Waaayyy "back in the day", as in, New York Circa 1869 or so...Bellvue Hospital was running Physicians and Surgeons on horse drawn ambulances. This didn't last all that long before running low on physicians became a problem. The hospital then tried using untrained staff to go out and get the patients. These staff were often times orderlies, kitchen staff and janitors. Death rates soared. As time went on, training was added, and ambulance crews became "dedicated" crews with one orderly in charge of driving and one in charge of patient care. Surely even in this the dark days of EMS, that orderly in charge of the patient sometimes spoke to a physician about what kind of basic level treatment they expected from the responders.
Ladies and Gentlemen of EMS, this is where you came from, this and the battlefields of the Napoleonic Wars, the US Civil War, World War I and II field hospitals and ambulances, Korea, Vietnam, and maybe even as far back as the Crusades (firefighters did at least). The US model of Civilian EMS system, which is what were trying to duplicate here, really got cooking in 1969 in Miami, and then Los Angeles, Seattle, and Columbus Ohio.
OK, now that were done with the really basic history, lets get to the point...
I give my students hell, its my job. Some days, maybe I take it to extremes, some days, maybe I'm a little too serious and surely some days I'm a little too pessimistic. I say this, not because my students have done anything fantastic lately, far from it, they're on vacation either relaxing, preparing for a pilgrimage of a lifetime, or getting drunk, chasing girls and doing all those things they're really not supposed to do. 3 or 4 of them have cracked a book, the rest are otherwise occupied. So why do I write this then? Simple, because today I was reminded by a facebook thread of all things, that US EMS "professionals" who learn in their own language, and have had the benefit of excellent hospitals and ambulances to learn on and have had experienced nurses and physicians to learn from are capable of being and are perfectly WILLING to be dumber than my students who come from a completely different culture, learn in a second language, and often have to "make do" with supplies and trainers that happen to be available.
So I'm going to make my point perfectly clear to my USA EMS brethren. Medicine at any level is a profession not a job. You should advance to the highest level your tiny, pea sized, dinosaur brain and your wallet can achieve. At that point however, you don't stop. You must continue reading, you must continue studying, you must continue perfecting. As you progress in your professional development, you become responsible for teaching as well. Whether formally in a classroom or by example in the field, your knowledge, skills and abilities need to be top notch so that you can set a proper example of how to treat patients and practice medicine (at whatever level) in general.
In today's world of social media, you are responsible for setting some kind of example or providing some form of encouragement to those trying to learn and eventually take the reins from your old, liver spotted, arthritic hands. When they ask a legitimate question, try providing them a legitimate answer, not an idiotic opinion. Try encouraging them to do some additional research, point them in the direction of studies that have been conducted, try explaining the reasoning behind certain procedures.
BUT PLEASE, FOR THE LOVE OF ALL THAT IS HOLY (can I say that here?) Stop spreading and regurgitating the same old non evidence based crap that you were taught, just because someone told you and you never bothered to research it!
So I leave you with these thoughts.
Q: Why do we backboard every patient who so much as hurt his wrist in a "trauma".
A: Because we started as Orderlies, Kitchen Staff and Janitors who regardless of intelligence level were given a very specific set of instructions to follow. IF A, than perform B. IF C than perform D.
No empirical evidence exists showing the benefit of non specific back-boarding of all trauma patients. In fact, it exists to the contrary, that we actually do damage this way. In modern prehospital medicine, we are not Orderlies, Kitchen Staff or Janitors, we are now capable of and responsible for study, thorough assessment, research, and evidence based practice approved by our medical control physician. Don't like it? The old jobs are hiring and probably pay better.
Q: Why is the Square Root of PI 1.77245xxxxx?
A: I have NO CLUE! I'm a Critical Care Paramedic, and Paramedic Instructor. But you can bet your ass if I called myself a mathematician, I'd know the answer.
You want to call yourself a medical professional? Act like one. Do your research, stay current, learn a little more every day, perfect your skills until the day the good Lord turns you back into dust and your time on this earth is over.
https://www.facebook.com/sincitymedic/posts/481378318563817
Thought provoking post !
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