I have spent a lot of time around Emergency Medical Technicians (or EMTs). This is the nature of my work. They go to the homes of the sick and injured, or to the locations of disasters and accidents, and transport patients to hospitals; usually to the emergency department. Sometimes they arrange for helicopters to take those patients to trauma centers or to cardiologists, burn centers or pediatric hospitals. In between these tasks, they transport people to and from nursing homes or rehab centers, or from one hospital to another so that needed care can be given.

While there are several types of EMT, they can be roughly broken down into EMT basic, EMT intermediate and EMT-P or Paramedic. These correspond with level of training, with the Paramedic having the most (now involving a two year degree) and being qualified to obtain IV access, manage complicated IV medications such as clot dissolving drugs for stroke, administer medications to manage blood pressure and also give some which paralyze patients in anticipation of airway management. As such, they also place endotracheal tubes into the airway and these days sometimes do on-scene ultrasound so that receiving hospitals have a better idea of the patient’s needs.

As news stories focus on the pandemic trials of nurses and physicians, it is important for us to remember that EMTs are critically important to the safety and well-being of our communities and vital to the function of health-care systems.

Unfortunately, they are typically underappreciated and under-paid. In fact, many of the best medics I have known over the years left pre-hospital care and transitioned into nursing. First of all, the pay was much better even though many of the skills are comparable to nursing (medication administration and IV access for instance). Second, work in the hospital may have its risks, but they are not usually the same as those of caring for patients in ‘the field.’ This is in no way to diminish the value of what nurses, physicians, respiratory techs, radiology techs and all the rest do on a daily basis. However…

The EMT arrives at a scene having been called by family members or police, or a volunteer ‘first responder’ (a group to whom I’ll owe a column soon). The patient may have something as mundane as an ankle sprain or head-cold (yep, they call for those). But their patient may also have been stabbed or shot. The story told to dispatch may have been incomplete or false. An assailant may still be on the premises. Their patient may be wildly psychotic from drugs and uncontrollable even with help from police.

They could be facing something rare and terrible, like an expectant mother near the end of her pregnancy who has suffered a life-ending injury; I knew a medic who saved the baby by doing a c-section at the scene.

Those medics, those brave men and women, also roll up to house-fires with fire-fighters, and to car crashes on dangerous highways where drunks and those impaired by other chemicals routinely whiz by and sometimes kill responders. I’ve known them to climb into overturned vehicles to manage the upside down airways of some poor unfortunate who was critically injured.

Setting up landing-zones for helicopters is also dangerous. As is loading the sick or injured as the rotors are spinning (known as a ‘hot load’) in order to save time. Once, as a resident, I nearly walked into the tail rotor of a MB-117 helicopter because I was tired and stepped out of the back of the aircraft as we landed but were still under power. Medics are tired too. Medics also fly on helicopters; a glorious, exciting job except that all those moving parts sometimes fail and gravity, or power-lines or tree-limbs win the day and create tragedy.

In addition, the severity of the weather does not stop patients from being sick or injured. Driving sleet, hip-deep snow, tornadoes, hurricanes, blistering heat, floods and all the rest may afflict a medic on his or her job.

This is dangerous work. And it is physically stressful. It’s no secret that Americans are getting a lot bigger. Who carries them when they are injured? Who moves them onto stretchers? Medics. They also walk up and down mountain-sides and float on rivers to do their work. Their backs and joints wear down over time. They develop heart disease from stress and the problems of their circadian rhythms coupled with eating whatever they can get in the narrow window they can have a break.  Two of my favorite medics ever have had cardiac events in the last month; thankfully both are doing well.

There is, of course, an emotional cost. Having practiced emergency medicine for nearly 30 years since residency, seeing the dead and dying, talking to families, giving bad news, treating grim injuries, all of these take a toll on our hearts and minds. And this is no less true, perhaps more so, for those who are first or second on the scene. Suicide is a problem across the world of first responders, and doubtless will have been worse in the era of COVID, once the numbers are all parsed.


COVID has stressed our EMTs in unimaginable ways. We count on them to bring gasping, hypoxic patients to the hospital and then, task them with taking patients from one hospitals to another which may have critical care beds or other specialty staff or equipment (like ECMO https://www.thoracic.org/patients/patient-resources/resources/what-is-ecmo.pdf) that smaller facilities lack. Medics are driving hours and hours from their home bases just to secure a place for the critically ill. This is taxing to say the least.

I was involved in one case where a COVID patient had such a high oxygen requirement that the medics had to set up stops at other EMS services every two hours (on a roughly eight hour one-way transfer) just to restock oxygen as they couldn’t carry enough for the transfer.

Sadly, it’s getting harder to find qualified medics. It may get still harder as the pandemic takes its toll. Certainly it will be rough as vaccine mandates thin the ranks of both nurses and medics. It is ironic, of course, that those people worked through the dark days of the early pandemic, facing death every day before a vaccine (or sufficient PPE) was available. And yet now, because they don’t want the vaccine, they are considered expendable and ejected from systems already stressed to breaking. That’s an aside, but a relevant one. (And again, I say it as a pro-vaccine physician who is also very fond of actually having staff with whom to work.)

Medics make, on average, between $25,000 and $50,000 per year. Many in America would consider that an unimpressive income; especially as inflation grows. A lot of my professional friends and colleagues would not encourage their children to be EMTs. It doesn’t offer the status of medicine or nursing and it can be done with a two year associates degree at a (gasp) community or technical college. Meh.

Those same people will call 911 and hope against hope that there’s a brave, skilled medic to show up and save the lives of their loved ones.

I think that we owe our EMTs, at every level, a lot more. We owe them healthy working environments, more staff, more security and ultimately more money as well.

We didn’t see COVID coming. And we won’t see the next threat, be it infectious or natural disaster or alien invasion.

Whatever it is, you can guarantee we’ll still be calling 911 and praying for the help of those under-appreciated medics.

Ladies and gentlemen, thank you for all you do. I couldn’t do my job without you.



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