30 years is a long time

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30 years ago today a 16 year old, brand new EMT took his first ambulance call in a small town in Northwestern Connecticut. He was pretty excited and loved being involved in EMS.

30 years later he sits in front of this computer typing this post and still loves being involved in EMS. I remember that call quite clearly, the intoxicated driver of a car who stopped to urinate off the side of a bridge and lost his balance and fell 20 feet into the river, floated downstream for a mile or so and then crawled up the bank to the road and sat there for three hours until the paperboy found him in the morning. Completely uninjured aside from a killer hangover we dutifully did what the books told us to do because of the mechanism of injury, board, collar, treat for shock, oxygen, and took him hot to the local community hospital. State of the art for a BLS ambulance 30 years ago.

EMS is different from back then, lots of things have changed, mostly for the better but some for the worse.

For for the better our ability to care for patients at all levels of certification has become much better. We are, in many ways, better educated than we were 30 years ago and many of us have become "thinking" EMTs and Paramedics rather than the a+b=c EMTs and Paramedics we were back then. Our equipment is better, we have greater treatment modalities available to us and technology, provided it is not used as a crutch, can assist our assessments in being more thorough.

The other major change that I have noted is the involvement of EMS professionals in the development of their own profession. Many more EMTs and Paramedics are involved in local, regional, national, and international organizations working to make EMS better and to change things that don't make sense. There is a growing community of EMS professionals who are working hard to better educate all of us, even me, a 30 year dinosaur, and teach us to think and understand not just what our patients complaint is but the process behind that complaint and how we can best treat the patient. We are starting to develop the ability to see the "big picture" and understand what our place is in it. The explosion of blogs, podcasts, newsletters, email mailing lists has made it even easier for us to exchange information and ideas and made the ability to connect with other professionals easier. The idea that I would be able to tap a paramedic from another county, state, or even another country for advice and information is something that didn't happen 30 years ago and while new media has made our community larger in numbers it has also made it easier to communicate.

Unfortunately not everything has gotten better. EMS is still the "red headed stepchild" in most areas, with limited support, limited funding, and limited career options. Even many of our own people tend to view this as a "stepping stone" to a career somewhere else, be it the fire service, law enforcement, other areas of medicine. Looking around I see very few of my colleagues from my younger days still in EMS. Lost of nurses, PAs, fire officers, but very few primarily employed as EMS providers. It's sad and we lose a lot of very good people that way.

Our own attention to safety has not improved much. Oh we have finally drilled our people to think about their own safety more. We are better about scene safety and visibility but we put our people in vehicles that are poorly constructed, unregulated, and generally unfit for the job we are doing. After all, there are no safety standards for the patient compartment of our ambulances, the manufacturers can do whatever they want and it is up to us to decide if we feel safe enough. Our ambulances keep getting bigger and while the larger ambulance chassis survive crashes better they are not any safer in the patient compartment. The modules we mount on the chassis are not designed for the dynamic loads of a collision. We focus on ads from manufacturers showing huge weights placed on top of a stationary module and the like even though that is not the type of force applied to an ambulance in a crash. We allow ourselves to be lulled into a false sense of safety by manufacturers showing off airbag systems in the patient compartments when we know deep inside that they will only protect us minimally since we are most likely not seat belted and because the box itself is not designed to withstand the forces of a collision. The sad fact is that I feel no safer in my modern Type III Road Rescue than I did on the 1976 Grumman van that I did my first call in.

We still spend way too much time running hot to calls and to the hospital with patients that have no life or limb threat too. We know the calls that we go to regularly that rarely, if ever, end up as a transport yet we still respond hot to many of them because someone dialed 911. I have worked for services where a fall in a nursing home would be a cold (no lights or siren) response while a 911 call for a fall would be a hot (lights and siren) response. The only difference was the source of the call. Responding hot to the intoxicated person on the street corner asking the beat cop to get him to detox? Been there. Responding hot to an urgent care for a patient with a cellulitis? Done that. Why? Services that claim that they must run red lights and sirens to the ED at all times when they have a patient in the back? Seen it. I've also seen ambulance crashes that occurred when we did things like this. Some of them even resulted in serious injuries. Why? Because we can? We need to look hard at each and every transport we do and ask ourselves if the few minutes saved were worth the additional risk to the lives of the patients, crew, and the public at large.

All of these things are true but the thing that disappoints me most is the inability of most of us to maintain professional relationships even when things go badly. Think about it, how many times have you had a call go really well and all services involved and all the members of the crew feel good about themselves and the job that they did? OK, now think about the times when things didn't go well. Did everyone involved look at the call and try to figure out what went wrong and how to prevent it from going wrong in the future or did everybody start looking for someone to blame for things going badly? The fact of the matter is when things go well we are happy with each other and when things go badly we turn on each other. This, unfortunately, is one of those places where EMS has gotten worse. In this day and age of decreasing funding, pressure form the fire service to take over third service or commercial EMS contracts, and the like our ability to view things that go badly as an opportunity to better our overall system we find ourselves trying to point the finger at somebody else so that we personally or our service don't take the hit for being the cause of the problem and that being used against us. In short, none of us want to own our mistakes. It's a pity too, because if we spent half the time figuring out what failures led to the mistake that we do finger pointing and posturing we could make sure that it didn't happen again.

I won't see another 30 years in EMS but I do plan on seeing another 20 years. I plan to continue the positive changes and hope that I that my effort can help to reverse some of the negative things. I also hope that everyone reading this will do the same.

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This page contains a single entry by The MacMedic published on September 3, 2010 8:23 AM.

MacMedic ReRuns: How to be a Hacker was the previous entry in this blog.

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