The Medics are Revolting

Howdy everyone! This pre-script note is my apology for starting off my first post on my new blog site with a rant. Yes… I am indeed ranting here.

Do you hear the people sing? Singing the songs of Angry Men. It is the music of a people who will not be slaves again! When the beating of your heart echoes the beating of the drums, there is a life about to start when the morrow comes.

Will you join in my crusade? Who will be strong and stand with me? Beyond the barricade there is a world you long to see? Then join in the fight that will give you the right to be free!”

– Jean Valjean, Les Miserables

< rant>

“You’re just a dumb EMT/Paramedic. Know your place. Shut up and take it. Don’t make waves. Don’t question the system. You’re a cog in the wheel. The system is in place for reasons you don’t understand. Stay in your lane. You don’t have to understand, just obey. Don’t overstep your boundaries. Shut up and do your job. Don’t be a “problem child”.”

All of my professional life I have heard the above. All of my professional life there has been the chorus of the negative. The naysayers have been winning and the apathetic have been in control. The dreamers are troublemakers and the innovators are punished for breaking the rules. They must control us, they must hold us within our role and not allow their status quo and their version of where we are, who we are, and the direction that we should be heading to be challenged. They set the rules and we are to follow them without all but the most superficial of questions.

All of my professional life I have seen patients suffer for it. All of my professional life I have felt my peers and myself suffer for it. Patients suffer from poor, outdated care borne from outdated thinking and EMS people suffer from it through pitiful wages, laughable working conditions, and no professional respect. The ones that conform to the status quo are rewarded for their compliance through slightly better wages and working conditions, but their patients still suffer the same. Every service delivery model has it’s problems. There is no unified voice. Every system has it’s limitations and those who seek to limit it.

And I’m mad as hell and I’m not going to take it anymore.

EMS is suffering from apathy. We’re suffering from a distinct lack of the pioneering spirit held by those that came before us. They saw that the lack of a system was causing suffering in their communities and built a system to care for those persons emergently sick and injured. Through their trials, tribulations, work, and sacrifice a system was put into place that we currently function within. Amazingly, our system is functioning well in it’s adolescence and I am proud to carry on under the banner of the Emergency Medical Services. Our blessing and our curse is that we are the ones whom our society has burdened with the responsibility of responding to our fellow humans in their time of need. It is an awesome responsibility and one that we are honored to hold a place within.

But are we honoring the work of those pioneers who came before us? Are we truly accepting the burden of our responsibility to those we’re sworn to care for?

Sadly, no. We’re not.

Here’s the deal. As a profession, we have some decisions to make and some lines to draw in the sand. First off: We all have to care about the right things. Yes, in some cases, it’s debatable what the “right things” are… but here are some that I think everyone can agree on.

  1. Every patient deserves our best
  2. Every patient deserves our advocacy
  3. Every patient deserves the best medical care we can give them
  4. No patient risk harm due to petty political games or power struggles
  5. No patient should risk harm due to ego
  6. Every EMS provider is responsible to ensure the best care possible for patients in their charge

That all sounds simple, right? Unfortunately, you all know that it doesn’t work like that every time. Systems fall through the cracks, mediocre providers coast along providing mediocre care, ego trips by the various health professions engage in endless power struggles using patients, jurisdictions, and policy as pawns in the game. “Uppity” paramedics who question their role are shamed into submission. Patient advocates who stand up for the rights of their patient against apathy and whatever requires the least effort are chastised. We’re called troublemakers. We’re vilified for our pursuit of improvement in the system or our pursuit of the best possible care for every patient, every time.

EMS 2.0 is the maturing of EMS out of the adolescent trade phase into a grown-up profession. EMS people need to take a stand together, casting off our petty differences and realize that we are here for the same reasons. Our awesome responsibility is to the patients who depend on us. It’s something that we can no longer take lightly. We can no longer allow the various outside forces to dictate our educational standards, our standard of care, and our “place” in the medical hierarchy.

I know “my place”, and it’s not where the ER nurses want me to be. I’m not “unlicensed assistive personnel”. It’s not where the fire unions want me to be, I’m not “a firefighter who works on the ambulance”. It’s not where the private companies want me to be, I’m not a “Pulse and an EMT card”. As a professional paramedic, “my place” is dictated by the professional competence and responsibilities earned by the members of my profession as supported by science and as allowed by law.

That’s just it. A true “profession” meets the following criteria, as can be found on our friend Wikipedia:

The main milestones which mark an occupation being identified as a profession are:

  1. It became a full-time occupation;
  2. The first training school was established;
  3. The first university school was established;
  4. The first local association was established;
  5. The first national association was established;
  6. The codes of professional ethics were introduced;
  7. State licensing laws were established.[2]

So does EMS meet the above criteria? Yes, and no. I think that we are indeed a full-time occupation. Even volunteers must put in full-time hours to maintain proficiency. We have multiple training schools that are loosely based on the National Standard Curriculum, but even with that standard there’s a ton of variation throughout states and regions. For example, somewhere on this site you’re going to see a Google ad for a “Guaranteed Pass” online EMT class. My wife, Gkemtp(it), is going for almost 15 months. Is there a University school? Yes, go ask Firegeezer about George Washington University’s EMS degree program. While there really aren’t any degrees above the bachelor level that I know of, at least it’s something. There’s local and national EMS associations, like the Wisconsin State EMS Association and the NAEMT. There’s the EMS Professional Code of Ethics and every state has licensing laws.

So why aren’t we a respected profession? We meet the 7 standards, don’t we? Mostly anyway.

I’ll answer for you, it’s because we’re not united… yet.

Welcome to Life Under the Lights. Welcome to my little piece on the web. I believe that we can unite under free exchange of impassioned ideas about the profession we believe in. I invite you to dig in, saddle up, and help our profession achieve the greatness we know that it can.

< /rant>

  • The University of new Mexico also offers a world class Bachelor's Degree in EMS. Great staff and resources made me the caregiver I am today. Never stop ranting CK!

  • It's a perfect first post.

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  • totwtytr

    A big part of the reason is because we are treated, and treat ourselves, as a skill set, not a profession. We are an add on skill set to fire fighters, police officers, athletic trainers, and you name it.

    Until we, as nursing did, take control of our own profession and destiny.

    NAEMT, the other EMS organizations, publications such as JEMS and EMS don't help either. Their publishers always seem to take a preachy – paternalistic attitude towards their readers.

    Working EMTs and medics have to take control of the destiny of the profession or we're doomed to be just interchangeable cogs with a useful skill set.

    • Ckemtp

      I completely and utterly agree with ya Tot, as I do with most things. I’ve never seen the NAEMT do anything. Not just anything for me, I mean ANYTHING.

      Is there any NAEMT supporters out there that would defend them? I mean, I’ll accept your opinions. I WANT to be wrong here.

  • roguemedic

    A nice Howard Beale entry. Let's hope there is not a Howard Beale exit. 😉

    You make some great points. These are well established problems, but that does not mean they should be tolerated.

    There are programs that have masters degrees in EMS. Hahnemann/Drexel University used to have a masters program, but they even closed the BS in EMS program.

    We do need to get rid of the people who want more dazzling uniforms, bigger utility belts, and noisier sirens. A move to having educated and experienced people running things would be great for our patients.

    • Ckemtp

      Since I work rural EMS, there’s a lot of volunteers that have a LOT of lights in their personal vehicles. Since this is Wisconsin, they are allowed to run red lights and sirens and are afforded the same legal status as regular emergency vehicles when responding.

      And I mean a LOT of lights in their POVs.

      I’ve often wanted to stop them at the scene of an EMS call after they’ve run lights and sirens to get there and ask them the pathophysiology of the complaint that they’re going to. I wonder how many of them would know it off hand… as opposed to knowing how many candlepower their WheelingCode37 MX50q32 Strobe lights put out.

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  • msparamedic

    Amazing post, CK!!! I thought I was the only one who was constantly beaten down by the “obedient” ones… Keep ranting, my friend, yours make more sense than mine!

  • Amazing post, CK!!! I thought I was the only one who was constantly beaten down by the “obedient” ones… Keep ranting, my friend, yours make more sense than mine!

  • Pj

    No one else has chimed in yet?

    “You said it, they stink on ice!”

    Good post. It’s frustrating how many people (nurses, primarily, but some ED docs are just as guilty) think that EMTs and paramedics can contribute nothing more than a strong back to patient care.

    U of MD once had a masters-level EMS degree…don’t know if they still do or not.

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