My partner and I were talking about how much EMS has and hasn’t changed over the years. Despite a lot of talk about changes and progress, a lot really hasn’t changed, at either the BLS or ALS levels.

Most, almost all, of what we do in EMS is temporizing. We treat the patient and hope to make them better, or at least keep them from getting worse, until we can get them to the Emergency Department. There, it’s much the same, stabilize the patient and send them to the OR, cath lab, ICU, or some other unit where they will get the definitive care they need. Neither we nor the ED actually cure much, if anything. We mitigate crises, but we don’t really “fix” the problem.

That hasn’t changed, but it’s not exactly what I’m talking about. Here are a few examples.

Hypoglycemia. The treatment hasn’t changed in almost 30 years. At least not in a major way. We still start an IV and give Dextrose. Or, if we can’t start an IV, we give Glucagon IM. The only real change is that we don’t have to automatically transport every patient. In fact, a lot stay home after we correct their hypoglycemia. Still and all, the basics haven’t changed.

Asthma. The big change here is that more patients receive ALS care, but that’s not that new. By that I mean years ago Asthma was pretty much a BLS call, which meant Oxygen and transport. Only the sickest Asthmatic patients got ALS treatment. BLS crews giving Albuterol is fairly big, but that’s just a reflection of the reality that it’s safe and there are a lot more patients with a diagnosis of Asthma than they used to be.

Trauma Care. Nope, no change there. Well, we don’t use MAST trousers, but other than that it’s ABCs and transport, as it always has been.

Cardiac care has changed quite a bit, in the drugs we give, doing 12 Lead EKGs, transporting to specialty centers that can do cardiac catheterizations. Of these, doing 12 Lead EKGs and early alerting of the hospitals to get the cath lab going is by far the biggest. Doing that pushes the hospitals, or at least most of them, to get their cath lab teams moving faster. That in turn decreases the time from when we first see the patient until they are in the cath lab. Which definitely benefits the patient in most cases. It’s big, but it’s not a game changer in that it hasn’t radically changed how we treat patients.

End Tidal CO2 monitoring is very cool and very helpful in diagnosing (a dirty word in EMS) the patient’s condition. It has made our job easier, if nothing else, although I think that there are some very real benefits to the patient.

So our discussion went for a while until we decided that there is one, and only one, game changing treatment that we do now that we didn’t do even five years ago. It decreases hospital stays, reduces the number of intubations we do in the field, makes patients feel better and actually be better. It makes patients better almost immediately in most cases, saves health care dollars, gets patients home sooner. Of all of the things I’ve seen in almost 30 years, it’s the game changer.

CPAP.

Having treated hundreds, if not thousands of Congestive Heart Failure patients over the years, intubating dozens upon dozens, and seeing many die in the ambulance, I’m amazed at how well CPAP works in turning a patient who was on the verge of needing intubation around. Five minutes later, they are sitting up, talking, sometimes laughing and joking. It might be hyperbole to call it a miracle, because in the end it doesn’t cure the underlying problems, but it allows us to deliver a patient to the hospital that is dramatically better than when we found them.

That dear readers, is change that I can believe in.