Friday, August 31

Happy Medic turns 4

It was 4 years ago today that a frustrated, stressed, borderline meltdown firefighter and Paramedic sat in front of a computer and began a therapy experiment.

It has fizzled, flown, soared even, and at other times consumed my time at the cost of ignoring my family.

 

This little blog helped me recover from the feeling that I was going to die and wondered why I only got hurt instead.

This blog took me to England,



 

To Baltimore,

To places I never dreamed.



 

But here, when HM smiles back at me from the homepage, I remember when it was more about therapy and less about EMS.  Now it is more about EMS and less about therapy, but when I feel stressed or need to unwind, I know that the keyboard is waiting and HM will say what needs to be said to make things right.

 

Thanks for stopping by these last 4 years and I hope you'll keep coming back.

Happy Birthday, Happy.

 

-Justin

Monday, August 27

Out of Left Field

Sometimes we forget who we're up against.

Sometimes the system is indeed rigged against us from the start.

But how can you win if the other party refuses to even play the game?

 

The term "blind sided" was used in a meeting today, much to my surprise.  You could even go so far as to say that I was blind sided by this blind side.

It was a jolt of reality back into my EMS 2.0 world that not all of our enemies lie within.  Some are just skirting along the outside of EMS, providing valuable services, only to pounce on ideas they find threatening.

Only problem is, I don't see it that way, not sure I ever will.

I've had almost a year to figure out this whole politics thing and I still just don't get it.  I don't care who had the idea, or who gets credit, I need some things to just happen.

In my role, very few decisions are actually within my control.  I do research and pass the info along.  If it gets rejected, I research more.  I've had my preconceptions busted more than a few times, comes with the territory.  But there is this perception that others see my actions as more for me than the system.

I just don't get it.

 

Some things come from out of left field, but that's all based on the assumption that what we're expecting was in left field to begin with.  My surprise came from the bleachers behind left field, caught my on the jaw and knocked me to the floor, blinking, wondering what just happened.  I had a ceiling do that to me once.  Once.

 

I'd love to say "never again!" but when you don't know what to expect, how can you prepare?

Wednesday, August 22

When a complaint is a cry for help

I absolutely LOVE answering the complaint line here at HQ.  Not HMHQ, my real HQ gig.  The complaint line at HMHQ never rings.  :P

 

Many may not want to hear the public rattle on about how we stole tens of thousands of dollars from their wheelchair or lifted a priceless piece of art the last time we were called code 3 for a spoon stuck in the disposal, but I LOVE it.

My pencil jots notes as I listen to the complaint in it's entirety never once asking for clarification.  I get the entire story out and make sure they say everything they want to say.  90% of their complaint is usually because they want to be heard, not because they have a legitimate complaint.  They want to hear that it's not cool that they don't have as much stuff as I do or that spoons fall into my disposal all the time.  The venting is the powerful process here, I should know, right?

 

However, every now and then I get a call from someone unclear on the concept.

 

THE EMERGENCY

Not sure that heading still fits, but we're almost 4 years into this thing, why change now?  A woman has called me requesting the ambulance crew who transported her 2 days ago be fired.

 

THE ACTION

OK...

Her story goes a little something like this:

The ambulance crew was late, rude and refused to help her.  They didn't carry her into the ER and refused to give her to a nurse.  The ambulance crew then pointed at her and make remarks that I won't repeat here.  Her language was colorful and hurried while I made notes and pulled up the chart from that day.

When she was finally finished I assured her I would look into her claims and explained the process.  While I was doing so I returned no records of a her being transported that day.

"Could this have been yesterday?" I ask seeing her name pop up on another day, then another.  In fact the software we use turns grey days blue if a patient is contacted on that day.

 

There are more blue days than grey.

 

I also notice that today is blue so I pull up the chart.

While I'm doing so she continues on that after the rude evil paramedics left she collapsed and had to spend 2 days in ICU.  She then described the pile of bills she is already receiving.

I noted her concerns for the file and asked the only question I needed to ask:

"Were you transported to St Closest today at 10 AM?"

"What? How do you know that? That's a violation of my privacy!  How dare you access my medical record without my permission!" a brief pause... "Well?"

"Ma'am, if you'll permit me.." and I restated her clinical concerns and her destination concern, and the claim that she was not delivered to a nurse, all of which is directly connected to her medical record.  And although I had no way of confirming her identity, no PHI was exchanged and clearly she knows most of the fleet and they know her.  As I scan a few of the charts looking for patterns of behavior I find what I'm looking for.

Most of the crews are using her statements in quotes and they match almost to the word:

"Patient states she will file a complaint if not transported to Saint Farthest, Saint Farthest is on divert, patient ambulated away angrily with steady gait."

 

When I asked if she had been transported to her facility of choice and if the Paramedics had actually been rude to her, she began the back track.  She didn't really want them fired, maybe just talked to, or even just mention that she was not pleased with the level of service she received.  Then we talked for a good 20 minutes about her medical conditions and her use of 911.  I offered a few contact numbers for local resources and even threw in a few breathing exercises for relaxing after a long day as an urban outdoorswoman.  She thanked me and in the end apologized for taking my time.

"That's why I'm here, Ma'am.  If my Paramedics ever do anything you don't like you call me right back, OK?"

 

That was in January.

Today I noticed her name on a chart where she was transported for a chronic condition, but the colorful language was gone.  I had to go back and check the name to be sure.

Her blue squares have decreased significantly since and I'd like to think I had something to do with that.  It wasn't a rapid response car, or an advanced skill set, it was taking the time to listen and offering support.

 

Try it.

Sunday, August 19

The end of the EMT-Basic?

I have always hated 2 terms in EMS but until I can get everyone to agree on just calling us "Paramedics" and assigning skills and licensing on a National level, I'm kind of stuck.

At a recent class a colleague mentioned how he hated the term "EMT-Basic" because it sounded too much like "EMT-Minimum."  This is the absolute minimum set of skills we think you need to be able to identify a life threatening emergency, intervene as indicated and arrange for a more educated assessment and treatment.

 

Another term that always dig sunder my skin is when we slap the word "Advanced" on the side of our ambulances.  Advanced compared to what?  To the basic?  To the minimum?  Current Paramedics are the advanced version of the minimum required.  Well, 3 is more advanced than 2, but it will never be a 10.

 

So how do we achieve the pinnacle of Professionalism with these outdated inaccurate terms chained to our ankles?

How is it that someone can be content with a certificate or license that uses the term basic?

Imagine you have a plumbing problem in your home and call the plumber.  The person arrives identifies themselves as a Plumber-Basic.  Perhaps they are trained and experienced to handle the problem, but what is our confidence level in that person?  Low, right?  Now what if he arrives and says "I'm an advanced plumber"?  We feel better, sure, but what if he simply arrived and said, "I'm a plumber, what's the trouble?"

 

As an EMT-Basic I hated having to rely on someone else to come help me with my patients, yet I refuse to seek out additional education above the level of Paramedic because I like where I am.  I get that not everyone wants to raise to the next level, I'm one of those folks, but I wonder if we're setting ourselves up for most of the problems we're experiencing.

 

EMT-Minimum and EMT-More than Minimum.

 

We need to get one name and stick with it guys, or this stratification will never end.  Paramedic - Level 1?

But Level 1 is basic, no?  Meets only the minimum.

How about EMT and Paramedic for now and we'll work on the details later.  The National Registry introduced the non EMT Paramedic requirements, that's a good first step.  Can we do the same for EMT-Basic? Just drop the basic part?  Can we at least do that?  I don't like the term technician, but in looking at the standards for EMT-Basic in this country, the term is accurate.

 

What do you think?

-HM

Tuesday, August 14

Overheard at the National Fire Academy

I finally took some trusted advice and put in for an EMS Quality Management class here at the National Fire Academy in Emmitsburg, MD.  Well, it's not A class, it's THE class.

And I am loving it.

The different levels of experience and system types in the room lend for a giant melting pot of ideas.  Folks are actively sharing, borrowing and down right stealing ideas.

 

Sound like anything we've been striving for?

 

There are a few anchors in my class though.  Not the anchors that drag EMS down, but the anchors that recently realized they were doing so and are working hard to reverse the damage they have done.  There are young bucks like me, middle managers from the deep south and more than a few Chiefs from the northeast.

I'm referred to as the guy from the Wrong Coast.

Cool by me I suppose.

The lessons I'm learning here directly relate to my current (part of anyway) responsibilities at the CQI office and I am absorbing as much as I can.  And not a single clinical scenario to be seen.  There is something refreshing about an EMS class that, whenever patient care differences arise, we are reminded "That's later" in this particular process.

 

This class is all about managing the quality of the system, looking ahead to spot trouble before it happens and realizing that if there is a problem, it is useless blaming the employee.

Yes, it is the system to blame.  The system that let them skate by, let their skills falter, let them hit the streets knowing full well they were ill prepared for what was coming.  All we did was wait too long to do something about it.  "No, Justin, Medic Bob is an idiot."  Then what are we for letting him still touch patients?

 

This class is all about designing the processes to do just that, intervene as soon as an issue arises and solve the problem starting with the simplest solution, not necessarily something that has been done before.  A new breed of instructor lives at this level of EMS Admin instruction, one that looks for solutions not in intubation success rates and response times, but quality of a system as a whole.  A 5 minute response time and 99% first pass intubation rate is useless if your average patient in pain goes too long without relief.

 

But I heard something today that really made me realize that EMS 2.0 is not coming...it is here.

 

A student was sharing the fact that they were barely able to attend this class because their Chief was worried they would take the class, learn how to do things right and then leave.  The instructor stopped the class and said, "Tell your Chief he should be more worried that you don't seek out education...and stay."

 

I'll let that marinate.

Saturday, August 11

Attention all companies and units in the field

We have a fellow member in distress.

http://muledungandash.blogspot.com/2012/08/lets-give-valerie-hand.html

 

Please do what you can to show your support.  Especially with September and the wave of pink in October, we seem to focus more on the lost than on those we can help right here, right now.

 

I've never met Valerie.  Don't need to know her to help, other than that people I know and respect need help helping her.

Done.

Wednesday, August 8

Post about our site and win a prize! - Seems Legit

I was going to let this one go and chalk it up to a bad decision.

A couple of weeks ago I got an email from a popular clothing and gear manufacturer to review one of their products.  Not uncommon.  I frequently get requests to review gear, host a guest post about an online EMT class etc etc.

They're all form letters likely sent to any email address that relates to a blog.

 

I've been asked to review helmets, boots, socks, you name it.  If the company sends me an honest email and meets my requirements, I review the product, write my honest review and post it.

 

99 times out of 100 the solicitation is bogus and often includes terminology reserved for Nigerian Princes.

"Please to review our new item!" etc etc.

 

When a company I respected reached out asking for a product review, I was curious to hear what they had in mind.

What they had in mind was no where close to what I expected. [my edits]

"Hi, [ no name...sure giveaway]

 

[a person you've never heard of] had initially emailed you [no they didn't but it seems like you missed it, right?] to to [poorly proofread, I mean who wrote this? Me?] let you know that we [we who?] have teamed up with [a company you respected] for a giveaway! [company] is the leading provider for law enforcement and tactical gear  and wanted to see if you would be interested in blogging about an experience that you have had using a [company] product. If you have not used [company], that's okay too! You could also write about a product that you are interested in using. We are doing a [companyBag and yes, the lack of a space between the company prize and the word Givaway is a ... giveaway---->]Giveaway with lots of great stuff for the best blog writers!

 

If you are interested please a post [again with the proofreading!] about your experience/write about a product that you're dying to try~!

 

To Qualify the Requirements are:

1. 300-500 words

2. This must be 100% unique and original content

3. 1 link to the main webpage ([company website])

4. 1 link to the product that you have used or would like to try out ([hint hint, here's a product we likely want to push])

 

When you have posted this article, please email  me and provide me with the URL so that you can be entered in the contest.

 

This giveaway will start Wednesday July, 11th and the winning blogger will be selected on August 31, 2012. We will enter in the URLs and randomly choose a winner. The winner will be contacted via e-mail no later than September 14, 2012. When you are contacted I will ask for all your info as to where to mail the [company prize, which is never explained] prize giveaway!

 

We wish you the best of luck!! And we hope that you decide to be a part of this amazing giveaway!

 

Good luck,

[another person you've never heard of]"

An email address not affiliated with the company reached out in Nigerian Prince fashion to ask me to review a product and write a blog post about it.

But wait!  There's more!

If I meet the qualifications listed below I could be entered in a contest with other bloggers to win a prize?  All I had to do was review a product I had never touched, write a 300-500 word review and post a few link backs within my post to be entered to win?

 

I made a snarky comment on facebook soon after and dismissed it as a fly by night internet PR firm's idea of drumming up site traffic.

 

Then I got an email today reminding me to get my post up soon to be considered for the contest:

"This is just a reminder about the [manufacturer deleted] giveaway contest. Time is passing by quickly! We know that sometimes there is so much to do that you don't have time to write a lengthy post. So for those of you interested but don't have the time, we have a different option that you can do to enter into the giveaway! Please email me for further details. For those that want to take a stab at it yourself, below are the requirements!

Thank you for you time and I wish you all luck!"

 

No I didn't email them to get a likely canned "guest post" nor will I.  Heck, part of me wants to send this in as my entry to their "contest."

 

Some companies understand the blogger, some go the less expensive route and hire a company or a 10th grade intern to dream up ways to drum up traffic.

Sorry, guys.  If you were aware of this you lost big points in my book.  If you didn't know about it, you lost even more.  Either way this is a letter in your file and I hope one of your folks sees this and thinks, "Oh crap, was that us?"

 

I will refrain from mentioning the manufacturer, but if you follow me, you already know.

 

Monday, August 6

Forensic Gastronomy

Field intubations are tricky.

Anesthesiologists like to talk about first pass rates on 12 hour fasted chemically sedated patients in a well lit room at table height.  Dude, if you miss those something ain't right.

We know from experience hitting the doors of the ED with a dirt covered ET tube holder and a solid ETCO2 waveform is a badge of honor.  Heck, hitting the door with good chest rise and a BVM is just as nice, but when we begin to relate the difficulties in clearing, securing and then ventilating through a challenge airway, some Docs seem to shake their heads at us as if we were telling them a tale about being chased by a giant dragon.

 

One crew recently decided to bring some evidence with them to the ED.

 

THE EMERGENCY

A local skilled nursing facility seems to have been feeding a dead man.

 

THE ACTION

First engine on scene requests a Captain and transmits CPR in progress.  The engine medic notes extreme difficulty in clearing the oropharynx of a dry mush-like substance, grey in color, which seems to ooze more as soon as some is scooped out.

Ventilations are not even useful and a few abdominal thrusts are performed which seem to clear most of the blockage.

The patient is pulseless so chest compressions are started and it seems to be helping.  Not seeing a chance to get the airway clear enough for the BVM ("Emesis too dry and chunky for suction") the ambulance medic has a grand idea:

Attempt laryngoscopy and suction the tube of the contents.

First attempt yields a placement and no air movement is noted, so they pull it and are almost shocked to see a perfect core sample (their words, not mine) of what is blocking this airway.  The decision is made to use a KING LT and hope most of the blockage is now inside the withdrawn ET tube.

 

The BVM moves air, the chest rises, and they're off the the ED to explain this airway.

 

When the ED Doc seems not too convinced the airway was as difficult as they described, the Medic produces the ET tube from earlier and describes the various layers of foods that were lodged in the trachea.

Core sample intubation.  You heard it here first.

Saturday, August 4

Perspective

Stress and worry moved into the office next to mine a few weeks back.

There was no precipitating factor, no big event, just all of a sudden I was upset, felt overworked and seemed to be missing my family more and more.

Work was getting complicated.

Life seemed never ending, always something we needed to do this week, weekend, next week, coming up.

It seemed as if I was drowning.

Often a break from the blog helps, but it didn't this time.

 

It was a facebook update and a call from a friend that put my reality in check.  Both stories have the same arch villain.

 

Cancer.

 

A co-worker found herself under the knife and a classmate needed help when his father-in-law deteriorated rapidly.  The phone call started, "Justin, I didn't know who else to call..."

My problems not only went away I felt bad for thinking I was in trouble in the first place.  We let the little things begin to drag us down.  Each problem a piece of straw, slowly building without notice until we begin to buckle from the weight.

 

Only in my case I had a small handful of straw I put there on my own.  So I shook it off.

I am alive, I have my health and my family is healthy.  The rest is icing.

 

Get checked.

 

-HM