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Lessons in imagining a future for EMS

Imagine an EMS future that solve real problems, reflect our passions and welcomes the input of those who will make the future

The EMS Agenda for the Future imagined the future of EMS in America. Touted as a roadmap for the years ahead, the document describes what the authors imagined EMS would look like in 2010. The authors envisioned empowered practitioners above the paramedic level who blurred the lines between EMS and public health; providers routinely treating and releasing patients and using an assortment of Star Wars-like technology to conduct assessments, gain instant access to medical records, talk to doctors, create reports and schedule patients to see other health professionals; EMS agencies adequately funded and reimbursed for readiness and prevention; EMS receiving the necessary attention at state and federal levels, spearheaded by an empowered and sufficiently funded lead federal EMS agency; multi-system, NIH-funded EMS research uncovering best practices in clinical care; easy, state-to-state reciprocity for all providers; and the availability of abundant and reliable national EMS data.

It was a grand vision, and the document is still worth returning to for a graphic view of the distance between what was imagined then and where we are (or are not) today. Some of what was imagined has become reality, but most has not. There is still a paucity of data, no lead agency, little integration into health care, little funding for readiness, no widely accepted level beyond paramedic and providers still struggling to move from state to state. Was this a failure of imagination?

Imagination is essential for creating a desirable future — it is the part of the psyche that helps us create. I believe we often use too little imagination in emergency services. However, if imagination is to be successfully employed for creating achievable roadmaps and plans for the future, it must be used appropriately.

What can we learn from The EMS Agenda for the Future about the use of imagination?

First, when imagination is employed for future planning, it must be tethered to present realities. In the mid ’90s, the vision of EMS was not tethered to the critical realities of fee-for-transport funding mechanisms; the turf-invading nature of expanded scope; the independent and fiercely self-protective nature of EMS at local and state levels; the industry’s chronic need to squabble over delivery models and speak with multiple voices; and an underpaid and largely volunteer workforce. I believe an imagined future tethered to these realities would have looked very different.

Second, imagination as a planning tool must reflect the delights of those who will turn the plan into reality. The heyday of modern EMS development in this nation (1966–1985) reflected an imagination of a system that was thrilling to the people who had to build it; this was captured in the likenesses of Johnny Gage and Roy DeSoto in the “Emergency!” television show, and there was no shortage of enthusiasm for turning an imagined world into reality.

Could it be that The Agenda simply did not reflect the interests of those who needed to roll up their sleeves and turn it into reality?

Finally, it seems that the process of imagining an achievable future must include the right people. The primary imaginers of The Agenda (the steering committee) comprised six physicians, three state directors, a fire chief and a corporate vice-president. I, along with dozens of others, participated in a conference that reviewed a final draft of The Agenda, but at that stage, the imagining had been done. How might things have been different if the steering committee had included those who lived the realities of EMS daily, including service directors, EMS chiefs and paramedics?

The lesson here is not to stop imagining but to imagine futures that solve real problems, reflect our delights and passions, and welcome the input of those who will put hands and feet to the futures we describe.

John Becknell, PhD, is a partner in the consulting firm SafeTech Solutions, LLP. John has been involved in emergency services for 40 years and writes and researches in the areas of leadership, culture, community and psychological wellbeing. He leads workshops, retreats and training programs for EMS, law enforcement and the fire service in living well, peer support and transforming the first responder experience into a path of growth, satisfaction and meaning. He is the author of Medic Life and numerous articles. John’s Masters and Doctoral degrees are in psychology with an emphasis on community psychology. Contact John at john@safetechsolutions.us

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