The 20 Keys to having a positive, productive exchange in Emergency Services.

1. Agree on your purposes upfront.  if you want to prove another system inferior, they may not be too cool with that.

2.  Observe, note, learn, apply, repeat.  Not everything will work in both places, politics will never allow it.

3.  Know why you’re choosing that place.  It needs to be a balance between person and system.  If neither is 100% it will never work.

4.  Get the third rail conversation out of the way early.  Talk religion, politics, family.  Find your differences and common ground early.  If you see another persons religion or values as an issue you may not honestly see the system they want to show you.

5.  Be honest with yourself and your partner.  If they ask your opinion, give it, but be prepared to back it up.

6.  4 days observation is a fair amount.  8 days away from home yields travel, 4 days on the streets and meetings.

7. Plan to be exhausted.

8.  Plan time between visits of at least 1 week for family time.  Mark and I did 23 days total, too much.

9. Get the support of the local media to showcase your work.  This should draw the attention of the politicians who can enact some of the changes you may want.

10.  Every system has one Chief or Administrator who wants to be involved.  Let them be.  Keep them in the loop, it is handy to have someone upstairs if you need it.

11.  Avoid the unusual or extreme.  Give them an honest average day in your life.

12.  Be respectful if things turn out differently than you thought.  Above all else be honest.

13.  Find alone time during your trip to reflect on why you are there.  Whether it be a meal, evening or part of a day, you’ll need a few hours to reflect on what you’re doing.

14.  Avoid heavy drink.  It can not only impact your next day, but reflect poorly on your partner, you and your service.

15.  Make sure you have permission from your Department to appear in your uniform and make public comments about your system.

16.  Avoid questions that start with “How come you don’t …” like “How come you don’t intubate kids?” The tone could be considered confrontational.  Try making it easier to answer. “What tools do you have to secure a pediatric airway?”

17. Eat the food.

18. Try to understand the culture, phrasing and customs.  Learn the local history.

19.  Remember not everyone has the same set of definitions you do. A rescue here may not be a rescue there.  When there, use their terms, not yours.

20.  Be Happy.  Smile.  Have fun.

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