“You’re gonna be here tomorrow, right?”

That’s become the mantra where I work. It doesn’t matter how bad you screw up, or whether or not you are actually competent at your job. As long as you show up on time, you’ll have a place to work.

They won’t fire you if you give the wrong dose of the right drug to a patient, and cause serious complications. No, they won’t fire you, as long as you can make it to a meeting where we can slap your wrist.

Oh, you gave the wrong drug to the wrong patient at the wrong time and the patient died? Don’t worry, that pink slip isn’t your termination notice, it’s your transfer notice. That’s right, they’ll just ship you to another division.

What? You sexually harass your employees and got arrested for beating your spouse? Geez, now they’re going to have to transfer that harassed employee! Don’t worry, though, they won’t fire you. You’ll get a new job title out of the deal, though.

You did what? You called a STEMI because the monitor doesn’t know how to recognize a right bundle branch block, and you activated the cath lab and cost the hospital thousands of dollars? They won’t fire you. Heck, they won’t even give you any remedial training. They’ll just make you transmit all your EKGs to the hospital.

Oh my goodness, you called a patient deceased in a motor vehicle crash without actually touching the patient? And that patient wasn’t actually dead? And another ambulance had to take that patient to the hospital? And you told the patient’s wife that her husband was dead? Don’t worry, they’ll somehow blame it on the fire department, even though the ambulance service is responsible for all patient care.

Yeah, you’re gonna be here tomorrow, right?


  1. I’ve seen this too. I work in a mid-size (less than 500,00 people) city in the Southern US and I have seen some things performed by my co-workers that are borderline criminal. For instance:
    -The medic that started an IO solely for Narcan administration for an obvious OD. When asked why he didn’t administer it IM or IN, his response was, “I hadn’t started an IO before and I wanted to try it”. The jackass didn’t even have the decency to give the pt an IO lidocaine infusion afterwards.
    -The provider who cardioverted Sinus tach. Twice.
    -The medic that gave dopamine to a pt as a 400mg fluid bolus.
    All of these men and women are still working. Only one (the dopamine pusher) even got reprimanded.
    My (admittedly biased- I went to Paramedic school at a hospital-based institution) opinion is that this is a consequence of private, for-profit EMS becoming the dominant model in the country. When your supervisors see a medic as an “ass in seat” instead of an autonomous clinician, they place the emphasis on the cost of replacing someone instead of the obligation to the public. This is the nature of for-profit EMS- our higher-echelon administration are salesmen, not medical professionals.
    Don’t mistake this as a condemnation of business, but it’s a reflection on the reality of EMS today- a business’ primary goal is to generate profit. As long as that is your primary objective, everything else will be secondary, and these things will keep happening.
    Events like this only serve to further discredit the abilities and potential of EMS- there’s a movement (and it’s gaining momentum) to make EMS simply transporters. We, as a group, need to effect the change to prevent these things (both the egregious actions above and the marginalization of EMS). Increasing education requirements (the majority of the western world requires a BS to work as a paramedic), improving accountability, and equalizing pay scales to other providers are only a few issues we need to focus on.

  2. Flash Larry says:

    At close to 4 decades in EMS, I am mystified as to what takes place in EMS administration today. I have about concluded that it has to do with incompetent management. The same people who were giving Dopamine boluses eventually get promoted into supervisory positions and they are no better at supervision than they were at being a paramedic.

    It seems to me that one of the problems may be that businesses are terrified of being sued for their personnel actions. I don’t know. We do know at my company that there are “protected” employees. These people can do anything and nothing will be done to the.

    Don’t show up for work. Come late and don’t call. Don’t answer the radio. Disappear from the ambulance for an extended period of time. Delay response to a call for personal reasons (and I don’t mean to pee). If you report them, management will say, “Write it up,” and nothing changes.

    We know who the protected people are and we know why they are protected.

    Single male in the back does a 12L on a young female. Spends the whole time talking about how good looking she is, how nice her body is, asks about her personal and dating life. She complains to management. They conclude that, “Well, it was just talk; he didn’t actually touch her inappropriately.” So he suffers no repercussions.

    But I can tell you exactly what will get you fired. Do something that gets the company on the news in a negative way. That will get you gone in a hurry. Bad PR will do it.

    Also, I think, eventually consistent failure to properly do billing paperwork will probably get results.

    I don’t think a college degree has anything to do with competence. The best medics I ever know, the ones most clinically knowledgeable and the most skilled did not have college educations. Having a college degree is no guarantee that a person is either sensible, has good judgment, or can manage the situations we encounter. It is no guarantee of a good work ethic or of competence. Or of literacy from what I’ve been able to tell.

    Nothing wrong with a college degree but some people don’t have that opportunity.

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