Fire Service based EMS and burn out

[EMT424]

Back when I started EMS in the fire service (career) in dinosaur year 1987, all firefighters assigned to the "meat wagon" loved to be paramedic firefighters. We fought like heck to get the mere $100 more per month and had peer pressure to do great at EMS providing. If you struggled, the team supported you and hassled you. Officers never had to discipline a medic because it would be considered double jeopardy. The skills were superb and the enthusiasm to come to work was always better. Nowdays, the FF EMTP's cry foul that you "make them work the ambulance--I've been on it for three minutes and I can't wipe the ammonic fluid from behind my ears from being ALS borne yesterday. I wannda work the truck to get some sleep." (okay a little melodramatic but you get the jist). Work the ambulance or don't join the fire service--it's 80% of what we do!. What do other services do with premature burnout regurgitation!

[Renee Roberts]

As someone who was in emergency medicine back in the early 1980's, I do understand burnout. Yes, there are the whiners, but I did a lot of scraping people off the pavement and running to the ER with them in the back of our rig. It impacted me greatly. Watching people die is never easy, as all of us can attest to. But I worked in the days before CISD was around, and we got the "suck it up and deal with it" attitude from our supervisors. It did burn people out, myself included (That, and being a little hot around the collar back then).

I got back into medicine in 2001 (right before 9/11), when I realized my true calling was still medicine. While I want to take it further, right now I am happy to be an EMT working part-time on a rig again. I am working in event medicine now, which carries with it its own stresses (Hey, we see and treat the same stuff, just more of certain things than others!).

Premature burnout regurgitation... wow... what a statement! (80%? In this area, it is 90+% of what FF's do). I think the best thing is to be supportive of staff you work with, notice the early warning signs of burnout (Late for shifts, sick a lot, staying to themselves when they normally aren't that way, etc), and talk. Yes, it doesn't matter what service you are on, you will have the whiners. If they didn't want the job, they wouldn't be there. Or perhaps they are using it as a stepping stone to get somewhere else. Its amazing what peer support can do.

[EMT424]

Yeah Renee! I loved your posting and can read your empathy to peers is powerful to you. Great thought. However, I don’t think I got my point across to you. What I see is a new generation that is more self-righteous than “our” generation. I believe that CISD is a valid manifest of burn out. What I see is not burn out but a generation-X and Next that listens to one channel—good ol’ WiiTFM station 1985 or later borne (What’s In it for me). I believe that station leisure is more important than giving service to the community while wearing a badge that represents their oath and swearing to serve the community first. To me it’s close to running the other way when the fires hot and the victim yells help. I agree with you that hugging your colleague is important after a “Columbine shooting-type call.” And being a leader, critical incident stress is important. But selfishness about the engine guys and ladder truck guys being less busy while they run a nursing home call is not critical stress nor a legitament source of burnout—it’s self-righteousness to the max! I worked the medic unit two weeks ago and got 3 hours self the first night and 4 the second night of a 48 hours shift and was in heaven—finally something worth all that time away from my family that is meaningful and makes someone else suffer less because of my work (except that lady I left feeling like a pin cushion instead of that no-vein wonder!) Renee, the death and dying stress I’ll give you but I see a huge change in calls—ETOH does flow like it did in the 80’s and heart disease isn’t the number one killer anymore. I believe it’s beneath this new generation to care!
I want to lead a group of medics and firefighters that have the respect of themselves and their peers that they have earned the right to slow it down instead of hiding behind a burn out excuse that isn’t pain and suffering but a jealous fit of more senior firefighters taking their right of passage to be on the slower rig after paying their dues you speak of. I see old peers in the private ambulance sector still doing a great job and loving their job running 30 transfers a day and being great to their patients and working to re-invent their skills to meet the new demands and protocol changes. But in the fire service of the departments that I run with including my own, I see a generation that is all listening to one radio station called WIIT—FM [what’s in it for me]. I believe the leaders (informal and formal) mustn’t accept second-rate attitudes hiding behind a fake badge of PTSD from running old people back and forth to a hospital when they need the help—it’s time for leadership to create the goodwill and culture that EMS is a great thing we get the priveledge assisting the sick and injured and is only done when we adopt the spirit of we are more of a EMS service than a fire service. If you don’t want to carry a stretcher—find a department that only drag hoses and throws ladders. America isn’t burning like it used to—we have fire codes working well. But we, the American Fire Service, must lead better to push for the betterment for the citizens and not the lack of discomfort of our firefighters. Carry a mission--not a weak whine!
So how do you see us leading to support the WIIFM generation--a hug? or is it time to give stern tongue wagging to act like a man or woman whom swore with their right hand up to serve and care for the citizens they serve. Perhaps leaders need to help Gen-x and Next make a career decision to leave the American Public Healthcare System (the fire service) and find a job where their desire to be doing only "bonafide hero work" can be more attractive than helping 82-year-old-Mrs. Jones get to the hospital for that 2 a.m. UTI. For my family and my old mother--I want the badge to mean they legitamently care about responding regardless of it being a UTI at 2 a.m. or the Swedish Biniki team trapped from a dragon-like fire eating at the walls. Being herotic isn't brave--it's being selfless for

[Jamie Davis, the Podmedic]

You both have good points about EMS Burnout! There are way too many in the fire service that look disparagingly on EMS. On top of that, fire dept leadership continues to try to force EMS providers into a work schedule suited to fire suppression duties. When an EMS crew works 24 hours straight, sleep or a warm bunk is one of the last things they see. The EMS crews get tired and that is how mistakes are made in medicine.

Good conversation starter. Let's see what some of the others have to say!
--
Jamie Davis, NREMT-P "the Podmedic"
The MedicCast podcast at MedicCast.com
visit the MedicCast Store and get your own lifesaving T-Shirt
The MedicCast News podcast at podcasternews.com
HeadlinerNews Roundup
email: [e-mail]
voicemail: [phone] -- (941) 30-MEDIC

[easi822]

I started my EMS carreer back in 1990 and have seen a little bit of everything since then. I innitially ran calls with my local ALS rescue squad, then went to work part-time with the county ambulance service and still ran with the rescue squad. Next I joined my local VFD while still running calls with the rescue squad and then working Full-time at the county ambulance service. I finally stopped volunteering and went to work full-time with the county ambulance working out of the county hospital in an adjacent county 10 years ago. I hate to dwell on money, but I honestly believe that money is the root of most EMS problems. I have always had to work at least 2 jobs (I didn't mention my other jobs above i/e steel plants and blood banks) to make ends meet. Right now every person at my station must work a second job in order to pay his/her bills. We don't drive expensive vehicles and eat steak every night either. To look at the vehicles in our parking lot, sometimes you'd wonder who's running the junk yard! You work 24 hours at one station for one service and must have an arrangement with someone at another service somewhere else to wait over so that you can come in and relieve them for another 24 hours there. I've seen and done this several days straight in years past. You leave your main service to go and work at a part-time service for straight-time while someone from that service comes to your station to work a shift there because neither service will pay overtime!! You're working your butt off for $10-14/hour and away from home and your family while the service or hospital doesn't care about your welfare at all. I have actually seen paramedics go to management at one service and say, "I need a raise or I'm leaving." Management's answer was, "Go ahead, paramedics are a dime a dozen!" The problem is that manager was right to an extent. Medics today jump on any overtime or open shift like a starving hound on a hotdog. That means their kids can have the braces they need or that X-box game they want for Christmas. I used to feel bad when a shift was left open, but I actually encourage folks to not take those shifts now. We must prove that we aren't a "dime a dozen".

[EMT424]

Wow, I have seen this vow of poverty scenario so many times that it saddens me to no end. To call NFL players heros whom make over 10 million dollars for 18 to 20 games per year and then pay a paramedic whom saves lives $10-14 dollars is a sad depiction of American's values. The Canadian Paramedics, although more schooled in many ways, are a good example of "liveable wages" for paramedics. In my opinion the services that are strictly EMS and provide a satisfactory for salary are union-based and public funded. Mighty AMR has had to make some salary-competitive adjustments but for the most part, I see services do much better if they unionize their career. I offer that $10-14 dollars is not adequate and if your working two jobs to make ends meet, I'd find a union job as my next goal or form a union at my present service. The fire service tends to pay more and in many areas takes paramedics like a camel on a very hot dry desert takes water at the first watering hole. Secondly, I believe hospitals are taking medics for a good wage for EDT and CNA's readily and may substain a family better. Denver Health in Colorado, a unionized force, is a great career path for only EMS services and has a great group if the fire service isn't your cup of tea. I'd put their skill and service level up against any service in the nation but you'd better be top drawer of the medics because they pay for what they get--high failure rates in the field instructors program but the results are great for the dedicated and strong medics. I have met a lot of medics now doing event paramedicine and love the job and pay.
Burn out in the fire service is more of a myth in my opinion because the pay is usually over $25 to 35 per hour and they work 10 days a month in a pure 9-1-1 setting. Don't get me wrong--10 years of the meatwagon or 10 critical calls and I can see burnout from PTSS occurring but I see an entitled generation not willing to be dedicated so that the pay that we so much love and need remains negotiated at the highest level. I agree paramedics are a time a dozen but good dedicated and skilled medics are a more rare commodity and that's what unions sell to get the pay. So easi822, I hope you muster the strength and leadership to start your cause of burnout (too much hours for too little pay) and seek an EMS group labor organization and by the way IAFF.org is a wealth of good information and the international helps labor with unionizing help free most of the time. I learned of a story 3rd hand of a small town in New Mexico whom was being mistreated and underpaid. The members of the fire/EMS called the local teamsters and away they went. By 60 days, the grocery stores couldn't get any product until the city ponied up a labor agreement that was just and fair. I think the mayor's last words were, "I'll fire every one of those rotten union firefighters and paramedics." His final days were spent wondering why he fought the teamsters. It takes courage and self-belief to be a bold service--think about it.

[Rob]

I agree that union services seem to do a little better than the non-union shops, even if it's not wages that are much higher, but increased benefits. Another thing that would help would be higher standards. In episode #102 of the mediccast Jamie speaks about essentially renaming the different levels of EMS providers. The exception to this is that paramedics become "allied health partners". Jamie further speculates that this may mean a higher education requirement for paramedics and possibly even an associate's degree. In Oregon you are required to have an associates degree in emergency medicine (not the actual name of the degree, but the actual intent, it's an associates in EMS) in order to get certified by Oregon to practice as a paramedic. There was a great deal of resistance to this at first, but one thing that has come from this is higher than average wages for paramedics in Oregon. I know paramedics who make in excess of $70,000 annually (which is a lot more than $10-14 per hour). So a change in state/national requirements would also greatly improve the pay issues. (Although I would veture to guess that most unions would fight such legislation because it would REQUIRE their members to get more education rather than simply make it available to them.)

[Edward]

Well, from what I understand the burnout rate in EMS service is fairly high and the turnover is roughly every 5 years. I rekon you need to have a well grounded support system to survive in the EMS world.

[Rob]

I started in the fire service to be a fireman, and the department I first started as a volunteer in was a combo department with the career guys all being paramedics who responded mutual aid with the ambulance to certain calls. Most of them weren't too excited to do EMS and I picked up that attitude too. When I had to move for a new job I joined a new volunteer department that was all volunteer and there was no EMS whatsoever, there were no medics, and myself and one other of the firefighters were the only people on the department who were NFPA FF1 certified. Talk about Podunk, USA. Now I'm on another all volunteer department in a semi-rural location but our department is the fire and ambulance service. And as you stated easily 80% of our call volume is EMS. I got bored loading the stretcher (and I kind of like being in charge) so I grudgingly got my EMT so that I could do more. As it turns out I absolutely love EMS and fire and I realize that they don't have to be exclusive of each other. I agree that to be in the fire service today you need to be interested in EMS or you aren't going to have a very long career. The advantage for us as a volunteer department is that when someone gets burned out, they can just take a break for a week, a month, a year; whatever it takes, and then come back with a fresh attitude because we aren't losing our livlihoods when we stop "playing" firefighter/medic.

[EMT424]

Rob--I love the refreshing view that the world is "half full" and it's great to see that a simplistic view finds that EMS and FIRE as the same animal. Well thought out--unfortunately, American Fire Services in larger communities fracture the two and enable this self-righteousness that I am speaking of . My thought--work hard to have both accepted like you have found and don't let anybody change that culture,

[Sharon]

Hi guys the system over here in Australia is so different, both in terms of volunteers, hours and FF/EMS.
Thing is there is change afoot with government moving a private company aside and providing the ambulance transport.
They haven't made it clear whether that will be hospital based or use the government Fire service similar to what I understand your workload is.
It's going to be messy swapping whichever way they choose.
Do you guys welcolm any of us over there to gain a working insight?

[Renee Roberts]

Flexibility and patience. Regardless of the outcome in terms of who will be in charge, you will still be providing needed EMS in your community. Realize during this period of turnover that rumors will fly faster than the truth. Wait until you hear something from the horse's mouth. Don't rely on co-workers for information.

[Sharon]

most of the time unfortunately that is the only way that any information is available!!
In terms of who is in charge there will be considerable change as the present company has only just instigated a university degree program for Paramedics and the rest of Australia have had this criteria for quite some time.
It is different in that volunteers do not not have a progression model to paid and even have to study out of state to achieve the degree if not offered a job by the company.