6 EMS professionals ask ‘What if we are wrong?’

Each author explores the other side of impassioned debates on naloxone, endotracheal intubation, STEMI alerts, professionalism, and lecture-based education

By Brandon Oto

One of the greatest dangers to progress is when we stop thinking and start believing.

That is to say, we all have opinions — some stronger than others — and if we’re wise, we came to those opinions using logic, reason and evidence. I have beliefs like that; I bet you have too.

But what should scare all of us is the possibility that one day, we'll have held those beliefs for so long, defended them so many times, and hung our hat upon them so repetitiously, that we forget about the “reason” part. Then, you see, we’ll never change our mind, because now the only “reason” we believe those things is from habit.

Debate teams are expected to argue both “pro” or “con” positions on any issue. Computer security companies hire “penetration testers” to attack their own networks. Making a serious effort to destroy your own beliefs is the best way to strengthen them.

Most of the time, when it comes to the EMS topics about which we are most passionate, we only consider the opposing arguments long enough to formulate a rebuttal. But the truth is, for any controversial topic, there are smart, rational, educated people on both sides, because there are plausible arguments from each side. You’re more convinced by one side, which is fine — but it’s not the only perspective. And we tend to forget that. Then we start saying things like, “You’d have to be an idiot or a criminal not to agree with me on this.”

And that’s just not so.

A dose of humility

There’s an even better reason to occasionally switch off our default mode and act like traitors to our own cause. It’s called humility.

Sure, we believe certain things. We think we’re right to have those beliefs. That’s just fine.

But we could be wrong. Couldn’t we? If your first reaction was to say “nope,” to say, “I cannot imagine any evidence or argument that would change my mind,” then I’m sorry to say that you’re no longer holding that belief for logical reasons. You’ve turned it into dogma, a personal religion, and that is not how we do things in medicine.

What if we are wrong?

A group of EMS authors, bloggers, and educators each hold strong beliefs they’ve argued and advocated for in the past — most of them many times in many settings. But they still know that they could be wrong.

So they’ve each written an article doing their earnest best to argue the opposite side to their own beliefs. If they hate epinephrine for cardiac arrest, they’ve tried to defend it. If they believe ALS is overused, they’ve given evidence why it should be universal. Not sarcastically, not half-heartedly, but a serious effort to weigh and consider another perspective.

1. The value of widely available naloxone

Michael Morse, a regular EMS1 columnist, is a strong opponent of civilian Narcan (naloxone) distribution programs. He argues here why they have value.

"Who am I to argue against something that can and likely will save even one life?"

2. Make supraglottic airways the gold standard

Jeff Poland is an advocate for endotracheal intubation as the gold standard of airway management. But he gives evidence here why we should be using supraglottic airways as our first line intervention instead.

"ETI in the prehospital setting needs to go the way of the dodo."

3. It might be time to abandon ETI

Ben Dowdy has a subtle and moderate attitude on prehospital intubation, but here, he lays out the case why we should be abandoning it altogether.

“‘We should be doing things FOR patients, not TO them.' For prehospital intubation, unfortunately, that does not appear to be the case."

4. EMS providers want lectures so let’s lecture them

EMS1 Editor-in-Chief Greg Friese is a passionate proponent of non-traditional models of education. He steps back to argue here why we should actually “unflip the classroom” and hold onto standard lecture-based instruction for EMS training.

"More than half of respondents to an EMS1 poll call on continuing education prefer to receive their CE by classroom/lecture."

5. Transmit every 12-lead for physician interpretation

Vince DiGiulio is a long-time believer in field STEMI activation based on ECG interpretation by well-trained paramedics. He argues here why paramedics should be transmitting their strips for physician interpretation instead.

"If you want optimal numbers, your system should be transmitting 100% of its ECG’s to an emergency physician base station for interpretation and activation."

6. The downsides to professionalism

Amy Eisenhauer is a staunch advocate for professionalism among EMS providers; here she makes a case that sometimes, professionalism can have its downsides.

“Could our uniforms cause more anxiety for patients and exacerbate their already compromised health?”

Are you occasionally wrong?

Have a look, and think about how difficult this was for them to write. Hopefully, you’ll be inspired to take a deep breath and acknowledge that you just might occasionally be wrong too.

About the Author

Brandon Oto, PA-C, NREMT-B is editor of EMSBasics.com and LitWhisperers.com. His interests include BLS fundamentals, evidence-based medicine, medical education, patient advocacy, and clinical decision-making. 

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