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EMS 2.5: Beyond the buzz

Time to stop whining, time to start building

Three years ago, Justin Schorr and Chris Kaiser articulated the concept of EMS 2.0:

"This refers to the reboot and reload of the mission of EMS in the near future to accommodate the changing requirements put on the system….. however it is that you deliver EMS needs to be drastically re-invisioned, re-trained and re-deployed. We are no longer an Emergency service but an Encompanying service, and Empowered service, an Evolving service."1

Kaiser further described it from a role-based perspective:

"I know 'my place', and it's not where the ER nurses want me to be. I'm not 'unlicensed assistive personnel'. It's not where the fire unions want me to be, I'm not 'a firefighter who works on the ambulance'. It's not where the private companies want me to be, I'm not a 'Pulse and an EMT card'. As a professional paramedic, 'my place' is dictated by the professional competence and responsibilities earned by the members of my profession as supported by science and as allowed by law."2

A groundswell or ant hill?
EMS 2.0 hit around the same time blogs became prominent in the ems and fire industries. A major vendor sponsored EMS 2.0 activities at internal and external conferences. The concept was becoming buzzworthy.

I was working with one of the organizations that provided a digital platform and technical support to many emergency service bloggers. They noted that EMS 2.0 online events and related websites showed less participation than other types of events. In a business that focused on "eyeballs" it was difficult to generate additional support.

Evolving opportunities
Even with thin eyeballs, a robust multimedia platform evolved from EMS 2.0 and continues to provide difference-making productions. Financing their dream required determination and creativity.

One of my most rewarding encounters at an EMS conference in 2012 was talking with Thaddeus Setla and Tom Bouthillet about developing the Code STEMI video series with the American Heart Association and funded by PhysioControl.3 The contacts and relationships that produced Code STEMI started with the EMS 2.0 activities.

Meanwhile, on the street
At the end of 2012 Justin Schorr provided a personal update on his blog:

"My dreams of an EMS 2.0 world were destroyed by regulators, bureaucrats and the realities of a for-profit system only to be rebuilt by a single EMT doing the right thing despite our policies to the contrary.  Our late night discussions in Baltimore, Vegas, Houston and other places all build into a mural of a future for our Profession, only to be sidelined by technical issues and personnel conflicts. 

It isn't an uphill battle we in EMS are fighting, it's an all out war.  There are those who wish to take over, give up, concede, demand even take a seat on the fence and wait to see who wins to declare their allegiances.  We can get frustrated, rant, moan and complain or we can give 100% to the one thing that matters: The patient. My posts may slow, my twitter may stagnate, but only because I have a chance to make a difference for more patients and I'm taking it. Join me?"4

From buzz to building the blocks of a profession
In the forty years that EMS has existed, other care providers that interact with EMTs and paramedics have professionalized. Consider the role of physicians. When the American College of Emergency Physicians started in 1968 emergency medicine was a low-pay, low-prestige side job. The mom-and-pop community hospital with a dozen beds maintained a poorly equipped "Emergency Room" staffed with part-time or fill-in physicians. Medicine considers five factors in defining a specialty:

  • Unique body of knowledge
  • Professional association
  • Peer-reviewed vetting of knowledge acquisition
  • Testing of competence
  • Institutional training: internship, fellow, clerkship

Emergency Medicine was able to satisfy these requirements and was recognized as a specialty in 1979.

Compare this to prehospital medicine. It took our colleagues with the National Association of EMS Physicians two efforts and 25 years to get EMS recognized as an emergency medicine sub-specialty.And why? 

  • EMS has a peer-reviewed professional journal, Prehospital Emergency Care.
  • Paramedics and EMTs are working under an Educational Standard with an evidence-based scope of practice.
  • We have many professional associations.
  • NREMT provides a testing of competence.

Immediate National Emergency Medical Service Management Association (NEMSMA) past president Skip Kirkwood, provided this observation about EMS as a profession:

"My frustration comes from the failure of, or the unwillingness of, so many EMSers to 'engage,' to spend even a few minutes or a few dollars to advance their profession. MANY are willing to speak, but a willingness to speak without the willingness to WORK on what you are speaking about is just whining.  And as a kid I learned (whap!) that there are few things worse than a whiner. My second source of frustration comes from the 'What's in it, or what's easy, for me' focus. Improving the stature of EMS in our communities, and improving the lot of EMTs and paramedics, is not rocket science. It involves improving educational standards, becoming active in political regulatory affairs, and stepping up to take control of our profession and our work environment. Unfortunately, the response seems to be 'If they're not going to pay me more, up front, I'm not going to make any additional effort in this arena.' Folks, you make the investment first, then you get the dividend. It works that way in the stock market, and it works that way in the economic, political, and academic environments."5

EMS 2.0 is only three years old. It is time to lay the professional foundation for EMS providers.


  1. Shorr, Justin (2010 September 6) Time to Upgrade Your System: An Introduction to EMS 2.0. TheHappyMedic.com. Accessed December 31, 2012 at http://thehappymedic.com/wp-content/uploads/2012/07/HMHQEMS2point0.pdf
  2. Kaiser, Chris (2009 October 15) The Medics are Revolting.  LifeUnderTheLights.com Accessed December 31, 2012 at http://lifeunderthelights.com/2009/10/the-medics-are-revolting/
  3. Bouthillet, Tom (2012 November 12) "What does an ideal STEMI system look like?" 2:11 minute video Code STEMI. accessed December 31, 2012 at http://firstrespondersnetwork.com/codestemi/
  4. Shorr, Justin (2012 December 29) The Hour is Late. TheHappyMedic.com. Accessed December 31, 2012 at http://thehappymedic.com/2012/12/the-hour-is-late/
  5. Ward, Michael (2012 May 21) How EMS Physicians Became Recognized and Rewarded. Firegeezer.com. Accessed December 31, 2012 at http://firegeezer.com/2012/05/21/how-ems-physicians-became-recognized-and-rewarded/

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