Quit Operating and Start Treating

It’s time for another one of my trademarked and patented rants on what’s wrong with EMS.  And to keep with the social media crowd, I’ve been triggered.

This afternoon, I received an email from a large, national EMS conference (cough, EMS World Expo, cough) promoting a “Complex Coordinated Terrorist Attack Workshop.” The add-on course, at an added expense of course, includes managing an active shooter incident combined with a hazmat/explosive scenario.  On a similar note, an EMS organization in my neck of the woods is working on a mass casualty scenario involving hostages, improvised explosive devices, and a firefighter down — all in one scenario that’s expected to span an entire day of training.

Right now, “tactical” and “terrorism” sell seats, especially for paid training.  I get that.  I also get that we need to train for events that are unlikely to occur, but have high risk if they do occur.  But for love of Pete, can we stop already with doing training just because it sounds sexy or cool?

If we’re going to train on a mass casualty, how about training on something that’s actually likely to occur in most EMS organizations’ service areas?  A MCI involving a school bus is much more likely to happen than a dirty bomb or an active shooter.  And if you factor in getting the right patients to the right hospitals, the logistics of parental involvement, or even factoring in road closures, this MCI becomes a real (and realistic) challenge.  Besides, if we’re truly following the National Incident Management System and the Incident Command System models as required by FEMA, the type of incident shouldn’t matter.  NIMS and ICS are what we should be using for command and control of any emergency incident.

Meanwhile, EMS providers can’t perform a basic assessment or master the skills associated with their certification level, let alone understand pathophysiology or pharmacology. And we have raised a whole generation of providers who think claims of PTSD and burnout are what constitutes experience.

I get that conferences need to sell to the masses if they’re to remain a going concern. I also know that we’ve got a bigger problem with our profession (or what passes for it) and our personal standards if this is who we’re marketing for. While we have people getting excited over this stuff, we still have all levels of providers clinging to dogma.  We have people still putting patients on backboards.  We have supposed advanced providers thinking all respiratory ailments are treated with an albuterol inhaler.  And let’s not even talk about the people who think that “pasta water” (IE, saline) fixes hypovolemia and scoff at the notion of administering blood products outside the hospital.

Yes, there are public safety aspects to EMS.  I will NEVER deny that.  But we’re also engaged in the clinical practice of medicine.  We need to quit playing at being “operators” and start actually being clinicians.

And truth be told, I know a few actual “operators” in the field of prehospital medicine.  The overwhelming majority of them rarely talk about being operators. They do talk about the medicine — all the time.

Finally, if we think that some more “tacti-cool” scenarios are what’s needed to advance EMS as a profession, that alone is a statement of why EMS is where it is. Not to mention why we’re not advancing and why the salaries are so low.

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