America's Emergency Medical Services System is in Urgent Need of an Overhaul
Why I loved it, left it, and why I've been calling for change
Happy EMS Week, past me
Good morning, friends! It’s National EMS (Emergency Medical Services) Week here in the U.S., where we celebrate the EMTs, paramedics, and firefighters that sacrifice their sanity, sleep schedules, and at times, their lives, for us. I was an EMT in a past life, and this week holds weight for me. Some of my colleagues are no longer with us, while many more have left the profession of first response for something more … relaxing.
Since I initially published a story about my experiences in EMS, I’ve gained many new subscribers, and now feels like a perfect time to share it - after, of course, a brief manifesto. I hope you’ll stick around for the whole thing- or you can scroll down to read the story. I highly encourage you to read some of the articles I’ve linked in this first section. They’re sobering and eye-opening.
It’s Past Time for Change. If Not Now, When?
Photo by Clay Banks on Unsplash
In spite of continued talks on inequity in emergency response, black patients are still most likely to be stereotyped in the field and denied proper care and pain medication when in need. Additionally, black first responders are likely to experience harassment at work, making them more likely to resign, leading to a lack of representation in EMS. Organizations like Omnibus were founded to fight the very problems black firefighters experience at work.
Racism and sexism exist within the institutions of EMS themselves, perhaps because it is a breeding ground for attitudes of American Exceptionalism. There’s a fine line between “it’s an honor to serve” and “I’m superior to you because I hold your life in my hands”.
In those moments that dwell between life and death (sometimes) and touch into the most vulnerable parts of our humanity, what is needed is not emotionally stunted, cynical, close-minded providers. What is needed are providers with open hearts and minds.
This is where the American healthcare system is yet again failing us. Lauded as heroes during the COVID-19 crisis, first responders earn an average of $35,000 a year in my state, and it doesn’t get much better in other states. Most are required to work a schedule something like this: 24 hours on, 24 hours off, 24 hours on, 24 hours off, 24 hours on, 24 hours off, 3 days off. Repeat. It’s exhausting. It often interferes with social life outside of work, isolating first responders and tanking mental health with less than comprehensive access to mental healthcare services.
Our first responders deserve better. Undesirable working conditions can’t be wholly to blame for attitudes and biases that prompted two Illinois paramedics to strap a black man having a medical emergency to a stretcher face down. Certainly not. Maybe, just maybe, giving first responders working conditions that promote a more well-rounded lifestyle would be a start toward creating first responders that are emotionally and mentally equipped to be meeting people in the worst moments of their lives.
In addition to, of course, action to eradicate racism and sexism from EMS. How? I don’t know. But I know it’s necessary to provide high-quality patient care for everyone. I know it’s necessary to break the use of the EMS system as a transport service for people who just want a place to sleep at night or a meal at the cost of a hospital bill they can’t pay. And I know these changes can’t happen in a vacuum.
EMS is a microcosm of some of society's most altruistic and inequitable behaviors
Photo by Zhen H on Unsplash
The only people who understand what you go through are sitting in this room
2 weeks before my life changed forever, I was sitting in a conference room at a hotel attached to the Prudential Center, affectionately known as “the Pru” by Bostonians listening to a seasoned medic tell myself, a friend sitting beside me, and a room full of strangers who were also first responders that the only people who would ever understand what we went through were the people sitting next to us.
Sitting in an epicenter of an imminent public disease outbreak, this man said, “Look to your left. Look to your right. These are the people who know what you go through. They are your team.”
Yes, I cried. It was very moving. I don’t really talk about my life in EMS, cherry-picking stories here and there for the listening pleasure of people who weren’t in it with me.
I sucked at a lot back then. EMS wasn’t one of those things.
EMS was my soft place to land when I moved away from home. From the outside, it probably looked like added stress, going to class from 6-10 every Wednesday night and spending several Saturdays training for my freshman year of college, eventually running almost 1000 hours in calls on a full-time student schedule.
It was added stress. It was too much. But I wasn’t ready for that conversation. I was ready to change lives when I moved to Philadelphia. My dream of becoming a doctor wasn’t driven by facts or logic- it was driven by the feeling of my life being changed so drastically by someone(my pediatric neurologist) that I had to figure out how to have that same effect on people.
Whoever said feeling deeply was a strength never chased the dream of going to med school on feelings.
I had so much passion for affecting change, and EMS gave me a place to put it- and it also gave me something to love. I wasn’t good at anything, really, during my freshman year. I did passably in my classes, even though I was trying so hard that I ended up in therapy.
Sitting in EMT training, I excelled, even when I fell asleep during class. It lit a fire under me to keep going in every way. I loved solving the puzzles. Oh, the puzzles!
Okay, symptom A, symptom B, and symptom C- high intracranial pressure- I’m seeing Cushing’s triad.
“I mean, yes, “ my instructor might reply,” but I just wanted you to end up at the patient needing rapid transportation.”
I met some of my very best friends in EMS, and while all of my peers were working in lab internships that I found dreadfully boring, I was running shifts.
All of the time.
It was lonely, exhausting, and addictive.
It was lonely. It made my friendships within EMS stronger but also increased the distance between myself and non-EMS people, save for a select few.
It was exhausting. I would get off of shift and sleep until noon on a Saturday, or just go to class if it was a weekday. Half of my closet lived at our base. I pushed myself to my physical limits. I loved it.
Burnout was a very close friend during college, and so was PTSD post-winter of 2017. The adrenaline of EMS was a high I was always chasing. Somehow, in an unhealthy, unsustainable way, it could keep it all at bay. Even when the adrenaline high was long gone, I loved the feeling of being there for other people.
It became who I was. Part of the reason my trip to Argentina was so formative was that I had to live for 6 months without running any shifts. No patients needed me. I found other ways to get my adrenaline high, of course. See “traveling through South America alone”.
Suddenly, I wasn’t C. Prairie, EMT, anymore. I was just a girl. A girl who missed C. Prairie, EMT.
I’ve had to learn how to be just a girl again over the past few years, and I’ve really enjoyed it.
I haven’t missed some of the worst things about EMS:
old, annoying, condescending coworkers( these don’t always go together, but often they do)
being harassed via social media by cops we ran calls with
bosses that play favorites
playing the “innocent, young, and dumb” card just to fly under the radar at work
knowing people are talking about you behind your back
lack of sleep
working a career that virtually no one could fully understand unless they were in it.
The closer my certification gets to expiring, the more I miss some of the best things:
my patients
the more healthy team dynamics
medicine. it’s been so long since I’ve talked about triads or syndromes or OPAs and NPAs or patent airways or suction or ST elevations
being a part of something bigger than myself
the memes
the people I got to meet
the coworkers who took the time to teach me, respected me, and treated me as an equal
The instructors who saw my enthusiastic, energetic personality as a strength. Not a weakness.
C.Prairie, EMT, off radio and unavailable for the last time
I don’t know how I could go back- I’m just starting to get established as a freelance writer. I make an impact with my words. Writing is now forever a part of who I am.
I don’t know how I could go back because I don’t want to be paid wildly low wages to be overworked and lose a lot of the autonomy I have right now, with no promise of good mentors or a healthy dynamic at work.
The choice is obvious. Yet, a part of me will always be in a med chopper. A part of me will always be learning how to rescue patients from confined spaces or how to use a HazMat suit. A part of me will always be call sign EMS 100.
Church Signs
This week’s church sign isn’t a church sign. The Cleaner World up the street has a sign, and for the past week, it’s simply said, “Wild Wednesday”. I don’t know what that means, but I think it’s hilarious. Wild discounts? Are they all throwing soap at each other? Is it Wild West Day for the employees? What’s Wild at the dry cleaner?
Let me know your thoughts.
xx
Camille
It was so good to read about your EMS experiences again and know that will forever be a part of who you are. I truly hope Dr. WCH can read this. Every time my gaze catches your EMT certificate, my QRS widens a bit and my heart rate slows to absorb the magnitude of it. ❤️