Well, it’s Monday and it’s the annual commemoration of EMS Week. This is the week where you’ll likely get some sort of junk food at the local ER, assuming the staff doesn’t eat it first. Your employer may give you some sort of trinkets and there will probably be a couple of extra motivational posters around the station. All of those are the traditional ways of celebrating our week and honoring what we do for our respective communities.
But I wanted to go a little past that. I saw something last week that got me to thinking. Last week, I saw pictures of a bunch of paramedics from a large EMS system undergoing boot-camp style training to become “rescue” paramedics, skilled in rope and water rescue. And that led to another thought – namely, how many of us add something else to modify the term EMT or paramedic. Firefighter/EMT. Special Operations Paramedic. Critical Care Paramedic. Firefighter/Paramedic. Flight Paramedic. Dive Medic. Community Paramedic. Firefighter Paramedic. Tactical Medic.
It’s absolutely great — and essential — to expand our knowledge and, in some cases, to expand what EMS does to meet our respective communities’ needs. However, the reality is that each and all of those roles fill limited needs. There are relatively few patients that need advanced life support provided by paramedics rappelling down a cliff or that need care under fire (at least in the civilian world). The chances of needing to intubate a patient in a radioactive environment are pretty close to nil.
Let’s go back to the famed “White Paper” issued by the National Academy of Sciences in 1966. That’s the paper that gave the impetus for modern EMS. It addressed accidental death and disability in the out of hospital setting. From that, EMS has evolved into the practice of prehospital medicine. To me, what EMS is delivering the practice of medicine, outside the clinical setting, incorporating some aspects of the public safety disciplines to do so.
There’s nothing wrong whatsoever with these additional skill sets. What is wrong is the explanation that I’ve heard from some of these providers as to why they pursue those skill sets. Time and time again, I’ve heard, “I wanted the additional challenge.” My continuing belief is that if you do the medicine right, there’s plenty of challenge. Medicine is constantly evolving. The clinical practice of medicine has changed dramatically in the twelve years I’ve been in EMS. More and more EMS systems have embraced selective spinal motion restriction, rapid sequence intubation, 12-lead EKG interpretation, and standing orders for pain management. When I first entered EMS, I’d never heard of ketamine or sepsis, yet both of these are now routine terms I use in my practice of medicine.
On this EMS Week, let’s each make the commitment to each and every one of our patients by doing the core mission that unites us all — providing the best medicine possible. On this EMS Week, commit to being a clinician first and foremost.
