EMS World Expo Opens in Las Vegas

LAS VEGAS -- The thousands of providers and responders attending EMS World's 2011 Expo in Las Vegas got a few words of advice from the keynote speaker today: don't ever become emotionally bankrupt.

"If your emotional bank account runs out, you're out of the EMS business," said Mike Smith, a paramedic and EMS provider for more than 39 years. "You've got to recharge your emotional batteries or you're done.

Smith is the program chairman for the Emergency Medical Services program at Tacoma (Wash.) Community College and a member of the EMS World editorial advisory board. He was tapped as the keynote speaker at the last minute to replace Federal Emergency Management Agency Deputy Administrator Rich Serino who was busy back on the East Coast dealing with the effects Irene left behind as it blew through the region.

Also welcoming the responders to the Expo, which is co-located with Firehouse Central and Enforcement Expo, was Mike Myers, chief of Las Vegas Fire and Rescue. In his welcoming comments, Myers said "doing more with less" is no longer a cliché, but a way of doing business for first responders everywhere. The expo and conference runs through Friday, Sept. 2.

In the past decade, he said Las Vegas has seen its land mass increase 13 percent, its call volume increase 31 percent, and its population increase by 36 percent, yet the department has added only 31 additional firefighters since 2000 and only two engine companies and six rescue units. Clerical and training staffs have been reduced as well, he said.

"We are clearly doing more with less and it's not uncommon everywhere," Myers said, noting that's why it is important for people to get all they can out of conventions like EMS World Expo.

"We are here to listen, to learn and to seek our benchmark... so we can be the best," Myers said.

In his remarks, Smith touched upon ways providers can continue to be their best for the long term.

Smith's speech, titled "Longevity in EMS: Will You Stay or Go Away," was punctuated with humor and honesty and filled with personal observations over his nearly four decades in the business.

"I have been blessed to get paid for doing something I love for 39 years," Smith said as he asked those with more than 15 to 30 years in the profession to rise. Those in the audience with 30 or more years received sustained applause from their peers gathered in one of the huge Las Vegas Convention Center conference rooms.

He said that being an EMS provider is a "seductive profession" because there's always one more shift to work, one more class to take or to teach.

"You are an emotional care giver and your patients are emotional takers," Smith explained, adding that it's important to replenish the emotional bank account from time to time with time away from the job.

He recommends taking care of oneself physically as it is one of the most important elements of longevity for providers. One of the greatest inventions for the EMS community was the power lift gurney, he said.

"When they came out with those, I nearly wet myself," Smith said. That invention, however, does not excuse one from being physically fit. Providers still must lift gear up flights of stairs, crawl in mud at car accidents and generally exert themselves to do the job.

Being aware of why you, or anyone else, is in the profession is a good reality check, Smith said. There are those who like to be in EMS for the "red lights and sirens" and the adrenaline rush, but those won't last long he said.

"Vomit makes up for the red lights and sirens doesn't it folks," Smith said, commenting that the "pasta surprise" and the "chili explosion" that often occur during medical calls takes the glamour away from the red lights and sirens.

And then there are the "wounded helpers" who witnessed the death of a loved one and were helpless to do anything or came upon a horrific accident, but were powerless to provide assistance. Those kinds of people often make it in the EMS profession, but may need help sustaining their enthusiasm for the profession, he said.

Watch out for those who expect to be heroes because they are in EMS, Smith said.

"That's disturbing to me," he said. "That worries me. In my 39 years in the profession, I have never done anything heroic... Being a hero is a god moment." He added having a hero mentality can blur people's judgment and lead them to do things they shouldn't do.

It is better, he said to "focus on being a quality provider" by taking advantage of educational opportunities like EMS World, he said.

EMS providers don't stay in the profession, as a career or volunteers because of great hours and benefits and the high pay, or the polyester uniforms, or the thank you notes that never come from patients, or the need to see people at their very best.

Rather it comes from a desire to serve, he said.

Smith offered his top 10 tips on how to succeed as a long-time EMS provider.

1. Number one is be ready to learn and to be curious about the profession.

"Nobody gets better by accident," Smith said.

2. Second, is to hope for the best, but plan for the worsst. He said providers should be "glowing" with hope and confidence, but always be prepared for the incident to turn bad quickly.

3. Three is to be ready to accept the unfairness of life. He gave the example of a drunken driver who kills a family of four and only receives minor injuries himself.

"We have a legal system to deal with that," Smith said, noting providers must render care to the injured person, paying no heed to the deeds he may have just committed.

4. Four is to like what you do and do what you like. That's what's kept him in the business so long, he said.

5. Five is knowing that the job that is done daily is important and makes a difference in peoples' lives. Not all calls can be "good trauma calls" with life and death decisions being made.

"The most common care we give is the most simple," he said. Being there for "the little old lady who hasn't pooped in four days" makes a difference in her life and being there and caring is important.

6. Number six is getting in and staying in good physical condition. Physical training must be part of every provider's regimen.

7. Seven is to build relationship and a support group among the providers. Being a provider is a tough business, Smith said, noting that they "see things no humans should see and hear things no humans should hear." There needs to be a way to process that with like providers.

"We are all on the same team," he said.

8. Eight is to expect to be humbled by the complexities of medicine. Smith said there have been times when he has been "whooped" by calls, but the point is to never take those calls that stump personally.

"There is no way we can all know everything there is to know about medicine," he said.

9. Nine is to cultivate and nurture a great attitude. Smith said he hates nothing worse than those providers who do nothing but whine and complain about calls when they come in.

"It's your job, so go out there and pull up your big boy or big girl pants and go out and get the job done," Smith said to thunderous applause.

10. And number 10 on his list is building and maintaining a balance in your career. Smith said it's sort of the "yin and yang" attitude. Being an EMS provider can be fast paced and hectic and when one doesn't pay attention to that, like a frog in a pot of slow to boil water doesn't realize it's being cooked, an EMS provider can experience the same kind of burnout.

Recognizing that people can't stay in EMS forever and retirement will one day come, Smith said it's important to mentor to young people coming up and provide them with the energy, knowledge and above all else, the enthusiasm to do be good providers.

"Do you really want someone caring for you who doesn't really care?" Smith asked.

Those who stay in EMS really need to be committed to serving and not just a job, Smith said.

"Medicine isn't a job, it's a calling," he said. "It's too hard to be anything but a calling."