That’s a wrap! Thoughts from the newly retired Wake County EMS Chief

What is your current role?

Unemployed! Also known as recently retired after just under 31 years with the most amazing EMS organization in the world.

 Tell me how you got started, where did your interest in EMS come from?

I have no idea where my interest in EMS came from, but it has been there since the first time I could communicate it. My parents required me and my siblings to write down our one year, five year, and life goals on index cards every New Year. When I was in high school, my mother shared my index cards with me and I consistently wrote that I wanted to work in EMS. The language changed over the years as I better understood (i.e. my first entry was that I wanted to be an ambulance driver) the profession and the titles.

I got started in high school as a student athletic trainer and then in my senior year a friend of mine and I joined a volunteer Fire Department/Rescue Squad. The first night I rode on an ambulance, we left the station a few minutes after our shift started and only returned once that night to restock because we had run out of supplies. During that shift, our ambulance was also struck by an out of control car on the interstate while we were in the back providing care to a patient from a previous MVC. I was hooked and never looked back.

How do you think your time in emergency medicine has changed your view of the world?

I would say it has given me an enduring feeling of hope and faith in humanity. By nature, I have been a fairly cynical person most of my life. I have always focused on the mistakes and the bad in situations, but throughout my career no matter how much badness and negativity I have seen from individuals or from society as a whole, I have also witnessed an enduring positivity in humanity. There are always more people willing to step forward and provide care and comfort to others or fight for what is right than there are people who want to tear things down.

EMS as a profession is hard. A few friends of mine and I have had a saying throughout our careers that “no one gets out of EMS without scars.” Some physical, almost always emotional, and too many times both. However, with the recognition of these truths in the last decade and the call to action to provide support and mitigation, I have a great deal of hope these scars for future providers will be lessened and manageable. I also have hope that the future will bring an EMS profession that doesn’t leave any provider broken and tossed to the side.

What do you wish you knew on your first day? What advice would you have for a new provider?

Nothing. I loved the journey and wouldn’t have wanted to ruin it. Even the mistakes I made helped me grow as a provider and a person.

 Advice for new providers:

·        Don’t try to prove you belong, just do your job. If you do your job, you will prove yourself.

·        Take care of yourself and your coworkers. Physically and emotionally. EMS is physically demanding and 30 years is a long time. The only slight regret I have is as an invincible young adult, I failed to take care of my body and it subsequently began to fail me in my 30s.

What advice would you have for someone interested in taking a leadership position?

Figure out why you want to take a position in leadership. Though most folks don’t believe this until it is too late, the best position in EMS is riding on an ambulance. On an ambulance, you only have to take care of yourself, your partner, and the patient. The burden only gets heavier as you move up (the rewards get bigger too, but the rewards are intermittent and the burden is constant). Sorry, the cynical side may be coming out a little here.

 Back to figure out why you want the position, if you want a leadership position for any reason other than you want to have a greater influence on improving the future organization and you want to work harder, you probably need to rethink what you are doing. Being a leader of an organization is incredibly rewarding work, but it is also extremely hard and very often thankless. If you want a leadership position because you want off of an ambulance, then reconsider the profession as a whole.

 I personally moved into leadership kicking and screaming because I wanted to continue to ride an ambulance and take care of patients. Unfortunately, once you cross that threshold and move out of the field, you always have something else you need to do. So, there is a constant tug-of-war between tasks you should be doing and spending time on an ambulance doing the task you loved (ie. taking care of patients). Leadership for me was wonderfully rewarding, but it came at a price for me personally and for my family. I lost count of the number of holidays I missed, trips my family altered or canceled, and social events that were cut short due to some issue at the organization that needed to be addressed. Leading an organization where staff members are always at work, always in harms way, and always have a need takes a toll and to be an effective and positive leader you have to adapt to the needs of your people regardless of the impact to you and your family. If you don’t go into it for the right reasons, you will fail your organization and the people you are trying to lead.

Where do you see EMS in 10 years?

I see an unending list of opportunities and I am jealous that my career is ending at this incredible time of growth for the EMS profession. Don’t get me wrong, EMS agencies are still struggling throughout the nation and in many areas of the world right now, but I am confident (and hopeful) that EMS is moving in the right direction. The pandemic demonstrated to the world the amazing value of EMS professionals and this recognition is providing many new opportunities.

From a field provider perspective, I see continued expansion into community paramedicine with a broader vision into prevention. I see the normalization of alternative destinations and the use of telehealth with EMS providers becoming expert patient navigators through the maze of healthcare options. I believe EMS providers will have to find a way to become insurance experts to accomplish the patient navigation, but I am confident tools will be provided to help EMS professionals manage this new task. I hope that we will see more coordination with other healthcare networks such as urgent cares, primary care physicians, and case managers so that we stop being an event-based service and become a more integrated part of the continuum of care for patients.

This is probably not a very popular statement, but I anticipate the number of different EMS delivery models to decrease over the next ten years. Even with healthcare finance reform, there are certain delivery models that I do not believe can survive. We are already starting to see many in financial crisis and without significant relief in the next couple of years, those models will cease to exist. In some ways, I believe there will be a reckoning for communities who bought into the myth that EMS can be provided without subsidy.