Things That Matter

I have “strong opinions, loosely held”. Many of these strong opinions relate to how I work and what I find to be most important in EMS. Here’s a few of them, in no particular order:

• Design matters. Details matter.
• Excellence in what we do and how we live ought to be our goal. “Perfection is not attainable, but if we chase perfection we can catch excellence.” (Vince Lombardi)
• The ability to focus deeply and work in flow states produces the best possible output. This ability can be trained and developed. Workspace and mental state should - optimize for flow states.
• Writing clearly and precisely matters.
• Always evaluate others’ actions in the best possible light. Assume the best intentions.
• Paramedics should be thinkers first, and treatments should be chosen based on specific goals in treating a differential diagnosis with an understanding of pathophysiology and how the treatments work.
• EMS protocols and treatments should be guided by evidence of what works, not tradition.
• The primary problem with paramedics intubating is not just the actual skill but the procedures and routines around the skill and a lack of practice and fluidity in - mitigating hypoxia, hypotension, and acidosis in a critically ill patient.
• Whole blood and blood products are a critical part of prehospital hemorrhagic shock management and should be available as early as possible.
• Point-of-care ultrasound is a useful tool for prehospital care. However, FAST exams have limited utility; much more value is found in understanding pulmonary and - hemodynamic functions previously not visible without central line monitoring and chest radiographs.
• Despite all of the advanced treatments, the most important care a paramedic can provide is being a listening ear and a loving human connection to patients. Meeting - emotional needs often (usually?) trumps patients’ physical, medical needs.