09 - We Are Where We Are.


We believe the process that has resulted in SALT was flawed and its basis non-existent. We know there is not an immediate crisis looming and that means agencies can afford to be measured before making any decision. If it is deemed SALT is truly superior to START we should form a unified national strategy to adopted it, simultaneously, to advert the piecemeal fragmentation that is occurring now. Until that time we have much work to do and other barriers coming our way we must prepare to overcome.

Next Steps:

Step one: Obvious. Stop the adoption madness. Resist the unfair lure of funding and take pause. If your state agency leaders have SALT on the table for consideration, request that they keep it there until the facts are in, the questions are answered and the field-testing is complete. Remind them their responsibility is to eliminate fragmentation, not create it.
Step two: Field testing. Real field testing. Double blind non-biased tests nationwide that extends from seasoned paramedics to green CERTs. Utilize the HSEEP exercise format to establish the test criteria and collect and pool the results into a single database so we can all evaluate the data in a meaningful way.

Why this most basic step was circumvented in the first place is beyond reason.
Step three: Social Media: Establish a simple on line portal where the subject can be monitored by all stakeholders so everyone can voice their opinion and express their thoughts. Some of our best ideas that have led to policy have come from those we lease expected it.

Do these three simple things and in six moths not only will we have the answers to the questions but we will be unified in our approach as to what happens next.

In the End:

We have no dog in this fight. We wish it wasn't a fight at all. Let dead dogs lay and cast no blame. We did not create this site to cause polarization, it is unification we seek. Yes our tone may have been less than cordial but we’re angry. It’s time to move forwarded with lessons learned. If we approach this correctly we will look back at these events some day and realize it was the catalyst for changing how we implement new ideas and policy.

Something Wicked This Way Comes:

The Working Group is not done doing what they do the way they do it. Far from it. They are picking up where they left off and planning to develop even more processes we will be mandated to use in mass casualty incidents. One process for how we conduct secondary triage/patient reassessment and another for how we prioritize the transportation of our patients to hospitals and provide reunification.

Excerpt from the Working Group’s publication:

“It is also important to conclude by noting that this guideline only scratches the surface of the decisions that need to be made during a mass casualty incident. In the future, the Model Uniform Core Criteria needs to be expanded to address issues surrounding secondary triage, including ordering transport, selecting destinations, patient tracking, and keeping together families with small children.”

That's what we get for being asleep at the switch. Thank goodness the federal government has our backs and knows what’s best for us and our public. We’d all be better off if EMS was federalized.

Life as a Lemming:

We can either sit back and watch as federal mandates are imposed on us from a group of experts in a closed room surrounded by research papers and funded by the government or we can let them know we want a seat at the table and be part of any decision that effects the process we use to care for our public.

There would be no reason why they should not want that. If it’s evidence they want we can bring it. We have the AARs they should have used in their data sets, we have the real time experience of managing MCIs and we have the power to act as a unified team and implement policy as a consorted group nationwide to minimize any potential detriment to patient care or interoperability. What we also have is the right, no the responsibility, to question and challenge things we feel are not right or need further testing. It is not up to them. It is up to us.

Normal people... believe that if it ain't broke, don't fix it. Engineers believe that if it ain't broke, it doesn't have enough features yet.”

- Scott Adams

As for us?:

We will keep ourselves appraised of developments and update this site as needed. One thing is for certain - if SALT comes our way before the data is in they will have to pry START from our cold, dead hands.