Thoughts From EMS Today

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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.

13 COMMENTS

  1. “Because it’s easier to change technology than it is to change society and people.” That, in a single sentence, says it all… Progress is not because of technology, but in spite of it…

  2. A pleasure as always, Sir. Indeed we are almost parrotiny a 15 year JD document we never knew of. But the cause of which we spoke willvinded earn some attention. Our differences side we find common ground in our opinions of content at conferences. See you in September?

    • And this is why you never reply to blog posts over your phone without checking the auto correct. A missed letter makes “exactly” into “parrotiny” and “EMS” into “JD.” And the “willvinend” should have read ” will in the end”
      At least that’s what i think it meant. Thanks to CKemtP for alerting me to my autocorrect fail. And no, the numerous pints prior to texting that had no effect. 😉

  3. I have never been to EMS Today. I’ve wanted to, just to say I had been at least once. But it’s always something- washing machine croaks, head gasket blows, something. But then, when I hear from you guys that go, I guess I haven’t missed much. I see the ads in JEMS and the other magazines and you are right, you can tell when something is going to last or not. And it is the same things we are talking about, the same hot topics. We are doing home visits here, on a small scale, but we still take a lot of people to the hospital that really do not need to go. And of course, we are taking them to the farthest hospital way too much.

    I have 12 more years to go to get a pension…maybe. I know folks like Justin, Glenn, and Chris are terribly optimistic, and I try to be. But in the end, I think your comment about technology and people is spot on. And to that end, it is just easier to keep on doing the same old stuff we have been doing.

    Anyway, maybe next year I will get to go. We’ll see.

  4. The funny thing is that if you look at out-of-hospital / pre-hospital healthcare in the UK, a lot of the things that “EMS Agenda For The Future” was supposed to bring, has been going on for some time. Not necessarily well, but…

  5. I wonder how much easier it might be to institute all that lovely prospective outpatient prehospital stuff if there were a single publicly funded nationalized healthcare system that used one electronic system to exchange information in real time, in addition to providing basic medical care for all citizens in a tax-funded system. Oh wait; that would be “socialized medicine”, which is bad. Right?

    • Weeellll… I’m not in favor of a socialized medicine system, but a less fragmented and wasteful one than what we have now would certainly be nice.

      I didn’t support Obamacare, but I think the Republicans are being stupid to try to repeal it without at least offering us a viable alternative. They seem to think that the status quo was working, which just proves the stupidity of politicians in general.

    • I don’t think it necessarily has to be publicly funded or centrally controlled to work. Given what I’ve seen of the federal government’s hand in things like disaster response, I think that the government would only make things worse. The medical IT community could make it so that differing systems could talk to each other pretty much seamlessly by adopting an open standard for programming those systems. What I’ve see of “Obamacare” so far convinces me that we are headed in the wrong direction. At least if what I understand of what they are doing in regards to funding of primary care. From what my PCP and others tell me, funding for primary care is already low and likely to get worse. I’ve posted about the shortage of primary care physicians here before, and I don’t see it getting better. You’re far more of an expert in that than I’ll ever be, so I’ll defer to your thoughts on that.

      More and more I see less and less of a role for the federal government in most things. As Ronald Reagan once said,
      “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.'”

      • Haven’t you heard? Obamacare is going to save us all, which is why there are now over 1,000 waivers so that friends of the Administration (ie unions and other big donors) don’t have to be a part of it.

        It’s going to be great! Rats jumping ship are always a good sign.

  6. Howdy TOT, I’m getting to this one late. Thanks for the mention.

    You know? I’ve never read the EMS Agenda for the Future (EMSAFTF). I think that I knew faintly of it’s existence a while ago… but I didn’t really become consciously aware of it until AmboDriver told me about it a few months ago. I’ve only been in EMS full time since 1998 and those ideas were before my time.

    And while I’m not a dinosaur of the profession, at least around the corner of the world where I live, I’m an old medic.

    It is said that “Without a heritage, every generation starts over” and I think that’s true with EMS. We have way too much turnover of people who leave before they ever get the notion that it is they themselves who are responsible for initiating and participating in change. Of the people that got fired up over the EMSAFTF paper, what percentage of them are still actively pursing the changes that were in there? How many of them are still in EMS? Who helped push the changes along? Why did it fall flat?

    I suppose that I could be called an optimist of sorts, but I’m a realist of sorts too. EMS needs change… and yes, like you said, everything that we need to do what we want to do already exists. The trick now is not so much in figuring out what we want to do as much as it is removing the roadblocks present. It seems that the people vying for control of EMS’s future are more pervasive than are our own internal cheerleaders.

    However, EMS 2.0 has things going for it that the EMSAFTF did not when it came out. We have the youth of the profession. New boots on the ground are being indoctrinated and are excited about the possibility of change. This is a phenomenon that is trickling upward, now downward. I was a new medic a few years after the EMSAFTF came out… and I never heard about it… However how many new medics are hearing about EMS 2.0 during their initial training and will carry the banner of this as their heritage?

    The EMSAFTF may be great. In fact, I plan on reading it very soon. I have a feeling I’m going to enjoy it and agree with a lot of it… then cheerlead it and other ideas under the banner of EMS 2.0. No use in reinventing a wheel… we need a lot of positive changes that we can bring about by energizing everyone.

    Oh, and congrats on the Diner Save. It was great to see you as always bud.

    • Keep in mind that the EMSAF the has, or at least had, the weight of the federal government behind it. Or maybe on top of it. Either way, it’s creaking along and that whole “national scope of practice” thing that is out there lurking on the horizon is a big part of it. I’m also guessing that there might be some federal dollars in the future (or maybe not), hence the interest in determining where EMS belongs in the federal government.

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