My name is Scott, and I’ve made mistakes. There. I said it. The medical world is one where we strive for perfection. That seems to be multiplied ten fold in the world of EMS. We expect ourselves to be perfect. We expect ourselves to be better than nurses and sometimes doctors as we stand back and watch residents and attendings make mistakes that we feel we are immune to making. We can point them out or cite the newest evidence but for some reason when it comes to our own industry, we are prohibited from pointing out those same mistakes. Some think that in the absence of protocol or knowledge, a good ol’ diesel bolus is the answer and should continue to be the answer when reeducation and more training would be far more appropriate. “Do no harm” is significantly different from “no harm was done” and we need to realize that. Just because nothing bad happened does not mean that something good happened. The key to success in this field is learning from the things that don’t quite go as well as they should have. When I hit the streets fifteen and a half years ago I was terrified. I made a lot of mistakes, and when things were not going well my partner’s foot had better be getting heavy. Through the course of my career, I have grown and I’d like to think today that I’m a better paramedic. In all of the intricacies of medicine that I learned, and all of the journal articles I have read the biggest lesson that I have learned is humility and the ability to admit when I was wrong. When things do not go well, the first question that I ask myself, or someone who takes my patient over is “what could I have done better?” how could I have improved my patient’s outcome? Which brings me to my ultimate point in this post. The internet has been on fire lately after a Virginia volunteer fire department was cited for transporting a pediatric seizure patient in the cab of the fire engine instead of providing care and assessment and waiting for a responding ambulance to...

Over the years some great ideas to change how we care for our patients have come from street level providers and their day to day encounters and insight to the challenges that they face.  Others, however, either fall flat on their collective faces or are proven at a larger scale with the use of evidence to be ineffective.  One of the most frequent discussions that comes up on many EMS related internet destinations is the effects of system abuse on our industry.  Some feel that it is the crippling factor that renders urban systems ineffective however I disagree.  While I do not dispute the presence of system abuse, and while these calls might stand out as being memorable, I think that it is less of an issue than we make it out to be in our own heads. But how show we deal with it?  One popular internet author suggested that something needed to be done, but has not present a plausible example of what that should be.  When the concept of increased education for providers to be trained to make non-transport decisions or recommendations for alternative ways of entering a patient into the health care system, he went as far as to state that I was being “negligent” for advocating for more education for EMTs and paramedics because he felt that this was refusing to address the problem.  While he can try and hang his hat on the anecdotal experiences of his career, I will instead choose to rely on evidence which tells a different story. How can we expect EMTs and paramedics to perform assessments and make treatment decisions when our training tells us to stabilize to the best of our ability and deliver a patient to definitive care?  Giving EMS providers the blessing to deny transport or to recommend alternative destinations or treatment options is something that we have received no training to do.  While there are some instances where our assessment can be spot on where we would tell a patient “you don’t need to go to an emergency room, and you certainly do not need an ambulance” this decision making power would need to be universal if granted at...

As the days tick past American Medical Response draws closer to going “live” with their new public/private partnership with the District of Columbia Fire and EMS Department.  After a story posted earlier this week about a traumatic cardiac arrest that sat for close to 30 minutes without a transporting unit being available, it is clear that the time is now for something to change in the nation’s capital. The coming months are going to be very telling for the future of EMS not only in DC but throughout the country.  From a personal stand point, I am very excited to see in what direction everything goes.  There is a lot of influence in the AMR DC operation from my old stomping grounds in Springfield, Massachusetts.  Their Operations Manager, a guy by the name of Mark Nuessle, was one of my first supervisors when I hit the streets back in 2000.  About a half a dozen people who are being brought in from around the country to help with the hiring and training process of close to 200 new employees have some sort of tie to Springfield as well.  It really speaks volumes about the system that I came from. With the involvement of national resources, I also think that this partnership says a lot about AMR’s ability to strive for success.  Often seen as the biggest of big business in prehospital medicine, when AMR steps up to the plate like they have recently on the east coast, they deserve a lot of credit.  Some critics of private EMS will speak of the “lost jobs” from the closing of companies like Transcare or like Falck’s recent move to pull out of Pennsylvania but AMR has been there to pick up the pieces.  Closures like this do not mean that jobs are going away.  People still have to do the work, it just means that a company with a better ability to operate in today’s health care climate are stepping up to the plate to provide the service.  In fact, AMR is adding close to 200 jobs to the Washington, DC market in particular, and that is a huge step forward for the private sector. I cannot...

“An ounce of prevention is worth a pound of cure.”  -Benjamin Franklin Throughout my career, I have been to maybe eight or nine critical incident stress debriefings.  I attended my first one when I was 17 years old after caring for a man who self-immolated as a means to take his own life.  Without getting into the details of this confidential event, the outcome for my family, who was on the call with me, and I was a long standing bond with the dispatchers in attendance.  About once a month for many years following, we used to take coffee and donuts down to the dispatch center to catch up with our new friends. I have always been a person who encouraged everyone involved to attend CISM’s, and I think I have spoken about that here before.  To those who have said, “I am not going to get anything out of it” I am quick to remind them that it’s not all about them.  Sometimes the best thing that we can do is offer something in our own personal experiences to someone else in attendance.  Sometimes, knowing that you are not alone is the greatest reassurance that a person can receive which is why I push people to stand together.  I would never mandate anyone to attend a CISM, and neither should anyone else, but I always strongly encourage people to show up. I do think, however, that we rely on CISM a little too heavily as a means to deal with the stress that people in our field shoulder day in and day out.  We sit back and watch people who struggle go to work every day.  We have all watched coworkers whose personal lives are crumbling around them, and have watched those personal issues spill over to their professional lives.  Heck, some of us have been those people.  We sit back and let people deteriorate because we don’t know what else to do.  Until something happens. Until that bad call.  That big call.  CISM is usually tied to major events.   It’s that nasty wreck on the interstate, or that pediatric cardiac arrest that results in a crew begging to take the rest of...

In my post last week about the importance of being comfortable with failure, I mentioned statistics and benchmarking.  Last month, I had a chance to present at my first national conference when I spoke at EMS Today as part of the EMS Compass preconference.  I’ve been involved with the EMS Compass project since November of 2014 and while the process itself has had some growing pains, the mission and goals of the project involve some of the most important things to the future of our industry. For example, it is only with a firm understanding of the role of benchmarking in quality assurance and quality improvement that we will be truly able to compare the impact that we have on patient outcomes.  Understanding the impact of our care and being able to compare it to other systems is how best practices are discovered.  It all comes down to asking a couple of simple questions? WHY? The first question is an easy one, and that is simply why?  If another system is seeing better patient outcomes for their STEMI cases, or if they have a higher ROSC and survival rate for cardiac arrest, you need compare your system to theirs and just ask “WHY?”  Do they have a different set of CPR protocols?  Do they have a more aggressive field pronouncement protocol that steers medics to stay and play instead of taking a load and go approach with their cardiac arrest patients? The easiest way to figure any of this out is to work backwards.  Take the example of ROSC and survival rates.  If another system has a higher survival rate, start with where they are delivering their patients.  Are they using hypothermia for their patients prior to arrival or have they omitted that step at recommendation of the AHA?  Are they part of a completely different system with different protocols that might call for later intubation or a different style of airway management all together?  What about their care in the field differs from the care that you provide? After analyzing the care that takes place on scene, look at who is going to those calls.  Are they sending more help than you are? ...

Tucked away in the back of the EMS Today Exhibit Hall was a board surrounded by a number of Post-Its bearing the question “What is the BIGGEST CHALLENGE in the EMS Industry?”  There were a number of responses on the board including head scratchers such as the one that stated standards should be lowered for volunteer providers, and no that was not my “trolling” submission.  Mine, unfortunately, did not make the final copy of the board, but I think that it needs to be delved into so what better place to do that than my little corner of the internet? My response was a simple one but an important one for all of us to remember.  My Post-It read “Stop being afraid to fail.”  We are so dead set on our own success that we are content with staying in a safe area of development in our industry.  Why try something new?  What if it does not work?  What if I do it wrong?  What if I cannot do it well?  What if somebody dies?  The answer to all of these questions are simple.  Respectively they read like this: our industry will not progress; dust off and try something else; practice more you’ll get it; again, practice; and finally, people die.  We cannot prevent that. When looking at some of the most successful people and industries one will find that many, many people have more misses than hits.  Take me, for example.  My first choice of where to spend my career, which I thought at one point that I would never leave, was not the right fit for me.  I’ve tried other blog ventures, and had two or three that never got off the ground before I even started writing on the pages that you are reading today.  I’ve invested time in countless projects that just did not work out.  All together though, the things that I put my heart into that have worked are in my eyes pretty successful. Even great inventors such as Thomas Edison, who held over 1,000  patents for his inventions had more than his fair share of failures.  Throughout his lifetime, he tried to invent devices that could project...

Over the past couple of years I have read a few articles about the importance of living in the community that one serves.  I have seen articles championing volunteer organizations because “people like being cared for by their neighbors” or implying that those who do care for their neighbors would do a better job because of their proximity both physically and emotionally to a patient. Other articles about fire based systems for example talk about how being part of a community can allow one to know the back roads and short cuts that might shave precious seconds off of response times thus saving countless lives.  Further reading will reveal criticism of private EMS departments that come in from outside of the area and know little about the people that they are caring for.  Some feel that not living in the area that one practices medicine in can result in them caring that much less about the people that they are providing medical care for. Based on some personal experiences that I have had, I fail to see any of these as being an absolute that one should lead an argument with.  My first EMS position was in the town that I grew up in.  Island Heights, New Jersey is small, populated by maybe 1,200 people during the summer months.  It was impossible for me to go into a house on a call and not either know the patient or one of their relatives.  From there I moved some 250 miles away for college, and spent the first twelve years of my career in Springfield, Massachusetts.  I was a transplant, and as a white kid from suburbia, I did not fit the cultural makeup of the city that I worked in at all.  Neither did the vast majority of my coworkers.  Much like the majority of the workforce in EMS, we were Caucasian and majority male. Although I was not from the area I was able to learn the streets, and learn a lot about the culture as well.  Working in Springfield pushed me to improve the quality of the Spanish that I spoke, and learn a little bit about the cultures that I was...

The recent resignation of Dr. Juliette Saussy the medical director of Washington DC Fire and EMS has been a boulder dropped in the lake of EMS that is sending ripples far and wide.  After her announcement and the letter accompanying her resignation was made public it seem that just about everyone has had a look at what she had to say, and what it means to specific services as well as our industry.  Not wanting to feel left out, I felt that it was my turn to do the same. There was not much in Dr. Saussy’s letter that surprised me.  Many of the issues that she brought to light were ones that have been there for years, and have been known about for years but commonly were just brushed under the rug.  To expand on that a bit, a lot of the problems pointed out in the letter closely resemble problems pointed out to me by friends working in a number of different surfaces around the country. You cannot blame Dr. Saussy for the decision that she made.  As medical director, the ultimate responsibility of who does and does not practice within her system rests on her.  She is a woman with a long standing reputation as an innovative, aggressive, and involved medical director.  Her capture by DCFEMS was one that should have been seen as a huge step forward for the department.  The only question that fire department leadership should have been asking following the hiring should have been “Tell us what to do next, doctor.”  Instead, Dr. Saussy was met with resistance and the usual “that will not work here.”  She was forced to go head to head with a union that has done so much to hold back its department, not to mention its “sister” union representing the single role providers serving Washington, DC. And then there is the proposed plan involving American Medical Response.  First, let me start out by saying that while some might not like AMR or their business practices, they really are one heck of a company.  I worked with them for 12 years, and although some of the leadership in the division that I worked...