Comfort and Failure

In my post last week about the importance of being comfortable with failure, I mentioned statistics and benchmarking.  Last month, I had a chance to present at my first national conference when I spoke at EMS Today as part of the EMS Compass preconference.  I’ve been involved with the EMS Compass project since November of 2014 and while the process itself has had some growing pains, the mission and goals of the project involve some of the most important things to the future of our industry. For example, it is only with a firm understanding of the role of benchmarking in quality assurance and quality improvement that we will be truly able to compare the impact that we have on patient outcomes.  Understanding the impact of our care and being able to compare it to other systems is how best practices are discovered.  It all comes down to asking a couple of simple questions? WHY? The first question is an easy one, and that is simply why?  If another system is seeing better patient outcomes for their STEMI cases, or if they have a higher ROSC and survival rate for cardiac arrest, you need compare your system to theirs and just ask “WHY?”  Do they have a different set of CPR protocols?  Do they have a more aggressive field pronouncement protocol that steers medics to stay and play instead of taking a load and go approach with their cardiac arrest patients? The easiest way to figure any of this out is to work backwards.  Take the example of ROSC and survival rates.  If another system has a higher survival rate, start with where they are delivering their patients.  Are they using hypothermia for their patients prior to arrival or have they omitted that step at recommendation of the AHA?  Are they part of a completely different system with different protocols that might call for later intubation or a different style of airway management all together?  What about their care in the field differs from the care that you provide? After analyzing the care that takes place on scene, look at who is going to those calls.  Are they sending more help than you are? ...

The EMS Compass

The EMS Compass

May 11, 2015

What determines “success” in EMS?  How do we know that we are doing a good job?  Is it measured by our department’s ROSC rate?  Or maybe it’s response time compliance (but I hope it’s not).  What makes a good paramedic a good paramedic?  Do we determine it by looking at how successful they are at starting IV’s or intubating patients?  Is it something simpler like the number of people who thank them at the end of the call because they genuinely feel better? With EMS still in its infancy there is still a lot of work that needs to be done to figure out exactly what our impact is on society.  We are a high speed, high volume industry that does not take nearly enough time to slow down and really look at what we are doing.  The biggest reasons for that lie in the fact that we lack the knowledge to really know what data to collect, or once we have the data we lack the guidance from within the industry to understand exactly how to process that data in a way that will allow us to paint a clear picture of how well we are performing. Which brings me to today’s post. As I mentioned in my post last week, I have taken on a lot of different responsibilities over the past couple of months.  One of my favorite ones in my involvement in the EMS Compass project.  I was asked late last year just before I headed out to Nashville, Tennessee for EMS World Expo if I wanted to be involved in a project tasked with developing statistical benchmarks and measurements for prehospital care.  From the sounds of what was to come, EMS Compass combined many of the things that I really enjoy about the field so I had no choice but to say yes. In the last five months we have had a number of conference calls, and two face to face meetings.  The team that I am involved with on the Measurement Design Group is made up of some of the smartest EMS thinkers in the field today.  And then there I am, adding my two cents and contributing...

No Show This Week

There will be no podcast this week.  I am currently in the process of renovating the site complete with a new theme.  Everything will be back to normal for next week!     Share...

Challenging Problems with Simple Solutions

In all my years in EMS and my almost 14 as a paramedic I have seen a lot of creative solutions to the problems that we face on a daily basis.  Some have worked and stuck for years.  Others?  Not so much.  There are two all too common issues that I seem to encounter on a week by week (or even shift by shift) basis that have some very logical products on the market that I feel present an excellent solution to an otherwise challenging issue.  Also, I feel the need to mention that neither of these companies solicited me to write reviews of their product.  These reviews are based on my own personal experience. The EP+R Hand-E Hand Hold Device – One of the biggest challenges of any cardiac arrest or even an unresponsive patient that we are required to move on a backboard present is the conundrum of how to keep their arms secured so that responders can assess them and provide treatment.  Some use tape, other try to tuck their hands into their pockets or waist band, or even use a creative tie with a cravat.  The best solution that I have found though is EP+R’s Hand-E device. Back in 2006, one of the paramedics that I worked with in Massachusetts decided to solicit a few companies for demo versions of their hand restraint devices.  There were straps that needed to be wrapped a certain way, and a few solid devices that aimed at keeping a patient’s arms “in” to prevent them from snagging on door jams or ambulance cabinets.  We tried a handful of them and none was as easy to use and effective as the Hand-E.  It’s quite simple to use: after attaching the device to a waist strap of a backboard you put a patient’s wrist in each of the openings and secure it with the rubber strap.  A patient’s  arms remain reasonably flexed to allow the flow of IV fluids to continue while their elbows are kept close enough to the body that moving patients through doorways or taking them out of an ambulance becomes remarkably easier. According to EP+R’s website, the Hand-E retails for around $22....

Sirens on USA Premiers Tonight!

It’s currently Thursday night, at 8pm and as I write this blog, I am counting down the hours until Sirens premiers on the USA Network.  From looking around social media I have found that there are some out there who not only are not excited about this show, but are damning its existence.  To them, and to everyone else in the field I am here to say, lighten up! I used do the opening lecture for an EMT class in Massachusetts that I called “So, You Want to be an EMT” that talked about a lot of the factors that one must think about before even considering getting into this field.  One of the subjects that I touched upon was what I personally consider the best PR machine that this field has ever had: the 1970’s show Emergency!  The show, which premiered in 1972, loosely chronicled the creation of the Los Angeles Fire Department’s paramedic program and shared the brand new concept of paramedicine with the world through the eyes of Johnny Gage and Roy Desoto.  Since the show went off the air in 1979, a few networks have tried to recreate it and have failed.  Miserably. Do I even have to bring up the horror show that was Trauma! that introduced Captain Versed (portrayed by social media’s own Ms Paramedic Natalie Quebodeaux Cavender)?  Or, if you really want a laugh, go on YouTube and search for episodes of a show from 1999 called Rescue 77 that once featured a paramedic doing a handstand on a patient to defibrillate them in a pool of water.  It was truly cringe worthy. While I thought that Rescue Me was a great character study, and the first season had a lot of telling tales about the stress that many in the field are subjected to day in and day out it was more about the people than the department.  Third Watch, again, was a show that I could never get in to, and I have yet to even bother watching an episode of Chicago Fire.  Saved, which lasted just one season, might have been my favorite but the show was not without its share of glaring flaws. ...

Tomorrow’s the Day!

It took some preparation but the time is almost here. Tomorrow morning I am presenting at the Massachusetts EMS Conference. On a personal level this is quite the first step for me. My goal, ultimately, is to be able to present at EMS Today or EMS World sometime in the next year or two. While I have always been quick to present on topics that have to do with the well being of a paramedic, and better treatment from a provider stand point rather than a clinician’s stand point, my class tomorrow is clinical in nature. The topic is one that I am passionate about: capnography, and specifically, how it should guide and effect your assessment and treatment. Furthermore, this visit marks my first “full” return to Massachusetts. I spent twelve years up there that I valued greatly because of the friendships and work relationships that I made. Truth is, if it was not for the time that I spent up there, I would not be the paramedic that I feel that I am today. In just six short weeks, I will mark my first year in my new system, and it has been quite the ride. My views on a lot of things have changed: skill dilution, and working in a union shop just to name a few. Municipal EMS is fantastic, and I have to say, I am now a firm believer that third service EMS is the best model. It might not be the most fiscally responsible but in my opinion, it does not get much better than that, especially for someone like me who has the utmost respect for fire fighters with zero desire to run into a burning building. But I digress. . . It’s time to suppress the butterflies and make a few last minute changes to my presentation, then tomorrow at 11am, it’s go time! Share...

Toronto EMS

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...

Keeping the Beat

On my first night in Baltimore, I had a chance to talk to Dr Ray Fowler the medical director for the Dallas Fire Department.  First of all, let me say that it was an honor.  This guy is so smart, and has so many great thoughts about EMS.  The topic was CPR, and compression rates.  Dr. Fowler told me that he read a study (which I am still trying to get a hold of) that discovered two facts: 1.  a rate of compressions in CPR greater than 140/minute increases mortality.  2.  The majority of people cannot tell the difference between 120 and 140 compressions per minute. Dr Fowler suggested that a more effective range to shoot for would be 100 beats per minute, or maybe even 110.  But how do we determine that?  I went on YouTube and found these kick drum metronome clips.  Take a listen to these two: 140 Beats per Minute 120 Beats per Minute Could you tell the difference?  Neither could I.  Now, take a listen to this: 100 Beats per Minute I find 100 beats to be a little more distinguishable.  This made me wonder: would the use of a metronome on a cardiac arrest improve outcomes?  Imagine, while doing compressions, your monitor would be beating right along with you, setting the rate at 110 or 120 or whatever is the final decision that produced the best outcome.  Just with setting that rate and sticking with it would not just potentially improve recoil, depth of compressions and of course rate, but it would also help signal when the compressor is tired and needs to be swapped out.  When the person running the code noticed that Joe was not keeping the beat, he could swap him out with someone else. Now, I fully admit, I lack a considerable amount of rhythm.  Anyone who has ever seen me attempt to dance can attest to that.  But I even think that I could keep up with a set metronome, pushing rhythmically. I am thinking about experimenting with this a bit, and I will definitely report back.  In the meantime, what does everyone else think? Special mention to JCox98 on YouTube for the...

The Best of 2011

2011 was a big year for me and a big year for EMS in the New Decade.  Born from some ideas discussed over a few beers in Baltimore was The First Responders Blogging Network, and I was fortunate enough to be one of its first members which brought about my domain move from Blogspot to www.medicsbk.com. While as of late there were a few technical glitches, I saw a number of visits and got some great comments, so I decided to share with you the top five articles viewed by you, the reader.  For those new to the blog, I welcome you to check out content that you have not yet seen.  For the faithful readers that have been with me all year, I invite you revisit some of this year’s most viewed and share your thoughts on them. 5.  A Punch in the Gut – In July, the Baltimore Fire Department’s EMS Training Center was shut down.  Read my thoughts on that here. 4.  IntuBrite Laryngoscope Blades – As part of my involvement with the Podcasting Studio at EMS Expo in Las Vegas, I was able to choose what I felt was the most innovative product on the show floor.  Here is my selection. 3.  A Call to Volunteers – Over the course of the last year and a half, I have become quite vocal about the New Jersey State First Aid Council and their efforts to bust EMS in New Jersey back to the stone age.  Here is one of those articles. 2.  EMS in New Jersey – A Call for Action – Here is yet another view of EMS in New Jersey, this one dealing directly with NJ State Bill S-818 and my thoughts on it.  Again, this was a very hot topic this year, and I invite you to read this, especially if you are a New Jersey EMT. 1.  Goodnight, ALCO – On October 31st 2011, AMR Alameda County closed their doors.  A lot of great paramedics and EMTs were forced to find other work in different counties or hop on board with the county’s new provider.  I owe a lot to the folks out in ALCO.  This is...

IntuBrite Laryngoscope Blades

Here is a video from The MedicCast.  As part of my podcasting in Las Vegas, the hosts were able to select what I thought was an innovative product on the show floor.  My choice was this new line of laryngoscope handles and blades made by a company called IntuBrite.  Here, Natalie Quebodeaux, Chris Montera and I speak with Todd McKinney, president of IntuBrite. Share...