EMS 2.0? Well, yes it is a dream.

In a number of emails I have been asked for an outline or “thesis” about what EMS 2.0 is. There was talk awhile back about a national EMS 2.0 organization to begin lobbying for the changes we all want to see. Others asked me for my suggested education requirements and how I expected a volunteer Paramedic already working two jobs to go back to school to keep doing what they want to do.

I have no answers to those questions.

Sometimes when asked I reply that I have all the answers, I just haven’t sorted out what questions they go to yet.

I used the phrase EMS 2.0, and I think Mr Chris Kaiser did as well, because it brings up the image of a reboot, or upgrade.
Many of the Windows 7 features I got are neat, but most of it is based on the same things I liked about Windows 3.1, sure it is full of random errors and can be frustrating, but the system is slowly updating itself.

A few years ago I had had it with my operating system and all the limitations I saw in it and jumped into Linux.
I was under the impression I was savvy enough to make code changes to effect the entire operating capacity of the system. And since I had only a basic understanding of the features I so desperately wanted, I was unable to have the comfortable computing experience I expected. The adventure ended months later with a partitioned hard drive and having to choose an operating system each time it started. Drove me nuts. But those who know how to make it work love it and it works fine.

So when I speak of EMS 2.0, I am indeed aware of the pros and cons of an “upgrade.”

Another list of questions I get is about the comparison to Web 2.0, the movement that led to the communities and user submitted content we call the internet today. I recall the early days of FTP file searching by tree late into the night in college, having the entire internet text based as a few html sites began to sprout up. I compare searching roots and file trees then and the “Web 2.0″ experience we have now and realize that it is the inter-activity of the internet that has made it a community rather than just a marketplace.

There is an element there I can identify with when it comes to EMS. One of the Medical Directors who came by the booth in Baltimore asked me how he could use blogs to get his Paramedics to accept changing their protocols. I told him he should listen to what the patients his Paramedics encounter need and let that guide protocol changes. Then I asked if his medics had any way of approaching him about changes and he looked as if no one had ever suggested a medic could ever suggest a policy change, let alone present evidence in support.
“An open door and an honest opinion goes a long way in folks feeling like you care about what they’re doing,” I told him.
“No, I need them to do what I say.” he replied and I couldn’t speak against that because I am not an MD, nor in his system, understanding his troubles and challenges.

So where does this all fit into the EMS 2.0 landscape?

I dunno.

We need change, we need a new re-thinking of EMS, what it is, what we’re doing and why, how, where, everything needs to be re-examined and reformed based on new research, response models, patient presentations and care taker abilities.
How that can happen on a National level all at once is something I would love to see happen, but we all know here are far too many feifdoms, unions, politicians, companies and providers who will fight tooth and nail to maintain the status quo, regardless of the benefits.
There are those who will not move forward no matter what they are shown or told. And not all of them are the old salt medics. Some of the new kids on the EMS block feel they have made it and will just sleep through their refresher every two years and keep drawing the pay check.
Departments will fight to keep licensing requirements low so as not to have to pay their people to seek out education, possibly because the higher educated can draw a premium at the next service over.

From my lofty perch here with my education and high paying EMS job you may think me a dreamer with all this CoEMS and EMS 2.0 talk and you’d be right.
But the Chronicles was a dream a year ago and now we’re set to travel the world doing exactly what we want to do, explore what EMS means.
So I’m going to keep dreaming about EMS 2.0 and hope one day I can meet a crew from a department somewhere who both have an advanced education and operate under protocols or guidelines that give them the flexibility to treat, transport or transfer citizens, clients and patients based on what they need, not what they or some future lawsuit want.
I think we can all agree on that.

But how do we get there? We all get there in different ways at different times, hence the trouble in explaining EMS 2.0 to people at different levels of different systems.

There can’t really be an EMS 2.0 “thesis” or guide, but more of a mission statement, and that I am thinking about.
So far three main principles come to mind and how to expand on them will be up to you. They will certainly mean different things to different people, and that is one of the things I love about it.

My EMS 2.0 is based on three main concepts.
Technology
Teaching
Trust

Using technology to improve our ability to assess and treat,
Advancing our educational levels to not only learn more about our patients and communities, but teach them what we can and can’t do.
We have to earn the trust of those who give us the power to do what we do in order to do more.

In short I need some expensive gear, a pricey college education and then let me go do what I’ve learned and proven competent to do. Exactly what that is will depend on your community.

The future is coming and we as a Profession have a chance to not only make ourselves a respected part of the health care system, but excel in providing care in an innovative manner that can release the burdens the current system is collapsing under.

It is a dream. But it had to start somewhere and if that is all it is for now, I’ll take it, but something is happening out there and I want to be ready if my Chief asks my, “What do you think we should do?”

What are the three concepts your EMS 2.0 platform would fight for? Let me know.

Agree? Disagree? Have something to add? Why not leave a comment or subscribe to the RSS feed to have future articles delivered to your feed reader?

18 thoughts on “EMS 2.0? Well, yes it is a dream.”

  1. You have truly made the point and will keep people thinking, but we do need handle the critics… What is next?

  2. You have truly made the point and will keep people thinking, but we do need handle the critics… What is next?

  3. I love this Justin. Great stuff. My thoughts on your three T’s

    Technology is a double edged sword. I see it encourage competence and I see it discourage competence. It certainly isn’t a medical panacea, but in the hands of a competent caregiver it makes for better care. So, perhaps. Competent care supported by technology.

    Teaching is a key component. I’d like to see higher standards of core knowledge. Of course that’s easy for me to say after two decades in EMS and education. I remember how overwhelmed I was by the knowledge requirements when I first entered the field as a paramedic. My head swam with information that I wasn’t ready to process in real time. So how do we encourage higher standards of knowledge without raising the barriers of entry so high that it becomes problematic? Also, some doctors have proven that you can have a huge volume of knowledge and still be a crappy caregiver. Perhaps ongoing education based on quality oversight and observation. (But quality control can have its own problems right?)

    Trust is huge. And today every medical director extends trust to his agencies to one degree or another. he trusts that the narcotics are secure, the education records are accurate and the care meets a certain standard. Often, we are worthy of that trust. Often we are not.

    Great discussion.

  4. I love this Justin. Great stuff. My thoughts on your three T's

    Technology is a double edged sword. I see it encourage competence and I see it discourage competence. It certainly isn't a medical panacea, but in the hands of a competent caregiver it makes for better care. So, perhaps. Competent care supported by technology.

    Teaching is a key component. I'd like to see higher standards of core knowledge. Of course that's easy for me to say after two decades in EMS and education. I remember how overwhelmed I was by the knowledge requirements when I first entered the field as a paramedic. My head swam with information that I wasn't ready to process in real time. So how do we encourage higher standards of knowledge without raising the barriers of entry so high that it becomes problematic? Also, some doctors have proven that you can have a huge volume of knowledge and still be a crappy caregiver. Perhaps ongoing education based on quality oversight and observation. (But quality control can have its own problems right?)

    Trust is huge. And today every medical director extends trust to his agencies to one degree or another. he trusts that the narcotics are secure, the education records are accurate and the care meets a certain standard. Often, we are worthy of that trust. Often we are not.

    Great discussion.

  5. I love the idea of the three core values. Higher-ups in the system love terms like “core values” and “mission statements”. I’m all for changing how things are done, but I think the first step in the whole EMS 2.0 process is public education. You hit on this at the CoEMS Seat at The Table discussion, but it needs to be emphasized. If the public thinks that EMS providers are “merely” ambulance drivers, then this isn’t going anywhere. Educating the public about when is the right time to call 911 (or 999 for Mark) and when to go to an urgent care clinic will help move administrators and doctors towards thinking that “hey, these people know how to assess patients, let’s let them do so”. Until the public realizes that calling 911 isn’t for every little sniffle, EMS 2.0 is a great idea, but only an idea.

    1. And it won’t improve until some systems stop reprimanding their providers for being honest and saying “No, you don’t actually need an ambulance for this” when asked. The for profit model is a big problem in that respect. it is up to you, when you make patient contact to educate your patients, clients and citizens as to the proper reasons to call 911. That is not against any protocols. You can be forced against your will to provide care (one excuse people use against a socialized system. Sorry guys, we are already forced to provide care to people) but educate that person all the way in.
      “You’ll notice I am giving you no medicine or treatment for your sore wrist.”
      “Please take note that we moved you directly into the waiting room”
      Both education, both allowed, so long as you treat and transport within your established guidelines.
      Thinking how inappropriate the transport is is the idea. Saying it outloud when the time comes, THAT is EMS 2.0.

      1. I see patients from the other end of the ambulance ride. I’m a respiratory therapist in an inner-city hospital. A lot of our patients don’t have any other option but to use the emergency department as their primary care provider. They don’t have insurance or Medicaid. That’s a whole other issue. My point is that a lot of EMS supervisors are stuck in the CYA mentality. Everyone gets a ride, regardless, because of the “sue everybody” mentality. I’ve spoken to a lot of our EMTs about EMS 2.0. Most of them say “yeah, that’s great, but we’re a for profit service. We want our money.” I don’t know how to respond to that. I’m all for getting paid for what you do, but how can EMT providers help those that really need help if they’re responding to the guy with a 2 in lac that happened 3 days ago?

  6. I love the idea of the three core values. Higher-ups in the system love terms like “core values” and “mission statements”. I'm all for changing how things are done, but I think the first step in the whole EMS 2.0 process is public education. You hit on this at the CoEMS Seat at The Table discussion, but it needs to be emphasized. If the public thinks that EMS providers are “merely” ambulance drivers, then this isn't going anywhere. Educating the public about when is the right time to call 911 (or 999 for Mark) and when to go to an urgent care clinic will help move administrators and doctors towards thinking that “hey, these people know how to assess patients, let's let them do so”. Until the public realizes that calling 911 isn't for every little sniffle, EMS 2.0 is a great idea, but only an idea.

  7. My experience in EMS is short, only about a year, but here goes!

    I’d love to be able to take patients that don’t need the ER to appropriate facilities such as an urgent care or even a place like a Walgreen’s clinic or just telling them that they need to schedule an appt. with their doctor. I’m amazed at how many people go to the ER for something that is very minor. A patient with a lac that had controlled bleeding, no adipose tissue exposed, no muscle or bone exposed probably could’ve been seen at an Urgent care. If we’re trusted with procedures such as intubation, administering morphine or versed, chest decompression, crics, then perhaps it’s time to trust us when we say the patient can go to another facility. When I call you and and you ask if the patient can go to triage, they probably aren’t in dire need of an ER facility.

    Equipment. Make sure we have equipment up to date with current recommendations. Biphasic defibrillators for example. We just got updated SMOs for induction of post arrest hypothermia yet we don’t have the equipment on our rig to store cooled saline. If the entire region is going to be expected to use this SMO why don’t we have the equipment?

    Along with that equipment goes the education. Some people have no clue how to use certain equipment. Here a combi tube is a BLS skill, yet I didn’t learn it until paramedic school. Another side to education is to make Paramedic at least a 2 year degree with pre-requisites of A&P, microbiology, and English 101. I’m amazed at how many people are paramedics yet can’t spell or use passable grammar in their narratives.

    And if we’re going to continue fire based EMS we need to quit having departments make everyone firefighters and paramedics. It’s rare you get one person that’s excellent at both, but in my experience there are medics that are firefighters b/c their department requires it but are crappy on the fire end and vice versa. Staff your truck AND your ambulance, don’t take an ambulance out of service b/c both respond to the fire. Then if your town has a full arrest come in before a change of quarters is issued there isn’t a lengthy response time from neighboring municipality.

  8. My experience in EMS is short, only about a year, but here goes!

    I'd love to be able to take patients that don't need the ER to appropriate facilities such as an urgent care or even a place like a Walgreen's clinic or just telling them that they need to schedule an appt. with their doctor. I'm amazed at how many people go to the ER for something that is very minor. A patient with a lac that had controlled bleeding, no adipose tissue exposed, no muscle or bone exposed probably could've been seen at an Urgent care. If we're trusted with procedures such as intubation, administering morphine or versed, chest decompression, crics, then perhaps it's time to trust us when we say the patient can go to another facility. When I call you and and you ask if the patient can go to triage, they probably aren't in dire need of an ER facility.

    Equipment. Make sure we have equipment up to date with current recommendations. Biphasic defibrillators for example. We just got updated SMOs for induction of post arrest hypothermia yet we don't have the equipment on our rig to store cooled saline. If the entire region is going to be expected to use this SMO why don't we have the equipment?

    Along with that equipment goes the education. Some people have no clue how to use certain equipment. Here a combi tube is a BLS skill, yet I didn't learn it until paramedic school. Another side to education is to make Paramedic at least a 2 year degree with pre-requisites of A&P, microbiology, and English 101. I'm amazed at how many people are paramedics yet can't spell or use passable grammar in their narratives.

    And if we're going to continue fire based EMS we need to quit having departments make everyone firefighters and paramedics. It's rare you get one person that's excellent at both, but in my experience there are medics that are firefighters b/c their department requires it but are crappy on the fire end and vice versa. Staff your truck AND your ambulance, don't take an ambulance out of service b/c both respond to the fire. Then if your town has a full arrest come in before a change of quarters is issued there isn't a lengthy response time from neighboring municipality.

  9. And it won't improve until some systems stop reprimanding their providers for being honest and saying “No, you don't actually need an ambulance for this” when asked. The for profit model is a big problem in that respect. it is up to you, when you make patient contact to educate your patients, clients and citizens as to the proper reasons to call 911. That is not against any protocols. You can be forced against your will to provide care (one excuse people use against a socialized system. Sorry guys, we are already forced to provide care to people) but educate that person all the way in.
    “You'll notice I am giving you no medicine or treatment for your sore wrist.”
    “Please take note that we moved you directly into the waiting room”
    Both education, both allowed, so long as you treat and transport within your established guidelines.
    Thinking how inappropriate the transport is is the idea. Saying it outloud when the time comes, THAT is EMS 2.0.

  10. And it won't improve until some systems stop reprimanding their providers for being honest and saying “No, you don't actually need an ambulance for this” when asked. The for profit model is a big problem in that respect. it is up to you, when you make patient contact to educate your patients, clients and citizens as to the proper reasons to call 911. That is not against any protocols. You can be forced against your will to provide care (one excuse people use against a socialized system. Sorry guys, we are already forced to provide care to people) but educate that person all the way in.
    “You'll notice I am giving you no medicine or treatment for your sore wrist.”
    “Please take note that we moved you directly into the waiting room”
    Both education, both allowed, so long as you treat and transport within your established guidelines.
    Thinking how inappropriate the transport is is the idea. Saying it outloud when the time comes, THAT is EMS 2.0.

  11. I see patients from the other end of the ambulance ride. I'm a respiratory therapist in an inner-city hospital. A lot of our patients don't have any other option but to use the emergency department as their primary care provider. They don't have insurance or Medicaid. That's a whole other issue. My point is that a lot of EMS supervisors are stuck in the CYA mentality. Everyone gets a ride, regardless, because of the “sue everybody” mentality. I've spoken to a lot of our EMTs about EMS 2.0. Most of them say “yeah, that's great, but we're a for profit service. We want our money.” I don't know how to respond to that. I'm all for getting paid for what you do, but how can EMT providers help those that really need help if they're responding to the guy with a 2 in lac that happened 3 days ago?

  12. I love the idea of the three core values. Higher-ups in the system love terms like “core values” and “mission statements”. I'm all for changing how things are done, but I think the first step in the whole EMS 2.0 process is public education. You hit on this at the CoEMS Seat at The Table discussion, but it needs to be emphasized. If the public thinks that EMS providers are “merely” ambulance drivers, then this isn't going anywhere. Educating the public about when is the right time to call 911 (or 999 for Mark) and when to go to an urgent care clinic will help move administrators and doctors towards thinking that “hey, these people know how to assess patients, let's let them do so”. Until the public realizes that calling 911 isn't for every little sniffle, EMS 2.0 is a great idea, but only an idea.

  13. My experience in EMS is short, only about a year, but here goes!

    I'd love to be able to take patients that don't need the ER to appropriate facilities such as an urgent care or even a place like a Walgreen's clinic or just telling them that they need to schedule an appt. with their doctor. I'm amazed at how many people go to the ER for something that is very minor. A patient with a lac that had controlled bleeding, no adipose tissue exposed, no muscle or bone exposed probably could've been seen at an Urgent care. If we're trusted with procedures such as intubation, administering morphine or versed, chest decompression, crics, then perhaps it's time to trust us when we say the patient can go to another facility. When I call you and and you ask if the patient can go to triage, they probably aren't in dire need of an ER facility.

    Equipment. Make sure we have equipment up to date with current recommendations. Biphasic defibrillators for example. We just got updated SMOs for induction of post arrest hypothermia yet we don't have the equipment on our rig to store cooled saline. If the entire region is going to be expected to use this SMO why don't we have the equipment?

    Along with that equipment goes the education. Some people have no clue how to use certain equipment. Here a combi tube is a BLS skill, yet I didn't learn it until paramedic school. Another side to education is to make Paramedic at least a 2 year degree with pre-requisites of A&P, microbiology, and English 101. I'm amazed at how many people are paramedics yet can't spell or use passable grammar in their narratives.

    And if we're going to continue fire based EMS we need to quit having departments make everyone firefighters and paramedics. It's rare you get one person that's excellent at both, but in my experience there are medics that are firefighters b/c their department requires it but are crappy on the fire end and vice versa. Staff your truck AND your ambulance, don't take an ambulance out of service b/c both respond to the fire. Then if your town has a full arrest come in before a change of quarters is issued there isn't a lengthy response time from neighboring municipality.

  14. And it won't improve until some systems stop reprimanding their providers for being honest and saying “No, you don't actually need an ambulance for this” when asked. The for profit model is a big problem in that respect. it is up to you, when you make patient contact to educate your patients, clients and citizens as to the proper reasons to call 911. That is not against any protocols. You can be forced against your will to provide care (one excuse people use against a socialized system. Sorry guys, we are already forced to provide care to people) but educate that person all the way in.
    “You'll notice I am giving you no medicine or treatment for your sore wrist.”
    “Please take note that we moved you directly into the waiting room”
    Both education, both allowed, so long as you treat and transport within your established guidelines.
    Thinking how inappropriate the transport is is the idea. Saying it outloud when the time comes, THAT is EMS 2.0.

  15. I see patients from the other end of the ambulance ride. I'm a respiratory therapist in an inner-city hospital. A lot of our patients don't have any other option but to use the emergency department as their primary care provider. They don't have insurance or Medicaid. That's a whole other issue. My point is that a lot of EMS supervisors are stuck in the CYA mentality. Everyone gets a ride, regardless, because of the “sue everybody” mentality. I've spoken to a lot of our EMTs about EMS 2.0. Most of them say “yeah, that's great, but we're a for profit service. We want our money.” I don't know how to respond to that. I'm all for getting paid for what you do, but how can EMT providers help those that really need help if they're responding to the guy with a 2 in lac that happened 3 days ago?

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