On Rhode Island

Point of personal privilege here. Because I’m about to rant. And seeing as this is my blog, that’s why you’re here, right?   Sorry, not sorry, that there aren’t any Baby Yoda or cat memes here.

There’s a ton of people posting memes making fun of Rhode Island EMT-Cardiacs and their supposed inability to master advanced airway management.  Most of these memes are being posted by people who like to fashion themselves the fountains of all EMS wisdom and knowledge.  Further, some of these same types believe that their fecal material is non-odorific.

I don’t blame the average Rhode Island EMT-Cardiac for this.  (FYI, for those of you unfamiliar with the certification, the scope is somewhere between Advanced EMT and Paramedic.)  They’re working in a system that they likely didn’t develop.  And at least some, including at least one friend who I’ve literally broken bread with, are competent providers.

I do blame a toxic political culture in Rhode Island where the IAFF, fire chiefs, and politicians hold more sway over the regulation and development of the state’s arguably dated EMS system than do physicians. Rhode Island has its share of EMS issues, including an outsized influence by the fire service, fire chiefs, and fire unions and nowhere near enough involvement from EMS physicians.  Rhode Island’s limited provision of ALS care (EMT-Cardiacs aren’t paramedics.  Sorry, not sorry for that truth.) and it’s relative lack of medical dispatching place Rhode Island severely behind the times in terms of prehospital medical care.

And let’s talk about those snarky edgy social media players criticizing Rhode Island EMS.  They claim to be science-based and evidence-based.  Fine.  I’ll give them that. But what they don’t get is public policy or the political process. Nor do they truly get “just culture,” which is (rightly) supposed to be all the rage in medicine these days.  Nope.  It’s much easier to make memes and make fun of the line-level EMS providers than it is to engage in even superficial analysis and note that Rhode Island’s EMS system and the politics behind it are the problem.

I’ll give Rhode Island credit for one thing.  At least someone in Rhode Island is looking at data.  Granted, the political culture up there is doing what ossified political types do — ducking and distracting, but the data is out there.  I wonder where the data is on actual clinical performance and outcomes for some of these “smarter than you” types posting memes and claiming to be “scientists.”

In summation, for all of y’all who are poking fun at individual EMS providers, I’ll leave you with some lyrics from Ice-T.  “Don’t hate the player, hate the game.”

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