Where Can Paramedic Skills Take You? All Around the World

What are some promising, interesting, satisfying alternative career pathways for paramedics who are looking for off-ramps from the daily grind of ambulance street calls while hoping to extend their careers and continue practicing the intense, high-pressure medical response for which they were trained? Some of the stressors standing in the way of a longer career for paramedics were discussed in a recent article in EMS World.

Phil Barquer, a paramedic in Austin, Texas, cites the often-quoted statistic that the average paramedic in the US lasts 6 and a 1/2 years on the job. “Personally, I go through a five-year cycle of feeling burned out and wanting to change [jobs and settings]. Making those changes has kept me in the field significantly longer.”

Barquer has cycled through a variety of options over the past 19 years, along the way picking up new skills and knowledge while keeping the work fresh. He started as an EMT working with lifeguards on Southern California beaches while still in high school. Later, after a couple of years with military operations in Kuwait, he worked with firefighters and did hurricane rescue, bomb squad, and various other roles in Texas. Along the way, he took advantage of new training opportunities while still finding ways to stay in practice for traditional ambulance calls.

Other paramedics have pursued jobs in the national parks, on oil rigs or cruise ships, providing medical support for police SWAT and forensic teams, as part of emergency flight or helicopter crews, and on humanitarian missions responding to natural and human-made disasters in other countries. Travel medicine, going from town to town wherever there are openings, is another way to shake things up. But being a paramedic doesn’t have to be the end of the line for career advancement, Barquer says. Some of his colleagues have gone on to become nurses, physician assistants, and physicians.

Growing Up Fast

Responding to emergencies—head and spinal cord injuries, drownings—and having to make life-and-death decisions on Southern California beaches starting at age 18 “made me grow up pretty fast,” Barquer says. Mentors encouraged him to get fire academy training, but he realized he preferred emergency medicine to firefighting.

“Later I opted to start applying out of state, somewhere I could really spread my wings as a paramedic and work more on my own.” He ended up working for Albuquerque Ambulance in New Mexico, which he calls a life-changing experience, moving out of Southern California to a place where he had no family and needed to set up new routines and ways of life, “the whole nine yards.”

In Albuquerque he was also allowed to work in a hospital emergency department, doing urgent care on PRN shifts for Presbyterian Healthcare, which managed the local EMS service. “I had never really seen what happens to our patients after we drop them off at the ER. I got to see the back end of things that I’d never seen as a paramedic.”

At the same time, the EMS consortium at the University of New Mexico was hiring for a new program of tactical medics, which it was creating from the ground up for the state Department of Public Safety. For Barquer, that included accompanying SWAT (Special Weapons Tactics) teams, firefighters, and other first responders on calls, providing medical support for those deployed in real-world crises. He also provided medical care for the explosive ordinance disposal team and helped to pioneer a new program to bring whole blood out to patients in the field.

Wildfires and Hurricanes

After a few years in New Mexico, Barquer’s fiancée, now his wife, herself a nurse and paramedic, returned from working a job as a medic on a sea cruise, wanting to find her new horizons. She started doing helicopter emergency medical transport. And from there it was a short step for both of them to sign up to go to Kuwait, providing emergency medical calls for US troops in the Middle East, diplomatic personnel, contractors, and others stationed there.

“We were getting paid for our knowledge, skills, and ability to run critical medical calls and critical incidents at a moment’s notice,” Barquer says. That could mean responding to army “dust-offs” (combat casualty evacuations) or loading up an air transport medical team for a drive across country to the nearest hospital or air transit vehicle. “That’s also where I got my first deep dive into critical care medicine, along with tactical medicine, and then I was promoted into another job that turned me on to the educational side of the house, training others,” he says.

When they returned statewide, they settled in Austin and Barquer started working in varied capacities for Austin-Travis County EMS, such as in a small division of special operations for the City of Austin, an all-hazard rescue team assigned at the request of state or local jurisdictions. “We do high angle rescue, using rope rescue techniques for vertical terrain, low angle rescue, wilderness rescue, swiftwater, hazmat, trench rescue, confined spaces, industrial rescue—we have to be proficient in all of these areas. I’m also a swiftwater boat operator to Texas Task Force One, responding when the governor activates the task force for significant weather events,” he says.

“We’re also the wildland paramedics unit and rapid extraction team for wildfires—which is a booming career path for paramedics these days. I’m also the paramedic team leader for the Counter Assault Team—a weekend job responding to mass shootings, riots, large vehicular crashes.” And he takes gigs as part of private security teams.

“In Austin, the variability of what we do keeps it interesting. Our department is also the state’s infectious disease response agency, which responded to the first planeload of Americans with COVID coming back from Japan in February of 2020.” Last year, Barquer had the experience of leaving a fire zone, where he had been providing medical support for firefighters who can’t be pulled off the front lines to deal with the medical needs of a colleagues, then picked up a Zodiac swiftwater boat and drove it straight into a hurricane zone.

Bear Mauling and Bison Goring

For paramedic Kevin Grange, his greener career pastures were discovered in the major national parks, starting with Yellowstone, where he landed in March of 2014 at a low point in his life in Southern California. As described in his 2021 book, Wild Rescues, (Chicago Review Press), Grange quickly learned new skills to address heat strokes, frostbite, hypothermia, broken bones from falls, allergic reactions, lightning strikes, even—depending on the local wildlife—bear mauling and bison goring.

“Sometimes it’s just me running the ambulance by myself and waiting for other park rangers to arrive. So that was a learning curve for me. And also having the expanded scope of practice because the nearest hospital is often hours away.” He now works as a full-time paramedic for Jackson Hole, Wyo., Fire/EMS, adjacent to Grand Tetons National Park.

“I didn’t even know there were paramedics and EMTs working in national parks,” Grange explains to EMS World. “When I found that out, it seemed like a light went on for me. I saw an opportunity to join my two passions, which are medicine, working as a first responder, firefighter and paramedic, and the outdoors. Once I got out in the mountains, I realized that this is the place I should be. And so I lost my interest in going back to the city. As you’re running these difficult calls, you’re in this beautiful setting, getting renewed spiritually, emotionally, and physically,” he says.

“Another thing I found working for the Park Service was that I was surrounded by my ‘tribe’. There are a lot of ways or areas people can work in EMS and fire. I like to tell people: Look to where your tribe is—the people who reflect you, that have your same interests.”

Grange has pursued additional training from the Wilderness Medical Society, NOLS (the National Outdoor Leadership School), and the Ski and Mountain Trauma Conference in Sun Valley, ID. Such training was not required to get started with the Park Service. “Generally they like you to have your national registry as an EMT or paramedic,” he explains, although the Park Service also provided him with additional orientation and skills tests.

He encourages other paramedics with leanings in this direction to explore the opportunities, which might be just taking a summer off from their regular job to work a busy summer shift in a national park—to see if it fits for them. Or even request a ride-along experience with a park service ambulance crew. Another option is to explore life in mountain towns, which may be located close to a park or other natural settings. “You’re still working in that wildland-urban interface, and we get to wear all the hats—wildland fire, structure fire, EMS, search-and-rescue, swiftwater rescue,” he says.

“It’s a fun time right now because you can really take that paramedic or EMT certification and explore,” with the potential for finding a better work-life balance. Meanwhile, Grange is learning to fly fish and regularly enjoys mountain biking, skiing, and whitewater rafting. “So I’m always outside, in my happy place. Even decompressing after a tough call, I find my inspiration in nature.”

What Lies Ahead?

For Rachel Matthews, a newly qualified paramedic after two years working as an EMT for Florence County, S.C., EMS, her current goal is to stay put for a few years as a street medic, honing her skills and growing more comfortable with her abilities. “And then I’m hoping to travel.”

That might mean just traveling to other locales with posted positions like travel nurses do. “I’d love to travel all over this country and out of country.” She also hopes to do relief work in the future—such as the international response to the recent earthquakes in Turkey.

For many of these alternative pathways beyond ambulance paramedicine, there may be a requirement for additional training and skills development, Matthews says. “For example, SWAT medicine has a physical aspect that not all other EMS work has. You have to be able to keep up with the SWAT team, and that’s on top of just really knowing your medicine, for example how to treat a gunshot wound. And it’s the same when you go into search-and-rescue, mountain rescue,” she says. “I hope to learn tactical medicine and wilderness medicine.”

Paramedics have lots of opportunities for specialization, which she has started to explore. “If you don’t want to work the streets, it could be on a cruise ship or an oil rig, or in the wilderness. I could either stay a street medic like I am—or choose to specialize. That’s my plan, to move in different directions.”