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

- Rogue Medic

Do We Have a ‘Bigotry of Low Expectations’?

Kelly Grayson writes that –

The biggest obstacle to the advancement of our profession is not the limitations imposed upon us by others, but the lies we tell ourselves[1]


Image credit.

Is this an unreasonable assessment?

No, it may be too subtle for most to understand, because Kelly does not appear to have received the usual hate mail that comes with the exposure of EMS problems.

What lies do we tell ourselves?


“We don’t diagnose.”[1]


We have no idea of what we are doing, but we give deadly drugs and perform deadly procedures based on this no idea.

“We work under the physician’s license.”[1]


Using similar logic, when I drive a car, truck, ambulance, . . . I am driving on the Governor’s driver’s license. If I drive dangerously, the Governor will share liability, since I am driving on his license.

It may state in the health code that medics in some states do practice on the license of the medical director, but please provide some evidence of action against that license because of a paramedic’s actions.

Where is the command responsibility?[2]

“The protocol says…”[1]


This is usually followed by misinterpretation.

This is not because protocols are so well written that they do not encourage bad treatment, but the approach is to find absolute rules to prevent the person from thinking. The person is afraid of his own thinking. This does not suggest that he does a good job of thinking. Therefore, whatever interpretation he makes can be expected to be a misinterpretation.

“Right or wrong, he’s the doctor. We have to follow orders.”[1]


That excuse has failed before.

despite the fact that the medication was ordered by a physician, each of these individuals knew from the Advanced Cardiac Life Support guidelines that the medication could have “lethal,” “disastrous” consequences when administered to someone like the plaintiff, and they recognized that the standards of care applicable to them required that they exercise independent judgment and not just “blindly follow a doctor’s order that they knew posed an extreme degree of risk to the patient”

Columbia Medical Center of Las Colinas v. Bush, 122 S.W.3d 835 (Tex. App.—Fort Worth 2003, pet. denied).[3]


We are responsible for our actions.

If you are looking to avoid responsibility, you should not be in any position of trust.

Where does all of this lowering of standards lead?

Never mind all that. We can’t meet our goal. Let’s lower the standard.

Allow me paint for you a little self-fulfilling prophecy:

  1. Paramedics gripe because they are underpaid and disrespected, and have difficulty obtaining reciprocity in other states.
  2. ED physicians complain because we bring them patients whose airways are poorly managed.
  3. . . . .[1]


Where does this lead?

Go read the full article.


[1] The bigotry of low expectations – The biggest obstacle to the advancement of our profession is not the limitations imposed upon us by others, but the lies we tell ourselves
By Kelly Grayson
August 13, 2013

[2] Command responsibility

[3] Malice/gross negligence.
Thornton RG.
Proc (Bayl Univ Med Cent). 2006 Oct;19(4):417-8. No abstract available.
PMID: 17106507 [PubMed]

Free Full Text from PubMed Central.