EMS as the Halloween of Healthcare

Just as each year transitions at harvest from abundance toward its inevitable end, we in the prehospital field often usher lives fraught with medical disorder or trauma from normalcy toward a cold, strange world. We wear uniforms with our stoic masks and find nature’s trickery affecting strangers who beg us for treatment.

Beyond the surface, the history of Halloween also parallels our profession’s path. Long ago, Pope Gregory ordered his missionaries not to destroy the traditions of potential converts. Instead, he recommended that his followers morph those practices into new forms of belief. Pagan and Christian traditions merged: a spring festival, a decorated tree, a time of renewal. The Celtic Samhain, a day when the veil between the present world and the world of the dead wears thin, became All Hallow’s Eve, and the day after it, All Saint’s Day. It was a gradual process, and the new holiday took an existing religious tradition in its own direction.

The development of Emergency Medical Services was just as incremental. The lofty goal of caring for the sick at the point of their injury was incorporated within the existing local government structure and within a budgetary process that allowed only for law enforcement and firefighting activities within public safety. It was a time when privately funded funeral homes delivered the dead and dying victims to hospitals. A system that was merely appropriated to address a new function. Even today our improvements on this system come not as much as acts of creation, but as steps built upon pre-existing logic. If society had created a mobile healthcare system from scratch, I doubt it would resemble much of our current model.

Like the Druid converts, we worship all sorts of sacred trees in the form of protocols and algorithms. These ideas are sprinkled with the holy water of a national physician group, and blessed by a local Medical Director. One who may not even believe it is the best actual treatment. He complies simply because upending tradition risks disenfranchisement and the toppling of an entire system of makeshift steps and opens himself to judgement.

Will the idea of strapping a patient to a flat, ridged board and transporting them for miles in the back of a vehicle based only on the method of his injury be looked at one day in the same light that we now view blowing tobacco smoke into a patient’s rectum? The fault, however, is not wholly his own. Meaningful change cannot be enacted solely from above. If faithful followers want evidence as the basis of practice, they must be willing to change their behaviors to match their beliefs. They must look beyond anecdote and set aside long-held tradition and recognize that working a cardiac arrest on scene has proven value over the immediate application of high flow diesel with ineffective CPR while en route to a cath lab. They must choose evidence-based practice and not simply beg at the door for treats.

There is no doubt that our profession will change. There is promise in community involvement by paramedics to pre-empt emergency calls for transport through Mobile Integrated Healthcare. There is value in offering alternative endpoints for definitive medical care to lower costs and reduce traffic in the emergency department. Practically, development will need to happen within a framework of the system we have in place, but significant change also means significant sacrifice of beliefs. We may even need to accept heretical ideas such as a professional degree. The first step, however, is to leave Halloween behind us.


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