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The face of EMS is diverse. Multiple types of systems provide emergency medical services to American communities: fire service-based, hospital-based and third-service. These systems also deliver varying degrees of performance. Systems fortunate enough to have strong management, active medical direction and a comprehensive quality improvement program can provide higher-quality EMS than those that lack them.
But at the core we all share many of the same basic problems: attitude, varying degrees of proficiency and a need for continuous quality improvement. The more clearly you can articulate your agency's values and expectations, the more likely your providers will exhibit the desired professional behaviors.
To tackle big problems, plan strategy or think big thoughts, it helps to get away from the distraction, noise and day-to-day chaos of EMS. I prefer to sit on the back deck of my house and smoke a Macanudo cigar. I've found a good cigar relaxes me, slows me down and somehow helps me think creatively.
I lit up a cigar one night not long ago while contemplating the myriad of quality improvement challenges facing my agency. As I sat back, gazed out at the stars and took a draw of my cigar, I saw the constellation of Orion. My mind wandered from the stars to the heavens to the gods and finally the imaginative answer I was seeking (and in record time, I might add). The 10 Commandments! If they're good enough for God, why not EMS? I started scribbling down ideas, and within minutes I held in my hands a (paper) tablet: The 10 Commandments of Quality EMS. I tweaked the wording a bit over the next few days, but in 10 short sound bites, I succeeded in capturing what I believe are the key concepts of quality patient care.
1. EMS is not just a job, it's a profession.
Back in the 1970s and '80s in my neck of the woods--Bucks County, PA--EMS was all volunteer. And we were all out to be the best. Nowadays, for many providers, EMS is nothing more than a paycheck. It's apparent in their attitude, but some will even confess their feeling that "It's just a job." But it's not, no more than a physician's or police officer's career is just a job. It's not an overstatement to say the importance of our job is life-and-death. That surely warrants a little extra effort and care…and caring.
2. Average, minimum and mediocre are not good enough in EMS.
Doing no more than you absolutely have to--the minimal amount of continuing education, a mediocre job of patient care--is not good enough for EMS. EMS is the highest-stakes practice of medicine there is. At the advanced life support level, we practice physician-level medicine--though a more restricted and focused practice. But we operate in uncontrolled and many times dangerous environments, and without the safety net and backup support of a hospital staff. If a critical intervention is required and we can't get it done, the patient dies, which is why every EMS provider has a moral obligation to go above and beyond the minimum requirements of education, preparation and readiness.
3. Always remember your patients are trusting you with their lives.
People have seen EMS portrayed on television and in movies and have expectations similar to those we all have of the rest of medicine. No matter what the problem is, once the patient gets to the doctor or hospital--or EMS gets to them--they believe we'll be able to fix what ails them and they'll be okay. That expectation of course may not always be realistic, but at a minimum all patients deserve to be treated by highly trained and highly motivated providers who will do everything they can to help those patients in their time of need.
4. Everyone gets to pick their primary care physician, but no one gets to pick their EMS provider.