Photo by Benjamin Voros on Unsplash

Dear future paramedic,

How did you get to this point? Have you always wanted to be a paramedic? Was it the loud sirens and flashing lights that drew you to this? Blood and guts don’t bother you? Do you like being a leader in stressful situations? Welcome! But first, read the rest of this article.

If you are finished with paramedic school already, then you have survived a rigorous level of school work, rotation times in hospitals, and most likely, a stressful field internship. You have passed a very difficult national registry test. You may have already worked some time on an ambulance as an Emergency Medical Technician. Ready for the next step? Are you excited about a challenging and sometimes stressful job? Excellent!

Here is my advice to you:

Do not become a paramedic.

“Wait, what?!” you may be thinking.

To be fair, you should first understand what you’re getting yourself into. I wish there had been some sort of “please read first” prior to my decision to entering the emergency medical services career path. This is my version of that for you. I hope you think long and hard before choosing this as a career.

Until there is a fully integrated and supportive system to deal with emergency medical services personnel, my advice to you is “STAY AWAY.” There is no built-in safety net to help way-fallen paramedics. I wouldn’t want my children to follow in my footsteps. I think many paramedics would agree with me. If you have been in the field long enough, would you actually want your children to pursue a similar path? I wouldn’t want them to see, hear, and smell the things I have. Isn’t the point of parenting to make sure that your children have a better life than you’ve had? Many will disagree with me, and that’s ok. This is MY opinion. Hopefully this stirs up some constructive dialogue and, if anything, points out some very real pitfalls of this career. The following is drawn from my own personal experiences. Disagree? Let me know in the comments below.

Compassion will make you a good paramedic. It could also be the reason you end up leaving.

The reason that most people get into this career in the first place is due to an above average level of compassion, empathy, and desire to help others. Most of us in this field feel the need to put others first. We enjoy making even a small difference in the lives of friends, neighbors, and strangers. I found this to be true, even at a detriment to my own well being. Empathy is what made me a good decision maker, a solid paramedic, and a great patient advocate. Empathy is also what eventually broke me. When witnessing the worst, the ability to “feel” what others are going through is not always a benefit. In the moment, I was adept at masking my outward emotions. But inside, I was crumbling. Your empathy will act as a two edged blade: making you an amazing caregiver but also leaving you open and vulnerable to real emotional and mental damage.

Conversations with the uninformed

Here is a very typical conversation that has played out many times when meeting someone new. You may also have to answer it eventually during your own career.

“Wow you’re a paramedic, that’s really cool! You must see some really crazy stuff! What’s the most fucked up thing you have seen?”

I have answered this question many different ways over the years. It’s interesting to note that my response is very different now than what I used to reply with. When I was new to the field I tried to embellish and come up with an answer that would awe my conversation partner. I tried to impress with “blood and guts” responses. The grosser the better. I also found that this was almost always a “let down” for the people who were asking. The things I had seen weren’t crazy enough for them. Later on, I stopped answering the question. “I don’t know, I have seen lots of stuff. I can’t really come up with anything.” Eventually I grew tired of the question and unleashed floods of really uncomfortable replies. Nothing bloody. Just inhumanity and truly horrible things people can do to each other. I kind of enjoyed seeing people’s eyes grow large. I was tired of tailoring answers to their needs. They clearly wanted to hear about a missing body part, a “cool shooting”, or wild car wreck. I wouldn’t allow them to live vicariously through my experiences. They hadn’t earned that. I wanted to mess with their heads. I wanted them to understand that “fucked up calls” were not the gory ones. They were the ones dealing with raw human emotion, rape, and violence towards children.

I was changing. I didn’t recognize it. Maybe others did. Now that I’m out of the field, when asked, I simply educate people. “I know you don’t mean anything by it, and are genuinely interested in what I did for work, but don’t ask paramedics that question. It’s not something most of us enjoy reliving nor sharing with those outside the profession. No hard feelings here, I know you weren’t trying to upset me.” That usually does the trick. As a paramedic, you may go through a very similar path of conversation with those not in the EMS community. Most people are just curious, but you will have to come up with a way to deal with this type of questioning.

Your mental health will suffer

You won’t see any changes right away. You may even surprise yourself. After your first difficult call, you may be quite happy with how you handled things. “That wasn’t so bad, I’m good!”

I have a hypothesis though, I call it “death by a thousand paper cuts”. I reason it as such: military soldiers do a tour of duty, or two, or four… They witness the absolute worst humanity has to offer over a relatively short period of time. They are hit in the face with a hypothetical sledgehammer of stress. It is hard, fast, and sudden. It leaves behind a wake of depression, anxiety, PTSD, and far too often, suicide. I cannot begin to imagine what that must be like. On the other spectrum, we first responders witness “minor” incidences every work day, for years and years. It’s a slow accumulation of micro damage. But, like with anything, that adds up over time. You might not even realize it. Others around you may be the first to notice the changes in you. Tiny little psychological cuts that aren’t noticeable over weeks and months. But you do bleed out eventually.

This will also directly impact those around you. If you have a significant other, they will probably be aware of these changes. I know mine did. I was very withdrawn and had lost my drive. I had no energy to promote, improve, or explore. I regret and blame this career for stifling my own ambition. It still annoys and angers me even almost 1 year removed from the job. I was unable to talk about my feelings. I wore a mask of apathy. It was my natural defense mechanism. Apathy allowed me to be a good paramedic. It also made me a terrible boyfriend and friend. In a big bag of tools of the trade, apathy and indifference were a necessary skill to wield at the right time. The problem is that the mask became the norm. I became an emotionless shell of my former self.

At this point, looking back on my career, I feel broken. I feel anxious about little things that never bothered me in the past. It’s frustrating to know that I used to make life or death decisions, run calls, and handle teams of people in extremely stressful situations. Now I get nervous about mundane day to day decisions. I feel like my leadership skills and confidence are not what they once were. I cannot begin to explain how frustrating this is. As a paramedic I was very good at having a calm demeanor in the face of extreme stress. I now have fear that I may not be able to act appropriately when confronted with any emergency in the future. I don’t want to freeze. I don’t want to run away. This is something you may also face down the road.

I was fortunate enough to recognize the symptoms of burnout and remove myself from the job when I knew it was time. Some people don’t, some can’t, and a few will brave it all the way through an entire career.

You will eventually know someone who will take their own life

This may be the most important thing I can explain to you. EMTs and Paramedics are 10x more likely to contemplate suicide than the United States’s national average. The Journal of Emergency Services published an article about it. Below is the link if you want to view the numbers.

Link to JEMS Article

I know first responders who have ended their lives. You will know some too.

Can you deal?

I can remember the exact moment of being hit with the thought of “What am I doing with my life?” I was crawling around on my hands and knees looking under cars parked alongside the curb. Much like one would be searching for an errant baseball that had rolled under the car. But I wasn’t looking for a baseball, I was trying to locate an eyeball. It was a such a surreal moment. What was I supposed to do if I found it? Does one put it in a tissue? Do you pick it up with just your thumb and index fingers? Or should I scoop it up in the palm of my hand? The owner no longer required it as he was deceased, but here I was, shuffling around on the pavement, looking for a lost body part. Perfect timing for such an existential crisis. I began having thoughts of what “regular” people get to do at work. I pictured water cooler chats, catered lunches, Friday afternoon happy hours with co-workers. Must be nice. Bathroom breaks when you actually need to go? No more holding it in for hours? Amazing! “Where is that damn eyeball?” I need a new job.

Difficult calls for me were always ones in which they directly reminded me of someone I knew. I transported my grandfathers and grandmothers hundreds of times. My sister was every female patient between the ages of 20–30. I learned the art of stoicism in the face of adversity. Cool, calm, and collected. No matter how loud a distraught mother screamed, or husband of 60 years cried after his loss, I learned to appear compassionate, but not out of control. I exuded confidence, yet laced my voice with a tinge of sorrow. The perfect paramedic response to all that the city could throw at you. Inside, your inner voice is fully aware of how awful the situation is. The job demanded that you make sure to keep all of your emotion bottled up; no reason to let your co-workers know how horrible you feel. That could make them lose confidence in your ability to perform your job. You might get pulled from your shift. You might lose your job.

Your physical health will suffer

I was in the worst shape of my life while working in EMS. I was weak, soft, and tired all the time. Props to those of you who manage to work out on a regular schedule while doing shift work. I was never able to do it consistently. Imagine sitting for the majority of your 12 hour work day. Now picture doing that for years and years. My back still hurts. I never made the decision to actively protect my body from the wear and tear of the job. You can. Lifting hundreds of pounds of human flesh down flights of stairs was a day to day occurrence. Back problems are far too prevalent in this industry. Learn how to lift patients and gurneys properly.

Poor food choices and options also contributed to poor health. I recommend bringing your own meals. It’s far too easy to fall into the “eat fast and eat heavy mindset.” When you never know when you are going to get your next call, you tend to try and stuff your face as quickly as possible. I can’t count the number of times I have walked away from a restaurant, having already paid, without my food. Or not being able to touch that sandwich for 6 hours due to calls pending after clearing a hospital. Cold food will become very familiar to you. High caloric food sounds much more appealing after a rough day at work. It’s similar to mental health: poor choices and decisions over time add up and contribute to physical health problems. This was my experience, other may have navigated this issue better than I had. You will have to decide what is right for you.

Not everyone will want your help

This is one of the largest fallacies of the job. You will encounter patients who do not want your help. Some will be so sick, mentally or physically, that they will be unable to understand that they need immediate emergency medical care. They will at times be a danger to themselves or others. Many times, the “others” will be you and your crew. Violence towards first responders is a very common occurrence. We often get mistaken for police due to our uniform similarity. You will be punched, kicked, scratched, bit, and spit on. In fact, we carry “spit socks” due to the high incidence of patients spitting at us. There is nothing quite like an angered and confused patient with a mouth full of blood who decides to spray it at your face.

You will have weapons pulled on you. Responding to emergencies often puts you in the line of fire, both literally and figuratively. Rage and raw emotion creates chaos on scenes, and you have to watch out for your own personal safety. I have found many weapons on patients that were deemed safe by police. Casually having a box cutter pulled on you while seated 1 foot away from someone is unnerving. It’s also just another day at work.

Unfortunately, in the real world, you aren’t always viewed as the “good guys.” The badge you wear will oftentimes have bad connotations associated with it. Mentally unstable people will accuse you of many things. You are the punching bag and scapegoat for all of their problems. It is a very dangerous job.

Good luck paying the bills

You will not be adequately compensated for the work that you do. This is a fact. You may in fact have to work as a volunteer for no money. You may need to find an additional job to make ends meet. You will never be as important to the public as a firefighter or police officer. Pension? Yeah right. I understand that most professions feel that they are underpaid. Paramedics and EMTs actually are underpaid. I’m not sure that you can even debate that. I was making $8/hr during my time as an EMT in 2008–2011. I never once received a raise.

After attending paramedic school, my wages increased. I had more responsibility and a larger knowledge base. I was fortunate to be payed $21/hr as a new paramedic in 2012. I know others that make far less. The reply that I most often received from others was “Just pick up some overtime!” Nothing like working an additional 12 hour shift, sandwiched between your normally scheduled shifts just to pay the bills. Some people love OT; I didn’t. I believe that paramedics should be compensated at a minimum 2x what they currently make. For whatever reason, you won’t be making the right amount of money for all the things you will end up seeing, hearing, smelling, and doing.

It’s ultimately your choice, I just hope it’s an informed one

Please understand, at the end of the day, I find my former co-workers inspiring. This article’s purpose is not to degrade or belittle the job of working paramedics. I have worked with some truly incredible men and women over the years. They are the best examples of humanity. They slog through the refuse and muck of social, mental, and physical fallouts. They are the safety net of modern society. They are relentless in their ability to deal with humanity’s worst moments. They continue to carry the torch for the downtrodden and injured. I write this article to simply point out how much burden many of these people go through. If I can put myself out on a limb and share my stories, maybe more people will start to speak out. Everything is not fine. We must find a way to create a better system to help those of us in society who are truly making a difference. I salute those of you who continue to work as first responders. I have your back. Let’s start to fix these issues so that I can someday write a follow up article titled : “Why working as a paramedic is the BEST career choice.” I feel that it’s only fair to let new and aspiring paramedics know what they are about to dive into.

I, at times, feel deep shame to have walked away from such an amazing group of people. I feel guilty to have let such extensive training and experience go to waste. These have been my experiences. Others may be able to relate, some may not. I hope by laying bare some of the things I have dealt with on this path, you may be better prepared for your future career. I do miss being a paramedic. I miss the tight knit community. I miss helping people, and, frankly, I miss doing some really cool shit. These days I always tell people: “I would rather miss it all than carry on doing it and hating it.”

In some small way I feel the need to continue to contribute to the first responder community. That at least has never left me. I do this by writing posts similar to this. I designed and am creating a mobile application CertPocket. It is intended to allow users to track and maintain their professional licenses and certifications. It will be completely free to use. In these small ways, I hope to continue giving back to the paramedic community in the future. I hope to teach new EMTs and Paramedics someday. Good luck on your new career. I wish you all the best. Please take care of yourself and your fellow co-workers. As I was told years ago by an old-time nurse while I was in school, “Take care of yourself first, so that you can better help others. You’re no good to anybody if you’re not watching out for for you.”

Brandon Iki is a former EMT and Paramedic who has worked in Los Angeles, Orange County, and San Francisco. He is the currently building a mobile app called CertPocket for fellow medical professionals. To learn more, visit certpocket.com. He still has no idea what he wants to be when he grows up.