Tuesday, April 28

State Bill allows Nurses to Staff Ambulances

In an interesting twist the state legislature in Texas is considering staffing ambulances with nurses.

And I'm for it.

Let me explain:

There is a place for nursing pre-hospital but we're going to need a complete retraining for the nursing staff.  Focusing on decision making without physician approval as well as adapting to adverse conditions will be needed and we in EMS are more than willing to help them prepare for this change in role and responsibility.

We need more specialized help in the field and nursing can help fill that void.

See Texas ENA, that wasn't hard now was it?

For those of you not in the know, head over to Unwired Medic's post for details about the Texas nursing group spreading lies to prevent medics from practicing in the hospital.

Before you grab a pitch fork to tear apart their hilarious claims, let's turn the tables for a minute.

Could a nurse staff an ambulance?

The short answer is no.  The nurse has no extrication training, no patient movement training and no idea how to react to standing orders.

But if I needed their expertise in the field I'll be the first in line to help them get trained up.  I certainly wouldn't be the first to write a letter about how placing a nurse in the field would be unsafe and endanger patients.

That's exactly what the Texas ENA did without thinking about, or researching, the capabilities of modern Paramedics.

We aren't simply techs wandering the halls performing IV sticks and other random tasks.  If the Texas EDs need practitioners with experience giving medications, performing intubations and other advanced procedures and reassessing complex patients, why not choose a Paramedic?

We do those things in low light with little rest and no back up as it is.

Texas ENA seems to think that giving us comfortable shoes, bright light and a room that doesn't move will somehow endanger patients.

Adorable.

Texas ENA is worried a technician with an associates degree can outperform their Nursing degree when the cards are down in a time sensitive situation.

You played your hand too early Texas ENA and are drawing for the inside straight.

We're holding the Royal Flush.

We're all in.

Do you call or raise?

PS - You should fold.

Sunday, April 26

the Crossover Show Returns May 1!



This is not a delayed April Fools joke.

The Internet's best (and only) Fire, EMS, Police crossover podcast triumphantly returns May 1, 2015.

Your hosts, the ruggedly handsome fire and EMS expert (yours truly) and the Po-po a go-go Traffic Enforcement guru Motorcop, are still in their beer drinking, opinion slinging moods but this time with intent.

We actually started planning out shows, guests, schedules...seriously, we even wrote stuff down.

Check your itunes feed as the first 51 episodes are down to make room for the glory that is the return of the Crossover Show!

Have a listen, give us a review on itunes or whatever other podcast player you use and enjoy the hilarity that is only possible when a cop and fireman don't have to play nice.

Details on topics, guests and overall shenanigans in the coming days, but get ready internet...

They're baaaaaaaaaaaaaack.

Tuesday, April 21

Happy FDIC!

I have arrived in Indianapolis for FDIC. After arriving late I got a text from pal of the blog Steve Whitehead from the EMT Spot.   In the sea of blue workshirts, FD T-shirts and hats was Steve and his cadre of friends. We talked as if we were all probies back in the day, instantly comfortable with stories, fishing tales and respectful disagreements on the quality of beer available at each establishment visited.

This is the side effect of FDIC that for too many has become the draw: Bars downtown overflowing with firefighters, scantly clad bar maidens and plenty of drinks.

Luckily for me, the nerd, our conversations went from training requirements, to wooden ladders to standardizing expectations on the fireground.

Eventually, and not long into the evening, Steve and I got that awkward question: "How did you guys meet?"

Our answer was quick and brought a laugh to us and a stare to them.

"Oh, we met on the internet."

TODAY'S SCHEDULE:

1030
FDNY Deputy Chief Frank Viscuso's class on his book Step Up and Lead. I hope to learn more about Fire Service Leadership traits (a theme you'll see me chasing a lot this week). I chose this class based not only on the topic, but when the description mentioned "...elevate their ability to lead themselves and others."

1530
Friend of the blog Bob Atlas from Fire Alumni fame is presenting 11 Essentials of the Company Officer. Not only is it a great topic I hope to learn from but I'll go and support my friend by laughing at his jokes and offering a familiar smile.

I've got the 1330 slot open for now, debating some technical suppression stuff to break up all this leadership training.

Hope to see you here!

-Justin

PS, in case you somehow blinked...I'm presenting Friday.

FDIC image

Wednesday, April 15

Informed Customers and the Irrational Medical Marketplace

Leonard Rodberg PhD, penned an article in July of 2013 discussing why Healthcare in America costs so much.  His take on the system boils down to an often overlooked glitch that is required for a market to thrive the way we are told the Healthcare market should:

The customers have no idea the cost, the options or the necessity of the products they are being sold.

Imagine you are going in to buy a television.  The clerk in the store has only 1 and there is no price listed.  He tells you there may be other TVs, but this one is the best fit for you.  You'd be out of that store in a heartbeat looking for a store with more choices, pricing information and make an informed decision.

Healthcare overall is still being treated like a product to be sold instead of a service to be delivered.  The Marketplace set up to handle payments for service can not work if the end user is purposefully being kept in the dark about pricing, options and alternate methods of care.

I'm not talking about healing crystals, but instead trying to focus on the actual end game for healthcare:  Healthy people.

A healthy population is more productive and costs far less in the long run in regards to care so why aren't we making a difference?

Shouldn't our goal be to prevent larger problems early?  What ever happened to an ounce of prevention being worth a pound of cure?

Turns out an ounce of prevention means a loss of billable services later on.

Jeffrey Brenner, Physician and co-founder of a group researching new methods of delivering care called the Camden Coalition of Healthcare Providers, was recently a guest on Freakonomics, a show about the hidden meaning of everything.

On that program he discusses his group's efforts to find high users of healthcare and address their problems head on.  By making them healthier, they use less of the system.

From the show:

"So we learned that 1 percent of the patients is 30 percent of the payments to the hospitals, and that 5 percent of the patients is about 50 percent of the payments to the hospital. So a very small sliver of patients are driving all of the revenues to the system. … And you know, the question really is this the fault of the patients or is this a system failure? And I think our journey over the last couple of years has really demonstrated to use that it’s a system failure and that we could be doing much, much better for these patients."

If we suddenly improve the health of 5% of the people visiting the hospital, just 5%, that hospital will lose 50% of their revenue.  There is no incentive to cure these people.  The same can be said for EMS.  If we actually start telling people they don't need an ambulance we lose our revenue stream and can't operate when someone does need it.  Of course that logic only holds if you consider EMS a product and not a service. (Here's a hint...the word Service is actually in EMS.)  Until EMS is considered a service just like police, fire, animal control and the courts it will be driven by profit and profit alone.  New methods of care will be challenged with "What is the reimbursement model on that?" instead of "How many people do you think we can reach and improve?"

Sounds a lot like some programs sprouting up recently, doesn't it?  Community Paramedicine needs to be that tool for EMS, but may get cornered into simply visiting folks post discharge.

In the meantime we need to change the way we deliver care.

We need to start educating our patients.

Ever been told by your managers or Chiefs not to discuss billing, costs or any other financial aspects of care?  Why do you think they do that?  Could it be that finding out the cut finger will be billed $1700 may impact the patient's ability to make a good decision or is it that the manager and Chief need the $355 State payment for the transport to keep the system afloat?

You know it's the latter but will still tell patients, like I used to, that worrying about money should be the last of their worries.

Or should it?

If patients knew the cost of the service they requested, were given options at various levels of cost that fit the situation and were able to choose a solution that met their needs, that would be a true marketplace and the cost of healthcare would fall dramatically while maintaining the same levels of care to those who need it.

We operate in a marketplace that hides cost, reduces choice and intentionally restricts access to services.

That is an irrational medical marketplace indeed.

Tuesday, April 14

Now in the Keg - Basic Ale

HA!  You thought I stopped brewing didn't you?

 

No you didn't.

A return to the basics this time.  An American Ale kit from More Flavor with California Ale Yeast.  No frills, no extra hops (Gods forgive me), just a basic simple beer brewed the week of bad news and ready to drink the day of worse news.

Sometimes the simple things are the best.

Slainte.

Basic Ale

Tuesday, April 7

Happy Medic at FDIC! Schedule Details

I have the honor of speaking at FDIC this year and am excited to share the details with you!

Classroom Session:

Social Media: The Rules are Already on the Books

Friday 1030--1215

Room 107-108

In a world swimming with social and sharing media, a chief officer may be inclined to apply a blanket blackout policy to social media. And he would be wrong! The focus of this class is to guide chief officers and company officers in applying pre-existing rules to new media, directing negative online actions into positive ones, and harnessing the power of sharing media for their benefit. Students are given the tools to apply the real world to rules already on the books and to understand the new generation and its desire to share  as well as the older generation’s reluctance to share at all. ALL LEVELS

I also plan on attending a number of classes beginning Wednesday and of course the end cap for the trip: INDY ON FIRE hosted by our old pal Fire Critic Rhett Fleitz