Cultivating Ignorance: The Liabilities of “Prehospital Care” Go Beyond Misplaced Expectations
On Sept. 3, 2025, two Galveston police officers lost their footing during a swiftwater rescue drill. They were quickly sucked beneath a raging torrent, the undertow holding them under the surface. Although the exercise was a simulation, performed under controlled conditions—the training was held at a water park and a dive team was on hand in order to effect rescue—in the course of being submerged for an extended period of time, one officer went into cardiac arrest.1
When Galveston EMS arrived, they initiated care in accordance with modern resuscitation science as it applies to cardiac arrest in the field: All interventions were performed on scene until a return of spontaneous circulation (ROSC) was achieved. In this instance, the results were not only congruent with that science, but speak for themselves: The officer is now at home, alive and well.
Despite this favorable outcome, criticism of the EMS was immediate and damning. “Galveston EMS should be ashamed of themselves…” began a Facebook post from the Galveston Municipal Police Association.2 “We are highly disappointed, and believe Galveston EMS owes our member and his family an explanation and an apology.”
Even the officer's wife didn't understand and appreciate that her husband is alive and fully functioning because EMS performed all resuscitation efforts on scene vs. simply rapidly transporting to a hospital.3 Writing that EMS’ not focusing on immediate transport amounted to “negligence” that “nearly cost my husband his life,” her misunderstanding reflects the emphasis of most of the criticisms, which focus on one primary question: Why didn’t paramedics immediately transport a near-drowning victim in cardiac arrest to the hospital, rather than resuscitating the patient on scene?
Despite the fact that 20 minutes of on-scene resuscitation resulted in a restoration of circulation and a final cerebral performance category of 1 (reflecting fully restored function with minor to no deficits), police spokespeople were quite vocal in advocating for a course of action that has been shown to lead to poor survival overall and poor neurological outcomes in particular—namely, focusing on transport at the expense of proceeding with care in the field.4
The blowback from the EMS in the face of those indictments was just as rapid. The police response was “loud, uninformed, and divisive” wrote one EMS professional.5
But have we ever stopped to consider the role that EMS plays in the ignorance we are so quick to condemn? What kind of mindset are we promoting on the part of not only our allied agencies, but that of the public—and even ourselves?
Consider an expression so pervasive that, despite not being an accurate description of modern field medicine, many people, including many in EMS, continue to use it to this day: “prehospital care.”
As many people weighing in on the Galveston incident have put forth, the idea of EMS being nothing more than a preamble to the hospital is antiquated and false. And yet, if you peruse almost any EMS forum, textbook, or other resource, you are sure to come across the term “prehospital” care at least once. If that is how we present ourselves, as nothing more than a stopgap until the “real” care can be given, then is it really any surprise that people who aren't familiar with the intricacies of resuscitation science don't understand why, in critical situations, we aren't just scooping and running? One paramedic calls out the police response as “childish and destructive” and refers to the “troubling ignorance” betrayed by their subscription to a “scoop and run” mentality.5
The plain, unvarnished truth is this: the biggest favor we could do our profession would be to strike from our lexicon a designation that not only sets us up for exactly the sort of disparagement being borne by Galveston EMS, but is marginalizing and demeaning to all of us who practice emergency medicine in the field. Other professions aren’t denigrated with descriptions that suggest that their identity—indeed, their only value—lies in their relationship to what happens after their involvement. Why do we allow it? Why do we perpetuate it?
Emergency medicine has evolved to the point at which significant, often definitive, care is often provided in the field following a rigorous assessment and diagnostic process. Many patients we evaluate and treat in the field never see the inside of a hospital—and don’t need to. In other situations, a patient should be evaluated by a physician following field interventions, for the same reason that anyone experiencing a bout of cardiac chest pain should be evaluated by a cardiologist after assessment and treatment in the ER: in order to afford the patient every opportunity for an optimum long-term outcome. Nevertheless, despite the ED physician being the first point of contact in a continuum of clinical care, no one disparages him by referring to him as a “pre-specialty care” provider. Neither should we allow the EMS to be defined by what (sometimes) happens afterward. In continuing to do so, we are doing a disservice to all, as the Galveston incident so clearly illustrates.
Envision an identical scenario to the one that took place in Galveston. Now, however, imagine if EMS had never been referred to as “prehospital” care. What if EMS had always been understood to be field medicine? That far more accurate term leaves no confusion as to why EMS is performing resuscitation efforts on scene, rather than loading a patient into a vehicle for a trip to a hospital, during which the patient’s odds of surviving neurologically intact quickly fall to little better than chance.
Of all times in the history of American public safety, this is certainly not one for divisiveness between EMS and the police. The best way to avoid mutual scorn is to prevent misunderstandings from happening in the first place. We are well overdue to eliminate a term that not only precipitates misplaced expectations but demeans every dedicated EMS professional.
It's time to stop using antiquated, marginalizing, and incorrect language when referring to our profession. Every instance in which we encounter the phrase “prehospital care” should give us pause, and be followed with a mandate to embrace modern EMS through replacing it with “field medicine.” Doing so would leave no doubt that the right thing is in fact being done in the many instances in which important, critical measures are performed on scene. The dividends go well beyond preventing another disconcerting Galveston situation.
Citations and References
1.) https://www.ems1.com/ems-training-and-education/galveston-police-training-incident-fact-perception-and-protocol
2.) https://www.facebook.com/100063582192860/posts/-announcement-galveston-ems-should-be-ashamed-of-themselves-for-the-action-or-la/1361157752680285/
3.) https://www.police1.com/ems/what-the-galveston-ems-controversy-teaches-about-police-ems-cooperation?utm_medium=referral&utm_source=facebook
4.) https://jamanetwork.com/journals/jama/fullarticle/2770622
5.) https://medium.com/@jbilyk/progress-over-haste-defending-modern-paramedicine-in-an-age-of-misinformation-1f933f83dbb0
Mark Rock, NRP, serves as a full-time paramedic in Ventura County, California. As an EMS educator, he conducts pharmacology, electrocardiography and patient assessment workshops. His publication, “21st Century Patient Assessment”, was featured in both American and European EMS journals, and he was invited to present at the 2020 European EMS Conference in Glasgow, Scotland (cancelled due to COVID).
