Classifications matter more to us than the patients we serve.

Are you a medic or an EMT? How you feel about answering that question probably has a lot to do with…well…whether you’re a medic or an EMT.

When I was an EMT, I sometimes felt like a lower life form. It wasn’t because of the pay; earning less than medics made sense to me. It was because of chain-of-command assumptions about generic capabilities—communication and decision-making skills—that have less to do with hours spent in classrooms than time on Earth.

I remember being asked, “Are you a medic or an EMT?” by an instructor in 1994, soon after I started medic school. It was a rhetorical question. My interrogator was unhappy with my performance during a patient assessment scenario, and seemed eager to stress the differences between EMT-level and paramedic-level skills. I sensed anger and frustration; he was shouting and waving his arms at the ceiling as if his favorite football team had just blown a three-touchdown lead. I’m not a violent person—just ask my cat—but I wanted to hit him. I hollered back, “I’m a medic!” even though that wouldn’t be true for another eight months. I wasn’t sure what I was. A hypothetical paramedic? An EMT+? All I know is I was expected to assert my prospective certification on demand, if not for my benefit then for my instructor’s. Hooah.

I’ve learned a lot since then: Seat belts won’t work sideways, a partner who barks like a Rottweiler will attract the wrong kind of attention, sushi from a diner is riskier than a needle stick, and certification doesn’t mean squat about caring or smarts.

The P after EMT confirms I’ve demonstrated baseline competence treating synthetic torsos with drugs and electricity during narrated scenarios. It doesn’t mean I’m considerate, conscientious, empathetic or trustworthy. Those qualities—important elements of patient care—have nothing to do with titles.

Classifying caregivers by education or certification means more to EMS providers than to the people we treat. We’re very title-conscious in EMS. If I say I’m a medic, my coworkers will know the level of care I’m licensed to deliver. Often there’s a need for that. However, if I introduce myself as a paramedic to outsiders, their conclusions will be much more abstract: Mike drives an ambulance. Mike sees dead people. Mike will work for less than bartenders make around here.

I know what I want my patients to think, and it’s none of those things. The way I see myself—the way I want people to see me—has less to do with my title than with essential services offered by all levels of field practitioners.

To me, EMS is a noble occupation, independent of title. According to my Webster’s, noble means “having or showing high moral qualities or ideals, or greatness of character; having excellent qualities.” All are important traits for people who take care of other people, although “ideals” reminds me we don’t always meet those criteria. Hey, even upright posture and opposable thumbs don’t make our species perfect, but as long as free will is part of our pedigree, we can do better. Sometimes EMTs and medics need to remind each other of that.

I’m not too happy with some synonyms for noble: eminent, lofty, illustrious, grand, stately, splendid, magnificent and aristocratic. Those words imply superiority. I wouldn’t want to be that kind of noble. We’re supposed to relate to our patients and to each other. That’s hard to do in EMS systems with distinct class structure, yet who can deny the prevalence of patient-EMT-medic hierarchies? We should rise above it, or sneak below it, or just ignore it.

My favorite part of our profession is that we provide services of unambiguous value to end users. No middlemen, just a couple of EMTs with B, I, P, CC or IV suffixes. I enjoy the innate, title-blind goodness of delivering prehospital care—especially the brief but evident one-on-one quality-of-life upgrades afforded our patients.

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