Be scared. Be very scared.

I saw a post in an EMS forum from a newly minted EMT expressing fear and trepidation about their knowledge base and their readiness to perform in the field. After some reflection and even a dose of cynicism and sarcasm, I hereby put these thoughts out there for the entry level EMT.

EMT is among the easiest certifications to get with the lowest barrier to entry and relatively low standards. Less than 200 hours of training should scare you. It’s but an entry level certification and a remarkably simple achievement. Holding yourself out as any sort of medical professional or hero with this little training should scare the heck out of you, your colleagues, and your patients.  And contrary to the t-shirts, very few paramedics are “saved” by EMTs.

But in all fairness, I don’t blame you.  I blame the EMS profession and some EMS educators and recruiters who’ve promised you that your entry level education will save lives and make you a hero.  If you haven’t already figured it out, much of what you were trained for rarely happens.  Some of those neat bandaging and splinting tricks (many of which are straight out of the old Boy Scout and Red Cross first aid texts) will never enter into your career.   The things you glossed over, namely medical emergencies and patient assessment, are the bread and butter of EMS.  You’re in a service career that deals with people.  And the general public doesn’t follow the same definition of emergency that you got in your class.  Remember, these are the folks that called their doctor after hours and got a recording saying, “If you’re having a medical emergency, hang up and dial 911.”  Thus, enter EMS — and the call nature that you don’t consider an emergency. In short, the reality is that you’re much more likely to use your ability to talk to a patient than you ever will an occlusive dressing or a traction splint.

So, what to do?  Well, first of all, as they say in the movie Jarhead, “Embrace the suck.”  In other words, embrace the fact that your new field involves much less heroism and much more service and caregiving.  You’ll be less disappointed and less burnt out along the way.  Second, recognize that a certification of minimal entry level competence is the entry to the field, not the pinnacle of achievement.  In other words, the real learning starts now.  Whether it’s podcasts, social media, journals (NOT trade magazines), or conferences, you need access to real medical education.  Finally, have a life outside of EMS.  Have hobbies, have a family.  Don’t wrap yourself solely in the identity of being an EMT (or a paramedic. Or even an attorney.)  And with that advice, you’re closer to ready to embark on your path in EMS, regardless of your certification.

Saving lives? Occasionally.  Providing service?  Every day.

We Aren’t Nurses. And Nurses Aren’t EMS Providers.

For the record, I’m sick and tired of the nurse bashing. Not here, but on EMS groups in general. While there’s some overlap between EMS and nursing, the two are entirely different fields and both have a special place. Sometimes, though, EMS proves its special place involves a crash helmet and a short bus.
EMS has very specific education (some might call it training) in a very specific field.  We are the experts in providing autonomous, independent immediate care, usually in non-clinical settings.  We excel at providing immediate care to acute patients in the first hour or so of care.  Honestly, in these settings, EMS does represent definitive care.  What makes EMS unique is our ability to deliver this care outside of a hospital/office setting.  I like to describe us as medical providers using a public safety background to deliver patient care. Talk to more than one experienced nurse or physician about EMS during a cardiac arrest and you’ll hear them acknowledge our very specific expertise in providing care during those first crucial moments of an acute medical crisis.  Outside of the immediate care setting, we start to flounder.  It’s not our fault.  It’s just that’s not what we’re educated to do.
Nurses.  Nurses are different.  Their education is much broader and focused on a wide spectrum of settings.  That makes nurses excellent generalists with opportunities for specialization. While it’s true that most nurses (and possibly even some ER nurses) border on helpless in an emergency setting, I can equally guarantee that most EMS providers would flounder at best in a setting where you’re caring for a patient for more than an hour, day after day, and probably more than one or two patients at a time (except in the most acute care settings in a hospital). And unlike EMS, nursing licensure is easily transferrable between states and there’s a ton of career opportunities in the practice of nursing, nursing administration/management, and nursing education.  Not to mention graduate degrees that provide real value in terms of careers.
EMS providers have knowledge of medicine that’s a mile deep in one field (emergency medicine).  Nurses have a knowledge of medicine that’s a mile wide.  Yes, there’s some overlap between nursing and EMS, as there is with any of the medical professions.  Just because I have skills with an endotracheal tube and a bag-valve mask doesn’t mean that I’m the same as a respiratory therapist. Nursing and EMS are complementary fields.  Neither is a springboard to the other.  Having said that, some of the best clinicians I’ve seen are those who are both RNs and paramedics.  They truly bring the best of both worlds to their patients.  And yes, EMS providers’ skill sets and knowledge belong in settings other than ambulances.  Paramedics would be great additions to the hospital and clinical settings as more facilities recognize the value of paramedic assessment and intervention in the rapidly deteriorating patient.
Let’s quit trying to compare ourselves to nurses.  Let’s quit trying to define ourselves by what we can do.  Instead of bashing nurses, maybe we need to ask why what EMS has been doing hasn’t worked for increasing our pay and respect. The short answer?  The public doesn’t know who we are or what we do.  Combine that with low entry standards and equally low educational standards and we’ve become the Rodney Dangerfield’s of medicine — No respect, I tell ya.

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