Should Response Times Matter? A discussion with Medic SBK

I’ve been discussing THIS story with good friend and fellow EMS 2.0 believer Scott Kier on the book of faces.

Since I can not mention the Department name here, just read the story and come back.

Disclosure:  I am a trained Firefighter/Paramedic.  I am a second generation Firefighter.  I am a card carrying member of the IAFF and my Local.

That being said, let’s move on to the meat of Scott and my discussion.

The story references a municipality struggling to meet increasing demand for ambulance responses under a state mandated market share of 80% responses shared with 2 local private providers.  To reach that target the municipality made funding available to replace an aging fleet (some stories reported over 200,000 city miles on some ambulances) and hire new EMS staff.

The Municipality operates an EMS transport tier within its Fire Department, a decision made in 1997 when the municipality’s public health ambulance group was folded into the fire department.  If you’ve been awake for more than an hour you know that never goes over well.

Skip ahead to about 2006 when single function EMS crews are sent back out from 24 hour assignments in the firehouses on a “1 and 1″ deployment model.  That means one EMT and one Paramedic per unit.  AKA the norm.

The 24 hour medics were reassigned to the municipality’s fire engines to increase the capability of ALS first response.

The local EMS Agency sets response times for all ambulances in the system and has magically chosen 10 minutes for code 3 calls and 20 minutes for code 2 calls.  The determination of code 2 or code 3 is made by the call taken and caller discussing the patient’s condition, weather and who knows what else.

The times are averaged using an approved statistical model and reported to the EMSA and State.

Now that that’s out of the way, let’s talk about response times.

Response times are solely to determine if a contracted agency is meeting contract parameters.

See, wasn’t that easy?

It would be a challenge to hold ABC Ambulance Company or Random Municipality to actually treating illness and injury to a certain level.  Imagine if the contract to earn a service area required an agency to treat all asthma patients with a bronchodialator or ensure that all patients with a revised trauma score less than 5 are being transported to a level 1 facility.

EMS needs to be held accountable for the assessments and treatments they provide not how swiftly they can arrive or how many people they can haul away in a day.

Trouble is we’ve spent the better part of 40 years telling people that “seconds count” when in fact they only count in groups of about 200.  Add to that that reimbursement is tied to transport, not treatment and the service simply looks to turn over calls as fast as possible.  Armed with the belief that a 10 minute response time is required for chest pain, ankle injuries, drownings and sleeping street people, the entire system must be built for the smallest community of patients: the critically ill.

EMS 2.0 is about stopping the band aid fixes and overhauling the EMS system in each community to meet the needs of that community.  For some that means EMS based EMS or a third service while others will need to lean on fire and PD to take up the slack when staffing levels can’t be filled.

Scott and I agree that a tiered approach is necessary, however, based on discussions we’ve had online and in person we are on opposite sides of that discussion.

Perhaps Scott can pick it up here over at EMS in the New Decade?

It’s OK to Not Be OK

As many calls as I’ve shared in this forum, there are still those that won’t make the cut.  Not because they’re “gruesome” or “funny” or even filled with heroic actions or memorable scenery, but because of the little things.  Little things that are mine and mine alone.  Frozen moments in time that impact me to this day.

On a recent call one of my most memorable calls came back.  Not like a wafting scent or a slowly rising tide, but like a slap to the face and a punch to the gut, taking all my breath away.

The dispatch was a simple fall in the bathroom.  A bread and butter call.  Likely someone with one too many drinks and not enough sleep.  As I walked towards the restroom, donning my gloves and admiring the large artwork in the lobby a woman came running out covering her mouth in fear.  She was hunched over and moved erratically as she exited the restroom.

In half a heartbeat I was taken back over a decade.  My pace quickened, my heart in my throat.  The little things were there.  A glimpse of broken mirror.   The faint smell of bleach long mopped up.  The first drop of blood.  I was afraid.  I went to work doing what we do.

All I’ll say is that I didn’t sleep much that night.

Then or now.

We deal with things that most folks fall apart after seeing.  Trouble is, so do we.

If you experience something and need to talk about it please reach out.  It can be a friend, clergy, co-worker, even drop me a line.

You don’t have to keep what we do inside.  You don’t have to make sick jokes or make fun to get along in EMS, all you need is an outlet.

We all have calls that wake us from a sound sleep like a clown in an old horror movie.  The trick is finding someone to help you through it before it eats you away from the inside.

It’s OK to not be OK.

It’s not OK to let it get worse.  Everyone feels like you and I feel, some are simply too scared to share it.  You’re not the problem.  If this job doesn’t shake you to your core, chances are you’re doing it wrong.

I’m reminded of that every time I see a handful of calls from my past.

I’m reminded of that when I read Kelly’s story about the swing set.

I’m reminded of it when I see a young EMT freeze up at a scene and wonder if I’ll be in their nightmares in 20 years, a simple bystander on their worst day.

I wonder if they know they’re in mine.

It’s OK to not be OK.

 

See also: CISD with OK GO, a 5 part series on addressing trouble using the music of OK GO

An EMS Expo Blogger Scavenger Hunt!

Here is a pic of a bunch of EMS Bloggers (and our ZOLL hosts) from 2011

Can you find them all in Baltimore this week?

If you find them, tag them and me (@thehappymedic) in a pic and throw it up on twitter.  Whoever finds the most gets bragging rights for at least a year and special perks at EMS World in September!

 

And if you are in this photo and don’t want to be found, better get to hiding!

Welcome to [insert City here]

On a recent job we went running up the jetway and onto the awaiting plane after being told a person was unconscious. Much like most other calls in my almost 20 years it was not what we were told.
After ensuring the person on board was assessed, removed and healthy, we gathered our gear and started making our way back to the jetway door.
As the large aircraft is unloading we’re like salmon swimming upstream. Part of the way there a flight attendant is passing by and tells one of the passengers, “Enjoy your stay in San Diego.”
They laughed and kept moving. For those of you new to the blog, we are not in San Diego.
However, it is late and we decide to have some fun as the crowd moves towards us faster than we can get to the door to get back to the rigs.
I jumped in first.
“Welcome to Toledo, folks.”
“Snow in Chicago tonight” the Medic calls out as a new group was nearby.
“You’ll need flip flops in Vegas tonight!” the EMT said as we finally got to the door and started our way out.

I think I’ll be trying this game far more often.

Run.

It was cold when they left the house.

In the early morning hours they gathered a bag from the trunk of the car and walked to the end of the icy block.

At the stop sign was a friend idling, waiting.  Waiting to run.

Climbing into the warm car they felt a glimmer of hope for the first time in years.  The drive to the airport was silent, the younger one in the back seat falling asleep almost immediately.

It wasn’t until the plane finally left the ground that she took a deep breath, confident in the decision she had made.  4 year old asleep on her lap she allowed herself a drink to calm her nerves on the first flight to Anywhere But Here, USA.

Unfortunately the stress, lack of sleep and drink caught up to her when they arrived and the gate agent was concerned.  Medical assessment finding nothing of concern rescuers turned to the events leading to their arrival without bags or a ride anywhere.

“We are trying to get to Anytown*” she said through teary eyes.

The 4 year old seemed curious about the tiny fire engine outside the window.

“We have a connecting flight but I think we missed it because of…” she pointed to the rescuers, the gate agent, the airport and broke down crying.

The agent confirmed the flight had been missed bit because of circumstances causing their delay and the next flight was being arranged.  That flight was tomorrow morning, a good day away.

After the ambulance ride had been refused and the airline snacks consumed, the gate agent approached with wonderful news.  He had arranged for a hotel room and a shuttle for the woman, her child and their grocery bag of earthly belongings.

As she was assisted to the shuttle stop the reason for their sudden departure crashed awkwardly into the conversation.

“It just wasn’t safe for us anymore,” she said to the 4 year old boy.

“Not for me, not for him and not for who he’ll turn into if we stay,” she mentioned casually over her shoulder.

They were on the run from an unsafe home or telling the most believable cover story ever known.  Violence and intimidation had turned fear into action late the night before.  She had a plan, a friend she could trust and took the next opportunity to run.

“Do the local police know about the father?” I asked looking for the shuttle van.

“He left three years ago.  Decided he didn’t want a kid after all.  His replacement didn’t know what he wanted most days.”

We stood in silence for a good 10 minutes.  I wanted to go straight home and hug my family.

After the van pulled away from the curb local law enforcement was notified of their physical description, origin and location for the night just in case the story didn’t hold water.

A week later I was informed an officer had followed up at their location and confirmed they had arrived safely with family in Anytown.  Hopefully the little guy only remembers the little fire engine outside the window and not the reasons they had to run.

 

 

image credit Shanon Wise via creative commons

Best Fire Department Social Media Presence?

I’m looking for someone who is doing it right.

A Department who understands the power of social and sharing media as well as its dangers and pitfalls.

Do you know of such an agency?  Mention them in the comments, I’d love to learn from their example and possibly recognize them at FDIC in April!

 

So, I’ll ask again:

What Fire or EMS agency is doing social media right?

Ask A Firefighter

Uniform Stories has got me fielding questions about the fire service!

 

Do you have a generic fire service question or a more specific question you need answered?

Shoot me a comment here, on the video or via email thehappymedic@gmail.com

 

The first response is about to be filmed, so get your questions in now!

Bag Baggage

I am not a fan of all the crap we have to carry around.

We carry the worst case scenario into every single call mainly because the manner in which we are assigned calls for service, by first come first served.  Add to that the impossibly broken categorization of calls into little boxes that has never, ever, EVER, been accurate or efficient.

Because of all that I have to carry my cardiac monitor/defibrillator, Oxygen, clipboard and ALS bag on every. single. call.

Why?

Because you never know what is waiting for you.  The 62 year old male with a headache you were dispatched on?  That’s a 34 year old woman in active labor.

The unconscious man in Apartment 4H is actually the 5pm dialysis transfer wanting to get in early.

 

Since my attempts to change the way we dispatch failed in the design phases, perhaps there is a short term solution to all the gear we carry.  Here at my current assignment I oversee between 2 and 5 ALS first response units depending on staffing.  It seems each crew has their own way of stocking the bags.  We do a lot of hiking with or bags since our call may be to Gate 67 but the patient is now closer to gate 82.

This means all our stuff needs to be carefully stocked and easy to carry long distances.

The roller bag version was suggested, but the size and need to carry it up sometimes very steep jetway stairs made that solution unfeasible.  I know everyone seems to run a different bag in a different set up, but that’s only because we all have different priorities and specialties when on scene.

For example, all my assessment gear is in the top compartment of my bag along with my oral glucose.  That’s my “This part gets opened on all calls” part.  Then inside is my IV bag, meds and intubation kit on the bottom.

I’m not looking to wake the sleeping dinosaur of EMS opinion on bags and bag set ups, just wondering if I’m the only one frustrated that we carry everything everywhere.

On the engine I don’t take a ladder inside every fire, I can go back out and get it, but for EMS, we carry cardiac arrest meds to stubbed toes.

0.5% of my call volume gets in my way the other 99.5% of the time.

“But if it saves one life…?”

But what if it negatively impacts another?

Am I over reacting, whining, or should we try something new?

Police Fail?

I recently completed a patient care report that came about as a result of…let’s just say our boys in blue were involved.  I have to complete a number of codes specific to the situation including the nature of injury, factors affecting care etc.

I never noticed that the code for Factors Affecting Care with Law Enforcement is…

 

wait for it

 

 

FALE.

 

I giggled just a little bit.