EMS is currently at a major crossroads as an industry.  Across the country requirements to become a paramedic are becoming loftier, and rightfully so.  In order to properly care for each patient we encounter, we need to be at our best, and the route to that is through training and that bar is being raised.  More education eventually should mean more pay, and some in the private sector are starting to realize that. This is evident from the recent well publicized labor dispute in Buffalo, New York and their eventual 10 hour work stoppage followed by a contract settlement.  From the publicity I have seen regarding those negotiations and others I have more intimate knowledge of, it leaves little to the imagination as to what is most important to EMS professionals: pay and benefits.  I know, that seems like a slam dunk, no brainer, but it also seems clear that at least in the private sector, purse strings are becoming tighter, and benefit packages are less and less appealing.  It’s quite the conundrum, actually.  Increasing educational requirements are driving paramedicine towards being a career, yet employers are still far too often looking at employees with the expectation that they have a job, and there is a divide the size of the Grand Canyon between the two. Now, the jury is still out for me on work actions such as strikes.  I do not really know if they truly follow the “spirit” of our profession and seem to do more of a disservice to the community than they do benefit the worker, but that is a debate for another time.  The fact remains that they happen, and there is certainly reason behind them, as evident by the Buffalo, NY Rural Metro incident. While the private sector is just one of a number of EMS models, it is quite often the quickest path of entry into the industry and employs more EMTs and paramedics than any other model, so discussing the big kid on the block is extremely important.  With health care taking on a huge for profit presence in the economic world, everyone wants their piece and if some of the bigger players want to...

A little over a year ago, I tackled the concept of “skill dilution” and its validity as a statement, and reality in the field.  My perception at that time was that a more important component to focus on instead of skill dilution was education for our paramedics.  While I still stand by the concept that we need to better prepare our medics for what they will encounter when they hit the streets, my views of skill dilution have changed a bit. The EMS system in Massachusetts is quite different from the one that I currently working in.  I know, that is no shocking revelation since it has been said to exhaustion that “if you’ve seen one EMS system, you’ve seen one EMS system” but I find the uniqueness of my current situation interesting in comparison to where I was.  The easiest way to look at it is by evaluating both environments on a county-wide basis. On a common day, Hampden County, Massachusetts has approximately 25 paramedic level ambulances protecting its citizens.  They respond to emergencies for the most part regardless of the complaint.  Everyone gets the same opportunity to have the most advanced care available to a sick person regardless of what the caller told the dispatcher, or what the Emergency Medical Dispatch (EMD) code says is the appropriate response for that incident.  Do you have a splinter?  You’ll most likely get a paramedic.  Are you having chest pain?  You’ll most likely get a paramedic.  That paramedic’s partner, however, could be an EMT, an intermediate, or even a paramedic.  All that Massachusetts requires is one paramedic to make an ambulance an ALS level ambulance. In the county I work in now, there are nine paramedic units for the entire county.  None of us transport.  We respond to only ALS level calls as determined by EMD codes, and we are supplemented by approximately 30 BLS level ambulances.  I do not know the exact number, but to me, that “feels” about right.  Every paramedic unit is staffed with two paramedics, and the state requires that each ALS appropriate 9-1-1 call gets at least two paramedics. According to the 2010 census (and Wikipedia), there were about 463,000...

I am writing this post today because I feel that I have been inexcusably quiet during EMS Week this year.  I do not want anyone out there to think that I am “anti-EMS Week” if you will.  Personally, I feel that we all deserve recognition year round, not just during one week out of the year.  We contribute to society every day, so why not recognize us more often, right? Throughout my years in EMS I have participated in a lot of EMS Week events.  I have been to banquets, had breakfasts, lunches, even dinners provided to me by employers and organizations to say “thank you” for another hard year’s work.  This year, I am with a different organization and my experience this year was a bit different and enlightening. Sure, we had a cookout, which was great.  Nothing like burgers and ‘dogs on a warm pre-summer day, but this past Monday, I got to dress up in my Class-A’s and have my mother pin my badge on me during an appointment and graduation ceremony put on every year for the new paramedics to join the organization.  It was a great experience, complete with bagpipes, drums, a color guard, and plenty of speakers, and I took a great deal of pride to have the honor to stand up there, but there was another group there that I think this event meant more to. The real winners Monday night were our families.  While the organization was saying, “thank you for being one of our paramedics” to us, the more important message was the “thank you” they were extending to our families for the time we sacrifice away from them.  They are the ones who have to put up with the time we spend working during holidays, and birthdays, and anniversaries.  I feel sometimes that our loved ones deserve the biggest pat on the back, so let this be my “THANK YOU” to all of you. It got me thinking about what other missed opportunities we, as an industry, have during each and every annual EMS Week and I can’t help but feel like taking the opportunity to educate the public is probably the biggest one. ...

It is not difficult to figure out where many of us out here in the blogging world get our material from.  Some of it is derived from frustration, and some of it from lessons we have learned that we feel the need to pass on to others.  With this blog more than three years old, it doesn’t take a rocket scientist to figure out where some of my material comes from.  It is from my past, and from MY experiences in the years that I worked for AMR in Springfield and frankly, I could not be more proud to say that Springfield was where I spent the first twelve years of my career. In a meeting Thursday night held by the City of Springfield’s EMS Commission, the five commissioners voted unanimously to recommend American Medical Response to handle the 9-1-1 contract in their city for the next five years.  Last night I posted on my personal Facebook page that this decision was a “. . . much deserved and expected victory” for the staff at AMR Springfield, and now that I look back on it, and look back on the decision, I do not feel that statement fully describes the impact of the EMS Commission’s recommendation to the city. The real winners in this situation are the citizens on Springfield because they are getting the best care that they possibly could by having the paramedics and EMTs of AMR Springfield to respond to their emergencies.  AMR has had the opportunity to be in the lime light a few times in the past couple of years with the tornado of 2011 and the gas explosion of 2012 to name just a few, and while those calls were very high profile and visible, they barely make up a chapter in the story of AMR Springfield. The things that are really important are the things that happen every day.  It is not the multitude of trucks that I had sitting in our staging area on Worthington St that night, it was the other ambulances that were out still answering the “routine” emergencies that made the difference.  It was not just our crews going to door to door...

Tuesday afternoon at 3:30pm, there will be a meeting held at Springfield City Hall to discuss American Medical Response and their ability to provide prehospital care to the citizens of Springfield.  Below is something I would like to share with the City Councilors who will be in attendance Tuesday. City Councilors of Springfield, Despite the favorable findings of WGGB in their investigation on emergency response, you have decided to hold a forum to discuss potential short comings of the current EMS provider to the City of Springfield.  Yes, that is right, I said it was favorable.  Although the ebb and flow of the story might not have showed it, all of the information provided shows that AMR exceeds the expectations set for it.  But maybe you should dig a little deeper.  Prior to walking in the door to Tuesday’s meeting, I would like to urge you to do a little research and maybe expand your vocabulary a bit. For instance, for just a second, let’s forget about response times.  They don’t nearly matter as much as you might think.  Try researching what a ROSC rate is, or how CPAP has reduced the mortality of shortness of breath patients, particularly in Springfield.  Ask Baystate Medical Center about the success of their ST-Elevation Myocardial Infarction program (STEMI for short) and ask them how many of those patients are delivered by AMR. Still not convinced?  Why not take a good hard look at other communities around the country and see for yourself how good you have it in Springfield.  An ambulance is on scene in a preset amount of time or less 97% of the time.  How do you think that compares to communities like Detroit, Washington DC, or Philadelphia just to name a few? Or how about closer to home?  Ask around to some of the neighboring more rural communities and see what their response times are like.  I guarantee that some will be longer than the average time publicized by AMR in WGGB’s article, but the patient outcomes will still be favorable. Just like with in-hospital medicine, perfection will never be obtained in prehospital medicine.  Errors are going to happen because not only are the...

Shortly after my post went up yesterday regarding WGGB Springfield’s story about AMR’s response time in the City of Springfield I received an email from reporter Brendan Monahan who did the story asking me if I wanted to talk about my concerns with the way WGGB depicted emergency response in Springfield, MA. Even before the story was aired Wednesday night on ABC 40, it had generated quite a buzz mostly on Facebook.  WGGB’s website received close to 400 comments and private messages in response to an inquiry looking for anyone who had waited more than 10 minutes for an ambulance to arrive after calling 9-1-1.  Some of those comments and messages were productive and informative others not so much, but such is the world of social media today. I had a very productive talk with Brendan lasting about 30 minutes.  The first thing that he wanted to point out was that his intention for this story was in no way to attack or offend any paramedics, EMTs, or anyone else affiliated with the industry.  His intention was to generate discussion about whether or not AMR should add ambulances to the upcoming contract, or if the city should consider making some changes.  He felt that he and the team at WGGB were presenting fact based information utilizing data that they had been given by the City of Springfield, and interviews with some officials with the city.  He acknowledged that the information I highlighted as what I felt to be most important in my response to his story was featured in Wednesday night’s segment, however it might not have been as prominent as I wanted it to be.  He stated, and I agree that as the reporter putting the story together, the structure of that story is his to determine. I shared with Brendan my feelings about the quality of response in Springfield as compared to other municipalities in the greater Springfield area as well as nationwide.  I tried to stress to Brendan that while 97% is not perfect, it not only exceeds Springfield’s standards, but it is also much better than some of the largest cities in the country, and if put up against other...

Does the perfect EMS system exist?  Is there really one perfect fit for every municipality and every paramedic as well?  I really don’t think that there is.  What each individual has to search for though is their perfect fit.  They need to look for that system that has what they are looking for, regardless of what it is. Believe it or not, some people like carrying gear up and patients down five story walkups.  Believe it or not, when my career started, I loved it.  I did not think that urban EMS was going to be for me, and did not see myself staying in Springfield, Massachusetts, but it happened.  I spent twelve years there, and for the most part, I really loved it.  I still have a deep seeded love for urban medicine but as the years passed, and as my career progressed, so did my tastes, and what I was ultimately looking for has evolved.  So what does my perfect system need?  What would be absolutely 100% perfect for me?  Here it is. . . 1.  Variety and diversity – I do not just want one “type” of call.  I want a system that can offer me different settings that I can tailor to my mood at that juncture.  I really feel like I have “EMS ADD” that is to say, I am constantly looking to something else, and my moods seem to change often.  Having a system that would provide for that would be great. 2.  Aggressive and progressive medical direction – I want a medical director who is not afraid to enroll in prehospital studies.  I want someone who is not afraid to look at his or her staff and say “what do you think could make us a better system?”  or “what is there that we don’t do well enough?”  They need to be engaged with their medics, and although knowing each and every provider in their system isn’t vital or in some cases reasonable, having an open door policy and being receptive to each and every one of them is, and has to be. 3.  Receptive and engaged leadership – In just about every system I have been...

If anyone ever asked me what the internet was, I would tell them that it is a series of fads.  Ideas, popular websites, and social media networks come and go sometimes at the blink of an eye.  Does anyone remember Myspace?  I didn’t think so. . . There is one fad though that has come about in the last three years that needs to be recognized, and people need to be reminded that it is still there.  While some might say it is not for them, the EMS 2.0 movement actually lives in all of us.  Any EMT or paramedic who has ever said “I think I have a better way to do this” deep down shares his or her beliefs with Justin Schorr, Chris Kaiser, and everyone else who had input into that initial manifesto. I was reminded the other day that although it might be quieter than it was a few years ago, people are still talking and sharing about EMS 2.0.  I was in a uniform shop in a remote town getting fitted for my new threads, and there, in a cabinet with about forty or fifty patches from police departments and fire departments from the surrounding states was an EMS 2.0 patch.  I do not know how it got there, but I do know that it was not from Justin, Setla, Random or myself.  Someone walked into that uniform shop, and said “hey, I’ve got a patch for you.”  And knowing the people that carry those patches and pins around with them, that was followed with “Let me tell you a bit about it.” Currently, the blueprint for the rebooting and redesign of EMS is a simple one.  All we need to do is find what works for our particular system.  Start with something simple.  Explore alternate treatment options, or rethink staffing and response.  Realistically, it could be anything. There are questions to be answered about the future of our profession, and it is our responsibility as the current crop of prehospital providers to decide for ourselves where we want to be in the next ten or fifteen years because in ten to fifteen years, we are going to be...

For the past two semesters, I have had the pleasure of doing the opening lecture to an EMT class at a local college.  This means I get to stand in front of a lecture hall of enthusiastic and often terrified EMT students who have no idea what to expect.  My lecture is called “So, You Want to be an EMT?”  Its purpose is to give the students an idea of what to expect out of EMS both as a career and as a provider.  I do not talk about patient care all that much, the lecture is more about stress management, the qualities that an EMT needs, what calls are really like, and also a generalized 50,000 foot view of EMS. In addition to all of that, I also talk about finding the right fit.  I explain to them that one of the beauties of EMS is if you don’t like the system that you are in, all you need to do is drive down the road and you can find someplace else to start over that might work a little better for you.  In the recent months that has been something that I have had to tackle as well, and it has left me asking myself a simple question: “what is the perfect EMS system for me?”  What I have tried to do is sum it up into five qualities.  Here is what I came up with: 1.  EMS centered – I want a system that is dedicated to EMS.  They need to be focused on patient care and encouraging the growth of their providers.  The focus cannot be on profit, justifying call volume or fire surpression.  It needs to be all EMS all the time. 2.  Horizontal career opportunities – This was a term that I heard Skip Kirkwood use a couple of years ago during a lecture at EMS Today.  The career path in EMS cannot and should not be solely vertical.  There needs to be opportunities for the street level providers to contribute to the organization with steering committees, study groups and assignments beyond the street.  This creates an environment where paramedics are encouraged to be involved with the growth...

With Emergency Medical Dispatch becoming the gold standard across the country we need to remember its limitations while appreciating its virtues.  EMD is far from perfect.  An example of this is the recent call in New York City that was reported by The Daily News where a woman died with an associated 14 minute response from the ambulance crew.  The initial nature, sick and not eating, warranted a non-emergent response, but 8 minutes later, when the woman began vomiting blood, the response was upgraded based on the information received. The public outrage from this fourteen minute response was so severe that one of the EMT’s was assaulted by a family member.  Although being upset does not justify assaulting someone, especially a person who is there to help out your loved one, I can understand to some extent why this woman’s son was as angry as he was. In a situation like this though who is to blame?  Was it the EMTs who arrived as quickly as they were sent?  I’d say no.  Is this woman’s other son who presumably has no medical training the one that we should look to when seeking someone to blame?  Again, I would think not.  How about the Emergency Medical Dispatcher who asked the questions and went off the information given to him or her from the non-medical trained witness to this tragedy?  Nope, wrong again. Although mistakes are going to happen especially in a system as large as New York City’s I think it is actually the FDNY’s administration’s fault that something like this happened. When a person picks up the phone and calls 9-1-1, their expectation involves ambulances, fire trucks, police cars, and anyone else they might want to be racing across the city, lights and sirens blaring coming to help them no matter how major or minor the situation is, and we allow this expectation to continue.  We allow people to determine what an emergency is rather than letting the experts make that determination. The emergency rooms have it right.  If you’re having chest pain, if you’ve been stabbed or shot, or have something time sensitive that needs immediate treatment you theoretically jump as close to...