There is a big difference between the medicine that occurs in the streets with ambulance personnel and the emergency medicine that is practiced in emergency departments. Despite the differences there is a closeness between those people and their respective disciplines. Both sets of people who work these jobs see humanity at its best and WORST.

When humanity is bad it is real bad. The medicine that occurs in the streets is in some ways, harder to come to grips with because people and their environment are enmeshed in all sorts of tragic ways. The obvious example is a car accident where metal and glass trap victims and crush flesh. EMS personnel: police, fire and ambulance will see this scene and sear it into their brains while they work to get the victim free of the tangled mass and provide care with the goal to get that person to an emergency room.

In the emergency most of the debris has been removed. The exception is when stuff is still stuck in the person, say via impalement. Nonetheless, the sights, sounds and smells are tempered in the ER. This tempering does not in any way diminish the significance of the work in the ER, it is just a different side of the same coin. Both groups of people form integral links in a chain of health care and emergency medicine and I am proud to have been part of these disciplines.