The Years

 If I ever had a call – a double shooting or a status seizure -- where I could look back and say here is where it all came together, then I have forgotten it.

What I remember from my earlier years as a medic is not so much one specific call, but rather gradual realizations over a series of calls that I was getting better at my job. Becoming a better paramedic is about reaching a series of plateaus where your realize you are doing something fairly well on a regular basis that you once had anxiety about. You give a quality report at the hospital and think, you know, I'm getting pretty good at that. You manage a cardiac arrest, coordinating the compressions, securing the airway, calling out the drugs, and getting pulses back, and you realize that not only do you know what you're doing, but you doing it like it is supposed to be done.

There are so many areas a paramedic has to master – from assessment and all its areas to the wide variety of our mechanical skills to other talents like scene management. --that it is hard for any of us to reach true expertise in all facets. There are some areas I became good at quickly -- like patient repore or IVs -- and others that have taken years to master -- like splinting or respiratory care (particularly suctioning) -- though mastery is often an illusion.

What I like about EMS is there is no resting on laurels. You truly have to prove yourself every day and on every call. Getting twenty tubes in a row doesn’t help you when you’re looking down the throat of someone you can’t for the life of you get the tube in, or being the nicest, most compassionate paramedic doesn’t cut it when you are in bad mood and set off either your patient or one of their family members with an ill-thought remark. This job is all about the present.

The only difference between now and my younger years is it is easier now to pick myself up when I fall. If I miss an IV or am off base in my assessment, it doesn’t crush me like it used to. Learn and move on. And when I do a really good job, well, I’ve been humbled too much to stick my chest out too far.

Community

Last week I had the privilege of attending a ceremony in which a town received a Heart Safe Community designation, which goes to towns who meet certain criteria in terms of their EMS systems and availability of training, education and public access defibrillators and other factors affecting the Chain of Survival.

At this particular ceremony there were three cardiac arrest survivors who all got up and told their stories -- of their lives on the day they went into arrest, of who saved them, and what they have done with their lives since. All three suffered their cardiac arrests in public places, recieved bystander CPR, were defibrillated within minutes, and had rapid response from EMS. All three returned to productive lives.

Watching them speak, for a moment, I pictured a dead version of them besides themselves. Cool, lifeless blue heads, bloated bellies, vomit strewn down their mouths, unending flat lines – a version that could easily have been a reality if the Chain of Survival had not held strong on their day.

Those grim images faded and were replaced again by the living, by the human warmth, smiles, and by their grateful tears as they recounted seeing a daughter graduate, being present for the birth of a grandchild, going on a trip to Paris with a wife of fifty years.

Every ambulance company president, every hospital CEO, fire chief, municipal elected official, EMS medical director, state and regional EMS representative, right on down to front line paramedic, EMT and first responder ought to attend one of these ceremonies every year.

Turf wars are too common in EMS. Over the years I have seen it in many forms. EMS versus fire, first responder versus ambulance, intercept medic versus transport medic, ground versus helicopter, commercial versus municipal, volunteer versus career. Field versus hospital. Big hospital versus small hospital. Town versus region, region versus state. While we all say we are for the patient, we all have our own agendas. And that can cause our eyes to drift from the prize. A badly put together conflicted system can kill.

It is so easy to forget what EMS is about. It is not about us. EMS is about our communitites. It is about those three living souls and their families who still have them.

EMS is about designing the best system possible, not necessarily for our service’s or hospital’s needs, but for the patient’s needs. We need to check personal and institutional egos at the door. We need science based protocols, system benchmarks, quality improvement/assurance programs, and out-of the box thinking that is never afraid to change the status quo if it is the right thing to do for the patient. And we need to each prepare personally, so we are always ready to do our best.

This is not frivolous work we do. Those three survivors are a testament to that.