We Deserve Respect?

At every gathering of EMS providers, whether in person or in the online world, we constantly bemoan the perceived lack of respect that the “ambulance drivers” get from the rest of the medical community, from other public safety providers, and from the public that we serve.  So, to answer the question as to “when will we get the respect that we deserve,” I present the following answers.

When doing the right thing for the patient becomes more important than doing something, no matter what it is.

When we embrace education and science-based medicine rather than dogma because “our instructor said so” or “I’ve seen it work.”

When we work constantly to raise the minimum standards for entry into EMS rather than continually watering down standards while using “the volunteer crisis” as an excuse.

When we spend as much on continuing education and pursuing knowledge as we do on getting another set of LED lights for our personal vehicle.

When we embrace professional self-regulation rather than being an afterthought in most states’ health and human services bureaucracies where the same people inspecting ambulances are inspecting tattoo parlors and tanning beds.

When the term “semester” replaces “clock hours” for ALL levels of EMS education.

When we recognize that patient advocacy and customer service are part of the job rather than something to be ridiculed with a t-shirt slogan.

When we realize that completion of a 120-180 hour EMT course and passing a test of minimal competency is but the beginning rather than the pinnacle of a medical career.

When we recognize that heroism consists of significantly more than merely working in the emergency medical field and doing your job.

When punitive medicine like selecting IV catheter size based on your annoyance factor with the patient or joking about rapid sequence intubation of a patient without adequate sedation is no longer accepted on your ambulance. (At the very least, can we not make these comments in a setting where the public can hear them?)

When shop-worn slogans denigrating advanced practice in favor of “BLS before ALS” are recognized as the anti-intellectual attitudes that they are.

When EMS education reaches a point where one can become a paramedic without first having EMT certification.  Doctors didn’t go to physicians’ assistant school first and lawyers don’t have to become a paralegal first.

When we recognize that “street experience” may actually be meaningless if it was three years of working a BLS transfer truck and learning nothing but bad habits, shortcuts, dogma, and who gives free coffee to EMS.

When we realize that the most important thing that any EMS provider can do is to provide a thorough, competent assessment rather than some “sexy” skill.

When we stop using “the lawyers” as a mythical bogeyman and start understanding the laws and regulations that impact the practice of prehospital medicine.

When we as EMS providers have a voice at both the US Capitol and each and every state capitol.

When our goal is that we leave every patient at least as well as we found them.

When we stop defining EMS by “what we can do.”

When we realize that we DO diagnose and that diagnosis is not illegal, but rather, is expected.

When we recognize that what’s not an emergency to us is still the most important thing that’s happened to the patient today.

When we realize that the most important person in the room is the patient.

When we cease to define clinical competency by parroting a skills sheet.

When EMS managers cease to define success by response time and cardiac arrest survival.

When every EMS provider in every EMS system knows who their medical director is and how to reach them.

When we realize that continuing education is designed to teach new concepts rather than just merely repeating the same dogma on a two year basis.

When we recognize that lowest common denominator medicine means that providers will sink to the lowest common denominator.

When we finally realize that the biggest obstacle to EMS advancement is the average EMS provider.

When we recognize that it’s not our job to judge our patient, but it is our job to treat our patient.


When we can hit even fifty percent of these goals, the respect will be earned.  And so will the salary.


  1. That’s a big list. All true, all valid, and spot on.

    • How about; When we recognize that we are human beings doing extremely demanding work, physically, mentally, emotionally, psychically and spiritually. and decide to learn to support each other before burnout negates all the good moves above.

  2. This was a good basic list.
    The following are intermediate qualities towards being better recognized:
    Understanding the importance of actively marketing EMS & knowing how to be effective

    Understanding how to use each patient and public interaction as a public relations event

    Understanding how to promote yourself, your organization and EMS without being condescending.

    Understanding of how to show return on investment to your customers and stakeholders.

    Understanding on how to build partnerships with organizations like fire & police, as well as community organizations like the Kiwanis & Rotary.

    There just a few. Could do a 25 hour educational program on this topic to get a base foundation on how to earn and garner respect.

  3. I agree with it all, except the straight to ALS without BLS certification. It’s the experience you gain as BLS, that helps you be better at ALS. Knowing sick, not sick, etc. there is so much, that a class room can’t teach.
    No, doctors don’t go to doctor assistant school, before med school, but there still is the steps before being a doctor, residency, internship, specialization etc.. Also, self regulation isn’t all it’s cracked up to be.

  4. Thomas Hannan says

    Doctors do not always become P.A.s prior to becoming a Physician and Attorneys don’t always become para-legals before going to law school. However, nearly all of then go through pre-med or pre-law major tracks as undergrads. I hope that you are not advocating taking untrained “civilians” who don’t know the difference between a traction splint and a cervical collar, and putting them into Paramedic school.

    • theambulancechaser says

      Of course not, but why does one have to take a separate EMT class and get a separate EMT certification? Why wouldn’t a program that integrates the EMT and paramedic curriculum work?

      • In my experience working full time as a paramedic, being an FTI, and teaching the EMT-B and Paramedic class at the local community college I think it is important to get experience as an EMT first. There is so much to learn as a new employee on the ambulance. Driving emergent, parking, working with fire and police on scene, dealing with difficult scene management, patient moment, working the cot, working the radio, and on and on. I see a lot of benefit in having these things dialed in before going to paramedic school. It makes the new paramedic more confident and more able to focus on the patient and the medicine.

    • Jay Cloud says

      Why not? Provided the education begins at the “no nothing” stage just like the beginning of EMT classes, and works through the entire EMS scope of education. There is no other health profession that has the “apprentice-journeyman-master” modular credentialing that EMS has. Our professional structure is more akin to being a plumber than being a health care professional. The “we’ve always done it this way” mentality does not always mean it is the best practice. Where is the evidence that the traditional progressive steps in credentials is the best practice? It doesn’t exist. If that is the best practice, then every other credentialed health care, legal and accounting profession needs to immediately stop what they are doing and restructure. All too often our resistance to change is the cause of our failings. My opinion.

  5. Gene Gandy, JD, LP says

    One more. Eliminate systems where base-hospital nurses, nurses who have no street experience and are not paramedics, determine the practices of the EMS systems they connect with (Arizona’s model). In fact, eliminate base hospitals completely and require that every service have an active and functioning physician medical director, preferably one who is also a Paramedic, who determines scope of practice and procedures for his or her service.