EMS Expo Closing Keynote: EMS is a Journey, Not a Destination

This year's closing keynote address at EMS Expo in Las Vegas was a humorous and inspiring discussion on why EMS needs to embrace change.

The presentation by Drs. Ed Racht and Baxter Larmon explored the beginnings of EMS, its ongoing evolution, and what changes they would personally like to see in the future.

"People have developed plans for us," Larmon said. "The question is, are we following them? Do we have an ultimate 911 system? The answer is no."

They emphasized that EMS is medicine, and medicine is science. If you stay in the business long enough you'll see things come in and out of fashion like women's shoes, they said. This is because some aspects of EMS have been based on anecdotal evidence and best guesses. As we look for evidence to determine best practices, change will be ongoing.

"Science is based on research, and research promotes change," Larmon said. "Are we open to change? We need to be."

However, they acknowledged that change can be difficult for rescuers to accept, such as the AHA's new CPR guideline to continue chest compressions immediately after using an AED. It is difficult for rescuers to abandon a previously accepted method of treatment -- not to mention that it can be frustrating to undergo constant re-education and changing of protocols.

Also, they noted, it is tough to admit that we were wrong and that we didn't know the answer, so we guessed with the best information we had at the time. Larmon said that to him, one of the most diffucult activities is teaching an EMT refresher course. This is because students take their initial training like gospel, and then two years hear it was wrong. They tend to resist and believe their textbooks, which are less up-to-date than the instructors.

However, we shouldn't throw out what we're doing until we have a reason to change, they said. Also, Racht added, we shouldn't look back and be discouraged about what we did in the past. "We did what we thought was right at the time," he said. "We do our best and refine it."

The speakers also emphasized that medicine is not only science, it is service, and much of its success depends on hiring the right people. They highly recommended the book by EMS educator Thom Dick, "People Care: Career-Friendly Practices for Professional Caregivers."

They also discussed issues addressed in the IOM report released this year on the problems in U.S. emergency care, and what changes they would implement for the future of EMS if it were up to them. These would include a stronger identity for EMS as a branch of public health, with a public education and injury prevention component, as the fire service has with fire safety and prevention education. Other changes would include more professional development for EMS providers and other improvements to make it a more desirable profession.

Wherever the future of EMS may lie, it is clear it will be ever-evolving. "Medicine is a journey, not a destination," Racht said. "Love the journey because we're never going to get there."