The question every new paramedic has to answer

An 'Open Commencement Address' to all paramedic graduates

The last time I addressed a paramedic school graduating class was my own ... nearly 30 years ago, almost to the day. On that day, I read a poem.

I don't remember the poem. I don't know what it was about or who wrote it, it was just what the staff told me to read. I would have given the valedictorian speech, but I missed it by a tenth of a percent. I'm not bitter. I'm just saying that by a tenth of a percent, Josh Binder gave the valedictorian speech and I read some crappy poem.

What kind of a provider are you?

Graduation day advice for you old dogs

As the new generation of paramedics hits the streets, you old dogs and veterans will face another onslaught of young, energetic, and impressionable providers who will follow the examples you set.

Just as this new legion must consider how they will change the world, you seasoned veterans must consider what impact you will have on these young minds. And how the world will change as a result.

As EMS welcomes the new grads, perhaps this is a good time to consider (or reconsider) who you are as a provider. Perhaps it is a good time to reevaluate the reason you do what you do, and the way you do it. Perhaps this is a good time to look back on your own career and remember the moments that have most touched you and those you wish you could forget.

Most of all, perhaps this is a good time to truly ask yourself what kind of provider you are. If, after serious reflection, you find that EMS is in your soul and that being the best is the only way to do it, then reach out and show the newcomers what it means to be a paramedic. If, on the other hand, you come to realize that your heart is just not in it anymore, then it is time to hang it up before somebody gets killed.

No matter how you answer, I urge you to remember the words of Polonius in Shakespeare's Hamlet, "This above all: to thine own self be true."

Graduation speech for new paramedics

Today, though, is a much different day, for both of us. Instead of reading a poem that somebody else wrote, I get to tell you how it really is; from real experience with real people and real blood. I get to tell you what I know to be true about being a paramedic.

When I say that I believe "paramedic" is the single most significant job there is, I'm not just blowing sunshine up your collective rectums because this is a paramedic school graduation; and I'm not saying it because I spent most of my adult life working as a paramedic; and I'm not saying it because defending paramedics and EMS providers is the cornerstone of my legal defense practice and some of you look like potential clients.

I say that "paramedic" is the most significant job there is because I know it's true. It is the paramedic who willingly puts himself or herself smack in the middle of tragedy. It is the paramedic who willingly seeks out life's worst moments and brings hope and comfort. It is the paramedic who willingly faces the absolute worst that human kind has to offer and takes control with a level head, a firm voice, and gentle hands.

But, more than all that, it is the paramedic — and nobody else — who goes to work every morning, takes out their license to practice, slams it on the table and says: "I dare you, world; I dare you to take this away from me today. I dare you to take my livelihood, my possessions, and even my life. I dare you."

Because, unlike any other profession, in EMS a simple twist of fate, a simple mistake or simple misjudgment can cost you everything. I've tried, but I cannot think of any other profession where that is true. There are jobs that are singularly more difficult. There are jobs that are singularly more dangerous. But there is no other profession that is more significant for those reasons and many more.

We are it

To add a little perspective, I remember lying awake some nights in quarters thinking to myself: "Wow, if I called 911 right now, I would get ... me. That's it. I'm it."

There is no 911 for 911 to call: You are it. For that reason alone, most people cannot do this job. Most people are not willing to take the kind of risks that you will take every minute that you hold a paramedic license.

Notice, I did not say "every minute that you are working," I said every minute that you hold a paramedic license. Because your status as a licensed paramedic, what is expected of you, is not limited to who you are and what you do on duty.

As an attorney who defends paramedics against actions taken by the California State EMS Authority, I am here to tell you, the State cares very much who you are and what you do all the time. As far as the State is concerned, who you are and what you do away from the job can have just as detrimental an impact on your license — and you career — as when you are working.

Again, most normal people are simply not willing to be held to those kind of standards, but you are — and you'd better be.

Experience has shown me that there are only three kinds of paramedics.

  1. The natural paramedics. The ones for whom it is effortless ... guys like Victor Oseguera, Paul Cooper, Kevin Murphy, or Mr. "tenth-of-a-percent" Josh Binder. These guys have it flowing through their veins.
  2. The high-effort paramedics. Then there are the ones who work very hard to be the best they can be; they read everything they can, they do twice the amount of continuing education they need to; the ones who bust their butts to make it look easy because being good is that important. That was me. (Probably why I only got to read a poem).
  3. All the others. And then there are the rest. The ones who slipped through the cracks. The ones who view being a paramedic as just another part of the job. The ones who reach limply for the bare minimum. The ones who, when you know they are working, you stay out of their first-in.

The choice is yours

Which one are you? Each of you knows the answer already and I hope my words here today will solidify what you need to do with that answer.

Standing here now, as a lawyer, it seems surreal that it has been so long since the Spring of 1989 when I did my internship at the old LA City 66's station at Florence and Western.

I clearly remember that my preceptors, Kelly McKee and Mike Samudio, spent a lot of time making sure I knew my policies and procedures and my drug dosages. In fact, Kelly carried with him a toy squeaky hammer and gummy-bears. When we would meet up with other crews he would show off what I knew by asking me difficult questions; if I answered correctly, I got a gummy-bear. If I was wrong, he would hit me in the head with the squeaky hammer.

Kelly and Mike showed me that as serious as this job is, it can also be fun; that, more than anything, the job is about people who depend on and deserve the best we have to offer every time, no matter what.

Of course, I also learned that the right amount of armor-all makes it impossible to stay in one place on the bench seat.

Decades in ems

That was years and years ago. I was twenty-years-old and ready to save the world. And back then, I believed I could. And I believed I would.

Looking back on those two decades, I believe I did. If only for one family, though I know it was many, many more, I did change the world. And now it's your turn.

The question now is how will you change the world? Who will you be??

Will your commitment and your effort allow an elderly couple to enjoy just one more anniversary? Or will your complacency and disinterest cause a grieving widow to wake up alone for the first time in 50 years?

Will your knowledge and skill remind you that a stomach ache is not always a stomach ache? Or will a culture of burnout and malaise allow you to believe that a drunk is always a drunk.

Will your passion lead you to find or create innovative solutions to problems old and new? Or will just enough, be enough?

Today is the day, now is the moment to ask yourself, not only what kind of paramedic you want to be or will be, but how will you change the world. Because, for paramedics, changing the world is not some ethereal or esoteric notion, it is what you will do every single day.

In fact, right now, someone somewhere is going about their regular daily life. They are not thinking of you any more than you are thinking about them. But they are out there; sitting in traffic, buying groceries, having a late lunch with an old friend, planning a wedding, making a baby, walking between classes, or just lounging by a pool somewhere having a drink. Wherever they are, they are just doing their thing.

They are happy and relaxed because they don't know that one day next week, next month, or maybe next year their entire existence is going to be hanging by a thread; their breath may be short, their heart may be fibrillating, their limbs may be convulsing or they may be staring helpless at the bloody, lifeless body of their child and the twisted metal that moments before was a bicycle. And there will be you. Your senses, your hands, and your decisions in that moment will be the difference between hope and hurt, life and longing, another birthday party or a child's funeral. What you do in that moment will change the world for them and for you and that change cannot and will not be undone.

So, I ask you: Who will you be in that moment? Will you be prepared or preoccupied? Will your passion for perfection carry the day? Or will the pursuit of mediocrity be too little, too late?

As you sit there, the slate is clean; the choice is yours and I offer you this: Being a paramedic is the single most significant job there is; it is rich with reward and possibly the most fun you can have with shoes on, but there are no second chances; not for you and not for those who depend on you.

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