The Path Less Traveled

      "It is only by following your deepest instinct that you can lead a rich life, and if you let your fear of consequences prevent you from following your deepest instinct, then your life will be safe and expedient and thin." --Katherine Butler Hathaway

   For me, opportunity came knocking in the form of a hastily scrawled number on a blue Post-it note.

   My boss was busy, and the name and number on the Post-it represented a waste of time. Nothing in his instincts told him the man who wanted to talk to someone about medical equipment design issues was anything more than another meeting and some hassle he didn't need. My instincts told me something different. So I offered to take the task off his hands, and that's how my journey down the path of a medical consultant for the biotechnology industry began.

   There's something to be said for taking the path less traveled. There are some clear advantages to leaving the security of the well-trodden trail and venturing off into uncharted territory. If you've been looking for something a little different lately, perhaps a new challenge or a change of scenery, I'd like to tell you about some folks who've traveled less-traditional paths through their EMS careers.

   Each of these individuals found different rewards on their journeys. Some found wealth, others found freedom, and some even found adventure, but all of them found personal growth and a job less average. These are just four of the countless ways to use your medical training in pursuit of a life less ordinary. Perhaps these stories will inspire you to head off on your own unique career adventure.

STEVE WHITEHEAD, BIOTECH CONSULTANT

   The name and number on my Post-it note led me to a biotech product development team looking for a way to bring their medical device into the prehospital environment. Before our first meeting, I did my homework. I found out everything I could about the product they were developing, a patient cooling device. I also studied the current state of medical research in the field of therapeutic hypothermia.

   On the day of our meeting, I was prepared with pointed questions about the status of the current product and good answers about things they might need to consider before taking it into the backs of moving vehicles. We discussed product options, design and safety. A few days after our first meeting, a contract showed up in my e-mail box for a long-term consulting gig with the company. I've been consulting with biotech companies ever since.

   Working as a consultant is similar to working in EMS. Clients bring you problems, and you provide solutions. Clients have questions, and you find answers. People who are self-motivated, confident, hard-working and good with others can excel at this type of work. And the rewards are huge: Each project or meeting brings a new opportunity to learn something about the cutting edge of medical technology. The hourly rate for your time is more than some EMTs see in whole shifts. And someday, you may open a magazine and see a product you helped develop featured on its pages.

   Working for design teams requires a think-for-yourself intuitive nature. You need to be able to recognize what the client needs next. It requires an ability to look beyond the question at hand and identify what problem the team is really looking to solve. Then you find a way to get the answers they need. It also requires some field experience, but not as much as you might think.

   When one of my clients brought me a nasogastric tube and asked where to place a temperature probe, I didn't have a clue. I had never inserted a nasogastic tube before. But I knew where to find a whole bunch of people who had. I asked the client for a few days to work on it, and then I wandered through a few ERs asking nurses, "Say, if this temperature probe were going to be attached to this NG tube, where would you put it?" A few days later, the client had more than my opinion; he had a survey with detailed feedback from an experienced team of nurses.

SHANNON DAVIDSON, ED TECHNICIAN

   While many of her coworkers served as ER technicians to get familiar with the hospital environment as they worked toward other medical specialties, Shannon always knew she would one day work on an ambulance. After losing her mother and brother tragically, she decided she would spend some time in the ED to prepare for the prehospital environment.

   "Some folks know right from the start they want nothing to do with field work," she says. "They want to be physician assistants or medical students, so the ambulance is totally unappealing to them. I thought it would be best to start in a controlled environment to sharpen my skills and toughen my skin, so when I one day did get on the ambulance, I'd know I could be a help and not a hindrance."

   Sharpen her skills is exactly what she's done. Shannon describes her typical shift much the same as life on the ambulance, only with a lot more clinical contact than a typical EMT might see. "We stock our designated spots in the emergency room, then spend much of our time starting IVs or getting baseline vital signs on everyone," she says. "Each of us can start up to 30 IVs in a shift, depending on how busy it is. We also transport patients to their various studies. On critical patients we'll do CPR or start second IVs. We cover the baseline patient care."

   The rewards of working in an ED include seeing the progression of medical care beyond the first 40 minutes. "It's really interesting to see the patient through the first six, 12 or 24 hours they're here," Shannon says. "To just see the amount of effort that's put in to see them home, and the difference in them from when they arrive to when they go home—it's intriguing to watch."

   Shannon warns prospective technicians that the ED environment has different challenges and rewards: "You have to have a lot of compassion and patience, threefold more than in the field. And you need a strong interest in medicine. But there's a feeling of gratification that comes from investing that much in the patient's outcome. When you're at their bedside over and over again, there's a satisfaction in knowing you made a pretty darn big difference in helping them walk out the door. As challenging as patients can be, it's nice to get to see them go home. I also think it will help me, when I do get onto an ambulance, to know the next steps that are going to happen and all the little things you can to help those next steps along."

DAVID RUSH, SMALL-BUSINESS OWNER

   When Dave Rush first started teaching CPR, it wasn't the idea of one day owning his own business that motivated him. It was the money. "I thought, Holy cow, I could earn $25 an hour!" he says. "I also really loved teaching the class. I loved seeing people get it. I loved getting those comments like, 'This was the best CPR class I ever took!'"

   But when Dave's coordinator cut his hours, he started looking for different solutions to getting in front of a class. "I remember sitting in the ambulance on a street corner with [my partner], bemoaning the fact that I couldn't get more classes to teach," Dave says. "He asked, 'Why do you need this other guy? Why don't you hang your shingle out and do it on your own?'" With that, CPR Professionals was born. "I can still remember sending out the first flyer," Dave adds. "I still keep a copy in a drawer."

   Eight years later CPR Professionals is a huge success. But it wasn't always smooth sailing. "There were some sleepless nights for a while," Dave says. "I kept wondering, Is the phone going to ring?" But ring it did, and "Once I saw the viability in it, I threw myself into it headlong."

   Rush's customer base kept growing. Today his little company has grown into an AHA training center serving more than 300 CPR instructors. "You do a good job, and people will hire you," he says. "We are, ultimately, only accountable to our own integrity. If you start cutting corners, it will eventually show up in your product. People will know. I feel very humbled by my success."

   Asked what it takes to build a successful business, Rush has a specific, well-thought-out list: "It takes a tremendous amount of discipline. Sometimes I work insane hours. You have to know you're going to lose your job or your clients if you don't follow through. And you have to have a sense of professionalism. People appreciate follow-through and professionalism. All those little pieces hold together the whole."

   For those who have what it takes, the rewards are almost limitless. "The sky is the limit," Dave says. "I can keep growing and growing. I love that freedom. I love that I'm not accountable to anyone but myself. It's my gig. If I'm not successful, it's all on me. If I am successful, I get all the accolades. And I don't have to commute. I stumble out of bed, pull on my sweats, and the phone rings. Nobody knows I'm working in my sweats."

CHARLIE OLIVER, WILDLAND FIRE MEDICAL UNIT LEADER

   Charlie Oliver first encountered wildland incident management teams while working as an EMT in Colorado. "I was the chief of police in a little rural town in southwestern Colorado," he recalls. "The local ambulance service needed more EMTs, and all our officers got trained. We had a series of wildfires in the area, and I started talking to [the firefighters], and they told me about the medical unit leader position. I immediately thought, I should look into this. After that I went to the Colorado Wildland Fire Academy. That's where I got hooked. I got out of law enforcement, and I've been involved with incident management teams ever since."

   Charlie sums up the position of medical unit leader (Med-L, as they call it in incident management circles) by comparing it to an HMO. "You are the one who designs the system that's going to provide healthcare to the emergency responders, and you're the one who arranges it and makes it all work," he says. "The challenge is to prepare for the worst possible scenario that can happen for the incident, and then be tickled to death when it doesn't happen."

   What draws Charlie to the Med-L position? "I like the nontraditional part of being a med unit leader," he says. "There's so much stuff we do that they just don't teach at EMT school. It's more like industrial medicine. You're really the health and safety officer. You're not just dealing with trauma or sickness. You're trying to do preventive care, dental work, vision, you name it."

   While wildland incidents have their share of challenges for Charlie, the large disasters hold a particular interest: "The non-wildfire incidents are where the really good stuff happens," he says. "I live for that stuff. It's unbelievable. If someone had asked me going in, 'Are you ever going to manage a methadone clinic, a well-baby clinic, a diabetes clinic, a dental office and optometrist office, a pharmacy and an urgent care all at once?' I'd have said never. But I did all that at hurricanes Katrina, Rita and Wilma. I've worked incidents with as few as 50 personnel and covered population bases as large as 30,000."

   Like any job, there are downsides. "There's no real system of reciprocity," Charlie warns. "You are going to work outside your system, and you'll have to deal with that. There's also a bunch of paperwork. As a manager you'll spend 80% of your time filling out paperwork. And, of course, there are a lot of meetings."

   Do you wonder if you might be cut out for the Med-L position? "To be good at this job, you have to be marginally insane," Charlie jokes, before switching to a more serious tone. "You can't live and breathe being an EMT. People who do well are the people who have other skill sets they've picked up in their lives and bring in. Having clinical skills is great, but first and foremost you're a medical manager and a designer. And you have to have really good people skills. Those people do a really great job."

CONCLUSION

   From the ED to corporate America, the small-business world and large-scale incident management teams, your EMT certification could take you places you never dreamed, if you're willing to be open to the possibilities. Will you be ready when opportunity knocks? It could come in the form of a Post-it note, an unenthusiastic boss, a special team or even just a simple desire somewhere within.

   These four individuals heard the knock of opportunity and opened the door. Their careers and lives became richer for the experience.

   Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colorado. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at www.theemtspot.com.