I work in Illinois EMS and I complain about how it is administered. If you know me you know that is not surprising. Illinois EMS has a system where 90% of EMS is administered by nurses. A lot of these nurses are good people who try to perform their job with the best goals in mind. EMS agencies are required to join EMS systems that are administered by these nurses. While there is a physician above them, this Dr. has no real knowledge of the people that work for him or her unless they transport to his or her hospital. So we wind up with cookie cutter solutions that only work for the people they see. Because there is no real interaction, the protocols tend to be designed to hold back the exceptional to ensure that people they never see do not screw up.
So, how can we fix this problem? My solution is that we require the systems to become modular. Each resource hospital has a set of base line protocols, and then has modular enhancements. These modular enhancements might include mechanical CPR, field clearance of C-spine, community paramedicine, and Critical Care Transport. These are just examples obviously, but it would be a start. Allow the providers to know what they have to do in order to allow these things to happen. Then you allow them to do it. Voila, a simple solution to a real problem.
The best solution is to allow agencies the option to allow EMS providers to hire their own Medical Director. This would allow for EMS agencies to put into place the protocols that actually serve their patients and communities best. But the reality is that this is not going to happen soon. Despite this being the reality on all surrounding states, Illinois resists change more than any other state. So we need to consider modular systems. It at least allows us to move in a more modern direction, instead of being stuck in 2002.
Now this is only slightly related, but I am going to encourage you to join the NAEMT and your state EMT association. The NRA is one of the most effective best lobbying groups out there for a reason. That reason is membership. NRA members donate and teach the majority of the gun safety classes out there. These things raise revenue for the NRA to lobby for gun rights. The NAEMT is that for EMS, yet less than 1% of EMS personnel are members. NAEMT membership pays for its self in discounts and benefits, while allowing for better representation at the Federal level. Most states have similar statewide organizations. NAEMT also provides AMLS and PHTLS as both an educational and fundraising opportunities. Please take these courses. They benefit you greatly.
As always, I value your comments and feedback,