November 2011’s Ruminations—a tongue-in-cheek transcript of a fictitious congressional hearing about the EMS industry’s lack of a united front—produced a number of e-mail comments. “My first thought is—you’re making this up,” commented one writer. “Second thought—maybe you are, but seriously, Congress calling foul on the inability to have all representatives in agreement is the pot calling the kettle black. Maybe you didn’t make this up. In any event an enjoyable read—albeit the sad truth.” Another writer declared, “If we can’t get together and work like grownups, we are likely to be asked to leave the room and spend dinner at the ‘kids’ table.’” Still another said, “This isn’t just national—it sounds like the people in our community today.” One writer asked, “Hasn’t this been going on for years? Why doesn’t anything change? Is there any hope?”
The lack of a united front in EMS has been around for decades and is rooted in history, leadership and social psychology. As EMS developed rapidly in the ’60s and ’70s, all attempts to provide national leadership failed. Even the Emergency Medical Services System Act of 1973 and the Boyd national plan for 300 EMS regions failed when Reagan’s budget cut the funding. So EMS grew up locally and organically, often without a mandate and often on a widow’s budget. A survival mentality surrounded its formation and cultivated fiefdoms, fear and protectionist leadership.
Paramedics had to fight for their place in the medical world. Local ambulance services fought against each other for territory and patients. The fire service came late and fought for something it wasn’t sure it wanted. Rural services fought for credibility and people and against a fear of big town services. EMS docs had to fight for their own specialty.
As the fiefdoms emerged, protectionist-minded leaders rallied followers through passionate fear appeals that proclaimed: they’re coming after our territory; fight back or they’ll take over; protect your job; they’re just after money; and they’ll take away advanced skills if we don’t have enough evidence. In the mid ’90s, during the heyday of private EMS consolidation, Al Whitehead, then the IAFF general president and speaking at a fire meeting in Las Vegas, brought his entire audience to their feet in roaring applause when he declared that the fire service would fight and triumph over profit-driven private EMS.
The fear appeals were (and are) wild exaggerations. Yes, there have been fights, and yes, a few ambulance services have changed hands and a few have closed, but EMS continues to be diverse. No one group is winning or dominating. Is the need to protect turf more important than working together to better the industry and the public good? Refreshingly, many of the young people coming to leadership today are saying no, and this is where I find great hope for the future.
Say what you will about the self-focus and supposed lack of commitment of young people today, but those showing up to lead in emergency services are just what we need. They have grown up in a world littered with baby boomer pollution, debt, divorce and lies and are not nearly as gullible about faux fears and enemies as a previous generation. They aren’t worried about being called ambulance drivers or protecting old traditions and doing what’s always been done. They don’t see enemies in EMS uniforms.
I recently had the opportunity to spend time with a group of young EMS leaders who work in private, public, fire and rural services. Over two days they listened, talked, challenged the status quo and in the end vowed to continue working with each other, not against each other. Imagine how things could be different if more joined them and embodied Margaret Mead’s admonition: “Never doubt that a small group of thoughtful, committed people can change the world; indeed, it’s the only thing that ever has.”
John Becknell is the founding publisher of Best Practices and a consultant who helps individuals and organizations clarify destinations and tell stories. He can be reached at jmbecknell@gmail.com.
