Let’s talk about something for a minute. Most departments are pretty familiar with the idea of fire based EMS. If you are in a department that doesn’t do fire based EMS then this blog entry will not be that interesting but for those of you that are in that type of system, you may understand what I am saying.
Over and over again, I hear complaints from crews about how much they have to ride the medic. Let me clarify for those of you that may call it something else (gut bucket, pus bus, puke wagon, tater toter, bandaid buggy etc.) I am referring to the ambulance. Time after time, they whine and moan and complain that they have to ride the rig instead of riding the engine or the ladder/truck. I used to get very upset with people, especially when I was a Chief, when people started to complain. I would throw out my go to statements like “that thing pays your salary” or “that is what keeps the lights on”. I still feel that way but I think my anger came from somewhere deeper.
I got into this business over 20 years ago as a volunteer EMT. I went to fire school after EMT and got on the FD as a volunteer as well ( the two where separate in the community I lived in). I got into EMS to help people and serve my community. I got into the FD for the same reasons though that side didn’t seem as connected with the community or as intimate with people in the community as EMS. I worked regular jobs and did EMS as a “hobby” because I had mouths to feed and bills to pay. In 1999, I started working part-time for a busy suburban department and really got a lesson in how EMS really works.
When I was volunteering, every call was the worst moment in the persons life, that’s why they called. The small farming community solved their own problems and took care of each other so when they called you, you knew it was important. That was not the case in the “big city”. I was quickly introduced to the system abuse. The calling for a ride club, the overdoses that would motherf**k you as soon as the Narcan kicked in and realizing that when someone said “my homie fell out” that didn’t mean they fell out of something, It meant that they passed out.
The day I realized when I was not in the country EMS system that I grew up in was the day that we went on a medical alarm activation in a not so nice neighborhood. I beebopped up to the door, standing in front of it knocking away when my captain yelled “get away from the front of the door, stand next to it on the side”. Puzzled, I did what he said but didn’t understand why. After I made contact with the resident and found out that there was no problem, I headed back to the truck and asked what that was all about. The Captain kindly explained that we don’t stand in front of doors when we knock because that is where the bullets come out when they try to shoot at you because they think you are the cops. He also explained that the side of the door is becoming less safe because they have learned that trick and have cut the wall out behind the exterior siding so they can shoot you in the legs when you stand off to the side. That was a rude awakening to what I was now dealing with. I wondered if I would survive in that area. I felt like I had no idea what really went on in EMS and from then on it has been a lesson in the new and unusual.
I still work in that environment but I have never lost my longing to serve the community and to help people when they need it. I was talking to a friend from another department yesterday at the ED when a young guy walked up to him and thanked him for taking care of him. As we walked away from the young man, my friend said that the young man wanted to be a neurosurgeon. We both said “I hope he makes it” at the same time. That exchange got me thinking about how weird our attitudes about people have gotten as the years have gone on. We hope for people but know there chances aren’t good all at the same time. That only comes, I think, from doing this work for awhile. It struck me as a weird mix.
Anyway, back to the lecture at hand, I often wonder what those people that complain about being on the medic think there experience in EMS was supposed to be like. I know some of them got into EMS because they needed an EMS card to get a “fire” job. But I wonder why the up front, direct interaction with people didn’t eventually make them enjoy doing EMS. I am a text book introvert but the charge I get out of that interaction is something that I have never found anywhere else. I wonder that if they had had a similar path as I did, would there idea of EMS be different? I spent some time in the private EMS sector and found people in that group extremely bitter about their jobs, which ultimately was transmitted to their patients. Now I know that the companies they worked for were most of the problem; I was a supervisor and everyone above me seemed to have one job and that was to make their employees as mad as possible but the volume of patients I saw was great because it gave me a chance to interact.
We all deal with people that are abusing the system. We know them by name or address and there are groans when we have to deal with them, but the core of what we do is to help. We all know those people that work with us that throw things when the tones go off for an EMS run. I don’t understand where people wonder off in the weeds in this job. Are they that cynical that they really don’t care that much for people? Then why stay in this business. I have spoken to people that have retired and still hate every moment they spent in the back of an ambulance. It just seems like a big waste of your life.
I know that some people I work with will say they have heard me complain about a particular run and that is the truth. I occasionally complain about not getting engine time, mainly because I need a quick break to let my brain rest or that I feel like my firefighting skills may be getting rusty. I have my days when I get frustrated with the system. Usually it is because I have something else going on in my life that is bothering me. But all in all, I thrive off of the opportunity to do something different everyday and I laugh at my friends who “can’t wait until Friday ” to do something crazy. I find myself in a crazy situation every week. I love the medic as much as I love riding the truck or the engine.
So what about those people? Why does it get to me? Is it the fact that I wish they could see the job like I do? Is it because I feel bad that they are not enjoying themselves? I think it is because I know that their patients don’t deserve to be treated poorly because you don’t like your job. It is not their fault. You don’t know if today is the day that your regular drug seeker is having an MI. You don’t know that today is the day that Mr. Smith who needs a lift assist all the time didn’t fall this time because he is having a stroke. You don’t know so don’t assume. It is like cancelling a structure response on a fire alarm call to get there and find out that the nursing home is actually on fire. You don’t know until you get there.
I had a discussion today with another friend from a department further south about the new generation of EMS providers coming on the scene. We both agreed that they seem a bit clueless . They don’t know how to do some basic skills and they don’t know how to interact with people. I chalked it up to the “everyone gets a trophy” generation but I think it is more than that. I think that the schools want to move kids through to get their tuition so badly that the students don’t get any time on the street. I meet a lot of students that are in paramedic school that just finished basic EMT. How are they expected to know how to “read” people if they have never been on the street. They don’t know when the scene is about to explode in violence. They don’t know when the patient is going to crash. They don’t know when the treatment path they started on will be 10 paths behind them by the time they get to the ED. They don’t know and I wonder if they care. Everyone has always fixed things for them so they find themselves in a world of hurt when everyone is looking at them to fix the patient. They also don’t understand that the protocol is a guideline and not a rule. They withhold treatments because it doesn’t fit the protocol. It is amazing to see and very scary.
Some claim that community paramedicine is going to be the answer to some of the problems in the system. I am still skeptical. From where I sit, I think time is going to be an issue. The time spent staying at someone’s home to help them contact the resources they need may be longer that the time it would take to put them through the system. I know there is more to it than that and that more people in the system clogs up the system but I still argue about time. Processing calls and turning around to do the next run may win out. Who knows. We will see.
So the point of this is that you should look at why you got into EMS and what you want to get out of it. Do you not like it because you don’t understand some of it? That’s ok. Knowledge comes with time believe me. Do you not like the work? Some garbage men don’t like their jobs but they don’t get mad at the trash can. Try to look inside yourself and find out why you are doing it. Your turn is your turn on the medic. Flexibility in the team is what makes the team a team. Do your job and treat people right. The patient is not your mother, brother, sister, father, grandma or grandpa but they are someones. Treat them like you would your own family! They may seem like a waist of time but they are human.
I am reminded of a line from the oath of Maimonides “May I never see in the patient anything but a fellow creature in pain”. I have always thought about that when I get to a point where I don’t think I’m doing any good for anyone. Maybe it will help someone find their way out of the weeds.
Thanks for reading my rants and have a great weekend!
Check this out as well, it’s a great read.