Before medical school, I had the joy and privilege of working as a prehospital provider.  And during my years as an EMT, I was lucky to have a few adept female mentors on my volunteer service in rural Virginia. I looked to them for examples of how to move up the leadership ladder.  Looking back, having only a fifth of our personnel be women was not outside the norm in EMS (Emergency Medical Services).  In fact, today only 34% of EMTs and 21% of paramedics are women.

As I advanced onto my career in medicine, I noticed female representation trailed, especially at the level of medical directorship.  As of September 2017, only 18% of EMS fellowship directors were women, and only 15% of our national board, the National Association of EMS Physicians, are currently female.  Of the ten largest cities in the US in 2017, only 6% of the medical directors are women.

Despite the numbers, it quickly becomes apparent women have played vital roles in the advancement of prehospital care.  Indeed, the entire concept of care in the field began with Clara Barton.  During the Civil War, Barton, a nurse from the North, watched many soldiers dying before getting to the medical tents.  In response, she coined the term, “Treat them where they lie,” becoming the first to encourage in-the-field care.

Fast forward to 1966 when the paper, “Accidental Death and Disability: The Neglected Disease of Modern Society” was published.  This study was a wake-up call; thousands of citizens were dying from car accidents, and these deaths were preventable.  Throughout the country, multiple agencies blossomed to meet this need for prehospital care and trauma prevention.

Leading the charge in Pittsburgh was one of the first female medical directors, Dr. Nancy Caroline.  Through training her paramedics, Dr. Caroline developed the first comprehensive EMS textbook, called “Emergency Care in the Streets.”  From the oversight of Drs. Caroline and Peter Safar, the Pittsburgh’s paramedic and resuscitation models spread as standards to use for the new programs beginning throughout the US.

The next few years were an uphill battle for women serving in the prehospital realm. Initially, EMS and Fire Departments served out of the same stations, and to be a paramedic, you needed to be a firefighter as well.  Fire departments did not want to hire women, and they were not shy about their bias.  Women were failed out of fire academy in spite of successful completion.  The aversion to hiring women was so strong, it often required a court decision to allow women to be hired.  The first official record of a female paramedic in the U. S. is from 1972, Dianne Rechle of Palm Springs, California, six years after medic programs were begun in the US.

As EMS was gaining footing in the prehospital arena, EMS physicians were working to establish themselves as a subspecialty.  After beginning advocacy efforts in the 1990s, in 2010 EMS secured its own board certification.  This herculean effort required a team endeavor and could not have been achieved without the labors of Drs. Debra Perina, Sandy Bogucki, and Jane Brice.

Female medical directors in EMS are increasingly garnering national distinction.  Recognized for their oversight under the great significance of mass casualty incidents, Drs. Jullette Saussy and Sophia Dyer have been commended for leading their EMS agencies during Hurricane Katrina and the Boston Marathon Bombing respectively.  And currently, the list is growing of women that are medical directors of major metropolitan areas, including Dr. Marianne Gausche-Hill of Los Angeles County, Dr. Katie Tataris of Chicago, Dr. Kathleen Schrank of Miami, Dr. Elizabeth Char of Honolulu, Dr. Kristi Koenig of San Diego County, and many of those mentioned previously for other achievements.

In a climate that has sometimes been known as “an Old Boy’s Club,” I wondered what methods have allowed certain women to thrive?  I interviewed a few of today’s leaders, and I shared their recommendations for success at FIX 2017, which you can watch here.

How can we otherwise increase women’s representation in EMS leadership?  First, we need to quantify how many women are in EMS.  If we want to identify areas to improve upon, we should first know where we are beginning at.  Currently, there is no national organization that gathers this data.  Second, we should aim to increase women providers in the field.  As many EMS medical directors pursue the prehospital subspecialty after working in the ambulance themselves, it is not surprising, that with a lower percentage of prehospital providers being female, that leads to fewer female physicians being involved in EMS.  Finally, women that aspire to enter the EMS world should seek out mentors, male and female, for guidance.  Those already established should develop their own mentor-mentee opportunities.

Overall, advocacy efforts are increasing, evidence-based protocols are growing in number, and the interest in EMS is expanding.  The future of EMS is bright!  We can be the leaders we aspire to be, if we #CrashTheParty.

Watch the full FIX17 talk below!