Being a first responder is overwhelmingly viewed as heroic and admirable. Emergency medical services (EMS) specifically, most notably consisting of paramedics and EMTs, are generally perceived as safe by the vast majority of the public. As an EMT, I was attracted to the profession for many reasons. I wanted to be the person others could seek help from in their most vulnerable moments. I wanted to be the person to provide emergent care regardless of the unpredictable high stakes. I wanted to be the person to save lives. I did not realize the gravity of what I would experience. Of course, everyone knows EMTs inevitably see gore and death. Like many others, I understood this, but it is completely different when you are in the field. Many people forget the physical and mental strength required to make it through each shift.
One thing that quickly became evident to me early on in my EMS career is healthcare inaccessibility. The majority of my geriatric calls were for nursing homes that were severely understaffed due to being funded primarily by Medicare, which consistently gets cut. Our patients were left soiled in their beds often with chronic UTIs and occasionally unnoticed strokes or fractures. I have also had patients resort to “treating” themselves. For instance, I had a call involving an older man that became septic after he yanked his own infected teeth out because he could not afford to see a dentist. Other examples of gaps in care that I have witnessed consist of people that cannot afford in-patient addiction rehabilitation or mental health treatment due to the cost and ineligibility for financial assistance programs. Additionally, I have had many homeless patients that are unable to be consistent with their medications, causing them to spiral and have psychiatric episodes that land them either in the ambulance or police custody. Being a first responder involves a significant mental toll of constantly interacting with patients struggling to receive long-term care; we always wish we could do more beyond the short ambulance ride.
Aside from systemic disparities, another aspect of being a first responder that is not talked about enough is being attacked by the same people you are trying to help. There have been several times when I was afraid for my own safety. When overdose patients are brought back with narcan, many wake up in defense mode and immediately begin swinging. I have had a postictal seizure patient try to grab my clothes and bite me. My most scary situation involved an aggravated schizophrenic patient that did not want to go into the facility we were transporting her to due to her hallucinations. She nearly punched my partner in the face and scratched at both of us while making violent threats. I do not blame any of these patients for acting the way they did; I understand that it was psychologically out of their control. However, being a first responder means inevitably putting your own well-being at risk when interacting with patients that are confused and/or scared for one reason or another. I have not even experienced the worst of it; some of my coworkers have been shot at and assaulted. The constant fight-or-flight mode is another aspect of the job that can be exhausting at times.
The most obvious part of working as an EMT is seeing death firsthand. Before my first DOA (dead on arrival), I had never seen a dead person before. Due to the patient passing before our arrival, I felt sad for the patient and his family, but I did not feel guilt due to it being entirely out of my control. However, it is very common for first responders to feel guilt when poor outcomes result despite using best practices. The first cardiac arrest patient that I had did not survive. After the arrest was called, I asked the medic I was with if we could have done anything different. He replied no and that the cause of her arrest and other circumstances made it nearly impossible; he said I did well for my first arrest. I accepted that answer, but I still wonder if anything could have changed the outcome. This “what if?” is a common thought for first responders that leads to post-call distress, especially considering people’s lives are literally in our hands.
Lastly, with all other things considered, having to immediately jump onto the next call while running on fumes can be very difficult. To put it into perspective, imagine going from a horrible trauma or cardiac arrest to someone experiencing toe pain that is complaining about EMS not getting there fast enough. Sometimes we have as little as five minutes at the hospital to clean up after transferring the patient before we move onto the next call. Occasionally, we do not even have the time to move onto the next call before other people act inconsiderate. For example, while actively working on a stroke call, the ambulance blocked traffic while trying to turn around to go to the hospital. Some people decided that their time was more important and proceeded to honk at the ambulance to hurry up and get out of the way. It is times like this when people are too focused on themselves that EMS can be very frustrating. I usually ask myself when encountering these people, “if this was their grandparent, parent, or child in the back, how would they feel?”
Working as an EMT has been the most rewarding experience that I have ever had. Despite the chaos and difficulty of the job, I have absolutely no regrets and look forward to every shift. Each shift I feel like I learned something new and made a positive impact in people’s lives. I have the honor of connecting with my patients and making them feel safe even on the worst day of some of their lives. The purpose of this article is not to stir people away from this calling, but to bring awareness to the aspects that are overlooked so people interested in EMS know what they are getting into. As long as your heart is in the right place and you are able to persevere through the tough times, it will be an incredibly gratifying career that enables you to truly make a difference.