Division of Labor

If you work commercial ambulance in a high volume system, and if one of you is a paramedic and one an EMT (the standard in our system), you and your partner are going to need to work out a way of dividing up the calls. In the course of your shift (Mine are 12 hours), you’ll do ALS, BLS, 911s and transfers. No two days are going to be alike.

My old partner Arthur used to talk with disdain about one paramedic he worked with. “He told me he didn’t do BLS,’” Arthur complained. Translated that meant Arthur teched all the transfers and all the BLS calls. The medic only did a call if it meant he had to pop in an IV or hook the patient up to the monitor, and this medic was not aggressive in his ALS care, which meant there were days Arthur did all the calls.

That’s not how I do it.

Here are my rules (guidelines) for division of labor.

I do all ALS (any call requiring a cardiac monitor, IV, advanced airway, medication, or anything only a medic can do), and whatever BLS I choose to do.

If we haven’t done ALS, and my partner has already done the first two BLS, I’ll do the third BLS, and then we’ll alternate provided we haven’t done any ALS in between.

Same with transfers. My partner does the first two transfers. If I haven’t done any calls yet, I’ll do the third.

I never have my partner get 3 calls ahead of me (unless he wants to do the calls).

Other circumstances may apply. If my partner is feeling sick, I may do more of the calls.

If one day I do all ALS all day, and the next day, it’s all BLS, and my partner wants to do the calls, that’s fine with me.

Here is the general mathematical formula, where “X” stands for the EMT and “y” for the paramedic.

X + 2 = y does the next call.

There you have it.


  • Matt says:

    Just switched from a dual-medic system to one just like you describe. I’ve been trying to figure out how to do this–I think I will adopt your system. Thanks!

  • Damian says:

    I agree, but unfortunately, my employer refuses to let basics or advanced tech calls on ALS shifts. I really am just an ambulance driver on those days. And ALS shift are considered a privilege. That’s why I have requested shift changes, so I can get patient contacts. And from what I understand, this is the only company in CT that does this.

  • Ian says:

    I work in a very high volume urban/suburban system as a paramedic with an EMT partner doing 911 and transfers, and sadly, EMTs here are not allowed to attend at all….so I get to do it all for 12 hours ! (average about 8-10 transports a shift)

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