Laying The Groundwork For ECG Success

I’ve been messaging a lot this week about basics and building upon the fundamentals before getting into what can be the sexy stuff of many EMS topics. Here is a quick FaceBook Live video I did were I talk about this in regards to reading ECG’s. [Read more…]

Ever Ask Yourself Why You Are In EMS?

This is a guest post by Jason MacKenzie, NRP. I think he gave some great insight and opinion many will agree with. Check it out and leave your thoughts in the comments below.

 

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Why did you take this job?

I have a bone to pick. I’ve seen a trend over the 20 years I have been in EMS. Firefighters work, love their job, take pride in it, maybe an IAFF sticker on their vehicle, maybe they wear an IAFF or department hat off duty. Police, go to work, love their job, take great pride in it, though they don’t advertise much off duty due to the fact that idiots abound and would likely vandalize their car, home or family. EMS……. we go to work, some love their job, most complain about running calls, many complain about move ups, and if you even think of putting a star of life window sticker on your car, or wearing a star of life hat, or t-shirt, you are the station joke! God forbid you have a waist pack that has basic tools of the trade within it, you are instantly known as Ricky Rescue. Why? Why on earth did you take the job?

When I became an EMT in 1997, I was excited. I was also planning to head towards the fire department as a career choice. After some time in the field, my desires changed and I realized I wanted to stay in EMS. Though the desire to run into a burning building still surfaces its head when I need an adrenaline rush. I worked as an EMT running mostly IFT calls (yes boring!!), I eventually moved into a slot within a busy 911 system in a major metropolitan area. I went to medic school. I loved going to work! And I’ll admit, I wanted to show pride in what I do. I occasionally found a decent hat or shirt with our Star of Life displayed. I chose to not buy it due to the fact that sadly the opinions of others mattered at that time.

I chose EMS because I didn’t know what to do with my life. I was working as a forklift operator in a PetSmart warehouse on the graveyard crew. I didn’t come from a family of public service workers, I didn’t grow up with crazy stories from dad about the calls he ran. I chose it because I wanted to do something with my life, and as I looked through the community college catalog “EMT” jumped off the page and sounded fun. I didn’t know I would love this job the way I do. In my career, I have worked the streets, I have worked in ER’s, I have been an instructor, and I have flown on helicopters. What I haven’t done is expressed the pride I have for what I do. I have allowed “the cool kids” to run their mouth and belittle those who show even an ounce of pride.

Our pride rears its head on occasion. A police officer dies, a firefighter dies, terrorist attacks happen, then suddenly our Facebook page becomes a memorial for 24 hours and then it’s back to ignorant comments. And we wonder why nobody takes us seriously? We complain on the very next call because it was a standard BLS call and didn’t involve arterial spray, mangled cars, and death. We complain because dispatch made an error and moved the wrong rig, or because another unit was 1 block closer to the grandma with abdominal pain at 0200hrs but instead we got the call. And lately, people are complaining about “no breaks to eat” on their 12-hour shift!! Are you kidding me?!?!

If you don’t like it, leave! Plain and simple. Maybe a job involving “would you like fries with that?” is more your style? Maybe you’d rather fold shirts for the display table at Target? Maybe that call center down the street is hiring? Or maybe you’re just not cut out for this job!

We claim we are a “family” when someone dies, or is hurt on the job. In reality, we are family when it suits us, and the majority of us have never once gone above and beyond to help those we call brothers and sisters. We have no respect for others in their beliefs, their way of life, and if they don’t fit in our small “mental mold” of what an EMT/Paramedic looks and talks like we instantly brand them. Lord help us if someone takes a small amount of pride in the private ambulance company they work for. Maybe if we step up our game, maybe our employers would see the need to step up their game. If not, then at least we have a leg to stand on when we try to fight for rights and benefits.

We must start working together to change the way we are viewed, the way we treat each other must change now! And we need to dig deep and grab hold of that pride we all had at one time. Being cool is no longer being the one who mocks the new guy, or mocking the one who does take pride in their work. Being cool is the one who comes in every single day, takes care of their gear/rig, is happy to be there, willing to take the trash out at the station, knows how to operate a vacuum, and has the heart and attitude to handle anything that comes there way (even when it’s not an emergency and you just drove Code 3 for 8 miles only to find out someone just bought a new home BP monitor and it hasn’t been calibrated yet).

Those of us that have been here for 20 years should not be complaining at all!! Our wages are higher (I started at $5.25/hr, how about you?), our gurney is now power (I learned on that aluminum Ferno with 537 pinch points….you?). We no longer have the Lifepak 5!! Those are now in the Smithsonian holding down the dinosaur display. Backboards are now a thing of the past. We have grown and improved. We have learned from mistakes. We have helped to train some in their new career choice. We have also forgotten why we came here in the first place!

I have recently returned to the field after a 3 ½ year break. My break was not from burnout, my break was to better myself and to take some time to really think about some personal things (I actually thought I was retired from EMS). Since returning, I have also realized after 20 years I had nothing to show for it. I had no photos of former partners or station mates, I had no ragged EMS t-shirt, I had no sweaty EMS fishing hat, I had no real connection to what I do. I had just the memories to talk about, and let’s face it, not everyone wants to hear those memories I need to talk about sometimes. I had no pride. I plan to stay in EMS for another 20+ years. I plan to further my career through education, volunteering, and being a voice that will change the culture of EMS. I plan to be alive to see the day EMS personnel are respected and respectful. I plan to be alive to see EMS personnel receive pensions and not just a simple 401(k). I plan to show what family looks like. I plan to be the change I want to see.

The Star of Life has meaning, 99% of us could not recite what each of the six points of the star mean, nor could we state what the Caduceus or Rod of Asclepius is (most are likely Googling it now). It’s time we represent that Star of Life in our own lives. It’s time we live a life worthy of that star. And, I’m buying a shirt.

Jason MacKenzie, NRP

Check out the new Turbo Medic PHD below and grow your knowledge base to succeed in EMS.

Turbo Medic Personal Hard Drive

The Arming Of EMS | New Top Salaries

This EMS Green Room episode talks about the arming of EMS and recent changes in top pay for EMS providers.

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Ultrasound In EMS & ED Docs On Patrol?

AUDIO5I’m posting this first quick podcast to hopefully begin a new series. Sort of a supplement to the longer shows and my quick takes and tips in EMS. Not sure what to call it… car cast, EMS daily’s or just a Jim Rant.

Take a listen and let me know what you think about the show, topics and suggest a title for me.

If your agency ever strikes it rich and begins using ultrasound how will you know where and what to look for? Knowing A&P is a great start and IMO (humble yet accurate) vital “know how” in EMS, ultrasound or not.

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Check out this great Anatomy course you can download to your computer. I have the details here.

A Focus On Raising The TXT Generation

txtgenIn this episode of Office Hours Jim sits down with Thaddeus Setla to talk about his project “Raising The TXT Generation”. While this may not be a direct EMS related topic, both Ted and Jim feel it does reflect in public safety and results from social media and children mixed together can bring EMS in contact with this issue.

Whether you are an EMS professional or a parent, get behind this project and show your support by clicking the link below and following the project.

Click here for complete details and short video on the Raising The TXT Generation project.

Follow Ted on Twitter here.

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When Your Patient Uses 10 Codes

I am going to tell a story here. One of those “it happened on the ambulance” stories.

ambrushblurSo, while on a call of an assault I am treating this patient who was in a fight along with about 5 other people. She said she was jumped and that her assailants used pepper spray on her and she couldn’t see, although five seconds before she was waving at us as we pulled up to the scene.

So, I treat her as any patient I have, irrigating her eyes and making a general wet mess in the back of the ambulance. Now of course she is hysterical would not hold still on the stretcher and saying she couldn’t breath, that her heart stopped one time from not breathing and any number of complaints in her post assault/fight hysteria.

Yes she was breathing fine and her vitals where good and all that other stuff you might be wondering about that could fit her into a zebra category.

My main reason for sharing this rather basic story is that as soon as her eyes where irrigated enough so she could grab and use her cell phone she makes a call and says “Hey it’s me, Code 10, so and so just jumped us and tried to kill me, Code 10.”

At this me and my partner looked up at each other. Wondering just what a Code 10 was.

She said that to whoever she was calling about four times. “Code 10, code 10″

I wanted to ask what it was although I pretty much could guess what a Code 10 in ghetto call signs meant.

But did Code 10 mean;

Get here with fists and hair pulling
Knives and chains
Guns and …

No matter what it meant, I wanted to be away from the scene. I didn’t know how far away the Code 10 was, when it could happen and the added comment to me about how ” busy” I was going to get as per the patient made me want to be clear from the area as soon as I could.

Of course, she refused transport despite her breathing complaints and her easily stopping heart. Even with my encouragement to go to the hospital thinking maybe that would delay any Code 10 that was coming.

She signed any appropriate paperwork and even though recently blinded jumped off the ambulance without assistance. Leaving me anticipating the mysterious Code 10 for the rest of the evening.

I did go and tell the police officers at the scene about her phone call so perhaps any heads up they could have regarding the impending Code 10 might be beneficial.

Luckily no further events from that scene occurred that night. At least not that I know of.

But I took away from the call a reminder of the dangers that we as providers encounter each day. That a simple call with a secret Code could mean more danger, more patients and a scene that was safe becoming unsafe.

A reminder that we have to be alert to these phone calls and to always have that situational awareness. Especially with what in my opinion is a growing lack of hesitation to assault and involve EMS providers in violent encounters.

Stay safe

 

EMS Week Show aka Jim Bitches About It

EMS Week 2014 has begun. Oh the fun, prizes, days off and benefits of being an EMS provider are finally bestowed upon us all.

Or – it is business as usual and the one week that is named EMS Week is shared with other events, requires us to be on a week long public awareness campaign and often is overlooked by even our management.

Hey we are not looking for too much, but maybe just like during Nurses Week you see posters and ads that say “Thank a nurse”. We could have something similar. Instead of lets show the public the ambulance, teach first aid or CPR for free and make sure we get to the ED to maybe get a free meal before the rest of the “EMS” peeps get it all. (Rest of EMS meaning ED techs, nurses, docs and housekeeping).

Join us for your EMS week joy installment.

Register for the EMS Week Giveaway Event here

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Paramedic License or EMTP Certification?

ems paramedic questionsThis content is from the Authorized Transmissions newsletter, but I thought it would be great to pull it out and highlight it all on it’s own.

When it comes to being a licensed paramedic or a certified EMTP, opinions vary and it will depend on who you talk to.

Certification: Agency or association grants recognition

Licensure: Governmental agency’s competency standards are met

Now when you think about it, for most states it is one and the same. Even states that require NREMT “certification” still mandate that you take a state exam or meet state standards to be considered competent to practice as a paramedic in that state.

From the NREMT website “…Licensure, .. is the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice. Under the licensure system, states define, by statute, the tasks and function or scope of practice of a profession and provide that these tasks may be legally only by those who are licensed.

As such, licensure prohibits anyone from practicing the profession who is not licensed, regardless of whether or not the individual has been certified by a private organization.”

So, what’s in a name then? Especially if both descriptions are interchangeable and more importantly any state allowing you to work as a paramedic is giving “license” to do it.

Well that is just it. Some states like NY and NJ have been getting petitioned for years to change the identification from certification to license, but for some reason it just has not happened.

What’s the hold up?

Resistance due to education levels? Fears of infringing on other healthcare fields? Perhaps even those EMS insiders who like things just the way they are?

However you look at it. The bottom line in my opinion is that the paramedic profession should be licensed.

States cannot continue to dictate requirements and keep it noted as a certification in order to keep other professions happy.

Nationwide, paramedics should hold licensure and if need be, individual states can set specific requirements for that region in order for that paramedic to work and practice within a set scope or guidelines.

Government agencies need to remove all mention of certification from paramedic programs and gear all education and testing to a licensure format. If that means making exams more difficult, setting higher continuing education requirements and holding individuals to a higher standard overall, then so be it.

I think that this would be a move in the right direction for EMS as a whole and a step that is relatively easy to implement.

Listen, I don’t have the answers to this or know why with a certainty the word license is not the accepted rule.

Maybe we shouldn’t be putting too much energy into this to begin with since in the end it’s just a word.

The reality is that, no matter what the state calls it, a state issued “license” or “certificate” is functionally the same and is a “license”.

The difference to be aware of is that while the terms might be interchangeable for what a state calls it, non-government agencies like the NREMT, are certificates since licenses grant an official privilege (like the ability to drive or practice medicine) whereas a certification is simply a non-government agency saying that you have met their standards (like NREMT, AHA, PHTLS).

What do you think? Does it matter?

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Enough with the buffoonery

You know, a lot of things in EMS just don’t make sense. Spinal immobilization, continued use of Lidocaine, Lasix, Epi the list can go on. I suppose we do these things for a variety of reasons. Following protocols, job security, going along to get along etc.

One thing that has been really buttering my biscuit these days is this whole patient signature thing. This idea that having the patient sign the privacy form, billing form, no fault form etc. clarifies why they are in the ambulance. To me if they are in the ambulance it “implies” they want to be there. If they can’t sign because they are unconscious etc. it still “implies” they want to be there and having me or a nurse sign that they couldn’t sign is ridiculous.

EMS1Shouldn’t our documentation be enough to state why they were transported. How we found them, their complaints, our findings and treatments. Isn’t that all enough to warrant the need for an ambulance? Why do we subject patients to signing unfamiliar forms and computer screens when they are in duress. Chest pain, difficulty breathing, trauma and otherwise. “Oh excuse me sir, I know you are having chest pain and your 12 lead is showing a STEMI but can you allow me stop everything I am doing to save your life and direct your attention to my billing form.”

“Ma’am I know you are immobilized to a flat board with a stiff collar on your neck and although this alone should be enough of unnecessary treatment, can you sign this no fault form while on your back unable to move your head and in a most uncomfortable position”

My personal favorite. The 80-90 year old patient who can barely see, has arthritis and is being asked to use a computer screen and stylus… (what’s a stylus) to sign their name. Now press hard, don’t let your hand rest on the screen, no lets try again, oh wait, that’s good enough, I know it looks nothing like your signature….. “UNCLE!!”

“What” you say, “most patients can sign”? They aren’t in duress or in precarious positions not to sign? Maybe these patients should be going by some other means to the hospital. Perhaps they should be signing before you transport, that in your opinion they don’t require an emergency transport and that they may be required to pay the ambulance bill themselves.

Sure some patients need the ambulance and they most likely can also sign. But why is that part of the deal? Shouldn’t our assessment, care and documentation of it all assure the need for ambulance transport?

Now there are those who will say that it only takes a few minutes to get a signature. Its not a big deal, its part of the job and on and on. While this may be true at the root of it all, requiring these signatures has evolved in EMS from not needing them, to sometimes needing them to needing them is mandatory, patient condition be damned.

To me, the fact that the patient is in the ambulance accepting transport and treatment as I document the same on my report implies they want to be there and agree to being transported. I don’t know about you but I have not seen ambulances driving around snatching people off the street and taking them to emergency rooms against their will. But I guess if they did, as long as they got a signature somehow it would be OK.

My Memorial Day Challenge

Barbeque’s, family time and TV specials. Another Memorial Day weekend. Another Memorial Day of looking at countless comments on Facebook about thanking a veteran, showing your troop support and general well wishes to our troops and families.

For me, it’s another day of remembering. A day of wanting the troop’s home, praying for their safety and wishing their families to be granted the strength and faith to withstand the sacrifices made. It’s a normal day for me.

You see, I have that luxury of simple prayer and reflection. If you know me, you know that every day is Memorial Day for me. I’m too old to be in the military and my time spent in the Army is long over. Still, I want to do so much more than I am. Sometimes I fear I have not done enough to honor the sacrifices being made by our military. Sometimes I am ashamed that I let opportunities pass me by.

I have given to the Wounded Warrior Project, joined in groups putting together care packages and have donated to various military support groups and causes. For some that can be enough. For me I want to do so much more. Yet opportunities pass me by that can make so much more of an impact.

Seeing that soldier, sailor, airmen or marine walking down the street or in the mall should propel me into a personal showering of gratitude upon each of them. But too often I let it pass. Feeling corny, apprehensive of the reaction from them, worried that I may become too emotional and embarrass myself, THINKING too much that the moment passes, gone.

Ashamed and frustrated, I let these opportunities pass by.  I long to have an impact, take action and, without restraint, show all our service members how much I appreciate who they are and all they do. I long to leave them with the feeling that they are truly supported, understood and thought of not just on designated days like Memorial Day but every day.  They must be assured that as I sit in my decorated yard, eating a hotdog, I know they are sitting in a desert eating MRE’s.   They should know that though I am surrounded by the noise and laughter of my family, I pause often to remember that they only have images and memories of those they left behind. I take moments to honor them.  I remind my children of their sacrifice.  I begin to see that the impact I yearn for, the one that carries forward and is so vital to our troops,  are forming In the words I write.  I recognize my inner restraints and can choose to let them go.   The moment -the opportunity – to reach out and say “Thank you” will pass by ONLY if I let it.   I have taken action and can now move forward and hope that I have made a difference; to the soldier I meet, the unit he returns to, the families who worry and perhaps, even the nation they have dedicated their lives to.  My inner battles will not – cannot – prevent me from remembering that their sacrifice may, in fact, be the ultimate one.

I challenge you to do more. Take actions that ensure our service members and their families feel our respect, concern and appreciation.  Do more than post in Facebook or click a like button. If you can donate, do so. Get involved with a local organization to send packages or letters. And if – or should I say when – you get a chance to thank a veteran in person, don’t let that moment pass. It is not easy, but I ask that you stop thinking “should I” or “do they want to be bothered” or “who am I to approach them”. Keep your focus on them and the voice of insecurity will relent. If you are like me, tears may begin to well and words may not come out as planned, but we cannot feel ashamed or embarrassed, for as quickly as those feelings may surface, so will fortitude and inner peace.   Making an impact requires strength; emotions are often the only force that moves us to take action.

We can, and must, do more than post comments from our den or office and as I bring this message to an end to join my family, I think about the most important word within this article – sacrifice. Each moment a service member spends away from home, each march they make or person they help is testament to their daily sacrifice.  Help them know it does not go unnoticed. Reach out.  Take action.  Sacrifice appearances and show your appreciation to the service member in front of you.  They will carry it with them.  Don’t let the moment, the opportunity, pass by; know that offering thanks to those serving is the best way to honor the memory of those, whose sacrifice was their last.

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