What motivates someone to come into EMS?
After unscientifically scouring my notes from hundreds of interviews with prospective new employees, the vast majority who are looking for their first job in EMS, here are the top 3 answers provided:
- I want to save lives
- I want/like to help people
- I want a career in the medical field doing (insert something OTHER than EMS here) and EMS is a great place to start, or so I’ve heard
Looking at that list, let’s take a moment to be honest with ourselves about how likely each of those things are.
The Life Savers
In July of 2011 the Centers for Disease Control and Prevention (CDC) published a report on Out-of-Hospital Cardiac Arrest (OHCA) Surveillance(1). The report is derived from 31,689 OHCA cases submitted from locations throughout the country. The overall survival rate through hospital discharge was a mere 9.6%.
Now if the police department only enforced 10% of the laws and the fire department only extinguished 10% of the fires, could they claim that they are doing a good job? If McDonald’s only served their food fast only 10% of the time, could they claim that they are fast food?
The answer is no. So why do we continue to perpetuate that we save lives when statistically in any other industry, public service sector, or healthcare we would be considered a failure? Is “saving lives” the only thing we do?
I’m sure some of you are going to argue that the statistic above is because of how response times are measured and we only need to drive faster. Perhaps you’ll argue that rural areas cause longer times in general and so everyone should be forced to move closer. There can always be the argument made that those arrests include other variables of which we have no true control.
To those of you who wish to challenge the 9.6%, I offer that the Utstein Survival Report for OHCA Events Witnessed by a 911 Provider(2) has 3,367 OHCA cases submitted. Out of those 3,367 cases there was a total of 625 discharged from the hospital alive for a whopping 19%. Even with response time removed from the equation our percentage only increases by 10%.
The fact is that while we may tout ourselves, allow others to believe, and recruit under the guise of being lifesavers the cold hard statistics show that we are, at the very least, deplorable at doing it. This is a hard truth that those who come to EMS in order to be “Lifesavers” have trouble handling. Their expectations are never met, they often become bitter and burned out leaving EMS angry at the professionals who continue on and at the perceived deception they have fallen for. Sometimes they don’t leave but rather vent their frustration and bitterness out on others, including patients.
The other day I received a complaint from a woman about where one of my crews had chosen to park. They were in front of a clinic building just posting for a call when she asked them to move so she could park there and pick up her mother who had issues ambulating, was frail, and required assistance. The crew explained to her that she couldn’t park there because it was “Ambulance/Ambulette” parking only, which was the truth.
The woman exploded emotionally and verbally to the crew. One of the crew members, fearing for his safety from an angry woman, ran across the street to get the local law enforcement involved. Surprisingly to the crew, although not to myself, they really did nothing to the now more enraged woman other than ask her to back her vehicle up so the crew could respond to an assignment they had received while this was unfolding.
As expected, the woman called to complain. When I asked the driver, who the woman had specifically singled out in my conversation, as to why he didn’t just move the ambulance he cited the signs. I inquired if he was moonlighting as a Parking Enforcement Agent, to which he denied being empowered to enforce parking regulation. When I asked him why he didn’t move the ambulance to help this woman out, he said it was because she wasn’t a patient. He also didn’t recognize that the simple act of moving the ambulance, although it may have been inconvenient for him to do so, was helping someone.
I’m always intrigued by people who say that they want to “help others.” I think that if that were truly the case then they would have joined a mission or an order where vows of poverty and service are above board, open, and mandatory. Of course EMS may be the right place for them because they take those vows without knowing it, but I often wonder why they choose EMS as that venue. Some of them, upon further prodding, recall a time when either they or a loved one were helped by an EMT or a Paramedic. It was that display of compassion, caring, and empathy that motivates them to come to EMS.
I often find myself trying to explain that a desire to “help others” does not necessarily mean EMS is the right place for a person. The fact is I can walk out in jeans and sneakers with a sandwhich board that reads “FREE DIRECTIONS’ and an iPhone with Google Maps installed, go to Times Square, and help the gazillion people who are lost from using Apple Maps. I’m helping people just as much, but I’m not required to have a certification or an ambulance to do so.
The Medically Oriented
There are those who in the course of their lives are looking for something satisfying to do and the idea of working in healthcare is appealing to them, but they remain unsure. The best way to ensure that this is the sort of work they want to do is to get an entry level position and give it a test run. A number of these people choose EMS to test the healthcare waters.
This can be seen as both good and bad. It is good because their time spent in EMS will give them an idea what they are in for should they continue down the path of nursing, becoming a physician’s assistant, or even on the road to medical school. It can be bad because EMS ends up as a training ground for other professions and is constantly under the strain of a brain drain.
We need to be ready to constantly challenge these providers with new and interesting information, techniques, processes, and procedures. They are the Hungry Hippos of formalized education demonstrated in real world scenarios. While its true they may choose to move on, hopefully their experience will be positive enough that they will at least keep some level of involvement with EMS.
So What Do We Do?
There are so many debates about ourselves. Are we Public Safety or Healthcare? Should we be referred by our certification level or should one title encompass us all? Are we truly pre-hospital care providers or healthcare entry point providers? Do we save lives and if not (which I think I’ve already demonstrated through citation) then what do we do?
The truth is that we change lives. Fundamentally at our very core we are agents of change for the millions that call us each year, not necessarily being able to increase the quantity of someone’s life but rather always working to improve the quality of it. We need providers who are motivated to be agents of change for the better to those who are unable to do it for themselves. We need leaders who understand that motivation, embrace it, encourage it, foster it, and are willing to help it grow.
Motivation is an important factor to any organization. It is important that we identify the motivations of our providers and foster their growth using what we know about their motivation to challenge them both professionally and personally. Engagement and stimulation will help their performance thereby helping you as their leader and ultimately helping the agency as a whole.
Not sure what motivates your providers? Well then ask.
1. Centers for Disease Control and Prevention, July 29 2011 Out-of Hospital Cardiac Arrest Surveillance on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6008a1.htm (visited January 6, 2013)
2. Utstein Survival Report Page 3 Cumulative Data October 1, 2005 – December 31, 2010 on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6008a1.htm#Fig9 (visited January 6, 2013)