As I talked about briefly last week I was recently asked to work a little bit with a paramedic class.  My purpose for being there was two fold.  I was expected to help them review for their National Registry EMT test, and I was also asked to prepare them for the test.  Personally, I feel that these are two completely different things. Way back in 1999, my paramedic instructor told us something very early on.  He said when it came to the paramedic exam and the Massachusetts Office of EMS, “the sky is purple.”  That is to say how we feel about a question and whether we think its answer is right or wrong based on our real world knowledge is a moot point.  We had to be book paramedics, and as far as the book was concerned, the sky was purple. This is not the fault of the authors.  They produce information in a clean form, and one that cannot possibly be updated as fast as the field moves. Revisions take time, and information in industry publications is moving and evolving faster than that in books.  Study the books for the test material (purple sky) but also educate yourself outside of that when the time is right to prepare yourself for the field (blue sky). When we review for a test, we make sure that the information is in our heads.  We talk about things sometimes to the point of exhaustion to make sure that we understand mechanisms, why things work, and concepts behind information that we are expected to know.  Reviewing information makes sure that it is in our head, and that we have retained the right stuff.  Test prep is a completely different animal all together. Test prepping prompts us to then take that information and apply it in answer form to whatever questions are being asked, whether it be multiple choice, narrative answer or true and false for example.  We know the knowledge and information is there and now we need to put it into a readable form that lets someone know that we “get it.” Multiple choice test taking specifically is a skill that one must have if they...

My post today is loosely in support of one called “EMS Week Resolution” that went up this morning at The Ambulance Chaser.com.  Have a look; it is a good read essentially about “growing up.”  My take on it though is slightly different, and is something that I am not alarmed about because it is a trend that I see from system to system and while attending EMS conferences. Our friendly neighborhood Ambo Chaser points out to us that he was involved in a message board discussion about a state that was mandating all paramedics who were even short a half a credit on their continuing education to retake their National Registry exam.  How dare a state demand that?  How dare they penalize their paramedics and jeopardize the infrastructure of their EMS system over a half an hour of training?  While our favorite attorney/paramedic makes some great points about accountability and professionalism and (yet again) personal responsibility, I want to look at it from a slightly different angle. Why the heck is anyone even close to the minimum hours when it comes to training?  How could you let that happen?  We are surrounded by education in this field.  You can get it online through great sites like MedicEd and CentreLearn, and you can find enough educational classes that both provide and don’t provide CEU’s that there is no excuse to even be near that bare minimum that we all seem to try to strive for when thinking about getting ourselves educated in our chosen profession. A friend of mine once used a great saying which I have used many, many times since hearing it and frankly, it seems to fit perfectly here: “Don’t shuffle your feet you’ll trip over the bar!”  We set the bar so low that there is not only no excuse to clear it but there is absolutely no excuse to even be close to it.  If you want to talk about professionalism and being responsible for our patient actions, well, this is where it starts. Greg Friese pointed out in a class of his that I took at EMS Today one year that free pizza brings in more students than good...

This week, Scott Kier is joined by RJ Stine, Ben Neal, and Amy Eisenhauer to talk about EMS Week.  The discussion quickly turns to the panel’s attempt to answer the question of “how do we make sure that people working in EMS see as many EMS weeks as possible?” Enjoy this week’s show, and Happy EMS Week! To read more from Amy Eisenhauer, check out her blog, The EMS Siren To read more from RJ Stine, check out his blog, Hybrid Medic To download this week’s podcast, click this link!  Otherwise, use the player...

After doing some work with a paramedic class and looking at the way they studied it made me think back to how I studied when I was taking my first paramedic class back in college.  When I got to college my study habits were poor to say the least.  I was one of those people who always got it or I did not.  I can count the number of tests that I studied for in four years of high school on one hand, because I would just absorb information. I could have gotten better grades if I had applied myself more.  While I was a good test taker, I skipped a lot of homework assignments because I saw them as being busy work.  When it would come time to take a test my score would be solid.  When I would have to do a report I could research it and put something good down on paper.  Homework though, that was my downfall. Once I got to college the game had changed all together.  I went from not having to study to having to learn how to study because it was something that I had never done all that much.   I had trouble confirming for myself that I knew something without some concrete evidence in front of me.  That is why products like Dan Limmer’s Paramedic Review app were so important to me when I got my National Registry Paramedic certification a few years ago.  I could take a test, get immediate feedback on it and then have a score in front of me that gave me an idea of how well I was grasping the information. Once I got to my paramedic class I found myself having to study more and more, especially in the first semester.  While carrying a moderately high class load I had to deal with the Fick principle, acid/base balancing and pharmacology.  Oh yes.  Pharmacology.  My program brought in a doctor for a month who gave us his own four inch d-ring binder full of information.  We did not just have to learn each medication, its purpose and its dose but we had to also know contra indications, mechanism...

I’ve been giving a lot of thought lately to what would make an EPCR system perfect for me. Most of these thoughts have stemmed from the last year that I have been using what arguably is the worst EPCR system that I have encountered out of the four that I have used. Yes, I know, four really is not that many when you consider how many products are out on the market still, the thing has a long way to go to reduce the frustration that I seem to consistently encounter. What I decided to do was create a few “Do’s and Don’ts” that might give someone developing or improving an EPCR system some things to think about when working on their product. DO have an open source coding system that will allow different products like cardiac monitors to upload their data to it with the greatest accuracy possible. Make sure that event markers line up with the wording in the monitor and if possible allow the patient information we put into the monitor (name, age, case number) to import into the chart so that it only has to be entered once. Also, allow preferences to be set for each person that can include truck number, crew member, and other information that is the same for every single shift. DON’T try to do too much of my job for me. I have never met an auto generated narrative that I like. It does not matter if it is CHART, SOAPE, or anything else that you can name, things just never seem to add up. Facts get missed, and what I see with my eyes is either left under described or completely missed. Anyone who teaches a PCR writing class will reinforce the concept that your narrative is your bread and butter. It is what will tell you the most about a call if you get called to the carpet for it years down the road. It is what will get you paid if there is a dispute with MEDICARE. Narratives are so incredibly important that they need to be left to the tech to write them, not the computer. DO have a repeat or...

I have met a lot of people over the last four years.  Few have had a bigger impact on my life than Natalie Quebodeaux Cavander.  She has been one of my closest friends since I started writing and podcasting, and has been incredibly supportive every step of the way.  Life’s changes take us all in different directions, which is exactly what it did for Natalie.  This week, Natalie and I talk about the twists and turns that her life has taken over the last couple of years, and discuss a few new angles she is taking a look at EMS from. To read some of Natalie’s posts check out her old blog, MsParamedic.com.  Even though she does not write there anymore her posts are still incredibly relevant. It goes without saying that Natalie was also an excellent podcaster.  Check out the podcast she used to be part of known as The Gen Med Show. Also, I feel it bears mentioning that the picture below is from Las Vegas in 2011.  Don’t worry though, we found out after this picture was taken that Jeff Sorenson better known as @Chicagomedic who is standing between us, was not an ordained minister, so like many Vegas weddings this one was over before it started! To download the podcast, click this link!  Otherwise listen on the player below....

On the heels of Wednesday’s podcast I wanted to share some more thoughts on Sirens and try to explain why I think this show is as great as I do.  It is a comedy.  No doubt.  Its crude at times, but I like that, I am a fan of that kind of humor.  The beauty of Sirens though, is it is not a comedy about working on an ambulance.  Instead, it is a comedy that takes place on an ambulance.  The real beauty of Sirens is in the characters. Take look around you.  Look at the people you work with, and the people that you know who work int he industry.  Each of us knows that person who is better at managing their work life than their personal life, whose partner seems to know their life better than they do, or someone who is obsessed with gore.  Each service has that sage-like older EMT, and someone who seems to have far more knowledge in their heads than the average EMT.  And final, we all know that far too eager rookie who has no idea what they are getting into. Each of those characters is represented in Sirens.  They’re all there.  Johnny, Hank, VooDoo, Stats, Cash, and Brian.  Each of them seems to represent a certain personality that we all encounter far too often, and they each do it well. Now, although I am a big fan of the character work on this show, the EMS, while not completely accurate treatment wise, is topically accurate.  They deal with those weird calls that we run into, and the MCI’s and frequent fliers.  They also dive just below the surface of how we as an industry deal with those types of calls.  If you want proof of that look no further than the 9th episode of the first season called There’s No I in Ice Cream.  It is probably the most serious of the episodes in the first season, and because of that, it is by far my favorite. The biggest thing that I took from my time talking to Kevin Bigley and Kevin Daniels was the amount of respect both men have for our profession.  This...

May 7, 2014

While the initial plan was to post my podcasts on Mondays, this one was too good to pass up on posting a little early.  In this episode, I talk with Kevin Bigley and Kevin Daniels who play Brian and Hank respectively on USA’s new comedy series Sirens.  I have been a supporter of this project from the start.  Personally, I think it is hilarious.  If you have not watched it yet, you really need to. I had a great time talking to both Kevin Bigley and Kevin Daniels.  Hopefully you enjoy listening to the podcast as much as I enjoyed recording it! To download the podcast, click this link!  Otherwise, use the player...

In the first episode of my new podcast, EMS in the New Decade, we talk about the direction the show is set to take, and learn a bit more about who I am, and where I got my start. To download the podcast, click this link!  Otherwise, use the player...

The news story that hit the internet last week about the woman who was “pronounced” by the paramedic who was later discovered to be alive is nothing new.  We have seen this type of thing before.  Chances are, if you ask me, probably just about every case of this has hit the media at some level.  If you ask me though this is not an EMS problem.  This is a personal problem driven by the laziness of a provider. In fact, one article mentions that this exact same medic had an issue a little over a year ago when he flew two patients that probably did not need to be flown, and should not have been flown.  I vaguely remember that story. The problem with this entire situation though is that what will most likely come out of it will be some policy change either at the state level or medical director level, and some fear within the system that “this might be missed again.”  This is not a systemic issue.  It’s not a state issue.  Its a provider issue.  And more importantly, it is one that should never happen.  The only thing that will prevent instances like this is a thorough assessment by a trained medical professional. Every field pronouncement protocol should contain a few core components.  For example, obvious signs of death.  Lividity, rigor mortis, and body temperature.  Or some injury that is incompatible with life; a decapitation, or massive evisceration, cranial evacuation.  These are the things that should be obvious to us when we assess a patient, and we do need to assess these patients.  We need to touch them, and inspect them, and make sure that we are making the right call, even if we are on a crime scene.  These things must be done. The other component that should be part of every field pronouncement protocol is the acquisition of an ECG that shows three leads of asystole for a predetermined amount of time.  The best way for any paramedic to check this is not to get a “quick strip” but instead to do something like a “10-20-30” evaluation of the patient’s ECG. What I mean by a 10-20-30...