Back In The Fire Service

Well, I’ve been away from my blog for a while. There are two reasons.  First, I’ve been busy.  Those of you who know me know that I’ve changed one of my volunteer affiliations.  (More on that later.)  Two, I tend to blog when the muses inspire me.  And this afternoon, the inspiration finally hit me.

So, let’s talk about that volunteer position.  Obviously, in keeping with discretion and good sense, I won’t say which department. But what I will say is that they’ve been unlike almost any fire department I’ve seen.  It’s a combination paid/volunteer department that actually welcomes volunteer involvement.  It’s easy to get on the schedule and, by and large, you’ve got the equipment and uniforms to do your job.  They embrace the EMS first response role — to the point of having paramedic level protocols and an active volunteer role for those who want to stay exclusively on the medical side of the department.

Truth is, I’ve probably been one of the bigger critics of the fire service both in terms of its commitment to quality medicine and its love/hate relationship with volunteers.  And I realize that I might’ve found that rare unicorn that’s rumored to exist.

And in EMS, many of us respect certain aspects of the fire service, particularly the perceptions of brotherhood and camaraderie. And we rightfully blame many EMS organizations for a toxic management culture that doesn’t respect clinical competence, that values the bottom line above all else, and where “meets minimum standards” is the gold standard. We also blame an EMS social media culture that appeals to the lowest common denominator of inappropriate humor mocking patients, where patient abuse is funny, and where “book learning” is for the other guy because you “do everything a doctor does at 70 miles an hour.”

And truth be told, I’ve despaired of this culture in EMS as well.  Even though I should know that toxic cultures exist throughout the human experience (and I’ve worked in some toxic legal settings), I let the EMS social media world convince me that this is an EMS problem, not a human or management problem.

Until today.  I just happened to see a post from a firefighter I used to know.  His post was full of braggadocio about “leading and training.”  The fire service seems to be full of these guys.  They’re the fire service version of the lowest common denominator medics on EMS social media. And the truth is that a lot of the firefighters who talk a big game on social media like they’ve got the experience of firefighters in urban departments like Houston, New York City, Chicago, Providence, or Boston are the fire service version of the EMS social media clowns who are career EMTs doing interfacility transfers and dialysis runs. And just like in EMS, there are plenty of lousy managers the fire service and perhaps even more so-called leaders whose only expertise is in self-promotion.

So, what’s the point here?  Namely, it’s not just EMS — every profession and human endeavor has its share of buffoons hogging the attention as well as toxic folks creating an even more toxic culture. If you’re in an organization where you’re valued and the toxicity is minimal, treasure it and do what you can to keep that culture going.  If you’re in the other kind of organization, do what you can to improve things.  If all else fails, do yourself, your career, and your mental health a service and find a better option.

For what it’s worth, the good options in any career, and especially in emergency services, are out there.  You have to look for them.

One final note — the really great organizations rarely have to advertise or promote themselves.  They attract quality and the right people without a hashtag or cute slogan.

Yes, you’re wrong.

Sorry for the interruption in my usual stream of consciousness blogging.  Nothing in particular has been on my mind as of late. (Although I may have to do a post in the near future about finding a potential unicorn.  Namely, a fire department that embraces both volunteers and ALS first response.)

But this morning, I saw a contrast between those who I’d call high speed EMS providers and those who, at best, deserve the title “ambulance driver.”

Example one.  Discussion about the risks and benefits of a particular prehospital intervention.  In this case, it was application of a pelvic binder.  An expert on trauma care provides their opinion and an article that includes citations. Learning and dialogue occur.

Example two. Discussion of prehospital ultrasound on a popular EMS social media page.  Truth be told, I’m still a skeptic on prehospital ultrasound.  I’m not sure what ultrasound can show me that a good patient assessment can AND change my course of care in the prehospital setting. But another EMS provider (and I won’t use the word professional) stated in said discussion, ” I guess when you’re burn out like me, it doesn’t matter any more and you just want to dump the pt in the er. However that’s mine own opinion.”  He then “doubles down on dumb” and goes on to state, “nope it’s my opinion, not ignorance. I jill just don’t care about those devices out in the field. Waste of time and money.”  When he’s challenged on his ignorance, he states, “It’s not an excuse, it’s just how I feel about being burn out. I believe we have differences in opinions and I respect that. I guess opinions are wrong to use. People have different opinions and has nothing to do with education.”

The truth is simple. You can have an opinion. But when your opinion is based upon bad information and beliefs and you refuse to change when given new information, then you are absolutely wrong. And if you’re basing your medicine on bad opinions, then you’re a bad provider.

So long as EMS tolerates those people who refuse to practice good medicine based on current evidence based practice because they “have a different opinion,” we’re going to remain the ambulance drivers.  We won’t be taken as a profession.  And until we step up the standards to be a clinician, regardless of what EMS does for educational standards (which may or may not fix things), we don’t deserve to be called a profession.

You’re entitled to an opinion.  You can be wrong.  But you’re not entitled to harm a patient because you choose to be wrong.  If you are still doing that, that’s why the legal profession exists.

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