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Paramedics on the Edge
The 90-minute documentary Into the Unknown: The Paramedics’ Journey—highlighting the work of modern-day emergency medicine—has finished post-production following a pause during the COVID-19 pandemic with plans for a fall film festival debut followed by a wide theatrical and then streaming platform release.
Its genesis was formed when Randy Mantooth—whose life was saved years ago by two paramedics—and Kevin Tighe played the roles of John Gage and Roy DeSoto in the television program Emergency!, airing from 1972 to 1979. It’s credited with helping launch the modern U.S. EMS system. However, many people still misunderstand the profession.
“We are 50 years into this profession and people still call us ambulance drivers,” Gary Bryskiewicz, Denver Health chief paramedic, notes in the documentary.
Paramedics' Responsibilities Today
Today’s paramedics deal with a myriad of calls, including drug overdoses and mental health issues. They face personal injury, hazardous work environments, mental health issues, assaultive behavior, and recently, a global pandemic. Paramedics have increased responsibilities, doing more pre-hospital services in ambulances en route to the ER. Richard Carmona, the 17th Surgeon General of the United States and the film’s co-producer, notes in the documentary he has been a first responder for more than 50 years.
“The paramedic has 1,200 or so hours of training, can start IVs, give you medication, and has a radio to connect to an emergency room,” he says. “It's an extraordinary privilege to make the selfless decision that you will risk your life for the benefit of someone else. First responders do that every single day.”
The documentary is directed by Tom Putnam, an award-winning director, producer, and editor specializing in telling the stories of first responders, including his Detroit firefighting documentary BURN. Producers include Tonya Mantooth—Randy Mantooth’s sister—who has won 10 Emmys among other awards. She is the CEO and artistic director of the San Diego International Film Festival. Producer Steve Martin is a retired Los Angeles County Fire Department assistant fire chief and a U.S. Air Force veteran and has been honored for his public education work. Producer Baxter Larmon, PhD, MICP, is a professor of emergency medicine at the David Geffen School of Medicine at the University of California at Los Angeles (UCLA). While Tonya Mantooth has experience working with many different teams, this team was unique due to its subject matter expertise. “What I love the most is we all learned from each other,” she says. “I was learning their world. They were learning my world. We had a lot of fun doing it.”
The Film's Mission
Martin notes the film’s threefold mission statement is to honor what paramedics do, educate the public, and inspire the next generation of paramedics. The film features a geographical cross-section of agencies in Crozet, Virginia; Baton Rouge, Louisiana; Denver, Colorado; Santa Barbara, California, and Sparks, Nevada. One issue in EMS is paramedics don’t always look like the community they're serving, Larmon says. The film features the work of African-American and female paramedics.
Producers highlight different systems: public, private, third-service, hospital-based, helicopter, and marine-based agencies as well as volunteer paramedics, whom Carmona notes in the film are the backbone of EMS services in parts of the country lacking paid services. The documentary highlights the work of dispatchers, whom Larmon notes are often “the forgotten people.” Tonya Mantooth says with the help of Randy Mantooth and Tighe, the team sought people who would represent the template for what would make a well-rounded documentary, were energetic, and look good on camera.
“The interesting challenge which was new for me as a producer is you cannot prepare a production team on what it's like to go on runs with paramedics,” says Tonya Mantooth. “We shot a total of 65 days across the country. The production team were all working professionals out of L.A. Many had just come off major films. We were only two days into filming when our crew really experienced the real world and what these paramedics lived through day in and day out.”
The expertise of the producers helped the production team process what they were seeing.
“The tagline of our film, ‘You can’t unsee what you’ve seen,’ became very real for the crew,” says Tonya Mantooth, adding it brought the crew closer together. “We made a better film because of that.” One production crew member decided he wanted to pursue a career in emergency medicine and is now enrolled in the UCLA EMT program.
Paramedics’ Personal Challenges
In exploring paramedics’ personal challenges, “we now have peer support and areas to help these people get through obstacles whereas before they were left on their own,” says Martin. “We still have those folks who do this job and say they would not do any other jobs. There's a calling to help others on their worst day. We let the film end with this inspiration of what is out there and what you can do.” “As a filmmaker, it was important to me we tell a human story that wasn’t statistically or data-driven, but rather a dive deep into their lives as opposed to just talking heads, but to really experience what they're experiencing so the audience can walk in their shoes and have an understanding,” says Tonya Mantooth. “I wanted the audience to walk away not seeing PTSD as a statistic, but rather as a human issue and to move the audience that way.”
The stress of the job is exemplified by a Marine veteran—now a paramedic—who at times wakes up from sleep reliving a moment in Iraq where there had been a catastrophic resulting from an IED explosion. Two sisters who are paramedics in the same agency were students in the same class during the Columbine High School massacre. “There’s a lot of survivor’s guilt,” says one. “That’s why I am a paramedic.”
They note how it’s hard to discuss their job with others who don’t know what it entails. One sister says her therapist started crying during a session, adding “I went for help and traumatized someone else.” The female paramedics were called ‘whores’ by a patient during filming. Another—who has responded to pediatric calls with undesirable outcomes—tries not to think about bad calls. The documentary also features Chiron, an equine therapy ranch in Medford, Oregon, where one paramedic is filmed talking about trying to get the dreams about “horrible pediatric traumas” to stop. Anne Kellogg, the executive director, notes: “Their exposure to traumatic death is extraordinary.”
Mobile Integrated Health in EMS
EMS is now comprised of subspecialties including wilderness medicine, tropical medicine, tactical medicine, hazardous medical care, and disaster medicine. A newer subspecialty: mobile integrated health.
“What you're going to see in our movie is unique. It’s not all gunshots and critical patients, but it shows the underbelly of America people don't want to really see—the addictive behavior we have,” says Larmon. “Medical prevention is a great area for EMS to be involved with partly with the mobile integrated healthcare system. I see that becoming the biggest future. But it needs to be recognized for funding.”
The documentary also touches upon the passion paramedics have for their work—one calling it the best job in the world, and another saying she’d do it for free.
“At the end of this movie, the resilience of the people in this profession is pretty amazing,” Larmon says. “It’s the resilience that makes you want to stay and the non-resilience that is going to make some people want to either promote out or get out.”
“You’re either born to be a paramedic, or you’re not,” says Randy Mantooth.
“You have to have the three qualities every paramedic has: courage, compassion, and caring.” Martin concurs. “We have paramedics recently who unfortunately have gone to prison because of choices they made doing their job, and it came back to them. It’s one thing to find those people who have that compassion and give them education and the tools to get that due diligence of sticking with the job. I’ve found the best people to ever do this job were the compassionate ones.”
In addition to the executive production crew, the documentary has an 18-member advisory board representing emergency medical services, public safety, academia, health care, and law, as well as the endorsement of 19 industry associations and several sponsors.
“We wanted to make a film that could document the life of a paramedic, how within their own community they seek to serve one another, promoting access to specialized care,” Tighe says. Being a paramedic is not just a job—it’s a calling. It takes a special person to journey ‘into the unknown.’ The public doesn’t see all that is out there. It’s a tough but rewarding profession caring for people on their worst days. ‘Into The Unknown’ seeks to stress the need for ongoing support within our EMS community—a place where we can all come together and heal.”
Carmona notes he is proud to be associated “with this behind-the-scenes inspiring work that allows the public to view the anonymous lives of those who care for us. It is a must-see.
