Trying to sleep tonight, I found myself instead thinking of Jerry Maguire. Perhaps not ironically, the beginning where he couldn't sleep and instead wrote the mission statement that would haunt him for the remainder of the movie. Less obviously, I was thinking of the conversation Jerry and Ron had outside the stadium where Jerry tells him that his problem is not that he gets no love or no coin, but that he has no heart. Ron replies quite explitively that he is "all heart...." and they part as Ron says "I don't want to be friends no more" That exchange made me think of what paramedics are missing, and why.

We are afflicted with the same absence of heart. While we are so wrapped up in who is trying to take our skills away or our pay or our respect, we fail to see that we lost our collective heart long ago. And, in a business so centered in caring as ours, he who lacks heart lacks identity and, ultimately, soul.

Jerry spends the entire movie recovering from a crisis of conscience he suffered after two slices of bad pizza. By a similar turn, paramedics have spent the better part of a half-century trying to emerge from the shadows of ambiguity crafted for them by the forgers of EMS. Our founders formed a grand vision of how pre-hospital care should be delivered in this country, but only the vaguest notion of how to meld that system into a complex healthcare framework that grows and changes daily with time and science. While our nation is governed by a living Constitution, paramedic
practice is still largely defined by a forty-five year old White Paper that is as dead as the victims who spawned it. Most notably missing from this document and those that followed is the fundamental part: how the highly skilled, throughly educated clinicians at its core will be integrated and regarded in the healthcare system.

I've spent alot of time recently looking at North Carolina General Statute 55B. As a matter of fact, it stares at me even now from an electronic sticky note on my desktop. In order to form my own business, I had to understand how this minor, relatively obscure piece of legislation applied to me...in the negative. For the unknowing, NCGS 55B was passed into law in 1969 and is titled "The Professional Corporation Act". This law outlines in Article 2, paragraph 6 the requirements for being considered a "professional", who may render a "professional service" and the specific job titles that are considered "professionals" The main requirement is "the obtaining of a license from a licenseing board." Some of these licensced professionals, as designated by their own statutes are architects, chiropractors, foresters and individuals noted in the "Nursing Practice Act, with regard to
registered nurses" Nowhere in 55B are paramedics explicitly or implicitly mentioned. As a matter of fact, NCGS 131E which outlines EMS rules, expressly refers to paramedics as being "credentialled" rather than licensed, thus by definition excluding paramedics from the professional designation and the myriad of privileges and responsibilities bestowed therein. Whether this verbage was meant to be an intentional exclusion makes for good academic debate, but leaves the larger issue unresolved.

It truly doesn't matter whether or not we can intubate, or if we're allowed to carry and use a certain medication, or even choose what hospital will receive our patient if the greater issue of lacking professional identity is ignored at the very fundamental root of our inception and organization.

Now is the time to stop squabbling about skills or worrying about how much crap will fit in your pockets or complaining that we don't make as much money as nurses. This is the time for a gut check. The time to decide if you really want to be a professional or just shout about being one, thus removing all doubt that you aren't.

Jerry Maguire has his living room moment in, well, the living room. Ours needs to be in each one of our ambulances, aircraft, hospitals and ultimately, the halls of congress.