(Another) reason why EMS isn’t taken seriously

EMS providers love to claim that “EMS isn’t taken seriously” by you-name-the-other-healthcare-profession.  And we’re right.  We rarely are taken seriously.  I’ve complained before about some of the reasons why.  (See also: T-shirts with flaming skulls and sayings about “Racing the Reaper” and “Doing Everything That a Doctor Does at 80 miles per hour.)

But today, I stumbled on another reason why we shouldn’t be taken seriously.   EMS professionals of all levels fail to grasp the science behind what we do.  I’m not talking about an EMT being unfamiliar with the Krebs cycle or even a paramedic not being able to explain why Trendelenburg is bunk.

What I’m talking about is more fundamental.  It’s about a failure to understand the scientific method, which subsequently adds to the continued issues with medics lacking critical thinking skills or understanding research.  This morning, I saw at least two experienced paramedics on Facebook hawking pseudoscientific woo as diet/health supplements.   Either they’re con artists or they lack the basic scientific literacy to understand that there’s ZERO science or evidence behind the overwhelming majority of these products.  Let’s not even discuss the amount of EMS providers who are vaccine deniers.  I won’t even give them the courtesy of invalidating their beliefs.  To me, vaccine deniers are the medical version of Holocaust deniers.

And then, there’s the other extreme in EMS.  We have the pedants who claim to be advocates of science and “evidence based medicine.”   All too often, though, these “experts” will immediately advocate massive changes in medical practice based on one journal article.  Sometimes, these experts don’t even critically analyze the article.  Patient who receive morphine in acute coronary events have worse outcomes?  Their solution?  Ban morphine administration.  Critical takeaway — most patients who receive morphine in acute coronary events receive morphine only because the nitroglycerine failed to relieve their chest pain.  Did it ever occur that the patients with more acute pain might be having a more extensive event?  Nope.  To the nattering nabobs of negativity who self-appoint themselves as “EMS research experts,” one journal article is enough to limit the EMS skills arsenal or drug formulary.  Yet, these same experts usually want multiple studies to enhance EMS skills or drugs because “the science hasn’t been proven yet.”  Folks, it’s a rare case when one journal article should change your practice.

I’ve blogged before about the shameful state of EMS legal education.  It’s somewhat understandable as EMS isn’t run by attorneys.  (And that’s probably a good thing, excluding your favorite blogger not named Kelly Grayson….)  But EMS is medical practice.  And medical practice is supposed to based upon science.  For EMS providers of any level to not understand the scientific method and inject a healthy dose of skepticism to most claims is to fail as medical providers.  And that, my dear minions, is yet another reason why we’re ambulance drivers and not healthcare professionals.

Controversy for the day.

Here’s another crazy idea for EMS.  I’ve heard it from several people in the past and I think I could get behind it.  What do y’all think?

Let’s separate the emergency response side of EMS from the pure interfacility transport realm.  Emergency calls and emergent responses to healthcare facilities (e.g. nursing homes and physician’s offices calling for a patient to be taken to the emergency department of a hospital) would continue to receive ambulances staffed by emergency medical technicians and paramedics.   Non-emergent interfacility transfers would receive a response from a transfer system.  Transfer systems would be staffed by nurses’ aides and vocational nurses who have received extra training and an endorsement in patient movement, patient transport, and vehicle operations.  As for the true “critical care” patients, the ones on multiple medications and/or ventilatory support, the minimum standard should be a true critical care paramedic.  In other words, a paramedic with a true critical care background (and yes, I realize there are a ton of competing critical care certifications) and possibly backed up by nursing and/or respiratory care practitioners.

A while back, I blogged about owning what you excel at.   EMS excels at providing emergent/acute care interventions on an unscheduled basis.  In other words, 911 calls and emergency responses.  Let’s focus on that.

It’s my blog…. (Endorsement warning)

And I’ll endorse candidates if I want to.  I run hot and cold on NAEMT because I know it’s the only association we have that can even claim to represent “all” of EMS, but I also see it fail to live up to its potential regularly — especially in terms of legislative advocacy.

These issues didn’t arise overnight and they certainly won’t be fixed overnight either.  Honestly, I don’t know whether to try to fix things or throw up my hands.   Today, though, I’m hoping that NAEMT can continue to improve.

One way that NAEMT can improve is with strong leaders on the board of director.  It’s truly my privilege and honor to endorse a friend and colleague as he seeks a position as an At-Large Director on the NAEMT Board of Directors.  Troy Tuke is the Assistant Fire Chief for EMS with the Clark County (Nevada) Fire Department.  I’ve known Troy (oops, Chief Tuke) for over seven years now since riding with him (when he was an engineer/paramedic) on my first trip to EMS Expo in Las Vegas.   Chief Tuke is one of the progressive minds in fire-based EMS.  (Yes, they do exist!)  He’s also a registered nurse.  In the years that I’ve known him, I’ve always known his integrity to be beyond reproach and that he is a continual advocate for EMS’s advancement as a profession.

If he doesn’t have three strikes already between being endorsed by an attorney, being a RN, and being a fire chief (I’m kidding, y’all!), I would highly encourage any NAEMT member to vote for Troy Tuke as an at-large director.

Thanks — and the snarky posts will be back soon.

Some sage advice from Sergeant Hulka.

Recently, a lot of EMS people online have fallen for some of the joke postings on a public safety version of The Onion called Call the Cops. Many of those people have gotten offended.  Apparently, making fun of ourselves offends the humorless.  These are usually the same people who are called upon to give the ethics lecture to medic students and who administer any pediatrics skills exams.

To these humorless sorts, I offer the following advice.

Hello world!

I’m new to blogging, but not to my passions which include the active practice of both law and paramedicine, good BBQ, and the occasional foray into politics.   I look forward to developing some devoted minions, I mean, readers.   I tend to be highly opinionated, blunt, and irreverent, so if you’re easily offended, you might not like this blog.   And as always, my opinions are my own, and not of any of my employers (whether past or present) or any EMS agencies I’ve been affiliated with.

About me?  I’m a Texas attorney and paramedic approaching middle age.  I actively practice both of my licensed careers — working as one of the minions of state government (NOT in EMS regulation, y’all) and volunteering as a paramedic and EMS educator.

Since I am an attorney, I’ll leave you with a couple of disclaimers.  All rights reserved.  No attorney/client or paramedic/patient relationship is assumed.  Contents may settle during shipping.  Shipping and handling not included.  Press hard, three copies.