Perspectives: Brian Bledsoe

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springer science journal

We Have Met the Enemy & He is Us: Another Perspective
Reprinted with Permission, as written on Nov 1, 2007 by by Bryan E. Bledsoe, DO, FACEP

There was a cartoon series entitled Pogo that was popular during the Vietnam War. Pogo was a possum that lived in a Georgia swamp. Life in the swamp satirically represented society. One of the most popular quotations that came from the widely read cartoon was the phrase “We have met the enemy and he is us.” The phrase subsequently became the mantra for Earth Day and reflected the fact that pollution and similar environmental issues are largely the responsibility of humankind. Unfortunately, the same phrase can be easily applied to EMS.

Lately, I have noticed three issues that illustrate how we are our own worst enemy. These three issues affect everybody who is or has been a part of the EMS community in the United States. Now, I don’t think anybody is consciously trying to hurt the profession, I believe it is occurring because of generalized apathy or ignorance. In addition, sometimes we place our own interests in front of those of the profession.

First, any profession needs a unified voice to represent the interests of the profession in society as a whole. The American Medical Association (AMA) represents physicians in general while the American College of Emergency Physicians (ACEP) specifically represents the interests of emergency physicians. The strength of a professional organization, such as the AMA or ACEP, lies in the membership. The more members, the more influential the organization.

The organization for EMS is the National Association of Emergency Medical Technicians (NAEMT). This organization was founded in 1975, and I was a charter member. While NAEMT has had its ups and downs, it still remains the only unified voice for EMS in the U.S. Furthermore, in recent years, NAEMT has cleaned up their act and have become duly focused on the issues facing the profession. The dues are inexpensive. The organization is sound. Yet, very few EMS people are members. Why do people not join? Unfortunately, some in EMS don’t feel they are a part of the EMS community. All of us, whether we work for a private EMS service, fire department, governmental entity, hospital or similar operation are all EMS providers. NAEMT is devoted to protecting the interests of EMS providers regardless of the employer or EMS delivery model. Likewise, many state EMS associations exist yet are also poorly supported by EMS providers. In the U.S., EMS is a local governmental responsibility. Because of this, representation of the profession at the state level is very important — yet almost nonexistent!

If you are not a member of NAEMT and your local EMS association, it is time to join. I joined both NAEMT and the EMS Association of Texas (EMSAT) although, technically, I am not a prehospital provider. Interestingly, I just recently read an email thread about the Johnson & Johnson television ad that supports nursing as a profession. EMS providers were angry that the entire ad showed nurses working in the prehospital setting. I completely understand. They complained like typical keyboard warriors. But that was it. Little did they know that NAEMT had already addressed this ad with Johnson & Johnson. If they were members, they would have known.

Second, EMS is one of the few public service professions without a national memorial that honors our colleagues who have fallen in the line of duty. We, as a profession, have an ethical duty to assure that our fallen brothers and sisters are forever remembered. There has been an EMS Memorial Service each spring in Roanoke, Va. While the need for a memorial and the memorial service are different issues, this is something each of us should be involved in. There is presently an ongoing controversy about where the memorial should be and who should be responsible for it. Different groups come to the table with different ideas and agendas. Instead of dividing the profession we should unite and work together to assure that a bona fide memorial is placed somewhere in this great land where people can come to reflect and remember those who have made the ultimate sacrifice. If we are all on one page, instead of the usually divided image, then we will attain our goal. If we are united, major sponsors will follow and make the national EMS memorial a reality.

Third, there has been a recent interest in preserving our legacy through a National EMS Museum. Many people have put in many thankless hours to get the museum up and running. NAEMT has provided some seed money. But, like everything in EMS, we are again divided. There is a push to have the national EMS museum at the Los Angeles County Fire Museum — not a bad idea. There is also a push to have a pure EMS museum at some location in the country — also not a bad idea. But, like usual, we have two to three entities trying to achieve the same goal that appear to be competing with each other. As well, personality issues now appear to be affecting the National EMS Museum project. We will never get the needed major sponsors for this project unless we put petty personality issues aside, stop bickering and have an organization that is squeaky clean and fiscally transparent. Again, we are our own worst enemy.

It is time for EMS providers to join our professional organizations and speak with a unified voice. Each EMS provider, whether volunteer or career, should join their state EMS organization and NAEMT. They should also belong to organizations that represent their other work interests (e.g., International Association of Fire Chiefs, International Association of Fire Fighters, International Association of Flight Paramedics, etc.). The dues are tax-deductible, and the benefits far outweigh the costs. Likewise, EMS organizations must work hard to be totally transparent and solely represent the interests of the membership. NAEMT has done a great job in addressing this problem. The National Association of EMS Educators (NAEMSE) appears to be trying to become more transparent. People will only join an organization if they feel their voice is heard by the officers, the organization does not misuse their dues, and the organization presents an image and voice that totally represents the profession.

So, can the apathy! Quit being EMS keyboard warriors! Join the organizations of the profession that pertain to your work. The future of EMS is dependent upon such actions.

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Another One Walks Away
Bryan Bledsoe, DO, FACEP
Another Perspective
2008 Jul 3
Mike Clark is a sector manager for an investment company that specializes in mutual funds. He arrives at work at 8:30 a.m. and spends his day on the telephone or watching one of the five screens that make up his computer monitoring system. He closely watches the Tokyo Stock Exchange and the Nikkei Average because many medical technology companies are based in Japan. Mike is an expert in evolving healthcare technology. He advises the fund manager as to which healthcare stocks they should buy and which they should not buy.

While he's leaning back watching the screens, he hears the screeching of tires followed by a thud. He stops and immediately thinks to himself, "Sounds like an auto/ped." He bolts to the window of his third floor office and looks down at the street. He was correct. A middle-aged man was struck by a car as he crossed the street. Mike can see the man on the ground. He can also see people, including a patrol officer, run to the aid of the injured man. Mike takes a closer look and thinks, "This is bad -- really bad." The victim, readily visible three-stories down, is unresponsive and starting to show some decorticate-like seizure activity.

A crowd starts to gather in Mike's office. They look down at the scene and gasp at the carnage before them. Mike is surprised the ambulance arrives so quickly. They watch the ambulance crew assess the patient. Mike thinks to himself, "You guys better protect that airway." The paramedics start asking bystanders about the accident. Mike, this time out loud, says, "Protect the airway guys." His co-workers look at him funny and then look back down at the scene.

Finally, the crew appears to direct their attention to the airway. They open an airway kit while a supervisor who just arrived starts an IV. Mike watches with extreme interest. He thinks to himself, "They're going to RSI him. Good idea. Better hurry." Sure enough, the paramedics administer an induction agent. "Probably etomidate -- maybe fentanyl", Mike thinks. Then, the paramedics give the succinylcholine. Mike, under his breath, says, "Why didn't you defasiculate him? Surely you got vecuronium down there." One of his co-workers gives him a funny look again.

The patient is quickly intubated, packaged and transported. The event is over. All that is left are police officers interviewing bystanders and measuring distances. Mike's co-workers slowly leave his office, talking amongst themselves about the poor man. Mike continues to stare out the window until the scene is clear and traffic is moving again.

Later, at the water cooler, Bill, one of Mike's friends, strikes up a conversation about the wreck. Bill says, "Bad deal for that man, eh?" Mike says, "Yes, a really bad deal. It looked like he had a bad head injury." For a moment, Bill looks perplexed. Then he says, "Oh that's right, you used to be a paramedic. Aren't you glad you outgrew that?" Mike thought for a minute and said, "I miss being in the field. If I could make a good living being a paramedic I would be doing it today." Bill says, "You're crazy Mike. What are you making? A buck-eighty, a buck-ninety?" Mike knows the local jargon. A "buck-eighty" is $180,000 a year and a "buck-ninety" is $190,000 a year. Mike says, "I'm doing all right. More than I ever could have made as a paramedic. But, there is more to life than IPOs and stocks. Some days I feel I am so removed from people -- isolated." Bill says, "Yes -- like an animal in a cage." Mike agrees, "Like an animal in a cage."

That night Mike is quiet. He goes about the motions of life but appears distracted. His wife, Karen, notices. She asks him why, and he tells her about the call. She shakes her head and says, "Poor man. I hope he will be OK."

Mike's wife has always supported him in his endeavors, and he supported her in hers. During his senior year of college at Duke, while pursuing a finance degree, Mike took a community service elective where he rode with an ambulance service off and on for a semester. He was bitten by the bug. At that point, he knew two things. First, he wanted to graduate. Second, he wanted to be a paramedic.

He moved back to his hometown in another state and enrolled in EMT school. He did well in the class. In fact, he was valedictorian. He got a job with the local ambulance making $10.25 an hour as an EMT. Shortly thereafter he went to paramedic school. Again, he was class valedictorian and scored 100 on the National Registry exam. Mike was an excellent paramedic. He was quickly promoted to field training officer. People liked him, and he liked people. Karen, his high-school sweetheart, finally agreed to marry him. She had a good job managing an insurance agency. Despite the fact she made more than Mike, they were happy -- he as a paramedic and she as a manager. They married.

Mike received several awards for his work and started teaching EMS at a local community college. But children soon came into Mike and Karen's life. With them came new responsibilities and a new outlook on life. Karen's salary continued to increase. Mike never made more than $35,000 a year despite a bunch of overtime. He was starting to see the writing on the wall. He said to his wife, "I have got to stop being selfish. I love being a paramedic, but now we have kids and a mortgage. I have got to do what is best for them. I have to find a job where I can support the family." Besides, his mom and dad were giving him grief about being "an ambulance driver with a degree from Duke."

Finally, Mike started to send out some resumes. Then one day, he got a call offering him an entry-level position with an investment firm. His starting salary was $108,000 a year with excellent benefits, a car allowance and a normal schedule. Mike went to the ambulance station, turned in his keys, said goodbye to everybody, and walked out the door and out of EMS. He never returned. Both EMS and society suffered a great loss the day Mike walked away. What is even sadder is that this same scenario is played out, day after day, across our great land. What a shame.