Oct 17, 2019

The world of social media is full of experts on almost every topic, including prehospital medical care.  When I say experts, I guess I should really be saying “experts.”  There are a lot of people out there who know how we should perform our jobs, and how things should be done.  Let’s take a closer look at one such example that recently made its way on to my timeline. You’re a BLS provider.  A 70 year old male who is experiencing chest pain calls 911.  The patient and his wife tell you that he has a history of an MI which was treated in Philadelphia in the year prior.  They are requesting to go to a community hospital without interventional cardiac catheterization capabilities that is about 20 minutes away.  About 15 minutes past the community hospital is a larger hospital with an interventional cath lab.  The paramedics are on the way, and you have an opportunity to meet them on the highway.  The safest place to rendezvous with them is at a rest area just after you get on the highway. You pull over, and wait for the paramedics to arrive.  The wait is described as causing as long as a “15 minute delay” to perform a 12-lead EKG.  The EKG is done, it comes back as non-diagnostic for STEMI, and the transport to the community hospital is completed.  At the surface, with the theatrics of a storyteller aside, as an “expert” on EMS, it seems appropriate to me.  There was a decision to be made and a determination of what definitive care was for that patient.  If he was positive for a STEMI, an interventional cath lab becomes definitive care, not a community hospital without those capabilities. A husband and wife residing in Sea Isle City, New Jersey disagree with my view.  They felt the care was inappropriate and the delay was not warranted.  They took their concerns to the town council. Barbara Crowley told the city council that “If this delay had been the last time, I would have lost my husband.”  I can play the “what if” game too.  If this delay had happened last time, the patient would have had...

Oct 8, 2019

Last week I wrote about how I was blocked by the National Association of EMTs on Twitter.  I received a lot of positive, supportive outreach from friends and colleagues so to all of you, thank you for that!  Additionally, I received a comment from NAEMT President Matt Zavadsky who left a comment on the post that included his personal cell phone number, and another correspondence from an old college friend who is now on the NAEMT board.  I am going to discuss my talk with Matt here, as our interaction was “on the record.” First, I want to say that I have a ton of respect for Matt.  I’ve taken his classes at conferences, and I closely followed the cultural changes that he led down at MedStar in Fort Worth, Texas.  He has always been an EMS leader that I admire, and my dealings with NAEMT have not changed that.  It meant a lot that he reached out, and we had a chance to talk about a few different issues in the time that we were on the phone. Regarding the issue of advanced degrees, Matt said that the issue of advocating for advanced education in EMS is one that is very delicate for the organization.  With a large mix of fire-based providers, with the fire sector being the most vocally opposed to the movement, and rural paramedics who are already strapped for staffing, there were concerns.  Couple that with the current funding streams that many sectors of the profession are struggling with, and Matt said (and I am paraphrasing) that the organization needed to take a far more neutral approach to the topic.  While, personally, I would like to be part of an organization that continues to challenge me, and make my profession more competitive and marketable, I understand. Now, regarding the issue of my Twitter block, my position as compared to the organization’s, as conveyed to me by Matt, become a bit more divisive.  In his comment, Matt said, “we maintain social media platforms to allow our members to express their opinions on EMS issue and their opinions about NAEMT, even when those opinions are not positive. The only restrictions we place...

Oct 2, 2019

Yup, your eyes are not deceiving you.  I have been blocked by the NAEMT.  But before I get into what is going on right now, let me give you a bit of background. Back in 2010, I started this little blog as a free Blogspot website lamenting about issues that I felt were important in EMS.  I made friends.  I became part of the EMS 2.0 movement and I took an interest in the National Association of EMTs.  The big draw from me was the large-scale advocacy that they were doing in Washington DC for EMS on the Hill day. I attended three of those EMS on the Hill days while I was living in Massachusetts.  I even wrote an article on grassroots advocacy for the NAEMT newsletter.  I became a State Advocacy Coordinator for Massachusetts and I was even approached by officials from NAEMT asking me to run against and hopefully unseat a long-standing Regional Director in the Northeast.  I contemplated doing it, as I felt it was time for a change of representation in the region where I was living.  A few months later though, I decided to relocate to Delaware which would move me to a different region anyway, so I declined the offer to run. Once I moved out of Massachusetts, I worked with the Advocacy Coordinator in Delaware for a short time but had trouble cracking the tight knit group down here.  There were no issues or hard feelings, it just did not work out and that was fine.  I was acclimating myself to a new area and a new EMS system.  I eventually just let my NAEMT membership lapse. About four years ago I signed on to the EMS Compass project aimed at determining and utilizing different measures to try and try an quantify and qualify how good we are at this whole EMS thing.  It was an ambitious undertaking.  Very ambitious.  A few things became evident rather quickly.  There was a lot that needed to be done. There was even more that could be done.  And there would be people and organizations who would probably not like the results, and some opposed it. NAEMT was one of...

Sep 30, 2019

Well, I am back.  It has been nearly two and a half years since I knuckled down and wrote about this career that I am so passionate about, but I feel like its time for me to sit down in front of the keyboard and just let this happen again. I am sure that some of you are wondering where I have been.  My best answer is experiencing life.  I am still working the job that I left AMR for nearly seven years ago.  I am engaged to be married in just over a month, and I currently live with my fiancée and our two four legged furry children.  My proposal can best be described as “epic” having proposed just over a year ago in front of part of the cast of the hit NBC sitcom The Office.  It even earned us our 15 minutes of fame and about 20,000 up votes on reddit. We have been vacationing in Disney World annually, which is more addictive than I would have ever imagined.  I have also dusted off my golf clubs for the first time in years, and I am hitting the links again with some of my coworkers, something that we are looking to make a regular occurrence. My professional career has been great.  I’ve been able to participate in projects like NHTSA’s EMS Compass initiative a few years ago, I am a faculty member with the Delaware Resuscitation Academy, and I have been given the opportunity to perform quality assurance and improvement on my department’s CPR cases.  Those who know me outside of this blog, or those who knew me back in my AMR days probably will not be surprised by that.  I have always been happiest when I’ve had my hands in more than just field care. While I have not been writing about paramedicine and issues in EMS, that does not mean I have not been writing.  A few years ago, I became a season ticket holder at Drexel University with their men’s basketball program.  Drexel is my dad’s alma mater.  Along with a few other season ticket holders, I have been following and covering the team for their last four...

Jun 22, 2017

There has been a lot of buzz over the past week about California’s EMS Bill of Rights.  Dave Konig has a great take on it over at The Social Medic that I encourage you to read.  American Medical Response has even launched a counter campaign to it complete with the hashtag #LivesBeforeLunch.  While that makes me cringe a bit, I want to touch on one line of AMR’s response to the bill that stuck with me. “As written, AB 263 is an unprecedented political power grab, and will heavily penalize private – but not public – employers of EMTs and paramedics.” When I look back at my career with AMR that spanned more than twelve years, I had a lot of ups and downs.  Had busy shifts and I had slow shifts.  I found myself mandated to work despite being sick, or just needing a day off.  Through the highlights and the lowlights of working in a busy 9-1-1 system that amassed roughly 40,000 calls per year, the instances where my 12 hour shifts hit double digits were rare when compared overall to my full body of work. I have friends who work in the “public” sector in some of the busiest EMS systems in the country.  One who works in a fire-based EMS system routinely does more than 20 calls in a shift.  In fact, the overwhelming majority of medic units in their system far surpass the volume run by their busiest suppression pieces, and you know what the response from some of his coworkers on the suppression side is?  “I know I occasionally get a full night’s sleep while you are out running, but you chose your career and I chose mine.”  They are under represented by their union and are the medics who really need protecting, not the EMS based paramedics and EMTs of the private sector, yet that is who this bill is targeted as. In all my years involved in EMS, AMR has never hidden what it is.  They are a for profit company.  They are a place for EMTs and paramedics to find a job, and rarely a career.  The higher that you go on the food chain,...

May 21, 2017

EMS Week 2017 is upon us and as always there are a lot of positives that need to be pointed out.  Its a time to recognize the little things that people do, and more importantly the people behind the uniform.  It is the week of the year that should be about us, because the other 51 weeks out of the year should be about the patients that we serve.  With taking all of that into consideration though, this is not going to be one of those positive posts. Last week, there was a call for articles and posts related to the tagline “EMS Strong: Always in Service” for this week’s message to providers.  It asked for people to talk about what it means to them.  Well, here you go. I grew up in a heavily volunteer driven community.  When I started EMS, every BLS unit on the street was staffed by people dedicating their time.  Much like myself, many went through their day to day activities with a Minitor II pager strapped to their hip, waiting to hear that rhythmic beeping that still gives me palpitations more than 20 years later.  Day or night, weekend or weekday, on school vacations or snow days, it did not matter.  I was always in service. At the time, I was a young, naive teenage EMT.  I was happier on the ambulance than I was on the high school basketball court.  I did not care if I got home from my summer job at 2am, if the pager went off at 3, I was going.  I did not have a care in the world.  EMS was what mattered to me.  I was always in service. In college, I sacrificed many Friday or Saturday nights where my college friends would be out drinking and partying to throw on a uniform, turn on the radio and go trucking out of my dorm to take care of the sick, vomiting, and ETOH students of Springfield College.  I cleaned vomit off of my boots.  I cared for people that I might see in my economics class come Monday morning.  I was ready to go at a second’s notice.  I was always in...

May 12, 2017

Roughly twelve years ago, AMR and AEV’s Safety Concept Vehicle made its way to Springfield for us to take a look at.  It included a number of interesting features like an expanded harness setup to allow providers to move a little more freely around the box while still being anchored.  There were mounting brackets for cardiac monitors, and video cameras to monitor both the rear of the truck for backing up, and the passenger side to check for traffic before opening the curbside door. The vehicle itself contained a lot of positives that have been adopted over the years.  I see more cameras used in emergency vehicles and I’m a a fan of the checkered or striped patterns on the backs of trucks to make them more visible to oncoming traffic.  I have also seen a few more monitor brackets.  But where is everything else?  When is that ambulance of the future going to get here? Year after year at conference after conference, there will undoubtedly be some ambulance parked on the exhibit hall floor touting itself as the “ambulance of the future.”  Some have bucket seats that allow a treating paramedic to ride front facing with all equipment available at arm’s reach.  Or cabinets replaced with pouches that can be slid on tracks to more easily make supplies accessible. Then, year after year, I pack up my chachkies and my six month supply of vendor provided pens and I head back to my EMS service relegated to sit on the same old bench seat that I sat on nearly 25 years ago when I first set foot on an ambulance that was ten years old at the inception of my career.  I take the same risks while I care for my patients mainly because I have all but accepted the fact that if that ambulance is involved in a serious crash, I’m pretty much screwed anyway. Concept vehicles are great, but when is anyone going to do anything with them?  I’ve worked in a just a couple of ambulances with the bench seat replaced by a bucket seat, and it left a lot to be desired.  It felt cramped, and nothing like these...

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,...

As we start to dive down the rabbit hole of what makes an effectively run cardiac arrest, it is important to understand the roots of what we are actually doing.  Personally, I could go back some 23 years to 1993 when I received my first CPR card.  I learned the importance of opening the airway.  Looking, listening and feeling.  If the patient was not breathing, and I could not give a rescue breath, I had to reposition the airway.  Simply put, until the patient had a patient airway, and was effectively being ventilated or breathing on their own, not a single compression was done. If I had somebody with me, for every five compressions that were done, a ventilation was given.  If it was just me, it would be 15:2.  Sometimes I am amazed that we saved anyone at all following that.  In the system that I started in, I feel like we were ahead of the curve.  CPR calls were commonly not transported to the hospital.  We would work them at home and leave them at home. Fast forward now seven years to my time as a paramedic student and my early days as a paramedic.  Not much from that airway focus had changed.  ROSC was rare.  Survival to discharge was even more rare.  Every workable cardiac arrest was transported to the hospital regardless of rhythm or downtime. The success and failure of the care provided rested on two factors: whether the patient was turned over to the emergency room staff intubated, and whether or not the call time was short.  We would walk away from a code high fiving each other for delivering a dead body to the ER in 30 minutes or less, like we were some glorified Dominos delivery drivers. Throughout my career, my views on EMS and the impact that we have on the general public has swung to both ends of the spectrum.  I’ve felt that we were completely necessary for the well being and survival of every single person that we encountered, and I’ve felt used and abused by the system.  As I enter my 16th year as a paramedic though, I can without a doubt say...