The Desk

Please be advised that the video does contain some language which might not be suitable for all viewers. In case anyone hadn’t realized it by now I am a huge fan of the HBO series The Wire.  I think it was one of the best directed, written, and acted shows I have ever seen.  I own every season on DVD, and I think I’ve been through every episode two or three times.  This is one of my favorite scenes, and I feel like it presents an interesting metaphor. Think of the desk as the current state of EMS today.  Everyone has an agenda for it, and has the intention of moving it in the direction that they feel it should go, whether that is where it belongs or not.  The one person who has the knowledge for the desk’s proper destination fails to speak up simply assuming that everyone else around him is already in the know, which they aren’t.  So he starts pushing.  From the opposite side, they start pushing.  More people arrive and decide that they know what is best, they take up their positions and start pushing as well.  What are you left with?  One big stalemate.  No progress. So what’s the answer?  In the video it is simple: everyone needs to shut up and decide as a group what needs to be done, and how to do it the right way.  In real life it is a bit more complicated.  We need a unified direction, and we lack that.  The NFPA sets one standard while evidence based medicine suggests another.  Some preach prevention and proactive medicine while others still insist on code 3 responses by multiple agencies to nearly every request for assistance.  Which is it going to be?  Do we want a fast, timely response or one more gauged towards what is medically efficient? Let’s pick one and stick with it. Share...

The Right Stuff

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...

The Portable Paramedic

In preparation for my quest for the disco patch, I started looking at reciprocity requirements throughout the country and I came to one conclusion: being a paramedic and trying to move is very frustrating.  For the life of me though I cannot figure out why this is. When I went through paramedic school so many years ago, we had a mix of people in my class: there were two of us from New Jersey, many from Massachusetts, one of New Hampshire, and a few from Connecticut.  We went through our Massachusetts approved paramedic class, but not all of us tested in Massachusetts.  A few of my classmates decided to go directly down to Connecticut and test there, as they had no intention of working in an EMS system in the great Commonwealth. Here is how it went: the classmate that I sat right next to who got the same training as I did, took the same tests, did the same amount of field and clinical time drove across a boarder that was less than twenty miles to the south a took a test that was not identical to mine but similar.  Both of us passed.  She worked for a service south of that boarder, and I worked for one to the north of it.  Despite the fact that our training was identical, in order for us to work in each other’s states we each would have more hoops to jump through to again prove our worth as a paramedic. Now, expand that out to a more national scale.  Some states accept certifications from other states as being just as good as certs from their own.  Others only accept National Registry.  Still others feel that National Registry is not even good enough and they require you to come in and take their state’s test.  Still another state on the west coast requires National Registry, a state certification, and then clearance within the specific county you choose to work in if you want to care for their sick and injured. Then there are Oregon and Texas.  Add on to that a minimum of an Associate’s Degree.  While I feel that these two states are right on...

Happy EMS Week!

First of all, I want to say Happy EMS Week to everyone out there.  Your dedication might not always been seen by everyone but the important thing is when you go home, you know that you made a difference. Now, we all need to remember and realize that EMS Week is not just about us. EMS week should be a time to recognize the professionals that sacrifice time with their families, friends and loved ones to put the needs of others above their own.  EMS is a thankless job and although I feel that as I write this blog post I am “preaching to the choir” it needs to be said again: thank you for everything that you do. If your service is anything like mine, you might be left with a bit of an appetite for more EMS Week activities, but my desire goes above the appreciation for the crews.  Although EMS Week was created for us to be the stars we still have a responsibility to the public and we need to use our “15 minutes of fame” not only to appreciate those who go out and “save lives” every day but we need to make sure that we share with those who we serve what we are all about. Let’s put it this way: if you service is not having an open house this week, they are missing out.  If there is not an article in the paper not only talking about the great people working in EMS but also describing the struggles that they overcome every day you are being short changed. I’d like to ask you all to make the most of your EMS Week, but also take the time to educate just one person about EMS.  When EMS awareness increases then so too will the respect that we all receive from those who we serve. Happy EMS Week, everyone! Share...

Interventions Issue 3

This one is for you.  That’s right: this quarter’s addition of Intervetions was written just for you, the EMT, the paramedic, the field provider.  Inside, you will find stories about training, the importance of communication, and my contribution all about stress management. Even though this is a quarterly magazine, there is a lot of work that goes into it.  The goal of the Interventions team is to give you, the reader, as much quality content as we can.  Personally, I think we have once again accomplished that. Thanks to the entire Interventions team for all of their hard work.  And especially, a big thanks goes out to Justin Schorr for his creativity with the magazine’s layout. Without further delay, I’d like to present to you this quarter’s Interventions Magazine.   Up next: The Interventions team will educate those who make the legal decisions that govern what we do: the politicians. Share...

Props to the Wall Street Journal

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...

Interventions Issue 2

This past Monday, issue number 2 of EMS INterventions went “live” on the internet.  Comprised of articles and videos put together by the team at the First Responders Network, the magazine offers a look at what we want from our Medical Directors and what they can do to help us achieve that reboot of EMS, that EMS 2.0 that we so desperately need. I would like to invite you to check out the edition and please share any comments that you might have either on our respective blogs or at FRNMagazine@gmail.com.  Additionally, I welcome you to download and print out the PDF version of the magazine and share it with your colleagues and medical directors.  This is where you, the reader comes in.  Help us spread the word, and help us put EMS 2.0 on the tip of everyone’s tongue. I am very proud of what we have put together, and would like to thank everyone involved in creating the publication for their hard work, dedication, and spectacular content that was contributed.  We look forward to putting together Issue 3, due for release sometime around EMS Today in Baltimore.  Stay tuned for updates in the weeks and months to come! Share...

Equality

Some posts are more difficult to write than others.  This is one of them. Coming from a volunteer background, I have seen a variety of levels of abilities in EMTs.  Some can’t hear a blood pressure.  Others just seem to say the wrong thing at the wrong time.  Some are just plain unreliable, and still others are downright negligent.  Sometimes, people tried to make excuses for these people by shrugging and saying “they’re doing this out of the kindness of their heart.”  That argument never seemed to hold much water to me. I came to the conclusion early in my career that not all EMTs are paramedics are created equally.  This should not be anything anyone considers earth shattering, some people is better at things than others.  As an industry though we seem to have taken this “all for one and one for all” mentality and it is hurting us. “A paramedic is a paramedic, and an EMT is an EMT.”  Have you ever heard anyone say that?  Unfortunately, if they don’t say it, many people think it.  There is no differentiation between a good provider and bad one, and there needs to be.  It is time to work with those who might not be cutting it.  It is time for them to get on the bus or move on. How much of the problem comes down to our reluctance to be educated?  Our view that continuing education is the two or three year grind that we have to do.  I think many providers might get a decent education under their belts right out of the gate, but once the reeducation or discovery of new educational opportunities is put in the hands of the “responsible” provider, we fail.  Miserably. But I digress. . . The first step to dealing with someone who is not cutting it is to correct them.  Be blunt about it.  Let them know that they are not getting the job done and show them the right way to do it at the right time: away from the patient.  Let them know what they are doing wrong, and tell them, no, show them how to do it the right way. When...

Goodnight, ALCO

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,...

Occupy EMS 2.0

Over the last month, I have been trying to follow the Occupy Wall Street movement.  I say “trying” because I have a tough time figuring out what their unified message really is.  Their communication attempts with the public have been highly ineffective and fractured.  No one seems to want to speak for the group, and all that seems to keep coming out is “down with big business!” Ironically, most of what I have read has been via social media through Twitter, Facebook, and YouTube.  I must say, I find it rather amusing to see someone send a Tweet out about how bad corporate America is, and on the bottom of the box on Tweetdeck, it reads “Sent via Twitter for iPhone.”  That’s right: this person who is bad mouthing corporate America is paying a monthly bill to it to be able to share their message. Change takes time and efforts.  One Tweet I saw that I found to be particularly interesting was one that read: “I was promised a job, go to college, get a job is the promise, I did my part.”  If a person wants real accomplishment they cannot sit back and expect it to be handed to them on a silver platter.  There is a certain level of personal responsibility that comes along with it and sometimes things take a little more work than expected.  You cannot always expect people to meet you half way.  Sometimes, you need to go a little farther. Much like Occupy Wall Street, EMS 2.0 is a grass roots “bottom up” movement spearheaded by street providers to try and enhance their ability to do their job.  I think that there some important lessons that those of us who are invested in EMS 2.0 can take from what I feel are some glaring failures of the Occupy Wall Street movement: 1.  Have a message — Don’t just blindly demand change.  Know what you are asking for, and have someone who is willing to step forward and speak for the group.  Show your numbers, but have a plan! 2.  Don’t demand change, make it — Far too often, we look at those around us and above us and...