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Be the Backbone

Rommie Duckworth

There are 207 bones in the human body. Conversely, EMS organizations wishing to improve typically have four, veteran paramedic and educator Rommie Duckworth told EMS Today attendees during Wednesday’s opening keynote in Tampa:

  • Wishbones, who always wish things were different;
  • Jawbones, who always talk about making things different;
  • Knucklebones, who always knock down the new and different; and
  • Backbones, who provide the structural strength to raise organizations up through difficult times.

As EMS grows into a full-fledged science-driven healthcare profession, that’s the strength it needs, said Duckworth, EMS coordinator for the Ridgefield (Conn.) Fire Department—to work together, to champion what’s right, and to make our own decisions before others make them for us.

An average person won’t make it in a field where diet, stress, and the rigors of the job can grind you relentlessly down. To maintain strong individuals, strong organizations need to provide the needed support and resources—to be a family when members can’t stand alone.

Duckworth told of a case from roughly a decade ago: The husband in an older couple developed shortness of breath on Thanksgiving. Everything about the call was difficult: He was in a second-floor bathroom, between toilet and tub, and providers struggled to help him breathe and raise his sats. Those troubles continued in transit and at the ED. Saying good-bye to the wife as the crew departed the hospital, Duckworth told the woman they’d done everything they could but honestly it didn’t look good.

Afterward, he said, it felt like a failure.

A few weeks later came a letter: The man had indeed died. But the wife wrote to say how much she’d appreciated the crew’s kindness and concern.

“Every single one of you has a story like this,” Duckworth said, even if they don’t produce cards or notes. What they demonstrate is the immense opportunity EMS has to impact lives, even when a specific outcome may not be happy. With quick calculations of audience size and call volumes, he estimated Wednesday’s crowd may impact half a million such lives a year between patients and their families.

That value can’t be maximized, however, in a field that’s fractured and isolated and by medics handcuffed in bad systems. That’s why those in the field must be strong enough to learn from their mistakes and improve moving forward.

It requires discomfort: recognizing problems and acting to solve them. “Comfortable people don’t [solve] anything,” Duckworth noted. “I want you to feel challenged. I want you to feel motivated and recognize the power you already have and be prepared to change the EMS landscape.”

It can start small—one change in one service. Shows of hands demonstrated those whose systems were taking forward steps like using point-of-care ultrasound, creating community paramedicine/mobile integrated healthcare programs, and improving rates of neurologically intact survival from cardiac arrest. Those grow and reach critical mass, and a profession changes.

Duckworth cited the creator of judo, a 19th-century Japanese doctor named Jigoro Kano. Though a master of his craft, Kano, when he died, opted to be buried in the white belt of a beginner rather then the black belt of an expert—it signified he would always be a student. Similarly, Duckworth said, we must be strong enough to learn and say, “I’ve learned, and I want to work with you.”


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