I posed this question the other day on Twitter: “If you offered your local politicians a lesson in EMS, how receptive do you think they would be?”  I got a variety of answers some more jaded then others, but it really got me thinking: what would I tell them, and what would I want them to take from what I have to offer? When it comes to EMS, many people both in the community and in positions of power have an attitude of “how hard can it be?”  They think if you put two people with a patch on their shoulder in an ambulance and put them on the street, they will pick someone up and get them to the hospital.  That is true if you want mediocre service that provides nothing more than a “point A to point B” relocation for people.  That, in my opinion, offers virtually nothing to the community.  Prehospital response and care is supposed to be much more than that. We have also accepted incorrectly that EMS is a time sensitive business.  Faster is better.  Fast care means effective care.  Not true.  Those of us IN the field understand that despite what some might think, lights and sirens do not always offer a safe response, and while they might get our ambulances there quickly there is little benefit to the patient in most cases.  Sure, in some having someone there in minutes could be life-saving, but those instances do not occur as often as some might think, but more times than not, I feel that as an industry we have the right tools to guide us in triaging emergencies and when we use them the right way, we do a good job of determining which calls need a fast response and which do not.  Contracts and public perceptions, however, have painted us into a corner and ambulances continue to scream from one end of communities to the other lights and sirens blaring. As an EMS provider, I would rather see a highly trained EMT or paramedic standing at my door equipment in hand ready to assess me or one of my loved ones.  I’d rather see an EMT take...

I really need to know: at what point did EMS stop being about patients and start being about providers?  When did EMS become more about justifying jobs than about taking care of people?  And when did scare tactics become an acceptable way of disseminating information to the masses? I am sorry, but I am angry, and I am not willing, as a prehospital provider, to take it anymore.  Preying off of the unjustified fears of others is just plain wrong.  Telling someone that lesser experienced less equipped EMS staff geared towards saving jobs rather than saving lives is the best choice is like telling your kids there is a monster under their bed to keep them from getting up late at night.  Anyone who takes these kinds of action, whether they be a public official, a private company, a fire department, a police department, a union, or anything else should be ashamed of themselves for utilizing such deplorable, unethical tactics. We need to get it through to the public that what is really important to their well-being is that they have strong providers standing at their door when the need for them arises.  A truly efficient high performance EMS system realizes the limitations of each of its participants and compensates for those by emphasizing the strengths of the other stake holders with one goal in mind: the effective delivery of prehospital care.  They are proud of what they do, and they let everyone know it, and most importantly they are not vindictive and manipulative.  They work together as a team.  They stand up for each other and they don’t allow bad blood to simmer or go unaddressed because they realize that teamwork is so important. One of the key goals of anyone employed in any branch of public safety should be to acquire the trust and support of the community.  It is really sad when instead of rewarding that trust with factual information about what EMS is, what its purpose is, and how it is best delivered, some chose instead to prey on that trust, distribute misinformation (sometimes to the point of it being a blatant outright lie or fabrication) all for their own...

Recently, Austin Travis County started hiring EMT Basics to work with their paramedics in order to create more units in the system and reduce what is commonly referred to as “skill dilution.”  But what is skill dilution?  Does it even exist, and should we worry about it? I started my career in suburban NJ, a state that, at the time, mandated that every paramedic unit in the state be staffed by two paramedics, operating out of a hospital or under a hospital’s license as an intercept unit.  In my county there were five paramedic units which grew to six, and eventually seven during the summer months.  Seven units staffed for the entire population of the county.  The medics on the truck would commonly take turns tech’ing calls, splitting the work down the middle.  I must say, and I’m sure many would agree, the paramedics that I saw working over the years for LIFE EMS out of Community Medical Center in Toms River, New Jersey were some of the most skilled providers I have ever seen. As time has progressed though, and I have been exposed to different systems, I see paramedic/EMT trucks more and more.  Call them what you like: P/B; 1-and-1; Medic/EMT, but it is all done with a few ideals in mind: to expand coverage, and to give them more chances at patient contacts.  I wonder sometimes though if it really truly makes a difference, and I also wonder about the consequences. For example: if patient contacts are so important to the ability of a paramedic to be able to provide care, then does that mean that urban paramedics who may see as many as ten times the patients that a rural paramedic sees in a given year as superior providers? And what about burnout?  Those of us who work P/B often have had those days when 75% or even 100% of the patients require a paramedic’s care.  When those days turn into weeks, and the overtime mounts up, those borderline BLS/ALS patients can slip through the cracks.  Running P/P trucks gives a system the chance to have a paramedic at a patient’s side from contact to turnover on every call.  If...

April will mark the two year anniversary of the Kansas City Fire Department taking over primary ambulance response in Kansas City, Missouri and the disbanding of the Metropolitan Ambulance Trust, or MAST for short.  Needless to say, the reviews of Chief Smokey Dyer’s promises to the city have been less than spectacular. The Kansas City Fire Department performance has been riddled with broken promises of service improvements.  The guarantee of faster response times for the city’s residents have not been met which led Chief Dyer to back pedal a few months ago, stating that meeting those response times with his current staffing would be difficult at best.  Basing their response times on nationally set standards by health organizations and the National Fire Protection Agency, Chief Dyer guaranteed an ambulance to each scene 90% of the time in fewer than 9 minutes, a standard that during its years of existence MAST had trouble reaching at times, ultimately leading to its restructuring at one point. While KCFD’s performance has not been as bad as some other municipalities with their 87% response time compliance, the fact remains that a promise for “better service” was made because KCFD stated that they could get there faster than MAST could.  That along with a restructuring that could save the city money, and also save fire department jobs were good enough for the city council to believe the scenario that Chief Dyer had laid out for them.  Now, the Chief is facing the need to cut over $7 million from his budget, which might result in the loss of over a hundred jobs. In May of 2011, I was on the panel for EMS Garage Episode 133, “Dyer Need” where Brad Buck, RJ Stine and I joined Chris Montera to take a look at MAST a year later.  I encourage you to listen to it and get a feeling for where the service was ten months ago, and where we saw it headed. The saddest part of MAST’s demise is it happened because of a false promise: KCFD stated that better response times would mean better service.  When will we realize that in actuality, better patient care means better service?  Far...

As I sat having breakfast and reading through the previous day’s news on the internet, a Tweet popped up on my other monitor from Greg Friese about a news article from the Wall Street Journal with the title of The Ultimate Lifesaver about advances in prehospital care outlining how services themselves are the ones who are driving these changes for their communities.  The article, written by Laura Landro, is part of an ongoing series called “The Informed Patient” and I must say, I am impressed with what I’ve read. The most impressive thing about this week’s article is how much Ms. Landro immerses herself into the EMS on a nationwide level, outlining not only the accomplishments that we have made as an industry but also the challenges.  For example: in a video interview, Ms. Landro states that “If you see one EMS system you have seen one EMS system.” The reporting that often takes place when it comes to EMS is most often based on assumptions.  People do not know what happens in the back of the ambulance (because we fail to educate them on this) so they make it up as they go along.  Because of the fear of HIPAA laws, the view of EMS is often from the outside of the rig, and not where it should be: right from the patient’s side.  Without getting right in there and “gloving up” herself, Ms. Landro has succeeded in getting the right story about what is going on in EMS. Ultimately though, she has called us out in the article.  While a lay person might take a lot of positive from what they’ve read, what she has shown us is the gross disparity of what goes on around the country.  Seattle’s CPR save rate should never be five times that of Alabama’s.  Pro Ambulance in Cambridge Massachusetts should have every resource available to them that the Phoenix Fire Department does on the other side of the country.  The only thing different about a cardiac arrest in San Francisco and Springfield, Massachusetts is the way that we handle them. Best practices, folks.  That is what this article should steer us towards.  We need to look...

How important are response times in EMS?  To most communities, they mean everything.  There is no greater measure of how effective an EMS system is than how quickly an EMT or paramedic gets to the scene of the call. We are, however, barking up the wrong tree.  Lets compare two calls and I will explain where I am going with this: An ambulance company has a required response time of 9 minutes 59 seconds or less ninety five percent of the time.  Medic 1 is dispatched to a single family home on New Jersey Avenue on the other side of the city from where they are posted.  They try the best that they can, but despite their best efforts, they arrive on scene in 12 minutes, almost two minutes after their longest allowed response time.  The crew gets out of the truck, gathers their equipment, and a minute later, 13 minutes into the call, they are greeting their patient and starting their assessment. After transporting that patient to the hospital, Medic 1 is dispatched to an apartment building on New York Avenue.  This time, they arrive on scene in 9 minutes, narrowly making their response time.  They again gather their equipment and start pressing buzzers.  After confirming the apartment number with their dispatcher and having them make a call back, one of the patient’s family members walks down from the fourth floor to let them in.  They start their trek up four flights of steps, and fourteen minutes into the call, they are at their patient’s side.  Given these two situations, which patient got the better service? In situation number one, the crew missed their response time but due to “geography” they were able to reach their patient more quickly than they did on their second call.  On the second call, they provided the service that is expected of them with their 9 minute response time, but their patient waited longer.  Should a question be raised about the second patient waiting as long as they did, the service provider could answer “we made our required response time.” Taking this into consideration, are response times really what matter in EMS or are they this mythical...

On November 1, at 12:01am Pacific time, Paramedics Plus took over 9-1-1 coverage in Alameda County marking the end of a lengthy service by American Medical Response.  I, however, cannot help but feel like AMR got the short end of the stick in the deal. I have read through both of the bids quite extensively, and I must say that from the perspective of Alameda County, they had a strong grasp of what they were looking for, and released a rather detailed document spelling out what EMS means to the county.  Both replies were lengthy and well put together, and in my opinion far exceeded the expectations that were set.  In the end though, the bid came down to one thing: the all mighty dollar. The last piece of the bid called for both companies to submit what they planned to charge for their patients for their services.  Paramedics Plus came in lower than AMR giving them the points they needed to push themselves over the top, and ultimately win them the contract.  Kudos to Alameda County for looking out for the wallets of their tax payers, but I feel like there was too much weight put on this stat.  While most services harp on response times, ALCO shifted that focus to financials.  Their response time criteria was still very strict, and they did a lot to further the quality of patient care provided in the county, but a lot of that feels disregarded to me when I see the weight that patient charges, most of which an insured person would never see, are figured into the equation. It must be understood though that I am a little biased.  I owe a lot to Mike Taigman and his team in Alameda County.  Level Zero was the project that opened my eyes up to EMS on the internet.  A profile of a few of the providers in the county, having seen the movie I was even more excited to hit the streets in ALCO when I had the chance hoping I’d just have the opportunity to run into someone I might already know a bit about.  While I only saw one “cast” member from afar,...

That morning in Dallas, I got to spend about two hours with Chief Skip Kirkwood from Wake County EMS, and boy did it fly by. The interview I posted in that previous post was a pretty good summary of what we covered in the more “formal” part of our talk. From there, the discussion turned to an exchange of ideas and thoughts on where we are at and where we are headed, and if you’re looking for inspiration, look no further than what you can learn from him, and his department in North Carolina. My admiration for Skip Kirkwood started about five years ago. I learned about the National EMS Management Association, and their list serv on Google, and I quickly signed up for both. If you don’t follow the NEMSMA List Serv, what are you waiting for? Its filled with some of the greatest minds in EMS who frequently share ideas and thoughts on the field, and Skip is one of their most frequent and well respected contributors. When he speaks (or in this case writes) people stop, take notice, and listen. I have actually saved many of his emails that I found to be useful, and I’ve shared them with those around me. I’ve closely followed the progress Wake County EMS has made over the years, and I even have a few friends from New Jersey who currently work in his system (who I am very jealous of). To me, Skip Kirkwood comes across as someone who is a fearless, confident leader who expects nothing but the best out of everyone around him, and I don’t see why simply his personality wouldn’t bring that out of people. He also projects himself as a very patient person, eager to share the life and professional lessons he’s gained over the years. I thought the most interesting moment in our interview was his response to the question “What lesson would you like to teach to a new EMT or Paramedic just getting their start in the field?” His response had nothing to do with anything clinical or even operational. It was about their personal well being. “Manage your finances,” he said, “don’t live outside of...

This is a blog post that I intended to put up months ago, but I never got around to finishing. Paraphrasing a sit down interview is something that I really struggled with, but I really feel that not sharing this information would major injustice to our time that we were able to spend with Skip Kirkwood, chief of Wake County EMS in Wake County, North Carolina. I hope you enjoy this two part post, and take as much from it as I did. A little over a month before EMS Expo in Dallas, I was speaking with April Saling (better known to the online community as Epi Junky, the author of Pink, Warm, and Dry) about our mutual admiration for Wake County EMS Chief Skip Kirkwood. We decided that since we were both going to be at EMS Expo in Dallas, and since Chief Kirkwood was also going to be at Expo, that we would contact him and attempt to arrange an interview with him for our blogs. Our hope was that Chief Kirkwood would be able to spare five or ten minutes out of a very busy schedule to sit and answer some questions for us about EMS over a cup of coffee. Well, much to our delight, Chief Kirkwood did one better by inviting us to join him for Breakfast on Thursday, the second morning of Expo. Skip got his start in EMS in 1973 when he was certified as a Hospital Corpsman. He then started his career in EMS and shortly after, he obtained his Paramedic Certification, By the Mid-80’s, he decided that there might not be much of a future in Emergency Medical Services, so he decided to look elsewhere for a career. He decided that the next step in his life should take him to law school, where he obtained his law degree and worked for a large Law Firm in Philadelphia for a few years. One day, while sitting in his office reading JEMS Magazine, Chief Kirkwood came across a Job Listing for the position of the Head of EMS for the State of Oregon. The recommended requirements were a Paramedic Certification and a knowledge of Law. He...

When I was in California, I had three similar conversations with three different crews. It went something like this: Paramedic/EMT — “So, you said you’re from Massachusetts, right?” Me — “Yes I am!” Paramedic/EMT — “How the heck do you work in the snow? What do you do?” My response at first was “What do you mean?” But I realized very quickly that in the Bay Area, dealing with a significant snow fall usually isn’t a logistical issue. I’m sitting in my truck right now writing this as I stare at a five and a half foot high snow bank, which is bound to get higher as in the next 48-72 hours, we might see as much as an additional twenty inches of snow fall dumped on us by Mother Nature. I’ve been in Massachusetts for almost fourteen years, and I can honestly say, I don’t remember a winter being that bad. Keep in mind though, that I don’t completely remember some parts of my college years! For those of you who live in warmer climates, I guess I should give you the rundown of what we do, and what we deal with when things get like this. . . right after I share an inappropriate hand gesture with you, and your “Its warm enough in January to wear short sleeves” weather. 1. Plowing, or lack there of. Over the last couple of years, my service has completely transitioned out of Box Ambulances. Our entire fleet of 35 trucks is now made up of vans, and let me tell you, I’m not that heart broken about that, especially at this time of year. Many side streets in our service area end up being very poorly plowed, and with cars parked on the streets, its very difficult to get a Box Truck down the streets. Even a not-so-experienced driver can park a Type II ambulance just about anywhere. 2. Hypothermia. The heat almost always stays on the back, so that all it takes is a flip of the “Master” switch to get that truck nice and toasty. Crews always make sure their IV warmer is stocked, and sometimes will even add a 1000 cc bag...