How Fast Will Things Change?

Change is a part of EMS. Our profession changes faster than most. Many of the treatments you learned in EMT class will be changed or refined before you reach your second year of EMS service. Advances in technology and research will place an ever-increasing demand on the field EMS provider to learn new skills and treatment modalities. EMS is not a job for folks who don’t like change.

But what about your organization? Will they keep up?

How tolerant is your organization to change? If you want to find out if the people you work for are resistant to change, listen for how often you hear people say these three key phrases. These are my top three “anti-change” catch phrases. The more frequently you hear people say these three things, the more likely that change will occur slowly…or not at all.

Anti-change phrase #1 – “That’s not the way we do things around here.”

This is a phrase that is used when people can’t find anything specifically wrong about an idea or proposition, they’re just afraid it might cause change. The folks who fear change use this line as a catch-all conversation stopper when a genuinely good idea shows up on their radar and they want to kill it quickly.

Part of the job of the old-guard in any organization is to protect the status-quo and avoid any initiatives that may lead to change. (This is what defines them as the old-guard.) Part of that change avoidance is being able to stomp out new ideas quickly. This phrase serves several purposes. It rejects the new idea outright and it also champions the status-quo. It lets the person with the new idea know that the way things are currently done is important and worthy of respect.

When new ideas are seen as disrespectful to the organization, you can bet that affecting change will be a long, slow and painful process.

Anti-change phrase #2 – “Let’s be realistic.”

Change takes ambition. It also takes motivation. A good way to stifle both ambition and motivation is to tell the ambitious, motivated change-makers that they are unrealistic.

When someone says, “Let’s be realistic about this.” they are subtly ridiculing the person with the new idea. It’s another way of saying that the person trying to affect change is naive. It’s patronizing. Labeling the ambitious, motivated change agent as a pie in the sky dreamer is a way of skirting the real issue. Instead of addressing the validity of the idea in question, they simply question the maturity of the person with the idea.

The big problem with this statement is that the people who create major change are very seldom realistic. Envisioning a better future, or a new way to do things better takes imagination and creativity. When the people in change champion reality, you can forget about meaningful change.

Anti-change phrase #3 – “I’ll run this up the chain of command.”

If you hear someone tell you that they are going to “run an idea up the chain” they are saying that your idea is about to go away. This is a great indirect way to kill a new idea. When someone in your direct chain of command listens thoughtfully to your idea and then tells you that they are going to take it to the next level for you, you can almost guarantee that you’ll never hear another thing about your idea again.

When people genuinely like our ideas, they don’t decide to take it to other administrators for us, they offer to take it to other administrators with us. The only reason to “take it up the chain” for us is because they don’t want us in the room while they explain why this is a bad idea. (No, they don’t want to steal your idea. Don’t flatter yourself. They want to kill it.)

Taking our idea and communicating it for us is a way to make sure the idea can be thoroughly dismantled without having us in the room to defend it. If you let your idea be championed by someone else, expect some slightly positive feedback about it being well received and someone important “thinking it over.” Then expect it to disappear.

Like the banner says, medicine moves fast. Organizations that resist change are bound to fall behind. If you hear these phrases used often by people in leadership positions in your organization, chances are, you’re already behind. You may need to embrace the status-quo…or move on.

What do you think?: Are there other anti-change phrases that I’ve missed? Is your organization resistant to change? What can you do about that?


  1. Timothy Clemans says:

    I think being resistant to change can be a good thing. A number of changes were proposed by the City of Seattle and past fire chiefs of the Seattle Fire Department including putting paramedics on fire units, sending paramedics on motorcycles, and charging for aid responses. All of these proposals were strongly denied by the fire department’s medically lead EMS program. I personally am happy that none of these proposals became reality.

    That said I don’t think the department is necessarily resistant to change. They are constantly changing and testing CPR protocols. They are adding a supraglottic airway as a backup device. They recently added versed to the protocol. They are looking at ways to improve the care of sepsis.

    “Organizations that resist change are bound to fall behind.” I’m skeptical. A 30 year review of King County’s survival rates showed that although they made several changes to the CPR protocol, only the change to 1 shock and two minutes of CPR lead to a major increase in survival. So they started out very high at 31% survival for bystander-witnessed VF (1978 – 1982) and had they never changed a thing they would still be out performing most communities including London (16%), Washington DC (10%), San Francisco (10%), Richmond, Virginia (19%), City of San Diego (26%), and New York City (16%). The survival rates mentioned are for 2008 and later and for EMS-treated bystander-witnessed VF (presumed cardiac etiology).

    The medical director for South King County’s ALS service recently gave a talk about current research and reasons why the service hasn’t made various changes including removal of intubation from CPR protocol and addition of fentanyl to the protocol. He did say however that they will be making sure all county paramedics decrease oxygen flow for patients where research has shown problems. When I rode with this ALS service recently I was repeatedly told that this medical director is not one to go in and quickly change things. He did lots of ride alongs and has tried very hard to understand why the system is what it is. I like this approach a lot. I have read several management books saying that good managers shouldn’t try to change things right away. I wish the new pastor of the church I grew up took that approach because he’s numerous changes destroyed a lot of good things that were going on and today that church has only about 20 people from about 70 when he first took over.

  2. Steve Whitehead says:

    Changing an operation always needs to be preceded by good judgment. King County is an excellent example of how organizations can experiment and aggressively pursue better ways to deliver care. They seem to constantly strive to refine what is working while being more than willing to abandon what does not.

    In the organizations I’ve worked for, being too open minded or overly willing to embrace changes has never been a problem. Being resistant to change has been.

    Change for the sake of change is dangerous. Resistance to change is even more dangerous.

  3. Timothy Clemans says:

    Thank you Steve for replying. I like how you phrased King County’s approach so much that I printed out in big letters and posted on my wall.

  4. Justin Sleffel says:

    I thought this was an excellent article and one that probably speaks very true of many EMS services. In response to Mr. Clemans, I’d like to say that while resuscitation is perhaps the crux of what we do, it isn’t the steak and potatoes of EMS. Excellent CPR rates are important, but how are we doing in other areas of medicine? Are we providing evidence based treatments in all areas of care, besides just CPR? And are we quick to abandon treatments which haven’t been shown to be effective and to take up those which have been? It’s not just making sure we get them back after they’re gone, but preventing them from progressing that far to begin with and increasing long term (to discharge) survival rates in areas such as AMI, respiratory emergencies, trauma, OB, gastrointestinal illness and others. I feel that we are in an ideal position to make a bigger impact in other areas of medicine outside of cardiac arrest, however this opportunity is sometimes passed over due to fear over provider capabilities or fear of change; the solution of which of course lies in increasing educational standards across the board and a more fluid approach to paramedicine.

  5. Timothy Clemans says:

    Justin, I agree we need to “aggressively pursue better ways of deliverying care” in all areas not just cardiac arrest.

  6. Nice thoughts by everyone. I think it goes without saying that precipitous change is unwise, and it’s worth watching out for that in a field where the evidence is often “interesting” long before it’s definitive. But I think the challenge is that many times, the resistance we have to change stems not from the balance of evidence at all, but from cultural and habituated motivations. Those are what need combating, and I hope that eventually we’ll be able to look around and see an industry where everybody expects and accepts that their best practice and standards of care may be in a state of continual flux, because that’s simply the nature of the business — and complaining about it won’t change a thing. Other professionals accept this; we may have missed the boat, and need to work doubly hard to redirect ourselves into that groove.

  7. Timothy Clemans says:


    You make a good point. What have you done to be more comfortable with change?

  8. Tim, I feel like I have something of an advantage because I’m a relative newcomer to EMS — give it twenty years and I may be just as set in my ways as anyone! However, one thing that’s helped me is to really work on the mindset that the things I do, I do for a reason… and outside of concrete protocols or laws that mandate my care, the “reason” is because it’s been shown to help. That means it’s based on evidence, and that means it may change. Sometimes the evidence is minimal or unclear, but that’s okay, we can still weigh everything and make a best guess; and yes, we can even take into consideration the anecdotal evidence we’ve accumulated in the field over the years. But into none of this does “other stuff” like my own complacency or personal preferences come into play. That’s just not on the table as something I get to consider, any more than it is when I’m deciding how to fix a leaky sink.

  9. Timothy Clemans says:

    Thank you Brandon.

  10. Steve, as always great insights.

    Have you read Seth Godin’s new manifesto – Poke the Box? It celebrates and encourages readers to start. It really resonates with me because I am a starter.

    I think sometimes we expect organizations to be resistant to change so thus we try to work through the assumed pathways to try to accomplish change. If instead of asking we were just to make small changes – poke the box – without asking, I wonder if anyone would notice that change was in progress until it just happened?

    I am still trying to wrap my head around the concept of “starting” in organizations with rigid hierarchy and protocols. I am convinced that just doing what we have always done is not going to reward us in the long-term.

    Got to go start something!

  11. Timothy Clemans says:


    I like the term “poke the box.” Thank you for telling me about it.

    What are some examples of where you and other successfully poked the box?

  12. Even though I’m an EMT student currently, my job is working in hospital security, and while the lead in is geared towards the EMS field, our manager has made all three statements. Just as medicine keeps moving, our area has to keep up. The area I live in has changed in size and in culture. No longer are we the sleepy friendly county in the south.


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