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!”
High Performance EMS 
A thoughtful response by Caitlyn Armistead in rebuttal: http://caitlynarmistead.blogspot.com/2014/11/tell-me-old-stories.html?showComment=1417016415539#c8401466510366332407
In the mid 1970s I was an EMT and State Trooper. I found a man at a lodge in the middle of now where with a busted up foot from a snow machine crash. He was at the bar trying to drink away the pain. I put on an air splint and the pain eased so he decided he would stay and drink a while before going to the hospital. I told him if he did not go I would not get my splint replaced so I had to take it. He said ok and as I started to let air out he changed his mind. In maybe 2007 as a small town cop I had a man with a broken arm and he refused an ambulance so I put a SAM splint on it and told him to go to the hospital. He had been drinking and said he would go tomorrow. I asked him if he remembered how much the pain was and he said yes and thanked me. I told him if he did not go now I would need to take my splint back and he decided to go in an ambulance. The old story still gave me what was needed to take care of an injured party about 30 years latter. This is just one of hundreds of stories that lessons learned are just as important as new knowledge.
Dale,
Your are right about being fixed in the past. The ability to change is important in this world. Change is something EMS professionals deal with, we don’t like change but our field keeps changing. The failure to keep turning with change is the beginning of burnout.
Stories are fine line, we use stories to feel good about ourselves and be accepted among our community. Stories are also how ancient societies kept culture alive and taught people. I like telling stories that teach, but it can be overdone. I think the past and change are two perspectives to consider when making decisions. Do you think lessons learned are old stories?
I have been in the fire/ems service for 26 years and was the youngest certified paramedic in the State of Nevada at the time I began. I learned from the best and never became an “SOP” paramedic. I treated my patients with knowledge gained from personal experience and lessons learned from myself as well as from others. Lessons learned strengthens the core of what we do. EMS and the firesercivce in general is in a constant stae of change, however, we need to be carefull not to change just for the sake of changing.
Does anyone have a High Performance EMS Shoulder Patch?
Actually, yes, now we do. Contact me for details.