The alarm pierces through the good time you and Scarlett Johansson are having in your dream, telling you it’s time to get up and shower. Your alarm is the house-tones from a popular TV show from the 70’s and 80’s about paramedics and firefighters. You mock other people that have that as a ringtone while secretly loving the nerdiness of it. You hit the snooze once trying to convince your soul and brain that it is a good idea to go through the next 24 hours of what you have to do. You silence the alarm again and make your way down the steps to the bathroom, motivated by something, but you are not sure what.
You stand in the shower as the drops of water hit you, each telling you that the day is real; the day has started and that it’s time to drag your heart, your mind, and your soul through the mire of emotions that you know you will have today. Like dragging a brand new coat through a mud puddle, just so you can take the coat back home to wash it and make it clean again. You look forward to getting in this shower when you get back home. It makes you feel like, if you have the water hot enough, you can wash the day off; the negative emotions off of your heart and the bad things out of your brain.
Before you know it, the shower is over. You shave so your SCBA mask will fit tight on your face. You know you probably won’t need it since you are on the medic today, but you do it anyway. You brush your teeth so that when you kiss your sleepy significant other goodbye, you leave them with the memory of your fresh breath and your clean body and cologne to get them through the 24 hours without you. “I love you, and you smell great,” they whimper through sleepy eyes. That’s all you need to light a fire in your soul that burns until you get back home the next day.
You get your stuff together and get to the car. You get in it and sit for a minute trying to remember which place you are working at today since you work a couple of different departments to make a living. You tell yourself you do it to make your work experience “well-rounded, ” but you know deep down that it’s because your inner EMS nerd can’t get enough of the work. You check the schedule to see who you are partnered with on the medic today and decide whether that person will make it a long, frustrating day or a fun-filled one. It’s someone that you work well with, so you have that going for you. It should be fun, but it will still be long.
You get to the firehouse at your usual time. You make your way in and survey the rig line-up to see what rig you are riding in today. It’s the big piece of shit medic. Your department just got some new medics, but the one from this station is out for repair already. Not a big surprise, since the dwindling tax revenue over the last decade has crippled the infrastructure of the city. The roads are shit; the water mains are shit; the city is decaying around you. It beats up the rigs as they traverse the streets, so things need to be repaired often.
You take in the smell of the apparatus bay. Yep, they had a fire. You can smell the burnt plastic and wood. You see the wet hose hanging up to dry. You can tell the engine ran a lot because it’s dirty. You know the crew washed it before supper last night, they always do. But it’s dirty again, so it went out at some point during the night. The medic is dirty too, so you know what kind of night they had.
You make your way to the kitchen and get the coffee going. You turn on the TV to catch up on the events on the news and see if anything newsworthy happened in the city last night. Yep, there’s the fire. A garage fire. It looked pretty simple. You scan for last names on coats so you can rib the guy that wasn’t able to hide from the cameras. It’s the new guy of course. The rest of us are like ninjas. We hide behind trucks and chiefs to keep from being seen. We’ve bought enough ice cream over the years. The new guy can have his turn. His mom will be proud of him anyway, so that washes out the ribbing he will get from us.
The rest of your crew makes it in. You sit and discuss the problems of the world and have them all hammered out by the second pot of coffee. Yesterday’s crew stumbles out of their bunks to go home. You sit with them and review the last 24 hours. You hear what got done and what didn’t. You get an apology for the fire truck being dirty. We all know why it was so it’s no big deal. It happens to all of us. The previous crew heads home, and you go out to check the rigs.
Nothing big is missing from your medic. You straighten up the supplies and cabinets. Have a quick review with your partner about what you need, so you can dig through the supplies at the station or get it from the hospital. Everything checks out except there is no shoreline power to the back of the medic. You have seen this 100 times before, and you quickly resolve the issue. You put it on your mental list of things to watch throughout the day.
The first call is banged out. Off to the nursing home for something easy. The staff at the ECF didn’t want to wait for the ambulance service to transport the patient to the Emergency Department for the abdominal pain they have had for three days, so they called you. You load the sweet old lady onto the cot and get the vague info from the staff. You have a mental check list. It looks kind of like a bingo card. You put a dot on the square that matches what the ECF “nurse” tells you in the report. “I just got here,” one dot! “This is not my patient,” another dot! “She was fine the last time we checked on her,” three dots! If I use the gingivitis “free” space, you only need one more to win. You covertly ask a few more questions to get the last space. And then she lays it on you……”her pulse was 50/20, so the doctor wants her to go to the ER” BOOOOM!!! You win with the vital signs that make absolutely no sense!!! The prize looks a lot like me not hating you for being incompetent. She doesn’t look like she feels the winning. It must be your smile and polite comments that are throwing her off. You have become a master at passive aggressive, sarcastic customer service by now, so you keep your opinions to yourself and share them with the ER staff when you get to the hospital. Everyone chuckles, but you know the loser in this scenario is the little old lady who is in the care of those nursing home idiots most of her day.
You clear the hospital and catch a few more calls. Nothing major. You and your partner trade call-for-call to even out the patient load. Shortness of breath, a fall, abdominal pain, back pain, shortness of breath again. Nothing gets you that adrenaline rush you used to have. You are good at what you do, so nothing scares you. You see the new guys with all of their enthusiasm and yearn for your younger days.
Your front row seat to the decay of society keeps you busy all day. You grab food when you can. The hours pass by. You get a full arrest around supper time. That gets you going a little bit, but they seem easy now. You and your partner along with the engine crew have worked together for a while, so the run flows well with not a lot of talking. Just working…IV, intubation, meds, shock, shock, shock. You call Medical Control to get the OK to terminate efforts, and they say “Yes.” Then you get a faint pulse back. You know it’s a waste of time and fuel, but you scoop the patient up and head to the ED. You call the ED and let them know things have changed. The nurse on the other end of the phone is super psyched that you are coming (sarcasm). You look forward to surfing the cot while doing CPR (it’s the little things) and you deliver the patient to the ED. You know you bought the family just enough time to say goodbye. The patient will die in the ED. You knew that before you left the scene.
You catch an overdose call as you leave the hospital. Those have been moved to the same category as the abdominal pain and shortness of breath. You do so many of them now that it is just another “thing” you do. The scenario plays out just like you knew it would. “What did he take?” “We don’t know,” the people watching TV in the other room say. You know what it is because you revived the guy in the recliner last week. You carry a MAD (Mucosal Atomization Device) in your pocket now because you do these so often. Oh look, he’s breathing four times a minute. Oh look, the Narcan brought him around after a few moments. I’m a life saver! Before he wakes all the way up, you pick out what lie he will tell you when he comes to. You have a short list; let’s see what he goes with. Wait for it….”I didn’t take heroin,” he says. Ahhh, come on! That’s the most boring one there is! You wish they would be more creative. “I was riding a pterodactyl into the Superdome, and the talking meerkats told me to heat up the magic brown sugary powder in a spoon and shoot it into my body.” At least that would be funny to everyone in the room and would give me a story to tell. “I didn’t take heroin….” Work on something better and have it ready for me when I wake your dumb ass up the next time. There will be a next time.
You finally get supper and a few minutes to relax at the station with the rest of the crew. They left the food out for you. You shovel it in case you have to bounce out again. They do stuff around the station and tell you to finish eating, but it makes you uncomfortable. You should be helping, but the food is good, even though you had to microwave it. Before you know it, they have washed your rig. You start the dishwasher. There, I contributed. I don’t feel as awkward.
Another overdose and a few more easy calls come in. You and your partner continue to volley them to each other. You are getting tired now. You want a nap. You remember a time, ten years ago when you could pull the “all-nighters,” but you were younger then. You had more energy. You weren’t overweight with high blood pressure then. Your mind wasn’t tired, your knees didn’t hurt, and your back could still take the jarring from the crappy streets. You were in better shape mentally. You didn’t see as much darkness in your work as you do now. You didn’t realize yet that you were just hauling freight, essentially. You didn’t understand that people need the hospital more than they need you. That, even though you do great things in the field, the end game is to get them to definitive care. You know why it’s called prehospital care now. You are collecting these people for the hospital since they don’t do it themselves. You know now that you are working for an EMS department that fights fire, on occasion. You were a dragon slayer once, at least you thought you were. You see skills being taken away from you because they don’t do anything in the field. You see what the future of this job is because you have the past to look back on. You see what people have done to each other. You have seen behind the curtain. You know that nothing happens when you die. You have watched countless people stop being people and become objects that need to be dealt with. You have watched people die. There is no quiet last breath in the company of family for most of them. There is me or someone like me hovering over them, poking, prodding, intubating, breaking ribs, managing puke and smelling the shit. You know what dying is. You have made friends with it. You feel like a recruiter for the grim reaper. Somewhere in the dark corner of your brain, you want their death to be horrible for them because you feel horrible dealing with their death. You want them to feel what you feel, but you get robbed every time. They are just an object. You might as well talk to the ground.
You make it back and crawl in bed for an hour or so. The ceiling witch wakes you up for an “unknown problem” at a location you know well. It’s either a shooting or a maternity if it’s up there, you tell yourself. You stage for the police and ding ding ding; it’s a shooting. You enter to find blood everywhere. You chuckle a little because it looks staged or like a movie set. You find your patient sitting on the couch holding his arm. Yep, they got him. A half a dozen times from what you can see. He is weirdly calm for being shot that many times but you dismiss it. He’s as used to people being shot as you are probably. You load him quick and jet out of there. He needs a surgeon; not you. You do your usual stuff. Trauma is easy for you. You work like a robot and roll up at the trauma center. You unload and meet the blue gown mafia in the trauma room. You shout out your findings and your treatments. You ask the trauma doc if she needs anything else from you and you hand off the patient to her with a “Good luck!”
You spend the next 45 minutes doing your report. You try to piece together the timeline. The first few minutes are a little fuzzy because you weren’t completely awake yet. You review the report several times so that you can maybe not get raked over the coals by the QA/QI people later at the trauma review. Your partner figured out how to get coffee out of the new coffee machine in the EMS room, so he’s the real hero this morning! You leave out of the ED awake because the adrenaline comes late for you. It floods in after the call is over. You are on autopilot during the call, but afterward, that chemical floods in and wakes you right up! You fool yourself for a minute by saying “I can do this until I’m 65.” You’re an idiot. You will be washed out or dead by then.
You catch a call coming back. You walk into the home of an elderly couple with the blood from the last guy on your boots. You figure out what is wrong. The gentleman has had pain for a while and just can’t bare it anymore. You load him up on the cot and get him in the rig. You come back in and collect his wife of 65 years and help her up into the front seat of the rig. Your partner has this one, so you make the short trip to the ED. The wife is concerned so you make polite conversation to ease her mind. They are on a new adventure this morning, but you are finishing up the long day you have had. For a second you think about that shower. You can feel the water warming your back. You can’t wait. But first, you have to finish the adventure you are on with these total strangers. You unload your cargo, and your partner rolls the cot in by himself. You help the wife out of the rig and walk with her as she shuffles along. You reunite them in the ED room. You accept the 100 “Thank you’s,” that you get from them. It feels good for a minute until you remember something you should have done on the shooting. You go from gracious to grumpy.
You put the rig back together and help your partner stay awake to finish his report. Hey, look, more coffee! You head back to quarters with 30 minutes to go. The new guy from the oncoming shift is always there early, so you know at least one of you will get home on time.
You back in the station and tidy up the rig for the next crew. Nothing else happens until shift change, so you get out of there after another world problem-solving session at the kitchen table.
You load up the car and head home. You pull in at home not knowing how you got there. Your brain was processing the shifts events all the way home because it didn’t have time to do it while the day was unfolding. It sorts through the stuff it wants to keep and the stuff that it will put in a box and shove in the dusty corners of your brain, never to be opened again. There are a lot of boxes filling the corners and one day all the boxes will fall over to spill out all of what’s inside. You don’t think about that very long. It’s the thing that lurks in the minds of all of us in this line of work. Is today going to be that day? Will a 10-second scene in this movie be the thing that knocks over all of those boxes like the school yard bully that doesn’t get his way? Will I be crying, loudly, in this theater? We wonder what will happen on that day. We try to put it off as long as possible. But it is not up to us.
You make your way inside to an empty house. That’s OK with you. You did enough “people-ing” during your shift. You welcome the opportunity not to have to explain something or interact with someone. You shed the blue Superman suit. You are sick of blue. You make it to the shower, the moment you have looked forward to. You wash off the day. You get warm. You relax. You fight the memories of the shift and what you could have done differently. You finish separating out the hours from the last 24 that you want to keep and the ones you box up. You try to decide if you are going to try to take a nap or stay up. Your significant other will be at work all day, so you have the house to yourself. You make some coffee and mull it over. Yes, more coffee.
You go back to the “keep and pack up process” because your brain just can’t get it done today. You look at each hour of the last 24 and decide if this is the moment I choose to quit doing this or is it the moment I decide to stay in it for another few years, months or shifts. It’s a weird decision, and you make it after every shift. You wonder if your lawyer dad or school teacher mom ever sat and thought about their job the same way. I’m not sure their jobs were as intertwined into the very fibers of who they are. This job is. This job violates spaces in your brain you didn’t know existed. It works into the spaces; between the spaces. You wonder and drink coffee.
The nap idea wins. You lay down and go blank. You wake up to a text from your significant other asking how it went and that they love you. You respond that there wasn’t much to talk about. “Just the usual,” you say. They will dig deeper when they get home. By then the sorting process will be complete. You won’t tell them about what you put in the boxes. You will talk about what you kept. The sweet old couple from the end of the shift will play well with your significant other. It’s more palatable. You won’t mention the blood on your boots. That’s for you to deal with. They know there is more, but they won’t push. That’s why you love them as much as you do.
So you had 24 reasons to leave or stay. You are the only one that can decide what you will do. Will you stay? I always do. It’s what I want to do right now.
Someday that won’t be the case. I will be OK with that.
Part 1: “Entitlement”
Part 2: “Running People Off”
The US is an industrialized nation. We have modeled everything after the assembly line or mass production. We have also taught people from infancy that you can only achieve if you progress down the assembly line of the educational system. To get high marks and to obtain a degree and promoting the idea that our bodies are just transportation for our brains. The idea that having the highest level of education in the land will be rewarded by the highest level of pay is something that all of us, up until the past decade or so, have been taught. Strive to be the smartest guy/gal in the room, so you will be looked upon as the problem solver.
The same holds true in the fire service. We tell the young men or women that they need to stay in the books if they want to wear the white helmet someday. We tell them that they all should want to wear the white helmet and if they don’t they are not formulating solid “career goals.” We disqualify people from promotional opportunities because they do not have or are not pursuing their “degrees.” I hear it from all areas of the country. Some of it is us, and some of it is our HR department.
The part that we don’t tell them is that the Chiefs that a lot of us grew up under didn’t have degrees. They worked administratively and operationally to build the departments up without the framed piece of paper on the wall. They did their jobs, and they did them well, and they learned what it took to run a department.
Now some of you will say I am unenlightened. You will say that a degree is what is needed to operate a department these days due to the political climates, budgets and personnel issues. I agree with that for the most part. The part that I begin to have a problem with is that the amount of operational or “street” time a person has continued to be less and less important when selections are made for command officers. People are getting promoted that test and interview well but lack the intuition or operational knowledge to command a fire scene to a successful resolution. They get promoted because their file is thick with certificates from classes they have “taken.” I know that every fire goes out eventually so each fire scene will end in time but there are ways to resolve incidents without a great loss of life, property or personnel.
Unfortunately, in some departments, as the individuals move “up the chain” they get further and further away from the operational side of the department. They lose touch with some basic skills of EMS and fire suppression and become knee-jerk commanders; spouting out orders that they think will work but are not based on operational knowledge. Nobody questions their decisions until something goes wrong or the scene goes off the rails.
The point I am trying to make is that you don’t always have to have a degree to be successful in this business. If that is something you want to shoot for, then go for it! I have spoken to many people who have spent a great deal of time and money on degrees that they don’t use. The fire service is full of people like that.
Just know that success is measured in different ways. I have always looked up to people who work with their hands. The people that I have looked up to in this job have been the ones that know every aspect of the equipment and can tell you 100 ways to do a task, and yes, I admire the guy who can force a door 29 ways. They have the knowledge that can’t be learned in a classroom. One of the people I look up to the most in this business can tell you everything you need to know about fire service hand tools. How to use them the way they were intended to be used and all kinds of tricks to use the tools in different ways. I learn something every time we talk about tools. That is knowledge that comes from working with your hands. That knowledge is priceless, and it didn’t cost him anything to learn it.
My father spent 8 years in college to become an attorney. I have always said he’s the dumbest smart person I know. He taught me about economics and government, how to balance checkbooks, how the banking system works and to ask the right questions to get the answers you want; all things that I use to
this day. However, that guy couldn’t show me how to build anything, fix a car or figure out why the breaker kept tripping when my mom and sister tried to run 2 hair dryers, a heater, a radio and a curling iron on the same circuit in a house with 100 amp service. Those things I had to learn from other people over the years. I love my dad, but he’s got the nerd gene that he passed onto me. I didn’t get the full nerd gene however, so I wanted to know how to work with my hands. I sought out people to teach me, and I’m glad I did. I still have no idea how to fix my car, though. I have people for that.
Wearing the white helmet is definitely a goal to shoot for. It can be challenging and rewarding at the same time. It can also shorten your life expectancy due to the stress involved. Your career success should not be measured by a white helmet at the end, it should be measured in how well you did your job; how well you passed on what you know and by how well you used the time you had in this amazing line of work to serve your fellow man.
Stay safe out there!
Put your faith in the knuckle dragging, window breaking, hose pulling members of your crew but don’t discount the guy who can figure friction loss in his head!
This is the second part to our Three Part Series Titled: “Entitlement, Running People Off, & the Push for Higher Education.”
If you missed it…Check out the First part: “Entitlement”.
In this 3-part-series, we will be discussing, or more realistically, I will be ranting. You will read this and at the end, you may or may not feel mentally violated.
Running People Off
This subject is intertwined with what we talked about in “Entitlement.” When the type of new employee that I described as being from the “everyone gets a ribbon” generation comes into the department, they need clear direction on what they are to be doing from day one. They don’t learn firehouse etiquette in their fire science classes. They don’t learn how to deal with firehouse personalities either. They are thrown directly into your firehouse and are subject to all the dynamics and personalities of your crew, so don’t get your undershorts in a bunch when they don’t automatically know what to do.
We all walked down our own path known as life. When we grew up, we all learned things differently. Make sure your rookie knows that it is not wrong to ask questions. It is not wrong to not know what the morning routine is and it’s not wrong to be oblivious to the fact that they shouldn’t ask the Chief any questions before he has his morning coffee. It is not the end of humanity to do a task wrong the first time. As the senior member, you need to explain why things are the way they are so that the new guy/gal understands.
But so often, we don’t do that, do we? We turn a blind eye to the fact that the educational facilities in our area only teach these kids just enough to maybe not get killed in a fire. We ridicule them and browbeat them for not “knowing what’s up” or “getting with the program” when they have no idea that they shouldn’t ask the senior guy who’s topped out and hates riding the medic. The haven’t been around to even know what their job is, let alone know which way the toilet paper goes on the roll.
The new boot has a hard run in the beginning and each mistake, no matter how small, is blown up by the rest of the crew to be the equivalent of stabbing a kitten in the face. It’s ridiculous, and it’s our fault. The mob mentality takes over and gains momentum. We make it so hard for them that they often leave. Or, we use the bull shit stories we made up about the minor mistakes they have made to get them removed from the company. We high-five each other about taking care of the “problem” but sit around the table our next shift and bitch like a bunch of grumpy old women when we are short on the rig or have to ride the medic two tours in a row. I guess being senior employees makes us feel like we have the right to bitch but not offer solutions. Bitching without providing a solution is called whining!
We tend to be in the business of not even giving people a chance sometimes and then wonder why we can’t get recruits or why our department’s reputation starts to slide. We can’t get our heads out of each other’s asses to see that it is a situation we created. Hey, but we get to retire someday and get paid by a place that we didn’t even contribute to, right? Super sweet!
I’m not saying that you need to powder their asses as they work to fit into your department. There has to be a clear understanding of the objectives that they need to meet. A standard set of goals for every recruit. There has to be an understanding on the part of the crews that not everyone learns the same way. We are seeing a crop of kids that may have been home-schooled, e-schooled or in some alternative learning environment growing up. That doesn’t mean they are stupid or inept; that just means they learned differently than you or your crew.
Assembly line education was great, wasn’t it? I mean, being made fun of and bullied or called a nerd for being different, that was neat, right? My scars run deep Mick; they run deep. Ahh, the memories….
All I am saying is keep an open mind when training the new recruit. They may need you to work outside of your comfort zone to help them learn. What they don’t need is an environment where no one can learn from a mistake. They don’t need to be pushed out of your department because you or your department leaders are too short sided or ignorant to find a way to help them. They don’t need to be asked, “What don’t you understand?” or “What don’t you know so that we can teach you?” They obviously have no clue what they “don’t know.” So why even bother asking? Are you there to teach them, or are you just there? Sometimes neither is helpful. And it’s not the new firefighter that is the “problem”; it’s YOU!
Next time we will talk about higher education. As the son of an attorney, higher education was the “end-all, be-all” in my house. Needless to say, I didn’t follow the same path as my sister. What’s it like sitting at a desk all the time? I can’t even imagine….
Stay Tuned for “The Push For Higher Education.”
Let’s talk about EMS for a minute…
There are industry-level publications, internet sites independent from the magazines and countless bloggers out there that have an opinion. I am no different. I pluck away at the keyboard and think that I can provide some insight, using the experience, which at this point, has spanned more than 20 years. Sixteen of that being in a busy(ish) urban department as well as the private sector, volunteer and any combination of the above. I have been in and out of administrations and held several command positions. I try to give my take on issues that I think warrant attention. I just finished my 24-hour shift which consisted of 8 calls. Not a bad shift. A little lighter than normal. I’m used to the double digits. We didn’t get beat up too bad. So anyway, I know you didn’t ask for my opinion, but you are still reading this so you might as well hear what I’m on my soapbox about this time. Have you a few minutes to kill? Or, at the very least, are you wondering if I will say something witty or lay on the sarcasm that is familiar to just about everyone in EMS? Read on to see if your dreams come true.
So today’s rant; pre-hospital emergency care! Shocker, I know!
Ahhh yes, what we all are doing whether we like it or not. What even the busiest departments in the country can no longer ignore. The fire service’s under-appreciated step-child (in most places) and the thing that pays the salaries of a lot of “dragon slaying”, “grievance filing”, “door slamming, when they get a run”, “treating their patients like shit because they have to be on the medic unit” fire service employees. The thing that has kept some departments afloat during hard financial times. That’s what we will be talking about this time, so let’s explore what is rattling around in my head.
What do you think we are doing out here? It’s a weird question to some, simply because I don’t think it is asked too often. When you ask the new guy or gal, he or she will say we are out here to save lives by implementing all of the groovy things they taught us at the learning annex in our emergency medical technological implementation class. If you ask the “salty dog” they will say that we are the ones crazy enough to stay up for 24 hours straight to cart the crazies to the ED so they can jump on the bus and be back home before you are done with your report. My opinion of us is somewhere in the middle, I think. You may not perceive it that way by the end of this post, but who knows.
I can hear you saying, “get to the point” so here we go (you’re not the boss of me by the way). When I was a young, green, two-pager-wearing, CPR mask on my belt, car lit up like a Christmas tree EMT; I was ready to save the world with the 120 hours of training that I received. I was ready to be a “code buster” as noted on the t-shirts of my local squad and ready to snatch people from the jaws of death like I had read about in all of the periodicals stacked up at the squad house. I was “doin it” on the 68 runs I took my first year as an EMT. I was a hero to my family and friends, and my mom couldn’t stop bragging to her coworkers and pointing out the picture of me in my gear that was on her desk. What has two thumbs and drives the ambulance while the medics work in the back? This guy right here! I wouldn’t say I was Johnny and Roy, but I could make a mean cot and restocked the ambulance with 4000 4×4’s because I knew that bus crash would happen sooner or later! Oh, they let me do CPR a few times…….not bragging……….just saying.
Now, when I get to work with a new EMT and their wet-ink Registry card, I find myself wishing I had the same boundless energy to help my fellow man as I did back then. I get a boost from those guys or gals for a minute but find myself spending the day dispelling myths about some of the crap that they were taught in school. At the end of those days, after snatching people from the jaws of mild discomfort, I wonder what kind of Kool-Aid they are feeding them in their training and what they think they will be doing out here on the street. I think back on conversations I had with the senior members of my squad about what we are doing. That’s after the adrenaline wore off from me driving them through traffic with the noise and the cherries activated!
What do you think you SHOULD be doing out here? Do you honestly feel that you are having the greatest impact on your patient’s clinical course, more so than what the hospital will have? Do you believe that YOUR treatments will “make or break” the outcome of the patient’s recovery? Some of that holds true, but there may come a day when you question that, and that’s okay. Some days you will feel like you are just giving people rides or “hauling freight” as someone mentioned to me once, and that’s okay. Just don’t get stuck there!
Or do you feel like I do? Do you feel like you have an impact on the entrance of the patient into the healthcare system at that time in history? Do you realize a greater portion of your patients need to be at the ED more than they need to be with you? Do you try to get as many of your “skills” done before you get to the ED? Do you feel like most of your “skills,” if done well and for the right reasons, will shave some time off of the patients ED evaluation? Do you know, just by looking at someone, that they need services provided by the definitive care facility and not by EMS? Do you feel like what you say in your hand-off report to the ED staff can get the patient what they need more rapidly? I certainly do. I know by looking at the septic, unresponsive nursing home patient with a 518 blood glucose and a 104.5 temperature that I can get them started. They need to be in the ED and ultimately the ICU and not sitting outside the nursing home in my medic unit while I try to get the $35,000 blood pressure machine hooked up, ECG leads on that won’t stay because the patient is diaphoretic and an IV started after two attempts. The patient needs to see the ED
doc, not me. If I get all of those things done on the way to the ED then “YAY” for the patient and me. Don’t get me wrong; we have made leaps and bounds in pre-hospital care with trauma, STEMI recognition and treatment, stroke recognition and pediatrics. We have a direct impact on the outcomes for those patients and need to be excellent at doing those skills in rapid fashion to give those patients a chance at a full recovery. Keep in mind that we are supposed to be RAPID transport. Not everyone needs you to do you. Some of these patients need the ED, plain and simple.
We need to know what we do for our patient affects them throughout their clinical course to their discharge from the hospital. Don’t be afraid to learn as much as you can from the hospital about how your patients progressed through the hospital system and their outcome.
I have had discussions with colleagues about this subject and have been accused of discounting the effect of EMS in the healthcare system. I always argue that point because I don’t feel like I am. (Clearly, otherwise, I would not be arguing!) I am just trying to keep a clear understanding of what I think my role as a paramedic is. I am the initial contact with the healthcare system at any given point, so I feel I should do everything I can to get them to the right hospital for their needs. My department transports to six different hospitals including level one and two trauma centers, a children’s hospital/trauma center and a Veterans Affairs hospital. I am the advocate for most of my patients and have gotten good at tailoring my hand-off reports to get the ED staff to focus on what the patient needs right now, and what they can take care of in a few minutes. I also try to steer my patients to the facility that will best suit their needs. I try to teach that to the new folks, but it is a hard concept to grasp for some.
I tell the new folks to look at it like this. You can be in the ED, or at least half way there, in the time it takes you to sit out in front of the patient’s house fumble f**king around. I understand you’re trying to get IV’s, scrutinizing their vital signs, getting the $98,000,000 monitor to take a blood pressure seven times or putting the patient through the “inquisition” about their past medical history, but you should get going. Put it in drive and get going. Nothing is more awkward than the family sitting in the car in the driveway with the shifter in reverse, waiting for the ambulance to move in the direction of the hospital. I’ve seen thirty-minute on-scene times AFTER the patient is loaded into the unit. That is infuriating to me. What are you doing??? It’s neat to meet new people but Christ on a bicycle, you could have been at the ED by now! Do you think that IV is worth holding up the show? Do you not have the skill level to take a manual BP after your forty-eight attempts with the monitor? I mean really? What do you think we are supposed to be doing out here? Granted, you may need to hold still for a minute to get a clean 12-lead or to do something special before you start bumping down the road. Applying CPAP comes to mind. We have all had that partner that thinks that they are driving a Lamborghini to the hospital and throws you around the patient compartment. Sometimes you need to do a couple of things so you can sit down and not die, but outside of that, you need to get rolling. You need to be good at doing your skills on the move. Surfers don’t win surfing competitions by standing on the surf board on the beach, they ride the waves and do that hand signal thing with their thumb and pinky finger. I have a RonJon shirt somewhere with that on it. Dude. Learn to do your skills on the move bruh!
We need to realize that we are not the wizards of pre-hospital sorcery that they convinced us we were in school. They tried to teach me to be an amateur cardiologist in paramedic school. They tried. I do the best I can. I have dumbed it down to whether the patient is symptomatic or not. It’s cool that I can spot that PAC, but this asymptomatic patient needs to follow up with his cardiologist. I am good at STEMI recognition, but we have dumbed that down to by saying if it sounds and looks and feels like a heart attack, even though you don’t have STEMI signs, you need to treat it as a heart attack. You really never know right? At least until you get a Troponin level……..at the ED. No sir, your properly working pace maker is not going to kill you. Your underlying cardiac disease probably will, but we are all just counting out the birthdays anyway, am I right?? (frowny face emoji)
There have been several studies about the effect of rapid transport by the first arriving unit on the scene. One study I read compared the outcomes of patients brought to the ED by the first arriving police unit as compared to the first arriving EMS unit. The outcomes were almost identical, with some outcomes being better when the patient arrived by the police officer. Those results are sobering and will make you wonder if what we do is even worth it. I think that as we evolve, we will continue to examine what aspects of our work do the best and focus our attention on those things. There will be new information, and we will be reactive to it and proactive with it. Hopefully, we will move more quickly to embrace the information; I’m looking at you, departments that are still backboarding! Are you dumb or just plain stupid?? Stop using “standard practice” as a reason to do it. Driving stakes into the brains of “crazy” people used to be standard practice but we quit doing that.
What we do is worth it. I had to put that in there so the new generation of “everyone gets a trophy for showing up” will not throw themselves off a building or be sad. (another frowny face emoji)……(and the one that looks like it is crying)
So ultimately, we are responsible for our actions and what we can provide to our patients. We need to stay current and proactive. We need to check ourselves before we wreck ourselves and try hard to provide rapid, quality pre-hospital care. It is what we do and is what we are supposed to be doing out on the streets.
We are often labeled as “Jacks-of-all-trades” when it comes to what we do. If you don’t feel like you have a broad enough understanding of what you are supposed to be doing, go out and find the knowledge. Work in different aspects of this business. I spent some time in a hospital-based air and mobile intensive care system. The short time I was there was invaluable in my eyes because I learned what happens from the time the patient was brought in by EMS until they were discharged. It gave me a different perspective on how I treat my patients, who gets advanced airways and who does not and what skills I can do in the field to impact the patient throughout their clinical course.
Be skilled and be quick. Get your patient to the definitive care that they need. Get your ego in check and do what is best for your patient. Listen to them. When they sweat, you sweat. Listen to the answers when you ask a question. Do your job and do it well. We are out there to be the first person they see on the day that their world may be crumbling. You should be honored that they trust a stranger to help them!
In this 3-part-series we will be discussing, or more realistically, I will be ranting about the above topics. You will read this and at the end, you may or may not feel mentally violated.
I used the term entitlement in the heading because I feel it encompasses several things. It seems that nowadays, the constant influx of the “everyone got a ribbon generation” has revealed some new(er) issues. Let’s discuss.
This crop of men and women arrive at the firehouse bright-eyed and bushy-tailed with an eye on a great career; at least most of them anyway. Some are just in it for the paycheck or to say they are a “dragon slayer.” Some just want to give it a try, eventually leaving the business because it’s not for them. We will talk about them later.
Back to our young guns. These folks get into the firehouse and are put on the training track that every other recruit has been placed on. Just like car wax and hair plugs, results may vary. Some of these folks pick up the training quickly, and some are turtle slow. But eventually, the “look what I did with the ladder” and “I washed the rig (poorly) by myself” situations come up, and they expect some sort of reward. They don’t seem to have the mental capacity to understand that they are not special in the fire service. You don’t get a ribbon or a pat on the head every time you do something that you think is worthy of said accolades. It becomes a hard sell to these new boots that this is the regular work that has to be done. I have seen these situations go as far as disciplinary action because the new guy/gal can’t seem to “get with the program.” Often, the new guy or gal claims that they are being picked on or treated unfairly. When the rest of the crew hears the new person claim they are being treated unfairly, they don’t understand why the new guy or gal can’t get it together. Everyone involved feels socially awkward, and it causes tension amongst the crews.
I suppose I should back up and give some background. I am speaking about small and mid-sized departments who don’t do big recruit classes. Rather, they get one to four new people at any given time and have to mentor them through the training process. The large recruit class model has its own dynamics and by its nature, weeds out the lazy (in most cases that are not involved in some sort of political shit-show) and incapable through the course of the recruit “class”. I have never been in that type situation because of where I am in the state and in the country. I have friends that have gone through the recruit class type scenario but again, I don’t have first-hand knowledge so I will leave that subject for other bloggers.
So back to Johnny or Jane new boots again, these kids want and need feedback for everything. They need to know what is expected of them. Unfortunately, they also are searching or waiting the entire time for the “quick fix” or “easy out” solutions because they were spoon-fed everything in their life system. They have a hard time believing that there isn’t a quick solution to some problems or a solution that doesn’t involve someone doing it for them. They want credit for their regular job duties, and when they don’t get the credit, they whine that the crews don’t like them or that they are being treated unfairly.
I am not sure what the solution is to that type of thinking but each situation is different, and they all need to be handled differently to have a positive result. Maybe gold stars are the answer…..or ribbons, perhaps cookies. You have invested a few man hours to get the individual through the application process, so put a little effort into keeping them and training them right. If they do it wrong, then show them a few times exactly how you want it done. If they have been told or shown multiple time and still don’t get it, then move on to the next step of corrective action.
Those recruits who joined up for the steady paycheck become average employees in my experience. They come in, do their job and go home. As much as we would like them to fall head over heels in love with this job and the culture that surrounds it, they just want to make a solid paycheck. Their dad’s told them they had to do something after high school, so they picked this course off the list at the community college. It is not likely that they will ever spend a week at FDIC, wear “I fight what you fear” t-shirts on their off days or work tons of overtime. They are just “making the donuts”. It beats working at the factory.
Watch out for the “dragon slayers”. They have the potential to get people hurt because they think they know more than they do. They cover their ignorance with arrogance and tend to be loose cannons. You can spot them on a fire scene because they are often working alone on an unimportant task or hanging back doing nothing. They have the potential to be good employees if you can harness the energy they use to run their mouths and channel it into doing the work.
We can spend the next year trying to keep those recruits that find out that this job isn’t for them. Retention is the large elephant in the room that needs the most attention. There are some great strategies out there to deal with it but I will leave that discussion for another day. Just remember, a retention plan should start the very second the recruit walks in the door!
Next article, we will talk about “Running People Off.” It is the opposite of retention and seems to be a type of game in some departments.
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As most of you have probably heard, there is growing evidence that the death of a Virginia female firefighter may be the result, in part, of bullying by fellow firefighters.
If that turns out to be true, then it is scary, sad, and shameful to all who bullied her and the profession. There is no reason for it! If it turns out not to be the case, we should not dismiss the subject. Instead, we should have a very clear and lengthy dialogue about the subject of bullying and the treatment of, not only to females but anyone who doesn’t fit the “mold” in our department.
As a former Fire Chief, I ask myself, “Why does it have to be that way?” I have witnessed first hand what female firefighters go through, and I took swift action in cases involving my department. However, I have close friends that are female firefighters, and I hear about the terrible things they go through. They continue to be bullied or simply treated much differently because they aren’t male. It’s absurd, and needs to be addressed. The problem in most situations is that the department leaders are part of the problem or that are too inept as leaders to handle it. The leadership in a lot of departments are part of the “old order” in that they think a female’s place is to be an auxiliary member, a supporting member, a secretary or in the kitchen making sandwiches. They don’t believe or understand that female firefighters are capable of doing this job and doing it well!
An article by CBC News Canada notes that almost every female firefighter in Canada has been bullied in some form or fashion. I would argue that the same goes for the U.S. The opportunity for this type of situation to happen is staggering, and it needs to be addressed at all levels. Verbal or sexual abuse/harassment and hazing are just a few of the most unprofessional forms of mistreatment that are found in the fire service. Why, if we are the professional firefighters or leaders in the community, should we even consider putting up with that type of activity? Are we turning a blind eye to it like we do other things? Are we saying that it’s not our problem? Or are we telling ourselves that it’s not happening or won’t happen in our department? All of those things may help you sleep at night but they are the coward’s way of handling the problem, and they will not promote any real progress on the issue.
So what can we do? Let’s mull over a few things and see where it takes us:
- Promote a dialogue: Your female firefighters may feel that they are unable to talk to you directly because issues should be brought up the chain of command. This issue is of such great importance that it needs to be addressed by you directly. Keep in mind that some of your command staff may be part of the problems, so give your firefighters an opportunity to bring their issue to you.
- Give them some immunity: Your female firefighters should not have any fear of retaliation or disciplinary action for revealing to you that they are getting harassed. They need to know they can count on you to help them, just like you would help one of their brother firefighters.
- Know when to remove yourself: If you are part of the problem then give them an avenue to talk to your boss. You were man enough to be part of the problem, so take what is coming to you. If you are that worried about your career, then you shouldn’t have been a part of the harassment in the first place. Real leaders recognize that they have made a mistake and deal with the consequences. If you are protecting the harassers, then you need to go down with them. You are a cancer on this great profession that needs to be removed.
- Support them as much as you can: When a female firefighter comes to you with a harassment complaint, give them all of the support they need. They may feel like they are on their own and them knowing that they have at least one person in their corner gives them the courage to fight for what is right.
- Make their options clear to them: Make sure they know what steps they need to take to bring a resolution to their situation. Most agencies have a policy for harassment, so make sure they clearly understand what that policy is and how to make their way through it. Make sure all the proper steps are followed. You don’t want to be the reason there was a failure to resolve their issue. You should know the policy better than anyone.
- Don’t judge and don’t be an a**hole: The issue they bring to you is very real. Try to look at it from their perspective and try to understand what they are feeling. The issue at hand may seem trivial to you, but it is important to them. Don’t be condescending or tell them to, “Suck it up; that’s the way it is in the firehouse!” They are most likely describing the tip of an iceberg in your department. If you investigate, you may find that you have a much bigger problem. If your first instinct is to try to hide your findings or dismiss the issue, then you should resign immediately because you don’t deserve to hold the position you have in one of the greatest professions on earth, you COWARD!
- Be the face of change: If you find yourself and your department in the midst of a bullying issue, be a true agent of change. Take all of the steps necessary to fix the problem. That may mean that you need to take disciplinary action against or terminate your “buddies”, but you need to do what the taxpayers pay you to do. It is YOUR responsibility to make it right! NO MATTER WHAT THE COST!
One of my favorite Lieutenants was a female. She taught me a great deal about this job and how to do it well. She was a role model of how to be a good leader. We had many discussions about being a female in a male-dominated profession. She didn’t take any crap from anyone and admitted that it was never easy. “Sometimes you need to be more of a man than they are,” she would say. I found it humorous at the time, but it made sense. She had to teach quite a few firefighters how to be men and how to do this job. She knew that some of them were scared to work with her. She would show them that the job could be done and how to follow a female leader.
I am sure that most of you know a female firefighter and have heard about what they go through. Someone very close to me is a female firefighter, and she has dealt with harassment for many years. Most of her department leaders have brushed off her complaints as “business as usual” in the fire service. Subsequently, she is looking to leave this line of work. She is tired of the macho neanderthals treating her like a second-class citizen even after she has proven herself to be a good (if not better than they are) firefighter. It is sad to see it happen because she had a real passion for the job that got snuffed out by weak Chiefs or department leaders who didn’t have the stones to take on the problem. I wonder how many other great firefighters have given up and left the business because of bullying.
So what are your thoughts? Do you have the ability to see a problem and fix it in your department or are you among those who take the cowards way out and ignore it?
Talk to your female firefighters about bullying. You will be surprised what you hear!
I am sure that most of you have heard that question 1 or 200 times throughout your career. It is a topic of interest to the people around you and at the holiday parties that you may be attending this time of year.
Note: I use “Paramedic” as a general term to mean EMT, Firefighter, and/or First-Responder because the general public doesn’t know the difference, usually.
Every Paramedic has an emotion attached to that question. With some, it triggers their depression. In some, it sets their mind on a journey of every horrible call they have been to their entire career. Some get defensive because they feel like they are being scrutinized. Some get excited and are more than willing to tell people what they do and sugar coat the bad parts, so the sweater vest wearing guests don’t reel back in horror. Everyone has their own response to the question but the core of what they tell people is about the same.
When people ask me that, I have just about every emotion listed above depending on the situation. The last few years, I have gotten a bit evasive because it has proven, in the past, not to be the question that they really want to ask. I try to get them off of the subject as quickly as possible with a quick “it’s a great job, you meet a lot of interesting people or it’s a different thing every day and that’s super duper” type answer. The entire time I am trying to deflect them, I am thinking ” you don’t want to open this Pandoras box” or “please don’t make me think about that stuff right now, I am having a decent time” but I try to wrap it up and ask them what’s up in their life. It’s worth sitting for the next 20 minutes while they talk about how little Johny did in soccer or how Amanda did in gymnastics. Your kids are awesome (sarcasm). I love my kids (not sarcasm); even more so now that they are becoming adults and are out in the world. By the way, your boy looks like the dead kid I drug out of a 1995 Cavalier back in ’99. I love parties!
Anyway, the person asking the question doesn’t want to know what it is like to BE a Paramedic; they want to know what is the most horrible thing, the second most horrible thing and the top 10 ways you have seen people die as a Paramedic. They want a sample of what you have rattling around in your brain. They watch Chicago Fire and Nightwatch and assume that what they see is the real deal. I will give credit to Nightwatch, at least it is following crews on the street and attempting to show what it is like to be a street medic. I don’t have that many patches on my shirt, and I don’t call every patient “babe” or “Hun”, but it is a decent representation of our job. It is primetime TV however, so the rough stuff is blurred out. We are not lucky enough to
be able to blur that stuff out of our memory.
I have seen several articles and blogs about the subject of this question and I find the responses interesting. They range from the conversation almost ending in a fist fight to the story teller breaking down into a puddle of their own tears, leaving the minivan driving guests trying to figure out why someone would do that kind of work for that kind of money and why that person was invited to the party. Your tears don’t go well with my Chardonnay and the guacamole dip. Whatever the result, we are the ones who are left at the end of the night feeling drained and violated mentally. The act of asking that question is the preface to emotional turmoil for the Paramedic. It is a scary place so answer the question at your own risk.
So what do I think about when that question is asked to me? Well, it immediately fires up synapses that are usually dormant, and it begins the roller coaster of emotion that I usually bury in alcohol before the night is over. If there is no alcohol, I probably would have left the party before the question is asked. Anyway, I usually ask some “safety questions” to the group that is congregated around. Like “do you really want to know” or “you don’t want some of this in your head so are you really that interested”? That is usually my subtle way of telling them that whatever your nightmares are tonight are not my fault.
Side note: I don’t want to give the impression that I work the party circuit during the holidays. I very rarely go to parties (the whole introvert thing), and I stay pretty quiet when I do end up at one. I get asked that question at various time throughout the year, but it comes up more for all of us this time of year.
So off we go on our emotional journey. I gauge what stories I am going to tell by the crowd that has formed. If they are people that know me pretty well, I talk about some of the more horrible stuff. If they are strangers, I keep it PG-13ish and leave out some morbid details. Some stuff that we see is impossible to explain to regular people because the only way it makes any sense is to see it first hand and absorb everything that led up to what you are looking at. We digest the information on scene and put it in our brain vault for later. I don’t try to give them a warm and fuzzy feeling about being a Paramedic because it is not warm and fuzzy (most of the time). I am honest and try to make them understand what the healthcare system looks like from the pre-hospital point of view. I try to give them insight on how a Paramedic fits in the overall scope of the system and how what we do affects the clinical course of our patients on down the line. I use the analogy that day or night, you have to go to a place you have probably never been before, talk to someone you have probably never met and decide whether they have a general math question, a story problem or a calculus equation for you to solve and you only have 5-10 minutes to solve it because you will be at the hospital ED in that amount of time. That doesn’t hold their attention for long because lets face it, they are all voyeurs. They want to peer into the dark parts of the job because, deep down, they are excited by stories of the suffering of other people. At least the ones they think are below them in social standing. They don’t realize that they are only one drift across the center line of being that ground beef in the drivers seat. That they are one Oxycontin away from being that unresponsive on the living room floor next to their daughter’s power wheels pink Jeep. That they are that one misplaced candle away from needing to be drug out of the inferno. That they are one cheeseburger away from being that coworker that their office pals had to do CPR on before I get there. They don’t realize that they could be that person that is minding their own business and gets hit with a stray round from the gun fight one street over. They don’t think that they may be a few failed life events away from being that
homeless junkie I had to revive. They don’t realize, and I am jealous sometimes that they get to go through their day without thinking about those kinds of things or not remembering a call you had six years ago and thinking if I had just done that one thing, that person may still be alive today.
So I lay it out for them if they can take it. I talk about working full arrests on people that are younger than them and that those people don’t spring back to life after I shock them then hug me as we sing “don’t stop believin’”. I talk about how I had to lay in mud so that I could talk to the 19-year-old kid that is in an upside down car with the brake pedal jammed through his leg and his dead friends head stuck under the seat from the impact. I talk about how I went to a full arrest at a nursing home to find a guy my age who has been down for 10 minutes before they even called, cool to the touch in the extremities, has cancer and had refused hospice care and have to ask the lead Paramedic “what are we doing with this because someone needs to make a decision”. I tell them about handling 4 or 5 overdoses in the same shift and giving Narcan to the same person twice in 12 hours. I tell them about doing CPR on a 90-year-old woman and feeling all of her ribs break with CPR while her husband of 50 years stands next to me and asks if I need any water or if he needs to take a turn at compressions. I tell them about the time I went on a call to find one of my dad’s best friends crushed under a piece of farm equipment and having my dad ask me every day for a week what happened and how his friend looked when I got there and had to say to my dad “you let me keep that picture in my head. You don’t want it. You just remember him how he was”. They are on the edge of their seats and hungry for more, like waiting for the next action scene in a movie. I give them a lot, but I know when I have had enough, so I switch gears.
I start talking about the people that stop us when we are out getting food to say thank you for our service or pay for our meals. I tell them about the frail old lady who apologizes 30 times for calling me in the middle of the night to take her to the hospital because she is at the end of a very long road and knows that she probably won’t make it out of the hospital this time but wants something to ease the pain. I tell them about how awesome the shift was when I got to sleep all night. I talk about reading to the kids at the elementary school and talking to community groups about fire safety. I talk to them about the fun and frustration of mentoring new Paramedics and new employees. I talk to them about how we support each other when that horrible call kicks us all in the st
omach. It gets emotional, but I use my 20 plus years of cramming my emotions down my spine and keep the conversation lively.
So we all have to deal with that question at one time or another. It brings out emotions in all of us that hang on for hours or days at a time. As I said in the last post, we all have different career paths. I may have seen more than the guy on my left but not as much as the girl on my right. They have been through what they have been through, and I have been through what I have been through. It affects us each a different way. Your answer to the question will be different than mine. That’s the way it is.
What will you have to say when they ask you? I would suggest that you be honest. If you get emotional, let them see that to. It may help them understand that the job you do is not like working on an assembly line or delivering the mail. Your job is woven into who you are and, in time, is wired directly into your heart and brain. That talking about it sometimes helps us to heal some of the wounds that we have acquired over the years of our career. Know when to say when. You need to know when you are done talking about it.
My answer to the question has changed over the years. The one constant is my ruthless attempts to freak my mother out about the situations I get into. I like to hear my mom say “I’m glad you are safe.” It never gets old.
What will your answer be?
Note: The bulk of this post deals with fire department EMS, so if you are not in a department that does fire department EMS, you may find it uninformative. Those of you that do fire department EMS, read on!
As you can imagine, I spend quite a bit of time on social media. I have slow shifts like everyone else, and I have time during my off time to decompress and be a couch potato, so I try to read and follow other fire and EMS blogs and social media pages, just to get a feel for what kind of attitude we have as a “business”. As such, I read articles and posts from various authors about various subjects and in turn, hear various opinions about the same topics or subjects. I am no different. I propose my opinion on subjects and try to give some background as to why I feel the way I do. I will admit that I do not get to travel and dine in the finest firehouses across the country like other “bloggers”, but I get a sense, from what I read, that the issues that I deal with are similar to other parts of the country. Granted, we have varying protocols and levels of service, but we all generally follow the same basic underlying methods and practices to do our jobs.
That being said, I have read several articles about being part of a percentage of firefighters that “gives it their all” or “trains until the sun comes up” or “they are the salty dogs that you should look up to, seek out and gain knowledge from. Ones to model one’s career after”. I agree with that fundamentally, but I have rarely seen articles about finding the senior EMS guy or gal and learning from them.
I have learned from some senior folks. I soaked up knowledge and learned the tips and tricks that made me a better fireman (at least it felt that way). They made me a better operator and gave me perspective on how to train the new guy, now that I am the “senior” man on many occasions. I have learned from street-wise and seasoned medics as well. I have always valued what I learned and have tried to pass it on as much as possible, but I am starting to wonder what the current “senior” folks think this business is supposed to be like in 2016. My opinion of this job seems to get further and further away from their opinion, and I find that curious.
I read recently that the FDNY and Detroit Fire are in the process of a major “overhaul” of their operations. Namely because of the fire load (the amount of fires they are fighting) has gone down and the EMS load is going up. That article struck a chord with me. Here are two of the busiest fire department in the nation taking another look at how they operate. I can almost guarantee that there are men and women in the FDNY and DFD rallying against changes. It’s what we do, right? Change is scary! From what I have read, the unions are taking what appears to be a “middle of the road” position right now so it remains to be seen how this will turn out, but I began to wonder, as I stated before, what the senior staff thinks the fire service should be like in 2016. Were they surprised to hear that they need to focus more on EMS? I am reading as much as I can about their issues, and it remains to be seen.
There is no doubt that a number of fires have dropped off, and the EMS calls have gone up in almost every area of the country. We are turning out on more and more weird and wonderful EMS related calls and even more that are due to the failures of the public health system. It’s a busy life for the fire department EMT/Paramedic, and it will only get busier.
So what of it. What’s the point? My point is this; it seems like our senior staff members continue to tell our cadets, our rookies, our new hires that “slaying the dragon” should be the highlight of your career. That being the 10% firefighter is what it means to BE a firefighter. That “doing work” and “getting some” are what makes a firefighter a firefighter in the firehouse. That EMS is just something that we have to deal with, as if it will go away in the future. Is it really? In 2016, does that make you the model firefighter? I submit that it does not.
Time and time again, I hear senior staff complain that “when they backed the ambulance in this firehouse, we quit being a real fire department” or that we don’t GET to fight fires anymore because we are taking all of these EMS calls. Really?? You have got to be joking! When I was a Chief, I told my staff that if they continued to complain about EMS, I would pay them using the fraction of funds gleaned from putting fires out. Once I broke down the percentage of the money they earned from fire and from EMS calls, they decided to be more proactive about transporting instead of trying to get refusals, and they didn’t feel as salty about not getting to slay the dragon every day.
I don’t see putting fires out as the greatest moments of my career. Yes, I had some great times kicking doors in and throwing water, and I still do. I love being an engine operator even more now and I love working on the truck, but there is so much more I have done that I am proud of. I have touched so many lives over the years. Some of my greatest “holy shit” moments came in EMS. Some of the “jobs” that made my heart pound out of my chest were in EMS. Some of my proudest moments were in EMS, and some of my biggest defeats were in the back of an ambulance. I have made a point to be the one of the 10% that completely changes the mood of an EMS scene for the better when I arrive. I have made a point to know more than the other guys about medicine and the future of our field, and I share that with the new guys. I feel I am part of the 10% but for other reasons that I feel are just as important as knowing how to force a door 29 ways.
I am not saying that firefighting isn’t important work. I truly believe in training until you can’t get it wrong. I get just as frustrated with poorly trained firefighters as anyone. I watch the news or videos on YouTube and armchair it with the best of them. I have put as much effort into being a good fireman as I have being a great medic. I will never feel like a bad ass dragon slayer. It is not my nature. I come from a line of lawyers and stamp collectors, not blacksmiths, butchers or bodybuilders. I have never claimed to be macho, but I can think my way through a difficult airway, a confusing medical call or a wicked trauma. Those skills are what makes today’s 10% in my opinion. We are EMS departments that fight a fire on occasion.
I have seen the FTM-PTB (fuck the mutts-protect the brothers) stickers around, and it makes me uneasy. Who are the mutts? Are they the ones that don’t think the same way about the fire service as you do? Are they the ones who think the medic is exciting? Are they the nerds? You should look around. Some of the leaders in this industry are hanging on every word that comes from NIST. The nerds are taking over so maybe it is time for a shift in perspective. I know the usual explanation is that the mutts are the ones who don’t care about training or drilling or working as a team. Can we put those hose jockeys that think that EMS is a stupid waste of their time in the mutt category? They aren’t embracing all aspects of the job, so does that make them a mutt? I mean, they have to stop dropping weights in the workout room or have to stop molesting the forcible entry training prop to take a stupid EMS call so do they have the right attitude about what this job should be in 2016?
The fire service is mired in tradition and therefore mired down in traditional thinking, so I expect change to come slowly. We still don’t realize that the equipment pays our salary, so we don’t take care of it. We are slow to purchase EMS equipment that would drastically change patient outcomes. We are slow to support the part of our business that generates revenue. Big red firetrucks look cool but if the wheels are falling off the rig that supports 1/3 or more of your budget then why would you neglect it? It’s a weird business model that will eventually shift for the better.
I rambled a bit on this post, but I hope you can get through that and see my point. It is time to redefine what we see as the “model firefighter” in my opinion. Knowing how to be successful in EMS will carry that firefighter into the future. Making sure they feel comfortable in an ambulance is just as important as them being comfortable climbing a ladder. This is a team sport, so if all of the team members are not trained up, in all aspects of the job, the team will suffer.
I work in a department that, when you promote to Lieutenant, you no longer have to ride the ambulance. I was operating the engine the other day for a newer Lt. and I said: “I trust you with my life in a fire, but I am getting less comfortable with you helping me on the medic”. With a strange look, my Lt. said ” why is that, I’m still a medic”? I said ” it’s because you don’t see patients anymore. Your skills are going to fade”. He agreed, and we had a good laugh, but I was being honest.
So what percent do you want to be? I want to be part of the group that sees past what we are doing today and looks ahead at what we can become. As a Chief, I always was excited about well-rounded employees because I knew I could plug them into any spot and they would excel. Can you excel in every spot? I hope you can!
As I have stated in the past, I am in no way an expert in the field. I am not a professional writer either. I just post my opinions in hopes that it will promote a dialog or get people to think about our business differently.
Thanks for stopping by and stay safe out there!