Sunday, March 22, 2015

Observations of Cultural Differences

I got some excellent feedback on my last post, which brought up some more points for discussion on the differences between fire, EMS and law enforcement culture. Bear in mind, most of my experience comes from third service EMS, followed by fire, and zero in law enforcement.

Third Service EMS Provider Culture:

In describing the culture of third service EMS providers, I have found a universal lack of brotherhood and camaraderie among coworkers. The Socratic Medic wrote an excellent blog post observing this phenomena. EMS culture tends to be a very produce or parish culture, where you either hack it or you leave. There is not much support from others, though this is slowly changing with the popularity of CISDs (despite an overall lack of evidence for them).

Where EMS culture succeeds is in promoting independence. I once read a fire fighter blog describing this independence, and how people he works with of the EMS culture don't typically eat communal meals, or hang out and watch movies with the rest of the crew. Probational employees are not subject to the same level of hazing and harassment common to the fire service. This independence is an excellent guard against groupthink, but can also be damaging in that when the single EMS provider is suffering, he does not have an entire crew of brothers to support him. When a fire fighter is having a hard time emotionally, his entire crew of brothers builds him back up. When a fire fighter becomes ill or injured, his entire crew of brothers raise money to pay his bills. No such brotherhood exists in EMS. An EMS provider having a hard time emotionally often ends up self destructing. Ill or injured EMS providers go into debt.

Fire Fighter Culture:

Fire fighter culture succeeds in many areas where EMS culture fails. Fire fighters take excellent care of their people. They have a strong brotherhood, which to me is foreign and strange. Fire fighters drop by the station on their days off for coffee. They hang out together on their off days. The brotherhood among fire fighters extends far beyond the individual fire fighter's station. Out here in the west, many fire departments changed their patches or altered the painting on their apparatus with messages such as "9/11 never forget." Why? These western departments did not lose people in the terrorist attacks. Cops and paramedics died in those attacks, but police departments and ambulance agencies did not add those messages to their patches. It simply speaks to the cultural differences between these three facets of emergency services.

Fire fighters have a culture of pride and ownership, which causes them to train harder and take better care of their equipment. Some of this pride and ownership has to do with the fire service's strong hiring practices. It is not uncommon to have over 1000 applicants for one job opening. Fire fighters know they of an elite few who made it through where most others failed. It is also a lot easier to take pride in your work when you have a crew of people, a boss, and a union looking out for your best interest. Strong interpersonal bonds grow from working alongside each other in IDLH environments, where one person relies on the person next to him for survival.

But when that closeness crosses the bounds into elitism, the fire service suffers. Fire fighters who enjoy medicine are often rejected from this culture. In recent years it has become an imperative of the fire service to swallow up EMS agencies for revenue, and in most cases of fire takeover I have studied, patient care suffers. For one, fire services, with all their tradition, are often unwilling to adapt to the specialized needs of an EMS system, such as system status management, community paramedicine, and critical care transport. Tying EMS licensure to wage raises causes skills degradation by saturating an area with paramedics. Many fire departments put their new guys on the ambulances, and treat ambulance work like an undesirable chore you would make the probie do, like cleaning the toilets. Probies work toward a promotion to a truck or engine. No fire fighter joins the fire service because they dream of driving people to dialysis someday. This creates a situation where fire ambulance personnel hate their jobs, which causes patient care to suffer.

Law Enforcement Culture:

This is an area where I have zero first hand experience, and can only speak to what I have observed in others. Cops do not often socialize with non-cops. They have much pride in what they do. It is a culture that promotes independence. They work along side each other in life threatening situations, but they never seem to develop the same strong brotherhood type bond as in the fire service, and LEOs suffering emotionally end up self destructing for a lack of support.

---

In all cases, paramedics exist so that fire fighters and cops can have heroes too. To any EMTs, paramedics, fire fighters or LEOs finding this blog, please comment and share your thoughts.

No comments:

Post a Comment