A Farewell to the NAEMT

Posted on January 28, 2019 Written by 7 Comments

Dear Mr. Zavadsky:

First of all, I appreciate your offer to reach out last week after my blog entry regarding my views on what appeared to be NAEMT’s no position of a position statement on the ongoing discussion regarding a degree requirement for paramedics.  Unfortunately, our schedules have yet to match up.  But I did find the explanation provided by one other NAEMT insider to be interesting to say the least – namely that the NAEMT position statement had been in the works for a while and was unrelated to the competing positions from other EMS and fire organizations regarding a paramedic degree requirement.  I might have been willing to believe such a statement had NAEMT (or you) provided such a background statement in conjunction with NAEMT’s position statement. However, such an explanation at this point, when prior opportunities were available, strikes me much more as an attempt at damage control than providing a nuanced policy statement. The fact that NAEMT hasn’t publicly clarified this statement speaks even louder as to the organization’s unwillingness to take a position. I stand by my original position that a degree requirement is worth exploring for paramedics, but will also require significant planning and buy-in from higher education stakeholders.

I was almost willing to view this position statement as merely another failed opportunity for NAEMT to advocate for the EMS profession until today.  As you know, last week, New York City Mayor Bill de Blasio spoke against EMS pay increases for New York City EMS professionals in comparison to Fire Department, Police Department, and Sanitation Department employees claiming, “The work is different.”  EMS social media roared. NAEMT was, once again, silent. Today, however, the National Association of EMS Physicians released a position advocating for EMS pay to be commensurate with the responsibilities of EMS providers. Again, I note – NAEMT, the supposed voice for “advancing the EMS profession,” was silent.

Two such notable flubs in the span of less than two weeks speaks volumes as to the culture and leadership of NAEMT.  I’ve criticized NAEMT before for a variety of issues, namely a focus on quixotic efforts to lobby the Federal government for programs that may not benefit our profession as a whole, a lack of advocacy at the state levels, and an overreliance on revenue from card courses.

More than anything, what I’ve seen from NAEMT is a continued failure to advocate for EMS for fear that it may ruffle some feathers.  What I also see is a culture that has the same usual crowd of EMS insiders and their cronies placed in positions of leadership. (In all fairness, I do have a great deal of respect for you and several of the board members.) This culture has created an organization that is slow to respond to the needs of EMS and to the news cycle as EMS is impacted. When applications for new positions and committee members are sought, it’s always the same names that you always see in EMS.  NAEMT has failed to develop a next generation of EMS leaders and advocates.

Finally, I see an overreliance by NAEMT on revenue from a plethora of card courses. NAEMT’s reliance on said revenue and the partnerships with textbook publishers mean that these largely repetitive card courses are seen as much as a cash cow as they are an actual source of current medical education. I’ve taught Advanced Medical Life Support for years and have even been affiliate faculty for the program.  However, the rise of social media and FOAM efforts means that many continuing education programs on a four-year cycle are, by their very nature, outdated.  Yet, NAEMT produces new courses every year and the publishers produce new updates and required materials on the same basis.

To me, NAEMT’s main benefit consists of the various discounts provided and discounted admission to the EMS World Expo.  While there have been some quality speakers at EMS World Expo, I’d also note that there are many presenters and topics at the conference which do not advance EMS and instead serve the “meets minimum standards” and “lowest common denominator” level of the EMS trade.  Note that I did not say “profession” in this case.

I fully expect that there will be consequences from my communication.  I say this not out of spite, but out of the recognition that my interests as an EMS professional aren’t always recognized by NAEMT.  I will quote another paramedic colleague of mine who says, “I am a member of NAEMSP, but not of NAEMT. I like my money to go someplace useful.”

Accordingly, I choose to speak with a clear action.  I hereby resign my membership in the National Association of Emergency Medical Technicians.

 

Filed Under: EMS, EMS Politics

Lead, Follow, or Get the Hell Out of the Way

Posted on January 23, 2019 Written by 8 Comments

If you’ve been following any EMS news as of late, you’ve read about the position paper that paramedics should have a minimum of a two year degree. The position paper was issued by the National Association of EMS Educators, the National EMS Management Association, and the International Association of Flight and Critical Care Paramedics. The position paper was peer reviewed and published in the academic journal Prehospital Emergency Care.  Shortly thereafter, what could charitably be called a rebuttal was issued by the International Association of Firefighters and the International Association of Fire Chiefs. Needless to say, the fire service, with some notable exceptions, has little interest in advancing EMS except as a continued source of revenue and mission creep.

So, you ask where our national “voice for EMS” was and what they had to say. Basically, what they said was that there were competing positions worthy of further study. In other words, they took no position.  Regardless of my feelings about the IAFF, the IAFC, and the fire service in general terms, the fire service took a position and they advocated for what they believe to be in the best interest of their members and their trade. I’ll give them respect for that.  And they’ve, by and large, been successful in crafting public policy to their benefit.  The NAEMT?  Not so much.  They took no position. As the famed Texas liberal populist Jim Hightower once said, “There’s nothing in the middle of the road but a yellow stripe and dead armadillos.”

One can argue that by taking no position, the NAEMT took a position in favor of the status quo, which may actually be closer to the IAFC/IAFF position which can be summed up by Pink Floyd, “We don’t need no education.” In all candor, I do think there are significant challenges and hurdles that face EMS if we advance to a degree requirement and that such challenges need to be seriously discussed, especially with higher education leaders.

But NAEMT is an enigma in the world of professional associations.  NAEMT’s primary connection to most members is its development, marketing, and delivery of a plethora of card courses, which are NAEMT’s primary revenue source. NAEMT’s lobbying efforts are primarily directed at the Federal level, while the majority of EMS regulation and legislation happens at the local and state levels. The one clearly identified national level solution, namely a change to how the Centers for Medicare and Medicaid Services (CMS) funds EMS, doesn’t appear to be on NAEMT’s radar. For me, as an EMS provider, the main benefit that NAEMT provides me are member discounts.  NAEMT’s real challenge is that it claims to represent any and all with an EMS certification. As I’ve said before, there’s not a ton of common ground to be found between everyone in EMS.  A flight medic working in rural Nevada has very different needs and wants from their professional association than does a firefighter/EMT who maintains their EMT certification because it’s a condition of employment at their department.

Maybe it is time to realize that NAEMT doesn’t speak for EMS.  And just maybe it’s time for paramedics to demand a separate voice for the advancement of paramedics. After all, the American Bar Association doesn’t represent attorneys, paralegals, law clerks, and legal assistants. The American Bar Association represents lawyers and lawyers alone.

Anyone for a National Association of Paramedics? And the acronym also reminds me of many paramedics’ favorite pastime, me included, namely NAP.

It’s time for paramedics to be our own voice and advocate for ourselves.

Filed Under: EMS, EMS Education, EMS Politics

Election Night (Not what you think)

Posted on November 7, 2018 Written by Leave a Comment

Election Night brings out the worst in many of us. In large part because of the 24 hour news cycle amplified by social media, we get way too invested in politics and sometimes let our mouth overload our rear. (Pro-tip for those of us who love politics and love discussing it, private groups are the way to go on Facebook.)

I saw some of the worst behavior come from my fellow members of the Bar. Many attorneys I know were posting things that I wouldn’t have expected from dispassionate professionals.  The comments (and they were from both sides of the political aisle) ranged from sour grapes, veiled passive-aggressive statements, or out and out statements that they’d be unfriending people. (Another pro-tip here.  I do know some of these people and it speaks volumes as to their professionalism and whether I might believe they have the temperament to handle a case I might refer their way.)

Late last night, a post started making its way through EMS social media showing a paramedic saying (in part), “I’ll start asking if you are a trump (sic) supporter – if you are, y’all will die in my ambulance.”  The response from EMS was swift and gave me a great deal of hope for our emerging profession.  Everyone denounced it.  Whether you wanted to “make America great again” or identified as a democratic socialist, everyone agreed that this sentiment had no place in EMS.  And they spoke up.  Not only did they speak up, they made a point to notify this guy’s employer and the various licensing entities that they didn’t want him in our profession.  At least one employer terminated their relationship with him by morning and at least one licensing agency is aware of his temperament to practice as a paramedic.

Regardless of whether the gentleman deserves to remain employed or certified as a paramedic, our profession spoke with one voice and said that we won’t tolerate such a mindset. And my other profession, the profession of law, has become so politicized and activist (on both sides) that we have, at least in some part, lost track of what we’re supposed to be doing, namely zealously representing our clients and providing them with sober counsel.

Last night, EMS stepped up and took a stand for our profession.  And for a change, we did it better than the lawyers.  Pardon me while I brag on being a paramedic. We’ve beat the other professionals at being professional and separating the personal from the professional.

Filed Under: EMS, Law, Politics

KISS: Keep It Simple Stupid

Posted on November 6, 2018 Written by Leave a Comment

When you’re involved with EMS social media, you see a lot of stuff scrolling through.  Some of it, like FOAMfrat, does a great job of making advanced life support and critical care concepts easy to understand. Someone much smarter than me said “Smart people take difficult concepts and make them easy to understand.”

Unfortunately, you also see some material that does the opposite.  A few moments ago, I saw a proposed post for an EMS education group that I help manage.  The post was about a flowchart than an instructor developed for EMT students to assess and manage patients. Unfortunately, the flowchart was poorly laid out and looked more like a bad Microsoft Project diagram for IT project management.  I’d be surprised if the average EMT student could follow it, much less master it.  And if by some fluke they did, they’d be convinced that they had achieved some level of mastery of medicine. (Spoiler alert.  A lot of EMT training is based on the same stuff that our ancestors learned in Boy Scouts or from the green American Red Cross first aid book.)

Friends, whether you’re a new student in a first responder class or an experienced flight paramedic, EMS isn’t all that complex.  Let’s stop trying to make it complex.  For at least some of it, we make it complex so as to justify our ego and sense of self-importance.  The average EMS textbook is written at roughly a tenth-grade reading level.  That fact alone should bring you right back to Earth.

At all levels, prehospital care can be summed thus.  For trauma care: control the bleeding, protect the airway, and get the patient to an appropriate trauma facility.  For medicine: assess, diagnose, treat, and get the patient to the right hospital the first time to fix their problem.  If you can do those things, do two other things as well.  First, be nice.  Second, make the patient comfortable.  Both of these additional guidelines also apply to being nice to the patient’s family, bystanders, and other healthcare professionals.  The only variation between an entry level first responder and a flight nurse will be in the treatment options and assessment tools you have available to you.

EMS doesn’t have to be hard.  But if all of this is still too hard or complex to understand, I’ll leave you with some sage advice that I got from an experienced flight medic the day I got my paramedic certification. “If you don’t know what else to do, it’s a good idea to take the patient to the hospital.”

EMS.  No, it doesn’t have to be hard.

Filed Under: EMS, EMS Education, EMS Social Media

Another Volunteer Crisis

Posted on October 23, 2018 Written by 1 Comment

As sure as the day is long, we can count on the EMS news sites to do a post on the volunteer crisis in fire and EMS organizations. And EMS1 did its part yesterday.

And of course, y’all know I have to comment.  So, let’s do a rehash and repeat.

Folks, it’s real simple. Too many organizations make it hard to volunteer, whether its applying or what’s required to remain a member. I’ve lost count of the number of volunteer organizations that don’t have their membership application online. Likewise, I’ve lost count of the number of “all hazards” departments that will allow volunteers to remain exclusively firefighters but won’t allow for EMS only volunteers, even when well over half of most departments’ call volumes are for medical calls. I’ve also lost count of the number of departments that are combination departments that only offer their “mandatory” training during the week when we “normal” people with an office job are already pulled in multiple directions. (Hint: There are infinite platforms online to make these classes available on demand or as webcasts.)

I’ve always held the position that standards should never be lowered. All that most volunteers (or potential volunteers) ask for is a bit of flexibility in how you reach those standards. Something as simple as allowing a volunteer more time or the ability to work with different field training officers could be a huge asset in getting a volunteer cleared to independent duty, especially as an advanced life support provider.

If you don’t believe that there’s a pool of volunteers out there, do this.  Look at how many people out there hold a fire and/or EMS certification and are currently unaffiliated with any service, whether paid or volunteer. If the National Volunteer Fire Council, NAEMT, or any of the other fire and EMS groups are truly serious about volunteers, I’d recommend a survey targeted at those people to find out why they’re not currently volunteering.  If you wanted to go above and beyond, survey those people who are active volunteers with departments not near their home.  Find out why they’re not affiliated with a closer department. Dollars to doughnuts, the answers will the same — there will be some artificially created barrier preventing them from volunteering nearby.

I’ll also note that the value of a volunteer group, especially in a combination department, isn’t immediately obvious until you have a disaster or other incident that’s stretched your department thin and/or exhausted mutual aid resources.  That guy who’s just a volunteer EMT can now free up the paid firefighter/EMT staff from medical calls.  That lady who’s qualified to drive and operate a tanker/tender means that apparatus is now in service and the paid crew isn’t cross-staffing it.

Unless of course, your goal is solely to show that you “can’t find volunteers” and really need that sales or property tax to hire paid staff. If that’s your real agenda, then, by all means, keep on doing what most departments seem to be doing. Sadly, in my neck of the woods, this strategy has been effective as a jobs program for paid firefighters and EMTs.

Filed Under: EMS 2.0, Volunteers

More on the Four Year EMS Degree

Posted on September 10, 2018 Written by 5 Comments
So, I’m thinking more about the push for an EMS degree. In theory, I think it’s a great idea. But here’s a couple of observations.
 
The “other countries have it” argument. Those other countries also have a national healthcare system where EMS is integrated into healthcare. We don’t have that in the United States. Additionally, some of these other countries don’t have a tradition of mid-level practitioners that the United States does like advanced practice nurses and physician assistants, so in some of these cases, paramedic providers are stepping into roles that might be filled by other healthcare professionals here.
 
As a corollary to that, much of our EMS is provided by the fire service and by large private EMS companies. The fire service does EMS because it “has to” in order to maintain some justification for its existence. It has no interest in EMS save for staffing and budget. They’re not going to be advocates for EMS. As for the privates, they want low wages and lower educational standards, since they’ve got a long history of churning through employees and needing a steady inflow of new people.
 
Volunteers. Yeah, truthfully, it’s going to be hard to require a four year degree to volunteer on the ambulance. And unfortunately, there are parts of the USA where the local authorities have chosen not to fund an EMS system or there’s not sufficient people to do it. As the old adage goes, you get the EMS system you pay for.
Clinical outcomes. Everyone talks about evidence based medicine, including me, until they don’t like what it says. Is there any evidence that a more educated paramedic provider has better clinical outcomes. Australia and Canada both have college-educated providers and that’s become the norm there. Yet, these paramedics often have a more limited scope of practice than many locations in the United States.  Is there any evidence to indicate that American paramedics with a lower educational standard and (often) a broader scope of practice have worse clinical outcomes than their more educated foreign colleagues? As a further question, would a four year degree expand the current scope of practice for American paramedics?  As a liberal arts graduate myself, I believe the real value of a four year degree comes from the critical thinking and communications skills that a core liberal arts curriculum develops, but the majority of EMS degree advocates seem to believe that only a four year EMS specific degree is going to “save” EMS.

Actual logistics. Let’s assume that we do decide to put in a degree requirement for paramedics. Let’s further assume that it’s going to be a four year degree. How many degree programs exist? Are there sufficient faculty with an “appropriate” terminal degree in the field to satisfy the higher education accreditation authorities?  And on that note, what is an appropriate terminal degree for EMS?  Would we now end up inadvertently or intentionally creating a doctorate in EMS education?  Would current EMS educators be ineligible to continue what they’re already doing? The demand for nurses and nursing education has already created a shortage of nursing educators.  What would EMS education do to meet that demand on day one?

What would happen with an actual EMS degree requirement?  The skeptic and cynic in me says that most places wouldn’t have degree-educated paramedics.  Instead, the “powers that be” will do one of two things.  They will continue the current paramedic education and call it something else.  Or they will water that down even further and create another “paramedic light” certification. See also: Rhode Island’s EMT-Cardiac, New York’s Advanced EMT-Critical Care, NREMT Intermediate-99 (thankfully being phased out), Virginia’s EMT-Intermediate, or Iowa’s “paramedic” based on the NREMT I-99 standard (the actual “full” paramedic in Iowa was called a “paramedic specialist). And I will make you a bet that the majority of large EMS operations in this country will immediately default to providing service at this “paramedic light” level.

 

If we want degree educated paramedics and believe that’s for the best, we’re going to need to answer these questions.  And we’re also going to need find the funding for this. That probably means getting the primary payer of EMS services, the Federal government, to change Medicare/Medicaid so that EMS systems are paid for treatment and services rendered rather than just transport mileage.  But to do that means that we’re going to have to be more involved in the political process rather than the occasional appearance on a designated “lobby your politician” day where you wear a uniform that looks something like a third world dictator. The truth be told, increased EMS education and increased EMS reimbursement are like the chicken and the egg.  I don’t know which comes first.

 

I’d also point out something said by a former EMS director of mine.  He said he’s paying paramedics (and EMTs) what he can afford to pay them, not what he wants to pay them.  Again, until reimbursement changes, there’s no magic source of increased paramedic compensation, even with higher education.

Before you think I oppose an EMS degree, let me say that I don’t.  I believe that a four year degree is appropriate for a medical professional. I also don’t know that all of the advocates of an EMS degree have fully thought out the impact of such a requirement, even if gradually phased in.

I believe that our current America EMS system may be like Churchill’s definition of democracy. Churchill said that “Indeed it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.…”  I believe that we may find this to be equally true for American EMS if we suddenly change our educational paradigm without considering the consequences.

These concerns and this rant was brought to you by a mostly proud graduate of a certificate granting paramedic program who also had a bachelor’s degree in liberal arts followed by a graduate and a professional degree. Higher education taught me to think. Paramedic education taught me to do. And coming into a paramedic program with a college degree taught me to think and consider what I do as a paramedic.

Filed Under: EMS, EMS 2.0, EMS Education

On The EMS Degree

Posted on September 6, 2018 Written by 15 Comments

So, because of a prominent fire chief’s article against EMS degrees, all of the usual EMS advocates are coming out for a gradual phase-in of a degree requirement. And it stands to reason that the fire service wants a low entry standard for EMS.  Most fire departments, especially the larger urban ones, see EMS solely to justify their existence.  Smaller fire departments often see taking on the EMS mission as a way to get increased funding, most of which will go toward the big red trucks and not the ambulance.  In many fire departments, the ambulance is actually called the “penalty box.”

In theory, I’m in favor of a degree requirement to be in EMS, especially at the paramedic level. More education can and should produce better paramedics. But with some experience in both consuming and regulating higher education, I know that giving power to higher education can have unexpected consequences.

So, since this train seems to be gathering some steam, let me throw out my conditional support.  I hope the advocates for EMS education and those accrediting college based EMS programs will listen before we hear about these issues arising once a degree requirement is truly and fully implemented.

  1. Grandfather current providers. I’m told that’s already in the works, but requiring everyone to back and upgrade to an EMS-specific degree would likely overwhelm each of these college based programs.  And for those who already have a bachelor’s or higher in a field outside of EMS, it would be unnecessarily repetitive.
  2. As a condition of accreditation, college-based EMS programs should be required to explicitly state how they plan to meet the needs of EMS students, especially those who are currently in the workforce. Such a commitment should address hours that the courses are offered, locations of the courses, transfer-ability of hours for non-EMS specific courses, and availability of clinical sites.  If you ask why I have a paramedic certificate instead of a paramedic degree, I’ll give you a simple answer.  The community college based program serving my area only offered the paramedic program on a full-time basis during daytime hours only.  With an outside career and already having three degrees, attending a certificate-only program was a no-brainer.
  3. Distance education is a must.  It stands to reason that those against an EMS degree will use the “poor volunteers” as a stalking horse to protect those who stand the most to benefit from poorly educated EMS providers — namely the fire service and the larger private EMS systems. Ensuring that EMS degree programs have distance learning AND nearby clinical rotation sites will ensure that rural and volunteer systems have their needs addressed — and eliminate one more argument against an EMS degree.
  4. In an ideal world, I’d like to see some sort of promise or commitment of an alternate entry degree program for those who already have a bachelor’s degree or higher. Such a program should be tailored to get people the scientific background they need for prehospital medicine (primarily anatomy and physiology) and the coursework necessary to function as a paramedic.
  5. Finally, the accrediting bodies need to ensure that these commitments and promises from higher education are kept ongoing. It will be entirely too easy to start backpedaling once the initial accreditation occurs.

I sincerely hope that those who advocate for an EMS degree take this in the spirit in which it’s meant — a reasonable way to ensure that we actually accomplish the goal of creating better educated paramedics and not solely in guaranteeing higher education a continued revenue stream. If we don’t plan now to address the needs of EMS providers and foresee unintended consequences, we are guaranteed to create even more of a shortage of providers (although some might argue that’s not an entirely bad thing) and creating a group of providers with significant student loan debt to go into a field not known for the highest wages.

We have one chance to get this right.  Let’s make sure that happens.

Filed Under: EMS, EMS 2.0, EMS Education, EMS Politics

Where To Fix EMS

Posted on September 4, 2018 Written by 2 Comments

We all know the problems with EMS.  Mostly they revolve around low pay, low standards, and unreliable sources of funding.  Easily fixed, right?  Well, maybe.

But there’s an ongoing problem in EMS. Most EMS systems operate under the belief that good clinical skills (or even worse, good clinical outcomes) are the primary determinants of who gets promoted.  Being a good clinician involves more than clinical skills.  And being a good clinician doesn’t mean you’re going to be a good educator or a good manager. Being a good clinician doesn’t correlate with much besides being a good clinician.

What does EMS lack?  And more importantly, what do most so-called EMS “Leaders” lack?  They lack the “soft skills” besides how to read an EKG, intubate, or start an IV. They may have a professional network, but they don’t know how to use it.  They rarely understand politics at any level — from the local government who decides how to fund and provide EMS to the state officials who regulate EMS to the federal officials who determine how Medicare and Medicaid reimburse EMS. They don’t understand the value of public relations.  They rarely understand budget and finance.

Ok, so you get the picture. So what is EMS doing about it?  Well, we’re doing the same thing as always.  We’re promoting folks on their clinical skills at best and most often based on who they know or how much management likes them. We’ve created a system where most EMS employers don’t have much of a career track.  And we continue to tell our best and brightest to move into another medical field, whether nursing, medicine, or physician assistant.

What should we be doing?  Simple.  Let’s actually grow our own EMS leaders and not just the usual gang of experts/idiots who speak at every conference simply because they’re loudly exclaiming they’re leaders.  Let’s encourage the best and brightest to remain in EMS and further their education.  They already know how to be EMTs or paramedics.  What they don’t know is what to do next.  Let’s get people degrees in adult education to become clinical educators.  Let’s get people degrees in business management or public administration so they can effectively manage and lead an EMS organization.  Let’s get people educated in finance to figure out how to keep the crews paid and fuel in the trucks. And maybe even get a few of us into law school and admitted to the Bar.  After all, we’re in healthcare, one of the most heavily regulated fields in the marketplace.  Having someone who knows how to navigate the legal, regulatory, and political landscape might just help advance EMS a bit more than just another guy who says “Narcan” at the right time. And since EMS is a business, maybe having someone with some marketing or public relations skills might help the public (and the politicians) understand that not all EMS is created equally and that, like anything else, you do indeed get the EMS system you choose to pay for.

Or…. we can keep doing what we’ve been doing.  The current results speak for themselves.

Filed Under: EMS, EMS 2.0, EMS Politics

The Social Media Medic

Posted on July 9, 2018 Written by 2 Comments

Social media is a wonderful thing.  It truly is.  For me, as both a paramedic and an attorney, it has been a godsend.  I’ve made a lot of friends that I’d have never known otherwise.  And, especially for medicine, it’s exposed me to a lot of new topics that enable me to give the best possible care to my patients.  The discussions in both law and medicine (and the combination of the two at times) make me think and grow in both professions.

However, there’s an old adage that applies. Caveat Emptor.  That’s Latin for “Let the buyer beware.” Like I said, social media is often a good thing, especially in EMS. But while it gives everyone a voice, its downside is that it gives everyone a voice, including those that might not be the best to listen to.

There’s a category of people I call the “Social Media Medic.” They’re the first to jump into a discussion with absolute certainty and moral clarity as to how you should be practicing medicine and what kind of person you should be. They protect their brand by saying all the right things because, often, their brand is the only thing they have and that’s how you get to make it on the EMS conference circuit. The “Social Media Medic” is often full of buzzwords and hashtags about EMS and medicine.  They’re often posting studies and blogs that promote them and/or their agenda. Sometimes, some of these people don’t even understand the study that they’re sharing. On social media, these people say all the right things.  They have the right hashtags.  They have the message down.  They might even be right.  But we rarely have a way to confirm that the loudest voice is the most correct voice.  Heck, on more than one occasion, I’ve found that some of the loudest voices who are the most insistent that they are right about medicine are those who are virtually unemployable in their field, often because their social media personality is a reflection of their actual personality of being an insufferably arrogant buffoon.  In other words, what the Greeks used to call sophmoric, literally a “wise fool.”

I’ll admit that I’ve been active on social media.  Some might even say I’m too active. They might be right. The truth is that I’m far from God’s gift to EMS.  I make mistakes daily and I don’t get enough time to do as much medicine as I’d like to be truly proficient. After all, as Clint Eastwood said, “A man’s got to know his limitations.” Hence, I rarely post about actual clinical issues in EMS.  It’s just not something I feel that I have the expertise or status to comment on with any authority. Now, legal issues, politics, volunteering, or professionalism are areas I feel qualified to comment on, so I do such.

In short, the loudest voice isn’t always the voice we need to be listening to.  And that especially rings true in EMS social media.

Filed Under: EMS, EMS 2.0

Why Doesn’t EMS Grow Up?

Posted on June 4, 2018 Written by 4 Comments

Social media is always full of EMS providers committing social media assisted career suicide (SMACS).  The latest was a perceived HIPAA violation where a medic was perceived to make fun of a cardiac arrest in a chicken coop, along with the associated chicken “byproducts.”  EMS Week always brings out the memes where the least bright and engaged of us in EMS demand to be thanked for our service, whether with free gifts or attention. We’re heroes, dangit. And EMS social media is always full of posts complaining about “misuse” and “abuse” of EMS and the emergency department of hospitals.

Of course, EMS and emergency department “misuse” and “abuse” are very subjective things. The general public doesn’t have the same definition of emergency that the average EMS provider has. Try to do the right thing and call your doctor after hours and you get a recording saying “If you’re having an emergency, hang up and call 911.” The problem is that no one defines emergency. Try to find after hours or unscheduled care for any sudden issue and you find that same or next day appointments are few and far between.  Urgent care hours often aren’t significantly better than many large clinics and that’s assuming that they even accept your insurance.  And if you do get in to see your doctor at their office, you can expect multiple follow-up visits for labs, imaging, and specialists for all but the most minor complaints.  Each of these are a separate absence from work and a separate insurance copay.  Is it any wonder that people go to a hospital emergency department where no appointment is needed and there’s virtually instant access to labs, imaging, and specialists.  As I like to say, the problem isn’t EMS or emergency department abuse, it’s that primary care has turned us into their after hours call coverage.

But that’s not the real point here.  The point here is that EMS seems to continue to remain in a teenager phase of not wanting to listen to the “adults” in the room who talk about educational standards and professionalism.  We continue to want to be “heroes” rather than caregivers and we demand attention and increased salaries while not doing anything to show why we deserve to be treated as a respected healthcare profession.  Why?

It’s simple.  The average career lifespan of an EMS provider, according to my quick Google search, is five years.  That’s right.  Five years.  It takes more than five years to be good at almost any career.  Like almost all of us, as a new EMT, then a new paramedic, I was full of all of the wrong answers.  I was full of dogma, misinformation, and the tendency to be way too eager about EMS. Fortunately, I was able to volunteer in some really first-rate EMS systems where I learned about medicine.  Also, the Internet and social media exposed me to some really smart people who actually cared about EMS and the medicine behind it.

However, the reality is this.  Many of the best and brightest in EMS leave for other careers in healthcare. And who can blame them? The opportunities in EMS pale in comparison to nursing, medicine, or as a PA, NP, or CRNA. With EMS’s short career half-life combined with our abysmal EMS education (Here, let me read the PowerPoints that the textbook publisher provides and I’ll throw in a war story on occasion.), we’ve created a revolving door of new providers who believe the dogma and misinformation.  They believe they’re going to be heroes and they’re disappointed when they’re providing geriatric primary care as opposed to “exciting and cool” trauma calls where they might “save a life.” (Spoiler alert:  Most of us in EMS don’t get the experience of being able to point to a specific life they’ve saved.  But if you do this right, you’ll get a lot of people to the right definitive medical care they needed to begin with.) And with our low barriers to entry, there’s little incentive to stick it out in EMS and make EMS great again. And while this revolving door continues, you continue to see EMS fail to progress and you see the same tired memes and complaints where we mock patients and our careers.  And when most are called to account for this behavior, they give the same tired excuses of how “you don’t know what it’s really like on the streets.”  Mind you, some of the worst offenders on EMS social media are virtually unemployable in EMS and don’t even work in an emergency setting.

To me, the heroes of EMS are the ones who’ve stuck it out; kept trying to improve EMS, even if it’s just their own EMS employer; and tried to teach good medicine to those coming in behind them.  If you actually took the time to take care of a sick person who’s septic and weak as opposed to bitching and moaning, you’re exactly who we need to stay in EMS.

Filed Under: EMS, Rants
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