Sorry for the delay in blogging.  None of my usual pet peeves have inspired me to blog as of late.  The truth is that volunteer EMS still has the same challenges and people still put beans in their chili, so maybe I needed to find something new to write about.  And something I shared last week on social media hit me.

I have a love-hate relationship with the internet, social media, and with EMS social media in particular.  I’ve made some incredible friends all over the world, some of whom I’ve met in real life.  Others I’ve yet to meet in real life, but I feel as if I’ve known them all of my life. But there’s also parts that drive me crazy beyond belief, yet I keep coming back to them like the guilty pleasure of watching Jerry Springer or Cops – or the morbid curiosity of looking at a car wreck.  Namely, I keep coming back to the amount of wrong information and/or dogma being spread online.  I used to try to engage and educate and I’ve stepped back a lot from that.  It’s like most debates with the willfully ignorant online: debating online with a moron is like playing chess with a pigeon —  it knocks the pieces over, craps on the board, and flies back to its flock to claim victory.

So, as a result, I’ve largely retreated and find my pleasure in sharing the stupid privately with like minded friends.  We largely laugh and bemoan the state of EMS and medicine in that such standards are allowed to exist.

The below average person in EMS (who we regularly mock) copes by making fun of patients, engaging in patient abuse, and the like because it’s their crummy coping mechanism for the things they don’t like, understand, or control about EMS. I think a large part of that comes from seeing the same things over and over.  I get that.

For me and people like me, what bothers us seems to be people repeating dogma, those failing to take personal responsibility for their development, and the general low standards out there. I’m as guilty of this as anyone here, if not more so, but I wonder if seeing that dumb behavior has made us cynical and jaded enough that we automatically assume the worst when we see someone post something that seems dumb as opposed to assuming they have a legit question or need for help? Heck, with the benefit of a bit of hindsight, I wonder how many of my questions as a newer EMT or paramedic came across that way.

I start wondering how many legitimate questions get overlooked because of the amount of chaff (IE dogma and mindless repetition) on EMS social media.   A friend of mine asked the same question and recognized that it’s hard to separate real questions from trolling. And then he asked the most important question, “Where do we draw the line at eating our own versus getting rid of an actual problem?”

I don’t have an answer to that.  What I do know is that the “eating our own” will likely continue as long as EMS education’s entry requirements focus on whether the check bounced and whether educational programs see their obligation as producing qualified clinicians as opposed to maintaining an arbitrary retention rate mandated from on high.

As long as retention remains more important than quality, I don’t think EMS social media will see an end to the “How do I pass National Registry?  I’ve failed four times already.” questions.

The challenge for those of us who want to excel in EMS is how to mentor and guide future clinicians without being jaded.  On a positive note, if it makes you feel any better, the attorney social media groups have enough of the same issues that I regularly wonder how some graduated law school or passed the bar exam.

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.

In economics, there’s a concept called Gresham’s Law.  Gresham’s Law states that bad money drives out good.

Sadly, the same is often true in EMS social media.  Bad discussion, particularly in some forums, drives away good discussion.  Most EMS pages on Facebook in particular are dominated by the loudest voices in the forum – most often poorly educated providers who repeat dogma, dated information, and flat out incorrect information. Combine that with some who want everyone to be “supportive” and not discourage people and you have a forum where bad information drives out good information.  Many of my intelligent colleagues in EMS and medicine have tired of trying to educate the unwilling.

And then, there’s another factor at play as well.  People in many of these forums want to discuss unlikely or arcane scenarios to the detriment of mastering the basics of good medical care.  Random medical-legal scenarios involving revocation of care, bizarre EKG cases, and random trauma pictures flood EMS social media.  Yet, there’s still a significant chunk of EMS providers who think that you can reverse a cardiac arrest with dextrose or naloxone (Hint: You can’t.) or that a long spine board is mandatory for every patient (Hint: The National Association of EMS Physicians and all of the current science says no.) And let’s not even talk about the number of providers at all levels who think that all respiratory difficulty gets treated with a nebulizer full of albuterol.

Bad information from bad participants drives out good information from the people who might know something. There are too many EMS social media participants who are constantly analyzing zebras when they can’t recognize the herd of horses coming towards them.

I don’t have a solution.  As the old saying goes, you can lead a horse to water, but you can’t make them drink.  While I try to educate when and where I can, I find I’d rather work with those who want to learn and want to improve themselves and their practice of medicine.  When you find those people, it makes it all worthwhile.  Until then, don’t forget the over the counter pain medicine of your choice from banging your head against your desk.