Just when I thought all hope was lost, all the chips fall into place. . . I have not missed a major EMS conference (EMS Expo or EMS Today) since my first trip to Dallas in 2010.  Because of all of the life changes that have happened over the year, and my demotion to “FNG” at my new job, I thought that this year’s EMS World Expo in Las Vegas might just be the first one.  It was tough to listen to everyone making plans, and talking about classes, and realizing that I just might miss it because of my work schedule. It took a little bit of work and a lot of overtime, but thanks to the generosity of some of my new coworkers in the form of swaps and their vacation days that allowed me to work almost non-stop, I have booked my hotel room, and scheduled my flights.  I will be arriving in Las Vegas on Sunday September 8th in the morning for four days and three nights of quality time with some of the best friends a guy could ever ask for. Yup, that’s right: our semi annual “reunion” will happen again!  I really did not realize how much I would have missed it until I took the time to schedule the trip.  The excitement that I am overcome with now, just about a month away, is overwhelming.  There is no better place than those conferences, and its not because of their location, its because of the people that I get to see there. To those of you who will be joining us for Expo this year, I look forward to seeing you all and catching up with you!  For anyone who is missing it, you will sorely be missed.  And finally, if you have never been, what are you thinking?!  You have no idea what you are...

EMS is currently at a major crossroads as an industry.  Across the country requirements to become a paramedic are becoming loftier, and rightfully so.  In order to properly care for each patient we encounter, we need to be at our best, and the route to that is through training and that bar is being raised.  More education eventually should mean more pay, and some in the private sector are starting to realize that. This is evident from the recent well publicized labor dispute in Buffalo, New York and their eventual 10 hour work stoppage followed by a contract settlement.  From the publicity I have seen regarding those negotiations and others I have more intimate knowledge of, it leaves little to the imagination as to what is most important to EMS professionals: pay and benefits.  I know, that seems like a slam dunk, no brainer, but it also seems clear that at least in the private sector, purse strings are becoming tighter, and benefit packages are less and less appealing.  It’s quite the conundrum, actually.  Increasing educational requirements are driving paramedicine towards being a career, yet employers are still far too often looking at employees with the expectation that they have a job, and there is a divide the size of the Grand Canyon between the two. Now, the jury is still out for me on work actions such as strikes.  I do not really know if they truly follow the “spirit” of our profession and seem to do more of a disservice to the community than they do benefit the worker, but that is a debate for another time.  The fact remains that they happen, and there is certainly reason behind them, as evident by the Buffalo, NY Rural Metro incident. While the private sector is just one of a number of EMS models, it is quite often the quickest path of entry into the industry and employs more EMTs and paramedics than any other model, so discussing the big kid on the block is extremely important.  With health care taking on a huge for profit presence in the economic world, everyone wants their piece and if some of the bigger players want to...

A little over a year ago, I tackled the concept of “skill dilution” and its validity as a statement, and reality in the field.  My perception at that time was that a more important component to focus on instead of skill dilution was education for our paramedics.  While I still stand by the concept that we need to better prepare our medics for what they will encounter when they hit the streets, my views of skill dilution have changed a bit. The EMS system in Massachusetts is quite different from the one that I currently working in.  I know, that is no shocking revelation since it has been said to exhaustion that “if you’ve seen one EMS system, you’ve seen one EMS system” but I find the uniqueness of my current situation interesting in comparison to where I was.  The easiest way to look at it is by evaluating both environments on a county-wide basis. On a common day, Hampden County, Massachusetts has approximately 25 paramedic level ambulances protecting its citizens.  They respond to emergencies for the most part regardless of the complaint.  Everyone gets the same opportunity to have the most advanced care available to a sick person regardless of what the caller told the dispatcher, or what the Emergency Medical Dispatch (EMD) code says is the appropriate response for that incident.  Do you have a splinter?  You’ll most likely get a paramedic.  Are you having chest pain?  You’ll most likely get a paramedic.  That paramedic’s partner, however, could be an EMT, an intermediate, or even a paramedic.  All that Massachusetts requires is one paramedic to make an ambulance an ALS level ambulance. In the county I work in now, there are nine paramedic units for the entire county.  None of us transport.  We respond to only ALS level calls as determined by EMD codes, and we are supplemented by approximately 30 BLS level ambulances.  I do not know the exact number, but to me, that “feels” about right.  Every paramedic unit is staffed with two paramedics, and the state requires that each ALS appropriate 9-1-1 call gets at least two paramedics. According to the 2010 census (and Wikipedia), there were about 463,000...

You are the medic on a busy urban unit dispatched to a serious call of your choice (cardiac arrest, shooting, STEMI, you pick it).  You arrive on scene, and get straight to work on your patient.  IV’s are started, maybe the patient is tubed, a 12 lead is done.  Holes that were not there before the incident that are not a direct result of actions of you and your partner are plugged.  You feel like time is dragging on, and you need to get going.  The patient is loaded, and your truck rumbles off lights and sirens blazing to the closest appropriate facility. Once you arrive at the ER, the patient is turned over to their staff, and you retreat back to your truck to write your run form.  All that is going through your head is “boy, we were on scene for a while, I need to justify this.”  You sit down in front of your onboard computer in your unit and wince as you bring up your times. Your eyes, however, get big as you do the quick math, and realize that you were actually only on scene for 8 minutes.  You share your surprise with your partner and move on to your run form. Anyone who has been in this field for any amount of time has experienced an incident similar to the one above.  When an emergency happens, time just seems to slow down.  Everything moves in slow motion.  If the experience of that sensation is true for someone who is a trained medical responder, imagine what it is like for someone who has no training.  Seconds feel like a minute.  A minute feels like five.  The perception of time is so incredibly subjective.  The reality of time, however, is not. This is why we have dispatchers who track times.  This is why most of the cardiac monitors out there today have event logs that allow you to track what you do and when you do it.  This why when you arrive at the ER with just about any critical patient, there is one nurse who is dedicated to charting.  Accuracy is so important, and one must overcome that perception...