One of the biggest complaints that most EMTs and paramedics have revolves around the pay that they receive.  Instead of living beyond our means or relying on overtime to support ourselves, what if we better managed our money and took better care of our finances?  Joining me this week is Jason Hoschouer, better known on the internet at Motor Cop, and one of his success stories, a well-known voice on EMS in the New Decade, Sean Eddy. If you are just getting started in EMS, or you are worried about your financial future, this one is a must listen for you! Check out Sean’s blog Medic Madness.  Or follow him on twitter at @SeanEddy. Want more information on Jason’s financial coaching check out his spot on the web GPS Financial Coaching. Finally, if you have not read his blog, what are you waiting for?  Motorcop.  Or, just follow Motorcop Facebook. To download this week’s podcast click this link!  Otherwise, use the player...

Jun 13, 2014

This is going to be my last post on this topic.  I actually intended on posting this about a week ago, but so much has come up over the past week that I kept pushing it back.  In fact, I was going to push it back even more with my Belchertown post that I released yesterday but I figured that this one could not sit any longer. The events of the “smiling and posing” paramedics in Detroit got me thinking back to a call that I did a few years ago. We were dispatched to a very well-known diner in the city I was working in at the time.  It was one that I frequented both while at work and occasionally off the job since it was close to my house.  That morning, we were dispatched to the patient having a “diabetic issue.”  The waitress told us that our patient was a regular in their establishment.  He was an elderly male who would walk down every morning for breakfast, and was a known diabetic.  Today, he came in sweaty and disoriented, and just was not himself. While the patient could follow commands, he was just “off.”  His sugar came back at 30, so we continued where the waitress had led off: we fed him glass after glass of orange juice and some toast as well.  As our treatment of the patient progressed he became more and more alert to the point where he was conversing with and joking with us.  We laughed as he jokingly told us how much he hated needles despite having to check his sugar multiple times a day. Being a busy Saturday morning, and this being a small diner (I’m sure many of my readers from Springfield know exactly the spot that I am talking about) we were the center of attention.  I’m sure people wondered what was going on as we cracked quiet jokes and then collectively laughed.  While the digital age was just starting to really take off, not many people had cameras, and the voyeuristic society that we live in today was not yet dominating the news and the Interwebs, so no pictures of the laughing paramedics...

I feel bad following up yesterday’s positive CPR piece with a negative one, but I feel like something needs to be said in a greater forum than just the timeline of my Twitter account. I spent Wednesday night reading some articles that I had put aside this week, specifically ones related to the paramedics who were allegedly photographed “smiling” at the scene of a motor vehicle accident and what can loosely be referred to as “reporting” by Fox 2 in Detroit.  I would link the original story but Fox 2 has pulled it from circulation without explanation.  I am not going to beat the dead horse of the issue revolving around the picture.  If you want to read some great articles about it check out Dave Statter’s page, or see what the Rogue Medic has to say about it. After reading a few articles and looking over the Twitter feeds of those involved, I decided that I would make a simple attempt to voice my opinion.  I posted the following four tweets and called it a night.   What I woke up to was a reply from Maurielle Lue, one of Andrea Isom’s colleagues at Fox 2.  Ms. Lue, who states on her Twitter profile that she is an “Emmy Award Winning reporter” posted the following reply on my timeline:             That’s right; an Emmy Award Winning reporter told me to “STFU.”  While, with that simple statement, she lost all credibility in my eyes, I engaged in a lengthy 140 character at a time discussion with her that ended with her telling me I should contact the station if I was so upset.  I took Ms. Lue’s advice and sent the following e-mail to Kevin Roseburger at Fox 2.   Mr. Roseborough, I am writing you in regards to the story that your station did last week about the paramedics who were thought to be smiling at the scene of a motor vehicle accident.  Last night, I sat down to catch up on a number of EMS related stories that I had bookmarked, your story and Dave Statter’s (Statter911.com) thoughts on it being towards the top.  After reading both, as...

My post today is loosely in support of one called “EMS Week Resolution” that went up this morning at The Ambulance Chaser.com.  Have a look; it is a good read essentially about “growing up.”  My take on it though is slightly different, and is something that I am not alarmed about because it is a trend that I see from system to system and while attending EMS conferences. Our friendly neighborhood Ambo Chaser points out to us that he was involved in a message board discussion about a state that was mandating all paramedics who were even short a half a credit on their continuing education to retake their National Registry exam.  How dare a state demand that?  How dare they penalize their paramedics and jeopardize the infrastructure of their EMS system over a half an hour of training?  While our favorite attorney/paramedic makes some great points about accountability and professionalism and (yet again) personal responsibility, I want to look at it from a slightly different angle. Why the heck is anyone even close to the minimum hours when it comes to training?  How could you let that happen?  We are surrounded by education in this field.  You can get it online through great sites like MedicEd and CentreLearn, and you can find enough educational classes that both provide and don’t provide CEU’s that there is no excuse to even be near that bare minimum that we all seem to try to strive for when thinking about getting ourselves educated in our chosen profession. A friend of mine once used a great saying which I have used many, many times since hearing it and frankly, it seems to fit perfectly here: “Don’t shuffle your feet you’ll trip over the bar!”  We set the bar so low that there is not only no excuse to clear it but there is absolutely no excuse to even be close to it.  If you want to talk about professionalism and being responsible for our patient actions, well, this is where it starts. Greg Friese pointed out in a class of his that I took at EMS Today one year that free pizza brings in more students than good...

The news story that hit the internet last week about the woman who was “pronounced” by the paramedic who was later discovered to be alive is nothing new.  We have seen this type of thing before.  Chances are, if you ask me, probably just about every case of this has hit the media at some level.  If you ask me though this is not an EMS problem.  This is a personal problem driven by the laziness of a provider. In fact, one article mentions that this exact same medic had an issue a little over a year ago when he flew two patients that probably did not need to be flown, and should not have been flown.  I vaguely remember that story. The problem with this entire situation though is that what will most likely come out of it will be some policy change either at the state level or medical director level, and some fear within the system that “this might be missed again.”  This is not a systemic issue.  It’s not a state issue.  Its a provider issue.  And more importantly, it is one that should never happen.  The only thing that will prevent instances like this is a thorough assessment by a trained medical professional. Every field pronouncement protocol should contain a few core components.  For example, obvious signs of death.  Lividity, rigor mortis, and body temperature.  Or some injury that is incompatible with life; a decapitation, or massive evisceration, cranial evacuation.  These are the things that should be obvious to us when we assess a patient, and we do need to assess these patients.  We need to touch them, and inspect them, and make sure that we are making the right call, even if we are on a crime scene.  These things must be done. The other component that should be part of every field pronouncement protocol is the acquisition of an ECG that shows three leads of asystole for a predetermined amount of time.  The best way for any paramedic to check this is not to get a “quick strip” but instead to do something like a “10-20-30” evaluation of the patient’s ECG. What I mean by a 10-20-30...

Friday’s post about the now deleted craigslist letter got me thinking about the need for an in depth set of policies and procedures to help in decision making for everyone involved in an organization.  My boss used to like to say that there were so many grey areas in EMS that writing a set of policies and procedures would be exhausting and quickly rendered invalid.  I could not disagree more. I went from a service that had very loose procedural structure to being handed a three inch D-Ring binder filled with my new department’s P&P’s that outlined everything from the procedure to call out from work to how to properly place the pins on my uniform.  It was clear and concise and I loved it. Despite what they might tell you I feel that EMS providers crave structure.  If you want proof of that look no further than standing orders and protocols.  While a single protocol might not fit the mold for every patient and you might find yourself crossing from protocol to protocol.  You might not start at step one and move to step twenty hitting steps two through nineteen along the way but you at least have a framework to work within.  Policies and procedures need to be viewed with a similar mindset. No situation is perfect, and no solution is going to be 100% correct 100% of the time, but I feel like if a policy gives you the answer 50-75% of the time then it is serving its purpose.  A prime example would be something like “ambulance crews are expected to be available in the hospital within twenty minutes of their arrival.”  Is that 100% achievable?  Of course not.  There are so many outside factors like patient condition, decontamination needs and ER backups that might prevent this but it sets an expectation and a parameter for crews that if their patient is turned over they should be available in that time frame. Failure to set expectations for people leads to freelancing and frustration.  Rules are enforced from supervisor to supervisor and dispatcher to dispatcher with little consistency.  I know that this happens because I was guilty of it.  There were...

Late night I was shown a very public reply posted to a very private email circulated by management in a New England ambulance service expressing displeasure with the performance of many of their employees that some have interpreted led to the loss of a 911 contract that they have been given a second chance at.  Although the original email was never posted, the reply made on a craigslist page and signed by an “anonymous employee” called out management for their practices.  I read it, and I cringed. The post itself was flagged for removal within the first eight hours of it being posted online which is fine, because I would not have linked it here as I personally felt it was in poor taste.  While there is a time and place for sharing with the outside what goes on in the inner workings of an organization this was a lot of dirty laundry to hang on the line for everyone to see.  Quite often they are posted too quickly with the thought that “if I let the public know what is going on here things are sure to get better!”  In actuality, all this does is increase the gap between the field and management. As someone who has, in the past, pulled the pin on a grenade and tossed it into the fray, I can testify that actions like this do not help as much as many think that they will.  As my career progressed, I found it easier to write the email or memo and let it sit on the computer for a good couple of hours.  Then, I would come back and take a second look.  More often than not, my opinion would have evolved to an “it’s the same old complaint, it won’t help anyway.  I’ll keep it in my back pocket though.”  The draft would then be saved, and the window closed, as some fights are just not worth it. The anonymous writer of this post clearly was upset, and I doubt that his or her intentions were completely malicious, they should realize that the damage they did might be irreparable.  While it might be fun for some people to...

For the first twelve years of my career the answer to most questions was “just take them to the hospital.”  Don’t know what’s wrong with them?  Take them to the hospital. Paramedics and EMTs seemingly start to “over think” calls?  Stop thinking and take them to the hospital. A certain facility doesn’t want our medics to do anything for the patients?  Just get them in the truck and take them to the hospital. More times than not “take them to the hospital” is at least a functional answer.  Whether they need to be there or not a trip to the ER either delivers the patient to definitive care or makes them someone else’s problem.  Oh, and did I mention that taking them to the hospital allows a department to bill for the call as well?  It does.  Or at least it did in my former service, but that is another discussion all together. The big question though is what do we do when taking them to the hospital does not benefit our patients?  Who am I talking about?  Our cardiac arrest patients of course. By now many of the readers have seen Tom Bouthillet’s picture of the “Resuscitation Fairy” who magically revives our patients when we deliver them to the ER.   While Tom and I don’t always see eye to eye on issues in our industry, I feel like we are not only on the same page, but the same paragraph when it comes to running cardiac arrests.  I have been lucky enough to spend enough time with Tom that I have learned a great deal from him.  Changing how we do things can be scary.  It takes a commitment to do it.  We all have our comfort zones and stepping outside of that can be difficult, but we need to for our patient’s sake. Moving patients kills them, or rather prevents us from saving them.  Wake County has studied it and proven it.  The simplest thought processes confirm it.  A heart needs to beat in order to sustain life.  In order to get that heart beating again, we must work for it, whether that be manually or with a CPR assistance device...

Back in September of 2010 when this blog was still in its infant stages and living on Blogspot, I wrote a post about STAR CARE, which I described as the “magnetic north of your moral compass.”  In light of the recent events in Washington, DC (say it with me folks: WHICH ONE?!) I want to take a look at the decision made by Lieutenant Kellene Davis that led to her granted retirement and dodging of department discipline. For those of you who have spent the last couple of months living under a rock, or just recently have been introduced to the wonderful world of the internet, Lieutenant Davis was the officer in charge of Truck 15.  To summarize, and keep the story short, she failed to act when 77 year old Cecil Mills had collapsed across the street from her fire station.  He eventually died.  While we cannot be sure that a response by Truck 15 would have saved the man, what we can be sure of there was no action taken. Now, Dave Konig was quick to point out to me that STAR CARE is an EMS tool and not a fire department tool, but DCFEMS is an EMS provider, so STAR CARE can and should apply to them as well.  As the commanding officer on Truck 15 that day, the responsibility ultimately rests on her shoulders, or at least that is what DCFEMS wants us to believe, so looking at her actions seems to me like the appropriate thing to do.  Let’s take a look at this and see how Lieutenant Davis did. S: SAFETY This was an unknown medical, so looking at it from the most positive side of things, she did not send her crew into danger or allow them to cross a busy street. T: TEAM BASED By preventing her crew from acting, she did not allow them to serve the purpose that the crew was deployed to do which is protect the people and property of Washington, DC. A: ATTENTATIVE TO HUMAN NEEDS I doubt that Lieutenant Davis would want a medical emergency experienced by herself or a member of her family with the same disregard that she...

While I only fit one of the above listed categories, a friend and colleague in the department I work for now shared with his Facebook friends a great piece he wrote on being both a paramedic and a father.  Seeing as how he has been at this for around twenty years, and has four little ones at home, i bow to his expertise on both.  So for today’s post, I bow to the wisdom of Paramedic Corporal Lee Morris: “I’ve come to realize that being a father and a paramedic is quite alike. Both titles involve a steady stream of people trying to excrete things on me and my attempts to dodge the mess. Both titles often require I solve problems others have caused for themselves. Both involve my efforts to keep others from playing in traffic or fixing the boo-boos associated with similar activity. Both involve long overnight hours, busy weekends and holidays, occasional soul-crushing fatigue, and little time to rest before my charges are out to play again. Both titles require I respond at rapid pace to the siren call of someone in dire need, and at times they really only think they are in dire need. Sometimes in both jobs I have to medicate people or stick things in people that don’t want to be stuck. Occasionally they both involve me holding someone down who is inconsolable, kicking and screaming and completely unresponsive to reason. Sometimes in both I have to attend to people creating a scene in a public place, help them while remaining calm, and try to keep them from disturbing the general public. In both titles I am expected to be professional, positive, helpful, and have a never-ending source of energy and solutions. Sadly, I occasionally miss the mark when performing in both jobs and have to humbly ask forgiveness and move on. For one title I am paid, the other I am not, and there are days during which I would gladly trade that fact between the jobs. (Neither title pays enough, by the way.) Both involve the occasional sense of extreme accomplishment as I look back at my efforts to see the difference I have made...