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Culture Club

A long time ago in a ready room far, far away, someone smarter than me said I needed a life outside EMS. That astute observation was probably based on my habit of commuting directly between my paying EMS job and my volunteer agency. I did that mostly because I was attracted to the customs, skills and opinions of people with whom I served. Our shared practices were, to me, the essence of rescue. Some would call it culture. My question is, does EMS have one?

Firefighters do. I know that because they tell me so. More than one has pinpointed their near-palpable culture as the biggest difference between them and us. I believe that, but I also think cultural gaps between fire and EMS are less about what we do and more about how long we’ve been doing it. Compared to fire, EMS is just getting started.

I once asked a firefighter who was also a paramedic to name all aspects of fire culture that came to mind. He mentioned danger, physicality, worth, camaraderie and discipline. I have no basis to argue with any of that. I’ve never been a firefighter, and it’s not on my bucket list. At age 60 I’m quite sure a tryout would teach me more about geriatrics than firematics. When I consider my colleague’s summation of fire’s cultural elements from an EMS perspective, though, I think we measure up pretty well:

Danger—Growing up in the ’50s, I was aware of three fundamental threats: sharp objects, busy streets and fire. I figured people who engaged the latter to protect the rest of us must be very brave. I’ve never doubted that or the dangers of firefighting. However, now that I know more about disease, disability and how hopelessly deranged some patients and bystanders are, I feel EMS is just as risky.

Physicality—I used to think physical demands separated firefighting from other essential services. That was before I spent 20 years carrying patients, equipment and patients with equipment. A few weeks in EMS were enough to acquaint me with muscles I didn’t know I had. During that first year I started to see definition in my limbs I hadn’t noticed since I’d retired from competitive hockey. I’m not saying I was ever strong enough to carry a 200-pounder safely down a ladder, but hauling even 50 pounds hundreds of feet three or four times a day definitely gets the blood flowing.

Worth—It’s hard to gauge the value to society of EMS or of any essential service. Even labeling EMS essential is presumptuous, although I don’t think most people who call us would argue with that classification.

In business value is usually determined by what a willing buyer pays a willing seller, but that assumption is less accurate when products and services are purchased through monopolies like our local 9-1-1 systems. To me, fire and EMS seem equally capable of meeting urgent, narrowly scoped needs.

Camaraderie—Firefighting is usually much more of a group activity than prehospital care is. I’m sure teamwork promotes unity within a firehouse; however, I don’t think there’s a closer nonfamilial relationship than what many pairs of EMS partners share.

Discipline—Let’s consider two kinds of discipline: internal and external.

Internal discipline is organizational—i.e., projection of, and respect for, authority. Having worked for both fire and EMS organizations, I’d say this is no contest; compliance with boundaries and responsibilities mediated by chains of command seems much higher in the fire service.

External discipline is the extent to which we obey other people’s rules. I think firefighters and EMS providers are similarly predisposed: We improvise, we adapt, we overcome, and we have little patience with anyone who interferes with that process.

Culture is evolutionary, not manufactured nor awarded. Nascent EMS traditions like those above must mix and meld to make an institution greater than the sum of its parts. Consider Scotch, aged in barrels before being sold; the ingredients have been there since day one, but maturation takes time. Rushing that process is beyond the bounds of human endeavor.

Firefighters can boast of a culture because the fire service has existed for more than 300 years. We can admire fire’s rich history, but we gain little by comparing ourselves to them. They’ve earned what they have, and so will we someday.

Let’s not be in a hurry to claim our culture. Like whiskey, EMS will improve with age.

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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