First of all I would like to thank those of you who commented on my post entitled Stress the other day.  There were some great words of wisdom there, and Bob Sullivan from EMS Patient Perspective shared some links to some really good articles. Greg Friese asked what I do to help those around me with stress.  Personally, I feel that as a field supervisor it is my responsibility to have a grasp on the mood of my employees.  That is a daunting task since I have around two hundred paramedics and EMTs, some full time and some part time, working in my service.  I personally need to be able to watch as many of them as I can for mood changes, and when I see them I need to be able to refer them to the places where they can get help. The resources available to them can be as simple as a walk through the garage and a friendly conversation or it could be a phone call to muster up our regional CISM team.  Additionally, EAP is a great route to refer employees to especially if the root of their issue lies outside of work. Most of all, the most important thing that any leader can do for their people is make themselves available to their employees whenever they may need to talk.  This needs to be a team approach though.  I know all too well that I am not the first choice for everyone to come and talk to.  Personalities clash, and frankly, not everyone gets along all the time and they cannot be expected to do so.  Thankfully, there are a number of other people on my management team, and for the most part, most EMS services are not a one leader shop.  If someone says, “I dont want to talk to Scotty about this” that is fine.  I don’t need to be their sounding board.  The important thing is that they go to someone about it. Availability and access.  That is what is most important.  People cannot get help if they do not know where to find it.  My advice to those in the field is to find someone...

Quite often I see some EMS news story come across the wire about how a paramedic neglected to care for a patient as they should, or delayed a response, or in extreme cases were involved in some sort of serious altercation resulting in the injury or a patient, a tech, or their partner.  With every story I read, I get more and more concerned about the state of EMS, and the people who are providing care.   While none of the situations I’ve read about are excusable, I think it is our responsibility to find the root cause, or at least minimize the chance of these incidents repeating themselves.  Personally, I feel that while stress is not an excuse it is a huge factor. As a community it is our responsibility to give each and every provider not only the access to the training that they need to best provide care but we need to police our own to make sure that every provider is fit enough to provide that care. Recently I read a story about a paramedic who was arrested for assaulting a patient.  While there is no excuse for his actions I cannot help but wonder what signs and symptoms this medic showed prior to the incident occuring.  I am not talking about during that shift but more in the weeks and months leading up to it.  When did they start to turn?  When did their attitude really start to decline?  Most importantly, what did anyone do about it to try and turn this person around? A lot of it points towards the question of “how busy is too busy?”  Of course one must also ask if this is the job for them, but the EMS industry is so  focused on a single mission which centers around getting people to the hospital.  While a typical day on the ambulance can offer a large variety of calls, the sheer volume and type of calls can certainly create a stressful environment.  As those days compound into weeks, weeks to months, and months to years, each individual day becomes a contributing factor towards what could eventually become a burnt out paramedic. I have written...

I’ve been thinking a lot about cardiac arrests, CPR, and the barriers that I face in the system that I work in.  Chances are, if it is a problem here then it is a problem somewhere else, which makes it worth talking about. In the system that I work in there are two types of dead people: people who are not workable; that is to say, they have some injury incompatible with life, or conclusive signs of death.  The second kind is one that ends up on a stretcher in an emergency room.  That’s right, if you get CPR, you get a ride to the hospital. After doing some research earlier this year for a class I was teaching about running a better code, I found a clip from Wake County, North Carolina where their medical director Dr. Brett Myers talked about the key points to the quality of cardiac arrest that they provide.  The one big one that stuck with me was “Don’t move them.  Work them where they drop.”  I realized very quickly that Wake County had one very important component to high performance CPR that my system lacked. Over the last two years we have learned a lot about quality of compressions and their importance.  Anyone who has taken ACLS or an ACLS refresher has heard that you never stop compressions, or at least you greatly minimize interruptions but what they fail to address is the importance of knowing when to say when and affording us enough options and guidelines telling us when to stop CPR.  Actually, let me rephrase that.  The content and evidence is there, but a few systems have chosen to ignore it. So am I saying that knowing when not to do CPR or when to stop doing CPR is an important piece to improving ROSC rates?  You better believe i am.  Let me describe a common cardiac arrest in my system: The crew gets on scene to a confirmed code with fire department first response and more times than not, a second ambulance is coming behind them to assist.  When that truck arrives, the patient is loaded into the best way to extricate them from where...

How good of a paramedic are you?  Have you ever wondered?  Well, lucky for you there is some proof in the numbers.  Getting an idea of how well a paramedic does their job is not as hard as some people think, and with a little bit of research it is easy to figure out how successful your patient care is.   With data collection what it is today, one can look at things like their IV and intubation success rates, or their time to STEMI recognition or even their scene times for trauma calls to make sure that they are, in fact, within the Platinum Ten.  The rest of the job though you are going to have to judge from yourself, from your gut, or simply ask your partner: “how good am I with my patients?”  Bedside manner might be the most vital skill that we all possess in our toolbox and while tools such as patient surveys might give a single provider or a service a better idea of how much compassion and empathy their employees show towards their patients it is largely immeasurable. When talking about employee surveys with a colleague a few years ago, he told me that from his experience with them they were largely polarized.  The surveys that were returned from patients usually either gave a glowing, favorable review of the providers or a scathing dissertation of how poorly they were treated.  Those people who fell largely in the middle rarely said that the care was “just okay.”  One is left to assume then that all of those unreturned surveys, sometimes three out of every four, reflected that the providers did in fact do nothing more than an adequate job. Adequate should not be viewed as a bad thing, and don’t think that I am trying to paint that picture.  Lets face it: you are not going to be able to please everyone, and someone who is sick or injured will most likely be exponentially more difficult to satisfy.   When reviewing patient feed back, I have seen all sorts of complaints: “The ride was too bumpy” “the driver took a longer route to the hospital than he had...

I admit it, I’ve slipped and stumbled.  My blog has been reduced nearly to the occasional urban tumbleweed (read: plastic bag) that kind of blows through every so often.  With high hopes for content, I have not nearly been putting out as much as I would have liked, and you know what?  It’s my fault.  It’s all my fault. While I was expecting big things for 2012, and I seemed to start off on the right track, the last few months have not been quite as fruitful for a number of different reasons, many of which will become more clear in the coming months. One thing is for sure though: I need to get back to what is important. I have been reminded a lot of why I really enjoy this online community lately, and why I am so passionate about EMS.  I had a chance to speak to the guy who made this all possible for me: the one who set me up in Oakland that opened my eyes to the Chronicles of EMS.  I have talked to a few people who I truly respect about the direction of my career and my potential future and have gotten nothing but support.  To those people: you know who you are, and I thank you. Above all else, I need to get to what is important to me: writing, being a good paramedic, a good supervisor, and a strong advocate for the industry and frankly, there is no better time than now for me to get cranking on that.  I am in a holding pattern at the moment, treading water if you will.  The NREMT-P card is in my pocket along with my PALS, PHTLS, and a new ACLS card.  It took a lot of hard work, and I am ready to put forth that sort of effort here among other places. I think that getting everything back on track is just what medical control ordered.   To all of you who have been faithful readers during the last year and a half, I am sorry I have neglected you.  I will tell you that I plan on continuing to write this blog for myself,...