Common Sense

Everywhere you look, there is an article related to a "black eye for ems".  From certification scandals http://www.ems1.com/ems-management/articles/912299-NH-officials-beef-up-after-EMT-certification-scandal/,  to a medic using medication out of the drug bag http://www.ems1.com/news-reports/904588-minn-paramedic-guilty-on-drug-charge/, to a medic taking photos of a dead teenager http://www.employmentlawtoday.com/ArticleView.aspx?l=1&articleId=1355.  All I have to ask is…WHAT WERE YOU THINKING? 

There appears to be a trend of medics making very poor decisions that are ending up in the public eye.  There are medics posting information that is very specific in relation to a call on social media sites.  The posting of photographs from a scene.  Inappropriate comments on Facebook and Twitter.  Cheating, fraud, and the list goes on and on.  At what point did these people say "yeah, this is a good idea" before posting the thought? 

The hope for the future is that we are recognized as a profession, that we will be treated like professionals.  To do so, we must not associate ourselves with these people.  If their judgment is this poor, what must their care and treatment be like?  We need to wake up and realize that this reflects poorly upon ALL of us, not just the person that had a lack of educated judgment. 

 

As friends and co-workers, we have to recognize the signs early on.  If you notice inappropriate comments, Facebook postings, etc, even if they are not work related, you need to assume that it is only a matter of time before there is one related to work.   As managers, we need to develop a policy in relation to social media.  This is not going to go away.  Social media is here for the duration, and it is only getting bigger.  Develop a policy that spells out a-p-p-r-o-p-r-i-a-t-e b-e-h-a-v-i-o-r.  Apparently common sense has left the building for some people.

If we can all be smart and diligent with our comments and our actions, we can prevent our own name or our service name from being a negative media headline.

State conference wrap-up

I am back from another Iowa EMS Association annual conference and have to say, it was a great time as always. I wore my EMS 2.0 pin with pride and had to explain the meaning to quite a few people. I also wore my CoEMS shirt and had a few people ask about it, and a few that knew what CoEMS was. I presented on Saturday morning and in my closing, guided my audience to the Chronicles website and asked for their support in presenting EMS as it really is for the world to see. I am also happy to announce that I will hold an at large position on the IEMSA board.

I spent over two hours in a class focused on technology. Let me tell you, this geek was on the edge of his seat. This logistics expert presented multiple ways that his agency is using technology to help both management and medics on the street. From being able to view traffic cams on an MDC from inside the ambulance (for passenger only), to viewing current and upcoming weather direct from the National Weather Service. I learned how to use CAD dispatch data and overlay it with GIS to see where the calls occur. Useful for agencies that do not use deployment strategies but have units in stations. When resources are depleted, they move available units to where calls are more likely to occur. I learned more about narrow-banding and 700 and 800 mhz than I ever wanted to. But…being the tech geek that I am, I enjoyed it.

Was surprised at a lecture from a physician on ems and community involvement. It was EMS 2.0, and he didn't know it. I had a nice talk with him afterward and was surprised that we know a lot of the same people in relation to community paramedics. There will be more on this talk in a later post.

What I want to get across here is that you MUST become a member of your state EMS association. This is the perfect spot to begin to have a voice. This is the opportunity to see what is new in ems, find out what others around the state are doing. It gives you the opportunity to discuss problems and solutions to problems that are affecting ems across your state. Plus, it is a chance to catch up with old friends from the past. A former co-worker, a former classmate, a former instructor.

If you wish for change, you need to have a voice. Being affiliated with your state's association allows your voice to be heard. It allows you to be a part of an organization that represents YOU. Many will say that the state association is just a "good ol boy club". Well, if that is true in your state, change it. Become a member and vote them out. Or better yet…run for a position yourself. All I ask is that you don't sit silent on the sideline and allow things to remain status quo.

Re-shaping the future of EMS

After last week's EMS Garage, I have decided to express my "ideas" on what EMS should be. I will start with today's post. It is a summary of sorts regarding a few key items WE need to work on. I will go into more detail with each one in future posts. What I would like is feedback from you the readers. Tell me what you think. What do you agree with? Please, post replies, send me a message, a smoke signal, whatever.

 

A set of standards for all ems agencies

Whether we are paid, volunteer, rural, urban…we need a set of standards that ALL of us must follow. Standards for safety, Protocol development, QA/CQI. Response times (because there is a point when it is irresponsible)

 

Improvements in the education system for ems providers

If we are to play a significant role in healthcare, our education has to be improved. There are too many medics on the street who were smart enough to make it through a class, not piss off the preceptors, and pass an exam. Is this really all we are asking of a healthcare professional? Apparently it is in EMS. EMS needs to become a "licensed profession", and not a "certified trade".

 

As an industry we need to move away from the "Mother may I?" concept of patient care

After forty years, we should be beyond this type of service protocol. We have come a long way in the treatment we are able to provide. Yet, services still exist that require you to contact medical control to administer pain meds for a fracture. Really?

 

More stringent standards for medical director involvement

There are services who have a medical director who plays an active role. They work with the development of policies and procedures, they have a part in protocol development. They respond in the field or do a ride along once a month. I believe these are services that would stand out from those who have a medical director that signs the paperwork each year.

 

Develop "One Voice" for ems

We need one entity to represent us and go to battle for us.  EMS is too splintered right now. You have the NAEMT, which is a fantastic organization. But…not all providers support the NAEMT through membership. You have the American Ambulance Association, yet another great organization. However, for some providers, these are not the groups they believe are doing the most to further our cause. To some, organizations such as NEMSA are the one pushing forward to make ems more of a profession.

 

Thanks for reading and to quote Hill Street Blues…"Be Careful Out There".

HIPPA and the patient follow-up

Does anyone else have a problem with getting a patient follow up so you know how they are doing, or for quality assurance purposes? We are supposed to be caring and compassionate, but I guess that ends when we leave the hospital.

It seems that every time we drop a patient at the ER and try to get a follow up later in the day, they act like we are complete strangers. Why is ems not looked at as part of the patient care process? We obtain the info and perform an assessment on the patient, we provide care and treatment, we give all the information to the hospital, and two hours later, we don't exist. We are at the very beginning of the "paper trail".

The patient chart goes from the ER, to multiple units/floors of the hospital, to billing and records. Sometimes this patient is transferred to another facility and the whole process is started over. All of these people are apparently part of the process because they work in the hospital, right? EMS on the other hand is exempt from obtaining this information.

What if when we arrived, we gave no report to the ER staff? Can you imagine what would be said? What if we told them that because of HIPPA, we could not release any information to them? Now…don't get any ideas people. This would be a bad idea in regard to the continuum of patient care.

OK…enough with my ranting.

Instead of just complaining, what can be done to fix this problem? Well…I might have a few ideas. Stay with me here for a few. To start with, do all of you leave a report with the ER when you turn the patient over to them, or at least prior to leaving the hospital? Do you do this every time? For every patient? For those of you that are fortunate enough to be able to do your EPCR during the call, this is easy. You arrive at the hospital, turn the patient over, go back and finish entering the information, have the accepting nurse of physician sign the screen, and you print. Maybe it prints to a printer at the hospital, or a printer in the truck. Done! Or, if you are like me, I leave a brief written report, and fax a copy of my EPCR to the hospital when it is finished. By doing all of this, we are part of the patient care process, and there is a copy of a report attached to the patient record to prove it.

From here we might be able to call back later, speak with a nurse who can look at the report and see that you were the medic treating the patient, and give you an update. After all…you are a part of the treatment process, right?

In a perfect world, we could have access to the hospital system and we could see what was going on with the patient. I had a long talk with a friend at EMS Expo in Dallas about just this problem. Apparently, his service exists in that perfect world. They have a system like this set up with the hospital. They are able to see the outcomes of most of their patients.

So, I ask you…what can we do to make this work? How can we improve the communications and actually be recognized as a medical professional that provided care for the patient?

Dallas - expo eve

So...I arrived in Dallas without incident.  Which is more than I can say for @Epi_Junky.  So far, this has been beyond my expectations.
For an impromptu meetup (tweetup) at House of Blues in Dallas, it was bigger than anyone could have expected.  The intention of RJ (@hybridmedic) and Scott (@medicsbk) to have a small gathering turned into a group of forty or more all speaking the same language...EMS.  It was beyond what anyone expected.  And then Zoll showed up to make it official.  The support and interest Zoll has in social media and its roll in ems is amazing.  They really understand that it has become a component of ems now and in the future.

Arriving at the House of Blues and not knowing an actual person made me a little nervous.  I had expectations of how I wanted the evening to go.  Earlier in the day I planned the possibility of being back to the hotel early because it didn't go as planned.  The idea that I would be in Dallas for the rest of the week, with nobody to talk to and enjoy the conference.  I am so glad that was not the result.   It ended up being so much more than I could have imagined.  EVERYONE was amazing.  It was as if we had known one another for years.  There was no judgement of who worked where and for whom.  We are all the same person playing a different roll for a different service.  It was great.

I will now break away from this to go and record an episode of EMS Garage.

Don't worry...There is more to come

Dallas, here I come

 

So, this is my second week with a blog, and this one will be none to exciting, but it will tell a story.

I want to talk about attending EMS Expo in Dallas.  Why you ask?  Because this is an opportunity to hear some of the best and brightest in the profession speaking on what's new and innovative for ems.  From induced hypothermia (yes they are doing that prehospital), to an ambulance that you load the patient from the side.

This year, for the first time ever, I am going to Expo alone. What I mean is there is nobody else from my service making the trip. The people I plan to meet in Dallas are those I chat with through social media on an hourly, daily, or weekly basis. These are people I call my friends, yet we have never met face to face. My wife thinks I am crazy, I think otherwise. I would not be attending EMS Expo if I was not fortunate enough to have become friends with Greg Friese on Facebook and Twitter. He helped me make the trip happen. Thanks again Greg.

Expo is the chance to see all that is ems.  You get to see the newest equipment and apparatus.  It gives you the chance to hear and see what others are doing.  You have to remember that there is a lot to learn from others.  Just because you think you are doing things the best way you think possible, does not mean that someone else out there does not have a better way of doing it. The opposite is also true; they might want to hear how you do it.

It is the opportunity to see and hear from the members of the "service of the year".  What have they done to deserve this honor?  What do we have to learn from them?  Are you happy with just being average?  Do we not strive to be the best?  Imagine the honor of being recognized as the best.

I have the chance to attend leadership presentations from some of the best, such as Skip Kirkwood. If you are not familiar with him, go check out Wake County EMS. Wake EMS is very progressive service in the Raleigh area that is leading the way for ems. They have a prehospital hypothermia protocol, and they have implemented the idea of "community paramedics". I am excited to learn what he has to teach.

Most important though…I am finally able to meet those who have inspired me. Geeky Medic, Happy Medic, Ambo Driver, Ms Paramedic, Imagemedic, Podmedic, and the list goes on and on.  These are the people who have been working so hard to move ems to the next level.  EMS 2.0.  These are the people who inspired me. They awakened the idea from within me, and gave me the tools to expand on the idea. While in Dallas, if I can help them to inspire more people to the 2.0 way of thinking, then that is all that matters.

This week I also get the chance to do a podcast (or two) face to face with the others. I finally get a face for the voice. The podcast thing is kind of funny for me. I remember mowing the yard and listening to ems garage and thinking, "wow, these guys are amazing, I have never looked at it (insert idea or concept here) like that. I thought to myself that someday, I might be on the garage. Others might care to listen to my idea and my opinion. Since I started doing some podcasts, I get feedback from people I know telling me how great it is that I am a part of it.

EMS Expo is about being with friends. Old ones and new ones. It is about round two of darts between Chris and Kyle (I am still accepting bribes guys). It will be the best time you can have doing anything related to work. From standing on the grassy knoll, to eating BBQ, it is an opportunity to sit back, relax, and take it all in.

In a little over twelve hours, I will be on a flight to Dallas and the word excitement just doesn't describe it. See you there.

 

 
 

A Standard of Care

After a great discussion on EMS Garage last week in relation to these articles, I thought I would go a bit further.

A recent article on Jems.Com discussed the Salt Lake City Fire acquiring the brand new technology of 12 Lead EKG. http://www.jems.com/article/news/salt-lake-city-begins-12-lead Really? New technology? It is something the citizens of Salt Lake City should expect from those providing emergency care. But, why has it taken them so long to obtain this equipment. In looking at their website, the Fire Department does not provide patient transport. That is provided by a private company contracted by the city. The article states that they are "working together" to use this new technology. Was the private service performing 12 leads prior to this? I surely hope so. I really enjoyed the quote "time is money". I do hope he meant to say "time is muscle", or the reporter misquoted him. Without all of the facts, it appears that the city is catching up with the modern care and treatment for cardiac patients. Which is more than I can say about the following article which talks about Chicago EMS not having the capability to obtain a 12 lead.

The next article is from last year, but relates closely with the previous. Chicago Behind the times in heart attack response.

http://articles.chicagotribune.com/2009-10-22/news/0910210406_1_chicago-fire-department-ambulances-myocardial

Yes, this article is old. However, I recently heard from a reliable source that they still do not have 12 Lead capabilities. I do not enjoy "be-rating" another agency, but…I found this article surprising, yet I was aware of these facts. It is hard to believe that an EMS agency this size, in this day and time, could be so behind. If I were a Chicago taxpayer, I would be outraged. EMS systems in much smaller areas and operating with a far smaller budget have the technology and are using it. 75 ALS ambulances…and not one have 12 lead capabilities. I would also be concerned as to what other forms of treatment are lacking.

 

The phrase "times is muscle" apparently has never been uttered in Chicago EMS. From the AHA to any current trade magazine or conference, the "Stemi" is still a discussion topic. There is a lot of research and many services and hospitals are "bragging" about their improvements in d2b (door to balloon time). There is little we can do to "save" the patient in these situations. The patient needs definitive care. The patient needs a cath lab.

 

How can Levinson say that patient care has not suffered? If a patient is having an MI, care is compromised. The 12 lead ECG is now considered a standard of care. Levinson states the cost to upgrade is $4 million. Only 1 % of the department's budget. Really… they could not spend this money on the new monitors and education? Are the hospitals in the metro area not willing to help out with the cost? It states the money was there, but then used for other operational needs. I am curious as to what those needs were.

 

In the 2007 and 2009 "State of Science" supplements in JEMS, Chicago was a NO for 12 lead, CPAP, and IO. The 2009 supplement also had Chicago listed as a NO for Therapeutic Hypothermia and Intranasal medication administration. After reading this insert from JEMS, I expected Chicago would move forward with the times and begin to implement current technology and treatments into their system to improve upon patient care. Two years have passed, and still no 12 lead. Is their theory that they will just drive fast to the hospital?

 

This article sheds light on the fact that because you are in a major metropolitan city does not mean you will get modern care and treatment.

 

Dispatch…Medic 33 is available

Every day, in every city and county, a phrase similar to this can be heard on the radio or read on the screen of an MDC.

After years of trying to figure out what to do with my thoughts, ideas, and opinions, I came across blogging. The thought of starting one of my own entered my mind, and then quickly exited. As the months passed, this idea kept picking at my brain. I realized that "The Blog" is like "The Borg" from Star Trek (No, I am not a Trekkie) and "resistance is futile". What I mean is there was no way I could not start one. No way I could not become involved.

This is an opportunity for me to rant like Dennis Miller, to share my thoughts and ideas, and to further my agenda of changing the perception of EMS in America. If one person changes their idea of what a paramedic does, or what EMS is about, then I will have accomplished what I am setting out to do.

I want to thank CKEMTP, The Happy Medic, 999Medic, Ambulance Driver, Geeky Medic and everyone else who gave me advice and support at creating this.

To all of my readers I say…

Welcome back my friends to the show that never ends. We're so glad you could attend. Come inside! Come inside! (Emerson, Lake & Palmer Karn Evil 9 First Impression Lyrics)