If you're like me, you probably have a number of news feeds related to EMS, emergency response, firefighting--all bookmarked in your browser and "liked" on Facebook.  You've read the articles about the EMTs and paramedics who have done great things, and others who have done horrible things.  You've read about the major incidents, rollovers, hazmat responses, and dash cam videos of crazy emergency driving and other "caught on cam" events.

But have you really read the comments posted on those sites by EMTs, paramedics, and first responders?

These comments are a discouraging, embarrassing, and unfortunately revealing window to the population that makes up emergency services in this country.  The disappointing nature of these comments goes beyond the routine misspelling, murderous grammar, and horrific syntax errors that might be whitewashed by the disclaimer "well that's just the internet, no one pays attention to spelling and grammar on the internet."

These comments illustrate the wide range of talent, education, skillset, ignorance, gullibility, tolerance, and intolerance found among the practitioners of EMS.  As a field, our members are drawn from the larger population of people who live in this country, so it is to be expected that there would be a diverse membership.  While the talent and professionalism of those at the top of the scale is heartwarming, the depths to which we have stooped to fill our ranks is alarming.  The bottom of the barrel is showing too many marks of having been scraped to fill our ranks.

Scroll through a typical discussion on one of these web sites and read the comments.  You'll see topics that begin with an honest question or a tale of something surprising or challenging.  As the discussion begins, it's rarely more than a few comments before the first denigrating, abusive, ignorant, racist, intolerant, inaccurate, or offensive comment is made.  These comments are quickly followed by additional abusive, ignorant, or inaccurate responses as EMTs and paramedics "educate" each other and tear each other apart.

True, the internet is a pseudo-anonymous medium and that anonymity encourages some to blast away first and ask questions later.  But the discussions sink to lows that go beyond trolling and flame wars.  The comments expose levels of ignorance that frighten me.  EMTs discuss how "driving past an accident when you're off duty with an EMS sticker or logo on your car will get you arrested" and marvel at the driving ability of a "caught on video" driver of an ambulance who weaves in an out of traffic at breakneck speeds, causing near misses everywhere he goes.  "Awesome driving!" they exclaim, "wish he was my partner."  

Comments about the patient abusing the system quickly devolves into racist and stereotypical images of minorities and suggestions of which countries they should return to.  Glory seekers post t-shirts and bumper stickers depicting a daily battle with the grim reaper and brag of the manner in which EMS is "here to save your ass, not kiss it."  Pictures of gruesome injuries are routinely posted as if these are daily events in our lives and to see such images is entertainment for us.  We tear each other apart as EMTs condemn paramedics as useless frill while paramedics bemoan the EMTs who just want to pick up and go, and "don't bother me with all that medical mumbo jumbo."

Why is this the case?

Well, first, the hurdles one must clear to become an EMT are not all that difficult.  A few months, a couple of tests, and your shoulder patch is in the mail.  No minimum general education requirements, no degree requirements, nothing that would indicate we take ourselves seriously as a profession.  A course to become a certified welder takes twice as long.

True, the EMT course is longer now than it has ever been.  True, if someone is dedicated to learning the material they can and will likely become solid EMTs doing good work.  But if they aren't all that committed, quality control in EMT courses isn't going to weed out the people who seek to become an EMT only to gain employment as a firefighter and hope they never see the inside of an ambulance again.

It's not just EMTs, of course.  Paramedics are also minimally educated, and minimally qualified.  No degree requirements, no experience requirements, and frequently--far too frequently--a paramedic student was an EMT student just a month or two before applying to the paramedic program.  There was a time when a person couldn't even apply to paramedic school until having served as an EMT for one or two years.  Market constraints and inter-school competition guarantee that students will have a seat in a paramedic class with short notice if they wish.

Also, no professional association represents all EMS personnel.  The National Registry of Emergency Medical Technicians (NREMT) is a credentialing process, not a professional association, and the NREMT does little to promote professionalism in the field.  The National Association of Emergency Medical Technicians (NAEMT) is a fine organization, but a minuscule fraction of EMTs ever join.  Not many, truthfully, have even heard of it.  Membership isn't required--in fact, it isn't even encouraged by many EMS organizations.  So it's power is minimal and carrying the card isn't a badge of honor.

Is it Really All That Bad Out There?

Yes.  And no.  There are many, many amazing practitioners of EMS out there on the streets every day.  Dedicated people, with bright and sunny dispositions, giving of themselves in a generous, meaningful, and enlightened way.  They are thorough, conscientious, clinicians who solve puzzles, eliminate problems, and present themselves with professionalism.

Their nemesis, however, are the bottom feeders who drag us all down.  The people who put more energy into avoiding the acquiring of skills and knowledge than it would take to learn it.  The negative, angry, hateful few who seem to infect our ranks with cynicism and ignorance.  Yes.  I said it.  They're out there, we see them, and we can picture them in our heads right now, every one of us.

What Can We Do About All This?

In part, I blame the agencies who employ us.  Setting professional standards is something employers are uniquely equipped to do.  If you don't have the right mindset or attitude, they could send a clear message to "keep right on walking past our door, pal."  Those who get in the door before their attitude is discovered can be set right, set on the path to improvement, or sent packing.

Managers often complain of how hard it is to get rid of dead weight.  It takes work, I agree.  But it's not hard.  It's just work.  Your work.  Your job.  That's why they call you a manager--so that you can manage.  Dutifully record an employee's actions, comments, complaints, corrective actions, improvement plans, and failure to meet those plans and any administrative law judge presiding over a termination hearing will land on your side of the fence.

Individually, what we can do is set a standard of professionalism in a ten foot diameter circle with each of us at the center.  Nothing happens inside that circle that demeans the professional standards we set for ourselves.

  • It's not okay to make racist, ignorant, hateful comments within that circle.
  • It's not okay to gloat about one's lack of knowledge and denigrate those who seek more knowledge for themselves within that circle.
  • It's not okay to sit in training and complain, "I don't need to know this.  You're speaking above my head.  This is all [insert level of certification here] stuff and I'm only [insert another level of certification here] within that circle.
  • It's not okay to argue everything is BLS and ALS is a waste within that circle.
  • It's not okay to argue that BLS is meaningless and ALS is the important stuff within that circle.
  • It's not okay to engage in hero worship of yourself within that circle.  You don't fight the grim reaper.  You don't do what doctors do but at 60 miles per hour.  You don't cheat death on a daily basis.

You are a practitioner of patient care in the prehospital setting.  Be a clinician.  Be a professional.  And insist that anyone withing that ten foot circle do the same.

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