An EMS Rant: Don’t Believe this Picture
April 9, 2014 | Emergency Medical Services, Emergency Nurse, Emergency room, EMS, ems 2.0, EMS ethics, EMS pep talk, EMS rant, EMS Topics, everyday ems ethics, grumblemedics, new perspective, Paramedic, profession, professionalism | Ckemtp | 22 Comments

So I saw this picture on Facebook today (Warning: There are some mild swear words in this picture you’re already seeing so I’m warning you that this warning is moot)

Two Kinds of EMS Calls

Don’t believe this picture.

I’ve read somewhere that people will believe anything they read from a picture with words on it they see on the Internet. While I need to capitalize on that to promote a few business ideas I have, I don’t want you to believe what you read in that picture. Just don’t. It’s not healthy for you and it’s not healthy for our profession. In fact, this kind of belief is precisely one of the problems that we’re trying to fix with this whole EMS 2.0 thing, and providers who look at patients as being not worth their time are holding us back.

So if you believe that above meme, stop it. Just stop it now. You’re burning yourself out and discounting a lot of human beings who are legitimately asking you for your help. The point of our existence is to help all who ask for it, not to judge anyone who dares to rouse us from our beds at 3am or who happens to have a complaint that we feel is beneath us. Help everyone, judge no one.

I’ve been on an ambulance for 16 years or so, and in that time I’ve responded to a lot of people who didn’t necessarily need an ambulance. I’ve even responded to a handful of people who didn’t need anything at all, but simply called for some very-much unrelated reason but I assure you that out of the thousands upon thousands of calls I’ve responded to these people are a small, insignificant minority. Most people who call an ambulance have some type of legitimate need for some kind of help and I believe that our frustration as providers comes from people who need types of health that we’re not prepared to, nor allowed to, provide for them.

My estimation is that 80% to 90% of all calls to EMS are for primary care problems that are really exacerbations of chronic conditions. I’d wager that more than half of these patients could have avoided being in need of emergency care by being able to better manage their chronic condition and by working through their primary healthcare channels. However, what are we doing for them? There are plenty of these patients who had very good reasons for not-being able to cope with their individual healthcare challenge. There are many good reasons for failing to be able to navigate the complex labyrinth of twists and turns that is our contemporary healthcare system and sometimes it just gets too much for people to handle on their own. Also, sometimes it isn’t their fault as their doctors offices and the healthcare system fails them by letting them fall through the cracks.

Sometimes calling 911 is their only option. Have you ever tried to get healthcare when you don’t have insurance? It’s terrifyingly expensive. Have you ever tried to get a primary care physician when you’re uninsured? It’s nearly impossible. Most urgent care clinics don’t take public aid and the only system that will treat people who are uninsured or are covered by the public system is the Emergency Room and the Ambulance service. We’re called the “Safety Net” for a reason.

I’m telling you not to believe the above picture because the overwhelmingly vast majority of people who call us for less-than life-threatening reasons aren’t bullshit human beings. They’re people who need help. Sure, there are some people who we may view as entitled or as other derogative adjectives, but if you were in their shoes and were treated as less-than deserving of care by every healthcare provider who treated you, wouldn’t you be jaded too?

Seriously, give me another option for these people. Oh, and try to think of an option that doesn’t require them to magically become NOT sick and NOT poor. Those things aren’t going away anytime soon.

It is OUR responsibility to find options for these people. It is OUR responsibility to be able to offer them the services they need. It is OUR responsibility to educate them about their options for healthcare and social services when they need it. After all, we’re the professionals, right?

Let the politicians, economists, and philosophers worry about correcting the overarching societal problems. That’s not our job.

Our job is to care, and to do our absolute best to leave every patient we see better off for the experience.

Now go do that.

  • Tami D. Bulik

    I’m glad that I was not alone in the offense I took over seeing this picture…it’s pictures/postcards/sayings like this that are killing what chances we ever have to become a respected “profession”…..You must first GIVE respect in order to receive it……….thank you for speaking out against this crap!

  • Mindy

    Thank you for this. In recently doing clinical rotations for my advanced EMT I was surprised by the attitude of the paramedics I was assigned to work with. The “What the hell are we doing here” and “Why are you calling us again” discouraged me. I volunteer as an EMT, and pursued the Advanced to better serve my rural community, and I finally ended up switching which city I did clinicals with to finish my time so that I could work with paramedics who didn’t forget why we get into this in the first place – or at least I hope why people get into this in the first place. My best memories aren’t the blood and gore semi-vs van or the three motorcycles vs. truck or the leg caught in an auger. It’s the lonely woman who would call 9-1-1 every Christmas with some vague ailment so that she didn’t spend Christmas alone. I got her set up with Meals on Wheels and a church group, hooked her up with the “RUOK” program – where she called other people every morning to make sure they were ok. She’d still call us on Christmas, but she’d call the non-9-1-1 number and we’d “have” to go pick up cookies – and we’d drop off a hot meal from our potluck stash.

    • I love this. Thank you for posting. First off, burnt out medics should never be preceptors. Burn out begets burnout.

      Secondly, what’s the RUOK program? Sounds like something I’d love to promote.

    • Susan M Burke

      Yours is the approach we need to cultivate and yes, please tell us more about RUOK program!

      • Michaela

        Maybe I can help with this. RUOK, here at least, is where we have a group of citizens who help keep an eye on at risk populations (elderly, chronically ill, etc.). This group of people might summon aid if someone in the program doesn’t check in, or they might go over to see if the person is ok and subsequently get help for them. These designated people usually are able provide information about the patient, much like a family member would. Personally, I think it’s an awesome program to have, and it’s especially great for them when we’re dealing with some kind of natural disaster.

  • Jason

    They forgot a category. Legit runs

  • Grant Turpin

    That’s excellent. Glad to read it, hope you don’t mind if I share it!

  • dtmedic659

    What a wonderful post and one that needs NEEDS NEEDS to be heard by the EMS community. As a paramedic who spent well over 20 years in the profession before retiring…the lackadaisical attitudes I’ve seen in way too many providers, as well as their complete disdain for anyone who they believe doesn’t merit their care/attention is incredibly disheartening…perhaps if enough of us say this enough eventually people will start to believe it.
    Well said…thank you!

  • David Newton

    Very good, we do need to monitor the preceptors for burn out altitudes so they do not jade new medics coming out of schools
    .

  • SAM1

    Great Post and so true these people are always complaining about calls are the ones that need to find a new career, as they are not being professional with that type of behavior. We need to move away from that and act professional and no treat patients like that.

  • Steve T

    Great comments, especially regarding burnout and an overall message that they are all people who need assistance.Some factors were neglected. It would be ideal if we all worked/volunteered in communities where each call could be managed without availability issues and resource constraints. If you are with someone who is triaged as a person not in in need of acute medical assistance but can use your service in others ways, there needs to be balance.Not every medic has that luxury of setting up social services or finding a pet. If one works in a community where you have 3 or 4 calls backed up, with that,availability issues must be weighed. It’s almost a social triage. Will you assist in the greater medical need, or set up that meals on wheels program? It’s obviously a system that has not yet caught up with the needs of the community it serves. I would not be serving my community if I stayed on that scene and a choking victim was awaiting my arrival. These are real circumstances in many places, and choices that must be made efficiently AND compassionately. It CAN be done with respect and efficiency, usually a part of the job learned over time. Does this make me a burnout who should no longer precept ?, or a realist learning to work within the system in place?.

  • Nursea00

    I work in a SNF and each time we call EMS they have the same crummy attitude. Just because our patents aren’t bloody or missing a limb they give off a rather loud “you are wasting our time.” If a nursing facility, equipped with doctors, feels the need to send someone for advanced treatment you can bet it’s warranted. Just because your assessment shows they are stable does not mean they aren’t a ticking time bomb. I have noticed that the older, more experienced are less likely to display a poor attitude. Maybe because they have seen more outcomes and understand how fast an acutely ill patient can becomev critical? Sorry for the little rant. I do appreciate anyone who steps up to help my patient in need. All about teamwork!

    • Tobias B. Santa

      Too right. We would get major attitude from EMS crews when we had to send our psych patients to the ER. We were free standing, so no medical wing. A lot of the psych people had comorbidities. We had one ambulance crew insist that the patient hadn’t overdosed! He had and ended up later on a vent.

  • David

    We are not trained for nor have the ability to address the problems you state above. We are medics, and I understand that not all are like me, working a large city, largely indigent population. I don’t know where you work, but quite frankly, your 16 years could very well be my first 5.

    Out of 15-20 calls a day, I have routinely found that 3 or 4 require ALS transport, 1 or two of those might require critical life saving intervention. Unfortunately, that is all we are really trained for. Paramedic school addresses life threatening signs and symptoms, and the life saving measures that are needed to correct them. We are not paid nor equipped to deal with the failure of the healthcare system, nor should the people in need of such services be made to suffer while we provide a “sort of” primary care to those that abuse the EMS system.

    Contrary to what most liberals think, no one was without health care even before the great Obamacare showed up. County facilities, would coordinate treatment, follow up, and medications when contacted. Is it less efficient that the alternative route of healthcare, yes, but those that pursued it received it. But why should we reward strife and perseverance when we have made it a habit to reward sloth and dependence?

    I disagree with you that it is “our”, frontline paramedics, responsibility to fix this, find options, and find social services for people who are not experiencing life threatening illness/injury. Doing so takes away the priority for people who need those services. Medical directors, social programs, whoever you want to point the finger at need to step up and direct these needs as necessary or the whole system will crumble. Let people who sign up for and are educated in social work deal with the best programs and avenues available for people trying to access healthcare, and Ill deal with unexpected visits from the reaper for the rest of society who finds themselves in a bad situation.

    • mr618

      Contrary to what David says, a lot of folks here in Maine were without healthcare prior to the Affordable Care Act, and even more are without it now (our Governor decided to pretty much eliminate Medicare, as “folks could buy on the open market”… yeah, if you have a job that pays enough to cover $400 – $800 a month premiums… and the unemployed don’t qualify for financial assistance, all we do is avoid the $95 fine for not having insurance). Hospitals are relatively far apart, and Maine Health, the largest hospital corporation in the state, is shutting down the smaller ones (“think of how profitable we’ll be if we don’t have to pay all those doctors and nurses”), leaving the walk-ins and EMS as the only viable options.

    • Jon

      Therein lies the problem, David. From day one, we are told we are life-savers and heroes. Thus, anything other than a “real” run is a garbage one. We didn’t get into EMS to help Mrs. Smith get back into bed at 0200hrs. We got into EMS to be woken up at 0200hrs for a heart attack or a bad crash.

      We need to understand the resources available, and maximize our use of them; it is better to spend 15 minutes on the phone with someone and ending up getting a refusal signed than it is to spend 30 minutes transporting a patient that you know does not, and will not benefit from a trip to the ER. But we won’t even play that game. We will cry foul, be judgmental towards the patient, and say “There’s nothing I can do”.

      How about this–your next dozen patients, identify why they called 911, and whether it was an emergency or not. If it wasn’t, identify what needed to be in place to fill that need, and then start the conversations to achieve that goal. Otherwise, you (generally speaking) will be just as disgruntled next year as you will be tomorrow.

      Public health *is* a Paramedic’s job, even if he didn’t go to school for it.

  • pdquick

    Amen! Ten years a paramedic, ten years a doctor, now retired. The mistakes I made are when I didn’t bring the empathy and leave the judgment. I diagnosed cancer more than once in people who annoyed me for being in my urngent care or an ambulance. And I had to say “I’m sorry, it was rude of my to act that way” to patients more than once. Jury’s still out over whether that was more therapeutic to them or me. Humility matters a lot. Have it. Reach for it by apologizing when you blow it. Empathy will usually come back to you as forgiveness, modeled by the patient who were such an asshole to, who really needs you, nonetheless.

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  • Don’t oversimplify

    Don’t get carried away. ‘Letting the politicians worry about the social problems’, i.e. ignoring them, is not the solution.

    As an urban paramedic, a significant percentage of calls I do are for non-medical problems. For example: homelessness, malingering, ‘no tolerance’ college intoxication policies, fear/interest in litigation. The very concept of an ’emergency’ is changing.

    Do not pretend these people we take to the hospital are ‘patients’ with a medical condition. EMS cannot continue to be the garbage disposal of public safety, while somehow gaining the professionalism and respect it deserves. As long as EMS providers are seen as servants that cannot perform an educated evaluation – such as independently deciding whether or not to treat and transport – this problem of professionalism will continue.

    • Don’t oversimplify

      I just saw your biography… of course, you’re a ff/medic. If you were serious about ‘bringing this profession into the future’, you would realize how much fire fighters are holding us back. You may have lofty goals and ideals, but perhaps you don’t realize how naive you sound.

  • Carrie

    Good point well made. I have been a Paramedic for 13 years now and am beginning to despair of the number of colleagues who believe that the majority of patients are faking or overplaying their condition instead of the minority. Unfortunately this mentality tends to be educated into newer ambo’s by the older, more cynical colleagues who have forgotten that this is supposed to be a caring profession. I deliberately try hard to pass on positivity and understanding for our patients to those I mentor but we all need the occasional reminder like this. Thank you

  • Linda Almekinder

    I do see the humor in the cartoon itself….. But I see no future for those who believe that it tells ” the truth” about what we do. In a rural community, people will sometimes call the FD or ambulance because they need a friend- someone who can help them figure out what to do next. All people need & deserve our respect for them & whatever crisis they are in. May we always remember ” People First”.

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