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EMS 2.0 as Explained to My Brother

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

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

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

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

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

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

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

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

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

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

Grumblemedics

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Grumblemedics, you know them. You’ve seen them. Heck, you may even be one. Whether they’re a Grumble Pee or a Grumble Bee, there’s an apparent glut of them in the profession and I’d like to know why. See, to me, EMS is the greatest job in the world. Sure, there’s the great pay and benefits, but there’s also the great hours, plentiful time off, and comfortable ergonomic working environment. I can’t tell you how many times I’ve been just left with a warm-fuzzy feeling after a shift…

Ok, so that could have been an exaggeration, I know that there are things in this profession that just plain ol’ stink. But I gotta tell you, EMS really is my favorite job. I really can’t imagine doing anything else. While there are times in my career that I’ve wondered if it was an abusive, co-dependent type of relationship, I realize that I would not want to be anything other than a paramedic.

So why does it seem like there are so many Grumblemedics? Could it be the long hours with little chance of getting a day off? Could it be the fact that we must get up at all hours of the night to take care of someone in better shape than we are? Tangent: The other day another crew transported a person with a chief complaint of “Dry Feet”. When they asked him if he really wanted transported, he said “Yeah! I got dry feet!” Or, the one last night where a woman had an NSAID pain patch fall off at 4am and called us because she thought that she was going into withdrawal. End Tangent.

OK, heck with the ending the tangents. There are a whole heck of a lot of calls that can be filed under “They called us for THAT!?” Why do people do this? Why? I mean, I’ve been called for things that I wouldn’t even take an aspirin for more times in my career that I can count (And I know that’s more than ten because I have ten fingers and if you think that I’m going to take off my boots after working in them for all of these 24 hour shifts you’re nuts). Why do people call us when they have a muscle cramp? Why did the guy call me when he got a fish hook in his finger? Why do people who happen to be type 1 diabetics drink themselves into a stupor and then call me first thing in the morning to wake them up? Seriously, I once spent a few months going to some guy’s house every shift bright and early in the morning to squirt him with a little D50 and he’d sign the refusal that would send him on his way. It ended when we began putting him on the cot and starting to drive to the ER before we sugared him up. He’d wake up in the rig just as we were backing into the bay doors and be mad at US for transporting him. Sorry guy, but you obviously need more help than we can give you.

So, there may be times in my career that I’ve been a Grumble Pee, but that might be expected. Heck, if I worked in a factory I’d probably be complaining about the lack of adequate ventilation and the fact that I couldn’t sit in the crew lounge and watch TV for a few hours of my shift. We all complain about things we can’t change or our own perceptions of injustice. I would guess that any profession has those things that the people in the profession just hate. Heck, would any of us want to work retail during the holidays? They don’t even get to jab strangers with sharp objects or have their own keys to the leather restraints.. Now THAT would suck.

You know what my absolute, all-time, worst pet-peeve is in EMS? No? I’ll bet you don’t care either but this is my rant and you can’t seem to stop me. My biggest, all-time, worst pet-peeve in EMS is: People who don’t call us when they need us. Yep, I would gladly take a hundred 3am “lost condom” calls rather than have one potential patient have that occult MI and lose any percentage more of heart muscle than they have to because they didn’t want to call EMS and bother us. You see, I work in rural EMS these days where people are nice, and they don’t want to bother their local EMS service with getting up out of their chairs, and they don’t want to bother their neighbors with having to look out their windows at the pretty flashing lights, and they really don’t think that the fact that the left side of their body is numb is any reason to be alarmed. These non-calls that should have been calls bother me more than any of them, and we all grumblemedics are somewhat on the hook here.

If you’ve read any of what I’ve written, you’ve probably seen my statement that “PR Saves Lives”. It means that the more positive Public Relations an ambulance agency has, the more people trust them, and the more people are apt to call them when they truly need them. I haven’t seen studies on what an effective PR program does in reducing so-called “nuisance calls”, but I have seen recent studies that say like 60% of patients having heart attacks make their first call to a friend or family member upon the onset of their crushing chest pain. I’m here to tell ya, I’m jealous. I want to get that call.

So maybe grumblemedics like I probably will be about an hour from now when someone calls me at 3am for something that I would take pepto-bismol for need to remember that we are blessed to do this job, and that EMS professionals need to approach this business with the heart of a servant. Because that’s what we are. We aren’t here for our health, we’re here for everyone’s health. Sometimes people get scared and call us because they’re scared and it is our job to make them feel better by telling them they don’t have to be scared anymore. Sometimes we need to haul them in so someone with a whole-heckovalotta medical education can tell them that same thing. I decided a long time ago that if I ever got to a point in my life where I had to call the ambulance just so I could get some human contact because my real chief complaint was loneliness that I didn’t need some punk kid with a pulse and a medic card judging me.

Us grumblemedics need to realize that the nuisance calls are never going to go away. We’ve got to realize that there are, however, ways to combat them:

  • Check your Ego at the Door: You serve the public. Not the other way around. You are blessed and dang lucky to be the person that this person asked to take care of them in their or their loved one’s hour of perceived need and you best not forget it, because your mental health is at stake, and their life could be too. The best EMS people approach this job with a servant’s heart.
  • Evangelize EMS: You want the general public to know how to properly use EMS, right? Then what have you personally done to help teach them. Get out there and get the word out. Don’t hide in your station, or in the parking lot you’re posting in. Get the message out about what you’re there for, what you’re capable of, and how friendly you are while you are doing it.
  • Everything is PR: Every single, solitary thing an EMS person does affects the publics’ perception of them, their service, and the profession in general. Really. When you meet up with another crew for breakfast in the morning and talk about how wasted you got last night at the bar don’t think that the people around you aren’t listening. When you swear in public don’t think that the kids who are looking up to you in your shiny uniforms with your neat big truck aren’t filing that away. Take your public image seriously. Exude professionalism at all times because it saves lives. The more comfortable everyone is with your professionalism affects how apt they are to call you first, call you fast, or call you at all in a life or death situation. That can make all the difference for a lot of potential patients.

There’s a lot more that every one of us can do, but I’m tired here and I still have the last 8 of my 24 to do be
fore I have to get up in the morning and do 8 hours with my other full-time job and then do a 4 hour training with my volunteer department. Hey! I have an idea!! Maybe if there weren’t so many grumblemedics and the public took a more positive view of our value to society we could maybe squeeze some more pennies out of them at budget time and get paid better so we wouldn’t have to have so many freakin jobs and work so many hours to feed our families! Yea, wouldn’t that be great!!

As always folks, comments and flames are welcome. Public commentary is most appreciated, but I may always be reached privately at: proems1@yahoo.com

Posted by on April 8, 2010 • Filed under: Ambulance, EMS, EMS ethics, EMS Health & Safety, EMS rant, EMS Topics, EMT, Fire department, Firefighter, first responder, friendly, grumblemedics, Paramedic, PR, Public relations

The Shine Factor

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 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

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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

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

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…)

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

Everyday EMS Ethics – Social Media and “Smart” phones?

9 comments

Today I finally joined The Future™ and got up to speed with the latest technology 2006 has to offer by purchasing myself a shiny new BlackBerry Curve™ “Smart” phone. This thing is SO COOL! I can access my tweets, my facey page, and all of my other online stuff right through it AT ALL TIMES. It’s not an overload, really… I like carrying on 14 conversations at once… at all times. Really I do.

This new addition to my arsenal of cool tech gadgets got me thinking about a story I heard somewhere about a young firefighter/EMT that ran into a bit of trouble with one of these things. Incidentally, this story could have come from any public safety agency anywhere these days, so you probably don’t know whom I’m speaking of here, but if you think you do then go kick that person in the butt for me.

Anyway, this young firefighter/EMT was a full-fledged, “smart” phone carryin’ member of The Future™. Like any good young member, he was fully invested in Social Media. This firefighter/EMT responded to an incident scene and thought that a picture of the incident would make excellent fodder to post on one of the social media sites that he participated in. So, he snapped the picture with his “smart” phone and immediately posted it on the social media site. Appended to the photo he put what undoubtedly was an especially witty and thoughtful comment related to the person(s) who caused the incident.

Thus ensued “all hell” being brought down upon this young firefighter/EMT by the upper echelons of his fire department. Turns out that the Chief, the Assistant Chief, and a number of his coworkers were “friends” of this young firefighter/EMT and were immediately notified of what he’d posted on the social media site. They were not amused in the least and did not find the humor in the especially witty comment that he’d posted with the picture.

I agree with the Chief on this one. Let me be the first one to expound upon the virtues of social media in EMS and Fire. The fact that you’re here reading this is a testament to its potential to positively influence our profession and our interactions with the public and each other. However, its potential to tarnish our image if used irresponsibly is there as well. This case was an example of that.

I never did get a chance to see the picture, but from what I heard of the case the picture did not involve any personally identifiable information. Locals could have seen the picture and identified it, so could those involved of course, but it didn’t violate any laws that I know of.

What it did violate, are the ethical standards in which we operate under. Public safety people respond to incident scenes where we see things not meant for public viewing every day. We’re all familiar, I hope, with HIPAA and the various other privacy laws that we operate under, but we also need to be aware of the ethical standards that guide our interactions with private information.

When I got into this business, the metaphor that we used was “The Coffee Shop”. We were told to keep our shop talk behind closed doors within the service, and not go down to the local coffee shop where people could hear us talk. In the small town I lived in, everybody knew everybody and everybody had a scanner. Even if one of our guys was talking about “This Person” who had had some type of medical condition or had injured themselves in a spectacular way, everyone would know whom he was speaking of. Thusly, we didn’t go talking about what we saw out in the public. It wasn’t a legally mandated standard, it was an ethical standard of behavior that allowed the public to trust us and feel comfortable calling us in their hour of need. People won’t call us when they need us if they fear public embarrassment. Most people, that is.

Nowadays, it’s gotten complicated. With social media sites more popular than ever and showing no signs of slowing down, the impulse for some of our ranks to post information of an ethically non-public nature up there on the interwebz can be irresistible. With my “smart” phone in my pocket at all times, I have an express lane to career ruin right there at my fingertips. All I have to do is act irresponsibly one time with a photo, comment, or post and my career is finished.
And I remember and respect that. 

Professionally Ethical behavior requires that we separate our professional lives from our personal ones. While it would have been no big deal for Joe-Public-Came-Across-An-Accident-Scene to snap a quick pic and send it off, it is a huge deal for a Professional Rescuer to do the same. We were called to the scene to help the people involved. Professional Ethics mandate we leave our personal feelings and personal lives at the station. If the public gets the perception that their personal business is going to be splashed across the interwebz by one of the people who came to help them, then I’ll bet that the public is going to be mad at that.

Just remember, folks. Friends and families of public safety people have always been interested in what we do out there. They always will be. With today’s ultra access into our personal lives that social media can bring, it’s easy for youngins to get carried away and violate the ethical standards on spreading private information. There’s a rule for this and technology hasn’t changed that rule. You don’t use your position of public trust to gain access to and spread private information.

Just don’t do it. Resist the urge and keep your career, and honor, intact.

Posted by on December 1, 2009 • Filed under: Administration & Leadership, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Topics, Ethics, everyday ems ethics, Fire department, Fire Rescue Topics, Firefighter, medical ethics, PR, professionalism, Technology & Communications, technology-communications-ems-topics, whattaya do
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