Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Another One Walks Away

Dr. Bryan Bledsoe[1] wrote an article for JEMS magazine called Another One Walks Away.[2] Copying the title was not imaginative, but I suspect that will be the least of the complaints about this post. This is an article that has generated a lot of comments at JEMS.com.
The article is about a medic, who left the profession club. EMS might be a bit better off if it weren’t viewed as just a simple task of transporting people, following protocols, and maintaining, or almost maintaining, low standards. 
If that were the case:
Maybe EMS would not be put in the hands of people who have a full time job in another field, but since they live in a rural environment feel they are qualified to provide medical care – As long as we keep the medical standards LOW.
Maybe EMS would not be put in the hands of people who are trained to fight fires, but due to the flashing lights and the woo woos feel they are qualified to provide medical care – As long as we keep the medical standards LOW.
Maybe it would not be put in the hands of nurses, but since they have a college degree feel they understand EMS better than those in EMS – As long as we keep the medical standards LOW.
Maybe EMS would not be put in the hands of people who are trained to be police, but since the state wants to maintain a monopoly on HEMS, feel that having a medic take a year off from EMS to work as a state trooper makes the medic better qualified to provide medical care than ground EMS providers – As long as we keep the medical standards LOW.
Maybe medical oversight would not be put in the hands of people who do not pay attention to what the medics actually do, but since they require a phone call for permission to do anything dangerous, they feel they are qualified to provide medical oversight – As long as we keep the medical standards LOW.
Maybe EMS would not be put in the hands of people who think that the purpose of a uniform is to blind you with a bunch of flare or some other appearance fetish, but since they have no clue about medical care, they think the uniform is important – As long as we keep the medical standards LOW.

Maybe EMS would not be put in the hands of people who are more concerned about the availabilty of ambulances, than the care provided by those in the ambulances – As long as we keep the medical standards LOW.

Maybe EMS research would not be put in the hands of people who think that the way to control for a variable is to make the same mistake as many times as possible – As long as we keep the medical standards LOW.
If I have missed anybody, I apologize, but I am working with low standards, here.
I do not mean to include all volunteer departments, all fire departments, all nurses, all police, all medical directors, all Liberace wanna be’s, all EMS researchers, . . . in my criticism. Part of the problem is that there are few who provide excellent EMS. Cross-training convinces people that EMS only requires part time attention.
I know people who provide excellent medical care and also do a good job in another field. Emergency services attracts the ADD personality. Some are good at several skills. Some are only good at making messes. Most are somewhere in between. Being an adult means having to make choices. Do I want to be a fire fighter, police officer, doctor, nurse, paramedic, . . . As a grown up, I need to choose.
Why should we eliminate people from a field, because the do not have a desire, or the aptitude, to be cross-trained in an unrelated field as a requirement of the job? Is our quality problem that everyone is too good? Absolutely not. We need to trying to recruit the best at EMS – not EMS and whatever the town council has chosen from a grab bag of jobs they, in their ignorance, think are related.
Cross-training only encourages the bean counters to devalue everyone. Look at triage nurses. They are required to provide all sorts of social screening and are having more added to their job requirements.[3] This is idiotic, but that’s what you get when you convince people that cross-training is a good idea. 
When we get serious about eliminating the lowest common denominators, we will need to eliminate this trend toward cross-training. In order to accept cross-trained providers, you have to accept that the LCD (Lowest Common Denominator) will drop even lower. Training people in unrelated fields will never result in higher standards in either field.
If there is a fire, I want those responding to be fire fighters – not paramedics cross-trained as fire fighters.
If I need the police, I want those responding to be police officers – not paramedics cross-trained as police officers.
If I need to be triaged in the ED, I want to be triaged by a nurse – not a social worker cross-trained as a nurse.
Maybe what we need is for anyone in EMS, who can get a real job (that includes fire fighter), to get one. Maybe we should leave EMS to those with only the ability to understand Would you like fries with that? 
On the other hand, maybe a job in EMS is one of the safest if there is a recession. It might even be better than having a real job.
Footnotes:
^ 2 Another One Walks Away

By Dr. Bryan Bledsoe
JEMS.com

^ 3 Here is the post I wrote about proposed changes in the duties of triage nurses.