Really? Did you just?? Oh come on now… you don’t really think?? Seriously… Did you really just call me an “Ambulance Driver”? An Ambulance Driver? Oh come on… Four years of college level classes, hundreds upon hundreds of hours of continuing educations, a veritable alphabet soup of certification acronyms behind my name, and this nifty Star of Life disco ball patch on my arm and you STILL just called me an Ambulance Driver? Really? Oh come now, do you know that calling me an ambulance driver is like calling a High School Teacher a “Nanny”, or calling a Police Officer a “Police Car Driver” or calling a Nurse a “Bedpan Jockey”, or calling a Firefighter a “Fire Truck Driver”, or calling a scientist a “Microscope Looker-Inner” or calling a Congressman a “Pork spewing bloviator” (I could go on, but I won’t… although that last one might be right) EMS is an acronym for “Emergency Medical Services”. EMT stands for “Emergency Medical Technician”. Nationally, there are three levels of EMS professionals. Each level signifies to the public that the person holding the Title and the requisite license or certification has met stringent educational and training standards that allow them to take care of people. These levels are EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Some of the states have expanded on this by offering additional levels of certifications between the levels, such as the EMT-IV Tech in Wisconsin (an EMT-Basic that can start IVs and give some limited IV meds), or the EMT-Paramedic Specialist in Iowa that is above the NREMT-P a bit but still below their Critical Care paramedic. A paramedic these days has a college level education, takes over 1000 hours of didactic (classroom) time and can spend anywhere from 6 months to a year in clinical rotations. We can poke, prod, cut, inject, bandage, stabilize, evacuate, and care for you sixteen ways from Sunday. In my ambulance I carry 48 different emergency medications that I have to know how to use REALLY well or I can kill you. (I do know how to use them really well, trust me, so do my peers). I can intubate your trachea so you can breathe, reinflate your collapsed lung with a needle, surgically open your airway if I need to in order to save your life, and do a whole host of other things that you wish that you never ever need. My ambulance is a critical care unit on wheels that can be at your curbside in under 8minutes flat twenty four hours a day seven days a week. Today’s ambulances bring the emergency room right to you and begin advanced medical care right away. This care saves lives and improves your medical outcome greatly for a whole host of medical complaints. And you, Joe public, still call me an “Ambulance Driver”. Which, if you hadn’t noticed, somehow irks me a bit. Unfortunately for me, and for the members of my profession, it’s not your fault that you call me that, dear Joe Public. It’s my fault. It’s the fault of each and every EMS professional out there that you know so little about our profession and our industry that you resort to calling us that detestable term. It is our responsibility to get the word out. It is our responsibility to educate you about our life saving services, and our responsibility to let you know just how and when to use us properly. If we don’t do it, and therefore let the responsibility fall to others, we EMS people aren’t going to be happy with the job they do. We’re not going to be happy with the popular representations of paramedics in the popular media. We’re not going to be happy with the results of our public health education campaigns. The American Heart Association has recently released a campaign entitled “Mission: Lifeline”. It’s a marketing campaign aimed at increasing public awareness of heart attack symptoms so that Joe Public calls us first when they start having the big one. If you’ve been reading this, you know that my all time biggest pet-peeve is when the people having conditions where they need us and need us now but aren’t dramatic like a car accident or cardiac arrest don’t call us. I can’t make a direct quote, but I read a study once where like 60% of people call a friend or family member first when they think they’re having symptoms of a heart attack. Calling EMS for these 60% or so of potential patients whose lives may very well depend on the early interventions we can provide them seems to be an afterthought. I can’t tell you how many people I’ve transported from small hospitals to big hospitals that were having the big one and DROVE THEMSELVES INTO THE ER without calling us. Please, Joe Public, know that the VERY FIRST CALL you should make when you have pains in your chest is 911. Do NOT hesitate. Do NOT worry about the cost. JUST CALL US!! Do you know that approximately 1% of cardiac muscle tissue DIES AND CANNOT BE SAVED per MINUTE in a bad heart attack (myocardial infarction)? The difference is simple. You call 911 and usually (depending on where you are located) an ambulance arrives within 10minutes and starts lifesaving interventions and gives you medications to help slow or stop the damage in progress and salvage heart tissue that is being damaged. Please remember that “Time is Muscle” and that the extra expense of an ambulance is more than covered by the quality of life that we’re keeping for you. Really. Please call. Don’t wait. You can call your family AFTER you call 911. Please, I’m begging. I’m also telling you EMS people out there to get the word out. Go market yourselves! If you want people to know what we do, it is YOUR PERSONAL RESPONSIBILITY to tell them. Go, do it now. If you want my help to write something, e-mail me and I’ll help. For free even. It’s that important. Ambulance driver….. Seriously.
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This is part 2 of a 3 part series on “The Shine Factor”
Part 1 of this series can be found here – The Shine Factor
Part 2 of this series can be found here – What Makes a Great Ambulance Service
Part 3 of this series can be found here – The Shine Factor – Grunts
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The other day I determined the most important piece of equipment in my ambulance for the day. It varies from shift to shift, you see. Sometimes it’s one of the sexier tools we carry, like the IO (intraosseous – Into bone marrow) drill or the $25k cardiac monitor. That day, it was definitely NOT sexy but nonetheless it attained the status of the most important piece of equipment of the day. It was (drum roll please): The emesis basin.
For my non-EMS audience (Yes!! I’m getting one!! Keep telling your friends!!) “Emesis” is a medical term for “Raalllpfffegh” or, more technically, “barf”. It’s puke, vomit, throw-up, and the like. It’s something that, (apologetically) has been mentioned a few times in my writings. For EMS people, as I keep saying, it tends to be an integral part of our careers. The “Emesis basin” is a polite, professional term for a puke bucket; A portable version of the Porcelain Goddess that people pray to on hungover mornings if you will. Having one on the ambulance is necessary for a lot of reasons, none the least of which is to keep the puke out of your shoes. If you ever want to see a medical person scramble, and I mean any medical person, yell that you’re going to need an emesis basin quick like.
Quick sidebar story: The other day I was working the clinic when a patient asked for someone to come into his room. He said “I think I’m gonna throw up!” and he definitely looked like he wasn’t kidding. The problem was, when calculating his probable trajectory; I saw that he was aiming for the exact ground level cabinet where the emesis basin was stored. I had to act fast. I sprung into action, diving commando style towards the cabinet. Seconds ticked like hours. Quickly I opened the door and grabbed for the basin, cursing myself in my head for the lack of dexterity I had in getting the basin out the door. If only I had more time! I could…
Yes, he puked on me… Only a little bit though… He just peppered my scrubs a bit with splatter off the floor.
So anyways, the emesis basin was the most important piece of equipment on the ambulance the other day. The patient needed it and needed it right then and there and I got it for her. Luckily for me we had one. Yep, we had ONE; Just ONE bucket that I used ten minutes into my hour long transfer. It was my fault too, because it was my ambulance for the day and therefore the responsibility to check the stock levels and functionality of the equipment was mine and mine alone. The fact is, though, that the emesis basin just isn’t on my mental list of things that I absolutely have to check. I check the biggies really well every shift. I make sure that there’s plenty of EKG electrodes because I really like 12-lead EKGs and I’ll do the fancy right sided ones when I think that they’re necessary. I check to see that we have a good supply of all sizes of IV caths just in case I need to turn multiple people into pin cushions. I check the airway stuff religiously, and even do a monthly op check on my monitor every shift just to make sure it works. That, and I follow our check list to the letter every time.
But I took the emesis basin count for granted, and it almost cost me another vomit bath.
Now, I’m not shying away from my responsibility to check out every piece of equipment on my truck before I head out the door every morning, but really if I was down to my last basin, so probably was the crew before. Since I don’t think that they had to use one, so probably was the crew before them. Then it goes right back to me, when I probably didn’t check it that shift either. More of my fault there then.
Luckily I had the one that I did.
I would wager that one of the most annoying things that can happen to an ambulance person is to find out that you’ve run out of something you need at the worst possible time. Everyone hates that. If it happens a lot it can really tear down The Shine Factor of your organization a lot. It makes the EMT that it happens to blame themselves a bit, but also blame their coworkers a lot more. Nobody likes to bear the blame entirely on themselves so they rationalize that while they may have not exactly checked that exact piece of equipment, the previous crew obviously didn’t either. Then anger starts, and eventually apathy blooms.
Here’s what a grunt like me can do to put an end to this: (Yes, very very simple, I know) Check your freaking truck!
I don’t mean check it like you are told to do per the rule book, I mean check it out thoroughly every single shift. Pull everything out. Make sure that it works. Make sure you know how to use it (couldn’t we all use a refresher on the traction splint?) Make a production of it to whomever happens to be around to see you do it. While you’re doing it, take the extra minute or two to spray something on the surfaces and wipe them off with a towel. It may not be a full decon, but it at least make things cleaner and more sanitary.
A strange thing will happen here, I guarantee it.
First, you will KNOW for sure that your truck is in tip-top response readiness. You can’t fix the fact that it may have 200k+ miles on it, but you sure can make sure that you’ve done your part. It’s a good feeling. Trust me.
Second, you’ve now just picked up a big part of the responsibility for increasing the shine factor in your organization by taking away a big potential aggravation spot for your other crews. They may not deserve it all the time… but at least you’re doing your part to keep everyone happier and to make sure that every patient in that ambulance doesn’t have to suffer additionally from the lack of needed equipment.
Third, by making this a production, and even by turning this into a game, you’ve single-handedly improved the overall care that your organization provides and therefore the pride that your coworkers have in the service. If you do your best truck check, and then challenge another crew to find something that you may have missed, you’re pulling their pride into it too. Make it a bet. Put breakfast or something like it on the challenge. Their pride is on the line too, and that will get them invested.
At a service I worked for in times past, we always stayed with the same truck day in and day out. Since I’m pretty much OCD on truck cleanliness, I got into a competition with another medic from a different station that was riddled with the same OCD that I was. We polished, shined, cleaned, vacuumed, and tried to generally outdo the other with how brightly our truck shone in the sunlight. If I would have had the ability, I’m sure that we would have taken surface cultures to see how sanitary our trucks were (and THAT would be a great topic for an upcoming piece!). That competition put our personal pride into making our trucks the cleanest and shiniest they could be. Once we were invested personally, our pride inspired us to clean the trucks better than any management policy ever could. In fact, management’s best option to further motivate us would probably have been to offer prizes and recognition for the competition. Positive reinforcement other than negative sanctions that there would have been. It works.
Here are some things that I resolve to check each shift:
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The batteries in my ear thermometer
- And I’ll make sure that we have the little cover things too
- I want at least two of every size ET tube in case the first one gets all mucked up
- Every blade too.
- I’m actually going to get out the test solutions and calibrate my glucometer. (Yea, when was the last time you did THAT)
- The child car seat.
- The portable suction unit, both manual and mechanical.
- The cot. I’ll bet that the one you’ve got needs at least ONE thing tightened and has at least ONE speck of blood on it.
- The number of towels in the cabinet. Does anyone else put one on their knee when they
kneel down at the side of the cot and put the patient’s arm on their knee to cushion the bumps? How many times have you had blood run down on your pants? Now, be honest, how many times have you just felt it easier to walk around that way for the rest of your shift? (Guilty. Ewww) - Every other little thing, too.
As always, “Get out there and polish some chrome”
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This is part 2 of a 3 part series on “The Shine Factor”
Part 1 of this series can be found here – The Shine Factor
Part 2 of this series can be found here – What Makes a Great Ambulance Service
Part 3 of this series can be found here – The Shine Factor – Grunts
I have an awesome set of protocols from somewhere, I don’t know how I got these and I don’t know who will be using them (to protect privacy). These are draft protocols being considered for adoption by a small EMS system. If you e-mail me at proems1@yahoo.com I will send you a copy for you to look them over and make your comments. They’re pretty advanced and very good, in my opinion.
Thomas Paine – Common Sense for 2009 While this could label this blog as overtly political, and if I do that it mostly won’t be here per se, I do think that anyone who comes here should know that I believe in what this guy says. Maybe not word for word, but it is a very well done video that deserves my mention in a public forum.
I found this link on one of the EMS websites I frequent – http://www.emsvillage.com/
http://www.jems.com/news_and_articles/columns/Bledsoe/Bledsoes_EMS_Scope_of_Practice_Model.html
This is Dr. Bledsoe’s EMS scope of practice model. In this document, he outlines his vision for what EMS should become.
This guy’s one of my heroes. 100% support here. If you care about EMS, you should know this guy.
As some of you have noted, I haven’t been posting as often as I was. I’d like to assure you that this is not because of writers’ block or lack of ideas, in fact, if anything it’s because I have too many ideas. Right now, my desktop has like some 15windows open on it with things that I’ve started but not finished. I’m looking for that big idea that I can get supremely motivated to write about. Then again, there’s my overwhelming oppressive laziness and high call volume as of late that are also contributing to it, but I digress. Some things that I’m working on at the moment: So, in the near future I’ll be finishing this stuff and posting it up here for your reading pleasure. Don’t give up on me just yet. Regards, got a call…
Oh my goodness it is such a beautiful day wherever I am in Southern Wisconsin and/or Northern Illinois!! 60 something degrees today, and a high of 70, count-em, seventy whole degrees tomorrow! And then snow on Wednesday… just a chance of flurries, it won’t stick because the ground is mostly unfrozen now thank goodness. What does this have to do with EMS? Nothing, ‘cept I have a headache and I’m having trouble putting words on the screen because of it. I’ll get a post up today, would anyone be mad at me if I put a generally political piece on here?
If you look over to the right of this post, you’ll see some things that I put there simply because the blogger interface lets me put it there. There’s some links to some of my favorite sites on the web, that I’m sure aren’t that cool to normal people, but I like them because I’m strange. There’s also a little blurb about my e-mail address. ProEMS1@yahoo.com I link to it a lot because I would like to increase your user experience by having y’all e-mail me a little message and let me add you to my e-mail address book so I can shoot y’all a blurb when I put something new up here, which works out to almost every third day when I have a slow shift day on the ambulance. I won’t spam ya, and I wouldn’t sell your address to anyone else for less than an undisclosed sum of money…. And it’d have to be a really big undisclosed sum.
I like Glenn Beck, and I’ve linked to his site over on the right hand side of your screen. THIS PICTURE (http://www.glennbeck.com/content/articles/article/198/22113/?ck=1) appeared on his web page today. I laughed, a lot. Thought y’all might too.
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