Crash course: A medic’s account of the field

By Russ Reina, Paramedic/Author
Moments in the Death of a Flesh Mechanic...a healer’s rebirth

When paramedic programs started in the privately owned ambulance sector in the early 1970s, some of the only people who were eligible for inclusion had histories that would singe your eyebrows. They were an odd mixture of wannabe cops, ex-cons, borderline (sometimes active!) criminals, thrill-seekers, ex-Vietnam vets with varying degrees of post-traumatic stress disorder, and, generally, people who were unfit for normal 9 a.m. to 5 p.m. jobs.

In 1972, a 25-year-old drifter could blow into a town in Florida and, destitute, need a quick, simple job. In an hour, he could be transporting dead bodies for a funeral home in return for “three hots and a cot"; a room in the back of the funeral home and three meals a day. He’d find himself doing emergency runs called “Courtesy Transports”. Within a few months, he would have to get Red Cross first aid training.

When the funeral home gave up its interest in emergency services, our drifter, having some experience, could be offered a paid position as an ambulance driver for the new private company. In 1973, he could find himself in EMT class. He had no choice; most states were making certification mandatory.

In 1974, a local doctor would decide to put a paramedic program into the hospital and hustle for funds and equipment to give it life. He’d ask the ambulance company owners, “Who’s been running emergencies longest?” Next thing you know, our drifter could be eligible to become a paramedic.

People like these turned into reluctant trailblazers; no choice. Budding programs had to work with the people with experience. The only option was to adapt or lose the job. For many of them, it was also their one shot at stability and respectability. The transition from corpse delivery boy to paid, professional paramedic — a period of about three years — seemed lightning fast at the time!

This new breed of medical support personnel had to be major hustlers or the program would fail. Literally thrust into positions of extremely high responsibility, many adapted well to the transition and became real role models for those entering the field. For just as many, however, the responsibility they had was not matched by their ability to carry it out.

They lived under constant scrutiny. The specialty came upon the scene so rapidly that even existing emergency support services were barely prepared to adjust to the change in the way of thinking. In the light of that watchful eye, many of the earliest medics crumbled under the pressure, or freaked out during off times.

For about nine months during 1977, I was the only active paramedic on the shoreline coast of Florida from St. Petersburg to Cape Canaveral. Two of the paramedics who had graduated from the first class of the pilot program had been fired, one after having been jailed for impersonating a police officer. Another lapsed into drug addiction and was caught stealing a patient’s medications. Still another burned out — literally “spooked” by the responsibility — and the last left shortly after having been given poor reviews for defibrillating a patient improperly; using no lubricant and placing the paddles in reversed position, leaving burn marks on his deceased patient’s body.

Luckily, most of this happened quietly, and the public was not aware of these early growing pangs. In the hospital emergency rooms, however, the former drifters who did survive, of whom I was one, had to start from scratch; building trust as if the program had never begun.

Medics had to prove themselves to each and every doctor with whom they worked in the emergency room. If a doctor worked in an ER it did not mean he believed in the program, or trusted medics. Unless they gained their confidence, and the confidence of every other individual in the allied protective agencies in their communities, they would not be able to do their jobs.

As a result, the medics who survived were smooth, streetwise schmoozers, but they also had to deliver. They had to know when it was essential to act and not back down. They had to learn how to get what they wanted, which was to be able to use all they knew to help save a life. But bravado alone would simply not work. When it came to knowing medical procedures, they had to have it together. The stakes were too high.

Many of the personal characteristics necessary to pull this all off looked like the height of arrogance. For many thrust into the profession, self-esteem issues were rampant, and most were driven to hold on to their hard-won and newly found status.

In a profession where financial rewards were nonexistent and the chance of receiving any kind of recognition was remote, the primary rewards were either in the quiet satisfaction of saving a life or the loud stroking of one’s own ego. Did I mention that silence was not an attribute of the early medics? Here’s a little story used to illustrate this:

A fireman died, like we all must, and found himself standing in a tremendously long line outside of the Pearly Gates. It took millennia to move even the slightest bit forward.

He was growing impatient. After much waiting, he noticed a guy dressed in uniform, stethoscope slung around his neck and carrying a cardiac monitor/defibrillator. The man arrogantly walked alongside the line and right up to Saint Peter. He said a couple of words to the Holy Gatekeeper, and without any delay, he was let in.

The fireman was flabbergasted. He said, “Hell, I went through paramedic training!” Pulling himself out of line, he boldly marched up to the gates and Saint Peter.

Saint Peter put out his strong hand to stop him. The fireman announced, “I saw you let that guy come through. Let me in; I’m a paramedic, too!”

Saint Peter laughed aloud and replied, “Don’t be a ninny, you worm. That was God! He just thinks He’s a paramedic!”