I was having a discussion with one of my favorite younger medics.  He’s brilliant; he’s got a mastery of the science; he’s just convinced he’s right and won’t always let you forget it.  (Sound like anyone you know?)

We reached a couple of brilliant conclusions.

1. With the current state of EMS education in anatomy, physiology, and pharmacology, I think it’s eminently reasonable to expect entry level medics to have mastery of the bare minimums of knowledge, particularly relating to medications and expand and grown their knowledge base through continuing education.  Of course, this means that continuing education becomes just that, rather than a biennial repeat of topics you already knew about.
2. EMS won’t be fixed with one big solution. It’s going to be fixed one medic at a time.  In other words, if you aren’t mentoring or being mentored by a colleague, why not?
3. Two of the most underrecognized failings of the average EMS provider are that we don’t understand the long term effects of our therapies nor do we ensure that the right patients get to the right hospitals.

There are a lot of phrases that encapsulate the “meets minimum standards” mentality that continues to hold back EMS.  However, one phrase continues to exemplify why EMS is relegated to being considered “unlicensed assistive staff.”

That phrase is : “Don’t need to know it.” This phrase captures the anti-intellectual bias that exists in EMS. (For example, “You don’t need book learning, let me teach you how we do it on the streets.”)  This phrases captures the blind faith in dogma, whether spread by their instructors, their colleagues, the National Registry, or what someone who thinks they heard about a legal case from two states over…

As we engage in fitful efforts to embrace mobile healthcare, particularly in dealing with long term chronic care patients, we’re going to find that our education is massively lacking in virtually any topic other than those topics tailored for a select few acute/critically ill and patients.  Paramedics have less clock hours in the classroom than most beauticians.  EMT programs are usually less than a quarter of the length of paramedic programs.

If anything, EMS should be pounding on the doors of educators asking for MORE knowledge and becoming life-long learners.  But instead, the sheep of EMS continue to bleat “Don’t need to know it.”

And now you know my skepticism when people claim that a new, improved EMS paradigm is just around the corner.  But I’m enough of an idealistic to keep tilting at that windmill.

As is the case in EMS every so often, we’ve attached ourselves to the supposed “next big thing” that will ensure adequate EMS funding, give EMS a level of professional respect, and provide for cleaner, minty-fresh breath.  As of late, that latest panacea is “community paramedicine” or “mobile integrated healthcare.”

Before I inject the lawyer’s skepticism, let me say that I wholeheartedly support an expanded role for EMS professionals in the world of healthcare.  I believe that EMS professionals are vastly underutilized in the healthcare field.  Personally, I believe that a variety of clinical settings would benefit from EMS providers being on site as a “rapid intevention team” to respond topatients who are acutely ill and/or rapidly decompensating.  Our ability to think under pressure, independently, would go a long ways towards improving patient outcomes.

However, let me throw out a couple of concerns with how/why “mobile integrated healthcare” may not yet be the solution that fixes EMS’s perceived woes.

1. Who’s going to pay for this?  Right now, there are a lot of pilot programs being funded from a variety of sources.  Eventually, this funding is going to dry up and/or the funding is going to have to continue past a trial/pilot period.
2. EMS providers are pretty darned good at reacting to acute events.  Many EMS providers don’t yet have the education in patient assessment, pathophysiology, and pharmacology to be effective in a longer-term setting.
3. Attitude.  Sadly, look at the number of EMS providers out there who want to limit themselves to a minimal standards mindset and who don’t even see themselves as healthcare professionals.  Thrse are the same ones who recite the shopworn mantras like “diesel bolus” and “we can’t diagnose.”  “You call, we haul” is their mentality.

So, what will fix EMS and give us a place at the adult table in healthcare? I thought you’d never ask me.

1. EMS needs to be reimbursed/paid for the care/interventions we provide, not solely as a glorified medical taxi with reimbursement for transport.
2. We need to develop an identity of who we are and what we do.  Further, we need to ensure that, like any other regulated profession, we do not let others intrude into our professional, regulated space.
3. Let’s embrace what EMS excels at — namely, using a public safety framework to deliver unscheduled, acute or urgent care medicine.

How can we achieve this?  We have to do the one thing that nursing beats EMS in every day — advocacy.  We need to be at the state capitol and in the halls of the regulatory agencies advocating for the future of EMS, rather than having various “stakeholders” define who they want EMS to be.  A professional identity would go a long ways towards making EMS a respected healthcare field.  The problem is that we aren’t educating the public and we aren’t making our presence known at the state house or at the myriad of regulatory agencies with oversight of what EMS does.

Of course, none of this is easy.  It’s a lot easier to look for the “next big thing” or maybe find a new t-shirt slogan.