It’s taken for granted far too easily that emergency workers are available to rush to your side with just a phone call. Paramedics, emergency medical technicians, and other critical care specialists are ready and waiting to assist, and it’s rarely easy work.

Not all emergency medical jobs are the same, and not all calls coming in are for life-threatening injuries, but it is an intense field that often requires long hours of work. To learn more about the field, we spoke with Lt. David F. Phetteplace, FF, CCP, IC, who works as a paramedic and an instructor.

Tell us a bit about your current work and how long you’ve been at it.

I’ve been in emergency services in Michigan for almost 10 years. I started as a volunteer firefighter. Moved on to become an EMT, then a paramedic, then a “Critical Care Paramedic and Instructor for Emergency Medical Services.”

What drove you to choose your career path?

It wasn’t anything planned. I really didn’t have much direction in my life at the time. I had just quit being in a band and was moving on from that point in my life. I one day asked the local fire chief if he needed any help on the department. He told me if I cut my hair and took all the metal out of my face that I could join the volunteer department. So I turned in my death metal gear for fire gear. I was not one of those kids that grew up wanting to be a firefighter and I never had any family in the fire service, it was just a spur of the moment type of thing that happened to change my life. I have thought for a long time the meaning of life was to help others, so it seemed like a good fit. I decided I would like to try it as a career, and that required that you be an “Emergency Medical Technician” at the time, so I went to EMT school. This was when the economy was going to hell in about 2007, so most public services jobs were almost nonexistent. It also meant I lost the job I had at the time.

It just so happened I really liked medical work and focused on that. I went on to become a paramedic and am now employed full time at an ambulance agency.

How did you go about getting your job? What kind of education and experience did you need?

To become a paramedic, you have to first be an EMT. From there, you can go to a paramedic program, which is now required to be through a college (in Michigan, at least). I have been in school for about 4-5 years to become a “Critical Care Paramedic.” Working in Emergency Medical Services requires a state license, which you can apply for after completely school and state based tests.

Critical Care is more focused on transporting patient’s from one hospital to another, often using medications or medical devices that are above the scope of practice of a paramedic. This might include chest tube pumps, ventilators, and certain cardiac devices like balloon pumps.

Many outsiders might not know that their is a difference between EMT and paramedic, but it is like comparing a nurse aid to a doctor. You now have a thorough education of physiology, pathophysiology, cardiology, pulmonology, pharmacology, and neurology. You can also performing skills such as intubation, IV/IO (in the bone) access, as well as medication administration.

Once you are in field working on an ambulance, you follow protocols that doctors have written and have been approved by the state. These are guidelines that offer a minimum of what should be performed and assessed for patients (an example being all patients that have been unconscious, have chest pain, shortness of breath, nausea and vomiting, or weakness all require an 12-lead ECG).

What kinds of things do you do beyond what most people see? What do you actually spend the majority of your time doing?

EMS jobs can actually be variable. Some people work for hospitals and just transport patients from one hospital to another, or to nursing homes. This can be as a basic EMT unit, or as a Critical Care unit for intensive care patients. Others work in urban systems, where you may run lots of calls, but are no more than five minutes from a hospital. Others, like me, work in a rural area, where we may not run that many calls in a year, but can be with our patients for longer than an hour at times. Each of us are doing different things with the same goal of treating and transporting the sick and injured.

What misconceptions do people often have about your job?

In my experience, many people call us “ambulance drivers,” which is like calling a police officer a “cop car driver.” The general public often thinks that all we do is take people to the hospital. While that is certainly part of the job, and how it was when EMS started—up to just about two decades ago—we have now moved to bringing the emergency department to the patient. There is very little that the emergency department does that we cannot in the short term. If a patient is in cardiac arrest, there is nothing the ED is going to do that we can’t. We often “work” those patients on scene until something changes, either we have a return of spontaneous circulation, or we decide that medical intervention is no longer able to help the patient. There are patient’s that do require the lights and sirens because there is nothing we can do, such as a stroke patient.

Paramedics are physician extensions, the same as a physician assistant or nurse practitioner. We are their eyes and ears in people’s homes and on roadways. We bring the patient’s story along with them to the emergency department.

Many people often think it is all blood and guts. Those calls are thankfully rare. Most of our calls involve geriatric patients that are acutely or chronically sick, and need some help on this day. It is more picking grandma up off the floor and making sure she is okay than it is car accidents (most of which are uneventful as well).

What are your average work hours? Is it a typical 9-5 thing or not?

In my agency, which is more rural than urban, we work 24 hour shifts. Sometimes days at a time. I just got off a 48 hour shift. I have 48 off, then I’m back on for 24, 24 off, then 24 back on. I worked 72 straight last week. No, it doesn’t make sense. We work 96 hours a week at my agency, most people in EMS work 48, often with 12 hour shifts. And yes, we do sleep at night if there are no calls.

What personal tips and shortcuts made your job easier?

I’m not sure there are any shortcuts that are helpful in EMS, but some of my tips are that every patient should be treated the way you would expect your family to be treated, and that we didn’t cause the emergency, people have called us on their worst day and expect us to help them. The way to do that is to remain calm and be professional. Be flexible. Things are going to change, be it with the patient, the job, medicine, or the industry.

What do you do differently from your coworkers or peers in the same profession? What do they do instead?

I spend a lot of extra time reading medical journals for EMS and physicians. Since I am an instructor as well, I am often planning education for the next meeting or upcoming classes. Medicine is constantly changing, and how we do things in EMS is not any different. I try to keep everyone up to date on the new information. I am also in change of quality assurance and improvement, so I read every report that our employees write, make sure our protocols are being followed, and that we are correctly treating our patients. This often makes me be seen as the bad guy, since I’m the one correcting peoples mistakes or showing where they can improve.

What’s the worst part of the job and how do you deal with it? I would assume being a paramedic is immensely stressful!

The worst part of EMS is working with children. I don’t mean that in “I don’t like kids.” I happen to really enjoy being around them, and I’m always happy to be there for them. But, we don’t get to see kids on good days. When you see kids hit and killed by cars, in cardiac arrest, abused, it is very hard, and can haunt you for a long time.

People that work in EMS have a very high burnout rate, most people don’t last more than a year or two before moving onto something else. It is physically demanding, and many of us, including me, are overweight. We don’t sleep well. EMS also has a high rate of divorce, alcohol and drug abuse, and has a higher rate of PTSD than the military. I have been diagnosed with PTSD myself, and have premature hypertension, nightmares, poor eating habits, and insomnia as a result.

What’s the most enjoyable part of the job?

Knowing that we do help people. Sometimes the days just start to blur together, and it is easy to become jaded. Running on alcoholics, psychiatric patients, and drug seekers gets old and some people stop caring. It is important to hold onto the good calls: the day we did save a child’s life, or helped someone’s grandma off the floor. When people thank us (which is surprisingly rare, honestly), it feels good. Recently we had a patient that was in a motorcycle accident and had a head injury and a collapsed lung. We were able to save his life, and he came in to our office to talk to me. He was difficult to handle on scene due to the head injury, but was able to fully recover. The look on his face when I told him I was the paramedic that day was wonderful.

What kind of money can one expect to make at your job? Or, what’s an average starting salary?

Pay can be a huge variable in EMS. An EMT will often not make much over minimum wage in my area. Being a full time Critical Care Paramedic at my agency pays around $45,000 a year starting (don’t try to figure that out against 96 hours a week, it’s depressing). I work for a city agency, and get very good benefits and a pension, but most are not that lucky. Unfortunately, EMS is very much still young. We are basically toddlers as an industry, and it will take some time before we get the same pay as nurses in the US. Personally, I find it an honor to be the person someone calls when their life has become a living hell.

How do you “move up” in your field?

Like I said, you start out as an EMT, then can move on to paramedic, then Critical Care (which is not another license, just a further education). The difference between EMT and paramedic is huge. It is like going from nurse aid to doctor. You not only know what to do, but why. You now can do things that might kill a patient if you don’t know what you are doing. If you want to move on from there, it can be difficult, as there is much further to go. Becoming an educator is always rewarding, but in Michigan it [requires] a state license just like your medic license, so it is more schooling. Depending on your employer, you may become a field training officer, supervisor, or manager. It can be very frustrating to suddenly hit a ceiling after becoming a medic.

Some paramedics make a move to become nurses, while some go to become physician assistants or physicians.

What do people under/over value about what you do?

I think many outsiders undervalue EMS, right up until the point they need an ambulance. To most people, we can be an annoyance. We made them pull over or something like that. A lot of people think we are often a taxi, and that we are just there to take a family member to the hospital. When I start doing an assessment and asking questions, they will often tell me, “The hospital has all that information.” And while that may be true, I don’t have access to it, and I’m going to be taking care of their loved one for the next hour or so, and it all may be important to my care.

What advice would you give to those aspiring to join your profession?

It is a great job and extremely rewarding if you like helping people. If you are in it to get a front row to someone else’s suffering, or because you think it is going to be lights and sirens and blood and guts, then this isn’t the place for you. It isn’t easy work, and you have to be able to handle those calls that are terrible. EMS is part emergency doctor, part social worker, part councilor, and part detective. It is a labor of love, and I couldn’t imagine doing anything else.