Is fire-based EMS destroying our best EMTs?

Immersion in cynicism takes a toll on the mind, body and spirit and those who sense their values slipping to often get off the ambulance and onto a fire company


New firefighter-EMTs begin their career at my department with great intentions. For 20 years I saw great kids, good firefighters and capable EMTs come out of the academy and into the department eager for their first call.

But it never took long for a steady spiral into disillusionment.

Nothing can prepare a person for life on a busy fire department ambulance. Nobody would believe what goes on unless they actually do it.

Sure, the stories give a small picture of what is about to happen. But it's not enough to stem the tide of frustration, anger and cynicism that is likely ahead.

At first, the relentless calls for rides to the hospital are dealt with through humor and resignation. It's not the new EMT's fault that the EMS system is a watered down version of what it was designed for, right?

So, they put their training and knowledge in their back pockets, leave the equipment on the shelves and put the "patient" on the bench. A set of vitals is captured, not because they are looking for clues as to what ails the patient, but rather because it is expected and automatic.

They use the lights and sirens, not because they need to, because they can. Nobody feels like being stuck in traffic when there is a way out, right?

Some people get out of their way. Some drivers don't bother because they are too busy texting.

The EMTs get angry and resentment builds. A distaste for the general public begins to fester — both for those in front of them who refuse to yield and those behind them who insist on beating the EMS system simply because it is there.

Eroding of a psyche
Weeks go by. No real emergencies come their way. The boredom sets in not from lack of activity, but rather from routine rides to the emergency room for non-emergency problems for people who can and do find rides for everywhere else they need to go.

The pace is cool for a while, about a call every hour, 24 hours a day. It's a test of their mettle, holding it together, 38-hour shifts, keeping their cool and never letting anybody see the sweat.

It works for a while, but cracks start to develop. When the 10th drunk in 15 hours tells them to shut up and do their job, well, things happen, things that shouldn't.

A sneer forms where a smile once was. Small character flaws develop and grow as time progresses.

Now and then emergencies come their way and they perform to save a life, a limb or heart muscle. The reason they are here in the first place envelops them with satisfaction.

The bad habits simmer down for a while, but never go away. They lay dormant until the next spell of prolonged non-emergent response, when emotion takes over and training, patience and professionalism disappear.

Not many last long on the EMS side of the house, not when there is a fire engine next to the ambulance with their name on it. They see in themselves things they do not want to face. They didn't become firefighter-EMTs because they dislike humanity, rather the exact opposite.

Far too often the most difficult part of fire-based EMS has nothing to do with the patients. Being immersed in a pool of cynicism takes its toll on the mind, body and spirit. Those amongst us smart enough to sense their values and ethics slipping away get off the ambulance and on an engine or a ladder company when their name is called. They let the new guys do the EMS stuff.

Problem is the EMS stuff makes up 75 percent or more of the calls. And we're letting the new guys do most of the work — feeding them to the lions — and they are coming out damaged, disillusioned and bitter.

It's no way to run an EMS division, no way to run a fire department and no way to keep good EMTs where they belong — on the ambulance.

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