TOXIC HEROISM AND EMS: THE PERFECT STORM
I apologize in advance to Sebastian Junger and his excellent book, The Perfect Storm.
If you’ve read it or seen the movie with Mark Wahlberg; (and you should read the book), you know it’s about a combination of circumstances that come together in an unprecedented way to cause devastation. It was a best-seller and blockbuster movie, because who doesn’t like watching disasters?
Kind of like observing EMS from a distance. A seemingly random set of events come together to create a storm that no one has ever seen before, and no way to counter it.
I said it before on the show, and in these blogs; that I think we are at a critical point in the profession of EMS. Where we go from here is going to depend largely on how we as clinicians define our role and how we do it.
Again, many running parts to this. But one of the most important is going to be how we define this job and whom we bring into the profession to carry it forward and be the leaders of the next generation. And here’s where I see one of the biggest problems:
We’re selling a bill of goods to people that aren’t interested in what the job entails. And that’s hurting the profession.
What am I talking about? Think back to when you first joined your cadet program, signed up for EMT or paramedic school, or took your first position in EMS. Think about the signs you see and the advertising for the available jobs. What do you notice?
Most of the time, you will hear talk about “saving lives”, “rescuing”, being a “hero”, or something of that nature. People looking to join EMS organizations get inundated with this messaging.
On television, shows with EMS are frequently portrayed as doing over-the-top resuscitations on patients, frequently in areas where buildings have collapsed around them, in the back of speedboats, trapped under leaking tank trailers….you get it.
So the recruit coming into EMS has this idea of what they do before they start doing it for real. This isn’t much different from most other jobs, honestly; otherwise, how would people choose their profession?
In school, they train relentlessly for life-threatening, potentially dangerous environments where lives are always in the balance. Everything from the assigned reading to simulator sessions focuses on the most critical, high-stakes situations.
And then, graduation and licensure. And now, finally; our newbie EMT or paramedic is finally going to go out there and do it.
And then, reality sets in.
The non-emergent transports to the ED, the “frequent flyers” who may need social services much more than a ride to the hospital or an on-the-scene rescue, the calls originally coded as emergent that turn out to be only urgent at best start eat at the newbie.
“This isn’t what I thought it would be.”
Aided by more jaded senior colleagues who also originally got into the job for the thrill and found banality, the job becomes “bullshit”. The calls are “bullshit”, and by extension, the patients are “bullshit”. This helps grease the way to burnout, poor care, and high turnover as EMTs and medics look to escape the job for something better.
Who’s responsible for this? Honestly, we all are.
We know EMS exists in a weird sort of netherworld between medicine, public health, and public safety. The range of what EMS is expected to do out in the world, and the future demands of the people we serve is astonishing in its breadth. But there is a problem with this, one that we’ve overlooked.
First, this job is very rarely about saving lives. Take a second from reading this and think back over your career. How many times can you say that the thing you did was the direct causation of that person walking out of the hospital? It’s quite rare; in over 25 years of being an EMT and paramedic, I can confidently tell you less than five of those instances in my career. Less than five out of a lot of patient contacts. I suspect that’s more often the case rather than the exception.
Am I a poor clinician? I don’t think so. Unlucky? Possibly.
Or is it that realistically, while our chances to pull someone from the grip of the Grim Reaper themself is very rare; the opportunity to help someone, to relieve suffering, and to assist families with end of life and grieving is more of what we do? We don’t sell it that way, but it’s much more common.
Giving patients a smooth comfortable transport, addressing discomfort in a variety of ways, and reducing or taking away pain are things we do every day. Or we should. Calming nervous patients or family and reassuring them that we do in fact care and that we will take good care of their loved ones isn’t something we look at as “cool”.
“We don’t have time for that touchy-feely stuff, we’re here to SAVE LIVES.” Or, as the shirt says, “Trained to save your ass; not kiss it.” But when the majority of the calls we go on our “touchy-feely”, what does that do to the clinician who is there for “the Big One”?
I’m not sure, because there is no data to support this hypothesis that I know of. But I bet if you sit around crew quarters or shift changes, away from supervisors; you’ll hear rumblings similar to this.
As a profession, we have to break this cycle of “toxic heroism”. Toxic Heroism is the idea that what we do is heroic and extraordinary all the time, when in reality; we are people doing a job who occasionally get to do the extraordinary.
What if we advertised EMS as NOT something heroic or “lifesaving”, and simply said this:
“You will get the chance to help a person every time you go out the door. It may be very small, it may be very big. They may understand and appreciate it, or they may not. Regardless, you help every time. And sometimes, you get the chance to change someone’s life for the better.”
Would we attract the same type of person? I’m not sure. And maybe that in itself would be a good thing. Instead of the classic adrenaline junkie, we attract the person who loves to care for people, who will talk to the elderly non-emergent transport the whole way, who will look at patients as people; not just procedures. Or worse, “bullshit” calls.
Again, not to knock the people that want to become EMTs or paramedics. They are fundamentally good people. But we’re not helping them to understand the job when we tell them what they think it is as opposed to what it truly is.
What if in our testing process we had a scenario where an elderly patient with dementia fell out of their chair, instead of the typical cardiac arrest or trauma? You could still show clinical acumen through a thorough assessment, addressing safety issues instead of the typical “BSI, scene safety” garbage, and being able to show the aptitude of both talking to patients as well as listening.
Because to be brutally honest, that call is way more common than the hair on fire, rock and roll trauma, or medical resuscitation. And we need EMTs and medics to not only recognize that but to embrace it.
Helping people is a good thing. It’s not always sexy, but it is rewarding. We need to sell it that way.
