The country is in the middle of a healthcare crisis, and hospitals are overburdened and overcrowded.  Unemployment is up, government benefits are being spread thin, and money is not going where it should.  We are in bad times, and there is no end in sight. This week, the effects of the healthcare crisis hit close to home.  In a cost saving measure, the largest hospital system west of Worcester, Massachusetts laid off 170 employees, and eliminated almost 180 unfilled positions.  All of this was done while construction continued on a large addition to the hospital which includes a brand new state of the art emergency room and a plan to increase the hospital’s bed count.  To my colleagues that work for the Baystate Health System, I hope you made it through this week unscathed.  To those of you who will find yourself unemployed, I’m sorry that you have to bear the burden of this current crisis. As I read Jim Kinney’s article from the Springfield paper The Republican there was one statement that stood out to me: “The three hospitals were underpaid $26.5 million by the state for the cost of care for Medicaid patients in 2010.”  The Baystate Health System is just the latest victim of a health care system that is underfunded, and not properly reimbursed.  The story is not a new one.  We have seen almost every other hospital in the area lay off staff as well, but the sheer volume of eliminated positions, the 350 hospital staff system wide that will not be there is staggering. Cuts and reimbursement rates are already taking their toll on some ambulance services, and it is only a matter of time until that lack of money trickles down hill even more and begins effecting more services both in the emergency and non-emergency business, which is scary considering how much EMS volume increases every year.  What are we going to do when the government and insurance companies make it even more difficult to collect pay for care?  What are we going to do when people can’t afford the bills that are landing in their mailboxes? Providing care is expensive.  The equipment that we use is...

Just about a year ago, I saw a post on Twitter from Kyle David Bates looking for people to come on and participate in an episode of First Few Moments about responding to ambulance accidents.  I decided to offer my own experience from a number of years ago when I had been one of the trucks to handle a call for an ambulance that struck a bridge abutment. At the time, I had made two brief appearances on the Gen Med Show, and I had called in one night to Jim Hoffman’s EMS Office Hours, but other than that, I was a podcasting rookie.  After we finished recording, Kyle asked if any of us wanted to join him for EMS Garage since he was covering for Chris Montera that week.  I nervously took him up on the offer. I had been a fan of EMS Garage for a while.  The podcast lived on my iPOD and I listened to it whenever I had free time, but had never thought I would have ever be on it, and there I was with Kyle, Tim Noonan, and Justin Schorr talking about EMS education.  A week later, I was one of a number of people who also participated in the 100th episode of EMS Garage.  I told Chris that I felt like a fan that had been plucked out of the stands and given a chance to play in the big game.  Ever since that show, I’ve been on the weekly email list and have been on a number of episodes.  Each and every one has been more fun than the one before it. Next week though I will be the guest host of Garage.  With Chris away in Florida, I am getting a chance to take the reins, and I am very excited about it.  Being on the weekly panel is one thing, but hosting is a completely different beast all together.  I have yet to nail down a topic, but I have some good ideas. Maybe I’ll skip my traditional glass of Garage wine.  Or maybe I’ll have two to help me get through! I hope those of you who are regular listeners to the...

I have worked in a largely urban EMS system for the last eleven years.  As with any city, we have some parts that are pretty shady, and on any given shift, I might be asked to respond into them.  I do it with my head on a swivel, taking in everything around me.  Sometimes we have the police with us, sometimes the fire department shows up, and other times it might just be our ambulance or even just my Expedition.  Its part of my job and it’s an assumed risk that comes along with it.  Still though, to this day, I don’t wear a bullet proof vest, and I can count on one hand the number of times that I’ve truly felt unsafe and in danger on a scene.  I take scene safety seriously, and encourage others to do the same. But what would you do if going into those higher crime areas was something you were asked to do when you weren’t on a call?  What if you were asked to drive around those neighborhoods and just keep an eye on things?  You would probably say to yourself “Well, then I’d be a police officer.”  That might not be true if you work forWashington,DCFire andEMS. Recently, the Mayor of Washington DC, Vincent Gray put forth a mandate that was backed by his deputy mayor for public safety.  Paul Quander who holds that position was quoted as saying “all D.C. government employees have a responsibility to look out for residents.”  Well, Mr. Quander, does that mean that you’ll be out on the streets too?  I sure hope so, because if you’ve deemed this assignment safe enough for the DCFEMS staff, then it should be a piece of cake for you.  You have just as much training in law enforcement as they do.  You might even have more. He followed that up by stating that he doesn’t plan on putting any of DCFEMS’s staff at risk, but with this mandate I would say that he already has.  What kind of deturrant is an ambulance or a fire engine anyway?  How is that going to prevent crime?  What do they expect the staff to do if they...

I was recently involved in what became a somewhat spirited, heated discussion through email with some of the smartestEMSthinkers and leaders that I’ve ever met.  The topic mainly revolved around grammar, spelling, and the education level of EMTs.  Anyone who has spent any time reading charts knows that there’s plenty of improvement needed for some.  The invention of ePCRs with grammar and spell checks has certainly helped, but the basics of it are In the 17 years since I took my first EMT class, things have changed.  Back then, we didn’t give Aspirin, we didn’t “assist” with medications, and epi pens were something that you saw occasionally with someone with an allergy to bees.  SOAP is still around though, and so is CHART.  The alarming thing is that in general, EMT classes are still the same length. These days, EMT instructors have a tough time.  They are forced to cram more information into what equates to the same amount of class time, and a lot of important things get overlooked.  Students leave class having not been brought up to date on simple yet necessary skills such as effectively communicating with someone who is sick, injured, and having arguably the worst day of their lives. How do we fix it? Require more papers?  Ask them to write more, and do more case studies?  What if we build in a reading and writing prerequisite, or, dare I say, build an EMT certification in as a semester in an Associate’s Degree program?  One thing is for sure, if we keep the bar where it is and the world around us keeps progressing, we will only be rewarded with mediocrity. And what about after they get out of class?  We need to remember that education doesn’t stop there.  Making a good EMT is not just the responsibility of an instructor.  Their responsibility is to give students the skills and tools to get through the black and white pages in a text book, and the black and white state exams.  It’s our responsibility to color in those pages.  When I say “our” I don’t just mean training departments, or medical directors, or even FTOs.  It’s the responsibility of each...

My name is Scott and I’m a coffee drinker.  I started at the age of seventeen down inNew Jersey, and it continued through college days and into my career as a paramedic in the city that I still work in.  I don’t really buy all of those tales about it stunting your growth, because lets face it, I’m 6’5”. During my years in New Jersey, all I drank was coffee from 7-11 or Wawa.  Both were excellent.  When I got toMassachusetts, 7-11’s were hard to come by, and Wawa apparently doesn’t know that the good Commonwealth even exists.  My coffee choice was really Dunkin Donuts or. . . well. . . Dunkin Donuts.  Slowly Starbucks have crept into the area, but I just can’t bring myself to drink it.  I don’t speak their language.  I like to order my coffee by size: small, medium, large. . . and I like to order it by what its called: coffee.  Good, old fashioned coffee.  Nothing mocha, nothing latte, just coffee. I took a break from the good drink for about three years, but fell off the wagon a little over a year ago, and boy, once I started drinking it again, I realized what I had been missing.  Time after time though Dunkin Donuts failed me.  They’d do something wrong with my order which is always the same and quite simple: “Large coffee, cream only.”  Not Hazelnut, not French Vanilla, and no sugar.  I like to say that I like my coffee like I like my women: bitter. This blog entry is dedicated to that delicious drink that keeps me going, and makes my day a little easier to start.  Here’s what I prefer to drink: 1.Green Mountain Roasters — Its my “go to” coffee.  I get it every morning on my way in at a convenience store on my short route to work.  Its what most of my K-Cups for my Kuerig are.  Breakfast Blend, Dark Noir, Rev, its all delicious to me, and more importantly, I get to make it myself.  No one messes it up. 2.  7-11— Over time, I’ve found two 7-11’s in my city, both of which are on opposite sides. ...