A Late-Night Rant about Petty Politics in EMS

awesome post, CK… you know I’m with you 100%

This is a huge problem in EMS. We seem to come up with every excuse possible to not put the patient first. There is only one real reason to not put the patient first – a threat to me or to my partner.

That threat does not include simple discomfort, such as -

Missing the end (or the beginning) of the big game.

Missing a meal.

Being late for my next job.

Having to transfer care to a rival service.

Et cetera.

Our job is to take care of the patients. Without the patients, we do not have a job.

The patients are not there to assist us with stroking our egos.

I came out ‘here’ from California. That means I came from an all-paid, professional (don’t even go there, I’m not debating that term here) EMS system with Paramedics on every ambulance on 9-1-1 response. I learned EMS as an EMT, Firefighter and Paramedic, and I learned that if you don’t value the patient FIRST, you’re not going to be around very long.

That said, ‘out here’ is the East Coast, Jersey to be exact. I was horrified to learn that a vast majority of this state (the nation’s most populous per square mile) is covered by VOLUNTEER EMS. Now, that’s not necessarily a bad thing, if properly managed. Volunteers can, and do, provide excellent EMS in many places. I didn’t work in one of those places. I worked fire-based EMS on a military installation, surrounded by volunteer EMS squads. All of their little fiefdoms and petty kingdoms fought, both internally and amongst each other. No one went to calls- too many petty arguments over who was senior, who’s doing what to whom, which squad is better, whose area a call is in… and many many more BS little things.

We, the full-time, staffed Fire-based EMS crew, sat in the station and listened. We listened as calls for dyspnea, chest pain, unconscious subjects, vehicle accidents with injuries, trauma, and yes, total crap calls too, went unanswered. I distinctly remember listening to the dispatch as this call went out:
“Attention *town first aid, respond to * care center for a person choking”
no response
TWO MINUTES PASS
“Attention *town first aid, respond to * care center for a person choking, second request”
no response
ANOTHER TWO MINUTES PASS
“Attention *town first aid, third request, respond to * care center, CPR in progress, requesting mutual aid”

I didn’t hear the outcome of that call, but it’s blatantly obvious to those of us in the business. That patient died. Not because there was no ambulance available, not because other calls had taken the volunteers away from their town. Because no one bothered to respond. The petty bullshit ran all the potential responders away long before this call came in, and too many egos were involved. This is a town that has significant tax basis for a full-time, paid EMS division. They get well over a thousand calls a year. There are major roadways going through town, a very large industrial area with numerous high-risk processes, a number of convalescent/care facilities, a very busy rehab hospital… they have the need for staffed EMS. So, why not go paid? Because someone would have to give up control of their little piece of the kingdom, and that means they wouldn’t be the “big boss” anymore. That simple. They don’t want to let go of control.

I know, I know. Why doesn’t the public do something? They don’t know, don’t care, don’t want to bother with it, don’t want to pay more taxes, don’t think it’s necessary because THEY don’t need the EMS right then and there. AND, NJ has a law preventing litigation against the volunteers. AND, the state “First Aid Council”, an all-volunteer group that… well, I don’t really know what they do besides prevent forward-thinking and progressive EMS from coming into NJ. It goes on and on and on… what it boils down to is exactly what your rant is based on- a lack of concern for patient care as the primary reason for existence.

So, all that to say, “I agree with you, I feel your pain, and I hope everything gets better soon.” I don’t see that happening here in Jersey. Too many people have to keep their little kingdoms, have to exercise power because they can, are afraid of change because it’s “change”.

Stay safe, take care of each other, and take care of the job. In that order.

This is just flogging the dead horse. It might as well be 1990 as 2010, same old song and dance. Personally, I am just sick of hearing about it. Here is my take on this.
Have you ever heard the “man song”. It has lines in it that go something like this,” I can do whatever I want, (When she lets me)”, “I can stay out all night, (When she says it is ok)”.

Volunteer Fire and EMS do the EXACT SAME THING! I am both a career Fire/Medic and a Volunteer, so stop the complaining now.

Here is the same song but with the volunteer flair,” I will respond to all calls, (As long as they don’t interfere with something else I would like do to more)”, “I want to be treated with the same respect as my career brother and sister”, (As long as I don’t have to have the same accountability).

Chris, I feel the pain in your message but I am going to tell you, the general public doesn’t care, the politicians do not care, and even the volunteers do not care!

Stop beating your head against the wall. 99.8% of the world thinks the system is fine. Tax payers don’t want to pay higher taxes for full-time EMS. The tax payer is willing to roll the dice and bet that they will never need an ambulance. The volunteers don’t want full-time EMS, and then they wouldn’t be needed. They receive too much of their self worth from this profession to give that up.

To all the people that will read this blog I say, “Let it go!” The systems that run well are doing so because they figured out that EMS is NOT about the EMT, it’s about the patient. Those that aren’t running well have not figured that out and I have found out that they usually don’t want to figure it out. They are much happier wearing their EMS coat around town with their little red light on the dash all the while busily patting themselves on the back.

Medic 1518 out!

Fire the Chief. Period. This is a management issue. Your bully is a bully because the Chief allows it. Like an untrained dog, this person will not change on their own.
New management will fix this problem hopefully, because the current can’t or won’t.

Medic 1518 out!

Nicely done, CK. Patient care should come before anything, ANYTHING, else. Period.

The Social Medic has a similar rant up on the specifics of New York State’s laws that prohibit assisting without being dispatched. Do Amoral Policies Justify Immoral Behaviour?

Chris – I join the pack who understand the frustration you feel and applaud you for venting, in a responsible way, in public. When we look at the money, perks, benefits and public esteem that the fire service and law enforcement receive we should not be asking why we are not on equal footing with those public agencies. We all know the answer – and for anyone who did not know before your post, you spelled it out. Although the “thin blue line” certainly has negative connotations with respect to the brotherhood in the law enforcement, when it comes down to having each other’s backs, it is instinctive. It has always been a fall back position to say that EMS is much younger than the law enforcement and fire service communities as an excuse for many of our failings. But just as an individual has to become responsible with age, so does EMS and the time for using “infancy” as our excuse is long overdue. When I become discouraged with system or agency politics or other absurdities of our system I try and remember the wisdom of Thom Dick, whom I like to think of as my long distance mentor and a quote from Robert Kennedy (regardless of whether you liked, disliked or don’t know about his politics. Essentially it is, if one person throws a stone into a pond it only makes little ripples, however if enough people throw enough stones into the water it will create a wave large enough to change anything.

Keep up the good work.