 Cartoon by Steve Berry |
Recently, I spent an hour or so with Steve Berry, the well-known EMS cartoonist and speaker. Steve lives in the Colorado Springs area and has been a paramedic at a few agencies for which I provide medical direction. I have known him for quite awhile in our little corner of the pre-hospital world.
The primary purpose for our discussion was to gather perspectives for a future talk that he was putting together regarding the “ideal EMS system.”
I tried to provide him some insight into my views on the subject. But eventually, we got a little more on the specific topic of medical direction itself.
What I heard come out of my mouth resembled the following:
Being a medical director is a lot like being a parent. Those who are real-life parents might relate to these analogies. (And I mean no disrespect by this; it’s just part of the deal.)
1. There is constant training involved with EMS — kind of like potty training. It never stops. It’s a source of muted joy, though, when the new hire is finally out of the diaper stage, if they ever get out of it. And while veteran EMS crews are (in my opinion) ridiculously mandated to have unrelenting refresher and recertification training, this phase is usually easier on the medical director and education staff. But, unlike real-life parents who eventually stop having kids, there are always new EMS people who begin in the diaper phase all over again and start the cycle…kind of like an unspayed feline.
2. Like any parent, we have great anxiety when we send our new-hire progeny off to the real world — School of the Street — for the first time. What will happen to them? How will they fare? Will they get in with the wrong crowd? Will they hang with the other children barely staying in school(i.e. barely staying employed)? (You know, the kids that make frequent trips to the principal’s office.) Or will they associate with the “A students” — the super EMTs and paramedics that are routinely successful in every aspect of school (job)? Only time will tell whether our kids will turn out to be really good at what they do, or not so good.
3. There are frequent squabbles that must be refereed. EMS folks have to play in the sandbox with lots of others and, frequently, one throws sand in the face of another. Potential squabblers include other agency medics, nurses, doctors, fire departments, police, government officials, sometimes patients and/or families – you name it! Investigations are mandated and lots of paperwork is generated. Sometimes the investigation is difficult and the truth does not come easily. “Johnny, did you pull Sara’s hair?” “No way, Freddy did it, I saw him!” (This is the SODDI Defense — Some Other Dude Did It. It’s basically the ever-popular “it’s someone else’s fault” excuse). Or perhaps more likely, “No one pulled her hair; she’s making it up again!” Once in awhile someone gets a spanking. Sometimes we have to apologize to other “parents” for our progeny’s foibles. On very rare occasions, we are on the receiving end of apologies from other “parents.”
4. Like many kids, EMS crews frequently require validation for what they do, or do not do, in the care of a patient. This is a very important aspect and one that a medical director needs to recognize and provide.
“Would you have done this or not, Doc? The ER doc to whom I brought the first patient said that I was correct to shock the lady with SVT rather than first trying adenosine.” “Here’s how I read this ECG, what do you think?” “I bagged this head injured patient rather than try to intubate them, was that OK?” “The other paramedic wanted to get a refusal but I said he needed transport. What’s your take?” I could go on, but I won’t.
5. Related to #4 is the constant need to prove worth (either for providers or the agency).This is closely tied to attention seeking. As such, providers and agencies are self-touted as “life savers” when, in fact, the act of saving a life occurs only very rarely. “Mom/Dad, I think I’ve been a good boy/girl. Can I have some ice cream (or more EMS gadgets)?” A corollary to this is that, in competitive markets, the EMS kids are frequently wooed and given little awards and rewards by “strangers.” That is, hospitals and other medical facilities provide education, food, or trinkets to our kids in order to hopefully win their loyalty (and patients). Beware of strangers.
6. “I’m taking my ball and going home!” This is generally more on the order of the agency level rather than the individual provider level. It’s sort of a bigger sandbox analogy. An example of this might be an agency that is disgruntled with another service that it had a relationship with for transport, or for mutual aid. So the affronted agency decides to find a new relationship with another agency and divorce itself from the previous one.
This scenario is related to the concept of turf protection. “This is my playpen and, if I must share my toys, I will decide with whom!”
7. Jealousy or envy is a very common human emotion, especially with children. It occasionally rears its ugly head in EMS. “Doc, ABC Ambulance just got 30 of those brand new transcobbulators that everyone is talking about. Why can’t we get a few of them here at our service?” The fact that the transcobbobulator cost nearly $20,000 per copy and has no proven patient benefit might not be understood and/or appreciated by the questioner. But it’s new, it’s shiny, and has a lot of buttons to push. Most importantly, the kids down the street have it — and we don’t.
Or…
“At the last service I worked for, we drilled burr holes in patients’ heads and were allowed to remove an appendix, if indicated. Our medical director was really great about letting us do what we wanted. (Translation: Why aren’t you half as cool as the neighbor’s parents?) Why can’t we do these procedures here?”
We are left to consider why, if things were that wonderful at the previous agency, the provider ever left it to come to work for ours.
8. On occasion, wayward sheep require tough love for infractions in the School of the Street. They may need to be sent to their room for a time-out (suspended), sometimes even without dinner (pay). Once in awhile a substantial offense may warrant grounding (privilege limitation or reduction), resulting in a significant curtailment in the ability to play with others.
9. However, like any proud parent, we revel in our progeny’s successes. When a new-hire academy graduates and finally does leave the diaper stage, it represents the culmination of hard work by the students and instructors. It suggests that, perhaps, the hiring was the correct decision in the first place. We are thrilled if our kids do really well by making correct choices in the School of the Street. And when our crews truly do save a life, or convince an unwilling patient to go to a hospital and a not-so-obvious immediate life threat is discovered later at the hospital, we beam with pride.
When a provider goes above and beyond the expected and spends extra time with a patient and family trying to reassure them or make them feel more comfortable in a stressful experience, we (should) express our sincerest appreciation and gratitude.
When a crew takes charge of a horrific scene and creates order from chaos while directing or providing life saving interventions to the patients, they have the parents’ full admiration and respect.
Like many parents, we really live vicariously through the experiences of our young.
These heroic circumstances, while infrequent, do occur. Making a difference in these situations is why we are all in this business, I think. It is why most “EMS kids” decided to embark on such a career and why we as “parents” agree to be in an oversight role. (And make no mistake, the vast majority of physicians have no desire to be an EMS medical director and want no part of the resultant parental responsibility and oversight).
10. The fact is that we parents love our charges because of the wonderful things they do — often for little reward. Parents accept the occasional failings because we are all human and erring is a part of life. We are family.
