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Real Medics

I became a real paramedic on June 18, 1998. At least that’s what Fred said. Fred had been one of about 20 senior medics at our hospital-based EMS office when I’d earned my first EMT-P card three years earlier. According to Fred, we’re not real medics until after our initial refreshers. Fred’s assertion had nothing to do with skills or test scores; it was about serving an unofficial apprenticeship that Fred felt taught new medics about real-world issues that weren’t covered in class. Three years was the magic number because that’s how often New York requires recertification. Your results may vary.

I agree with Fred; it takes some number of years in the field—I’m not sure how many—to supplement theory with street smarts. For example, some of my early lessons were:

  • Patient assessment has little to do with scripts; there are too many variables.
  • Primary and secondary surveys, so regimented in school, might be edited, inverted or combined according to initial impressions on scene.
  • Decisions to treat first or transport—often critically important—are based on observation and instinct instead of algorithms.
  • The odds of favorable outcomes depend on the intersection of capable caregivers, street-friendly presenting problems and luck, rather than scholarship.

I understand how familiarity with subtle aspects of patient care helps make a real medic, but there’s a parallel track, focusing on demeanor, that I’m convinced is more about form than substance. Call it medic cool. I saw it in many of my practical instructors. There was something casual, even effortless, about their behavior. I might have been wrong, but their priorities often seemed to be less about what they did and more about how they did it. Through a haze of inexperience, I concluded:

Real medics prize proficiency in psychomotor skills no less than bedroom prowess (one of my preceptors actually characterized endotracheal intubation as “a manhood thing”). “I tubed her while hanging from the B-post” trumps “I spotted a right-ventricular MI.”

Real medics favor a posture that broadcasts, “I know what I’m doing; now step aside and let me do it.”

Real medics embrace risk. When I started, gloves and seat belts were optional. So were cigarettes. In the ambulance.

Real medics pass exams, somehow. It doesn’t matter to them by how much.

Real medics are politically to the right of the John Birch Society. Pick an issue—taxes, social programs, states’ rights, gun control, immigration; there isn’t a lot of support for moderate sentiments.

Real medics play hard, but avoid major trauma…well, usually.

Hey, I was new. Some of my impressions might have been premature. I wonder, though, how many novices in our field draw similar conclusions from early exposure to seasoned coworkers. Do mentors focus more on medic cool than medic competence?

I think we need to take a fresh look at the real-medic mystique. After 16 years in the field, my concept of real medics has little to do with charisma, brass or balls. It’s more about someone you’d call to care for your family. Now I believe:

Real medics value spiritual strength more than physical strength. If our spirit stays strong even as our bodies start to give out, we can find new ways of leveraging experience to improve patient outcomes.

Real medics understand the difference between treatment and care. The latter doesn’t always require the former.

Real medics see continuing education as something more than a prerequisite for recertification.

Real medics find enlightenment outside of EMS. Broad-based education helps us understand our environment and our customers.

Real medics don’t let experience curtail enthusiasm. I work with a few high-time colleagues who get just as excited about spotting a hot appendix as they did 15 years ago.

Real medics work against stereotype. We have opportunities every shift to enhance the public’s perception of what we do.

Real medics, your patients know who you are.

Seeking Input

I’ve been offering my opinions in this space for more than two years. Now it’s your turn. I’d appreciate your feedback on any of the following:

  • Your first EMS call.
  • Suggested improvements to prehospital equipment.
  • What you would do differently if you could start over in EMS.
  • Something you learned during the past six months that made you a better practitioner.
  • Your favorite EMS memory.

I’m planning a column that will highlight readers’ contributions. Send your views to me at I’ll get back to you when I start putting it all together. Thanks!

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at

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