A Solution to EMS Stagnation?

As I look at EMS’s stagnation in comparison to nursing, I have a thought. Nursing has made it where a Registered Nurse is the minimum level of entry to almost any acute care role — and where an associate’s degree is the minimum education level at best.

If we’re going to push the EMS degree narrative, we need to ensure that paramedics become the de facto provider of acute prehospital care. The Emergency Medical Technician should become the Certified Nurse’s Aide of prehospital medicine — in other words, not associated with acute care — except in a first responder role.  As a friend and colleague of mine noted, an EMT’s skill set makes an immediate difference in a few cases — rapid defibrillation, tourniquet application, and the use of an Epi-Pen.   Interestingly enough, those are all skills taught in the American Heart Association’s First Aid curriculum, once again providing credence to my belief that EMT education merely adds on to a general course in first aid.  While we’re at it, in my ideal world, EMT and paramedic education would be separate, albeit with a track to advance from EMT to paramedic.  You don’t have to progress from CNA to LVN to RN, although there are programs for LVNs to transition to RN.  We should do the exact same for paramedics.

Combine that with defining the role of a paramedic (which I see as rapid assessment, stabilization, and initial treatment) in statute and zealously protecting that role from intrusions by any other profession and you might actually get EMS to become more like nursing.  In my view, nursing has succeeded for three reasons.  First, nursing defines what it is.  Second, nursing makes sure that no one else intrudes on their defined role.  And finally, nursing is willing to engage in the political process to protect their role.

Let’s not do what Canada does and call every EMS provider a paramedic.  Let’s reserve the paramedic title for those who actually do what a paramedic does.  We don’t lump physician assistants and physicians together.  Let’s keep paramedic OUR title.  Of course, that also requires us, as paramedics, to educate the public and our government about what we do — which seems to be the one thing that we are still either unable or unwilling to.  See also:  the general public, other healthcare professionals, and government officials mixing the terms ambulance driver, EMT, paramedic, and first responder.

In summary, we need to define what a paramedic is, protect said role, and ask the public to demand paramedics.  As the advertising slogan goes, “Accept no substitutes.”

Community Paramedicine

Years ago, I attended a Citizen’s Police Academy program sponsored by my local police department.  It was designed to give the general public an insight into how the police department works and foster communications between the police and the public.  (And for what it’s worth, EMS is massively behind the times on our public outreach.  Fort Worth MedStar is the only non fire-based EMS system I’m aware of that operates a citizen’s academy for EMS.)

One of the best things that I got from this program was an explanation of community policing. The officers presenting this material explained that the police might have an idea of the community’s needs, but without actually engaging with the community and determining what the community wanted, there wasn’t community policing. The example was that the police might assume that the community wanted something done about an uptick in car burglaries, but the community might not even know about this and might well be more concerned with people speeding through a school zone. In other words, the police figured out that community policing doesn’t work without community engagement.

And now, let’s flip the conversation to EMS. EMS is talking a lot about “change” to meet call volume and demand.  We’re talking about alternative destinations for patients.  We’re talking about triage and different response models for “non-emergent” calls. But more than anything, we’re bandying about buzzwords and have convinced ourselves that the public is “abusing” the EMS system. We’ve almost become the police in the “bad old days” of policing where the cops were “us” and the public was “them.”

In other words, we’re doing what the police did before the community policing model developed.  We’re developing an EMS system based on what we think the public wants.  Perhaps we might even be developing an EMS system based upon what EMS wants. What we’re not doing is engaging the public to determine what they want, need, and expect from their EMS system.  Absolutely, we have a professional obligation as medical providers to first do no harm. That responsibility has some obligations.  As does the responsibility to be responsible stewards of the money provided to the EMS system.

But outside these obligations, how many EMS systems or political leaders engage the public to find out what they want or expect from their EMS system?  How many EMS systems educate the public what EMS is or does beyond “call 911 for an emergency?”  How many EMS systems teach that there haven’t been mere ambulance drivers for decades — or that EMT and paramedic aren’t necessarily interchangeable terms? And have we asked the public if they want mobile integrated health?  Or if they judge an EMS system by cardiac arrest survival rates and response time?  My strong guess is that many member of our public would be very happy with their EMS system if the medics showed up on time, were nice, gave them a safe ride to the hospital, and just maybe everyone’s medical records were synced together.

But if we don’t ask the public what they want from us and how we can help, we’re doomed to irrelevance and distrust, just like the police were — before they engaged the community.

Another Volunteer Crisis

As sure as the day is long, we can count on the EMS news sites to do a post on the volunteer crisis in fire and EMS organizations. And EMS1 did its part yesterday.

And of course, y’all know I have to comment.  So, let’s do a rehash and repeat.

Folks, it’s real simple. Too many organizations make it hard to volunteer, whether its applying or what’s required to remain a member. I’ve lost count of the number of volunteer organizations that don’t have their membership application online. Likewise, I’ve lost count of the number of “all hazards” departments that will allow volunteers to remain exclusively firefighters but won’t allow for EMS only volunteers, even when well over half of most departments’ call volumes are for medical calls. I’ve also lost count of the number of departments that are combination departments that only offer their “mandatory” training during the week when we “normal” people with an office job are already pulled in multiple directions. (Hint: There are infinite platforms online to make these classes available on demand or as webcasts.)

I’ve always held the position that standards should never be lowered. All that most volunteers (or potential volunteers) ask for is a bit of flexibility in how you reach those standards. Something as simple as allowing a volunteer more time or the ability to work with different field training officers could be a huge asset in getting a volunteer cleared to independent duty, especially as an advanced life support provider.

If you don’t believe that there’s a pool of volunteers out there, do this.  Look at how many people out there hold a fire and/or EMS certification and are currently unaffiliated with any service, whether paid or volunteer. If the National Volunteer Fire Council, NAEMT, or any of the other fire and EMS groups are truly serious about volunteers, I’d recommend a survey targeted at those people to find out why they’re not currently volunteering.  If you wanted to go above and beyond, survey those people who are active volunteers with departments not near their home.  Find out why they’re not affiliated with a closer department. Dollars to doughnuts, the answers will the same — there will be some artificially created barrier preventing them from volunteering nearby.

I’ll also note that the value of a volunteer group, especially in a combination department, isn’t immediately obvious until you have a disaster or other incident that’s stretched your department thin and/or exhausted mutual aid resources.  That guy who’s just a volunteer EMT can now free up the paid firefighter/EMT staff from medical calls.  That lady who’s qualified to drive and operate a tanker/tender means that apparatus is now in service and the paid crew isn’t cross-staffing it.

Unless of course, your goal is solely to show that you “can’t find volunteers” and really need that sales or property tax to hire paid staff. If that’s your real agenda, then, by all means, keep on doing what most departments seem to be doing. Sadly, in my neck of the woods, this strategy has been effective as a jobs program for paid firefighters and EMTs.

More on the Four Year EMS Degree

So, I’m thinking more about the push for an EMS degree. In theory, I think it’s a great idea. But here’s a couple of observations.
 
The “other countries have it” argument. Those other countries also have a national healthcare system where EMS is integrated into healthcare. We don’t have that in the United States. Additionally, some of these other countries don’t have a tradition of mid-level practitioners that the United States does like advanced practice nurses and physician assistants, so in some of these cases, paramedic providers are stepping into roles that might be filled by other healthcare professionals here.
 
As a corollary to that, much of our EMS is provided by the fire service and by large private EMS companies. The fire service does EMS because it “has to” in order to maintain some justification for its existence. It has no interest in EMS save for staffing and budget. They’re not going to be advocates for EMS. As for the privates, they want low wages and lower educational standards, since they’ve got a long history of churning through employees and needing a steady inflow of new people.
 
Volunteers. Yeah, truthfully, it’s going to be hard to require a four year degree to volunteer on the ambulance. And unfortunately, there are parts of the USA where the local authorities have chosen not to fund an EMS system or there’s not sufficient people to do it. As the old adage goes, you get the EMS system you pay for.
Clinical outcomes. Everyone talks about evidence based medicine, including me, until they don’t like what it says. Is there any evidence that a more educated paramedic provider has better clinical outcomes. Australia and Canada both have college-educated providers and that’s become the norm there. Yet, these paramedics often have a more limited scope of practice than many locations in the United States.  Is there any evidence to indicate that American paramedics with a lower educational standard and (often) a broader scope of practice have worse clinical outcomes than their more educated foreign colleagues? As a further question, would a four year degree expand the current scope of practice for American paramedics?  As a liberal arts graduate myself, I believe the real value of a four year degree comes from the critical thinking and communications skills that a core liberal arts curriculum develops, but the majority of EMS degree advocates seem to believe that only a four year EMS specific degree is going to “save” EMS.

Actual logistics. Let’s assume that we do decide to put in a degree requirement for paramedics. Let’s further assume that it’s going to be a four year degree. How many degree programs exist? Are there sufficient faculty with an “appropriate” terminal degree in the field to satisfy the higher education accreditation authorities?  And on that note, what is an appropriate terminal degree for EMS?  Would we now end up inadvertently or intentionally creating a doctorate in EMS education?  Would current EMS educators be ineligible to continue what they’re already doing? The demand for nurses and nursing education has already created a shortage of nursing educators.  What would EMS education do to meet that demand on day one?

What would happen with an actual EMS degree requirement?  The skeptic and cynic in me says that most places wouldn’t have degree-educated paramedics.  Instead, the “powers that be” will do one of two things.  They will continue the current paramedic education and call it something else.  Or they will water that down even further and create another “paramedic light” certification. See also: Rhode Island’s EMT-Cardiac, New York’s Advanced EMT-Critical Care, NREMT Intermediate-99 (thankfully being phased out), Virginia’s EMT-Intermediate, or Iowa’s “paramedic” based on the NREMT I-99 standard (the actual “full” paramedic in Iowa was called a “paramedic specialist). And I will make you a bet that the majority of large EMS operations in this country will immediately default to providing service at this “paramedic light” level.

 

If we want degree educated paramedics and believe that’s for the best, we’re going to need to answer these questions.  And we’re also going to need find the funding for this. That probably means getting the primary payer of EMS services, the Federal government, to change Medicare/Medicaid so that EMS systems are paid for treatment and services rendered rather than just transport mileage.  But to do that means that we’re going to have to be more involved in the political process rather than the occasional appearance on a designated “lobby your politician” day where you wear a uniform that looks something like a third world dictator. The truth be told, increased EMS education and increased EMS reimbursement are like the chicken and the egg.  I don’t know which comes first.

 

I’d also point out something said by a former EMS director of mine.  He said he’s paying paramedics (and EMTs) what he can afford to pay them, not what he wants to pay them.  Again, until reimbursement changes, there’s no magic source of increased paramedic compensation, even with higher education.

Before you think I oppose an EMS degree, let me say that I don’t.  I believe that a four year degree is appropriate for a medical professional. I also don’t know that all of the advocates of an EMS degree have fully thought out the impact of such a requirement, even if gradually phased in.

I believe that our current America EMS system may be like Churchill’s definition of democracy. Churchill said that “Indeed it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.…”  I believe that we may find this to be equally true for American EMS if we suddenly change our educational paradigm without considering the consequences.

These concerns and this rant was brought to you by a mostly proud graduate of a certificate granting paramedic program who also had a bachelor’s degree in liberal arts followed by a graduate and a professional degree. Higher education taught me to think. Paramedic education taught me to do. And coming into a paramedic program with a college degree taught me to think and consider what I do as a paramedic.

On The EMS Degree

So, because of a prominent fire chief’s article against EMS degrees, all of the usual EMS advocates are coming out for a gradual phase-in of a degree requirement. And it stands to reason that the fire service wants a low entry standard for EMS.  Most fire departments, especially the larger urban ones, see EMS solely to justify their existence.  Smaller fire departments often see taking on the EMS mission as a way to get increased funding, most of which will go toward the big red trucks and not the ambulance.  In many fire departments, the ambulance is actually called the “penalty box.”

In theory, I’m in favor of a degree requirement to be in EMS, especially at the paramedic level. More education can and should produce better paramedics. But with some experience in both consuming and regulating higher education, I know that giving power to higher education can have unexpected consequences.

So, since this train seems to be gathering some steam, let me throw out my conditional support.  I hope the advocates for EMS education and those accrediting college based EMS programs will listen before we hear about these issues arising once a degree requirement is truly and fully implemented.

  1. Grandfather current providers. I’m told that’s already in the works, but requiring everyone to back and upgrade to an EMS-specific degree would likely overwhelm each of these college based programs.  And for those who already have a bachelor’s or higher in a field outside of EMS, it would be unnecessarily repetitive.
  2. As a condition of accreditation, college-based EMS programs should be required to explicitly state how they plan to meet the needs of EMS students, especially those who are currently in the workforce. Such a commitment should address hours that the courses are offered, locations of the courses, transfer-ability of hours for non-EMS specific courses, and availability of clinical sites.  If you ask why I have a paramedic certificate instead of a paramedic degree, I’ll give you a simple answer.  The community college based program serving my area only offered the paramedic program on a full-time basis during daytime hours only.  With an outside career and already having three degrees, attending a certificate-only program was a no-brainer.
  3. Distance education is a must.  It stands to reason that those against an EMS degree will use the “poor volunteers” as a stalking horse to protect those who stand the most to benefit from poorly educated EMS providers — namely the fire service and the larger private EMS systems. Ensuring that EMS degree programs have distance learning AND nearby clinical rotation sites will ensure that rural and volunteer systems have their needs addressed — and eliminate one more argument against an EMS degree.
  4. In an ideal world, I’d like to see some sort of promise or commitment of an alternate entry degree program for those who already have a bachelor’s degree or higher. Such a program should be tailored to get people the scientific background they need for prehospital medicine (primarily anatomy and physiology) and the coursework necessary to function as a paramedic.
  5. Finally, the accrediting bodies need to ensure that these commitments and promises from higher education are kept ongoing. It will be entirely too easy to start backpedaling once the initial accreditation occurs.

I sincerely hope that those who advocate for an EMS degree take this in the spirit in which it’s meant — a reasonable way to ensure that we actually accomplish the goal of creating better educated paramedics and not solely in guaranteeing higher education a continued revenue stream. If we don’t plan now to address the needs of EMS providers and foresee unintended consequences, we are guaranteed to create even more of a shortage of providers (although some might argue that’s not an entirely bad thing) and creating a group of providers with significant student loan debt to go into a field not known for the highest wages.

We have one chance to get this right.  Let’s make sure that happens.

Where To Fix EMS

We all know the problems with EMS.  Mostly they revolve around low pay, low standards, and unreliable sources of funding.  Easily fixed, right?  Well, maybe.

But there’s an ongoing problem in EMS. Most EMS systems operate under the belief that good clinical skills (or even worse, good clinical outcomes) are the primary determinants of who gets promoted.  Being a good clinician involves more than clinical skills.  And being a good clinician doesn’t mean you’re going to be a good educator or a good manager. Being a good clinician doesn’t correlate with much besides being a good clinician.

What does EMS lack?  And more importantly, what do most so-called EMS “Leaders” lack?  They lack the “soft skills” besides how to read an EKG, intubate, or start an IV. They may have a professional network, but they don’t know how to use it.  They rarely understand politics at any level — from the local government who decides how to fund and provide EMS to the state officials who regulate EMS to the federal officials who determine how Medicare and Medicaid reimburse EMS. They don’t understand the value of public relations.  They rarely understand budget and finance.

Ok, so you get the picture. So what is EMS doing about it?  Well, we’re doing the same thing as always.  We’re promoting folks on their clinical skills at best and most often based on who they know or how much management likes them. We’ve created a system where most EMS employers don’t have much of a career track.  And we continue to tell our best and brightest to move into another medical field, whether nursing, medicine, or physician assistant.

What should we be doing?  Simple.  Let’s actually grow our own EMS leaders and not just the usual gang of experts/idiots who speak at every conference simply because they’re loudly exclaiming they’re leaders.  Let’s encourage the best and brightest to remain in EMS and further their education.  They already know how to be EMTs or paramedics.  What they don’t know is what to do next.  Let’s get people degrees in adult education to become clinical educators.  Let’s get people degrees in business management or public administration so they can effectively manage and lead an EMS organization.  Let’s get people educated in finance to figure out how to keep the crews paid and fuel in the trucks. And maybe even get a few of us into law school and admitted to the Bar.  After all, we’re in healthcare, one of the most heavily regulated fields in the marketplace.  Having someone who knows how to navigate the legal, regulatory, and political landscape might just help advance EMS a bit more than just another guy who says “Narcan” at the right time. And since EMS is a business, maybe having someone with some marketing or public relations skills might help the public (and the politicians) understand that not all EMS is created equally and that, like anything else, you do indeed get the EMS system you choose to pay for.

Or…. we can keep doing what we’ve been doing.  The current results speak for themselves.

The Social Media Medic

Social media is a wonderful thing.  It truly is.  For me, as both a paramedic and an attorney, it has been a godsend.  I’ve made a lot of friends that I’d have never known otherwise.  And, especially for medicine, it’s exposed me to a lot of new topics that enable me to give the best possible care to my patients.  The discussions in both law and medicine (and the combination of the two at times) make me think and grow in both professions.

However, there’s an old adage that applies. Caveat Emptor.  That’s Latin for “Let the buyer beware.” Like I said, social media is often a good thing, especially in EMS. But while it gives everyone a voice, its downside is that it gives everyone a voice, including those that might not be the best to listen to.

There’s a category of people I call the “Social Media Medic.” They’re the first to jump into a discussion with absolute certainty and moral clarity as to how you should be practicing medicine and what kind of person you should be. They protect their brand by saying all the right things because, often, their brand is the only thing they have and that’s how you get to make it on the EMS conference circuit. The “Social Media Medic” is often full of buzzwords and hashtags about EMS and medicine.  They’re often posting studies and blogs that promote them and/or their agenda. Sometimes, some of these people don’t even understand the study that they’re sharing. On social media, these people say all the right things.  They have the right hashtags.  They have the message down.  They might even be right.  But we rarely have a way to confirm that the loudest voice is the most correct voice.  Heck, on more than one occasion, I’ve found that some of the loudest voices who are the most insistent that they are right about medicine are those who are virtually unemployable in their field, often because their social media personality is a reflection of their actual personality of being an insufferably arrogant buffoon.  In other words, what the Greeks used to call sophmoric, literally a “wise fool.”

I’ll admit that I’ve been active on social media.  Some might even say I’m too active. They might be right. The truth is that I’m far from God’s gift to EMS.  I make mistakes daily and I don’t get enough time to do as much medicine as I’d like to be truly proficient. After all, as Clint Eastwood said, “A man’s got to know his limitations.” Hence, I rarely post about actual clinical issues in EMS.  It’s just not something I feel that I have the expertise or status to comment on with any authority. Now, legal issues, politics, volunteering, or professionalism are areas I feel qualified to comment on, so I do such.

In short, the loudest voice isn’t always the voice we need to be listening to.  And that especially rings true in EMS social media.

Couple of Quick Thoughts

While perusing social media this morning, I noticed a couple of things that bear repeating.  Again.

The same professional EMS committee members are now taking public input on “EMS Agenda 2050.” yet we can’t always even get the core mission of EMS right — namely getting people to a hospital — ideally the right hospital and with the patient in no worse (and hopefully better) condition than we found them. I’d like to fix EMS 2018 before we turn EMS Agenda 2050 into another document forced upon us by the same people who largely created the current mess.

Everyone continues to look for a single silver bullet that will fix EMS.  Education. Increased reimbursement. The latest equipment.  Some buzzword usually involving “data.”  EMS in the United States is a local responsibility provided for in a variety of models.  Imposing and implementing one “magic solution” won’t work.  What works in a compact city like Boston with multiple academic medical centers in a small area isn’t going to apply well to rural Nevada where a small hospital is an hour’s drive.  The reason why our nation’s Founding Fathers embraced federalism is in recognition of the simple truth that one size fits all solutions from a central government rarely work. (See also: IRS, “Affordable Care Act,” and the Post Office.)

The only thing I see more than people in EMS routinely advocating for us to take people to destinations other than hospitals are stories of EMS getting refusals wrong and a patient getting sicker or dying. I say this after seeing, just this week, an article about a child whose parents called EMS to take their child to the ER for the flu, EMS obtaining a refusal, and the child ultimately dying.  Was EMS responsible?  We don’t yet know at this point.  But I do know that taking a patient to definitive care is a large part of what we do.

Most ER physicians will tell you that the hardest decision they make is the decision to admit a patient. That’s coming from a physician with access to labs and imaging and specialist consults. I’m not ready to trust someone with (at most) two years of education, minimal diagnostic equipment, and a short assessment to make the decision that going to the hospital isn’t a good idea.  Yes, there are obvious cases that we can consider “abuse” of the emergency care system. But the lawsuits will result (and they WILL happen) from the patient with vague symptoms who’s relying on the judgment of the lowest common denominator of providers who just wants to get back to their station.

And that brings me to my final thing worth repeating today.  An EMS system is only as good as its worst provider on their worst day.

Feel free to refer back to this post in 2019.  I’m sure it will remain just as relevant.

Stay In Your Lane

Years ago, my parents called the same plumber anytime they had a plumbing issue.  Norman the plumber knew all about plumbing. Norman didn’t claim to know anything about carpentry, electrical work, or appliance repair. Norman didn’t claim that with a few more hours of continuing education, an extra certificate class, and his expertise as a plumber that he could do the job of a general contractor perfectly well.  Sounds ridiculous that a plumber, without anything outside of his experience as a plumber, would claim that he’s perfectly capable of being a general contractor, doesn’t it?

Yet, my friends, that’s exactly what we’re doing in EMS on a daily basis. At least in the United States, EMS exists because of the 1966 “white paper” entitled “Accidental Death and Disability: The Neglected Disease of Modern Society.” As a result of this paper, the United States began to develop an EMS system and trauma centers to care for the most severely injured patients. Around this time, emergency medicine began to emerge as a separate, distinct specialty of medicine.  Wikipedia (don’t laugh, it’s becoming a more respected source of information) defines emergency medicine as “responsible for initiating resuscitation and stabilization, starting investigations and interventions to diagnose and treat illnesses in the acute phase, coordinating care with specialists, and determining disposition regarding patients’ need for hospital admission, observation, or discharge.”  The National Highway Traffic Safety Administration defines EMS as “dedicated to providing out-of-hospital acute medical care, transport to definitive care, and other medical transport to patients with illnesses and injuries which prevent the patient from transporting themselves.”

So, in short, EMS exists to take care of the acutely sick and injured and get them to the right hospital.  As I’ve defined it before, EMTs and paramedics should excel at the delivery of out of hospital urgent and acute care.  Further, we should excel at getting the right patients to the right hospital. In other words, we should know better than to take a patient that might need an ICU bed to a rural critical access hospital.  Likewise, the patient who demands to go across town to the hospital where their primary care physician “has privileges” might be just as well suited to go to the closest appropriate facility as it’s virtually unlikely that the patient will be admitted by their primary care doctor.

I expect a good paramedic to be able to provide advanced cardiac care, assess a patient, provide pain management, manage an airway, and get the patient to the right destination safely, among other things.  I don’t expect a paramedic, even with an additional “certificate course,” to be competent too far afield from emergency and acute medicine. While it’s true that EMS providers are seemingly a logical choice for any form of out of hospital care, the truth is that our current education model and skill set leave us ill prepared to deal with sub-acute complaints or routinely chronic conditions. It’s the definition of the old axiom “stay in your lane” – mind your business and keep moving forward.

Otherwise, when we keep telling EMS providers that the future is in mobile integrated healthcare, but don’t provide EMS providers the formal education necessary to be doing nursing and home health care, we end up fouling up and losing sight of what we do best — care for urgent and acute patients.  In a purely “hypothetical” case, you might end up missing an obviously septic patient because you ignored what the patient’s family had to say and kept suggesting “social work and home health care” because the patient also had chronic health issues.

When it all comes down to it, EMS has a basic mission.  Getting a patient into the healthcare system, ideally no worse than we first encounter our patient.

Which brings me to my final point.  By the time that EMS has been called, patients and their family members are already stressed and potentially frightened. If you’ve added to their stress, fear, or anxiety, you’ve failed the patient and haven’t been a good advocate for EMS.

The Challenge of EMS Conferences

I attended EMS World Expo last week in Las Vegas and had a good time.  I had the opportunity to reconnect with several of my good friends in the Las Vegas emergency medicine world.  I got to see a bunch of people who I only see at these conferences and meet several people who I previously only knew through the Internet. And I ate like a king.  (If you know me away from the blog, you can easily find my Yelp reviews with some incredible food suggestions for Sin City.)  And being as it was Vegas, well, I had fun in Vegas.

But here’s the sad, but honest truth.  I learned very little.  I did come away with one huge new thing — apparently, there’s now an EZ-IO placement in the distal femur for pediatric patients.  But the rest of the presentations were pretty “ok.”  There’s not a lot of new information out there.  And sadly, in a presentation on recent research, a renowned EMS scholar presented information on fluid resuscitation in sepsis that is not only not current, but may even be contraindicated by more recent research.  Sadly, some of the best airway education was occurring in the exhibit hall practicing the SALAD technique with disciples of anesthesiologist and EMS airway physician Dr. Jim DuCanto.

I wasn’t going to gripe about this until seeing my friend and EMS airway ninja post some excellent education online regarding surgical airways and the need to rapidly move to a surgical airway. I asked myself why a presentation like this didn’t occur at a major EMS conference.  I came up with three reasons.

  1. Audience.  Truth be told, not everyone in EMS wants to learn the most current medicine.  There’s a large, loud contingent of folks who want to learn the bare minimum to maintain certification and/or pass the test. “Meets minimum standards” is a mantra in EMS.  And as we’ve all heard me gripe before, you can never go wrong in overestimating the number of people in EMS who are in it for the hero status as opposed to the medical professional status.  See also: EMS t-shirt sales.
  2. EMS celebrities. Truth be told as well, there are certain speakers on the EMS conference circuit who are known quantities.  They’re entertainers first and educators last.  They fill the seats and are like flypaper attracting the “meets minimum standards” crowd.  These people can speak on any topic, present dated or questionable information, and have limited expertise on the topic.  But because they’re funny and/or appeal to the lowest common denominator, EMS conferences continue to invite them as speakers.  Why?  Because they put butts in the seats.
  3. Timing. Most of these conferences put out calls for presentations almost a year before the conference commences. As such, the most current research and practice doesn’t always make it in time.

If you wonder why I spend so much time on EMS social media and blogs, I will close things out with a quote from Dr. Joe Lex, the intellectual godfather of #FOAM.

If you want to know how we practiced medicine 5 years ago, read a textbook.
If you want to know how we practiced medicine 2 years ago, read a journal.
If you want to know how we practice medicine now, go to a (good) conference.
If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM.

And if you don’t know #FOAM, it’s likely you’re already a step behind the EMS education curve.