Guest Editorial: Generations

Let me tell you about my grandson Hunter. He’s almost 2 and more kinetic than a ferret on steroids. As a paramedic I admire his bias for action.

I love that photo of him in turnout gear. His father—my son, Rob—wears the same. He’s a paramedic too, but I can’t take credit for that. Rob was drawn to rescue long before I was. He buffed his first call at age 6 while I was still in the corporate world. All he needed was a tricked-out two-wheeler with plenty of pedal power.

Kids: They humble us with their energy and delight us with their enthusiasm. Rob’s youthful obsession with emergency vehicles wasn’t that different from my own passion for prehospital care as a 39-year-old FNG at a volunteer ambulance squad. Our paths intersected scholastically in 2003 when he graduated from the same paramedic program I’d attended eight years earlier.

Rob was a different kind of student than I’d been. He grasped the subtleties of our profession intuitively, whereas I had to rely on my engineering background and life experience to compensate for my late start in EMS. When I finally got to ride with him one day in 2007 at his 9-1-1 job in Delaware, I could see right away that his talent as a caregiver exceeded mine. I was thrilled by that and did whatever he told me to do.

Now we’re blessed with Hunter. If you’d asked me 10 years ago whether I’d want a grandson of mine to follow me and his dad into EMS, I would have said sure, why not? These days I find myself holding back, wondering about the future of our occupation. I’m assuming there’ll be at least as many changes to paramedicine over the next 30 years as there have been in the past 30. 

30 Years Ago

When I started riding in 1992, PPE mainly meant gloves. Most of us didn’t wear them, even during invasive procedures. As for goggles, I never actually saw them on an ambulance.

Almost all the paramedics I served with were white males. The only ones with degrees had completed them while pursuing other vocations. Street medics became supervisors with or without college. Management wasn’t considered a skill set yet.

EMS was more hands-on and less automated. We had MAST suits and KEDs but no glucometers, pulse oximeters, capnometry, 12-lead EKGs, automated BPs, video laryngoscopes, sharps with sheaths, CPAP, ultrasound, GPS, ePCRs, or Internet access. Everyone had pagers.

The only specialty hospitals in our region were trauma centers. The closest we got to calling STEMI alerts was using lights and sirens. Usually we went to the closest ER. On the way we valued personal experience over current research and didn’t bother with seat belts. Patients were loaded and unloaded the old-fashioned way: with our bad backs.

30 Years From Now

Paramedic pay should respond favorably to supply-and-demand influences. Our per-capita numbers will decrease as public service becomes less attractive, but a much higher proportion of medics will have four-year degrees—many with EMS-related majors. The medical establishment will use our newly vetted smarts to help assess 9-1-1 callers remotely before deciding what sort of doctors they need, if any. With fewer trips to and from patients’ homes, the risks of fatigued responders on the road will drop, leading to healthier work habits and longer careers. 

I think college as I experienced it will end, largely due to pandemic-mediated changes. Families will save on tuition despite universities’ huge profits from shedding overhead and embracing online learning. And those remote, multimedia-driven bachelor’s-degree programs will be easier for students to finish without encyclopedic textbooks and crowded classrooms.

The risks and benefits of prehospital care don’t change dramatically from one generation to the next. They evolve, constrained by the reality that scenes are never completely safe and rescuers don’t earn as much as most of the people they’re helping. I still think EMS is a noble endeavor, but I’m not sure how I’d sell it to anyone who didn’t already want to do it. The rewards of public service should be self-evident.

I have no idea what Hunter will make of all this 20 or 30 years from now. Will he embrace his family’s legacy and sign up for an EMT class or opt for a more conventional career? “Conventional” didn’t work too well for me or his father, but who knows? Maybe Hunter will become the first in our family to be president of something safe and solvent.

Meanwhile, if you see a cute little guy in turnouts at a scene, please remind him not to park his bike too close to the ambulance.

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