Category Archives: Administration & Leadership

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?

CA SB556 – The “He looked like them” Law

Special thanks to Mr Herrera for bringing this back to the front burner for me.

Just a quick reminder: The views on this website are mine and mine alone and not endorsed, reviewed or supported by my employer, co-workers, mother or hair dresser.

That being said,

SB 556 s a giant load of Gou shi.

“Oh my Happy…language…”

It is Gou shi.

Somehow the legislature is concerned that Erma Fishbiscuit is going to be confused when the nice men from the fire department arrive to take care of her, but then a completely different group of men arrive to take her into the hospital.  The uniforms may seem similar, but if she puts on her glasses she’ll see the patch on the sleeve does not say Fire Department, nor does the ambulance, nor does the bill she’ll get in a few weeks.

 

Apparently the law makers want to make sure Erma is aware that her local Fire Department has no interest in taking care of her by making sure the Fire Department employees wear a patch that clearly states “Government Employee.”

Oh, wait.

Scratch that.  Reverse it.

This bill would require uniforms that are similar, but only those not a government agency, to read “Not a Government Agency.”

Are we that stupid?

Don’t answer that.

 

This bill had obvious beginnings, that being to make sure the guy AT&T sub contracted my install to can be held liable when he screws up, but it was clearly hijacked by someone, likely a Fire Department Union or 2 unhappy with the ambulance contracts in their area.

Disclosure, I’m a union thug myself.

Requiring private contractors to wear a patch or insignia that states “Not a Government Agency” is just as stupid (and would be shot down in a heartbeat) as asking all municipal fire, police and EMS agencies to wear a large orange hat, designating them Government Agencies.

It’s good to know we solved the homeless problem and all the children can go to college free since we’re passing legislation to make contractors wear patches to tell the public what it already says on the side of their trucks.

 

This kind of crap makes me want to run for office just to slap them with the patch that says “Government Agency” and make them pay for it.

“That’s not fair, Happy” Yeah…I know…get it?

 

If you are for SB 556, I welcome your comments and ask that everyone commenting be respectful to one another, whether they be union thug or for profit people mover.

Response Time or Patient Outcomes – How do you measure your EMS system?

I know it’s been quite around these parts lately but a recent article caught my attention this morning.

High Performance EMS posted “Does Response Time Matter?” and it got me thinking.

The author states an example of a patient being “treated” by fellow citizens at an airport and having to wait 20 minutes for an ambulance to arrive.  The author goes on to describe how we need to arrive quickly to save the public from themselves.  After 30 years of telling them to call 911 for anything and convincing them that “seconds count!” what did we expect?  While I agree that a delayed response to certain patient presentations could result in an adverse outcome, that points out a glaring omission from the story.  Missing from the story is the patient outcome.  The outcome will allow us to marry all the data from the response to determine the answer to the author’s question in the headline.

The short answer is no, response times don’t matter.  And no, I don’t have to pee.  I have data that does not have any correlation between quality of treatment, outcome and response time.  From my perch here at the data hub of a quite busy EMS system we have been trying to determine the quality of our EMS system and we rarely look at response times.

Don’t get me wrong, we look and our Department statistician collects, quantifies, qualifies and reports to regulators the 90th percentile of all code 2 and code 3 calls to meet their requirements.  We report it, they receive it.  The document says nothing about the quality of care or patient outcome.  The reason being that we can not guarantee a positive patient outcome, but can measure when we left and when we arrived.  Imagine if we had to treat 90% of symptomatic asthmatics with oxygen within 5 minutes of arrival and document an improvement in condition.  Can your system guarantee that?  Why aren’t EMS systems measured by the quality of their care instead of the quality of their response?

Apply this metric to any other industry and it fails.  Industry is measured by their quality and efficiency, not the speed in which they complete their tasks.  So long as we only look at one metric with any regularity we will continue to shuffle ambulances 2 blocks at 5 minute intervals to meet an average instead of realizing just leaving them still would bring the same outcome.

That’s where I come in.  My Medical Director and I, unhappy with the lack of actual patient care quality metrics, created our own in an effort to determine the quality of care being provided.  We learned very quickly that our ambulances do not respond in a vacuum.  Each patient receives a call taker, dispatcher, first response, ambulance response, assessment, treatment and some get transported.  Once at hospital they receive a whole new level of care and review until they are finally sent home.  It is hard to argue that the time it took to get an ambulance from point A to B has an impact on this outcome without any review of the call taker’s coding of the call, the dispatcher’s assignment of the ambulance all the way to the destination hospital capabilities and location.

We can all sit at the Pratt Street Ale House in Baltimore and discuss short times that had a bad outcome and long times that had a good outcome, but the worst part of all of this discussion is that so few systems measure anything more than response time.

If you consider response time your metric of success you have already failed.  You have failed the patient who improves when you arrive “late” and discounting that response as a failure, yet trading high 5s when a 2 minute response yields a call to the Medical Examiner’s Office.

We all know the stories of companies staffing ghost cars near the end of the month to bring down the monthly response metric to meet guidelines.  It happens.  But I also wonder if that flood of ambulances to help more people had any other impact.

The complication in tracking outcomes is the relationship your agency has with local hospitals.  We may never have a seamless transfer of data but what we can do is pull data from the PCR to determine if the patient received the indicated treatments for the recorded chief complaint and observed complications.  By reviewing your policies and protocols as well as your patient demographics you can quickly spot your core performance indicators and design tools to track them.

It may be nice to know that we make our 90th percentile in 8 of 10 districts on a regular basis, but what if those 2 districts happen to have the highest number of cardiac arrest survivals to discharge?  Are they still a failure?

Widen your view to include more than how quick you can put the ambulance in park.  This goes far beyond the lights and sirens System Status Management debate and speaks to the core of the reason we’re out there to begin with:

To make someone’s bad day better

Delays can hurt, but not unless you look deeper into your system to find out if that is the case…or not.

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