When is Enough Too Much

Over the years pre-hospital education has taken many turns and has dramatically increased in both educational requirements and scope of practice.

During it’s inception, pre-hospital medicine involved only quick transport, sometimes proving only the most rudimentary knowledge of medical care. Many early ambulance vehicles were owned by funeral homes. The attendant would pick up the patient and drive fast toward the hospital, if they should happen to die, the “ambulance” would simply turn off it’s red lights and proceed to the funeral home.

But have we gone too far. We include in training a few topics that while they sound good on paper have no basis in scientific care… There have never been studies that show the efficacy of Long Spine Board immobilization, yet many hours of EMS or OEC training are dedicated to their use. Recent information actually points more toward the practice being detrimental to the patient.

Every area of pre-hospital care has issues with recruiting and retaining providers. Many hours of training are dedicated to perhaps low or no paying careers. Many hours training equipment that is seldom to never used. There have been many hours dedicated to practices that will not be used in practice.

Currently there’s some that are pushing back. The National Ski Patrol, as a certifying agency for Outdoor Emergency Care, has received push-back from many resort owners. The owners are saying that the program is requiring proficiency in areas that will never be provided as ski patrollers. . .  Poisonous plants, Childbirth, Poisonous spiders & Reptiles.

Ski patrollers provide care in very specific conditions, Winter skiing activities. The rub exists in the NSP wishing to expand their product. The wish to be the certifying agency for all forms of extreme outdoor activities, including specialties that have no similarity to our core. . . Skiing. The program is now designed to exceed national requirements for Emergency Medical Responders (EMR); a level of training just below EMT.

The resort owners are contending that they don’t need the patrollers trained to handle all of these unrelated activities and the insistence of the NSP to train everyone for every activity makes it far to difficult to bring in new patrollers. These requests have fallen, until now (hopefully) upon deaf ears. The resort owners have felt so jilted that they have recently actively promoted their resorts to seek out alternatives to NSP patrollers.

All pre-hospital certifying agencies in the US are bound by USDOT standards that themselves have flaws. The standards have removed the critical thinking of the providers. The standards require training in equipment but have removed the component to true understanding of the benefits that they provide, or worse yet the damage that they may cause.

If we want EMS or OEC to continue, we cannot continue with the Pondzi model of train enough people to make up for the abysmal retention. We cannot continue to increase the hurdles for entry level positions. We must provide education that is relevant to the care and cases that will be experienced, and we need to educate the providers to understand the body well enough to improvise.

All areas of pre-hosptial care have difficulty acquiring new providers, but until we make some changes this trend will continue.

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