Should EMS Education Involve Customer Service?

Separating the front and back ends in EMS

 

 
 
 

Keith Wesley, MD, FACEP | | Tuesday, June 16, 2009


Review of: Campeau A: "Introduction to the 'space-control theory of paramedic scene management'" Emergency Medicine Journal. 26(3):213-216, 2009.

The Science

The study from Ontario, Canada was a survey of "novice" (< 5 years' experience) and "experienced" paramedics to ascertain the elements they consider when taking control of a scene and caring for a patient during the course of their duties. The author's goal was to compare these elements to those that had been proposed in their previous paper, "The space-control theory of paramedic scene management," which was published in Symbolic Interactionism in 2008. (1)

The basics of this theory are that the workplace of EMS is unique in many ways. In the vast majority of workplaces, there is a "front space," where the customers receive their service, and a "back space," where the goods and services are created or prepared. In EMS, there is a blurring of these spaces. The author postulated that "experienced" paramedics were more able to list those elements of patient care that are "front space" and "back space."

Although the author didn't list the distinct differences that "novice" and "experienced" paramedics, came up with they did provide a wonderful list of elements to consider.

Antecedent and sustaining social process(es):Establishing a safety zone.

Specific social processes

  • Reducing uncertainty through social relations
  • Controlling the trajectory of the scene
  • Temporality at the scene
  • Collateral monitoring

The author suggests in the discussion that current texts do not take into consideration the social interactions necessary to facilitate space control and that education and psychomotor testing needs to be modified.

The Street

Although this article may seem at first glance to be a bit "high brow," it's in fact saying a very simple thing. "Get real." We don't train the way we practice in the field. How many times have you done a mega code on the table with a separate CPR mannequin and "Fred the Head" and no bystanders to control? No first responders or BLS providers to interface with? Then you wonder why it all goes wrong in the field? We worry about whether the scene is safe while looking for downed power lines when we should be more concerned about whether the scene isunder control. Does everyone know what they're doing? Do I have the public in the "front space" so that they only see what they need to see and not what they don't need to see? Can I get the patient to the "back space" so patient care can be provided in a controlled environment?

These things are never discussed in the textbooks. The expectation is for us to learn them on the streets. Why? Isn't the purpose of military boot camp not only to learn how to fire your weapon but also how to work as a team? Why shouldn't the same apply to EMS education?

Kudos to author for introducing the interesting theory of basic customer service to EMS.

Reference

1. Campeau A: "The space-control theory of paramedic scene management." Symbolic Interaction. 31(3):285-302, 2008.




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