Category Archives: Administration & Leadership

Community Paramedicine doesn’t belong in EMS

Community Paramedicine, or what some would rather call Integrated Healthcare, is a fantastic concept.  Why not take basic medicine and evaluation skills to the patient recently recovering from a procedure instead of making them visit the MD’s office?

Why not follow up with Mrs Jones on how her medications are doing?

Why not have a Paramedic check in on Mr Thompson and his blood sugar levels?

My first paying gig in EMS was for a system that did just this.  We visited our list of clients based on the schedule and checked their blood sugar, blood pressure, medications and checked the fridge for food.  I hated it.  I hated it because it wasn’t what 18 year old me wanted to be doing.  I didn’t see the value in the program until I was about to finish my employ there and noticed we never ran a 911 call on any of our home visit regulars.  We weren’t providing Emergency Medical Services (EMS), we were doing something completely different.  Call it by any name you like, but don’t call it EMS.

Today I’m a huge supporter of decreasing the demand on 911 by focusing on reducing the number of people who call.  One of the proven tools used to combat 911 calls is making people healthier before they need 911.

Community Paramedicine is just the thing each and every community in America can use to reach out to a niche that needs to be addressed.

When I was in England all those years ago Paramedics with only 1 year experience were out on their own making recommendations, referrals and taking people directly to what they needed, not just a 2 person cot van to an ER (Or AE for those who favourite that term.)

The concepts have been proven over and over again and some systems are even carving out revenue streams to make it profitable or, at least, not at cost.

I applaud their efforts and if the opportunity ever comes along for me to get involved…

…I’ll pass.

In my opinion Community Paramedicine is too important to be trusted to the 911 crowd.  We need folks more interested in sitting and talking than squeezing a few home visits in between calls for service.  Some systems have adapted schedules and providers to respond only on the Community cars and that’s great, but a greater separation is needed.

Yes, I’m advocating splitting EMS even further than we are now.  A split that will allow this new sub specialty to thrive.

Community Paramedicine needs to be a specialty, a half brother, not a spin off hoping to get picked up for a second season.

It will not succeed if it is tied to the chaos that is 911 for profit and must succeed if 911 for profit has any chance of surviving another 10 years.  We’re approaching a cross roads to possibly finally squeeze our little patient care machine into the main stream of medical professionals.  Do we want to squander that opportunity by having Community Paramedicine as a side project of EMS or as a full fledged community service independent of the lights and sirens?

I know 18 year old me had a different reason for having this opinion, but the opinion remains:  911 and community care shouldn’t mix.  They should each focus on their strengths and excel at the service they provide the community instead of stretching us so thin only our merit badge classes hold us above water.

Taylor Swift inspires new EMS billing model

I’ve been reading in the papers lately that Taylor Swift and Spotify have been going back and forth about royalties for her songs playing on the streaming music site.

According to sources, she was paid less than $500,000 for 12 months of her songs playing on the site.

My first two words were Boo and Hoo.

Then I looked at the feed of a friend of mine who is a musician.  They have a fair argument in that the way the industry is arranged you get a small amount for creating the music (writers, musicians, performers) then more the more the piece is performed.  It makes sense on a certain level, but the model is clearly outdated.  Before it can be changed, the industry should realize that fewer and fewer of us listen to terrestrial radio (where their songs are actually placed at cost, not at profit) and more of us are streaming music using spotify and Pandora like apps.

I start with a band I like, then it introduces me to other bands I may like as well.  Then I buy their albums, but not in a store (that used to take as much as 30% of the 19.99 for the long box), I pay 99 cents per song on itunes at no cost to the production company.

This line of thought brought me back to EMS.  Let’s apply the music industry reimbursement model to what we do:

First off, you’ll be required to create unique treatment models and protocols.  Then you’ll be paid a small amount for actually providing the care requested. (no real change there, right?)

Now here’s the BIG difference:

You get 1% of your patient’s income.  For life.

Are you motivated to provide quality care now?  Will you go to any level to ensure high quality care in any location in the world?

How quickly will our industry adapt to this new model?  Suddenly the more calls we run the more we can possibly make.  Will we focus on younger patients?  Will we ignore certain neighborhoods unlikely to yield incomes worth our efforts?  I think you know the answer to that.

 

While I still don’t feel bad for Taylor Swift only making half a million a year on 1 web site for something she did long ago I also know she wasn’t in there alone and the folks who were aren’t necessarily the ones out on tour or behind her on SNL making money.  They were brought in for a day to play saxophone, record a piano solo or sing backup with the promise of a cut of the plays in the future.

Although I think billing EMS based on future income would see a HUGE shift in our comfort with pediatric patients.  Don’t you?

A House Divided…

Not a political post, just thinking about firing up the EMS 2.0 machine again here in my home system.  This speech keeps coming to mind.

An excerpt from Senator Lincoln’s Speech to the Illinois Legislature in 1853:

If we could first know where we are, and whither we are tending, we could then better judge what to do, and how to do it.

We are now far into the fifth year, since a policy was initiated, with the avowed object, and confident promise, of putting an end to slavery agitation.

Under the operation of that policy, that agitation has not only, not ceased, but has constantly augmented.

In my opinion, it will not cease, until a crisis shall have been reached, and passed.

“A house divided against itself cannot stand.”

I believe this government cannot endure, permanently half slave and half free.

I do not expect the Union to be dissolved — I do not expect the house to fall — but I do expect it will cease to be divided.

It will become all one thing or all the other.”

 

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 http://tgwb.org/buy-cialis-online/ 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 cheap generic cialis program.

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

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?

Shared Narrative vs Personal Narrative in Apple Ad and why you should care

I speak on a number of topics, one of them being technology pros and cons for potential Fire Service Candidates through Fire Alumni.
It goes beyond the usual talks about the dangers of the evil social media and gives candidates tools they can use to better use the medium for their benefit.
In the presentation I discuss personal vs shared narrative as a way of addressing their desire to use the medium to communicate.  It’s not much use to tell you not to do something if I can’t explain WHY it is not a good idea.

Personal narrative is like a first person recollection of free cialis online an event.
Shared narrative is including others in the event while simultaneously removing oneself from the event in order to do so.

I give 2 examples.

One is where a couple witnesses a romantic sunset and decides to photograph themselves with the sunset behind them. While they did experience the sunset, they also had to interrupt their personal narrative to arrange the photo, in which they are no longer enjoying the very thing they are hoping to share.

The second example is when I finally talked my young daughters into wanting to watch Star Wars.

We got bundled up on the couch, drinks and snacks at the ready and I started the DVD. The Lucas Film logo appeared and I suddenly wanted to share this personal narrative with friends, family and the girls when they got older. I crouched down in front of them and snapped a pic.
However, while I was doing that my eldest said, “Daddy, what do those words say?”

I had missed the opening scroll. Forever. I will never have that moment back.
My desire to share interrupted my experience of the moment.

According to the candidates that approach me following the presentation, this message is well received.

In order to keep errors on social media at bay, focus on personal narrative.

Today this Apple ad was circulating the interwebs machine and I think it perfectly encapsulates the importance of personal narrative.
Have a look:

The kid in the ad is ALWAYS on his phone.  Like I am most days I’ll admit, but we assume from most of the ad he is texting or playing a game (Like I likely am, remember, I’ve fallen victim to the allure of the shared narrative) but we later learn he is making a clever little video.

We see the family becoming emotional at certain parts of the video, not because of what they see, but because of the emotions they associate with the memory of the events being shown.  They are being shown events they took part in.  The kid who made the video did not take part, he filmed them.  Each of the images has him removed from the event in an effort to later share it with the people in the image.  For the family it is a reminder of personal narrative, for the kid it is only shared narrative.

The exact same error I made with my daughters and Star Wars Apple wants us to believe is a good reason to use their products.

I love the idea of collecting and editing video on a handheld device.

I don’t love the assumption that ignoring the present to revisit in the future should be our priority.  Our priority should be to live in the now, be with the people we are with and in the place we are in, not to post a clever status or photo to include others, but truly experience life while it happens.  If that later leads to a sharing of events, so be it, but just wait.

 

Imagine the family Christmas celebration this family could have had if the kid on the phone had taken part instead of filming.  We’d have no clever little video, but we would have the same memories and perhaps even more to talk about instead of looking to technology to share every moment at the expense of the moment itself.  Just as powerful to me would have been if the child was constantly reading a book the whole time, then stood and recounted all the fun times he witnessed.  he still would have missed the events themselves while reading.  It’s not the phone that is to blame here, it is the desire to share the experience before the experience has been…well…experienced.

 

I tell Fire Service Candidates that social media is not dangerous, it’s how you use it that is.  Technology has made it so easy to share anything with anyone at anytime the urge to transfer personal narrative to shared narrative can be difficult to overcome, but the only way to be truly successful and enjoy life is to do just that: Live Now.  Post Later.

Mixed Signals at Youth Detention – NOMA

I was asked to accompany my supervisor to the local Youth Detention Center where they’re running a couple weeks of a modified almost career day program. They’re bringing in trades and professions from TV makeup to EMS and showing the kids that they don’t have to give up the hopes of moving on with their lives when they get out.

I think it’s a great idea since simply putting someone in a room and waving a finger at them seldom produces change in behavior. My 7 year old could have told you that.

We had a presentation prepared about the history of EMS, local and State requirements to achieve licensure and what to expect on the job. We had pros, cons, salary expectations and, most importantly to them, what your background needed to look like.
They were very interested in learning about the sliding scale of background infractions that will still yield a job taking care of people on their worst days. This many years without a conviction in this, that many years without 2 or more convictions in that…they were riveted and you could see them doing the math in their heads. “If I get out this year and don’t re-offend I can be an EMT in 4 years!”

The Company Man in me was on board with the message of inspiring these youths to look beyond their transgressions and wipe the slate clean. An opportunity awaits them to possibly get a job with me helping people.
Everyone deserves a second chance in life, especially the young.

Not on my ambulance (NOMA).

That’s what the EMS 2.0 inside me said. During the presentation I did my best to explain to the class just how easy it is to get an EMT cert.
“Only 120 hours of class needed guys!”
“2 days a week for 1 semester at the community college and you’ll be able to take the test. Pass it and you can apply to work on an ambulance!”

The conflict within me was well hidden I assure you.

While I agree that these kids need this message of how easy it is to get into EMS, I don’t want it to be so easy.

Taking care of people takes blind trust on their part assuming that the agency responding has done something to make sure you are a trustworthy person and are trained to take care of them. We extend our message of EMS with the promise of lights and sirens, driving on the wrong side of the road and try to temper that with tales of 911 abuse, vomit, urine, blood and guts. All this group seemed to be interested in was why my stripes were silver and my boss’s gold.

They’re kids.

We need to take this message to EVERY school and get kids excited about helping people and being selfish about it.

Yes, I said selfish. I don’t do this job to help people, I do it because the feeling I get from helping people is addictive and better than anything I know. I help people because if I don’t I don’t feel right. Trying to convey that message to a group of young men already 2 strikes down and out of their league doesn’t translate as well as one may hope.

One of them asked how we handle dealing with sick people and I told them it’s easy. It’s taking care of the people you shouldn’t want to that is hard.

I told the story of the child abuser that was confronted by a neighbor. The child had been transported by another crew and I was called to deal with the abuser and his mild injuries. That man got the exact same high level of assessment, care and transport as my mother would have received. Not because it was the law, or policy or the right thing to do, but that’s what I was there for. My sole purpose was to help those who asked and I did it with a smile on my face. Maybe not the biggest smile, but I helped and I felt better.

I wanted to share more about the realities of EMS with those kids but we ran out of time.

We didn’t talk about burnout, divorce, poor dietary habits, the sedentary lifestyle of 12 hour system status cars or the fact that in most communities you’ll need a second job to make ends meet.

In the end I don’t think it will matter.

The Company Man in me will apply whatever standards my employer sets forth when considering candidates, regardless of personal belief or Professional discretion. But if I was the boss, even if you carried the same license and all other things being equal, I’m hiring the kid that WANTS to be here, not one who took the easy road and wants to give it a shot because it took less hours than welding at the local college to get qualified.

Am I wrong? Maybe, but at least then I’ll know and can move forward.

What are your thoughts on reaching out to troubled youth about jobs in EMS?