The power of the Blog

Mark has chimed in about an update to the Project, the Trans-Atlantic Paramedic exchange I’m always reminding you of. Pop over and read his post, answer his question, then come back for my thoughts on whether blogs are bad.

It seems that the powers that be on both sides of the pond are still nervous about the reality of patient confidentiality laws, and rightly so. It is understandable to be worried about litigation if one of your people is blogging, facebooking/Myspacing or tweeting the address of a patient, a patient’s name, history, likeness or scene photo, but what about those of us trying to make an impact on the Profession of EMS?

These same supervisors who are nervous about Mark’s blog being perceived as NHS driven and my supervisors to even allow me to tell you my name, surely sit down with other professionals and share tales of “the big one” or “the call that went wrong.” Are those violations of privacy rights?

What about ACLS scenarios? Each time we enter the classroom we are encouraged to share stories of patient outcomes and interventions. Are those violations of privacy rights?

Many of you may be shaking your heads and saying, “That’s different, it’s not in the public realm,” I say sure it is. I go home, tell the wife about a rough call or scenario in class, she tells a friend, etc etc.

We share information all the time, and mostly even more details than have even been shared in this arena. Privacy is so private that people will scream for help on a busy sidewalk, then refuse to give their name because they don’t want a bill. Will rail on and on about their medical history, in front of dozens of strangers, then I have to get a form signed saying I promise not to share their information with anyone outside of our billing system. That’s makes sense, right?

I took this opportunity to re-read the Health Insurance Privacy and Portability Act (HIPPA) and find out once and for all if what I’ve been doing is allowed. Here’s a shocker…yes.

From the text of HIPPA:

What Information is Protected

Protected Health Information. The Privacy Rule protects all “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information “protected health information (PHI).”12

“Individually identifiable health information” is information, including demographic data, that relates to:

  • the individual’s past, present or future physical or mental health or condition,
  • the provision of health care to the individual, or
  • the past, present, or future payment for the provision of health care to the individual,

and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. §1232g.

De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15

Take note of the “and” following the bullet points under Protected Health Information. If I post about someone who, even if I change all the information, can still be identified by someone not there at the time, it becomes questionable.

I understand the reason for privacy rights, believe me, but I also understand how sharing information of a non-sensitive manner can help move our understanding of this Profession forward by leaps and bounds.

I don’t know what privacy laws are relevant in the UK, but I’m sure Mark is well aware of his limitations, as evidenced in his post.

Blogging can do harm Mark, when done recklessly and without respect to our patients, clients, employers and co-workers.
But when done following the intent AND letter of the law, it can only help.

I’ll explain more when you pick me up from the airport in Newcastle during our blog born EMS exchange to advance patient care. But keep that private, OK?


Not in that sense, I steer clear of that here, you all know that.

I mean the politics of EMS. I mentioned a while back that I sought out and was appointed to a seat on the local EMS Committee in my community. At my first meeting I was a nervous wreck thinking I was way out of my league amongst industry reps and MDs with years and years of experience. I sat in the corner and said nothing.

This most recent meeting, I pitched the Project and they loved it. Everywhere I mention this opportunity, folks are interested in our differences and our similarities to our friends across the pond.

I had the opportunity to have a few words with the Medical Director who empowers the Paramedics who will treat my family and I had to smile. His thoughts on the Project were great and where he wants the system to go are progressive and treatment based. He showed interest in the Advanced Practice Paramedic concept as well as expanding the State’s Paramedic training. Champion.

They also want to hear about what I learned from the Project when I return.

So now the pressure is on to gather as much information as I can on this exchange. I’m not looking to adopt a socialized response system, that won’t work here. I’m looking for ideas that can reduce our requirements to default to transport to the emergency room. I’m looking to see if the rapid response model might work in my department to ease the burden on some of the nation’s busiest ALS engines.

And on top of all that, I’m looking forward to finally meeting my friend Mark.

If you’re also interested in meeting Mark and will be in the Northern California area around November 12th, let me know and we’ll get together and talk shop.

And even though anyone paying attention knows exactly where I am I still need a bit longer to “come out” to you. It’s a big deal, you know, but will be revealed as we promote the Project. Baby steps, hence the new banner.


Plane tickets to England: $1000

New laptop for trip to England: $399

Seeing the fast response model first hand with a new friend to show the way: Priceless.

Clear your blog calendars in November friends, Mark and I are on a mission.

the Project is a go.

the Project

The details of the Trans-Atlantic blogger Paramedic meet up better known around here as “the Project” are starting to gel and a tentative date has been set for the start.
I will now jinx the Project by posting details before they are concrete.
Medicblog999 and the BBC will arrive the second week of November and I’ll head out there after 6-7 days of filming and stay until the Thanksgiving holiday.

With that in mind, I am preparing to write up my official assignments request to the Chief describing what experiences I think Mark should have when he arrives.
Although what we do may differ from what you do, I want to give him a solid understanding of what it means to deliver EMS in a fire model.

So, I want you, my readers, to chime in on what you think Mark should see or do on his ride alongs with Happy. I have already worked out time on a lone engine company, an engine in a triple house downtown and scattered dynamically deployed ambulances. (Our 24 hour cars will all be closed by the time he arrives, including my beloved 99).

But what else should he see?

Here are some suggestions of what I would like to see, but can’t fit it all into the time schedule we have:

Mark tillering downtown on the 100′ ALF (With help and supervision of course)

A drill in the smoke house or at the tower

A ride with our heavy rescue squad

A cruise on the fire boat

A low angle rope rescue drill

Make Let him cook at the triple house (Engine, Truck, Squad, Division Chief – 15 people!)

A ride in the helicopter (Oh wait, we don’t have those here)

A blogger meet up opportunity for folks in the area (You already know where I am, remember, I won’t tell you) to come by and meet Mark while here.

What of these would you like to see Mark do? Do you have another suggestion? Remember, this is mainly to show him EMS delivered from a fire model, not a comprehensive evaluation and comparison of EMS from different regions. Maybe he’ll head your way next year, but this year he’s dropping by my neck of the woods.

the Project

You heard it on the EMS Garage podcast, didn’t you?

That’s what sent you linking over here to confirm the seemingly impossible.

Two Paramedics, worlds apart, who ask each other never ending questions, will indeed meet to not only discuss their differences, but find common ground, all the while being filmed for the world to see.

Medic999 and myself have been comparing our systems for almost 10 months now, each finding the strengths and weaknesses in our own and comparing them to what we can learn of the other. With ambulances able to redirect patients and supported with rapid response cars, I am curious to see this system in action.
Hearing that I serve as a Paramedic from a Fire Engine, Medic999 is curious to see how a 4 man resource can multi-task from fire to EMS and back.

Wouldn’t you know it, the BBC has taken interest in our mutual curiosity and will be recording each of us showing the other how our own system works, then switching places. Mark will ride with me, then I with him, all on camera.

I hope to learn from this project how to better serve the clients in my area, both with EMS care and fire protection, without overlapping services and making one rely on the other. I will be blogging, twittering, facebooking and sending smoke signals from here until the project is completed, letting you all in on what I am learning and what I like and don’t think will work in the current “for profit” American systems.

Some who read these pages may think Happy is all about a solicalized, government run system. Reading some of my more political posts, I can see how someone would reach that conclusion, but I’m simply searching for something that can help a unique system like mine do more with less. If I get there and don’t think it will work in my system, count on me to give it to you straight. Clearly they like it, I want to find out why.

I hope you all will come along with us, both online and possibly in person, depending on where you are. And of course be sure to watch the finished program when it airs. When that is, I will let you know.
As they say over the radio: Details to follow. Stay tuned.

I told you we were going to change the world. What did you think I meant?

The Brass is about

Tuck in your shirts and zip up your boots everyone, Happy Medic’s bosses have been made aware of our little therapy experiment in anticipation of a major announcement.

I hope they find Happy Medic Head Quarters to be a place where a tired Medic found friends who understand and a chance to make things better.

For their benefit I would like to remind all of you that the dispatches shared here are from all over my career and every detail that can pinpoint a person has been changed or removed, but never “imagined” or “created.”

Since they are just now finding out in an official capacity it goes without saying (but I’m saying it anyway?) that they do not endorse, support, officially sanction, reimburse or supply any means for me to keep this thing going. Aside from letting me work. This is my forum, not theirs.

I am simply letting them in on the blog so that when the project happens, it is no surprise.

Welcome Chief, I hope you find a smile. Feel free to leave a comment, if you like. That goes for everyone.
Here’s a crash course on what the Happy Medic is all about:
The beginning, getting noticed, frustration, You make the call, memories and the man in the green jumpsuit discussions begin.

So look alive! Polish that diamond plate! Mop those floors! Study!

Your Happy Medic