A Late-Night Rant about Petty Politics in EMS

I had to think about a Facebook comment that I just posted on my personal Facebook page. Admittedly, I’m pretty angry right now and I probably shouldn’t be writing. It’s been a long night, you see and I’ve had it up to my eyeballs with what I’m angry at.

However, this blog is my therapy and I can use it to get some stuff off of my chest whenever I see fit, right? Good, then here goes.

Tonight I’m going to forget that my computer has been acting up on me and has lost two 1000word-plus articles that I was lining up for the end of the week. I’m not even going to mention that I’m behind on a lot of projects because I’ve been overwhelmed with work. I’m not even going to talk about how the workload that I’ve let pile up has been making the blog suffer. Nope. I’m going to jump to the front of the line and bring that Facebook comment right here, to the front of this blog page where a few thousand EMTs and Medics might read it this month.

Revenue Preservation, Area Preservation, Ego Preservation, and Political Capital Preservation
These things are the top priorities of some EMS agencies I’ve dealt with over the years. Patient care is on the list, but its way down on the bottom of these agencies’ priorities. Some agencies have their priorities straight, but more it’s more common than I’d like to admit that EMS agencies have those four things at the beginning of this paragraph firmly implanted into their unwritten mission statements.

I’ve written at length about EMS politics and how I hate them. For example:

Is What You Do The Best You Can Do?

Volunteer Fire/EMS : Taking the High Road and Letting Go

Two Cases, One Letter: From One Paramedic’s Struggles, Change Can Come

Cat Puke Chicken

EMS 2.0, Bernoulli, Fluid Dynamics, and Changing the World

And Much, Much more

And tonight, again, I’ve seen yet another example of the worst kind of EMS politics. I’ve seen these situations countless times before and I’ll see them countless times again, I’m afraid. People who don’t put the patient first have missed the whole point to this EMS thing. We’re here for the patient. We’re here for the citizens. There is a selfless aspect to EMS that must be respected in the preservation of the greater good. To miss that for almost any reason is to disrespect not only the foundation that EMS was built upon, but also the foundation of the entire healthcare system.

First, Do No Harm

Yea, that’s the first pledge of the Hippocratic Oath, the same one that Physicians take when they become doctors. EMS people are an off-shoot of physicians and we should follow those four words up there as much as they have to. Using the citizens of your jurisdiction as pawns in a political game is to violate those most sacred of oaths. EMS people tend to feud for the flimsiest of forgettable reasons. These feuds escalate unchecked for years until every action taking by the opposing party seems only to reinforce the perceived validity of the petty feud, even when the original actions or inactions that caused the feud were lost to history or died with the people who started the feud to begin with. Often, neighboring squads hate each other for no reason that they can remember. Factions within a single EMS agency may feud internally for no good reason whatsoever. These things escalate and escalate until patients are harmed by them for no reason at all.

And if there ever has been a reason to harm a patient for a petty feud between services, between cliques, or between individuals, I’ve yet to hear it. In my opinion, using a patient as a pawn in a political game is the worst kind of offense.

These petty EMS politics, these laughable feuds, and the little kingdoms must have the light shown upon them. As I said in my probably politically incorrect Facebook post:

“I don’t like it when Petty People play petty politics with peoples’ lives. Really, people die from the kind of stuff I’m angry at without ever knowing that they were pawns in a political game. EMS politics must be exposed to the light so that the people that play them can be scattered like the cockroaches they are.”

Do you see anything that I’m going to be in trouble for tomorrow when people read that post? Remember, that’s on my personal account; not the blog account. Yes, I do take personal responsibility for everything I say on this blog page or in any of my public speaking or writing for that matter, but there’s a chance that people I know and may or may not have been talking about will read that tomorrow. My guess is that I will be the bad guy for saying it.

And frankly, I don’t care.

As I said in the post that I linked to above, Volunteer Fire/EMS : Taking the High Road and Letting Go, I am willing to bury each and every hatchet I do now hold or have ever held and solemnly pledge to conduct myself in friendship, mutual understanding, and for the good of the ideals in which we all should share. My guess is that there are people out there tonight who should do exactly the same. Don’t let petty politics harm those whom we’re pledged to serve. It’s not about us. It’s about them. It’s about our ideals.
It’s bigger than us. We are more than the sum of our parts. Don’t forget that.

I know that this hasn’t been the most polished piece I’ve ever posted up here, but everything I’ve said I believe. That’s why I’m a blogger. It’s why I’m a paramedic as well. Thanks for letting me rant.

The EMT Oath as adopted by the NAMET

– See more at: http://www.lifeunderthelights.com/2010/10/27/a-late-night-rant-about-petty-politics-in-ems/#sthash.012BNQoN.dpuf

  • Msparamedic

    awesome post, CK… you know I’m with you 100%

    • Ckemtp

      I know, Nat. I’m honored to count you as a friend. You know that I’ve got your back as well. Thanks for letting me rant tonight on Mutual Aid.

  • This is a huge problem in EMS. We seem to come up with every excuse possible to not put the patient first. There is only one real reason to not put the patient first – a threat to me or to my partner.

    That threat does not include simple discomfort, such as –

    Missing the end (or the beginning) of the big game.

    Missing a meal.

    Being late for my next job.

    Having to transfer care to a rival service.

    Et cetera.

    Our job is to take care of the patients. Without the patients, we do not have a job.

    The patients are not there to assist us with stroking our egos.

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  • Hilinda

    I hear you. I’m having difficulty with my own fire department because the officers prioritize petty control issues over anything remotely related to quality patient care.
    I just want to do my job, and provide the best care possible.
    When I got into this, I assumed that was everyone’s goal.
    Disappointing that it isn’t.

  • Jared Alexander

    I came out ‘here’ from California. That means I came from an all-paid, professional (don’t even go there, I’m not debating that term here) EMS system with Paramedics on every ambulance on 9-1-1 response. I learned EMS as an EMT, Firefighter and Paramedic, and I learned that if you don’t value the patient FIRST, you’re not going to be around very long.

    That said, ‘out here’ is the East Coast, Jersey to be exact. I was horrified to learn that a vast majority of this state (the nation’s most populous per square mile) is covered by VOLUNTEER EMS. Now, that’s not necessarily a bad thing, if properly managed. Volunteers can, and do, provide excellent EMS in many places. I didn’t work in one of those places. I worked fire-based EMS on a military installation, surrounded by volunteer EMS squads. All of their little fiefdoms and petty kingdoms fought, both internally and amongst each other. No one went to calls- too many petty arguments over who was senior, who’s doing what to whom, which squad is better, whose area a call is in… and many many more BS little things.

    We, the full-time, staffed Fire-based EMS crew, sat in the station and listened. We listened as calls for dyspnea, chest pain, unconscious subjects, vehicle accidents with injuries, trauma, and yes, total crap calls too, went unanswered. I distinctly remember listening to the dispatch as this call went out:
    “Attention *town first aid, respond to * care center for a person choking”
    no response
    “Attention *town first aid, respond to * care center for a person choking, second request”
    no response
    “Attention *town first aid, third request, respond to * care center, CPR in progress, requesting mutual aid”

    I didn’t hear the outcome of that call, but it’s blatantly obvious to those of us in the business. That patient died. Not because there was no ambulance available, not because other calls had taken the volunteers away from their town. Because no one bothered to respond. The petty bullshit ran all the potential responders away long before this call came in, and too many egos were involved. This is a town that has significant tax basis for a full-time, paid EMS division. They get well over a thousand calls a year. There are major roadways going through town, a very large industrial area with numerous high-risk processes, a number of convalescent/care facilities, a very busy rehab hospital… they have the need for staffed EMS. So, why not go paid? Because someone would have to give up control of their little piece of the kingdom, and that means they wouldn’t be the “big boss” anymore. That simple. They don’t want to let go of control.

    I know, I know. Why doesn’t the public do something? They don’t know, don’t care, don’t want to bother with it, don’t want to pay more taxes, don’t think it’s necessary because THEY don’t need the EMS right then and there. AND, NJ has a law preventing litigation against the volunteers. AND, the state “First Aid Council”, an all-volunteer group that… well, I don’t really know what they do besides prevent forward-thinking and progressive EMS from coming into NJ. It goes on and on and on… what it boils down to is exactly what your rant is based on- a lack of concern for patient care as the primary reason for existence.

    So, all that to say, “I agree with you, I feel your pain, and I hope everything gets better soon.” I don’t see that happening here in Jersey. Too many people have to keep their little kingdoms, have to exercise power because they can, are afraid of change because it’s “change”.

    Stay safe, take care of each other, and take care of the job. In that order.

  • Keep going CK. A fb post like that will only enrage those who stand in the way. When they make themselves known, ask them if they actually thought about it or simply jumped out of their chair their knee jerked so fast.

  • Anonymous

    This is just flogging the dead horse. It might as well be 1990 as 2010, same old song and dance. Personally, I am just sick of hearing about it. Here is my take on this.
    Have you ever heard the “man song”. It has lines in it that go something like this,” I can do whatever I want, (When she lets me)”, “I can stay out all night, (When she says it is ok)”.

    Volunteer Fire and EMS do the EXACT SAME THING! I am both a career Fire/Medic and a Volunteer, so stop the complaining now.

    Here is the same song but with the volunteer flair,” I will respond to all calls, (As long as they don’t interfere with something else I would like do to more)”, “I want to be treated with the same respect as my career brother and sister”, (As long as I don’t have to have the same accountability).

    Chris, I feel the pain in your message but I am going to tell you, the general public doesn’t care, the politicians do not care, and even the volunteers do not care!

    Stop beating your head against the wall. 99.8% of the world thinks the system is fine. Tax payers don’t want to pay higher taxes for full-time EMS. The tax payer is willing to roll the dice and bet that they will never need an ambulance. The volunteers don’t want full-time EMS, and then they wouldn’t be needed. They receive too much of their self worth from this profession to give that up.

    To all the people that will read this blog I say, “Let it go!” The systems that run well are doing so because they figured out that EMS is NOT about the EMT, it’s about the patient. Those that aren’t running well have not figured that out and I have found out that they usually don’t want to figure it out. They are much happier wearing their EMS coat around town with their little red light on the dash all the while busily patting themselves on the back.

    Medic 1518 out!

  • Sinnamon_smith

    I love my job. To me, it’s an honor to be trusted to help people in their time of need. That said, my company has MAJOR in-fighting that has resulted in frequent lapses in patient care. All of it can be traced to one person who loves being a bully. Why not get rid of this individual? Because this person successfully bullies our Chief. This person doesn’t bother to hide that he/she goes home to sleep during the shift (does not live within our response area), blatantly ignores calls and changes the schedule at their whim. How do you handle this when the person who is the problem intimidates the Chief and board members, and is close with the human resources manager? Any advice is appreciated…

    • Anonymous

      Fire the Chief. Period. This is a management issue. Your bully is a bully because the Chief allows it. Like an untrained dog, this person will not change on their own.
      New management will fix this problem hopefully, because the current can’t or won’t.

      Medic 1518 out!

    • If nothing else is working, notify someone in the local media, so they can film this. As much as it hurts to let someone else solve our problems, the public exposure is better than allowing this to continue.

      The bad image is entirely the responsibility of the person misbehaving, not the fault of the person bringing this bad behavior to the attention of others.

  • Nicely done, CK. Patient care should come before anything, ANYTHING, else. Period.


    I think a lot of this comes down to knowing that there’s a time and a place for rivalries and politics, and a time and a place for those not to be present. The majority of my time working as an EMT (2.5 years working, 6’ish certified, employment lapses due to school) was down in Southern California in a county where the only paramedics are with the fire department. Now anyone who recognizes my handle from EMTCity or EMTLife web forums or my other handle (“Joe P”) from JEMS Connect knows that I absolutely hate EMS based fire suppression for multiple reasons that aren’t appropriate for this topic. However, if I needed paramedics, I’m not going to have an internal debate about the fact that the paramedics are with the fire department. I call, they come, I hand over care, I provide what assistance I can. End of story. I can debate the merits about EMS based fire suppression anytime else, except when it comes to working with patients or interagency training. If that means that I’m helping to carry bags in, or cleaning up my ambulance while the paramedics are finishing up turning over care and their PCR, then, well, that’s what I was being paid to do.

    Politics should never interfere with patient care, and anyone who lets it interfere with the care that they provide, including the decision on whether to request additional resources, needs to seriously reevaluate why they are responding to calls.

  • The Social Medic has a similar rant up on the specifics of New York State’s laws that prohibit assisting without being dispatched. Do Amoral Policies Justify Immoral Behaviour?

  • PiiShii

    While I love my job, I have always hated the politics. Thank you for saying what most of us have been feeling for a very long time.

  • Jdmedic

    Chris – I join the pack who understand the frustration you feel and applaud you for venting, in a responsible way, in public. When we look at the money, perks, benefits and public esteem that the fire service and law enforcement receive we should not be asking why we are not on equal footing with those public agencies. We all know the answer – and for anyone who did not know before your post, you spelled it out. Although the “thin blue line” certainly has negative connotations with respect to the brotherhood in the law enforcement, when it comes down to having each other’s backs, it is instinctive. It has always been a fall back position to say that EMS is much younger than the law enforcement and fire service communities as an excuse for many of our failings. But just as an individual has to become responsible with age, so does EMS and the time for using “infancy” as our excuse is long overdue. When I become discouraged with system or agency politics or other absurdities of our system I try and remember the wisdom of Thom Dick, whom I like to think of as my long distance mentor and a quote from Robert Kennedy (regardless of whether you liked, disliked or don’t know about his politics. Essentially it is, if one person throws a stone into a pond it only makes little ripples, however if enough people throw enough stones into the water it will create a wave large enough to change anything.

    Keep up the good work.