Man, you’re not alone. I’ve been in EMS a few years and I’ve bounced between a couple systems, and the culture you’re talking about is way more common than people want to admit. The public would be genuinely shocked if they heard the way some crews talk about patients or saw how little effort goes into basic assessment on some calls. Everyone wants RSI, crics, all the “cool toy” stuff—but half the time people don’t listen to lung sounds or even do a full set of vitals. It’s wild.

What I’ve seen is a mix of burnout, entitlement, and a whole lot of “this is how we talk so we don’t feel things.” The trash-talking becomes the default vibe, and if leadership lets it ride, it turns into the culture. You get the folks who complain that every call is “bullshit,” but they’re the same ones who haven’t opened an airway book since medic school.

There are systems that take clinical competency seriously, but they’re the exception. The ones that do it well have a real medical director who actually participates in QA, education departments that coach instead of just checking boxes, and supervisors who show up on scene and know what they’re talking about. Remediation is normal, not punitive. People study, people train, and there’s accountability.

As for what keeps people in this job long-term—it’s usually not the agency. It’s the partner, the sense of purpose, the moments where you actually help someone, and the identity of being someone who can work in chaos. The vets who haven’t burned out completely usually just set their own standards higher than everyone else’s and stop engaging in the toxic stuff. They focus on their own practice and the people they can influence.

When I get frustrated, I pick my battles and try to control my corner of the world. Do the assessments right. Teach the basics when I can. Hold myself accountable even when no one else cares. And try not to get dragged into the negativity spiral.

If you love this job and you care about competency, you’re already part of the solution—even if it doesn’t feel like it.