You’ve met satisfied EMS employees in the past. You’ve also, no doubt, met some dissatisfied EMS employees along the way. I would contend that our patient care priorities has a lot to do with how much satisfaction we receive from doing our job.

As an example, the hierarchy of priorities for a highly dissatisfied EMS employee might look like this:

• Gain praise and recognition
• Increase reputation and influence
• Avoid risk and liability
• Avoid hassle and work
• Make money
• Have fun
• Create relationships
• Make meaningful connections with patients and family
• Deliver high quality, competent care
• Learn and develop experience

The hierarchy of priorities for a highly satisfied EMS employee might look like this:

• Learn and develop experience
• Deliver high quality, competent care
• Make meaningful connections with patients and family
• Create relationships
• Embrace work (and hassle)
• Have fun
• Make money
• Avoid risk and liability
• Increase reputation and influence
• Gain praise and recognition

I think you see my point…

When we roll out on the street to do our job, we all carry our hierarchy of priorities with us. If you’re dissatisfied with your EMS career, you may need to flip your list.

Now it’s your turn: What’s on your list of EMS job priorities? What does your hierarchy look like? What needs to move on your list? Leave us a comment and let us know.

When we think about public safety professionals as advocates for public safety, there is probably no better example than the Uniform Fire Code. Strong evidence for the effectiveness of public safety driven advocacy is no farther away than your nearest, clearly marked and unobstructed fire exit. Car seat belts use, helmet use and child car seats all owe their popularity to the advocacy of public safety personnel.

I know that you’re a public safety responder, but do you also see yourself as a public safety advocate? What do you do to promote public welfare? Do you see education and prevention as an important part of your job?

When I used to hear these stories, I would habitually begin considering how we in EMS education might prevent these incidents from occurring in the future. I even posted a warning to The EMT Spot readership to beware of the perils of indiscriminate social media posting. However, after a few of the more recent events, I’m starting to readjust my thinking on this subject. I think the thing that got me thinking differently about it was the term the Dave coined.

I remember earlier in my career how Dr. Jack Kevorkian really got the media establishment churning on the issue of physician assisted suicide. High profile cases like the Terri Schiavo ordeal brought the importance of a strong assisted suicide policy into the public consciousness. But for many of us in the medical field, it was all too obvious that some form of end of life termination of care guideline needed to be addressed. Many of us recognized the beneficial aspects of “physician assisted suicide”.

In much the same way, I’m now beginning to consider the benefits of social media assisted career suicide. You see, some of these cases involve perfectly adequate caregivers who had a momentary lapse in good judgement. But the more that I read about these cases, the more I’m recognizing that social media channels are an effective means for identifying people who shouldn’t be involved in a caregiver or public service role.

There is no place for racism in the fire service or EMS and I’m glad that this latest  fire officer is now on his way to the unemployment rolls. He should have never been afforded the honor of wearing a fire service uniform. He is an utter disgrace to our profession and if not for the large public bull-horn that social media can give individuals like this, he would still have his job.

That’s an important distinction. The problem here wasn’t Twitter or Facebook or any other social media outlet. The problem was a racist, hate filled individual pretending to be a public servant. And, if not for social media, he would still be responding to public calls for assistance. Score one for social media assisted suicide. In fact, I may become a huge advocate for SMACSS.

If you are callous, rude, hate filled, racist, sexist, bigoted or involved in emergency services for any reason other than to be of service to the human beings who call for help, I highly recommend that you open a Facebook account and announce yourself to the world. If you do not have the heart of a servant, we don’t need you. Please create a twitter name for yourself so you can stand up and be identified.

I don’t grieve for the EMS jobs lost to social media assisted career suicide. We are better off without them. Rest in peace.

Such is medicine.

And now I’m going to throw another curve ball at you. Do you remember when we told you to aggressively flush burns with copious amounts of sterile water? Yeah, well…um, stop doing that too. I’m sorry. We were apparently wrong about that.

I know. It runs counter to everything we taught you, right? I agree. I learned about aggressively cooling burns over two decades ago in my EMT class. Stop the burning process and then cool the burn by flushing it with copious amounts of water. Keep flushing until you arrive at the hospital.

Years later the treatment guideline backed off a bit on the flushing. We started emphasizing stopping the burning process and also warned students to guard the burn patient against hypothermia. It seemed that our aggressive cooling techniques were delivering a ridiculous percentage of burn patients to the hospital mildly hypothermic. Hypothermia is apparently not conducive to healing in the burn patient population.

I was just as guilty as anyone of pouring massive amounts of saline on significant burns until it ran out the back door of the medic unit and the patient shivered like they were having a seizure. So we put away our garden hoses and buckets of cold saline and transitioned to more localized cooling. Patient warm, burn cool. Got it.

Apparently that is incorrect as well.

As it turns out, burns seem to heal better when they remain warm. Our burn centers are now recognizing that burns that are cooled seem to have more extensive tissue damage and heal slower than burns that are allowed to remain at or slightly above body temperature.

The theory behind the delayed healing of excessively cooled burns is that excessive cooling may promote vasoconstriction in the region of the burn that limits the circulation of lipids, white blood cells and proteins that are essential to the healing and reconstruction of damaged tissue. Maintaining a healthy blood supply to the effected region is apparently more important than cooling the wound.

This doesn’t mean to stop putting water on burns. You still need to halt the burning process. But after the burning is stopped, further application of cool water, while it may be soothing to the patient, does not promote healing. Wrap the wound. Keep them warm. Protect the airway and transport to an appropriate facility.