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Selective Service


Sometime during the first half-century of EMS, the public we serve got the notion we’re doing them a favor.

Before I tell you how I think that happened, consider the following example:

Early in the post-Y2K decade, I was channel surfing at home between shifts at my favorite hospital-based EMS agency when I spotted a county official on a call-in TV talk show (a format long since replaced by exposés about naked-and-afraid housewives who hoard). I recognized him as someone whose chain of command I was part of, so I stopped clicking long enough to hear him take a call. It was from a resident who complained about a slow response to some sort of emergency by either fire or EMS—I don’t remember which.

There had been lots of debate at my job about response times: how they should be measured, who should measure them, what reasonable goals were, etc. Now I was curious about how my boss’s boss’s boss was going to respond to the televised complaint. Addressing the caller, he replied, “When you start getting up in the middle of the night to answer emergencies, then you can criticize.”

Wow—that was like saying you have to be a chef to send back an undercooked steak. Surely there would be an outcry from indignant viewers who shouldn’t have to be paramedics in order to call for one.

There was no outcry—not even a murmur. It was as if the government guy had spoken the truth, or at least what viewers thought was the truth.

That talk show reminded me of two things: Never underestimate the entertainment value of live TV, and essential services are considered by many to be favors granted by those who are paid to deliver them. It embarrasses me to acknowledge that some who share the latter view are EMS providers.

On my worst days, I’ve behaved as if my patients were privileged to have me. I didn’t mean to; it just happened sometimes when I wasn’t properly motivated to be a rescuer, like the time the husband of a pleasantly confused patient tried to tell me which hospital his wife preferred. I cut him off and told him we were going to the closest ED, even though the patient’s stable condition gave us more flexibility than that. The husband smiled and shrugged, sidestepping an opportunity to point out that I was exhibiting an aberrant form of role reversal: a public servant who wanted to be served. We both knew our destination was convenient for me, not for my patient.

Speaking of convenience, I don’t know how I got the notion I was owed any. So many of us go into EMS to avoid environmentally controlled jobs with mind-numbing routines. It shouldn’t have been hard for me to roll the dice and let my patient pick the hospital.

There is no shortage of excuses for the entitlement we feel when we parochially “qualify” patients for assistance we’re required to offer. Being overworked and underpaid certainly makes it easier for us to justify, at least to ourselves, the need for a defensive posture. An us-against-the-world attitude leaves little room for courtesy, though, and turns us into caricatures of the public servants we’re supposed to be.

That explains how EMS providers get confused about who’s serving whom, but why does the public cut us so much slack for acting that way?

One reason is that people don’t know much about what we do. Another is that people don’t want to know much about what we do.

I think most of the public is comfortable regarding EMS as a black box with mysterious mechanisms that somehow cause ambulances to appear at medical emergencies. That knowledge gap is an issue for another day. Meanwhile, if you’ve not only carried a stretcher but occupied one as well, you know how disruptive emergent illness or injury can be for the sufferer, and how welcome the slightest courtesies can be to patients transitioning from self-sufficient to dependent.

Suppose those of us in EMS really are special, with nobility fused to our DNA like wings on angels. What better way to show we’ve earned our blue blood than by delivering service, instead of expecting it?

Even if it means getting up in the middle of the night.

Mike Rubin is a paramedic in Nashville and a member of EMS World’s editorial advisory board. Contact him at

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