I helped teach CPR to our latest EMT class this past week. This class is always a good reminder of how fast emergency medicine changes.
Here in their first week, the new students are beginning to hear our warnings.
“You are going to hear about many different ways to perform this skill. Some are older methods than the ones we are teaching you today. Some are newer. Some things you are learning will quickly go away. New methods, new machines and new research are all in progress. That doesn’t mean what you are learning right now is wrong. It is an imperfect method. Prepare for change.”
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I’ll confess. I like EMS blogger’s who rant about stuff. I know I don’t rant much here at The Spot. It’s not really my style and it doesn’t really fit with the mission of the blog. But sometimes we need folks to rant. Sometimes there’s just nothing quite as effective as someone who knows how to respectfully, intelligently rant.
Sometimes we need folks like Rouge Medic, Buckman and Ckemtp who are willing to call us all out. A passionate, well thought out rant can inspire change. It can motivate, encourage and provoke the kind of thoughtful introspection that we need.
We need someone to tell us when the emperor has no clothes. There are a lot of ideas floating around out there in EMS and many of them are just plain bad. Let’s face it, we can come up with some whopper bad ideas now and then. Unfortunately, these ideas have a tendency to stick around for a long … long … painfully long time.
You want an example don’t you? OK … how about just one. The protocols I work under today require base station contact before a medic performs a cricothyrotomy. There … I said it. And now we’ll move on. I don’t want this to be a rant.
So why do bad ideas stay around so long in EMS? Here are a few of the reasons I see.
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Some of the stacks of trip reports were nearing four feet high and they filled the musty closet. Dividing them up, we started sorting through them in earnest. The dates indicated that the calls had been 
run between 1972 and 1978. Most of the narratives were as brief as the treatment lists.
Hall Ambulance’s station one was an older house in an early residential area of Bakersfield, California. It had been, at one time, the residence of the company’s owner, Harvey Hall. In the early days of the ambulance service, Harvey had both lived in the home and run his fledgling ambulance service out of it.
One of the crews stationed at the home had gone digging in the dusty storage closets and struck EMS history gold. Stacks and stacks of old trip reports from the Mother, Jugs and Speed days of EMS. That’s where we found it. A call run by our medical director back in his days as a paramedic for the service. A cardiac arrest, no less. The total list of treatments given; CPR, BVM, Epinephrine 1mg, Sodium Bicarbonate 2 amps.
The year was 1991. We found this hilarious. We were still in our ACLS infancy. There was no CPR first or AEDs or Amiodarone. Nobody had heard of capnography and there was nothing therapeutic about hypothermia. Yet we felt very advanced looking at our medical directors run report. The massive Sodium Bicarbonate doses of the seventies had long since gone away.
More than happy to reminisce about the call, our doc read the report with a bemused sort of faraway look and announced, “I remember this guy.” He told us the story of the overweight, mid-sixties male who had collapsed in the parking lot across from the hospital. And then he made an observation that has stuck with me my whole career.
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