Have you ever noticed….?

Have you ever noticed how many new, inexperienced, poorly educated providers talk about how much they’re allowed to “do” in their EMS organization/system/region?

Today, I was involved in a discussion in EMS social media where an EMT with three months of experience was bragging about taking a sixteen hour course where he would get “training” on administering three additional medications and be allowed to use a supraglottic airway. In the grand scheme of things, all of these medications and the supraglottic airway are relatively benign interventions.  There’s relatively low risk for each of the medications and the airway device in question. What is NOT benign is the prevailing mentality in EMS that a card class or an in-service is all that’s needed, especially to teach an entry-level EMS provider skills that are normally reserved for providers with a higher certification. Even with its numerous faults, paramedic education has a depth of education in anatomy, physiology, pharmacology, and patient assessment that an EMT or AEMT course don’t have. While a sixteen hour course might be able to teach the ins and outs of those particular medications and that particular airway device, that course is zero substitute for actually having the education that an advanced provider has.  We can teach almost anyone how to do something.  Knowing when to do something — or when not to do something — is where education is superior to training.

Sadly, our profession has done little to disabuse EMS providers, especially inexperienced entry level providers, of the notion that EMS consists only of a set of skills that can be added and subtracted at whim.  Rather, like any academic discipline, particularly one involving the healing arts, EMS consists of knowledge.  And there is no statutory limit on the knowledge that any provider can have, regardless of their certification level. Professional education does not end with initial certification.  Rather, initial certification is but a determination of entry level minimal competence.  Professionalism involves the relentless pursuit of mastery well above and beyond the minimum standards.

As I’ve joked before, a cook knows and follows the recipes.  A chef understands the culinary arts well enough to be able to create their own recipes.  The majority of EMS providers are technicians — and as such, we’ve become the short order cooks of medicine.

EMS will become a respected part of the medical system when we stop talking about what we can do and start talking about what we know.  There’s a big difference between training and education.  When we routinely produce educated clinicians as opposed to trained technicians, that’s when the respect — and the money — will show up.

Things You Don’t Hear In A Law Office

In honor of some of the things I hear in the EMS world, I decided to see how they’d translate to the legal profession.

If these new lawyers would spend some time as legal assistants before going straight to law school, they’d understand how the legal system really works, not all that book learning.

  • Lawyers save clients, legal assistants save lawyers.
  • If I work as a paralegal for a few years, can I just apply for transition to attorney and pay the fees?  After all, my attorney has been letting me do attorney work and just making sure I don’t screw it up.
  • Our state has a special kind of paralegal that can do everything a lawyer can do, but they don’t get a full law school education.  They call a senior attorney or a judge if they need to do certain legal skills.  We couldn’t afford lawyers in our community anyway and there’s no law school nearby.
  • My bar exam cut off after two and a half days, did I pass?
  • Lawyer: I’m here to sue your butt, not kiss it.
  • My law school professor said….. (Actually, this might work since law school professors are supposed to be subject matter experts in their field.)
  • Even though the law says no, I’ve seen it work with a jury!

Yet, if you put in the EMS analogies to these statements, you’d see how common they are to EMS. Maybe this is why lawyers are presumed to make “big bucks” and EMS providers don’t “get the respect we deserve.”

My advice for improving EMS?  Let’s police our own profession.  Let’s get rid of the idiots. Let’s improve the minimal standards above and beyond “minimal competence.” And I guarantee the wages and working conditions will improve.  Just ask the nurses that we continually have an inferiority complex with.

It’s Never About the Pay

Years ago, as a new attorney working in state government, I worked for a state agency that determined they had a problem retaining attorneys.  They did a lot of surveys, most of which revealed discontent with working conditions.  The reality was that … [Continue reading]

Fight For $15

So, in a fit of rage, I was almost tempted to write a screed about how EMS providers don't deserve the $15 per hour wage that fast food workers are protesting and clamoring for. My rationale was (and remains) simple.  After watching the attitudes … [Continue reading]

Are You Really Surprised?

This morning, I happened to read an article where a Senator was grandstanding about the supposed opiate abuse epidemic.  He was blaming the epidemic on everyone.  Doctors, the "evil" pharmaceutical industry, and even the DEA for not "doing … [Continue reading]

About Orlando, Paris, San Bernadino, and Everyplace Else

Knowing me, I'll bet you thought this would be about gun control.  Nope.  If you know me, you know where I stand. I'm not going to convince those who disagree with me and they're unlikely to change me either. What most of us agree on is that we … [Continue reading]

Time To Call It Like I See It

In my EMS career, I've been very fortunate for two things.  One, I've had the opportunity to work for some great EMS systems.  Two, by virtue of my outside career, I don't have to rely on EMS to make ends meet or pay the bills.  To me, that also … [Continue reading]

On Fire and Medics

Recently, a lot of my Canadian EMS friends and colleagues have been concerned about proposals for Canadian firefighters to provide emergency medical care.  In much of Canada, prehospital care is exclusively the province (pardon the pun) of EMS and … [Continue reading]

So, You Want To Be An EMS Writer?

Everyone wants fame and notoriety.  Some even find it. A few find fortune with that fame. I may not be able to promise fortune, but I can sure tell you the keys to becoming famous by writing another EMS social media clickbait posting. If you just … [Continue reading]

We Deserve Respect?

At every gathering of EMS providers, whether in person or in the online world, we constantly bemoan the perceived lack of respect that the “ambulance drivers” get from the rest of the medical community, from other public safety providers, and from … [Continue reading]