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31
Mar
10

The Seven Dollar Dent

By Jeramedic 3 Comments
Categories: Rants
Tags: , , , , , , , , , , ,

Today I was out and about town. This morning I took my car to the mechanic for some passed due maintenance (Thanks Chronicles of EMS) Then this afternoon was I off to the good doctor (and family friend) for some passed due personal maintenance.   Then off to the office supply store, and a quick phone call to headquarters to enquirer about some new uniforms. All and all, I’d say it was a productive day. Yup… the well oiled machine of society was running smoothly… or was it?

On my home, I needed a phone number that had been emailed to me. I turned into the parking lot of a shopping mall to (safely) access the internet on my cell phone. On my way out of the parking lot, I noticed a homeless woman sitting on a wall near the exit. And there it was, the familiar feeling we all get. That uniquely human sensation brought on by a cocktail of guilt, remorse, empathy, sympathy, compassion, frustration, anger, helplessness, and denial. I don’t know what to call it, but it’s “that” feeling. Perhaps us EMS folks feel it a bit stronger then others do. The sight or thought of someone in need can at times wreak havoc on our caring nature. It urges you to do something while stabbing you in the back with the knowledge that it’s never enough.

As I got closer I could see she was in her late 30′s. she looked healthy enough, and had some luggage with her (Clean, new luggage.) She also had a large, detailed cardboard sign, “Homeless with two daughters”- I couldn’t read on… There was traffic behind me, so I had to pull out on to the street. I circled the block and went back.

It’s wrong. The well oiled machine of society was broken… It broke a long time ago, and no one seemed to care. “as long as my Iphone  doesn’t get scratched, and Starbucks doesn’t run out my triple shot ignorance late’ then all is good…” No, I’m sorry. It’s broken. “But that’s like why I go to Starbucks, because I care… Cuz like, their coffee is all free trade and stuff… I think… right?… what does free trade mean again?”  *head desk*

In a parking lot full of luxury cars, in a world enamored with money, and this woman had nothing. After working in any branch of emergency services, you become intimately aware of society’s dirty truths that it wishes you didn’t see. The drugs, the violence, the corruption, and the injustice. Because of that, you become quickly skilled in reading people. She was not a drug addict, or a prostitute, or mentally ill (not that any of that should matter) she was a person.  I’ve had coworkers argue that, “I bust my but all day picking up bums. They are not getting my money or time when these boots come off.” Yes, on duty you have a legal responsibility to these people. But what about your human responsibility? The human responsibility that lead  you to this job in the first place…

In my wallet I had seven dollars cash. Seven dollars that was left over from money I had borrowed. It was her’s… I drove back to her corner of the lot and parked next to the Mercedes Benz she was near. “I want you to have this” I told her. She thanked me, and the society machine got a much needed drop of oil.  One thing I learned from my father was to give. He is a very generous man, even when he has little  him self.  He never told me I had  to be this way. He never explained its importance. As a child I would just watch him do it with grace and humility.

Seven dollars would not fix this woman’s problems, or fix society. But it made a dent. It showed this woman that someone cared. It set an example to everyone who watched and did not act. It made a dent… This is what we do, try and try, one little dent at a time. The sad truth is that after that, I saw at least a dozen more people who needed a dent.

I know the readers of this are compassionate people. We may have never met, but I know you. I encourage every one of you to go make dents, in what ever way you can. What am I saying… I know you make dents. I guess I’m saying don’t stop making dents, or even better make more.

This is what we do, try and try, one little dent at a time.

23
Mar
10

Maybe A Little Crazy

By Jeramedic 10 Comments
Categories: Uncategorized
Tags: , , , , , , , , , , , ,

For some time now, I have exhibited some rather odd behaviors.  This has lead me to consider the possibility that I may be a little bit crazy.

Some examples of my possible craziness include:

I guess elderly peoples medical history while in line at the grocery store.

I look at strangers necks, arms and hands and get a  happy feeling when they have “good veins”

I yell obscenities at the television  during Trauma, ER and House… well House is “ok”.. sometimes.

I have  a Pavlovian response when I hear a pager go off.

I feel  strangely comfortable talking to drug addicts and “legit” crazy people.

I have a bright orange jump bag in my car for “just in case”

I know the door codes to hospitals all over the county, and which hospital cafeteria has the best french toast.

I instinctively turn and look when I hear a diesel engine, and for a moment are confused when I only see a pick up truck.

I feel a bit more comfortable when I have a pair of exam gloves in my pocket. Again, for the “just in case”

The list can go on and on but you get the idea. Some may say I’m burnt out, but that couldn’t further from the truth. I love what I do, and I could not imagine doing anything else. Every day I am excited to do more, to learn more and to be more. Maybe it’s just me?

I suppose I am a bit crazy. I mean we all are to some extent. But  what about you? What makes you crazy?

20
Mar
10

Don’t Just Do Something, Stand There!

By Jeramedic 4 Comments
Categories: Good Medicine
Tags: , , , , , , , , , , , , , , , ,

Being a passionate provider, as I’m sure many of you are as well. We are drawn to this line of work because of a sometimes overpowering drive to do the best and the most we can for others. There are however times when doing the best for our patients means doing nothing.

This can be a difficult time for anyone put in this situation. We want to do all that we can, no matter what.  Sometimes we find ourselves in scenarios where we are unable to provide care do to safety issues, or at other times having reached the limit of what can be done in the field. Either way, in any situation the EMT or Paramedic is sometimes left feeling helpless, frustrated, and angry at themselves or at others involved. There is a lot of talk and research on the other, more commonly thought of job stresses. Things like, sleep loss, post traumatic stress, the time spent away from home and its impact on families and so on. But I see this occurrence as an equally significant, and yet less mentioned stress.

Some of us take patient outcomes very seriously, and we all like to be in control.  When put in a situation were things are out of our control, or there is nothing else that can be done, feelings of stress can soon follow. When feelings get out of hand, I see basically two behaviors. One having thoughts and feelings directed towards  our self, such as feelings of failure or inadequacies. The other being directed outward, such as blaming others for what happened.

Like other forms of stress, over time these feeling and behaviors will negatively effect your professional and personal life. Proper management and care must be taken in order to have a long and healthy career. I say this because I have experienced these feeling myself. I can remember arriving to shootings before the police, and having to wait a block or two down the street until the scene was secured. I could see the incident, I could tell that I was needed, and yet I couldn’t help. There were times when someone would run down the street to the ambulance pleading for us to help. Often they would not understand why we had to wait, and I would find myself feeling helpless and frustrated.

There have also been times when I’ve had to take care of someone who was very sick, and yet had nothing for them. Again, more feeling of helplessness and frustration. I found this to be a common scenario when I was an EMT Basic while waiting for ALS to arrive. Even still, as an ALS provider there are times when you cant fix the problem. And what you do have to treat the patient, may actually do more harm then good.

It’s important to be rational about these situations. And to come to terms with your limitations, and to work with them the best you can. Remember that on calls of a hazardous nature like violent crimes, and HazMat, that the safety of yourself and your partner or crew is vital. I know you have heard it before, but I can not stress it enough. You can not help anyone if become a patient yourself. As hard as it may be sometimes, just stop. Stop and wait for the scene to be safe. Your grand kids will thank you for it.

Also, be honest with yourself about your limitations. Now prehospital care has made huge advances in a relatively short period of time. But as much as we can diagnose and treat in the field, very little of that is definitive care. And very often just getting the patient to the hospital is still the best treatment we have. I know that statement may go against what many progressive system are working towards. Like alternative transport and treat and release protocols, but its true. Despite what your ego may tell you, you are not a superhero. And being a good clinician not only means knowing what to do, but also knowing what not to do.

There are of course other situations when no treatment is the best treatment. Like when honoring a Do Not Resuscitate order, or having to triage a Mass Casualty Indicant. The decision to stop or withhold treatment can be a difficult one, even when you know it’s the right one.

Remember why you do this, and that you do make a difference.

Be well my friends, I promise you  it’s all worth it.

An episode of the GenMed show was inspired by this post, and recorded soon after. To listen to the show click here

06
Mar
10

Low Cost, Low Risk Strategies For EMS 2.0

By Jeramedic 1 Comment
Categories: Good Medicine
Tags: , , , , , , , , , ,

Lately I have been having a lot of discussions with fellow EMS providers and the general public about the state of health care, and the delivery of EMS in this country. The opinions expressed in these conversations are as varied as the individual, but one thing remains the same. “There has to be a better way.”

When doing some research on the subject, I was frankly overwhelmed. If you search for information concerning health care reform, public opinion or pros vs cons. You’ll be met with a mountain of research, pseudo research, statistics, projected statistics, public polls from three different news agencies with three different results, propaganda and conspiracy theories.

In the pursuit of better health care and delivery of EMS the debate is ginormous, the hurdles are tall, and the road is long. But there is a better way. There are in fact many ways. The United Kingdom, Canada, The Netherlands, New Zealand and Aulstralia are just a few examples of countries that provide health care and EMS differently and arguably in some ways better then the United states. I do not know what the best way to provide health care and EMS is. Every system has it’s good points,and it’s bad. But I do know there is a better way.

As it stands right now. No mater how much education, training and specialized equipment we possess, we are left with one option to deliver care.  Take the patient to the Emergency Room. Now on paper that makes sense. We are an emergency service that responds to emergency calls. Naturally we should transport to emergency departments.

The reality is that many of our patients are not in a state of emergency. That is not to say that they are not in need of care, they are. Often they are in need of a lot of care, just not the care that is available at the emergency room, or in the back of the ambulance. What this means is that we are not providing appropriate care. And as long as we continue to do so, we are  causing a huge disservice to the patient, the ER, the EMS system and are contributing to the problem.

“Oh, and by the way. Can I have $1500 for the ride I gave you to that inappropriate facility where you did not get your problem corrected? Thanks very much and feel free to call us back anytime”

*                    *                    *

There is a better way. And there will be change. It wont be next month or next year, it may not be for many years. But there are ways you can start providing better care, and help to get the EMS 2.0 ball rolling a bit faster.

  • Provide your patients with resources. Online and in the ER are lists of community resources like homeless shelters and food banks, free and low cost clinics, mental health services  and counseling, detox/rehab centers and 12 step groups and more. Make copies of these lists and keep them in the ambulance. When you have a patient “in need” provide them with a copy of the list, and take the time to explain the other options that are   available. Of course never refuse transport, and reassure them that the ambulance will always be there. But reiterate that there are other services that may be able to help them more appropriately. A good time to do this is during transport when you have a private “teaching” moment with the patient
  • Provide monthly or bi-monthly free community health screenings. Partner up with a local hospital or urgent care clinic and hold the event in their parking lot. Other great places are schools and community centers. Along with the health screenings, give a short talk about health and safety. And teach the signs and symptoms of things like heart attacks and strokes. Why not go one step farther and teach basic CPR. It’s all about compressions, and a lay person doesn’t need a paper card from the AHA to do compressions.  What this does is it puts EMS into the community and back on peoples minds.
  • Show the Chronicles of EMS to everyone. Show it to the medical field and the public alike. Show them that there is another way, show them that the current system is broken. the status quo remains not just because of the fear and reluctance to change, but also because many people are unaware of the problems and their possible solutions.
  • Educate the public, and start a petition. explain to patients (stable and non emergent) the limitations of the current EMS and health care system. Explain that there are other places in the world that do things differently and have more flexibility to provide appropriate care.  Ask them “If I could take you somewhere other then the ER or provide  more and or different care and service, would you want that? Where would you like to go? What would you like me to be able to do for you? Collect the signatures and take them to your chiefs, hospital administrators, medical directors, representatives, and  politicians.

These are just a few ideas. and I am sure you can think of some more strategies that may be better suited for your system and community.  Please feel free to share your ideas, and things that you or your agencies are doing to provide better care and advance the profession.

24
Feb
10

ALS Kills People

By Jeramedic 37 Comments
Categories: Rants
Tags: , , , , , , , , , , ,

While I was in Paramedic school, my instructors would say things like “you’re not a real medic until you’ve killed someone” and “soon you will all have your P-cards and a license to kill”

Studies show that ALS interventions give little to no benefit to trauma patients, and in some cases cause harm. We also still have no hard evidence that ACLS drugs are effective during cardiac arrest.

Systems across the country are downsizing their scope of practice, and losing medications and procedures because mistakes are being made in the field. And some medical directors are feeling like ALS is more of a risk then a gain.

The logical conclusion? ALS Kills People. Well, let me be a bit more specific. ALS kills people when it is used inappropriately and or incorrectly.

Don’t get me wrong, I am a firm believer in the benefit and need for ALS care in the field. But it must be done right. Otherwise you run a high risk of  killing someone.  I know you have heard it before, but its BLS before ALS. And it takes a good EMT to be a good paramedic. And I of course agree, I would also add that a well educated Paramedic with BLS equipment will give better care then an average Paramedic with ALS equipment.

So where am I going with all this? The answer is education, more emphasis on high quality BLS care, followed by appropriate ALS interventions. ALS care,well any level of care for that mater is a two way street of skill and knowledge. With out a thorough education base to start from, is it any wonder why intubation success rates are low and pneumonia patients are receiving Lasix. Not when you consider the fact that some clinical sites don’t allow students to intubate, or that some schools teach airway in a 8hr block and then move on. Another reason ALS is often harmful and seen as a liability, is because many of our new (under educated and under trained) providers go into the field and are so excited to play with their new toys they forget BLS and are unnecessarily aggressive with ALS. Again, this all comes back to more education.

Up until recently, the general consensus has been to remove procedures that are considered “an opportunity for error or that are infrequently used”,  rather then provide more training and education to prevent errors and keep less utilized skills current. Why Is it so taboo  to want more for our patients and our profession? Should a police department get rid of it’s SWAT team because it’s been 15 years since a hostage situation? Should  fire engines respond without lights and sirens because it’s potentially dangerous to other drivers? So why should EMS stop using medications that are harmful when Improperly Used? Or remove procedures that are only used on 5% of the patients.

This is an opportunity to adopt some things from our colleagues in Fire and Law Enforcement. Because as different as our roles are, they are also similar.  I am a big supporter of frequent In service trainings and drills. The Fire service often trains and drills for operations that may have  been done in the field only a few times in the history of the department, in addition to training on daily operations.  Police Officers are frequently at the firing range, even though they may go their entire career without drawing their gun in the field.

EMS is very much the same. we are educated, trained and equipped for the worst. Even though most calls meet BLS criteria, or less. But for that 10% who are legitimately critical ,we still need ALS. So how do prepare for the worst? By completing 48hrs of continuing education every two years…… Really? Kinda embarrassing when you think about.   Go look in the back of your ambulance and consider how many things we carry, and how many are actually used on a daily basis.  Then consider how many things you remember how to use (Properly)

We as individual providers and as a profession can not just wait for the National Registry or our local agencies to require more from us, because they won’t. We need to be responsible and proactive for our industry and require more from them, and from our selves.

As individuals we can educate our selves and practice skills on our own or in small groups. As a profession we can raise the bar for all of us  by increasing the minimum standards for employment. Individual schools can increase the required hours (or years) of education, and begin asking for more prerequisites. The industry standards will not change for us, we must change the industry. And it starts today with you.

If you are interested more on the importance of good BLS care, Steve Whitehead has a great post on the subject. Also   Rescue Monkey brings a different perspective, and adds a good dove tail to the issue.

03
Feb
10

Frequent Flyer Benefits

By Jeramedic 8 Comments
Categories: Good Medicine
Tags: , , , , , , , , , ,

Is there such a thing as Frequent Flyer Benefits? Yes there is, and I’m not just talking about flying across the country on the cheap either.

In this business, “Frequent Flyer” is a semi derogatory term given to those patients to whom we see often. They are the homeless alcoholics, the poorly managed type II diabetics, and the lonely widow. Anyone who has been in the field for a few months can tell you who their preferred customers are, and they know their address and chief complaint by heart.

These patient are not just the habitual 911 callers, but are also the weekly scheduled transfers like dialysis and chemo patients. I recently had a discussion about this with a good friend of mine. He is an administrator at a mid sized ambulance company specializing in inter facility transfers, and he has been dealing with a rather problematic trend amongst the field providers. He told me that  many of his personal were not doing assessments on frequently transported patients.

When he would ask why they weren’t doing full assessments, he was met with poor excuses like “Mr Johnson has CHF, he’s always tired” or “Ms Conner is post CVA, she’s always altered.”

This is a very dangerous  practice. I know at times it is tempting to think of our frequents as static characters that we give rides to. But that is  just  not the case . And it should be reiterated that for the time on scene and during transport, regardless of your level. You are the person that is most responsible  for that patient. And not doing a full assessment is frankly irresponsible and could cause harm.

So you ask where’s the benefit’s? , why should I be happy to be transporting this patient for the third time this week? well because you are at a huge advantage to provide really good care. You’re even at a greater advantage then the patients primary physician.

If you transport Mr Fillips to and from dialysis three time a week, that means you do six assessments a week on the same patient. That’s twenty four assessments a month, and one hundred and forty four assessments  every six months!  Do you think his primary physician, let alone anyone assesses this man health twenty four time a month? Probably not. And if anything was out of the ordinary, who do you think would notice first? You would. That is of course if you did an assessment.

When treating a frequently seen patient, we should pretend that it is the first time we have seen them. Sure you know their name and medical history but that’s where the familiarity stops. Afterward ask yourself  how what you found compares to what you know? Whats different or new about the patients presentation?

EMS, despite what it might claim is not an emergency service. At least not exclusively. Our place in medicine is quickly expanding in many ways.  If we can lose the “trauma junky ” hero mentality, and embrace our true role as Health Care Professionals. Then we will not only benefit ourselves as providers and our industry, but also provide our patients with better care.

So the next time Mrs Miller starts singing “ca’mon ta my my house, ca’mon ta my house” Be true to your role. Be kind to your patients. And give them the respect and attention they deserve.

29
Jan
10

Author Interview With Steve Whitehead

By Jeramedic 4 Comments
Categories: Interviews and Guests
Tags: , , , , , , , , , , ,

I’m finishing off this week of Best Practices with an Interview of Paramedic and author of the new E-Book  The Nonconformists Guide To EMS Success, Steve Whitehead.

This is a follow up to My review of  Steve’s book, which you can read Here.

It was wonderful speaking with Steve earlier this week. He is very knowledgeable, friendly and approachable. And  has two decades of experience in EMS, both as a field provider and an educator.

Steve very graciously made time for this interview and was supportive of the project. And I thank him for that.  So Lets begin.

Jer:   In the beginning of the book, you tell us that you were once very  irritated
and unfulfilled with your work. what made you decide to change your
attitude?

Steve:   It may have been one call specifically. I was working in a very high
crime and economically impoverished community in California. I was angry at
my job. Upset that it wasn’t what I expected it to be. I felt that nobody
understood what we were supposed to be doing as EMS professionals. I was
upset at the low pay, the bad working conditions, the long hours, all of
it. I was young and immature. Probably too immature to be a paramedic yet.

We worked 24 hour shifts and we were usually up all night dealing with
very sick respiratory patients (most of the community smoked), people who
were drunk, and people who abused methamphetamine. Most of are calls at
night were for the meth users.

We ran a call for a meth overdose and our patient was a combative,
out-of-control female. She injured my partner while we were restraining
her. By the time we had her in full restraints (We couldn’t sedate people
back then.) my adrenaline was in overload. My treatment of her after she
was restrained was totally inappropriate. It was what we might refer to as
“punitive medicine.”

Nothing I did was to really help her. I used my medical skills to punish
her. This wasn’t unusual for our service. Lot’s of the paramedics I knew
used their medicine to take out their aggression on their patients. But it
wasn’t normal for me. After the call I felt horrible. I wanted to quit. I
realized that nothing I was doing had anything to do with why I chose EMS
as my profession.

I decided to stay in EMS, but I had to ask myself some serious questions
about why I was doing this job and what I wanted to stand for as a
caregiver. Since that call I made the decision that I needed to always be
an advocate for the patient. Regardless of whom the patient is. Regardless
of whether or not we like them. Regardless of whether or not they like us.
We exist to serve the patient. If you’re not willing to serve people, you
have no business being in EMS.

My journey of success in EMS began the morning after that call.

Jer:   I can see how that must have been a very difficult time for you. I think it’s obvious by now that we are grateful you chose to stay in EMS.

You tell us about three types of people to watch out for. The critics,
the old guard and the bottom feeders. It’s possible that some of your
readers are these people, and it may be very difficult for them to apply
your principles. Can you offer any advice for them?

Steve:  Great question. I secretly hoped many of the readers would identify with
one or more of the archetypes. (To one degree or another.) I used to be
one for these people too. I used to be a critic. I defined everything by
what was wrong with it. It’s a very unhappy way to look at life.

You can’t talk people into changing. Changing the way you see the world is
phenomenally hard and it takes years of effort. When people decide they
want to be something fundamentally different than they are, they will. You
can’t make that happen for them. Hopefully, if they make that choice,
they’ll find my book useful.

Jer:  Yes they will.

But some may argue that conformism breeds uniformity. And that uniformity
is something we are lacking in EMS. how do you defend you point of
non-conformism?

Steve:   In my own selfish view, I’d like to see people be uniform in all the
things I advocate for and non-conformist in everything I advocate against.
That’s probably an unrealistic goal, but it’s a goal none-the-less.

It’s important to consider that the term non-conformity implies that I’m
rallying against something. I’m really not. I’m rallying for something.
Actually lots of things. I’m rallying for competence, personal
accountability, a servants heart, a willingness to contribute, and a
desire to make EMS better for the next guy or gal.

If we’re going to seek uniformity, we have to decide what we’re going to
unify around. I like my list. …And I think it would serve our profession
well.

Jer:   I agree very much with you Steve.

You also encourage readers to find a mentor. Who was your mentor, and how
did you meet?

I’ve had many mentors. from my first paramedic preceptor (Phil Rigardo)to
many members of my current leadership team and fellow paramedics and
firefighters.

I’d say some of the folks who most served to shape my career and who I
wanted to be were my father Ed Whitehead, Thom Dick, Jeff Forster, Twink
Dalton, Billy Kraft and Mike Taigman. All of them helped me decide who I
wanted to be in EMS and helped me on the path (In their own way.)

It’s impossible to relate how many people influenced me over the past two
decades. But it’s important to note that we never really know when and how
we are going to influence the people around us, for better or worse, but
it’s worth considering when we decide who we want to be each day.

Jer:   You say that for us to change and grow, we must  be willing to have
difficult conversations. What was a difficult conversion you have had,
and needed to overcome your fear about?

Steve:   As a supervisor, I needed to have difficult conversations all the time. I
had to tell some poor dude that his hygiene wasn’t up to par. That was a
tough one. All his coworkers talked about it, but nobody, I mean nobody,
was willing to talk to him about how bad he smelled. That’s a pretty
extreme example.

Every day we run into those conversations. The dude who always leaves the
ambulance understocked, the gal who’s always complaining even though
everyone’s tired of hearing it. If you come from a place of caring and
respect, those conversations can be powerful opportunities.

Jer:   Well said Steve, I have just one more question.  Many reader of your book and your website are New Providers.     if you could only give them one ideal to live up to in their new career, what
would it be?

Steve:   Be kind.

Jer:   Thank you Steve.

Weather you are a student or a seasoned veteran, an educator or administrator. I highly encourage you to go and download your FREE copy of  Steve’s E-B00k, The Nonconformists Guide To EMS Success.

28
Jan
10

Book Review: The Nonconformists Guide to EMS Success, By Steve Whitehead.

By Jeramedic 2 Comments
Categories: Book Reviews
Tags: , , , , , , , , ,

This is the first in a seires of book reviews that will be featured here at Jeramedic. And I thought what better choice then to start things off with a  new and great E-book.

The Nonconformists Guide to EMS Success . By Steve Whitehead.

Steve is a Paramedic/Firefighter and EMS Educator. He has authored several articles for EMS Magazine, Advanced Rescue Technology and JEMS, and can often be heard on the EMS Garage and EMS educast pod cast’s .

The E-book is a first for Steve, but he writes and posts frequently on his website The EMT Spot .

The Nonconformists Guide to EMS Success could be considered a blue print to a foundation on which to build a rewarding and successful career. Or a renovation project on your current career, depending on where you stand.

The book revolves around three points. Growth, Leadership, and Connection. Steve believes that by focusing on these three elements. And having a clearly defined goal for yourself personally and professionally, that  success is well within reach.  Steve asks us to “Tear up the old social contract of conformity and move in the direction of what matters to you.”

And what does matter to you? For me what matters is to be happy of course. To feel that my work and effort really mean something. To be valued and respected. To be treated fairly and honestly. And to help make positive changes. Not just for my patients, but for my industry and for myself. But how do we achieve that?  Where do we look?

“Your Leadership Doesn’t Have What You Need.” Steve explains that they are not responsible for your happiness and success. At least not in the ways you might believe.

That if you want something, Or  feel that a change is needed then “stop waiting for permission.” There is no S.O.P that restricts you from having a conversation with the boss or finding fulfillment.

Steve goes into detail on these subjects and many others, and speaks from years of experience from being on both sides of the table. He also shows us an exercise for personal review and goal setting, and explains why we should be “Remarkable” and to “recognize that the value of your work is directly and irrevocably attached to the value of the patient being served”

My Thoughts.

I enjoyed this book very much. It delighted me to see that another professional held the same or similar values as I do about this career. This not to say that did not get anything out of it. far from it. There were many concepts and principles that were new and useful to me. I think a provider of any level and experience would find it to be a valuable resource.  I also love how the information is presented. Not just in Steve’s writing, but also the format. As an E-book, it is easily obtained. If you can wait 30 seconds for it to download, it’s yours.  Being that it comes as a PDF file makes it easy to store and transport amongst your devices of choice.

It is easily printed and can be shared with crew mates, or given as a hand out during a class. I’d go so far as to say that it should be required reading for EMT and Paramedic programs.

In my experience, I find myself to be very happy with my work and my contributions to the industry. And it shows. My colleagues would ask “how come things don’t bother you?” and “you’re always in a good mood, what’s with that?”  I would try to explain and give advice, but talking about it at hospitals or between runs just doesn’t cut it. Just one read of Steve’s book could do more for a troubled EMT then five straight shifts of an in ambulance lecture ever could.

Normally when someone starts to offer up some “free advice”, you may find yourself more confused or upset then when you started. Steve and his book are the exception.  And did I say FREE advice? Yes.The Nonconformists Guide to EMS Success is available  for free download at his website.

I highly recommend that you download and read this book, and share it with your co-workers, with your class mates or your students. You’ll be glad you did.

****Coming up on Saturday the 30th. I’ll be posting an interview I had with Steve Whitehead. He’ll be talking about the book and it’s lessons, as well as what inspired him to change and find success in EMS.****

26
Jan
10

Good Enough, Is Not Enough

By Jeramedic 7 Comments
Categories: Good Medicine
Tags: , , , , , , ,

when you think of a good EMT or Paramedic what comes to mind?

when you remember back on someone who influenced and inspired you, who do you remember?

I want to introduce you to two EMS providers.  we will call them “John” and “Jane”. Now John and Jane share many things in common with one another, but they are also very different.

They both work  for the same EMS service. They both went to the same school, and they both have been working in the field for  six years.  But this is where the similarities stop.

Lets meet John.

John arrives at work for all of his shifts on time, every time.  He attends his company’s mandatory CE trainings without a fuss and always keeps his certs and licenses current. He has good patient care skills and treats them appropriately for their illness or injury. At the hospital he is the model of efficiency. He gets his patients in a bed, gives report and is back in service in record time. He is also a training officer and preceptor. He promoted to the positions after only 2 years at the company. He Trains new employees and has students any chance he gets. And at the end of his shift, he leaves work at work. And knows how to relax on his days off.

Now lets meet Jane.

Jane is usually on time, but has been late on more than a few occasions.  She also attends the training classes and keeps up her certs. She has good patient care skills too, but has had meetings with her supervisors  about mistakes and breaking company policies and procedures. At the hospital she chats with the staff and tends to take a bit longer to clear. She is a training officer and preceptor as well, But she doesn’t see as many new hires or students as John does. And she is very picky about who she rides with. She bounces around the company, and has worked at every station. She doesn’t stay in one place with one partner for very long. When she goes home, she often thinks about  tough calls she had the shift before. And even on her vacation, it’s hard to get her mind off work.

Now who do you wish to emulate? who would you rather be known as?…… If  you said John, hold that for a minute. And lets look a little deeper.

John arrives at work for all of his shifts on time, every time. His shift starts at 0700, he gets to the station at 0658. 

He attends his company’s mandatory CE trainings without a fuss and always keeps his certs and licenses current. He is required to do 48 hours of CE, he does 48 hours.

He has good patient care skills and treats them appropriately for their illness or injury. He has too. Otherwise he’d be injuring and killing patients, have multiple  lawsuits against him and he’d lose his job. 

At the hospital he is the model of efficiency. He gets his patients in a bed, gives report and is back in service in record time. He hates being out of the station and wants to get back to the football game and then take a nap.

He is also a training officer and preceptor. He promoted to the positions after only 2 years at the company. He Trains new employees and has students any chance he gets. FTO’s get a 10% raise and preceptors get $1,000 for every student they have. He wants a new boat by next summer and thought he could make some extra cash.

And at the end of the shift, he leaves work at work. And know how to relax on his days off. He spends his weeks call bonus as beer money and gets drunk on the weekends, drinks when he can’t sleep and drinks when the bad calls come back to haunt.

Still thinking you want to be like John?

Jane is usually on time, but has been late on more than a few occasions. She’s on time because she gets to the station early to make sure the ambulance is stocked, fueled, and clean.  When she is unexpectedly  late she informs her supervisor and dispatch before her shift.  And  also attempts  to find someone to hold over until she gets there.

She also attends the training classes and keeps up her certs. As well as her required 48 hours, she also takes classes that interest and challenge her. And she teaches CPR and First Aid three times a month. 

She has good patient care skills too, but has had meeting with her supervisors  about mistakes and breaking company policies and procedures. She admits to her mistakes and learns from them. When she broke policy and procedure, she had a justifiable cause and did it in benefit of the patient. 

At the hospital she chats with the staff and tends to take a bit longer to clear. She consults with the doctors and nurses about the patients she brings in. She asks for others opinions and suggestions on the care she gives. 

She is a training officer and preceptor as well, But she doesn’t see as many new hires or students as John does. And she is very picky about who she rides with. She loves to teach. When there are new hires or a fresh crop of students, she take her time and chooses the ones that are struggling or needs extra attention.

She bounces around the company, and has worked at every station. She doesn’t stay in one place with one partner for very long. She has been able to experience a much wider variety of calls then John, because she has worked all over the city. She know everyone at the company and has many friends.

When she goes home, she often thinks about  tough calls she had the shift before. And even on her vacation, it’s hard to get her mind off work. She remembers the tough calls and reviews her text books, does research and thinks of way she can do better next time. One of her favorite times of the year is when she goes to EMS Expo

When you look at John, and realize that as skilled and accomplished as he is. He is doing the bare minimum that is required by law to keep his certs and not be fired or sued. That’s it…. the bare minimum.  The sad part is that in my experience, I have met many Johns. and I’m sure you have too. You could be reading this and realize “wait a sec, I am John!”  If you are John, I hope this is a wake up call. A kick in the pants to get you in charge of your life and your chosen profession.

I encourage you to get out there and be the change, be the example. Find someone more experienced then you and learn something from them. Find some less experienced than you and teach them something. Read a text book, read a medical journal, read a blog, READ ANYTHING. Go to conferences, take a class or two. Be proud of who you are and what you do. And do it well.

It’s easier than you might think.

10
Jan
10

Can I Get You A Blanket?

By Jeramedic 2 Comments
Categories: Good Medicine
Tags: , , , , , , , , ,

Today I read I great article by Greg Friese about cold weather response tips.  Greg writes that provider safety is number one, and of course I agree. Personal safety always comes first on any response, no mater what the weather. Ok, so we made it safely to the call. We are  wearing the appropriate gear for the weather and the type of call, and we have a safe and secure work area. Now what? Now we must try keep the patient as warm and safe as us. At the end of Greg’s post, he also has a short video showing how to keep a patient warm using sleeping bags and a plastic tarp. This is a great technique, but is better suited for wilderness medicine or extended rescue or extrication times.

Here’s  the deal. It doesn’t have to be -20 and actively snowing before you should  start thinking about keeping your patients warm. when our patients are ill or  traumatically injured, their ability to maintain an appropriate temperature is compromised. To compound that problem we remove their clothes, put them on a cold backboard or gurney, start to fill them with IV fluids that may as well have  come from a refrigerator and then take them outside into cold  ( unless of course the above was all performed on the cold ground and outside to begin with )  This is bad patient care plane and simple. Consider this: When  someone is cold, they shiver. Shivering yields poor EKG’s, it changes respiratory patterns,  and it increases oxygen demand. When someone is cold they will have peripheral vasoconstriction which makes it more difficult to start IV’s, it changes skin signs, it gives inaccurate SpO2 readings and above all when someone is cold, they are uncomfortable. There are some simple things you can do on your next call that can keep your patients warm and happy.

  • First, if your service has a linen exchange with your local hospital then use it. Stock up on extra blankets and keep two or three on the back of your gurney.
  • Use yourself as a thermometer. If you are cold, so is your patient.
  • Pad the backboard. this is something we should be doing anyway.
  • Only expose the patient as needed, and once you are finished with the exam or treatment  cover them back up.
  • If time and you patients condition allows, encourage and help them to dress warmly before leaving their house.
  • When you arrive on scene turn on the heat in the ambulance. After ten minutes it should be nice and toasty.

These practices are simple and effective.  It’s about taking care of our patients.  Not just clinically but as people. “Can I get you a blanket?” and “are you comfortable?” go a long way.

What are some ways you look after your patients in the colder months? Does your service have special protocols for cold weather operations? speak up! and stay warm out there.

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