Tuesday, October 27, 2009

EMS 2.0 – What Is This All About, Anyway?

I’ve only recently started reading about it. In fact, I’ve been exposed to it on a couple of blogs that I regularly follow: my friend Chris talks about it here, TOTWTYTR has a post about it here, and Kelly Grayson (the true “Ambulance Driver”) has written about it here. In all three posts the theme is pretty clear, and they all interconnect with one another by making some things that should be obvious, well, obvious.

But what does it mean? Well, I think they all say some things that pretty much sum up what should be, in effect, things to live by in the future. And from what I’ve read (and I will continue to read and try to figure out how it all is supposed to fit together), it seems to me that the points these men are making are things that should have probably happened at the outset. However, since hindsight is almost always 20/20, there is no real way to have been able to arrive at some of this without doing some soul-searching.

If you take a few minutes and follow the links – and these articles scratch the surface, I suspect – you’ll find some profound ideas about the direction EMS should go in. Some of them are, by and large, simple ideas. It goes to what I was driving at up above: some of these concepts are things that should have happened from the time EMS was in its embryonic stages 35-40 years ago. Probably the most direct thing is what TOTWTYTR talks about with respect to how Paramedics treat EMT’s overall. And it is something I happen to agree with: we treat them badly.

Yep – I said it. We treat our EMT brethren poorly. Sure, we always hear things like, as TOT pointed out, “Paramedics save lives, but EMT’s save Paramedics.” Personally I have always thought there was credence to that statement, but I know a lot of medics who barely give that idea lip service. Hell, I’ve worked with medics who have no use for BLS providers; they think BLS is useless and don’t feel a need to utilize it. One of my recent partners, in fact, used to disrespect BLS providers regularly on scenes and wouldn’t have anything to do with them if he didn’t have to. He didn’t think EMT’s knew anything, either, and he made sure they heard that message. To be sure, this would aggravate me to no end, but I never got a chance to tell him so or why I felt this way.

In the interest of providing good soup-to-nuts care in the field, the basic standards of care have to be both utilized and followed for any level of advanced care to be effective. Plain and simple. It’s like putting up a house: you have to have a solid foundation in place for the walls and floors to stand solidly. If not, it all collapses.

The other thing TOT (and Kelly, by indirect referral) talks about is training, and he touched on something I hadn’t really thought about up until I read it: EMT’s aren’t trained thoroughly or well enough most of the time. And it’s a good point; the EMT-Basic curriculum, as defined by the USDOT in 1994, is only about 140 hours in length. And in that 140 hours there is no clinical requirement. Granted, most programs cobble one together, usually consisting of ride time on ambulances or observation time in a hospital emergency department. But there is nothing written in stone that says this is mandatory.

It should be. As should an expansion of the skills EMT’s are taught be mandatory as well. Like airway management and dealing with respiratory emergencies. That is probably one of the most common problems we deal with as pre-hospital providers, and at the basic level it isn’t necessarily always taught well. I’ve encountered some EMT’s that can’t differentiate between an expiratory wheeze and stridor. Or that can identify crackles on someone who is in CHF. From across a room… On the other hand, I’ve worked with some who have excellent clinical skills in this regard as well as in other areas of their skills repertoire. And it all comes down to how well they were trained.

I’m not merely pointing this out with regard to EMT’s; many Paramedics are in this same boat with respect to their own skills. Especially those I’ve encountered who’ve graduated from medic school over the past 2-3 years. It’s as though something has changed that makes it so some of these people don’t really have a good clue as to what they’re doing. And I don’t know why that is.

Then there is the issue of response time. Kelly makes some good points about that, and I won’t regurgitate them. I’ll ask you to read his article yourself and come to your own conclusions. But the bottom line is that the priority one, lights-and-siren responses we do are not necessary the vast majority of the time. Nor are they appropriate. And the one thing that seems to happen often enough is that we damage vehicles by driving them too fast, not paying attention, and crashing them into other vehicles or inanimate objects. More importantly, people get hurt or killed unnecessarily, which is really, really bad.

And he’s right about that.

I guess the bottom line of all of this is we really want the recognition we deserve as a profession, then EMS overall really needs a tune-up. Seriously – how else can this be stated? We need to move ahead. We need to maybe do things differently.

We need to grow up. Could EMS 2.0 be the way to help us do this?


TOTWTYTR said...

Walt, I think a lot of the problem is the whole "trade versus profession" thing. Being a trade isn't necessarily bad, ask a plumber. The problem is that we are a skill set in search of something, but we're not even sure what.

Becoming an EMT in particular is so ridiculously easy that it's no wonder that so many people think BEING an EMT is easy. I've had more than one person come up to me and tell me that they are losing their real job and ask if they should go to EMT school so they can have a fall back job.

As long as the public sees us that way, we have no hope of becoming either a trade or a profession.

Walt Trachim said...

I couldn't agree with you more.

Karen Brook Westhaver said...

I wonder how this goes in other countries. As, in thinking about this, I see it as part of a larger, cultural problem of crazily mis-aligned priorities in our country. For example, in some other countries teachers are viewed with great respect, as well they should be! Yet here, we know how that goes although teachers often have far more impact on the formation of children than their parents do. I see a parallel between this "profession", hearing people say things like, well, if I can't get a job in blah blah, I might as well be a teacher etc. etc. and I can even get my summers off (don't even get me started...). Having been in that profession as well as in EMS, there are definite corrolaries. Broaden it even further to other service oriented vocations and we see the same thing: overall lack of respect and minimizing of value. How crazy is it that those in whose hands we place our lives/survival in times of great crisis (police, fire, EMS)are viewed with such lack of respect which is demonstrated further when it comes time to set budgets. Yet good hair stylists (and this job isn't as easy as one might think) are revered and paid extremely well. Our culture is one which is turned upon it's head. How to fix it? Now there's a big question.