You're getting ready for another shift. You fill your thermos with coffee, iron the uniform you forgot in the dryer, clip your ID to your shirt, slide your glove holder on your belt and head out. Did you realize this would be your last day in EMS?
Preparation is one of the key words in emergency care. Crew rosters are arranged weeks or months in advance. Preventive maintenance is routinely scheduled for rigs and equipment. Before every shift, rig lights, flashers and beacons are checked, defibrillators are charged and tested, glucometer readings are recorded and oxygen levels are checked. After the shift, any equipment that has been used is cleaned and stowed, supplies are recounted and restocked, and the rig is washed, fueled and made ready for another day.
Being unprepared in EMS is bad for patients and bad for business; that's one of the reasons organizations plan and prepare so extensively. From the CEO's office to the medical director's desk, successful companies plan for positive outcomes. Their business goals reflect trends in politics, nationwide healthcare changes and community needs. The plans incorporate changes in working relationships with other first-responder agencies through mutual aid, SWAT and hazmat. Plans are passed down to employees through changes in policies and procedures. Patients are part of the changes when they're affected by response times, protocol changes, transfer guidelines and insurance and Medicare coverage.
As EMS providers, we prepare ourselves by attending classes to get new certifications, tracking CEUs to maintain our proficiency, memorizing protocols and practicing scenarios at training sessions, and reading EMS journals about trends in prehospital care.
However, there's one important event to which many of us haven't given much thought. Although we may be well prepared for every day in EMS, some of us are completely unprepared for our last day in EMS.
Sure, we all know that everyone has a last day in the business. It's just common sense--everyone has to leave EMS sometime. We've seen it happen to other people: They get hurt, develop a serious illness, have a conflict with the boss or make a serious error in patient care, and suddenly that person's name is no longer on the shift schedule. They're out of EMS.
Sometimes leaving EMS happens to more than one person at a time. A fact of EMS life is that sometimes companies go out of business, change owners or reorganize, and all the employees lose their jobs. Many of those employees didn't expect anything to happen and don't have a plan for their future. They didn't realize, when they went to work that day, that it would be their last day in EMS. Although they may have been well prepared for their role in prehospital care, they were not prepared to work in another job when EMS stopped being an option.
Imagine, just for a moment, that you can't work in prehospital care any longer. You have just had your last day in EMS. What would you do? Your options will be determined in large part by the reason you are out of work.
Reasons for Leaving EMS
If you are injured on the job, you will probably be eligible for disability pay, but do you know what portion of your wage you will receive and for how long? Does your disability coverage start as soon as you're injured, or do you have to supplement your hours with personal time or sick days? Will your disability check pay your bills? Does your company have a retraining program or a policy of placing injured employees on light duty or restricted work? If your injury is permanent and you can't go back to working the street, is there another place for you in the company? Have other employees with work-related disabilities been transferred to permanent positions?
What would happen if you were injured outside of work? If you have a serious car accident or fall off your roof, will you have any disability coverage through other insurance? How long would your organization hold your job for you if your return to work was delayed?
If you or someone in your immediate family develop a serious illness, you may need to take some time off work. Do you have enough sick or vacation time saved to deal with a long-term health problem? In some situations, the Family Medical Leave Act (FMLA) may provide protection for your job, although it won't supply any income. Your employer should let you know about this option when necessary; however, it's a good idea to know ahead of time just what the FMLA covers and how it would apply to you or your family if you should need it.
Termination or suspension
Losing your job due to being fired or suspended can be an emotional and financial disaster, and it may make getting another job in EMS nearly impossible. If you are terminated and believe it's due to discrimination or unfair treatment, getting a legal opinion is important, but legal processes can be expensive and time-consuming. Do you have enough money saved to tide you over until you get your job back or are hired somewhere else?
The healthcare industry has had financial problems for many years, and these problems have spilled over into EMS. When ambulance services go out of business or change owners, every employee in the company may be terminated, and the new owner may only rehire a few. Wages and benefits may not be the same if the company changes hands. If you were rehired at a lower wage, could you make ends meet? If you are not rehired, there may be a lot of competition for other EMS jobs in the area. Would you be eligible to work for another EMS provider, or would additional certifications (e.g., National Registry, PALS, BTLS) be necessary? Is there anything you could do to put yourself in a better position to work for another employer? In the event no other EMT or medic jobs are available, how much do you know about unemployment benefits?
Take a look at your local paper and imagine you're looking for a job. How many want ads are there for EMTs or paramedics? Major EMS providers across the country hire frequently, but would you be willing or able to relocate to stay in EMS?
What about training requirements for other healthcare-related jobs? If your local emergency departments use EMTs or paramedics, do they require additional training, such as nursing assistant or specific EKG certifications? Do most of your EMS educators have four-year degrees, teaching credentials or only vo-tech certifications?
The Market Outside of EMS
What other skills do you have? A medical background can be an advantage in other areas of emergency response, such as law enforcement or the fire service. Are there more positions available locally in those fields than there are in EMS? If you had a career before EMS, could you go back to that or a related field?
What is your emergency plan for budgeting after your last day in EMS? Having a financial safety net will help you make better decisions about your next job. Could you afford to go back to school to master another career if you weren't working? If you are close to retirement age, can you actually afford to retire? Talking to a financial planner when you have options available is a far better choice than waiting until you are forced into a difficult position.
If you have to leave EMS, will you be leaving most of your friends at the same time? Being unemployed is a high-stress situation, and it's important to have a support system. If friends at work drop out of the picture, who else can you depend on to be there for you?
There aren't many answers to all of these questions because the decisions have to come from you. It would be ideal to be able to choose if and when we will leave EMS. Some of us would stay in EMS until retirement; others would happily leave right now for jobs with better hours and less chance of injury. Usually people who aren't happy in emergency care burn out in a few years, but they may stay longer because they can't or won't find another job unless they're forced to.
Although the technical skills acquired in EMS may not transfer easily to other occupations, the strengths of prehospital providers lend themselves well to the business world. The self-confident decision-maker at a critical incident is a natural leader who won't get ruffled when things don't go as planned. The understanding of teamwork gained through working with colleagues and other care providers is an essential aspect of positive business relationships. The abilities that allow us to function in the challenging prehospital setting make us assets to many organizations. These personal attributes and our value systems are part of who we are, and we take these strengths with us wherever we go.
Just as preparation is a key word in prehospital care, so it is essential for our future security. Don't let a career change take you by surprise. When is your last day in EMS going to be?
Frieda A. Bruck, BA, EMT-P, began her career as a volunteer EMT for a rural ambulance service in 1986, and recently retired from her position as a paramedic supervisor for North Memorial Health Care in Minneapolis, MN. She is finishing her MA in communication while working as a business consultant, educator and freelance writer. She can be reached at firstname.lastname@example.org.
Leaving EMS With a Plan
There isn't any other job in the world like EMS. Making life-and-death decisions while surrounded by chaos isn't a normal work setting. We've all been asked, "How can you do that?" We usually answer with a shrug and a smile. The truth for most of us is that we love the physical, mental and emotional challenges of being successful at a job that most people can't do. There are few professions that test confidence, leadership and competency in the same way that EMS does. The 9-1-1 lifestyle gets in the blood and becomes, like some posters proclaim, "Not a job, but a way of life."
The downside of our way of life is that EMS might not be a lifetime job. Every year, many paramedics and EMTs work their last days in EMS. Some of them will leave because of injuries, some because they have medical conditions that shorten their time on the street, and some because their jobs have disappeared due to business changes. Unfortunately, many of the EMTs and paramedics who are going to lose their jobs don't have plans for their futures. They have never visualized themselves facing their last day in EMS.
Planning for the future is essential for success in business. Companies with sharp leadership not only have yearly plans, they have five-year and 10-year plans too. The same rules that apply to successful businesses also apply to those of us who work in EMS. Goals and flexible short- and long-range plans can help us weather the changes and problems we'll face in the future. A lifetime career in one organization with a comfortable pension waiting at the end--a situation that was taken for granted only a generation ago--seldom happens anymore. Careers have become a series of winding trails with many forks, uphill climbs and a few dead ends for the unwary. In this challenging environment, we need to tailor our skills to find the best career paths and become equipped to make good choices when faced with those forks.
One of the problems we face is that there aren't many natural career paths out of EMS. Most jobs outside of emergency care aren't easy transitions for EMS professionals. We may be good at what we do, but the narrow scope of our job skills doesn't prepare us to be good at careers outside it. Are there options out there? Absolutely! We just have to think about what we like to do, what we're good at doing and how we can transition those abilities into other professions. The following information shared by three paramedics might give you some ideas.
Mike--Mike has worked full-time as a paramedic for 28 years. He serves the community as an FBI SWAT medic and helps his coworkers through his work as a peer counselor. Mike has taught CPR and first aid and supervised a medical staff for a large public-event center. For his second official career, Mike became part owner of an EMS equipment sales business.
Mike began working toward independence through his sales career partly because he was looking for additional income. His strong interest in all things related to emergency medicine led him to EMS equipment sales. This job now takes up about 16--24 hours a week and contributes about a third of his income. Mike says that his knowledge of issues and needs related to EMS, plus his field expertise, has helped him achieve success in equipment sales. At some point Mike plans to leave EMS, but for now his business is a second career.
Mike recommends finding something you're interested in and getting a degree to make yourself more marketable. He says that "people jobs" seem to be a good fit for medics.
Jim--Jim has worked in EMS for 16 years. He decided he needed a creative outlet early in his career and began writing. Jim's articles on EMS have appeared in trade journals, and he also has a book in progress. In addition, he has applied his emergency medical knowledge by editing novels for other authors.
Jim spends anywhere from 0--20 hours a week writing, depending on projects that are pending and family schedules. The rewards are tangible, but he says they haven't contributed a great deal to his income at this point.
Jim advises other medics to pursue second careers. He believes it's good for your mental health to take a step away from the intensity of day-to-day work in the streets, and such a career could be an essential backup in the event of injury.
Nate--Nate has been involved in EMS for seven years. He decided a little over a year ago that he needed a second career because of the challenge of raising a family on a paramedic's income. He began taking classes and learned how to start and operate a small business. Nate now owns an investment company that specializes in real estate. His organization buys and rents houses, handles lease-to-own options, rehabs and sells homes and helps out people who are behind on mortgage payments or in foreclosures.
Nate says it took 40 hours or more a week in the early stages of his company to get everything up and running. Now he works about 10 hours a week or more, depending on how much money he's trying to earn.
Financially Nate's company is just beginning to repay his efforts. About 10% of his income is from his business right now, but he expects that to increase as he acquires more properties.
Nate says EMS has helped him with his second career in several ways, one of which was making him a strong team leader and teaching him to stand firm in his decisions. Paramedics have great responsibility, he says, and that helped him deal with the responsibility of running a company.
Customer relations are another important skill Nate learned from EMS. He says he can deal with people in some of their worst situations because being calm in a stressful environment now comes naturally to him.
Nate doesn't plan to totally leave EMS. He loves being a paramedic, and that's how he wants his feelings for the job to stay. Nate wants to be able to work as a paramedic while having fun and not being stressed by dependence on medic wages. He does plan to cut down on his hours as his business becomes busier and he needs the paramedic income less.
Nate advises other EMS providers to do what feels right for themselves. "If you don't like your job," he says, "you're in the wrong profession."
Mike, Jim and Nate all love working in EMS and believe that having a second career is essential. They have each taken different paths but have found that their training and experience in EMS have given them an advantage in the business world. The flexibility they've achieved by beginning second careers while still keeping the security of regular paychecks is making their transitions easier.
The technical skills learned for EMS may not be useful in a business setting, but the ability to learn and master those difficult skills--sometimes performed under extremely difficult circumstances--is a strength that must not be taken for granted. The ability to triage and multitask while calming a storm of chaos is an advantage no business or trade school can teach. Every one of us will have to face our last day in EMS, but by preparing for the future, we can be ready to move on--by leaving EMS with a plan. --FB