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Change Medicare? Save EMS

I’ve said this before, and I’ll continue to say it until I can do something about it: The Fee-For-Transport model has failed EMS. We have to change it and we have to change it soon.

In fact, I believe that the entire revenue model we use for our industry has failed. I think that the “Fee for Transport” model employed by the Emergency Medical Services industry is flawed, archaic, outdated, and is not conducive for the development of our profession. I think it stifles growth and development. I think that it is unfair to make this inequity up through local property taxes.

I think it has to change.

Don’t know what I’m talking about? Let’s hear what Medicare has to say on the subject:

“The Medicare ambulance benefit is a transportation benefit and without a transport there is no payable service. When multiple ground and/or air ambulance providers/suppliers respond, payment may be made only to the ambulance provider/supplier that actually furnishes the transport.” (https://www.cms.gov/manuals/Downloads/bp102c10.pdf)

Yes, that’s what that means: Medicare sees EMS solely as a “transport provider.”

Basically Medicare is saying that all they’re going to pay for is taxi service. Sure, they’ll reimburse some other expenses, but without the taxi component, they’re not picking up the tab. They’re certainly not going to pay for you to provide medical care for one of their clients on a scene. They’re not going to pay you for sweetening up an unresponsive diabetic and leaving them at their house, they’re not going to pay you for providing Community Paramedicine, and they’re certainly not going to pay you for other home health or primary care services. To them, we’re a medical transport industry. They pay for transportation and that’s it. Sure, they make a differentiation between “Emergency” transportation and “Non-Emergency Transportation” and use the term “skilled medical treatment” for some of the things done in the back of our rigs, but that whole “transportation” thing is always there. No transport, no payment. It’s as simple as that.

This very appropriate image was sent in to me by Matthew Rausenberg while I was writing this post. Thanks Matt!

Not sure about that? Well, here’s more reading on what Medicare WILL and WILL NOT pay for in this informative booklet that I just printed out for every EMT at my service to read:

That’s the link to the “Official Government Booklet” that explains:

“When Medicare Helps Cover Ambulance Services”
“What Medicare Pays”
“What You (the patient) Pay”
“What to do if Medicare Doesn’t Cover Your Ambulance Service”

I’ll admit, this is pretty light reading by government standards, but it’s important for all of us in the profession to read, understand, and know this stuff. Sure, I know that some of you out there are going to fall back on our old standby statement that “I’m not in this for the money, I just want to help people” or some other platitude just like that, and I understand and appreciate your altruistic motivations… but I will tell you that EMS needs money to operate. Whether you’re a volunteer or a full-time paid employee, your ambulance service needs money to function. Paid employees need to make a living, ambulances need fuel, stations need heat, equipment needs to be replaced, and communities need 24-hour ambulance coverage to meet both their emergency and non-emergency needs. Ambulance services are critical for any community, no matter their capacity, and all of that stuff takes money. Medicare, through the “Centers for Medicare and Medicaid Serivices” (CMS) sets the tone for the entire healthcare payment industry and by default they have become responsible for propping up a majority of ambulance services through providing the lion’s share of their total revenue in some areas. They’re the big dogs in the healthcare payment arena… and they’re holding us back.

Not that I’m solely picking on Medicare here… but let’s read further into their definitions, shall we? (From the second document I linked to above):

“Emergency ambulance transportation

Emergency ambulance transportation is provided after you’ve had a sudden medical emergency, when your health is in serious danger, and when every second counts to prevent your health from getting worse. The following are examples of when Medicare might cover emergency ambulance transportation:

You’re in severe pain, bleeding, in shock, or unconscious.
You need oxygen or other skilled medical treatment during transportation.
You need to be restrained to keep you from hurting yourself or others.

These are only examples. Medicare coverage depends on the seriousness of your medical condition and whether you could have been safely transported by other means.”

Clearly, Medicare thinks that only “Skilled Medical Care” provided whilst tires are rotating under a patient is valuable. They pay no attention to the fact that there are better and cheaper alternatives out there that our profession could offer them. I know that Medicare represents taxpayers and the payments they give out are tax dollars, and I appreciate and want them to be responsible with those tax dollars…

I just don’t think that they are.

Medicare has determined that the only way they can be responsible with our tax money is to deny as many payments as possible and to only pay for the bare minimum that they feel is important. That’s why ambulance services are “Transportation providers” in their eyes. However, this ignores so much potential in cost savings in my opinion. They pay no attention to the fact that while it’s nice that they pay for “Wait-and-return” ambulance transfers to and from nursing homes and clinics, those services could be provided in a lot of cases by paramedics who could take care of the patient’s needs on site and save them a ton of money by offering the new service. They ignore the fact that if they provided a $250-$300 benefit for an ambulance to come, fully assess, treat an unresponsive hypoglycemic diabetic, and then release them safely without transport, they could avoid the (estimated) $500 transport bill and subsequent $1000 ER bill. The savings are potentially enormous… and there are a ton of ideas like that waiting to be explored.

We, as a profession, just have to convince them that these ideas are worth being explored.

The healthcare payment system shapes healthcare. It certainly has shaped the way we operate in EMS. The pressure to do only what we’re going to get paid to do is so prevalent a force in the industry that it is almost the very foundation of what we do and how we’ve evolved. The payment system didn’t evolve to meet our potential; EMS has evolved to fit its limiting influence. This is why we do the BLS transfers that cost too much for too little benefit. This is why new products that can’t be reimbursed aren’t making their way into the hands of field providers. This is why treatment modalities aren’t expanding as fast as in other areas of medicine. The CMS fee schedule dictates all of this.

And we as a profession have to change it.

Imagine what EMS would be today if we could bill for any service we thought provided benefit to our patients and our communities? To be sure, this would cause some “waste, fraud, and abuse” in the initial phases… but that exists in today’s system. Could you imagine if Community Paramedicine was fully reimbursed? Can you imagine that if instead of providing a wait-and-return BLS transport for a nursing home patient needing a surgical wound re-check, you came, assessed, took some pictures on a cell phone camera and sent it to the physician wirelessly? Can you imagine if you could charge for responding, assessing a patient with a minor medical complaint, and then having the patient transported to an urgent care center that would continue your care? Can you imagine how different everything we do could be?

Well, at least I can start to imagine. I see additional revenue streams that would come into our industry and improve the profession, strengthen our patient care, and save the healthcare system a boatload of money while improving access to primary healthcare. I see paramedics and EMTs not being taxi drivers. I see a real career and a bigger impact upon the overall health of our communities. I see more fiscal responsibility. I see lots of great potential.

And I don’t know how to do this yet, but maybe somewhere, someone reading this might have an idea.

Do you?

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I’ve written on this before, and maybe you’d be interested in reading some of those ideas:

“What is the next ‘Low Hanging Fruit’ of EMS 2.0 and US Healthcare Reform?”

And to look at a real-life example of how our British brethren are handling this issue and are having success across the pond:

“A Shoutout Across the pond to our British Brethren”

Posted by Ckemtp on March 17, 2011 • Filed under: Administration & Leadership, change, EMS, ems 2.0, EMS Management, EMS Topics, Funding & Staffing, new perspective, Paramedic, paramedic salary, politics, potential, profession, Uncategorized, universal healthcare, US economy

Colorado CRNAs Vs. Virginia Physicians? An interesting feud for EMS

24 comments

This article came across my Twitter stream this morning. It regards a letter sent to the Centers for Medicare/Medicaid Services by the Governor of Colorado informing them that in some Colorado hospitals it is now acceptable for Certified Registered Nurse Anesthetists to work independently of physician supervision.

The article, which is in the form of a letter written to the editor of The Aspen Times, is written by a Dr. Paul Rein who is the President of the Virginia Anesthesia and Peroperative Care Specialists. He takes issue with the lack of physician oversight and is “quite concerned” about it.

I think that the letter is important for EMS people to read. Especially us EMS people that are looking at how to expand our profession, grow our scope of practice, and expand our skill sets. It shows that there are struggles over these kinds of boundary and oversight issues all over the healthcare arena and that the politics and power struggles aren’t just limited to those of us that ride ‘round in ambulances.

The full text of the letter can be found here at The Aspen Times: http://www.aspentimes.com/article/20101004/LETTER/101009942/1020&ParentProfile=1061

The parallels I can draw from this issue to EMS are striking and enlightening. Here are some of the parts of the letter that I found the most interesting:

“A nurse anesthetist is an advanced practice registered nurse who has received special training to administer anesthesia, usually being supervised by an anesthesiologist. Anesthesiologists are physicians who, after medical school, receive an additional four to five years of specialized training during residency. Not only do anesthesiologists function in the operating room but they are trained to medically evaluate patients prior to surgery and to take care of problems that may arise immediately after surgery. In a few small hospitals a nurse anesthetist may be supervised by the surgeon if there is no anesthesiologist.”

I was curious as to the educational standards of a Certified Registered Nurse Anesthetist and so I went to their National Association’s web site: Http://www.AANA.com – It says this:

“The requirements for becoming a Certified Registered Nurse Anesthetist (CRNA) mainly include having a bachelor’s degree in nursing, or other appropriate baccalaureate degree, Registered Nurse licensure, a minimum of 1 year acute care experience (ICU, ER for example), and the successful completion of both an accredited nurse anesthesia educational program and the certification examination.”

(Source: http://www.aana.com/BecomingCRNA.aspx?id=98&linkidentifier=id&itemid=98)

Huh.

Actually, I wasn’t familiar with the requirements for a CRNA before I read that, but it says that they have to have:

A four year degree in Something
Licensure as a Registered Nurse
A minimum of One Year Acute care experience
Completed an Accredited training program
A passing grade on the certification exam

I was curious, so I popped on over to Salary.com and typed in “Registered Nurse Anesthetist” in my own zip code for a base salary search. I found that they start out at $131,000 and top out at over $170,000 in my local area.

Then, after giving serious consideration to changing this blog from “Life Under the Lights” of Fire Trucks and Ambulances to “Life Under the Lights” of an Operating Room, I decided to point something else out about the differences and similarities of a Paramedic and a CRNA.

“The didactic curricula of nurse anesthesia programs are governed by COA standards and provide students the scientific, clinical, and professional foundation upon which to build sound and safe clinical practice. The basic nurse anesthesia academic curriculum and prerequisite courses focus on coursework in anesthesia practice: pharmacology of anesthetic agents and adjuvant drugs including concepts in chemistry and biochemistry (105 contact hours); anatomy, physiology, and pathophysiology (135 contact hours); professional aspects of nurse anesthesia practice (45 contact hours); basic and advanced principles (sic) of anesthesia practice including physics, equipment, technology (sic) and pain management (105 contact hours); research (30 contact hours); and clinical correlation conferences (45 contact hours).

Most programs exceed these minimum requirements. In addition, many require study in methods of scientific inquiry and statistics, as well as active participation in student-generated and faculty-sponsored research.

Clinical residencies afford supervised experiences for students during which time they are able to learn anesthesia techniques, test theory, and apply knowledge to clinical problems. Students gain experience with patients of all ages who require medical, surgical, obstetrical, dental, and pediatric interventions. The results of a 1998 survey of program directors show that nurse anesthesia programs provide an average of 1,595 hours of clinical experience for each student.”

(Again, from http://www.AANA.com – the emphasis is mine)

Remember that the CRNA’s have a Bachelor’s Degree and a RN license prior to beginning their training. This is different from the Paramedic curriculum. We have hour requirements as well:

“The emphasis of paramedic education should be competence of the graduate, not the amount of education that they receive. The time involved in educating a paramedic to an acceptable level of competence depends on many variables. Based on the experience in the pilot and field testing of this curriculum, it is expected that the average program, with average students, will achieve average results in approximately 1000-1200 hours of instruction. The length of this course will vary according to a number of factors, including, but not limited to:

-student’s basic academic skills competence

-faculty to student ratio

-student motivation

-the student’s prior emergency/health care experience

-prior academic achievements

-clinical and academic resources available

-quality of the overall educational program”

(Source: Http://www.EMS.gov – Thanks to Chris Webster, Sam Bradley, Greg Friese and Kevin Reiter)

Not that the above is related to the article I read, I mean it’s saying that people with a BS degree in something, a medical license, and what amounts to a little more than an EMT-B class plus an EMT-P class from an accredited school make an average of $150k… but I digress.

Back to the article, Dr Rein has this to say about CRNAs:

“It is interesting to note that the United States is the only westernized country in the world that allows nurses to administer anesthesia unsupervised. Countries such as Canada, Australia, New Zealand, Japan and Israel, just to name a few, have no nurses administering anesthesia. In some European countries there are a few nurse anesthetists who work under the strict supervision of a physician.”

He continues and says this:

“So what’s up with us? Well, it seems that the American Association of Nurse Anesthetists have convinced our government in Washington that unsupervised nurses are just as safe as a physician. They point to the fact that there are no comparative studies to show they are not. The reason there are no studies is that it would be unethical to perform such a study in which some people get a physician and some do not. Can you imagine a patient agreeing to participate in such a study?”

Can you imagine indeed?

Dr Rein is right when he says in the letter that Anesthesia is a Medical profession and is a specialty of physicians for a reason. When he says “Just because we have made it safe is no reason to take it for granted”, he’s right as well. Anesthesia is dangerous for the untrained and inexperienced provider and it is a specialty not to be taken lightly. However, where’s the line? Is this an attempt by the”Virginia Anesthesia and Peroperative Care Specialists” to fire a shot at the “American Association of Nurse Anesthetists?” Are Doctor Anesthesiologists afraid of losing jobs to the nurses? Where is the line where patient safety is best maintained while being most cost-effective and efficient?

If this doesn’t provide incentive to you to think about requiring a degree for Paramedics, I don’t quite know what will. I’m not doing this job for the money and neither are you, but does that make us any more or less moral than a CRNA who “Isn’t doing his/her job for the money” either, but still makes a ton more of it than any paramedic I know?

You could change the names of the players in this argument, fiddle just a bit with some of the details, and change this into one of a thousand other feuds going on under the healthcare umbrella. This is the same story that paramedics face when we’re trying to get new skills, new techniques, more money, and more responsibility. While I’m not taking a stand on the CRNA/MD issue because it’s not my specialty, I’m offering up this debate as a study in professional growth and conflict between two of the myriad of medical camps out there. As we push EMS forward, grow as a profession, and promote the EMS 2.0 agenda, learning from things like this will be of value to us all.

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Thanks to the following for their contributions:

The Aspen times – Http://www.AspenTimes.com
The American Association of Nurse Anesthetists – Http://www.AANA.com
www.EMS.gov

Posted by Ckemtp on October 4, 2010 • Filed under: ckemtp rants, Emergency Medical Services, EMS, ems 2.0, ems education, EMS pay sucks, EMS pep talk, EMS Topics, EMS training, medical ethics, News, Paramedic, paramedic education, Patient Management, physician, politics, potential, profession, Training & Development, Uncategorized

What Difference Does EMS Make? Choose Your Own Ending

17 comments

John didn’t need his alarm clock this morning. In fact, he was wide awake just a few minutes before it went off. He turned it off so as to not wake up his wife and got up quietly to start the day. Today was going to be great. It was huge. Months of work at the office were finally going to be recognized today in the biggest project meeting he’d had in a year. Today’s meeting would launch his career faster than almost anything he’d done before. He was excited. He was ready.

John showered, shaved, and got dressed up in his new suit that he’d bought the day before. He wanted to look his best for this meeting. Everything was counting on it. His wife Joanne had coffee and a quick breakfast ready for him when he came down the stairs. He sipped on his coffee for a bit as he ate his breakfast. It was really sweet of her to do that, He thought and he told her so with an extra hug and kiss as he left for his commute. He wanted to be to work early today to make sure that he was there to answer any pre-meeting questions. This was the day.

Traffic was light on the interstate that morning and John was moving at a good clip. It was strange, he thought, for traffic to be this kind to him on a Monday morning but he figured it was a good omen. His phone buzzed with an e-mail and he glanced at it. It wasn’t anything that couldn’t wait until he was in the office, he thought. Then a great song came on the radio. John reached down to turn up the volume so he could get pumped up for the drive…

He never saw the cars stopped just in front of him.

Mary took care of herself pretty well for a type one diabetic. Her doctor had told her that. She stuck to her diet, maintained her sugar levels meticulously, and took her insulin on a sliding scale that seemed to be working perfectly. Her blood sugar readings were always right where her doctor said they should be. Mary was proud of that. She worked out and tried to get out walking or jogging the trail at the park at least 3 or 4 times a week. She felt good, looked good, and thought that she was doing all she could to take charge of her health.

It was a beautiful Saturday morning and Mary thought that she should take her dog Patches out for a walk around the pond. Patches was a 1 year old Golden Retriever and loved jumping in the lake to fetch sticks. Mary had taken her morning dose of insulin, popped a multivitamin tablet from her new bottle that she’d bought the day before, and ate a quick bit of breakfast before she put Patches on his leash and started walking to the park. It was about five blocks away and patches knew the route well. Everything was great, until the nausea hit… Mary tried to fight it but knew that she was going to throw up when she started salivating and breathing heavily. She ended up throwing up in some bushes next to the sidewalk. She thought that she was lucky. Nobody saw her hurl up her breakfast and she immediately felt better. It must have just been the new vitamins that made her stomach upset, she thought as she continued walking to the park. She figured that she just wouldn’t take them again.

Mary never felt sick. She just thought that she should take a nap. The rock over there looked like a good place. Why was she so sleepy? Never mind… Just lay down and nap. Nap good.

Luckily, another jogger happened by to find Mary unresponsive.

Work had been scarce lately and Steve was happy to get his truck back on the road. He drove a live-bottom trailer hauling asphalt for a big local paving company and they hadn’t had many big projects come their way lately. Driveway work was steady, but rarely did the company need Steve to drive a big truck out to a site for a driveway job. Steve made his best money and hours when the company had highway work and today was the first day of a big job they’d just gotten. He’d been in line with the other trucks waiting his turn to dump his load into the paver for hours and even though he was happy to be working, he had to pee. Minutes turned into hours and finally it was his turn to drop his blacktop and head back for a new load. He couldn’t wait to be done. He really had to pee by this time and he knew exactly where his next opportunity would be. He backed his trailer up to the paver and raised the bed. Then through his rear-view mirror he saw the people scramble and jump off of the paver. He felt his truck lurch forward as the paver machine was pushed into it from the impact of a car travelling too fast in the construction zone. When he jumped out of his truck after looking to make sure there was nobody coming at him, he saw his friend Luke laying on the ground. Luke was bleeding, bad. The car and the paver were a tangled mess of metal and there was someone screaming at an unmoving figure in the passenger seat of the car.

Steve no longer had to pee…

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Note to blog readers: I can’t quite decide on what I should do from this point on. I can take two paths, one is a rallying call to community members asking them to put themselves in the place of the people in the above cases and get out there and support their local EMS. The other, is a rallying call to us EMS people… I’ve written it both ways. You can see what you like best.

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Option #1

Every day, Paramedics and EMTs put on their uniforms, fire up their ambulances, and get ready to face the onslaught of whatever mayhem the streets produce for them during their shift. They do a job that is unpredictable, complicated, and vital to the community. These three stories could happen to you or someone you love tomorrow and each of them will require the response of a highly trained, expert Emergency Medical Services (EMS) provider. There are times when your local ambulance service makes the difference between life and death but there are far more times when they make a big difference in a person’s continuing quality of life. By interceding in the first few moments of a medical emergency with highly trained experts, EMS makes a difference for us all. Communities that support their local Emergency Medical Services have better services and community members that are more educated about what makes quality EMS are better suited to support their local services.

You may not think about the people who respond to your call when you dial 911, but all we do is think about you. Get informed, get involved, and support your local Emergency Medical Services.

We’re there for you. We need you to return the favor.

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Option #2

As you come in to work today, lace up your boots, or turn on your pager, think about the patients in the above cases. They’re people just like anyone you see in your day to day life. They and others like them didn’t intend to be placed in the situations they’re facing and to them; theirs is one of the most intense situations of their life. Their very life and the continuing quality of their lives could rest in your hands today. They are depending on you. Their families are depending on you. Your knowledge, skill, and preparation to perform your best are paramount to these people. Their care rests on you. You owe them your best and there is no excuse they’ll accept for poor performance.

EMS providers transcend their self when they lace up their boots and sign on for duty. Society needs us. Our patients need us. We need us. We will never know the impact we’ll have on the lives of our patients, their families, and their communities… but it’s huge. We as EMS providers play a pivotal role in our communities. They’ll never acknowledge it en masse… but that doesn’t diminish its importance. Recognition for our skills isn’t necessary for our skills to be vital. EMS people do their jobs because they’re important. We do our jobs because our guts tell us that what we’re doing is right… and even when we stumble and find ways to improve ourselves and our care, it doesn’t diminish the importance of what we’ve done. We have acted, and we continue to act in the best interest of humanity.

Today you can make a choice. You can make the choice to seek out and become the best EMS provider you can be or you can choose not to. I suggest that you make the right choice but no one will ever be able to force you. Your care is an art and a science. Your performance is based upon hard science and soft intuition. There can never be a book that will tell you exactly what is right for every situation… you simply have to learn it and learn how to make the right decisions to fit the situations you find yourself in.

My advice to all EMS providers is to take the high road. Err on the side of what you truly feel is best for your patient. Do your best. Study hard and learn from those you consider the best among us. As an EMS provider, you bear the burden of an overloaded system that pays poorly and garners little respect. I feel it too. I say that it doesn’t diminish the importance of what we do and it isn’t the individual patient’s fault. They deserve our best no matter what the system is doing to us. It’s our responsibility and our calling. It has been said that the definition of a “Professional” is one who can perform their duty adequately in conditions that would cause the amateur to turn back. I’d say that we’re living in those conditions today, but we still have to perform. Do your best and know your stuff. Lives depend on your commitment.

It is our job to promote ourselves. It is our job to elevate EMS. It is our job to speak out and optimize the system. The fault for its failings lies within our profession and it is our job to change it. All of us, individually and collectively have the responsibility.

Will you answer?

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So I got a little philosophical in this one. Which ending do you like better?

Posted by Ckemtp on September 7, 2010 • Filed under: 911, edemse, Emergency Medical Services, EMS, ems 2.0, ems education, EMS Motivation, EMS pep talk, ems scenario, ems scenario based education, EMS Topics, EMS training, Ethics, everyday ems ethics, Fire Rescue Topics, In the Line of Duty, inside the mind of a paramedic, letter to the editor, Line of Duty, Paramedic, paramedic education, Patient Management, pride, profession, professionalism, Public relations, scenario, scenario based training, stories, Training & Development, training-fire-rescue-topics

EMS: Is what you do the Best You Can Do?

11 comments

Not too long ago I was reading an article in Entrepreneur Magazine when I came across an article speaking on negotiating tactics. I wish I could find it, but unfortunately it was long enough ago that I’ve disposed of the printed issue (I subscribe) and cannot find it on the web. It was a good article and it taught me some words that I’ve since used quite a bit in my own life:

“Is that the best you can do?”

From the time our parent’s first put us out there in the world most of us have probably been told to “Do our Best” when we try to do something. No matter if we win or lose, we’ve been told that it’s ok as long as we “do the best we can” while trying. We seem to feel better at the outcome of almost anything if we feel that we’ve “Given our best shot” when we try to accomplish what we’ve set out to do. We all like to do our “best” and we hope that our “best” will be good enough.

This begs the question… is what you’re doing today in EMS “the best you can do?” Career wise, operationally, with your service’s treatments, with your own personal training and education, and with your own attitude… is this really “the best you can do?”

I would like to think that I “try my best” in my own EMS career and paramedic practice. I would also like to think that I work for an EMS organization that is trying to do the best it can for its people and its collective patients. However, there are quite a few situations where I have felt that I have not done or have been prevented from doing my best for a number of reasons. Some are reasonable and others are not. I’d think that all of us would give the answer that we always want to provide every patient with our “best” possible care. However, I’d also guess that everyone reading this can think back to any number of situations where they feel that they didn’t give it. Sometimes this reason comes down to the skill set of the individual provider. This could be a situation where the provider didn’t have the best possible information or knowledge available to them. They may have provided an ineffective or even harmful treatment modality or might have failed to act upon a missed assessment finding, such as by giving a medication for which a patient has a documented allergy because the provider didn’t know or simply forgot that the patient had the allergy. Sometimes the actions of others in the organization can prevent a provider from rendering the best possible care. This could be by failing to check, clean, or restock a needed piece of equipment or by providing inadequate care prior to a provider assuming patient care such as in the case of a first-responder crew failing to place a patient in full c-spine precautions when indicated prior to moving a patient to the transporting ambulance and the transporting EMT not having enough manpower to safely immobilize the patient. Sometimes the organization can hinder an EMS provider from doing his or her best by doing things such as providing inadequate equipment or medical protocols, or by mandating that a provider regularly work past exhaustion-level hours.

People inherently want to do well at whatever they choose to do for their careers as well as at other tasks where they feel strongly about the outcome. I may have accepted that I’ll never be as good of a basketball player as Michael Jordan, nor the same-level of cartoonist as Scott Adams, nor the best noodler in the world… but I’m certainly going to try to be the best paramedic I can be.

THIS guy, however, may be The Best Noodler In the World

Sometimes our own personal biases prevent us from doing the best we can do and for this I’m not talking about bias regarding any protected classes or topic, rather I’m talking about our own version of the status quo. A personal example of this would be my ALS Quick Response Vehicle at work. We went a solid week without having the proper forms available for the daily equipment checks and I didn’t have the computer access to print more off. During that week, I got in the habit of not using the forms and simply checked the truck based upon my knowledge of what was supposed to be in there and what was supposed to be checked. The way it played out, I ended up continuing to not use the check sheets when checking the vehicle, even though the forms had been replenished. A few weeks later, someone found that there was equipment missing in the vehicle that had gone unnoticed for some time. At that point, I realized that I had developed my own bias against using the forms for a reason that is even unbeknownst to me. I had gotten in the rhythm of not using the forms, and that caused me to miss that the infrequently-used piece of equipment was missing. I had developed a personal mental bias that prevented me from “doing my best” and thoroughly checking the truck.

Another preventer of best practices can be organizational politics, both internal and external. As a paramedic who regularly responds to other ambulance services to provide “ALS Intercepts”, I have observed that the politics between the services we work with can affect patient care for both the negative and the positive. While I am not saying that any of these arrangements result in inadequate patient care, I can say that the services with whom I interface most frequently and most pleasantly get a better provider out of me than do the services with whom my relations are less frequent or are strained due to political turmoil. When I respond to a request for an ALS intercept, I am being called to the “house” of another group of providers. While I am the highest level of care on the scene, I’m also a guest in their house. They have their own internal biases and I have mine. Sometimes the synergy in our working relationship can be strained, which results in a palpable difference in the flow of the scene and the teamwork exhibited at it. While I will ensure that I “do my best”, it’s easier to do it when I work well with the team I’m working with.

So how do we change things? We’re all human and we all have things that prevent our “best shot” from being the only thing that we “give it” in our EMS careers. This may be consciously, as in the case of internal politics; Subconsciously, as in the case of my not using the check sheet; or Involuntary, as in our service not providing us with needed equipment or our coworkers failing to replace an item in the ambulance that we did not have an opportunity to check. As in most things, the easiest thing for us to change is ourselves. Changing ourselves is a great place to start and will make serving as an example to others your main tool to use to try and get the best out of them.

Most situations can be made better and almost all of us can try harder. The secret is to attempt to do our “best” at all times and to try and ingrain our own best practices into our daily routines. This can be as simple as always trying to check the truck in the most thorough way possible or by making sure that you always check and recheck things to ensure that they’re done right. It helps to continuously seek out and recognize one’s own personal biases, (remember my check sheet?) to make sure that our own preferences and routines aren’t leading to suboptimal performance. Consistently ask yourself if what you’re doing is the “best you can do” and then ask yourself what you can do to make it your best. Mentally prepare yourself for your shifts with adequate rest when possible, manage your stress level so you can keep your thoughts focused on your care, and train hard. Ingrain your best efforts into the systematic way you do things and make your best way your normal way of doing things. We can’t change everyone around us in an instant, but our quiet positive efforts can pay large dividends in how people around us think, feel, and act. Our best may in turn get the best out of our partner, which may in turn get the best out of the next crew, and so forth. Soon enough… deciding to give our best may change your organization, our industry, or our profession.

And I assure you, doing your best will indeed make the difference in someone’s life. It’s just what we do, Folks.

“Is that the best you can do??

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For more on doing your best in EMS and in getting the best out of your EMS people read: “The Shine Factor”

Posted by Ckemtp on August 19, 2010 • Filed under: Administration & Leadership, ALS Intercept, Ambulance cleaning, Command & Leadership, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Topics, EMS training, Fire Rescue Topics, Firefighter, Management, Paramedic, Patient Management, politics, pride, profession, professionalism, Training & Development, training-fire-rescue-topics, Uncategorized

Paramedics and EMTs are Special, a salute to the Spork!

11 comments

Ah, the humble Spork. At once it is an example of utility and futility. It is well suited to nothing but bridging the gap between the usefulness of its parent utensils and the burden of having to provide a separate spoon and fork. Sporks are great for when you need to have an eating utensil that is suited to a variety of food consumption scenarios but do not have the space nor the gumption to provide separate utensils. Sporks can perform lots of tasks but they do nothing very well. While I love the concept and the fact that the name is *really* fun to say (Spork? Spork… Spork!!), eating anything with a spork is a challenge. I mean, have you ever tried to eat soup with a spork? You’ll end up wearing a percentage of it. Heaven forbid that you have to use it to hold something you have to cut with a knife like a piece of meat. It’s nearly impossible. I suppose that eating salad with a spork would be fairly manageable but not if you have a lot of non-lettucy stuff in the salad like cherry tomatoes, mushrooms, and/or pepperoni. Honestly, who wants a salad that is comprised only of rabbit food?

Die hard Sporksters, that's who

However, I digress. What I’m trying to say is that the spork, the half-breed malformation of a spoon and a fork, has its place as a substitute for either when it is not economical to provide both. Like its lesser known brother the “knork”, it is a natural idea and a somewhat cool concept. However, there is a very clear reason that the spoon and the fork are separate utensils. There are specific purposes for the design of the spoon and the fork and good reason to have separate tools that are suited to the kind of tasks that they’re used for. The spork is the watered down version of both. It can somewhat perform the tasks of its parents, but not well. It is the “Jack of all trades, Master of none” if you will.

And that is why I’m writing about our humble friend the Spork in my usual rotation of EMS topics. A conversation I had on Twitter the other day with my tweeps @pgsilva and @rescue_monkey brought up the spectre of why exactly ambulances aren’t staffed with nurses and physicians’ assistants and are instead staffed with Paramedics and EMTs. PG and The Rescue Monkey thought that the conversation would make that vein pop out of my forehead like it does sometimes when I get enraged. They were mistaken. It doesn’t make me angry. In fact, I informed everyone that I would write a post on what exactly it makes me think about. This is that post.

The “Why don’t nurses and/or (insert title of healthcare provider here) staff ambulances debate” has a clear answer for me. Here it is:

EMS providers are sporks. We’re also not sporks. We exist in the realm of both the specific and the generalized. We are jacks of all trades and the master of the non-specific. EMS providers are generalized in nature and that generalization is specialized into the random nature of the work in which we perform.

Or women with sporks, you know. That too.

Are you confused? Well that’s understandable. Let’s look at it this way. The ultimate healthcare provider has always been the physician. Since the beginning of western medicine, the physician has always been the healer that people have turned to. Physicians are learned professionals who seek to learn and apply knowledge to the human condition in the name of healing. Physicians are “clinicians” in the fact that they make a clinical diagnosis based upon an examination of a patient and then devise a proper treatment path to treat a patient’s diagnosis. They physician assesses a patient, makes a diagnosis of the patient’s condition based upon their knowledge base and ongoing research, and then uses that same knowledge base and research in order to devise the best treatment possible for the patient. It’s the definition of a clinician.

Nurses, and their modern incarnation as the Registered Professional Nurse (RN) developed as the ultimate assistant to the physician. Their goal was to be the caregiver, the person with enough medical knowledge to continue the care plan and treatment that the physician determined with the compassion and the ability to meet the ongoing needs of the patient. While the physician devoted their efforts to learning and education, the nurse required less education and more compassion. Medical technology and knowledge has expanded greatly and has required the nurse to develop a vast array of knowledge and a myriad of specializations, but their basic function has remained the same. They care for patients in the long term during their convalescence from an illness or injury.

Physicians and nurses have worked in concert. They have developed a system where the sick and injured are brought to them so they may take care of them using the resources they gather together. Each of them performs their role with the goal of making people get better. As knowledge of medicine has increased, different types of physicians and nurses have developed into specialties. The general practitioner acts as a gatekeeper to specialties and treats the most common maladies and is assisted by nurses qualified to care for the largest population of patients. Specialists, such as Cardiologists, Oncologists, and Surgeons, have developed to allow patients the benefit of having people treat them who have sought out to become experts in exactly the illness that the patient may have. The nurses have adapted and have become specialized in their own right, with nursing specialties that complement the specialties of the physician.

However, there is a drawback to all of this specialization. When you have a malady that affects your feet, you would benefit being under the care of the podiatrist. However, you wouldn’t get the best care possible if the only physician available were a cardiologist. The same holds true for the oncologist that attempts to treat your pulmonary condition or for the proctologist who treats your sore throat. While the basic concepts are there, the specialization of focus is not. To be sure, while a person who has graduated from medical school may be able to treat pretty much any condition that you may have at a level that is basically adequate, specialists have devoted their time in the quest of knowledge in their specific area at the possible expense of their knowledge of other areas. This is a good thing, and it’s the reason that pretty much every hospital is full of people with vast arrays of knowledge in singular topics. This system wasn’t designed. Like capitalism the system designed itself. It works and works well, most of the time. However when economics dictate a limited number of available specialties, certain conditions may be left out.

Nurses have done much the same. While the basic concepts are the same pretty much across the board, a School Nurse would have trouble transitioning into the operating theatre as much as the Oncology nurse would have trouble transitioning into public health. Both of them can probably change a bedpan, start an IV, pass medication, or lend a caring smile in the same manner but the oncology nurse would be much more well versed in the management of chemotherapy drugs and chronic pain management than a would be a surgical nurse.

This brings us to Paramedics and EMTs. We are a profession born out of necessity and forged in battle. Really. We can thank Napoleon for bringing forth the first example of the “flying ambulance” which was a brigade of horse-drawn ambulances staffed by medically trained soldiers. They appeared on the battlefield during the Napoleonic wars and boasted that “No soldier lay with undressed wounds for more than a quarter of an hour”. Battlefield “Medics” have always been on the forefront of emergency acute care in the field. While some examples of ambulance care available to the civilian population exist, in the US it wasn’t until after the Vietnam War that civilian emergency ambulance service became popular and seen as a need rather than a nice thing to have. While physicians often made house calls where they travelled to the patient to provide care, in the interest of efficiency they began to confine themselves in clinics and hospitals where they could more efficiently care for larger patient volumes. With the publishing of the “EMS White Paper” entitled “Accidental Death and Disability: The Neglected Disease of Modern Society” in 1966, the attention of the public was focused on the need for an effort to extend care out of the walls of the hospital or clinic. The white paper laid out statistics of trauma, stated the need for injury prevention and education, and stated the need for standardization of emergency medical training. The US. Dept. of Transportation took up the mantle of the new Emergency Medical Services system due to the alarming number of fatalities on the burgeoning highway system and modern EMS was born.

"Stick a Spork in me, I'm done" should be part of your daily speech patterns

The EMT and the Paramedic are the equivalent of sticking a spork in the problem and calling it done. EMTs were cheap to train, cheap to employ, and could be widely distributed out there in the field. At the time, it was the perfect solution. Train people in how to perform in the first few moments of a severe injury or acute illness and give them the ability to safely transport a patient to a hospital where the physicians could work in concert to help heal the patient. The nurses, in their role as the assistants to the physicians, stayed in the walls of the hospital or clinic and developed within their specialties. The system grew and developed as the innovators in the field saw more and more acute treatments that could be performed by these new breed of healthcare providers and as the EMTs and Paramedics proved themselves in service.

EMTs and Paramedics are clinicians in the sense that we evaluate a patient and develop a treatment plan that we follow to help them. Our specialty is in the acute, the treatment of disease in the here and now. If it’s happening to a patient and it is directly threatening their life, chances are that an EMT or Paramedic can intervene in a meaningful way. Our specialty is to stabilize and stop the progression of the acute disease process or chain-of-events in an injury that will eventually lead to death. We plug holes and we do it with a knowledge base taught to us by physicians. Our generalization is across the entire spectrum of possible patients, from field delivery of neonates, to jumping in to help stabilize patients in outpatient surgery centers, to taking care of the elderly in nursing homes. Whether a patient is crushed in an industrial machine, is trapped in a rural car accident, is having a heart attack on a baseball diamond, or whatever happens to a person wherever it happens to them, the Paramedic or EMT is the person most specialized in coming to their aid. We gain knowledge and hone experience not just in the treatment of our patients’ medical conditions, but also in the environmental circumstances in which we find them. We may be generalized sporks when it comes to treating any possible injury or acute illness across any patient population, but we’re highly specialized utensils when it comes to treating emergency conditions anywhere at any time.

"Sporks and Phasers" would be a good name for a Rock Band

No other healthcare provider fits into our role… and that seems to make us a full-fledged utensil in my opinion. We are unclassifiable into any other role yet indispensable for our own.

And we need to get out there and let everybody know just how special that role is. Nobody has developed the breadth of knowledge in our specialty that we have. We have made the spork our own.

And that, folks is my answer to why no other healthcare professional can quite full our role. While as a paramedic I am competent in the basic skills needed to say, work in a endoscopy unit, I would not function there to the level of a person experienced and knowledgeable as an endoscopy nurse. Neither would they be able to manage a traumatic airway upside down in a crushed automobile at night as well as I would. It’s my specialty to do the latter, not the former, even though the basic skills may be the same.

For more on this, g’head and read “Any Random Person” an older post of mine. Then get out there and shine up your sporks.

Posted by Ckemtp on July 6, 2010 • Filed under: ALS Intercept, Emergency Medical Services, EMS, ems 2.0, ems education, EMS Topics, EMT, humor, Paramedic, paramedic education, politics, potential, profession, Training & Development, training-fire-rescue-topics

Master Paramedics? I’m asking you a question

27 comments

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

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

What would we call them?

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

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

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

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

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

Here’s what I think:

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

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

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

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

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

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

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

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

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

EMS 2.0 as Explained to My Brother

14 comments

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

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

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

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

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

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

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

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

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

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

EMS Week 2010 – Sent to the Newspaper

19 comments

I wrote this post for publishing in my community’s local newspaper. You may wish to send it to yours as well. It’s a generic “EMS Needs Your Support” piece. It might work for any time of the year, but it’s customized for EMS week 2010.

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“Anytime. Anywhere. We’ll Be There” National EMS Week 2010

National Emergency Medical Services Week or “EMS Week” 2010 is coming up this year on May 16^th through May 22^nd. It is a time to think about the people whom our communities rely on to help us when the unthinkable happens. Every day in our community and in communities like ours throughout the nation, emergencies happen to people just like you and I. These local emergencies may not get the press coverage that the big disasters happening thousands of miles away receive, but to our friends and neighbors these day-to-day emergencies can be just as dangerous and deadly. We rely upon Emergency Medical Technicians (EMTs) and Paramedics to respond and make a difference in our lives. No matter the need, no matter the call, EMS stands ready to serve you.

Logo for EMS Week 2010 - from ACEP

EMS is at once the most iconic and visible part of the emergency healthcare system. It is also probably the most misunderstood. Almost everyone can recognize an ambulance and most people have an idea of its purpose. However people rarely give thought to the capabilities and education of the people working inside of it. EMTs and Paramedics have long since evolved from their humble beginnings as simply a fast ride to the hospital. Today’s ambulances are highly specialized mobile intensive care units and today’s EMT attends hundreds of hours of classroom education for their initial certification. Paramedics, the highest level of field medical providers, attend thousands of hours of initial education and internship time and must be masters of acute care. Not only that, but EMTs and Paramedics alike must recertify their license every few years and must attend hundreds more hours of continuing education to achieve their recertification. This training covers all aspects of acute emergency care and is quite intense and rigorous.

Today’s EMS system, with Paramedics and EMTs working in tandem, brings the first hour of Emergency Room care to the patient’s side no matter where the patient may be. EMS focuses upon providing immediate stabilizing care that stops or slows the progression of the acute disease process or damage from any injury, protects the patient from further aggravation of the condition, and impacts their long-term continuity of care. This care reduces Mortality, or loss of life, as well as Morbidity, or future quality of life. Calling 911 during a medical emergency produces better outcomes than does simply driving a seriously ill or injured person to a hospital. Early intervention in cases such as a heart attack or stroke can mean the difference between those conditions leading to long-term disability or a full recovery.

Every community in our region has emergency ambulance services available at a moment’s notice that are simply a 911 call away. Some communities provide Basic Life Support ambulances, with EMT level personnel. These ambulances are supported by Advanced Life Support ambulances and units staffed by Paramedics that can respond with the Basic ambulances to provide advanced level Paramedic care. It is important for people within our community to ask questions and get to know the people responding to their calls for help. Learn about their capabilities and their needs. Pitch in and help where you can. EMS people have always been the absolute masters of doing anything with nothing but we are desperately in need of the support and attention of the communities we serve. It is common for community members to not think about their local ambulance services until the time that they need their services however, EMS needs your support. Americans have always been massively charitable towards disasters happening thousands of miles away when images from them flood our television screens and newspapers, but rarely does that same charity flow to their local emergency responders who are taking care of our friends and neighbors. Your local EMS service needs your support to maintain high-levels of lifesaving service in your own communities. You can directly impact the service that your local EMS can give to your friends, your neighbors, your loved-ones, and even yourself.

Get informed, get involved, pitch in, and help us help you.

The official theme for EMS week 2010 is “Anytime. Anywhere. We’ll Be There.” EMS has made the commitment to be there for you. This week, please think about how you can be there for EMS. The impact of your support for EMS translates directly back into improving the lives of the people in our communities. As the saying goes, the life you save may be your own.

Respectfully,

Chris Kaiser NREMT-P

www.LifeUnderTheLights.com

Posted by Ckemtp on May 14, 2010 • Filed under: 911, Administration & Leadership, Ambulance, ckemtp, Emergency Medical Services, EMS, EMS Management, EMS Topics, EMS week, ems week 2010, Paramedic, politics, profession, professionalism, Uncategorized

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

20 comments

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

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

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

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

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

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

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

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

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

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

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

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

A Slap in the Face to Paramedics Everywhere?

89 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

What do you think?

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

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

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

Trust… It’s everything

4 comments

Dooooo Doooooo! Beep Beep Beep Beep Beep Beep Beep - Attention AMBULANCE ONE, Ambulance One. Respond Code 3. 1234 Anystreet lane, 1234 Anystreet lane for the (Insert Age and Gender Here) patient found unresponsive, unknown if breathing.

Imagine you heard that dispatch go out just now. Imagine you’re at home, off duty, and just happen to be listening to your dispatch channel. Perhaps you’re a volunteer, perhaps you have a scanner, but picture yourself hearing that and realizing… “Oh My God… That’s So-and-So’s house! A (blank) aged Male/Female? That’s gotta be So-And-So!!”

As an EMS person who lives in your district you know the people who work on the service. Now you’re sure you know the patient too. It’s someone you care deeply about and it sounds like they may be in mortal danger. As someone “in the know” you know what you’re going to do next, right? You’re going to listen intently to whatever traffic happens to come out next on the radio, aren’t you?

“Come on, Come on, Come on!” you think to yourself as you wait the agonizing seconds for the crew to acknowledge the page and go enroute to the scene. “What’s taking them so long!?” you ask yourself. “Ambulance 1 is enroute to 1234 Anystreet Lane” says the crew of Ambulance One over the radio. You don’t think that they sound excited enough. They must not know that this is So-and-So! To them, this is just a routine response for an unresponsive patient. They’re going to do a routine, every day job and perform their routine, every day care. They don’t have any idea that this patient is special to you and they’re going to give this patient the same care they’d give anyone else.

Now, since you’re sitting at home and unable to respond, you’re going to be glued to that radio, right? You’re going to know from the voice on the radio exactly who it is that will be taking care of “So-and-So”. You’re going to either be relieved or horrified by your knowledge of who’s on that responding ambulance. If you have trust in the medic on the truck, you’ll feel slightly better about So-and-So’s chances of survival. If you don’t have trust in the medics, you’ll probably feel a lot worse… right?

It’s always been a sticky ethical situation for a healthcare provider at any level to work on someone they know well and care deeply about. Try it just once, or more realistically for an EMS provider, have the situation thrust upon you, and you’ll see that “Stuff gets real” really quick. We have a vested interest in the care that our loved ones receive and while some of us may know that it isn’t always best that we personally be the one caring for them, we all understandably want them to receive the best care possible.

Trusting a provider to care for your special “So-and-So” is a big deal. I’m sure we all have secret mental lists of our colleagues whom we’d want caring for our loved ones and also our lists of who we wouldn’t. It is a supreme responsibility to be a healthcare provider in charge of the care of any patient and I believe that EMTs and Paramedics hold that responsibility every bit as much as or more so than any other healthcare provider. It is a responsibility that I don’t take lightly and one that I hope my colleagues do not either. We are the first people that our patients and their families want to see walk through their door when the unthinkable happens. When the situation is critical, and skilled, complex, time-sensitive care makes the difference between life and death, we are the ones out there doing just that. A good paramedic must be knowledgeable, highly skilled, and experienced to provide that level of care. Not just that, they must do it every time they get in their truck; because every patient is somebody’s “So-and-So”.

Speaking of “stuff getting real” I have to ask you: What kind of provider are you?

Are you out there every day earning the trust of your peers?

Do you work hard enough, study hard enough, and train hard enough?

Do you do your absolute best for every patient, every time?

When it does happen (and it will) that you are sent to care for a colleague’s “So-and-So”, are you the kind of provider they will trust?

If you think about these questions, you know the answers already. If you can honestly say that you’re good enough, I salute you. If not, well then we have some work to do, don’t we?

Earn it. Study hard. Know your stuff. Do your best. Every patient. Every time.

Posted by Ckemtp on March 15, 2010 • Filed under: Administration & Leadership, edemse, Emergency Medical Services, EMS, ems education, EMS ethics, EMS Motivation, EMS Topics, EMS training, Ethics, everyday ems ethics, Fire Rescue Topics, medical ethics, Paramedic, paramedic education, patient care, Patient Management, pride, profession, professionalism, scenario, Training & Development

Guest Post – From JDmedic on Two Cases, One Letter

5 comments

This is a guest post coming to you from a Mr. John Fekety (JdMedic) who took the time to leave a thoughtful comment on the recent post I wrote “Two Cases, One Letter… From One Paramedic’s Struggles, Change Can Come”. He doesn’t have a website for me to link to, but his resume is pretty impressive. I gave him the opportunity to flesh out the thoughts he wrote in the original comment, and I’m turning the post over to him. Good Stuff.

As promised, I’ll put a plug in for his friend’s Safety Training Business: Http://www.Source4Safety.com – Safety & Health Solutions, LLC

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Many good comments were made regarding the anonymous letter published here last week. Here are my two cents on the things raised in the letter by Ckemtp and others. First, I confess that I also routinely rant about other healthcare providers not understanding our profession, what we are capable of and what we required to do at times. However, the point of the matter is it is not in their job descriptions to educate themselves about us. We must become much more proactive in educating professionals and the public about whom and what we are. Granted, in a situation like described with the cancer patient with heated emotions, educating someone is not easy – if indeed possible. However, we need to begin to relate one-on-one during down times and talk about what we do and the things we come up against. Will it solve all of the problems? Obviously not, but it may crack open a door for dialogue in the future that can help defuse a tense situation.

Secondly, as both the letter writer and I have learned you have to pick your battles. Would it have done any good to bring up the MRSA issue with the sending hospital? Probably not. They could have simply said, “We told them.” Or more abrasively, “Are you questioning our professional ability to give a simple transfer report?” I think the suggestion of Dave Konig represents the best of both worlds. You let it slide with the sending facility and keep your relations there happy. However, you protect the patients in the other facility and maintain your professionalism by giving the receiving facility a heads up. Before the patient reaches the room you may say something like, “While I was checking the patient’s history during the transport I discovered a history of MRSA and I wanted to make sure you knew.” Everyone wins. Another part of this lesson is the patient does not leave your litter until you are comfortable with releasing the patient (more on this below), or you have no other choice.

Thirdly, we have to educate ourselves about the programs and people we deal with. In that regard, Dave makes a good point about hospice programs as well. Many hospice contracts require a patient to agree not to go to the ED in exchange for the hospice services, including in-patient care when appropriate. Under those circumstances, a patient who goes to the ED is dropped from the program and becomes responsible for all medical bills. Given the cost of just medications, conditions like this alone could drive a patient and family members over the edge. Whether that was the case with the patient in this instance is unknown. One service that I worked for had the director of a hospice service come out to a meeting and give us a presentation (did someone say education?). She explained the various services of hospice, why they may need a patient transported, and what we could do – within our scope of practice – to make things go as easy for the patient and family. It’s about communication folks.

Fourth, like others here I have been in the situation where I needed to be a patient advocate. I was doing an interfacility transport of a trauma patient who still rated pain at 9 out of 10 after meds. I asked the nurse about additional meds and she said the patient had already received everything he/she could recieve. I could have taken a chance, loaded the patient and called for pain management en route but I chose a more direct approach. I tracked down one of the ED docs and asked him to check on the patient with me since I did not feel comfortable accepting the patient in her current condition. (I learned that once the patient is on your litter nobody is willing to help since the person is now your “problem”.) When he saw the girl, he readily agreed she required more meds and not only ordered more immediately but gave me orders for addtional meds en route if needed. No arguments with the nurse, no bad feelings and the patient got what she needed. However, there are those times when feelings be damned and you have to take a stand for your patient.

An example of that situation was when I did an interfacility transport of a patient going for a cardiac cath and other procedures. The patient, in addition to having flunked his recent stress test, had a hisory of a previous MI. When we arrived at the receiving facility nobody knew where he was supposed to go because there was a question about which of two procedures were to be done first. We were finally sent to one location only to find it empty. We were redirected to another location to put the patient in a room until things were sorted out. We got to a hospital room with no monitor and an aid told us to put the patient in the bed. I asked about the monitor, she said there was none, and since he was not going to be there, long he did not need it. I explained that he came from a monitored bed, he required a monitor in the ambulance and he was not leaving my litter until he could be placed on a monitor. She huffed out of the room and came back with a nurse who restated that a monitor was not available and not needed. When I once again explained that the patient was not leaving my litter until a monitor was found. She left in a huff saying she was going to get a nursing supervisor to “… straighten you out.” I thanked her since getting a supervisor was better than us waging war. She came back without a supervisor, but with a monitor and told me the supervisor said I was to leave. With the patient in the bed and on the monitor, I thanked her for getting it and asked her to sign that she received the patient. Not unexpectedly, she refused. However, the patient’s wife who witnessed me ensuring that her husband received the proper care was more than willing to witness my note that the nurse refused to sign.

If we and the rest of the medical community (and/or the public safety community) want to use polite words, EMS is the redheaded stepchild.(Ckemtp here: “ouch”) In not so nice terms, we are the bastards. Either way, we are the new kids on the block and we still have to prove ourselves everyday. It has not been easy nor will it likely get any easier for quite a while, but there are ways we can stop shooting oursevles in the feet. When we hit the street if we keep the following in mind, maybe we can begin to level the playing field.

1. Look professional: If you wear a hat – one that is appropriate – wear it correctly, not to the side or backwards. How you chose to dress/look on your own time is your business. If your dress impacts me and my profession it becomes my business. Although I slack at polishing my boots, my uniforms are always clean and neat (at least at the start of the shift – stuff happens). Take a couple of seconds to tuck shirts in.

2. Act professional: Everyone likes a joke. And, God knows many times with what we see we need humor to get through. However, remember what your parents said about a time and a place for everything. The parking area outside the ED is not the place to have a water fight with syringes. Nor is it appropriate to run up and bang on in-coming units.

3. Talk professionally: You do not need to be a walking dictionary or memorize Grey’s Anatomy. For the most part just dropping the slang and cursing would go a long way. “Thank you.” You’re welcome” Have a nice day.” would not hurt either. And out of respect for Thom Dick, let’s get rid of “No problem.” as a response to a thank you.

4. Respect your patients: If you call your patient, any one of the degrading words used in EMS to refer to, especially nursing home, patients (such as cheese or GOMER), go get a job for FedEx or UPS and deliver packages. You will make more money, not have to put up with mouthy nurses or winey patients. These are people we are supposed to be caring for. Many times, there may be nothing we can do except listen or hold a hand – and many times that is enough.

A final thought comes from a quote supposedly said by Mark Twain. “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.” Whenever it may be possible for you to be an example of an EMS professonal, act like one rather than acting as our detractors characterize us and provding their proof.

There are many things all of us can point to and complain about EMS and the systems, institutions and people we work with. I have worked in other professions and with all of the problems EMS has, I would not want to work anywhere else, as it sounds like so many other people feel.

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Great Post, JDmedic. (Yes, this guy has more education than I ever want to sit through). He’s a lawyer-turned-paramedic and that just brings a smile to my face, I have to tell ya’.

Comments are, as always, very much welcome.

(Would YOU care to guest post? Shoot me an e-mail at ProEMS1@yahoo.com – Or Tweet me @ckemtp)

Posted by Ckemtp on March 2, 2010 • Filed under: EMS, EMS ethics, EMS Motivation, EMS Topics, EMS training, Paramedic, profession, professionalism

The Shine Factor

4 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now get out there and polish some chrome.

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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 Ckemtp 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

17 comments

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 Ckemtp 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

Thank you EMS – Some reasons I love what I do

6 comments

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.

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

Why I am Passionate about the Chronicles of EMS

15 comments

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

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

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

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

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

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

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

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

Expanding Our Career Options – Non-Traditional EMS Jobs

16 comments

In my decade or so working in EMS, I’ve had the chance to ply my paramedic skills in more places than the back of an ambulance. I’ve been employed as an ER technician, which is of course the usual suspect for a paramedic looking to move their career options from more than just “The back of the truck” and “the front of the truck”, I’ve been employed as a security guard *slash* paramedic for a hospital chain that ran an ambulance service using their security department, and I’ve worked as a paramedic in an urgent care clinic. I think that EMTs and paramedics can and should expand their career options and that to do so, we’ve got to take a few collective steps.

The professional knowledge, skills, and abilities held by a paramedic combined with the unique personal characteristics of successful EMS people makes our profession a valuable resource to a wide variety of potential employers. These employers, beyond the traditional ambulance services, fire departments, and emergency healthcare providers, stand to benefit greatly from opening their hiring processes to paramedics, as does our profession and the general public. Imagine one day that you’ll type in the word “Paramedic” into your favorite job search engine and have more options available to you than you’ve ever thought possible. Imagine that one day when you’ve progressed to a point in your career where the prospect of getting up at all hours of the day and night no longer sounds like a good idea you would be able to get a job that is a better fit to your personality and your unique set of side skills. I say that our ability to improvise, to think quickly on our feet, and to make solid decisions based upon our knowledge base and experiences in the face of limited and evolving information are useful to business in this day and age.

At the urgent care clinic where I worked, there rarely was a call for my advanced life support skills. Rather we had the run-of-the mill cases that would come into the clinic for immediate-access primary care. My skills at patient history-taking, assessment, triage, and bandaging got a work-out. So did my skills in relating to patients on a personal level and interfacing with patients and their families across the demographic spectrum. I also learned how to prepare, acquire, and process various laboratory tests including point-of-care testing for common conditions and how to properly obtain and prepare samples for advanced labs. Surprisingly perhaps, I got a great deal more practice drawing-up, mixing, and administering medications more so than I ever have in the field. Working with the doctors greatly improved my skills as a diagnostician and has helped me immeasurably in my ambulance practice. (Yes, I said “my ambulance practice”) I highly recommend for both Urgent Care Clinics as well as for paramedics to explore this wonderful partnership.

What that experience taught me is that I could “fit” into that job description as a paramedic, it also taught me that there was a learning curve in moving out of the ambulance arena and into a clinical one. In my secret squirrel job that I don’t put out here on the blog, I use my healthcare background as a statistician and data management guru of sorts to help make decisions for a large organization assisting a lot of smaller ones and dealing with a lot of people. There was a learning curve there too, but my experience as a paramedic with knowledge of the real-world of healthcare makes a huge difference and brings a lot to the table. Nurses have expanded into this role for quite a while, and a lot of organizations from Education to Public health employ nurses in a lot of capacities apart from their traditional role as a bedside caregiver. Paramedics and EMTs can and should do this as well.

Previously, I had envisioned a certification as a “Clinical Paramedic” to provide paramedics with the knowledge and skills required to function in a physician’s office setting. I still believe that having additional certifications that build upon our initial licensure and education is the way to go. Imagine that once you attain your initial paramedic education there would be multiple educational options for you to choose from that would lead to a wide variety of career paths. You could be a “Public Health” paramedic working in the inner city to improve health standards and access to care, you could be a “Clinical Paramedic” staffing a clinic, working in primary or specialty healthcare, or you could be some type of “Specialty Paramedic” working perhaps as a liaison with children with special healthcare needs for a community organization. The possibilities are literally endless if we dare to explore our options and trumpet our strengths as a profession to the masses.

In order to do this, we’ll have to fall back on the “We Need More Education” answer as well as exploring how our licensing bodies will have to modify our legal scope of practice to allow us to function in these roles. I’m afraid that we’ll have to fight to “own” our licenses like the nurses do (and AmboDriver, you could weigh in on this) but the fight will be worth it.

I’d love to hear from my readers about how they apply their EMS skills in a manner outside of our traditional role. This is a subject area where I believe our brethren in the volunteer part of our industry can assist us greatly in explaining how their EMS training helps them in their primary occupation. If you are an EMT, Paramedic, jump in and help move us forward. What would do as a medic and what would you like to be doing tomorrow?

Posted by Ckemtp on January 18, 2010 • Filed under: Ambulance, change, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS Topics, EMT-Intermediate, EMT-Paramedic Specialist, ER, new perspective, Paramedic, paramedic education, physician, potential, profession, salary

Life Under the Lights – From behind the Windshield

6 comments

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.

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

Fiddling While Rome Burns – The “Ambulance Industry”

14 comments

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.

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

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

21 comments

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.

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

Thanking Those who REALLY Deserve it – Merry Christmas

4 comments

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.

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

Education vs Training: The “Professional Ambulance Cleaner”

22 comments

Imagine if you will this hypothetical scenario:

You and your roommate have just graduated EMT school together and go to work at competing ambulance companies in the same city. He works for HIS ambulance service, and you work for YOUR ambulance service. Both services have similar fleets, similar deployment patterns, and similar call-volumes. In fact, there’s really no way to tell them apart other than the fact that the HIS ambulance service uniforms are sickly green jumpsuits, and YOUR ambulance uniforms are Macho Blue Shirts with navy blue pants.

You both go off for your first day on the job which understandably includes several hours of training on company policies. For both of you, the whole day turns out to be a long class on how to clean the inside of ambulances.

Here’s the differences, though. At YOUR ambulance, you learn about the biological functions of bacteria and viruses. You learn their strengths, their weaknesses, how they reproduce on inanimate environmental surfaces, how they create biofilms to increase their reproductive capabilities and life span, and how pervasive they are in randomized samples from real-life ambulances. You learn how grime collects in the ambulances, how it adheres to the surfaces that you will be cleaning, and what the various types of substances are that you will most commonly find in real-world applications. The whole first day is spent on nothing but learning about dirt, grime, and germs and how they contaminate ambulance interiors. They even threw in the types of materials that the ambulance interior is made from and what the specific dirt-holding and germ-breeding properties of each material are. You see samples and scenarios pertaining to germ and dirt proliferation on ambulance interiors.

Not only that, there’s homework, reading material, and a report due the next day.

The second day that you report to YOUR ambulance service, you learn all about different types of cleaning products, tools, and disinfectants. You learn how to properly choose the detergent needed for optimum dirt-dissolving power on what type of surfaces you may have to clean; You learn the proper disinfectant to choose for each type of commonly encountered bacteria, virus, and fungi spore; and you learn the proper contact times to leave each product on for optimal disinfection and/or dirt dissolving power. Then you learn about every different type of sponge, mop, rag, fabric, and tool used to clean the ambulances. You spend a few hours in the laboratory they have testing out the material and performing experiments in the name of learning.

Oh, and after that day too, there’s a lot of homework and reading material.

Your roommate, on the other hand, went to work and found out that he too had to learn about ambulance cleaning. He learned that they also expect clean ambulances, however his choices and training are much simpler. He is told to clean the ambulance using two bottles: One marked “Cleaner” and the other marked “Germ Killer”. He is given ten rags and is told to clean the ambulance for inspection by the owner of the company using the tools given in the time allowed. He does so and is told “Good, now do it again tomorrow”. The next day, he again cleans the ambulances using the tools and training provided, and is again told “You did a good job”

In the above scenario, the first ambulance service, “YOUR Ambulance, uses a form of advanced education to teach their people how properly to clean the ambulances to their specifications. The education is rigorous and in-depth.

At “HIS Ambulance” they use training, and vocational experience to teach their employees how to properly clean the ambulances.

Here’s some questions I have:

Which ambulance service do you think will have cleaner ambulances in the long run?
Which employee do you think will do an overall better job in cleaning the ambulances?
Which employer, “YOUR Ambulance” or “HIS Ambulance” do you think has the better philosophy?
Which ambulance cleaning class will result in the better, more motivated, happier employee?

Anyone else see the relationship to EMS training/education here? Which one results in a more “Professional Ambulance Cleaner” that is better equipped to handle the job?

Posted by Ckemtp on November 12, 2009 • Filed under: Ambulance cleaning, Ambulance maintenance, disinfection, Emergency Medical Services, ems 2.0, ems education, EMS Management, ems scenario, ems scenario based education, EMS Topics, EMS training, Management, Paramedic, paramedic education, profession, professionalism, sanitize, scenario based training, Training & Development, training-fire-rescue-topics

A Motivational EMS Article Geared towards Newer EMTs

5 comments

The following article is what I submitted to my Fire/Rescue/EMS department’s monthly newsletter for this month’s EMS column. It has a readership of every one of the the 110 or so members of the department, their families, and a good percentage of the 30k or so people in our district. They know me personally as someone who (Imagine this) likes EMS.

If you like this article, feel free to steal it and use it for your purposes. All I ask is that you keep the links intact and give byline credit. Shoot a comment to me too so I can see if it indeed does go anywhere.

Oh, and here’s a thought. If you would like a short EMS related piece to put into your department’s newsletter, shoot me an e-mail at proems1@yahoo.com I’ll be happy to come up with something.

————————————–

It’s well known around the department that I like the ambulances and EMS in general. I do, and I’ve always been proud to be a part of (My Department’s) EMS program. I think that the level of dedication and professionalism in our department is second to none and that our program is certainly one of the best in the region and in the state.

With that said, in EMS there is never a time to slow down and rest on our laurels. The science that drives our brand of medicine is constantly evolving and the only constant is change. In my EMS career, I’ve seen “The Right Thing to Do” for my patients change more times than I thought possible. Continuing education, reinforcing the basics, and studying the latest research is key in keeping oneself in step with how best to care for our patients. As with any community based Emergency Medical Services provider, our citizens are our families, neighbors, and friends. We have the responsibility of being the first line of defense against the very worst times in peoples’ lives and it is our duty to be at our best when we are called to make a difference. The people we care about most are depending on us.

Just as in firefighting, in EMS, the little things make the biggest difference. It really is the Basic Life Support care that makes everything else work and our calls run the smoothest. Patients do not necessarily perceive the skillful application of Advanced Techniques or medications given to them, but they certainly appreciate the attention given to treatment of their ABCs, their comfort on the cot, pain relief and stabilization through proper splinting techniques, the compassion of the care providers, and the cleanliness of our ambulances and equipment. It has been said that “Perception is Reality”, meaning that the way someone perceives you or your organization affects their own reality. In EMS, good perception actually has been shown to provide for better patient outcomes. Really, if you have more confidence in the skill or effectiveness of your medical provider or a technique, you’re statistically more likely to have a better outcome.

It is so important for us as healthcare providers to focus on providing the best care possible for our current patients, but also to keep an eye out for future patients. Start now by making sure that the ambulance is thoroughly cleaned at the start of every day and after every call. Make sure that your equipment is ready to go and that you’re an expert in its use. Read something educational every day to keep yourself in the right mindset and to keep your skills sharp. Pull things out and practice with them. Come up with questions to ask the more experienced providers and don’t be afraid to ask them. It is every EMTs duty to become an expert in prehospital care and you are the only one who can expand your knowledge enough to become one. Study every day.

Here are some resources I use every day, they teach me something every time I use them:

- Http://www.happymedic.com – A San Francisco Firefighter/Paramedic and his adventures in EMS.

- Http://www.999medic.com – A British paramedic working EMS with our neighbors across the pond.

- Http://www.theEMTspot.com – Educational tidbits, tips, and tricks from a Colorado Paramedic.

- Http://www.EveryDayEmsTips.com – A Social Media, training, and EMS guru with daily tips to improve your care.

- Http://paramedicine101.blogspot.com – In-Depth Educational Articles for EMS providers.

- Http://www.LifeUnderTheLights.com – Your’s Truly’s random musings on the EMS.

Of course, getting your hands on a copy of JEMS or EMS Magazine is great too. Learn something every day, take pride in yourself, your service, and the care you provide. Your next patient could be your loved one, make sure they’d get care that you’d be proud to give them.

Posted by Ckemtp on November 3, 2009 • Filed under: Ambulance cleaning, courtesy, Emergency Medical Services, EMS, ems education, EMS Motivation, EMS pep talk, EMS Topics, EMS training, EMT, medicblog999, Patient Management, profession, professionalism, Public relations, technology-communications-ems-topics, Training & Development, volunteer fire department, volunteer firefighter, Your Happy Medic

Sunday Randomness – Some EMS Pet Peeves

6 comments

< Rant>

Call me old and cantankerous. Call me obsessive too, probably. After being in EMS for a while now, like over a decade or so, I’ve become somewhat set in my ways.

No, not to the point where I’m not keeping up with cutting edge medic stuff or to the point where I won’t try out new fast food joints… and heck, just today I even tried out a new way to clean the station bathroom using the hose and the truck brush.

You know that the “Wash and Wax” stuff we use to shine up the trucks works AWESOME on the porcelain goddess! I can see my reflection!

But I have definitely developed some Old Guy in EMS Pet-Peeves (or as you UK folks call them, “Frumpydumples” or something weird like that) and I just remembered that I have a blog that people come to read. Because of that, I think that I’m perfectly entitled to rant a bit on what my EMS pet-peeves are. It’s a beautiful thing, for me.

So, without further ado, in no particular order, here are some of Ckemtp’s all time EMS pet peeves.

#14245 Swearing in front of a (member of the public)

Look, there are days where I can spew forth a string of sassy talk that would make Popeye blush. I get it from my mother (She’s a saint). I also grew up in the country around farmers and got my start in a rural firehouse. I know how to swear with the best of em’ (“#$Q#$” See? There ya go). However….

IF YOU ARE AN ON-DUTY PUBLIC SAFETY PERSON DO FREAKING NOT SWEAR IN FRONT OF A PATIENT, THEIR FAMILY, OR ANYONE ELSE FOR THAT MATTER!!!

It’s not cool. It’s not “Just how I talk” and I don’t have to get used to it. People don’t have to adjust to you. You’re a professional, you have to adjust to them. When you do this, it not only makes you look like an ignorant ass (ahem) but it also makes ME look like one by shaping public perception of our profession.

Call me what you want to. I don’t really care. It doesn’t matter matter if we’re with a patient, at a facility in front of staff, or out in public having lunch. You are representing everyone, every EMS and public safety person. Act like it.

Do this in front of me and expect correction, immediately, in front of the patient. (Yes, it’s that important). Swear in front of children and I might just have to hit you.

#3523 Encouraging the Refusal of Medical Assistance (RMA) before assessing and treating the patient

Hey, guess what… I understand that you’re tired. I understand that you’ve got better things to do today. I completely understand that you’re tired of running what you consider to be “BS” calls all day.

But you’re an EMS professional, right? You’re SUPPOSED to be sent to people who call 911. Yea, there… I said it. It’s your FREAKING JOB to assess everyone who calls you to the BEST OF YOUR ABILITY before you give them a professional recommendation about what they should do. If you ask a person “So do you want to go to the hospital or what!?” angrily before you even, like, feel for a radial pulse or get a pertinent history and physical exam you’re NOT DOING YOUR JOB. Most patients WANT you to give them a recommendation on what you think they should do. You’re an EMS professional, do just that.

If we told more people “Well, Ma’am/Sir I believe that what’s going on doesn’t really warrant an ambulance trip to the emergency room. I’ll be happy to take you if that’s what you want me to do, but perhaps you could get better care by taking a trip over to the (Insert Local Urgent Care Clinic Here) or by calling your personal physician and telling the receptionist that a paramedic/EMT told you that you should be seen today, or (Insert locally specific alternative treatment path here)” we could defer a lot of what you consider to be “BS” calls. Not everything is an emergency, but every patient deserves our professionalism, if not our respect. It’s our job and our duty to everyone. Yes, it really is. No, your argument doesn’t hold water with me. You don’t deserve to be so cynical.

Appropriately assess, treat, and make your decisions on behalf of every patient. Don’t put your personal feelings in there. It’s not ethical. No, it’s not. You want to be an EMS professional? Act like one and Earn It.

#7628 Not being EXTREMELY CAREFUL when handling the cot

Ok, this is a patient safety gripe. Have you ever dropped a patient while they’re on your cot? I have. I don’t consider it to be my fault other than the fact that I was responsible by being one of the two people holding the cot at the time. I’ve never forgotten the look of horror on each and every one of their 4 faces. I. Felt. Terrible. It haunted me for weeks. It still does. We’re supposed to protect our patients. To ‘First Do No Harm’ is somewhere in our extended code of ethics. If you’re dropping people on your cot, you’re doing harm.

If I see you absentmindedly wheeling the cot, I will stop the cot, watch you continue walking until you wrench your arm out of it’s socket, and then laugh under my breath. I will compel you to pay friggin’ attention to the cot and the patient before I move again. If you resume being absentminded, I will repeat.

If you don’t know basic physics, which will tell you that the center of gravity for flipping a cot is much smaller when the cot is travelling on from side to side rather than from front to back, then you shouldn’t handle a cot. Yes, the cot wheels rotate 360degrees but that does not mean that you can move the cot sideways. Move it in a straight line. When you need to turn you stop, rotate the cot on its axis, then move in a straight line again.

Yes, I ended that paragraph with a period. There wasn’t any more to say about that. Know what else there isn’t much to say about? The fact that you WILL have BOTH hands on the cot when moving on anything less stable than a level hospital hallway. That’s the only time you can use that little handle on the front of the cot. If you’re on ANY other surface, it’s both hands on the cot.

Yes, that was another period. Trust me. I’m saving you years of torment and some lawsuits.

Alright. Today’s rant has gone on long enough. Thanks for reading! < /rant>

And yes, there will be more coming. I rant a lot. It’s one of the reasons I started blogging. Thank you for reading it.

Posted by Ckemtp on October 25, 2009 • Filed under: Ambulance, ckemtp, ckemtp rants, Emergency Medical Services, EMS, EMS Health & Safety, EMS rant, EMS safety, EMS Topics, pride, profession, professionalism, Public relations, rant, Vehicle Operation & Ambulances

The Profession that is EMS

10 comments

(Attention: I edited this post heavily. I think that my ADD was in full effect when I wrote it. It’s better now, I think)

The results are in: the bloggers, posters, commentators, columnists, partners, colleagues, and other people even passively involved in EMS have spoken. It seems that EMS ain’t much of a profession these days.

Dang it. I wanted this to turn out to be a real career. I thought that it would. I needed it to.

You see, I have wanted to be a paramedic since I was about 14 years old and didn’t really know what a paramedic truly was. It’s my father’s fault. He was the volunteer fire chief in the small town where I grew up. And I mean really small here. There were (and still are) about 400 people on a good day if everyone was home with their families and there were a couple tour busses rolling though. The town was Edgington, IL and dad was the chief of the Andalusia/Edgington Vol. Fire Prot. Dist. I’d say that there is where I got my passion for this stuff. It was the kind of department where everyone was a farmer and I got pulled up into a truck to go to my first house fire when I was only 14 years old. I was a body and they needed all the bodies they could get. I was hooked and had to continue. It made me want to know more. I wanted to be a firefighter and EMT so bad when I was a young teenager that I tried to get the state to let me challenge the EMT class before I was 18. I worked very hard to get them to bend the rules for me, but they didn’t let me. I know now that they were right. I should have spent those formulative years doing something productive like learning math or biology or picking stocks or something. Instead, I spent those days carrying around a copy of “Emergency Care and Transportation of the Sick and Injured” that my dad gave me from when he took his first EMT course. I treasured that book. It was my bible. I was a young EMS Geek.

When I turned 18 I signed up for my first EMT-B class and joined the local vollie squad. It was a very rural service with a huge area. We covered 275 square miles of rural territory providing only Basic Life Support (BLS) care. Not much has changed there since then. They’re still an all BLS squad. After a few years I became a paramedic at the age of 20. With that, I became an Advanced Life Support (ALS) provider and was licensed to do all these cool new things but the vollie squad didn’t change for me and I couldn’t do all those cool things with them. This disconnect between my licensure level and my career path lead me to obtain employment at an ALS service. It was interesting being a Medic at 20… I could give complete strangers schedule “A” narcotics but I couldn’t go have a beer after a hard day’s work spent scraping up humanity. Man was I young and dumb. I had no idea what I was getting myself into. There was quite a few times where my bravado got smashed into my face. Luckily I had many, many mentors along the way who took the time to give me their best and train me in the arts and sciences that are the Emergency Medical Services. Without those dynamic individuals, I shudder to think of how some of the calls that I’ve had would have turned out.

Thanks to everyone who has helped me along the way.

However now as I reflect upon the decade or so that has passed since then it brings some things to mind. It is debatable whether this next statement deserves a “fortunately” or an “unfortunately” in front of it. I wrote it both ways but neither word seemed to fit the statement. So here it is stripped of any adjective. Most of those people who mentored me are still on the street with me or have moved out of EMS altogether. While this could seem almost normal in some other professions it could go both ways in EMS. A lot of those people were veterans in the service at the time I met them and were where I am now in the profession. They had around ten years on the job and were at the top of their game as far as providing care was concerned. I don’t want to have such gaul as to say that I am as good as my mentors were even though I have worked very hard to be so… but I have given my all so that I can say I can hold my own with dang near any medic out there. The problem is, I feel like I peaked at 20… as some of my mentors may have peaked when they got their licensure. The ones that are still on the street are getting tired. It’s extremely hard on the body to do this emergency stuff every day for twenty or thirty years. It tears you up. But they’re still doing it. They’re still in the thick of things with me in the same job. They’re still slogging through the blood and the mud and the tears fighting for their pay checks and living their lives working multiple jobs being a slave to overtime shifts. They’ve proven that there is precious little career advancement. The others who left the profession, well they’ve gone on to other jobs taking their lifesaving experience with them. Teaching those of us that are left in the trucks that our income potential is limited if we stay here in the field. We may be saving lives, but we’re hurting our families by working jobs that don’t pay squat.

Sure, there are some good EMS jobs out there. There are EMS jobs that pay well, have great hours, and have a well defined career path. Unfortunately that’s not even close to being the norm. We need every EMS job to be like that but most aren’t.

I don’t say the names or exact locations of where I work on here for a few reasons, like I never want to cross patient privacy guidelines or HIPPA laws. That and I don’t want my comments to be associated with my employers. My opinions are my own and nobody else’s. With that said, some time ago I took advantage of the family package being offered by a member of the opposite sex. This changed my life in ways that I couldn’t imagine. (as a matter of fact, I have to take a “read me a story” break in the middle of writing this) One of the ways that I couldn’t have imagined was that one of my jobs became nearly incompatible with family life. I work for an agency that responds to disasters in a governmental way that I won’t name here in the hopes that google won’t pick it up. With that job I had been making enough money to support a house, a couple of cars, and a good existence. However, being gone 6 months out of the year isn’t good when one has a 4 year old. Because of that, I decided to stay closer to home most of the time and make my fortunes solely as a paramedic again, after spending a few years splitting my time between my busy ALS-Providing Volunteer Fire Department (around 3k calls per year) and travelling around the country for my other job.

With that decision I’m back to being a wage slave and an overtime hog. I work three jobs and I’m gone a lot. I make the same exact pay rate as do the new medics right out of the school. While I’m expected to help mentor the others I’ve found that the program is really only lip service at the full-time place where I work. I do my best because I really, truly care about the patients, the people I work with, the community, and the service (in that order). But I fear that I’m going to end up like my mentors have… still stuck in a truck making very little pay while being so concerned about the patients who need me that I can’t leave them for the sake of my family. Or in an entirely new profession that I don’t love and am not passionate about.

It’s precisely that dilemma that prompted me to start writing about EMS.

I want EMS to be a profession that I can be proud of. Not a job that anyone can do with a moderate amount of education, but a career that spawns true professionals that can make a living doing this and progress up a true career ladder.

Here are two suggestions I have on to do this:

First, we need to make the educational requirements hard. The more we learn and master, the more useful we are. While I don’t want to leave my mentors behind, I don’t think that any idiot out of high school should be able to take an EMT class and hav
e my position… like I did to my mentors. The volunteer services won’t like this statement, and neither will the IAFF or the IAFC or the ENA or the (insert acronym here)… but I believe that the MINIMUM STANDARD to become a PARAMEDIC should be an associate’s degree. Perhaps even a Bachelors degree should be required for a PARAMEDIC.

Secondly, EMS needs new revenue streams. The fee for service model doesn’t work. Neither really does taxation (and I’ll get into both of those in another post). We need to capitalize upon and monetize our current skill sets while developing additional skill sets that will bring new sources of revenue into our services. I believe that the cost of an ambulance shouldn’t be a barrier for someone to call 911 for a life-or-death situation… however I also believe that I deserve a fair wage. With additional revenue streams, both of my ideals could be optimized.

For further consideration, read these:

http://medicscribe.blogspot.com/2009/04/profession.html#comments – Peter Canning’s Blog on the same topic

http://tooldtowork.blogspot.com/2009/04/rant.html – Too Old to Work, Too Young to Retire’s blog on the same topic

http://www.communityparamedic.org/ – A new program that I really think shows promise

Posted by Ckemtp on April 19, 2009 • Filed under: Ambulance, EMS, EMT, Paramedic, paramedic education, profession, professionalism

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