We always hear that EMS is still a relatively new discipline. And in the scheme of medicine, or even public safety, that is certainly true. But we shouldn’t letÂ the fact of its youth keep us from acknowledging that it has already been around long enough to accumulate some of its very own antiquatedÂ dogma. If you have any doubt, consider the reaction to changes in protocolÂ – even those with good evidence to support someÂ newÂ practice. Working cardiac arrests on scene, for instance, was not met, at least in my experience, with enthusiasm at the prospect of improving patient outcomes. What I heard were excuses for why something different wouldn’t work.Â I thought about that exchange this week as I was listening to a recent Medicast podcastÂ on an entirely different topic. Near the end of that recording,Â Rob LawrenceÂ remarked that we really need to do away with the old stories that start out with “back in my day…”
The stories of someÂ grizzledÂ professionals include not just memories of MAST pants or nitrous oxide, but the idea that tourniquets take limbs, not save lives. More recently stories have been spun about the movement away fromÂ the long-held relianceÂ on theÂ long spine boardÂ as an immobilization splintÂ duringÂ transport or even the value ofÂ therapeutic hypothermia for cardiac arrests.
While there is no denying, or even stopping, a rapid state of change in EMS, we must be sure that it is not just change simply for the sake of change or even resistance for the same reason. Change must be meaningful change that is guided by reasoned thought and scientific evidence, not personal anecdote. And new practices should be carefully modified to address current issues or new understandings of the problem.
Another sacred, yet unjustified, belief among too many providers is that the dynamic deployment of resources (commonly referred to as “SSM”, or System Status Management) is an unmitigated failure of cost-consciousness that actually leads to increased expenses and provider dissatisfaction. The evidence, however, from many of the services who now employ some facet of dynamic deployment has proven that while it can be trickyÂ to implement well; the savings in time, money, and lives are definitely real. And those savings need not come at the cost of provider safety or comfort either. Whether you have had bad experiences in the past, or just heard about it from others, it is time to set aside the old stories and take a new look at the current technology and practice in every aspect of EMS that leads toÂ improved performance.
To advance our profession, we must completely ban the expression, Â “but thatâ€™s how weâ€™ve always done it” and look toward “how we can do it now!”