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Rural EMS and Those Who Sacrifice are Amazing!

In January I attended the Arrowhead EMS Conference and Expo, Minnesota’s largest EMS conference.  Long before this, its 40th year, prehospital folks could simply refer to it as “Arrowhead.”  Kind of like Prince.  It takes place in Duluth, MN and caters to those in the northeast corner and east central portions of the state.  There is typically a sizable contingent from the Metro (Minneapolis and St. Paul, nearly 200 hundred miles away).

This was my first year at Arrowhead.  What struck me were the number of EMRs and EMTs in attendance. But then again, I wasn’t where Big City paramedics abound.

Acting as membership representative for both the Minnesota Ambulance Association and National Association of EMTs, I spoke with many volunteer EMRs. What became clear was better funded EMS systems we take for granted in the Metro. One common thread between urban and rural factions is the apathy towards legislative impact.  But I digress.

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For those unaware, EMRs or Emergency Medical Responders, are the base level of the prehospital system of response.  These men and women have basic knowledge of life saving skills.  Essentially, they open airways, perform CPR, protect patients from further harm (risking their own lives to extricate victims), and assist us with more advanced training.  

What super rural EMRs go through really hit home.  Call this my exposure to a world outside large, urban paid EMS. 

What I learned came during a breakout session.  Most EMRs drive upwards of 45 minutes to a scene.  Add to that from home in their personal vehicle.  What 15 person volunteer fire department could afford a take-home duty vehicle?  They then provide care alone for various amounts of time. Many face having to perform CPR through coordination with family… or by themselves due to inability or reluctance of others on scene.  Being closer than a deputy, they risk entering scenes not advertised as potentially hostile.  The list went on.  And my appreciation grew.

For context, the first scenario we waded through involved a snowmobile rider who hit a tree.  One mile deep on groomed trails, the sole EMR first to arrive had to find a ride to the patient.  This event was in a state forest, outside range of 800 mHz radios, let alone cell phone service.  A question about satellite phones was countered with one asking who would fund it?  As this single EMR assessed patients, the victim’s friend was distraught and provided more problems than assistance.  Additionally, snowmobiles zipped by, unaware of the crash.  About 20 minutes elapsed before more EMRs reached the scene and 30 minutes beyond that for the closes paramedic ambulance.  

Egress was complicated due to distance.  Both out to the ambulance, which could not get as close as the first arriving EMR’s personal vehicle and then to the landing zone for the helicopter (approximately 11 miles farther).  

They enlisted citizen snowmobile riders to cart out the unresponsive patient on a long backboard.  More accustomed to redlining it, these volunteer snowmobile riders had to go slow enough to allow others to walk next to the ride.  Well-rehearsed plans to meet the helicopter at one of 7 camping/picnic sites was out of the question.  Such a plan was reserved for summertime.  Currently, the roads and sites were buried deep under snow.  

In the real event, the EMR running the breakout stated patient contact time was about four hours.  Logistics, problem-solving, life sustaining efforts are commonly shouldered by these volunteers who form an essential component of EMS.

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There was no ulterior motive behind this post.  I simply wanted to express my amazement at these unsung heroes we in major metropolitan regions rarely consider.  But how many of us go camping in a state park; drive through remote areas of any state on a family vacation; or even respond as an air ambulance crew to a location hours from a level two trauma center?  

This story is one of a million that happen annually across these United States, held together by a network of volunteer EMRs.  It isn’t even a personal story; yet it made such an impact, I feel as if I was there.  [We cannot discount the scenario-based learning for immersion!].  To EMRs who serve your communities and risking life and limb to do so.  Thank you.

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Emotions for the Betterment of EMS

I was introduced to the work of Prof. DeSteno through the EdX course, Empathy and Emotional Intelligence at Work.  An article written by DeSteno was assigned, which simply laid out three emotions useful in goal achievement.  These three are, Gratitude; Compassion; and Pride.  I instantly saw compassion and pride relating to EMS.  Gratitude seems generic and could fit any profession.

Compassion and Pride: The Low hanging fruit

So as not to gloss over compassion and pride, allow me to address those emotions first.  Compassion is why many of us got into EMS.  And hopefully, it is what drives us to continue toiling odd hours, in all types of weather.  There are degree to which compassion comes easy.  I’ll get more into this with my exploration of gratitude, because I am finding they go hand-in-hand.  I am not even sure, in a context of EMS, compassion and gratitude are mutually exclusive.

Pride is necessary for personal satisfaction.  DeSteno wrote:

When [pride] is authentic, it signals to others that you are a capable and reliable person, which is how it evolved in the first place—as a way to raise one’s status in a group. People with greater authentic pride tend to attain their goals and have higher self-control.

Pride is why many wear EMS shirts and festoon personal vehicles with emblems.  It shows we are a part of something important, ready to help and enjoy promoting our profession.

Gratitude: The less obvious

Gratitude instantly brings to mind a gleeful tip to a helpful waiter.  The act of being grateful and overjoyed is difficult to plug into the EMS mindset.  I am not seeing a lot of gratitude on Twitter to ambulance agencies for be able to earn a check.  On the contrary, there is ingratitude for being paid so little.

Similarly, there is no appreciativeness to patients who call for transport so frequently their address causes everyone’s eyeballs to roll.  Interestingly, Dictionary.com lists “obligation” as a synonym for gratitude.  Yes, we are obligated by law to respond and render aid.  But who got into EMS feeling obligated, let alone joyful, to care for someone who requests unnecessary transport?  If this was the case, abandonment would not be such an issue!

In the psychological sense, DeSteno found gratitude relates to “greater average patience and self-control.”  In the context of a paramedic’s dealing with a frequent caller who has no real need for ambulance transport, issues arise when patience is worn so thin, the encounter results in a disciplinary problem.  Self-control fails; words or actions result in less than dignified care.

Turning this seeming negative into a positive, consider specific reasons each patient calls 911.  Look beyond their act of calling emergency medical service.  You and your partner likely surmise why 911 was called.  Even if you cannot do something about it for future encounters, recognizing there is a root cause can soften your demeanor to the person with a perceived need.  Be grateful you were summoned.  Show compassion for their need, even if it isn’t medical.  Take pride in your role as a community outreach provider; be thankful this person did not need lifesaving efforts.

And by all means, pass along this new found view on their situation.  Even if your ambulance service does not have a Community Paramedic program, perhaps hospital staff can work to resolve some issues the patient is experiencing.  This act of being gracious with your compassion and improve their existence, so you may help others.

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You’re Welcome & Other Thoughts on Gratitude

Today I saw an industrial psychologist. The visit stemmed from a work-related injury and an extended stint of “light duty” (end of April to mid September). In other words, the injury kept me “off the street.” Prior to being barred from doing my job, I failed to see how the job defined me. It became an expression of my worthiness and kept me feeling important. For those not in EMS, any restriction – lifting or otherwise – essentially keeps a paramedic away from working normal duty. During the therapy visit, a conundrum made itself evident to me regarding EMS and us. It has to do with retention, possibly unrealistic expectations of those entering the field, and feelings of both over and under appreciation. The session was fortuitous because I was reconsidering “thank you” and “you’re welcome.” And yes, these are tied together in certain ways.

Allow me to go back a few days. I had been struggling to write a blog post on accepting appreciation. Converting disassociated thoughts to text helped me parse the topic. But I had no convenient way to express thoughts. Marshall Goldsmith is an executive coach and wrote What Got You Here Won’t Get You There (2007; Hyperion). One of the factors he identified keeping people from gaining the next ladder rung is “Habit #17 Failing to express gratitude” (pg. 88). In Goldsmith’s estimation people fail to say “thank you” to a compliment. Unqualified, unmodified thank you; full stop. In my opinion, so many people pay EMTs and paramedics compliments without explicitly saying thank you I don’t even notice. Regardless if I or anyone else notices, too many compliments and heartfelt expressions of gratitude go unappreciated. And payers of compliments go unacknowledged or worse, minimized.

If I ask you what’s your reply to someone who says: “You must see so much. I couldn’t do what you do.” Did you think/say “It’s nothing” or something similar? I do… or used to as of last week. Goldsmith explains anything other than “thank you,” minimizes the desire of the person paying the compliment. It may even dissuade them from complimenting others (and you in the future). Even those whose intention is to only solicit a gory story from making a question out of a statement (“You must see some gross stuff?”) are enthralled with the profession and happy you do it and not them. Those who live vicariously through others often do so because they can’t.

In my observation, co-workers who strive to get recognition and adulation are well outnumbered by those who eschew awards, recognition and fanfare. That’s fine. No one is making you take a damn stork pin. But the same anti-recognition person may gripe about how they are not recognized for doing their job. Having been one of those in the majority, I was blind to the hypocrisy. Why is it unreasonable to get a pin or certificate suitable for framing when you birth a baby or return someone’s circulation so he or she can walk out of the hospital in two days, but not being acknowledged because you completed the start-of-shift rig check every shift? To prevent myself swinging like a pendulum, I’ll go halfway and say both should be recognized. No, I don’t think doing even the minimal tasks of the job on a routine basis requires a ceremony; just a compliment in passing or noted on the annual review would be nice.

So, I have adopted a new strategy. Give an unqualified “you’re welcome” when someone says thank you. People thank others for various reasons, but mostly because the other was helpful or did something they couldn’t do. Such as patients or family members who resorted to calling 911. Realize it or not, you did something important to the patient. Sure it is your job, but you performed it well enough that someone is appreciative of your efforts. Your choosing to the job.

When someone pays a compliment in cryptic messages, like “you must deal with a lot of stuff,” there is no need to minimize EMS or your role. I’ve made a history of saying, it was nothing or “I just cover it up.” To me this is truth and expresses a way to avoid distracting injuries or bodily fluids. But to the nonEMS professional, it diminishes EMS in the minds of others. Likely this person has a specific, personal encounter in mind when they offer a veiled thank you. They aren’t thanking you as an individual for expert care in their situation, rather they are thanking you for being a part of a profession that means greatly to them.

It is similar to thanking a vet or police officer. “Thank you for your service” shows appreciation for their role and general duty, not a specific task or operation they conducted. Being familiar with deflection of appreciative comments, when a vet replies “I didn’t go over seas” or denies taking part in combat, I am forced to reinforce my appreciation. They don’t know it, but I don’t care if they sat behind a desk or drove a forklift stateside. I recognize the loss of choice and control one experiences when signing up or being drafted. I commend vets (in my mind) for not taking credit for missing stress-inducing warfare, I am not only looking to thank combat veterans.

So back to today and my visit with the therapist. After a recounting of my injury and all the trials and tribulations that go along with work comp, he paid me and EMS a compliment. I nearly stopped the psychologist as he was going to say “you are saving lives.” My knee-jerk reaction is to downplay the life saving aspect of EMS because it happens less than often than it does no television. I made some convoluted comment to this effect, to which he thought he may have found therapy gold. “Do you not like working in EMS?” No, I said. Inside I thought, what would give him that impression? Well, the impression I portrayed downplaying the activities that go on in EMS.

He doubled down on his appreciation of EMS and our job and its duties. After recanting the efforts I made to diminish EMS, I explained EMS means so much to me. And thanked him for his appreciation.

And so it dawned on me. I had to think outside of myself and my profession. Experts don’t self-deprecate to clients, those who are reliant on their expertise. Self-deprecation is for families and cohort; it is not decreasing the status in the eyes’ of the public. We may spend 800 hours a year with uninjured elderly patients who fall, get that non emergent g-tube replacement, or transport the runny nose person who refuses to go to primary care. These take up the majority of a shift, day-in and day-out. And this is what I think of when I reply to a thank you or suggestion that EMS must be difficult given what we deal with on a daily basis. So, when I reply “naw” or offer some other qualified answer, the profession is brought down a few notches in their mind and I’ve diminished their gratitude.

From now on I will say thank you to direct compliments. And to admiration for doing my chosen profession, I will say something along the lines of “it is satisfying” or “I am glad to help people.” And ask if EMS has helped them or their family. My goal is to elevate EMS and have some self respect.

UPDATE
My Fitness for Duty test was occurring today. This is the physical agility test “permitting” me back to work after a prolonged absence. In thoughtful consideration, my wife wished me good luck on the test. My first reply was “I’ve already passed several of the exercises. It’s no big deal.” Instead of saying thank you to my wife, showing gratitude for her concern and wishes I do well, I effectively told her her input does not matter. Her reply was a question to the effect of what happens if you don’t pass. I had not concerned myself with this because I was confident in passing the test. Now, not only was I forced to consider a poor outcome, but we were put in a place to ponder more time on light duty. A heartfelt well wish turned to a focus on possible worst case scenario.

Not even 24 hours after writing and posting my intention on correcting my conduct, I failed. Thankfully I did not fail the test! But now, my wife may pause before wishing me luck or showing support. My retort and lack of a simple thank you showed I did not respect her concern. By not accepting her support I counter her unconditional hope that I achieve something important to us; downplay her appreciation of my efforts; or positive thoughts to quell her apprehension.

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Discontent Breeds Distrust and Confirms Bias

I am not a very fast writer. My vacillation and rewriting means I miss the hot take. Case in point: An unidentified bearded man in jean shorts scrawled scandalous messages and awful claims on ambulances and buildings owned by FDNY. In my queue there currently sits draft number two of a post on public perception of EMS. More specifically, how social media griping fuels public distrust of EMS.

This rewritten piece originally began as my thoughts on lambasting EMS on social media. It was timely that this serial tagger struck. With several FDNY personnel able to keep jobs in the sunlight of past illegal behavior, it surprised me little that a person would label (literally) ambulances with horrible things. While I did not search out any

But this is what I was beginning to see. When lawsuits are made public, current and former employees (anonymous posters who identify themselves as such) concur with facts of the case. We cannot ignore all of these discontents as simply fed up. Some may have legitimate complaints; the majority just want to assign misplaced hatred or distrust of whatever on the large company. But when someone, posting with “authority of knowledge” by having worked for the agency being sued, claims this is standard operations for the company, it brings disrepute upon those who employed. We all know a few who struggle, but they do not represent the workforce as a whole.

It began affect me!
I am an insider. I sit around the picnic table and hear the gripes and suffer the same poorly thought out schemes. Yet I am not on social media broadcasting issues making them appear to be similar to every single ambulance service. My employer has had some press-worthy data breaches. Looky-loo nurses perused medical records of those they shouldn’t have and it made the news. As a result, I’ve sat in the ambulance deflecting suspicious inquiry of me, and my integrity when it comes to the electronic medical record (EMR) system.

But that is less hurtful than another EMS provider doing something stupid. No, let me say this: It is more hurtful to see a string of replies on social media that confirm all ambulance services are like this. That is not a quote; rather it is a generalization of any number of ways some anonymous malcontents inflict disrepute on his or her former employer.

I will not name the most derided multi-state provider of EMS care in the country. Suffice it to say, I’ve read some very negative things about the company. Enter “I hate [this company]” and you’ll likely find a sub Reddit. Anyone with a gripe against this company, EMS providers, poor service, “corporate America” or any popular diatribe will find their biases confirmed.

This summer I had the pleasure of traveling to two cities where this outfit provides EMS. I couldn’t help but wonder if the two crew members in there were proficient, happy, caring about those they encounter, overworked, so incompetent through the mismanagement of their overseers, etc. Some of those claims are legitimate; others are not and are painted with a broad brush. But I’ve had it so ingrained from reading social media posts I see their rig and fear for my life should I need an ambulance. I can reasonable decipher the list and extract those issues with legitimacy. The general public may not.

Who do they really hurt?
So who pays for such foul reputation? Not the company. Because of the Keyboard Warrior, an underpaid and overworked EMT or paramedic struggles to care for an untrusting patient who fears he or she may not make it to the hospital.

This is horrible to think. I say to those disgruntled internet posters, where do these multi-state companies get their employees? Do they fly in out-of-towners who couldn’t care less about who they treat or what they do to the community? Or do they employ local people? That is about as close as I will come to defending any ambulance service. My aim is not to prove a subset of employees wrong. I just want to remind them there are still people working there who care for people.

Ok. We know you hate your employer (or former employer). And you have grievances. But can you pause for a few seconds to reconsider a Tweet or Facebook post that harms current EMS professionals and the system people rely on?