So You Want Your MC to be a Paramedic or Firefighter: 10 Things to Keep in Mind

There is a fascination with making characters have really cool professions, like firefighter or paramedic. But even though there are a ton of TV series out there showing the “wrong” way to model this kind of character… there aren’t that many resources out there to help build strong characters with realistic job details.

As writers, we owe it to any profession we choose to use for our characters to get it right, to the best of our ability. A profession, whether it be office staff, reporter, hair stylist, lumberjack, or archaeologist needs to be rooted in solid research. This holds true with professions like police officer, firefighter, or paramedic. I’ve been a firefighter for 16 years, and a paramedic for 13. Nothing frustrates me more than seeing books, movies, or TV shows that portray these professions inaccurately or unrealistically. 

So… I decided that I needed to write a post on 10 things you should keep in mind when creating realistic MCs who are firefighters / paramedics. At the end, I’ll list some non-fiction recommendations to make your characters even better.

Humor:

We have a very warped, dark, twisted sense of humor. I can’t stress this enough. The longer we’ve been in EMS or firefighting, the more warped and morbid and dark our humor can be. I heard it said once that “we laugh first because we don’t know if we’ll laugh last.” At the very core of it, humor is a coping mechanism. We know that tomorrow isn’t promised, so say the nice things today. Or make sure you tell your loved ones you love them. And the jokes that come out of our mouths, born out of tragedy, are what keep us sane and moving forward. Its unspoken between firefighters or paramedics — we “get” each other’s outlook and humor. Cops may get it as well (and probably have just as twisted and morbid a sense of humor) but the general public… not so much.

Vocabulary:

In EMS or firefighting, we have our own vocabulary. Some of this is region specific, particularly in firefighting. There was a push after 9-11 to have common terminology across the US, but today it still has regional differences in the day-to-day operations. Do your research and find out what simple things are called, so that you can fit the dialogue and actions to what makes sense for the profession. Placing a tube for breathing into a patient’s trachea is “intubating” or “tubing” a patient. A “line” can be an intravenous line for fluids and medication (if you’re a paramedic) or a hose line from the engine to the fire (if you’re a firefighter). There are a lot of inside jokes with this kind of vocabulary and vocation, too. Look into that so you can give characters appropriate humorous reactions. 

Training:

Absolutely a requirement. And this is almost always in OUR spare time. It takes time away from family to keep up with the training required to be a paramedic or firefighter. It can be hands on, or it can be “death by power point” or online training. Some things can’t be taught by simply talking about them. Repetition is key for many things, and if you aren’t using skills, some of them are what we call “perishable” — meaning, you can lose them. EMT school typically is 140-160 hours of training long. That can be compressed into a 4 week program, or stretched out over several months. Advanced EMT school typically lasts between 3-6 months. Paramedic school (the original training) was 6 weeks long. When I went through, I went on a “unit day” program and it took 8 months (and over a thousand hours of clinical time). Now it usually takes a year.

There are several levels of firefighter training: the 36-hour “volunteer” firefighter course, Level I Firefighter (the 120-hour class) and the Level II Firefighter (240-hour class) (this is what it is in Ohio, anyway). To be trained in “rescue” disciplines can take longer, and depends on showing proficiency at skills like rope rescue, water rescue, hazardous materials training, and the like. Wildland firefighting is very different training requirements from structural / urban firefighters (what most people think of when they think of firefighters) and has very unique challenges. Most trainings require a specific age before being “certified” to perform. Some fire departments have “cadets” who can help on fire ground operations, around the station, and can start their training while still in high school to get a feel for the profession. 

What We Wear:

Uniforms. All jobs like this (unless you are portraying a volunteer department) require the wearing of a uniform. Typically, these are navy blue. In firefighting, these should be non-synthetic materials or flame-retardant materials. Polo shirts, button down shirts, or t-shirts are usually worn with pants. I’m of the opinion the more pockets I can have, the better I like it. Some women prefer more “fitted” style trousers — those are not the rule, but the exception. The last thing you want in EMS is to squat down and have your pants split at the crotch. Most people wear a belt with their pants — it is a tidy look, but also handy to clip a portable radio to. Pockets — guys tend to not carry things in their pockets, particularly on a fire department. I always did, unless I was on the fire apparatus and had to get bunker gear on quickly (bunker gear is the structural firefighter’s heavy gear that protects them from heat and flame).

My pockets when I worked as a paramedic held: my wallet, gloves (in 2 separate pockets), pocket knife, multiple pens, trauma shears, phone charger for the vehicle, and anything else that I needed for my day. Very rarely will there be a uniform exemption for a skirt — typically only in EMS, and only in areas where there are large groups of Mennonites or Amish who are serving in these roles. Just to be clear, we wear clothes that are utilitarian, unflattering, and uniform. It is hot in the summer wearing long pants and boots. In the winter, we might be standing outside in sub-zero weather working on patients or fighting fires. There is no “snow days” or “heat index is too high” days for our profession. 

Perspective and Reactions:

Our reactions are different from the normal public. We are tuned in to sounds like sirens, air horns, pagers, paging tones, phone ringtones from work, odd clicks that denote an overhead paging system about to go off, differences in breathing, monitor beeping sounds, and more. Sitting in the passenger seat, we often say “clear” to the driver to let them know that there is no traffic coming and they can proceed. (And we do this OFF duty, too) This stems from the fact that “GO” and “NO” sound very similar.

Firefighters look at structures and mentally put together a radio report on how to explain what kind of structure is on fire. Firefighters have to understand the different building styles over history, what is specific to their regional area, and how that impacts fighting fire. Paramedics  look at people and see “good veins for IV starting” and “they look like they’re about to collapse” or “they’re diabetic” or even “they’d be a tough person to intubate”…

These professions don’t switch the “work brain” off easily. We don’t panic easily. We look for solutions to problems. We like direct action. Firefighters and paramedics are able to compartmentalize things. We can be working a cardiac arrest and talking about what we want to eat later for supper. (You think I’m joking…. But I’m totally not.) 

Strength:

`. Being a paramedic or a firefighter involves physical strength as well as mental fortitude. Our job involves a LOT of lifting, moving, shifting, tugging, awkward positions, carrying amounts of gear, etc. There ARE absolutely small people who can do all of this and big people who can’t… but make sure you understand the physical strength it takes to do this job.

As an example: a “first in” bag — a bag containing medications, airway equipment, trauma dressings to control bleeding, and vitals equipment to check heart rate, pulse, oxygen saturation, blood pressure, temperature, glucose and more — can easily weigh up to 20-25 pounds. It can be in a backpack style, but those aren’t as common. An oxygen cylinder usually weighs about 5 pounds. The cardiac monitor, typically 20+ pounds. And those are things that people carry around routinely.

The cot itself can weigh between 80-100+ pounds. If it is “self-loading” that helps save backs, but means the cot itself weighs closer to 180 pounds. Patients aren’t small — they are in fact getting larger by the year, with obesity a rising trend. So, 180 pounds is a “light” patient, and we might end up with a “heavy” patient weighing 300+ pounds. Hard “spine boards” or “back boards” range between 10-15 pounds. A stair chair (helpful for moving patients without having to physically carry them when getting them extricated out of hard to reach areas) can weigh 50 pounds.

Our backs are constantly at risk. Patients do NOT end up in places that are ergonomically safe for us to move or lift them. We have to learn techniques to ensure we use our legs instead of our backs. So… your character should / will have muscles, and should be aware that they need to maintain them.

Being a firefighter has another set of requirements. Firefighter helmets (to protect from falling debris / water) can weigh about 15+ pounds; more if it is made out of leather. Fire boots are tall (mid calf / near the knee) leather or rubber boots, and can add about 10 pounds. Bunker pants and coat adds another 30 pounds, easily. Nomex hoods are lightweight, but necessary to protect throat and head. An SCBA (self-contained breathing apparatus) with mask — another 20-25 pounds. Then add a hose pack (about 50 pounds — this is 100 foot of dry hose wrapped together), a hand tool (ax, sledge, halligan, Kelly tool — could be 8-12 pounds), water can (10 pounds), or whatever is required for the job. It can nearly double a person’s weight… and we are then expected to move, twist, climb, crawl, drag, and work in those conditions, with limited air to breath, in hot conditions. It is not a job for the faint of heart or people who are not physically fit (and committed to staying that way).

Sleep is for the Weak:

Sleep patterns and eating habits for firefighters and EMS workers are different than a normal person. This is a huge, huge deal. Because we often work 24 hours straight while staying at a station (now this can be different depending on where you work — Europe is typically only 8 hour shifts, where the US is most often 12 or 24 hours straight), we don’t get quality, normal sleep, and we don’t get nearly enough of it. Chronic lack of sleep is a huge issue in EMS and firefighting.

We learn to sleep whenever we can, wherever we might happen to be (raises hand as champion sleeper in front passenger seat of ambulance with neck bobbling around). We wake up quickly. We might not be coherent, but we are able to roll out of bed, jam feet into boots / slide into bunker gear in less than 2 minutes, and be on the way. Fatigue causes a lot of issues, and is really not great for long-term health. We don’t sleep through the night while at work, even if we don’t get a call out — we’re unconsciously waiting for the “tones to drop”. When I quit working full time as a paramedic on shift work, it took me roughly 6 months before I slept through the night without waking up suddenly thinking I’d missed a call. This is something that both firefighters and EMS deals with routinely.

Eating habits — we scarf our food in minutes, not savoring our food. If you don’t eat quickly, you might not eat at all. Same with coffee intake — I always said there are 3 temperatures: too hot to drink, the perfect time to drink it, and stone cold. Our diets can suffer, particularly in EMS, where the nature of our work means we never know when we might get to eat. Firefighters typically have more structured days, depending on their geographical location and call volume. Golden rule for fire and EMS: eat when you can, sleep when you can, and never pass up the opportunity to use the bathroom. 

Worst Calls:

This is one of the big questions you just… don’t ask a paramedic or a firefighter. Just don’t. Our worst calls aren’t always blood, guts and gore. To truly hit the “worst” and potentially be the stuff of nightmares, it haunts us. It lives in our memory, and usually not in a good way. They are specific to the person. It could be a bad call involving child abuse or the death of a small child. It could be a rape victim. It could be finding a dead body in a house fire and the smells. It could be dealing with a hysterical mom who just lost a child. It could be watching an elderly patient watch their spouse die. It could be a bad wreck where a drunk driver caused fatalities.

These aren’t memories we want to remember and regurgitate for people who want a flippant answer. We share those with other people in our profession, as a coping mechanism. We pick calls apart that we’ve been on, discussing them with other professionals to analyze what, if anything, we could or should have done differently. We learn in the profession — new medics make different mistakes than those who have been in the profession longer. We all have scars, some visible, some invisible. Factor that into your character. They deserve to have that nuance. And remember, that some of us don’t have issues with certain calls or specific calls — not everyone has PTSD. We cope well with things. We de-stress by talking to each other. Some drink, some run or do something physical, some internalize everything. But nobody is “broken” because they handle it differently than someone else.

WHY:

This is a huge question, and it varies from individual to individual. Why do we do this job? For firefighting, a lot of times it is a family tradition. Multiple generations have served on the fire department. This is more common with males. Firefighting is predominately male, because it is physically demanding, it is made of a bunch of alpha personalities, and it is traditionally a male profession.

Women DO serve as firefighters, but if you’re writing a female MC, look into the history of females in the fire service. It took a lot of guts, persistence, and proving over and over again they were capable of doing the job. There are still examples of women being treated differently than men in this profession. And there still are enough women who want to behave as though they are owed something, while not actually performing their jobs. The girls who have to have hair and makeup and fingernails and who flirt give every woman in firefighting who IS there for the job and not for a guy a bad reputation. You can be a female firefighter and not act like the world is out to get you (in other words, no need for a chip on your shoulder)… but you WILL have to prove yourself (often times over and over again).

WHY do we do this job? Because it is adrenaline rush. It is fun to challenge ourselves. It is rewarding to help people, to know that in their emergency, you are the one they call. It is stimulating to mentally analyze the problem and come up with a way to solve it. This profession is one of camaraderie and friendship and “brotherhood” — these people you will trust with your lives in situations most people don’t ever want to face. We see things that nobody else gets to see, or has to see. We get to help others. For some, firefighting becomes their identity, and their personality needs that “identity” and that “recognition” (everyone loves firefighters!).

In EMS, there’s a more even split of male/female EMTs and Paramedics. (Also, please use the correct term for the profession. In the USA, EMTs are emergency medical technicians and are the base level training required to work on an ambulance. Advanced EMTs can start IVs, interpret certain cardiac rhythms on the monitor, and give some medications. Paramedics are the highest trained recognized by the National Registry of EMT organization, and they can do all the things. There are specialized trainings above Paramedic — Critical Care paramedic and Flight paramedic — and both are similar, but defined by their scope of practice laid out by the International Board of Specialty Certifications). Not everyone on an ambulance is a “paramedic”.

There’s less camaraderie in EMS, though we ALL, world over, tend to see the “same patients” and have similar points to identify with other medics. Paramedics typically work with one other person, a partner, and that’s who we spend about 1/3 of our life with if we work 24 hours on, 48 hours off. A good partner makes the world of difference. They have your back, they are your checks/balances, they work WITH you and not against you. You have a bond with a good partner that goes well beyond “work”. And if you have a bad one? Your working days become dreaded days.

Paramedics are more independent minded. We became paramedics because we didn’t want someone else telling us what to do, or to be able to do more for our patients. The term “para-god” is a not nice term for someone whose ego doesn’t fit through the door with them. Their “superhero” cape is tripping them up. They are the paramedics who think they can do no wrong. And when you think that you have nothing more to learn in the field of medicine, you should quit that day. Medicine changes rapidly, and it requires people willing to keep learning and looking and trying new things.

Important Points

In every profession, there are some key events or dates that are “universally known”. Several of these include 9-11 (the Twin Towers in New York City) — it was the largest loss of firefighter lives in a single event. That number was 343. Other large scale incidents are known in the firefighter traditional memory. Unless your story is set before 2001, know that these dates have huge importance and significance. A lot of firefighters have stickers of 343 on their helmets or other ways of remembering these dates.

Colerain Township in Ohio is one that is state specific to my geographical region. It pushed drills on how to call a “Mayday”, going into a fire with a charged hoseline, and doing a 360 walk around a structure, because firefighters died. Another drill that many firefighters practice is the “Denver drill” — named for the firefighters who died, unable to get out because of their situation.

A death in the fire service while on duty is called a LODD, or Line of Duty Death. Firefighter funerals are hands down some of the hardest funerals I’ve ever been to. The symbolism and ceremony of these are just… heartbreakingly sad. When we had a LODD death in my county, we had hundreds of firefighters show up, from all over, to pay their respects. Not because they knew the firefighter, but because of the “brotherhood” of the fire service. Hearing the “last call” over the radio broadcasting system is incredibly hard to listen to. 

For EMS, funerals are typically much less ceremonial. We work alone, or we work with a partner. I often think of EMS being the unsung, unappreciated professionals. Nobody knows who we are, and nobody cares until they call us to show up at their doorstep. EMS really was born out of the Vietnam War era, with how medical innovations were going. The TV show Emergency is actually quite accurate to that era’s way of providing EMS and rescue services. The fact that their calls still ring true today is a bonus.

EMS started with a lot of funeral homes providing medical services in a hearse. Back then, it was “throw the patient into the vehicle and drive to the hospital” and ambulances were often hearses. Columbus, OH, had the “heart mobile” and some of the nation’s first paramedics, who went through a 6-week class of training. 

There is a difference between volunteers and career firefighters or EMS providers. Volunteers typically donate time to take emergency calls in their geographical location. They’re dedicated, motivated individuals who do it for the love of the profession. They don’t get paid, or at best, are paid per calls attended a small stipend. They do their own fundraising for equipment they need, including pancake breakfasts, fish fry events, raffles, and so forth. Volunteers may work as full-time / career EMS and firefighters, or they may hold other jobs in their community and use their free time to respond.

Career EMS and firefighters make this profession their livelihood. Nobody gets into this profession to get rich, particularly EMS. Firefighters are often paid well, especially city firefighters. EMS typically earn just over minimum wage, unless they are fire department based or government funded. Most people who work fire and EMS jobs work more than one job. Starting out, it is not uncommon for a new firefighter / EMT to work 3-4 different part time jobs. Hiring often is by word of mouth — and your reputation is your “foot in the door” to help your resume. 

Working fire and EMS means that you work holidays, weekends, nights, birthdays, special family events, and more. They may miss a lot of their family time, unless they are good about structuring it and saying “no” to overtime or helping out a colleague. Going to work tired, not feeling well, working in ALL kinds of weather… that’s what we do. 

In conclusion… I hope this has been informative and helpful to start ideas flowing for the truly awesome characters who will become firefighters or paramedics in your story! If you are looking for good resources to help you write excellent characters, check out any of the books listed below. Thanks for reading!

Firefighter References:

  • The Last Men Out – Tom Downey (FDNY)
  • Report From Engine Co. 82 – Dennis Smith (1980s FDNY)
  • B-Shifter – Nick Brunacini (western US)
  • Fighting Fire – Caroline Paul (California, one of the first female firefighters)
  • First In, Last Out – John Salka (FDNY)
  • Quick, How Do You Dial 9-1-1? – Randy Nickerson (Texas)

EMS References:

  • Blood, Tears, and IVs – Elissa M. Lonsdale (US Military medic, Iraq)
  • 999 – Lysa Walder (British paramedic)
  • Trauma Junkie – Janice Hudson (flight RN, California, ’90’s)
  • Blood, Sweat, and Tea: Real-Life Adventures in an Inner-City Ambulance – Tom Reynolds (book 1 of 2, British paramedic)
  • Street Talk – Thom Dick (legend in EMS, talking about things other than patient care)
  • People Care – Thom Dick (similar to Street Talk)
  • I’m NOT an Ambulance Driver series – Steve Berry (EMS cartoons, Colorado Paramedic)

-Soli Deo Gloria –

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