What's it mean?

VentMonkey

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So I was at the gym the other day and I could not help but notice another guy with a Star Of Life t-shirt that read "EMT" in big bold letters, almost as if it was brand new. It got me thinking what does "it" mean to me?

First off, let me explain what I mean by "it", I'm not specifically referring to the Star Of Life itself; I mean all of it; the job, the field, the profession. What do prehospital services mean to you? I'll go first:

Sure, when I first started I wanted to see "cool stuff", I thought what I did mattered in the same way that most wide-eyed newcomers think it matters. I wanted to run "emergency calls" just as bad as the next new person. Then, like anyone else reality set in, etc., etc., etc. Flash forwards 15 years later, several systems later, and many different forms of experience---from basic, to front line middle management, to flight paramedic---later, and I still ponder what's this job mean to me?

Now, to me it means helping others will problems that my younger self would never imagined to be "emergent" (yep, that dumb 22 year old kid). It means learning to leave judgement behind on every call more and more, and never settling for anything less than improving with this skill set (and others) from now until retirement. It means accepting the fact that I plain, and down right like and enjoy most everything about being a field paramedic. It means accepting other people's emergencies for exactly what they are...an emergency to them. It means continuing to educate myself for several reasons to include: preventing stagnation, improving my clinical insight, staying ahead of, and/ or up to date with EBM, articulating myself better to hospital staff which in turn helps foster a professionally charged prehospital provider, accepting that mentorship comes in many forms, and is often indirectly learned when the mentor suspects it least.

If I could do it all overall again, I personally would not have changed a whole lot aside from maybe learning to be kinder, and more patient with most people a lot sooner, and a lot younger. People push buttons, patients are no different. It won't stop, and it won't change anytime soon. We can embrace that reality sooner in our careers and be better off for it, move on, and just provide what we define as care, or we can become embittered; our choice.

That leads me to my next question: what do we define as care? Is it providing "life-saving" measures to an arrest? Rushing a critical trauma patient to the regional trauma center "hot"? Is it seeing that the diabetic has food in the fridge before leaving their house on a refusal, or even understanding some diabetics are truly better off observed, and/ or admitted to the hospital regardless of how benign their complaint seems once they've been woke up from a diabetic coma? Is it talking down the psych patient with soft skill so well that you see the person in them when not in a ballistic fit of rage? My personal belief is that it is all of it. We're an all encompassing outlet for the sick, and ill, but who are we to define sick, or ill? emergent, or non-emergent?

We either accept this job for all of what it is, or have no business embracing any of it for a lifetimes worth of a career, let alone as a stepping stone. I am choosing to embrace it more and more everyday. Is this a new topic? Hardly, but perhaps one ore two newcomers to this site will read it before asking "what's it like being an EMT or paramedic?", or "what should I expect?"...

This is where I'd like to hear from others old, new, and in between. What's it mean to you? Is it really racing the reaper from the clutches of death (be honest, it can only help improve your longevity)? Is it hand holding, and or just being so nice you don't get sued? Is it being the ultimate badass clinician that all other seek to emulate? Is it that stepping stone to a better paying career because you "just know" this isn't for you forever (totally fine as well)?

Whatever it is that this line of work means to you now as it stands, your insight and honesty are appreciated; it can only help build on a "professional outlook", IMO. I figured it's time we open up some dialogue again, as it seems no matter how much any of us piss and moan (myself included), we are drawn back to this field, and/ or remain passionate about it. It has to be more than just truly defining punishment gluttony. Perhaps asking ourselves what we want from this field both in the beginning our careers, and with some time on will help guide our direction with what we're doing, and/ or where this field is headed.
 

akflightmedic

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I agree with much of what you wrote.

My summary is much shorter. I have gone from thinking I am needed for a singular emergent event to understanding my role and place in the continuum of care as a competent, educated team member where we all add value and need to work together to help the people in front of us. No, the real long term "emergencies" are not all guts and gore....the REAL emergencies are access to care and addressing all the non-glamorous causes of that elusive real emergency we all crave.

Basically, we SHOULD be working towards putting ourselves out of business (kind of like firefighters). They have increased building codes, public education, smoke detectors...they have impacted so many lives by educating, promoting and training...that the majority of today's FFs do NOT see even half the action a generation ago did (fire calls).

WE, as medical providers should be educating, promoting, advocating for prevention of all the things which cause the emergencies we see frequently. Twenty years ago you would never had heard me being a strong supporter of and actively participating in funding and establishing a Community Paramedicine Program or advocating for higher education entry standards.
 

NomadicMedic

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Good points and some good thoughts to ponder. I guess I still believe that EMS is the life ring that's tossed to patients who are at the end of their rope. I'm not counting the system abusers, taxi ride takers or drug seekers in this mix. I'm talking about the legit patients. I'm not so dewy-eyed to think that everyone who calls needs EMS, and I'm not so jaded to think that nobody needs EMS. I guess I'm still in the middle.

I find I get a fair amount of satisfaction from helping people who are at the end of their cope rope. The people who just can't take it anymore. The diff breather who is been suffering all day and it 2 o'clock in the morning got scared because it felt like they were sucking air through a coffee stirrer. The guy with intractable back pain who tried to muscle through all day and couldn't make it.

I like being able to help these people. Provide CPAP. Some analgesics to get them to the hospital. Temporizing measures, sure. But, at 2 o'clock in the morning we're the people that make a difference. And that makes it worth while to me.

I would be lying if I said I still didn't enjoy good trauma calls. I would lying if I said I still didn't enjoy working a cardiac arrest that flowed smoothly. I would be a liar if I said I didn't enjoy treating the truly emergent cases where I have to be a real paramedic.

I also enjoy low stress non-emergent transfers. I had the best conversation with a guy the other day, 45 minutes talking about his life and my life and his kids and my kids. It was a great call.

I also enjoy complex transports. The vent patient on multiple pressors. Those calls make me think. It makes me work. It sharpens my edge and makes me a better clinician.

In all honesty, I enjoy most aspects of working as a paramedic. I love to be outside. I love the fact that I never know what's going to happen with my radio tones drop. I love the fact that I work with a great partner who likes to learn.

And yeah, occasionally I like to be a hero. I don't think there's anything wrong with that. Most of us are type a personalities and we like the praise and feeling of satisfaction we get when we do our job well.

I'm not one of those guys that wants to become a PA or nurse. Not that there's anything wrong with that, it's just not what I want to do. I don't think I could spend my time cooped up in the hospital. I don't begrudge anyone who wants to do that, but it's not for me.

I enjoy the fact that I can work on side projects because I only work two days a week as a medic. I like the fact that I have a lot of freedom to spend time with my family. I like the fact that I can go to the beach with my daughter four or five days a week if I want to.

Working as a paramedic doesn't define who I am, but it makes what I am and what I do possible. It lets me have side projects. It lets me pursue higher education. It gives me the opportunity to get involved with protocol committees and helping to change regulations at a state level. It gives me the opportunity to become an instructor and help teach new paramedics. It gives me the opportunity to mentor my less experienced coworkers. It lets me make a difference in a life occasionally.

Take the job seriously, but most of the time not too seriously. Somebody said to me once that 90% of ALS could really go BLS and 90% of BLS doesn't need to go to the hospital. I guess I still like doing that 10% when they really need some ALS para-magic. I still like the job. I'm glad I'm able to do it and I want to keep doing it for a long time.
 
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VentMonkey

VentMonkey

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Good stuff so far guys, thanks. Where does this put our image, or the image that's been portrayed of what we do vs. what we actually do?

Should our profession get an "image overhaul", and do we really need such things as the Star of Life to distinguish us from the other public services? Would banking less on t-shirts with cheezy taglines, or grim reaper pictures on them help change our industry in more of a professional connotation for the better, or does it even matter?

For the newer providers: are you still being fed the same taglines such as "you can go from a cardiac arrest, to a shooting, to a baby delivery all in one shift" (or something similar) while learning the fundamentals of "emergencies" in EMT school? If so, do you believe it to be true? What if it isn't? What do you expect from the field?

It'd be nice to have some newer folks chime in as well. While we all tend to give one another a hard time now and again, experiences and expectations from novice to veteran only help open up, and continue dialogue so that maybe by some small chance we can begin to figure out where we are, and where we (collectively) need to be...
 
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Seirende

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Broadly, I think of EMS as a "societal safety net." My view of EMS has probably been shaped strongly by the couple times that I talked to dispatchers when I was a kid. The first time, I had no idea what was going on, only that "Mommy" was outside "looking at the grass" and she wanted us to call 911. My family has the recording of my five y.o. big brother and my three y.o. self having a pleasant chat with the dispatcher, while she directed an ambulance to my mom, who was experiencing a cardiac dysrhythmia. The second time, I again did not know what was going on, only that my father had told me -- in a slurred, almost unintelligible voice -- that he was dying. Being that I was eight, and the only person home with him, this was scary. In that case, there was no "real" emergency, no true life-or-death situation. However, being able to call 911 and have some grownups show up in a hurry was something that one panicked little girl very much needed that day.

In short, we show up for people. Sometimes it is an emergency, at all times it is service.
 

NysEms2117

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Now here comes a relatively new EMT's take.
To me I think EMS as a whole is trying to be the best person, and best provider of care(ranging from emotional, all the way to pacing/intubating) to the people that call us. We respond to some of the worst points of peoples lives. To me that is what being a civil service(man/woman) is all about. I also think my opinion is skewed a bit due to working in a different field before EMS(matured a little bit i think?).

My EMT school i think was very good, because they didn't feed that typical EMS drama that you see everywhere. My instructor was an EMT-B for 35 years, she said she had 2 shootings in 35 years, albeit she wasn't in a major city, but the point remains. While I personally don't know what it is like to be on a "normal" ambulance, I personally would like to see it eventually to provide the more "im here for you" support, as opposed to being on the CC rig(where i am now) where most of our job is the "life saving" stuff.

I think two really experienced and dedicated individuals(+ the OP my pal Vent) have chimed in, and i really think thats how we need to relay EMS. In EMT school sure it's cool to say "hey i saved somebodies life", but part of me wants to give more credit to the EMT/Paramedic that talked to the depressed patient, went the extra mile and saved somebodies life that way, as opposed to pushing ACLS drugs up the wazoo.

The only part that i will say about EMS is that I personally don't feel that "brotherhood/sisterhood". If any of you don't know i work LE as a main "gig" and i truley feel part of a brotherhood. In EMS, I know I can rely on my 2 partners, but when we go to the station or see other services, i just don't feel that "click".

Working as a paramedic doesn't define who I am, but it makes what I am and what I do possible.
This is something i whole heartedly agree with. *I am an EMT not a paramedic*.

In my opinion if we in EMS can stop being the reaper chasing tacticool folks, we will go leaps and bounds further. If we realize that all people have the possibility of being our patients(black,white, 7'11, to a 5 lb baby, drug addict, alcoholic) and we treat them as if our own mother/father were in the ambulance with us that is truly what we need to focus on. We have to realize that we are trained, just as the accountant is trained, or the tax professional, or lawyer. Our training teaches us to be calm in "emergent" scenarios, not everybody has that training. Grandma falling and breaking a hip can be terrifying to a grandkid, because they have never seen grandma cry before. For us it's BLS splint and non emergent transport, however thats now how everybody views it, it is THEIR emergency.

To answer Vent's newer questions, I hope I don't see another shooting, i really do, but i also need to be realistic. I hope nobody else on earth ever has a heart attack, but again I must be realistic and I would prefer myself and my partner to show up then nobody at all. I think we need to be pro-active, community involvement is key in every civil service field job. It can start with general physical health, then going to individual topics: seat belts, CPR within the first 5 minutes(some highschools are teaching every single freshman in gym class, to start faster compression times), things that will better society so we don't need to be the reaper racers all the time.
That is all.
 

NysEms2117

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VentMonkey

VentMonkey

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Well then perhaps someone can offer up their definition or opinion of what experience is? Is it a years worth of "gnarly calls"? Is it 10 years worth of a plethora of calls? Is it life experience, and all of the wisdom that follows suit.

I vote the latter of the three. The reason I created this thread is in hopes that it can be segued into various "meanings" that this job brings from various providers perspectives.

If we know where we're coming from then maybe we'll have a better understanding of where we are going, carry on...
 

NysEms2117

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I personally think an experienced EMS provider is somebody with the following:
1. Life experiences, has dealt with various situations good bad and indifferent.
2. Knows their sht medically.
3. Can truly understand people, whether that is a drug addict, or a 8 year old talking about how He wants to be like Lebron James.

I went through this same thing when I was in college, one of my teachers was probably the smartest man I've ever met(to this day) but he couldn't teach, because he couldn't make it fundamental enough to understand as a student. You can be the best paramedic(medical skill wise) to walk this earth but if you can't communicate to your patient it does no good, especially when the call isn't a "medical call in nature" The mind is a very powerful thing!!


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EpiEMS

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Well then perhaps someone can offer up their definition or opinion of what experience is? Is it a years worth of "gnarly calls"? Is it 10 years worth of a plethora of calls? Is it life experience, and all of the wisdom that follows suit.

I vote the latter of the three. The reason I created this thread is in hopes that it can be segued into various "meanings" that this job brings from various providers perspectives.

If we know where we're coming from then maybe we'll have a better understanding of where we are going, carry on...

As long as it's not 1 year of experience, repeated 20 times....
In all seriousness, it is life experience (and broader knowledge than the national standard curriculum) that makes a good EMS provider a *great* EMS provider.
 

StCEMT

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I kinda follow with what DE (it's easier to type DE) said, just with newer eyes.

At a very basic level, it's just a job to me. It pays my tuition, feeds me, and let's me buy some cool things.However it's a job I actually love doing which I can't say for prior jobs. I think it is an important part of the continuity of care. Not for everyone, I often get people I wish I could hand a refusal form.That being said, I also often meet people I realize what I do has an impact on the care they receive and I do love that part of my job.

I never really looked for it this way starting out, but it is a growing experience for me, both individually and as a provider. 4 days out of the week I am some bum college student and the other 3 I actually have the potential to have a lot of responsibility thrown my way. Today for example I transported a vent dependent 5 year old. Stable and not at all difficult, but I have also been entrusted with the oh **** ped calls more than once and that is pretty damn intimidating, especially knowing I am 10+ years younger than some of these parents. That's pretty humbling to think about being so new. I also get to learn a lot of cool **** from yall. I have a laundry list of jobs I'd love to do, but what I pick up here, in the field, etc. all help work towards attaining those goals and there is so much more to learn.

It's an opportunity to combine the only 3 career paths I have ever had an interest in. 1. Medical 2. Military 3. Teacher. I got to have a new EMT student do their very first ride with me the other day(#1&3). Kind of a dud day, but I got to try to throw in a few teachable moments about the equipment set ups, mentally preparing for calls, what dealing with people (drunk in this case) is really like and I enjoyed the chance. It helps not having forgotten that feeling of being lost and wanting to be a part of others growing from those first beginnings.

And I'll own it. I'm new and I love an exciting call. I am not the kind of person that likes to sit (not when I post all day). When I go to work, I want to do my job. I want to be challenged and to have to think. They don't necessarily have to be nearly dead or mangled, but narrowing down AMS causes, ICU transfers, etc are all interesting and require some effort and knowledge. And you're damn right I love being part of a well run code or seeing someone go from asystole to alert and talking 20-30 minutes later. I'm not so naive as to think that is the only thing that matters though. It's satisfying helping the little old lady clean up or be the first real conversation someone from a nursing home has had in a while. Those moments are still parts of this job I think are important.

And I am tired of typing on my phone and trying not to fall asleep, so I think that's enough thinking for now. Jumbled thoughts of wee baby medic.
 

hometownmedic5

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I think we all started out with a hero complex. I sure did. I wanted to be the guy. I wanted to save the world, one bls call at a time. Naturally, that mentality was beaten out of me forthwith.

Now, I see my job as making my patients feel better when they're in my care. This can vary from kind words, coherent explanations of what's going on with them, an ice pack or narcotics. Whatever my patient needs, I see my job as making them better than when I found them by the time I deliver them.

Too many medics, at least in my area, are lazy hacks. Their only goal is to meet the bare minimum for their qa requirements and have a story for why they didn't do this or that. They are more than willing to, in some cases at the level of the hard rule not the exception, patently ignore a patients needs so they do t have to do work. I truly don't understand why these people attained certification as, and remain, medics. If you don't want to intervene for your patients, go do something else.

So that's how I see my job. Making the people in my charge better than they were before I walked in the door.
 

NomadicMedic

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I've had a busy day today, but two calls from today sum up why this job is great and why I love it. One was an 90 year old lady with a femur fx. I medicated her, we moved her gently and get her to the truck. On the 45 minute trip I had her comfortable enough to talk to me about her world travels, the two books she wrote and her life growing up in Italy and how excited she was to become a US Citizen in 1954. The other was a 80 year old dementia patient. She was well cared for and obviously well loved by her family. Her daughter rode with us to the hospital and after we arrived she hugged me and tankednme for taking such excellent care of her mom.

These weren't exciting paramedic calls. I didn't race the reaper. But I made a difference today. I took care of people. It was worth it. This is what we need to do as paramedics.
 
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VentMonkey

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So how do we bridge this "gap" if you will, between the idealistic and unrealistic?

When you're being spoon fed images of exciting calls at a young, and often extremely immature age only to find out it is in fact so much less about your own ego, and so very much about someone who more often than not truly feels that they need your services and assistance?

I guess I kind of feel like with that giant gap in what it is we do versus what it is we may "think" we should be doing causes an endless cycle of frustration both for the sage and experienced providers, and for the young, and/ or new providers who have been oftentimes by no fault of theirs, mislead; there has to be a middle ground.
 

EpiEMS

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I was thinking about this...I cannot help but feel like there has to be some data to show people to indicate "hey, man, it's the rare call where your interventions are going to save a life", and emphasize how a large number of our patients need social workers as much as they need health care.

(i.e. Most of EMS is service to people who probably don't need much in the way of healthcare - and I need to find some data on this.)
 

NysEms2117

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So how do we bridge this "gap" if you will, between the idealistic and unrealistic?
my answer to most things now-a-days is education. As Epi said, most people need social workers as much if not more then they need health care.
SO wouldn't it make sense to restructure the EMS degree? Put social work classes in as part? I consider it a part of the degree, few examples:
Mathematics in computer science, psychology in criminal justice. By no means would you be a social worker, but you'd know the fundamentals, so maybe we can eliminate that 5 years of experience to get the hang of things, and the newer medics can start going right along, instead of having that learning curve.
In my opinion most of the issues with "Todays world" can be solved with educating the "problem". Whether it be in Criminal Justice, Healthcare, Accounting, whatever it is, chances are education can fix part of the problem if not all.
 
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VentMonkey

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I love it! This thread alone makes me feel better knowing that there are still good people out there, advanced certifications, degree, or not.

Someone mentioned the lazy "hack" medics at their service. I agree as well, and it's sad, but it's such a small part of a bigger problem. I really believe finding out where we are as it stands universally can really help us figure out where we need to restart.

I agree with education for many reasons beaten to death by myself and others on the forum repeatedly. I think if it detracts people that would otherwise view this career choice as "too much work" then that's that many more people that we do not need in the industry.

I like AK's points about preventive steps so much so that we decrease morbidity and mortality. Is it "cool", or "sexy"? Nope, but it shows that our services are indeed validated, and shouldn't that be what we all strive for?

I agree, I too still enjoy getting to know some of my patients (war veterans, and the elderly are some of my favorite patients), providing relief to their suffering whatever that may be. I also like a good critical call that validates my occasional need for a challenge with regards to prehospital medicine.

All in all it's good knowing that not everyone is so blindsided by cliches, symbols; "blood and guts" and taglines; bragging to others what they did, versus what they really didn't do.

It affords hope for that paramedic, or EMT who from time to time may lose sight and is bogged down by the "reaper racers" they feel outnumber them at their respective services.
 

StCEMT

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At least as far as I can tell, the reaper racer types are generally pretty known and not highly sought after as partners. I even have a buddy who is that type of EMT. Only worked with him once before I became a medic and I haven't sought him out as a partner since I did get a P number. Not because of ability, just the maturity. Most people I have met are at the very least, just there to do the job, but I have met many who strive to go beyond the minimums.
 
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