As EMS evolves — almost by the day — many of the “ways of the past” are being replaced by new, more efficient and effective “ways of the now.”
Hyperventilating head injuries has gone the way of MAST trousers; the flow meter on oxygen has been turned down and there are even new contrary opinions about Narcan.
One particularly dramatic change seems to be the shift from strict medical control to standing orders and protocols. Going, if not gone, are the days of calling Rampart for IV and defibrillation orders.
Paramedics are becoming more and more autonomous and less and less dependent on Dixie and Dr. Bracket for handholding. Previously difficult and complex decisions, once made by base hospital physicians and specialty nurses, are now in the hands of the providers on scene.
You guessed it: I have mixed feelings.
First, I am thrilled that paramedics are finally getting the respect they deserve for being the professionals they can be. The scope of practice is expanding and patient care modalities are improving, seemingly by the minute. Patient outcomes are also improving as a result, and EMS is passing through puberty and forging into adulthood.
On the other hand, autonomy in the hands of the … lesser-motivated, can be a very dangerous thing. You know as well as I do that there are still plenty of providers who operate from a subjective, complacent, and downright lazy place.
Combined with the ever-expanding autonomy, that provider just became more dangerous than he or she ever has been – to the patients and to you.
Working without a safety net
Autonomy in patient care places more pressure for excellence on the provider charged with delivering it, and also on the partner and crew members on scene. Since the base hospital is not involved like it once was, they are likewise less responsible for the errors and omissions of the medics on the scene.
Now more than ever, crew members are being held to answer for the mistakes and follies of their coworkers; now more than ever, EMS providers are working without a net.
What’s next? I predict (and hope) emergency medical Darwinism is going to force some painful and necessary changes. First, increasing autonomy is going to result in the better and best providing superior patient care.
More personal ownership of the results is going to manifest in outcomes such as increased cardiac arrest survival rates, faster and more complete stroke recovery, and significantly better outcomes for STEMI patients, all leading to the brass ring: EMS as a profession, not just a job.
On the flip side of that coin, you will see consequences for the not-so-good and completely awful providers. There will be higher instances of licensure action, internal discipline, and wash-out. Unfortunately, all of those things will stem from preventable negative patient outcomes.
Weeding out the worst
The danger for the better provider will be in the penumbra; the murky, gray area of time when providers are self-categorizing. Specifically, the better provider who is aware of the dangerously poor provider, but does nothing to fix or flush him or her, is almost certain to be caught up in a bad situation caused by sloppy, complacent, or ultimately negligent patient care that should have been corrected or stopped.
The answer is as simple as it is difficult. If you are reading this, it is more likely because you are one of the better, more committed, more professional providers. This transition is up to you.
You have to muster the strength necessary to face the issue and force the change; you have to demand more from yourself and of those around you. You must have the willingness to help those providers who want it -and respond to those who need it, but don’t want it - with tough love by showing them the door.
In the end, EMS will only ever be as good as you make it. If you lay silent through its evolution, you forfeit the right to complain when it crumbles around you.
