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The Ambulance Driver's Perspective
by Kelly Grayson

Joining EMS? Here's what you're really getting into...

It may not be the highest paying of professions, but you’ll be rewarded in other ways

Recently, I was asked by a colleague to write an introduction letter for her EMT class. I had read David Givot's excellent commencement speech for paramedic graduates, and I thought long and hard about what I wish someone had said to me on my first day of EMT class, before I even embarked on this career path. This is my answer.

Welcome to the profession whose entry-level practitioners — you, in a few months — rank 4th from the bottom in the Bureau of Labor Statistics salary rankings. The only people paid less than you are pre-school teachers, dishwashers and meatpackers. The guy riding on the back of the garbage truck, or holding a sign at a highway construction zone, makes more money than your EMT instructor. Likely, a lot more.

And none of those people are required to make life-or-death decisions. You will.

It is a profession where the line-of-duty death rate is comparable to firefighters and police officers. For those of you who aspire to flight paramedic status, that particular niche is by far the most dangerous profession in America — ahead of loggers, miners, and Alaska crab fisherman.

It is a profession whose divorce, suicide and substance abuse rates soar far higher than the general population. The average career expectancy of an EMT is five years.

Five years.

Some of you will go on to jobs in nursing or other healthcare fields. Those of you that don't move on to nursing or PA school will leave EMS with a career-ending back injury, or leave EMS healthy but not whole; jaded and cynical, your idealism burned away in the furnace-like reality of our profession, your faith in the innate goodness of man gone like so much ash and smoke up the chimney.

You'll be disrespected
You will be disrespected by patients and bystanders who don't know any better, and belittled by doctors and nurses who should. And many of you will endure the abuse for free labor, donating your services as volunteers.

So why do I tell you this? Well, they call it informed consent, a concept you'll learn about in the first few chapters of that EMT textbook you're carrying. Before you agree to the abuse you're about to suffer, it's only fair that you know what you're getting into.

And it's not what you think.

You will sift through broken glass and twisted metal, wade through urine and feces and vomit, weather heaping torrents of verbal abuse from the people you're trying to help, all for the prospect of a few dollars on payday, and perhaps…just perhaps…a show of gratitude now and again.

I'm here to tell you that what you've been promised is a lie, if only a little white one. When you're green and idealistic, the romance and thrill of EMS is powerful. All of us were adrenaline junkies at some point. Plus, there's a decent chance it might even get you laid. What's not to like?

You won't save that many lives
But you will soon discover the hidden truth, the one that drives most people out of our profession:

We don't save that many lives.

Lifesaving may be what we train for, but the opportunity to actually save someone comes all too rarely, and when it does present itself, the outcome depends more upon luck and timing than our skills. In my career, I've had my share of code saves. Some of them even made it out of the hospital alive. Others hung on just long enough for their families to tell them goodbye. I've made the critical diagnosis, gotten the tough airway, turned around the crashing asthmatic, and stabilized the shocky gangbanger with multiple unnatural holes in his person. I've needled chests, paced, defibrillated, and cardioverted, and given countless drugs.

But, other than a handful of exceptions, I can't state with any certainty that my actions were the difference between life and death. In that handful of exceptions, all but one or two were saved simply by applying the techniques that any John Q. Citizen with a basic first aid course could have done. Ask your instructor if you don't believe it's true. They'll tell you the same thing.

The reality of the profession
The reality of your profession isn't exciting rescues and cardiac arrest resuscitations twice a shift. Your reality will be dialysis transfers and people who can't poop. It will be toothaches at 3:00 am, and you'll have to maneuver your stretcher around five parked cars to get to the front door, and weave your way through five able-bodied drivers to get to the patient with a complaint so minor you can't believe they called 911 for it.

So why, if you're not going to save all that many lives, should you even bother?

You should bother because EMS is a calling. Even when you leave EMS, it never really leaves you. It's what Henry David Thoreau meant when he said, "Do what you love. Know your own bone; gnaw at it, bury it, unearth it, and gnaw it still."

You should bother because, even if we're not saving lives, what we do matters. It matters in ways unnoticed by us, to people you may not even remember tomorrow.

You should bother, because EMTs are privileged to play in life's great game. Too many unlucky people watch the action thunder by, stuck at a desk, or watching it on television at home.

You should bother, because it's the little things that matter. Most of your patients are ignorant of your skills. Few of them understand the technology you wielded so expertly. But they'll remember the smile you gave them, or the way you tucked the blanket in to ward away winter's chill, or the way you stood in the rain, getting drenched as you held the umbrella over them as your partner loaded them in the rig. They'll remember calm competence, and gentle speech.

They'll remember the joke you made to lighten the tension. They'll remember those things and more, and they'll remember your face long after you've forgotten theirs.

You'll be remembered
They'll remember you because, even though they were just another call to you, you were a major player in a defining event in their lives. They'll come up to you, years after the fact, and say, "I remember you. You take care of me when I had my heart attack."

And likely all you did was apply oxygen and take them to the hospital. Maybe you helped them with another dose of nitro or encouraged them to take an aspirin — really nothing they couldn't have done themselves. But you're the one they remembered, and you're the one they thanked.

You should bother, because in the tapestry of human existence, you get to contribute your own unique stitch. You get to make your mark in ways that cannot be quantified on a spreadsheet or a profit and loss statement. Not everyone gets to touch the life of another, but EMTs do.

You should bother, because when people are at their most vulnerable, they will invite you into their homes and tell you things they won't even tell their priest. And they'll expect you to make it better somehow. I'm not sure you understand now how profound an honor that is, but hopefully one day you will.

The question is, can you be worthy of that honor?

If you think so, then welcome to EMS. Do us proud.

About the author

Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (, or email him at

The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Eli Eaton Eli Eaton Saturday, May 24, 2014 8:02:12 AM So true, logically why would any one do this job.
Erika Laucirica Erika Laucirica Saturday, May 24, 2014 8:05:00 AM Wow, this is amazing.
Jill M Susie Jill M Susie Saturday, May 24, 2014 8:06:57 AM OMG! So true
David Boykin David Boykin Saturday, May 24, 2014 8:27:48 AM Hopefully with your permission I can use this in my EMT class. With proper credit to you.
Debbie Brown Debbie Brown Saturday, May 24, 2014 8:33:45 AM Fantastic. So well written.
Charlotte Gibson Brown Charlotte Gibson Brown Saturday, May 24, 2014 8:37:06 AM It is a calling, but it is also a gift: to help others in need, albeit often w/out recognition by the patient or others, takes a special person. Many may think they have it, but then discover they don't. I applaud all of you who stick it out, and find that the good outweighs the bad. God bless you all.
John Smiley John Smiley Saturday, May 24, 2014 8:52:43 AM Excellent article
Keith Regan Keith Regan Saturday, May 24, 2014 9:08:50 AM So true even here in the UK
Darlene Hughes Darlene Hughes Saturday, May 24, 2014 9:29:22 AM Boy if this didn't hit the nail on the head! Proud to have served the public 33 yrs and still counting ! Counting!
George Beltz George Beltz Saturday, May 24, 2014 9:47:15 AM This is a not just a job, it is a calling to help people in need. When I was in my basic class our instructor told us that we would be bored about 90% of the time but that other 10% we would make a difference. They also said that while it may not be an emergency to you, to the patient it it is. When I was certified as a basic, yes, I was an adrenaline junkie for the first few months. Now I look forward to each call, I may not be saving a life when they are needing a transport for that minor issue, but, I can help calm their fear.
Bruce A Mills Bruce A Mills Saturday, May 24, 2014 9:48:06 AM Can't argue with the truth . Noble Peace Prize worthy.
Skip Kirkwood Skip Kirkwood Saturday, May 24, 2014 10:11:42 AM I like it, except for the first paragraph. The salaries that Kelly describes are simply not the case everywhere. There are plenty of EMS organizations where folks get paid a living wage. It's like real estate - location, location, location.
John McKay John McKay Saturday, May 24, 2014 10:26:27 AM So very true. And is IS a calling, in every sense of the word.
Roland Blanchard Roland Blanchard Saturday, May 24, 2014 10:42:58 AM EMS. She is an intoxicating, abusive mistress with no sense of loyalty. She will beat, bruise, and berate; and some of us will embrace her for it all the more so.
David Shrader David Shrader Saturday, May 24, 2014 11:09:58 AM There are lots of rewarding calls. One that stand out to me was a vaginal bleed following a miscarriage. The doc told the husband on the phone that the chance of his wife' surviving was slim. Standard procedures and pitocin gave here a chance. A few seeks later she and her husband came to the Fire Station with a plate of cookies. The husband gave me a hug and broke down crying. All he could manage was to say, "thank you for giving me my wife back." Many other successes occupy a special place in my heart, but that guy still gets to me.
Ed Hillenbrand Ed Hillenbrand Saturday, May 24, 2014 11:26:19 AM Some of this is very similar to the article I wrote for the Times-Journal for EMS Week.
Mike Haas Mike Haas Saturday, May 24, 2014 11:28:49 AM Averaged for EMS only, not Firefighter/EMT - it's pretty low. add to that the public and private institutions who turn a blind eye to how many hours part-timers are working to survive...
John Boissonneau John Boissonneau Saturday, May 24, 2014 1:00:48 PM Yeah, right.
Skip Kirkwood Skip Kirkwood Saturday, May 24, 2014 2:52:14 PM Mike Haas - at least in this area, starting paramedic, starting LEO and starting FF are about the same. In some cases, starting paramedic is even better, with a better schedule.
Sandy Hill Treadway Sandy Hill Treadway Saturday, May 24, 2014 3:03:07 PM Where would that be Skip Kirkwood? We would like to consider a move there, because it is certainly not where I live. EMT $9.00, Paramedic $13.00
Skip Kirkwood Skip Kirkwood Saturday, May 24, 2014 3:52:46 PM Sandy Hill Treadway - North Carolina. Almost all 911 service is provided by county government. Brand new paramedic (no experience) in my county (Durham) starts at 34,200. Full county benefits, 5% 401k, vacation, sick leave, health insurance, etc. EMTs not so much, but everybody is ALS service, so EMTs are expected to become medics pretty soon. Most counties are pretty comparable to this.
Matt Leicester Matt Leicester Saturday, May 24, 2014 6:24:54 PM I also disagree with the premise that we don't save a lot of lives. Sure, we don't resuscitate dozens of people, but as the author mentioned, we have crashing asthmatics, diabetic shock, STEMI's which are correctly diagnosed, treated, and transported to appropriate facilities. Do we not save those lives? If those of us in the business, including those who teach, aren't aware enough of the good that we do to advocate for that, then we aren't starting these new EMT's off well. When the only defense we have of our jobs and the value of it, is to use code save statistics, we are failing to provide the justification and explanation of who we are and what we do, both to our public and our elected officials. I have saved countless lives, not just those who were resuscitated.
Matt Leicester Matt Leicester Saturday, May 24, 2014 6:30:24 PM And Skip Kirkwood you are correct. Even in my county in NC (Bertie) which is a poorer county, with scheduled OT our new medics are making $40k+. We also offer county paid insurance, retirement, 401k, and other benefits. One thing NC has shown me, is that we have done a good job of recognizing the value of our EMS professionals overall. Can we do better, yes. But we do an overall good job of compensating ours for the work they do. Sure, we lose some to PA, nursing, or med school, but there seems to be an awful lot of EMS professionals who move from other areas into NC.
Sandy Hill Treadway Sandy Hill Treadway Saturday, May 24, 2014 6:53:50 PM Thanks Skip Kirkwood and Matt Leicester :-) Would have to re-license for NC...only licensed in Bama...but have considered a move to NC before, for other reasons. Now have one more
Andy Moynahan Andy Moynahan Saturday, May 24, 2014 7:20:26 PM Good story. Miss you out there.
Wes Cook Wes Cook Saturday, May 24, 2014 8:15:19 PM Unfortunately we are needed everywhere, so many will toil away for a pittance. But their reward will be found in that occasional thank you or gentle hug.
Graeme Marchand Graeme Marchand Saturday, May 24, 2014 8:32:27 PM Very true. Canadian wages are excellent. We are usually in the 75000-85000 range.
Rob Bruner Rob Bruner Sunday, May 25, 2014 3:12:43 AM don't forget PTSD and a lousy pension...
Mike Haas Mike Haas Sunday, May 25, 2014 3:36:47 AM Skip Kirkwood those are more the exception than the rule. in the context of a graduating EMT class and EMS systems, averaged for private and public institutions it consistently ranks low. there are fast food restaurants that pay their employees a living wage but not ready to elevate that industry to a good living yet - neither is EMS. To point out the outlier examples is a disservice, lets get the average expected salary and work environment to where it should be.
Chris Millman Chris Millman Sunday, May 25, 2014 4:12:13 AM 15 years later, I'm still monkey dicking around this EMS I beat the statistics! WOOT!
Skip Kirkwood Skip Kirkwood Sunday, May 25, 2014 5:08:42 AM Wes Cook Being "needed" is one thing - but if the community is not willing to pay a living wage, we are under no obligation to work. Involuntary servitude was done away with many years ago. Vote with your feet, as they say.
Skip Kirkwood Skip Kirkwood Sunday, May 25, 2014 5:13:02 AM Mike Haas - I don't think so, Mike. I think we keep hearing about the worst case, as though it was the norm. It is not, and we should not teach our "young" to expect or accept the sub-poverty wages. EMS is not a religion - we are not required to take a vow of poverty. And there are decent wages to be made, if you're willing to look for them. We hear about sub-poverty wages all the time, from people who live and work in screwed-up EMS systems, in states where the system is poorly designed, etc. Let your feet do your voting, and don't accept it. (PS - North Carolina is hardly a high-wage, "outlier" state. - No unions to speak of, rural agricultural economy except in a few areas - yet even those pay decently.)
Kim Sullivan Kim Sullivan Sunday, May 25, 2014 5:14:42 AM Every single word is true to the core !
Mike Haas Mike Haas Sunday, May 25, 2014 5:27:21 AM Skip Kirkwood the average is low, higher wages are the exception not the rule. take a harder look at the labor statistics. letting your feet do the walking is an opportunity many don't have.
Skip Kirkwood Skip Kirkwood Sunday, May 25, 2014 5:32:58 AM Mike Haas - averages can and do hide a lot of things - that's why when we look at response performance, we look at the 90th percentile. And opportunities are things that you make. If you want something bad enough, you can find a way. Too many people are content to wallow in misery, sit back and complain. I am growing tired of people complaining about how bad things are, but not being willing to do anything to change the environment, or their place in it. It is fine to call attention to an issue - but then DO something about it, please!
Mike Haas Mike Haas Sunday, May 25, 2014 5:37:09 AM Skip Kirkwood we are doing something about it, we are talking about it. yet some find this to be "complaining" then offer anecdotal cherry picked examples against the norm. percentiles are great but a statistical average that consistently ranks low can't be ignored. it's not made up.
Skip Kirkwood Skip Kirkwood Sunday, May 25, 2014 5:40:39 AM Mike Haas - Sorry, but I don't accept that talking about something is the same as doing anything about it. People have been "talking" about wages in EMS for 40 years, but nobody has done anything about it. And that "nobody" is the EMS community - nobody else is going to address our needs, and nothing is going to change as long as so many are willing to accept whatever crumbs are thrown our way.
Mike Haas Mike Haas Sunday, May 25, 2014 5:46:25 AM Skip Kirkwood can't do something about it if you don't talk about it. The more it's brought to light, the better chances to find an opportunity to act. it's an uphill battle when you have people in your own community put blinders on and say it must not be a problem because i don't see it. that's what talking is about, making sure you provide info for more realistic and informed conversations.
Skip Kirkwood Skip Kirkwood Sunday, May 25, 2014 5:49:09 AM Mike Haas - Sure you can. You cut your grass without talking about it....and you can make a decision not to accept substandard wages without talking about it. Talk without associated action accomplishes nothing. Best example of that today is our Federal government - tons of talking but no action.
James Griffith James Griffith Sunday, May 25, 2014 6:59:58 AM Well said my friend keep fighting the good fight and gods speed to you all
Mark Fesco Mark Fesco Sunday, May 25, 2014 7:06:31 AM I just got tired of rubber neckin' lol
Matt Wood Matt Wood Sunday, May 25, 2014 9:50:12 AM Thank you, this really does help
Sheryl Jolly Ezell Sheryl Jolly Ezell Sunday, May 25, 2014 3:24:22 PM shitty. There are plenty of ways to tell the story that doesn't have to trash people and be disrespectful. Yes, those stories are out there - but this is a shitty way of telling it.
Kelly Grayson Kelly Grayson Monday, May 26, 2014 1:12:05 AM I'm curious, Sheryl. Just what of the essay did you consider "shitty," and who do you think I'm trashing and disrespecting?
Sharon Jones Sharon Jones Monday, May 26, 2014 5:01:31 AM I was a volunteer and did not get paid at all for over 35 yearsw and then we got "compensated" $10 a run. for getting up at any hour of the day or night. It did not amtter if you were sicker than the person who need to go to the hospital. You did not ask or care. I only did this to take care of the sick and wounded. My soul was wounded on many runs. I did not like to be the one telling the person their loved one was beyond help. I miss those days but my body wore out. Let younger stronger flods do this.
Loren Coleman Loren Coleman Monday, May 26, 2014 9:36:41 AM I love this article that was posted about EMS and I want to say that I am so proud of each and every person that has decided to answer the calling to become an EMT. May God richly bless each and everyone of you.
Ben Treakle Sr. Ben Treakle Sr. Monday, May 26, 2014 6:10:21 PM So very true,it gives me goose bumps. when they do thank you tho,ask what they are going to do with the second chance given them.You earned it!
Donna Marie Kisslan Donna Marie Kisslan Wednesday, May 28, 2014 11:47:24 AM Enjoyed the article, just wish that someone would have told me that there would be toxic people within the field that would take pride in their lack of compassion and take pride in beating down some of the very people and reasons we as EMS professionals strive and live for..... I am proud and blessed by every patient I had the privilege to care for. But disappointed that after twenty years of dedication to patient care..... the toxic people with whom I have encountered, have succeeded....... Be Safe
Donna Jacques Trumfio Donna Jacques Trumfio Friday, May 30, 2014 8:06:29 AM Great people we need more like them in the world God Bless
Bryan Hunt Bryan Hunt Wednesday, June 04, 2014 1:31:25 AM couldn't say it better myself remind me of another profession though not paid 21 years as an EMT ret. thank you very much
Bryan Hunt Bryan Hunt Wednesday, June 04, 2014 1:34:14 AM couldn't say it better myself, reminds me of another profession though not paid. 21 years as an EMT retired thank you very much it really is a calling I started in Calif at $3.35 hour shows you how far back I go
Shawn Santore Shawn Santore Wednesday, June 04, 2014 7:06:01 PM well that pretty much sums up ems
Kristy Greening Kristy Greening Tuesday, August 05, 2014 10:13:36 AM This!!!!
Jake Cvetan Jake Cvetan Tuesday, September 16, 2014 11:20:11 AM To those in the comments section bantering back and forth about wages. Realize one thing you are taking away from the point of this job description. This job description lets a person considering the EMT Profession know that doing the job needs to be what you really want a job you love it, you marry it, or you burn out and move on. The one thing you wont do is become rich (monetarily speaking). It brings to the for front a discussion that should be had with any perspective new comer to the profession. If you have these frank conversations maybe our professions burnout rate and employer turn over rate would lessen.
Abel Feltes Abel Feltes Tuesday, September 16, 2014 5:31:30 PM Skip Kirkwood What's tricky about this is that some people simply care very much about the community that they live in and wish to work for that community. I'm all for people doing what they can to advocate for decent wages, but the reality is that most places will simply watch their rural EMS services fold before they recognize the need for change. If your family, friends and community live in the area, you may not be willing to do this. Voting with your feet is a silly pipe dream to many who have something at stake in their local EMS system.
Steve Besselman Steve Besselman Tuesday, September 16, 2014 5:40:06 PM It's all true and you know what? I LOVE this job. I honestly look forward to coming to work every single day. I wouldn't trade this profession for anything and have made some of the best friends of my entire life. If you think you have it in you GO FOR IT. You won't regret it!

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