Wednesday, July 31

CA SB556 - The "He looked like them" Law

Special thanks to Mr Herrera for bringing this back to the front burner for me.

Just a quick reminder: The views on this website are mine and mine alone and not endorsed, reviewed or supported by my employer, co-workers, mother or hair dresser.

That being said,

SB 556 s a giant load of Gou shi.

"Oh my Happy...language..."

It is Gou shi.

Somehow the legislature is concerned that Erma Fishbiscuit is going to be confused when the nice men from the fire department arrive to take care of her, but then a completely different group of men arrive to take her into the hospital.  The uniforms may seem similar, but if she puts on her glasses she'll see the patch on the sleeve does not say Fire Department, nor does the ambulance, nor does the bill she'll get in a few weeks.

 

Apparently the law makers want to make sure Erma is aware that her local Fire Department has no interest in taking care of her by making sure the Fire Department employees wear a patch that clearly states "Government Employee."

Oh, wait.

Scratch that.  Reverse it.

This bill would require uniforms that are similar, but only those not a government agency, to read "Not a Government Agency."

Are we that stupid?

Don't answer that.

 

This bill had obvious beginnings, that being to make sure the guy AT&T sub contracted my install to can be held liable when he screws up, but it was clearly hijacked by someone, likely a Fire Department Union or 2 unhappy with the ambulance contracts in their area.

Disclosure, I'm a union thug myself.

Requiring private contractors to wear a patch or insignia that states "Not a Government Agency" is just as stupid (and would be shot down in a heartbeat) as asking all municipal fire, police and EMS agencies to wear a large orange hat, designating them Government Agencies.

It's good to know we solved the homeless problem and all the children can go to college free since we're passing legislation to make contractors wear patches to tell the public what it already says on the side of their trucks.

 

This kind of crap makes me want to run for office just to slap them with the patch that says "Government Agency" and make them pay for it.

"That's not fair, Happy" Yeah...I know...get it?

 

If you are for SB 556, I welcome your comments and ask that everyone commenting be respectful to one another, whether they be union thug or for profit people mover.

Tuesday, July 30

EMS Flashmob

Eli Beer formed an all volunteer First Aid/EMS group when he was 17.  In the process of developing the program he volunteered on an ambulance and was always upset when they would get stuck in traffic.

Eli attributed his dying patients' demise on the extended response time and wanted to do more for them in the time between when they needed help and when help arrived.

This video goes directly to the core of the Response Time argument and it is important to make a clear distinction between first response and ambulance response times.

We can all agree that getting someone in the door quickly can help guide the rest of the system's response.  This can be a fire department engine, an EMT Police Officer or perhaps a third service handling first response.  What we don't need is to send a reclined cot van on every call, nor does it need to get there in 4 minutes most of the time to make a difference.

In this TEDMED talk, Eli talks about how he came to found United Hatzalah and send motorcycles he calls "Ambucycles" to the scene of an emergency to help until an ambulance can arrive.  He touts a 3 minute response time to over 207,000 incidents last year and is using mobile technology to achieve it.



The phone app broadcasts the medical incident to the 5 closest volunteers in the same way CPR needed apps do so in the states.  When he mentioned it was kind of like an EMS flash mob he had my attention.  We're locked into some old ideas and this one breaks the mold.

 

Why aren't we as communities encouraging this kind of organization?  Sure there are volunteer First Aid Squads all over, but this is far far simpler than that.  And don't wave the liability flag here, those folks would have to be trained to get access to the app and with the right kind of basic QA program built in you're golden.

What do you think of the various things mentioned in this video?

  • Motorcycle first response

  • Volunteers

  • Phone App dispatching


 

Monday, July 29

Bridget Red Ale

First was Saffron, then Yolanda, now Bridget Red Ale completes the 3 known aliases of Malcolm's mystery bride.

image

All 3 have been the same More Beer American Red Ale extract kit and very similar in flavor.

1,000

This is my 1,000th post here on what I now call HMHQ.  One fracking thousand.  Gorram, that's a lot.


I have been putting a lot of thought into what this forum means to me and even considered shutting it down or at least no longer adding to it.


 


This therapy experiment worked.  I was able to overcome the PTSD I was experiencing and the little blog took on a life of it's own.  Many a night was spent ignoring my young family and fussing over every little pixel and post, word and emotion, trying to get out on the keyboard all the frustration I was feeling.  I'm not sure how it looks or feels on that side, but it worked great on this side.


 


Since getting my new gig here at work I've realized that what I used to post about just isn't me anymore.  It feels forced to try to put up a post that fits with what I've done in the past.  Gone are the days of the funny calls, silly patients and unbelievable dispatcher antics.  Here are the days of data analysis, chart reading and the occasional day in the field to remind me what this is all about.


 


My initial intention was to make post #1000 my last, I even told Motorcop I was going to convert the homepage and just walk away.  A large part of me still thinks that is the best idea.


However, not being one to go with the flow, I've decided to give this forum a rebirth of sorts.


August 31st 2013 is Happy Medic's 5th birthday.  But he's just that logo up in the corner.  What used to consume my life is now just a part of it.


But this site was never really his and his alone, it's mine too and I have hobbies and interests that extend past trying to make my day job better.  At some point I came to realize that work is one thing that I do to make home better.


In recent months the Mrs and I have gotten serious about our finances (mostly inspired by GPS Financial Coaching), my eldest is getting way more fun to talk to and the younger one's personality is beginning to show through the tantrums and crying.  Kind of.


This forum needs to spread it's base for me to once again blow off some steam and get some things out onto the virtual paper so they don't drive me insane.  Not that being insane is a bad thing, it's just a touch inconvenient at the present juncture.


In the weeks ahead the blog is going to split into three main categories.  Don't worry, all the posts you've seen will still be here, but will be organized slightly different.


I'm splitting the blog into "Fire/EMS" "Home Brew" and "Life" to accommodate my new interests while keeping the old ones close.  You can choose to read only 1 or all three together depending on whether or not you like the new topics.  I figured this way when I talk about brewing or the family and all you want is EMS, you don't need to see it and vice-a-versa.


 


So please excuse the virtual dust as I eek out a few minutes here and there to fiddle with the layout, categories and the like.  There is no set date on this project, just something I've been putting off.


 


A special thank you to all of you who participated in the Happy Medic and helped me overcome a rough spot, then inspired me to do better.


Thank You!


-Justin "HM" Schorr



Monday, July 22

Response Time or Patient Outcomes - How do you measure your EMS system?

I know it's been quite around these parts lately but a recent article caught my attention this morning.

High Performance EMS posted "Does Response Time Matter?" and it got me thinking.

The author states an example of a patient being "treated" by fellow citizens at an airport and having to wait 20 minutes for an ambulance to arrive.  The author goes on to describe how we need to arrive quickly to save the public from themselves.  After 30 years of telling them to call 911 for anything and convincing them that "seconds count!" what did we expect?  While I agree that a delayed response to certain patient presentations could result in an adverse outcome, that points out a glaring omission from the story.  Missing from the story is the patient outcome.  The outcome will allow us to marry all the data from the response to determine the answer to the author's question in the headline.

The short answer is no, response times don't matter.  And no, I don't have to pee.  I have data that does not have any correlation between quality of treatment, outcome and response time.  From my perch here at the data hub of a quite busy EMS system we have been trying to determine the quality of our EMS system and we rarely look at response times.

Don't get me wrong, we look and our Department statistician collects, quantifies, qualifies and reports to regulators the 90th percentile of all code 2 and code 3 calls to meet their requirements.  We report it, they receive it.  The document says nothing about the quality of care or patient outcome.  The reason being that we can not guarantee a positive patient outcome, but can measure when we left and when we arrived.  Imagine if we had to treat 90% of symptomatic asthmatics with oxygen within 5 minutes of arrival and document an improvement in condition.  Can your system guarantee that?  Why aren't EMS systems measured by the quality of their care instead of the quality of their response?

Apply this metric to any other industry and it fails.  Industry is measured by their quality and efficiency, not the speed in which they complete their tasks.  So long as we only look at one metric with any regularity we will continue to shuffle ambulances 2 blocks at 5 minute intervals to meet an average instead of realizing just leaving them still would bring the same outcome.

That's where I come in.  My Medical Director and I, unhappy with the lack of actual patient care quality metrics, created our own in an effort to determine the quality of care being provided.  We learned very quickly that our ambulances do not respond in a vacuum.  Each patient receives a call taker, dispatcher, first response, ambulance response, assessment, treatment and some get transported.  Once at hospital they receive a whole new level of care and review until they are finally sent home.  It is hard to argue that the time it took to get an ambulance from point A to B has an impact on this outcome without any review of the call taker's coding of the call, the dispatcher's assignment of the ambulance all the way to the destination hospital capabilities and location.

We can all sit at the Pratt Street Ale House in Baltimore and discuss short times that had a bad outcome and long times that had a good outcome, but the worst part of all of this discussion is that so few systems measure anything more than response time.

If you consider response time your metric of success you have already failed.  You have failed the patient who improves when you arrive "late" and discounting that response as a failure, yet trading high 5s when a 2 minute response yields a call to the Medical Examiner's Office.

We all know the stories of companies staffing ghost cars near the end of the month to bring down the monthly response metric to meet guidelines.  It happens.  But I also wonder if that flood of ambulances to help more people had any other impact.

The complication in tracking outcomes is the relationship your agency has with local hospitals.  We may never have a seamless transfer of data but what we can do is pull data from the PCR to determine if the patient received the indicated treatments for the recorded chief complaint and observed complications.  By reviewing your policies and protocols as well as your patient demographics you can quickly spot your core performance indicators and design tools to track them.

It may be nice to know that we make our 90th percentile in 8 of 10 districts on a regular basis, but what if those 2 districts happen to have the highest number of cardiac arrest survivals to discharge?  Are they still a failure?

Widen your view to include more than how quick you can put the ambulance in park.  This goes far beyond the lights and sirens System Status Management debate and speaks to the core of the reason we're out there to begin with:

To make someone's bad day better

Delays can hurt, but not unless you look deeper into your system to find out if that is the case...or not.
999

Tuesday, July 2

Paramedics say the Darndest Things

Mutual Aid company Captain Chair Confessions has a new post up that made me laugh, smile, snicker, exhale, then almost cry.

I miss it.

I miss the witty banter between rescuer and patient, between rescuer and pseudo-patient and above all else I miss the banter between rescuer and liar.  Gods I miss that.

I miss the basic interaction of assessment.  I miss Erma Fishbiscuit and her 23 meds prescribed by 24 doctors.  I miss her son Bubba and his drunken insults, the relief on the face of a CHFer on CPAP and the chill you get from hearing the EMT say "I think I feel a pulse you guys" after 35 minutes of CPR.

I miss it.

From my ivory tower at Headquarters I read most of the charts, checking my check boxes that the crews checked all of their check boxes and fielding calls from angry nurses that the crews didn't check the check boxes.

I turn off the light, close the door and head home, fire up the computer and live vicariously through you all.

Didn't that used to be the other way around?

The post today seemed like something from 2009, 4 years ago, when I was at the height of my posting, fired up and ready to change the world!  It seems so long ago.

Turns out the world wasn't in the mood to change.  They never got the memo, so I hand delivered it.

This therapy experiment we've been working on together has seen some incredible ups and some devastating downs.  We've shared war stories, ideas, concepts and solutions.  We've laughed together, mourned together and still cling to this one tiny thing we believe in above all else: EMS.

From PTSD to stress relief, from Chronicles to Seat at the Table, from Baltimore to Houston to Vegas this blog has not only opened doors but kicked them in guns blazing kickin' ass and takin' names.  Clinically speaking of course.

And now I wonder what it's place is anymore.  Most of my frustrations about the system not working come out in written form to Chiefs, Medical Directors and regulators who take them seriously and many are being considered or have already been implemented.  Motorcop and I spar on our weekly video show and I get great satisfaction from that interaction.  I can't tell even HIPAA cleansed stories because for each one I filter another pops up that fits that description.

Everything that made this forum what I wanted has found another outlet.

 

This forum, this community, you, helped me through a dark time and I came out shiny on the other end.



What's next?