The Education Conundrum

I recently attended the EMS World Expo in Las Vegas and heard many ideas on how to improve EMS as a whole from responder to system. Surprisingly, one of the more controversial suggestions was higher education for EMS providers affiliated with current training. One side argues that providers will be no more than mere technicians without collegiate stature. The other side argues that continuing education is more than adequate since most providers across the nation are volunteer and time constraints would cause less volunteerism and more shifts to be covered. Of course, EMS is a tangled ball of interconnected arguments that have left us in an adolescent quagmire of how to proceed in our growing pains and the above discussion can lead in several different directions, none of which discuss the place of higher education in EMS.


Before you all get too excited, I am not going to trumpet the benefits of either side as it pertains to EMS. I would like to point out general benefits to attending college, even if you don’t graduate for several years and take the sloooooooooow road (like this author).  An important point to note is that your degree does not necessarily need to be EMS related, and it is probably a benefit if it is not.  Take a look at degrees related to business, public administration, government or anything that will assist in a management/ leadership role as an alternative to nursing or medical related degrees.
The Author hard at work.

 Higher Education provides critical thinking skills. These skills are well used throughout your entire life. In elementary school we are generally taught by reading, remembering and repeating. Not many kids question, “Why?” and the ones that do usually get branded as troublemakers. In college, they WANT you to ask why (to a point) and teach you to do the research to form your own opinion or understanding and not just ingest the information being fed to you.

EMS Provider Benefit: Critical thinking can help you understand the why behind treatment protocols and disease processes, how to best treat the patient and maybe even why your boss just doesn’t make any sense.

 Higher education improves your writing skills. At some point, especially since the advent of the internet, we will all be expected to correspond in the written word. Even an associate’s degree will provide the benefit of learning to write adequately if not well and how to perform research and present it professionally. Yes, people do judge you for text speak/ misspelling/ bad punctuation and construction. No, they don’t care that you don’t like it.

EMS Provider Benefit: Improved documentation skills beyond, “ Patient looked bad.  Took them to hospital.”


Higher education improves your speaking skills. At this point you are probably thinking, “Speaking!?! I got this!” This aspect is related to being well written and having critical thinking skills. Once you can form cohesive thoughts, they usually come out of your mouth well. However, being well spoken is even more than just spouting good ideas. Basic public speaking is part of most curriculum now and helps you appear more poised and prepared even when giving a personal speech (like at a wedding or party) even though you are shaking in your boots.

EMS Provider Benefit: Improves your ability to think on your feet while speaking with angry drunks and crazy family members.  Speaking well improves your credibility and level of respect with other providers instead of using slang and jargon.


Higher education provides exposure to new ideas and people. So many people put off going to school because, “I don’t know what I want to do.” Even going to school one class at a time not only starts the road to your completed degree, but can give you ideas on professional avenues or simply new interests you would like to pursue. People of all ages, nationalities, and stages of life attend college giving you access to their views and experiences.


EMS Provider Benefit: You gain a broader experience in your education enabling you to appreciate the vast differences between our patients and their cultures.


Higher education improves your self-confidence and maturity.Completing each class and interacting with other students and professors increases self-confidence and maturity of the student. Doing well and succeeding at school makes students feel accomplished and encourages them to move on and continue doing well both academically and professionally. Maturity is nurtured during the education process through team work and expectations from professors and fellow students. Self-confidence can help students reach for opportunities they never would have imagined being able to obtain prior to academic success.


EMS Provider Benefit: Occasionally there is a heavy gravity to situations providers must perform within. Even if the provider is not exactly sure what the best response is in a non-traditional situation, the maturity and confidence gained in college can assist in the “fake it til you make it” situation and make it seem like it’s what happens all the time.


Even completing some college credits can make you more marketable to ANY potential employer or supervisor. Let’s be real. No one wants to be “the fry guy” for life and even management at well-known establishments such as McDonald’s require some sort of post high school education or training. Even some college credits and evidence of current pursuit of a degree can help land a better position.
EMS Provider Benefit: Marketability can increase your value to get hired or promoted by your current employer opening new opportunities in the administration, education, or planning section of your department.


Eddie Murphy in Coming To America
Obviously, this list is not all inclusive. However in addition to the non-material benefits above, higher education can increase your net worth. Per the Census Bureau a high school graduate earns about $1,371,000 over a lifetime while a college graduate with a Bachelor’s degree earns about $2,422,000.  A million dollars more over a lifetime makes the monetary and time investment more than worth spending.
Show me the money!
If finances are an issue and loans are out of the question there are LOTS of scholarships out there if you dig for them. They are the only reason I can afford to go to school and eat at the present time. Check out your local IAFF, FMBA, PBA, FOP, VFW, EMS or OEM unions or support agencies for their scholarships. Most 2 year colleges have county or state wide academic scholarships or endowments and that information is usually available at student accounts or the financial aid office. If you do well and have good grades, PHI THETA KAPPA is a 2 year college academic fraternity that has access to international internships and opportunities and most importantly scholarships for when you want to transfer to a 4 year institution.
Whether you think higher education has a place in EMS or not, educating yourself will improve your life exponentially ($1 MILLION DOLLARS!). It will improve your family’s lives, your organizations and you might inspire your friends or brothers and sisters.





Back in the Day

I recently returned from the Incident Response to Terrorist Bombings Course (IRTB) and learned many lessons, the most illuminating was the reverence for dangerous things and situations. Prior to witnessing some of the detonations at this class I thought, “Yeah, yeah, safety distances and recommendations. Blah, blah, blah.” After witnessing the devastation wrought by even a small device I am sobered by the realization of just how weak we really are and that any moment might be our last. Our strength is in knowledge and the USE of this knowledge for our safety and the safety of others in our daily operations.
The End of the Dinosaurs


Dinosaurs are extinct for a reason, they did not adapt to the changing atmosphere on Earth. In our case safety is the changing atmosphere and we have our own dinosaurs. A dinosaur is an individual or individuals within an organization that disregard or block new ideas or mechanisms to improve the organization or responses to events. Unfortunately, our dinosaurs can endanger all of our lives not just their own.
In our business we are exposed to a variety of possibly dangerous situations and have to be continually mindful of safety. This starts with planning via training, NFPA and OSHA codes, disaster and public health planning to name a few. Safety also includes the proper use of personal protective items like turnout gear, helmets, gloves and masks. We practice situational awareness and scan the scene and continually reassess for changing conditions. We do all this in the name of safety, but how often do we refresh our minds looking for innovative ways to improve our planning, response or gear?
Safety Steve at the Calgary Zoo
Life Safety is our mission and the most important life is your own. This is controversial to some although I don’t understand why, I really like my life. On a serious note, not only will response to the incident you are going to or arrived at be delayed if you are injured, but secondary units will likely be diverted to you and the initial call will be further delayed. In addition, there is a monetary and emotional cost to your family and organization if you are injured or killed. A small organization can be decimated if other responders leave the organization due to stress resulting from your injury or death. During initial training we are taught about situational awareness and protecting ourselves first. Yes, our job is dangerous but how many of us follow the lessons we learned to mitigate some of this danger?
It seems that the longer a responder serves, the less they value the safety lessons they learned initially. While this does not apply to everyone, we all know someone who always comments, “ Well, back in the day we…” and means it. We all have experience with this member or members stall tactics and nay saying when trying to implement proactive safety changes or any changes at all. They also usually use the secondary phrase, “It’s worked fine for this long…” Indeed, these dinosaurs have been the death knell of many organizations because they refuse to move into the modern era.
So what do we do about this culture of nostalgia to be respectful of our past yet embrace advances in responder safety? How can we convert these dinosaurs to change their views and not taint new responders with their example? Veteran responders should be an example of how to be safe, not an example of what not to do. Whether we like it or not veteran responders are an example to the new members of our agencies even if it is the wrong lesson taught.
Is this how your dinosaur treats you?
The following are some suggestions on how to deal with this phenomena in your agency. They are not all inclusive and may only be a part of your plan to implement improvements as there are several different types of agencies and models used in our region and nation.
Research what other reputable agencies are doing in your region and the nation. These plans are usually evidence based and with implementation the kinks have been ironed out already. If this is your agency’s first time updating your Standard Operating Guidelines (SOG’s) or Standard Operating Procedures (SOP’s) adapting a current plan will be easier than starting from scratch. Your dinosaurs will have a difficult time refuting these plans as they are already being used in similar agencies.

Make your members NEED to change. This depends on your responders, what is important to them? This could be new training, new improved gear, new gadgets. Show them how this one uncomfortable moment of modifying their behavior will benefit them in the long run.
Present the effects of non-action. This could be examples of exposure to lawsuits or Line of Duty Deaths (LODDs) that have occurred due to similar situations. Show how your organization could be held to account for their lack of planning.
Utilize current safety training programs. There are many training programs across the country focusing on safety. Everyone Goes Home is a fire based program, but has excellent potential in the EMS community. Contact your local representative and request a presentation! The Department of Transportation is also an excellent resource and most partner with state level fire and EMS organizations to present safety programs. Do some research, there are lots of free programs out there.
Reassure your dinosaurs and others that might not be ready for buy in. Much resistance to change is the belief that you are trying to usurp them or destroy the organization. Let them know that the entire unit needs to buy in for complete safety implementation and that your interest in in protecting the responders and organization. Unfortunately, in my experience those most averse to change are not the ones in the street. That may be another part of the problem your members need to address.
Like I said above, these recommendations are not exhaustive, only thoughts to get started. I practice EMS in New Jersey and we have been fractured for quite awhile, but the process for safety across the board and unity in our services has moved forward since I started. Though it is in small increments the safety at our organizations have improved. Developing, implementing and practicing safety standards is a team process. The standards are useless if even a few don’t follow them as we operate as a team. This may be something that you start and others finish; don’t be discouraged. Our business is to save others, we must keep ourselves safe to accomplish this task.

The author at The Museum of Natural History

Dress for the job you want.

Dress for the job you want, not the job you have.  This adage is commonly used in reference to the business sector, but maintaining a professional and appropriate image is as applicable in EMS as on Wall Street.  People may not be investing their money in our bank, but they are investing a treasure that is greater than any monetary fund, they are entrusting us with their lives or those of their loved ones.  According to research by Harvard Medical School and Massachusetts General Hospital, people assess your competence and trustworthiness in a quarter of a second based exclusively on how you look.  You haven’t even made it up the sidewalk to the patient and they already know what they think of you and how you will care for them.  Patients are not the only people we encounter that are making judgments based on what we look like.  Bosses, nurses, doctors, police officers, firefighters, politicians, and every citizen on the street are looking at you, how you act and what you are wearing.  If you look like a mess, your organization looks like a mess.  Being mindful and aware of your appearance not only benefits your personal career, it benefits the advancement of EMS as a whole.
When I was a “new guy” I will admit I was quite a hellion.  Of course, you can’t properly raise hell without looking the part.  Short red hair with a white stripe in the front and shaved to the skin in the back, ears full of hoops (definitely more than four) and of course Doc Martins.  Begrudgingly I wore my super-hot and absolutely uncomfortable, polyester, French blue shirt and navy pants with matching stripe.  You can imagine my poor partners’ horror every day they had to work with me, “that guy.”  Not because I couldn’t lift or was a poor clinician, but I made THEM look bad because we were associated by the uniform. I didn’t get much respect from the old timers and surely not from nurses and doctors that I just met.  Time went on and my unique hairstyles evolved.  In the late 1990s there was a popular hairstyle that was long and straight in the back with “sprockets” or multiple twists that looked like battery coils at the crown.  Yes, I was enamored and loved to wear this style all-the-time.  One day at work our most infamous homeless guy called the ambulance, for the fourth time in six hours to go back to the hospital he just left.  A discussion turned into a rather heated debate with a police officer about what to do in the situation since taking this gentleman back to the hospital was not really what he wanted (that would be food and a cool place to sleep).  The police officer commented on my silly hairstyle during this argument.  The officer had deduced that I had no real responsibilities in life and had no liability to be concerned about when making patient care decisions because I wore unprofessional hairstyles to work.  I am just thankful no one has a photo.  If you do have one, please burn it.
When you put on your uniform, you are no longer your own unique individual.  Yes, you bring you and all your gifts and attributes to work, but the uniform signifies your representation of an organization of unified practitioners.  You can be unique and as fancy or silly or slovenly as you want to be on your own time.  When you are at work, you are not you, you are the job.  Uniforms are not all bad.  They can inspire authority, not only in patients’ eyes, but within our psyche as well.  On, Adamjh3 states, “I’m way more confident in my uniform than I am normally, it’s like I’m a whole different person.”   Uniforms can inspire unity between employees, assisting in producing a team environment.  They also help others identify what role you play if they need assistance.  Uniforms can offer safety via blood borne pathogen or fire protection within the garments.  Most of the common complaints I have noted in reference to a uniform appearance for EMS workers deal with how the practitioner is wearing the garments or their appearance while in uniform.
Some commonly noted uniform faux pas are:
Wrinkled uniforms:  I recently attended a funeral for a fellow EMT. One of the mourners, also an EMT, had on a uniform shirt that looked like he pulled it out of the bottom of the hamper.  On a regular day that is awful, at a funeral it was disrespectful and disgusting.  Iron your stuff, or at least throw it in the dryer (I won’t tell).
Dirty Uniforms:  Some of us wear light blue or white shirts and dirt from various sources finds its way right to the front of the shirt for everyone to see, it is part of the job.  If your shirt is grey or brown and it wasn’t that color when it was issued, please wash your uniform.  I won’t mention all the other things living on a dirty uniform, you can imagine on your own.
Ill-fitting uniforms:Too big and too small look equally bad.  All your parts should be covered without looking like you borrowed your Dad’s clothes.
Shirt tails:  Tuck your shirt in!  This was the big winner when I asked providers for their feedback on their biggest uniform peeve.  This one thing can instantly make you look slovenly and lazy.
Wear a t-shirt:  In addition to having an extra layer of protection against the gross things our uniform shirts attract, a t-shirt makes what is under your uniform shirt opaque and protects you from wardrobe malfunctions. As a new EMT rebelling against my unfashionable uniform, I did not wear a t-shirt.  One day while driving back to headquarters I looked down to find my shirt wide open!  Three buttons “malfunctioned” and all I could think about was how to button my shirt without my partner noticing.  Thankfully, he was a gentleman and made up an excuse about going to the corner store and left me to fix my shirt in peace.  Guys, this goes for you, too!  No one wants to see your Magnum PI chest hair through your shirt.  White, navy or black are typical colors that compliment most uniforms, but of course wear what your organization’s SOPs direct.
Hair: Since my days of rebellion via coif I have been reformed and now stick to either blond or red that could occur via nature.  My professional life has improved greatly.  Yours can, too.  Men, keep your hair cut or styled (the ladies like it, too).  Shave your face if it looks bad and follow your organization’s SOPs for facial hair. Ladies, if you have long hair or loose where it could get into bodily fluids that aren’t yours (yes that happened) please secure it.  This is a blood borne pathogens issue and a security issue.  If you are attacked by someone your beautiful hair can be used as a weapon against you.
Piercings and jewelry: No, you should not wear your septum piercing and Marilyn Manson gauges to work.  Granny may have a conniption and the goal is to not upset your patient any more than they already are.  In reality all jewelry should be avoided for safety and security reasons, someone can attack you and rip out your piercings, use a necklace to choke you; your rings can get caught on many items in your truck or on a scene.  Everyone wants to go home at night with all their parts intact.
Accessories:  Please wear a belt.  A belt can hold your radio and many other doodads you may need at work.  A belt can also help with that pesky shirt tail that won’t stay tucked in or pants that are a little too large.  If you note that your boots are looking scuffed, dirty or broken down, please clean and polish them or replace them.  The lady with the white carpet does not care that you were at a cow pasture last week; you are not getting into her house with those boots.
We do a job that requires exertion at times and yes, we sweat and that can be quite fragrant.  You should not be malodorous BEFORE your shift.  Good hygiene benefits your partner and your patients who will be in close quarters with you and your aroma at some point.  It benefits you as well since you don’t want to be “that guy” no one wants to work with.  Clean, neat hands are important in our profession since they are our tools to administer treatment to patients.  Not only can they carry disease, but like our uniform they demonstrate our attention to detail.  No one wants to be touched by grubby hands, even when enclosed in gloves.
I recently attended a seminar at a prestigious university where a speaking coach was discussing how to have your message heard.  The very first thing she talked about was visual presentation.  People make their decision about whether or not you are worth listening to within milliseconds.  That may not seem “fair”, but it is what we have to work with when attempting to deliver our message and treat our patients.  In our business our message can affect our own or others’ lives, what message could be more important?