Apr 15, 2015

This weekend a number of friends on Facebook linked a video that was making the rounds of a person presumed to be in cardiac arrest in a car in front of a bus stop.  This scene provides with a number of important lessons.  First you see an SUV in the middle of the road with people yelling at the driver asking him if he is okay.  9-1-1 is called and somebody starts doing chest compressions on the person before removing him from the car and placing him in the road.  CPR is continued until EMS arrives.  At the end of the video you see the driver being wheeled to the ambulance sitting up appearing to be conscious on the stretcher. The video itself spans about seven minutes and I encourage everyone to take the time to watch the entire thing from beginning to end.  Some content might be difficult to watch and there is some language that might be considered offensive used by those watching the scene unfold.  Regardless of that though, there are a few lessons that I think both the EMS community and the general public can learn from this. http://medicsbk.com/wp-content/uploads/2015/04/Street-CPR.mp4   There are still people out there who are willing to help – In a world dominated by social media, Twitter and cell phones people seem to either want to record or just call for help and make a potential emergency somebody else’s problem. Seeing this video is reassurance that there are still people out there who will get their hands dirty to benefit another person.  They saw somebody in distress and they acted.  They realized that doing something is better than doing nothing. When you call 9-1-1 help is on the way almost immediately – Confusion is common. People misidentify locations in fact, I can tell you that happened here.  Once a location is confirmed help is on the way but for dispatchers that is not where their job ends.  If there is one place that a dispatcher’s role in providing prearrival instructions can save a life it is in the case of a patient in cardiac arrest.  The bystanders can insist that the caller “just tell them to come!” until...

Apr 6, 2015

In almost fifteen years in this field I have seen a lot of people come and go, and that does not just go for coworkers but also spouses and significant others.  I don’t know what it is but so many of us in this field are so self-destructive when it comes to our interpersonal relationships, myself included, and I cannot help but search internally for an answer.  I have yet to find one. This job is difficult.  This career is difficult.  The level of depression, substance abuse, and suicide that we see in emergency responders is way too high.  It goes without saying that one occurrence is too many, but we are so far beyond that and the numbers just keep climbing.  I have seen far too many broken homes through the years and it makes me sad.  I just do not know what we can do to make that better.  Do we need an orientation class for spouses when their loved one gets hired into this field?  Should we be sending take home information with our new EMTs and paramedics to share with their families to help them understand the signs and symptoms of depression, and to guide them in better handling all of that time away that they might have to deal with at special times of the year? Or maybe we just need to do a better job of including our work force’s families.  If your service caters Christmas dinner for the staff, why not extend an open invite to your employee’s families to thank them for the sacrifices they have made over the past year?  On top of that, if you are an EMS manager and you are not strapping on an apron and serving your people on holidays I question your commitment to them.  I realize that people have made sacrifices over the years and “paid their dues” but if you run a department and you are not willing to make the same sacrifices as the front line staff makes then that will make you into a “boss” and not a “leader.” A few of us used to have a very quiet and not so funny inside joke that when...

Mar 25, 2015

Every day you go to work seems to start the same way.  You clock in on time to the sound of your truck backing in to you station.  Your scope goes on the dash, coffee in your cup holder, and gear in the cabinet.  You pull the bag out of the curbside door and start checking through as the loud speaker overhead crackles to life: “Medic 3 respond. . . “ and you’re off. The next ten hours of your day is filled with fourteen more responses every one of them with lights and sirens to the scene, and lights of sirens to the hospital.  As you wait for a nurse to give you your bed assignment, from your radio’s shoulder mic you hear the dispatcher of the day: “Holding a chest pain on the west side.  Is there anybody available to clear?”  “Medic 3, are you ready to go yet?” You’re rushed.  You’re overworked.  The general public thinks that based on the overtime numbers that your department releases you’re overpaid because that choice group of people who torture themselves day in and day out with two or three calls an hour on the ambulance make more than the department’s chief.  And it’s the same thing, day in and day out, for your two days and two nights as you look forward to your four days off. Until. . . Until your department decides that since the guys and girls on the fire trucks are on 24 hour shifts that you should be too.  That is exactly what is getting ready to happen in Baltimore, Maryland.  According to the Baltimore Sun, BCFD is a department that has nearly fifty of their 232 paramedic jobs left unfilled from last year.  That leaves approximately 185 paramedics.  Those 185 paramedics make up just shy of 15% of their department’s 1,250 person staff.  That’s right: 15% of the employee base is responsible for handling nearly 160,000 calls which makes up the vast majority of the department’s annual responses. Now, those 185 paramedics are on the verge of being forced into 24 hours shifts.  It is not right, it is not safe, and it needs to be squashed before...

Mar 16, 2015

With the season finale of Nightwatch coming up this week, I got thinking about the value of EMS based EMS.  This thinking was also fueled by yet another series of perceived response failures in fire-based EMS services on different sides of the country, specifically in San Francisco and Washington, DC.  While I stand by the argument that response times do not matter as much as we allow us to this that we do, I still fail to understand how the general public does not recognize the value of an EMS only service, especially after a certain population and call volume size. As always, I feel the need to point out that there are exceptions to every rule.  There are private services that get it.  There are EMS services that are fire-based that do it right.  But, as I said above, at a certain size there are others in both of these sectors that fail miserably and fall short of their expectations.  The difference between the two though is when a private service fails to meet expectations, they are usually replaced.  Quickly.  When it is a fire service they are given chance after chance after chance.  The vast majority of third service stand alone EMS systems are successful in their missions, and they are successful because they are dedicated to EMS. What could be better than a team of medics dedicated to providing medicine?  How can an argument be made that in a vacuum when you take away any funding issues that might arise from having a standalone department that a stand alone EMS service dedicating themselves 100% to the medical well being of the community that they serve is not the best possible delivery model? Last month, there was an EMS1 article written about priorities in EMS training.  While fire training is usually a lot more extensive than most EMS CEU classes (I am basing this on what I am told by my fire centric colleagues) from the numbers that I have seen reported from a number of different departments the volume of training is not anywhere near to equal or equitable.  In my EMS based EMS service, for example, we schedule around sixty hours...

Mar 13, 2015

Find me a paramedic who feels that they are adequately financially compensated for the job that they do and I will be shocked.  Pay in this field has always been an issue.  We blame it for a lot of our recruitment and retention problems.  People constantly cite it as a stressor that makes our lives more difficult.  Maybe though, just maybe, we are putting too much emphasis on how large our paychecks are and not enough emphasis on the money that we bring in. When I had a chance to interview Skip Kirkwood about five years ago, I asked him to tell me one piece of advice that he would give to any new paramedic or EMT.  To summarize the points that he made, Skip told me that he would want people in our field to learn to manage their money better.  Learn to live within your means, and you will not have to work sixty or seventy hour work weeks. Sean Eddy and Jason Hoschouer talked about it on a podcast that I did last year, and if you have not read Sean’s series on Money Smart Medics, you are really missing out.  There are lessons to be learned from all of it, and sitting and talking to Jason and Sean inspired me to make some changes in my life. I have always been good with numbers.  I speak them fluently.  The problem is though I have never been quite as good with how I managed my own money.  As long as I had money in the bank, I felt like I could spend it.  I was one of those people who would live from paycheck to paycheck not because I had to but because I often chose to.  It was a vicious cycle and one that I got sucked into.  Sean and Jason were so enthusiastic with their ideas and values that I felt that I should take a couple steps to try and fix myself. I started by charting my income.  Since I work a set rotating schedule, I could predict my work hours out for the entire year.  I started to chart how much overtime that I was working, and...