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Street Cred' for EMS Physicians

I recently was at a national meeting where I had the opportunity to hang out with other EMS physicians and have discussions. One topic repeatedly came up: the issue of street credibility. It was conveyed to me in a positive light.

One EMS physician who HAS been an EMS provider said the following:

We know how close knit the EMS/fire family is. Many times, this is due to the collective experiences that we, as providers, share through spending difficult times together. For an outsider, this family can sometimes be a hard shell to crack. In order to make changes, one must have street credibility so that their colleagues will buy into the changes and trust that those changes are in their best interests. You can forward them the best journal articles as supporting evidence, but they won''t accept a radical change without the credibility.

There are several things I may want to change over my time at an agency. However, building credibility with them is my first priority. One way I accomplish this is by riding with the providers on a unit twice a month for a minimum of half a day. Also, I spend two days teaching each quarter. This lets them get to know me, and ultimately allows me to get to know them and their system, too. Hopefully, they ll believe in and adopt the changes when I unveil them due to the time and effort I ve have put into developing "street cred".

Another EMS physician who HAS NOT been an EMS provider said the following:

Since I ve never been an EMT or paramedic, I am lacking in the street cred department. With this in mind, I often ask EMS crews how they might have handled a tough scene, rather than refer to my own experience. And, because I don''t have street cred, it is much harder to get on my soap box and tell them how "it ought to be done," since I ve never been there. They may listen politely to my preaching, but not really buy what I''m saying. Or they may outright resent me for pushing into their area of expertise. I have to be careful not to overstep my bounds and make my crews angry with me unnecessarily, yet I still have to be the medical director with ultimate responsibility for what they do. In other words, I don''t want to upset them for no good reason, but I can''t be a pushover either.

For someone like me who is not out in the street and has no prior experience, I can attain street cred by supporting the medics if I agree they are right. The veterans trust I won''t turn tail and run on them if they need deserved support. Occasionally, that has made other physicians in our community very angry with me, but I don''t care about that. I am also very willing to swim upstream if I think I need to make changes in EMS and in our EDs. This dedication to EMS and the personnel may be the biggest reasons I get respect.

On the drive home, I thought about it some more and I m still not sure I understand what it means. A handful of nationally known EMS physicians have some background as EMS providers, but many of their peers don t.

I m very interested in what you think about this issue, how you see it from where you stand either as an EMS provider, administrator, educator or physician? Based on my interactions with a couple other docs, I want to put some things out there for you to chew on and please ask you to send me your thoughts.

What gives an EMS physician street cred ?

  • Is it being on the street now, or is it having been on the street then (or both)?
  • Is it such resume items as an EMT card from 1984 and stories of being paid $3.35/hr (back in the dark ages) to get shot at?
  • Is it knowing how to play the siren?
  • Is it knowing when something just doesn t sound right on the radio?
  • Is it owning not just one, but two pairs of steel-toed boots?
  • Is it doing practical and didactic teaching for the providers?

Do you think street cred is a plus or a minus for an EMS physician? How and why? What do you see as the added value? Does it really have a positive impact on the practice of an EMS physician and the agency they provide guidance to? Does it help them interface with administration/county government, or does it just help them with the providers?

What about your own medical director? Do you know them? Do you feel like you can approach them with questions, issues, concerns and ideas? Do you feel like they would have your back ? In your perfect world, what do you wish from your medical director?

E-mail me with your thoughts!

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