I spent my Friday and Saturday traveling through New Jersey, New York, Connecticut, and eventually to Massachusetts after a painful, traffic filled ride up Route 15, a ride that has rewarded me so many times with a much quicker travel than using 95, but I digress. Friday, our travel framed a stop at Pulse Check, an EMS conference held just north of the New Jersey, New York boarder, and Saturday I spoke at the Massachusetts EMS Conference in Springfield where I spent the first twelve years of my career.
Both conferences had some great topics however there was one thing that really summed up one of my major frustrations with EMS on a national scale. It is something that I have seen at every conference that I have attended including the major ones like EMS World and EMS Today. A speaker will be talking about his or her topic, and they will get to the treatment and management portion of the lecture. For example, let’s say someone is presenting on chemically managing a combative patient. The exchange will go something like this:
Speaker: “In MY system, we are able to give the patient 5 mg of Haldol and 5 mg of Versed for sedation, and then we can call our doctors and ask for more. How do you do it?”
Student #1: “We don’t have orders, but we carry Ativan for seizures so if we can convince our doctor to ‘back door’ the protocols, we can give them some Ativan to sedate them”
Student #2: “Well, in my system we have the protocol in place the same as yours, but I cannot even take the meds out of my bag unless my doctor says I can, and when I call the hospital I have to speak to a nurse and then ask them for a doctor.”
Student #3: “What is chemical restraint? Are you talking about when they get combative, I call for four more police officers to come and they pepper spray my patient on the stretcher so we can four point them?”
So here we have four different experiences from four distinct, different systems dealing with the same problem in four completely different ways. And chances are each of these paramedics learned the same general material in their class that was just spun in a different way by a different publisher, and it is even possible that each of them took the exactly identical National Registry paramedic exam.
One of my favorite things about attending EMS conferences is having the opportunity to learn something new or cutting edge that another system is doing. I want to know how Hilton Head handles their pit crew CPR, or how Memphis Fire rolled out LUCAS devices into the field. And I want to know how Jersey City improved their response times. Whether we are talking about a one on one patient to paramedic relationship or a system wide improvement, these conferences are and should be about best practices, but why does the divide between the systems need to be as wide as the Grand Canyon? It is one thing to be on the cutting edge and ahead of everyone else, but it is another thing entirely for a system to be so far behind that they refuse to evolve.
One of my favorite iPhone apps is the “PPP” app which gives you access to protocols from all over the country. Interestingly enough though, there are a lot of different evolutions for protocols even when looking at specific states. For example, Connecticut by population is ranked 29th largest by population. On the app, they have twelve different versions of their state protocols. And let’s not even get into how many Texas and California have. If a paramedic works for two different counties in California, they might have to learn two completely different set of calls.
A number of years ago, I applied for a management spot for AMR in Washington, DC. To prepare myself for my interview I did some research about the system. One of their biggest problems was one that I found to be rather interesting, and extremely frustrating. Because of their proximity to Virginia and Maryland, and due to the fact that each of these locations within a small geographical area had different requirements for their state certifications dispatchers had to keep track of which truck they were sending where to make sure that certain paramedics were not potentially picking up and/or transporting a patient to a place where they were not certified.
Obviously, the problem here is as soon as you drive across a state line, you forget everything you learned in paramedic class.
The time is long overdue for us to all get on the same page. Paramedics and EMTs around the country are seeking out this information at conferences. They are giving feedback on what they want to hear. I have heard many stories and even had personal experiences where you walk away from a class and get excited about the next patient you find with a presentation similar to the one you heard someone present about.
Let’s take these ideas and these best practices and let’s seek out a way to make them national standards. We need them, and our patients need them.
Scott,
Sure this is partly education, but is seems more like a system design problem.
On the bright side at least the students in your post are a) willing to attend an EMS conference b) share how their system handles combative patients. Good on them and good on the speaker for involving the audience.
There are many barriers to using knowledge other than simply having the knowledge. Pushing education to an audience that neither has the ability to apply the knowledge nor the power to change their system is a challenge for any educator – especially a clinical topic presenter.