For a long time, I was not a regular reader of EMS-related titles, nor did I tend to watch the movies. I was not inspired to service by Emergency and fell asleep during Bringing Out the Dead. As I began writing about EMS, I found myself reading the genre more and more. From memoir-style to fiction featuring EMS, there are some incredibly talented writers out there. Jim Page, Peter Canning, Thom Dick, Kelly Grayson, Kevin Hazzard, Jamie Davis, Maggie Dubris — if you have not picked up some of their work, you should. Even if you are prone to nitpicking details, it is invaluable to see our world from the various perspectives of such eloquent minds.
One of the titles I enjoyed was written by Ret. Captain Michael Morse, of the Providence Fire Department. It is called Rescuing Providence and provides a detailed insight into the day-to-day activities of Providence’s fire-based EMS unit. He is an evocative writer, the highs and lows, street-level perspective, and physical and emotional fatigue all come through. I recommend his work to anyone interested in narratives about Fire or EMS.
He captures the cadence of life doing EMS in a depressed city environment. Coming from a busy urban system, his work resonated with me. Then I came to page 49 and read the following excerpt:
“I’ve told everybody I work rescue with the same thing, make sure you do time on a
fire truck before it is too late. When our days are closing in and we look back at our lives, what we will be most proud of will probably be the years spent as a firefighter. I want everybody to experience the thrill I’ve felt while battling a fully involved house fire. There is nothing like strapping on a Scott, grabbing a line and facing what most men fear. Working to the brink of exhaustion, then finding a little more when needed and ultimately beating the beast is priceless.”
~ (Michael Morse, Rescuing Providence)
I had a visceral response to this; it made me angry. I went back and read it again, and again. I passed the book around to my peers, without preparation, asking them to read just that one paragraph. I watched their faces as they nodded first in agreement, and then twisted into consternation as they got to the latter half that contained this part. They handed it back with furrowed brows and disappointment.
What had started out as a tribute to our work felt like it was relegating us to second-class status. Again.
Why wouldn’t you look back and be most proud of your time doing EMS?
It is important to point out that if you follow Captain Morse’s work, you know how strongly he feels about his time in EMS. He makes it clear how he grew to love the work. I have no doubt that he is sincere and would never take away from his experience or contributions to the field in both Fire and EMS.
What that paragraph does is demonstrate why forced hybridization of Fire and EMS may not be well-received, is difficult to attain or maintain, and why mashing the two together often gives it the reputation of performing less effectively. EMS is not strong in its individual identity and is still seen in many fire departments as a “lesser” assignment, even punitive. For EMS, in many circles “fire medic” is seen as a derogatory term, implying a lesser skill set or ability to critically think — even when that is certainly not the case.
Fire and EMS are different creatures. It is not a matter of forcing EMS into a Fire mold, more often it causes the Fire mold to have to expand to include an entirely new scope of issues. The science, the equipment, the needs, and the skills are all different — there is little crossover at all.
To say “put the wet stuff on the red stuff” may elicit a chuckle, but it is an insult to the sheer amount of training and technical expertise required to extinguish a blaze. Constant rigorous training, attention to equipment and detail, and the following of orders are a necessity not only to accomplish tasks too but to protect the lives of the crew and the public.
EMS is expected to make order out of chaos and prioritize care based on limited information. Operating frequently in teams of two, they are required to use critical thinking to make rapid decisions and enact a clinical plan without direction. This is not fire science, or physics, or even meteorology — it is medicine, psychology, and social science application. It is understanding things like competence and consent and adverse reactions.
By forcing a hybrid role, are you hurting your agency? Many firefighters excel at their jobs but cannot master the medicine. Many excellent paramedics have never wanted to fight a fire. So, when you force these people to do one or the other that they do not have the drive, passion, or talent for — who decides what to settle for? Which area are you willing to sacrifice quality in — fighting a fire safely or providing emergency medical care in a critical situation?
They are apples and oranges; they exist in the same family and bring their unique flavors and benefits to the basket. Both are good for you, but they are not the same. They should be cogs of the same system, turning in sync to advance the care of the community they serve. It can be done.
My paragraph might read a little differently.
Make sure you do time on an ambulance before it is too late. When our days are closing in and we look back at our lives, what we will be most proud of will probably be the years spent as a paramedic. I want everybody to experience the thrill I felt the first time I had an arrest patient open their eyes and speak to me or heard the shrill cry of a newborn safely delivered in risky circumstances. I want each of you to realize that sometimes just the time it takes to talk to someone and hold their hand, could mean the difference between life and suicide. I want you to have the hug of a grateful parent, and the laughter that comes with the bizarre cases life hands us. There is nothing like being presented with a complex medical case, and using all that studying you’ve invested time in to come up with a clinical plan that works. Working to the brink of exhaustion, then finding a little more when needed and ultimately saving a life is priceless.
Thank you, Captain Morse, for your service and for sharing your career with us via your writing. I hope it continues to inspire the next generation — whether they are picking up a Scott pack, a Lifepak … or both.