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Equality, professional respect and parity in pay

Reflecting on how far EMS has come in 50 years

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Way back in 1974, President Gerald Ford declared the third week in May to be EMS Week, celebrating EMS practitioners and the important work we do in our nation’s communities. May 17 will be the 50th anniversary of that declaration, and the theme ACEP has chosen this year is “Honoring our past, forging our future.” Perhaps it’s because my career has straddled the past and the future of EMS, but this is the best EMS Week slogan I’ve heard in my 30 years in the profession.

There is a trite saying that goes, “Those who don’t study history are doomed to repeat it.” I’ve been repeating that phrase more often as I get older, but it is more relevant than the old paramedic shaking his fist and yelling at the new EMTs to get off his lawn.

At least, I hope it is. There’s nothing worse than being irrelevant.

Because I have been doing this a long time, I’m in a unique position to counsel younger providers who are passionate and idealistic about their profession. All too often, they get discouraged because change happens too slowly. They look around and see everything that is wrong with EMS and despite their zeal, change happens too slowly. Old attitudes persist, archaic protocols defy current best practices, and salaries still lag behind our peers in allied health professions.

Viewed with only the perspective of a few years in EMS, it’s easy to assume that nothing ever changes, but when you’ve been doing it for over 30 years, the growth of our profession is obvious. The difference in EMS from now and when I was a rookie is stark.

This year’s theme, “Honoring Our Past. Forging Our Future,” reminds us to acknowledge the foundational work of those who came before us, while also striving to build and lead the EMS system we envision for our future. Check out our curated content.

Growing EMS salary

In one of my first jobs, the local Taco Bell had a sign out front that read, “Now hiring smiling and happy people for $9/hour.” The EMTs at our service would read that sign and say, “Well, I ain’t happy and smiling, but for nine friggin’ dollars an hour, I could be!”

Our pay still lags egregiously behind other healthcare professions with similar education, but now I make close to $40/hour as a paramedic. I can pay my bills with one EMS job without killing myself working overtime hours. The COVID epidemic and the ongoing staffing shortage has driven a sharp spike in wages, but we still have a long way to go.

Even with substantially better entry pay, the career span of EMS professionals dwindles every year. Not so long ago, the average career span of an EMT was 5 years. That’s not a figure that inspires confidence in EMS as a career, but I read an article some months back that said over half of new EMTs leave the profession within one year.

When you’re just starting in EMS, that landscape can look particularly bleak, but that’s only because we focus on the bad news. There are still good places to work, just maybe not in your home town. And when you look back across the last two generations in EMS, our growth has been phenomenal.

Things do change. Things have changed, and the balance of those changes have been good.

A technology quantum leap

I got my first save as a paramedic with a Physio Control LifePak 5 introduced in 1976. It only monitored Lead II, and you had to gel up the paddles to keep from scorching the patient’s skin and apply them “with 25 pounds of paddle pressure” like they made us recite endlessly in ACLS courses.

Last week, I transported a patient with five IV infusions of sedatives, paralytics, vasopressors and the like, an open abdomen, bilateral chest tubes, intubated and mechanically ventilated, with an arterial line in place. I attached the patient to a transport ventilator that alone cost more than the first five cars I owned … and that’s cumulative worth. I could buy a nice car in 2024 for what that ventilator cost. I attached the patient to a monitor that included 12-lead ECG, pacing, NIBP, waveform capnography, pulse oximetry with pleth variability index readouts, and two hemodynamic monitoring channels.

My partner and I drove him 3 hours to a Level I Trauma Center in a $100K ambulance, with only a registered nurse with me in back to monitor the blood transfusion – and that’s only because New York has silly laws about EMS and blood products.

Earning respect

But it wasn’t only the quantum leap in technology that was different from when I started; it was the attitude of the hospital staff when we arrived. A surgeon, an anesthesiologist and two ICU nurses were relieved when we pushed our laden stretcher into the room.

Not a single one called us ambulance drivers (we did have a driver, but that’s beside the point).

No one acted as if they were unsure we could handle a complex patient.

No one acted as if we were second-class citizens or subpar clinicians, marginally trained skills monkeys who didn’t understand the background of the technology we were utilizing.

A nurse read me lab values and hemodynamic parameters with the expectation that I knew what she was talking about.

The anesthesiologist explained the vent settings and didn’t quibble when we suggested changing the mode of ventilation to something more suited to rough ambulance transport. He acknowledged us as the experts in our particular field of transport medicine and followed our suggestions.

Now you may say that such calls are a rarity, and that such collegial respect isn’t often seen in our profession, but I beg to disagree. One thing I have learned in my years of EMS is that competence within any field rises to its own level of trust and respect. Within any ED, there are nurses that physicians trust implicitly. They make clinical decisions and make suggestions to the doctor, and only the most naive physician ignores them. Many of them carry out treatments as a matter of course that protocols and policies would require a doctor’s order first, yet they have gained such a level of trust that the physicians do not expect them to ask, “Doctor, may I?”

In the hospital, surgeons and intensivists know which ED docs and hospitals they can trust implicitly, and which ones they need to check behind.

It works the same way with paramedics and hospitals. Some paramedics are afforded a greater degree of trust, even beyond what their protocols specify, because they have proven their worth. Others who carry the same patch are viewed with skepticism every time they give a report or ask for orders, because the ED nurses and physicians have been burned by their incompetence in the past.

I’ve seen in often enough, in dozens of hospitals, with hundreds of EMS and ED personnel, to know that it’s rarely, “They don’t respect EMS.” Far more likely is it that they simply don’t respect the person saying that, and for good reason.

In the part of New York where I work now, the bar is set low; the default assumption for most of the ED staff is that the EMS personnel who bring them patients are marginally competent at best. Yet within two weeks, the ED staff were greeting me by name and treating me with the same level of collegial respect that I had enjoyed for years in Louisiana. I saw that pattern repeated with several of my more knowledgeable colleagues.

I’ll repeat, maybe, it’s not that the rest of healthcare doesn’t respect US, it’s that they don’t respect YOU. If you feel that you have been stereotyped and judged unfairly, consider that those stereotypes were formed based upon negative interactions with other people who wear the same patch and uniform.

If that offends you, it should … but you have the ability to change their minds, and it doesn’t take long at all.

Video: 50 years of progress in EMS

Be the positive image

Equality, professional respect and parity in pay were a fantasy when I first started in EMS, and we’re closer now than we ever have been. We can get there.

So when you celebrate EMS Week this year, remember the slogan: “Honoring our past, forging our future.” Remember that your profession, as dysfunctional as it is, is not unique in its struggles, nor are we stuck in neutral. We’re far better than we used to be, and we have the potential to get better still.

All it takes is for each of us to reflect a positive image of EMS and not a negative one. columnist Kelly Grayson, is a paramedic ER tech in Louisiana. He has spent the past 14 years as a field paramedic, critical care transport paramedic, field supervisor and educator. Kelly is the author of the book Life, Death and Everything In Between, and the popular blog A Day in the Life of An Ambulance Driver.