Let’s Talk About Delivery

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....

Fact Checking the EMSCNJ

Fact Checking the EMSCNJ

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...

An Open Letter to Mr. John Bendel

An Open Letter to Mr. John Bendel

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,...

We’re Back!

We’re Back!

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 next! Share...

MedicSBK.Com Gets a Facelift!

MedicSBK.Com Gets a Facelift!

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...

Episode 14: Should We Arm Them?

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 below. Share...

Podcast Episode 13: The Generation Gap

On this week’s episode, Scott is joined by RJ Stine and William Random Ward to discuss the existing generation gap in the EMS community.  The trio talk about some of the challenges faced by the new generation of paramedics and how preceptors can help that mentoring process.  While many in the older generation focus on where we were, RJ, Random and Scott talk about where we are, and where we need to be in the future. To download this week’s podcast, follow this link!  Otherwise, use the player below. Share...

Ignorance and Litigation

Last month, a group of us created a new Facebook page called Modern EMS Issues. We wanted to give people an outlet to discuss what they felt were the important challenges that we are facing both today and tomorrow. One of the first questions that we asked everyone was to name what they felt were the biggest challenges that we face today. There were some terrific answers, but I feel like the root of much of the issues that we deal with comes down to two things, ignorance and litigation. Far too often, we allow people who do not understand our profession and what it is capable of to make decisions about how we perform our jobs. We allow the general public to believe that response times are more important than high quality care. Some of this is he fault of those who prey on the ignorant, but for the most part it is our fault for not properly educating those that we serve. I cannot count the number of news stories that I have read that either cite what people interoperate as “poor care” that was directly related to response times. Take a look at the situation in Minnesota last week where a family was “outraged” by a seven minute response time to their residence. There was no talk about what happened after the ambulance responded in what many would say is a reasonable amount of time. There was an article that got a decent amount of attention a few years ago when the Super Bowl was held in Dallas regarding MedStar’s response times during that week when they also faced a sizable Texas snow storm. Many responses were made to “emergent” calls in a “non-emergent” fashion with no marked reduction in patient mortality.  The thing that I like about the information that MedStar released was there was no “spin” to it.  It was just straight facts backed up by statistics.  Not many places take that road.  Far too often, they rely on public opinion and speculation of what the public thinks is important. Furthermore, we allow ourselves to continue to believe that while urban responses require someone to be on scene in less...

BLS Defibrillation: Are We Doing Enough?

BLS Defibrillation: Are We Doing Enough?

Jul 23, 2014

Recently, on the Resuscitation Facebook group, a discussion started regarding time on chest, time off chest, and the safety of defibrillation with active CPR being performed by a rescuer.   While the core of the debate and the reasons behind why and why not one would voluntarily subject themselves to an electrical shock is one that really needs more research to validate, it became clear that reducing the peri-shock pause (the time with no CPR prior to and immediately after defibrillation) could actually make the concept of receiving said shock a non-factor. The discussion quickly turned to how long five seconds was, and how long three seconds was, and how with proper training and practice, a shock could almost be delivered on an upstroke with little to no pause in CPR.  It goes without saying that time on chest is vital for cardiac arrest survival.  Pit crew CPR teaches us some techniques to best deliver effective emergency responder CPR, but I feel like we can do better. What about the other lengthy hands off time in the pre-shock period?  I am talking, of course, about the time that it takes an AED specifically to analyze the heart rhythm of a patient in cardiac arrest.  Usual analyze time for a monitor in my experience has been around 5-7 seconds depending on the model.  Once analysis is complete, many AED’s continue to announce “Stand Clear!” and start “spooling up” to their preset energy setting to prepare for a shock.  When it comes to dealing with the general public, this is, in my opinion, appropriate.  I do not expect some “Average Joe” who pulls an AED off a wall at the Mall of America to have the same ability to use it as someone who spent months (in some places a year) in an EMT class.  Public AED’s are a great thing, but why are we not putting better training and maybe simple EKG recognition skills in the hands of our BLS providers? The first time I encountered an AED was in 1994.  It was a big deal for our town.  We had one for our two ambulance first aid squad and would switch it back and forth...

Podcast Episode 12: Emergency Money Management

One of the biggest complaints that most EMTs and paramedics have revolves around the pay that they receive.  Instead of living beyond our means or relying on overtime to support ourselves, what if we better managed our money and took better care of our finances?  Joining me this week is Jason Hoschouer, better known on the internet at Motor Cop, and one of his success stories, a well-known voice on EMS in the New Decade, Sean Eddy. If you are just getting started in EMS, or you are worried about your financial future, this one is a must listen for you! Check out Sean’s blog Medic Madness.  Or follow him on twitter at @SeanEddy. Want more information on Jason’s financial coaching check out his spot on the web GPS Financial Coaching. Finally, if you have not read his blog, what are you waiting for?  Motorcop.  Or, just follow Motorcop Facebook. To download this week’s podcast click this link!  Otherwise, use the player below. Share...