Chronicles of EMS - A double edged sword?

I've been struggling lately.

Struggling with all of the information I am absorbing from all of the professionals I get to communicate with on a daily basis these days.

I am suddenly exposed to a wealth of EMS knowledge and experience which would, I assume, be seen as a gold mine of information to many people. Indeed, that is how I see it also, and I have gained so much from that, that sometimes my head hurts from the combined thoughts of hundreds of people’s experience.

The Chronicles of EMS has given me so much more than I would have ever thought possible, but there is a flip side to it also, and this is what is affecting my day to day work life.

I have had a post in the back of my mind for a number of months, one which constantly sits there and sometimes raises its head asking to take up its place in the archives of this blog.

It was going to question whether EMS 2.0 is a purely American thing. Does the UK need EMS 2.0 or are we already there?

I mean look at what I can do? I can tell people that they don't need to go to hospital, I can organise for alternative care providers to come and see the patient at home instead of transporting them to the hospital. I can make autonomous decisions about what is best for my patients and have them agree with that treatment plan. Surely that is already EMS 2.0, right?

Well yes, I would say that that part of my role is definitely part and parcel of whatJustin, Chris Kaiser and I hope to see develop from the Chronicles of EMS and EMS 2.0. However, what I am learning and what I am finding more and more difficult to accept is the fact that in other ways, the UK ambulance services are far behind our brothers and sisters in EMS across the great pond.

Before all of this crazy show started, I lived and practiced in my own little bubble. I used to naively think that we were the best at what we can do. If a patient needed emergency care, then they would get the best the world has to offer. In some cases I still believe that, but not in all.

Now, I can say this because I am not criticising my service here, I am looking at the NHS ambulance service as a whole and recognising that what has happened for years and years still happens now and will continue to happen. That is that we follow US developments in the field of medicine, usually anywhere from 2-5 years after the new development has been tried and tested in the USA.

That's never been a problems for me before because I have never had the awareness that I have now from spending so much time in the US and talking so much to operational staff, managers, Chiefs and industry professionals.

Now, it is becoming a huge frustration for me because I can see what I should be doing and I can see what will be coming, but until that happens I feel angry that we are lagging behind.

Let's take one example.

Out of hospital cardiac arrest.

I used to think that we were as good as this as anyone else. But now I know that there is so much more that could be done, like:

More hands on scene - that has always been a role I would like to see our colleagues in the UK fire service take on. If not, then even getting more ambulance responses on scene would be a benefit. One crew, 2 members of staff, no matter how well trained cannot perform continuous compression CPR on a patient from arrival on scene until handover at hospital, it is impossibility. As much as I can see flaws in a Fire Based EMS model at times, the one thing I saw which has obvious benefits is the amount of hands on a patient when necessary. There is no point in me looking for someone to swap in for some compressions when I am in the back of an ambulance alone, and if we can't have extra hands then why not look at equipment that can help us.

Compression assist devices such as the Zoll Autopulse and the Physio-Control Lucas device could take the place of the extra pair of hands needed for a UK paramedic crew on scene. This will come, without doubt, but it will be a couple of years down the line.

What about the apparent holy Grail of prehospital induced therapeutic hypothermia? How long before that hits the UK shore.

Please don't get me wrong, I'm not saying that all of these things will bring real benefit to patient care (well, actually I guess I am), but why does it take so long for them to make their way over here?

Why should I have to go to some of my patients knowing that there may be better ways of caring for them, which I may well not have access to for a number of years?

Uk pre-hospital care isn't the yard stick for all other EMS systems to be judged against, far from it, but maybe this just goes to show the value that The Chronicles of EMS and the EMS 2.0 movement can have.....bringing new thoughts and ideas to services which feel that they may be doing things the best way they can already.

I have had my eyes opened and I can see the future of prehospital care, and it includes every bit of knowledge and experience that I can gather, and more importantly share, with services throughout the world.

Until that day comes though, I will remain hopeful and proud to work in my system, but also frustrated waiting for best practices to make their way over here as well as some of ours making their way over the the States.

To finish off, just read this article from the Richmond Ambulance Service in Virginia. This is what I want to be doing for my patients!

Richmond Ambulance Authority nearly doubled prehospital ROSC rate because of the ARCTIC program


Rogue Medic said...

I could not write a short comment, so I wrote a post. I only used part of your title.

Double Edged Swords

Adam Thompson, EMT-P said...


I am sorry about your cleansing of blissful ignorance, so-to-speak. There has been times where I wondered why the UK or the military got to do stuff 4 or 5 years before I did.

I think this realization of where your department can improve is what EMS 2.0 is all about. If you continued in your ignorance of thinking 'we are the best', as so many of us have thought in the past, EMS 2.0 would not be doing it's job.

Every department can improve. I think that part of EMS 2.0 should improve all departments by putting together a HIPAA-compliant online database with information from every call run. If we could get information on such a massive level, Evidence-Based Medicine would begin moving at light-speed in our field. I fear this concept is a bit far fetched.

Anyhow, I am glad you openly discuss this evolution. I am seriously envious of many of the things that you get to do. I believe a major tort reform would be needed here in the states prior to being able do to most of it.

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