Should we really be upset when people in the community listen to us? After all, EMS protocols and people are notorious for creating our own problems. We write the public a “blank check” saying that if they believe it is an emergency to call 9-1-1 immediately and as a result we have created an increase in calls for non-emergent complaints. We continue to treat every call we can by transporting to the hospital and create a class of consumers called “frequent flyers”. When we need funding, we tell the public that “seconds matter” and we define a parameter that the public uses against us to measure our success. Perhaps they listen much closer than we typically give them credit.
So what happens once we figure out they have heard us – we change our story! And we feel that we must do it dramatically in order to make the point that “we don’t do it like that anymore.” At some point we began to use MAST or PASG as a primary treatment against shock but eventually removed them from every ambulance as they fell from favor by delaying definitive care for a short-term gain. At first it was critical to get cardiac arrest patients to the ED, but now we set policies to work them on scene for better survivability. We drill into each responder that every single fall must be suspected to have a spinal injury and now some have begun to campaign to remove long spine boards from vehicles. Evidence showed us that tourniquets should be used only as last resort measures before learning evidence now shows that proper application early can have the best effect. And then we learn that there is nothing magical that actually requires a doctor to remove them as well! It seems that the “evidence-based” trend in EMS requires that being “progressive” means we lay in wait for some “proof” in order to jump on a previously long held belief so we can debunk it as some old “wive’s tale.” But why must we always go to an extreme new position? Our industry is designed to resist “fashions” by accepting change of practice slowly for safety reasons. While personal beliefs can be more fluid, it takes a while for the protocols to catch up. Perhaps we need to moderate both ends.
Change within a system is not expedited by extreme positioning, but reasoned and thoughtful conversation. The article on Things Your System Should Deliver is well written and certainly worth the read and consideration. You don’t have to become a zealot for change, a thoughtful advocate is powerful enough. Learn from the process we work within and work with it instead of against it if you want it to update more quickly. Engage in dialog with medical direction AND politicians AND the communities you serve. It is through these channels that change is truly affected and we will find the success we can live with.