Researching EMS Culture

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Permalink Reply by Dave Leach on November 13, 2009 at 2:47pm

Personally Matthew I think you might or should look into another profession. Take your four years and multiple that by four and one half times to get where some of us are......I do not feel sorry for the world, nor do I complain about my pay or my back.
If after all you want to enjoy the life of luxury and have all the amenities then maybe EMS is not for you, go back to school and become something else, with a purpose.
Otherwise I consider your whining pediatric like actually, and do not appreciate some one as young as you degrading my career.....I have 14 years on you sir, and don't whine about it (many have more).....I love what I do......

I believe that this site is for constructive criticism and new ideas that make our career as a whole better, I have VERY little time for folks that want to degrade other health care professionals more over our job day to day

Be well,

Dave

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Permalink Reply by Will Adams on November 15, 2009 at 2:34pm

I agree, I love my job and I keep myself in shape physically for it and have never had a back problem, also I'm not complaining about my pay, honestly if your about the money your in the wrong field.

Will

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Permalink Reply by Dewayne on November 15, 2009 at 2:07pm

Where do I even begin?

First off Matt, re-read Skip's post about 100 or so times. He hits the nail squarely on the head. Secondly, if you routinely save a "dozen lives this week" my hat is off to you. Where I live and work (a place known as the real world) true life saving chances are far and few between. I also find that those that like to brag about their dozen saves this week turn out to be sub-par EMTs and medics (at best) and are the ones that I routinely get asked about by the ER staff. And trust me, the questions are not about how great you are.

Now, do we have a chance to affect lives everyday? Can we assist people in bad situations and help them towards a positive outcomes? Yes. I hopefully do this everyday that I am at work.

Trying to cite the amount of "suffering" that you have seen and endured in your four years as an EMT is just a bit over-dramatic. With twenty one years total in EMS (17 as a paramedic) I am still thankful everyday that I do not work at a children's hospital, or a burn center (which I have done), on a cancer ward, or several other places where people face so much more pain, suffering, and grief on a daily basis than I do. Remember, no matter how bad you think your lot is, there is always someone else that is worse off.

I will stop there. Read some of the posts Matthew, then go back and re-read what you put down. If you still think that everything is just as you state, then it's time for you to move on to another career.

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Permalink Reply by Sue Copinga on November 17, 2009 at 1:46pm

Matthew, I'm really sorry you got such explosive reactions to your post from some of the "old timers" in EMS. I'm sorry you seem frustrated at the downsides of EMS and I can empathize with your irritations. It may help to know that it takes a very long time to make any changes in the EMS system. All things have to work together perfectly. The right Med control doc, the right combination of supportive EMS, a champion for your cause, and the right timing all have to come together to make positive changes to a system and that doesn't happen very often. It is frustrating when you can see that a negative change seems to pop up with little effort. All we have to do is get lazy for a moment and a bad habit has been formed! If you are going to make EMS your life long profession you will need to come to grips with a few things. First of all, we will always be "ambulance drivers" to most of the public. Occasionally we get a "thank you" or a hug, maybe even a thank you note but that is rare. If we had any idea this was going to be a glamorous job that would bring us admiration and fame we quickly find out it does not. If we are ever a "hero" in this line of work it is only for a moment and we are the only one who remembers it. If we can go to bed every night and say to ourselves, "I did a good job today and I learned a thing or two", that has to be enough. There isn't anymore. Second, after being around for a few years I have noticed something I think is really important. If you really believe you "save a life" (not just say it but believe it) then you have to shoulder the guilt when your patient dies and you will have patients die. I have seen lots of good EMS people "burn out" under that kind of guilt. We don't save lives. We are not the ones in control; we are just a little more in control that the poor guy who has called us. We train and study and change and learn so we can give it our best but the day we believe we make the "ultimate decision" is the day we begin our journey to leave the profession. Third, our pay raises will be slow to come. There are those who work hard to get us the money we believe we deserve but let's face it, it isn't going to "pay the bills". Most of us can't "make a living" on the ambulance. We have part time jobs or full-time jobs that allow us to run part time. We teach EMS on the side or get a job completely unrelated so we can have our cake and eat it too. I'm one of those lucky people who works in an ER full time, works on the ambulance part time, gets "paid" to put in the extra hours it takes to be a training officer and I teach several classes in EMS a year for which I also get paid. All that put together I make a wage I can live on, but it took a lot of years and a lot of extra training to get here. At half the pay I would feel privileged to work in a field that I love and have a passion for. We aren't being "punished". Some people have to go to work everyday of their lives to a job they hate. I don't have to do that; I GET to go to work and I am grateful. If you have a wife and kids and bills to pay now and you need to live in a nice house and don't have the years it takes in this field to get a little more comfortable, you may have to make some changes. Another job on the side is always a possibility but walking away from a bad fit isn't a bad thing either. I laugh at our hospital when they offer inservice classes on lifting. The instructor has never had to lift anyone twice her size out of a bathtub, in a bathroom only big enough for her and her patient. She has never had to maneuver a patient onto a backboard when they are under a vehicle and there is limited space. Use all the back saving tricks you want but at the end of the day you put some real wear and tear on your body. If you are experiencing back pain after only four years in this field, you may need to look at a profession that gives you the fulfillment you need but demands less of your physical body. One last thing. I am of the opinion we need MORE education and training to be in EMS. In my state all it takes to become an entry level EMT is 120 hours. Oh sure, we are expected to keep up our CME hours and do extra training but all the new EMT-B has to put out at first is 120 hours. Most beauticians have more schooling than that! I want my hair to look good but I want the guy controlling my airway to have practiced his craft a little longer than that! Good luck, Matthew. I hope this all works out for you. I hear a nurse anesthetist makes boo coo bucks and what a fun job that would be!

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Permalink Reply by Skip Kirkwood on November 13, 2009 at 10:35pm

If I said "incessant whining without the willingness to expend personal effort to fix what is being whined about" would my colleagues think that I'm out of line?

Matthew seems to be an example (maybe he's a great activist and I'm just not seeing it), but I see the whining part.

First, before you get too hard on the people "in charge" try walking a mile in our shoes. Try keeping a service going with a limited amount of money. So you've been an EMT for four years, but you talk about "all the medical training we've had to go through." Huh? You went through a course that is the equivalent of four full-time weeks of instruction, in the most basic of health care procedures. Here's an economic fact - few people with 160 hours of training in anything make an income that will let them become homeowners and live the "American dream." That requires education, measured in years, and admission to a trade or profession whose members work together to improve their lot, and who have done so for many years.

Read the early history of nursing - and then look at where nurses are now. They used to have to bring fuel to work with them to heat the wards, etc., until they turned in to a profession and started demanding education of themselves.

I've had a great career in EMS, but I didn't stop with an EMT card and wonder why I didn't make big bucks (my first EMS job paid $3.25 per hour, not including sleep time). Three college degrees later, plus hundreds of hours of professional development (all the instructor cards, several cross-country moves to find more advanced positions), and 36 years of commitment to improving things, and I'm pretty happy with my career. And I work with a bunch of great EMS professionals, many of whom have 20+ years full time on the truck, who have nice houses, and families, and lives that bring them great personal and professional satisfaction - and the don't whine!

EMS folk have to understand that growth and development require after-hours work. The first is continued personal development - education and training. The second is a commitment to your professional associations, labor organizations, whathave you. If you won't pay dues, go to meetings, work on political campaigns, then you will be well and truly stuck! And I'll be sorry for you, becuase you have let opportunity pass you by......

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Permalink Reply by Nick Nudell on November 15, 2009 at 1:29pm

I'm with you Skip - very good points. The EMS culture that focuses on comparing oneself with others in medicine really borders on narcissism and is self aggrandizing. The training to become an EMT and then working for a few years as an EMT is really only an entry level step.

If you peruse the forums for medical school hopefuls you can get a perspective of where this fits in the bigger picture of medicine. Many applicants weigh volunteering in a hospital with working as an EMT and many (most) choose to volunteer instead. They perceive that EMTing provides less benefits (in terms of understanding, appreciating, and learning about their future career in medicine) than volunteering. How many EMTs proclaim to be 'almost' a doctor?

I don't think any amount of whining or meeting attendance and political work is going to change this. It is what it is no matter how we perceive ourselves. As long as 'we' continue to view ourselves as different than how everyone else views us the culture will not change. Is there a culture among EMS providers that we don't need to get further education, that a degree is really not necessary? Is this a culture that is also our downfall?

One strategy for increasing the value of a team is to make it more difficult to join the team... by having minimum standards. A recent news article described a nursing school that refuses to matriculate students that have visible/uncovered tattoos. That is one example of making it more difficult to join the team, making it more prestigious, making it more unique.

Whatever the specific mechanism is, minimum standards go a long ways... why does the EMS culture fight minimum standards?

Cheers,
Nick

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Permalink Reply by carl j. post on November 15, 2009 at 2:36pm

The culture you are looking for is delimited in part by cumulative stress (brownout) or worse still what Professor Jeff Mitchell identified as a 300 real treat limit (burnout). . The business wears EMS providers out on the inside. They have to cope with it and the endemic outlaw mentality replete with unusual jokes and death halos are an expression of it. Read a novel about it. Neely's Street Dancer or a coarser one by Post (The Scramble Call) at EMS Village.com for signs and symptoms of it. Or dig up a copy of Kate Dernocouer's Streetsense by way of the Hunter Library. If EMS providers are victims to any extent, then it is due to the process they involve themselves in.

Carl J. Post
Montclair State University
Capella University

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Permalink Reply by Will Adams on November 15, 2009 at 2:42pm

I don't know man, I think the humor thing is big, the only other thing I would mention is something I experience personally, and may be different for other folks out there. I find it impossible to talk to anyone about the job who doesn't actually do this. I don't even bother trying to discuss things with my wife anymore. When I was in basic school I remember one of my instructors telling me about this, so maybe others have had the same experience. Bottom line is you have to love the job more than it disturbs you or you will fall apart pretty quick.

Good luck with the research
Will

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Permalink Reply by Firecarp on November 15, 2009 at 3:52pm

In 2000, After 14 years in the residential building construction field and 6 years as a volunteer FF EMT-B my wife and I were able to afford to buy our first home here in one of the lowest income areas of Northern California. I believe wholeheartedly that if you became an EMT or Medic with the idea you were going to get rich, you are sorely mistaken. Maybe in the big metropolitan areas you might, but I have seen those guys complain about their cost of living as well. It is solely incumbent on you that you keep up with a daily physical training regimen or face the consequences of the lack thereof.

Instead of blaming the job or the company you signed on with how about finding the good in what you are doing and can do. All it takes is a little perspective on how bad it con be to truly make you appreciate what you have. I now have 14 years as a volunteer and cannot see a point where I would give it up. Maybe because I volunteer to do it instead of it being my job makes it more enjoyable, or maybe it has more to do with being capable of providing a service to my fellow man just because I can is why I enjoy it. If you take on this job to be labeled as a hero then you are in it for the wrong reasons.

Back to the subject at hand, I can still sum up images of many of the calls I have been on and I am thankful for not being on some of the calls I have heard others speak about. It seems the worst ones to process involve children and one of the worst ones I recall had a victim that looked much like one of my loved ones, or hearing the tormented cries of a family member wanting us to do more. I have benefited greatly from Critical Incident Stress Debriefing and have become a member of a CISM Team in my area. Knowing that other people process this stress in similar ways helps me to recognize that my reactions are normal and that there are many ways to deal with the stress in constructive ways. Don't shut down and don't shut people out. The profession needs you and your community needs you.

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Permalink Reply by Jeremiah Bush on November 15, 2009 at 4:25pm

First of all this is a very good question, and I am pleased to see all the responses so far. What I'd like to do, is go a little deeper and personal in to the subject by sharing a bit of my own experience and attempt to explain my own psycho/emotional state. First off a little background, I have wanted to be a Paramedic since I was 5y/o. And because of that I feel so privileged to able to do what I do. EMS is not like any other job in either public safety or health care, we are not firefighters (well, some of us) we are not cops, or doctor or nurses or social workers or counselors or teachers.... we are everything- all the time. We are in fact professional problem solvers. For Me, it just makes sense. Oh, you're hurt or sick. Of course I'll come help. Perhaps it's just me. I have always adopted the part of the "rescuer" in this movie called life even before I started working. There is one question I always ask when I have a trainee or a ride along, and the is "would you do this for free?" It takes a interesting type of person to endure the sleepless nights, the some times questionable pay, the danger and some times the utter lack of respect and still keep coming back for more. Maybe I'm crazy but I would rather work 48hr on a rig over 5hr at Starbucks. Because to me EMS isn't a job- it just is... People outside of EMS need to understand two things. First, even though many of us do not hold high level degrees, we are still educated and are constantly being educated. And we take our jobs very seriously. And second that we have a very different prospective on life because we see it without the filter that the rest of society does. We see the good the bad and the ugly, mostly the bad and the ugly. EMS has been picking up the pieces of the public health crises long before Washington or the general public gave it a second thought. We see people die of preventable diseases and senseless violence and are expected to clock out at the end of shift and just go about our marry way as if nothing happened. it's not always easy, but we keep coming back because there is something in side of us that drive us to fight the fight, and maybe make a difference in just one persons life. I have been called "Ricky Rescue" because I keep a pair of gloves in my pocket when of duty, but I know from experience that SH*T happens. And I have the skills and training to do something about it. I know I don't have all my gear, but I can at least do compressions or hold open an airway or c-spine. And that may be the difference. Like i said before, It just make sense.

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Permalink Reply by Nichole LaFrancois Diaz on November 18, 2009 at 2:49am

To everyone and anyone that whines and cries about this profession realy needs to find another one. I was 14y/o when I started, I am now 30y/o. I have seen many thing s good and bad. No one every said that you could live the good life doing this. I agree with the comment that EMS isn't a job.. it just is. I love it. I had gotten out of it for a few yrs but missed it and came right back. As far as outsiders undstanding us, they never will. They don't understand why when you come off shift and you can't talk about the kind of day you had. We all know those days when you couldn't help and you wished you could have, and time is needed to get over it. This is not the kind of job that you punch a time clock and forget about. Some of the things we see or have to do stays with you for life and molds you. No matter how much you try not to let it , it does. The only way outsides can help is just listen, don't judge. Give a shoulder , not matter how strong someone thinks they are everyone needs a shoulder, a hug, and good words thrown their way.

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Permalink Reply by Nate on November 15, 2009 at 5:36pm

Hey Marc, I'm not sure if I'm the right person to be responding to this question, as I don't have nearly the amount of the experience and dedication like the rest of these fine folks posting, but for a whole, uh, 6 months now (as a First Responder) and 2 months (as an EMT-B student), I can say that I find the culture of EMS refreshing. My EMT-B instructor has been so passionate about his experiences (always abiding by HIPAA, mind you) as a Paramedic for the last 20+ years, that it's inspired me to try and follow in his footsteps. So to get to the point, the passion of EMS, which still burns in people after working so long in this field, amazes me. It truly does become a part of you, ingrained, and in your blood. That, I think, is what the culture of EMS brings, passion. Like most of you, I'm doing this not for a paycheck, shit I don't care if I'm doing volly work for the next 10-15 years, but for just the sheer fact in my mind that I'm saving lives. Now as to how you affect lives everyday, there's the quite obvious one... You save them. But in more than one way, as in also being role models for people like me, some of you may or may not realize just how much of an influence you guys are on people like me, people just starting out in this field, and let me tell you, it's a huge one.

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