Either Lead, Learn, or Please Stop Talking



The Internet is a wonderful educational resource.

I hope this doesn’t come as a surprise to anybody, but it’s good to be reminded. As little as 20 years ago, it simply wasn’t possible to learn things in the same way or to the same extent as today, because you had to seek out the information like Indiana Jones hunting a lost jewel-encrusted kumquat. Now there are a thousand PhD’s worth of knowledge available for anyone with a modem (although it behooves us to remember that much of it is still more easily found offline, and some remains completely undigitized even now).

I have always relied heavily upon this resource, and the majority of the synapses currently rattling around my noggin wouldn’t be there if it weren’t for the ’net. I went to school, sure, but when it came to pursuing my interests and hobbies, that’s not where the money was. It even filled the bowl of my early work history — I worked in web design, various sectors of freelance writing, even as a certified locksmith, all of it made possible by self-education via an endless tap of bits and bytes.

When I first became involved in EMS, I expected that to remain true. But it wasn’t.


EMS 2.0: Good, bad, and ugly

Although somewhat inchoate in my early days, the EMS 2.0 movement was already getting legs, and was driven by an online community of paramedical luminaries hoping to remodel our damaged field into a modern, functioning system.

More recently, the larger arena of the medical community — with emergency medicine leading the way — has embraced FOAM, the general principle of free online medical knowledge-sharing. This is good stuff, and it’s just what we need.

But when I was a green EMT — and we all know how unprepared a freshly certified newbie can be — I turned to the web in the hopes it would help me learn, improve, and become better at my job. To some extent, it did. But I was also stymied.

Everywhere I turned I found veteran EMTs and paramedics advocating for increased education and training within our field. They seemed to passionately believe in making prehospital providers become better clinicians. Yet whenever I would ask medical questions to try and do exactly that — become better — I wouldn’t get answers. I would get further diatribes about the shortcomings of EMS education. Or suggestions to read a textbook (only rarely was one recommended). Or, if I pressed the point, the advice to go to paramedic or even medical school, because this sort of inquiry was likely to make me a fish out of water in my current profession.

Truth be told, I rarely got any answers where I didn’t dig them up myself. And I found this strange. Why would people purportedly so interested in advancing their profession seem to have so little motivation to actually do it?

Time has passed, and I have more perspective. In retrospect, the folks on the other end of the screen often didn’t know the answers to the questions I was asking, or only knew the answers in an incomplete or experiential way. Time has also brought along some actual progress, and there are more true FOAM resources out there.

Yet in the prehospital world, noisemaking still seems to predominate over knowledgemaking. For every blog post, website, forum thread, or social media group dedicated to transmitting information, there are ten whose primary occupation is posting long, repetitive screeds about the gaps in EMS education and the sorry state of our profession.

Now, everybody has a life outside of the internet (well, most everybody), and some of these people are indeed practicing what they preach. They’re teaching and precepting, writing and organizing, even lobbying to accomplish the changes we all dream of achieving.

Many others, though, seem to have endless time and energy for complaining about how dumb everyone else is, and very little for correcting that dumbness. More disturbingly, in recent times, the tone of these complaints has taken a strange turn toward arrogance. Novices foolish enough to poke out their heads are decried for not being up to the level of the complainer (interestingly, the level of the complainer is usually presumed to be the appropriate one — nothing more and nothing less). I imagine a great deal of this stems from frustration. But it certainly doesn’t contribute to a solution, nor does it speak very highly of the veterans behind the keyboards, who are missing the opportunity both to educate and to model professionalism. (Hint: there is no degree of expertise that ever makes arrogance appropriate.)

Yes, ideally we will move to a place where everybody staffing an ambulance has a strong initial education in anatomy, physiology, pathology, and medicine. Yes, this will probably entail degree-granting programs and a fundamental paradigm shift from our current model of training. But until then, there are thousands of EMTs and paramedics on the road or in the classroom with a grossly limited knowledge-base, and a significant number of them are motivated to do better than that. Are you going to blow them off until the day of rapture, or are you going to try and help?

I didn’t want to write this post, because I didn’t want to be part of the problem. This site aims to be zero percent complaining and 100% educating. But we’re just a drop in the bucket, because there are a lot of smart people out there who could do far more good than a hundred EMS Basics, and I wish they would remember it.


  1. Yes!

    I believe in the value of the journey, of research, of seeking answers, but one of the best routes students can take toward achieving education is through mentorship–finding the answers to their questions, not from a single, text-based, isolated resource, but in a relationship that can put the cogs into context. When simple questions are rebuffed, the student is less likely to ask a deeper one. This leaves the student not only without an answer, but with less desire to continue the search. Eventually, it can quench the desire to learn altogether.

    • Well said!

      I think part of the problem is just frustration, i.e. hearing “dumb” questions that the questioner shouldn’t have to ask. But we have to work with the world we live in, not Fantasytown, and in this world our trainees aren’t given very much. (And frankly, even “competent” newbies tend to seem dumb to veterans, because they forget how much they initially had to learn; they’ve sublimated most of it into unconscious knowledge. This is an intrinsic part of teaching, has nothing to do with your students, and if you can’t get past it this isn’t the game for you.)

  2. Mike Smertka says:

    Brandon, whenever you need a textbook recommendation, just fire me off an email or a PM on Facebook. I’ll make sure you have at least 2000 pages of quality reading.

    One of the things that leads to arrogance and frustration is people believing everyone has an equal opinion. You know I have typed novels worth of information trying to educate people. (for free I might add) But then somebody with far less knowledge, education and even experience, comes along and expects their opinion to be given equal or better consideration. Without knowledge of how the scientific method even works they demand sources for null hypothesis. When that doesn’t work, they resort to personal attacks. I have even had a paramedic claim his work experience gave him more insight to molecular biology than I have and make a post about how I have a degree but I am not as smart or as informed as he is.

    The reality is people are not all equal. Their opinions are not all equal, and many of us are frustrated not at the lack of respect, but at the outright contempt for what we say because somebody simply doesn’t agree or want to face reality.

    I am well aware that my introspection and writing style can come off as arrogant. I am not alone in that and I actually talk to people about it. I admit sometimes I lose my cool and point out the differences in knowledge and capability in no uncertain terms. Yes, it makes people feel like crap. That is pretty much the intent of it. Call me wrong if you must, but I don’t have infinite tolerance for trying to humor peoples’ egos.

    I also don’t always have a study of “Everything mike has learned in his life about topic X” handy. Unfortunately, many do not have the base knowledge required to even evaluate the validity of what I can cite. They are really good at reading conclusions though.

    Do you think it would help if I put my titles and credentials in every post, because I always thought that was a bit over the top in the arrogance and self importance category?

    I also would point out I did not tell people to get more education until I walked that walk myself.

    BTW, I think your theory on Gestalt is exactly opposite of what I would describe it as. Rather than the obvious, I would point out that because of the vast array of sensory input providers experience when examining patients and scenes, the normal physiology of the brain filters perception in sort of a “signal to noise” ratio. Gestalt, listening to your gut, or whatever you want to call it has been described as the ability to recognize important but not overt sensory perception. (I didn’t come up with the theory, but I like it)

    • Mike: no, I think the dignified way to handle people who are aggressively wrong is to point the way to the facts as best you can, render your opinion simply and directly, and otherwise ignore the nonsense. The ad hominem part never needs to enter into the picture. Appending “… and you’re what’s wrong with EMS” contributes nothing to the facts, and while it’s true that the person you’re addressing may be so wrong on so many levels that it’s farcical, pointing that out adds nothing either except to diminish us all. It’s like the head of an astronomy department getting pissed off at a 6-year-old who thinks the moon is made of cheese. “Don’t you know who I am, you little snot?!”

      Remember that you’re mostly speaking to the silent majority reading and learning, not the vocal strawmen whom you may never convince. “Getting into it” is like wrestling with a pig; you get dirty, it dilutes the actual learning, and it doesn’t accomplish anything. Nobody is going to be “convinced” out of fundamental idiocy and bad attitudes by us being loud on the internet; in fact, it may turn off other learners who wonder why the smart people are so very douchy.

      Lead by example. Those who want to follow will move ahead, the rest will gradually fade away.

    • Mike, one of the primary differences I’ve seen in you when compared to others, is that, although you look down at all of us from your well-earned knowledge mountaintop, you do not seek to emphasize our relative position below, and you strive to help us up to whatever level we choose to pursue. You don’t mince words (which to do so would help no one in the long-term), but you are not unkind; you don’t spoon feed, but you willingly provide a ready road map to the answer. With that said, I’ll now thank you heartily and return to my Guyton and Hall.

  3. craig cundiff says:

    I’m a nurse want to go back get my Emt mike get with me so we can talk Tex me 8597491323 I looking for help ECT

  4. Nancy Magee says:

    All I can say is ” Amen”. Thank you for saying what needs to be said. The competition to be the ” smartest kid in the class” , the arrogance, the over inflated egos and sense of entitlement ( I deserve more autonomy/ respect/ money/ recognition )blah blah has done nothing but turn off the average provider looking for answers. Very discouraging and needed to be addressed.

  5. Hey Brandon, this reminds me of a conversation I’ve had half a year ago:
    Me: “Hey there, what does epi exactly do for a heart in arrest? It ‘jumpstarts’ the heart somehow, right?”
    Paramedic: “Well, epinephrine is supposed to lower the heart’s threshold for defibrillation.”

    I could only give a half-blank stare and an “Okay” in response, but later I was left with such a bad taste in my mouth in thinking about how inadequate my and many others’ base of knowledge was.

    Since then, I’ve learned and read, with the intention of creating a foundation much like you have, with emphasis on foundational knowledge and skills. Much has been taken from the internet, a fantastic tool, but one can only do so much beyond that.
    The only way I’ve found to SPEAK to people about the bigger picture is to either:
    – Go fishing on EMTLife
    – Find the rare provider or educator who is willing to deal with the proverbial 6-year old wanting to know more
    – Go to medic/nursing/PA/medical school and enter a field that is more willing to take your mistakes rather than shove them back at you

    • Disregard medic school, it obviously is still part of the prehospital culture, apart from the exceptional educators/preceptors/providers who are in the minority.

  6. It is true, education can give you general EMS knowledge and training, but when you are actually in the field and perform necessary emergency work, you realise how little you know. Sometimes when performing duties, one comes across situations that were never taught or heard during Certification. In this respect, the knowledge, research, and experience shared by experienced EMTs, Paramedics, and medical people online can be a treasure house for aspiring and working emergency medical personnel. Such knowledge can also make a difference at the scene of the emergency and life of the sick or injured.

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