WHY DO WE PUBLICLY CRUCIFY EACH OTHER?

EMS

WHY DO WE PUBLICLY CRUCIFY EACH OTHER?

Aaron Dix

In a remote area, nearly 60 miles from a trauma center, a child sustained what should have been an unsurvivable traumatic injury. Part of the child's injury included a laceration of the subclavian vein near the heart.

The first paramedic unit arrived within seven minutes of receiving the 911 call. Within 12 minutes, two additional paramedic units arrived - including two blood coolers stocked with fresh frozen plasma and packed red blood cells.

The child was found peri-arrest; unresponsive, cyanotic, cold, with a systolic blood pressure of 40 mm/hg - she only had a few moments left of life. Within ten minutes of EMS arrival, the patient was ventilated with a BVM. Commercial chest seals were applied, multiple IVs established, push dose epinephrine mixed and administered, and warmed Fresh Frozen Plasma (FFP)

Packed Red Blood Cells (PRBCs) were administered. The child was intubated and flown to a trauma center. Upon arrival at the hospital, a massive blood transfusion protocol was initiated, and a period of open cardiac massage was necessary.

After several surgeries, the child was discharged home after an inpatient stay of only six days.

With the family’s permission, the crew was recognized for saving the child's life. The system, the training, the providers, and the equipment worked - a child's life was saved.

But then came the social media comments – real EMS systems carry whole blood, Why was TXA not given, TXA is more important than blood, blood products are not blood, the crew must have spent too much time on the scene putting in

IVs, etc. Questions from the general public should be expected, but the shellacking by emergency service workers is not. Why do we intentionally and publicly attack our own, especially during a time of record position openings and degrading public trust? We claim to be a brother and sisterhood, yet the internet has many sites and emergency services keyboard warriors publicly assassinating our profession. A video of a structure fire will surface, and the department will get hammered for "hitting it hard from the yard" for a quick defensive knockdown before entry. But the video is only two minutes long and does not accurately represent the entire event. But that does not stop people from publicly humiliating the department. The same people will then crucify a department that takes unnecessary risks when going interior to an abandoned building. There appears to be no possible "winning" with social media judgment. Some social media sites appear to be purely dedicated to the skewering of EMS and fire but are literally published by EMS and fire members. Posts and comments take literal enjoyment from finding fault and attributing blame. We question everything, do it publicly, and do it viciously, and we wonder why we have staffing and morale problems. Then other posts hit the internet with vicious memes concerning being continuously short-staffed and overworked. Just review the conversations surrounding the now famous Baltimore radio traffic of an EMT threatening to drive the ambulance into the inner harbor. Many celebrated the radio traffic, made memes, blamed management, made similar comparisons to their own departments, and did so publicly. What message did we send to the public and new possible recruits? There is nothing acceptable with the Baltimore radio traffic – nothing. We work in a highly stressful, dynamic, and inconsistent environment. Patients, rescue situations, and fires change rapidly, and every department has its unique challenges. What works in New York City does not work in rural SC, where the tax base only provides for a handful of paid members who must shuttle water to every fire and rely on numerous neighboring departments for sufficient personnel. But we'll publicly roast that rural department for immediately going defensive when two guys show up in a single engine with 1,000 gallons of water, no hydrant, and their second due is still ten minutes out. Public humiliation not only degrades our profession and hinders our hiring, but it also inhibits productive conversations that can improve performance. Quality assurance and improvement are a necessity for any department providing emergency services. Lives depend on our correct, quick, and deliberate actions. Members must be open and honest in debriefs after serious calls. Social media posts and comments negatively influence members' willingness to be transparent. Even worse, members and the public are taking social media chatter as fact without independent verification. Having patient care and fire rescue tactics influenced by social media commentary is dangerous. Social media discussions negatively influence members' willingness to be open. Additionally, members and the public are taking social media chatter ha fact without independent verification. Social media commentary should never drive patient care and fire rescue tactics. There's a saying from the TV show Ted Lesson "Be curious, not judgmental." The show attributes the quote to Walt Whitman, but no historical indication exists that Walt ever spoke those words. Regardless of the origin – the meaning behind Be Curious, not judgmental, is clear. We need to ask more questions, listen to answers, and learn what we can from others- what went well and what should have been better. Conversations need to be productive – not accusatory. We all too frequently listen to respond instead of listening to understand. The work we do is essential- lives do hang in the balance. We should all strive to do better and work diligently to provide better service to our communities. The current social media discourse is harmful and unprofessional and hinders our ability to learn and improve. Be great, be kind, be curious.

Aaron Dix, MBA, NRP,

is the Executive Director of EMS and Patient Flow for Prisma Health, Commissioner for Clear Spring Fire Rescue, and an Executive Board Member of the South Carolina EMS Association. Prisma Health operates a large EMS department providing 911, ALS, Mobile Integrated Health, Emergency Medical Dispatch, and Critical Care services throughout the Upstate and Midlands of South Carolina. Dix is a national speaker and has authored multiple articles. He can be reached at aaroncdix@gmail.com.

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