Fight For $15

So, in a fit of rage, I was almost tempted to write a screed about how EMS providers don’t deserve the $15 per hour wage that fast food workers are protesting and clamoring for. My rationale was (and remains) simple.  After watching the attitudes from so many EMS providers, especially in the average online discussion, I’d be hard pressed to argue that many people in EMS deserve to be paid this much even.  Whether it’s the blind devotion to dogma (See also: Spinal motion restriction), the overinflated sense of self importance (See also: the usual t-shirt slogans about how under 200 hours of first aid training is equivalent to being a physician), or the culture that mocks education (See also: The usual claptrap about EMTs saving paramedics and/or “BLS before ALS”), it’s clear that many people in EMS are overpaid at minimum wage.

Today, though, I dug deeper into a recent EMS discussion about the priority between hemorrhage control and the classic “Airway, Breathing, Circulation” priorities that are drilled into almost every EMS provider.  I noticed that the majority of providers wanted a definite, absolute answer.  They wanted a clearcut answer.

Here’s the problem.  In any learned profession, whether it’s engineering or medicine, the answers are rarely clear.  Answers to most questions are heavily dependent on both the facts of the situation and the judgment of the professional.  As both an attorney and a paramedic, my favorite answer to any question is, “It depends.”  But too many of us in EMS want a definite answer.  We want a protocol or a flowchart to follow.  We claim that we want to be treated as professionals, but then we want someone to supply us the answers and make it easy for us.  Following the protocols or the skills sheet truly is the medical version of being a fry cook.  Congrats!  We’ve earned our $15.




  1. Dan Limmer says

    EXACTLY! Another great post.

  2. Yep. Not that I think EMS shouldn’t be paid more, but we’ve got to get our proverbial sh*t together before we start making demands.

  3. Lavonne Dinerman says

    Can we take it smaller? People have two minds – one for learning & one for applying. Learning requires a training statement: situation equals answer. Applying requires a learned statement: situation equals training + experience + What Would Mama Do? or “It depends”. To successfully define the patient answer you must have Plan A & Plan B. As no one is born knowing this stuff, it is not wrong to expect your training to give you an answer plus the knowledge that you must never stop learning.

  4. How would you suggest making Paramedicine a more professional job/career? Taking away protocols? Almost every medical job has protocols, physicians, nurses, paramedics, EMTs, etc. all have protocols to abide by. Nurses are given jobs and tasks to do by the doctors they also have protocols. Paramedics recieve orders from doctors and have protocols. I understand that what a nurse does is different in the scope of things compared to a paramedic. There are paramedics out there with their undergraduate in Paramedicine and there are paramedics what just have certifications, a price of paper dosnt make them any better. If a doctor has to follow protocols and is considered a professional career why cant a paramedic?

  5. Sam Benson says

    First of all, on-line discussions are not a good way of judging people. Too much passion, too little nuance, etc. Having said that, EMS providers are captives of the EMS training, EMS protocols, and EMS systems.
    We train people in just a few hours giving some basic rules, e.g. ABCs, and test them against a rigid set of algorithms. We treat patients according to protocols of varying specificity. We manage (!) many of our systems with a unhealthy does of negative feedback (“we only call you in if there’s a problem”) and time micronmanagment (convenience bias–time is the easiest thing to measure). For a number of reasons, EMS people bond to each other and take on a mentality of “you wouldn’t understand” to those who don’t “work the streets.”
    The bottom line in too many cases is ignorance of nuance, rigid mentation, and a bit of a hero complex.
    To a certain extent, we get from our EMS providers what we put in:
    you reap what you sow.

  6. Alfonso R. Ochoa says

    Physicians also follow protocols to a certain extent. For example, a patient who presents to an ER with LOC after a fall, despite their overall clinical condition will have a CT of the brain without contrast done. The same goes for a patient with new onset seizures, regardless of the apparent cause. And don’t get me started on hospital core measures…

  7. Charles Cowles says

    Physicians follow protocols but are not bound to do so. But physicians hold full and final accountability for their decisions, actions, or lack thereof. EMS has always had difficulty with the concept of training vs. application. If a medical director allows RSI and trains accordingly, then the rate of application of the new skill goes through the roof. Even though a medic might experience 2-3 patients a year who truly need RSI, now the threshold is lowered and you now have a slightly combative drunk patient who arrives at hospital intubated and now prone to aspiration, tube dislodgment, malignant hyperthermia, and now vent dependent with a huge hospital bill. The arrogance and entitlement of a lot of EMS workers doesn’t help. As to what would get EMS value would be to perform a gap analysis in pre-hospital care as part of the overall treatment of medical and trauma patients and adjust their services accordingly. Sometimes this means a simple BLS trip to the hospital, but if that is what is needed then do the job and do it really well. Learn to assess patients with the intent that the assessment is guiding you to what should and should not be performed. Finally listen to what others are telling you especially if they are saying $15 / hour is too much.

    • Sam Benson says

      I won’t disagree that there is problem with the “arrogance and entitlement of a lot of EMS workers” but when the argument is over $15/hr, that ain’t a lot of entitlement.