Three Phases of Being a Paramedic

I have thought about this for awhile. I did some Internet searches, but came up with nothing. I even asked some of the veterans in the profession whether they’ve ever thought about it. None had, but they quickly offered their suggestions. I agreed with some of them and disagreed with others.

What I wanted to know is why some paramedics act differently toward the job than others. Why do some paramedics exhibit high levels of enthusiasm while others seem to be just going through the motions? Why do others have more energy than a 3-year-old child who just drank a can of Jolt?

This has been puzzling me because, over time, I have seen one particular paramedic display all of the behaviors I just described. The answer is simple: There are different phases of being a paramedic.

Phase one is the “Newbie Phase.†This phase is represented by new paramedics – those who just received their licenses, completed their firefighter certification classes and have been hired by their first departments. They are full of excitement and probably had a hard time sleeping the night before their first shift. They have their new paramedic licenses in their hands and they want to take them out for a spin to see what they can do.

Their approach to the job and the profession is pure excitement and adrenaline. They look forward to coming to work every day and dread missing a “good call.†Within their six months on the job, however, they discover not every call involves a shooting, stabbing, car accident, major trauma, heart attack or cardiac arrest. Sure, some of those “good calls†are mixed in, but the majority of calls are routine. They begin to think, “Wait a minute, I watched those old reruns of ‘Emergency!’ and Johnny and Roy were always going on exciting calls and saving lives. I don’t remember any calls where somebody called because they needed a prescription refilled.â€

This is when the new paramedic begins the slow and methodical journey into phase two – the “Burnout Phase.†This phase comes about slowly, over time, and can take years. In essence, the paramedics came into the profession with idealistic fantasies about what they are going to be doing and accomplishing and what kind of difference they were going to make. But responding to too many 3 A.M. calls for people who have had rashes for weeks begins to eat away at their conviction toward the profession.

Following Orders

Another factor enters into the equation: In school, paramedics are taught to be independent and autonomous decision makers. After all, this makes sense. Many times, they will have to function on their own without the benefit of another paramedic. Now, here comes the dichotomy. Particularly in the fire service, paramedics are integrated into a very structured environment. They are always accountable to someone, even if that person is not on the scene. This tug-of-war can cause conflict in paramedics and accelerate the Burnout Phase.

This is a critical point and can also last for years. Will the paramedics survive? They are vulnerable at this point. Complaints from citizens will increase because of the paramedics’ attitude on calls. Their use of sick leave increases and they become more susceptible to injuries. Paramedics in this phase will find themselves trying to talk patients out of going to the hospital.

Many will begin thinking about another career. Some will think about bridging over to nursing. Others will think about going into completely different lines of work, which can include joining a family business or even taking a lesser-paying job without benefits.

Many will leave the profession, but others will move to another department thinking that will solve the problem. In some cases, a move to another department will help. Paramedics who leave poorly managed departments where morale is low and suddenly find themselves in better-run departments, on good shifts in good engine houses may find that their burnout becomes more tolerable and may be offset or even reversed. Still other burned-out paramedics will find support from peers while others will consider giving up their licenses and performing only firefighting duties.

Paramedics who make it through the Burnout Phase eventually will transition into phase three – the “Tolerant Phase.†One may even think congratulations are in order. You have made it through the Burnout Phase and survived. You can now tolerate anything that comes your way. A patient who calls at 4 o’clock in the morning because he scratched himself while he was clipping his toenails does not bother the paramedic in the Tolerant Phase. Unlike the Burnout-Phase paramedic who will try to talk the patient out of going to the hospital, the Tolerant Phase paramedic tells him to “put your shoes on and let’s go to the hospital.†In some ways, such paramedics cherish these calls because there’s no hard work to do and no ambulance to clean up. These paramedics let most things rolls off their back and generally do not get too upset about anything. They are more “tolerant†of new rules in the department that make little sense, they usually mind their own business, and they know the system backwards and frontwards. They become the seasoned veterans who have “been there and done that.†There is very little they have not seen, especially if they work in suburban or urban systems where call volumes are high. The Tolerant-Phase paramedic usually puts 20 or more years into the profession before being promoted or retiring.

Exceptions, as Always

Now, before I am bombarded with e-mails from those of you who disagree with this theory, let me add a disclaimer: I am not an industrial psychologist, so I have no scientific data to support my ideas about the three phases of the paramedic profession. They are merely my observations of the behaviors of paramedics over the years.

Second, there are always exceptions to the rule. I have seen paramedics never leave the Newbie Phase, even after 25 years of service. They are just as excited to come to work in the 25th year as they were on the first day of the job. Other paramedics seemed to be burned-out on their first day, while others skip right to the Tolerant Phase within their first six months. There will always be exceptions that skew things when you are talking about human behavior. The important thing to remember is that regardless of what phase you are in, this is a great profession with fantastic people working in it every day.

Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 28 years of fire-rescue service experience, and previously served 25 years with the City of St. Louis, retiring as the chief paramedic from the St. Louis Fire Department. Ludwig is vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC), has a master’s degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally. He can be reached through his website at