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...

11 years ago right around this time, I was spending every free moment that I had studying for my Paramedic Class Final. It had been 11 long months of work, where I had sacrificed time away from family and friends to help achieve a dream that I had: to be a Paramedic. That 250 question final was staring me straight in the face, and after that, it would be off to my Clinical and Field time. I had learned a lot in those 11 months, and had also learned a lot in my 4 and a half years that I had been an EMT prior to that. There were still plenty of lessons that were waiting for me on the road ahead throughout my career. If someone was to ask me what I thought some of the most important qualities that a Paramedic should have, some buzzwords that come to mind are “caring,” “compassionate,” “clinically competent,” and “hard working.” That would be my politically correct answer though. There are some other qualities that lie under the surface that are rarely discussed with the public that people should know about and be ready for if they choose to make EMS their career: Strong stomach — During your career, you will see and smell things that no person should ever have to. When you encounter them, you will be expected to keep a straight face, stay calm, and act like it doesn’t bother you one bit. Able to work independently — There will be times when that other truck, or even your partner might not be near by. You may have to work a cardiac arrest by yourself. You could pick up the radio and ask for another truck and hear those terrifying words: “No units available.” Above all else, be ready for as much as you can with little to no help. Innovative — In EMT and Paramedic class, you will learn about algorithms and what to do for a patient quiet often in the best case scenario, but remember what Murphy’s Law teaches us: “Anything that can go wrong, will go wrong.” You need to be able to think outside the box and adjust...

During our careers, we all make mistakes. We’re human. It happens. What really matters is what you do with the lessons that you learn. The only thing that is more difficult than accepting that you made a mistake is admitting that you made one, so I thought I would share one here. I started out my EMS career working the weekend overnights. Every Friday and Saturday night, I spent my time flying around the city while everyone else seemed to be enjoying themselves. Well, thankfully, I was enjoying myself too. I looked forward to going in every night. I had a great partner, and a great group of coworkers who I became very close with. Everyone had everyone else’s back, and as afar as an EMS environment goes, it was exactly how I hoped it would be. Every Saturday morning, the core of the group (about 6 or 8 of us) would head out for breakfast and drinks together at our local watering hole. We’d swap stories and talk about the experiences we had the night before, and then head to bed to ready ourselves for the Saturday night that was ahead of us. Occasionally, we would repeat this ritual on Sunday mornings. Sadly, our usual spot was closed on Sundays, so we would randomly pick another breakfast nook somewhere in the city. The Saturday night before the morning in question was a particularly busy one. We hadn’t seen much of each other, so a little quality time with the group was welcomed by all of us. As we sat waiting for our breakfast, the topic of conversation turned to two patients that we had encountered the night before. One had called us three times, the other twice. This was not an uncommon occurrence for either of these individuals. The three time caller, we’ll call him Fred, was our most notorious of frequent fliers. He was a lonely alcoholic who would take trips to the ER just to have someone to spend time with. On this night though, the ER didn’t want anything to do with him, so each hospital discharged him quickly, put him in a cab, and sent him home. The other...

Battle On Over Emergency Response Vs. Emergency Caution – Jackson News Story – WAPT Jackson Jackson, Mississippi is back in the news, and Councilman Kenneth Stokes is at it again. Take a look at the video that I linked above, and reread my previous post on this issue. Why doesn’t Kenneth Stokes see what the problem here really is? Its not faster ambulance response, its a larger police presence. The question at hand is should an ambulance respond into a potentially dangerous scene until it has been secured by the police department? My training and my gut both tell me NO. Kenneth Stokes recommends bullet proof vests for AMR’s staff, but a vest isn’t a magical suit of armor that will keep you safe. The right angle to take of all of this is to promote safety at the scene. Bulk up Jackson’s police force. If the city is that unsafe that this has become so much of a problem, make it safer. Expecting AMR’s Ambulance staff to do some of the police’s work for them is unfair, and it puts more people at risk. But, remember, that would cost tax dollars. Its much cheaper to drag the Ambulance Company through the mud, encouraging them to drive into potential “war zones” and put themselves in the line of potential danger. I looked up some information about Jackson, Mississippi. It ranks 4th in the nation for homicide rates per 100,000 residents behind Baltimore, St Louis and New Orleans. In 2009, it was ranked as the 23rd most dangerous city in the United States. If anything should scream for a larger police department, that should. It doesn’t give Jackson the portrait of being a safe city, or a safe place for EMTs and Paramedics to work. What Councilman Stokes is doing is making it more dangerous for the Paramedics and EMTs in Jackson, Mississippi. He’s setting them up so that each time they walk into a scene after the police department, the perception could be “What took you so long?” Every time a truck is posting in a parking lot, or waiting for police to arrive at the scene, it will spark the question of “What...

Last Thursday, I was given the opportunity to participate in an episode of EMS Garage. The topic that night was Liability, and revolved around a news story from Missouri. You can read about it here but the gist of it is this: A crew goes to a chest pain call. They evaluate the patient, tell him its most likely GERD and has him sign a refusal. Later, his family calls 9-1-1 again, and the patient, who is still having difficulty breathing and chest pain, is transported to the hospital where it is revealed that he actually has a Pulmonary Embolism. He dies later that day. First of all, in my eyes, there is no defending this crew. They went outside of their scope of practice, and gave advice that they did not have the right or the training to give. If they had done the right thing from the start and said “well, we don’t know why you’re having this chest pain, but let’s go to the hospital and find out” then this patient might have had a different outcome. I was lucky to be on with a great panel, and there were lots of thoughtful, well informed points made. I urge everyone to take a listen to it. One of the most interesting points and topics to me though was about what should be called “The 11th Hour Syndrome.” Wonder what that is? Well, the 11th Hour Syndrome is what makes a Paramedic change the way they take care of their patient when it’s close to the end of their shift. Do your speed, depth of assessment, and motive change just because it’s almost time to go home? It shouldn’t, but in some cases, it just might. Whether you’re rushing through your assessment, looking at a poor 12-lead because its “good enough” and bypassing that occasional necessary prep work to get a good clean picture, or trying to burn through that last Patient Care Report, the only person that suffers is the person who is receiving the care you’re providing. The hours that one works in EMS can be demanding. This is not your typical 9-5 Monday through Friday job and I think...

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...

Most EMS Professionals are asked to act on their own, and be responsible for their actions and decisions. In a system such as the one I work in, there’s a chance that the EMT’s contact with their direct Supervisor will be limited to twenty minutes at the start of their 8 to 12 hour day, and twenty minutes at the end of their shift. For the rest of the day, they are essentially their own boss. In order for them to achieve the goal of working so independently, we ask them to take inventory of their personal values and remember the goal and mission statement of the organization when making decisions that might not be clinical in nature, but that could have a profound impact on themselves and those around them. That is a lot of responsibility for some people to handle, but we expect them to be able to do it because not only do we ask them to watch out for their own personal well being, we also put the lives of others in their hands. EMS can be an exhausting job. We’ve all been there: we’ll go an entire day without a bite to eat, and barely a bathroom break. We encounter overworked nurses, patients who may or may not appreciate our presence in their lives, and (dare I say) fellow EMS workers who might not possess the same work ethic and goals as we do. Add to that sleep deprivation and you could say that you have a recipe for disaster. As each moment ticks by, that filter between our internal dialogue and our external one grows more and more thin, and the chance that those inappropriate words or actions could slip out increases. Lately, I’ve been on a quest to find articles, tips, and tricks to pass on to my colleagues here in my system that will help them to walk the straight and narrow, and do the right thing, not only for themselves, but also for their coworkers and their patients. With the words, blogs, and tweets that many of you have shared with all of us over the last seven months, I’ve acquired some great tools, and...