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

- Rogue Medic

Why Don’t We Specialize in EMS?

At The EMS Patient Perspective the topic of discussion is Now That Doctors Specialize in EMS, Shouldn’t We?

I think it’s great that physicians interested in overseeing EMS can now specialize in it, but we’re the ones going on calls every day. We need to accept more responsibility for our performance, from figuring out what the best treatment is, measuring how well that treatment is delivered, and adjusting operations so it is delivered consistently. So my question is, how many hats can we be expected to wear and provide excellent care? Can communities to rely on volunteers do this in addition to their full-time job?

In the comments, Skip Kirkwood writes –

Before we can get to specialize and sub-specialize, we have to have a PROFESSION to begin with.

So what is a profession? One definition is “a calling requiring specialized knowledge and often long and intensive academic preparation.” That, we are emphatically NOT. The recognized attributes of a profession are well described here: http://www.maxwideman.com/papers/spectrum/attributes.htm

We have high-school or at best trade school education. We have no distinct body of knowledge. We resist education and entry standards. We are, as a nationwide body (in the U.S.), someplace between a hobby and a trade or vocation. Profession? I wish, but I don’t think so.

One of the reasons for not having significant education requirements is that such a requirement would suggest that it is not appropriate to have us do every other job that someone thinks can be multitasked.

People don’t really want us to be specialists. They want to think that we can use a magic syringe, with only enough understanding to follow a protocol. As if a protocol can be applied to any patient without having the understanding to properly assess the patient.

We act as if EMS is about treatment, rather than assessment.

Treatment without assessment is not medicine.

A lack of understanding of assessment is not medicine.

A lot of people do not want the responsibility for understanding medicine enough to do a proper assessment.



  1. Unfortunately, “people” as Rogue uses the term above is mostly people in our own community. It’s as if they WANT what we do (EMS) to be a hobby or secondary occupation, because they don’t know enough or care enough to invest what it takes to make it a “primary” profession.

    To make it a primary profession, you would build it on a base of quality general education, then learn all of the science behind what you do, and learn what you need to go out and do it, safely and competently (instead of barely and minimally).

    Maybe in somebody else’s lifetime?

  2. It deeply saddens and disheartens me that such a great nation like the US has failed to do probably half of what has been achieved outside its borders with twice as much time as it has taken other nations.

    I would say more but there is nothing I can say that or suggest that is not already common knowledge.


  1. […] even by Mr. Kirkwood’s definition.  Rogue Medic and Skip have had a few exchanges on Roguemedic.com blog regarding professional status of EMS. Rogue Medic, as always, makes a good point.  It will not […]

  2. […] Specialties.  The venerable Skip Kirkwood weighed in on the topic and prompted the Rogue Medic to chime in.  Take a moment to check out those posts and come on […]

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