Read the original post and the comments it generated: Bad Publicity and Saving Face In my two years of blogging, I have seen what I considered to be a few “big” days.  A post goes up, it generates some buzz, and I get a decent amount of hits, usually a few hundred.  This past Monday though, any previous numbers I had seen were blown out the window.  In the first 24 hours that my post about Joshua Couce and the Newton First Aid Squad was up, I saw almost 4,000 visits to my site.   I received a number of comments about this post, and I thought that I would take some time to highlight some of them for you. First of all, I would like to share with you a few comments from Newton FAS members: Member of 15 years: “It is an unfortunate situation that has come about by someone that has been mentored by some of the finest EMT’s around, yes I am a member of the NFAS and I have to say yes Josh made a bad decision by over indulging in the truth, I believe that youth plays a big role in his decision making process. I am in NO WAY CONDONING his behavior or how he portrayed himself and the squad however there is not one person out there that has not made a bad decision weather it be in the professional sense or the personal sense, and unless your back yard is completely clean maybe people should reach out to Mr. Couce and help him grow and mature within the EMS community rather then hanging him out to dry along with the rest of the squad.” Debora Baldwin Phillips: “Mr Kier, I thank you for your insightful post. Some of the points you address are valid. We, as the squad are aware of them. I will not address them in a public forum. However, I, as Captain of the squad, assure you, and anybody else concerned the issues are being addressed. Deborah Phillips, CT1” Thanks to both of you for sharing your thoughts, especially you, Captain Phillips.  Believe it or not, I wish you well in your future...

Recently, Austin Travis County started hiring EMT Basics to work with their paramedics in order to create more units in the system and reduce what is commonly referred to as “skill dilution.”  But what is skill dilution?  Does it even exist, and should we worry about it? I started my career in suburban NJ, a state that, at the time, mandated that every paramedic unit in the state be staffed by two paramedics, operating out of a hospital or under a hospital’s license as an intercept unit.  In my county there were five paramedic units which grew to six, and eventually seven during the summer months.  Seven units staffed for the entire population of the county.  The medics on the truck would commonly take turns tech’ing calls, splitting the work down the middle.  I must say, and I’m sure many would agree, the paramedics that I saw working over the years for LIFE EMS out of Community Medical Center in Toms River, New Jersey were some of the most skilled providers I have ever seen. As time has progressed though, and I have been exposed to different systems, I see paramedic/EMT trucks more and more.  Call them what you like: P/B; 1-and-1; Medic/EMT, but it is all done with a few ideals in mind: to expand coverage, and to give them more chances at patient contacts.  I wonder sometimes though if it really truly makes a difference, and I also wonder about the consequences. For example: if patient contacts are so important to the ability of a paramedic to be able to provide care, then does that mean that urban paramedics who may see as many as ten times the patients that a rural paramedic sees in a given year as superior providers? And what about burnout?  Those of us who work P/B often have had those days when 75% or even 100% of the patients require a paramedic’s care.  When those days turn into weeks, and the overtime mounts up, those borderline BLS/ALS patients can slip through the cracks.  Running P/P trucks gives a system the chance to have a paramedic at a patient’s side from contact to turnover on every call.  If...

Editor’s Note: With this story now being five years old, I have removed the names of those involved.  I do, however, feel that there are a lot of lessons that we can learn from this situation. Late last week Kyle David Bates posted an article from a New York State college paper about a New Jersey EMT from the Newton First Aid and Rescue Squad in Newton, NJ.  In the article this EMT describes such events as “driving over 100 MPH” in an attempt to beat the “golden hour” and being covered in a variety of patients’ bodily fluids.  The outcry and comments on the from EMTs, some of whom know this person personally, are mostly filled with disdain for the way the article painted EMS professionals as a group as an unprofessional group of adrenaline junkies more concerned about what they are able to accomplish with a heavy right foot than the outcome of their patients. The response of the Newton First Aid and Rescue squad was to post a message on the department’s Facebook page denouncing the article, stating that the EMT had been suspended and disciplinary action was being taken effectively hanging him out to dry to take full blame for the statements and quotes within the article.  It stated that the article was written “without the consent of the squad and its officers.”  The only problem with that is, as KDB so aptly points out, the squad’s 2nd Lieutenant was quoted in the article as well. The entire course of events is a real comedy of errors, the fallout of which is far reaching.  Not only have personal reputations been effected, but the squad’s integrity has been brought into question and potentially the values of EMTs everywhere could be brought into question. 1.  The Newton First Aid and Rescue Squad – First of all, a full admission of what knowledge of the article prior to its publishing needs to be explored and put into public record.  I am basing this off of the squad’s swift stroke of the virtual pen in putting the entire burden on the shoulders of an 18 year old kid. Also, it would be wise for the First Aid Squad to take...

No, this is not an article in favor of bringing back the Super Size to McDonald’s.  What I am talking about is creating a strong base for an EMS organization. What does it mean for someone to grow within their career?  In EMS, for the most part, that refers to any upward movement that someone might have.  For a field provider, that mostly means that they will end up in one of two places: supervision and leadership, or clinical services.  We either lead or we teach.  But is there enough for people who have no interest in doing either of those?  And because we lack options, are we losing people to other professions?  I’ve heard it before: when someone gets that rocker on their shoulder that says “paramedic” the immediate reaction is “I’ve made it.”  Well, why should being a field paramedic be the be all end all for someone who does not aspire for a life with any more upward movement.  It is not a glass ceiling that is holding us back in EMS, its glass walls. Some services have done a great job of developing what Skip Kirkwood refers to as horizontal employment opportunities.  That is to say: there are other opportunities for employees to use their skill at their level that does not require upward movement.  Down at Wake County EMS, they do a large number of standbys for some of the colleges in the area, and offer other options such as bike teams, tactical EMS, an increase in HAZMAT training among other things.  The hope is that it keeps things fresh and new for their field providers and keeps them from becoming stagnant in their current position in the organization. With these horizontal opportunities comes a chance to obtain continuing education credits on topics that were previously not available thus helping to solve the current often point and click or wink and nod status of many (not all) EMS educational opportunities.  Most of all, there is an opportunity to try something new and different.  It promotes growth, outwardly, much like the nursing field does.  Not every RN works in a nursing home, an emergency room, or a doctor’s office.  They...

On my first night in Baltimore, I had a chance to talk to Dr Ray Fowler the medical director for the Dallas Fire Department.  First of all, let me say that it was an honor.  This guy is so smart, and has so many great thoughts about EMS.  The topic was CPR, and compression rates.  Dr. Fowler told me that he read a study (which I am still trying to get a hold of) that discovered two facts: 1.  a rate of compressions in CPR greater than 140/minute increases mortality.  2.  The majority of people cannot tell the difference between 120 and 140 compressions per minute. Dr Fowler suggested that a more effective range to shoot for would be 100 beats per minute, or maybe even 110.  But how do we determine that?  I went on YouTube and found these kick drum metronome clips.  Take a listen to these two: 140 Beats per Minute 120 Beats per Minute Could you tell the difference?  Neither could I.  Now, take a listen to this: 100 Beats per Minute I find 100 beats to be a little more distinguishable.  This made me wonder: would the use of a metronome on a cardiac arrest improve outcomes?  Imagine, while doing compressions, your monitor would be beating right along with you, setting the rate at 110 or 120 or whatever is the final decision that produced the best outcome.  Just with setting that rate and sticking with it would not just potentially improve recoil, depth of compressions and of course rate, but it would also help signal when the compressor is tired and needs to be swapped out.  When the person running the code noticed that Joe was not keeping the beat, he could swap him out with someone else. Now, I fully admit, I lack a considerable amount of rhythm.  Anyone who has ever seen me attempt to dance can attest to that.  But I even think that I could keep up with a set metronome, pushing rhythmically. I am thinking about experimenting with this a bit, and I will definitely report back.  In the meantime, what does everyone else think? Special mention to JCox98 on YouTube for the...

On most Christmas mornings that I can remember, in his collection of books my dad usually had one from Clive Cussler.  If you’ve never heard of him, he is quite the author.  Most of his stories involve the main character, a guy named Dirk Pitt who is an Indiana Jones-type character: a treasure hunter who seems to wear many different hats.  For those of you in the younger generation, the movie Sahara starring Matthew McConaughey and Penelope Crews was based on Clive’s novel of the same name. Excuse me while I shutter uncomfortably for a moment. . . I’m sure you’re asking yourself: “What does Clive Cussler have to do with EMS?”  Well, I got an email from my mom the other day telling me the story about one of their friends who shared with them an excerpt from Clive’s 2006 novel called Skeleton Coast that they thought I might find interesting: Sloane laughed.  “May I ask you a question?” “Fire away.” “If you weren’t captain of the Oregon what would you do?” The question didn’t veer into any dangerous territory, so Juan gave her an honest answer.  “I think I’d be a paramedic.” “Really?  Not a doctor?” “Most doctors I know treat patients like a commodity – something they have to work on if they want to get paid before returning to the golf course.  And they’re backed by a huge staff of nurses and technicians and millions of dollars’ worth of equipment.  But paramedics are different.  They are out there working in pairs with just their wits and a minimum of gear.  They have to make the first critical assessments and often perform the first life saving acts.  They’re there to tell you everything is going to be all right and make damn sure it is.  And once you get the person to the hospital you simply fade away.  No glory, no God complex, no ‘gee, doc, you saved my life.’  You just do your job and go on to the next.” “I like that,” Sloane said after a beat.  And you’re right.  My farther cut his leg really badly on a charter once and we had to radio for an ambulance...

April will mark the two year anniversary of the Kansas City Fire Department taking over primary ambulance response in Kansas City, Missouri and the disbanding of the Metropolitan Ambulance Trust, or MAST for short.  Needless to say, the reviews of Chief Smokey Dyer’s promises to the city have been less than spectacular. The Kansas City Fire Department performance has been riddled with broken promises of service improvements.  The guarantee of faster response times for the city’s residents have not been met which led Chief Dyer to back pedal a few months ago, stating that meeting those response times with his current staffing would be difficult at best.  Basing their response times on nationally set standards by health organizations and the National Fire Protection Agency, Chief Dyer guaranteed an ambulance to each scene 90% of the time in fewer than 9 minutes, a standard that during its years of existence MAST had trouble reaching at times, ultimately leading to its restructuring at one point. While KCFD’s performance has not been as bad as some other municipalities with their 87% response time compliance, the fact remains that a promise for “better service” was made because KCFD stated that they could get there faster than MAST could.  That along with a restructuring that could save the city money, and also save fire department jobs were good enough for the city council to believe the scenario that Chief Dyer had laid out for them.  Now, the Chief is facing the need to cut over $7 million from his budget, which might result in the loss of over a hundred jobs. In May of 2011, I was on the panel for EMS Garage Episode 133, “Dyer Need” where Brad Buck, RJ Stine and I joined Chris Montera to take a look at MAST a year later.  I encourage you to listen to it and get a feeling for where the service was ten months ago, and where we saw it headed. The saddest part of MAST’s demise is it happened because of a false promise: KCFD stated that better response times would mean better service.  When will we realize that in actuality, better patient care means better service?  Far...

Its slightly ironic that as I write this post, I am lying on my couch, heating pad on my back, and a cat on my lap holding me firmly to it.  Yes, I, like many in EMS, have a bad back, and an old nagging injury has reared its ugly head.  Thankfully, my flareups are few and far between (knock on wood) but they still happen, and when they do, they suck. The strives that we have made in back safety in EMS during my career have been huge.  We have added a number of devices to help us along: stair chairs with tracks on them, stretchers with hydrolics that are raised and lowered at the touch of a button. even stretchers that load themselves.  In Australia, ergonomics is extremely important to EMS.  They are using lifting techniques, slide sheets, and moves that I hope one day make their way over here to the western world as it would do nothing but benefit us.  Still though, the possibility for a back injury exists, and I feel that the biggest risk comes from a topic that is currently extremely controversial: backboarding. So how does backboarding a patient result in potentially landing on one yourself?  Think about lifting a backboard that is flat on the ground.  Think about how difficult it is to use a proper lifting technique to get that board up.  I am 6’5″ (although I claim I am 5’9″) and let me tell you, its a long way down for me to get that backboard.  I don’t enjoy it, and my lifting technique admittedly probably is not the best, but I do the best I can with the body and its mechanics that I was given.  The lesson for this one is simple: do the best that you can, and make sure you have enough help if needed.  Keep the stretcher as low as possible (all the way down if it is not a manual one) and try and minimize the lift as best you can. Most of all though, don’t let yourself get complacent.  When we are not lifting as much as we used to we get comfortable with that, and when...