11 years ago right around this time, I was spending every free moment that I had studying for my Paramedic Class Final. It had been 11 long months of work, where I had sacrificed time away from family and friends to help achieve a dream that I had: to be a Paramedic. That 250 question final was staring me straight in the face, and after that, it would be off to my Clinical and Field time. I had learned a lot in those 11 months, and had also learned a lot in my 4 and a half years that I had been an EMT prior to that. There were still plenty of lessons that were waiting for me on the road ahead throughout my career. If someone was to ask me what I thought some of the most important qualities that a Paramedic should have, some buzzwords that come to mind are “caring,” “compassionate,” “clinically competent,” and “hard working.” That would be my politically correct answer though. There are some other qualities that lie under the surface that are rarely discussed with the public that people should know about and be ready for if they choose to make EMS their career: Strong stomach — During your career, you will see and smell things that no person should ever have to. When you encounter them, you will be expected to keep a straight face, stay calm, and act like it doesn’t bother you one bit. Able to work independently — There will be times when that other truck, or even your partner might not be near by. You may have to work a cardiac arrest by yourself. You could pick up the radio and ask for another truck and hear those terrifying words: “No units available.” Above all else, be ready for as much as you can with little to no help. Innovative — In EMT and Paramedic class, you will learn about algorithms and what to do for a patient quiet often in the best case scenario, but remember what Murphy’s Law teaches us: “Anything that can go wrong, will go wrong.” You need to be able to think outside the box and adjust...

Battle On Over Emergency Response Vs. Emergency Caution – Jackson News Story – WAPT Jackson Jackson, Mississippi is back in the news, and Councilman Kenneth Stokes is at it again. Take a look at the video that I linked above, and reread my previous post on this issue. Why doesn’t Kenneth Stokes see what the problem here really is? Its not faster ambulance response, its a larger police presence. The question at hand is should an ambulance respond into a potentially dangerous scene until it has been secured by the police department? My training and my gut both tell me NO. Kenneth Stokes recommends bullet proof vests for AMR’s staff, but a vest isn’t a magical suit of armor that will keep you safe. The right angle to take of all of this is to promote safety at the scene. Bulk up Jackson’s police force. If the city is that unsafe that this has become so much of a problem, make it safer. Expecting AMR’s Ambulance staff to do some of the police’s work for them is unfair, and it puts more people at risk. But, remember, that would cost tax dollars. Its much cheaper to drag the Ambulance Company through the mud, encouraging them to drive into potential “war zones” and put themselves in the line of potential danger. I looked up some information about Jackson, Mississippi. It ranks 4th in the nation for homicide rates per 100,000 residents behind Baltimore, St Louis and New Orleans. In 2009, it was ranked as the 23rd most dangerous city in the United States. If anything should scream for a larger police department, that should. It doesn’t give Jackson the portrait of being a safe city, or a safe place for EMTs and Paramedics to work. What Councilman Stokes is doing is making it more dangerous for the Paramedics and EMTs in Jackson, Mississippi. He’s setting them up so that each time they walk into a scene after the police department, the perception could be “What took you so long?” Every time a truck is posting in a parking lot, or waiting for police to arrive at the scene, it will spark the question of “What...

Last Thursday, I was given the opportunity to participate in an episode of EMS Garage. The topic that night was Liability, and revolved around a news story from Missouri. You can read about it here but the gist of it is this: A crew goes to a chest pain call. They evaluate the patient, tell him its most likely GERD and has him sign a refusal. Later, his family calls 9-1-1 again, and the patient, who is still having difficulty breathing and chest pain, is transported to the hospital where it is revealed that he actually has a Pulmonary Embolism. He dies later that day. First of all, in my eyes, there is no defending this crew. They went outside of their scope of practice, and gave advice that they did not have the right or the training to give. If they had done the right thing from the start and said “well, we don’t know why you’re having this chest pain, but let’s go to the hospital and find out” then this patient might have had a different outcome. I was lucky to be on with a great panel, and there were lots of thoughtful, well informed points made. I urge everyone to take a listen to it. One of the most interesting points and topics to me though was about what should be called “The 11th Hour Syndrome.” Wonder what that is? Well, the 11th Hour Syndrome is what makes a Paramedic change the way they take care of their patient when it’s close to the end of their shift. Do your speed, depth of assessment, and motive change just because it’s almost time to go home? It shouldn’t, but in some cases, it just might. Whether you’re rushing through your assessment, looking at a poor 12-lead because its “good enough” and bypassing that occasional necessary prep work to get a good clean picture, or trying to burn through that last Patient Care Report, the only person that suffers is the person who is receiving the care you’re providing. The hours that one works in EMS can be demanding. This is not your typical 9-5 Monday through Friday job and I think...

Think back, if you will, to the first EMT class you ever took. It might have been a few months ago, or for some folks, it might have been 20-30 years ago. Now, think about what they taught you about your own safety, and what is most important when you hit the streets. Lets take it a step further. Think now about any EMT Practical exam that you’ve taken, whether it be for your EMT-Basic certification right on up to your Paramedic. Lets take the Assessment station. You walk into the station, stethoscope around your neck, with a State or National evaluator sizing you up and staring you down. You look over your station, and indicate you are ready. Your evaluator looks at their sheet of paper, and begins reading the same scenario that the person before you most likely just heard. It could be a car accident, a shooting, or something as routine as a fall, abdominal pain or a chest pain call. Regardless of what the nature of the “call” is, you take the information in, and start your station the same way. “Scene safety, BSI, number of patients.” You might use different terms depending on where you’re at, but the intention is always the same: Is the scene safe for my partner and I to enter? Do I have the necessary protective equipment on? Do I have the resources I need initially to handle this incident? Now, keep that in mind, and read this article that has made its way around the internet: http://www.wlbt.com/Global/story.asp?S=13191657 Take a moment to compose yourself, pick your jaw up off the floor and stop screaming at your computer. I’m sure you’ve already asked out loud, “What is this guy’s problem?” AMR has not written a policy that needs to be changed, the responding crew followed their training perfectly, and did the right thing by not putting themselves in a dangerous situation. If any other Ambulance service, Private, 3rd Service, or Fire based told their crew to just rush in there, I’d question their devotion to their Field Employees. Tim Noonan over at RogueMedic.com has said it better than I could have. The blame here has been...

As you remember from my last post, recently, I have seen an increased interest in a lot of the blog posts and articles that I’ve been sharing with some of my coworkers. Now, here I was on a Sunday evening with our Training Coordinator sitting in front of my computer. I went straight to http://www.levelzeromovie.com Ever since Ted Setla released his documentary about Alameda County EMS, I’ve been trying to find some way to work it into sharing it with as many employees as I could. He paints the providers in the movie as true professionals who love their jobs. Their messages and words of wisdom are so powerful and should be heard and understood by anyone who is trying to get into this field. After showing him the Level Zero trailer, I told Dave that I thought that this would be a great way to spend 20 minutes of our New Employee Academy. He liked what he saw, and liked what he had heard, and told me that if I could get him access to it and permission from Ted to use it, he’d be happy to include it. Well, 20 minutes later, after a brief conversation with Ted, I had everything lined up and ready to go for the premier of Level Zero at my company. Monday morning, I was still handing out a few copies of Steve Whitehead’s Blog Posts. People were reading them and saying, “Wow, yeah, that makes sense.” Or “that’s the exact problem that we’re having here!” Eyes were starting to open. At 9am, I walked into our daily management meeting, laptop in hand. After we had gone through the regular business, I looked at a few other members of the management team. “Can I borrow you guys for 20 minutes?” Three of them agreed to stick around, and I fired up my Netbook, and started streaming Level Zero for them. To say that the reactions that I got from them were positive would be an understatement. Not only were they impressed with the quality of the production, but they loved the message behind it all. They loved how the providers were portrayed not only as EMTs and...

Earlier this year, Steve Whitehead and Natalie Quebuedeaux coined the phrase “Make your own Thunder.” It has quickly become one of my favorite phrases. Here’s my story, broken down into two parts, about the rumbles that I’ve created over the last week. . . For the last couple of years, I’ve been a member of the National EMS Management Association (NEMSMA) List Serv through Google. It’s a hotbed of conversation and information about the industry, and I highly recommend it to anyone interested in furthering their career in EMS. Quite often, I would find posts or articles that seemed very relevant to the issues faced within my company, so I would copy and paste like mad to some of my colleagues, hoping that it would have some impact. This practice increased ten fold this past February when I became involved in the Social Media movement in EMS. As I have read more blogs, I’ve grown more and more excited about the information that had been right under my nose. Who would have thought that there were so many people out there with the same ideas and motivations that I had? Quite often, I would send the copied and pasted articles and links out, and I wouldn’t really hear back from anyone. I knew a few people read them, but I never really got much feedback about what they were reading. In the last week, that changed. It all started last Wednesday when I got an email from one of my main “targets” of all of my forwards, our Operations Manager. It asked a simple question: “Can you send me the links to what you read and listen to?” I was really excited, and I got right to work. I started going through my bookmarks, sharing every podcast, blog, and publication that I frequent. While he is a very open minded guy, and thinks along the same track that I do, here was my chance to really open up his eyes to what was out there. By Friday, I had already received a number of links from him pointing out articles and posts that he really liked. By Sunday, he had sent out an email...

Last night was a big night for me. It started out with the opportunity to participate in a great Podcast hosted by one Kyle David Bates called The First Few Moments. If you haven’t checked it out yet, please do so. It’s got some great information about dealing with issues such as triage, treatment, and management of the critical first minutes of a scene. That was followed by the 100th episode of EMS Garage. Not only was I able to listen to the show, but I was actually on it too. Like I told Chris Montera, the show’s host, “Being on the Garage for me was like being a fan that is plucked out of the crowd and put on the court.” It was a great experience, and I am extremely grateful. I finished the night catching up with Ms. Paramedic and Jeramedic over Skype. If you haven’t heard of them, check them out on their many projects: The Gen Med Show, Mutual Aid, and their personal blogs to name a few. I had a great discussion with Jeramedic about some of the recent events here in Massachusetts. As many of you know, my wonderful Commonwealth has been in the news quite a bit over the last few months, first for the more than 200 EMTs who have had their certifications suspended, and more recently, the law that was signed in by Governor Deval Patrick making the minimum staffing for an ALS Ambulance one Paramedic and one EMT. Previously, it was two Paramedics, and if a service wanted to run with anything less, they would have to obtain a waiver from their Region. The President of the Professional Fire Fighters of Massachusetts has expressed his concerns for this proposed minimal staffing change by saying that “People are going to die because of this law.” In my opinion, that assessment of the new law is a touch dramatic. There are many, many systems across the country of a variety of sizes that staff with a “one and one” standard. So the question was raised: “Is more less?” Does the presence of more Paramedics mean the deterioration of one single Paramedic’s skills? I was excited to...

I was looking through some old files and articles that I bookmarked, and I found last year’s Career Cast Worst Jobs of 2009. Emergency Medical Technician was ranked as the 6th worst job in the United States using Physical Demands, Stress and Income as criteria. That’s right, everyone, this job that we all love to do, some of us as volunteers, others as our careers, is ranked as one of the worst jobs in the United States. In case you’re curious, Sailor, Taxi Driver (does anyone else find humor here?), Diary Farmer, and Lumberjack were the only jobs that were considered worse then EMT. So, how in the eyes of the folks at Career Cast, can we improve the Emergency Medical Technician position as a job? Let’s take a look at their criteria: 1. Physical Demands — We are already moving in the right direction here. The physical aspect of EMS is greatly diminished thanks to innovations such as tracked stair chairs, hydraulic stretchers, and AutoPulses. Although there is still some wear and tear, and the necessity to lift will always be there, as an industry, we are doing the best that we can for our people. 2. Stress — Stress will be the hardest piece of this puzzle to improve on. Let’s face it, we see things every day that some couldn’t imagine seeing in a lifetime. The best thing that we can do is afford as many outlets for stress relief for our employees. That could come in the form of increasing the availability of Critical Incident Stress Debriefing, or something as simple as giving our people other outlets for their stress by giving them something as simple as gym membership. 3. Income — With the progression of our field, the expansion of our scope of practice, and better understanding of what we do, Income will improve as well. EMS is still a very young field when compared to the other two branches of public safety. We have come a long way in a very short time, but we still have a long way to go. Interestingly enough though, in 2009, USA Today ranked Fire Fighting as one of the best most...

I have totally immersed myself into the Twitter world, and for the last couple of days I have engaged in some great conversations with some great people. Today, I got into a discussion about a few different topics, but my favorite was professionalism, and our image in the public eye with TheRoadDoctor, Rescue_Monkey, CKEMTP, and In_The_City. I was working at the time, and it was really hard for me to put my phone down. Many great points were made, about how many parts of the industry reward mediocrity, and how there is a “just good enough” attitude, rather than people being driven and motivated to go above and beyond. Was this how people really are, or as In_The_City put it, is our perceived apathy a “learned behavior” taught to us by poor role models? I have a feeling that throughout this discussion, I shared a lot of “head nods” with my colleagues as the great points summed up in 140 characters or less flew across the Internet from Twitter to Twitter. It got me thinking though, what steps can we take to be more professional? Professionalism starts before you punch in. One of the things that TheRoadDoctor and I agree on is that like it or not, the public is watching us, and our appearance definitely shapes the opinion that colleagues and the general public has of us. The first thing that every provider in the industry can do to take a step towards being more professional is simply stopping in front of that mirror before walking out the door. How does that uniform shirt you’re wearing look? How are your boots and shoelaces doing? Is it time for a relacing or a polish? Guys, are you up to your department’s grooming standards? Girls, how’s that hair look? Next, grab a quick breakfast. Don’t rely on that early morning *Insert greasy breakfast sandwich of your choice.* Go in on a full stomach. Its rather refreshing. Finally, be on time. Walk up to that time clock when you’re supposed to, or even better, early. Tardiness is a huge pet peeve of mine. I’m ready to go when I’m supposed to be, and lets face it,...

The debate has started in the Blog and Twitter worlds regarding EMS Pay. Is it possible to support a family on a 40 hour paycheck as an EMT or Paramedic? Many say “no” and its hard to find people who can make it work. In the Company I work for, the desire for more money is always there, but I feel that there is a big misconception in a lot of EMS Services, my own included. Like it or not, EMS is still in its “toddler” phase. We’ve just learned to walk, and we will eventually learn how to run. We’re sitting here, eyes at table level looking at that juicy prize that is just out of our reach, and we need to figure out how to get it. For the time being, we might need to work for less money and show our value, so we can get more pay in the future. We need to let our field develop and play active rolls in its development. Many, however, want to be given pay for a job not yet done. People want the pay in order to make them professionals. What we need to do is be professional to earn that desired pay. The important task to focus on now is to work on our image in the public’s eye as providers, people, and caregivers. We need to show the population that we serve what we are capable of. It’s rather clear that we, within our community, convey our message to each other. This is evident simply by looking at the Social Networking movement that many of us are involved with. We need to find a public forum. We need to find a way to get people listen. Public education I feel is a great path for us all to start down. Bring people in for mass CPR classes, and couple it with a piece about who the EMTs and Paramedics are. We need to try and establish partnerships and get involved with organizations like the Red Cross. When our people go above and beyond, put them out there, and show the world what they have done. None of us want the world’s...