Well, as the title of this post suggests, I am back. I know, I know it has been quite some time since I have posted anything here, and it has been a lot longer since I have posted consistently but with EMS Today coming up this week, I decided to reopen the door to blogging and start writing again. For the last six months I have been focusing on a lot of aspects of both my personal and professional life. I have been teaching more, developing classes more, and just generally enjoying life outside of the blogging world. After writing for five and a half years, I guess that I just needed a break. I have spent the last couple of months writing for Dragons Speak, a blog about Drexel University’s basketball team in Philadelphia. As a present to my dad, a Drexel grad, I got us season tickets. Sports writing has been a good outlet, and has helped me break down some of the more serious setbacks that I have had with writer’s block over the last couple of months. I am sure that most of the other bloggers who are still out there and active will agree that writing is a labor of love. Unlike some, I don’t make any money from doing this. This website is completely self-funded and maintained. I write because I enjoy it, and I write because I am passionate about my chosen career. My main motivation for coming back and writing, however, is two-fold. Moving past my love for it and my field, I am not at all happy with the direction that the online community of bloggers has taken. While there are still the likes of Noonan, Grayson, and Schorr gracing this series of tubes that we call the internet with their thoughts and feelings on this field, there are others who have become more frequent contributors who leave me scratching my head. But enough of the negativity. Let’s get back to writing, right? Lately, EMS Compass has taken up a lot of my time, and with that coming to a close I plan on having more time to spend with a cup of coffee and...

The city council in Washington DC passed an ordinance this past week to contract with private ambulance companies to provide additional ambulance coverage to handle an overflow of lower priority calls.  The response from the paramedic’s union is the usual rhetoric one would expect: “If we don’t show up people are going to die!”  Wrong, folks.  If nobody shows up that might happen.  Does it have to be a DCFEMS ambulance?  Absolutely not. For the life of me I cannot figure out how a system the of Washington, DC’s can operate without a safety net.  How is there nobody there to pick up the overflow?   In Springfield, Massachusetts for example, a city of 150,000 people we had a relief valve for when the volume outpaced the resources.  Other companies signed agreements and participated in the 911 system when we needed them to and guess what?  Because of the structure of our system, and the allowance that we could select who was part of the system in my seven years in management I never heard a complaint about the level of care that was provided in any instances of backup response.  Sure, you ran into the occasional response time issue however much like the proposed DCFEMS changes those units were commonly handling lower priority calls.  It is much easier to get a truck who is making a turnaround at a hospital to pick up a CPR call or a shooting than it is the toe pain or another suicidal person. The key to a partnership like this is structure and oversight.  While some might complain that the hastily made plan by the city council might lack just that, but creating and instituting these measures should not be difficult.  For example, a great place to start is to set standards for who you will let in on the action.  Is it smart to let every mom and pop shop descend into the neighborhoods of DC to provide emergency care?  Absolutely not, but there are plenty of services in the heavily saturated DC area who could more than handle the volume. And let’s not lose sight of the fact that although the patch on one shoulder...

Sep 22, 2015

My trip to Las Vegas for EMS World EXPO 2015 was my eleventh consecutive trip to a major EMS conference.  I feel like I have had a front row seat to see the direction that conferences like EMS World EXPO and EMS Today have taken on a number of different levels.  The crowd certainly has changed.  You still have your big names that show up year after year and those faithful attendees who come year after year and take classes.  Many products stay the same, while many “new and great ideas” are here one year, and gone the next.  Ambulance design shows the continued utter lack of advancement particularly from a provider safety stand point, which I continue to find alarming.  My car today looks nothing like the 1987 Volkswagen Jetta that was my first car in high school, so why does the back of my ambulance look exactly the same as the 1984 box truck that I first road in back in 1993? It is interesting the direction that conferences in general have taken.  For a few years there seemed to be a bevy of new content mixed in with the usual trauma, mass casualty and pediatric classes that always seem to populate the convention schedule.  We used to learn about how ultrasounds were going to be the next big thing, and now Mobile Integrated Healthcare has taken yet another conference by storm.  It’s important information about the future of our industry but come on, folks, it’s time to see something new. To JEMS and EMS World, I beg of you, step outside of your comfort zones.  Let’s move away from the same speakers that present year after year, regardless of how many awards that they have won, or how many articles that they have published.  We need some fresh new ideas and fresh new presenters.  I know that might ruffle the feathers of a few people out there who do not like being turned down, in fact I know of one in particular who has already said he is not submitting to a certain conference anymore because they did not want him this time around, but the time has come.  We are...

I have been asked occasionally by friends why I don’t take more pictures and post them on Facebook.  Previously I never had much of an answer beyond “I just don’t” that was until a recent trip to Washington, DC when a far more practical reason became clear to me. With some time to kill my girlfriend and I took a walk through the heart of the Smithsonian and down to the monuments on its west end.  The Washington Monument, Lincoln Memorial and the Reflecting Pool that lies between them has always been one of my favorite spots in DC, and it is a visit that I frequently try to make when in town.  As we walked past the reflecting pool I saw a number of people taking pictures however they were not standing around and snapping shots of what was going on around them. What we noticed was selfie after selfie after selfie being taken.  Everybody standing by the reflecting pool was trying to do their best to capture a shot of themselves and everything that was going on behind them.  Some crouched with arms out stretched, and others had their Selfie Sticks deployed to help them do the job.  What I realized though as I walked past person after person was that all of these people were experiencing life, and one of the greatest places in this country, with their back to it. I became much more aware of what was going on once we got up the steps to the Lincoln Memorial.  The view from there is incredible as you look back across the Reflecting Pool to the Washington Monument and then on to the Capitol Building at the far end of The Mall.  We were surrounded by people trying to get their picture with Honest Abe as they seemingly disregarded everything else that was around them. To sum it up, if anybody is ever wondering why they don’t see me taking or posting more pictures it is because I refuse to live life with my back to the world.  There is far too much going on right in front of me that I would rather experience with my own two eyes...

Years ago, when discussing the precepting program at my division, somebody said, “I don’t know why we are taking so much time to evaluate these people.  They were able to pass the paramedic test that right there should tell us that they are ready for the field.”  What this person did not understand is that testing that takes place in the written and practical settings have very little to do with.  Our testing, which has evolved very little in the fifteen years that I have been a paramedic, has become so disconnected from what our profession actually does, and we need to start reevaluating it. Granted, my frame of reference is about three years old, and I am otherwise going by what I have heard third hand from people, but I can say, without a shadow of a doubt, that the practical stations that I went through in 2012 for my National Registry certification almost matched the stations I participated in back in 2000 when I received my certification in Massachusetts, the exception being the two oral stations that NREMT has added to the testing. I guess most of the credit for my performance in 2012 goes to the staff at Springfield College and the meticulous teaching of Gary Childs who was the head instructor back in 2000 who spent more than a year instilling on me the importance of things like memorizing the critical fail points of each station, ripping the tape before starting an IV, and making sure that I verbalize every single step as I do it in case an evaluator is not watching. I did, however, have to break a number of bad habits to get myself ready for the 2012 test.  I found as I walked into each station that a number of steps that I was asked to do had little to do with how I perform as a paramedic.  For example, as I freely walked around a patient and worked from all angles to apply the KED to the volunteer who was my patient, I could not help to think about not only how impractical this was, but I also wondered how many items I would have...

Your department has a policy that they send two ambulances to reported cardiac arrests.  On one particular busy night two of your trucks are dispatched to a person reportedly not breathing.  The first truck gets on scene and finds a patient beyond help.  Before they can cancel the second ambulance, they are involved in an intersection accident.  In response to this incident the next morning your director releases a memo stating that second ambulances will no longer be dispatched to cardiac arrests. In a labor management meeting, an employee suggests development of an “emergency code” for field personnel to report to dispatch that they are in trouble to help activate a large law enforcement response to assist them at their location.  Your boss says that this will not happen because they think field crews will abuse it.  A week later, a paramedic is seriously assaulted by a psychiatric patient.  The dispatcher on the other side of the radio was unable to make out their calls for help.  Your boss then revisits the policy. Your division uses a non-disposable laryngoscope blades.  A supervisor goes to your boss and suggests following the industry trend and shifting to disposable ones to reduce the risk of infection for patients.  Your boss decides against this since your company has never been sued by someone receiving an infection from this means of transmission.  You are convinced that the only way this policy will change is through some sort of tragedy. All three of these incidents are loosely based on actual events that I have either been part of or have heard about from friends of mine working in different systems throughout the United States.  They are all evidence of the same though, change driven by catastrophe.  We have all experienced it at some point in our career.  We have all been sitting around in a conversation with our friends and coworkers and had somebody utter the words, “Nothing is going to change until somebody gets hurt.”  Some of this attitude from leadership is because of a generalized disconnect from the field.  Some of it is because of the kneejerk, reactive nature of EMS that seems to carry on with people...

Last month I headed down to Baltimore for an afternoon to visit the exhibit hall at Firehouse Expo.  While I was there I had the chance to sit in on a class about leadership on the fireground that raised some interesting questions for me about the safety of responders and more specifically our regard for that safety. The instructor took a considerable amount of time out of the class to question the “culture of safety” that we operate with feeling that you need to be willing to sacrifice more to save more, likening his battlefield experience in an extremely admirable and heroic military career to his time on the fireground.  To sum up what I, as an attendee in the class saw as his message, you need to be willing to sacrifice more to save more.  He was saying that many were too cautious by putting the concept of “at the end of the day, everybody goes home” above the mission of the department which generally is to save as many lives and as much property as possible.  He disagreed with the “nothing is worth your life” concept of the culture of safety. Now, let me start off by once again stating, as I have many times before, that I have zero experience in firefighting.  My personal participation on a fire scene consists of me standing around, waiting for a patient to be delivered to me, or handing out Gatorade and water in an attempt to keep those on the fireground from not becoming my next patient.  What goes on inside that house is something that I have no knowledge about. What I do have, however, is a great respect for those who do put their lives on the line in those situations.  The angle of this class that I want to discuss is the bleed over from the fire side to the EMS side of the profession since in many communities the two are so closely tied.  Some firefighters might sit in on a class such as this and receive and honor the message that “when you’re on the engine, you need to be willing to risk it all.”  Then, the very next...

Well the summer of 2015 is now behind me and it is time to get back to writing.  I have been doing a lot of traveling as of late both to Austin, TX for the EMS Compass project as well as some traveling for pleasure as well.  It was very therapeutic and frankly it was nice to get away from the keyboard for a couple of months.  It did, however, remind me of how much I enjoy writing so it is good to get back to that as well. I have a lot of ideas developed that I hope to roll out here over the next couple of months.  One of the biggest ones is I plan to include a few posts here and there that have nothing to do with EMS at all.  If you follow me on Twitter or are friends with me on Facebook you know that I can be pretty opinionated about some issues.  While I plan to touch on those on occasion I also want to talk a bit about life outside of EMS because getting away from the field can be just as important as what we do on the street. After over five years of writing, I feel like a break was exactly what I needed but rest assured, I am back!  Now, let’s get back to it. ....