The EMS Military Industrial Complex

2000px-star_of_life2-svgWhen I was a paramedic, I noted a very disturbing trend among EMS providers that seems to have only worsened since I hung up my stethoscope. A lot of providers were getting themselves confused with the police and military medics. While some of the clothing is akin to police and military – and this truly is out of necessity… for the most part – there is also a very hard line between EMS providers and law enforcement. EMS is a medical profession, at least that’s what EMS is supposed to be. EMS providers working in a given county are not law enforcement and are not the military and should not act like they are.

Many EMS providers already seem to think they need tactical pants, tactical boots, tactical flashlights, tactical shirts, tactical jackets, tactical socks, tactical hats, tactical underwear… Yeah, it’s as ridiculous as it sounds. Some EMS providers even want to be able to carry firearms while on duty (something that I am adamantly opposed to except in some very specific situations such as taking part in a raid as a SWAT medic). But now, we have a new tacticool item.

Enter the tactical ambulance.

BusinessWire has announced that ambulance manufacturer REV Group is now marketing a tactical ambulance. “The REV Guardian, an ambulance wrapped in Level IIIA ballistic protection with run flat tire inserts.” The vehicle is painted a subdued black/gray color (which is against design regulations in several states, including Mississippi) and sports such features as bulletproof glass and a Kevlar wrapping around the entire vehicle. As it is, the average ambulance before any equipment is placed in it is around $150,000 so you can bet your next paycheck that this unnecessary monstrosity probably costs at least double that.

The continued militarization of EMS disturbs me to no end. As it is, EMS providers are often placed in more peril because of already resembling police officers due to their uniforms and a vehicle such as this will do nothing but increase the divide between patient and provider. Experience tells me that if a patient thinks that an EMT or paramedic is a cop, they will not be honest with the provider about drug use, alcohol use, etc. out of fear of being arrested. EMS is fighting to be recognized as a medical profession and many – thankfully – are fighting to increase educational standards for licensure. This continued desire to become more like our brothers and sisters in blue by responding to a nursing home transport in an armored troop carrier has no place with such endeavors.

If one wants to be a cop, that’s fine but they should join the police force and not the EMS.

“But what about provider safety? The EMTs should be protected!” My friend Justin Schorr – AKA “The Happy Medic” – refutes this argument nicely.

Ambulances aren’t getting shot up. Send in one of those fancy military grade trucks PD is buying up. No need for a reclined cot van with those features. None. It would make as much sense to have a mailman with this level of protection. They’re riding the Tacticool wave.

Gotta love when a company takes advantage of mass hysteria and engages in fear mongering for profit.

Paramedics are taught not to risk their lives after mass shootings. Rightly so.

2000px-star_of_life2-svgI became a paramedic to provide medical care out of a hospital setting to the sick and injured. I, for the most part, enjoyed my career and I was able to even save a few lives along the way. One of the things I discovered early on in my career was that a large part of being an EMT or paramedic is about making some kind of connection with the patient and/or their family. Sometimes this means holding the hand of the elderly lady who you just picked up off their bathroom floor after she fell and broke her hip. Sometimes this means listening, truly listening, to the young guy who has reached rock bottom and wants to kill himself because he feels that no one cares. And sometimes it means talking to the gang member who just got the everlasting crap beaten out of him over a girl he asked out on a date who, unbeknownst to him, was attached to a member of a rival gang.

I’ve ran many calls like the ones above in the eight years that I have worked in EMS. The last scenario in particular stands out because this guy made it clear that he was not talking to anyone because he was going to get his revenge as soon as he was out of the hospital. He refused to tell the police anything. Once in my ambulance after I completed an assessment and treatment which I could provide, I began to talk to him. At first he wouldn’t even talk to me because, as he put it, “you work with the pigs (his words, not mine).” I pointed out that I was unarmed, didn’t even have a ballistic vest, and that I was not a cop. After a few moments he did begin opening up to me about what happened. I talked to him about letting it go and allowing the cycle of violence to stop with him, how beating the other guy up was not going to solve anything and how at the end of it all he could possibly be dead. Perhaps he listened to me. Perhaps not. I will never know. But one thing is for sure: If I had presented myself as an authority figure by acting like “Billy B.A.” like so many in EMS do, I may not have had the opportunity to reach out to this kid.

From that experience alone, I make a case for why EMS providers should not be armed or otherwise regularly take on the role of a combat medic. We are not authority figures contrary to what many of us think. Those of us working the streets for Someplace County EMS are not combat medics in need of tactical gear. When we work for AMR as contractors for a hospital or nursing home we have no need for a duty belt with a side arm, extra ammo, and cuffs. Certainly, a SWAT medic does need these things from time to time but for the 99% of us who will never attend an active swat raid, we simply do not need those things.

Presenting ourselves as no different than the police serves no real purpose, gives people more reasons to distrust us, and paints and even bigger bull’s eye on our backs than are already there.

A former medic turned writer for the CBS show “Code Black” (I will reserve my opinion on this show except to say that I’ve watched one episode and don’t plan to watch another) thinks differently. The Washington Post published an opinion piece written by Kevin Hazzard where he lays out a ridiculous case for EMS providers regularly being placed in harm’s way. In case you want to go ahead and know how I feel, Mr. Hazzard is way off base and is advocating for things which only work in Hollywood shows and movies.

I will respond directly to some of Mr. Hazzard’s statements.

I was a paramedic for nearly 10 years. In that time, my job certainly put me in danger’s way; like many of my co-workers, I believed that saving a patient’s life was worth losing my own.

Nonsense. I know not one EMS provider, not a single one (including and especially myself), who would die for a patient. Perhaps Mr. Hazzard didn’t care about going home at the end of the shift but the rest of us do. The reasons for one going into EMS are varied but I can assure you that dying for a patient is not on the list or reasons for the vast majority. Perhaps Mr. Hazzard needs to remember the part in EMT class where one is taught that if the provider is hurt, they are no good to anyone. When this situation occurs, further strain is put on the system by forcing someone else to care for the patient and for the injured EMS worker because they felt the need to play GI Joe.

Mr. Hazzard, if you’re indeed interested in risking your life in such manners, the military are always recruiting medics.

In many cases, people died while waiting for help that was just outside the door. Patients treated within 60 minutes of an injury — the “golden hour,” in emergency-medicine parlance — have the best chance of survival.

This is barely worthy of a response, as the notion of the so-called “Golden Hour” has been debunked again and again by this thing that so many EMS providers seem afraid of called science. This statement was never based on anything other than some surgeon’s slick marketing phrase for a tack-on certification. If someone is going to bleed out from traumatic injuries, I can assure you that it will likely happen in much less time than the “golden hour.”

Imagine if paramedics had entered the Pulse nightclub and started treating patients immediately. Imagine medics in flak jackets and helmets, surrounded by police assault rifles, setting about the critical work of saving lives right there on the dance floor. Would more people have survived if EMS had been able to treat patients sooner? The answer is almost certainly yes.

Any EMT or medic with any kind of knowledge and experience (and any other person with knowledge of traumatic injuries) knows this simply is not true. An uncomfortable fact: When one sustains multiple significant injuries from a high-powered assault riffle, they likely will die. Again, the notion of a “golden hour” is hogwash. Besides, what good does sending EMS providers into an active shooting scene do Shooting victims can be somewhat stabilized by EMS but, at the end of the day, they need a surgeon (and sometimes even that isn’t enough). Last time I checked, a thoracotomy was not in my scope of practice and I doubt it is in any other medic’s either.

If I have not made it obvious enough, I could not disagree with Mr. Hazzard any more if I had to. He’s wrong, ignorant, and needs to understand that such notions are dangerous. The image of a medic arriving at an active shooting scene and, without regard to himself or his family, running in to drag a victim out makes for a good TV show but in practice it’s not quite that simple and not worth the risk to the provider’s safety.

I believe Mr. Hazzard is getting Hollywood and the real world mixed up.

Take my advice, sir: Stick to Hollywood. Your fantasies should only exist there.

(Some edits made after publication for clarity and correction of typos)

An Open Letter to the Kentucky General Assembly about EMS Death Benefits

The ambulance carrying paramedic Andy Sharp on his last ride as it passes under a United States flag held in place by ladder units from the Philadelphia (Mississippi) and Choctaw Fire Departments. Credit: Brandi Smith-Wyatt

This letter is also being emailed to my state Senator and Representative. If you would like to use this letter as a template for your own, please feel free to modify it however you wish. I encourage you to contact your elected officials and encourage them to support line duty death benefits for EMS providers both in the Commonwealth of Kentucky and elsewhere. – Jonathan

To the Representatives and Senators of the General Assembly of Kentucky: Grace and peace to you in the name of our Lord Jesus Christ.

My name is Jonathan Tullos and I am the pastor of Shiloh United Methodist Church in Stanton. I am also a licensed paramedic in the Commonwealth and work part time at Powell County EMS as a paramedic and chaplain. When I attended paramedic school one of the things I was taught was to be an advocate for every patient I care for. Part of my call to pastoral ministry involves EMS chaplaincy – to be an advocate for the advocates. It is in that capacity that I contact you.

I, like many other EMS providers in the Commonwealth, am very disappointed to hear that the Senate defeated House Bill 54. As you are aware, line of duty death benefits are not currently offered to Kentucky’s EMS providers. According to the National EMS Memorial, there have been 27 reported line of duty deaths in Kentucky since they began collecting data. The recent line of duty death of paramedic John Mackey of Jessemine County EMS will be number 28. This means that at least 28 families in the Commonwealth have had to struggle with end of life expenses and income instability because they are not currently entitled to the same benefits that families of law enforcement officers and firefighters killed in the line of duty receive. Simply, this is an injustice that needs to be corrected.

There are many who view EMS as a vocation that is not as dangerous as law enforcement and firefighting. According to data available from the federal government, this is simply not true. EMS has death rates that are comparable to those of firefighters and police officers. Among the leading causes of death for EMS providers are heart attacks, vehicle accidents and violence. The notion that EMS is not a dangerous profession is a myth.

Daily, EMS providers in Kentucky and elsewhere face harsh working conditions, sleep deprivation, violence, and exposure to infectious disease among many other hazards. EMS providers often have to work more than one job due to low wages and inadequate benefits for themselves and their families. They do all of this in order to help others in need – possibly even yourself someday. Their families should not have to be saddled with the burden of financial difficulty due to their loved one dying in service to their community.

I encourage you to support Kentucky’s EMS providers by ensuring that their families will be taken care of if they are killed in the line of duty. Please do all you can to enact line of duty death benefits for Kentucky’s EMS providers.

Thank your time and your service to the citizens of the Commonwealth. May God bless you and may God bless Kentucky.

Rev. Jonathan K. Tullos, Nationally Registered Paramedic (NRP)
Chaplain, Powell County EMS Stanton, KY

Powell County EMS Devotional January, 2016

mousepad_ems_chaplainIf you don’t know, one of the hats I wear is chaplain of Powell County EMS located in Stanton, KY (this is where Shiloh, the church I serve, is located). Every month I’m writing a devotional to share with the crews. This is the one I wrote for January; I shared it with a few friends and it was suggested that I post it here. So, here it is! February’s will be written this coming week and I will post it here as soon as it’s finished. – Jonathan

From the Chaplain:
Devotion – New Year 2016 Edition

Did you make a resolution for 2016? Some stats I found online indicate that about 44% of us will make resolutions but very few of us will keep them. The tradition of making promises at the beginning of the new year goes all the way back to the Babylonians making promises to return things they had borrowed and to repay debts. If you made a resolution, you are in some numerous and even ancient company!

Hopefully one of your plans in 2016 is to take better care of yourself and your family. I know all too well how tough it is to practice self-care, especially working in EMS. Self-care is essential, I would even say it’s as essential as keeping up with our own medical conditions. In order to be good providers, we simply have to make taking care of ourselves a priority. Last semester, I took a class in seminary that spent a decent portion of time talking to us, a room full of mostly future pastors, about the importance of caring for ourselves. In scripture, God looked at rest for our bodies and souls with great importance.

We know about the fifth commandment where God instructed the Israelites to work for six days and rest on the Sabbath because God rested on the seventh day. We also see God’s concern for Elijah’s physical wellbeing in 1 Kings 9 when he sent an angel to look after his needs. There are some ways that we can ensure that we are caring for our needs adequately. Doing so ensures that we are better care providers, better for our families and better for ourselves. We also honor God by taking the time to care for ourselves. Her are a few simple ways we can do just that:

• Do the basics. Things like eating right, getting enough exercise, getting annual physicals as well as regular vision and dental care contribute much to our overall wellbeing. It’s vital to make taking care of our health needs one of our highest priorities.

• Rest. This is difficult to do in our fields as we often work more than one job or at least work 24 and are off 48 and all of that in addition to family commitments. Simply, we must make time to rest our bodies. God did not tell us to rest one day a week just because He felt like it. He knows that we have our limits. Lack of bodily rest can not only impact our physical health but also our mental health. Studies have shown that sleep deprivation contributes to depression and suicidal ideations. Making time for rest is vital.

• Use your vacation time! I cannot stress this enough: If you have vacation time, take it. Take time off to do things you enjoy, travel, or simply hang around the house and rest. Working for extended periods of time without adequate time off to recharge is detrimental to your health and performance as an EMS provider. Lack of time off also leads to burn out. Take time off at regular intervals. It’s one of the best things you can do for yourself.

• Don’t neglect your spiritual life. Again, the EMS lifestyle is not always conducive to being able to read scripture or attend worship on a regular basis. When you are able to attend worship, I certainly encourage you to do so. When I have had to be away from church for a long time, going back to a community where I am loved and where God is praised was always such a huge relief. It is also possible to study scripture anytime using such things as the Bible app, which is available for free on your phone or tablet. From there you can access a variety of translations, reading plans and devotions. There are even EMS devotionals! If you are interested, I would be happy to make recommendations so please don’t hesitate to contact me. On a similar note: If there is enough interest, I will be happy to figure out a way for there to be a short time of worship on Sundays at the station.

These are but a few ways where we can begin 2016 on the right foot: By taking care of ourselves.

As always, if you need help with anything do not hesitate to ask for it. Part of my job is make myself available to you anytime you have spiritual concerns or just need someone to talk to after a bad call. Please do not hesitate to contact me if I can help you in any way. Remember: You are loved and you are never alone.

May God bless you and keep you. May He cause His light to shine upon you now and always.

Grace and peace,

Jonathan Tullos, NRP
Chaplain, Powell County EMS