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.

Working on the Holiday – A poem

So you’ve got to work the holidays, or your boss will get real mad?

You work in a big box store in town, and your schedule makes you sad?

Well let me tell you another story, of some folks who just like you,

are working on the holiday, so that others do not have to.

We are your firefighters, your medics, your cops,

your nurses and doctors ready to assist,

just like every other day, not just December 25th.

We’d like to teach you something you’ll eventually figure out,

a holiday is just a number, there’s no need to pout.

Turkey tastes delicious on November 29th,

and sometimes we celebrate Christmas on the 26th, at night.

Your place was open last year and the year before,

on the day so suddenly special you want to blame the store.

So for those of you who complain about working this holiday,

remember the others who are always working regardless of the day.

You won’t have to work the holiday when you get a better gig,

but if you’re lucky, you will, cause you’ll be with us in the rig.

 

-HM

Community Paramedicine doesn’t belong in EMS

Community Paramedicine, or what some would rather call Integrated Healthcare, is a fantastic concept.  Why not take basic medicine and evaluation skills to the patient recently recovering from a procedure instead of making them visit the MD’s office?

Why not follow up with Mrs Jones on how her medications are doing?

Why not have a Paramedic check in on Mr Thompson and his blood sugar levels?

My first paying gig in EMS was for a system that did just this.  We visited our list of clients based on the schedule and checked their blood sugar, blood pressure, medications and checked the fridge for food.  I hated it.  I hated it because it wasn’t what 18 year old me wanted to be doing.  I didn’t see the value in the program until I was about to finish my employ there and noticed we never ran a 911 call on any of our home visit regulars.  We weren’t providing Emergency Medical Services (EMS), we were doing something completely different.  Call it by any name you like, but don’t call it EMS.

Today I’m a huge supporter of decreasing the demand on 911 by focusing on reducing the number of people who call.  One of the proven tools used to combat 911 calls is making people healthier before they need 911.

Community Paramedicine is just the thing each and every community in America can use to reach out to a niche that needs to be addressed.

When I was in England all those years ago Paramedics with only 1 year experience were out on their own making recommendations, referrals and taking people directly to what they needed, not just a 2 person cot van to an ER (Or AE for those who favourite that term.)

The concepts have been proven over and over again and some systems are even carving out revenue streams to make it profitable or, at least, not at cost.

I applaud their efforts and if the opportunity ever comes along for me to get involved…

…I’ll pass.

In my opinion Community Paramedicine is too important to be trusted to the 911 crowd.  We need folks more interested in sitting and talking than squeezing a few home visits in between calls for service.  Some systems have adapted schedules and providers to respond only on the Community cars and that’s great, but a greater separation is needed.

Yes, I’m advocating splitting EMS even further than we are now.  A split that will allow this new sub specialty to thrive.

Community Paramedicine needs to be a specialty, a half brother, not a spin off hoping to get picked up for a second season.

It will not succeed if it is tied to the chaos that is 911 for profit and must succeed if 911 for profit has any chance of surviving another 10 years.  We’re approaching a cross roads to possibly finally squeeze our little patient care machine into the main stream of medical professionals.  Do we want to squander that opportunity by having Community Paramedicine as a side project of EMS or as a full fledged community service independent of the lights and sirens?

I know 18 year old me had a different reason for having this opinion, but the opinion remains:  911 and community care shouldn’t mix.  They should each focus on their strengths and excel at the service they provide the community instead of stretching us so thin only our merit badge classes hold us above water.

Taylor Swift inspires new EMS billing model

I’ve been reading in the papers lately that Taylor Swift and Spotify have been going back and forth about royalties for her songs playing on the streaming music site.

According to sources, she was paid less than $500,000 for 12 months of her songs playing on the site.

My first two words were Boo and Hoo.

Then I looked at the feed of a friend of mine who is a musician.  They have a fair argument in that the way the industry is arranged you get a small amount for creating the music (writers, musicians, performers) then more the more the piece is performed.  It makes sense on a certain level, but the model is clearly outdated.  Before it can be changed, the industry should realize that fewer and fewer of us listen to terrestrial radio (where their songs are actually placed at cost, not at profit) and more of us are streaming music using spotify and Pandora like apps.

I start with a band I like, then it introduces me to other bands I may like as well.  Then I buy their albums, but not in a store (that used to take as much as 30% of the 19.99 for the long box), I pay 99 cents per song on itunes at no cost to the production company.

This line of thought brought me back to EMS.  Let’s apply the music industry reimbursement model to what we do:

First off, you’ll be required to create unique treatment models and protocols.  Then you’ll be paid a small amount for actually providing the care requested. (no real change there, right?)

Now here’s the BIG difference:

You get 1% of your patient’s income.  For life.

Are you motivated to provide quality care now?  Will you go to any level to ensure high quality care in any location in the world?

How quickly will our industry adapt to this new model?  Suddenly the more calls we run the more we can possibly make.  Will we focus on younger patients?  Will we ignore certain neighborhoods unlikely to yield incomes worth our efforts?  I think you know the answer to that.

 

While I still don’t feel bad for Taylor Swift only making half a million a year on 1 web site for something she did long ago I also know she wasn’t in there alone and the folks who were aren’t necessarily the ones out on tour or behind her on SNL making money.  They were brought in for a day to play saxophone, record a piano solo or sing backup with the promise of a cut of the plays in the future.

Although I think billing EMS based on future income would see a HUGE shift in our comfort with pediatric patients.  Don’t you?