Teaching EMS dinosaurs to evolve

Appeal to our shared purpose to help people when introducing changes in clinical care

This feature is part of our Paramedic Chief Digital Edition, a regular supplement to EMS1.com that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Spring 2016 issue, click here.

By Kelly Grayson

A few years back, I wrote a column calling EMS the low-information voters of health care. In it, I decried the willfully ignorant among us, their propensity to reject change and their unwillingness to further their education. There are a lot of them in EMS, but that does not make us different from any other profession. Pick any health care discipline and half of the people practicing it are, by definition, below average.

Since then, the term "LIV" has taken on a life of its own, becoming a pejorative we use to describe the colleagues we deem unworthy to practice this profession. It's a smug in-joke for the smart kids in EMS.

But I want to show some respect to the EMS dinosaurs among us. They may look, talk and act like low-information voters, but I call your attention to the words I used in the opening paragraph of this column: willfully ignorant.

There are plenty of dinosaurs in EMS, whether they got their patch 30 years or 30 minutes ago, who are good-intentioned, well-meaning people with honorable motivations. They are ignorant, but not willfully so. Many of those people have valuable talents and institutional wisdom, if only they could embrace the inevitable changes in health care.

Resistance to change is human nature
But let's face it, the only people who like change are babies with soggy diapers. Change is messy and uncomfortable. It forces us to acknowledge the uncertainty of the future, when all we'd like to do is keep on doing the things we know in the same old way we've always done them, because we know it works.

And when told that it actually doesn't work, we close our minds to the message and as often as not, try to kill the messenger. It's only human nature.

To the dinosaurs among us, there isn't much wrong with EMS. They were doing just fine until these uppity kids came along with their egghead ideas they got out of some textbook or journal, who have never practiced real EMS, where all that fancy book learning and science doesn't do you much good when you're trying to save a life on a muddy ditch bank at 3 a.m. by the dim light of a flashlight.

And they wish those kids would just get off their metaphorical lawn.

To those people, changes in EMS practice were always brought about by them; a vague and shadowy group of people they had never met, people who sat on committees and wrote textbooks and did weird and arcane research that any fool could spot the flaws in, because the people that sat on those committees and did all that research weren't EMS people. They just didn't understand the reality of the streets like a real EMS dinosaur.

Those shadowy people wrote all these textbooks, the very same textbooks that the current generation of EMS puppies are saying aren't worth the paper they're printed on. The current generation of puppies insists that we read research because textbooks can't keep up with the rapid change of evidence-based medicine. Research written by yet more of those shadowy committee-sitters and research eggheads, who probably wouldn't know a Kansas board from an EOA.

The dinosaurs read about the Gathering of Eagles conference and scoff, because they've been around long enough to recognize that some of those Eagles are actually buzzards with a good PR department. They're not interested in hearing the latest novel approach at fixing problems that some of those buzzards unwittingly created in the first place.

To many of the dinosaurs, that Kelly Grayson guy is just another one of those eggheads, some arrogant ass who writes an Internet column about how the dinosaurs have been doing it wrong all these years. Even more galling is that he's been in EMS long enough to be a dinosaur himself. He should know better.

The dinosaurs have been around long enough to actually see the pendulum swing from one extreme to another, and they have developed a highly sensitive BS detector because of it.

The dinosaurs remember when cardiopulmonary resuscitation was a mostly BLS proposition, and then they were told that ALS was the better way and became paramedics because of that belief, and now the research eggheads at the American Heart Association are making it all about BLS again.

The dinosaurs remember when we carried all sorts of IV fluids on the trucks — normal saline, D5W, Lactated Ringers, maybe even D5¼ Normal Saline for the pediatric patients and the occasional head injury. And then some committee-sitter said that normal saline could pretty much work for everything, so their agencies quit carrying all those other fluids. And now they’ve changed their minds again, saying that for sepsis patients, fluid choice really does matter and that we need to go back to Lactated Ringers for fluid boluses in sepsis patients. Something about hyperchloremic acidosis or some such nonsense.

The dinosaurs remember when the saying used to be, "Levophed, leave 'em dead," and now the puppies are saying we should be using it again, maybe even in conjunction with the Lactated Ringers the committee-sitters said we didn't need all those years ago.

Build rapport, then share your message
The next time you have a similar exchange with an EMS dinosaur, don't be so quick to write him off as a low-information voter. Take a moment instead to consider what it is you're telling him and what he's telling you.

When you approach a dinosaur with your impassioned, evidence-based argument on changing a long-standing paradigm in EMS, what you're actually telling him is, "You've been killing people all these years, and you're too ignorant to realize it. And what's more, you don't care enough about your patients to try a better way."

That may not be the message you intended, but that's the one he's hearing. It's a failure in the delivery. Education, at its heart, is nothing more than knowledge salesmanship. Even if the knowledge is rock-solid and irrefutable, if you can't sell it, then nothing will change.

What use is a salesman if he can't get any customers?

The first principle in salesmanship is to know your buyer and build a rapport with him, but many of the best and brightest of our latest generation of EMS professionals really suck at salesmanship. Exquisitely well-educated worshippers at the altar of evidence-based medicine, all of them, but woefully deficient at preaching a meaningful sermon that reaches the sinners.

Makes you wonder — if they can't build rapport with an older generation of their own profession, how can they build rapport with a patient with whom they have even less in common?

And when the dinosaur turns a deaf ear to your impassioned argument and rejects all of your scientific evidence, what he's really saying is, "Don't take my saves away."

Who among us would willingly accept that all the good he's done in his career was all for naught? That's a bitter pill to swallow.

Appeal to our shared sense of purpose
Much of the problem lies in the fact that we have traditionally defined ourselves not by what we know, but by what we do. We have limited ourselves to little more than a patch and a skill set, framing our sense of self-worth as providers not by what we do for patients but by what we do to patients. Learning that many of those procedures we spent countless hours perfecting — intubation, spinal immobilization, traction splinting, certain medication doses, CPR ratios and techniques — were ineffective at best and harmful at worst shakes the very bedrock of our self-image as providers.

If you really want to help an EMS dinosaur evolve, you need to appeal to the soft skill that matters most — the motivation to help people. That motivation is what created a provider with the resilience to withstand a career that chews up and spits out most people within five years, and it's one that everyone passionate about EMS shares. The foundation of our self-image should be laid on what we do for people.

If we focus on that, then changes in how become a lot easier to accept.

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