Q&A With Paramédico Author Benjamin Gilmour

Of all the labels used to describe Benjamin Gilmour—author, filmmaker, advocate, activist—the one he’s most fond of is “paramedic,” a fact that makes itself evident throughout his latest book, Paramédico: Around the World by Ambulance.

Gilmour, an Australian paramedic from Sydney, has been visiting EMS systems in far-flung locations for over 15 years, and in the process has put together a truly captivating account of his experiences riding along in 13 different countries. His latest book is packed with eye-opening experiences that could make even the most seasoned medic squirm, while also offering no shortage of thoughtful insights on what EMS looks like in very different cultures. At EMS World Expo 2013, Gilmour premiered his companion documentary, Paramédico, which takes a rare and candid look at the secret lives of paramedics featuring some of the characters encountered in his book, including Mohammed Azam in Pakistan, Mitzi Rodriguez in Mexico, Manuela Sylvestri in Italy and Tippy Lee in Hawaii. In a special interview for EMS World, J. Friesen spoke with Gilmour about his experiences.

How did this all start? What inspired you to leave the relative safety of your home and write about EMS in unfamiliar countries?

As a teenager I witnessed a couple of tough Sydney paramedics revive two heroin addicts at a city railway station and coolly swagger off like they were heading back to the pub, which back then they probably were. From that moment on I wanted to join up. Unfortunately, I was too young. Unlike nowadays, the ambulance service didn’t care much for applicants with degrees. They were looking for life experience. So, at 18 I flew to Calcutta, volunteered for Mother Teresa and knew after that I’d never stop traveling. It doesn’t take long working in thrilling places to figure out how entertaining your experiences might be for others. International EMS is not only quirky, but sometimes downright unbelievable.

You write about 13 very different nations. How did you choose the ones you did?

Lively locations were my target, with perhaps the exception of Iceland. But Iceland was interesting for other reasons. Iceland wouldn’t have the great EMS it does without the Center for Emergency Medicine in the U.S. and Pittsburgh EMS. To qualify as a paramedic in Iceland, you have to work on Pittsburgh ambulances. Moreover, Iceland is one of the few nations to have recently made the successful transition from Franco-German prehospital care to the Anglo-American model, which is a truly remarkable feat.

In your chapter on Pakistan, you write about a harrowing experience during a suicide bombing. And in Mexico, about gang violence, and the sensationalist nota roja ("red note") journalism that splatters gruesome pictures across the tabloids. Do you believe EMS professionals in these places have a higher tolerance for dealing with regular large-scale violence?

How EMS personnel in these countries have any career longevity at all amazes me. The suicide bombing behind my car in Pakistan and the aftermath I was involved with is nothing new to local medics. In Lahore, one medic I rode with was shot at 36 times and still upbeat. An important factor for withstanding psychological trauma is the relationship we have with coworkers. It’s no coincidence that I found great camaraderie and high morale in countries where medics face the most extreme tragedies daily. In Mexico they do sing-alongs in down time and dance to cumbia. In Pakistan they make up bizarre war cries and massage each other’s backs after drive-by assassinations and bus bombs.

In some systems you must have come across treatment modalities that you considered substandard care. How did you handle these situations?

My book, Paramédico, was never intended as a comparative clinical study, but rather a fun and humorous collection of worldwide EMS adventures. The poor clinical care I occasionally witnessed was usually due to lack of equipment and medication rather than deficient training or commitment from medics. So I didn’t want to focus on substandard treatment, because it might have reflected on the medics, which would have been unfair. If you’re a medic with an imagination, there is plenty you can achieve with very little equipment anyway. In Mexico, where the paramedics had no analgesia, I saw one female Red Cross medic bring a patient’s pain from 10/10 to zero with nothing but masterful reassurance. The patient had a compound femur. It surprised me, but I learned a great deal from paramedics accustomed to such limitations.

System abuse seems to be a universal characteristic of prehospital care. This was particularly evident in your telling of the Roma gypsies in Macedonia. What are your thoughts about system abuse?

More often than not abuse happens because people simply don’t know any better, and it partly reflects providers’ lack of involvement in public education. In my view, system abuse is mainly an affliction of Western nations where the standard of living is high and there’s ease of access to quality EMS. You mention the Macedonians, but I found this to be an exception and largely attributed to their taste for benzodiazepines, especially the Roma gypsies. Every second emergency call in Skopje—the capital of Macedonia—was a request for IM Valium. Some will argue that system abuse is lower in poorer nations because there’s often no system to abuse. But take South Africa, where the system is pretty good. People in Johannesburg still won’t call for anything less than a gunshot wound or multicasualty accident. I believe some societies are simply more resilient than others. Over time, exposure to the pressures of violence, poverty and war will do that.

What's next? Can we hope to expect anything more from you?

Of course! I have another book about Australian paramedics almost finished and several film projects in development. Readers can follow Paramédico on Facebook and keep up with events or send me feedback. After the success of Paramédico, some colleagues ask me why I’m still working as a paramedic. Truth is, I just can’t keep out of an ambulance. I love the job too much.

J. Friesen, MPH, EMT-P, is the founder and director of Trek Medics International, a non-profit organization dedicated to improving EMS in developing countries. Learn more at their website: https://trekmedics.org.