Sep 4, 2014

Social media has done a lot of good for society.  I have reconnected with long lost friends.  Because of it, I am writing on this blog today, and I have a way to advertise while I write.  Also, everyone can participate in the conversation with their own soapbox to stand on, and they can share their opinion to anyone who will listen.  On the downside, everyone can participate in the conversation with their own soapbox to stand on, and they can share their opinion to anyone who will listen.  In the weeks since the tragic events in Ferguson Missouri, I have made a frequent statement on Twitter and Facebook that can be summed up as “everyone is an expert in public safety.”  What I am talking about is the “should have” mentality that many have adopted. Take, for instance, that now infamous moment in time outside of Detroit, Michigan where two paramedics were photographed allegedly posing and smiling.  A friend of patient Jake Glover told the reporter that “you should be tending to someone who obviously needs your help, instead of worrying about taking a picture.”  From that moment in time with her limited knowledge of procedure and patient care, she made that conclusion.  Based on a picture.  A snapshot of a moment in time. Or how about an example that is much closer to home.  There is something that happens on almost every call that I have ever done involving a 12-lead EKG.  I like to call it “the stare.”  The leads go on, someone pushes the “12-Lead” button, and everything stops.  All of the providers on scene turn their attention towards the monitor and sit very still as they wait for it to start spitting out its treasure.  Once that print starts, all motion around the patient seems to start back up with it.  A number of years ago, I was caring for an unresponsive patient in a dimly lit apartment in a not-so-nice part of the city.  The leads went on, and the 12-lead started doing its thing when a friend of the patient walked in the room and saw what he thought was a couple of paramedics just staring at...

Sep 2, 2014

Last night, one of the major EMS news outlets (I cannot find which one this morning) posted a question on Facebook asking “What effect will raising minimum wage have on EMS?”  Since we are days away from a planned strike of fast food workers, I felt like this was as good a time as any to take a look at the topic.  While part of me hopes that some news outlet other than The Onion will post the headline “Fast Food Workers Strike, Americans Forced to Eat Healthy” my opinions on this topic are not quite so tongue in cheek. If you follow me on Twitter, or are friends with me on Facebook you will learn pretty quickly that I am not a fan of our President and more specifically his policies.  I think the affordable care act has been a painful rollout and the promises made to appease those who opposed it, “if you like your plan you can keep your plan” specifically have been violated and scapegoated on the system itself rather than those who have set the now stringent regulations associated with the act.  Now, there is a considerable push from many to raise minimum wage as high as $15, a wage that many EMTs in the field currently do not make.  If this happens, the response by many EMS departments and companies might be surprising to some. Raising minimum wage is effectively a “war” on big business.  People want a bigger slice of the pie that currently goes to the upper echelon of companies or their stakeholders and shareholders.  This same structure exists in EMS but in many ways, we are handcuffed when it comes to how much money that we can make by the very people who are talking about raising the money that companies are expected to pay their workers.  Ambulance reimbursement is a constant hot button topic at lobbying events and with EMS advocacy groups and in leadership forums.  We, as an industry, are just getting by.  If you want proof of that, look no further than Rural Metro ambulance after they declared bankruptcy in 2013 and are now getting ready to shut down their failing Indiana division. Or,...

Aug 20, 2014

I was really happy when I started seeing chatter on twitter from Cherise Leclerc from CBS 3 after she read my original post Best in the Country that I put up on Sunday.  They were interested in Roy and Nick’s story and wanted to do a piece on it.  Over the course of the day on Tuesday, the whole thing was recorded, the interviews were done, and footage from the competition in Colorado was obtained.  I have to say Julia Leonardi did an excellent job with the story.  Have a look for yourself. . . CBS 3 Springfield – WSHM These are the kinds of stories that we as an industry need to make sure are told.  It shows the true clinical ability that service is capable of because Nick and Roy are a product of the environment that they are surrounded by.  Although people do not always get to see and hear about it, the staff at the Springfield Division of AMR does one heck of a job.  They are professional, they are competent and they bring a level of experience both collectively as field providers as well as a service provider in the area that cannot be duplicated.  A piece like this gives people an inside look into what happens after the time stops on the response time clock that so many people like to say is so important when it comes to EMS. To add to the press coverage of this story, Masslive.com reporter Conor Berry did his own piece based on the CBS 3 story.  Check it out here! Although Roy and Nick did not place, they had one heck of an experience in Colorado and I am proud of both of them and I know that I am not alone.  Well done, guys.  And thanks to Julia Leonardi, Cherise Leclerc and the team over at CBS 3 Springfield for telling a story that had to be...

Aug 17, 2014

Every year, American Medical Response holds a nationwide skills competition amongst their divisions.  Tryouts are held regionally and eventually the top six divisions in the country who scored the highest in the preliminary competition are sent to Colorado to compete for the right to brag that they are the best in the country.  For the second year in a row, the Springfield, Massachusetts division is represented in the finals.  Last year, it was a pair of paramedics Erin Markt and Kim Arnone who represented my old stomping grounds.  This year it is a pair of paramedics Nick Chirekos an Roy Rudolph who will be representing Western Massachusetts. The event is held in a large “simulated” city where a crew is given a fully stocked ambulance and asked to respond to calls in this mock setting where they are heavily monitored and thrown curve balls around every corner.  The stories that Kim and Erin told me last year were great.  It sounds like such a fun experience, and each of them took something from the competition. First of all, I want to to say how great it is to see AMR holding an event like this.  As the largest ambulance company in the United States, it rests on their shoulders to also strive for clinical excellence.  Putting their divisions in the spotlight like this is a great way to showcase just how good the company has become clinically.  While I am not surprised to see Springfield heading to the finals yet again, I feel like it is something that deserves quite a lot of attention. With the brewing turf war in Holyoke, Massachusetts with their fire department, and past investigative “reporting” on the division’s performance in Springfield that revolved around response times this is yet another example of how great the clinical care being provided in the greater Springfield area really is.  While some will complain about AMR as a corporation and their motives in the medical field which are occasionally driven by their need to be a profitable company for the stakeholder’s sake, the motive for the street personnel has and always will be to deliver the best patient care that they are capable...

Last month, a group of us created a new Facebook page called Modern EMS Issues. We wanted to give people an outlet to discuss what they felt were the important challenges that we are facing both today and tomorrow. One of the first questions that we asked everyone was to name what they felt were the biggest challenges that we face today. There were some terrific answers, but I feel like the root of much of the issues that we deal with comes down to two things, ignorance and litigation. Far too often, we allow people who do not understand our profession and what it is capable of to make decisions about how we perform our jobs. We allow the general public to believe that response times are more important than high quality care. Some of this is he fault of those who prey on the ignorant, but for the most part it is our fault for not properly educating those that we serve. I cannot count the number of news stories that I have read that either cite what people interoperate as “poor care” that was directly related to response times. Take a look at the situation in Minnesota last week where a family was “outraged” by a seven minute response time to their residence. There was no talk about what happened after the ambulance responded in what many would say is a reasonable amount of time. There was an article that got a decent amount of attention a few years ago when the Super Bowl was held in Dallas regarding MedStar’s response times during that week when they also faced a sizable Texas snow storm. Many responses were made to “emergent” calls in a “non-emergent” fashion with no marked reduction in patient mortality.  The thing that I like about the information that MedStar released was there was no “spin” to it.  It was just straight facts backed up by statistics.  Not many places take that road.  Far too often, they rely on public opinion and speculation of what the public thinks is important. Furthermore, we allow ourselves to continue to believe that while urban responses require someone to be on scene in less...

Jul 23, 2014

Recently, on the Resuscitation Facebook group, a discussion started regarding time on chest, time off chest, and the safety of defibrillation with active CPR being performed by a rescuer.   While the core of the debate and the reasons behind why and why not one would voluntarily subject themselves to an electrical shock is one that really needs more research to validate, it became clear that reducing the peri-shock pause (the time with no CPR prior to and immediately after defibrillation) could actually make the concept of receiving said shock a non-factor. The discussion quickly turned to how long five seconds was, and how long three seconds was, and how with proper training and practice, a shock could almost be delivered on an upstroke with little to no pause in CPR.  It goes without saying that time on chest is vital for cardiac arrest survival.  Pit crew CPR teaches us some techniques to best deliver effective emergency responder CPR, but I feel like we can do better. What about the other lengthy hands off time in the pre-shock period?  I am talking, of course, about the time that it takes an AED specifically to analyze the heart rhythm of a patient in cardiac arrest.  Usual analyze time for a monitor in my experience has been around 5-7 seconds depending on the model.  Once analysis is complete, many AED’s continue to announce “Stand Clear!” and start “spooling up” to their preset energy setting to prepare for a shock.  When it comes to dealing with the general public, this is, in my opinion, appropriate.  I do not expect some “Average Joe” who pulls an AED off a wall at the Mall of America to have the same ability to use it as someone who spent months (in some places a year) in an EMT class.  Public AED’s are a great thing, but why are we not putting better training and maybe simple EKG recognition skills in the hands of our BLS providers? The first time I encountered an AED was in 1994.  It was a big deal for our town.  We had one for our two ambulance first aid squad and would switch it back and forth...

Last week, actor Tracy Morgan was involved in a serious motor vehicle accident that also killed a friend of his. The pair were struck by a Walmart owned tractor trailer that was being driven by a driver who had reportedly been awake for more than 24 hours. When I heard reports of the accident the circumstances surrounding it, I started to wonder how many responders at the scene were in the same boat as the driver. Long hours are a well known part of our job, however how long is too long? In the system that I work in now, many of our BLS units are staffed by people who are on 24 hour shifts. A number of the people working these units have a number of different shirts in their drawers from the departments that they work part time for. It is not an unusual occurrence to find some people working back-to-back 24 hour shifts in an attempt to cram a good number of hours into their work week to maximize their days off. In the study that Fitch & Associates did of Alameda County back in the mid-2000’s, it was noted while riding with some crews that “many responders appeared exhausted.” They added that one even “nodded off during a midday conversation.” Again, ALCO was a system where people would try to cram their work week into a couple of days. The effects of sleep deprivation and sleep inertia are well documented in the medical industry as well as the transportation industries. This is why medical interns have seen their hours cut, and pilots and truckers are required to have a certain amount of downtime. Here in the world of EMS though, we push forward. Many of us work multiple jobs. For the first time in my career, I do not have one. It was not unusual for me to work sixty-plus hours at my full time job at AMR, and follow that up with a shift or two at my part time job without a second thought. It was natural to me. I remember days as a supervisor where I would encounter certain employees in the same boat as me who...

Jun 13, 2014

This is going to be my last post on this topic.  I actually intended on posting this about a week ago, but so much has come up over the past week that I kept pushing it back.  In fact, I was going to push it back even more with my Belchertown post that I released yesterday but I figured that this one could not sit any longer. The events of the “smiling and posing” paramedics in Detroit got me thinking back to a call that I did a few years ago. We were dispatched to a very well-known diner in the city I was working in at the time.  It was one that I frequented both while at work and occasionally off the job since it was close to my house.  That morning, we were dispatched to the patient having a “diabetic issue.”  The waitress told us that our patient was a regular in their establishment.  He was an elderly male who would walk down every morning for breakfast, and was a known diabetic.  Today, he came in sweaty and disoriented, and just was not himself. While the patient could follow commands, he was just “off.”  His sugar came back at 30, so we continued where the waitress had led off: we fed him glass after glass of orange juice and some toast as well.  As our treatment of the patient progressed he became more and more alert to the point where he was conversing with and joking with us.  We laughed as he jokingly told us how much he hated needles despite having to check his sugar multiple times a day. Being a busy Saturday morning, and this being a small diner (I’m sure many of my readers from Springfield know exactly the spot that I am talking about) we were the center of attention.  I’m sure people wondered what was going on as we cracked quiet jokes and then collectively laughed.  While the digital age was just starting to really take off, not many people had cameras, and the voyeuristic society that we live in today was not yet dominating the news and the Interwebs, so no pictures of the laughing paramedics...

I’ve been giving a lot of thought lately to what would make an EPCR system perfect for me. Most of these thoughts have stemmed from the last year that I have been using what arguably is the worst EPCR system that I have encountered out of the four that I have used. Yes, I know, four really is not that many when you consider how many products are out on the market still, the thing has a long way to go to reduce the frustration that I seem to consistently encounter. What I decided to do was create a few “Do’s and Don’ts” that might give someone developing or improving an EPCR system some things to think about when working on their product. DO have an open source coding system that will allow different products like cardiac monitors to upload their data to it with the greatest accuracy possible. Make sure that event markers line up with the wording in the monitor and if possible allow the patient information we put into the monitor (name, age, case number) to import into the chart so that it only has to be entered once. Also, allow preferences to be set for each person that can include truck number, crew member, and other information that is the same for every single shift. DON’T try to do too much of my job for me. I have never met an auto generated narrative that I like. It does not matter if it is CHART, SOAPE, or anything else that you can name, things just never seem to add up. Facts get missed, and what I see with my eyes is either left under described or completely missed. Anyone who teaches a PCR writing class will reinforce the concept that your narrative is your bread and butter. It is what will tell you the most about a call if you get called to the carpet for it years down the road. It is what will get you paid if there is a dispute with MEDICARE. Narratives are so incredibly important that they need to be left to the tech to write them, not the computer. DO have a repeat or...

The news story that hit the internet last week about the woman who was “pronounced” by the paramedic who was later discovered to be alive is nothing new.  We have seen this type of thing before.  Chances are, if you ask me, probably just about every case of this has hit the media at some level.  If you ask me though this is not an EMS problem.  This is a personal problem driven by the laziness of a provider. In fact, one article mentions that this exact same medic had an issue a little over a year ago when he flew two patients that probably did not need to be flown, and should not have been flown.  I vaguely remember that story. The problem with this entire situation though is that what will most likely come out of it will be some policy change either at the state level or medical director level, and some fear within the system that “this might be missed again.”  This is not a systemic issue.  It’s not a state issue.  Its a provider issue.  And more importantly, it is one that should never happen.  The only thing that will prevent instances like this is a thorough assessment by a trained medical professional. Every field pronouncement protocol should contain a few core components.  For example, obvious signs of death.  Lividity, rigor mortis, and body temperature.  Or some injury that is incompatible with life; a decapitation, or massive evisceration, cranial evacuation.  These are the things that should be obvious to us when we assess a patient, and we do need to assess these patients.  We need to touch them, and inspect them, and make sure that we are making the right call, even if we are on a crime scene.  These things must be done. The other component that should be part of every field pronouncement protocol is the acquisition of an ECG that shows three leads of asystole for a predetermined amount of time.  The best way for any paramedic to check this is not to get a “quick strip” but instead to do something like a “10-20-30” evaluation of the patient’s ECG. What I mean by a 10-20-30...