I’ve been going to EMS Today, off and on, since 1995. The format of the conference, which is more of a trade show, hasn’t really changed. There are educational sessions, social events, and a large exhibit hall. Many of the vendors there this year didn’t even exist, or at least didn’t sell to the EMS market 16 years ago. A lot of companies arrived on the scene with a big splash one year only to never be seen again. There are an awful lot of single, limited purpose, products out there and unless they fill a really vital niche, they are not going to last. In most EMS systems money is chronically tight. Some do better, some few get a steady stream of grants, but more and more EMS systems have to pay for most or all of their operational costs and have scant money left over for equipment. What they buy has to be durable, serve a fairly broad range of patients, and work. Lots of junk falls by the wayside. Other companies have been around seemingly forever.
It’s interesting walking the exhibit hall floor and seeing items that you know will never be seen again. I play a game with myself when I walk through the hall. I make bets with myself whether products will be there the following year. My track record is pretty good, actually.
So, that’s the exhibit hall. Now on to the educational sessions. I’ve commented before that the educational sessions at EMS Today are stale. That’s true, but it’s also true that in spite our posturing that EMS is cutting edge, we aren’t.
One of the sessions, OK, the only session I attended, was about controversies in C-Spine management. The controversy is whether we use that “treatment” too much. Which, when you think about it, isn’t a controversy at all. Most people in EMS agree that we do use immobilization way too much. Only no one wants to tackle the issue because of the risk of litigation on the off chance that someone will be paralyzed as a result of a missed C Spine injury. The doctor doing the presentation had some interesting data, Xrays, and Fluoroscope video that showed that not only is most C Spine immobilization unnecessary, much of it is actually harmful to patients. Still, he didn’t seem hopeful that the protocols followed by most EMS systems in the country are going to change soon.
He even quoted from a 1996 study showing the same thing, only that study was retrospective and had far fewer participants. The funny thing is that I remember when another doctor presented that the results of that study at EMS Today in 1996. He told the audience that much of the C Spine immobilization we were doing was unnecessary and even harmful and that EMS and the EM Physician community had to advocate for change. And here we are 16 years later, not having made a whole lot of progress. The reason for that is the same now as it was then. Risk managers won’t countenance such a drastic change in practice without study and no one will even attempt a randomized trial because of the risk of litigation. Instead we concentrate on better ways and technology to perform a procedure that we probably shouldn’t be doing in the first place.
I also stopped by to see Justin Schorr of The Happy Medic. Great guy and he has a lot of great ideas. The only thing he’s missing is the long term perspective that I have. That’s not an criticism, it’s an observation. Justin, along Mark Glencourse and Chris Kaiser of Life Under The Lights are the bright young EMS guys that came up with EMS 2.0. It’s a concept I like and have liked for a long time. I say that because EMS 2.0 is almost identical to The EMS Agenda for the Future that was released in 1995 or 1996. By now we were supposed to have paramedics that did home care, preventative health care, real time monitoring of medical conditions so that EMS could be alerted before a patient had an MI, reengineering of residences for injury prevention, and telemedicine so that medics, or if my memory serves me correctly, something between a paramedic and a nurse practitioner who would come out to the patient’s house, do an evaluation, consult with a doctor, send data back to medical control and then the decision as to whether or not the patient needed to go to the hospital would be made. If no ED visit was needed, then the crew on scene would use their handy dandy hand held computer to schedule the appointment and the transportation for the patient. Sounds great and we’ve barely started to do any of that.
A lot of the technical bits are in place, as I saw on the exhibit hall floor. I watched several podcasts being produced and I know that people all over the world are watching them either live or later on when it’s convenient for them. In fact, I’ll go so far as to say that every bit of the technology needed to do the things that both EMS 2.0 and The EMS Agenda for the Future encompass exist and are in use today. Some of them in medicine, many of them in other fields.
So, why aren’t we doing it? Because it’s easy to change technology than it is to change society and people. As progressive as we like to think we are, the truth is that many people and institutions are tradition bound. Once we change the people, we need to find a way to finance the future. Which brings us back to people. The people who currently only pay for transport by EMS, and not for treatments that don’t include transport, aren’t inclined to upset the system that has sort of worked for so many years.
I wonder if I go to EMS Today in another 15 years if the same “hot topics” and controversies will still be being discussed? I sure hope not, but I’m not as optimistic as I probably should be.
I’ll have more observations and thoughts about EMS Today, especially about the bloggers I met up with, in a day or so.