I was part of a brand new movement in medicine. 40 years or so later, I’m trying to make sense of what it has become. It seems I’ve been subjecting you to standards of an old paradigm that is in its death throes today. Forgive me! But there’s still enough of it left living in today’s EMS culture that it might be useful for us to explore how it effects EMS.
Every day I read a good 100+ posts on EMTlife.com (I’m a Community Leader there) and it is there I get to notice trends and patterns. One of the trends is I keep missing something! I’ve got a MAJOR blind spot, kind of like I’m thinking I’m still in Brooklyn when I’m really in…
Back in my day, the “idea” of the paramedic program was more complex than just saving a few lives here and there. It was based on a movement by our society to extend the capabilities of modern medicine out into the streets where everyone, no matter the circumstances, would have access to sophisticated pre-hospital emergency care and transportation.
The future I envisioned then included steady advances in technique, internal organization and checks and balances, equal distribution of services to the public, required advanced education, inter-agency cooperation, career paths, adequate compensation, improving working conditions, respect from the community, and comprehensive physical and emotional support for its workers.
Our populace DESERVES the BEST when it comes down to Emergency Intervention. That was the guiding light that got all of us here, don’t you agree? But somewhere along the line something has gone wrong so that now, enough to get by is enough; on EVERYBODY’S end. What happened?
The “profession” I thought I was getting in to was one where, as our technology and medical knowledge grew, it would be Standard Operating Procedure that those committing their working life to the cause would be able to grow with the profession and be able to make those advances available to the populace. Along with advances in their ability to serve would come acknowledgment and a cycle would begin of hands helping hands.
So much for adolescent dreams!
That would mean making sure that even if the heavy duty tools and protocols weren’t used much, the medics that showed up to your house had them available, knew how to use them and could if they needed to. The idea was to plug as many holes in a leaky patient as quickly and efficiently as posssible because that was what the public wanted as well; they deserved the best; all of them. What have they gotten?.
What I hear now is a lot of medics questioning their own validity, in a few words, it goes something like this:
We’re learning so many of our advanced procedures don’t do all that much good for long-term recovery, so, really, how much do you need ALS? Why bother having two paramedics on board when the evidence shows that for most of our patients, Load and Go will suffice? Hell, most of our calls are about IFT, what kind of training do we REALLY need?
And for me, a continuing disturbing trend is the one where more and more often medics are claiming that if they found themselves off-duty and in the middle of a medical or traumatic emergency they would refrain from assisting or even identifying themselves as medics for fear of litigation, or the risk of getting harmed in real or fantastically imagined ways.
It almost seems like we’re seeking reasons to minimize our impact on our populace. Why? So we don’t have to invest in our communities? So we don’t have to really educate ourselves? So we really don’t have to take the time to mold this into a real profession? What’s up with that? Why are so many of US beginning to say things like:
Really, if you do a cost-benefit analysis, the paramedic program doesn’t pay! Let’s get by with the minimum service we can get away with.
So, in a thread I started, I asked “What happened and what can YOU do to change this?”
One of the responses was from a soon-to-be physician with a background in EMS, Veneficus. I think his response is worth reprinting here in its entirety with some of my comments. I’d like you to seriously consider some of his points because he enlightened me on what IS rather than what I’d hoped would be. He begins:
Having been involved during the time of the transition, I think that while we still try to save as many as possible, at least I do, using the most sophisticated knowledge and technology available, many things have changed.
Most importantly, we have realized there are things worse than death.
There was a time when we got a pulse back and delivered this person to the ER (not ED, as it was usually a room) if that person sat in a medically induced vegatative state until they either died of pneumonia, sepsis, or a court or family finally pulled the plug, it was a win.
Not because the person might wake up or live again, but we wanted and perhpas as humans needed to prove we could defeat death with science and our will.
We are now realizing how foolish that notion is.
Vene’s opening passage was particularly annoying to me because I so much believed in what I was doing; that every time I brought someone’s pulse and breathing back he or she was a “save!” Even though I suspected I was contributing to filling my community with “Cardiac Cripples” I had no idea how dangerous were the drugs that the best of medicine at the time gave me to use.
Considering that there is NOTHING in the philosophy of EMS that has really changed; namely that we’re still going out after death with a vengeance and using aggressive treatments in the streets to combat it, I still insist 20 years from today you, too, will be lamenting over the total uselessness of what you did back then! Vene goes on:
Society has changed.
Many of us old folks grew up in a society of helping your neighbor and your neighbor would help you. For no other reason than you were neighbors. A community pooling together to survive and prosper.
Now the US is an “every man for himself” society. Even the very possibility of the common good is considered distasteful and an antithesis to the very values of the US.
It is one thing to risk your life and health for somebody who might watch out for you or your kid. Let you borrow a cup of sugar, or help you in a nonmedical way if you needed.
It is quite something else to take such a risk for a person who would shoot or stab you for “not doing enough” or at least threaten to sue you for all you had. If they outright didn’t just to make the whole event profitable for themsleves or their lawyer.
Everybody’s a stranger is what he’s saying. I have to laugh at my own idiocy! Let’s look at what the U.S. population has done since I’ve been born (1951):
Damn near doubled, hasn’t it? I concede to you all I grew up in an incredibly different world than you’re in. Your life is filled with twice as many people in your space. The way we have been taught to deal is to draw more closely into ourselves. I got it.
I have to remind myself though to be gentle on ME! I continue to live in an insulated, sparsely populated environment (150,000) on an island in the most isolated part of the Earth! I confess; I still live in a bubble and am out of touch!
But still, turning your back on someone who falls down right alongside of you and may be in serious danger? Vene makes a great observation:
Biology has changed.
Over time, new viruses and bacteria have evolved. Being up to your elbows in blood (literally, even surgeons were not using gloves) or putting your lips on a stranger for mouth to mouth meant you were no more likely to get something that you didn’t already have.
But things are different, now you can get diseases that you cannot see or feel but will not only kill you, but degrade your very life to torture doing it.
I honestly hadn’t taken that into consideration. There truly appear to be a lot more “Nasties” around today than there were in my time and that would have to include the people we serve. Vene goes on to say:
At one point, the idea of these responding providers, was a community investment. They collectively paid a little for a service they may need. They valued that piece of mind, insurance, if you will.
The idea of everyone benefitinng was something they were willing to sacrifice for.
Now if you are sick, it is your problem, why should I have to sacrifice to help you? With no promises of a positive outcome?
An interesting point. Our populace is more concerned with their personal well-being than they are concerned that EVERYONE has fair access to services. Coming together to raise everybody is no longer in our ethics. That’s a pretty chilling observation but it might very well be true. Vene hits another target:
Our understanding of disease has changed.
(some are slower than others to catch on)
We thought people suddenly and unpredicatably suffered from things like heart attacks.
We know now most diseases are neither sudden nor unpredictable.
With the management of chronic disease, including things we used to simply attribute to “getting old” sometimes by the time EMS is called to intervene, the person is well beyond the help of modern medicine.
This reflects my contention that while my job was attacking acute diseases — and not having a whole lot of success with it — yours seems to be management of chronic states until you can get them to the hospitals. But the same thing that happened to me is happening to you. According to Vene:
We spent money we didn’t have, on things that didn’t help.
We mandated care, even if people could not pay, without setting up a way to make this sustainable.
It not only caused some people/groups to take impossible losses, but it drove up the costs for everyone else.
…and if you start to follow the money, you better get real about the driving forces that power medicine in the U.S. today as well…
We also try to make substantial profits off of other people getting sick. It literally benefits somebody if somebody else is not well.
What a sad truth this is, but is not profit intertwined in every facet of medicine today? How that little word has the power to distort our very intent, and Vene’s conclusion is not all that encouraging.
Finally, we lost sight of what medicine is supposed to be.
A helping hand when things go wrong.
Now we destroy ourselves with our diets and activities and think medicine is simply resetting to the beginning as opposed to help in living with whatever we did.
Like belief in the divine, we now believe in the miracle of medicine. At the very least we want to.
It appears that modern medicine is still in its infancy, it is showing us its limitations and asking us to re-work the way we’re using it. Can you see how EMS can play a part in that re-definition?