. So that's a bit about paramedics. Sounds like there's way more to it, right, But you got anything else for now? Okay, Well, since Chuck said no, sir, it's time for listening to mail. All right, I'm gonna call this we helped the dude win something. Yeah, I love this one. Hey, guys, been listening to your show for about four years and I always wanted to write

in but now I have a great reason. A local store was doing a giveway a few days ago, and they posted that the first people to show up and answer correctly would win a prize. The question was bacon and eggs was not always a breakfast food? And what year did it become so? And who was the man behind the marketing idea? So this guy sounded super excited because he knew the answer. Immediately, I thought of your show and the uncanny ability of Mr Edward Burney's to

pop up in seemingly strange histories. I remembered your pr episode and knew it was sometime in the twenties. So I hopped in my car and took off for the business. When I got there, I told him to answer with a startled look. They told me I'd want a huge case of meat, and not just junkie stuff either. This place sales to restaurants and businesses all across the country. That I was super stoked. Good he's like I won

meat and not just like terrible meat, like good stuff too. Uh. When they asked if I had to look it up, I told them no, that I listened to stuff you should know, and they retained it in the back of my mind. They asked for the name of the show. Uh, and they said they were going to play it for all the workers there during the day, so now they can get more difficult and random questions. That's awesome, and he said it doesn't in there. I went back later in the week and the same girl I've spoken to

recognized me. So they had two other people come in that had known the answer from stuff you should know as well. Al Right, even though we live in super rural uh, Utah, you apparently have a large following. And that is from John Robeson. Thanks John Robeson. I hope you have a healthy E M S Service out there to come find you after you eat that box of meat. Yeah, and you know what, let's hear from Salt Lake City because we have debated a live show there and just

didn't know if we had the support. So I want to I want to hear it. Okay, well, come on here, we want to hear from Utah in's and E M. S. Workers. Yeah. If we get ten people that email us and say to come to the Salt Lake City will come. I think we should set the bar higher than that. Okay, Okay, Uh, Well, if you want to let us know that you're from Utah and you want us to come, or you're an E M S worker and you've got some good stories for us. You can tweet to us. I'm at josh

um Clark and at s Y s K podcast. Chuck's at Charles W. Chuck Bryant on Facebook dot com and at Stuff you Should Know on Facebook as well. You can send us an email. It's probably easiest to stuff podcasts at how stuff Works dot com is always joined us at at Home on the web Stuff you Should Know dot com. For more on this and thousands of other topics, is it how stuff Works dot com