Isn’t It Ironic that Saying the Same Things Separately Limits Our Chances of Success?

Jonathon Feit

Dispatch 1 of 2 (Pun intended!) from APCO 2023

As I journey through adult life, I find myself remembering tidbits and sayings from youth that suddenly fit together differently, but better. They are contextualized, like watching Ghostbusters again as an adult, and “oh my gosh, that’s what that means?” This feels especially true of religion: seemingly nothing about matters of faith are the same through adult eyes—and ironically, that evolution fits well as I walk through the 2023 APCO conference in Nashville. In reviewing its agenda, overhearing early conversations, and contemplating which sessions to attend, I cannot help but notice the similar to the Mobile Medical ecosystem.

That seems intuitive on some level: Dispatch and Mobile Medical professionals sit on a continuum that starts with a call, proceeds to response, then on to care and finally learning how to improve. The similarities also mean noise in the market—repetition and difficult telling who needs what. Avoidable silos, and difficulty determining what will benefit which patch color most (which is highly counterproductive). If everyone is experiencing the same challenges, why aren’t those among us who work together anyway sharing knowledge of how to save everyone else some drama? Why don’t folks want to learn from each other how to save themselves some drama?

Overlapping Priorities

The politics of the PSAP ecosystem (which is highly aligned with police) obviously overlap with Fire and Mobile Medicine. In case it was unclear, take one look at the agenda. But the fact that the red, the white, the blue and the yellow “go it alone”—each with their own conference covering the same topics as would be heard at the other’s—make me wonder why few seem inclined to look outside of their bubble to say, ” We see where this train is going. Should we divert to avoid the cliff? No? We’re going to follow that train over the edge. Okay, hold on!” 

Like many fathers, my instinct is to protect my kids by doing what Dads do: Clueing them into some of life’s harsh realities. How to hit a baseball. What a “crush” means. Please don’t touch the stove until it has cooled down! Then my wife noted a harsh truth that parents must incorporate into our psyches: Children have to get hurt. They need to make mistakes. They can’t be protected from everything because that’s how they build up the scar tissue that defends them against life’s unexpected parts later.

Consider the line from Marvel’s “Black Panther” that worms through my mind every time I go on the road, putting my life in the hands of the pilot (let alone a rideshare driver): “A man who has not prepared his children for his own death has failed as a father.” 

Which brings me back to religion—an important part of the Mobile Medical psychology. The Jewish Passover holiday is heavy with stories about legacy and collective memory. One of the more famous is “The Four Sons.” In order of appearance, they are the Wise Son, the Wicked Son, the Simple Son, and the Son Who Cannot Ask (he is presumed to be too young, but it’s also possible that he simply can’t communicate).

The Wise Son solicits all the “right” information, making his parents proud of having done such a swell job; he’s a bit of a kiss-up. The Wicked Son questions his folks—and while he is chastised in Passover liturgy, a rich body of commentary heralds him as the son most worth emulating because only he seeks to really understand what he is being told, rather than blindly obeying. The Simple Son merely follows his parents’ advice, and he is okay with that. The one who can’t ask gets a pass. Ultimately, this story put faces to the Passover holiday’s theme of conveying knowledge from generation to generation. 

I didn’t expect to recall the Passover story as I walked the Nashville Music Center’s halls during APCO 2023, but the session announcements highlight discussions about data standards, mental health and resiliency, information technology policies, hiring challenges and what it was like to keep working during a pandemic. In other words, much the same things as would be featured on signs at EMS, Fire, Community Paramedicine, NEMT, Medical Direction, and Co-Responder conferences.

The Four Sons

It occurred to me that if these conferences represented one of the Four Sons, I’m not sure which I would be looking at. Everything seems “correct”—all the usual topics are represented—so does that mean the conference aligns with the Wise Son? Or are the topics “obedient” low-hanging fruit, unchallenging and down-the-middle, like the Simple Son?

Either is fine, but neither moves the needle. I know which one we need here, and again and again: the Wicked Son. We need to shake up the status quo and try something different: We need to convene a conversation that features Fire and EMS and Police and Dispatch and Community Paramedicine and Critical Care and Non-Emergency Medical Transportation and Co-Response (for my purposes here, defined as combining medical and law enforcement/public safety activities). We need physicians and nurses and medics and firefighters and chiefs and line personnel and municipal managers and psychologists who care for Responders themselves and business experts and billing experts and lawyers and regulators.

We need to ask the question: What do these topics mean to you—and how does that align with what they mean to me? We’re repeating each other, but separately, and that saps the collective power. It confuses the issue for those outside the community—like lawmakers—who have trouble understanding how one organization’s request differs from the others; and if they are the same, why are they setting up separate meetings instead of working together to accomplish the common objective?

NENA is the National Emergency Number Association. It should not be confused with NASNA, the National Association of State 911 Administrators. Neither of these should be confused with Association of Public-Safety Communications Officials (APCO). (Why are there three 9-1-1 telecommunicator associations?) The “separate but similar” approach is eerily reminiscent of Mobile Medicine, a reality that cannot be lost on anyone who steps foot in more than one such event…but how many people ever do?

When I raised the question of differentiation—naively, perhaps—at the 2023 NENA Goes to Washington conference, I was surprised at how some of the organization’s leadership was surprised by my question. Isn’t “Why do both associations need to exist?” the most obvious question? If the answer isn’t stark, then why not advocate together? After all, if the issues are aligned, there is power in numbers. And that power extends to Mobile Medicine, too, adding many thousands of potential voices to the chorus for health and safety.

One of the first discussions I ever had with my dear friend, now-retired Chief Mike Touchstone, asked the same about EMS: Why is there an International Association of EMS Chiefs and a National EMS Management Association? Why is there a California Professional Firefighters and a California State Firefighters Association? Why is there an Oklahoma EMT Association AND an Oklahoma Ambulance Association?

I understand different groups for management and labor—their issues are meaningfully different, from human resources to finance and more—but at some point, the groups simply cannibalize one another. Could dissatisfaction with our aligned professions’ trajectories be a sign that we have too many associations but not enough crosstalk?

At the EMS Administrators Association of California 2023 conference in San Diego, I raised this question publicly after Marianne Gausche-Hill and Mike Taigman, two highly esteemed leaders of Cailfornia’s Mobile Medical community in California, cited “interoperability” as a challenge in the nation’s most populous state. I pointed out that, at an event run by the state’s public regulators, in attendance were relatively few private ambulance services, fire-based ambulance services, physicians, nurses, tech firms, billing companies, or health information exchanges—all of which have a role to play in the ecosystem.

Achieving Critical Mass

Instead of collaborating, these many groups host their own conferences and listservs, without crosstalk. Walking around APCO, I felt the same as at NENA, EMSAAC and Cal Chiefs: Wouldn’t it make more sense for all of these folks to talk to one another and work together to achieve critical mass? Surely discussions about supporting mental health and resiliency are not so different whether one trained as a Police Officer, a Medic, a Firefighter, a Telecommunicator, a Medical Director, or the CEO of a company that gets to hear stories of trauma and loss, then one day jumps into the pool to act on all he’s learned?

I cannot resist wondering: When the Wicked Son asked, “What does this mean to you?” what if he found that it meant the same to everyone, but no one had bothered to check?

What if instead of following the same path as always—attending this conference or that, paying these dues or those, and venting on social media about the pace of change—we paused to realize that when asking Congress for a raise, or to fund XYZ, or to officially recognize this group or that, and to acknowledge that everyone wants to care for their family… we swap a dozen separate messages that kind of sound alike but are so similar that the details get lost, and instead declare our needs with one powerful, confident, unified, dedicated, patriotic voice? The message is ultimately more likely to succeed.

More from the Author

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Brave New Interoperable World: Part 2: The Liberation (At Last!) of Healthcare Data

The Economics of Co-Response: Designing a Sustainable Approach

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Sacred Cows & Data Cubes: Artificial Intelligence, ‘Special Populations’ and the Economics of Community Paramedicine

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