April 12, 2018 • 47 mins
Paramedics are not EMTs. Or fire fighters. Or cops. But they do ride around in ambulances (and drive) to help to save lives. It's a stressful job and we're here to shine a light on this noble profession.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Should Know from how Stuff Works
dot Com. Hey, and welcome to the podcast. I'm Josh
Clark with Charles W. Chuck Bryant and there's Jerry Jerome
Roland and this is Stuff you Should Know the emergency
(00:22):
re Rear rear wo er er Ah. We should have
a new podcast called Sirens Around the World. Yeah, it's
annoying showever, it would be pretty annoying, but there'd be
some subset of people who like just really despise themselves.
(00:43):
That would be popular. I'm on so we would love it. Uh,
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
(01:05):
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
(01:26):
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.
(01:47):
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
(02:08):
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
(02:31):
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
(02:54):
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,
(03:17):
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,
(03:39):
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
(04:02):
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.
(04:24):
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
(04:44):
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,
(05:05):
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
(05:29):
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
(05:52):
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
(06:16):
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,
(06:40):
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
(07:04):
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
(07:25):
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
(07:48):
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
(08:08):
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.
(08:31):
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.
(08:53):
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.
(09:14):
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
(09:36):
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
(09:57):
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
(10:18):
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,
(10:39):
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
(11:01):
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
(11:22):
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
(11:44):
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
(12:07):
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
(12:27):
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
(12:47):
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,
(13:07):
we will put the broken system behind us momentarily. Talk
about e m t s and paramedics change to change,
(13:41):
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
(14:04):
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
(14:25):
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
(14:45):
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
(15:07):
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
(15:29):
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
(15:50):
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
(16:11):
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
(16:34):
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
(16:54):
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,
(17:15):
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
(17:35):
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
(17:56):
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
(18:17):
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.
(18:37):
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
(19:01):
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
(19:21):
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
(19:43):
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
(20:05):
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
(20:28):
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
(20:49):
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
(21:10):
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
(21:34):
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
(21:56):
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,
(22:20):
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
(22:40):
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,
(23:03):
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,
(23:23):
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
(23:46):
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
(24:07):
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
(24:28):
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,
(25:03):
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
(25:26):
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
(25:49):
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,
(26:11):
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
(26:32):
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,
(26:53):
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
(27:19):
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,
(27:39):
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
(28:02):
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
(28:26):
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
(28:48):
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,
(29:12):
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.
(29:33):
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
(29:54):
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
(30:16):
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,
(30:37):
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
(30:58):
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
(31:20):
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
(31:42):
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
(32:02):
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
(32:25):
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
(32:48):
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,
(33:09):
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.
(33:29):
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
(33:52):
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,
(34:13):
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
(34:36):
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
(34:56):
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
(35:16):
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,
(35:37):
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
(35:59):
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
(36:22):
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
(36:44):
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.
(37:07):
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
(37:27):
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
(37:50):
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
(38:12):
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
(38:35):
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
(38:56):
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
(39:19):
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
(39:42):
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,
(40:05):
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
(40:26):
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,
(40:49):
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
(41:09):
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
(41:29):
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
(41:52):
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
(42:13):
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
(42:36):
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,
(42:59):
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
(43:21):
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
(43:42):
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
(44:03):
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
(44:23):
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,
(44:46):
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
(45:08):
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
(45:29):
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
(45:49):
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
(46:10):
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
(46:34):
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
(46:55):
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
(47:17):
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
Welcome to Stuff You Should Know from how Stuff Works
dot Com. Hey, and welcome to the podcast. I'm Josh
Clark with Charles W. Chuck Bryant and there's Jerry Jerome
Roland and this is Stuff you Should Know the emergency
(00:22):
re Rear rear wo er er Ah. We should have
a new podcast called Sirens Around the World. Yeah, it's
annoying showever, it would be pretty annoying, but there'd be
some subset of people who like just really despise themselves.
(00:43):
That would be popular. I'm on so we would love it. Uh,
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
(01:05):
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
(01:26):
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.
(01:47):
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
(02:08):
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
(02:31):
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
(02:54):
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,
(03:17):
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,
(03:39):
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
(04:02):
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.
(04:24):
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
(04:44):
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,
(05:05):
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
(05:29):
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
(05:52):
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
(06:16):
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,
(06:40):
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
(07:04):
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
(07:25):
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
(07:48):
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
(08:08):
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.
(08:31):
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.
(08:53):
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.
(09:14):
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
(09:36):
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
(09:57):
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
(10:18):
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,
(10:39):
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
(11:01):
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
(11:22):
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
(11:44):
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
(12:07):
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
(12:27):
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
(12:47):
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,
(13:07):
we will put the broken system behind us momentarily. Talk
about e m t s and paramedics change to change,
(13:41):
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
(14:04):
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
(14:25):
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
(14:45):
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
(15:07):
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
(15:29):
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
(15:50):
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
(16:11):
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
(16:34):
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
(16:54):
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,
(17:15):
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
(17:35):
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
(17:56):
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
(18:17):
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.
(18:37):
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
(19:01):
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
(19:21):
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
(19:43):
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
(20:05):
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
(20:28):
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
(20:49):
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
(21:10):
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
(21:34):
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
(21:56):
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,
(22:20):
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
(22:40):
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,
(23:03):
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,
(23:23):
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
(23:46):
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
(24:07):
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
(24:28):
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,
(25:03):
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
(25:26):
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
(25:49):
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,
(26:11):
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
(26:32):
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,
(26:53):
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
(27:19):
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,
(27:39):
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
(28:02):
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
(28:26):
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
(28:48):
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,
(29:12):
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.
(29:33):
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
(29:54):
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
(30:16):
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,
(30:37):
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
(30:58):
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
(31:20):
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
(31:42):
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
(32:02):
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
(32:25):
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
(32:48):
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,
(33:09):
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.
(33:29):
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
(33:52):
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,
(34:13):
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
(34:36):
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
(34:56):
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
(35:16):
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,
(35:37):
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
(35:59):
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
(36:22):
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
(36:44):
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.
(37:07):
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
(37:27):
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
(37:50):
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
(38:12):
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
(38:35):
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
(38:56):
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
(39:19):
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
(39:42):
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,
(40:05):
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
(40:26):
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,
(40:49):
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
(41:09):
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
(41:29):
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
(41:52):
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
(42:13):
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
(42:36):
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,
(42:59):
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
(43:21):
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
(43:42):
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
(44:03):
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
(44:23):
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,
(44:46):
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
(45:08):
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
(45:29):
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
(45:49):
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
(46:10):
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
(46:34):
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
(46:55):
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
(47:17):
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
Stuff You Should Know News
Hosts And Creators
Chuck Bryant
Josh Clark
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