20 years later, in 1995, I was working as the EMS operations manager of a large, suburban fire district. I was serving on various committees, task forces, and advisory roles. I left that rewarding an successful career to pursue other avenues, but in 2010, partly due to the economic downturn, I found myself unemployed. It seemed the easiest way to find employment and keep our house was to regain my paramedic license and find EMS employment. Six months later I was employed by a large corporate ambulance transport agency.

At first it was quite challenging. Much had changed, yet much remained the same. Essentially I’d been out of the field for 20 years, though I still ran calls and did a lot of teaching in the 90s, I was mostly a desk jockey. And though I worked for a non-transport agency,  my previous experience included both air and ground EMS. The hardest part about returning was the pace. I soon learned how busy system status EMS takes it’s toll on medics and EMTs.

After getting through FTEP and settling into the role, I had a period of joy. It was really fun being back into the career I always loved. It was great to run calls again, solve problems, and take care of people with needs. But that joy quickly wore off. EMS is different now.

When I first worked in EMS, prior to the implementation of the 9-1-1 system, the ambulance company I worked for ran without first responder support. My partner and I were often the only ones on scene, and the calls seemed to go much smoother. We were able to establish rapport with our patients, comfort family members, and reduce the chaos and confusion we found. After EMD was implemented and communities decided to send firefighters as EMS first responders, things started to get more complicated on scenes.

There were attempts in the 1980s and 90s to streamline our EMS systems by awarding ambulance serve contracts and eliminating the duplication of agencies, but from what I can tell, far too few communities have accomplished this. To me, this is one of the most disappointing aspects of our current systems.

About six months ago I found myself working the graveyard shift on a system status ambulance. The county I worked in had no quarters and we covered thousands of square miles with just a few rigs. We spent the night moving from post to post. Sometimes we would be at a post for hours, sometimes we never sat still. This began to take its toll on me. I began to realize that this shift, combined with the claustrophobia of the ambulance cab, was killing me – and killing my family.

I’m convinced that system status is taking an abnormally high toll on EMS workers. The stressors of the job, considered one of the more stressful careers in the US, and the long hours, are killing our paramedics and EMTs. It’s a shame really. People come into EMS excited and with high hopes of making a difference. But after about 5-10 years, they grow demoralized and depressed. I’ve never worked with so many discouraged people in my life as I have in the last two years.

I worked hard to stay healthy, keep a positive focus, and improve the lives of my coworkers. But I’m afraid the task is too big. There are several agencies and communities around the country who do EMS really well. They not only offer quality patient care, but they treat their employees well. Other communities have not been so quick to adapt. Sure, paramedics are being paid much better than in the early 80s – back then I made $4.10 an hour and I was working one of the busiest ambulances in the country.

Somehow, our society has forgotten to take care of its EMTs and paramedics. Unless they find employment in a well-funded public agency, I would not recommend people seek EMS as a lifelong career. This pains me to say, as I love my coworkers and the job, but I don’t see changes happening anytime soon.

Last week, after a two month break, I resigned my position. I’m too old for this, and I’m not a good fit. I’m not a bad paramedic, but I wasn’t getting enough sleep. After reading this article (Life in high gear takes toll), I realized I was taking too big of a risk. If I mess up on a drug administration, which according to David Marx, happens one out of 700 times, it is my career and livelihood on the line. I know my employer wouldn’t stand behind me.

The sleep deprivation, the pressure to make scene times, the lack of quarters, and the lack of focus on quality patient care have made me realize I need to move on. I don’t know where I’m going next, but I feel peace. I would gladly work at an agency that cared about their employees, put customer service and patient care needs above the desire to make a profit, and used their resources to improve the local system.

Just like when I was a 15 year old kid, I just want to make a difference by caring for people in need. I’m not in it for the money – I gave up that pipe dream a long time ago. I just want to serve my patients and their families. It is my hope that paramedics, EMTs, physicians, nurses, and system leaders will continue to improve our fledgling profession. There is still great potential, but it won’t be cheap. It will take a great influx of energy, desire, and vision.

Related:

• Study Examines Effects of Sleep Deprivation on Shift Work
• EMS ranks among most sleep-deprived occupations in US
• Effects of Sleep Deprivation on Fire Fighters and EMS Responders

[Note: This post is inspired by This Post, by The Happy Medic.]

Credit: Flickr

Interestingly, in those days, we, the paramedics, could refuse to transport someone who didn’t need an ambulance – it wasn’t in the protocols, but it was easy to do. Also, most of us really, really cared about being professionals, and we didn’t really need these regulations.Now, 35 years later, those laws are cast in stone. Most, if not all of the shoddy ambulance operators have sold out and moved to warmer climates, and the profession has changed – substantially. Now, those concrete laws are like shackles around our feet. Eight minute response time requirements are only needed for a small percentage of our calls. Eight responders on every call – the same.

There needs to be changes, but it feels very daunting to even begin that process.

Is it worth it?

I see older coworkers who are barely able to put one foot in front of the other. They are depressed, broken, sick, and tired. Back issues, arthritis, obesity, and other burnout symptoms are rampant. It saddens me to see this.

What good does it do for us to save the whole world, but lose the lives of ourselves and our families?

When we were young we had visions of saving the world. We didn’t care about long hours and poor working conditions, we were pioneers in the exciting world of EMS and we were willing to do whatever it took to save people. My first full-time EMS job paid $4.10/hr. I worked 48/48s, and we ran 32 calls a shift. We learned to sleep and eat whenever – fortunately, most of the hospitals fed us well, and we ran our tails off. I was 21 years old and literally, living the dream! That first year, I made $6000 total.

That first EMS job cost me my marriage. I was either working or sleeping – that didn’t work well.

For the next 15 years, I got one of those elusive fire-medic positions. My pay tripled, my hours were cut by a third, and our call volume was only 10% of the big city ambulance gig. At first I was bored, but I now see how that saved my life.

I left EMS 16 years ago and completed by degree and began to work on post-graduate education. I got remarried, found a new career, and we have a couple of kids. Unfortunately, when the economy tanked, I lost my job – along with about 40 million other people. I figured that the best way to keep my house and feed my family, was to go back into EMS. So, I got re-licensed and found a job as an ambulance jockey.

It was fun to come back. I really never wanted to leave – and I always missed the challenges of transport – something many fire medics don’t get to do.

But a month ago, I had to take a medical leave. I didn’t hurt myself. I don’t have a medical condition. I am just exhausted. Because I have no seniority, I’ve been working nights. Because we had a house in the country, I’ve been commuting three hours - round-trip. It was killing me, killing my family, and destroying our quality of life.

We decided long ago that we had to move, but because we were now upside down on our mortgage, we couldn’t sell the house. Because our income is 30% less than my previous career, we were barely surviving. We drive very old cars, rarely eat out, and don’t take vacations – other than an occasional camping trip. Although we are not in debt, financially, we are in debt emotionally, physically, and medically.

Many of my younger colleagues are so eager to get the adrenaline rush they don’t see the path they’re on.

For the past few years we avoided house repairs, car maintenance, and medical/dental check ups. The co-pays are too expensive and we didn’t want to go into debt. Our lives are literally falling apart around us.

Being older, wiser, and with a few more trips around the infield, I can see this happening. The sad thing is, many of my coworkers didn’t see the job changing around them. And now they’re trapped. Many of my younger colleagues are so eager to get the adrenaline rush we all used to live on, they don’t see the path they’re on.

Something has to change – at least in the for-profit EMS world.

But even the non-profit sector has some self examination to do. Recently, I applied for a management position at a non-profit, hospital-based system. The crews work 48/96s – and apparently, this is causing some big issues. Safety and crew health are being negatively affected, but without hiring additional personnel, they can’t really change the system.

As a profession, we need to look at the issues, address the problems, and create positive solutions. What good does it do for us to save the whole world, but lose the lives of ourselves and our families?

The other day, a cop friend of mine was talking about some of the things she has seen.  She mentioned how they joke about using the MIB “flashy thing” when they retire – to erase all the things they’ve seen.

The next day, a paramedic friend of mine told me about a horrendous car wreck he responded to when he was still a “wet-behind-the-ears,” 21 year old, newly-minted, paramedic.  These images never leave us.

Over the past three weeks, I’ve been plunged back into the abyss of society’s broken people. The folks I see as a paramedic, are terribly broken, terribly wounded, and terribly lost – in many ways.  Due to HIPAA privacy laws and professional etiquette, I am unable to share great details.  But somehow I want to convey the utter brokenness of people in our midst.  While there are a great number of people who live in stable homes, in stable environments, and who have regular medical issues – there are many whose lives are so far removed from our own, that you may actually believe they are from another world.

People so poor, financially, spiritually, and socially, that they allow people into their homes who are abusing their children – just because they need a caretaker, or a companion.

People so poor, financially, spiritually, and socially, that they allow people into their homes who are abusing their children – just because they need a caretaker, or a companion.  People so broken, that they lay in their own excrement and urine for days on end.  People so broken, that when you first see them, you wonder how they even survive.

Emotionally, these folks are so broken that you see no soul in their eyes.  Physically, they often look 20-30 years older than their actual age.  Spiritually, they are lost.  No longer wandering, no longer seeking – just hopelessly lost.  They have been abandoned by their families, discarded by their friends, and swept aside by society.  They live in the nooks and crannies of our cities – wherever they can find space.

I’m not talking about the homeless tramps downtown, nor am I talking about the mentally ill who wander the streets.  I’m talking about the people who came from relatively normal homes.  But because of physical, emotional, sexual, or spiritual abuse, they have been broken, busted, and discarded.  Nothing short of a miracle could save them now.

As I drove home the other night, my own spirit was overwhelmed by what I’d seen that day. I reflected on the people I’d seen over the past week.  I reflected on people I’d seen over the past month.  They call 9-1-1 for assistance, but they don’t really have an emergency.  They need help, but it isn’t the kind of help a paramedic can offer.  And even though we take them to the emergency department at the nearest hospital, there really isn’t anything they can do either.  A few hours later, these people are discharged and sent home – but they’re just as broken, nothing has changed.

One lady told me she called for a taxi, but because she didn’t have the $10 for the cab fare, the taxi wouldn’t take her to the hospital.  She didn’t need an ambulance, but we don’t refuse people.  So, she called 9-1-1 and within minutes she had three firefighters and two paramedics in her living room.  There was nothing we could do for her, except take her to the hospital.  What she needed was caring family and friends, what she got was an impersonal cadre of emergency responders and a ride to the hospital.  My heart bleeds.

As I drove home the other night, my frustration with our society, for being so damn egocentric, turned to anger.

We saw a lady the other day who, according to one firefighter/paramedic, had been transported by ambulance over 60 times in the last year. She was lying in a heap outside her front door.  She was so mentally exhausted that she could barely get on the stretcher.  We would take her to the hospital, they would evaluate her, and she would be out the door in a few hours – because there was nothing medically wrong with her.  The “system” is not designed to deal with these people.  In fact, there really is no system in place.  They take resources from those who may be having a true medical emergency, they cost the taxpayers millions of dollars, and they cycle through the system over and over again, until they die.

• Is it their fault that they’re broken?  No.
• Is it their responsibility to overcome their brokenness?  Yes.
• Do they know how to overcome their deplorable condition?  No.
• Is it a waste of money to send fire rigs and ambulances to their calls?  Yes.
• Can we stop sending emergency responders?  No.
• Is their a better way? Probably – I just don’t know what it is.

We walked into the middle of a tornado.  Four generations of women living in one desperate home.  The tragedy that was unfolding left everyone in tears.  It was a painful experience to be there – and yet, it was a privilege.  I held their hands, tried to help them make sense of death, looked them in the eye, and did my best to bear some of the weight.

My soul hurts for those who live lives of constant pain.

Later that night, lying on my bed, I wept. My soul hurts for those who live lives of constant pain.  My soul weeps for those who have the means, but not the will to step into these lives, and share the love that has been so freely shared with them.  I wept, because the pain is great.

More than a box of food, or a pile of cash, people need a friend – a genuine neighbor, who cares about them.  Someone who will listen, without judging – or trying to “fix” them.  Someone who will hold their hand when tragedy strikes, and someone who will walk with them, over the rough patches of life.

People need caring without ulterior motives. We need to pass it on to others, no matter how scary that sounds.

How much worse does it have to get?

Something has changed in the last 30 years, and I’ve been trying to put my finger on it.  My first experiences in emergency services were with organizations that truly sought to help people in need.  Whether working for a government agency, or a for-profit ambulance company, there seemed to be a push to help people.

Things are different now.

Some of my co-workers will say outright that EMS should not be provided by for-profit agencies.  I’m not in full agreement with that.  Most healthcare in the US is provided by for-profit agencies.  Physicians, Chiropractors, Dentists, Hospitals – all of these seek to make a profit by caring for people’s medical and health needs.  Even some non-profit hospitals have really good cash flow.

Many of my coworkers see their private ambulance employment as merely a stepping stone towards a full-time career with a public agency.  As a veteran, who has worked for public, private, and non-profit, hospital-based EMS agencies, I encourage many of my younger coworkers to find a more solid career path.  Private ambulance paramedics earn fraction of their public agency colleagues.  The benefits, health insurance, and retirement packages are nowhere near what fire service paramedics make.  And yet they work just as hard, and have the same amount of training and license requirements.

Several of my coworkers are pursuing a nursing career.  Though paramedics have a broader scope of practice and the same level of education, we are paid about half of what an RN makes.  And, like the illustration above, the benefits, healthcare insurance, and retirement package pales to that of nurses.  Should a paramedic have to become a nurse, in order to have less responsibility, yet a better quality of life?

Research has shown that paramedics are one of the most respected of all career fields.  People usually look at me in amazement when discovering they’ve met a real paramedic.  Their praise flows freely.  A lady the other day said something to the effect that I must be “really smart” to do this job.  I laughed and brushed it off with some self-depreciating humor.  I’m certain she would be fascinated to learn that I can barely keep my family afloat on the wages I make.

“It’s natural, EMS is still in its infancy”

I’m certain people have no idea how similar the nursing and paramedic jobs are – yet how much disparity exists in our wage and benefits packages.  I know that people have a very high regard for fire agency paramedics, and rightfully so – they are all well-trained, highly motivated individuals, working for great organizations.  But I bet they don’t know that we actually are grossly underpaid, compared to what those firemedics earn.

It’s natural, EMS is still in its infancy.  Less than 50 years old, we don’t have longevity and history of the other helping professions.  Nurses came into their own during the Civil War; Police agencies have been operating for centuries; and modern firefighting was an invention of Benjamin Franklin.  Relatively speaking, the EMS professions are a mere blip on the timeline of history.  It’s no wonder that a whole generation of people still think of us as mere ambulance drivers.  When they were kids, there was no such thing as a paramedic – there were only ambulance drivers.

Many of us had high hopes in the early days of EMS.  We believed we would rise up and be recognized as medical professionals – treated with the same respect as our counterparts.  Unfortunately, it looks like we’ve fallen to the technician level.  Very interesting.

“In other words, it’s complex and will take time to evolve…”

My coworkers, and our local union, are currently embroiled in collective bargaining negotiations.  There has been a strike authorization vote, and things could get interesting in the next few weeks.  In this economy, and this stage in the development of EMS as a profession, I’m not sure we are ready to see the breakthroughs we need to have a decent standard of living.  I believe there are three four five things standing in our way:

• Public Perception.  I’m certain the general public has no idea what we do, how much education we have, and how dedicated we are to making a difference in the lives of our patients.

This is, in my opinion, the single greatest impediment to change within EMS.  The fire service has done an amazing job of helping the public understand their role and place in society.  Our employers, Unions, and professional organizations are making some progress in this arena, but much more remains to be accomplished.

• Lack of Professionalism.  While some of my colleagues are striving to be more than just employees, the bigger picture eludes others.  Until we go above and beyond what is asked of us – collectively, we will never achieve the respect we deserve from other medical providers.

Advanced education is one of the single biggest ways we can  improve our professional image.  In Oregon paramedics are now required to have at least an AS degree, and a few have Bachelor degrees – however, even without the requirement, more of us need to strive for post-graduate degrees and pushing forward – even when there is no pay or benefits associated with this advanced education.

In addition, we need to develop a learning culture – where we are reading books, gathering in discussion groups, and looking for creative ways to advance ourselves personally, professionally, and as a group.

• Supply & Demand.  Currently there are more paramedics and EMTs looking for work than there are jobs available.

There is nothing inherently wrong with having too many aspiring paramedics.  However, we may need a better screening process to help channel the right people into the career path, and help those who would not be a good fit to avoid going down the wrong road.

In addition, as the professional standards improve, the costs (monetary, personal, and academic), will be self-selecting and recruitment factors will drive wages and benefits upwards.

• The Economy.  With zero job growth last month, a looming federal deficit, and rampant unemployment – our employers are just not able to make drastic fiscal changes in their business model.

Where do I start?  I think I’ll leave this issue alone.

• Passion for Caring. In many ways, EMS has lost it’s vision.  Due to the pressures of the economy, the desire to actually make a profit, and the consolidation of the industry into two primary, for-profit competitors, we have lost our passion to actually make a difference in the lives of the people we care for.

If our employers are not going to supply the passion, the employees need to take the high road, by going above and beyond what is required of us – even if our wages and benefits are not up to par.

In other words, it’s complex and will take time to evolve…

Image by lumaxart via Flickr

It’s easy to complain about stuff.  In fact, without trying to hard, you can find something wrong with almost everything.  So, when one stops to think about it, complaining doesn’t take much skill, art, or imagination.  And yet, everyone seems to want to outdo everyone else in their powers of complaint.  Why is this?  What is it about our culture that makes complaining so ubiquitous?  What is it about our lives that make us unable to appreciate the good and instead focus on the negative?

If you are reading this, most likely you live in the United States – the most prosperous and richest nation in the world.  According to some researchers, even the poorest Americans are richer than 99% of the world’s population.  Yet, we still grumble, bitch, and moan.

We attribute our lack of happiness to our employers, our spouses, or our government. We seem to think that if we made more money, had a better job, or had lower taxes, our lives would suddenly become pristine journey’s of joy.  I don’t believe this is true however.  I don’t think higher wages, a better boss, or the perfect government is going to solve your problems.  Indeed, the issues of happiness probably go much deeper than this – and I’m not going to try to address them here.  However, I would like to propose one simple idea that we can all employ to better our home, work, and social lives.

It seems as if the younger medics have the highest level of resentment.

The other day we responded to multiple calls that really did not require Code-3 ALS response.  You know the drill: complain on the way to the call, treat the patient with disdain and contempt, and then ritually disembowel the system that sends highly trained, super-important paramedics like us to take care of low-life system abusers like these.  Grumble, grumble…. and then we all join in on the chorus.  It’s a well rehearsed and popular song and dance – performed in EDs, fire stations, police cruisers, and ambulances across the country.

It seems as if the younger medics have the highest level of resentment.  Somehow they thought the job would involve more lifesaving and less social work.  Their expectations of adrenaline highs and heroic accolades were overblown, and now, the resentment is overwhelming.  Older medics have either become cranky and cynical, or have resigned themselves to the grind of trudging forward until retirement.  Either way, it seems as if for many, the joy of the journey has been lost.

Occasionally we meet people who are a breath of fresh air.  They are a pleasure to be around, a pleasure to work with, and seem to find pleasure in their jobs.  What is it about these folks that makes them so, um, pleasurable?

For many, they have learned to not sweat the small stuff.  For others, they have learned to accept the things they cannot change, and the courage to change the things they can.  Still others have learned to be the change they expect in others.

You must be the change you wish to see in the world.”  ~Mahatma Gandhi

Do you want your place of work to be more fun?  Then start the revolution?  Do you want your spouse to be more joyful?  Try creating that joy within your own life first.  Would you like having more discretionary spending cash?  Take charge of your finances and use better discretion.  Would you like your patients to be less abusive and to better respect the system?  Why not respect them and have more compassion for circumstances  you would never understand.  Would you like other healthcare providers to treat you with the respect you deserve?  You’re going to have to earn it.

It’s time for EMS Professionals to step up and lead by example.  It’s time for us to be the lifesavers we can be.  It’s time for us to step up and be respectable.  Don’t wait for your employer, your spouse, your patients, or your coworkers – take the lead.  Show others how it can be done.

• Be the change you want to see in others.

• Be the example you want your employer to show.

• Be the example you want your patients to exhibit.

How wonderful it is that nobody need wait a single moment before starting to improve the world.” ~Anne Frank

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As I walked into the bedroom, it looked like there was more drama than necessary – more than I cared to deal with on this laconic Thanksgiving Day.  Our 55-year-old female patient was sitting on the floor, propped against her bed.  She was breathing fast and her CO2 levels were down – it looked like an anxiety attack, so I squatted down and tried to convince/coach her to slow her breathing down.  But something didn’t look right.

She was trying to cooperate with me, but there was no way her breathing was slowing down.  It was fast, about 40 respirations a minute, and deep.  Her eyes were closed and I discovered she had some chest pain – which she was unable to describe.  In fact, all of her concentration went into her breathing and I, as with the other medics in the room, were just a distraction.

It was at this point that I got very concerned.

As I tried to attach the electrodes to get a 12-Lead, I discovered she was very wet, very cool, and very pale. It was at this point that I got very concerned.  I could barely get the electrodes to stick to her skin – the 12-Lead was inconclusive, but no obvious STEMI.  Her BP was only about 80/40, HR was 120, PaO2 was 90%, and her CO2 was only 5.

The IV was in place, and something was seriously wrong.  ”Let’s get going!”  I said to my teammates.  They agreed.

As we moved her to the gurney, her eyes rolled back into her head, deviated to the left, and her pupils got huge.  Her arms briefly went decorticate – she stopped responding, stopped breathing, and went flaccid.  Oh, and she didn’t have a pulse.

“Let’s get going!”  I said to my teammates.  They agreed.

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We started CPR and bagged her.  She had a bradycardic rhythm of 30, so we paced her and got pulses back.  Her pressure came up to 90, but her pupils remained fixed and dilated.  It was just a short trip to the local ED – and upon arrival, she would occasionally lose pulses.  After about 20 minutes, they had a viable rhythm, with pulses – but that was only after lots of epi and lots of dopamine.

In retrospect, I saw it in her eyes. She knew she was dying – but she wasn’t verbalizing it.  Her eyes however told me she was scared – very scared.  She was trying to tell me she was going to die.  She was right.

I ran a similar call about three months ago. The man was 40 and living on the streets.  He’d been having chest pain for about three days, and finally he called 911.  At first we thought he was just a wet, cold homeless man – about 40 years old – wanting to get out of the rain.  But as we loaded him onto the stretcher, it became apparent that he was in real distress.

He was complaining of classic Triple-A pain and his skin was cool, wet, and pale.  Over and over he said, “I feel like I’m dying!  I feel like I’m dying!“

The 12-Lead showed a definite STEMI and we began our Code-3 transport to the local ED – which was only five minutes away.  As I transmitted the 12-Lead, our patient coded.  His internal pacer was producing a rhythm, but he had no pulses.  He was right – he was dying.

It’s one thing to arrive on scene and our patient is already in full arrest, it’s quite another to establish a relationship with them – no matter how brief – and then have them code. Both of these calls affected me to the core.  Both of them told me they were dying – and both of them did.  There was nothing I, or anyone else could do, to reverse this process.  Sometimes death is what it is – an end of life.

Yesterday’s call reminded me of an old Far Side cartoon.  A caveman is lying on the ground with an obvious fractured leg.  Two other cavemen are standing over him, one is wearing a white lab coat.  The one wearing a lab coat says: “I’m sorry Thor, medical science hasn’t advanced to the point where we know how to cure broken legs.”

I wonder how much more we can learn about saving those who experience sudden death like my patients above. Will we be able to treat aneurysms (aortic or brain)  in the field?  Will we be able to reverse the effects of STEMI? Will we be able to save patients who have experienced severe blunt-force trauma?  I don’t know, but it sure would be nice.

When I first started in EMS, the save rate for prehospital cardiac arrest was only 3-5%.  Now it is up to 25% in some areas.  I wonder if we’ll ever approach 50% in our lifetimes?  It sure would be nice, wouldn’t it?  What other areas do you see us making major gains in?  Where else do we have room for improvement?

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In the old days, we would have quarters to retreat to and many distractions from one-on-one interaction. Whether it be chores, fire inspections, drills and training, or just TV – at least one wasn’t forced to interact with their partner all day.  Times have changed and employers are getting more calls out of their medics through that great invention of System Status Management.  Consequently, we spend our entire shift locked in a cage and chained at the hip to our partners.  Depending on the situation, this can be a good thing, or a bad thing.

Assuming you draw a good partner, a friendship usually unfolds and going to work can  be quite pleasant.  However, given the opposite situation, this doesn’t always work out so well.  How does one deal with endless minutes, hours, and shifts with the partner from Hell?  Dismiss the fact that we all have bad days, and overlooking some minor personality defects – which we all possess, what do we do with people who are just plain hard to be around?

Over the years, I’ve used multiple techniques.  Here are a few:

• Brute Force and Awkwardness.  As a young, testosterone-driven paramedic, I used my size, my mental acuity, and sheer brazen attitude to overpower others.   Back in the day, it was my way or the highway.

• Passive Aggressive Sulking.  Being a good student of my own parents’ codependency, I learned at a very young age to withdraw into my own world when I didn’t get my own way.  I guess you could say that often I was that “grumpy partner.”

• Avoidance.  Like I said in the intro, due to the fact that we had quarters, I was able to hide out in the bathroom, watch TV, take a nap, read, or work on hobbies.  The only time I saw my partner was when we ran calls.   This worked well.

• Bribery.  Food and treats are the universal language.  Buying ice cream every shift seemed to soothe the savage beasts.

• Transfer Request.  Eventually one has to acknowledge the lost cause and move on.

But times have changed and drastic situations call for drastic actions.

But times have changed and drastic situations call for drastic actions.  How does one handle a grumpy (angry, sad, depressed, unstable, [insert adjective here]) partner, when there are very few external solutions?  What do you do when you have no quarters?  What if your partner doesn’t eat ice cream, or like Starbucks, what now?  What if company policy, or company size, doesn’t afford frequent transfers?  What are you going to do?

How do you handle a grumpy partner?—
Johnny Gage (@johnnygage51) November 21, 2010

I asked this question on Twitter recently, but I really didn’t like any of the answers that came back.  Most suggested I avoid the dilemma.  But I didn’t get to be a good paramedic by avoiding other people’s problems.  (eg; “I’m sorry you’re having suicidal ideations sir, but I can’t be bothered with your issues – I have my own problems.  Besides, I’m afraid I might get sucked into your chaos.“)  No, for me, avoiding conflict is the first step in breaking a relationship – when in reality, conflict dealt with well, is the first step in a lasting and solid relationship.

The question you may be asking me is “why should I bother?”

We are professionals, and we have training in mental health issues.  In fact, many of our patients have more baggage than the average grumpy medic.  We shouldn’t be anymore afraid to deal with our grumpy partner, than we are to RSI someone who is soon to crash from respiratory failure.  Here are some tips to consider before you ever start:

• First consider your motives.  Is this for you, for your partner, for the agency, or for your patients?  If it’s all about you, I would suggest you rethink your frustration.  Maybe you’re half the problem.  Are you just being selfish?  Do you want everything to go your way all the time?  Maybe you just want a partner who conforms and enables your own codependent patterns.  However, if you think your partner’s attitude is affecting patient care, their own lives, or is detrimental to the agency or EMS profession, it wouldn’t hurt to explore why this person is grumpy.

• Two, timing is everything.  Don’t react to poor behavior or attitudes.  Don’t react on scene, in a hospital, in a public place, or in front of others.  Don’t react at all – absorb and plan a strategy.  Wait for the right timing.  Maybe this is best handled off-duty – invite your partner out to breakfast, or a cup of coffee.

• Seek first to understand, then to be understood.  Ask questions, listen, seek to discover why they are grumpy.  Often, if you listen, you will hear why before you ever start asking.  Maybe they are struggling financially, or with their significant other.  It could be they are upset with changes in EMS regarding call volume, system utilization, or the increase in BS BLS calls.  Seek to understand what is going on.  If it is deep baggage, like childhood abuse, poor parenting, drug and/or alcohol abuse, career burnout, or marital strife, you should direct them to professional services – like your agency’s EAP.

• Develop an attitude of empathy.  Understanding why another is struggling will enable us to overlook some of their issues.  Someone who is going through a relationship breakup may be unhappy for a while.  It’s good to give them some space to process that.

• Draw the line at unacceptable behaviors. Drug and alcohol abuse are never acceptable.  If your partner is showing signs of addiction, you need to do whatever is necessary to get them some help – and protect your patients.  It is OK to tell your partner that you will not tolerate emotional outbursts, violent behavior, overly aggressive C-3 driving, or other unacceptable behaviors.  If they don’t respond to your request, talk to your superiors.

• Don’t give advice without permission. Generally talking through the issues will release your partner to open up and share.  That process alone will reveal your attitude of concern.  As you share similar life events, from your own story, your partner will most likely learn to trust you and respect your relationship.  If they give you permission, you can offer a few words of advice – but be careful and don’t go too far.  Limit your advice to one or two bullet points.

• Praise and affirmation.  Don’t be critical of your partner.  We are all just trying to survive the issues thrown our way.  More criticism, especially if they’re going through a rough spot, won’t help.  Finding ways to affirm your partner (and other co-workers, for that matter) will go a long ways to helping them over the barriers of personal growth.

• Know when to walk away. It’s OK to walk away from a relationship that is damaging and hurtful.  If your partner is unwilling to grow, unwilling to leave grumpiness behind, or unwilling to seek solutions to their brokenness, then seek out a new partner and start over.  It is also OK to report illegal and abusive behavior to your superiors.

Years ago, early in my EMS career, I was going through a divorce.  I was depressed, angry, lonely, and broken.  I wasn’t sleeping well and would often walk around in a haze at the fire station.  Most crew members ignored me, but one of the firefighters seemed to think bullying me would get me to change.  Not only didn’t it help, but it almost drove me off the edge of sanity – due to my anger towards him.

At first I ignored him.  But as we continued to work together, his story began to reveal itself.

Once I worked with someone who was showing classic signs of career burnout.  He complained about every new policy, every request made by dispatch, and every patient who wasn’t in critical condition.  He denigrated those living on public assistance, management, and uncooperative ED staff.  He complained about the government, other drivers, and his marriage.  I never heard a positive word come out of his mouth.

At first I ignored him.  But as we continued to work together, his story began to reveal itself.  In turn, I shared my story – the ups, and the downs; the good, the bad, and the ugly.  Our relationship grew, but his grumpiness persisted.  After several months of working together, we were becoming good friends.  But I knew I had to deal with the grumpiness.  I didn’t want to – but for his sake, for his family’s sake, for the sake of his patients, and for the sake of his career – I knew I had to deal with this.

So, knowing my motives were more about him, I waited for some serious down time – posted at the corner of “Walk” and “Don’t Walk” for several hours, gives partners time to talk.  I began asking questions, seeking first to understand.  Within minutes, he began to talk, share, and self-analyze.  All I had to do for the next two hours was listen – actively; and reflect.  It was one of the best shifts I’ve had in ages – and our partnership is stronger than ever.

As we continued to work together, my partner grew and flourished

As we continued to work together, my partner grew and flourished.  In fact, he became one of the most positive medics at our agency.  He became a real leader and an inspiration to others.  It will be exciting to see where he takes the future!

The bottom line, and the question you may be asking me – if you’re still reading – is why should I bother? That’s a good question.  I have two reasons.  First, being a paramedic is a lifesaver’s job.  Why not save the life of those closest to you first – like your partner, other coworkers, or even your family?  Second, helping your partner to work through their stuff will help you have a more enjoyable workplace.  I mean – really – do you want to work with a grumpy partner?

I ran my first EMS call in the early 70s.  I’ve been involved in this profession since I was a teenage, snot-nosed, kid.  Those early days of EMS were incredible.  CPR, Hurst Tools, Advanced Life Support, and even the 9-1-1 system brought radical life-saving to the prehospital setting.  But now I have to ask, what have you done for me lately?

When I left EMS, to pursue other dreams, in 1995, some great things were happening.  We were working to raise the standard of care by requiring paramedics to have a college degree.  We were increasing the scope of practice to include RSI, 12-Lead EKGs, and a host of other procedures and medications.  Indeed, the advent of the modern trauma systems brought great changes to the way we dealt with injured patients. But some of the biggest changes were occurring in the political spectrum.

Municipalities and agencies were developing administrative rules, ordinances, and laws that would eliminate duplication of services, streamline provision of care, and assure cost-effective, high-quality ALS treatment and transport to those who most needed us.  Unfortunately, we’ve stopped moving forward.  All these ideas that were so great in the 80s, were finally passed in the late 90s, but we have failed to move into the 21st Century.  EMS is stuck in the 80s.

Don’t get me wrong, I loved the 80s – but it’s time to catch up to the times and technologies available in this century.

For instance, the mapping and communications on my phone are far better than what I’ve witnessed in most emergency response vehicles.  The triage afforded my the standard EMD protocols is not getting the right resources to the right calls in the right time.  Requiring ambulances to arrive to all Code-3 calls within a six, eight, or ten-minute window is not just unsophisticated, it is dangerous.  Also, sending multiple paramedics, from multiple agencies, to all calls is crazy.  Not only is there a breakdown of scene-management, but it causes our patients unnecessary stress.  In addition, we need to stop transporting everyone who calls 9-1-1.

Here are some ideas for us to consider as we move into the second decade of the 21st Century – and as we approach the 40th anniversary of the Paramedic Program:

• First, we need to better triage the incoming 9-1-1 calls. People don’t need a fire and ambulance crew on every call, but more importantly, less than 50% of these incidents require a Code-3 response.
• Second, it is not cost-effective, practical, or safe to require an arbitrary dispatch to arrival window.  We need better data, deeper analysis, and a more nuanced system of measuring our EMS delivery systems.
• Third, we need to find a way to eliminate the duplication of services that is prevalent in so many regions.  While there are times it is good to have a lot of medics on scene, and there are definitely times you want the closest units to get their quickly, we aren’t utilizing our equipment and personnel wisely.  This needs to be streamlined.
• Finally, we really need to find a better way to treat, and release, patients who are experiencing minor trauma or medical issues.  There is really no reason for us to be transporting everyone who calls 9-1-1.  Paramedics are perfectly capable of treating, arranging alternative transportation services, or connecting people to appropriate social services.

What do you think?  Is it time for us to move forward?  What are some of your ideas?

By the way, if you haven’t connected already, you need to check out EMS 2.0.  Things are starting to happen, and I’m pretty excited by the potential.  Join the conversation!

The first kid I saw that had been backed over was in a retail parking lot. His mom had run into the store really quick and the kids took the opportunity to get into mischief. First the three-year-old boy got out of the car, then, coincidentally, his older sister took the car out of gear. Upon our arrival, we found the boy lying in the parking lot, crying. As I bent down to assess him, he began projectile vomiting – which is a terrible sign for someone with a head injury.

We quickly packaged and transported him to the closest trauma center. I never did hear whether he survived, but I sometimes think of the guilt the mother and sister must feel for that incident.

I was working on the helicopter the last time I treated a kid who’d been backed over by the family car. This was a four year-old boy in a nearby rural community. We landed the helicopter in the middle of a residential intersection, about 40 yards from the incident. Firefighters and paramedics were already treating the boy.

Like many emergency scenes in rural communities, everyone seemed to know each other – plus, there was a lot of chaos. CPR was being performed, but there was no IV access and he had not yet been immobilized. I inserted an intraosseous needle into his lower leg while the flight nurse, intubated the boy. We moved him to a backboard and then into the helicopter.

On this particular, warm Summer day, we were in our older helicopter, the BO-105 – which is an amazing machine, but a lot smaller than most EMS helicopters today. Because of its size, it’s impossible to take along extra personnel, and makes it more difficult to work on critical patients. This means we had to work together as a team, to cooperatively take care of this boy – who was most likely not going to survive.

At one point I found myself doing chest compressions with one hand, and squeezing the bag-valve device that was breathing for him. To do this, I had removed my safety harness and was up on my knees. I took a quick glance out the window, to see where we were, and discovered the helicopter was actually making a sharp turn.

Looking out the side window, I was looking right at the ground – 800 feet below me. And I was leaning against the door – without my safety harness fastened. In the midst of trying to save this boy, I had a quick vision of the flimsy aircraft door popping open and me falling to my death. I didn’t like that scenario. But fortunately our pilot was so good that our g-forces were towards the floor of the helicopter, not sideways!

That’s what it’s like to work here…

As I continued to do CPR on this boy, the flight nurse was preparing to give him blood. She plugged it into the IO and pressurized the bag. Unfortunately, the tubing popped off of the connector and blood began to spurt all around – mostly all over me.

We landed at trauma center and delivered this pulseless boy to the team. If he had survived, he’d be 24 this year.

I gathered our gear and proceeded to our fifth-floor office to clean the equipment and myself. Both the flight RN and I were exhausted, dejected, and sad. No one likes to lose a patient, especially a child.  We worked hard to save this kid.

Meanwhile, my colleagues were interviewing potential new flight paramedics upstairs. As I was walking down the hall, the interview team asked the interviewee if he had any questions. He asked what it was like to work in air medicine. The interview team saw me outside the office and called me in. I had no idea what was going on.

In I stepped, my uniform shirt was covered in blood and blood was dripping from the MAST suit that we used to try to control our child patient’s shock. I had blood on my sunglasses, in my hair, and on my face. I stood in the office with a dazed look – and five faces looked back at me with equally morbid looks. I turned and left.

As I walked down the hallway, I heard them telling this potential flight medic, “That’s what it’s like to work here.”