Friday, November 30

Station Tour + Fire Safety + Training = OCFA Doing it right

You new folks may or may not know why they call me the Happy Medic, but for this post you need a refresher on the Angry Captain.

The Angry Captain was a name given to my father, a retired Fire Captain, because of the way he handled logistics when the USAR team was deployed.  He was a stickler for receipts.  Long story.

But long before he was the Angry Captain, he worked at a firehouse in Orange County, CA.  He was assigned to this house during the years I decided to seek a career in the fire service.  I rode along on Engine 4 as an Explorer and the crew there became my second family as well.

 

When the Orange County Fire Authority posted this video to their Facebook page I was curious to see what other agencies are doing for inter-Department training using video.

It's a great tool for standardizing station tours as well as working in home fire safety tips and I recommend it for anyone who ever gets visitors.


OCFA Station Tour Video from Orange County Fire Authority on Vimeo.

 

So much has changed to that house I almost didn't recognize it, kind of like seeing someone living in your childhood home long after you moved out.

Does your agency have a standardized tour or does the junior member have to wing it?

 

Thursday, November 29

Sideways

I am a big skeptic of putting the 2 people with the least ability to assess a situation in charge of the system's response to a reported emergency, but until we change things they can only code what they are told, right?  And the caller is never, ever, EVER, wrong.  Especially when describing technical rescue.

 

THE EMERGENCY

A caller is reporting he has fallen over 50 feet and is unable to walk.

 

THE ACTION

I had to read it twice too.  First party caller has fallen 50 feet, unable to walk.  Should be unable to do most things after that fall, especially when he would have hit the ground at a decent pace, then suddenly stopped.  Stranger things have happened, right?

The dispatch rounds out, after us in the engine, the truck, medic, Battalion Chief and Captain, with the Rescue Squad.  Further questioning suggests the patient is trapped.  Never before have I wanted the TV version of EMS to be true so they could patch me directly through to the caller and figure this all out.

 

Arriving on scene my firefighter and driver are grabbing some hand tools and a long spine board when we all look around the address for a second, an old habit of sizing up burining buildings.  None of the surrounding structures, trees, even light poles are more than 20 feet off the ground.

Something doesn't smell right.

The balance of the assignment arrives as we head inside, ready to treat trauma.

We found drama.

A middle aged man is sitting on a chair still on the cell phone with the call taker, no apparent injuries.  He is inside a single story building and the folks standing around him seem confused as to why so many firemen have arrived.  The rest of the units are cancelled as we begin to learn the tale of the "long fall."

This gentleman tripped on the sidewalk and would like to know who he can complain to after we take him to the hospital.

"Why would you goto the hospital?" I asked, already knowing it was a mistake.

"For my injuries, of course.  I must be hurt if the ambulance took me in.  I'm on disability already and can't be expected to get around on my own all the time." Was his response as his cell phone rang.

The caller on the other end wants to speak to "whoever is in charge over there" and I LOVE these calls so as the EMT confirmed the appearance of non-injury I spoke to the patient's wife who also heard what our call taker heard.

"He says he fell 50 feet!  He needs to be taken to a hospital or something, he could die!"

"Sir?" I was embarased it took me this long to put 2 and 2 together, "Where did you trip on the sidewalk?"

"50 feet up the block!  I couldn't walk!  Go look at that crack!"

He kept giving the distance TO the fall, not OF the fall, hence all the confusion. GIGO.

After refusing to listen to our reassurances that an ambulance ride was not only unnecessary but would end up costing HIM money, he was taken to the local ED "to get checked out."

While loading up the gear the engine boss decided to go have a look at the crack in the sidewalk that could end up being a killer.  About 25 feet up the sidewalk we saw a slightly raised seam that someone could indeed trip over.

So we taped it off.

Tragedy averted.

 

Sunday, November 18

Move up or move over

In a recent post I mentioned my service is using CAD data to monitor just how busy the EMS Division is when addressing calls for service.  All of this is gearing up towards a State mandated increase in market share without (so far) an increase in staffing or units available to staff.

 

Knowing how busy you are is crucial in any business, that's how the supermarket knows how many checkers they should need at 5pm.  Yet you've never seen all 24 check stands open have you?  There is a buffer built into most operations, a surge capacity if you will, that anticipates a need for more than the usual compliment of people and supplies.

 

Trying to anticipate that surge is the job of our in house statistician.  Yes, we have one.  She determines the need, designs the staffing models and anticipates surge.  She's the one who says we need 19 ambulances on Friday night, not 18.  her models are all built on her understanding of how the system reacts to calls for service.

 

She and I have many conversations where I explain EMS systems and she explains stats and we slowly come down to realize we're using the same word to describe 2 different things.  The wife and I have this problem all the time.

 

We're both tearing through data looking to find where we can squeeze another 10% of the market share of responses out of an already taxed system.  We're looking at what we're calling the logistics gap, or when a rig is staffed but not available for a call because they are getting checked out or returning to base close to the end of shift.

We're also looking at their posting patterns or lack thereof) to determine if we really are sending the right unit to cover a post.  Maybe we could move someone else and save time, fuel and misery?

We're also looking at the way we use our non ambulance EMS resources, our engines and Captains to maximize the availability of transport resources.

In a perfect world, my regulator will change one sentence in their policies and I can flex 3 more non emergent transport vehicles already deployed into service.  Change one more sentence and we can better serve the homeless population while simultaneously drastically decreasing ED overcrowding.  I have said before, EMS holds the key to ED overcrowding.  So many solutions are just waiting for the 40 year old rules to change.  But proving that those rules need to be changed has to be supported with data that can be confirmed, recreated, and stamped approved by someone who knows what that means.  I am not that guy.  But I know who is.

 

There is no switch to flip to make it work better, we all know that, but I have a good relationship with the people who do the wiring.  Our dispatch data folks, the Dept data folks, the statistician, everyone has been very receptive when I came in asking for our police designed CAD to spit out EMS metrics.

 

You can sit in the cab and complain and I can sit in an office and complain but until we provide solutions that will work and can be verified, we will continue to stagnate as a profession, content with the status quo because no one is stepping forward to help us.

You are the change your system is looking for.  Get involved or get your bags packed.  I've got 18 years left and I'm not taking them sitting down.

Tuesday, November 13

Ellerbe may be ahead of his time

DC FEMS Chief Kenneth Ellerbe unveiled a plan for EMS redistribution in the Nation's Capital and it is getting some nasty comments online and from the local Firefighter's Union.

I can't necessarily comment on Ellerbe's reasoning for his move, since I don't know what it is, but I can tell you that he's WAY ahead of his time.  I just think he doesn't know it yet.

You see, DC FEMS will be down staffing ALS transport units from 0100 to 0700, a time when calls for service are drastically less than the daytime hours.  On the surface, it makes perfect sense.  Cut extra resources when they're not needed.  If it can be done and still meet the demand for quality ALS transport, great.  If it can be done while still meeting all the guidelines set forth by the local EMS regulatory agencies, great.  (Now our UHU calculations come in handy, don't they?)

But what happens when your calls for service are ALS?

Ellerbe's answer is to staff up that ambulance for the transport with one of the 21-25 ALS engine resources and 7 ALS supervisor units.   That also makes sense, until that fire engine is doing something else, like already transporting an ALS patient.  Forget being on a fire or an alarm or rescue, these resources will be BLS as their extra member attends another transport.  now units are scrambling to pick up medics at hospitals or BLS ambulances are out returning medics to their company.

My agency could consider such a move in the future, but it will be doomed for failure because of the high call volume of seemingly ALS calls as defined by the local EMS regulatory agency.  Without decreasing the number of patients, we can't decrease the number of transports.

If DC FEMS can also flex their ALS Supervisor resources to augment the system of transports, they will also soon run out and someone from the engine will need to return their buggy to the hospital or the BLS unit give them a ride back to their buggy parked back at the scene.  More time will be spent returning units than responding in many cases.

 

Ellerbe's plan is ahead if it's time, but as far as I've been able to find it will not be as efficient as it needs to be.

Why you ask?

Because it needs to be coupled to a "Respond Not Convey" program, or as we call it on the street, the Paramedic Initiated Refusal.  Refusing transport to certain patients who do not need it is the relief DC FEMS needs to better serve the population.  So long as every stubbed toe and runny nose that wants transport gets it, you will continue to have 4 person ALS engines or ALS supervisors at the scene of incidents waiting for an ambulance.  We call it "Medic to Follow" and it is the number one drain on our system. "But Happy, that's a BLS run!" Not if they used the magic word "Chest pain" to get triaged faster.  And we all know that NEVER happens...right?

 

With the sudden interest in the Community Paramedic model, many systems will have to address the issue of Respond Not Convey if they want to increase services without increasing resources.  I would love nothing more than to deploy our fleet of ALS supervisors to handle community paramedicine, but we're dealing with an increase in call volume and market share.  And we have less than HALF the amount of ALS supervisors DC FEMS deploys.

 

Ellerbe's plan seems like a slap in the face to some, but I see it as a new way of deploying resources.  Thing is, it will work.  That is until a second call comes out.  Then a third, then a fourth and next thing you know Engine 99 is sitting on the curb IFO the clinic awaiting a second engine to respond with a medic so the BLS unit idling at the scene can transport.

 

Just a gentle reminder: These views are my own, not those of the SFFD, the City or any one else, just me.

Thursday, November 8

How busy are you?

How do you measure an EMS system?

Cardiac arrest survival rates?  Profit? Market share?

 

How can one system accurately compare themselves to another?

I was tasked earlier in the year with a seemingly simple question: "Are we busy? How busy?"

 

Um, yes and um, a lot?

 

Many systems use a measurement of Unit Hour Utilization (UHU), or a numerical value of how much time you spend doing EMS stuff.  This number can then be compared to others since it uses two basic measurements.  Those measurements are Hours Staffed and Time on Task.

Let's say you're on Medic 99 for 12 hours. 12 is your denominator, since you spent 12 hours on the rig.  Your time on task is defined slightly differently from place to place, but the standard definition is any time you spend responding to, at the scene of, transporting from or at hospital following a call for service.  This total becomes your numerator.  So let's just say that on your 12 hour shift you ran 5 calls for a total time of 7.25 hours.  That means 7.25(time on task)/12(hours staffed) is a UHU of .60.  Quite busy indeed.

But I learned very quickly this is not a complete picture of the shift.

You see, you didn't magically appear in service when you came on duty, you had to get the rig checked and fueled.  Then at the end of your shift you had to return to base and try to get the rig squared away for the next shift.

We refer to this time as the "Logistics Gap" or the amount of time we are paying you to do what should have been done already.  On average this can take 30 minutes at the start and end of a shift.  Now your 12 hour shift feels like an 11 hour shift.  That increases your UHU from 7.25 hours in a 12 hour shift to 7.25 hours in an 11 hour shift, or a .68.

That's even busier.

But STILL not accurate.

What about all that post moving?

We spent months trying to get our servers to spit out CAD data that tracked post moving, but the language just didn't understand what we were trying to do.  Adding up all the post moving time gives us an idea of how much time we are paying you to drive around instead of sitting still eating, going to the bathroom, studying, etc.

 

Applying that total, let's say it's a whole 60 minutes per shift, brings our UHU to 8.25 (7.25 time on task plus 1 hour post moving)/11 hours (12 hour shift - logistics gap) or .75.

 

From a .6 to a .75 is a HUGE difference!  If you are only tracking your UHU Actual, or the Time on Task/Hours paid, you are not getting an accurate picture of how busy your crews really are.

 

The best part of tracking these 3 values is that you can track them separately and add them up in a simple table.  Now when you introduce a new inventory tracking system that reduces restocking time, the impact can be measured and compared to previous days.  Or if a new software program at dispatch makes post moving less efficient, we can track it and break it down.

 

If your reports can be configured properly you can then measure each rig, each hour, each area of your district to see who is busy and how busy they are compared to others.

 

My agency is in the middle of gearing up for an expansion of market share and trying to figure out how busy we will be at different staffing levels is a breeze.  Just add a few rigs to the mix and rerun the math.

Yup, that's what I do now.

So, how busy are we? That's a secret. ;P

Tuesday, November 6

Control V

We have become a cut and paste society.  Not just us social media savvy kiddos either, oh no, no.  In a time when the conclusion that shapes your opinion has already been authored, why not just copy and paste it as your own?  Who will notice?

 

Probably me.

 

And not just because I can access all the same resources you can when you did the original search for your opinion, but because I have grown up on this technology and can spot certain abnormalities that many don't.

Yes, I have these powers.

I can see the difference between MS Word 97 Times New Roman 12pt and MS Word 2003 TNR 12 pt when printed.  It looks the same on the screen and had you cared to standardize your document, maybe it wouldn't have been so obvious.  How do I know this? I've done the same thing before, but caught it in time.  When copying references to cite on a page, most folks copy and paste, resize and move on, not even noticing the font is different.

So what does this tell me about your abilities in the field to which you are professing knowledge?  That I should be highly suspect and investigate ALL aspects of your findings.  And that's when I get frustrated.  Nay, UnHappy.

There have been few documented cases of me being honsestly UnHappy.

 

Trying to trick me?  Try harder.