All the World's a Stage

“There are four ways, and only four ways, in which we have contact with the world.  We are evaluated and classified by these four contacts: what we do, how we look, what we say and how we say it.” ~ Dale Carnegie

On the short list of advice I would consider truly valuable to a person newly entering EMS as a career field is this:  “Never get involved in a land war in Asia.”

No, wait … wrong venue (though you get extra credit if you know the reference) – it’s really this:

“Every day that you are out there is one long job interview.”

Regardless of what area of the country you work in, EMS by design is a small field.  Whether the distance is measured by county, region or state, the gap between you doing something epic (good or bad) and the people on the other end of said area finding out within the week (or day) is actually pretty small.

That was true before there were smart phones and YouTube.

One of the tried and true cautionary adages for anyone working the public sector is that you never know who you are talking to, or performing in front of.  It is short-sighted to think that prudent behavior should be reserved solely for the public eye.  Just as true customer service applies to everyone you interact with – including your co-workers, so does your reputation.  To act as if what you say or do in the “privacy” of your truck, station or any other sort of quarters you inhabit does not have a direct effect on professional perception of you is profoundly naïve.  It will likely become an unfortunate lesson for you at some point in your career.

Why is that?

EMS is part of the Emergency Service eco-system and in such an in-bred subculture there is very little you can do while working that will not create ripples in the professional gene pool.  The area you work in may be different, but in my experience it’s rare to find someone who works only one department – or at the bare minimum, have friends or family in multiple departments across multiple branches of service.  

To enjoy some longevity in this field it’s important to realize that the person sitting next to you today may be the one across the table from you when you need a job next month – or next year, or five years from now.  If you do not think that your actions on everyday routines is not being noted and mentally filed, think again.

We function in a tiered system, a hierarchy by design.  Each rung of the ladder has those that struggle to reach, those that hang on but never get a foot up and those that climb it with ease after some practice.  Every level has eyes upon it.  If you are a sloppy EMT with poor skills who becomes defensive about correction, you are going to end up losing valuable learning opportunities and chances to be coached into becoming a better clinician.  Perhaps you will find yourself having a difficult time entering a paramedic program.  If you are a lazy paramedic who revels in doing the bare minimum, then at some point you may find it very difficult to gain additional or new employment, even though you carry the same card as everyone else.  When you attend educational programs, do you show up on time, prepared, engage in the class?  Those classes are often taught by the people who will make the decision if you’re worth an investment later on.  Where on the ladder are you?

This scrutiny and its effects holds doubly true for paramedic interns.  You should bring your absolute “A game” to every one of your clinical hours.  If you think that as the student you are beneath notice guess again – hiring a brand new medic with no mileage on it is a true gamble.  Especially if that medic did not come from within the system and you have no idea what their performance ability is.  Rest assured however, your preceptors know exactly what you are (and are not) capable of.

None of this has anything to do with your direct patient interaction; the average person really has no idea what the true quality of the emergency care they’re receiving actually is.  I know quite a few EMTs and Paramedics who are absolutely beloved by their patients and other agencies because they are so nice and accommodating in person.  Yet behind closed doors these people rarely come to work on time, uniforms are incomplete or optional, they do not check their vehicles or follow SOPs regularly, they only take education that they are absolutely required to and that is under duress – is this starting to sound familiar to anyone?

While having coffee at shift change at my part-time employment a couple of years ago, I waited for my relief to come in.  There I am in a line position, with the same responsibilities as anyone else.  This was a newly certified paramedic – as in brand new, first shift as a second.  Ever.  They walked in late, uniform undone, boots unlaced and from the moment they came through the door they complained about having to be there.  This was followed by an indignant rant on how they were not given the shift assignment they wanted.  There was no move to take report on the truck, or even obtain the keys and radio and make a suggestion that they might be planning to at least check their vehicle out.  Most of my interactions with them since that day have been in a similar vein.  This person is always looking to take the easy way out, shortcuts wherever they can find them.  There is no drive to be anything more than the minimum necessary.  

In my full-time job my role is a little different and I am one of the people responsible for hiring.  Fast forward this unfortunate interaction a few years and now that same person is looking to me for work.  As much as nobody likes to be the bad guy, the reality is that hiring someone is an investment of money and man-hours.  Just like any other type of investment you have to look for the best return you can get.  Needless to say that person was not a successful candidate, the person hired in their stead had less experience but far more drive and is moving forward with developing this as their career versus just a job.  It is not always enough to be a good provider, this is a profession and if we are to be treated as such then the realization must be made that you need to be a good employee as well.

If you are familiar with the idea of “six degrees of separation” (or Kevin Bacon) then you know that it is the concept that everyone is six or fewer steps (by way of introduction) from any other person in the world.  If you know EMS then you know our degrees of separation or even shorter – down to two, maybe one step away from knowing someone who knows you.  People in the position to hire or advance you have usually been in their respective field for longer than ten minutes, in all likelihood it is more than ten years.  This means they know A LOT of people, probably more than you do and certainly enough to get some decent intel on what you are *really* like.

We interview dozens of candidates a year, reputations notwithstanding.  A poor work reputation is not a death sentence, merely a burden or obstacle toward professional development.  Poor reputations can be overcome with time, effort and someone willing to be objective and honest.  We often take on people with “baggage” from other departments because we know what the issues are and if they demonstrate enough value then very often a clean slate and new environment is just what the doctor ordered.  However that is not as easily done when you have direct knowledge of someone regularly engaging in the exact behaviors you are looking to avoid in your hiring.

Any advice I have for interviewing is not much different than you will read in any number of professional development articles – be on time, dress well, bring your documentation, prepare your answers, do your homework and have some questions in return.

But in this very small field, what do you do when you find yourself sitting across from someone who you know might not have good reasons to hire you?

Own it.

From the moment our fledglings walk into orientation we tell them the same thing – be honest at all times.  Own your mistakes, be accountable for your behavior, do not push something you’ve done off on a pallet of weak excuses.  The same holds true if you know you have a poor track record.

Do not avoid it; if the subject comes up discuss it objectively.  Answer questions fairly, do not shift blame.  Accept the onus that comes with it and make clear your intentions to avoid repeating those same mistakes in future.  Make the person interviewing you believe that you if given the chance you will prove that while you may have baggage, nobody else has to carry it for you.  That given the opportunity, you will be a good investment – a solid provider AND employee.

Own it.

The rest is easy.  Once you’re given the chance then you come to work (on-time & in uniform), be nice, take sick people to the hospital and then go home.  The rest will work itself out with time and consistency.

Please take this as a cautionary tale.  Evaluate your work habits – are you a good employee, or just a good provider?  Look at your interactions – not with the patients, but with those you must work with and rely on to be there for you.  Is your job performance a reflection of your attitude and do you want it to be indicative of who you are as a provider?  Are you looking to move elsewhere in the field and what is your professional reputation going to do to help or hinder that?

My very first job offer as a paramedic occurred before I ever had a card.  It was as I exited my clinical test for National Registry.  I was sitting on the steps, trying very hard to keep the anxiety attack at bay and maintain my composure now that the practicals were done.  One of the evaluators (not mine) came and sat with me, we’d never met before that day.  After he finished talking me off the ledge, he introduced himself as the director of a paramedic project about an hour away – he shook my hand and told me when I had my card, I had a job.

I was taken aback; I thanked him and said, “You don’t even know me.”

His response was, “No, but the people whose opinions really matter do.  Keep up the good work and call me when that card comes in.”

I never forgot that.