Note: This article was originally published in December 2003.
The term “EMS cowboy” has often been used to describe those in EMS who don’t seem to follow the rules. In fact, a JEMS reader recently called me a “cowboy” because I had the audacity to challenge some long-held EMS beliefs.
As I reflected on this, I quickly realized that I’m proud to be a cowboy and, in fact, EMS could use a few more cowboys. The cowboy culture is part and parcel of living in the southwestern United States. It’s a culture that’s misunderstood, yet steeped in rich tradition. However, when you actu- ally examine it, the culture has a great many tenets that EMS personnel should consider embracing:
“¢ Treat a man like you’d treat a brother. People must be good to each other. EMS is a caring and helping profession, and you must always be kind to your patients and their families, your coworkers, your employer and those you deal with daily. By following this simple rule, a variation of the Golden Rule, you will likely be treated well yourself. Take care of your neighbors, and they will, in turn, take care of you.
“¢ Treat a lady like you would have a man treat your mother. Somehow, somewhere, we crossed a line in dealing with members of the opposite sex. Many interpersonal problems, sexual harassment suits and similar problems would be avoided if we each followed this simple dictum.
“¢ Make your word (or handshake) your guarantee. Honesty is a big part of cowboy culture and an essential part of EMS. It is said, “Truth is the ruler for the measure of a man.” Being honest means actually counting the patient’s respirations and not estimating them. Being honest means doc- umenting only the parts of the physical exam that you actually completed. It is said, “You can’t shoot a hole in an honest man’s story.” Being honest means that when you
make a mistake, you promptly acknowledge it, apologize for it, learn from it and move on. This concept is clearly described in another cowboy saying “The easiest way to eat crow is when it is still warm. The colder it gets, the harder it is to swallow.”
“¢ Respect your elders. This practice has, unfortunately, been lost in modern society. Many in our society and profession mis- treat, malign and disparage old folks. The old folks are our heritage, and we are their legacy. Many fought for our way of life. The least we can do is to show them the simple respect they deserve. This means calling a person “Mr. or Mrs.” and not by their first name. It’s also showing respect by using such phrases as, “yes ma’am” or “no sir.” This same core belief means that you should look out for the ill, the infirm, children and the feeble-minded. A fundamental tenet of cowboy culture is to respect all living things. This should be among EMS providers’ fundamental beliefs.
“¢ Respect others’ possessions. This simple admonition should also be an integral part of EMS. It involves such things as taking off your dirty shoes (or boots) before entering somebody’s house, picking up your waste after patient care and ensuring that cherished pets and other items are taken care of before leaving a patient’s house. Always leave things in a better condition than when you found them. Also, this admonition holds true for things borrowed. If you borrow something, return it. If it breaks, fix it. If it can’t be fixed, replace it.
“¢ You can talk, but I’d rather you show me. A real cowboy leads through example. Likewise, real professional EMTs lead through example. People are more apt to follow leaders who practice what they preach.
“¢ You can’t rope another man’s dreams. Be yourself. Don’t try and be something you’re not. But don’t be afraid to go after what you want or what you believe in. Let your coworkers get to know you, and get to know them. An old cowboy saying is, “Don’t try passing for something you can’t be.” This is equally true.
“¢ You got to hold the trail and get the herd in. It’s very easy to get distracted by many of the issues and conflicts that surround EMS. But you must remember that your primary concern is always the patient and their wel- fare. Patient care always comes first. If you always put the patient first, you will contin- ue to be an excellent EMT.
“¢ Always take care of your horse, your saddle and your riggings. Cowboys know that their lives depend on their horses and tools. Likewise, in EMS, our patients’ lives depend on our ambulances and equipment. Always ensure that your equipment is clean, available and working properly. You never know when the most obscure item on your ambulance will be needed. People depend on you, and you should never let them down.
“¢ Always ride for the brand and the glory. Be loyal to the profession and to your employer. Many employer-employee issues can be averted by the employer respecting the employee and the employee respecting the employer and being loyal to the organiza- tion. Good EMTs are loyal EMTs, and good employers will reward loyal EMTs.
“¢ You can’t ride a greenback. If you’re in EMS only for the pay, you’re in it for the wrong reason. EMTs and paramedics must be paid a livable wage, and things will improve. But, if your only motive for working in EMS is the paycheck, you’re destined to be horribly disillusioned and disenchanted.
“¢ Don’t bow to nothing but the Lord on bended knee. Stick to your convictions. Most of the things you need for success in life were acquired before you were 10 years old. Trying to change your culture or con- victions later in life will cause internal distress that will ultimately lead to external stress and a resultant deterioration in your quality of life.
“¢ Respect the land, and it will respect you. We are stewards of the earth and must take care of it for our children and grandchildren.
Although cowboy culture is full of colorful, even corny metaphors, you can see that the principles of cowboy life easily translate to EMS. If you practice these, you’ll be an excellent EMT. So the next time somebody accuses you of being an “EMS cowboy” or “EMS cowgirl,” simply tip your hat and say, “Yes sir, I am, and proud of it.”
About the Author
Bryan Bledsoe, DO, FACEP, EMT-P is an emergency physician and former EMT and paramedic from Texas.