“Hey, it’s Josh.”

When City of St. Paul paramedic-firefighter Josh Garubanda responded to a recent 911 call, he recognized the person with a significant physical injury as someone he grew up with. “When they saw me,” Josh recounts, “and I [said], ‘Hey, it’s Josh,’ … they snapped out of their pain for a moment, to be like, ‘Oh, hey Josh’ … he’s like ‘I just knew at that point I’ll be fine’ in the long term. I’ll take care of him.”

Having a community’s diversity reflected in its emergency medical services (EMS) and firefighting departments provides a critical degree of understanding, empathy and comfort during major times of crisis. However, major barriers, cultural and otherwise, can hold women and people of color back from pursuing a career in these fields. Fortunately, EMS academies in St. Paul and Minneapolis are helping make these opportunities more accessible at a time where there is a massive paramedic and emergency medical technician (EMT) shortage.

In today’s episode of Off the Charts, Josh and fellow paramedic Nela Kurtic talk about how they came up through St. Paul’s Pathways Program (now EMS Academy), their on-the-job experiences and challenges, the importance of having community members as first responders and why seeing people like them in these positions is so inspiring. Listen to the episode or read the transcript.

The pathway to today’s St. Paul EMS Academy

Josh and Nela have multiple years of experience: Nela is in her eighth year as a paramedic, currently a community paramedic for Regions Hospital having spent the last seven years working pre-hospital for a hospital-based system. And before Josh joined the city of St. Paul a few years ago, he was as a paramedic for a private service.

Both started their current careers through the city of St. Paul’s Pathways Program, now known as the St. Paul Fire Department’s EMS Academy. Similar to other pipeline programs nationwide (including Minneapolis), the EMS Academy is directed toward low-income communities, people of color, immigrants and women living in or near St. Paul and looking for a new career. Now in its 15th year and 21st class, candidates in the tuition-free program receive paid training in EMS skills. At the end of the 12-week program, graduates earn their National EMT certification.

As early graduates, both Josh and Nela have seen the program’s content evolve from a single course into a comprehensive curriculum that includes crucial work experience and connections to current career opportunities. Today, the EMS Academy is helping to fill the shortage of paramedics and EMTs with qualified and diverse graduates that better reflect the communities they serve.

Tackling cultural and clinical obstacles

While the EMS Academy does a superb job of preparing diverse candidates for the field, there are still plenty of cultural obstacles that remain once they start answering calls as paramedics. When Nela started her clinical experience and ambulance ride-alongs as part of her training, she was the only woman despite being part of a diverse academy class. And while today’s EMS departments have a more even gender split, they are still primarily white – much like the area’s firefighting departments.

That lack of diversity, paired with having to navigate existing cultural nuances in an already extremely stressful job, provides major barriers to entry for women and people of color. And even when they enter the field, the dual stressors of the job itself along with the isolation of navigating a homogeneous work environment can be too exhausting for some graduates to stay.

That’s why the community, connections and mentorships created by the EMS Academy are so important. By staying in touch, academy graduates past and present can help navigate the conversations and situations that can come up during shifts, sharing strategies and knowledge on everything from nurse reports to on-the-job interactions.

As Nela discusses during the podcast, it’s good to call someone and ask a second opinion about your working diagnosis or if you chose the right medications, or to text someone in your community to get and give advice. By having open lines of communication through a network of resources, everyone that’s connected has what they need to become better paramedics and to receive the support they need.

The relief and inspiration of community reflection

While the EMS career path for women and people of color isn’t easy, it’s also tremendously fulfilling and community-critical. As Josh says during the podcast. “I’m very fortunate and I feel very blessed to be able to work in the city that I grep up in … I feel like it’s a privilege to be able to help take care of people that are my friends’ family members … to help be a liaison in that moment of pain and uncertainty. I’ve heard that there’s a sigh of relief because they knew [that when we] close those ambulance doors, there’s someone in the back there that’s going to look out for them.”

It's also especially important for immigrant community members to know that they’re being heard and respected during unfamiliar times of crisis. By having familiarity with specific customs, family structures, communication styles and decision-making approaches, community-based paramedics and firefighters can deliver a unique degree of empathy and understanding that brings efficient and compassionate care to those in need.

But representation is also important for expanding the horizons of young women and people of color. As podcast co-host Dr. Jackson says often, “you can’t be what you can’t see.” Josh didn’t see any Black firefighters growing up, not realizing it was even an option before meeting a Black firefighting crew in Colorado. Being able to see and hear from people like him in these positions helped to create that access and make it a reality for himself. And now with 317 graduates and counting, the St. Paul EMS Academy is also making that path real in neighborhoods across the city and surrounding suburbs.

To hear more from Josh and Nela, including their early experiences as paramedics, the role of mentorship in preventing awkward situations and how asking the right questions empowers the people they serve on calls, listen to this episode of Off the Charts.