I get emails from EMS1 pretty much daily. Occasionally I’ll take a peek at an article or two. Either they no longer allow comments or you need to create an account to comment. Either way, I’m not commenting. After all, I have a blog. Also, I don’t want my email to be spammed more than it is.
You should read the article as I’m only going to quote a few snippets to which I’ll respond. I don’t want to over quote and have them threaten to sue me.
Five years later: How COVID-19 changed EMS for good
Keep in mind that at the start of COVID I had been retired from active EMS work for seven. I still had many contacts in EMS especially at my former service. I also attended rounds regularly and knew a lot of medics at my client services. I’d see them often before COVID and we could be honest with each other. All of that is just to let you know where I got my perspective.
When a novel coronavirus began to spread across the globe and within the U.S., paramedics and EMTs faced an unrelenting wave of uncertainty. While guidance and best practices shifted rapidly to keep up with researchers’ evolving knowledge of the virus, it began to spread rapidly, overwhelming EMS systems with skyrocketing call volumes and forcing providers to make life-or-death decisions.
This is pretty much true, but we know that much of the “best practices” were actually made up on the fly and often not for medical reasons. What is true is that EMS systems were overwhelmed. Not just with patients, but lack of resources. Just before everything shut down I was talking with one of my former bosses who was the #3 person in the command staff. He told me that he was worried because of EMTs and paramedics started getting sick it wouldn’t be long before he couldn’t field enough units to meet demand. He also knew that every other service was going to face the same challenges so “mutual aid” would be none existent.
When the first community-spread case of COVID-19 in New York State was identified in New Rochelle, paramedics and EMTs rose to the challenge. Among them was then 28-year-old Alanna Badgley, a paramedic with Empress Emergency Medical Services in Yonkers, who found herself in an unexpected spotlight — featured on the cover of “Time” magazine as part of a special report, highlighting the “Heroes of the front lines.”
My initial reaction was surprise that Time Magazine still existed even then. But I digress. I’m again quoting this for perspective. MS Badgley was a two year paramedic at the time, so hardly a seasoned veteran. Her commentary should be considered with that in mind.
The pandemic didn’t just expose weaknesses in the healthcare system — it magnified the operational problems EMS had long faced. “All of the cracks in the foundation got exposed,” Badgley said. “Funding issues, retention issues, recruitment problems — everything got worse.”
Again true. Anyone who was symptomatic and tested positive was sent home for two weeks at that time. I know, or maybe I should say suspect, that there was some gaming the system by people who needed a break. Which is fine, but it also put more demand on the people still working. Again, this is not a positive.
A paramedic at one of my clients, and she was a good paramedic and a nice person, walked off the job in the middle of her shift. She just wrote out a resignation letter, brought all of her equipment to headquarters and dumped her gear and the letter on the chief’s desk.
She got out of medicine entirely.
Perhaps even worse is the number of providers who are still working, but only going through the motions. “Line and Ride” medics have always existed, but I’ve seen more and more reports that reflect that the medic is only doing the bare minimum to get through a call without getting “dinged” by the QA Police.
Some of them are trapped like birds in a gilded cage. That is their pay and benefits make it hard to leave for a new field. Fire fighters in particular seem to be afflicted, but no doubt it goes on in other fields. For fire fighters, the only salvation is that if they accrue enough seniority they can transition to an engine, ladder, or heavy rescue unit and minimize their EMS contact.
“If there’s one good thing that came out of this, it’s that we’ve made progress in destigmatizing mental health in EMS,” Badgley noted. Peer support teams, telehealth therapy options and a broader cultural shift toward acknowledging provider stress have all gained traction in the last 5 years.
This is what happens when you’re two years or so into your career. You have no long term perspective. CISD and Peer Support have been around since the late 1980s. Not everyone has it yet, but I suspect that’s more prevalent amongst the private services. Doing that properly is expensive. The fire and police services were well ahead of EMS in this regard, but there is much more parity now. All of which is to say that she’s overstating the case and reporter isn’t curious or maybe smart enough to do some research.
As a union leader representing EMS providers in one of the hardest-hit regions, Badgley understood the significance of the opportunity to speak with “Time”, but didn’t anticipate its lasting impact. “I knew people around the world would see it, but I underestimated how long that recognition would resonate,” she reflected.
More identity politics than anything else. I’ll address “impact” for a bit.
Here is what I saw. People left EMS in droves. Some just quit, others found other jobs. Good providers with enough time in to retire and collect their pension did so. That lasts to this day because it’s hard to get people to get into EMS now. If you look on Facebook, you’ll see services big and small, public, private, and volunteer advertising for jobs. Of course that isn’t just in EMS. Thanks to the protests in 2020 and defunding the police cities soon realized that they needed more police officers. Again, those that could retire did, others moved to other areas more welcoming to police. To a lesser extent that happened in the fire service.
Another effect of COVID was that a lot of people got used to not working. There was a lot of “free money” floating around and people grabbed it when they could. Even after the money ran out, no one wanted to go back to work. And it wasn’t just in emergency services. Retail stores were more or less self serve, even for paying customers.
Not exactly a positive.
Another silver lining from the COVID-19 pandemic has been the increased recognition of EMS. “Before COVID, I heard ‘ambulance driver’ way too often. Now, people say EMT or paramedic more. They understand that we’re part of the healthcare system,” Badgley noted.
That awareness has translated to legislative momentum. In New York, where Badgley works, the governor has included EMS initiatives in the executive budget for 4 years straight. But the fight for sustainable funding and recognition as an essential service continues.
I’m skeptical. The news media and some government agencies still refer to EMS providers as “First Responders.” Inside EMS, First Responders are the people who get to the site and do what they can while waiting for the ambulance to arrive.
Two things drove the creation of First Responders. The first thing was to use it as a tool to stop the response time clock. Once the First Responders got to the scene the magical and mythical 8:59 response clock stopped. I won’t go into who came up with that, why, or how other than to say it was based on long disproven “science,” but lives on in EMS.
The other reason was to give fire departments that wanted to get their foot inside the EMS door without having to actually commit to doing EMS. In an era where there were fewer fires to fight, it was a job retention program.
Note that the article doesn’t say if the Governor has succeeded in getting those EMS initiatives through the New York legislature and funded. That would be interesting to know and if it had happened, it would be news.
In that spirit, Badgley co-founded the EMS Sustainability Alliance, an organization working toward long-term solutions for recruitment, retention and workforce well-being. “We’re still a young profession. That means we have an opportunity to shape it into what we want it to be,” she said.
It’s a very nicely designed website, but it’s not overloaded with useful content. As to the above quote, I guess it’s a young profession in some terms, but if we use the EMS Systems Act of 1973 as the birthdate of modern EMS, we’re not that young. Sadly, many of the problems that the act was intended to solve still exist and a few are worse.
Here is the first question. Is EMS a profession? Or more accurately, is being an EMS provider of any level a profession? Or is it a trade as some people believe? Or, is it a skill set?
Think about that. I know EMS providers (all levels) who work on ambulances. I know some that work in hospitals. The US Coast Guard has EMTs. Every US Air Force Pararescue Jumper (PJ) is a nationally registered paramedic. Every US Navy SEAL Team has at least one paramedic. I know several police officers who are EMTs and a smaller number that are paramedics.
When it comes to EMS services, there are about 50 different system designs in the United States and Canada. I could create a list of the ones I know of, but it would be a blog post of it’s own.
Every paramedic who is also a Fire Fighter identifies as a “Firefight/Paramedic’ even though 80% of the run volume for most fire departments is EMS.
As to unions, the fire, police, and some EMS agencies have unions. The military obviously don’t, nor do volunteers.
The problem isn’t so much that EMS is a young profession at all. The problem is that EMS isn’t unified in any sense other than locally.
The emotional approach to improving EMS doesn’t work. Never has, never will. EMS more and more is data driven and EMS has to prove using hard numbers that it’s worth more money. We suck at that.
EMS has to decide what it wants to be when it grows up and if it even wants to grow up.
The original title for this post was “COVID Almost Destroyed EMS,” but that seemed overly dramatic. The title came from the song linked below. Listen to the lyrics and you’ll understand the message in the song and why I chose the title.