EMS 2.0 – What are our Core Beliefs?

Building a foundation.

A comment I got on my last post – EMS 2.0 – Momentum Building – from Timothy Clemans has inspired me to write this post. He stated that EMS should develop our set of core beliefs. Click over to go read it, and then please come back because this is a participatory event.

Second Edit: I didn’t finish writing this as soon as I wanted to, and Ambulance Driver got out a post I want to answer, but yesterday and most of today have been blogging days off. So expect my answers to the issues raised by our respected friend AD

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What should we state are the core beliefs of the “EMS 2.0 Movement” as it’s being called now on Twitter, Google Groups, and as I’m sure by the time I get this finished, all over the interwebs? What are our core beliefs, the truths we hold to be self evident? What are our virtues and our rallying cry to fend off the slings and arrows that are sure to be launched at our group as we sally forth to set right what we see wrong in EMS today?

Here’s the deal, I’m from the country. I love country music (Yea? So?) and one of the songs I like is from INSERT NAME OF ARTIST HERE. In it, the HE sings “You’ve got to stand for something or you’ll fall for anything”. I believe in that. It actually shapes my political beliefs quite a bit. Here’s why, there is so much happening out there that one single human being cannot possibly keep up with it and form a coherent opinion on everything. Even if you tried, you’d still be basing some opinions on some shoddy reasoning and incomplete information. This is why I pay more attention to what I believe as a person. I have tried to develop my sense of right and wrong, and use that as a filter to determine whether a belief is good or bad.

That’s what we should do with EMS 2.0, in my opinion as someone who writes about it as a concept and yearns for change in my profession. We should develop our core beliefs and possibly a statement of our mission and use them as a filter to determine our stance and actions to take as we move forward. They must be general, universally acceptable, and applicable to a broad range of circumstance.

They should be the ethical standards that guide our progress.

And no, they cannot come directly from me and they will not be easy to implement. They must be collaborative and engaging to as many people as possible in order to have broad appeal and effectiveness.

So here’s what I’m going to do:

I’m going to write my thoughts on them, and my recommendations on what I think they should be. I ask you to comment on what I’ve written and add your own thoughts. If you have a blog, please link to any posts you’ve posted. Please join the Google Groups and follow EMS2Movement, (and ME too!) on Twitter. Participate and grow this. If we can harness the thoughts, feelings, and ideas of the multitude of EMS people out there from across the nation and the world, we’ve really got something here.

EMS is truly on the brink of something very exciting. Yes, I know you’ve heard that before and you have your doubts about whether anyone can actually do anything to fix what you see as being wrong with the profession. I say that EMS has never had what it has now, we have never had the EMS blogosphere and online communities bringing forth cooperative and collaborative voices in such a powerful way as now. Through our efforts we can bring positive change. We can set the tone and the direction for our profession to follow and set forth to improve emergency care for everyone.

It will be a long road, but through cooperation and collaboration, we can start the journey together.

And that’s powerful stuff.

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Proposed Mission Statement for EMS 2.0 – By: Chris Kaiser (Ckemtp)

“EMS 2.0 is the common name for a group of interested professionals within the Emergency Medical Services that strive for excellent and ever improving patient care within our communities. We will work to establish guidelines for EMS professional education, common licensure and certification standards, evidenced based medical care protocols, and professional ownership of EMS by paramedics and Emergency Medical Technicians. We will establish strategies for improving compensation and working conditions for our fellow professionals as well as strategies for increasing our service level to individual communities in the face of dwindling resources and revenue by developing new services and revenue streams for our industry. Our focus will be intentionally broad and collaborative and will serve to encompass the spectrum of well thought and tested ideas through research, communication, and self-regulation of our profession.”

Proposed “Core Beliefs” for EMS 2.0 – By Chris Kaiser (Ckemtp)

  • Emergency Medical Care is a right, not a privilege for those members of our society truly experiencing a life threatening emergency. Communities must fund EMS as they would fund any other essential public service.  
  • EMTs and Paramedics are members of a profession serving the most basic of human needs and the most diverse of all patient populations. We must attain the tools necessary to serve our mission through education and flexibility.
  • EMS providers must seek out new educational opportunities and work within regulatory systems to allow new knowledge to be translated to our care.

I’ll add more later. What are your ideas?

  • Ambulance_Driver

    Agreed, although we differ on semantics.

    From my libertarian viewpoint, I don't believe health care is a right. A right is something imbued of all men. Neither governments nor individuals can grant rights.

    Our rights are God-given, or if you don't believe in a diety, they are the founding principles of freedoms, intrinsic to all men.

    Our own Bill of Rights did not grant us anything; it merely codified the fact that our government cannot deny the rights intrinsic to all free people. They were there before there were governments.

    As the saying goes, “You're rights end where mine begin.” As such, if you believe health care is a human right, something you are entitled to from birth, then it stands to reason that someone should be required to provide that health care for you.

    You cannot require, by law, for one person to provide a service another. It may be a moral imperative, but when you try to codify that into law, what you're doing is enslaving the person providing the service.

    The other person's rights end where mine begin.

    I'd say more, but I fear I'm only going to veer off into a libertarian rant about taxation, so I'll shut up now. ;)

  • http://www.lifeunderthelights.com Ckemtp

    I don't do politics much here on my blog… because I believe that the discourse, or at least what passes for it these days, is already so polarized that real work on issues isn't getting done.

    However, with that said. I believe in pretty much everything you've said and my political beliefs are of the fact that individualism is the most important trait that a person can have. I know that your right to swing your fist ends at my nose and I believe in the principles of our founding fathers.

    However, as a civil society, we have an obligation to help those truly in need. If someone is truly in need of help, I feel a moral obligation to help them. Yes, it probably stems from my religious beliefs. It also stems from my roots in the rural midwest, where when a person calls 911 their neighbor gets out of bed to help them. I believe in that, and in a life or death situation, it is a person's right to believe that good people will stand up and help them.

    That's what I meant. Not the compulsory health work that some are trying to mandate. Healthcare must be profitable to pay the people that do it for a living.

    I'm sure that I'll get more on this topic later. Right now there's a bonfire burning and brats on the grill. The kids are running around playing and ghost stories are in the air. A great Midwestern Fall night.

  • http://thehappymedic.com the Happy Medic

    I agree to a point AD, but is not the soldier who stands to defend my family a volunteer who believes my family has a fundamental right not to be killed by a foreign invader? He is not enslaved to the cause. Granted the Constitution has no requirement for the Army to do that, but it also says nothing about corporations being individuals and covered under the first amendment. But that has been interpreted as a “fundamental right.”
    I think we all agree with CK's intent that we owe it to each other to make available a common resource when our fellow human beings are in peril.
    You can't require by law one person to do something for another, but some of us are just wired that way. if they don't want to provide the service, they're welcome to find another line of work.
    Well said, AD.

  • Ambulance_Driver

    I agree. However, “provide for the common defense” is already enumerated in the Preamble to the Constitution, and elsewhere. It is an identified function of government, whereas health care is not.

    I agree with CK in that, morally and ethically, we owe it to one another as human beings to care for one another, be it health care or otherwise, and I have no objection to our government providing structure to that.

    The problem is one of responsibility. Regardless of what may be said, reforming health care – including EMS 2.0 – is not about access, but in financing it all.

    And if the most common end-user of EMS continues to have zero financial stake in paying for the service, there will be zero incentive to use it wisely. EMS is never truly going to be Emergency Medical Services until that problem is addressed.

    These are the type of wet blanket arguments that often extinguish the idealism behind such ideas as EMS 2.0, but they are valid arguments.

    You guys keep plugging, though. As I said in my post, revolution is often accomplished by the dreamers who were too hardheaded or naive to know that what they were doing was impossible.

    Here's to hardheaded dreamers, I say!

  • Ambulance_Driver

    I agree. However, “provide for the common defense” is already enumerated in the Preamble to the Constitution, and elsewhere. It is an identified function of government, whereas health care is not.

    I agree with CK in that, morally and ethically, we owe it to one another as human beings to care for one another, be it health care or otherwise, and I have no objection to our government providing structure to that.

    The problem is one of responsibility. Regardless of what may be said, reforming health care – including EMS 2.0 – is not about access, but in financing it all.

    And if the most common end-user of EMS continues to have zero financial stake in paying for the service, there will be zero incentive to use it wisely. EMS is never truly going to be Emergency Medical Services until that problem is addressed.

    These are the type of wet blanket arguments that often extinguish the idealism behind such ideas as EMS 2.0, but they are valid arguments.

    You guys keep plugging, though. As I said in my post, revolution is often accomplished by the dreamers who were too hardheaded or naive to know that what they were doing was impossible.

    Here's to hardheaded dreamers, I say!

  • http://twitter.com/firehat firehat

    I am intrigued by what you guys are pushing here but am not optimistic. AD said it best about the hard-headed dreamers and far be it from me to rain on your mission; it is certainly worthy of undertaking. I am just not sure that the EMS system in this country can be reformed into what you are advocating. Rural volunteer EMS services, for-profit companies running 911 on the side, and fire-based EMS appended to the mission as an afterthought are incompatible, in my admittedly cynical view, with things like evidence-based medicine. Until the fire service and EMS world are not alternatives to professional careers but merely different kinds of professional careers we will not see change.

    This is a question I have considered in great depth on the fire side. Until this service is no longer a refuge for people who “just don't like school” we will not move forward. In my opinion EMS is even further out of touch than the mainstream fire service. Our people aren't even equipped to know what evidence-based medicine is, much less understand how to use it.

  • http://twitter.com/firehat firehat

    Allow me to amend my terms a bit:

    You are advocating a system based on education. Our current system is based on training. But our whole system, throughout its history, in every facet, has been education-averse and often downright hostile to education.

    A second comment that will probably come off as an ad hominem attack but isn't: if you're a firefighter too then why are you discussing EMS in a vacuum? EMS is inextricably linked to the fire service all over the country, even where FD's don't provide transport.

  • http://www.lifeunderthelights.com Ckemtp

    EMS is not “inextricably linked to the fire service”

    No, nope. Naw. No how. Not going to buy it.

    I love firefighting. I do. Really, it's fun and awesome and stuff. Big trucks, risk, tradition, camaraderie. All that's just great and I love to have it in my life.

    But I believe in “EMS based EMS”. Do you think that the US fire service believes in that? Ask yourself truthfully. I believe that EMS is a healthcare profession. We're inextricably linked to healthcare, and physicians, and hospitals and stuff. Every bit of what we do is linked to that. EMS is not linked to fire just because fire says it is.

    Your post didn't come off as an attack, well it did a bit but I wouldn't be a blogger if I didn't have thick skin. I'm used to firefighters taking shots at me because I love EMS and try to excel at it. I will support Fire Based EMS if and only if they treat EMS as seriously as it deserves to be treated. Most don't so I don't support them. It's the same way that I don't support any other delivery model that doesn't treat EMS with the respect it deserves. Private services that put transport revenue in front of good patient care or equipment? Nope. Hospitals that treat their EMTs as bastard step-children? No how.

    EMS 2.0 is a grassroots movement. EMS has been goverened by paternalistic groups trying to control us for too long. We should be controlled by science, education, and what is best for the patient and society. Those are our moral and ethical principles. Yes, we have a long way to go. Yes, it will be extremely challenging. Yes, idealistic dreamers like me have spouted off like this before.

    However, I ask a few simple things of the naysayers: Do you know how many people are reading the thoughts of those of us touting EMS 2.0? Compare that to the media types before the blogosphere took off… do they have the interactivity that those of us in the blogosphere do? You personally got to reach out and add your thoughts and ideas. Have you ever got to do that with any other medium?

    We have something here on this blog and on every other blog out there. We have momentum and the ability to connect every EMS person out there. We're rising from the street-level provider up.

    My friend, I welcome your voice. Please challenge us. We are strengthened by scrutiny and hardened by criticism. Ideas earn respect through challenge and examination. We need you to collaborate with us.

    Glad to have you on board

  • http://twitter.com/firehat firehat

    America's extant EMS system certainly is inextricably linked to the fire service. The last JEMS survey I saw showed that something like 90% of EMS first response is done by fire departments. I would argue, anecdotally of course,that where EMS transport is taken most seriously is within fire departments. The other most common form of transport service is for-profits with a 911 contract; if you think they offer a better or more professional product than even an unhappy FD I'll just have to disagree with you. So I guess I'll rephrase: good EMS is inextricably linked to the fire service. For-profits companies generally do a very poor job on several different levels and hospitals are rarely involved in running ambulances (and lack the cultural inclination to manage it correctly anyway).

    Of course most FD's don't care about EMS (or outright hate it) and of course EMS properly belongs as a health profession. But you are talking about the way things ought to be and I am talking about the way things are. As I said in my first post above, your goal would require nothing short of a complete revolution: the destruction of the current EMS system and rebuilding it from scratch (organizationally).

    And briefly, to address your note that EMS is not properly fire-based: I completely disagree with that notion because of the unique environment encountered in the field. Physicians and nurses in the American system are in no way prepared to deal with the realities of the scene, much less scene management. The mindsets are just too different and the mindset required for EMS closely matches that required for fire/hazmat. That's why it's a natural fit.

  • http://www.lifeunderthelights.com Ckemtp

    My esteemed colleague, I must respectfully disagree with some of your points and agree on some others. That's how a good discussion takes place we can probably agree.

    Invariably, when talking about change in the US EMS system, the issue of Fire-Based EMS Vs. The World rears its head and I've never seen the argument lead to a productive end. I have my opinions on the matter and I've written about them before on this very blog. Admittedly, however, this is an issue that I try to avoid due to the sheer amount of venom that it can cause to be spewed forth upon any web page that dares mention the heresy that Fire-Based EMS may not, in fact, be the end-all-be-all for EMS.

    That's why my stated policy is that I support “EMS based EMS”. Nothing more and nothing less suits my goals for the profession. We all serve our patients and our communities. Some of us do so better than others, some systems are better than others. I've said that I don't support Fire-Based EMS systems that treat EMS like the bastard step children of the shiny red trucks. I stand by that.

    In your comment, you stated that EMS is taken most seriously within the realm of the fire department. I can counter with anecdotal evidence, but I choose not to do that here in this comment. I counter with the following:

    114 to 6.

    If you are familiar with EMS as you could be, I am sure that you are aware of the Commission on Accreditation of Ambulance Services, or “CAAS”. In my opinion, it represents the highest level of quality measurement in US EMS. There are 120 accredited ambulance services in the US today.

    Of those, 114 are non-fire based. 6 are fire based.

    Does that mean that the CAAS is biased against the fire departments? Perhaps. Does it mean that non-fire-based EMS services must try harder in order to convince the governments that oversee them and the public that the governments answer to that they are meeting their expectations? Perhaps as well.

    You stated: “Of course most FD's don't care about EMS (or outright hate it) and of course EMS properly belongs as a health profession”

    Really? Did you just say that “Good EMS is inextricably linked to people that don't care about EMS (or outright hate it)”?

    Seriously? THAT's your argument?

    No… I won't tear you apart on that one because I'm the blogger and you're someone who I really, honestly appreciate coming to my blog and it's not my practice to cut someone down because of something they may have mistyped. I'll trust that you didn't mean to say it that way. You have that luxury and I do not. It's just the way it is because I'm the one who's the author of an EMS website.

    I've been in EMS full-time in multiple capacities for more than the last decade. There are plenty of people out there with more knowledge and experience than I and I respect their, and your opinions. However, perhaps the reason I am working so hard to “reboot” EMS is because of the opinion that I've seen to be so rampant through EMS is just what you've said… that EMS is seen to be best performed by people who hate it.

    In my experience in the field I've seen the “Unique” environment of which you speak. It is wild and wooley, isn't it? Yea, it sure is unique and isn't experienced in any other realm of healthcare. The field environment unique to EMS is unique to EMS. What, like 90% of our calls are to private residences that aren't on fire? Yea, sure is unique to EMS. EMS scene management sure is unique to EMS and is best handled by EMS professionals. Whatever mindset that “Closely Matches” that needed by an EMS professional is irrelevant. EMS professionals are best for handling the scene environment unique to EMS, right?

    I'm a firefighter too, and I'm proud to be one. I've been a firefighter longer than I've been a paramedic. I'm pretty darn good at firefighting and I try to be the absolute best I can be at paramedicine. I don't hate it, and I certainly care about it.

    And isn't that what's best for EMS?

    No matter the patch, or lack thereof, on your sleeve. EMS based EMS rules the day. I don't care if you arrive on a fire truck, a hospital based fly-car, or a freakin' hearse. You better be bringing your best to the profession… or you're not in my camp.

    Agreed?

  • http://twitter.com/firehat firehat

    My argument is simply that, while most fire departments do not take EMS seriously enough, EMS is still done best by fire departments. Even an FD that regards EMS as an afterthought will generally do it better than a private service running 911 just to get a transfer contract. There is no contradiction there.

    I trust you would never argue that something that gets by 90% of the time is adequate in any emergency service. So why would you argue that 90% of the time EMS does not require skills that are not found in other healthcare disciplines? Yes, a nurse or doctor or ED-based paramedic will perform adequately at the bedside in a house. Will they do so down in a ditch with a fuel leak and the car upside down? That's not solely an experiential difference; it is also a different worldview.

  • http://twitter.com/firehat firehat

    At any rate, I think we're beating a dead horse. I am not saying FD's are the best options for EMS. I am simply saying that the current EMS system is best performed by fire departments.

    I agree with your EMS 2.0 notion but I believe it points to more of a French model. And as I've said, I believe it would require an outright revolution.

  • http://thehappymedic.com the Happy Medic

    :-)

  • http://thehappymedic.com the Happy Medic

    Both of you need to realize that beating a dead horse is NOT outside of your scope of practice.

    A great discussion here, CK and firehat. as someone trapped straddling the fence (by choice) I can tell you that without fire resources many communities would struggle to provide services under their current requirements. But as Rogue and AD will remind us, those numbers are based on the AHA and their belief that people are beginning the chain of survival before we arrive.

    We have to make ALS calls within 8 minutes and BLS calls within 5. Backwards, yes, but only because we could never meet the 5 minute ALS standard because we built the ALS framework on top of the BLS frame.

    EMS is not connected to the fire service any more than Motorcop is connected to directing traffic. Sure a traffic department would be better, but many communities can't afford people jsut to write tickets and re-direct traffic.

    It comes down to how EMS landed in the fire service to begin with – A budget looking for a mission. While the Chiefs that were sat at teh table wondering how to keep their call volume up and justify all the resources scattered throughout their jurisdictions, the sirens of passing ambulances lit a bulb over their heads.
    “If we go where they're going, we'll never be slow!”

    It was a brilliant idea that was horribly implemented in most of he nation. Now it has morphed into an ALS Ladder Truck mentality where sending a $750,000 5 man truck for an asthma attack is justified. Take that medic and put him in a car, on a bike, or *gasp* put him in an ambulance and let's make some sense out of all this.

    For now, we need each other. Fire needs the business and EMS needs the man power.

    The goal of EMS 2.0, when I first envisioned my perfect system, let's us stretch man power by allowing medics to be trained to refuse an ambulance to those who truly don't need it.

    A cardinal sin today, a reality tomorrow? if I have something to say about it, then yes.

    Keep up the discussion guys, this is what has been missing every other time this has been tried. Keep the channels open.
    HM

  • Ambulance_Driver

    Inextricably linked, Firehat?

    And this is not an ad hominem attack on you or the fire service, but why does a discussion of EMS need involve the fire service?

    You say “inextricably linked,” and that may be so in many cities.

    But is that a good thing?

  • Ambulance_Driver

    How many times have you heard this statement?

    “There is no room for improvisation on the fireground.”

    I've heard it from many of my firefighter colleagues, and I would submit that if you ever run an EMS call that doesn't involve some level of improvisation, I'll eat my hat.

    That's a significant difference in mindset right there, Firehat.

    I'll readily concede that there may be fire departments out there that could do a great job with EMS… with could being the operative word.

    But when your call mix is 80/20 EMS vs fire suppression, and your training, promotional pathways and budgeting is 80/20 the other way, that in my mind does not seem like a department takes EMS seriously.

    EMS may indeed be a natural fit, for the fire department's needs. For EMS's needs, not so much.

  • Ambulance_Driver

    I actually did a 3 part series of columns on this very subject, Happy Medic. Go to EMS1.com and look up “Marriage Counseling: The Dysfunctional Fire/EMS Relationship.”

  • Ambulance_Driver

    Inextricably linked, Firehat?

    And this is not an ad hominem attack on you or the fire service, but why does a discussion of EMS need involve the fire service?

    You say “inextricably linked,” and that may be so in many cities.

    But is that a good thing?

  • Ambulance_Driver

    How many times have you heard this statement?

    “There is no room for improvisation on the fireground.”

    I've heard it from many of my firefighter colleagues, and I would submit that if you ever run an EMS call that doesn't involve some level of improvisation, I'll eat my hat.

    That's a significant difference in mindset right there, Firehat.

    I'll readily concede that there may be fire departments out there that could do a great job with EMS… with could being the operative word.

    But when your call mix is 80/20 EMS vs fire suppression, and your training, promotional pathways and budgeting is 80/20 the other way, that in my mind does not seem like a department takes EMS seriously.

    EMS may indeed be a natural fit, for the fire department's needs. For EMS's needs, not so much.

  • Ambulance_Driver

    I actually did a 3 part series of columns on this very subject, Happy Medic. Go to EMS1.com and look up “Marriage Counseling: The Dysfunctional Fire/EMS Relationship.”

  • Ambulance_Driver

    Inextricably linked, Firehat?

    And this is not an ad hominem attack on you or the fire service, but why does a discussion of EMS need involve the fire service?

    You say “inextricably linked,” and that may be so in many cities.

    But is that a good thing?

  • Ambulance_Driver

    How many times have you heard this statement?

    “There is no room for improvisation on the fireground.”

    I've heard it from many of my firefighter colleagues, and I would submit that if you ever run an EMS call that doesn't involve some level of improvisation, I'll eat my hat.

    That's a significant difference in mindset right there, Firehat.

    I'll readily concede that there may be fire departments out there that could do a great job with EMS… with could being the operative word.

    But when your call mix is 80/20 EMS vs fire suppression, and your training, promotional pathways and budgeting is 80/20 the other way, that in my mind does not seem like a department takes EMS seriously.

    EMS may indeed be a natural fit, for the fire department's needs. For EMS's needs, not so much.

  • Ambulance_Driver

    I actually did a 3 part series of columns on this very subject, Happy Medic. Go to EMS1.com and look up “Marriage Counseling: The Dysfunctional Fire/EMS Relationship.”

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    Andy
    Why do Ambulances Carry Epi-Pens?
    Very valid points raised. We have addressed that issue thru education and number of drugs carried. Everyone is educated in drug checks and how to administrator via IM, also our FR have to call clinical and they do step by step instructions and EMT have more training in drug administration but still call some for…
    2014-12-22 18:15:00
    Andy
    Why do Ambulances Carry Epi-Pens?
    I work outside the USA as an EMT and can draw up and give IM epi for anaphylaxis, no calls nessisary. I also can nebulize it for angiodemea. Our First Responders are trained to draw up and can give it with a call to clinical. It amazes me that some US services still use auto…
    2014-12-22 13:57:00
    Rommie Duckworth
    Why do Ambulances Carry Epi-Pens?
    An interesting thought for sure, and one that is of particular concern to me as someone who has to manage a budget. However, it is countered by another concern that I have which is the frequency of medication administration errors especially among providers who draw up meds infrequently and must do so under field conditions.…
    2014-12-22 09:25:00
    Ckemtp
    I Got Attacked – A Paramedic Speaks About Public Trust
    I somewhat agree, though I assure you I didn't set out to waste your time. I probably should have broken this down into two separate points as the second point was the one I most wanted to emphasize. My bad on this one, I'll do better next time. Thanks for the feedback. If you'd like,…
    2014-12-16 20:25:00
    hawk4080
    I Got Attacked – A Paramedic Speaks About Public Trust
    Wow. That was a total waste to read.
    2014-12-16 19:20:00

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