By Wes Ogilvie
Recently, while browsing an EMS-related Facebook page, I read a post from a brand new, eager and enthusiastic EMT. “Now I gotta start saving lives,” wrote the EMT. This is my reply and reality check for all new EMTs.
Dear new EMT
I’m a practicing attorney and a practicing paramedic. And on behalf of the EMS profession, I’d like to apologize to you and every frustrated EMS student. You see, our profession and our recruiting efforts have lied to you. And as your lawyer (well, not really), I think that the EMS profession is massively guilty of false advertising. For you see, we really don’t save lives all that often.
Lifesaving, not so much
We really don’t go to massive accidents all that often. In fact, in most traumatic injuries, EMS providers don’t save lives. That’s a surgeon’s niche. What does work in EMS trauma response is bleeding control and rapid transport to definitive care. In other words, basic life support skills that you could’ve learned in a Boy Scout first aid class, along with a quick how-to on modern tourniquets.
Out of hospital cardiac arrest survival rates are still not what they should be in most places. And we’ve found that for the majority of these patients, great chest compressions and early delivery of electricity are the biggest fixes. Again, basically a BLS skill and infrequently used one at that.
Sick people? You’re going to see quite a few. Some may be experiencing acute events that you, especially if you are a new paramedic, may be able to provide significant relief for. Asthma, heart failure, allergic reactions and acute coronary syndrome are among the disease processes that any paramedic should be a master atassessing and treating.
People in pain? Every day, whether the acute pain from a recent injury or from a chronic illness, you’ll be seeing these pain patients and they’re expecting you to “make it better.”
EMS is more than the collection of skills
While we can teach almost anyone EMS skills, there are two things that we can’t teach easily. The first is when to do or, even more importantly, not to do, an intervention. The other is to actually care for your patients.
Most days, you’re going to push more pain meds than ‘lifesaving’ ACLS medications. And the truth is that many of these ACLS medications are now being questioned.
Each shift you’ll give more blankets, ice packs and emesis bags than paralytics. Your skills in psychiatry and social work, despite a lack of training, will be more utilized than your intubation skills. You’ll do more lift assists in your career than you will all of those odd-ball trauma skills you glossed over in your initial EMT class, like occlusive dressings and petroleum gauze. You may go an entire career without using a KED or a traction splint, but you’ll spend more time with bariatric devices than you ever thought possible.
We are medical professionals
EMS is rarely glamorous or exciting. What it really comes down to is that this isn’t “Emergency!,” “Rescue 911,” or “ER.” By and large, most days we aren’t in the rescue business. We’re medical professionals and we care for people. We don’t determine the patient’s definition of emergency. They do. Our job is to provide care, comfort and refer them to the appropriate resources to best address their emergency. When you realize that we’re rarely in the lifesaving business and often in the patient comfort business, you’re less likely to burnout and you might just enjoy getting in the ambulance, quick response SUV, helicopter, or fire truck each shift.
My first medical director, Dr. Ed Racht, said. “Our profession, one of taking care of folks when their need is greatest, is one of the most honorable professions on the planet. It is something we should all be collectively proud of every day.”
If, after having the privilege of caring for others at their weakest moment, you still feel cheated by not getting to save a life every day, let me know. I know a few people in my other profession who’ll sue anyone for anything.
About the author
Wes Ogilvie is a Texas licensed and nationally registered paramedic as well as a Texas attorney. He blogs at www.theambulancechaser.com. When he’s not knee deep in contracts or patient care, he’s passionate about good barbecue and EMS education. He’s currently employed in state government, where he does not deal with EMS regulation, volunteers his weekends as a paramedic, and is an instructor in several EMS disciplines including his position as an adjunct assistant professor of emergency medicine at the University of Nevada.