Another Picture Not to Believe – On The Soul of EMS

I’d like to talk about our culture as a profession and the soul of EMS.

A while ago, I wrote a post entitled An EMS Rant: Don’t Believe this Picture which ended up being one of my most popular posts ever. In the first day it was up it garnered over 11,000 readers and has done much more than that since. It has been shared on various social media sites over 10,000 times with mostly positive comments from what I am able to see and chances are that if you’re reading this post, you’ve seen it too.

In that post, I spoke to what I see as a deficiency in the EMS culture we’ve created online, the same culture that I owe the existence of this blog to. While I love the collaboration, the humor, and the camaraderie that the EMS social media and other online presence has brought to our profession and believe that it has enriched us all greatly, I also see a dark downside that needs to be addressed by all of us, because we’re all responsible for our profession. This affects us all.

In some cases and in some places, our newest members are being brought up to believe that our darkest humor and most private sentiments are normal and are part of what we do. In those places, we’re telling our incoming members, as well as the outsiders who chance to look in through the window that the worst manifestations of our mindset are what define us and are what we hold up to others. By glorifying our worst behavior, we are making our worst actors cool and are holding them up as something to be aspired to. The new kids are taking notice and are displaying evidence that they actually believe some of the stuff they are seeing. They’re seeing their potential mentors saying they are burnt out and justifying their remarks and actions because of it. The new kids are then assuming that burn out is our natural career progression and are believing that if they want to appear as part of that group that they need to be burned out as well, mostly before the first ember ever reaches their personality.

Collectively, we have got to stop doing this.

If we indoctrinate our newest providers directly into burned-out apathy, we’re only perpetuating the cultural stereotype. We’re charring them into charcoal so they burn out much hotter and faster when they actually reach the fire, so to speak. By burning out our young, we’re only ensuring that the problems we face as a profession will continue long into the future, long after we are gone.

I’ve been blogging about EMS for five years and have been doing EMS as my career for sixteen. That’s longer than most and shorter than some. I’m not talking about my longevity in order to add any weight to my opinion, but I am using it as an example to say how I understand exactly how inappropriate and dark humor can and sometimes must be used as a psychological defense mechanism. I’ve used it too, sometimes in inappropriate settings. I’m not perfect and some of the stuff I have experienced has caused me to breach my own ethical standards at times. While I may not be proud of it, I can do better and so can you.

I touched on this concept previously in the post My Butt Isn’t Hurt Defending EMS’s Public Image where I said that most EMS related Facebook Pages make me weep for my profession decrying the level of discourse exhibited by a lot of the EMS pages out there. Some, not all of them for sure, but a good number of them glorify things that are wholly unethical, abusive, and just plain bad. They do it under the guise of it being the dark humor that we all share by the fact that we can survive in EMS but that’s not really why they’re doing it. Blowing off steam after taking abuse from a particularly bad patient or having a beer with a buddy after doing CPR on a child is one thing, but competing for readership on an internet site or Facebook page is another. There are a lot of EMS related Facebook groups out there that are getting a lot of likes and are competing for the eyes of the same audience. However, it’s hard to get a lot of eyes on the internet without some sort of shock value or cuteness. It’s why pictures of cats with captions are going to be regarded by archaeologists in the distant future as some sort of religion. By competing for eyes, the pages have to make posts that are effective in doing so by pandering to the broadest possible audience and some do so, effectively, by making a fast race to the bottom.

This concept exists elsewhere too, not just on the internet. It exists in EMS classrooms where instructors spend 80% of their time telling War Stories that glorify the instructor rather than teaching real medicine. It exists in the internal popularity contests within individual EMS services that turn into high-school level hijinks that glorify the rebels without acknowledging the professionals. This teaches our young that it is ok to be mad at the people who call us for bullshit without acknowledging that our calling to serve our fellow humanity is the highest possible calling in life.

Not everyone can do this job, and not everyone who can do this job will do it well. That’s a truth. However, telling ourselves that patient abuse and burnout is ok is not going to help those who could do this job exceptionally well but don’t want to stand up against the grain and actually do it.

Last night, I got into another Facebook comment argument on a page I’m not a member of. I’m not mentioning the name of this page because the page admins choose to be anonymous and also because I’m not calling for anyone to go tell them anything. For one, you should make up your own mind about what you stand for, and for another, this page is not by far the only page that does things like this. However, even though I don’t like this page, I saw a young EMT from a service somewhat local to mine like a post as it scrolled though my timeline. Since I didn’t recognize the name of the page, I clicked on it.

This is what I saw.

This is wrong. Don't do this.

This is wrong. Don’t do this.

he original picture included the name of the page as some sort of advertisement in their competition for eyes, but I have erased that with my terrible picture editing skills. The picture is theirs though, so if they’re seeing this and want me to include their logo back in I guess I would be obliged to do so if asked.

First off, giving a patient a placebo and telling them that it is something is one of medicine’s most highly unethical morays. Don’t do this. The entirety of medicine is based on the fact that patients have to trust their healthcare providers. Physicians, then nurses, then other healthcare professionals have spent hundreds of years earning their trusted place in society and almost everything we do rides upon that trust. If you choose to break that trust because you’re too lazy to open the seal on your drug box, or too timid to actually discuss pain control options with your patient, or too much of a jerk to actually care about your patient’s pain, or believe that through some sort of divine providence you happen to be someone who can judge others based upon your own personal experience then you’re violating the trust earned by giants who sacrificed much to earn what you’re pooping on because you’re a jerk.

Don’t do that.

Predictably, this post gathered a handful of likes by the page’s followers and even got a few Yeah! We HATE those patients! Those patients are stupid and are beneath us because we’re awesome! Comments underneath it by people who were just messing around on the internet and not actually considering the ethical ramifications of what they were advocating. As with all Facebook posts, and all blog posts for that matter, most of the people who saw it said nothing and it can be assumed that most ignored its message as noise.

But since I was following the Like of one of the young EMTs I know, I posted This is an egregious breach of medical ethics. just to see what might happen.

Within an hour, the comment space became filled. Lots of people were standing up for the rights of patients and against the ethical breach the page was using as an advertisement for their content. The page admins responded by saying we just didn’t understand how those patients were abusing the system. Some called us fun sponges and of course, we were said to be butthurt.

But we weren’t. Once someone stood up for what they believed in, lots of others did too. It’s funny how that happens a lot in lots of situations but how we so seldom think of it or are usually too timid to stand up ourselves.

The page admins deleted the post, banned me and a few other commenters, and issued a long rant that told us how they would never actually do that with their patients and also explained how we were just stupid idiots that didn’t know anything because we were stupid and how we didn’t know what they went through in their careers which by the way are big and awesome so we should shut up.


Complaining to your partner about how the 900 pound bariatric patient that called you for toe pain hurt your back is one thing. Taking a picture of a whale with a caption and posting it on a telephone pole in your town is quite another.

Glorifying a terrible breach of ethics complete with a wink and a nudge about those patients. You know what I mean is bad. It makes us all look bad. It’s not funny.

Stop bringing our profession down in order to get likes for your website or facebook page.

I don’t ask for unicorns farting rainbows, but we work in a profession where our average career length is four (or five) years. The divorce and suicide rates in our profession are much higher than those of the general population. We are exposed to enough stress and terribleness as it is, and you’re not helping by perpetuating the stereotype that our worst behavior is the example to be followed.

When you tear us down in order to build yourself up, expect to ban more people from your page.

Believe me when I say this, there are a lot more good people in EMS than there are jerks who do bad things. There are still lots of people who have been doing this a long time who still believe the reasons they were originally called to do this job. Believe that, live it, and support those who exemplify our highest ideals. Be one of those people, it’s worth it.


As always, Kelly Grayson said this much better than I did way before I even had the idea to write this in his post: �Welcome to EMS� He even quoted Thoreau.

If you’d like to go on the Life Under the Lights Facebook page and find stuff to bash me publicly on, I promise not to ban you. I’ll even answer you using my real name.

  • magicmedic

    What more can be said. You have said it so well..I wholly agree with this blog post and intend to share it. It will take all of us standing together united to stop allowing malcontent and egregious medics to set the public image of our coveted profession. This is a well written prospective that hopefully makes its much needed targeted audience.

  • Gary Merrill

    Very well said. It’s nice to see that there are still some EMS professionals who set the bar high. I can’t make everyone meet that standard, but I can hold myself to it and lead by example. Thank you for speaking up.

  • Tami D. Bulik

    I no longer “subscribe” to a lot of those pages on Facebook, simply due to the fact they like to do a lot of ‘public’ bashing and ‘ego’ polishing :( but you can usually bet that within the next few hours or days, they will throw something up about not getting respect….until we ALL stand up and agree that we won’t allow it, it won’t get better….thanks for being one of the few that will stand up ‘against’ the bashing. Once in awhile a friend will pass on one of their stupid posts and I get drawn into the bullcrap of debating morals on those pages, but they like to ban those of us that disagree so I tend to choose my battles carefully. Which isn’t hard, since there are a lot out there…..I agree, we all need to monitor our ranks closely and push for a return of professionalism….thanks Chris~~

  • Linda Kuban


  • Shelley Davies

    Good post :)
    I even remember the original post you are talking about, although I have since stopped following it primarily due to the myriad shock-value injuries (nobody say ouch or we’ll ban you) and the constant accusations that anyone who disagrees is “butthurt” (that has become one of my most hated words).

  • Emma Bourdon

    Thank you for that pertinent reflexion on our practice. I am a paramedic from Quebec, Canada and I am doing a doctoral thesis on paramedic collective strategies to maintain health following a conceptual model from ergonomy on work activity regulation. In other words I am developing knowledge on how us paramedic manage to effectively, or not, regulate our human energies through the work we accomplish.

    Thinking and moving require lots of energy. Energy is limited and need to be restore through sleep and alimention and then need to be preserved for surviving each day. Depending on the work we do, life and work situations we encounter and level of stress involves, will spend more or less.

    What I hope this research will bring is more memories on the knowledge of our best collective and intuitive strategies that prevent some of us from experiencing BO or PTSD or delaying its onset. But more, this study could bring in light how we could stay happier from the early start in the career to later in life even in a work situation where moderate chronic stress or acute stress are inherent, essence to the work we do. It will contribute to our theory of practice.

    Cultivating a good moral through resting well and engaging in responsible social behavior towards the rookies, and more through professionally identifying on other aspects of our jobs then mostly its darkness maybe skills to teach and train in our group. Hope the best for us as a human collective dedicated to serve its society.

    Again congratulations on that editorial!

  • tammy

    Love this. Definitely needs more exposure. I got in EMS to help people over 20 years ago and I am getting back into it. Still have our trusted “Paragods” running around with their better than everyone attitude. It makes me sick to run into those guys because I know they are only in it for the Power trip. One of the reasons I quit years ago was because of the Egotistical Medics I was working with. I think this should be discussed in all EMS classes.

  • Kerri West

    Thank you so much for posting. It aggravates me when I have to work with people who think that doing the job properly and ethically is for “goody two shoes” and that being a sloppy, rude, lazy, cross-contaminating jackoff is “cool.” The first priority I had coming into EMS was to prevent burnout by practicing good mental hygiene. It’s sad to see how many EMTs don’t even have interest in that, and I wish burnout prevention was a more significant part of EMS education. It’s not for people who are “pussies” or have “vaginitis” – it’s for professionals.

  • e.hart

    Well said. This article was posted on Facebook by a coworker of mine and so I read it. It is a good wake up call. I sometimes hate how my mentality has developed. I think about the person I was when I entered this profession to who I am today. We’re vastly different people – not all in bad ways. I find myself being a lot more introverted than I once was. I go through phases where I feel offended by people’s “misuse” of 911 but then I try to put myself in their shoes. I have varying degrees of success with this.
    My well-developed apathy was painfully obvious when my father was dying of cancer and I continuously debated his pain level in my head. I had a long conversation with a friend of mine about how I wish I could just turn that side of my brain off, that it didn’t matter what his pain was. If he said he hurt, then he did. I have a lot of regret regarding this because the one thing I could not do was comfort my own father as he made his slow and painful decline until he died.
    I think part of it came/comes from a sense of helplessness. How many times have we had patients in obvious discomfort, but could do nothing to alleviate their pain due to strict protocols? Ours have greatly relaxed on that front, but seeing people in pain and the defensive posture still exist.

    So, thank you for standing up for the little guys: the ones who still love doing their jobs and try to do right by everyone. I’m not there again yet, but perhaps I will be.

  • Dani

    Very well said. Its very nice to be reminded of this, and to put it to use. Thank you for reminding those of us who know better, and educate those of us who don’t.

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    Patient Friendly Jokes
    i think it is follicle stimulating hormones.
    2015-03-28 18:05:00
    Andrew Randazzo
    Why do Ambulances Carry Epi-Pens?
    Interesting. I've never heard of ambulances carrying EpiPens. I've worked in Wisconsin and Tennessee. Both places have always allowed EMT-B to draw up from Epi ampules. However, when seconds count, I could see EpiPens being something EMTs and Paramedics could benefit from. It's just costly.
    2015-03-18 09:34:00
    Why do Ambulances Carry Epi-Pens?
    It's definitely faster and it's accurate. There's really no down side to it at all. Other than the fact that some people give it when it's not needed, but that's not dose related.
    2015-03-17 21:01:00
    Colorado CRNAs Vs. Virginia Physicians? An interesting feud for EMS
    Paramedics aren't educated or organized enough to pull anything like that off. Hell, you can't even protect your medics from dangerous hours, lack of downtime requirements, and horrific pay.
    2015-03-17 00:20:00
    Colorado CRNAs Vs. Virginia Physicians? An interesting feud for EMS
    They "choose" it because the administrative portion of billing for service is a nightmare. Who doesn't just want to clock in, do the job, and go home? Some of you people must've never set foot in a hospital or dealt with docs in any capacity. Pay your tuition and you'll make it through med school.
    2015-03-17 00:18:00

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