Why Rhode Island is Getting It Right

Why Rhode Island is Getting It Right

Apr 24, 2017

As I said in last week’s article about Bob Harper, I am kind of playing catch up with a lot of topics, this being one of them.  In late 2016, the State of Rhode Island announced publicly that on March 1 of this year, there would be a significant protocol change to their cardiac arrest protocols.  Crews would be expected to remain on scene for 30 minutes prior to being transported. Topically, I applaud Rhode Island’s Department of Health for being as public and transparent as they were about this change.  Anybody who has been in the field for even a modest amount of time has been on a scene where they were asked “why aren’t you just taking them to the hospital?”  In some cases, there is some merit to that.  In some cases there is very little that we as paramedics and EMTs can do for a patient on a scene.  Cardiac arrest is not one of those emergencies. I saw some pushback online from some who consider themselves experts on the topic, but that’s neither here nor there.  One common complaint that I saw revolved around scene safety.  Obviously, scene safety trumps all.  If I am coding someone in the middle of a street with an aggressive or growing crowd, I am going to think about moving.  But on these calls are the exception to the rule, and on the vast majority of runs, even in the worst areas of someone’s coverage area, communication with families goes a long way. “We are doing everything for them right here that they would get in the emergency room.  It is their best chance to survive.”  That’s the common statement that I have made a number of times to families of patients in cardiac arrest. Maybe those dissenters failed to read the protocol, it states “Regardless of proximity to a receiving facility, absent concern for provider safety, or traumatic etiology for cardiac arrest, resuscitation should occur at the location the patient is found.”  Emphasis is mine.  Most of the write ups that I read from the online blogging community were written on or around the month of December.  It is certainly possible that the...

Surviving Cardiac Arrest

Surviving Cardiac Arrest

Apr 21, 2017

I’ve been out of this writing game for a bit, so you are all going to have to forgive as I play catchup to some stories that might be just a little older.  I assure you that they still carry relevance. In my time “away” from writing, I’ve been doing a lot with the Resuscitation Academy.  Yes, that Resuscitation Academy.  I teach its concepts, and some of my colleagues and I have completely drank the Kool-Aid.  I will talk more about that at a later date, but I point it out here because I’ve become very passionate about all things cardiac arrest care which brings me to today’s story. Some of you might have read the story about Biggest Loser trainer Bob Harper who, while at Cross Fit in February, suffered a sudden cardiac arrest.  In the article posted by CNN, Harper talks about how “. . . the fact there were doctors in the gym when I had the attack saved my life.”  He talks about how the doctors did CPR on him, and the doctors pulled the AED off of the wall and used it on him. Mr. Harper is right, the almost immediate CPR and early defibrillation saved his life, there is absolutely no doubt about that, but the fact that the two people who provided care to him were doctors is completely irrelevant.  It wasn’t two doctors who saved his life, it was two people who were willing to act instead of just waiting for someone else to do something.  In this case, their occupation is not important.  I do not want to diminish the heroics of this event but had the story could have been an incredibly powerful vessel had it been told a different way. The message that people need to hear in this case is that they need to learn CPR, some kind of CPR.  They do not need an AHA card in their pocket but understanding the fundamentals of hands-only CPR, for example, a skill that can been learned in 15 minutes or less, is one that can save a life.  Knowing where the AED’s are in the gym where you work out, or having the...

The Surfside Beach CPR Debacle

The first time I laid hands on a patient’s chest and did CPR, I was 16 years old.  There were probably close to a dozen total times that I used the skill that I learned at the age of 14 before I was legally able to be the treating EMT by myself in the back of an ambulance, a responsibility that one must be 18 to hold.  On the overwhelming majority of the CPR calls that I have been on in my career, let alone those two years before I was of legal age, I left the patient just like I found them, dead. On January 25, 2015, the Surfside Beach Fire Department in South Carolina rolled a rig with a CPR certified junior firefighter on the truck.  At some point, it was that teenager’s turn to tag in on compressions and do their two minute duty.  Much like nearly 93% of all cardiac arrests worked nationwide, that crew from the Surfside Beach Fire Department left the patient how they found them, dead, much to the dismay of the Surfside Beach town council. Almost a month ago, an “unnamed official” with the town filed a complaint, prompting an investigation by the State of South Carolina’s Department of Health and Environmental Control.  The investigation, concluded earlier this week, found no evidence of wrong doing despite the shock and horror expressed by town officials. These are the kinds of stories that make the news that are related to our industry.  No matter how futile the efforts might be, the loss of a patient is obviously catastrophic to a patient’s family, but blaming a teenager for performing a skill that is taught to kids as young as 10 is preposterous.  Thankfully, there are many who agree with me on this stance. I got my start as a cadet on my first volunteer squad, and I had the chance to mentor a few other cadets over the years.  It takes a special kind of person to handle the responsibilities that an EMT or first responder is tasked with at such a young age, but for every call, much like that junior firefighter in South Carolina, I was closely...

Let’s Talk About Delivery

I wanted to follow up on my reply to Councilman John Bendel’s letter to the editor in the Asbury Park Press a little bit and talk about delivery and goals.  Realistically, regardless of what sort of department an EMT or paramedic works for, their goal should be the same.  We should be aiming to reduce morbidity and mortality of the conditions that we can directly impact and for those that we cannot have lasting impact on in the prehospital setting, we should aim to deliver them to a place where they can get treatment while doing everything that we can in our time with him to promote a favorable outcome in our limited time with the patient. Too often, when debating about what delivery method works best, we get caught up in the weeds of the minor details that have a greater impact on the provider than the patient.  We worry about the training that we must do and the time that it takes, or the unproven theory that people serving their own community has a greater impact on patient outcome than the ability of the provider.  We get hung up on the importance of response times when they have less to do with patient outcome than care provided in most cases. In Bendel’s letter, he touched on the fact that “MONOC can probably tell us how many lives were saved because a highly qualified EMT was on calls.  But no one can tell us how many lives were saved because a local squad got people to the hospital faster than MONOC would have.”  He’s probably right, but we need to ask ourselves why this is.  With a call volume that is often a fraction of what MONOC runs, why can’t volunteer squads better report their impact on patient outcomes?  I think that the answer to this is twofold. First, most squads probably do not possess the outcome data that a company that MONOC has access to.  That is partially the fault of the system for not including volunteer services in this feedback loop, and partially on the squads for not seeking it out, and creating the infrastructure within their organization to acquire it....

Fact Checking the EMSCNJ

Fact Checking the EMSCNJ

Apr 17, 2017

Read my Open Letter to Mr John Bendel here. For today’s post, we are going to continue to analyze the saga of the Asbury Park Press editorial battle regarding EMS in New Jersey.  The EMS Council of New Jersey has sounded off.  Last week on April 10th, the EMSCNJ’s president, one Mr. Joseph G Walsh, wrote a letter of his own in order to, as he puts it, “correct several points.”  So let’s fact check some of Mr. Walsh’s statements, and dig deeper into what the EMSCNJ has said in the past. “Paid or volunteer, every New Jersey EMT must pass the same certification exam. Volunteers conduct monthly drills, and education and skills sessions to stay current. The misleading editorial might have panicked some readers into falsely thinking their local volunteer squads are not staffed with properly trained responders.” It is true, indeed, that every EMT must pass the same certification exam.  So what?  I would dare to say that the ability to study and regurgitate information from a textbook is not the be-all-end-all in evaluating one’s effectiveness as an EMT.  I have worked with great EMTs, and I have worked with people who could not be trusted to work on a crew of two because they lacked the ability that they needed to take the knowledge in their head and apply it in a real-life practical setting.  They all had one thing in common though, they passed the same test. Then there is the other statement that Mr. Walsh makes here about proper staffing.  While all EMTs take the same test, that fact alone does not mean that every person operating on a volunteer ambulance in New Jersey is a certified EMT.  In actuality, many responders might just be certified at a lesser level.  How do I know this?  Mr. Walsh tells us. “Every one of our member squads is required to respond to calls with at least one EMT who remains with the patient. On many calls, two or more EMTs respond. The EMS Council of New Jersey (EMSCNJ) is unaware of any squad — member or nonmember — answering calls without such trained responders.” Currently, when a paid or career ambulance...

A Reply to Mr. Bendel and I

A Reply to Mr. Bendel and I

Apr 13, 2017

  I am happy to share with everyone that Mr. Bendel has seen and read the post from earlier this week.  I look forward to speaking with him in the future. The issue with BLS care in New Jersey has never and will never be about passion.  It’s about training.  Every good EMT needs to possess a balance of passion, compassion, medical knowledge, and the ability to apply that knowledge.  I am happy to say that I come from a family that possesses those values.  I have two parents who both had lengthy careers as volunteer EMTs.  After reading my letter to Mr. Bendel, my mom, Karen Kier, decided to share some of her thoughts about what it means to be a small town EMT.  What you will read below are her thoughts, from the heart. Mr. Bendel and MedicSBK: First off, EMS is one of the defining aspects of my life. To go one step further, EMS in Island Heights (where you both either currently or have formerly resided) creates this passion.  It’s a passion both for the profession and for the people I so dearly cared for during my 22-year career as an EMT on the Island Heights First Aid Squad. MedicSBK, you, above all, should know this about me.  I watched you closely (and protectively at first) as your skills developed – and then we switched roles.  I knew that you were bound for great things – and I proudly watched you fly. I have performed CPR (successfully) on a dear friend, the parents of friends, people I have known and not known . . . and watched others drift away after a devastating stroke.  I have simply and quietly held many hands.  Was it hard?  Yes.  But it would have been harder not to have been there. I like to believe that with few exceptions I brought this same compassion to all of my calls, whether in Island Heights or in one of our neighboring communities.  In my own simple, naïve way I can only hope that this is something that permeates the entire profession. For personal reasons I have made the decision not to renew my EMT certification –...

An Open Letter to Mr. John Bendel

An Open Letter to Mr. John Bendel

Apr 11, 2017

Last week, the Asbury Park Press posted a letter to the editor entitled “Letter: Emergency response teams must have volunteers.”  The piece was written by John Bendel, a town councilman from Island Heights, NJ; the same Island Heights, NJ where I got my start in EMS more than twenty years ago.  John’s letter is a reply to an editorial done earlier in the week called “EMS system deadly hodgepodge” which addressed several the shortcomings of New Jersey’s EMS system, many of which were identified more than ten years earlier by a study done about the state’s slowly dying prehospital care system. To say the least, Mr. Bendel’s letter sparked a fire in my belly.  I wanted to address some of the points that he attempted to make here. “Sure, it would be nice if every Emergency Medical Technician (EMT) were as qualified as the legislation you endorse would mandate.  But if they were, far more would be paid professionals than volunteers.  In America where health care still bankrupts families, that’s a big deal.  We need volunteers.” Let’s address the semantics of this statement first.  “Health care” is not bankrupting families.  Many have begun pointing out that it is health insurance that is doing this.  Skip Kirkwood has taken to frequently correcting people telling them that what they are seeing is attempts at health insurance reform, and not health care reform.  He’s right. Now, on to the meat and potatoes of this statement.  First, what is the issue with creating more jobs, and putting more money, and insured individuals, into society?  Why is it so bad that some would like to see people compensated for the hundreds of initial training and numerous hours of refresher and continuing educational training that EMTs are required to do?  Career EMS providers (because professionals can be paid or unpaid) guarantee that someone is going to be there when the tones drop.  Volunteers cannot always make that same assertion. And let’s talk, for a second, about the chain of survival that drives health care.  With the exception of bystanders, every other link in that chain is staffed with employed, compensated individuals.  Nurses, doctors, dispatchers, people who work in rehab centers,...

We’re Back!

We’re Back!

Apr 10, 2017

Or better put, I guess, I’m back. It has been quite some time since I put anything up on this website.  I’ve spent the last year or so setting up and running a site about Drexel University Men’s Basketball called Always A Dragon which has been a nice diversion from EMS in general.  Writing about sports is very, very different and it has helped sharpen my skills in a lot of ways, but I think that its high time that I get back to writing about my passion: EMS. I have noticed a lot of things in myself recently.  I’ve been frustrated by a number of things going on immediately around me, as well as in the industry.  Social media, something that previously opened a lot of doors for collaboration and change in EMS has largely descended into a hodge podge of name calling and “my service is better than yours” debates.  Publications have turned to some providers and former providers who might not always be what they seem at the surface, and leave a lot to be desired for the direction that they are leading our younger generation in.  Health care, or rather health insurance, in our country is in shambles.  Our country as a whole, in fact, is in shambles for many different reasons, depending on who you ask.  Things just are not good right now. For me, writing on these pages has always been rather cathartic.  Finishing up a post and pressing “PUBLISH” for me has always put a smile on my face, and I need that.  Hopefully some of that enthusiasm can spread to those of you who are taking the time to read what I have to say. Tomorrow, we hit the ground running.  We are going to start where I started: Island Heights, NJ and a letter to the editor submitted by a councilman in the town that I called home for the first 19 years of my life.  From there, who knows where we will go next! Share...