I first saw this story Saturday night. My post originally was going to be short and sweet. After watching the video and then seeing the news story that could no longer be the case. This is a complicated matter and to not give it the attention or space it deserves would be just as wrong. For that reason I’ve broken the post up into parts that you can easily access here:
I know it’s a lot. I think this would easily qualify as epic. Ultimately you’ll decide by sharing it or not.
Polk County Paramedic Graham Judd posted a videos on Facebook ranting about the $15.00 an hour wage increase sought by fast food workers. He was also kind enough to put it on YouTube, so here it is…
Graham has been actively engaged in this debate. He has a number of posts on his Facebook Profile about the topic and is making use of the Hashtag #MoreValueThanAValueMeal.
I don’t think ranting against fast food workers is the right way to go about this. I also don’t think trying to compare what EMTs/Paramedics do to what Fast Food Workers do is fair, as Graham explicitly does. For that matter, he questions them on duties that fall under the job description of an EMT/Paramedic as opposed to the role of the Fast Food Worker that they function in.
That really annoyed me. Here is what Graham asked and I’ve decided to follow them up with my own answers to help provide a little clarity as to where I am coming from:
- “When was the last time you provided CPR on someone who went into cardiac arrest?” – How many cardiac arrests happen in fast food restaurants? More importantly, how many cardiac arrests does your system actually have? Chances are you are not doing an arrest a day. Even if you are, how many of them are you getting back with ROSC and neurologically intact?
- “When was the last time you shocked somebody with an Automated External Defibrillator back into a sustainable rhythm?” – Automated External Defibrillators deliver a shock that stops the rhythm, not put you “into” a rhythm. They are also designed for anyone to be able to use and there are a bunch of them stored in public places like airports, malls, and arenas.
- “When was the last time you provided emergency rescue breaths to an asthmatic who would have died without your assistance?” – How many asthmatics have asthma attacks in fast food restaurants? Better yet, what is your system response time that an asthmatic would have to wait so long for an ambulance that they would need to be ventilated? The vast majority of my asthmatics puff the pipe on the ride in. So either you have an asthmatic education issue or a system response time problem.
- “When was the last time that you had to go to a mother and father and tell them that their child was dead and there’s nothing more that you could do?” – When was the last time you had to do that Graham? No, be honest now, because thankfully it happens a lot less than you are making it sound. When it does happen the EMT/Paramedic should work the arrest and bring them to the hospital. I made my position on this clear in 2010. EMTs and Paramedics are not trained or equipped to assist grieving parents either at home or on the scene. I stand firm on that today. It’s a tragedy when it happens, and no amount of money will ever change that, so don’t try to cheapen it dragging it into this issue.
- “When was the last time that you had to crawl into a vehicle that was upside in a ditch in the middle of the night to pull someone out because they’d been involved in a severe car accident?” – Unless it was in the drive-thru, not likely. This is actually the only scenario I see happening at least once if not more during a work week.
The job description of an EMT/Paramedic is different than that of a Fast Food Worker. Therefore to compare the duties of each is like comparing apples to oranges. If you want to compare job duties and compensation why aren’t you comparing Paramedic/EMT to Firefighter or Law Enforcement Officer? Those are jobs where there are a number of similar duties and the wage gap is there.
Now, believe it or not, a lot of the things he says in the video I actually agree with.
The News Story
So the video got quite a few views and grabbed the attention of the local media. They did a story on Graham right here:
I felt it was a fair and honest news story. Of course the part that irritated me happens at the 0:46-second mark. At that point Graham says, “What we do is save lives.”
The truth is we don’t save lives.
In this world nothing can be said to be certain, except death and taxes. – Benjamin Franklin
Everyone, at some point and time, will die. This is an indisputable fact.
Another fact is that the overwhelming majority of attempts at extending a life end up as failures. In July of 2011 the Centers for Disease Control and Prevention (CDC) published a report on Out-of-Hospital Cardiac Arrest (OHCA) Surveillance10. The report is derived from 31,689 OHCA cases submitted from locations throughout the country. The overall survival rate through hospital discharge was a mere 9.6%.
To put it in layman’s terms, if there are 100 out of hospital cardiac arrests today then 10 of those (9.6% rounded up) will get Return Of Spontaneous Circulation (ROSC) and eventually be discharged from the hospital.
But neurologic status matters, because if someone is being discharged from the hospital in a vegetative state or with a severe disability then their quality of life will be harshly altered. To measure neurologic status post-cardiac arrest the Cerebral Performance Category (CPC) is the supposed gold standard for assessing neurological recovery after a cardiac arrest. Patients that were discharged with a CPC of 1 or 2 (with no or little neurological problems) totaled 493 of the 625, for a percentage of 78%. That number may actually be higher, but there were 86 cases where the CPC was unknown.
So to translate that in layman’s terms, it there are 10 patients with ROSC then at best only 3 of them are being discharged neurologically intact.
When it comes to “saving lives”, we have a 3% success rate.
If the fire service extinguished only 3% of the fires, could they say that they extinguished fires? I suppose so if anyone could see them through all the smoke as the world burned. If law enforcement arrested only 3% of the criminals, could they say that they were enforcing the law? I guess they could, but chances are whoever they would have told that to probably didn’t make it in because they got robbed, or their car stolen or perhaps murdered. If your local fast food chain delivered edible food only 3% of the time, do you think people would keep going there to eat? No, they wouldn’t.
Why do we continually insist that we “save lives” when, by the numbers, we only really do so around 3% of the time? Maybe it’s because we were spoonfed it growing up, the propaganda machine just continues to lumber on, and we cling to it in denial that we really are not good at it. Whatever the reason may be it’s at best an extreme stretch of the truth and at worst an outright lie. We need to stop doing it.
This little piece right here is really the cliff notes version of Chapter 10 in 25 Things They Should Have Taught You In Medic School… But Didn’t.
I just saved you $2.99.
What EMS Actually Does
In another post on this topic, I made mention of the above, that EMS doesn’t save lives. I received a comment from Daniel that said:
Interesting coming from a medic when you say we do not save lives. What do we do then? I mean, if someone is having a myocardial infarction and are only saved by the CPR we provided…or arterial bleeding that we stopped…they are now alive when they otherwise would not have been.
It’s simple really. It’s a philosophy I’ve held for at least the last 8 years. I’ve written about it, talked about, and try to live it every day.
EMS changes lives.
This is what we in EMS truly do. It is our calling to change the lives of others for the better and it is what we need to prepare to do every time we put on the uniform, answer the pager, and arrive on the scene. The trust people put into us to change their lives is sacred. The ability to change lives for the better is the most powerful thing you can do.
Want to know the best part? You can do it every single day in ways you may never have imagined before. It doesn’t need to be a cardiac arrest call in order to do it. The success rate of being able to affect positive change is far greater than attaining ROSC and a neurologically intact discharge. We can do it by maintaining a positive tone, listening to their needs, rising up to meet those needs beyond their expectations, and by simply touching the patient or their family while reassuring them that they are being cared for. Truly, undoubtedly, and without question cared for.
That tidbit of information right there is really the cliff notes version of Chapter 25 in 25 Things They Should Have Taught You In Medic School… But Didn’t.
I just saved you another $2.99. So please feel free to go buy a copy with at least one of the $2.99’s I just saved you.
The True Value of What We Do
Graham posted this picture… the one that reads “$15 per hour sounds great but really, I’d save you for free.”
So if the guy who is ranting about how little EMTs and Paramedics get paid is willing to do the job for free, then obviously society places the same value on the service as he does… and we’ll continue to be paid next to nothing. The Fast Food workers are NOT willing to do their job for free. Don’t be mad at them because they have higher self-esteem and value what they do more than how we value the work that we do.
So what is the true value of what we do? How do we determine what is fair and what is not?
The truth is we as a profession don’t.
It is the customers who will determine what they are willing to pay and what they aren’t willing to pay for a product or a service. The fact is that Americans have already indicated how little they value EMS by such things as allowing the Zadroga Act to expire and the seeming country-wide budget cuts as reimbursement decreases while operating costs increase. This is where I fully agree with Graham, American priorities are screwed up.
The way we can change this is to stop focusing being successful on what usually ends up being about 1% of a system’s call volume and instead focus on the 100% of the system’s call volume. Don’t just look to meet the expectation, but look to exceed it. It won’t be an overnight transformation. Once your goals are properly aligned for broad success instead of narrow failure, amazing things can happen including better morale, better work conditions, and better pay.
I understand the frustration that lead Graham to make that video. There are some things in there that I can definitely agree with. The two things I am in disagreement with is trying to compare two completely different jobs and continuing the false EMS propaganda that is both factually inaccurate and utilized in a way to put others down for what they have chosen to do as a career.
Instead of spending energy arguing about whether or not Fast Food workers deserve to make $15 an hour, I’d rather see us use that same energy and prove why we deserve more than $15 an hour. That criticism definitely includes myself, because after four hours and 2,060+ words I have spent WAY too much time on this.
With that said, be well and go change some lives…