Monthly Archives: November 2014

We Need Some New Stories

We always hear that EMS is still a relatively new discipline. And in the scheme of medicine, or even public safety, that is certainly true. But we shouldn’t let the fact of its youth keep us from acknowledging that it has already been around long enough to accumulate some of its very own antiquated dogma. If you have any doubt, consider the reaction to changes in protocol – even those with good evidence to support some new practice. Working cardiac arrests on scene, for instance, was not met, at least in my experience, with enthusiasm at the prospect of improving patient outcomes. What I heard were excuses for why something different wouldn’t work. I thought about that exchange this week as I was listening to a recent Medicast podcast on an entirely different topic. Near the end of that recording, Rob Lawrence remarked that we really need to do away with the old stories that start out with “back in my day…”

The stories of some grizzled professionals include not just memories of MAST pants or nitrous oxide, but the idea that tourniquets take limbs, not save lives. More recently stories have been spun about the movement away from the long-held reliance on the long spine board as an immobilization splint during transport or even the value of therapeutic hypothermia for cardiac arrests.

While there is no denying, or even stopping, a rapid state of change in EMS, we must be sure that it is not just change simply for the sake of change or even resistance for the same reason. Change must be meaningful change that is guided by reasoned thought and scientific evidence, not personal anecdote. And new practices should be carefully modified to address current issues or new understandings of the problem.

Another sacred, yet unjustified, belief among too many providers is that the dynamic deployment of resources (commonly referred to as “SSM”, or System Status Management) is an unmitigated failure of cost-consciousness that actually leads to increased expenses and provider dissatisfaction. The evidence, however, from many of the services who now employ some facet of dynamic deployment has proven that while it can be tricky to implement well; the savings in time, money, and lives are definitely real. And those savings need not come at the cost of provider safety or comfort either. Whether you have had bad experiences in the past, or just heard about it from others, it is time to set aside the old stories and take a new look at the current technology and practice in every aspect of EMS that leads to improved performance.

To advance our profession, we must completely ban the expression,  “but that’s how we’ve always done it” and look toward “how we can do it now!”

 

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Filed under Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighting Operations, Opinion, Technology & Communications, Training & Development

Quick Thoughts from EMS World Expo 2014

I love Nashville, so one of the highlights from my trip to EMS World Expo was eating at Jack’s BBQ on Broadway, but there was also plenty more to be excited about at the actual show held in the Music City Center this week. While I missed the Preconference sessions and World Trauma Symposium, I arrived on Tuesday for the opening ceremonies. The keynote presentation was by Dr. Alexander Eastman on the subject of “Improving Survivability During Mass Shootings”. EMS1 did a quick article on the talk covering his two main points: first, that EMS must train more closely with other services such as law enforcement, and the second that we must take better advantage of hemorrhage control technology and become true “experts” at controlling blood loss. After all, the mass-shooting scene resembles the battlefield and people die there from the same wounds that soldiers do in war.

Choosing which classes to attend is always a difficult task; however, it is the key to getting the most value from a major EMS conference like this one. Sessions varied from the High Performance EMS Master Class on the “10 Top Tips for Improving Your Operations” with Rob Lawrence to “The Psychology of Pediatric Resuscitation in the Field” with Dr. Peter Antevy. They can both be frightening in their own way, but facing your fears for the benefit of others is what we do. So choose the topic where what you learn can be directly applied in your service. Learn everything you can and go home determined to make a difference with your new found knowledge. In some cases, that knowledge may be applied at a more personal level, as David Page reminded us in a session about our own mental health. He asked us to “Repeat after me: We diagnose and we are OK with that.”

It is also good to check out some of the less traditional learning opportunities such as watching (or even participating in) live podcast recordings, labs, and topical panel discussions. Several thought-provoking ideas came out during the EMS Education panel yesterday where instructors shared openly while earning CE credit. For instance, “you know there’s a problem with our standards when our EMTs can’t give Narcan, but our LEOs can.”  And ideas that challenge current thinking such as how to move out of the classroom in order to provide more realistic field experience or simulating that experience by integrating smartphone apps that can do everything a book can do, and even cost less while still being more mobile.

The simulation lab in the exhibit hall was an excellent opportunity to play with some of the latest in patient simulation technology. I specifically sought out an infant CPR simulator from Laerdal Medical that not only helped me feel the right depth and rhythm of compressions, but it provided feedback on respiration quality with various infant ages/sizes too. This is experience I seldom get in the field or have the experience to feel comfortable doing well. Many other exhibitors also provided simulation manikins and an equal number provided moulage aids to make up real volunteers as trauma victims. EMS World recognizes the top innovators in the exhibit hall each year with an award and links articles to their products on its website. You can check out the latest award recipients here.

For those who could not make it to the show in person, you were certainly not alone. My friend Greg Friese, who normally posts Everyday EMS Tips, was also not able to attend this year but described how he followed what was happening by using social networking and posted his observations here. No matter how you get your news, just be sure to get the news and stay current in the exciting and changing field that is your profession.

 

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Filed under Administration & Leadership, Conferences, EMS Health & Safety, EMS Topics, News, Patient Management, Social Media, Technology, Training & Development