I believe it all started in the weeks following the 9/11 attacks. The transformation was subtle at first and then gradually became more palpable. The change was slow enough that lots of us probably failed to notice. What I am referring to is our interactions with EMS.

In the months following the attack, the entire country looked at our EMS providers and firefighters in a different light. We saw bravery in action and suddenly realized that these men and women have dangerous and difficult jobs. The vague understanding that firefighting and lifesaving is potentially dangerous work was made manifest when 343 died in the time it takes to brew a pot of coffee.

People started wearing FDNY hats and shirts. Young men and women found real heroes to emulate instead of the parade of empty headed idiots we get from popular culture. Firefighters and EMS providers walked a bit taller and felt even better about what they did for a living.

Along with this positive transformation, I also noticed that providing feedback to the EMS community became more difficult. Even writing what you are about to read is really sticking my neck out. What I have found, over the past decade, is that people in the EMS system tend to bristle at negative feedback and even find ways to turn it back on the person who is trying to be helpful. Suddenly the person trying to be the good guy is the bad guy.

One might argue that we should not be critical. These are, after all, community heroes doing tough and dangerous work. Why not just leave it be? That’s all well and good; however, we should recall that every paramedic operates under the license of a physician. Although we are colleagues and we should always be collegial, paramedics are in a subservient role, and it is our job to oversee their performance. The tail does not wag the dog.

Now some paramedics are quite open to feedback and often invite a critique of their performance. Others, however, are quite sensitive about criticism and will drag their hurt feelings as far as someone will listen. Some feel the necessity to grumble all the way to the office of the CEO.

Asking too many questions on the radio, questioning why a stable patient was taken to you rather than the hospital where they were admitted a week prior, and suggesting that an action would have been better taken after discussion with medical control are all offenses that can land you in hot water with your medical director or your administration.