Nope, this post has zilch to do with EMS wages, so put those pitchforks away. Rather, I’ll ask a semi-rhetorical question. Why do people stop at McDonald’s when they’re travelling? It’s simple. People know what they’re going to get and they like consistency. A McDonald’s in Boise isn’t going to differ all that much from a McDonald’s in Miami. By doing such, tourists may miss out on an incredible local diner. Just as likely, though, they could miss out on food poisoning by visiting a so-called local institution.
As of late, it seems that EMS is taking the McDonald’s approach to medicine where consistency is valued above all else. Again, as is the case with dining options, an obsession with consistency drives away exceptionally low standards and performance. But it also seems to drive away high performance as well. And unlike a Big Mac, prehospital medicine in rural Nevada with long response times and limited access to hospitals is going to need to differ from a compact, urban center like Boston with multiple academic medical centers.
A good friend of mine has asserted that there’s a growing advocacy movement for mediocrity in EMS. I’m not sure I’m ready to go that far. But I do believe that the movement in EMS that pushes buzzwords is hurting EMS.
The buzzword movement pushes catchphrases such as metrics, data, standards, accreditation, “best practices,” and regularly misuses “evidence based medicine” in an effort to ensure a level of uniformity, consistency, and mediocrity in prehospital medicine.
The buzzword movement obsesses maniacally over cardiac arrest survival rates because dead/not dead is an easy metric. Nevermind that cardiac arrest represents a very small part of what EMS does and that most out of hospital cardiac arrests are not salvageable, it’s an easy metric, so it becomes what determines “success” in EMS. Symptom relief and routing the right patients to the right care are nowhere near as easy to quantify, so these things (which EMS should be getting right) get overlooked regularly.
I’d much prefer that EMS systems focus less on consistency and compliance and more on excellence. From my experience in prehospital medicine, I’ve found that if you encourage medics (of all levels) to achieve a high level, most medics will do their best to reach it. As the old axiom goes, a rising tide lifts all boats.
Instead of striving for consistency, I think it’s time for EMS to strive for excellence. Even if we occasionally miss said mark, we’re going to improve rather than stagnate. Our patients deserve a commitment to excellence, not a commitment to consistency — which all too often has become shorthand for mediocrity.