How to thrive in a dysfunctional EMS system

Focus on controlling what you can and leave the big picture to other people


In my city, it seems as if only about one in 100 people who call 911 for help appreciate what we do. Perhaps they are used to other people treating them like cattle and simply overlook the care, consideration and skill that they receive whenever we show up, no matter the time or reason. It’s kind of funny how the sicker the person is the more grateful they are.

Even gang members full of holes tend to be kinder than the ones who are barely wounded. There’s nobody on earth less grateful than a kid shot who isn’t going to die.

I learned to step back every now and then and take a look at the little pictures.

The big picture can be full of the aches and pains, heartbreak and misery that so often is self-imposed. It’s the little pictures that matter. The little pictures are the ones that need to be in focus. They are the ones that are full of the things we take for granted.

The calls that make or break you

A guy’s wife has had four seizures since midnight. It’s 4 a.m. She’s sitting in a chair in their living room, unaware. We get the stair chair ready and carry her out of their home and into the ambulance.

"She goes to the hospital on the other side of the city," says the woman’s husband.

"She’s having seizures," I reply. "The closest hospital is a block away, we’ll take her there."

"She goes to the farthest hospital," he repeats.

"Not tonight."

The ride is uncomfortable. He glares at me all the way. She begins to seize. He looks at me as though I caused this.

For some unknown reason, I feel the need to explain the situation to him while pharmaceutically stopping the seizure. His hospital of choice is 15 minutes away. I’m sure we would make it there without any harm to the patient, but sometimes I have to go on principle. Both hospitals operate in the same system with the same doctors and record keeping system.

It’s odd, how he can be angry at somebody who rushed to his house in the middle of the night, carried his wife out the door, onto a stretcher and into an ambulance, gave her oxygen, started an IV, assessed her vital signs, administered medication to help with the seizure and got her to a world class hospital in less than 30 minutes from the time he made the call. Existing without taking notice of the little things to be grateful for makes for a long, bitter unsatisfying life.

I have never expected thank you’s or atta boys. I am grateful to have the opportunity to do what I do. Just doing it is all the thanks I need. But I can’t help but wonder where the gratitude went and if it will come back.

Alas, getting stressed out over things I cannot control is no way to run an EMS call. If I allowed myself the luxury of obsessing over every detail of the dysfunctional system that I worked in, and the reasons why people called us and their subsequent unrealistic expectations, I would never have made it as long as I did.

Things I stopped obsessing about

The first thing I learned to do was recognize the fact that the system I worked for was dysfunctional. Once I realized that on the street, I was able to put the baggage that I had accumulated aside and focus on the job at hand. By taking the job one run at a time, I was able to stop obsessing about these pitfalls that ruin a good EMT or paramedic.

  • Abuse of 911
  • Lack of support from administration
  • Hostile public
  • Indifferent partners
  • Burned out hospital staff

In a perfect world, EMS would be adequately staffed with well-trained individuals acting like a team responding to medical emergencies and trauma. The people who called us would do so because they had no other choice. They would use EMS for emergencies, ambulances would be available for non-emergency transports, insurance companies and the government would reimburse at reasonable rates and everything would be as perfect as could be expected in a business where we respond because of the unexpected.

In my world, EMS is understaffed, inadequately trained, unsupervised, ill equipped and unmotivated. We respond to anything and everything the public throws at us; scrapes and bruises one call, evisceration the next, cardiac arrest before noon, intoxicated persons after. Money is always the number one issue, not patient care. When I look at the big picture, I feel myself begin to suffocate over the weight of an unsustainable system.

Avoiding the big picture

The patient who was seizing arrived at the hospital of my choice safely. She did not wake when we transferred her from our stretcher to the hospital bed. Her husband continued to glare.

The nurse at the triage desk graciously accepted the patient, not because I am charming, funny, but because the patient was well cared for, properly medicated and comfortable. My patient care report was articulate and complete. My attitude was professional. I didn’t complain, begrudge or carry on about the state of the world and the knuckleheads that keep us up all night.

I did my job, focused on the patient, arrived at the ER prepared, went in service and was ready for the next one. By doing so, I avoided the deluge of hostile thoughts and feelings that can poison a less experienced person and considerably shorten their career.

Sometimes, you have to leave the big picture to other people, and take control of what you can. 

About the author

Captain Michael Morse (ret.), mmorsepfd@aol.com, is the bestselling author of Rescuing Providence, Rescue 1 Responding, City Life and Mr. Wilson Makes it Home. Michael has been active in EMS since 1991 and offers his views on a variety of EMS and firefighting topics, focusing mainly on the interaction between patient and provider as a well respected columnist and speaker. Captain Morse is a Johnson/Macoll fellow in literature from the Rhode Island Foundation. Follow Michael on Twitter and Facebook

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