Becoming force multipliers

In 1974, President Gerald Ford authorized that one week be dedicated to celebrating the work of EMS professionals.

The original EMS Week was planned for November 3-10. Thank goodness they changed it to the third week of May back in 1992, the year before my EMS career started. Hunting seasons are open in November after all, and I’m sure I had better things to do.

It’s no secret that I have become an EMS Week cynic over the years. I’ve ridiculed the chosen themes every year. I’ve sniped that EMS On the Hill Day is more about photo opportunities and gladhanding than it is for any real advocacy; “Let’s humor those EMS people and ignore and abuse them for the other 364 days a year.” As someone who has spent a career working rural EMS or night shifts in the city, the schwag is all gone and the food gone or inedible by the time my shift starts. I still say we should be advocating for EMS the other 51 weeks of the year, and that we all take a vacation for the third week in May, to let the public get a taste of what a week without EMS would be like.

On that note, we have a unique opportunity to advocate for a reimagining of EMS – a paradigm shift if you will – when we consider the theme for EMS Week 2023: “Where Emergency Care Begins.”

Where does emergency care begin, actually?

Does it begin with the arrival of first responders on scene? Does it begin with the call to 911? Does it begin with the arrival of the paramedic? What if the medic arrives in a sprint car and not an ambulance that can transport? Does it begin with bystander care?

Where does emergency care begin?

Military Surgeon Nicholas Senn said way back in 1897, “The fate of the wounded rests with the one who applies the first dressing.”

The real role of EMS

I’d say that emergency care begins well before the arrival of EMS professionals. It begins with the person who dialed 911, or the frightened bystander who first performed compressions or slapped on a bandage.

If we look at emergency care in that light, we must re-examine our role in it. We may think of ourselves as the first professionals to begin emergency care, but truly the lifesaving interventions these days are a function of bystander care; Stop the Bleed, bystander CPR and public access defibrillation. The times when an EMS professional actually saves a life are often more of a function of location and fortunate timing rather than professional skill.

“The fate of the wounded rests with the one who applies the first dressing.” Or administered the naloxone. Or started CPR. Or applied the AED.

We need to start looking at ourselves as the Special Forces of emergency care. The United States Army Special Forces – or the Green Berets, as we call them – have long been among the elite military units in the world. They punch far above their weight class in terms of effectiveness.

And the reason they do that is not so much because of their martial prowess – which is legendary – but because Green Berets are force multipliers. Their specialty is unconventional warfare in which they train native troops in counterinsurgency and guerilla warfare. A 12-person Special Forces A-Team can train and equip many times their number to fight and carry out active resistance in their own countries.

That should be the real role of paramedics and EMS in general: to train ourselves out of a job.

Think of how different EMS would be if that became our focus. The first step in being an emergency care professional is teaching the lay people when professionals are needed – or not. The most qualified people to roll back the generations of teaching the public to call 911 for every little ache and pain are us. We created this monster, it’s on us to slay it.

Training the public to respond

If the roughly 70% of emergency department patients who didn’t need to be there no longer used the emergency department as their primary care clinic, and didn’t utilize an ambulance to get there, imagine what it would look like.

No more ED overcrowding.

No more long wall times.

No more staffing shortages, because we don’t spend an hour or more tied up babysitting someone who by law is now a hospital patient.

No more system abuse … OK, maybe we’ll just say less system abuse.

No more street corner posting. If we’re not striving to meet unrealistic and arbitrary response time standards, of what use is system status management?

No more skills dilution and rust-out. When we run calls, we’re providing sophisticated care that the lay public cannot, not just providing a very expensive ride to the hospital.

We’d be the Special Forces of emergency care, used for only the most difficult missions, because we’d trained the public as the regular troops.

The foundation is already there. We proved during the COVID pandemic that we can triage effectively, that we can treat in place, that we can provide alternate destination transport. The world didn’t end, and many of those things were being performed by EMS providers who weren’t even trained as community paramedics. Not only did the world not end, we garnered goodwill and accolades from the public and our fellow healthcare professionals.

All it takes is for us to make those extraordinary measures the rule rather than the exception.

Make the expectation that the emergency ends when we arrive on the scene. Make ourselves gatekeepers to the emergency department and the healthcare system. Make it the expectation that our role is treatment, and only infrequently transport. Make the public understand that an EMS provider with a telemedicine video link in their living room is a far better alternative than a day-long wait in a room full of other sick people.

Imagine what EMS would look like if we spent 51 weeks a year educating the public and being healthcare force multipliers.

Heck, we might even be able to take off the third week in May and they wouldn’t even miss us.