Dec 21, 2014

Saturday’s cold-blooded murder of two New York City police officers has rocked the public safety world.  The best emotion that I can come up with for myself right now is I am angry.  Extremely angry.  If you connect with me on any form of social media you have probably already seen some of my thoughts about it either reposted in the words of some of those who I follow, or in my own original thoughts.  I feel like many, many people have failed the NYPD.  The media has failed them, the mayor of New York City has failed them, and society in general has failed them.  They have not gotten nearly the support that they deserve for the incredibly difficult job that they do, and that is what i want to write about today: support, but not for who you might expect from the tone of this first paragraph. It is currently 2:30 in the morning.  I am at work, and I have been combing my Twitter feed for the last thirty minutes or so since I got back to the station from my most recent call.  That is when I saw this tweet posted by the NYC EMS Website’s Twitter account: “. . . no one talks about it but all the EMS EMT’s & Paramedics who responded to the 2 NYPD Police Officers who were killed carry a heavy load.”  Far too often, the involvement of EMS is so quickly forgotten.  I know, because I have been there. I briefly mentioned in a blog this Summer a call that I did back in 2012 for an officer who was shot and killed and it was by far one of the most difficult runs that I have ever been part of, and it is amazing the difference that two and a half years can make.  Just because of the incidents in New York City and Ferguson, Missouri this Summer, the climate in this country when it comes to not only law enforcement but all branches of public safety is rapidly changing. A call like this one can completely change someone.  It can ruin a career, and it can ruin a life.  If ever...

Dec 16, 2014

In the past couple of weeks, the pattern of assaults against EMTs and paramedics has continued.  If you have not seen the reports from Boston on the attack by a patient on Boston EMS EMT Tony O’Brien, then I suggest that you take a look.  The bite that Mr. O’Brien suffered to his hand is unlike anything that I have ever seen.  Chris Kaiser recently posted an email that he received from a fan who was attacked by a patient.  The circumstances are a little different but the narrative remains the same.  The question now is what will happen?  And what will we as an industry do? Early last week a very well-known EMS leader advocated on social for EMTs and paramedics to show up at a local county courthouse in uniform in a show of solidarity and support for a paramedic who was assaulted on a call.  His attacker’s sentencing was being held, and the hope was that a show of force might encourage a judge to take the sentencing seriously.  The attacker, 25 year old Remy Blaisdell Gagnon, received a sentence of 60 days after undergoing a mental health examination.  All of this was the result of a guilty plea to certain charges in a deal cut by the prosecutor. Personally, I cannot help but feel that this was a slap on the wrist, and I fear that the Boston attack will result in the same.  We are not law enforcement, but we are in harm’s way almost as much as they are and our safety needs to be taken seriously by everyone.  If you are assaulted by a patient, take it seriously and make sure that your employer takes it seriously.  File charges, and when it comes time for a trial or sentencing tell everyone that you know.  Advocate for them to show up to support you.  We cannot let events like this one, or the attack by Brooklyn Assistant District Attorney Michael Jaccarino on New York City EMT Teresa Soler receive such light punishments. If you do not know Soler’s story, I suggest you read up on it.  In November of 2012 She was transporting an intoxicated Jaccarino who has...

Dec 3, 2014

For most of my life I have been a night owl.  Many who have seen me early in the morning can attest to that.  I remember one paramedic who was on modified duty that would come in shortly after I did for my 6:30am supervisor day shift.  He would occasionally get up from his desk and check the volume of my 24oz coffee cup that came to work with me every morning.  On most occasions he would not address me until it was at least half empty. I am better now today than I have been in the past.  I can’t seem to sleep past 8am on my days off.  On mornings when I do have to be at work at 8am, I am usually up by 6:30 at the latest.  Still though, I consider myself a night owl. Before I got promoted, I worked for about four and a half years on overnights.  I worked a lot during the day as well because I have always been a person who works a lot of overtime, but the core of my schedule involved me being at work while most of the work slept.  There has always been something that is very appealing about overnights to me.  Traffic is almost non-existent.  Nurses at the ER’s seem to have a different sense of humor, and a different outlook all together on society.  And let’s face it: the lack of administration and some of the extra red tape that comes along with day shifts just is not there. It took a special person to work overnights on the ambulance as well.  When you are street corner posting at 4am, your body fights you.  It wants to sleep, and it wants to pass out but that is not always possible.  I have always found that those who work exclusively on the overnight seem to respond better when they wake up for a run, or are asked to operate at long stand bys.  They are not winning the fight against their body’s desire to sleep but they are doing better than most people do. The big problem that I saw for years was the overnight crews were often forgotten. ...

Nov 25, 2014

Last week, Justin Schorr, The Happy Medic, stepped up on his virtual soapbox to let the EMS world know what he thought about Community Paramedicine. I was to surprised to find that Justin, a rather vocal advocate of reducing needless EMS volume, was against the measure saying that it was “too important to be trusted to the 911 crowd” saying that it needs to be a specialty and not a “spin off” of our current EMS system. From one end, I can see where Justin is coming from. As a paramedic in a busy urban 911 system, demand and the current work load for paramedics is high. When you are stretched thin, and your workforce is not deployed to reflect the needs of the community, then every warm body that you have becomes important and no matter what we do, response to emergency calls will always be the primary mission of a system like Justin’s.  To add to that Justin works in a fire-based system. Far too often in fire-based EMS, running the ambulance is seen as a subspecialty thereby turning Community Paramedicine into a subspecialty of a subspecialty. With the additional training that should come along with the title Community Paramedic, a person is effectively being asked to wear “three hats” instead of the two that they were hired to wear.  That might not exactly be true in Justin’s system but plenty of providers can attest to this. In all reality, what else do we have in our potential toolbox that will help us reduce those unnecessary EMS runs? As it stands now, Community Paramedicine is the best option. Justin is quick to point out that when he was in England, “paramedics with only 1 year experience were out on their own making recommendations, referrals, and taking people directly to what they needed, not just a 2 person cot van to an ER.” The difference there is training and education. They were prepared for such an event and although there have been limited studies done on the matter, the evidence exists that paramedics in the United States do not do a good job determining who should and should not go to an emergency...

Nov 19, 2014

The EMS model debate of fire-based EMS vs. private EMS is more active than ever on Facebook thanks to recent articles shared by JEMS, EMS World and EMS1, and I have been a frustrated, screaming at my computer participant. Both sides make some irrational arguments but when one searches through the mess, they can find some well thought out compelling cases made for both sides of the debate. It is no secret that I am a big advocate for EMS based EMS, whether that is in a private model or more preferably in a municipal model. Like many others, I feel that when you serve two masters you cannot perform both jobs as effectively as a person could perform one of them. Furthermore, I think that in fire-based EMS systems dedicated, highly skilled practitioners are locked out of the system for one reason or another to the detriment of the general public. The anti-private arguments are the ones that I always find interesting. The first one of “they are only in it for the all mighty dollar” amuses me. Almost any department regardless of their delivery model relies on the dollars that the business generates. With the model of health care that we have in this country, everyone is in it for the all mighty dollar. The other argument always seems to revolve around private EMS not being able to differentiate their business. They send units on non-emergent calls while disregarding emergency calls. Or they strip coverage to get dialysis transfers done. As someone who has worked in the world of privates and spent a decent amount of time perusing request for proposals for EMS services, I cannot help but think that most of what people are complaining about is a direct result of low standards contracted providers. When I worked in Massachusetts we had four contracted communities that we provided emergency services to. Once you moved past the out clauses, insurance requirements, and legal mumbo jumbo, the core of the requirements for each of these contracts came down to “you will provide X ambulances at the paramedic level and respond to calls in Y minutes or less.” That was it. Monthly reports were generated...

Nov 17, 2014

If you ever want to get under an EMT’s skin, call him an ambulance driver.  The resulting rage, either in front of you or via social media later will tell a lot about them.  I was having a discussion last week at EMS World with a couple of friends kicking around a silly idea to host a bar crawl that required everyone to either wear one of those god awful EMS slogan t-shirts, or make their own to be able to participate.  My nurse friend who was part of the conversation just shook her head and said, “and people wonder why EMS struggles as an industry to get ahead.” I understood what she meant, we have always been, and seemingly will continue to be our own worst enemies.  Then, while waiting in the airport with a friend, the two of us were flipping through some industry centered Facebook pages having some laughs over some of the comments that people were posting on shared articles.  “I don’t know if I am reading comments from EMTs or YouTube comments,” is what he likes to say. We sat there over lunch and tried to figure out where this attitude is born from.  Is it a product of people’s environments and predispositions?  Is it due to people just being Type-A personalities in this field?  Or is it just general immaturity? Maybe we are over-recruiting.  It is no secret that if you are an EMT with a card in your back pocket for twenty years or twenty minutes, you can find employment somewhere.  It might not be the greatest job in the world, and it might not be an endpoint for your career but the opportunities are out there, it is just a matter of what a person is willing to settle for.  Its not really an industry recruiting problem, it is more of a lack of standards when it comes to recruiting.  And exposing impressionable younger people to the folks who have the wrong attitude just makes it more difficult to break this cycle of disrespect and immaturity. Anyone who knows me personally will confirm that I am, in fact, a huge goofball.  I can be inappropriate with...

Nov 6, 2014

This week I started what is essentially my first real true vacation since my trip to New Orleans for EMS Expo 2012.  I’ve had time off, however most of it has been because of swaps.  This time around though, I burned enough vacation time to put me out of work until the 22nd of November.  It’s an exciting break to say the least. No fall break would be complete without a trip to EMS World’s annual EMS conference being held this year in Nashville, Tennessee.  For those of you who have never been to a national conference I ask you again, what are you waiting for?  If you want to see the latest products, or have a chance to rub elbows with some of the most brilliant thinkers in this industry then conferences like EMS Expo or EMS Today are for you.  This trip marks my 9th consecutive major conference.  I’ve made some great friends, amazing professional contacts, and I have always walked away with a little different view of our field and where we are heading. I am sure that many of you are wondering what happened to the podcast.  Well, it’s not dead.  Not even close.  The last couple of months has been taken up by a lot of extra work, extra teaching and side projects which have taken time away from my social media existence, particularly the development of the podcast.  Schedules clash, ideas need to be saved until the right people are available to talk about them, and some ideas just never seem to fully develop.  We will be recording an episode of the show on the exhibit hall floor thanks to Jamie Davis and the crew at the ProMed Network.  They have always been so good to me, and continue to be supportive. Furthermore, I hope to get together with some people down there to actually have a chance to schedule some upcoming shows.  So the podcast is not even close to being a dead project.  I have invested in it, and plan on getting back to it in Nashville and in the coming months.  In the meantime, check out the already recorded episodes here. Tomorrow I hop on...

Nov 3, 2014

I spent some time listening to Chris Cebollero and Kelly Grayson’s show about the presence of cameras being present in the back of an ambulance, and I cannot figure out what everyone is afraid of.  I know what most will say that their fears are, but is there any foundation for those fears?  First of all, let’s throw HIPAA right out the window, or as many on the internet call it, HIPPA.  People who complain about patient privacy issues with cameras and HIPAA laws are people who do not understand HIPAA. A little more than ten years ago, I had the dubious honor of being my union’s chief steward.  One of the major fights that were dropped on our plates was the arrival of the infamous “black box” driver tracking devices in our ambulances.  If your system does not have them, I will briefly explain their function. The boxes track the truck’s speed, breaking, use of lights of sirens, use of seatbelts, and use of a spotter while backing up.  All of their information is downloaded to a master computer and is fully accessible if needed for any sort of investigation.  In addition to its, tracking, the boxes used accelerometers and g-force detection devices to give Pavlovian real time feedback to drivers in the form of growls and beeps from an audible speaker to create a safer and smoother ride. The fear from street personnel was always that “Big Brother” was watching.  People were absolutely petrified that information would be randomly pulled, and people would be disciplined as a result of their driving techniques.  I had to be the mouthpiece for the employee body, and because of a number of factors, we did not get very far with our argument, and the company pushed forward and installed the boxes into the ambulances. In the two years that followed, the number of disciplinary hearings that I remember taking place as a result of the boxes were few and far between.  Most of them were ones where someone would try to tamper with or fool the box.  The most amusing of them was a crew that was being investigated for “repeatedly slamming the truck into ‘reverse’...