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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.

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

The Drunk Responder

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

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

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

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

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

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

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

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

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

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

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

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

Soapy Demons – Ckemtp is a geek

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Washing Machine Sta 1Ok, so this post really proves just how much of a geek I really am. Just bear with me for a bit.

This subject causes me a lot of personal grief. I know that it probably shouldn’t and that I am indeed a geek for worrying about this issue because seemingly no one else does, however this issue has plagued me for years and I need to get it off of my chest.

This is about the washing machine at the main fire station where I work. I’m at this station a lot, whether I’m working one of my three weekly scheduled paid shifts, hanging around with my wife who works there three scheduled paid shifts as well, or volunteering my time for call response, training, or work projects. So I have the opportunity to use this particular large, commercial, washing machine quite a bit.

It’s a nice machine. It handles the huge loads that we generate on a daily and nightly basis. It cleans the stuff pretty well and runs pretty quickly and quietly.

The problem is, the soap. It does not rinse the soap out of the clothes, bed sheets, blankets, turnout gear, or anything else that we put in there. The “rinse” water is always white with suds and everything comes out soapier than when we put it in there.

I am well aware that this is not a sexy problem. It’s not a big issue and castles will not fall because of it. It just drives me nuts.

When it comes to be my time to use the machine, I run two full cycles at a minimum to rinse out the machine. The third cycle usually has at least some soap in the water but I use it anyway because all of the residual soap that is left in the stuff that we constantly wash in there. The stuff is full of soap! Our sheets, our towels, our turnout gear… everything. After you run a load in there, even after a second full cycle, the water is white with suds on the final rinse phase.

For a few years, I begged, pleaded, cajoled, and bargained to get people to use less soap in the machine. I tried to get the purchasing division to get us a different type of soap that might rinse cleaner. I even went so far as to post up a few memos in the washing room and write a couple of written requests to the purchasing division and the officer above them.

Predictably, nobody cared those times and still nobody cares about the issue now. Everybody still dumps the same big glob of soap into the machine when they start it and then promptly forgets about it. Whomever comes in and removes the stuff from the washer just puts the stuff right in the dryer, still soapy as all get out, and throws another load in the washer. Then, they dump a big glob of soap in the machine and the cycle perpetuates. Honestly, it’s a losing battle for me and I know that I’m the only geek who cares out of the 100 other people on the department. Nowadays I’ve resorted to trying not to care about it so much and also by surreptitiously watering down the soap that we use. I’ve been doing that for years and nobody seems to ever have noticed (until they read this). It helps a bit, but still our stuff is soapy as heck.

Am I crazy? Probably, but consider this: This small issue is hurting my department and the way we function. Really. We spend hours per week cleaning and polishing our apparatus. To do that, we need towels. Lots of them. Now that they’re all full of soap, they don’t soak up water anymore and we have to constantly replace them with new towels that promptly get full of soap and don’t absorb water and leave our trucks streaked with laundry soap and water spots. Then, we replace the towels again and the cycle perpetuates. How much money do we spend on new towels?

Consider this also: Our guys sleep on linens that get washed every day after they’re used. These linens are full of soap and are against our guys’ skin every night. What happens when one of them develops an allergy? Occasionally, some of this linen goes for use on an ambulance… when will we get a patient with an allergy to our soap?

Consider this as well: How much does it degrade our turnout gear to be full of regular laundry soap? Sure, we bought the expensive specialized turnout gear cleaner, but it doesn’t matter because the water we’re using to wash the gear is full of the soap from everything else? Does that degrade our protection? How much are we harming our very expensive protective clothing by filling it with soap? When will the gear fail and someone get burned because of this? Will it happen? When someone gets burned will it be my fault because I didn’t try hard enough to fix an issue that I saw?

Yes, I’m a geek for caring about this issue so much. I feel like an OCD Chicken Little. However, this small, nothing issue is costing the department money overall and could get someone hurt out there on the fireground. After that, I’m sure people will wonder how this could have been prevented. I’m sure also that they’re looking for ways to cut costs now that the economy tanked and tax revenues are down.

And there sits the washing machine, quietly driving me crazy.

How many issues out there do people know about like this? Issues that are small enough so that nobody else cares but that snowball into big problems for the organizations. How many of these issues affect EMS and the fire service industry-wide. How many of them affect everything?

One day I’ll conquer my soapy demon. For now, I have to keep watering down the soap in secret… but as crazy as it seems, I feel that I’m making some small difference. You can too. Be it the way your equipment is checked in the morning, the way you package your lifesaving gear, the way you make sure that the gas tank is full, or the way you do whatever it is you do to make your service the best it can be.

Now get out there and water down your soap. You might just save a life.

Posted by on October 10, 2009 • Filed under: edemse, Emergency Medical Services, EMS, ems 2.0, EMS ethics, EMS safety, EMT, Ethics, everyday ems ethics, fire, Fire department, Firefighter, new perspective, Paramedic, pride, professionalism, soap

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

 

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

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

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

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

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

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

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Perhaps I really am an EMS geek. I do EMS tourism. No, I don’t find new and interesting ways to hurt myself enough to require emergency services but when I’m travelling I usually stop in to EMS and Fire Stations along my way and go look over the service. This has been a lot of fun some times (Thanks MAST in Kansas City and Sedgwick Co. EMS in Wichita! I had a great time) and has been somewhat less fun in other areas. If you’ve ever done this, you’ve probably noticed some things like I have.

First, there are services out there that are average. They run ok equipment, they have an ok group of people working there, and they appear generally competent.

Then there are services that are not so good, the kind that leave you shaking your head at in the car when you leave after politely pretending to be impressed.

And finally, there are services that really, truly do impress you. They’ve got this stuff down to a science. Their rigs are clean, well taken care of, and in great shape. Their equipment is top of the line and well stocked, their uniforms are cool, their people are really friendly and seem more intelligent than your coworkers, and their facilities make yours look like a single-wide trailer. Heck, the place even smells like freshly squeezed awesome. These services are so much of a class act that you find yourself wondering why exactly you work where you do and aren’t working there with them.

I’ve seen these services along my path and I have noticed a few things that seem to characterize all of them. Sure, some do these things better than the others to different extents however you will find a healthy mix of these things at all of these services. I’d like to share some of these things with you.

Things I’ve found out about awesome EMS Services:

  • Their people are proud of the organization: You’ll find that the people who work at awesome services sincerely have pride in where they work. They’re there for a reason. They enjoy working for a service that has a good reputation in the community and the wider region. They think that their service is cool; they think that working for their service is cool; and they are respected by people from other agencies because of the position with the agency that they have. There’s a general feeling among the people that work for the service that it takes hard work and performance to earn a position within the agency. A service earns self respect the same way a person does, by having high standards and meeting their own challenges. A service that earns the respect of its people earns the respect of the wider community. Their Shine Factor is high.

     

  • Their people truly care: “Apathetic” is not an adjective you would use to describe these people. The culture that they’re in allows them to know that they make a difference in everything the service does, not only in the lives of their patients. They know that they are an important part of their service and that they would be missed if they were gone. They care about their coworkers and are as much friends as they are colleagues. There is mutual respect and a feeling that everyone there has to pull their weight in order for the service to meet its goals and thrive. Have you ever seen something wrong in a truck and haven’t spoken up because it was someone else’s fault or someone else’s job to take care of it? These people care enough not to do that.

     

  • Their community cares about and supports them: Community support is absolutely essential if an EMS agency is going to thrive. The best services have proven their worth to their communities and constantly work to prove why they need, deserve, and responsibly use the support they receive. The community supports them because they see the benefit in supporting them. You can see the community’s support in the newness and quality of their equipment and facilities as well as in the salaries that the employees are paid. You can see how responsible the service is with the support they get in how well they treat the equipment and the community in return.

     

  • The culture of the service just ‘feels good’: The culture of the organization defines the way everything runs. Bad organizational cultures breed discontent and apathy in everyone over time. Good organizational cultures breed people who feel comfortable coming to work and handing the responsibility of being an employee. People that work in a bad culture form cliques and get angry a lot. People that work in good cultures come up with ideas that get judged on their merits. People that work in bad cultures fear mistakes because of the punitive measures that will come down from on high. People that work in good cultures acknowledge their mistakes and are allowed to learn from them so that they grow as a provider and as a person. People that work in bad cultures hate coming in to work. People that work in good cultures have friends at work and feel comfortable, if not happy, with being there. I think that you can get what I’m talking about.

     

  • Their people are experts in what they do: Paramedics and EMTs are experts in Pre-Hospital medical care. They have to be, there is nobody else who could or should be. The people in awesome EMS systems have great protocols that are challenging to learn and require advanced skills to perform. Their protocols evolve with emerging science and keep on the progressive edge of medicine. The training, quality review, and quality improvement programs are tough and demanding. People take pride in being the best at what they do and earn their own self respect by doing it well. They respect themselves for their efforts and respect their coworkers for earning their respect every bit as much as they do. Ever been scared that you or a family member or friend would get hurt while so and so’s on? These people don’t have to be.

     

  • The organization respects and supports the employees: This relates to the organizational culture but deserves its own point. Employees will not respect the employer unless the employer respects the employees. In awesome EMS services, the employees and management function in an atmosphere of mutual respect. The management provides the employees with adequate, functional equipment and facilities even when asking them to do more with less. They strive to promote fairness in corrective actions and policies, knowing when to cut someone slack when appropriate. The employees are treated like adults and are encouraged to innovate and take ownership of their areas.

I’ve been to these services and I can honestly say that I left their station with the feeling that I wanted to be a part of their organization. Then, I’ve gone back to my service and taken an inventory on what we needed to do to emulate them. It’s all about being able to enjoy coming to work for the right reasons where you work with people who care, respect, and strive for the same things that you do. EMS people who are passionate about EMS who are allowed to shine build great organizations no matter where they happen to land. EMS people who aren’t build organizations that fall into the other two categories. I suggest that you take some of the suggestions below to help get your service to where you want it to be:

  • Read “The Shine Factor” – One of my previous posts and the predecessor to this one.

     

  • Realize that your community won’t care about you u
    nless you tell them why they should – EMS organizations need to market themselves just as any other business. No matter what your classification is, you need to market yourself to your community every day. Your constituents are your customers and they won’t think about you unless they either need you or you put your message in front of their faces. Tell them what you do, tell them why you do things the way that you do, and tell them what you need to do what they do. Let them know how you strive for quality. Let them know how well you are stewards of their hard-earned dollars. Let them know who you are and what you stand for. Trust me, PR saves lives and EMS budgets.

 

  • Right now, resolve to treat everyone else in your organization like a professional. Try to earn their respect. Someone has to take the first step here, it should be you.

 

  • End any secrecy in your organization – Sure, direct personnel actions are one thing, but unwritten policies and issues directly affecting all employees are quite another. Allow people to become involved in the organization in any role they want to. Organizational secrecy builds “Silos” where people tend to stratify themselves based upon their own perception of what is most important to the group and allows individuals to worry that anyone with a new idea is there to steal their position within the silo. Allow people to participate and collaborate on decisions affecting the organization.

 

  • Encourage innovation. Encourage participation and new ideas – No idea is a bad idea. Business these days thrives on the economics of ideas. Don’t shoot down any idea without a collaborative review of its merit. Employees come up with new and better ways to do things every day, let them develop those ideas and test their effectiveness. If those ideas are repressed in an organizational culture that resists change, the whole organization will suffer when people begin to feel that their contributions never matter.

 

  • Encourage people to take ownership of their roles and responsibilities – I work for my ambulance service because it would miss me if I was gone. Why would anyone ever go to a place where it didn’t matter if they were there or not? When people begin to feel that their time isn’t valued or their efforts aren’t appreciated, they stop putting forth any time or effort above what it takes to avoid being fired. That’s it.

 

  • Never let anything stagnate – If you haven’t reviewed a system in over a year, you’re lagging behind. If your protocols haven’t changed in over a year, you’re not keeping pace with medical science. Even if something is working very well, that doesn’t mean it shouldn’t be reviewed and measured regularly. Make systems prove their worth. Don’t let anything get stagnant. Pull ineffective policies or programs and replace them with another idea. Review those ideas and see if they’re better suited to your goals. Set lofty goals and try hard to reach them.

 

  • Reevaluate why you do what you do – Why are you in the organization? Are you there because you care about what you do? Are you passionate about it? Once you remember what it was that brought you to EMS and to the organization where you’ve happened to land, evaluate if you still see your organization fires your passion. If it doesn’t, work diligently to make it meet your design. Earn your own respect. Forgive and forget past grievances and collaborate on new solutions. Bust silos and build bridges, not fences.

 

As always, I welcome comments and e-mails: ProEMS1@yahoo.com

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

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

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

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

 

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