Commentary, Exclusives

Why ‘The Laura Begins’ of Our Industry are Imperative Now

Laura Begin (Photo by the author.)

As a boy growing up in Los Angeles during the Lakers’ “Showtime” era, I read Earvin “Magic” Johnson’s 1989 autobiography Magic’s Touch and recall one lesson 30-something years later: If you watch the ball, you miss most of the game. It isn’t the star of the show who empowers collective success. Each win is the product constructed of every assist, rebound, pick-and-roll, and locker room “call-to-arms.” Put another way that jives more closely with our industry’s daily existence, ambulances and engines aren’t staffed by one-person crews.

Since its inception, my column has been about celebrating underdogs—or, at least, the under-celebrated. Many prehospital care professionals engage in regular self-reflection; it takes a special kind of faith to work in our industry. But few gain (or seek) national attention, so although a few celebrities always get invited to speak at conferences, most local heroes go relatively unknown. In March 2020, I interviewed Laura Begin, emergency medical services (EMS) coordinator at the San Ramon Valley Fire Protection District (SRVFPD) in the greater San Francisco Bay’s East Bay region. The COVID-19-colored sky had not yet fallen on our daily life, so the impact our chat had on my soul was not yet clear. I did not yet know that her optimism and team orientation would stand as an exemplar of our industry’s path through the mess to a more sober-minded and self-aware other side of the chasm. (Disclosure: I live in a town that is served by the SRVFPD.)


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Before interviewing Begin, I connected with her chief, Paige Meyer, and immediately detected something awry…in the best possible way. By the end of our first conversation, I understood: while Begin has ambitions to be excellent, her focus is on the team, which makes her charismatic to her colleagues. I asked where she would go as word spread of her renown for enhanced quality assurance and data integration with area hospitals.

She responded, “I’m not thinking about that. I just want to do the best job I can here.” Such a brush-off would have been eye-rollingly cliché if not for the fact that, in 10 years working around prehospital care professionals, I have never before heard a fire chief say of his EMS coordinator “[she’s] a breath of fresh air, and [I] really don’t want to say ‘change agent,’ but definitely upgrade.”

SRVFPD is better known by its reputation than by name. The widely lauded PulsePoint app was born there under prior leadership. It then spread out like…well… like a virus (but the good kind!). Given its history with PulsePoint, Begin’s fit into the SRVFPD culture makes sense. The department has a history of looking beyond its walls. She is an amalgam of tomorrow’s prehospital care, she’s a Canadian and deeply rooted in her family’s European history, embodying the emerging global nature of our industry’s learning and science. She worked in San Francisco General’s trauma system as a nurse before joining the fire service, then served overseas during an extended exchange of insights with Tanzania’s clinical ecosystem, some of which she helped bring to fruition. She’s a born-and-bred translator across the political chasm of patient handoff.

Begin also appreciates, by virtue of rich personal and professional relationships, that the bickering with which our industry struggles such as whether or not degrees should be required; that the “right name” of community paramedicine/mobile integrated health should be; the self-perpetuating and largely unnecessary turf war among physicians, nurses, and medics; public vs. private agencies; EMS vs. fire; and so on pales when a visiting young clinician from Tanzania, living on a stipend in San Francisco, is willing to forego basically anything fun so that he or she has enough money left over to blow an entire residency’s cash on a first-ever laptop. Then you realize that some of the young African clinicians who Begin mentored—and who mentored her in turn—are the ones jump-starting a new height of medicine there. Few people in prehospital care can draw a line of impact that extends from the San Francisco suburbs to actual lives saved on the other side of the world.

Begin is a member of the emerging “new guard” of prehospital care professionals whose vista spans firefighting, emergency medicine, nursing, social work, clinical informatics and analytics, and organizational behavior and team building. A win for this group means that egos have given way to cohesion. It’s a national trend—powerful, data-driven, and exciting. It’s visible in the agencies self-selected for ET3 that realize the substance use disorder problem hasn’t gone away; it is tracking coronavirus exposures among the staff using something more than a spreadsheet. The new guard appreciates that COVID-19 is testing our collective preparedness and grit, and that we must take notes on where we fall so that we don’t do so again in six months.

SRVFPD’s embrace of the need to lead may have come in the form of “a breath of fresh air,” but Begin harbingers a trend. They say luck is where opportunity meets preparation, and she represents the emerging prehospital leader who has trained to see lines of need crossing over because both human and organizational pain live there, from POLST to EHR data-sharing. Even during a crisis like the novel coronavirus, you can only improve what you can measure, and you’ll only measure what you’re looking for.

Author’s Note: In the words of the inimitable reporter Lester Holt, “Take care of yourselves, and each other.” Stay safe, friends.