One of the things that amazes me about this field is how tightly we hold on to our beliefs.  It does not matter if it has to do with oxygen management or medication administration, or even C-Spine.  People always seem to revert back to how they were taught the first time that they learned something presumably because it is uncomfortable.  Maybe it is time to get comfortable with being uncomfortable.  Make it is time to make change a way of life. It has been my experience that people seem to base a lot of decisions that they make off of one negative experience in their career over a more frequent positive one.  We balk at giving pain medications to some patients because we believe that they are lying to us thanks to that one addict that we feel pulled a fast one on us in the early days in our career.  Or we put the nitro aside on an inferior MI because this one time a medic that you met told you about a medic that they knew who dumped the pressure on a patient who then coded on them.  The truth is though that the person in pain, regardless of their background, could benefit from that fentanyl, and chances are, that person having the MI will maintain their pressure and could greatly benefit from the treatment that you are so reluctant to give them. Or take response times as another example.  Despite evidence to the contrary, and despite studies that have been conducted, there is little correlation between response times and mortality in a majority of the emergencies that we as EMS providers respond to.  I happen to know of one rather large service that despite having an excellent ROSC rate they see a lower percentage of CPR saves in the more densely populated section of their service area with considerably lower response times than they do in the more suburban or rural areas.  While the difference in miniscule, it is further proof that despite the fact that somebody gets on scene more quickly than in other areas, speed alone does not constitute more lives saved. I have always found the concept of...

Your department has a policy that they send two ambulances to reported cardiac arrests.  On one particular busy night two of your trucks are dispatched to a person reportedly not breathing.  The first truck gets on scene and finds a patient beyond help.  Before they can cancel the second ambulance, they are involved in an intersection accident.  In response to this incident the next morning your director releases a memo stating that second ambulances will no longer be dispatched to cardiac arrests. In a labor management meeting, an employee suggests development of an “emergency code” for field personnel to report to dispatch that they are in trouble to help activate a large law enforcement response to assist them at their location.  Your boss says that this will not happen because they think field crews will abuse it.  A week later, a paramedic is seriously assaulted by a psychiatric patient.  The dispatcher on the other side of the radio was unable to make out their calls for help.  Your boss then revisits the policy. Your division uses a non-disposable laryngoscope blades.  A supervisor goes to your boss and suggests following the industry trend and shifting to disposable ones to reduce the risk of infection for patients.  Your boss decides against this since your company has never been sued by someone receiving an infection from this means of transmission.  You are convinced that the only way this policy will change is through some sort of tragedy. All three of these incidents are loosely based on actual events that I have either been part of or have heard about from friends of mine working in different systems throughout the United States.  They are all evidence of the same though, change driven by catastrophe.  We have all experienced it at some point in our career.  We have all been sitting around in a conversation with our friends and coworkers and had somebody utter the words, “Nothing is going to change until somebody gets hurt.”  Some of this attitude from leadership is because of a generalized disconnect from the field.  Some of it is because of the kneejerk, reactive nature of EMS that seems to carry on with people...

Apr 24, 2017

As I said in last week’s article about Bob Harper, I am kind of playing catch up with a lot of topics, this being one of them.  In late 2016, the State of Rhode Island announced publicly that on March 1 of this year, there would be a significant protocol change to their cardiac arrest protocols.  Crews would be expected to remain on scene for 30 minutes prior to being transported. Topically, I applaud Rhode Island’s Department of Health for being as public and transparent as they were about this change.  Anybody who has been in the field for even a modest amount of time has been on a scene where they were asked “why aren’t you just taking them to the hospital?”  In some cases, there is some merit to that.  In some cases there is very little that we as paramedics and EMTs can do for a patient on a scene.  Cardiac arrest is not one of those emergencies. I saw some pushback online from some who consider themselves experts on the topic, but that’s neither here nor there.  One common complaint that I saw revolved around scene safety.  Obviously, scene safety trumps all.  If I am coding someone in the middle of a street with an aggressive or growing crowd, I am going to think about moving.  But on these calls are the exception to the rule, and on the vast majority of runs, even in the worst areas of someone’s coverage area, communication with families goes a long way. “We are doing everything for them right here that they would get in the emergency room.  It is their best chance to survive.”  That’s the common statement that I have made a number of times to families of patients in cardiac arrest. Maybe those dissenters failed to read the protocol, it states “Regardless of proximity to a receiving facility, absent concern for provider safety, or traumatic etiology for cardiac arrest, resuscitation should occur at the location the patient is found.”  Emphasis is mine.  Most of the write ups that I read from the online blogging community were written on or around the month of December.  It is certainly possible that the...

The first time I laid hands on a patient’s chest and did CPR, I was 16 years old.  There were probably close to a dozen total times that I used the skill that I learned at the age of 14 before I was legally able to be the treating EMT by myself in the back of an ambulance, a responsibility that one must be 18 to hold.  On the overwhelming majority of the CPR calls that I have been on in my career, let alone those two years before I was of legal age, I left the patient just like I found them, dead. On January 25, 2015, the Surfside Beach Fire Department in South Carolina rolled a rig with a CPR certified junior firefighter on the truck.  At some point, it was that teenager’s turn to tag in on compressions and do their two minute duty.  Much like nearly 93% of all cardiac arrests worked nationwide, that crew from the Surfside Beach Fire Department left the patient how they found them, dead, much to the dismay of the Surfside Beach town council. Almost a month ago, an “unnamed official” with the town filed a complaint, prompting an investigation by the State of South Carolina’s Department of Health and Environmental Control.  The investigation, concluded earlier this week, found no evidence of wrong doing despite the shock and horror expressed by town officials. These are the kinds of stories that make the news that are related to our industry.  No matter how futile the efforts might be, the loss of a patient is obviously catastrophic to a patient’s family, but blaming a teenager for performing a skill that is taught to kids as young as 10 is preposterous.  Thankfully, there are many who agree with me on this stance. I got my start as a cadet on my first volunteer squad, and I had the chance to mentor a few other cadets over the years.  It takes a special kind of person to handle the responsibilities that an EMT or first responder is tasked with at such a young age, but for every call, much like that junior firefighter in South Carolina, I was closely...

I wanted to follow up on my reply to Councilman John Bendel’s letter to the editor in the Asbury Park Press a little bit and talk about delivery and goals.  Realistically, regardless of what sort of department an EMT or paramedic works for, their goal should be the same.  We should be aiming to reduce morbidity and mortality of the conditions that we can directly impact and for those that we cannot have lasting impact on in the prehospital setting, we should aim to deliver them to a place where they can get treatment while doing everything that we can in our time with him to promote a favorable outcome in our limited time with the patient. Too often, when debating about what delivery method works best, we get caught up in the weeds of the minor details that have a greater impact on the provider than the patient.  We worry about the training that we must do and the time that it takes, or the unproven theory that people serving their own community has a greater impact on patient outcome than the ability of the provider.  We get hung up on the importance of response times when they have less to do with patient outcome than care provided in most cases. In Bendel’s letter, he touched on the fact that “MONOC can probably tell us how many lives were saved because a highly qualified EMT was on calls.  But no one can tell us how many lives were saved because a local squad got people to the hospital faster than MONOC would have.”  He’s probably right, but we need to ask ourselves why this is.  With a call volume that is often a fraction of what MONOC runs, why can’t volunteer squads better report their impact on patient outcomes?  I think that the answer to this is twofold. First, most squads probably do not possess the outcome data that a company that MONOC has access to.  That is partially the fault of the system for not including volunteer services in this feedback loop, and partially on the squads for not seeking it out, and creating the infrastructure within their organization to acquire it....

Apr 17, 2017

Read my Open Letter to Mr John Bendel here. For today’s post, we are going to continue to analyze the saga of the Asbury Park Press editorial battle regarding EMS in New Jersey.  The EMS Council of New Jersey has sounded off.  Last week on April 10th, the EMSCNJ’s president, one Mr. Joseph G Walsh, wrote a letter of his own in order to, as he puts it, “correct several points.”  So let’s fact check some of Mr. Walsh’s statements, and dig deeper into what the EMSCNJ has said in the past. “Paid or volunteer, every New Jersey EMT must pass the same certification exam. Volunteers conduct monthly drills, and education and skills sessions to stay current. The misleading editorial might have panicked some readers into falsely thinking their local volunteer squads are not staffed with properly trained responders.” It is true, indeed, that every EMT must pass the same certification exam.  So what?  I would dare to say that the ability to study and regurgitate information from a textbook is not the be-all-end-all in evaluating one’s effectiveness as an EMT.  I have worked with great EMTs, and I have worked with people who could not be trusted to work on a crew of two because they lacked the ability that they needed to take the knowledge in their head and apply it in a real-life practical setting.  They all had one thing in common though, they passed the same test. Then there is the other statement that Mr. Walsh makes here about proper staffing.  While all EMTs take the same test, that fact alone does not mean that every person operating on a volunteer ambulance in New Jersey is a certified EMT.  In actuality, many responders might just be certified at a lesser level.  How do I know this?  Mr. Walsh tells us. “Every one of our member squads is required to respond to calls with at least one EMT who remains with the patient. On many calls, two or more EMTs respond. The EMS Council of New Jersey (EMSCNJ) is unaware of any squad — member or nonmember — answering calls without such trained responders.” Currently, when a paid or career ambulance...

Apr 11, 2017

Last week, the Asbury Park Press posted a letter to the editor entitled “Letter: Emergency response teams must have volunteers.”  The piece was written by John Bendel, a town councilman from Island Heights, NJ; the same Island Heights, NJ where I got my start in EMS more than twenty years ago.  John’s letter is a reply to an editorial done earlier in the week called “EMS system deadly hodgepodge” which addressed several the shortcomings of New Jersey’s EMS system, many of which were identified more than ten years earlier by a study done about the state’s slowly dying prehospital care system. To say the least, Mr. Bendel’s letter sparked a fire in my belly.  I wanted to address some of the points that he attempted to make here. “Sure, it would be nice if every Emergency Medical Technician (EMT) were as qualified as the legislation you endorse would mandate.  But if they were, far more would be paid professionals than volunteers.  In America where health care still bankrupts families, that’s a big deal.  We need volunteers.” Let’s address the semantics of this statement first.  “Health care” is not bankrupting families.  Many have begun pointing out that it is health insurance that is doing this.  Skip Kirkwood has taken to frequently correcting people telling them that what they are seeing is attempts at health insurance reform, and not health care reform.  He’s right. Now, on to the meat and potatoes of this statement.  First, what is the issue with creating more jobs, and putting more money, and insured individuals, into society?  Why is it so bad that some would like to see people compensated for the hundreds of initial training and numerous hours of refresher and continuing educational training that EMTs are required to do?  Career EMS providers (because professionals can be paid or unpaid) guarantee that someone is going to be there when the tones drop.  Volunteers cannot always make that same assertion. And let’s talk, for a second, about the chain of survival that drives health care.  With the exception of bystanders, every other link in that chain is staffed with employed, compensated individuals.  Nurses, doctors, dispatchers, people who work in rehab centers,...

Apr 10, 2017

Or better put, I guess, I’m back. It has been quite some time since I put anything up on this website.  I’ve spent the last year or so setting up and running a site about Drexel University Men’s Basketball called Always A Dragon which has been a nice diversion from EMS in general.  Writing about sports is very, very different and it has helped sharpen my skills in a lot of ways, but I think that its high time that I get back to writing about my passion: EMS. I have noticed a lot of things in myself recently.  I’ve been frustrated by a number of things going on immediately around me, as well as in the industry.  Social media, something that previously opened a lot of doors for collaboration and change in EMS has largely descended into a hodge podge of name calling and “my service is better than yours” debates.  Publications have turned to some providers and former providers who might not always be what they seem at the surface, and leave a lot to be desired for the direction that they are leading our younger generation in.  Health care, or rather health insurance, in our country is in shambles.  Our country as a whole, in fact, is in shambles for many different reasons, depending on who you ask.  Things just are not good right now. For me, writing on these pages has always been rather cathartic.  Finishing up a post and pressing “PUBLISH” for me has always put a smile on my face, and I need that.  Hopefully some of that enthusiasm can spread to those of you who are taking the time to read what I have to say. Tomorrow, we hit the ground running.  We are going to start where I started: Island Heights, NJ and a letter to the editor submitted by a councilman in the town that I called home for the first 19 years of my life.  From there, who knows where we will go...

Aug 14, 2014

Since the blog is 4 and a half years old, I felt like it was time for a change.  As I mentioned in my announcement about the lack of a podcast post for this week, the site got a makeover.  For the last couple of days, I have been tweaking and moving, and playing around with all of the new settings on the new WordPress theme that I downloaded.  I know it might sound boring, but actually it is kind of fun! There will be more changes on the back end which will probably be less noticeable to those of you who read the blog regularly already.  I am currently playing around with a few different search engine optimization plugins that Go Daddy! offers. Also, I feel like this is a good time to mention the direction that this blog has taken over the past couple of months. As many of you know already, I moved my blog off of the First Responders Network of blogs.  This is in no way a reflection on my relationship with Ted or any of the other folks over at FRN it is a great organization that I am still affiliated with.  The truth of the matter though is the blog started to outgrow the capabilities of what could be offered to me on the hosting side of things.  My move to self-hosting the blog and running it through Go Daddy! was a tough decision to make but it was vital to the future of MedicSBK.com. The fact is, if it was not for Ted Setla, I would probably still be writing over at the little Blogspot site where I got my start four and a half years ago.  He believed in me, he got me started, and he gave me a soapbox to stand on for more than four years. So take a look around the site!  If you notice something that is not working, or a link that is dead, please feel free to report it to me.  There is still plenty of fine tuning and tweaking that will take place here over the next couple of weeks, but all in all, I feel like the...

One of the most controversial topics in the world of EMS today is whether or not we should arm EMTs and paramedics or rather, should we allow those who possess conceiled carry permits carry on the job?  And furthermore, in whose hands should this decision rest in?  Lawmakers?  Department leaders?  The individual? This week, Scott turns over the podcast to the Geekymedic Chris Montera and Sean Eddy which allows the pair to engage in a spirited debate on the utlimate question: should we arm them? Also, stay tuned after the closing music for a little nugget from the cutting room floor. . . To download this week’s podcast, follow this link!  Otherwise, use the player...