Everything you need to know about EMS management…

you’ll learn in a bar.

Or at least while at a bar.

It sounds cliche, but let me explain.

Hrs HM and I had a chance to escape for a lunch date today and headed for our favorite local watering hole that hosts Buzztime Trivia.  Over some buffalo style wild wings many a taunt is heard about who will win and our bartender is welcoming, as usual, offering this special and that while fetching the Mrs a water and me a tall IPA that looks new.

As we exchanged heated discussions about how I was right, just not how the game people thought, the bartender and the manager got into a discussion about the beer coolers.

This discussion has been had between bartender and manager, Paramedic and manager since the dawn of their respective professions.  Yes, bartenders are still considered a profession over paramedics, more on that soon.

They were discussing the location of the beers on display in the 2 large coolers flanking the bar.  Being a beer snob, I never drink bottled beer when the same on draft is available.  Drinking a bottle when the same beer is on draft is like choosing to skype with your girlfriend instead of have a face to face conversation.

It suddenly occurs to me some of you will miss that…let’s move on…

The discussion was about how the beers should be displayed, the order and location compared to the other cooler.  One said they should be mirrored, the other claiming they are to be the same.

My OCD kicked in and despite the Mrs’ frequent requests to stop, I was searching for a pattern to the location of the beers.  Alphabetical by name? No. Light to dark? No. Sorted by type? No. Size of bottle? No.  There was no discernible reason for the beers being in the order they were until I happened to mention a random joke: ” I bet it’s corporate’s idea!”

Yup.

Someone in the home office was deciding what goes where and why.

Sound familiar?

I had the exact same conversation with an EMT from the medic unit just 24 hours prior and asked her to look at 3 spare bags we had, speak to her co-workers and their partners and figure out what works best when providing patient care, then get back to me.

Problem solved.  The EMTs get what they need and the medics get what they need and, as a nifty side effect, the patients get what they need.

Back at the place of wild wings the bartender joked about how the night shift will just change the coolers back to what they were before, all the while the manager was referencing an inventory sheet that clearly stated where the beers should be in each cooler.  The day manager conflicting with night. Perhaps there’s a contract with beer X that says they have to be front and center?  I’d buy that but why not hand that decision over to the folks who have to pull the product day in and day out instead of mandating it from on high without reason other than “That’s how it’s always been?

 

And yes, achieving status as a fully fledged bartender takes up to 10 months…about the time as the average Paramedic program.

Happy Feet – the Blauer 6″ Clash Boot Review

Blauer has been making boots longer than I’ve been wearing them and the Clash Waterproof line shows they’re still improving on the concept.

In my career I’ve worn all manner of boot from slip ons (yuck) to steel toed zip ups (Big City fireman boots!) to whatever was cheap at the uniform store.

I’ve reviewed Magnum Boots in the past and enjoyed their fit and specs and the Blauer Clash did not disappoint.

Often I give the boots I review a thorough testing period through random Engine Company duties such as footing ladders in drills, PT, footing gurneys etc but my new gig doesn’t have much of that but it does have one thing most jobs don’t:

Walking.

I do a lot of walking where I am and having a comfortable boot to do it in is essential.  The Clash 6″ is far more flexible out of the box than I expected and it fit my foot well in my regular duty socks.  No extra thick hiking socks needed here to fill gaps.  There is no safety toe which may exclude it from some EMS and Fire duty, but as a supervisor I can get by without it, especially since I have the option at work of wearing a dress shoe instead of my boots.

The Clash has a number of features that set it aside and the first one that caught my attention before putting it on was the goofy looking disc on the front.  I say goofy looking because, well, this boot has no laces, zipper, or other discernible method of applying pressure to snug the boot.  They reminded me of Marty McFly Jr’s shoes from October 2015…wait a minute…that’s next year!

That disc is part of the new BOA system, a steel cable that is tightened by spinning the disc and loosened by pulling the disc forward.  I’ll admit I was skeptical at first but the disc does what they say and I am able to quickly don the boots and tighten as well as release and don turn out boots (in case I need a safety toe…see?)

The BOA system does take some getting used to but as soon as you learn your comfort level, the boots begin to give support to the ankle and above right away.

However, once the boots are on and you begin to walk, and remember I do a lot of walking now, the real clever feature of this boot is revealed.  In the rear of the 6″ Clash boot is a notch about an inch deep, padded, that allows an almost full range of motion with your ankle when walking.  Where my usual boots catch and have to bend, this boot remains supportive laterally and my achilles tendon never feels stressed.

The toe takes polish like a champ but did scuff easily before I got a coat of polish on.

Another feature of the Blauer 6″ Clash Boot I didn’t expect is the almost velcro grip on the sole of the boot.  Your pal Happy is a lover, not a fighter, and I am known to wipe my feet, dirty or not, on door mats.  When I did so in my Blaur 6″ Clash boots they did not move.  The honeycomb pattern somehow grabs the flooring and won’t let me wipe my feet naturally.  Perhaps my old boots are old and worn, but this was a pleasant surprise.

 

In conclusion, the Blaur 6″ Clash Waterproof boot is a safe investment for anyone who needs a reliable boot to do a fair amount of walking.  If your agency requires a steel or safety toe sadly this won’t fit the bill, but those in law enforcement, security and some EMS agencies should certainly find them at your local shop and give them a try.  If you are doing special events or are on your feet most of the day this is the boot you’ve been looking for.

I recommend the Blauer 6″ Clash and give it a 446 out of 654 based on math I won’t bore you with (but the spreadsheet looks amazing!)

 

On a sidenote to boot manufacturers:  Stop putting your logo on the inside of the boot.  It never lasts more than a day and I’ve had that with every boot I’ve ever tried.  It makes me feel dirty when I wear them for 9 hours, then see your logo mostly gone.  That is all.

Still Here. Still Sharing.

30 days away from you guys was tough, but I did OK.  I know there’s a hole in your heart from missing my rambling therapy experiment, but fear not fair reader, I’m back.

For reasons I can’t discuss I left the content of this site unchanged for 30 days, at my own request.

Now I can get back to venting, wishing, dreaming and sharing.

Speaking of sharing, those of you who subscribe to Fire Engineering Magazine should keep an eye out for your August 2014 issue which should contain an article about the way to enforce rules and regulations when it comes to sharing media.

“What the frack is sharing media?” you ask?

Sharing Media refers to the ever growing methods and, more importantly reasons, for sharing traditional (photo, paper, magazine, TV) and electronic (facebook, tweet, instagram, video) media.  Social media seems to focus on the facebook and the twitter and the instagram, which all require a set audience or group of friends.  I use Sharing Media to refer to any and all instances where an idea, sentence, paper, image, concept or anything else is shared with another in any format.  This covers internet sites, phone apps, newspaper and magazine articles, even the cork board at the local coffee shop.  The reason for this new definition is not only to expand the definition of media out of the pixels you see here but remind folks that it is the reason to share, not the method, that we should focus on.

In other words, focus on WHY, not HOW.

Most Fire Departments have rules covering the HOW that already cover the non pixelated methods of being foolish.  Simply expand that already existing net and, -boom-

 

You don’t need a social media policy.  You already have a Sharing Media Policy.  Use it.

More on that topic, why WHY is so important and what you as a line firefighter, emt, manager, company or chief officer can do TODAY to get out of the digital swamp of social media restriction in the upcoming (I’ve been told) issue.

As always I welcome you feedback on that and any other ramblings you find on these pixels, in other articles, forums or sites, in the interwebs or magazines.  I stand behind all my shared media and always consider the WHY before I share.  There’s a lot I want to share but have chosen not to.

Thanks for coming back and keep coming back as lots of product reviews are in the works including the flashlight I wish they sent me 2 of and a pair of boots without laces.  No, they’re not the Nikes from Back to the Future.

Above all be safe!

-HM

18 year old woman dead after chasing cop with knife. Family wanted ambulance instead.

Yes, you read that correctly. What you will also read correctly is this cobbled together “news” story written to inflame your hatred of the po-po:

Worried family calls 911 hoping for ambulance, cops show up instead and KILL HER

Great work on the headline there Eric Owens, Education Editor. I guess there’s no need to think this call through as far as my 3rd grade daughter could, but let’s give it a try shall we?

1.  The family should have intervened long ago.  Years ago.  Waiting until someone with known mental health issues starts grabbing the cutlery is not the time to reach out for help.

2.  Ambulances can not make people take psych medications.  Again, see #1 “Family.”  So far we’ve identified people far more responsible for the death of this girl than the police, but let’s keep going.

3.  They called 911 “hoping” for an ambulance.  No one calls 911 and requests resources, that’s not how it works.  People call and state what is happening, the dispatcher assigns the appropriate resource for the situation described.  Speaking of which…

4.  Paramedics can not safely deal with persons who have stated their desire to harm others or who may have weapons.  Paramedics are trained to assess and treat medical and traumatic conditions.  The reason the dispatcher sent a Police officer is because what happened happens far more often than people realize: People who want to hurt others pick up stuff that hurts others.

5.  Even the 12 year old kid saw the knife.  Let’s put you in the Officer’s shows for a moment.  A woman chases you with a knife.  A woman with known psychological issues.  A woman who is not taking her medications.  Now what do you do?  There can be all sorts of outcry about tazers and tackles and other such nonsense but when it comes down to it the Officer did what they had to do to remove the threat.

6.  To all of you about to comment that I don’t know what I’m talking about, I wasn’t there, I don’t have the full story, go over to Eric’s story and comment there first.

 

Eric, here are some headlines I think better fit the story:

“Woman killed by police after chasing them with knife off psych meds”

“Officers forced to kill knife wielding woman after family fails to assure she is healthy”

“Family unable to help 18 year old prior to her chasing police with a knife and being shot”

“Ambulances do not help people take medicine”

“Education Editor writes inflammatory headline oblivious to how 911 works”

 

Motorcop has a post up that should shut up all the “Why didn’t they just taze her” folks.  Go have a read and see this situation through an Officer’s eyes.

A human being is dead because someone waited too long to help her.  Blame the family, the system, the Doctors, Obama, Bush, God, heck blame me, pick your enemy, but don’t turn this into a situation where the evil police are to blame. They were just there at her worst hour and did what they are trained to do when people attack them with knives.

 

 

Off Duty EMT and been drinking? Guess what?

You’re not an EMT.

This may seem like it’s coming from left field, and it kind of is.  One of the perks of having a website is that I get to see all the terms people type into search engines to find the site.  Until the Hangover movie I was the #1 google result for “strippers and cocaine.”  True Story.

However a google search today troubled me a touch.  Especially since they hit me 6 times with it:

“if im an off duty emt and ive been drinking” (sp)

Well, Tiger, I think you might be a few into your day already so if you were the one doing this search put the drink down and let’s have a chat.

Your search cut off a bit early didn’t it?  Was there something else there like “should I help people?” or “will I get fired?” or “do I have to use apostrophes?”

Here’s the short answer to all your possible questions:

No.  Except the apostrophes part.

As soon as you take a drink, smoke, snort, shoot, heck even if you pop an ambien or a flexoril you’re not an EMT, you’re just you.  While I have been known to break that rule, it was because one of my close friends had been badly cut in a fight.  I didn’t go running into a situation inebriated simply because I just got signed off on splinting.

Take off the star off duty and have a responsible time doing what it is you do, but remember that anything you do while using that title or wearing that star reflects not only on you but the tens of thousands of us who know the difference between Professionalism and irresponsibility.

“if im an off duty emt and ive been drinking” yields far more relevant discussions on this topic and I hope you read them.

A Comment on Typical Idiot EMS Managers by Burned Out Medic.

Burned Out Medic had a post up recently I thought I commented on, but apparently you have to hit ‘submit.’  Who knew?

The post is in reference to a Call the Cops story about an ambulance crew being reprimanded for going 90 MPH even though the vehicles govern out at 70.

Have a read and come back for my comments.

Well let me start by saying I agree 100% and that I’m going to have to disagree 100%.  Typical EMS Manager, right?

 

The trouble with the situation mentioned in the Call the Cops story is that there are no facts.  There does not appear to be any investigation policy or framework, nor is there any documentation confirming the speed of the vehicle, the exact location, time of day, etc.

Most field crews believe EMS Managers are sitting in the office hoping beyond hope that someone calls in a complaint so we can puff up our chests and assert the hair’s width of authority we have.

Let me confirm that that is not the case at all.  In between phone calls from hospitals, regulators, our own managers, chart reading, report filing and other mundane tasks involved with making sure you can still practice, citizen complaints are taken very seriously.

I used to get weekly calls from a fellow who swore up one side and down the other that a crew raped him*.  Same crew, every week. Seriously.  For over a year we were on casual conversation terms each time he called.  Heck one week he didn’t call and I was actually worried.  But the first time he called it was taken very, very seriously.

The conversation was recorded, run data was pulled, AVL signals gathered and only after confirming details from the caller was I able to conclude his complaint to be without merit.

The crew accused wasn’t even working that night but had transported this individual a number of times.  That same crew had recently been accused of other things by other members of the public and medical system.  Each time he called I’d pull the AVL map as we spoke to confirm the crew in question was in the clear.

You see my friends, complaints do not happen in a vacuum.  They are most often the result of someone getting a bill for service or just plain not liking EMS in general.

The example given by Call the Cops that Burned-Out references is hilarious because it can be easily disputed:

  • Obtain complaint in writing or verbally recorded.
  • Pull the unit history for the ambulance in question.
  • Pull AVL data for location.
  • Access maintenance data to ensure governing device installed and properly working.
  • Access previous violations for pattern behavior.

That’ll take maybe an hour.  The thing most field crews don’t realize is that good people can still do bad things.  If you’re a 5 star crew and get a complaint I handle it the same as a complaint about the crew that was in my office yesterday for what ever other frivolous thing the rumor mill says they were in for.

The tough call comes when the AVL data shows the unit traveling on the roadway in question, at the time in question, at the speed limit, but 3 hours earlier data show the vehicle traveling above the speed of the governor.

Now what do you do?  The crew has been proven to not be guilty of the accused offense, yet we now have data that show their defense is faulty.

It’s easy to sit in the rig and gossip about how the managers are out to get you after what happened to so-and-so but just remember it’s a lot of work to get you in trouble, and you know how we pencil pushing EMS Managers hate work.

If your managers are so bad at what they do, promote.  Nothing in EMS is easy, even sitting in a little room with a tie on reading charts and going to meetings.  The ultimate answer to bad leadership is to become a leader yourself.  Show me you can do it better than they can and your service will be the better for it and, as a result, your patients will have a better experience, which is all that matters in the end.

 

EDIT – *Forgot to mention, not the real reason he called, but just as unusual and hard to believe.

Deposition time and a friendly face appears

As a middle manager I get pushed forward as the “expert” at certain ways my agency handles things.  For example, since I am the only one that reads through all the charts I am the default “expert” on how to read through charts.  You get the idea.

This is important when a court case comes along that a chart was written for.  This happens often since many assaults, vehicle collisions and the like end up going to the lawyers.  I won’t say going to court since it appears the system is rigged to favor them handling this all before we get to a judge.

I’ve been brought in to explain how ePCRs are created, stored and retrieved more times than I care to recall since each and every time the questions are exactly the same as are my answers.  I get a City Attorney to sit next to me and make sure I only answer the questions I’m supposed to and they often greet me in the hallway with a “The usual today” as if ordering an egg salad on whole wheat.

Every time it was exactly the same, until I suddenly sat down across the table from a familiar face.

This lawyer did his homework.

As I sat down, poured my water and readied my notebook I saw a 3 inch tall pile of clearly well handled papers, some stapled, some not, but in just enough disarray to show they had been reviewed, not simply all printed at once.  Right on top I saw a familiar face: Happy.

This lawyer had printed out at least 100 of my blog posts, news stories about the Chronicles of EMS, had photo copies of articles I wrote for magazines, photos of vendor events at conferences…you name it, it was there.

I suddenly felt a wave of panic flow over me and my wool dress coat was heavy.  He had achieved his initial purpose of setting me off my game and I did my best to recover as he launched into personal questions about my experience as a Paramedic and blogger.  The City Attorney was surprised to see all this material and at that point I wish I had mentioned the blog in our preparation.

Luckily, when we got to the vendor photos I was able to mention they are the same vendor as the medical charting system we use and my familiarity with the product is a result of those interactions.  The City Attorney made a very complex legal statement that I believe translates to, “Move along.”

The rest of the interview went as always, I describe the manner in which crews enter data, that the final report can not be edited, that anyone viewing the chart afterwards is in the log, blah, blah, blah.  The clinical interviews are far more interesting but are very far between.

After the interview the City Attorney pulled me aside and mentioned that I should have told him about the blog and I apologized.  He laughed it off and said, “At least this time you had something new to say!”

Fresh perspective

Can you really ever see something from a fresh perspective?

If you are in the middle of a storm, how can you step back and see anything BUT a storm?  Much like looking 20mg cialis online at a cloud, as soon as it looks like one thing, you’ll constantly see it as that until it’s gone from site or morphed into something new.

 

Listen to an old song and sing the wrong words?  Even though you know for a fact there’s a bad moon on the rise, not a bathroom on the right?  How can we clear out the mental cobwebs that keep us seeing what we see and hearing what we hear?

Do we seek out new clouds and new music or are we simply exchanging one set of perspectives for another?  How can one truly CHANGE perspective?

It begins with challenging your comfort zone, your home base.

Why do you feel the way you do?

What motivates you to feel that way?

What influences are in place to maintain those feelings?

Do the people around you support your perspective or do they challenge it?

Do your activities allow you to challenge your perspective or do you find comfort in the status quo?

All these questions are important when evaluating change of any kind but are essential when evaluating change that impacts more than simply your own little world.  Imagine that seeing that cloud as a dinosaur instead of a tea pot meant lost jobs, revenue, market share or something else important to your agency?  What if the old lyrics meant a low paying, poor working conditions job but the proper lyrics meant a better opportunity for you and your family?

Would you still stick with the dinosaur or would you ask others what they see and possibly be tainted by their perspectives?

Would you sing the old lyrics and shuffle along or will you challenge your perspective, your ideas, your beliefs?

Changing course on major decisions isn’t easy and should not be undertaken without serious consideration of the impacts of your perspective.

After all, what if you’re wrong but won’t challenge your pre-conceptions enough to find out before it’s too late?

Paramedics Make the Worst Patients

We’re experts at assessment, treatment and disposition of life threatening emergencies.  We’re also good at that stuff for all the other reasons people call 911, but when it comes to more complex medical issues we are lousy at assessment and can muddy the waters for the rest of the medical community.

But don’t worry fellow medics, there is a solution I have discovered after almost 2 decades of falling into this trap:

Play dumb.

Luckily it’s a skill I know for sure you possess.  Use simple lay person terms when speaking to the doctor.  “Adverse Lung Sounds” becomes “Funny breathing noises” for example.  Leave your education at the door and use the simplest terms to describe your condition.  Over simplify it if you have to.  At a recent visit I told my MD that I thought I heard a kind of clicking or bubbling in my throat at night and it always happened if I didn’t use both pillows and even then I could still hear it.  Had I tried to describe to him that I was sure I was experiencing pneumonia symptoms all he would have heard was “Hi, Antibiotics please.”

Instead he explained the difference between a bacteria and a virus and I let him.  I pointed out that I only had 2 of the 5 signs of a viral infection and 4 of the 5 for bacterial bronchitis or pneumonia.  I then mentioned my daughter was recently given (Not prescribed) medicine for her pneumonia and she got better almost overnight.

He pondered my statement and I looked at him and said “Doc, drugs or no I just need to be able to sleep so I can get back to work.”

Prescription in hand and meds on board I can tell you that right now (18 hrs post loading dose) I awoke after almost 4 hours uninterrupted sleep after having done about the same time at least once more in the night.  HUGE improvement.

Had I gone in as a medic and explained my self assessment I keep him from doing his full assessment and he may not reach the same conclusions we do.  Had my kid not been sick with the same thing last week I’d be in the weeds.

After all, isn’t your least favorite patient the one that calls you and then proceeds to tell you their assessment findings?

Play dumb!

 

Celebrating the Voices

I hear voices.

At least I used to hear voices, before I took this desk job at Headquarters, but before that, in the field, I heard voices.

The voices woke me from my sleep and interrupted meals more often than not and always seemed to know someone was ill or injured.  Most of the time anyway.

For all my griping about MPDS, dispatchers and call takers, they still show up everyday to do a job I would fake a seizure to not have to do.

They take the confused, rambling mumblings of someone, code it, send it and away I go to deal with the problem.  So what if it’s not always what they say it is, all they’re doing is telling us what someone told them.

And many times, after listening to some of these calls for QA purposes, “told” isn’t exactly the right word.

A man is shouting to please hurry! please hurry! but won’t say why or what is wrong.  He simply says please hurry.

The woman holding the lifeless baby can’t get a word through her screaming but the voice still tries to talk her through CPR.

The whispers of the young boy hiding in the closet while someone assaults his older brother in another room are barely discernible because the call taker next to them is dealing with the screaming mother from before.

The voices belong to a group of folks who aim to bring a few moments of sanity to an insane world, and all over the phone and the radio.

Call them dispatchers, broadcasters, call takers, whatever, they still always answer the phone and will always answer the radio when you need them to.

So call up your local dispatch center and see if they have an event planned.  If not, step up and put something together.

A therapy blog with an EMS problem