It is hard for me to believe that it has been a whole year since an EF-3 tornado tore its path through Western Massachusetts.  We were very lucky that day.  Loss of life and the occurance of injury was surprisingly low.  Most importantly though I was lucky enough to work with some amazing people that day.  Back on June 13th of last year, I shared some thoughts on the day that I would like to invite you to read. Late last year, however, an even better opportunity was presented to me: I was given the chance to write a chapter for a book called Springfield Tornado: Stories from the Heart.  The book was officially released today, and I am extremely proud of it.  Clicking on the title of the book, or the picture below will take you to the ordering page for the book.  If you ask me, it is worth the read, but of course, I am biased....

With Emergency Medical Dispatch becoming the gold standard across the country we need to remember its limitations while appreciating its virtues.  EMD is far from perfect.  An example of this is the recent call in New York City that was reported by The Daily News where a woman died with an associated 14 minute response from the ambulance crew.  The initial nature, sick and not eating, warranted a non-emergent response, but 8 minutes later, when the woman began vomiting blood, the response was upgraded based on the information received. The public outrage from this fourteen minute response was so severe that one of the EMT’s was assaulted by a family member.  Although being upset does not justify assaulting someone, especially a person who is there to help out your loved one, I can understand to some extent why this woman’s son was as angry as he was. In a situation like this though who is to blame?  Was it the EMTs who arrived as quickly as they were sent?  I’d say no.  Is this woman’s other son who presumably has no medical training the one that we should look to when seeking someone to blame?  Again, I would think not.  How about the Emergency Medical Dispatcher who asked the questions and went off the information given to him or her from the non-medical trained witness to this tragedy?  Nope, wrong again. Although mistakes are going to happen especially in a system as large as New York City’s I think it is actually the FDNY’s administration’s fault that something like this happened. When a person picks up the phone and calls 9-1-1, their expectation involves ambulances, fire trucks, police cars, and anyone else they might want to be racing across the city, lights and sirens blaring coming to help them no matter how major or minor the situation is, and we allow this expectation to continue.  We allow people to determine what an emergency is rather than letting the experts make that determination. The emergency rooms have it right.  If you’re having chest pain, if you’ve been stabbed or shot, or have something time sensitive that needs immediate treatment you theoretically jump as close to...

Since it is EMS week, I decided to take some time and look back over my career.  This is my nineteenth EMS week which is a staggering statistic for me.  I knew from day one that I loved this field, but there was a part of me that always doubted that I would stick with it as long as I have. I have picked up a lot of hobbies and side projects over the years but nothing has stuck with me the way that EMS has.  From the first day that I was eligible to get on ambulance that has been where I have wanted to be.  It is hard for me to pin point one reason as my motivation has changed as I have evolved and progressed in my career.  On that first call I think that it was the adrenalin rush.  It was being involved in that emergency and stepping up and seeing it through to the end.  I remember watching the paramedics working out of Community Medical Center and thinking of them almost as gods.  I was always amazed at what they were able to do.  They were larger than life to me, and I could never imagine myself being in their shoes. Once I got my paramedic card in the mail, I was motivated by all of the new things that I would be able to try, but I was also terrified.  I remember sitting in my car getting ready to head into work for my first shift as a cleared paramedic, dry heaving in the parking lot because I was so nervous.  I saw great opportunity in what I was doing, but I also saw great responsibility, and having that responsibility was very scary for me, and I feel like that showed through in my medicine for the first year or two that I was a practicing paramedic.  I could be quite high strung and on edge at times. As I got more comfortable though I feel like I progressed into a pretty decent paramedic.  I was not the strongest by far, but when I was unsure of something, I was always quick to ask.  I knew my limits,...

May always seems to be a busy time of year where I live.  Within about a twenty mile radius there are eight different four year colleges and two different two year colleges.  Each weekend seems to be chock full of graduations and graduation parties. This past Saturday I had a chance to go to the pinning for some friends who were finishing up their doctorate in physical therapy.  I am extremely proud of all of them, and although I know they are all destined for great things, I will wish them luck anyway. During their pinning ceremony, a class video was shown featuring comments by each of their professors within the departments.  Everyone had a lot of great things to say about the class.  They shared pearls of wisdom, stories, and reflections over what they saw from these sixteen individuals over the last year.  After hearing what each professor had to say I understood why my PT friends did as well as they did: they had great mentors and role models. Except for one. . . When it came time for the department’s management instructor to share her thoughts, the statements she made on screen was one that stuck with me, and not for a positive reason.  She informed the class that they would go on to be leaders, but then corrected herself stating that “not all of them” would be, and some would just be physical therapists.  Mind you, I am paraphrasing a bit, but I think you get the point. Its hard to believe that the professor of a graduate level program does not understand the difference between management and leadership.  While the two might be closely associated by some, one does not need to be in management to be a leader, and just because one is in management that certainly does not make them a leader.  During my premanagement days, there were many, many “blue shirts” that I would follow anywhere.  Heck, there are still a lot that I would gladly take a back seat to just based on the respect that I have for their abilities which in many ways are better than mine. In order for a person to...

First of all, I want to say Happy EMS Week to everyone out there.  Your dedication might not always been seen by everyone but the important thing is when you go home, you know that you made a difference. Now, we all need to remember and realize that EMS Week is not just about us. EMS week should be a time to recognize the professionals that sacrifice time with their families, friends and loved ones to put the needs of others above their own.  EMS is a thankless job and although I feel that as I write this blog post I am “preaching to the choir” it needs to be said again: thank you for everything that you do. If your service is anything like mine, you might be left with a bit of an appetite for more EMS Week activities, but my desire goes above the appreciation for the crews.  Although EMS Week was created for us to be the stars we still have a responsibility to the public and we need to use our “15 minutes of fame” not only to appreciate those who go out and “save lives” every day but we need to make sure that we share with those who we serve what we are all about. Let’s put it this way: if you service is not having an open house this week, they are missing out.  If there is not an article in the paper not only talking about the great people working in EMS but also describing the struggles that they overcome every day you are being short changed. I’d like to ask you all to make the most of your EMS Week, but also take the time to educate just one person about EMS.  When EMS awareness increases then so too will the respect that we all receive from those who we serve. Happy EMS Week,...

I posed this question the other day on Twitter: “If you offered your local politicians a lesson in EMS, how receptive do you think they would be?”  I got a variety of answers some more jaded then others, but it really got me thinking: what would I tell them, and what would I want them to take from what I have to offer? When it comes to EMS, many people both in the community and in positions of power have an attitude of “how hard can it be?”  They think if you put two people with a patch on their shoulder in an ambulance and put them on the street, they will pick someone up and get them to the hospital.  That is true if you want mediocre service that provides nothing more than a “point A to point B” relocation for people.  That, in my opinion, offers virtually nothing to the community.  Prehospital response and care is supposed to be much more than that. We have also accepted incorrectly that EMS is a time sensitive business.  Faster is better.  Fast care means effective care.  Not true.  Those of us IN the field understand that despite what some might think, lights and sirens do not always offer a safe response, and while they might get our ambulances there quickly there is little benefit to the patient in most cases.  Sure, in some having someone there in minutes could be life-saving, but those instances do not occur as often as some might think, but more times than not, I feel that as an industry we have the right tools to guide us in triaging emergencies and when we use them the right way, we do a good job of determining which calls need a fast response and which do not.  Contracts and public perceptions, however, have painted us into a corner and ambulances continue to scream from one end of communities to the other lights and sirens blaring. As an EMS provider, I would rather see a highly trained EMT or paramedic standing at my door equipment in hand ready to assess me or one of my loved ones.  I’d rather see an EMT take...

I really need to know: at what point did EMS stop being about patients and start being about providers?  When did EMS become more about justifying jobs than about taking care of people?  And when did scare tactics become an acceptable way of disseminating information to the masses? I am sorry, but I am angry, and I am not willing, as a prehospital provider, to take it anymore.  Preying off of the unjustified fears of others is just plain wrong.  Telling someone that lesser experienced less equipped EMS staff geared towards saving jobs rather than saving lives is the best choice is like telling your kids there is a monster under their bed to keep them from getting up late at night.  Anyone who takes these kinds of action, whether they be a public official, a private company, a fire department, a police department, a union, or anything else should be ashamed of themselves for utilizing such deplorable, unethical tactics. We need to get it through to the public that what is really important to their well-being is that they have strong providers standing at their door when the need for them arises.  A truly efficient high performance EMS system realizes the limitations of each of its participants and compensates for those by emphasizing the strengths of the other stake holders with one goal in mind: the effective delivery of prehospital care.  They are proud of what they do, and they let everyone know it, and most importantly they are not vindictive and manipulative.  They work together as a team.  They stand up for each other and they don’t allow bad blood to simmer or go unaddressed because they realize that teamwork is so important. One of the key goals of anyone employed in any branch of public safety should be to acquire the trust and support of the community.  It is really sad when instead of rewarding that trust with factual information about what EMS is, what its purpose is, and how it is best delivered, some chose instead to prey on that trust, distribute misinformation (sometimes to the point of it being a blatant outright lie or fabrication) all for their own...

There has been a topic that has been bothering me for quite a while now, and I feel it is time for me to weigh in on it. One of my favorite shows that has ever been on TV was HBO’s miniseries A Band of Brothers, based on Stephen Ambrose’s book of the same name about Easy Company of the 506th Parachute Infantry Regiment in World War II.  In one of the show’s best episodes, the company’s medic is forced to ration medications and supplies so as to provide as best he can for The result is him having to hoard morphine for the more severely injured soldiers and carefully consider his treatments and who gets them and who does not.  I have watched that particular episode many times and thought to myself that I could never imagine having to make those decisions.  I always felt that in medicine, everyone deserved the same care, whether it be in the form of life saving medications, supplies, or pain management. Now, here I am, almost 70 years later, and I am on the verge of being forced to stare at a drug bag with expiring medications that cannot be replaced, and having to choose between morphine and the far superior fentanyl based on what I feel my patient’s needs are.  But who really is to blame? One of the greatest tragedies in this country is the profit machine that is health care.  It exists on every level from insurance companies to hospitals to manufacturers of medical equipment to the big bad drug companies and even to prehospital ambulance services.  In fact, I am not a fan of any ambulance service being referred to as “for profit.”  The fact is whether an ambulance service is privately owned, classified as a non-profit, fire based, third service, or any other model that sends out a bill they are, in fact, in the EMS business to make some sort of profit.  But I digress. Some drug manufacturers have decided to stop producing certain medications because regulations and quality controls have become so strict that without a significant price increase, the profit that they can make from these drugs becomes little...

I am sure that most of you have noticed that I have been wading my way through another bout with writer’s block.  It happens, right?  I’ve beaten it before, and I will beat it again though.  I’ve gotten some great support from some friends who have suggested topics, and offered ideas for future posts.  The one I am sharing with you today though is one I find interesting. Last week, I was complaining on my Facebook wall about my struggles with writer’s block, and my friend friend sent me an interesting question: “I saw that you had writer’s block the other day and was curious to know if you’d be interested in running an informal and non-scientific survey of your faithful readers. Here’s what I am curious to find out: I have the opportunity to watch hundreds of transfers by the various private services in RI take place at various hospitals while I am posting. It seems as though virtually all of the techs riding with their patients sit in the airway seat behind the patient, usually entirely out of view of their patient. About the only time that I sit in that seat is when I have a backboarded patient (so my patient can see me) or a patient with an airway issue, at all other times I am either on the bench or in the “captains” chair, in full view of my patient. I wonder if this is generational/experiential/company SOP, etc. and why so many EMT’s now choose to be out of view of their patients? Just a thought, I am sure you have your own feelings and experiences from Springfield, and maybe this will help break your block.” Personally, my answer is simple, but it comes with an “*”.  Although I often tell people that I am only 5’9” the truth is I am actually 6’5”.  When I am working on a truck, they are 99%-100% of the time, van ambulances.  With my long gangly arms, I can reach everything in the truck from the comfort of the bench seat.  When I say everything, I pretty much mean everything.  Its freakish.  The only time you will find me in the airway...

In the digital age that we live in, it is becoming increasingly important for organizations and their leadership to embrace social media and use it to its fullest capability.  It is the fear of the unknown that really causes the problems that we see, and developing an organizational culture that promotes safe, appropriate use of social media is key. Take, for instance, the Facebook pages of Hennepin EMS in Minnesota and Boston EMS.  They do a great job of not only promoting their members but fearlessly advertising the successes of their organizations.  They report call volumes, medical advances, and in Boston EMS’s case, even tweeted a ride along day that was done a few months ago.  Bravo! While the press plays a key role in the public’s perception of EMS, with an increased emphasis on social media, blogging, and a means of making our own “press releases” we can, as a profession, dictate our own direction.  It is becoming more common for blogs to be just as well respected as some news outlets, and some of those outlets are even looking to bloggers to fill their printed pages with their online content. So how does an organization “get there?”  It starts with structure.  When people do not know what limitations and rules are set for them, they are more apt to push the envelope and see how far they can take things.  Remind them what is appropriate to post and what is not.  More importantly, remind them WHEN it is appropriate to be in their phone.  Nothing irks me more than when I hear about someone in the back of a truck answering a text or a Facebook message.  Let’s keep it confined to the downtime people! The key above all else though is to be responsible.  Think before you post.  That goes for status updates, tweets, pictures, anything you can think of.  While social media can be very useful, it can also present some challenges when the WRONG thing is posted.  Even if you take it down, there is a chance someone out there might have already captured it, and even if something is up for just a few minutes, someone is going...