This morning, I read an article with great interest about our local EMS system using a physician assistant who’s also a paramedic to provide enhanced EMS care — both for acute patients and to divert non-acute patients from the emergency room. The truth is that such a program has a ton of merit and would probably benefit a lot of EMS systems. While the funding may not be there, I personally believe that controlling the loss of funds from unreimbursed ambulance transports might be worth the money alone.

But this article illustrates a bigger problem with EMS. Namely, that a paramedic certification leads nowhere, except maybe a paramedic to RN bridge. The truth is that we know a lot of things about emergency medicine — and if you’re a decent provider, a lot of that knowledge carries over into other aspects of medicine. But there’s no recognized mechanism to transfer that knowledge to another discipline. And even if it did transfer over, most people in EMS don’t have the pre-requisites to get into other programs. Me included as my BA was a very studied attempt in avoiding hard science courses at UT because those courses were used to weed out pre-med students.

And the funny thing is that a MD friend of mine said she never uses those courses in her work. The truth is that the health care education field requires the wrong prerequisites. They attract people who do well in science and not necessarily those with the ability to communicate or even those who want to be caregivers. We see the results regularly, especially with physicians, when we see a clinician who can describe lab values to the molecular level but can’t communicate with a patient or their family, let alone show empathy.

We need to address two things as EMS. First, we need to find ways to bring our skillset, clinical knowledge, and life experience into healthcare above and beyond the usual two options of being on the ambulance or being a “tech” in an emergency department. Second, we need to encourage those in health care academia to recognize that alternate pathways to higher education in medical care can and should be recognized. I’d much rather attract clinicians with a proven interest in medical care as well as exposure to medicine than I would people who’ve checked off the right arbitrary coursework and who’ve never seen a sick person, much less talked to one or their family.

The challenge is for us to convince everyone else that an EMS certification brings something to the table when we want to move past working on the ambulance or the emergency department.

As most of y’all know, I’m a native Texan.  I’m proud of being a Texan.  (Just ask me about BBQ and our better country music.) I’m equally proud of Texas EMS.  I believe that our regulatory structure and environment have created some excellent EMS systems and some of the best EMS providers in the United States.

As many of you know (or should know), we now have a new state EMS association in Texas, the Association of Texas EMS Professionals. There have been a few nattering nabobs of negativity questioning the need for a state EMS association and/or the motives of the founders.

As a member of the association, a paramedic, and an attorney, I feel a bit qualified to explain why a state EMS association is a must, as well as what it should and shouldn’t be doing.

A state association of any sort exists for one primary reason — to advocate at the state capitol for the profession.  Primarily, that means legislative advocacy as well as advocacy with the regulatory agencies.  As we know, many of the EMS rules and regulations receive little input from EMS. It is well past time that we as EMS professionals advocate for own profession and identity rather than allowing other “stakeholders” to define the world of EMS.  As most EMS laws and regulations exist at the state level, having a voice at the state capitol is critical for EMS.

Our national EMS association, the National Association of EMTs, exists especially to advocate for EMS in Washington, DC with the federal government.  My occasional gripes aside, they’ve made great strides in giving EMS a voice both on Capitol Hill and with the myriad of federal agencies who have a regulatory stake in EMS.

I’ve heard some moans and gripes from some EMS folks who want our state association to intervene in employer/employee disputes and advocate for wage increases.  Quite simply, that’s not how this works. State associations don’t exist for this reason.  Local associations and/or unions are the best place for advocacy with a specific employer.

A stool needs three legs to stand.  EMS needs those same three legs to stand — and thrive. For me, those are memberships in associations that advocate nationally, on the state level, and the local level.

It’s time for Texas EMS to take the next step.  Join me and the other Texas EMS providers who’ve invested $49 in our future by ensuring we have a voice at the Texas Capitol.

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.

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.

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.