Texas EMS Conference 2023 Postmortem

Well, it’s the week of Thanksgiving and for most people that means
turkey.  For me, Thanksgiving has always been stressful – mainly due to
family issues.  But therapy has helped with that.  (Mostly kidding,
y’all.) For me, this week has always been about the Texas EMS Conference and
all that means.  This is my nineteenth year taking care of Texans, first
as an EMT and now as a licensed paramedic. (For those of y’all reading this who
aren’t from Texas, the licensed paramedic thing is one of those weird Texas
differences – just like no beans in chili. For Texas EMS, we’re also special in
being a true delegated practice state and have no state protocols or scope of

This has been one of my best years at conference ever. There were a couple
of minor lowlights.  The keynote speaker was a very generic motivational
speaker you could hear at any corporate conference, but I suppose that’s okay
too.  Also, lunch on Monday could’ve been better.  (Food wise,
there’s a really strong, albeit underrated, BBQ option just around the corner
from the Austin Convention Center.

2023 has been a year of growth and change for me in both my legal practice
and my EMS passions.  Being at the Texas EMS Conference has really brought
some of those changes home to me.

First and foremost, I am coming to recognize my own worth to this profession
based on my experience and education. Case in point.  I had a good friend
come to me about the challenges they’re facing at their department and
describing the recent promotional process.  (For what it’s worth, I think
I did pretty well on the exam questions.)  The discussion then changed to
a part time position with that department and where and how I’d fit in. Not
that long ago (maybe even six months ago), I’d have started working out the
details of a start date and such.  Not this time.  First and
foremost, I’ve got two excellent EMS homes that are giving me room to grow
personally and professionally with the goal of helping both of these
organizations get even better.  Second, I don’t need to drive a
significant distance if I really want or need to get on an ambulance. I
explained exactly that.  If they want me to come on board, it’s going to
involve me helping them advance and progress doing the things that I can do
that maybe their current staff doesn’t yet excel at – risk management,
education, clinical management, training, and organizational development.
I’m rapidly approaching the point in my EMS journey where the opportunity to
lead, advocate change, and develop my colleagues is what drives me much more
than running calls. In the spirit of full disclosure, I STILL love running
calls – even more so if I’m with a newer provider.  Watching them grow and
learn is as fulfilling as getting a good call, just in a different way.

The conference has also brought more personal recognition of my changing
roles in my EMS career. I attended classes that were directed to my roles as
the opportunities arose. I’d have never thought that I’d attend or enjoy a
class on electronic charting software. But the class couldn’t have come at a
better time as I’m evaluating software choices at one of my departments. It was
a huge confirmation when the issues I’d identified and been working through on
my own. Attending classes like that and learning about other topics that I want
to bring back to my departments gave me a whole new understanding of why chiefs
and officers attend conferences. It’s not about getting a vacation or about
taking the opportunity away from the field staff.  It’s for us to learn,
network, and bring back things to the entire department. Sometimes, with
limited budgets being what they are, the best return on investment is for
leadership to attend to improve the entire department. Now, whether the leaders
return with relevant knowledge to make better decisions for their organization
or share that knowledge with their team is an entirely different story.

This week has really helped me realize how my EMS experience is changing,
and I think for the better.  During the conference, two EMTs from one of
my departments reached out to me with questions – one about how to document a
call and the other based on information they learned at conference.  After
the second one of these, I realized I’m now (whether officially or
unofficially) the one that gets the call when there’s an issue.  (And
there’ve been other calls/emails/texts this past year along the same lines.) In
other words, for better or worse, I’m feeling that my new roles now mean I’m
one of those people who get the call when something unusual comes up, whatever
the issue.  The recognition from others has been both humbling and
flattering.  And just as we feel unsure of ourselves as a new provider,
the feeling of imposter syndrome is even more intense as a leader, whether
official or unofficial.

Being a leader – or identified as one – means you feel different or at least
you should. Getting that email or text about an uncovered event gives me a
bit more of guilt than it used to.  And the “level zero” page has caused
me to change clothes and load my car up to go out and work.  If you’re not
feeling that same sense of obligation or responsibility, maybe a leadership
role isn’t right for you. Being out in the field, helping shoulder the load,
and setting an example by being present is what being a leader is about. Any
leader who doesn’t get that is no better than the volunteer EMT or firefighter
who’s just there to get the t-shirt.

I really felt the change in my age and role on Sunday – which is typically
the day that most of us wander around the conference exhibit hall to get free
pens and swag while we catch up with people we haven’t seen since the last conference.
Sometimes, we actively avoid some of the people we haven’t seen since the last
conference. Especially this year, I managed to rebuild a few bridges I might’ve
burned over the years.  I like to think
that those of us on either side of some of those arguments both grew.  At least, that’s what we told each
other.  But what really made me realize
my growth came from a new EMT I know who’s likely coming on board with one of
my departments. Like me, she’s a bit older and is going to volunteer while
deciding if EMS is the right path for her, including the possibility of
paramedic school. She asked if she could come up to the exhibit hall to hang
out.  I remember that same eagerness (and
I try to keep it going for both me and others) and encouraged her to come hang
out.  I made sure to introduce her to all
of the people I’ve known over nearly 20 years in and around EMS.  She’s already scheduled for a ride along with
a large urban third service EMS system as well.
She commented on how many people I knew and how willing I was to
introduce her around.  It’s called paying
it back.  And if you’re not doing it, you’re
part of why so many in EMS are worried about where the next paramedics and
paramedic leaders and educators will come from.

When I first got started in this field, I heard a lot of jokes about the people
who wear their uniforms to conferences.
And I assumed they were yahoos, yokels, and every other slang term for “Rescue
Ricky” out there. I made sure to avoid that by and large over the years. While
at our Texas conference this year, I noticed how many folks WERE wearing
uniforms or at least their department polo shirts or job shirts.  More importantly, some of these people were
presenting. And quite a few other people were walking around the conference
looking perfectly normal.  Having said
that, though, not everyone needs to wear a full dress uniform reminiscent of
Idi Amin.  If you are going to wear some
of your department’s uniform, whether fully or partially, wear it in a way to
reflect the obvious pride you have in your organization.  Tuck the shirt in.  And don’t be passed out drunk in the
uniform.  As for me?  I finally broke down and went ultra casual
the last day – jeans, a polo shirt, cowboy boots, and the zip up fleece from one
of my departments. I will draw the line at a radio, pager, utility belt, or a
dress uniform more suited to a Park Avenue hotel doorman.

My lecture on Monday confirmed that I’m on the right path.  While some of my usual conference friends
came, I couldn’t think of higher praise than seeing one of my current chiefs in
the room along with a former battalion chief that I used to argue with like
cats and dogs. That vote of confidence in my knowledge and my abilities spoke
volumes to me.  I hope I found myself
worthy of that trust. I’m just glad that I’ve been able to, at least in part, use
both my legal education and EMS experience to demystify some legal concepts and
give practical advice to EMS professionals and agencies.  FYI, I’ll travel.

Here’s hoping that conference was as rewarding for you as it was for
me.  And if you’re in EMS and haven’t
been to a major conference, it’s past time to go – and learn outside of your
own department.  On that note, some of
the best learning happens outside of the classroom sessions when you get to network
with others and see what others are doing.


Why Can’t We Get Perfect Volunteers?

Earlier this week, I watched a great documentary movie about the volunteer fire (and EMS) service called Odd Hours, No Pay, Cool Hat. The movie does a great job illustrating the various cultures of volunteer emergency services throughout the country as well as people’s motivation to volunteer and why they remain. As a volunteer myself (almost 19 years now), I saw a lot of myself in the movie and recognized some of the people I’ve worked with, even if the names and locations weren’t the same ones in Texas that I know.

Then, I looked at one of the departments they highlighted. Said department (which is NOT in a poor or rural backwater) wants their members to do a weekly night shift and a 24 hour Saturday shift every 4th week. That kind of schedule isn’t a volunteer schedule. It’s a part-time employee schedule. While this department was along the mid-Atlantic Eastern Seaboard, I’ve seen several volunteer fire and EMS departments in Texas that operate along the same scheduling concept. And the department that I spoke to in Texas seemed genuinely offended that I wasn’t able to meet their 48 hours per month commitment via a twelve hour shift weekly as opposed to my suggestion that I could come for two 24 hour shifts on the weekend. Apparently, at least there, they had a surplus of Texas licensed paramedics willing to work for free.

What I routinely see is the self-fulfilling prophecy that “we can’t get volunteers.” The truth is that volunteers are out there. The truth also remains that not everyone has the time, temperament, or inclination to basically work a part time job — especially with the added burdens of attending monthly meetings, fundraisers, committee meetings, and various mandatory trainings only offered at certain times. Even more so if you’re driving a way because of limited (or no) opportunities to function as an EMS provider or firefighter nearby.

Even the “hiring” process at volunteer organizations can be haphazard. People often don’t know that an organization exists, let alone is looking for volunteers. And attending a few “business meetings” to be voted in as a member, whether it’s a pro forma vote or a popularity contest undermines the notion that a volunteer department is truly staffed by “unpaid professionals.” Attending some department’s monthly meetings also demolishes that notion as you witness the lack of accountability, personal politics, self dealing, sense of entitlement, and rampant spending on pet projects. Thankfully, these are not issues at either of my current departments (one combination department and one entirely volunteer organization), but the stories ring true nationwide when my volunteer (and former volunteer) fire and EMS friends discuss their experiences. And those are just the issues that arise at the business meetings — not even addressing training, equipment, operations, and the other day to day issues that will either cause people to remain long term members or rage quit when the final straw breaks the camel’s back.

Volunteer fire and EMS is often its own worst enemy as it lowers standards, engages in petty politics, and creates a self-fulfilling prophecy of not being able to find volunteers. Oftentimes, they can’t fund volunteers because people don’t know they’re looking. Or if people do express an interest in volunteering, they are turned away because the volunteer organization only has one way to use them, whether it’s the failing model of the fixed duty calendar (see also: You’re working as a part time employee at this point and you should be paid as such.) or the idea that one must be all things to the department to be of any use. (See also: Most volunteer fire departments that turn away EMS-driven individuals. Pro-tip: Giving an “EMS-only” EMT or paramedic the keys to a squad truck means those who want to fight fire can do exactly that.) And of course, once a motivated member makes it through the malarkey and is still motivated, they’re all too often met with the conundrum of command staff playing the martyr, yet who are unwilling to delegate anything. The idea that new members need to pay their dues seems in direct contradiction to the martyr mindset of many chiefs and officers who simultaneously bemoan that the younger generation doesn’t want to help while also retaining their positions and duties even longer than some United States Senators. (For example, take a look at the interlocking boards of most of the EMS organizations and “stakeholder” panels where board members and stakeholders haven’t been on an ambulance or fire apparatus since there was a BioPhone and MAST trousers.)

Until we stop chasing the perfect volunteer and take what’s available to us, we’re doomed to the volunteer fire and EMS model being a historical relic that will, at best, limp along only because of the unwillingness of local governments to adequately fund emergency services. While we still have a volunteer or combination model for emergency services (by the way, there are reserve police officers too, even in large agencies), we have to either adapt our organization to reality or adapt the prospective volunteers to the organization. The former will be easier, no matter what the old guy in the back of the meeting says.

Otherwise, the stagnation will continue with the duty roster becoming more and more empty and no one wanting to “put up with that BS” to “work for free.”

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