Endangered Species

So, I recently read an article online in Fire Apparatus Magazine bemoaning the state of EMS. Because, as we all know, the most current information on emergency medicine comes from a magazine that shows pictures of big red shiny trucks.

When you go through the article (I’m not going to link it because I don’t want to give this guy any more legitimacy), he raises the standard argument that fire chiefs and large EMS system managers always use as their stalking horse in their arguments to keep EMS educational standards low — or even lower them. Yep, that’s right. The mythical rural EMS volunteer who will disappear if we change the science and/or add one more bit of knowledge to their already overflowing brain.

I feel more than qualified to address this issue. I’ve spent the majority of my EMS career as a volunteer at both the EMT and paramedic levels with both fire-based systems and third service models. I’ve worked urban, suburban, and rural. The majority of my experience has been in combination departments where paid and volunteer medics work side-by-side. And to the premise of this article, I say, “BULL.” Well, I said more, but this is a family-friendly blog.

I’m more than tired of using the overworked rural volunteer provider as a straw man. First, regardless of whether you draw a paycheck or not, an EMT or paramedic certification is the same. In many states, you can’t say the same for a paid versus unpaid firefighter. Second, in my experience, volunteers are some of the most motivated people out there when it comes to seeking continuing education and opportunities to advance their medicine. In the rural service where I currently volunteer, we have an active continuing education program consisting of monthly online classes as well as a full panoply of “card courses” covering resuscitation, cardiac care, medicine, trauma, pediatrics, and tactical medicine. Our medics, at all levels, routinely exceed state mandated training requirements. I’d further note that several of our paramedics are volunteers who work in outside professions and maintain licensure in those professions as well. Furthermore, come to any of the big EMS conferences. There, you’ll notice a disproportionate number of volunteer providers, especially compared to those employed in large EMS systems.

In short, Chief Haddon of the North Fork, Idaho Fire Department is wrong. Volunteer EMS providers can, will, and do exceed educational requirements and expectations. Give them a chance and you’ll find out. And if you don’t believe me, I’m extending a personal invitation to come down to Texas. I’d be happy to introduce you to some volunteers who actively seek to improve themselves professionally for the benefit of their patient. Heck, I’ll even treat to BBQ.

I’m not expecting a visit, though. It’s a lot easier to use the myth of the overworked, overwhelmed volunteer EMS provider who will go away if we add one more class. Sadly, this “don’t need to know it mentality” usually only benefits the “mongo mentality” of “you call, we haul” that seems to hold back EMS. The worst part is that the same departments and administrators who bemoan increased EMS education can be seen at all of the structural fire conferences. Maybe its time to have more volunteer EMS systems and less volunteer fire systems?

Heresy in a paragraph (or less)

A few years ago, the formerly ALS skill pushed to the masses was the Epi-Pen.  Now, it’s Narcan.  What’s different?  Simple.  Narcan is going to be needed less in the field but will probably be used more. What would work is teaching people how to properly ventilate with a BVM.  It fixes the real problem (depressed respiration) and has more uses than just an opiate overdose.  But why should we teach BVM skills?  After all, it’s barely taught properly to EMS types.

And let the heresy accusations begin.  At least I didn’t bring up backboards.  Yet.

Observations from Facebook Friday

Spent some time actually observing and digesting some EMS stuff on Facebook today.  Two random thoughts. 1) Less than a few moments ago, I watched my Facebook feed roll by with another NAEMT post shilling the "Field EMS Bill." Tell me how making … [Continue reading]

Category 9

In many EMS systems, Category 9 or some code involving the number 9 is the code for cardiac arrest.  This number comes from the Medical Priority Dispatch System "determinant" codes.   And as we all know, the easiest, simplest, most low-hanging fruit … [Continue reading]


Recently, a good bit of publicity has been devoted to allowing EMTs to administer Narcan intranasally to patients who have overdosed on opiates.  speaking purely from a practical and clinical standpoint, these patients aren't going to die from a lack … [Continue reading]

What medical types don’t understand

I'm fortunate enough to practice both law and paramedicine regularly.  As a result, I see a lot of ignorance where lawyers don't understand medicine.  Namely, that lawyers continue to mislead the lay public that a bad outcome equals … [Continue reading]

Toxic exposure

Some of my EMS friends refer to the less enlightened of us in EMS as LIV, shorthand for Low Information Voters.  I'm the first to admit that I like the term and use it.  Sadly, I have occasion to use it regularly, especially seeing what some … [Continue reading]

If you see something, say something.

The Homeland Security folks have plastered the saying, "If you see something, say something" all over the place.  EMS needs to adopt this saying as well for what we do. First of all, when you're part of a team providing care to a patient: "If you … [Continue reading]

What’s our paradigm?

Fair warning.  I'm going to offend a lot of you.  Hell, I'm expecting a nasty snarky reply or two. I love the public safety aspects of being a paramedic.  I admit it, I'm enough of a sparky type that I like having a utility belt. I love my duty … [Continue reading]

The future is here…

We just don't realize it.  There's a lot of discussion about community paramedicine and what that entails. For a while now, there has been additional training and education available for EMS providers in the tactical and critical care arenas.  Our … [Continue reading]