EMS Providers: Are You Out of Your Friggin’ Minds?!

This was the message from American Medical Response Chief Medical Officer Ed Racht, MD, to his staff for EMS Week.

This is National EMS Week. Sponsored by ACEP and NAEMT, National EMS Week was started in 1974 to bring together local communities and medical personnel to publicize safety and honor the dedication of those who provide the day-to-day lifesaving services of medicine’s “front line.”

If you’re reading this, that’s you. This is the week when everyone in every community, in every walk of life, regardless of who they are or whether they’ve ever even needed you, says thanks.

Are you out of your friggin’ mind?!

On your own accord, with no one twisting your arm, with (in principle) sound mind and body, you decided to pursue a career in EMS or one directly supporting the myriad of critical efforts that have to come together exactly right to make the clinical care of EMS effective. You’ve chosen to be part of a team that focuses everything they do on taking care of others. Unbelievably admirable. But I have to ask you…

Do you not realize that almost everyone else you know—most of your neighbors, the majority of your family, total strangers, even—sleeps at home almost every night in their own beds? When it gets dark outside, the sandman cometh and takes them to la-la land. They enjoy a great night’s sleep with only an occasional noisy cricket interrupting their slumber. Not you. Nope. Ha—you made that choice.

When the weather is yuck—it’s raining outside, pouring, snowing, hailing, lightning like your mom used to scoop you up for—everyone else is high and dry. Not you. You’re out in it. As a matter of fact, the more it rains, the nastier the weather gets, the more you go into it. Are you out of your mind? Smart move, this choice of yours…

When your best friend smells something nasty—vile, rotten, horrific, one of those smells that stops them in their tracks gagging—they grab their nose, cover their mouth, scream, make some disparaging comment and find the fastest way away from the stench. Not you—nope. You smile, decrease your respiratory rate and depth, shift from nasal to mouth breathing, find a mask, long for anything peppermint and press on. Not your non-EMS friends. They’re gone. Choking and gagging all the way to safe smell-land.

If someone pokes or punches your buddy in the chest and calls them a disgusting, rude piece of [insert substance of choice here]—degraded them and laughed—they’d probably poke back, push, counter-yell and ramp up an impressive defense. If they were birds or reptiles, feathers and scales and big red things on their heads and under their chins would puff out. If they could spray, they would. Not you—nope. You’d resort to a calmer discussion, reposition yourself and (short of immediate need for defense) try to de-escalate the anger. No battles? Are you out of your friggin’ mind? Really—you chose this?

I’m guessing most of your non-EMS pals head for home when their shift is over. Last time I checked, the guy in the men’s department at Dillard’s didn’t hang past his quitting time because there were people holding up sweaters and someone just might want to buy one in a little while. How about you? The shift is over, and someone decides to change their anatomy or physiology, and instead of you heading home and enjoying your family, away you go. Brilliant career choice—spouses, kids, significant others love to get your call that you’re late because someone had those infamous two beers.

So, most of the grocery stores are closed in my neighborhood on Christmas and Thanksgiving, along with a few other holidays. Their employees celebrate at home and make cool holiday memories every single year. Not you—nope. You chose the 24/7/365 gig. Smooth move, ex-lax (remember that little saying?). Your memories will probably be everyone else’s catastrophes. You chose this, remember?

So again, with all due respect, I just have to ask you: Are you out of your friggin’ mind?!

I mean, really?

When you’re getting ready to end a shift in the middle of that rainstorm, hail and massive lightning on Thanksgiving Day, when your buddies are all celebrating with their families and your own family is at home without you, and you respond to an intoxicated, homeless, abusive, screaming guy on the third floor of a warehouse with broken steps, rats, roaches and other “things in the dark,” and he spits at you, cusses, swings and coughs while through the broken glass window you watch the guy from Dillard’s heading home in his warm car so he can grab some quality family time then snooze the night away without tones, radios, screaming (careful), and the cop looks at your patient and says…

“Your choice, pal: jail or the hospital?”

And you chose this?

Granted, in fairness there are other encounters and experiences in the EMS world that are slightly different. It’s pretty neat to wake up an unconscious, hypoglycemic diabetic patient whom everyone else outside the store thought was “dead.”

And it’s indeed true there are very few professional feelings that can match the way you feel when you shock a patient out of v-fib and feel that pounding pulse and realize you just helped pull someone out of the Big Doorway.

And granted, it’s one of the best professional compliments in the world when someone looks at you with those really scared, what-the-heck-should-I-do? eyes and asks, “What should we do?” Even better, when they ask, “If this were your dad, what would you do?” Translated, that means that on one of the toughest decisions they’ve faced in a while, they want a recommendation from you—a total stranger.

I have to admit, it’s nice to be able to create order out of others’ chaos. And it’s even better to do it in a calm, confident way. People watch that in amazement. They have no idea what’s going on inside our heads, but what they see outside makes their world better. Immediately. That’s powerful.

In a very weird kind of way, it’s also kinda neat when someone seeks you out at a party or in a restaurant or at the football field or somewhere that’s nowhere near work and says, “Excuse me, but they need you over there.” Work? Yeah. Phenomenal sense of worth? You bet. Ability to change someone’s outcome for the better when you least expected it? Priceless.

It’s pretty satisfying to give a complex radio report on a train wreck patient and have the receiving facility respond “Sounds good—see you in eight.” Translated, that usually means “Good job—nothing for us to add.” Got it right.

And it is nice that total strangers immediately trust you enough to tell you things they will tell no one else (and usually deny later, but that’s neither here nor there).

It’s nice to have a job where so many strangers greet you with “Thank God you’re here.”

And think about this: Do you realize that what you do is so important, so time-critical and so vital to people that we measure your ability to do it within minutes and seconds? Not within the day. Or this week. Or by the end of the month. In the next few sweeps of the hands on a clock.

And, while a bit awkward at times, it certainly is nice when some stranger (them to you, not you to them) comes up to you in public, hugs you or shakes your hand and says, “Good to see you again!”—and you realize you have no earthly idea who they are, what happened to them, when it happened or where it was. But you can tell by the way they interact with you that they know every detail. And then they introduce you to their family. Nice to meet you, Stranger Family. Glad I could help (whatever I did).

When people see you in uniform, carrying “that stuff,” or watch you in the ambulance, command vehicle or engine approach an intersection with blaring lights, sirens, pomp and circumstance and pass through, you know for a fact that they think to themselves, I wonder what happened—wonder where they’re going. It’s the intrigue of the secret world of lifesavers. I do it myself every single time I see it.

It’s also nice to be able to take a whole list of confusing symptoms, past history, medication names and a physical exam and come up with the answer to the puzzle.

It’s nice to tell a terrified mom that her infant son has a scalp laceration, and all the red on the floor doesn’t mean this is the end. Talk about instant relief. Powerful.

It feels good when total strangers in healthcare or public safety come up to you after a particularly tough call and say, “Nice job.”

And it’s one of the most powerful compliments in the world when someone looks at you with that distorted face, scrunched-up nose and squinted eyes and tells you, “No way could I ever do what you do.”

But I’ve digressed. I started this discussion with an important question for you: “Are you out of your friggin’ mind?!”

You chose this craziness. You chose the challenges. You chose the risk. You chose the unknown.

Think of all the people you know who didn’t. Think of the folks who didn’t have to respond at the end of a shift in the middle of that rainstorm, hail and massive lightning on Thanksgiving Day, when their buddies were all celebrating with their families, and their own family was at home without them, and they responded to an intoxicated, homeless, abusive, screaming guy on the third floor of a warehouse with broken steps, rats, roaches and other “things in the dark” and he spat at them, cussed, swung and coughed while through the broken glass window they watched the guy from Dillard’s heading home in his warm car so he can grab some quality family time then snooze the night away without tones, radios, screaming (careful), and the cop looked at the patient and said…

“Your choice, pal: jail or the hospital?”

Funny thing. Those are the same people who will never have a chance to know what it’s like to wake up a diabetic or provide order in someone’s chaos or restart a dead heart or know what to do when everyone else is panicked or get those hugs from the strangers or end an exhausting, wet, busy shift when everyone else is playing and say, “Wow. Not a bad gig.”

So, coming full circle, I have just one question for those folks who didn’t choose to devote their heart and soul to EMS:

Are they out of their friggin’ minds?!

Happy EMS Week. I’m proud to be your colleague, and I’ll tell you, not a day goes by that I don’t think about what an absolutely fantastic, amazing choice the EMS profession is.

You are one of society’s greatest treasures. This is your week. Bask in the praise.

Ed Racht, MD, is chief medical officer for American Medical Response. He has been an EMS physician for 25 years and served as medical director in private, fire-based, third-service, public utility and volunteer EMS systems.