If anyone ever asked me what the internet was, I would tell them that it is a series of fads.  Ideas, popular websites, and social media networks come and go sometimes at the blink of an eye.  Does anyone remember Myspace?  I didn’t think so. . . There is one fad though that has come about in the last three years that needs to be recognized, and people need to be reminded that it is still there.  While some might say it is not for them, the EMS 2.0 movement actually lives in all of us.  Any EMT or paramedic who has ever said “I think I have a better way to do this” deep down shares his or her beliefs with Justin Schorr, Chris Kaiser, and everyone else who had input into that initial manifesto. I was reminded the other day that although it might be quieter than it was a few years ago, people are still talking and sharing about EMS 2.0.  I was in a uniform shop in a remote town getting fitted for my new threads, and there, in a cabinet with about forty or fifty patches from police departments and fire departments from the surrounding states was an EMS 2.0 patch.  I do not know how it got there, but I do know that it was not from Justin, Setla, Random or myself.  Someone walked into that uniform shop, and said “hey, I’ve got a patch for you.”  And knowing the people that carry those patches and pins around with them, that was followed with “Let me tell you a bit about it.” Currently, the blueprint for the rebooting and redesign of EMS is a simple one.  All we need to do is find what works for our particular system.  Start with something simple.  Explore alternate treatment options, or rethink staffing and response.  Realistically, it could be anything. There are questions to be answered about the future of our profession, and it is our responsibility as the current crop of prehospital providers to decide for ourselves where we want to be in the next ten or fifteen years because in ten to fifteen years, we are going to be...

It’s been quite the week.  I moved into my new apartment about 24 hours before I was due at my first day on the job, and due to circumstances beyond my control, I had no internet access!  Well, a week later, the problem was solved and the interwebs are once again pulsing through the lines in my apartment allowing me to share with you another reflection of what I have experienced over the last twelve years at my “old” job. While having a conversation a few years ago about dealing with low morale, I was told “there is not much that I can do about morale.  It depends on the individual.  It is an internal thing.”  While it might be true that a paramedic’s happiness might be guided by what he or she wants out of a service as an individual, leaders still play a major role in steering and guiding the values of those who work for them.  Simply showing value is the easiest way of doing this. In a field that has been described both internally and externally as having “inexcusably low pay” it is up to “the brass” to get together and find ways other than adding zeroes to someone’s paycheck to let them know that they are an important piece of the team.  Putting forth an attitude of “I give you a paycheck, what more do you want from me?” will do nothing but give a service a good reason to remove their bay doors and replace them with revolving ones because they will see people leave as quickly as they walk in the door. This is a thankless job, and frankly, the statement of “it’s your job” does carry some merit.  We do have a job to do, and we do have people to serve.  “Routine” emergencies happen, and even serious ones that will slip past medical directors, bosses and peers and go completely unnoticed, but it’s not the individual call that people deserve recognition for it is the individual doing the call.  It is the overall performance that deserves to be recognized.  It is the fact that someone is always there to answer the call, 24 hours a...

Nov 26, 2012

Someone can have the ability to make command decisions that steer an organization whether it be large or small but that person is not a leader until they find someone who is willing to follow them.  In the last year and a half, I have written about a few of the incidents that I have been part of, mainly the tornado that hit Springfield on June 1 and the ice storm that we had last year around Halloween.  Just the other day though, I added another one to my list. In the downtown area of my city, we had what started out as a simple gas leak.  That all changed when four miles away, sitting in our office, I heard a loud bang.  The building with the leak exploded with two of my crews only a short distance away.  Thankfully, they were okay, but we were called to action to organize and take care of close to twenty people who were injured.  Everyone involved is still counting our blessings that no one was killed. In moments, the people that I had in the streets started to mobilize.  Crews cleared the hospital.  People in their homes, not 100% sure what had just occurred started to put their uniforms on and head to work.  I took the new supervisor I was training to take my spot and started a ride that felt like it took an eternity down to the scene.  It took about twenty minutes to get organized, get a staging area setup, and to really start getting a grasp on what we were dealing with but once we did, we were ready for whatever would be thrown at us.  The response from the EMS community was amazing.  At peek, we had more than twenty ambulances in our staging area ready to do whatever it took to make sure every patient got out of there.  The unsung heroes though were the fifteen people who showed up at the office who were not even scheduled to be in that day ready to jump on ambulances and go wherever they were needed.  With all of the trucks that we had assigned to the explosion, we were able...

Okay, so my absence lately has been more than noticeable but there IS a reason behind it, I swear.  And despite what the title of this blog might imply, no I am not closing the blog down, quite the contrary, actually. At the end of last week I did something I never imagined doing, I gave my 2 week’s notice to my current employer.  After twelve years, I am moving on.  It has been quite the ride for me, and I am taking many, many lessons and memories with me, but a move to a high performance EMS system that can offer me more of a future is a must at this point. As I start my career as a twelve year FNG, I am sure I will have plenty more to share. Right now though my focus is on my final five shifts.  Next Monday is my last day.  I’ll have plenty more to say between now and then!...

First of all I would like to thank those of you who commented on my post entitled Stress the other day.  There were some great words of wisdom there, and Bob Sullivan from EMS Patient Perspective shared some links to some really good articles. Greg Friese asked what I do to help those around me with stress.  Personally, I feel that as a field supervisor it is my responsibility to have a grasp on the mood of my employees.  That is a daunting task since I have around two hundred paramedics and EMTs, some full time and some part time, working in my service.  I personally need to be able to watch as many of them as I can for mood changes, and when I see them I need to be able to refer them to the places where they can get help. The resources available to them can be as simple as a walk through the garage and a friendly conversation or it could be a phone call to muster up our regional CISM team.  Additionally, EAP is a great route to refer employees to especially if the root of their issue lies outside of work. Most of all, the most important thing that any leader can do for their people is make themselves available to their employees whenever they may need to talk.  This needs to be a team approach though.  I know all too well that I am not the first choice for everyone to come and talk to.  Personalities clash, and frankly, not everyone gets along all the time and they cannot be expected to do so.  Thankfully, there are a number of other people on my management team, and for the most part, most EMS services are not a one leader shop.  If someone says, “I dont want to talk to Scotty about this” that is fine.  I don’t need to be their sounding board.  The important thing is that they go to someone about it. Availability and access.  That is what is most important.  People cannot get help if they do not know where to find it.  My advice to those in the field is to find someone...

Quite often I see some EMS news story come across the wire about how a paramedic neglected to care for a patient as they should, or delayed a response, or in extreme cases were involved in some sort of serious altercation resulting in the injury or a patient, a tech, or their partner.  With every story I read, I get more and more concerned about the state of EMS, and the people who are providing care.   While none of the situations I’ve read about are excusable, I think it is our responsibility to find the root cause, or at least minimize the chance of these incidents repeating themselves.  Personally, I feel that while stress is not an excuse it is a huge factor. As a community it is our responsibility to give each and every provider not only the access to the training that they need to best provide care but we need to police our own to make sure that every provider is fit enough to provide that care. Recently I read a story about a paramedic who was arrested for assaulting a patient.  While there is no excuse for his actions I cannot help but wonder what signs and symptoms this medic showed prior to the incident occuring.  I am not talking about during that shift but more in the weeks and months leading up to it.  When did they start to turn?  When did their attitude really start to decline?  Most importantly, what did anyone do about it to try and turn this person around? A lot of it points towards the question of “how busy is too busy?”  Of course one must also ask if this is the job for them, but the EMS industry is so  focused on a single mission which centers around getting people to the hospital.  While a typical day on the ambulance can offer a large variety of calls, the sheer volume and type of calls can certainly create a stressful environment.  As those days compound into weeks, weeks to months, and months to years, each individual day becomes a contributing factor towards what could eventually become a burnt out paramedic. I have written...

I’ve been thinking a lot about cardiac arrests, CPR, and the barriers that I face in the system that I work in.  Chances are, if it is a problem here then it is a problem somewhere else, which makes it worth talking about. In the system that I work in there are two types of dead people: people who are not workable; that is to say, they have some injury incompatible with life, or conclusive signs of death.  The second kind is one that ends up on a stretcher in an emergency room.  That’s right, if you get CPR, you get a ride to the hospital. After doing some research earlier this year for a class I was teaching about running a better code, I found a clip from Wake County, North Carolina where their medical director Dr. Brett Myers talked about the key points to the quality of cardiac arrest that they provide.  The one big one that stuck with me was “Don’t move them.  Work them where they drop.”  I realized very quickly that Wake County had one very important component to high performance CPR that my system lacked. Over the last two years we have learned a lot about quality of compressions and their importance.  Anyone who has taken ACLS or an ACLS refresher has heard that you never stop compressions, or at least you greatly minimize interruptions but what they fail to address is the importance of knowing when to say when and affording us enough options and guidelines telling us when to stop CPR.  Actually, let me rephrase that.  The content and evidence is there, but a few systems have chosen to ignore it. So am I saying that knowing when not to do CPR or when to stop doing CPR is an important piece to improving ROSC rates?  You better believe i am.  Let me describe a common cardiac arrest in my system: The crew gets on scene to a confirmed code with fire department first response and more times than not, a second ambulance is coming behind them to assist.  When that truck arrives, the patient is loaded into the best way to extricate them from where...

How good of a paramedic are you?  Have you ever wondered?  Well, lucky for you there is some proof in the numbers.  Getting an idea of how well a paramedic does their job is not as hard as some people think, and with a little bit of research it is easy to figure out how successful your patient care is.   With data collection what it is today, one can look at things like their IV and intubation success rates, or their time to STEMI recognition or even their scene times for trauma calls to make sure that they are, in fact, within the Platinum Ten.  The rest of the job though you are going to have to judge from yourself, from your gut, or simply ask your partner: “how good am I with my patients?”  Bedside manner might be the most vital skill that we all possess in our toolbox and while tools such as patient surveys might give a single provider or a service a better idea of how much compassion and empathy their employees show towards their patients it is largely immeasurable. When talking about employee surveys with a colleague a few years ago, he told me that from his experience with them they were largely polarized.  The surveys that were returned from patients usually either gave a glowing, favorable review of the providers or a scathing dissertation of how poorly they were treated.  Those people who fell largely in the middle rarely said that the care was “just okay.”  One is left to assume then that all of those unreturned surveys, sometimes three out of every four, reflected that the providers did in fact do nothing more than an adequate job. Adequate should not be viewed as a bad thing, and don’t think that I am trying to paint that picture.  Lets face it: you are not going to be able to please everyone, and someone who is sick or injured will most likely be exponentially more difficult to satisfy.   When reviewing patient feed back, I have seen all sorts of complaints: “The ride was too bumpy” “the driver took a longer route to the hospital than he had...

I admit it, I’ve slipped and stumbled.  My blog has been reduced nearly to the occasional urban tumbleweed (read: plastic bag) that kind of blows through every so often.  With high hopes for content, I have not nearly been putting out as much as I would have liked, and you know what?  It’s my fault.  It’s all my fault. While I was expecting big things for 2012, and I seemed to start off on the right track, the last few months have not been quite as fruitful for a number of different reasons, many of which will become more clear in the coming months. One thing is for sure though: I need to get back to what is important. I have been reminded a lot of why I really enjoy this online community lately, and why I am so passionate about EMS.  I had a chance to speak to the guy who made this all possible for me: the one who set me up in Oakland that opened my eyes to the Chronicles of EMS.  I have talked to a few people who I truly respect about the direction of my career and my potential future and have gotten nothing but support.  To those people: you know who you are, and I thank you. Above all else, I need to get to what is important to me: writing, being a good paramedic, a good supervisor, and a strong advocate for the industry and frankly, there is no better time than now for me to get cranking on that.  I am in a holding pattern at the moment, treading water if you will.  The NREMT-P card is in my pocket along with my PALS, PHTLS, and a new ACLS card.  It took a lot of hard work, and I am ready to put forth that sort of effort here among other places. I think that getting everything back on track is just what medical control ordered.   To all of you who have been faithful readers during the last year and a half, I am sorry I have neglected you.  I will tell you that I plan on continuing to write this blog for myself,...

Please be advised that the video does contain some language which might not be suitable for all viewers. In case anyone hadn’t realized it by now I am a huge fan of the HBO series The Wire.  I think it was one of the best directed, written, and acted shows I have ever seen.  I own every season on DVD, and I think I’ve been through every episode two or three times.  This is one of my favorite scenes, and I feel like it presents an interesting metaphor. Think of the desk as the current state of EMS today.  Everyone has an agenda for it, and has the intention of moving it in the direction that they feel it should go, whether that is where it belongs or not.  The one person who has the knowledge for the desk’s proper destination fails to speak up simply assuming that everyone else around him is already in the know, which they aren’t.  So he starts pushing.  From the opposite side, they start pushing.  More people arrive and decide that they know what is best, they take up their positions and start pushing as well.  What are you left with?  One big stalemate.  No progress. So what’s the answer?  In the video it is simple: everyone needs to shut up and decide as a group what needs to be done, and how to do it the right way.  In real life it is a bit more complicated.  We need a unified direction, and we lack that.  The NFPA sets one standard while evidence based medicine suggests another.  Some preach prevention and proactive medicine while others still insist on code 3 responses by multiple agencies to nearly every request for assistance.  Which is it going to be?  Do we want a fast, timely response or one more gauged towards what is medically efficient? Let’s pick one and stick with...