A Day That Never Ends

One of the biggest challenges of working in EMS is there’s never truly a day off.  There’s no reason to put locks on the doors of our industry because someone is always there.  If there’s not a call going on, there’s the potential that call is going to happen.  There can never be a lapse in coverage when it comes to providing EMS in the field, and when making the transition to management, we need to not lose sight of that. The “normal” world exists on a typical 9-5 schedule Monday thru Friday with holidays and weekends off, and managers in EMS seem to stick to that schedule as well.  There is a lot to be done behind the scene to keep things operating smoothly.  There are budgets to manage, capital purchases to make, people to hire, and meetings to attend with stake holders and customers alike.  Additionally though there are people to manage, and those other sixteen hours of the day should not be overlooked. A forty hour a week manager is only there for about a quarter of their company’s work week.  They are missing three quarters of the work week, and as a result potentially missing two thirds to three quarters of their work force.  Evening and overnight crews can feel neglected, and even run the risk of missing out on employee appreciation functions due to an unwillingness to come in off the clock for such events. Keeping a presence in the field is a positive thing as well.  A manager never has to put on a set of gloves or lay hands on a patient, but imagine how you would feel if you walked out of an ER to find your boss cleaning the back of your truck, or they carried your oxygen bag out of a house for you.  Its small gestures like that which will make people’s days easier. Normally, I look to a lot of EMS leaders for advice and guidance.  Now, it’s my turn, as a mid-level manager to share some with them. 1.  Remember, the work doesn’t stop when you stop working — Things keep going when you’re at home.  Whether it’s the evenings, the...

Progress

I’ve seen a number of changes since I first stepped on an ambulance at the age of 15.  Some of them have been good, and some of them not so good.  In this edition of EMS in the New Decade, I want to point out what I feel has been the best piece of equipment and the best treatment that I have seen added to my toolbox mainly in my last eleven years as a paramedic. 1.  The LP 12 Monitor — When I was in paramedic school at Springfield College, I was trained on an LP-10.  We had no way of doing 12-leads besides that old trick of moving that single electrode around the chest to get the pictures that we wanted.  We could look at the inferior leads with the old “hold down the print button” function on the LP-10 to put it in diagnostic mode, but without a little bit of work, we couldn’t get the monitor to do a lot on its own. Don’t get me wrong, I loved my LP-10, but it was dated, and it was evident to me from the start of my paramedic career that as an industry we had moved past it.  In fact, for the last two years of my career in New Jersey when I was in paramedic school in Massachusetts every LIFE EMS unit that intercepted my BLS ambulance had an LP-12 on it.  I was a bit behind the curve on reading 12-leads due to my inexperience with them, and my trips home brought that glaringly to the forefront. Adding an LP-12 to my truck somewhere around 2003 when Massachusetts made them a requirement was a huge step in the right direction.  Not only was I able to do 12-leads but I had an O2 Sat machine build into the monitor, and I was able to measure end title CO2 not only on intubated patients but also via a nasal cannula-like detector.  That was technology that our emergency room didn’t have.  In fact, our larger ER still relies on breath sounds and a color metric device. My scene times may have gotten longer after I packed my LP-10 away, but I...

I’m a Paramedic, not a Paleontologist

“Nothing stops an organization faster than people who believe that the way you worked yesterday is the best way to work tomorrow.” — John Madonna Patrick, one of my colleagues here in Massachusetts shared that quote with me one night when we were having one of our nightly conversations about where our service is, and where it is heading.  John Madonna’s words describe many people that I’ve encountered in EMS.  They fear and are resistant to change, and they really shouldn’t be.  They need to learn how to embrace it, and be comfortable with change, and view it not as “change” but as evolution. I’ll paraphrase Patrick’s thoughts that followed: “We could call this the ‘Dinosaur Mindset.’  Extinction thinking.  We must grow, learn, evolve, become, and always improve ourselves and our ability to serve the world.  All the while not changing or letting go of the core principles, truths, and values that should never change.  If we waver from our course, we will just find another way to become extinct and irrelevant.” Every generation has seen change in EMS.  Otherwise, we’d still be driving around in Cadlillacs that doubled as hearses.  We wouldn’t be doing 12-Lead EKGs, and CPAP would just be some silly thing that respiratory therapists apply in the hospital. If you’re one of those people that’s not really comfortable with change, that’s fine, but don’t fear it.   Don’t hold it back.  Throw the phrase “That’ll never work” from your vocabulary, and right next to it, file the phrase “well, 5 (or 10, or 15) years ago, we didn’t do it that way.”  Be patient, and let evolution take its course.  It might not be comfortable at first, but with time, change becomes easy, and often can be beneficial. Be willing to try old tricks but with a new twist.  Just because something hasn’t worked in the past doesn’t mean it can’t be made to work now.  Finally, learn from what goes on around you.  If you want to change, don’t be set on reinventing the wheel.  The best answer might not be within your organization, or even within the industry.  Be willing to take that extra time, and make the...

Fool Me Once. . .

Did anyone else see the story that came across EMS1 yesterday about Dennis Leary producing a pilot for an EMS show?  After what I’ve seen him do with Rescue Me, I must say, I am excited, but I’m also reserved.  I’ve been burned one too many times. Maybe its because we compare every show that comes out to Emergency! or maybe its because we compare them to our everyday experiences.  Regardless, there are some bad ones that have been out there. Need I list the complete failures of EMS shows that I’ve seen in my time? Let’s face it. . . It’d be a short blog post if I didn’t. Rescue 77 — This one came out in 1999.  I was a few years into my EMS career, and excited to watch something a little more modern that Emergency! which was a show that I loved.  Well, I couldn’t be more disappointed.  This was filled with unrealistic scenarios, people doing handstands on patients so they didn’t have to defibrillate someone in water, and a doctor reducing a patient’s intercranial pressure in the field with a Black & Decker drill after being begged to “think like a medic!”  It’s a shame the producers couldn’t do the same thing.  This one was dead after 8 episodes. Third Watch — This was a favorite of a lot of people, and I will probably take some flack for mentioning it, but boy this show just didn’t do it for me.  It was too much adrenaline, and went a bit too far at times.  From the EMS side, there really weren’t any likeable characters for me either. Trauma — Um Hello?  Do I really need to say anything about this one?  There are really only two cool things this show gave us: The term Captain Versed, and the Halloween costume associated with it created by Ms. Paramedic. Paramedics — Okay, so it was a reality series.  Great, right?  Sure.  It had a lot of redeeming qualities, but it failed me due to poor editing.  Treatments were out of sequence, and to anyone who had a trained eye, it was easy to notice. Saved — This one was the best...

Happy Father’s Day!

  On February 18th, 1985, I was 6 years old.  It was Washington’s Birthday, and I was off from school so my dad took me out to go bowling for the afternoon.  It wasn’t something that we did very often, so it was nice for a change. Back in the early to mid-1970s, my dad was an active member on the Island Heights First Aid Squad.  When I came along in 1978, family became the priority.  He took a break from the “EMS thing” for a while, but always kept a blue metal first aid kit in his trunk, just in case he ever needed it for our family or someone else in need. As we drove home on Route 37 in Toms River that evening, an intoxicated elderly woman left a bar somewhere along the route.  Route 37 is a six lane road in most parts, with an often ignored speed limit of 50 MPH, and a large median separating the east and west travel lanes.  She got on the wrong side, and started traveling east bound in the west bound lane.  Our local fire chief from Island Heights saw this happening, and despite his frantic calls over the radio, there was nothing anyone could do.  She slammed head on into an oncoming car ejecting the driver, a younger woman, who was obviously unbelted. As we came up to the scene on our way home, my dad felt compelled to stop and help.  I sat impatiently in the car, just wanting to go home at this point, a six year old not really understanding or comprehending exactly what happened.  Eventually, after the ambulance and paramedics had gotten there and taken her away, my dad cleaned himself up along with the other good Samaritans who had stopped, and we took the short trip the rest of the way home.  We still talk about it sometimes, but it’s really just another story in the long list we’ve accumulated over the years. Twenty seven years later, my dad is now a nineteen year member of the Island Heights First Aid Squad, serving his second tour as the squad’s captain.  A month ago, he was driving his...

What? No PIO?

“Couple Claims Ambulance Took Too Long“ I stumbled across this story on the JEMS website the other day. Click on the link, check it out and come on back to read what I have to say about it.  Okay, ready?  Another tax paying citizen is upset that it took too long for an ambulance to get them to the hospital. An elderly woman “felt ill” so her husband called 9-1-1. Tippecanoe County EMS responded to her aide in a timely manner and loaded her up for transport. Her husband and neighbor left the scene and rushed to the hospital. When they got there, the ambulance wasn’t there yet, and they had to wait for her to arrive. According to the husband stated it took an hour. The patient even made a statement to the report that she “wondered if she was going to make it.” The service director stated to the media that according to their records, the truck took 18 minutes to get to the hospital, and that she was transported without lights and sirens. Some people might shake their heads because of the job done by the reporters, but I feel it’s a failure of the service and their public information officer (or lack of one). When an ambulance transports to the hospital without lights and sirens, it tells me a lot about the condition of the patient. The crew did not rush the patient urgently to the hospital seemingly because there was no need to. When we transport without lights and sirens, it’s for the comfort of the patient and the safety of the crew. EMS professionals might not do a good job determining who should and shouldn’t go to the hospital, but in my experience they do a great job of determining how fast you need to get there. The chief didn’t do a bad job considering his HIPAA handcuffs. The family and the patient were so vague about what happened that there really isn’t a clear picture painted, and he appropriately didn’t add to that patient care picture at all. What he failed to do was take a great educational opportunity for the media and the public to let...

Recognition

EMS seems to have this chronic problem of not putting their people out there enough and recognizing them for the vital role they play in their community each day.  Sure, there are organizations out there such as the American Ambulance Association which takes great EMS providers and puts them in front of members of congress as examples of what an EMS provider should be, but it seems to me that those instances are few and far between. It should be noted that if someone gets into this field looking for ticker tape parades and medals to be pinned on their chests, they’ve definitely gotten into the wrong field.  EMS is 90% routine, and 10% action.  Sadly though, it is that 10% action that seems to be recognized 1% of the time.  The public isn’t going to care that Pat the Paramedic took care of thirty chest pain patients last month, but they should care that when Pat walks in the door of their home, they are going to have a caring, and compassionate provider standing in front of them. There are a few things that I feel hold us back from really getting our people out there, and they’re all internal: 1.  The “It’s your job” mentality — Some leaders in EMS overlook consistent performance, citing that the person is doing what they are supposed to do.  While that statement might be accurate, reward and praise for consistency is a must.  Chances are, if this person meets the expectations set for them every day, they are frequently exceeding them, so praising them might actually go a long way.  If it seems like you have a number of people that are failing to meet the standards you are setting from them, take a good look at how they are being relayed to your people.  Chances are, they aren’t out there enough, or aren’t fully understood. 2.  Not enough eyes — In larger services, it’s not always easy to see and understand everything that is going on in the field.  Patient interactions can frequently go overlooked, and great employees can be overshadowed by that 5% of the employee base that takes up 90% of your time. ...

The Storm

Over the last week I’ve been giving a lot of thought as to how I would relate my experiences after a tornado hit my city.  I could give you all a play by play of where I was when everything happened, and what I did, but the truth is, my role  in the response from a provider stand point was pretty small. That isn’t to say that I didn’t do a lot, but for the first time in a long time, it was a “gloves off “situation for me.  In the first 72 hours of the tornado response, which were arguably the most crucial, I touched only two patients, put two pair of gloves on, and never actually made it to an emergency room.  That was by far the strangest part of the entire experience for me. I’ve always enjoyed being in the field, and have always been a hands on provider, but this time around, that wasn’t my job.  That was the responsibility of the great field employees I had working with me, and they did a hell of a job.  Instead, I was running staging locations, organizing the next 48-72 hours of our response, and keeping track of where my people were.  I had to do some of that “big picture” thinking that I talked about a few posts ago.  It wasn’t as large as what would affect my service for the distant future that EMS managers have to tackle, but it was more than the “next 24 hours” thinking that I do in my day-to-day supervisory role, and a lot more than the call-to-call problem solving that I did in my years before I was promoted. The success of our endeavors over those first four or five days was a team effort.  I really feel that I am blessed with a great group of EMTs and paramedics that work for me, and I can’t say enough about them, and the job that they did.  They made the “personnel management” part of my job very easy.  Our schedule was overflowing with people willing to help, trucks were stocked, cleaned and ready to go, and whether people were on their 4th or 24th...