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February 02, 2010
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The Ambulance Driver's Perspective
by Kelly Grayson

EMS 2.0: Where's our Martin Luther?

Challenging the status quo through grassroots efforts

Editor's Note: Kelly Grayson outlines in the following article how the EMS 2.0 movement is a re-thinking of prehospital care. But it's a small, grassroots movement in need of fertilizer, he says, and that fertilizer is the rank-and-file street medic. What do you feel are some of the problems EMS in the United States is facing? Share your thoughts on how EMS needs to change in the member comments section.

By Kelly Grayson

There's something happenin' here,
What it is ain't exactly clear.
There's a man with a gun over there,
Tellin' me I got to beware.

I think it's time we stop, children,
What's that sound?
Everybody look what's goin' down…

- from "For What It's Worth"
Buffalo Springfield, 1966


My apologies for the 1960s-era earworm, but it's one of only two protest songs I know, and somehow The Beastie Boys' "You Gotta Fight for Your Right to Party" just didn't seem apropos for the subject at hand.

In case you've missed it, EMS 2.0 has become a bit of a buzzword in the EMS blogosphere these past few months. Distilled to its essence, EMS 2.0 is a re-thinking of prehospital care in this country — from dispatch to system design, provider education to system protocols. It's a grassroots effort to fundamentally redesign EMS from the ground up.

What it isn't is more patchwork fixes to the flawed model we have today, although you'll find plenty of that type of thinking in the various discussions. Even the name EMS 2.0 conjures visions of a software Beta release, one still with plenty of bugs and prone to system crashes. And like many of those software developers, the movers and shakers in EMS are still busily insisting, "They're not bugs, they're features!"

This idea of re-inventing EMS is not a new one. The topic flowers into intense debate every few months on various online forums, and has been for as long as I've been a paramedic. And in these debates, little is produced beyond hot air and histrionics. Slog through enough of the comments, and you might even wonder from which end of the debater the hot air emanated.

EMS cartoonist and JEMS columnist Steve Berry does a presentation at EMS conferences entitled, "If I Could Redesign Your EMS System." The various professional organizations all have committees that purport to guide or shape the Emergency Medical Services of the future.

It has long been my observation that most of those committees are populated with EMS stakeholders whose primary career seems to be, well… professional committee members. That's what they do. That's all they do. Every new committee, commission, task force, or blue ribbon panel is populated with members from the last committee, commission, task force, or blue ribbon panel. They're too entrenched in the system.

I used to belong to all the national EMS advocacy and EMS education groups. I dropped membership in one because I got more spam and useless e-mail chain letters from that organization's president than official correspondence. I currently belong to an association whose most recent public policy statement was a press release denouncing NBC's Trauma. Or at least, I think that was their most recent public statement. I usually only hear from them when it's time to renew my membership.

But the problem is bigger than entrenched EMS leadership. The reason that EMTs who rail about the flaws of modern EMS will never be able to effect substantive change is because they're still thinking like EMTs.

Maintain your distance
We're too close to the problem, people. We need to start thinking like business leaders, academics, urban planners, and public officials. Those are the people who are going to shape the future of EMS, and if we're going to shape their way of thinking, we're going to have to understand their way of thinking.

Or at least, learn to communicate well enough that they understand ours.

We have a few people out there who are giving it a try. There are people like Mark Glencorse and Justin Schorr, a pair of EMS bloggers who embarked on a unique EMS cultural exchange they call the Chronicles of EMS. In it, two street medics — one from the UK and one from San Francisco — compare what does and doesn't work in their respective EMS systems. They'll take those observations back to their command leadership in the hopes of effecting change in the way they deliver EMS to their communities. Other EMS bloggers have embraced the concept and added their voices to the discussion. Right now, it's a small movement, likely even small enough to have escaped the attention of the professional committee members in EMS.

Thus far.

Right now, it's a small, grassroots movement in need of fertilizer. That fertilizer is you, the rank-and-file street medic. We need your voices, and we need your ideas.

One of our biggest handicaps as EMTs has always been our disdain for the politics of EMS. As medical providers, we consider ourselves above such machinations, and consequently become forever condemned to be at the mercy of ignorant policy makers, rather than become the wiser policy makers our profession needs. And sometimes we remain silent because we doubt the ability of one man (or woman) to change things. To that, I'd like to point out one thing:

On October 31, 1517, a mad monk named Martin Luther nailed The 95 Theses to the door of the All Saints Church in Wittenberg, Germany. He was one man, a heretic and malcontent reviled and ridiculed by the hierarchy of his faith, who dared to challenge the teachings of the Catholic Church, the closest thing to a superpower in the Middle Ages.

One man dared to challenge the biggest religious and political organization in the world, and in so doing, sparked the Protestant Reformation. And heck, he didn't even have Twitter, Facebook, and YouTube to help spread his message.

Who is the Martin Luther for EMS? If you're out there, we're ready to hear from you.

About the author


Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (www.facebook.com/theambulancedriverfiles), or email him at kelly.grayson@ems1.com.

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Robert Martin Robert Martin Friday, August 30, 2013 6:13:13 PM It may be me.