Delayed Response: Thoughts on Public Safety from a Frontline Firefighter/Medic
It’s not uncommon for EMS (Emergency Medical Services) arriving at an emergency to be confronted with civilians who have no idea what to expect from the ambulance crew. There are two types of misconceptions: those who expect too much from EMS, and those who don’t expect much at all. And who can blame them? We, as an industry, have not done much to educate the public on our capabilities. Sure, we have open houses and events to show off our toys. But how often do we truly explain to the public what it is we do?
I'm not claiming there's been no public education because there has been plenty. But the education I've seen tends to focus on recognizing an emergency and activating the system as early as possible. Most of us (at least in Massachusetts) have seen those cartoon commercials of grandma having a stroke and the family recognizing all the signs. They sing a catchy little song about her facial droop and slurred speech while grandma starts to drool and, when they're done with their song, they call 9-1-1 and grandma is saved. This is a great start and has certainly made a difference in getting help to those who need it as soon as possible.
Family members and patients often have no idea what they're in for when EMS arrives. I once cared for an old man having a heart attack who was reluctant to accept my treatment. He looked at my cardiac monitor and asked me three times, “Are you sure you’re qualified to use that thing?” To him, a paramedic was just an ambulance driver, there to throw him in the back of the ambulance and speed to the hospital.
This type of confusion is found in middle-aged and elderly patients who, up until the current situation, have been in relatively good health and may have never needed an ambulance. What they may not realize is that EMS has come a long way since the days of Johnny and Roy. Today’s EMTs and Paramedics are trained to higher standards than ever before. We maintain a variety of certifications including some that are required of most emergency doctors.
For example, all Paramedics must be certified in ACLS (Advanced Cardiac Life Support). This certification is exactly the same for doctors and nurses. In fact, it is often Paramedics who teach these courses. A seasoned medic’s understanding of ACLS is often supported by the fact they’ve provided this care in the field countless times with no more than two or three people. Emergency department staff often have the luxury of as many as eight or ten people on hand. This is not a slam on doctors or nurses, or the jobs they do. No doubt, the care offered in today’s emergency departments is top notch. My point is that the initial care a paramedic ambulance crew can offer (such as in a cardiac emergency) is exactly the same as the initial care you would receive in an emergency room, and the medic’s mastery of these skills is generally considerable. Of course, just like any profession, some paramedics will be stronger than others.
Other types of care provided by paramedics include:
- Advanced Cardiac Life Support
- Advanced Airway management
- Pain Management
- Pre-Hospital Trauma Life Support
- Pediatric Advanced Life Support
- End of Life Support
- And many more…
The other end of the “expecting too little” spectrum commonly comes in the form of very young adults, although it is encountered elsewhere, too. It’s not unusual to be told “Stop asking so many questions! Just do your job and take them to the hospital!” In my experience, this is spouted by the Alfa Male (or Alpha Female) of the college-aged group whose friend has done something stupid to land them in the back of my ambulance. Like the old man in the earlier example, this section of the public does not realize EMS’s role as part of the overall health care system. Thorough assessment, rapid treatment, and appropriate history taking are an integral part of our job as providers.
Opposite the “expecting too little” phenomenon is the “expecting too much” phenomenon. For the most part, this type of misconception is not as common. Expecting too much can also be mimicked by the grieving process. A person who has just lost a loved one unexpectedly will sometimes say things like, “You must be able to do something!” The grieving process is a whole class in itself and I don’t mean to include people in these unfortunate circumstances as part of this category, but it’s worth mentioning.
The people expecting too much from EMS will call for an ambulance and then be disappointed or aggravated when we suggest being seen by a doctor for definitive care. Sometimes they expect us to stitch up their wounds. Other times they would like us to simply make them feel better and then leave them at home. While EMS may someday delve into that type of care, it is not currently considered definitive care nor is it meant to be. We can bandage wounds or begin the rehydration process, but the system is designed to then transport the patient to a doctor where the wound can be stitched in a sterile environment or antibiotics can be administered to the sick as needed. Often, these people will be frustrated we have not provided them with the service they were expecting.
To make matters a little more complicated for the public, there are two main classifications for EMS workers: EMTs and Paramedics. The public frequently does not recognize the difference between the two. Generally speaking, it's nearly impossible for them to distinguish between the two in the field. In your service, the paramedics might wear a different color shirt or have a slightly different patch. But does the public know that? Probably not. Even if they did, like I said, they may not understand the difference between the two.
More effort should be made to educate the public on what EMS services are available to them in their communities. Let them know what to expect when they’re expecting an ambulance to show up at their door. Social media has become a tremendously valuable tool in reaching out to the public and can easily be used to help spread this type of information. As I’ve said in previous articles, this has become a profession centered on customer service. Reaching out to our citizens will not only give the public a better understanding of what we do, it will help solidify our image as dedicated public safety professionals and members of the greater community.
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Tom Valle earned his EMT certification in 2000. After graduating from UMass, Amherst in 2001, Tom worked private ambulance in both Springfield and Greenfield, MA while earning his paramedic certification from Greenfield Community College. He continues to work as a professional firefighter/paramedic in western Massachusetts and serves as the secretary for union’s Local. Tom is continuing his education by working towards a Bachelor’s in Fire Science through Columbia Southern University.
Tom can be reached directly at