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!