In mid-April, Texas state representative Armando Martinez submitted a bill to the Texas House of Representatives that proposed to allow Texas paramedics to operate at their full scope of practice in Texas hospitals, emergency departments, and free-standing clinics. An identical bill was submitted to the Texas Senate by Sen. Donna Campbell, R-New Braunfels, an emergency physician and former ICU nurse.
Currently, Texas paramedics are allowed to practice a limited set of skills in those settings. Dr. Campbell, with her background as a nurse and interaction with paramedics as an emergency physician, is undoubtedly familiar with the capabilities of both nurses and paramedics in emergency settings, and felt that the paramedics were being underutilized. The bills, HB 2020 and SB 1899, sought to rectify that situation.
Shortly thereafter, Carol Twombly, president of the San Antonio chapter of Texas ENA, sent an email to members of her local chapter. Twombly stated that the governmental affairs chairperson of the Texas Emergency Nurses Association urged her to share the email with all Texas ENA members. In it, she urged fellow ENA members to voice their opposition to the bills to their state legislators. She included a form letter outlining the reasons for their opposition.
The letter was, quite frankly, offensive garbage. It denigrated paramedics as barely trained skills-monkeys, questioned the value of their education, and implied that paramedics operate under strict protocols and narrow guidelines whereas nurses operate with autonomy in the emergency department. Twombly went on to assert that allowing paramedics to practice in hospitals posed a potential hazard to patient safety.
Are we to suppose paramedic skills and assessments become unsafe once they pass through the magic portal of the emergency department doors?
Mobilization of the EMS Facebook army
On April 24th, a nurse/paramedic and member of the Texas Emergency Nurses Association, incensed by the tone of the email, shared it with Matthew Whitt, a Texas paramedic and flight medic.
Anthill status: kicked over.
Whitt, understandably just as incensed as his nurse/paramedic friend, shared the email with his Facebook friends and urged them to contact their state legislators and voice their support of the bills, and to rebut the misconceptions and factual inaccuracies in the letter.
In short order, the Facebook friend army mobilized. Posts were made to the NAEMT Facebook page, urging their involvement and support. Christopher Matthews, wrote a post for his blog Unwired Medic, fisked - a point-by-point criticism of the letter on his blog. I wrote a rebuttal form letter, as well.
Rapid growth of an EMS grassroots movement
In four days, those blog posts and form letters were shared hundreds of thousands of times, a Texas EMS legislative advocacy group was formed on Facebook that now boasts well over 1,000 members, a fundraising campaign for the Association of Texas EMS Professionals is underway, and the moribund Texas Association for EMS was revived. EMS1 lent its support, as did EMS World Magazine and the International Association of Flight and Critical Care Paramedics.
A group of six dedicated Texas paramedics traveled to Austin to testify in support of the bill, and rebut the assertions in Twombly’s letter.
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| Texas paramedics advocate for EMS and speak out in support of SB 1899. Pictured from let to right are paramedics Jill Robey Dodson, Matthew Whitt, Erika Remlinger Lansford and Brittany Leigh Crandell (image courtesy Texas Association for EMS) |
This happened In four days.
Ultimately, both the national Emergency Nurses Association and the Texas Emergency Nurses Association disavowed Twombly’s letter, saying they do not agree with its content, and never sanctioned its promulgation. NAEMT is currently working on a joint statement with ENA.
Some substitutions were made to the bills as a concession to ENA, after which they voiced their support for their passage. The substitutions do not give paramedics carte blanche to practice as paramedics in hospitals, but if passed, the legislation allows paramedics to use emergency medications, vascular access, intubation and other ALS skills in resuscitations and other emergency situations under physician oversight. At the very least, it will pave the way to paramedics acting as full members of hospital rapid response teams.
In other words, not everything we wanted, but a lot more than we had before. I think it is safe to say that Twombly and ENA never anticipated the furor her letter caused. Had it not been for Texas paramedics voicing their support in such numbers, the bills would have died a quiet death in committee, and few would have ever known of their existence.
Template for more EMS grassroots movements
This is a perfect template for a grassroots movement, folks; a few dedicated and passionate people accomplishing big things. And they did it by not resorting to Carol Twombly’s tactics of attacking and denigrating another profession.
The response and actions is our recipe for success in the future. There is a lot we can learn from the nursing profession, both in terms of advocacy, but also in education and patient care. They are a partner to support on other issues important to EMS, like better working conditions and wages and shorter shifts. We cannot match the numbers and political clout of the nursing lobby, but we can enlist their support on matters of mutual interest.
But if EMS can accomplish so much in four short days, imagine how much more might be accomplished if we harness that momentum and keep our foot on the gas? What else might we change?
I have written before about how little people can do big things. Martin Luther sparked the Protestant Revolution. Only 3 percent of colonists took up arms in the American Revolution. Only 10 percent of the colonists lent them materiel support. Only 20 percent of colonists even supported American independence at all. They were outnumbered 5:1 by their fellow Americans, and facing the might of the British Empire, the mightiest nation on the face of the Earth at the time. Yet still they fought.
And here we are today, Americans.
Still think you can’t make a difference, that you can’t effect change at your own agency, much less EMS as a profession?
Half-a-dozen paramedics in Texas would disagree with you.
