“I thought people would be nicer”: Why paramedics may not seem the most caring of the healthcare professions.

Chatting over coffee with one of our new grads recently, I shifted to conversation to see how she had been coping with the inevitable bullying that comes with working as a new paramedic.

Although seasoned in the workforce (she had been a teacher before joining ambulance), our intern/grad had been surprised by how some paramedics treated their patients and colleagues. To summarise her frustration she stated:  “I mean, for a job where we’re meant to care for people and help one another….I  kinda thought people would be nicer”.

I have to be honest, compared to teachers, social workers, physiotherapists and the majority of doctors and nurses, many paramedics aren’t as kind as others in ‘the caring professions’.

My theory for this is two-fold:

Firstly, paramedics, along with other front line worker such as police officers and emergency department staff often end up with ‘compassion fatigue’: you get lied to, abused, pour yourself out over and over again to patients who don’t appreciate it or self care and inevitably end up back in front of you all over again. You let yourself care about patients and then they do terrible things or die……. (no matter how much we humbly brush it off, yes you do see terrible things). After years of this, as well as seeing precious funding being wasted by government and organisational mismanagement, a lot of practitioners get a bit cynical ( or maybe burned out), and may not be as ‘caring’ as they once were.

It’s almost unavoidable.

Don’t get me wrong, this is certainly not the majority of people. Many of these ‘jaded’ healthcare workers, also deliver the highest quality of care, so be careful before you dismiss cynicism towards work as indifference regarding patient outcome.

But enough about front line workers. Let’s get back to being specific on paramedics.

To find why paramedics (especially senior ones and management) can be prone to treat those around them so terribly, it involves a brief understanding of where paramedicine has come from in the last 5o years.

Remember, going to uni/college to be paramedic is a very new concept.

Pretty much up until the late 70’s ambulance was just people driving around town in a vehicle that could carry someone lying down- they’d pick you up from the ground, put you in the car and drive you to hospital. If they were lucky, the paramedics would have oxygen and maybe a single type of pain relief (certainly nothing IV). Paramedicine was a blue collar job, with most guys (there were no girls in early ambulance) being ex-military or tradies. The internet is filled with horror stories of newbie medics turning up, being thrown the keys, and without google maps spending excess of an hour trying to find how to get to the hospital with a patient in the back.

This was pre- workplace health and safety. Pre safety glass, air bags and crumple zones on cars. This was a harsh work place and the bastardisation, bullying and abuse of new employees occurred as you would expect from hardened men making sure the new apprentices knew who was boss, and who could ‘take it’.

In the 80’s things began to change. Paramedics pushed to have more skills and interventions. By the time the 90’s rolled around, the worldwide concept of intensive care paramedics began to take off. Ambulances were actually kitted out, and the paramedics who drove them had pain relief and some other interventions. Yet despite some women now being in the service, it was still a blue collar job, and still filled with the same harsh bullying and tough guys attitudes that had prevailed before.

Here’s where it changed though: ambulance was now attracting different people. People who didn’t agree with the macho bull crap. But in order to make it, they had to endure the initiation rights, the bullying, the stigmatisms. They had to develop thick skin, and they had to force their judgement and opinion on others. Because the moment they backed down or showed any weakness, they would be eaten alive.

But somehow they did survive, and they laid the foundations for turning paramedicine into a respected aspect of pre-hospital care.

These people who helped forge the ambulance world we see today, are those that now occupy the senior roles. The current ‘old school’ of ambulance who bully, who abuse their power, who embarrass people or make someones life horrible simply to show that they can…… they are the way they are because they had to be. And there’s no way they’re going to change. They may be as subtle as the never present CSO who messes with students, or they may be as obvious as an abusive ICP.

But they unintentionally are training the next generation of paramedics to be the same as them. So unless a paramedic purposefully commits to not being a jerk, that’s what they’ll be.

Yes it’s getting better.

Not, not all experienced ambos are like this.

There is no excuse for bad behaviour.

But the reason ‘people aren’t nicer’ in ambulance, is because they were taught not to be nice.

And it’s up to us to break the chain.

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