This was written as a response to the question: Why haven’t we seen this product yet?
Progress appears in two ways: New technology and its applications, or adaptation. From-pre industrial times as far back as the Roman Empire, adaptation served as a “temporary” (hundreds of years) solution to a problem. No fire trucks or even pumps? Form a chain of individuals passing buckets. No fire resistive materials? Create strict laws governing use of candles; leading to the concept of Fire Prevention, another adaptation. (If you can’t solve the problem, prevent it). You can look back thousands of years to see the human ingenuity and resolve leading to the best adaptations to a problem possible.
Even the Paramedic career itself an adaptation. The problem: We do not have enough physicians for our population. Solution: Adapt a new type of healthcare professional: one specializing in short term stabilization. Since there would never be enough doctors to travel TO patients, EMTs became the first point of contact. Thus, in lieu of a superior technology, First responders would arrive on scene, stabilize the patient, and transport them to physicians at the hospital. Physicians would diagnose and order treatments. Then technicians would treat. Finally, nurses, who specialized in palliative, longer-term care, would continue patient care until discharge. Paramedics were the next step in the evolution from EMT.
Emergency Medical Services and the Fire Service are both synonymous for their adaptability. This is common sense—emergency scenes are by their very nature, random and chaotic. These scenes are adopting SCBA breeding grounds for adaptation, forcing responders to either “adapt and overcome” or lose everything. Sometimes these adaptations are quick and immediate – like sitting on a burst firehose to regain control of it. (Looks silly but it absolutely works) Others are slow and involve the service culture as a whole, like air packs or practicing universal precautions.
Yet, for all of the strengths of adaptability there is also a dark side. It leads to a tradition of convention, of habit and routine, of, “This is the way we’ve always done it.” This isn’t a criticism of tradition—one must understand what went into these adaptations, literally, people’s actual lives. These formal and informal standards were often written in blood. Added to this was a culture where machismo was a prerequisite. This results in a very persistent breed, one that was stubborn to give up and stubborn to change.
Case in point: The first self-contained breathing apparatus was invented as early as 1825, depending on how generous you are with the term “self-contained”. And “breathing.” ("Apparatus Aldini" I spent more time than I care to admit trying to find a photograph of this. It is so old it predates the actual commercial photograph) Whether we choose 1825 or 1870’s, the concept was there. And yet, the fire service as a whole did not even begin to use SCBA until the 1970’s, nearly a hundred years. True, we can’t blame the lack of innovation solely on adaptation as a phenomenon. (Who ever heard of adaptation being described as a problem?) Let’s allow for factors like developing technology, industry priorities, etc.
Training is a similar issue that has yet to embrace the new technology as a whole. Current training is ineffective for translating experience. The “10,000 hours to master a skill” doesn’t apply to Fire and EMS. Note – I am not talking about physical skills here, like IV’s or hose deployment. (See ARTICLE TITLE for the discussion on Critical thinking to learn more). I’m talking about the more broad and mental skills of assessment, incident command, and scene management. The ways to train on these topics are limited in their effectiveness, especially when it comes to translating to experience. Right now the only way to truly gain experience as a paramedic or an incident commander is to run an actual real call or command a scene or work a cardiac arrest.
You may be wondering if training is as ineffective as I claim, how does the fire and ems systems manage? Adaptation, how else? We rarely work alone, which means we have teammates watching over us, many of these are veterans who have the experience. We also have had tremendous medical directors who accept the idea that we don’t have same education or training as they do but we are doing the best with what we have. Mistakes (not gross negligence mind you) are usually not a point for punishment but education. Many paramedics who have made a ‘goof’ often will be required to write a paper for their medical director. (I did, ask me about my first cardiac arrest and the Scapula incident) This education is never punitive or caustic but rather, represents both the actuality of industry standards and our collective desire to improve it.
There are things we can do at our stations to help with training. Nail the physical stuff for certain. This can take a good portion of your day but it's critical. But what about the mental side of things? Sure, you can learn drug dosages and your incoming unit’s assignments by training. But the totality of experiences that translates to authentic competency can only be granted by reality itself. Reality, or something close to it.