Christmas is right around the corner, and it is time to hit the stores, or in my case hit the websites, and get that shopping done.  But what do you buy for the EMT or paramedic who seems to have everything?  Well you’re in luck because here are what I feel are five of the best gifts that every provider should have this year. 1.   Ripshears – These might be one of the best purchases that I have made in my EMS career. They’re affordable, they attach right to your favorite pair of shears, and they do the job.  But don’t take my word for it, check out The Happy Medic’s review! 2.  A subscription to EMS World or JEMS – This is the gift that every EMT and paramedic out there should have.  There is a wealth of information available today on the internet, but nothing beats print media when it comes to trade publications.  I have subscriptions to both, it is one of the perks to going to their national conferences, and if you or your loved one does not, it’s a great gift for the holidays this year! 3.  5.11 A.T.A.C. 8” Side Zip Boots – In my 13 years as a paramedic I have gone through just about every brand and style of boots imaginable: Magnum, Rocky, Blauer.  On my first day last December at my new job, I was issued a pair of brand new 5.11 A.T.A.C. 8” Side Zip Boots.  A year later, I am still in that pair.  First of all, I was always used to going through boots every six to eight months or so.  Most of that I attribute to the harsh New England winters, regardless of what I did, or how much I worked, I never had a pair of boots last me a whole year until now.  These things are great.  They’re comfortable, functional, and really hold up. 4.  A new flashlight – Currently, I own two flashlights: the first I reviewed earlier this year made by Coast Portland.  This one lives in my truck’s door during my work week.  Its bright, light, and functional.  The other one that I own is a...

I have been giving some thought to the recent events in Springfield involving an ambulance being struck by bullets, and a rather real looking BB gun being pulled on a tech in the back of an ambulance.  That, along with the law passed this year in Delaware got me thinking, and i figured I would pose a question of the readers. If an EMT or paramedic is assaulted, where should the responsibility of filing charges fall?  Should services have a zero tolerance policy regarding violence against their employees?  Should they be encouraged to strongly advocate for their employees with law enforcement and encourage their people to file charges, assisting them along the way?  Or should they take a hands off approach and leave the decision and procedure of pressing charges to their individual employee? So, what do you...

EMS is currently at a major crossroads as an industry.  Across the country requirements to become a paramedic are becoming loftier, and rightfully so.  In order to properly care for each patient we encounter, we need to be at our best, and the route to that is through training and that bar is being raised.  More education eventually should mean more pay, and some in the private sector are starting to realize that. This is evident from the recent well publicized labor dispute in Buffalo, New York and their eventual 10 hour work stoppage followed by a contract settlement.  From the publicity I have seen regarding those negotiations and others I have more intimate knowledge of, it leaves little to the imagination as to what is most important to EMS professionals: pay and benefits.  I know, that seems like a slam dunk, no brainer, but it also seems clear that at least in the private sector, purse strings are becoming tighter, and benefit packages are less and less appealing.  It’s quite the conundrum, actually.  Increasing educational requirements are driving paramedicine towards being a career, yet employers are still far too often looking at employees with the expectation that they have a job, and there is a divide the size of the Grand Canyon between the two. Now, the jury is still out for me on work actions such as strikes.  I do not really know if they truly follow the “spirit” of our profession and seem to do more of a disservice to the community than they do benefit the worker, but that is a debate for another time.  The fact remains that they happen, and there is certainly reason behind them, as evident by the Buffalo, NY Rural Metro incident. While the private sector is just one of a number of EMS models, it is quite often the quickest path of entry into the industry and employs more EMTs and paramedics than any other model, so discussing the big kid on the block is extremely important.  With health care taking on a huge for profit presence in the economic world, everyone wants their piece and if some of the bigger players want to...

A little over a year ago, I tackled the concept of “skill dilution” and its validity as a statement, and reality in the field.  My perception at that time was that a more important component to focus on instead of skill dilution was education for our paramedics.  While I still stand by the concept that we need to better prepare our medics for what they will encounter when they hit the streets, my views of skill dilution have changed a bit. The EMS system in Massachusetts is quite different from the one that I currently working in.  I know, that is no shocking revelation since it has been said to exhaustion that “if you’ve seen one EMS system, you’ve seen one EMS system” but I find the uniqueness of my current situation interesting in comparison to where I was.  The easiest way to look at it is by evaluating both environments on a county-wide basis. On a common day, Hampden County, Massachusetts has approximately 25 paramedic level ambulances protecting its citizens.  They respond to emergencies for the most part regardless of the complaint.  Everyone gets the same opportunity to have the most advanced care available to a sick person regardless of what the caller told the dispatcher, or what the Emergency Medical Dispatch (EMD) code says is the appropriate response for that incident.  Do you have a splinter?  You’ll most likely get a paramedic.  Are you having chest pain?  You’ll most likely get a paramedic.  That paramedic’s partner, however, could be an EMT, an intermediate, or even a paramedic.  All that Massachusetts requires is one paramedic to make an ambulance an ALS level ambulance. In the county I work in now, there are nine paramedic units for the entire county.  None of us transport.  We respond to only ALS level calls as determined by EMD codes, and we are supplemented by approximately 30 BLS level ambulances.  I do not know the exact number, but to me, that “feels” about right.  Every paramedic unit is staffed with two paramedics, and the state requires that each ALS appropriate 9-1-1 call gets at least two paramedics. According to the 2010 census (and Wikipedia), there were about 463,000...

You are the medic on a busy urban unit dispatched to a serious call of your choice (cardiac arrest, shooting, STEMI, you pick it).  You arrive on scene, and get straight to work on your patient.  IV’s are started, maybe the patient is tubed, a 12 lead is done.  Holes that were not there before the incident that are not a direct result of actions of you and your partner are plugged.  You feel like time is dragging on, and you need to get going.  The patient is loaded, and your truck rumbles off lights and sirens blazing to the closest appropriate facility. Once you arrive at the ER, the patient is turned over to their staff, and you retreat back to your truck to write your run form.  All that is going through your head is “boy, we were on scene for a while, I need to justify this.”  You sit down in front of your onboard computer in your unit and wince as you bring up your times. Your eyes, however, get big as you do the quick math, and realize that you were actually only on scene for 8 minutes.  You share your surprise with your partner and move on to your run form. Anyone who has been in this field for any amount of time has experienced an incident similar to the one above.  When an emergency happens, time just seems to slow down.  Everything moves in slow motion.  If the experience of that sensation is true for someone who is a trained medical responder, imagine what it is like for someone who has no training.  Seconds feel like a minute.  A minute feels like five.  The perception of time is so incredibly subjective.  The reality of time, however, is not. This is why we have dispatchers who track times.  This is why most of the cardiac monitors out there today have event logs that allow you to track what you do and when you do it.  This why when you arrive at the ER with just about any critical patient, there is one nurse who is dedicated to charting.  Accuracy is so important, and one must overcome that perception...

It is not difficult to figure out where many of us out here in the blogging world get our material from.  Some of it is derived from frustration, and some of it from lessons we have learned that we feel the need to pass on to others.  With this blog more than three years old, it doesn’t take a rocket scientist to figure out where some of my material comes from.  It is from my past, and from MY experiences in the years that I worked for AMR in Springfield and frankly, I could not be more proud to say that Springfield was where I spent the first twelve years of my career. In a meeting Thursday night held by the City of Springfield’s EMS Commission, the five commissioners voted unanimously to recommend American Medical Response to handle the 9-1-1 contract in their city for the next five years.  Last night I posted on my personal Facebook page that this decision was a “. . . much deserved and expected victory” for the staff at AMR Springfield, and now that I look back on it, and look back on the decision, I do not feel that statement fully describes the impact of the EMS Commission’s recommendation to the city. The real winners in this situation are the citizens on Springfield because they are getting the best care that they possibly could by having the paramedics and EMTs of AMR Springfield to respond to their emergencies.  AMR has had the opportunity to be in the lime light a few times in the past couple of years with the tornado of 2011 and the gas explosion of 2012 to name just a few, and while those calls were very high profile and visible, they barely make up a chapter in the story of AMR Springfield. The things that are really important are the things that happen every day.  It is not the multitude of trucks that I had sitting in our staging area on Worthington St that night, it was the other ambulances that were out still answering the “routine” emergencies that made the difference.  It was not just our crews going to door to door...

Recently, I was checking out some EMS related blogs while enjoying my morning coffee when I came upon a post at Captain Chair Confessions called “I don’t like to take riders.”  In the post CCC talks about the fact that he feels that passengers are a “distraction” to him in the pack and to his partner who would be driving. In a comment that follows, he outlines that his service has a policy that states only a parent of a child under ten can ride in back and all others go up front.  Beyond family members his service has a policy that all other riders are taken “at the crew’s discretion.”  This sounds very familiar to the policy that was in place at my previous employer. I was fortunate that through my seven years as a supervisor I did not field all that many complaints about my team working in the field.  Sure, you would get the occasional nursing home RN who felt that an EMT was rude to them, or someone who complained about being cut off by a speeding ambulance, but beyond that, I took about a dozen calls from people who wanted to go to the hospital with their loved one, and were denied by the ambulance crew. When I approached the crews and asked them what happened, most of them were able to give me a valid reason why they would not allow someone else to come to the hospital with them but there were a few crews that stated “well, it’s up to our discretion.”  And when I asked them what they meant by that, they replied “we don’t take riders.”  I explained to each of those people that this was not discretion.  I would stress them that each individual situation needed to be evaluated and we needed to do what was in the patient’s best interest, and sometimes not having to sit in the hospital alone is in their best interest. I would always do the best I could to back my crews 100% on situations like this if they gave me the ammo to do so.  Calls that involved violence from assault right up to a stabbing...

Have you made the trip to Washington, DC this year for the annual EMS Today hosted by JEMS?  If so, you should come by the JEMS booth on Friday and say hi. Friday morning, and into the early afternoon, I will be there participating in a few podcasts starting at 10am.  The podcast studio will be open and active all day on Friday and Saturday, complete with the social media lounge.  Stop by, say hi, and take in some great...

One of the first assessment skills I learned when learning about trauma assessment was the “sticky test.”  Done early in the assessment, it was designed to a be a quick once over on a patient to check for any bleeding.  The EMT runs their hands over the patient occasionally looking at their gloves to check for any bleeding that might be severe enough to need immediate treatment.  It is a very effective technique.  I know of people who have found missed stab wounds or injuries simply by looking with their hands. At a fire department where I used to work in Massachusetts and in a few departments in my new system I have noticed EMTs and first responders using black non-latex gloves.  Black.  How are you supposed to see anything or know where your hands have been with black gloves on? On a typical call, I usually go through two sets of gloves, sometimes more.  If I am not taking my gloves off, I am always looking at them before I touch a bag, or my radio, or before I go into my pockets or a cabinet to get any equipment.  How can one do that if they are wearing black gloves? Furthermore, what about black straps or bags?  Doesn’t that pose the same problem?  Maintaining clean equipment is dependent on being able to tell what equipment is contaminated.  It’s time to move away from the red and the black. Green, especially ANSI compliant light green, is the way to go for bags.  Sure, it’s a little tough on the eyes but it makes the provider more visible and it makes it much easier to identify those little pieces of a call that we occasionally take with us. The same goes for straps.  Anything that we can do to make ourselves more visible is vital.  Its time to move away from black. And finally, the black gloves?  Let’s toss those boxes out.  The companies that make them need to stop.  You can’t properly treat a patient if you cannot properly assess them, and you can’t properly assess a patient with black treatment gloves...

Early in January I was contacted by Coast Portland and given the opportunity to review their HP 14 LED flashlight.  Their timing was perfect, as I was in the market for a new light since my old one had seen better days.  This was my first opportunity to use an LED flashlight as all of the ones I have owned prior to this have been halogen.  I have heard from a lot of people that these days, LED was the way to go, so I decided to give this one a try. For the last month, I have been using the light on the job.  Here is what I thought about it: At $65, the HP 14 is affordable and not overpriced.  It advertises a run time on the high setting of just shy of 5 hours, with a considerably longer life of 20 hours on the low setting which when compared to LED flashlight reviews of similarly priced lights is excellent.  In the month that I used the light, I had no issues with the quality of its performance.  The battery life seems pretty true to me and the quality of the stream stayed consistant. The first thing that stood out to me about this light was its overall appearance.  The HP 14 is a sharp looking light.  It is light weight, comfortable in your hand, and easy to use and adjust.  Not only is it powered by 4 AA Batteries, but they are included with the light. Switching from high to low is as easy as double clicking the power button on the back end of the light.  The lower 56 lumen setting offers a much softer but still bright and usable option.  The telescoping focus while quick to adjust but takes two hands to do.  At its narrow setting, you get a nice tight, bright stream, with the wider one giving you a nice area and it softens the light enough that on the low power setting you can easily check a patient’s pupils.  The light needs to be usable not only to illuminate a scene but for patient care as well when being used by a paramedic.  The HP 14...