When I was initially approached about writing a series of management/leadership articles for EMS1.com, I thought, Great, a new forum to spread my words of wisdom. But, as with all opportunities, there is that unfortunate little detail of actually having to come up with something interesting.
While sitting at my desk thinking of great concepts, it dawned on me that, having turned 50 years old in July, I have spent half of my life in EMS management. In a healthcare field as relatively young as ours, that is a significant period of time. It has allowed me to witness the maturation of our profession, as well as the winterization of my hair color.
I know that those of you who have not yet cracked 30 cringe every time one of us old guys starts talking about the good ol’ days, but if you stop and listen for a moment, you’ll realize we may actually be talking fondly about the present day.
My time has been spent in the private/hospital sector, so my experiences have ranged from the poorly-funded service hoping to get their Medicare check so they can make payroll to the cutting-edge hospital-based service.
When I first started working part-time as an EMT in the late 70’s, most of us were oblivious to how little we knew. We used equipment – such as coroner cots – that was at times ergonomically dangerous, and were incredibly skilled at making an ankle hitch out of WWII surplus material to secure a Thomas half ring traction splint. We truly believed that people could be resuscitated after 45 minutes of CPR. And I need not bore you with the stories of our amazing driving skills.
Management skills 25 years ago were represented by the adage: Do as I say, not as I do. Low wages, long hours, little or no benefits. Promotions were often based on the assumption that a great medic would also be a great leader. And more often than not, promotions came not because of what the person knew, but who they knew. I may well be part of this group, able to get my first management position because I sold myself a little better than the other candidates, not due to my superior skills.
When I became a medic in the 1980’s after graduating from college and falling a little short of making medical school, I found myself on the street with a reasonable amount of education but way too much confidence, a condition shared by many of my colleagues at the time. We had convinced ourselves that we could saves lives by doing magic on the scene with serious trauma patients. While we were very skilled at intubations, we had very few other tools available for airway management outside of oral airways and EOA/EGTAs. We gave large volumes of bi-carb under the belief that acidosis was the main culprit to be overcome in order to resuscitate the patient.
Looking back, possibly the scariest thing was our lack of education on the potential health threats posed by blood borne contamination. My undergraduate degree is in microbiology, so logic says I should have had some level of understanding and been a bit more careful. Alas, I can remember more than once being splattered with large volumes of body fluids from very sick patients and just washing it off without thinking twice about it.
To this day, I remember going on my first call to treat an AIDS patient. When the call was toned out, we were told that we were responding to an AIDS patient. When I got to the scene, all the first responders were standing unsure about what to do. In this case, my degree at least gave me a basic enough understanding to know that the HIV virus was an issue of preventing exposure.
We took care of the gentleman and I remember the look in his face that was a mix of saying “thank you for not treating me like a leper” and a sadness that he had a death sentence from a blood transfusion. I think that may well have been the single most critical experience in showing me that being nice and compassionate was as important as my ability to start an IV.
So here is why I think these are actually the “good ol’ days.” In the 21st century, our field of care is positioned at the forefront for dealing with our ever-increasing number of elderly, a growing population that is challenging the healthcare system to find new and cost-effective means for providing needed services.
EMTs and paramedics today are coming out of school with levels of training that us old guys couldn’t have imagined years ago. States are starting to require that paramedics have at least two-year degrees, and a solid level of education in core sciences like A&P and Biology are becoming a standard. While some of you may disagree, I am convinced we are developing a new level of leadership that is better educated and more carefully selected on their ability to lead. It used to be the exception when people in leadership roles had an undergraduate degree, much less a graduate degree. Today, I am seeing more and more EMTs and Paramedics working on degrees in business to ensure they have the needed skills to transition into leadership roles. Does it take a degree to be a leader? Of course not. But in today’s healthcare management environment, you are challenged to be as skilled as possible in a wide range of disciplines. Mastering the spreadsheet does not save lives, but it does help ensure we will have the necessary tools on the street to complete our mission.
And most importantly, today we are light years ahead in our understanding of the risks affecting not patients and providers alike. The equipment used today is more ergonomic, complex and stringently tested than I could ever have imagined 25 years ago.
Before you start thinking I am seeing the world of EMS through rose-colored glasses, please know that I clearly understand that we have EMS providers in this country who have some distance to go in improving levels of service and work environment. But the majority are on the right track.
I wouldn’t give up anything I learned in the early days of my career; it formed the basis of my knowledge of how far we have come. But I do think the current state of EMS represents the “good ol’ days” for the profession. Whether you are in the field providing care, working in one of the support departments or in a management role, the future should be exciting for all of us who call ourselves EMS professionals.
