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The Shine Factor

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.

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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

Care to Share My Stuff?? C'mon, Go ahead.

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

Two Cases, One letter – From one Paramedic’s struggles, change can come

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A letter I received from a reader recently has gotten me just as mad as he is, even more so maybe. This letter came in from someone who identifies himself as a paramedic but asks that I protect his identity and location completely. I will do so, only identifying that the letter comes from someone who works out west, somewhere between the Mississippi and Montana but not east as Maine or as far south as Amarillo.

So He comes from somewhere in the US, not the east coast, and not Hawaii. He’s a paramedic and he’s male. That’s all I’ll say. I’m going to work the things he wrote me in his letter with my thoughts and feelings on what he wrote and the situation he wrote about. I’ll rewrite the letter keeping the point of it intact. I’m fairly sure that you’ll be just as angered as I. (Note – This is LONG but it’s good. It will probably tick you off too, enjoy)

(more…)

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Posted by Ckemtp on February 25, 2010 • Filed under: Administration & Leadership, DNR, Do Not Resuscitate Order, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS ethics, EMS paramedics, EMS system, Emergency Medical Services, Ethics, Line of Duty, PR, Paramedic, Patient Handovers, Patient Management, Public relations, change, ckemtp rants, edemse, ems 2.0, ems education, everyday ems ethics, medical ethics, paramedic education, patient care, politics, potential, pride, profession, professionalism, rant, stories

A Shoutout to Emergiblog – Every EMS person should read this

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Go here – http://www.emergiblog.com/2010/02/why-dont-you-just-become-a-doctor.html

Read that post from Emergiblog. Then read it again. Then read it a third time.

Did you read what she’s saying? Try substituting “Paramedic” for every time the word “nurse” comes up in the text.

Couldn’t you imagine any EMS blogger saying that? What about any paramedic or EMT you’ve ever known?

Expect more on this post tomorrow. Right now I want you to look at what she has to say. It’s an important message.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 21, 2010 • Filed under: Administration & Leadership, EMS, EMS Blog, EMS Health & Safety, EMS Topics, EMS blogosphere, Paramedic, link

A writing Exercise – Working a weekend 48hr shift equal randomness

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I like Scott Adams a lot. The guy who writes and draws the Dilbert comic strip, not any other particular Scott Adams you may know. I’m not saying that I wouldn’t necessarily like any other Scott Adams, it’s just that I’m a huge Dilbert fan and also of its creator’s writing.

Why am I saying this? Well as has become en vogue to say with bloggers these days, “I told you that so I could tell you this”

Scott Adams, creator of Dilbert, was once asked his about his opinion on what to do about writer’s block. He gave this answer: (Courtesy of The Internet Writers Journal)

“One of the most common questions I get is “Do you ever get writer’s block?”

The thing I love about that question is that it reveals a wonderful optimism in the person who is asking. I suspect that the people who ask this question believe they possess deep wells of creativity and talent that are inexplicably blocked. All they need is the secret unblocking spell from a cartoonist and then a geyser of bestselling books will spray forth.

I wish I had that kind of attitude. I imagine myself asking an NBA player how he deals with Jumper’s Block, under the theory that if I can learn how to unblock my jumping skills, I will no longer need a car. I’ll just jump wherever I want to go, like the Hulk, but less angry.”

A smart man, Scott.

(like I know him well enough to call him “Scott” and not Mr. Adams… but like all great writers, a reader gets the feel that they know him through his writings so please forgive me. One day I hope to be that good of a writer… so if and when we ever get the chance to meet, please call me “Chris” or “Conan” or “CK” or something, it’ll make me feel better)

Maybe to stretch his analogies further for a paramedic blogger, if I were to unblock my “deep wells” of something, I imagine that I would miss in my unblocking attempt and might unblock my sarcasm well, or my “getting back to back calls starting at 2am” well, or something even less pleasant than those. However, judging from the 14 or so unfinished articles on my desktop right now, my geyser of creativity is not spewing forth. I’ve had like 6 good post ideas today, but not enough has come up from my deep wells in order to make them into a good post on their own.

So what I’m planning on doing here, is to just write the intros to each of these posts and post them here. I’m hoping that this exercise will pop the cork on my deep wells and allow the spewing of creativity to ensue.

Post #1: (dramatic intro to something… ahem)

It’s a foggy and overcast winter’s evening here on shift tonight. The sky is crowded with thick, dark clouds that are taking the colors from the multicolored illuminants below them on the shining streets. The fog is nearly impenetrable. In fact I’m almost surprised that my response vehicle is slicing through it as smoothly as it seems to be. The reflections of my red emergency lights bounce back inside the truck, turning the drive into a shining, bright experience as the fog pushes back against my truck’s insistence that it’s progress is indeed urgent. Somewhere, out there in the fog, someone needs me.

Post #2 (Feel good story with a twist)

Hey! While writing this second post intro, I actually finished it! I’m scheduling it for Monday Morning. So, instead of Post #2, I’m giving you a video…

Post #3 – Interrupted due to my being sleepy

Hey! This little exercise worked! I think I’ll try it again sometime. Today and tomorrow I’m working a 48hr shift, so you’ll probably be seeing some random posts come up in that time.

Happy Interwebbing!

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 20, 2010 • Filed under: EMS, EMS Health & Safety, EMS Topics

Splashed Sadness – A look at negative emotions in EMS

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WARNING TO NON-EMS PEOPLE: This post is pretty emotional. If you’re not emotionally equipped to handle really sad descriptions of EMS calls, don’t read it.

Here’s a revelation: EMS People are better suited to handling sadness than are laypeople. Of course we are. Not because we are necessarily any emotionally stronger than anyone else but because we have experience in dealing with it. As anyone could see, a good number of the situations we respond to and either assist with or observe are really sad. In my decade or so of riding the ambulances I have come across more situations than I could possibly remember that I wouldn’t want to casually discuss outside of the industry for fear of really making laypeople very uncomfortable. A story that might turn into a running joke among your colleagues might just depress a layperson for weeks.

Like all medics, I have my coping mechanisms and some of them are healthier than the others, they include sarcasm, dark humor, clean humor, Tanqueray martinis dirty and dry up with three olives, blogging, fishing, picking on my soon-to-be wife (9 days till the nuptials as of today!), playing with my boy, fishing, MGD, cigars, and sarcasm. There are a few other things in there too, I’m a rich tapestry.

This blog gets read by mostly EMS people, but there are public people out there that read me too. For both of your benefit, I’m going to relate some stories here of calls that I’ve personally attended to over the years:

A 16yo male takes his 24yo soon-to-be brother in law out into the city for the 24yo’s bachelor party. On the way home, they’re both just obliterated after drinking all night. The 16yo boy is driving home and is going way too fast to notice the semi hauling gravel that pulls into the right hand lane of the 4-lane road they’re driving on. The kid notices it at the last second, swerving just in time to impact the passenger side of the car against the back of the semi trailer. The impact shears off the left side of the 24yo’s skull, popping out the left side of his brain and leaving it, mostly intact, in between the front seats of the car (I almost put my knee into it). The 24yo dies a not-so-immediate death (I don’t want to get into it. Hopefully it was mostly painless). I pronounced the 24yo dead and took care of this very intoxicated 16yo. He was barely able to comprehend the terror of the situation and was covered in blood and brains that formerly belonged to the man his sister was going to marry. He was unhurt but I ran him into the hospital anyway. How could I leave him there immersed in the terror of that scene, in the terror of what he was more or less responsible for?
A 19yo male comes home from the military and his friends throw him a house party. During the party the 19yo takes his 18yo male friend down to the basement of the house to show the friend a new pistol that the 19yo brought home with him. The friend takes the gun to look at it and playfully twirls it around his finger ‘Old West’ style in an attempt to be cool. When he does, the gun fires, shooting the friend from the chin through the top of the skull. When I got to him, he was still breathing and had a strong pulse however it was mostly his brain stem that was controlling the reflex. Most of his brain was splattered on the basement floor. We worked him, transported him to the trauma center, and I believe that they were able to harvest his organs.
A man and his wife of upwards of twenty years are just bumming around the house on a nondescript weekday. It’s about lunch time and they’re going to eat at home before they go to the wife’s doctor appointment. The wife gets up to make sandwiches, gets to the counter, and slumps to the floor. She never woke up. We worked her very hard, but her heart had just decided that it had reached its allotted number of lifetime beats.

The above short summaries of calls that I’ve been to are sad. There’s no joke that can make them not sad. If you read this, there are two reactions I expect from you here:

For non-medical people: You’ve related these stories to yourself. You may be crying. You’ll think about them and your heart will go out to the unfortunate people involved. You’re sad.
For EMS People: Don’t these sound like good calls? They were. Yep, they were sad and I felt very bad for the people that were involved. Good calls though. What’s for lunch?

I think I remember what I did after the above three calls. I think that it was profound although my memory is pretty foggy after all these years. After the first one, I cleaned up the truck and actually got to sleep the rest of the night. After the second I cleared and went to a few more calls and then had lunch. After the third I um, had lunch because it was lunch time.

EMS people can probably know what I’m talking about here. I call it “The Howl”. It’s the sound that a family member makes after you’ve transported their close loved one to the hospital where the patient is pronounced dead by the ER Doc before the family gets there. So there you are, cleaning your equipment while the ER staff makes the sad announcement to the family. Here comes The Howl of anguish that the family member makes when they hear the news. I’ve heard it time after time in hospital after hospital. It’s loud. It’s haunting. It haunts my dreams some nights. I say that The Howl is an example of direct sadness. Direct Sadness is the pain/sorrow/anguish/horror that a person feels when they are a primary person in the situation. In my position of hearing The Howl after working the patient and unsuccessfully trying to save their life I experience Indirect Sadness. For the coworkers that I tell the story to and the readers of this blog, “Splashed Sadness” is the term I use. I think that “Splashes Sadness” is what a person experiences when hearing a terribly sad story like that.

In this business, Splashed Sadness is everywhere. It is one of the hallmarks of professional EMS. Think about it like this, I will always remember a conversation that happened between a group of coworkers and me one nondescript morning some time ago. They told the story of a college age male that overdosed on illegal drugs, stopped breathing, and was resuscitated from asystole (flat-line) by the paramedic that was telling the story. He mentioned that the fiancé of the patient was in the ER with the most-probably brain-dead patient and was holding the patient’s hand and telling anyone that happened by that they were supposed to get married that weekend. He said that she just kept repeating “We’re getting married this weekend” over and over again.

The sadness contained in that story splashed on to me and I’ve remembered it to this day. It will probably be there tomorrow too…

I responded by asking if they recommended that she cancel the caterer. Then there were fart jokes and wrestling (It was an all male crew that day). That’s how I dealt with the splashed sadness. I try not to get any of it on me and I try to psychologically squeegee any of it that I do get on me off as quickly as possible by interjecting humor and sarcasm into the situation. Extreme humor to deal with extreme sadness.

EMS people gain experience in dealing with negative emotions and sadness through all of these routes, direct, indirect, and splashed. While I have dealt with Direct sadness in cases of the deaths of close loved ones including my father, I don’t want to deal with any more. I get indirect sadness a lot of the days that I show up for work, and splashed sadness happens every dang time I talk to a coworker or discuss a bad call with a peer. I’m splashing sadness on you all right now as you read the above stories. If you’re an EMS person, you can deal with the splashing. If you’re a layperson, I’m very sorry for doing that to you but I did warn you before you started reading. My theory is that the more experience you
get with sadness, the better equipped you are to deal with it.

Or you go nuts.

Or you go nuts and start blogging and drinking martinis like I did.

Maybe I’ll get credit in a psychology journal for coining “Splashed Sadness” in EMS.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 16, 2010 • Filed under: Ambulance, CISD, EMS, EMS Health & Safety, EMS Topics, EMS ethics, EMS pep talk, EMT, Emergency Medical Services, Fire Rescue Topics, Fire department, Firefighter, Firefighter Safety & Health, In the Line of Duty, Paramedic, bad calls, emotions, inside the mind of a paramedic, paramedic education, psychology, sadness, safety

The Chronicles of EMS – Day 3?? Who knows, I’m flying

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My goodness I’ve got to get into this room! That was a long set we’ve just had. Oh yea, Mark’s in the building so I had better check the lock on the door. It’s locked… good. I shouldn’t have had so much coffee in preparation for the talk I just had. Was I nervous? A bit maybe… I feel silly about it though. After all, I was really just shooting the “breeze” with some people who have become good friends of mine over the last year or so and I honestly feel pretty comfortable being in front of the community that’s popped up around the Chronicles of EMS.

Yes I was talking about what the Frumpydumple crowd calls the “water closet” and I had just gotten done filming Episode #1 of “Chronicles of EMS – A Seat at the Table” with an amazing panel of guests. I can’t tell you how much I’ve enjoyed being here in San Francisco to watch this all take place, I can’t really put into words how much I have enjoyed meeting the people I’ve gotten to meet, and I just wouldn’t do the feeling of inspiration I’ve gotten any justice if I were to put it into static black and white words on this page. For you to know how I feel about this I’ll just have to use an analogy.

Picture that you’ve been laboring in a tunnel for years, digging as fast as you could every day you were down there. You’re passionate about your digging but you don’t really know if you’re ever going to get anywhere before you run out of steam. You dig and dig and dig… Then one day you feel like you can’t dig any more… not even one more shovel full of dirt… You’re tired, cold, hungry, and cranky and it feels like eons since you’ve seen the sun… Finding Herculean strength you tell yourself that this shovel full of dirt may be the one that finally counts, so you dig the shovel into the dirt and…

Break through into an underground lake that fills the tunnel with water and sweeps you away.

And just when you find you’re about to drown you start a blog and find out that there’s people out there that will throw you a lifeline. You reach out to them and find yourself at a television premier in San Francisco having the time of your life.

So um, yea. That’s how it is. See why I said that I couldn’t do it any justice?

I was here to watch the show and I’m still here writing this from my hotel room. I have to say this: We all knew that Mark and Justin were caring, competent paramedics who are fantastic at what they do. It wasn’t really a shock to me to see them portrayed in the video as just that. No camera could hide how much they care about this stuff and it wouldn’t be possible to hide how committed to the cause of furthering emergency medical care around the world as they are. I know them, they’re really, truly good people and I’ll vouch for them. What impressed me, nay, amazed me the most was the quality of the camera work and the production of the film. I was quite literally blown away by the superb quality of the production. Hats off to Chris Eldridge and Ted Setla… You guys honestly blew right past my preconceptions and delivered a product that was way beyond my expectations. I mean, I knew that it was going to be good… I just did not expect the quality to be so high. I had high expectations and you blew past them. That’s solid work guys. I know that there were many behind the scenes that I don’t know all of the names of to thank properly, but rest assured that I am thoroughly impressed by the class act that you have developed here.

So what I am saying is: Thank you. Thank you for the work you have done to further our profession and emergency medical care around the world. I am happy and downright honored to have played a small part in it and I cannot wait to see the heights that you all reach with this endeavor.

You guys rock.

So tonight, I am frankly having way too much fun here with my wife over Valentine’s day hanging out with the Chronicles Crowd to spend any more time on this computer. I’ve met a ton of great people, all of which I will dish about (Mwa Ha Ha ha!) in a later post. But tonight is about fun, and off I go.

Here’s some suggested reading:

Http://www.setlafilms.com – Ted Setla’s Production Company

Http://www.LevelZeroMovie.com – The Level Zero Movie (I have a signed copy!!)

Http://www.ChroniclesOfEMS.com – The page for #CoEMS

MsParamedic’s article on #CoEMS – Great Meeting you!

EMS1.com ‘s article on #CoEMS

David Konig’s article on #CoEMS

FireGeezer’s Article on #CoEMS – Really? Johnny and Roy?? Well, maybe…

Fire Daily’s article on #CoEMS – Bromance indeed

And Just to Enhance the Social Media Experience – I put out a tweet looking for posts that referenced the meetup this weekend. Here are the ones I’ve gotten so far:

- From @FirstDueMedic - http://gatesofintegrity.blogspot.com/2010/02/are-we-ready.html

- From @ssgjbroyles - http://1union801.blogspot.com/2010/02/chronicles-of-ems.html

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 13, 2010 • Filed under: Ambulance, EMS, EMS Blog, EMS Conference, EMS Health & Safety, EMS Motivation, EMS Topics, EMS blogosphere, EMS ethics, EMS pep talk, Paramedic, ems 2.0, ems education

Thank you EMS – Some reasons I love what I do

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Judging by how I felt this morning when I got up at 06:43 for a seizure victim after getting to bed at 03:30ish beforehand, I would say that I’ve been doing this for a while. I’m not as young as I used to be and I certainly am not the same person I was when I first got behind the wheel of an ambulance and flipped on the flashing lights.

I’ll never forget that first time I ever drove an ambulance lights and sirens. I was so excited. When I was younger I had always wanted to be an EMT and I viewed my first emergency driving experience as the time when I’d really “made it”. I was working as a security guard in a hospital where our security department ran an ambulance service that existed solely to transport patients from a free-standing ER attached to an outpatient facility to our larger flagship hospital with inpatient beds. Mostly we did tech work in the ER and transported every admission to the larger facility. Occasionally we got to “knock the cobwebs outta the siren” and run the ten minute trip “hot”. That was my first time driving in an emergency fashion… it may have not been a clean win since it wasn’t a 911 call… but it was still my first.

However, I digress. This post isn’t about my youth and exuberance that I didn’t know I was in the midst of when I first pinned on an EMS badge. This post is about the person I am today. I’m a paramedic now and I will say that I am proud of my son, my wife, my family, and my skills as a paramedic. I try not to brag on much, but I have put so much effort into all of the above that I am proud of the way they’re turning out. As a paramedic I have put in years of continuous effort to become the provider that I am today and even if nobody else ever cares about how good I was when I retire one sad day in the future, I will, and that’s enough for me to drive on.

I will never have the ability to give back to EMS all of the positive gifts that it has given me. Growing as a paramedic and as a healthcare provider is directly related to my growth as a person. I entitled this blog “Life Under the Lights” because I feel that I’ve lived a significant portion of my own life “Under the lights” of an ambulance. We all share a lot of the same experiences on our journey as EMS providers and we’re only starting to realize our true potential as a profession.

So here are a few things that I am thankful for that I’ve gotten back from my career as a paramedic so far:

- Thank you EMS for allowing me to see the power and passion in people going through the worst times in their lives… and in some cases the best ones.

- Thank you EMS for allowing me to have conversations with fascinating individuals I’ve met as I’ve taken care of them. I love hearing the stories my patients tell me… it’s got to be one of the best parts of the job. I’ve learned so much from my patients.

- Thank you EMS for taking me on a journey through my own emotions and allowing me to feel the highest peaks and lowest valleys of my own psyche as I’ve lived out the world through facing emergencies. I may have never known such things about my own capacity for feeling.

- Thank you EMS for teaching me that I always have it in me to go on fighting when the stakes are high… Without having to fight through the pain, exhaustion, and other discomforts that you’ve thrown at me I wouldn’t know nearly how much I could take.

- Thank you EMS for allowing me to meet my wife. I love her more than I love you.

- Thank you EMS for allowing me to meet my coworkers, some of them have become my closest friends. Maybe I’ve had better parties while on the clock than I have had off-duty. Being at work is just such a blast sometimes.

- Thank you EMS for showing me that no matter what struggles I’ve been facing in my personal life, that there is always someone out there struggling harder than I am.

- Thank you EMS for shaping my personality. I used to be a shy introverted person. Now I can almost always come up with something close to the right thing to say by thinking on my feet.

- Thank you EMS for giving me the opportunity to Drive Fast and Break Things occasionally, it’s the manliest thing I do most weeks.

- Thank you EMS for making my life exciting. I love the feeling I get when the stakes are extremely high and the adrenaline is pumping… it has to be better than any drug.

- And finally, Thank you EMS for more than I can thank you for. I (quite geekishly, actually) can relate most things to something I have done or might do in the field. That’s very cool in my book.

Without my starting point in EMS more than a decade ago, you wouldn’t be here reading this right now. I would be some guy doing something somewhere else. My life is shaped because of what I do and who I’ve become from pounding the streets every day. Thanks for making me “somebody”. Thanks for giving me something to write about. Thanks for being as cool as you are.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 9, 2010 • Filed under: EMS, EMS Blog, EMS Health & Safety, EMS Motivation, EMS Topics, EMS paramedics, EMS pep talk, EMT, EMT-Intermediate, EMT-Paramedic Specialist, Emergency Medical Services, Fire Rescue Topics, Firefighter Safety & Health, Paramedic, appreciation, emotions, potential, pride, profession, professionalism, thank you

Why I am Passionate about the Chronicles of EMS

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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 11^th for the premier of their pilot episode. I wouldn’t miss it for anything. Look out world, EMS is moving forward.

Care to Share My Stuff?? C'mon, Go ahead.

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

Ten (or so) things that you should try to do with every patient

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I am not a perfect medical provider. In fact I’m really only practicing prehospital medicine (Ha ha!) but there are a few things that I try to do with every patient to improve my care for them and improve their comfort level as I care for them. I can’t claim that I always remember to do these things, but I really try to. I think that you should too.

Here they are (in no particular order other than ZIP code):

Always introduce yourself and your partner to the patients and their loved ones using your first name. I wouldn’t want some upstart guy in some uniform type thing just randomly poking at me. I think that it reduces patient anxiety when you properly introduce yourself to your patient. I say “Hi, I’m Chris and I’m a paramedic with F&B Ambulance Service and Taxi Squad. This is my partner Fuzzy McGee. What is your name Sir/Madame?”
When you’re in the back transporting the patient after you’ve given them most of the care you were planning to give them, go over your assessment again. Ask the patient questions that get them to expand on their original answers. Challenge yourself to find anything that you may have missed.
Play a game with yourself. Try to have the patient diagnosed by the time that you get them to the ER. If you can’t figure it out, fire up the internet when you get back to quarters and look it up. You’ll learn a lot of good medical information by doing this. I have.
Once you get the patient in the back of the ambulance if they’re not facing an immediate “Life-or-Death” crisis ask them “Is there anything I can do to make you more comfortable?” Maybe another pillow or moving the head of the cot up or down would help them. Do it if they ask.
Try not to have the pillow stuffed under the patient’s shoulder blades. It makes it uncomfortable when they’re lying on the cot. Moving the pillow up from under their back and placing it under their heads makes them a lot happier. They won’t know to ask for it. Just do it.
If you find a patient down with an isolated fracture or dislocation get pain meds in their system before you start splinting or packaging them. It does take a bit more time, but you’re not being very humane if you don’t.
You are the patient’s advocate when you walk in to the imposing world of ER care. Your job is to present them to a medical system that is overworked and overtired. Stick up for them and make sure that the medical care providers that are following you learn about what is wrong with the patient before you throw him or her to the wolves… er, um, nurses. I mean nurses.
Before you hand off your patient to the ER, ask them: “Is there anything that I haven’t addressed? Is there anything that you would like me to be sure and tell the ER about?”
Explain to the the patient WHAT you are going to do and WHY you are going to do it.
Approach EMS with a servant’s heart. No matter what some EMTs may think, we are here for the patients. It’s not the other way around.

By trying to do these things you’ll provide better patient care. I think that I’ve grown as an EMS professional by doing these things. I’ve also grown as a person by doing these things. Let me know how this works out for ya.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 7, 2010 • Filed under: Ambulance, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS training, EMT, Paramedic, Patient Management, comfort, courtesy, patient care

Mental Quickness – Do Smart Alecks Make Better EMTs?

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Alright, I admit it. Driving to work this morning was a bit of a challenge. We had two inches of fresh snow and the tires in my car are in desperate need of replacement. Yes, I drive a Subaru and usually it’s all-wheel drive does awesome in the snow… but I cheaped out on the tires, and they’re honestly a bit mismatched size-wise. Therefore driving it in conditions even remotely slick is hard as heck. I would have driven the SUV and had no problems at all but the wife had to drive the kid to school and then had to drive into the city afterwards and I wanted her to have the safe vehicle. Who cares if I go into the ditch? Work can do without me if they have to, but I need my family to be safe.

Since I think of things to write about when I drive, this morning brought my thoughts to how hard I had to concentrate on the road and the minute adjustments of the steering wheel and the accelerator needed in order to keep the car safely on track. Like everyone who knows about driving in slick conditions, I kept my eyes on the road ahead of me in order to “read” the changes in the road surface before I got to them in order to be ready to quickly make the adjustments needed to keep the car heading in the right direction. See a dark shiny patch? Foot off the gas, be ready to steer slightly away from it when the car slides in that direction. See a pile of snow with a frozen rut running through it? Minutely avoid it if possible and steer into the slide with just enough change in the gas to power through the slide. I made it to work, but I had to call in a favor to have a guy stay over for me for ten minutes. I let him know the night before that he might have to, and I did leave early… but I’m not wrecking the car just so I can save a few moments.

I consider myself a pretty good driver in the snow. In a vehicle with good tires I wouldn’t even worry about anything less than 6 inches this far into the winter season, but today was hard. I’m not patting myself on the back here, because if I would have put good tires on the car in the first place I wouldn’t have been in this position, but isn’t that most of what we do in EMS? We end up using our mental prowess to clean up other people’s messes caused by their lack of planning all the time. Today wasn’t much different. The amount of mental power and concentration needed to keep a car moving forward safely in snow-covered conditions is actually quite staggering when you think of it. You have to make quick observations of rapidly evolving conditions, surmise what you think the presentation of the road surface means to vehicle’s path of travel using your limited observations paired with your past experience and knowledge, and come up with a near simultaneous decision on how to handle the situation ahead of you. If you find yourself to be wrong, based upon the car not reacting the way you want it to, you have to instantaneously correct the situation while adjusting for the conditions ahead… or crash.

Now picture yourself managing a challenging patient presentation, one requiring a handful of pharmacological and physical interventions. You’re pretty much doing the same thing as driving in snow. Just like playing a game of chess, you have to be “thinking a few moves ahead” in order to keep up with what the patient’s physiology is going to throw at you. Do you have a fall victim with a broken hip in need of pain control? Did you think that they’re possibly going to drop their blood pressure with a dose of morphine? Well then you better be ready to give fluid to bump it back up to acceptable levels. However, what if you’re treating a CHF patient that would suffer further from the added fluid? What if they were a patient with Chronic Renal Failure? Would that affect your initial dose of morphine based upon the unknown factor of untoward hypotension? In my Northern system, I’d choose to use Fentanyl over Morphine in that case because of the lessened risk of hypotension, but in my Southern system I’d just have to start with a lower dose of Morphine and slowly titrate to an acceptable level of pain control once I gauged the patient’s response to the med.

How about a patient with a large anteriolateral MI? Their Left Ventricular function is soon to be compromised if not treated in a cath-lab. You need to increase blood flow to the Left Ventricle and decrease overall cardiac work by decreasing afterload with use of nitrates, but that’s going to decrease their cardiac output and blood pressure by decreasing their preload as well. You need to stabilize the infarct as best as possible while maintaining the patient’s hemodynamic state, and you may need to consider supporting their left ventricular function with the use of a vasopressor such as dopamine to treat possible cardiogenic shock. In this case, careful observation of the patient’s presentation and all information available to you is of paramount importance in order to make the minute treatment decisions necessary for your patient’s best possible outcome.

It all comes down to “Mental Quickness” or having the mental prowess and state needed to rapidly intake complex information, process it against your knowledge base, and then make reasonable decisions on a course of action in a very short period of time. We call people who are good at this “Quick Witted” and it applies to myriad situations in daily life. People who are good at this are usually funny, are quick to react to new situations, handle change fairly well, and make darn good EMS providers. I practice by trying to have a joke ready for any situation… so you could also call a person who’s mentally quick a “smart ass”.

You can practice your skills at being mentally quick the same way I do. Use humor and try to make good comebacks to the hooks and barbs that your coworkers and friends throw at you. When we’re sitting around busting each other’s chops… we’re actually practicing our EMS skills, right?

Think about it. Exercise your mind through reading, learning new things, and trying to come up with new ways to think of existing information. You’ll be funnier, more popular, will be able to knock your buddies down a peg better, and will improve your patient care.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 2, 2010 • Filed under: Administration & Leadership, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS paramedics, EMS practice, EMS training, Emergency Medical Services, Fire Rescue Topics, Paramedic, Patient Management, Training & Development, change, ems education, ems scenario based education, inside the mind of a paramedic, mental imagery, paramedic education, patient care, scenario based training, training-fire-rescue-topics

EMS practice

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Did anyone else play a sport (or sports) in high school? I did, actually I played football for a few years. I was on the line, which in my small high school meant that I played every position on the line, both offense and defense, because there just weren’t that many kids out there to play. My graduating class was 83 in my small, small town.

I didn’t touch the ball though. Coach told me just to go out there and hit people. I haven’t touched a football since.

Every day after school we went out there no matter rain, shine, snow, heat, or better things to do and practiced for three hours every night. We did this all season and I hated it. It sucked and sucked bad. However, it did make me a much better football player. It kept my mind focused and kept me in shape. I was a much better “Go out there and hit people” guy than I would have been had I just taken a football class and then played parts of the game every day.

Does anybody do this with EMS? Sure, we all do Continuing Education, but do we really practice as hard as we should as much as we should?

We play parts of the game every day but just as sure as I didn’t intercept a pass and run in a touchdown every game, I don’t perform a pericardiocentesis every shift. I can plink in an IV in my sleep (and do… a lot…) and I probably can treat a STEMI as good as the next guy. Playing the parts of the game that we do more often than the others gets us good practice on what we do most often, and if we don’t allow ourselves to get complacent, that’s just fine. However, how many times have you calculated a dopamine drip lately? Even if you live in the busiest, most dopamine swillingest jurisdiction on the planet you’ve still interpreted Normal Sinus Rhythm a lot more than you’ve shown off your math chops.

The other day I missed a tube. I was caring for a patient who crashed in front of me while heading to the ER. The Pt went from CAOx3 to very obtunded in a matter of a minute or two. The first time I went to tube, (the Pt) was clenched and by the time I got the etomidate ready we were close enough to the hospital that bagging was my best option. When the Pt got sux and sedate juice in the ER I tried again…. and missed.

I freakin hate that! Man, I never miss a tube! At least almost never. I hate it when I do and beat myself up about it. Probably more hard than I should, but that’s just me. I take this stuff seriously if you can tell. The next shift I spent an hour playing with our two intubation dummies and our “Fred the head”. I tubed over and over again every way I could think of. For an hour. Yes, I know that it’s not exactly like the real thing, but it was all that I had access to for practice.

Something cool happened right after I got done with my hour long tubing pennance. I sat down for lunch and immediately got toned out to intercept a code with CPR in progress. I pointed my SUV towards the rural address and hit the gas. When I got on scene, the BLS crew told me over the radio that they were having difficulty with the airway. I walked in, and got the most beautiful tube that I think that I’ve ever gotten. Right in, right through, and right hole.

I think that my football coach would have been proud.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 1, 2010 • Filed under: ALS Intercept, EMS, EMS Health & Safety, EMS Topics, EMS practice, EMS training, EMT, ET Intubation, Emergency Medical Services, Fire department, Paramedic, Patient Management, ems education, ems scenario based education, intubation, paramedic education

Zombies!!!

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I hate horror movies…

A while ago I walked into our crew lounge where the other members of my crew had just popped in some low-budget zombie flick. It was your classic “B-Movie” and had all the hallmarks of every good zombie show that I’ve ever seen. Gratuitous bloodshed by hapless victims? Check. The walking dead feasting on human flesh? Check. A few good looking zombified women? Check and Check. I watched it against my better judgment. I hate horror flicks for all of the above reasons, except for the good looking women of course. I have an annoying habit of taking on the characteristics of every movie that I watch for varying lengths of time. After watching Top Gun, for instance, I drove my car like a fighter pilot for a few days. After watching Star Wars I tried to use the force to get the TV remote from across the room when I lay down on the couch. After watching the South Park Movie I swore every other word. Really. So I don’t like horror flicks because I get scared like a little girl afterwards and I don’t like it.

Unfortunately though, I watched the whole thing like a doofus, knowing full well that I’d be having nightmares later.

Cue the call for the unresponsive seizure victim…

We went to an apartment complex where our patient had fallen into a seizure right by the inward swinging door to his apartment. He had fallen in a way that made it so his body was blocking the door and I could only swing it open a few inches, just enough for me to squeeze inside. He was pretty out of it, and wasn’t responding with anything but unintelligible grunts and groans.

Then, of course, he moved and shut the door, blocking it with his body and trapping me alone in his apartment with him while he was groaning on the floor.

Does it make me a scaredy cat because I thought I was going to be eaten by a zombie?

I hate horror flicks…

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Posted by Ckemtp on January 29, 2010 • Filed under: EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMT, Fire Rescue Topics, Fire department, Paramedic, funny, humor, professionalism

Equipment Review: Scary Post Ahead

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This was one of my first posts. Since I’m attending an EMS conference, I figured it deserved a bump-up too. Good Luck!

Some of you have been telling me: “Chris, you’re a good paramedic. You should be providing tips and tricks for EMS people so that they can use your hard-won wisdom to improve their patient care. Don’t spend your time ranting about things that bother you in the back of the truck and keep making feeble attempts to make people laugh. Write a serious article, darn it!!”

Actually, I’m really the only one that’s been telling me that, since this blog is only read by like, six people including my mother, fiancé, and my cat… but nonetheless I am going to attempt a serious piece regarding actual patient care issues. As such, I have identified piece of equipment that is carried on my ambulance and is most probably carried on every ambulance in the country. This particular piece of patient care equipment is rarely used, yet critical for patient care when needed. When this piece of equipment is called for, the patient needs it and needs it NOW. Yet, I’m sure that even the most experienced EMTs and Paramedics are struck with horror at the mere thought of its use.

I’m talking here about: The bedpan.

Yes, in my storied career I have been called upon to use a bedpan more often than I would have liked to. The situation is almost always the same, the patient is otherwise stable but the pressures of the bumpy ride on the human bowels are just too much for him or her during the prolonged transport time. Usually in complicated cases like these I prefer to bring along a nurse, since they are eminently more qualified to perform in these critical patient care scenarios. However, as is often the case in EMS, we are called upon to take care of any patient presentation in any patient population and must perform professionally in all situations. I have researched the use of this piece of patient equipment in numerous trade publications and critical care guides and have been struck with the lack of educational materials available for this critical patient care skill.

So, as any EMS writer would do when setting out to write a patient care article, I hit the streets to query other paramedics and EMTs on their secrets for the proper use of the bedpan. I began with the coworkers I have at my two ambulance jobs, one a private, not-for-profit city 911/Specialty Care Transport service and the other a Fire Department based service. Both of them work around 3000 calls per year and run at the ALS level. Here is a sampling of the responses I received:

Question: By a show of hands, how many of you have used a bedpan in the back of an ambulance??

Answer: I raised my hand.

Some of the people there wanted me to clarify the question, they wanted to know if I meant had THEY themselves personally used a bedpan in the back of an ambulance? One guy admitted to using a urinal in the back while transporting a patient. When badgered by the other providers, he clarified by saying that it “was a pretty long trip”. I offered that there have been some situations in my career where I have put the bedpan under a patient who absolutely HAD to go poopie during a trip to the hospital. However, and I just realized that this is the most blessed thing to ever happen to me ever, not one of them has ever been able to “go” with me hovering over them.

Of course, in EMS, I have been covered with every imaginable bodily fluid, including the unholy trinity of urine, vomit, and feces ALL AT THE SAME TIME. And I have plans to erect a statue to the person who came up with the idea of prehospital people administering Zofran (an anti-throw up medication). The other day I spent a few minutes starting a saline lock IV on a lady in her bed inside her apartment just so that I could give her that blessed medication. My fairly new EMT partner wanted to know why I did that, when I usually wait until we’re back in the truck. I let him know that I had been on the foot end of the stair chair going down the stairs before the golden-age of zofran had arrived.

Yes, us “experienced” EMS providers (read: old people who never got real jobs) will tell you that when you can’t let go of the end of the stair chair without letting your patient plummet down a full flight of stairs and the patient chooses THAT EXACT MOMENT to decide that they just *have* to throw up. You well, you just have to close your eyes, close your mouth, lower your face to cover your nostrils, and take it like a true professional. Been there, done that, cleaned the chicken and rice out of my ears with a q-tip. It’s moments like that when you reevaluate your commitment to the profession, and realize that it must be something other than the *interesting* amount of money that they pay you that keeps you coming to work every day. For me, it’s the amount of time that I get to spend typing up articles about bedpans and vomit in my ears… at least it is right now. Has anyone else ever thought that they had been ruined by EMS? I mean, I don’t think that I could ever do an office job. Years of EMS work has left me with the remarkable ability to begin to focus on something like a laser beam for 90minutes tops, then… Hey look!! A Bunny!!

Oh yea, bedpans. So you slide them under the patient and um… Pray that they’re positioned correctly. Wear correct BSI including a pair of gloves, a mask, goggles, and Vick’s Vapo-Rub under your nostrils. Of course, for us old timers, this is required even when you’re making your partner use the bedpan in the back while you drive (heh) Ever So Carefully to your destination. Tell your partner that they need the experience, tell them how professional they are being and tell them that they’re showing true compassion to the patient. Then go out and buy them an ice cream cone filled with Rocky Road. With any luck, you’ll get to eat that too when they suddenly become less than hungry.

In all seriousness, everyone poops. Never let your patient suffer when you can alleviate their suffering with a simple slide of the bedpan under their derriere. Of course, make sure that they REALLY have to go to lessen your risk of contaminating yourself with some really funky pathogens, and also to avoid ticking off the nurses’ lobby by taking their jobs.

Until next time…

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on January 23, 2010 • Filed under: Ambulance, Bed pan, Bed pans, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS ethics, EMT, Ethics, Fire Rescue Topics, Fire department, Firefighter, Paramedic, bedpan, everyday ems ethics, odansetron, puke, zofran

Life Under the Lights – From behind the Windshield

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This post goes out to my blogger buddy @medicthree - (http://www.medicthree.com) whose been having a few rough shifts lately. If you’ve been having a few rough ones lately, this one’s for you too. It’s kind of a rambling, disjointed post about emotions in EMS. It made me feel better to write it. Here’s hoping that it makes you feel better to read it.

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Cruising down the interstate has always been a Zen-like experience for me. I do it a lot due to living here in the rural Midwest. I like it. It’s a quiet time for me to be alone with my thoughts… which can be both good and bad I guess. It’s not uncommon for me to point my car in the direction of some commonly travelled to destination and be exploring the depths of my subconscious mind the whole way. It’s my meditation time, my time to reconcile the goings on in the world with my opinions on them. I’ve had some of my biggest epiphanies with my foot on the gas pedal. Give me the radio, the open road, and a not-so-specific time to be somewhere and I can solve almost any problem I’ve got.

This morning’s cruise home from my Northern job was no different. Today the world was subtly shining with a brilliant white coat of ice. The icy fog that had lingered all night had coated each individual twig, blade of grass, and exposed surface with tiny fernlike diamonds giving the quarter-mile or so of visibility around me an eerie, ghost like quality. It was beautiful. I wonder if anyone else calls this stuff “Ice fog”? I do. At least today I do. My father taught me that pilots call the small ice that builds up on the leading edges of airfoils and antennas “Rime Ice” and it was forming on my antenna as I cruised down the highway. It made me remember my dearly departed dad and smile to myself as I did it. Remembering things he taught me tends to do that. I’ve found that as I progress deeper into my own path of fatherhood I remember the things he taught me more and more. I try to pass that on to my own son but I suppose that I’ll always worry about not being able to live up to the task.

See what I mean? Just thinking about the drive time tends to make my thoughts ramble. Perhaps everyone does this, perhaps not… but I would think that everyone has their time alone with their thoughts. My time is my drive time. Perhaps it is yours as well.

Being a paramedic who thinks while driving affects my rides home from work the most, I believe. If you’re in the business, you know about the peaks and valleys of emotion and the human condition that we witness on our shifts. My drive home is my place to sort them out and reconcile the lowest valleys with the highest peaks so I can be more balanced. There’s been times where I’ve gone through a toll booth with tears streaming down my face, trying to regain my composure to give the toll-booth guy my patented “You ‘ave a good day, my friend” as I hand him my eighty cents. Other days I’m laughing like a fool while blaring European techno, country western, or whatever tripe the pop station’s playing repetitively these days. Sometimes I’m sullen, thinking about some stranger’s death that shouldn’t have happened. Sometimes I’m elated, thinking about something that’s just full of EMS win. Whatever the case, my thoughts tend to run down the calls I had over the previous day’s shift and I dissect my decisions and the circumstances that lead me to make those decisions while I’m sitting there alone in the car. I think that it makes me a better paramedic to do this, I also think that it keeps me only borderline insane. Someone once sent me an e-mail with tips on how to keep oneself with “A Healthy Level of Insanity” and I love that term.

I’m sorry that this post is just a bit of rambling on about emotional stuff, but I hadn’t posted in a while and this Sunday just felt like a good day to let my fingers put something out there. I’ve always believed that EMS people experience the world differently as they live their “Life, under the lights”. Our experiences and the viewpoint they give us make us just a bit different than our neighbors. We laugh at inappropriate times, our thoughts sometimes wander, and we take some things more seriously, and some things less seriously than others. While collectively we EMS people are a diverse lot, we share a common bond that could make me comfortable sitting down to throw back a cold one with almost any of my colleagues. That is, until we get onto a debate about some minor topic and both of us are right beyond the shadow of a doubt. I’ve told students that in the decade or so I’ve been doing this, working in a high-stress environment, surrounded by type-A, ADHD personalities who make their living on making the “right” decisions every time, I’ve ticked some people off along the line. If I hadn’t, I’d have been doing it wrong. I tell the students that they’ll tick some people off too and that they should have fun with it while trying to be as nice as they can and realizing that they can disagree with someone without having to dislike them… and vice versa.

Sometimes, this job sucks. Sometimes our best isn’t good enough… and sometimes we think that we weren’t able to our best for whatever reason. Those times are low times that can consume you in total darkness. Sometimes it’s just the opposite and your shift full of EMS Win leaves you full of inflated confidence. The lows are days when I drive the speed limit, the highs push me over a bit. My advice is to just remember what’s important to you and what your end goal in life is. You’ll get there if you keep travelling in that direction, no matter the speed you’re going at the time. Remember that this profession is like a sine-wave with peaks that can thrill you and valleys that can um, kill you if you let them get to you too much. Just remember, my friends. Someone up there has a purpose for all of this that we’re not meant to understand. Just keep doing your best, honestly putting forth the effort that leaves you honestly convinced that you’ve done your absolute best for everyone you’ve been charged to take care of and you’ll survive this stuff out there.

And keep driving.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on January 17, 2010 • Filed under: CISD, EMS Health & Safety, EMS Topics, Line of Duty, ckemtp, mental imagery, new perspective, profession, psychology, sadness, stories

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 3^rd 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.

Care to Share My Stuff?? C'mon, Go ahead.

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

“CPR Theatre” – Pediatric Deaths, resuscitations, and futility

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This post is a cooperative joint topic with two widely respected EMS bloggers, Steve Whitehead from Http://www.TheEMTspot.com and Greg Friese, from Http://www.EveryDayEMStips.com – Our topic is supposed to be on why it is that EMTs, Paramedics, and other healthcare providers will sometimes “go through the motions” and continue on with futile resuscitations with pediatric cardiac arrest victims. I’m sure that they will have very insightful posts on the topic, as they always do. Here’s my take.

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Can someone say “emotionally charged”?

One of the truths about where I’m sitting right now is that I’m chained to a lot of potential responsibility. Today, like a lot of days I’m one of two paramedics on-duty in my service area and the next call is mine. No matter what the next call is, it is my responsibility to get up and answer that call… without regard the horror that fate may be sending me to bear witness to and intervene in. All medics have to accept this inherent part of the job. One of the worst of those possibilities is that it may be a call that involves the significant injury or illness to, or even the death of a child.

Mention the possibility of a child’s death to even the most cynical and seasoned of healthcare providers and you will send a very cold chill down their spine. It’s just horrible. For me, the blessedly rare times that I’ve lost a child have been sentinel events in my life, things that are often thought of but rarely spoken of… almost always spoken of only to comfort the pain of a colleague experiencing the same thing. The loss or suffering of a child just burns into our souls and leaves an indelible scar that only someone who has experienced it can have true empathy for.

And I for one, wish that I didn’t have the empathy that I have for it.

Heaven forbid that I ever have to be one of the parents with pleading eyes at one of those tragic and traumatic scenes. I just can’t imagine what they go through when I’ve said “I’m Sorry”. I can’t imagine their pain, and frankly I don’t want to. As a parent myself the thought is blocked from my conscious mind and relegated only to the deepest recesses of my subconscious fears. Losing an adult patient is one thing, as we humans come to know that our lives are fragile and that our price of admission is to be removed from this existence. It’s a knowledge that we get as we progress through life and gain the experiences, both good and bad, that make us who we are and will become. However, the terrible thought that one could be ripped from us in their age of innocence is an affront to everything that almost everyone holds dear… and it’s more than a lot of us can bear to make the last decision of a child’s life. Instead, we try. We try hard and we keep trying. We hold out hope against thought and fight on, sometimes against futility.

But in my mind, I think I know why it is… because no healthcare person wants to be the person who looks into those pleading eyes and says “I’m sorry”. That decision takes an enormous emotional toll upon the parents and family, of course… but also upon the EMT or Paramedic. It’s ultimately easier on us as EMS people, we reason, to fight on. To race headlong into futility and hold out hope that someone else won’t have to say “I’m sorry”. At least we won’t have to.

There are probably psychological studies out there that I haven’t read that deal with the issue of whether “CPR Theatre” is harmful or helpful to the long-term well being of the surviving family. These studies are probably well-researched. I took a class once that told me that it was better for family members to be in the resuscitation room inside of a hospital to witness the events as healthcare people try to save their loved ones… and I can understand that I guess. Perhaps it is better to witness that “everything possible was done” for your departed loved one. I don’t know.

As healthcare providers, it is our sworn duty to alleviate suffering as best we can using the tools at our disposal. I, like most of my colleagues, realize that the secondary and tertiary patients that we treat are the family members and their grief reactions to the tragic circumstances that resulted in their calling us. I am reasonably comfortable handling their grief reactions and sadness when an adult passes on scene but I am humbly inadequate to be of much comfort to a parent that has just lost their child no matter how I might try.

My guess that futile CPR theatre can be explained as being more for the parents and families of departed children than it is for the slight chance that we might have missed something. We make the effort in the name of showing to the family members that “everything possible” was indeed done, up to and including running their child lights and sirens to a hospital. I’ll even admit that in the back of the ambulance while I’ve done this, I’ve prayed right along with the family that just perhaps this once we would have a miracle. Never once has it happened.

Here’s a mea culpa for you, even though every time I’ve gone through the motions I’ve said it was for the family… It may really have been for my own benefit as I’ve stated it could be above. I am a paramedic and I’ve seen my share of pain, but I don’t think that I can look a parent in the eyes and say “I’m sorry” ever again. I just don’t want to and as I write this, I can’t imagine that I could do that and then come back and look the guy in the mirror in the eyes without wondering if maybe this time would’ve been the miracle. I am probably selfish for this practice… but is that wrong?

From a completely actuarial perspective, no futile resuscitation should be performed due to safety concerns and the unnecessary costs involved. I agree that with adults, transporting cardiac arrest victims is probably deadly. I also understand that no ambulance should risk a lights-and-sirens trip to transport a body to the emergency room. However, I am not an actuary. In those cases I’m a witness to horrible emotional pain and I want someone else to be the one who says “I’m sorry”. It’s human nature, perhaps.

In my career, I have told parents “I’m sorry, there’s nothing I can do” in cases where it was blatantly obvious that the child was long beyond hope of any intervention. I’ve done it more than once and I can see the places where I’ve done it in my mind to this day. Sometimes it’s completely obvious that there is indeed nothing that anyone can do. However, occasionally I have indeed known this and just done it anyway. Perhaps it’s completely subjective. Perhaps it was my level of experience and intuition that guided me at the times I’ve made the decision. I’ll tell you this, it certainly wasn’t a decision made from the pages of a textbook.

I don’t have the answers to this. But I do want to go home and hug my kid. My only advice to the EMS people out there is to realize that we’re all human, and that all you have to do is your best. Be compassionate, and use your best judgment. For that’s all we can ever do.

For more on this powerful topic for EMS, head over to Greg Friese’s page and also to Steve Whitehead’s page. You also may want to read “Splashed Sadness – A look at Negative Emotions in EMS” where I further explore the sad side of EMS and our reactions to it.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on January 5, 2010 • Filed under: Ambulance, EMS, EMS Blog, EMS Health & Safety, EMS Topics, EMS ethics, EMT, Emergency Medical Services, Ethics, Fire Rescue Topics, Paramedic, Patient Management, The EMT Spot, Training & Development, bad calls, cpr, emotions, everyday ems ethics, inside the mind of a paramedic, medical ethics, patient care, psychology, sadness

EMS Pay Sucks!! (part 3) – Who or What is at fault here!?

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Welcome back to the “Life Under the Lights Bar and Grille”, your local dive bar filled with lousy food, tepid beer, bad ambiance, and great friends. Like any local Midwestern dive bar, it’s a come-as-you-are-and-sit-on-down-and-hang-with-your-buds kinda place. A conversation has broken out on the topic of “EMS Pay Sucks!! Let’s DO something about it!!” and me, your local blogger has decided to write a series of posts explaining the issues as I see them.

So, if you haven’t been here to read the last two, I suggest you go back and read them before you read this. If you don’t, well then that’s your choice. It’s a pretty informal place we have here.

Part 1: “EMS Pay Sucks!! Let’s DO something about it!!”

Part 2: “EMS Pay Sucks!! (Part 2) – Identifying the Problem

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In the last two parts here at the Life Under the Lights Bar and Grille, we’ve established that the time for talking about the issues is over, and that all EMS people need to band together in an effort to affect the pay rates in our profession. We’ve also established that this is a very complex issue and it can pretty much be said that if this was going to be easy, that it would have been done already.

If you’ve read the comments that I’ve gotten on the other posts in this series, this is a hot issue with vastly different valid arguments that have been brought forth by people I respect. While I agree with a lot of what has been said, I would like to boil the issue down a bit further than it has been brought in the comments section and in the information that I have previously been exposed to. Basically it’s like this: By examining other occupations that are well compensated for their skills, we can examine the position we find ourselves in with our profession.

I think that it works like this, Well Compensated Occupations have these things in common:

There is a medium-to-high barrier to entry – Whether by education requirements, location, or the unpleasant nature of the work, there is a barrier to entering the occupation that requires work and/or an affinity for the location or work involved to get into the field. Not everyone can do it, the people that do it but cannot do it well easily fail out, and the people that can hang around to do the work are rewarded for it. Look at Dental Hygienists, teachers, and IT professionals.
There has to be a perceived value in compensating the people in the field at a higher rate to achieve higher performance – Look at the salaries of professional athletes and CEOs. They create value intensively based upon their knowledge and talents and the better they are at doing what they do, the more value they create for their employers. Think of it, if you could raise profits in your company $5million per year, wouldn’t that be worth an extra $1million per year in payroll?
The Industry they work in turns significant revenue overall – You could be the most talented Ice Sculptor in the world, but if you couldn’t find a market to sell your ice sculptures to before they melted, you wouldn’t make any money at it. Nor would you if you were the executive chef at a greasy spoon. Sure, you’d have the same job title, “Sculptor” or “Executive Chef”, as a sculptor that worked with Marble and Gold, or an executive chef that worked at a very fancy restaurant in downtown New York… but since the places you worked for weren’t making any money, you couldn’t possibly be paid very much; Even if you were as highly educated and more talented than your counterparts at the fancy joints.

I think that overall, point number three above sets the tone for us. Our industry doesn’t make much money, therefore, no matter how caring, compassionate, qualified, or talented we are, we won’t be making much for working in it. It’s pretty much that simple. Sure, some salaries are artificially inflated due to varying degrees support from governmentally levied taxes, subscriptions, or corporate support but if we were to stand solely on our current business model, the “fee for service” model where we only get paid if we transport and most of our customers do not pay then we’d all be much poorer than we are now. In fact, most ambulance services would be out of business.

I’ve heard the argument that one form of EMS delivery or another is “Ruining it for the rest of us” with people in one camp bemoaning “the privates” for being all about profit and not paying their employees due to the money grubbing nature of their owners, and people in another camp bemoaning “The Fire Guys” for holding the profession back and keeping educational standards low so that their fire guys don’t have to get the advanced education that would be required of other well-compensated healthcare professions. People in almost every camp bemoan the volunteers saying “If they do it for free, how can we expect people to pay for us!?”

Well, while all of those arguments sound plausible enough and may hold some truth to them, they’re crap when you really look at them. Should all restaurants be Governmentally based like the Fire Departments because then pay would be equal across the board? Right now people that work in Government cafeterias earn better money than those working in Flo and Gino’s Diner down on 5^th St. Flo and Gino’s Diner is *ruining* the restaurant business, right? How about IT professionals? People that work doing advanced networking at IBM earn WAY more than the people that do networking at your local newspaper office. Does that mean that smaller operations, and not large companies are *ruining* the IT business? Waitresses that work in Casinos and at Hooters make way more than do waitresses that work at your local fancy chain restaurant… Is TGI Friday’s to blame?

Every business, governmental organization, or organization on Earth in one way or another, is a system that takes in money and other resources, does something to it, and then spits out something with perceived value to it. The military takes in vast amounts of money, manpower, and other resources and doesn’t make a dime doing it. Its value is in protecting the interests of the society that funds it and therefore it’s usually a governmental pursuit. Diamond mining takes a lot of resources and money to perform as well, but since diamonds are sold for huge profits, it’s a pursuit of the private sector. I don’t get much into politics on my blog, but I can say that personal experience has taught me that capitalism works and that government rarely does anything better, more efficiently, or faster than does the private sector. Government bodies, by definition, rarely are any good at staying within budget, let alone making a profit, and when they do try to make a profit, they fail spectacularly… e.g. Fannie Mae and Freddie Mac. By definition, the Fire Service doesn’t make a profit, and they have branched out into providing EMS in a lot of cases, solely to get a piece of the transport revenue to support their other operations. Private services, by definition, are doing the same… Neither one is inherently evil.

And neither are volunteers. I work in rural areas and I’ve always lived in them. Heck, my hometown had more cows than people and yet I still needed someone to bring the ambulance whenever the farm hand got trampled on by Bessy. Rural areas have voluntary agencies where community members step up to the plate to provide services out of the humanity they have to their neighbors and also because of the fact that if they didn’t do it, nobody would. That’s not evil, it’s just a reality of rural life. (There are benefits to the volunteer services that I will expound upon in a later article not in this series as well.) (Disclosure, I’m a volunteer paramedic and dang proud of it).

A paramedic blogger who I really respect, TOTWTYTR (Who writes the blog “Too Old to Work, Too Young to Retire”) offered the following comment on my post “Paramedics Providing Physicals? Decreasing Healthcare Costs and Improving Patient Care – EMS 2.0”

“Chris, you seem to be intent on finding more for paramedics to do. I’m not sure why, when there is a “shortage” of paramedics we need a heavier work load or “expanded scope”. We’re also likely intruding into someone else’s work space in the process.

Nor can I say that giving more for the same amount of money of benefit to the profession. In fact, I’d opine that it will have the opposite effect.”

His argument looks good too, when you don’t share the same definition of a business as I do and you don’t view EMS as a business, which it is. Remember my third point above, the one about industries that don’t make any revenue being unable to compensate their employees at a reasonable rate. My idea in the above post, to have a paramedic provide your next annual physical, is another service that we can use to sell for a profit. The belief that we can survive solely on transport revenue has not panned out when most of our transport revenue is based upon dwindling government reimbursement through Medicare and Medicaid (and the looming universalization of healthcare) and the tax revenues we rely on from local governments is starting to be eaten away. We have to find new sources to generate revenue from. We’ve got to compete in the marketplace to either do old things better and/or cheaper or do new things before anyone else does them. Our profession is not insulated from capitalism just because we layer ourselves in compassion.

So to end this long rant, I think that we can go a long way towards solving our pay problem by turning our attention to the three points above.

First, educational standards must be universally standardized, universally raised, and must be owned by our professional governing body. While we should probably never make a Master’s degree the entry point to ambulance work, it shouldn’t be a GED either. Probably some PE classes should be in there as well, or at least the ability to pass them. Go Get Educated!

Second, we have to educate the public about what it is that we do and why being good at it is important. If the public thinks that a volunteer service with a BLS response is adequate, then they’ve never laid there with a broken femur only to be bounced down a gravel road next to an EMT-Basic that can’t give them a squirt of Morphine. They’ve also never had their MI go into cardiogenic shock because the BLS volunteers couldn’t give them correct medications to mitigate the damage. They have to be shown convincing evidence of these facts before they will, and someone has to be our cheerleaders. Honestly, I’ve never seen an “EMS Cheerleader” or someone who was promoting the profession to the public, that hasn’t been skewered by their peers. Maybe NBC’s “Trauma” wasn’t the most accurate show in the world… but neither was “Top Gun” and we loved that movie and wanted to be a fighter pilot after seeing it (last week, again). Be an EMS Cheerleader in your community!

Third, your EMS service needs to go do something to make itself money. Figure out what you can do to boost revenue, and do it. Try new things. There are a lot of business ventures that have a good synergy with EMS.. Perhaps you could sell those little “I’ve fallen and I can’t get up” buttons and home-safety devices to the elderly in your community. Perhaps you could do home healthcare. Perhaps you could offer OSHA safety consulting to business and industry in your jurisdiction. All of these things are very much part of what we can, and probably will be doing in the future. Seek out New Ideas and Profitable Ventures!

I haven’t figured out the title to the next post in this series, but I’ll be writing it tomorrow. I’ve loved the debates that have been popping up in the comment’s section and I’m sorry that I haven’t jumped in there much as of yet. I’m just trying to keep my ideas to the main posts, and then I’ll come back and debate when I get out what I want to say. You all have been creating some great energy and while we’re not going to agree on this, I’ll say it again “Perfection is the Enemy of the Good Enough”. Complete agreement is not necessary for us to act upon a consensus.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on December 30, 2009 • Filed under: Administration & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS pay sucks, EMS pep talk, Economics, Emergency Medical Services, Funding & Staffing, Paramedic, change, ckemtp rants, ems 2.0, ems salary, paramedic salary, politics, profession, salary

EMS Pay Sucks!! Part 2 – Identifying the problem

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Part 1: “EMS Pay Sucks!! Let’s DO something about it!!”

Part 2: “EMS Pay Sucks!! (Part 2) – Identifying the Problem (you’re here)

Part 3: “EMS Pay Sucks!! (Part 3) – Who or what is at fault here?

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The way our country compensates its EMS personnel is an abomination. It’s almost criminal, it’s inhumane, and it’s just plain wrong. Paramedics and EMTs do not deserve to live at, near, or below the poverty line simply because they chose to make a career out of helping others. We do not deserve the shame of being struggling from paycheck to paycheck. We do not deserve the hardships of trying to raise a family and continuously have to explain to them just why it is we have to work so many hours and have such little in our paychecks to show for it.

I know that EMS compensation is frankly despicable… but you don’t have to take my word for it. There is a lot written on the subject that comes from some very credible sources. Some examples:

“Five Surprising Salaries” – From Http://www.CNN.com

Favorite Quote (but the read the link to get even angrier):

“Paramedics

What they do: Paramedics respond to emergency situations and attempt to provide the necessary medical care, whether it involves transporting participants to a hospital or treating them on the scene.

Surprising salary: $27,070. Seeing as paramedics have high stress jobs that require them to be on call and ready to save lives at a moment’s notice, you might expect their mean annual salary to be higher.”

“We Don’t Pay Them Like Heroes” – By one of MY heroes, Dr. Bryan Bledsoe – This article is about 5 years old now, but it’s sadly very much still relevant. It’s from Http://www.EMSresponder.com
The US Bureau of Labor Statistics page on Paramedics – This one’s a long read, but if you’re only skimming it you should skip to the statistics on the salaries. Here’s my favorite quote from the article, under the heading of “Related Occupations”

”Other workers in occupations that require quick and level-headed reactions to life-or-death situations are:

Air traffic controllers

Fire fighters

Physician assistants

Police and detectives

Registered nurses

All those links work, by the way. Here’s a little pre-test question for you: Of those “occupations” listed above, which one is markedly the lowest paid??

I’ve been in full-time EMS for over ten years and currently work two-full time paramedic jobs. Not only do I feel the low wages, awful benefits, and long hours personally, but I also see what my coworkers go through with their lives and their families. What does one do when their calling is something so vital to the community, yet is so unappreciated financially that it hurts their families and their future?

In my travels throughout the nation I have had the chance to seek out and speak with EMS people in a lot of localities. I tend to visit odd places and I make it a point to seek out and get into conversations with interesting strangers. Luckily, all of the EMS people I know seem to fit the description of being “interesting”. I’ve heard them speak of the same problems that I’ve experienced. I’ve seen the pain and embarrassment in their eyes as they describe their love for the job and try to downplay the fact that they’re struggling financially. I’ve heard the same stories almost every time I’ve spoken with them. When they were young and new to the profession the long hours and low wages didn’t matter all that much to them… However, once they spend about five to ten years working the box they tend to experience the same struggles that I have. Spouses and Children don’t like it when the EMS person continues to work 100 hours a week to earn a paycheck that only comes close to covering the bills. They don’t like not having any disposable income. They don’t like the 24/7 demands of the job too much either. These facts rear their ugly heads when the EMS provider reaches a certain point in their life, and a career in EMS gets harder and harder to justify. Ever wonder why you don’t see many EMS professionals that have been continuously working full-time EMS for more than ten or so years? It’s for this reason. Sure there are a lot of exceptions, but I would think that the statistical clustering would bear this out. Eighteen-to-twenty year olds enter the profession, become family people around five-to-ten years later, and realize that the hours and the money they get for those hours are killing their family life… then they get other jobs, or stay in EMS and become very bitter about it.

So if I were to be asked to identify the problem using words that everyone could understand, I’d say this:

“The public is counting on the people in Emergency Medical Services to protect the lives of themselves and their loved ones. They then turn around and compensate them for this task at about the level they compensate fry cooks. They demand that there is a paramedic or EMT immediately available to them at all times to help them when the unthinkable happens, but they aren’t willing to pay them more than they do their bartender or waitress. People need advanced care immediately available to them in order to maintain the quality and presence of their lives after an emergency, and they need highly trained, experienced, and dedicated people to provide that care, but all that care seems to be worth to them is poverty-level income. What is wrong with our priorities?”

What is wrong with our priorities indeed.

I think that the above information is enough to identify that I think there is indeed a problem here. It’s an almost overwhelmingly complex problem as well. However, if it were an easy problem to fix, it would have been fixed by now. Fixing this has become mandatory for me, as it is mandatory for all of you. I’m writing this to contribute to the solutions that we’ll have to put into place, and by participating in this, you’ll be too. Over the next few days, I’ll be posting parts in this series, because I don’t think that one post will provide as many angles as I feel I need to.

One thing I do know, we’re going to act on what I put out here and on what you add to the discussion in the comments section and in your daily lives. We can no longer hope someone else will act. I ask every person who reads this to participate for our own well-being and the improvement of our profession. We’re not going to agree on everything, but “perfection is the enemy of the Good Enough”. Complete consensus is not necessary, action for our collective professional well-being is.

Coming tomorrow: EMS Pay Sucks!! Part 3 – Who or what is at fault here?

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on December 29, 2009 • Filed under: 911 fail, Administration & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS pay sucks, EMS rant, Economics, Emergency Medical Services, Funding & Staffing, Paramedic, change, ckemtp rants, ems 2.0, ems salary, paramedic salary, politics, salary

EMS Pay Sucks! Let’s do something about it

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We’re gonna have ourselves a little Audience Participation Exercise.

This whole blogging thing is a pretty intimate relationship, isn’t it? I mean, you all have your favorite bloggers that you regularly read and I’d be quite honored if you’d count me among them. I write straight from the front of my ambulance and I’ve been repaid by all of you for it by your sheer act of coming to read what I have to say. I rarely hold anything back from your eyes, and this is no exception to that rule.

So please, dear reader, humor me for a bit here while I pull you in to a pretend scenario. I’m a rural Midwestern guy and like any of my peers I like my dive bars. Of course, I’m a family man and I try to be a good one so I don’t frequent them very often anymore, but the one thing that I’ve always liked about them is the conversation that develops centered around the non-formal atmosphere that they hold. It’s pretty intense most times, usually brutally honest, and always entertaining as all get out. Everybody’s equal with a can o’ PBR in their hand. (or, diet pepsi for the young folk as we’re a family establishment) (no swearing either) (well, not much).

So let me invite you to the “Life Under the Lights Bar and Grille”. Coming soon to this little blog of mine is the beginning of my crusade to kick the current EMS pay rates and system thereof squarely in the behind. I’m frankly, mad as heck and I’m not going to take it anymore… well, at least as blogging is concerned as I still have to make a living, you know. Don’t get dressed up, come as you are, and let’s have a spirited conversation about why EMS people make such crappy money for doing what we do. I’ve got enough ideas on this topic to carry me through a few evenings of my wooden “free drink” nickels and I’d love to share some brutally honest conversation with the EMS folks in my audience that I think can make a difference in the quality of life for those who save lives. We need to, we have to, and we deserve to.

On duty personnel will be limited to a three-drink-maximum, as long as it’s coffee or a soft drink of their choice. We are consummate professionals, you know.

Starting tomorrow I’m going to be writing a few good rants on this topic. I’m holding back tonight because well, coffee lends itself to more coherent writing than does late night camaraderie enhancement beverages. However, if you all would do me the honor of getting started by reading the following posts of mine:

Read this too if you want to get mad:

http://www.bls.gov/oes/current/oes292041.htm – The US Bureau of Labor Statistics Paramedic Salary page

————————

I’m turning this into a 5 or 6 part series, so here they are:

EMS Pay Sucks!! (part 2): Identifying the Problem

EMS Pay Sucks!! (part 3): Who or What is at Fault here?

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on December 28, 2009 • Filed under: EMS, EMS Health & Safety, EMS Topics, EMS pay sucks, Economics, Emergency Medical Services, Funding & Staffing, Paramedic, US economy, ckemtp rants, ems 2.0, ems salary, politics, potential

Thanking Those who REALLY Deserve it – Merry Christmas

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I originally meant to post this during Thanksgiving, but this season seems appropriate enough. I love Christmas. It’s my most favorite time of year. I love family, friends, cooking, and giving gifts. I love Christmas parties, I love the fellowship, and I love being kind to everyone and having them not look at me strangely… ok *as* strangely as they do other times of the year.

And also, I tell people “Merry Christmas”. I don’t say “Happy Holidays”, “Happy Winder Holiday”, or “My lawyer sez to tell you ‘good luck”. If someone responds with “Happy Chanukah”, or “Happy Kwanza”, or “Happy MishMash Shaloob” I’m not offended by it and I’m happy that they wished me the sentiment so there ya go.

Oh, and to my UK friends, Merry Frumpydumples to ye’

So what’s my Christmas post going to be? Well, it’s about thanking who’s really important to thank. As you all know, I’m a volunteer paramedic and firefighter as well as being a career paramedic and firefighter. This time of year in the small towns, it’s pretty common to have people stop by and offer up sweet treats and tell us “Thank you” for what we do for them. Let me make the blanket statement that I really appreciate it folks, even if my waist line and my pending diabetes doesn’t. However, I don’t think that I deserve your thanks.

I have always gotten more from my service to others than I could ever hope to give back to it. I love EMS and I love the Fire Department and I love helping people. I identify with it and I couldn’t imagine my life without it. Even after a solid decade of running my “Life Under the Lights” I can’t imagine doing anything else. I am rewarded a thousand times over by every smile I get, every person I comfort, and every person that I am privileged enough to come into contact with as a caregiver.

So who should the people that wish to thank us actually be thanking?

Well , first thank my wife for every time that I’ve had to get up and leave for a volunteer call in the middle of a family dinner. Thank my kid for every time that I’ve missed out on play time, or story time, or nap time because the pager called me away. Thank my family for all of the times that they’ve had to do without me because I was working mandatory overtime. Thank my wife too for all the nights she sleeps alone because I’m on a 24 and am sleeping at the station. Thank my friends for all the times that I’ve stood them up on plans because I’ve gotten stuck running calls. Thank everyone who cares that I spend time with them, because a lot of the time I could be doing that I’m off caring for everybody else.

Thank the same people for every volunteer or public safety person you know… because without the caring and understanding of the people that truly matter in life for us, we couldn’t be out there doing it for you. They’re the heroes here.

That, and one more thing. I was never in the Military and I probably should have been. This may not be much, but Thank You to all of our Military Men and Women out there serving for me and my family. I can’t write enough to say how much I deeply, and truly appreciate your sacrifice… but from the most humble part of my heart, Thank You for everything you do. The same thanks goes to your families and loved ones as well.

Merry Christmas, Every one.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on December 24, 2009 • Filed under: 2009, Ambulance, EMS, EMS Health & Safety, EMS Motivation, EMS Topics, EMS ethics, EMS pep talk, Emergency Medical Services, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, In the Line of Duty, Line of Duty, News, Paramedic, appreciation, fire, pride, profession, professionalism

Swinging a Sledgehammer and Thinking about the UK… Strange times

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So here’s the good news. The ambulance service I work for up North, “Ambo’s R’ us” has finally taken the leap and is getting us a new station. Yep, that’s right folks. I will no longer be living in squalor whilst working up here in the vast frozen wastelands.

Except for one little hitch in the gittyup.

In big ambulance services, when one gets a new station, usually the service employs people to work on the station, build and/or remodel the station, and move the stuff from the old location to the new one. Not so in a small, rural ambulance service. Nooooo…. Here, a paramedic is expected not only to work on the ambulance during their shift, they’re also expected to put on their tradesman hat and get their hands dirty.

So, yep… today Ckemtp was not *just* a paramedic. Today yours truly was a demolition man, a moving man, a wall-paper remover, and a carpenter’s apprentice. All of my crew mates were today too, as were the crews yesterday, and so will be the crews who are unlucky enough to come work ambulance shift any time in the next couple of weeks.

But here’s my mea culpa confession folks: I’m not handy.

There, I said it. I am so not handy that hardware stores actually have my picture up on their walls stating that I must ask for staff permission to enter their premises. Apparently they want someone to follow me around with a fire extinguisher because there’s a concern that I might come into contact with a carriage bolt or something and the resulting sparks will start a fire. I, like most of my colleagues, became paramedics because we’re generally not handy enough to get a good paying job in the construction and/or “real job” industry.

What’s that you say? You’re a full-time paramedic/EMT and you own/work/watch a construction business on the side? Well good for you. I don’t. I write stuff about stuff and ride ambos.

The dreaded “other duties as assigned” clause in my job description is being stretched so thin here that you can hear it singin’ in the wind. I didn’t sign up for this. It’s actually very hazardous to my health and well being for me to be doing anything remotely construction or “handyman” related.

There’s a lot of reasons why, the risk of fire, explosion, and/or structural collapse being amongst them… but they’re not the real reasons that I’m so worried about this. You see, I have a lovely wife named Gkemtp(it) who is the absolute light of my life. However, together we own a home which happens to be the scourge of my existence. Like EVERY guy who owns a home, my home is full of things that are disintegrating at an alarming rate. There’s ALWAYS something that needs fixing and they rarely respond to an IV, o2, and monitor. Heck, even my clock radio didn’t do well with defibrillation. I can’t give my clothes dryer Epinephrine to get it started again, my clogged drain didn’t respond to a heparin bolus, and my leaky faucet leaked right through an occlusive dressing. I just don’t understand my home and its malfunctions the way I understand humans and their maladies. It’s awful.

So my wife knows that I am the opposite of the handyman… and she’s pretty ok with it, lest she nag and have me end up breaking something much, much worse than it was before I tried to fix it. I *like* that she’s ok with it… And I don’t need her to think that I came to work, built us a shiny new ambo station, and learned how to be Bob Vila with an NREMT-P patch. It’s bad enough that I clean toilets, vacuum, and do dishes here at work. If she found that out, she might make me do more of that at home.

So I’m stuck here. I’m destined to make anything I fix much worse than it was before, I’m destined to demolish something I’m not supposed to demolish, and I’m destined to make an egregious wiring error that’s going to burn the place down while I’m sleeping inside of it and I won’t even get to go to the fire because I’m on ambulance detail!

Maybe I should move to the UK and work with my good buddy Mark Glencourse, of Medic999 fame. One of the biggest things I took from the Chronicles of EMS, his and Justin Schorr’s (The Happy Medic) foray into cross-national EMS exchange (Soon to be an AWESOME TV show!!) is that UK firefighters DON’T CLEAN THEIR OWN STATION! Yes. They FREAKING HAVE CLEANING CREWS THAT COME IN AND CLEAN UP ALL BUT THE MOST SUPERFICIAL MESSES! Hell, they even have a bona-fide chef to cook for them.

And here I am, scrubbing toilets and swingin’ a sledge hammer here in the ‘States.

So, I’ll keep toiling until I break something so bad that they make me go post somewhere where I can’t hurt myself, and Mark will keep living in the lap of luxury.

Maybe being a Limey isn’t so bad.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on December 20, 2009 • Filed under: 911 fail, EMS Health & Safety, EMS Humor, EMS Topics, EMS pep talk, EMS rant, Fire Rescue Topics, Line of Duty, UK paramedics, Your Happy Medic, appreciation, ckemtp, ckemtp rants, grumblemedics, humor, medicblog999, united kingdom

A quick Shoutout to EMS Chick

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EMS Chick has shared a bit of my EMS geekery on her blog “That’s BLS, not BS” (which is a title I just love). She wrote a post about decontaminating the ambulance from a LOT of mud… and um, showering with EMS equipment too…

http://emschick9.blogspot.com/2009/12/hidden-joys-of-ems.html

I wonder what results one would get if they fired up Our Friend Google and typed in “EMS Chicks Showering with EMS Equipment”. Are ya back? Good, now try it with the “safe search” off. (Note to my wife, I did not try this)

Take care everyone

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on December 15, 2009 • Filed under: EMS Health & Safety, EMS Humor, EMS Topics, Emergency room, Uncategorized, disinfection, humor, infection control

Welcome to Hell Feet 2: Magnum Boots Review

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As promised, here is the review of the new EMS Duty Boots that I was given to try out.

First of all, if you didn’t catch why I am writing a post about EMS and Fire work boots, you should read the post here: “Welcome to hell, Feet”

A while ago, I was contacted by Magnum Boot company to review their new Magnum Elite Force 8.0 WPI boots. The deal was, they’d send me free boots and I’d wear them and tell the devoted readers of my “Popular EMS blog” (both of them) about my thoughts on the boots.

So I decided to put these boots, and my poor feet, through hell week. My thoughts were that you all were gonna get Magnum Boots Money’s worth and the fruits of my foot pounding in a post where I review these things that are on my feet as I type this.

I wear my boots a lot. If I am working, my boots are on my feet. Since I work anywhere from 70-110 hours every week I had quite the chance to try them out. Trust me, this post isn’t going to be boring. During my hell week for my feet I had one of the best rescues of my career. Sure, I did lawn work, and played tag and kickball with the kids, but I also free climbed a 70 foot 100 year old grain silo to treat a critical trauma patient and put in some pretty tough other calls too. So let’s dive in, shall we?

Magnum Boots sent me their Magnum Elite Force 8.0 WPI boots to try out. The first thing I noticed is that they look sharp. They don’t have the nylon filler stuff on the sides that I don’t like the look of, and while they’re not exactly what I’d consider to be leather, they’re made of some stuff that looks and feels great. They’re also not even close to what I’m used to. I have always worn steel toed boots in the past. I like them because of the things we get exposed to in the field and the dogs that sometimes think my hindquarters look tasty. I also like the side zip models and these are straight laces. I suppose that one could put in a front-zipper insert, but I didn’t for this post. They’re also taller than I usually wear by about three inches.

They took some getting used to, but I didn’t want to review them before I broke them in. So, the first thing I did was put them on and mow my lawn. I don’t usually do that in my duty boots in order to keep them looking nice, but I wanted to see how they felt. As expected, when new they rubbed in places that they shouldn’t have. I didn’t get any blisters though and within a day or two they broke in quite nicely. Now they’re comfier boots than I’ve had in years.

Another thing I notice is that when working 24hour shifts or working in a fire station where you must put them on and take them off quickly, the height and the laces impede me getting them on and off as fast as I’d like. I’ve got the hang of it now, but they’re not as fast getting on at night when getting up for a call than my zipper boots were. They also got sworn at once or twice when trying to slip them off and get into my fire boots. Again, I’ve got the hang of it now… but I’d suggest that they add a pull-loop at the back to help in getting them on more quickly. This isn’t an issue if you’re working a shift where you don’t sleep or straight EMS without turnout gear.

The next thing I noticed was how stable and light they are. I played tag for an hour with my 5yo boy and the neighbor boy and was able to juke them like nobody’s business in damp grass. They don’t quite feel like I’m wearing tennis shoes, but they’re close. I can run and jump and play with the kids in them and be quite comfortable. The first ambulance shift I worked in them it was raining hard, I didn’t slip a bit on the wet leaves and didn’t have a drop of water get in. I’ve purposely walked in puddles and sprayed them with the hose and my feet stay dry. They have something called “Ion Mask Technology” (which is something scientific involving bonding individual threads with something sciency.. I think. It means “liquid-proof”) which they bill as a new process to treat them, head to their website to check it out.

That first ambulance day was awesome, we got called as a single ambulance response to a very rural dairy farm for a “Male Subject Crushed By an Engine In a Silo” Going out there, the information was that he was 70 feet in the air. We arrived first after having dispatch tone out the volunteer fire department that covers that area. Right off the bat, I hopped off the ambulance into ankle deep cow poop that was covering the whole area around the silo. The sheriff’s deputy directed me to a small, dark ladder on the side of the 100 year old silo that lead up to the top. The “rungs” of the ladder were steel rebar and after all that time, they were very worse for wear. I climbed it and noticed (Yes, I was actually thinking about the boot review) how stable the boots were. Once I got to the top, the silo was full of corn silage (shredded corn stalks) and our patient was lying on top of them, gravely injured from having a 700 pound engine that powered the silage pump fall on and crush him. It took a 2 hour tech rescue on top of that pillowy, messy, unstable silage to get him out. He survived… and so did my feet.

All it took to clean the boots? A quick spray from a garden hose. My feet felt great. I even took off the boots that night for bed and noticed that my socks weren’t wet. It was like my feet hadn’t sweated at all. My old boots had big holes in them and my socks came out soaked with sweat even on a dry day, these boots breathe and that doesn’t happen. I’m really shocked about that.

After two weeks of hell on my feet, the boots don’t show any signs of wear other than being broken in. I’ll wear them from now on.

I recommend them without reservation other than the above caveats. Magnum Boots, your free boots passed my test. You can send me free stuff anytime J

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on November 28, 2009 • Filed under: EMS, EMS Health & Safety, EMS Topics, Emergency Medical Services, Fire Rescue Topics, Magnum boots, duty boots, fire boots, magnum elite equipment

The day I didn’t die – Firefighter Close Calls

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Laying prone on the quivering floor, I had been pushed down flat on my stomach by the searing heat and smoke. I was as terrified as I’d ever been as I frantically yanked and tugged on the inch-and-a-half hose line that was stretched down the basement stairs towards the engine company that had disappeared down the dark hole an eternity ago. What had started out as a small, concealed fire with light wispy smoke conditions had quickly deteriorated into this hellish, searing inferno that I was convinced was killing the three men below me.

Twenty minutes before this, my two man tanker company had been first on scene to this structure fire that had been dispatched while we were returning from a small brush fire. We were the closest unit and were first on scene. Light staffing that day caught us when this fire was reported during the height of our daytime volunteer shortage. These factors combined a two-man tanker company together with a two-man brush-truck company to make a primary search of the structure. The light smoke and little heat had lulled us into a false sense of security as we entered the single-family home. The concealed fire between the first floor and the basement caught us unaware. It spread quickly and weakened the floors we were standing on. When I found the first floor had been weakened, I sent out my partner to inform command as we were on the tanker and had no radio communications inside the structure. Unfortunately, another engine company with a hot-shot lieutenant arrived and, despite my fervent protestations to the contrary, he took his three firefighters down the stairs to the basement. I stayed to mark their exit.

Outside the air-horns sounded their three quick blasts, calling for an evacuation of the structure. I stayed, waiting for the crew to emerge from the staircase so that I could lead them to safety. They never showed. The intense heat burned me through my turnout gear as I screamed as loud as I was able through my SCBA mask into the abyss. I tugged on the hose and screamed at them to return, only taking a break to recognize the ringing of my low-air warning bell on my air tank. I had no idea how long it had been ringing, but when I noticed it, it was slow. Instead of a sharp ring, it was a slow ding that was getting slower as I was sucking as much air as I could to yell down the staircase.

This moment, this intense moment, was where I made a decision the likes of which I hope I never have to make again. I knew that if I stayed more than a few moments longer, I would suffocate and burn to death right there on that floor. I also knew that the men below me needed me to be there for them when they came out of the basement. They needed me to be there to lead them to safety.

It was a decision that made me choose between leaving my brothers to perish by saving my own life, or staying to face my own probable death. Ding… Ding… Ding… the sluggish bell ticked off my air supply, inching ever closer to the point where it would just stop, leaving me to asphyxiate.

That moment, I chose to flee and save myself. It’s why I’m sitting here typing this story.

I knew where I was in the structure. While it was pitch black from smoke and I was blind, and while every movement made my skin contact my turnout gear and burned me, I turned tail on my stomach and frantically crawled towards the doorway I knew it was only a few feet away. I knew I could make it. I knew my brothers were dead or dying. I knew…

“CRACK” went the floor as it opened up to reveal the inferno underneath my belly. I felt myself falling I saw the flames come up and envelop me. My vision turned from completely black to completely orange as I felt myself falling into the intense heat. I screamed and reached out ahead of me into the darkness. I clawed and flailed forward, grasping on to anything that I could grab to save me. God willing, my fingers found the concrete steps out the outside door to the residence. Inch by excruciating inch I pulled myself up and out into the light and the fresh air.

As soon as I was out of the house I stopped breathing as my SCBA mask sucked into my face for lack of air in the tank. I ripped it off of me and sucked in the sweet outside air. Waiting for me outside, about to try and find me, were the three firefighters who had went into the basement. They had evacuated through a basement door. Nobody knew that I was still inside waiting for them until they made a headcount in the confusing scene and found that I was not accounted for.

Looking back at this experience, I am proud of myself for finding out that I will go up to the last possible second to try and save my brother firefighters… although thinking about the decision I made to turn tail and run, I’m almost ashamed that I didn’t stay past that point of no return.

Of course, my policy is that I go home at the end of the day every day… but still.

Close calls are terrifying experiences. Thinking about losing any one of my coworkers or colleagues is unfathomable. It can happen, however, and we combat this reality with safety and organized command structures. This call was years ago in my career but it sticks in my mind at every call I’ve been to since that day.

Train hard. Keep your wits about you. Take everything seriously.

The Hole a firefighter fell through in a strucure fire (uninjured)

The Hole I fell through in a strucure fire (look right by the door)

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on November 25, 2009 • Filed under: EMS Health & Safety, Fire Rescue Topics, Fire department, Firefighter, Firefighter Safety & Health, Firefighting Operations, Fires, accident, fire, training-fire-rescue-topics

Uh oh, is it that time again? EMS Recert Time Cometh…

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I’ll betcha that a lot of you reading this are in the same boat that I am… Here’s the reminder!

Yesterday I had the occasion to pull out all of my various certification cards and licenses, photocopy them, and turn them in to one of my departments for verification that I still had them. Much to my chagrin I noticed that it is indeed that time again… the time for me to start gathering up all of my hard-won continuing education hours and credits, compiling them into packets, and begin sending them off to the various places that I hold licensure through.

So let’s see… that’s Illinois, Iowa, Wisconsin, and the National Registry of EMTs. Actually, the Illinois license is on a 4 year schedule, so this is an off period for them. Thank goodness for small favors. Unfortunately though, I also noticed that my ACLS card expires this month and I hadn’t noticed it till now. Now I have to frantically find a class to sit through and get me some learnin’ at. Here’s hoping it’s not like the last time I took the class… It was horrible. Since I had let my card expire by, ahem, a “short amount of time” (3 months) I had to take the full class. Worse yet, the only class I could find happened to be when one of the big hospitals near me was pushing through a bunch of OB/Peds nurses through the class so that they could accept regular med/surg patients on their units. The nurses, suffice to say, were less than thrilled to be there and answered most of the questions with “I don’t know, what does the Doctor order me to do?” The instructor, who was also a nurse, actually accepted that answer for most of the questions. Really. I listened to them give waaay off the wall answers that were accepted as correct by the instructor.

I don’t think any one of them has ever been in charge of a code resuscitation… at least not a successful one. But I digress.

The State of Wisconsin EMS bureau has been changing the rules for renewing your licensure quite a lot this year. Frankly, I don’t quite understand what I have to do as of yet but I’m working on finding it out. As far as I know right now I have to take a “refresher” program. I *think* that by completing a National Registry refresher program I will be fine. Feel free, however, if you’re in the know for Wisconsin EMS renewals, to set me straight on this in the comments section. It’s kinda important for my livelihood.

My Iowa EMS license is much easier. All I do is send them in the exact photocopied packet I send in to the NREMT, fill out a short little form, and a few weeks later I get a shiny new license in the mail. Thank you State of Iowa EMS! Keep Being Awesome!

For the National Registry, I’ve heard faint rumblings about this whole “Computer test based” renewal program. It sounds cool, from what I’ve heard… but I’d have to do the exact same CE for my Wisconsin and Iowa licenses and I wouldn’t get the CE bump I need for the 4 year Illinois license. So much for that, then.

Lucky for me, there’s an awesome NREMT recert class they put on in Davenport, IA. I’m heading out that way to get me some high-quality learning and have me a little bit of fun as well. Thanks EICC and MEDIC EMS!

This post doesn’t have much of a message to it other than for me to gripe about having to yet again put all of this stuff through. I am all for education, and I research EMS stuff nearly every day, but unfortunately I haven’t thought of a way yet to translate stuff I learn from my colleagues on the EMS blogosphere and the other sites on the interwebz into hard Continuing Education credits. Maybe I’ll spearhead that issue too once I get time. Maybe…

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on November 20, 2009 • Filed under: AHA, EMS, EMS Health & Safety, EMS Topics, EMS training, EMT, EMT-Intermediate, EMT-Paramedic Specialist, Emergency Medical Services, Iowa, Iowa EMS, Paramedic, Training & Development, ems education, paramedic education, wisconsin

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