Recently, a good bit of publicity has been devoted to allowing EMTs to administer Narcan intranasally to patients who have overdosed on opiates.  speaking purely from a practical and clinical standpoint, these patients aren’t going to die from a lack of Narcan, but they are going to die from a lack of ventilation.   We should be reinforcing good BVM skills rather than adding ALS interventions piecemeal based on the media’s epidemic du jour.

This is nothing new.  Every few years, many BLS providers petition the powers that be for certain ALS skills.  In my EMS career, I’ve seen a few of these skills added or considered from nebulized albuterol to nitroglycerin to Epi-pens and now Narcan. In most of these cases, we limit the application of these (now formerly) ALS skills to specific patients in specific situations.   This is our attempt at managing and mitigating the risk of allowing an EMT with approximately 120 hours of training to perform a skill that was previously reserved for paramedics with over 1,000 hours of training.  (I’ll save the training versus education debate for another day.).  What we end up with is a cookbook, bastardized, piecemeal approach to the provision of advanced life support, based largely on public and political pressures as opposed to sound medical science.   What we don’t end up with are providers who understand the how, when, where, or why to apply these newly acquired skills.

I’d favor EMTs being allowed to perform these ALS skills in two situations. First, where the skills are being performed under the direction and supervision of an ALS provider in an effort to provide a true “extra set of hands.”  Second, and subject to strict clinical oversight, in rural systems without ALS access.

In my opinion, if you want to be able to perform ALS skills, you need the knowledge of an ALS provider.   That means if you want to do the “cool” paramedic stuff, go to paramedic school.   Otherwise, this trend to add ALS skills to the EMT protocols is yet an another example of the instant gratification model that continues to hamper EMS and EMS education in particular.

Yep, I think I’ve finally turned the corner and become one of those crusty (at least relatively speaking) and cynical older medics.

I was discussing the role of passion in EMS with a friend of mine.  She reminded me that there are plenty of people with a passion for EMS who don’t have the aptitude for EMS.  That got me to thinking.

Maybe there’s a distinction to be made.  The people who are the long-term successes in EMS have passions for the right things about EMS.  You know, things like the actual practice of medicine, the life-long learning, and the compassion.

Because if all you are passionate about the ability to drive with lights and sirens, sleep on duty (not that the “safety nap” is a bad thing, mind you), and get two days off after working twenty-four hours, you’re quite likely to have one of two things happen to you.  Number one, burnout when you realize that real-life emergency medicine in the field has no resemblance to the infamous EMS t-shirts claiming that you’re a “Trauma Junkie doing everything the doctor does, only at 80 miles an hour.”  Number two, disappointment when you’re one of the people posting on a Facebook group that “you love EMS and want to be a paramedic, but you’ve already failed National Registry three times, so it must be the fault of your instructors.”

Be passionate about the medicine, not the perks.

Lately, I’ve been thinking about my blog and also about speaking engagements.  In fact, a fellow blogger and I were discussing conference topics.  She and I were both complaining about some of the topics that people seem to like us to speak or write about.   For a while after getting into EMS, I wanted to be known as something other than the paramedic/attorney who speaks about legal issues.   So, I tried a few presentations on clinical topics.  They went over OK, but that’s not what people wanted to hear about from a paramedic/attorney.  Truth be told, I know several people who do much better “medical” presentations than I do.  Kelly Grayson and Bryan Bledsoe are both phenomenal speakers who have a real ability to take a difficult medical topic and put it into terms that a rookie EMT can master.

Over time, I began to realize something, namely that Kelly and Bryan (and most other EMS types) aren’t attorneys.  And I know that I can present a medical-legal lecture that’s fun, informative, and accurate.  Being an attorney and a paramedic is something kind of different in our EMS world.  So, I’ve become one of the few people who OWNS the medical-legal topic.  (By the way, I also OWN the topic of turning a volunteer program into a success.  More on that in another blog post.)

So, back to my friend.  She says that her most popular blog post was about dressing professionally.  My advice to her — OWN the topic of EMS professionalism.  It’s something that needs doing well.  With the amount of “low information medics” on social media, we all need a reminder about acting professional.  Even worse, so many of the popular EMS columnists and authors who write about ethics and professionalism come across as overly moralistic scolds whose shaming of natural human responses would make the Spanish Inquisition blush.  Anyways, I hope she OWNS the topic of EMS professionalism.

What’s your EMS topic that you’re passionate about?  OWN it — and share that passion with your colleagues and others.