Toxic Heroism

Many  have heard the oft overused phrase "toxic masculinity". We could argue the merits of that phrase ad nauseum but that is not what this post is about. I want to talk about the culture of "toxic heroism" that has found its way into certain parts of the military, emergency medical services, law enforcement and fire services among others. First I want to start out by making it clear I am not disparaging the work done by these entities. I want to make that very clear. This is not a bashing of our public servants who often go in harms way for no other benefit than a meager paycheck or sense of accomplishment.

What I do want to talk about are those that make sure we know that is what they are doing. The humble braggers, the "thank me for my service" folks. I spent 22 years in the military in a unit many consider "elite". I thought of myself as such and treated others accordingly. While there was certainly justifiable pride in my accomplishments as I matured and particularly after I retired, I realized that I was but a small cog in the great machine and truthfully my contribution was no better than anyone else's. This became painfully clear as my career came to an end and I felt myself being brushed aside as the operational pace kept moving forward without me.

I have spent the last 13 or so years involved in public safety both as a EMT/Paramedic, private Security Manager and a reserve Law Enforcement Officer. In those capacities I occasionally come in contact with the " We do everything a Doctor does but at 80 MPH" crowd or the " You will respect my authoritah!" folks. So what do all these groups have in common?

First there is a large dose of the Dunning Kruger effect at play here. In a nutshell Dunning Kruger is a cognitive bias where people mistakenly assess their abilities as greater than they actually are. Unfortunately those that seek the most attention normally deserve it the least. Secondly due to this cognitive bias these individuals look down on or discount the contributions of others as part of the whole team concept or chain of events. Thirdly and most importantly the news media and present culture have co opted the word hero and applied it inappropriately so often, its very meaning has changed. Webster's defines Hero as  "a person who is admired or idealized for courage, outstanding achievements or noble qualities" By applying the word hero to every service member who completes an enlistment or every EMS provider who transports a sick/injured person to the hospital the word has been cheapened. And this very cheapening has encouraged further abuse of the term.

Is every individual who finished basic training and spent the rest of their enlistment training stateside a hero? Is every volunteer firefighter a hero just because he responds? I would suggest that these folks are just doing their job and doing your job does not make you a hero. And by suggesting they are it simultaneously cheapens the word and fosters an aggressive culture of "look at me."

We need to do better

Dark Angel Medical Direct Action Response Training 7.28-29.2018

I spent my weekend attending the Dark Angel Medical DART class. Dark Angel Medical is a national medical gear and training company based in Colorado. The course description for DART is as follows:

• Physiological and Psychological reactions to environmental stress
• The importance of having the proper Combat Mindset
• Basic Anatomy and Physiology of life-sustaining systems
• H, A, B, C’s—Hemorrhage, Airway, Breathing and Circulation
• Breakdown and usage of Individual Med Kit components
• Proper stowage and employment of the IMK
• Hands-on application of the IMK
• Basic and Advanced Airway management -treating and monitoring tension pneumothorax, sucking chest wound and flail chest
• Airway adjunct device placement-Nasopharyngeal Airway
• Basic First Aid and Advanced wound care
• Application of Bandages and Hemostatic Agents
• Application of tourniquets
• Recognition and Treatment of various injuries (Gunshot, Laceration, Burn, Airway, Head, Orthopedic, Environmental)
• Recognition and treatment of hypovolemic (hemorrhagic) shock
• Moving and positioning victims with various injuries
• Response to active shooter situation
• Proper use of cover and cover vs. concealment
• Casualty recovery in an Active Shooter situation
• Mass casualty triage procedure

I had been wanting to train with them for a few years as I am a fan of their gear. The 2 day course did not disappoint. The instructor was a fellow Paramedic and although  the techniques were not anything I had never seen I did pick up some pointers. It was a good way to spend a weekend with responsible people trying to become better. I would recommend this course for lay people that want to learn some life saving interventions.

EMS Hobbyists

Most Emergency Medical Service providers in the United States are volunteers. Paid professional providers are statistically the exception rather than the rule. Volunteers providing emergency medical coverage to their communities are invaluable assets. They are required to maintain a certain level of proficiency to continue to certify at the national and state level. This is done mainly by continuing education hours. There is a small but stubborn subgroup however that are hobbyists. We need to do our best to weed those individuals from our ranks.

We all know who these folks are. They hold the same EMT rating as we do but they haven't provided patient care in years. They instead prefer to jump in the front of the ambulance to drive. They sport the "We do the same thing as a Doctor but at 80 mph" shirt or the "You better behave or I get to see you naked" shirt. They show up to calls in dirty clothes and open toed shoes.They have joined the squad as a status symbol or as a social group.  They do not take the onus placed on them by the community seriously. 

When a 911 call goes out the individual or family that calls has an expectation in this country of prompt, professional response. As EMS providers we owe them the best service possible when they are at their most vulnerable. These folks allow us into their house, we hear intimate details about their lives. They are looking to us to fix the problem. How we present ourselves,our professionalism, skill and decisiveness is what will provide that comfort. If we waste our training opportunities, if we don't take our responsibility seriously then we are doing the public a disservice. 

Do some self examination. Are you a professional or a hobbyist?

EMS pay and dangers.

I have been a member of emergency medical services since 2006. I have worked or do work in a volunteer based service ,private for profit based and County government affiliated EMS system. Prior to that I spent 22 years in one of the most dangerous and demanding jobs in the United States Military. Where real life and death decisions were made in training and combat on a regular basis. Where people died on training jumps and by the hand of the enemy. So I am going to lay out some truth here.

Truth #1
EMS providers are not "heroes". Individual providers may do heroic deeds but 99% of the time the job is pretty mundane. Are we any more heroic than a nurse or doctor if all we do is establish an IV and administer some pain medication? The answer is no. In those situations EMS providers are doing the job they are paid for. Before anyone gets their panties in a bunch I also wholeheartedly think the term "hero" and the phrase "thank you for your service" are terribly overused in the context of our military as well. It is all very disingenuous. Heroes do heroic things. This is heroic: Benevidez MOH Citation as is this Medic refuses to leave man with grenade lodged in leg. Putting a pressure dressing on a laceration is not.

Truth#2
EMS providers pay is for shit. As a Paramedic I get paid between $10-$13 per hour. At the security firm I manage an individual can walk in off the street and with a high school diploma or GED and make the same amount to guard a pallet of bananas. I had to go through thousands of hours of training, spend thousands of dollars on tuition and have to attend continuing education to maintain my proficiency. Depending on the call I may literally have someones life in my hands or have to dispense narcotics or other drugs. I was once told that you get paid for responsibility and not how hard you work. This holds true in most professions but not EMS. Most EMS providers I know work at least 2 jobs to stay afloat. I personally work a full time job in the security industry and two parttime EMS assignments. The pay levels are abysmal.

Truth#3

Truth #2 is more than likely because of a actual or perceived lack of professionalism within our own ranks. EMS in the United States needs to raise the bar of professionalism. Volunteers and paid services should be held to the same standards. At a minimum it should be required that a Paramedic acquire an associates degree. Pay should be based on experience and training much like nurses. To advance you should be encouraged to get a B.S. As long as EMS providers wear shirts like this:

We will never be taken seriously. EMS needs to UFY

I haz Paramedic

This post is a bit overdue. I originally meant to write it last summer but due to reasons of which I will speak it didn't get written. Once it was appropriate to post I had simply forgotten until it just occurred to me that I had never brought closure to my Paramedic journey. So a bit of a recap. I started in Emergency Medicine in 2006 when I took an EMT-Basic course on a whim to see what it was all about. I graduated and didn't due much with that skill. When it came around for my 2 year renewal I discovered it was easier and cheaper to renew if I was actually running on a service. I started volunteering on a local ambulance service and the rest is history. Eventually I got hired for a paid EMT position. I progressed to EMT-Intermediate and I took the class for Advanced EMT although I never finished the written exam. More on that later.

Being a paramedic had always been in the back of my mind but in 2012 I realized I needed to get in the 2013 class at my local community college or it wasn't going to happen. Several reasons for his. They only accepted applicants once a year, my GI Bill eligibility would expire in 2014, and The National Registry of EMT was phasing out my current rating. It was go back down the chain or go up by 2016. So January 2013 found me sitting in the classroom as an new paramedic student. Fast forward 15 months and I graduated from the program in May of 2014 with a AAS degree in Paramedicine. That was all good and well but really only made me eligible to be nationally registered. The degree means I had completed the training I still needed to take the required practical (hands on) skills test and the written exam. Ask any Paramedic and they will tell you that theses tests are very difficult and definitely a right of passage.

The day of the practical I was nervous and very concerned about my performance. Not knowing exactly what to expect I had poured over numerous youtube videos in a final effort to cram for this hands on exam. I was really concerned about the static and dynamic cardiology stations:








As luck would have it I passed those stations with no problem. I did however have to retest the very last station I had tested. This was one of the oral stations where you were given a medical or trauma scenario and had to verbally relate in great detail how would handle the scenario, There were 2 of these stations during the test. I was surprised when they told me I had failed that station as I thought for sure I had done well. Good news was I only had to retest 1 station, bad news was I totally fell apart on the retest and was a no go. So this meant I had to pay another fee and drive 150 miles to retake the one station I had missed twice at the first available opportunity. So 2 weeks later I did just that. I was even more nervous than originally because now if I failed I would have to retest the entire practical after paying for a refresher class. But things went my way that day and I was in and out in less than 2 hours having passed the practical. I breathed a sigh of relief. But now I had to pass the written test.

Myself and National Registry of EMT written tests have a long and sordid history. These tests are adaptive meaning they base your questions on how well you are doing answering the other questions. They are also highly regulated. Here I write about my troubles with other tests:

NREMT EMT-I Practical

NREMT-I Written Exam

What I didn't write about was the fact that I took the AEMT written test 3 times and never passed it. I eventually stopped trying putting all my eggs in the paramedic basket. So I studied for my written test and when I showed up to take it I was apprehensive but hopeful. When I left the test center I really had no idea how i did. Well I bombed it failing 4 out of 5 sections. I was crushed. So I doubled down, spent money on a pay study site as well as the free one I already had. I gave it 4 weeks and tried again. This time when I left I knew I had not done well. I was not surprised at all to see that I had failed again. At this point counting AEMT and EMT-Intermediate, I was 1 for 8 in my last 9 attempts at an NREMT written test. Not very good odds. I was crushed and serioulsy doubting if this was something I could do. I had some long talks with a friend that I consider my EMS mentor and he told me some things that helped me feel better about the results but not the process. So I studied and studied some more. I approached the test center to take my last and final chance with the confidence of a gnat. As I answered questions I was feeling more and more confident however. This time was different somehow. I actually started getting optimistic. After the test I hoped against hope. I tried not to think about it for 36 hours until I forced myself to check my account to see if I had passed. Miracle of miracles I had passed!! I finally was a paramedic. Things have moved swiftly since then, I am working as a paramedic at 3 different services on a PRN basis. I still have much to learn OJT but my long academic journey is over.

Paramedic update

Just a short update for those that care. I am entering into my last and final semester of the paramedic course. It has been a long haul with just a few more hills to climb. I am hoping in May I will be able to write a post on how I passed the psychomotor and written exam. At this point clinicals are consuming my life but there is light at the end of the tunnel. Wish me continued success and a bright future full of many routine transfers and naked old people

On the Ambulance

As a member of EMS in rural Iowa I pick up my fair share of older folks. Iowa has a large geriatric population and it is getting bigger. However the other day I had a patient that both made me proud and sad. Recently we picked up a 95 year old gentleman from a care facility to be taken to a local hospital for evaluation. This gentleman wasn't too thrilled with  the idea to say the least. The sad fact is these folks often go to the hospital never to return and the other residents know this. We EMS providers have a duty to transport them for care but it often isn't a very pleasant job.

It was my turn to attend the patient so we loaded him on the cot and placed him in the back of the ambulance. Once he was comfortable and hooked up to the monitor my partner hopped in the driver's seat and started heading towards the hospital. I wasn't providing much but comfort care so I struck up a conversation trying to ease some of his stress.

He was wearing a hat that said " WWII/Korea Veteran" so I asked him which war he was in. He said "Both". I mumbled some comment about being a Vet myself but I find it hard to compare my service to men such as this. Men that spent years away from home, with no contact but the occasional letter. I don't know if it is hero worship or just much respect. This gentlemen told me he had been in the Navy and was a gunner on a Torpedo Bomber. He had been in Navy for 10 years much of that in combat. Then he had come home and driven a truck for 40+ years. Raised a family and went on with life. His wife had recently died and now he was all alone. By the time we reached the hospital I had him laughing but inside I felt sadness that great Americans such as these ended up so lonely.

We are losing the Greatest Generation day by day and week by week, our newest greatest generation. Veterans from Iraq and Afghanistan are everywhere. Working jobs and raising families. I hope in 40 years things do not turn out the same.

Should EMS Be Armed?

I am a strong proponent of the individual rights the Second Amendment spells out for us. Notice I said spells out, the Second Amendment merely defines or explains the rights we already possess. Government does not have the power or the authority to take these away. This is not a new or original position, and I am not the first to express it. It is however what I believe. I am permitted to carry a concealed weapon in my home state and do so religiously where legal and appropriate ( almost everywhere). I do not take this responsibility lightly. And make no mistake and armed citizen takes on an awesome responsibility. They incur the responsibility to remain proficient with their designated firearm and to stay vigilant and aware so as to avoid confrontation. They must be acutely aware of the force continuum and when to use it appropriately .

I also am very passionate about emergency medicine. EMS providers also need to be acutely aware of protocol and when to proceed into a scene. Scene safety is something that is drilled into every EMS student. However in the ever changing world we live in a scene that may be deemed safe initially could evolve into something quite different during the course of a call. Also you have rural EMS services where law enforcement may be a good distance away during the initial scene size up.

 EMS providers must be afforded the same rights and opportunities that are afforded to private citizens.Arming EMS in situations where it may be appropriate is a discussion that must be pursued.

Here are some resources to continue the discussion

An excellent podcast on EMS STANDING ORDERS

http://emsstandingorders.com/2011/12/13/episode-8-surviving-the-next-shift/

Posts by nationally recognized EMS educator  and Second Amendment advocate Kelly Grayson

http://ambulancedriverfiles.com/2011/09/06/gun-rights-were-winning/

http://ambulancedriverfiles.com/2007/01/26/the-armed-emt/

Discuss amongst yourselves

Douchebag of the Week

As an EMT and a retired Special Forces soldier I have seen my share of douche bags. You know who I am talking about, the guys from suburbia who have there pants so low on their hips they walk like a frickin penguin or the hipster at Starbucks drinking their Latte while talking on their iphone and wearing their sunglasses indoors. My douche bag of the week is not any of those however; my douche bag is emergency medical personnel who think they are too cool for school (pardon the use of the way back machine for that expression.)

            Don’t get me wrong I have always said that if it is black and has Velcro then it by default must be cool. However gear alone doesn’t make you cool it is what you do with your gear that makes you and the gear cool. Emergency medical personnel who show up at the scene with their 511 tactical pants, titanium trauma shears, and sunglasses and then can’t do a basic assessment just look like the ring leader of the ass clown circus.    We used to call people like this a walking clusterfuck.

            EMT-B Smith pulls up to the Ambulance garage in his Ford Ranger pickup with the EMS license plates and flashing white light, the white light denotes he is EMS but doesn’t allow him to drive any faster or ignore any traffic laws. Hey, having a light is cool. On his back windows are the Star of Life and the slogan “EMS saves Lives”. He hops out of the truck ready to spring into action. In the cargo pocket of his pants are his trauma shears in tactical black, 15 ink pens in case he runs out on scene or has to do an emergency tracheotomy and his ipod with a copy of the EMS field guide. His coat is a personally obtained Level 3 reflective coat that says EMT in big reflective letters on the back. That’s in case anyone forgot when he gets on scene. He has tactical communications in the form of his pager and handheld “walkie” so he can talk the lifeguard helicopter in or coordinate with medical control should he be the incident commander. He is wearing GSG9 Addidas tactical boots in the hopes that SWAT is in need of a helping hand.

            When EMT-B Smith arrives on the scene he dons his medical gloves and heads straight for the patient, damn scene safety!!! The patient has an altered mental status, is lethargic and diaphoretic. The patient is showing obvious signs of a diabetic issue so naturally EMT-B Smith slaps a cervical collar on, backboards the patient and declares a trauma alert. Hey trauma is cool, medical issues take a backseat. PUHA or Pick Up and Haul Ass are the watchwords of the EMS douche bag. Lights and sirens are also cool. When EMT-B Smith gets to the Emergency Department he is much more interested in talking to the charge nurse about his exploits than giving a thorough report and handover. Did I also mention that patient blood pressure is always 120/80 for this douche?

            When I was in Special Forces we called ourselves “quiet professionals.” It is not the loudest or the flashiest operator that you want on the objective but that quiet professional that is tactically and technically proficient and can get the job done. This can also apply to many other professions such as EMS. Be proud of who you are and what you have accomplished as an EMT. However let your actions speak for you not your attitude or the gear you wear. The world needs Emergency Medical Personnel we have plenty of douchebags.

What I Would Do If I Was Rich (Don't Quit Your Day Job)

So I have been MIA from this blog for a few weeks, honestly and surprisingly I really had nothing to say. I mostly reserve this forum for more lengthy diatribes and leave the short day to day comments for other places like  http://twitter.com/mikemac356  and  http://mikemac356.tumblr.com . But today I was daydreaming, as usual, and I got to thinking how much I enjoy my work as an Emergency Medical Technician and that if I was rich it would be what I would do for a living. In fact over the last few years I have kicked myself for not becoming an 18D Special Operations Medic while I was in Special Forces. If I had taken that opportunity I would be light years ahead of where I am now in terms of emergency medicine skills and knowledge. At my age being light years ahead in anything is a big plus. In fact it was the 18D's during my military career who lit the pilot light on my current interest in emergency medicine.

Back in the day, when there was nothing to do and it was too early to head for the hacienda it was inevitable that the current Team Sergeant would announce to the 18Ds that it was time for some medical cross training. Hell when I was a Team sergeant I did it myself. Medical training was appropriate for a few reasons, it is a perishable skill which requires repetitious practice, if both medics where down in combat or busy who was going to treat the other wounded, and it was easy to do. So grab a few IV administration sets and a SAM split and go to town. Thing was I always liked this training and to this day I would put any one of my medics on any of the ODA's I was on up against anybody for all around knowledge and medical skill. Thanks Carl, Glenn, Jeff, Matt, Mike, Curley,Craig,Jerry,Aaron, Chris, Ron and any other 18D that ever showed me anything.

So going on five years ago I took the EMT-B course because of this interest in medical "stuff." However at the time I took it because it was a prerequisite to get on the local fire department, the action guy in me thought I might like to be a firefighter. Well the department wasn't hiring that year and I was too old to wait so I moved on and started volunteering my time at a rural ambulance service. Most of the services here in Iowa are volunteer and rural. Well fast forward to the present day and I am a member of the leadership council at that service and I also work as a paid albeit part time EMT on another rural ambulance service. So between both services I am on call about 140-200 hours a month mostly overnights because , hey, I still have a day job. And that is the main issue with why I don't do EMS full time. Big secret if you don't know and I think most people don't but EMS personnel are paid not much more than your local convenience store clerk. An EMT-B makes an average of $9-$10 an hour that is if they are even paid and aren't volunteers. Paramedics get paid more but not a lot more. I think this is a travesty and a shame. The EMS personnel I know are some of the most dedicated people you will ever meet. Hundreds of calls are run and lives are saved every year by people that cultivate their skills and service their communities and expect nothing in return. Next time you see an Ambulance or someone in EMS, tell them thanks for me.

So in a nutshell that is why I don't do this full time. However because I am a definite TYPE "A" I am doing the best I can to progress in my knowledge of EMS as fast as I can. Sometimes this doesn't seem very fast but slow moving wheels still turn. Currently I am attending the EMT-Intermediate course with the intention of transitioning to the Advanced-EMT designation when the National EMS Standards come into full effect in the next few years. I also plan on trying to get into the Paramedic course next Winter. However despite the pay issues this is a very popular course, I wasn't able to get in this year. Hopefully by the time I am 50 I will be a qualified paramedic running on an ambulance service somewhere. Then when I retire from my day job I can run ambulance calls to stay busy. I will also be able to drink coffee and bore the young kids while I alternate between "When I was in Special Forces " and "When I was a Paramedic" stories. That will be some good times.

Kraut Route 5K and other nonsense

So last weekend was a very busy one although unintended, I had scheduled myself to be on duty at the Lisbon Mt Vernon Ambulance Service on Saturday morning and too late I realized it was the same day as the St. Jude's Sweet Corn 5K which I run every year, not wanting to leave the service hanging without coverage I registered instead for the Lisbon Sauerkraut days 5K which I had never run before. My intention was to run about 10 miles before the race and use the race as part of my training for my upcoming marathon. This was not to be as a all hell broke loose at work Friday night and I ended up getting somewhere between 1 and 3 hours of sleep and not all at once.

Since no plan survives first contact I adapted and decided just to run the 5K. This 5K was a small local race in a small community. There were 200 registered runners and it had none of the fanfare of some of the other races I have participated in. As usual I started off at the back of the pack and worked my way through the crowd. My intention was to just jog and that is what I did for most of the first part. The course started out flat but then after about a mile we encountered some rather large hills. The last hill to the turn around was pretty steep and probably about 3/4 to one mile long. It was while I was motoring steadily up this hill that I saw a guy I knew coming downhill after turning around. Lets just say he and I do not see eye to eye.

Me being me it then became my Ranger mission to run this guy down and beat him in the race. Don't worry that we are both over 40 and our fastest days are well behind us, rivalry and male ego do not have a age limit. So I picked it up making the turnaround and lengthening my stride as I went downhill. I could see him in the distance cresting the next hill and as I hit the bottom of that hill I tried to keep my pace the same. I steadily gained ground on him until I was close enough to see hear his labored breathing (between my own breathes). On the next uphill he slowed and I did not and I went running past him not even looking to give him the satisfaction of eye contact. He ate my dust, my mission then became to put as much distance between myself and him as possible. I kept up the pace feeling pretty good about myself until up ahead who should I see but the same 8 or 9 year old kid that just beat me at the 5K I ran on July 4th. I decided to run him down as well and get the old double play. So I picked it up again and caught up to him, as I was pulling even he slowed to a walk.

Right then and there my thinking changed, I went from super-competitive Former Action Guy to a guy who admires effort and heart. I looked that young man in the eye and said " You beat me on the 4th, are you going to let an old fat guy beat you today?" He looked at me and without so much as a word he took off on a dead sprint as only the young can do. I tried to keep up with him but the hills had taken the kick right out of me and he ended up beating me by 20 seconds or so. After the race he disappeared and I didn't get a chance to tell him he had run a good race. I beat my last 5k race time by almost a minute and beat Mr. Attitude by over two minutes,put that in your pipe and smoke it.

http://results.active.com/pages/displayNonGru.jsp?rsID=97655
When I got back to the ambulance garage I ended up driving the ambulance in the festival parade and throwing out candy, later that day as I was finally trying to take a nap we got a page for medical assistance at a fire which ended up involving 6 fire departments and our ambulance service. We were on scene about 5 hours. Needless to say when I got home I went to bed early that evening

Extracurricular Activities #1: Emergency Medical Technician

As many of you know and many do not I spend a lot of time doing "jobs" that aren't really jobs. My wife claims I am a workaholic and can't sit still, my kids say I have OCD. Bottom line is I try to keep myself busy because honestly ever since I retired from the military I get bored just sitting at home. I have several things I do on a regular basis and I thought I would write about each one of them.

When I was on a Special Forces ODA we did cross training on medical treatment procedures. This was out of necessity since there was twelve of us and we only had two medics. We often broke down into even smaller units so not every group got there own medic. However we still needed to manage any situation that may happen in training or combat, so our medics trained us. Special Forces medics are some of the most highly trained medical personnel in the military as far as trauma management and all around general medical practices. I trusted these men with my life, I even let one of them operate on my dog. That is how much I respected their skills. So long story short I spent a lot of time in the military training on medical issues even though I was not a medic. When I retired from the military I got this wild idea that I should get qualified as an Emergency Medical Technician both because it interested me and because I had this vague idea of applying to a fire department somewhere.

The fire department idea never happened but I did get qualified as an EMT-B. The course was ten weeks long, two nights a week, four hours a night. We started out with over thirty students and about 11 of us finished our national registry. Not that the training was all that hard but it took discipline to study around work etc... and as I discovered then and since outside of the military there is a lot of lazy floating around. Many of the "students" thought the instructor was being unreasonable when he/she asked them to produce results on a weekly basis. The class I took was fast paced, we went through two chapters of the text a night, followed by an hour of practical skills and every class ended with a must pass test on the material from the class before. The national registry exam consisted of a proctored written exam and a practical where you had to assess and treat a patient in three different scenarios either medical or trauma related. Reminded me of about every school I attended in the military, but like I said many couldn't and didn't make it through the training mostly due to lack of effort.

After graduating I used my skills sparsely for a few years, life took over and my idea to be an EMT went on the back burner. I did work part time at the local Minor League Baseball park for one season as an EMT which mostly consisted of me watching the game and putting ice packs on people who got hit with foul balls. Was a pretty sweet gig but it only lasted a few months. Eventually my certification was coming up for renewal and I discovered since I wasn't employed by any medical service ie.. a ambulance service, hospital, or fire department. I would have to attend a 24 hour EMT refresher if I chose to remain certified. After attending the refresher and getting re certified, I decided I better get on the stick and use my skills or give the idea up. I searched around the internet and found an ambulance service 15 miles from the town I live in that took volunteers, I applied and they accepted me.

The service I run with covers a rural area of over 150 square miles and services a population of a little over 6000. There are about 20-25 volunteers, we have 3-4 paramedics, most of the rest of us are EMT-B and we have a few volunteers that aren't certified, here is our website http://www.lmvas.org/. The service will send you to EMT-B class if you agree to volunteer for a year. The State of Iowa rates us as a Paramedic-minimal staffing service. That means we are a Paramedic level service but if one is not available we can leave the garage with an EMT-B as crew chief. If that EMT encounters a situation where advanced level skills are needed they can call for a mutual aid from the County Sheriff Paramedic or the paid service in the large town where I actually live. This doesn't happen too often as our Paramedics are some of the most dedicated volunteers I have ever seen and they volunteer hundreds of hours a month and go on dozens of calls all for volunteer wages and while holding down their own full time jobs. I and a few other EMT-B's are training currently to become future crew chiefs to re leave some of this workload however.

Since I live out of town and we are required to respond within seven minutes of a page I have to stay at the ambulance garage when I am on call. They have a little bunk room there with TV and internet access so it isn't too bad. My wife is awesome as usual and doesn't say one word about the 7-10 nights a month I sleep away from home. She is used to me being deployed anyway after 23 years of marriage the first 17 in the military.

Over 80% of the EMS services in Iowa are covered by volunteer services most of them rural. Iowa is also heavily geriatric so we get a lot of calls for older patients.  I actually attended a class this winter on GEMs (Geriatric Emergency Medicine) just because of this demographic. That is not the only type of call we get however. Since I have been on the service I have responded to unexpected home births, car accidents, serious trauma, hypothermia, motorcycle accidents, and a multitude of medical calls. Others on our service have responded to gunshots, suicides, and heart attacks. We pretty much run the gambit. I have learned a lot and I really enjoy the opportunity to use my medical training helping people. So next time you see a ambulance go by say a prayer for those inside and thank the volunteer who is in the back and driving the rig. They save lives for no or little pay so a thank you is always appreciated.Better yet hook up with a service and volunteer yourselves. If you're ever close to Highways 30 and 1 in Northeastern Iowa stop by and say hi.