Earlier this year, Steve Whitehead and Natalie Quebuedeaux coined the phrase “Make your own Thunder.” It has quickly become one of my favorite phrases. Here’s my story, broken down into two parts, about the rumbles that I’ve created over the last week. . . For the last couple of years, I’ve been a member of the National EMS Management Association (NEMSMA) List Serv through Google. It’s a hotbed of conversation and information about the industry, and I highly recommend it to anyone interested in furthering their career in EMS. Quite often, I would find posts or articles that seemed very relevant to the issues faced within my company, so I would copy and paste like mad to some of my colleagues, hoping that it would have some impact. This practice increased ten fold this past February when I became involved in the Social Media movement in EMS. As I have read more blogs, I’ve grown more and more excited about the information that had been right under my nose. Who would have thought that there were so many people out there with the same ideas and motivations that I had? Quite often, I would send the copied and pasted articles and links out, and I wouldn’t really hear back from anyone. I knew a few people read them, but I never really got much feedback about what they were reading. In the last week, that changed. It all started last Wednesday when I got an email from one of my main “targets” of all of my forwards, our Operations Manager. It asked a simple question: “Can you send me the links to what you read and listen to?” I was really excited, and I got right to work. I started going through my bookmarks, sharing every podcast, blog, and publication that I frequent. While he is a very open minded guy, and thinks along the same track that I do, here was my chance to really open up his eyes to what was out there. By Friday, I had already received a number of links from him pointing out articles and posts that he really liked. By Sunday, he had sent out an email...

ER Over crowding.System abuse.Lack of resources.Lack of treatment pathways.Its all there! Last night, I was in Philadelphia for the Chronicles of EMS 3 City Meetup for the premier of Firestorm, a documentary about the Los Angeles Fire Department and their struggles to provide efficient appropriate care to the citizens of Los Angeles in a setting where resources are often scarce, hospitals are closing, and abuse of the system is out of control.The atmosphere is described by one LAFD Captain as “The Perfect Storm” with no relief is sight, and from what I saw last night, that statement couldn’t be more accurate. Firestorm focuses mainly on the men and women ofLos Angeles’ Station 65, which houses two Paramedic Level Ambulances.It is one of the busiest stations in the city.They deal with everything that one would expect to deal with in an urban setting.The spectrum ranges from violent crime, like shootings and stabbings, MI’s and major cardiac events, to stubbed toes, fevers, and abdominal pain patients.Their options for patient pathways are limited, just as they are in almost every otherEMSsetting that you’ll find, and their task times are increasing due to ER closures and generalized overcrowding.On numerous occasions, ERs inLos Angeleshave wait times in excess of 24 hours. One scene that was particularly telling of the struggles that the LAFD faces featured a woman and her young son.She wanted the 2 year old evaluated because he had a fever and had appeared to have been shaking.The child, from the assessment that one could make by watching the movie, was clinging to the woman, appeared to be acting in the shy and bashful manner that you would expect from a kid under the age of 3.The LAFD Medic painted a picture of his assessment, that in short and without straight out saying the words said “He seems to be okay now, and would be more appropriately evaluated by a pediatrician.He doesn’t need an ambulance.”The woman’s reaction?”I’d still like to get him checked.We all have our opinions.”The Medics then did the right thing, and loaded the kid up and transported him. Now, this woman will probably sit in the Emergency Room for 12+ hours, with her already sick...

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...

History was made this week in our Nation’s Capital. EMS week might still be more then a week away, but on May 4th, we had what could be best described as our “E-Day.” It was EMS on the Hill Day in Washington DC, and although I didn’t make it there in the capacity that I wanted to, I can say I was there. The nearly 6 hour drive was worth the lack of sleep, and the time away from home as I had the opportunity to meet some great people, namely Natalie (MsParamedic), Jeramiah (Jeramedic), and Matt (Squirrel325). The bonds that I created with this group in the short time was a great testimony of the passion that we all share for this field that we are involved in. The first annual EMS on the Hill Day was an event sponsored by the National Association of EMTs intended to give interested EMS professionals a chance to network with each other and more importantly it was a chance to advocate for some issues that were carefully chosen by the organization’s leadership. There were three of them, but the two main ones were the Medicaid/Medicare reimbursement rates, and the establishment of a fund for the families of EMS Professionals who suffer line of duty deaths. In my opinion, they did a great job picking these topics. If they set their sights on more controversial issues, then as a group we ran the risk of seeing too eager at this first event. NAEMT, however, made the right choice and helped establish the credibility of our profession. The event, as described by Jeramedic was attended by about 140 Representatives from 40 states, and there were some big names in attendance. KC Jones, a ground braking EMS educator was there, and so was past NAEMT President Kenneth Bouvier from Louisiana. I am proud to say that according to my friends who attended the event after “E-Day” both of these EMS Icons were wearing EMS 2.0 Pins! There was also even a Gary Wingrove siting! The one common thread that I found in everything that I read after the event was it was a huge success, and a great job...

May 1st is upon folks, and it is going to be a big month for many of us. Next week marks the first annual EMS on the Hill day, sponsored by NAEMT. What is EMS on the Hill Day, you ask? Its a chance for you, the provider, and the advocate to go to Washington, DC and speak with your representatives in Congress about the issues and challenges that you face every day. Although I am not going to be able to attend the actual EMS on the Hill events, I am making the trip to DC to meet up with some great people involved in The Movement: mainly Miss Paramedic and Jeramedic, and I can’t wait! Two weeks from now, EMS week will kick off. Here’s our chance to get the word out there even more about who we are. Contact your local papers, and media, and let them know if you are planning any EMS week events! Personally, I will be attending the Chronicles of EMS 3-City meetup in Philadelphia on the 16th, and participating in an EMS Banquet on the 18th to honor our local EMS Heros, and I’ll be attending any events my boss decides to put together. I feel, though, that its time for me to throw the challenge out there. Its time for all of us to make our own Thunder. Thats a phrase that was coined by (I believe) Ms Paramedic, and Steve Whitehead. What does that mean? Its quite simple, actually, put the word out there about EMS 2.0, the Chronicles of EMS and our profession in general. Let people know that we are here. Create a little rumble, and watch the storm grow. Jim Hoffman, “The EMS Professional” (@EMSSafe on Twitter) has already gotten off to a great start. Check out this link about his EMS Week 2010 giveaway: http://ems-safety.com/emsweek2010.htm. Maybe its time that we all follow Jim’s lead. Break out those EMS 2.0 pins, and those Chronicles of EMS t-shirts and show your colors. Do you live in Philadelphia, Chicago, or San Francisco? Come out to the Meetup and meet some great people. Ultimately though, lets take EMS Week and make it the best...

I was looking through some old files and articles that I bookmarked, and I found last year’s Career Cast Worst Jobs of 2009. Emergency Medical Technician was ranked as the 6th worst job in the United States using Physical Demands, Stress and Income as criteria. That’s right, everyone, this job that we all love to do, some of us as volunteers, others as our careers, is ranked as one of the worst jobs in the United States. In case you’re curious, Sailor, Taxi Driver (does anyone else find humor here?), Diary Farmer, and Lumberjack were the only jobs that were considered worse then EMT. So, how in the eyes of the folks at Career Cast, can we improve the Emergency Medical Technician position as a job? Let’s take a look at their criteria: 1. Physical Demands — We are already moving in the right direction here. The physical aspect of EMS is greatly diminished thanks to innovations such as tracked stair chairs, hydraulic stretchers, and AutoPulses. Although there is still some wear and tear, and the necessity to lift will always be there, as an industry, we are doing the best that we can for our people. 2. Stress — Stress will be the hardest piece of this puzzle to improve on. Let’s face it, we see things every day that some couldn’t imagine seeing in a lifetime. The best thing that we can do is afford as many outlets for stress relief for our employees. That could come in the form of increasing the availability of Critical Incident Stress Debriefing, or something as simple as giving our people other outlets for their stress by giving them something as simple as gym membership. 3. Income — With the progression of our field, the expansion of our scope of practice, and better understanding of what we do, Income will improve as well. EMS is still a very young field when compared to the other two branches of public safety. We have come a long way in a very short time, but we still have a long way to go. Interestingly enough though, in 2009, USA Today ranked Fire Fighting as one of the best most...

The debate has started in the Blog and Twitter worlds regarding EMS Pay. Is it possible to support a family on a 40 hour paycheck as an EMT or Paramedic? Many say “no” and its hard to find people who can make it work. In the Company I work for, the desire for more money is always there, but I feel that there is a big misconception in a lot of EMS Services, my own included. Like it or not, EMS is still in its “toddler” phase. We’ve just learned to walk, and we will eventually learn how to run. We’re sitting here, eyes at table level looking at that juicy prize that is just out of our reach, and we need to figure out how to get it. For the time being, we might need to work for less money and show our value, so we can get more pay in the future. We need to let our field develop and play active rolls in its development. Many, however, want to be given pay for a job not yet done. People want the pay in order to make them professionals. What we need to do is be professional to earn that desired pay. The important task to focus on now is to work on our image in the public’s eye as providers, people, and caregivers. We need to show the population that we serve what we are capable of. It’s rather clear that we, within our community, convey our message to each other. This is evident simply by looking at the Social Networking movement that many of us are involved with. We need to find a public forum. We need to find a way to get people listen. Public education I feel is a great path for us all to start down. Bring people in for mass CPR classes, and couple it with a piece about who the EMTs and Paramedics are. We need to try and establish partnerships and get involved with organizations like the Red Cross. When our people go above and beyond, put them out there, and show the world what they have done. None of us want the world’s...

  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...