Life in Emergency Medical Services (EMS)
There is a shortage of firefighter and other EMS workers across the nation, especially when it comes to volunteers. Might emergency services be for you, either as a career professional or as a volunteer? In this interview, we talk with Mike, training center coordinator at AED Superstore, the world’s largest distributor of automated external defibrillators, and discuss his career in EMS.
MIKE: HOLD ON!
DISPATCH: …LAKE TOM FIRE, YOU’VE GOT A ONE VEHICLE ACCIDENT WITH INJURY AT 7488 RIVER ROAD…
MIKE: I GOTTA CUT YOU SHORT—THAT’S ACTUALLY JUST DOWN THE ROAD FROM ME…
…So ended my interview with an emergency medical services (EMS) worker named Mike regarding what life is like for firefighters, EMT’s, paramedics, etc. He is now the training center coordinator at AED Superstore, the world’s largest distributor of automated external defibrillators (AEDs), as well as his community’s assistant fire chief. Mike’s current positions in firefighting and first aid, CPR, and AED training are a natural result of his lifelong work in all things emergency.
Getting a call from dispatch was a fitting end to my hour-long conversation with Mike. He has had a varied career in emergency services and I felt I had hit the jackpot as I interviewed him to get a picture of what life is like working in the EMS field. Taken from a wider view, Mike’s EMS career started in childhood as he began rescuing imaginary victims. He imagined people were trapped in snow caves dug into the side of mounds created by snowplows passing in front of his childhood home, then spent his playtime energy getting them out alive.
This natural passion which emerged when he was a 5-or 6-year-old kid (“I wanna be a firefighter”) spurred entrance into his high school Firefighting Recruit Academy his junior year. Completing the academy equipped him with a technical diploma and sufficient knowledge to take state firefighter certification tests which led to a fulfilling EMS career. As I discovered talking to Mike, at the core of his life experience in EMS are impassioned values of helping people, working as a skilled team member, acting bravely, and thinking cool-headedly in situations where most people instinctively run the other way.
Here is what Mike had to say as I talked with him about his career in EMS:
STEVE: “Tell me about your current position. What is your job title now and how does it fit in the EMS field?”
MIKE: “Currently I am the training center coordinator at AED Superstore and my position is to run our American Heart Association CPR training center. We offer CPR and AED training for the lay rescuer and healthcare providers across the entire country. I started at AED superstore in customer service and moved into this position. I’ve been a CPR instructor since ’99 and my background as a paramedic and a firefighter suited me for this position. Having a good working knowledge of cardiac arrest put me into a position where I can move our training centers into a big nationwide model which supports our mission to train as many people in CPR and AED use as we can. Our goal is to reduce the number of people who die each year from sudden cardiac arrest. Right now the American Heart Association estimates that number to be around 300-350 thousand.”
BECOMING A FIREFIGHTER/EMS PROVIDER
STEVE: “Sounds like you have had a wealth of experience and have a real sense of purpose in what you’re doing. I want to dig more into the process you went through in getting to this point. Were you first a paramedic?”
MIKE: “I actually started in public safety as a junior firefighter while still in high school, at a small fire department in Door County, Wisconsin and, once I turned 18, I was able to become a full member. I went through State of Wisconsin level 1 and level 2 firefighter training, completed both of those courses and also became an EMT Basic. I was offered the opportunity, through a private EMS company I worked for, to go through EMT/IV (intravenous) technician training, an advanced level that trains EMT’s to start IV’s and deliver some life-saving but relatively safe medications. Being able to do this reduces the number of people who require transport to an emergency room. A good example is diabetics who can be treated on scene, preventing them from having to spend 4-5 hours in an emergency room.
I was hired by the city I retired from and was immediately put through paramedics school, then spent just shy of 13 years as a paramedic. For the whole time I worked as a paramedic, I maintained my fire background. [Then] I let my paramedic license lapse. A lot of the reason for leaving the paramedic position was work burnout. We were a relatively busy department—we ran just shy of 2000 calls a year. Our department worked 24-hour shifts, and the burnout rate was pretty high in that scenario. I wanted to explore something that was a little bit different but still in a closely-related field.
Currently, apparently because I can’t stay out of the game, when I moved to Lake Tomahawk I was recruited by our local volunteer fire department and was just recently promoted to assistant chief.”
STEVE: “How would you say you got interested? What people or events got you going in this direction, even as a young guy in high school?”
MIKE: “There were quite a few different impacts…one of the first ones—I was always fascinated by fire trucks and people would ask me, ‘What do you want to be when you grow up?’ and I would always respond, ‘I wanna be a firefighter!’…I always had a passion for it even as a little kid. Not too long ago before my parents passed away I remember my Mom and I were talking and she asked me if I remembered this—she told me in the winter when I was little and there would be all of the big snow piles in the driveway, she goes ‘you put a little hole in there and pretended you were rescuing somebody out of there.’
Looking back it makes a lot of sense I did that, but it was that spark and that passion that was always inside of me…something I wanted to do. I started when I was 16 very early in my junior year of high school.I became a junior firefighter in a volunteer department that only ran 80-125 calls a year. The chiefs we had were all great teachers and really valued young people coming into the service because it provided an opportunity for them to show the young ones the ropes before they make a final career decision. One of our assistant chiefs, who unfortunately passed away in the line of duty, was a huge influence on me pursuing this as a career. One day he said ‘Hey, we were at a big chief’s conference and we heard about this school offering one of the best fire academies and they integrate EMS into it.” He was a big positive influence in my public safety career.
STEVE: “Did you end up going to one of those schools the assistant chief recommended?”
MIKE: “I did—myself and two other junior firefighters went through. We all rented an apartment together. Even though all three of us graduated from that location, only two of us actually pursued a career in fire and EMS.”
Note: As we talked, Mike outlined the various certifications one typically earns in the process of becoming an EMS provider. He pointed out that every state has its own requirements which are tied to National Registry minimum requirements. In addition, there are various training academies and college-level degrees that can be earned in fire science and emergency medical services. Below are listed those we discussed:
- Firefighter I
- Firefighter II
- Emergency Medical Responder
- EMT Basic
- EMT Intermediate
- PARAMEDIC (According to Mike, medically speaking, “Paramedic is top of the food chain with advanced knowledge, training, and certification in life-saving procedures. Paramedics are able to do out in the field generally the level of care that you’d receive in the first 30 minutes of arrival at an emergency room.”)
MIKE: “The crux of a lot of the training you receive at any one of the levels is critical thinking. It takes a lot of specialized training for an EMT, Paramedic, etc., to get their brain to function in a way that is difficult to explain to those who haven’t worked in the industry. You have to think almost abnormally, almost against what others would do in the same type of situation. We’re the ones going into a scene that people are trying to run away from. At the same time, we’re trying to maintain our safety and constantly monitoring our surroundings. The training at any level revolves around teaching the emergency responder how to think in a critical and very quick fashion, and to execute decisions that are kind of cookie cutter—see this-do this, see this-do this—but to also maintain the overall safety of the responders and the people who are involved in each incident.
There are medical procedures we refer to as “monkey skills.” A lot of things EMTs and paramedics do you could literally train a monkey to do; however, knowing when to do it and why to do it and what the possible side effects and outcomes could be is why we don’t have trained monkeys right now doing this. Basic life support is where it all starts. In the world of EMS, you need to be a good detective. For example, identifying if someone is breathing or not, if they’re conscious or not, then going from there to identify what the problem is, then knowing what you’re able to do and using your knowledge to fix that problem.”
EMS ROLES & RESPONSIBILITIES
STEVE: “What are the different people on scene doing in responding to an emergency, employing this kind of thinking or procedure?”
MIKE: “A really good way to highlight how all three levels of providers are responding and what their responsibilities are is to take a cardiac arrest patient. In the EMS world, the SCA patient is one of the most complicated calls you can ever go on—there are so many different moving parts in that. The first responders and even lay rescuers, their job is to get there quickly and to start CPR and to deploy an AED as quickly as they can. EMT basics are going to do CPR, place what is called a non-visualized airway (set up so someone can put it into the patient’s mouth, blow on some balloons on the end of that tube and that forces air directly into the trachea and down into the lungs.) The EMT intermediate and/or the Paramedic use the endotracheal tube. They are actually going to put a breathing tube down through the vocal cords and into the trachea. There is no margin for error in where the air is going to go.
Over the years we’ve found that good compressions, defibrillation, and medication is where we see success in returning someone essentially from dead to, well, not dead! The EMT Basic’s role stops after the airway is placed. Intermediates will start an IV and deliver some medications, but the Paramedic is definitely going to get IV access or even intraosseous access (actually putting a needle into the bone and delivering medications). The paramedic is going to use a lot of different medications to try to get the heart into a rhythm that electricity can fix.”
STEVE: “So the Paramedic is really doing some sophisticated ER doctor stuff at that point?”
MIKE: “Absolutely! If you look at cardiac arrest in an ER, cardiac arrest in the back of an ambulance or cardiac arrest in somebody’s house, the same procedures and the same level of care is happening. The biggest difference is the ER is a controlled setting. There’s good lighting, the scene is safe, you’re able to get the person up so you’re not kneeling down next to the person on the floor, doing chest compressions and starting IV’s and everything else. I can’t tell you how many times in my career we’d respond to an unconscious person and it ended up being a cardiac arrest and they’re wedged between a toilet and a wall; or they went into cardiac arrest on the bed and they’re a large person and it takes several of us to move that person down on the floor. They don’t face that kind of challenge in an ER, but the actual care being delivered is identical.”
STEVE: “So, these are life and death situations. How long did it take to become confident on the job?”
MIKE: “The ‘When did I stop [expletive]ing my pants?’ question? As an EMT it was a pretty quick transition from being brand new to being fairly comfortable and confident. When I became a Paramedic it was a good year of going on a lot of different calls. My first call as a Paramedic I was nervously confident because the program I went through was the University of Wisconsin’s and I can’t thank my instructors enough for the education they gave us. My first call was pretty serious— a gentleman at one of our clinics whose heart rate was weak and fast, and the medication that we used to correct that [condition] pauses their heart for a moment in time. I was getting ready to give the medication, and my instructor’s voice popped into my head and she told us that when we are giving the medication, that brief pause (and we’re talking a second or less usually) is going to feel like an eternity. You’re going to sit there and watch the cardiac monitor and you are going to want to see that change very quickly— but that brief pause is going to feel like an eternity.
But it was a good year before I was actually confident. It was the training and the phenomenal experience I had through my Paramedic program that gave me that confidence so quickly. I’ve known Paramedics that didn’t hit their comfort zone until they hit their two-year mark. It really depends on the individual and the training. When you have really good training officers and senior medics that you’re working with that are good teachers, that can really help shorten the time until you’re comfortable.”
LOOKING AT THE BOTTOM LINE
STEVE: “What is the EMS person’s typical schedule?”
Note: When I asked this question Mike launched into a lengthy description of various EMS work situations and some of their typical schedules. I have again arranged his responses in a bullet list in an effort to clarify the main points of his response:
- MUNICIPAL EMS PROVIDER—Union represented department, Usually 24-hr shifts:
- “Modified California Shift”—1 day on / 1day off…1day on / 1 day off…1 day on / 4 days off (total 9-day rotation)…
- Or—2 days on / 2 days off…
- Or—1 day on / 2 days off…
- Or –2 days on / 4 days off…
- PRIVATE SECTOR PROVIDER—Hospital or Stand-alone; schedules vary depending on services provided:
- Emergency Response—24-hour shifts, varied days off
- Or—12-hr shifts, varied days off
- Or—On-call, especially for non-emergency transport (e.g., patient transfer from hospital to nursing home)
STEVE: “My impression is that most EMS persons are not in it for the money, but for the meaning and purpose that makes the work fulfilling. Is that generally true?”
MIKE: “It’s a pretty accurate statement and pay varies everywhere. For those who want to make a career, their big goal is municipal employment. Full-time Paramedic/Firefighters are generally organized and represented so they have the ability to negotiate their salaries and benefits.
Private ambulances pay enough, but not in the same ballpark as municipal employment. With most of the 24-hour schedules, you have those chunks of 4 days off. A lot of guys and girls work second jobs and construction seems to be one of the most popular side jobs. But at 24-to-45,000 dollars a year in an entry-level position, no you’re not going to get rich working in this industry.”
STEVE: “Is most EMT pay hourly?”
MIKE: “Generally, yes. There’s some EMT Basics in a company or community role that make decent money, but for the most part, EMT Basic is viewed as an entry level position.”
STEVE: “Do you have any favorite stories like administering those meds on your first call?
MIKE: “One of my favorite stories is one that I share in every CPR class that I teach. It was a response to an athletic club for a cardiac arrest. We defibrillated the gentleman shortly after our arrival, and by the time we were loading him into the ambulance he was asking what happened. He made a full recovery and we found out later that he got to go see his oldest daughter graduate college and his youngest daughter get married just shortly after his cardiac arrest.
Those are the calls we like to talk about because it had a really positive outcome. Those are the ones you default to because there’s so many other calls we were on where we saw the gory gruesome stuff—not always blood and guts—sometimes it was child abuse and neglect, or elderly abuse and neglect. We had a saying on our shift, ‘When we show up it’s because you’re having a bad day. Now we’re involved and your day just went to hell in a hand-basket.’
Taking care of yourself mentally, dealing with those bad calls, you tend to look at the positive calls and the positive impact you made not only on the patient’s life but their family and friends and everybody that’s associated with them. Guys and gals that are in the business understand the stuff that we’ve seen, and we talk…there’s a healthy way to talk about this stuff so you don’t keep it internalized and let it eat at you. If you do that it can mentally and emotionally and physically destroy you.”
FINAL WORDS OF WISDOM
STEVE: “Anything else you would say to somebody that’s looking at the kind of career you’ve experienced?
MIKE: “If you have a passion for it, follow that passion and let your passion and your desire drive where you end up. I’ve known people that started out in fire and EMS and then went into law enforcement and they’re great cops. There’s never anything wrong with changing a career path right in the middle of beginning it. If you love what you do, it’s going to be easy and you’re going to be good at it. The best thing ever is good firefighters, good Paramedics, good law enforcement officers that love their job and are there for all the right reasons—to help other people when their day has just turned around on them and it’s not going so well.
The other thing is that as you get into this, asking questions is where you learn. One of the things I’ve always said, and I say this to my wife quite often, ‘The day I feel I’ve learned it all is the day that I completely retire from all of this.’ It’s an ever-evolving business, technology has made our life easier, has made the outcomes for the people who are suffering these emergencies better. There’s always something out there to learn, something new that somebody’s tried…it’s the experience you learn on that call from talking with another provider and you say ‘Oh, wow, I’ve never seen that!’ And now you’ve seen it and you have a knowledge base to work on that. The day that anybody who’s in this business feels they have learned it all is the day they should retire.
I would add that if you’re not a team player then this isn’t the business for you. When new people came in I would always ask, ‘Did you ever play organized sports, or do some kind of activity where it took teamwork to achieve a common goal, at any time as a kid?’ Those that did were great members of the team, they understood the team dynamic and how we all work together to achieve a goal. I coach youth hockey and I always tell the girls how valuable teamwork is in their everyday lives, but teamwork in public safety is paramount.”