Blunt Talk

I was discussing some issues with some EMS friends online this afternoon and the topic of physician and nurse involvement in EMS practice, policy, and regulation came up — and how physicians and nurses seem overrepresented when EMS policy is being set. The challenge is that while most of these physicians and nurses know more medicine than we do – we know more about how to deliver medicine in a non-clinical setting.

The overwhelming majority of people in EMS aren’t invested in their profession. (See also the posts regularly occurring on EMS social media asking basic questions about topics such as how to recertify. But that’s another rant.) And since they aren’t invested, they don’t care or do anything. Those that are invested rarely understand how to fix or change things. Sharing trivia and/or virtue signaling from Med Twitter and talking down to others is counterproductive. (In other words, “you’re a bad medic if you didn’t recognize this obscure EKG change” rarely encourages people to do better – or be better.) So is solely focusing on the clinical side of EMS. You have to understand operations, law, policy, business, economics, human resources and all of the other “soft skills” that the pedantic EMS science types scoff at. Why does the fire department get what they want? PR and politics. And we don’t do that.

Yet another example from this same group of friends discussing EMS policy — a state is discussing prehospital administration of blood products. (Shameless plug — Texas has no state scope of practice or state protocols to limit such an initiative.) The state invited a wide variety of attendees. The room had only two paramedics attending but was full of nurse trauma coordinators. And when the inevitable policy rollout happens that doesn’t count for the realities of prehospital care, you can guarantee that every medic in that state will complain about how “EMS is controlled by nurses.”

I know some highly intelligent people in my EMS family. And many of y’all know OMI much better than me, the ALS hobbyist. But I also know who to call at the state EMS office and can get them to call me back. I also know how rulemaking works and how a county budget gets approved. For the long term success of EMS, I’d say that’s every bit as important as knowing that OMI is the new fancy term replacing STEMI.

You may not be interested in politics. But politics is interested in you. And when that happens, knowing pharmacology may not be as helpful as knowing how the city approves your department’s budget, how the state health department can change the scope of practice, or how the county awards the contract for a vendor to provide EMS services.