This past Monday, issue number 2 of EMS INterventions went “live” on the internet.  Comprised of articles and videos put together by the team at the First Responders Network, the magazine offers a look at what we want from our Medical Directors and what they can do to help us achieve that reboot of EMS, that EMS 2.0 that we so desperately need. I would like to invite you to check out the edition and please share any comments that you might have either on our respective blogs or at [email protected].  Additionally, I welcome you to download and print out the PDF version of the magazine and share it with your colleagues and medical directors.  This is where you, the reader comes in.  Help us spread the word, and help us put EMS 2.0 on the tip of everyone’s tongue. I am very proud of what we have put together, and would like to thank everyone involved in creating the publication for their hard work, dedication, and spectacular content that was contributed.  We look forward to putting together Issue 3, due for release sometime around EMS Today in Baltimore.  Stay tuned for updates in the weeks and months to...

How important are response times in EMS?  To most communities, they mean everything.  There is no greater measure of how effective an EMS system is than how quickly an EMT or paramedic gets to the scene of the call. We are, however, barking up the wrong tree.  Lets compare two calls and I will explain where I am going with this: An ambulance company has a required response time of 9 minutes 59 seconds or less ninety five percent of the time.  Medic 1 is dispatched to a single family home on New Jersey Avenue on the other side of the city from where they are posted.  They try the best that they can, but despite their best efforts, they arrive on scene in 12 minutes, almost two minutes after their longest allowed response time.  The crew gets out of the truck, gathers their equipment, and a minute later, 13 minutes into the call, they are greeting their patient and starting their assessment. After transporting that patient to the hospital, Medic 1 is dispatched to an apartment building on New York Avenue.  This time, they arrive on scene in 9 minutes, narrowly making their response time.  They again gather their equipment and start pressing buzzers.  After confirming the apartment number with their dispatcher and having them make a call back, one of the patient’s family members walks down from the fourth floor to let them in.  They start their trek up four flights of steps, and fourteen minutes into the call, they are at their patient’s side.  Given these two situations, which patient got the better service? In situation number one, the crew missed their response time but due to “geography” they were able to reach their patient more quickly than they did on their second call.  On the second call, they provided the service that is expected of them with their 9 minute response time, but their patient waited longer.  Should a question be raised about the second patient waiting as long as they did, the service provider could answer “we made our required response time.” Taking this into consideration, are response times really what matter in EMS or are they this mythical...

Some posts are more difficult to write than others.  This is one of them. Coming from a volunteer background, I have seen a variety of levels of abilities in EMTs.  Some can’t hear a blood pressure.  Others just seem to say the wrong thing at the wrong time.  Some are just plain unreliable, and still others are downright negligent.  Sometimes, people tried to make excuses for these people by shrugging and saying “they’re doing this out of the kindness of their heart.”  That argument never seemed to hold much water to me. I came to the conclusion early in my career that not all EMTs are paramedics are created equally.  This should not be anything anyone considers earth shattering, some people is better at things than others.  As an industry though we seem to have taken this “all for one and one for all” mentality and it is hurting us. “A paramedic is a paramedic, and an EMT is an EMT.”  Have you ever heard anyone say that?  Unfortunately, if they don’t say it, many people think it.  There is no differentiation between a good provider and bad one, and there needs to be.  It is time to work with those who might not be cutting it.  It is time for them to get on the bus or move on. How much of the problem comes down to our reluctance to be educated?  Our view that continuing education is the two or three year grind that we have to do.  I think many providers might get a decent education under their belts right out of the gate, but once the reeducation or discovery of new educational opportunities is put in the hands of the “responsible” provider, we fail.  Miserably. But I digress. . . The first step to dealing with someone who is not cutting it is to correct them.  Be blunt about it.  Let them know that they are not getting the job done and show them the right way to do it at the right time: away from the patient.  Let them know what they are doing wrong, and tell them, no, show them how to do it the right way. When...

My Sunday ritual is a fun one.  I am up by nine or ten in the morning, I have a cup of coffee, and I’m usually on my couch by 12:30 or so ready to enjoy a day of football.  Most of my day is spent watching NFL Red Zone.  If you have not yet experienced this, you need to.  Every touchdown in every NFL game is shown.  Every time a team gets inside their opponent’s 20 yard line, that game becomes the priority.  If no one is in the “red zone” then the most exciting game at that moment is featured.  You get to see a lot of football. Being from Massachusetts, it is a requirement to be a Patriots fan if you live in the state for any more than a couple of years.  It’s in the state charter, and it’s a question on your state tax returns.  Trust me.  When the Pats are not on though, one is free to watch whatever football they like. A few weeks ago, while indulging in some Red Zone, I was watching a little bit of the Cowboys game and it got me thinking: how do we pick our leaders?  Jason Garrett is the head coach of the Cowboys and his career as a player would be described as mediocre at best.  He started nine times in his seven year career and played behind two other quarterbacks for most of that time.  He did, however, have a great mind for the game. Or how about the Patriots coach: Bill Belichick.  Like him or not, he has been successful in his years in New England.   Belichick never played professional football. Now, take that analogy and apply it to EMS.  There is an opening in management, or maybe in a field supervisor position.  If a list of paramedics was put in front of a field provider and they were asked, which one would you pick and why?  I would bet my paycheck that nine out of ten people who answer the why with “Because he/she is a good paramedic.” Does a good paramedic translate to someone being a good manager?  Does the ability to accurately interoperate a...

Hey, did you know it can snow in New England in October?  I always thought it might be a possibility, but what we experienced up here in Massachusetts last week was unlike anything I have ever seen.  This year, I have sat through a tornado, a hurricane, an earthquake, and now one of the nastiest winter storms of my career.  Hey, Mother Nature, I am waving the white flag! My Saturday was just like any other: I spent it on the streets, responded to a call or two, and was ready to head home, shovel a few inches of snow off my front walk and enjoy the first snowfall of the year the best way I knew how: with a glass of wine and some dinner.  Things took a turn at around 5pm though when the snow picked up. With many of the leaves still having yet to fall, trees began to be weighted down.  Many of them broke taking power lines with them.  By 8pm, most of my city was without power including my house.  It is an eerie feeling when you are sitting on a main artery of a city surrounded by lit street lights and there, 100 yards down the road past an intersection is nothing but darkness.  At this point, I saw no reason to go home so I turned my 12 hour day into a 24. In comparison to the tornado that struck my city on June 1, dealing with the October snow storm was much more challenging.  When the tornado hit, we had our damage path, we knew what the threats were, and we figured out what we had to do to work both in them and around them.  What we found in the snow storm was the damage was much more wide spread, and the environment was constantly changing.  What was a clear intersection just 5 minutes prior could now be blocked with a tree or downed power lines.  Keeping track of street closings and hazards was a logistical nightmare. I spent the next week (yes, week) couch surfing with friends or sleeping in my cold house.  Although it was a stressful seven days as I waited...

On November 1, at 12:01am Pacific time, Paramedics Plus took over 9-1-1 coverage in Alameda County marking the end of a lengthy service by American Medical Response.  I, however, cannot help but feel like AMR got the short end of the stick in the deal. I have read through both of the bids quite extensively, and I must say that from the perspective of Alameda County, they had a strong grasp of what they were looking for, and released a rather detailed document spelling out what EMS means to the county.  Both replies were lengthy and well put together, and in my opinion far exceeded the expectations that were set.  In the end though, the bid came down to one thing: the all mighty dollar. The last piece of the bid called for both companies to submit what they planned to charge for their patients for their services.  Paramedics Plus came in lower than AMR giving them the points they needed to push themselves over the top, and ultimately win them the contract.  Kudos to Alameda County for looking out for the wallets of their tax payers, but I feel like there was too much weight put on this stat.  While most services harp on response times, ALCO shifted that focus to financials.  Their response time criteria was still very strict, and they did a lot to further the quality of patient care provided in the county, but a lot of that feels disregarded to me when I see the weight that patient charges, most of which an insured person would never see, are figured into the equation. It must be understood though that I am a little biased.  I owe a lot to Mike Taigman and his team in Alameda County.  Level Zero was the project that opened my eyes up to EMS on the internet.  A profile of a few of the providers in the county, having seen the movie I was even more excited to hit the streets in ALCO when I had the chance hoping I’d just have the opportunity to run into someone I might already know a bit about.  While I only saw one “cast” member from afar,...

How does a paramedic handles those three words says a lot about the kind of provider that they are.  Despite all of the training and continuing education one might seek out, there are still going to be situations where we just are not sure what to do.  We will encounter conditions we have just read about and never seen firsthand.  There will be tools in our bags that we might never pull out during our careers, and in many cases, never having to use something like a Quick-Trach or a needle crich is never a bad thing.  None the less, we need to be ready for anything. This is where personal responsibility comes into play.  If someone does not understand something, they need to speak up when asked if they have any questions.  They need to be ready to seek out the answers if they do not understand.  For example: CPAP is still relatively new to my service.  We have had it now for just about a year, and as a supervisor, I am not getting nearly as many patient contacts as I used to.  In the course of my field time, I have had to use CPAP six times, and on three of those, I did not feel as though I had done as good as I could have.  I did not feel that the seal was tight enough, and as a result, the device was not working as well as it could. I decided it was time to ask a respiratory therapist that I know if he had any tips for how to achieve a better seal, and he was able to give me some great advice: “if the patient is able, let them control 90% of the mask when it is being applied.  Get it tight and comfortable for them, and work on tightening the straps when they have it placed.”  On the next CPAP call that I had, I gave this a shot, and it worked really well. I had identified a part of my patient care that I was not doing as well as I could, sought out advice, applied that advice, and was now a better provider as...

Communication is such a huge part of this job.  We need to be able to communicate with our patients and get information out of them, we need to be able to speak on a radio (which is sometimes easier said than done) and we need to be able to translate what our patients say into medical jargen so the doctors and nurses we give report to fully understand what they are going to be dealing with.  In addition to all of this, we need to be able to communicate with our partners as well. Jamie was my third partner in my career, and she was the one that I worked with the longest.  The two of us were partners for close to two years, working evenings and weekend overnights.  We had some great times, and did some really good calls over the years.  Our styles were completely different.  I was more aggressive medically, where she was quite a bit more on the conservative side, but because of that I learned a lot about holding back, and what to treat and not to treat. We would seem to commonly encounter a problem in the street though: while our silent communication skills, we were not always able to read each other’s minds.  It was on a slow shift that we solved this problem.  Jamie and I decided that we were going to create our own language, one that was spoken by touching different parts of our face to let the other person know what was needed in more of a silent fashion. For example: there is a crying woman sitting on a bed, not talking with her boyfriend/husband looming over her.  Jamie might tap her temple with her index finger which, according to our silent language dictionary, says “let’s clear the room so I can talk to her alone.”  I’d say to the husband, “Sir, can we go take a look at her medicine?”  or “Can you hold the door for me while I get the stretcher in?” At its peak, we had just about fifteen different silent phrases we’d “speak” to each other on calls, covering everything from “This is ridiculous, why are we here?” ...

Over the last month, I have been trying to follow the Occupy Wall Street movement.  I say “trying” because I have a tough time figuring out what their unified message really is.  Their communication attempts with the public have been highly ineffective and fractured.  No one seems to want to speak for the group, and all that seems to keep coming out is “down with big business!” Ironically, most of what I have read has been via social media through Twitter, Facebook, and YouTube.  I must say, I find it rather amusing to see someone send a Tweet out about how bad corporate America is, and on the bottom of the box on Tweetdeck, it reads “Sent via Twitter for iPhone.”  That’s right: this person who is bad mouthing corporate America is paying a monthly bill to it to be able to share their message. Change takes time and efforts.  One Tweet I saw that I found to be particularly interesting was one that read: “I was promised a job, go to college, get a job is the promise, I did my part.”  If a person wants real accomplishment they cannot sit back and expect it to be handed to them on a silver platter.  There is a certain level of personal responsibility that comes along with it and sometimes things take a little more work than expected.  You cannot always expect people to meet you half way.  Sometimes, you need to go a little farther. Much like Occupy Wall Street, EMS 2.0 is a grass roots “bottom up” movement spearheaded by street providers to try and enhance their ability to do their job.  I think that there some important lessons that those of us who are invested in EMS 2.0 can take from what I feel are some glaring failures of the Occupy Wall Street movement: 1.  Have a message — Don’t just blindly demand change.  Know what you are asking for, and have someone who is willing to step forward and speak for the group.  Show your numbers, but have a plan! 2.  Don’t demand change, make it — Far too often, we look at those around us and above us and...

My name is Scott, and I am a PC. I admit it: PCs have been my life and my passion for quite a number of years.  I remember my first one when I was 8 years old.  I still speak DOS fluently, in fact, the computer that I am typing this on right now is a computer that I built myself a little more than two years ago. That said, I am still mourning the death of Steve Jobs today. In addition to my love of PCs, I also have an affinity for gadgets.  Just the other night during some downtime at work, I was replying to tweets on my iPhone while reading a PDF on my iPAD, all while listening to music on my iPOD.  I have them all, and I love them all and a day does not go by where I am not using them.  Steve Jobs revolutionized mobile media for me.  He changed the way I surf the net, he changed how I listened to music, and he changed how I communicated with people. You Android users out there should be counting your blessings as well.  If it was not for the iPhone, do you think the Android would be half as good as it is?  Jobs did not just challenge his own company; he challenged everyone else as well.  He pushed them to make their products better just to stay competitive, and they did the same right back to Jobs and Apple.  Because of that competition, we have what we have today. I found a couple of inspirational quotes from Steve Jobs as I was reading through an article about him on the Huffington Post today that I thought I would share: “That’s been one of my mantras — focus and simplicity.  Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple.  But it’s worth it in the end because once you get there, you can move mountains.” — BusinessWeek interview form 1998. I love this quote, and I feel it embodies everything that EMS 2.0 stands for.  Make things simple again and start over.  Don’t over complicate things...