More on EMS and adult tables


The other day I ran across an article that I not only had to share, but found it amazingly insightful. So much so I think it should be mandatory reading for every EMT and Paramedic student in the world.

Here is a link if you are wondering:

A few weeks ago I posted an insight that some mistook as a rant on a self-purported EMT demanding I cite a study that anesthesiologists are better at resuscitation than EMTs. Anyone reading the comments can see that US EMS providers have certainly overstepped their expertise. I had to edit out some comments of people intentionally trying to impersonate others, especially me.

In the weeks since then while perhaps not what I think is my best post, it is certainly the most viewed. Normally about 25-30 people read my posts. But that one is seen by at least 5 people a day, and even hit the 5000 views mark.

This post isn’t meant to boast, in fact, there are other posts I would much rather people read, but I think it illustrates the point of the link I referenced perfectly.

You see, for many years I was involved in US EMS. I worked in almost every manner of it possible, in a number of states and countries. (I was never an air-med crew member and frankly, despite my earlier enthusiasm about it, I wouldn’t apply for one of those jobs today in any country)

Throughout my life I was always told I was very smart, on numerous occasions, too smart to work in the fire service or EMS. I really didn’t think I was smarter than anyone else, I just figured I worked hard and anyone who worked as hard as I did could do the same things, maybe even more things. One of my earliest mentors, and in fact I would say “heroes” liked to tell me “You can have anything you want as long as you work for it.” It turns out that was a lie, or most probably, not an accurate assessment of the truth.

You see no matter how “smart” or “experienced” or “capable” I was as a firefighter or EMS provider, I could never break through the barriers of being smart (which for a long time I was actually ashamed of) or more important to my career, having my opinion being seriously considered formally.

Many of the doctors I worked with informally accepted my opinion in private; a few even took credit for my moves. But ultimately I was told in order to really effect the changes I sought, I had to become a doctor. I hemmed and hawed over it for a few years until one day when working as an ER Tech, a doctor whom I greatly respected told me that one day he hoped to work for me. So I figured it was time to go to medical school. This was obviously a big step from my 750 hours of paramedic training. (I may have done some extra clinical time for my own enjoyment, but on paper, 750 hours) Having experience under my belt making diagnostic and treatment decisions in EMS, I found that in medical school I could worry less about certain aspects of “practice” and focus in on the material explaining “why” and all of the theory that I could reconcile with my experience to determine what works, what doesn’t, and what could be improved.

During this period of being a student, I actually got some doctors and even departments to change some practices. But mostly I was ignored as simply “another student.” I was told yet again, if I wanted to be taken seriously, I would need a PhD. So, I figured there was no point in procrastinating, and during my 5th year of med school, also started working full time on the requirements for my PhD. (I went to school in A European country where a medical degree takes 6 years and the requirements for a PhD are more demanding than in the US.)

Having finished all of this, and actually being taken seriously among experts as knowing something, I actually believed I was finally “an expert.” I put in the work, I got the papers, I had proven myself to other people who had proven they were experts.

So I was a little taken aback by people who had not worked as long (or as hard) as I did claiming either I didn’t know, or I didn’t cite a source for my statements. Despite accusations I didn’t give US EMS providers enough credit, I have come to discover I have given them too much. You see, I like to talk to people like they are my peers. As was eloquently said in the link above, experts have a certain level of understanding. They don’t have to prove every statement they make with a citation because there is a base level of understanding among experts.

The people demanding citations or even providing citations themselves for information that experts recognize as basic knowledge simply do not possess that basic knowledge themselves. They are imitating the methods of experts by citing things that are so painfully obvious and such a basic level of understanding, that most experts just accept the word of others who have demonstrated themselves as such. They erroneously believe this imitation makes them expert.

Now I am sure there will be some comments calling me an arrogant elitist asshole. But I have noticed something, which is why I was so taken with the article I posted in the beginning. This phenomenon is unique to the USA. It is only there I have experienced that people believe everyone is equally expert, despite limited or no formal education or training in a subject. They believe their skills at googling can make up for a lack of base knowledge and education. It is only in the US where every idiot is expert and every expert is an idiot. What’s more, this celebration of ignorance and lack of value on education is so pervasive that people are on the internet, TV, and print everyday suggesting education is a waste of money!

I know of no other people or place in the world where people view education and the educated in a negative way. Now while there is definitely some issue with the cost of education in the US, I ask myself, if it is so useless or invaluable, why do people in other nations give their very lives trying to get an education? Some will say that not every job requires an education. Certainly this is true. But I would point out every profession does. Even priests must have formal schooling.

When and how did being called “elite” become an insult? I do not see “regular” sailors calling US Navy SEALS “elitist” in a derogatory way. I do not see minor league athletes calling Olympians or Major League athletes “elitist” in a derogatory way. Instead they aspire to emulate and attain their level. Which is a completely different concept from “imitate.”

In my original EMS training, let’s not fool ourselves and call it education, it was taught and reinforced that a doctor was the high level expert. The one you were a representative of, to use an analogy, Darth Vader is the emissary of the emperor, and while extremely powerful and capable, was still the junior colleague. You see, just because you are part of the team doesn’t make you an equal player. Soldiers are all part of a team, they are not all equal players. Some are cannon fodder, some are generals. They do not have equal knowledge, training, or responsibility. They cannot step into any role in the army effectively, though it is much easier to move down and be successful than move up. For many years, and I accept equal guilt, US EMS providers saw anyone outside of the emergency medicine specialty as less capable as doctors or barely useful at all. There are even jokes about “what would you do if an “OB/Gyn showed up and offered to help at a car crash?” But really, an OB/Gyn is a surgeon, with training in general surgery. In fact, more training in general surgery than any US EMS provider has EMS training and they are a doctor to boot! Where did this hubris that they are not worthy to help come from? How does it apply to any doctor? I know a GP who spent most of his >15 year career in war medicine, is he not a capable doctor in an emergency? (He can be my doctor any day.)

I realize not all doctors are created equally, nor are they equally capable. But they are still experts at medicine. There are a lot of complaints by EMS providers doctors do not so enough to support or help them with everything from training to becoming a professional. But I offer this question. Why should we help? If I don’t tell you how great you are you call me names and try to defame me in clever ways like quoting me out of context and making up arguments I never stated. EMS providers do not recognize me as having any more expertise or knowledge than they do. In many eyes, I am not even an emergency doctor, so how could I possibly be of value?

Here is an expert insight my mom once told me.(In the western world females are taught from a young age to maintain relationships) “If you want somebody to be nice to you, you have to be nice to them.” If you do not respect my internationally accepted expertise, why should I accept yours? Simply because you can imitate an expert by citing a study for an argument so basic we could accept it as fact without a citation based on our detailed knowledge?

I submit, it is not US EMS that is in trouble, the article I linked demonstrates it is the whole country! Don’t believe me? Read the news. Measles outbreaks, articles on “don’t go to school it is a waste of money”. I don’t think it is possible for US citizens to vote to harm themselves any more than they already do at every level of society except the very top. I think you are all getting played; EMS is just a symptom of the disease.


3 thoughts on “More on EMS and adult tables

  1. S. Benson, EMT-P

    Thanks for sharing this–fascinating article.
    While I disagreed with the tone of your article on EMS, I can’t say I disagreed with with most of your observations. Too many EMS people live in an “echo chamber” of feedback in which they basically “talk amongst themselves.”
    Patting themselves on the back for a “great job” but not knowing if their efforts provided any benefit, or even harm, to the patient. The concept of M&M is foreign to the vast majority of EMS providers.
    I don’t know that EMS is symptom of the disease as much as it is another victim that meets the case criteria you presented.

  2. mpatk

    I’ve noticed for a long time how many people think that “common sense” is better than “book learning”; and how the more ignorant some people are, the more confident and confrontational they are in defending their ignorance. I finally read that the phenomenon actually has a name: the Dunning-Kruger effect.

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