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.


  1. Robert A Martin says

    That would also require the leadership of many systems to acknowledge that there’s problems. Which they’re in deep denial about.

  2. While we beat our heads, sometimes hoping to change EMS and its mindset overnight, I keep trying to remember that our educational endeavors are long-term investments. I want a high Rate of Return.

    “If you want to really change it in the long term, I think it comes down to doing so through education of the young people.” ~ James Mattis

  3. Susan Dietrich says

    I understand your frustration and I think many of us would be great talking in person. As a long time paramedic I have to say that the purse strings and boards governing what we do are not dominated by providers. Until more of us get involved things are not likely to get better. Have physicians help would be great but many would sign off but are so overwhelmed by their own work coming to a meeting seems not to be possible. The best physicians all say that. Keep the faith! Peace to you

  4. They will get the usual professional EMS committee members in a room and issue high and mighty statements about the EMS Agenda Version Whatever.

    Which they will immediately change once the IAFC, IAFF, and NVFC complain about it.

  5. You and I have discussed this many times. All of the points you make are valid, especially the last one. There is never going to be a global fix for EMS because EMS is affected by so many local issues.

    I worked in an urban system with many high level hospitals within a short transport time. That affected system design from the very start of the system and does to the current day.

    OTOH, we have a mutual friend who worked in a system where the nearest high level hospital was two hours away by ground on a good day. That certainly affected how her system operated.

    Which, as you point out, is why there should never be a “National Scope of anything” in EMS.

    All of the national organizations have their own agendas and none of those agendas are at all interested in improving patient care.