Why Doesn’t EMS Grow Up?

Social media is always full of EMS providers committing social media assisted career suicide (SMACS).  The latest was a perceived HIPAA violation where a medic was perceived to make fun of a cardiac arrest in a chicken coop, along with the associated chicken “byproducts.”  EMS Week always brings out the memes where the least bright and engaged of us in EMS demand to be thanked for our service, whether with free gifts or attention. We’re heroes, dangit. And EMS social media is always full of posts complaining about “misuse” and “abuse” of EMS and the emergency department of hospitals.

Of course, EMS and emergency department “misuse” and “abuse” are very subjective things. The general public doesn’t have the same definition of emergency that the average EMS provider has. Try to do the right thing and call your doctor after hours and you get a recording saying “If you’re having an emergency, hang up and call 911.” The problem is that no one defines emergency. Try to find after hours or unscheduled care for any sudden issue and you find that same or next day appointments are few and far between.  Urgent care hours often aren’t significantly better than many large clinics and that’s assuming that they even accept your insurance.  And if you do get in to see your doctor at their office, you can expect multiple follow-up visits for labs, imaging, and specialists for all but the most minor complaints.  Each of these are a separate absence from work and a separate insurance copay.  Is it any wonder that people go to a hospital emergency department where no appointment is needed and there’s virtually instant access to labs, imaging, and specialists.  As I like to say, the problem isn’t EMS or emergency department abuse, it’s that primary care has turned us into their after hours call coverage.

But that’s not the real point here.  The point here is that EMS seems to continue to remain in a teenager phase of not wanting to listen to the “adults” in the room who talk about educational standards and professionalism.  We continue to want to be “heroes” rather than caregivers and we demand attention and increased salaries while not doing anything to show why we deserve to be treated as a respected healthcare profession.  Why?

It’s simple.  The average career lifespan of an EMS provider, according to my quick Google search, is five years.  That’s right.  Five years.  It takes more than five years to be good at almost any career.  Like almost all of us, as a new EMT, then a new paramedic, I was full of all of the wrong answers.  I was full of dogma, misinformation, and the tendency to be way too eager about EMS. Fortunately, I was able to volunteer in some really first-rate EMS systems where I learned about medicine.  Also, the Internet and social media exposed me to some really smart people who actually cared about EMS and the medicine behind it.

However, the reality is this.  Many of the best and brightest in EMS leave for other careers in healthcare. And who can blame them? The opportunities in EMS pale in comparison to nursing, medicine, or as a PA, NP, or CRNA. With EMS’s short career half-life combined with our abysmal EMS education (Here, let me read the PowerPoints that the textbook publisher provides and I’ll throw in a war story on occasion.), we’ve created a revolving door of new providers who believe the dogma and misinformation.  They believe they’re going to be heroes and they’re disappointed when they’re providing geriatric primary care as opposed to “exciting and cool” trauma calls where they might “save a life.” (Spoiler alert:  Most of us in EMS don’t get the experience of being able to point to a specific life they’ve saved.  But if you do this right, you’ll get a lot of people to the right definitive medical care they needed to begin with.) And with our low barriers to entry, there’s little incentive to stick it out in EMS and make EMS great again. And while this revolving door continues, you continue to see EMS fail to progress and you see the same tired memes and complaints where we mock patients and our careers.  And when most are called to account for this behavior, they give the same tired excuses of how “you don’t know what it’s really like on the streets.”  Mind you, some of the worst offenders on EMS social media are virtually unemployable in EMS and don’t even work in an emergency setting.

To me, the heroes of EMS are the ones who’ve stuck it out; kept trying to improve EMS, even if it’s just their own EMS employer; and tried to teach good medicine to those coming in behind them.  If you actually took the time to take care of a sick person who’s septic and weak as opposed to bitching and moaning, you’re exactly who we need to stay in EMS.

Comments

  1. 9-ECHO-1 says:

    My take on part of this is that so many (myself included) want to see EMS change. We want to take it to the next step.

    But, we do not know how to ‘play the game’. As I have said elsewhere in the past few weeks, we can look at nursing as an example. 40 years ago they were kind of where EMS is now. But with some savvy ‘system playing’ they got a world class advocacy group together, and they even have the major employers of nurses singing their tunes.

    EMS?

    Well, the major national advocacy groups are NAEMT, IAFF, IAFC, and AAA.

    Really? That is the best we have?

    NAEMT represents a small fraction of EMS providers. Why? Because, like me, there is no value seen in NAEMT. What national issue has NAEMT addressed that would benefit EMS providers as a whole?

    I’ll wait.

    IAFF and IAFC are looking after the fire service slice of the pie. And top quality patient care is typically not a part of the agenda. It is always ‘all hazards response’.

    AAA? I cannot see where they are doing much of anything except perpetuating the status quo.

    I’ll stop now. I am thankful I have but 6 years until I can retire and greet people at Walmart.

  2. I wonder how many nursing groups you belong to, there just as much of what you’re talking about in Nursing as there is in EMS.

  3. Ted King says:

    I love you Wes, and I cannot wait to get home to Texas. Northwest EMS is a different world. But that is a story for another time.

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