Does the perfect EMS system exist?  Is there really one perfect fit for every municipality and every paramedic as well?  I really don’t think that there is.  What each individual has to search for though is their perfect fit.  They need to look for that system that has what they are looking for, regardless of what it is. Believe it or not, some people like carrying gear up and patients down five story walkups.  Believe it or not, when my career started, I loved it.  I did not think that urban EMS was going to be for me, and did not see myself staying in Springfield, Massachusetts, but it happened.  I spent twelve years there, and for the most part, I really loved it.  I still have a deep seeded love for urban medicine but as the years passed, and as my career progressed, so did my tastes, and what I was ultimately looking for has evolved.  So what does my perfect system need?  What would be absolutely 100% perfect for me?  Here it is. . . 1.  Variety and diversity – I do not just want one “type” of call.  I want a system that can offer me different settings that I can tailor to my mood at that juncture.  I really feel like I have “EMS ADD” that is to say, I am constantly looking to something else, and my moods seem to change often.  Having a system that would provide for that would be great. 2.  Aggressive and progressive medical direction – I want a medical director who is not afraid to enroll in prehospital studies.  I want someone who is not afraid to look at his or her staff and say “what do you think could make us a better system?”  or “what is there that we don’t do well enough?”  They need to be engaged with their medics, and although knowing each and every provider in their system isn’t vital or in some cases reasonable, having an open door policy and being receptive to each and every one of them is, and has to be. 3.  Receptive and engaged leadership – In just about every system I have been...

I recently read a story that came across the EMS wire about an EMSA paramedic in Oklahoma City who was assaulted by a patient and as a result, she lost her unborn child.  Last week, I read a story about a politician or lawyer (forgive me, I cannot find the actual article to reference it) who assaulted a medic and was not charged.  Over at Rogue Medic, Tim brought to light a man who assaulted a Chicago medic who got off easy. Our job can be dangerous.  Sure, for the most part, our calls are routine, and we are not at risk, but then there are those cases, like the ones referenced above, where we are put at risk.  When these incidents happen, I’d go as far as to say that paramedics and EMTs are more at risk than doctors and nurses who have other staff there who could potentially back them up, and police officers, who are trained to deal with such situations.  When a provider is one on one with a patient who could potentially become violent, or does become violent, there is not a more dangerous scenario that we as prehospital providers are put in. Some of these tips are my own.  Some of them I picked up from Mike Taigman and the street safety course he was teaching through EMS1.com a couple of years ago. First of all, each of us needs to remember that scene safety carries into the back of the ambulance.  Next time you’re in the back of your truck, take a look at your surroundings.  Where are the potential “weapons” kept?  Are there sheers or IV needles in the cabinet right next to the patient?  Are they accessible on the bench seat?  What do you keep on your belt, and how well is it secured?  Make sure your sheers are always fastened if you carry them.  And although I have not found much of a use for them in my years as a medic, make sure your knife is discretely tucked away. Work a “pat down” into your assessment.  It can be as simple as a head to toe assessment, and can be very discretely done. ...

I posted a question on my Facebook page asking my followers what they felt the “most innovative change” was that they have seen during their career in EMS.  To date, I have gotten 26 responses of varying degrees of seriousness but the most common one that I have seen is prehospital CPAP.  In fact, one nurse even weighed in with that answer.  I decided to do some research and see what else I could find out about the topic. I remember being an EMT in New Jersey home for the summer back in 1999 and watching the LIFE paramedics pull out a large bag with their CPAP setup out of the trunk of their unit.  It was admittedly an intimidating piece of machinery to me.  CPAP in my home system in Massachusetts was as foreign as prehospital 12-Lead EKG’s were at that time.  We did not get LP-12’s until 2002 or 2003. When I did a Google search for prehospital CPAP, I found an article from EMS World written in 2005 by my good friend Bob Sullivan outlining its use, why it is effective, and why it is so important to start CPAP sooner rather than later.  Some of his references in the article date back to as early as 2000.  The proof has been in the pudding for years, CPAP works. Why then did it take a special project waiver and two years of evaluations to get it approved for use by paramedics in Massachusetts?  Randy Cushing, a paramedic with the Agawam Fire Department was one of the leaders in the push for prehospital CPAP and his efforts finally paid off in 2010 when the change went through in the state protocols giving paramedics standing orders for prehospital CPAP.  Eleven years after I was seeing it used in New Jersey.  Five years after the article, one of many, was posted about its effectiveness in prehospital care.  This leads me to make the broad conclusion that in 2013, there are still probably some systems out there that don’t use it, or haven’t gotten full approval to use it yet. This makes me think about studies such as the one that compared usage of IM...

I have been wracking my brain for the last week as to what to put up for my 200th post.  Yes, folks, this is it.  Number 200.  It has taken almost three years, but it is quite an accomplishment if you ask me. As I take a look at my current career, I cannot help but reflect back on where I have been.  2013 is a year of new experiences for me.  I’m in a new service with new protocols, and new opportunities.  It took me a while to figure out where I wanted to land, and if you had asked me a year ago, I would have told you I was content with where I was.  I might not have been overwhelmingly thrilled with it, but I was content.  The last six months though was like writing on the wall for me that it was time to move on. Fifteen years ago in January of 1998, I tested for my second EMT card.  I had gotten my New Jersey certification a few years prior, and the fall of 1997 found me enrolled in my second EMT class.  I decided to retake the class to refresh myself, because I had the option of trying to get reciprocity and testing out.  By February of 1998, I got that envelope in the mail, the big envelope. In the state of Massachusetts, when a person gets certified as an EMT they are given their own certification number that will travel with them for their career, barring them doing something like forgetting to recertify.  The number on the card that I got in the mail that day was 848810.  Two and a half years later when I got my paramedic card in the mail, it had the same number, 848810. The recertification process in Massachusetts is not an easy one.  Well, from the provider side of things it is not too bad.  A paramedic needs to do 24 hours of continuing education and a 48 hour approved refresher class every two years, and then send all of their recertification in along with a check made out for way too much money via US mail (certified mail if you’re...

FNG.  If you work in the field, you know what it means.  Personally, I’ve never been happier to be called something in my life.  Being the new guy here isn’t that tough, especially with the group I am lucky enough to work with. It’s been a month in my new system, and although some things have been a struggle, I have really enjoyed myself.  Some people have referred to things as being like “riding a bike” you kind of never forget.  Moving to a new system as a paramedic though is nothing like that.  I like to think that it is more like driving a car. In a different country. Where you sit on the opposite side of the car. And drive on the other side of the road. And the pedals are reversed. The end point is the same.  We all want to provide good patient care, and turn our patients over to the hospital feeling the same, or better, than when we picked them up wherever we found them.  How we all get there though is different.  Protocols are different, and treatment can be more regressive or (preferably) progressive and sometimes taking those old habits, and those old protocols and completely dismissing them can be incredibly difficult, especially when they’ve been part of your everyday life for a number of years, in my case twelve of them. I’m not going to sit here and try to reinvent the wheel and tell anyone that I know the best way to solve this portability problem because I don’t, short of nationally set protocols that everyone follows, but as long as we are all in our own little sandboxes, that will never happen.  Truth is though, I really like the way things are done where I am now.  Treatment modalities are aggressive, and pretty straight forward allowing a medic to do what they feel is best and all of this with the blessing of our medical director. With each tour, I am feeling more and more comfortable.  Sometimes I feel like I’m all thumbs with two left feet, and a brain that is a step behind, but as I slowly settle back into a comfort...