Administration and Leadership, Commentary, EMS Today

EMS Today Keynote: Rommie Duckworth Issues Challenge

My name is Rom Duckworth, and I’m a paramedic. For just over 30 years, I’ve served in career and volunteer departments, hospital-based healthcare and commercial EMS. Like many of you, I’ve seen a lot of weird stuff in that time. On the one hand, I’ve probably not done as many really bad pediatric calls as you’d think, but on the other, I’ve managed to find myself at an unusual number of disasters including Hurricane Andrew, a 3-school-bus crash at our local high school and I led a team operating adjacent to World Trade Center Tower 2 on Sept. 11, 2001. In reflecting on this, I’ve begun to realize that these aren’t just calls I’ve been on. This isn’t just a job I do. This is who I am. I know that for many of us, this not just what we do. This is who we are.

I see this in the role we typically play in our families. Are we the family fixers? How many of you have had this phone conversation? “Why are you calling me? Call 911! Wait, let me find out who’s working first.”

Whatever color uniform we wear, we share both the satisfaction and the burden of serving those in our communities. Every day, we deal with new personal and professional challenges. Sometimes we struggle to find the mental, physical and emotional strength we need to meet the difficulties that we face. Often, we eat and drink too much and exercise and sleep too little. Add to that the physical and psychological stresses of the job, and we find ourselves in a profession that will grind us up if we’re not careful.

We have to take care of ourselves. But I want you to know that when we feel we don’t have the strength to stand alone, we must find the strength within “us” as a family of emergency responders and healthcare providers working to care for our patients and our communities as we watch out for each other.

I believe that part of being able to find that strength is being able to articulate: “What’s the value of EMS?” We provide a dynamic workforce helping to manage emergency scenes and deliver on-site emergency medical care in a ridiculous variety of environments at any time of the day or night. We do not care about your race, creed, background or ability to pay. All that we care about is that you need help. We hold a special place in our communities because of this. We’re motivated to do this not because of the attractive pay and benefits package. We do this because it has tremendous value. And yet, we still undervalue it.

I want to share something personal with you. This is a call that really opened my eyes to the difference we make as EMS providers. It happened on Thanksgiving about 10 years ago.

We had all finished a big Thanksgiving meal when a call came in for shortness of breath. We responded four people — two on an ambulance and two on an engine. I was on the ambulance double-medic that night. They were an older couple having Thanksgiving alone. The wife meets us at the door and tells us her husband has a history of CHF and COPD and wasn’t feeling well after dinner. I’ll tell you that he was a big guy, so you tell me where he was in the house. That’s right, on the second floor, but where specifically on the second floor? That’s right, the bathroom. But where specifically in the bathroom? That’s right seated on the toilet. We see right away this guy isn’t doing well, so I ask my partners to get him out of the bathroom and down to the ambulance and I ask my captain to help the wife with whatever she needs for the trip to the hospital.

As the patient continues to struggle to breathe, we struggle to help him. We use every tool and technique we can think of, but it’s all we can do to get him intubated and keep his saturation from falling any further. Eventually, we get him handed over at the hospital, but they struggle as much as we did. As I pack up our gear to put the ambulance back in service, I see the man’s wife and help her to the family room. I am as encouraging as I can be but let her know that things do not look good. I tell her that we have done everything we could in the back of the ambulance, but we had failed to turn things around. And that’s how it felt. We had failed. As a paramedic and as a person, I felt like a failure. And then, a few weeks later, I get this exact letter.

This very small token I offer with more appreciation and gratitude than I can put into words. Four or five emergency medical personnel arrived at our house at about 9:30 on Thanksgiving evening. I’d called about my husband, Ed, and (no surprise) you arrived speedily and went to work trying to make the situation a better one.

Despite everyone’s efforts, Ed died the next evening at (the) Hospital. I have yet to begin to believe that this has happened; but what I will not forget – ever – is the kindness of all of you, some of whose names I didn’t ever know. But Mike and Rom spoke to me in the emergency room and wished us well; my thanks were heartfelt, but my appreciation felt inadequate compared to the compassion you all had shown to us.

I experienced a similar event in August of 1988 when we lived on (another) Street; you rushed my first husband to the hospital, where he also subsequently died a day and a half later.

So much of the sting is taken out of crises like this when one has no doubt that everyone involved has done absolutely everything he or she possible could. Despite the fact that the outcome in each case was not the one I wanted, I am left with no resentment or recriminations; that is an enormous gift.

I am so grateful to have lived in Ridgefield for 35 years and to know that we can count on you to help when we need it. Bless each one of you; know that our family thanks you.


Whether you realize it or not, every one of you has a story like this. How many lives do you affect if every call you go on you meet a patient, maybe their spouse or significant other, and maybe a bystander? Three people per call. Three calls per day, Three days a week (and three more on Sunday) – that’s 30 people a week. That’s 1,560 people per year that you are affecting their lives. Multiply that by the people reading this, and that’s more than half a million people per year, every year, just for us. That is the strength within us. We don’t just run calls. We serve communities. We help people. We help families. There is nothing more valuable than that.

“Emergency Care.” We do both. The emergency and the care. And that’s tough. I’m not going to lie to you. There are some difficult challenges ahead for EMS. There are some controversies. What do we call ourselves? Do we need degrees? Are we healthcare, public health, or public safety? Do we give epi?

We have a lot to figure out, and it is going to be hard work to make things better. But Dr. Martin Luther King Jr. didn’t give that famous speech called, “I have a lot of problems.” He said, “I have a dream.” And that’s where we have to start. 

My dream for EMS is for a diverse but unified service that is part of a whole system providing immediate care to anyone, anywhere, anytime, using tools and techniques that have been proven to improve patient outcome. And I’m not the only one. Take a look at the EMS Agenda 2050. See what EMS should be in 30 years. That may seem like a long way off, but I’ve been in EMS 30 years and I can tell you when you look back, it goes like that!

  • Safe and effective
  • Integrated
  • Reliable and prepared
  • Equitable
  • Sustainable and efficient
  • Adaptable and innovative

This is where we need to be. This is what we need to be. But we can’t accomplish this if EMS in the United States remains as ridiculously fractured and isolated as we currently are. Who’s to blame? Who got us into this mess? At this point, who cares? We certainly have a lot to learn from mistakes of the past, but more important is our focus on the future. It doesn’t matter the size of your organization. Where there is weakness and “I” and “me,” there is strength in “us.” We may have to give a little, but we’re going to get a lot back if we can learn to work together better than we do right now.

Henry Ford said: “Coming together is a beginning. Staying together is progress. Working together is success.”

You can learn and study and practice and be the best individual EMT or medic in the whole world, but it isn’t going to help if you’re still working within a broken system. I wish I could give you all the answers. I wish I could wave a magic wand and give you all the resources you need, but I can’t. That’s going to feel uncomfortable, but that’s okay. Being uncomfortable is the first step. It means that you’re aware of the challenges we’re facing, and it means that you’re getting ready to solve them.

People who are comfortable don’t do anything. If you’re here just to consume oxygen and expel carbon dioxide to get some continuing education credits, there are plenty of places for that. This is not one of them. I want you to feel challenged and motivated. I don’t want you to feel like we’re only saying, “Here are a bunch of problems; figure them out.” I want you to feel empowered and encouraged to do something about it. I want you to recognize the power that you do have, and I want you to be ready to change the EMS landscape.

For example, in my own department, we’re doing training to implement apneic oxygenation; high flow O2 through a regular nasal cannula to help maintain a patient’s saturation through intubation. It’s a new thing so I ask them, what can we do to help remind you to do this new thing and to help make it easier to do it? Together we come up with packaging the nasal cannulas and the end-tidal CO2 sensors right in the BVM package. I contact our supplier and they say, “Sure we can do that for you.” This wasn’t me laying down some training. This was us solving a problem together! This is what I’m talking about.

But maybe you have different problems. Maybe you’re trying to capture different opportunities. What I can do, what EMS Today can offer you, is information and inspiration. I want you to leave here informed and inspired by those around you; able to make better decisions for yourself, for your service; and, by doing that, help us advance our profession as a whole.

Informed. Who has more than ten years of experience in emergency services? These are the people who’ve been doing it. Who has a successful recruitment and retention program? Who has started up a community paramedicine program? Who uses point of care ultrasound? Who has improved the rate of neurologically intact survival from cardiac arrest in your area? When I say informed, this is what I’m talking about. There are plenty of people out there doing these things right now and doing them really, really well. If it exists in EMS, there is someone at this conference who has it and wants to share it with you. And if it doesn’t exist, then there are people here who are working hard to do the work to make it a reality. That’s the strength in “us.” Individually, we can become uncomfortable, frustrated, frightened, and angry, but with the support of the people in this room, we can help you move things forward.

This isn’t just a job for the “leaders” in EMS. Each one of you is an advocate. Each one of you represents “us.” I’m talking to you. And you. And you. And you. And each and every single person in this room. I’m not saying these words for people to just hang back and listen to. I’m telling you that every single person in this room has the power and the strength to join together with the other people in this room to make these things happen.

That’s the strength within us. None of us have all the answers, but together we have a lot of the answers. And that can make a real difference in people’s lives. I’m not saying we have to change every time a new thing comes up. But I’m saying we have to be comfortable with the idea of change. This isn’t a matter of admitting, “I was wrong.” It’s a matter of being able to be mature enough to say, “I’ve learned, and I want to work with you.” Be informed not just by the educators but by the people in this room who are ready, willing, and able to share so you can build on their successes.

Inspired. I’ve been doing this for more than 30 years, and I certainly don’t have all the answers. I feel lucky if I can even get some of the questions right. I take my inspiration from a man many of you probably have not heard of. Kano Jigoro was the founder of Judo. He was the ultimate master of his craft. When he died, he wasn’t buried in his master’s black belt. He insisted on being buried in his white belt so that he remained forever a student of his art. That’s where we have to be to succeed. No matter where you are in your career, you have to remain a student, open to new information and inspiration.

Now I’m talking to the people just at the beginning of your careers. The rest of us, we have bad habits. You don’t have those habits. We need you to help us break them. We’re going to need your enthusiasm and energy to make things happen. It takes more than just knowing what to do. We need your inspiration and your energy.

There are 207 bones in the human body, but there are only four different kinds of bones in any EMS organization.

1. The wish bones who spend their time wishing that things would just get better.

2. The jaw bones who talk about what should be done.

3. The knuckle bones who knock anyone who is actually doing the work.

4. The back bones who get under the load and do the work, no matter how hard.

If we’re going to transform EMS into what it needs to be, it is going to require us to do things we’ve never done before. As we move from a skills-focused trade to science-driven clinical care, we’re going to have to work together like never before. We’re going to have to invent new technologies. We’re going to have to change EMS education. And, if that seems like something impossible, I have to tell you, we’ve done it before.

Fifty years and eight month ago, only 125 miles from here, we launched the ship that landed men on the moon. That had never been done before. That required new technology. That required an overhaul in education. That required people to work together and demand a level of excellence of each other that had never been seen before. And many said it could never be done, but we were the first people to ever leave the planet and stand somewhere else in our galaxy. We’re Americans, and that’s how we did it. When something is important to us, we dedicate the people and the resources that we need, and we get it done.

In the space race, we were faced with a tremendous challenge, and we rose to meet that challenge. And now I’m issuing you the challenge. To reduce deaths from trauma. To improve resuscitation rates. To reduce time to treatment for stroke and sepsis and more. Not simply to change some numbers, but because this changes the lives of the people around you. Take what we learn at EMS Today and effect that change for real people in the real world.

This is the job we’re faced with. Not just running calls but transforming the way we do business. It’s going to take real commitment and hard work but take inspiration from one of the greatest figures in sports. Muhammad Ali said: “I don’t count the sit-ups. I only start counting when it starts hurting because they’re the only ones that count. That’s what makes you a champion.”

People ask me how long it takes an average person to become an EMT. I tell them that an average person won’t make it in EMS. Are you ready to do the job? Not just run calls, but make a real and lasting difference?

Can you do the job? Yes? Bu can we do it together? That’s the trick.

When I say the strength within us, I really mean us. Not our little tribes. We have a lot more in common than we have to gripe about, and if we can’t get it together, then other people are going to make decisions for us and we’re not going to like where we find ourselves. We all have things to contribute. MD, PhD, GED, I don’t care. We cannot continue to be fragmented and isolated. Join a national organization. Work with other healthcare and emergency services to help local, state, and federal representatives understand the needs of EMS. Train together, work together, quit bickering over issues that are tiny in the face of how we’re going to need to transform our profession for our communities, for our families and for ourselves.

I know it’s tough. I know that sometimes it’s all we can do to keep the wheels on the ambulances, but here’s what I want you to do. Do you believe you may have a loved one or yourself cared for by EMS in the next five years. The next 30 years? Where does EMS have to be to be at the level you’ll demand? What do we have to do to make this happen? I know we have our work cut out for us.

In EMT class, in paramedic class, they let you think that the day you pass your final test you earn the patch. What they don’t tell you is that you have to earn that patch every single day. You earn that patch when you move yourself forward. When you move your service forward. When you move our profession forward. You have to earn that patch every day, but you are not alone.

We are here for you. I literally mean WE are here for you. These people right next to you. If something happens to you, this is who is going to take care of you and the ones you love. I don’t just mean on an emergency call. I mean if things go really bad. This is who is going to help your spouse, your kids, your parents. This is who is going to put your name on a T-shirt to help make sure your mortgage gets paid. Would you do that for them? Yes, you would. And they’d do it for you. That’s the strength in us! There it is.

With that support, with the information and inspiration that we get right here, we’re going to make the changes we need to take ourselves, our services, and our profession where it needs to be.

We need to come together.

We need to stay together.

We need to work together.

We need you to not just sit back but lean forward.

Not just lean forward but rise up.

Rise up, and together we will bring EMS to the next level.

To make the world better for patients.

To make the world better for our families.

To make the world better for our each other.

To make the world better for EMS today.

Because that is the strength in us.

And we’re here to get it done!