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...

For the last couple of months, the term Personal Responsibility has become one of my favorites.I think it’s the answer to many of the questions that we ask day in and day out not only on the streets as we take care of our patients, but in life in general. I constantly struggle with how to provide effective QA/QI and where Chart Review falls into that whole mix.Now, I haven’t done a ton of Chart Review in my day, but I’ve read some truly bad ones, and I’m sure I’ve written my share of less than desirable charts in my day, but does it go without saying that a poorly written chart means substandard care was provided?I don’t think that is always the case.A strong argument could be made that the quality of the chart written can be a direct reflection of quality of care, just like the cleanliness and readiness of one’s ambulance could indicate the same, but ultimately, what is a Patient Care Report? That PCR isn’t just the picture that we paint for those that we turn care over to, or those that review our charts in the Chart Review process.Ask yourself this: Do you think James Patterson, Stephen King, or your favorite author could write an effective chart?I’d say they could probably paint a pretty clear picture of what happened.Does that mean they have the patient care to back it up?Absolutely not. Effective documentation shows a person’s ability to tell a story and craft words.Don’t let the term “Craft words” confuse you.I’m not saying that people are not truthful, because I have a lot of faith in the people that work in this field.I think that a majority of the time, what is documented is an accurate account of the call, but we need to start looking at patient care beyond the chart, and beyond the capacity that an English Professor, or a Math Teacher would look at it from. How do we do that?Well, that’s the difficult question.When practicing medicine in the pre-hospital setting, we often act alone, in the back of an ambulance, or with one other knowledgeable person present to help us.Random visits on calls by Supervisors,...

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...

CareerCast’s Best and Worst Jobs of 2011 have been released, and guess where Emergency Medical Technician ranks?That’s right, number 195!The career I have chosen is the 6th worst in the country. CareerCast evaluates the jobs based on Work Environment, Stress, Physical Demands, Hiring Outlook, and Income.If you’re interested in seeing their full methodology, its right here. I took a closer look at our score, and how we stood up against some higher ranked jobs.Our Work Environment score is comparable to that of a General Practice Physician, which is ranked #83.Job Stress is similar to that of a Lawyer, ranked #82.Our Physical Demands score is about the same as Heating and Refrigeration Mechanics, who are ranked #93, and our Hiring Outlook is better than the #20 ranked job of Economist. Where do we fall short?Its really no mystery: Income.As I perused the articles that accompanied CareerCast’s report, I stumbled on a great quote from Andrew Strieber in his piece about The Ten Worst Jobs of 2011: “. . . jobs like EMT have considerably better hiring prospects (than the others at the bottom of the list), but rank in the bottom 10 due to harsh working conditions, high stress, and inexcusably low pay given the extremely important nature of their work.“ Let those last couple of words resonate for just a few seconds: “inexcusably low pay given the extremely important nature of their work.”Mr. Strieber gets it.While his words are alarming, and spell out the struggle of our profession, its refreshing to me to see someone in the media voicing a concern with how our profession is treated, even if it is just an excerpt out of a Paragraph.So how do we fix it?How do we move forward in improving our profession, and moving up on the list? Its time to focus on establishing a united front as a profession.Once we come together, and take control of our own fate, we can improve so much of what we do, not only for ourselves but for our patients as well.For now though, we are left to be the pawns of the Public Safety and Medical communities. What’s the first step in getting out of this rut...

I was visiting with one of our Educational Coordinators the other day, and I noticed this cartoon drawn by Paul Combs who you might have heard of over at The Happy Medic’s blog. Now, how does that cartoon make you feel?Do you have a little chuckle over it?Its very well drawn, and rather amusing, but to me, its quite alarming, and it defines our struggle pretty accurately. I fall short of saying that its the perfect depiction of the struggle of EMS because I would make one change to it.The yoke and egg whites would actually be money.Isn’t that really what it comes down to?Isn’t that really what is holding us back?Everyone is worried about getting their hand in the cookie jar, instead of worrying about what is truly important: the patients.Until that changes, we will continue to struggle, stay stagnant and fail to evolve Think about it: we are seeing abuse in every size and type of system, and if we redesign them to reduce transports, what does that mean?Less income.It will be very difficult the reduction of revenue flow in any service if you can’t supplement it from elsewhere.Municipal services such as Fire or 3rd Services use it to reduce their necessary tax basis.Private services use it to keep the trucks on the road, and the stakeholders happy. Simply put: money makes the EMS world go ’round. It shouldn’t matter if you get paid for this or you do it as a volunteer.It shouldn’t matter if you park your truck next to one that has hoses, or a police car, or another unstaffed ambulance.If you want the real answer to the question “Who does the best job providing prehospital care to the sick and injured?”it was best put into words by Michael Morse, author of Rescuing Providence: “An EMS system staffed by trained and motivated individuals is the most effective way to deliver quality patient care to the community.” I admit that I am taking his words out of context.At the time, he was talking about how efficient Providence Fire is at handling the EMS side of things in their city, but that sentence could be applied to any EMS system in...

There are a lot of good clinically focused blogs out there on the Internet, and mine certainly isn’t one of them. That’s not to say that I don’t feel I’m a sound, clinical paramedic, because really I do, I just don’t write about the medical topics. “Being a provider” and the challenges that we face as an industry interest me more. I do, however, feel the need to talk a bit about Quality Assurance and Quality Improvement and what they mean to me. I came from very humble, small EMS Beginnings. Growing up in Suburban New Jersey, most of the BLS 911 work was done solely by Volunteers. While my clinical experience was great, my knowledge that went into documentation and the feedback that I saw from it was almost non-existent. Although we would provide what I felt was excellent care, when we got to the Emergency Room, it seemed to me that the care started over. Run forms that were written were poorly written at best, some as short as one or two sentences that attempted to sum up the events that led to the patient landing in the ER. Fast forward now a few years to my freshman year of college. I didn’t know any better from what I learned in New Jersey. I thought that was “the way” to write a run form. I participated for four years in our Campus EMS Department, and in my freshman year, our advisor brought in a Lawyer to review our run forms and let us know how we were doing. I’ll never forget it; mine was one of the ones that ended up on the overhead projector: “Patient fell during a flag football game and injured his ankle. Patient refused treatment.” That was it. Two sentences and I was done. There I sat, a young 19 year old EMT, raked across the coals by a lawyer pointing out all of the problems with documenting like this. I quickly learned my lesson, and put 100% into my documentation, both at college and at home in New Jersey. Now, here I am, 13 years later, working in a busy urban system as a Supervisor and ten...

Imagine its late in the afternoon. You’re home doing some chores around the house, and you look outside, and notice smoke coming from your garage. What’s the first thing that you do? Pick up your phone and call 911. Somewhere, a dispatcher presses the magic buttons, and a Fire Department is en route to you. What would your reaction be if the Fire Department said “Nope. We’re not showing up.” What would you think as you watched that fire spread to your house and consume all of your possessions? I’d be pretty angry. That’s exactly what happened in South Fulton, TN last week. For the full story, take a look at this link and come on back. FireNation.com Article What it comes down to is this: A family lost their home, their pets, and all of their belongings over a $75 subscription fee that was unpaid. I’ve seen many different view points about this as I’ve surfed the Blogsphere this morning, and some of them really bothered me. There are Firefighters out there who stood up applauded saying that everything went just as planned, and rules are rules. My question to them is: Why are you a firefighter? Why do you do the job? Thats right. I’m questioning your integrity, and your willingness to do what you pledged to do. I have no experience as a firefighter. ZERO. I am very content standing outside of the burning building, so I’ve never walked in your shoes. I have, however, been to many, many fire scenes, and I’ve never once heard a firefighter ask “I wonder what kind of home owner’s insurance these people have.” They are there to help, and do what they have to do to put the fire out and save both life and property. With the help of some twitter friends, some research about the South Fulton Fire Department was done, and here’s what we came up with: The Department is staffed by approximately 20 Fire Fighters, only one of which, the Chief, is full time. The rest of the Department is Volunteer. They have five pieces of Apparatus. Two Pumpers, one Tanker, a “Command Unit” and one Brush unit. Finally, according...

An employee walked up to my window this morning to pick up his gear before going on the road. We engaged in some small talk, and before he left, this was the exchange that we had: Employee: “Hey, EMS 2.0!” Me: “Where did you hear about that?” Employee: “(My partner) told me about it.” Me: “Wow! Who told her?” Employee: “Its out there, man. People are talking about it.” Our conversation shifted briefly to some of the movement’s origins, and then he was off to start his day. For those of you who know me, you’ll realize that rendering me speechless is not an easy task. This employee was almost able to do it. All it takes is telling one person a day about what EMS 2.0 is, and what it means. They will take care of the rest. People are talking. People are taking notice. People want to listen. People want to...

As you remember from my last post, recently, I have seen an increased interest in a lot of the blog posts and articles that I’ve been sharing with some of my coworkers. Now, here I was on a Sunday evening with our Training Coordinator sitting in front of my computer. I went straight to http://www.levelzeromovie.com Ever since Ted Setla released his documentary about Alameda County EMS, I’ve been trying to find some way to work it into sharing it with as many employees as I could. He paints the providers in the movie as true professionals who love their jobs. Their messages and words of wisdom are so powerful and should be heard and understood by anyone who is trying to get into this field. After showing him the Level Zero trailer, I told Dave that I thought that this would be a great way to spend 20 minutes of our New Employee Academy. He liked what he saw, and liked what he had heard, and told me that if I could get him access to it and permission from Ted to use it, he’d be happy to include it. Well, 20 minutes later, after a brief conversation with Ted, I had everything lined up and ready to go for the premier of Level Zero at my company. Monday morning, I was still handing out a few copies of Steve Whitehead’s Blog Posts. People were reading them and saying, “Wow, yeah, that makes sense.” Or “that’s the exact problem that we’re having here!” Eyes were starting to open. At 9am, I walked into our daily management meeting, laptop in hand. After we had gone through the regular business, I looked at a few other members of the management team. “Can I borrow you guys for 20 minutes?” Three of them agreed to stick around, and I fired up my Netbook, and started streaming Level Zero for them. To say that the reactions that I got from them were positive would be an understatement. Not only were they impressed with the quality of the production, but they loved the message behind it all. They loved how the providers were portrayed not only as EMTs and...