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5 tips for starting and sustaining a career in EMS

You may be surprised to treat more psych than critical patients, but protect the ABCs and you’ll be off to a great start in a career in EMS


The emergency medical services field is one of the most rewarding, fulfilling, awe-inspiring and challenging careers that anyone could ever embark on.

Photo/Greg Friese

By Brad Davison
American Military University

The emergency medical services field is one of the most rewarding, fulfilling, awe-inspiring and challenging careers that anyone could ever embark on. Since its contemporary formation in the 1960s, EMS has played a critical role in our nation’s healthcare system by providing high-quality emergency care and contributing to the improved health and wellness of countless individuals. Yet, as noble and rewarding as the profession may appear, there is significant turmoil within. Surprising to most outsiders, the average paramedic’s career is only 6.5 years, and the average suicide contemplation and attempt rate is 10 times higher than the national average.

These statistics are not intended to scare anyone away who is considering joining the profession, but rather to provide a realistic picture. Along with high levels of stress and relatively low pay, not fully understanding the realities of working in EMS is a significant contributing factor to early burnout. Unlike the action and adventure portrayed in movies and TV, the real world of EMS is remarkably different. Here are five tips for starting and sustaining your EMS career:

1. What you learn in school may not be the same as what happens in the field

EMS curriculums are designed to teach students how to treat seriously ill and injured patients. Shockingly for most new EMTs and paramedics, the vast majority of patients will be far from critical. In fact, you may go weeks or months between critical transports. When you do get a critical patient, you will likely find that the situation is not as cut and dry as it was in school. The “classic” clinical symptoms are not always apparent and patients will often over- or under-dramatize their condition.

Additionally, while cardiac, respiratory and trauma patients may be the material most covered in your schooling, you will often take care of far more psych (suicidal, depressed, addicted, etc.) patients than you expect. You will undoubtedly do a great deal of good for your cardiac, respiratory and trauma patients, but I highly recommend you pay particular attention and focus studying on methods for treating and transporting psych patients.

2. Your coworkers may not welcome you with open arms

As in other public safety fields, EMS professionals are not known for being excessively warm to new providers. This is largely due to the fact that you are likely coming straight out of school and have yet to amass respect and trust from your coworkers. In public safety professions, respect is a valuable and sought-after commodity. It is earned through a great deal of time, patience and work. Seasoned veterans can spot a new person from a mile away, so don’t try to impress or convey that you know and have seen more than you actually have. This will diminish your respect rather than help you gain it. The best way to earn respect is through humility and hard work.

3. Becoming calloused can be a positive and a negative

At first, the conversations and seemingly insensitive jokes among veteran coworkers may seem a bit strange or even uncomfortable, but displaying a cold exterior is often a defense mechanism against the chaos and stress of being an emergency responder. While your EMS schooling undoubtedly told you that every patient should be treated as a family member, in reality, that isn’t possible or, frankly, healthy.

In a 2016 report, Dr. Beverly J. Paschal found that the only personality trait that could predict the longevity of a paramedic’s career was “warmth” or, more accurately, the lack of warmth. Paramedics scoring low in warmth actually stayed longer in the EMS profession. While I do not advise you to become a calloused and cold provider, it’s important to remember that a little distance and emotional protection may help you and your career. A continual challenge in this profession is to find the balance between protected coldness and caring sympathy.

4. The administration is not the enemy

This one might sound strange to a newbie, but eventually, you will find that there is often a rift between line staff and administration. As with almost any conflict, this stems from a lack of communication and understanding. The administration often has to make decisions that are difficult and affect multiple aspects of the job. Unfortunately, these decisions don’t always get well-communicated to staff, so they often aren’t aware of the many things that influence administrative decisions.

If you don’t understand or agree with the decisions that are coming from the top, instead of joining the kitchen table gossip, open a line of communication with the top brass.

5. Don’t expect to be a physician, just protect the ABCs

As a new paramedic or EMT, you will inevitably come across a situation where you do not know the extent of a patient’s injury or illness and you’ll feel overwhelmed to create a treatment plan. In this moment, take a breath and remember that you are not a doctor and there are only a few critical things you must monitor.

In these situations, often the best thing you can do for these patients is to simply protect their airway, breathing and circulation. There is a fine line between over- and under-treating patients, but if every transport you bring in has stable ABCs, then you have completed a large part of your EMS duty. While those in EMS like to hold ourselves to extremely high standards (which is good in many ways), just remember that your main objective as a paramedic is to present emergency room doctors with a patient to treat.

Keeping these five things in mind before embarking on a career in EMS can prepare you for the road ahead and help steer you towards a long and rewarding profession.

About the author

Brad Davison is a firefighter/paramedic in a suburban department in Minnesota. In the fall of 2017, Brad completed his Master’s degree in Public Administration, with a concentration in Emergency Management from American Military University. Brad has been a contributing author to numerous fire and EMS publications, and enjoys teaching whenever possible. To contact the author, please email To receive more articles like this in your inbox, please sign up for In Public Safety’s bi-monthly newsletter.

This article, originally published on July 13, 2018, has been updated.

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