July 20, 2020

Bandage, Sort, and Hustle: What is it like to be an Ambulance Worker?

Author photoBy Karen Sternheimer

The recent COVID crisis has drawn our attention to the risks health care providers take in treating patients. Ambulance personnel are on the front lines, often the first responders in treating injuries and illnesses.

As this recent PBS Newshour interview reveals, not only are Emergency Medical Technicians (EMTs) in high-outbreak areas regularly exposed to COVID, they bear the emotional scars of feeling like there is little they can do to help the COVID patients they transport, all while earning relatively little pay.

Ironically, their work often provides no health insurance, as the last three minutes of this clip details:

What is it like to be on the front lines? Sociologist Josh Seim conducted an ethnography of ambulance crews, first by riding along for nearly a year and later by becoming part of the crew as an EMT himself for nine months. The goal of ethnography is for the researcher to better understand and share with readers what it is like to be a member of this group. Ideally, ethnography also connects the everyday experiences of the participants to the larger social structure to help us understand the larger context that ambulance workers operate. (Full disclosure: Seim is a colleague in my department.)

In his book Bandage, Sort, and Hustle: Ambulance Crews on the Front Lines of Urban Suffering, Seim takes us inside the ambulance, where we learn about the kinds of cases ambulances respond to. In contrast to television dramas, where every case is truly a life and death action-packed adrenaline rush, many of the calls are not exactly emergencies. These might involve minor, non life-threatening health issues exacerbated by the lack of access to primary care, or cases where a person is drunk and disorderly in public and disturbing the peace.

Seim observes that these calls are seen as “bullshit” calls, while shootings, traffic accidents, and serious medical emergencies are deemed “legit.” He details in his second chapter how ambulance crews view the latter as central to their professional identity, as they gain honor in practicing their skills in serious emergencies. Of course, the most serious cases can take an emotional toll as well. Seim describes how responding to a brutal rape case was so difficult for him that he could not continue working as an EMT afterwards, acknowledging that most of his coworkers did not have the option of returning to academia as he did.

Ambulance work does not take place in a vacuum. We learn about the private company that operates the ambulances and their contract with the county government. The company faces pressures to earn money while meeting the county’s requirements and avoiding any penalties for failing to do so. This means keeping ambulances moving and responding to calls, which in turn can mean limited breaks for meals and bathroom stops for crews.

Ambulance crews also work with hospitals and law enforcement and have to navigate sometimes-difficult situations with both. While responding to a violent crime is more clear-cut, many police-involved calls “involve the police forcing ambulance crews to transport people by writing seventy-two-hour involuntary psychiatric holds” (p. 87). This, in turn, can lead emergency room personnel to resent EMTs for bringing such cases into their departments. “There seems to be a near-universal frustration with so-called bullshit,” Seim writes, describing the process as “burden shuffling” (p. 87).

Ambulance workers have to negotiate all of these cross-organizational relationships as well as their usual duties: driving quickly through traffic to handle “legit” medical emergencies when they arise. They do this “for pennies above the county’s living wage” (p. xiii). By helping us understand the realities of ambulance work, we are better positioned to think of how it might be improved.

For one, Seim suggests that we think about the larger issue of health care access. Throughout his book, he never loses sight of the fact that ambulance workers are dealing with human suffering, whether they are dealing with an acute medical emergency or not. He suggests “decommodification” of ambulance operations, decoupling it from profit or other monetary metrics governing its purpose. He also suggests that EMTs experience “a transformation of vocation,” where they have training in life-saving skills but also some basic social work tools. This would of course require better pay, and as the New York-based EMTs highlighted in the video above, health insurance.

Ambulance workers have always been “essential workers,” and they should be treated as such now and well after the COVID crisis has passed.

Want to hear more about the book and how Josh Seim gathered and analyzed his data? Listen to the podcasts below.

Josh Seim book overview

Josh Seim methods

 

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