Category Archives: Command & Leadership

Everything you need to know about EMS management…

you’ll learn in a bar.

Or at least while at a bar.

It sounds cliche, but let me explain.

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

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

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

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

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

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

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

Yup.

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

Sound familiar?

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

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

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

 

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

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.

Official Fire Service Ice Cream Rule

To finally dispel the myths, rumors and falsehoods regarding the Fire Service Ice Cream Rule (AKA Steaks, Cigars, etc) I offer the following definitive ruling on the matter:

Official Fire Service Ice Cream Rule:

1.  Purpose

To establish when a Member of a Company owes Ice Cream to the other members of said company.

2.  Scope

This rule applies to all Fire Service personnel, both paid, paid call and volunteer regardless of rank, station or assignment.

3.  Definitions

Company – A unit or similar single resource.  This can be defined as an Engine Company, Station House or Volunteer Post.

Member – Any person in official capacity at the time of the incident in question.

Ice Cream – While an abomination in the eyes of the Lord your God, something with a crap load of ingredients.

4.  Enough with the bullet points!  Onto the rule!

Ice Cream is owed only if a member of a company is portrayed in the media, be it television, print, online or otherwise (social media not affiliated with a media outlet excluded (see rule 8))  portrays the member in activities not associated with the assignment they are recorded at.  Being filmed fighting fire, cutting a car, rendering aid or performing regular assigned tasks on the scene of an emergency response DOES NOT entitle the members of the company to ice cream from the member involved. Also, for rules on double parenthesis, see rule 9.

5.  Who gets Ice Cream

Only other Members of the offending Member’s Company are required to be appeased with the cold Ice Cream goodness.  Depending on Agency or Department, this may include all units assigned to a house or all shifts on that unit.  It DOES NOT apply to other Companies, units, houses or personnel who wander in to mention being “owed” Ice Cream.

6.  Who doesn’t get Ice Cream

Officers above the rank of front line supervisor (Lieutenant/Captain/Sergeant) unless they were at the scene and may have to answer to the activities of the member caught not performing duties relevant to the scene in question.  All other houses, members and companies not assigned to the offending Member’s HOME Company.

7.  Oh yeah, that reminds me, HOME Company

Ice Cream is only owed to a Member’s HOME Company, not the Company where they were assigned when said incident took place.

8.  Social Media not involving media outlet

That doesn’t get Ice Cream but instead a pat on the head for the person trying, because that wreaks of desperation.

9.  Multiple Parenthesis

Nah, looks weird…or like math, which is WAY worse.

 

You got WHAT stuck in a bowling ball?

In my memoirs of EMS (Working title – My Life in CQI: Kill me now, just document it properly) some calls will stand above all others.  This, sadly, is not one of mine, but from a friend overseas.

No, not Mark.

I got an email about a curious rescue his agency was called to and was wondering what I would have done.

So, here is the scenario:

 

A 19 year old male has gotten his finger stuck in a bowling ball.  He somehow wedged it in there so far, it up against the webbing of his hand with very little wiggle room.  Rotating the ball is out of the question as he seems to have the finger next to it wedged in almost just as bad.

25 minutes into the call you’ve tried gel, ice, lubricants of questionable origin (who carries that stuff into a bowling alley?) and brute force.  Prayer is taking place and all options seem exhausted when the decision is made to simply move him, and the 16 pound bowling ball, to the hospital.  What will they do there?  Dunno.

 

What would you do?

A quiet weekend in the City

Some boats in the bay…

America’s World Cup

More boats…
Fleet Week

Air traffic ticks up a smidge…

Blue Angels

Music…

Hardly Strictly Bluegrass

A bit of sport…
Cincinatti Reds at SF Giants MLB Playoff Game

Buffalo Bills at SF 49ers NFL Game

 

Should only triple to population for a few days, all 33,000+ hotel rooms are booked, and I wish my weekend cars luck.

Out of Left Field

Sometimes we forget who we’re up against.

Sometimes the system is indeed rigged against us from the start.

But how can you win if the other party refuses to even play the game?

 

The term “blind sided” was used in a meeting today, much to my surprise.  You could even go so far as to say that I was blind sided by this blind side.

It was a jolt of reality back into my EMS 2.0 world that not all of our enemies lie within.  Some are just skirting along the outside of EMS, providing valuable services, only to pounce on ideas they find threatening.

Only problem is, I don’t see it that way, not sure I ever will.

I’ve had almost a year to figure out this whole politics thing and I still just don’t get it.  I don’t care who had the idea, or who gets credit, I need some things to just happen.

In my role, very few decisions are actually within my control.  I do research and pass the info along.  If it gets rejected, I research more.  I’ve had my preconceptions busted more than a few times, comes with the territory.  But there is this perception that others see my actions as more for me than the system.

I just don’t get it.

 

Some things come from out of left field, but that’s all based on the assumption that what we’re expecting was in left field to begin with.  My surprise came from the bleachers behind left field, caught my on the jaw and knocked me to the floor, blinking, wondering what just happened.  I had a ceiling do that to me once.  Once.

 

I’d love to say “never again!” but when you don’t know what to expect, how can you prepare?

Special Call Mobile Surgery 1, Mobile Surgery 2, EMS Surgeon 1…

A nice resource to have if your system is innundated by, oh I don’t know, the shaking of the earth until everything falls down.  Especially in a City with water on 3 sides and only 4 trauma bays…total.

 

[yframe url='http://www.youtube.com/watch?v=lc707gqtzcM&feature=fvwrel']

 

[yframe url='http://www.youtube.com/watch?v=J67e2qclHe0&feature=related']

Interventions Issue 4 – Supervisors

Please enjoy!

Please Albert, not in mixed company

Sometimes we spend a few days with like minded folks and forget that we speak differently when around them.  We speak candidly about our jobs, our frustrations and our opinions of others not like us.

 

When waiting with a large crowd for the train at the airport it is not advisable to have a raucous conversation about people who commit suicide by jumping off of buildings.  You compared highest falls, genders, dispersal of remains, even splatter patterns.  The disgusted looks you were getting from those around you went unnoticed by you but I’m sure they took note of your ambulance companies which were prominently displayed on your shirts.  I tried to get your attention to distract you, but when you made the Humpty Dumpty joke, I decided to pretend I was offended too.  It wasn’t hard at all.

 

The Complaint Box

…is my email inbox at work.  Or my voicemail…whichever…

I knew our CQI position handled citizen complaints, but I had no idea how many there were.

“It’s a thankless job” they told me when I took it.  Like being a Paramedic in the City was a thankful job?

Almost like clock work most mornings I get a call from a person I’ll call “Bob.”

Bob doesn’t like the Fire Department, or my mother, or my race, or the fact that I am his employee since he pays taxes.  Bob was taken to an ER for a complaint and was shocked and appalled we were directed to place him in the triage waiting area after a nurse assessed him.  In other words Bob is 99% of our business.

Bob and I have a 30-45 second conversation about his most recent abduction by the Paramedics and how they assaulted him, robbed him and left him to die…at the hospital.  When I pull up Bob’s run history the computer returns “Seriously?”

Some may say Bob’s calls are a hindrance or a distraction, but Bob keeps me on my toes.  Bob is my window into the mind of someone who does not know our lingo, our policies or our commitment to his overall health and safety.  Others may say I should report Bob, but that’s what he wants, a reaction, and all I do is listen, explain and then he hangs up.  then I get a coffee.  It’s a routine we have.

 

Other  complaints vary from legitimate clinical concerns from local hospitals, to regulators who question charting, to folks who simply want to vent.

But my favorite calls of all are the ones I can tell in an instant are without merit.  Bob helps he spot them easier.  How do I know?  They don’t know our lingo.

 

For example, if you tell me the ambulance people told you they would “throw you out of the truck” you’re lying.  How do I know?  Because a “truck” to us is a giant 5 man device with a 100 foot ladder on the back and is big and red.  We do not call it a truck…only you people do.  And by you people I mean the ungrateful masses who demand our services in 4 minutes or less only to complain that we took you to the wrong ER, since they “kicked me out” earlier today.

Kicked you out did they?  How do I know you’re lying?  Because they don’t kick people out.

When people get bored waiting 4 hours for a refill of Plavix (which they were never going to do in the first place, we told you that) they leave or are told to go to the pharmacy, but they are not kicked out.

We stole your wallet you say?  (Keep in mind folks, I am required to investigate these complaints no matter what they are)

Doubtful since I recognize your name from my days on the ambulance and we keep track of these things.  2 years ago you claimed we stole $500 from your wallet, then 8 months ago another $700 and today the total is up to $900 and we somehow walked off with your brother’s bass guitar.  I’ll investigate this but I should warn you, the No Merit letter is on my desktop I use it so often. (The Further Investigation by Investigative Services Bureau Recommended is there too FYI).

But just for once think about what you are about to say to me in your complaint.  If the crew kicked you out of the truck how again did you get to the hospital for the nurse to sign our form that they accepted you?

If we stole your grandmother’s $2000 necklace, why can you not describe it to me?

I’ll take your call, I’ll treat it as true until I complete my queries, but put some effort into it first folks.  If you’re unhappy and make something up you’re just wasting my time and yours.  If you have a legitimate concern I want to know about it.

 

Think twice about questioning the professionalism of the folks who took care of you when you didn’t need it, only wanted it, and how they did everything you needed up to and including taking you to an ER you did not need for a reason you could have handled yourself.

But if they weren’t professional, if they didn’t do what you needed, I’ll be the first one to tell you so.

 

Talk to you again on Monday Bob.