Three Percenters

A couple of weeks ago, we celebrated Independence Day, the 235th anniversary of the birth of our nation. On that July 4 and the days immediately preceding it, our Founding Fathers pledged their lives, their fortunes, and their sacred honor to the cause of freedom, to the establishment of an American nation.

They followed through on that pledge, and for many of them, it did indeed cost them their lives and their fortunes. I believe their sacred honor remains intact, however, as long as we today remain true to their ideals. In the generations since the signing of that document, we have become the beacon of freedom for the entire world.

We are also ridiculed and reviled by allies and enemies alike; we vain, naive, idealistic, arrogant, hedonistic, greedy, exceptional Americans. For the most part, we have been content to ignore such condescension, mainly because we were too busy doing the things those older, wiser and more enlightened countries were unable or unwilling to do for themselves. Today, 235 years later, we take our freedom for granted. Indeed, we even relinquish much of it willingly in return for false promises of security.

And we forget how, during the American Revolution, how remote the likelihood of victory really was.

It is estimated that only 3% of American colonists took up arms against England. Only 10% of American colonists actively supported the fighters with arms, munitions and materiel. Only 20% or so of their neighbors even supported their cause at all. Fully a third of the American colonists considered themselves loyal British subjects, and a third more had no strong opinions either way.

Yet they prevailed, and in so doing, threw off the yoke of the most powerful nation on the face of the Earth.

Right now, you're thinking, "Hey, AD, the time for the treatise on American exceptionalism was a couple of weeks ago."

Bear with me, I'm going somewhere with this.

More than anything else, the success of our American Revolution is testament to the ability of a small but dedicated group of individuals to prevail against overwhelming odds. History is replete with momentous events and accomplishments brought about by dreamers who were too damned naive or stubborn to realize that what they proposed was impossible.

There's a lesson in there for us as EMS providers, if we choose to see it.

As TOTWTYTR put it in comments to this post:

"Progress is generally only made by irrational people who won't go along with the herd."

A bunch of malcontents founded our nation. In their day, at least a third – perhaps even a majority – of their neighbors viewed them as traitors. Yet 235 years later, history has judged them more kindly. In my EMS1 column entitled EMS 2.0: Where's Our Martin Luther?, I put it this way:

On October 31, 1517, a mad monk named Martin Luther nailed The 95 Theses to the door of the All Saints Church in Wittenberg, Germany. He was one man, a heretic and malcontent reviled and ridiculed by the hierarchy of his faith, who dared to challenge the teachings of the Catholic Church, the closest thing to a superpower in the Middle Ages.

One man dared to challenge the biggest religious and political organization in the world, and in so doing, sparked the Protestant Reformation. And heck, he didn't even have Twitter, Facebook, and YouTube to help spread his message.

You want other examples, closer to medicine and EMS? Fine, I got 'em.

Back in 1956, most experts thought that, once your heart stopped beating, there was no way to restart it. Peter Safar and James Elam thought otherwise, and today everyone knows what cardiopulmonary resuscitation is, and a significant portion of laypeople even know how to do it. And despite all the whiz-band advances in medical technology and new medications, CPR is still the only thing that we know works.

In 1953, Watson and Crick barged into the Eagle pub in Cambridge, UK, and boldly proclaimed, "We have found the secret of life!"

How many pubgoers do you think even paused their game of darts or looked up from their pints? I suspect those that did were rolling their eyes. Most scientists in their day knew that DNA was the building block of life, but none knew how it was arranged. The structural models proposed by their peers were all wrong. James Watson and Francis Crick went a different direction, and in 1962, they were awarded the Nobel Prize for their discovery.

Just over 40 years later, we've mapped the entire friggin' human genome, and the effects of Watson and Crick's discovery will still be expanding for generations to come.

R Adams Cowley was, in his day, considered an arrogant ass by many of his peers. Doctors used to transfer patients to Cowley's "Death Ward" when they considered it certain that those patients would die. By letting Cowley have them, they kept administrators happy by keeping the mortality rates on their units comfortably low. And what better way to do that than by transferring them down the hall from the morgue, to the arrogant surgeon who thought he was so much smarter than everyone else?

Except that, well, Cowley inconveniently saved a bunch of these patients. His numbers didn't suck as bad as you'd have thought. No one knew what he was doing differently, but Cowley did.

Now, he's considered the father of modern trauma care. He once sketched out an idea for a PR campaign on a cocktail napkin, musing on how he'd convince the embyonic EMS systems of the day to bypass the smaller hospitals and bring patients directly to him. Today, the Golden Hour has practically become an article of faith for generations of emergency medical providers.

Back in November 2010, I spoke about Three Percenters at the Texas EMS Conference. It's arguably the biggest state EMS conference in the country, yet its 3500 annual attendees barely represent 7% of the EMS providers in that state. If only half of those attendees were to bitch as long and loudly about the things that matter to the people who matter, instead of arguing the trivial amongst themselves, they could totally transform EMS in their state.

The same holds true for your EMS agency and your state organization. We have the power to affect change within our organizations, if only we'd learn to bitch about the things that matter. Instead, we cut our own throats.

The thing that dooms most revolutions to failure is not the power of the despot they're rebelling against, but the internicine warfare that often erupts within the rebel ranks. The revolutions that succeed are the ones where disparate factions can put their conflicting agendas aside to rally for the greater good.

Paid medics look down on volunteers as unskilled amateurs.

Volunteer EMTs sneer at private EMS, because you know, volunteers are morally superior because they provide their services for free.

Municipal third service EMS agencies zealously guard their turf from fire departments, because everyone knows that fire departments view EMS only as a means to an end.

Fire department medics demonize private EMS contractors, as if their corporate mission is to put heroic firefighters out of work, and probably starve their children to death if they can get away with it.

Now imagine if only 3% of each of those factions united in a common voice to lobby elected officials and policy makers for the things our profession needs.

Instead of whining about the lack of respect from our peers in health care, or pretending that the name of this blog influences those opinions, what if they lobbied for higher educational requirements?

Or if, instead of bitching impotently about being overworked and underpaid, they advocated for reform of the reimbursement system that drives EMS salaries?

If just three percent of the nation's EMS providers would just agree to tackle one issue of interest to our profession, and lobby ceaselessly to fix it, I can't help but believe that issue could be resolved relatively quickly. After it's done, we can turn our eyes to one more issue, and one more after that…

… until one day we look up to discover that EMS is finally the profession we always wanted it to be, and everyone is happy.

Well, everyone except that 33% who thinks that things are just fine the way they are now. As our American Revolution demonstrated, history will judge those 33% as being the shortsighted and ignorant ones.

Provided, of course, that we Three Percenters fight long and loud enough.