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EMS Syndrome: The Chronic Disease of EMS

The disease struck again. A productive conversation with an EMS executive about the future of his organization suddenly ended when his cell phone vibrated and he started thumb-poking the screen.

“Sorry man,” he said with a grave look on his face. “I just got to take care of this.”

And just like that, the conversation was over as he hurried away to deal with an urgent budget matter related to a threat from the fire department.

During my years of working with EMS organizations and leaders, I’ve become convinced that the industry is afflicted with a chronic and debilitating disease. Merriam Webster describes disease as “a problem that a person, group, organization, or society has and cannot stop.”

EMS certainly has such a problem. I call it EMS Syndrome.

The major symptoms of EMS Syndrome are:

  •          being stuck in busyness
  •          jumping from crisis to crisis to put out fires
  •          experiencing chronic shortages of time, imagination, creativity and innovation
  •          feeling victimized by circumstances beyond our control
  •          avoiding deep reflection and planning about the future
  •          failing to have a vision and provide leadership on critical issues
  •          sticking Band-Aids on problems instead of solving them

The impact of EMS Syndrome is devastating. Our growth is stunted, potential is thwarted and our standing in the larger community is dwarfed.  

Lest I sound pompous, I know this syndrome well because I have often been afflicted by it. I have failed to plan. I have bounced from project to project. And often, I have been led by circumstances and events, rather than leading them.

But I have also made EMS Syndrome a subject of study. I believe its pathology is rooted in the nature of the EMS business and comes from the following causes.     

Living in a reactive paradigm

It should be no surprise that EMS leaders often live in crisis mode. Reactivity is in our DNA. When tones sound, we jump. When things get bad, we mobilize. When blood pressure drops, we spring into action. There is a certain addictive satisfaction in reacting, and after a while we start looking for opportunities for more reaction.

Over time it is easy to get stuck in the reactive paradigm. Everything becomes a crisis, and busyness is the only way we know how to live. Consequently, we don’t slow down. We don’t plan. The idea of taking our team away from the daily chaos for reflection and planning seems impossible and unnecessary.  

A focus on symptom management

EMS is expert at recognizing and managing symptoms. We handle what is right in front of us, and we’re good at it. But because our time with patients is short, we don’t invest in root cause analysis. Instead, we are good at Band-Aids, and it shows in big industry issues.

Consider the fee-for-transport reimbursement system. The symptom is well known. Reimbursement does not cover costs in many systems. So we look for ways to Band-Aid the system and make it work. Currently lots of resources are being put into lobbying to make Medicare extenders permanent. But there are virtually no resources or efforts being put into understanding and changing the root cause – a flawed system that is based on wrong assumptions.   

Adaptation to scarcity rather than abundance

EMS developed in poverty. Look at the historical development of most local systems and we find shortages of funding, workers, recognition and community support. An infusion of federal funding in the 1970s was intended to help the infant industry develop appropriately and sustainably. But that funding was ripped away during the 1980's fever to balance the federal budget and, in many respects, the industry continues to live below the poverty line.

Knowing how to react, we have learned to cobble things together, wait in line for soup and tighten the belt. But like people who grew up during the Great Depression, we spend our time saving string and clipping coupons instead of living from a perspective of abundance. We view the world through the lenses of scarcity, and it shows in our unwillingness to imagine big positive change.

Mentality of isolation and protectionism

Perhaps because of this sense of scarcity, we remain preoccupied with clutching onto what we have and are chronically suspicious of “the other” in our industry. I’m still amazed at all the suspicion and fear: fear of the fire service, fear of AMR, fear of the agency next door, fear of the helicopter service in the next town. This fear leaves us fractured, voiceless and impotent as we isolate and try to protect what is ours.  

Is there a cure for EMS Syndrome?

I’m not sure EMS Syndrome is curable. But my experience and observations suggest we can mitigate its grip on us.

As with most behavior-related diseases, the first move toward mitigation is bringing more awareness to the presence of the disease in our lives and organizations. Some key questions to see if you are infected are:

  •          Is my day leading me, or am I leading my day?
  •          Am I only fully engaged when in crisis mode?
  •          Am I addressing the symptoms or addressing the cause?
  •          Would those who love me agree that my life is balanced?

Second, we need to engage in practices that slow us down. Both personally and organizationally, we need time away from the chaos to reflect, plan and nurture internal strengths. We need to schedule such time every day.

Organizationally, we need regular time for our leaders to decompress, reflect, dream and plan. Retreats should be a regular activity.

Finally, we need to spend time with influencers that are accustomed to viewing the world from a perspective of abundance. For me this means: spending relaxing time in nature settings where there is an abundance of beauty and life; reading and re-reading materials like Covey’s Seven Habits, Coelho’s The Alchemist, and Pink’s Drive: The Surprising Truth about What Motivates Us; and watching inspiring TED talks by presenters like Peter Diamandis, Elizabeth Gilbert and Simon Sinek.