Over the past couple of days I have read a number of articles both about EMS and computer science. One of the common themes of them was how to be the "best" at what you do. One of the articles was by Eric Raymond who, among other things, is the author of "The Cathedral and the Bazaar" which is a collection of essays about software and the open source movement.

For the sake of this discussion it is important to understand the difference between a "hacker" and a "cracker". A Hacker is someone who is adept at his chosen field, delights in solving problems, and continually strives to overcome limits of some kind. A Cracker on the other hand, is one who uses his (or her) skill to break the security of a computer system. In a nutshell, Hackers build things, Crackers break them.

Raymond discusses the "Hacker Attitude" in one part of his book. When I read this I found it to resonate with me professionally. Raymond lists the 5 things that outline the Hacker Attitude.

1. The world is full of fascinating problems waiting to be solved.

2. No problem should ever have to be solved twice.

3. Boredom and drudgery are evil.

4. Freedom is good.

5. Attitude is no substitute for competence.

As one who considers himself to be a serious geek and, when time permits, writes computer software for fun and relaxation I can see how these elements are relevant to the classic definition of a hacker. I can also see how they, along with the entire hacker ideal could work in almost any profession. As I was reading this I was in the company of an ambulance crew who, while I believe they meet the minimum standard, has no desire to surpass it.

When I put the 5 elements of the Hacker Attitude into an EMS perspective they fit quite well and seem to point to how one can assure that they will be "the best" in their field.

In EMS the world is always full of fascinating problems waiting to be solved and EMS folks have been doing this since the beginning. Look at some of the tools we use every day. Initially many of them were not designed specifically for what they were being used for and various EMT, paramedic, and yes even as far back as "ambulance driver" hackers saw the problems and had the vision to find new and unique solutions to them. Some of these solutions involved modifying existing tools and some of them involved the building of completely new tools that had never even been thought of before.

In EMS we should never have to solve the same problem twice. We strive for this and in a larger sense we succeed by finding the general principle that solves the problem and inventing numerous ways to implement it. Even in those things that have multiple procedures and/or multiple devices to solve the problem the general principle of each always seems to be the same. It is our own ingenuity that allows us to apply these principles in different ways to meet the needs of different situations.

I don't know a single person in any field who would not agree that boredom and drudgery are evil. Look at our coworkers who we see as having the bad attitudes, the ones who take no pride in their work, the "bad apples". What do they all have in common? They are bored with what they are doing, they feel that they are doing the same thing day in and day out. None of them started out that way. Somewhere, somewhen, someone or something stifled their ability to think on their own, to expand on what they are experiencing and harness that energy and information to continuously think about the problems and come up with new solutions. I'm not saying that "the best" in EMS never complain, rather that if you listen to them they frequently complain and voice possible solutions to their complaint in the same breath. Their enthusiasm lets them look at the problems as a challenge to be met rather than a limitation that forces them into the same path day after day.

Freedom is good. In general the hackers in any field are anti-authoritarian. Not to say that they fight authority, rather to say that they see that authority for authorities sake is appallingly stupid. Anyone who orders you not to continue to solve the problems that you encounter and are fascinated by for the simple reason that they can and it better serves their purpose fits that description. Authoritarians thrive on censorship, secrecy, and the use of force. The hackers among us believe that reasonable adults do not need censorship, secrecy, and the use of deception or force to compel them to excel. They excel because they want to and because they are given the freedom to.

The last element, attitude is no replacement for competency, is so unbelievably simple that it is amazing that so many people fail to comprehend it. Hackers worship competence, it is their holy grail. Attitude alone will not make one good at what they do just like acting like a professional athlete does not make you one. Respecting people for their competence and abilities and striving to move your own level of competence continually higher is actually enjoyable to the hacker. Learning and the acquisition of knowledge is an ongoing process. The hackers in our profession recognize this and this allows them to develop a healthy attitude, one of confidence in their abilities and in their dedication. There is no disdain for those who are less skilled than they are as long as they continue to strive.

We have hackers and crackers in EMS just like every other profession. It is easy to see the difference between the hackers, who are always trying to make themselves better and do a better job, and the crackers who believe that they know all they need to know and are try to do nothing more than, at best, simply meet the minimum standard, and at worst, try to drag those around them with a hacker mind set down their level.

I am sure that we all can point out people we work with who have the hacker attitude or the cracker attitude and we know how being around them effects us. I know that I revel in being around the hackers in my profession. As strange as it may seem, some of the people I consider hackers, are not the best paramedics I have ever worked with. What they have in common with some of the best paramedics I have worked with is the continuous striving to make themselves and their profession better.

I really had no desire to come to work tonight. I spent the morning at the District Courthouse and didn't get to spend much time with my family today which made me unhappy. I arrived at work feeling like I needed to have an easy day and spend my time getting projects to points where they could be shelved for the week while I am on vacation next week.

Last week I received a visit from the local police department. They came bearing a gift, a subpoena ordering me to appear in court as a witness in a DWI case. It's not that unusual for EMS to end up in court for one call or another to give testimony. This case was a bit different as this was the DWI case for the driver that almost struck me head on back in April. One of the things that I have still yet to get used to here is that you don't get much warning, 1 week is all you get.

Recently a paper was published in the journal Prehospital Emergency Care entitled "

Alcohol-Associated Illness and Injury and Ambulance Calls in a Midwestern College Town: A Four-Year Retrospective Analysis.". Some people have already started to criticize this research just on the abstract as being useless, irrelevant to EMS and a waste of time and resources.

Interestingly I am not going to be one of those people. I say this for two reasons. 

First, while I agree that this seems foolish to research and publish this paper I also understand that before we use any data for further research we much have more than anecdotal evidence to work with. Even common sense needs to be verified to protect the integrity of research based on those conclusions. My hope is that is foundational research and the author is going to use the data and conclusions for further research that is relevant and useful.

Second, I work for a regional service in New England that covers a college town and we actually need to perform a study such as this to prove to University administration (who pay a subsidy to support our service) that alcohol is a much bigger problem than their staff epidemiologist is saying. He says 1 in 4 students drink alcohol yet I have data from Halloween last year that had 21 calls in 9 hours and 19 of them were alcohol related. He's using data collected form questionnaires administered by the Health Services Office, my practical data shows something else. Admittedly Halloween may have been aberration but the fact remains that anecdotally our data still does not match with that cited by the epidemiologist even for other, non-holiday shifts.

A study like this can help us prove the extent of the alcohol problem on campus, influence the administration to act on it, and mean that my EMS units are tied up less frequently taking intoxicated students to the ED and are available for other calls. In my mind, improving EMS availability is definitely a worthwhile goal and research that supports that goal may not be as silly as it seems at first glance.

Your milage may vary but from my view this may not be as frivolous as it appears. 

The Happy Medic poses an interesting question over on his blog today. What do you do when, off duty, you come across someone in uniform drinking in a bar?

That is an interesting question that does not appear to have an answer that is a really good answer. Certainly I would strike up a conversation and try to determine if they were on duty. Drinking on duty is just wrong no matter what the situation. If he was on duty I'd have to tell him that it was wrong and that he shouldn't be here. Contacting his supervisor would probably be in order if I could determine who that was.

Beyond that I guess it depends on how talkative the guy is. I'd try to get some idea of why he was there. Did he have a bad shift and needed to decompress? Could I help even just by listening? I've had those days. I'd certainly consider, as politely as possible, suggesting that he consider taking off the uniform shirt and stethoscope so as not to attract as much attention. I usually have a spare shirt in my car to wear after work if I'm going somewhere besides home, perhaps I'd offer it to him.

If he told me to bugger off I would just go back to my seat, not much else I could do at that point. I would have made a good faith effort to try and help.

I guess my point is that just like Police and Fire we in EMS need to stop eating our young and try to take care of each other a little better.

I taught at our EMT-Intermediate class last night and while the class itself went very smoothly and I felt that the students got a lot out of it. I was a little disturbed when I spoke to them about EMS Research. We had been talking about CPAP, Intraosseous Infusion, and Capnography, and I mention that it was through clinical research that these skills were added to the prehospital scope of practice in our area and even more research that showed that they could be brought into the EMT-Intermediate scope of practice. I went on to a little tangent talking about how much of what we do in EMS today is not backed up by any actual evidence and how there needed to be much more research done to justify what we did today and determine what we should be doing in the future. I closed the tangent by saying that it was our obligation to assist as best we could any research project going on in our services or area so that EMS could continue to advance.