First10EM – The past, present, and future


It doesn’t seem possible, but First10EM has now been part of my life for 5 years. The first post went up on March 4th 2015 (and seems a little dated now, but I think the ethos of being mentally prepared for the first 10 minutes of the worst emergencies still survives.) In that time, I have written more than 270 blog posts encompassing more than 500,000 words. At this point, I can’t really remember why I thought starting this blog would be a good idea, but I can’t imagine my life without it. Writing about resuscitation and evidence based medicine for the last half decade has made me a far better doctor. More importantly, engagement with the FOAMed community has enriched my life tremendously and is likely to prolong my career in what can otherwise be a rather grueling profession. 

First10EM stats from the last 5 years
I am currently writing about the equivalent of a full book every year

I hope that in some small way this blog has also contributed to enriching the careers of some of my readers out there. I know that the number of people accessing the blog has exploded over the last 5 years. I am humbled and honoured that so many people are willing to take time out of their incredibly busy days to read First10EM. Thank you friends. I hope that means you find this site valuable.

Traffic has grown astronomically

Unfortunately, the increasing traffic also comes with some unexpected downsides. The blog loads slower than it used to, despite my having spent hundreds of hours minimizing image size and cleaning up the website’s code. Increasing traffic and improvements to the appearance of First10EM has also increased the cost of running the website. Although FOAMed is free for the users, there can be significant costs associated with creating and hosting this content.

You might have noticed that many of the core FOAMed sites now have advertisements or mechanisms that allow you to donate to the cause. First10EM has always been a hobby for me. It is a side project that makes my clinical work more enjoyable. I don’t like the idea of mixing money and pleasure, because I worry that First10EM will then transform into more of a job. However, the costs continue to increase, and I would really like this blog to be sustainable into the future.

I really don’t want to place ads on the website. Obviously, I don’t want to create any conflicts of interest. Too many of our current problems in medicine arise from the huge influence of corporations. Furthermore, too much of what is sold on the internet is snake oil, and ads directed at any of that crap would conflict with the ethos of First10EM.

Thus, I think the best option to keep First10EM alive is to rely on the kindness (and personal interest) of my readers. I have started a Patreon account that I hope some of you might contribute to, to help cover the operating costs of this website.

Become a Patron!

For anyone who isn’t familiar with Patreon, it is a service that allows patrons to support some of their favourite content creators by donating a small sum of money every month. I currently use it to support a number of the podcasts that I really enjoy. 

I am just a guy sitting at a computer writing about medical evidence. I don’t have a lot to offer to entice you into this Patreon membership. I don’t have cool swag or exclusive content (I produce as fast as I possibly can and I put everything up on the site for free). I am not about to start holding back content behind a paywall. Thus, I can only offer my dedication to continue to bring you the highest quality content I can possibly provide. I hope that is enough to encourage a small number of you to help keep this site alive. 

That being said, I do read far more papers than I have time to write about on the blog, and there is often a lengthy delay from the time I read a paper to when I have time to write about it. One perk I plan to offer my patrons is a series of short 1-2 minute videos that record my initial reaction to newly released medical literature, and maybe some other critical care tips and tricks. 

This is an experiment. If you hate it, let me know. I plan to continue to create content either way, and I hope that First10EM can remain alive and ad free long into the future.

If Patreon isn’t your thing, there are lots of other ways that you could support First10EM. Perhaps the most important is spreading the word. If you find this website useful, chances are that your colleagues will too – but maybe they haven’t discovered it yet for themselves. Letting people know that First10EM exists is one of the best possible ways to help the site.

You can also help by giving me feedback. Are there ways I could improve the site? Is there content that I really need to cover? Should I change the site name now that I am covering a lot more than the original “First 10” approaches? Let me know. (Positive feedback is also a tremendous motivator. If First10EM has ever changed your practice or improved outcomes for your patients, I would love to hear about it.)

I am excited for the next 5 years of First10EM, and I am incredibly grateful to have you all along for the ride. Again, if you have the means and feel like the site deserves your support, please consider contributing through Patreon.

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