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EMS 2.0

Why vs How and Book vs Street

As of today the argument that street smarts outweighs learning from a book will be officially retired.  At the same time, the demand for an Associates degree before hitting the streets will also be retired.


Because one can not succeed without the other.  We all agree this is true and for years have been attributing a common phrase to one another:

“Do you have 10 years of experience or 1 year of experience repeated 10 times?”

Experience is respected in EMS, mainly because we eat our young and slowly replace the limbs and joints of our elders until they literally fall apart in their 40s.  If you’ve been here the longest, regardless of your skill level, you must know something.

EMS succeeds in keeping standards low to keep a fresh crop of adrenaline seeking folks in the seats to move Mr Jones back from dialysis at $42.50 and 50 cents a mile.

Too many EMTs and Paramedics I meet demand higher wages yet don’t think they need additional education to justify it. Most often their rationale is linked to their experience doing the job, not in learning how.

Ambulance Chaser recently re-opened the Crimson Tide Ramsay vs Hunter discussion of “Why.”  We are reminded that simply performing a task is not the goal, but understanding why we are performing the task, as well as the intended outcome and consequences is the benchmark of success.

“I can teach this cat to intubate, but I can’t teach him when not to,” is quite possibly my favorite EMS quote of all time and puts this topic into terms we can understand: cats.  We refer to supervising EMS as herding cats, denoting a variety of influences and intended outcomes rapidly applied in random fashion with the same outcome expected.  Put 10 Medics in a room and you’ll get 10 different impressions from an assessment.  Mostly because they all had different training, different education and different experiences.

How much weight do we give to these three separate forms of learning in EMS?

Can I interpret a 12 lead because of the class, the internship or the field time?  I’ve been devoting a good deal of time researching this idea and am hitting on some good points.  For example:

“Truly successful decision making relies on a balance between deliberate and instinctive thinking.” – Malcolm Gladwell

In one of his bestselling books, Outliers, Malcolm Gladwell examines how we attribute success.  Most notably he points out that Bill Gates is described as brilliant and tenacious by those that know him and that his success comes directly from these traits.  “But I know brilliant and tenacious people who aren’t worth 60 billion, so what is the secret?” asks Gladwell.

I won’t spoil the book, but it turns out Gates was also a brilliant programmer with thousands of hours of tinkering and designing to go with his other skills.  Had he been around 10 years earlier or later, would those skills he enjoyed, was good at and did often combine with the same tenacity and brilliance to achieve the same level of success?

Not likely.


Where am I going with all this?

Our argument is not a new one.  Other professionals had these discussions decades or centuries ago and have been tweaking the qualifications ever since.  We are on the verge of an awakening of sorts, where EMS will not splinter into sub specialties but come together to recognize the need for a base of knowledge crucial to provide the services our communities expect and deserve.  From that foundation we can begin to build our profession to address the special needs and services so many communities already offer.  We won’t do this with a certificate and a patch, but with curriculum designed with purpose as part of a larger program.

Chris Montera and others have been doing just that and are seeing success with their pilot programs that are not only spurring others to follow, but allowing their service to prove value and earn respect to begin moving into other niches left open.  When you can prove you were right people are more likely to give you another shot at success.  Take it.


Don’t just want change in EMS, understand WHY we need that change.


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