Once you understand the protocol / skill connection you might come to see a
host of problems with the way we develop, use and teach our protocols. I’d like to tell you about two biggies.
As we explained in the protocol / skill connection, we are dependent on our protocols to different degrees at different levels of skill development. This is defined by the Dreyfus model of skill acquisition. Misunderstanding this concept leads to some predictable problems.
The problem with our protocols is that they were written with the expectation that everyone would use them the same way.
The problem with our field education is that proficient and expert field providers teach novice and advanced beginner students. These two groups think differently about their protocols.
Let’s look at both of these problems a little more closely.
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I’m blessed with two kids. They are amazing. My kids changed my whole perspective on the world. They re-framed my purpose. It’s wonderful, the way a few minutes with your kids can put an entire bad day in perspective. They also force you to evaluate some of your own behaviors. (If you’re lucky.)
Here are a few of the more valuable lessons I’ve learned from my kids.
1.) Test Your Limits.
Kids know this instinctively. The moment you create a boundary they begin testing it. There is no running in this area. How fast is running? Can we just walk really fast? What about jogging? It’s like they just instinctively know that life is more fun when you’re testing the limits.
Sure there are boundaries that we all have to live within but when was the last time you gave them a little test or maybe tried to actively redefine them? “OK, are you saying that I can’t attend this training or that you’re not willing to pay for me to attend this training? So are you saying we can’t use the conference room for an EMS journal club or we can’t use it during business hours?”
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Not everything that counts can be measured. Not everything the can be measured counts.
– Albert Einstein
Merriam Webster defines quality assurance as a planned and systematic production processes that provide confidence in a product’s suitability for its intended purpose. 
And with that definition, and the best of intentions, our quality assurance teams march forward to confirm that our care has “got air”.
Don’t misunderstand me here. This isn’t going to be about beating up on the QA folks. I know that QA programs get a bad rap. In general we tend to both fear and loathe them. We do this for two reasons.
- They’re overseeing us. We really don’t like people looking over our shoulders do we? Especially people who are waiting for us to do something wrong. And for all the talk about recognizing the folks who are consistently getting it right, QA evaluators are looking to see if we’re doing anything wrong. You just can’t pick up one side of that stick without picking up the other.
- We’re afraid of them because they amplify our own insecurity about or care. We fear that we may not be up to the task in our knowledge or skills and QA reviewers are monitoring our work with the same concern. They amplify our own fears.
The point I’d like to make is this. In EMS, quality is a complex animal. To begin with, were not exactly sure what our intended purpose is. We get away with not knowing because the public is even less sure about what we’re supposed to be doing.
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