FossilMedic lets us in on some secrets:

When I retired from “the job” and entered academia, I often felt like a stranger in a strange land. It was difficult going from an experienced fire department insider to a rookie academic. With decades of experience, I could work the informal organization and was as familiar with the ebbs and flows of the fire department as an Eastern Shore waterman knows the Maryland bay. My first couple of years in academia was a barrage of overdue deadlines, unfamiliar rituals and never knowing what was trivial and what was vital.

Last year I participated in a master teacher program. A year-long intensive program designed to help clinical directors improve their education skill sets. It was as much of an educational socialization as it was skill development. The “academy” – a phrase used to describe the community of educators that comprise a university – has certain procedures and methods on how knowledge is gained and shared.

The master teacher program coordinator almost had a stroke when she observed the first poster presentation from my group. Unlike the standard presentation, a single oversized document with dense prose and charts, ours looked like a collision between a child’s mobile and abstract art. It was obvious that we did not get the poster procedure correct. We still had to learn the secret academic handshake. 

Not FossilMedic

By the end of the year, we stumbled through enough exercises to grasp the basic concepts of academic research, effective adult learning procedures, poster presentations and peer-reviewed medical research. To complete these exercises, we needed to meet and collaborate with many colleagues at the university. Most who I never thought to make the effort to meet when I first arrived. At the end of the master teacher process, I felt that we got the starter version of the academic secret decoder ring. 

One impact of the EMS Scope of Practice is to require more involvement by the physician who is the medical director for the fire department. Moving from a vocational skill set to an allied health provider means that the medical director’s responsibilities expand beyond the annual “signing of the state paperwork.” We need to develop an orientation program to help the medical director learn the fire service secret handshake and get his version of the secret decoder ring.

By legislation and practice, the medical director will have more impact on the fire service in the next ten years that he/she had on the department in the last thirty. I have attended emergency medicine conferences or meetings where physicians are discussing the following issues:

• Who is in charge of fire-based ems? 
• What happens when the medical director permanently removes the ability of an EMS street supervisor to practice as an ALS provider, but he keeps his position after arbitration?
• If 75% of the fire workload is handling ems incidents, how does the physician increase the amount of resources that ems receives? 
• What happens if the most effective clinical delivery of ems does not meet the fire chief or union’s delivery plan?

Giving a physician fire gear, a response vehicle and a couple weeks at firefighter school may not be effective. A young and eager medical director was making a presentation covering the challenges of working in a fire-based system. Perhaps assuming that he was in a physician-only room, he spend a considerable part of his presentation sharing the “dirty secrets” of firefighting. Because he participated in a recruit school, he seemed giddily empowered to share the secrets he learned. “It is just putting the wet stuff on the red stuff!” Some of his statements struck me as belittling and minimizing the work done at structure fires and physical rescue events.

His presentation had the same impact on me as my first attempt at a poster presentation had on the master teacher director. Enthusiastic but misdirected. The fire service needs to develop an orientation program for medical directors to provide the secret handshake and a starter fire-rescue secret decoder ring. It needs to be more than the excellent Fire 101 that many IAFF locals use for politicians, opinion leaders and news media. We need to protect our secrets and protect the image.

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