Our community recently suffered the loss of a 19 year old woman who fell from the scenic bluffs overlooking the Mississippi River.   As a follow-up to this tragedy, the regional newspaper was doing a story on 'safety tips' for people to keep in mind when visiting those sometime treacherous areas.   In speaking with the reporter, I related the series of call types we had responded to over the past several months.   Falls, heart attacks, mountain bike crashes, sledding injuries and the typical car crashes.   Pondering the possible common thread that may have been responsible for most of those injuries or deaths, it suddenly was clear as day.... In virtually every incident, the victim exceeded their own reasonable limitations.   The '60 something' out of shape male who decides to go hiking, the mountain biker who went too fast or down too steep a slope, the woman who may have run to far and too fast at night with limited visibility and so on.   They all exceeded their capabilities and limitations.

Thinking more about that conversation in the days gone by, this theory has a lot of applicability in our personal and professional lives, especially as EMS providers.

We all have certain strengths and weaknesses - things we do well and some we don't do so well.   For EMS professionals, it may be a clinical skill, a management task or even a leadership principle.   Personally acknowledging your limitations is the first step in either overcoming it, or adapting to it - sort of a 'capabilities anonymous'.  

You've certainly experienced this in your own life.   For instance, you're involved in a critical technical or important theoretical discussion that becomes a battle if wits, when you suddenly realize you are unarmed.   Worse yet, you are trying passionately to make an important point when you are overcome with the feeling that the person you're trying to get the point across to is totally clueless.  

What do you do lifesaver?

If it's a limitation YOU have, make a decision whether or not you want to overcome it, or adapt to it.   For me, one of my limitations is anything mechanical.   Many of my friends can tear down and completely re-assemble their motorcycle with high performance fuel injectors and a re-tooled suspension system.   Me? I'm afraid to change the oil on my bike.   This is a limitation that I choose NOT to overcome, so I adapt to it by having a great relationship with the local Harley-Davidson service shop.   Conversely, another limitation I have is workaholism.   Like many of you, after almost 30 years in EMS, I've never "worked" a day in my life.   It's easy to put in 70 hour work weeks without a second thought.   But, that is not fair to my family or friends and a limitation I need to overcome.   For this, I rely on my new wife who grounds me and can easily divert my attention to the other more important things in life.

Sometimes identifying your own limitations is tough.   Solicit the assistance of friends, family or co-worker.   Believe it or not, they know your limitations probably better than you do, but will not let you know unless you ask.... So ask!

EMS as a profession has some serious limitations as well, many of which have been the focus of other Insights columns.   Failure to establish outcome-based performance standards, difficulty proving what we do makes a difference in the communities we have the honor of serving, failing to develop good future leaders, focusing on turf protection, politics and fighting with each other as opposed to the focusing on the patient.   One of the harsh realities we need to face is whether or not we are willing to overcome these limitations, or simply adapt to them.  

The recent Pinnacle EMS Conference in St. Petersburg is a classic example.   Our industry's best minds outlined the numerous capability limitations facing our industry and the need to change our service delivery models.   Many of these messages are not new.   In fact, the EMS Agenda for the Future foretold many of the same issues back in 1996 - but we've been so busy fighting with each other, that only a few forward thinking leaders (without some of the capability limitations some of us suffer) have actually implemented positive programs for their community.   Those leaders overcame their limitation to excel in improving their EMS programs.

Another example is the Institute of Medicine Report.   Many of us predicted that congress would act quickly to implement some of the recommendations contained in the report regarding accountable, outcome-based, regional EMS systems.   Well, guess what, on July 25^th the House and Senate introduced bills to appropriate $12 million in grant money for regional EMS demonstration projects, ostensibly modeled after the IOM recommendations.  Are we going to overcome our localized limitations regarding turf, politics and infighting to drive this process, or are we going to simply adapt to what Congress eventually mandates?

It's often said that if you want to be successful, surround yourself with people smarter than you.   For me, that's not too difficult and helps me to adapt to my limitations.   But, can our entire profession accomplish the same feat?   Can we rely on others to outside of our profession to make up for our own limitations?   Are we the 60 something person clearly beyond our limitations trying to reach the pinnacle of a bluff that is a regional, accountable, outcome-based EMS system focused on the patient?

The hill is before us....   It's time to lean on each other to collectively and cooperatively overcome our personal, professional and industry limitations to meet the mandate of the EMS system of the future.