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Emergency Medical Services: Time for a Truce

On a recent listserv I belong to, a question was posed about the five most pressing things in EMS that need to be addressed.

This listserv has a wide variety of members, including fire-based EMS, and the replies started rolling in quickly after just a few minutes. There were the standard answers such as bringing the EMS profession up to the level of law and fire, better education, requirements for a degree and evidence-based systems with appropriate oversight.

And then there it was; the one I had been waiting for finally appeared. Fire-based EMS pushes for the least amount of education, wants the minimum instead of what is right and probably shouldn’t be providing EMS. We all know that you can’t be a good paramedic and a good firefighter, and more time is spent on fire training than EMS.

The fight was then on. Posts started flying back and forth about what fire-based EMS does and what we don’t do, expectations that to be a good medic you must be singularly focused, and it went on and on.

Then came the question: Is EMS public safety or is it medicine? An answer provided by a pretty prominent EMS author basically said that if it’s a response to an accident, it’s public safety. If it’s to an illness, then it’s medicine and we better know what we’re doing.

He went on to say that “when the one he loves most has the big one, I'll hope for the prompt arrival of great BLS first-responders backed up by medical professionals who are there because they want to be and because they're competent, not because of their political affiliation.” Well said!

I’ve written here before that there’s no one best model for providing EMS in this great country of ours. I’ve seen excellent volunteer third-service systems, volunteer fire systems, hospital based, private ambulance, career fire, and combination systems. Some are a mix between two, where fire-based EMS is the first response and a third service provides the transport. All of these were providing a very high level of care, with patient care being the sole focus.

I’ve also seen, and written about, other agencies in these same types of systems providing less than desirable care. Poor attitudes, poor equipment and providing service because they have to. If you’ve been around for long, you’ve probably seen one of these systems.

My concern lies with the venom that is aired between all of these different service providers against each other. It’s like the rivalry between two professional sports teams (out here its Denver and Oakland or Denver and Kansas City); in some cases, the rivalry leads to hatred.

Rivalry in sports has recently led to violence: fans have ended up being beaten, stabbed and even shot while attending a game. Is this where we’re heading? Are we so polarized that we potentially hate any other service model that isn’t like us?

Collectively, we’ve been trying to move EMS forward for a long time. When I speak of “we,” it isn’t just fire-based; it’s all EMS providers who care about our profession. We have worked to improve training and education, improve our patient care through evidence-based research, designed better equipment and ambulances, and most recently, provided feedback on where EMS should reside in the federal government.

None of us have gotten wealthy from all of this. We have done this because we care about what we do and we want to provide the best possible care to our patients. It’s called making a difference. And whether it is for many patients or just one, true EMS professionals do this because we want to.

So, I propose we call a truce. We don’t need to be the Hatfields and McCoys, we don’t need the name-calling and we can’t afford to have it escalate to the point where it prevents all of us from moving forward.

We need to work together with a common goal of ensuring that everything we do results in outstanding patient care. We still won’t get rich, but we’ll be doing the right thing. And, I believe it’s possible. It won’t be easy, but it is possible. We just need to set aside our egos and attitudes and then focus on what is right.

Remember, as Thom from the listserv said (you know who you are), patients don’t care what color your rig is, what patch you have on your uniform, your agency affiliation or whether you’re a firefighter or not. The only thing they care about is that they get great care to treat their problem from competent medics who want to be there.

This is what we need to remember and what we all need to be striving for.

Norris W. Croom III, EMT-P, EFO, CMO, is the deputy chief of operations for the Castle Rock (Colo.) Fire and Rescue Department. He’s been a member of the EMS Section since 1998 and currently serves as the section’s director at large.

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