Charity Begins At Home

Posted on December 1, 2016 Written by

Recently, I’ve seen more than a few EMS types posting requests for crowdfunding for them to engage in medical work, either as a medical missionary or in solidarity with various protest movements.  I get it.  The urge to help others, especially in moments of extreme need, is a huge motivator for many of us in public safety or medicine. (And yes, that’s controversial right there.  EMS is a mix of public safety and medicine.  We use a public safety model to deliver medical care.  Prehospital care is what I like to call “operational medicine.”)

But, to me, asking for crowdfunding to subsidize your passion reeks of so much that I don’t like about EMS.  There’s a vocal portion of people in EMS who are all about “LOOK AT ME!  VALIDATE MY EXISTENCE!  I’M DOING SOMETHING NOBLE AND YOU SHOULD APPRECIATE ME!”  It’s so common throughout EMS, as we see with the t-shirt and bumper sticker brigade. I get it.  We want to help.  But it seems that, for a vocal portion of EMS providers, we only want to help when we’re getting attention. (Bonus points if you appeal to social justice and get subsidized for being a medical activist…)

Bluntly, if you’re having to get others to pay for your altruism, you probably aren’t in a financial situation to be taking the time off to travel to a faraway land, whether overseas or even in the USA. It’s, at best, highly irresponsible.

The honest-to-God (or insert your deity of choice) truth is that there’s plenty of places local to each of us without access to medical care.  Heck, there’s plenty of places within an hour’s distance of each of us that are probably lacking access to quality EMS care and would love to have a passionate, dedicated volunteer provider on board.

Way too many folks in EMS make fun of volunteers and claim that volunteers are responsible for poor EMS standards and low wages.  Yet way too many people in EMS volunteer — when it gets them attention and a partially funded trip out of town.

As the old saying goes, charity begins at home.  Find your local service or local medical organization where you can begin to address the lack of care locally.  Ok, rant over.

Filed Under: EMS, Rants, Volunteers

A Note Of Optimism

Posted on November 17, 2016 Written by

I’ve been away from the blog a bit, mainly as a result of some writer’s block.  With an upcoming trip to the Texas EMS Conference to speak (Tuesday, November 22 at 2:00 PM, by the way) and to get some continuing education, I’m more rejuvenated about EMS than usual.  And then, tonight, I heard from a dear friend of mine who works for a large, urban third-service EMS system in Texas.

She proceeded to tell me about her patient earlier this evening (without violating patient confidentiality), while working a high-volume truck in the inner city.  Her patient needed to go to the hospital for treatment of an illness that had been lingering for a long time.  She made arrangements to have all of the patients’ belongings moved as that was one of his objections to getting care.  She then administered pain medicine because “that looked like it <expletive> hurt.”

Honestly, it’s what we’re supposed to do.  But a lot of us miss the mark.  But ultimately, she took care of a patient, got them to care, addressed their pain, and gave them a bit of dignity.  Stories like this don’t make the news.  They don’t make great t-shirt slogans.  But taking care of the least among us is exactly what EMS is supposed to be all about.  Things like this remind me why it’s a privilege to be a medic and why it’s truly a sacred honor to take care of patients.

I’m not a Bible verse kind of guy, but her patient care tonight reminds me of this verse, “whatever you did for one of the least of these brothers and sisters of mine, you did for me.”  And ultimately, that’s the standard we should strive for as medics, as public servants, as caregivers, and as human beings.

Filed Under: EMS

Enthusiasm

Posted on October 19, 2016 Written by

There’s a lot of enthusiasm on EMS social media and some of the most enthusiastic of these people want you to know just how much enthusiasm for EMS.  There’s a lot of people saying how much they love being in EMS.  There’s a lot of those people sharing pictures of ambulances, fire trucks, helicopters, and badges. These are usually the people who have all the cool sayings, catchphrases, and memes down.  These are the ones about heroism, pride, sacrifice, and everything else all-American and apple pie. There’s also a group of marketing types who make a fair amount of money selling T-shirts to those enthusiastic EMS types.

Here’s what I never see from those types.  I rarely see why they’re enthusiastic about EMS.   And I never see their enthusiasm about the MS of EMS — medical service.  These people are never at the EMS conferences, except at the vendor’s booths getting their latest “Big Johnson EMS” t-shirt. If they go to continuing education, it’s because it’s mandated.  They share the hero stuff.  They don’t share the medical stuff.  And what they do share about medicine falls into two typical categories — war stories and dogma. For them, it’s even better if they can share both. “There I was, taking this guy to the ER who’d slipped and fell.  Good thing we put him in a C-collar and a backboard because he had a hairline fracture of C-3.  You can’t ever be too careful.”  These are the same people who believe that cutting edge medicine involves a backboard, a non-rebreather mask, and a diesel bolus.

I’m enthusiastic about EMS.  What I love is that it’s an opportunity to help someone and provide medical care when someone doesn’t know where else to turn. And to me, that opportunity to serve comes with an obligation to provide the best care possible. There’s an imperative to be up on the medicine.

EMS social media is a phenomenal tool for networking with like-minded providers and to share the latest developments in medicine.  I am incredibly thankful to some great, smart EMS professionals online who’ve shared their tricks of the trade with me. I’ve learned more about Ketamine, sepsis, rapid sequence intubation, push dose pressors, and countless other topics from the online EMS world than a hundred local classes could ever have attempted to provide. And when I’ve despaired over things, whether in EMS in general or in my personal EMS world, there’s been a friend out there who’s shared the same frustrations.  But social media friendships, just like “real world” friendships, are highly dependent on who you choose to associate with. As the old saying goes, “choose wisely.”

In conclusion, it’s great to be proud and enthusiastic to be in EMS.  The challenge is to channel that enthusiasm into being a provider that provides a service to your patients. If not, you’re just another whacker.  Don’t be that whacker.

Filed Under: EMS, EMS 2.0, Rants

A Media Time-Out

Posted on October 17, 2016 Written by

I’ve gotten tired of the media.  I’ve gotten tired of the same stories appealing to the uneducated masses.  I’ve gotten tired of the same talking heads spreading the same talking points.  You thought I was talking about the upcoming national election in November?

Wrong.  I’ve gotten tired of the EMS media, both print and online. Virtually every EMS social media, online presence, and print publication consists of the same things. A few clinical “advances” highlighted, usually by a professional EMS Celebrity, the right EMS system, and/or the same cabal of professional committee members who’ve created the mess that is modern EMS — but wait, this time, they’re really going to fix it.  Then, there’s all the stuff to tell you what a hero you are.  Yes, you should wear your lack of education, your immaturity, and your inability to feed a family on an EMT paycheck as a badge of honor. And the majority of EMS “news” sites consist of results of content searches.  If a news article mentions “EMS” or other keywords, it gets shared on EMS news sites.  In my mind, this partially explains the Narcan for everyone craze — because, golly gee, they keep reporting on heroin and other scary drugs.

And EMS social media is more of the same.  Pandering to the least educated of the profession mixed in with some hero worship and mindless adulation because merely going to a job that involves less than 200 hours of initial education makes you a hero.  And by God, if you can’t pass an exam that measures minimal entry level competence to safely function, then don’t worry.  We’ll keep encouraging you and tell you to keep chasing those dreams, no matter how unrealistic they are, you special snowflake!

At times, you’ll see EMS media get it right.  The cover of the current edition EMS World is about prehospital ultrasound. Some of my friends in EMS who want to advance EMS as a profession and expand the role of EMS providers have tried, with occasional success, to raise the bar.  Yet, the reality is that there’s always more average and below average EMS providers to consume the media.  And in a capitalist society, we go where the money is.

I don’t know that we can fix the problem.  What I do know is that there is plenty of good educational material out there to be an informed, current provider.  You just have to look for it.  There’s even some good stuff online.  If you’re not familiar with FOAM, you should be.  There’s some incredible cutting edge medicine being spread on social media.  I like the quote that Dr. Joe Lex says:

If you want to know how we practiced medicine 5 years ago, read a textbook.
If you want to know how we practiced medicine 2 years ago, read a journal.
If you want to know how we practice medicine now, go to a (good) conference.
If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM.

 

And that brings me to the final point that I have regarding becoming and remaining an informed practitioner of prehospital medicine.  If what we are doing is medicine — and I believe it is, then we need to be getting our education from physicians. I admit to being a nerd about medicine. I have several physician level texts that I use to expand, broaden, and challenge my notions about medicine.  And a personal goal is to attend more physician level professional education.

A rising tide may not always lift the rest of EMS, but I believe that if the smartest and most motivated of us in EMS demand more for our professional development, just maybe, we can start to be taken seriously as professionals.

Filed Under: EMS, EMS 2.0, EMS Education, Rants

Mental Health

Posted on October 3, 2016 Written by

I work in a profession with high rates of substance abuse, mental health challenges, and a high potential for burnout.  I regularly hear how people in my profession don’t even realize they have these mental health challenges.  It’s gotten so bad that my profession’s association in my state has created a peer support and referral network for substance abuse and mental health.  You thought I was talking about EMS, didn’t you?  Wrong.  I’m also a lawyer and we are regularly warned about mental health issues involved with lawyers. (Nope, not going to put a lawyer joke here.)  There’s also a ton of profession-specific outreach and awareness of mental health issues going on for physicians as well.

It’s VERY true that EMS has the potential for mental health challenges.  We’d be improving if we said that EMS did a crummy job of addressing provider mental health. In too many organizations, mental health is ignored or paid lip service at best.

But we’re EMS. We are convinced that everything is all about us.  ALL THE TIME.  We wear t-shirts with slogans that confirm the worst about us being “ambulance drivers.” We constantly want you to know how special we are, whether it’s t-shirts or attention-seeking social media posts and memes about “racing the reapers,” how we “save lives,” or some other random “look at me” theme. So, when the less informed of us in EMS get interested in mental health, it’s the same thing.

The truth is that we’ve all seen things in EMS that no person should ever see. We are in a position of public trust where we get a ringside seat to the human condition at its ugliest. I’ll let you in on a secret.  A lot of other people get to see some of this as well.  Imagine what social workers dealing with the abuse of the elderly, the disabled, and children see.  Imagine being a school teacher and dealing with the outcry of a child who’s been sexually abused or who’s coming to school hungry. Heck, imagine being a lawyer and being involved in a criminal trial for sexual abuse of a child or a civil case involving someone who made the decision to put profit ahead of the public.  In other words: EMS isn’t as special or unique as we think.  One of the biggest things that I learned from my psychologist is that the challenges I came to see her about were not unique.  That alone was the biggest lesson I learned and the biggest thing that I remind myself daily. It’s a very liberating feeling to know that you’re not alone in your challenges.  I think that EMS could collectively benefit from knowing that we’re not as special or unique as we think.

Mental health is a health issue.  Period.  It’s treatable.  But first, it has to be diagnosed. BY AN ACTUAL MEDICAL PROFESSIONAL.  There exists a subset of EMS providers who are convinced they have PTSD or some other mental health issue solely because they work in EMS and they wear it as a perverse badge of honor and martyrdom because “LOOK AT ME.  I’M A HERO AND I WEAR THESE WOUNDS.  LOOK AT ME!” Think about that for a second.  I didn’t diagnose my own diabetes.  My doctor did.  She’s given me wonderful coping tools (namely dietary modifications and medications) to deal with this diagnosis and live my life as normally as I can.  I don’t brag about being diabetic. I don’t seek attention because I’m diabetic.  But there’s too many of us in EMS who wear a supposed mental health diagnosis like it’s a badge of honor or rite of passage in being a “real” medic.

I’m a lawyer.  And the truth is, I love being a lawyer most days.  There are days where it gets stressful, frustrating, or challenging. And you know what I do?  Something other than being a lawyer. Whether it’s a road trip, time with family or friends, or even my passion of EMS, I do something other than being a lawyer. I recently saw a post on social media from a person worried about their mental health.  They also work several EMS jobs and their profile has a typical “EMS hero” slogan on it. They need two things.  1) They need to see a qualified professional to make a diagnosis.  They aren’t going to get a diagnosis on social media. 2) They need to restore their work-life balance.  Take the time to do that which makes you the person that you are.  And that’s not always EMS, law, or any other profession that you practice.

I apologize for the rant.  I apologize for the indiscriminate use of capitalization.  I apologize if you think I’m not being supportive. But I will never apologize for my belief that mental health in EMS (or life in general) is too important to be distilled into another meme.  If you’re facing the challenges, get help.  Real help. Professional help.

And one other thing.  You’re more than your professional identity of being an EMT or a paramedic.  Find that which recharges you.  Find what makes you the person you are.  When you’re off work, truly be off work.  Maybe even take the time to hug someone in your family, your friend, or a significant other.

Filed Under: EMS

Your Internship in EMS

Posted on September 29, 2016 Written by

Some of my best ideas for discussion fodder come from EMS social media.  Both the great insights and the “what was that guy thinking” moments get me to thinking about EMS and how we can “Make EMS Great Again.”

Today, several discussions led me to the topic of today’s blog entry for y’all.  A good friend of mine was bemoaning the lack of critical thinking in EMS providers of all levels, particularly after reading yet another “experienced” paramedic say the worn out, discredited, incorrect cliché of “BLS before ALS” yet again.  He suggested a need for an assessment and scenario based class on critical decision making, especially in relationship to airway management.  Another smart paramedic commented on a need for a course in scene management.  A few short moments later, I got an email advertising a textbook for a new NAEMT “card course” on “EMS Vehicle Operator Safety.”  And several days prior, people were bemoaning the current state of EMS continuing education where mandatory “card courses” like CPR and ACLS are virtually impossible to fail, yet also devoid of much educational value.  Then, there are all the new “tactical” classes for incidents unlikely to occur in your jurisdiction. Meanwhile EMS continuing education fails to keep providers current on the science and treatment of “bread and butter” EMS calls like respiratory distress, chest pain, abdominal pain, and routine trauma.  But there are certifications for critical care medicine, flight medicine, tactical medicine, and community paramedicine.  Before we reboot into EMS 3.0, let’s try to make sure that EMS 1.0 isn’t a completely flawed platform.

And then, all of these thoughts combined as I realized that they all, in part, address the same challenge. Namely, the idea of a “street ready” paramedic doesn’t exist. The National Registry exam, by its own admission, measures minimal entry level competence to safely practice.  Most organizations have some sort of field training process.  In these organizations, they usually run between one of two extremes. Some sort of quick orientation process that exists solely to say the new hire was “checked off” or some sort of extremely long process that is a virtual repeat of your EMS educational program’s clinicals where you are evaluated on clinical proficiency in each and every skill.  And in all too many programs, the FTO process becomes a legalized hazing process where you perform to your FTO’s prejudices, biases, and whims. Having been through a variety of field training programs, I can say that what doesn’t exist is an orientation to things you might experience daily — how to use the two way radio, how to troubleshoot various pieces of equipment, how to get supplies, etc. And depending on where you’re employed, you may go weeks — or years — without being exposed to certain types of calls and patients to put in your personal library of encounters that you can call upon for the next patient care challenge.

As a new lawyer, I experienced many of the same frustrations.  I came out of law school and the bar exam supposedly “ready to practice law.”  But my first few years as a lawyer, I was really learning how to practice law. And I began to recall something that was discussed in law school – namely, there is no internship or residency for lawyers like there are for physicians.

As a paramedic who didn’t have to rely on a paycheck as a paramedic, I got lucky.  I worked part-time for a while for a suburban service as I realized how little I actually knew.  I then got VERY lucky to find a volunteer position with the service that made me the paramedic that I am today — Harris County Emergency Services District 1 (now called Harris County Emergency Corps).  I walked into a perfect situation.  At the time, the District utilized their volunteers primarily as third crew members on a truck.  The paid staff usually appreciated an extra crew member to help.  And there were plenty of crew members who were willing to take the time to teach and pass on lessons.  It also didn’t hurt that the District was like the Bermuda Triangle of EMS.  Calls happened at HCESD-1 that simply didn’t happen anywhere else. High acuity calls in an economically depressed inner city combined with access to the best hospital systems in Texas made this an ideal learning environment for a motivated paramedic wanting to truly learn their craft.

In other words, I walked into, without realizing it at the time, a virtual internship and residency in urban EMS.  I remain convinced that my three years there made me a competent, motivated paramedic.  I actually even remain in contact with several of my former colleagues.

I realize that the funding issues and operational issues remain out there, but don’t we owe it to our patients, and even more to our professional identity, to create paid internships and residencies in EMS where a new paramedic has a safety net of experienced providers to work with in the right environment to truly become a master clinician?  Clearly, what we’re doing now is window dressing.

An internship program for EMS would create truly “street ready” paramedics.  Having an opportunity to truly learn medicine, both clinically and operationally, functioning as a third crew member with an experienced mentor (NOT a FTO “checking you off”) in a high volume system would be a perfect transition from student to employee.  If we can continue to tilt at windmills in EMS, like the quixotic quest to declare EMS an “essential government service,” why can’t we decide that we want providers who are truly ready to practice?

Let’s make the commitment for some high volume systems to serve as true training grounds for new paramedics to earn their spurs.  It’s time.

Filed Under: EMS, EMS Education

The Quest for Balance in EMS Social Media

Posted on September 20, 2016 Written by

For those of you who know me outside of this blog, you may know that I run several EMS groups on Facebook. Several are private groups for friends and colleagues, but one group has grown well beyond expectations.

Running an EMS page on social media is a constant challenge.  I like to compare it to Goldilocks and her porridge tasting. Some porridge is too hot. Some is too cold.  She had to try to find the right porridge.

EMS social media is the same way. There’s one extreme where we always have to be supportive. Everyone should follow their dream and passion to be in EMS, even if you’ve failed the National Registry exam three times.  These people recite the dogma quotes we all cringe at. “BLS before ALS.” “EMTs save paramedics.” “Race the reaper.” Their sources of information include “my instructor told me” and “our protocols said.” If you challenge these folks, you’re automatically unsupportive and get called a “paragod.”

There’s an opposite extreme as well.  These are the people who obsess and drone on about arcane clinical topics.  No minutiae of biochemistry or pharmacology is too obscure for these pedants to emphasize that you’re “dangerous” if you don’t understand.  These people, or their companions, like to post random EKGs with subtle findings that even cardiologists would debate.  They will post these EKGs without any patient presentation and expect any EMS provider to find the zebra or risk their scorn and ridicule.   It’s as if Sheldon and the rest of the cast of The Big Bang Theory started working on an ambulance and/or as EMS educators.

So, there’s a balance.  The truth is, it shouldn’t be that hard to pass an entry level EMS exam which measures minimal competency.  Mere certification determines entry level competency.  We must always strive to be better, each and every day. It’s my personal belief that EMTs should be reading paramedic level material for continuing education and/or possibly considering pursing AEMT/Intermediate or paramedic certification.  It’s my belief that paramedics should be reading physician-level educational material to supplement their knowledge. With the advent of open learning sources such as FOAMed and the like, the material is accessible.  However, it’s also important that we remember our fundamental role in the world of medicine. In most cases, we are the entry into the healthcare system.  If we can get the right patients to the right level of care the vast majority of the time, then EMS is a success.  Don’t worry about the Krebs cycle nearly as much as you worry about taking care of your patient.  I don’t expect the average EMS provider to provide physician level care or have a PhD’s understanding of the underlying science.  I expect competent, compassionate care where a clinician recognizes their limits, but challenges themselves to expand those limits daily.

Medicine is a parallel to engineering.  While both are based on the sciences, they are the application of pure science to solve human problems.  Never forget that what we do is about people.

Having said my peace for now, I make one promise to you.  I’ll try to be a better clinician, caregiver, and person today than I was yesterday.  I merely ask that if you share a passion for EMS that you make the same commitment.

Filed Under: EMS, EMS Education, Rants

Thinking About EMS Education

Posted on September 7, 2016 Written by

A friend, grizzled EMS veteran, and sage (all the same person) recently opined about the state of EMS and it got me to thinking. So, allow me to share my thoughts on initial EMS education and perhaps offend everyone in EMS and EMS education all at once.

I’m not sure that accreditation or degree requirements improve EMS one iota. What they do is create artificial barriers to non-college-based programs. There are plenty of good programs that aren’t affiliated with a college. And there are colleges that turn out crap EMS providers. Speaking purely anecdotally, the colleges know this.  The local college in my area offers the paramedic program only as a full-time, daytime only program.  There’s no alternative.  Some of the required courses make sense. (Anatomy and physiology come to mind.)  But especially for someone who’s already got a degree, it makes little sense to require general education classes all over again — much less a physical education class.

As for EMTs. The EMT basic curriculum is way too short and way too superficial. In most places, it’s little more than teaching first aid and some basic medical knowledge. It creates people who think they’re heroes with less than 200 hours of training. We end up with people who practice medicine based on dogma and “my instructor said” and who truly believe that BLS saves ALS and they’re heroes. Meanwhile, we have more than a few places where EMTs can’t administer over the counter medicines that the lay public can and are legally prohibited from using the same glucometer that a child is taught to use.

And let’s talk about one other thing. The various ALS skill monkey levels that exist between EMT-Basic and Paramedic. These people get some or ALL of the ALS skills that a paramedic gets with none of the understanding. It’s a recipe for malpractice and for killing patients. Don’t give me the BS that it’s “for the volunteers.” There are plenty of us who volunteer who took the time and effort to educate ourselves. I’ve never worked full-time paid as either an EMT or a Paramedic and I’ve reached a decent place in the EMS world. Whether paid or volunteer, certification standards remain the same.  And allowing someone without a foundation in anatomy, physiology, pharmacology, and patient assessment to perform high risk skills like rapid sequence intubation, even with calling a physician for a radio/phone order, is a recipe for a disaster.

My solution to all of this? Enhance the educational standards for EMT-B to be more like the current AEMT. The current EMT standards should be the standard for the first responder, not one who staffs an ambulance. And I’m not sure that paramedic should be an associate’s degree. What about entering paramedic education after already having a bachelor’s degree? It’s a lot easier to teach prehospital emergency care to someone who already has critical thinking and communications skills than it is to teach critical thinking and communications skills who’s got a paramedic certification and only a vocational/technical education.

These are just my thoughts. I don’t pretend that these changes will improve EMS overnight, lower the cost of healthcare, or raise EMS wages.  What I do believe is that these are the right changes for better patient care.  And patient advocacy demands just that.

Filed Under: EMS, EMS 2.0, EMS Education, Rants

The Soft Bigotry of Low Expectations

Posted on August 30, 2016 Written by

Yes, I know that’s a quote used in a George W. Bush speech.  Yes, I know some of you may not like President Bush.  Truth be told, I don’t always either. (He’s like the Diet Coke of conservatism: Just one calorie, not conservative enough! — Apologies to Dr. Evil, by the way.)

But, truth be told, it’s a quote that applies so well to EMS.  I’ve been guilty of it myself.  And I think a lot of us are incredibly negative about EMS, our past, and our future. Day after day, I read posts on EMS social media about provider mental health.  I read posts about the pay in EMS.  Heck, I even read posts about poor EMS protocols, poor working conditions, and poor coworkers.  When you read that, it’s easy to get discouraged about EMS.

Here’s the great news.  Provider mental health is an issue.  But we’re addressing it.  The Code Green Campaign is raising awareness, promoting access to mental health care, promoting resiliency, and promoting self care.  Reviving Responders is doing similar work as well.

As for the other issues, there are solutions.  Forming associations to represent our profession at the state capitols where the majority of EMS regulation occurs is a huge step.  Yesterday marked the one year anniversary of my state’s EMS association, the Association of Texas EMS Professionals.  In that year, we’ve accomplished a lot – from providing paramedics the ability to work in hospital ERs to being recognized as the state affiliate of the National Association of Emergency Medical Technicians to being called to testify before the Texas Legislature as witnesses on EMS issues.

For those of you complaining about poor pay, poor working conditions, and poor protocols, there are services out there that are looking for EMS professionals like you.  It may involve getting out of your comfort zone, but these places exist — all over the country. At the risk of sounding like “tough love,” if you choose to still work for a bad employer, you have made your choice.

And yes, there are places where learning happens.  Social media may have its faults (see also: EMS “clickbait” articles), but the FOAM (Free and Open Access to Medical Education) movement is bringing current medicine to all of us.  Granted, much of it is geared to emergency physicians, but we should be learning at their level anyway.  Medicine is medicine.  EMS remains the only profession with arbitrary concepts like BLS and ALS.  While there may be regulations governing scope of practice, I’ll give you some free legal advice.  THERE IS ZERO LEGAL LIMITATION ON EXPANDING YOUR KNOWLEDGE.  Other learning opportunities exist at EMS conferences.  If you are only learning your profession from within your department, you’re selling yourself and your patients short.  Insular clinical thinking and inbreeding in education is a disservice to our profession.  Professional networking and exposure to new, outside ideas is how change happens in EMS.  And there’s even opportunities to expand one’s EMS horizons on Facebook.

So, in conclusion, I’ll leave you with another cliché politicized quote that also applies to what we do in EMS.  “It gets better.”  And it starts with each of us.  Go. Do. Medicine.

Filed Under: EMS, EMS 2.0

Have you ever noticed….?

Posted on August 9, 2016 Written by

Have you ever noticed how many new, inexperienced, poorly educated providers talk about how much they’re allowed to “do” in their EMS organization/system/region?

Today, I was involved in a discussion in EMS social media where an EMT with three months of experience was bragging about taking a sixteen hour course where he would get “training” on administering three additional medications and be allowed to use a supraglottic airway. In the grand scheme of things, all of these medications and the supraglottic airway are relatively benign interventions.  There’s relatively low risk for each of the medications and the airway device in question. What is NOT benign is the prevailing mentality in EMS that a card class or an in-service is all that’s needed, especially to teach an entry-level EMS provider skills that are normally reserved for providers with a higher certification. Even with its numerous faults, paramedic education has a depth of education in anatomy, physiology, pharmacology, and patient assessment that an EMT or AEMT course don’t have. While a sixteen hour course might be able to teach the ins and outs of those particular medications and that particular airway device, that course is zero substitute for actually having the education that an advanced provider has.  We can teach almost anyone how to do something.  Knowing when to do something — or when not to do something — is where education is superior to training.

Sadly, our profession has done little to disabuse EMS providers, especially inexperienced entry level providers, of the notion that EMS consists only of a set of skills that can be added and subtracted at whim.  Rather, like any academic discipline, particularly one involving the healing arts, EMS consists of knowledge.  And there is no statutory limit on the knowledge that any provider can have, regardless of their certification level. Professional education does not end with initial certification.  Rather, initial certification is but a determination of entry level minimal competence.  Professionalism involves the relentless pursuit of mastery well above and beyond the minimum standards.

As I’ve joked before, a cook knows and follows the recipes.  A chef understands the culinary arts well enough to be able to create their own recipes.  The majority of EMS providers are technicians — and as such, we’ve become the short order cooks of medicine.

EMS will become a respected part of the medical system when we stop talking about what we can do and start talking about what we know.  There’s a big difference between training and education.  When we routinely produce educated clinicians as opposed to trained technicians, that’s when the respect — and the money — will show up.

Filed Under: EMS, EMS 2.0, EMS Education
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