Are You an EMS Robot?

Each EMS service is different, in each town, state, country and continent. But we are going to propose discussion about an issue that has crept into our profession like a cancer, gradually trapping more and more EMS personnel around the globe in its clutches. We don’t expect you will be able to change the way every EMS school and service operates, but we would like to shed some light on an ever-growing problem of robotic EMS providers. We ask only that you measure yourself as you read this article, and determine which path you have been taking.

The most significant characteristic of robots is they do what they’re programmed to and complete the task given. They don’t ask questions, analyze or solve most dilemmas, unless further directed to do so. We have a problem in EMS with too many providers memorizing assessment steps and following through with protocol treatments, but failing to take this treatment to the next level, or think beyond that first step. Those next steps in the puzzle are what actually make a great provider. Critical thinking—the ability to analyze the whole scenario involving any patient care problem or its initial emergency management—is the golden nugget. Seeing the big picture is absolutely vital to excellence in EMS.

A common breeding ground for EMS robots is many times the very learning institutions they graduate from. Although there are some examples of excellence in EMS educational and training facilities around the world, the exploding business of breeding new EMS generations seems hurried and pointed more at getting the most students through a course in the shortest time possible. Students get wedged into fewer clinical sites, both in-hospital and in the field. In our professed attempts to “raise the bar,” it seems we have simply lowered the bar in many ways, and painted it as efficiency.

We place educators in direct competition with profit, rather than results. In other words, it seems EMS has decided that the “corporate raider” mentality should drive its professional goals, rather than achieving quality through excellent instruction and example. Instead of setting realistic goals and giving outstanding teachers a place to teach, it seems we are more interested in pushing out as many newbodies as possible in pursuit of the almighty dollar. Many of us believe it is time for a new concept in EMS education and practice.

Ask yourself the following: How many instructors/educators have you been held hostage by who have never learned how to teach? How many of those instructors are still out there lecturing and guiding other students, teaching them to check off lists of skill completions and assessment details, but never finding the time to show students how to think critically?

Critical thinking is a new buzz phrase for something that used to be taught as a matter of course. It seems that somewhere in the 1990s, it fell by the educational wayside and is now so lacking in young adult students as to create an educational crisis. In EMS, critical thinking skills are paramount to our success and the professional treatment of our patients. But we would like to propose that instead of just educating students and providers to step outside of the box through critical thinking, why not stretch the box? Ask yourself how many others could not or did not teach you how to take that box and stretch its sides, until what used to be “outside the box” was now inside and became an important part of your field arsenal?

To stretch the box, ask yourself:

Outside of your protocols, can you make a decision on your own?

If you are presented with a patient with chest pain or shortness of breath, do you blindly travel down a treatment protocol without completing an assessment and analyzing what else might be causing the symptoms?

When something happens to your patients during your “time of care,” do you possess the ability to efficiently determine how you’ll deal with it?

When a bumper of a vehicle involved in a collision is lightly dented, do you automatically immobilize the occupants because it is protocol to do so?

We are not in any way suggesting that you stray from or ignore your guidelines. We simply want you to recognize the opportunity to add some depth to your overall care and assessments. Let’s think about examples we have all around us and see if we might improve our skills.

For example: A physician asks a patient more questions than we might ever pursue in our field assessments, right? Do you think he inquires with the intent to complete the lists that he was taught in medical school? Admittedly, some do. And what is our reaction to them? Not a positive one, right? But watch the really good physicians. You’ll find when they ask questions in a patient interview, they do so with exact intent, attempting to determine what can be ruled in or ruled out as they go along. Given certain pieces of information, they can change direction on a dime; but they do it for a reason, not because some flowchart tells them to. (If you watch closely, you can almost see it in their eyes.) And we admire their skill, do we not?

Imagine if a physician prescribed medication just because the patient fit a general category in a medical journal. Stretch that example further. When that physician hands off a patient, do you think he states that he asked all the questions he knew? No! He conveys the pertinent findings gleaned from his completed detailed assessment. Now think of all the nurses and physicians who receive your patients. Are you direct and informative in a truly educated and professional manner, or do you give a formulaic report because it’s easier?

Let’s get even closer to home. How many of you administer 100% oxygen when a patient has an injury that matches a classroom textbook picture (e.g., a young adult with a splinted sprained ankle, having oxygen administered)? How many of you place oxygen on a patient with the sole purpose of making it look good, or with the intent of making a patient feel better psychologically, perhaps thinking they got something for their money? (And don’t tell us you haven’t heard that one before!) The day that someone challenges you to consider oxygen as a medication (it is a medicinal gas, correct?) instead of a tool, you may finally realize the need to ensure that the patient did require that treatment.

Don’t allow yourself to take a lazy, uneducated approach to your emergency care. Protocols have been defined by well-respected and experienced EMS physicians as guidelines, not absolutes. Your brain should be the bridge between the protocols/assessments and the patient care. Pursuing this career as a way to legally drive fast, crank up a siren or wear a uniform to boost your ego won’t get us anywhere as a profession. Rather, it will negatively affect professional perceptions of EMS and deter optimal patient care. A sad commentary on the mind-set in this profession is the common response, “I don’t get paid to think, just to do what I do.” Such an attitude not only becomes evident in your social interaction at work, but heavily jeopardizes your ability to appropriately assess and care for patients.

Diagnosing patients is what we are suggesting. EMS providers assess and provide treatment specific to symptoms with possible etiologies. Admittedly, with experience and exposure, many of us are able to take it to the next level, and in collaboration with EMS physicians, we do. Such collaboration can only lead to better patient care and advancement of prehospital EMS. Thus, whether as a student new to EMS or a seasoned professional, we need to work against falling into the trap of treating patients by the book, instead of basing treatment on good assessments and wise analysis of our findings. To do so, we must take the time to learn. Learning of this quality does not happen overnight, but the time and effort involved should not stop us from working toward that goal. We need to promote this effort and not continue to cultivate systems and providers that ignore it.

Push for excellence in all you do. It can only lead to success in your career and, more important, stellar care of your patients.