It doesn’t take long in an EMT career before the excitement of “rushing to an emergency” turns in to “just another transport call.” The philosophy of “you call, we haul” in nearly every service can break the community servant’s spirit by turning a skilled paramedic into just an ambulance driver. But our system “just is what it is,” right?
Well, far from being a service based strictly on tradition, EMS is constantly challenging previous assumptions and struggling to reinvent itself. How we administer CPR has changed (again), we question the effectiveness of C-spine immobilization that we do standard on nearly every trauma patient, or argue the very validity of the “Golden Hour” around which many services have been designed. Almost all assumptions are open to be questioned. I say “almost” because I have found that there still are some boundaries to the willingness of many EMS practitioners to consider change. Some limitations are easily admitted, like the aversion to legal liability that means we transport anyone who asks us to do so regardless of their suspected need or ability to pay, but there are also less easily acknowledged sacred beliefs.
One of those that comes quickly to my mind is response time. To many, a quick response indicates excessively fast driving and is contraindicated by safety concerns. Besides that, we can justify ourselves since very few of our daily calls actually “require” a code response. While that point may be strictly valid medically, I would argue that our performance is often measured by the public in the agonizing minutes between the 9-1-1 call and the ambulance arriving at the curb. A patient does not need to be in some form of arrest in order for them, or their family members, to be distressed. Part of our job is being a calming and supportive influence. At the same time, I admit that it does not justify putting the driving public or ourselves at risk with an ambulance speeding to every call. But is it really a given that one means the other?
System Status Management – oops, another term laden with strong negative feelings in the field – is actually all about improving performance (both time and economic efficiency) without sacrificing safety. As advocates for patients, medics see themselves sometimes fighting the system in order to provide the best possible care. Talk of economic efficiency is seen as just making their job harder. But again is it really a given that one necessitates the other?
Imagine a system where patient needs are accurately forecast in advance. Where the posting of ambulances is not just another place to sit and wait, but in a practical sense it is the staging for a call that has yet to be received. Response is thereby improved not by excessive haste, but by the strategic pre-positioning of resources. The cost savings is not simply an amount taken from others in a “zero-sum game”, but effectively rescues budgets for proactive wellness programs or, in the current economy, may mean simply saving jobs that allows us in turn to save lives. This process really works and these systems do exist. They are called “High Performance EMS” systems and many are profiled here each month while others receive recognition through accreditation agencies like CAAS. What sets them apart is often observed in technology, but the reality is that it is a culture of seeking constant improvement by the entire staff that makes a difference.
While we consider improvements to the many technical aspects of our profession, let us not neglect the philosophical perspectives that motivate us as individuals. We operate as a team, not just the pair on the truck, but the whole EMS system is one team with a singular goal. A goal to do even better each day. So, as we continue to assess our profession should the index of suspicion not include our attitudes toward improving the overall system?