The last letter in EMS stands for Service.
· What is your current role?
My name is Casey and I am currently a Charge Paramedic for a county-based EMS system on the west central Florida Gulf coast. We cover almost 900 square miles from the sandy beaches to the inland rural commercial farms. We have over 410,000 permanent residents, 75,000 seasonal residents, and over 3.5 million tourists each year, and respond to more than 56,000 calls a year. I am a field preceptor for the local college and am also an Adjunct Instructor for another college EMS program.
· Tell me how you got started, where did your interest in EMS come from?
When I was born, my father was a Fire Protection Specialist in the United States Air Force and I grew up as almost all children do: wanting to be a firefighter. The fire department may have shown up at my house to talk to my parents after I told the firefighters who visited our school that they didn’t have all their equipment out or use the proper names. My first memories of EMS growing up was of the fire department responding to calls in our neighborhood in the early 1980’s. I was always more interested in the fire trucks that responded with the ambulance. We lived just two and a half blocks from the hospital so when we heard the medical helicopter approaching, we would run through our neighbor’s backyard to watch it land in the hospital parking lot, but never considered a career in EMS.
When I became a volunteer firefighter in the Midwest in the summer of 1998, my department also required members to become EMTs and provided the class inhouse. I attended class and studied because it was required to be a firefighter, not because I wanted a career in EMS. After successfully passing the class and National Registry in the spring of 1999, my department offered to sponsor me for an EMT I-85 class that was offered by the university at our department. In March 2000, I had one of the most traumatic calls of my then very young career, and today it remains one of my worst calls. I almost quit the fire department. The department got me professional help and I eventually returned to duty, just in time for them to encourage me to attend paramedic school (this time at my own expense) beginning in August 2000. I wanted to be able to provide patients a higher level of care and a better chance at survival. Finally, I considered EMS as a career choice.
· How do you think your time in emergency medicine has changed your view of the world?
The world (and medicine) is a lot more complicated than my 19-year-old self understood or tried to understand when beginning my career. In my eyes then, the world was black and white, good and evil with no middle ground. I joined the fire department three years after the Oklahoma City bombing, and three years before September 11th. I took my EMT-B National Registry the day after watching the Columbine shooting live. My first ten years as a paramedic were in an urban academic level 1 trauma center. I saw the effects of alcohol, drugs, gang violence, poverty, and homelessness on individuals and their families. Later I worked in suburban fire departments and rural EMS departments where people called 911 because they needed assistance and apologized for calling. It is impossible to NOT be changed by the job. The social programs that I didn’t fully appreciate and spoke out against in my youth and ignorance, I now embrace. I am more tolerant. I am empathetic. I advocate for my patients, fiercely when necessary. I am more sensitive overall because I have seen the fragility and finiteness of human life. Looking back over the last 25 years, the same calls that I used to hope for, are the calls that I now dread getting.
· What do you wish you knew on your first day? What advice would you have for a new provider?
When I finished paramedic school, I thought I knew how to be a paramedic. I didn’t know what I didn’t know. You don’t know everything (or anything). You WILL make mistakes, learn from them. Find a mentor (or mentors) and listen and learn from them. It will take you at least three years to become comfortable in his job, sometimes longer based on your call volume.
It is our choice (and privilege) to care for people. The last letter in EMS stands for Service. Sometimes we provide medical services and sometimes it is social services. Regardless, it is our job to take care of people and their needs when they call us. If you are “salty”, you need to find another career.
When you show up on scene (whether volunteer or career) look the part of an EMS provider. Instill confidence in your patient and their family that you are going to take care of them.
Attention to detail. Actually check out and clean your truck at the start of EVERY shift. When the critical call comes in at shift change is not the time to find out the monitor batteries are dead, someone forgot the medications while swapping into a spare ambulance, or you don’t have that piece of equipment that you thought you would never use. What does it say about your level of professionalism when there is blood or vomit on the stretcher, ceiling, sidewall, or equipment?
Learn to talk to people, not at them. Listen to what your patients actually have to say. Older patients have lived long lives and had amazing experiences! Ask them what they do/did for a living. If they are veteran, ask what branch and thank them for their service to our nation. Don’t sit behind them in the airway seat because you can’t actually see what is going on with them looking at the back of their head.
I have always taught new paramedics and those that I am training just because you can do something, doesn’t mean you should do something. Part of the art of EMS is learning when you should intervene and when you should leave something alone.
NEVER stop learning. Read professional journals (consider expanding into emergency nursing and emergency medicine). If you don’t know what a word is, look it up. Listen to reputable podcasts. Go to as many conferences as you can (and actually go to classes). At least once a year travel at least 2 hours away from your home area so you’re not hearing the same people lecture on the same topic. Go to a national EMS conference at least every 3-5 years.
While in your ambulance or firetruck, always wave at the child who is waving at you. When out in public and you see a child looking at the truck, invite them over and show them the inside. Sign up to do public events. Be part of your community.
· What advice would you have for someone interested in taking a leadership position?
Who makes a good EMS leader? Is it the highest performing paramedic? Is it the person who scores highest on the promotional exam? I don’t know what the answer is because I’m still searching for it myself. The informal leader, the senior members, have a great deal of influence and can be just as powerful, if not more so, than formal leaders. People look to the senior member for guidance. They help to establish and maintain the culture of the department. I believe in taking care of your crew and they will take care of their jobs and you. I believe a good leader has to recognize their own weaknesses (and acknowledge them) and strengths and then surround themselves with people who compliment those and aren’t’ self-serving ‘yes’ men or women. At the end of the day it’s about the crews on the street taking care of the community. To prepare for a leadership position, start by asking questions, although some leaders take this as a sign of questioning their authority or decision making. Seek to understand the policies and procedures and why they exist. Take available leadership courses or apply for leadership mentorship programs. Talk to leaders who you respect and are respected in your department (or other departments!). Apply for leadership positions when available. You can learn just from the interview process. Never give up!
· Where do you see EMS in 10 years?
Unfortunately, I believe that EMS will continue to struggle while facing a multitude of challenges over the next 10 years and beyond. Each of these issues are multifactorial and can be a separate blog post themselves. We have weathered the COVID-19 pandemic and shown how important we are to the community and the healthcare system. Yet, we are still not considered an essential service in the majority of states. Many communities, especially in rural areas, are consolidating or ceasing ambulance service due to staffing. At the same time, education quality and training standards must be increased. Providers demand to be treated like our professional peers, while continuing to refuse higher education and accountability. I believe that it is time that degrees are required for entry level practice for paramedics. Pay in many areas of the country falls equal to or below that of fast food and retail workers. The call volume continues to increase and without staff, we will be unable to meet the needs of our communities. As an industry, we have to fight for fair pay and safety standards to protect ourselves and the patients from unnecessary injury or death. Reimbursements continue to be well below actual cost of providing EMS. SARS and the various influenzas during the early 2000’s should have served as a warning to EMS leaders (granted many leaders have retired since then). We must take the lessons learned (infection control, supply chain, treat in place) during the pandemic and prepare for the next major healthcare threat. We need to embrace the injury prevention role in the same manner that the fire departments embraced fire prevention. Is it not better to prevent an injury or illness before it occurs? I believe that community paramedicine is a necessary and valuable extension of traditional EMS. Despite the many issues, EMS providers across the country continue to respond to the needs of their communities to the best of their ability.