No units available.  Not enough paramedics.  Citizens dissatisfied with response times.  The public and private sectors at odds.  Paramedics and EMTs bearing witness to horrors and atrocities on a daily basis.  This could easily be a story line from FOX News in Detroit but it’s not.  These are just a few major plot lines in the documentary Tell Me and I Will Forget. On a snowy afternoon, I decided to look through NETFLIX for something that I had not seen yet and I stumbled upon this video.  I have watched Parmedico, Firestorm, Burn, and any other public safety documentary that I can get my hands on.  While each of them has been extremely moving and left some impression on me, none has been as powerful as this movie. The level of violence in the country of South Africa leaves me speechless.  While emergency responders encounter a lot state side, the level and brutality experienced by South African medics is unbelievable.  In the first five minutes of the movie, you meet Kallie, one of about 400 paramedics working for the government service as he responds by himself without ambulance backup to a shooting.  You watch him work, eventually sedating and intubating a disoriented patient with a hemothorax as he waits on the side of the road for what feels like an eternity for a responding ambulance.  The system is overwhelmed on a daily basis.  The work force is depleted.  Thankfully, however, the public and private sectors seem to work well together. It was interesting to see an overview of what NETCARE 911 a for profit EMS system in South Africa has to offer.  While much of what was expressed was done by their own employees the view of many in the private sector was that they had more equipment, more ability, and better resources to draw from.  It was an interesting contrast to what many find in for profit EMS in the United States which focuses on being the more lean, cheaper option for EMS.  Far too often American private ambulance services are more concerned about their own bottom line than they are patient care. . . at least at the management level. Comments made by...

By now, the New York Times article from last week has made its rounds in the EMS online community.  If you have not read it, I will give you the short version.  Based on the response to the Boston Marathon as well as some other high priority incidents, Federal Emergency Management Agency released new guidelines this past September in regards to the response of first responders to active shooter incidents.  The new recommendations revolve around what FEMA’s fire administrator Ernest Mitchell Jr refers to as “risk a little to save a little, risk a lot to save a lot.”  According to FEMA, risking a lot means sending EMS responders into the “warm zone” of an incident to treat and extricate patients. Most of the article revolves around one particular paragraph of the seventeen page document: b. While the community-accepted practice has been staging assets at a safe distance (usually out of line-of-sight) until a perimeter is established and all threats are neutralized, considerations should be made for more aggressive EMS operations in areas of higher but mitigated risk to ensure casualties can be rapidly retrieved, triaged, treated and evacuated. Rapid triage and treatment are critical to survival. Rush in, keep your heads down, and get out safe.  They have not completely ignored our safety, however, adding a few lines later: d. If exposed to gunfire, explosions or threats, withdraw to a safe area. e. Consider/Investigate the use of apparatus’ solid parts such as motor, pump, water tank and wheels as cover in the hot zone. Understand the difference between cover (protection from direct fire) and concealment (protection from observation). f. Remove victims from the danger zone in a manner consistent with predetermined agency training and standards of practice. LE officers may bypass casualties in order to eliminate the threat. Recommendation “f” leaves me with some hope that there eventually will be more mandated training and education for EMS providers, but the document seems to largely ignore any mandation of this.  There are, however, recommendations made in regards to what FEMA feels should be addressed when planning, and developing standard operating procedures.  For example, much of the treatment modalities recommended revolve around tactical emergency casualty...

Christmas is right around the corner, and it is time to hit the stores, or in my case hit the websites, and get that shopping done.  But what do you buy for the EMT or paramedic who seems to have everything?  Well you’re in luck because here are what I feel are five of the best gifts that every provider should have this year. 1.   Ripshears – These might be one of the best purchases that I have made in my EMS career. They’re affordable, they attach right to your favorite pair of shears, and they do the job.  But don’t take my word for it, check out The Happy Medic’s review! 2.  A subscription to EMS World or JEMS – This is the gift that every EMT and paramedic out there should have.  There is a wealth of information available today on the internet, but nothing beats print media when it comes to trade publications.  I have subscriptions to both, it is one of the perks to going to their national conferences, and if you or your loved one does not, it’s a great gift for the holidays this year! 3.  5.11 A.T.A.C. 8” Side Zip Boots – In my 13 years as a paramedic I have gone through just about every brand and style of boots imaginable: Magnum, Rocky, Blauer.  On my first day last December at my new job, I was issued a pair of brand new 5.11 A.T.A.C. 8” Side Zip Boots.  A year later, I am still in that pair.  First of all, I was always used to going through boots every six to eight months or so.  Most of that I attribute to the harsh New England winters, regardless of what I did, or how much I worked, I never had a pair of boots last me a whole year until now.  These things are great.  They’re comfortable, functional, and really hold up. 4.  A new flashlight – Currently, I own two flashlights: the first I reviewed earlier this year made by Coast Portland.  This one lives in my truck’s door during my work week.  Its bright, light, and functional.  The other one that I own is a...

This post can also be found at The EMS Leader I remember the first time that I watched Mother, Juggs, and Speed and saw Larry Hagman walk into F&B Ambulance for the first time, and put his resume on the table.  After barely even looking at his resume, Mr. Fishbine hired him, with barely an interview.  No selection process, no nothing.  A guy with a card, getting a job.  Many might see that as a Hollywood shortcut, but sadly in my experience in many places, especially the private industry, the vetting of prospective employees is far too brief.  You then are introduced to the rest of the “team” at F&B ambulance which includes the veteran, Mother.  The guy who is really in charge, seemingly because he is the guy who has been there the longest. I point out this great 70’s movie because it was actually the first exposure to EMS that many people who are my age had.  Sure, I’m 35, and this movie came out the same year that i was born, but even nineteen years later when I was a freshman in college we watched it as part of one of our EMS management classes.  Although my two full time jobs have been with pretty large, put together organizations I have plenty of friends who have and do work in the smaller mom and pop sized section of the industry.  I have heard plenty of stories about people being sent out on the street as fast as they come in the door.  It is time for EMS to take a good look at their career ladder and hiring processes.   First though, we need, as an industry, to decide who we want and decide what a career ladder really entails.  Should the evolution of BLS to ALS really be considered part of that ladder, or is it possible to move “up” the chain in EMS without having a paramedic patch on your sleeve? Can a BLS provider be qualified to be a section leader on a major incident?  Can they receive and utilize the training necessary to deal with day to day personnel and scheduling issues that always seem to pop up?  Far too...

In the wake of the controversy with the Mayor of Toronto, Canada allegedly using crack-cocaine, I revisited a post from a few months back regarding the struggles of Toronto EMS, and the attempted takeover by the Toronto Fire Department, and it got me thinking about priorities.  When it comes to delivering high quality pre-hospital care, we really need to take a closer look at what drives us to choose the systems and models for our community. EMS is a diverse field, much more so than our brothers and sisters in the other branches of public safety.  Largely, it is an a la carte industry.  Choices about response structure, desired time, equipment, and protocols based on what decision makers feel is best for their community.  Fire based.  Third service.  Private.  With first response.  Without.  Two trucks.  Twenty trucks.  One paramedic and one EMT versus two paramedics.  There are countless choices and configurations one could come up with, and countless community models to serve.  All in all though, it all comes down to Frank Stroud’s old saying of “ambulance services can be fast, cheap, or efficient.  Choose two out of the three.” Once a decision is made about a system’s design, the community has to stick with it, at least for a little while, to see what is good and what is bad about it, and then decide what changes need to be made.  Far too often changes are made based on snap judgments driven by one or two particular calls that usually require a high amount of attention.  Instead, when making a change to their system design, especially when looking at who provides the care, the first question that should be asked should be “how will this improve patient care?” I used to work a part time job in a small town outside of Springfield, Massachusetts for what was then the only third service municipal agency in the area.  It was really a terrific system with experienced providers who did a great job.  It had its share of short comings, but no system is the perfect system.  When time came for the reevaluation of the town’s delivery method, there was a strong push to shift...

I spent my Friday and Saturday traveling through New Jersey, New York, Connecticut, and eventually to Massachusetts after a painful, traffic filled ride up Route 15, a ride that has rewarded me so many times with a much quicker travel than using 95, but I digress.  Friday, our travel framed a stop at Pulse Check, an EMS conference held just north of the New Jersey, New York boarder, and Saturday I spoke at the Massachusetts EMS Conference in Springfield where I spent the first twelve years of my career. Both conferences had some great topics however there was one thing that really summed up one of my major frustrations with EMS on a national scale.  It is something that I have seen at every conference that I have attended including the major ones like EMS World and EMS Today.  A speaker will be talking about his or her topic, and they will get to the treatment and management portion of the lecture.  For example, let’s say someone is presenting on chemically managing a combative patient.  The exchange will go something like this: Speaker: “In MY system, we are able to give the patient 5 mg of Haldol and 5 mg of Versed for sedation, and then we can call our doctors and ask for more.  How do you do it?” Student #1: “We don’t have orders, but we carry Ativan for seizures so if we can convince our doctor to ‘back door’ the protocols, we can give them some Ativan to sedate them” Student #2: “Well, in my system we have the protocol in place the same as yours, but I cannot even take the meds out of my bag unless my doctor says I can, and when I call the hospital I have to speak to a nurse and then ask them for a doctor.” Student #3: “What is chemical restraint?  Are you talking about when they get combative, I call for four more police officers to come and they pepper spray my patient on the stretcher so we can four point them?” So here we have four different experiences from four distinct, different systems dealing with the same problem in four completely...

It took some preparation but the time is almost here. Tomorrow morning I am presenting at the Massachusetts EMS Conference. On a personal level this is quite the first step for me. My goal, ultimately, is to be able to present at EMS Today or EMS World sometime in the next year or two. While I have always been quick to present on topics that have to do with the well being of a paramedic, and better treatment from a provider stand point rather than a clinician’s stand point, my class tomorrow is clinical in nature. The topic is one that I am passionate about: capnography, and specifically, how it should guide and effect your assessment and treatment. Furthermore, this visit marks my first “full” return to Massachusetts. I spent twelve years up there that I valued greatly because of the friendships and work relationships that I made. Truth is, if it was not for the time that I spent up there, I would not be the paramedic that I feel that I am today. In just six short weeks, I will mark my first year in my new system, and it has been quite the ride. My views on a lot of things have changed: skill dilution, and working in a union shop just to name a few. Municipal EMS is fantastic, and I have to say, I am now a firm believer that third service EMS is the best model. It might not be the most fiscally responsible but in my opinion, it does not get much better than that, especially for someone like me who has the utmost respect for fire fighters with zero desire to run into a burning building. But I digress. . . It’s time to suppress the butterflies and make a few last minute changes to my presentation, then tomorrow at 11am, it’s go...

I am the kind of person that craves numbers.  I’l comb the sports section of any website or newspaper looking for the line scores from baseball games, and the statistical leaders for the NFL in a given week.  I’ve always spoken in numbers.  I think that they are a great way to measure effectiveness in EMS. We have gotten to be very good at tracking response times.  We have defined methods of how to do it, and often when a system decides on a tracking method, we stick with it.  The same cannot be said, however, for tracking ROSC rates.  While everyone in EMS can agree on what a ROSC is, we struggle in agreeing upon what a ROSC is not.  Some systems omit traumatic arrests from their ROSC numbers.  Others do not count field pronouncements.  Personally, I feel that if a provider puts his or her hands on a patient’s chest with the intention of doing CPR, then that call should count positively or negatively against their ROSC rate depending on the outcome. I feel, however, that there are a few other statistics that we as EMS systems should be looking at on a regular basis.  Here are a few examples: PMD input vs. paramedic impression – Keeping with the theory that an EMS system is responsible for a patient from the moment the phone is picked up to the moment that they turn the patient over to a higher level provider at a hospital, I feel that tracking the effectiveness of PMD is incredible important.  We need to recognized that being as accurate as possible from step one is extremely important in providing the correct resources for a given EMS call. Last month, I wrote a post about the recoding of shootings and stabbings in Oakland, California and shared my thoughts as to what I felt that the problem was.  In the original article I referenced many were critical of Priority Medical Dispatch.  Over the years, my opinion of it has fluctuated.  I have seen it work tremendously well, and I have seen it be the downfall of an EMS system.  The bottom line though is the industry is moving away from...

Well, here we are, it’s October and in just ten days, I will be back in Massachusetts standing in front of what will hopefully be a room full of people giving a new lecture for the first time: The Solution is Pollution.  It goes without saying that I am quite excited.  I am hoping that this will be the first step for me, and maybe someday, AJ Heightman or Scott Cravens and their teams will see fit to bring me in as a speaker at EMS Today or EMS World Expo. For a long, long time, I was completely terrified of public speaking.  Now, I love it.  I do not know when the change happened, but it did, and hopefully I’ll be able to capitalize on it. The conference is scheduled for two days, October 18th and 19th, and it is being held in Springfield, Massachusetts at the Mass Mutual Center right in the heart of downtown Springfield.  There are hotels just a block away from the convention center, and plenty of places to eat and drink just a few blocks away. Over the last four or five years, the Massachusetts EMS Conference has grown exponentially, and this year is no exception.  They are expanding their exhibit hall, and continue to bring in high quality speakers to lecture on the topics that their audience wants to hear about.  This year, I am lucky enough to be in the company of people like Dave Aber, who had to put up with me as my Field Training Officer for my first six weeks at my new job, Jim Politis, and someone I think very highly of: Dr. Ed Racht, the national medical director for American Medical Response.   Unfortunately, due to my travel schedule I will most likely miss most of the lectures from Friday, but I will be there all day on Saturday, as that is the day that I am presenting. Registration for the conference is not closed yet.  You still have a chance to get in there and not only get some credits but have the opportunity to take control of your field and be a better provider for you and your patients.  Just click...

Over the last couple of years, there has been a group of paramedics that I work with who have taken it upon themselves to grow mustaches in the name of cancer awareness during the month of October.  The event is known as Stachetober, and each year, more and more paramedics and EMTs throughout my county have joined to participate.  Many would ask why we are not doing this in November, as many other people do, but many view November as a month where you do not shave at all.  Sadly, our departmental regulations prevent that.  They do, however, allow you to have a sweet mustache, so we do our own thing in the month of October. This year, against my better judgement, I have decided that I am going to join my colleagues (who are all male by the way) and grow myself as sweet a stache as I possibly can. In keeping with the growth of Stachetober, we have also decided to take on a charity this year, and are soliciting for donations from friends, family, and the general public.  The charity that has been selected is All the Difference Inc Pediatrics Services For Developmental Difference which one of my colleagues rightly describes as “a phenomenal non profit company that works with children with developmental disabilities and special needs.”  It is a charity that is near and dear to one of our paramedics’ hearts. So how can you help?  How can you support us in growing our sweet sweet ‘staches?  Just head over to our GoFundMe account and contribute!  Any amount will help. . . even if it is just a dollar.  Any amount will help us make the itching, the funny looks, and the laughs worth it.  More importantly you will be giving to a GREAT charity. And, as always, thanks to everyone who takes the time to contribute.  The money this year is going to a great cause.  Let’s see how much we can raise!...