Emergency Medical Services.
You can tell a lot about a provider by which of those three words upon which he places the most emphasis. It’s as much a measure of one’s career maturity as it is a personal vision for what he believes EMS is, or should be.
In the first few years of my career, I was all about the emergency. Transfers were beneath me. Low acuity patients were a waste of my time and talents. I was a Paramedic, with a capital P, the master of the realm of code saves and trauma resuscitations. I viewed dialysis transfers and hospital discharges back to the nursing home with all the foot-dragging and loathing of a kindergartner forced to eat his broccoli.
My bosses’ reminder that those runs paid our salaries was met with the same skepticism as a parent’s assurance that the broccoli was indeed good for us. I mean, if I fed the broccoli to the dog and still survived childhood couldn’t my service stay afloat without those dialysis transfers?
As I matured professionally, I became all about the medical. I came to realize that much of what I had been taught was wrong, and emerging science challenged many of my beliefs. I discovered that many of the skills I had labored to master were unnecessary, perhaps even harmful. Some skills that really made a difference for my patients, I did not possess. Many of the factoids I had memorized in class turned out to be irrelevant, while others turned out to be vital.
And all too many of the useful ones were things I learned after I sewed that sparkly patch to my sleeve.
I wasn’t as good as I thought I was. I was lacking as a paramedic. When you define yourself by what you do for a living, it’s enough to shake the foundations of your entire belief system. It certainly shook me.
Devotion to science of medicine
And thus was born my devotion to the science of medicine. I rediscovered the sense of wonder and discovery that comes with being a lifelong learner, those questioning moments of quiet reflection where you whisper to yourself, “Huh. I never knew that.”
And the pride that comes in realizing that yes, now you do.
Those are the sort of epiphanies that make you wonder what else you don’t know, and arouse a thirst to learn those things, too. I began to question everything, to discard old knowledge and replace it with new, something with stronger foundations. Something I could justify with science, and hard, irrefutable data.
Evidence, care evolve
But something else happened along the way. I learned that science often raises more questions than it provides answers. I learned that there is precious little scientific justification for many of the things we do in EMS.
The more I knew, the less I did.
I learned that knowledge is a constantly evolving process; the more one learns, the more one realizes how little he actually knows. I learned that the only constant is change, and that the best a paramedic can do is let his treatment be guided by the best evidence of the day.
And accept the fact that, inevitably, that evidence will evolve, and so will your care.
Art of medicine
Which brings me to where I am now, well into my third decade in EMS and just beginning to understand that, at least for me, the most important word of the three is service.
Service is the element that defines the art of medicine, the skill set we can still employ when the science fails to provide meaningful answers.
At the heart of the matter is that most of our patients are not emergent, and that will never change. There will always be patients who utilize our services inappropriately, be it from ignorance, or laziness, or whatever the reason. To rail against it is an exercise in futility and a recipe for career dissatisfaction.
And most of the patients will not benefit from the medicine, either. It’s rather difficult to screw up a patient significantly in an hour or less of patient contact. You have to work at it. And for those patients most likely to be harmed, inaction is a far greater sin than lack of knowledge.
But service, on the other hand, is something we can provide to each and every patient, and it benefits us just as much as them.
“I don’t know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve.”
— Albert Schweitzer
It doesn’t matter where on that career arc you fall — and it’s just as much a function of personal outlook as it is career longevity — the service part of emergency medical services is what drives all the rest.
Service and the sense of duty is what makes you keep your skills sharp for the truly emergent patient, while giving you the perspective to accept those who aren’t.
Service is what makes you keep learning the science of medicine, so that you can treat your patients more effectively, or recognize that subtle presentation that you may have missed otherwise.
Service is what you can give the vast majority of your patients who are neither emergent nor truly in need of medicine. It’s the way you can make a bad day for someone a little bit better, no matter how trivial the gesture or mundane the task seemed at the time. It’s the thing that makes even the renal roundup and interfacility transfers worth your time. And it’s the thing that your patients will always remember, even the ones who were truly emergent and desperately in need of the best medicine we can provide.
Service is the embodiment of that noble goal we all had when we entered EMS, before we became jaded and cynical; I just want to help people.
And if reading this column has reminded you of that, then I will have rendered my service to our profession.
