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Discontent Breeds Distrust and Confirms Bias

I am not a very fast writer. My vacillation and rewriting means I miss the hot take. Case in point: An unidentified bearded man in jean shorts scrawled scandalous messages and awful claims on ambulances and buildings owned by FDNY. In my queue there currently sits draft number two of a post on public perception of EMS. More specifically, how social media griping fuels public distrust of EMS.

This rewritten piece originally began as my thoughts on lambasting EMS on social media. It was timely that this serial tagger struck. With several FDNY personnel able to keep jobs in the sunlight of past illegal behavior, it surprised me little that a person would label (literally) ambulances with horrible things. While I did not search out any

But this is what I was beginning to see. When lawsuits are made public, current and former employees (anonymous posters who identify themselves as such) concur with facts of the case. We cannot ignore all of these discontents as simply fed up. Some may have legitimate complaints; the majority just want to assign misplaced hatred or distrust of whatever on the large company. But when someone, posting with “authority of knowledge” by having worked for the agency being sued, claims this is standard operations for the company, it brings disrepute upon those who employed. We all know a few who struggle, but they do not represent the workforce as a whole.

It began affect me!
I am an insider. I sit around the picnic table and hear the gripes and suffer the same poorly thought out schemes. Yet I am not on social media broadcasting issues making them appear to be similar to every single ambulance service. My employer has had some press-worthy data breaches. Looky-loo nurses perused medical records of those they shouldn’t have and it made the news. As a result, I’ve sat in the ambulance deflecting suspicious inquiry of me, and my integrity when it comes to the electronic medical record (EMR) system.

But that is less hurtful than another EMS provider doing something stupid. No, let me say this: It is more hurtful to see a string of replies on social media that confirm all ambulance services are like this. That is not a quote; rather it is a generalization of any number of ways some anonymous malcontents inflict disrepute on his or her former employer.

I will not name the most derided multi-state provider of EMS care in the country. Suffice it to say, I’ve read some very negative things about the company. Enter “I hate [this company]” and you’ll likely find a sub Reddit. Anyone with a gripe against this company, EMS providers, poor service, “corporate America” or any popular diatribe will find their biases confirmed.

This summer I had the pleasure of traveling to two cities where this outfit provides EMS. I couldn’t help but wonder if the two crew members in there were proficient, happy, caring about those they encounter, overworked, so incompetent through the mismanagement of their overseers, etc. Some of those claims are legitimate; others are not and are painted with a broad brush. But I’ve had it so ingrained from reading social media posts I see their rig and fear for my life should I need an ambulance. I can reasonable decipher the list and extract those issues with legitimacy. The general public may not.

Who do they really hurt?
So who pays for such foul reputation? Not the company. Because of the Keyboard Warrior, an underpaid and overworked EMT or paramedic struggles to care for an untrusting patient who fears he or she may not make it to the hospital.

This is horrible to think. I say to those disgruntled internet posters, where do these multi-state companies get their employees? Do they fly in out-of-towners who couldn’t care less about who they treat or what they do to the community? Or do they employ local people? That is about as close as I will come to defending any ambulance service. My aim is not to prove a subset of employees wrong. I just want to remind them there are still people working there who care for people.

Ok. We know you hate your employer (or former employer). And you have grievances. But can you pause for a few seconds to reconsider a Tweet or Facebook post that harms current EMS professionals and the system people rely on?

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To predict or determine the future, it is in self-interest that prehospital professionals do both

I’ve made it a goal to be a participant in determining the destiny of our profession.

To predict is passive; to determine is affirmative and conveys a sense of control. In the context of our profession, my opinion is prehospital personnel generally do neither. I am not speaking of issues within an organization or local jurisdiction. Rather, I am speaking of larger issues like federal legislation or professional self-determination. Note how there is no such thing as “self-prediction.”

Too much cynicism facilitates easy predictions. Dare I say negative suppositions at that. And it is ingrained in public safety folks to expect the worse, but hope for the best. As the retort goes, hope is not a strategy. Strategy is something like Community Paramedicine. Innovative EMS leaders did not just hope populations become less reliant on EMS, they created a model of proaction.

Positive or negative, predictions are necessary. They make one consider future results. Consider driving with your eyes closed, experience suggests the inevitable crash. Determination is the act of opening your eyes to prevent an unfavorable outcome. In this case, prediction educates a determined action. Participants of EMS Agenda 2050 were asked to imagine prehospital care and public service in the distant future. It was not easy. The one instruction we received was to avoid today’s solutions as ways to fix future problems. This doubled the difficulty. We were to consider today’s problems in order to both fix and prevent them for future EMS professionals.

What is EMS Agenda 2050?

In November I attended the EMS Agenda 2050 session held in Minneapolis, Minnesota. You may still participate in a couple of ways. In person, at one of two upcoming public meetings or through a form on their website. I suggest contributing in person. However the online form is always available.

For more information check out The Straw Man Document.

The Straw Man broadly covers numerous categories of EMS system design. It is written to both prompt predictive consideration and encourage professional determination. These public meetings explore many paths through discussion.

To keep discussions fresh and dynamic, EMS Agenda 2050 organizers use the World Cafe approach. The concept is fresh dialogue as participants rotate at times intervals. For each six future think topics, participants move to a new table every 30 minutes. The goal is to sit with new individuals with each move. At this event, technical expert panel (TEP) members facilitated sessions and took notes.

It was daunting to think of an EMS workforce thirty years in the future.

As we moved around the tables, solutions were being considered for today’s problems. Kudos to futurists who dreamt of autonomous cars and pocket-sized computers as powerful as a 1950’s mainframe. All we could muster were future tools such as upgraded iSTAT blood monitoring or point-of-care ultrasound (POCUS) devices. In other words, we simply want improved versions of tools currently available.

Across several tables and topics, I synthesized a future EMS more interesting than revolutionary. First, to raise paramedics to the level of physician assistant or advanced practice nurse would enhance our profession. Second, higher training would allow stabilization of patients on scene or in their home. For instance, treatment with fluid, antibiotic, and a pressor if needed would reduce need for emergent transport of a septic patient. This enhances safety of crews, patient, and public. But as I pointed out, these are the next stages of profession advancement and beneficial results to all stakeholders. Who knows, perhaps by then we can beam them to Dr. Bracket on the U.S.S Rampart.

What next?
I highly suggest contributing to the ongoing round table discussion that is EMS Agenda 2050. Read The Straw Man Document. I will not go as far as calling it controversial, but it is indeed thought-provoking. We all ponder the good and bad of delivering prehospital emergency care. Do something about it! As providers, we are intimately familiar with barriers and solutions. Get involved farther away from your sphere of influence. If you are unsure how lobbying and petitioning your legislators works, find someone who can. Learn from and join with them to become a determining influence. Join groups and associations; maximize personal efforts by participating in groups.

Continue to examine current problems; solve them for future providers. With this, bring solutions not just complaints. Do not just predict “nothing will change.” Be the determinant that things will be different!