I’ve seen a number of changes since I first stepped on an ambulance at the age of 15.  Some of them have been good, and some of them not so good.  In this edition of EMS in the New Decade, I want to point out what I feel has been the best piece of equipment and the best treatment that I have seen added to my toolbox mainly in my last eleven years as a paramedic. 1.  The LP 12 Monitor — When I was in paramedic school at Springfield College, I was trained on an LP-10.  We had no way of doing 12-leads besides that old trick of moving that single electrode around the chest to get the pictures that we wanted.  We could look at the inferior leads with the old “hold down the print button” function on the LP-10 to put it in diagnostic mode, but without a little bit of work, we couldn’t get the monitor to do a lot on its own. Don’t get me wrong, I loved my LP-10, but it was dated, and it was evident to me from the start of my paramedic career that as an industry we had moved past it.  In fact, for the last two years of my career in New Jersey when I was in paramedic school in Massachusetts every LIFE EMS unit that intercepted my BLS ambulance had an LP-12 on it.  I was a bit behind the curve on reading 12-leads due to my inexperience with them, and my trips home brought that glaringly to the forefront. Adding an LP-12 to my truck somewhere around 2003 when Massachusetts made them a requirement was a huge step in the right direction.  Not only was I able to do 12-leads but I had an O2 Sat machine build into the monitor, and I was able to measure end title CO2 not only on intubated patients but also via a nasal cannula-like detector.  That was technology that our emergency room didn’t have.  In fact, our larger ER still relies on breath sounds and a color metric device. My scene times may have gotten longer after I packed my LP-10 away, but I...

“Nothing stops an organization faster than people who believe that the way you worked yesterday is the best way to work tomorrow.” — John Madonna Patrick, one of my colleagues here in Massachusetts shared that quote with me one night when we were having one of our nightly conversations about where our service is, and where it is heading.  John Madonna’s words describe many people that I’ve encountered in EMS.  They fear and are resistant to change, and they really shouldn’t be.  They need to learn how to embrace it, and be comfortable with change, and view it not as “change” but as evolution. I’ll paraphrase Patrick’s thoughts that followed: “We could call this the ‘Dinosaur Mindset.’  Extinction thinking.  We must grow, learn, evolve, become, and always improve ourselves and our ability to serve the world.  All the while not changing or letting go of the core principles, truths, and values that should never change.  If we waver from our course, we will just find another way to become extinct and irrelevant.” Every generation has seen change in EMS.  Otherwise, we’d still be driving around in Cadlillacs that doubled as hearses.  We wouldn’t be doing 12-Lead EKGs, and CPAP would just be some silly thing that respiratory therapists apply in the hospital. If you’re one of those people that’s not really comfortable with change, that’s fine, but don’t fear it.   Don’t hold it back.  Throw the phrase “That’ll never work” from your vocabulary, and right next to it, file the phrase “well, 5 (or 10, or 15) years ago, we didn’t do it that way.”  Be patient, and let evolution take its course.  It might not be comfortable at first, but with time, change becomes easy, and often can be beneficial. Be willing to try old tricks but with a new twist.  Just because something hasn’t worked in the past doesn’t mean it can’t be made to work now.  Finally, learn from what goes on around you.  If you want to change, don’t be set on reinventing the wheel.  The best answer might not be within your organization, or even within the industry.  Be willing to take that extra time, and make the...

  On February 18th, 1985, I was 6 years old.  It was Washington’s Birthday, and I was off from school so my dad took me out to go bowling for the afternoon.  It wasn’t something that we did very often, so it was nice for a change. Back in the early to mid-1970s, my dad was an active member on the Island Heights First Aid Squad.  When I came along in 1978, family became the priority.  He took a break from the “EMS thing” for a while, but always kept a blue metal first aid kit in his trunk, just in case he ever needed it for our family or someone else in need. As we drove home on Route 37 in Toms River that evening, an intoxicated elderly woman left a bar somewhere along the route.  Route 37 is a six lane road in most parts, with an often ignored speed limit of 50 MPH, and a large median separating the east and west travel lanes.  She got on the wrong side, and started traveling east bound in the west bound lane.  Our local fire chief from Island Heights saw this happening, and despite his frantic calls over the radio, there was nothing anyone could do.  She slammed head on into an oncoming car ejecting the driver, a younger woman, who was obviously unbelted. As we came up to the scene on our way home, my dad felt compelled to stop and help.  I sat impatiently in the car, just wanting to go home at this point, a six year old not really understanding or comprehending exactly what happened.  Eventually, after the ambulance and paramedics had gotten there and taken her away, my dad cleaned himself up along with the other good Samaritans who had stopped, and we took the short trip the rest of the way home.  We still talk about it sometimes, but it’s really just another story in the long list we’ve accumulated over the years. Twenty seven years later, my dad is now a nineteen year member of the Island Heights First Aid Squad, serving his second tour as the squad’s captain.  A month ago, he was driving his...

“Couple Claims Ambulance Took Too Long“ I stumbled across this story on the JEMS website the other day. Click on the link, check it out and come on back to read what I have to say about it.  Okay, ready?  Another tax paying citizen is upset that it took too long for an ambulance to get them to the hospital. An elderly woman “felt ill” so her husband called 9-1-1. Tippecanoe County EMS responded to her aide in a timely manner and loaded her up for transport. Her husband and neighbor left the scene and rushed to the hospital. When they got there, the ambulance wasn’t there yet, and they had to wait for her to arrive. According to the husband stated it took an hour. The patient even made a statement to the report that she “wondered if she was going to make it.” The service director stated to the media that according to their records, the truck took 18 minutes to get to the hospital, and that she was transported without lights and sirens. Some people might shake their heads because of the job done by the reporters, but I feel it’s a failure of the service and their public information officer (or lack of one). When an ambulance transports to the hospital without lights and sirens, it tells me a lot about the condition of the patient. The crew did not rush the patient urgently to the hospital seemingly because there was no need to. When we transport without lights and sirens, it’s for the comfort of the patient and the safety of the crew. EMS professionals might not do a good job determining who should and shouldn’t go to the hospital, but in my experience they do a great job of determining how fast you need to get there. The chief didn’t do a bad job considering his HIPAA handcuffs. The family and the patient were so vague about what happened that there really isn’t a clear picture painted, and he appropriately didn’t add to that patient care picture at all. What he failed to do was take a great educational opportunity for the media and the public to let...

EMS seems to have this chronic problem of not putting their people out there enough and recognizing them for the vital role they play in their community each day.  Sure, there are organizations out there such as the American Ambulance Association which takes great EMS providers and puts them in front of members of congress as examples of what an EMS provider should be, but it seems to me that those instances are few and far between. It should be noted that if someone gets into this field looking for ticker tape parades and medals to be pinned on their chests, they’ve definitely gotten into the wrong field.  EMS is 90% routine, and 10% action.  Sadly though, it is that 10% action that seems to be recognized 1% of the time.  The public isn’t going to care that Pat the Paramedic took care of thirty chest pain patients last month, but they should care that when Pat walks in the door of their home, they are going to have a caring, and compassionate provider standing in front of them. There are a few things that I feel hold us back from really getting our people out there, and they’re all internal: 1.  The “It’s your job” mentality — Some leaders in EMS overlook consistent performance, citing that the person is doing what they are supposed to do.  While that statement might be accurate, reward and praise for consistency is a must.  Chances are, if this person meets the expectations set for them every day, they are frequently exceeding them, so praising them might actually go a long way.  If it seems like you have a number of people that are failing to meet the standards you are setting from them, take a good look at how they are being relayed to your people.  Chances are, they aren’t out there enough, or aren’t fully understood. 2.  Not enough eyes — In larger services, it’s not always easy to see and understand everything that is going on in the field.  Patient interactions can frequently go overlooked, and great employees can be overshadowed by that 5% of the employee base that takes up 90% of your time. ...

This Post can also be found at the First Few Moments website. Bob Hurley Sr is the basketball coach of St. Anthony’s High School in Jersey City, NJ.  As one of the most successful coaches in the history of the game, he was inducted into the Basketball Hall of Fame this past year.  If one was to ask Coach Hurley why he has been so successful, he will tell them it comes down to two things: discipline and practice.  Hurley is well known for his intense practices and his ability to always get the best out of his players, and we could learn a lot from him.  His players don’t practice at half speed in unrealistic circumstances.  Their practices are intense and at game speed.  His team practices like they play, and as a result, they play with the intensity that they show in practice.  Think for a second about how your department trains for a major incident. Â  What can be done to make them better?  What can be done to challenge the participants more and to bring out their best?  Here are a few of ideas: Make sure the circumstances are realistic — You want to be put into a situation that tests your ability to manage a major scene that is as accurate as possible.  Does your department staff only two trucks for the shift?  If so, then don’t have four available to them for the drill.  Make injuries look realistic with moulage, and make sure the management of those injuries is timely and appropriate.  Throw in a monkey wrench or two – Try and simulate the outside distractions you may encounter as part of the incident.  Think about bystanders, and traffic patterns and how they might affect access to the scene.  When units are responding, advise them that due to the incident, the intersection of Main St and Washington Blvd is completely gridlocked and impassable.  Make your responders think of alternate access to the incident, and make the scene commander adapt his or her plan to the unexpected challenges they might encounter. Expand on your debrief — When the exercise is over, don’t just look at the good and the bad...

Yesterday, I spent my day doing something I hadn’t done in a long time: Teaching.  I volunteered (was drafted?) a few weeks ago to produce an entire day of content for one of our paramedic refreshers, and the opportunity excited me.  As I started putting together my topics, I decided early on that I wanted to expose the class to things that they hadn’t been exposed to before.  The four presentations I put together were: EMS and the Non-Transport Call, The Well Being of the Paramedic, The Future of EMS, and EMS and the Internet. The content seemed to be well received, and some of it sparked some decent conversation.  It got me thinking about our struggles here in Massachusetts over the last year. As most of the EMS community knows, starting last summer, Massachusetts saw a number of indictments of instructors and course coordinators who were falsifying documentation to recertify EMTs and paramedics.  It was a pretty big deal, and punishment was not just served to the instructors but also to the recipients of the alleged training who signed the rosters.  Suspensions of certifications were as short as 90 days, and as long as in excess of a year.  Some even lost their cards and could face jail time. In response to the problems experienced, the state’s Office of EMS has responded by increasing the oversight they have on classes throughout the state.  Evaluators will occasionally “drop in” on classes, sign in, sit to audit for content, and make sure everyone is there.  I’ve heard of it happening a few times, but unfortunately, I did not receive a visit on Thursday. Let me preface this by saying I feel that the punishments handed down were just.  People got what they deserved for the mistakes that they made.  It saddens me though that thus far, the state seems to have missed the big picture.  Refreshers need to be revamped and restructured.  Priorities need to shift. With all of the data that is being collected in the prehospital setting, we have a better look than we have ever had.  It’s time to put it to some use.  Tell me, and tell my colleagues in my...

May 25, 2011

I am writing this blog post this morning from my favorite bar.  Its 7am, and I’m waiting for them to start serving breakfast.  According to the sign, it’s the “Best Breakfast in the City” and I’d tend to agree.  I’ve put a lot of money into this place over my years working here, and it’s been well worth it. Eleven years ago this week, I started my career with the service that I currently work for and it’s been quite the ride.  When I started I was 22 and had just finished my paramedic student time.  I was waiting for my test date to come around so I could get myself upgraded and start my career as a paramedic, something that I had dreamed of doing for a long, long time. As I stated in a post last week, ten years ago this month, I also graduated college.  That marked the start of my career as a full-time paramedic.  My work weeks were 60+ hours long, and I had to work some shifts that was viewed as “less desirable” due to my lack of seniority.  My very first shift was 3p-11p on Mondays and Tuesdays, and 7p-7a on Fridays and Saturdays.  The evening crew on my 8 hour shifts were your typical group, nothing really special.  We spent our evenings running here and there, and really didn’t have too much contact with each other simply due to the sheer volume of calls that we’d run.  The group that I got to work with on the weekends though was a different story all together. We were the younger crowd.  I’d dare to say that the oldest of us was probably in their early 30’s and most of us were between the ages of 20 and 25.  When we worked, we traveled as a pack from post to post.  Our trucks had hackee sacks, decks of cards, frisbees, and plenty of other stuff to keep us occupied.  When the calls started coming in though, we were quick to pack it up and get the calls done. There was a strong sense of camaraderie between the crews.  If someone had a bad call in a shady area of...

How do we make decisions in EMS?  Sure, we are guided by our protocols and medical control, but truthfully what is our focus when we make a decision as a paramedic or EMT on an emergency call?  Is it fair to say that most of those decisions are based on what is going to happen in the next 15-20 minutes?  In the most critical instances, I’d say that it is. When we work a code, we are fighting for that ROSC.  We want it quickly so the patient has the best outcome.  On a STEMI call, we are basically doing prep work for our patient’s trip to the cath lab.  Those IVs we start, the medications we give, and the serial 12 leads we perform are all gauged to getting our patient through the ER as quickly as possible.  For a trauma patient, often times surgical intervention is the focus.  Unless there is some other underlying cause of that trauma, “medical” treatment is usually not necessary, or secondary to the potential surgery they could receive when they get through the ER. The next 15 minutes.  That’s what matters.  It is what we are trained to deal with.  We are there to deal with these acute emergency situations and quickly bring calm to the chaos in the best way possible.  When you want to transition from the streets to the front office, how does that thinking change though?  How do our problem solving processes have to change? In the field, the attitude of “just do it and get it done quickly” is great, but that doesn’t translate well to making decisions that could effect departments that might be staffed by hundreds of providers.  Messages need to be clearly relayed, and people need to be given notice of change.  That’s the unique thing about EMS.  It’s a 24/7 business, and implementation can be a real challenge.  You can’t close the doors on Friday, and tell your people that “Monday morning, we are changing ‘X’ ‘Y’ and ‘Z’” it just doesn’t always translate well. This is where I feel great field providers struggle in the transition to be great supervisors and managers.  The critical thinking and problem...

Ten years ago this month, I graduated college.  I had been a medic for about eight months, and I was still terrified.  I was really comfortable with my BLS skills, but a lot of that ALS gear still felt new to me.  It’s amazing how much is different now. . . Ten years ago, I dreamt of having an LP-12 in my truck.  I was stuck though with an LP-10 with paddles. Ten years ago, I was getting ready to live alone for the first time in five years.  The ink was barely dried on the lease for my new apartment. Ten years ago, Osama Bin Laden wasn’t a household name. Ten years ago, people felt safe.  Terrorism was something that happened elsewhere, and Anthrax was a 90’s heavy metal band. Ten years ago, I was getting ready to start my first full-time shift with a friend of mine from college.  Now, he’s on the verge of being the fire chief in the town he works for. Ten years ago, I had never done a shooting.  I lost count of how many I’ve done long ago. Ten years ago, I had my first cell phone: a cheap one by Sprint.  Texting didn’t exist, Twitter wasn’t what it is today, and I had dialup. Ten years ago, I had a Livejournal.  Today, I’ve got my own url. .. But you knew that, I mean, you’re on it! Ten years ago, being a supervisor was a goal.  Now, it’s a reality. Ten years ago, I loved my job.  Now, I love my career. Time sure does fly, doesn’t it?...