Breakfast with Skip (Part 1)

This is a blog post that I intended to put up months ago, but I never got around to finishing. Paraphrasing a sit down interview is something that I really struggled with, but I really feel that not sharing this information would major injustice to our time that we were able to spend with Skip Kirkwood, chief of Wake County EMS in Wake County, North Carolina. I hope you enjoy this two part post, and take as much from it as I did.

A little over a month before EMS Expo in Dallas, I was speaking with April Saling (better known to the online community as Epi Junky, the author of Pink, Warm, and Dry) about our mutual admiration for Wake County EMS Chief Skip Kirkwood. We decided that since we were both going to be at EMS Expo in Dallas, and since Chief Kirkwood was also going to be at Expo, that we would contact him and attempt to arrange an interview with him for our blogs. Our hope was that Chief Kirkwood would be able to spare five or ten minutes out of a very busy schedule to sit and answer some questions for us about EMS over a cup of coffee. Well, much to our delight, Chief Kirkwood did one better by inviting us to join him for Breakfast on Thursday, the second morning of Expo.

Skip got his start in EMS in 1973 when he was certified as a Hospital Corpsman. He then started his career in EMS and shortly after, he obtained his Paramedic Certification, By the Mid-80’s, he decided that there might not be much of a future in Emergency Medical Services, so he decided to look elsewhere for a career. He decided that the next step in his life should take him to law school, where he obtained his law degree and worked for a large Law Firm in Philadelphia for a few years.

One day, while sitting in his office reading JEMS Magazine, Chief Kirkwood came across a Job Listing for the position of the Head of EMS for the State of Oregon. The recommended requirements were a Paramedic Certification and a knowledge of Law. He decided that this job would be perfectly cut out for him, so the decision to relocate to Oregon was an easy one for him. It was then that he realized that his search for a career had come full circle, and EMS was really where he belonged.

During his tenure as the Chief of EMS for Oregon, Chief Kirkwood accomplished what he describes as one of his greatest accomplishments: he established a higher education standard to go along with a Paramedic Certification. When a new Paramedic graduated, in addition to that State Card, they also had an associate’s degree. Additionally, in order to gain reciprocity, a prospective State of Oregon Paramedic must have a minimum of an associate’s degree. This groundbreaking standard has been in effect since 1994, and so far, a handful of states have followed Oregon’s lead.

In 2005, Skip Kirkwood was hired into the position he currently holds today: Chief of Wake County EMS and he has brought that service to the cutting edge of EMS innovation. Since his arrival, Wake County has seen an increase in Return of Spontaneous Circulation (ROSC). They’ve kept their employees current on American Heart Association CPR and ACLS updates, and have helped advanced our field as a whole with their research in Post-Resuscitation Hypothermia.

Additionally, Wake County has given the EMS Community a peek into the future with their Advanced Paramedic Program. These highly trained, highly skilled Paramedics respond in non-transport units to assist with Cardiac Arrests, and do follow-ups with some of the more frequent users in the system. In their interactions with these people, they focus on education and preventative medicine to help try and keep them out of the hospital whenever possible. Alternate routes into the Health Care system are pushed to help reduce ER and Hospital overcrowding.

Currently, there are 17 Advanced Practice Paramedics in Wake County. The goal eventually is to have 42.

Wake County EMS also offers many opportunities and side projects for its employees to participate in. They have a Bike Team, a HAZMAT and Urban Search and Rescue Team, a Tactical EMS Team, and even a specific crew called Team Wolfpack that spends time with the North Carolina State Football Team’s Surgeon, and is specifically assigned to handle any medical emergencies involving the team’s players.

For those who do not think any of those projects are for them, there are also numerous standbys, events, and special details to be hand. Wake County EMS covers all of the NC State sporting events for both the players and the event attendees. They also have a county-wide fair once a year, and many other events throughout the 860 square miles that the Department covers.

Chief Kirkwood also attributes a lot of his department’s success to the wide variety of calls that they have throughout the county. Depending on which station a Paramedic is assigned to, he or she could work in an Urban environment, a very rural environment, and could be taking care of a young or old population providing the Medic with a chance to get experience in a number of different settings.

Change is a constant part of the culture in Wake County. When they find a new process or product that they feel can improve their service, they grab it and try it out. Some of those ventures have been successful, but others have not. Their goal is constant improvement.

Chief Kirkwood wants “. . . committed individuals who put their patients first” as part of the Wake County Team. They have to embrace and welcome change in the constantly evolving system that they have created. Some people find that the system is not for them, but there are many of individuals who have thrived in the environment created in his Department, and they will spend their entire career there.

With the upcoming changes to the Health Care System, Chief Kirkwood sees the model that EMS uses changing. He sees more systems with Advanced Practice Paramedics popping up, and Paramedics becoming a big part in helping Hospitals provide continuing care to reduce unnecessary repeat visits and admissions to the hospital. He also sees more transport options being presented to the Pre-Hospital provider. The ER will not be our only choice. Urgent Care facilities, Mental Health facilities and even Detox units will be added to our destinations, just to name a few.

These evolutions will also come with additional training for the Pre-Hospital provider. The Chief was quick to point out to us that the studies that have been done which have said that “Paramedics do a poor job of making transport vs. non-transport decisions for their patients are very accurate.” That’s not a reflection on the current care provided, and that is not to say that Paramedics do a great job. This is simply not a job that we receive any training in doing. In order for his described model to evolve, he feels that this additional training will be added to Paramedic curriculums.

EMS is a field fueled by a younger generation, and Chief Kirkwood realizes and embraces that. He urges all of us to plan for our future. Think about bettering your education. Be financially responsible, and live within your means. That will help reduce your chances of experiencing burnout, and will help progress your career in EMS.

If you want to move forward into a Supervisory or Management position, think about obtaining a degree from an institute of higher learning. This has been a big part of what has helped open doors for Chief Kirkwood throughout his career. He told us that he feels “You can’t get through a lot of doors unless you are at least perceived as an EMS Professional.” Having that degree will help those outside of the industry to realize your commitment to the service.

Although there were some bumps in the road throughout his career, Chief Kirkwood attributes his success to having a strong educational background, and a passion for his work. He feels that the higher education he has obtained has opened up some doors for him, and recommends obtaining a degree to anyone who plans on going up the career ladder in EMS.

Having the chance to spend the time that we did with Chief Kirkwood was a terrific and enlightening experience. It certainly was the highlight of EMS Expo for me, and I can’t thank him enough for making it possible.

In my next post, I’ll share my personal reflections on the interview.