The Adrenaline Rush Is a Bonus

Last week I got a email from an author who is writing a book about career options.  She asked if she could speak to me about career or volunteer opportunities in EMS.  I wrote back and we chatted for about 20 minutes later that day.  One of her questions was what kind of qualities it takes to work as an EMT or paramedic.  I told her that the people need to enjoy taking care of people, and that vast majority of which are in no danger of dying while in your care.  I’ve read that less than 5% of incidents require a critical intervention.  That has been my experience, though I don’t have a reference for that number.  The people who get in EMS for the action and expect shifts filled with shootings, cardiac arrests, and plane crashes are quickly disappointed with 95% of their work day.  Some of them get disillusioned and bitter.  Those who stay in the field do so at the detriment of their coworkers and patients.

I have found that the most passionate people in EMS make the most of the 95% of calls they go on.  They enjoy making a rapport with difficult patients.  They freely dispense Fentanyl and Zofran, and take pride in helping people feel better.  But they also still get a rush on the cardiac arrests, unstable dysrhythmias, respiratory failure, seizures, and shootings.  Of course we don’t want any of those things to happen to anyone, but they are the ones you want to show up when they do.  They are a challenge to manage and come induce an addictive endorphin rush.  There’s nothing wrong with that, but it is fleeting.  It’s a perk that comes occasionally, and should never be the only reason to work in EMS.   Our best people embrace the different type of satisfaction that comes from taking care of the less acute patients well in between.  Adrenaline will not keep anyone’s emotional gas tank filled for a career, or even a shift.

I was also asked about what opportunities for career advancement exist within EMS.  Had she asked me that five years ago, I would have told her nursing or PA school.  Today we’re starting to take baby steps toward specializing with community paramedics.  I explained how so many people use EMS and emergency departments for primary care.  Some frequent flyers have minor complaints, mental health, or substance abuse issues, and others do not mange chronic conditions that become a crisis.   A growing number of services have attacked both ends of this spectrum, by directing the one group to more appropriate and less expensive resources, and intervene before an emergency with the other.

About a year ago I wrote about who the community paramedics might be.  Most services use experienced paramedics who have demonstrated high clinical performance.  I’d like those paramedics to still go on some emergencies too, which is why I like Wake County’s model.  There Advanced Practice Paramedics respond to calls on the opposite ends of the bell curve – the 5% most and least critical patients.  The sickest patients benefit from the clinically strongest paramedics, and the community paramedics still get the occasional adrenaline rush in addition to their nontraditional roles.




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