I read an interesting article on Jems.com this week called "Street Cred" for EMS Physicians written by Sabina Braithwaite, an emergency physician (and paramedic) from Charlottesville, Virginia. She asks an interesting question about whether the relationship between paramedics and their medical directors is affected by the medical director's experience or lack of experience with the prehospital environment.
She asks:
What gives an EMS physician “street cred”?
Is it being on the street now, or is it having been on the street then (or both)?
Is it such resume items as an EMT card from 1984 and stories of being paid $3.35/hr (back in the dark ages) to get shot at?
Is it knowing how to “play” the siren?
Is it knowing when something just doesn’t sound right on the radio?
Is it owning not just one, but two pairs of steel-toed boots?
Is it doing practical and didactic teaching for the providers?
Do you think “street cred” is a plus or a minus for an EMS physician? How and why? What do you see as the added value? Does it really have a positive impact on the practice of an EMS physician and the agency they provide guidance to? Does it help them interface with administration/county government, or does it just help them with the providers?
Here are my thoughts on it:
I have great respect for a group of doctors called the Street Medicine Society who have taken their paramedic pasts, gone onto medical school and then becoming physicians, have dedicated themselves to improving and advocating for prehospital care and care-givers.
But I don't necessarily feel that being a paramedic is essential to being a better (or more respected) EMS medical director or even ED physician. In recent years as more and more hospitals are offering emergency medicine residencies and medical school students and residents are being required to ride with paramedics (however briefly) as part of their training, as a group, newer doctors are more in tuned with the prehospital environment and more understanding of what we encounter than some of their predecessors -- many of whom did not like us doing "doctor" jobs such as intubating and pushing drugs on standing orders.
I have met many non-paramedic EMS physicians who are very pro-EMS. The key is not about their street experience, but their willingness to listen to us, try to understand what we face, to advocate for us, and to share their medical knowledge with us so we can better apply it to the work we do.
Time riding with us is a bonus, but not essential.
The best thing that can be said about an EMS medical director around here is that he or she is pro-EMS (meaning they respect and value the work we do and fight to see our work is recognized). A pro-EMS physician would be more supportive of standing orders than a mother-may I approach and would work to increase our education and scope of practice rather than reduce it. At the same time a pro-EMS physician would set high standards for us and help us try to reach them as opposed to a you guys are great whatever you want goes attitude.
A good EMS physician doesn't have to try to be one of the boys to be respected.
I should point out that EMS medical directors around here are full-time employees of their hospitals and often carry a large clinical load. They are really not at liberty to spend much if any time on the road with us. I know other cities have their own dedicated medical director who works 100% of the time for the EMS system, and thus is out riding on a fairly regular basis.
What do you think gives an EMS physician "street cred?"
Post a comment here and/or send an email to Dr. Braithwaite at the email address listed in the article above.
