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The Midlife Medic: Understanding Agency

This month we’re going to move away from the subjective observatory deck and dive into an important concept—one that will directly impact your long-term success in your field or organization. I’m going to be throwing some sociology and maybe philosophy around, and some of it’s pretty dry, but stay with me.

For this discussion we need to understand what the term agency means. If you’re like me, you probably think you have a good handle on it. We throw that word around all the time: We work for an agency, we belong to an agency, we are part of an agency. Here’s the thing about agency: Yes, it’s an entity, but it’s also a capacity. It can be a thing, or it can be a thought. (Whoa—don’t go; I’m making a point, I swear.)

An agency is defined as administration, an instrumental organization established to provide a service. We know that one. Dealing with or working for agencies is part of our daily bread, but the concept is larger than just whom you work for. After all, our entire purpose deals with service. 

Every one of us who enters this field sacrifices some of our individuality due to agency. When we join an organization, we take on that mission as our own and agree to pursue those objectives as agents—representing not only our employer but the profession as a whole.

Think about how you identify yourself. For most it is role first, department second, personal third. You are an EMT/paramedic/firefighter who works for [insert department here]. If you ask me what I do or I am, my reflex is, “I’m a paramedic.” It’s the first rung in my personal hierarchy. As soon as they handed you that card, patch, or badge it happened to you too. Congratulations, you’re an agent.

Now, to be successful as an agent, let’s employ some agency. 

In social terms “agency” is the independent ability to act on one’s will. It’s the power to act or exert influence. It is free will and the subject of 200-plus years of arguing between philosophers in fancy coffee shops as to what comes first, the society or the agent. Are we the product of our environment, or do we drive the culture that shapes it? If abstract argument is your thing, this is the rabbit hole for you. 

Agency and Culture

To stay out of the sociological mire and on firmer ground, let’s use the concept of agency to move into culture. Webster has the best set of definitions for it, and it has application from the corporate world through the humanities. We will use this one: the set of shared attitudes, values, goals, and practices that characterizes an institution or organization.1

While their roles as agencies may be the same, every department has a unique identity as a result of its culture. It needs to be cultivated like any other organic, dynamic thing. It can grow and evolve or wither and become toxic. It requires invested leadership, vision, and staff with a strong sense of agency who are engaged and empowered to drive the process toward its objectives. It is the hardest thing to change or influence; sometimes it must happen one person, one agent, at a time. 

I want to clarify that while I mention leadership here, I am speaking to the line—the front line, the field agents, if you will. You have as much ability as anyone else to promote yourselves in a positive light, more so because you will influence those around you. 

You want resilience, you want long-term success, you love this job? Then use your personal agency to promote a positive, just culture in the organization you work for. “People play an active role in making and remaking culture and the manner in which their psychology is culturally organized,” wrote evolutionary psychologist Carl Ratner.2 It’s science, folks. 

All of It Matters

“For want of a nail” is a proverb that has been around in some version since the 13th century, and one of its better-known versions can be found in Benjamin Franklin’s Poor Richard’s Almanack.  

“For the want of a nail the shoe was lost,

For the want of a shoe the horse was lost,

For the want of a horse the rider was lost,

For the want of a rider the battle was lost,

For the want of a battle the kingdom was lost,

And all for the want of a horseshoe-nail.”

What does good old Ben have to do with agency?

It means you matter. What you say, what you do, how you look, how you treat others—all of it matters. 

Whether you’re a brand-new EMT or a crusty veteran, what you do at work each day resonates so much farther than you think. Hold a high personal standard, set the bar, and others will help hold it up.

Wear the patch you earned, square the uniform away, demonstrate excellent work habits to others. Be consistent, use positive feedback, but correct your peers if you must—you are your brothers’ and sisters’ keeper and mirror. The public does not see you first, it sees your agency—whether that means your department or your profession. Your words and your actions represent everyone wearing that patch or one like it. You represent me, I represent you.

I will do my best not to let you down. 


1. Merriam-Webster. Culture,

2. Ratner C. Agency and Culture. J Theory Social Behav, 2000 Dec; 30(4): 413–34.

Tracey Loscar, BA, NRP, FP-C, is chief of operations for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, Alaska. She spent 27 years serving as a paramedic, educator, and supervisor in Newark, N.J.  She is a member of the EMS World editorial advisory board.


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