A Very Smart Guy


A short post over at Ambulance Drivers place prompted me to read this article by very smart and all around good guy Dr. Bryan Bledsoe.

Here is a quote from the article,

The late Jim Page disdained SSM and Public Utility Models (PUMs). But, his mind was open enough that he allowed Jack Stout to publish his writings in JEMS for many years. Once, on a bus between the Orleans Hotel and a steakhouse in Las Vegas, Jim told me that SSM was nothing more than a way of making the most out of a young and expendable workforce and, in the overall scheme of things, it was much ado about nothing. His skepticism was right on. As with many things in EMS, Jim had this all figured out long before the rest of us.*

James Page had a lot of stuff figured out before the rest of us.

RTWT, as they say. I’ve said much of what Bryan says in the article on this blog and in person over the years but he does a great job demonstrating the complete lack of science behind all three “standards of care” or whatever they are called these days. At least the “Golden Hour” was written out on a cocktail napkin.

There he goes again, poking holes in conventional wisdom. Bryan harpoons three sacred cows of EMS. Yeah, I know it’s a mixed metaphor, but it’s the best I could do.

As I’ve said many times before, all of the card dispatch systems are designed to produce consistent results that are legally defensible in court. Of course they don’t even do the first.

As Bryan points out in the article, SSM is designed to save money at the expense of the young (mostly) paramedics and EMTs who are considered by management expendable commodities, not much different than a 4×3 or O2 mask.

Lights and siren responses for all but a very few call types do little more than increase the danger to crews and the public with little benefit to patients. But, since the #1 complaint lodged against EMS systems (at least mine) is over response times, that’s not going to change either.

The problem being, as I’ve pointed out to my partner who whinges excessively and continuously about fire department first response, is that response time complaints often go to City Hall. Actually, they ALWAYS seem to go to City Hall. City Hall being staffed mostly by people who work for politicians and the politicians themselves response time complaints from people who might vote get a high priority. Same as with people who complain about street lights, trash pick up, and the like.

As a result if someone complains to City Hall that an ambulance took too long to get to their (perceived) immediately life threatening tooth ache, our equivalent of Internal Affairs gets a call. Incident reports will be reviewed, audio tapes, and CAD times will be reviewed, people in HQ will collectively meet and the Mayor will get a Harumph. The crew won’t get a Harumph, but they might get a bad report in their permanent record, along with some non paid time off. Of course the actual nature of the “emergency” won’t be reviewed. Nor will the actual need for an emergency response. Don’t even talk about the need for an emergency transport.

So, not only is something that we do not based on one shred of science, it’s driven to a large part by politics.

“Built on a foundation of sand.”

Damn, I wish I had said that.

*If you don’t know who Jim Page was and you are in EMS, shame on you. Even more so if you are involved in fire based EMS. Go read the article and then go and read through this site.


  1. I qualified as an EMT but have not worked as one. Speaking merely as an outsider who gets occasional glimpses of the field via the nurses, paramedics, and others I know, that remark about the “expendable work force” rang the bell loudly as regards EMS workers. As to basing changes on science instead of “this will look great when we present it at the symposium”, that is the age-old battle between workers and administrators.(As the article pointed out, between those who must answer for themselves professionally and those who answer politically.) That battle will never end: ignorance is a renewable resource.

  2. Good one, and those arguments are the SAME ones we were having back in the 70s… And there is a distinct LACK of science in a lot of the EMS world, still today.

  3. “If you don’t know who Jim Page was”

    Forward thinkers tend to have short lifespans in this profession. It seems a bunch of years ago I read a rant published on the Texas EMS Yahoo list written by a fellow who I know to have been in EMS for a day or two longer than either you, me, or Bryan Bledsoe. This fellow’s lament was that our profession had the repugnant habit of first placing some perceived leader on a pedestal… and then knocking them off when they showed the least sign of advocating progress. These deposed leaders would then change focus and move on without us. Who could blame them?

    It has often been said that this profession has the nasty habit of eating its young, but that is far from our only fault. Jim Page is fortunate in one respect. He died before his worshipers could turn on him and knock him off that pedestal.

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