The Places You’ll Go: EMS in Nontraditional Job Environments

Working in EMS would never be considered a routine 9–5 day. The nature of the job requires unpredictability, irregularity, and constantly shifting environments. That’s part of its allure.

Still, many of your colleagues in prehospital care are plying their trade in even more extraordinary environments than what typically comes to mind. Read on for some of their remarkable stories.

Swimming With the Sharks

After speaking with Mike Hudson for just a few minutes, you get the heart-pumping urge to climb into a wetsuit, strap on an air tank, and dive into shark-infested tropical waters. Hudson is a high-energy child of 1970s-era Southern California and doing exactly what he’s cut out to do.

“I grew up in and around the water, and I still am—the ocean is a part of me,” says Hudson, a paramedic and dive safety consultant for The Discovery Channel’s smash hit “Shark Week,” now in its 30th year of production, which brings viewers up close with some of the deadliest marine animals known to man. Hudson travels the globe coordinating the safety protocols and deck operations of on-location shoots from Cuba to Guadalupe to the Mediterranean Sea. “A number of years ago I was hanging out with locals in Guadalupe staring at the moons of Jupiter rising over a volcano,” he says. “You stop, look around you, and just say ‘wow.’”

The hair-raising job didn’t fall to Hudson by accident—his list of certifications and experiences is lengthy and impressive. Following a stint in the Navy as a hospital corpsman, Hudson served as a paramedic, flight medic, and training instructor at services in San Diego, Colorado, Delaware, and New Jersey. Along the way the USLA-qualified open-water lifeguard-instructor has doubled as a lifeguard, supervisor, and ocean-rescue specialist at some of the Eastern seaboard’s most heavily populated beach towns.

Hudson’s current “dry job” is MICP paramedic and field instructor at JFK Health in New Jersey. He’s also been a captain with Sea Bright (N.J.) Ocean Rescue since 2014. Both services are accommodating when Shark Week comes calling—typically a dozen or so high-risk excursions to some of the world’s most beautiful (and hazardous) coastal seascapes each year. Hudson coordinates all safety briefings, enters the water to extract divers in distress, treats injuries, maintains equipment, and liaises with local health authorities. 

“You’re a politician as much as anything else,” says Hudson of collaborating with local governments and health systems. “You’re playing under their rules. You can’t be a cowboy.” Intense preparations mean bites, catastrophic air failures, and other serious events are rare, but when they happen, having a transportation and care plan in place that involves local systems is critical.

And while Hudson’s a self-admitted adrenaline junkie who is mesmerized by the power and beauty of these 20-foot, 2000-pound apex predators, he is acutely aware of his role both on-deck and as a representative of his profession. “I’m a fanatic about safety, and I’m surrounded by people who are the same,” he says. “If I act irresponsibly and get hurt, my friends’ lives are at risk. I’m also casting [EMS] in a negative light. I don’t take the responsibility for granted.”

The money can be good—as can the accommodations. Hudson is often put up in four-star tropical resorts. Rubbing elbows with A-list guest stars such as Guy Fieri, Shaquille O’Neal, and Michael Phelps is just another day on set. Hudson has compiled so much experience and respectability that he’s even executive-producing his own episodes of the series, to air later this year. 

“I’ll be doing this until I physically can’t make the grade any longer,” laughs Hudson. “And even then I’ll probably be in consulting or producing. This is where I belong.”

From Zero to 100 

The world of high-speed auto racing, where conditions can go from routine to havoc in seconds, seems acutely suited for EMS work. “It’s a rush for sure,” says Lisa Kaplan, paramedic and crew chief for AMR and a member of the AMR NASCAR Safety Team, which covers all races on the NASCAR Monster Cup circuit with a 7–8-person EMS crew. 

In 2017 Kaplan, who works in Rochester, N.Y., received a call from her general manager, who was looking to staff a safety team to cover the events at Watkins Glen (N.Y.) Speedway. 

“I think they actually liked that I wasn’t a fan,” says Kaplan, who travels to most of the events on the East Coast—Charlotte, Atlanta, Bristol (Tenn.), Talladega (Ala.), Daytona Beach (Fla.), and other storied racing venues. “They don’t want a fan. They want competent professionals who can handle their business.” A series of interviews culminated in her being named to the team in January 2018.

A typical race weekend begins with a Thursday “track walk” with a race official, followed by three days of racing culminating with Sunday’s Monster Cup main event. Kaplan sits in a chase vehicle with a physician during the race and monitors activities such as driver extrication, fire suppression, and clearing debris in addition to caring for the driver, who can be disoriented or unconscious. The safety crew is responsible for stabilizing drivers and removing them from the track—if transport to a medical facility is called for, the local on-site EMS crew from the track’s jurisdiction steps in. Crew members communicate with the tower and coordinating physician in the infield care center through headsets.

Unlike Kaplan, AMR paramedic Brandon Carroll has breathed asphalt and rubber his entire life. A child of the racetrack, Carroll’s uncle raced against NASCAR Hall of Famer Richard Childress, and his father was the jack-man at local tracks around his home in Martinsville, Va. In his 20s Carroll began working as a paramedic at events at Talladega and Martinsville Speedway. When AMR was looking to assemble a traveling safety team two years ago—negating the cumbersome need to assemble individual crews at each event—Carroll was a natural fit. The operations manager of Martinsville Speedway contacted Carroll, and he was named to the team following a series of interviews. 

Training takes up a significant part of serving on the safety team, he says—NASCAR has practice vehicles at its Technical Institute in Mooresville, N.C. to hone extrication and fire suppression skills.

In the event of a crash, upon arrival at the car the crews operate under the mnemonic Go WEST—for window net down, electric shut off, steering wheel removed, and toggles to shut off all car controls. Each track has a tool truck, a fire truck, and an ambulance, says Carroll. Cars are equipped with on-board heat-activated fire extinguishers. Drivers have an additional extinguisher within arm’s reach. Improvements in vehicle safety design and attire allow drivers to survive 200-mph crashes they wouldn’t have just a decade ago.

And while nobody wants to see a driver seriously injured, for Kaplan treating a driver seconds after a crash, rather than minutes, is a surprising change in perspective. “Any injuries are in the very early stage of manifesting,” she says. “It’s fascinating to witness the mechanism of injury from a medical perspective.”

“This is very much a family atmosphere,” Carroll says of the collegial nature of the job. “You bond with the officials, the drivers, the crews. I’m a fan of NASCAR, but that’s not why you’re there.”

Sole Medic on a Floating City

When Richard Montgomery heard from his former paramedic partner who was working on a Chevron oil platform in the Gulf of Mexico, he was intrigued—but completely unaware this specialty area of EMS even existed. Nevertheless, he called the hiring manager of his partner’s company for an informal chat. He was astounded to find himself driving south to Louisiana the next day.

“I had no idea what I was in for,” says Montgomery, who underwent 28 days of intensive training on everything from specialized hazmat instruction to scaffolding inspections, the policies of working in international waters, minor dental procedures, and even how to survive a helicopter crash in the water. 

The newly certified Montgomery was issued a hardhat and gloves and assigned to Hercules 251, a jackup platform rig stationed just off the coast of Louisiana in a block of the Gulf of Mexico called Main Pass 58. “They lift you from the boat in a basket by a crane that’s bobbing around in the water,” Montgomery says of the eye-opening initial days.

Within the first five minutes on the rig, he fell down a flight of stairs directly in front of the offshore installation manager, the most senior official on the platform. “Not the first impression I was hoping for,” he says.

Montgomery would quickly come to learn that life on a self-sustaining offshore oil operation is spartan, crowded, and continuous. “You get quickly overwhelmed by the scope of your responsibility,” says Montgomery, adding that OSHA comes down hard on any preventable injuries or safety violations. Treatment decisions are called in to a medical command physician for approval, but you’re expected to have a detailed care plan already in place. If something goes wrong, “Suits come in on choppers,” he says of the high-pressure environment. His schedule was 14 days on, during which you’re on-call around the clock, then 14 days off. Traveling all the way home to Florida during his off-time became a grind.

But there are perks. While there can be 100 men on a midsize platform, sharing close sleeping quarters and eating in shifts in a four-table dining room, OSHA requirements mandate a large separate sick bay that doubles as the spacious living quarters for the on-site paramedic. The food is plentiful and top-notch. The money can be excellent—Montgomery cleared a six-figure salary with bonuses. Responsibilities such as deck logistics management, helicopter landing, and health, safety and environmental supervision expand the scope of the job and can clear the way for career advancement.

“From day one, you’re considered one of the people in charge,” Montgomery says. “You spend most of your time operating like a primary care physician.” Medics also take the lead in mandatory safety meetings, educating the crew on topics as diverse as suspension injuries, flu prevention, and electrocution.

If you’re considering this unique line of work, finding a position may not be as difficult as you think, Montgomery says. While networking in this niche is still very much driven by word of mouth, “The truth is that there are lots of opportunities, and these companies are dying for help.”

The Right Temperament for the Trade

While EMS providers share many personality traits and skill sets, these out-of-the-box job environments carry specific requirements, and not everyone will be a seamless fit.

“They don’t want the trauma junkie,” Montgomery says of the operators of oil platforms, as so much of the work can be administrative in nature. “You can’t have an ego, and you have to get along well with others. People don’t realize how much of this is actually customer service.” Be calm and confident, not cocky, and hone your patience and people skills. 

“Get really good at what you want to do, and be a quiet professional,” Hudson adds of following your passion. “Get your fundamentals wired tight. Reach out, make connections, but don’t boast. Let your attitude and your skills do the talking. The opportunities will present themselves.”

Sidebar: Water World

Twists and turns, spraying and splashing—life at a water park is fast-paced, high-energy, and fun. For the EMS team at Wild Waves Theme Park in suburban Seattle, safeguarding the health and safety of the 7,000 daily visitors to the 70-acre water park means responding to everything from heat illness to river-ride collisions to bee stings.

Josh Pelonio, NREMT, is a full-time training coordinator at Skagit County EMS. During the summer he also works several shifts per week at Wild Waves.

The park’s EMS staff operates out of two separate first-aid offices and responds on foot and on specially outfitted golf carts, explains Pelonio. EMTs communicate through hand-held radios and an interpark phone system accessible to all employees. Calls are triaged through a dispatch base.

“Teamwork and integration with the aquatics staff are key points of the job,” Pelonio says. “We work very well in tandem.” 

Risk management on water safety and avoiding hazards in and out of the water ensure a safe and fun day for families at the park. But the EMTs at Wild Waves are just as likely to get questions about the location of the rest rooms or how to open a stuck locker as they are about how to treat sunburn.

“We’re here to provide a good experience,” says Pelonio. “You need to be a people person and carry yourself as a professional. This is EMS, but at the end of the day you’re an employee of the park.”

Jonathan Bassett is editorial director for EMS World. Reach him at jon@emsworld.com. 

Sidebar: The Show Must Go On

There I was, a properly licensed medical professional standing by at a chess tournament in a really big hotel.

That would be me at Opryland, fellow thrill-seekers. I was a paramedic at that Nashville resort for six years. It did not remind me of working EMS in Brooklyn.

At the center of the huge banquet hall were dozens of teenage players paired at desks with chessboards and clocks. Family members and other enthusiasts whispered as they wandered from game to game not far from where I was stationed. Discreetly attired in a generic work shirt, I could have been the guy called to change a lightbulb.

Did I mention I was nearing collapse after six hours of handing out Band-Aids and Tylenol? But wait, there’s more…

I was nodding off when I heard raised voices from a cluster of adults among the contestants. I grabbed my gear and hoped for a reason to use it.

And that’s how it was in the recreation business, folks: many hours of inertia punctuated by the occasional chance to practice.

Playing paramedic at Opryland’s most prized properties—the hotel, the Grand Ole Opry, and the General Jacksonshowboat—was a big change for me after 15 years of 9-1-1 in New York. It wasn’t a North-South thing—just a different set of rules where EMS had more to do with hospitality than hospitals. You had to stay ready for that rare, real emergency, knowing your employer cared more about your smile than your experience (I say that because a nice lady in HR told me my smile got me hired).

If you’re considering employment in the entertainment industry, perhaps my story will help you prepare.

One of the first things I learned as a healthcare provider at Opryland is that the show goes on despite medical emergencies. By show I mean whatever services, accommodations, recreation, or entertainment guests are paying for. Unlike real EMS agencies, where patient care and transport are the revenue producers, amusement centers make money on people having fun. Mood killers like illness or trauma interrupt fun. Our priority as paramedics was to minimize those interruptions.

At that chess tournament my patient turned out to be a high-school student in the clonic phase of a generalized seizure. People around me kept playing as the kid became apneic. It was tempting to suggest “medic takes both kings” as the next move for the game closest to my BVM, but at Opryland we risked discipline for disrupting guests’ good times.

It was common to work conventions carrying small subsets of supplies and equipment found on most ALS ambulances. For example, I didn’t have benzodiazepines that day—less of a factor when the young man’s seizure stopped, but I still had to use my own glucometer to make sure hypoglycemia wasn’t an issue.

Most of my calls at Opryland involved potentially emergent conditions only if one considered worst-case scenarios. Of 1,000-plus patients complaining of headaches, none bled into their brains on my watch. A similar number suffering from nausea didn’t need cath labs, and just as many with abdominal pain got through the week without appendectomies, bowel resections, or liver transplants. Still, cutting patients loose without a signature made me nervous. 

There were no procedures for turfing high-risk refusals to physicians. Our medical director, a good guy who helped me with a couple of outside-the-box scenarios, wasn’t hired to facilitate informed consent. Employees, performers, and guests who summoned EMS usually preferred to keep doing what they were paid or had paid to do, rather than taking time-consuming trips to hospitals.

When transport was inevitable we’d call Nashville Fire. They’d respond with an engine and an ambulance. Their personnel expected the same diligent preparation from us as ED nurses do from most of you. Medication routes, current vitals, and thorough histories were much appreciated.

My supervisor at Opryland was a medic, but his boss and everyone else up the chain of command had only as much EMS knowledge as the average titan of industry. What those executives did know was the value of happy guests. That’s why being a human buzzkill could cost you your job.

Once my postictal patient started breathing on his own, I tried to expedite transport but was confronted by a delegation from guest services. They told me the tournament director was unhappy about the evening’s distraction and wanted a copy of my PCR. I said no. Then I went about my business. The suits eventually found something better to do.

When I showed up for work the next day, nobody sent me home. That was almost as good as a thank-you.

Author’s note: Opryland no longer provides in-house EMS.

Mike Rubin is a paramedic in Nashville and member of the EMS World editorial advisory board.