People who have read my previous blogs know that I am an
advocate of EMS changing. I am a firm believer in EMS personnel becoming the
true first line providers they should be. But good reader, I have met the enemy
and he is us. We all know that competent medic that looks at new research and
blows it off. He is the guy that has a great IV ratio but looked at 12 leads as
unnecessary. He is the guy that says
that sounds nice but it will never happen. When it does happen he is shocked.
Well that guy is part of the problem
Another problem is the medic that refuses to know anything
more than the protocols. He has no desire to understand the pathology of the
illnesses he treats. He looks at new advances as a pain because he has to
change his routine. This is the guy that probably judges his skills as a medic
based on scene time and being able to immobilize a patient so they can’t move.
So how do we change these people? One, engage them in
conversation. When doing this, point out things that were commonly held truths
in EMS that have been disproven. These guys are like you in that they want to
help people. Point out that Performing 12 as well as 15 lead EKG’s and early
activation of cath labs do not just save lives, they improve them. Ask them if
they remember things like the Oral Screw, rotating tourniquets, and wide open
IV’s. These people are your friends, colleagues, and mentors. Treat them as
such.
To those of us in states that require EMS services to work
with a resource hospital, learn to communicate with your Medical Director.
These people probably have to deal with multiple services and can’t tailor
their protocols to your service. Some services will actively oppose any change
because it will cost the more than they are willing to spend. Your service
might have medics that are so opposed to change that these Medical Directors
are not willing to allow you more leeway. Look at it like this, if you can’t
get all of your medics to perform a 12 lead, how can you expect to argue
effectively for high dose nitroglycerine for CHF.
I am speaking from experience. I work as a supervisor for a
service that is encountering many of these problems. When working to improve
things and move from traditional paradigms to evidence based models people have
to accept they can be wrong. This means me as well. I remember when Vasopressin
and the new drug that is going to save everybody. It was the new thing, and I
couldn’t wait to give it. I never did. Turns out that Vasopressin is no better
than Epi and was packaged in a manner that discouraged its use. It turns out
that there is no evidence that any antiarrhythmic drug has a positive effect on
patients having a neurologically intact return of spontaneous circulation.
Early BLS does though, and we should take that into consideration.
Now what I would like to see is a randomized trial of
patients being intubated and ETCO2 capnography in place to see the effects on
patient outcome. I know that in local experience it has improved the quality of
CPR, but that is anecdotal evidence. We need several randomized studies in
urban and rural locations. The studies need to be replicated for the new
mechanical CPR devices as well. These things show promise, but we need to find
out early if these things are good medicine or as another blogger calls it
quackery.
I value your feedback,
Lone Medic
