The Quest for Perfection

Does the perfect EMS system exist?  Is there really one perfect fit for every municipality and every paramedic as well?  I really don’t think that there is.  What each individual has to search for though is their perfect fit.  They need to look for that system that has what they are looking for, regardless of what it is.

Believe it or not, some people like carrying gear up and patients down five story walkups.  Believe it or not, when my career started, I loved it.  I did not think that urban EMS was going to be for me, and did not see myself staying in Springfield, Massachusetts, but it happened.  I spent twelve years there, and for the most part, I really loved it.  I still have a deep seeded love for urban medicine but as the years passed, and as my career progressed, so did my tastes, and what I was ultimately looking for has evolved.  So what does my perfect system need?  What would be absolutely 100% perfect for me?  Here it is. . .

1.  Variety and diversity – I do not just want one “type” of call.  I want a system that can offer me different settings that I can tailor to my mood at that juncture.  I really feel like I have “EMS ADD” that is to say, I am constantly looking to something else, and my moods seem to change often.  Having a system that would provide for that would be great.

2.  Aggressive and progressive medical direction – I want a medical director who is not afraid to enroll in prehospital studies.  I want someone who is not afraid to look at his or her staff and say “what do you think could make us a better system?”  or “what is there that we don’t do well enough?”  They need to be engaged with their medics, and although knowing each and every provider in their system isn’t vital or in some cases reasonable, having an open door policy and being receptive to each and every one of them is, and has to be.

3.  Receptive and engaged leadership – In just about every system I have been a part of someone has made the statement “the leadership has forgotten where they came from.”  While priorities change, leadership needs to make sure they are still in touch with their work force.  I whole heartedly believe that not all of these instances were as they seemed.  I believe that some leaders are more engaged than people realize, but perception is reality.  They need to let their staff know that they are still in touch.  That might mean responding to a call here or there, or just being visible at stations and events.  Oh, and just like with medical directors, LISTEN!  Nothing lets people know that a boss is in touch more than just being open to what people have to say.

4.  Horizontal job ladders – Again, it comes back to a class I saw Skip Kirkwood teach in 2011 at EMS Today.  Movement does not always have to be upward.  It can be sideways as well.  Having opportunities to participate in think tanks, or side projects, or be able to each, ride a bike, do community outreach, all of that is important to keep me interested for years.

5.  A structure that provides for a career – I need a system that is going to provide for me both on the street and off it.  On the street, I need tools that reduce the wear and tear on my body.  A system does not have to be a non-transport system to provide for a medic’s career, but they have to have those nice power stretchers, tracked stair chairs, and the means of getting help to lift when necessary.  Comfort is key too.  Trucks need to be designed properly to provide a favorable working environment to those on the streets.  Also, a pension would be nice.  I need to retire someday!

6.  Priorities must be straight! – I saved this one for last, but really, it is most important.  I need a system that is not driven by how much money they can make off of reimbursement, or driving up volume to justify jobs and positions.  What I really need a system that is patient driven.  Leadership and medical direction need to both be on that page, and they need to work together for that common mission.  Couple that with a happy, experienced, and motivated work force, which is created with a balance of the other points I’ve made here, and an EMS system will thrive for years and years.

Each of us is different.  Each of us has a different idea of perfection.  Some people like to have the fire side of things tied in.  Others might look for a smaller system, or a larger one.  The key for each and every person in the national work force should not be to look for the perfect EMS system, it is a matter of making priorities, and finding the perfect system for them.

So what does everyone else think?  What is important to you?