Transparency for the Future of Mobile Medicine

Reflecting on My “Sacred Cows & Data Cubes” Interview with Chief Stuart Mills

My interviews for the JEMS podcast “Sacred Cows & Data Cubes” don’t always spark accompanying articles, though perhaps they should. After all, it’s both an honor and a vocation to extract perspectives and prognostications from the iconoclasts who are working to yank, coax and thrust Mobile Medicine into a data-driven, evidence-based future that bolsters the case that fire, ambulance, and community paramedicine services deserve a seat at healthcare’s “table of the future.” Neglecting them risks both health and safety, both now and later. That neglecting Mobile Medicine means every conclusion regarding the social determinants of health—from barriers to chronic disease management, to the contexts that let substance use disorders fester—are flawed by a lack of data and, therefore, erroneous conclusions. Without consideration of the responders whose mission is to care for the safety net, the safety net’s holes will tear.

Not Just ‘Ambulance Drivers’

But those are the outside messages—the messages that we, as a profession, should be giving the public to help them understand the Mobile Medical professionals are more than “ambulance drivers.” What about the inside messages? For example: Mobile Medical professionals are not only ambulance drivers. But they do drive ambulances. They must be ready to drive ambulances—something like seventy-five, eighty-five, even more than ninety percent of the time—and those ambulances don’t power themselves on coffee and smiles. They don’t certify themselves, gas or clean themselves, document their own successes and learn from their failures. 

Don’t Sacrifice Nuance and Throw Ambulances Under the Bus

Rather, the realities of managing professionals are both art and science; managers bring to bear their own experiences—What inspired them? What did the opposite? As such, they must prepare to persuade, defend, cajole, teach, discipline and realize that people bring their baggage to the job. All of these were the focus of my unusual, enlightening interview with Stuart Mills, chief of Colorado’s Larkspur Fire Protection District, whose approach to management is so frank—and so unusual in its radically transparent—that I wanted to shine light on it in a different form. Not everyone will take the time to watch an interview, but everyone will find something to learn here. I advise all aspiring agency leaders to watch the interview. In a nutshell, Chief Mills adopts an approach that aligns with a philosophy that this author heard spoken emotionally in the Marvel film “Black Panther,” during an emotional exchange between generations. The late king tells his ascendant son: “A man who has not prepared his children for his death has failed as a father.”

A Lonely Job

Not everyone wants to be a manager, director, CEO—I can speak from experience that when they say “it’s a lonely job,” they undersell the burdens of leadership and authority. The buck stops with us. Sometimes, it’s joyous; often its laborious; it usually means angering someone because the show must go on. But here’s something real as a heart attack: across these United States and around the world, agencies are suffering from hiring crunches. (Want to be deemed “essential”? GREAT…but that still won’t bring more people into the profession.)  As a result, by simple reality of mathematics, more responsibility will land on those who remain. This means that some will become leaders because they are the only ones left. Some will become leaders faster than they expected. Some who otherwise might have been overlooked will get their chance to shine and evolve this work in ways that it has long warranted (but couldn’t while the “Old Guard” held sway).  All of these land in precisely the same place: understanding more than one ever wanted to about how the gears turn. When to say yes and no, how much things cost, and the time-value of money.

Sizzle Accomplished. What Happens When a Conference Highlights an Ethical Quandary?

Charisma may be an innate gift but management is a skill—the stuff of business school programs, and Lindenwood University’s practicum- and informatics- centric paramedic training model—and it starts with sitting down with every single member of the crew, one by one, so they can take a tour of the budget and ask questions in a dialogical fashion. It is the chief’s pride to rest assured that, when the team member advances to his or her next job, she or he succeeded in sowing the seeds of understanding.

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