Selects: How Paramedics Work
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Hi, everybody. Chuck here. I just realized I...

I've almost cut my finger off while I was playing with a pocket knife just now, and it's bleeding quite a bit. So I'm going to call 911. And in the meantime, I'm going to listen to this episode from April 12th, 2018, How Paramedics Work. Oh, thank God. Welcome to Stuff You Should Know, a production of iHeartRadio. Hey, and welcome to the podcast. I'm Josh Clark with Charles W. Chuck Bryant, and there's Jerry Jerome Rowland.

And this is Stuff You Should Know, The Emergency. We should have a new podcast called Sirens Around the World. Yeah. It's the most annoying show ever. It would be pretty annoying, but there'd be some subset of people who just really despise themselves that it'd be popular among. So we would love it.

We don't hate ourselves, do we? Tell me. I need to know. No. I guess 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 I'm just like, I am so sick of myself. Is that what you're talking about? That was a good song. Remember that song? No. 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 in an article I was reading. I was like, I forgot about him. Haven't heard about him in 20 years. And then, bam, Bader Meinhof, here he is again. Well, he's still around. He's an Atlanta guy, you know.

I didn't know that. Yeah. Well, that's cool. Yeah, no, I think that's like the way it goes. Just because you had one hit and 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. He had two hits. Usually the artist like keeps going. Yeah. You know? Yeah, he had two hits though. I know Girlfriend and then the other one you were talking about. Yeah, Girlfriend. That's a great song. Yeah, it's a good song.

Okay, so obviously what we're talking about today are paramedics. Paramedicine really is what we're talking about. Yeah. Which is – it's actually a pretty interesting topic because you kind of look into it. You're like, oh, these people save lives. That's great. Yeah.

here's some of the life-saving techniques that they do. Fantastic. But there's like actually so much more to it. It's got a really interesting history. It's got a, a, a,

It's one of those things where it's way worse off than it should be as far as like funding and like logistics and stuff like that goes. I just find it interesting. 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 poke back. Yep. With forceps. So I guess we should say right off the bat that the word paramedic, para means alongside paramedic.

So alongside medicine, I guess, which I'm not quite sure what that means. So what I think it means is as follows, Charles. Okay. These people, paramedics, they are not doctors. Correct. But they work.

With and alongside and really honestly as an extension of a doctor, an MD. I buy that. 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 ER doctor, an ER nurse would be doing in an ER. Yeah.

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 dust in your face. I don't know. It would depend on what the effect of the green dust was. That's true.

So I think that's what paramedic means, right? Okay. We can go further back, actually, and describe what ambulance means. We know that one for certain.

Yes, that came around in 15th century Spain during the Inquisition. They clearly had a lot of need for medical work. Yeah. And they actually had field hospitals that were called ambulancias. Right. It was just basically like a mass unit out in the field. And then eventually the –

The French, shortly after, I think under Napoleon, they innovated on the ambulance and said, well, that's great. That's neat that we have these things out in the field. But there's some guys way over there who are injured. And they probably wouldn't die if we could get them to these ambulances, these field hospitals, right? Correct. So they came up with basically mobile ambulances, right?

Which is this idea of a flying or a moving ambulance, which is like a little medical facility that they would put the people into and move them away from battle to go patch them up rather than waiting for the battle to end. Well, yeah, and before that even, during the Crusades, when they also had a great need for medical care, there were the Knights Hospitaller. Hospitaller? I think Hospitallier. Yeah.

Oh, whoa. Is there an extra? I might be putting an extra syllable in there. Well, that's all right. I'm known to do that. That's your pastime. Knights Hospitaller, that's what I'm going to say, of the Order of St. John of Jerusalem. And they were the first kind of the first people to practice emergency medicine on the battlefield. And they even invented the what we now call

The stretcher, although it's still called a litter in some circles. Yeah, it's a pretty intuitive thing, but 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. Hooray. Hooray.

So, yeah, so this is the idea of emergency medicine grew basically exclusively out of warfare over the centuries. Well, yeah, but what's remarkable to me is that from that time, they had the right idea. Let's get these people out of here quickly. It took about 130 years all the way until the mid to late 1960s until they said, hey, wait a minute.

If we actually put trained medical people in these things and weren't simply driving people to a hospital, we might have even more luck. Yeah.

That was the late 60s. Isn't that amazing? It is. And at the time it was, so a lot of medicine was practiced through house calls, right? Oh, yeah. Including emergencies. Like if there was an emergency and you could get a hold 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 or local morticians were tasked with, basically it was called like a scooping job.

Scoop and run or scoop and carry where you just basically get the person out of that car wreck or from the bottom of that ladder or whatever just happened to them. Throw them in the back of a car, a cop car or a hearse. I looked it up. The Ecto-1, the Ghostbusters ambulance is a modified Cadillac hearse. Oh, yeah.

So, they would throw some... I imagine that was a sinking feeling. It really was. For a mortician to show up in a hearse and be like, I'm going to 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? Oh, that's a good point. Hopefully not, but yeah. Take the long way? On paper, yeah, right. Or they just, you know, casually put their hand on the person's nose and mouth in the backseat. Yeah.

It's dry. Terrible. 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 ER room. ERs didn't come about really until like the mid-70s where you could find them in fair abundance around the United States.

Like ERs just didn't exist. It was, here you go, doc. I know you just delivered a baby and you treated somebody else for angina, but now you've got to put this person's head back together.

Wow. Yeah, and it was all just medicine at the time. So, yeah, the idea of getting somebody to a hospital and having a medical person, a professional, in the car that's transporting them, it came out of Ireland, I think, right? Yeah, big shout-out, 1967, 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. Right. And everyone went, huh, never really thought about that. But there it is. There's a study. Yeah. Pretty cool. So he definitely 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, 65. I think it was like the National Academy of Sciences or somebody basically got together with another group and said, let's study accidents. And what they came up with was this idea that there was like this overlooked phenomenon

disaster that happened. Like accidents were a huge, major leading cause of injury and death in the United States.

And this inquiry determined that we weren't doing much about it. And specifically, a lot of people died who otherwise wouldn't have if there had been something like an emergency medical service to attend to them at the accident scene and on the way to the hospital. And then having the hospital actually know what they were doing as far as emergency medicine goes. Yeah, it's just staggering to me. It seems so intuitive. And I can't believe it took that long.

for this to happen. You know? And in fact, the Emergency Medical Systems Act was signed in 1973.

which basically said we need a standardized system here nationwide. That was after that paper came out in 1966. Yeah, many years later. I mean, that's the speed of government, I guess. Sure. And then in 1977, the publication of the first, very first national standard curriculum for

for EMTs and paramedics. 77. Yep. And then so alongside this, para-this, there were people like around the country, universities around the country and around the world who...

We're kind of all recognizing all of this at the same time, that there's a lot more that could be done for people who were injured in accidents. And so you had the people at Pitt, University of Pittsburgh, taking up the cause. Go Panthers. Yeah, they started, is it the Panthers? Yeah. Huh. They started creating some of the first curriculum for paramedics, some of the earliest tests for paramedics.

The University of Cincinnati came up with the first curriculum for training physicians in ER medicine. I think the University of California was an early entrant into the world of medicine.

teaching paramedicine. And I think they were the first one to be accredited in 1980. Like they had their operation going for years, but they were the first one to say, hey, somebody take a look at this and make sure we're kosher. And then we can say we're an accredited training facility for paramedics. Amazing. It is pretty amazing. And then...

The problem is this. So the federal government got into the act in 1973 with the Emergency Medical Services Act. But by 1981, there was an omnibus budget that said, we're out, we're done, we're not funding emergency services anymore. And then from that point forward, the emergency service system in the United States, whatever had been developed to that point,

broken to patchworks of state, local, county programs. Sometimes multiple ones within a single county. I think there's a county in Michigan that has like 18 different emergency services. And that has kind of created this where we are now, which is

people doing the absolute best they can in what amounts to a broken system in a lot of ways. Should we take a break? Sure. All right. When we come back, we will put the broken system behind us momentarily and talk about EMTs and paramedics. I'm serious.

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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 EMT, emergency medical technician. And this is the person who has undergone about between about 120 and 150 hours of coursework

They're well-trained in all kinds of life-saving procedures. If you need CPR, if you need oxygen administered, if you were having some bad allergic reaction that your life is in jeopardy. But there are limits to what they are allowed to do. So one thing they cannot do, even in the case of

giving shots is they can't break the skin. Right. Which is super interesting. I never knew that. No, I didn't know that either. But you can consider an EMT like an entry-level paramedicine professional. Right.

That's where you would start. And in fact, I think you have to start as an EMT to go on to the next level, which would be paramedic, right? For sure, yeah. So if you're a paramedic, you have about 10 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 six months

at least of prior, immediately prior EMT experience to start becoming a paramedic as well, which I'm sure is the way most people go is you start out as an EMT and then you, you know, move on to the next level, which is paramedic. Yeah, which like you said, 10 times. So that's about anywhere from 1200 to 1800 hours, depending on

your state or your municipality to get certified. And this is where the real action can happen. You can give an IV. You can, if someone's having a heart attack, you can deal with that. You can operate a defibrillator. Fibrillator? Fibrillator. Fibrillator. It's fun to say once you master it. They should have just called it the clear machine. Yeah, the...

But it's a lot of work and a lot of hours. And one of the people that they interviewed in this article said that, you know, it's really grueling. And when you're in paramedic training and 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. Yeah, that's tough stuff. So the paramedic is actually, they operate under the license, not just like,

like under the direction, but under the license of a physician and their locale, right? There's a couple of ways that you can do it. And as you'll start to see, like I saw a quote that said, if you've seen one emergency medical system, you've seen one emergency medical system. They're all just so different. And the whole thing is so patchwork. But 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 too, depending on where you live. But there is like a national accreditation and national coursework. But then how the system functions and runs is what's the patchwork part of it. Yeah, and it'll cost you, I mean, it depends on where it is, of course, and what program. But the example they used was

And our article is the UCLA Center for Pre-Hospital Care. And they quoted about 10 grand for just the tuition. And then, of course, like any college or coursework, you're going to have to pay for books and equipment and uniforms and stuff like that. That's exactly where they get you. The plaid skirt. And then after that, though, the good news is, is that you have a really good chance of getting work. I get the impression that

if you have gone through all of your paramedic training, you're not sitting around. Like, there's usually a job waiting for you somewhere. Yeah, I saw that as well. And actually, it doesn't necessarily pay super well. No. People, so if you ever see a paramedic

be extra nice to them for sure because not only are they running around saving people's lives they're not getting rich off of it at all um they're doing it because it's something they care about yeah um but they're despite that despite the the mediocre pay um it's i saw it's going to be one of the most in-demand jobs over the next like 10 to 15 years i really wish i could remember the statistic exactly but i think they're like

expecting another like 53,000 EMT jobs or paramedic jobs to be added to the American economy over the next like decade maybe. So it's definitely a growing career for sure, growing profession. Yeah, and you mentioned the pay. If you go to the U.S. Bureau of Labor Statistics to kind of find a mean salary or something,

They do it. It's not really – they should separate it out, but they lump in EMTs and paramedics when, of course, EMTs don't make the kind of money a paramedic would. But they had a mean annual wage of about $31,000 a few years ago. And if you're in the top 10%, it's about $54,000. And apparently the state of Washington is on the higher side. You can get as high as $71,000.

In the state of Washington. Right. But I mean, you know, that's it. 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 31 grand a year. It's sort of like being a school teacher. It's a I feel like it's a calling in a lot of cases. For sure. For sure.

As I was saying about the license that they operate under, right? So if you're a certified paramedic, when you are, 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. Yeah.

Or you could also be operating under the license of a local physician. Like that physician's license covers you, covers the physician's assistant, basically everything working for everyone working for him or her. So you might be operating under that physician's license.

Or, I didn't know this, man, during an ambulance ride. So remember how just adding like a trained medical professional to the ride from an accident scene to the hospital improves outcomes? And we've done that since 1966 at least. They figured out that if you can communicate with a doctor, an ER physician en route, you

you could also improve outcomes even more. So during this transportation from an accident to the hospital, the paramedic is probably in touch with an ER doctor who is instructing 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. Wow.

Would that make you feel better or worse? What? That the paramedic was getting instruction from a physician? Yeah. Like if you hear 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? Right. And you would hate to hear like the doctor say, well, get the something something and for the paramedic to say the what?

You're right. I don't know what that is. I've never seen this before ever. Have you ever had to take an ambulance ride for yourself? No. No, thank goodness. I didn't think I had either, but then I did remember when I was 13 or 14, my brother was 16 or 17, we were in a car wreck. There were eight people in a Jeep, in my brother's Jeep that was once my dad's Jeep.

And that was definitely not safe to do to begin with. But we were going to a movie after church on a Sunday night, a bunch of kids in youth group. Raising hell. Piled in my brother's Jeep, wasted. No, just kidding. Completely sober. Wasted on the Lord. We were. And it was raining really hard. And, you know, at Ponce de Leon Avenue here in Atlanta, everyone that doesn't live in Atlanta probably laughs that we pronounce it that way.

Instead of Ponce de Leon. But on Ponce where it kind of... If you're leaving from Atlanta, it's that big curve where you go over that large stone archway. Yes. Kind of headed toward into Decatur. Uh-huh. 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 hydroplaned, hit a curb, and turned the Jeep over on its side, and I ripped through the canvas ceiling or whatever it's made of. Oh, man, you got thrown? Oh, yeah. We were scattered all over the street. You are lucky. I know. It's the only time I think that I've been knocked unconscious, and I just remember waking up,

You know, what would have been probably seconds later, the pouring rain and looking around and seeing my friends like scattered within like 20 feet of each other in various places. Man, that is scary stuff. It was scary. So in the end, the good news is no one had like I think the worst injury was like a broken collarbone. I broke my finger. There were little cuts and scrapes, but nobody was hurt bad. But I do remember this. Oh, my brother doesn't listen to this one.

In the ambulance, on the way, my brother was just sort of catatonic, and they said they were trying to get information, and they asked what his name was, and he said, A-hole. What? Yeah.

He said a-hole. He said the real word, though. Because he felt so bad? Yeah. I think he was just sort of out of it and felt terrible. Poor Scott. And he didn't curse at all at the time. Still doesn't even curse much, but it was just so weird that that is what stands out in my mind. I wonder if he remembers that, actually. Well, that's a big one, especially if you didn't curse, you know? It's so funny.

Man, you were a great storyteller. Was that a good story? Yeah. I was like, I was seriously where you kept like going off on tangents. I'm like, no, we got to get back to the story. What happened to the cheap? I know, you looked a little nervous. Yeah. So, yeah.

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 was good. Everybody was good. I think my brother broke his foot. Man. Yeah, it was just stuff like that. Heck of a story, Chuck. Heck of a story. Thank you. Yeah, let's take a break and regroup, shall we? Yeah, let's do. Okay.

Serious. Serious.

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Okay, we're back. I'm not reeling quite as much as I was, but that was a good story again. I feel like we should mention, even though it's kind of silly, that emergency TV show. Oh, yeah, for sure. From the 70s, because it seems like it definitely...

like actually played a part in ramping up ambulance services.

Yeah. So this is, I think, 1971 or 72 when it premiered. And remember, the Emergency Medical Services Act wasn't passed until 1973. That white paper had come out in 1966. So this idea of like this new type of medicine, this new type of like health care worker was really on America's mind. But one of the ways it got there was from that TV show Emergency.

in part because it was shot like documentary style. People played themselves on it. Like there were real dispatchers on the show acting as dispatchers. It just captured America's imagination. Yeah, I remember watching it.

I don't think I ever saw an episode of it. Yeah, it was Emergency with an exclamation point. It ran until 77, and it was mainly two dudes, two firefighter characters is what the story centered on, and one of them was a young Kevin Tig or Teague. He was the Jersey Roadhouse. Yeah. He was the owner. He's a character actor. He's been in a million things. Oh, yeah. He owned the Double Deuce.

Yeah, he's great. Yeah. I can't remember what else I've seen of him. I've seen him young before. I wonder if it was Emergency now that you mention it. Maybe. Huh. Maybe I have. I bet it ran in reruns. For sure it did. But I'm a Jack Webb fan, and I think he produced or created it. You're a big Jack Webb guy? Mm-hmm. Are you not? I don't know. Uh...

He's the dude from Dragnet. He's Sergeant Friday. Yeah, I guess I need to think about that. Yeah, he's awesome. I'll let you know. Man, if you go back and watch old episodes of Dragnet, oh my God. Yeah, that was a good show. Yes, it was. And I think Emergency, maybe Adam 12 is 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 the Teague fella from Roadhouse. And then...

Wasn't Dragnet Colonel Potter? Yes. Harry Morgan. Right. We had a – Emily and I had a long conversation about M.A.S.H. the other day.

And how that was, I was a mash nut. Yeah. And how that show was one of the few to survive, like, major cast changes. Oh, yeah. Like, three of them. Yeah. They certainly didn't, like, 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, and a few others. But they had, like, Radar and Clinger.

Although they coexisted, I think. But eventually Radar left and Klinger took his job. Potter took over for, what's his face, the original guy. I don't remember, but he wore the fishing hat. Yeah, he was, oh man, the saddest ending ever for that one. When he left? Yeah, 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. On his way out. Wow. And then, of course, Frank Burns left and was replaced by Winchester. And then Trapper left and was replaced by Honeycutt. Right. But it just, it was still great. Well, 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 ever. No, true. For sure. But you're saying they pulled it together in the last episode? Yeah, I think I remember the last couple of seasons, it was a little bit like, you know, maybe it had run its course. Huh. I guess. But I was a very discerning 12-year-old viewer. Yeah, I guess so.

Yeah, like they've really gone to the hooch gin joke too many times this episode. It is funny, though, that like little 12-year-old me thought like the funniest thing in the world was war surgeons, drunk war surgeons. Right. Drunk philandering war surgeons.

All right. I really got off track there. Yeah. Maybe we should take a third break. No, I don't think so. I don't think we should either. So we're talking about paramedics today. Yes. Believe it or not. And one of the things we talked about was the idea that paramedics – well, let's talk a little bit more about their job, right? Okay. One of the things that paramedics are sometimes criticized for is that they don't run to the scene of an emergency. I've never thought about that once. Okay.

You haven't. I really hadn't either, but then I started thinking about it. I'm like, yeah, I could totally see that. Apparently, for some people who are at an emergency scene and see the paramedics kind of walk up, they appear a little too casual and they want to know, what are you doing? Why aren't you rushing to this scene? And paramedics, I think we saw a question answered on Quora or something like that.

And 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 going to park as close as they can. Sure. So that running is only going to shave a couple seconds off. But really the number one reason or one of the top reasons is that they're supposed to be, they're supposed to bring with them to this scene of catastrophic,

catastrophic panic, basically. Calm and professionalism and being in control. Yeah, I get that. Like, I think it would be a little disconcerting if I was injured and I saw a paramedic burst into the room, like, breathing heavy. Like, oh my God, what's going on? What's going on? Is everybody okay? Yeah, plus they might get hurt running. That's another one. And they're usually, you know, or not usually, but I would say probably a lot of times it's not like...

they're walking through a, you know, a perfectly laid pathway. Like, they could be running upstairs or through a house of hoarders or, you know,

you know, through the woods. Like, you don't know what's going on. You got to 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 are as you're walking into them rather than running into it and being like, oh, the guy who shot you is still here waiting for me. You know? Now that I've run into the scene, I know that, but it's terrible. It's also...

kind of hard to run from place to place depending on the equipment that they're carrying with them. The stretchers get heavy. The EKG machines get heavy. The defibrillators get heavy. All that stuff gets heavy. So there's a number of reasons why you won't see a paramedic rushing to the scene. You will see him rushing to the scene in the ambulance, though. And from what I understand, 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 EMT or paramedic, is don't call them ambulance drivers. Yeah. Because that's part of their job. And it's a weird thing, too, that 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.

I mean, while they're EMTs or paramedics. Yeah. And so, you know, if you've ever seen an ambulance going through an intersection, they're going to slow and maybe even stop and then proceed. They still get broadsided very frequently by people going through the intersection because they have a green light and they're not paying attention.

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

aspect of the job from what I've seen. Yeah, another interesting thing that I saw from that list you sent was that if you're in a big city, a lot of times they even have divided up between EMT and paramedic for different cases. So like if there's a scene of trauma going on, like a car accident, then you're more likely to get an EMT. Whereas if you're at home and you're like, my husband's having a heart attack or

or my child's having a seizure, then you're more likely to get a paramedic. Yeah. Which is interesting. Yeah. And if in cities as well, if you're a paramedic, you probably once you get into your ambulance, you're basically stationed at the ambulance for the rest of your 12 hour shift.

You don't go back to the firehouse or to the ambulance clubhouse or anything like that. The ambulance clubhouse. You're on a designated street corner parked waiting for your next call. Yeah. Probably killing time somehow, but there's not very much downtime in a city especially. The opposite is true for more rural areas.

EMTs and paramedics and that there's a lot of downtime. So much so that this guy who is actually one of the consultants on that show, Emergency Years Back, he became a minister of health, I think, in Nova Scotia. And he created this program for rural EMS workers to use their downtime in much the same way that like a country doctor would have made house calls.

Yeah. So they're like, wasn't the idea that they would go to places and sort of help train like regular citizens on how to avoid getting hurt and stuff to begin with? Right. Yeah. Like like doling out preventative medicine, like making sure that people are taking their medicines correctly, teaching CPR classes, etc.

teaching leading exercise classes for like seniors at a senior center, like doing all this stuff to reduce the number of calls that they have to go on anyway. So it cuts down on their downtime, which I think is actually very much appreciated by paramedics because there's really nothing more boring than sitting around constantly. And then they're actually doing something and, and also, um,

making their community a healthier place. Yeah, I thought it was funny when they were talking to some real on-the-ground paramedics about the downtime. They were like, well, HBO Go's kind of awesome. Right. Yeah. Like, oh, well, I guess you got to pass the time. It's better than...

Nicholas Cage and bringing out the dead. What did he do? Because I remember that movie, but I don't remember all the details of it. Well, it wasn't that great. I liked it. He did tons of drugs. Oh, okay. That's why he was on the job. I think he was like a speed freak or something. I gotcha. Yeah. Yeah, he kept begging to be fired, right? Yeah.

I don't remember it very well at all, actually. I think he did. Like that was his shtick. He begged to be fired. So one of the things about those that downtime the community preventative medicine initiatives that have kind of spread from Nova Scotia out through around the country is

when you see a paramedic doing that, 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 and insurance companies will reimburse people

Only if they have transported someone to a hospital? Yes. So in other words, if you go as an ambulance and a paramedic or EMT to a place and you actually can just help and treat someone there and they don't need to go to the hospital, then that's a freebie? Yes. Or do they send a bill to...

To the people. From what I understand, it's a freebie. 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 Medicaid and Medicare won't pay for it. So there is a substantial reason to say,

keep working chest compressions on a person who is obviously dead all the way to the hospital. Interesting. 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 bill Medicaid for that as well. And the problem is that that leads to other problems as well. Like hospital ERs are very much overcrowded and understaffed and overworked, right? Yeah.

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 those EMTs bringing people to the ER and the people who staff the ER and are accepting these people. And so much so that it's become kind of common for ER rooms to issue ambulance diversions. Right. Saying, don't bring anybody to our ER, go somewhere else. And on a really bad night in a really populated city, you might find every single person

ER room, like with that diversion alert on and you got to take somebody out to like a country hospital that doesn't know anything about trauma. And it takes 45 minutes to get there. And they're not going to get the care they could receive at a good trauma center in the city. So that's a real problem. Yeah. And isn't too, in terms of pay,

And we need to hear from people on the ground because this – it's surprisingly confusing when you research this on how it all works. And maybe that's the point. But it seems like it's also a fixed rate. There's no difference between –

I treated a kid for an allergic bee sting reaction to I brought a guy back from the dead who had had a heart attack or heart failure. Yeah. Is that right? Yeah, so long as you transport both of them to the hospital, you're going to get, I think I saw, as low as $25 from Medicaid in some places. I don't understand this. 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 EMS workers under their fire departments so that they fall under the fire department's funding, which I think fire departments tend to be way better funded than any kind of EMS service. Uh-huh.

So I think that's how – that's one way that it happens. But I just – I don't get how this actually works money-wise because it doesn't add up. It doesn't make sense. Yeah. I mean it's not often that we're a little stymied. So we're going to follow up for sure with some emails soon.

But I think it's also going to vary from place to place. Right. Because the other thing that I got really confused about was private, the privatization of ambulance services. Yeah. And as best as I can tell is in the 70s and 80s, there were a lot of small private ambulance companies that,

but then they merged into more regional things and that these days there's just a few like big multinational companies that are the most dominant in the industry. Right. But I don't get how that works. Like if they're private, are

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 or a county or wherever. And I think they go wherever they're called to. I know that there can be like competition among them. So like multiple ambulances will show up at a scene sometimes. It's just, it's kind of a bit of a cluster as far as...

competing with the local EMS services. And I think it's on the decline from what I've seen. Yeah, but when you call 911...

Do you have a choice? So what you can do, I think it's kind of like Uber, where the 911 dispatcher has a log of companies or services, like public-funded or private services, that it can be issued to. And they send out the alarm, and whoever takes the call goes and gets it.

Interesting. So the problem is, is I saw a Las Vegas Review Journal article about this. Las Vegas was debating whether to just totally privatize their EMS services. Their EMS just like went berserk. They're like, no, like this is, this doesn't work. The private companies are late. I think they were late like 10,000 plus times in one year in Las Vegas. Their response time tends to be less than the actual fire department or EMSs. It's just not,

as preferable. And the reason why private ambulance services came about or became widespread is 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 theirs, right? Yeah, I think Giuliani is one of the people that really tried, and of course, no surprise given his politics, trying to privatize

the industry. But apparently a lot of those had gone bankrupt, basically. And during the housing boom, the financial collapse, strangely, or maybe not strangely, because I don't understand it, a lot of private equity firms started buying up ambulance services. Yeah, there you go. There's the downfall. It's just so interesting. I know that this is one of those where someone's going to knock our socks off with a great email.

Yeah, I think also one more thing about the private ambulance services. It's not like they're just a bad idea all around. Sure. In a locale that is underserved, if a company wants to come and set up ambulance services, that would be great for that area. Yeah. Because they have a far, you know, they can get places faster in an ambulance than they could have before. In a place where you've got your EMS overstretched and the county's like, no, we're not hiring a single additional EMS worker.

the company that sets up shop can actually take up the slack. There are good aspects to it. It's not just some terrible idea, but in practice it hasn't worked out as well as one would hope from what I understand. EMS workers, email us. Explain this because I really, like you, I do not get who's footing the bill. It has to be insurance companies. And if you don't have insurance, it has to be

Just the person, the individual. Yeah, and I think we have, we waded into the waters of doing a 911 podcast once and didn't. Isn't that correct? Because it was, I mean, we'll do it at some point, but I remember thinking, oh, that's a good easy-ish one. And it ended up like being super convoluted. Yeah, I think we should do that. We should also do just ERs in general too. Yeah.

So that's a bit about paramedics. Sounds like there's way more to it, right? Yeah. But you got anything else for now? No, sir. Okay. Well, since Chuck said no, sir, it's time for Listen to Mail. All right. I'm going to call this We Helped a Dude Win Something.

Yeah, I love this one.

So, this guy sounded super excited because he knew the answer. Immediately, I thought of your show and the uncanny ability of Mr. Edward Bernays to pop up in seemingly strange histories. I remembered your PR episode and knew it was sometime in the 20s, so I hopped in my car and took off for the business. When I got there, I told them the answer with a startled look. They told me I'd won a huge case of meat. Ha ha ha ha.

And not just junky stuff either. This place sells to restaurants and businesses all across the country. I love that. I was super stoked. Good meat. He's like, I want meat. And not just like terrible meat, like good stuff too. When they asked if I had to look it up, I told them no, that I listen to Stuff You Should Know, and I retained it in the back of my mind. They asked for the name of the show.

And they said they were going to play it for all the workers there during the day, so now they can get more difficult and random questions. That's awesome. And he said it doesn't end there. I went back later in the week, and the same girl I'd spoken to recognized me, so they had two other people come in that had known the answer from Stuff You Should Know as well. All right. Even though we live in super rural Utah, you apparently have a large following, and that is from John Robeson.

Thanks, John Robeson. I hope you have a healthy EMS service out there to come find you after you eat that box of meat. Yeah, and you know what? Let's hear from Salt Lake City because we have debated a live show there and just didn't know if we had the support. So I want to hear it. Okay. So we want to hear from Utahans and EMS workers. Yeah, if we get 10 people that email us and say to come to Salt Lake City, we'll come.

I think we should set the bar higher than that. Okay. Okay. Well, if you want to let us know that you're from Utah and you want us to come or you're an EMS worker and you got some good stories for us, you can send us an email. It's probably easiest to stuffpodcasts at howstuffworks.com. As always, join us at our home on the web, stuffyoushouldknow.com.

Stuff You Should Know is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This podcast is supported by BetterHelp, offering licensed therapists you can connect with via video, phone, or chat. Here's BetterHelp Head of Clinical Operations Hesu Jo discussing who can benefit from therapy. I think a lot of people

A lot of people think that you're supposed to be going to therapy once you're like having panic attacks every day. But before you get to that point, I think once you start even noticing that you feel a little bit off and you can't maintain this harmony that you once had in relationships, that could be a sign that maybe you want to go talk to somebody.

There's always a benefit in talking to someone because we can all benefit from improved insight about ourselves and who we are and how we behave with other people. So if you're human, that's like a good indicator that you could benefit from talking to somebody. Find out if therapy is right for you. Visit BetterHelp.com today.

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