And So It Goes

Posted on August 14, 2019 Written by 3 Comments

Years ago, my friend Mike Levy used to close out his email blasts on local politics with “and so it goes,” implying his despair that things would change or improve.  This morning, I happened to see an EMS colleague post a cartoon about how everyone wants change, yet no one seems willing to change.  Below are my thoughts on where we’re at in EMS.

 

We hear a bunch of people say we need the next generation of EMS leaders step up. Then we step up and we’re told to wait our turn, bide our time, and not speak until spoken to. Meanwhile, the people who created the problems of modern EMS are on all of the blue ribbon committees and consulting teams to fix the problems they created in the first place. Tact prevents me from naming names, but if you’ve been around EMS for more than fifteen minutes, you’ll recognize the names of what Mad Magazine called the “usual gang of idiots.”

And of course, as is the trend in modern politics, EMS continues looking for the single solution that will fix all that ails EMS.  A few years ago, it was community paramedicine.  (By the way, yours truly still thinks that knowing how to navigate the healthcare and social services systems and pointing patients to the right resources is an essential skill for a medical provider of any sort.)  Now, the latest push for EMS success has been distilled into a single catchphrase: “EMS Needs Degrees.”  It may not be as catchy as Bernie Sanders’ catchphrase of “Medicare For All,” but it’s equally simplistic and just as poorly thought out. Almost no one in EMS has thought out how a degree requirement would work, what such a degree would contain, or even found out if the higher education system(s) have the ability or desire to take on the task of educating paramedics. (Hint: Part of the nursing shortage relates directly to a shortage of qualified nursing faculty.  Considering how few in EMS already have EMS specific degrees, I can’t help but think that the shortage of qualified faculty to teach paramedics at the college level will be even worse.) And now, we have the first state proposing an actual degree requirement for EMS, namely North Carolina, which will require an associate of applied science in EMS to obtain paramedic licensure.  For many people and in many situations, this degree will be the end of their higher education journey, at least in part because the AAS curriculum rarely transitions well to bachelor’s degree requirements.  Once again, EMS looks for an easy fix to a complex problem.  As I like to say, good public policy can rarely be distilled to a meme or fit in a single Tweet.

The issues with EMS are complex and heavily tied to public policy, namely how the Federal government’s two financing mechanisms, Medicare and Medicaid, pay EMS as a transportation service as opposed providing healthcare.  That also explains why the historical option for EMS care is to offer a ride to the hospital emergency department.  But right now, instead of recognizing the need for future EMS leaders to have some concept of management, finance, politics, and public policy, we’re confining what constitutes EMS education to a set of technical skills. (I truly think that some of the loudest voices on EMS social media advocating for a degree are basing what an EMS degree should be on a wish list of skills and technology they’d like for an ambulance.  I’d also note that’s not how most educational models work aside from trade or vocational school.) We are not even guaranteeing that EMS providers are educated in the arts and sciences to understand the hows and whys of medicine and the context in which prehospital medicine fits into everything else.  And going back to my earlier comment about the current crop of so-called EMS leaders not wanting to relinquish their positions — you couldn’t think of a better way to keep the “new kids” out of leadership than to deny them the actual skill set and education they need while claiming that you’re helping the profession advance.

And so it goes.  Indeed.

Filed Under: EMS, EMS Education, EMS Politics

Quit Operating and Start Treating

Posted on July 24, 2019 Written by Leave a Comment

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.

Filed Under: EMS, Rants

Back In The Fire Service

Posted on July 14, 2019 Written by Leave a Comment

Well, I’ve been away from my blog for a while. There are two reasons.  First, I’ve been busy.  Those of you who know me know that I’ve changed one of my volunteer affiliations.  (More on that later.)  Two, I tend to blog when the muses inspire me.  And this afternoon, the inspiration finally hit me.

So, let’s talk about that volunteer position.  Obviously, in keeping with discretion and good sense, I won’t say which department. But what I will say is that they’ve been unlike almost any fire department I’ve seen.  It’s a combination paid/volunteer department that actually welcomes volunteer involvement.  It’s easy to get on the schedule and, by and large, you’ve got the equipment and uniforms to do your job.  They embrace the EMS first response role — to the point of having paramedic level protocols and an active volunteer role for those who want to stay exclusively on the medical side of the department.

Truth is, I’ve probably been one of the bigger critics of the fire service both in terms of its commitment to quality medicine and its love/hate relationship with volunteers.  And I realize that I might’ve found that rare unicorn that’s rumored to exist.

And in EMS, many of us respect certain aspects of the fire service, particularly the perceptions of brotherhood and camaraderie. And we rightfully blame many EMS organizations for a toxic management culture that doesn’t respect clinical competence, that values the bottom line above all else, and where “meets minimum standards” is the gold standard. We also blame an EMS social media culture that appeals to the lowest common denominator of inappropriate humor mocking patients, where patient abuse is funny, and where “book learning” is for the other guy because you “do everything a doctor does at 70 miles an hour.”

And truth be told, I’ve despaired of this culture in EMS as well.  Even though I should know that toxic cultures exist throughout the human experience (and I’ve worked in some toxic legal settings), I let the EMS social media world convince me that this is an EMS problem, not a human or management problem.

Until today.  I just happened to see a post from a firefighter I used to know.  His post was full of braggadocio about “leading and training.”  The fire service seems to be full of these guys.  They’re the fire service version of the lowest common denominator medics on EMS social media. And the truth is that a lot of the firefighters who talk a big game on social media like they’ve got the experience of firefighters in urban departments like Houston, New York City, Chicago, Providence, or Boston are the fire service version of the EMS social media clowns who are career EMTs doing interfacility transfers and dialysis runs. And just like in EMS, there are plenty of lousy managers the fire service and perhaps even more so-called leaders whose only expertise is in self-promotion.

So, what’s the point here?  Namely, it’s not just EMS — every profession and human endeavor has its share of buffoons hogging the attention as well as toxic folks creating an even more toxic culture. If you’re in an organization where you’re valued and the toxicity is minimal, treasure it and do what you can to keep that culture going.  If you’re in the other kind of organization, do what you can to improve things.  If all else fails, do yourself, your career, and your mental health a service and find a better option.

For what it’s worth, the good options in any career, and especially in emergency services, are out there.  You have to look for them.

One final note — the really great organizations rarely have to advertise or promote themselves.  They attract quality and the right people without a hashtag or cute slogan.

Filed Under: EMS, EMS Social Media, Volunteers

Yes, you’re wrong.

Posted on June 4, 2019 Written by 4 Comments

Sorry for the interruption in my usual stream of consciousness blogging.  Nothing in particular has been on my mind as of late. (Although I may have to do a post in the near future about finding a potential unicorn.  Namely, a fire department that embraces both volunteers and ALS first response.)

But this morning, I saw a contrast between those who I’d call high speed EMS providers and those who, at best, deserve the title “ambulance driver.”

Example one.  Discussion about the risks and benefits of a particular prehospital intervention.  In this case, it was application of a pelvic binder.  An expert on trauma care provides their opinion and an article that includes citations. Learning and dialogue occur.

Example two. Discussion of prehospital ultrasound on a popular EMS social media page.  Truth be told, I’m still a skeptic on prehospital ultrasound.  I’m not sure what ultrasound can show me that a good patient assessment can AND change my course of care in the prehospital setting. But another EMS provider (and I won’t use the word professional) stated in said discussion, ” I guess when you’re burn out like me, it doesn’t matter any more and you just want to dump the pt in the er. However that’s mine own opinion.”  He then “doubles down on dumb” and goes on to state, “nope it’s my opinion, not ignorance. I jill just don’t care about those devices out in the field. Waste of time and money.”  When he’s challenged on his ignorance, he states, “It’s not an excuse, it’s just how I feel about being burn out. I believe we have differences in opinions and I respect that. I guess opinions are wrong to use. People have different opinions and has nothing to do with education.”

The truth is simple. You can have an opinion. But when your opinion is based upon bad information and beliefs and you refuse to change when given new information, then you are absolutely wrong. And if you’re basing your medicine on bad opinions, then you’re a bad provider.

So long as EMS tolerates those people who refuse to practice good medicine based on current evidence based practice because they “have a different opinion,” we’re going to remain the ambulance drivers.  We won’t be taken as a profession.  And until we step up the standards to be a clinician, regardless of what EMS does for educational standards (which may or may not fix things), we don’t deserve to be called a profession.

You’re entitled to an opinion.  You can be wrong.  But you’re not entitled to harm a patient because you choose to be wrong.  If you are still doing that, that’s why the legal profession exists.

Filed Under: EMS, Rants

The Degree Advocates

Posted on April 22, 2019 Written by 6 Comments

After a few minutes engaging this morning on the American Paramedic Association Facebook page, I’ve realized that many of those advocating higher education and a degree requirement for paramedics have little understanding of higher education or how higher education works.

There’s tons of people saying they need more science classes and advocating for specific EMS related courses. Meanwhile, there’s a lot of people also advocating against any humanities or liberal arts core curriculum coursework. I would submit to you that a course in research design and methodology like you see in many bachelor’s level social science curricula may be of much more long term benefit to EMS than a specific, technical course in the most recent innovation. Remember when backboards and rotating tourniquets were considered current EMS practice? However, a course in understanding research would enable the paramedic to have a lifetime knowledge base in evaluating EMS innovations and a healthy dose of skepticism, which is a virtual requirement for scientists and clinicians.

Many of these people arguing for an EMS degree don’t understand that college is designed to produce a well rounded education, even if the degree is in a specific field. There’s several people saying that the EMS associates degree needs to be a technical degree. What they don’t understand is that an Associate of Applied Science degree is often a terminal degree for a technical job. (Think ITT Tech or DeVry for those of us that remember the commercials on daytime TV.) And further, an AAS degree often doesn’t easily transition to a BS or BA degree in the future, even further limiting EMS career progression and upward mobility.

Bluntly, the more I see, the more I think an AAS degree will end up dooming EMS to remain a technical education with limited chance for upward mobility or further education. What I’m seeing is largely people engaging in either playing pretend at creating their dream college curriculum or wanting to turn card course curriculum into college hours.

I’m almost willing to come on board with requiring a degree for paramedic providers. However, I think we need to aim for the ideal and negotiate to what’s manageable. In my opinion, I believe that the role of a paramedic is actually that of an advanced practitioner with the ability (and likely the requirement) to exercise critical thinking and clinical decision-making. That critical thinking comes with an expanded knowledge base including the core liberal arts curriculum. And that level of education happens at the bachelor’s degree level.

The political process, which is ultimately how we’ll reach a decision on what education is required to be a paramedic, requires that we negotiate from an ideal solution to get to a realistic solution. The ideal is a paramedic with a bachelor’s degree, whether that’s a bachelor’s degree in paramedicine or a bachelor’s degree in another field, followed by a paramedic transition curriculum (see also the plethora of BSN transition programs for those with a BA/BS degree).

If we end up making the paramedic degree requirement an associate of applied science as many seem to be advocating, we’re dooming EMS to remain a technical field with limited upward mobility. An EMS degree, especially for the paramedic level, should not be in the same category as HVAC technicians or diesel mechanics. (Truth is, the average HVAC technician or diesel mechanic probably has a better salary than the average EMS provider — or even many so-called “white collar” jobs.)

As I’ve said before, we’ve got one chance to get the degree requirement right. Let’s not foul this up. And if we turn this into an echo chamber among ourselves and creating a curriculum that’s solely based on “cool new skills” for paramedics, we’re dooming ourselves with a degree requirement that ends up producing perishable skills that will be outdated within a few years of practice.

Filed Under: EMS, EMS Education

How To Foul Up National Volunteer Week

Posted on April 8, 2019 Written by Leave a Comment

So, we all know that volunteer fire and EMS organizations routinely say they’re short of volunteers. Check out any small town media or even fire and EMS websites and social media sites and you see the same stories about organizations struggling for volunteers.

So, you’re with one of these organizations that has volunteers. Maybe you’re even seeking volunteers. As such, you do what all of the self-appointed experts (maybe even me) tell you to do and post on social media. A great idea might be to post something about this week being “National Volunteer Week.” Thank you President George H.W. Bush and the “thousand points of light.” You even get bonus points if you do this in Dana Carvey’s voice.

Now you’ve got your post up on Facebook for National Volunteer Week. All you need to do is watch your Facebook inbox for volunteers, right? No need to close the deal or such, right?

Well, one enterprising paramedic sent such a department a Facebook message inquiring for more information on volunteering with a group. The reply the paramedic got back was “Ok stop by my office and we can talk it just involves a simple application.”

Part of running any organization, whether paid or volunteer, is doing a bit of salesmanship for recruiting. That means selling your organization to prospective members. And when a potential member inquires about membership and asks questions, it pays to answer them as opposed to giving a few generic facts about your department. Speaking somewhat selfishly, if a prospective member is interested and engaged enough to ask specific questions about activity requirements before applying, it’d be smart to answer them and to even offer to reach out via telephone. Instead, some vague answers about the organization’s probationary process that seem almost canned make the potential member think that whoever’s handling social media is either not an actual fire/EMS member of the organization or is completely disinterested in bringing on new members. An offer to make a phone call might go a long way in sealing the deal with the potential member as opposed to the potential member just replying with “thanks” and walking away with a skeptical feeling about your organization.

Compare and contrast this with another organization. When a new member reached out to them, they received a call from a department board member who followed up with an email containing an application, EMS protocols, policies, and department bylaws. (Note to the first department I described: Maybe it might benefit y’all to post the membership application and/or these basic facts on your website or Facebook page.)

Needless to say, you can guess which department got this blogger’s interest and which department got a “thanks” in reply to their amateur attempts to inquire to potential membership.

It’s like I’ve said before. You have to make it possible for people to volunteer. You have to make people want to volunteer. Otherwise, you end up creating the self-perpetuating story of being unable to find volunteers. And eventually, you end up having to create a paid fire and/or EMS department.

Filed Under: EMS, Volunteers

Masters of Our Own Destiny

Posted on March 28, 2019 Written by 1 Comment

EMS is dependent on others to get what little we do.  Whether it’s getting physician involvement for clinical changes or convincing those with the money that a new ambulance is needed, we have to get others involved in our destiny.

If you listen to the current voices on EMS social media, you’ll hear the lamentations that EMS is broken.  The current consensus, promoted by all self-proclaimed EMS save those in the fire service, is that EMS degrees are what will surely fix EMS and make us respected.  Mind you, the EMS consensus has brought us some other sure-fire winners as system status management, declaring EMS an “essential service” (Hey, where did that go?), and community paramedicine.  We’re on EMS 3.0 or something now and we still haven’t mastered the basics of getting the right patients to the right hospital and treating people right, both as people and as patients.

I agree that more education is needed for EMS. But the last thing we need to do is follow the rest of the healthcare professions and have a solely clinically focused degree.

Too many people in EMS (and the rest of healthcare) think that all you have to understand is the medicine. If you don’t understand (or participate) in the policy and business aspects, others make those decisions for you. If you don’t believe me, look at our modern American healthcare system. For years, physicians refused to be involved in the business of medicine.  As a result, hospital and healthcare administrators developed to handle the business of medicine.  And ultimately, we have ended up where we are currently — where a lot of decisions about medical care are made by the business office rather than by those providing the actual care.

It often seems that there’s a belief in the world of healthcare that being involved in business or policy is somehow “unclean” or beneath the profession.  As a good friend of mine said, “Even if you aren’t interested in politics, politics is interested in you.”

So, in short, I’m not opposed to increasing EMS education.  But what an EMS degree should NOT be is a degree focused solely on the clinical practice of medicine.  Too many of the EMS degree advocates on social media would promote a degree that awards three hours of college credit for a course entitled “Latest Clinical Fads Capstone.”

EMS, like the rest of the healthcare world, does not exist solely in a clinical vacuum. For EMS to advance, we need to understand the business of healthcare.  That means an EMS degree needs to include coursework in the political and regulatory process, finance, personnel management, and the research process.

In other words, it needs to be a well rounded degree as opposed to a narrowly focused clinical pathway that will be doomed to irrelevance with every change in medical practice. But without this kind of education, an EMS degree is doomed to become an expensive addition to the current workplace.  If the current people pushing for a degree requirement better understood the non-clinical aspects of what we do, they’d see the potential pitfalls of an EMS degree such as a lack of buy-in from higher education and the availability of appropriately educated EMS faculty to teach in a college setting. By the way, the same shortage of faculty is partially responsible for the current nursing shortage. This is but one example of why healthcare education (including EMS) needs to understand business and policy. Take ultrasound.  It’s the current EMS clinical fad on social media.  Everyone wants it.  But has anyone developed a position as to how ultrasound saves money, improves care, or how EMS can get paid for ultrasound.  I’ll wait here for that answer.

And if you don’t believe that healthcare providers (including paramedics and EMTs) don’t need to understand the big picture of healthcare outside the actual provision of medicine to patients, then you’ve illustrated exactly why healthcare administrators often make even more money than the doctors do.

Filed Under: EMS, EMS Education

We Need More Lawyers

Posted on March 20, 2019 Written by 2 Comments

Shakespeare wrote in Henry VI, “The first thing we do, let’s kill all the lawyers.” Even as a practicing attorney, I can empathize.  As I like to say, ninety-nine percent of attorneys give the rest of us a bad name.  Or there’s my other favorite attorney joke, “What do attorneys use for birth control?  Their personalities.” But joking aside, the Shakespeare quote is often misinterpreted. In fact, many have argued that the villain in Henry VI proposed killing all the lawyers because they ensure the rule of law exists, that is a fair system where people understand the rules and are held accountable to follow said rules. In other words, we need lawyers for the system to work.  And I’d submit to you that one of the reasons why the EMS system isn’t working is precisely because we need more lawyers.

As I stated above, lawyers make sure the rules are understood and followed.  All too often in EMS, that doesn’t happen.  In EMS, people make arbitrary decisions that are rarely applied fairly, much less with an understanding of the law.  In the National Registry testing and renewal process, I’ve heard and witnessed stories of various EMS functionaries refusing to sign renewal paperwork, all without giving an explanation of why.  The National Registry even has a process for a former paramedic to recertify provided certain conditions are met, including obtaining the signature of your state’s EMS director.  In Texas, a previous state EMS director refused to engage in this process based on the vague claim that he did not believe he had “authority” to sign the document.  Again, an EMS provider harmed by an arbitrary and probably incorrect view of the law.

Another example of EMS arbitrariness routinely comes up with state licensing laws, particularly relating to reciprocity, the process of moving your certification from one state to another.  More than one state has laws and regulations requiring state residency and/or employment prior to granting reciprocity. The problem is that such a requirement appears to fly in the face of legal precedent established by the United States Supreme Court in the case Supreme Court of New Hampshire v. Piper, 470 U.S. 274 (1985).  In the Piper case, the Supreme Court found that a New Hampshire state law requiring one to be a resident of their state before being admitted to practice law was unconstitutional.  The parallel to several states requiring state residency and/or employment for EMS reciprocity is striking, yet EMS continues to ignore it, either from sheer ignorance or perhaps believing that EMS is “special enough” that a Supreme Court case might not apply to it.

Much of my day as an attorney is spent counseling clients on what the law means, how it applies, and how we can use the law to mitigate risks. In EMS, we routinely seem unwilling to seek such guidance, preferring instead to rely on “we already know what a lawyer is going to tell us.” We see this all the time with policies. The classic examples in EMS often seem to revolve around HIPAA. People routinely use HIPAA as an excuse for failing to get patient follow-up or why EMS can’t see transfer paperwork.  EMS managers routinely sign contracts and make personnel decisions without the benefit of legal counsel and may end up subjecting themselves and/or their employers to liability as a result.

Even with education, EMS “leaders” are often unaware of the regulatory and legal hurdles that may exist with the current push toward EMS degrees. Namely, most of the accrediting organizations that accredit colleges and universities require that college faculty possess a terminal degree in their academic field. This oversight may, again, be an example of EMS “leaders” not seeking the counsel they need.

Finally, EMS needs lawyers to keep our profession honest and to uphold standards. The latest viral video on EMS social media is of two South Carolina EMTs appearing to refuse to treat or care for a patient lacking the adequate mental capacity to make a decision. At some point, a lawyer needed to be involved, whether in the initial EMS education process to teach actual medical-legal concepts as opposed to myths and urban legends, providing legal advice as to capacity and refusals, or in the aftermath of liability or licensure.

I’ve had very little overlap between my legal career and my volunteer work in EMS.  (Having said that, if you have the ideal position that combines both, I’m open to discuss…) However, for EMS to grow and develop as a profession, we need more lawyers, not less.  EMS needs the protection that lawyers provide, both from risks outside the profession and in many cases, from ourselves.

Filed Under: EMS, EMS Legal

Community Paramedicine

Posted on March 4, 2019 Written by Leave a Comment

Years ago, I attended a Citizen’s Police Academy program sponsored by my local police department.  It was designed to give the general public an insight into how the police department works and foster communications between the police and the public.  (And for what it’s worth, EMS is massively behind the times on our public outreach.  Fort Worth MedStar is the only non fire-based EMS system I’m aware of that operates a citizen’s academy for EMS.)

One of the best things that I got from this program was an explanation of community policing. The officers presenting this material explained that the police might have an idea of the community’s needs, but without actually engaging with the community and determining what the community wanted, there wasn’t community policing. The example was that the police might assume that the community wanted something done about an uptick in car burglaries, but the community might not even know about this and might well be more concerned with people speeding through a school zone. In other words, the police figured out that community policing doesn’t work without community engagement.

And now, let’s flip the conversation to EMS. EMS is talking a lot about “change” to meet call volume and demand.  We’re talking about alternative destinations for patients.  We’re talking about triage and different response models for “non-emergent” calls. But more than anything, we’re bandying about buzzwords and have convinced ourselves that the public is “abusing” the EMS system. We’ve almost become the police in the “bad old days” of policing where the cops were “us” and the public was “them.”

In other words, we’re doing what the police did before the community policing model developed.  We’re developing an EMS system based on what we think the public wants.  Perhaps we might even be developing an EMS system based upon what EMS wants. What we’re not doing is engaging the public to determine what they want, need, and expect from their EMS system.  Absolutely, we have a professional obligation as medical providers to first do no harm. That responsibility has some obligations.  As does the responsibility to be responsible stewards of the money provided to the EMS system.

But outside these obligations, how many EMS systems or political leaders engage the public to find out what they want or expect from their EMS system?  How many EMS systems educate the public what EMS is or does beyond “call 911 for an emergency?”  How many EMS systems teach that there haven’t been mere ambulance drivers for decades — or that EMT and paramedic aren’t necessarily interchangeable terms? And have we asked the public if they want mobile integrated health?  Or if they judge an EMS system by cardiac arrest survival rates and response time?  My strong guess is that many member of our public would be very happy with their EMS system if the medics showed up on time, were nice, gave them a safe ride to the hospital, and just maybe everyone’s medical records were synced together.

But if we don’t ask the public what they want from us and how we can help, we’re doomed to irrelevance and distrust, just like the police were — before they engaged the community.

Filed Under: EMS, EMS 2.0

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
Next Page »