A reader asked me to comment on the following article. Public Safety Personnel Work Through Danger Here is the most relevant passage: A few years ago, in a discussion among several of us who do critical incident stress debriefings, we talked about the difference between acknowledging and meekly accepting danger as part of one’s career. It wasn’t long before we were in total agreement that the majority of us were willing to quickly acknowledge danger, but none of us would buy into the old myth that merely accepting injury or death was part of our professions and that was what we were paid to do. One member of our group summed it up best when he said that we were paid to serve and survive, not serve and die. As medics and EMTs we generally don’t go into burning buildings or face down badmen with guns. If we come close to gunfire, we get the f—out of the way. Now, every year or so, a medic is shot or stabbed in the line of duty, it is much rarer obviously than a policeman being shot. The danger for us comes in three main areas. 1. Ambulance crashes 2. Pathogens and communicable diseases 3. Psychological I have been impressed with ambulance safety efforts in recent years. The company I work for has installed black boxes in the vehicles, which have led to mandatory use of seat belts, much slower and safer driving and turning. They have also installed safety nets, which I have written about before. I also believe as each new generation of ambulances come out they will have more and more safety features. The state is also in the process of adopting a new lights and siren policy that will reduce the use of lights and sirens – particularly their use to the hospital from the scene. The area I would like to see improved is the use of lights and sirens to the scene. I think the current EMD is way too permissive in its lights and sirens use, and I feel police and fire too frequently request our arrival hot for non-life-threatening reasons – standbys, vehicles in the road, psychs. The pathogens and communicable diseases are a little harder to control. We get our training, which is sort of a waste of time. It can be summed up with the following words: there is nasty shit out there, wear your gloves, put on a mask if you have to, eye shield when intubating and be cautious. I don’t use gloves as much as I should, and have never gotten in the habit of putting the face shield on intubate. I use to wear glasses, and then when I lost them, well, I just never got another pair. (I’ve done mouth to mouth on patients only twice, but they were both babies, handed to me limp and inbreathing, and I did what I had to do until I could get them in a position where I could use an ambu-bag.) They have gone to safety needles, which I think are great and probably have reduced needle sticks. Still — ambulances are teeming with germs and disease, and when the avian flu or anything new and bad gets here, we are going to get whacked with it, no matter what we do. The third danger area is more insidious. I think over time the damage that EMS does to people’s relationships, to their mental health and view of the world is a silent epidemic. The divorce rate is EMS has to be off the charts. I heard about a soon to be published study of sleep deprivation done on EMS workers that showed EMS again is off the charts. Most people in EMS work unbelievable hours to support their families. There is little advancement, and then the time comes when the job has beaten them down so bad they can’t physically or mentally work any more. Unless you have a job with a city pension, it doesn’t leave you much in the end. So to go back to the article, I think EMS people and society need to acknowledge that EMS is dangerous, but we should not accept it. We all need to continue to work to make it less so. I applaud the efforts people have made so far, but there is more to be done. While I see ambulance safety continuing to improve (partially for liability reasons), and I see the disease training being continued to the extent mandated by OSHA, I don’t see any efforts being undertaken for the psychological aspects. I think here is where we need to protect ourselves. If it is a job that we love and if we love our families, we need to fine the balance that enables us to do both. But the problem comes from wanting more for the family, we work harder to pay for the house, the family vacation, the better school, the Christmas gifts, the health care bills, and then some people get behind and can never get ahead. The problem with unlimited overtime is you start doing it to pay for something better, and then you get in a position where you have to work it to survive. And then when your body starts breaking down, you just can’t keep it up. You can’t keep carrying people down from the third floor out into the icy night and not expect it to wear on you, particularly if you are not staying fit. And sometimes, it’s the mind that breaks down under the stress and you lose perspective. When patients who you entered this profession to help become the enemy, it’s time to reassess. Go do something else if you can. I know many good medics who have walked off the job for this very reason. And you have to applaud them for having the courage to recognize the job was killing them. We all know there is no pot of gold at the end of this rainbow. No million dollar reward for twenty or more years of grinding the runs out. If we are not getting the reward each day, or even once a month, something to keep us going, we need to save ourselves if we can. Finances are hard all around – it is not in the interest of towns and cities already burdening their citizens with high taxes to take on more costs either by upping benefits for exiting city EMS personnel or by replacing commercial EMS service with a new tax-payer funded city service. I just don’t see that trend happening. We can’t let the job become a lives – it shouldn’t define us – because it will betray many of us in the end. I see it in some people and I fear it one day happening to me. I don’t want to be old and bitter and betrayed by this job I love. Be safe out there people – in body and mind. Don’t let this job take your life or your happiness. Acknowledge it can happen, but don’t accept it.