In the last 2 days I have had my hands in the chest cavities of 3 patients.
If you have never been to a cardio surgery, I would really suggest making every effort to be a part of the experience.
I had a few minutes to look around at the wonder that stood before me.
There was all of the anesthesia get up. Monitors of every shape and size, a gas mixer, a ventilator, even a machine that measured real time blood clotting. Then there was the cardio bypass machine and all of its wonderous functions. More stainless steel and electronic devices than I care to describe. A team of 3 cardio surgeons, 2 anesthesiologists, 2 nurses, and a student.
The event starts out as a procedure. No different from any EMS station or service I have ever been to. You come in, have some coffee, discuss what's going on, check the equipment, get assigned a patient, prepare yourself for what you are going to do, and then, start treatment based off of a guidline that tells you how everything should go and how you should go about doing it.
Just like EMS, it doesn't always go like it should and in no time at all, you can find yourself completely off the map.
Now, when this happens, there is no research, no textbook, nobody to call. The various members of the team put their heads together to make something up. When you add it all up, this team has easily a hundred of years of education and experience. Without aid of a bar napkin, an idea is formed.
What makes this team ALS, isn't a few gadgets or gizmos. A technological solution to make up for shortcomings. It is the ability for them use all of their mental faculties, anecdotes, and scientific wild A** guesses in order to attempt to achieve a positive outcome.
So it makes me wonder...
Why is there always somebody in EMS forums who when faced with a conundrum, always posts something like: "Our protocol says" or "we must follow the protocol" or "that's not in my protocols?"
There is no lack of technology in EMS.
No lack of situations that go as far off the map as possible.
But yet only a handful seem to have the capacity to step outside the comfort zone and engage their collective knowledge and experience to attempt to improve on what has been, as well as prepare for what might be.
Does the reliance on guidline, mathmatically measurable studies, or the ability to call for help, stop EMS from being advanced? From being all that it could be?
No matter the outcome (which I am happy to report so far has been 100% positive) there is no doubt as to why these surgical people are paid. No doubt why they are funded, and certainly beyond question if they are worth it.
We talk a lot about education in EMS. Rather the lack of it. Ad nauseum.
But the last few days, I have come to the conclusion it is not the education holding EMS back. It is the attitude of many of the providers.
Not because it is antieducation, or antiadvancement. But because it is antiresponsibility. Everyone wants to be considered a hero, important, etc. But at the same time they want to be told what to do. They want all the quantities known. They do not want to be held accountable. They want it to be somebody elses problem.
It is like "hero in a can." No risk. All good, and the ability to punt on first down if need be and walk away clean.
Perhaps we should stop our focus on education, and focus more on provider attitude?
Perhaps before weeding out the minimally educated, we should weed out the minimally motivated?
Often times the earlier EMS providers didn't have guidlines that were supposed to cover it all. They were given what was deemed adequte info to make a difference, then kicked out without benefit of FTO, or senior guidance to succeed or fail.
They didn't have benefit of technology, but they somehow saved lives. They didn't have the benefit of research, but somehow managed to cultivate their expert opinions to make a difference. Many didn't exactly "fit in" to society, but then EMS didn't need people who did. They needed free thinkers. People not afraid to take what little they had and make hard choices. They faced the same problems as today. Patients with social issues, medical issues, mental issues, even no issues.
Those providers, like the surgical team weren't advanced because they had some invasive procedures. They were advanced because when the S*** hit the fan, they put their heads together and make something up. Usually more fearful they would fail the patient then get into "trouble" with the boss.
Doesn't EMS still need that?
If not, what is the value of EMS?
If you have never been to a cardio surgery, I would really suggest making every effort to be a part of the experience.
I had a few minutes to look around at the wonder that stood before me.
There was all of the anesthesia get up. Monitors of every shape and size, a gas mixer, a ventilator, even a machine that measured real time blood clotting. Then there was the cardio bypass machine and all of its wonderous functions. More stainless steel and electronic devices than I care to describe. A team of 3 cardio surgeons, 2 anesthesiologists, 2 nurses, and a student.
The event starts out as a procedure. No different from any EMS station or service I have ever been to. You come in, have some coffee, discuss what's going on, check the equipment, get assigned a patient, prepare yourself for what you are going to do, and then, start treatment based off of a guidline that tells you how everything should go and how you should go about doing it.
Just like EMS, it doesn't always go like it should and in no time at all, you can find yourself completely off the map.
Now, when this happens, there is no research, no textbook, nobody to call. The various members of the team put their heads together to make something up. When you add it all up, this team has easily a hundred of years of education and experience. Without aid of a bar napkin, an idea is formed.
What makes this team ALS, isn't a few gadgets or gizmos. A technological solution to make up for shortcomings. It is the ability for them use all of their mental faculties, anecdotes, and scientific wild A** guesses in order to attempt to achieve a positive outcome.
So it makes me wonder...
Why is there always somebody in EMS forums who when faced with a conundrum, always posts something like: "Our protocol says" or "we must follow the protocol" or "that's not in my protocols?"
There is no lack of technology in EMS.
No lack of situations that go as far off the map as possible.
But yet only a handful seem to have the capacity to step outside the comfort zone and engage their collective knowledge and experience to attempt to improve on what has been, as well as prepare for what might be.
Does the reliance on guidline, mathmatically measurable studies, or the ability to call for help, stop EMS from being advanced? From being all that it could be?
No matter the outcome (which I am happy to report so far has been 100% positive) there is no doubt as to why these surgical people are paid. No doubt why they are funded, and certainly beyond question if they are worth it.
We talk a lot about education in EMS. Rather the lack of it. Ad nauseum.
But the last few days, I have come to the conclusion it is not the education holding EMS back. It is the attitude of many of the providers.
Not because it is antieducation, or antiadvancement. But because it is antiresponsibility. Everyone wants to be considered a hero, important, etc. But at the same time they want to be told what to do. They want all the quantities known. They do not want to be held accountable. They want it to be somebody elses problem.
It is like "hero in a can." No risk. All good, and the ability to punt on first down if need be and walk away clean.
Perhaps we should stop our focus on education, and focus more on provider attitude?
Perhaps before weeding out the minimally educated, we should weed out the minimally motivated?
Often times the earlier EMS providers didn't have guidlines that were supposed to cover it all. They were given what was deemed adequte info to make a difference, then kicked out without benefit of FTO, or senior guidance to succeed or fail.
They didn't have benefit of technology, but they somehow saved lives. They didn't have the benefit of research, but somehow managed to cultivate their expert opinions to make a difference. Many didn't exactly "fit in" to society, but then EMS didn't need people who did. They needed free thinkers. People not afraid to take what little they had and make hard choices. They faced the same problems as today. Patients with social issues, medical issues, mental issues, even no issues.
Those providers, like the surgical team weren't advanced because they had some invasive procedures. They were advanced because when the S*** hit the fan, they put their heads together and make something up. Usually more fearful they would fail the patient then get into "trouble" with the boss.
Doesn't EMS still need that?
If not, what is the value of EMS?
