Mar 16, 2015

With the season finale of Nightwatch coming up this week, I got thinking about the value of EMS based EMS.  This thinking was also fueled by yet another series of perceived response failures in fire-based EMS services on different sides of the country, specifically in San Francisco and Washington, DC.  While I stand by the argument that response times do not matter as much as we allow us to this that we do, I still fail to understand how the general public does not recognize the value of an EMS only service, especially after a certain population and call volume size. As always, I feel the need to point out that there are exceptions to every rule.  There are private services that get it.  There are EMS services that are fire-based that do it right.  But, as I said above, at a certain size there are others in both of these sectors that fail miserably and fall short of their expectations.  The difference between the two though is when a private service fails to meet expectations, they are usually replaced.  Quickly.  When it is a fire service they are given chance after chance after chance.  The vast majority of third service stand alone EMS systems are successful in their missions, and they are successful because they are dedicated to EMS. What could be better than a team of medics dedicated to providing medicine?  How can an argument be made that in a vacuum when you take away any funding issues that might arise from having a standalone department that a stand alone EMS service dedicating themselves 100% to the medical well being of the community that they serve is not the best possible delivery model? Last month, there was an EMS1 article written about priorities in EMS training.  While fire training is usually a lot more extensive than most EMS CEU classes (I am basing this on what I am told by my fire centric colleagues) from the numbers that I have seen reported from a number of different departments the volume of training is not anywhere near to equal or equitable.  In my EMS based EMS service, for example, we schedule around sixty hours...

Mar 13, 2015

Find me a paramedic who feels that they are adequately financially compensated for the job that they do and I will be shocked.  Pay in this field has always been an issue.  We blame it for a lot of our recruitment and retention problems.  People constantly cite it as a stressor that makes our lives more difficult.  Maybe though, just maybe, we are putting too much emphasis on how large our paychecks are and not enough emphasis on the money that we bring in. When I had a chance to interview Skip Kirkwood about five years ago, I asked him to tell me one piece of advice that he would give to any new paramedic or EMT.  To summarize the points that he made, Skip told me that he would want people in our field to learn to manage their money better.  Learn to live within your means, and you will not have to work sixty or seventy hour work weeks. Sean Eddy and Jason Hoschouer talked about it on a podcast that I did last year, and if you have not read Sean’s series on Money Smart Medics, you are really missing out.  There are lessons to be learned from all of it, and sitting and talking to Jason and Sean inspired me to make some changes in my life. I have always been good with numbers.  I speak them fluently.  The problem is though I have never been quite as good with how I managed my own money.  As long as I had money in the bank, I felt like I could spend it.  I was one of those people who would live from paycheck to paycheck not because I had to but because I often chose to.  It was a vicious cycle and one that I got sucked into.  Sean and Jason were so enthusiastic with their ideas and values that I felt that I should take a couple steps to try and fix myself. I started by charting my income.  Since I work a set rotating schedule, I could predict my work hours out for the entire year.  I started to chart how much overtime that I was working, and...

Mar 9, 2015

While watching an episode of Nightwatch the other night, I got thinking about the concept of staging.  In the call that was presented on the show, the crew of Dan and Titus was sent for a possible stabbing victim.  They responded as normal but shut down and parked a few blocks away from the call to wait for an overburdened New Orleans Police Department to get on scene and report that it was secured for them.  While waiting, they were approached by someone who told them about the stabbing. I have been in this situation more times that I can count.  It was not unusual to be sent for the unknown third party caller for the psych patient or the suicidal person with instructions to stage for police.  The ambulance would be sent lights and sirens so as to maintain the contract’s requirements of having a truck on scene to all “priority 1” calls in under ten minutes.  Without talking to the patient or having someone looking at them and reporting what was going on, the call was classified as being “unknown” which by some determination made in the dispatch center required that it be “priority 1.”  So the ambulance would respond lights and sirens, and in this case, being on scene meant that they were calling out a few blocks away, putting the truck in park, and waiting.  If all of this happened at “shift change” the wait could be as long as 20-30 minutes. I have always been one who was leery of the concept of “staging” within itself.  In my Springfield example, who benefits from having an ambulance driving lights and sirens, which has been proven to be far more dangerous than driving without them, seemingly for nothing, because you will not be going into the scene?  From the example in New Orleans, how far away from a scene is far enough to park?  A crew is always at risk of being found, and as former Jackson, Mississippi city councilman Kenneth Stokes taught us in 2010, if a city official can’t understand the importance of keeping an EMS crew safe, how can we expect the general public to understand it? How...

Mar 5, 2015

Read Justin Schorr’s post by following this link! Everybody loves a good internet debate, right?  This afternoon I engaged in one of those with my good friend and Chronicles of EMS star Justin Schorr about response times and their impact on EMS.  Sparking the debate was an article that Justin shared that discusses the impact of response time compliance on a large city in the United States covered by a fire based EMS system backed up by two private services. In his post, Justin disclosed that he is a firefighter/paramedic and a “card carrying member” of the IAFF.  Staying in the same mentality, I need to disclose that I worked for a private EMS service for 12 years that held a busy urban 9-1-1 contract.  I now work for a municipal ALS only third service that intercepts a number of BLS level fire departments.  Also, as some might have heard, I am associated with the EMS Compass performance measures initiative.  The views in this post are my own and in no way reflect those of anyone associated with the project. The debate that Justin and I had revolved around two topics: the importance of response times, and the importance and relevance of ALS first response.  I am going to break down those two topics separately. Do response times matter? In most EMS systems, response times are king especially when it comes to those serviced by the private sector.  “Just get there, and we have nothing to worry about.”  All that matters is an ambulance shows up, and is most cases stakeholders want somebody on that ambulance to have a paramedic patch on their sleeve.  What happens from there does not really matter unless somebody complains. It is funny that this topic comes up now, because currently sitting on the desktop of my computer is an almost completed blog post about anecdote vs evidence.  The concept that response times matter to patient outcomes is one of the most anecdotal statements that has ever been made.  There are three different arguments that I feel support this. First think about the path that the majority of our patients take when they arrive at an emergency room.  Think about...

Mar 5, 2015

In my twelve years from Springfield, I heard the words “start us a 7” come over the police scanner more times than I could count. The number seven was the radio code for an ambulance.  Usually what this meant was the cops had found some indigent on the side of the road that they wanted transported to the hospital, or some assault victim who needed a routine transport for a stitch or two. In a somewhat related incident, a friend shared a conversation that they were privy to that occurred between a fire and EMS dispatcher about a person stuck in the middle of the road in a broken motorized wheelchair.  I am paraphrasing but it went something like this: Police Dispatcher: “We don’t have any way to move the wheelchair.  This is an EMS matter.” EMS Dispatcher: “Neither do we.  It looks like a traffic problem to us.” As always, the outcome was as expected: paramedics responded (eventually. . . it was a busy day) and had to deal with something that was well outside of their scope of practice.  Or how about this one that happened more times than I can count in my career: You respond to a college campus for the intoxicated student.  On arrival, you find a mildly inebriated individual who is being sent by the campus police because it is the “campus policy” that intoxicated students get transported.  The student is defiant, and they are told by the police officer on scene that they can make a choice “hospital or jail.”  Mr. Defiant decides that he is going to be daring and he chooses jail. The police officer responds by putting the patient’s hands behind his back and slapping the cuffs on him.  To you and your partner’s surprise though he does not put the patient in the back of his cruiser.  Instead, he marches him straight to the back of your ambulance where he sternly lectures the student, removes the cuffs and sends him off to the ER in your more than capable hands. I am not saying that these people do not need help.  The problem though is their access point for their desired help, whether...

Mar 2, 2015

Last week I spent Wednesday thru Saturday in Baltimore, Maryland attending EMS Today.  It was my tenth major EMS conference that I have been to since 2010.  I am starting to feel like somewhat of a veteran.  I have seen a lot of people come and go.  I have seen good years, and I have seen bad years.  In 2012, I barely made it out of Connecticut before Hurricane Sandy shut down the northeast. For the first two or three years, there was a certain buzz at the conferences.  Twitter personalities and bloggers were everywhere.  The podcast studio was a constant revolving door of people coming in and out to see who was there and who was going to be on during the next time slot.  Classes were full of innovation.  New speakers were sharing new ideas.  Lines outside of certain doors were so long that you knew which classes were going to be standing room only. In 2013, the conference world seemed to slow down a bit.  JEMS decided to move EMS Today to Washington, DC.  Some bloggers started families.  Others just did not have the money or time to take off of work.  Classes seemed to be the same thing that we had seen the year before.  Sure, the huge push for Community Paramedical education had started but even that seemed to be starting to repeat itself.  It was almost as if we were hitting an educational plateau. From a personal stand point, I had opportunities to take more classes thanks to winning a free registration from JEMS and the generosity of the team at MedicEd who provided me with free registrations in Nashville and Baltimore this year.  Prior to this past week, while I felt like I was getting some knowledge out of class it seemed to be more of a reinforcement of what I had heard in previous years rather than some new innovation. The exhibit hall moved in the same direction.  2011 was filled with speculation of what ultrasound was going to do for prehospital care.  There were new devices everywhere that you turned.  Through the end of 2014 though, not much seemed to change.  The atmosphere this past...

Feb 27, 2015

If anybody had any doubts about how the cast of Nightwatch would be received at EMS Today, all questions were answered at the first day of one of the largest EMS conferences in the United States. I got my first glimpse of the crew at the Physio Control booth signing autographs at the entrance to the exhibit hall.  For a second, I almost forgot that I was at at an EMS conference and thought that I was at ComicCon.  Here was the cast of a TV show entertaining star-struck fans.  But this was not Daryl Dixon or the cast of Firefly.  The group that was signing autographs are just regular people just like the rest of us. Later in the evening, the group made an appearance at Zoll’s Shockfest.  Once again, the marketing team at Zoll knocked this event out of the park.  There was great music, great food, cold drinks, and a fun atmosphere (shout out to Zoll’s Brooke Taylor who headed this one up yet again).  It didn’t take long for everyone notice that the celebrities where in the house. I cannot say enough about how the entire group from Nightwatch handled their fans.  As one would imagine they were mobbed.  At one point, it almost looked like a receiving line waiting to get their turn to say hello to Holly or Dan or whomever they had noticed.  Each of them were all smiles.  They were humble, they were friendly, and they were fun. Personally, I do not feel like I got nearly as much time as I would have wanted with this group, but I feel like I was in the majority with that.  I said my hello’s, tried to put a face to the bevy of tweets that I have sent out about the show (whether they put two and two together or not) and most importantly, I had a chance to thank Holly for shedding some light on my analysis of Gavin. After my review of Nightwatch a few weeks ago, some took exception to my assessment of Holly’s partner, mainly when I said that he looked to me like he was getting burnt out.  One cast member of...

Five years. . . Its been five years. I never thought that I would have kept this blog going for as long as I have.  There have been many highs and lows in the 357 posts that preceded this one.  I’ve been accosted by the main stream media, shared my struggles with starting over, interviewed the stars of the show Sirens, and even posted an obituary with the most notorious of EMS “super users.” When I started writing back in 2010, I viewed it as cheap therapy.  I always enjoyed writing, and saw the opportunity to blog as a great outlet for a lot of my frustrations while working in Springfield.  Five years later, while sharing my thoughts is still extremely cathartic, I have seen the external benefits of the blog as well.  Two weeks ago I saw my first article posted at EMS 1.  I’m hoping that it is the first of many to come. Once again, thanks to everyone who has stuck with me through the highs and the lows.  This little experiment that started as a free Blogspot has grown to be what medicsbk.com is today.  I’m looking forward to the years and opportunities to...