I took care of a patient today. Poor kid, he had a lot of congenital issues and was noncommunicative and deformed. He was completely bedridden and needed constant care. Poor kid. In treating the condition that he had I put him on an EKG and much to my surprise I saw ST elevation in leads II, III, and AVF. “Huh?” I said to myself, “this kid is 15. He shouldn’t be having ischemia” So I did a 12-lead. The ST depression that I saw on the monitor disappeared, but the lifepack 12 print out gave a diagnosis of “Abnormal EKG, Dextrocardia” The EMT-B that was riding with me to get experience wanted to look at the EKG and I showed it to him. He asked me what “Dextrocardia” was. I told him exactly what it was… um, it is something that I think that I must have learned about in school but forgot about a long time ago. That’s what it is. So HERE is the Wikipedia link to a search on “Dextrocardia”. Apparently it isn’t what I thought it was which was something to do with dextrose in the heart or something like that. It’s a congenital defect where the heart grows over on the right side of the chest cavity instead of the right. In some cases, it’s a mirror image on the right side, in others; it’s not a mirror image. I don’t know, just read the article. According to Wikipedia it only happens in one in 12,019 people, which means that if we have around 30000 people in this district that there are two of them that have dextrocardia. I met one of them today I guess.
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(Attention: I edited this post heavily. I think that my ADD was in full effect when I wrote it. It’s better now, I think) The results are in: the bloggers, posters, commentators, columnists, partners, colleagues, and other people even passively involved in EMS have spoken. It seems that EMS ain’t much of a profession these days. Dang it. I wanted this to turn out to be a real career. I thought that it would. I needed it to. You see, I have wanted to be a paramedic since I was about 14 years old and didn’t really know what a paramedic truly was. It’s my father’s fault. He was the volunteer fire chief in the small town where I grew up. And I mean really small here. There were (and still are) about 400 people on a good day if everyone was home with their families and there were a couple tour busses rolling though. The town was Edgington, IL and dad was the chief of the Andalusia/Edgington Vol. Fire Prot. Dist. I’d say that there is where I got my passion for this stuff. It was the kind of department where everyone was a farmer and I got pulled up into a truck to go to my first house fire when I was only 14 years old. I was a body and they needed all the bodies they could get. I was hooked and had to continue. It made me want to know more. I wanted to be a firefighter and EMT so bad when I was a young teenager that I tried to get the state to let me challenge the EMT class before I was 18. I worked very hard to get them to bend the rules for me, but they didn’t let me. I know now that they were right. I should have spent those formulative years doing something productive like learning math or biology or picking stocks or something. Instead, I spent those days carrying around a copy of “Emergency Care and Transportation of the Sick and Injured” that my dad gave me from when he took his first EMT course. I treasured that book. It was my bible. I was a young EMS Geek. When I turned 18 I signed up for my first EMT-B class and joined the local vollie squad. It was a very rural service with a huge area. We covered 275 square miles of rural territory providing only Basic Life Support (BLS) care. Not much has changed there since then. They’re still an all BLS squad. After a few years I became a paramedic at the age of 20. With that, I became an Advanced Life Support (ALS) provider and was licensed to do all these cool new things but the vollie squad didn’t change for me and I couldn’t do all those cool things with them. This disconnect between my licensure level and my career path lead me to obtain employment at an ALS service. It was interesting being a Medic at 20… I could give complete strangers schedule “A” narcotics but I couldn’t go have a beer after a hard day’s work spent scraping up humanity. Man was I young and dumb. I had no idea what I was getting myself into. There was quite a few times where my bravado got smashed into my face. Luckily I had many, many mentors along the way who took the time to give me their best and train me in the arts and sciences that are the Emergency Medical Services. Without those dynamic individuals, I shudder to think of how some of the calls that I’ve had would have turned out. Thanks to everyone who has helped me along the way. However now as I reflect upon the decade or so that has passed since then it brings some things to mind. It is debatable whether this next statement deserves a “fortunately” or an “unfortunately” in front of it. I wrote it both ways but neither word seemed to fit the statement. So here it is stripped of any adjective. Most of those people who mentored me are still on the street with me or have moved out of EMS altogether. While this could seem almost normal in some other professions it could go both ways in EMS. A lot of those people were veterans in the service at the time I met them and were where I am now in the profession. They had around ten years on the job and were at the top of their game as far as providing care was concerned. I don’t want to have such gaul as to say that I am as good as my mentors were even though I have worked very hard to be so… but I have given my all so that I can say I can hold my own with dang near any medic out there. The problem is, I feel like I peaked at 20… as some of my mentors may have peaked when they got their licensure. The ones that are still on the street are getting tired. It’s extremely hard on the body to do this emergency stuff every day for twenty or thirty years. It tears you up. But they’re still doing it. They’re still in the thick of things with me in the same job. They’re still slogging through the blood and the mud and the tears fighting for their pay checks and living their lives working multiple jobs being a slave to overtime shifts. They’ve proven that there is precious little career advancement. The others who left the profession, well they’ve gone on to other jobs taking their lifesaving experience with them. Teaching those of us that are left in the trucks that our income potential is limited if we stay here in the field. We may be saving lives, but we’re hurting our families by working jobs that don’t pay squat. Sure, there are some good EMS jobs out there. There are EMS jobs that pay well, have great hours, and have a well defined career path. Unfortunately that’s not even close to being the norm. We need every EMS job to be like that but most aren’t. I don’t say the names or exact locations of where I work on here for a few reasons, like I never want to cross patient privacy guidelines or HIPPA laws. That and I don’t want my comments to be associated with my employers. My opinions are my own and nobody else’s. With that said, some time ago I took advantage of the family package being offered by a member of the opposite sex. This changed my life in ways that I couldn’t imagine. (as a matter of fact, I have to take a “read me a story” break in the middle of writing this) One of the ways that I couldn’t have imagined was that one of my jobs became nearly incompatible with family life. I work for an agency that responds to disasters in a governmental way that I won’t name here in the hopes that google won’t pick it up. With that job I had been making enough money to support a house, a couple of cars, and a good existence. However, being gone 6 months out of the year isn’t good when one has a 4 year old. Because of that, I decided to stay closer to home most of the time and make my fortunes solely as a paramedic again, after spending a few years splitting my time between my busy ALS-Providing Volunteer Fire Department (around 3k calls per year) and travelling around the country for my other job. With that decision I’m back to being a wage slave and an overtime hog. I work three jobs and I’m gone a lot. I make the same exact pay rate as do the new medics right out of the school. While I’m expected to help mentor the others I’ve found that the program is really only lip service at the full-time place where I work. I do my best because I really, truly care about the patients, the people I work with, the community, and the service (in that order). But I fear that I’m going to end up like my mentors have… still stuck in a truck making very little pay while being so concerned about the patients who need me that I can’t leave them for the sake of my family. Or in an entirely new profession that I don’t love and am not passionate about. It’s precisely that dilemma that prompted me to start writing about EMS. I want EMS to be a profession that I can be proud of. Not a job that anyone can do with a moderate amount of education, but a career that spawns true professionals that can make a living doing this and progress up a true career ladder. Here are two suggestions I have on to do this: First, we need to make the educational requirements hard. The more we learn and master, the more useful we are. While I don’t want to leave my mentors behind, I don’t think that any idiot out of high school should be able to take an EMT class and hav Secondly, EMS needs new revenue streams. The fee for service model doesn’t work. Neither really does taxation (and I’ll get into both of those in another post). We need to capitalize upon and monetize our current skill sets while developing additional skill sets that will bring new sources of revenue into our services. I believe that the cost of an ambulance shouldn’t be a barrier for someone to call 911 for a life-or-death situation… however I also believe that I deserve a fair wage. With additional revenue streams, both of my ideals could be optimized. For further consideration, read these: http://medicscribe.blogspot.com/2009/04/profession.html#comments – Peter Canning’s Blog on the same topic http://tooldtowork.blogspot.com/2009/04/rant.html – Too Old to Work, Too Young to Retire’s blog on the same topic http://www.communityparamedic.org/ – A new program that I really think shows promise
e my position… like I did to my mentors. The volunteer services won’t like this statement, and neither will the IAFF or the IAFC or the ENA or the (insert acronym here)… but I believe that the MINIMUM STANDARD to become a PARAMEDIC should be an associate’s degree. Perhaps even a Bachelors degree should be required for a PARAMEDIC.
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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Perhaps I really am an EMS geek. I do EMS tourism. No, I don’t find new and interesting ways to hurt myself enough to require emergency services but when I’m travelling I usually stop in to EMS and Fire Stations along my way and go look over the service. This has been a lot of fun some times (Thanks MAST in Kansas City and Sedgwick Co. EMS in Wichita! I had a great time) and has been somewhat less fun in other areas. If you’ve ever done this, you’ve probably noticed some things like I have.
First, there are services out there that are average. They run ok equipment, they have an ok group of people working there, and they appear generally competent.
Then there are services that are not so good, the kind that leave you shaking your head at in the car when you leave after politely pretending to be impressed.
And finally, there are services that really, truly do impress you. They’ve got this stuff down to a science. Their rigs are clean, well taken care of, and in great shape. Their equipment is top of the line and well stocked, their uniforms are cool, their people are really friendly and seem more intelligent than your coworkers, and their facilities make yours look like a single-wide trailer. Heck, the place even smells like freshly squeezed awesome. These services are so much of a class act that you find yourself wondering why exactly you work where you do and aren’t working there with them.
I’ve seen these services along my path and I have noticed a few things that seem to characterize all of them. Sure, some do these things better than the others to different extents however you will find a healthy mix of these things at all of these services. I’d like to share some of these things with you.
Things I’ve found out about awesome EMS Services:
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Their people are proud of the organization: You’ll find that the people who work at awesome services sincerely have pride in where they work. They’re there for a reason. They enjoy working for a service that has a good reputation in the community and the wider region. They think that their service is cool; they think that working for their service is cool; and they are respected by people from other agencies because of the position with the agency that they have. There’s a general feeling among the people that work for the service that it takes hard work and performance to earn a position within the agency. A service earns self respect the same way a person does, by having high standards and meeting their own challenges. A service that earns the respect of its people earns the respect of the wider community. Their Shine Factor is high.
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Their people truly care: “Apathetic” is not an adjective you would use to describe these people. The culture that they’re in allows them to know that they make a difference in everything the service does, not only in the lives of their patients. They know that they are an important part of their service and that they would be missed if they were gone. They care about their coworkers and are as much friends as they are colleagues. There is mutual respect and a feeling that everyone there has to pull their weight in order for the service to meet its goals and thrive. Have you ever seen something wrong in a truck and haven’t spoken up because it was someone else’s fault or someone else’s job to take care of it? These people care enough not to do that.
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Their community cares about and supports them: Community support is absolutely essential if an EMS agency is going to thrive. The best services have proven their worth to their communities and constantly work to prove why they need, deserve, and responsibly use the support they receive. The community supports them because they see the benefit in supporting them. You can see the community’s support in the newness and quality of their equipment and facilities as well as in the salaries that the employees are paid. You can see how responsible the service is with the support they get in how well they treat the equipment and the community in return.
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The culture of the service just ‘feels good’: The culture of the organization defines the way everything runs. Bad organizational cultures breed discontent and apathy in everyone over time. Good organizational cultures breed people who feel comfortable coming to work and handing the responsibility of being an employee. People that work in a bad culture form cliques and get angry a lot. People that work in good cultures come up with ideas that get judged on their merits. People that work in bad cultures fear mistakes because of the punitive measures that will come down from on high. People that work in good cultures acknowledge their mistakes and are allowed to learn from them so that they grow as a provider and as a person. People that work in bad cultures hate coming in to work. People that work in good cultures have friends at work and feel comfortable, if not happy, with being there. I think that you can get what I’m talking about.
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Their people are experts in what they do: Paramedics and EMTs are experts in Pre-Hospital medical care. They have to be, there is nobody else who could or should be. The people in awesome EMS systems have great protocols that are challenging to learn and require advanced skills to perform. Their protocols evolve with emerging science and keep on the progressive edge of medicine. The training, quality review, and quality improvement programs are tough and demanding. People take pride in being the best at what they do and earn their own self respect by doing it well. They respect themselves for their efforts and respect their coworkers for earning their respect every bit as much as they do. Ever been scared that you or a family member or friend would get hurt while so and so’s on? These people don’t have to be.
- The organization respects and supports the employees: This relates to the organizational culture but deserves its own point. Employees will not respect the employer unless the employer respects the employees. In awesome EMS services, the employees and management function in an atmosphere of mutual respect. The management provides the employees with adequate, functional equipment and facilities even when asking them to do more with less. They strive to promote fairness in corrective actions and policies, knowing when to cut someone slack when appropriate. The employees are treated like adults and are encouraged to innovate and take ownership of their areas.
I’ve been to these services and I can honestly say that I left their station with the feeling that I wanted to be a part of their organization. Then, I’ve gone back to my service and taken an inventory on what we needed to do to emulate them. It’s all about being able to enjoy coming to work for the right reasons where you work with people who care, respect, and strive for the same things that you do. EMS people who are passionate about EMS who are allowed to shine build great organizations no matter where they happen to land. EMS people who aren’t build organizations that fall into the other two categories. I suggest that you take some of the suggestions below to help get your service to where you want it to be:
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Read “The Shine Factor” – One of my previous posts and the predecessor to this one.
- Realize that your community won’t care about you u
nless you tell them why they should – EMS organizations need to market themselves just as any other business. No matter what your classification is, you need to market yourself to your community every day. Your constituents are your customers and they won’t think about you unless they either need you or you put your message in front of their faces. Tell them what you do, tell them why you do things the way that you do, and tell them what you need to do what they do. Let them know how you strive for quality. Let them know how well you are stewards of their hard-earned dollars. Let them know who you are and what you stand for. Trust me, PR saves lives and EMS budgets.
- Right now, resolve to treat everyone else in your organization like a professional. Try to earn their respect. Someone has to take the first step here, it should be you.
- End any secrecy in your organization – Sure, direct personnel actions are one thing, but unwritten policies and issues directly affecting all employees are quite another. Allow people to become involved in the organization in any role they want to. Organizational secrecy builds “Silos” where people tend to stratify themselves based upon their own perception of what is most important to the group and allows individuals to worry that anyone with a new idea is there to steal their position within the silo. Allow people to participate and collaborate on decisions affecting the organization.
- Encourage innovation. Encourage participation and new ideas – No idea is a bad idea. Business these days thrives on the economics of ideas. Don’t shoot down any idea without a collaborative review of its merit. Employees come up with new and better ways to do things every day, let them develop those ideas and test their effectiveness. If those ideas are repressed in an organizational culture that resists change, the whole organization will suffer when people begin to feel that their contributions never matter.
- Encourage people to take ownership of their roles and responsibilities – I work for my ambulance service because it would miss me if I was gone. Why would anyone ever go to a place where it didn’t matter if they were there or not? When people begin to feel that their time isn’t valued or their efforts aren’t appreciated, they stop putting forth any time or effort above what it takes to avoid being fired. That’s it.
- Never let anything stagnate – If you haven’t reviewed a system in over a year, you’re lagging behind. If your protocols haven’t changed in over a year, you’re not keeping pace with medical science. Even if something is working very well, that doesn’t mean it shouldn’t be reviewed and measured regularly. Make systems prove their worth. Don’t let anything get stagnant. Pull ineffective policies or programs and replace them with another idea. Review those ideas and see if they’re better suited to your goals. Set lofty goals and try hard to reach them.
- Reevaluate why you do what you do – Why are you in the organization? Are you there because you care about what you do? Are you passionate about it? Once you remember what it was that brought you to EMS and to the organization where you’ve happened to land, evaluate if you still see your organization fires your passion. If it doesn’t, work diligently to make it meet your design. Earn your own respect. Forgive and forget past grievances and collaborate on new solutions. Bust silos and build bridges, not fences.
As always, I welcome comments and e-mails: ProEMS1@yahoo.com
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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
My lovely fiancé (The wedding is May 30th and yes, we’re riding in a fire truck from the Church to the Reception) is working the BLS truck at the private ambulance service that she works at. They’re busy down there. The service puts up 3 or 4 ALS trucks per day and has one BLS day car. They then try not to use the ALS trucks for any transfers and run the BLS truck ragged. Poor girl. She works her butt off down there. I like all ALS systems staffed by Medic/Basic trucks for urban EMS. I just think it works better, and while I know that the point is debatable, I have debated it and I think that it makes all the trucks in a service equally useful and allows for better management of resources while not singling out one crew to run their butts off. I better not do too many of these short posts, she’s going to be home by 5ish and I have to have the house clean. Oh, check this out Http://harlemroscoefire.com
So be prepared for short quips. I listen to talk radio and I gotta tell you that I’m scared about what’s going on in our country. Take that as you will, but this isn’t an overtly political blog. That, and the Good Ol’ USA will always prevail because of people like you and me. Individuals are the strength of this country and as we participate, care, and grow stronger we will carry this great nation out of any miasma. But that’s not what I’m speaking about. I wish that there could be a grassroots movement in EMS. I want people who put their butts in the seats every shift and slog through the muck that is this profession to take ownership of it. I’ve written about it a lot, but that’s what I believe is needed to save EMS. If we take ownership of it, we will succeed in changing it for the better. Is anyone with me?
If you’ve been reading the blog lately you’ve probably noticed that I tried to tinker with the layout. In this endeavor, I was able to find out that I know nothing of XML… Nothing! If anyone would like to help with my less than stellar blogger layout and knows how to hack this into a 3 column thingie.. That’d rock. Some Announcements: Don’t worry. I like putting this stuff on the net. I’m sticking around
I’m starting a new blog, and there’s another one ready to come. This first one is waaaay still in the works, but it’s up. The address is: http://emsprotocols.blogspot.com What follows below is it’s tentative introduction. “EMS” for those of you who might have stumbled on here by mistake stands for that specialty of both Public Safety and Healthcare known as the Emergency Medical Services. This blog is dedicated to its advancement. Here you will find as large as a compilation of EMS Protocols (Also known as “Standing Medical Orders” or “SMOs”, “Standing Medical Guidelines” or “SMGs”) as I can make available to the wider community for review. I will also review individual protocols, protocol sets, medication formularies, and procedure lists as I have the time and I welcome anyone to do the same either on the available comments section or via a post, which I invite people to write. You may contact me if you wish to do so at proems1@yahoo.com.
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