Welcome to EMS

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.