For ages, many people have grown up wishing to become a firefighter or police officer. Youthful interest in these iconic figures is reflected in Halloween costume choices, and is reflected in the awed expressions on many kids’ faces when they meet a real person in uniform.

Then there’s EMS. Emergency Medical Services. EMTs. MFRs. Paramedics. Medics. Ambulances. Rescue. What? Who or what are all these things? The general public is understandably confused by the jumble of EMS terms.

Identity confusion regarding EMS is real. Modern EMS came along helter-skelter, being invented as we went along in the 1960s and 1970s. Compare that to the long histories and traditions of fire (“the Bravest”) and police (“the Finest”). They enjoy not only innate respect, but also powerful, organized unions which have yielded beneficial legislation, decent pay and benefits, and enviable career paths.

No such luck, EMS. Although the care itself is broadly standardized and generally decent, the framework for EMS as a profession is scattershot. Few people even understand the very real difference between an EMT and a paramedic. EMS personnel arrive in your homes variously, maybe as volunteers, members of a fire department, a municipal service, or as private ambulance service employees. Whereas police and fire look like who they are, EMS offers wild variations in uniforms, logos, color schemes. The public is often deservedly confused.

This discrepancy of appreciation elicited tears this year, when the 2020 theme for Macy Department store’s holiday display was announced. The glorious NYC tradition of six giant, elaborately-decorated store windows stems back to 1874. This year, it’s a touching tribute honoring the city’s “essential workers” including first responders. It’s a giant “THANK YOU” offering an undeniable message of gratitude.

Not to take anything away from the good intentions here, which are (finally) occurring widely for first responders these days, but I was startled to realize that my unbidden tears were generated by frustration and anger. After pondering this startling response, my conclusion is that, while all the accolades on behalf of my colleagues in the emergency services are heart-warming, there’s an elephant in the room needing to be acknowledged.

My career has been spent both responding to calls for help and writing about the people in emergency services—particularly the emergency MEDICAL services. It’s been interesting to observe the public’s rush to say thank you this year – and I’m grateful for that, I really am. For the record, we don’t do the job for the thanks, which may be good since in 10,000+ emergency calls, I’ve had precious few thank you’s, personally.

We do the job from an inner passion to make some sort of difference in lives upended by unexpected circumstances. But most EMS personnel do not share the decent job security, benefits, and longterm career path enjoyed by most fire or police agencies. Even within FDNY, there is separation between the fire folks and the EMS providers – to the tune that people in the EMS division run far more calls for something like 47 cents on the dollars made by the firefighters—while also often being treated as second-class citizens inside the firehouse.

Certainly, it’s partly the EMS industry’s fault for being so confusing. EMS providers have never developed a central voice. Maybe we’re too busy running calls. Retention is dismal. There’s precious little enduring history. Efforts through the decades to coordinate and unite EMS as a profession have failed, leaving disparities (especially compared with cops and firefighters) that are ethically short-sighted and heart-breaking

So, when gratitude is generalized for “the first responders,” please remember that the people doing most of the really heavy lifting outside the hospitals right now are those staffing the ambulances. EMS personnel have been run especially ragged through the COVID months. Not only is there no quick end in sight, even with the advent of vaccines; the situation is worsening. Yet every day I read of someone whose administrators are arguing about whether they are obligated to cover worker expenses when they come down with COVID because, well, maybe it isn’t a line-of-duty event, maybe they didn’t get it on the job. Really?

Now, some municipalities are threatening layoffs of emergency personnel because of budget issues, despite all the blithe platitudes. Again: really? C’mon! What actually happens when the “essential” force is reduced by X percentage, because of “budget constraints? The numbers of emergency calls aren’t reduced. How can coverage can be adequately maintained when the system is already stretched thin and people are already on mandatory overtime and overloaded/stressed? It’s not sane.

Good people are leaving the important work of EMS in droves, burned out by low pay, lack of status, hazardous and unsupported work environments. There’s a three-year turn-around in the industry. Work for five years on an ambulance these days, and you’re regarded as a “veteran.” It’s not the calls that typically drive people away; it’s administrative insensitivity and lack of support or respect. “Thank you” rings hollow when you might lose your job after months of going above and beyond.

Although every tribute, such as Macy’s 2020 holiday windows, is beautifully well-intended, I am grieved to know that there are people I regard as colleagues getting thrown under the bus. Especially in this pandemic, the folks running ambulance calls not only need our gratitude, but also real collective societal support for decent living wages and job security. Niceties are not policy. They don’t change the fact that my friends in EMS are suffering from a dearth of protection intended to help them build better lives and have better capacity to stay in this compelling, difficult line of work.

To laud our “heroes” one day and then leave them wondering if the job they gave their heart and soul to will be there tomorrow is just wrong. Indeed, frontline workers from all the first responder agencies have performed their jobs impressively in the face of our most recent and terrible threat, as they always do. But in too many instances, the effort has cost them their health, and even their lives. Why not take a moment to ponder what you as a private citizen can do to back up the thanks and help build a seat at the table of legislation and policy development for those who would drop everything—even leave their own tables—to come and help you?

*Blog title courtesy of a bumper sticker created by Jon Politis, paramedic and former fire chief and friend. And, from the Department of Shameless Self-Promotion for your holiday shopping list, consider getting your favorite first responder a copy of Streetsense: Communication Safety & Control, available in both softcover and audiobook!