19 Years

It’s hard to believe that I have been working here nineteen years. I remember my interview at Worcester City Hospital like it was yesterday. Those were the glory days of this job. It was a rough and tumble, by the seat of your pants EMS. Do no harm; always do what’s best for the patient. Things sure have changed.

The fire department never went to calls back then, only when we needed the Jaws of Life. A cardiac arrest got a second ambulance assigned to it for help. We are so busy now we can’t find two of our trucks available at the same time. We are busy 47 minutes out of every hour. I don’t know how they figure we have twenty minutes for the documentation of every call. Fire is now dispatched to nearly 20,000 of our 34,000 calls per year.

It’s good to have the help. Since our patients have doubled in size. I can’t believe how fat people are. There is no such thing as a “little” old lady. Cripes, I see morbid obesity in people in their twenties. When they get sick I get to carry them. Fat people should get the same disdain as smokers. Obesity now costs more health care dollars than smoking.

It was hard to get a job here. There simply weren’t any openings. People stayed here. It was a civil service job. Even when UMass took over, people still wanted to come here and stay here. We thought it would be a career now that we were state employees. That didn’t last long. The hospital was privatized, we lost our state benefits. Here is where it all went to shit. Corporate had stepped into our health care. It’s all dollars and cents, despite the fact it is a nonprofit hospital. It was no longer, do what was best for the patient. Dollars and no sense. The pay scale was attacked repeatedly by administration. Now new paramedics can’t even dream of making what I am making for pay. I am paid their overtime rate for doing the same job. I’ve just been doing it longer. The lack of parity is frustrating. The private EMS services pay more than we do now. So now we have a revolving door. People aren’t even finishing probation and they are leaving for other jobs. We have become the training ground for area fire departments. If you do a year or two at Worcester EMS, you can get a job almost anywhere. Then stay here per diem to keep your skills sharp. We have as many per diem employees as we have full time. But now they don’t all want to work in the bus city. Shrewsbury provides a good night’s sleep for the same pay. Why kill yourself in Worcester? That’s why we have been down a truck every day this week. Forty plus per diems and we can’t cover an open shift. Why do people want to work here? Just to say they work here? There are people working here that I don’t even know their names. I nearly cry over the friends that have been chewed up and spit out by this job. The ones forced to move on, never be heard from again.

FMLA- Family Medical Leave Act. Not fuck my life again. A good intentioned act to provide leave for pregnant women. Of course, corporate perverted it. Now, no matter how much sick time you have, you are placed on leave. If you don’t return after 12 weeks you voluntarily resign your position. Yup, that’s right. Fired. What a damn joke. 12 weeks is nothing. Try getting back to a job this physically demanding after an ACL rupture. Pro football players are out 6 months or more. I was back in 11 weeks and 6 days. A coworker recently had to do the same. That’s how health care takes care of their own people.

I remember being pulled aside by my partner one day after a call. I didn’t start an IV on an asthma patient. He yelled at me and told me that’s not how we do things here. We have lost that staff leadership. We suffer from a general leadership void. Our chief quit wearing his uniform after a disagreement with the union. A move not taken lightly by the staff. Our deputy chief tries his best but doesn’t appear to have the support of the hospital or the staff. The program director is a policy generator. Memos come out weekly about a new policy and how the supervisors will be monitoring us for compliance. A private ambulance service mentality is overtaking the hospital based service.

A few things are better. The vehicles are new. Pretty much forced upon us by the Office of Emergency Medical Services. Our station was renovated. New tiles and paint. No furniture or time to enjoy it.

We will be moving into the Providence Street station. It has been a year and a half to get the job done. Partly due to this blog. I haven’t seen the place yet but hear it is very nice. Still no furniture or time to enjoy it. It will be our training facility so I am sure to see it at some time. It’s too bad the grand opening was for the area services and we weren’t even invited. That’s right, our own station. It seems some managers are more worried about training the area services than welcoming us.

Our year long embarrassment with the state and the local press over patient mistreatment by very small minority of staff has brought us more oversight. But oversight isn’t leadership. Some of our supervisors are great while some need work. It has been painfully obvious that they are not rank and file anymore and have become the mouthpieces of management.

We don’t get any more training, despite the new training facility. We have quarterly mandatory staff meetings. Mandatory means they have to pay us. That’s why they are only quarterly. One of those meetings is an annual retraining for RSI. We have a full time training person and a new facility. Where is the training? When UMass took over years ago we were promised training and research. Nothing ever materialized.

When I started here I worked an eight hour day. Four days on, two days off. It was awful, it seemed like you were always working. Then UMass switched us to a 12 hour schedule, three days a week. The last four hours was made up training or on committees. Life was good. Burnout was low. You actually had time to decompress after a lousy week. But people abused it and never worked the four hours. So we were given the horrible schedule we have now. Twelve hour and eight hour days, four days a week, every other weekend. We have begged for the return of the twelve hour schedule but it falls on deaf ears. Everything is about the dollar and negative financial impact. How much does a wrongful death lawsuit cost? Probably a lot less than three twelve hour shifts a week. But they insist on this schedule.

In 1991, Worcester City Ambulance staffed two ambulances twenty four hours a days and one ambulance sixteen hours a day. We responded to 14,000 calls per year. In 2009 Worcester EMS responded to 34,000 calls. In March, UMass will staff four ambulances twenty four hours a day in Worcester, one in Shrewsbury. Another ambulance will be staffed ten or sixteen hours a day, depending on what day of the week it is. I stated earlier how busy it was. This adds one additional ambulance between the hours of 3am to 7am, and 7pm to 2am. I work days, so it means absolutely no relief for me. My shift actually loses an hour of coverage.

We have moved to paperless charting. We have one notebook computer per crew for charting. But they don’t always work. The charting software clashes with dispatch software and monitoring equipment software. Charts get stuck in cyberspace and supervisors have to track them down. We get chastised for missing reports that aren’t missing at all, just stuck on a laptop somewhere. We can save ECG’s to the computer but they don’t go with the patient report and we can’t print them. So we still have to print them and leave copies with the ER. That is ridiculous. They keep updating them to include fields that the state wants to see data on. Like what device did you use to carry them to the ambulance?

Our vehicles are now equipped with GPS/mobile data terminals. They stink. The GPS has a “learning” capability that takes traffic patterns and previous responses into consideration when giving you a route to a call. This thing is so inaccurate that the supervisors and training department are telling new people not to use them for navigation. It has repeatedly shown me to drive in circles. If the system is inaccurate for navigation, how can it be accurate enough to assign priority of vehicle dispatch? The dispatchers and supervisors can see where every vehicle is on the computer or PDA. This will eventually lead to a system status management model. Get your truck and go hang out on the corner until you get a call. That’s pretty much how it is now but we are being dispatched from the last hospital we transport to. I tell new people, if you don’t bring lunch you don’t get lunch.

The protocols used to be a guideline for patient care. It was ok to go outside a protocol if it was in the best interest of the patient. Our medical director would stick up for you. Within reason, of course. That isn’t the case anymore. The protocols are rigid rules to be followed without exception. It is not do what’s best; it is do what won’t get you in trouble. Patient care has taken a backseat to patient safety. One idiot gives the wrong type of epinephrine. Instead of retraining and reprimanding that medic. The whole state has to use the idiot proof epinephrine pens. It’s better to bring in a fatality than a protocol violation. The state is reviewing every call of ours, scrutinizing them for protocol errors. Then screwing us for them. It has been rumored that the state scrutiny is due to an inspector’s personal vendetta against our service. But that hasn’t been proven yet.

I have to say, it’s not the job I signed on for. It has changed a lot and not much of it for the better. The system abuse is at epidemic levels. Acuity is in the basement. People call for the most ridiculous things. You cannot imagine the lack of respect people have for us. It is not patient care, it is patient carrying. Carry me or I will complain. It’s sickening. And I am sick of it. The stress is killing me at a faster pace every year. But I don’t know anything else. Or want to do anything else. I’ll be here another nineteen years. This is my dream job; it’s unfortunate that the dream is often a nightmare.