People in EMS claim they’re like doctors. I disagree in many respects. (Despite all of the t-shirts that say we’re “doing everything a doctor does, but at 80 miles an hour.) But here’s where EMS people are just like doctors. They think everything is solely about the clinical practice of medicine and that they’re somehow “above” the world of billing and finance, let alone policy, politics, regulations, and the like.
I’d note that the fire service has adopted training levels for officers/administrators (Fire Officer I-IV) that include subject matter above and beyond putting out fires. And the fire service has a nonprofit accrediting body, the National Fire Protection Association, that adopts these standards. Various training programs and state licensing bodies then follow and/or apply these standards. EMS? Well, our leadership training revolves around seminars put on by self-promoters, trainings put on by consulting firms (Hire us to help you fix the problems we created to begin with!), and a few associations that are largely cliques of self-appointed and self-important “cool kids.” And the majority of what counts for EMS leadership training is expensive and requires extensive travel. Meanwhile, you can find Fire Officer classes readily available both in person and remotely. Fortunately, the NFPA is working on a similar set of standards for EMS Officer. It’s a pity that our self-appointed association for EMS providers is more interested in producing even more “card courses” in conjunction with a textbook publisher than it is in developing the next generation of EMS leaders and administrators.
Then when others get into that space and control EMS because they control the flow of money, EMS claims that our clinical prerogative is being disregarded. In the physician world, we hear physicians bemoan the power of hospital administrators, practice managers, and insurance companies. They complain that these non-clinical personnel are dictating the practice of medicine. And in many EMS settings, we hear EMS types complaining about the constraints placed on their practice of medicine by someone — whether it’s “management” or the governing body overseeing the EMS provider.
You’re damned right that “the man” is at least partially disregarding how you want to practice medicine, especially in your idealized model. Because no one, not even the Feds, have a money tree that grows cash.
So, yeah, people get told no. And they get offended. Why? Because they’ve never understood the world outside of treating a patient. And they don’t understand the constraints. And so they ask for the moon and the stars because they’re insulated from reality. But if they’d just asked for the moon, they might have gotten it. For the average 911 EMS system or a first response system, do they really need the newest cardiac monitor? Are the added features worth it? Does adopting a new monitor mean that your current stock consumable supplies are now unusable? And could the extra cost of the latest and greatest be better applied elsewhere?
I’ve always loved the adage that “perfection is the enemy of good.” I’ve lost count of how many good ideas in EMS have never gotten off the ground or have been significantly delayed because someone is striving for perfection. (Let’s face it, how many programs have we heard are coming “soon” or in “two weeks?”)
My paramedic instructor also taught my EMS instructor class. He said there’s a huge difference between need to know and nice to know. From a budget and finance standpoint, the same advice applies.
Once again, EMS gets lost in the practice of medicine and fails to see the business of medicine. Until we wise up to that, we’re likely to be at the mercy of someone else. And that someone else probably doesn’t know anything about EMS.
