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FossilMedic
by Mike Ward

Hi, my name is Mike and I have emergencytitis

How to move beyond the adrenalin rush

By Mike Ward

Consider this an intervention.

I appreciate your dedication and commitment to being a life-saver. I acknowledge the time and sacrifice to get where you are today. For those who pay their groceries as a life-saver, I appreciate that many are paid poorly. But, you suffer from the same disease as our fire colleagues — emergencyitis.

Emergencyitis: "An adrenaline-fueled obsession with responding to potential life-threatening trauma and medical emergencies at the expense of everything else … sleep, relationships, personal development."

It is not your fault. We are EMERGENCY medical service providers. We were developed as one of the federally-funded Great Society responses to a social need, in part based on Dr. J. D. Farrington's 1967 "Death in a Ditch" article in the May-June issue of the Bulletin of the American College of Surgeons1. But, we need to get past this condition. It will continue to be the bane of our existence and ability to progress forward. The emergency care environment has changed since the 1960s!

Where ALS can make a difference
Let's take a brief look at patient severity in urban EMS systems. The number of transported patients requiring ONE ALS skill is 18%. Those patients received an IV line, cardiac monitoring, breathing treatment, EPI pen or glucose.2 Of that 18%, about one-third require TWO ALS skills. Those patients required airway control, chest decompression, or more than one medications. Those were identified as the "Sick Six Percent."

Less than 2 percent of the transported patients require two paramedics to aggressively take multiple actions to keep patient alive. These are patients with:

  • Smoke inhalation/burns
  • Multiple system trauma
  • Not breathing/severe trouble breathing
  • Myocardial infarction/stroke

Few of the critical 2 percent of patients get to hospital discharge with intact mental and physical capabilities, despite our interventions. It is really the "Sick Six Percent" that most benefit from our actions:

  • Cardiac arrest patients resuscitated with AED
  • Significant emergency/existing respiratory, cardiac or metabolic diseases
  • Controllable trauma (airway, chest, fluid replacement)

This is where your experience as a paramedic makes a difference. Henry Wang, MD, points out that "EMS research is hard to do. It has unique technological, clinical, cultural, and other barriers." Doctor Wang was the first prehospital researcher to receive Agency for Healthcare Research and Quality (AHRQ) Independent Scientist funding in 2004.  Dr. Wang received $629,910 over five years to study the effects of out-of-hospital endotracheal intubation errors.

Expand your impact — get a university degree
The National EMS Advisory Council describes our need:

"Evidence-based medicine has become the standard for change in healthcare. As healthcare systems become increasingly data-driven, the efficacy and usefulness of Emergency Medical Services (EMS) has come under increased scrutiny. The challenge facing EMS today is to affect a system-wide transformation from practices based on tradition and expert opinion to adoption of national guidelines and protocols that have been developed through a rigorous examination of the scientific evidence and a systematic guideline development process."3

So who is going to do the rigorous examination of the scientific evidence? It needs to be you. Not the other guy, not one of the fossils … you. How will you do this? By getting a university degree. Don't think you can? Read on.

Develop your skill sets
EMS providers are passionate about making a difference. Providing direct patient care provides the immediate feedback we desire. For many of you, it appears impossible to believe that investing years as a student will have a similar impact. It does not, because it is better. You need the formal education (Bachelor’s, Masters and Doctorate) to provide the credible examination of the scientific evidence and develop evidenced-based practices that will save more lives.

She did it

One of the first graduates from a university program I directed was a single parent making minimum wage as a paramedic. She enrolled in our distance education degree completion program. It took four years to finish the bachelor’s degree, taking one or two courses each semester. Upon completing the bachelor degree, she became an emergency department manager at a hospital.  She started taking graduate school courses. With her master’s degree, she obtained a position as a manager of clinical education for a multi-hospital corporation. She impacts hundreds of patient care providers and makes very nice money.

They did it

About 13 percent of my graduates continued on to get a professional or graduate degree.  Three entered medical school in their late 30’s. At some point, each had an "ah-ha" moment and empowered themselves to continue their academic adventure.

You can do it — four tips

Attending college is not like high school.  Treat it like a part-time job.

  1. Schedule you study time. Plan a regular time when you will work on the class. For shift workers, make it a regular part of your rotating schedule. Write in study time on your calendar or however you keep track of work.
  2. Identify deadlines and deliverables. Track when homework and papers are due. Keep sight of quizzes and major exams. Distance education courses take from two to four times as much time as a face-to-face course. There are more reading, writing and deliverable activities than in a similar face-to-face course.
  3. Understand the grading schedule. Identify the point value of every activity. If you need to triage you time, focus on the high-value assignments first.
  4. Keep the instructor informed. The instructor would rather hear that you may not make a deliverable deadline or online activity BEFORE you miss it. Despite advances in instructional technology, clairvoyance remains elusive.

A Doctor Phil moment …
When working with adults returning to school, we need to process some educational trauma. Almost everyone seems to have a past incident or situation that becomes an impediment to going back to school. It dominates your consciousness. Sometimes the incident is more than a decade old. The new faculty and school do not care. If you were admitted that means they feel you are capable of completing this academic endeavor.

This is YOUR time – seize the moment!

References

1. Farrington, J. D. Death in a Ditch. Bulletin of the American College of Surgeons. 1967 May-June. 1-10.

2. Ward, M. J. (2012 January 24) Evidence Based Impact on Out-of-Hospital Care. Paramedic Refresher, The George Washington University, Ashburn, VA.

3. National Highway Traffic Safety Administration (NHTSA). (2009 December) "EMS Makes a Difference: Improved Clinical Outcomes and Downstream Healthcare Savings: A Position Statement of the National EMS Advisory Council." Washington, DC: US Department of Transportation.

 

About the author

Michael J. Ward, BS, MGA, MIFireE, NREMT-Basic, spent 12 years as an academic, ending as Assistant Professor of Emergency Medicine at George Washington University in 2012. He treated patients as an EMT (commercial, volunteer and seasonal) and paid firefighter/paramedic and, during a 25-year career with Fairfax County (Va.) Fire and Rescue, worked in every division of the department, retiring as the acting EMS division administrator. Ward is also a textbook author and conference presenter.
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