Tag Archives: EMS change

EMS as the Halloween of Healthcare

Just as each year transitions at harvest from abundance toward its inevitable end, we in the prehospital field often usher lives fraught with medical disorder or trauma from normalcy toward a cold, strange world. We wear uniforms with our stoic masks and find nature’s trickery affecting strangers who beg us for treatment.

Beyond the surface, the history of Halloween also parallels our profession’s path. Long ago, Pope Gregory ordered his missionaries not to destroy the traditions of potential converts. Instead, he recommended that his followers morph those practices into new forms of belief. Pagan and Christian traditions merged: a spring festival, a decorated tree, a time of renewal. The Celtic Samhain, a day when the veil between the present world and the world of the dead wears thin, became All Hallow’s Eve, and the day after it, All Saint’s Day. It was a gradual process, and the new holiday took an existing religious tradition in its own direction.

The development of Emergency Medical Services was just as incremental. The lofty goal of caring for the sick at the point of their injury was incorporated within the existing local government structure and within a budgetary process that allowed only for law enforcement and firefighting activities within public safety. It was a time when privately funded funeral homes delivered the dead and dying victims to hospitals. A system that was merely appropriated to address a new function. Even today our improvements on this system come not as much as acts of creation, but as steps built upon pre-existing logic. If society had created a mobile healthcare system from scratch, I doubt it would resemble much of our current model.

Like the Druid converts, we worship all sorts of sacred trees in the form of protocols and algorithms. These ideas are sprinkled with the holy water of a national physician group, and blessed by a local Medical Director. One who may not even believe it is the best actual treatment. He complies simply because upending tradition risks disenfranchisement and the toppling of an entire system of makeshift steps and opens himself to judgement.

Will the idea of strapping a patient to a flat, ridged board and transporting them for miles in the back of a vehicle based only on the method of his injury be looked at one day in the same light that we now view blowing tobacco smoke into a patient’s rectum? The fault, however, is not wholly his own. Meaningful change cannot be enacted solely from above. If faithful followers want evidence as the basis of practice, they must be willing to change their behaviors to match their beliefs. They must look beyond anecdote and set aside long-held tradition and recognize that working a cardiac arrest on scene has proven value over the immediate application of high flow diesel with ineffective CPR while en route to a cath lab. They must choose evidence-based practice and not simply beg at the door for treats.

There is no doubt that our profession will change. There is promise in community involvement by paramedics to pre-empt emergency calls for transport through Mobile Integrated Healthcare. There is value in offering alternative endpoints for definitive medical care to lower costs and reduce traffic in the emergency department. Practically, development will need to happen within a framework of the system we have in place, but significant change also means significant sacrifice of beliefs. We may even need to accept heretical ideas such as a professional degree. The first step, however, is to leave Halloween behind us.


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Filed under Administration & Leadership, Command & Leadership, EMS Topics, Funding & Staffing, Opinion, Training & Development

Looking Back to See Ahead: 2014 in Review

The end of the year is a great time to take stock in what has already passed and to make plans for the future. The vision I had when I started this blog four years ago was summarized in my first blog post, Hello World. Welcome to HP_EMS!  I’m glad to say that today, while many other things have changed about the business, that vision hasn’t strayed from the original intention of sharing news and trying to build community around the efficient and effective delivery of emergency medical care outside of the hospital environment.

Now, as I look back over this past year, I find it interesting to review which articles have generated the most interest. Topping that list was Rob Lawrences’ list on “11 of the Top 10 Tips for High Performing EMS.” I was so convinced it would generate some conversation that I “trickled” it out one point each day on the EMS Deployment Community of Practice to allow reader comments to be directed at each point. And I hope those comments continue to build. The second most active post was “Is ‘SSM’ Still a ‘Bad Idea’?” I hope it wasn’t just the way I phrased the title, but it may have been helped by timing it with the recognition of the lifetime accomplishments of Jack Stout at the Pinnacle conference or the release of a book I co-authored with John Brophy on “Dynamic Deployment: A Primer for EMS“. As any previous reader of my blog will know, I have a desire to improve the poor implementations of SSM and promote the successful ones.

We hear a lot lately about “Evidence-Based Medicince” (EBM) or “evidence-based practice” as it applies more directly to EMS. But we must sometimes learn how to interpret and apply these “best practices” as I tried to challenge readers in the next most popular post, “Could Busier be Better?” which showed evidence that “busier” services generally gave “better” care to patients. I also hear many comments about how the public is abusing EMS by not using our services “appropriately”. Just today, I posted the question on the High Performance EMS Facebook pagedo we provide the emergency medical services that the public wants, or are we trying to train the public to use the EMS services that we can provide?” It was gratifying to see so much activity on the corresponding post from October asking “Is our success a sign of our failure?” and an honorable mention to the later post “We Need Some New Stories” on the same theme.

I am also heartened to see that the fifth most popular post was about deeper engagement with peers on other social media outlets, specifically Twitter, from the post “Influencing Paramedics on Twitter.” It has never been my desire to create the most popular blog, have the most “Likes” on Facebook, or even the greatest number of Twitter “Followers”, but to simply spark meaningful conversation. It doesn’t immediately need to ignite significant changes either. I want to help people think differently about their job and gradually see new perspectives. I plan to remain in this field for the long haul. The business of EMS does not change quickly, but still change is coming nonetheless. I want everyone concerned to participate in that change and make intelligent decisions for themselves and their service to help us all deliver the best EMS care – whatever that might eventually mean.

The title I chose for that first post four years ago included the phrase “Hello World” as an acknowledgment that my background was in programming and business optimization consulting prior to becoming an EMT late in life and really starting to focus my work specifically in public safety. As I saw the emergence of social networking and its potential to affect change in industries, my hope was to leverage it to build an effective community around change in EMS. As I look back over the years, I find that while my intentions have remained resolute, the results have been skewed toward sharing news rather than building community. That is the reason I brought the idea of a “Community of Practice” to this page centered around EMS Deployment. I hope you will check it out and become part of the discussions on the future direction of EMS (or whatever it becomes.) My hope is still to build that forum of respectful community where both providers and administrators have a voice. Even though I am a relative newcomer to this field, I am a field provider like many of you. I am not an administrator, but my work also brings me closely into their world as an adviser. I hope this unique perspective not only gives me different insight, but that it inspires others in “mobile healthcare” to see things things differently in the coming year. So, here is to the prospect of a prosperous new year for all of us!

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Filed under Administration & Leadership, EMS Topics, Opinion, Social Media, Technology & Communications

Is Our Success Killing Us?

Should we really be upset when people in the community listen to us? After all, EMS protocols and people are notorious for creating our own problems. We write the public a “blank check? saying that if they believe it is an emergency to call 9-1-1 immediately and as a result we have created an increase in calls for non-emergent complaints. We continue to treat every call we can by transporting to the hospital and create a class of consumers called “frequent flyers”. When we need funding, we tell the public that “seconds matter? and we define a parameter that the public uses against us to measure our success. Perhaps they listen much closer than we typically give them credit.

So what happens once we figure out they have heard us – we change our story! And we feel that we must do it dramatically in order to make the point that “we don’t do it like that anymore.? At some point we began to use MAST or PASG as a primary treatment against shock but eventually removed them from every ambulance as they fell from favor by delaying definitive care for a short-term gain. At first it was critical to get cardiac arrest patients to the ED, but now we set policies to work them on scene for better survivability. We drill into each responder that every single fall must be suspected to have a spinal injury and now some have begun to campaign to remove long spine boards from vehicles. Evidence showed us that tourniquets should be used only as last resort measures before learning evidence now shows that proper application early can have the best effect. And then we learn that there is nothing magical that actually requires a doctor to remove them as well! It seems that the “evidence-based? trend in EMS requires that being “progressive? means we lay in wait for some “proof? in order to jump on a previously long held belief so we can debunk it as some old “wive’s tale.? But why must we always go to an extreme new position? Our industry is designed to resist “fashions? by accepting change of practice slowly for safety reasons. While personal beliefs can be more fluid, it takes a while for the protocols to catch up. Perhaps we need to moderate both ends.

Change within a system is not expedited by extreme positioning, but reasoned and thoughtful conversation. The article on Things Your System Should Deliver is well written and certainly worth the read and consideration. You don’t have to become a zealot for change, a thoughtful advocate is powerful enough. Learn from the process we work within and work with it instead of against it if you want it to update more quickly. Engage in dialog with medical direction AND politicians AND the communities you serve. It is through these channels that change is truly affected and we will find the success we can live with.


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Filed under Administration & Leadership, EMS Health & Safety, EMS Topics, Firefighting Operations, Funding & Staffing, Training, Training & Development