So in the last two posts in this series you have learned how I started on the road to ruin. Our last episode ended with me hanging by a thread, having started my own company while on my way out with another. This was probably one of the most uncomfortable times in my entire professional career. Every time I tried to get an audience with the Regional Manager I was ignored. This went on for weeks. I would hear outlandish rumors about my old boss who had left the state after being accused of rape. I heard that he was living in Chicago, then Michigan. I remember once being told that he had moved back to Texas. Probably none of it was accurate. So I planned my exit.
After a while I had enough money built up with my company that I felt comfortable striking off on my own and paying my own salary. This was a big leap of faith, but I was ready to take it. This is when I became bold. My current employer could no longer hurt me. I had a backup plan. Since the Regional Manager would never talk to me or return my phone calls I decided to write him a long email detailing my grievances. In this email I complained about my lack of resources, and impossible tasks. I detailed what I had accomplished, and what I had not been able to accomplish. I also told him that he was making it painfully clear that he did not want me to work there, and that if he did not make time to sit down with me and try to iron out some of these issues he would shortly have my resignation. He ignored that email for days. During this time I really stopped working to try and make the place better. I just worked shifts on my truck and in my spare time worked on projects for my company.
A few days later he finally did grant me an audience. But the meeting was a big song and dance. It was nothing I had not heard before. I told him so. I was never inappropriate. I never told him what I really thought of him. I just sat back and listened to the drivel, thanked him for his time and left. Shortly after that I turned in my resignation and started working full time for myself. Believe it or not, they instantly went in to panic mode and found a replacement for me. I knew the person that accepted the position, and I counseled him a bit. I warned him about the position. The gist of my warning was, “I am not sure why they want anyone in this position to be honest. They never let me do anything, and never gave me any resources. I have been here seven months and I have not been given so much as a chair or a desk even though I launched a paramedic program. I thought for sure that the position would be eliminated. Good luck.” He lasted about two months before resigning.
Initially my company was a success. However, like usual, my timing was impeccable. I decided to start a company right before a banking collapse and a movement to change paramedic education across the country. Needless to say, my company did not survive this, but that is the subject of another blog post. Needless to say, a couple of years later I was badly in need of a job. My company had failed. But you don’t just shut down a paramedic school. Even though I am not currently teaching any classes, I have many students in various stages of hospital and ambulance internship. I need to maintain insurance and infrastructure for these students even though my company has no income. As things got tight I started to work for a rural provider 911 government-based provider in Kentucky. I function as part of the management staff doing QA and IT tasks. The job is actually very nice, but it doesn’t pay all the bills. It pays about half of them. So…I needed another full time job really quick. Every service worth working for has a long hiring process. I started thinking, “Where is there a place close to my house that will provide me with an instant full time position, no questions asked, and let me binge work around my other fulltime schedule?” The answer was hard to swallow, but it was obvious that I needed to go back to the scene of the original crime to support my family.
So I called the new Operations Manager up, “Hey, remember me? Got any openings?” I was hired for part time work before the week was up. They were so desperate for people that no one really objected. The worst that happened during the hiring process was that the Scheduling Manager asked why I wanted to come back after it was obvious that I was so displeased before. What did I have to lose? So I tried some old fashioned honesty, “Look, for several reasons that are too lengthy to get into right now, my business failed and I am financially fucked. I don’t have any aspirations of promotion here. I don’t want to make waves. I don’t want to cause trouble. It is true, I don’t necessarily like working here, and this is one of the most awkward and uncomfortable things I have ever done. But my family needs me to work. So all I want to do is come here, clock in, make runs, and leave. Mail me a check every two weeks, and everything will be fine. I need to pay for groceries for my daughter. You need someone on a truck fast. The arrangement is tense, but mutually beneficial.” He thanked me for my honesty, and I was hired back. It was only a couple of months before it was obvious that I needed to work fulltime and I quickly slid into one of those slots. My regular schedule had me working 84 hours a week at two services. It was hard, but it paid the bills.
I have been applying to other jobs ever since I was hired back, but did not get a winning offer until now. I have been hired by a non-profit organ donor service. The hours, pay, and benefits are nice. I will finally be treated well, and I have given notice at the private service I have been speaking of. Since I have another job, and nothing was stopping me, I started this series of blog posts. And while I have taken a while to get around to it, I wanted to record some details about my return to this service. Many lessons can be learned from this experience as well.
First of all, the service has grown since I first left it. They now make over 100 runs a day and have almost over 15 trucks on the road during the day. Since they were doing so much business they had moved into a new building. Almost none of the old staff still exists. All but a handful have quit.
My orientation was shockingly brief. A few years before I had been asked to expand a two-day program to five days. Now orientation lasted about six hours. They took a copy of my certifications, had me pee in a cup, and had me watch about 4 hours of video. After that, I was cleared for service. They had me ride out for one 12-hour shift with another paramedic because we had a new ventilator that was complicated, but after that I was released.
In Kentucky, there are many laws regarding the kind of vaccinations and protective equipment that must be provided to an EMS worker. This company had never inquired about any vaccinations and has never fit tested me for any sort of mask or protective equipment. I have never had any sort of physical.
We carry morphine and ativan on our trucks. However, none was issued to me for about the first four months that I worked there. I inquired about it several times in writing and in person, and was told to just go out without it. I have those medications now, but the ativan is not being refrigerated. According to the manufacturer, this drug is supposed to be refrigerated or the potency cannot be guaranteed. I have brought this to their attention. They researched it, found it to be true, and have still done nothing to fix the problem. I had a patient in horrible status epilepticus the other night, and had nothing to treat him with except for this drug which has not been kept properly. Now that I do have the drugs, I have been given no way to lock them up on the truck. I am expected to keep them on my person at all times.
We do not have radios at this service. We have Nextel phones that are programmed on ‘group connect.’ These devices also function as pagers, but the paging system is often down and the group connect often fails. My main issue with this is that we make roll-over 911 runs from the local urban 911 service. Many times I have made entry into shady residences in bad parts of town with nothing but a Nextel that had no signal and could not connect. The dispatchers could not talk to us, and did not check on our progress. If we were attacked there would have been no way to call for help. EMD is not required by dispatchers anyway and they are not familiar with 911 safety techniques for crews. Dispatch will often misuse the Nextels by paging us with an emergency run at night, but not following up with a verbal dispatch. Since the paging system fails so often, it is not uncommon for a dispatcher to send a page for a run on something such as a breathing difficulty, and the crew will be unaware of it for five to ten minutes. These delays are simply lazy and unacceptable.
Speaking of being dispatched at night…all crews are told to stay awake for their 24 hour shifts. No sleeping quarters are provided. There were beds in the old building, but when operations were moved to the new building crews were told that they could not post at the station. They are sent out to hospitals and intersections to simply sit in the truck all night until there is a run. There was a barren break room that had two couches, but those were moved so that crews would not attempt to sleep there. Despite the fact that virtually every study done on 24-hour shifts has reported dangers even when crews are allowed to rest, it seems ridiculous that we should be made to stay up all night. No coffee is provided at the station. Basically, there is nothing for the crews accept a bathroom and a time clock.
I will come clean. I posted at home. I live near our base station, and I simply drove to my own house, parked the ambulance in the driveway, and slept in my own bed. My partner would take the couch. We usually leave two or three times a night, but we got some rest in a comfortable place. My wife would help me listen for the Nextel. Most people at the company knew I did this and never said a word. I have never had a partner complain about this arrangement, because most people try to sleep in the truck behind a building somewhere. My couch looks a lot better than that arrangement.
Our trucks are old and badly in need of repair. Other regions in the country have state laws that prevent services from using trucks over five years old. Buying trucks at that rate across the entire company would not be profitable. So we have never been allowed to buy new trucks and we never will. We get the left-overs from other services in the country. By this system, every truck we use is at least five years old. Some of our trucks have over 400,000 miles on the odometer. The truck I am in today is a first-line ALS truck and has over 370,000 miles on it. Every truck in the fleet has known issues and some sort of interior or exterior damage. Ancient trucks are cannibalized for parts for the merely-old trucks. I saw a truck the other day that had two different colors of interior finish, gray and tan. The door panels had been replaced from a truck of a different color.
Let’s turn our focus towards equipment. Apparently, crews were stealing too many items off the trucks, so a system was devised so that nothing could ever be stolen again. When I started here, everyday at start of shift crews were issued a cardboard box full of supplies. This included the Nextel, B/P cuffs, stethoscope, and other items. Management thought that too many ALS bags were stolen, so the bags were removed and equipment was issued in a box. So we had no kits to take in for emergency runs. Honestly, I sometimes put a cannula and a non-rebreather into the box with some other equipment, and I would take the box into the nursing home. It wasn’t long before I got an old kit I used to carry and started loading that up in the morning so I would have something to use on patients. Not long ago, all the boxes were upgraded to milk crates. I am not kidding. Milk crates. A new, recently hired supervisor just put an end to this and started issuing kits again. But as of today, only four of those are in service. Everyone else carries equipment in a cardboard box or milk crate.
Driver’s training is non-existent. There was a big scandal here a while back about an employee who had totaled a unit in spectacular fashion. After the incident, his partner refused to work with him anymore and he was placed on my truck for a day until they could find a permanent home for him. It was rumored that he had damaged five trucks, although I do not have first-hand knowledge of this. I asked him how long he had been with the company, and he answered almost two years. I asked him if he had ever received any driver’s training, and he answered that he had not. I asked him if they had attempted to do any training with him since the incident, and he stated that they had not. The only driver’s training I had received was about one or two hours worth of videos during orientation. A regional risk management guy came by after several accidents had occurred and assessed the situation. He concluded that our driving policy should be copied and re-issued to every employee. That is the only drivers training I have received since orientation.
Until last week, there was no field supervision for this company whatsoever. The only management staff consisted of an Operations Director, a Scheduling Officer, a Dispatch Supervisor, and a Billing Clerk that checked for insurance information. That’s it. Any other staff in the building was regional level or above. There is no quality assurance program. No one reads runs accept for the billing clerk who has no medical training whatsoever. Last week they hired one Field Supervisor to cover all crews seven days a week, twenty-four hours a day. He doesn’t really function as a supervisor. He functions more on the management level. There is no infection control officer. Even though I have been here for a few months, I cannot tell you the name of our Medical Director and I have never been told how to contact him. Or her. Or whoever the hell it is. Our protocols are fantastically out of date, not even in compliance with the 2005 changes in ACLS. Many trucks do not have a copy of these protocols, and like I said earlier, I have no way to contact the Medical Director to inquire about such matters.
I could go on, but I will spare you. But I feel absolutely confident in saying that in my 14 years of EMS experience, I have never worked for a more poorly managed, poorly equipped company. All employees who work here have just learned their jobs from trial and error. They have had no training, guidance, supervision, or quality control. If they provide any sort of quality care, it is a testament to their own ingenuity and self-guidance. Many have not flourished at all in this environment. It is not uncommon to see employees out making runs with their shirts untucked, or simply wearing a non-uniform shirt. Some employees wear silly things like camouflage trucker caps, instead of uniform issue clothing. It is embarrassing to be associated with these types. Nurses at facilities have become accustomed to dealing with idiots and so I am often treated with the same respect due to these unprofessional hacks trying to pass themselves off as EMTs and medics.
In short, this job is miserable. It is an ill-equipped, dirty, untrained, unsafe, unsupervised, un-managed, ridiculous carnival of stupidity that is compounded by the fatigue of trying to stay awake for 24 hours and trying to work out of a fucking milk crate. And of course, people are cruel. So as I drive around doing this miserable job, I get to have uncouth idiots ask me questions like, “What’s the matter, did you business go under?” and “Hey, I heard you declared bankruptcy. That’s gotta suck,” and “Why are you working for these ass-clowns, I thought you knew what you were doing?” Yep. It’s been fucking swell.
So I endure two 24-hour shifts at this place, and a 24-hour shift and a 12-hour shift at my pleasant rural job. I work overtime when it presents itself. Somewhere in between that I am trying to provide some sort of guidance to my students who are still participating in ride time. I am tired, poor, overworked, and pissed off as hell.
However, I am an educator. Well, not anymore. But I used to be an educator. So, my first instinct after having this experience is to tell someone about it. That is why I am here writing this. And tomorrow I will hopefully have the time for part four of this series. In my next and final installment I will try to explain the lessons I have learned from this. I will never look at EMS or management jobs the same way.
Stay tuned.
**UPDATE** I was trying to finish this blog post between calls today. I only have one shift left after today. For the next four days I am working at my new job. We also found a little money yesterday that we did not know we had. So I was on the edge anyway. A couple of hours ago we were dispatched to a run at a nursing home and they gave us very little information. I got back on the radio and asked if the run was code three or code one. There was no answer. I asked again. A dispatcher came back with attitude and stated, “If the run was code three, you would have been told during the original dispatch. Proceed on your run and stop questioning call information.” I snapped a little after that, but the fact that the family called me an “Ambulance Driver” closed the deal. After that run I simply drove back to base, and turned in my equipment. Someone new was in support and asked, “Are you done for the day?” I said, “Yes. Yes I am.” I then went to the computer based clock-in system. It asked me why I was clocking out early. I wrote, “I quit,” and left. I now have two glasses of wine on board, and I am feeling better already. More tomorrow.
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