McDonald’s Applied To EMS

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.


  1. Hmmm….I get it. However, I may be one of those that pushes for consistency sometimes. And don’t’ string me up, but if crew #1 runs a particular type of call, and crew #2 runs the same kind of call, while there will be nuances in treatment, the basic ‘consistency’ should be there.

    I am never one to push for mediocrity- I am chastised at times due to my interpretation of the “paramedics save lives, EMTs save paramedics” is that before you can save me, you need to know my protocols, procedures, medications, and diagnosing information just as good as I do.

    But I would like to see a certain consistency amongst the 21 ambulances and 3 QRVs that I oversee training for.

    • theambulancechaser says

      I agree. And consistency within a system is excellent. It’s trying to make every system consistent with others, which strikes me as unreasonable, which is my concern.

  2. Don Phillips says

    Interesting. Take a look at “The Power of Habit: Why We Do What We Do” by Charles Dihigg. He posits that we go to McDonald’s more out of habit than anything else. I do agree with the spirit of the post. There should be more emphasis on quality.

    The issue is how. Do you notice that most small rural towns don’t have a McDonald’s? Why is that? Simple answer really, they don’t have the population base to support one. There is a requirement for a certain population to buy a franchise. What would happen if the government (at any level) mandated that every town or even every county had to have a McDonald’s? They would close or require government support to stay open.

    How about the workers? I’m sure you are aware that most fast food restaurants have a 200% turnover every year. Do we want the same in EMS? Think of system status management as an “EMS McDonald’s”: they have high turnover, often the workers go to better working conditions, they work the people very hard while they are there, they learn useful skills (one EMS-MD said he realized his SSM EMS allowed him to influence most every EMS system in his area). I’m not saying it is all bad. SSM does weed out those not really dedicated to EMS.

    Just some thoughts.