I got a strange voice mail from the Secretary of the Chief of Department asking if I could talk to a reporter about our advancements in cardiac arrest survival.

Um…yes please?

Laura Landro from the Wall Street Journal asked the kind of questions I wish more reporters asked.  Not just asking for our survival rate, but the more important question:

“Why is your number improving?”

We discussed continuous chest compressions, training the entire department to AHA standards and ensuring our BLS fleet can anticipate ALS interventions.  We discussed esophogeal airways, CPAP, see through CPR (from ZOLL), end tidal capnography, so many different tools that come together to make a 9% into a 23%.  And that was all before I got my job at HQ.  It’s nice to highlight the work of those who came before including Jeff Myers, Seb Wong, Brett Powell, Pete Howes.

Hopefully this is just the beginning of a conversation with the public about how EMS impacts their daily lives, not just when they, for lack of a better term, drop dead.

The Ultimate Lifesaver

TOTW has a great article responding to a reported breakthrough in ambulance design by our friends on the other side of the pond. Clicky for ready.

As I was reading that article, and the original he linked to I was taken back to my days in Newcastle upon Tyne with (then) UK Paramedic Mark Glencorse.  I didn’t like the ambulance layout at all, but the full access around the patient and forward facing seat in the back were great.  But it works for the patients they treat, which is one of the hallmarks of EMS 2.0.  That each community has unique challenges and needs unique solutions.  We treat heart attacks the same all over this nation, unless you take into account the training, equipment, vehicles, staffing, location, hospital capabilities, transport times…you get the idea.  With this in mind each community will look slightly different, much like they do now, only we hope to strengthen what is working and eliminate what is not.

Finishing TOTW’s review of the “advances” the littlest of the HM JRs, Miss Eliza, was playing in the room with the ambulance bin.  We call it that because these girls have a lot of ambulance toys.  Go figure.

I peeked over my shoulder to see her little ambulance company lined up for her inspection.

Asking why she did that, her reasoning was to make sure everyone knew what to do today.  But then I began to look at some of the “non-ambulance” toys that had made the lineup.

Then she blew my mind.  Her description of why each vehicle was in the lineup sounded like a research project from my college days.

I give you Miss Eliza’s Ambulance Company LLC.

Miss Eliza staffs 8 distinct apparatus in her fleet

1.  Emergency Ambulance – “I like the noises”  A standard 2 person reclined van ambulance.  This rig likely carries most of her clients, is painted in distinctive colors for safety and has an impressive warning lights and sirens package.
2. Heavy Rescue (for tiny things) – “It does lots of sounds. It has Happy on it.”  Indeed this truck does have the markings “Happy Medic” and a license plate of “Free Ride” (all thanks to the Angry Captain).  But with decreasing budgets at the municipal level, Miss Eliza may be unable to call another agency for extrication or rescue.  It also allows her to train her people with her own equipment instead of having to rely on other agencies.  She’s thinking ahead.
3. Light Duty Transport – “The back opens for the bed in the back.”  This unit is short and narrow, clearly for use at special events.  It fits one provider, who can then drive while the patient reclines in the back.  A great use for tough to access patients.
4.  Advanced Care Clinic -  “I like it colorful” She likes the colors on this rig and the irregular shapes, but I like what’s inside.  Cabinets, sinks, an x-ray machine, hospital type lighting, it really is a clinic on wheels.  Even better, the entire side folds down to reveal a treatment area.  Park this rig at a special event and all those treatment dollars the hospital is getting are now to Miss Eliza.  Added benefit, no need to staff multiple ambulances at the event.  Just call one if you need it.
5.  Rapid Response Car – “Because the car can go fast.”  Jimmy Johnson will be surprised to know he’s been flexed into active EMS duties, but Miss Eliza sees the benefits of getting ALS eyes on scene first to guide the remainder of the system depending on the patient’s presentation.  Perhaps there is a better vehicle available, but she opted for #48, so who am I to judge.
6.  Ladder Truck – “I like the fire truck and the ladder” I see where she’s going on this one, but really, the ladders should be fitted to your heavy rescue squad.  I don’t think we’ll need that 100′ stick nearly as much as she thinks.
7.  Tactical Response Vehicle – “It does new tricks. Goes fast and has guns.”  The SWAT has a giant armored vehicle, we need something too.  Maybe the Green Hornet car is a little much, but pull up in this baby on the scene of a violent assault and the crowd will not only part, but disperse…and fast.  Added bonus?  Competing companies won’t want to meet you at the intersection trying to grab the same call!
8.  Ambulance (Non-Emergency) – “I like that its white.”  At first I thought she was just looking at the colors of the toys, but then I realized…that’s exactly what she’s doing.  The white rigs are passenger vans for non-emergent patients and clinic appointments.  If the little blue van can get me to the airport with 2 hours notice, surely we can apply the same design to scheduled transports to appointments.  Put a modified ramp on the back for wheelchairs and I think she’ll corner the market.

So there you have it.  She didn’t design the inside of an ambulance, that will take a complete redesign from the patient out, not the walls in, but she does bring up some interesting concepts in response models that I think should be considered moving forward, especially if municipalities keep cutting back.

I’ve been posting some of Sean Eddy’s paramedic memes recently, having a few laughs when I posted one about a TV Paramedic only being in EMS until he gets into medical school.  I thought is was pretty self explanatory.

This morning I see 23 comments.  How can there be 23 comments about a silly picture?

Here is the first one:

“sad…yet why true? we do more thanmost nurses in poor conditions, more than many allied health care providers, yet who wants education and a true unified body to be compensated at a higher wage?? sad when mileage is reimbursed at higher rate tan our evals and treatments, oh yeah, that we diagnose.”

I liked the comment and went on.  After all medics do do more in worse conditions than nurses.  Fact.  Mileage seems more important than our treatments. Fact.  I agree.  This seems to be a running argument between the bed pan washers and the knuckle dragging ambulance drivers: “Who is better?”

Then there was this comment:

“Nurses think they are better than medics. I hear it all the time when im working in the ED, but I enjoy what I do. We are more hands on then they will ever be.”

And from there it just goes downhill. My comments are a general response to the debate, not a direct response to those who posted on the page.

The medics found an unconscious person in a hallway. They assessed, treated, extricated and transported to local ER. At local ER the nurses turn up their noses at the medics’ “diagnosis’ of DKA and remind the ambulance drivers that they haven’t completed a lick of medical school or nursing school.  Time is wasted gathering information instead of continuing care, care started by the medics in the field without direct medical oversight.

Am I right so far?

Nurse monitoring 11 patients due to short staffing has orders for 3 of them requiring him to re-assess, draw, administer and reassess the meds making sure they do not go against possible future interventions on another floor or in another ward.  Making sure room 6 doesn’t sneak in a sandwich before surgery, room 8 needs a wound irrigated and the woman in the hallway is asking for details on her newly prescribed medication.  Dr Johnson’s hand writing is still illegible and his 3cc should actually be 3mg, confirm and administer.  Ambulance patient arrives and will need his full attention.  But first he needs to make sure the rest of his patients are cared for.

Am I right so far?

People, please.  I hate nurses as much as they hate me.  Meaning likely not at all.

Paramedics get upset for not being recognized as a profession while they’re out there breaking hearts and saving lives.  Nursing has curious roots and took a long time to reach where they are in the medical hierarchy.  We in EMS have just as curious a birth (less prostitutes but more dead people) and are well on the way to being a recognized profession within EMS.  You want it tomorrow?  I hate to break it to you, but most of the EMS professionals reading this are not educated, trained or qualified to reach the Profession status in the eyes of the medical community.

Raise the education guidelines, licensing requirements, hiring standards and maybe, just maybe we’ll be on our way.

Many medics are upset at nurses because they get the salary, benefits and opportunities for advancement that EMS lacks.  OK, hate the fact you didn’t go to nursing school, not that they did.  The pay sucked in EMS when you got in.  The opportunity for advancement in EMS was nonexistent when you got in.  It isn’t the nurse that did that, it’s us.

If the nurses don’t give you the respect you demand, try earning it.  You’d expect nothing less from them, right?

Those words used to make me run.  That is the pre-empt our dispatch gives us when one of their call taker colleagues shouts across the dispatch center “Box going out!”

It means there’s a fire.

In my new staff role I haven’t answered a 911 call, EMS or fire in months.  I’ll be honest, it’s weird.

But today I was in the Chief’s Secretary’s office getting ready for a hospital meeting and heard those words I used to dream of, “Units on the air stand by for the box…”

And I almost didn’t notice.

The light duty firefighters nearby huddled around the radio as the first in engine reported heavy fire from the third floor.  I was more focused on the dozen cases being presented at my meeting and how I would defend the actions of my Paramedics if questioned.

I think I’ve made a turn.

We can all agree my life has been more patient focused than fire, but I never realized how little I would miss the engine.  It kind of makes me wonder if I just accepted the engine work because it meant more patients.  Engine work is pretty straight forward when you boil it down, especially for a layout guy like I was.  Not easy, just straight forward.

“Standby for the box” was what I heard the morning a ceiling fell on me.  “Stand by for the box” is what Vince and Tony heard on the way to the fire that claimed their lives.  And at this moment, when all my brothers and sisters were hearing those same words and stepping up to answer the call, my mind was elsewhere.

It was a powerful moment for me, difficult to describe, even reading this short explanation leaves so much emotion out I wonder if posting this is even worth it.

The drive to the meeting took me near the fire, but not close enough to get caught up in the chaos.  On the way I thought about what I should write about on the blog and nothing came to mind.  All I wanted to do was get to that meeting and remind the doctors and nurses that the reason they can have a meeting about patients who are still alive is because my guys and gals did their jobs.

I can still throw a 24′ aluminum and take a pole on the 50′, advance a 1 3/4″ up a stairwell or re-position the aerial, but my main focus, my passion and my drive is that little room on the third floor where I get to stand up for good patient care.

Call me crazy, but I’m happy.  Stressed, confused, scattered and unsure, but happy.

Standby for the box…You guys get this one.  Let me know if anyone’s hurt.

My EMS career has been just over 12 years.

It has been a fantastic time and has changed me in ways that I would never have thought possible.

And it all ends in a little over 9 hours time.

Justin has kindly offered to let me have some space on his blog so that I can say my farewell to EMS and share why I feel so privileged to have spent time in this most amazing of careers.

It seems a fitting place to say my goodbyes. Justin and Ted Setla have been a constant part of my life for the past few years and the opportunity that presents itself to me, that allows me to take my future in a different direction can be traced back to Justins and my ‘Project’ which later became the Chronicles of EMS after Ted found us and brought his vision to the screen.

One person who was watching along was Mathias Duschl, a paramedic from Switzerland who also shared our vision of trying to make EMS better for all of those that we care for. Just over a year ago, Matt and I met in Newcastle, where he showed me this rather cool medical device called the RhinoChill. I was hooked, and our relationship developed until he invited me to become part of the Benechill family. That has led to now, and my new career in research across Europe.

Im not quite done for with EMS yet though, I have this last shift left.

One shift left to enjoy the feeling of being an operational paramedic…
One shift left to maybe make a difference….
One shift left to try not to show my frustration with some of the people who will be calling 999…..
One shift left to avoid the one job on my ‘tick list’ that I still haven’t had to deal with and one that I don’t ever want to see.

But most importantly, one shift left to work with my wife!

We haven’t worked together for about 6 years. It didn’t seem to work once we were well into our relationship and on the way to getting married. I am her boss at work….She is my boss 24hrs a day! I think you can see the conflict.

Tonight will be different, because this is the last chance we will get to work together for a very long time, maybe forever. Tonight is going to be great.

I think that my leaving the ambulance service is harder for her than me at the moment. EMS has been ‘our thing’. We met over a decapitated head (only a medic would find that amusing!), and most of our conversations revolve around the job and the patients that we meet.

She needn’t worry though, she is now my insight into paramedicine on the front line. I will live through her and the stories that she tells me when she gets home.
Whatever control, or the world wants to throw at us, we will enjoy working together and seeing out my last shift at North East Ambulance Service.

But, what about me?

Sandra (my wife) keeps asking me if I am upset to be leaving and I keep saying, no not really. I am excited about the prospects ahead and the work that I can do and contribute to, that may well go on to save thousands of lives around the world. But then I am here, sitting alone in my response car and I realize that I am upset to be leaving. This is who I am.

That’s a simple sentence to write. Five words.

This is who I am.

I am a paramedic.

I am incredibly proud of that title. It is who I am.

The situations that I have experienced, the patients I have cared for, the good times and the bad.

The memories that I have, both happy and sad.
The pieces of my soul that have taken on indelible imprints of people I will never ever forget and who still touch my heart to this day…..

I see them all now, I hear the cries and screams; the blood and the devastation.

The lifeless baby and the hanging body. The man whose hand I held while he looked me in the eye to tell me that he was going to die, and he didn’t want to, he wasn’t ready yet. The grief and the despair.

Its all there….and it wont go.

But…

There is also the joy, satisfaction and happy times.

Laughing so hard with Dominic, that I had to sneak out of patient’s houses so that they wouldn’t see my hysterical laughter.

The caressed hand that brought so much comfort.

The sound of a baby’s first cry and the thank you from the grateful parents.

The visits to the intensive care units to see those that we have saved on their way back to their families.

The times when you come home so tired that its difficult to keep your eyes open, but you know you have made a difference.

The first time I worked with Sandra, when I knew…..she was the one.

There is so much that I could write, but I guess that’s what the 450,000 words were about from my blog.

EMS is not just a job. It cant possibly be. It changes who you are and how you view the world. It can make you hard, but it can also reduce you to tears when you least expect it.

I have been in the ambulance service 12 years. That may not be long to some of you, but it has seemed like a lifetime to me. I can’t imagine that I was ever happy doing anything else.

In my very first year,  a paramedic came up to me and said

“ if they were to cut you in half, you would have green and white checks through the middle of you “ (they were our service colours at the time)

I feel the same now.

I may be leaving the ambulance service tomorrow, but it will never, ever leave me.

-Mark Glencorse, Paramedic

As part of my new role, I also wear the hat of Risk Management.  This means that all complaints and reports of medical errors come through my office.  It also means that I get all the “He said, she said” crap that comes with EMS not being accepted as part of the patient care team.

Surprisingly I have received more than one report of a crew “not giving notification via radio” from a hospital.  This often happens when the person who answered the radio was unhappy with the report, lost the triage slip and is in trouble or that the crew simply didn’t make the call.  It happens.  Sometimes we’re busy with a little thing called patient care and our partners driving should not be distracted by talking on the radio while driving if we’re that busy.

Now for the best part: The investigation.

I go over to the computer and pull up the crew, date and time, review the chart and get a feel for what was going on during the call.  Most importantly I look through the timeline of interventions to see if there was time to make a call, and then I script what my report would have sounded like.

Then I go over to the fax machine and pull out a Request for Radio Traffic Form and pull the tape.

Much like politicians, I think some people forget that everything is recorded these days and simply saying “No they didn’t” can be proven wrong in as little as 24 hours.

When that CD arrives and I listen to a pretty good radio report matching the patient I just read about, then hear a voice aknowlege it I feel great.  My guys did the right thing and I get to play that sound clip to the hospital.

Of course it’s also a drag when I get an email from radio that states “No traffic exists for specified date/time, please check.”  Then I can’t confirm what really happened and have to be the bad guy.

When your CQI calls you on the phone or into the office, it’s not because of some sadistic desire to torture you (despite how much that seems to be the purpose), but because we can no longer find evidence to support your version of events.  I have already been able to deal with most of the complaints that come in by reviewing your documentation, your previous documentation to ensure it wasn’t a fluke, and everything else available to defend your care and demeanor.

Sometimes you just plain screwed up.

Make it easy for me:

Do what’s right, write down what you did, tell the right person when you get there.

They’ll still complain, but at least I’ll have the ammo to defend you.

An Ambulance company in Fort Worth, Texas is taking advantage of the black Friday mentality and offering discounts in ambulance services early on Friday morning.

“It’s a chance to break into a section of the population that might not normally think of us” said Bill Lockheart, Manager of Forth Worth’s seventh largest ambulance service provider, Fort Worth Ambulance Group or FWAG. “If they need us, we’re there. But if they need us between 4am and 10 am Friday morning, it’s going to save them 25%.”

Mr Lockheart is not alone in his thinking that savings on goods and services should not be limited to the big box stores and items manufactured in China.

“I call them every week for my asthma,” says 33 year old mother of 8 Stephanie Johnson, “If I can get a discount on Friday morning, that means less Medicare I have to pay.” Ms Johnson was unable to provide documentation to that effect.

Bryan Stevens, a 66 year old diabetic from Galveston was visiting Fort Worth when he heard of the discounts. “Well by golly, have they no shame.  It’s a service for emergencies, not for profit.  I remember my early days as a lad in the…” We cut him off because we saw 40 year old Ted Remmit, an unemployed employment expert who called the Forth Worth Ambulance Group at 4:15 this morning with a sore thumb.

“I pay taxes, this is a service I ‘m entitled to.  You can quote me on that.”

Only on the front lines can you tell where the bullets are coming from.

Everywhere.

To say I might be in over my head is an understatement.  To say I thought it would be worse is also an understatement.

This is an entirely different world.  My commute is twice as long as it was 6 months ago when I first tested it, or maybe since it’s an everyday thing now it just seemed half the time before.

I wake at 5 to make the train by 6 so I can do research till 7 and make the office by 8.  Then I have to time my departure to make the train right before the tens of thousands of others exiting the City at closing time.  It’s different than wandering into the fire house after an hour and 20 minute drive.

That’s the only drawback so far.

I realized on my first morning of reviewing charts and advanced interventions that I am now responsible for more than my own patients.

To borrow from the meme, “I get ALL the patients!”

Seriously. I am able to act in the best interests of each and every patient this system comes into contact with.  Sometimes that will mean counseling a provider or defending them from an MD unclear on the concepts of EMS.  Other times it will be discovering where we’re not doing enough and finding the evidence to show it, then provide solutions to the command staff.

Some they will embrace, others they will reject.

I am not here to change the world for myself or even EMS, but for each and every person in my City who calls for help.  That is my new goal.  Not a 20 minute intervention, but a 20 week analysis of their experience and outcome.

Bring it.

On a summer day back in 1996 I walked into the trailer at the Isleta EMS and Fire Station and began my paid career helping people.  I have worked a variation of a 24 hour schedule ever since and it has become second nature to be away from my family for long stretches in exchange for a few days in between.

That will make Monday all that much more interesting.

On Monday I hang up my turnouts and late nights without sleep in exchange for a promotion and a reassignment downtown.  That also means giving up that ever so comfortable and vacation friendly schedule.

I was bummed at first until I realized that now the HMjrs are in school and we can’t just pick up and go somewhere whenever we feel like it anymore.  When this job at headquarters opened up it seemed too perfect a fit.

Monday I will take over the vacant CQI position that has been retooled ever so slightly to now officially include research.  Talk about a perfect chance to mine the data to see what is really going on out there.  I have lofty goals for my service, but it’s going to be a long while of playing catch up and learning the new job before I can start going forward with new ideas.  I also have a new political landscape to consider and will be in direct contact and communication with the regulatory agencies, budget writers and vendors that all have a stake in patient care in my jurisdiction.

It’s an amazing opportunity for me both professionally and personally and I am beyond excited to get started.

About the blog…

There will be a slow tapering off of 911 stories, I’ve got quite a few more half written and half anonymized just waiting in the wings, but there will likely be a shift in what I share.  My EMS 2.0 rants may well turn into updates about what I’m dealing with in that little office downtown.  I won’t be changing the name of the blog to Happy Captain (or Happy Cappy as MC suggested) since this is about my therapy, not necessarily an accurate mirror to my own life.

I now join the ranks of Sparrow, Morgan, Crunch and Stubing, to name a few.

Thanks for all your supportive messages on FB and Twitter.

-Captain HM 

In all the discussion, bickering and complaining about what EMS providers should be called (EMT, Paramedic, Ambulance Attendant, Steward etc etc) I got to thinking about the first part of my current title:

Firefighter.

Walk into a room in most places on the planet, say you are a firefighter and I think it safe to say everyone knows what you do.  It has something to do with a big red truck and water and red stuff.  The specifics aren’t important and where you work isn’t important.  Or is it?

If I walk into that room as my 18 year old self I am a Firefighter following a 40 hour volunteer firefighter academy.  40 measly hours, yet I carry the same title as my counterparts in San Francisco, New York, Seattle, Los Angeles, Boston who have spent upwards of 18 weeks on the material.  They have more hands on training, more book time and a greater ability to do the job, but our titles are the same.  2 completely different skill sets and levels of education, same title.  No one who calls the Fire Department wonders how many IFSTA Certified, NFA FireFighter Level II’s are coming.  They care about how many firefighters are coming because what they need are people who can do the job.

At a car accident, no one has ever turned to a friend and said “Quick, call the EMT-99s this person is injured!”  No one holding a cyanotic child screams “Help! I need 2 Nationally Registered EMT-Basics trained to the new curriculum!”

They shout one of 2 things:

“Call the ambulance”

“Call the Paramedics”

The Paramedics

I say we run with it.

I am in favor of calling pre-hospital care providers Paramedics even though there is a large gap in the training, experience and capabilities of the many levels from sea to shining sea.  They don’t see the shiny patch on your shoulder is different than your EMT partner, nor do they notice you only inserted an OPA as an EMT instead of an ET.

They need help. We are it.  They call us what we are.

The  Paramedics.

Heck even most of us in the job are unsure exactly what a Paramedic should be, so what a great time to come together as one for once.

To those who will immediately back off and claim, falsely, that they earned a different title than the EMT when they completed their 2 year Paramedic program, come back when you’ve completed your Bachelor’s in EMS and tell me if you feel the same way.

My name is Justin Schorr and I am a Paramedic.  I have been a Paramedic in my patients’ eyes for almost 20 years, even though my little slip of paper says only 10.