Most of the time when we see change, our gut reaction is to resist it, and do what we can to poke holes in it.  At least that has been my experience at many EMS services.  I guess I am just not lucky enough to work in an environment where fluid change occurs. Some change is really for the positive, and there is no more positive change in EMS that I can come up with than the new ACLS guidelines prioritizing chest compressions.  The problem though is breaking old habits. For my entire EMS career, it was always drilled into our heads that we “must get the tube” and we must do it well or someone would take the ability to intubate away from us.  Since the beginning of time, paramedics have seen their “right” to intubate patients as this sacred lifesaving skill that they must have and that no one should touch.  Through progressive thinking though, it has become more and more evident that intubation is not a lifesaving skill, but it is actually more of a life sustaining one.  In most instances, intubating a patient will help keep their airway patent and keep them alive, especially when sedated. I have studied up on CPR in Seattle and one thing that they discuss at great length is the importance of chest compressions and the minimization of interruptions.  We all need to keep that in mind and we all need to adopt that.  Nine out of ten times, airway is not important.  Early CPR, early defibrillation, and the minimization of interruptions are what are proving to be lifesaving interventions, not pauses in compressions to get a tube or vigorous bagging of a patient to get oxygen in.  Blood needs to go round and round in order for that air going in and out to be effective and measuring end title CO2 proves that. Have you ever had your APNEA alarm on your monitor go off?  The cause might not be a bad tube; it might actually be inadequate compressions.  Low CO2 output is a sign that there is little to no gas exchange at the alveolar level because there is not enough blood going...

Anyone who knows me or spends any time perusing this blog knows that I feel that scene safety and the wellbeing of those of us who work in this field is the most important thing there is.  As a supervisor, my first goal is to make sure every single one of my employees goes home to their families at the end of the day.  They might not go home on time all the time, but I need to make sure that they go home. This past week I had a chance to attend the EMS1 Street Survival seminar put on by EMS1 and Calibre Press.  The program itself was created from the principles developed as part of their law enforcement scene safety class.  Much to my excitement, the class was taught by Mike Taigman, someone who I have a great deal of respect for. Prior to the class, Mike conducted an online survey that revealed that a quarter of EMTs responding had been involved in a fight or violent altercation with a patient.  75%, however, reported that as a result of those violent altercations they were injured in some way.  These numbers are unacceptable, and the need for training and education is evident.  The focus on the class was not to teach a “rip ’em up, tear ’em up” fight with everyone mentality.  While physical resolution of a conflict was covered, first and foremost, avoiding such a conflict was the priority. Day one dealt with coordinating these scenes and acting as the eyes and ears while someone else makes patient contact.  The focus was awareness: be aware of who is there, be aware of how you got in to the scene (out doors or in doors) and being aware of how to get out of a scene.  The videos and photos, actually and staged, that were shared during this first day were geared towards being focused on those little details that one might encounter.  How would you approach a certain scene?  What windows need to be watched?  How should you enter a house to best appraise what sort of situation you are walking into. When it comes to verbal communication in an escalating situation,...

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...

There are a lot of good clinically focused blogs out there on the Internet, and mine certainly isn’t one of them. That’s not to say that I don’t feel I’m a sound, clinical paramedic, because really I do, I just don’t write about the medical topics. “Being a provider” and the challenges that we face as an industry interest me more. I do, however, feel the need to talk a bit about Quality Assurance and Quality Improvement and what they mean to me. I came from very humble, small EMS Beginnings. Growing up in Suburban New Jersey, most of the BLS 911 work was done solely by Volunteers. While my clinical experience was great, my knowledge that went into documentation and the feedback that I saw from it was almost non-existent. Although we would provide what I felt was excellent care, when we got to the Emergency Room, it seemed to me that the care started over. Run forms that were written were poorly written at best, some as short as one or two sentences that attempted to sum up the events that led to the patient landing in the ER. Fast forward now a few years to my freshman year of college. I didn’t know any better from what I learned in New Jersey. I thought that was “the way” to write a run form. I participated for four years in our Campus EMS Department, and in my freshman year, our advisor brought in a Lawyer to review our run forms and let us know how we were doing. I’ll never forget it; mine was one of the ones that ended up on the overhead projector: “Patient fell during a flag football game and injured his ankle. Patient refused treatment.” That was it. Two sentences and I was done. There I sat, a young 19 year old EMT, raked across the coals by a lawyer pointing out all of the problems with documenting like this. I quickly learned my lesson, and put 100% into my documentation, both at college and at home in New Jersey. Now, here I am, 13 years later, working in a busy urban system as a Supervisor and ten...

Is your service ready for “the big one?”You know what I’m talking about: that big call that we all dread, that MCI to beat all MCIs, the one that no matter how much you train for it, you never will be completely prepared.What can you do though to help make the day that your department is faced with a disaster you never expected?A lot of the steps are simple, but because of that, we might be more apt to overlook them. 1.Review your disaster protocols.If you’re on the streets that day, where will you fall in the chain of command?What will the Fire Department’s responsibility be?How about PD?You don’t need to know every move that everyone is supposed to make all the time, but knowing peoples rolls will let you know who to ask when you need something. 2.Make sure your vehicles start!I know this sounds silly, but imagine getting to that moment when someone tells you to “roll the MCI Truck,” and you go turn that key and . . . NOTHING.In my department, our MCI truck is constantly plugged in to keep it charged, but it’s lets face it, it’s a 12 year old ambulance with close to 200,000 miles on it.Once she gets going, she’ll go forever, but to help make sure that she can run, I try to start her at least once or twice a week. 3.What level of certification do you have in Incident Command?Everyone here is required to have 100 and 200, but because of my position, I have to take extra classes, assuming that I will be wearing a vest and hold some sort of authority if things ever went bad.Some might think of ICS classes as dry content, but if you ever need it, you’ll appreciate having taken the classes. 4.Run through scenarios in your head.At my part time job, we have a jar, and on the outside of it, it says “What if, right now?”When things are slow, we pull two different colored pieces of paper from the jar, and one of them will have a location, and the other a situation.An example would be pulling “Big Roller Coaster’s lift hill” and the other...