For the past two semesters, I have had the pleasure of doing the opening lecture to an EMT class at a local college.  This means I get to stand in front of a lecture hall of enthusiastic and often terrified EMT students who have no idea what to expect.  My lecture is called “So, You Want to be an EMT?”  Its purpose is to give the students an idea of what to expect out of EMS both as a career and as a provider.  I do not talk about patient care all that much, the lecture is more about stress management, the qualities that an EMT needs, what calls are really like, and also a generalized 50,000 foot view of EMS. In addition to all of that, I also talk about finding the right fit.  I explain to them that one of the beauties of EMS is if you don’t like the system that you are in, all you need to do is drive down the road and you can find someplace else to start over that might work a little better for you.  In the recent months that has been something that I have had to tackle as well, and it has left me asking myself a simple question: “what is the perfect EMS system for me?”  What I have tried to do is sum it up into five qualities.  Here is what I came up with: 1.  EMS centered – I want a system that is dedicated to EMS.  They need to be focused on patient care and encouraging the growth of their providers.  The focus cannot be on profit, justifying call volume or fire surpression.  It needs to be all EMS all the time. 2.  Horizontal career opportunities – This was a term that I heard Skip Kirkwood use a couple of years ago during a lecture at EMS Today.  The career path in EMS cannot and should not be solely vertical.  There needs to be opportunities for the street level providers to contribute to the organization with steering committees, study groups and assignments beyond the street.  This creates an environment where paramedics are encouraged to be involved with the growth...

Nothing seems more satisfying than when hard work pays off.  I set the bar high for July.  I knew I had some work to do, and I had to make sure everything was done, and everything was in order.  That meant getting my PHTLS recertified, taking PALS again, updating my ACLS, and obtaining my National Registry certification.  While that just seems like four classes, it is a lot harder than one might think. The first thing that I realized was PHTLS classes are very hard to come by.  I did, however, luck out and find one class down in Connecticut at the end of the month.  That would be the last piece of the puzzle, but it was scheduled.  PALS was the easiest of the group.  I found a class pretty quickly and got that squared away.  ACLS?  They’re a dime a dozen.  Scheduled, and done.  No problem. Then there was my National Registry paramedic certification.  That’s right: the Quest for the Disco Patch.  This was the one that terrified me the most.  Being twelve years out from any EMS related exam that I had taken, and eleven years since I took any standardized test, I was a touch nervous.  Add to that the fact that I felt the pressure of actually being a provider, and I was then really nervous.  I scheduled the written first, followed by the practical more towards the end of the month. I studied almost every day for three weeks.  I would take practice exams, then study what I got wrong, and then take another one trying to absorb as much of that supressed information as I could.  When the test day came, I was a wreck.  I sat down on a Thursday afternoon and fired up the computer that I was put in front of and cranked through 87 questions.  Yes, that’s right, just 87.  I got there, and it shut me down.  “You have completed this exam, and will get the results in two to three business days.” Headache number one was gone by Friday afternoon.  NREMT was quick to get me my results, and I knew my written was all set.  Then it was on to...

I was working at my part-time job the other day, and we got into a lengthy discussion about Do Not resuscitate orders and when to honor them versus when to treat a patient.  Today, the conversation continued and we came up with an interesting scenario, and I wanted to see what everyone out there thought both from a moral/ethical stand point as well as a legal one. Here’s the story: You are called to the home of an 80-year-old male who lives alone.  His neighbor frequently checks on him.  Today, his door is locked, which is unusual.  Your unit arrives at the same time as the fire department who is there to help you gain entry and assist with patient care. You enter the patient’s apartment and find him supine on his couch.  His breathing is clearly agonal and you cannot detect a pulse.  In plain view sitting on the coffee table in front of him are the following: A bottle of hydromorphone which was filled two days ago.  The cap is off and the bottle is empty. An appropriately filled out Do Not Resuscitate order which clearly states that the patient does not wish to have CPR performed on him. A suicide note stating that he had been recently diagnosed with cancer and does not want to live anymore.  It outlines what he would like to be done with his personal effects. What would you do?  Would you start CPR on the patient?  Would you honor the DNR?  Does the suicide attempt void the presence of the DNR? Normally, I would expect a bunch of comments on this topic to say “I would contact medical control to see what they would like me to do.”  While I understand that, I would like to know what YOU would do as a provider. Also legal folks, I know you’re out there, what do you...

Twelve years ago I walked out of my state KED station declaring to everyone who would listen that “I hope I never have to do that again.”  I passed my state practicals the first time around which really was the bigger piece that worried me.  The written would come as I was a pretty good test taker but the hands on stuff needed to be done correctly on the first pass.  There was no passing by a skill and coming back to it if I was not sure about it. In August I plan on heading up to New Hampshire and taking my practical station for National Registry and I have to revisit all of this again.  My practical day for both my EMT and paramedic exams were pretty anxiety filled.  I wanted to get it done and never look back and that is really what I did.  Now I have twelve years of bad habits to put aside for one day of testing. Still though, even after all these years my paramedic instrutor Gary Childs, or GAC as he was known back then, standing over me reminding me to “rip the tape” on my IV station or stressing the importance of that first rhythm interperatation on a quick look.  I was well educated in paramedic school and for that I am extremely greatful. Paramedic school was extremely fun but challenging all at the same time.  I had a great group of classmates and we were close.  Some of us were college students who had entered a small four year program together while others were from fire departments, private services, and the community.  Regardless of our background we all bonded quickly and even today when I see any of them it is always nice to catch up on the old times and figure out where everyone is today.  Having them around helped surpress a lot of that anxiety that I had.  I always knew that if I had a problem that an insturctor did not point out to me one of them would share it with me. When it came time for state testing though I was on my own.  I had no partner...

I have a confession to make.  I have not taken a test in 11 years that was not based on material that I was taught in the few days prior.  That is to say, since college, if it was not ACLS, PHTLS, or some other EMS related course, I have not tested on it.  It has also been 12 years since I took a standardized paramedic certification test.  Now, I am on the verge of facing the National Registry paramedic test head on.  Every piece of information that I obtained in 1999 and 2000 will be called out, along with anything else that I might have learned along the way.  No pressure, right? The biggest change that I have seen over the years is the way that we are able to study is completely different.  Back then, having information “at my finger tips” involved me adjurning to my book shelf or hoping that the correct material was hiding in my bag somewhere.  Now with the inventions of Google, the enhancement and growth of the internet answers are even easier to come by, as they should be.  I am struggling though to figure out if that will make it easier for me to study or harder. I feel like I am a prety computer savvy individual with a good grasp on what is out there in cyber space but in embracing that I am also putting aside much of what I previously knew. For my entire academic career, when I had to I buried my nose in a book.  I was not very good at studying mainly because I did not do it.  My grades in high school were good, not great but good.  They were that way because as I look back now, I was bored.  I did not study very often and somehow still did well on tests but my grades were brought down becuase I was one of those lazy kids that did not see the value of homework.  When I got to college that hurt me in some of my classes because my study skills were not as good as some of my peers.  It was not until I got into...

Yes, I know, it has been a while. I feel like an absentee landlord failing to plug a leak in the blogosphere but here I am, back for a quick update. To put it lightly, June was a stressful month for a number of reasons both professional and personal. As time has gone on, I have pushed through, mainly with a focus on studying for my national and getting that Disco Patch on my shoulder. Because of this my time to spend updating you all on my progress and sharing my thoughts on what is going on in the world of EMS has suffered. Rest assured though that I am still here. With each day that I spend studying and with each practice test that I take I am feeling more and more confident with the information I have refreshed on and retained. Still though, I am still dealing with a considerable amount of test anxiety. Want to read about what I am going through? Check out my Wednesday and Friday posts. They will give you a better idea! Rest assured, as my Quest continues, I will keep you all updated. Failure is not an option. Stay safe out...

Last week the area that I work in suffered a horrific tragedy: we had a line of duty death of one of our city’s police officers.  The impact of this has been far reaching and very difficult on many of us.  One of the questions that I have heard over the last couple of days has been about scene safety.  The “what if” scenarios are being played out left and right.  “What if we were there?”  “What if it was for a medical call and not a domestic?”  While I too have asked myself these questions, the thing that I keep reminding myself and that I think we all need to remind ourselves is scene safety is not an absolute.  I am not going to talk about specifics of this call however I feel that this is an important topic to reinforce. Kyle David Bates of First Few Moments and Pedi-U fame teaches a class called “Scene Safety Stinks” and I could not agree more with him.  The words “scene safety” and the declaration that the “scene is safe” might give us a piece of mind, but all it truly represents is a false sense of security that we all hold near and dear to our hearts.  We should not “practice scene safety” or even worry about.  What needs to be important is “scene awareness.” Every scene that we are on evolves and changes moment by moment.  Something as simple as the introduction of another family member or a patient uttering the word “ow” in the presence of the family dog could change things in a second, and the number of police officers, fire fighters, or national guard that you have there with you will not be able to prevent whatever happens next.  When responding to any scene, keep the following in mind: 1.  Always have a way to call for help – Cell phones are great, but I’d rather have a radio.  No dialing required, no identifying yourself or asking for anything.  All any of us should need to do is announce our unit number and declare that we need help.  My radio now lives on my hip all the time so I...

In preparation for my quest for the disco patch, I started looking at reciprocity requirements throughout the country and I came to one conclusion: being a paramedic and trying to move is very frustrating.  For the life of me though I cannot figure out why this is. When I went through paramedic school so many years ago, we had a mix of people in my class: there were two of us from New Jersey, many from Massachusetts, one of New Hampshire, and a few from Connecticut.  We went through our Massachusetts approved paramedic class, but not all of us tested in Massachusetts.  A few of my classmates decided to go directly down to Connecticut and test there, as they had no intention of working in an EMS system in the great Commonwealth. Here is how it went: the classmate that I sat right next to who got the same training as I did, took the same tests, did the same amount of field and clinical time drove across a boarder that was less than twenty miles to the south a took a test that was not identical to mine but similar.  Both of us passed.  She worked for a service south of that boarder, and I worked for one to the north of it.  Despite the fact that our training was identical, in order for us to work in each other’s states we each would have more hoops to jump through to again prove our worth as a paramedic. Now, expand that out to a more national scale.  Some states accept certifications from other states as being just as good as certs from their own.  Others only accept National Registry.  Still others feel that National Registry is not even good enough and they require you to come in and take their state’s test.  Still another state on the west coast requires National Registry, a state certification, and then clearance within the specific county you choose to work in if you want to care for their sick and injured. Then there are Oregon and Texas.  Add on to that a minimum of an Associate’s Degree.  While I feel that these two states are right on...

As EMS providers, we deal with tragedy every day.  We see people at their worst and are expected to put on a stern, professional face and take control of each and every scene, but what happens when the person that you are dealing with is one of your own?  Emotions run high, and while the expectation should remain that we put those feelings aside we are, after all, human. Throughout my career, I have had to care for colleagues who have had medical emergencies.  I had to do CPR on a past fire chief from the town I grew up in.  I’ve transported an old crew chief of mine when his heart rate was 40 and he was on his way to get himself a pacemaker.  Tragedy can strike at any time, and although we look at ourselves as impermeable to it, we are just as mortal as everyone else. What it comes back to is knowing our own limitations.  When it is in the best interest of our patient, there is nothing wrong with “tagging out” and letting someone else take control of a call that has a clearer head than you might at that moment.  It takes a clear mind to properly care for a patient and we need to remember that as paramedics and EMTs, we need help sometimes too, and we just need to be humble enough to ask for it. There is a lot of pressure on prehospital providers, and I do not think that many people in the public safety and medical communities realize and accept that.  Often, an EMT or paramedic is expected to deal with a patient on a one-on-one basis.  Take, for instance, a STEMI patient.  Quite often, a single paramedic is expected to obtain baseline vital signs, perform and correctly interpret a 12-lead EKG, give medications, start an IV, reevaluate the patient, and make the proper notifications to the emergency room. If that same patient walked into an ER, the tech would perform the EKG.  One nurse would administer meds and start that IV while another one charted.  The secretary would make the notifications to the cath lab, and the resident or attending physician...

There comes a time when we all reach a crossroads in our lives when we are forced to make a decision of where to go and what to do next.  I reached that point just the other day and have decided that it is time to make some changes in my life.  I’ve realized that there is more out there beyond my little world and I want to go out and explore a bit. The gut checks that I have had to do on myself have been becoming more and more frequent, and I feel that it is time to put myself first, which is something that I frequently fail at.  Far too often I have made my job and other responsibilities while pushing my own well-being to the back burner.  It has never been a smart decision and always seems to go against the “practice what you preach” concept that I advocate for so frequently, but I am learning. Changes take time, and they take effort.  The next steps in my life are going to be a sizeable challenge but if… no.. WHEN the ends justify the means then I know I will be happier and in a better place in life.  The first step for me is an obvious one: my quest for the coveted Disco Patch has begun!  The next six weeks of my life is going to be spent nose in a book studying for an upcoming National Registry test.  From there, the possibilities are limitless. One thing that is not going away or changing is my love for writing.  In fact, my upcoming adventures are a real inspiration and I would like to invite you along for the ride.  It might be a bit bumpy, but eventually things are going to smooth out and everything will be okay. The only question that I have though is: do those disco patches come with a leisure suit or do I have to buy that...