Category Archives: EMS

Open, Pending

As the default Risk Management guy for my agency (until the new gig kicks in that is) I get routed all manner of citizen complaint that has anything to do with the Ambulances.

As a result I often have the opportunity to do some public relations work right there on the phone.

Did the mean Paramedics stab you with a needle?  Let me just take a look at your chart here…oh.  It says here you’re a known diabetic and had a blood sugar of 21.  Yes, Sir.  Yes I understand you have trouble remembering to take you medicine.  Yes I do think they should have woken you up first before stabbing you with the needle.  But here’s the thing…

Problem solved.

Most complaints seem to come in about 2-4 weeks following the date of service.

Our billing turn around is about 2-4 weeks.

Total coincidence I’m sure, but every now and again I get a phone call that brightens my day.  Often it has to do with someone most certainly under the influence of a central nervous system depressant and their attempt to recover said intoxicant from the Paramedics that took it.

Take Eddie Dean(Not his real name, but think of Eddie from the Dark Tower series).  Eddie called me doing his best Tommy Chong impression, right down to forgetting to answer some of my questions until after I ask “are you still there Eddie?” “Wha?”

Boils down to this:  Eddie is refusing to pay the ambulance bill because the Paramedics stole his marijuana.  Tough part on this one is that Eddie seriously needed some aggressive ALS care a few weeks back and I’ve got a gold star chart to prove it.  He mixed up a few prescriptions for a few diagnosed ailments and…BAM…altered, parastesias, the whole 9.  Most complaints revolve around fizzled attempts at a Lawsuit Chart, which still has to be paid prior to their surely losing case being heard.

Eddie is worried the Paramedics thought he was high at the time, which he claims he was not and I believe him…until he starts to try to explain how high he is right now.  While on the phone with me.  “Like…like right now, I’m able to smoke some and feel good, but I didn’t smoke a lot that night.”

He swears his girlfriend can corroborate that the Paramedics took his weed so I ask for her number to call her.  Eddie didn’t think that all the way through and is asking that I not call her right away, that he needs to call her first to tell her what to say.

Smooth move, Eddie.

On the answering machine at my office is a message that ends with “If this is a pressing clinical matter, please call (my cell phone number).”

Eddie left me three messages yesterday (Saturday) moderately sober and begging me to call him immediately so I can talk to his girlfriend who “can tell you more about what happened because I talked to her already.”

So now I get to hang onto an open file about how while in the midst of a code 3 scene time of less than 11 minutes  at an 8th floor apartment, my crew somehow had time to grab a few little green bags.

Marked:Open, Pending

 

C-Spine Policy Rooted in Science

Friend of the blog Nick Williams sent this on from a Reddit feed.

VMtHUmF

The future is here folks. Long spine boards are no longer the standard of care.

Speaking of the future, I posted all this from my phone. In my pajamas. While drinking wine. #micdrop

A Big Move

I’ve been cryptic about things recently, and for good reason.

Those of you following on Facebook noted last week that I was preparing for an interview, but never explained for what.  Yesterday I got word that it went well.

Starting July 1st I will be assuming the role of EMS Director for the newly formed Detroit Unified Healthcare Service which will rebuild Detroit’s EMS service from the ground up.

Plagued with difficulties for decades the DUHS will erase the problems of the past and build on an EMS 2.0 platform of prevention, home visits and has already connected with a vast network of secondary transport facilities.

Upgrading salary, training and service levels are just the beginning!

More details are to follow as the official announcement will be made on Friday at a joint press conference, we’re still working on getting the house sold here, didn’t expect this to happen so quickly.

This is an exciting time to say the least and I’ll miss the SFFD but this is an opportunity not to be missed!

 

Interested in coming along?  We’re hiring! Detroit United Healthcare Service info

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Comments on ‘a flickering flame’ by Captain Chair Confessions OR How to confine burnout to the area of origin

Fellow EMS Blogger Captain Chair Confessions (CCC) has a post up that will likely sound familiar to anyone who has spent more than 10 days in EMS.

CCC is experiencing the first smoldering effects of burn out.

The reason CCC is going to recover and grow from this experience is their ability to come out and talk about it.  Granted, it’s more of a 1 way conversation considering the way the interwebs works, but it’s enough.

Simply recognizing something is happening is the first sign of recovery believe it or not.

I know CCC is feeling more than they are writing, and that’s OK, because everything will come out in the end.  Every emotion, every angry thought hidden by a forced smile with teeth clenched on a transport everyone knows is unnecessary, everything will see the light of day.

That flickering flame CCC is feeling is easy to ignore and is often missed because of pride.  Misplaced pride, but pride just the same.  We tell ourselves that we need to toughen up, grin and bear it, grow a pair or some other lie we tell ourselves and ignore the growing flickering flame.

Worst part is, at this small stage the flame is easy to extinguish.  Even the softest of breezes causes it to waver.  Believe it or not, simply saying your frustrations out loud can be enough to knock down the tiny flame.  Of course the fuel still remains and needs to be dealt with, but try taking a candle apart while it’s burning and you’re going to get hurt, spread a fire and be in worse condition than you are now.

The amount of fuel in EMS is staggering and I’ve seen shovels on both sides adding more.  Admin needs more transports to meet payroll, response times need to be faster, posting moves aren’t efficient enough…you know the complaints.  At the same time patients are getting less and less emergent and are calling more often looking for the quick service we’ve spent 40 years convincing them they needed.

Somewhere between a missed lunch and an angry call from the QI Captain you run a call like the one CCC had and the flame is back, flickering away in the back of your mind, ready to grow unchecked as soon as it can.

Don’t ignore that flickering, fluttering light.  Talk to someone, anyone, write a letter and throw it away, get the frustration out of your system.  Ever heard of screaming?  Go for it.  Find a local supermarket and ask them if you can borrow their walk in fridge for a minute.  Shut the door and scream.  Go ahead, I speak from experience when I tell you that the sky is a little brighter when you emerge.

From there attack the problem.  Get involved, get active and if things can’t change, then you have to.  Staying in a broken system that refuses to change isn’t healthy for you or your patients.  Move.

Again, from experience, it helps.  I got up, got out and landed somewhere where I eventually, just this last week, had a chance to rewrite our C-spine precautions policy.  And it might just pass.

It took a long time to get where I am, but the flickering flame I spotted when I got hurt was doused when I first stepped into this little room on the internet and began to scream.

And CCC is doing the same thing.

Keep strong Brother (or Sister)!

 

If you feel that flickering of burn out and want to vent, drop me an email, I’ll read it, or not, whatever, just talk to someone, anyone.

You’ll be glad you did.

@KYECOMMUTENBC

Proper use of Long Spine Board pre-hospital

Friend of the blog Nick Williams sent a photo to me about Monday’s commuter train derailment in Chicago that left over 30 injured.  It was upon closer inspection of the photo by KyeCommuteNBC that I almost spit beer onto the screen tonight.

Take a look at this photo for proof that long spine boards are an important tool in the pre-hospital setting.

 

@KYECOMMUTENBC
@KYECOMMUTENBC

Without that long board, someone could have been injured…

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Missing the Grind of the Lightbar

I was doing some math and realized my career in EMS has reached past middle aged.  I have 18 years in and 17 to go.

It made me think of how I am still perceived as a new guy by some and an out of touch almost dinosaur by others.

Thinking back to the early days of when I realized this was what I wanted to do brought back some memories many in this field will never experience.

 

For example:

Manual transmission water tender.  My first paid unit was a 1970s 10 speed double clutch 1000 gallon water Tender.  I learned to drive code 3, work the siren and shift, all while reaching a top speed somewhere in the high 40s.

But as memories went through my head of that beast of a unit a certain sound crept into my head and has stuck for a few days:

 

The grinding of the rotators in the lightbar.

While some of you might still have an “old” rotating lightbar, most of you are likely used to all manner of flashing light bulbs and diodes.

Back in the olden days we had lights that turned on and spun around in circles.  Our old rescue truck on the Reservation had 3 bright white lights mounted on a 12″ diameter spinning disk covered with a sun bleached almost still reddish pink cover.  When you turned it on and pulled out of the station is spun slowly.  When you pressed the button for the old Federal Q siren mounted on the front bumper it would slow and almost stop.  It was not uncommon to reach the scene and go to work only to see the beacon slowly begin to dim as the alternator on the ford pickup could no longer keep it shining and turning.  It was later upgraded to a strobe light and we thought that was the neatest thing ever.

On the ambulance was the Code3 standard lightbar of the time, 2 rotating lights and a series of reflectors as well as intersection lights that swept back and forth on each side, apparently designed to get the attention of drivers coming from the sides.  Those rotators were noisy!

That grinding was constant, loud and almost annoying.  And they were especially annoying if one of the reflectors got dislodged and stuck while on a run at night.  Or in the snow.  Or in the rain.  Or at all.  A single beam of bright red or white light trying desperately to distract you from looking at the road.  And Gods help you if it was an intersection light that got stuck!  That was worse than driving code 3 with your alley lights on.

 

Nowadays the kids have these LEDs that blink in ever impressive patterns.  For those noobs unsure of exactly what I’m talking about when I mention the grinding of the old rotators, imagine how much nicer your drive would be without the high beam flasher motor clicking away under the dash.  You’ll be glad when it’s gone, then 15 years later remember when things were bigger, clunkier and less efficient and miss it ever so slightly.

 

All Stop! Quick Quiet!

It’s been a while since I took one of those famous blogger breaks and considering the time between posts these days you may not have noticed me stepping away from the keyboard for a bit, but I need to do so for a little while. I’ll leave it vaguely there.

-HM

Up to and including death

This is a phrase I see a lot in my line of work.  There are a number of variations including another favorite “seizure, coma, death” that are designed to cover the hind quarters of the author in some half cracked attempt at documentation.

For you folks out there who will swear up one side and down the other that you were told by an EMS Anchor that if that phrase isn’t included you’ll goto court and get sued for malpractice, just take a deep breath and relax, Sparky.

Your local policy likely includes guidelines for patients to be eligible to refuse transport, care or a combination of both in certain circumstances.  For example, the patient must be alert, oriented and not under the influence of alcohol, understand the risks involved with refusing an assessment or transport and sign acknowledging that they understand…you know, the basic stuff.  When I see so many less than EMT-Basic calls being completed and the risks of refusing transport for a hand abrasion include “patient advised of all risks including seizure, coma, death” I have to shake my head and laugh.

Funny part is that this blanket statement calls into question the rest of your document most times.  Do you really believe the hand abrasion will lead to death?  In what fashion?  If it is such a risk, why isn’t the patient being transported?

A more accurate statement could be “patient advised of risks of infection and advised how to avoid repeat injury.”  BAM!  That simple statement covers you far more than the giant heavy blanket of death.

So dial back the drama and have an honest discussion with your patients, otherwise get ready to explain to me or someone like me why you were worried this was a possibly mortal wound.

Mixed Signals at Youth Detention – NOMA

I was asked to accompany my supervisor to the local Youth Detention Center where they’re running a couple weeks of a modified almost career day program. They’re bringing in trades and professions from TV makeup to EMS and showing the kids that they don’t have to give up the hopes of moving on with their lives when they get out.

I think it’s a great idea since simply putting someone in a room and waving a finger at them seldom produces change in behavior. My 7 year old could have told you that.

We had a presentation prepared about the history of EMS, local and State requirements to achieve licensure and what to expect on the job. We had pros, cons, salary expectations and, most importantly to them, what your background needed to look like.
They were very interested in learning about the sliding scale of background infractions that will still yield a job taking care of people on their worst days. This many years without a conviction in this, that many years without 2 or more convictions in that…they were riveted and you could see them doing the math in their heads. “If I get out this year and don’t re-offend I can be an EMT in 4 years!”

The Company Man in me was on board with the message of inspiring these youths to look beyond their transgressions and wipe the slate clean. An opportunity awaits them to possibly get a job with me helping people.
Everyone deserves a second chance in life, especially the young.

Not on my ambulance (NOMA).

That’s what the EMS 2.0 inside me said. During the presentation I did my best to explain to the class just how easy it is to get an EMT cert.
“Only 120 hours of class needed guys!”
“2 days a week for 1 semester at the community college and you’ll be able to take the test. Pass it and you can apply to work on an ambulance!”

The conflict within me was well hidden I assure you.

While I agree that these kids need this message of how easy it is to get into EMS, I don’t want it to be so easy.

Taking care of people takes blind trust on their part assuming that the agency responding has done something to make sure you are a trustworthy person and are trained to take care of them. We extend our message of EMS with the promise of lights and sirens, driving on the wrong side of the road and try to temper that with tales of 911 abuse, vomit, urine, blood and guts. All this group seemed to be interested in was why my stripes were silver and my boss’s gold.

They’re kids.

We need to take this message to EVERY school and get kids excited about helping people and being selfish about it.

Yes, I said selfish. I don’t do this job to help people, I do it because the feeling I get from helping people is addictive and better than anything I know. I help people because if I don’t I don’t feel right. Trying to convey that message to a group of young men already 2 strikes down and out of their league doesn’t translate as well as one may hope.

One of them asked how we handle dealing with sick people and I told them it’s easy. It’s taking care of the people you shouldn’t want to that is hard.

I told the story of the child abuser that was confronted by a neighbor. The child had been transported by another crew and I was called to deal with the abuser and his mild injuries. That man got the exact same high level of assessment, care and transport as my mother would have received. Not because it was the law, or policy or the right thing to do, but that’s what I was there for. My sole purpose was to help those who asked and I did it with a smile on my face. Maybe not the biggest smile, but I helped and I felt better.

I wanted to share more about the realities of EMS with those kids but we ran out of time.

We didn’t talk about burnout, divorce, poor dietary habits, the sedentary lifestyle of 12 hour system status cars or the fact that in most communities you’ll need a second job to make ends meet.

In the end I don’t think it will matter.

The Company Man in me will apply whatever standards my employer sets forth when considering candidates, regardless of personal belief or Professional discretion. But if I was the boss, even if you carried the same license and all other things being equal, I’m hiring the kid that WANTS to be here, not one who took the easy road and wants to give it a shot because it took less hours than welding at the local college to get qualified.

Am I wrong? Maybe, but at least then I’ll know and can move forward.

What are your thoughts on reaching out to troubled youth about jobs in EMS?

Ambulance Response Time Resolution Theater

A Paramedic I work with in CQI and I were having a conversation that was originally aimed at discovering the best way to handle complaints that had no merit.
You know the complaint:
“your paramedics stole $8000 from my wheelchair when they took me in for a swolen toe”
or
“I was almost late for my podiatry appointment…”
We also discussed how to respond when someone mentions a minor issue and follows it up with “II don’t want to get anyone fired or anything but…”
Apparently telling them “Oh, no one is getting fired. Not for using the siren on your street when you told the call taker your husband couldn’t breathe.”
But our conversation yielded a brilliant idea I don’t think anyone has tried before:
Ambulance Response Time Resolution Theater.
Here is how it works:
Someone calls in complaining about the time it took to get an ambulance for a minor issue, that they were taken to the wrong ED even though transport was not indicated etc etc. In other words, most of our clients.
When they call in, tell them to come by at 4:30 on Friday for a formal apology. If 4:30 isn’t when your cardiac arrest survivor comes in to meet the crew that saved them, then adjust as necessary. Tell the complainant they can sit in if they like but you’ll need to address the heart attack first.
They may not connect the dots but it sure will make you feel better.

cialis