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Police Car Drivers, Ambulance Drivers, and their responsibilities

12 comments

Look at the pictures below and see if you can identify the three occupations represented by the people in the pictures.

What are their jobs?

What are their areas of expertise?

What would you expect them to be responsible for?

                                     

 

Yep, pretty much everyone reading this and almost every lay person you can think of should probably be able to answer the above questions. The Police Car Driver chases bad guys; The Fire Truck Driver squirts water at things; and the Paramedic takes care of people who are sick and hurt, right? Sure, their jobs sometimes overlap and so does some of their training, but the jobs and the requisite education and responsibilities are different and separate for a reason. The different roles up there are different, specialized, and require expertise in order to be effectively performed… right?

And before you think that I’m opening the Fire Based EMS can of worms, I want to direct you to this news story I just read on EMS1.com – Kentucky EMTs not called for 5 hours until coroner ruled woman was alive. Go read this and then come back please. It got me all riled up and I’m sure it will you as well.

The moral of the story, is that police officers were called for a dead body found in some bushes some where. They started doing their cop stuff and didn’t call EMS to evaluate the body because their cop training told them that the woman was obviously dead. Unfortunately for all involved, when the coroner arrived he told them that their police-issued medical training wasn’t adequate and that the woman was indeed alive.

And yes, I am 100% sure that nobody intended for that to be the tragic result.. people make mistakes, I know… but:

How many times have you been called out in your ambulance to a potential medical emergency and then cancelled while en route? Have you ever wondered who is cancelling you and for what reason? When we arrive on scene, we evaluate the patient and determine their need for transport. We have extensive training to help us do this and we function within a complex set of laws and regulations to help ensure that bad outcomes like this happen as infrequently as possible. Unfortunately, however, things like this do happen, even to experienced paramedics. How many times have you heard news stories about paramedics calling someone dead only to have them be found alive later on? How many times have you heard about occult neck fractures and other severe injuries being found later even after a patient was evaluated by a physician? It happens, folks… and it happens to us medical people too. Even with the training, knowledge, skills, and experience we have that is specifically geared to emergency medical care that is again enhanced by the fancy tools that we carry with us, we sometimes still make mistakes…

So why in the heck would a police officer, who as stated above chases bad guys and does other kinds of “cop stuff”, want to make the decision that someone was dead or not? It simply doesn’t make any sense to me. I have always been leery of having police officers call us off of medical scenes. Even when I know the officer and trust his or her judgment, I know that my medical training and tools are superior to theirs. That’s the way the system is designed, we do medical stuff and they do cop stuff.

I think that there’s a pervasive trend out there that causes dispatchers to send police units first to things like auto accidents and possible crimes in progress and then potentially forget to send EMS. Most of the time, it’s perfectly ok and turns out just fine. Other times, incidents like the above happen. How many times, also, has a police officer determined an auto accident to not require medical response and an occult injury been found later? I don’t know and haven’t seen any statistics… but I’ll bet it happens a lot more than is ever reported.

My advice? I promise to let the cops to their cop stuff. They just need to always remember to call me out to do my stuff. I don’t mind doing the report if I’m not needed or I get a refusal, I just don’t want anyone to suffer needlessly.

Be careful out there.

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Want more of my thoughts on Fire Based EMS? See: “Fiddling While Rome Burns… The ambulance “industry”

Posted by on June 15, 2010 • Filed under: 911 fail, Administration & Leadership, Ambulance, Command & Leadership, Emergency Medical Services, EMS, EMS Topics, EMS training, Firefighter Safety & Health, Paramedic, paramedic education, patient care, Uncategorized

Master Paramedics? I’m asking you a question

27 comments

Let me ask YOU a question. What do you think about this:

How do we recognize the best and brightest among us? How would we distinguish the EMTs and Paramedics who have earned the respect and admiration of their peers for being “Really Good” at what they do? I don’t mean just a little bit good, or “pretty” good. I mean masterfully good. The kind of Paramedics that Johnny and/or Roy would have wanted to be had they grown up watching them on Saturday mornings. The kind of people that have worked in the profession for as long as they can remember but that never lost the passion for the job. The kind of people who read everything they can, study everything they can get their hands on, and always seem to have the answers to the most challenging of EMS trivia, as well as the most mundane.

What would we call them?

The old trade guilds used to call their most experienced and skilled members “Master”, as in the term “Master Craftsman”. As their members worked through the years and learned the ropes of the trade, they progressed through the various levels until they reached “Master” status. Some unions still use those terms and honestly, I’m unfamiliar with what all of them are. That’s ok with me because I see Paramedicine as a profession and not as a trade, but I do respect their tradition of honoring those that have earned the title of “Master” by thoroughly mastering their craft.

So what do we EMS people do? How would we recognize a “Master Paramedic” or “Master EMT”?

I’ve been thinking about this for quite a while, honestly. As I progress in the profession and in my career path, I’ve seen the people who were my mentors keep working alongside of me. They’re my colleagues now, and although they still mentor me in some ways, they have been progressing along their own paths just as I have this whole time. Some of them have become true masters of the profession. Some of them have not. Some of them could really be called “Master Paramedics” and I would like to know how we as a profession should recognize those people. I see that these people don’t tend to be treated very well by the profession in general and I think that it’s a crying shame. Think about it, new paramedics walk in the doors to the profession and are allowed to work in the same capacity as our master medics within a relatively short time. Employers tend to not want to keep these people around when budgets get tight because these people tend to be on the upper end of the pay scale. In some agencies there’s a defined career path and upward ladder, but in a lot of (and dare I say most) agencies there is not.

So what if there were a certification, or some way to define a “Master Paramedic” and/or “Master EMT”? What would be the qualifications? What would be the benefits? How would we define those people who have earned (Yes, really EARNED) “Master” status?

This is one of the things I’m asking you to think about. If you would please, put some thought into this and write what you think would make a “Master” paramedic or “Master” EMT in the comments section. No, I don’t think that this is silly. I really want to know what you all think about this.

Here’s what I think:

-          Minimum Years in the Profession: The Master EMT or Paramedic should have more than 10 years of FULL TIME service (15 years if volunteer, depending on call volume)

-          Minimum Experience and Type of Calls:  The master EMT or Paramedic should be experienced in a broad spectrum of the different types of EMS. 911 response within diverse response strategies, Medical Transports, and In-Hospital medical care.

-          Teaching and Precepting Experience:  The Master EMT or Paramedic should have experience teaching EMS classes and in mentoring new providers.

-          Command Experience:   The Master Paramedic of EMT should have experience in being in command of different types of emergency scenes and large scale responses.

-          Knowledge:  The Master Paramedic or EMT should have to pass a complex series of tests that show not only rote memorization, but also complete conceptualization and deep background knowledge of a broad spectrum of EMS and Medical related knowledge.

-          Acknowledgement by Peers:  The Master Paramedic or EMT should have the support and admiration of his colleagues, coworkers, and peers and should be able to get them to vouch for him or her when asked.

Now, I also ask you. If you were to recognize a person that could pass the standards that I’ve set, or that you and others set in the comments below, how should we show our respect to these people for their professional achievements? How should our profession honor and acknowledge our highest achievers?

I’m very curious about this issue. Please feel free to add your thoughts.

Posted by on June 8, 2010 • Filed under: Administration & Leadership, appreciation, Command & Leadership, Emergency Medical Services, EMS, ems 2.0, ems education, EMS ethics, EMS Management, EMS Motivation, EMS pep talk, EMS Topics, Paramedic, paramedic salary, pride, profession, professionalism, Training & Development, training-fire-rescue-topics

EMS 2.0 as Explained to My Brother

14 comments

My brother is an engineer. Yes, he’s a firefighter and occasionally he still drives the Fire Truck, but I’m not talking about being an engineer as it relates to the fire service. I’m talking about a pocket-protector wearing, slide-rule-sliding Engineer who draws lines on paper and calculates weight to strength ratios and the like. It’s math that’s way over my head and I’m glad that he’s the one that has to do that type of work every day and not me. When he explains his job to me my brain starts to overheat and I’m surprised that my hair hasn’t caught on fire yet. It started smoking once, but I was able to catch a glimpse of “The Hills” on the TV and it slowed my mental activity just in time.

My brother, Captain Kaiser, is a volunteer fire captain and he used to be an EMT although he let it lapse due to the fact that it limited time with his family. I guess that I got the EMS genes and he got the “go to college and get a real job that pays well” genes. I say more power to him and he’s one of my best friends. I don’t get to see him as much as I should, but we talk often on the phone. He has always been interested in hearing all of my tales of EMS glory, and I listen to tales of his two daughters. Raising daughters sounds waaaay different than raising my son.

The other day I was talking to him about “this blogging stuff I do” and I breached the subject of EMS 2.0. I haven’t written much about EMS 2.0 by name lately, although the concepts I’ve been bringing forth fit into my model of it, but trust me when I say there has been a lot of behind the scenes activity. It turned into an interesting conversation with my brother. He was an EMT but never got past the volunteering when his community needs him stage. That’s an honorable place to be, no doubt, but he didn’t delve into the level that I take it to. So explaining EMS 2.0 to him was close to explaining it to an educated lay person.

In the conversation, I brought up the scenario that I used to write the post: “Are We the Gatekeepers to the Emergency Healthcare System?” (Unofficially titled, “Did I do good?”) and explained to him how I evaluated a patient in a nursing home, performed a full assessment on her including a 12-lead EKG and a review of her recent lab work, held a telephone conference with her Primary Care Physician and the Nursing staff on scene, and triaged the patient to the Primary Heathcare System as opposed to the Emergency Healthcare System. In the process, I saved the healthcare system (in the form of Medicare) thousands of dollars and provided better care to the patient by deferring her from the emergency room. I explained to him that my ambulance service could not bill the patient for the care I provided her because we did not transport and that the current system needs to recognize the value in having EMS provide such services in terms of cost-savings. If I would have transported, our service would have made the revenue, but Medicare would have paid thousands of dollars in unnecessary care overall. Since I didn’t, I saved Medicare thousands, but the service wasn’t valued and we didn’t receive any compensation for our work.

Basically, the conversation wound up being that he agreed with me that EMS has a powerful position to improve access to primary care and “save” healthcare as it were by increasing access to primary care, properly deferring patients from the emergency healthcare system when their care could be more appropriately managed in the primary care setting, and by saving millions of dollars in the overall healthcare setting. He agreed with me that it would require deregulation of the EMS industry to allow us to attempt programs and offer new services outside of our current mold and would require increased education of street-level EMS providers to get this done. He also agreed with me that money we’re already collectively spending should be allocated from inefficient programs and given to efficient high-performance EMS systems to do this in order to realize greater savings.

Remember, he’s an engineer. He’s good at math. He may not be a healthcare provider currently schlepping patients around in a shiny red and white bus that makes “woo woo” sounds, but he’s as smart as they come…

And when I told him that he’s exactly who we should be getting our message out to, he disagreed. He thinks that we should be out there talking to politicians and Insurance Industry executives. Honestly, he chastised me for not being in my local congresshuman’s office to do just that.

So, here’s a shoutout to the politicos out there: “EMS can ‘save’ healthcare through a free-market, grass-roots, innovative solution using currently available resources. We can save millions and improve the entire healthcare system just by putting in place a few good ideas and allowing EMS professionals the ability to think outside of the box”.

So do me a favor, y’all. Go tell your local politico to e-mail me at Proems1@yahoo.com. I’d love to have a talk with them. You should too.

Posted by on May 26, 2010 • Filed under: Administration & Leadership, Command & Leadership, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS system, EMS Topics, Fire Rescue Topics, Management, Paramedic, paramedic education, PR, profession, US economy

EMS Week 2010 – Thank You Letter from Management to EMS Crews

7 comments

This letter is free to copy and customize for your organization. It is a thank you letter from Management to Medics. I do not wish for any credits and you may use it as you see fit.

Oh, and if anyone who comes here wants a custom EMS Week 2010 letter written to fit their needs I will do it for free. Shoot me an e-mail at: Proems1@yahoo.com

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Dear fellow EMS professionals,

EMS Week again is upon us and we’d like to take this chance to say thank you for all that you do. We know that everyone who works here puts in long hours and sleepless nights taking care of the needs of our community and meeting our (company)’s mission. We know that you’re dedicated, we know that you care, and we also know that you don’t get the amount of thanks that you deserve most of the time.

So today, we’d like to take this opportunity to say “Thank you” to everyone who works here. Thank you for your time. Thank you for your dedication. Thank you for your caring, your compassion, and your devotion to patient care. Thank you for working long shifts and for holding over to cover late calls. Thank you for taking time away from your families to keep our trucks on the streets for our communities 24/7. Thank you for thinking on your feet to solve new problems for our patients. Thank you for comforting families. Thank you for comforting the community. Thank you for risking your safety. Thank you for your bravery. Thank you for your commitment. Thank you for more than we have space to thank you for. Thank you for more than we know how to thank you for.

EMS Week is an opportunity for the public to recognize what we do out there every day. It’s an opportunity for us to showcase our talents, to let the public know how to use us, when to use us, and why to use us. It’s an opportunity for us to connect with our communities and for them to connect with us. What we do is important. EMS is a necessary service that is vital for our community and the nation. EMTs and Paramedics are the healthcare safety net for all of us. We’re there for everyone when they need them, on their terms, doing what’s best for them. We come to them, meet them as they are, and give them the best that we have to offer. We should use this week to reinforce that, and to improve our relationship with them.

In closing, EMS Week isn’t quite up to the task of thanking heroes. In reality, nothing is. Please know that no matter what happens, we know that you work hard and that you care. We know what you are accomplishing out there and we give you our respect. We give you our sincere thanks. We pledge to support you as best as we are able and we know that you’ll continue to give us your best.

Respectfully,

Management of Some Ambulance Company Somewhere

http://www.LifeUnderTheLights.com

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Just change it to suit your needs. Rework it as you see fit. It’s free to use and to modify. Do me a favor and leave a comment, anonymous if you’d like, about your using it.

Posted by on May 4, 2010 • Filed under: Administration & Leadership, Command & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Management, EMS pep talk, EMS Topics, EMS week, ems week 2010, Fire Rescue Topics, Management, Paramedic

A Slap in the Face for Medics? How about a Wake-up call

20 comments

Thank you everyone! Yesterday when I posted “A Slap in the Face to Paramedics Everywhere?” I recorded my biggest traffic day ever by at least one thousand visitors. I’m honored. Thank you for coming and reading this and thank you for caring about EMS. Especially, thank you those who left such intelligent comments and added to the debate. We who care about our profession need people who are passionate, intelligent, and who are ready to work alongside of us to improve who we are and what we do. By participating here and in the wider EMS blogosphere, you’re helping spread the ideas that we need to spread. Read, Talk, Learn, and Think. Make this the profession you want it to be.

I’m going to repeat that above statement: “Make this the profession you want it to be”

And there lies the true meaning of what I wrote yesterday. Sure, I was mad about the perceived encroachment by nurses onto our professional “turf”, and sure I played my anger up into what I thought would be something to fire you up as well, but there was a message there that not everyone may have gotten.

I know that there are good nurses out there that know a lot about a lot of stuff. A lot of them do a great job in the field within their scope and their experience in such things as neonatology, pediatrics, and critical care has proven invaluable to me on a lot of occasions. Yes, like each and every medic out there I can speak volumes about the times I’ve seen and worked with nurses who seem to be lacking vital chromosomes, but I’ve seen members of every profession that seem to have written their final exams in crayon. It’s no different when I am staffed alongside an idiot partner of the EMT persuasion… give me a smart nurse in their place any day.

However, my beef is this: Why is it necessary that a nurse need ever step into the field? The times I’ve had to carry one in the back of my rig have been mainly because of protocol deficiencies, where the EMS system I was working in at the time didn’t allow me to transport a specialized piece of equipment that was attached to a patient or to administer medications that were beyond the normal scope of the field. Now days, my EMS system allows me to transport pretty much anything and I’ve personally taken the steps to educate myself on the less-common things that I see. However, I’ve grabbed a nurse on occasion when called to transport multiple uncommon medications along with unfamiliar equipment. I’ve never been too proud to ask for help when I wasn’t fully confident in my abilities to fully handle possible eventualities with the patient. It’s not about my ego, it’s about patient care. I live by that motto. However there is no reason, in my opinion, that a paramedic cannot take the education necessary to become experts in any and every aspect of out-of-hospital care. It’s our bread and butter and the thought that our skills are lacking causes me concern. Whatever you call it: inter-hospital, pre-hospital, field, or other care… Paramedics are supposed to be the experts at that in my opinion and I want us to take the steps to ensure that we are so.

If you were angered by the actions of this ambulance service plastering their truck with the phrase “Staffed by Nurses”, that’s good. You should have been. Be angry at the management of that service for existing in a system that they haven’t changed for the better so that they don’t have to use nurses for things that paramedics should be doing. Be angry at their EMS system and their state for limiting their paramedics’ scope of practice and education so that they cannot be used to adequately staff the truck. Then, be angry at each and every one of us for not taking the ownership of our profession so that we can step up and dictate what is best for the patient’s we serve.

Is that petty “turf preservation”? Maybe. However we need some of that. For us to have pride in our profession we need to take the steps necessary to own what we are supposed to own. If we can see our profession lacking the necessary educational background, skills, or just plain old gumption to fix a problem, then we have to band together to do the work needed to fix it. The fact that this service and this system are thinking that having and advertising a “special” truck, “Staffed by Nurses” is a good idea is representative of a bigger problem, and that bigger problem must be handled by our people stepping up and handling our deficiencies so that we can solve the problem. We must improve the education, improve our skills, and improve our public perception so that people trust us beyond just the feel-good perception we have as “life saving” “ambulance drivers”.

You’ve heard me, Justin “the Happy Medic” Schorr, Mark “Medic999” Glencorse, and many, many others talking about EMS 2.0 over the last year. Well, this is part of it. My version of EMS 2.0 involves us paramedics taking ownership of problems like these and taking the necessary collaborative steps to fix them. We have to do just that if we want to advance. Now is the time for us to analyze the problems, dissolve the political boundaries, do the necessary work, and collectively grow up as a profession.

And fixing management philosophies that view us as contemptible morons is first.

One last comment, I got a link in a fascinating article by the Nursing Show ran by my buddy Jamie Davis. You should read it, it’s a good way to see how the nurses take this.

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Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”

Posted by on April 26, 2010 • Filed under: Administration & Leadership, ckemtp, ckemtp rants, Command & Leadership, Emergency Medical Services, Emergency Nurse, EMS, ems 2.0, ems education, EMS Management, EMS pep talk, EMS rant, EMS system, EMS Topics, Paramedic, paramedic education, politics, potential, pride, profession, professionalism, Training & Development

A Slap in the Face to Paramedics Everywhere?

90 comments

As some of you probably know, last weekend I went to the Fire Department Instructors’ Conference (FDIC) in Indianapolis, IN and I spent a great deal of time wandering the convention floor, looking at cool things and talking to cool people. There were plenty of great things to see and great new things to learn about and I immersed myself in doing just that. One of the things I’m always interested in is looking at the new trends in ambulance design and the manufacturers always have their coolest new vehicles on display to feed my interest. However, while walking the conference floor, I came across an ambulance that did more to tick me off than it did to promote their new vehicle design. Seriously, it was like someone slapped me in the face. Here’s the picture I took from my phone:

 Ambulance Staffed by RNs

Does anybody see anything wrong with that picture? I was immediately ticked off…  I’m talking a level 7 hissy fit. I was livid for quite a while and if you follow my twitter feed, you probably saw the three or four times I TwitPic’d it.

I mean really? They had to put “Staffed By Nurses” in six inch high script on three sides of this thing?

I blocked out the name of the service that runs the ambulance and in all fairness to the manufacturer, this truck is awesome. I would be quite happy to work in this truck although being that it has no bench seat, its usefulness as a 911 truck is hampered by its inability to carry more than one patient at a time. However, I would flatly refuse to work in this truck or for the ambulance service that puts it on the street. I happen to know the service that bought it and I’m trying to avoid naming them directly, but they serve a midsize city in Illinois.

Before you go all West Side Story, whip out your switch blade and zip gun, and prepare to have a dance fight with the nurses out there, realize that I’m not mad at them. Sure, mostly they’re well-paid and have climate controlled jobs inside of well-lit buildings, but they didn’t do this to us. My beef is with the management of this particular ambulance service.

So, let’s say that you’re the manager of this particular ambulance service. Obviously, sitting there in your office you must think that your paramedics and EMTs are contemptible morons who live simply to cause you problems. Furthering your view of the world, you probably think that the rest of the medical profession and the members of the general public in your area view them the same way and simply don’t trust them to provide medical care when it’s like *really* complicated and stuff. You probably feel that everyone would feel safer knowing that their patient or loved one is traveling via the companionship of “nurses” whom you must view as actually being like actually *Competent* and stuff.  

And that’s what this rolling billboard to your contempt of your employees and their profession says about you. It’s a slap in the face to the good men and women you have working for you and there is flatly no excuse for it.

Here’s a tip, anonymous ambulance manager person (AAMP). There isn’t a need to have your precious ambulance be “staffed by nurses” when you have sufficiently equipped and prepared paramedics working in it. Paramedics are acute care specialists. We’re also experts in mobile medicine. Our education, training, and experience prepare us for the unique environment that we create when we move patients from one place to another. Critical Care Paramedics have the intensive Care experience, training, and background needed to operate in a critical care ambulance environment, nurses do not. Sure, ICU and ER nurses are great at Critical Care. However you shouldn’t regularly staff a critical care nurse in the transport environment for the same reasons that you wouldn’t put a critical care paramedic inside of the ICU. The professions are like in a lot of ways, but they’re separate for a good reason.

And you, AAMP, don’t respect that. Perhaps it’s because you’re burnt out. Perhaps it’s because you’ve beaten the system you’ve created into such a pulp that nobody wanted to staff your new Critical Care Truck. Perhaps it’s because of a lot of reasons, but it’s certainly not because you wanted the best in patient care or to show that your employees are capable of operating your shiny new “special” ambulance. No, you wanted “nurses” to “staff” that truck… and not only did you want the medical people you’re contracting with to know this, you wanted everyone who saw the truck to know it as the 6 inch high letters stating that fact clearly show. Do you think that the public views your crews as incompetent? If so, do you think that furthering the notion by advertising that your “special” truck is “staffed by nurses” will help that situation?

If your protocols are so draconian that even critical care certified paramedics cannot be allowed to staff that truck, then your protocol system is in the Stone Age. If your educational system isn’t up to the challenge of preparing your most experienced medics to staff it, then fix that problem. I know that there are great medic/nurse combos out there and I know that flight nurses have garnered quite a bit of respect out there in the world… and heck, I’m not knocking them for doing it. However, this is the time for Paramedics to step up and claim our turf. This ambulance clinched it for me. AAMP, your shortsightedness has caused me to lead a revolution of sorts here. You’re contempt for your staff has indicated to me that now is the time for paramedics and EMTs, such as the ones that work for you, to stand up and start claiming what is rightfully ours. Frankly, AAMP, your ambulance and your attitude is ridiculous and thinking like that must be stamped out right now by the good medics among us.

And I should also say this to the nurses in the audience before you start skewering me for knocking you: Have you looked at the debates in your circles concerning the use of paramedics in the ER and in other hospital units? Have you ever seen the term “Unlicensed Assistive Personnel”? Well I have, and it’s what the upper nursing echelon calls me and my professional colleagues.  It’s offensive, but hey… our jobs are different. You have the hospitals and the fixed facilities. That’s what you do. We have the field. It’s what we do. There’s a line, respect it. If you want to do EMS, go through a real paramedic program. If we want to do nursing, we should go to nursing school. Really, it’s that simple. The transport environment is difficult and requires the use of specialized personnel… which we have, they’re called paramedics. The medical care we provide is close to the care that you provide, except we have autonomy that you do not and we are use to working independently in the environment in which we operate. Your focus is different than mine.  You may be the best transport nurse out there, but even though you personally may be awesome, my profession needs to have people as awesome as you working on our side. That’s what this is about, not to knock your transport nursing skills, but to kick us paramedics in the shorts and get us to step up and maintain ownership of what we should own.

The responses I got back on Twitter show me that there are a lot of like minded individuals out there. Perhaps some of them might work for you, AAMP. You better take that into consideration because if I have my way the paramedics are going to get the notion that we’re not just a bunch of contemptible morons and we’re soon going to take control of our own profession. On that day, managers like you will be obsolete. Perhaps you can get a job managing nurses.

Here is my personal ‘thumbs down’ for the graffiti against my profession that you had someone slather on your shiny new truck, AAMP. My advice? Take it off and reconsider your staffing patterns. What you’re doing is bad for my profession. It affects me negatively, it affects my profession negatively, and it shall not go unanswered.

What do you think?

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Be sure to check out the follow-up to this post “A Slap in the Face? How about a Wake-Up Call?”

Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”

Posted by on April 26, 2010 • Filed under: 911 fail, Administration & Leadership, Ambulance, Ambulance Driver, ckemtp rants, Command & Leadership, Emergency Medical Services, Emergency Nurse, EMS, ems 2.0, EMS Management, EMS Motivation, EMS rant, EMS Topics, EMS training, Paramedic, paramedic education, politics, potential, pride, profession, professionalism, Scope of Practice, Vehicle Operation & Ambulances

Red Lights to the Left of them, Blue to the right! – Coloring Emergency Lighting

52 comments

So you’re driving down the road in an unfamiliar state, let’s say that it’s Iowa or Wisconsin, when in your rear-view mirror you see flashing red lights on a big utility truck coming your way. You can’t really make out what kind of truck it is, but you see red lights flashing so you pull over to let it go by. When it does, you realize that you’ve just pulled over for a tow-truck.

Or how’s this? The same thing happens, but it’s a flashing blue light in Colorado. When you pull over, you realize that you just got pulled over by a snow-plow.

I live in Illinois and work between IL and Wisconsin and there’s quite a bit of a difference between the different lighting colors and upon who can use what color light for what purpose. As a volunteer paramedic/Firefighter in Illinois I run a blue light with no siren in my personal vehicle. Even though I rarely turn it on, I have it in case I get stuck behind a 20mph Grandma on my way to the Big One. Interestingly, the blue light gives me no legal authority or any legal leeway on traffic laws and I must obey all traffic laws even while running the light. I Wisconsin, however, volunteer firefighters and EMS people may use red lights and sirens in their personal vehicles. They have the same legal status as governmental emergency vehicles when they’re driving with their lights activated.

In Iowa, volunteer firefighters may run blue lights in their personal vehicles with no legal authority granted them, and EMS volunteers may run clear (white) lights in their personal vehicles. Volunteers for fire and EMS combination agencies may run a mixture of both, however if a person volunteers for both a separate Fire department and a separate EMS agency, they must be careful to run the clear light for EMS responses and the Blue light for fire responses.

Of course, that’s just for personal vehicles right? Allowing emergency lights in the personal vehicles of emergency volunteers is a debatable issue in some circles. I argue for responsible control of their use and think that they are needed in some communities and not needed in others. Out of the 400-500 volunteer runs I respond to annually, I probably turn on my blue light for less than ten percent of the runs. I use it judiciously, but I know others that I can say did not.

However, this isn’t a post about volunteer emergency lighting and the pros and cons of it. It’s about the messed up spectrum of colors that we use on emergency vehicles in this country. Sure, we have the same stock colors pretty much everywhere. Red, blue, amber (yellow), green, clear (white), and in some states purple (Yes! Purple!). In the southern states, blue lights are for law-enforcement only and red is for fire only. In Wisconsin, law enforcement runs red and blue lights and fire and EMS is red only. In Iowa, up until a few years ago everyone ran red lights except for volunteer firefighters. They changed the law and now allow blue on the Passenger side only. In the City of Chicago, the Chicago Police Department runs blue only and the Fire department runs Red and Green. Downstate Illinois (Read: Outside of the City of Chicago City Limts) runs red and blue for all “Authorized Emergency Vehicles” and blue lights for the volunteers. Green lights are only permitted on stationary vehicles for command lights but can also be used for private security officers. As I mentioned before, in Iowa and Wisconsin, tow trucks run red lights. In Colorado, snow plows run blue. In some states, funeral processions run purple.

Confused?  I sure as heck am.

Consider this: Different lighting colors exist because different members of the driving public see different wavelengths of light in the spectrum (i.e. “Colors”) better or worse in differing ambient light conditions. Also, different colors penetrate different atmospheric and/or ambient light conditions better than others. You can see blue forever at night or in the fog, but not so much in the bright light. Red washes out to amber in the day light but is still fairly visible. Clear lights penetrate for a very long way but can be confused with light reflecting off of a surface almost the same as amber lights. We need a diverse spectrum of colors emanating from our response vehicles in order to ensure that the highest amount of drivers out there are able to see the lights. If someone’s color blind to the particular light color that we choose, they’re not going to see us all that well, are they?

The arguments that I hear for the use of lighting colors don’t hold much weight with me. Who cares if the public is able to see that an approaching emergency vehicle is Fire, EMS, Law Enforcement, ASPCA, Haz-Mat, Tech-Rescue, Volunteer, or miscellaneous. They just need to pull over and get out of the way. One color lighting schemes may give the agency a sense of personality or whatnot, but they’re certainly not the safest way to be seen. An emergency vehicle needs to throw out a lot of light across the spectrum of visible colors in order to help ensure the safest response possible.

So why are we having this hodgepodge of warning light colors? Why do people think they’re a good idea? I can think of a few advantages of having “law enforcement only” colors, as in reducing false traffic stops from people impersonating police officers, but having one color and one color only simply makes it easier for a criminal to get a hold of that one color of light. Why fire would only need red lights is a question that I can’t come up with a good reason for.

So good luck driving out there! If you see me, I’ll be on the side of the road letting a tow-truck go by. Then I’ll run my blue light in Wisconsin because we got a house fire in my district that touches the WI state line and I’ll get arrested for impersonating a police officer. Then I’ll be at work getting into a crash because someone driving out there was color blind to the color red.

Anyone want to add to the confusion? What colors do your state or country use? Is anybody else in favor of a national standard?

Posted by on April 7, 2010 • Filed under: 911 fail, accident, Administration & Leadership, Ambulance, Ambulance Driver, Ambulance maintenance, ckemtp rants, code-3, Command & Leadership, drive fast, Emergency Medical Services, EMS, EMS Health & Safety, EMS Management, EMS rant, EMS safety, EMS Topics, Fire Rescue Topics, In the Line of Duty, Iowa, Iowa EMS, lights and sirens, Line of Duty, Management, politics, Technology & Communications, technology-communications-ems-topics, Vehicle Operation & Ambulances, Vehicle Operations & Apparatus, volunteer fire department, volunteer firefighter

Saved by the Bell? High School Student EMS

61 comments

Ahhh, High School. The classes, the lockers, the bells, the peer pressure, the parties, the immaturity, the congestive heart failure, the overdoses, the emergent response, the…

Wait, what?

I’ve been hearing a lot recently about Emergency Medical Technician training being held in High Schools (9th – 12th grades) with teenage high school students being trained to be EMTs. At first blush, it actually seems like an innovative way for communities to meet the EMS staffing shortage problem head-on. In addition, it would seem to be a great way to get young people interested in EMS. In fact, THIS ARTICLE posted recently by Zoll EMS&Fire on their Facebook page seemed like a good idea to me at first. A county partnered with a technical high school in order to train new EMTs to swell the rosters of their county’s services. It’s gotta be a good idea? Right?

Then how about this service in Darien, CT. that is ENTIRELY STAFFED BY TEENAGERS AND HIGH SCHOOL STUDENTS? (Dept. Web Site)

Or this service, in Hoboken, NJ that has a student emergency response team that “respond(s) with the school nurse to non-emergency calls”? (additional article)

I have been hearing about such things for a while now and even spoke about it with Tiger Schmittendorf on the March edition of the Firefighter Netcast, however I didn’t give it very much thought until I read the “Last Word” section of JEMS Magazine in what I believe was the March 2010 issue (although I can’t find it anywhere on their web site www.jems.com). It talked about our friends in Darien Connecticut that run Post 53 EMS, a service that is staffed and ran almost entirely by high school students. I was a bit peeved after I read that. Then yesterday when I read the article about the service in Sussex County, I got just plain mad. I don’t agree with this at all. In fact, even though I might have been for it without thinking it through, now I am coming out completely against it.

There, I’ve said it. I am against beginning Emergency Medical Technician training in high school and I am most certainly against persons under the age of 18 staffing ambulances. I also must strongly condemn persons under the age of eighteen responding to emergencies, operating emergency vehicles, or taking responsibility for professional level patient care.

Look at the words there and understand just how much I condemn the actions of the politicians and officials that permit this. You are endangering the public, harming the profession of EMS, and creating a systemic negative impact on patient care throughout the system. You run the chance of increasing patient morbidity and mortality, run the risk of getting teenagers injured and/or killed on an emergency scene, and are exposing youth to situations that they cannot possibly be experienced enough to understand.

I am fully aware that the above paragraph is inflammatory and I am aware that the proponents of these situations are not going to like what I have said, but that doesn’t make it less true. Look for a minute beyond the arguments that you are going to make about the kids themselves, who I am sure are all upstanding young citizens who are surely beyond reproach. Look for a minute even beyond the fact that evaluation of the kids themselves must be taken on “a case by case basis” as I’ve heard before when this issue is argued. T o be certain, there are kids that are capable of functioning to the EMT-Basic level with proper, adult, professional supervision… However, I want to know why there is a perceived need?

The communities that support and offer these plans where students are trained to the EMT level and especially those communities where persons under the age of 18 are active emergency responders generally purport to be offering these plans in order to combat a “shortage” of trained emergency responders. This is where my biggest grievance lies. This “shortage” of which they speak is manufactured. It’s false, and it’s created by the very attitude that causes the local political powers to think that a program that provides a consistent stream of young, inexperienced, naive EMTs who are willing to work just for the “excitement”, “honor”, and “cool factor” that these programs seem to offer is a good idea. Here’s the thing, these communities don’t have a shortage of adult, professional EMTs who are willing to do the job. They have a shortage of adult, professional EMTs who are willing to work for peanuts in a system that has no respect for what they do.

Get it? If you have such little respect for EMS and the EMTs that provide it that you are comfortable letting teenage kids work your trucks, you obviously have such little respect for EMS that you provide horrible pay and working conditions to the point where no self-respecting adult can make a living on the wages and conditions you offer them. There’s no shortage of EMTs willing to provide excellent EMS. There’s a shortage of pay and professional respect that causes them not to be able to survive working the available jobs. Trust me, if these communities paid better and provided better jobs there would be no shortage of EMTs. It’s manufactured by their willingness to just have someone with a pulse and an EMT card on their trucks. It’s manufactured by their thought process that EMS is simply childs’ play and that since “any idiot can do it” they might as well put kids on the trucks. The EMT shortage has always been created by lack of pay, poor working conditions, and an unwillingness of local politicians to provide adequate amounts of these things. Creating high-school EMT programs reinforce this by always providing a stream of fresh meat willing to work for nothing. Young people don’t worry about such things as pay high enough to support a family, nor do they care so much about things like insurance, benefits, or retirement plans. They just want to get out there and go to work. 

I make the argument that putting inexperienced high-schoolers on ambulances increases morbidity and mortality using my experience as an experienced long time paramedic. I offer the full body of research that proves that experienced healthcare providers provide better healthcare than do inexperienced ones. The fact that there’s such little research out there does not diminish the fact that you have no such research that shows safety in what you do. I say that your communities would be better served by adult, professional, well compensated providers. I say that they would save more lives and reduce more suffering than do your high-school kids. It is well known that patients have better outcomes when they trust their healthcare provider and you ask your patients to put their trust in high school students. There are many possible scenarios out there where the patient’s very life and/or death rest upon the skilled interventions provided by an EMT. In these situations, even experienced providers make mistakes. You’re telling me that the incidence of these mistakes will not be unacceptably higher using teenagers?

When your Wife, Son, Husband, Daughter, or friend is lying there, dying on the floor, the roadway, or on the cot, will you feel comfortable with your decision to put a high school student at their side to be in charge of their continued comfortable survival? I make the charge that you will not. Your community members do not need a child coming to them in their hour of highest need. They need a professional, adult provider and your system denies them this.

I support EMS education in high schools. I support explorer programs that give firsthand experience and education to teenagers and younger students. I support CPR and First Aid Training at any age. I will support students coming to the EMS station, cleaning the trucks, taking classes with the crews, learning about EMS, and even staffing first-aid stations and special events under the watchful eye of an experienced adult provider. I do not support students responding in ambulances for the reasons I’ve stated above… but in closing I also offer this:

In one of the articles above, someone stated that these programs prepare students for a career in the emergency medical services. They might. However, by their very existence they prepare students for a career in a low-wage, low respect industry that might as well be provided by teenagers. These programs are a slap in the face to our profession. We will never advance when mindsets like these are allowed to propagate and flourish

Your thoughts?

Posted by on March 29, 2010 • Filed under: 911 fail, Administration & Leadership, ckemtp, ckemtp rants, Command & Leadership, edemse, Emergency Medical Services, EMS, ems education, EMS ethics, EMS Health & Safety, EMS Management, EMS rant, EMS Topics, EMS training, EMT, Ethics, everyday ems ethics, Fire Rescue Topics, Firefighter Safety & Health, medical ethics, politics, rant, Training & Development, volunteer fire department, volunteer firefighter

Huddled Masses. Healthcare. Honor. EMS.

19 comments

A conversation that I had with another healthcare provider has me pondering a lot of things. Until now, I’d been pondering these things in a solitary way but I think that I’m going to put these ponderable thoughts up on the blog.

This post gets a little more political than my usual stuff. I don’t post politics up here unless the politics specifically relate to EMS (unless they’d get me in a lot of trouble, for example the best EMS delivery model).

But today, I’m making an exception. I think that some of the things that I’m pondering have to be put out there and I think that if I don’t throw this out to the blogosphere I’m gonna go nuts.

I work in a community that has a large Hispanic population. A good portion of them are probably undocumented immigrants from Mexico. Yes, I said “undocumented” and that can mean Illegal immigrants if you so choose to say that. It’s a fact that small towns in the Midwest have been growing by leaps and bounds with undocumented immigrants looking to find work wherever they can. Some of them have legal members of their family that they live with, some don’t.

There’s a huge debate going on in this country over illegal immigration. It’s bigger than me, it’s bigger than this blog, and it’s bigger than EMS. I’m not going to get into my personal opinion on the topic as much as I would if we were discussing this in a bar over a couple of beers, or a country cafe over coffee if you’re a morning person. I can say this: I’m all for border security. I’m all for people following the law and I believe that illegal immigration is a drain on our resources. Those points are barely arguable. Another thing I believe in are the words to a song that I used to sing when I was with a rather patriotic small-town childrens’ choir. The song went something like this: “Give me your tired, your poor, your huddled masses yearning to breathe fee. The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me. I lift my lamp beside the golden door!” There’s a lady that stands in the harbor that has these words inscribed upon her, and they mean something.

I look upon this debate and I see both sides fervently trying to destroy any point-of-view other than their own. The lefties want them here because their hearts bleed for them. The righties think that the lefties want them because they can mold them into a new communist workers’ party. Both of them may be right. I am more of the opinion that America is an experiment. We’re a melting pot of people that have come together over the last two-hundred and some odd years to be stronger in our diversity. I believe that any cultural group entering our melting pot should come here and embrace the American ideals. “Melt” into the pot if you will. This has made us strong over the centuries and has built the country that I love, the one I will stand up for. Europe didn’t do that, they isolated their ethnicities into countries and fought amonst each other for a thousand years. We melted and homogenized into a strong nation full of rugged individuals championing their best ideals. I say that the most successful immigrant groups in the storied history of this nation celebrated their old cultures while melting in to our diverse one.

As far as today’s debate goes, I wonder if that would be the whole rub. Are the new illegal immigrants celebrating their own culture while melting into ours? Or our they placing their old culture on top of the American culture and creating discord within a proud nation? I think that we have always accepted the “Tired and poor huddled massess yearning to breathe free” because of our American Dream. People here have equal opportunity, a guarantee of the equal chance for humans to strive to reach their potential. Everyone has the chance to try and succeed to their own definition of success. “Life, Liberty, and the Pursuit of Happiness” is a guarantee of the chance to pursue. It is not, however, a guarantee of results. Our experiment is that everyone who has the chance will strive to give it their best shot, and that the people who succeed will pull others up alongside them.

I can’t say what’s right here. I don’t know. I don’t want to offend, but here I am, a paramedic. My job is to help everyone and anyone who needs me. I will do so. I have always done so. I took an oath and I honor my convictions. The hypocratic oath means something to me. Healthcare providers are honor-bound to help everyone as much as they can. I always will.

The conversation that we had was short, but he got his point across. I had brought up that while we have a large hispanic population in our coverage area, we rarely have calls involving those hispanic members of our population. I think that this is a bad thing because obviously these people fall ill and get injured at a rate comparable or even moreso than the other demographic groups in our area. I don’t know why they’re not calling but I can figure that it might be alleviated for the good of our community as a whole if we reach out to this population and let them know how, and when, to access the emergency healthcare system. I don’t believe in race and to me “hispanic” is a cultural label and is not even close to whatever “racial” means, but this is a cultural group that should be calling us and doesn’t. It’s deliniated over cultural lines and therefore is handy to address that way.

The other guy thought that it was stupid, pointless, and maybe even wrong to do this. It was because of the “illegal” thing. As strongly as I feel on that issue, and I do have strong feelings, as a healthcare provider my job is to help everyone. Every human deserves the best care that we can give them, every time. I don’t judge people. He shouldn’t either.

Neither should you.

Thoughts?

Posted by on March 25, 2010 • Filed under: Administration & Leadership, Command & Leadership, Economics, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS Topics, Ethics, everyday ems ethics, Fire Rescue Topics, In the Line of Duty, inside the mind of a paramedic, medical ethics, politics, professionalism, socialized medicine, Uncategorized

The Shine Factor

4 comments

 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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You know what I’m talking about here. The distinctly subtle, but powerful mix of sights, smells, and sensory input you find when walking into the apparatus bay of your station. The faint smell of diesel exhaust mixing with rubber tires, the musty smell of damp hose drying on the rack, the smells of not-so-clean turnout gear (best right after a good fire), and all of the various cleaning products used to keep the trucks looking their best. My favorite is when I’m just walking in the station for start-of-shift. It’s about 6am and the guys before haven’t gotten up yet to turn on the lights in the bay or make noise. One of my favorite things to do is to walk around the bay with the lights off, with the sun just starting to glint in from the windows onto the dark floors. It’s quiet. I love the first sunlight making deep reflections off of the shiny paint and gleaming chrome. The trucks just seem to be anticipating the day, yearning for the next call to come in. The atmosphere is electric, and quite palpable. You could blindfold me and take me into any fire station in the country and I could identify it just by smell alone. It’s intoxicating. I think that I like it more than my fiance’s perfume. It’s ok, she’s a firefighter too. She gets it.

So, what I’m about to suggest here plays off of that knowledge that we’ve all got… It’s basically an EKG hooked right up to the morale of your organization. I call it the “Shine Factor”.

Fancy name, huh? Yea, I liked it too. I’d recommend that every person who works in any fire station or ambulance base walks into the apparatus bay every time they start their shift. Don’t go in through any other door. Walk right into the apparatus bay with the memory of the favorite time you’ve ever been there. Take a big whiff of the natural aroma and look to see how much your trucks shine. Check the corners for cobwebs too. Then, simply file the information away in your brain and know exactly how the morale of the troops is doing.

Why is this so simple, yet so powerful, and a lot of the time, so unnoticeable? It’s because every organization has grunts, and the grunts carry out the day-to-day operations of your organization. No matter how many policies are written, budgets are adhered to, or strategic plans are championed by administration, the grunts are out there actually performing the duties that make your organization do what it does. If your department is like every department in the country, the grunts have more tasks than just providing service to the public; they’re responsible for cleaning, maintenance, and upkeep of your equipment. The lower and more “gruntish” they are within the organization, the more responsible for the upkeep they are. This is where the Shine Factor comes into play. Every group has assigned or assumed maintenance and cleaning tasks. Administration can formalize it with all of the written plans, paperwork, and task sheets that they want to, but all those pieces of paper ever do is ensure that the tasks are done to the minimally acceptable level. They cannot and will not make the grunts put in the elbow grease required to get that extra shine out of the equipment. My theory is that only happiness and pride in the organization entice the grunts to go above and beyond, to put the extra few swipes with the rag onto the chrome to really bring the shine out. Think about it, when you complete a task and get it looking good enough to pass muster, you could stop… but if you really have the pride and desire to make the equipment look it’s best, you’re going to go get the magic cleaner in the storeroom and clean out the crust around the lug nuts to make it look perfect, to reflect the personal pride you have in the organization and your fellow grunts.

Do you think that the grunts will spend those extra few seconds, minutes (or in my case, hours.. but I’m obsessive) to make that floor it’s cleanest, or that chrome it’s shiniest if they’re ticked off about management’s latest asinine policy or off the cuff directive? I don’t. It’s human nature. It works on a subconscious level across all of the grunts you have who polish your stuff. If the morale of your department is in the tank, your stuff may be cleaned regularly because the grunts will be sanctioned if they don’t clean off the first layer of crud… but that’s usually where it stops. When morale goes down, the shine factor goes down. When morale goes up and people are uplifted, pride goes up and the grunts put forth the extra effort. It affects more than their performance at the station too, it affects how polite they are to the public, how clean and pressed their uniforms and presentation are reflecting your public image, it affects how much personal effort they put into training, and it may very well affect patient and emergency scene outcomes too. You can regulate all that you want, but the beatings never improve morale. The only things that can do that is respecting your grunts and treating them like adults.

I haven’t formally named it, but I think that new officers and/or managers in the EMS and Fire industry who were promoted from the troops arrive to their new posts with a predetermined agenda. I don’t think that they can help it. Usually, it’s from the mistakes they’ve seen their coworkers make on the streets around them and builds especially upon their own pet peeves. They arrive to their managerial desk wanting to “fix” things and usually the result is a lot of new policy objectives and memos. They know who, at least subconsciously, they want to get back at for the aggravation that they’ve caused them over the years and think that the rest of the organization will share their personal pet peeve. Unfortunately, these attempts to “fix” things usually do just the opposite. The new managers with their personal objectives take things to the extreme. They fail to respect that the people who committed the offenses against the manager’s pet peeves are concerned adults that may have very different pet peeves, and they fail to recognize that every single employee’s pet peeve is micromanagement.

To some managers, paper seems to solve everything. If your ambulance turn-around times are too long in your opinion, you create a paper system to fix it complete with a memo and/or a new policy. The crews fill it out, and it’s supposed to make the management and crews aware of the time it takes them and it’s supposed to fix the problem. Got dirty floors in the trucks? Make a “clean floor” policy with a tracking sheet. Got a crew who uses too much gauze? Make a “Gauze Utilization” flowchart with a tracking sheet. Does your station go through too much toilet paper? You see what I mean. While all management wants to create measurable objectives, all employees hate being micromanaged.

Shortly after I got my first management position my boss, the COO, related to me a story about what he did one day when he found a truck that had been left absolutely filthy by a crew after their shift. Apparently this crew hadn’t been running more than usual that day, and had just left the ambulance filthy. Now, what he could have done, being the COO and all, is write an edict to be handed down through the chain-of-command to have the crew reprimanded from on high about the clean truck policy and the proper utilization of cleaning materials. He could have written a memorandum, or even a shiny new “Clean Truck” policy to enforce the rules. There could have been reams of paper and managerial-type fire power brought down on these guys. But that’s not what he did.

When the crew who had left the truck that dirty came back in for their day shift the next morning the COO met them at the door and lead them to their ambulance. At their ambulance they found a whole host of cleaning supplies… and two chairs. The COO then proceeded to have the medics sit in the chairs while he cleaned their entire ambulance, inside and out, from top to bottom.

Unorthodox? Sure.. Effective? Yes. The problem had been attended to, the desire for a clean
truck was reinforced, and the crews saw just how badly the COO wanted the trucks to be cleaned. Now maybe that’s not something that would work at your department, but it sure seemed to at this ambulance service. Maybe your shine factor would be increased if the grunts got the chance to work with the brass on solving problems like this. Maybe myriad policies aren’t the answer, and teamwork and mutual respect are the answer. Maybe communication increases it. Maybe the full realization by everyone within the organization that everyone has their roles and everyone has to be given the tools to take responsibility for what they own increases it.

Until now, this piece has focused on management, but us grunts can benefit from increased shine factor as well. Right now, you need to decide that you’re going to put in the effort to increase the shine factor in your department. Remember, it’s a subconscious thing. Everyone just feels better when it looks like people are taking pride in the department. Everyone from your partner, the guys, the brass, the public… even you. If the grunts make the effort, it can benefit the shine factor too and maybe the other stuff will come along with it. Positive attitudes breed positive results. It sounds corny, but someone’s gotta make the decision to be the positive change in the organization. Even in a perfect situation, if there even is one, someone’s gotta keep making the decision to keep it that way. Let that be you and others will follow suit.

Now get out there and polish some chrome.

——————————————————————-

 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

Posted by on February 28, 2010 • Filed under: Administration & Leadership, Ambulance, Ambulance maintenance, Command & Leadership, Emergency Medical Services, EMS, ems 2.0, EMS Health & Safety, EMS Management, EMS Motivation, EMS pep talk, EMS Topics, EMT, Fire department, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, Management, Paramedic, PR, pride, profession, professionalism, Public relations

Why I am Passionate about the Chronicles of EMS

15 comments

If you’re an EMS professional, you should be paying attention to the Chronicles of EMS.

I think every person involved in EMS on any level needs to pay attention to the work of three of the profession’s upcoming giants, Mark Glencourse, Justin Schorr, and Thaddeus Setla. Their collective project is a warp-leap forward for how our profession is presented to, judged by, and thought about by our internal and external observers, customers, and colleagues. With their efforts come Hope… Hope that one day soon EMS will take its rightful place as a true profession; Hope that our profession will get the paid the attention that it deserves; Hope that our educational standards, resource needs, and compensation will finally be improved; and Hope that we will be able to improve our total service to our patients and our community through shedding a new light on our profession.

If this works… everything could change. Everything could change quickly, incredibly, and wonderfully. Imagine if EMS became “cool” and the public finally thought about who we are, what we are, and what it is that we do for them. Imagine if people demanded that their community leaders pay as much attention to EMS as we need them too… Just Imagine.

EMS needs a strong, unified message. The Chronicles of EMS can be that message. It is a professional, smart, and uber-cool message aimed straight at where we want to be going. It is not lip service, it is not Hollywood glamour, and it is certainly not dramatized for profit. It is being prepared by industry-experts who are still working the same streets that we are everyday. Everyone involved is one of us. Everyone involved is passionate. Everyone involved wants this, and they want it as bad as you do.

The reason I write about EMS is because I want to improve our profession and our service to others. I want to make this better so bad that I can taste it and I’m willing to work as hard as I have to. Our patients and our communities deserve the best we can give them and I believe that key to fixing EMS is communication and the spreading of our message. This blog exists for that reason and so do the other blogs in this genre. The other bloggers, authors, speakers, and writers I’ve met have all spoken to me of the same goals. Our profession exists to save lives and alleviate suffering and improving our profession help us save more lives and alleviate more suffering in our communities. EMS does indeed make a difference out there in the world and we’re the ones doing it. The Chronicles of EMS is a great beacon of hope in our collective quest.

EMS Deserves More. Our Patients deserve more; Our Families deserve more; and yes… We deserve more. Mark, Justin, Ted, and everyone involved in the Chronicles of EMS are working hard to give us just that. They deserve our support and our attention.

I’ll be in San Francisco on March 11th for the premier of their pilot episode. I wouldn’t miss it for anything. Look out world, EMS is moving forward.

Posted by on February 8, 2010 • Filed under: Administration & Leadership, change, Command & Leadership, Emergency Medical Services, EMS, ems 2.0, EMS Blog, EMS blogosphere, ems education, EMS Health & Safety, EMS Management, EMS Topics, EMS training, EMT, Fire Rescue Topics, Firefighter Safety & Health, Happy Medic, humor, Line of Duty, medicblog999, News, Paramedic, paramedic education, Patient Management, pride, profession, professionalism, Public relations

Questions About EMS on a sleepy morning – Care to answer?

9 comments

It is a very sleepy morning for me today. Yesterday was a hard-fought day on the ambulance by our standards. For the first part of the day I couldn’t run a call without somebody getting angry at me. It really didn’t bother me all that much, but you know how it goes. I actually got about 6 hours of sleep during the night though, so I got that going for me. Perhaps it’s the morning fog mixed with the lack of coffee available in the station this morning that’s causing my AM neural firings to generate random questions… perhaps I’m just nuts. However, if y’all would like to think about some things (and perhaps answer in the comments section, please) I invite you to join in on my personal morning groggies.

Here goes:

  • If Medicare would assign a payment that you could access for treating and releasing patients, thereby diverting them from the Emergent healthcare system and redirecting them to the more cost effective healthcare system, how would that change the industry?

 

  • If your service could choose to accept a lower payment from Medicare and Medicaid for every transport without regard to the nuances of medical necessity and never have to be denied reimbursement in exchange for a lower payment for every call, would your service take it? How would that change the industry?

 

  • How would you improve your service if all of a sudden a big, national competitor moved into your service area and started taking your share of the market… you’re losing calls to them and it’s affecting your bottom line… What do you do to improve your service to keep yourself in business?

 

  • How would you change your care if your medical director was watching over your shoulder on every call? What would change if it were your mother watching you?

I think that these questions aren’t the biggest questions facing the industry today, but I’ll bet ya’ that if they were considered by peons like us and also by the powers that our landscape would change quite a bit, wouldn’t it?

See you in the comment’s section.

Posted by on January 26, 2010 • Filed under: Administration & Leadership, change, Command & Leadership, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS Topics, Funding & Staffing, Patient Management

Cat Puke Chicken

9 comments

Note: This is a repost. I’ve been a busy blogger and this post deserved a bump-up. Also, the “Fiance” in this post is now my lovely wife. Enjoy.

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The other day I got off shift at 8am and had to be to work at my other full-time job at 10am. Since both of the jobs that I work at are about a half hour from my house in opposite directions it worked out that I had about a half hour to go home, perform the personal hygiene ritual, change uniforms, and get on my way to work again. So I did that, got home, fed the cat, and got all prettied up as quickly as I could. Then, without warning, on my way out of the house I noticed it: A pile of cat puke on my rug.

Yes, I like cats. I have one. She’s a keeper, regardless of her regurgitation issues. I think that I’m more of a man because I love my fluffy-wuffy lil’ Kitty-Witty. So cat puke on my rug isn’t the horror of horrors to me that it might be to some people. In EMS, we tend to get puked on by humans more often than does the regular population and that fact may have further desensitized me to the violent act of emesis perpetrated on my rug by my mostly cute little kitty. However, I do like a clean house and the cat puke on my rug is an issue that normally warrants immediate action.

But of course, that’s not what happened. And for those of you in a spousal relationship with another human being you know exactly what I did. You guessed it, I left the cat puke on my carpet and went to work. For those of you who are not in a spousal relationship with another human you may not understand the thought process here. Yes, as I looked down at the cat puke on my otherwise (mostly) spotless rug the thought that it must be immediately cleaned up did in fact occur to me; but the other thought that occurred to me was: “I can leave and go to work and when I get home, my lovely fiancé will have cleaned this up for me. She’ll think that the cat puked on the rug *after* I went to work and I’ll get off scot free!”

And so that’s what I did. Yes, I *could* have taken the five or so minutes it would have taken to clean up the cat puke… but in my defense I’m a model employee and I need those extra five minutes of early arrival time at work to drink coffee and to tell everyone what a model employee I am. So if I would have cleaned it up I would have taken the risk of not being such a model employee. So you see, leaving the cat puke for my lovely, beautiful, and remarkably intelligent fiancé (who will probably read this, btw) to clean up was not something that I did because I’m lazy. It was something I did so I could continue to bring home the bacon for my family in the most productive manor possible.

That’s what I thought anyway, until I came home late that night after a hard day’s 10 hour shift off of a hard fought 24 hour shift spent saving lives and alleviating the suffering of the sick and injured and stepped in the same pile of cat puke on my carpet that I had courageously not cleaned up the morning before. True, she had put in a paltry 12 hour shift at the fire department practicing for the recliner racing 500 and had fed, bathed, and put our son to bed; but that didn’t stop my obviously well-earned righteous indignation to the pile of cat puke permeating my pile covered floor. She had decided (although she swears that she did not in fact see the pile of puke) that I should be the one to clean up the cat puke using some amount of flimsy logic that I have yet to understand.

So, to tie the above 646 words back into the title of the piece, “Cat Puke Chicken” is not the new special at your local Chinese Restaurant. It is the battle of wills that solidified between my fiancé and I as soon as my sock made contact with partially digested Kitty Kibble. We both subconsciously agreed to ignore the cat puke for as long as we could stand it in order to have the other person clean it up first. (See also: “Laundry Chicken”, “Last Sip of Milk in the Carton Chicken”, and “Couples’ Counseling”). This occurs a lot, unfortunately, in most relationships between other perfectly rational human beings. We know that we don’t like having cat puke on our carpeting; we obviously know that the cat puke should be cleaned up at the first available opportunity; and we also have continued doing the other things that we normally do to keep our houses from turning into slovenly hovels. In fact, while this has been going on I have cleaned numerous dishes, laundered, dried, and folded at least four loads of laundry, and have started (but not finished) three household improvement projects. I’m at least as good as a housekeeper as the next guy (Read: Not a good housekeeper) and I do indeed do my best to keep my family and myself from living in squalor.

So why, as two perfectly rational adults who um, chose to work in EMS, are we locked into this powerful battle of powerful wills? In a word: “politics”. Not the kind of politics that provide the revenue stream for the myriad of cable news networks, but the politics of household supremacy that truly affect our day to day lives. This isn’t Senator So-and-So bloviating about the fact that pork in the stimulus bill is in fact, not pork… it’s me and the woman that I love and want to spend the rest of my life with deciding who shall be the designated Cat-Puke-Cleaner-Upper!! Pulse pounding stuff here.

And as with everything else, this got me thinking about politics in EMS.

Say you’re in a service way far away from anywhere where I work and you have a small volunteer squad that covers the areas that your service is not jurisdictionally bound to cover. Sure, your service would be glad to come if they called you, but somewhere back in history when the powers that be drew the political boundaries they decided that your service was not responsible to respond to the pleas for help that come from that particular geographic area. Suppose that your service just happens to be a small ALS service with two paramedic ambulances and a BLS ambulance on duty 24/7 and the other service was a BLS squad with volunteers coming from home and/or work. These volunteers are dedicated, caring individuals that want to do the best that they can for their friends and neighbors but work in a system where when a call for service comes out it takes about 20 to 25 minutes for the system to get an ambulance to the patient’s side. Say also that the service that you work for has your three ambulances and paramedics about 6 miles from their patients staffed and on duty but you can’t respond because the political system is such that you would be in trouble if you did so.

You may also relate to having that coworker in your EMS or Fire service that just isn’t up to par. They may be a basically qualified EMS provider through the state licensing body, but you still would cringe at the thought of that person responding to take care of anyone in your group of family or friends. They’re a provider that just doesn’t get it. Their care is substandard, their attitude is poor, and you can’t help but feel that the patients being “cared” for by this individual or crew aren’t getting the best medical care possible from your service. You’d want to say something, and normally would, but you’d become an outcast in your agency and would be looked down upon for blowing the whistle. Besides, even if you did the service is short handed and your management wouldn’t fix the problem anyhow because they need to staff the trucks.

Or maybe you can see that EMS in general is underfunded, underappreciated, and undereducated and you can’t shake the feeling that something has to be done to improve patient care industry-wide. You feel powerless to do so, but you’re angered every time you see a representation of bumbling ambulance drivers on TV, or see the local news completely mishandle a news story involving EMS, or especially when you look at your paltry pay check.

In all of the above cases, you’ve got cat puke on your rug and you’re hoping that somebody else is going to clean it up.

As EMS professionals, we know that there are myriad little political games that play out in each and every little jurisdiction a
cross the map. This service may not call this service for mutual aid because someone’s brother once stole a pumpkin from one of the other service member’s brother’s pumpkin patch. “Jim” may not provide good care, but you let it slide because he’s popular with the other crews. Sure, the local fire department gets a kajillion dollars more in funding than your EMS service does and runs like a tenth of the calls that you do, but that’s just the way it’s always been, right?

We need to step up as a profession and clean the cat puke from our carpet. Ignore the politics. Ignore the personal hurt feelings and the power plays. EMS is about the patient. It isn’t about you, or me, or that person down there. We exist solely to save lives and alleviate suffering in the people that we serve in the best possible way that we can. Nothing else matters more than that. So if you can see that cat puke on your rug, and I’m absolutely positive that you know exactly what I’m talking about no matter where you are, you probably have better things to do than be playing chicken. We all need to stand up and say that we are the Cat-Puke-Cleaner-Uppers and that quality EMS is our responsibility, no matter what little political games of chicken are going on. Our patients deserve nothing less.

(Fiance’s note: As of press time, the pile of cat puke on Chris’s floor is still intact solidifying into the fibers of the carpet)

 

Posted by on January 22, 2010 • Filed under: Administration & Leadership, Ambulance, ambulance humor, cat puke, Command & Leadership, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Humor, EMS Management, EMS Topics, EMT, Ethics, everyday ems ethics, Fire department, Fire Rescue Topics, Firefighter, Paramedic, politics, relationships

Fiddling While Rome Burns – The “Ambulance Industry”

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Allow me if you will to allude to some Roman history here. I know that it’s a little heavy for an EMS blog but if you would please search the dusty recesses of your memories to think of the Roman Emperor Nero, it would help this post. You know, the one who “fiddled while Rome burned”

I am way oversimplifying this, but the way that I remember the story was that Rome was being swept by the “Great Fire of Rome” that burned for days and decimated the city. Popular legend has it that Nero, unconcerned with the plight of his citizenry, played the fiddle while the city was burning.

 (Although, the MOST TRUSTWORTHY SITE ON THE INTERNET *Other than Mine* has this on the subject: http://en.wikipedia.org/wiki/Great_Fire_of_Rome)

Recent events and some things that I’ve been reading lately have brought some EMS issues to light in my mind, and thoughts about good ol’ Nero have popped into my head.

Are we Fiddling while Rome Burns?

There’s a few competing EMS system design models out there that have various people in their camps. Mention the virtues of one over another and you will get passionate and snarky responses from the various members of these camps. Trash Fire Based EMS and you’ll get a ton of people that will take a break from lifting weights and will bombard you with reasons while Fire Based EMS is awesome while wearing their T-Shirts emblazoned with “FIRE RULES!!”. Mention that 3rd service and not-for-profit EMS may have their downfalls and the EMS Chess Club will bring forth obscure research that shows how much better they are for the patients than everyone else is. Trash Private-for-profit EMS and um, the employees thereof will trash it right along with you and their management will be too busy putting out fires to care.

Try as you might to convince me that one is better than the other and I’ll agree with you on some points and disagree with you on others. I will only endorse what I call “EMS based EMS”, which is EMS provided by truly dedicated caregivers who base their decisions and actions simply upon what is best for their patients and their communities. I have my beef with fire based services that place protecting firefighter jobs and the “fun” stuff involving spraying water on things that happen to be on fire over solid patient care. I have my beef with private-for-profit services that always default to the bottom line, and admittedly, I have a bias towards third service and not-for-profit EMS agencies. However, no one system has ever proven to be a good fit for every community, none are inherently evil, and other professions find their fit within lots of configurations.

If the system design models out there are really locked into a competition for the soul of EMS then they’ve all got a lot of work to do. In this piece, I’m going to ignore patient outcomes, efficient use of tax money, and all of the stuff that I usually talk about… and focus on one thing and one thing only.

The way EMS people are treated by the competing systems will probably decide this debate we’ve got going on here. The model that treats the paramedics the best will win and will take over the industry. Why wouldn’t it? What paramedic with half of a brain would continue to work in a service model that didn’t pay and treat them the best?

Here in Northern Illinois, there are very few options for a paramedic that doesn’t want to do Fire Based EMS for one reason or another. The few options that there are don’t pay nearly as well as the fire-based groups and this creates an endless revolving door of young paramedics entering the system, working the “privates” for a while, while trying to get a “real job” with a fire department. The private services suffer for it, and the fire based services reap the benefits while fostering a system that (gulp, here it comes) focuses less on the healthcare and more on the fun stuff.

So I challenge the private, third-service, and not-for-profit services out there with my next statement.

You’re fiddling while Rome burns.

If you aren’t out there doing your absolute damndest to treat your employees well and pay them what they deserve, you’re failing. You push your employees away. You push the best and brightest into other professions and into fire-based EMS which hands down has the best pay and benefit structure. Your lack of interest in caring for your caregivers is killing our profession. You fiddle whilst complaining about decreased reimbursements and failing to do anything about it. You fiddle whilst focusing on minutia like stupid rules and regulations that degrade the dignity of the adults who work for you. You fiddle while worrying about protecting your jurisdictional boundaries and contracts while they’re eroded away by the constant stream of departing employees.

Nero could have been an ambulance manager in some of the services I’ve been to, worked for, and observed from the outside. Could he be you?

You have got to find a way to pay your people better. I don’t know exactly how it’s going to happen either, but it has to be priority #1 for every ambulance manager out there. Trust me, if you don’t do it you will find that your capital city has burned to the ground. You will lose your empire and it will not come back. If you aren’t out there doing every possible thing you can to keep your employees as happy as you can get them, you’re fiddling, and you’re failing our profession.

This blog has a lot of content on it that explores new revenue sources for ambulance organizations already. Coming soon: Ways for each individual EMS professional to take control of our own income potential, own our profession, and improve our care to our patients. I’ve said it before and I’ll say it again folks, hang on cuz it’s going to get fun.

Posted by on January 6, 2010 • Filed under: 911 fail, Administration & Leadership, change, ckemtp rants, Command & Leadership, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Health & Safety, EMS Management, EMS paramedics, EMS pay sucks, EMS rant, ems salary, EMS Topics, Funding & Staffing, Management, Paramedic, paramedic salary, politics, profession

Everyday EMS Ethics – Thoughts on Ethical Behavior in EMS

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Everyday EMS Ethics? Where do I get my authority to talk about anything ethical? I’m definitely not a perfect person. I’ve made some decisions that I’m not proud of in this life, I’m human, and I’m certainly not immune to the mud that life can sling on a person. How then can I talk about ethics with a straight face, knowing that I’ve made some of the very mistakes that I seem to be condemning?

It’s because that just like everyone else, I have the ability to feel good or bad about anything that happens to me and anyone else, I have the ability to introspect and wonder why my gut feels the way it does about something, I also have the ability to want to be a better, more ethical person. As silly as it seems in this world sometimes, striving to be a better person on this journey we call life is what we all must do as we edge closer to “Point B” in our path.

The omnipresent “they” have always told me that “Being a good person means doing the right thing even when nobody’s looking” and I like that phrase. If a lot more people took that view, I think that the world could improve overnight. Imagine if everyone did the “right” thing all the time? We’d have no crime, no “half-assed” jobs, and everyone would get along, right?

Well no, probably not. Of course things would improve and crime would cut down, but since two perfectly ethical people can have logical disagreements on the same issue, we’d still have discord and differences of opinion. We’re all still human and human beings have different thoughts, feelings, emotions, and standards of right and wrong. Therefore, when one throws out the term “Ethics” it seems to draw a lot of shrugs from people who aren’t looking for the conflict it can generate, or who simply aren’t looking to put forth the effort to debate their positions effectively.

Grey areas abound in any discussion involving ethics, but I think that it can be simplified. Even in an area where lives are literally on the line such as in EMS or other healthcare disciplines, the realm of ethics can be summed up in the above phrase about doing the right thing when nobody’s looking and with the application of the Golden Rule, the one about doing unto others as you would have others do unto you.

Of course, that’s not always easy as it sounds, is it? People are motivated by different things and behaving ethically in one situation may justify behavior that may be considered unethical in another. For example, take the case where a family’s breadwinner has to make more income to feed his/her family at home and that need justifies taking more overtime at work than would normally be considered his/her “share” of the OT and the extra income that it brings. The breadwinner’s coworkers may consider the person to be an “overtime hog” and may think that he/she is behaving unethically whereas the breadwinner may feel that the need to feed his family with the extra OT income justifies his taking more OT than is his/her share. Who would be “right” here? If everyone had a family at home that they were supporting with the extra income from the OT, it wouldn’t be ethical for that one person to take more than their proper percentage of the OT… but would it be right if everyone else was a single person with no families to support? Who would decide that?

We have to be unafraid to discuss the grey areas and tailor solutions to fit the unique situations we face. Discussion among rational adults can help guide the actions of the group towards a more ethical and equitable organization, which makes everyone happier in the end. Some organizations discourage this, and instead make overarching rules that discourage the rational adults within those organizations from free thought that would benefit the overall operations, and some are too lax and instead encourage unethical behavior by never sanctioning those who engage in it.

On political topics, I’ve always liked the words of a country song that state “You’ve got to stand for something or you’ll fall for anything” meaning that a person has got to have a set of values and beliefs based upon their own moral compass and introspection in order to guide their decision making when faced with an overwhelming amount of information.  And we’re all overwhelmed. I firmly believe that human beings can only process so much information and that there is no possible way for any human being to be well-enough informed on every issue to form a truly solid and rational opinion. Therefore, when we hear something, if we judge it based upon our foundation of core beliefs, we have a way to gauge how we feel about it. For example, I’ll bet that if any, only a small percentage of the people who read this post have ever studied the effects of globalization on the food supply in Micronesia. Sure, we could research the issue, but our core beliefs most probably would tell us that anything that decreases affordable food for the majority of the population is bad. My guess is that this opinion on the issue is perfectly fine and I don’t have the time to put in the requisite study to find out otherwise. This can be applied to EMS almost daily. I believe that a thorough assessment and judicious application of treatment modalities benefits the highest number of patients. I believe that any amount of study time that I put in learning about pathophysiology enables me to better assess my patients and judiciously apply treatment to them. Therefore, I can ethically and logically assume that putting in one hour of study time per day on pathophysiology is a good thing.

Of course, if there were to be a study that came out unequivocally showing that 45 minutes per day is the optimal number and that one hour actually causes degradation in knowledge through um, brain fatigue or something, then my opinion would be wrong… but nobody has studied this topic with enough depth to be sure of that.

Here’s what it comes down to for little ole imperfect me: “Shower Guilt”. I usually say that when I make decisions it’s because I have to look myself in the mirror and shave every morning but that’s honestly not where it gets me. My conscience rears its head during my morning shower. If I’ve done something that I don’t feel deep-down is ethical, my “Shower Guilt” kicks in and I beat myself up for it. I usually can tell how I’m doing by how rough my showers are. It’s been that way for years for me and I’m thankful for it. The introspective time has made me a better, more rounded person.

I guess what I’m saying with this post, and with my whole Everyday EMS Ethics series is that ethical issues must be discussed in a positive, adult manner for progress to be made. When people look at problems or violations in ethical standards in a rational and objective manner, solutions come out that go beyond heavy-handed rule spewing and approach the realm of positive resolution and healthy growth. By maintaining an open dialogue, others participating and observing the dialogue can glean lessons that will allow them to make more ethical decisions in their own lives and professional situations. Ethical behavior encourages others to behave ethically. Discussing the ethical standards of a group in a positive and uplifting manner makes people within the group feel good about doing the “right” thing.

Paramedics and EMTs face heavy ethical questions in our day to day work. It’s in our job description.

What does your organization do to encourage ethical behavior?

Posted by on December 2, 2009 • Filed under: Administration & Leadership, Command & Leadership, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Topics, Ethics, everyday ems ethics, Fire Rescue Topics, medical ethics, Paramedic, professionalism, Training & Development

Dear State of Illinois EMS…

16 comments

State of Illinois EMS… It’s time that you and I had a little talk. You see, I’m an EMT-Paramedic holding licensure in your fair state. I’m also a mostly life long resident except for a short, torrid affair with residency in the State of Iowa. I moved back, you welcomed me back with your open arms and I’ve been here ever since.

Except for now, State of Illinois EMS, while your EMT-Paramedic licensure will always be the first card I carry… I’ve been flirting with other states. Yes… it’s true. I have my licensure in Iowa as a Paramedic Specialist, and my Paramedic card from Wisconsin too. I don’t want to hurt your feelings, State of Illinois EMS but frankly their paramedicine is more exciting than yours is. Yes, State of Illinois EMS… the magic just seems to have gone out of our relationship. I can do so much more in the other states. They UNDERSTAND me and my need to take care of my patients to the best of my ability. They’ve given me exciting advanced techniques, medications, protocols, training and technology that enables me to breathe new life into my practice. They let me LIVE, State of Illinois EMS! They help my patients to live longer, fuller lives.

And now, State of Illinois EMS, this conversation comes on to the prospect of what we should do about our relationship.

Yes it’s been a torrid love affair, State of Illinois EMS. Really it has. Unfortunately, I’ve changed. It’s not you… it’s me.

Literally. It’s like you haven’t changed in ten years. What’s up with that? Medicine’s changed. Techniques and research have changed. Evidence based EMS practice has changed… but, State of Illinois EMS… you haven’t hardly changed a bit. You’re not a national state, your CE requirements are strange, your license hasn’t gotten easy reciprocity anywhere I’ve tried, and your policies are dictated by the ‘Little Kingdoms’ that you call EMS systems and EMS regions, and well… it’s just not working for me anymore.

I’m not leaving you, State of Illinois EMS. I wouldn’t, you mean too much to me and a good chunk of my income is dependent on that little green card I carry with your picture on it. Remember when you gave me that card, State of Illinois EMS? It seems like just yesterday… but it was a while ago I guess. We’ve been together a long time, haven’t we? I think that our relationship is worth salvaging, don’t you?

Here’s what I think we should do, State of Illinois EMS: Let’s work together on a plan that I’ve come up with. It’s a plan that I think will help fix everything that is wrong with our relationship. I think that the way you’re all set up, the way you’ve parceled yourself into EMS regions and the Little Kingdoms that you call “EMS Systems” has given too much control to local politics and individual egos without enough accountability. I think that the EMTs and Paramedics that work within these EMS systems, you know the ones working for actual EMS agencies, are actually “customers” of these EMS systems. Only these EMS systems seem to treat the EMTs and Paramedics like “Bothersome Bastard Stepchildren”  instead of the customers they are and don’t give them any support or service.

Yes, I know that not all of these Little Kingdoms that you call EMS systems function like this, State of Illinois EMS… some actually treat their EMTs and Paramedics like (gasp) People. However, in my decade or so of toiling in these Little Kingdoms, State of Illinois EMS, I’ve seen that to be the exception and not the rule.

So here’s what I propose to you, State of Illinois EMS. I propose that we inject these three things into the whole system: Information, Competition, and Accountability.

Yep, I think that we will both benefit by adding healthy dashes of those three items into our relationship. I’ll explain:

  • Information: I want to put every little policy, procedure, and standing medical order from every EMS system in Illinois on the interwebs. I want every form, personnel roster, and individual quirk of every Little Kingdom in the land to be posted up for scrutiny by every individual EMS provider and provider agency in the state and elsewhere. If they do something, I want everyone to know how and why they do it.
  • Competition: When EMS systems compete, we win. Really, if your hardware store sells your widgets for cheaper than the store across the street, you’ll get more business. If they lower their prices to match yours but your service is better, you still get the business. If their service is just as good but your widgets are of better quality, you still get the business. They have to improve their service, quality, and price just as consistently as you do. It’s called competition and it’s healthy in any food chain or market. Right now as things stand, there’s barely any competition in the EMS systems in the state. EMS provider agencies stay within their systems usually no matter what the conditions are and only rarely change. It’s difficult for new and better ideas to flourish in the current system. It’s also hard for the EMTs and paramedics working under the systems to get any kind of service. Remember, I think that the EMTs, paramedics, and EMS provider agencies are customers of the EMS systems. Now they kneel… with competition and information, they can vote with their feet. EMS systems will be forced to improve or wither and die. The cream will rise to the top, the others… well they may be floaters or sinkers if you know what I mean.
  • Accountability: Are EMS systems accountable to anyone? I mean, if there are complaints against them, to whom are the complaints addressed? If the paramedics and EMTs working under the system are treated like diseased cattle and they are unhappy mooing and coughing like that, whom do they complain to… their EMS provider agencies that don’t want to switch systems due to the immense amount of effort for no real perceived benefit? We need to make them accountable not only to competition, but accountable to a public airing of grievances and peer evaluation.

So there you have it, State of Illinois EMS. Three little words that I’ve come up with that I think will fix our long-term relationship. Sure, I’ll probably keep dabbling in the other states… but I feel entitled to because I know that I’m not your only one either. We can tell people that we have an “arrangement”.

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Look, Illinois EMS could use some repairs. Not every EMS system behaves badly or treats their members poorly, and that’s just it. Those systems should be encouraged to flourish and expand. I don’t think that one blog, one blogger, or one paramedic can disband the Illinois practice of creating EMS systems… but I do think that there should be competition and accountability injected into the system.

So, could we do that?

If there’s any fellow Illinois EMS people out there reading this, feel free to interject. I’d love to get a conversation going on this. Grassroots activism to change EMS from the professional level up? Wow, that’s way EMS 2.0

Posted by on October 28, 2009 • Filed under: 911 fail, Administration & Leadership, change, ckemtp rants, Command & Leadership, crisis, edemse, Emergency Medical Services, EMS, ems 2.0, EMS ethics, EMS Management, EMS protocols, EMS system, EMS Topics, idph, illinois, Iowa, Iowa EMS, new perspective, northern illinois, Protocol development, southern wisconsin, wisconsin

Something I found in the Iowa State EMS Protocols

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I hold licensure in three states as well as my NREMT-P certification. This is partially because I work in both Illinois and Wisconsin but also because I used to work in Iowa and maintain my license as an Iowa EMT-Paramedic Specialist. I keep that license too. Since Iowa’s a National Registry state, it’s a simple matter of forwarding them my National recert paperwork to keep it up. Also, because I’m um… “Rather Opinionated” and one never knows when I’ll get ran out of a state with pitchforks and torches from the townsfolk, I need a backup plan.

Oh, and I like being called a “Specialist” in something. Cool, huh? I’m Special, it says so right here on this card I carry. “EMT-PS”

Today, my friend Google landed me on the web link for the new revision of the Iowa State EMS protocols (Revision Aug 2009) and I had the chance to study up on them. There’s some interesting things in there. You can find the link below.

While they aren’t as advanced as the EMS protocols that I function within in Wisconsin, there is something I found in there that I really like and want to bring to the attention of the EMS 2.0 crowd.

- From the Iowa State EMS Protocols – August 2009 Revision

APPENDIX D GUIDELINES FOR NEW PROTOCOL DEVELOPMENT A RATIONAL DECISION MAKING PROCESS*

(Also can be used to evaluate existing protocols) Making a decision to develop a new protocol or evaluate an existing one should be based on a rational process. Questions that should be asked and answered when considering a new drug therapy or procedure are as follows:
Key Questions for any New Protocol
1) Is the drug therapy or procedure medically indicated and safe?
2) Is it within the scope of practice for the provider?
3) How specifically will this protocol benefit patient care?
4) What specifically is needed to implement this protocol (education/training, medical director protocol development/authorization, equipment needs, etc.)?
5) How will this protocol impact operations?
6) What is the opinion of providers concerning this protocol?
7) Does the medical community support this protocol change?
8) What are all the costs versus benefits associated with implementation and maintenance?
9) What are the medical-legal implications?
10) What ongoing provider involvement such as skills maintenance and continuous quality improvement is necessary?
11) How will success be measured?

Rational Protocol Development Process to Make the Right Protocol Decision
1) Study the issue thoroughly
2) Identify key questions
3) Compare with goals
4) Assess fit with system
5) Cost benefit analysis
6) Identify measuring tools

Stakeholders in this process are recognized to include, but not be limited to:
2) Medical direction (on-line and off-line)
3) Educators/training programs
4) Regulators of policy and rules
5) Service directors
6) Service providers
7) Consumers
8) Third party payers

*Developed based upon discussion at the October 1998 meeting of the Quality Assurance, Standards, and Protocols subcommittee of the Iowa EMS Advisory Council; and on concepts from the article „When to Implement Clinical Protocol Change?’ From EMS Best Practices September 1998.

My understanding of the Iowa State EMS system is that they have mandatory state EMS protocols that all providers must adhere to. Each service may have a medical director, who may choose to use the state protocols at their base level, or may choose to add additional protocols for more advanced treatment. 

Huh… A state that says “This is the minimum standard we’ll hold you to. Now go make them better and report back to us” Then actually gives each individual paramedic and EMT the logical framework to evaluate ideas and make revisions and improvement? 

Also, and this is just HUGE. A state that posts the name and phone number of the State Director of EMS on the protocols… Know what? He actually answers his phone. I know, I’ve called him.

Bravo State of Iowa EMS. Bravo a lot.

Posted by on October 26, 2009 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, Emergency Medical Services, EMS, ems 2.0, EMS protocols, EMS Topics, EMT-Paramedic Specialist, idph, Iowa, Iowa EMS, Paramedic, Protocol development, SMG, SMO

The Drunk Responder

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Greg Friese, over at Everday EMS Tips, has written a post in observance of Drug Free Work Week – Oct 19-25th, 2009 entitled “When a Coworker is Intoxicated” In it, he asks what we would do as EMS professionals and Firefighters in cases where we suspect that a coworker is under the influence. This originally started as a comment to his post, but it went long enough that I thought I could get a post out of it. Here it is:

Ewww, I hate these situations. I’ve worked full-time EMS for a long time, but I’ve volunteered for longer than that. One would think that this is a problem that I’ve encountered more often in the volunteer services, however I’d have to say that the few times I’ve actually noticed it are about equally distributed.

Thankfully, these situations have been few and far between. However, EMS and Fire people like to drink sometimes (ahem) and the potential exists for this to happen more often than you’d think.

In a volunteer service, the classic example is someone showing up for an emergency call after consuming alcohol. Often, these people sincerely did not want to “show up drunk” but thought that the need was great enough for them to show up after having “Just one or two”.

For the paid services, aside from the absolute taboo of consuming alcohol while on duty, the classic example would be spending a late night out at the bar and then showing up for work in too short of a time for the alcohol to be removed from the person’s system. If you’ve ever had a coworker show up complaining of a hangover, this may indeed be the case.

Both are unacceptable. Personally, I know that my career depends on never doing this. I also know that my patients deserve a caregiver who is on top of his (or her) game. I subscribe to the FAA’s rule governing pilots, or the “8 hour from Bottle to Throttle” rule. I take myself out of the response roster for at least 8 hours if I have had one sip of ETOH and I stop drinking a minimum of 8 hours before having to go on duty.

There’s no excuse for a provider having any amount of alcohol on board while performing any aspect of EMS. If the patient smells even a whiff of ETOH on their provider, that provider is drunk until proven otherwise. Even if the provider is under the legal limit the patient loses confidence. Our patients deserve better. If you had EMS come for a family member and smelled alcohol on the responding ambulance crew, you’d think the same thing and would probably become very angry or fearful for the actions of the responding crew.

Remember, each “drink” defined as one ounce of alcohol, raises your BAC (Blood Alcohol Content) by roughly 0.02%. That amount of alcohol takes approximately one hour to be removed from your system by your liver. Each person is different, and other factors come into play… however if you’ve been drinking you need to leave hours between your personal fun and your professional care.

The problem here, of course, is the percieved effect on the person who reports a coworker for possibly being under the influence. In some agencies there may be fear on the part of the coworker who notices the smell of ETOH or other intoxicant that they will be ostracized by the group for blowing the whistle and turning the offender in. In reality, it is your duty to your future patients and the reputation of your agency to turn someone in no matter the percieved ill effects. However, to make this easier I have some tips:

  1. Act immediately – If this person gets activated for a call or otherwise interacts with a patient, they could cause that patient harm. This is unacceptable.
  2. Enlist the aid of a coworker if you’re uncomfortable immediately going to a supervisor – Get someone else to nonchalantly speak to the person or linger in their vicinity to see if they notice what you do. Go together to report the suspicions even if the other person doesn’t notice what you do. It’s that important.
  3. Remember that someone’s life may very well depend on your actions – Friendship among coworkers is one thing, but a drunk firefighter or EMS provider may very well kill someone. You or another coworker may be injured or killed by their actions on the fireground or emergency scene. Your patients may suffer at their hands because their decision making ability and reaction times are impaired. Can you stand that on your hands for not reporting it?
  4. You may be helping the person through a real problem – Is the coworker an alcoholic? Could they be? Being at work drunk, especially in such an important job as EMS and firefighting is indicative of a real problem with alcohol. Turning them in may be the first, and biggest influence in getting that person help or in allowing them to help themselves.

This is a tough situation, but is an easy call. Keep alcohol and other drugs out of the emergency services. Keep yourself sober and sharp while on-duty or responding. It’s just not worth losing everything over a couple of beers. Have your fun and enjoy yourself while off duty but remember, alcohol can be a wonderful servant but is a terrible master. Do yourself, your career, and your patients a favor and leave ETOH in your personal life, far away from your station.

Posted by on October 22, 2009 • Filed under: Administration & Leadership, Command & Leadership, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS safety, EMS Topics, Ethics, everyday ems ethics, Fire Rescue Topics, Firefighter Safety & Health, medical ethics, professionalism, safety

EMS Week 2009 – Thank You Letter for your Crews

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This letter is free to copy and customize for your organization. It is a thank you letter from Management to Medics. I do not wish for any credits and you may use it as you see fit.

Oh, and if anyone who comes here wants a custom EMS Week 2009 letter written to fit their needs I will do it for free. Shoot me an e-mail at: Proems1@yahoo.com

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Dear fellow EMS professionals,

EMS Week again is upon us and we’d like to take this chance to say thank you for all that you do. We know that everyone who works here puts in long hours and sleepless nights taking care of the needs of our community and meeting our (company)’s mission. We know that you’re dedicated, we know that you care, and we also know that you don’t get the amount of thanks that you deserve most of the time.

So today, we’d like to take this opportunity to say “Thank you” to everyone who works here. Thank you for your time. Thank you for your dedication. Thank you for your caring, your compassion, and your devotion to patient care. Thank you for working long shifts and for holding over to cover late calls. Thank you for taking time away from your families to keep our trucks on the streets for our communities 24/7. Thank you for thinking on your feet to solve new problems for our patients. Thank you for comforting families. Thank you for comforting the community. Thank you for risking your safety. Thank you for your bravery. Thank you for your commitment. Thank you for more than we have space to thank you for. Thank you for more than we know how to thank you for.

EMS Week is an opportunity for the public to recognize what we do out there every day. It’s an opportunity for us to showcase our talents, to let the public know how to use us, when to use us, and why to use us. It’s an opportunity for us to connect with our communities and for them to connect with us. What we do is important. EMS is a necessary service that is vital for our community and the nation. EMTs and Paramedics are the healthcare safety net for all of us. We’re there for everyone when they need them, on their terms, doing what’s best for them. We come to them, meet them as they are, and give them the best that we have to offer. We should use this week to reinforce that, and to improve our relationship with them.

In closing, EMS Week isn’t quite up to the task of thanking heroes. In reality, nothing is. Please know that no matter what happens, we know that you work hard and that you care. We know what you are accomplishing out there and we give you our respect. We give you our sincere thanks. We pledge to support you as best as we are able and we know that you’ll continue to give us your best.

Respectfully,

Management of Some Ambulance Company Somewhere

http://www.LifeUnderTheLights.com

 

Posted by on May 17, 2009 • Filed under: Administration & Leadership, Ambulance, appreciation, Command & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Management, EMS pep talk, EMS Topics, EMS week, EMS Week 2009, ems week 2010, EMT, Letter, Paramedic, thank you

Follow up to The Shine Factor: What makes a great Ambulance Service

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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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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:

  • 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.

     

  • 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.

     

  • 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.

     

  • 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.

     

  • 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:

  • 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

 

Posted by on April 17, 2009 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, edemse, EMS, ems 2.0, EMS ethics, EMS Health & Safety, EMS Management, EMS rant, EMS Topics, EMT, Ethics, everyday ems ethics, Fire department, Firefighter, new perspective, Paramedic, professionalism, technology-communications-ems-topics, The Shine Factor

Oh no you didn’t…

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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.

Posted by on March 31, 2009 • Filed under: AHA, Ambulance, Ambulance Driver, American Heart Association, ckemtp rants, Command & Leadership, edemse, EKG, Emergency Medical Services, EMS, ems 2.0, EMS ethics, EMS Humor, EMS Management, EMS rant, EMS Topics, EMT, Ethics, everyday ems ethics, funny, grumblemedics, inside the mind of a paramedic, Mission Lifeline, new perspective, Paramedic, Public relations, rant, STEMI, technology-communications-ems-topics

Follow Up to the Shine Factor – Grunts: Part 1

1 comment

 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:

  • 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

Posted by on March 30, 2009 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, edemse, EMS, EMS ethics, EMS Health & Safety, EMS Management, EMS Motivation, EMS pep talk, EMS Topics, EMT, fire, Fire department, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, Firefighting Operations, Paramedic, The Shine Factor
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