In a comment on this post, @sapphire asked, "Would you recommend being an EMT at all?"
In 2017, after I got fired from Google for being racist against white men, I decided to execute on my plan of changing careers to work in health care, with the goal being a role where I could prescribe hormones to trans people. After taking some classes, in 2019 I completed EMT training at Merritt College in Oakland, a community college. The training program was not like other college classes. The instructors were current and former members of the Oakland Fire Department. Most college instructors I've met had, to more or less of a degree, a desire to accept feedback from students; if you pointed out in class that they were wrong, they didn't take it as a personal attack. It turns out that in career education, you're less likely to find that attitude, and more likely to have an instructor who repeats things that are factually false but expect a hierarchical environment where no one points out when they're wrong.
I did succeed in getting my EMT certification, though. During the class, I learned that at least in urban areas in the US, no one gets a job as an EMT in the 911 system without prior work experience. The way that you get work experience is by working for an interfacility transport company (IFT), doing "basic life support" calls. "Basic life support" means that you're a glorified taxi driver, who transports patients who aren't able to sit up in a car, but don't need any other medical care in transit. Most of the work amounts to transporting elderly or disabled patients between hospitals and warehouse-like "skilled nursing facilities" (a misnomer). These are generally people with no one to advocate for them, because if they had family or friends who were involved in their care, they would probably be able to get around another way.
So I got a job at one such company in the Bay Area, in summer 2019. Eventually, they let me drive the ambulance. Then I backed into stationary objects, twice, and they made me take the driver training class again and I got to drive the ambulance again. What you do when you're not driving the ambulance is ride in the back, with the patient, while your partner drives. You take the patient's vital signs every 15 minutes and document them on an iPad with a terrible user interface. All the way from EMTs making barely above minimum wage, to MDs, most of your actual work time as a health care worker is spent writing documentation to ensure that your patients or their health insurance companies can be billed for the care you're giving them. Taking vitals provided the thin veneer of medical justification needed to bill the patients' insurance, claiming that it was medically necessary for them to ride in an ambulance rather than a medical transport van or a taxi. The patients were stable and didn't need it -- if they weren't stable, they'd be riding with a paramedic, not an EMT.
"EMT" and "paramedic" get used interchangeably by lay people, but at least in the US, paramedics have about 18 to 24 months of training, while EMT training can be completed in a couple of weeks if you take an intensive class (or a semester if you take a normal class). EMTs have a much more limited scope of practice. In California, only paramedics can start IVs, intubate patients, and give medication (with a few exceptions; EMTs can administer epi-pens and Narcan, just like anyone else can).
One time, I had a patient who came on with low-flow oxygen and whose oxygen saturation was dropping, so I put him on a non-rebreather mask with high-flow oxygen. Actually, I didn't, because the one time I had a patient who needed that, I had a student riding with me and I gave him the opportunity to do it. It only happened once. Another time, we had an elderly patient with dementia who declined rapidly after we left the hospital, and my partner gave her ventilation with a bag-valve mask. I was driving, so I dealt with the logistics of turning around and going back to the ER. Once or twice, we were first on scene at an accident, but no one was seriously injured and we didn't do much besides sit there until the fire department arrived on scene. Other than that, the most I would do would be to disconnect oxygen from the concentrator they were on at the hospital and reconnect it to the tank attached to the gurney and then the one in the ambulance. I didn't use any of the other skills I learned, and had I gotten a 911 job, I'm not sure I would have been prepared for it.
The actual work of caring for patients as a BLS EMT is usually pretty depressing. You're taking people who are usually not in a good place in life to a place where their life won't get any better. I could say something about how even during a 10-minute ride, you can extend kindness and respect to somebody who might not be getting any of it from elsewhere, but really, that would be insincere. Of course, I did do my best to treat everyone with kindness and respect. It's just that you see someone for 10 to 15 minutes (usually), and then never see them again. The theory is that these jobs provide you with experience so you can get a job for a different company, or for the county (depending on how far your county has gone in privatizing EMS), but you don't actually learn that much from them; maybe a little about how to lift and transport patients, but you learn that in the first week or two.
The job paid $17 per hour, which was less than some fast food jobs in the same area. The fast food workers should get paid well, too; it's not their fault that the economy is structured to demand more and more from service workers while providing less and less reward. Most of my co-workers were college-aged or barely past college, living with their parents. It's hard to imagine how someone could live on that salary as a full-time worker in Marin County, without parental support. For most people, it was a stepping stone to another job, including me, of course -- nursing, med school, physician assistant school, or in a lot of cases, firefighting or police. There were a lot of bros, it was mostly men, and because it was in Marin County, mostly white men. I would have partners who talked about being a "Second Amendment guy".
I mentioned that I started in summer 2019, which means I was working as an EMT when COVID hit. Most of my co-workers didn't take it seriously, even after it was clear that COVID was serious. When I wore a mask inside the station, a young male co-worker said in a sneering tone of voice, "are you afraid of COVID?" (We were required to wear masks.) Our company would only let us wear N95 masks when we were transporting a known COVID-positive patient. We never got hazard pay. Just before I quit (in fall 2020), they announced they were giving us all a "COVID responder" enamel pin. I never even got my fucking pin.
Despite all that, there were a lot of good things about the job. There was plenty of downtime between calls, even after COVID. Our company was about what you would expect for a for-profit ambulance company, but they weren't trying to work us to 100% efficiency. Enough people were on shift that we weren't rushing to turn around the ambulance after every call. An eight-hour shift would normally have 2 or 3 calls. Between doing the rig check (taking inventory of all the supplies on the ambulance, which my co-workers usually wanted to skip), driving to and from the pickup and dropoff points, and cleaning up the ambulance between calls, that would take maybe 50 to 60% of the shift most of the time. There were even fewer calls if you worked nights. That gave you plenty of time to sit in the station and watch TV, or work on the book you were writing if you were me. (I haven't finished the book, because I got another job, and then another one.) Supervision was extremely minimal; when you're out on the road, who knows what you're doing? (Unless someone complains, which they rarely do.) Driving around is fun. And when you were on a call, it was (almost) always clear what you needed to do and it was addressing a direct, immediate need.
I might still be in that job if it paid a living wage, to be honest. A job with downtime, where you aren't expected to look busy when there's no work to do, and you get to drive around and see different places (even if most of them are hospitals), is kind of the dream. But there was no way to make a living. I had other jobs the entire time, and that still wasn't enough. I got a better-paying job in health care, and then I decided I wasn't going to go to nurse practitioner because no one gets treated with respect in medicine except MDs, and med school didn't feel like it was on the table for me. So I went back to being a software engineer.
In more rural parts of the US, EMTs get to do more, and 911 calls might actually be handled by a pair of EMTs (in the Bay Area, it would always be a paramedic with an EMT). That would be a very different experience. As it was, being an EMT wasn't much like what people imagine when you hear "EMT", and the need to pay your dues at a job like the one I had for at least two years means it's less of a stepping-stone to a higher-ranked job in health care, unless your final destination is being an EMT or paramedic. (By the way, paramedics don't get paid much more than EMTs in return for their greater level of responsibility, at least in my area.) It makes sense for prospective firefighters, since they have to be certified as EMTs anyway. Other than that, the reasons I would recommend it aren't the reasons you might think. Most people don't think "routine, boring job where you don't actually have to work very hard", but there you go.
I haven't stayed in touch with any of my former co-workers and I don't know how the field has changed in the post-taking-COVID-seriously, "no one wants to work anymore" era. My co-workers at the software company where I am now seem to fall silent when I talk about my previous jobs. I don't know how people feel about having been at home, working on the computer while I was out driving ambulances. Actually, I do know how some of them feel, to wit: that the biggest trauma anyone could have experienced during the early part of the pandemic was to be isolated at home, collecting paychecks and watching Netflix. I have a set of experiences and memories that are likely to be unshared by most of my peers for the rest of my life. I've been inside prisons. I've stopped worrying about how much I recycle, after seeing the sheer volume of single-patient-use shit that hospitals throw away. I'm glad for the realness of it, but let's be honest, I'm also glad to be getting paid a lot more for doing work that's easier in some ways, though not so much in others. (I work for a consultancy, so I actually have to work a minimum number of hours per week and it doesn't include watching TV on a couch.) If you want an entry-level health care job that will teach you something, it's probably better to train as a CNA (those are the people who do the real constant patient care in hospitals and nursing facilities) or an MA. But if you like to drive around and not have to do actual work for most of your shifts, and if you're (somehow) independently wealthy or have support from a partner, family or whatever (or you live somewhere cheap), there are worse things than being a BLS EMT.
