Last, we need seed money to prove the viability of the changes I have proposed. ASPR, DHS and others have provided fortunes in grant money to healthcare and public safety agencies to develop capacities that may never actually be used, or may only be used for rare, catastrophic events. It would be wise and timely to redirect some of those funds to incubate demonstration projects, expand projects already under way, and document the results of those projects in a manner that will withstand the scrutiny of peer review.
Barriers Within EMS
One view of today’s EMS system is that we are our own worst enemies—that we focus on distinctions between our subgroups and won’t even consider that the other guys might have something to offer. We don’t want to join forces because “we” are good and “they” are evil. In this behavior, we shamefully mimic our polarized, politicized elected officials, who make policy based not on what is good for the citizens they represent, but what is good for the political party that supports them. As we see every day, that is not a great way to solve complex problems.
Along with that we have some groups that don’t want to see EMS embrace new roles because it involves effort they don’t have time for—people who see EMS as an ancillary activity to their primary mission or role. In this group I see firefighters and fire chiefs who accept EMS only as a necessary evil they must endure, and now a viable way to maintain jobs for their workforce or union. I also see many volunteers who see any added training or service mandate as a bad thing and who, given the chance, will mobilize to oppose it. Note this is not all firefighters, fire chiefs or volunteers, but it is surely enough to keep the advance from moving smoothly.
The third barrier is our lack of in-depth education. We have evolved too far toward a “don’t teach me anything I don’t need to know to pass the test” mentality. Our education at all levels is mostly bare-bones, entry-level, test-oriented and an insufficient foundation on which to build a new generation of EMS services. We have eschewed and resisted in-depth education in areas that do not relate to the glamorous 5% of what we do, while we have little or no education about the needs of the many in our communities who could benefit from our services.
We need to move toward a solid academic foundation for EMS medics, with baccalaureate degree programs that include the basic sciences, clinical knowledge and skills, and in-depth study of community health, indigent care, injury prevention, the workings of the healthcare system, alcohol and substance abuse, and the like. And we have to stop whining that we don’t get paid enough to learn all that stuff. We get paid as well as many baccalaureate-educated allied health professionals, K–12 teachers, social workers, etc. We have to make the first step. If we wait for somebody to say, “OK, we’ll pay the medics more if they agree to get the education they need to do their jobs in the 21st century healthcare environment”…well, I won’t hold my breath. We must overhaul EMS education in this country as it is being overhauled, advanced and improved in Canada, the United Kingdom and Australia, if we are to move forward.
We need to work, in a unified manner, toward removing both these internal and external barriers. Specifically:
Making omelets means breaking a few eggs—Yes, there are people heavily invested in the status quo. Some of them are bosses or owners. Proposing and working for change is going to annoy some of them. But building a good system for the future involves moving some cheese today! Our forefathers risked their lives and went to war over a three-pence tax on a pound of tea. Isn’t our professional future worth fighting for?
Yes, if you make someone powerful angry through your efforts to do the right thing, you might get fired. Stuff happens! Be prepared so that if you have to change jobs, you can do so without discomfort. Consider a little Dave Ramsey-style financial management. There are always organizations out there looking for good people, but you might have to move to find one. Be ready.
Join your professional associations, and support them with money, time and effort—Collective effort is the only way to influence public policy. Fewer than 5% of credentialed EMTs belong to the National Association of EMTs, and fewer than 2% of supervisors and managers belong to their professional associations. Of those who do, fewer than 1% are active members who contribute to their associations’ activities.