Houston was underwater, Florida about to be, and I was nestled in my football chair in New England getting ready for the start of another NFL season.
The pre-game ceremony started a little differently this year; the announcer took a moment to recognize the emergency medical teams and the first responders who were working tirelessly following the destruction that resulted from Hurricane Harvey, and whatever the future held for Miami.
Wait a minute ... did I hear that right? Emergency medical teams and first responders?
Is that what the public thinks of EMS? Are we not considered first responders?
I guess not. Most of us do not respond to 911 calls. Most of EMS is privately operated as for-profit businesses. Many EMS providers work non-profit, hospital-based ALS and BLS inter-facility transport units. Many communities contract privately-owned ambulance companies to respond to emergencies.
I spent 25 years working with the Providence Fire Department, first as a frontline firefighter, then as what we labeled a rescue technician and finally as an EMS officer responsible for providing ALS care at emergency scenes. I never considered any of my roles anything but first responder.
My time on the ambulance was every bit as dangerous as when I worked on engine and ladder companies. My crew of two was first in at building fires, shootings, mass disturbances, murders, building collapses, heart attacks, childbirth, diabetic emergencies, intoxicated people, babies with fevers and lonely elderly people worried that they were dying.
When we were not first in at emergencies, we were quickly rushed to the very reason for everybody’s response – people whose lives were in danger. Our job was the first and foremost mission for all public safety – protecting the lives of the people who needed protecting.
As a firefighter, I worked with a great team of like-minded individuals, all of us with the same goal; protecting lives and property. My EMS role was more focused on protecting lives than property, and rightly so.
I was fortunate to be in the position to help save a lot of lives, and the vast majority of the saves I was personally involved in occurred while I was assigned to the EMS unit.
Responding as a team, with police and firefighters providing security, and handling fire, collapse, manpower and the thousand things that potentially go wrong on an emergency scene, I was able to do my part in saving those lives as a vital component of an effective response effort – each of us doing our part to ensure the best possible outcome.
Private vs. public EMS entities
For EMS to become the third arm of public safety, right alongside law enforcement and fire departments, some separation must occur.
We simply cannot all be considered vital infrastructure while existing with profit as our business model. Private security companies exist for profit, armored trucks with armed security routinely work alongside the public, fire inspectors are employed by insurance companies and fire extinguisher businesses flourish.
EMS needs to distinguish between private entities and their part in the public safety equation.
If opportunities for paramedics and EMTs were as vibrant as they are for our police and firefighter colleagues, there would be no need to separate the services we provide.
Unfortunately, by grouping all of us as EMS, our essential piece of the public safety puzzle is overlooked, and the providers pay the price.
Fire-based EMS is sometimes paid on par with the fire service employees, but often is not. Privately operated ambulance companies pay what the market dictates, quite often wages just above the minimum wage.
The industry suffers from career burnout, depression, lack of motivation and overall dissatisfaction with EMS, leading to increased injuries, excessive turnover and the inability to inspire public confidence.
Distinctions between EMS roles
The common denominator that holds EMS together is the people who respond. We are the people who provide care, professionalism and safe transport to the public.
We are the people who interact with the very reason public safety exists; the safety of the people we are sworn to protect.
Some take that oath in a well-attended ceremony, right hand raised, solemn words repeated and badges pinned to our chest. Others pass the drug test, don’t have any priors, have a license and show up for work.
Some are dispatched for life threatening emergencies. Some do routine transports. All of us take care of people who cannot or will not take care of themselves.
None of us are considered part of the vital infrastructure that holds the country together during crisis.
So, how do we change the public perception that EMS and the people who provide it are almost-but-not-quite first responders?
Seperation. We are all competent providers, dedicated and caring, but we are not all the same, nor do we all want the same things from our EMS experience. There is room in EMS for people who seek nothing more than an 8-hour shift with few complications, transporting stable but unable people.
We have plenty of spots for people who enjoy transporting fragile elderly patients to and from their appointments. Plenty of people need to be taken to dialysis centers and cancer treatment centers.
And of course there is always room for people who are willing to respond to the unpredictable 911 emergencies, which at the end of the day, puts the “E” in EMS.
