re: Are we "developers" gatekeeping "knowledge" from our juniors and peers? 🤦 VIEW POST

FULL DISCUSSION
 

As someone who was trained in a more "disciplined profession" as am Emergency Medical Technician, I would not get your hopes up about things becoming more logical and evidence-based over time. It's still disturbing to me how much of medicine was luck...someone lives or dies because you have a random hunch you can't explain to order some atypical lab work. Even the curriculum for EMTs, featured a ton of recommendations and skills that science demonstrated was at best ineffective and worst-case actually reducing the odds of survival (example: spinal immobilization and backboarding suspected spinal injuries). Becoming a good EMT had a ton to do with fortune; if your partner wasn't burnt out, cynical and in general just not a joy to spend 12 hours with, you would miss out on a lot of knowledge and find yourself developing some of the same negative beliefs.

Professionals are a product of their environment. Toxic organizations breed toxic leaders of tomorrow.

 

High five there, as a fellow EMT. Not an active one - but still go for my recertification every 2 years.

I think I get what you mean, regarding procedures changing - at times it's small and incremental - but when you have a gap of 2 years before recertification. These small changes add up (and improve survival rates, according to science and data!).

So it was, for lack of better words, interesting experience for me to be fighting against muscle memory at times, haha. (What was drilled into your head to help others, does the opposite!)

Becoming a good EMT had a ton to do with fortune;
...
Professionals are a product of their environment. Toxic organizations breed toxic leaders of tomorrow.

Completely agree!


Sidetrack: I presume you're referring to - jems.com/articles/print/volume-40/... regarding changes to spinal management.

 

It's weird when you talk to paramedics outside of the US. My best friend used to be an Australian paramedic and they don't backboard at all...they basically have a form-fitting inflatable matress for lack of a better description so the patient sinks in and isn't moving around a lot (the amount of time a patient spends backboarded once at the hospital can produce further complications).

In 2013, I had instructors telling me to go for a jugular IV in critical situations even though we had IO lines available. I guess some people are very comfortable in their old-school ways.

As someone who was trained in a more "disciplined profession" as am Emergency Medical Technician, I would not get your hopes up about things becoming more logical and evidence-based over time.

In a sense, you are really proving your point on culture is still a large part of how things will run. We can be in an industry with over a thousand year worth of data, and still fall back to instincts.

In 2013, I had instructors telling me to go for a jugular IV in critical situations even though we had IO lines available.

This is personally very terrifying to hear, I have heard similar stories on how EMT in US differs greatly from state to state (let alone another country).

In Singapore (where I am at) we are told the opposite to never attempt such a procedure on-site unless it's an extreme last resort (no valid IV on hands and legs) with no other means of evac. Making such a procedure theoretical, instead of practical.

Because we are a small island, we are pretty much 15 minutes away from any hospital on any part of the island. There is always an evac route. So god forbid if there is ever a large disaster which turns that theory into practice. Only seen jugular IV done in ER once, and never on route.

We did a lot to standardize things over the past 5 years or so. They changed the curriculum into a national standard, as states had some very unique systems to cope with logistical challenges. There has always been EMT-Basic, EMT-Intermediate and Paramedic, but states used to have a lot of freedom to define those. In Montana, where there are counties that are 600 square miles and all volunteer, Basics could get training to intubate or do IVs because they didn't have resources to train paramedics. Now Basics are EMTs, Intermediates are Advanced EMTs, and Paramedics are still Paramedics.

It's sad how much of our system is dominated by profit. The provider I used to work for claimed they couldn't meet their contractually obligated response times without a $10 million grant (keep inb mind they bid on this contract, so they knew exactly what they were getting into). The city's main EMT service said their studies showed meeting the goal was possible without any additional funding, so the private company stopped 911 service over a weekend and forced the city to take over 60 square miles of coverage. The sickening part is that they kept all their staff in the area to continue running private facility transfer calls because they were making money off of those.

Didn't expect so many other EMT developers on here, thank you all for your service!

We did a lot to standardize things over the past 5 years or so.

That's awesome to hear

It's sad how much of our system is dominated by profit.

A sad truth, of human greed on every system we touch - regardless of industry

the private company stopped 911 service over a weekend and forced the city to take over 60 square miles of coverage

This is literally taking hostage of lives 😞

Didn't expect so many other EMT developers on here, thank you all for your service!

I think it actually makes sense, they have much overlap in core skill sets in my opinion.

But they have a huge difference in pay (hence why I believe the switch makes sense to many). Did a long tweet thread on this before, on how those in the medical profession deserve a better salary.

PS: its a long tweet thread, so click on it to view the full thing.

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