My Sunday ritual is a fun one.  I am up by nine or ten in the morning, I have a cup of coffee, and I’m usually on my couch by 12:30 or so ready to enjoy a day of football.  Most of my day is spent watching NFL Red Zone.  If you have not yet experienced this, you need to.  Every touchdown in every NFL game is shown.  Every time a team gets inside their opponent’s 20 yard line, that game becomes the priority.  If no one is in the “red zone” then the most exciting game at that moment is featured.  You get to see a lot of football. Being from Massachusetts, it is a requirement to be a Patriots fan if you live in the state for any more than a couple of years.  It’s in the state charter, and it’s a question on your state tax returns.  Trust me.  When the Pats are not on though, one is free to watch whatever football they like. A few weeks ago, while indulging in some Red Zone, I was watching a little bit of the Cowboys game and it got me thinking: how do we pick our leaders?  Jason Garrett is the head coach of the Cowboys and his career as a player would be described as mediocre at best.  He started nine times in his seven year career and played behind two other quarterbacks for most of that time.  He did, however, have a great mind for the game. Or how about the Patriots coach: Bill Belichick.  Like him or not, he has been successful in his years in New England.   Belichick never played professional football. Now, take that analogy and apply it to EMS.  There is an opening in management, or maybe in a field supervisor position.  If a list of paramedics was put in front of a field provider and they were asked, which one would you pick and why?  I would bet my paycheck that nine out of ten people who answer the why with “Because he/she is a good paramedic.” Does a good paramedic translate to someone being a good manager?  Does the ability to accurately interoperate a...

Hey, did you know it can snow in New England in October?  I always thought it might be a possibility, but what we experienced up here in Massachusetts last week was unlike anything I have ever seen.  This year, I have sat through a tornado, a hurricane, an earthquake, and now one of the nastiest winter storms of my career.  Hey, Mother Nature, I am waving the white flag! My Saturday was just like any other: I spent it on the streets, responded to a call or two, and was ready to head home, shovel a few inches of snow off my front walk and enjoy the first snowfall of the year the best way I knew how: with a glass of wine and some dinner.  Things took a turn at around 5pm though when the snow picked up. With many of the leaves still having yet to fall, trees began to be weighted down.  Many of them broke taking power lines with them.  By 8pm, most of my city was without power including my house.  It is an eerie feeling when you are sitting on a main artery of a city surrounded by lit street lights and there, 100 yards down the road past an intersection is nothing but darkness.  At this point, I saw no reason to go home so I turned my 12 hour day into a 24. In comparison to the tornado that struck my city on June 1, dealing with the October snow storm was much more challenging.  When the tornado hit, we had our damage path, we knew what the threats were, and we figured out what we had to do to work both in them and around them.  What we found in the snow storm was the damage was much more wide spread, and the environment was constantly changing.  What was a clear intersection just 5 minutes prior could now be blocked with a tree or downed power lines.  Keeping track of street closings and hazards was a logistical nightmare. I spent the next week (yes, week) couch surfing with friends or sleeping in my cold house.  Although it was a stressful seven days as I waited...

On November 1, at 12:01am Pacific time, Paramedics Plus took over 9-1-1 coverage in Alameda County marking the end of a lengthy service by American Medical Response.  I, however, cannot help but feel like AMR got the short end of the stick in the deal. I have read through both of the bids quite extensively, and I must say that from the perspective of Alameda County, they had a strong grasp of what they were looking for, and released a rather detailed document spelling out what EMS means to the county.  Both replies were lengthy and well put together, and in my opinion far exceeded the expectations that were set.  In the end though, the bid came down to one thing: the all mighty dollar. The last piece of the bid called for both companies to submit what they planned to charge for their patients for their services.  Paramedics Plus came in lower than AMR giving them the points they needed to push themselves over the top, and ultimately win them the contract.  Kudos to Alameda County for looking out for the wallets of their tax payers, but I feel like there was too much weight put on this stat.  While most services harp on response times, ALCO shifted that focus to financials.  Their response time criteria was still very strict, and they did a lot to further the quality of patient care provided in the county, but a lot of that feels disregarded to me when I see the weight that patient charges, most of which an insured person would never see, are figured into the equation. It must be understood though that I am a little biased.  I owe a lot to Mike Taigman and his team in Alameda County.  Level Zero was the project that opened my eyes up to EMS on the internet.  A profile of a few of the providers in the county, having seen the movie I was even more excited to hit the streets in ALCO when I had the chance hoping I’d just have the opportunity to run into someone I might already know a bit about.  While I only saw one “cast” member from afar,...

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...

Communication is such a huge part of this job.  We need to be able to communicate with our patients and get information out of them, we need to be able to speak on a radio (which is sometimes easier said than done) and we need to be able to translate what our patients say into medical jargen so the doctors and nurses we give report to fully understand what they are going to be dealing with.  In addition to all of this, we need to be able to communicate with our partners as well. Jamie was my third partner in my career, and she was the one that I worked with the longest.  The two of us were partners for close to two years, working evenings and weekend overnights.  We had some great times, and did some really good calls over the years.  Our styles were completely different.  I was more aggressive medically, where she was quite a bit more on the conservative side, but because of that I learned a lot about holding back, and what to treat and not to treat. We would seem to commonly encounter a problem in the street though: while our silent communication skills, we were not always able to read each other’s minds.  It was on a slow shift that we solved this problem.  Jamie and I decided that we were going to create our own language, one that was spoken by touching different parts of our face to let the other person know what was needed in more of a silent fashion. For example: there is a crying woman sitting on a bed, not talking with her boyfriend/husband looming over her.  Jamie might tap her temple with her index finger which, according to our silent language dictionary, says “let’s clear the room so I can talk to her alone.”  I’d say to the husband, “Sir, can we go take a look at her medicine?”  or “Can you hold the door for me while I get the stretcher in?” At its peak, we had just about fifteen different silent phrases we’d “speak” to each other on calls, covering everything from “This is ridiculous, why are we here?” ...