Administration and Leadership, Columns

New EMS Tech Shifts Focus Away from Responders

Issue 5 and Volume 41.

Over the past 25 years, I’ve realized a truth about EMS in the United States–we love to buy stuff! We yearn for new devices that make our jobs easier.

EMS has become a hotbed for device manufacturers of everything from stretchers that load themselves into an ambulance, to miraculous adjuncts to stop massive hemorrhage.

New technology that transmits data directly to the ED, for example, allows the physician a five-minute head start on what’s coming through the door. Although it’s clear some of these items improve the care of our patients and the safety of our workforce, many are simply looking for a reason to exist. Post 9/11, EMS has enjoyed unprecedented favoritism from our admiring public, and we’ve been scurrying to spend ever since.

If you attend any EMS or fire-related conference, they’re filled with fancy stuff, flashy stuff and Velcro stuff. Every year, there seems to be a new monitor that does a little bit more than the version before it, enticing us to buy the latest and greatest.

I was recently involved in a focus group hosted by one of those monitor manufacturers. They were interested in adding a waveform that measured a new type of vital sign to help diagnose occult shock. They asked for my opinion, but my response wasn’t exactly what they expected. The technology was clever, but I had reservations. It wasn’t about the technology, but the ability of our paramedics to weigh this new data point along with the history, physical exam, blood pressure, heart rate, end-tidal carbon dioxide, 12-lead ECG and ultrasound findings to make a difficult clinical decision.

The past several decades of American EMS have seen an onslaught of new technology and devices, with no substantial advancement in our mission to ensure paramedics are keeping intellectual pace with changes in the job. This includes interpreting new sources of data input in the development and refinement of their differential diagnoses.

We have to understand that this is a trade-off. As an industry, we’re sacrificing our medics’ educational opportunities, increased pay and decreased workload so we can buy new stuff!

In contrast, when I look around the room at my Level 1 trauma center, I see a different trend emerging. I see cardiac monitors that are more than a decade old. I see the utilitarian furnishings and telemetry devices that are functional, but not top-of-the-line.

In a perfect world, it would be nice to have cutting-edge equipment, but the latter is good enough to get the job done. We have medical practitioners in EDs who don’t need all of the extra adjuncts to interpret data for them–they’re trained how to do it themselves. They don’t need devices to detect occult shock because they have diagnostic tools and clinical acumen to help make those determinations.

The market competition for physicians, nurses and allied health professionals is fierce. In order to recruit and retain talented individuals, we have to pay well, provide better benefits and establish ongoing educational opportunities. This means less money to buy stuff.

In the quest for American paramedics to transition from technicians to clinicians, we must align our goals so that how we spend our money is congruent with moving the profession forward.

Although some technology in the field has been of unquestionable benefit (e.g., tourniquets, continuous positive airway pressure and 12-lead monitors), others are categorized as “nice to have, but not essential.” We must strike a balance between the essential equipment and the fluff, so that we can focus more time and money on our most important tool: our medics. Instead of filling in the knowledge gaps with expensive devices, how about we fill them in with knowledge? EMS administrators must reprioritize the educational and professional development of our workforce by dedicating more resources to these efforts.

As medics, we have to stop being lured into jobs by the promise of the “latest and greatest” equipment, and seek out EMS systems that are dedicated to education and development. As an industry, we have to transition paramedics to paramedic practitioners who can see patients in the field and disposition them without transport to the hospital.

In doing so, we can create a career path that isn’t dependent on working 24-hour shifts and pulling 20 hours of weekly overtime to make a good living. As much as I love the stuff myself, I realize that our focus on it is holding us back from advancing as a profession.