The Soft Bigotry of Low Expectations

Yes, I know that’s a quote used in a George W. Bush speech.  Yes, I know some of you may not like President Bush.  Truth be told, I don’t always either. (He’s like the Diet Coke of conservatism: Just one calorie, not conservative enough! — Apologies to Dr. Evil, by the way.)

But, truth be told, it’s a quote that applies so well to EMS.  I’ve been guilty of it myself.  And I think a lot of us are incredibly negative about EMS, our past, and our future. Day after day, I read posts on EMS social media about provider mental health.  I read posts about the pay in EMS.  Heck, I even read posts about poor EMS protocols, poor working conditions, and poor coworkers.  When you read that, it’s easy to get discouraged about EMS.

Here’s the great news.  Provider mental health is an issue.  But we’re addressing it.  The Code Green Campaign is raising awareness, promoting access to mental health care, promoting resiliency, and promoting self care.  Reviving Responders is doing similar work as well.

As for the other issues, there are solutions.  Forming associations to represent our profession at the state capitols where the majority of EMS regulation occurs is a huge step.  Yesterday marked the one year anniversary of my state’s EMS association, the Association of Texas EMS Professionals.  In that year, we’ve accomplished a lot – from providing paramedics the ability to work in hospital ERs to being recognized as the state affiliate of the National Association of Emergency Medical Technicians to being called to testify before the Texas Legislature as witnesses on EMS issues.

For those of you complaining about poor pay, poor working conditions, and poor protocols, there are services out there that are looking for EMS professionals like you.  It may involve getting out of your comfort zone, but these places exist — all over the country. At the risk of sounding like “tough love,” if you choose to still work for a bad employer, you have made your choice.

And yes, there are places where learning happens.  Social media may have its faults (see also: EMS “clickbait” articles), but the FOAM (Free and Open Access to Medical Education) movement is bringing current medicine to all of us.  Granted, much of it is geared to emergency physicians, but we should be learning at their level anyway.  Medicine is medicine.  EMS remains the only profession with arbitrary concepts like BLS and ALS.  While there may be regulations governing scope of practice, I’ll give you some free legal advice.  THERE IS ZERO LEGAL LIMITATION ON EXPANDING YOUR KNOWLEDGE.  Other learning opportunities exist at EMS conferences.  If you are only learning your profession from within your department, you’re selling yourself and your patients short.  Insular clinical thinking and inbreeding in education is a disservice to our profession.  Professional networking and exposure to new, outside ideas is how change happens in EMS.  And there’s even opportunities to expand one’s EMS horizons on Facebook.

So, in conclusion, I’ll leave you with another cliché politicized quote that also applies to what we do in EMS.  “It gets better.”  And it starts with each of us.  Go. Do. Medicine.


  1. Gene Gandy says

    Wes, this is your finest writing to date. As one who has opined often on the state of EMS, I am put to shame by your eloquent writing today. This should go viral! Kudos, my friend. You have it right in every way.

  2. Sam Benson says

    Thank you!
    I am reminded of a refresher class that I took. I was chatting with the medical director and said that, frankly, it was a bit boring: we were simply reviewing old material. I said it would be nice to use refresher to quickly review but also add some new stuff–experienced paramedics would be receptive to learning more.
    The response has stuck with me to this day: “we can’t…we have to worry about the weakest link”

  3. Maybe we’re looking at this wrong. We could feel better about 120 hours of elevated first aid training by changing EMT to “Paramedic Apprentice”. Then we could study to be a Journeyman Paramedic.

    The truth is that we need more education at all levels, not to get in a dither over where and how we will find time and money to get our CE (which is all too often just repeating our initial education and ensuring we meet minimum standards like the NR requires), in a “profession” we chose to be a part of. We should view continuing education as an opportunity to expand our knowledge-base and become better clinicians. We should prove we are worth more money, not just demand it because feelings and because fast-food workers are doing it that way. Advocacy for your profession is not achieved by kitschy slogans on T-Shirts about how much you sacrifice and endure and declare your perceived-elevated level of heroism to all who see, and by bitching about how bad you have it on public and even closed social media pages. It is done by being a part of a professional organization where you elect and select representatives to carry your voice to the legislation, locally, at state, and nationally. Better yet, volunteer to be that voice by filling an opening or running for election in your state association or the NAEMT. If you don’t have a state association, reach out to the Association of Texas EMS Professionals at or on Facebook and they’ll help you take the steps to get one off the ground in your state. To plagiarize The Transformers Movie Witwicky Motto: No sacrifice, no victory!