Ambulance Drivers: Why It's Our Fault No One Knows Us- Anna Ryan
Remember being a teen at Thanksgiving but you still weren’t considered an adult? You were put at a separate table from the grown-ups, your brothers and sisters were always poking you under the table or pinching your side, your cousin is throwing a temper tantrum because his peas are touching his mashed potatoes, and your dad is staring at you from across the hall mouthing that you had better eat your Brussel sprouts or you can’t get up from your seat. You want to tell your grandma that you got a part in the play or your uncle that you passed your history exam. You’re making big moves; great things are happening to you and if you could just get a seat at the table with the rest of the adults you could prove that next year you deserved to be there. You call out to your mom, “Hey look at me! Hey! I’m doing things you want to hear about! I’ve made big moves! Talk to me!” But all you get is your parents shooting you dirty looks as the rest of your family ignores you and your little brother punches your shoulder deadening your arm.
Is the visual lost here? I’ll break it down: fire and police are mom and dad; and, they’re allowed at the table by the rest of the public because everyone sitting there knows what they do. We are this fledgling service line that is just on the cusp of maturity, but still asking if what we do is ok. Instead of sitting there miserably, what would happen if we stood up with our plate and marched our grown ass over to that empty chair next to our 3rd cousin and sat down?
Why are we waiting for permission to sit at the table with the other services?!
Here in NJ, EMS is fractured and to start, BLS is a mess. There are volunteer EMTs who may or may not be considered a dying breed; the paid corporate service EMTs who cater to transports for their contracted facility’s non-emergent needs; the municipal paid service EMTs that are either based in a town fire department or police department; the other paid service EMTs that are also corporate in that they are owned by a hospital system; and the Mom and Pop shops run by people who were once EMTs and got their hands on some money, a couple of vans and some vinyl, and are currently running operations out of a garage on an abandoned lot of somewhere seedy. On any given day, any of those services can be in each other’s wheelhouse. A fire-based ambulance can do a transport from a nursing home while the transport company does a town 911 job they happen to also be contracted to. A police ambulance will respond to the fall victim, while 25 volunteers respond for the shooting. Woof!
ALS isn’t much better but at least there are less of us and only two options; you can work for a hospital or for a private company. Even then, you’re faced with adjusting to the standards of whatever BLS service responds with you and most of the time you’re demonized for the level of care you’re trained to administer. We fight amongst ourselves, we advocate for who is right on a scene instead of what is right for the patient, we disparage volunteers as being stupid vs paid as being entitled vs paramedics having too much salt in their voice or too much char on their attitude. We could fist fight in the parking lot of a “coffee with an officer” event and then wonder why no one takes us seriously. Somehow it eludes us to why it is that the public doesn’t know us and why the other services insist we hide in their ranks.
Put a steak on your eye and listen up; WE ARE NOT ON THE PLAYGROUND ANY MORE! We have a problem with the rest of the table. The public understands police and fire because they have been around for -literally- ever but even then, they had humble beginnings. Rome had volunteers that would respond to fires, that service has become the service we have now. Police were an extension of the courts in an AD era. Before that they were soldiers; that service evolved into the law enforcement brotherhood we have today. Each service had its ups and down but eventually they put their differences aside and managed to not only work towards a common goal but also reach the public in a way that got the public on their side. At what point do we do the same?
When we are ready to step up to our seat, the question we must ask ourselves is how do we do it? As a service, we can’t just stroll up to anyone’s table and sit without first introducing ourselves. If you’ve read anything else I’ve written, you can guess what I’m going to say next: education!! This time, however, I mean education of both those involved in EMS and those who are not.
I’m of the opinion that if we are going to go about increasing our ranks through our own curriculum then we may as well include duty in the ranks of it. The uncomfortable truth: volunteering is dead. At least where I am it is. There is a smattering of squads who are still up and running, who get out for every call and believe me they have my utmost respect but for the most part those who haven’t already become a paid service are headed in that direction and those who aren’t considering either are leaving the people they are supposed to be serving in the lurch. What we’ve therefore lost here is a sense of obligation to the public we protect. Paid EMTs may have noble intentions but their families eat on the hours they work so eventually they’re not doing it just for good intent. They are doing it to put a meal on the table or to make a mortgage or to make sure the dog gets the good treats instead of the ones that make his breath smell like feet.
Volunteer EMTs start out with even more noble intent. Let’s be clear, I started in this field as a volunteer and there will never be a time that I will disparage their efforts. There have been calls I’ve arrived at with a volunteer squad that have been particularly difficult and while I may have struggled with it these people were out there doing it for free! Let’s be more clear, in the day and age we live in asking someone to do a job for free is simply unrealistic. No matter how dutiful volunteers would like to be they can’t be at the station at 3pm when grandma has a heart attack if they also have to be at work. It’s the nature of the beast, and the beast is dying.
Not all is hopeless, but this isn’t a one size fits all fix. It will take work to implement and even more work to maintain but consider the seat we so covet.
First, we have to find a way to get people interested in EMS again. If the people of the community can’t volunteer, then the only place for our service to go is to a career track. Some states have it, I’m sure, but tell me why it is that we aren’t in vocational schools? Is this field not most commonly a route that students take to get to the next level of providing healthcare? Why is it ok that we are still just a stepping stone? And why aren’t we capitalizing on the requirements of medical schools and hospitals; where you must have your EMT at the least to be accepted or be offered a job. Why aren’t we in the unemployment offices offering people a way to enter the job market again? Yes, the stigma exists that those walking that line are not worthy humans, but I’ll tell you I’ve been on that bread line and I would have given anything to be offered more than a resume’ tutorial and a hand out. How will those people pay? They won’t. Its state funded. And they have to pass, or they have to pay the money back. An initial EMT class here costs upwards of $1,500 if you’re not affiliated with a first aid squad, talk about motivation
Now that we have the students with the motivation, we have to reexamine the content of our courses. There is not a single other line of healthcare that demands respect and allows their providers to touch the public in a meaningful way after only attending a cumulative 5 weeks of class. If your ER physician walked into your room with a blood pressure cuff and sweat on his upper lip, nerves clearly rattled like he had never seen a sick person before would you trust his diagnosis or any of his interventions? No, hopefully not. You’d be crazy to! So why do we allow for our communities to be served by people held to those standards instead in their worst moments?
Our classes are not up to the scientific standard of where medicine is now, and we are lacking for it. The whole of the profession is halted and for what? Because we are scared that the content may turn people off to the class? Well, that’s not a problem anymore if they want a cert on their resume or a job to feed their families, so let’s put them through their paces! Let’s re examine what we present to these laymen and make them clinicians, and in doing so let’s make the lofty titles above us take notice. A nurse should be so involved in your upbringing as an EMT that there isn’t a question as to what you are doing in her ER at 3 in the morning. A doctor should know your face because he taught you medical terminology, not because you brought in the “frequent flyer” for the third time this week. I’m not saying we shouldn’t teach our own, that’s unrealistic. I’m saying we should not only build a class on current sciences but involve our hospital staff and those being trained to take our reports to ensure continuum of care. We are too detached from them and truthfully, we are their roots.
Once we’ve reinvented our standards, lets instill that sense of duty to our communities again. I have a friend who just graduated the state police academy after a grueling six months, and while I won’t be the one to tell you to send your students out to bear crawl on the beach, part of her training made her get involved with a community charity. It gave her a sense of duty to the people she would eventually be serving and even familiarized that community with her as a trooper. Why aren’t we doing the same thing?
Send these eager students, of any skill level, out into the world to get their hands dirty with the community while they are learning to heal it. All along the spectrum of provider education are small chapters and tiny mentions of how important being part of the community is, but nowhere is it discussed how. Let’s do that here. Soccer games are a good place to start; you can have them hand out band-aids to the bruised and abraded while learning from the athletic trainers how to wrap an unstable joint. They can show the moms in the bleachers that there’s a force developing that will protect their children. Put them in assisted livings so they can learn to relate to the elderly, gain tolerance and patience with the forgetful or disabled. Directors at these facilities have a quota of community outreach to do each year and they’ll be thrilled to have the attendance. Have your students meet these people’s families and explain why they’re there, what they’re working towards, and how they respect their loved ones as part of their community even when some others would not. Put them in shelters, homeless or women’s, and have them do assessments and vitals; but most importantly have them talk to the residents. Engage in active listening, make their patients feel welcome and heard where they maybe haven’t before, aid the nurse on location with bandaging or starting therapies if the student is at a higher level.
Task these students with finding a way to invite the public to come and see them in action; a touch a truck event, a carnival with “ambulance” hay rides for a small cost that they’ll donate the proceeds to a soup kitchen or a children’s hospital. Make a presence in the community and be prepared to constantly explain who we are, not just on a surface level but as a demonstration of professionalism and education. The result? We become a fixture of our own merit in the streets. We aren’t just part of the fire department or the police force. We are finally seen as EMS, the people who they are going to trust their kids to and allow to speak to our confused great uncle; we become public servants made worthy by our own design and most importantly not just an ambulance driver.
Finally, we must step out on our own. We must grow up. We deserve our own service line because we train differently than any of the others and offer services that aren’t like anything else that will walk through the door in a crisis. We shouldn’t show up to a call for service in a fire department ambulance or a police department truck because then we’re an afterthought. We must show up in public funded rigs because we are for the public, “ANYTOWN EMS” across the cab. We must establish our own training standards equal to our initial licensing standards and let the public see that we are maintaining ourselves at the top of evidence-based practice for their benefit. We must maintain our community outreaches, along side the other service lines so we are never out of the public eye again.
Its easy for me to sit at my computer and paint this picture of the EMS phoenix, rising from the ashes of our own minimization to become this mythical creature of public service. The truth is this is nothing without the group of people on the front lines and in the classrooms standing together and being ready to work. We don’t have a presence, the way we are trying to get one is much like standing in the middle of a mad riot, screaming for people to rally behind us without a bullhorn. We have to stop standing in our own way and evolve. There is a seat at the table just waiting for us to fill it, but we have to be worthy of sitting with the adults. The alternative is getting comfortable at the kids table; little ambulance drivers still crying over our deadened arms and cold brussel sprouts.