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Breaking EMS: Challenging 200 Years of Tradition

“How many of you think the status quo is fine? We won’t be flourishing or floundering, but pretty much staying right where we are?” Dan Swayze, DrPH, MBA, MEMS asked attendees this question at his EMS World Expo session, “Breaking EMS: Critical Lessons Learned from Challenging 200 Years of Tradition.” No one raised their hands. He followed, “If we continue to do the things the way we’re doing them today, how many of you think we will be floundering in the future?” Most hands shot up.

“The largest army you will ever face are the defenders of the status quo when you try to be a change agent,” said Swayze. EMS has been functioning uninterrupted for the last 200 years, and it shows (this encompasses care that pre-dates our modern system, like battlefield medicine and retrieving troops via makeshift ambulances to transport them to hospitals). The same problems persist in plaguing our industry—insufficient funding, lacking resources, and low retention and recruitment. Most people believe they could solve their organization’s problems if only they had more money. This is not the case, according to Swayze, who works for a billion-dollar company and claims it, too, is burdened with the same issues any small company has. A bigger budget just means bigger problems. No leaders go without struggle.

Swayze said there are two types of leaders. Type 1 is known for being the best ever at what they do, and they got to their position because they grind. Type 2 is known for being the first ever—they’re the pioneers who take things from good to great. The latter is the kind of leader EMS needs if we want to make true progress.

“You’re not going to be popular with the status quo people if you’re trying to be an agent of change,” said Swayze. But the end result could be revolutionary. Most famous inventors and trailblazers, especially in the medical community, were told by their peers that they were crazy, yet their brazenness is the reason why we have some of the lifesaving medical interventions we have today.

Though not a healthcare provider, a modern trailblazer to look to is Elon Musk, who said, “About the worst thing we can do is ask our engineers to optimize a system that does not work.” Swayze says we must view EMS the same way. Medical transportation, for example, only improves patient outcomes by about 15%, but we do it all the time anyway. We need to find the inspiration to stop trying to improve bad practices, he said, and either develop new ones or just try existing ones that haven’t gained traction yet.

“Innovation is trying something that’s new to you. It doesn’t require you to come up with the idea,” said Swayze. “Go talk to people who are already doing this. It’s not brand new, just new to you in your industry.” He likened this to his initiative to authorize paramedics to administer immunizations in Pennsylvania, much to the dismay of public health nurses and legislators. But his success in getting this change enacted proved itself worthy when H1N1 hit and 17,000 paramedics were able to help administer seven million immunizations—something that could not have been done with the number of nurses they had.

Swayze offered the following guidelines to be an agent of change:

  • Follow the familiar if you’re unsure where to start. When Swayze started working as a community paramedic, he felt naked with just a clipboard and no cot and AED in tow, so he followed an experienced community health worker to learn the lay of the land.
  • Start small. After consistent lobbying, Swayze managed to acquire one patient who agreed to be followed in a pilot community paramedicine program. He used their success story to propel the now-flourishing CP program.
  • Learn to fail. Failure is critical, but it’s never fun and rarely fast.
  • Welcome change, and if someone tells you you’re wrong (and you are), don’t defend yourself.
  • Don’t be married to your ideas. Look different and think outside the box.
  • Build a tribe. Find your first followers to support your cause—the people who think like you. Use networking opportunities like conferences to learn new things and meet new people, because you can’t do this alone.
  • Start. Period. “The process of getting started is the most important step. Challenge yourself and the way you do things,” said Swayze. “Be willing to experiment. Break the rules that are set for us and find our own pathways forward. It’s the only way to facilitate change as the leaders of our industry."



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