If you’re an EMS worker who is thinking of relocating or just wants to learn more about life across the U.S., EMS World’s State Department is worth a look. We start with “snapshots” of featured states, then bring you exclusive guidance from local EMS leaders. Our goal is to highlight everyday aspects of potential destinations from a prehospital provider’s point of view.
Most populous cities (approximate): Los Angeles 3,976,000; San Diego 1,407,000; San Jose 1,025,000
Violent crime one-year change: Los Angeles +2%, San Diego -5%, San Jose 0%2
State violent crime rank (↑): 363
State property crime rank (↑): 243
Health rank (↓): 174
Top state income tax: 13.3%6
Average sales tax: 8.5%6
Average property tax: 0.76%6,7
Median home value: $544,9008
One-year change: +6.5%8
Median monthly rent: $2,7508
Average cost of electricity: $0.21/kwh9
Average temperatures: Summer 73ºF, Winter 46ºF5
Plenty of Attractions
What’s California like? Big and diverse—the most populous and third-largest state—with major cities, sprawling suburbs, and unspoiled wilderness north and south. Its climate, culture, and attractions offer something for everyone. Consider these features:
California is roughly 250 miles wide, with 50-degree temperature differences between coastal and inland areas due to the state’s distinctive topography. We’re talking mountains and valleys, but not just any mountains and valleys: the highest peak in the contiguous U.S., Mt. Whitney (14,505 feet), and the lowest point in North America, Death Valley (282 feet below sea level).
California has 840 miles of shoreline that stretches from the Northwest to the Mexican border. Only Florida and Alaska have more oceanfront territory. Average summer temperatures vary by 20 degrees from Eureka in the north to Los Angeles in the south.
With so much access to the Pacific coast, it’s not surprising that water sports are a prime source of recreation—but so is skiing.
All five major professional sports—football, baseball, basketball, hockey, and soccer—are represented by at least three teams each and 20 in all.
California has two of the five most populous urban areas in the country, Los Angeles and San Francisco, but 45% of the state is forest, and 25% is desert.
Per the Modern Language Association of America, 43% of Californians speak languages other than English at home.
California’s tourist attractions are as dissimilar as they are famous, from grandiose amusement parks like Disneyland to natural preserves like Yosemite National Park.
Disasters and Other Challenges
More important than climate or recreation to some incoming EMS personnel would be environmental challenges posed by California’s geography. Wildfires were the most publicized risks to health and property in 2018, but you can add floods, droughts, tsunamis, strong winds, landslides, earthquakes, and volcanos (eight in the state are primed for eruption, according to the U.S. Geological Survey) to the list of conceivable West Coast disasters. Those could be deal-breakers or career-defining events, depending on your point of view.
Howard Backer, MD, MPH, FACEP, FAEMS, director of California’s Emergency Medical Services Authority (EMSA), oversees a multilevel disaster management system that includes ambulance strike teams and widespread access to patient details through SEMS—the Standardized Emergency Management System, a precursor to the national NIMS database. “The counties have primary responsibility for operations,” he says, “but we have mutual-aid support at the regional level and then, of course, the resources of the state.”
Most recently EMSA’s disaster teams were activated in November for the first of the catastrophic wildfires in Butte County, 90 miles north of Sacramento. The town of Paradise was hardest hit—13,000 homes destroyed, 26,000 residents displaced, and 200 patients transported. Four helicopters, four fixed-wing aircraft, and 34 ambulances responded from outside that 1,700-square-mile region to support local assets.
Day-to-day prehospital care is more conventional, including ongoing efforts to help patients overcome socioeconomic issues. “Lots of the people we see are battling poverty, substance abuse, and mental illness,” says Dan Smiley, chief deputy director of EMSA. “Getting them to the right place the first time is the goal. Community paramedicine helps with that.”
Overseeing 85,000 Personnel
Before getting into the structure of EMS in California, it’s important to understand the local terminology: An EMS “provider” isn’t a person; it’s what many of us call an agency—an ambulance company, fire department, or first-response service. So what do Californians mean when they say “agency”? Any of 33 local regions or councils, typically county-based, that are responsible for planning, coordination, discipline, data analysis, and offline medical direction. Online medical control is handled by physicians or mobile intensive-care nurses at base hospitals.
California’s EMS titles coincide with three national levels of practice: EMT, AEMT, and paramedic. EMTs are certified at the agency level, while paramedics are licensed by the state. Renewals require the following:
EMTs: 24 hours of CME or a refresher plus verification of skills competency;
AEMTs: 36 hours of CME or a refresher plus verification of skills competency;
Paramedics: 48 hours of CME or a refresher.
Backer credits California’s health information exchange as a valuable tool to track caregivers and their calls. “Medics in the field can send their PCRs to hospitals and access patient data on their tablets or laptops,” he says. “We’re hoping to get outcomes as well. We’ve been piloting that.”
An Upbeat Outlook
According to Smiley, there’s plenty of room for incoming EMS personnel. “We have quite a bit of capacity here. We handle more than four million emergency calls annually—the majority with ALS capability. You can come here and work for public or private providers in urban, suburban, or rural areas. People think of California as mostly big cities, but there’s lots of wilderness too.”
Backer mentions cultural diversity as another selling point for the state: “Anyone can find their niche and be comfortable here, no matter how fringe they are.”
As large as California’s EMS system is, Backer favors a hands-on approach to oversight. “In some ways we might be disadvantaged because we’re decentralized and can’t mandate statewide protocols,” he says. “On the other hand, we spend a lot of time collaboratively trying to move forward. We have a very strong group of administrators and medical directors. I think we’re considered fairly progressive.”