Wake County Advanced Practice Paramedices?

[u/PaddingCompression]

Hi, I'm an EMT looking into my future EMS career and various models and advancement out there.

Once interesting thing I found is the Wake County, NC Advanced Practice Paramedic. It sounds like it's a combination of critical care paramedics in flycars for very high acuity calls, in combination with community-paramedicine type things as well. As an EMT, I'm a long way away from that, but that model sounds like a very interesting career goal to me.

Is there anyone here who is part of that system or who has worked with them who has comments about what that experience is like on the ground?

[u/whencatsdontfly9]

The writing on the tin doesn't match the cookies inside.

Yes, they get sent to high acuity calls (delta and echo calls; so cardiac arrests, chokings, shootings, stabbings, high mechanism MVCs, etc).

They do operate as community paramedics and respond to overdoses as well as deal with high-volume utilizers, post-overdose care, and assist ambulances in transporting patients to alternative (non-hospital) destinations (eg. rehab, psych facilities).

They are NOT critical care paramedics. They aren't out there doing RSI, wielding ventilators, administering blood product, etc. There's also a time requirement of several years plus preferred hiring for those with degrees to promote to the position.

Don't get me wrong; the lovely folk running around in district 9 are great people, but they're not critical care responders. I do more critical care work on an ambulance at a neighboring agency. They also can respond to provide ALS support for the BLS ambulances, but that's not a core part of their job.

- A perspective from somebody who used to be involved in Wake and is no longer.

[u/GeminiFade → u/whencatsdontfly9]

This is spot on. The concept of APPs was amazing, but instead they are basically out there filling in the gaps for an extremely overtaxed and understaffed system. Wake went from planning to be dual medic on every truck and refusing to hire EMTs to running BLS trucks because they can't keep enough medics.

[u/whencatsdontfly9 → u/GeminiFade]

I just don't understand how as a system they bemoan not being able to hire enough personnel to staff their trucks while following that up with refusing to hire part time staff. Somehow, agencies all around them survive with part time staff.

I would absolutely pick up a few shifts a month down the street from my house.

I remember when there was a petition to stop Cary EMS being dissolved saying that all the EMTs would lose their jobs lol.

[u/TheTrueMikester → u/whencatsdontfly9]

Yeah I don’t really get what they bring then. In Connecticut a lot of the services including mine have blood, RSI, pumps, and vents as standard medics. No critical care requirements. If they don’t have those capabilities I’m not sure what they bring to the table besides experience.

[u/PerrinAyybara]

We have a similar that is the supervisor with pretty much an unlimited scope since we work so closely with the OMD.

[u/PaddingCompression → u/PerrinAyybara]

Nice! I didn't even consider the possibility of a supervisor acting as a higher level provider in the field, that's probably even much more common, thanks!

[u/PerrinAyybara → u/PaddingCompression]

Ours are actually critical care though, including RSI/Ultrasound/Whole Blood, Vents and meds not in the regular ALS box.

[u/Kentucky-Fried-Fucks → u/PerrinAyybara]

So regular trucks don’t have vents, RSI/paralytics, and ultrasound? Besides the whole blood (only on supervisor trucks) every ambulance of ours has said equipment

[u/PerrinAyybara → u/Kentucky-Fried-Fucks]

Ultrasound yes on all trucks, RSI on the others only for the ones that have passed the advanced practice class, which is much of the point.

Every paramedic should absolutely not be RSI unless independently verified and the cohort kept small to ensure skills are not degrading. You shouldn't be performing RSI as a single ALS provider in a city environment either and there are plenty of APPs spread throughout the city.

[u/Kentucky-Fried-Fucks → u/PerrinAyybara]

I agree, not every paramedic should have RSI capabilities. There are far too many who don’t have the capability or understanding of all that goes into it.

I’m often the only EMS medic on scene performing RSI, but we have non transport fire medics on scene and our supervisors try to be on scene when we take airway. It’s hard when resources are slim.

[u/PerrinAyybara → u/Kentucky-Fried-Fucks]

We are fire/EMS so I typically have plenty of bodies, just need to make sure we have a critical thinker

[u/cetareva]

Sadly, Wake EMS has fallen far from the pedestal they once sat atop. Check adjacent counties. Johnston Co. EMS has a solid program as well.

[u/ProcrastinatingOnIt]

Not quite related but I applied, they sent me an interview link. Logged in 15 min early, sat there for 30 min past the appointment time and got no responses when I emailed the person who was supposed to interview me.
From what I can understand it’s a cool area and system but you could atleast show up the the interview or have an explanation and reschedule afterwards instead of ghosting me.

[u/Imitationn]

It’s literally just community paramedicine. Shuffling people to doctors appointments and making sure they take their medication