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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)

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

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

The Shine Factor

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now get out there and polish some chrome.

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

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

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

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

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

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

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

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

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

(more…)

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

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

Thank you EMS – Some reasons I love what I do

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why I am Passionate about the Chronicles of EMS

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

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

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

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

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

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

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

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

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

Expanding Our Career Options – Non-Traditional EMS Jobs

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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?

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

Life Under the Lights – From behind the Windshield

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

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

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

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

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

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

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

And keep driving.

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

Fiddling While Rome Burns – The “Ambulance Industry”

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

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

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

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

Are we Fiddling while Rome Burns?

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

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

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

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

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

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

You’re fiddling while Rome burns.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thanking Those who REALLY Deserve it – Merry Christmas

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

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

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

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

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

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

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

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

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

Merry Christmas, Every one.

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

Education vs Training: The “Professional Ambulance Cleaner”

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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?

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

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

A Motivational EMS Article Geared towards Newer EMTs

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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.

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

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

Sunday Randomness – Some EMS Pet Peeves

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< 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.

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

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

The Profession that is EMS

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

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

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

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

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

Thanks to everyone who has helped me along the way.

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

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

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

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

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

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

Here are two suggestions I have on to do this:

First, we need to make the educational requirements hard. The more we learn and master, the more useful we are. While I don’t want to leave my mentors behind, I don’t think that any idiot out of high school should be able to take an EMT class and hav
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

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

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

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