Legacy

I ran my first EMS call in 1974 as an explorer scout. When we arrived on the scene of the car crash, the lead paramedic handed me three flares and told me to set them up down around the corner. When I walked down there, it was dark and I had no idea how to light the flares. I tried everything to get them lit, but I didn’t have a flashlight, there was no light, and I’d never lit a flare before. My biggest fear wasn’t approaching traffic, my biggest fear was not looking stupid. So, of course, I didn’t walk back and ask for help, I just figured it out and got them lit.

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

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Time to Make Some Changes?

Years ago we enacted legislation to protect our patients, improve professionalism, and improve the standards of care. I’m old enough to remember the shoddy ambulance practices that existed here in Portland. We had the best of intentions – we wanted to get rid of those funeral home operators who were only trying to squeeze a little more profit out of their vehicles. We wanted people to get the best of care. We wanted to stop the crazy madness of call jumping, fist fights over patients, and scoop and run transport – without any standards.

[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.

Killing Us Softly

It’s no secret that sleep deprivation is a killer. Too little sleep is linked with depression, obesity, diabetes, and heart disease. We are lifesavers, but we are killing ourselves while we save others. Whether working in a system that requires overtime, working overtime to make up for low pay, or working in a busy system that requires 24, 48, or longer shifts – your life is ebbing away.

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?

Tears in Rain

I’ve seen things you people wouldn’t understand.  I have images burned into my brain – that have wounded and scarred me to the core of my being.  I’ve seen things that no caring person should ever have to see.

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.

Sometimes I Drive the Ambulance (but I’m not an ambulance driver)

Paramedics and EMTs were drawn to EMS for various reasons.  Obviously there is the excitement, the variety, and the opportunities to help people.  EMS workers are usually lumped in with the other helping professions: Physicians, Nurses, Firefighters, and even Police Officers.  In fact, when you talk to any of these folks, you’ll find the overwhelming majority are motivated to help people.

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.

Ductus Exemplo!

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.

I’m Going to Die

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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.

How to Deal with a Grumpy Partner

Image via Wikipedia

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?

The Next Step: EMS 2.0

We can’t keep doing things the way we’ve always done them, or we’ll keep getting the same results over and over again.  That’s called insanity.  We have to keep moving forward.

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?

This is What it’s Like

Three times in my career, I’ve treated small children who were accidentally backed over by the family car. These kids are so small, so mobile, and very quick – in a heartbeat they are where they shouldn’t be.   It’s made me very cautious when backing my car around my kids. Usually, I just bring them into the car with me – that way I know where they are.

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.