Paramedics Are So Much More Than Ambulance Drivers

Lindsey Kaczmarek gets called an ambulance motorist more frequently than she gets called a paramedic. “That’s absolutely not what I do,” she informed me. What she does do is appear when somebody requires medical assistance, determine what’s incorrect with them, and do whatever she can to assist them endure the journey to the health center—in her case, the Mayo Center in Rochester, Minnesota. The main sign for one in 3 911 medical calls is just “pain,” however throughout any provided shift, Kaczmarek may take care of a cardiac arrest, a stroke, an auto accident, a labor and shipment failed, a mental-health crisis, a shooting, or a senior client struggling with a serious urinary system infection. “If they’re not breathing, I will breathe for them,” she stated. “If their heart’s not beating, I will be the heartbeat for them.”

The job of offering emergency situation medical services, or EMS, frequently looks like medical investigator work, with restricted hints, no experts to speak with, and extremely bit, if any, of the advanced devices offered to medical professionals and nurses. However despite the fact that emergency situation medics—a catchall term utilized throughout this story for paramedics, lifesaver, and emergency situation medical responders—deal with 10s of countless employ the United States each year and make life-altering choices for their clients every day, they stay all however left out from institutional medication. “You’re basically like a glorified taxi,” says Sarayna McGuire, a Mayo Clinic emergency situation physician who has studied pre-hospital health care.

The misconception that emergency situation medics provide transportation, not medicine, leaves them to cope with all sorts of indignities. “They’re used to being second-class citizens,” says Michael Levy, the president of the National Association of EMS Physicians. In one hour—during which they may respond to several 911 calls—the median paramedic or EMT makes a little more than $17. That’s half the hourly pay of registered nurses and less than one-fifth the pay of doctors—if they’re paid at all. During the pandemic, emergency situation medics were literally enclosed in rolling boxes with COVID-19 patients. But in some states, they were not prioritized alongside other essential health-care workers for the first round of vaccines. After delivering their precious cargo to a hospital, in many cases they don’t learn the final diagnosis, or whether their patient ever makes it back home.

That medicine treats emergency medics like disposable, low-wage workers instead of the health-care professionals they are isn’t just unfortunate for the workers themselves—it also leads to less than optimal care for the rest of us on the day we may need it most.

The divide between health-care workers who respond to medical emergencies and those who treat patients in brick-and-mortar clinics is not new. In the 1800s, most accident victims were rushed to their homes, where they awaited medical care from private physicians. Hospitals started to staff their own 24/7 emergency departments only in the mid-20th century, in part thanks to the advent of lifesaving measures such as antibiotics, defibrillation, and blood transfusions. By the 1960s, a loose network of unregulated emergency medical systems had sprung up around the country. Undertakers and law-enforcement officers provided the bulk of hospital transports—known as “you call, we haul” missions—in the back of police cars, hearses, or delivery vans. These makeshift responders often had little or no formal medical instruction. “It was a little bit of the wild West,” says Chris Richards, an emergency-medicine physician at the University of Cincinnati.

In the late ’60s and early ’70s, in response to growing concerns over traffic fatalities, the Department of Transportation—not the Department of Health and Human Services—developed a structured national EMS system, codifying the idea that emergency medics are drivers, not health-care workers. But the field has evolved significantly since then. Today, some emergency medics can dispense medications, and ambulances can house heart monitors and ultrasound machines. Over time, training and accreditation requirements have grown more and more rigorous. Still, in the eyes of some hospital staff, medics belong as much to today’s medical establishment as police officers and undertakers did in the 1960s.

Three paramedics intubate a gravely ill COVID-19 patient.
John Moore / Getty

Many of Remle Crowe’s EMT runs in rural Ohio ended with a dissatisfying reminder of her place in medicine’s hierarchy. “I would drop [patients] off at the hospital and they would disappear,” she told me. As she sped off to the next call, she’d wonder about her last pickup, and what happened to them beyond the emergency-room doors. “There was no way of knowing,” Crowe said.

For the most part, EMS providers don’t learn whether the split-second choices they make—say, whether to intubate someone—ultimately help their clients. Only about one in three EMS agencies reports having any access to electronic, patient-specific medical information. Many hospitals refuse to share any outcome data with EMS, claiming it’s a HIPAA violation (legally, it’s not). Ultimately, even in the most clear-cut of cases, if a patient dies in the ambulance, an emergency medic may not learn the cause of death, or whether there was anything they could have done differently to change the outcome. “They’re kind of flying blind,” says Michael Sayre, the medical director of Seattle’s EMS.

Leaving emergency medics out of the loop doesn’t only turn their jobs into repeated chronic cliffhangers. It also keeps them from improving the care they give to their patients, experts told me, robbing them of the opportunity to learn which of their instincts are correct and which to avoid. “Without creating this feedback loop, you really can’t get better,” Sayre says. “Of course medical errors happen because of that. You didn’t have enough of the puzzle pieces.” Few other fields, especially in the world of medication, demand that its professionals tolerate working in a feedback-free environment. What if a chef never tasted a final dish? What if a teacher wasn’t allowed to grade tests? Would a lawyer be okay with never hearing a verdict? “If you don’t know if you’re bettering patients,” Kaczmarek said, “how do you keep coming to work?”

Some don’t. Emergency medics routinely struggle with high rates of burnout and job dissatisfaction, as well as PTSD and other mental illnesses. They are regularly bitten, punched, or otherwise assaulted by their patients, enduring a rate of occupational violence that is about 22 times higher than the average for all other U.S. workers. Altogether, the low pay, the absence of performance feedback, and the chronic mental and emotional toll “sends the message that no one cares about you and your work,” Crowe said.

The treatment of emergency medics as chauffeurs and not clinicians—as a profession of nonprofessionals—means that not enough Americans choose this career. While nurses and doctors generally stick around in the field for decades, the average age for an emergency medic is just 34, and about 80 percent leave the job after seven years or less. This affects the quality of medical care provided: Data suggest that more experienced EMS clinicians save more patients and lead to better health outcomes. Retention issues in EMS are so widespread that some states and counties are plagued by staffing shortages and, in turn, delayed emergency care. “In many places the turnover in this workforce is very high,” Sayre states. “People accumulate these mental injuries that don’t heal, and they don’t work in the field long enough to become truly excellent.”

As emergency situation medics continue to be undervalued, their work has actually never been more valuable. We needed them, and badly, during the pandemic, as 911 call volumes skyrocketed. We need them to respond to the urgent health needs of the country’s growing population of elderly people, who are more likely than in the past to suffer from several chronic conditions and take a dozen-plus prescriptions. We need them on the scene of mass shootings and drug overdoses. We need them as our planet continues to warm, leading to natural disasters, bouts of extreme weather, and infrastructure collapses. America’s health-care system ignores emergency situation medics at its own threat—and all of ours.

Jobber Wiki author Frank Long contributed to this report.