Just in time for your next meeting, event or shift, an introduction to the initial EMS 2.0 concept is now available for download.

You can print it out and give it to a friend, colleague, supervisor, Chief or just to prove to folks that just because something is online doesn’t mean it doesn’t have merit.

Go have a look.

And while you’re there, get a T-shirt, pin and patch to help spread the EMS 2.0 word!  All profits benefit Chronicles of EMS and EMS 2.0.

I have stolen a peak at the new EMT Curriculum and had a chance to go through it word by word.

Unfortunately, there are a few sections missing that I feel need to be highlighted and returned to the standard knowledge base of every EMT in the country.

1.  Understanding Paramedic Humor – Too often I have restocked from an ambulance and when asked if I need anything else replied, ‘Get a cup of hot fat, the Beatles White album, oh, and bring me the head of Alfredo Garcia.” only to be handed a hot pack.

2.  Carrying heavy shifting loads under threat of vomit – Sounds like it should be day 1 to me.

3.  Resetting Life Alert Base Stations – See the big button with the yellow light that says reset?  PUSH IT!

4.  Spelling – When I ask you to copy down the meds list, don’t guess, simply recreate what you see on the bottle right there on the form.  Don’t go rogue and try out some new abbreviations or interpretations.

5. You are not here to save the paramedic – Turns out most of the things you’re reminding us of (C-spine, O2) are actually bad for them anyway.  I’m not ignoring their sat of 98%, I’m 2 steps ahead of you.  Now where is my stethoscope again?

6.  Pens – You carry them, they get tangled in my cape.

7.  Nurse interactions – When we hit triage and no one will make eye contact, block the entrance to the nurses station with your patient.  Don’t try to apologize, try to get their attention by making them look at what they need to be looking at.

8.  Stop pissing off the nurses – We’ll be back here in an hour and they’ll remember.  Unless it’s 6:30, in which case, let’s have some fun!

9.  Social Workers have it lucky – They get to sit in an air conditioned room and do the same interview we do, but 2 days from now, after our client has been to the ER 3-4 times for the same “hunger pains.”

10. When I’m hungry, we eat.

As reported by WPTY in Memphis, Memphis Fire EMT Kenneth Montgomery was assigned to a unit transporting a patient.  Instead of completing the transport he steered the unit to Firehouse 16, parked and went looking for a relief to take the rest of the job.

Kind of a no brainer to me and I hope to you too.

Finish the job you’re sent on.  That’s a letter in your file and in case you thought this would get you off the ambulance, think again.  Unlike many folks on Facebook, I’m not asking for your resignation, your EMT card, or anything else.

Why not?

The video posted at the news website includes certain “details” that got my memory spinning.

You see, I’ve been on this call 100 times.  I’ve even been on the call that is the 1 in a million like this, but I know that wasn’t an actual emergency and I’ll tell you why in a moment.

Using my amazing holistic detective skills I can tell you this was a morning run to a rehab center for chest pains.  I would honestly be surprised if they had to look at the map book for this one.  999 out of 1000 times the chief complaint does not match the signs and symptoms, someone will start to hospital shop, refuse a 12 lead ECG etc.  Treat every job like that 1 in a million until proven false.

I have no details as to the patient care or condition in this circumstance so don’t even comment that I’m not being compassionate.

I do have one set of details that, had it been happening, the press would have mentioned it for sure:

No lights and sirens to the hospital.

We can debate the benefits of playing Paramedic Pinball code 3 to the hospital, but it can tell us a lot about what may or may not have been happening in the back of that ambulance.

Had this been a code 3 return Mr Montgomery would indeed be facing harsher punishment from the likes of me, but having recently taken a promotional exam that dealt with similar situations there are a number of statements I need to gather before passing on a recommendation for disciplinary action:

1. Interview the call taker and pull the E911 tape to confirm the call.

2. Interview persons at the scene as to the disposition of the crew.

3. Obtain admission condition and discharge condition of the patient.

4. Interview Paramedic in charge of patient care.

5. Interview Mr Montgomery as to his thought process and justifications, if any.

and most importantly,

6. Were there actually any rules or regulations broken?

Is there a rule in your system that mentions being required to go straight from the scene to the hospital?  Even something as vague as “Timely Discharge of Orders” might stick to the wall, but my guess is Memphis is about to get one of those rules that can be traced to a name.

Mr Montgomery, what you did may not have been right, but it brings us into focus in a way we don’t need.  I’m sure private ambulance companies will be mentioning this event at the next system bid for sure.

Justin Schorr, FF/NREMT-P, WhO.C-arES

Emergency Services seem to thrive on certificates.

I’ve got some paper on my wall, I’m very proud of it.  At times I mention it behind my name when trying to gain credibility for what I am writing, saying or presenting.  People pay more attention when they know you are trained in what you are about to tell them, right?

But looking through some old files a few days ago I came across my last college paper “Shortening the Chain of Survival” in which I studied and showed the importance of, wait for it, early ALS intervention.

What bothered me right off the bat was how hard I was trying to establish myself on the title page.  I included my rank at the time, my NR status, my MICU cert and 3 more abbreviations I had earned at school.

I sure was trying hard to prove that paper legitimate, perhaps not relying enough on the paper itself.

Wandering through some recent issues of the leading EMS magazines and articles on leading EMS websites (blogs excluded) we can see folks doing the same thing.  An article is submitted and, as if to make us believe they’re an expert right off the bat, the letters start to get added to the name. RN, NR (Which I just noticed mirror one another) MD, BSN etc etc.

As a struggling profession it is as if we are clinging to any semblance of formal education to catch up to the MD, RN, BSN, PA etc, sometimes without reading through the things we propose to let them stand on their own merits, just like that paper I found.

Talking with a father and son Firefighting family at FDIC, I saw a generational divide on the perception of the letters after the name.  The father, near retirement, wanted to hear more about the letters I had earned, while the son seemed more interested in what can be learned on the job.  Book smarts vs street smarts all over again.

There aren’t many high school kids writing policy these days, however, no matter how much it seems like it, so maybe a touch of credibility is warranted.

When we present something, an idea, a new protocol, procedure or concept, perhaps one set of letters is appropriate, but let’s call it good there, shall we?

Today was my second day helping to set up the newest Engine Company in the SFFD, Engine 51 in the Presidio. Today was day 4 of the new services provided and the contractors working at the old firehouse are flying. Last I saw the house it was still dirty and disorganized. Today the painters were touching up while the flooring folks were starting on the final rooms.
I’m collecting photos to put together in a before and after post, so keep an eye out for that.
My next scheduled day on the Engine is after we are all moved in, so that will be interesting for sure!

New paint, new flooring, clean cabinets and bed frames.

The rest is up to us.

Not “us” the SFFD, but “us” the 15 Firefighters, Paramedics and Officers staffing the Company.

This morning we heard word that some of the other firehouses around the City have pledged to donate extra pots, pans and some plates and cups to us to help get us going.

It really is like one big family out here.

And in related news, some of the firefighters previously employed by the Park Service started an abbreviated SFFD Academy this morning.

HM

Break out your green and yellow backgrounds everyone!

“Welcome Back” doesn’t seem right since you were never really gone, just on a long job.  Now you are back home.

Over the next few weeks you’ll be hearing from me about the Tak Response Conference in San Jose coming up September 14th-16th.

Chronicles of EMS was invited to be a part of this collaborative training opportunity that will bring the best of all fields together to network and learn from each other.

This conference combines nursing, Fire, Haz-Mat, law enforcement, SWAT, EMS, public works and a number of other disciplines together, since when we all arrive on scene we have to work together.

Let’s start to train together.

Tak Response is not only a chance to learn from other disciplines where you fit in at “their” scene, but to network socially with your fellow providers before the you know what hits you know where.

Imagine a scene where the Battalion Chief, Patrol Officer and EMT all already know each other and what each agency expects from the others.  That’s a smooth running scene.

Here’s the episode of Seat at the Table where we meet the organizers of the Tak Response Conference and run the concept by paramedics, firefighters and even a cop.

You all know I am not a fan of little boxes.

I dislike the little boxes we have to cram our patients into to treat them based on chief complaint.

Also on my list is the little boxes we take them to the hospital in.  Bolting a box onto a van isn’t enough.  More on that another time.

On the top of this list in big red letters are the little boxes our call takers are required to fit their callers into.

They must meet criteria in order to be coded, qualified, weighted, and then sent out to the trauma hungry troops on standby all over the City.

Problem is, it doesn’t work.

I do not know Dr Clawson, but I do know his system and that, if a system can correctly act on the information gathered and coded, it works most of the time.

What really gets me going these days is the purposeful miscategorization or non categorization used to move calls out of the call center faster than they need to be.  I am not alone in this experience, getting messages, tweets and emails from folks all over the USA asking me what they can do to improve dispatch.

You can’t improve dispatch.  Not until you improve the callers themselves.

One of my readers described it as GIGO (Garbage In, Garbage Out) meaning, in the most respectful of terms, that dispatch should not be changing anything the caller says and that if the caller is wrong, then I do hope my dispatcher is wrong as well.  If a person calls and tells the dispatcher that the space shuttle has crashed on main street and thousands are dead, maybe it did.  But the problem lies in sending that call out before it is coded.

The two most inexperienced people in the system are the ones guiding the system.  The caller and the call taker.

I have never been to a call that was reported, coded and turned out to be the same thing, mainly for the same reason my patients’ chief complaints never seem to jive with my treatment per protocol:

They don’t fit into your pre-determined boxes.

Many systems run a BLS tier, or perhaps a single paramedic resource to handle Omega, Alpha or even Bravo calls.  Here in mine, there seems to be no rhyme or reason to the assigning of resources on some calls.

A call coded by the system, based on information provided by the caller, to the call taker has been declared a 26A1, a sick call.  Yet in the call classification next to the code is the term BLEED-SEVERE.  And now the call becomes a code 3 and 6 or more lives are at risk.

“Better safe than sorry, right?”  Good thought.  Who is in more danger?  The person who bit their lip and called 911 or the 6 responders using red lights and sirens to respond to the call now thought to be more than it is.

“Then what’s the answer, smart guy?”

Ditch the codes.  Stop the tiny box requirement.

If they call and say “I bit my lip,” Dispatch it as such.  Let the responders apply calculated risk to the situation without being blinded by administrative tricks used to ring the bells faster, improving your call center stats.

If you can send a call out in 30 seconds without gathering all the information, that is not a success.

I am not blaming dispatchers.  That voices that tell me where the sick people are are not the ones in control of the dispatch system, but the ones required to work within it, not unlike me not liking aspects of my treatment protocols.

GIGO.

They relay what they are told and code the call.

It is the trick of changing the code or description that I don’t like.  That is how the cut fingers, bit lips and sleeping people send out a full ALS response and drain the system of resources at a time when we are getting stretched thin.

By changing from a criteria based system to a “plain text” system, two distinct things will happen.

Firstly, crews can use their judgment, ETA and experience to determine their response priority based on what the caller actually said, not what the system thinks they might be saying.

“My back hurts again” is not coded as “Non-Traumatic Pain-Code 3″ so the crews can apply their expert training to audit the dispatches in real time.  I worked in a system like this and it worked.

Secondly, it will become very complicated and difficult to classify and track types of calls for analysis after the fact.

“We don’t know how many CPR calls went out last quarter because we have to go back through each call instead of just pulling the codes.”

A recent study by UCSF and SFFD Medical Director Karl Sporer celebrates the finding that 1 out of 7 reports of a rescusitation in San Francisco turned out to be just that.  You can’t find stats like that celebrated outside of baseball.  1 in 7 was a success.  I see the 6/7 mis-reported or mis-coded calls as room for improvement indeed.

All the studying, testing and nervousness has paid off and you got that paid spot!  Only problem is the commute, 1.5 hours each way 3, towns over.  But, it’s with a good company and you hear great things about them.

Your first day comes along and you arrive at the ambulance yard, clean new uniform and gear, only to discover you were hired over many of the senior part time folks who also applied.  Needless to say they aren’t thrilled by your arrival.

During morning check out you are assigned to a brand new EMT-Basic, ink still wet on his card, who is not familiar with the roads, equipment or hospital locations.

Gulping your coffee, you decide to head into the supervisor’s office to see about a reassignment, at least until tomorrow.

“Nobody else wants the new guy, or gal, so make do.”  Is what you’re told.

Back to the rig and gear is checked but your narcotics are low.  Back into the office the supervisor tells you they don’t have a license for narcs, you’ll have to restock with the FD in the next town.

Something is off for sure.  Is this a test?  Some kind of cruel first day prank?  At the end of the first shift you feel like tossing in the towel but a friend reminds you that their are no other companies hiring anywhere nearby.  2 local ambulance companies recently went under and the remaining one isn’t hiring.

Keep the job and most likely the house and the car payments relying on it, or get out while you can?

You make the call.

There will be no Monday follow up to this week’s situation, it was sent as a request for advice to thehappymedic@gmail.com.  If you have a situation and you’d like to ask for a wide variety of insights, send it in, no name needed.

Ah, a day off! You’ve decided to head out for a few quick drinks with friends and meet at a little restaurant/bar in a quiet suburb. As you try to describe to your fire and PD buddies about the culture at an event such as EMSExpo, they ask if folks wander into area bars in uniform.

Replying in the negative, they laugh and ask if folks wander into bars in uniform wearing stethoscopes.
When you glare at them they laugh and point over your shoulder to the other side of the bar.

Seated at a stool and drinking a beer is a fellow in EMS pants, a blue shirt with a large “EMT” on the back and, sure enough, a stethoscope around his neck.  The shirt shows no company or department name and he is wearing no ID you can see.

While you try to make sure you are seeing what you are seeing, your PD buddy says, “Well, are you going to say something?”

You make the call.