EMS: Are Current EMS Practices Barbaric?

I was looking at some medieval medical practices recently, many of which sounded barbaric and crazy. I could not believe that some people would allow certain “procedures” to be done on them, thinking it would cure them. But back then—between the 5^th and 15^th centuries—those people thought it was the “standard of care”; that was all they knew. Science is an evolutionary process, and the medical practices back then were simply as far as science had taken them at that point.

Evolving medical standards

Some of the more bizarre practices included using urine as an antiseptic. Henry VIII’s surgeon recommended that all battle wounds be washed in urine. One doctor recommended urine be used on the plague, and you could even buy a bottle of “Essence of Urine.”

Another medieval practice was bloodletting. This was done either through leeches or venesection. It was believed that certain fluids in the body were in excess or caused deficiencies, affecting a person’s health. So doctors would remove large quantities of a person’s blood to “cure” them. As a preventive health tool, some people would routinely have blood removed from their body, whether they were sick or not.

All this got me to thinking how what we do in EMS today—and even 40 years from now—will be seen 500 years from now.

When I first became a paramedic 38 years ago, we would take a long needle with epinephrine and inject it straight into the heart in order to stimulate it during a cardiac arrest. In the future, will medical practitioners think we lost our minds for using this practice? What about placing two devices on someone’s chest and shocking their heart with electricity? I am sure the medical providers in middle ages thought nothing of using urine, as it was probably cleaner than water out of a river for washing battle wounds, just like we think passing electricity through someone’s body is justified. 

Will medical providers in 2518 laugh when they read accounts of providers giving someone a precordial thump, drilling a hole into someone’s bone to give fluids and drugs intraosseously, and using stretchers to move patients? I am guessing by the year 2518, they’ll be moving patients on some type of hover board system or cot that does not roll and does not have to lifted by two firefighter-paramedics. The firefighter-paramedics of the future will likely not have bad backs by their 20^th year of their career.

Will future paramedics think it was barbarous to insert a needle into someone’s chest to relieve a pneumothorax, particularly if they have developed a less invasive technique that does not add to the existing trauma? Even jumping on someone’s chest and pushing hard with your hands to do CPR I bet will be strange to a future generation 500 years from now. At least we’re making progress with manual CPR compression devices.

Our profession is an evolutionary process, and we seem to continually build upon methods and practices. Times change fast. Many things that paramedics did not do 40 years ago are commonplace today. Simple things, such as using a stair chair, were unheard of 40 years ago. You usually strapped a patient to a kitchen chair with bedsheets and carried them down the stairs. Today’s stair chairs practically move themselves down the stairs. And we now have Power Cots to lift and move patients into ambulances. 

Forty years ago, paramedics would use pen and paper to calculate drug dosages and how much of a drug to put into an IV bag. Now they whip out their phone and enter the info into an app to get the answer. Back then, patient reports were handwritten, and some states even had the bubble forms that you filled out with a #2 lead pencil. Today, they sit down to their tablet and Bluetooth all the data from the monitor/defibrillator.

Here and now

We really don’t know what the future of prehospital care will look like 500 years from now, and quite frankly, it is nothing we need to worry about. The only thing that is important is the here and now and doing the best we can every day with what we know and what we have.