7 Alternative EMS Careers: Part 1

In part one of a two-part feature, columnist Mike Rubin discusses nontraditional EMS jobs in the hospitality and entertainment industries. Read part two here.

When I started paramedic school in 1994, I couldn’t imagine EMS outside of 9-1-1. Every full-time EMT and medic I knew seemed attracted to the urgency of ambulance lights and sirens.

The public favors an analogy of ambulances as our “offices,” but that’s pretty far from the truth. Our rigs are reminders that we don’t need offices; that we’re not constrained by the same four walls limiting the independence and imagination of white-collar workers. We take pride in the distinctiveness of patient care at 40 miles per hour, when every turn reminds us EMS is an unnatural act mastered by few.

I’ve enjoyed 9-1-1 as much as anything I’ve done, but since 1994, I’ve spent a surprising amount of time—18 of 22 years—working for EMS employers who didn’t even own an ambulance. We’re talking about providers of emergency services other than transports—perhaps the core mission of EMS. Such nontraditional postings in our industry have given me unusual and much-appreciated opportunities beyond the on-scene/en-route model that influences so much of our training and expectations.

Some jobs I’ve had have been so specialized, they’re rare. For example, supervising medical control for a large, mostly volunteer EMS system with 100 individual agencies was mostly a matter of being in the right place at the right time. Although it would be fun for me to recount those years, I don’t think there’d be much of a payoff for you.

Merchandising is an EMS-related activity I’ve pursued that would be hard to replicate—not due to any brilliance on my part, but just because of the specialized assistance I needed to succeed. I wouldn’t want to waste your time discussing such low-probability ventures.

Writing is my main EMS job now. We could debate whether that craft belongs in an article like this one, so let’s just leave it out. Teaching is another “off-road” EMS vocation, but so many of you already do that on the side, just as I did for years. I don’t think there’s much value I could add to your experiences.

I’ll focus instead on seven other nontraditional EMS opportunities that I feel are among the most favorable alternatives to 9-1-1 work. As of this writing, each of those occupations has openings at salaries comparable to customary EMS roles. Experience matters, just as it does on the streets, but none of these positions require extensive retraining.

One caveat: Some of you will be much better qualified than others for unconventional assignments—not because of your years in EMS or the number of acronyms after your names, but because of your people skills. I know that sounds like a prerequisite for EMS in general, but it’s an even bigger factor when you encounter hundreds of healthy customers daily instead of one or two really sick ones.

Off-the-grid EMS employment isn’t for everyone. There’s no shame in deciding ordinary 9-1-1 is your specialty.

Why even consider a nontraditional EMS occupation? Not for the money. With few exceptions, the pay is pretty much the same. Don’t do it for benefits, either; they tend to be industry-specific perks that you can live without, like discounts on hotel rooms. And advancement opportunities are just as limited as they are on the 9-1-1 side.

There are advantages to nontraditional EMS, though. Here are a few of them that sealed the deal for me:

• Health and safety: Ambulances crash. Being involved in one less wreck or none at all increases your chances of grandparenthood. And if you’re looking forward to lifting your kids’ kids someday without the use of hydraulics, eliminating patient transports from your job can be positively therapeutic after a decade or more of lumbar abuse.
   
• Variety: Saving lives gets so monotonous, doesn’t it? Seriously, it’s OK not to feel the same adrenaline surge answering calls as you did your first year. Maybe it’s time for a change, especially if 9-1-1 is becoming not just less interesting for you, but more frustrating or even unhealthy.
   
• Extended practice: During one of my first shifts as a medic in the hospitality industry, I encountered a young man who asked about a rash on his palms. Somewhere in an underused, rarely accessed part of my brain, a neural connection between “palmar rash” and “syphilis” fired, leaving me wondering if I might heroically diagnose a disease that had been mentioned perhaps once, and with very little emphasis, during my entire paramedic program. I immediately contacted our medical director and asked if I was on the right track. He said no, but encouraged me to keep thinking beyond ordinary protocols in an environment where sufferers of nonemergent illnesses would continue to seek my advice. I figured I’d better learn a little more about chronic conditions and even OTC meds.
   
• The challenge: At one of my nontraditional jobs, I operated without the support system we usually have in EMS—hospitals, well-integrated medical control and even partners. On my way to work, I’d relish the prospect of running “my hotel” or “my boat” for the day. It helps to have a positive sense of self when you’re on your own, as long as you don’t start thinking the job is about you.

Let’s take a look at the first three nontraditional EMS opportunities worth considering.

Entertainment

Growing up in Framingham, MA, Jonathan Hall liked amusement parks as much as any kid, but he never thought he’d eventually help run one.

Hall, who supervises EMS at Six Flags New England in Agawam, MA, says 9-1-1 experience certainly has value in an entertainment setting, but it’s not the only consideration, or even the most important attribute he looks for from candidates.

“The hardest thing is finding people who want to be here,” says the 45-year-old paramedic. “If I hire a new EMT with a great attitude, I can teach that person EMS and the way we operate, but it’s difficult to find experienced providers with the kind of customer-oriented personality we want in this business.”

Hall says some EMS veterans have it easier on the streets than they would at Six Flags.

“It’s not hard to do a 24-hour shift in 9-1-1 with one or two calls, and not know or care too much about what you’ve accomplished. We’re looking for more than that. We want the whole package—compassion, good medicine and a desire to work in entertainment.

“Of course, it’s a two-way street; you attract people by offering the kind of environment they want to work in. That means making them part of a team with plenty of support—at least 8–10 medics and EMTs per shift, where everyone’s working toward the same goals, and there’s no dispatcher yelling at them to take another call.”

Most EMS providers who come to Six Flags are already looking for a change.

“Some get tired of being with the same partner doing the same thing,” says Hall, “or they might tell me, ‘I’m sick of working alone’ or ‘My company doesn’t appreciate me.’ A lot of them have a huge passion for medicine and EMS; they just want to do something different.”

And different it is at Six Flags, where your patients often value entertainment over medical care.

“We work for a company whose job is to provide a good experience for people who are trying to get away from their usual frustrations, maybe only for a day,” Hall explains, “but by the time they come to your first-aid station, they’ve already waited in line for their morning coffee, had to fight traffic into the park, spent $200 to get in and then, just when the fun begins, one of their kids throws up. Medical care really isn’t the main issue for these customers; it’s trying to turn things around for them—going the extra mile to finally give them that good time they’ve been seeking.

“Maybe it means getting them on a ride without having to wait, or offering them free ice cream. We want employees who are compassionate and are going to look for opportunities to provide that special experience. If you don’t like being around people, this job isn’t for you.”
Surprisingly, years in EMS isn’t a prerequisite for Jonathan’s department.

“Some recruits come right out of EMT school,” he says. “They’ve never been on an ambulance, never worked the streets. It’s great because we train them the way we want them to be. They come to us for 6–7 years, then go on with their careers. Some of them become medics while they’re with us. We have a program that encourages that.

“We even hire people who’ve worked in other parts of the park and send them to EMT school. We just add the EMS part on top of what they already know about operations.”

Hall says the learning curve for new EMS providers is steep—particularly non-medical aspects of the position.

“They have to learn their way around the park and learn our systems. Some feel comfortable after only a couple of weeks; others need the whole season.

“The EMS part of the job is pretty basic. Most patients have non-emergent issues. Instead of putting them in ambulances, we say, ‘Hey, have you had anything to eat and drink today?’ Lots of them just need to be rehydrated and spend some time in air conditioning.”

According to Hall, starting salaries at Six Flags are comparable to other EMS openings in the region: $15 per hour for EMTs and $20 for paramedics. Employees get free theme park admission and are able to tailor shifts to their personal schedules.

Hall adds there are similar opportunities for EMS providers at amusement parks throughout the country.

Hospitality

I’ve stayed in lots of hotels—just never on-duty as a paramedic until 2007, when I took a job at Nashville’s Opryland. The resort at that time included the 2,882-room Opryland hotel, the Grand Ole Opry, the General Jackson showboat, Ryman Auditorium and other properties. The Opry and Ryman are now managed separately.

Doing EMS in a hotel involves some of the same prerequisites Hall mentioned above: a passion for customer service and a familiarity with chronic, nonemergent conditions that even 9-1-1-system abusers rarely call about.

A staff of approximately 15 Opryland paramedics are taught to give directions around the 172-acre complex as effortlessly as they offer medical assistance. It’s also not unusual for medics to act as intermediaries for guests about hotel matters like billing or accommodations. As Hall discussed, EMS providers’ success at vacation destinations like Six Flags or Opryland usually depends more on employees’ courtesy, friendliness and good humor than on assessment skills.

Guests are reluctant to become patients when they have to choose between a hospital visit and a round of golf. Consequently, most EMS calls at Opryland become refusals or treat-and-release, the criteria for which are far more flexible than in most traditional systems. Even with a remotely located physician serving as medical control, treat-and-release decisions are routinely made by paramedics alone, who must thoroughly document guest-patients’ wishes. Transports, when necessary, are handled by Nashville’s fire department.

The most challenging medical scenarios often occur aboard the General Jackson, a 300-foot showboat that carries up to 1,200 passengers up and down Middle Tennessee’s Cumberland River. The General Jackson is always staffed with at least one paramedic who might work alone on an unstable patient for 30 minutes or more, depending on the boat’s location when the emergency occurs. One cardiac case I had aboard the General Jackson would certainly be on my career’s top-five list of challenging calls. Even in the presence of sudden and severe illness or trauma, medics are expected to remain personable and customer oriented.

Salaries for full-time, part-time and per-diem paramedics at Opryland are in the $15–20 range—average for the region. EMTs are no longer hired.

The lighter side of EMS in an entertainment setting is that the public doesn’t always recognize you as a caregiver. That’s not such a bad thing during an idyllic afternoon cruise, after years of high-visibility patient encounters.

One day when I was running the elevator between decks as a courtesy on the General Jackson, a guest mentioned what a great idea it was to give elevator operators stethoscopes. I had to agree.

Events

Carole Matthews-Dempsay is no stranger to nontraditional occupations. The former opera major and catfish-farm manager has been involved in event EMS since becoming an EMT in 2004. Now a full-time paramedic at Nashville’s Opryland, Matthews-Dempsay still supplements her income by working events for a medical-services provider, CrowdRx.

“In (conventional) EMS, you never know what you’re going to get,” says Matthews-Dempsay, “but in event medicine, you can anticipate who your primary patients will be. You might just need to do a little research; a horse show is going to be different from a music festival. With a little knowledge and experience, you can be very comfortable.”

Getting acclimated to event medicine also requires a mixture of humility and technical know-how, according to Matthews-Dempsay.

“Prepare to go back to the bottom of the pecking order,” the 32-year-old Sparta, TN, native says. “It’s like moving from EMS to nursing; no one’s going to know or care about your past. There are lots of paramedics I’ve seen who come into event medicine and get knocked down a few pegs before they show they can adapt to large crowds at remote venues.

“You’re not on an ambulance filled with supplies. You carry as much as you can with you and try to make do with what you have.

“Last year I had a patient with a shattered ankle who was trampled in a mosh pit. I looked around and found a three-inch pool noodle used for padding on one of our carts. It made the perfect splint.”

Not surprisingly, alcohol and drugs are responsible for much of the illness and trauma at recreational events. Airway management skills are particularly important.

“I did my practical training in Nashville; I’m used to treating overdoses,” says Matthews-Dempsay. “It doesn’t hurt to learn more about the different drugs people take, though, and maybe get some RSI practice. That might not be something the typical medic feels expert in.”

Matthews-Dempsay likes the aggressive nature of event medicine.

“You can’t be weak-minded and doubt your skills when you’re in a crowd of people ready to trample you. There’s no time for second guessing. You have to be assertive.

“At the same time, you want people who can work as a team,” she adds. “If you come in with a chip on your shoulder and don’t communicate well, things are going to get missed.”

Event work is usually done on a contract basis, which means EMS providers are responsible for paying both the employer’s and employee’s FICA taxes (7.65%, each, on net earnings). Wages are comparable to 9-1-1, and benefits can include off-duty admission to ongoing events.

Next month we’ll cover other nontraditional EMS opportunities.

Mike Rubin is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.