The Ambulance Chaser

Garison Keiler used to describe Lake Wobegon as “‘Where all the women are strong, all the men are good looking, and all the children are above average.” EMS has a similar malady. Not every EMS system is “progressive.” Not everyone in EMS is an “operator.” And not every educator or continuing education event is “high speed.” Sometimes, it’s not even cutting edge.

If you go to almost any EMS recruiting advertisement, you’ll see them describe their system as “progressive.” Now in this case, we’re not referring to AOC or Bernie Sanders. Most EMS recruiters are referring to some whiz bang aspect of their protocols. Truth is, I’m amazingly happy as an ALS hobbyist at a service where we’re entrusted with delayed sequence intubation, blood administration, IV pumps, and IV antibiotics — all on standing orders. And bluntly, in the year 2025 with the availability of video laryngoscopy, the ability to pharmacologically manage an airway should be a given. (Spoiler alert: There are indeed EMS agencies describing themselves as progressive where this given isn’t happening.) But clinical is just one aspect of progressive and it’s the easiest to advertise. You want progressive? Let’s talk about a system that manages provider fatigue, supports mental health, has stations as opposed to convenience store parking lots, and has leadership with qualifications above and beyond good clinical skills. What would be truly progressive is a decent salary that means you don’t have to pick up extra shifts unless you want to and a defined benefit pension system. And for what it’s worth, such systems do exist.

On this note, not everyone in EMS is an “operator.” This is especially true in the world of EMS education. EMS education, present company excluded, often consists of three categories of people. Category one consists of the jaded medic who’s unable to work in the field anymore. What passes for education from them is reading the PowerPoint slides and interspersing dated dogma and war stories. Category two are the entertainers. These people are fixtures on the conference circuit. Whatever the subject, they’ll teach it, regardless of their subject matter expertise. They often have catchphrases, a uniform that looks like something out of a banana republic, and/or a persona that may or may not match their field expertise. Finally, we have the terminally arrogant. These people delight in proving they’re smarter than you. Whether it’s obscure EKG findings, clinical zebras, or plain ol’ data analysis, these people and their acolytes have their following at conferences and on EMS/medical social media. Honestly, these are some of the smarter people in EMS. Their biggest problem is that they know it and want you to know it too. See also: “I’ve got two years of paramedic education and I’m going to speak with absolute certainty on findings that fellowship trained physicians at academic medical centers may quibble over.”

And for those EMS providers who think they are indeed above average, there’s a whole class of frauds, posers, and grifters with flashy course titles and cool social media combined with dubious credentials or expertise. In fact, if you wear enough camo and use the right buzzwords, you can get people’s continuing education money even when the courses are no longer accredited. (Not to mention taking money from gun enthusiasts and other “outdoors” types who will instantly take courses and buy products from anyone who claims they’re tactical.) On that note, being a military medic, in many cases, means you’re very good at managing trauma in healthy young people. The definition of confusion can often be a military EMT or paramedic making the transition to a civilian 911 position and getting their first geriatric respiratory patient. And just like the “regular” EMS people, “cool” social media will always sell. This week, in fact, I saw social media advertising from one provider of “austere medical and rescue services” that crossed a very clear line in terms of medical decorum. In other words, it’s not just the regular EMS medics who have some work to do — it’s also the supposedly smart people.

Me? I’ll settle for competent EMS providers of all levels who can run a 911 call with good clinical skills, the appropriate level of compassion, and maybe, just maybe, getting the right patient to the right care. And none of that requires you to look like you’ve been operating behind enemy lines. Even more so if the biggest battle you’ve fought is dodging a dialysis transfer.