Longhorn Student EMS

The University of Texas has decided not to provide insurance or legal protection to a student EMS group on campus.  Since this is my alma mater, I felt compelled to share my $0.02 with University of Texas President Gregory Fenves.  If you feel compelled to reach out, do so (and keep it polite).  He can be emailed at [email protected]

Dear President Fenves:

It’s rare that I find myself writing an email that hits multiple areas of who I am – a Texan, a Longhorn (BA 1996), an attorney, and a paramedic.  But the decision of the University to deny funding for Longhorn EMS’s liability insurance and/or assumption of liability hits home for me.

The University of Texas and the University of Texas System are blessed with many outstanding attorneys, both of counsel to the University and the System and throughout the faculty.  I would never take away from their counsel or guidance, but I would note to you that the liability for the provision of emergency medical services in Texas, especially by a governmental entity, is exceptionally limited. Texas Civil Practices and Remedies Codes §§74.151-74.154 and Texas Health and Safety Code §773.009 provide broad protection and multiple Texas appellate court decisions have broadened said liability protection.  As such, I would assert that the legal liability for the provision of emergency medical services, particularly at the EMT/basic life support level, is exceptionally limited and that the costs of any liability insurance would reflect such limited exposure. In short, this concern about legal liability on behalf of the University is a red herring at best.

University spokesperson Bird’s statements that the University wants students to be students and not to take on potentially dangerous professional responsibilities is, at best, ignorant of many students who are already certified as EMS personnel or might even be in the armed services.  Wanting students to be students first ignores that many students already are working including as employees of the University. Several UT students already work as emergency medical services providers in other venues even including as employees of the organizations that provide EMS coverage for University athletic events.  Additionally, many students of the University already volunteer in many campus organizations, several of which provide direct services for the University. And finally, there’s the eight hundred pound gorilla in the room that shatters the illusion that students should be only students – namely, men’s and women’s intercollegiate athletics. I am pretty certain that the time involved to become an emergency medical technician and remain active with a student EMS organization is a small commitment in comparison to the time that student athletes spend in service to the University.

From a public safety standpoint, having an on campus EMS system makes sense.  Even on an urban campus like the University, EMS response time takes time. The closest Austin Fire Department stations to campus, Station 2 on Martin Luther King, Jr. Boulevard and Station 3 on West 30th Street do not have ambulances.  The closest ambulance, if available for assignment, is Medic 3, located in the parking garage of the old Brackenridge Hospital.  At best, there is a delay in getting emergency care to campus.  Having responded to the University campus as an EMS provider, I can tell you that calls on campus are a challenge, especially in getting emergency resources to the right location because of the combination of obstacles in terms of vehicle access, determining the right location, and getting access/entry into University buildings, many of which are secured.  In a critical emergency such as cardiac arrest, severe allergic reaction, or uncontrolled bleeding, having a trained set of hands on scene sooner can, will, and does regularly make a significant difference in patient outcome.  In some cases, that difference in patient outcome is life as opposed to death.  Waiting for City of Austin resources and also waiting for someone from the University to provide access to a building just doesn’t make sense. And in case of a severe emergency or disaster, having “all hands on deck” and a force multiplier in the form of a University recognized and accredited group of EMS providers can and does make a difference.

The University has always encouraged public service.

As an undergraduate government major, my spirit of public service and engagement was encouraged and nourished by Dr. Janice May’s classes on state government and her public service internship program which gave me a foundation and prepared me for a career in state government. Especially as the University develops its own medical school and expands its involvement in all aspects of healthcare, encouraging a student volunteer EMS program is a no-brainer decision.  Encouraging students to volunteer and to become engaged in healthcare is, plain and simple, an outgrowth of the University’s mission to educate.  Such a program should be encouraged, not stopped. Many notable physicians and healthcare leaders got their first exposure to EMS, medicine, and volunteerism through campus EMS programs.

Texas A&M University has long had a student-run EMS.  In fact, Texas A&M University has student-run EMS for university events as well as a separate EMS program that provides paramedic-level ambulance coverage for the university campus as well as providing mutual aid backup coverage to the cities of Bryan and College Station.  Rice University has a student-run EMS program operating under the supervision and guidance of their campus police department. Rice’s EMS program operates as a campus first response organization, providing advanced EMT level care until the arrival of the Houston Fire Department’s ambulances. Colleges and universities throughout the United States have campus EMS organizations.  In fact, there’s even a National Collegiate Emergency Medical Services Foundation that exists to guide and promote campus EMS programs.  At the University of Texas, we are a “University of the first class,” as described by Article 7, Section 10 of the Texas Constitution.  More bluntly, to quote our former athletic director, DeLoss Dodds, “We are the Joneses.”  The University of Texas shouldn’t take a back seat to anyone. And that includes providing emergency medical services to the University community and its visitors.

Bluntly, the idea of a student EMS on the Forty Acres has grown in fits and starts.  Good intentions alone are nowhere near enough. And some of the attempts to provide this service have been, at times, amateurish. That is why it’s even more imperative for the University to recognize, fund, and support this effort, if for no other reason than to provide the resources of the University to supervise these students and ensure that what goes on with this organization is a credit to and not a harm to the University.

If I may offer my services to you, the University, or these students, I stand ready to do so – as a volunteer.  I am a Texas licensed attorney, a Texas licensed (and nationally registered) paramedic, a Texas EMS instructor, and a proud Texas Ex.

I encourage you to reconsider the University’s decision and strongly commend you to take steps to help this fledgling EMS program get the right start it needs.

Respectfully submitted (and Hook Em Horns!).

 

Part of being a clinician

Today, I heard from a good friend of mine who happens to be a good paramedic out of state.  They were telling me about issues with a family member who’s in the hospital and in poor condition.  Part of this involved the communication from the hospitalist who asked if the family member had a do not resuscitate order because the family member in question is “very sick” and without a DNR order, the patient’s ribs would be broken during CPR and “her insides would be messed up.”

I’ve dealt with similar conversations before both as a medical provider and as a family member.  Without going into my rant against hospitalists (who don’t know the patient outside of the hospital, rarely have an idea as to the patient’s baseline, and are often the bottom of barrel clinically and academically), this is completely unacceptable.

However, I will say that this is how people in medicine get sued. Not because their medicine hurt or helped. But because they have zero idea how to communicate with people. There are way too many physicians who have a pure science background and see patients as lab values on paper. They see patients and their families as a distraction. Likewise, there are way too many in EMS who are bitter because they were promised a chance to race the reaper and save lives and taking care of sick people isn’t “what they signed up for.” I am far from religious and definitely not Christian, but the verse from the Gospel of Matthew says it all. “I was sick and you visited me.” Ultimately, that’s what being a clinician is about. Taking care of sick people. Not flashing lights or even geeking out over lab values. And caring (and dare I say ministering) for the sick means caring for their family too.

I see way too many physicians who have a gift for the sciences and not a gift for communication.  I see way too many in EMS who can improvise a solution to make MacGyver proud but who make Chuck Norris look sensitive and compassionate. Medicine is not a pure science, no matter what anyone says.  It’s a profession.  Whether you’re a brand new EMT or a tenured medical school professor with subspecialty certification, you’re a professional using your scientific knowledge to solve human problems.  And human problems require interacting with humans.  Part of that interaction means communicating with other people, not all of whom you may like or who you may think are as smart as you are or even worth your time.

And the human factor in any profession, especially including medicine, is why professions aren’t mere sciences.  Yes, there’s a ton of science in medicine.  It is the foundation for much of what we do.  But we apply this knowledge to help others.  And helping others goes significantly beyond acid-base balances, covalent bonds, thermodynamics, or gas laws. It’s about demonstrating a bit of compassion and empathy.

You don’t necessarily learn those things in a science lab.  You learn them from interacting with others.  You learn these things in a liberal arts classroom where your views about the world are challenged, where you learn to defend your views, where you learn to maybe change your views, and most importantly, where you learn to communicate and get along with others.

Medicine — at any level — is ultimately a people profession.  If you’re not comfortable with people, you’re not likely to succeed.  It’s why EMS clinical evaluations are supposed to include an “affective domain” aspect.  And this is why I think that the constant drumbeat for more “science” classes in EMS also needs to be tempered with more classes in English, psychology, sociology, history, geography, and management.  In other words, being a solid clinician requires understanding people as much as it does the science.

And to add in my legal advice, people rarely know if you’re good at what you do.  They do know whether or not you’re nice to them.  And many of these cases of being “not nice” often involve poor or failed communications with the patient and/or their family.  Learning how to talk to others, whether to get information or to persuade, was a significant part of my education as a legal professional.  It needs to be a significant part of our EMS education as well — and that means more than rapidly brushing through the mnemonics of “SAMPLE” and “OPQRST.”  It means active listening and then incorporating that information with your scientific knowledge to actually care for your patient.

That’s what being a professional is about. That’s what being a clinician is about.  It’s not about the flashing lights.  It’s not about the lab values.  It’s not about an obscure EKG finding.  It is about caring for others.  Period.

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.