Robert Vroman, M.Ed., BS NREMT-P

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EMS1 Daily News

Mobile stroke ambulances to treat victims in Chicago suburbs

The ambulances will carry CT scanners, cameras for communicating with stroke neurologists and medication that can begin to dissolve clots and restore blood flow to the brain.

U.S. confirms 11th death due to defective Takata air bags

Takata air bags can inflate with too much force, which causes a metal canister to rupture and spew shrapnel into the vehicle.

Man gets probation after lodging octopus in toddler's throat

The boy later vomited at a hospital and medical staff suctioned an octopus measuring more than 2 inches long from his airway.

NC EMS, police aid Hurricane Matthew flood victims

EMS director: “This is the worst devastation I have ever witnessed.”

Chicago dispatchers take leave; causes overtime spike

Officials have had to hire dozens of additional dispatchers since at any given time, almost half of the city's dispatchers are on federal medical leave.

Inside EMS Podcast: How to care for geriatric patients

Our co-hosts discuss how one program is teaching paramedics how to deal and empathize with dementia patients by using virtual training.

Idaho grocery stores to offer Narcan

A two-pack of the Narcan nasal spray sells for about $150, which includes a counseling session on how to recognize the signs of an overdose and how to use the product.

Boston increases EMT staff to improve response times

A $2.5 million department budget will allow the city to hire on 20 new EMTs and replace 10 ambulances.

Wash. student saves father's life using CPR

The 14-year-old recognized his father was ill, so he dialed 911, laid him on the ground and performed CPR.

Watch: Paramedic stuns colleagues with opera voice

The paramedic said he sings for patients while transporting them in the ambulance

EMS1 Topic Articles

Mobile stroke ambulances to treat victims in Chicago suburbs

The ambulances will carry CT scanners, cameras for communicating with stroke neurologists and medication that can begin to dissolve clots and restore blood flow to the brain.

U.S. confirms 11th death due to defective Takata air bags

Takata air bags can inflate with too much force, which causes a metal canister to rupture and spew shrapnel into the vehicle.

Man gets probation after lodging octopus in toddler's throat

The boy later vomited at a hospital and medical staff suctioned an octopus measuring more than 2 inches long from his airway.

NC EMS, police aid Hurricane Matthew flood victims

EMS director: “This is the worst devastation I have ever witnessed.”

Chicago dispatchers take leave; causes overtime spike

Officials have had to hire dozens of additional dispatchers since at any given time, almost half of the city's dispatchers are on federal medical leave.

Inside EMS Podcast: How to care for geriatric patients

Our co-hosts discuss how one program is teaching paramedics how to deal and empathize with dementia patients by using virtual training.

Idaho grocery stores to offer Narcan

A two-pack of the Narcan nasal spray sells for about $150, which includes a counseling session on how to recognize the signs of an overdose and how to use the product.

Boston increases EMT staff to improve response times

A $2.5 million department budget will allow the city to hire on 20 new EMTs and replace 10 ambulances.

Wash. student saves father's life using CPR

The 14-year-old recognized his father was ill, so he dialed 911, laid him on the ground and performed CPR.

Watch: Paramedic stuns colleagues with opera voice

The paramedic said he sings for patients while transporting them in the ambulance

EMS1 Columnist Articles

Inside EMS Podcast: How to care for geriatric patients

Download this podcast on iTunes, SoundCloud or via RSS feed

​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss a program that's bringing awareness for EMS providers when caring for geriatric patients. They also discuss NAEMT's GEMS course and what you need to do to ensure you are delivering great care to this special population.

EMS workplace stress and warning signs

The situation in the scenario is all-too-common. EMS providers, along with their brothers and sisters in the fire service and law enforcement are asked to respond, remain calm and render care in the midst of emergency situations on a daily basis. It becomes easy to simply characterize this as someone else’s emergency and continue forward with the belief that these experiences do not affect the involved responders.

The culture within EMS is not universally conducive to supporting practitioners. Some EMS systems play host to a culture with a "suck it up" mentality that discourages timely processing of difficult calls.

In 2015, a group of EMS leaders participating in the Fitch and Associates Ambulance Service Manager training program created a survey to characterize the state of the mental health and well-being of EMS providers. The report resulting from the convenience sample, meaning respondents self-selected and opted in to participate, is titled " What's Killing Our Medics"" [1].

The findings from the survey are alarming and demonstrate a far higher incidence of suicidal thoughts and attempts among EMS providers than the U.S. average. In the survey, 37 percent of respondents reported having considered suicide compared to a CDC report of 3.7 percent for the U.S. population. Also, 6.6 percent of survey respondents reported a suicide attempt while 0.5 percent of the U.S. population makes a suicide attempt annually.

The survey also summarizes respondents' views on the effectiveness of mental health resources available to them. A majority of respondents who had previously participated felt that Critical Incident Stress Management, private counseling and employee assistance programs were all effective.

Alarmingly, however, many respondents had not sought assistance because of concerns about notations in their employee file, what their peers would think and not wanting to be identified.

Acute versus cumulative stress
Most EMS providers have been asked by a member of the lay public about "the worst call you’ve ever run" or "the worst thing you've ever seen." Honest versus sugar-coated answers aside, many providers can think of particularly traumatic or upsetting calls without too much difficultly.

These are the types of calls which may produce acute stress for providers. There may be some aspect of the call which is too familiar and makes it uncomfortable (a fatal vehicle collision involving the same make and model of vehicle your wife drives) or the nature of the call may be especially upsetting (child abuse or drunk driving collisions).

These calls are increasingly being recognized by EMS leadership as needing or at least offering an intervention. Even small EMS systems may be able to offer CISM services, peer support team or an employee assistance program in conjunction with surrounding agencies. As mentioned in "What's Killing Our Medics," participants in these programs reported that they found them useful in dealing with stress.

While acute critical stress incidents are better recognized, chronic stress may not be as well perceived. EMS providers are subjected to low levels of stress every time they are on a shift. Driving with lights and sirens, dealing with combative patients, fear for personal safety and compassion fatigue can all add up. Pile on the lack of sleep, long hours and difficult relationships at home and at work and it's easy to see from the outside how a provider can become overwhelmed over time.

While this may be apparent from the outside to the chronically-stressed EMS provider it may all feel routine. There have been reports of several EMS provider suicide deaths to particular acute stress incidents. Many EMS provider suicide deaths are more likely attributed to the build-up of every day stressors.

Stress management techniques
One of the first steps in managing stress is realizing that it is inevitable and is particularly prevalent in our line of work. The nature of EMS requires that providers not become easily overwhelmed while on a call and treating a patient. Over time, providers become adept at compartmentalizing that stress so that they can provide effective care during a call.

This is only the beginning, however. Finding a way to process that compartmentalized stress and finding a healthy release is key to maintaining good mental health. In the "What's Killing Our Medics" report, one third of respondents reported utilizing exercise to cope with stress while another quarter reported talking about stressful incidents.

Exercise and talking are good strategies for dealing with stress, but providers need to work to become aware of when standard coping strategies are ineffective. As reported in the survey, the mental health resources available to you are likely to be effective when used.

Intervening with others
EMS providers may recognize stress in their peers more readily than themselves which begs the question "What do you do about a coworker who is struggling""

Lending an ear is certainly a great step forward and processing stressful calls in a safe environment (like with your partner) helps manage your cumulative stress. Providers should be comfortable, however, with encouraging their peers to seek additional help if it seems like stress is becoming chronic, is resulting in unhealthy or risky decisions or if a coworkers begins talking about violence or suicide, even if they laugh it off as a joke. If you believe that a coworker is at immediate risk, contact a supervisor.

After checking out the ambulance, you and Jeff go into service. Once you arrive at your post, you mention to Jeff his recent streak of attendance issues and ask if everything is okay.

"Sure," he says. "I guess. I just feel like we aren’t really making a difference out here anymore. That and my school load is pretty overwhelming this quarter so I haven’t been sleeping much."

"Do you have anyone you can talk to"" you ask.

"Yeah I talk a little bit with my roommate, but he doesn't really understand what our job is like."

"Maybe you can see if the supervisor has a number of someone who has experience working with EMS providers or you can contact our employee assistance program directly."

"Yeah I guess, I just don't want people to think any less of me for looking for help; like I can't handle things here."

"I think people would rather you get a good handle on things and keep working here."

"Yeah I guess. I’ll give her a call when we get off tomorrow."

To learn more about stress and the EMS provider, check out the report " What's Killing Our Medics " and the site Reviving Responders developed by the authors of the survey. If you or someone you work with is struggling and in need of resources, The Code Green Campaign may be able to help. Their website has general and EMS-specific mental health and suicide resource links.


  1. Cord, A., Barber, E., Burke, B., Harvey, J., Newland, C., Rose, M., & Young, A. (2015, April 21). What’s Killing Our Medics" Retrieved from

How ePCR data improves patient care

Once upon a time, a medical emergency would be called into the neighborhood police or fire station, using a local seven digit number. The address of the call would be scribbled onto a sheet of paper and then dispatched over a radio to the ambulance crew, which recorded the information onto a log sheet. If patient contact was made, any patient care would be documented on a paper form, which may or may not have been left with the patient at the hospital.

Any records brought back to the station were boxed up and put in a storage room. Occasionally the patient care record might be requested for something like an investigation, but otherwise they gathered dust and were eventually tossed into the large circular file.

In the early history of modern EMS, this was how data was captured and kept. Forms became longer, and patient care reports became more detailed, but beyond the immediacy of billing and short-term quality assurance, little could be done with the information. While the data revolution may have begun in the mid to late 1980s with the advent of personal computing and electronic databases, the provision made by the Affordable Care Act to require electronic data capture into patient medical records and the drive to quantify outcomes in patient care has helped to spur a revolution in how we view the delivery of field care.

Indianapolis EMS monitored and analyzed its patient care report data to understand and respond to the opioid crisis with the police department. This is one example of identifying trends that can affect patient care. Systems that carefully and systematically collect data from system operations have influenced the evolution of emergency cardiac care, airway management and community paramedicine.

But data entry is onerous on the field provider. Most of us are grappling with electronic patient care reporting systems that are at times clumsy and unwieldy. The time spent documenting patient care is inordinately high. Data that should transfer seamlessly between monitors, tablets and dispatch computers often don't.

It's hard to keep in mind that all of these issues are part of the evolutionary change that is big data. Over time, systems become more reliable, interfaces become easier to navigate and data entry becomes easier and more consistent. Projects like the National EMS Information System (NEMSIS) and EMS Compass are helping to really identify, for the first time, trends in field care that relate to patient outcomes. It's critical that we understand what actually helps the patients versus what we think is helpful.

Of course we'll continue to gripe about how documentation is the bane of the profession. No doubt, it's a genuine pain sometimes, especially when you're stacked up three patient care reports and it's the end of shift. While not much of a comfort, take a small measure of solace in that the information you are helping to collect may have real impact in the profession locally and nationally.

How well do you know your patient's medications?

Knowing your patient's medications is an important part of determining or collecting an effective patient history. In this quiz, we will test your knowledge on the most commonly prescribed and top selling prescription medications. Research firm IMS Health released a list of these medications from April, 2014 to March, 2015. See how many you know.

How did you do" Make sure to share your results and challenge your EMS colleagues to match or beat your score.

Presidential debate medical coverage: 7 top takeaways

Medical coverage for high-profile mass gatherings, like a presidential candidate debate, is a critical, but often overlooked element of the complex and intense preparation activities of public safety personnel.

Planning for the October 9 debate between Donald Trump and Hillary Clinton at Washington University in St. Louis began many months before the two candidates met on stage. This was the fifth debate held at the University since 1992.

Here are some of the important and shareable takeaways from my participation as the EMS medical director in planning, logistics and operations of this event.

Tight security logistics
A presidential debate is definitely a mass gathering event, but the added element of tight security posed a unique logistical challenge when planning ingress and egress routes for crews and apparatus. Because access to the debate hall itself was tightly controlled and restricted, medical coverage to immediately stabilize, treat, then transport any serious medical emergency was a high priority leading to the development of an on-site, pre-staged medical team.

Medical equipment for the on-site, pre-staged medical team also had to be brought in several days beforehand for screening and security clearance. So pre-planning for necessary medications, equipment and supplies was essential.

Debate hall medical crew
The composition of the debate hall medical crew included an EMS physician and four paramedics. If needed, the team would initiate emergency treatment while simultaneously working with the Emergency Operations Center on campus to coordinate ambulance pickup.

The debate stage ready for the candidates. (Photo courtesy Washington University in St. Louis Facebook page)

Multiple medical operation areas
Additionally, the debate hall was only one of several areas of operation that needed medical coverage. Large numbers of police, fire and EMS personnel were assembled in strategic areas to cover routine calls in and immediately surrounding the Washington University campus. Public safety personnel were also positioned to form a quick response contingency should civil unrest or other incidents unfold.

Journalists from around the world cover the Debate from the media work area. (Photo courtesy Washington University in St. Louis Flickr page)

Strategically placed resources helped reduce response times that were significantly degraded due to the extensive traffic re-routing patterns and road closures required for security purposes.

Multi-day incident
Though the debate only lasted for 90 minutes on Sunday evening, many first responders started arriving and staging on Friday to provide medical services to the hundreds of personnel assembling for the event. Medical force protection assets were available in the various staging areas. A cadre of paramedics, along with one or two EMS physicians, formed the core element of these rapid response force protection medical assets.

Hillary Clinton speaking at the Debate. (Photo courtesy Washington University in St. Louis Facebook page)

Anticipating traumatic injury
Scores of protestors arrived on campus making the trauma potential from thrown objects or even biological substances a major concern. Medical response teams were created to rapidly extract injured personnel and were equipped with rapid decontamination capabilities and blunt trauma kits. Mutual aid paramedics were brought in to staff these teams and were augmented by EMTs from the university's campus-based EMS system.

Public expression zone at the intramural fields located on the campus. (Photo courtesy Washington University in St. Louis Flickr page)

A heavy security presence to help protect law enforcement and medical teams seemed to be an effective deterrent during the weekend and throughout the debate itself.

Value of NIMS and IAP
The value of using and adhering to principles of the National Incident Management System cannot be overstated. The entire Incident Action Plan was continually updated in an organized and step-wise manner.

In addition to ensuring medical response capability, the IAP also included scheduled clinic hours for the hundreds of personnel on campus who may have sustained a minor injury or illness during their operational period. An on-site clinic made it possible for essential workers to obtain an evaluation while optimizing their chances of performing and completing indispensable tasks. The clinics were staffed by EMS physicians and at least two paramedics with arrangements made with a local pharmacy to expedite delivery of medications.

Communication to medical control
In ICS, the operational medical assets are under Operations section and force protection medical assets are under the Logistics section. Which means the medical component of such a large and complicated operation may span across an IAP making the importance of good communication and pre-planning even more crucial. Having access to direct medical control in the form of physicians experienced in the subtle complexities of field care can also be advantageous especially in the rapidly changing environment of a mass gathering event with high potential for prolonged operations and evolving hostilities.

Mass gathering principles of EMS preparation and planning become more complicated when high profile and high-security elements are introduced. Frequent plan revisions are to be expected, but can be attenuated by a well-organized NIMS approach and reliance on trusted community partners to provide assistance.

Your career road map: From aha moment to dream job

By Jennifer Wyatt Bourgeois, Faculty Member, Criminal Justive with American Military University

As a child, your teacher might have asked the class, “What do you want to be when you grow up"” I remember in my classroom filled with 6 and 7 year olds, my fellow classmates declared with excitement and giddiness, “I want to be an astronaut,” or “I want to be a police officer.” When it was my turn, I stood up, cleared my throat and said with pride, “I want to be a doctor when I grow up.”

Fast forward 25 years, and I’ve ended up pursuing a career in criminal justice. I’ve been a probation officer, Federal Special Agent for the Department of Immigration, a forensic scientist and now, as a Criminal Justice professor, I stand before students (or do so virtually, in an online discussion forum) and ask the same question: “What do you want to be when you grow up"”

I have received responses ranging from blank stares to “I don’t know” to the elaborate response from the student who knows exactly what they want to pursue.

Full story: Your career road map: From aha moment to dream job

Why EMS providers are at risk of becoming a second victim

It's not uncommon to read an EMS journal and learn about a provider who has taken their own life. Perhaps the suicide, or attempted suicide, of a co-worker has impacted you during your career. Unfortunately, depression and suicide among health care professionals traumatized by adverse events occur too often and touch many lives and organizations.

Kathy Wire, JD, MHA, CPHRM, Project Manager for the Center Patient Safety states, "Individual EMS providers are the backbone of the health care system. Their ability to respond by bringing their best to work every day is critical to effective care. Yet these individuals face stress and tragedy that few outside their world can imagine. If the industry ignores the mental health of individual providers, it will lose the best resources. Conversely, efforts to acknowledge the potential fragility and humanity of providers protect them and their patients."

Emotional care
How do we care for frontline EMS provider's emotional well-being" Most EMS organizations have access to employee assistance programs and critical stress debriefing programs that are designed to assist employees during their most critical hour of need. However, gaps are apparent immediately following the adverse event, when intervention/peer support could begin the healing process before the employee reaches a crisis level.

Historically, EMS leaders have worked hard to encourage injury prevention and promote the benefits of a balanced diet and regular exercise, but incidents which challenge a providers' emotional resiliency after an unexpected outcome are usually not discussed as openly. Much of this has to do with a culture of EMS providers not wanting to appear weak or vulnerable.

However, EMS providers rely on emotional resilience to help get them through the day. Accumulated stress or unanticipated events can take a toll on this emotional resiliency, leaving a provider susceptible to depression and self-doubt as an EMS professional. When this happens to a provider, they become a second victim of the event.

Second Victim intervention
CPS understands that health care is not just physically demanding, but also emotionally demanding. This places EMS providers at risk for becoming second victims. Therefore, CPS is including The Second Victim intervention in this report as an industry call to action.

What is the Second Victim" In today's health care settings, clinicians face a multitude of demands requiring personal resiliency that relies on emotional defenses to carry them through the workday. Sometimes an unexpected patient outcome intensifies the emotional aftershock making it impossible for the clinician to focus on the task at hand. If not addressed, the emotional suffering may be prolonged, resulting in self-doubt regarding their future as a health care professional. This emotional response has been described as the second victim phenomenon.

The Second Victim program was designed by health care providers for health care providers. It supports the provider at the unit level with a program that can be tailor-made for each organization. And lastly, it fills a gap in health care that of proactive support for the provider, before they leave the profession or worse, make a decision to take their life.

When patients suffer an unexpected clinical event, health care clinicians involved in the care may also be impacted and are at risk of suffering as a second victim. Understanding this experience and recognizing the need for supportive interventions is critically important.

Six risk factors that put a provider at risk to become a second victim:

  • Pediatric cases
  • Multiple patients with bad outcomes
  • Unexpected patient demise
  • Young adult healthy patient
  • Patient known to the staff
  • First death on their watch

EMS physicians: We still make house calls

By Jay MacNeal

Mercy Health MD-1 is a 24/7/365 physician staffed response vehicle available to respond with EMS in the field and assist with patients for 15 counties in southern Wisconsin and northern Illinois. Mercy Health has a long interest in vertically integrated health care and views EMS as a significant part of that integration. The MD-1 program launched in 2013 has grown to four response vehicles staffed by an EMS medical director, Jay MacNeal, MD and seven associate medical directors.

Paramedic Chief asked MacNeal about the history of the program and its components, how MD-1 physicians are selected and trained, the response to MD-1 and how the program has improved patient care.

Paramedic Chief: What is the purpose of a field EMS physician"

Jay MacNeal, MD-1: Football teams would not go to the Super Bowl without their coach nearby. One of the key components of a high-functioning EMS system is an involved coach. That coach is the EMS medical director.

The rationale to have a physician on critical scenes seems obvious to EMS physicians. We knew we could better support our EMS providers with further training, bedside teaching and physician response to critical patients.

There is no better place to see in real time what an EMS system is doing than in the field working directly with EMS providers. Many EMS medical directors participate in field care with EMS providers when they are able. This experience can be obtained by riding with crew members on an ambulance, riding with a field supervisor or by using a physician response vehicle.

Paramedic Chief: What qualifications are needed for the physicians"

MD-1: The MD-1 vehicle is staffed by residency-trained emergency medicine physicians who have an interest in prehospital activities. All EMS physicians who staff MD-1 have served in fire, EMS or law enforcement at some point during their careers. The physicians also staff our emergency departments to retain that skill set and work on the receiving end of our EMS system.

We set our goal to be the kind of physicians who people look up to in their communities as leaders and trustworthy colleagues. We see our EMS providers as every bit as important as any other part of the health care system.

Keep in mind the first 10, 20, 30 or even 60 minutes of critical patient care does not occur in the hospital. The most critical time period of patient care occurs in the field.

Paramedic Chief: What training do the physicians receive"

MD-1: EMS physicians staffing the MD-1 trucks complete extensive training and an orientation program before they are allowed to take independent call on the truck. Emergency vehicle driver training, incident command, hazmat and TEMS training are required. They are mentored by a seasoned EMS physician and approved by the system medical director prior to ever working a shift on the truck.

Paramedic Chief: What equipment is stocked on MD-1"

MD-1: In addition to physician knowledge, the MD-1 vehicle arrives with equipment and medications not routinely carried or even allowed on paramedic ambulances. Ultrasound, chest tubes, central lines, an amputation kit and junctional tourniquets are just some of the extra equipment carried.

The fleet has two Chevy Tahoes and two Chevy Suburbans equipped with lights and sirens for emergency response. All are equipped with local and statewide radio networks for both Illinois and Wisconsin, since we cover 15 in both states.

Paramedic Chief: How have EMS providers reacted to MD-1"

MD-1: Before launching the program, we made extensive efforts to educate EMS providers about what the program was here to do. Despite our best efforts, the program has not been without some road bumps. Some EMS providers were concerned early on that the EMS physicians would interfere, write them up or just be another mouth to feed at the dinner table.

We also needed to work through regulatory issues with Illinois and Wisconsin since this was a new concept. Both state EMS offices sat down with us and worked through a solid process and plan to ensure the program was compliant and served as intended to improve EMS care.

Paramedic Chief: What about opposition from competing hospital systems"

MD-1: We educated competing health systems that the program would benefit them as well, since the skills learned by the EMS providers would also benefit their patients.

MD-1 does not bill the patient or EMS agency. It transports with EMS to the nearest appropriate destination, and when requested to respond, works with all EMS providers regardless of their medical direction.

Paramedic Chief: How did you gain the trust of EMS providers"

MD-1: Building relationships with EMS providers was critical. We knew the MD-1 was a new concept. We did not want EMS providers to think we were taking over their skills or coming into the field to punish them.

MD-1 stands for Medical Director-1, not Mobile Discipline-1. We have physicians do ride time on the ambulance and give extensive training lectures.

Physicians value EMS providers’ efforts and their importance to the overall patient care. Physicians are there when EMS has a concern. Basically, physicians are doing all the things a physician should do in the eyes of their EMS providers and patients.

Paramedic Chief: How has MD-1 improved patient outcomes"

MD-1: Once EMS providers became comfortable with the EMS physicians and the EMS physicians became comfortable with the EMS providers we knew we were on to something. The amount of bedside teaching, critical procedures and integration of the EMS system into the overall health care system was incredible. Clear indicators the program was working were:

  • Decreasing door to CT times for trauma and stroke patients
  • Increasing cardiac and traumatic arrest survival
  • Improving communications between EMS and the receiving hospital

EMS physicians have considerable protected time for field response and really become immersed in it. MD-1 EMS physicians handled on-scene rehab during major events and served as a linkage between EMS and public health during a recent outbreak. They also improved patient stabilization, thus allowing transport to the specialty center initially which reduced time to definitive care.

Paramedic Chief: How has the program grown since it was founded"

MD-1: As the program developed, we continued to grow. In four years, we had three 24/7 trucks with a backup truck available as needed. We have grown from one EMS physician to eight and we are actively recruiting for several more.

The program has been a benefit to both EMS and the doctors. EMS providers can call their EMS medical directors 24/7 for real-time consultation. The EMS physicians feel they are part of the system, see true value to their work and the physicians have suffered less burnout than they had prior to the program.

Paramedic Chief: What are some other MD-1 successes"

MD-1: We have published papers on issues we have seen and improved upon as EMS physicians. Those papers include:

We created Casualty Care Kits for mass wounding events. We helped with ramp-up alarm tones for better firefighter health. We offer community based tactical training. The classroom casualty care program has been presented to EMS providers and physicians at EMS World Expo, the Exemplar Innovation Trauma Center, the Iowa EMS Association conference and the American Association for the Surgery of Trauma) Conference.

We are working on methods to validate physician field response and looking at our European counterparts’ life and cost savings to the system. EMS physicians in the field have incredible value in integration of health care for routine and emergency situations when appropriately trained, equipped, and motivated.

The success of this program is the direct result of EMS providers learning to work in tandem with unconventional responders. Having a physician in the back of an ambulance can make some EMS providers nervous. At the end of the day, we are all here to save and improve lives.

My associate EMS medical directors — Drs. Chris Wistrom, Todd Daniello, Sean Marquis, John Pakiela, Matt Smetana, Ken Hanson and Mitch Li — and I are blessed to be part of the most critical time period in emergency medical care. We are incredibly proud of our EMS providers and their willingness to teach us, work with us and give their best to our patients every day.

EMS Artwork: Ditch doctors

Dan Sun Photos Routine

Sometimes I just have to stop and think how crazy my job is and how much I love it. Trying to intubate someone in a car during a thunder/hail storm while firefighters are ripping the car apart to extricate my patient just reminds me why I wanted to be a paramedic in the first place. The situations we find ourselves in are sometimes truly unbelievable.

At times, other healthcare professionals don't understand the environments we need to work in. When we arrive in the ER, our patient is neatly packaged and stabilized, they don't know that in order to get that IV we needed to use our cell phones as a flashlight to see what we were doing or that we needed to cut the fence out around our impaled patient to get him in our ambulance. Sometimes we don't have the convenience of checking their Mallampati score or even getting a history before treatment.

How joining a first responder credit union can increase your savings

By Andre Wong and Megan Wells, EMS1 Contributors

Want to save more money" As an EMS provider, you're eligible for membership at many credit unions that serve first responders. These institutions may offer you special rates to help you grow your savings.

First responder credit unions are able to offer their members higher APY rates for savings deposits and IRA accounts. Depending on your banking needs, a credit union might be the best choice for setting up a retirement fund and long-term savings.

Credit unions and banks share many of the same functions. Both can make loans, issue checks and credit cards, and offer investment services. The main difference is that since credit unions are nonprofit organizations, they don't pay income taxes and can pass the savings to their members. For example, you may pay fewer fees and lower interest rates on large purchases and homes.

First responder credit unions and APY

APY stands for annual percentage yield, or the amount of money your deposit will earn over a single year just for letting the bank use it. If you made a deposit of $1,000 and had an APY of 1 percent, you’d end up with $1,010 after one year.

Wells Fargo savings account APY 0.01 - 0.07 percent

The vast majority of first responder credit unions on our list offer a starting APY of 0.05 percent for a savings deposit. That number may increase to 0.25, 0.50, and even 2.00 percent APY depending on the organization and how much money you deposit.

First responder credit unions and IRA accounts

IRA accounts are meant for long-term savings. You can expect greater returns from an IRA, but they require more money to start and can't be withdrawn without penalties until certain conditions (such as retirement) are met.

The rates offered by Wells Fargo are about what you can expect from a large bank, yielding a little over 1.00 percent annual growth when APY is maxed out.

Wells Fargo IRA account APY 0.10 - 1.05 percent

Not all EMS and fire credit unions offer the option of starting an IRA account, but many that do can offer even better rates for long-term savings. Of the 22 credit unions on this list, 19 offer a higher maximum APY on their members' IRA and CD accounts than what a large bank can provide.

Some of the APY rates for savings and IRA accounts offered by firefighter credit unions can be found in this table:

State Credit Union Savings APY IRA and CD All PenFed 0.05 - 0.15% 0.05 - 1.26 % Arkansas Little Rock Fire Department Federal Credit Union 1.10 - 1.60 % N/A California San Diego Firefighters Federal Credit Union 0.10 - 0.50 % 0.15 - 2.00 % California Firefighters First Credit Union 0.05 - 0.30 % 0.25 - .070 % Colorado Denver Fire Department Federal Credit Union 0.10 - 0.20 % 0.15 - 0.30 % Colorado Aventa Credit Union 0.05 - 0.30 % 0.35 - 2.02 % Connecticut FD Community Federal Credit Union Varies 0.80 - 2.02 % Delaware Wilmington Police & Fire Federal Credit Union 0.05 % 0.05 % Florida Jacksonville Firemen's credit union 0.05 - 0.25 % 0.05 - 1.06 % Hawaii Honolulu Fire Department Federal Credit Union 0.10 - 0.15 % 0.20 - 1.25 % Illinois Chicago Firefighters Credit Union 0.10 - 0.25 % N/A Indiana Firefighters Credit Union 0.10 - 0.25 % 0.30 - 1.30 % Massachusetts Haverhill Fire Department credit union 0.05 % 0.25 - 2.00 % Massachusetts Boston Firefighters Credit Union 0.25 - 0.60 % 0.75 - 2.02 % Missouri Greater KC Public Safety Credit Union Max of 0.30 % Max of 1.87 % North Carolina Charlotte Fire Dept. Credit Union 0.15 - 0.25 % 0.35 - 1.00 % North Carolina Emergency Responders Credit Union 0.25 - 0.65 % 0.25 - 1.25 % Nebraska Omaha Firefighters Credit Union 0.10 - 0.20 % 0.85 - 1.40 % New Jersey Bloomfield Fire & Police Federal Credit Union 0.50 - 0.70 % 0.85 % New York Syracuse Fire Department Federal Credit Union 0.45 - 0.50 % 1.15 - 1.46 % Ohio Dayton Firefighters Federal Credit Union 0.15 - 0.30 % 0.35 - 1.53 % Ohio Firefighters Community Credit union 0.05 - 2.00 % 0.20 - 1.45 % Ohio Akron Firefighters Credit Union 0.10 - 0.25 % 0.15 - 0.90 % Oklahoma Fire Fighters Credit Union 0.05 - 0.40 % Varies Pennsylvania Police and Fire Federal Credit Union 0.10 - 0.50 % 0.50 - 2.00 % Tennessee Nashville Firemen's Credit Union 0.10 - 0.29 % 0.75 - 1.15 % Texas Houston Texas Fire Fighters Federal Credit Union 0.15 - 0.45 % 0.15 - 0.60 % Utah Firefighters Credit Union 0.15 - 0.35 % 0.35 - 2.31 % Virginia Richmond Virginia Fire Police Credit Union 0.20 - 0.60 % 0.40 - 1.51 % Washington Spokane Firefighters Credit Union 0.10 - 0.35 % 0.75 - 1.00 %

Are we missing a credit union" If you’re a member of a credit union for EMS and fire professionals that you don't see named here, please let us know in the comments below so we can include your organization on our list.


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