What’s Wrong

This morning, I received a long email from a long-time mentor of mine who’s also a paramedic and attorney.  He was pretty upset about the lack of involvement from physicians in improving the state of EMS.  As I replied, I realized that I needed to adapt my reply to share with my three or four devoted followers.

I blame the docs too, but only tangentially.  They write protocols for the lowest common denominator.  They are risk averse and rightfully so.  There’s a lot of good paramedics out there, but there’s even more who shouldn’t even be trusted with a BVM (which I still think is the most dangerous and under-respected tool on the ambulance).  It goes back some to education.  We have way too many people teaching EMS education whose only expertise is that they hold an EMS certification. Law school and medical school aren’t taught the entire way through by the same someone with a JD or MD.  There are multiple classes, each taught by subject matter experts.  One of the things I hear from some of the EMS dinosaur types is how some of their classes were taught by physicians (including specialists) and nurses.  We don’t have that anymore and I think the education has suffered as a result.  CoAEMSP doesn’t care. They care that you’re using FISDAP or “Platinum Planner” to track your students and develop more metrics. They don’t care about the quality of the content.  NAEMSE doesn’t care.  They are too busy promoting “flipped classrooms,” “learning styles,” or whatever other trendy topics are out there.  The NAEMT doesn’t care.  They’re too busy promoting new card courses to cover things that should’ve been covered in initial education.  The American Heart Association doesn’t care.  They’re too busy promoting ACLS, BLS, and PALS to care.  And the NREMT?  They should care, but they don’t.  They will get the usual professional EMS committee members in a room and issue high and mighty statements about the EMS Agenda Version Whatever.  And the item writing committees for the exams will give a de facto veto to the state with the worst EMS standards because the exam “has to reflect the entire country.”  And the publishers of EMS texts don’t care.  They know their market.  Truth be told, there’s more people reading at a tenth grade reading level who are getting their paramedic because their fire department requires it than there are students (or teachers) who really want to understand the whys of prehospital medicine.  And the students and educators that do want to know how to practice prehospital medicine are supplementing their texts with medical and nursing texts as well as online material. The state health bureaucracies don’t care.  EMS is a small part of their mission.  They see their mission as public health and welfare — and to the average bureaucrat with a RN and a MPH degree, EMS is best seen and not heard — and then, only seen during EMS Week.  The Feds?  Well, truth be told, EMS really isn’t a Federal responsibility and making it such will ensure that the same people who brought us the VA will be in charge of prehospital medicine as well.
And don’t even get me started about the usual gang of idiots.  In short, every EMS committee is tasked to solve the ongoing problems of EMS but is full of the same EMS celebrities who created the problem in the first place.
EMS as a whole is beyond repair.  But virtually no single EMS system (except maybe perhaps some of the large urban systems) is beyond salvage.  Fix each system and fix the individual EMS education programs and eventually, the rising tide will lift all boats.
Until then, rant globally, fix locally.

Things You Need To Know

As an EMS provider, there are a lot of things you need to know. Many of them are clinical things about the practice of medicine that a lot of people who are a lot smarter than me can teach.  But for your reading pleasure and hopefully, for your education, here are some other things I’ve learned.

1) Most of your patients have no idea if you know what you’re doing.  They do know if you’re nice.

2) I spent a great deal of my time in EMS looking for the perfect EMS system.  I found out more than once that such a system doesn’t exist. Find the system that works for you (or that you can make work for you).  You’ll be infinitely happier in the long run.

3) It’s important to be current and correct on the practice of EMS.  It’s less important letting others know you’re correct. Corollary to this axiom: If you do need to coach or correct others, there’s an art to doing it.

4) EMS as it exists now in the USA has only been a thing for 45 years or so.  It’s still growing. And I think most of us are impatient. I know I am. But one thing I continually have to remind me myself is that EMS is still growing and maturing. Whether its your EMS system or another, it isn’t going to magically improve overnight or reach the level we know it can overnight. Continual gradual improvement is a thing. And in some systems, that improvement is showing. It’s just not going to happen immediately.

5) Your mentors will change. As we grow and mature in our practice, we find that some of the people we idolized aren’t as smart as we first thought.  And that’s ok too.

6) Knowing what to do is easy.  Knowing when to do it or not do it is the hard part of being a clinician.

7) Taking a patient to a hospital incapable of managing their condition is a disservice to the patient.  Part of being an EMS provider is that we are supposed to know where to take our patients.

8) This is actually supposed to be fun. When it’s no longer consistently fun, it’s time.

9) A significant portion of our time in EMS is spent dealing with emergencies.  The patient defines emergency.  We don’t.  And our education fails to recognize what patients consider emergencies.

10) A preceptor once told me that the paramedic’s job is to bring order to chaos.  If you can combine that skill with the passion and zest that most rookies and volunteers have along with being current on medicine and slaying dogma, you’re on your way.

Bread And Butter

Today's blog post (and sorry for the delay to my Mom and the two others who read the blog) was going to be about continuing education.  I was going to write about the seeming inability to get the majority of EMS providers to engage in continuing … [Continue reading]

A Time To NOT Volunteer

If you know me or you've come by this blog a few times, you know I'm very passionate about the role of volunteers in the world of emergency services, particularly in the fire and EMS world.  Today marks a change.  One, I'm about to give some very … [Continue reading]

Want to Volunteer?

Anyone who knows me knows that I'm pretty passionate about my volunteer work in EMS.  To me, it's a wonderful way to give back and it's a wonderful change of pace from my workday of moving contracts through the bureaucracy. Those of us in the fire … [Continue reading]

Brotherhood and Family

Everyone talks about the fire/EMS “brotherhood.”  Everyone says that we’re “family.”  Today, a few of my close online fire/EMS “family” were talking about how the term “brother” bothers them for some reason. In the most abstract sense, I can get … [Continue reading]

The Semi-Regular Reminder on EMS Politics

Yep. It's that time again. "EMS On The Hill Day" is just around the corner.  As we all know from EMS social media and the EMS "Powers That Be," AKA:the usual conference speakers and the people who now provide consulting services to fix the messes … [Continue reading]

Your Ride-Share To The Hospital

There have been several articles lately about the use of ride-sharing services like Uber and Lyft to get patients to the ER.  In one article, AMR is looking at a yet-to-be-defined partnership with a ride-sharing service.  Another article making its … [Continue reading]

The Access To Knowledge

One of the greatest things about the Internet is that it has democratized access to information.  Most academic journals are available online, some of which are even available for free.  Wikipedia has improved, in most cases, to provide reliable … [Continue reading]

What Really Happened With The Proposed Sale of AMR

A friend and fellow blogger recently posted a blog where he lays the blame at the Trump Administration for the possible sale of AMR due to the possible repeal of the Affordable Care Act, AKA "ObamaCare."  While it's certainly trendy to blame … [Continue reading]