Archives for the-project
Thanks to the Chronicles of EMS, both Mark Glencorse and I will be attending the JEMS EMS Today Conference in Baltimore, Maryland, March 5th and 6th.
It’s a big deal for us to be able to spread our message to as many people as we can and there is no better way to share ideas than face to face. Even though we can communicate here in the internets machine, Mark and I didn’t really see what each other meant until we stood shoulder to shoulder in each other’s systems.
Since it will be a little while until we can get to everyone’s systems and learn from everyone how best to deliver EMS, heck even what EMS means anymore, we’ll travel as much as we can to meet you and keep the dialogue open.
That’s where our sponsor ZOLL Medical comes in.
SFFD Zoll Rep Roy Kniveton was kind enough to give the Chronicles of EMS team a run down of things coming from Zoll and let us put the new E Series through some quick tests. Not any of that scientific lab type stuff, but medics dragging it around a room type tests. Roy even offered to let the 100′ aerial ladder truck run over it to show it’s durability.
The truck officer declined the request.
But aside from coming in and letting us see what was new, Roy actually listened when we told him about our growing following. He was genuinely interested in the EMS 2.0 movement and did some quick searching to see what we were interested in getting from our equipment in the future.
We must have done something right because our near future included a generous sponsorship in our pilot episode and flying Mark and me to Baltimore for EMS Today. We will be Zoll’s guests at their booth and we’re looking forward to meeting all of you and answering questions about the Chronicles show, new concepts coming in social media TV and anything else you want to talk about.
I’ve never had anyone fly me anywhere before.
And to EMS Today no less. Check out the web page HERE and look for JEMS Editor in Chief AJ Heightman to wander in to give you the details on all the exciting things happening around me and Mark. Yes, there will be more than us ruggedly handsome frumpydumple fellows.
If you get a chance to make the premiere of the Chronicles of EMS in San Francisco on Feb 12th, we’d love to have you, sign up to let us know you’re coming HERE. And a special thanks to EMS1.com and AAM Consulting (Randy Africano) for sponsoring the premiere event at the Hotel Frank. More about them soon.
See you in SF.
See you in Baltimore.
It all comes down to this meeting doesn’t it. The entire project, everything I hoped to learn comes down to sitting with Mark’s supervisors and policy makers in the UK and making a solid impression that American EMS is not awash in profit driven patient care.
But then again, we kind of are.
I started the meeting starving hungry from my hours in the dispatch center downstairs and was told this would be a kind of working lunch meeting.
Sandwiches and various appetizer type dishes were brought in and my personal favorite, fresh coffee. The conference room at the NEAS appeared to have been recently remodeled or redecorated as there were literally dozens of legal sized computer generated signs reminding those reading not to place cups directly on the table.
So what do I do?
Yes, and luckily I had Peter right behind me to place a saucer beneath the cup and shoot me a “Hey stupid” look. It was in this framework that the rest of the administrative team made their way in and began a presentation on the stats of the NEAS. Population, call volume, etc.
It was made clear to me ahead of time that Fiona, the Chief Executive’s aide, had prepared the presentation and Simon Featherstone gave credit where credit is due.
Mr Featherstone, the aforementioned Chief Executive of the NEAS, seemed like any other person I had met on my travels so far and that made it very easy to listen to him discuss his system.
A few slides in he turned to the dozen or so folks in the room and suggested we do more interacting. This was, after all, common knowledge to all but one person in the room, me, and they wanted to hear from me, not their Chief Executive.
I went into a brief overview of my system in the SFFD and also explained other systems around the country. Much time was spent, and not surprisingly, with their fascination with the idea of for profit ambulance services.
Each member present asked a number of questions about billing and a person’s ability to pay and I had to remind them many a time that that doesn’t come into play until well after the call, but does drive policy decisions in the end, therefore changing our field care decisions.
Each time I snuck a bite to eat another question would have me or Mark discussing his observations of the system as well as his tales of life in a San Francisco Firehouse.
When it came to Mr Featherstone asking what differences we have observed patient care wise, I brought up CPAP and cardioversion and that those are widely used skills in the US. Pacing and cardioversion along with adenosine surely more common than CPAP, but it is such a wonderful tool more services should invest in it.
In true executive fashion Mr Featherstone turned to his clinical care person and said, “How soon can we look into doing these things?”
Bang.
Right then and there, slightly leaned back in his chair, the Chief Executive might be moving forward on something that can directly benefit the patients Mark encounters as well as giving him tools to help more people.
The meeting ended with handshakes and wishes of luck, but very little was said regarding the lack of Ted Setla and the Chronicles of EMS team in the room to record all of this fantastic learning and sharing of best practices.
But I understand that. England is a far less litigious society than the US, but they still have to concern themselves with the appearance of the service and those who function in it.
Everyone reading this post knows Mark and his blog are a source of incredible knowledge and a commitment to improving himself through new pathways. If Mark wrote a book about EMS I would buy it. If he had a radio show I would listen to it, but until those things happen (If he had a TV show I’d watch it) I will follow the media he uses to become a better Paramedic. Right now that is his blog http://999medic.com, twitter @ukmedic999 and on facebook. All media that is growing not only in popularity but usability and relevance to what we’re trying to do in the pre-hospital care fields.
I don’t expect every service in the world to be open to bloggers sharing patient care and contact stories, regardless of permissions, and the few that value the following some EMS bloggers have are doing so very carefully.
One of the things Mark and I hope to work on in the years to come is acceptance of new media and new ways to share information that still respects a patient’s privacy while allowing those doing the care to share insight and best practices in real time.
A unique airway solution is discovered in Australia, blogged about, read by an ECSW in England who passes it along to their Paramedic who posts a link to twitter where I read it. Suddenly a technique that 5 years ago would wait months to get considered for a trade journal has been seen by thousands of caregivers who are about to share it with their friends and co-workers, and all in minutes, not months.
After a morning of listening to the Pathways system work in the dispatch center, then seeing the openness of the Executives to concepts and treatments, I think Mark is in a good place with the North East Ambulance Service.
In Conclusion-
The NEAS provides a high quality service in a straightforward manner to a well informed population. Powers rest with the Paramedic at the scene to determine transport, not the patient ahead of time like in my system. Front loading and getting eyes on a patient is a reliable way to handle system resources and gauge response.
The service is not reliant on insurance companies reimbursing for the services rendered nor are their paramedics passing perfectly capable ERs to reach a certain carrier’s preferred spot.
Mark Glencorse was a gracious host and everyone I met from A&E tech to Chief Executive was welcoming and asked great questions about American systems and I did my best to represent all of us in a professional and knowledgeable fashion.
The food was great, the coffee we can work on in future visits.
Will the NEAS model work in San Francisco? I won’t know until tomorrow when I get a tour of the Tyne and Wear Fire and Rescue Service by Station Manager Peter Mudie. Fire readers, this is the post you’ve been waiting for. But like most of what we do, EMS comes first and accounts for 80-90% of what we do. Why should my UK story be any different?
Subtitle for this post: Can you reach that for me?
Coming off a superb time on the Rapid Response Car, nappy time aside, we’re on the vehicle today. The vehicle is what you and I would call an ambulance, but since anything that can take people to the hospital is an ambulance, it needs to be narrowed down a bit.
The car is certified as an ambulance since it can take people.
The vehicle can, as that is the main purpose of it.
But hiding around town, and just out of camera range as we drove by were swarms of non emergency ambulances, almost buses in their capacity. When asked their function, Mark and our ECSW Becky (more on her later) informed me they take folks to their appointments, get tests and from one facility to another.
Collecting my jaw from the floor I explained to them and reminded Mark how many times we activated 6 people to do just that. Becky shot me a look from the driver’s seat of the vehicle and asked a great question I still can’t answer.
“Why not just give them a ride in a van or bus? Why send the ambulance?’
Why indeed Becky, why indeed.
I could try to explain to her how, in America, people have become so expectant of lights and sirens whenever they want them that they’re willing to sue if they don’t get them. Regardless of the condition, reason or outcome, folks will threaten a lawsuit and managers will blink and change protocol. Why inconvenience the few when we can just take them and inconvenience the many, right?
That was the start of my shift on the vehicle. I’d love to tell you that life on a UK ambulance is so much different than in the US. But when it finally gets to comparing apples to apples in these systems, having someone in the back is it.
Previous posts have covered my impressions of the ambulance layout and ways I think they can be improved to benefit patient care and provider comfort and safety.
Mark had difficulty accessing most of his equipment from the cabinets. Everything he needed he got to, but not without ducking around the patient, around the family member, then leaning over. The trash was also oddly placed, lying directly behind the family member so that to dispose of bloody mess you have to ask them to lean aside.
But that being said, with the current layout based on “safety” there is no other place to put these things.
Mark described to me the regulations in place to protect the persons traveling in the back of the vehicles and it makes perfect sense. Until we have to actually do patient care.
After my description of the ambulances in a previous post I was contacted by an ambulance manufacturer who wishes to remain anonymous, I’ll call them Box inc. Box inc wanted my thoughts on what makes the perfect ambulance and I told them I have yet to see it. But, Box inc had some new ideas about making your ambulance more versatile when on post, more on that another day. But Box inc will still take a van or pickup truck, rip off the back, slap on a place for a cot and make it flash, there really isn’t another option at this point.
But back to Newcastle and the McDonald’s parking lot.
Yes, we’ve found our way to the parking lot at the McDonald’s, on post if you can believe that, so I snuck in for a coffee. It’s an addiction, I know. We had a chance to talk on camera about Becky’s role in the NHS and what an ECSW is. But as we talk about it, a few points to look for first.
I am sitting on the cot and Mark in the chair for family members. The pass through to the cab behind him has a small door on the top that leads to the trash bin behind that seat he’s in.
The cabinets behind us and between as as we talk contain all of Mark’s equipment. Just from the layout you can see how challenging it could be to access them with a poorly patient in the back.
When I said that Becky was above an EMT, the comments section at youtube went insane. What I meant was that she can give pain relief without medical direction. She can do something I can’t do, mainly because I’m told I need more education and training to deliver pain gas to those in need. Becky is proof I do not. So when I said she is above an EMT, I was referring to her ability to medicate them in that manner. An EMT can transport, Becky can not. Apples and Oranges folks.
Our jobs on the vehicle were similar to what Mark and I saw on Medic 99 in the City, moving folks with this complaint over there and that complaint over here.
It was on the vehicle that we encountered the only person, out of dozens, who demanded transport.
As you all plainly know, my clients demand transport 90% of the time and need it 5% of the time. Newcastle respects their Paramedic’s opinions, likely because they can get in and get seen outside the A&E in a reasonable amount of time compared to here in the US.
This person activated 999 to report an assault and we entered the house cautiously. It was quite a bit reassuring knowing that the occupant was most likely not carrying a weapon that could mow us down from 40 feet away. I’m no ninja but I’ll take a clipboard to a knife fight over a knife to a gun fight any day.
The local police were close on our heels, again, without firearms (hard to get used to) and the scene was more than secure. Very secure the police confirmed, poking holes in our patient’s story. Then there was the recounting and description of the event given and none of that matched what we were looking at.
Clearly there were behavioral issues in play and the decision was made to transport based on the inability to confirm normal mental status. We’ve all been there and trying to communicate with eye movements and physical gestures must have appeared as though Becky and I were flirting.
My eyes said “Look at the door, the things piled in front of it, it opens inward, no one broke in there.”
Her eyes said “What?”
My body, arms crossed, said ‘Over there, look, the door!”
Her body, arms raised to the side and shoulders up said, “Huh?”
Mark’s eyes said “Stop it!”
Mark does not ring down, or pre-alert, the hospital himself, but relays it through his control center. When I saw what the control center did the next day, I decided that was unnecessary. If your service relays patient reports trough a third person you are introducing another player in the telephone game and just another chance for pertinent information to get lost. I would love to be able to forward my report to that point to the hospital and they can move that information to a bed and await our arrival.
Oh, did I nod off?
Right now my service gives audio radio reports to whichever nurse lost the coin toss that day and has to answer the radio. I tell them what I have and why, vitals and hang up.
Many Americans may shudder at the idea of waiting 2 hours for an ambulance but I met a woman who disagrees.
Mary, I’ll call her, fell down on a friday afternoon and injured her hip. Being of a stoic generation, she didn’t want to bother anyone with her trouble, so she hobbles through the weekend until her doctor’s office opened monday morning. She called the office and spoke to her doctor who advised her to go into the A&E to be evaluated since his office had no x-ray capabilities.
The doctor called the ambulance and the call was classified as an “urgent” meaning there was no life threat, but still a need for a transport. This call is then put in hold in the system with a maximum wait time and an ambulance is assigned as soon as the system has the available resources.
Mary met us at the front door and walked us in with a slight limp, dressed and ready for her trip to the A&E like many of my lights and sirens patients. We took our time making sure her medications were gathered and the stove turned off, then into the chair and down to the ambulance.
Because this trip was arranged her medical records were waiting at the hospital, as was a bed reserved for her and she was seen as soon as she arrived. I asked her if the 2 hour wait was too long and she looked at me as if I asked her what color the sky was.
“I waited all weekend to call, another few hours wasn’t going to kill me, son.”
I wanted to hug Mary right then and there.
After a day of back and forths on the vehicle and torturing Becky with the American and the camera duties, we were close to finishing our shift when that dreaded job came in.
The late job.
We were planning on meeting some of the rank and file for a social evening and this job would put us over our shift and we’d be late.
We screamed through the streets of Newcastle, pushing old women off the road and opposing traffic wherever we could. OK, not really, we were sent on a common case that would later bring out our common response “Same patient, different country.”
With the patient on board and her friend safely secured we made our way through the evening traffic to St Farthest, all the while talking and keeping our patient in good spirits.
The day went fast in retrospect. Traffic still doesn’t get out of the way when you’re rolling lights and sirens, you still have to go hunting for the extra blanket at the hospital and the nursing staff is still often glad to see you when it counts.
The evening was a night out with some of Mark and Sandra’s co-workers, we were fashionably late after some creative dropping off and ride sharing. I got to talk to them about Mark without him listening and their opinions were high and genuine. Mark is a respected and admired Team Leader in his station and his system.
The iphone rang so early I thought I was still dreaming. Sure it said 5:15 AM and Mark would be along to pick me up in 30 minutes time, but I felt destroyed. My body still thought it was 10 PM and was gearing down for night.
NO! I yelled to myself and turned the lights on.
This was going to suck.
I got cleaned up and dressed, then went to make a cup of coffee. Coffee in England is different than in America. In America you get a nice drip brewed cup of joe from perhaps a Peet’s, or even a Starbucks or gas station. In room 501 of the hotel, my HMHQ for the week, there was a water kettle and a baggie of freeze dried coffee. A taste I choked down at first and then missed as soon as I was on the plane ride home. I had come prepared for the coffee situation, however, as you may recall from this video I posted later in the day:
Mark took me over to his station, the sun yet to rise. Inside I met a few of the night shift going off duty in the ambulance room of the Fire and Ambulance Station. It immediately took me back to microwaving 25 cent burritos and drinking tap water during my internships. There was a TV in the corner, 4 very nice green chairs (green is the color for EMS there) a couple of side tables, small kitchenette with sink and a microwave. We really are the same.
Craving more coffee I went to fire up the kettle and prepared another cup of the freeze dried goodness as Mark took me out to the floor and to Swalwell 405, our Rapid Response Car for the day.
It was exactly as I had imagined. A ford station wagon, appointed with safety markings, emergency lights and the ever important aspect to the RRC, the label “Ambulance.”
The RRC with the Appliances at Swalwell Station
Mark led me on a quick overview of the equipment kept inside and what I could carry on a job and what I should stay away from. We talked about interventions I could perform, such as assisting persons to stand or to walk, the basic stuff we all do, but at no time was I to use his giant Lifepack 12 to cardiovert someone in unstable SVT.
As soon as we were checked out we were sent on a system status post in a nearby neighborhood. Not to get Mark in trouble, but I needed more coffee (some have cocaine, others a hobby or “life”, I have coffee, let it go) and the only place that pours a cup is a place I hadn’t been in over two decades, the McDonald’s.
We were on post for an hour when we were called back to the station. You see, Mark and his co-workers are given a rotation back to the station each hour for bathroom trips, food and what not. When we left our area, another vehicle or car would fill in. This seemed simple enough at first, but a few days later, while watching the allocators try to juggle all the breaks and rotations, I wondered just how important that 1 hour mark was.
At the station Mark’s point to point radio came alive. I had trouble understanding the accents at first to decipher our assignment and there was no station alarm or alert system. Perhaps it would have awakened the firefighters upstairs? We climbed in the car and away we went, blue lights flashing to a reported fall victim. Specifics aside this was the perfect first call for me to see the NHS in action.
I in my station duty uniform with badge of office and Mark in his now famous green jumpsuit made our way in and found a run we EMT and Paramedics handle all the time, a minor muscular injury. Mark went into his comfort zone, patient care, and I handed him the BP cuff and placed the stethoscope across his shoulders to have it in reach. That got me a look I often saw as a small child when I would break something expensive. No one over there stores their stethoscope around their neck. I only do it on scene, mainly so I don’t lose it, but throughout my trip I never saw one ’scope around one neck.
As I recovered from that faux pas a walking Saturday Night Live memory came through the door. The patient’s neighbor was a Scotsman, a true Scotsman, and when he found out I was American he began to tell me a story about an American he knew back in the 60s. I know this because Mark translated for me later. I could only make out a few words here and there, no unlike watching TV in a foreign country.
The Scotsman was ignored when I heard Mark tell the woman she should take some Peracetamol and the ambulance will be along in a moment. He is allowed to let his patients medicate themselves for new conditions. Now, I can create a gray area and make it work, but imagine telling the receiving facility that you let your patient dose up on Tylenol (acetomeniphon/paracetamol) for a new injury. The ambulance crew arrived and away the patient went and we were back in service. Nothing extraordinary, a simple run of the mill job we both encounter all the time. The only difference was arriving at the scene in a car, and alone (without me) would be challenging at first, but some days, with some crews, I am kind of am responding alone.
In my next post I’ll describe the odd moment when we were waiting in the middle of the highway for a second ambulance as a fire engine drove by, not assigned to the accident and something I think the NEAS needs to change immediately to better serve their citizens.
After following Mark’s day by day adventures, I’m dragging you right along on the second week, the one not covered by the Chronicles of EMS cameras.
But why is this going up at 11PM your time Happy? Because that is 7 AM Newcastle time. Wrap your head around that one and let’s get started.
Mark’s San Francisco adventure covered 10 days in total and he was clearly as exhausted as I and likely more. I last saw him at the BART station on the way back to the City and then to the airport.
I wouldn’t see him again for 48 hours.
In that time I let my girls crawl all over me, literally and figuratively, all the while packing and preparing for my England trip. When the time came to board the plane emotions were high. The littlest one giggled when I gave her a kiss, the older one asked me to say hi to Mark in England. She seemed to be taking this experiment remarkably well considering the enormity of it and her comparatively small understanding of the world. The Mrs was understandably emotional and supportive, something she does very well. I had already given 10 days to this project rarely seeing the girls awake, if at all, and was about to give 10 more.
Into the airport I saw the car drive away and took a deep breath. This was not going to be easy.
The plane was packed. I had one of the window seats, but they neglected to tell me the foot room is severely restricted thanks to the new video on demand units. I had been to Seat Guru, but it seemed every seat sad that. In exchange for a place to put my feet I had dozens of movies to watch to take my mind off the tingling in my lower extremeties.
The time difference was 8 hours ahead. To help deflect the impact of the time change I knew I would have to get on the plane, eat and get to sleep as soon as possible, then sleep most of the flight. The last time we flew across the Atlantic I fell asleep during the safety video, then not a wink the rest of the flight, I was exhausted 20 hours later.
Imagine my surprise and pride when I finished dinner, put on my headphones and fell asleep. Then again we medics have been known to fall asleep in odd places at odd times.
I was awoken an unknown time later (6 hours I discovered) to the following conversation:
(This was an Air France flight)
“Keep heir on ze oxee-jin and we can moove heir to zee floors.”
Oxygen? Moving someone to the floor? This sounds like a job for…
…the flight crew.
Watch this video from my layover in Paris to find out what happened next:
After a quick commuter flight from Paris, we landed in cloudy, rainy, windy Newcastle, met by a somewhat rested Mark Glencorse.
Newcastle International Airport
I was whisked away to mark’s home and welcomed as family. It was nice after a long flight to sit down on a couch surrounded by familiar names and voices. We enjoyed a wonderful dinner (Tea, I was told to call it, the evening meal if you prefer) and the perfect start to what would become an exhausting week.
Even though my family was far away, I had a new one just a few minutes down the road.
I had shared a family story that my late Grandmother was fascinated by the King Arthur legends and that recent research believes Arthur to have been a Roman General defending Hadrian’s Wall from Northern Invasions. I had mentioned this in passing on an episode of EMS Garage and Mark and Fiona had heard me. Fiona scheduled a dinner meeting at the Swan Inn in a town called Heddon-on-the-Wall who’s cathedral was built with stone from the wall.
I was hoping for a brief time during the trip to go out to see the wall my Grandmother spoke of, but didn’t expect much at all. Little did I know that, on the drive back to the hotel, we passed by part of the wall there in the middle of town. Mark made it a nice surprise and swung the car around, parked and said, “There’s your wall, Mate.”
I froze. I had trouble moving for a moment. It was kind of like meeting someone you admired. I climbed out of the car into the cold night air and took a deep breath. I could hear my Grandmother’s voice as if she was right there with me. “He stood here. He garrisoned here. This is history.”
It was a small section, only 6 feet wide, maybe 30 feet long and a few feet tall, in a protected grass area near homes, but it was the wall she spoke of.
I took a few photos and a quick one of me on the wall before heading back to the hotel to rest. As is now a Chronicles of EMS custom, the internet was pay as you go, so uploads were going to be difficult.
Mark dropped me at the hotel and I went straight past the pints in the lobby and straight to bed. The first day on the Rapid Response Car was waiting for us early the next morning and I wanted to be ready for it.
That story, and video of what I look like before coffee, next time.
Here is the long awaited trailer to the pilot episode of the EMS Series Chronicles of EMS.
Watch it full screen, Ted Setla did an amazing job.
http://www.vimeo.com/8235377Do you think Mark Glencorse and Justin Schorr should visit your system? Drop a line to the Chronicles of EMS and tell them where and why.
When responding with Mark and his colleagues in and around Newcastle I noticed the seamless integration of their dispatch and GPS systems. From the person answering the phone, to the allocator, to the crew in the car or vehicle, everyone can pull up the location of the vehicles responding.
While the reliance on GPS has been ridiculed when crews go down a street that appears to go through but doesn’t, in my experience this happens with map books as well. More than once Medic 99 was delayed because the street ends at the bottom of a hill, even though the map shows it going through. Area familiarization can help, but when most of your day is running calls, these things seem to find us when we least want to meet them.
That being said, we were dispatched to an address that made me scratch my head. Up to day 3, each dispatch had a street and number. Much of the older parts of town had addresses facing different streets, since other streets did not exist when the house was built. For example, we had one where the address was on south street, but the door was on north avenue, always has been, but address is south street. Confusing? Imagine my head scratching when we were sent to a home with a name, not a number.
The patient’s details are not important, what is important is the fact that houses on this block we found had names. Names like “Watterson Cottage,” “Peterson Place” and “Fireman Hostel” all of which had doors facing different directions. It was clear that the road access to these buildings was long after they had been built and occupied.
But the GPS knew exactly which house we were to respond to because of the 6 digit postal code given by the caller. We were inside for a few minutes expecting the police to respond, it appears they had trouble finding it as well.
We are lucky in most parts of the City knowing that 851 5th avenue is mid block on one side of the street. These houses had small wooden signs with 2″ lettering on the side, not always facing our approach, which made finding which door was the one we needed a puzzle.
Without the GPS we would have needed to know the postal codes specifically to find the house. I can only imagine how difficult it would be to find it at night. Thank goodness it was daytime. Notice I didn’t say bright and sunny.
There are many things I wanted Mark to see while visiting the SFFD EMS system. Not once during his trip did he experience the mad shuffle that is our resource allocation when we drop to level zero. What he did get to see was the rampant abuses in the SF 911 system and the paramedics helpless to do anything about it.
I don’t want to ruin the pilot episode of the Chronicles of EMS by telling you about specifics that Mark was able to witness (All with the patient’s full permissions of course), but I wanted to touch on something I didn’t see in the UK system in my short time there: 999 abuse.
Of all the calls we ran, I can think of only one that didn’t have a legitimate need for medical evaluation by someone higher trained than a Paramedic. Notice I didn’t say ambulance, because of the versatility of the NEAS Pathways system. This one person claimed to have a condition that he clearly did not, yet wanted the ambulance to take him in regardless. It was clear to everyone on the scene that it wasn’t necessary, but away we went anyway, just to be sure.
Most of the other persons who dialed 999 and got the tall American Fireman were simply looking for medical advice when they were scared or frightened. Does anyone remember the last time someone called 911, you responded and THEN they made their decision based on your assessment and advice? It sure as hell was more than 11 months ago, I’d wager even more than 11 years ago.
the Project has shown me how we in the EMS Profession have allowed our abilities and responsibilities to be hijacked. We are no longer help arriving in a time of need, but a means to get into the ER. Granted, the few instances when we have to say, “No, always call us if this happens” through gritted teeth to the old man who fell out of bed aside, I have been told to do my job and take someone to the hospital for the last time.
My job is not to take someone to the hospital, but to assess their complaint and devise an appropriate treatment, if necessary. Not drive someone to the hospital, especially in my new fire engine only capacity.
Imagine you drive a tow truck. Someone calls stating their car is broken down and they need a tow. When you arrive you find their stereo is broken, but they want the car towed to the shops, just to be sure. You’d hook that car and be glad you can bill them, right? But what if you ran a free towing service and other cars were actually broken down, needing you more? Another one of my bad analogies for sure, but one that always creeps into my mind when I meet folks who decide to go before I tell them otherwise.
No longer should we let our clients dictate their transport options without a complete assessment and history, condition permitting. In an emergency, we will obviously default to transport, but what about the other 95% of our business? The ones who decided to goto the hospital hours ago, but waited to call us for their stubbed toe, or cough, or fever of 101, or sprained wrist? They have grown accustomed to a level of service they do not need. They are entitled in their minds and it is not just a certain generation, this cuts across all economic and age levels.
ALS units flying through traffic to meet that magical response time, and for what? A sprained knee? Painful for sure, urgent certainly, an emergency…debatable.
Somewhere along the line lawyers wiggled their way into the medical care field, willing to pull the trigger and sue any paramedic who flinches and tries to tell their car accident victims that going to the ER when uninjured will not help them in court. I find myself practicing defensive EMS all the time, it was witnessed by Mark more than once, most notably on a minor scooter accident he can elaborate on.
But it’s easier to C-spine everybody than to learn how to clear, prove to your medical director you can be trusted, and then do it right?
Enough of what’s easy. Enough of playing to the lowest common denominator. Enough of listening to someone with ZERO training and education tell me about how the shoulder articulates, not even able to name a single bone, muscle, nerve or blood vessel in the area. Tell me what happened, what hurts and what doesn’t and let me do my job. Answer my questions honestly. At the end I’ll tell you what I think and discuss with you your options and what I believe is best.
“That will never work!” You shout at your computer. I saw it work. The problem is convincing the newly retired man that he can drive to the ER or clinic himself for the insect bite from 2 days ago, provided he stops scratching it to make it red every time I can’t find it on reassessment.
We are the reason our clients are so poorly informed. There is abuses of the 999 system, there have to be and reading Nee Naw, we know there are, but I didn’t see it in my 4 days with Mark and the NEAS.
So what can we do to make people understand we are more than a flashing lights taxi service?
That is what we need to focus on and something I hope to expand upon in the very near future.
The Chronicles of EMS Reality Series was filming Mark’s visit to the SFFD, in case you haven’t been reading this blog. Or twitter. Or Facebook. OK, I think everyone knew that, but did you know being filmed while doing patient care is tough?
Our pal Mark has had cameras along for the ride before. This was my first time having non co-workers and non-family members in the back of the ambulance with me. Having a preceptor in the back is hard enough, but having these guys back there can really make you sweat. In case you’re thinking it’s no big deal, keep in mind how many little things you do that might not be the exact prescribed method. Little short cuts and tricks that help you do your job better, but might need a little explanation can give the perception that you don’t care.
I hope I don’t come off that way on camera. Having Mark, a fully licensed Paramedic, watching was OK, but directly over Mark’s head was a large mounted camera capturing the entire patient compartment. Next to Mark, near the pass through was Producer/Director and also licensed Paramedic Ted Setla, camera moving to capture my movements as I treated. Then at the edge of the bench seat was Camera Stud (My term, not his) Chris Eldridge moving his camera around as well, making my wonder what they were capturing.
At a motor vehicle versus pedestrian accident, I made my scene survey and made patient contact, Mark close behind. As I got a report from the engine company I took another look at the car involved and there on the other side of it, looking at me, was the Dridge and his camera. Turning a quarter to my right, there was Ted, doing the same. I didn’t want to be that Medic we all hate to see, doing something stupid on camera. “Just do what’s right and nothing goes wrong,” was all I could hear in my head. Could they see me sweating hoping I don’t screw up the IV or make a wrong decision?
It turns out, on that run at least, I appeared calm and collected, even though I was screaming on the inside. Ever had one of those patients that just needs to calm down and relax but won’t stop crying? Mark stepped in, sexy accent (Her description, not mine) and all to calm her and hold her hand while I worked. Strong work, Mate.
No pressure. Just act natural.
It’s easy to say “just be yourself” here in my recliner, but saying that over and over again at the time made me even more self conscious of the cameras and what I was doing. It didn’t change any treatment, everyone got what they needed, but it really made me focus on the little details. Where normally I would leave a sharps down (our caths auto retract for safety but I like to get a sugar off of it later) on the chux until later in the run, I now swiftly secured it.
Times when I would tell patients, and especially clients, that they need to stop smoking, drinking and shooting heroin to get better, I made more of a broad speech about personal responsibility. My usual speech comes off a bit preachy I’m told, so I left it behind.
And it’s not just the emergency calls that makes having the film crew along rough, it’s the down time.
Let me choose a better phrase than downtime, “Interviews.”
After every run and most spare moments we talked on camera about our experiences to that point. If we had nothing to say, we were updating twitter and facebook with photos and thoughts, always trying to keep you guys up to date.
On the ambulance the cameras were pretty easy to get used to, but on the engine it was just the Dridge. He would go running to the engine when the first bells hit, climb in my side and across to the other side of the engine, staying as out of the way as you can with 4 people in a 4 person cab. After the Dridge, Mark would climb in, giving me room to turn out or in case of a medical, just climb in and take my jump seat. Getting dressed for a fire in a moving fire engine is a learned skill. Doing it with a camera rolling isn’t much different, but with all seats full and gear all over, it took a few runs to get the hang of it.
I hope the footage they got gives you the story of what we went through. There wasn’t a lot of helicopter action, no MCIs, and nobody fell in love. As far as I know. So it’s not the usual EMS show that has been thrown at us before we could duck. I’m excited to see how the Chronicles team puts it together and shows it to you. Although you already know what is going to happen, since you’ve been following along the whole time.
More updates on the Project and Chronicles of EMS to come, including my thoughts about the NEAS Administration, giant patient compartments with extra space and something I like to call a bad ass training facility.
One of the things that drives me nuts is the public constantly thinking I’m a police officer. While Motor Cop likely giggles at that idea, I commonly respond to these people by pointing to the fire engine and then at my hip. “No gun, fire engine.”
One thing I noticed both here and in the UK with Mr Glencorse was the unmistakable uniforms he and his fellow ambulance employees wear.
The green jumpsuit. They also have green pants and polo shirts, vests, fleece jackets and the high vis jackets, but everything revolves around that green color. It made it easy to figure out who was who at an accident scene for one thing.
We wear a navy pant, navy shirt and navy jackets and sweaters/sweatshirts, just like the police do. More than once in England, wearing my SFFD uniform, I was spoken to as if I was law enforcement. One woman, when I asked if she was OK after a minor accident, began to go into detail about where she was coming from and how fast she was going.
Mark would love it if I came out asking for the green jumpsuits over here, not going to happen. When Mark took me around to meet the nursing staffs at local hospitals in the UK, they all commented about my uniform and badge. Mark groaned and laughed, but kept introducing me. They just aren’t used to Paramedics that look like police officers, or firefighters for that matter.
But I am pretty sure Mark has never been mistaken for anything else other than what he is. Most of the garments are labeled simply “Ambulance.” I have always appreciated the professionalism that my current uniform reminds me of, especially as many departments are now wearing t-shirts and shorts and wondering why no one takes them seriously.
I also appreciate that my department still honors the cap and tie and the traditions they represent. When we are sent out of our regular stations to another house for the day, it is tradition to wear your cap and tie and make proper introductions first thing in the morning. Even though it is met with smiles and everyone saying, “Take that stuff off,” not wearing it gets you noticed even faster. It is a sign of respect to the regular members of the house and is a little bit of the past I like to have around.
That would be odd in a jump suit or polo shirt.
But Mark doesn’t have the same responsibilities I do in the fire house and a jumpsuit would actually make the transition from EMS to Fire quicker and safer. Imagine just zipping out of a jumpsuit and into your turnouts instead of unbuttoning a shirt, then pants. I doubt there is a happy medium there.
But what about colors? We wear different colored helmets and helmet shields, maybe different patches, why not a completely different uniform?
Because we’ve always worn these and they work just fine, we just need to figure out a way to convince the public that not everyone in navy blue outside a coffee shop is a police officer.
Does your service have a distinctive uniform?
I’m not sure how many parts this report will have. I’ve been writing pages and pages of observations, recollections of discussions, talks with patients, staff, Doctors, other Paramedics, all in the hopes of learning something from the 23 days that I so hoped would open my eyes. We can occasionally get caught up in the details of what we do without seeing the broader picture, the entire system, with all it’s players and pieces. I found that visiting other systems around the US helped, but the same obstacles presented themselves.
When blogger Mark Glencorse an I dreamed up the Project, it was initially partially for fun. Then we began to talk even more about what we did differently and I had to see it first hand. And I did, for the most part. Just as with Mark’s visit to San Francisco didn’t show him everything we do, I know I missed a lot of the problems with the NHS system. That being said, I was able to burst many of the myths of socialized medicine and an ambulance service run by bureaucrats.
My experiences with Mark here and also in England taught me that there are all the same people in EMS no matter where you go. There are the flirts, the nerds, the jerks, the dirty guy and the OCD fellow. Some want to be there, others are on the way somewhere else, but for the most part people were genuinely curious as to what we might learn from the Project.
What did I learn, you might be wondering? It boils down to this:
We are two countries separated by a common language.
Not sure who said it first, certainly not me, but it is true. For example, in the North East of England a Chips Buttie is a nice afternoon snack. Here it is called a french fry sandwich with butter. There things are made with sugar, here High Fructose Corn Syrup. There the EMS system is seamlessly joined to the hospital and clinic care, here it is a fight to get triaged in a timely manner. In both places family means family, I now have a new one 9,000 km away.
Looking over my notes from this Project, I have a boat load to tell you about and a lot I hesitate to tell you about since it may appear my mind was made up before I went about socialized care. I do have some suggestions how to make that system more efficient, but things there are so completely different when it comes to health care, it will never work here. Not because of the administration, or government, or labor unions, but because Americans have come to expect instant gratification from their EMS systems. They refuse to believe their sprained wrist can wait more than 4 minutes for a fire engine and ambulance. It is this basic understanding of what EMS is that is lacking in America and I know who is at fault.
We are. Anyone who has been in this business more than 2 years is responsible for the complete lack of understanding that grips the common American about their emergency medical systems. It is time we recognized this fact and did something about it. Exactly what that is will depend on those above us in this machine to recognize their part and help us educate our “customers” (I hate that term in this business).
For my short career I’ve been repeatedly discouraged by people using EMS as their free taxi service when more appropriate, far less expensive methods of treatment are available. I did see, in my short time there, EMS abuse in England, but not nearly at the rate I see it here at home. I believe it stems from the belief that people have a “right” to an ambulance whenever they want. And not just the entitlement generation, but those who have paid into the system and want something, anything, back from it. We need to show these people that they are entitled to help when they need it and an honest discussion about what is best for them.
I also learned from my experience that my system is not being as efficient as it could be, nor is Mark’s. Believe me when I say that each of those statements could have their own volume, and likely will, since most of the things I want changed there, labor will never allow and the same here.
Before I start boring you with the countless posts about what I did, saw, learned and learned to avoid, I want to take a moment to thank a few people that made this trip everything it turned out to be.
To Mrs HM – The woman who sat next to a burnt out EMT on the tailgate of the rescue truck in rural New Mexico and said, “You don’t belong here.” She is the reason I got off my ass and got serious about going back to school full time. I graduated 3 years later. She’s been right here with me this entire time and made this whole thing work.
To Mrs 999 – Who I’m sure had just as many headaches as my Mrs while mark was away, you welcomed me into your home each night for tea and made me feel at home.
To Firegeezer – For noticing a little blog about the joys of 911 abuse.
To Lt Talmadge and her UK counterpart Fiona – Meetings, dinners, etc, all went to plan.
To anyone and everyone who donated to help make the Pilot episode of Chronicles of EMS. Having the cameras along was unlike anything else I have ever done, I hope you all like it. And I hope that Ted mentions I hit every IV first try with three witnesses and three cameras rolling.
And finally to Mark – Thanks for being so easy to get along with, bad jokes aside. and sorry all the nurses liked my uniform and accent…wadda ya gonna do?
I’ll get more specific on my observations over the coming weeks, keep an eye out here and at Mark’s blog. Thanks for following along.
Mark’s last day in the firehouse in San Francisco flew by today and filming went great.
We were lucky to be assigned to the Fire Boat Guardian, since that is one of the responsibilities of Engine 13. A group of school children arrived for a tour and a cruise and we got to come along to staff the boat. Mark and I, and the Dridge, had a wonderful cruise along the embarcadero, off under the golden gate bridge, then around to Alcatraz Island.
It was a beautiful clear morning and, now that I think of it, it hasn’t been cold or foggy since Mark got here. I think he finished with 3 videos and 60 some odd pictures, all available on the flickr link.
It wasn’t really “Paramedic” related, but this was part of my regular day, so away we went.
It was a somber mood on the set of Chronicles of EMS today with the England filming still in the air with 72 hours until I depart. It was also a little difficult scheduling wise this week since the original schedule prepared months ago was thrown out do to a new policy here in the SFFD. Not a huge deal, we just had to call in each day to find out what the schedule was for the next day. But then again, that’s how I get my schedule on regular days.
I want to prep you guys for amazing news and bad news. I’m not sure which to tell you yet, because I don’t know myself, but I want to say something ahead of time. When Chief Hayes-White walked into the conference room a week ago, she had a 5 minute notice that Setla Productions would be filming. She walked in seeing me, Mark, Ted and Chris and rolled with it. So did Cheif Howes. That being said, since Ted got funding at the last minute, we were still unsure of whether it would be filmed until halfway into the meeting when we realized they hadn’t stopped the filming.
They could just have easily told us to turn off the cameras and tell Mark he wasn’t welcome, then keep me around to show me my pink slip. All these actions seem extreme, but not outside the realm of possibility.
You guys have been following along behind the scenes of the Pilot pisode of the Chronicles of EMS but have seen none of the actual show yet. I think Ted said they have 26 or so hours of film for the show and a number of Mark and I talking about the patients we saw and the differences, but I think tomorrow’s exit interview will be the real deal this is all about.
The Dridge, camera man and all ’round cool dude, will be there to capture it for the show and for all of you.
Now, about England. The Project is a go, Chronicles might not make it, this time. Think about the timing and the costs for flying international with all this camera gear with 3 days notice. If they can’t make it, don’t panic or get angry or try to blame someone. I don’t want to see any posts about somone who’s “fault” it is they don’t make it. The last thing we need is to fall apart now. If we start bickering and complaining those who control this machine we’re trying to fix will excuse us as a bunch of dreamers and complainers.
We are neither.
Mark and I are learning a great bit from each other and I get frustrated when he asks me, “Do you always have to…” and my answer starts, “To avoid litigation…”
Hang in there guys, I have Ted’s flip camera, the one he used to update all of you and I’ll be using it to send updates whenever I can. Just keep in mind I’ll just be one person if the crew can’t make it this time.
More tomorrow after I send Mark along.
HM
It is not easy to find time to get logged on and update you guys about the Project.
Not Chronicles of EMS necessarily, but Me and Mark meeting up and talking shop. I apologize to any of you who clicked over on Friday morning looking for my usual You Make the Call segment, or on Sunday for the Sunday Fun, but I felt like the updates were coming fast and didn’t want to bury something else in with all the bits about Mark arriving.
I did put up the Angry Captain’s Close Call, which happens to be the theme for the November Blog Carnival, get your submissions in early, I plan on writing it on the plane and setting it to publish after I land. I’ll be sending out the deadline before long.
Mark and I are hitting it off just fine. It’s awkward trying to have the conversations we want to have with the cameras about, but it’s a learning curve and an amazing opportunity to bring you along with us in the way we had hoped in the beginning.
I arrived at Mark’s hotel a bit early this mornign and we had some time alone to just talk.
Then it was a fast frenzy of Chief’s, meetings, phone calls, twitters and facebook status updates. I got Mark a local phone, but no data plan, so he’s started borrowing my iphone to make his updates as well.
Tomorrow is our first day out in the field, on an ambulance, and we’re both looking very much forward to it. I’m trying to lod up pictures, but Mark’s hotel wifi is useless. They’re looking into moving him to another hotel now.
It’s hard to do a project about social media and the internet without an internet signal. Go figure.
Tonight is a free night, Mark and I both anxious to get somewhere and talk without the microphones, a chance to be 100% honest about some of the ideas discussed today. We’re not holding anything back from our readers, don’t think that, just looking to not have to watch our language.
Mark promises to teach my to swear like an Englishman.
Keep an eye on the flickr feed on the sidebar for when the internet is back up and running where Mark is.
Big day tomorrow.
HM
OK, just one, but I will be calling this out in the airport later today.
If you are reading this it means that UK Medic Mark Glencorse is on a plane from London to San Francisco to begin the Project, our Trans-Atlantic Paramedic Exchange.
In case you were wondering how this all started, you can catch up by clicking on the tag “the Project” over in the right hand sidebar.
This is my last reminder to follow us on Twitter, @ukmedic999 and @thehappymedic, as well as the flickr feed and youtube channel. Mark’s first update will be tonight, so make sure you’re subscribed to the channel.
The action starts tomorrow morning with a meeting with Chief of Department Joanne Hayes-White, EMS Chief Pete Howes and PIO Lt Mindy Talmadge, who will no doubt be glad I’m not calling and emailing multiple times a day now that this has started.
When we finish at Headquarters, we’ll be off on a walking tour of some of the high points of the history of the SFFD. Many of these can be found in a variety of tour books and at the SFFD Museum, but when I took some of my early days in the City wandering around I found some specific things I find fascinating. I’m working on a book specifically for visiting Firefighters to enjoy these places, but as you’ve been reading on this blog, I’ve been a bit busy.
That should wear him out so he’ll sleep well and be ready for our first shift on the ambulance on Tuesday.
Like the Angry Captain used to say when the lights went down at the movies,
Here we go.
Well Captain Tom, you asked…
“OK HM, It’s November. When does 999 land in SF?”
…and I’ll answer. Sunday.
Paramedic Team Leader Mark Glencorse will be the guest of the San Francisco Fire Department beginning on Sunday November 8th, when he touches down at SFO. From that moment until he departs on the 16th we will be comparing our systems at the ground level, care giver to care giver. No “company line” no prepared statements, just two friends meeting and getting the low down on what is really happening in each other’s systems.
Later this week I’ll be adding links to the sidebar here at HMHQ to help you follow along on our experience. Follow us on twitter @thehappymedic and @ukmedic999. The new slideshow on the right hand side there is the Project Flickr slideshow. That will certainly be added to as we go along. Daily if not hourly.
Then there is the youtube channel we established that many of you are already following (subscribed to). We have decided that the visiting medic will do his best (nights of drinking aside) to do a nightly update as to the day’s activities, impressions and thoughts. Mark will of course be updating you mostly at first, then I’ll start when I arrive in Newcastle on the 19th.
We are both not only representing our Departments but, more importantly I think, the power of this new creature we all have come to embrace, social media. Twitter, Facebook, blogs, online news, flickr, IM, SMS, all these amazing on demand services at our fingertips and we’ve harnessed them for a good cause, making ourselves better care givers.
So not to make this another boring “the Project is coming” post, maybe something new?
Since the official SFFD press release went out today I guess it’s fair to tell you who I am.
the Happy Medic is, and always has been, Justin Schorr, a Firefighter/Paramedic currently employed with the San Francisco Fire Department.
That’s me with the patches-Photo Credit SF Chronicle.
I hold a Bachelor’s of Science in Emergency Medical Services from the University of New Mexico School of Medicine where I studied under Larry Cobb and Rick Lynn, to name a few. I was one of the first 10 graduates of the BS in EMS (no giggling) program there and was one of 4 to first stand within the School of Medicine group to graduate (God they hated that!)
My career started as a Fire Explorer, then as a volunteer firefighter getting hired at 18 with a small Indian Reservation outside Albuquerque, New Mexico. Talk about rural EMS.
I later moved on to a small suburban department struggling to find it’s identity with a strong Public Safety model that relied on fire trained police officers to assist when emergencies struck. It was there that I learned the best way to confirm a house has been ventilated prior to forcing the door is to do it yourself.
Now I find myself in beautiful San Francisco and raising my family.
So there you have it. The first official, documented privacy violation of the Happy Medic, my own.
See you at the big one,
HM
In preparation for the Trans-Atlantic journey Medic999 and I are about to make, I thought I’d prepare a list of things to keep us occupied on the flight.
That got as boring as the flight itself will be, so I borrowed a few ideas from the guys at That was funny. This list has been edited, considerably, as to not offend small children, the elderly, Llamas or Antonio Banderas. Enjoy:
1. Fart loudly and act shocked, looking around to see who did it
2. Fiddle around with the emergency exit, then ask a fellow passenger if he has a crowbar
3. Hijack Ask to see the cockpit and, over the loudspeaker, announce that the first class passengers and luggage are to switch places
4.Run down the aisle screaming,”He’s got a bomb! He’s got a bomb! I am ‘da bomb!”
6. Fly into a rage whenever the word “Skymall” is mentioned
8. Go up to someone and ask loudly if they wouldn’t mind applying Preporation H to your hemrrhoids
11. Mess up your hair, untuck your shirt, basically look crude, and mingle with a first class guy as if you were long-lost friends
12. Give someone a coin, saying “Heads, I get your shirt. Tails, I don’t”
13. Go into the bathroom, drop your pants, then come out, yelling “We’re out of toilet paper! Stewardess!”
14. Describe your sex life in great detail to the five-year-old next to you
15. Try to lead plane in song “Oh I wish I was an Oscar Myer Weiner”
16. Lead a revolt against the first class passengers
17. Attempt to promote Hinduism among passengers
18. Moon passing Delta planes
20. Start a hot dog stand
21. Steal businessman’s laptop, play solitaire on it
23. During the inflight movie, ask to share headphones with someone
26. Tell the person next to you your life story, from DNA to that afternoon
28. Remark that perhaps you shouldn’t have put superglue in your undies that morning
29. Pick your nose and pat the person next to you
30. No matter what the meal choices are, demand rice-a-roni
31. Show off your Batman underwear
33. Switch accents and see if anyone notices
39. Go into the cockpit, flick on the intercom light, then loudly inquire as to why the fuel dial says “e”
40. Go into the cockpit, ask the pilot in an obnoxious voice “Why do the call it the COCKpit?” then snort as if it’s the funniest thing in the world
42. Sneeze, using somebody’s sleeve instead of your hand to cover it
43. Listen to James Brown on your Walkman, sing along (especially the
“Oooh Oooh” parts)
44. Snort when you laugh
46. Wear a hairpiece and switch it often, seeing if anyone notices
49. Hum the Monty Python theme song
51. Scream and dive under your seat for no apparent reason
52. Ride carry-on luggage down the aisle, yelling “Yeee-ha!”
53. With a desperate look, ask the stewardess where the bathroom is, then look relieved and say “Nevermind. Do you have any towels?”
56. Bring a microphone and act like Frank Sinatra
57. Ask someone for their autograph, pretending that you think they’re Kevin Costner or Goldie Hawn (This best when the person looks nothing like the movie star in question)
58. Start talking Korean
59. If someone has a bad toupee, whack it off take it.
60. Pretend you’re flying the plane
61. With a fellow passenger, Re-enact the disco scene in “Airplane!”
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 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.
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?
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
