10 Tips for Surviving an EMS Career

You've chosen a rewarding career; here are some tips from a veteran paramedic on how to make it last for many more years to come.

1. Have fun, laugh out loud

Take your job seriously, but not yourself. At least not too much! We all know there are situations that require a poker face, but in my opinion the rest of the time should be steeped in fun and mischief. Comedy is essential to both our own mental health and to the management of patients. After all, laughter triggers the release of endorphins that inhibit the transmission of pain signals. In my view, medics who laugh often are on top of their game. A sense of humor eases pain, relaxes the anxious and lifts morale.

2. Keep fit, eat smart, rest well

Working on ambulances can be physically demanding. Climbing stairs with gear and carrying heavy people out takes its toll on your body. Building core strength and keeping cardiovascular fitness makes your job easier and reduces the risk of injury. But fitness and good sleep is equally essential to your mental health, your ability to cope with shift work and emotionally draining cases. Do at least some light exercise before every shift. I do sit-ups, push-ups, stretches and a short run. And don’t forget to sleep. It’s not an indulgence. It’s allowing your body and mind time to rejuvenate and remain in peak condition. Be conscious of your nutrition. Eat smart.

3. Wear other hats, take time off

I encourage all paramedic trainees I mentor to develop interests outside the job. It might be playing in a band, regular adventure travel, fundraising for a charity or doing a sport—something, anything, far removed from EMS. We all know colleagues who have ambulance work on the brain 24/7 and spend their days off doing overtime shifts. Some can even sustain this for a whole career, but it’s rare. Most burn out or get a desk job in the end. Moreover, they tend to be just a little tedious to work with. Over-saturating yourself in this business is unwise. I also believe the odds of career longevity improve if you take an extended period off work at least every 5–7 years. Distraction, variety and vacations are essential to staying the distance.

4. Complaints are inevitable, don’t panic

Complaints from the public are inevitable. They’re inevitable because some of the people we interact with have unrealistic expectations. I’m not talking about expectations of politeness, professionalism and competent clinical care. These are realistic. I’m talking about expectations that we’ll get to them in less than two minutes, we’ll agree with their self-diagnosis, give them the drugs they ask for and take them where they want to go. The last complaint I got was from the relative of a patient with a minor laceration requiring nothing more than a band-aid. The individual took exception to my suggestion the injury didn’t “look that bad” and they “shouldn’t worry.” Apparently, these words were “dismissive” of their concerns and “downplayed” what they considered to be a nasty wound. Essentially they complained about my reassurance. Our work environment provides fertile ground for such misunderstandings. We deal with patients from all backgrounds and socio-economic groups. There will always be those with poor communication skills, poor historians and others who are perpetually disagreeable, angry and unsatisfied. The fact our managers are obliged to investigate every complaint can make us defensive and stressed, especially when some of those managers rarely praise our hard work. But if we know our modus operandi is professionalism and our habit is providing the best clinical care we can, then we shouldn’t worry.

5. Be kind to your dispatchers, they pull the strings

It’s incorrect to think that in the age of GPS and computer-aided dispatch systems dispatchers can’t manipulate and override technology. Thankfully, human choices are still made in EMS dispatch. If there are two ambulances in roughly the same area and two cases come in at the same time—an obese man covered in diarrhea vs. a catwalk model feeling faint—which case will the dispatcher give to you? How friendly have you been on the radio lately, how polite on the phone? How quickly have you been turning around each case? If you think dispatch is entirely objective, keep dreaming.

6. Accept the banality, it’s easy work

Wouldn’t it be great if the only calls we ever got were critical patients who desperately needed our valuable life-saving skills? While such a scenario sounds exhausting to me, I’ve worked with plenty of medics who wouldn’t mind 100% action and constantly complain about the banal, low-acuity cases. Patients with chronic illnesses and non-emergencies are not going away any time soon, no matter how passionately we whine about it. Solution? Accept them. Many of our clients are poorly educated and poorly informed about what we do and the limited resources we have. More often than not, they simply don’t know any better. Not all of them are deviously abusing the system! While finding logistical solutions to reducing inappropriate calls is the priority of many modern EMS agencies, allowing these callers to make you miserable is pointless. Look on the bright side. These patients often stay at home or rarely travel on your stretcher, they’re less likely to bleed all over the place, use up your equipment or force you to break a sweat. That sounds pretty good to me.

7. Don’t compromise your safety—ever

Always enter a case with caution. Always keep an exit. Always lift patients correctly. Always wear PPE. No case is too pressing to forego these basic safety measures. If career longevity is what you’re after, never compromise your safety at work. Not once, ever. Whatever you come across, take a long, deep breath. And in that moment think calmly about your next move.

8. Know that all people die

We know that death is inevitable for all of us. While people describe our core business as saving lives, it’s probably more like delaying death, although I accept this doesn’t have quite the same ring to it. Many of us struggle with the conflict between accepting death as inevitable on one hand while trying to prevent it on the other. Some patients, such as the young, are natural candidates for resuscitation because their probability of survival is higher. Yet many of us try to revive the elderly with equal vigor, patients in their late 80s and even 90s, forgetting that death is a naturally occurring phenomena. Of course, when we put on our uniforms we represent the ethics of our organizations, and are often compelled to act against our own views. In that sense, we are kind of set up for disappointment. But if you’re looking at a long career in EMS, avoid too much agonizing over patients who don’t make it. No matter how good you think you are at your job, you’re a mere mortal with a limited ability to work miracles. You’ve got the tools, skills, medication and experience. And sometimes these things help delay death for a while. But let’s not have delusions of grandeur about our powers to resurrect. All people die. That is the norm. When you save someone, it’s an exception to the rule.

9. Live with your demons

All of us who work on the frontline of EMS have demons. There are cases we’ve attended that will haunt us forever. No examples are needed, you know the ones. Some first responders have had particularly horrendous experiences that spelled the end of their careers. This is always a possible scenario, one I hope never happens to me. While none of us are bulletproof, there are ways we can reduce the probability of being knocked out by post-traumatic stress. My personal approach has been to make these tragedies part of who I am. As humans, we own our experiences. We own the memory of them. All our experiences, be they happy or sad, help to shape our character and beliefs, and help ignite our compassion. So I claim them as my own. I make no attempt to forget the horrors I’ve seen. I suspect this would be futile anyway. Instead I acknowledge the place these experiences have in my life and I try to live with them. It’s kind of like learning to live with an unpleasant extended family member. They’re family, they’re not going away. Your best course of action is to make peace with the fact.

10. Talk it out, get help

Learning to live with your demons is easier said than done, and sometimes we all need extra help. Informal debriefing has been the most useful in my career. By informal debriefing I mean simply talking to your work partners, uninhibited. Aim to get yourself into a work environment where you don’t feel shy to share your feelings with your colleagues, and where your mentors and fellow medics are respectful, supportive and without judgment. If you’re losing sleep, hitting the bottle hard or generally not functioning at your prime after a traumatic case, never hesitate to get professional help. You’d be surprised just how many EMTs and paramedics have visited, or regularly visit, qualified counselors. I certainly have. Whatever it takes to keep your mind in shape for your quality of life, your family and your work is worth doing.

Benjamin Gilmour is the paramedic, author and filmmaker behind ‘Paramedico: Around the World by Ambulance’ (HarperCollins). Watch 'Paramedico' the film now at www.paramedico.com.au.