I would agree that one of our weak points is understanding the science behind what we do. However, I disagree that it’s only the EMTs and Paramedics who lack this understanding. I would venture to say that there are a large number of nurses and doctors, both in and out of EMS, who don’t fully understand the science behind what we do.
I would also agree that often times in our rush to change practice we’ll grab hold of only one piece of scientifically processed theorem and hold it aloft as the new testament to the standard of care. Hypothermia resuscitation is the most recent one that comes to my mind. The problem is that I think there is real value in the treatment, but I think that it is only one piece of the bigger puzzle. Putting hypothermia into a system without increasing the communities capacity to perform bystander CPR, having an aggressive public access defibrillation program, communicating these events through technology such as the Pulse Point app, and keeping response times down will be overall ineffective.
Too often we approach our challenges thinking there is a single solution instead of looking at it as the integrated system it is, requiring multiple tweaks and changes for an overall positive effect. There is no magic pill to solve it all, but for some reason we keep thinking we’re going to find it.
The part where I really (and when I say really I mean REALLY) disagree is the part where he says, “But EMS is medical practice. And medical practice is supposed to based upon science.”
Medicine, even when based on science, is an art.
EMS medicine is no different and we’re kidding ourselves if we think otherwise. Our seeming inability to be flexible and dynamic in the care of the patient as an individual is what other professions will point to and argue that really all we’re doing is reading the manual, the cookbook, following the instructions or whatever other metaphor you want to insert highlighting our failure to think critically in such situations that require it. What’s worse is when we have providers who do just that, we look to scold, berate, and punish them for their decisions.
To be good at your art, you need to practice. Ask any artist… whether it be a writer, a painter, a piano player, or a dancer what the secret to their success is and they will most often point to two things. Sacrifice and practice.
We already sacrifice a lot for our art. Our bodies. Our minds. Our souls. We sacrifice for our art the same as the other artists do. We already practice heartily. We practice in a variety of settings. With a variety of subjects. We practice at all times of the day and night.
Yet we continue to measure our successes and failures by the highest standard of ROSC and very little else. This high standard gives us the false impression that we are failing… and when you are failing you can start floundering looking for anything and everything that may be able to turn that failure around. This creates the environment when every journal article that has just a whiff of scientific process, because science to most is infallible, should become the new standard because it’s “based on science”.
It’s a vicious cycle.
Now, don’t get all in a tizzy and think that I am against evidence-based medicine, because that is far from the truth. I will still hold the Cultists of Mechanism and their infernal Ceremony Of C-Spine Immobilization to task each and every time they try to torture those poor innocent vertebrae on that hard flat surface as if they were witches in Salem during the Salem Witch Trials.
My disagreement is that EMS, and medicine in general, is not easily defined by just one aspect. It is not just about the science, but also about the art. There is no one magic solution to our issues. It is going to take discoveries in the science, practice of the art, and change in the culture to bring us where we want to be.
Educate yourself on the science. Practice your art. Be open to change in both. Success will be ours. It’s a systematic solution to the systematic problem.