Happy Medic’s Blog opened my eyes to a fire-based EMS system that is actually quite similar to the system that I currently work in. Until recently, I would cringe at the words “fire-based EMS”. Well…..I still kinda do, but I have a lot of respect for Justin and the work that he has done to promote the concept of EMS 2.0. He has shown me that it is possible (although difficult) to be a good paramedic and firefighter at the same time.

Reading Ambo Driver’s blog has made for some good laughs and valuable lessons learned. For example; his article about spinal immobilization made me read further on the subject and really rethink my “c-spine everyone” mentality. I have been able to use his many years of experience and expertise to improve my practice in the field.

Mark Glencorse has really opened my eyes to a different kind of EMS system with his Medic999 Blog. For the first time, he showed me that other systems have options to advise and even deny people transport to an ER by ambulance! This is something unheard of in my area. Reading his blog has shown me that patient advocacy doesn’t always consist of transporting everyone to the hospital. I have also found it very interesting to read that while fire departments in the United States are standing in line to start providing paramedic-level service, fire departments in Europe are doing everything they can to stay out of EMS all together! It’s just another example of people working differently to achieve the same goal.

I recently started to read MsParamedic’s blog, which grabbed my attention when I read her article about scene safety. It really drove home the fact that we are not invincible. I was able to relate as I had a very similar experience. Her post brought me back to that time and made me remember how important it is to make sure that myself and my partner are safe and make it home at night.

Having the opportunity to be a guest on the EMS Garage (or Happy Hour if you will) was a wonderful experience. I learned a lot by speaking with all of the experienced EMS professionals on the show. Hearing everyones takes on fire-based EMS and the future of EMS in general was quite the experience. It is something that I hope to do again in the near future.

Last and certainly not least, I must give major thanks to hard work put into the Chronicles of EMS. Following the project has really shown me that we are all after the same goal. I think that it is a wonderful way to connect EMS professionals from around the globe in an effort to perfect the important job that we do. It is truly the beginning of a new era. As the project grows and more people become involved, we will see EMS 2.0 transform from an idea to reality.

I read so many blogs everyday that I would be nearly impossible to list what I have gained from everyone. I can only hope that my posts and contributions will someday attribute to another EMS professional’s knowledge base. Thank you all for everything you do for not only EMS professionals, but the patients that you serve as well.

Keep up the good work!

In any type of business there is a chain of command. If you are self-employed, you answer to your customers. If you work for a large corporation, then you probably have several levels of management. EMS is no exception. We all work for somebody.

If your an EMT, you probable answer to your paramedic. If you are a paramedic then you probably answer to your supervisor. If you are a supervisor, then you probably answer to an operations manager. If you are an op’s manager, then you probably answer to the owner. So now comes the big question. Who does the owner answer to? The owner answers to the people making his/her business possible. The customers, AKA the patients.

I’m sure that I will get some coments explaining that this doesn’t apply to government-run operations. That is actually far from the truth. Government-run ambulance services usually answer to either a city counsel or a county board of supervisors. They of course answer to the tax-payers that utilize your service. See where I am going with this?

The moral of this story is simple. Your patients are ultimately your boss. You work for them. They don’t work for you. Think of them as your bosses, bosses, bosses boss. Without them, you don’t have a job. They are what makes this wonderful thing called “EMS” possible.

During times of a recession, it’s a wonder how any ambulance service can survive. With more and more people becoming unemployed, reimbursement for emergency services is at an all time low. This also means that less people are paying taxes to provide services like fire, police and EMS. Medicaid and Medicare programs have always had a history of cutting reimbursement during tough times. It’s now to the point where ambulance providers are only getting pennies on the dollar for what they bill.

All over the country, private ambulance services are going out of business or selling to larger providers. EMS jobs are not as abundant as they used to be. I happen to be fortunate as I work for a private ambulance service that remains financially stable right now. This of course has given me an opportunity to see what some people are willing to do get a job. We have paramedics not only moving from out of town, but out of state to work for us. It is unlike anything we have ever seen.

Now you would think that people working a secure EMS job would appreciate it, being that they can see whats going on around them. That isn’t exactly the case with everyone. I still hear attitude with crews when they are dispatched on a call for a skilled nursing facility or an inter-facility transfer. Sure, nobody enjoys those calls, but they are keeping services like us alive. While the 911 call for a stabbing is certainly exciting, it doesn’t pay the bills. As a matter of fact, 911 calls for the most part are a money loser.

If you are fortunate enough to be employed right now, remember that the calls you are running is the very thing keeping you in a job. When your employer cuts overtime, remember that it’s better than getting laid off. It’s far better to take a small hit now to ensure that you still have job in a year.

For those who are interested, I have another article I wrote a little while back about how a recession affects EMS.

I just finished reading a great guest post on “Everyday EMS Tips” by Steve Lichtenberg about teaching CPR to kids. He gives some great advice about teaching to a younger audience. But more importantly, he makes it clear that kids can be taught to save lives. This post really hit home, as I am living proof on how teaching kids to perform CPR or First Aid can really make a difference.

When I was 12 years old, I took a health class in school to get out of having to take Spanish. For 2 weeks, we learned CPR and first aid. We were also certified in the skills once we showed our instructor proficiency. To me, it was more of an excuse to goof around and pretend to make out with the CPR dummy and make people laugh. It still didn’t change the fact that I had to learn the skills in order to pass that part of the class. I actually did find the first aid part of training to be interesting. So after I passed the class, I had 2 neat cards to put on the refrigerator and show off to my parents. I never thought I would use any of those skills, especially as a child.

A couple days after I completed that class, I was riding bikes home with a couple of my friends. One of the kids that was riding with us decided to take off across traffic and was hit by a pickup truck. I watched him fly over the handlebars, hit his head on the windshield and fall off the side of the truck to the street. After a couple seconds of watching him lay motionless, I ran over to him to see if he was ok. He wouldn’t respond to me and basically laid there limp.

The lady driving the truck got out and started screaming at me to get out of the road so that she could pull him off to the side. I knew that we shouldn’t move him, although I didn’t exactly know why. I just remembered that we should keep the head still. I held his head and told the lady to call 911. This was before cell phones were popular, so there was really nothing she could do. I yelled at my friend to ride to his house that was only a block away and call instead.

Several people stopped to help, and pretty much everyone wanted to pull him out of the road. I was adamant that we couldn’t move him and I tried my best to convince the adults on scene that I was doing the right thing. It basically came down to the fact that I refused to let go of his head, so they really had no choice. I had one of my friends hold pressure with a towel on a large laceration that he sustained from the accident in attempt to control the bleeding. He too had just taken the same class.

The ambulance (the same one I work for now) arrived on scene first and took over care. I don’t remember much of what they did, but I do remember one of the crew members thanking me and saying that I did the right thing by holding his head. A couple months later, the kid returned to school. He suffered minor brain damage and a spinal fracture. He had no lasting neurological deficits and pretty much made a full recovery. I’m sure his helmet probably did more of the life-saving than anything, but It’s nice to think that I may have actually made a difference in his outcome.

So yes, I do think that kids can and should be taught to perform life saving interventions. Image how many victims of cardiac arrest would survive if we taught all high school students to perform CPR? We make them learn to use a computer and type properly on a keyboard. Why not teach them how to react in a life-threatening emergency? They may never take another CPR class for the rest of their life, but they will always have at least some of the knowledge in the back of their head. Bad CPR is always better than no CPR. I wonder if the American Heart Association has tried to approach programs that would teach young adults CPR before graduating high school?

If anyone knows of such programs, I would love to hear about it.

Of course, I explained the science behind the AHA guidelines and why they recommend fast and hard compressions. The hard part was explaining why me and most of my coworkers don’t follow them. Being a paramedic, It’s easy to explain that my focus is around ALS interventions. Being that I have plenty of BLS providers on scene with me, I don’t typically have to worry about doing CPR. However there isn’t really a good excuse as to the large number of EMS providers that just “pump and blow”. It kind of makes me wonder how much of the Heart Associations studies actually included pre-hospital cases. More importantly, it makes me wonder if it really makes a difference.

….which brings me to my next point.

It seems like every time I teach a class, whether it be CPR or an EMT class, I always find myself having the “when you get into the field” talk. There seems to be this big separation of what you learn in the classroom and what you learn on the streets. I get that there are many things that experience teaches you that a textbook just cant. But why can’t our education be more realistic? It almost seems that we do everything BUT prepare our EMT and Paramedic students for real life scenarios.

We don’t tell people in CPR classes that bagging patients for any period of time usually leads to abdominal distention and regurgitation. Sure if you “properly ventilate”, that shouldn’t happen. But throw in the “bouncing ambulance” factor and the “2 people trying to do five things” factor and you got yourself a gurney caked with used hot dogs.

We don’t seem to tell our paramedic students that Mr. Homeless on 4th street only calls 911 complaining of chest pain because he knows you will give him Morphine, a bed and a hot meal. Is it that the people writing the books are so far disconnected from pre-hospital medicine? Or do we just think it’s too “politically incorrect” to tell our students that our patients lie to us?

All I’m trying to say is that we as EMS educators and providers need to put more emphasis on teaching our students the reality of working in this field. I would like to see us try and close this gap between classroom and field learning.

Anyone beg to differ?

Once upon a time lived a boy named Sue. He was well known as the bully around town. Sue was quite the perfectionist. It was understood that when you are in Sue’s territory you play by his rules. One wrong look and you better hold on to your lunch money for dear life, because Sue would have you roughed up and broke before you even knew what hit you.

On the other side of the neighborhood lived a boy named Doc. Now Doc was quite the opposite. He spent his days helping people with their various issues. A problem solver if you will. As a matter of fact, other kids were willing to pay Doc to help them with their problems. He was good at what he did and had a heart of gold. Unfortunately Doc wasn’t perfect. Sometimes he made mistakes, and that often made the other kids mad.

One day came and a kid named Pat had a problem that Doc just couldn’t solve. Pat became very upset as he paid Doc all of his lunch money and didn’t get what he wanted. Pat decided to track down Sue and see what he could do to help. Sue assured him that he would get his money back, as long as he got to keep half. Pat couldn’t resist the offer and decided to take him up on the deal. So Sue tracked down Doc, roughed him up and took all his money. As a matter of fact he took more money than Pat gave him to begin with. Pat ended up getting all of his money back and Sue kept the rest.

Now Doc eventually recovered and went back to his business of helping people. That is until one day Pat returned and requested his services again. Not really sure what to do, Doc agreed to help him. Once again Pat wasn’t very happy with the service he received. Pat once again called upon Sue to get him his money back. Only this time Doc called upon his friend Sharky to defend him in his time of need.

Sharky stood up to Sue and saved Doc from losing all of his money again. This continued until one day Sharky realized that he was providing a valuable service for Doc. A service this good was worth some form of reimbursement. After all, if Doc didn’t have Sharky to help, then he would lose all of his money every time Sue came around. Eventually it got to the point where it cost more money to have Sharky help, then to just give Sue what he wanted. This of course made for hard times with Doc.

More and more kids were getting the idea that they could just call Sue to get what they wanted out of Doc. Of course Doc couldn’t stand to lose all of his money as he had to have something to buy his lunch with. So Doc decided to ask for more money in exchange for solving peoples problems. As the cycle continued, many people couldn’t afford to pay Sue anymore and therefore would not seek his services. Even with the small number of kids that were actually paying Doc for his services, his high prices still provided for enough money to buy lunch.

Times were tough, but Doc managed to eat everyday. That is until the kids that didn’t have enough money to pay Doc called upon Sue to help them with their problems. Sue then told Doc that whether or not the kids had money, he was going to help them unless he wanted to get roughed up and robbed again. Unfortunately it got to the point where Doc was helping every kid in the neighborhood and only a couple kids were actually willing to pay him for his service.

Eventually Doc just couldn’t keep helping people. The constant fear of Sue coming around finally got the best of him. He had no choice but to quit trying to help people and find another way to earn his lunch money.

Chronicles of EMS – The Reality Series (Season 1 Episode 1) from Thaddeus Setla on Vimeo.

The wait is over. The much anticipated first episode of “Chronicles of EMS” is now available for viewing. I must start off by saying that I am very impressed with the quality of work done by the group. I am very excited to see more episodes as they arrive. Just watching the first episode really opened my eyes to many differences and similarities between the system in San Fransisco and system that I currently work in.

For starters, I noticed that Justin walked many of his patients to the ambulance. In the area where I work, that is against our policy. We aren’t supposed to walk patients at all. Obviously what he is doing is working for him and we do works for us. It’s just one example of how we all take different approaches to achieving the same goal.

Another thing I noticed was his short radio reports. I’m not sure if this was a result of cuts in the video during the edit, or just how medics give report in that system. We typically try and keep our reports under 30 seconds, but we also include a lot of information that isn’t exactly needed “right now”.

I guess it doesn’t matter if you live in San Fransisco, New York, Texas or anywhere for that matter. We all run the same patients. The system, protocols, equipment, and colors on the ambulance all change. The only thing that remains the same is the patients and the emergencies. This is why I believe that the Chronicles of EMS will be a huge success.

If you are reading my blog and haven’t checked it out. DO IT. It’s a great piece to watch, and I’m sure that it will continue to grow and improve. The concept of EMS 2.0 is growing right before our eyes thanks to the hard work of this group. I really hope to see more people become involved and interact to share their stories and maybe even bring Chronicles of EMS to their home town.

Take the time and check it out. You wont be disappointed! http://www.chroniclesofems.com

Also feel free to join the discussion about #CoEMS on twitter. Follow Chronicles of EMS on Twitter!

We get on scene to find an intoxicated biker standing in the roadway talking to law enforcement. They don’t want him to go by ambulance as they are arresting him for dui. The officer asks me to evaluate him and make sure he is ok to go by squad car. I walk up to the man and ask “what’s going on?”

“I got bit by a shark” he replies.

Sean – “very funny, are you hurt?”
Patient – “you tell me”
Sean – “are you having any pain?”
Patient – “am I getting billed for this?”
Sean – “only if you are transported”
Patient – “then I’m not going”
Sean – “do you know where you are?”
Patient – (he tells me the cross streets)
Sean – “what is the date today?”
Patient – (tells me a date that is off by a couple days)
Sean – “what does that man look like over there?”
Patient – “a cop”
Sean – “what do I look like?”
Patient – “a dumbass”
My preceptor – “well sounds like he’s alert and oriented to me!”

Your ambulance is dispatched to a scene for a complaint of seizure activity. You are arrive on scene to find a young male in his 20’s shaking violently on the floor. Your initial reaction is to protect his head and place him on high flow oxygen. You instruct your partner to place him on the ECG monitor and get your narcotics. Your just about ready to start your IV when you glance at the ECG and see a rate of 60 beats per minute. “Wait a minute, 60?”.  You then tug at his arm and pull it towards you with little effort. He then pulls it back with a few second delay. Having a pretty good idea of what’s going on, you stand back and say out loud “well I can’t find a vein, looks like we have to give rectal valium!” Suddenly his “seizure” stops and he immediately starts talking.

Obviously the patient above was not having seizure. Luckily you were able to figure this out. Had you have just assumed he really was seizing, you would have administered a controlled substance for no reason. Sometimes knowing when a life-threatening illness is not present, is just as important as knowing when one is.

Emt and paramedic school is great at telling you what to do when a patient complains of chest pain or has a seizure. Unfortunately, nobody really tells you the reality of treating patients in a pre-hospital setting. The fact is, people lie. People want drugs and people want attention. I really think that we need some some emphysis on teaching paramedics to detect when someone is “faking”.

In my opinion, part of doing a thourough assessment is determing whether or not the patient’s complaint is ligitiment. I wouldn’t give atropine to a patient in SVT, and I wouldn’t give nitroglycerine to a patient that was hypotensive. So why would I want to give valium to someone that wasn’t having a seizure?

Any seasoned emt or paramedic knows when a complaint is real or not. But this comes from experience in the field, not from training. At some point, we all had to learn our lesson from the one guy that fooled us. Why can’t this be taught as part of our detailed assessments?

I really think that we need to start training our paramedics the reality of working in the field. We need to promote having an open mind and realizing that things aren’t always as they seem.

It’s probably no surprise that public safety work from all aspects can have negative effects on relationships. Long hours, mandatory overtime, irregular work schedules and work-related stress can certainly wear on your partner over time. Does this mean that our line of work makes it impossible to maintain a healthy relationship? Absolutely not.

Yes it is true that most ems jobs come with long hour shifts. But let’s not forget that it usually includes more time off. For example, people working 48 or 24 hour shifts usually get stretches of 6 or 8 days off. It’s all of the overtime that we pick up that causes problems in the household. Now I live on private ems pay too and I truly understand the need for extra money. But it must come in moderation. Try not to live outside of your means and make what time you have with your spouse quality time. Being apart from each other can actually have positive effects if it’s not excessive.

We all get irritated when we get held over to run “late calls” or support a busy system. Trust me, your partner feels the same way. The last thing your significant other wants to hear after you have been away for 2 days is that you are not coming home on time. Not to mention the fact that you probably just want relax or sleep for a few hours to recover from your shift. Rather than fight over this, try talking about it and come up with a set of agreements. For example, you can set rules like not making plans immediately after your shift or designating some time for rest when you come home. Now on the occasions that you do come home well rested and on time, you can surpsrise your partner and do something special.

Everyone knows that our line of work comes with its share of stress. High work loads, financial trouble, critical incident stress and desicions concerning promotion or relocation can take its toll on a person. Unfortunately, most of the time we keep it inside. Trust me when I say that it shows, and it can negatively affect your behavior. Always make sure to talk to your partner about stress in your life. Try including them when it comes to important decisions abour your job or your life. Call your partner throughout the day to tell them about your shift and talk about stressful calls. This will keep you on the same page and will allow your partner to have a better understanding of what you are going through. Let your loved one support you. Don’t let your work issues become home issues.

Working in ems doesn’t mean the end of the world for your love life. It certainly isn’t easy. It’s no surprise to me that many ems professionals date and marry nurses, firefighters or other ems professionals. Communication and quality time are going to be your best friends when it comes to maintaining your healthy relationships.

I would love to hear about your stories or experience with relationships and the ems field. Please feel free to comment below or email me.