Why We Burn Out.

In a perfect world, EMS workers would acquire their license to practice and press perpetually onward, never waning or questioning their efficacy or the measure of their efforts. We would all go to work and feel a deep sense of reward for every time we make a difference in the life of a patient. That, along with modest pay, would be enough to sustain us and we would never, ever burn out. Reality is different, and we do burn out. Some faster than others, a seldom few never at all, but the majority of EMS personnel do eventually burn out. Why?

Each EMS worker is pregnant with conjectures a plenty as to why this may be: poor wages, poor working conditions, the political climate of their local governments handcuffing operational efforts, lack of quality education, lack of career path, and the list goes on. To trim the fat (i.e. the internalized BS we all eventually try to solidify as undying truths) I would ask that any of these conjectures that were not with you when you first decided to wear the badge of fire and EMS, be disposed of. I remember being green, and I decided to do the job because I wanted to help people. I wanted to give myself to others and hope that made life seem full of purpose. Quite a mutualism, really. When I first began, I didn't care much about politics, wages, or any other extraneous excuse for my malcontent.

Of all the reasons given, which would truly sustain us, almost indefinitely, and see us through to the end of a rewarding and wholesome career? Allow me to address each common retort to burn out:

1) Lack of wages.

Fire and EMS do not pay especially well, but given that most of our schedules are favorable, they do allow for external ventures which would assure us more pay on the side. The key, as a former sergeant named Dave Williams told me long ago, is that we don't find ourselves in a financial predicament where we will forever be forced to work two jobs. If we made six figures, would we remain happy forever? Some people may be, but not everyone. I still envision griping at shift change, moaning about running calls after midnight, and feeling slighted when we transport the person who stubbed their toe. No amount of money changes how we address being met by those challenges. And believe me, they are challenges - they challenge our patience.

2) Lack of political backing.

It can be disheartening when our elected leaders don't outwardly support our agency, but how deeply would we allow that lack of support to affect us? It is us who are tasked with deciding how we let their decisions as political leaders affect us. They give us the equipment, the trucks, and the benefits, sure, but they are not the ones who decide what we allow to bother us - we are! Every time you allow a politician to bother you, it is not because they willed it to be so, it is because you allowed it to bother you. Every time we are met with external stimulus, we are making a decision about how we feel about it, and ultimately we are the gate keepers to our own disposition, and our own outlooks. Even if there were a political paradigm shift and commissioners began throwing themselves at our feet, would that good feeling sustain us over the course of a 30 year career? I believe it would not. I think we need something more to sustain us, and political backing isn't it. Political backing is an ephemeral occurrence, a hot button issue which comes and goes with the times.

3) Lack of education.

Especially within EMS, we often feel slighted by other medical professionals, and we feel we do not garner the regard due to us. The truth is, we are owed nothing. Short of legislature which mandates an associate's degree at minimum to practice as EMTs and paramedics, this may not change. Would be instantly be granted increased credibility upon jumping through more hoops to practice emergency medicine? I do not think so. It seems to me that we, as practitioners, could simply do a better job as a whole, and that would organically shift the perception of EMS. If we surmise that the real studying begins once paramedic school ends, and we seek out meaningful continuing education (more than just "getting the hours" needed to maintain credentials), and we bury our noses in peer reviewed journals and statistically-sound medical studies, we will get that more favorable perception eventually. But too many of us become complacent, and we stop being students, we stop learning and at that point we languish instead of thrive. We gradually become more ignorant about the ever-changing and fluid nature of medicine, and we are left behind like fossils. That is what garners the negative perception, and we shouldn't wait for legislature to mandate degrees to change that. We can start now by trying harder.

Those are three of the most common complaints I hear that attribute to burn out. In addition to the bellows of "I'm tired of running BS calls!". I have news for you: nurses, doctors, and so on also have to deal with bullshit. You are not above it just as they are not. When you say you are tired of bullshit calls, you are entitling yourself to a more dignified job which simply does not exists. Here, in reality, we run bullshit calls, a lot. If you grow tired of it, then begin educating your patients and make an earnest attempt at doing so. If people truly tried to educate their patients, they would make a difference. Some people simply feel resigned to complain idly about every single nuisance of the job and they would not have it any other way.

So I've cut through all of these with my medical shears: lack of wages, lack of political backing, lack of education, and surplus of bullshit calls. If these are not the true contributors to burn out, then what is? Perhaps you pinned it down before this blog, or you surmised it while reading it: it starts with you as the individual.

I do not dig entitlement, or reaching for external resolutions to problems which we have internalized in the first place. It is up to us to decide to not be bothered by the influx of bullshit calls. It is up to us to be thankful we're even getting paid to help people in the first place. It is up to us to make this job feel as meaningful as it really is! We DO a meaningful job, and whether imperceptible or not, we make a difference with every - EVERY - call we run. It is up to us to reflect on the call and realize that we tried our best to make for a better outcome for each patient we treat. That includes the bullshit calls.

It is up to us to honor those who have died in the line of duty to try our best, to be our best. It won't be handed to us and it requires some sweat effort on our behalf. Study hard, work hard, and expect nothing. If you do these things, you can maintain the same happiness I maintained for nearly eight years doing the job. If you can reflect on each run and realize that you did, in fact, make a difference, that positive energy may just be enough to sustain you until retirement. At that point you can be incredibly content simply knowing you spent a large chunk of your life making other peoples' lives better.

We burn out because of us. That is my foolish and limiting belief. We are ultimately responsible for ourselves and for how we react to adversity. In essence, we determine how strong and resilient we will be. So, do it.