This post can also be found at The EMS leader hosted by EMS Blogs. Last week, we talked about the problems and challenges presented to us by the young work force that some EMS leaders are having a difficult time adapting to dealing with.  I have been giving a great deal of thought to what the solution to this problem is, and I cannot help but feel that it is evidence of a need to change how we train.  No, I am not talking about adding hours to an EMT class, or teaching CEU classes on how to be what some would consider a better employee, I am talking instead about changing how we utilize our field trainers. Any EMS service that cares about what happens in the street, and cares about how their patients and customers are treated has established some form of a field training program, usually staffed by experienced employees who are initially shadowed by and then later evaluate the new EMT or paramedic to make sure that they are ready to be cut loose and released to practice their trade on the unsuspecting public.  I have seen many different methods used over the years from a group teaching approach, or a one on one tactic where the new employee spends all of their time with one FTO.  Others use a system where the “student” is bounced around from preceptor to preceptor to prevent them from picking up just one person’s bad habits.  They each have their own merits and shortcomings, but the real testament to their effectiveness is what we do with our FTO’s and their new employees once all of their requirements have been met. Far too often in too many systems, employees finish up their precepting time and they are given the “okay” to hit the streets.  From there, they are on their own.  They might get a follow up six months or a year out to say “good job, keep it up” but beyond that the contact is minimal.  Maybe what we need is to establish a stronger bond and relationship between field trainers and new paramedics or EMTs and instead utilize them as mentors. When there...

This post can also by found at The EMS Leader hosted by EMS Blogs. One of the unfortunate things about having a new job is I fall at the bottom of the list when it comes to vacation time.  With the days off that I could get I was forced to miss the last day of EMS Expo in Las Vegas this year.  While following on Twitter though, I caught Greg Friese commenting on a panel discussion by members of the National EMS Management Association (NEMSMA for short) during a program called “The EMS Situation Room: NEMSMA Administrators, Managers, and Chiefs Forum.”  To sum up the discussion simply, the focus of the forum turned to what we will refer to as the “youth movement” in EMS today. As a former supervisor for a service that likes to populate itself with lesser experienced individuals, it has become clear that the work force is changing, and it seems like some of the “old guard” is having difficulty dealing with a lot of the new attitudes and changing needs of the work force.  The entire topic is something that has certainly raised my eyebrow, and it is really something that we need to look at from the first day of EMT class moving forward to someone’s last day with an EMS service. When I was in Washington DC this year for EMS Today, I was on a podcast hosted by Dave Aber where the panel included two of my paramedic instructors from Springfield College.  One of the main topics of discussion was the changes that they had witnessed in their student population over the years.  Fifteen or twenty years ago, when paramedicine was still in its infant stages, most of the student body was made up of people who had been practicing EMS for a number of years.  The vast majority of paramedic students were street smart, seasoned adult learners.  We staffed ourselves from the inside using people who were already integrated into the system and had a strong foundation and framework to help them through class.  As time has gone on though, both the work force and the pool of students have gotten younger and less...

Last week, I had a very interesting and very exciting prospect proposed to me.  David Konig who runs EMS Blogs  and writes primarily at The Social Medic  contacted me and asked me if I had any interest in being part of a new project that he was putting together.  As Dave looked around the internet, he saw a distinct lacking of EMS related blogs that addressed management and leadership topics so he decided to address that by creating a blog appropriately titled The EMS Leader. The EMS Leader will be managed by a series of contributors including myself discussing topics that we feel should be important to leaders and managers.  Although I am currently not involved at a management level, I am excited that Dave thought enough about me and my writing to include me in his newest endeavor. Look for my post to hit the internet Wednesday morning.  Posts will also be shared here, and can be sorted using the category “The EMS Leader” on my blog. In the meantime, go check out the posts that Dave already has up!  The blog is already rolling, and there is some good stuff...

Recently I read a story from Alameda County, California describing the issues that they are having there particularly with responses to stabbings and shootings.  According to the article, the dispatch center in ALCO has abandoned their previous “send anyone to anything as soon as it comes in” system for a more nationally accepted system utilizing Priority Medical Dispatch. Priority Medical Dispatch, or PMD, is supposed to prioritize calls and tailor responses to those calls by classifying them utilizing a limited amount of medical information.  Calls are classified from the lower “ALPHA” level response to the most serious calls classified as “ECHO” level calls.  ECHO runs are mostly reserved for cardiac and respiratory arrests.  The purpose of the system is to get the most serious calls taken care of first.  It is a means of phone triaging.  Using a series of questions, call takers do their own little “choose your own adventure” flow chart and end up with a call’s classification. The claim made by paramedics and EMTs in ALCO states that on occasions since the change over from AMR to Paramedics Plus, runs that turned out to be fatal or serious shootings and stabbings were classified at the less serious “BRAVO” level.  Field providers are now demanding that prioritization changes be made to give these calls a quicker response.  I, for one, cannot help but feel like they are barking up the wrong tree. I feel like I have seen both the “very good” and the “just okay” of Emergency Medical Dispatch and PMD throughout my career.  I have seen it work well, and I have seen it misused.  Any system that gets used is going to be less than perfect, and utilizing Priority Medical Dispatch is no exception to that rule.  I believe it was Justin Schorr who once described Priority Medical Dispatch’s greatest flaw as the “least informed person (the caller) is talking to the least trained person (the dispatcher)” any anytime we discuss dispatch, or the prioritization of any calls, that needs to be kept in mind. The real issue in Alameda County, as is in most systems that have I seen struggle with the problems they are having, is a...

This past week, Washington DC finally took a step in the right direction by hiring what they call “civilian paramedics.”  While I am not a huge fan of the term they use for their new employees, I cannot help but stand up and applaud their move to hire staff that can be 100% dedicated to addressing the department’s shortages. I have seen a lot of numbers of the past week: 38 paramedics on a shift with only 14 in ambulances.  80% of the department’s 160,000 calls medical in nature.  Trucks out of service.  Running out of gas.  Catching on fire.  Lately, it has been one horror story after another for DCFEMS.  While hiring paramedics seems like a logical move, one city councilman went as far to call it a “step in the backwards” for the department.  City Councilman Phil Mendelson was part of the Rosenbaum Commission which, in response to the assault and death of New York Times reporter David Rosenbaum.  That commission was a driving force in the cross-training of EMS personnel, and the overall integration of the fire and EMS systems in the nation’s capital. The circumstances surrounding Rosenbaum’s death seem more to me to be driven by complacency and burnout than the failure of the EMS system.  The EMTs involved failed to recognize a serious medical emergency and wrote the patient off as being drunk.  Because of this, he did not get the care that he needed.  The only place where the system failed was by not having the EMTs that initially responded to the call properly prepared for what they encountered. Now, almost six years after that committee’s recommendation, it is easy to see that the changes that were aimed at improving the system have failed.  The biggest sign of this is not the response times.  It’s not the number of trucks out of service.  It is the number of overworked and underappreciated paramedics who carried 80% of the department’s volume who have left the department because they have seen the writing on the wall.  The time for change clearly is now. Many have called for the firing of Chief Kenneth Ellerbe.  Some would even argue that due to his...

As a follow up to last week’s article about violence against EMS professionals, I wanted to share with everyone the state law that was passed in Delaware at the end of June. On June 30, the state of Delaware added “emergency medical technicians and paramedics” to a state law that makes “offensive touching” a class A misdemeanor.  To summarize the law, offensive touching is defined as “touching another person either with a member of his or her body or with any instrument, knowing that the person is thereby likely to cause offense or alarm to (the) other person. . . “  Interestingly enough, the law also includes “intentionally striking the other person with saliva, urine, feces, or any other bodily fluid” and mandates that a defendant be tested for “diseases transmittable through bodily fluids.”  In the state of Delaware, punishment for a class A misdemeanor could land someone in prison for up to a year, and could result in a fine up to $2,300. EMS advocates, services, and unions that represent EMS professionals should take note of this, and start laying the groundwork with their local law makers if laws similar to this do not already exist within their state.  This is a major victory for EMS professionals everywhere.  While laws such as this one do not make my job any safer persay, they do at least create greater consequences for those who choose to assault EMS professionals. Like I said, take note, share and advocate.  Our safety is no one’s responsibility but our...

The other day, I had a chance to read an article about Toronto EMS, and their relationship with the fire department, or more specifically, the fire department’s union.  In a recent study done by a third party, it was recommended that paramedic unit hours be increased, and that a fire station on the city’s west side be closed down.  Ever since then, it seems like in Toronto, the fight has been on, and boy is it an ugly one.  With headlines like the one on a 2010 article reading “We’re in a War with the Fire Department” do nothing but draw unnecessary lines in the sand. Dispatch protocols were reviewed, and fire first response was removed from 50 of those protocols, but added to 22 others.  In the year since the revamping, they have been added back onto less than ten of those they were removed from.  It is the position of the Toronto Paramedic Association that what the citizens of Toronto need is exactly what last year’s study calls for: more paramedics.  Ed Kennedy, president of the Toronto Professional Fire Fighters’ Association disagrees.  He feels that care being provided to the citizens of Toronto suffers without the fire department’s first response, and even says that Toronto should scrap their third service paramedic system in favor of a fire-based EMS service. My question to Mr. Kennedy is a simple one: where is the evidence?  What does he have to hang his hat on that says not only that fire fighters should be added back as first responders but should, in fact, take over the ambulance service?    The study, which provides evidence to the contrary, recommends against consolidation and advocates for the addition of 25 ambulances per day, a jaw dropping number regardless of the current size of the service.  It is time to cut through the B.S. and let the evidence speak for itself. Toronto EMS, however, is not without their problems.  Their response goal of under 9 minutes 90% of the time is not even close to being achieved, and currently sits at an abysmal 65%.  Does that mean that the system needs first response, or does that say that the need for...

Imagine if you will. . . It’s a typical day for you.   You came into work, just like any other shift, you got assigned your truck, and you hit the streets.  You did a few calls, here and there, mostly routine, you transported them, finished your paperwork for each, and got yourself back on the road.  Then, you are dispatched to a male in crisis. You arrive on scene, just like any other call to find the depressed, suicidal, and slightly intoxicated patient.  You put him on the stretcher, and place his bag on his lap and load him into the ambulance.  Initially, your patient is calm and cooperative, so you hop in back, sit on the bench seat, and get on your way to the city hospital, just like any other call. Without warning, the patient goes into his bag and pulls from it a black handgun.  A scuffle ensues, and you are able to disarm the patient, restrain him and finish the transport.  After removing your heart from your stomach, you inspect the gun and find it to be a BB gun.  Regardless though, you feared for your life, and you are assured that after being medically cleared, the patient will be dealt with by the proper authorities. This really happened to a good friend of mine.  Lucky for him and his family, he was fine.  The outcome of the patient, or rather the assailant, however, is unknown to me. Safety is a growing issue.  Recently, a Jersey City EMT had a knife pulled on them in the back of an ambulance.  They were able to dodge the first swipe, sustaining only a minor laceration, but the party they were transporting then impaled the knife in the EMT’s shoulder.  Fortunately, the injuries sustained by the EMT were not serious, and according to an article I read, they will be fine. An official in Jersey City made some eye opening comments in the article.  Robert Luckritz, the Director of Jersey City Medical Center Emergency Medical Services said that “some EMTs accept it as part of the job.”  He went on to add that “it is relatively common that EMTs are assaulted and it...

Just when I thought all hope was lost, all the chips fall into place. . . I have not missed a major EMS conference (EMS Expo or EMS Today) since my first trip to Dallas in 2010.  Because of all of the life changes that have happened over the year, and my demotion to “FNG” at my new job, I thought that this year’s EMS World Expo in Las Vegas might just be the first one.  It was tough to listen to everyone making plans, and talking about classes, and realizing that I just might miss it because of my work schedule. It took a little bit of work and a lot of overtime, but thanks to the generosity of some of my new coworkers in the form of swaps and their vacation days that allowed me to work almost non-stop, I have booked my hotel room, and scheduled my flights.  I will be arriving in Las Vegas on Sunday September 8th in the morning for four days and three nights of quality time with some of the best friends a guy could ever ask for. Yup, that’s right: our semi annual “reunion” will happen again!  I really did not realize how much I would have missed it until I took the time to schedule the trip.  The excitement that I am overcome with now, just about a month away, is overwhelming.  There is no better place than those conferences, and its not because of their location, its because of the people that I get to see there. To those of you who will be joining us for Expo this year, I look forward to seeing you all and catching up with you!  For anyone who is missing it, you will sorely be missed.  And finally, if you have never been, what are you thinking?!  You have no idea what you are...

EMS is currently at a major crossroads as an industry.  Across the country requirements to become a paramedic are becoming loftier, and rightfully so.  In order to properly care for each patient we encounter, we need to be at our best, and the route to that is through training and that bar is being raised.  More education eventually should mean more pay, and some in the private sector are starting to realize that. This is evident from the recent well publicized labor dispute in Buffalo, New York and their eventual 10 hour work stoppage followed by a contract settlement.  From the publicity I have seen regarding those negotiations and others I have more intimate knowledge of, it leaves little to the imagination as to what is most important to EMS professionals: pay and benefits.  I know, that seems like a slam dunk, no brainer, but it also seems clear that at least in the private sector, purse strings are becoming tighter, and benefit packages are less and less appealing.  It’s quite the conundrum, actually.  Increasing educational requirements are driving paramedicine towards being a career, yet employers are still far too often looking at employees with the expectation that they have a job, and there is a divide the size of the Grand Canyon between the two. Now, the jury is still out for me on work actions such as strikes.  I do not really know if they truly follow the “spirit” of our profession and seem to do more of a disservice to the community than they do benefit the worker, but that is a debate for another time.  The fact remains that they happen, and there is certainly reason behind them, as evident by the Buffalo, NY Rural Metro incident. While the private sector is just one of a number of EMS models, it is quite often the quickest path of entry into the industry and employs more EMTs and paramedics than any other model, so discussing the big kid on the block is extremely important.  With health care taking on a huge for profit presence in the economic world, everyone wants their piece and if some of the bigger players want to...