Jun 5, 2017

Any time I peruse the pages of EMS related articles I will inevitably come across some service that is trying to take over another service’s area.  Diving deeper into those articles usually reveals the same usual arguments.  Imagine my surprise when I clicked on an article about the East Longmeadow Fire Department’s move to take over EMS response in the town of East Longmeadow. I should first point out that what I am about to write is meant to represent my own personal views on the state of the industry.  I have not inquired about anything having to do with the current staffing of ambulances and volume.  What I am reflecting on is the article and just the article coupled with my years of experience in the greater Springfield area. Just to give a little bit of background here, I used to have a dog in this fight.  As many of you know, I was a 12-year employee of American Medical Response, the last seven of which as a supervisor.  I participated in contract bids for the town, and saw service improve as the requirements of those contracts increased.  AMR currently provides EMS service to the towns of East Longmeadow and Hamden free of charge.  The service is paid for by those who use it.  They respond to more than 2,000 calls a year, and AMR or its predecessor companies have served the town for more than two decades. The East Longmeadow Fire Department is currently a part time department covering daytime hours only, with off hours supported by call staff and volunteers.  Their Chief, Paul Morrissette, has spent his entire career in East Longmeadow.   The East Longmeadow Fire Department does not provide EMS first response in town and even if they did, the ambulance would most likely beat them to virtually every call because they are deployed from street corner posting, quite often from the same area where the fire department is located.  To put it briefly, neither Chief Morrissette nor the department currently have any experience operating an EMS service. In an article recently posted in The Reminder, a regional online publication, Chief Morrissette is quoted as saying, “AMR isn’t always familiar...

May 9, 2017

The biggest barrier to many systems’ CPR survival rates skyrocketing is the pubic’s lack of willingness to perform CPR before a rescuer gets on scene.  Those roughly five minutes might be the most important five minutes in a patient’s chance for survival.  Many systems have tried to teach more hands only CPR, or perform “flash mob” trainings as a way to get the word out there about the importance of CPR.  Frequently, the top two concerns that I’ve heard expressed by the public are the perceived legal issues, or the “what if I do it wrong?” attitude, and the fear of giving mouth to mouth to a stranger.  In reality though, neither of these factors truly come into play anymore with good Samaritan protecvtion laws and a new found focus on compression only CPR. This morning I read a news story shared by EMS1 about a woman who nearly lost her son who now hosts “CPR parties” and it got me thinking.  My girlfriend has a problem, and I know that she is not alone.  On an almost weekly basis, our mailbox becomes filled with products from some company called Lu La Roe, or as I have come to call it “Lou Lou La Rue.”  In reality, I am okay with it because I feel a little more justified when I buy games off of Steam or have an afternoon of craft beer and Amazon Prime purchasing.  She told me how she has spent time on Facebook attending virtual parties where people will go through their inventory on a platform like Facebook Live. I know for a fact that there are at least a couple of paramedics who sell products like Lu La Roe on the side, and I thought that this might be a great opportunity to do some teaching.  In reality, all that one needs to learn how to do hands only CPR is a pillow and a couple of minutes.  In corporate some “100 beats-per-minute” music, and a person could put together a free, informative CPR class that could save a life with just a couple of minutes of education tied in to a sales presentation.  Seems simple, right? These are the...

To expand on last week’s posts about the evolution of cardiac arrest, I got thinking about how things have changed over the centuries.  I remember watching Killing Lincoln on the history channel a few years ago.  In the moments after President Lincoln was shot, an army surgeon who was at Ford’s Theatre stepped up to care for the doctor.  He instructed people to “lift his arms up and down” to help facilitate respirations for the president.  Its something that today, we would look at as being ridiculous.  The funny thing is, as I look over my career and a lot of the treatments that I talked about last week, I see a lot of what used to be cornerstones of resuscitation only a few decades ago as being equally as ridiculous. It makes me wonder how many life saving events that I could have been a part of had our approach to cardiac arrest been similar to what it is today.  The changes that we have seen in the last 20 years have been simple ones.  We have changed compression rates.  We’ve prioritized compressions.  We have realized that getting that tube is not nearly as vital as we once thought it was.  17 years ago, if I delivered a code without a tube to the ER, it was seen as a badge of shame. You did everything you had to do, the rest of the care be damned, and you got that tube. What if we had stayed on scene and played for some of those codes instead of just throwing a backboard under them and whisking them away to the hospital morgue?  What if we had admitted defeat to a difficult tube and stuck with a BLS airway since that was working anyway?  What if we had done compressions in between my stacked 200, 300, and 360 joule shocks?  How many more lives would have been saved? The first CPR save pin that I ever received was when I was 16 years old.  The patient was 80-something and she collapsed at home.  22 years ago, New Jersey was doing some things right.  If we didnt get them back we did not go anywhere.  This patient though,...

Apr 21, 2017

I’ve been out of this writing game for a bit, so you are all going to have to forgive as I play catchup to some stories that might be just a little older.  I assure you that they still carry relevance. In my time “away” from writing, I’ve been doing a lot with the Resuscitation Academy.  Yes, that Resuscitation Academy.  I teach its concepts, and some of my colleagues and I have completely drank the Kool-Aid.  I will talk more about that at a later date, but I point it out here because I’ve become very passionate about all things cardiac arrest care which brings me to today’s story. Some of you might have read the story about Biggest Loser trainer Bob Harper who, while at Cross Fit in February, suffered a sudden cardiac arrest.  In the article posted by CNN, Harper talks about how “. . . the fact there were doctors in the gym when I had the attack saved my life.”  He talks about how the doctors did CPR on him, and the doctors pulled the AED off of the wall and used it on him. Mr. Harper is right, the almost immediate CPR and early defibrillation saved his life, there is absolutely no doubt about that, but the fact that the two people who provided care to him were doctors is completely irrelevant.  It wasn’t two doctors who saved his life, it was two people who were willing to act instead of just waiting for someone else to do something.  In this case, their occupation is not important.  I do not want to diminish the heroics of this event but had the story could have been an incredibly powerful vessel had it been told a different way. The message that people need to hear in this case is that they need to learn CPR, some kind of CPR.  They do not need an AHA card in their pocket but understanding the fundamentals of hands-only CPR, for example, a skill that can been learned in 15 minutes or less, is one that can save a life.  Knowing where the AED’s are in the gym where you work out, or having the...

“An ounce of prevention is worth a pound of cure.”  -Benjamin Franklin Throughout my career, I have been to maybe eight or nine critical incident stress debriefings.  I attended my first one when I was 17 years old after caring for a man who self-immolated as a means to take his own life.  Without getting into the details of this confidential event, the outcome for my family, who was on the call with me, and I was a long standing bond with the dispatchers in attendance.  About once a month for many years following, we used to take coffee and donuts down to the dispatch center to catch up with our new friends. I have always been a person who encouraged everyone involved to attend CISM’s, and I think I have spoken about that here before.  To those who have said, “I am not going to get anything out of it” I am quick to remind them that it’s not all about them.  Sometimes the best thing that we can do is offer something in our own personal experiences to someone else in attendance.  Sometimes, knowing that you are not alone is the greatest reassurance that a person can receive which is why I push people to stand together.  I would never mandate anyone to attend a CISM, and neither should anyone else, but I always strongly encourage people to show up. I do think, however, that we rely on CISM a little too heavily as a means to deal with the stress that people in our field shoulder day in and day out.  We sit back and watch people who struggle go to work every day.  We have all watched coworkers whose personal lives are crumbling around them, and have watched those personal issues spill over to their professional lives.  Heck, some of us have been those people.  We sit back and let people deteriorate because we don’t know what else to do.  Until something happens. Until that bad call.  That big call.  CISM is usually tied to major events.   It’s that nasty wreck on the interstate, or that pediatric cardiac arrest that results in a crew begging to take the rest of...

In my post last week about the importance of being comfortable with failure, I mentioned statistics and benchmarking.  Last month, I had a chance to present at my first national conference when I spoke at EMS Today as part of the EMS Compass preconference.  I’ve been involved with the EMS Compass project since November of 2014 and while the process itself has had some growing pains, the mission and goals of the project involve some of the most important things to the future of our industry. For example, it is only with a firm understanding of the role of benchmarking in quality assurance and quality improvement that we will be truly able to compare the impact that we have on patient outcomes.  Understanding the impact of our care and being able to compare it to other systems is how best practices are discovered.  It all comes down to asking a couple of simple questions? WHY? The first question is an easy one, and that is simply why?  If another system is seeing better patient outcomes for their STEMI cases, or if they have a higher ROSC and survival rate for cardiac arrest, you need compare your system to theirs and just ask “WHY?”  Do they have a different set of CPR protocols?  Do they have a more aggressive field pronouncement protocol that steers medics to stay and play instead of taking a load and go approach with their cardiac arrest patients? The easiest way to figure any of this out is to work backwards.  Take the example of ROSC and survival rates.  If another system has a higher survival rate, start with where they are delivering their patients.  Are they using hypothermia for their patients prior to arrival or have they omitted that step at recommendation of the AHA?  Are they part of a completely different system with different protocols that might call for later intubation or a different style of airway management all together?  What about their care in the field differs from the care that you provide? After analyzing the care that takes place on scene, look at who is going to those calls.  Are they sending more help than you are? ...

Sep 22, 2015

My trip to Las Vegas for EMS World EXPO 2015 was my eleventh consecutive trip to a major EMS conference.  I feel like I have had a front row seat to see the direction that conferences like EMS World EXPO and EMS Today have taken on a number of different levels.  The crowd certainly has changed.  You still have your big names that show up year after year and those faithful attendees who come year after year and take classes.  Many products stay the same, while many “new and great ideas” are here one year, and gone the next.  Ambulance design shows the continued utter lack of advancement particularly from a provider safety stand point, which I continue to find alarming.  My car today looks nothing like the 1987 Volkswagen Jetta that was my first car in high school, so why does the back of my ambulance look exactly the same as the 1984 box truck that I first road in back in 1993? It is interesting the direction that conferences in general have taken.  For a few years there seemed to be a bevy of new content mixed in with the usual trauma, mass casualty and pediatric classes that always seem to populate the convention schedule.  We used to learn about how ultrasounds were going to be the next big thing, and now Mobile Integrated Healthcare has taken yet another conference by storm.  It’s important information about the future of our industry but come on, folks, it’s time to see something new. To JEMS and EMS World, I beg of you, step outside of your comfort zones.  Let’s move away from the same speakers that present year after year, regardless of how many awards that they have won, or how many articles that they have published.  We need some fresh new ideas and fresh new presenters.  I know that might ruffle the feathers of a few people out there who do not like being turned down, in fact I know of one in particular who has already said he is not submitting to a certain conference anymore because they did not want him this time around, but the time has come.  We are...

May 18, 2015

With EMS week upon us, I wanted to talk about what this journey through EMS has meant to me, and what it has taken to take some of the steps that I have in my career and there is no better place to start than that first leap. One of the most common questions that I have been asked by new and prospective EMTs and paramedics is “when will I feel comfortable?”  It is one of the most difficult questions to answer and one that I really do not know the answer to.  Truth be told, it took me a lot longer than I ever expected to be comfortable in my skin as a paramedic. When I started medic school I felt confident as an EMT.  I had a strong grasp on what my role was at a scene, and felt that I could effectively perform any of the skills in my toolkit when called upon to do so.  Medic school proved to be a struggle at times, more because of my lack of good study habits but I got through and added that “PARAMEDIC” rocker to my EMT patch.  Once I hit the street as a medic though I felt very overwhelmed. I remember sitting in my car in the parking lot at Springfield College with my door open dry heaving the morning before my first 7:30am shift as a medic.  I was terrified.  Most of it stemmed from the fact that I did not want to disappoint anybody, especially myself.  That first shift went well though, and the first group of shifts did but for the most part, I can fully admit that I was scared.  When it comes to type of air that a medic must carry with themselves on a scene, I tell most brand new medics that they need to be “like a duck.”  Under the water, you might be paddling your little duck behind off but outwardly, above the water line, you need to be cool, calm and collected and just quack your way along with no one any the wiser.  I was a terrible duck. This overall sentiment went on for about the first year or so...

Apr 30, 2015

I am a vocal supporter of the police in the world of social media and in my every day life.  My stance has gotten me called many different names such as asshole, racist, conformist, and even boot licker by some.  Much of the support that I express for them is derived from my life experiences with people in law enforcement.  I grew up in a small town where every cop was on a first name basis with just about every resident.  I worked for twelve years in a metropolitan area that was recently named the second most dangerous metropolitan area in the northeast.  I have been pulled over a few times in my now twenty years of driving and received two tickets.  Regardless of the offense that I committed or the fine I always treated the officer that pulled me over with respect because you respect. Over the last ten months tensions in this country have hit a new high.  Dumping fuel on the fire, as usual, are people like Al Sharpton or Joe Madison to name just a few.  City Council members in the City of Baltimore have done press conferences standing next to the “leadership” of street gangs.  Their mayor is now back peddling after she talked about her poor choice of wording or justification for the destruction in her city (depending on which side of the fence you are on).  Leadership in other cities continue to stand on the wrong side of the lines that have been drawn, much like Rebecca Lisi has in Holyoke, Massachusetts.  Mainstream news outlets like Fox, CNN, or MSNBC do not try to put a stop it because it gives them things to fill their 24 hour news cycle and the people who suffer are the citizens and the responders.  I will be the first to admit that not every police officer is the most legitimate, upstanding person.  There are bad eggs in every single profession including my own, but the vastly overwhelming majority of those who have chosen law enforcement as their careers do their job because they care.  Sometimes, sadly, they are asked to care for those who could care less about their well-being. Everybody...

Apr 15, 2015

This weekend a number of friends on Facebook linked a video that was making the rounds of a person presumed to be in cardiac arrest in a car in front of a bus stop.  This scene provides with a number of important lessons.  First you see an SUV in the middle of the road with people yelling at the driver asking him if he is okay.  9-1-1 is called and somebody starts doing chest compressions on the person before removing him from the car and placing him in the road.  CPR is continued until EMS arrives.  At the end of the video you see the driver being wheeled to the ambulance sitting up appearing to be conscious on the stretcher. The video itself spans about seven minutes and I encourage everyone to take the time to watch the entire thing from beginning to end.  Some content might be difficult to watch and there is some language that might be considered offensive used by those watching the scene unfold.  Regardless of that though, there are a few lessons that I think both the EMS community and the general public can learn from this. http://medicsbk.com/wp-content/uploads/2015/04/Street-CPR.mp4   There are still people out there who are willing to help – In a world dominated by social media, Twitter and cell phones people seem to either want to record or just call for help and make a potential emergency somebody else’s problem. Seeing this video is reassurance that there are still people out there who will get their hands dirty to benefit another person.  They saw somebody in distress and they acted.  They realized that doing something is better than doing nothing. When you call 9-1-1 help is on the way almost immediately – Confusion is common. People misidentify locations in fact, I can tell you that happened here.  Once a location is confirmed help is on the way but for dispatchers that is not where their job ends.  If there is one place that a dispatcher’s role in providing prearrival instructions can save a life it is in the case of a patient in cardiac arrest.  The bystanders can insist that the caller “just tell them to come!” until...