They Said What?

So US News & World Report has declared EMS to be one of the top jobs of 2012. Even though EMS was classed as one of the ten WORST jobs of 2011, growth in the field, relatively decent pay and "excitement" all played into the decision to move us to the "A" list for this year. I'm thinking that magazine researcher might also be a good choice. It apparently doesn't require any particular effort or knowledge of the subject you're "researching". I don't want to scare anybody away from the field. I love it, after all, but the article paints a wildly inaccurate picture of the field. Let me give you a more accurate picture.

First off, if you're looking for excitement and glory, try pro sports. Sure, we have our moments. Some calls really ARE exciting, but most aren't. Let's face it, we very rarely get the chance to really save a life. Most of the calls the average ambulance runs are nowhere near "emergencies". We get a lot of calls from people that simply got scared, and just didn't know what else to do. Are they sick? Sure they are. Is it an emergency? Not really, but it could be if they don't do something about it fairly soon. That's where we come in. It's not that we can actually fix the problem, but we can reassure the patient while we take them to the hospital, where they CAN fix it. Seeking glory? Stay away from me. Those people are the ones that get themselves or their fellow responders killed. If you see my picture in the paper, it means I didn't see the photographer in time to duck behind a firefighter or hustle the patient to the truck. I like my anonymity, thank you very much. The glory hounds don't last long, for some reason they think hosing puke out of the back of the truck at 3 A.M. is beneath them.

Money? Right. Now in all fairness, my agency pays at the top of the scale for Kansas, so I don't have any real room to complain. Would I like more? Of course. But if you're looking at the field as a career, you need to remember that the vast majority of EMS providers in the United States are volunteers. They either don't get paid at all, or receive a small (VERY small.) payment for responding to calls. Sure, volunteering is a great way to build up experience and/or get noticed by the full time agencies, but there are a lot of areas that haven't got any full time ambulance service. Private services tend to pay poorly. My first job as an EMT paid $7.50 an hour, and we ran our asses off for that money. Public agencies tend to have the best pay and benefits, but you need to remember that you're dealing with a fixed budget every year, and a lot of government agencies have been forced to implement hiring and pay freezes recently.

Something the U.S. News article didn't mention is the conditions we work under. Most people have no idea what our job is like. TV either depicts us as incompetent bunglers, or as sociopathic burnouts. Occasionally, the burnout is allowed to experience some kind of redemption, and show some emotion in the form of that one subtly macho tear rolling down your cheek as the closing credits roll. It ain't like that, folks. There are days you'll see stuff that makes you want to puke, or scream obscenities with your middle finger extended to the sky. We deal with things that no human being should ever have to see. And when we're done, we clean up and DO IT ALL OVER AGAIN. No time outs, no commercial break, no fortuitously timed appearance by the world renowned brain surgeon who just happens to know the one obscure technique that causes the patient to miraculously make a full recovery. Nope. In the real world, that patient dies. And we get to stand there and watch it happen. Helpless. And then we move on to the next one. Every time.

Given all that, why the hell would anyone EVER want to do this for a living?

Because it's really a great job. Your coworkers will become like family to you. You'll laugh, cry, and everything else together. You get paid to hang out with your friends. If you look at the hours we get paid for versus the amount of that time we actually spend working, it seems like really easy money. Out of a 24 hour shift, we probably only actually "work" 4-6 of them. People respect you. They want to see you around, and they're glad you're there. Every so often, you get the chance to really make a difference. I've had quite a few people come up to me at the gas station, or in the grocery store, or in Walmart, and tell me that they remember the day I saved their life, or their child's life, or even a complete stranger. I don't remember it, of course. It's just another call to me most of the time, but it makes quite an impression on them. And that's a good thing. It means they'll tell that story to anyone that will listen, and eventually the whole community will know that no matter who they are, or where they are, or why they call, they CAN call, and we'll come get them.

I don't really care what some magazine I never read says about my job. I don't care if I have one of the "top" jobs in the country. That label, like most labels, is ultimately meaningless. What I know is this: This isn't a job, it's a calling. If you want in, you have to get in all the way, or you won't make it. It can be tough, and it WILL change you. But it's rewarding in ways most people will never be able to understand. so is it one of the top jobs? No. It's THE top job in my book.

Drama Activation

I'm often asked how many of the calls we get are legitimate. That is, how many people that call 911 actually NEED an ambulance? If pressed, I'd estimate that somewhere between 40 and 50 percent of our calls are true medical emergencies. The other 50 to 60 percent? Everything from nursing homes no longer wishing to deal with a difficult patient, to law enforcement officers covering their asses by calling an ambulance for the newly arrested person with the sudden onset of vague symptoms (Known in the business as "acute incarceritis" or "handcuff allergy".), to patients that just want someone (Not necessarily us.) to pay attention to them. The third group is by far the largest.

Chest pain and/or difficulty breathing are the afflictions of choice for the dramatic. Those two things don't necessarily produce visible symptoms, and thanks to years of public education, everybody takes them seriously. OK, almost everybody. To EMS providers, all calls are assumed to be bullshit until proven otherwise. We can usually tell in less than a minute or so if your complaint is real or not. We'll still do a thorough exam, of course. We ARE professionals, after all. But the whole time we're checking you out, we probably already know what the results are going to be. So seriously, don't try to bullshit us. We can see right through it. If you manage to fool us, you'll never fake out the cardiologist, and very few of them have a sense of humor to start with. Plus, they bill more than we do, and if we think you're faking it, by the time a doctor sees you, we've already told them you're probably not sick. You might wind up getting a very large bill for little more than sitting all by yourself in a room with no TV for six hours.

Fake seizures are also popular, and far more entertaining for us. We've been known to applaud a particularly good performance. REAL seizures produce some predictable symptoms, so if we don't see those, we assume it's not actually a seizure. Little hint- if you're trying to fake a seizure, wet your pants. Nobody ever thinks to do that, and it's actually relatively common in a real seizure. If you can arrange to lose control of your bowels as well, I'd probably go ahead and give you the valium, just as a reward for authenticity. Plus it'll keep you from doing it again, at least until I get you to the hospital and the drugs wear off.

Fainting or being "found" unconscious is popular among the younger melodramatic patients. It's not all that uncommon in the actually sick, and the number of things that cause it is astronomical, so finding a 16 year old passed out doesn't necessarily register as obviously fake. Most of the time. But when it's obvious, it's REALLY obvious. Again, we can tell if you're truly out in less than a minute. Flickering eyelids and purposeful movement are dead giveaways. If you try to hold your eye closed when I go to check your pupils, I know it's fake. Really unconscious people tend to go totally limp and don't resist being moved. So if you fake unconscious, we'll find out. The common way to do this is to check your reaction to noxious stimuli. Meaning pain. Like a knuckle rubbed on your sternum. Or the same knuckle on the mastoid bone. Or take the first joint of the pinky finger, bend it down in it's natural direction, and squeeze hard. Hurts like hell if you do it right, and can also be used to unobtrusively encourage troublesome spectators on a scene to go find something else to do for a while. If you insist on playing this little game out, it's entirely possible we're going to cut your clothes off you so we can do a thorough exam. Someone that's legitimately unconscious for an unknown reason has to be assumed to have a hidden traumatic injury until we've definitely ruled it out. That means we have to go hunting, which means it's scissors time. Unless you're wearing a down jacket. EMS Rule #2- Never cut a down jacket unless you absolutely have to. Cut one, and I have, and you'll be sweeping feathers out of the ambulance for weeks afterward. Don't worry, we WILL cover you up eventually. And no, we don't have to pay for or replace what we cut. You probably should have thought of that.

I don't know why people call 911 expecting sympathy. In the paramedic dictionary, "sympathy" is nothing but the word that appears between "shit" and "syphilis".

Actual Conversation

Patient (Who is obviously way high on meth.): "What is it? What's wrong with me?"

Me: "I'm not sure. We'll probably have to wait for the autopsy results."

Patient: "How long will that take? I have to work tomorrow."

From my very first ambulance job, in Independence, Missouri. At the time, it was the methamphetamine capitol of the world. Since that day, I have viewed tweakers and other obnoxiously intoxicated people as playthings put on this earth purely for my amusement.

Someone Has To Be The Bad Example

I was bad this morning. I had to stop for gas on my way home from work. There's a Love's truck stop just off I35 at my exit, so I pulled in there. Their gas isn't any more expensive than anybody else's in town, which is, as most of you already know, really unusual for a truck stop on an interstate. Love's also apparently has a corporate policy that only pretty girls are allowed to work the register, which may or may not have influenced my decision to stop there. They also have a Hardee's, which is the REAL reason I got my gas there rather than the place on the other side of town. The other place has biofuels, which I approve of, and a Scooter's Coffeehouse inside, which I also approve of. (Usually more than the biofuels. My Explorer is a flex fuel, and I burn E85 as much as possible, but I will bypass the environmentally friendly fuels in favor of good coffee every time. sorry.) The downside of the other place is that it's usually staffed by people that look like they just left their real job as stars of "People Of Walmart", or "Faces Of Meth". I'm already foggy from lack of sleep and lack of caffeine, I really don't need to see that on my way home. Sets a bad precedent for the day.

Anyway, I fed my truck, then fed myself. I have to admit to an addiction to fast food breakfasts. Mainly because bacon, eggs, and frozen biscuits are pretty hard to screw up. It can, of course, be done, but it takes a degree of effort most of the folks on the morning shift aren't willing to expend. Besides, they've been sucking down industrial grade coffee for four or five hours by the time I get there, so they're wired enough to take the time to deliver perfectly flat bacon and egg served on a biscuit split precisely along the equator. I appreciate the effort. Now, as a health care provider, I know that even the best of the fast food breakfasts is horrendously bad for you. That's why I rarely eat them. I tried to behave at Hardee's today, I really did. I ordered cinnamon raisin biscuits. No egg, no cheese, not fried, just two fluffy lumps of sugar coated happiness. I haven't had them in a long time, and they were good. I was not the only customer, of course. There was another guy at the counter, ordering a "Monster" biscuit, which comes with a sausage patty, ham, bacon, cheese, and egg. It looks REALLY good in the pictures. He also ordered a large hash browns, and "the biggest coffee you have". I went to the next register and ordered, then looked over. What I saw made me chuckle a little, and when he realized why, he did, too. I paid, got my food, and as I was leaving, told him, "I didn't see a thing. See ya in the cath lab, doc." Cardiologist. Someone has to be the bad example.

Public Education Pamphlets They Should Write

Good morning, all! Yesterday at the station, I flipped through a catalog of REALLY generic public education materials. I'm sure you know the ones. They have titles like "The Police And You", "Mindless Obedience Can Be Fun", and "Trust Me, I'm With The Government". They have poor quality drawings, contain no real substantive information, and are sold by the bale to be handed out at public education events. Most people that take them do so just to be polite, or because they are running low on kindling for their fireplace at home. The poor selection of EMS related literature got me thinking that they really need to add some new materials that may be a little more useful in our education efforts. So, without further ado, here are ten suggestions I came up with, in no particular order:

1) A Hangnail Is NOT An Emergency
2) You Can Still Wind Up In Triage, Even If The Ambulance Brings You In
3) Stupid People Should Not Drink
4) Don't Eat That
5) Why Did You Stick That In There?
6) Darwin Was An Optimist
7) There Is Nothing Wrong With You That Losing 200 Pounds Wouldn't Fix
8) Don't Call 911 If You Want Sympathy
9) In Fact, Don't Call 911 At All
10) You Are The Reason I Will Never Let My Daughter Date