Embracing Change

Emergency services, regardless of the specific discipline, are unique animals. We work in a dynamic environment where things can, and are almost expected to, change at a moment’s notice and yet somehow we do not do well when the status quo changes. I could sit and talk ad nauseam about how the most dangerous words in any organization are, “We’ve always done it that way.” In my humble opinion, any organization that cannot change with the industry is doing a great disservice to both their employees and clients alike.

For those of you that have been in the industry for more than a hot minute, you are undoubtedly no stranger to change: change in policy or protocols, change in medical directors, change in the cabinets in which supplies are kept, change in company ownership, change in your charting system (secretly everyone’s favorite), or simply a change in the way the industry as a whole approaches an issue. Specific to EMS, let’s use Point-of-Care Ultrasound (POCUS) as an example. I’ve always said that today’s POCUS is yesterday’s 12-lead. Ten years ago, you would have been labeled as “crazy” if you said you wanted to put an ultrasound machine in your transport vehicle. Now, with advances in technology, the use of such a tool is not only more practical but far more commonplace. There still exists some hesitation by various organizations, however, that insist use of such a tool requires more oversight. The same can be said for 12-lead ECG’s. At one point in time, that technology was new and, I feel, some entities did not quite trust that prehospital providers could utilize it correctly. Now, 4-leads, if not a full blown 12-lead, are pretty much expected on everyone that has any symptoms beyond a sneeze.  

When it comes to change, it should come as no surprise that not all changes are good and some may even ruffle your feathers. So, when it comes to change, one must honestly ask themselves one important question: Do you not like the change simply for the sake of change, or do you not like the substance of that change? For example, do you not like the new charting software because it’s a departure from what you knew and as a result makes you uncomfortable since you no longer know all the ins and outs to it, or is the new program legitimately less functional? Did you recently switch paralytics, so now there’s a bit of math now involved in your RSI drug calculations instead of the old “one vial or two” bedside calculation? Or, did you switch a given piece of equipment or process that is more cumbersome than its predecessor? Is “all of this new stuff” just too much and, as a result, it’s time to consider moving on, or are these new changes something that can be addressed with some good ol’ muscle memory? If the former thought happens to be the case, and the thought of moving on has entered your mind, I highly recommend that you skim my last article when it comes time to consider your Line in the Sand.

When it comes to embracing change, a prime example comes from my new organization and it came in the form of personal PPE. During my orientation all incoming employees, for those that wanted them, were given the opportunity to get fitted for bulletproof vests. This ultimately resulted in much discussion and questions within my orientation class on the subject. Questions ranged from what it was like to wear them in the summer to how restrictive they are when it comes to personal mobility to the rationale regarding their implementation in the first place. There were even very poignant comments where people outright said that they didn’t get into EMS to wear a vest. Let’s be real here for a minute, though: Unfortunately, while the basic job of taking patients to the hospital has not changed, the rules by which we do this job, and the environments in which we do them, are ever-changing. Historically, Fire and EMS have been looked upon as “the good guys”. You would have never have heard of such a thing as bulletproof vests for non-law enforcement professionals. This isn’t completely accurate anymore, however. I stand by my belief that you cannot control who rolls up to you on your 911 scene and, like it or not, whenever an emergency vehicle shows up somewhere, the occupants are looked upon as a position of authority. As a result, EMS can be just as much of a target as our brothers and sisters in law enforcement. For those that may doubt this, you clearly haven’t been paying attention during your terrorism awareness classes.

War story time: I recall back to the days when I first started in EMS and one of my co-workers got in a vehicle pursuit with his ambulance when an individual tried to rob them of all their narcotics at gunpoint. Yet another more recent example is when an EMS co-worker was approached by an unknown individual on the scene of a 911 call, brandishing what appeared to be a rifle, and stated that the voices in his head told him that he needed to steal an ambulance. There are countless other examples as well. The most memorable one for me is Mitchell F. Lundgaard, the Appleton, WI firefighter that paid the ultimate price when he was tragically shot by his patient during an EMS call gone wrong.

While I digressed quite a bit on the topic of bulletproof vests, it remains one that I’m particularly passionate about. Despite individual, and sometimes polarizing, opinions on the implementation of such equipment, it serves as a real life example of how we need to remain flexible and roll with change. It was definitely a profound moment when I first started in public safety, and I watched a video presented by the FBI showing secondary devices designed to take out first responders. Who would’ve ever thought there were people out there that wanted to hurt those that made it their mission to help others? While the discussion of whether Miranda applies to a discussion with a criminal suspect while you’re performing your official duties, law enforcement or not, is a discussion well beyond the scope of this article. 

Getting back on track, nobody ever said change was easy. Your personal position on the above issues aside, I use them to illustrate my point that it is imperative that both you and your organization remain open and flexible to change, otherwise you’re destined to be behind the curve when it really matters most. Besides, when you fail to embrace change, you may actually miss out on something pretty amazing. 

Stay safe out there!

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