This Post can also be found at the First Few Moments website. Bob Hurley Sr is the basketball coach of St. Anthony’s High School in Jersey City, NJ.  As one of the most successful coaches in the history of the game, he was inducted into the Basketball Hall of Fame this past year.  If one was to ask Coach Hurley why he has been so successful, he will tell them it comes down to two things: discipline and practice.  Hurley is well known for his intense practices and his ability to always get the best out of his players, and we could learn a lot from him.  His players don’t practice at half speed in unrealistic circumstances.  Their practices are intense and at game speed.  His team practices like they play, and as a result, they play with the intensity that they show in practice.  Think for a second about how your department trains for a major incident. Â  What can be done to make them better?  What can be done to challenge the participants more and to bring out their best?  Here are a few of ideas: Make sure the circumstances are realistic — You want to be put into a situation that tests your ability to manage a major scene that is as accurate as possible.  Does your department staff only two trucks for the shift?  If so, then don’t have four available to them for the drill.  Make injuries look realistic with moulage, and make sure the management of those injuries is timely and appropriate.  Throw in a monkey wrench or two – Try and simulate the outside distractions you may encounter as part of the incident.  Think about bystanders, and traffic patterns and how they might affect access to the scene.  When units are responding, advise them that due to the incident, the intersection of Main St and Washington Blvd is completely gridlocked and impassable.  Make your responders think of alternate access to the incident, and make the scene commander adapt his or her plan to the unexpected challenges they might encounter. Expand on your debrief — When the exercise is over, don’t just look at the good and the bad...

Yesterday, I spent my day doing something I hadn’t done in a long time: Teaching.  I volunteered (was drafted?) a few weeks ago to produce an entire day of content for one of our paramedic refreshers, and the opportunity excited me.  As I started putting together my topics, I decided early on that I wanted to expose the class to things that they hadn’t been exposed to before.  The four presentations I put together were: EMS and the Non-Transport Call, The Well Being of the Paramedic, The Future of EMS, and EMS and the Internet. The content seemed to be well received, and some of it sparked some decent conversation.  It got me thinking about our struggles here in Massachusetts over the last year. As most of the EMS community knows, starting last summer, Massachusetts saw a number of indictments of instructors and course coordinators who were falsifying documentation to recertify EMTs and paramedics.  It was a pretty big deal, and punishment was not just served to the instructors but also to the recipients of the alleged training who signed the rosters.  Suspensions of certifications were as short as 90 days, and as long as in excess of a year.  Some even lost their cards and could face jail time. In response to the problems experienced, the state’s Office of EMS has responded by increasing the oversight they have on classes throughout the state.  Evaluators will occasionally “drop in” on classes, sign in, sit to audit for content, and make sure everyone is there.  I’ve heard of it happening a few times, but unfortunately, I did not receive a visit on Thursday. Let me preface this by saying I feel that the punishments handed down were just.  People got what they deserved for the mistakes that they made.  It saddens me though that thus far, the state seems to have missed the big picture.  Refreshers need to be revamped and restructured.  Priorities need to shift. With all of the data that is being collected in the prehospital setting, we have a better look than we have ever had.  It’s time to put it to some use.  Tell me, and tell my colleagues in my...

May 25, 2011

I am writing this blog post this morning from my favorite bar.  Its 7am, and I’m waiting for them to start serving breakfast.  According to the sign, it’s the “Best Breakfast in the City” and I’d tend to agree.  I’ve put a lot of money into this place over my years working here, and it’s been well worth it. Eleven years ago this week, I started my career with the service that I currently work for and it’s been quite the ride.  When I started I was 22 and had just finished my paramedic student time.  I was waiting for my test date to come around so I could get myself upgraded and start my career as a paramedic, something that I had dreamed of doing for a long, long time. As I stated in a post last week, ten years ago this month, I also graduated college.  That marked the start of my career as a full-time paramedic.  My work weeks were 60+ hours long, and I had to work some shifts that was viewed as “less desirable” due to my lack of seniority.  My very first shift was 3p-11p on Mondays and Tuesdays, and 7p-7a on Fridays and Saturdays.  The evening crew on my 8 hour shifts were your typical group, nothing really special.  We spent our evenings running here and there, and really didn’t have too much contact with each other simply due to the sheer volume of calls that we’d run.  The group that I got to work with on the weekends though was a different story all together. We were the younger crowd.  I’d dare to say that the oldest of us was probably in their early 30’s and most of us were between the ages of 20 and 25.  When we worked, we traveled as a pack from post to post.  Our trucks had hackee sacks, decks of cards, frisbees, and plenty of other stuff to keep us occupied.  When the calls started coming in though, we were quick to pack it up and get the calls done. There was a strong sense of camaraderie between the crews.  If someone had a bad call in a shady area of...

How do we make decisions in EMS?  Sure, we are guided by our protocols and medical control, but truthfully what is our focus when we make a decision as a paramedic or EMT on an emergency call?  Is it fair to say that most of those decisions are based on what is going to happen in the next 15-20 minutes?  In the most critical instances, I’d say that it is. When we work a code, we are fighting for that ROSC.  We want it quickly so the patient has the best outcome.  On a STEMI call, we are basically doing prep work for our patient’s trip to the cath lab.  Those IVs we start, the medications we give, and the serial 12 leads we perform are all gauged to getting our patient through the ER as quickly as possible.  For a trauma patient, often times surgical intervention is the focus.  Unless there is some other underlying cause of that trauma, “medical” treatment is usually not necessary, or secondary to the potential surgery they could receive when they get through the ER. The next 15 minutes.  That’s what matters.  It is what we are trained to deal with.  We are there to deal with these acute emergency situations and quickly bring calm to the chaos in the best way possible.  When you want to transition from the streets to the front office, how does that thinking change though?  How do our problem solving processes have to change? In the field, the attitude of “just do it and get it done quickly” is great, but that doesn’t translate well to making decisions that could effect departments that might be staffed by hundreds of providers.  Messages need to be clearly relayed, and people need to be given notice of change.  That’s the unique thing about EMS.  It’s a 24/7 business, and implementation can be a real challenge.  You can’t close the doors on Friday, and tell your people that “Monday morning, we are changing ‘X’ ‘Y’ and ‘Z’” it just doesn’t always translate well. This is where I feel great field providers struggle in the transition to be great supervisors and managers.  The critical thinking and problem...

Ten years ago this month, I graduated college.  I had been a medic for about eight months, and I was still terrified.  I was really comfortable with my BLS skills, but a lot of that ALS gear still felt new to me.  It’s amazing how much is different now. . . Ten years ago, I dreamt of having an LP-12 in my truck.  I was stuck though with an LP-10 with paddles. Ten years ago, I was getting ready to live alone for the first time in five years.  The ink was barely dried on the lease for my new apartment. Ten years ago, Osama Bin Laden wasn’t a household name. Ten years ago, people felt safe.  Terrorism was something that happened elsewhere, and Anthrax was a 90’s heavy metal band. Ten years ago, I was getting ready to start my first full-time shift with a friend of mine from college.  Now, he’s on the verge of being the fire chief in the town he works for. Ten years ago, I had never done a shooting.  I lost count of how many I’ve done long ago. Ten years ago, I had my first cell phone: a cheap one by Sprint.  Texting didn’t exist, Twitter wasn’t what it is today, and I had dialup. Ten years ago, I had a Livejournal.  Today, I’ve got my own url. .. But you knew that, I mean, you’re on it! Ten years ago, being a supervisor was a goal.  Now, it’s a reality. Ten years ago, I loved my job.  Now, I love my career. Time sure does fly, doesn’t it?...

One of the most important skills a person can possess whether they’re working in the streets as an EMT or a paramedic, or they’re sitting behind the desk as a supervisor or manager is the ability to actively listen.  It’s not a very easy skill to perfect. Too many people confuse active listening with actively hearing what is going on around you.  There’s a distinct difference between the two. When a person hears something, they are acknowledging that there is noise.  Have you ever said to someone, “did you hear that?”  If the person’s response is confusion, or a lack of recognition, it’s almost instinctive to follow that up with a one word answer: “Listen!”  Listening involves the actual processing and recognition of what a person hears.  Hearing is instinctive.  People do it, animals do it.  Listening though takes focus and higher brain function. Now, let’s apply this to a situation in the field.  It’s our job to listen to our patients, and it is really one of the biggest pieces of our assessment.  It is what gives us a story, and a history of the events leading up to what led them to call 9-1-1 in the first place.  While it’s important to hear the story that you are being told, it is much more beneficial to the patient if you listen to what they are saying.  There might be more to what is going on, and by not paying attention (not listening) you could miss that little piece of the story that puts everything together. As a supervisor or manager, the act (art?) or listening to something that one of your employees has to say is a great way to make them feel involved, and lets them know that you truly care about the input they have to share with you.  It’s a great way to show an employee that they are valued.  Not every idea is achievable, I think most people realize that, but that doesn’t mean that an idea can’t be explored or even entertained. Body language says a lot about whether or not a person is listening.  Are you facing me or staring at your computer screen?  If it’s...

Almost a year ago, I wrote a post about NJ State Bill S-818 which was set to change the landscape of EMS in New Jersey.  In the year since that article was written, the bill and a second one also making its way through the New Jersey legislature have been revised, but the opposition has remained. I got my start in EMS at the Jersey Shore on a small volunteer first aid squad.  We ran, on average, around 400 calls a year, pretty busy for a town of our size.  Often times, it was not uncommon to have two or three, or sometimes even four EMTs standing in your living room in my town ready to render you emergency care.  The communities around us were no different than we were.  We all took pride in what we did, and knew that we could deliver better service than any paid provider who came into the area because we held ourselves to a very high, very professional standard. To this day, I am still proud of my accomplishments as a volunteer.  I was an active member of two excellent services, and the staff of those services taught me to be the caring, compassionate, knowledgeable provider that I am today.  My roots in New Jersey run deep, and I have been very troubled by what I have been reading lately. As time has progressed, and the political and economic climate in this country has changed, volunteer EMS has taken a turn, and is not as prominent as it was even ten years ago.  Families are working harder to support themselves, and the call volume and expectations of care have grown and evolved.  Some might say that these factors spell the end of volunteer EMS, and I hope every day that it isn’t the case.  It’s not the time to expect less from our volunteers; it’s time to expect more for our patients. Sadly though, the New Jersey State First Aid Council seems content with the past.  Their staunch opposition to Bill S-818 has taken the focus off of where it needs to be: the patient and put their stress on what EMS is about on the provider. ...