A Check Up From the Neck Up For EMS' Future Leaders

By Steven P. Velasquez
June 13, 2009

Radio talk show host, attorney and activist Ron Kuby introduced me to a phrase some time ago, regarding young hot shots with a head full of new information. He said "you cannot preach, as truth, today, what you only learned yesterday."

I wish this concept would have been imparted on me as a young paramedic in my 20's. It certainly would have saved me some personal embarrassment and I really think it needs to be taught to today's new generation of paramedics as they appear to be coming out of school much younger, far less experienced and increasingly arrogant. 

At the risk of sounding like an old man shooing a bunch of youngsters off his front lawn, please allow me to explain myself. When I became a paramedic at the age of 22, I immediately came home and wanted to master my craft and to improve my resume. I inquired about teaching ACLS & PALS with a very special lady, and nurse, named Linda Sylvester (may she rest in peace). She gently explained to me that her strong suggestion was that I first "go out and see ACLS work, before attempting to teach it to others." I was fit to be tied! This arrogant, self-appointed deity in a skirt was going to tell me what's up with ACLS? I've worked over five years in Union City, Passaic and Jersey City. I've seen more ACLS than some people see in a career; or so I thought. I could run through those algorithms better than most people I knew! "Shock, shock, shock, everybody shock, little shock..." Remember? My God, I was incensed! This woman obviously doesn't know anything about what she's talking about and less about me.

What Linda had shared with me was that I cannot preach, as truth, today, what I only learned yesterday. But, like a petulant child, that wasn't the truth I wanted to hear. Fast forward 17 years, a bunch of life experience, and a pair of careers and no truer words could be spoken. It took a lot of time and exposure, not to memorize the order of a list of directions but to answer the why's and how's of the process down to the cellular level. We often hear that one can teach a monkey to perform certain tasks we perform to illustrate the difference between rote memorization and actual conscious thought (not to mention having an opposable thumb). Yet, our newest and youngest are jumping out of the box with not much more than enough information to qualify -- to go out and really begin learning the truths of the field. That is NOT to say that they are unintelligent or that they could not explain the nuances of J-Points in 12-lead EKG's which were not part of my primary paramedic education, it just means that all those concepts, terms, algorithm's etc... need time and exposure, like developing film for a camera (device used to capture images on paper using chemicals and brief exposure to light prior to the digital age. Avg. size was 24 exposures vs. 4 GB). We have yet to enter the age of Neo in the movie "The Matrix" where we can plug wires in the back of our skull, download a couple of Judo lessons and come out as masters of the art. 

Today’s newest paramedics hit the streets, answer their first couple of calls and are immediately convinced:

· That EMT’s (the cert they held only yesterday and only for a few years) are a lesser form of the species or misguided hobbyists.

· Anyone who is not on the brink of death is not a candidate for ALS

· And my personal favorite flawed philosophy “my patient’s have to prove to me that they are candidates for ALS.”

Who in the world is teaching these people? When did we become deity’s, sitting in thrones, having subjects brought before us to evaluate if they qualify for or merit our services? Those uninformed EMT’s only a few weeks ago were your partners, co-workers, BFF’s, your best man, or Godfather to your children. Suddenly, they’re there only to lift your patients or to serve as the subject of your sarcasm? 

Read your Hippocratic Oath folks! The information you are now (temporarily) in possession of, has been distilled over the ages and over the bodies of the millions of dead and diseased. It is yours to add to, subtract from, modify or refine based on evidence -- gained from your experience. The information is not yours! It's only yours for now, to improve upon and then pass it on. 

Go out and discover, research, prove and disprove the fields' truths. There will be plenty of time to preach later.