When a medical emergency occurs, the first professional a patient comes into contact with is usually a paramedic in the ambulance. Paramedics often work long shifts in high-stress, life-or-death situations. Due to the physically (and psychologically) demanding nature of the job, workers frequently burn out, which can lead to shortages.
Jason Hernandez is a paramedic with MedStar in Fort Worth, Texas. Hernandez was awarded the American Ambulance Association’s Star of Life award last year for his dedication to his work.
For The Atlantic’sseries of interviews with American workers, I spoke with Hernandez about the stress and chaos of being a paramedic, and how he handles medical emergencies and family members. The interview that follows has been lightly edited for length and clarity.
Bourree Lam: What do you do as a paramedic, and how did you get into it?
Jason Hernandez: I'm a paramedic with MedStar, so I’m a 911 respondent for emergency medical services (EMS). I got into it in college; I have an associate’s degree in paramedicine. I was planning on doing firefighting, but in the end, I found that I just really enjoyed the medical work.
Lam: What did you like about it?
Hernandez: It takes a lot of thought. It’s different every time; there’s no monotony to it. Yesterday, for example, I had two patients with almost identical symptoms, but completely different problems. They were both having what appeared to be anxiety attacks, but one was, I believe, cholecystitis—gallstones. The other patient had a broken rib, but the symptoms were exactly the same.
Hernandez: Usually, I get up and get ready for work around 2 p.m. because I work the night shift. I’ll roll into work and pick up our supplies at the counter. I typically start my shift around 4:55 p.m. We get a page and we are told to go to that location and wait for a call or until somebody else needs to fill another post. Typically, the most frequent calls are a toss-up between psychiatric or chest pain.
For psychiatric calls, you never know what’s going on. It could be anything from somebody calling for a medication refill—where they just want to go to the hospital to get their medication—to a schizophrenic episodes or suicidal ideations.
For chest pain, which is another really frequent one, those are harder to diagnose. It could just be acid reflux, or a heart attack, or an asthma attack, or a blood clot in the lungs. There's no sure way of fully diagnosing it in the field. You’ve got to use all of your knowledge to figure out as best you can what they’ve got going on.
Lam: What are some other challenges that you deal with?
Hernandez: There are challenges all over the place. Everybody’s got a different thing going on. You have to worry about the dangers of a chaotic environment, from violent people to safety on the road.
Lam: How do you deal with the stress of all that chaos and uncertainty?
Hernandez: As far as not being sure what’s wrong with a patient, we will pick the worst thing that we can possibly treat if we're not 100 percent certain. A heart attack is typically going to be the worst thing that we can treat. The medications that we give for it are relatively benign: aspirin to prevent the blood clot from getting any larger, and nitroglycerin, which dilates the blood vessels to allow blood flow back to the heart. If I am in doubt, I run every test that I can. If it still could be a heart attack, I’ll go ahead and treat for that because it’s not going to hurt them to get aspirin and nitroglycerin—but it could save their life.
Otherwise, a lot of the other symptoms will show signs. If you’re having an asthma attack, it’ll show up in the lung sounds and the vital signs. If it were a pulmonary embolus, it’s similar to a blood clot in the heart, but it’s in the lungs. It kills a lot quicker. What you end up dealing with are people who are sick, and in a lot of cases, they’re sicker than you might realize initially because we can’t get a full diagnosis. It’s hard to tell the difference between those, and so your perception may be that they’re not all that sick when, in reality, they are sick and you need to get them up to the hospital.
As far as the stress goes, everybody’s got his or her own different way. For me, a lot of times it’s talking to friends and family about what I’ve seen that day. We lighten the situation with jokes. Primarily, my wife is the one who gets to hear about it. When I get home from work I’ll tell her about how my day went. If there was a particularly stressful call, I'll tell her about that one. There have been times when I’ve had to go see a therapist just to talk about it.
I’ve been doing this for seven years. For the most part, my life has to bend around my job. When I’m working, I work a 12-hour shift. For the most part, I can’t do anything else unless I sacrifice sleep time. Then on my weekends, I get to hang out with the wife. EMS, it’s literally half of my life. I’m getting used to the fact that sitting in an ambulance ends up being more time than I get to spend with my wife. It’s almost like having a second marriage. That ends up being one of our jokes.
Lam: When you’re working, do you have downtime until you get a call?
Hernandez: Yes and no. There are no specific duties that we have to serve during our downtime. Usually, if we're sitting in the ambulance and we've got a little bit of downtime, we'll sit back and watch a movie. But typically, there's not a whole lot of downtime.
We run off of what’s called system status management. There are a lot of studies to figure out roughly how many ambulances we're going to need on a given day, and then we try to get pretty close to that number. The idea is to use the fewest amount of resources. Usually, they’ll staff six extra units over what we need on average for that day.
Lam: Are there any misconceptions about your line of work?
Hernandez: People perceive us as a taxi for the hospitals, which goes all the way up to the government level as far as how we are billed with Medicare and Medicaid. The patients that call us to get their medication refilled, for example—that’s not exactly the appropriate use for an ambulance, but we won’t say no. If you call us, we’ll take you up to the hospital.
For the most part, people don’t really understand exactly what it is that we're trained for. When we go through school, the primary focus is emergencies—things that are going to kill you in the next 15 to 20 minutes or the next few hours. If it’s severely painful, and you feel like it’s beyond what you can handle, we're trained to treat the pain in that case.
Lam: How does that make you feel when people treat ambulances as a taxi for the hospital?
Hernandez: That’s frustrating. When you go to school and learn about emergency medicine, you're trained for the emergencies. When you're released into the field, your perception is that you’re going to be dealing with the sickest people.
At this point in my life, if you call, I’m happy to take you up to the hospital. It’s a struggle to come to grips with how frequently people call you for things that don’t necessarily require going to the hospital. You either come to grips with it, and you just say, “Okay, it’s part of the job,” or you end up burning out, and you’ve got to get out of EMS.
Lam: Are there other hard parts about your job?
Hernandez: Absolutely. There’s one call that stuck with me; it’s just one of those calls that I’ve never fully gotten over. [There was a motorcycle accident and] there was nothing we could do for him. Before we managed to get off-scene, his wife came up. She didn’t quite make it to the scene; she got to the railing overlooking the highway on the bridge. She stood there, and just started screaming. It was an anguished scream. That still stays with me. Then, I ended up meeting some friends of theirs a couple of years ago, and found out that she committed suicide over his death. That sticks with you. For me, seeing trauma like that doesn’t really bother me. It’s the reaction the families have to it. If I have to get to know the person through their family, it becomes a lot harder. You’ve got to find ways to cope with that.
Lam: In spite of that aspect, what are some rewarding parts of your job?
Hernandez: When you save a life. It can be as simple as a diabetic person that took too much insulin and their sugar dropped. After about six hours of having your sugar too low, it’ll absolutely kill you, but it’s an easy fix. It’s something that we can fix in the field, and so we’ll start an IV. We’ll give them some glucose in their vein and five minutes later they’re awake. That’s one of the simple ones, and it’s just kind of a quick little boost. You get those pretty frequently: You have saved a life. Somebody noticed that they were unconscious, and we were able to give the right medication, and figure out what was going on. By the time we are ready to leave, they are back to normal. That’s a cool thing.
The other one is when you get one of those bad traumas. You’re not necessarily saving them, but you are keeping them stable and alive until you can get them to the hospital where a surgeon can take over. Those are the situations that keep you going back every day.