Few phrases get my blood going like “we’ve always done it this way.”

Seriously, find me at a conference and tell me that something new is a bad idea because how it has always been done works just because it does.

Better yet don’t do that, because you will get me all ranty.

I’ve been pushing back a lot against that train of thought lately, it mainly stems from logistical issues that we have been facing, but today it stemmed into a related clinical area. I was basically told that we need to have thousands of liters if IV fluid because we won’t have enough if we get a trauma patient.

Are you serious? The most you should ever be hanging on a trauma patient is 2 bags at a time and we rarely, if ever, hang a bag of fluid on someone anyway in the course of a normal day just simply because they don’t need it. We could theoretically put 4-1000 mL bags on the ambulance and leave them there until they expire at our current rate of consumption, so how can you stand there and in good conscience tell me we need more on the off chance we will get someone who needs that much.

I debated a trainee (I wondered why I was debating a trainee, but we trained him to think and act this way, so I am partially to blame) the other day about the new BD Insyte AutoGard BC (Blood Control) IV catheters we will be getting soon (another project I am seeing come to fruition after a co-worker got a needle stick from a supposedly safe needle) about the necessity of getting blood glucose readings and the accuracy of the meters with venous vs capillary blood. His argument was that venous blood is more accurate and we should draw it from the flash chamber of the IV catheter or from the needle hub. The reasoning behind this is that we are sticking them unnecessarily.

I countered that the manufacturer builds the equipment to perform at certain specifications at certain parameters, and that using the equipment in a manner not intended will not give accurate readings. “But we’ve always done it this way” was the gist of his reply. Luckily I have some sway over his opinion at the moment, so I am still able to plant seeds that will hopefully blossom correctly later into an “aha!” moment.

Gosh, I got ranty.

Anyway, each organization has personnel that either have been on long enough to be stuck in their ways or too young in the practice to know any better. I have developed a term for the first: C.R.U.M… or

Change Resistance Unswayable Medic

Like the crumbs left over after a very bready sandwich, these are the leftovers of an era when the rest of the organization moves on. They rely purely on anecdote and luck, calling both “experience” and failing to update skills and knowledge, and using both to trounce any word against them as being incorrect or to attempt to discredit anything new that threaten their existence.

As Steve Whitehead says “medicine moves fast… keep up” and these are off the mark and way behind. The CRUMs are easily spotted using the phrase “this is how we’ve always done” or “this always works because I’ve seen it work” some similar defense as a last ditch effort to resist the research and study that contradicts their position.

My charge to you is to convert your CRUMs, kicking and screaming if you have to, into the fold. Don’t let a brother drown!


Category: Commentary

About the Author

Russell Stine is a firefighter/paramedic in a large urban system. He has been employed for 6 years as a street level provider and has delivered care as an EMT and a paramedic across the urban, suburban, and rural settings. He has been in emergency services for 15 years.

  • Tena (F.E.S. Tidbits)

    Two sides…. “If it aint broke don’t fix it”…. But at the same time…. “Change is good” Just cause something has always been done in a certain way, doesn’t mean it’s the best way.

    • http://hybridmedic.com HybridMedic

      However, how does one know its broken if one doesn’t want to admit the problem? That’s the issue, things are broken, and no one wants to admit there’s a problem.

  • Tena (F.E.S. Tidbits)

    For some reason I’m having trouble as a reply, hybrid, it keeps messing up on me….

    Very true. A (dare I say) weakness in the fire & Emergency Medical Services = unwillingness to change (the I’ve always done X so why change now mentality). So we’re back to the question of how to get folks to open their eyes to the need for change – to the fact that improvements are needed. How do you pull these people (as you say) kicking & screaming into modern times. Only answer I have (and not really an answer) is to just keep at it trying to get people to realize there’s a need for change and continue to educate, educate, educate

    • http://hybridmedic.com HybridMedic

      The solution we have is that we continue to educate and train to a certain level, and when we refuse to budge from those standards on principle, we will get what we are desiring.


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