Dec 16, 2014

In the past couple of weeks, the pattern of assaults against EMTs and paramedics has continued.  If you have not seen the reports from Boston on the attack by a patient on Boston EMS EMT Tony O’Brien, then I suggest that you take a look.  The bite that Mr. O’Brien suffered to his hand is unlike anything that I have ever seen.  Chris Kaiser recently posted an email that he received from a fan who was attacked by a patient.  The circumstances are a little different but the narrative remains the same.  The question now is what will happen?  And what will we as an industry do? Early last week a very well-known EMS leader advocated on social for EMTs and paramedics to show up at a local county courthouse in uniform in a show of solidarity and support for a paramedic who was assaulted on a call.  His attacker’s sentencing was being held, and the hope was that a show of force might encourage a judge to take the sentencing seriously.  The attacker, 25 year old Remy Blaisdell Gagnon, received a sentence of 60 days after undergoing a mental health examination.  All of this was the result of a guilty plea to certain charges in a deal cut by the prosecutor. Personally, I cannot help but feel that this was a slap on the wrist, and I fear that the Boston attack will result in the same.  We are not law enforcement, but we are in harm’s way almost as much as they are and our safety needs to be taken seriously by everyone.  If you are assaulted by a patient, take it seriously and make sure that your employer takes it seriously.  File charges, and when it comes time for a trial or sentencing tell everyone that you know.  Advocate for them to show up to support you.  We cannot let events like this one, or the attack by Brooklyn Assistant District Attorney Michael Jaccarino on New York City EMT Teresa Soler receive such light punishments. If you do not know Soler’s story, I suggest you read up on it.  In November of 2012 She was transporting an intoxicated Jaccarino who has...

Dec 3, 2014

For most of my life I have been a night owl.  Many who have seen me early in the morning can attest to that.  I remember one paramedic who was on modified duty that would come in shortly after I did for my 6:30am supervisor day shift.  He would occasionally get up from his desk and check the volume of my 24oz coffee cup that came to work with me every morning.  On most occasions he would not address me until it was at least half empty. I am better now today than I have been in the past.  I can’t seem to sleep past 8am on my days off.  On mornings when I do have to be at work at 8am, I am usually up by 6:30 at the latest.  Still though, I consider myself a night owl. Before I got promoted, I worked for about four and a half years on overnights.  I worked a lot during the day as well because I have always been a person who works a lot of overtime, but the core of my schedule involved me being at work while most of the work slept.  There has always been something that is very appealing about overnights to me.  Traffic is almost non-existent.  Nurses at the ER’s seem to have a different sense of humor, and a different outlook all together on society.  And let’s face it: the lack of administration and some of the extra red tape that comes along with day shifts just is not there. It took a special person to work overnights on the ambulance as well.  When you are street corner posting at 4am, your body fights you.  It wants to sleep, and it wants to pass out but that is not always possible.  I have always found that those who work exclusively on the overnight seem to respond better when they wake up for a run, or are asked to operate at long stand bys.  They are not winning the fight against their body’s desire to sleep but they are doing better than most people do. The big problem that I saw for years was the overnight crews were often forgotten. ...

Nov 25, 2014

Last week, Justin Schorr, The Happy Medic, stepped up on his virtual soapbox to let the EMS world know what he thought about Community Paramedicine. I was to surprised to find that Justin, a rather vocal advocate of reducing needless EMS volume, was against the measure saying that it was “too important to be trusted to the 911 crowd” saying that it needs to be a specialty and not a “spin off” of our current EMS system. From one end, I can see where Justin is coming from. As a paramedic in a busy urban 911 system, demand and the current work load for paramedics is high. When you are stretched thin, and your workforce is not deployed to reflect the needs of the community, then every warm body that you have becomes important and no matter what we do, response to emergency calls will always be the primary mission of a system like Justin’s.  To add to that Justin works in a fire-based system. Far too often in fire-based EMS, running the ambulance is seen as a subspecialty thereby turning Community Paramedicine into a subspecialty of a subspecialty. With the additional training that should come along with the title Community Paramedic, a person is effectively being asked to wear “three hats” instead of the two that they were hired to wear.  That might not exactly be true in Justin’s system but plenty of providers can attest to this. In all reality, what else do we have in our potential toolbox that will help us reduce those unnecessary EMS runs? As it stands now, Community Paramedicine is the best option. Justin is quick to point out that when he was in England, “paramedics with only 1 year experience were out on their own making recommendations, referrals, and taking people directly to what they needed, not just a 2 person cot van to an ER.” The difference there is training and education. They were prepared for such an event and although there have been limited studies done on the matter, the evidence exists that paramedics in the United States do not do a good job determining who should and should not go to an emergency...

Nov 19, 2014

The EMS model debate of fire-based EMS vs. private EMS is more active than ever on Facebook thanks to recent articles shared by JEMS, EMS World and EMS1, and I have been a frustrated, screaming at my computer participant. Both sides make some irrational arguments but when one searches through the mess, they can find some well thought out compelling cases made for both sides of the debate. It is no secret that I am a big advocate for EMS based EMS, whether that is in a private model or more preferably in a municipal model. Like many others, I feel that when you serve two masters you cannot perform both jobs as effectively as a person could perform one of them. Furthermore, I think that in fire-based EMS systems dedicated, highly skilled practitioners are locked out of the system for one reason or another to the detriment of the general public. The anti-private arguments are the ones that I always find interesting. The first one of “they are only in it for the all mighty dollar” amuses me. Almost any department regardless of their delivery model relies on the dollars that the business generates. With the model of health care that we have in this country, everyone is in it for the all mighty dollar. The other argument always seems to revolve around private EMS not being able to differentiate their business. They send units on non-emergent calls while disregarding emergency calls. Or they strip coverage to get dialysis transfers done. As someone who has worked in the world of privates and spent a decent amount of time perusing request for proposals for EMS services, I cannot help but think that most of what people are complaining about is a direct result of low standards contracted providers. When I worked in Massachusetts we had four contracted communities that we provided emergency services to. Once you moved past the out clauses, insurance requirements, and legal mumbo jumbo, the core of the requirements for each of these contracts came down to “you will provide X ambulances at the paramedic level and respond to calls in Y minutes or less.” That was it. Monthly reports were generated...

Nov 17, 2014

If you ever want to get under an EMT’s skin, call him an ambulance driver.  The resulting rage, either in front of you or via social media later will tell a lot about them.  I was having a discussion last week at EMS World with a couple of friends kicking around a silly idea to host a bar crawl that required everyone to either wear one of those god awful EMS slogan t-shirts, or make their own to be able to participate.  My nurse friend who was part of the conversation just shook her head and said, “and people wonder why EMS struggles as an industry to get ahead.” I understood what she meant, we have always been, and seemingly will continue to be our own worst enemies.  Then, while waiting in the airport with a friend, the two of us were flipping through some industry centered Facebook pages having some laughs over some of the comments that people were posting on shared articles.  “I don’t know if I am reading comments from EMTs or YouTube comments,” is what he likes to say. We sat there over lunch and tried to figure out where this attitude is born from.  Is it a product of people’s environments and predispositions?  Is it due to people just being Type-A personalities in this field?  Or is it just general immaturity? Maybe we are over-recruiting.  It is no secret that if you are an EMT with a card in your back pocket for twenty years or twenty minutes, you can find employment somewhere.  It might not be the greatest job in the world, and it might not be an endpoint for your career but the opportunities are out there, it is just a matter of what a person is willing to settle for.  Its not really an industry recruiting problem, it is more of a lack of standards when it comes to recruiting.  And exposing impressionable younger people to the folks who have the wrong attitude just makes it more difficult to break this cycle of disrespect and immaturity. Anyone who knows me personally will confirm that I am, in fact, a huge goofball.  I can be inappropriate with...