Editor’s note: Skip Kirkwood takes the reins as our guest columnist for this issue.
As I write this, 2011 is drawing to a close and I am contemplating my wishes for the EMS community in the coming year. I’d like to share some of those thoughts with you.
First, let me preface this by saying that we are in a time of great change and great opportunity. Yes, we do face challenges: Our national economic crisis, the lingering “jobless recovery,” and the heat of political rhetoric coming out of our national and state capitols certainly represent some form of crisis. Yet despite that, I believe we are at an important turning point in our history and in our evolution as a profession, a service and a community. If we can join forces and make some good decisions, we can elevate what we do into an essential community service, one that is worthy of the support of our taxpayers and our colleagues in the health care and public safety communities.
Now let’s get down to my wishes.
1. I wish we would focus on our commonalities, instead of our differences. The citizens don’t care much about the color of our trucks, what patch we wear, what our corporate pedigree is or which labor organization we belong to. Only inside the fence do we focus on our differences, and when we do, we tear ourselves apart in a most unhelpful manner. If we could focus on the 85 percent of what we do that we agree on, we could be a political and social force to contend with.
2. I wish we would put our patients first, instead of ourselves. When we put our patients first, we make good decisions. When we let organizational, political and personal factors come before the interests of our patients, we do things that in the end don’t serve us very well. Let’s resolve to do what is right for our patients and make all the other factors adapt to that single, most important focus.
3. I wish we would educate and train our young in a way that teaches them the knowledge, skills and behavioral attributes that are necessary to do the job in the real world. Our pre-service EMT and paramedic curricula are among the most minimal in the first world and English-speaking nations. We teach aspiring members of our profession all about resuscitation, and we have them spend clinical education time in ICU, CCU and emergency departments. But we don’t teach them much about the elderly, the indigent, the mentally ill, those with chronic diseases, and those whose lives include too many drugs and alcohol. And then we send them out into the world to deal with patient populations made up largely of those groups. Is it a wonder so many become quickly disillusioned and move on to other careers?
4. I wish we would consider the law to be a tool for good, instead of something to be feared. Too often, when I ask why a medic or an agency doesn’t do something that I believe to be the right thing, I hear “fear of lawsuits and liability” as the reason. Yet although I follow EMS-related litigation faithfully, I’ve never seen the basis for those fears. There are few EMS-related lawsuits, and fewer still when EMS people have done the right thing with regard to their patients.
I’d like to see what I consider to be a lame excuse eradicated from our vocabulary. If we believe there is a potential for legal risk, we should work with counsel to minimize that risk, not avoid doing the right thing because of an abstract fear.
5. I wish we would act as though we consider our people to be our greatest resource. We are 45 years into the “modern era” of EMS, yet in many communities, EMS work is something people undertake while they are on their way to another profession or occupation. The loss of talent in our industry is frightening, and it may be our downfall as the demographics of our population change. If we don’t develop organizations that pay living wages, afford competitive benefits, and offer opportunities for development and advancement, we will lose the competition for caring, talented people.
We all want the EMS providers of the future, who will care for us and our families, to be of the finest quality. If we don’t build the foundation for that now, it will be too late when you and I need those services.
6. I wish EMS would develop a community of scholars. I love and respect our physician colleagues, I really do. But it pains me when I read the journals and see that much of our important nonclinical research is being performed by physicians. Why is the research money going to physicians, when the topic is vehicle safety, EMS system economics, or the health and safety of EMS providers? I wish that funding agencies like NHTSA would direct their contracts and cooperative agreements to organizations of EMS leaders and schools—except there aren’t enough of them, and they are not sufficiently organized, to fulfill these important obligations. It seems we’re too busy keeping our tiny little services independent to work together for the advancement of our profession, and this needs to change. Our men and women need to be out front, producing the scholarly works that will guide our future.
7. I wish our efforts to achieve a strong, funded lead federal EMS agency would come to fruition. EMS is scattered throughout the federal government, spinning off programs that are not prioritized or organized like so much space junk whirling through the galaxy. While I am a firm believer in a limited federal government and I recognize that EMS doesn’t appear anywhere in the U.S. Constitution, the truth is this: Lots of money goes to Washington in the form of federal taxes. If this money is to ultimately come back to the states in the form of grants, I’d like to see an appropriate sum of it come to EMS. We can only get this to happen with a strong federal lead agency that listens to the unified voice of the EMS community.
8. I wish somebody would design and build a safe ambulance. Our current ambulance standards, including the soon-to-be-adopted NFPA 1917 standard, are abysmal. When the only “test” conducted on an ambulance for its federal certification is one that involves placing a tank of water on the top of the box, the people who will live and work in that vehicle are at risk. We need vehicles that are designed to withstand reasonably foreseeable impacts, from a variety of angles, and that do not have internal components that will (a) not skewer medics on impact; and (b) not deconstruct on impact, unleashing missiles to fly about the patient compartment. Yes, they will cost more. Yes, we will have to find a way to pay for them. It’s the right thing to do.
9. I wish we would achieve alignment between those who develop standards, those who enforce standards and those who live with standards. For too long, I’ve heard EMS providers lament, “What they test on the licensure exam doesn’t have anything to do with life on the street!” Meantime, EMS educators complain, “What’s in the national education standards and guidelines doesn’t match what the EMS agencies in our communities think is important.” And EMS officers fume, “Those state rules do nothing but get in the way of us doing our job.”
In the better world of 2012, we will all talk together so that education, testing and state regulations all line up with—you guessed it—the needs of the patient. And where there is a difference of opinion, we will work it out in advance and not have to engage in muscle-flexing posturing, threats of going to our elected officials, and that oh-so-annoying “We’ll just stop using the National Registry.” Taking-our-toys-and-going-home behaviors stopped being acceptable at about second grade. Let’s bring our adult behaviors to the table and resolve these things before they become impediments to good patient care.
10. I wish every EMS provider would do what is necessary to achieve an adequate level of personal health. For several years running, at least one person at nearly every EMS conference I’ve been to has commented on the high percentage of EMS folks who are in poor shape. Sure, many compensate for their poundage in one way or another, but let’s face it: If you can’t carry your kits, monitors and such to the top of the stairs and be ready to begin patient care without taking a breather—and that means being able to auscultate lung sounds and breath sounds without first hearing the pounding of your own heart in your stethoscope—you’re not in fighting form. And for those who think that personal fitness is something you can only attend to on-duty and with equipment provided by your employer, please think again. You had that body long before you got into EMS, and you will need it long after you stop serving. Make taking care of yourself your priority!
11. I wish we had a good system to document bad things that happen to us. Bad things happen on any job, including ours. Most industries, or their government regulators, have systems and procedures to document those happenings in the hope that they can be analyzed, addressed and minimized. We’ve spent fortunes on NEMSIS-compliant patient care reporting systems. Other trades and industries, such as airlines, commercial trucking, firefighting and mining, have reporting systems and registries, but not EMS. We need a mandatory reporting system so that we can effectively address the many bad things that happen to EMS personnel every day.
12. I wish we would better train the EMS community to identify, avoid and address violence directed toward EMS providers. Our approach to scene safety is minimal at best. From the classroom to the test to the street, provider focus on scene safety seems to be limited to body substance isolation techniques and a cursory check for downed electrical wires. Is that all that might hurt us? For some reasons that are not clear to me, our community is reluctant to discuss the fact that 52 percent of us will experience violence in some form over the course of our careers. We need education, delivered by competent experts who know our business—not watered-down courses delivered by law enforcement “experts” whose knowledge of conflict ends with custody (their goal) rather than escape (our goal). This needs to happen at the pre-service level and in continuing education programs throughout the country.
13. I wish for greater unity within the EMS community. I wish the numerous associations would merge, consolidate or otherwise join forces. NEMSMA, IAEMSC, even the AAA and the IAFC EMS section could accomplish so much more for EMS if they were one. EMTs and paramedics who belong to labor organizations whose principal national focus is not EMS would join forces to form a single national EMS labor organization that could speak with one effective voice. And everyone who holds an EMS credential from every state would join NAEMT, so that 500,000 or 600,000 EMS voices could be heard in the halls of national and state government. We would all join forces to support the National Registry of EMTs as the single testing and certification body for EMS in the United States, and every EMS educational institution would commit itself to becoming CoAEMSP-accredited within the next 48 months.
So there you have it: my wishes for EMS in 2012. If we can get a start on some of them, I’ll feel fulfilled. If we can actually achieve a few, that would be fantastic. If I can get a few of you to sign on to each one, we’ll be well on our way. What do you think?
Meanwhile, I wish for each of you, and your families, a proud, productive and prosperous 2012.
