Why The Advice Is Rarely Free

Anyone who knows me (especially on Facebook) knows how much I rant about giving free legal advice.  To be more exact, I rant at the expectation that some in EMS have that they are entitled to ask me for free legal advice.  (But Wes, it’s just a quick question!)  That would be the same as asking an EMT who does transfers to give my dad a free ride to a doctor’s appointment, because, after all, it’s just a quick ride over to that clinic on the other side of town. As I’ve said more than once, I’m a volunteer paramedic, not a volunteer lawyer.

Kidding and ranting aside, I do get it, at least somewhat.  For a lot of us who are attorneys, we may be the only attorney that our friends know.  And I think that may be even more the case in EMS.

Law pays my bills and EMS keeps me sane. (Think on that one for a while.) Having said that, I need a law license to pay my bills and those things that could potentially jeopardize my license are things I typically try to avoid. Just like in EMS or any other licensed profession, as a lawyer, I’m subject to certain legal and ethical obligations. In my case, as a Texas attorney, my ground rules are largely set by what our State Bar refers to as the Texas Disciplinary Rules of Professional Conduct.

Generally speaking, my obligations to you start once an attorney-client relationship is established. I would refer you to Part 10 of the Preamble of the Texas Disciplinary Rules of Professional Conduct which states, in part, “Most of the duties flowing from the client-lawyer relationship attach only after the client has requested the lawyer to render legal services and the lawyer has agreed to do so.” In other words, if I’m providing you legal advice, the attorney-client relationship may well exist and I’m under all of those professional, ethical, and legal obligations.  Even if it’s “just a quick question,” please understand and respect me when I say that you need to seek legal counsel. After all, “legal services” constitutes what I do.  I’ve heard a few folks say, “Well, I’m just asking your opinion since you’re also a medic.”  If that’s the case, why was I picked out of every EMS provider you know to provide guidance on a legal question?

Please understand that another one of my obligations as an attorney is to only provide representation on matters that I’m competent in. Rule 1.01 states, again, in part, “A lawyer shall not accept or continue employment in a legal matter which the lawyer knows or should know is beyond the lawyer’s competence…”  I primarily do administrative law and government contracts.  I know about EMS law because it’s a field that’s near and dear to my heart personally.  That doesn’t mean that I know anything about your child custody, your speeding ticket, or your Aunt Erma’s will.  It’s the same as expecting your orthopedic surgeon to read an EKG.  Sure, they’re licensed and permitted to do such, but would you really trust their opinion?  More importantly, would you trust an orthopedic surgeon who’s actually willing to read and interpret an EKG?

As I’ve said more than once when discussing legal issues, both the underlying facts of the case as well as the laws of the jurisdiction make a huge difference in providing legal advice or in answering a question.  That’s why most of us who are lawyers have a favorite answer — it depends. Also, because lawyers need all of the facts and to find out the relevant law, it’s rarely just a short answer that we can give quickly. When you combine this with the duties that attach to an attorney-client relationship, you can hopefully understand why I’m loathe to wade into a social media debate about the law.  These debates often become a debate about what the law should be rather than what the law is.  If you want to change what the law is to your version of what the law should be, the political process exists for that very reason.

Also, just like I wouldn’t ask or expect my EMS friends and colleagues in Vegas to come to Texas and immediately start practicing as medics, please understand that my law license is issued by Texas.  I can provide legal advice in Texas — and no other state until or unless I apply to become licensed in another state.  As there’s no National Registry of Lawyers, the reciprocity process for attorneys (if it’s even granted in other states) tends to be a bit more complex and expensive. Otherwise, I end up taking another state’s bar exam to get admitted.  For reference, the Texas Bar Exam is offered twice a year and is a two and a half day exam.  That explains, at least in part, why the Registry exam didn’t seem like too much of a hurdle in comparison.

When I get tagged into or dragged into these debates online, it creates a dilemma for me and my fellow medic-lawyers. One colleague of mine recently noted to me that replying to “Facebook lawyers” puts us in an awkward position because even replying to or arguing with their positions, even when clearly and blatantly wrong, could be construed as providing legal advice. And when it’s about a specific instance, that’s even more likely to be considered providing legal advice — which is the practice of law.

Hopefully, these thoughts give you a better understanding of my mindset about not wanting to give legal advice, even if it’s “just a quick question;” why I like to say “it depends;” and why I recommend you get legal counsel of your own if you do have a question.  In Texas, our State Bar offers a lawyer referral service to find legal counsel.  For EMS issues affecting your liability or license, insurance coverage is available which may include legal representation.

I love our EMS community (ok,  most of the time) and I am always in favor of EMS providers being better educated on the laws and regulations that affect our practice.  However, please understand that while I am a lawyer, I am not your lawyer.  And for those of you who I’ve actually given “free” advice to, I hope you might understand and appreciate what exactly is involved when I do that. Being a lawyer is as much a part of my identity as being a medic — and both are a form of public trust that I sincerely value and hope to maintain.

 

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 education above and beyond the usual “required” card courses and/or the state-mandated refresher course material.  (Parenthetical.  I’m very glad to practice prehospital medicine in the Lone Star State where the state mandates very little as far as specific content and leaves it up to the provider as to what continuing education to seek out, subject to a few broad categories.)

I was going to complain about people not attending high quality continuing education, even when it’s offered for free.  I was going to mention the challenge of bringing the knowledge from international and national conferences like SMACC and EMSWorldExpo back to one’s home EMS system.  I was going to mention what I call the “Goldilocks” challenge of EMS continuing education — ensuring that the material isn’t so introductory to be a rehash of EMT classes but isn’t so complex as to require a PhD in pharmacology and physiology to understand the material, let alone apply it. I could even mention the whole volunteer versus paid debate, not even mentioning how so many volunteers manage to attend outside continuing education and conferences on their own dime, but you’ll rarely see a large EMS system (let alone a fire-based EMS system) sending people to a conference, let alone their members attending on their own. (See also: If I need to know it, they’ll do it in-house and pay me overtime for it.)

These are all worth mentioning.  And they deserve mentioning.  But here’s what really struck me. We can have all of the high-speed providers going to courses like these.  And there’s also going to be a lot of people going to “cool” sounding continuing education courses in tactical medicine, hazmat, or some sort of technical rescue. (Please, please tell me why an EMT working interfacility transfers needs to know how to be an “operator” in the hot zone.) But we rarely have good, consistent, clinically current, relevant continuing education on the topics that are the bread and butter of prehospital medicine. Think about your last shift on the ambulance.  Chest pain, respiratory difficulty, sepsis, ground level falls, abdominal pain, routine MVCs.  How much continuing education have you received on these matters? If you did receive continuing education on these topics, was it merely a repeat of what you’ve been told every recertification cycle you’ve been in EMS? From the amount of providers who think that any heart rate above 120 must be some form of arrhythmia that requires treatment and who think that EMS administration of diuretics for CHF patients is a good idea, clearly, we’re not getting the bread and butter of EMS down, much less mastering it.

What we see with continuing education is but a symptom of what’s wrong with EMS.  We want to do all the new cool things of the moment, whether it’s community paramedicine, technical rescue, tactical medicine, or critical care medicine.  We don’t want to do the bread and butter of medicine (see also: every EMS social media forum complaining about system abuse, drug abusers, or “frequent flyers”) and when we do the bread and butter, we aren’t always current.  If we can’t get the routine right, why should we be trusted with thinking outside the box?

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 broad, generic “free” legal advice.  Two, I’m about to tell you NOT to volunteer.

Event medical standbys. At least in Texas, those fall into a massive loophole where they’re not subject to any regulation from the state. In Texas, transport providers (officially called “EMS Providers”) and “first responder organizations” are subject to state regulatory requirements.  Because event medical standbys don’t fit into Texas’s definition of EMS Provider or First Responder Organization, they’re completely outside the purview of our state EMS regulatory system.

These events always say “BLS only” or “CPR/first aid” but seem to recruit heavily from the ranks of EMS providers. If they truly only want “BLS” or layperson aid, why are they recruiting so heavily from EMS?  Simple.  They want EMS providers on site, but they’ve gotten some legal or risk management advice to not call it an “EMS standby.”  They think that by saying it’s only first aid that their liability will somehow be limited.  Truth be told, I’m not sure if it would or wouldn’t be limited.  But I know this much from law school — anyone that can be sued will be sued, both collectively and individually.  While you may not end up being found liable, I can guarantee that will not protect you from either a suit or the lawyer’s bills to represent you.  (Speaking of which, you do have your own EMS liability insurance to protect you and provide for legal representation, don’t you?)

This is the closest you’ll ever get to free legal advice from me. Just say no. You’re unlikely covered by any medical direction or protocols, which begs the question of what you’re doing there and whether you’re practicing “medicine” or delivering EMS care. And if all they want is “BLS” or first aid, why are they asking you to be there by virtue of you holding an EMS certification? I’ve helped at these events before and it feels very odd to be there without the ability to function at your certification level, assuming they’ve even verified your certification.

In the very best case, you’re probably going to be poorly equipped.  You’re even more likely to be expected to supply your own gear. And I will virtually guarantee that if something bad happens, you will be on your own. The worst part? Many of these events are for profit. Those that aren’t are usually run by nonprofits that have plenty of money for everything besides real EMS coverage. Many of these so-called event medicine companies have a business model based on you being an “independent contractor,” meaning that they’ll throw you to the sharks and claim that they had no oversight of you.  In other words, helping some of these events out for free as a “volunteer” isn’t much better than offering to drive Lyft or Uber for free.

If you truly want to “feel good” by volunteering, get a t-shirt, and/or be thanked for your service, there’s probably a volunteer service within an hour’s drive of you that would actually benefit from your volunteer hours. To me, it’s really ironic is how many paid firefighters/EMTs jump at the chance to work at these events and then say how volunteering “holds back the profession” and artificially lowers salaries.  If that’s the case, then it’s high time that we tell each and every one of these large public events that they need to provide EMS coverage just like they have porta-potties, trash collection, food service, and security on site.

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 and EMS world hear a lot about the supposed shortage of volunteers.  Last week, I saw the irony of a state volunteer fire association doing a media outreach at the state capitol using trucks from a department that is primarily paid and doesn’t even have information on its webpage about volunteer recruitment.

So, in the spirit of an intervention filled with tough love, I offer you the following advice.

Want to join a volunteer fire or EMS department? Let’s talk about what happens.
1) Good luck finding the department online. If you do find them online, good luck finding an application.

2) If you do apply, you can expect some sort of committee process to see if you “fit in” with the prevailing culture of the department, which is probably dysfunctional.

3) If you have no interest in 80% of the fire department’s calls being medical, no worries. You don’t have to even get your first responder. But even if you already have your EMT or Paramedic, we will demand that you be a firefighter.

4) Training? What’s that? We’ll do training when we feel like it, on topics that only interest us, conducted by people with no qualifications. If you need additional training to maintain your certifications, that’s probably going to be on your own, with your own money.  But if the training sounds “cool,” you can fully expect that the connected members of the department will be travelling to it — on the department’s dime.

5) Equipment?  Yeah…. Here’s a t-shirt or two. We’ll issue you a radio, pager, safety apparel, and EMS equipment sometime, maybe — if we like you and/or you still keep coming around after putting up with us.

6) Leadership?  What’s that?  We’re likely run by a self-perpetuating group of insiders who are completely insular in our thinking and definitely don’t wear how anyplace else does things, especially from you, the new guy.

7) You’ll be on some sort of probationary process for a while, which will be a form of institutionalized hazing until we “check you off.”  Good luck getting one or two of the very specific training classes that you need to be released from probation.  We only offer those every few months at best.

8) We will continue the same things we’ve been doing for 40+ years, then wonder why we can’t find volunteers.

9) If we have paid guys, they’ll unionize and then claim that they can’t work with volunteers.

10) We will beg and plead everywhere for volunteers, show zero flexibility, and use that as political cover to put in another tax levy to pay for more unionized firefighters. Once we do that, we’ll then try to become an “all-hazards” department and get ambulances staffed by 18-25 year old firefighter/medics who want to do suppression only.

If you find a department where the majority of these thing don’t apply, stay there.  You’ve found a gem.

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 that.  “Brother” sounds like something you’d call someone in a religious order, a cult, or maybe the Moose lodge.  For some reason, I immediately picture Fred Flintstone and Barney Rubble in the Loyal Order of the Water Buffaloes.

But seriously, let’s assume that we want to be “brothers,” or to be politically correct and diverse, “brothers, sisters, and the pronoun you choose to identify with.” Well then, let’s really talk about what brotherhood and family mean in the fire/EMS world.

Brotherhood and family isn’t a t-shirt.  It’s not a cute slogan.  It’s not something we should do when it’s convenient.  It’s taking care of each other, watching out for each other, and yeah, it means we hold each other accountable too.

Brotherhood and family is checking on a partner after a rough call.

Brotherhood and family means taking the extra time to see a sick person in the hospital.

Brotherhood and family means that when you have a “brother” visiting from out of town, you spend a bit of time with them and maybe take them someplace local to get the feel of your home.

Brotherhood and family means that you take the time to mentor and train your station mates, even if both of you take time away from work to master the trade, because doing the job right matters.  Period.

One of my favorite incidents of brotherhood and family came when I did a ride at Station 11 in Clark County on the south end of the Las Vegas Strip.  As I was leaving, one of the firefighters gave me the station phone number.  I asked why.  He told me to call the station if I needed anything while I was in town because I’m “family.”

Brotherhood and family isn’t about hazing the rookies.  It’s not about creating a ridiculous paramilitary boot camp atmosphere.  And it’s sure as heck not about abusing the public trust or treating the public or our so-called “brothers” with anything less than respect.  And an IAFF sticker or a paid/volunteer status doesn’t mean a hill of beans about “brotherhood” or “family” either. It is always supposed to be about taking care of the public who implicitly trusts us to walk in their door at any hour and take care of them, hopefully like we’d take care of our family.

In other words, you can have all the slogans you want, wear all the t-shirts, say “brother” to everyone at the station, and eat all of your meals at the station’s dinner table as a “family,” but if you still have a toxic environment, inadequate leadership, a bunch of youngsters playing at being firefighters and medics, and a tolerance for inadequate service – then, no, you’re not my “brother” and you’re not my “family.”

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 that they created in the first place, merely showing up one day in Washington DC in a uniform that’s a cross between Idi Amin and the Knights of Columbus will magically fix all that is wrong with EMS.

 

I’ve worked in state government for years.  I’ve been a lawyer for years.  I’ve been involved in many political campaigns and involved in political parties.  I’m telling you — that’s not how any of this works.

 

We can fix EMS through the political process.  But it’s going to take more than one day per year in Washington DC.  Here’s what it’s going to take.

  1. MONEY.  Money fuels politics.  The reality is that politicians need money to get elected.  Money buys access to the game.  In other words, you can’t watch the game if you don’t have a ticket.
  2. All politics is local.  This famous quote from Tip O’Neill is so true. The Federal government has a limited role in the provision of EMS services, much of which relates to the role that Medicare/Medicaid funding plays. Local governments make the decisions on how to provide (and fund) the EMS system.  State governments typically are the ones who license and regulate EMS personnel and services.  And here we continue to think that the solution to EMS lies in Washington DC. State EMS associations need to step up the advocacy game.  Period.
  3. This is a year round sport.  EMS has to be engaged in the advocacy process year round.  Even in states like mine where the Legislature only meets every two years, there’s plenty going on in the “off season,” which is when interim studies happen and future legislation gets planned.
  4. It’s all about the staff.  Elected officials’ staff members are the subject matter experts and they help the officials develop their positions.  Their schedules are usually much more open than the elected official — get to know them and turn them into your ally.  In turn, they may well call upon you for input — and influence.
  5. The regulatory process matters. Getting legislation passed is great.  But oftentimes, the devil is in the proverbial details.  That’s why it’s imperative to be involved in the rulemaking process and in monitoring how the various regulatory agencies implement and interpret the law.
  6. Funding matters.  When you get funding, things happen.  If you want to fix EMS, fix the laws and regulations that reimburse EMS for being a transportation service rather than a medical service.
  7. Present the image of being professionals.  You want the elected official or their staff to consider you a professional they’d trust, not someone who looks and acts like they just got out of a clown car.

 

Of course, we all want the quick and easy answer to “fix” EMS.  We’ve been trying the quick and easy answers for years and here’s where we are.  Maybe it’s time we try what the adults have done to get their various professions a seat at the table in terms of funding and professional recognition from government.

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 way around the EMS social media circles describes people getting a ride to the hospital from one of these services.

Of course, the schizophrenic nature of EMS raises its ugly head.  You’ve got some people saying, “About time.  These people don’t need an ambulance because they’re not having an emergency.”  And then you’ve got other people taking the other extreme position in EMS, namely, “If we don’t take you to the emergency room in an ambulance, you could become ‘unconscious, comatose, or dead,'” — just like the speech that most EMS providers give when obtaining a refusal.

Why should we be offended or bothered by this? EMS social media is constantly filled with complaints about how people should only use the ambulance for “real emergencies.” Now that people do, I notice some of the comments are about the risks of not going by ambulance. So, what’s it gonna be?
EMS can’t have it’s cake and eat it too. Do we want people to use us? Or do we want to discourage using EMS unless it’s a real emergency? And of course, how is the lay public to know what’s a so-called real emergency?

And as I’ve said more than once, we somewhat have ourselves to blame for everyone calling 911 for a ride to the emergency room.  Especially in comparison to the police and fire services, we’ve done a terrible job of public outreach and education.  Everyone knows who the cops and firefighters are and what they do.  Us?  Not so much.  It’s amazing how many people don’t even know that there’s a difference between an EMT and a paramedic and what they do. We’ve delivered one message well, perhaps.  That message is “If you’re having a medical emergency, call 911.”  When you combine that simplistic message with the failure of American/Western medicine to deliver medical care outside of a 8:00 AM – 5:00 PM, weekdays only model and end up sending patients to multiple specialists, labs, and imaging centers all on those same inconvenient schedules, is it any wonder that John Q. Public decides to “call 911 for an emergency.”  In other words, EMS and emergency medicine have become victims of our own success.  People know that if they need medical care, EMS and the emergency department exist and won’t turn anyone away.

What we really need are trained professionals who have the ability to assess and transport/refer to someplace in addition to the ER. And while we’re verbally masturbating over whether to be offended by this or an Arby’s ad, we’re not doing what we truly need to be doing — developing our profession into the role of a mid-level provider who’s able to deliver both the medicine and the patient in a manner that meets patient needs in the most cost effective way possible. And what emergency medicine needs to do is to actually read EMTALA, provide a “screening exam,” and refer non-acute patients to an alternative setting.  However, we need these prehospital mid-level providers and these alternative settings to exist in the first place.  I recognize there’s no funding stream as of yet, which is one of the major failings of the so-called community paramedicine initiative.  The truth is that you sometimes have to spend a little to save a lot.  That’s a truth that our government and healthcare payment systems have yet to grasp.

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 information on most subjects.  There are plenty of other sites that provide scholarly level information out there.  Then there are sites like Khan Academy that make basic education in a variety of subjects available for free.  And if you can’t find the information online, you can order virtually any book online through retailers like Amazon.

In other words, you can have access to the same educational materials that train professionals in any field.  Want to learn gastroenterology?  The books used to train residents and fellows can be ordered online.  Want to learn engineering?  The materials are available online too.  Want to be an administrative lawyer?  Yep, law can be found online too.  You can find most legal codes online and with a bit of searching, you can even find the relevant cases too.

Here’s what none of these books will teach you.  They won’t teach you the mindset of how to think like a member of a profession.  The materials alone don’t teach the academic or professional discipline. Reading statutes, regulations, and cases may provide some insight on the law, but you won’t necessarily grasp the legal principles or reasoning, much less how a single law in and of itself interacts with all of the other laws out there.  Likewise, one can buy all of the cardiology texts out there and become quite knowledgeable about the heart while at the same time failing to realize that the heart is but one interdependent organ in an entire human body.

The democratization of information has done wonders for our society.  Yet, one of the biggest challenges is that mere access to information doesn’t necessarily mean understanding the information.  Nor does it mean placing said information into its proper context.  If you don’t believe me, look at the number of self-appointed experts who have “done their research” posting online. Cherry-picking from a discredited study doesn’t make you an expert on autism and vaccines. An undergraduate degree combined with a medical degree is where you learn to skeptically examine scientific claims, understand how the human body works, and put that knowledge together to treat patients. Likewise, merely cutting and pasting a statute that you found via Google doesn’t make you the next Clarence Darrow.  As much of a cliche as it is, “learning to think like a lawyer” is exactly what law school does — teaching legal research, teaching legal writing, and ultimately, teaching enough legal reasoning so that you realize that a case is rarely won by merely cutting and pasting a statute in and of itself.

Information is great.  Education is more than information.  Education is the process of learning how to process, synthesize, contextualize, and use the information outside of a vacuum. And that’s why there’s such a market for the coffee mugs that say “Don’t confuse your Google search with my professional license.”  Whether it’s an EMS certification, a professional engineer’s license, or a subspecialty in medicine, thinking that reading the books and journals on your own makes you the equivalent of a licensed professional is hubris to the point of danger.

How does this apply to my usual writing about my self-described expensive hobby of EMS?  Quite simply, our field has a fair amount of self-appointed experts in anything vaguely and tangentially connected to EMS.  While there are many in our field who worship at the altars of dogma, vaguely defined “experience,” and the even worse defined “how we do it in the field,” probably the most dangerous are so-called leaders in our field who routinely opine on subjects in which they have knowledge, but not the education to contextualize, synthesize, or harmonize the knowledge outside of what they just read and parroted.  If you don’t believe me, look at how many places immediately remove (or add) an intervention or medication based solely on one article that’s been making the rounds of the EMS community.

In conclusion, the summation of human wisdom in any field is rarely going to be found in a Facebook post or a blog post.  As the Romans would say, “caveat emptor.”  As Reagan would’ve said, “Trust, but verify.”