Tuesday afternoon at 3:30pm, there will be a meeting held at Springfield City Hall to discuss American Medical Response and their ability to provide prehospital care to the citizens of Springfield.  Below is something I would like to share with the City Councilors who will be in attendance Tuesday. City Councilors of Springfield, Despite the favorable findings of WGGB in their investigation on emergency response, you have decided to hold a forum to discuss potential short comings of the current EMS provider to the City of Springfield.  Yes, that is right, I said it was favorable.  Although the ebb and flow of the story might not have showed it, all of the information provided shows that AMR exceeds the expectations set for it.  But maybe you should dig a little deeper.  Prior to walking in the door to Tuesday’s meeting, I would like to urge you to do a little research and maybe expand your vocabulary a bit. For instance, for just a second, let’s forget about response times.  They don’t nearly matter as much as you might think.  Try researching what a ROSC rate is, or how CPAP has reduced the mortality of shortness of breath patients, particularly in Springfield.  Ask Baystate Medical Center about the success of their ST-Elevation Myocardial Infarction program (STEMI for short) and ask them how many of those patients are delivered by AMR. Still not convinced?  Why not take a good hard look at other communities around the country and see for yourself how good you have it in Springfield.  An ambulance is on scene in a preset amount of time or less 97% of the time.  How do you think that compares to communities like Detroit, Washington DC, or Philadelphia just to name a few? Or how about closer to home?  Ask around to some of the neighboring more rural communities and see what their response times are like.  I guarantee that some will be longer than the average time publicized by AMR in WGGB’s article, but the patient outcomes will still be favorable. Just like with in-hospital medicine, perfection will never be obtained in prehospital medicine.  Errors are going to happen because not only are the...

Recently, I was checking out some EMS related blogs while enjoying my morning coffee when I came upon a post at Captain Chair Confessions called “I don’t like to take riders.”  In the post CCC talks about the fact that he feels that passengers are a “distraction” to him in the pack and to his partner who would be driving. In a comment that follows, he outlines that his service has a policy that states only a parent of a child under ten can ride in back and all others go up front.  Beyond family members his service has a policy that all other riders are taken “at the crew’s discretion.”  This sounds very familiar to the policy that was in place at my previous employer. I was fortunate that through my seven years as a supervisor I did not field all that many complaints about my team working in the field.  Sure, you would get the occasional nursing home RN who felt that an EMT was rude to them, or someone who complained about being cut off by a speeding ambulance, but beyond that, I took about a dozen calls from people who wanted to go to the hospital with their loved one, and were denied by the ambulance crew. When I approached the crews and asked them what happened, most of them were able to give me a valid reason why they would not allow someone else to come to the hospital with them but there were a few crews that stated “well, it’s up to our discretion.”  And when I asked them what they meant by that, they replied “we don’t take riders.”  I explained to each of those people that this was not discretion.  I would stress them that each individual situation needed to be evaluated and we needed to do what was in the patient’s best interest, and sometimes not having to sit in the hospital alone is in their best interest. I would always do the best I could to back my crews 100% on situations like this if they gave me the ammo to do so.  Calls that involved violence from assault right up to a stabbing...

How good of a paramedic are you?  Have you ever wondered?  Well, lucky for you there is some proof in the numbers.  Getting an idea of how well a paramedic does their job is not as hard as some people think, and with a little bit of research it is easy to figure out how successful your patient care is.   With data collection what it is today, one can look at things like their IV and intubation success rates, or their time to STEMI recognition or even their scene times for trauma calls to make sure that they are, in fact, within the Platinum Ten.  The rest of the job though you are going to have to judge from yourself, from your gut, or simply ask your partner: “how good am I with my patients?”  Bedside manner might be the most vital skill that we all possess in our toolbox and while tools such as patient surveys might give a single provider or a service a better idea of how much compassion and empathy their employees show towards their patients it is largely immeasurable. When talking about employee surveys with a colleague a few years ago, he told me that from his experience with them they were largely polarized.  The surveys that were returned from patients usually either gave a glowing, favorable review of the providers or a scathing dissertation of how poorly they were treated.  Those people who fell largely in the middle rarely said that the care was “just okay.”  One is left to assume then that all of those unreturned surveys, sometimes three out of every four, reflected that the providers did in fact do nothing more than an adequate job. Adequate should not be viewed as a bad thing, and don’t think that I am trying to paint that picture.  Lets face it: you are not going to be able to please everyone, and someone who is sick or injured will most likely be exponentially more difficult to satisfy.   When reviewing patient feed back, I have seen all sorts of complaints: “The ride was too bumpy” “the driver took a longer route to the hospital than he had...

I really need to know: at what point did EMS stop being about patients and start being about providers?  When did EMS become more about justifying jobs than about taking care of people?  And when did scare tactics become an acceptable way of disseminating information to the masses? I am sorry, but I am angry, and I am not willing, as a prehospital provider, to take it anymore.  Preying off of the unjustified fears of others is just plain wrong.  Telling someone that lesser experienced less equipped EMS staff geared towards saving jobs rather than saving lives is the best choice is like telling your kids there is a monster under their bed to keep them from getting up late at night.  Anyone who takes these kinds of action, whether they be a public official, a private company, a fire department, a police department, a union, or anything else should be ashamed of themselves for utilizing such deplorable, unethical tactics. We need to get it through to the public that what is really important to their well-being is that they have strong providers standing at their door when the need for them arises.  A truly efficient high performance EMS system realizes the limitations of each of its participants and compensates for those by emphasizing the strengths of the other stake holders with one goal in mind: the effective delivery of prehospital care.  They are proud of what they do, and they let everyone know it, and most importantly they are not vindictive and manipulative.  They work together as a team.  They stand up for each other and they don’t allow bad blood to simmer or go unaddressed because they realize that teamwork is so important. One of the key goals of anyone employed in any branch of public safety should be to acquire the trust and support of the community.  It is really sad when instead of rewarding that trust with factual information about what EMS is, what its purpose is, and how it is best delivered, some chose instead to prey on that trust, distribute misinformation (sometimes to the point of it being a blatant outright lie or fabrication) all for their own...

In the early days of EMS, especially in many urban settings, there was a “cowboy” mentality.  Paramedics and EMTs were expected to rush into situations, some more dangerous than others, swoop down, and scoop up their patients and then rush them off to safety.  I’ve heard stories of paramedics carrying everything from mace and collapsible batons on their belts to as extreme as a shotgun under their bench seat. Paramedics from yesterday will tell you “It ain’t like it used to be” I know this for a fact because I say it myself.  As an 11 year medic, I feel I have earned that right.  Newer providers will sometimes try to emulate the “old days” in their own way, carrying black “whatcha gonna do” gloves in their pockets or knives visibly displayed on their belts.  It’s time for everyone to remember that times have changed. While the environment that we work in is still strikingly similar to what it was fifteen or twenty years ago, scene awareness (not scene safety) is taught in a much better fashion.  Thanks to priority dispatch, we are able to deprioritize those less urgent calls allowing us to send crews into certain scenes with more help than they had before.    It is time for us to abandon that cowboy mentality completely and move on to a more patient oriented focus.  As scopes of practices expand, as we are seeing in different parts of the country, the role of the prehospital provider is changing as well and we need to better prepare ourselves for that.  We are asked to solve problems every day, but now we need to use our brains more than our brawn.  A wealth of knowledge and a cool head will take us farther than brute strength and a led foot will. I work urban EMS.  I have for the past twelve years, and I love it.  As someone who came from a calm, cool suburban background, the high volume, potential for high acuity and fast pace keeps me interested in the field.  I have, however, also come to realize that sometimes a safer response comes from either approaching a situation a little more slowly or even...

You are dispatched to a single family house for a patient with abdominal pain.  Just like any other call, you pull up in front of the house, gather your gear and head up to the front door.  After ringing the doorbell, you are greeted by a gentleman n his mid-20’s who is holding a camcorder, filming you as the door opens.  “He’s over here.  I just want you to know, you’re being video and audio recorded.”  How would you react to this?  Would you demand that the man put the camera down?  Would you cite a violation of the patient’s HIPAA rights?  Maybe you would state that your own personal rights are being violated.  Ultimately though, I would like you to ask yourself one question: What’s the big deal? If you are doing the right thing, maintaining a professional demeanor, and delivering the best patient care you are able to, what is the big deal if someone is videotaping what is going on?  Realistically, nothing about what you would do for that patient should change.  The only difference is you have a captive audience. A search through YouTube will reveal what some people would describe as videos of patient neglect or people not being treated with the respect they deserve.  Take the recent video of the Houston FIre and police personnel taking pictures of the passed out woman while they stand around waiting for the ambulance to show up.  The fact is, more times than not, you won’t find the YouTube titles of “Police officer is perfectly respectful during traffic stop.”  Or “Watch this homeless person as they are taken care of by caring and compassionate EMTs” why?  Because there is no shock value to that.  No one wants to watch that boring video.  They want to be outraged and shocked with what they find on the internet. I fully admit that I frequently surf YouTube and religiously check out the CopBlock YouTube page.  Now, while I do not agree with the stance and opinions of many of its members, I like to see how the officers who are taped handle themselves when faced with an aggressive camera person and I have seen good...

How does a paramedic handles those three words says a lot about the kind of provider that they are.  Despite all of the training and continuing education one might seek out, there are still going to be situations where we just are not sure what to do.  We will encounter conditions we have just read about and never seen firsthand.  There will be tools in our bags that we might never pull out during our careers, and in many cases, never having to use something like a Quick-Trach or a needle crich is never a bad thing.  None the less, we need to be ready for anything. This is where personal responsibility comes into play.  If someone does not understand something, they need to speak up when asked if they have any questions.  They need to be ready to seek out the answers if they do not understand.  For example: CPAP is still relatively new to my service.  We have had it now for just about a year, and as a supervisor, I am not getting nearly as many patient contacts as I used to.  In the course of my field time, I have had to use CPAP six times, and on three of those, I did not feel as though I had done as good as I could have.  I did not feel that the seal was tight enough, and as a result, the device was not working as well as it could. I decided it was time to ask a respiratory therapist that I know if he had any tips for how to achieve a better seal, and he was able to give me some great advice: “if the patient is able, let them control 90% of the mask when it is being applied.  Get it tight and comfortable for them, and work on tightening the straps when they have it placed.”  On the next CPAP call that I had, I gave this a shot, and it worked really well. I had identified a part of my patient care that I was not doing as well as I could, sought out advice, applied that advice, and was now a better provider as...

That morning in Dallas, I got to spend about two hours with Chief Skip Kirkwood from Wake County EMS, and boy did it fly by. The interview I posted in that previous post was a pretty good summary of what we covered in the more “formal” part of our talk. From there, the discussion turned to an exchange of ideas and thoughts on where we are at and where we are headed, and if you’re looking for inspiration, look no further than what you can learn from him, and his department in North Carolina. My admiration for Skip Kirkwood started about five years ago. I learned about the National EMS Management Association, and their list serv on Google, and I quickly signed up for both. If you don’t follow the NEMSMA List Serv, what are you waiting for? Its filled with some of the greatest minds in EMS who frequently share ideas and thoughts on the field, and Skip is one of their most frequent and well respected contributors. When he speaks (or in this case writes) people stop, take notice, and listen. I have actually saved many of his emails that I found to be useful, and I’ve shared them with those around me. I’ve closely followed the progress Wake County EMS has made over the years, and I even have a few friends from New Jersey who currently work in his system (who I am very jealous of). To me, Skip Kirkwood comes across as someone who is a fearless, confident leader who expects nothing but the best out of everyone around him, and I don’t see why simply his personality wouldn’t bring that out of people. He also projects himself as a very patient person, eager to share the life and professional lessons he’s gained over the years. I thought the most interesting moment in our interview was his response to the question “What lesson would you like to teach to a new EMT or Paramedic just getting their start in the field?” His response had nothing to do with anything clinical or even operational. It was about their personal well being. “Manage your finances,” he said, “don’t live outside of...

CareerCast’s Best and Worst Jobs of 2011 have been released, and guess where Emergency Medical Technician ranks?That’s right, number 195!The career I have chosen is the 6th worst in the country. CareerCast evaluates the jobs based on Work Environment, Stress, Physical Demands, Hiring Outlook, and Income.If you’re interested in seeing their full methodology, its right here. I took a closer look at our score, and how we stood up against some higher ranked jobs.Our Work Environment score is comparable to that of a General Practice Physician, which is ranked #83.Job Stress is similar to that of a Lawyer, ranked #82.Our Physical Demands score is about the same as Heating and Refrigeration Mechanics, who are ranked #93, and our Hiring Outlook is better than the #20 ranked job of Economist. Where do we fall short?Its really no mystery: Income.As I perused the articles that accompanied CareerCast’s report, I stumbled on a great quote from Andrew Strieber in his piece about The Ten Worst Jobs of 2011: “. . . jobs like EMT have considerably better hiring prospects (than the others at the bottom of the list), but rank in the bottom 10 due to harsh working conditions, high stress, and inexcusably low pay given the extremely important nature of their work.“ Let those last couple of words resonate for just a few seconds: “inexcusably low pay given the extremely important nature of their work.”Mr. Strieber gets it.While his words are alarming, and spell out the struggle of our profession, its refreshing to me to see someone in the media voicing a concern with how our profession is treated, even if it is just an excerpt out of a Paragraph.So how do we fix it?How do we move forward in improving our profession, and moving up on the list? Its time to focus on establishing a united front as a profession.Once we come together, and take control of our own fate, we can improve so much of what we do, not only for ourselves but for our patients as well.For now though, we are left to be the pawns of the Public Safety and Medical communities. What’s the first step in getting out of this rut...

I was visiting with one of our Educational Coordinators the other day, and I noticed this cartoon drawn by Paul Combs who you might have heard of over at The Happy Medic’s blog. Now, how does that cartoon make you feel?Do you have a little chuckle over it?Its very well drawn, and rather amusing, but to me, its quite alarming, and it defines our struggle pretty accurately. I fall short of saying that its the perfect depiction of the struggle of EMS because I would make one change to it.The yoke and egg whites would actually be money.Isn’t that really what it comes down to?Isn’t that really what is holding us back?Everyone is worried about getting their hand in the cookie jar, instead of worrying about what is truly important: the patients.Until that changes, we will continue to struggle, stay stagnant and fail to evolve Think about it: we are seeing abuse in every size and type of system, and if we redesign them to reduce transports, what does that mean?Less income.It will be very difficult the reduction of revenue flow in any service if you can’t supplement it from elsewhere.Municipal services such as Fire or 3rd Services use it to reduce their necessary tax basis.Private services use it to keep the trucks on the road, and the stakeholders happy. Simply put: money makes the EMS world go ’round. It shouldn’t matter if you get paid for this or you do it as a volunteer.It shouldn’t matter if you park your truck next to one that has hoses, or a police car, or another unstaffed ambulance.If you want the real answer to the question “Who does the best job providing prehospital care to the sick and injured?”it was best put into words by Michael Morse, author of Rescuing Providence: “An EMS system staffed by trained and motivated individuals is the most effective way to deliver quality patient care to the community.” I admit that I am taking his words out of context.At the time, he was talking about how efficient Providence Fire is at handling the EMS side of things in their city, but that sentence could be applied to any EMS system in...