The Response Time Debate

The Response Time Debate

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...

DC Fire and EMS from a STAR CARE Point of View

Back in September of 2010 when this blog was still in its infant stages and living on Blogspot, I wrote a post about STAR CARE, which I described as the “magnetic north of your moral compass.”  In light of the recent events in Washington, DC (say it with me folks: WHICH ONE?!) I want to take a look at the decision made by Lieutenant Kellene Davis that led to her granted retirement and dodging of department discipline. For those of you who have spent the last couple of months living under a rock, or just recently have been introduced to the wonderful world of the internet, Lieutenant Davis was the officer in charge of Truck 15.  To summarize, and keep the story short, she failed to act when 77 year old Cecil Mills had collapsed across the street from her fire station.  He eventually died.  While we cannot be sure that a response by Truck 15 would have saved the man, what we can be sure of there was no action taken. Now, Dave Konig was quick to point out to me that STAR CARE is an EMS tool and not a fire department tool, but DCFEMS is an EMS provider, so STAR CARE can and should apply to them as well.  As the commanding officer on Truck 15 that day, the responsibility ultimately rests on her shoulders, or at least that is what DCFEMS wants us to believe, so looking at her actions seems to me like the appropriate thing to do.  Let’s take a look at this and see how Lieutenant Davis did. S: SAFETY This was an unknown medical, so looking at it from the most positive side of things, she did not send her crew into danger or allow them to cross a busy street. T: TEAM BASED By preventing her crew from acting, she did not allow them to serve the purpose that the crew was deployed to do which is protect the people and property of Washington, DC. A: ATTENTATIVE TO HUMAN NEEDS I doubt that Lieutenant Davis would want a medical emergency experienced by herself or a member of her family with the same disregard that she...

The Butterfly Effect

    LEVEL ZERO – The Movie from Thaddeus @Setla on Vimeo. Yesterday marked the four year anniversary of this blog, and what a ride it has been, and sitting here in a completely different system in a different state with different friends and colleagues around me, I cannot help but reflect back at how crazy this journey has been.  For me it all started with a trip to California provided to me by AMR, and a few conversations out there with a few paramedics about a little movie called Level Zero that I had stumbled across on the internet. For those of you who have read through the posts of this blog, you know where it went from there.  I started writing.  I connected with Ted Setla and Justin Schorr.  The EMS 2.0 logo and pin were created.  I came out of my shell and found a love for teaching and now, four years later, I am still at it. The road has not been without bumps, and times have not always been easy but ultimately I could not be happier about where I landed.  I wonder sometimes what i would be doing had Mike Taigman not reached out to the east coast for help, or had I not gotten a ride down to one of the southern hospitals in the county from one of their Clinical Specialists.  Any little turn in that road could have changed everything.  I was lucky though.  I have come out of this four year rollercoaster with some great friends who I would not trade for anything.  I have had a little hand in sparking change in my old system in Springfield, and still love following their accomplishments even now, over a year after I left.  I’ve sung Karaoke with people from EMS World and EMS Today.  I’ve sat down and interviewed a man who someday I hope to have a shred of his ability to lead.  Justin Schorr’s number is in my phone, although I don’t talk to him nearly as much as I’d like.  I’ve lobbied on Capitol Hill.  I’ve hosted a podcast that I used to listen to and wish that maybe someday I would...

Spare Some Change?

This post can also be found at TheEMSLeader.com With EMS Today right around the corner, I got thinking the other day about the past conferences that I have been to.  This year’s gathering in Washington, DC marks my ninth consecutive major conference that I have attended.  I’ve been to Baltimore three times, this will be my second appearance in DC, Las Vegas twice, New Orleans, and the first conference that I attended back in 2010 in Dallas. That year in Dallas, Had quite the opportunity drop in my lap.  One morning, I had the chance to sit down and interview a person who I very quickly came to admire because of his involvement in the National EMS Management Association, Skip Kirkwood, who at the time was the chief of Wake County EMS.  Even before I had a chance to meet Skip the words “Well, in Wake County. . . ” were a constantly used phrase in my vocabulary.  I admired the changes and strides that they had made in their quest to provide the best possible patient care for the residents of Wake County. More than that though, I admired Skip’s approaches to problem solving.  For years to follow, presentations that I have given have involved little pearls of wisdom that I have obtained at the hands (and fingers) of skip over the years from e-mails and posts that I have received from him, so while I had a long standing admiration for Skip, having the chance to sit down with him as a captive audience and pick his brain was quite the opportunity for me. One thing that stood out to me was how he approached change and progression in Wake County.  As I read about his service it was clear that things always seemed to progress quickly there.  Skip’s answer to me was that he always promotes an environment that is comfortable and welcoming to change.  He wanted his people to be ready to walk in one day and find a new piece of equipment, or a new policy change.  By doing this, when major changes were rolled out his staff was more welcoming and willing to adapt. I cannot tell you how...

Some Thoughts about EMS Week

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. ...

Advocacy: It’s That Time

Another year has gone by, and it is time for the third annual EMS on the Hill Day!  Unfortunately, I am not going to be participating this year, but that does not diminish the need to stress the importance of advocacy not just this week, but year round. There are decisions that need to be made that are not made by EMTs, paramedics, or their services’ leadership.  They are championed, led, and voted on by senators and congressmen who act largely on their gut, and information given to them by their staff.  It is our responsibility as a community to make sure that they are getting the right information.  While year-round advocacy is vital, EMS on the Hill Day gives us a chance to take Capitol Hill by storm and share with them in one unified voice to talk to our representatives and lawmakers about issues that are important to us and our future. Take a look at this video from NAEMT about last year’s EMS on the Hill Day.  And yes, that’s me. Share...

848810

I have been wracking my brain for the last week as to what to put up for my 200th post.  Yes, folks, this is it.  Number 200.  It has taken almost three years, but it is quite an accomplishment if you ask me. As I take a look at my current career, I cannot help but reflect back on where I have been.  2013 is a year of new experiences for me.  I’m in a new service with new protocols, and new opportunities.  It took me a while to figure out where I wanted to land, and if you had asked me a year ago, I would have told you I was content with where I was.  I might not have been overwhelmingly thrilled with it, but I was content.  The last six months though was like writing on the wall for me that it was time to move on. Fifteen years ago in January of 1998, I tested for my second EMT card.  I had gotten my New Jersey certification a few years prior, and the fall of 1997 found me enrolled in my second EMT class.  I decided to retake the class to refresh myself, because I had the option of trying to get reciprocity and testing out.  By February of 1998, I got that envelope in the mail, the big envelope. In the state of Massachusetts, when a person gets certified as an EMT they are given their own certification number that will travel with them for their career, barring them doing something like forgetting to recertify.  The number on the card that I got in the mail that day was 848810.  Two and a half years later when I got my paramedic card in the mail, it had the same number, 848810. The recertification process in Massachusetts is not an easy one.  Well, from the provider side of things it is not too bad.  A paramedic needs to do 24 hours of continuing education and a 48 hour approved refresher class every two years, and then send all of their recertification in along with a check made out for way too much money via US mail (certified mail if you’re...

Looking Back at 2012

As 2012 wraps up, I spent a little time looking back at my posts from this year.  It was a turbulent year for me, and although real life tore me away from the blog a bit more than I wanted it to, I still did my best to keep it active, and I think I had some great posts in there. This was a year of change for me.  The working environment that I was in changed drastically, life changed drastically, and I decided that in order to best respond to that I needed to find a new place to call home, and a service that was a bit more in line with what I believed in as a paramedic and more importantly, as a person.  While certain aspects of my life are still working themselves out, I still feel that mission was successful.  Anyway, on to the posts. “Bad Publicity and Saving Face” – No post that I made in 2012 stirred things up more than this one.  I saw more than 6,000 visits to my page as a result of it, and got a number of comments both on the blog and over on Facebook.  It is all about a controversial article that, of all places, was written in a college newspaper.  It is a gut check for everyone out there who has ever told someone what being an EMT is all about, and it is a reminder that our profession follows us into each and every social circle that we put ourselves in.  Check it out, and see what everyone had to say about it.  Then, read the follow up to the article here. “What Would You Do?” – Sparked by a conversation that we had in the office at my part time job, this post was about a sticky situation involving a DNR, and a patient who did not want to be around anymore.  Legally, morally, and ethically, each opinion might differ from the one before it.  There are some great comments in this post. “Officer Gene Cassidy” – Everyday, police officers, fire fighters and paramedics make sacrifices.  This past June, an officer in the city I used to work...

EMS 2.0: Do Not Lose Sight

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...

Saying Goodbye

My career at AMR in Springfield came to an end this past Monday night.  I was going to put up a post about my last shift, trying to take all of you through my night step by step, but it was a pretty “ordinary” night for the most part.  There were a few goodbyes sent, a few coffees shared, but all in all, the only thing that made it memorable for me was the fact that it was my “swan song.”  My twelve year career came to a close at 6:30am when I punched out for the last time, took a deep breath, and walked out the door. The rest of my week was spent catching up with friends both new and old to say one last goodbye.  I was humbled and overwhelmed by the turnout at our local watering hole of people who showed up to say one last goodbye and share a beer or two.  Or three.  Or maybe four. I have to say that if anyone is ever in Western Massachusetts and you’re looking to enjoy a beer, O’Brien’s Corner in Springfield is the only place to go.  I’ve had many a beer, a lot of breakfasts and some great memories that were created just by pulling up a stool to the bar. Thursday night was my time to say “see you soon” to some folks from my part time job.  They gave me this great picture as a going away present.  I don’t normally work through the fall so I have not been present for many of the group pictures that they’ve taken from year to year.  Their response was to photoshop me into the picture.  Well done guys! The house was completely loaded into a UHaul Thursday night, and Friday I made the move south to my new “headquarters.”  The unpacking was done, a stop was made in New Jersey, and right now I am in my dad’s car typing away as we roll across the Tapanzee Bridge about two hours away from Springfield.  I’ll make one last stop there, pick up some precious cargo (the cat) and head back south for my four hour trek.  Monday I start...