I’ve noticed two interesting discussions going on simultaneously on EMS social media. One discussion, which started on the National EMS Management Association list on Google Groups initially started out as a medical director trying to update his protocols. It has since evolved (or perhaps, devolved) into a discussion about keeping endotracheal intubation as a paramedic skill. The usual positions are being hashed out. Again. In short — one position is that EMS, as a whole, doesn’t do a good job at intubation — either in initial education and skills mastery or in skills retention. The other side is the argument of “That may well be true, but things are different at the XYZ EMS System where we absolutely excel at intubation. Here’s why and take a look at our numbers.”
Another discussion has been brought up by friend and fellow blogger Chris Kaiser. He’s raised some very good concerns about the current American Heart Association Advanced Cardiac Life Support program sinking to the level of a merit badge course that every advanced life support EMS provider has and that most hospital staff have.
I see both of these discussions as a symptom of what I call the McDonald-ization of EMS. In other words, we want to ensure a similar experience wherever you get EMS, regardless of previous excellence (or incompetence). Face it, when we travel, we stop at Mickey D’s because we know what we’re getting, not because it’s the best burger anywhere.
EMS seems to be trending towards this as well. The statistical gurus and the usual crowd of professional committee members and buzzword repeaters all bloviate (sorry for the Bill O’Reilly word there) about the need to have a common standard. Two problems there. First, the common standard doesn’t take into account the variations throughout the entire United States. To me, it’s unreasonable and illogical to presume that Cut Bank, Montana and Boston, Massachusetts have the same needs for EMS, much less the same populations and sources of funding. Second, like McDonald’s, when your chief concern is consistency, your product or service easily becomes the lowest common denominator. What you end up with is a consensus model where pit crew CPR, good airway management (both including and excluding intubation), and even more cutting edge advances like dual defibrillation and transporting certain cardiac arrest patients straight to the cath lab end up sacrificed because “we all need to be delivering the same care everywhere.”
As for me, I’ll take the occasionally singed porterhouse in recognition that even that is better than the uniformly average Big Mac, which for the record, isn’t even prepared the way I like my burgers to begin with. It’s time that we quit punishing the EMS services that try to deliver excellent patient care just so that everyone receives the same, consistent, AVERAGE care.
Of course, the statistician will tell me that there’s always going to be an average. We just need to keep IMPROVING what we do so that the average keeps advancing too.