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...

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...

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...

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...

With my decision to go back to the street more than two years in the rear view mirror, I got thinking the other day about what it has all meant to me.  The system that I came from had a relatively high rate of turnover for supervisors.  I was there for twelve years and the group of five full-time supervisors that were employed there in their position the day that I left were a completely different batch than the one that was there on the day that I got hired. Every supervisor obviously went somewhere.  A few went up in the company, a few went down, and many moved on to another service.  All of them stayed in the field though.  To me, that shows the level of dedication and love for the field that everyone who put on a “white shirt” shared.  We wanted to be there, and wanted to do whatever we could to make things work. Life after supervision is not always easy.  With no system being perfect, it is almost second nature at this point in my career to look and try and find a solution.  That is where I find myself jerking my own reins because as we so commonly see in this industry, what is good for the goose is not always good for the gander.  That is to say, what works in one system does not always work for the industry as a whole. And then there is the overall focus of my day.  At peak in my old job, I was responsible for close to twenty five ambulances.  At any given time, from the chatter on the radio, I could tell you what just about everyone was up to, and who was on the truck.  After a while, it became second nature to me.  In fact, I felt like it was a necessity.  Each crew out there had their own unique set of problems and challenges that they would have to deal with and although I was not nearly as successful as I would have liked to have been in solving those problems, I would like to think that I did okay some of the time....

Jul 14, 2014

It goes without saying that many medical professionals (not just prehospital providers) really do not understand HIPAA and how it affects their job.  More importantly, many do not realize how it actually does not affect their job.  For this week’s episode, Scott steals Natalie Cavender again on her ride home to talk about HIPAA from her point of view. To download this week’s podcast, click this link!  Otherwise, use the player...

CPR is increasingly becoming a requirement for high school graduation throughout the country, and personally I could not be happier.  I love seeing news stories about this topic. When we are dispatched to a cardiac arrest in our system, one of the first questions I ask myself is “is anyone doing CPR?”  I usually find that compressions are being done in about one out of every three “workable” cardiac arrests.  More times than not, the thing most often preventing CPR being done is the fact that the caller has difficulty getting the patient from where they are to the floor. The second most frequent one is that the caller is too scared or just unwilling or unable to do it because they are too hysterical.  I completely understand this.  EMS professionals walk into these situations with training and the expectation that they will be there to bring order to the chaos.  It is what we do.  It is part of who we are and what our profession is all about.  One cannot have that same expectation of the general public. Should a bystander be willing to do CPR, and they are untrained, they will get a crash course on the phone of how to do hands only CPR in the form of prearrival instructions from an Emergency Medical Dispatch certified person on the other end of the phone.  It is virtually impossible to make sure that the person on the other end of the phone is following the instructions as they should.  Of those one third that get compressions, probably half of them are done well.  The plus side though is something is better than nothing when it comes to cardiac arrest care. Here we sit in 2014 with a generation of people (that arguably I am on the older side of being part of) who are consumed by their cell phones.  People live in their phones, and use them to make potential medical emergencies someone else’s problem.  Gone are the days of people moving away from these sorts of things.  They call, and then they stand around to see what happens.  Rarely do people get involved and try to help.  We need to...

How many paramedics should be on an amulance?  Truth is, we really do not know.  With operational concerns, skill dilution, and burnout as chief concerns, Sean Eddy, Russell Stine, and host Scott Kier share their opinions on the topic. Check out Sean’s blog post that started the conversation over at MedicMadness.com To download this week’s podcast, click this link!  Otherwise, use the player...

Jul 2, 2014

Over the past fourteen years or so I have owned a lot of different brands of boots: Magnum, Rocky, and 5.11 to name a few, and even a pair of boots I found at Walmart called Brahmas that I used as a spare set for a winter or two.  A couple of months ago though, I found what might be the worst pair of boots that I have encountered. One of the benefits of my new job is I am issued just about every piece of my uniform that I wear.  We get shirts, pants, a belt, jackets, and even boots.  It is very unusual coming from the private sector where I had previously received just shirts and was left to fend for myself for most of the rest of my uniform.  My 5.11’s that I was issued when I got hired were about a year and a half old and were starting to look a little sad.  Admittedly, I don’t take as good care of my boots as I probably should but in the past, if I had gotten a year out of a pair of boots I was pretty happy with them. As a replacement for my boots, I received a pair from a brand called HAIX, which apparently is a German company.  Full disclosure, I only wore these boots for about ten days before going back to my 5.11’s but the experience that I had was less than satisfactory.  Here is what I thought of their Airpower R1 model. Fit:  Although I had been fitted by a “specialist” who sized me once at our headquarters, these were by far the most uncomfortable boot that I had ever put on.  It was not a width issue or anything like that, the pain that I experienced was actually in my heels which ran up the back of my calves.  At the end of the day, my feet flat out hurt.  I could not wait to take these boots off. Functionality: The zipper down the center of the boot is an interesting feature.  I found, however, that you pretty much needed an engineering degree to tighten the laces on the boot.  They run laterally...

It is time for me to take a few days off.  I am heading to New Jersey for the weekend to enjoy the annual fire department brewfest/fund raiser in Island Heights where I grew up.  There will be no podcast on Monday, but posts will start up again next Wednesday. Enjoy your weekend, stay safe if you are working and I will see you in July!