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What's Your Plan B?

Over the course of my 20-plus years in EMS, the subject has come up time and again about what EMS providers can do when they are no longer able to work on the ambulance.

I was mulling this question over a few months back, thinking about my own backup plan, and I began to wonder what my peers have already experienced in this regard.

Let me be clear, many of us are fairly happy taking patients to hospitals, treating various traumatic injuries and medical maladies and having the opportunity to interact with other professionals on a daily basis. But if you were injured, wanted to explore new avenues or were otherwise unable to work on the streets, what would you do? Do you have a plan B? Have you thought about what skills (or even credentials) you have acquired in your EMS career and how they might assist you in establishing a back-up plan?

To gain the broader perspective of a wide variety of people functioning in various EMS positions (both providers and management), as well as those who work in fields tangential to EMS (nursing, public health, consulting, etc.), I decided to poll my Facebook friends. I posted the following question on my Facebook page: "Do you have a professional plan B in the event you are unable (by choice or not) to work on an ambulance? If so, what is it?"

  As expected, some of the answers reflected an intuitive reality about possible next steps, such as teaching, reviewing emergency plans, engaging in contract work and the like. There were also some out-of-the-box examples of what current and/or former EMS providers have planned for or have implemented as their plan B. These include:

  • State trauma system designation coordinator
  • Director of risk and safety for an EMS agency
  • Various public health positions
  • Moving into EMS administration or management.

But how does one get from point A--being an EMT, EMT-I or paramedic--to point B? Is there a template approach or specific skills needed?

Each plan B will be somewhat unique, but one of the more common themes mentioned was the need to include some level of educational attainment (bachelor's, master's or even other degrees and/or certificates) that may or may not relate to EMS.

Planning to add widely recognized credentials or certifications to your resume is a good idea. For example, the Project Management Professional (PMP) credential is the most important industry-recognized certification for project managers (more information is available at Another is the Certified Public Manager, or CPM. The CPM is also widely recognized as an essential certification for those who want to work in government circles. Classes usually last about a year to a year and a half and cover topics like financial management, governmental processes, leadership versus management, and many other applicable areas. You may want to focus on a degree at either the undergraduate or graduate level.

Nowadays, educational opportunities are varied and, between distance learning and off-hours classes, can accommodate almost all work schedules. The overall value of a degree cannot be overstated, as it demonstrates to future employers an ability to set and attain a goal, a certain level of intelligence and motivation.

To illustrate this point, I reference a comment on my Facebook wall in response to my question from a long-time fire service leader, who said, "Education is paramount to survival outside the fire and EMS world. You are only one injury away from not being able to work on the street." He advised personnel to be careful about having all their education in "career-limiting" degrees and pushed them more toward broad-based humanities or sociology education that has the potential to provide greater opportunities down the road.

Another plan B could be developing a business that includes some of the elements mentioned above, such as teaching (teaching CPR to various community and/or medical groups), reviewing safety plans, consulting, or even establishing an ambulance service where one is needed. This, too, will not be done overnight and will require some effort.

Understand that starting a business, no matter how small, involves researching the marketplace to see who is delivering similar services, developing a business plan, making key financial decisions about the product/service you will be providing, as well as start-up costs (for supplies, equipment, leasing space, etc.) and completing a series of legal activities. The United States Small Business Administration has a website with excellent tips for those wishing to start their own business. In addition to the SBA's advice, speak to others who have started a similar business. Although a lot of small businesses fail within the first few years, you can plan appropriately and make the transition to making this venture into a full-time money making endeavor.

Some additional steps toward making your plan B include:

  • Networking: Getting to know other people in the field, or in related fields, can go a long way in reinventing yourself. People often think of those they know when looking to fill an open spot.
  • Become a subject matter expert: There are a lot of niches in the wide world of EMS, including special operations, technology, education and more. Becoming an SME may take some time, but it is practically a guarantee of speaking and writing assignments (which could be a plan B or an element thereof).

EMS providers are traditionally action-oriented, which unfortunately means that issues like researching and developing a backup plan can slip off the radar screen. Taking the necessary steps now, whether it means furthering your education through a degree or certificate, networking more, or attending a state or national EMS conference, will make things easier if there is ever a need to implement your plan B.

Many of the comments shared on Facebook were quite optimistic, but I have to say that I have seen many providers go "down in flames" over the years because they didn't have a backup plan. Please take the opportunity now to map out, and even begin to implement, a plan B before you actually need it. I speak from experience, as I began thinking about my plan B quite awhile before I needed it. I was working full- and part-time jobs in EMS while attending graduate school. Along the way, I decided that, although I wished to stay in EMS (or a related field), I didn't see myself as a field provider for my entire career. When the time came to move into management positions, it was fairly easy and, eventually, my plan B became my plan A. I am not saying the road was easy or always clear, but putting the pieces of my plan together and thinking about the many possible futures I could encounter made things infinitely easier in the long run.

Raphael M. Barishansky, MPH, MS, CPM, is director of EMS for the Connecticut Department of Public Health. A frequent contributor to and editorial advisory board member for EMS World, he can be reached at

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