Have you made the trip to Washington, DC this year for the annual EMS Today hosted by JEMS?  If so, you should come by the JEMS booth on Friday and say hi. Friday morning, and into the early afternoon, I will be there participating in a few podcasts starting at 10am.  The podcast studio will be open and active all day on Friday and Saturday, complete with the social media lounge.  Stop by, say hi, and take in some great...

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...

It’s been quite the week.  I moved into my new apartment about 24 hours before I was due at my first day on the job, and due to circumstances beyond my control, I had no internet access!  Well, a week later, the problem was solved and the interwebs are once again pulsing through the lines in my apartment allowing me to share with you another reflection of what I have experienced over the last twelve years at my “old” job. While having a conversation a few years ago about dealing with low morale, I was told “there is not much that I can do about morale.  It depends on the individual.  It is an internal thing.”  While it might be true that a paramedic’s happiness might be guided by what he or she wants out of a service as an individual, leaders still play a major role in steering and guiding the values of those who work for them.  Simply showing value is the easiest way of doing this. In a field that has been described both internally and externally as having “inexcusably low pay” it is up to “the brass” to get together and find ways other than adding zeroes to someone’s paycheck to let them know that they are an important piece of the team.  Putting forth an attitude of “I give you a paycheck, what more do you want from me?” will do nothing but give a service a good reason to remove their bay doors and replace them with revolving ones because they will see people leave as quickly as they walk in the door. This is a thankless job, and frankly, the statement of “it’s your job” does carry some merit.  We do have a job to do, and we do have people to serve.  “Routine” emergencies happen, and even serious ones that will slip past medical directors, bosses and peers and go completely unnoticed, but it’s not the individual call that people deserve recognition for it is the individual doing the call.  It is the overall performance that deserves to be recognized.  It is the fact that someone is always there to answer the call, 24 hours a...

Nov 26, 2012

Someone can have the ability to make command decisions that steer an organization whether it be large or small but that person is not a leader until they find someone who is willing to follow them.  In the last year and a half, I have written about a few of the incidents that I have been part of, mainly the tornado that hit Springfield on June 1 and the ice storm that we had last year around Halloween.  Just the other day though, I added another one to my list. In the downtown area of my city, we had what started out as a simple gas leak.  That all changed when four miles away, sitting in our office, I heard a loud bang.  The building with the leak exploded with two of my crews only a short distance away.  Thankfully, they were okay, but we were called to action to organize and take care of close to twenty people who were injured.  Everyone involved is still counting our blessings that no one was killed. In moments, the people that I had in the streets started to mobilize.  Crews cleared the hospital.  People in their homes, not 100% sure what had just occurred started to put their uniforms on and head to work.  I took the new supervisor I was training to take my spot and started a ride that felt like it took an eternity down to the scene.  It took about twenty minutes to get organized, get a staging area setup, and to really start getting a grasp on what we were dealing with but once we did, we were ready for whatever would be thrown at us.  The response from the EMS community was amazing.  At peek, we had more than twenty ambulances in our staging area ready to do whatever it took to make sure every patient got out of there.  The unsung heroes though were the fifteen people who showed up at the office who were not even scheduled to be in that day ready to jump on ambulances and go wherever they were needed.  With all of the trucks that we had assigned to the explosion, we were able...

First of all I would like to thank those of you who commented on my post entitled Stress the other day.  There were some great words of wisdom there, and Bob Sullivan from EMS Patient Perspective shared some links to some really good articles. Greg Friese asked what I do to help those around me with stress.  Personally, I feel that as a field supervisor it is my responsibility to have a grasp on the mood of my employees.  That is a daunting task since I have around two hundred paramedics and EMTs, some full time and some part time, working in my service.  I personally need to be able to watch as many of them as I can for mood changes, and when I see them I need to be able to refer them to the places where they can get help. The resources available to them can be as simple as a walk through the garage and a friendly conversation or it could be a phone call to muster up our regional CISM team.  Additionally, EAP is a great route to refer employees to especially if the root of their issue lies outside of work. Most of all, the most important thing that any leader can do for their people is make themselves available to their employees whenever they may need to talk.  This needs to be a team approach though.  I know all too well that I am not the first choice for everyone to come and talk to.  Personalities clash, and frankly, not everyone gets along all the time and they cannot be expected to do so.  Thankfully, there are a number of other people on my management team, and for the most part, most EMS services are not a one leader shop.  If someone says, “I dont want to talk to Scotty about this” that is fine.  I don’t need to be their sounding board.  The important thing is that they go to someone about it. Availability and access.  That is what is most important.  People cannot get help if they do not know where to find it.  My advice to those in the field is to find someone...

Quite often I see some EMS news story come across the wire about how a paramedic neglected to care for a patient as they should, or delayed a response, or in extreme cases were involved in some sort of serious altercation resulting in the injury or a patient, a tech, or their partner.  With every story I read, I get more and more concerned about the state of EMS, and the people who are providing care.   While none of the situations I’ve read about are excusable, I think it is our responsibility to find the root cause, or at least minimize the chance of these incidents repeating themselves.  Personally, I feel that while stress is not an excuse it is a huge factor. As a community it is our responsibility to give each and every provider not only the access to the training that they need to best provide care but we need to police our own to make sure that every provider is fit enough to provide that care. Recently I read a story about a paramedic who was arrested for assaulting a patient.  While there is no excuse for his actions I cannot help but wonder what signs and symptoms this medic showed prior to the incident occuring.  I am not talking about during that shift but more in the weeks and months leading up to it.  When did they start to turn?  When did their attitude really start to decline?  Most importantly, what did anyone do about it to try and turn this person around? A lot of it points towards the question of “how busy is too busy?”  Of course one must also ask if this is the job for them, but the EMS industry is so  focused on a single mission which centers around getting people to the hospital.  While a typical day on the ambulance can offer a large variety of calls, the sheer volume and type of calls can certainly create a stressful environment.  As those days compound into weeks, weeks to months, and months to years, each individual day becomes a contributing factor towards what could eventually become a burnt out paramedic. I have written...

May always seems to be a busy time of year where I live.  Within about a twenty mile radius there are eight different four year colleges and two different two year colleges.  Each weekend seems to be chock full of graduations and graduation parties. This past Saturday I had a chance to go to the pinning for some friends who were finishing up their doctorate in physical therapy.  I am extremely proud of all of them, and although I know they are all destined for great things, I will wish them luck anyway. During their pinning ceremony, a class video was shown featuring comments by each of their professors within the departments.  Everyone had a lot of great things to say about the class.  They shared pearls of wisdom, stories, and reflections over what they saw from these sixteen individuals over the last year.  After hearing what each professor had to say I understood why my PT friends did as well as they did: they had great mentors and role models. Except for one. . . When it came time for the department’s management instructor to share her thoughts, the statements she made on screen was one that stuck with me, and not for a positive reason.  She informed the class that they would go on to be leaders, but then corrected herself stating that “not all of them” would be, and some would just be physical therapists.  Mind you, I am paraphrasing a bit, but I think you get the point. Its hard to believe that the professor of a graduate level program does not understand the difference between management and leadership.  While the two might be closely associated by some, one does not need to be in management to be a leader, and just because one is in management that certainly does not make them a leader.  During my premanagement days, there were many, many “blue shirts” that I would follow anywhere.  Heck, there are still a lot that I would gladly take a back seat to just based on the respect that I have for their abilities which in many ways are better than mine. In order for a person to...

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...

No, this is not an article in favor of bringing back the Super Size to McDonald’s.  What I am talking about is creating a strong base for an EMS organization. What does it mean for someone to grow within their career?  In EMS, for the most part, that refers to any upward movement that someone might have.  For a field provider, that mostly means that they will end up in one of two places: supervision and leadership, or clinical services.  We either lead or we teach.  But is there enough for people who have no interest in doing either of those?  And because we lack options, are we losing people to other professions?  I’ve heard it before: when someone gets that rocker on their shoulder that says “paramedic” the immediate reaction is “I’ve made it.”  Well, why should being a field paramedic be the be all end all for someone who does not aspire for a life with any more upward movement.  It is not a glass ceiling that is holding us back in EMS, its glass walls. Some services have done a great job of developing what Skip Kirkwood refers to as horizontal employment opportunities.  That is to say: there are other opportunities for employees to use their skill at their level that does not require upward movement.  Down at Wake County EMS, they do a large number of standbys for some of the colleges in the area, and offer other options such as bike teams, tactical EMS, an increase in HAZMAT training among other things.  The hope is that it keeps things fresh and new for their field providers and keeps them from becoming stagnant in their current position in the organization. With these horizontal opportunities comes a chance to obtain continuing education credits on topics that were previously not available thus helping to solve the current often point and click or wink and nod status of many (not all) EMS educational opportunities.  Most of all, there is an opportunity to try something new and different.  It promotes growth, outwardly, much like the nursing field does.  Not every RN works in a nursing home, an emergency room, or a doctor’s office.  They...