From a Distance

A year ago I left my last clinical position in EMS. My back had started to demand more of my attention than patients on some calls. I decided to walk away while I still could—a state my gimpy left leg reminds me I shouldn’t take for granted.

I’m not done with EMS; I still read about it, write about it, even dream about it. I also miss it a lot…well, not all of it. Working in snow, for example. I hate snow. I’m glad I don’t have to respond when it’s snowing, or when it’s cold enough to snow, or when people say it might snow. We get tornadoes and other wrath-of-God storms every few weeks in Tennessee, but at least it doesn’t snow much.

Here are some things about EMS I don’t miss, besides snow:

Harsh tones from telephones, pagers and radios—I still flinch when the phone rings. I’ve read it has something to do with a heightened startle reflex. Good thing I don’t do IVs anymore. Or serve the soup course.

Meaningless administrative practices—I didn’t mind a little paperwork, but duplicate entry of obscure patient demographics was particularly irritating. I’m waiting for research that correlates patients’ outcomes to their occupations.

The absurdity of treating the sick while sick—When I was in the corporate world, we were expected to work even when we were germ-ridden. That would be ridiculous on so many levels in EMS, wouldn’t it?

Unstable respiratory patients—Watching someone struggle to breathe is especially hard, I think, because we’ve all been short of breath. Ninth-inning Red Sox rallies still do that to me.

The real meaning of HIPAA—“How I Prevent Administrative Action,” I’d guess, acknowledging data gatekeepers who arbitrarily and unnecessarily invoke HIPAA as a barrier to clinical QA/QI. There are legitimate, unobtrusive ways of giving EMS providers regular feedback about patient outcomes.

Parents who don’t advocate for their kids—I was amazed at the risks some parents took on behalf of their children. Moms and dads whose pursuit of entertainment was interrupted by sick or injured kids often tried negotiating with me to delay definitive care. The worst part was knowing even clueless parents have the final say.

Maternity calls—What scared me about birthin’ babies was all that stuff I’ve never done but would have had to do if something other than a head presented. Practicing with a plastic perineum was pretty far from reassuring.

Different protocols for the same diseases, same species—It’s like having different rules for baseball east and west of the Mississippi.

Most of my EMS memories are pleasant, though:

Good calls with good outcomes—Seeing patients wake up made me wonder why I’d waited so long to get into EMS.

The value of paying attention in class—I loved discovering Hey, that actually works! the first time I’d try something theoretical on a real patient.

Partners with good advice—Nothing against wives, but sometimes you need a friend who doesn’t know you that well.

Partners with good ideas—I can’t count how many times my coworkers knew a better way and made it so.

Learning, trying, teaching—I’m not sure there’s any such thing as an observer in EMS. Whatever orientation time I thought I had, or was told I had, was always overestimated. Maybe that doesn’t sound like a positive, but I usually preferred doing to watching. Soon after doing came teaching, which I still think is the best way to learn.

Sharing a noble profession with like-minded people—There’s a sweet spot within an us-against-the-world mentality where you celebrate, rather than resent, what makes you different.

Being needed—My daughter needed me, and my wife still needs me (at times), but being needed by total strangers made going to work seem worthwhile even when I wasn’t at my best.

I think I’ve adjusted fairly well to life without protocols. I look forward to most days, even without that surge of anticipation I used to feel on my way to calls. I’d like a little more money in the bank—who wouldn’t?—but not if it meant working in offices the past 22 years.

I’ve learned more about the human condition than any engineer I know. I’ve been to the brink and back; it’s time to move on.

Or maybe I could still do per diem…

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.