2nd podcast episode with Selena Xie of Austin EMS

Episode 2 of Urban Affairs, my new podcast, is here! Click here to listen on Apple Podcasts or here to listen on Spotify. And please make sure to follow the podcast on either podcast and, if you think it deserves it, leave a good review!

Similar to my guest last week, Chris Baker, who works with the homeless, Selena Xie sees the tragic consequences of America's woefully inadequate social safety net on a daily basis.

In my conversation with Xie, who recently stepped down as president of the Austin EMS Association after a six-year stint, we discussed the role EMS plays in filling the gaps of our unjust health care system. Contrary to popular belief, most incidents EMS deals with aren't legit emergency care. It's really more like poverty care –– a resource for people without any other resources.

I also find Selena's perspective on the labor movement and politics in general, very interesting. She's a self-described leftist with a degree from an elite liberal arts college who leads a blue collar union with no shortage of conservatives. But they all want the same stuff: good pay and benefits, safety and respect on the job. It's a lesson the Democratic Party should heed as it seeks to repair its relationship with the American working class.

Other stuff we covered:

• How confronting death on a daily basis makes one feel about their own mortality
• The highs and lows of her union's relationships with the police and fire unions
• Why Austin is one of the few cities with a separate fire and EMS department & why she does NOT want that to change. I think at one point she accuses me of fire supremacy.
• The prospect of Gov. Greg Abbott making it even harder to raise taxes to fund public services and the consequences of that.
• Selena's upbringing in a Chinese immigrant family in Dallas that " very stereotypically" wanted her to be a doctor.

Below is a heavily edited transcript that captures about a third of our conversation.

Why she's stepping down

Me: So, after six years you step down. Why are you done?

Xie: I'm done for so many reasons. When I look back on the six years, I can't believe how much we went through. I became president in 2019 and the previous president, Tony Marquardt, had been president for eight years. And when I talk to other people, we constantly talk about how you really do need new leadership because you develop a lot of blind spots.

...In 2020 we had the pandemic and that was definitely the most stressful time in my life. I'm really proud that we never had any medic die from COVID. We never had any medic intubated from COVID.

In 2021, we were still dealing with the height of the pandemic and also the ice storm, which was also extremely traumatizing for our medics...

And I negotiated three contracts with the city and that will really take it out of you. And the other thing is that I also was next on the civil service list to get a promotion to commander. And I find that a really exciting opportunity to serve our medics in a really different way.

Me: Do you like being a paramedic?

Xie: I do, I do. When the promotion came through, I was actually a little sad that I wouldn't get to be on the ambulance for longer. Now I'm in a command vehicle and I supervise other ambulances.

We're in smaller vehicles. They're basically trucks with equipment on them. And we go to the highest acuity calls. So somebody who's in cardiac arrest, somebody who is having some kind of event that we plausibly believe could lead to death in the next five to 10 minutes.

Mortality

Me: I remember talking to you a few years ago and asking you if being confronted with death on a daily basis makes you more at ease with mortality. And you said no.

Xie: Yeah, I still agree with that.

Me: It was a disappointing answer. I remember you saying that if anything, it's worse because you just see the horrible end that many people face.

Xie: No, I don't think that it's that I see the end. I think it just makes me really value living more. As a commander, when I show up on scene and we are performing CPR on a patient because they're dead and we're trying to revive them –– if we're unsuccessful or if we are successful, my job as a commander is really to provide support to the family that's there. And of course what they express the most is the things that they didn't do with the person who died, the things they wish they had said and so it just reminds me to do those things and say those things.

Me: I mean that's the kind of thing I hear from people who work in hospice and people who tend to talk about how being confronted with death actually makes them appreciate the finitude of life. It just seems when I've talked to you or with ER nurses, the vibe I get is a little bit less equanimity, perhaps because the death they are seeing not ideal? Dying in an ambulance or a hospital bed. It's not that ability to plan and spend your remaining moments, your remaining days in the best way possible surrounded by family.

Xie: I don't know that it's specifically about the death aspect as it is also about us having to churn and burn. Our paramedics and our nurses, they will respond to somebody who is dead and then literally five minutes later have to go take care of a sick kid or take care of somebody who has a stubbed toe. And I think that kind of churn and burn is really hard, but I wouldn't say that that's not been my experience that any death is so much more undignified.

Are medics paid enough?

Me: So you're referring to how hard your work is and unfortunately it's very hard and very important work but not at great pay. You've done some work on the pay front. To what end? How would you rate the compensation of Austin EMS right now?

Xie: I am really proud of the wins that we got in our two big contracts. I think our medics are much better compensated than we were three years ago.

When I, in 2019, when I became president, our paramedics started at $19.56 an hour. And now our paramedics start at $31 an hour and our EMTs start at $25 an hour. So we've made huge improvements in pay. I do think we have more to go. We have always sought for, pay parity when it comes to the three public safety agencies. and police just got a huge contract and I've already spoken to the city manager we believe that we are entitled to as large adjustments in pay as well.

Me: So how much does a 10-year medic make?

Xie: $85,000.

Me: OK, that's slightly below the median income for a single person in Austin, which is now $88,200. How many of your members live in the city?

Xie: We only capture their zip code when they first start working here. We have not recently asked the department for all the zip codes, but our estimate is about 30 % in Travis County.

Me: Do you think most would like to live in the city?

Xie: I don't think most of our members would like to live in the city. I think of course if the city had what our members were looking for –– if they can afford having a house where each of their children gets their own bedrooms, they maybe have an extra living room and a little bit of space. Our paramedics are so overstimulated when they're on the job that a lot of them do not want to live very close to people.

I think there are many of our paramedics, especially our younger medics and paramedics, who would like to live in the city in apartments but can't afford them. And I hear a lot of stories of people who slowly get priced out and pushed out into the surrounding counties.

Emergency care vs poverty care

Me: So much of what you're doing isn't actually responding to legitimate emergencies, right?

Xie: That's true.

Me: So what are they?

Xie: So EMS is the medical safety net for the entire community and for every community in this country. So people call us if they can't get transportation, if they can't afford a medication that's been prescribed to them.

But things are improving. City Council invested in what we call our C4 line.

And so if you call 911 and you ask to speak to EMS and you say, "Hey, my blood is like 160 over 90. I think I need to go to the ER." Our C4 line will actually pull that call, get on the phone with them and say, "Hey, 160 over 90. Yes, it needs to be lower, but that's not going to kill you anytime soon. And so do you have a primary care doctor? Do you have a prescription for medication? What's going on?"

And a lot of times what we find is somebody says their car broke down and their prescription is waiting at the Walgreens. So we can actually help navigate people to getting what they actually need. So our C4 can jump in a Tahoe and actually go pick up those medications and drop them off to patients and prevent them from having to have really high hospital bills and also from taking up a valuable resource in our emergency rooms.

Me: What's another example of a non-emergency call you'd get?

Xie: We had somebody call 911 because they couldn't find their glasses. And we actually do probably need somebody to go check on them to help them find their glasses. Otherwise they will fall and it will become an EMS call. EMS, even though we think about it as emergencies, we really live in the spectrum between prevention and emergencies, right?

So it is a much better use of taxpayer dollars to send one person in a Tahoe to take care of this call and also prevent them from calling 911 every single day.

Me: But what would be an even better solution than sending somebody in a Tahoe?

Xie: I mean, universal healthcare? Having our healthcare system not run by two major conglomerations. Not having these middlemen insurance agencies take so much profit. I mean, it's way more systemic. It's not something that our, department or the city can fix, but I think that, C4 is, is, is really what we can, what we can do.

Me: How much does a ride in an ambulance cost?

Xie: It depends what we do. So there's "basic life saving" and "advanced life saving."

For example, if I start an IV, if I give you medications, that's going to move us into the realm of ALS. But it can range between $800 to $1000 or more.

Me: And a large percentage of people who get ambulance rides do not pay that, right?

Xie: It's a large number of people.

EMS vs Fire

Me: Is our EMS department big enough?

Xie: I hoped we could hire our way out of the problem. I'm just not convinced that we can do that. It's the number of calls, the complexity of calls is just overwhelming.

I mean, the last shift when I worked on an ambulance, 10 times in one shift we went to the transition center, which is where some people go after they leave jail. And two other ambulances went there five more times. So this one location is calling us 15 times and out of those 15 times, only one of them was a medical emergency. And I guarantee you that nobody from the transition center is paying for those rides. This private quasi-prison company is basically just stealing money from the city of Austin, because they refuse to provide any healthcare for people at the transition center. So shit like that happens all the time and it's infuriating. You are paying because a private prison company does not want to provide any health care services to a very large population.

Me: Well, and we're also paying because Greg Abbott doesn't want to expand Medicaid, right? I mean, we're paying for ambulance rides that wouldn't be necessary if we would just take the billions of dollars that have been on the table for the last decade.

Xie: Yes, if more kids had Medicaid, they would not rely on EMS for a lot more things.

Me: So our fire department is significantly bigger than our EMS department. But the great majority of fire calls are medical calls. One might conclude that it would make sense to have a smaller fire department and a bigger EMS department.

Xie: Look, we need fire trucks available if there are fires and we need them quickly and we need a lot of them. And it is true that because building codes have gotten better, because a lot of buildings now have sprinkler systems and other fire prevention techniques, there are fewer fires. That doesn't mean that we don't need them to be available. But because we have fewer of them, they now respond to medical calls. And they are going on a lot of medical calls when there's not an ambulance available because our ambulance system is being so overtaxed. And that's really frustrating to firefighters because they want to be responding to fires.

And so I would love the luxury also of having a lot of EMS available when somebody's having an emergency, but I don't think that we have too many firefighters.

Me: So if I have a medical emergency right now, let's say I have a heart attack and someone calls 911, there's a good chance that a fire truck will be the first thing that shows up?

Xie: If your call is turned into a high level priority, then yes, you will get a fire truck and it is a high chance that they will show up first.

Me: So in most places in the country, EMS and Fire are in a single department, right? And here it's separate.

Xie: So Austin is really unique in the fact that we're one of the few cities that run their own EMS department. And I do think it really benefits the community.

We do so many things that many other places just wouldn't even be interested in thinking about because they're fire departments and they want to focus on fire suppression, which totally makes sense.

And so that's why we have one of the most robust community health programs. We started a model of helping folks that have substance use disorder that has been replicated nationally and a lot of other places. We carry whole blood.

And Austin is really lucky to have Austin Travis County EMS. It's always named one of the top three EMS agencies in the country. And to me, it's sad that a lot of residents don't know that.

Me: I can see how there's this sort of cultural inertia that if it's a fire department, it thinks of itself as a fire department and EMS could be considered secondary. But why must that be the case till the end of time? I mean, it just seems obvious to me that eventually our elected leaders and our city manager and whatnot would look at the situation and say to the fire department, "You guys are mostly a medical services agency."

Xie: Look, when I worked on Christmas, I worked at this fire station and a firefighter came up to me and goes, "Man, don't you want to be merged into the fire department? Like, wouldn't that be awesome?" And I said no. And he asked what would need to happen in order for EMS to be merged into the fire department. And I said, "There's only one thing we would need. It would need to be called the Austin Travis County EMS department with a fire division. So how do you like that idea?" And then he was really upset and like flummoxed and mad about that. And that's how we feel every time people say that we should be merged into the fire department. It's insulting.

Me: That's interesting. I thought of it as equal. A merger is equal. I didn't see the fire department as eating you.

Xie: Yeah. And so if it's really equal, it should be called EMS because emergency medical services really is the primary thing that we do. But there's no way that the fire department would ever allow that to happen. Like in your mind, Jack, when you thought about us merging, you were calling it the fire department. You were not calling it an EMS department.

Me: I don't think I took a position on the naming of the future merge department.

Xie: You were thinking it.

EMS vs APD

Me: How is the EMS-APD relationship these days?

Xie: It's really good. I actually worked with APA president Michael Bullock on a bill at the legislature last session and we are running a similar bill this session. I have always said that police advocates, the police union and EMS advocates – there's so much overlap in what we want. We definitely want the right agency to be taking care of certain calls. If it is a mental health call, EMS wants to be the one in charge and taking care of that. But because of state law, we are not able to make some of those medical decisions and police are the only ones empowered to do so.

Me: I often hear from police that EMS won't go into this situation unless police sort of secure it first. Is that true and should that be true?

Xie: So it depends. I think that's a real simplification. If there are no weapons involved, EMS certainly can be the only ones that go and the first ones that go. If there are weapons involved, we do need to make sure that we're safe.

I think there is another caveat that I would say is that the city of Austin has invested in community health paramedics that have very specialized training when it comes to responding to mental health calls. And so if somebody's having a psychiatric emergency, CHPs have a much different level of comfort when it comes to going to a call when there also might be weapons involved. But I would not ask our frontline paramedics who have not been given this specialized training, to do anything that makes them feel unsafe.

Me: Until a few years ago, the Austin EMS Association was the only non-police union that was a member of CLEAT, which is the statewide federation of police unions. Why are you no longer a member of CLEAT?

Xie: Police officers wanted to pass a proposition that would require the city to provide a much larger allocation in the budget for police. And so we did find that to be an existential threat. And so we endorsed against that.

CLEAT did not like that and they thought it was two unions going against each other, so they said, "We're a police union, we choose APA." And that's totally fine. And I think that, you know, I think it was not a great fit for a really long time.

Me: Well, you won't say it, but I'll say it. I thought it was total horseshit. I thought the letter CLEAT sent to you guys accusing you of some kind of labor treason was total bullshit.

Unions and American politics

Me: What percentage of medics are dues paying members of the union?

Xie: About 95%.

Me: Would you say your membership is politically diverse?

Xie: It's extremely politically diverse.

Me: Do you have any sense if you had to guess what percentage of your members voted for Trump or Republican in general?

Xie: I really don't know. We don't gather that kind of information. And I think because people know that there are a lot of Republicans, a lot of Democrats, a lot of leftists, a lot of conservatives that work for EMS, so people treat those subjects pretty delicately in person. And I've even had to learn that lesson myself. Before I was union president I was much louder about my own personal political beliefs. And, you know, I actually saw firsthand that I could have and should have had more sensitive conversations.

Me: So how would you describe your politics, Selena?

Xie: I believe in Medicare for All and if I were a single issue voter, I would have Congress change rules that were changed because of Citizens United. I'm a leftist.

Me: Right. And so that's what's so interesting is that your politics are pretty left. You were a guest of Greg Casar at his swearing in. You roll with folks like that, and yet you were the president of a very politically heterogeneous organization. How do you balance that?

Xie: I have my own personal political beliefs and I also represent a very diverse group of people. And when I was doing that representation, I was very careful and I represented them to the best of my ability. I basically had a separation between my personal political beliefs and I became a lot more quiet about them because of the position that I wanted people to feel comfortable to come to me.

I set up an environment where we could all work together and so for me to be super vocal about a lot of things wasn't in the best interest of the membership.

Me: Have you seen how unions can bridge that political divide, those cultural divides? Can you radicalize the working class through democracy in the workplace, Selena?

Xie: I think that that is probably the only future that this country has is by organizing workers. And I have seen that. And I do think that we have to stray away from certain terms that are triggering and are basically meaningless at this point and talk about common goals. We have conservatives on our board and we all recognize a universal class struggle and that we have a lot more in common than we have differences in the divisive era that we live in. And yeah, I think that that is the only way that we can progress this country because working people are failing right now.

Me: What terms are "triggering"?

Xie: For example, DEI. Like if as a board, we say, "We support DEI!" Like that's so meaningless and stupid. Like DEI as a concept is also in a lot of ways a corporate notion just to appease the left. And it doesn't actually even do what the left is asking for or, have ever wanted, but you know, like, now we have to rally cry around that. It's dumb.

Me: You know what totally summed that up to me was the outgoing DNC chair, Jaime Harrison. So Costco was is in the midst of a labor dispute with the Teamsters. The Teamsters were threatening to strike. And I see Jaime Harrison retweet something about how Costco is sticking by its DEI program. And that pretty much sums up how fucked up the Democratic Party is. You're like crossing a picket line to link arms with a corporation for some bullshit symbolic stand.

Xie: Yep.

Public services in an age of austerity

Me: You said you talked to the city manager and you want the same raises that the cops got, but how the hell is that gonna be possible in this fiscal environment? And this is a long-term problem that you're gonna have to deal with. We are already operating under very strict revenue caps that the legislature put in place five years ago.

And now Governor Abbott is talking about doing something even more extreme. The voters of Austin will have to vote 67 % to support a tax increase just to keep the lights on at the city of Austin.

What does that mean?

Xie: It's total bullshit and it's all politics to me. I do think that cities should do a better job at really looking at their spending and I do think there are cuts that can be made.

Do I think they should have the ability to raise (tax revenue) more than 3.5%? Absolutely. And do I think that increasing the number of people that need to vote for it is the right thing to do? Absolutely not. The fact that they feel like they have to do that shows that people do want more services and are willing to pay for it, and it just shows the weak political position they're in.

People want more services. People want their kids to go to better schools. Even if I do not have kids, I want AISD to have more money to provide more and better services and education.

Me: So if this bill does pass and we're looking at a future where just to keep services afloat, periodically the city is going to have to get 67 % approval from the community, I'm thinking there's going to need to be a strong political coalition working together for that. I would imagine the public safety agencies and their workforces would be an important part of that. Do you see the police, fire, EMS unions doing that?

Xie: I really can't speak for the other unions, but I know that and I'm not the president of the EMS union anymore, but if I were president, absolutely would support that.

Childhood, college, career

Me: Tell me about your upbringing in Dallas.

Xie: So my parents, they grew up in Beijing and during the Cultural Revolution, they got kicked out to the countryside and later (after the normalization of relations between the U.S. and China) the US government invited Chinese students to study in America and so my parents went to graduate school here and they both got professor positions at UT Southwestern. And so they obviously very stereotypically wanted me to become a doctor. And yeah, I didn't really have any interest in following that track, but I'm a lot closer than I think they ever thought I would be.

Me: Do you ever get to use Mandarin as a paramedic?

Xie: I have used Mandarin as a paramedic and also as a nurse. And I really enjoy those calls because I think that it's very comforting to patients when they can speak the language that they're comfortable in. And especially somebody that's providing care to them, I see it make a huge difference. That's why we fought for more bilingual stipends so that more medics would potentially want to learn different languages in order to help their community feel comfortable.

Me: I also think it's funny you went to Amherst. That seems like an unusual step towards becoming a paramedic.

Xie: I think that you'd be surprised at how many people we have from the Ivy Leagues and other liberal arts colleges. One of my favorite commanders went to Princeton, for example. But no, I mean, I think it's a little unusual for me to have a bachelor's degree, go back for an associate's then get a second bachelor's degree.

Me: What percentage of your members do have bachelor's degrees do you think?

Xie: That I don't know. I would probably say 20 to 30%. Most have an associate's degree.

I'm a huge fan of trade schools and other types of professional degrees. And in looking back, I really have a lot of feelings about my liberal arts education and how I actually couldn't get credit if I did something that was too practical.

Me: Selena, I'm gonna let you go now. Is there anything else you wanna tell me?

Xie: No, Jack. I enjoyed this conversation.

Me: Good. Thank you so much for coming on. And good luck with everything that you do. Solidarity forever.

Xie: Absolutely.

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