Friday the Washington Post published an opinion article by Toby Halliday.  Mr. Halliday is apparently the son in law of David Rosenbaum, the New York Times reporter who many feel died because of the inactions of the Washington DC Department of Fire and EMS.  Rosenbaum’s death in 2006 prompted the formation of a committee in 2007 that shaped DC’s EMS system today.    Mr. Halliday was part of that committee. The restructuring that took place in 2007 has been a far cry from an effective solution of the problems that plague DCFEMS.  Some of them were not even addressed, for example, mismanaged ambulances that caught on fire, ran out of gas, or were out of service when they were needed.  While the 2007 study addressed some operational issues it completely ignored many cultural issues the likes of which resulted not only in the death of David Rosenbaum, but also Medric Cecil Mills Jr who died on a DC street while firefighters from Engine Company 26 refused to go across the street and see what was going on. It seems like the article posted by Mr. Halliday is one that is attempting to address and defend the findings and still unfollowed recommendations of the committee that was convened seven years ago in the face of criticism that DC should adopt an EMS system similar to that of Boston, which, arguably is the most effective metropolitan EMS service in the country.  While different systems might be more effective at different levels, I think Washington, DC is a strong testament to the needs of large municipalities when it comes to prehospital medicine.  In Friday’s article, Mr. Halliday shares the “key task force recommendations” from the 2007 committee. 1.  Elevate and strengthen the EMS Mission – While Halliday cite leadership failures and a lack of patient-care experts in leadership positions, if they are searching for an effective mission statement they should look no further than the EMS based EMS system in Boston.  Boston EMS’ mission statement reads as follows, “Boston EMS, the provider of emergency medical service for the City of Boston, is committed to compassionately delivering excellent pre-hospital care and to protecting the safety and health of the...

It’s currently Thursday night, at 8pm and as I write this blog, I am counting down the hours until Sirens premiers on the USA Network.  From looking around social media I have found that there are some out there who not only are not excited about this show, but are damning its existence.  To them, and to everyone else in the field I am here to say, lighten up! I used do the opening lecture for an EMT class in Massachusetts that I called “So, You Want to be an EMT” that talked about a lot of the factors that one must think about before even considering getting into this field.  One of the subjects that I touched upon was what I personally consider the best PR machine that this field has ever had: the 1970’s show Emergency!  The show, which premiered in 1972, loosely chronicled the creation of the Los Angeles Fire Department’s paramedic program and shared the brand new concept of paramedicine with the world through the eyes of Johnny Gage and Roy Desoto.  Since the show went off the air in 1979, a few networks have tried to recreate it and have failed.  Miserably. Do I even have to bring up the horror show that was Trauma! that introduced Captain Versed (portrayed by social media’s own Ms Paramedic Natalie Quebodeaux Cavender)?  Or, if you really want a laugh, go on YouTube and search for episodes of a show from 1999 called Rescue 77 that once featured a paramedic doing a handstand on a patient to defibrillate them in a pool of water.  It was truly cringe worthy. While I thought that Rescue Me was a great character study, and the first season had a lot of telling tales about the stress that many in the field are subjected to day in and day out it was more about the people than the department.  Third Watch, again, was a show that I could never get in to, and I have yet to even bother watching an episode of Chicago Fire.  Saved, which lasted just one season, might have been my favorite but the show was not without its share of glaring flaws. ...

This past week, an article posted by EMS 1 caught my eye.  It tells the story of a Minnesota man who had his video camera confiscated and was eventually charged with “interfering an ambulance crew.”  According to the article he was videotaping the interactions between a man living in his building and sheriff’s deputies who were accompanied by EMT’s who intended to transport him to the hospital.  I am not going to get into the article and story itself, as I really truly feel like this should be a non-issue.  In the society we live in today people have video capabilities and use them on a daily basis to shoot a variety of things.  It is part of the social media YouTube society that we live in.  What I found truly alarming was the reaction from the EMS community. The article received over 150 comments on the EMS 1 Facebook page, many stating that there was a “HIPPA” violation.  First of all, it needs to be pointed out that the abbreviation for the law is “HIPAA” and not “HIPPA” and no, the headline of this post was not a typo, I meant to do that. HIPAA, which stands for Health Insurance Portability and Accountability Act, is a law that has multiple parts.  Title II which deals with health care fraud and abuse is the one that is most important to EMS providers.  Covered entities of the HIPAA laws are those who record, collect, or store a patient’s health care information potentially for billing purposes.  Most HIPAA education began in the early 2000’s but judging from the comments that I saw this week; I cannot help but feel like it might be time for some reeducation. Over the years, I have encountered HIPAA on a number of different levels.  I have been told by facilities that I “should not open the sealed envelope” that was containing a patient’s medical information because I would be violating their HIPAA rights.  I have heard HIPAA cited as a stumbling block for QA/QI officers in getting information on patients who were delivered to a medical facility.  Simply put, so many entities that are HIPAA covered keep the information more...

This past weekend I had an opportunity to speak at my first national conference.  A few months ago I submitted and was accepted to present at that National Collegiate Conference which brings together campus based EMS systems and EMTs from around the country.  This year’s gathering was in Boston, so I headed back up to New England for the weekend.  First of all, let me start out by saying that as of late I have become a fan of the train, but i was persuaded by a friend to fly up.  What a great decision.  Fifty five minutes in the air, and I was on the ground at Logan.  It was well worth it. But i digress. . . I was amazed at the number of people who attended this conference.  From what I was told there were over 1,100 collegiate EMTs who had come from as far away as Arizona.  They were probably the group that I felt the worst for.  Sometimes I wonder if they actually sell clothes in Arizona that are capable of handling thirteen degree weather. The conference itself had about 110 presentations over the course of three days, an aggressive undertaking for even the most polished conference, but it was handled well.  Each block had five or six presentations dealing with everything from MCI response to toxicology, and over to career related ones like mine, and ones on administrating and running collegiate based EMS services and developing best practices for them.  To me, it was also a training session for these kids (and I use that term loosely) for how they should perform and what they should be ready for should they head off to EMS Today or EMS Expo in the future. The collegiate audience presents an interesting one.  Personally, I feel that there are two kinds of conferences that we attend.  The first is to just put credits in our bank so that we can re-up our cards.  People sit back with folded arms, sighing and looking at their watches waiting for the next break, and asking questions like “Are we going to go all the way to 5pm today?”  Those are not as much fun to...

Now that I got my charger fixed for my Netbook I can finally share this post that I wrote on my train ride back from EMS Today 2014.  Enjoy!! Here I sit on the train ready to head back home after another series of adventures at EMS Today.  Although the vibe at this year’s conference was different than years passed, the one factor that remains constant is there are a number of people who are extremely motivated to do more than just spend their 40 hours on a truck, collect a paycheck, and go home.  For the most part, the people who attend these conferences are doing so in the hopes that they become better clinicians both for themselves as well as their patients. Lines were drawn in the sand at this year’s EMS Today conference and the goals and direction was apparent from the get go.  The major focus of many of the classes was what some call community paramedicine which others have termed mobile integrated healthcare.  There were  a number of classes about branding, data, attitudes, and expectations that should be important to a service as well as a paramedic as they prepare themselves to provide care outside of the traditional “emergency” environment so many of us are active in today.  While the classes and churiculum are great, however, I want more. This year’s conference marked the 8th major one that I have attended dating back to EMS World EXPO in Dallas in 2010.  I have seen a number of fads come and go.  I remember just a few years ago when the exhibit hall was full of venders looking to sell everyone on the importance of their products when it came to prehospital ultrasound, something that a lot of us thought might have a practical use in the field.  For the past two or three conferences, community paramedicine has been showing up more and more.  I remember last year, when NAEMT’s EMS on the Hill Day was canceled, Chris and Anne Montera (then known as Anne Robinson) along with a team from MedSTAR in Texas lead by Matt Zavadsky held a half day workshop for the NAEMT delegates to talk about...

I was out with some coworkers for some frosty beverages last night in celebration of a friend’s birthday, and of course, predictably, the conversation turned to our profession.  We got talking about how we handle and respond to cardiac arrests, and mainly the medications that we give.  While we are all proud of our 40% ROSC rate, one of my friends made a bold, and not complete unexpected comment, “I think we need to get rid of epinephrine.” It is an argument that has been made by numerous people, including my friend the Rogue Medic, and it is one that is not completely unfounded.  Patients who receive epinephrine in cardiac arrests have worse outcomes.  To me, that is not completely surprising.  Personally, I feel that patients who we save with epi are people we would have not gotten back without it.  That statement might be slightly confusing, but as far as I am concerned, people with better outcomes without epi have those improved outcomes because their cardiac arrest was intervened with sooner, and the underlying cause was one that made them an easier save. So now we have these ROSC patients who end up with poor long term outcomes and some who might not even make it out of the hospital.  We are saving people only to put them in a vegetative state, or only prolong their lives for a short time, right?  One might think so. . . Then I looked a couple of seats down at the bar, and the whole purpose of epi, and the entire argument became clear to me.  We were joined that night by and celebrating the birthday of, a former paramedic who gave up her career to go into organ procurement and transplantation.  When we brought in one of these patients that was expected to have a poor or short outcome, which is when her company got involved.  They match donors to transplant recipients and get the ball rolling with screening and dealing with a family.  Her company and profession have saved countless lives over the years. If our documented ROSC rate tells us we are “saving” four of out every ten cardiac arrests, let’s say, for...

This post can also be found at TheEMSLeader.com With EMS Today right around the corner, I got thinking the other day about the past conferences that I have been to.  This year’s gathering in Washington, DC marks my ninth consecutive major conference that I have attended.  I’ve been to Baltimore three times, this will be my second appearance in DC, Las Vegas twice, New Orleans, and the first conference that I attended back in 2010 in Dallas. That year in Dallas, Had quite the opportunity drop in my lap.  One morning, I had the chance to sit down and interview a person who I very quickly came to admire because of his involvement in the National EMS Management Association, Skip Kirkwood, who at the time was the chief of Wake County EMS.  Even before I had a chance to meet Skip the words “Well, in Wake County. . . ” were a constantly used phrase in my vocabulary.  I admired the changes and strides that they had made in their quest to provide the best possible patient care for the residents of Wake County. More than that though, I admired Skip’s approaches to problem solving.  For years to follow, presentations that I have given have involved little pearls of wisdom that I have obtained at the hands (and fingers) of skip over the years from e-mails and posts that I have received from him, so while I had a long standing admiration for Skip, having the chance to sit down with him as a captive audience and pick his brain was quite the opportunity for me. One thing that stood out to me was how he approached change and progression in Wake County.  As I read about his service it was clear that things always seemed to progress quickly there.  Skip’s answer to me was that he always promotes an environment that is comfortable and welcoming to change.  He wanted his people to be ready to walk in one day and find a new piece of equipment, or a new policy change.  By doing this, when major changes were rolled out his staff was more welcoming and willing to adapt. I cannot tell you how...

A few weeks ago I was sitting around the station talking to a couple EMT’s about some issues that they had with the translation of a “lift assist” or public assist into a patient refusal.  It was not so much a personal problem since, as one of them put it to me, “If I touch them, I get a refusal” but it was more the actions that they had seen some of their coworkers take to minimize their own paperwork.  Interestingly enough, the debate of “what is a patient” and “who gets a refusal” was a long standing debate that I had with some people during my years as a supervisor. The scenario we most commonly encounter is a simple one.  It is like that old Life Call from the 80’s.  Mrs. Fletcher falls in her bathroom, pushes her pendant and moments later, she is telling someone “I’ve fallen, and I can’t get up!”  EMS, the fire department, the police department, and whoever else gets called is on the way to her in no time.  A few minutes later the crew gets on scene and finds Mrs. Fletcher as they would expect her to be: seated on the floor unable to get herself off the floor and back in her chair.  The responsible ambulance crew gets on each side of her, hooks their arm under hers, puts her back in the chair, and they’re out the door without another word spoken.  The paperwork is simple, and they’re back in service. That is how it happens, right? If they were my ambulance crew that better not be how it happened.  Anytime Mrs. Fletcher finds herself on the floor it is up to us to at least make an attempt to find out how she landed there.  The first question that should be asked is “what happened?  Did you trip?  Did you get dizzy?”  Follow that up with another simple one: “Are you hurt?”  I know, it seems like it would be a no-brainer, but that is not always true. You need to get a look at the medications that these patients take.  Is there a beta-blocker in there?  Are they a diabetic?  These patients need...

Last week a news story made its rounds on internet sites and blogs about a New York State EMT who had been suspended for six weeks and then quit his volunteer department for what many called “doing the right thing.”  If you have not seen the article, feel free to follow this link.  Otherwise I’ll give you the Cliff Notes version of the story: Twenty year-old Stephen Sawyer, a member of the Ellenville First Aid and Rescue Squad was at his station alone when a call came in for a four year-old having a seizure.  Sawyer, who is one year under the Squad’s policy stated age to drive but is an employee at a private EMS service in the area was the only EMT available that day when the paramedic on scene “called for an ambulance” for transport.  Unable to find any available mutual aid unit to respond to the call, Sawyer decided to take matters into his own hands.  Sawyer, referred to in one article as a “squad leader,” a member of the Squad’s communications committee and an advisor to their Youth Squad who presumably had knowledge of his department’s policy did what he “felt he had to do” and violated the 21+ driving policy, responded in an ambulance, and transported the patient to a local ER. The response of the Ellenville First Aid and Rescue Squad’s board of directors was to suspend Sawyer for 60 days.  Sawyer then resigned from the squad on the spot. In another article that interviews the Squad’s captain Mr. John Gavaris, the captain states the under normal circumstances, Sawyer might not have been suspended if not for his previous disciplinary record which was not focused on in greater detail.  The response both from his community and the social media EMS community was one of “online outrage.”  People felt that the 60 day suspension was too harsh and called from Sawyer to be reinstated immediately.  Although the argument could be made that 60 days is a pretty harsh sentence, I have to stand with the Squad on this one.  They made the right call. Like it or not, policies exist.  Policies have to exist.  They are what give...

As I was getting ready for my first day of work last week, I started loaded up my pockets with the usual stuff that I carry.  In my right leg pocket, I keep my shears strapped into their little holders.  I always crisscross the straps to their snaps.  In my left hip pocket I carry my gloves.  At my new job I was surprised to find that many people carry sterile exam gloves so I started doing the same.  (If we are ever partners, I am an 8 and a half.) I loaded up my belt the same way that I do every day.  Between the second and third belt loop on the left, the clip for my radio goes.  In the same spot on the right side I have a holder for non-sterile gloves.  I usually load it up with four pairs at the start of my shift all rolled a certain way so I can grab a pair quickly if I need them. I then got ready to pocket the last little trinket that I carry: my Smith & Wesson knife that sits clipped into my right front pocket and realized that I could not find it.  I slipped into a momentary panic. Although I have used it just twice in the four years that I have owned it the knife is always sitting there, just in case. Fortunately, I found it in my hamper.  Apparently, it fell out of my pair of pants from the previous shift but it got me to thinking about all of the little idiosyncrasies that I go through in my day.  I have a certain way of doing things in my job that makes me comfortable.  It is kind of my own personal way of holding on to my sanity I guess.  My GPS goes on the windshield a certain way.  I keep my traffic vest in a certain spot in the truck.  My bulletproof vest sits behind the headrest of the back seat on whichever side I am driving.  These things get done every shift.  The same way.  I end up almost unconsciously reaching for things just knowing that they are there.  it is comforting....