Skip to main content

EMS Narratives | Friday Night [Under The] Lights

EMS Narratives Columns

Below is the first in a series of monthly personal narratives from EMS leaders. If you would like to submit a column for consideration, please email

Written Friday, November 25, 2022 | By Ed Racht, MD

Happy Friday, and happy Thanksgiving weekend. I hope by now your blood sugar is slowly but surely heading back to baseline despite all the leftovers calling you from the fridge. Worth it though, right? My dad taught me long ago, “everything in moderation—even moderation.”

So, I want to tell you something tonight, especially because it is the Thanksgiving season. I’ve been thinking for a while about how to say this without sounding cliché, routine, robotic, or insincere. And then—as so often happens in life—I got a little help from a very unlikely encounter.

This past Saturday, my bestie, Heather, and I went to try a local diner for breakfast. This place has been around since air was invented. Cash only. Same tables and seats since the day they opened. Part Formica, part particle board countertops. None of the coffee cups match. Open only until 2:00PM and always closed on Sundays. The ham & cheese omelet is $7.99. Biscuits, bread, or hashbrowns only. Everyone that comes in knows everyone else. And it is packed all the time.

We chose a booth in the corner by the window because our server told us that was the warmest table she had available. She was right.

As we sat drinking our coffee in mismatched mugs, we both noticed an elderly man sitting by himself at the end of the counter. He had placed his walker against the ATM along the wall (cash only, remember?).

Then he slowly got up from his stool, grabbed that walker, and carefully wobbled his way to the restroom. It was one of those moments where we both watched and quietly prepared to jump up to help prevent what seemed like an inevitable fall. We didn’t want to offend him with an offer to help but didn’t want him taking a trip to ground either.

We looked across the table at each other and did that mutual raised eyebrow thingy. Ugh. “Warmest booth we have,” she said. Great.

A few minutes later, he slowly made his way back to his spot. But he went a few feet too far this time with the walker, making a beeline directly toward the warmest booth in the diner. He stopped for a minute (what the heck?) grabbed the handwritten check off our table and turned around, without saying a word, and made his way back to his seat. His walker made those sequential two inch turns.

Great. How do you tell an older man he has OUR check (and why did we come here again)?

“Excuse me?” We both said, eyebrows up again.

He turned to us and said, “I’ve got it.”

Wait. What?

He said, “I come up here every day for breakfast when they’re open. Twice a month, I like to buy somebody else’s breakfast. I’ve got it.”

Wow. We sat in stunned silence as this gentleman made his way back to the counter and sat down on his stool.

To make a long story short, we thanked him and struck up a small conversation with him. A few minutes in, he asked, “can I get closer?”

Of course.

So once again we went through the diner-walker challenge and he made his way over to the warmest booth in the restaurant and sat with us for the next hour. We talked about all sorts of things. His wife had been a nurse (mental health was her specialty). He told us about where they had lived and their adventures. He talked a little about his opinions of healthcare today (you can fill in those blanks).

At one point, he told me he lived in Texas and he’d always travel into Mexico to get his medications because they were so much cheaper than in the US. I asked him if he was nervous about going.

He laughed, and said, “I always went in the morning. Bad guys don’t get up early.”

Now, I’ve been in EMS for a few years and you know what? He’s right. Holy crud. Funny and spot-on relevant.

So, why am I telling you about Gary (his real name, by the way)? First, I need to cover a few more things to pull the meaning of this story together. Bear with me.

Fair warning. This next part doesn’t feel Thanksgivingy, but I’m going to argue that it’s at the very heart of a meaningful “thanks.”

Take a look at some of the toughest parts of our world right now:

  • How can we ever understand recent senseless acts of violence—and how will we ever comfort our own who responded?
  • What do we do about the fact that a recent survey shows that nine in 10 nurses believe the quality of patient care often suffers due to nursing shortages?
  • And, by the way, the majority added that they feel guilty about taking a break because they think they must always be on call (55%).
  • … resulting in half of the nurses polled admitting they have considered leaving the nursing profession altogether (50%).
  • And how about this one? According to a AAA survey of 258 EMS organizations across the country, nearly a third of the workforce left their ambulance company after less than a year. Eleven percent left within the first three months!
  • Did you know that the number of serious patient safety incidents reported to The Joint Commission jumped in 2021, reaching the highest annual level seen since the accrediting body started tracking them in 2005?
  • And … In Minnesota, nearly 60% of the state’s EMTs and about 15% of Paramedics did not provide patient care in 2021. This suggests that they left the EMS workforce altogether.

I’ll stop there, because I think you get the gist. How (and why) do I go from a Gary story to this?

This is, without a doubt, the most challenging period of EMS and healthcare history that we have faced together. Ever.

It’s really, really hard right now. And it’s hard in a different way than we’ve ever faced. Clinically hard. Operationally hard. Financially hard. Culturally hard.

Which also means that it’s personally hard. Whether you are directly providing care to a patient or supporting all the complexities that make that interaction possible and effective, it’s hard on us. The facts above reflect exactly that.

Now, I’ve been in EMS for a year or two (insert big-eye emoji), and one of the most rewarding feelings on the planet is creating order out of someone else’s chaos. I honestly believe that people like you choose this profession and support this profession in large part to make other people’s lives better.

Our mission is among the purest and most important on the face of the earth. Just think about how many people enjoyed a Thanksgiving with the people they loved because someone years before fixed their distorted anatomy or disrupted physiology.

It’s easy to forget the massive good a profession, an organization, or an individual can do. Gary gave us a little gift. When I first saw him, I was certain we would end up having to help him. But instead, he helped us.

When we work hard to take care of our patients, our communities, each other, our organization and our profession—They. Take. Care. Of. Us.

So. When our workplace is supportive, people want to join us. When our partners are fun, we seek them out. When our medicine is strong and sound, the medical profession embraces us. When our operation is accountable, we grow, evolve, and thrive when the art and science changes. When we come together as a team, we become the model of effective care. And when all that happens, WE, as individuals, can help tackle all the tough stuff in the most effective way possible.

I’d love to have more people choose EMS as a profession. I’d love to see them seek out advancement and growth. I’d love to see the science evolve to support better outcomes in unplanned illness and injury. I’d love to see hospital metrics and EMS metrics get better, not languish. I’d love to help communities become safer. And I would absolutely love for every one of us individually to be a part of that. I promise. That’s the way we make things so much better.

So tonight, on this day after Thanksgiving, I want to tell you that I’m not just thankful for what you do, I’m also extremely grateful. My daughter taught me there’s a difference. The definition of thankful is “pleased and relieved.” The definition of grateful is “feeling or showing an appreciation of kindness and gratitude.” In that spirit, I wanted to share that I’m grateful for you and I’m grateful for EMS.

We need the best in one another right now. There are four legs in our Bench of EMS Strength:

  • Taking care of ourselves
  • Taking care of our partners
  • Taking care of our patients
  • Taking care of our organizations

There is plenty of hard stuff ahead, so let’s do this. We can sit in the warmest booth in the place. I’m so grateful for that.

So, that’s it from my World. Happy Friday, and happy Thanksgiving.


8 Ways You Can Support Millennials in Your Workplace

Millennials… am I right?

That seems to be the most popular punch line when I am sitting around a table with colleagues discussing organizational change or current challenges in EMS, particularly staffing and development. I recently attended a conference focused on leadership in EMS and if there was a session without mention of the dreaded millennial and how awful they are, I missed it. To be honest, it’s getting old and my ability to filter my exasperation is wearing thin, especially as we are now seeing offers of multi-day trainings for how to work with millennials. The entire concept seems quite strange to me… were there classes offered to the Boomers on how to get along with the Generation Xers?

The words I usually hear associated with the generation at hand are entitled, needy, whiney, lazy, untalented and impatient. I don’t believe anyone I know well or have worked with over the years would describe me with any of these terms (ok… maybe impatient from time to time), although I am in the generational age range for millennials. In fact, I am willing to bet many of you work with people who are within the age range for millennials, yet you would not immediately lump them into the group you find so difficult. According to the PEW Research Center, millennials were initially described as those being born after 1981 are now defined as those born between 1977 and 1992.

While I am not attempting to climb up and be a representative for the entire millennial generation, I do believe this simple list addresses many of the issues I have heard, from both sides of the generational gap, over the past few years.

  1. Stop complaining about millennials.
    Generally, please stop using the word millennials to begrudgingly sum up every challenging situation or conversation you’ve had involving someone younger than you. Specifically, please stop complaining about millennials to me… a millennial. I realize you think my entire generation is made up of needy children who cannot be bothered to show up for work, but is that how you would describe me? I will admit the above description does fit some of my generational cohorts, if you can admit there is a certain irony in constantly complaining (whining) about a generation of whiners.
  2. Get to know me.
    Time is precious, and you don’t have enough of it. Staffing shortages, schedule changes, contract demands, and personnel issues take up so much of your time it can be easy to overlook the simple things that really make a difference in an organization. Something as small as a conversation can drastically change how I feel about, and in, an organization; it helps me learn about the culture of the organization, how I should approach leadership with any issues that come up in the future and how long I’ll stick around. Leadership taking the time to have a conversation, even 15 minutes, will set the foundation for the relationship I will have with the individual(s) as well as the organization.Seriously, take time out of your day to get to know me as a person instead of an employee number. This can start in the interview or orientation process, and continue while I’m on shift. Most EMS organizations have shift supervisors that are also working on the truck and, in many cases, orienting new employees during their first 60 days; take the time to have a conversation about expectations (from both sides), communication preferences and styles, and personal and professional goals. Onboarding someone to your organization is about more than protocol compliance and radio reports.
  3. Stop talking to me about money.
    Yes – money is important, and I expect a reasonable level of compensation for the work I am doing. I want to be able to support myself, my family and my lifestyle but I’m about more than that. By and large, I am value driven; I want to know that what we are doing is making a difference somehow, and that my values are mirrored in the organization I work for. To clarify, money is NOT the primary motivator and when you lecture me about finances (the way my father would), I shut down and know that you do not understand me.PS: Organizations that take the extra time to lay out and explain complete compensation including benefits, insurance costs, etc. and offer resources for budget planning are absolutely adding value to all employees, not just millennials.
  4. Share your vision, so I know the path and the timeline
    I might seem impatient…but my whole life I’ve been told to set goals and reach them. Go to college and get a respectable job. DO better. BE better. Nobody ever told me to be PATIENT. Share the vision of the organization. Share your vision for me (specifically) within the organization, and ask what my vision is. Work with me so I can understand my potential career path and a realistic timeline, so I can be an active participant in my development and, together, we can manage my expectations.
  5. Realize that when I ask you “why” I’m not challenging you.
    I legitimately want to understand why I’m doing what I’m doing. The things we do during downtime, on scene and in the back of the ambulance are all part of a process, not the entire process. Understanding where my “place” in the process is and what happens next helps clarify the importance of specific tasks, particularly those that need to be completed in a certain order or timeframe. It is important for leadership to go beyond the “because I said so” reasoning. I remember being told once, long ago, that I should never tell anyone something I can’t show them. That message stuck with me and I have come to expect the same from others, particularly those handing out orders. Help me see the why and I will gladly complete the task… maybe I’ll even find a way to do it more efficiently.
  6. Stop telling me “Good Job”. It’s a cop out – you know it and I know it. Just stop.
    Recognizing effort is always better than recognizing completion. EMS is a high-stress, mentally demanding industry that can feel somewhat all-consuming. When I take on a project that means extra time away from my family or squeezing more work into my already busy shifts, learning and exercising new skill sets or successfully coordinating the work of others, an “Atta Boy!” just doesn’t cut it. Also, I know I’m not perfect, so when performing my annual review, a blanket “you’re doing a great job…” tells me you’re really not putting the effort into giving me an honest review and you’re not invested in my continued improvement.
  7. Don’t be my punchline.
    This is a simple one… I expect you to practice what you preach. For example, if you implement (and enforce) an organizational policy that says employees cannot call in late or sick via text message, do not cancel a meeting or let me know you will be late via text message. Require a minimum of a 4-hour notice for a sick call? No problem, until you cancel our meeting at the last minute, or even worse, after it has already started, you’re not there and I have to call you. Please do not talk to me about the importance of dedication and doing the right thing even when no one is watching and let me see you leave early when your boss is out of town or hear you complain about meetings that go past 5pm. Coaching me on the importance of follow up? Please, please make sure you set the example of what good follow up looks like, because if you’re enforcing rules that you clearly believe you are exempt from and failing to provide the example, you lose a lot of credibility.
  8. Get Social
    It’s a social world, and we’re proud of what we do and where we work. For many being an EMT or paramedic isn’t just a job, it’s their identity; take the opportunity to post your new hire photos and bios on your social media accounts and tag the employees in the celebrations so their friends and family can share in their pride and success.


Maintaining Compliance Within an EMS Service

Maintaining compliance within an EMS service can be a daunting task, especially given the number of regulations that we must follow.

One way to look at EMS is if a trucking company married a hospital.

There are rules and regulations to abide by for an entire fleet of vehicles, from safe operation guidelines all the way down to the use and color of lights. Then there are requirements for a group of healthcare providers, which include necessary certifications such as CPR and knowledge of pertinent life-saving skills.

Not only does maintaining compliance keep vehicles and equipment running smoothly, but it can offer employees valuable peace of mind and keep everyone focused on the same goals of providing the best care possible.

I like to consider compliance an investment in common sense.

Employees know what is expected of them at all times, and they know what type of support their employer will provide to keep their skills sharp. In turn, an EMS service gains from being in good standing with regulators and from an engaged, confident workforce.

The benefits of a strong culture of compliance are immense. An organization that lives and breathes compliance can help ensure a smooth-running operation that features top-notch communication and quality providers who offer excellent care.

Journey to Compliance

These six key ways ensure compliance will serve as a roadmap to a strong culture in your organization:

  1. Start from the top: Backing from leadership ensures a strong culture of compliance. For certification and education compliance to stick, it starts with the attitudes of upper management, such as the board of directors, chiefs, officers, and day-to-day operations staff. Leaders must actively support all compliance efforts, including regular compliance-related reports, approving policies and having a general knowledge of the rules that govern EMS providers. Without the right tone from the top, an EMS service’s compliance efforts are usually undermined and ultimately fail. This results in issues with governing bodies, payers, scheduling and staffing.
  2. Commit to resources: Having the right personnel and systems in place are both vital to creating a strong compliance culture. The organization’s compliance staff should have experience in directing compliance efforts and supporting the evaluation of compliance-related risks. When it comes to certifications and education, compliance is always black and white. Knowing how to evaluate and respond to operational issues is important to maintaining compliance and successfully operating an EMS service. Systems that provide information to assist the service in complying with its obligations are a necessity.
  3. Have the write stuff: Developing written policies and procedures for compliance programs and internal controls is essential to adequately address regulatory requirements and an EMS service’s specific risks. Having these policies and procedures in writing sets the expectation of what is required of both managers and employees. Assessing risks before drafting these programs will help identify key areas where controls are needed. A compliance program should include how a service’s policies can be implemented from an operational perspective. This will include internal controls and standard operating procedures.
  4. Provide education: Providing the training for your EMS employees gives them peace of mind that they will be in compliance and acknowledges that the service values them.
  5. Test the system: Subjecting procedures to an independent review and audit ensures the compliance system is working correctly. This review provides an evaluation of where the EMS service’s compliance efforts stand. It also offers an opportunity to correct deficiencies before an outside regulatory audit is performed.
  6. Communicate more: Communication is vital to all organizations, but it can be the most difficult piece of the puzzle to achieve. With compliance-related responsibilities, sharing information is very helpful and, in some cases, required. Communicating expectations within EMS training programs is imperative. Reporting compliance efforts and noting any deficiencies should be a part of a communication strategy, especially if your state has an active medical director and/or board of EMS.

Stay In Touch!

By signing up, you agree to the AAA Privacy Policy & Terms of Use