This post can also be found at TheEMSLeader.com With EMS Today right around the corner, I got thinking the other day about the past conferences that I have been to.  This year’s gathering in Washington, DC marks my ninth consecutive major conference that I have attended.  I’ve been to Baltimore three times, this will be my second appearance in DC, Las Vegas twice, New Orleans, and the first conference that I attended back in 2010 in Dallas. That year in Dallas, Had quite the opportunity drop in my lap.  One morning, I had the chance to sit down and interview a person who I very quickly came to admire because of his involvement in the National EMS Management Association, Skip Kirkwood, who at the time was the chief of Wake County EMS.  Even before I had a chance to meet Skip the words “Well, in Wake County. . . ” were a constantly used phrase in my vocabulary.  I admired the changes and strides that they had made in their quest to provide the best possible patient care for the residents of Wake County. More than that though, I admired Skip’s approaches to problem solving.  For years to follow, presentations that I have given have involved little pearls of wisdom that I have obtained at the hands (and fingers) of skip over the years from e-mails and posts that I have received from him, so while I had a long standing admiration for Skip, having the chance to sit down with him as a captive audience and pick his brain was quite the opportunity for me. One thing that stood out to me was how he approached change and progression in Wake County.  As I read about his service it was clear that things always seemed to progress quickly there.  Skip’s answer to me was that he always promotes an environment that is comfortable and welcoming to change.  He wanted his people to be ready to walk in one day and find a new piece of equipment, or a new policy change.  By doing this, when major changes were rolled out his staff was more welcoming and willing to adapt. I cannot tell you how...

A few weeks ago I was sitting around the station talking to a couple EMT’s about some issues that they had with the translation of a “lift assist” or public assist into a patient refusal.  It was not so much a personal problem since, as one of them put it to me, “If I touch them, I get a refusal” but it was more the actions that they had seen some of their coworkers take to minimize their own paperwork.  Interestingly enough, the debate of “what is a patient” and “who gets a refusal” was a long standing debate that I had with some people during my years as a supervisor. The scenario we most commonly encounter is a simple one.  It is like that old Life Call from the 80’s.  Mrs. Fletcher falls in her bathroom, pushes her pendant and moments later, she is telling someone “I’ve fallen, and I can’t get up!”  EMS, the fire department, the police department, and whoever else gets called is on the way to her in no time.  A few minutes later the crew gets on scene and finds Mrs. Fletcher as they would expect her to be: seated on the floor unable to get herself off the floor and back in her chair.  The responsible ambulance crew gets on each side of her, hooks their arm under hers, puts her back in the chair, and they’re out the door without another word spoken.  The paperwork is simple, and they’re back in service. That is how it happens, right? If they were my ambulance crew that better not be how it happened.  Anytime Mrs. Fletcher finds herself on the floor it is up to us to at least make an attempt to find out how she landed there.  The first question that should be asked is “what happened?  Did you trip?  Did you get dizzy?”  Follow that up with another simple one: “Are you hurt?”  I know, it seems like it would be a no-brainer, but that is not always true. You need to get a look at the medications that these patients take.  Is there a beta-blocker in there?  Are they a diabetic?  These patients need...

I try not to complain very much, and I think compared to most medics I don’t.  Mind you, that’s not a dig at my fellow caregivers, I just think that we are Type-A personalities who want it all, and we get vocal when we don’t get it.  That said. . . This winter, I have had a huge pet peeve of mine rekindled.  In all of my years working in Springfield, Massachusetts there was one thing that I always checked when I was putting my truck together at the start of my shift.  It was not the oxygen, it wasn’t my backboards, paperwork, or anything else like that.  The one thing that I always made sure that I had was a sheet or blanket sandwiched into my stair chair, especially in the winter time.  For me, there was no more necessary item to carry into a scene. I was what one might refer to as “stair chair dependent.”  Many people liked to bring their stretcher to the door and park it there, or leave it on the curb but frankly I did not and still do not like leaving it unattended.  For me it was always easier to carry a stair chair to my patient’s side regardless of their condition so I could have something to use to move my patient to the back doors of the ambulance.  It got used a lot, and there were a lot of butts of varying conditions that saw time on that chair.  For me, the blanket gave me a barrier for my patents to sit on. In the winter time, it helps keep the patient warm.  In every season it gives you a great way to move your patient if they are not able to get over to your stretcher.  Nothing is easier than scooping a patient up with a sheet and popping them down with a draw sheet.  It is one of the simplest and earliest taught “moves” in the industry. And let’s not lose sight of the “don’t reach out” factor.  We all give that speech to our patients about how important it is for our patients to keep their hands in, don’t grab hand...

Last week a news story made its rounds on internet sites and blogs about a New York State EMT who had been suspended for six weeks and then quit his volunteer department for what many called “doing the right thing.”  If you have not seen the article, feel free to follow this link.  Otherwise I’ll give you the Cliff Notes version of the story: Twenty year-old Stephen Sawyer, a member of the Ellenville First Aid and Rescue Squad was at his station alone when a call came in for a four year-old having a seizure.  Sawyer, who is one year under the Squad’s policy stated age to drive but is an employee at a private EMS service in the area was the only EMT available that day when the paramedic on scene “called for an ambulance” for transport.  Unable to find any available mutual aid unit to respond to the call, Sawyer decided to take matters into his own hands.  Sawyer, referred to in one article as a “squad leader,” a member of the Squad’s communications committee and an advisor to their Youth Squad who presumably had knowledge of his department’s policy did what he “felt he had to do” and violated the 21+ driving policy, responded in an ambulance, and transported the patient to a local ER. The response of the Ellenville First Aid and Rescue Squad’s board of directors was to suspend Sawyer for 60 days.  Sawyer then resigned from the squad on the spot. In another article that interviews the Squad’s captain Mr. John Gavaris, the captain states the under normal circumstances, Sawyer might not have been suspended if not for his previous disciplinary record which was not focused on in greater detail.  The response both from his community and the social media EMS community was one of “online outrage.”  People felt that the 60 day suspension was too harsh and called from Sawyer to be reinstated immediately.  Although the argument could be made that 60 days is a pretty harsh sentence, I have to stand with the Squad on this one.  They made the right call. Like it or not, policies exist.  Policies have to exist.  They are what give...