fire technicians

Welcome to EMS. It may not be the highest paying of professions, but you’ll be rewarded in other ways.

Recently, I was asked by a colleague to write an introduction    letter for her EMT class. I had read David Givot’s excellent    commencement speech for paramedic graduates, and I thought long and hard    about what I wish   someone had said to me on my first day of EMT   class,  before I even   embarked on this career path. This is my answer.

~ Kelly Grayson, NREMT-P, CCEMT-P

Welcome to  the profession whose entry-level practitioners — you, in a    few months —  rank 4th from the bottom in the Bureau of Labor    Statistics salary  rankings. The only people paid less than you are    pre-school teachers,  dishwashers and meatpackers. The guy riding on the    back of the garbage  truck, or holding a sign at a highway   construction   zone, makes more  money than your EMT instructor. Likely, a   lot more.

And none of those people are required to make life-or-death decisions. You will.

It  is a profession where the line-of-duty death rate is comparable    to firefighters and police officers. For those of you who aspire to     flight  paramedic status, that particular niche is by far the most     dangerous  profession in America — ahead of loggers, miners, and Alaska   crab  fisherman.

It is a profession whose divorce, suicide and  substance abuse rates    soar far higher than the general population. The  average career    expectancy of an EMT is five years.

Five years.

Some  of you will go on to jobs in nursing or other healthcare    fields. Those  of you that don’t move on to nursing or PA school will    leave EMS with a  career-ending back injury, or leave EMS healthy but    not whole; jaded and  cynical, your idealism burned away in the     furnace-like reality of our  profession, your faith in the innate     goodness of man gone like so much  ash and smoke up the chimney.

You’ll be disrespected

You  will be disrespected   by patients and bystanders who don’t know any   better, and belittled   by doctors and nurses who should. And many of you   will endure the   abuse for free labor, donating your services as  volunteers.

So why do I tell you this? Well, they call it  informed consent, a    concept you’ll learn about in the first few chapters  of that EMT    textbook you’re carrying. Before you agree to the abuse  you’re about to    suffer, it’s only fair that you know what you’re getting  into.

And it’s not what you think.

You will sift  through broken glass and twisted metal, wade through     urine and feces  and vomit, weather heaping torrents of verbal abuse     from the people  you’re trying to help, all for the prospect of a few   dollars on payday,  and perhaps…just perhaps…a show of gratitude now and    again.

I’m  here to tell you that what you’ve been promised is a lie, if    only a  little white one. When you’re green and idealistic, the romance    and  thrill of EMS is powerful. All of us were adrenaline junkies at    some  point. Plus, there’s a decent chance it might even get you laid.    What’s  not to like?

You won’t save that many lives

But you will soon discover the hidden truth, the one that drives most people out of our profession:

We don’t save that many lives.

Lifesaving  may be what we train for, but the opportunity to actually    save someone  comes all too rarely, and when it does present itself,    the outcome  depends more upon luck and timing than our skills. In my     career, I’ve  had my share of code saves. Some of them even made it  out   of the  hospital alive. Others hung on just long enough for their     families to  tell them goodbye. I’ve made the critical diagnosis,   gotten   the tough  airway, turned around the crashing asthmatic, and   stabilized  the shocky  gangbanger with multiple unnatural holes in his  person.  I’ve needled  chests, paced, defibrillated, and cardioverted,   and given  countless  drugs.

But, other than a handful of exceptions, I can’t state  with any    certainty that my actions were the difference between life and  death.    In that handful of exceptions, all but one or two were saved  simply by    applying the techniques that any John Q. Citizen with a basic  first   aid  course could have done. Ask your instructor if you don’t  believe   it’s  true. They’ll tell you the same thing.

The reality of the profession

The  reality of   your profession isn’t exciting rescues and  cardiac arrest    resuscitations twice a shift. Your reality will be  dialysis transfers    and people who can’t poop. It will be toothaches at  3:00 am, and  you’ll   have to maneuver your stretcher around five parked   cars to get  to the   front door, and weave your way through five   able-bodied  drivers to  get  to the patient with a complaint so minor you  can’t  believe they  called  911 for it.

So why, if you’re not going to save all that many lives, should you even bother?

You  should bother because EMS is a calling. Even when you leave EMS,    it  never really leaves you. It’s what Henry David Thoreau meant when     he  said, “Do what you love. Know your own bone; gnaw at it, bury it,    unearth it, and gnaw it still.”

You should bother because, even  if we’re not saving lives, what we    do matters. It matters in ways  unnoticed by us, to people you may not    even remember tomorrow.

You  should bother, because EMT’s are privileged to play in life’s    great  game. Too many unlucky people watch the action thunder by, stuck    at a  desk, or watching it on television at home.

You should bother,  because it’s the little things that matter. Most    of your patients are  ignorant of your skills. Few of them understand    the technology you  wielded so expertly. But they’ll remember the  smile   you gave them, or  the way you tucked the blanket in to ward  away   winter’s chill, or the  way you stood in the rain, getting  drenched as   you held the umbrella   over them as your partner loaded  them in the rig.   They’ll remember calm  competence, and gentle speech.

They’ll remember the joke you made  to lighten the tension. They’ll    remember those things and more, and  they’ll remember your face long    after you’ve forgotten theirs.

You’ll be remembered

They’ll  remember you   because, even though they were just another call  to you,  you were a   major player in a defining event in their lives.   They’ll come  up to   you, years after the fact, and say, “I remember you.  You take  care of   me when I had my heart attack.”

And likely all you did  was apply oxygen and take them to the    hospital. Maybe you helped them  with another dose of nitro or    encouraged them to take an aspirin —  really nothing they couldn’t have    done themselves. But you’re the one  they remembered, and you’re the   one   they thanked.

You should  bother, because in the tapestry of human existence, you    get to  contribute your own unique stitch. You get to make your mark in    ways  that cannot be quantified on a spreadsheet or a profit and loss     statement. Not everyone gets to touch the life of another, but EMT’s  do.

You  should bother, because when people are at their most vulnerable,    they  will invite you into their homes and tell you things they won’t    even  tell their priest. And they’ll expect you to make it better    somehow. I’m not sure you understand now how profound an honor that is,    but   hopefully one day you will.

The question is, can you be worthy of that honor?

If you think so, then welcome to EMS. Do us proud.


Beautiful fire spinners. I want to do it all!