How our physician colleagues got respect

To follow up on last night's discussion on compensation, a board-certified emergency medicine physician with five to ten years experience earns an average of $258,000 per year, or $124/hour. (2009 data)

It was not always so. Forty years ago emergency medicine was a low-pay, low-prestige side job. The mom-and-pop community hospital with a dozen beds maintained a poorly equipped "Emergency Room" staffed by part-time or fill-in physicians.

Defining a Profession:

Medicine considers five factors in defining a specialty:

• Unique body of knowledge
• Professional association
• Peer-reviewed vetting of knowledge acquisition
• Testing of competence
• Institutional training: internship, fellow, clerkship

Three organizations have pushed emergency medicine and EMS physicians into the light.

1968: American College of Emergency Physicians (ACEP)

The first professional organization, established Annals of Emergency Medicine in 1972 as their peer-reviewed scientific journal.

Establishing a scientific journal is a major component in establishing a specialty, from the Annal's website:

Annals is the emergency medicine journal most frequently cited by authors and has the highest impact factor over the years of all 19 journals in the emergency medicine category of the SCI (Science Citation Index). The impact factor (the average number of citations per published article) is the commonest measure of journal influence; the 2010 impact factor for Annals was 4.14, placing it in the top 12% of all 8,005 science and medical journals tracked by the SCI.

Not only is Annals most frequently cited, but it is cited more promptly and longer than any other emergency medicine journal (9.5 years, 83% longer than its nearest competitor). In the past 5 years, more than1,200 different journals in the ISI science journal database cited an article in Annals, and in a typical year, Annals articles are cited by more than 400 different scientific journals, most of them from a broad range of specialties outside of emergency medicine.

In 1979 Emergency Medicine becomes the 23rd specialty recognized by the American Board of Medical Specialties.

1984: National Association of Emergency Medical Service Physicians (NAEMSP)

One hundred emergency physicians established NAEMSP to define the needs and specialties unique to an EMS Physician. The first effort was a task force started in 1992 to establish EMS as an emergency medicine subspecialty. Their efforts moved the ball forward, but not enough to achieve recognition. The task force disbanded in 1996.

In 1997 Prehospital Emergency Care (PEC) was created as the scientific journal for emergency medical service physicians.

From the 2011 NAEMSP annual report:

In July, PEC received its third Impact Factor, which increased to an impressive 1.889. This Impact Factor placed PEC as the 8th most oft-cited Emergency Medicine journal out of the 23 that are currently rated by the ISI Web of Knowledge.

PEC had an even more impressive Immediacy Index, which indicates how rapidly articles that are published in PEC are cited in the same year. PEC had an Immediacy Index of 0.533.

This ranks PEC 4th out of the 23 EM journals that are ranked in terms of being rapidly cited. PEC continued to be placed ahead of such well-established journals as Journal of Emergency Medicine, Pediatric Emergency Medicine, Journal of Emergency Nursing, Emergency Medicine Clinics of North America, and European Journal of Emergency Medicine.

PEC is also the official journal of the National Association of State EMS Officials (NASEMO), the National Association of EMS Educators (NAEMSE) and the National Association of EMTs (NAEMT).

1998: United States Metropolitan Municipalities Medcal Directors Consortium

Known as the "Eagles," this group is comprised of most of the jurisdictional EMS medical directors for the nation's largest cities 9-1-1 services. Read more about them HERE (510 minutes that shape EMS: The Eagles speak in Dallas)

Establishing a unique body of knowledge

By 2005 the professional, peer-reviewed literature was sufficient to make a second effort at establishing EMS physicians as an emergency medicine subspecialty.

NAEMSP members wrote a four volume Emergency Medical Services Clinical Practice and Oversight publication that covered four areas:

1. Clinical aspects of prehospital medicine
2. Medical oversight of EMS
3. Evaluating and improving quality in EMS
4. Special operations medical support

The books were published in 2009.

The content and organization of EMS Clinical Practice and Oversight matched the proposed curriculum for the EMS subspecialty fellowship.

EMS was recognized as an emergency medicine subspecialty in 2010. You can go HERE (How medicine approaches EMS credentialling) for details of the ems physician fellowship. The first board exam is anticipated in late 2013.

You get what you invest in.

I appreciate Skip Kirkwood's response to yesterday's article. It provides an appropriate conclusion to today's example:

My frustration comes from the failure of, or the unwillingness of, so many EMSers to "engage," to spend even a few minutes or a few dollars to advance their profession.  MANY are willing to speak, but a willingness to speak without the willingness to WORK on what you are speaking about is just whining.  And as a kid I learned (whap!) that there are few things worse than a whiner.

My second source of frustration comes from the "What's in it, or what's easy, for me" focus. Improving the stature of EMS in our communities, and improving the lot of EMTs and paramedics, is not rocket science. It involves improving educational standards, becoming active in political regulator affairs, and stepping up to take control of our profession and our work environment. Unfortunately, the response seems to be "If they're not going to pay me more, up front, I'm not going to make any additional effort in this arena."

Folks, you make the investment first, then you get the dividend. It works that way in the stock market, and it works that way in the economic, political, and academic environments.

Mike "FossilMedic" Ward

Offer Expires Midnight Tuesday

OUR BLOGGING COLLEAGUE GREG FRIESE has found us a great deal on a new EMS eBook.  A free download until midnight Tuesday night.  Here in Greg's words he tells us about the book and the author of 2 Weeks a Year:  Finding Humor While Deployed in Iraq, Chat Trent Cherin.

In this episode of the Medical Author Chat Trent Cherin tells us about his book 2 Weeks a Year: Finding Humor while Deployed in Iraq which is about his deployment to Iraq as an Army National Guard Medic. Unlike most authors being a medic wasn’t something Trent did full-time. Rather it was something he did away from his normal work because he enjoyed helping others and being part of the National Guard. He describes being a medic as "a nice break."

2 Weeks a Year is a chronicle of Trent’s 548 total days of deployment. Much of which he spent on a base in Iraq just north of Baghdad. The book was put together from photos and emails he sent to family and friends during his deployment. He also wrote the book as a way to remember his experience.

EMS Week Special: Trent is graciously offering a free download of 2 Weeks a Year from Amazon for the Kindle e-reader or Kindle app during EMS Week 2012. This download is only available from midnight Sunday to midnight Tuesday. Make sure to take advantage of this opportunity to download the book.

The list price for the eBook is $4.99, but you can download it for FREE to your Kindle or your Kindle app on your smartphone or computer.

Just CLICK HERE to get the order page and download NOW (remember, offer expires at midnight Tuesday).  Thanks, Chat!

Firegeezer sez:  I just downloaded one for me.

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Latest Recalls

This first one is for you folks who pull utility trailers.

Carlisle Brake and Friction Co. is recalling (NHTSA recall #12E-003) certain Hydrastar and Hydrastar XL trailer brake actuators produced from Oct. 5 thru Dec. 9, 2011.

One of the rotating components in the hydraulic pump missed a heat treat operation causing the actuator to wear at a higher than normal rate. As a result, the hydraulic pump could fail and result in a loss of braking ability.

Carlisle Brake and Friction Company will notify owners, and dealers will replace the hydraulic pumps free of charge. The recall is expected to begin during 2012. Owners may contact Carlisle at 800 542 0972.

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Daimler Trucks North America is recalling (12E-009) certain Detroit Diesel EPA07 and EPA10 engines. These engines were installed as original equipment on various heavy duty trucks and emergency vehicles. The pump to rail high pressure fuel line used on these engines is sensitive to assembly torque and may be damaged during service work. As a result of other repairs, the line supports may loosen, potentially leading to fuel line cracking and a fuel leak.

DTNA will notify owners, and the high pressure fuel line support will be replaced by DTNA authorized service facilities, free of charge. The safety recall is expected to begin during March, 2012. Owners may contact DTNA at 800 547 0212. DTNA’s recall campaign number is FL-622. Detrot Diesel’s campaign number is 12C-2

DTNA has the same recall out via Freightliner, Sterling and Western Star. It would not surprise me to see Pierce join in at some point, since they use some of the same engines.

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Pierce has joined (12V-080) the recall for engine shutdown software that was reported in January. Pierce will notify owners and DD dealers will make corrections free of charge. Pierce has not provided a notifications schedule. They may be contacted at 888 974 3723.

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Mack and Navistar have joined the Bendix ATR-6 traction relay valve recall.

Navistar is recalling (12V-196) certain 2010 through 2013 Paystar, Workstar, Transtar and Prostar, and 2012 through 2013 Lonestar trucks, equipped with a Maxxforce 11 or 13 engine (Feature Code 12UXJ or 12UXH) and with Bosch alternator Feature Codes 08GGN, 08GGR, 08GHG or 08GHH.

The alternator cable may rub on the high pressure power steering hose, possibly chafing its insulation and causing an electrical short.

Navistar will install a standoff bracket and improve harness routing to better route the alternator wires away from the power steering hose. Navistar did not provide an expected start date for the recall, but an interim notice will be mailed to owners if parts are not available before June 30, 2012. Owners may contact Navistar at 800 448 7825. Navistar’s campaign number is 12515. This recall supersedes safety recall 11V-426, Navistar #11516. All owners that had their vehicles repaired under the earlier recall campaign will need to have their vehicle remedied under this one.

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Goodyear is recalling (12T-003 certain Wrangler Silent Armor tires, sizes LT235/80R17 LRE, LT325/60R18 LRE, LT275/70R18 LRE, LT265/70R17 LRE, LT245/75R17 LRE and LT285/70R17 LRD produced from March 31 thru May 31, 2009.

These tires may experience a partial tread area separation under certain severe usage conditions. Goodyear will notify owners and replace the tires free of charge. The safety recall is expected to begin on or before March 22, 2012. Owners may contact Goodyear at 800 592 3267.

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Ford is recalling (12V-035) certain 2011 and 2012 F53 and F59 stripped chassis vehicles. The "PRNDL" cable may break at the attachment to the transmission control selector arm assembly mounted on the steering column. If the cable breaks, the transmission gear indicator will remain in the first gear position regardless of the gear selected.

Ford will notify owners and dealers will replace the transmission selector arm and the cable, free of charge. This recall campaign began on March 1, 2012. Owners may contact Ford Motor Co. Customer Relationship Center at 866 436 7332. Ford’s recall campaign number is 12S27.

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Mitsubishi Fuso is recalling (12V-058) certain 2012 FEC52, FEC72 and FEC92 trucks for failing to comply with the requirements of FMVSS 208, "Occupant Crash Protection."

During assembly, incorrect passenger’s side seat belt buckles were installed. The passenger’s side seat belt tongue will not engage correctly.

Mitsubishi Fuso will notify owners and dealers will replace the buckle free of charge. The safety recall is expected to begin during March, 2012. Owners may contact MFTA at 866 467 4500. The recall campaign number is C10051100.

…..That's it for this month.  Enjoy the Spring weather…..Sam.

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Party Doll's Weekend Comes to Quick Conclusion

ANOTHER RURAL/METRO AMBULANCE was stolen Sunday morning in the Buffalo suburb of Amherst, New York.  It all began around 6:30 am when a policeman brought Heather Sullivan, 37 and drunk, into the emergency room of the ECMC hospital.  Once she was left unattended, she dashed out the ER entrance where she found the ambulance, also unattended and with  the keys in the ignition.  WGRZ-TV continues the tale:

She started heading east down Kensington Ave. with police in pursuit. Once she reached the first traffic circle, she lost control of the ambulance and went straight through the circle and continued towards the Walgreens. She slammed into a brick wall surrounding the parking lot, slowing her down before the ambulance came to a rest.

WIVB-TV

"Thank God she missed the building though. The brick wall stopped her, otherwise, she would have been definitely into the building," said Amherst Police Senior Investigator Scott Lawida.

The ambulance was heavily damaged due to the impact of the brick wall.

The woman has been arrested and charged with reckless endangerment, grand larceny, criminal possession of a stolen vehicle and other charges.

A Rural/Metro spokesman says that the ambulance will probably be a total loss with damages estimated at $80,000 to $100,000.  The police said that she was driving at an extremely high rate of speed.

WGRZ-TV filed this video report:

The Buffalo News has the STORY.
WIVB-TV has MORE.

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Driver-Only Responding

THE DRIVER OF A CHARLES CITY COUNTY fire department tanker is hospitalized in serious condition following a single-vehicle accident Sunday morning.

photo by James Bates

According to Virginia State Police, Michael Buchanan, 51, of Quinton was responding with the 3,000-gal. tanker around 5 am Sunday morning when he drifted to the right drainage ditch, then crossed over the narrow 2-lane road to the left side where he rolled over and struck a tree.

WRIC-TV

The crash destroyed the truck, breaking it into several pieces.  Buchanan was trapped inside the cab and had to be extricated.  He apparently has some serious damage to his legs and was airlifted to Virginia Commonwealth Univ. Hospital in Richmond.

WTVR-TV Ch. 6 has the STORY.

WWBT-TV

Firegeezer will attempt to get more information for an update today.

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Another excellent music video from Farooq Muhammad (KingFarooq Productions)

from FireEMSRescue:

A music video showing the potential hazards EMS professionals face on a day to day basis. It emphasizes the importance of safety while working under these dangerous conditions.

Blauer provided the funding for this project and is a huge supporter of EMS, Fire and PD all around the country. Please visit www.blauer.com for more information on their wonderful products and services

Mike "FossilMedic" Ward

Monday Morning – "Say Kids, What Week is This?"

This is EMS Week…. it began yesterday and runs through Saturday.  This year's theme is incorporated into the banner:

National EMS Week – May 20 – May 26

FossilMedic Mike Ward is keeping us abreast of the activities and pronouncements that are accompanying the focus during the week by posting a daily essay or news item each evening around 7 pm Eastern.  He began his series last night and the first installment is the posting immediately preceding the Lineup.  So be sure to scroll down beyond our morning greeting and see what he is leading off with.  While you're at it, keep on scrolling and catch up on the rest of the Sunday articles you may have missed.

The National EMS Week is sponsored by the American College of Emergency Physicians and you can read more about this year's program on their website HERE.  So if you are assigned to any unit, fire or EMS, that responds to medical emergencies, then check out the web page and be sure to keep up with Mike's daily postings.

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While we are talking about designated weeks, now is a good time to remind you of the upcoming Firehouse Expo 2012 that will be held in Baltimore in just under 2 months from now.

The week-long event includes training, conferences, lectures, and the always-popular Exhibit Hall.  The exhibit hall is open during the final three days of the Expo and for the 5th year running, Firegeezer and STATter911 will be sharing a both right on the central aisle in the heart of the action.

Dave and I will be looking forward to seeing you there again this year.  For me, this is one of my most-looked-forward-to weekends of the year.  I get a lot of enjoyment out of seeing and talking with our readers who stop by for a visit.  So mark your calendar now and begin making your plans.  A lot of people round up a group and ride down in the FD utility van, and use that department gasoline for the trip.

See you there!

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It's time to get the Monday equipment check started now, so let's get going.  I'm headed for the Bunn-O-Matic to make sure there's plenty of that life-extender for us.  See you back in the digital day room.

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NHL Playoffs – Conference Finals

Sunday afternoon the Phoenix Coyotes staved off a sweep by the underdog L. A. Kings by beating the Kings on their home ice, 2-0.  The next game will be back in Phoenix and they will be charged up in this must-win contest.  Now we'll see if Los Angeles is still on their improbable roll, of if their high-flying streak has been snapped.  Phoenix has a real challenge ahead, needing to win three more consecutive games to move on to the final round.  The Kings however only need to win one… and this will show us if they've still "got it."

Western Conference – Los Angeles (8) vs. Phoenix (3)
Game One: Los Angeles – 4, Phoenix – 2.
Game 2: Los Angeles – 4, Phoenix – 0.
Game 3: Los Angeles – 2, Phoenix – 1.
Game 4 Phoenix – 2, Los Angeles – 0.
Game 5:  Tuesday 6 pm Pacific NBCSN.

Los Angeles leads series 3 games to 1.

Eastern Conference – New Jersey (6) vs. New York (1)
Game One: New York – 3, New Jersey – 0.
Game 2: New Jersey – 3, New York – 2
Game 3: New York – 3, New Jersey – 0.
Game 4:  Monday, 8 pm Eastern NBCSN.

NY Rangers leads series 2 games to 1.

Highlights From Sunday's Game in Los Angeles

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How do WE get engaged?

This video shows how a population was motivated to participate in their first free elections.

Click here to view the embedded video.

The Return of Ben Ali. On January 14th 2011, we chased former Dictator President Ben Ali out of Tunisia. Since then many had lost interest in politics.

After many uneffective attempts to push Tunisian people to go out and vote for the upcoming elections, a new campaign was set up in La Goulette, to the shock of residents.

Their reaction was filmed. Results: On October 23rd, there was 88% turnout when 55% were expected.

EMS: More than a job (??)

This year's theme selected by the American College of Emergency Physicians is: EMS: More than a Job, a Calling

If you have been following the posts by National EMS Management Association President Skip Kirkwood, you may have a different observation. He is not a snarky pundit, but someone who has been doing heavy lifting for EMS. I would say he is a little frustrated.

Working conditions for many paramedics are grim, near minimum wage.

The US Department of Labor identified 2010 median pay for 226,500 "paramedics and emts" at $30,360 per year ($14.60 per hour).

As a contrast, the 310,600 firefighters 2010 median pay is $45,250 per year ($21.76 per hour). Police and detectives make more than firefighters.  Registered nurses even more than police and detective, at $64,690 per year ($31.10/hour).

I appreciate that this year's theme is:

… reflecting the idea that EMS practicioners don't choose this field for big salaries, comfortable working conditions, or 9-to-5 hours; they have a true calling to help and care for others in their hour of need.

Over the same 38 years, physicians dedicated to the practice of emergency medicine have significantly improved their compensation and professional status within the universe of medicine.  Nurses have transformed their profession.

Why are medics still near minimum wage? Why are some single-role ems providers engaged in 9-1-1 service without the same worker compensation presumptions that fire and police have?

Celebrating working for free does not pay the rent

My three passions; teaching, writing and emergency service, are not known as wealth builders.

When I went to work full-time as a community college fire science program director, I was making less money than the rookie firefighters I was teaching … with a master's degree and a dozen years experience as a part-time college instructor.

At the beginning of every academic year, one of the college leaders would celebrate that a retired federal worker was teaching for free. After four years I left the college because of poor pay and threadbare resources.

This week we are going to look at issues affecting the profession of out-of-hospital care that will probably make you annoyed or uncomfortable.

Mike "FossilMedic" Ward

An Annual Tradition

EACH YEAR, THE FAIRFAX COUNTY FIRE AND RESCUE SERVICE fully participates in the Labor Day Muscular Dystrophy events, primarily through the Fill-the-Boot campaign that runs for four days over the holiday weekend.  This is done with the full support and encouragement of the County Board of Supervisors, and the Fire Chief's office sees that every accommodation is made to make for a successful weekend.  This is a large part of why the FRD is always in the top five departments for amount of money raised each year.

One of the encouragements delivered by the Fire and Rescue administration is a reward for the station shift that raises the most donations per capita in the department.  One day is selected and the winning shift gets to sleep in at home and be with their families while a full crew of white shirts and multi-bugles show up to staff all the apparatus.  It's not very often you get to see a deputy chief pull the handline and take it in.

Joel Kobersteen, Information Officer of Firefighters and Paramedics Local 2068 tells us about this years winners:

The "Fill in" Crew:

Front row: Deputy Chief Michael Reilly, Technician Michael Macario, Firefighter Jason Pryor
Back row: Captain II Reggie Johnson, Captain II Steve McFarland, Assistant Chief Garret Dyer,
Captain Cindy Brown, Deputy Chief J.J. Walsh, Deputy Chief Keith Morrison,
Lieutenant Craig Schellhammer, Captain Tim Fowler  (IAFF Local 2068 photo)

On May 14, 2012 uniformed members of the administrative staff and communications section of Fairfax County Fire & Rescue gave the crew from Fire Station 5, C-shift 12 hours off and staffed the apparatus themselves. This was done to recognize 5/C for their tremendous job being the highest raising station and shift per capita during the 2011 Labor Day Weekend Fill the Boot campaign to benefit the Greater Washington Muscular Dystrophy Association. Station Captain Fred Brandell, who is also the Shift Captain at 5/C, inherited the "MDA Fevered shift" from the previous Station/Shift Captain Tyrone Harrington and has since run with it.

Captain Brandell's shift makes an annual pilgrimage down to the MDA Summer Camp in Leonardtown, Maryland where they show the campers around fire apparatus, swim, eat and play with the campers and staff a dunk tank along with now Battalion Chief Harrington. Fire Station 5/C has been the per capita leader for last five years, last year collecting $14,911, which works out to $1,656 per person for the 9 person crew.

Congrats to 5-C, and to the great folks in the "ivory tower" who enthusiastically show up every year to spell the crew.

Fairfax County Fire and Rescue WEBSITE.
Local 2068 WEBSITE.

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Semester-Ending Celebration Gets Too Hot

A LOUISIANA TECH UNIVERSITY Fraternity house in Ruston burned down Saturday afternoon, completely destroying the large home that was next to the university campus.

News-Star

The fire was first reported at 4:30 pm, but it may have been burning for quite a while before then.  The early speculation is that several residents were celebrating the end of the school year by burning some textbooks in the fireplace and the fire got into the void space around the chimney and spread through the walls.  Somebody on campus had called the police to say that they saw smoke coming from the house.  Why they called the police instead of the fire department has not been asked yet.

When an officer showed up to check on the report, the boys (perhaps unknowing of the hidden fire spreading) told him that everything was under control.  It wasn't long after that the fire suddenly broke out and the FD was called.  It didn't take long for the roof to collapse, thus dooming the entire structure.

WSLA-TV posted some raw video of the fire:

The Shreveport Times adds:

Lt. Tim Parker, spokesman for the Ruston Police Department, said the fire began in the fireplace or chimney of the Pike house, and quickly reached the attic where it grew rapidly.

He said one firefighter was injured when the roof of the building collapsed, knocking down a flight of stairs the man was standing on. He was taken to the hospital with minor injuries.  Two other firefighters were treated for heat exhaustion, Parker said.

Parker said officers with the Ruston police managed to awaken and evacuate one student who was still asleep in the apartments at the back of the fraternity home at the time of the fire. All six students who (were) in the house were evacuated safely with no reported injuries, according to Parker.

Read the full story in the Times HERE.
Ruston Fire Department WEBSITE.

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