The first recorded EMS Bromance was in the late 17th century when two stretcher carriers began to hang out together off the battlefield.

Centuries later a Geordie Paramedic and a Yankee Fireman who spent most of his time providing EMS began reading each others blogs on the interwebs.

Reading led to commenting, commenting led to cross posting, cross posting led to extensive discussions, discussions led to podcasts and podcasts led to a TV pilot.

There was a little more to it, but that’s the gist of mine and Mark Glencorse’s friendship.  It started with curiosity about each other’s systems and led to what will surely be a lifelong friendship.  Mark made a huge impact in my life and my career.  While this therapy experiment called the Happy Medic was helping me heal, learning from Mark and the community that I discovered has helped me grow, both personally and professionally.  I think we can all agree that when I first noticed a visitor to the blog was from outside the US, telling me that years later I would be watching videos of us goofing off around San Francisco and England would have brought a chuckle.

But watching the videos reminds me of how passionate about EMS Mark and I were and how we wanted to share our unique experience with as many people as possible.  That passion remains.  A passion not just for running calls and treating patients, but also looking outside the ambulance for solutions.

I chose a staff job at HQ.

Mark is heading into the private sector.

Although his blog 999Medic was shuttered awhile ago, Mark is still active in the online EMS Communities on Facebook and Twitter.  This week Mark will be working his last shift in EMS.

I have accepted the honor of hosting a message from Mark about the experience very soon.

I hope that when it is up you will read it and share it with your friends, readers and co-workers.

Stay safe,

HM

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.

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.

Oh here he goes again, ranting about customer service in fire and EMS…

Well, kind of.

I was bamboozled!  Hoodwinked!  Can you believe it?! Someone mark your calendar, get Guinness on the phone (both of them actually) because, wait for it,

A salesman lied to me to make a sale.

*GASP!*

My 5 year old DVR is great and all, I enjoy the level of service from my TV provider but the bundling has gotten good.  TV phone and internet all for almost what we’re paying for TV alone, no 12 month intro rate, no pesky plan changes.  That was all in writing from the provider, so I was good.

But I had some technical questions that this fellow had the perfect answers for:

“Can we transfer the shows on this DVR to the new one?” I asked, knowing the answer to be no.

“Until about a year or 8 months ago no, but now we can upload your DVR to a hard drive and the technician installs it with the new software on installation day, so ‘transfer’ no, but all your shows will be on the new DVR.”  his statement was factually correct but completely misleading in context.  He told me there would be no transfer and that all the shows would be on the new DVR (just not saved, I can watch them when they’re on), but he painted the picture with tech and terms I understood to answer my question in a manner that fit his end goal.

“Will they have to run new coaxial cable?”

“No, they can use your existing satellite.” A flat out lie.  The installer removed his glasses and rubbed his eyes when I mentioned this.  “What else did they promise you I could magically do?” He asked.

I imagined an ER Doc listening to all the promises made by EMS in the field to talk someone into the ER in the first place.  “They said you’d give me a fancy scan” or perhaps “They promised pain medication.”

The point being that if you buy into the customer service ideals you are a salesperson when it comes to talking someone into transport.  Not the folks that need to go in, those are an artform, but the ones who we choose to take in to keep them from calling back later, or because protocol says the rash she’s had for weeks could be a reaction to meds.

If you make promises to your patients you had better be available to explain them and be held accountable if your statements were inaccurate.

I have an understanding installer who has heard all manner of tales promising this exotic install and that computer glitch repair, all so a salesman can chalk up another commission.  This is the modern model of customer service folks, this is the example being used to move ahead in these economic times.  The point of service man saves time by making the more valuable service provider work longer, costing the service more in the long run.

And if your service is hurting from lack of income from decreasing transports…what lies are you ready to tell to increase transport revenue?

Inspired in part by Motorcop and his hatred for the confusion between jail and prison I too would like to clear a few things up for the general public.  Nearly everything you have ever seen on TV about fire, police and EMS is false, yet you assume it to be accurate.  Especially all the medical dramas…I get that you watched season 3 of Grey’s last night and know what abdominal pain could be, but listen, it was probably the 4 packages of TGIFridays jalapeno poppers, not an AAA, so sit down before you hurt yourself and actually need an ambulance.

Misconception #1: You call for an ambulance.

When your kid cuts his finger, when your cough won’t go away or when your neighbor seems to be walking funny and the Today Show says it could be a stroke, you do not call an ambulance.

You call for help.

The help that arrives is what you want, don’t look at me funny when you report your kid’s laceration won’t stop bleeding and I arrive 4 minutes later in a big red truck.  Don’t get testy when I tell you the ambulance is coming but that he doesn’t need it.  I’m the expert, I’m going to talk for a few minutes and you’re going to do what I say.

OK, not really, the law makes YOU in charge of this emergency, what was I thinking?

In your extensive medical wisdom you’ve decided junior’s finger needs the ER, despite my assurances to the contrary and your ambulance has arrived.  We aren’t doing anything for him because, aside from the self adhesive bandage I have already applied, there is nothing more we, or the ER, can do.  “But because we go in with you, we’ll get seen quicker, right?”

Misconception #2: Arriving by ambulance will get you seen quicker.

No, no no my friend.  When you arrive by car and go inside and wait in line, then the person behind the desk asks you to fill out all the info and they let you see a nurse real quick, then sit and wait, that is called triage.

Triage is a word that means to sort.  We take the sickest people first.  Well, the ER does, I have to take every Tom Dick and Harry who asks, completely ruining what could be a proper working system, but that’s another blog entirely.  Well…not really, but we’re off track now.  See what you’ve done?

When we bring you in by ambulance, no lights and sirens, stopping for every red light, we’re traveling no faster than you could be.  Then we arrive to a little nurse’s station where they collect your info and the SAME NURSE checks you out real quick.  Now guess what happens.  If you’re not sick enough to be seen right away, we take you off the cot and walk you to the chairs in the waiting room.  Then we make sure we have your billing address correct and say good day.

Misconception #3: The ER fills and refills prescriptions.

Cough been keeping you awake all night?  Too bad you never got that prescription filled.  You see, when a Doctor examines and diagnoses you, they may write a prescription for medication.  This little form lists your medication, dose and instructions and is the Doctor’s way of healing you, but you have to go just a might further on your own.  Goto the local Walmart and go back to that cool little office in the back and hand them the piece of paper the Doctor gave you.  You’re going to have to wait a few minutes, so go wander the tackle isle and wait for your name to be called.

Take the medicine home, read the instructions and follow them.  Oddly, your health will improve.  I know, weird.

Calling 911 at 4 in the morning and handing me the prescription will not help.  I do not dispense medications,  I administer them when indicated.  The ER does not have a pharmacy that dispenses medicines, just one that facilitates administration.  The ER will look at the prescription form and point you in the direction of the nearest 24 hour pharmacy.  I tried that, but you wouldn’t listen to reason and do the right thing, you demanded transport.  When you get home in 45 minutes, don’t call back.

Misconception #4: Your Doctor will be at the hospital.

Hate to break it to you Erma, but Dr Johnson is NOT at St Farthest today, it’s Sunday and he’s an endocrinologist.  He works for the same corporation as your hospital, cubbied into a group for billing purposes and is allowed access to your insurance corporation’s network of specialists and tests, but he is not there.  He will not be there, nor will I call him to let him know you’re going in again.  He will be notified should your condition warrant review by someone of his specialty.

Only once in my career have I seen a primary care race to the ER to meet a patient and she had more money than God, which gets you that kind of attention.  But still only gets her me in a City ambulance.  Figure that one out.

There it is, a quick list of some of the most common misconceptions in modern Emergency Medical Service.  If you ever wonder why it’s taking so long for an ambulance, chances are we’re taking care of someone who wants it, but doesn’t need it.

For someone called the Happy Medic I do seem to complain a lot.  A recent discussion with a trusted Fire Service friend who introduces himself as ” A Basic for life” circled back to why EMS folks are always complaining.

We complain about money, hours, crappy bosses, Medical Directors who don’t get it, patients who don’t need it and other agencies who aren’t doing exactly what we want them to be doing.

When he rattled off that list I couldn’t help but stifle a chuckle and agree, “Yup, that’s EMS in a nutshell.”

We in EMS love to be abused and have had plenty of chances to jump off this roller coaster but never do.  We come back over and over again not to complain and bitch and moan about it, which we love to do, but because we love to do this thing called EMS.  For every crappy call I make a difference on 2 others.  For every MD who has no clue what we do another steps forward and smiles when they see the compassion and care we give our patients.

The positives are out there and we see them, we even secretly think back to the times we were instrumental in making someone’s bad day just a hint better even if it was just for bringing them a blanket or putting their little dog in the back room before we left for the hospital.

EMS bloggers are notoriously negative because sharing the good moments isn’t as therapeutic as letting the bad ones out.  Griping about how much I hate little rat dogs (Nothing but love, MsP) relieves far more stress than a post about how nice it is that the elderly can keep pets better these days.  See, rat dog tirade beats observation about Granny any day.

From the outside my blog is a collection of complaints, gripes, wishes and dreams with very few shimmers of hope.  Well, that’s how it is on the inside as well, but if I came to this little wordpress screen and began to tell you all the good things about my chosen profession I would spend 22 hours on it instead of just the 2 I do complaining.

This is still my therapy experiment, shouting into this room of mine that used to be empty, but somewhere you and I connected on something, be it good or bad, inspiring or deplorable and each of you reading this likely has a different reason for stopping by again and again.

The Google tells me most of you like a good misuse of 911 story or a letter in the file of some EMT or Paramedic doing something stupid and I can see that, but keep in mind I have a smile on my face most days because this therapy experiment lets me get those emotions out here and not on scene.

And when we can side step burnout simply by venting, we extend a job into a career, and that’s what I’m here for.

Thanks for reading,

HM

Michael Morse is hiring for The EMS.

I don’t swear often, but when I do, I say:

“Michael, Hells yeah I’m in!”

Thanks to the folks in the recent Santa Clara County Grand Jury, we now have positive proof that fire based EMS delivery using fire trucks is inefficient.

Phew.

I was worried we would never discover the problems draining tax payer dollars.  Did they know we’ve known this for nearly 20 years?  All they had to do was call me, or just google it even.  Instead tax dollars were used to show tax dollars are being used inefficiently.

I guess all the murders, robberies and other court cases are all finished there in Santa Clara.  Good thing they don’t have a baseball doping case to worry about.

What the grand jury failed to do, perhaps it is not in their interests, is look beyond the “retirement costs” and perhaps look at the system and how to deliver what our pal Chris Kaiser dubbed EMS based EMS.  Looks like Santa Clara needs to stop and rethink things, then start from scratch.  Someone suggested that once…but I digress.

This grand jury report will be cited by every union basher come election time in an effort to privatize public safety accounts and likely not lead to any changes in the delivery of first response EMS in Santa Clara County.

The report fails to mention that the local private provider does not have enough resources to completely cover the district for first response ALS.

So now what?

Oh, I covered this topic 2 years ago.  What, you missed it?

Top 10 New Responders without the Fire Department

and then

Top 10 New Responsibilities of the Fire Department

Poking fun at a serious topic for sure, but until we get away from a fee for transport model, this thing will never work guys.  Fire based, mailman based, if we base our service on what we can get paid instead of how best to serve the community, the system will never work properly.

Jump - Aza Raskin

No, this isn’t a post about the Golden Gate Bridge.

Although it could be.

More a comment a bout blind allegiance without question.

I think everyone’s mother at one time uttered the phrase “If all your friends were jumping off a bridge would you do that too?” when our defense of a choice was “But all my friends are doing it!”

I was wondering recently why so many systems are running full speed towards certain treatments that have a great effect, but not necessarily pre-hospital.  If the beneficial time of application is within 3 hours of illness or injury and my average time from patient contact to hospital is 30 minutes, is that worth the investment for the system?

What if the time of application is 6 hours?

If studies show that applying treatments within 6 hours is beneficial, is that a good investment for my system?

So many systems are running towards therapeutic htpothermia and judging by the studies it is a beneficial treatment.  But do we need to be starting it immediately?  From what I can tell systems with prolonged transport times, only Intermediate Life Support, most rural areas, could see a great improvement in patient outcomes.

But in the urban settings, when even the ER could wait to apply it, is it something we need on the rigs, in our continuing education, and yes I’ll go there, additional opportunity for misapplication (liability)?

When does the risk/cost outweigh the benefit?

I think it is similar to the decisions I make in starting an IV pre-hospital.  We have nifty little saline locks attached to tubing for “gaining access.”  With the risk of infection in the back of my rig, or worse yet in the street, I will only take that risk if the benefit is there.  Why am I breaking the skin simply to attach tubing?  If I am not anticipating the administration of life saving fluid or medication, then why even do it?

When these pricey little guys arrived in our bags there was a training session and now 4 saline tubes and tubing are in my overflowing 40 pound bag.  In the early days someone (I don’t know who…) put a little paper in the baggie with the saline lock that read:  “Peripheral venous puncture is not a benign procedure.  If you do not anticipate the administration of life saving fluid or medication, does the benefit of administration outweigh the risk of infection?”

I still don’t use them and am quite within policy, protocol and the one that should be first on the list, the patient’s best interests.

BUT, on the other side of the bridge jumping argument, I like to think I surround myself with people who are like minded, forward thinking individuals.  If Ted Setla, Radom Ward, Chris Montera and Jeremiah Bush jumped off a bridge I would have to ask some serious questions as to why.  Or trust my friends.

I have made some blind leaps in the past that I now find foolish, probably still a few left in my future, but a blind allegiance is the thing I want to bring to your attention.  It is said that the most dangerous person is the true believer and someone who will blindly jump off that bridge with their friends no questions asked is the same in my mind.  However, a constant doubter, someone who refuses to jump or stay, but wants to see what the majority of folks do first is equally as foolish.

So when Mom asks  ”If all your friends jumped off a bridge, would you jump too?”

I’ll answer:

“Well…is there a train coming?”