Can You Justify The Continuation Of The Current EMS Model(s) ?

[Steve Whitehead]

After my response to this string passed 1,000 words, I made it into a blog post. Here's the meat of it.

Some of the ideas are great. There’s always plenty of insightful, well thought out input. But there are also a lot of EMS solution myths that rise to the surface when these discussions get rolling. Many of our ideas for how to fix all that ails us are shrouded in false beliefs and oversimplified analogies.

Here are six EMS fit-it myths that find their way into so many of our EMS rants. How many do you fall for?

1) The myth of solution by committee

In this delusion, we convince ourselves that even the most complex and pressing problems could be solved if only we just got the people closest to the issues to come together and talk. If that were to happen, we believe that the right solution would emerge from the dialogue and then we would ll agree and implement those solutions.

This idea is flawed on many fronts. First it places its faith on the myth of the single solution. (See below) It also disregards how difficult true dialogue becomes in these situations. Committees are notoriously awful at producing worthwhile solutions. The old axiom that a mule is a thoroughbred designed by committee is true.

When we elevate groups of individuals to the level of “problem solvers” we interject ego, turf wars, personality conflict, competing interests, inter agency politics and the interloping of millions of stakeholders all looking for a piece of the influence.

If you think problem solving within your organization is difficult, doing the same thing at the national level is monumental. (Literally…if it were to work, we would build a monument.)

2) The Myth of the single solution.

This one is endemic to conversations about the woes of our EMS nation. It’s the belief that a single solution could be applied to EMS systems across America and they would work universally. Our EMS systems are unfathomably diverse. We have fire based EMS systems, private EMS industry, public service EMS delivery, hospital based EMS providers and combination systems.

Add to this the fact that we serve diverse populations from rural areas where EMS response can take hours (or longer and call volumes are measured in calls per week to busy urban systems over-run with system abuse, overtaxed hospitals and annual declining budgets.

Don’t forget that over half of us are volunteers and most of us are under-trained and the idea that a single panacea idea or movement could solve the issue of modern EMS becomes extremely unlikely.

3) The Myth that nothing is being done.

Here’s a shocker that most of the arm-chair EMS quarterbacks will have a hard time wrapping their brains around. Most every problem endemic to EMS in America and around the world is already being addressed and worked on by some organization or group of people. And here’s the really sad thing. Most of them are begging for your support and you don’t even know they exist.

That’s right. While you’re angry about the lack of national representation of EMS, the NAEMT is working hard every day to fix that. (And you’re still not a member.) Movements like EMS on the Hill Day are taking place every year and you aren’t present. Worried about EMS education? NEMSA is working hard day and night to raise the standards of pay, recognition and political clout of EMT's and paramedics both publc and private. NREMT is fighting for a minimum national standard of EMS education as well with one of the most advanced testing processes available to anyone ever. (Even though you bash the test every time you take it.) And online education groups like CenterLearn and The EMS Web Summit are striving to bring real, cutting edge EMS education to your desktop.

Upset about system abuse? Agencies like West Eagle County EMS and Colorado Springs Fire are experimenting with community paramedic models to try to head off the call before it comes. Progressive EMS organizations are partnering with community service agencies to identify repeated 911 abusers to find more long term solutions to their ongoing problems. And that idea of a national committee? Groups like FRN-TV are working on creative ways to create that national dialogue you’re talking about. You should watch…and comment.

Instead of trying to launch a movement, find where the movement is and join it. Champion the EMS champions who are already working hard to solve the problems of EMS.

4) The myth of EMS ineffectiveness

For folks who subscribe to the myth of ineffectiveness, EMS doesn’t do any good because so few of our interventions or actions are truly lifesaving. It’s as if providing medical care that falls short of life-or-death interventions is beneath us.

By this same logic, urgent care clinics should close their doors. I mean really, how many of their interventions are lifesaving? If someone has a true emergency they have to call 911. They should feel so ineffective.

Of course, that’s ridiculous. They practice medicine. So do we. We listen, we question, we evaluate and then we give people advice. We also apply medical treatments and, yes, we take people to the hospital. We make a difference. We make a difference to the people we serve. If you need someone’s life to hang in the balance before you can feel like your work is important, you may want to switch jobs.

5) The myth that only field EMS providers know the real answers to the problems.

This myth rears its ugly head with a rant that sounds something like this, “The problem with EMS is that the people implementing changes have been riding a desk for the last 20 years and don’t know a thing about real EMS. These jokers would be more likely to find Jesus in their morning toast than find a real solution to a real EMS problem.”

We’re convinced that real system solutions are only found behind the windshield of an ambulance. Anyone outside of direct patient contact is an idiot. Here’s the thing…I only hear this opinion from people who don’t spend any time with nationally recognized EMS leadership.

Sit in a room for a while with creative EMS managers and consultants like Chris Montera, Mike Taigman and Skip Kirkwood and your head will swim. You may find yourself overwhelmed with their creativity and the depth of their understanding of EMS operational challenges. (With all things truly considered.)

Let them give you an eye opening perspective of what EMS looks like from 30,000 feet in the air. Suddenly, your ground level, overly simplistic EMS solutions might seem a little naive. If you spent less than 30 minutes trying to solve our nations EMS woes you may leave feeling a little foolish (or enlightened).

6) The myth of instant results.

While the myth of instant results is present in every industry, it is particularly endemic to EMS. We don’t just want solutions; we want solutions that present themselves fast. We are results oriented people. If an idea works, then it should work now. If it hasn’t created results in six months scrap it and do something else.

Here’s the thing we so often forget. Today’s problems are the result of yesterday’s solutions. Emergency services are in-and-of-themselves solutions to yesterday’s problems. Fifty years ago, getting sick people to life saving interventions in a timely manner was a real problem. It isn’t much of a problem anymore. We created a system where anyone call a simple number and get bedside delivery of our most time-sensitive medical interventions. But the way we designed the system created a bunch of new problems today. Those problems are what we’re talking about now. Yesterday’s solution = todays new problem.

The better we design our solutions today, the fewer problems they will create for the next generation. But slow implementation solutions don’t win managers awards. Creative solutions that solve problems ten years from now aren’t that popular in an immediate gratification society.

We want sloppy, fast answers that show immediate results. With any luck, but the time the new problems emerge, we’ll be on to our next promotion and some other poor sap will have to solve the new problems we created.

7) The myth of the perfect solution

We are also deeply intolerant of answers that only partially solve the problem we are trying to address. Even when the problem is death itself, we demand changes that produce dramatic results. If our cardiac arrest save rate is 4% before the implementation of continuous compressions CPR and it’s 7% after, we deem the intervention a failure.

Death happens to be a remarkably difficult process to reverse, and yet a 3% decrease in this troublesome disorder is apparently nothing worth celebrating. We are apparently in search of an intervention that will definitively reverse death. Nothing else will do.

It seems ridiculous, but this is how we measure positive change in emergency services. Unfortunately, this isn’t how positive change tends to happen. It happens slowly over many years, backed by the hard work of a whole bunch of really smart people.

And yet, when new EMTs enter the field they find that people don’t always call 911 for appropriate reasons and more often than not, the people who die stay dead. In a few short years (or less) they are frustrated and angry. They write angry blogs dedicated to EMS rants and adopt the affect of the burned out old-timer. (Not realizing that we’ve seen this all before.)

There’s a much better way to go about all this.

If you’d like to work towards positive change in EMS, instead of adding one more angry rant to the pile, here are a few possibilities that would be far more productive.

A.) Embrace the imperfection. Life isn’t perfect. Neither is any job…anywhere. Life is about solving problems. When we’re done solving these problems, we get more. That’s the way it works.

B.) Join the fight. You don’t need to start a movement. (There are already several.) You need to look into the long list of groups and organizations already working to advance the cause of improving EMS. They could all use your support.

C.) Champion the people who are doing good work. There are a bunch of them. EMS doesn’t need another rant. Rants are easy. Use your voice to talk about everything that’s right with EMS. If you can’t see it, you aren’t looking hard enough. When you do see it, help other people see it.

D.) Be patient. Do the right things because they are the right things to do. If you don’t see immediate results, be patient. EMS isn’t going to change overnight, but it will change. It’s been slowly improving for the past 50 years and it will continue to improve. You could be a part of it.

E.) Respect the folks who have invested their lifetimes working in EMS. Just because you don’t understand why they are moving in the direction they are moving doesn’t mean they are wrong. Ask them. You may learn something.

F.) Keep your eyes open. The next brilliant idea is around the corner, but you’re going to miss it if you’re too caught up in your “everything sucks” mentality. People who explain what’s wrong are a dime a dozen. People who see what’s going to happen next and move in anticipation are rare and valuable. Be valuable.

Thanks for the question.

[Bieber]

Steve, I was about to deliver one of my rants about the EMS system but before I posted it I read your post. I decided to click the backspace button. You make a lot of excellent points, I'll have to pause and think about them for a bit before I reply.

Edited May 22, 2012 by Bieber

[Just Plain Ruff]

Damn steve, I sat back and thought about my last post about committee and you are completely right. I really looked at it and realized that while committee may have worked in one of my orgs before, I remembered the total hell we wemt through to find common ground and then I thought about it on a national level and said

No freaking way my idea would work but I just didnt get back to the thread to say that my ideas no matter how awesome I thougjt they were, they just were total crap.

I have no answers now exvept to help my former co workers make small imcremental chsnges from witjin their very small system. To make changes that will affect them and then hopefully help them take those changes to the nect level which is to their surrounding EMS systems and then beyond.

Baby steps one at a time.

[rock_shoes]

Steve you have obviously given this a great deal of thought and made some excellent points in your post. My own take is that the job is currently in a state of flux. The things we used to do are no longer enough. If we are to survive and maximise our potential for benefit we must take on additional responsibilities both educationally and in our approach to patient care.

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