  “Hello, Mr. Smith the chauffeur is finally here to pick you up”, “Hey, Doctor Berg! The ambulance driver would like to speak with you about the condition of your critical patient”, “Hey driver! Right here!” are amongst more popular greetings by which I get addressed by the hospital staff on a weekly basis. Thus whenever I get asked, “So what is that you do?” by someone, the scripted answer that I reply with is “I am just a driver” and I smile, with such succinct job description I am abstained from bewildered looks and apprehensive conversation that usually follows.
The truth of the matter is that I am a Critical Care Paramedic and my current line of work is unique and multidisciplinary involving: medicine, science, math, logistics, communications, providing education, critical decision making, and the only component that is usually acknowledged by the hospital staff and the public is driving an ambulance. Nevertheless, it’s those unique moments of patient interaction and care, while executing difficult tasks that appear seamless to the bystanders, yet took years to built and fine tune that make this job truly rewarding.
          On June of 2012 I graduated Borough of Manhattan Community College with honors, earning A.A.S degree. After two years of rigorous schooling, I was at last certified as a New York State Paramedic with brand new card. All I wanted to do is get out and start saving lives. I was trained in the traditional Paramedic model of emergency scene response, where “911” call is placed then I arrive on the ambulance with all my shiny equipment, skills and knowledge to save the day. Starting an IV, give you medicine whilst transporting you to the closest hospital in NYC, which is usually 10 minutes away. However finding a 911 Paramedic job proved very difficult straight out of school and I found myself working critical care transport (CCT) straight out of college. The calls here were nothing like a “911” emergency scene response that I was trained to perform. Rather, these calls had some of the most complicated hemodynamically unstable medical patients on respiratory ventilators, cardiac monitors, feeding tubes, vasoactive medication infusion pumps, drains, central lines, heart bypass machines and plethora of other engineering concoctions that I have never seen in my life. Here I stood, a brand new Paramedic being tasked with transporting these critical patients from small rural facilities to level one tertiary care centers. Not only was this job out of my league, we were not even playing the same sport.
          I was quickly out of my element, with limited training only responding to 911 calls. Now I found myself responding to emergency calls originating from inside the hospital intensive care units. Who would have thought that hospitals with doctors, nurses and respiratory therapist all with much higher level of formal education than I had, needed us to come and transfer the patient to another facility. I was undereducated and ill prepared to be transporting such high acuity patients with only EMT-Basic as my partner. I didn’t just face adversity, I was thrown to the wolves with constant pressure to perform from the start. Constant surveying scrutiny from doctors, nurses, and patients family whilst you are packaging the patient and troubleshooting multiple beeping machine alarms. Sink or swim was the new mantra, this was no longer traditional paramedicine this was real medicine and not the kind you see in the show “House” practiced by real specialist physicians with decades of schooling who in the industry called themselves “Intensivists”. I was now entrusted by the Intensivists with continuation of patient care and treatment of the very sick, the extremis. In my new world transport times were no longer minutes, but rather hours apart which opens up doors for many more deleterious things to come into fruition and resuscitation measures to employ en route which at that time I did not even know about.
I did not have formal critical care training nor the credentials. This was unacceptable to me, the fact that level of patient care rendered would drop precipitously when I took over care for the duration of transport from the care provided in the hospital’s ICU. I was not about to quit because this new world showed me a much more exiting and demanding path. Thus I elected to remedy the situation by saving up necessary funds and paying out of my own pocket to attain appropriate education. The new goal became to facilitate such care during transport that the patient never feels that they have ever left the ICU. My unwavering philosophy henceforth for patient transfers was ICU-to-ICU patient treatment and care of equivalent or higher standard that the patient never feels that they have ever left the ICU. I have completed Pediatric Neonatal Critical Care Program presented by Johns Hopkins Hospital in Baltimore Maryland, Critical Care Emergency Transport Paramedic Program at UMBC and passed my Flight Paramedic Certification from The Board for Critical Care Transport Certifications, among many other emergency medicine and critical care certifications such as ATLS (Advanced Trauma Life Support), FCCS (Fundamentals of Critical Care Support course) traditionally only offered to emergency physicians and hospital staff that I acquired over the years. This path was not easy, as it took lots of money, time and many times begging and pleading with course providers to allow myself a Paramedic to pay and register for the course.
        Currently, I am a registered nurse working on finishing my BS Nursing degree from City Tech College of Technology, which I believe adds to my repertoire as a critical care provider and as an educator. Regardless of the letters after my name, I will make it my life goal to devote my time and effort to help other providers excel at this job and bring forth high yield professional content and education free of charge! As EMS providers we barely get by from pay check to pay check, and money should not be a limiting factor in getting good education. We are trusted with lives of the very sick and injured, they deserve our outmost excellence.
My intent with CriticalCareIFT.org website is to provide free high yield professional video demonstrations, how to tutorials, supporting medical literature, articles to enable you to become a better health care provider for yourself and ultimately for the patients that you will encounter.
My ultimate life goal is to obtain a terminal degree become a great educator and practice real medicine. I want to practice critical care medicine in a rural and underserved community and push the envelope to provide the highest care possible in addition  provide high quality education to all the providers free of charge regardless of the circumstances I find myself in. Ultimately, I believe it’s your constant education, perseverance and strong desire to uphold the highest standards of care that will dictate what kind of practitioner and human being that you will embody.
by Nikolay YusupovÂ
