Posts Tagged ‘Communication

23
Oct
11

A view from the other side.

By Jeramedic Leave a Comment
Categories: Good Medicine and Rants
Tags: , , , , , , , , , ,

Lately I have been spending some time in other parts of the company other then the back of an ambulance. I must admit that I was a bit apprehensive when I started to take on some duties behind the scenes. But I found it to have been a very eye opening and educational experience in the world of EMS, especially from the prospective of a field provider.

I thought I would share a little of what I have learned with you, in the hopes that perhaps you will think a little different about your job the next time you pull into the station, or are dispatched to a call.

So here are a few things that as a field provider, you may not of necessarily known was going on while you were out running calls.

  • You are posting, or on a move up because other units are busy. its as simple as that. Its not because the dispatcher doesn’t like you, or because “those knuckleheads at station 18 can’t handle their area”. It’s because coverage is being lost left and right, and you are one of only a small number of crews left in the city.
  • Document Document Document. I know that may sound obvious, but if you knew how many calls come through every day from lawyers asking for patient care records, you would think twice about what you’re signing.
  • No one likes to run the non-emergent, “BS”, system abuser calls. It’s one of the issues being handled in EMS 2.0. But would you believe that many people, (sometime several a day) call non emergency phone numbers, asking for simple BLS transport for things like: Chest pain with shortness of breath. Altered levels of consciousnesses. Seizures. And Obstetrical problems.
  • It really takes a lot of time, money, and energy to keep “your” ambulances and equipment in working order. So please take care of them when you’ve got them.
  • Dispatch is not a cushy job. Its had work. It might just be me, but I found dispatching to be more challenging and stressful then any field work. So when the dispatcher does’t copy you back, understand that sometimes it’s loud, business phones are ringing, while emergencies are coming in, while neighboring cities are calling for mutual aid, and any number of other distractions. So please… Give them a minute.
  • And finally, and this one is important so pay attention. We all know that reputations mean everything in this industry. When you are in a position where you can watch over fifty field staff working throughout a shift, and over multiple shifts, you realize that it doesn’t require much effort to stand out from the crowd, in both positive and negative ways. And that should be your take home message. Small changes in your behavior and work ethic, really make big differences.
So there you go, just a few tidbits of insight from the other side. Do with it what you will, but do good, and be safe.
03
Apr
11

No Habla Espanol

By Jeramedic 1 Comment
Categories: Book Reviews
Tags: , , , , , , , , , , , , , , ,

No habla espanol? No hay problema, at least not entirely.  Language  and the ability to communicate is something often taken for granted. It’s not until that fundamental part of human interaction, and a pillar of patient assessment is challenged or completely removed do we realize and respect its importance.

We have all had to manage patients that were unconscious or had an altered mental status due to drugs or alcohol, seizures, trauma, etc. Theses patients have limited, or are incapable of verbal communication. So we work around it the best we can, and rely on our physical assessment and findings to help guide the treatment plan.

But what if you have a patient that is completely awake and alert, is in obvious distress, and can not communicate because of a language barrier? Well, like we have all done, you probably look around at the other personnel on scene, patients family and friends, or sometimes even bystanders to find a translator. While this practice is an option, its not always practical or reliable. And in the case of bystander assistance, no longer is the patients information confidential.

A 2007 American Community Survey conducted by the United States Census Bureau, showed that Spanish is the primary language spoken at home by over 34 million people aged five or older, making the United States the world’s fifth-largest Spanish-speaking community, outnumbered only by Mexico, Spain, Colombia, and Argentina. Thus making Spanish one of, if not the most common non-English language encountered by EMS providers in this country.

If only there was a better way…

Lately I have been using, and introducing others to a little book called, EMSpanol.  And in my opinion, it is the most user friendly, and comprehensive English to Spanish (and Spanish to English) field translating system, that is not digitally based. I believe one of the big advantages to EMSpanole is that it was created by working EMS providers, and not a language teaching company. It is straightforward, and intuitive.

Jeff Dean, the co-creator, and working Paramedic and Firefighter says “Like most of  the prehospital providers I know, I basically speak no Spanish at all, but I work and volunteer in a region with a large and growing Hispanic population. I’ve struggled with other commercial products, finding them either too general, too disorganized, or created by authors with no EMS experience, so I created my own list of phrases and looked around for someone to translate them for me. More than seven years went by before I finally met FF/EMT-B Miguel Castañares, who embraced the project and took it to a whole new and exciting level.”

The book comes in two sizes: A 30 page ambulance edition which is approximately 9″x11″  and can be easily stored in the patient care area, and a smaller 37 page pocket version that fits comfortably in uniform pockets, and first-in bags. The two books are identical in content and format. It covers everything form the initial patient contact, all the way to MCIs and even refusals.

Each chief complaint is laid out in a logical sequence, so that the provider can start at the top of the page, and simply read through the call as if there was no language barrier to begin with. The questions are also written so the patient need only answer, yes or no. There is even a basic anatomical chart on the back.

In my experience with other field guides, I found them to be disorganized, and hard to understand. But honestly the only problem I have found when using EMSpanol, is that having a Spanish speaking partner is an easy excuse not to use it.  At this stage I can understand more then I can speak, But it has increased my emergency Spanish vocabulary.

I would love to see this little book be used in practice as common as the Broselow Tape. I would also recommend it as a gift to any new EMT, Paramedic, or Fire Academy graduate.

But wait, there’s more.

It’s obvious after talking with, Jeff that he is very passionate about EMS and providing the best care that he can give his patients. He also has brought up some very thought provoking issues in regards to scope of practice in a language barrier scenario. Most will just try to ignore it, but these are discussions we as a community need to be having.

Jeff was featured as a guest on the EMS Educast podcast, where he talks about the book, and his thoughts about scope of practice in a language barrier scenario. I encourage you to listen the episode —-> HERE

For more information check out  http://www.emergencylanguage.com/ and follow on Twitter and Facebook

12
Oct
10

The Community of Paramedicine: Pt 2

By Jeramedic 5 Comments
Categories: Good Medicine, Rants and Uncategorized
Tags: , , , , , , , , , , ,

So in part one I discus the idea of an “EMS Brotherhood”, and that we are all one and the same (even if your partner or common perception tells you otherwise) But after looking at how the industry is set up, and even still how we as members of this industry interact with one another, I am starting to look at things differently.

EMS does not have a “brotherhood” (at least not in the way as defined be our colleagues in Fire and Law) because we already have something . We have a community. And just like any small or mid sized town, we all know each other, we see each other around town, we share stories and ideas, we drive similar yet personalized cars, we all live and work in different areas, and we take pride in our little town, no matter how small it may look compared to the bright lights of New York city.

But how did we all become residence of “EMSville” ? And how can we expand? Well, like often mentioned, the connections and friendships made with social networking sites combined with the face to face interactions at regional and national, and even international conferences has helped to strengthen the community tremendously. The fact that you are reading this, and even care what I have to say is proof of that.

But Why?

Well, we need more friends. Both in, and out of EMS. We make these friendships by taking a leap, and talking to strangers.  Ever since many of us were little kids, we were told to never talk to strangers. While this was done out of a concern for our safety, many of us have carried this mantra over into adulthood. But its okay now. I don’t think the EMT ride-a-long thats with the other company, or the ER Doc, or the police Sergeant is going to lore you away with a bag of skittles and lost puppy story. And if you are still stuck on the ridiculous notion that “I wear blue, they wear white, we’re not from the same tribe.” All I can say is, Evolve already.

By not talking to, and getting to know your neighbors, you (and we as a community) are losing out.  Your best friend, fellow supporter of a cause, Jedi master educator, or ever your future medical director could be standing next you, and you would never know.

I used to work in an area where my main hospital was also the regional trauma center. Three fire departments and two private ambulances would all transport there, not to mention all the non emergency transport services as well. If you ever wanted a melting pot, the wall of that ER was it. I would talk to everyone, and guess what? I made friends. Friends that had on different uniforms, and made less then me, and who made a lot more then me. And it pays off. When I needed help with a patient, they were there. When then needed help with CE’s or a new job, we were there. Its like borrowing  cup of sugar.

Expanding a small town community into a thriving city is the same for EMS as it is a real town. Strong relationships must be made, trust must be built, and Infrastructure put in place.  There must be a sharing of recourses, and so on. Whats good for you, is good for your neighbor. We are not stealing secrets, we are sharing knowledge.

But How?

First off,  introduce yourself.  Say where you’re are from and what department or company you work with. Don’t think that just because you are in uniform that your patches and badges will speak for themselves.

Take a genuine interest in the other person. Hard to admit, but we all like to talk about ourselves. So Let them talk. Who are they? What are they doing in their career? Where do they want to go? Afterward, remember somethings about that person and the conversation. Next time you see them in the ER, or elsewhere, you’ll have something to talk about.  ”Hey Jen, how’s that fire science class going?” “Mike, I did not see you last week, did you take that vacation you were talking about?”

People like it when you remember their names, and something about them. You may have only just met lest week, but it creates a bond. Before you know it, you’ll have a study buddy, or a great reference for an application. And they will benefit too.

Also, and I must stress this. No egos allowed. When making friends, leave the deck of certs in your pocket. No one uping stories, no Medic vs EMT  rubbish. When speaking to someone with less experience and education then you, remember where you came from. When speaking to someone with more experience and education then you, still remember where you came from. Just be human.

And these gestures of peace are not just for personal gain. These are the people that are going to have your back on a major incident. building a strong relationship with not only your fellow EMS workers, but also Fire, Police, and Hospital staff  is something the strengthens the communities you serve. These were the driving principles behind the TAK Response conference I attended in September. And the San Bruno gas explosion the week before was a great example of expanding their our community aided in the response, fire fight, and patient care.

The community is growing, and with the help of friends like you, it is getting bigger and brighter every day.

06
Oct
10

The Community of Paramedicine: Pt 1

By Jeramedic 4 Comments
Categories: Events, Good Medicine and Rants
Tags: , , , , , , , , , , , , , ,

Last week I spent my time in Dallas at this years EMS Expo. It was a wonderful experience of both personal and professional growth, and something a recommend everyone attend at least once. But this post is not about the event, or the speakers, or the podcasts, blogger meetups, or even the “shhhh, super secret high-viz, bluetooth  enabled airway adjunct/C-Spine translator backpack gurney, that is going revolutionize the way we…”

This is more of an observational post about what happens at events like EMS Expo, and in the online communities. Something that I am seeing more of, but not as much as I’d like. Our friends in Fire Suppression and Law Enforcement have had a “brotherhood” for nearly a century. That unspoken bond that removes the illusion of rank and department and simply says “we are.”

Granted, Fire and Law have had about a century’s head start. And when it comes to the method and delivery of Fire protection and Law enforcement, a  near uniformity exists from one department or city to the next. But when it comes to EMS, there can be near poller opposite within the same county. Private, Public, Volunteer, Hospital based, Progressive protocols, and antiquated equipment, BLS, ILS, ALS, all sharing boarders. And any combination of the above could respond in teams from one on up to six plus. They could be in a car, ambulance, fire engine, or a private vehicle.

No wonder we struggle to find an identity, let alone a brotherhood. In many ways we are our own oppressors. Thanks to the “popularity” of privatized/for profit ambulances, we are treated like numbers, and view other providers from other services as competitors rather than colleagues. This is a an unfortunate and foolish mistake. We are all EMTs and Paramedics. We went through the same testing, we have same card(s) in wallets, we take care of the same people. So can we just be done with this whole tribal nonsense already?

The funny thing about all this, is that it only happens in the field. What is it about driving around in different colored ambulances that makes many of us act this way? You see, I don’t believe that this is our true nature. I don’t act this way, and I know many other who don’t either. But for some reason only at EMS conferences and on social sites like twitter and facebook do these  walls come down on a large scale.

There, out of uniform,  we stand as equals. Its in this space, in person and online where a student from Ohio can be mentored from Louisiana. Where providers from opposite coasts can feel like old friends, when in fact they just met. And where Medics from around the world can come together and create something bigger then themselves, and give back to the community that helped create it.

This community is what strengthens us as a profession, and as individuals. Its this community that wanted EMS 2.0 when its was just called “I wish things were better.” And its this community thats going to gets its wish. We all agree that it take a special kind of person to do this work. Well, what kind of person is it who will take time off of work, and spend money to go be surrounded by work? This is EMS Expo, and this is the community of paramedicine.

This kind of community is what we need when the boots hit the ground. I wear a blue shirt, you a white shirt, and others red and green, But we are all on the same team, and until we start playing like a team, none of us will win.

More to  in part 2.

22
Jun
10

Believe Me

By Jeramedic 2 Comments
Categories: Rants
Tags: , , , , , , , , , , , , ,

In this day of computer aided dispatch (CAD) systems, GPS locators, and EMD (Emergency medical dispatch) algorithms, one could argue that the process of getting the closest and most appropriate resources to the scene of an emergency, has been greatly stream lined. There is however two things these technologies are lacking: Eyes, and judgment.

You see no matter how much tech we load into a response vehicle and or dispatch center, there are still humans that need to operate the system, update the information, and make treatment and transport decisions. Field providers, dispatchers, and hospital staff need to be able to communicate effectively with each other, and most of all, believe each other.

What follows are two examples of a break in the communication trust.

Example 1:

30min before the end of my shift, and I am en route back to the station. My partner and I notice a large cloud of black smoke rising up a few blocks away. It was 12:30am, and radio chatter was lite. We did not hear anything relating to a fire go out, and so we thought we would go investigate. What we found was a two story house, fully involved in flames, and no one was around. No crowd of neighbors, no police, and no fire engines. Me: “Base, 1116”. Dispatch: “go ahead 1116”. Me: “1116, who do you have responding to the structure fire on 132nd street?”. Dispatch: “ummmm, no response. There is no fire on 132nd street”. Me: “yes there is, I’m looking at it” Dispatch : “umm, ok? Well we don’t show any fire calls in your area. Where are you?” Me: “At 123 132nd street, and there is a house that is VERY much on fire”. Dispatch: “……. Oh! There it is… ok, well show you on scene”. Me: “Thank you”

Example 2:

At a red light, a car pulls up behind the ambulance, and two men exit the car. “this is when we get robed” I jokingly said to my partner, Bobby. The two men begin pounding on the window, they did not speak english, but it was obvious that they were asking for help, and not for our wallets and cell phones. I flipped on the amber secondaries as Bobby followed the men back to their car. As I stepped out of the ambulance I saw Bobby’s eyes get wide. “Its a GSW” (Gun Shot Wound) he shouted. I met him with the gurney at the back of a blood soaked SUV. The patient was quickly loaded into the ambulance, and I was on the radio. Me: “802, were at the corner of Any street and Somewhere Blvd, With a still alarm GSW, we need PD!”. Dispatch: “can you repeat?”. I repeated. While I waited for a reply, I helped Bobby assess and and start treatments. The patient was a male in his late teens. He was pale and moist with labored respirations and diminished lung sounds on the left. He had a a 2cm entrance wound to his left upper chest, mid clavicle. And a 3-4cm exit wound just below his left scapula. Dispatch: “whats the gender of the patent?” Me: “Male! Is PD en route?” I handed Bobby an occlusive dressing and asked if he was ready to go, “yeah, lets get moving” he said. I got into the drivers seat just as a county sheriff pulled up. I gave him a 10 sec report and left. Me: “dispatch 802, we are transporting code 3 to Saint F’s “. Dispatch: “do you need fire to respond”. Me: “No thank you”.

I understand that dispatching is not always the easiest job, and that there are protocols and procedures that must be followed. But when I ask for help, believe me. I promise I don’t make things up just to complicate things.

We are a team. And if we cant communicate and trust one anothers information, we loose points on the field. I am not ragging on dispatchers, I’m just promoting better professional trust. I encourage you to get to know your colleagues in the little dark room, offer a ride along, and play nice.

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