Is what we are called important?

“I don’t know man, I think I’m burnt out.”

The voice on the other end of the phone sounded stressed. He is one of my friends from a previous EMS job. He had called me to vent and he sounded tired, like the passion for the job was gone.

“I became a medic because I was tired of seeing burnt-out medics BLS everything. I wanted to actually step up and treat patients, not just roll my eyes and downgrade them to my EMT. But now I feel like I get it. These patients aren’t actually having emergencies…half the stuff they call for could be taken care of at an urgent care!” He was sounding exasperated. “I don’t want to be that medic, but I am tired of showing up in an ambulance with lights and sirens that says Emergency Medical Services on the side, just to be used as a taxi. I didn’t want to become a salty burnout, but here I am.”

This wasn’t the first time I’d discussed burnout with fellow medics. It’s a common theme in EMS, and for plenty of reasons – long hours, poor pay, tough work environments, abuse of the system…the list goes on. My thoughts went back to when I had multiple EMS jobs and worked nearly every day. I had struggled hard with burnout for a while myself for many of the same reasons. I had realized if I was going to enjoy a successful career in EMS, I needed to find a way to combat it. One way I did that was to change my perspective of the job itself.

“Do you think being in the Emergency Services changes your expectation of the people calling you?” I said. There was a pause on the other end of the line. “What do you mean?” he asked.

“You are the Emergency Medical Services, so do you think that self-image imposes an expectation that people calling you need to be having an emergency?” I said.

“Well, we are the Emergency Medical Services. You shouldn’t be calling 911 if it’s not an emergency” he replied.

“I agree,” I answered, “but what is an emergency? Your education allows you to define it easily, but the public can’t always do that, so what they feel is an emergency often doesn’t match your definition. What if you called yourself Prehospital Medicine instead of Emergency Medicine? Would that change the expectation of your patients needing to have an emergency to be worth your time?” 

The line was silent for a second, so I went on to explain how I had struggled with the same frustrations of being called as an emergency resource only to care for patients that were clearly far from experiencing any actual emergency. Every time the pager went off, I would find myself hoping that this would be a real one, and I would be disappointed and angry most of the time when it wasn’t.

Then one day, I decided that if I wanted to enjoy this career, I needed to stop living for those true emergency calls. I needed to change the way I saw my role in this field. So I chose to see my role as prehospital medicine, not emergency medicine. This meant that no matter what the acuity of the call was, my job was no longer “saving their life” but assessing, triaging, and treating to the highest level my scope of practice allowed.

I tried it as an experiment and remained somewhat skeptical that this would actually change anything at all. It took some time, and I had to continually and consciously decide that I was not Emergency Medicine anymore. Eventually, I noticed something very interesting happen. I wasn’t angry with low acuity patients anymore. I began caring more. I was becoming more compassionate. I would give pain medication much more readily. I would start IVs and give fluids and Zofran to the intoxicated people. I talked quietly and turned the lights down. I began to dive much deeper into assessments and medical history. I stopped asking just a few quick questions and then leaving patients with the BLS crew because I was asking myself what treatments I could start for them now rather than whether they could wait to be seen. 

I noticed a few other changes as well. I was becoming better at my job. I was becoming better at interpreting assessment findings, making decisions, and initiating treatments. This was very important to my performance when I did get critical patients. I began wanting to learn more. I wanted a higher scope of practice to be able to do more for my patients. I wanted to know more about holistic approaches to medicine outside of just emergency care.

Most importantly, I noticed that I was happier and more satisfied with my career because I changed my expectations to match the job instead of continuing to be disappointed that the job was not as advertised. 

So maybe what we call ourselves is important. Maybe it’s time to rebrand, and maybe it’s time to stop calling ourselves the Emergency Medical Services. Maybe setting the expectation that we provide fast-paced emergency medicine with lights and sirens most of the time is leading to dissatisfaction when what we actually do is provide medical care outside of the hospital.