Posts Tagged ‘ realemt ’

To stay and grow or change and evolve?

I want to tell you all how much I appreciate each and every one of you. I consider our interactions here a conversation that I hope will continue for many years to come. 

I have not been as active on both Tumblr and my WordPress pages recently. I have been debating with myself. I want to start my podcast and have been researching just how I should go about doing it. It is a lot more involved than I initially knew. I have now come to a very serious question and I need everyone’s input. Please feel free to comment below, email me to ouremssite@gmail.com or private message me. 

My question is this: Should I continue OurEMSsite or should I rebrand the whole thing and begin fresh?

My goals have not changed:

1. To provide support for EMS providers everywhere.

2. To advocate for EMS providers and EMS as a career. 

3. To educate the public about EMS.

4. To grow EMS from within. To make it better.

Unfortunately I see a limit to where Ouremssite can go. Will the brand be accepted at a state level? On a lobbying board or helping local elected officials when they are pushing for legislation? That is what I don’t know and I think I need to know this before I begin the next stage of my journey. 

Any information, feedback, both good and bad is welcome.

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Is ems worth it?

I was recently asked anonymously if I thought EMS as a career was worth it. I began to think about it. How to answer this question?

The truth of the matter is that the answer will be different for everyone. There will be some bad. Do not expect to get out on time, for example. Other jobs talk about the long hours, EMS relishes in making people get out of work late. You have plans right after a 12 hour shift? Here’s a cardiac arrest 20 minutes out of your area. There’s a concert or event you want to go to, you’re on shift. Accept this and you will be much happier, I still haven’t been able to do this.

There will be boring, regular calls. These can tire you out more than the real ones. Don’t let them get to you.

Sometimes we are not recognized for what we do. Belittled and called drivers. Us in EMS don’t do the job for the glory. At least not those of us who have been in it for a long time.

I have described EMS and a career in EMS like a marriage. Initially you are enraptured and in awe. You love all aspects of the job. You find little things that are annoying but you find them endearing. You’re tired, half lost as you learn the ropes, but you are happy. This is the honeymoon phase. This will end.

Next you start to feel the repetition wearing you down. You start to hate aspects of the job. The drunks, the regulars, the transfers, THE PAY. Some people stall out here. Some stay in this phase and don’t leave it or the field. The honeymoon is over. This is where some burn out. Their drive to learn is gone. They stop believing EMS does much good. They become paycheck medics. Most negative comments (pure negative) come from this group. Some can never get through this stage.

Then some grow past. These medics can see the faults in EMS but have learned to understand them. Like a long marriage you understand there is no perfection. There are things you don’t like but you stand them because you love the field.

There are going to be times you hate EMS and that hate can spill over onto people because of what you are going to see them do to each other. There will be greatness. There will be moments when you can’t see yourself doing anything else.

Is it worth it?

I can answer for myself and in my situation I can answer with a resounding yes. Will it be worth it for you? I think that at the minimum you will learn a lot, the rest you will have to answer for yourself.

Consequences and repercussions

Funny story that happened a medic. Please, no one attempt to reproduce, you could get into a lot of trouble with the hospital staff.

Close to where I work there is an emergency room where the restrooms can easily be opened from the outside by just sliding the unlock mechanism and pulling the door open, it’s a safety feature for patients. Well one medic went into the restroom after delivering a patient and kept getting pestered by his partner from outside the door. We’ll call the medic inside Pete and the one annoying him Dick.

Dick would keep messing with Pete just outside the restroom door. This annoyed Pete. On the way out Pete triggered the emergency button in the restroom. Dick walked in and sat down to handle his business. Moments later there was a knock on the door, a nurse was asking if everything was alright. She was accompanied by a security guard and a tech. Dick of course didn’t buy it was a nurse, he was sure it was someone from registration Pete had put up for the job.

After a few knocks the nurse asked if he was ok, Dick answered he was in a lot of pain. Not even two seconds later the door was unlocked and open and somewhere, obviously not in my possession, there is a video of this classic moment. In all honesty Dick might have been telling the truth, he sure was straining as the door swung open.

The clean-up

I went to the hospital after one of the other ambulances on shift had just arrived with a pediatric arrest. I didn’t want to go inside, seemed a little overkill, the patient was already on the hospital bed I was sure and there was another unit assisting them. My partner wanted to go in and so I stayed outside the ER.

I saw the ambulance they had transported the patient in had their back doors slightly open and decided to clean up for them a little bit while I waited. Inside I found the usual, boxes of epi, narcan, vials of vasopressin, ET tube wrapping, suction tubing attached to the wall suction, the usual syringes, packs of ky to lubricate the tube as it is placed in the trachea. I saw all of this but I felt what had happened. The male and female paramedics had fought to keep this kid alive, had used narcan as some last ditch effort in case somehow this was an overdose. To breath for someone, to pump their chest in an effort to move blood through their entire body, to face the parents during the moment that will define the rest of their lives. This, all of this is, is not something that is easy to convey.

EMS is truly a job no one can understand until you live it. I can explain to you what I was feeling and thinking as I threw away the remnants of our weapons against death. You can read the words, try to empathize. If you have been in EMS you will know what I am talking about. If you have not there is nothing I can write that can adequately explain it.

They lost the battle. The patient was called in the ER.

The parents come outside and meet with the medics. The father shakes their hand and thanks them for trying, you can almost feel the emotions coursing through his hands. It’s tough to shake the hands of someone you have failed in the most profound of ways. The mother is hugged as she walks away and says, “you have the worst job in the world.”

She’s right you know, in that moment EMS is probably the worst job out there. Some people don’t recover from some deaths. I saw one of the best medics I ever knew leave the field after a bad shift. He said he couldn’t work in a career with so much uncertainty, in a job that showed you the worst of life. As the lady walked away after losing her daughter any words you say will be empty and useless. She can’t know the greatness that EMS can show you. The saves, the lives that are benefited by our work. The compassion that we can show, the ability to lessen someone’s suffering if only for a moment or two.

That medic, on her next shift responded to a female patient in respiratory arrest. They were able to intubate the patient and keep her from coding. The patient was found to be hypotensive and after a bolus she dropped the hammer and started a dopamine drip. The patient was stabilized and is still alive.

We can work in the worst job out there, but because that paramedic still decides to wake up and come in and do her best people are alive today that may not have been. Thank you to her and all of you that continue the struggle, a battle we can never truly win, but damned if we won’t give it a Hell of a fight.

Death of ER co-worker’s family member

This was submitted to me anonymously.

I feel bad every time I see her.

It’s been months since me and my coworkers had to try to save her husband’s life. We did everything we could but he had been dead for too long, whatever it was that killed him did not let him return. I know I tried as hard as I could, became very aggressive in my medication administration, made sure CPR was being done as we carried him down multiple flights of stairs. It was no use and while I think I know she knows we did everything we could, I feel empty in front of her. I can walk into the ER smiling but my smile disappears once I see her. Is it that I met her children and don’t know if they can smile like I can?

Improving EMS part 3 Regulation

ImageThis next portion of how to improve EMS may be controversial. Depending on your political leanings this could be anathema.

I will be very blunt to hopefully diminish any misunderstandings. I also want to start by saying this may be very restricted to what happens in the USA and maybe even just what is needed in my home state of Texas. This is after all where I work and see most of the first hand things that happen in the EMS systems around me.

We need more regulation in our industry and more power given to those tasked with regulating it. Currently if a semi-truck driver is working and he is pulled over by the state troopers that truck driver is responsible for everything going on with his vehicle. Broken lights, missing license plate, too many hours on the road without taking mandatory breaks for sleep and he can get cited and even stopped completely until he complies. A paramedic can work 48 hours or more and no one even thinks to question if he is still safe to operate an ambulance.

 

 We can talk about how much this would cost, or who would implement it, or even if it would initially be more of a burden followed by the benefits it would bring across the field. What is plain to see is that it would help normalize what is expected from ems in the long run. Imagine if a police officer working for one city went and worked another full time job somewhere else. Adding up both full time jobs would only equal 80 hours. There are some medics that can work 96 hours per week and no one examines it, no one even is tasked with trying to look into it. Some companies are policing themselves, but even then it is sparse and hard to do if other companies are hurting for medics. We can talk about why it shouldn’t be necessary for a person to work so much to provide for their family and the role of increasing pay for medics across all levels would help cut this down, but no one wants to begin the conversation of setting concrete limits on amount of hours worked in one shift, let alone in one week or some sort of network to monitor if they are moonlighting somewhere else.

Some will come right out and say the agencies are already in place for dealing with these types of incidents and much more. The state regulating agencies and so forth. So let me tell you a story of an ambulance service in a nearby area. In the past few years this company has been investigated and fined for animal cruelty, lacking necessary medical equipment such as oxygen, dextrose sticks for their glucometers, functioning lights both in the patient compartment and emergency light bars. There were cases against that ambulance service for hiring a registered sex offender and then mandating he work on an ambulance that went out and made contact with children. There were cases of missing equipment on an ambulance that responded to a cardiac arrest, the missing equipment? A cardiac monitor.

With all this going on with the service, surely the powers that be, who sided against the ambulance service, must have taken some pretty drastic steps to prevent it from happening again. So what was the result of all of these incidents? A fine. The service was never even threatened with closure or suspension of their license. Accidents involving serious injury to medics, even deaths, have happened with this company. Two of them, at least, were a direct result of a medic being on duty for too long and lack of equipment. (One case involved a paramedic who was on duty for 36 hours with the last 9 or so hours spent driving, the other case involved a unit deficient in needed emergency supplies that made them transport a normally code one transport code 3 that resulted in a massive collision with a death and six other people transported to the hospital.) This has to be an isolated case? A fluke in the system. Unfortunately that is not what I have seen. Sure we occasionally hear about a suspension, a closure of an EMS service, usually these are due to extreme financial problems within a company and not a direct result of deficiencies or a state agency taking action. Suspensions of medics are usually drawn out affairs and I have heard of many more cases involving very bad care go unpunished, not because there was a lack of evidence or a clear lack of explanation by the medic, but because the agency tasked with investigating was overburdened. Can you imagine how fast companies would rush to comply with each and every rule if one day, just for one day even, they started shutting down ambulances on the spot if major deficiencies were found?

I did an informal survey in my area, two things came into shocking focus. One: most EMS personnel do not even know where to look for the rules and regulations that can cause the state agency to suspend, fine or decertify them. Two: most EMS personnel were more afraid of getting sued than being punished by a state agency. Even though no one they personally knew had ever been successfully sued. (This survey is still in progress and if anyone wants to participate just let me know, it is only a few questions and will be used in a future post.)

I’m going to take this argument one step further. Critical Care ambulance services. Currently there is a local hospital that requires critical care ambulance transports for cases they cannot handle internally. There are 4 services that rotate throughout the month. Each service takes a full week of transfers. Each of the ambulance services that provide the care say they are critical care certified and have the capabilities to do these transports. The differences between the services is staggering. One service carries LTV ventilators as well as Carevents on each and every critical care ambulance as back up, along with the usual assortment of BVM’s, ET tubes, LMAs, Cric kits, EZIO’s, Lucas devices, IV pumps, refrigerators for medications and hypothermia treatment equipment. Training on ventilators is done by respiratory therapists and an unusual amount of training, at least for this area, is provided yearly. AMLS, NRP, PHTLS, ATLS, ACLS, PALS, and more that I’m not thinking of right now. Each of the critical care trucks must be manned by at least one flight certified medic.

Now that is one service out of 4. The other services, even though they are called critical care by the hospital, do not do any of this. Let me repeat, they do not do any single thing that I mentioned as far as training. All training is done in-house and such gems as these have been heard:

  1. I was told we didn’t need to know what PEEP was, just plug in what the RT tells you.
  2. I didn’t know we could turn on the waveform of the CO2 on our monitors, I thought we could only see the numbers.
  3. We went through that class too, well we got the cards, we didn’t really take a test or anything.

Now let me be extremely clear here, I am not saying the other three services are bad, but shouldn’t there be clear cut policy for who can and can’t be classified as critical care? Shouldn’t an agency be able to monitor who is taking these extreme patient cases out of ICU’s and transporting patients with extremely sensitive medications? In just my current area there have been at least two cases of a ventilator failing and a patient dying. I was not at those scenes and I know that some of these patients are very sick and can be troublesome, but it also nags at me thinking about some of the comments I’ve heard from even the people that provide training in our areas on critical care.

Can there be problems with more regulation and more power given to those that are entrusted with policing it? Yes, of course, but the problems we are facing right now in many areas are too dangerous to just be let up to the capitalist survival of the fittest. A coworker I talked to about this told me why I worry so much about this if our immediate area and service is not a problem and would pass any regulatory visit. I answered because I have family in other areas that may one day need an ambulance and may have to be treated by a service that has not been compliant with state regulations in a long time. It is because there should be very clear cut minimums when it comes to anyone providing ambulance transport. It is because a service that is cutting every possible corner and hurting people ends up hurting our reputation as a whole.

Any questions or comments are always welcome.

 

About Apathy

About Apathy

A little read that got me thinking into all those medics that do the bare minimum for their patients. Have a read:

 

Just for those of you who asked, I will post my thoughts on the state of apathy. I might even use a big word. Just bear with me.

Everybody just wants to complain. Whine, moan, bitch, and complain. But they don’t want to do a thing about it.

We want more drugs, more procedures, more leeway to determine who does and does not need to go to a hospital. But we don’t accept the responsibility that comes with it. We don’t go to lectures at the teaching hospitals offered to the medical staff. We don’t read. We don’t write. We don’t further our profession.

No. We come to work for our checks and we bitch all the way to the bank.

And I’m tired of it.

I know other paramedics don’t go to medical staff lectures. I know this because I do, and invariably, I am the only paramedic in the room. Hell, I’m the only guy in the room that doesn’t have MD or DO behind his name.

I know this because I have been going regularly. Some of the doctors at Big Teaching Hospital know me by name. Because I am involved. I take notes. I ask questions. Good questions, too. Questions that other medics should be asking, but they can’t because they are too busy planning their next vacation or playing the newest video game or planning their next drinking binge with their buddies.

Call me self-righteous all you want. But don’t call me lazy. And you sure as hell better not call me apathetic.

Why wouldn’t we go to the same continuing education programs that physicians do? For crying out loud, the word Paramedic means a person who is trained to work in an auxiliary capacity to a physician.  

I know other medics don’t read. I know this because of the looks I get when I reference medical research. “There was an article in the BMJ a few months ago that…” “What the hell is the BMJ?” is the response I get. “Why would I read a medical journal?”

We don’t further our profession because we don’t care about our profession. Perform your own experiment at your service: ask your coworkers what their plans are for EMS 2.0. Let’s see what the response is.

But nobody cares. NOBODY CARES.

Sure, there are those of you who are regular readers of EMS bloggers. You care. Those with the blogs care. But the rest of EMS doesn’t. I can wade through my almost 1,000 comments posted to my blog since I started roughly 14 months ago and bet that there are fewer than 50 contributors The same people are commenting over and over again.

I’m no prolific blogger by any stretch of the imagination. But when I review my stats, the two posts that have the most views are posts entitledI don’t like people and A letter to a stethoscope thief. That’s what interests the vast majority of blog readers: sophomoric musings on why people generally suck and an asshole that stole my stethoscope. (Well, mine at least.)

But when I try to get people involved, to actually take ownership of EMS, and to play a more proactive role, I am met with a lugubrious apathy that irritates me to my very core.

I was met with this during our protocol-writing meetings. “It’s not fair that some paramedics would be able to use drugs that other paramedics can’t” was the paraphrased response I heard when we were discussing carrying some antihypertensives. “Life ain’t fair, buddy. You want to use the fancy stuff, go to the fancy classes.” was my response.

Andrew Grove, who rose to be CEO of Intel, wrote a book called Only the Paranoid Survive in which he gives leadership advice to people that work in any industry. Andrew Grove knows how to be successful. He says that there are:

“…moments in any business in which massive change occurs, when all the rules of business shift fast, furiously and forever. He calls these moments “strategic inflection points (SIP)” and he has lived through several. They are not always easy to spot – but you can’t hide from them.”

These strategic inflection points can make or break a business. I believe we are in the midst of what Mr. Grove would refer to as an SIP. Community Paramedicine, Critical Care Transport, expanded scope, changing educational requirements. Those that aren’t prepared to change and adapt are doomed to suffer terrible losses, the same that Intel suffered for three years before realizing they had to change their business model to compete with the Japanese.

Those in our profession who are not willing to change, who are okay with the prevailing apathy, are about to get, run over by a train. And when they get knocked out and wake up to a bright light, it’s not a paramedic checking their pupils; it’s that train coming right back for them.

So, if you aren’t ready to change, if you aren’t ready to make this the true profession that it should be, if you aren’t ready to learn, to take responsibility, to take ownership, to be proactive, then leave.

Go get a job doing something else. Do everyone a favor.

And if you are a manager, and you are the resistant force to this change, step aside and let a true leader take over. Managers manage, and anyone can do that. It’s not hard to babysit employees and to slap their wrists when they do something wrong. It is a whole different story when it comes to being a leader. Leaders have vision, and they know how to accomplish their vision.

Rudy Giuliani was by most accounts, a great mayor. Mayor Giuliani recognized that he did not know how to solve problems, but he had a vision for the way things should be. He used his vision to select people who shared his vision to fill his positions of leadership. And he accomplished his goals as a Republican in an overwhelming Democratic city. I am not from New York, and if you want to disagree with me on Mayor Giuliani’s politics, do it somewhere else, not here.

This is my career. This is what I want to do. It is not a ‘stepping stone’ nor am I in a ‘holding pattern until something better comes along.’ This is what I do.

And frankly, I am tired of the same old lazy, apathetic losers standing in the way of our progress.

Change, get out of the way, or get out. Period.

A grand quote from the aforementioned Mr. Grove:

“Your career is your business, and you are its CEO”

Would you fire yourself? A lot of EMTs and Paramedics should.