EMS: The low information voters of healthcare

Making decisions purely on emotion and superficial knowledge

You've all seen the Internet memes: somebody gets thousands of signatures on a petition to ban dihydrogen monoxide because it is found in all cancerous tumors and is the primary ingredient of acid rain, or a documentary filmmaker with a hidden camera asks people to sign a petition preventing President Obama from completing his proposed sale of the White House to China as a tourist attraction.

And we all shake our heads in bemusement, "Stupid people," I'll lament. "They walk among us, and they breed."

Worse yet, they vote.

Some of the displays of ignorance are so astounding that we jokingly propose repealing the Voting Rights Act and reinstating literacy tests for eligibility to vote.  They're so common, we've even coined a term for them; we derisively call them "low information voters," people who vote based purely on emotion and a superficial knowledge of the issues.

It's not so funny when it's people in your own profession.

No such thing as a professional EMT

Recently, a young paramedic named Robert Martin posted a diatribe on Facebook lamenting the lack of professionalism and initiative among many of us in EMS. The post went viral, garnering 700 comments and counting between Nocturnal Medics, Paramedics on Facebook, and The Most Interesting Ambulance Crew In The World:

"There is no such thing as a professional EMT. There are only paramedics and ambulance drivers. This is a controversial and inflammatory statement, but please, bear with me. This is not a slight against those who hold EMT certification, nor is it dismissing your service. Today, approximately 70 percent of American EMS workers are EMT's of some permutation, and your efforts are absolutely vital to our current operations. With that being said, we have a serious problem in our industry, and it starts with our fascination with titles and our notions of what they should be. I offer this observation of truth from the perspective of a self-identified new paramedic. Many will hate me for it, many will accuse me of being an elitist and a 'paragod', there will be much protest. But ask your doctors, your corporate leadership, your lawyers, your enlightened non-ambulance-driving leadership. Ask Kelly Grayson, Skip Kirkwood or the JEMS regulars. They will likely agree with the sentiment."

I do agree with the sentiment. Heartily.

You really need to read the whole thing to appreciate it, but basically he states that anyone who conducts himself as a professional, adheres to a code of professional ethics, and continues to advance his skills and knowledge base should be considered a paramedic, regardless of their certification level.

Likewise, the lazy and incompetent, the ones who reject evidence-based medicine in favor of anecdote, the ones who do barely enough to get by, are mere ambulance drivers, even if they wear the sparkly gold paramedic disco patch on their sleeves.

In short, he wasn't talking about certifications, he was talking about mindset.

The paramedics versus ambulance driver dichotomy

He's not the first person to voice that sentiment, although he may be the first to propose the paramedics versus ambulance drivers designations. A great many pretty sharp EMS thinkers – including field medics, not just the ivory tower professional committee members – would agree with his basic premise.

There was a lot in his essay to think about, and plenty to disagree with. I myself don't agree with all of his points or the validity of some of his supporting arguments. He could have phrased his arguments a little more succinctly, and been less verbose. He could have couched his message in softer language, and offended fewer people. I doubt he anticipated the amount of shrapnel he'd get when he pulled the pin on his Facebook grenade.

But he's a 21-year-old, idealistic, passionate paramedic, not a professional writer. I'll give him a pass on his rhetorical skills. None of that diminishes the truth of what he said.

But what is truly distressing is the number of people who totally missed his point.

I invite you to go read some of those comments, and marvel at the low-information voters of EMS. I warn you, it's not pretty. Douchebag is one of the gentler epithets used. You'll find people who think he was insulting BLS personnel when he clearly wasn't, and you'll find grizzled old veterans who condescendingly say, "Come back and talk to us when you have some experience." Quite a few commenters prefaced their statements with "TL;DR" (Internet-speak for "too long, didn't read"), and then made disparaging comments anyway.

If you admit that you didn't read the post, but then proceed to make negative comments about it, I've got news for you: you are one of the ambulance drivers he is talking about, and in your case, "TL;DR" translates to, "Not only am I lazy and ignorant, but I revel in it."

A few people read his post in its entirety, understood it, and politely disagreed with him. Even fewer agreed with his sentiment. But lost in the flood of indignation stemming from poor reading comprehension and bruised egos is the fact that this 21-year-old "paragod," despite his lack of that nebulous and mystical "experience" we all value so much, hit the nail directly on the head: we are a vocation, not a profession. EMS is sparsely littered with professionals, but at present we are only a trade.

And as long as the professionals are outnumbered 10:1 by the low information voters of EMS, a trade is all we'll ever be.

Willfully ignorant and loving it

I commented in one of those threads, to the effect that 75 percent of EMS workers are willfully ignorant and never care to learn, 15 percent are unintentionally ignorant, and perhaps 10 percent are truly knowledgeable prehospital care professionals.

I don't bother to speak to the 75 percent. Many of them don't read my column or blog anyway, nor do they attend EMS conferences. The few that do wander by spend all their energy feeling insulted by the titles of my column and blog. I used to reply to them with the dictionary's definition of "satire," but these days I don't even bother to do that, because it became obvious that most of them shun dictionaries, and haven't read a book since they highlighted all the important-looking words in their EMT textbook so many years ago.

Instead, I focus my energy on the 15 percent. If we add just a few more voices to the 10 percent of knowledgeable prehospital care professionals, we'll eventually outshout the low information voters of EMS. The American Revolution was won against far more daunting odds; we should be able to revolutionize EMS if we swing a few more undecided voters to our cause.

It shouldn't be all that hard. After all, the people who'd oppose us are all sitting in front of their computers, still arguing that they don't care what the science says, they know the PASG works because they totally saw it save that shocked guy one day on that call one time.

Don't be one of those guys. Don't be one of the low information voters of EMS. 

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