In my 12 years in EMS, I’ve worked for entities ranging from smaller private companies up to major city third-service, in mixed environments ranging from inner city to true suburbia. For many of us, that’s actually a pretty normal career path – we follow our instincts about where the “best” place for us to work is, as we pursue the sometimes-elusive goal of making a lifelong career out of a field which is unfortunately still not seen by many in the public as a “true” profession.

One question which comes up frequently when someone finds out that you’re an EMT or medic is the loaded “so where do you work?” As we’ve all seen, the answer that you give can unfortunately change the way that someone sees what you do. If you tell someone that you work for a private ambulance service, they may categorize you as “lesser” somehow than someone who works for a city – partly due to a belief that carries over from the distinction that many folks make between “real” police officers and those who work private security.

Unlike the differences between a sworn officer and an unarmed guard, however, there is no distinction made that I’m aware of in any state protocol manual as far as the roles and responsibilities of any EMS provider based upon who signs their paycheck. So why do some of us persist in thinking differently about someone based upon where they work? Let’s discuss.

“That’s Not Real EMS”

There is some truth to the notion that selectivity makes a difference in the standards that someone has to meet in order to work someplace, and arguably how “good” someone who works there is, but it’s by no means definitive. The barrier for entry into some private EMS in the past has, in some cases, been relatively low: be breathing and have your ticket. Those places are few and further between these days, thankfully, and the modern reality is that the entrance requirements for private EMS which provides any kind of municipal service are actually pretty stringent for many services. (In some cases, their exams and practicals may even exceed the difficulty of those imposed by municipal services.)

Be that as it may, we’re still going to run into the issue that I experienced personally when working private service versus working for the elite city system: you’re most likely not going to be listened to as well if you’re wearing the “wrong” uniform, be it by officers or fire on scene (unless they know you), or the nurses or docs at triage… at first. But here’s the great part, and what makes the true standard that we should be measuring ourselves on: if you prove that you do, in fact, know what you’re doing, and you care about your patients (compassion is part of competence, in my book), those attitudes can and will change, regardless of the uniform you wear.

Outcome = Respect

Given the fact that we have a true and unifying mission in EMS, where we are literally all working towards the same goal (optimal care for each patient), we are also in a unique position to leverage each others’ strengths in order to attain a higher level of respect. Segmentation of training is another area in which we find differences between public and private EMS, but if we are really all out here in the field to take care of every patient to the highest possible degree, we should break down those barriers and make the best training available to everyone.

The model for this can be found in the Police Officer Standardized Training (POST) concept, where training is standardized at central locations in order to ensure that the best trainers, regardless of who they work for, are the ones instructing everyone within a given state. We in EMS have long had standardized protocols, but how those protocols are translated into the real world via training has vast differences, which does a disservice to our best providers if they don’t happen to be working in a place with access to that knowledge.

Joe Basic working for MakeMoney Ambulance Service could in fact have the capability of becoming a top-level provider, but we’ll never find out if we don’t give him the chance to show that he can learn and perform. Ultimately, not giving him that access is failing our patients, as well, because none of us can ever know that he won’t be the one responding to someone who needs that knowledge applied in order to survive or avoid disability.

Some of overcoming that barrier, again, comes down to attitude. I’ve seen people in the “elite” system who nobody respects, save for the fact that they work for that system and therefore have “made it,” and people in the privates who are EMS gods, but who are assumed to not be “as good” because they never “got on” with a fire department or third service.

We need to stop assuming that membership in a given agency is a validation, and start looking more at each other as individual providers on the same playing field, with the same goals: no matter who you are, or what patch is on your sleeve, at the end of the day we will all be meeting patients on the field of “battle” which is the noble fight against death and disability, and neither of those two care at all about what that patch says. They respect skill, and skill alone, and it’s up to all of us to ensure that we are all supporting each other in increasing our professionalism so that we might, someday, present a truly unified barrier to throw against them.

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Greg Bogosian is certified as a Reserve/Intermittent Police Officer by the Commonwealth of Massachusetts, and spent twelve years working as an EMT-Basic, including four years as a field EMT and dispatcher for the City of Boston EMS. He was additionally a member of a Federal medical disaster relief team for ten years, with experience responding to the aftermath of Hurricane Katrina, and the pre-deployment of resources for Hurricane Ike. Greg currently has a passion for educating public safety professionals about matters which impact their lives every day, and welcomes feedback and suggestions in the spirit of ensuring that best practices make it out there for all to benefit from.