In any endeavor, there will always be those at both ends of the spectrum, and many between.  Both good, and bad.

My father was a plumber in a small isolated community of 200 in the Siskiou Mountain Region of Northern California.  Not every job was a new home construction or a remodel. He wasn’t fond of the late night calls for frozen pipes in the dead of Winter, or calls on week ends during a televised baseball or football game for a backed up septic system. With every career there are unpleasant tasks, but always part of the job. Even in EMS, and if we loose focus of customer service it makes the situation worse. We do poorly when we don’t have a proper attitude.

I too have experienced those who have come and gone, who do EMS for all the wrong reasons. Usually those people are short lived in a field that continues to have a high turnover and high burn out. Statistics say most are doing something completely different in 3 years. “Old Timer’s” have my respect and gratitude just for sticking with it. We all know there’s no pot of gold in EMS anywhere along the way, not even at the end.

I’ve also had my experiences with those who forget why we in EMS exist, the patient, regardless of need.  Simple concept to grasp.

Hearing some refer to nursing homes as “Gomer Homes” or “Lizard Farms”. Having a patient being referred to as a “Poob”, “Gomer”, or “Wet Bottom” defines one’s inability to realize purpose and value of people. In reality those people are someone’s mother, father and maybe even a grandparent.  Given a conscious choice most who reside in nursing homes wouldn’t, and are there because it’s a place where they can receive ongoing care and are unable to provide it, either by self or family. Modern medicine and technology has extended our longevity and hasn’t been able to overcome the quality of life issues that ensue. We have a lot of Hudson’s and Studebaker’s stored in our parking garages, just can’t drive them anywhere and there’s limited parts available.

There are many who live alone and will actually engage the 911 system as a means to get attention or access the system for medical care. In 1996 it was reported that 92% of the population retires at or below the poverty level. That means under-funded social programs to address the needs of this segment of society. Some of these will slip in to the EMS system at some point, I’m certain.

The homeless and those who wander the streets, engage in drug and alcohol abuse is an ongoing issue that’s solution is deeply buried in politics, economics, social programs and psychiatry, and the priorities of those who we elect to represent us.  Mental health programs suffered serious setbacks in the 1980’s when funding for those programs at Federal levels was abruptly cut.  Today we have higher rates of poverty and people on the street then five years ago. We don’t always elect those who will be proactive because political priorities shift more frequently then the sands of the Sahara. That means there will be more “patients” and comes with the job. For those who can’t accept this I would suggest either a career change or another venue for social activities.

The frequent flyers come with the territory.  What I’ve noticed over the years is when one dies a new one takes their place. Almost as if by predetermined destiny. Magic even. Some communities have passed ordinances to prevent these, but enforcement is difficult.

Not everyone has health insurance or bank accounts full of money and there are those on limited incomes and resources who will put off seeking medical care until the situation becomes a crisis, which often is a matter of their own perception. What’s an emergency to them may not be an emergency to us.  My own father waited until he had a cardiac arrest before seeing a doctor. Took 77 years to get him to a doctor. At that point he wasn’t given a choice, nor did he make the call.  But I am very grateful to the volunteers in the community who acted as first responders and provided him care and who continue to do it on an ongoing basis to make the small community a better place to live.

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In some areas of this country we have many areas with new immigrants or transient migrant cultures who’s first access to medical care of any kind is by dialing 911. Not available back home, used with abandon at times here. That means more calls.

In the late 1970’s I started noticing a change of attitude of the new EMT’s and Medic’s coming in to the system.  It was as if they had been touched by God,  their skills and abilities were only to be used for those who were only the most seriously ill or injured. Their abilities to harass dispatch when given an assignment was creative, always doing their best, or worst to get out of going on the call. I’ve seen crews who prided themselves on releasing the patient at scene to avoid transporting them to a hospital only to be sent out later and it became a Coroner’s Case. What we need to act on when we see this is to educate these people to patient care and customer service. Not every call is stat trauma and in many responses between there will be many instances where a smile and showing concern will do more for the patient then anything else. I’d actually put that as part of the ABC basics in patient care.

One of my tasks at work is reviewing compliance issues by the providers in our county.  It’s a mix of private, public, paid and volunteer agencies. One of our private providers instituted a customer survey that gets sent to every patient or family for every response it makes.  This provider includes the responses they receive back in their reports. Yes, there are a couple of responses where “bad attitude”, get sent back and “employee counseling” for the follow up. It shows the company is concerned and takes action to educate its employees. For the most I see responses that say, “Your people were wonderful and treated me good”, “They showed me a great deal of compassion”, “Please, thank them for the care and concern they showed me”. These kinds of response show me there are still those who treat a patient with respect and focus on customer care.

In Loveland, Colorado the Thompson Valley EMS Agency instituted a program “Random Acts of Kindness” for their employees, where if they see a need the organization will provide funding to that employee to help people and encourage the employees to act. What a great idea.

In my previous column I cited two instances where people with an EMS background did something that was selfless and compassionate. I still believe it is a core value with those who currently or previously work in EMS, and do it for the right reasons. Patients and their needs.

EMS is far from being a perfect system with perfect patients and perfect people. But when we as a Paramedic or EMT log on duty we are there to run calls and take care of patients. That’s why we are here and what we do. Sometimes our skills and abilities are put to the test. More often our interpersonal skills is really what’s being put to use on every response.  For those who don’t realize it McDonald’s is always taking applications, but they too have customer service values that are probably enforced much tighter.