Let’s Talk About Delivery

I wanted to follow up on my reply to Councilman John Bendel’s letter to the editor in the Asbury Park Press a little bit and talk about delivery and goals.  Realistically, regardless of what sort of department an EMT or paramedic works for, their goal should be the same.  We should be aiming to reduce morbidity and mortality of the conditions that we can directly impact and for those that we cannot have lasting impact on in the prehospital setting, we should aim to deliver them to a place where they can get treatment while doing everything that we can in our time with him to promote a favorable outcome in our limited time with the patient. Too often, when debating about what delivery method works best, we get caught up in the weeds of the minor details that have a greater impact on the provider than the patient.  We worry about the training that we must do and the time that it takes, or the unproven theory that people serving their own community has a greater impact on patient outcome than the ability of the provider.  We get hung up on the importance of response times when they have less to do with patient outcome than care provided in most cases. In Bendel’s letter, he touched on the fact that “MONOC can probably tell us how many lives were saved because a highly qualified EMT was on calls.  But no one can tell us how many lives were saved because a local squad got people to the hospital faster than MONOC would have.”  He’s probably right, but we need to ask ourselves why this is.  With a call volume that is often a fraction of what MONOC runs, why can’t volunteer squads better report their impact on patient outcomes?  I think that the answer to this is twofold. First, most squads probably do not possess the outcome data that a company that MONOC has access to.  That is partially the fault of the system for not including volunteer services in this feedback loop, and partially on the squads for not seeking it out, and creating the infrastructure within their organization to acquire it....

Fact Checking the EMSCNJ

Fact Checking the EMSCNJ

Apr 17, 2017

Read my Open Letter to Mr John Bendel here. For today’s post, we are going to continue to analyze the saga of the Asbury Park Press editorial battle regarding EMS in New Jersey.  The EMS Council of New Jersey has sounded off.  Last week on April 10th, the EMSCNJ’s president, one Mr. Joseph G Walsh, wrote a letter of his own in order to, as he puts it, “correct several points.”  So let’s fact check some of Mr. Walsh’s statements, and dig deeper into what the EMSCNJ has said in the past. “Paid or volunteer, every New Jersey EMT must pass the same certification exam. Volunteers conduct monthly drills, and education and skills sessions to stay current. The misleading editorial might have panicked some readers into falsely thinking their local volunteer squads are not staffed with properly trained responders.” It is true, indeed, that every EMT must pass the same certification exam.  So what?  I would dare to say that the ability to study and regurgitate information from a textbook is not the be-all-end-all in evaluating one’s effectiveness as an EMT.  I have worked with great EMTs, and I have worked with people who could not be trusted to work on a crew of two because they lacked the ability that they needed to take the knowledge in their head and apply it in a real-life practical setting.  They all had one thing in common though, they passed the same test. Then there is the other statement that Mr. Walsh makes here about proper staffing.  While all EMTs take the same test, that fact alone does not mean that every person operating on a volunteer ambulance in New Jersey is a certified EMT.  In actuality, many responders might just be certified at a lesser level.  How do I know this?  Mr. Walsh tells us. “Every one of our member squads is required to respond to calls with at least one EMT who remains with the patient. On many calls, two or more EMTs respond. The EMS Council of New Jersey (EMSCNJ) is unaware of any squad — member or nonmember — answering calls without such trained responders.” Currently, when a paid or career ambulance...

A Reply to Mr. Bendel and I

A Reply to Mr. Bendel and I

Apr 13, 2017

  I am happy to share with everyone that Mr. Bendel has seen and read the post from earlier this week.  I look forward to speaking with him in the future. The issue with BLS care in New Jersey has never and will never be about passion.  It’s about training.  Every good EMT needs to possess a balance of passion, compassion, medical knowledge, and the ability to apply that knowledge.  I am happy to say that I come from a family that possesses those values.  I have two parents who both had lengthy careers as volunteer EMTs.  After reading my letter to Mr. Bendel, my mom, Karen Kier, decided to share some of her thoughts about what it means to be a small town EMT.  What you will read below are her thoughts, from the heart. Mr. Bendel and MedicSBK: First off, EMS is one of the defining aspects of my life. To go one step further, EMS in Island Heights (where you both either currently or have formerly resided) creates this passion.  It’s a passion both for the profession and for the people I so dearly cared for during my 22-year career as an EMT on the Island Heights First Aid Squad. MedicSBK, you, above all, should know this about me.  I watched you closely (and protectively at first) as your skills developed – and then we switched roles.  I knew that you were bound for great things – and I proudly watched you fly. I have performed CPR (successfully) on a dear friend, the parents of friends, people I have known and not known . . . and watched others drift away after a devastating stroke.  I have simply and quietly held many hands.  Was it hard?  Yes.  But it would have been harder not to have been there. I like to believe that with few exceptions I brought this same compassion to all of my calls, whether in Island Heights or in one of our neighboring communities.  In my own simple, naïve way I can only hope that this is something that permeates the entire profession. For personal reasons I have made the decision not to renew my EMT certification –...

An Open Letter to Mr. John Bendel

An Open Letter to Mr. John Bendel

Apr 11, 2017

Last week, the Asbury Park Press posted a letter to the editor entitled “Letter: Emergency response teams must have volunteers.”  The piece was written by John Bendel, a town councilman from Island Heights, NJ; the same Island Heights, NJ where I got my start in EMS more than twenty years ago.  John’s letter is a reply to an editorial done earlier in the week called “EMS system deadly hodgepodge” which addressed several the shortcomings of New Jersey’s EMS system, many of which were identified more than ten years earlier by a study done about the state’s slowly dying prehospital care system. To say the least, Mr. Bendel’s letter sparked a fire in my belly.  I wanted to address some of the points that he attempted to make here. “Sure, it would be nice if every Emergency Medical Technician (EMT) were as qualified as the legislation you endorse would mandate.  But if they were, far more would be paid professionals than volunteers.  In America where health care still bankrupts families, that’s a big deal.  We need volunteers.” Let’s address the semantics of this statement first.  “Health care” is not bankrupting families.  Many have begun pointing out that it is health insurance that is doing this.  Skip Kirkwood has taken to frequently correcting people telling them that what they are seeing is attempts at health insurance reform, and not health care reform.  He’s right. Now, on to the meat and potatoes of this statement.  First, what is the issue with creating more jobs, and putting more money, and insured individuals, into society?  Why is it so bad that some would like to see people compensated for the hundreds of initial training and numerous hours of refresher and continuing educational training that EMTs are required to do?  Career EMS providers (because professionals can be paid or unpaid) guarantee that someone is going to be there when the tones drop.  Volunteers cannot always make that same assertion. And let’s talk, for a second, about the chain of survival that drives health care.  With the exception of bystanders, every other link in that chain is staffed with employed, compensated individuals.  Nurses, doctors, dispatchers, people who work in rehab centers,...

Accountability for Providers

“I’m just a volunteer EMT.” Have you ever heard anyone say that?  Neither have I.  Just about every volunteer provider that I have encountered in my career, regardless of how long they have been doing it or what their dreams and aspirations actually are take a ton of pride in serving their community.  As many readers already know, I come from a family full of volunteers and an area that up until about ten years ago, the area that I grew up in was almost 100% maintained by volunteer EMS.  Sadly, volunteerism is on a decline, and there are many, many reasons for that.  A few weeks ago, EMS 1 reposted an article and tried to tackle some of those reasons with a few really good articles. One article cites expanded EMT training for lack of volunteers.  EMS 1 Editor in Chief Art Hsieh then wrote what I feel is an excellent reply pointing out a lack of change and evolution as the culprit.  Both stories make some excellent points. In the past, I have written rather candidly about the problems as I see them that the New Jersey State First Aid Council presents to EMTs in my home state.  Their organization demands different standards for staffing a volunteer ambulance than a paid ambulance to try and keep volunteer EMS alive.  Essentially, they are trying to create a new level of care that is specific to their services resulting in them keeping the EMS system in New Jersey on life support. In many states EMT students are expected to learn more than they have ever been asked to before.  They are asked to expand their assessment skills, provide more invasive treatments, and give medications that previously were reserved only for paramedics.  To be able to properly understand how those medications work, a greater knowledge of body systems is also required. Enough is enough.  Sure, obtaining an EMT certification takes more time now than it did even five years ago, but there is a good reason for that.  No one is trying to circumvent the volunteer system in any state.  The changes instead are in place to improve the level of care that patients receive...

Bad Publicity and Saving Face – Your Comments

Read the original post and the comments it generated: Bad Publicity and Saving Face In my two years of blogging, I have seen what I considered to be a few “big” days.  A post goes up, it generates some buzz, and I get a decent amount of hits, usually a few hundred.  This past Monday though, any previous numbers I had seen were blown out the window.  In the first 24 hours that my post about Joshua Couce and the Newton First Aid Squad was up, I saw almost 4,000 visits to my site.   I received a number of comments about this post, and I thought that I would take some time to highlight some of them for you. First of all, I would like to share with you a few comments from Newton FAS members: Member of 15 years: “It is an unfortunate situation that has come about by someone that has been mentored by some of the finest EMT’s around, yes I am a member of the NFAS and I have to say yes Josh made a bad decision by over indulging in the truth, I believe that youth plays a big role in his decision making process. I am in NO WAY CONDONING his behavior or how he portrayed himself and the squad however there is not one person out there that has not made a bad decision weather it be in the professional sense or the personal sense, and unless your back yard is completely clean maybe people should reach out to Mr. Couce and help him grow and mature within the EMS community rather then hanging him out to dry along with the rest of the squad.” Debora Baldwin Phillips: “Mr Kier, I thank you for your insightful post. Some of the points you address are valid. We, as the squad are aware of them. I will not address them in a public forum. However, I, as Captain of the squad, assure you, and anybody else concerned the issues are being addressed. Deborah Phillips, CT1” Thanks to both of you for sharing your thoughts, especially you, Captain Phillips.  Believe it or not, I wish you well in your future...

Bad Publicity and Saving Face

Editor’s Note: With this story now being five years old, I have removed the names of those involved.  I do, however, feel that there are a lot of lessons that we can learn from this situation. Late last week Kyle David Bates posted an article from a New York State college paper about a New Jersey EMT from the Newton First Aid and Rescue Squad in Newton, NJ.  In the article this EMT describes such events as “driving over 100 MPH” in an attempt to beat the “golden hour” and being covered in a variety of patients’ bodily fluids.  The outcry and comments on the from EMTs, some of whom know this person personally, are mostly filled with disdain for the way the article painted EMS professionals as a group as an unprofessional group of adrenaline junkies more concerned about what they are able to accomplish with a heavy right foot than the outcome of their patients. The response of the Newton First Aid and Rescue squad was to post a message on the department’s Facebook page denouncing the article, stating that the EMT had been suspended and disciplinary action was being taken effectively hanging him out to dry to take full blame for the statements and quotes within the article.  It stated that the article was written “without the consent of the squad and its officers.”  The only problem with that is, as KDB so aptly points out, the squad’s 2nd Lieutenant was quoted in the article as well. The entire course of events is a real comedy of errors, the fallout of which is far reaching.  Not only have personal reputations been effected, but the squad’s integrity has been brought into question and potentially the values of EMTs everywhere could be brought into question. 1.  The Newton First Aid and Rescue Squad – First of all, a full admission of what knowledge of the article prior to its publishing needs to be explored and put into public record.  I am basing this off of the squad’s swift stroke of the virtual pen in putting the entire burden on the shoulders of an 18 year old kid. Also, it would be wise for the First Aid Squad to take...

More on New Jersey EMS

To read all of my posts about the New Jersey State First Aid Council, and the struggles of EMS in New Jersey, just click here. For more information on the NJSFAC click here. Earlier this month, I had a friend from New Jersey send me the latest information sheet put out by the New Jersey State First Aid Council in regards to State Bills S818 and A2095.  While the bills are slowly gaining momentum with the current vote on Bill S-818 resulting in 21 “Yes” 15 “No” and 4 “Not Voting” as an official for the NJSFAC stated in a recent email, “The fight is not over.”  EMTs and paramedics that live and work in New Jersey need to understand the true fabric and importance of these bills. The First Aid Council’s intention was to share their views which are in the form of oppositions to many of the amendments that were recently made to the bills.  Here is my rebuttal to a few of their arguments.  Please take a good look at this, especially if you are a New Jersey EMT. FACT: The New Jersey State First Aid Council opposes the establishment of a new lead agency for EMS.  For some reason, the NJSFAC opposes this amendment because it would give “. . . complete control over and all facets of EMS in the state including some that are already overseen by other groups. . .”  My question to this is: what’s the issue? EMS is a fragmented profession, and New Jersey is no exception to this.  In fact, in many aspects the fragmentation of EMS is magnified in New Jersey.  In some states, differences exist in counties.  In New Jersey, the unique setup of each EMS system right down to staffing and equipment varies from town to town and squad to squad.  Rules and regulations vary depending on whether or not you are a volunteer ambulance service or a professional one.  In New Jersey, an ambulance is not an ambulance and an EMT is not an EMT. Establishment of a lead agency for the state would create one entity for everyone to answer about everything.  Standardization could be developed.  Studies could be...

EMS in New Jersey – A Call for Action

Almost a year ago, I wrote a post about NJ State Bill S-818 which was set to change the landscape of EMS in New Jersey.  In the year since that article was written, the bill and a second one also making its way through the New Jersey legislature have been revised, but the opposition has remained. I got my start in EMS at the Jersey Shore on a small volunteer first aid squad.  We ran, on average, around 400 calls a year, pretty busy for a town of our size.  Often times, it was not uncommon to have two or three, or sometimes even four EMTs standing in your living room in my town ready to render you emergency care.  The communities around us were no different than we were.  We all took pride in what we did, and knew that we could deliver better service than any paid provider who came into the area because we held ourselves to a very high, very professional standard. To this day, I am still proud of my accomplishments as a volunteer.  I was an active member of two excellent services, and the staff of those services taught me to be the caring, compassionate, knowledgeable provider that I am today.  My roots in New Jersey run deep, and I have been very troubled by what I have been reading lately. As time has progressed, and the political and economic climate in this country has changed, volunteer EMS has taken a turn, and is not as prominent as it was even ten years ago.  Families are working harder to support themselves, and the call volume and expectations of care have grown and evolved.  Some might say that these factors spell the end of volunteer EMS, and I hope every day that it isn’t the case.  It’s not the time to expect less from our volunteers; it’s time to expect more for our patients. Sadly though, the New Jersey State First Aid Council seems content with the past.  Their staunch opposition to Bill S-818 has taken the focus off of where it needs to be: the patient and put their stress on what EMS is about on the provider. ...

I Couldn’t be More Proud. . .

Back in the 1970’s, my dad decided to take his shot at getting involved in the town’s First Aid Squad. When I was born in 1978, he stepped away from hit to be a father. In early 1992, he began working on getting his EMT Certification Recertified and rejoined the Island Heights First Aid Squad. Island Heights is a very small town at the Jersey shore. Approximately a mile by a mile, it has a year round population of 1,500 people, and gets a little higher in the Summer Time. Throughout the late 80’s and most of the 90’s, the majority of the EMS Runs the Island Heights First Aid Squad had were during the day, Monday thru Friday in neighboring Dover Township, now known officially as Toms River. Annually, they would run around 500-600 calls a year, about 150 of those in town. My dad was involved in EMS for about 6 months when my mom got tired of just sitting around listening to the pager go off all day. She decided that she would give this whole “EMS thing” a try. Her first year was very tough. She lost 15 lbs, and on some early mornings would cry when the pager would go off, although she probably wouldn’t admit to that today. She scaled things back a bit, and started running more abbreviated hours, and then decided that EMS really was for her. Through out the 90’s, my parents became more and more involved in EMS in the town. They both served as Captain, my dad spent time as Squad President, and they’ve both been the most active members of the squad for the last 18 years, and most importantly, they’ve been an inspiration to me. I got involved in EMS at the age of 15 as a Cadet with the Island Heights First Aid Squad, following in the footsteps of my parents. Say what you want about young people in EMS, but I think I handled myself the right way and learned how to be the right kind of EMT because of my parents, their involvement in the squad and their involvement in my early years in this field. They supported...