EMS Is Community Medicine

Calling EMS “ambulance drivers” sounds small, but it exposes a huge gap in how the public and even parts of healthcare understand prehospital medicine. We sit down with Pennsylvania Paramedic Justin Whitney during National EMS Week to get specific about what the job really looks like on the street and why the future of EMS is trending toward community medicine, not nonstop high-acuity 911 calls. If you’re considering EMT training, AEMT, or paramedic school, this conversation helps you reality-check the work before you commit.

We unpack why “routine” calls still deserve real assessment, how pressure changes as you climb the certification ladder, and what mentorship should look like when it’s done well. Justin explains community paramedicine and why many calls are really about gaps in the healthcare system: confusing discharge instructions, medication dosing issues, chronic conditions, isolation, and limited access to care. We also talk EMS Officer training, field training officer (FTO) responsibilities, and when an incident command mindset matters most.

From there we zoom out to the big operational challenges: siloed agencies, too little collaborative training, and the friction between EMS and hospitals when each side doesn’t understand the other’s scope and workflow. We close with direct, grounded burnout solutions including fair wages, sustainable schedules, and dependable equipment so clinicians can deliver safe care without running on fumes.

Subscribe for more leadership and operations conversations. Share this with someone in your station, and leave a review if you want more EMS-focused guests. What’s one change that would improve outcomes in your area right now?

DISCLAIMER

The views, information, or opinions expressed by guests during this podcast are solely those of the individuals involved and do not necessarily represent those of AFSO21's Weekend Wrap-up Podcast and its hosts. Furthermore, any views or opinions expressed by guests are their own alone and unless otherwise stated, do not reflect the opinions, beliefs, or official policies of any organization, institution, or employer they may be associated with or employed by. 

Transcript

EMS Week And Why It Matters

SPEAKER_00 0:04

Welcome everybody to Episode 21 Radio. You're listening to the Weekend Wrap Up.

SPEAKER_01 0:15

Welcome everyone to another episode of the Weekend Wrap-Up Podcast. I'm your host, Kevin Ferrar. Folks, this week, our episode continues our discussions involving EMS. With National EMS Week taking place from May 17th through the 23rd of this year, this annual observance, first authorized by President Gerald Ford in 1974, honors our EMTs, paramedics, dispatchers, and out-of-hospital medical care providers for their life-saving contributions to the public. This year's theme is Improving Outcomes Together. The campaign highlights the critical partnerships EMS clinicians form with 911 Dispatch, Public Health, Law Enforcement, and Fire Services, as well as advancing pre-hospital interventions like infield blood transfusions. So, as local EMS agencies, hospitals, and communities traditionally mark the week with award ceremonies, appreciation banquets, public education events, and memorials, we here at the Weekend Wrap Up Podcast are excited to have our guest, Justin Whitney, in the studio to share his thoughts on EMS Week, his career progression in EMS, and what challenges he sees that involve leadership and operations. So, with that, let's welcome Justin Whitney to the show. Hey Justin, glad to have you here on the show today.

SPEAKER_00 1:32

Hey, nice to nice to be here. Nice to be here. So tell us who you are, what you do, why you're here. Well, the wonderful introduction of my my name uh is correct. My name is Justin Whitney. I'm a medic in the state of PA. I've been in EMS for uh coming up on five years now. Backstory of how I got into it. I was honestly uh bored in college, and

Justin’s Path Into EMS

SPEAKER_00 2:00

you uh introduced me to an EMT class while we were also volunteering at the same fire department. And it was about three classes, maybe four classes into that EMT course, that I decided that this is what I was gonna do for the rest of my life. So I worked as an EMT for a couple years. I went and got my advanced EMT from uh Harrisburg Area Community College, and then about a year or so after that, pursued my paramedic certification. And then ever since there, I've been doing that for just over a year now.

SPEAKER_01 2:34

So nice, nice. So as you were going through the and and we've got a lot of listeners out there, you know, that are that are probably in the the same boat you were, you know, thinking about getting into the you know the EMS field. What words of advice do you know do you have to encourage you know our our youth, our our younger generation to seek out, you know, you know, whether it be an EMR, emt, advanced EMT, or even paramedic, you know, what what words of advice would you give that audience listening today to do what you did? You know, jump in, you know, feet first and say, hey, this is this is what I'm doing, you know, I'm gonna make the most of it.

SPEAKER_00 3:18

Uh the first thing that I would probably say is when you look online and you look at courses and they have this kind of perception that when you go and you get your or you get into EMS, you're gonna become this big time hero and everything. I I I strongly urge not to look at that stuff. Instead, go to local EMS agencies, actually sit down with them, both administration and the ones on the trucks to see exactly what it is that they do. That's one of the things actually in this world now is there's this false perception of EMS and that everybody in EMS are running 911s only. They're going to these super high, stressful, critical uh uh environments and situations and scenarios, and that's just not the case. We're in this world of really it's it's paramedicine, uh,

The Myth Of Hero Calls

SPEAKER_00 4:10

your it's community medicine. It's it's no longer emergency medicine. And if you have that perception of going into it, I've I see a lot of people, especially the newer people coming in, they are disappointed in what they're doing. They'll they'll join an agency and they'll see that they're yes, going to be going to those 2 a.m. toe panes. They're going to be getting called for people who just need a band-aid because they cut themselves. They're going to be going to these things where they think, how is this a 911 call? And that's the world that it is. You're here to supply supply community medicine. Uh it's it's not just gore, high stress, you're doing all this cool stuff anymore. Maybe back in the 60s when EMS first started, but not anymore. If you have a really strong passion for medicine, uh it's it's your baby. I mean, EMS is is you get everything. You're you're not focused in one specialty. You get called out at any moment to do whatever it is that you've been trained on or that you've even heard about. And a lot of the times it's stuff that you've never heard about, and you have to deal with it. It's you and one other person, maybe a second person uh along with with that as well, and you gotta figure it out. And that's that's that's why I like it. It's you get thrown into this weird situation, and then you're just there to figure out what to do, and it's like a big puzzle, and it's it's exciting, it's fun.

SPEAKER_01 5:41

So what you say you you know you you get thrown into it, it may be you and a partner on on the rig. You know, what what type of I guess what kind of pressure has that put on you? I mean, you're you're still you know a young individual. I mean, what kind of pressure have you encountered, you know, even even starting as an EMT, be like, hey, I'm I'm the only one here, or you know, it's just it's just a few of us here. Help is, you know, more help is still on the way. I mean, is that does that put a lot of pressure on on you? And do you think you know that that is impacting why some of the you know the younger generation, I mean, you know, the the kids today, you know, when they were your age getting into this, why they may be hesitant to to jump into this this type of field?

SPEAKER_00 6:36

Sure, absolutely, yeah. I I think at first when I got into EMS, that was definitely a thing of can I handle this? Like when I wanted to make the decision to progress to a higher level of of certification, it was yeah, can I can I make those decisions? Because as you progress up the EMS ladder from EMR to EMT, A EMT, paramedic, all the way up even to like critical care, the higher you go, the more responsibility you have. And a lot of people are worried

Pressure, Responsibility, And Confidence

SPEAKER_00 7:05

about that. For me, it was it was uncertain at first, but then it was pretty quick for me to to determine, yeah, that's that's what I want. I want to have that responsibility. And when you go out on these calls, for me at least, I like being uh I like being the one making making the calls. I I like being the one making the decisions because I like uh having that controlled environment and not having to really rely on somebody else's judgment, if that makes sense. So yeah, I I it it might sound like a little egotistic, but I feel like when people get up into those roles, they they understand a little more when you when you witness a lot of people who don't provide the best level of care, and you're kind of under their wing, you're there to support them, uh it can get frustrating. That was one of the motivations for me when I decided to get my paramedic was I was frustrated at the the care that was I saw being provided. So I wanted to be the one who was making the decisions and providing the care. But for the for the younger people who are getting into it, uh it's all gonna be a mindset thing. It some people aren't aren't meant for it, and that's totally fine. Some people are naturally gonna climb that ladder really quick. Some people it might take a little more time. There is no set amount of time with which you should progress. I've seen people go from EMT to AEMT after 20 plus years of working as an EMT. I've seen people go from EMT to paramedic in eight months. And I I've seen it on both sides, they've both done great. So there's really no set answer. Um, it's all gonna be off of your confidence level. It's gonna be off of you know you the best. Don't get pressured by people to progress if you don't want to progress. Take your time with it.

SPEAKER_01 8:57

So so how how important do you think mentorship is in this process? You know, I I come from a fire service background, and you know, we always had you know mentors, you know, that we would we would shadow, and you know, they they would you know guide us through you know career progression, professional and personal, you know, development. How important do you think that is in the EMS world? And do you well let's start there. How how important do you think mentorship is in the EMS, you know, for for EMS folks?

SPEAKER_00 9:32

I I think it's I think it's really important. I think that you should have a good mentor that's going to guide you accurately, and that's the important thing, is that they're gonna guide you accurately and honestly through your introduction to the career field. I I've seen it a lot where people kind of they kind of like latch onto people just because they

Mentorship That Actually Helps

SPEAKER_00 9:55

get along with them, and that might not be the best idea. When I got into the field, I latched on to the people that I noticed were always pursuing continuous education on their on their own time, not because they were required to. They were always wanting to learn, they were always wanting to build their skills, they were always very humble, they they admitted when they were wrong, and those were the people that I that I wanted to mentor, mentor under. I didn't want to go to the people because they were you know cool with me. That that's not a good that's not a good guide. But I always every time somebody new comes into the field, and students especially when I see EMT students, a students, uh medic students, I I always offer them. I'm like, hey, if you have questions or anything, here's my number, call me, text me, we can talk about whatever you want. And if you have any doubts or troubles during your progression through the field, also let me know. So maybe I can help guide in that in that sense. But yeah, it's it's super important.

SPEAKER_01 11:03

So how much how much you know, you as the mentor and and even the mentee, I mean, you you play both both roles there. I mean, I and I think everybody does. You know, how those that you're mentoring, how how much feedback have you received? You know, you you said, you know, you just said, you know, if you got questions or whatever, you know, here's my number, email, you know, reach out and contact me. Has has that been a positive thing that you've seen for for the folks that that you're mentoring? I mean, do you get do you get feedback, whether good or bad, you know, from from those that that you're mentoring?

SPEAKER_00 11:45

Oh, yeah, absolutely. Yeah. I just last week actually, there was like three different people that when they when they were starting into a a new field, I I offered them my info and everything, and that they can talk to me or call me whenever they want. And just last week there was there's three of them that asked me questions. One of them was medical related, another one was like operational related, the other one was like a mix of both. But I'm always getting feedback. Also in passing, too. I I hear people, and I don't I don't personally like it. It's just me. It's my my mentality behind it, but people say that they like learning under me. And I don't know. It just I don't like compliments. So it's one of the weird things about me.

SPEAKER_01 12:34

No, I I I get it. You know, it's you know, you're you're doing you're doing what you're doing for the right reasons, it sounds like. I mean, you're not you're not doing it for the you know, the the awards, the accolades, the notoriety, be like, oh, you know, here's a spotlight, look at me. I mean, you're looking at the career as a whole, and you know, you're trying to do what what I you know here in the podcast and and and you know professionally try to try to advocate for is that when it comes to leadership, you have to you have to do it for the right reasons. And often it's it's difficult for folks, you know, to say, well, you know, uh looking at the fire service background, you know, that's what I that's what I noticed, you know, with a lot of my mentors was that you know, we were we were almost assigned a mentor. You know, it was just like, okay, you know, here's we mostly called them sponsors. You know, when you come into military in the fire service, we'd be like, okay, here's here's you know, here's your sponsor, you're gonna shadow them. And oftentimes, I mean, they were lack of better words, I mean, they were they were slugs. I mean, they they just did the bare minimum, you know, they were just getting by, didn't have a, you know, really the you know the initiative to to do good for the the service or the department as a whole, but it sounds like you know, you're looking at you're looking at the 30,000-foot view. You know, you're looking at the the EMS service as a whole and you know, saying, saying to yourself, how do I make this better? And you know, how do I encourage others to make that better? And I think that that shows what true leadership is. So Mary, I'm you know, I'm I'm giving you the kudos that you know, you don't, you know, you're you're not you know, you're not out to to get, but I you know, I think that's what you know our listeners need to understand is that we have to, it's not the about me mentality, it's about the us mentality.

SPEAKER_02 14:33

Yeah.

SPEAKER_01 14:34

And I think that's you know, you're you're instilling that, you know, you know, not just for yourself, but you know, for for those that you mentor as well. So something you mentioned earlier, I wrote down here on my notes community medicine. What you know, what what is that? You know, for the listeners that don't know, what you know, we we hear we hear paramedicine, we hear you know all this other stuff, but you know, this seems to be a new term that's coming out is community medicine. You know, as a as

Community Medicine And Community Paramedicine

SPEAKER_01 15:05

a EMS clinician out in the field, what what what is that? Can you explain that?

SPEAKER_00 15:11

Yeah, so community medicine is you're just going out there and you're assisting your patient with some type of medical abnormality, medical weird event that they experienced. Could this be an emergent event? Sure, it could be, but when you're talking about community medicine, you're going out there and you're supporting people with their medical needs. We don't and it's not measured in the sense of a severity, you can kind of look at it as just a blanket term. You're just going out and somebody's having a problem and you're going out there to support. So the community paramedicine programs, which are starting to be adopted more and more, those are a great example of kind of where kind of where EMS is moving towards as a whole. Uh they go out and they are m providing more of a like a an in-home uh in-home supportive uh outreach or supportive care. They go and and they assist these people who may have just recently been discharged from hospitals, recently discharged from rehab facilities, whatever the case may be. And they're going out there and they're making sure, hey, do you understand your discharge paperwork? Do you understand the dosaging in the appropriate amount of medications you should be taking that you've that you've just been prescribed? Or they're going out there and they're helping with their diseases, diseases, whether it's recent or chronic diseases that they may have contracted, they're going out there and they're helping them with that. So that's where EMS is kind of turning towards. It's not just, we're not getting dispatched, we're not getting calls for just emergent care anymore. It's not a life or death situation every single call you go out to. It's like those cases where, hey, I've had back pain for 25 years. Now it's getting a little worse. Okay, well, let's see how I can support you in that method. Is that an emergent call? Of course not. Or it could be somebody who doesn't even understand their medications but how they're supposed to take them and they have nobody else to turn to. You know, they they weren't able to receive at-home care. The hospital might have dropped the ball and said, here's your discharge paperwork and didn't explain it. Uh, and they could be living alone. They could, they could have no family or nobody to help help care for them. Sure. So community paramedicine is going out and they're they're helping them uh in those cases. And we're seeing that more and more. I mean, that's the majority of EMS calls nowadays. It's no longer, you know, 911s only. You know, we're we're going out there and we're dealing with everything. And it's it's just the way that the healthcare system is at. Can it change? Sure. It's gonna take a while. There's a lot of people in the EMS field that complain about having to go out for BS calls. They always call it, you know, oh, this is stupid. They they hear the dispatch info or they read the CAD info and they think, oh, this is dumb. Why is this even a 911 call? You know, they couldn't drive themselves. But well, these people, you know, people just aren't these people aren't having received any of that that education to understand all of the options that they have. So when they see a medical abnormality, they do what they're told to do and call 911. And sure, that's that's where we're at. Things could change, but it's gonna take a long, long time. But until then, that's just the world we're in. And I don't think it's a problem. I I think that's what we're here for. I think you know, EMS, it I think you could take the E out of out of EMS. You could just make it medical services. I think that's a that's totally appropriate. That's what we do most of the time anyway. Most of it's not emergent, but we just provide medical services.

SPEAKER_01 18:54

So and that's I mean, that's that's a really good that's a really good statement there. And one, you know, I gotta be honest, I you know, I've never considered is you know, I think in today's society you're spot on. We we have to reevaluate our medical service providers. I mean, you know, historically, EMS, emergency medical services, you know, you call you call 911 or you know, however, however the call got into dispatch, you know, that that person, that person that's that's making that phone call, you know, whether it's a stub toe or a laceration or a cardiac arrest, you know, what whatever the call is, I mean, that is that is their worst day of their life when they make that phone call. And, you know, so like you said, I mean, it they may not know. I mean, it's you know, it could be, you know, something just minor, could be a minor reaction to, you know, a dosage, you know, they just you know got a new medication or whatever, and something something's wonky going on, and and you know, they weren't briefed on it or they weren't prepared for it, and all of a sudden, you know, their their normal day has changed and they they start panicking. So they call 911 and be like, you know, I I need I need help, you know. Yeah. And I think, you know, on the flip side is when you know the providers see that CAD, and I I think it's a disservice, you know, for them to say, oh, well, you know, this is you know, this is a stupid call or whatever, you know, without, I mean, there are there it sounds like you know, some folks are already being judgmental, you know, when when they do that. It's like, okay, you're you're already diagnosing the situation before you even get on scene and do a patient assessment, you know, and I have to admit, I mean, I've I've been on a lot of lift assist calls, and you know, it's you know, we got on scene, and you know, traditionally, you know, it's just okay, you pick the patient up, put them back in a chair, whatever, it's usually an older patient, and you're on your way. But, you know, when I became an EMT, you know, I took it upon myself. I said, you know, I'm not leaving until I'm confident that this patient is going to be okay. And I would do a head-to-toe assessment. And a lot of times that what was considered a mundane lift assist call turned into a BLS. Sometimes it even turned into an ALS. And it's like, whoa, wait a second, you know, something's going on here. But you know, dispatch and and I don't fold dispatch. I mean, they're they're only going off of whatever they're being told. And they enter, you know, they enter that information into the CAD. So, you know, it it it you know gets sent off to you guys and be like, okay, you're looking at the CAD and be like, okay. But you know, once you get on scene, that's where that's where folks need to really be the best, you know. And I'm talking about EMS providers, they need to be the best that they can be.

SPEAKER_00 21:58

Yeah.

SPEAKER_01 21:58

And you know, whether it's Personal professional development, they have they have to really be able to diagnose the situation in route, and then once they get on scene. So, you know, all of this conversation it's it's tying into what our last episode was, that being EMS Officer One. And I'll be honest, you know, I you know, being in the fire service, you know, all I heard when it came to officer was, you know, fire officer one, two, three, and four. You know, here there's, you know, I've learned, you know, that there is an EMS officer one, two, and three. Now, it's, you know, for from the the homework that I've done on this, there's really no Pro Board or IFSAC certification. There's no national accreditation of this that I could find. So it's sort of a hit and miss, you know, depending on where you go. NFPA does mention it, you know, EMS officer one, two, and three. But depending on where you're at, you know, in the States, it could range, you know, an officer one, EMS officer one could range anywhere between 36 hours of training down to 16 hours of training, you know, and so the that quality of training you get is dependent on where you go. But but I guess what I'm saying here is, you know, what are your thoughts on, you know, you talked about this community, community medicine, you know, you're going out and you're evaluating the situation, you know, something you talked about was, you know, medicine dosage. You know, it's you know, you you look around, you look around the house, you know, is is there factors that that influenced, you know, as to why why you got called to this patient? You know, there's there's a lot of things, you know, as a fire officer, you have to do the 360 evaluation. You know, you gotta you gotta walk around the building, see what's going on, you know, have that situational awareness. And I think EMS Officer One incorporates that, but on the medical side. So what are your thoughts, you know, as a paramedic and you know, developing, you know, going up the ranks, you know, you know, from EMT or you know, EMT to AAMT to paramedic. What are your thoughts on EMS Officer One? Is it is it necessary? And you know, if so, you know, expand on that. So give me give me your thoughts on that.

SPEAKER_00 24:16

I when it comes to it, I I'd have to see exactly what it entails. Like when you're going to pursue that that officer

EMS Officer Training And Readiness

SPEAKER_00 24:25

certification, what, what exactly is it, is it educating you on? I mean, is it is it focusing more on like logistical aspects when you're talking about like operations or or leadership management, you know, stuff like that? Or is it looking more at the clinical side of things? Is it is it looking more at professional development in the case of of building on your your medical information or your medical education? If it was pursuing more of like a medical route, I I don't really see how that would how that would be super beneficial. That that's just I think gonna fall under a bigger push for, or at least I would rather see a bigger push for more routine in organized education sessions, not even just between like a certain agency or just a certain certification level, but a collaboration between multiple different departments or multiple different types of services. So, you know, doing a monthly training exercise with a collaboration between, you know, fire department, uh PD, even dispatch at local hospitals if they wanted to get involved, I think that would be more beneficial if you were looking at the the clinical side of things. But where I think officer one, and again, if it's tailored this way, I don't know. But if Officer One was more tailored towards the the operational and logistical side of things, I could see it being really beneficial there for those who are pursuing if the agency is structured based around like a fire department or a militaryistic outli uh outline, you know, where they have like their lieutenants, their captains, different tiers of chiefs. If they had it something like that, I could see it, I could see it being more beneficial there. The thing is though, at least from what I have seen, it's anecdotal, but uh, I don't see a lot of agencies that adopt that ranking system. Uh if they do, uh it's gonna be captain is your supervisor, or lieutenant is your supervisor, or like a battalion chief is your your supervisor. So it's all it's just a different name, just doing the same thing though. I I wouldn't be upset though if uh if it was a requirement uh to pursue that type of of uh responsibility, that type of leadership, that you had to obtain uh a certain level of of officer certification, whether that's officer one or above, uh I I don't think that would be a bad idea. Uh I think that would again, I'm all for education. I'm all for continuing to learn. And if you're if you're throwing people into a leadership role with no leadership training or education, especially those who have little to no experience, uh, that can be really dangerous. So trying to support those people as best as you can, I think is the responsibility of of higher administration. So, you know, I I I've seen it at other at other places within Pennsylvania where you get somebody who's fresh out of school, fresh out of paramedic school, and they're they're hitting a supervisor spot. And I'm like, oh, and I'm sure fire department does it too, military, I'm sure does it too.

SPEAKER_01 27:44

Oh yeah, yeah.

SPEAKER_00 27:45

You get you get people who are fresh out of class and you know they're gung-ho and confident, and then they get into that role and they're like, oh, what did I what did I just get into? What is this? And that's I feel like that's that's irresponsible. Not and I'm not blaming that person. You know, I I completely understand why you would want to jump to that spot, but I think it's irresponsible for the ones above them to put them in that role. I feel like it's unfair for them, especially without any training. So if they were to to give them something, I think that would be that would be great. Maybe officer one could do that.

SPEAKER_01 28:18

So well, you know, it's you you talk about the military, and I mean, you know, you know, 20 years in the military, retired from the from the air force, and and you know, we we called it stovepiping. You know, so you had you had folks that would move up the ranks, and they were stovepiped into these different roles, and they they had to do that in order to get promoted. So, you know, your your promotion was based on I would say almost there there was a percentage of the role versus experience.

SPEAKER_02 28:56

Yeah.

SPEAKER_01 28:57

You know, so you had you know, for example, you know, you move, you know, you you get a young a young troop that that moves into like a staff sergeant position, and you know, now they're in a they're in a supervisory position. And fire officer one was a requirement of that, you know, and it's you know, so that they're they're somewhat of a supervisor, you know. They they may have had, you know, a couple folks under under their belt that you know be in charge of a truck or you know, or whatever. But for them to to to get on that career progression path, you know, oftentimes, you know, they were pushed into they were pushed into this this career progression when they had little to no experience under their belt. And what I you know, what I observed is that you know, these folks would would move up that career ladder, but when they were looking back, it's like they didn't really have a lot of experience to to back it up. You know, they were being put into these positions, and at the end of the day, I think it was detrimental to to them and to the to the service overall is that wait a second, you know, you're putting these people in these positions because you you had to, they were they were forced to, you know, for them to promote, you know, if you weren't if you weren't progressing, quote, progressing uh a certain way, then your career performance reports, you know, whatever they're called today, I mean they they change all the time. Your annual enlisted performance, you know, whatever they are, yeah, they would the you know, the the the senior supervisors would would annotate that on there, be like, oh well, so and so is not doing this, or you know, they they would mark them down, and that would impact their their opportunity to be promoted. So I, you know, I saw I saw a lot of kids that were just like I said, stovepipe, they were they were pushed through that through that pipe to to reach these these upper levels, and you know, I just sat there and I'm like, you know, this person's just not they're not ready. And and I said it myself uh several times to be like, look, you know, that's great. I love the opportunity, but I'm just I I just don't think I'm ready for it. And they're like, well, you know, you have to, and you know, blah, blah, blah. If you want to get promoted, and I'm like, uh, you know, at the end of the day, I didn't have a choice, you know, they just threw me into it. And I'm like, but then you know, you're you got to make the most of it, you know. And I think when when it comes to EMS, you know, I'm in the position to where, you know, I I see I see what they're saying, you know, NFPA is saying, you know, EMS officer one, it's like a first-line supervisor. So, like you said, lieutenant, you know, it could be a captain, whoever, you know, so you know on you mentioned earlier, you know, as an EMT, you know, you may go out on on an ambulance on a rig, you know, and it's just you and somebody else. Do you think, you know, as that truck, as that ambulance, do you think who's ever riding in the right seat, you know, because in the fire service, who's ever in the in the front right seat, that's your that's your that's your officer of the rig? Do you think there needs to be a quote officer of some type on on every ambulance? Or is you know, is it just an equal equal across the board? You know, you're both EMTs and this person may have a year or two up on the other one. But you know, do you think do you think somebody should have some type of officer leadership, you know, experience or training under their belt if they're gonna be in charge of that that ambulance or that crow?

SPEAKER_00 32:36

I feel like if it's gonna be a a BLS unit that's just going out for a call, I can't uh logistically see any benefit to to one having an officer uh over the other. The way that it's been pretty universally is uh they they swap off of every call. If if it's two EMTs, whoever's tacking the call, whoever's writing the chart is in is in the right seat, supportive providers drive into it,

FTOs, Command, And Crew Leadership

SPEAKER_00 33:05

they're doing everything they can for that person in the in the right seat with when they're making the the calls for for that incident. Uh if they start to pursue where I think it could come into play is if they start to pursue some type of like mentorship position or like a like a field training officer, like an FTO position, I I could see it being a a little beneficial there as well. Uh again, the the FTO role is to uh uh mainly supervise uh regarding somebody's clinical uh experience. So new person fresh out of school or new person, new hire uh at the agency, that FTO's job is to make sure that they are showing competency regarding all of the uh operational aspects to that to that agency. So that could be you know skill checkoffs for different pieces of equipment that they have. Uh but the other portion of that is also making sure that they're familiar with policies, procedures, know-how of the uh different resources that are available at that company, medical directives, everything like that. So I could see an officer, an officer certification being a little more beneficial in that aspect. But for the the day-to-day, whether it's a BLS unit, maybe a double medic ALS unit, intermediate, stuff like that, unless you're hitting like a weird incident where you got multi multiple units on scene, you know, maybe like a like an incident command structure, something like that. Uh I I could see like, okay, yeah, whoever's got officer one, they're they're running command, or they're assuming command as soon as they hit the scene. I could see that that being kind of like a like a telltale of you know who's in charge on that scene. But the the run-in-the-mill 911s, I I can't see how that would how that would be impactful, really.

SPEAKER_01 35:00

So then at the end of the day, do you think which is 96% of the the fire departments here in Pennsylvania are volunteer? So you know, at the end of the day, do you think you know, on these routine EMS calls, if you will, do you think the incident commander should they have some level of EMS training? I mean, if they're gonna be say, say they roll up on a vehicle accident, you know, should that incident commander have a minimum level of EMS training in order to properly you know effectively manage that scene? You know, most I guess what I'm saying is that you know, most here in Pennsylvania, you know, the the minimum is first aid, first, you know, first responder, you know, CPR.

SPEAKER_00 35:54

Yep.

SPEAKER_01 35:55

I mean, do you think do you think you know these incident commanders should they have EMR as a as a minimum? I mean, you know, is that the minimum level of of EMS training they should have in order because I mean if they're gonna if they're gonna dictate you know what's going on, you know, with the with the the incident scene, and that includes EMS providers, they're they have oversight of these EMS providers. I mean, wouldn't it make sense to for the incident commander to have some minimum level of of EMS training?

SPEAKER_00 36:27

Yeah, I I think so. I I think the minimum would make the most sense of being EMT. I think that if and and the reason for that is if you're running an incident command, you have to be able

Should Incident Command Be EMT-Trained

SPEAKER_00 36:40

to delegate resources appropriately, and whether that's the ones that are showing up on scene or that you're calling for additional. So when you get a triage report you know, radioed back to you, you know, I've got this many red, this many yellow, this many green, and we're talking an MCI only. But if I've got if I've got X, Y, Z laid out in front of me, uh, I think an EMT would be able to do a good job at saying, okay, I know what's on the trucks in these areas, I know their capability, and I know how many I'm gonna need. So I think an EMT certification or education uh to back those decisions would be more beneficial. I didn't go for an EMR, and and I'm gonna be very honest, I don't know exactly the level of education that an EMR gets. I know in the state of PA what an EMT gets. And I think an EMT would be absolutely capable of uh establishing command on an MCI and delegating resources appropriately. If they're if they have that that also that fire background, you know, they have that that that establishing command background, they have that incident command know-how, and they know everything on those trucks that's coming up. I I think that that's that's where where that emt certification would really shine. We don't need them to go out and do emt skills, that's not their job. I I just I think that they should just know what's in the scope, what can they do? And oh, EMT can't cover this. Okay, I need more. So A EMT paramedic, honestly, at that point, I don't care, but they recognize they need more. Okay, we'll send more, like something of a higher, a higher capability. Yeah.

SPEAKER_01 38:20

So awesome. So moving on, I mean, it's you know, you know, we we've heard, you know, your professional development went from an EMT, advanced EMT, now paramedic. And I think you've done that, I mean, in a pretty short amount of time, I mean, compared to some other folks. You know, but what I I guess I'm interested, and I I think my listeners are will be interested, you know, what what challenges have you seen, you know, I guess going through that professional development. And now that you're, you know, as a paramedic, you know, what challenges do you see, you know, in the EMS field? Because again, we you know, we're getting back to the you know, the EMS week, you know, and their theme is improving outcomes together. You know, so they want to they want to highlight that clean, you know, that that critical partnership between clinicians and dispatchers and public health law enforcement fire services. So, you know, what you know what challenges or obstacles, you know, have have you know, have you encountered or have you heard about or you know that that that you think you know needs to be addressed so we can we can improve these outcomes together? You know, at the end of the day, it's you know whether it's it's an accident or you know, an MCI or even a structure fire, anything like that, it's a joint operation. You know, it's you know, so you have all of these different agencies that all come together to, you know, with the the common goal of mitigate the scene and you know, everybody goes home and you know safely, you know, and you know, so what like I said,

The Biggest Fix: Train Together

SPEAKER_01 40:05

you know, what what challenges or obstacles do you see that were that are out there and that that could be improved?

SPEAKER_00 40:12

Well, thankfully, in the the area that I work in, I I don't see a ton of challenges. Everybody everybody does a really solid job in what they do. So I I have no complaints about that. The the only thing that I've that I've seen that I've always thought could have been improved on was training, like education and training. That's everywhere. Yeah, everywhere, absolutely everywhere. Yeah. And specifically collaborative training. Yes. For some reason, there's this weird mentality, and I don't know if it's if it's across the board of the world, maybe just the US. I don't know. But when you go and you start working in a field, fire department sticks with fire department, ems sticks with EMS, PD sticks with PD, and there's nothing to go in between. I've heard of like maybe a couple like MCI training like scenarios that were hosted by somebody to where they wanted to get multiple agencies in PD, and that's it. And I don't I don't understand it. I I don't I don't understand why because I every call that I've been on, if it's bad enough, you get all three. You you get you get you get fire, pd, ems, and you're just expected to just work together with no problems. And most of the time it's true, like you, yeah, you work together, like everybody knows their role, so to speak, but I don't understand why there isn't more of a push to collaborate together in in train. And that can even be pushed over to like the hospitals too. EMS and hospitals, local hospitals, especially if you're a hospital-based service, uh, it makes no sense as to why there's not a collaborative training between those two. Because I've I've seen personally as well, I guess that's another thing, a challenge as well. Nobody understands what the hospital does, and the hospital doesn't understand what EMS does. And we we bring in patients, like I bring in patients and I have nurses, physicians asking me, well, why'd you do that? And I I look at them and I'm because that's my scope, that's what I'm supposed to do. I don't understand. Like, are you upset? Are you is are you just are you just unsure? I don't know, I don't understand where you're coming from. And there's and it's vice versa. It's it like I I always like to see what hospitals do. I I think that it's it's really important if you're gonna be a clinician in the field, that you should understand how EMS does things and you should know what the hospital is going to do when you drop that patient off. So because then you can prep your you can prep your patients, you can prep your your stuff for when you get them to the hospital. Sure. So and not everybody does that. We're we're handed out protocols, and this is what we're supposed to do. You know, you see A, you do B, and you drop them off at the hospital, and physicians are like, Well, why'd you do B? Like we should have done, you know, Y, X. Like this is this is ridiculous. And then everybody's upset and confused at the same time.

SPEAKER_01 43:11

Yeah.

SPEAKER_00 43:12

So I think a a collaborative uh process, specifically for EMS, of course, but a collaborative process where EMS and hospitals in that area should come together and do a you could make it a monthly, you could make it a bi-monthly, who cares? But they should do something to where they start to build that relationship with those EMS providers and those those hospital employees, too. So yeah.

SPEAKER_01 43:38

But it's a you know, I mean, that's a good point because you know, in the military, we we encountered this a lot, you know, at least in the Air Force fire emergency service. You know, we had our our commanders, they just didn't know why we were doing certain things and and what we actually did. So, you know, years ago, you know, they they came up with this this program to where you the the the leadership we would invite them not just in the fire department but other you know other units within the squadron so EOD security forces you know emergency management so they would go around to each one of these for the day and just you know work with you know side by side with us to see what we were doing so then they could get you know a little bit better perspective of hey this is this is why we're asking for this or we're doing this so it sounds like that could be something that would be quite beneficial in the EMS world is that you know if you had if you had your your your field clinicians do you know it and all would have to be it's just you know maybe a day or or two you know out of the month just you know go work in the ER for a day and then you know rotate out you know some of the the ER you know the hospital folks and be like here do a ride along with the EMS and now you understand you know why we're doing now you know the down the downside of that is you know oftentimes when that happens you don't get the emergencies that you know you were hoping for you know so you know they're just they're they're sitting in a rig or sitting in the in a station for the day and be like okay you know they're they're they're twirling their thumbs and be like boy this is great you know I'm glad we did this but you know but you can't let that you know get to you it'd be like okay yeah we had a down day today but you know hopefully the next time you know we we have something because you know often I've saw you know when we talk about joint operations is it's usually an annual thing oh you know we're gonna have this this mass casualty exercise and that's where everybody comes together for you know that one time out of the year and it's you know it's all scripted and everybody plays the game right you know it's it and oftentimes it's really not realistic. You know it's yeah you know I I think there there needs to be more of that you know so like you said you know when because oftentimes you know my my experience is the cops are the first one on on a traffic you know accident.

SPEAKER_02 46:06

Yep.

SPEAKER_01 46:07

Okay well then you know sure they they they they know their cop role but do they know the fire and EMS you know what what they can expect you know from those units coming in

EMS And Hospitals Misunderstanding Each Other

SPEAKER_01 46:20

so that they could sort of prep you know give a good brief and then you know say hey here's what I encountered you know rolling up you know I I think there's a lot of a lot of things that could be done to make those interactions a lot better. So yeah yeah absolutely yeah so as as we start to to wrap up here I mean I I I want to give you the the opportunity to you know to to get off your chest you know thoughts about the about the the profession you know things that you think the you know the the listeners are gonna tune into and and and enjoy and and provide feedback. So what do you got to that you can throw out there?

SPEAKER_00 47:02

Well actually I I would like to ask what what do you think are like outside perceptions of EMS because I I don't know working in it I might be blind to this but I don't I don't know what are some of the outside perceptions of of EMS I I guess specifically maybe from other other roles but I don't know if you've heard rumbles of you know people talking about EMS in general one of the things I saw and it was funny for EMS week was a it was a medical company that posted something calling all of their EMS providers ambulance drivers and it was thank you thank you for your service we appreciate our ambulance drivers do you think that that's a accurate perception of what EMS is I I don't I personally I don't know I don't know I I think I think that is a good stereotype for EMS providers because all they see is the ambulance that shows up they don't they don't see what we've been talking about today is you know the the behind the scenes stuff they don't see that that patient interaction they don't see the the training that goes involved with it they don't see the the the the stressors you know you as a provider deal with you know day in and day out I think they just they believe that somebody calls 911 an ambulance shows up they they meet the patient put them on the on the stretcher put them in the ambulance and into the hospital they go I think you know if a lot of these these companies you know that that made those those claims and I think I know who you're talking about and I think they they got they got some flack over that and they oh they did yeah they apologized yeah yeah um well yeah it's uh but you know I I I think I think if they they did more ride alongs you know if they were more if they were more involved with their their clients their customers the consumer base I think they would not have made that that statement they would have they would have gone about it a a different way but I mean you know it's our listeners know you know when it comes to EMS fire law enforcement it is there's the there's that that invisible divider between the three and EMS has always been sort of the outcast you know they've never they've never really been taken seriously but I think times are changing I think you know it's and it's and it's a long time coming.

SPEAKER_01 49:42

I I think they're finally getting the recognition they they they've deserved for years I think they're they're they're really making a positive impact in emergency services I think leadership is moving in the right direction. So I yeah I think I think time for changes I mean they've got folks like yourself that are involved that are you know you know advancing leadership qualities calling for more leadership so yeah I you know I I I think it is making a change good good because uh I don't know it it's I it it seems like it's going slow but I I do see it progressing a little bit you you talked about leadership as well and I there's definitely I feel a disconnect between a lot of of leadership and and field personnel you know field clinicians that they don't and I I can kind of understand why you know once you hit that administrative role your focus shifts you know you're you're no longer looking at it from a clinical aspect you're looking at it from a business aspect. Yep and that's and that's any any career field unfortunately is that when you get put in those positions you lose all sight of where you came from yeah no you're now you're now focused on the logistics of keeping the business afloat you're you know of all this other all these other things that are involved and you've got your blinders on because you know you you've for whatever reason you gotta you know you got to cut costs you got to do this you got to do that but meanwhile folks like yourself that are out in the field you're bearing the the full brunt of those decisions

Outside Perceptions And “Ambulance Driver”

SPEAKER_01 51:26

and I think it's important for you know folks that once they get into those leadership positions those those those business positions they have to they have to keep in contact you know with where they came from you know in order to to to keep the ship afloat because otherwise you know good people are going to leave and when people leave you know you you don't have an agency anymore.

SPEAKER_00 51:48

Right right yeah that's what I I mean that was one of that's always the hot topic of EMS is burnout. Yeah it was high turnover rates in in positions as well and and a lot of the blame is put on leadership and I I understand like I I I get why because leadership's making the decisions but yeah maybe if there was a little a little more involvement across the board or even just a mutual understanding between the two because I to defend leadership as well people in the field who aren't in the leadership role don't know what they're doing. Like they don't know what leadership is doing. Sure they don't know the whole workload and personally I've seen it to where leadership is incredibly overburdened with a ton of responsibilities when we're talking like the huge hospital based services they've got so much on their plate and a lot of people are blaming them for the the day-to-day things that they're that they're really it's not even like an issue it's just minor inconveniences that they're seeing day to day and they're blaming leadership they're like oh we couldn't get this but we'll spend money on this and yeah well yeah leadership has all of these responsibilities and then they also have a boss so it's not entirely their fault either they they can absolutely be upset with what's going on too so but that's where that's where your open lines of communication your transparency really comes into into play.

SPEAKER_01 53:15

I mean you know I I get it you know not all decisions have to be revealed to everybody down down the ladder but at least leadership needs to be open you know with with the staff and say look this is why we're doing what we're doing and this is the short term and the long term outcomes of of what we're doing it you know and I and I think that goes a long way but you know when leadership just does their thing and then folks out in the field you know the bottom of the the bottom rung of the ladder they don't understand and they're kept in the dark that's where I think people get a lot of you know frustration and stuff but you know real quick you mentioned burnout you know what what is Justin Whitney's top three solutions you know if you were if you were in if you were in a position today that you could resolve burnout what are three things that that you would do or suggest oh man if if I had like a a magic wand and and I could just put into effect anything I the I think the biggest thing is wage.

SPEAKER_00 54:24

Like that's people the job that they're doing in EMS a lot of them and it it's justified I I completely agree but the job that EMS providers are doing is not financially backed appropriately. I mean there was the joke I think it was I think it was during COVID people at like gas stations managers at gas stations were were making more than your you know BLS providers even ALS providers. Oh yeah yeah no doubt it's like yeah it's like well yeah I don't I don't blame them leaving uh they could have been the best provider that you've ever seen and yeah I don't blame them leaving they'll make more money at the gas station so yeah wages I think is the is the biggest one everybody's always talking about how they how they don't make enough and also the hours that you put in people are just generally overworked. I mean to in relation to those poor wages that they're receiving if they need to support a family they have to pick up an extra job maybe a third one I've seen a fourth and they're working nonstop I I've I've heard people who they do 12 hours at one at one station they'll

Leadership, Communication, And Burnout Fixes

SPEAKER_00 55:35

then drive to do a 12 at their next station come back to the first one to do another 12 and then they'll do a 24 at a third it's like yeah I don't and then they then they wonder oh man why are these people so tired all the time I I could only imagine I don't know it's crazy.

SPEAKER_01 55:52

Well then that that affects that affects their performance in the field. I mean if they're absolutely they're tired I mean it's just like a doctor I mean you wouldn't you wouldn't want to go have surgery from a doctor who's been up for 36 hours straight.

SPEAKER_00 56:08

Right.

SPEAKER_01 56:08

And they're you know they're falling asleep over top of your you know your flayed open chest right you know you wouldn't you wouldn't want that and I don't it's happened.

SPEAKER_00 56:16

Yeah yeah well yeah it's it's happened yeah yeah you know and and I think our listeners can agree I I I don't think patients would want that either and if patients knew that was occurring I think they'd have second second thoughts on you know do I want this particular provider this you know agency showing up right yeah that would that that could open up a can of worms so yeah yeah so what's what's your third thing uh if I guess maybe if like proper supply of of resources so like equipment everybody's everybody's always talking about vehicle condition everybody's always talking about just general equipment how it could be better even now new doesn't mean good i there there's been some I won't I won't go into details sure yeah no I think I think we can all relate yeah the there there's new newer critical metal medical equipment that's released and it doesn't function the way it's supposed to yeah and people are upset about that and yeah I I totally understand but it it goes back to when they see uh larger agencies I remember I remember seeing something it was like it was from a it was from a big medical group they they said that they did a study and it was it was funded like $2.2 million dollars or something and somebody commented that the the EMS agency attached to that medical group couldn't get new couldn't get new trucks. They were they were pushing 400 000 miles, 500,000 miles on their units and they said that that wasn't trucks weren't approved in the budget. But at the same time the hospital is doing a multi-million dollar study and it wasn't even anything like super crazy. I think it was like mushrooms or something. But yeah it was just it was it was nuts.

SPEAKER_01 58:18

So people see that and they might not understand yeah those those two things aren't connected you know the the funding for that was allocated for the study doesn't even fall in the same bucket as the funding that's allocated for EMS but when you you you're just working as you know a new hire or even a a a veteran in the EMS world and you see that the same name that's on your patch uh is on the same name as the study and you see all the money going towards that yeah that that would be a problem that would be a huge problem so awesome awesome so anything else before we wrap up here on the wrap up podcast nothing nothing for me nothing for me I appreciate the the time and in thought provoking questions it was very it was very fun it was very uh yeah this was this was an awesome podcast so yeah um don't be surprised if we ask you to be a you know a guest co-host on here in in future future episodes so yeah no this was this was awesome so I'm always here I'm always here you know when I'm not being an ambulance driver I'm always here so awesome awesome well folks I think that's gonna do it for uh for this episode here in the weekend wrap up so if if this episode has helped you make sense of the EMS profession has stirred some thoughts as to you know what's going on within your own agency share it with those in your department and definitely share with your local officials oftentimes those local officials are the ones that are that are funding emergency services so if you keep them abreast of what's going on hopefully that helps you get some more more funding so with that until next time folks stay safe watch your six and keep the rubber side down