Strategies for Longevity in EMS

No matter how gifted you are, your talent comes without instructions. In fact, some of us live for decades without realizing we’re actually pretty good at dealing with people who suffer.

Aided by partnerships with wonderful caregivers and great teachers (many of whom were once sick people), this author survived many years in EMS by learning to see the work as a source of joy rather than a feat of endurance. Please consider the following 12 strategies in the evolution of your own career.

1. Love what you do...

We all have good days at work, and we all have bad days. But for people who are born with the right gifts, EMS can be more than just a great job. If you like people, have a feel for their suffering and like taking care of them, EMS can be a daily source of joy for you.

Think about the fact that every single person you meet in an ambulance is someone who’s not as fortunate as you are. They’re all having the worst days of their lives—struggling for every breath, facing the consequences of a stroke, dying of something, grappling with a mental disorder, maybe, or freakin’ scared to death. Being an EMT means going to work every day and being told over and over, by people you don’t know, that you’re so lucky. So lucky. Not everybody gets to do that.

Don’t forget, there is life after EMS. You’re going to get too old for the work someday, and you may retire. If you do, your memorabilia will be absolute treasures—unless you didn’t have the foresight to collect any. If you haven’t been keeping souvenirs, start now. Ideally you should keep your original CPR card, your first EMT certs, your insignia and badges, and maybe an old uniform or two. Keep photos of your EMT instructors and the people in your first EMT class, your first partner and your first ambulance. Try to rescue and keep some of the equipment your agency discards when it becomes outmoded or gets broken.

Take pictures, too, of your tools; they’ll be wonderful topics of conversation for the rest of your life. And keep every single card and thank-you note you receive from sick people and their families. Those things are like a paycheck that never gets spent. They’re priceless reminders of people who appreciate what you do for them. Throughout your career, you can lean on them after shifts when you’ve tried to help somebody and they responded with disrespect. We all need to be reminded, from time to time, of the dignity of our work.

2. ...And if you don't, stop!

On the other hand, if you find you hate being an EMT, stop. As EMS educator Greg Friese has observed, “It takes a lot of courage to leave anything, even when it is miserable.” So many of us seem to get to that point and hang on, making those around us even more miserable than we are.

If you’re miserable, stop. No matter how you got here or why, do something else. EMS is not something you can continue to practice if you hate it. Why? Because other than loving your work, EMS’ rewards are small and not predictable. Hating this work can induce you to take shortcuts, and when you do that, you inevitably make sloppy, deadly mistakes. (When you make those kinds of mistakes, you generally take someone else down with you. A partner, maybe, or a dispatcher.) Besides, if you hate taking care of sick people, they will find endless ways for you to demonstrate it clearly—to the ones who love them, to other caregivers and to the general public. None of that ends well.

Nor does leaving mean you have ceased to be—or have ever been less than—good and decently human.

Consider the following benediction from South Carolina ED physician Edwin Leap: “To everyone who sees and intervenes in life-and-death situations, I say this: You’ve done more good than you can ever imagine. If you tell me it hurts too much to go back, then there’s no shame. Go in peace. Because that 200-proof pain is bitter stuff. And you don’t have to go to combat to get a bottle full of it.”¹

3. Balance = health

You’ve studied chemistry, biology, anatomy and physiology. You’ve also maintained relationships with parents, family and other loved ones. By now you realize that all of life is about balance. EMS is important, and it will always be bigger than your job. But your life is bigger than EMS. Imbalance, no matter how you decorate or sanctify it, is unhealthy.

Discipline yourself to think of EMS as a part of your life. Those two things can never become synonymous. If you work in a system that usurps your personal life due to its lack of financing, planning or necessary resources, you’re working in an unsustainable system. Either it needs to change, or you need to leave. Divorce, substance abuse, depression and poor health are simply not components of an EMS system’s design.

Prior to the preparation of this article, the author sought input from 35 veteran (more than 15 years’ experience each) caregivers, all of whom were EMTs or paramedics, four of whom were also nurses, two licensed clinical psychologists and one a physician. Most of those who responded stressed the importance of leaving work at work.

One of those veterans is Ed Bevers, NRP (30 years, Lakewood, CO). “I’ve seen some providers just not be able to handle the calls,” he says. “For instance, bad injuries, multiple fatalities or just being overwhelmed with the calls they’re running. Mostly, though, I believe it’s because they’re unable to integrate work into their lives. By that I mean they allow work to dominate their lives, leading to problems with relationships and health.”

4. Stay humble

Samuel Johnson has been quoted as saying that the true measure of a man is how he treats someone who can do him absolutely no good.²

That S in EMS stands for services, and to serve others we need to learn to humble ourselves. Having precepted many, many EMT and paramedic students, one learns how impossible it can be for some people to learn humility. Still, it’s more a discipline than a gift. We seem to learn it best from great models—Ghandi, maybe; Jesus, the Buddha, our parents, our preceptors and other caregivers (especially CNAs and hospice workers). We also learn it daily from some of the sick people we meet and their families. As an EMT, you have probably noticed that some of the finest people you’ve ever met have been plainly wrapped.

Gary Wiemokly, RN, NRP (41 years, Enfield, CT), acknowledges the low pay and lack of respect EMTs receive but also stresses the importance of humility: “We serve others on bended knee, on the worst days of their lives,” he says. “We do it willingly and without regard for compensation, (or) at times even our own well-being.”

Humility is one of the gifts EMS gives back to us, and if we allow it to, it can make us better people. In case you haven’t thought about it, next time you’re on scene at a private residence, note the body position the crews instinctively assume. They tend to kneel, don’t they? See, as an EMT, you dignify yourself most when you lower yourself.

5. For extra income, look elsewhere

If you find it impossible to make ends meet on an EMS provider’s salary despite allocating your resources sensibly, you’re not alone. Plenty of us have depended on secondary incomes. But if you resort to secondary employment, try hard to find something that’s totally unrelated to EMS. Why? Because we all need to get away from EMS sometimes. You need to take care of your primary source of income. And in doing so, you can’t afford to report for your regular shift already tired of listening to other people’s problems.

By the way, great caregivers tend to be really bad financial planners. It’s just how they are. Don’t merely rely on your employer’s retirement strategy to somehow take care of you. Your future is your responsibility, no one else’s. Find a good financial planner to help you manage your resources and take control of your own financial future.

6. Keep your family first

EMS can be a tough life, not only for providers but also for the families and loved ones whose support is so essential to us all. Communicate honestly and openly with those who love you, short of subjecting them to endless war stories. Make sure they understand your schedule, your call load, your sleeping patterns and your requirements to work sometimes when most people aren’t working. But take care to talk less than you listen to their accounts of life while you’re away. And try to remember that your important work doesn’t always matter as much to them as a once-in-a-lifetime family event, a wedding anniversary, a funeral or a soccer game.

7. Remember how much you matter

Some people exaggerate when they recruit EMS providers. To listen to them, EMS is all excitement and public adulation. That’s nonsense, of course, but it’s not news that people want to know that what they do matters.

Adam Grant is a professor of psychology at the University of Pennsylvania’s Wharton School of Business, where he is the school’s youngest tenured and highest-rated professor. He has consulted for numerous organizations, including Google, the United Nations and the U.S. Army. His most recent book describes three natural dispositions one finds in people: givers, takers and matchers. According to Grant, these dispositions have a strong influence on people’s happiness with their work in various industries And they influence the personalities of organizations. In Grant’s terms (and by anyone’s description), the happiest people in EMS are certainly the natural givers.³

But there’s a reason why we call this work: It’s work. Sometimes it’s the most challenging, most dignified, most important work in the world, but most of the time it’s pretty mundane. There are station duties to perform, vehicles to clean, equipment to check, charts to write, interns to precept and meetings to attend. There are also skills to practice, public education to conduct, interagency drills to attend, continuing ed requirements to fulfill, and recerts to complete—not to mention some calls, cover moves and standbys. Hopefully you’ll have a little time for chow in between, and maybe you’ll even get some sleep.

8. Get your beauty sleep

Speaking of sleep, many EMTs are still assigned to 24-hour shifts. If that includes you, and you know you’re likely to run night calls, avoid eating big evening meals. Then, once your station’s evening routine is done, hit the sack early.

There’s nothing you can do about back-to-back calls. But going to bed at 11:30 or midnight when you know you’re up for a call doesn’t make much sense. Also, try not to schedule anything until after noon on the following day, in case you get hammered, and keep track of how many hours you sleep without interruption. When you get off duty, if you haven’t had enough sleep, make a nap your first priority. Most of us are cranky if we don’t sleep, and whether we admit it or not, we’re terrible drivers. Both of those are natural consequences of 24-hour shifts, which can make us hate our jobs, jeopardize our family relationships and cause accidents that hurt us and others.

9. If you need help, ask!

Depression can be described as a state of sadness, unhappiness and loss of interest in life. It’s not necessarily pathologic. For instance, it’s normal to be depressed following the emergence of bad news, like a significant breakup or the death of a loved one. But sadness without a focus or an identifiable cause is not normal. There are many such causes, and some of them have been attributed to the work of an EMT. Others probably have nothing at all to do with being an EMT. Either way, if you find yourself stuck in a rut and can’t seem to get better, don’t go it on your own. Take some help for yourself. Seek a source of professional help and pursue it until you get better.

10. Take a well-earned day off now and then

Think about the last time you flew on a commercial airliner. During the preflight instructions, did the flight attendant tell you that in the event of an in-flight emergency, oxygen masks might drop from the overhead compartments? And in case that were to happen, did he or she instruct healthy adult passengers to secure their own oxygen masks before assisting children or other passengers? Well, mental health days work like those oxygen masks. Every single one of us gets overwhelmed sometimes. When that happens and you feel the need for some “oxygen” before you can take care of even one more patient, take a day. Remember, you’re not a machine.

11. Let criticism make you stronger

No matter how hard we work to obtain and maintain them, our certificates and licenses don’t belong to us. They belong to the public. Consequently it’s standard practice for our medicine to be scrutinized, questioned and criticized by colleagues at all levels of practice. That’s not personal, and it’s not meant to offend anyone. It’s how we and every other medical professional learns. Try hard not to be intimidated by that, whether you’re a brand-new EMT or a 20-year medic.

In fact, embrace it. None of us know everything, and you probably don’t respect people who pretend they do. Next time someone criticizes one of your calls, offer to research the topic and present it as continuing education. You don’t need to be a red-hot teacher. (Who knows? Maybe you are!) Research the call and present what you learned from it. Be yourself and do the best you can. The very least that will happen is you’ll become a better EMT.

12. Recognize toxic work environments—and flee

Some organizations support cultures that are not good for you, and they’re easy to recognize. Perform an imaginary “physical exam” on any organization where you consider working and look for the following three signs of diseases that could render a long, happy career impossible:

• Gossip—We all gossip too much. Maybe that’s because EMS people are people people, so they find people interesting. But gossip is not benign. It can sabotage people’s careers, end their marriages and destroy their lives. When you interview with an employer, think of yourself as interviewing them just as much as they’re interviewing you. In fact, do one or more ride-alongs with them as part of your own selection process. While you’re in their stations, listen to how they talk about one another. Do the crews respect one another (including their leaders), or are they a bunch of blatant backstabbers? Pay attention also to how their leaders talk to and about the crews. You can expect them to regard you in the same way.
• Intellectual dishonesty—In some organizations (public and private), dishonesty is a normal daily business strategy. It always emanates from the top leaders, and it’s always a potential threat to every single member of the organization. If anything good comes from gossip, it’s this: Even a small serving of gossip contains a grain of truth. When you “interview” a potential employer and you’re listening for gossip, pay attention to how the crews talk about their leadership. Listen for evidence of distrust. If you find it, you should probably consider a different employer—one with an environment that won’t eat you alive.
• Disrespect for safety—One of the disadvantages of being an EMT or paramedic is that you’re always one injury away from the end of your career. If you can’t lift, you can’t run calls. An advantage of riding with a prospective employer’s crews is that it offers you evidence of an agency’s approach to safety. Clean, up-to-date equipment tells you the crews and their leaders are serious about checking and maintaining the tools that can either earn you a living or kill you. The crews in that kind of organization tend to talk about safety consistently, faithfully use their safety equipment and feel more personally valuable. (That single thing—a sense of personal value—is the most powerful key to safety in EMS.) Conversely, sloppy, old, banged-up ambulances with missing inventory are indisputable warnings that an organization takes no pride in its name and doesn’t respect its people or its mission. And finally, consistent crew discussions about frequent injuries, high turnover, poor morale and careless driving practices should scare you away before the end of your first ride-along.

Find related content from Thom online at www.emsworld.com/12246926 and www.emsworld.com/12246929.

Footnotes

1. Leap E. Suffering and Burnout in the ER. Huffington Post, www.huffingtonpost.com/edwin-leap-md/suffering-and-burnout-in-_b_8448704.html.
2. Grant A. Give And Take: Why Helping Others Drives Our Success. New York: Viking Press, 2013.
3. Ibid.

Thom Dick has been a passionate advocate of sick people and the safety of their field caregivers since 1970. He has written hundreds of articles and three books on those subjects, including the People Care books. Order the second edition of People Care here. You can reach Thom via Facebook or at boxcar414@comcast.net. Thom is also a member of the EMS World editorial advisory board.