What we don't know about EMS

The National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services (OEMS) has made the document EMS Workforce Agenda for the Future (EMS Workforce Agenda) available for download online at www.ems.gov.

The EMS Workforce Agenda was prepared by the University of California San Francisco with funding from NHTSA and the Emergency Medical Services for Children program at the Health Resources and Services Administration.

Reading this report, I can't help but think about how much we still don't know about EMS and, as a profession, how far we have still to grow.

When we learn as individuals, we go through several stages of development:

1) Being unconsciously incompetent: We don't know what we don't know. Ignorance is bliss.
2) Being consciously incompetent: We know what we don't know. This is where we begin to learn.
3) Being conscious competent: We know what we know. For most of the time, we're kinda happy here.
4) Being unconsciously competent: We don't know what we know. The experienced expert lives here.

As EMS systems go, we're unfortunately at the stage of, "we know what we don't know." This report affirms what many colleagues have been saying for a long time: we really don't take ourselves seriously.

Heresy, I know! I'm one of the biggest fans of our profession. But really, can you argue with me? Modern EMS has been around since the early 1970s — 40 years ago. I began my career in the early 1980s. The problems that plague EMS then still haunt us today:

  • We lack serious data. Question: How many EMS providers are there in the US? Answer: We don't know. How many volunteers? How many EMT training programs? How many EMS runs? Answer: right, we don't know.
  • Recruitment and retention continue to be major challenges, especially in rural regions of the country. Low pay, low recognition, and low respect continue to be plagues.

I've heard this comment a few times: "We're such a young profession. Of course we're not 'there' yet." My response: Baloney. (I actually meant to say something else, but my editor would have had a coronary.)

Physician Assistant programs began in the early 1970s. Where are they today, in terms of retention, pay and respect? How about nurse practitioners? The first program for NPs was in 1965. The first bachelor degrees in nursing? Early 1970s.

We can do better than this, don't you agree? Somewhere in the recent past, there was a bunch of very smart folks who said to themselves, There must be a Better Way for [insert nurse, NP, PA] to grow into a profession. And then it was built. Nurses, NPs and PAs enjoy a level of education, income and respect because of it. We EMS folk continue to believe it's our cross to bear and not be a profession.

We can do better than this folks.

About the author

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at Art.Hsieh@ems1.com and connect with him on Facebook or Twitter.

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