Most Likely to Succeed: Advice for New EMTs & Paramedics

I saw a list of "101 Things We Should Teach New EMTs" circulating around Facebook a while back. Typically, lists like this strike me as cliché or superficial, so I thought I would take a shot at creating my own list of advice for newcomers.

I tried to avoid the clever one-liners we throw around at parties that end up on sketchy looking t-shirts and instead come up with more profound things I wish someone had told me along the way (I didn't even make it half way to 101, so I guess I still have a lot to learn).

These are things I have discovered on my own over the years, “the hard way,” although I concede it is likely that someone may have tried to tell me things that I was too hardheaded and young to understand. Hopefully the list is useful or meaningful or at least somewhat entertaining to you, and maybe it will make you more likely to succeed in this profession.

1. The vast majority of our training prepared us for the vast minority of situations we have to deal with.
2. Most patients are not that sick.
3. Most patients are sort of sick, but do not have problems we can fix.
4. Almost all patients believe they are sick. It is not our job to convince them otherwise.
5. A few patients are really, really sick. Sometimes we recognize this and sometimes we don't, but we always have to be prepared for it.
6. No one deserves to be treated disrespectfully until they treat us disrespectfully first.
7. The most important equipment is packed in a bag for a reason. Take it. It is a giant pain in the butt until you actually need it.
8. Take a full history before moving the patient if at all possible. He/she might not be alive by the time you get back around to asking questions.
9. Carry a flashlight, a pair of scissors and a pen. Don't waste money on gadgets you'll never use.
10. Take care of the patient and let someone else talk on the radio.
11. Treat responders with the same respect you expect from nurses and doctors.
12. Never treat volunteer responders badly. They don't have to be there.
13. Recognize and appreciate it when you and your partner are the only people on a scene who are being paid. Make sure you're just as filthy as everyone else by the time you leave.
14. It's hardly ever wrong to stop talking.
15. Avoiding a fight with a patient is more important than being right.
16. Listen to the patient. Wait for the whole answer before asking another question.
17. Backboards are stupid. Don't use them if you don't need to.
18. Don't push traffic through red lights. Turn off the siren and wait.
19. We are not the police. We do not want to look or act like the police.
20. Stethoscopes are for when we're not sure. If the problem is obvious, treat now and listen later.
21. Personal budgets should not rely on overtime.
22. Your life outside of EMS is more important than EMS. Go home sometimes.
23. It's ok to cry.
24. It's ok not to cry.
25. Good partners are hard to come by. Cherish and cultivate your relationship with a good partner, but recognize that it probably won't last forever.
26. Respect and take care of your partner whether you like each other or not.
27. Supervisors can be helpful, but actual patient care decisions are between you, the patient and the doctor.
28. Recognize and admit when you screw up. Apologize to the patient if the mistake affects him/her.
29. You are going to screw up a lot.
30. Co-workers who act like they never screw up are either lying or delusional.
31. Every time we get embarrassed, we're learning something valuable.
32. Some people really are magnets.
33. Full moon nights really are worse.
34. Our knowledge and capabilities are limited. We don't always have the answer. There's no need to make things up.
35. Specifically, never make up the first set of vitals.
36. Don't plan anything immediately after a shift is supposed to end.
37. Call in when you're sick.
38. Make a special place in your heart and mind for dispatchers, right next to your spouse, children, pets or exotic classic sports car. No matter how much they aggravate you, you'd better not ever be mean to them.
39. Check the radio mic before you start ranting, especially if you are ranting about a dispatcher.
40. The cab of the ambulance is the only place in the world where unprofessional behavior is acceptable. In fact, it's encouraged.
41. Nothing real ever happens when students are around.
42. When in doubt, give the pain medicine.
43. When in doubt, work the code.
44. Our role in most patients' clinical courses is brief and small. We're not going to be everyone's hero.
45. You will rarely, if ever, truly be recognized and appreciated for the work you do.
46. There is no incentive for excellence. Choose to be excellent for yourself and your patients, and don't expect a reward for it.
47. Most hearts that stop will not start again.
48. Try as hard as you can to restart them anyway.
49. Career EMTs and paramedics are truly special people. Learn everything you can from them, and realize that you are probably not one of them.
50. When you feel like it's time to get out, it's time to get out.

I made this list a few years ago not long after I left full-time EMS to pursue a career in nursing. Rereading it now, that final item seems like the most important. I see a lot of people quickly lose whatever idealism drew them into EMS in the first place. Too often, that idealism is replaced with anger, sadness, bitterness or some other complex concoction of negativity. Good EMTs and paramedics sometimes become unhappy, unpleasant, unprofessional EMTs and paramedics at an alarming rate.

It's unfortunate, bizarre and sad for us as individuals and as a profession, but even more bizarre is the way we deal with the situation. We take it all in stride like it's our destiny. We wear our anger and cynicism like badges of honor. We sigh and talk about how burned out we are but we keep coming back and doing the same thing. I think we actually kind of enjoy thinking of ourselves as grizzled, old, one-eyed veterans soldiering on against the odds. We’re proud of still saving lives after all these years despite the toll it has taken on us, sacrificing for the good of society, working 80-hour weeks and surviving on hardtack and black coffee, becoming old men and women at 25 and ranting about it constantly to each other and anyone else who cares to listen.

We have to stop believing that being unhappy is a job requirement. We have to stop revering negativity. We have to realize that it's not normal to live that way. Whenever I work with someone who has managed to make a successful career out of EMS, I try to interview them a little bit and find out the secret(s) of their longevity. These are the people who quietly show up on time for 20 or 30 years and do their jobs. They don't get upset and make a big fuss about things. They fly under the radar and go about their work with a sort of calm unflappability regardless of the situation. They never seem unfulfilled or starved for praise. They don't care about becoming supervisors or running high-profile calls or seeing themselves on the news.

The best advice I have ever gotten from one of these people came from a paramedic named Derek Horst. At six feet three inches tall and 280 pounds, I am not a small person, but Derek makes me feel like a child. When I say that I look up to him, I mean it both figuratively and literally. He is a very large human in the way that Shaquille O'Neal is just a very large human. I'm not sure where they find uniforms to fit him or how he manages to cram himself into an ambulance, but he has done it successfully for a very long time. He is that guy I just described—not flashy or dramatic or high-maintenance, not angry or unhappy, just content with the job he has dedicated himself to.

Derek told me that the secret to the longevity of his EMS life is simply that EMS is not his life at all. EMS is his job. His self-worth is not tied to what happens at work. He is a person who happens to work as a paramedic, but that is only one aspect of the (figuratively speaking) larger person he is.

I think Derek is onto something here. For a long time, being a paramedic was my entire identity. I started volunteering in EMS at 16 years old, and by 18 it became my whole life. I ran across my high school yearbooks recently, and couldn't help noticing my conspicuous absence from most of the pictures of my friends. They were acting, playing sports, participating in school clubs, going to dances and social events, dating each other. I was on an ambulance running calls. At the time, it seemed like I was doing something high-speed and unique that was really going to take me somewhere. Looking back, it seems like I wasted a lot of my young life doing something that ultimately turned me into one of those unhappy paramedics I mentioned earlier.

Looking at the picture of 18 year old me, sitting on a picnic table alone in black cargo pants and a generic navy blue t-shirt with a star of life on the chest, I wish I could tell myself to do things a little differently.

“You should be with your friends,” I might say.

“Figure out who you really are, learn to play the piano, find a boyfriend. Do something stupid. There will always be more ambulance calls to run.”

I'm 34 now, and I could still benefit from 60-year-old me coming back in time to say these exact things to me, but I'm getting there. When I work on the ambulance now, I try to be like Derek— friendly, calm, unflappable. More importantly, I try to be like Derek outside of work. I am building a relationship, attempting to stay in touch with friends, planning for the future and working toward a career that might not involve crazy hours and tons of overtime.

Maybe the most important piece of advice I can give new EMTs and paramedics is to make sure that being a new EMT or paramedic is not the only thing you are doing with yourself. It's a wonderful job, but it's not a life. Make a life for yourself outside of work. You will be much more likely to succeed and stick around long enough to give your own advice to the new people.