Toxic heroism: The perfect storm in EMS recruitment

“It’s not that millennials and alphas don’t want to work; it’s that they don’t want to be lied to anymore, and let’s be honest: EMS has been living a lie for too long.”


The rules have changed. A global pandemic led to one of the largest hiring booms in recent history and historically low unemployment. Add a “great resignation” of people leaving jobs for greener pastures, and a residual moral injury that we are still measuring.

What does it mean for EMS? A perfect storm.

If you have seen the movie, or read Sebastian Junger’s excellent book, you know that the “storm” is a combination of elements that come together in a way no one saw coming, which changes everything we thought.

"Agencies need to stress helping people every day over the excitement of saving lives. This extends to public relations and how we sell our profession to the public," writes Schwester. (Photo/Tribune News Service)

EMS used to attract people with the promise of the adrenalin rush of life-threatening, death-racing heroes fighting a desperate battle for life. We stressed the speed, the lights and sirens, the catecholamines flooding your system as you fought the Grim Reaper. We recruited (and attracted) people drawn to the bright lights of the big city, so to speak.

The reality was much different. Faced with long, boring post assignments on street corners; moving from place to place because a computer told them to; endless transports for urgent, rather than emergent patients; and patients who access the system because there simply is no place for them anywhere else; many EMS clinicians give up and move on to other roles. More than a few say, “This just isn’t what I expected,” or worse.

In short, we sold a myth.

A lie.

In a world where there is a seemingly endless supply of entry-level EMS staff to fill the holes from those who leave; the myth works. It works because once we see behind the curtain, we can decide if we want to do the job; or if this is just a waystation to the engine, police cruiser or another level of medicine with better pay.

Here’s the problem: EMS agencies seem to be running out of bodies to fill the seats. Social media and some news agencies have peeked behind the curtain and told the real story, and our recruiting pool is much savvier about the ins and outs of the job than ever before.

It’s not that millennials and alphas don’t want to work; it’s that they don’t want to be lied to anymore, and let’s be honest: EMS has been living a lie for too long.

What we need to tell EMS recruits

So how can EMS agencies weather this storm?

We need to stop recruiting for the rarity. Telling someone they will save lives every day as an EMT or paramedic is as ludicrous as recruiting police officers with which pistol they will carry on duty.

This is provocative, but I want it to be. We have to attract the right mentality for helping people. We cannot continue to attract people for the excitement of a job where the excitement is rare at best.

Here’s what we need to tell prospective recruits:

“You will get the chance to help a person every time you go out the door. It may be very small, it may be very big. They may understand and appreciate it, or they may not. Regardless, you help every time. And sometimes, you get the chance to change someones life for the better.”

We need to remove the idea of toxic heroism from recruitment and retention. Toxic heroism is the byproduct of the belief that only life-threatening emergencies matter and that anything else is unworthy of our level of skill.

Burnout and poor work performance are direct results of toxic heroism; as the new EMT or medic starts to believe the majority of the work they do is unfulfilling or worse: unworthy. Repeat 911 users, non-emergent calls and poorly managed chronic illnesses are all targets for toxic heroism and at risk for poor care.

Agencies need to stress helping people every day over the excitement of saving lives. This extends to public relations and how we sell our profession to the public. Patient privacy laws are a limiting factor, but too often, agencies give up instead of working this critical role into their organization. Fire and police have mastered the skill of educating communities about everything they do. We need to embrace this.

Finally, EMS Week should stop being a free pen-and-pizza bazaar, and start being a week of public education, advocacy and showcasing the profession.

Pull the ambulance into the shopping mall and run stop the bleed and bystander CPR demonstrations. Go to schools and do “Touch-a-Truck” and career presentations. When clinicians see the benefit of these public displays, we can begin to suppress toxic heroism and exalt the role of the everyday helper.

We simply have to.


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