What I Wish Emergency Physicians Knew: An EMT's Perspective

Some EMTs are extremely young and are doing their best. Please don’t quench that drive, even when they make mistakes.

I started volunteering with my college’s student EMS program when I was 19. I had no emergency medical experience at all, save a few years of CPR though lifeguarding. I had no idea what I was getting myself into when I strolled up to my first call. I was so excited to be a part of a real medical emergency and help someone that I didn’t think about what caring for someone in an emergency was really going to be like. That night, I ended up covered in vomit, unable to help with the blood pressure cuff, scolded by the county paramedics for being in the way, and ready to quit EMS. On the way back to headquarters, our supervisor came over and pointed out all the things I did well, rather than just focusing on what I could improve. He encouraged me to practice what I failed at that night, and strive to do better on my next volunteer call. In emergency medicine, minor setbacks and fumbles are annoying at best and dangerous at worst, but forgetting how to use a blood pressure cuff will not decide the patient’s fate. I wish ER physicians knew how much it means to us when you leave room for construction as well as criticism. As you know, the first few times in emergency medicine is daunting to say the least. We need more people who are willing to be a part of it at our level, too.

EMTs do things differently based on where we work.

EMTs, like emergency physicians, come from diverse backgrounds. However, while most physicians have similar medical training, EMTs can have very different practices based on where they’ve lived and worked. I always worked as a suburban EMT in a college town, which meant I could usually afford more time with my patients and their trip to the hospital was just a few miles down the road. When I lived in rural Kentucky for a summer, I saw how the suburban approach I had always known would kill people. The rural Appalachian Mountains had narrow roads and miles of open space. Houses were miles apart and hospitals were even further. Rural EMTs have to get the patient ready for a long journey over rough terrain. The planning and execution of first responder care is fundamentally different. This disconnect is true for EMTs all over the country; where you work defines how you care for a patient. Because we all want what is best for our patients, we often bring our best practices with us when we relocate, causing frustration for nurses, physicians, and fellow EMTs. I hope we find a way to look forward, together, rather than letting our shared frustration splinter the emergency medicine community.

We’ve seen where the patients live

We’ve been inside the patients’ houses, weddings, graduations, and parties. We drove to the crash site and walked through the glass. We’ve seen the pictures of their families going down the stairs and the bills piling up in the corner. We’ve smelled the burnt dinners that were forgotten in the oven when the accident happened. We’ve heard the apologies over lack of electricity, messy living rooms, and pets crowding around our ankles. And when I think of all of that, when I have to hand off my patient, I think of all the things I don’t have time to tell you. All the circumstances that contribute to their recovery. I wish I could tell you that they don’t have a refrigerator to store their insulin in or that the closest and most accessible food source to their house is McDonalds. I wish we had the time to tell you what they are going home to, if they ever get to go home because getting those details about a patient’s environment could help better their care plan once they leave the ER. I implore you to discover what they are going home to. Ask their loved ones, Google their address if you are able, check to see if they have a place to store their medications from others at the homeless shelter. 

We experience the same accident, but don’t get to experience the same closure  

One of the hardest things that I had to accept as an EMT is that once I transfer care, I will most likely never know what happens to those that I care for. I don’t get to know if they lived after recovering fully, passed away from their injuries, or ended up somewhere in between. In some cases, it’s okay; you can live with the probability that the child who broke his arm falling from a tree will be fine. But in other cases, not knowing the outcome can sit with you and pop in your head when you least expect it, just as memorable cases can pop into the head of a physician. I wonder where the people I cared for are, if they ever received the care that they needed once I left them. Are they still alive? Did they ever start using their medications? This flaw in the system asks EMTs to perform immense emotional labor as they proceed with a shift as if it were a clean slate, though the lack of closure on a trying case can be exhausting, frustrating, and heartbreaking. 

Many of us wish there was more time for solidarity  

I wish there was more time for solidarity. EMTs and emergency physicians experience two sides of the same trauma, heartbreak, elation, and relief. Part of the job is that we don’t interact with you for long periods of time, and therefore cannot share this emotional journey. When we do have the time, we spend it sharing vitals, facts, and quick bites of information. It’s not long enough to acknowledge that we have cried from joy, broken down, screamed in frustration, been scared, and not known what to do. There’s never time because our focus is on care and making the patient better, as it should be. Though I know the patient is the priority, it is hard to know we never get to connect and reflect on our work together. I wish there was space to grow community through our shared experience, and I hope this helps you understand that yearning just a little bit more.