For the last couple of days, I’ve been reading a lot about the changes that have happened in Detroit, regarding their responses to EMS Calls.If you want to see a great summary of how it is working, check out RJ Stine’s take on it over at Hybridmedic. I’m not going to get into my views on tiered responses, and Priority Dispatch.Do I think its the right thing forDetroit?Honestly?I don’t.I think they have bigger problems to solve systemically that has nothing to do with putting more of their leadership on the chopping block, but for me to sit here and bad mouth what they are doing from 500 miles away just isn’t fair, so I am going to reserve my right to share my opinion until things progress a little more. I realize that I might have been very critical in the months that closed out 2010, and it was because all that I was hearing from Detroit Fire’s hierarchy was excuses and half hearted solutions to problems.Brainstorming, and tossing ideas around the table is one of my favorite things to do, but when you have the ear of the people who can make those changes happen, and you don’t take advantage of it, it just turns to lip service.That’s all that I was hearing from the previous leadership of Detroit Fire: lip service. I have decided to turn this post into positive words for the new leadership ofDetroit Fire.Why am I applauding them?Because without really saying it, they’ve admitted that there is a problem, and they’ve taken a step towards fixing it.Romewasn’t built in a day, andDetroit’sEMSproblems won’t be fixed overnight, but showing the willingness to change how things are done is a giant step in the right direction. Now, my advice to them as they progress is to continue to embrace change as an organization.Everything you try might not work the way you intend it to.Don’t get discouraged.Carry on with what works, and learn from the mistakes that are bound to happen.In time, you will find the formula that works perfectly forDetroit, and being fluid and willing to evolve over the next year or two will make that happen a lot quicker than...

Battle On Over Emergency Response Vs. Emergency Caution – Jackson News Story – WAPT Jackson Jackson, Mississippi is back in the news, and Councilman Kenneth Stokes is at it again. Take a look at the video that I linked above, and reread my previous post on this issue. Why doesn’t Kenneth Stokes see what the problem here really is? Its not faster ambulance response, its a larger police presence. The question at hand is should an ambulance respond into a potentially dangerous scene until it has been secured by the police department? My training and my gut both tell me NO. Kenneth Stokes recommends bullet proof vests for AMR’s staff, but a vest isn’t a magical suit of armor that will keep you safe. The right angle to take of all of this is to promote safety at the scene. Bulk up Jackson’s police force. If the city is that unsafe that this has become so much of a problem, make it safer. Expecting AMR’s Ambulance staff to do some of the police’s work for them is unfair, and it puts more people at risk. But, remember, that would cost tax dollars. Its much cheaper to drag the Ambulance Company through the mud, encouraging them to drive into potential “war zones” and put themselves in the line of potential danger. I looked up some information about Jackson, Mississippi. It ranks 4th in the nation for homicide rates per 100,000 residents behind Baltimore, St Louis and New Orleans. In 2009, it was ranked as the 23rd most dangerous city in the United States. If anything should scream for a larger police department, that should. It doesn’t give Jackson the portrait of being a safe city, or a safe place for EMTs and Paramedics to work. What Councilman Stokes is doing is making it more dangerous for the Paramedics and EMTs in Jackson, Mississippi. He’s setting them up so that each time they walk into a scene after the police department, the perception could be “What took you so long?” Every time a truck is posting in a parking lot, or waiting for police to arrive at the scene, it will spark the question of “What...

Think back, if you will, to the first EMT class you ever took. It might have been a few months ago, or for some folks, it might have been 20-30 years ago. Now, think about what they taught you about your own safety, and what is most important when you hit the streets. Lets take it a step further. Think now about any EMT Practical exam that you’ve taken, whether it be for your EMT-Basic certification right on up to your Paramedic. Lets take the Assessment station. You walk into the station, stethoscope around your neck, with a State or National evaluator sizing you up and staring you down. You look over your station, and indicate you are ready. Your evaluator looks at their sheet of paper, and begins reading the same scenario that the person before you most likely just heard. It could be a car accident, a shooting, or something as routine as a fall, abdominal pain or a chest pain call. Regardless of what the nature of the “call” is, you take the information in, and start your station the same way. “Scene safety, BSI, number of patients.” You might use different terms depending on where you’re at, but the intention is always the same: Is the scene safe for my partner and I to enter? Do I have the necessary protective equipment on? Do I have the resources I need initially to handle this incident? Now, keep that in mind, and read this article that has made its way around the internet: http://www.wlbt.com/Global/story.asp?S=13191657 Take a moment to compose yourself, pick your jaw up off the floor and stop screaming at your computer. I’m sure you’ve already asked out loud, “What is this guy’s problem?” AMR has not written a policy that needs to be changed, the responding crew followed their training perfectly, and did the right thing by not putting themselves in a dangerous situation. If any other Ambulance service, Private, 3rd Service, or Fire based told their crew to just rush in there, I’d question their devotion to their Field Employees. Tim Noonan over at RogueMedic.com has said it better than I could have. The blame here has been...

I sat down last night and watched Chronicles of EMS again and realized that there is an EMS system operating right under my nose that just might be the perfect EMS system. Let me tell you about it: It is a fully functional ALS transport system which staffs both ALS and BLS and usually has 6-8 people on duty on any given day. The population served fluctuates from around 10,000 people to as many as 25,000 people and covers an area that is about 5 square miles in size. It serves both the young and the old, the rich and the poor and has a decent sized migrant worker population. In 2009 the service had nearly 4,000 patient contacts and, are you ready for this? It only transported 100 patients. Average response times to all calls is under 7 minutes and it drops to under 5 minutes for higher priority assignments. Severity of the calls ranges from bee stings and knee scrapes go trauma activations, cardiac arrests and STEMIs. There are a number of different patient pathways available to the paramedic who has a large influence of the final disposition of the patient. They include: -Ambulance transport to an ER -Private vehicle transport to an urgent care facility -Monitoring of a patient and then releasing them back into the public -Treat and release of minor injuries -And reevaluation and continued care of prior injuries. When a patient IS transported they have access to ALS care and there is no charge for the ambulance service provided. ER services still need to be addressed but the ambulance services are completely free of charge. When the staff isn’t taking care of patients they turn towards preventative measures to help the community they serve. This includes auditing the safety and durability of buildings roads and attractions, and conducting free CPR classes to insure that as many people as possible are certified at the laypersons level. I’m sure by now you’re saying to yourself “come on, Scott spill the beans! Where is this EMS Utopia?” okay I will tell you but you’ll never believe it. It’s actually at my part time job at the New England branch of a...

While discussing EMS Issues over my first crepe breakfast, the focus of the conversation between Jeramedic, MsParamedic, and myself briefly turned to howEMSis viewed and measured in the prehospital setting.How are we evaluated by the people who monitor our performance? Jeramedic remarked that, “For a lot of departments, and for a lot of decision makers, if an ambulance gets to somebody’s house in a reasonable amount of time, and they end up at the hospital, that’s a successful, efficientEMSsystem.”All three of us agreed that this was a very poor measure of how good we are at our job.Its like saying that when there is a fire, all that matters is how quickly we get a fire truck there.Once they’re there, they can stand there and watch the place burn to the ground, but it doesn’t matter because they got there! Police Departments can hang their hats on arrest numbers and crime rates.Fire Departments can measure the number of actual fires they have, and other factors such as inspection results, smoke and CO detector compliance, and loss of life from fire.InEMS, The focus simply on that first ten minutes of a call.Are you making your response time compliance?If so, how far under the bar are you?Whatever happens between the arrival at the scene and arrival at the hospital is mostly overlooked.The reason for this is its very difficult (unless we are talking about ROSC) to measure the performance of anEMSsystem within that time frame.Clinical measurement is based on success rates of skills such as IV attempts and ET attempts, and subjective QA/QI. A Paramedic friend of mine brought her 4 year old son with her to some of her skill practice session prior to testing for her State certification.She was able to teach her son how to intubate a mannequin, and if she let him play with sharp things, I’m sure he could have learned how to establish an IV as well.Those skills can be taught to anyone, and are a poor measure of the ability of a paramedic.That doesn’t make them unimportant.Those skills are a vital piece of the treatment we provide, and we have to be good at the to be successful.The point...

  Before I get to the meat and potatoes of this blog I feel I should firs clarify a few things. The fire departments in this country are staffed by some of the hardest working most highly skilled professionals I’ve had the pleasure of working with.They risk their lives everyday, and put others before themselves without a second thought.If I could shake each of their hands and thank each of them personally for that I would. Their job is a very important one, and they are an essential piece of the Public Safety model in this country. Over the past 30 years, Fire Suppression and more importantly Fire Prevention has greatly improved nation wide.Fires are down almost everywhere you go.Fire inspection regulations and building codes have become more strict.Fire Fighters are better trained and better prepared to do their jobs than they ever have been.They have achieved their desired result: less fires.Now, with less fires, the question that comes up is “what do we do with all of these fire fighters?”You now have all of these municipal employees doing so much less work at higher wages than they’ve been paid in the past.The result: find more work for them or lay them off. None of this should be viewed as the Fire Departments’ fault.The blame should be placed (dare I say) on our local and state Politicians who stare at spread sheets all day and worry about the all mighty dollar.Lets face it, if Fire Prevention wasn’t what it is, and Crime was instead exponentially down, Ambulances would be driving around with the words “Police Department” on the side of them.The Cash Cow that is the ambulance business would be moved to which ever department was in the bigger budget crisis. Getting back to the problem at hand though, the answer to budget shortfalls has been simple for many departments: Respond to Medical Calls, either in a first response capacity or take over the ambulance.Lets face it, Ambulance runs mean volume and money.Money means jobs.Its a no brainer, right? Wrong.The result in some of our largest cities has been to put a band aid on a sucking chest wound.Take a look at these examples...

Last Month, the Canadian Government took the first step towards what they refer to as an increase in Labor Mobility: they are going to be standardizing the certification, assessment and recertification of Paramedics on a national level.According to the Canadian Government this is being done to make it easier for Paramedics to move throughout the country, and work acrossProvidencelines.Canadaestimates that more than 200,000 of its citizens relocate to a differentProvidenceeach year.These actions will make it easier for Paramedics to move around, and seamlessly transition from job to job. You can read the whole article here: http://news.gc.ca/web/article-eng.do?nid=511429 What was probably looked at by the Canadian population as a small step towards improving the country’s economy, it should be looked at by theEMScommunity as a big move towards unification of our industry. The EMS Leaders and Lawmakers in our country should take a good hard look at what is taking place north of the boarder and take notes.Our community has numbers, in the Public market, the Private market and still in parts of the country in the Volunteer market and uniting those people could be what propelsEMSas a whole to the next level. The things I need to practice medicine in my urban setting might not exactly fit what is needed by a rural Paramedic in the far reaches ofMontana, potentially an hour or more from the care that is needed.So how should a unified National EMS Front work?Well, from a regulatory standpoint, this is how I see it: The National EMS System would be broken up into four levels, National, Regional, State, and System.Providers would be governed by the National, Regional and System levels, and services would be monitored and dictated by the National, Regional, and State levels. 1.Certification, recertification, and core training should be standardized on a national level.The didactic, field and clinical portions of EMT and Paramedic training should be the same inArizonaas it is inMaine.This would, in theory, give every provider the same base education. 2.System qualifications should be determined by the system’s Medical Director.You are, after all, working under their license.They can determine required training needed above and beyond the CEU requirements setup nationally. 3.Protocols should have a set core at...