Category Archives: EMS

From Trade to Profession – Thoughts from a Reader

Here on the blog I’ve had a favorite photo of Johnny and Roy in the Squad and Johnny looks like someone took a steamer in his cereal. (Chet most likely)

Under it I imagine Roy saying “Don’t worry Johnny, one day we’ll be a profession rather than a trade, just you wait.”

Well, he’s still waiting.

The folks over at Webster’s say a profession is:

A field in which one is in a paid occupation, especially requiring prolonged training and qualification.

We can argue the merits of 2000 hours, but that is certainly prolonged and we do require a state license and there is even a list of folks who passed a special test and get “registered.”  It would appear that, technically, we’re there.  You can relax, Johnny.

 

However, ask any EMT struggling to get by if they feel part of a larger Profession and they’ll likely tell you no.

Reader Garrett Kajmowicz shot an email to me asking the following question in regards to being considered a profession:

“How many professions exist where you aren’t allowed to buy your own tools?

As it stands, as a paramedic, can you go online and buy your own supply of medications? How about diagnostic equipment like a heart monitor? I think that some form of legal independence is going to have to exist as a part of the trade to profession shift, though I don’t know when, where, or how.

Thoughts?”

Interesting question there, but I’ll have to go with no. Being able to purchase our own tools won’t steer us one way or the other.  Case in point, no one would argue that being a pilot is not a profession because the pilots do not own the planes.

By the way, now that I work at the airport most of my bad analogies will be aircraft related.  Sorry for the inconvenience.

Being recognized as a profession takes time.  A long time.  Some will argue that we need an over arching Federal office to oversee licenses, skills and practices.  I agree and disagree at the same time.  While many similarities can be drawn looking to our close cousins the fire service (started as slaves chained to street corners) and nursing (started as prostitutes) who both have National level organizations, cabinet positions and offices in DC, we still have no idea what we are so where would our federal agency live?

Are we in the public safety business or the public health business?

Both need to be filled but with drastically different professionals in drastically different fields of specialization.

Our trouble is that we still sit on the fence and cry that the other kids won’t let us play when both teams are a player short.  Do you want 911 or Community Paramedicine?  Can’t do both.  Those who say you can are the same who say you can’t be both a firefighter and a competent Paramedic.

In the past I’ve caught flack for suggesting I was competent in both, but have since specialized.  As my position required more focus on EMS I had to pick a side.  And did.

I say pick one and run with it.  A community can certainly offer (and would be doing a dis-service not offering) both services, but not using the same person.

You want to run 911?  I need you also swim certified, low angle rescue certified and in haz mat and active shooter training.  I need to put you in harm’s way.

You want to do Community Paramedicine?  I need you back in school. Advanced A&P, pharmacology, psych, social work, community planning, administration and education and none of this community college stuff, I need you in the cadaver lab with the pre meds.

Two distinct professions can emerge from our little trade house if we want it enough but back to the original comment from Garrett, no, I don’t think buying my own LifePack 30 (Are we up to the 30 yet?) will make me part of a Profession.

Only I can do that by lifting up my co-workers, my agency and my passion for patient care.  I would hope we are all doing the same.

What do you think of Garret’s thought?  Will being able to order a monitor, ambulance and medications, the tools of our trade, allow us to become a profession?  If so, how? If not, why not?

Tell me in the comments.

A House Divided…

Not a political post, just thinking about firing up the EMS 2.0 machine again here in my home system.  This speech keeps coming to mind.

An excerpt from Senator Lincoln’s Speech to the Illinois Legislature in 1853:

If we could first know where we are, and whither we are tending, we could then better judge what to do, and how to do it.

We are now far into the fifth year, since a policy was initiated, with the avowed object, and confident promise, of putting an end to slavery agitation.

Under the operation of that policy, that agitation has not only, not ceased, but has constantly augmented.

In my opinion, it will not cease, until a crisis shall have been reached, and passed.

“A house divided against itself cannot stand.”

I believe this government cannot endure, permanently half slave and half free.

I do not expect the Union to be dissolved — I do not expect the house to fall — but I do expect it will cease to be divided.

It will become all one thing or all the other.”

 

Would I make a good Cop? Find out what Motorcop thinks

Get over to Uniform Stories to see if my buddy Motorcop thinks I’d make a decent cop.

 

Spoiler alert:  You know I’d get lost on day 1.

Frequent Flyers

In my new spot serving as the EMS Supervisor for a busy International Airport I have had to learn a new normal.  For example, we get toned out on medical calls for both the approximately 5k-15k people in the terminal at any given time as well as the almost 140k people that circulate through the airport every 24 hours.

Gone are the days of the homeless man asleep in the bus shelter getting a 911 call for being unconscious (Who doesn’t want to be unconscious at 3am?) and here are the new unconscious calls, called in by a flight crew on final approach.

The thing I’m still getting used to, however, is that there will be an ETA included in our dispatch, often 10-15 minutes, which eliminates the need to rush out the door on every bell.  That indeed takes getting used to.  No point rushing out the door and to the gate in 4 minutes when the flight has yet to even land, let alone taxi to the gate.

We’ll grab our gear and access the jetway from the outside and wait for the flight to arrive, often having little to go on regarding the patient’s condition.  The flight crew often calls in “ill passenger” or “vomiting” but the all too common chief complaint is “lost consciousness, now awake.”

You can agree, that could be gosh darn anything.

The rules at our airport say if you call for us we get on the aircraft before anyone stands up, assess the patient and determine the best course of action.  Most often this is finding someone very embarrassed who isn’t handling the flight as well as they hoped.

We do our best for them and handle the encounter like any other EMS system.

The most interesting part of waiting for a flight is when it is an International flight.  Now not only do we have the local police, ambulance company (and their airfield safety escort) but now a whole alphabet soup of customs agents.  If the patient and family needs to be transported they will get quick access to customs and be dealt with first, right there.  They even carry the stamp on their belts.  Very interesting indeed.

 

More to follow from the Airport soon,

HM

18 year old woman dead after chasing cop with knife. Family wanted ambulance instead.

Yes, you read that correctly. What you will also read correctly is this cobbled together “news” story written to inflame your hatred of the po-po:

Worried family calls 911 hoping for ambulance, cops show up instead and KILL HER

Great work on the headline there Eric Owens, Education Editor. I guess there’s no need to think this call through as far as my 3rd grade daughter could, but let’s give it a try shall we?

1.  The family should have intervened long ago.  Years ago.  Waiting until someone with known mental health issues starts grabbing the cutlery is not the time to reach out for help.

2.  Ambulances can not make people take psych medications.  Again, see #1 “Family.”  So far we’ve identified people far more responsible for the death of this girl than the police, but let’s keep going.

3.  They called 911 “hoping” for an ambulance.  No one calls 911 and requests resources, that’s not how it works.  People call and state what is happening, the dispatcher assigns the appropriate resource for the situation described.  Speaking of which…

4.  Paramedics can not safely deal with persons who have stated their desire to harm others or who may have weapons.  Paramedics are trained to assess and treat medical and traumatic conditions.  The reason the dispatcher sent a Police officer is because what happened happens far more often than people realize: People who want to hurt others pick up stuff that hurts others.

5.  Even the 12 year old kid saw the knife.  Let’s put you in the Officer’s shows for a moment.  A woman chases you with a knife.  A woman with known psychological issues.  A woman who is not taking her medications.  Now what do you do?  There can be all sorts of outcry about tazers and tackles and other such nonsense but when it comes down to it the Officer did what they had to do to remove the threat.

6.  To all of you about to comment that I don’t know what I’m talking about, I wasn’t there, I don’t have the full story, go over to Eric’s story and comment there first.

 

Eric, here are some headlines I think better fit the story:

“Woman killed by police after chasing them with knife off psych meds”

“Officers forced to kill knife wielding woman after family fails to assure she is healthy”

“Family unable to help 18 year old prior to her chasing police with a knife and being shot”

“Ambulances do not help people take medicine”

“Education Editor writes inflammatory headline oblivious to how 911 works”

 

Motorcop has a post up that should shut up all the “Why didn’t they just taze her” folks.  Go have a read and see this situation through an Officer’s eyes.

A human being is dead because someone waited too long to help her.  Blame the family, the system, the Doctors, Obama, Bush, God, heck blame me, pick your enemy, but don’t turn this into a situation where the evil police are to blame. They were just there at her worst hour and did what they are trained to do when people attack them with knives.

 

 

Off Duty EMT and been drinking? Guess what?

You’re not an EMT.

This may seem like it’s coming from left field, and it kind of is.  One of the perks of having a website is that I get to see all the terms people type into search engines to find the site.  Until the Hangover movie I was the #1 google result for “strippers and cocaine.”  True Story.

However a google search today troubled me a touch.  Especially since they hit me 6 times with it:

“if im an off duty emt and ive been drinking” (sp)

Well, Tiger, I think you might be a few into your day already so if you were the one doing this search put the drink down and let’s have a chat.

Your search cut off a bit early didn’t it?  Was there something else there like “should I order cialis online help people?” or “will I get fired?” or “do I have to use apostrophes?”

Here’s the short answer to all your possible questions:

No.  Except the apostrophes part.

As soon as you take a drink, smoke, snort, shoot, heck even if you pop an ambien or a flexoril you’re not an EMT, you’re just you.  While I have been known to break that rule, it was because one of my close friends had been badly cut in a fight.  I didn’t go running into a situation inebriated simply because I just got signed off on splinting.

Take off the star off duty and have a responsible time doing what it is you do, but remember that anything you do while using that title or wearing that star reflects not only on you but the tens of thousands of us who know the difference between Professionalism and irresponsibility.

“if im an off duty emt and ive been drinking” yields far more relevant discussions on this topic and I hope you read them.

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.

Deposition time and a friendly face appears

As a middle manager I get pushed forward as the “expert” at certain ways my agency handles things.  For example, since I am the only one that reads through all the charts I am the default “expert” on how to read through charts.  You get the idea.

This is important when a court case comes along that a chart was written for.  This happens often since many assaults, vehicle collisions and the like end up going to the lawyers.  I won’t say going to court since it appears the system is rigged to favor them handling this all before we get to a judge.

I’ve been brought in to explain how ePCRs are created, stored and retrieved more times than I care to recall since each and every time the questions are exactly the same as are my answers.  I get a City Attorney to sit next to me and make sure I only answer the questions I’m supposed to and they often greet me in the hallway with a “The usual today” as if ordering an egg salad on whole wheat.

Every time it was exactly the same, until I suddenly sat down across the table from a familiar face.

This lawyer did his homework.

As I sat down, poured my water and readied my notebook I saw a 3 inch tall pile of clearly well handled papers, some stapled, some not, but in just enough disarray to show they had been reviewed, not simply all printed at once.  Right on top I saw a familiar face: Happy.

This lawyer had printed out at least 100 of my blog posts, news stories about the Chronicles of EMS, had photo copies of articles I wrote for magazines, photos of vendor events at conferences…you name it, it was there.

I suddenly felt a wave of panic flow over me and my wool dress coat was heavy.  He had achieved his initial purpose of setting me off my game and I did my best to recover as he launched into personal questions about my experience as a Paramedic and blogger.  The City Attorney was surprised to see all this material and at that point I wish I had mentioned the blog in our preparation.

Luckily, when we got to the vendor photos I was able to mention they are the same vendor as the medical charting system we use and my familiarity with the product is a result of those interactions.  The City Attorney made a very complex legal statement that I believe translates to, “Move along.”

The rest of the interview went as always, I describe the manner in which crews enter data, that the final report can not be edited, that anyone viewing the chart afterwards is in the log, blah, blah, blah.  The clinical interviews are far more interesting but are very far between.

After the interview the City Attorney pulled me aside and mentioned that I should have told him about the blog and I apologized.  He laughed it off and said, “At least this time you had something new to say!”

Paramedics Make the Worst Patients

We’re experts at assessment, treatment and disposition of life threatening emergencies.  We’re also good at that stuff for all the other reasons people call 911, but when it comes to more complex medical issues we are lousy at assessment and can muddy the waters for the rest of the medical community.

But don’t worry fellow medics, there is a solution I have discovered after almost 2 decades of falling into this trap:

Play dumb.

Luckily it’s a skill I know for sure you possess.  Use simple lay person terms when speaking to the doctor.  “Adverse Lung Sounds” becomes “Funny breathing noises” for example.  Leave your education at the door and use the simplest terms to describe your condition.  Over simplify it if you have to.  At a recent visit I told my MD that I thought I heard a kind of clicking or bubbling in my throat at night and it always happened if I didn’t use both pillows and even then I could still hear it.  Had I tried to describe to him that I was sure I was experiencing pneumonia symptoms all he would have heard was “Hi, Antibiotics please.”

Instead he explained the difference between a bacteria and a virus and I let him.  I pointed out that I only had 2 of the 5 signs of a viral infection and 4 of the 5 for bacterial bronchitis or pneumonia.  I then mentioned my daughter was recently given (Not prescribed) medicine for her pneumonia and she got better almost overnight.

He pondered my statement and I looked at him and said “Doc, drugs or no I just need to be able to sleep so I can get back to work.”

Prescription in hand and meds on board I can tell you that right now (18 hrs post loading dose) I awoke after almost 4 hours uninterrupted sleep after having done about the same time at least once more in the night.  HUGE improvement.

Had I gone in as a medic and explained my self assessment I keep him from doing his full assessment and he may not reach the same conclusions we do.  Had my kid not been sick with the same thing last week I’d be in the weeds.

After all, isn’t your least favorite patient the one that calls you and then proceeds to tell you their assessment findings?

Play dumb!

 

Celebrating the Voices

I hear voices.

At least I used to hear voices, before I took this desk job at Headquarters, but before that, in the field, I heard voices.

The voices woke me from my sleep and interrupted meals more often than not and always seemed to know someone was ill or injured.  Most of the time anyway.

For all my griping about MPDS, dispatchers and call takers, they still show up everyday to do a job I would fake a seizure to not have to do.

They take the confused, rambling mumblings of someone, code it, send it and away I go to deal with the problem.  So what if it’s not always what they say it is, all they’re doing is telling us what someone told them.

And many times, after listening to some of these calls for QA purposes, “told” isn’t exactly the right word.

A man is shouting to please hurry! please hurry! but won’t say why or what is wrong.  He simply says please hurry.

The woman holding the lifeless baby can’t get a word through her screaming but the voice still tries to talk her through CPR.

The whispers of the young boy hiding in the closet while someone assaults his older brother in another room are barely discernible because the call taker next to them is dealing with the screaming mother from before.

The voices belong to a group of folks who aim to bring a few moments of sanity to an insane world, and all over the phone and the radio.

Call them dispatchers, broadcasters, call takers, whatever, they still always answer the phone and will always answer the radio when you need them to.

So call up your local dispatch center and see if they have an event planned.  If not, step up and put something together.