Archive for the ‘Opinion’ Category

Detroit EMS – Government Healthcare at It’s Best

After reading about the budget shortfalls and response time issues with Detroit EMS, I am left to wonder why they haven’t considered contracting the service to a private ambulance provider? This is just another example of what happens when government is in charge of providing healthcare. Obviously Detroit’s issues go much deeper than EMS. As a matter of fact, their EMS service probably isn’t the problem at all. It’s the lack of funding and support that has put them and their citizens in this unfortunate position. Keep in mind, this is a service that not only bills the patients but receives tax dollars as well.

Had this problem come up with a private provider, they could put the contract up for bid and get someone else in who is capable of fulfilling the needs of the community. For those of you that argue that private EMS is bad because they can go out of business, then just read these articles. This sounds like a service that NEEDS to go out of service so someone can come in who isn’t subjected to cuts and do the job.

Our response time is atrocious. At any given point, day or night, consecutively for the last few months, there were no units available. That means if you call 911, it may be an hour, it may be two.

Emergency workers told Local 4 that they’re already understaffed, but come July 1, 33 more EMS positions will be eliminated.
The cause of the layoffs comes from a planned $1.8 million cut to the city budget.

Rationing care? That nonsense could never happen here!

I feel for the EMT’s, Paramedics and patients that have unfortunately been subjected to this. I really hope this gets better for them.

http://www.jems.com/article/news/budget-cuts-hit-detroit-ems

http://www.allvoices.com/contributed-news/6550028-chaos-continues-in-detroit-ems-workers-frustrated-over-lack-of-units

http://www.jems.com/video/news/detroit-ems-relying-crwon-vics

Customer Service – No Base Orders Required

Try to image yourself having a true medical emergency. Whether it be chest pain, shortness of breath or a stroke. You are scared as you don’t really know what’s wrong. Perhaps it could be nothing. Maybe it’s worse. Perhaps you wont make it through the night. You aren’t trained in emergency medicine so you don’t know what’s serious and whats not. Naturally, you call for help. 2 people show up to care for you and take you to the most appropriate hospital. One of the men that comes to your aid appears to be uninterested in your problem. He rolls his eyes and asks you if you considered going in to see your primary care physician in the morning.

Does he not understand that I’m having an emergency? Did I do something wrong?

Now you don’t know whether to feel scared or stupid. You have never done this before. You want to make sure you are OK, but now you are worried that you are wasting this man’s time. You decide to go to the hospital, obviously against this guys wishes. Reluctantly he loads you into the ambulance, sits behind you and doesn’t say another word for the rest of the trip. You were seen by the ER physician and as it turns out, there isn’t anything seriously wrong. You go home with some relief, but at the same time you think to yourself that this was definitely a bad experience.

Now next time you start to experience chest pain, wouldn’t you think that you would be more likely to stay home or wait until the last minute to ask for emergency medical services again?

As EMS professionals we tend to forget the impact that we can have on every call that we run. Sure, in this scenario nobody physically suffered from this paramedic’s actions (or lack of action). However this experience could affect someone’s willingness to seek much needed help days, months or even years down the road.

To us, this may be one call out of 10 that we run in one shift. We go on to the next call and the next call and probably forget about this patient by the time we clock out. But to the patient, this ONE CALL can make a big impact on their life. If we performed life-saving interventions, they may get to live another day to spend with their family. If we fail to perform our jobs, we can negatively impact someone to the point where it actually costs them their life! Remember this is ONE CALL that we are talking about here.

I’ll be the first to admit that I have been guilty of taking what we do for granted and getting by with the minimum. For the longest time I would clock in, check out my drugs and then just do what I had to do to stay out of my supervisors office. I wasn’t rude to my patients, but I certainly lacked the TLC factor. My patients never called in complaints, but they also never called in compliments, which meant that I wasn’t doing a good enough job.

Customer service is something that is more important that anything else that we do. Sure, we may be able to start and IV while driving 70mph or intubate in the rain on the side of a busy freeway, but what good is that going to do anyone if they are too afraid to ask for our help? Simple things like talking to the elderly lady about her grandkids, or giving your pediatric patients a sticker and a toy really go a long way.

When I talk about good customer service in EMS, I am constantly reminded of the movie “Patch Adams”. The lead character in that movie did absolutely nothing medically to help his patients but what he did do significantly improved their quality of life. He made them laugh, smile and feel good about themselves. Isn’t that what we all really want?

As with any job, you occasionally run into difficult people. Some people aren’t going to be happy no matter what you do. But you still have a job to do. Sometimes you just have to bite your tongue and kill them with kindness. When all else fails, you can at least say that you tried your best.

Taking this approach not only improves your relationships with your patients, but it improves your outlook on your job. Once I realized that I am here for the patients, my stress level significantly decreased. I stopped hitting the dashboard when I was dispatched on transfers and nursing homes. I didn’t mind so much when I got back-to-back late calls. Overall, it improved my job performance to the point where I was promoted to a very nice position in the company over much more senior employees.

Just remember, you work for the patient, they don’t work for you. It is YOUR job to make sure that they have the most pleasant experience possible. If treating people with dignity and respect is too much to handle, then go work at an impound yard or a prison. It really is as simple as treating everyone as you would want your family to be treated.

For those of you out there that already do this, keep up the good work.

As always, I welcome all comments and hate mail. Have a great week!

Assembly Bill AB2456 Hurts California EMS

Assembly Bill AB2456 recently passed through the state Assembly and is now making its way to the Senate floor for a vote. What does this mean to us as California EMTs and Paramedics? Well….lots of things. Some known and some unknown. The proposed bill aims to virtually eliminate local EMS agencies and give ultimate governing authority to our wonderful State EMSA. That’s right, the same agency that takes 90 days to process your license renewal, doesn’t return phone calls and takes years to complete investigations. Yep, those guys.

Mark my words, THIS WILL AFFECT YOU NEGATIVELY.

The sponsors of this bill want to see statewide protocols as opposed to the county system that we currently have in place. Sure I get the reasoning behind this, but do you really think that they are going to adopt aggressive and cutting edge protocols? No, because that would require them to fund mandatory training for the majority of the counties around the state that still play “mother may I” instead of para-medicine. Instead you would see everyone “dumbed down” to the level of the county with the tightest standards. I hope you don’t mind taking a few steps backwards because thats where we are headed.

Such a wonderful plan must come with a price right? Nobody eats for free in this world. The proposed legislation will add at least $800,000.00 to the state budget. That’s right, the budget that our legislators haven’t passed on time AGAIN. But don’t worry folks because it wont add to the current deficit. No, instead we the EMS professionals will pay for it in the form of fees tacked on to our license renewals.

The authority may develop and, after approval by the

commission pursuant to Section 1799.50, adopt a schedule of fees

to be collected from each certifying entity, and an increase in fees

pursuant to subdivision (d) of Section 1797.172, in amounts

sufficient to support the authority’s actual additional costs to

promulgate regulations pursuant to paragraph (1). The fees shall

be imposed proportionally between the certifying entities, and

through EMT-P licensure fees, based on the number of EMT-Is

and EMT-IIs Advanced EMTs certified by certifying entities and

the number of EMT-Ps licensed by the authority.

Translation: We are going to take as much of your money as we see fit.

Our current EMSA is under-staffed and under-funded. Do you really think that they are equipped to handle the task of managing EVERY agency in California? Imagine how much money it would take to hire the staff, buy the equipment, establish committees and do studies to formulate a statewide set of protocols. All of that money will come from you and me.

If you are interested, you can download and read the legislation by clicking on the link AB2456. See it for yourself.

It’s time to act

If we do nothing, this bill will pass with flying colors. Maybe we don’t have a perfect system, but lets not let the legislators in Sacramento decide what IS best for us. You can help kill this bill by calling not only your local senator, but every senator out there and voicing your opposition. It doesn’t take much time and it’s really easy. Just call them, tell them your name, zip code and the fact that you are an EMS professional and explain that you OPPOSE this bill. We have to get people from all over the state lighting up their phones to get the message through.

Follow this link for a list of all the Senators and their phone numbers. California State Senate

Please don’t let this pass. Make the calls, talk to your friends, and write letters. Lets work together to bring EMS forward, not backwards.

If you have any questions regarding this bill, you can e-mail me at sean@medicamdness.com. I will answer any questions I can in a timely manner.

Nursing Homes

We all know them. We run calls there, mostly at the end of our shifts or in the middle of the night. They all have a unique smell that we love so much. When we pickup patients there, it always seems to be shift change. Nobody seems to have a clue as to what’s wrong with the patient yet everyone including the janitor can tell what room you are looking for the second you walk in. Having a nurse that speaks fluent English is considered a priveledge that only few have experienced.

Sound familiar?

Every community has its nursing home that we all love to run. Unfortunately many of them are just as described. They are about as consistent nationwide as McDonalds. So what makes paramedics think that bitching and treating the staff like crap is going to change anything?

As you can tell, I’m the first one to recognize that nursing homes have their share of problems. But let’s not forget that EMS has its share of problems as well, like arrogance. At some point in time, we as paramedics and emts decided that we are better than anyone not trained to our level in emergency medicine.

Many of us talk down and outright belittle the staff at these facilities. And for no good reason! It is not our job as EMS professionals to judge other healthcare workers. These people are faced with a task that most of us couldn’t handle. Paramedics bitch and complain about washing their rigs. Imagine giving all of those elderly people a bath every day. The nursing home staff is taking care of those elderly people simply because nobody else is willing to do it.

We manage to run medical calls at peoples homes with NO report given and we do our assesment and go on with the call. Yet we consider that to be a huge inconvenience when the patient is at a nursing home?

“Shut up and play your guitar” is a saying I frequently use when musicians and singers start bitching about politics. Well I ask all of you to shut up and run your calls. Pick up your patient, get your paperwork, smile and wish the staff a good day. You can bitch and complain as soon as you leave the hospital. Let’s be professional and keep the venting away from the patients and staff.

Intubation – So easy a caveman can do it

I cringe every time that I read an article regarding governing boards considering pulling intubation from a paramedic’s scope of practice. It floors me how such an easy (yes easy) and essential skill can find itself on the chopping block time and time again. What I don’t understand, is why there are paramedics out there that can’t seem to get it right.

I took a job as a paramedic supervisor about 3 years ago. Since then, the amount of calls that I run have decreased by more than half. I went from intubating multiple times a month to once every 4-6 months. While my anxiety level has gone up in fear of being out of practice, I still manage to successfully intubate pretty much every time. It’s just not that hard.

Let’s take a look at other skills that we perform far more often than intubation and compare the level of difficulty.

I’ll start with the everyday task of starting IVs. This is arguably more difficult than intubating. The only reason people don’t freak out over it is because it’s not a life-or-death procedure. There are far more people out there with bad veins than there are people with difficult airways. Paramedics miss a hell of a lot more IVs than they do intubation attempts. Sure, you can argue that the volume of people that require IVs is much greater, therefore the numbers are skewed. But think about this: If we start so many IVs every day, shouldn’t we be really good at it? Likewise, if intubation is a skill that is considered to be difficult AND we don’t get to do it very often, then why do so many areas have success rates in the high 90 percentile?

I’ll even take it down a notch and compare intubation to a BLS skill, the traction splint. I will argue any day that applying a traction splint is far more difficult than intubating. Dealing with a screaming patient who just broke a femur exceeds visualizing vocal cords hands down.

I really wish that we would look at solutions to these problems other than taking away the skill. If we have people in the field that can’t handle the simple task of securing an airway, then maybe they shouldn’t be paramedics.

Anyone care to argue?

Should EMS be Allowed to Carry Weapons?

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

2nd Amendment - United States Constitution

All of us that work in EMS know that our job comes with it’s fair share of risks. I think most of us would argue that we put ourselves in harms way far more that than the average citizen. But what mechanism do we have in place to protect ourselves? …….anyone?

Every ambulance service I have worked for has strict rules against carrying weapons of any type while on duty. This includes guns, knives, pepper spray, etc. Every time I have heard these policies questioned, it is typically addressed with a general “we are not cops” statement. And they are right. We aren’t cops. We don’t enforce laws and we don’t track down bad guys. But we DO deal with the same people that law enforcement does. We run drug overdoses, assaults, homicides, suicides, etc. We find ourselves in the middle of trouble almost on a daily basis.

So back to my previous question.

What mechanism do we have in place to protect ourselves? Well for starters we have a dispatcher who decides whether or not the scene is safe to enter based off a 30 second phone call. Our next line of defense is a radio to call for help. And lastly we have the ability to run away. Criminals beware!

I’m going to come right out and say that I believe that EMS professionals should be allowed to carry concealed weapons in the name of personal defense. As a citizen the United States Constitution grants me to the right to keep and bear arms. So should my employer be allowed to deny me this right while I’m on duty?

Now I must play devils advocate for a minute. To look at this issue from an employer’s prospective, I can see where they might have issues with their employees carrying and possibly using a weapon. This opens up the doors to legal action and liability in the event that one of their employees acted inappropriately and killed someone. Employers have the right to tell us how to dress, speak, act and even cut our hair. In exchange for following these rules, we get to stay on board and receive a paycheck every 2 weeks. If we don’t like the rules, then we are free to leave at any time.

I guess where I am going with this is that while I believe that I have a right to protect self on and off duty, I don’t think that employers should be told they HAVE to allow their work force to carry weapons. Having said that, I think that liability should not be placed on an employer in the event that an EMT or Paramedic had to exercise their rights and harm someone in the name of defense. When my life is placed in danger to the point where I have to draw my weapon and kill the person who is trying to kill me, I am no longer acting as a Paramedic. I am acting as Sean Eddy. A human being that is trying to do what I can to make sure I make it home to my family. At that point I have taken all responsibility for my own actions AS A PERSON, not as a Paramedic.

Anyone disagree with me? I would love to hear your thoughts.

The pros to private-based EMS

After my last post in regards to “fire-based EMS“, I got a few e-mails starting with “what the hell dude?” So I decided to make a post defending my real position on private-based EMS. As most of you know, I work in and favor a private-based single-medic EMS system. My last post was written to make a point that other systems do have their benefits. So here is my rundown on why I prefer a private-based EMS system.

Cost

Private-based EMS is the most cost-effective solution for any municipality. Ambulance companies operate at no cost to the tax-payers unless they actually use the service. In times of financial hardship, it just makes sense.

Contracts

Exclusive operating contracts comes with requirements that must be met in order to continue providing service. These include response time compliance, complaint resolution, QA programs, community service programs and in some cases, minimum staffing. There is a good argument that there is actually more oversight for private companies than public services.

Single Medic

Private ambulances typically run 1 medic per ambulance. This means that each medic does more skills, has more responsibility and runs more calls on their own. For skills like intubation, paramedics need to be performing it as frequently as they can. I do realize that single-medic systems are not unique to private-based EMS, but it is more common amongst those types of systems.

Single Function

One of the biggest reasons that I prefer a private-based ambulance service, is that paramedics employed by these companies are only working as medics. Their roles are not split up by other jobs like firefighting or law enforcement. On top of that, I don’t think that being a firefighter should be a prerequisite to being a paramedic in a 911 system.

I have a few articles out there arguing for private-based EMS systems. If you are interested, check them out.

privates-to-the-rescue

two-paramedics-are-not-always-better-than-one

Private EMS – The Stepchildren of public safety

The pros to fire-based EMS

For those you that have been reading my blog for any amount of time, this title probably comes as a shock to you. As you know, I make it no secret that I prefer a private-based EMS system. Perhaps it’s my conservative, pro private-business background that has molded my opinion on the matter. Regardless, I have yet to publicly acknowledge that other types of systems can be beneficial. Well today the pigs are a go for take-off, because I am going to take some time to talk about the benefits of fire-based EMS.

So here it goes, my list of the “pros” to fire-based EMS.

Training

For the most part, fire crews are running less and less fire calls and more medical calls. This being the case, they typically do a lot of training for medical-related emergencies and drill often to try and keep their knowledge and skills up. This is something that many private providers have lacked for a while.

Funding

Fire departments have done a wonderful job of securing funds at the state, local and federal level for a long time. This allows for high-quality equipment, better salaries and more resources. In areas where the fire service also provides ambulance transport, they are able to bill for their services as well to increase revenue.

Selection

With high pay, good benefits and an unbeatable retirement package, fire departments have qualified applicants lining up for miles for a job opportunity. This of course allows the department to be more selective when they hire personnel.

Health and Fitness

Firefighting can be a very physically demanding line of work. So naturally, fire personnel must work hard to stay healthy and physically fit. Regular exercise is something commonly seen amongst the profession. This leads to better concentration and less chance of injury.

Non-profit

In order to write this section, I must take some time to lock my stubbornness in the other room so it doesn’t interfere….so hang in there a minute.

…..ok still there? Good, here it goes.

I will admit that there is benefit to making decisions concerning equipment purchases, in-field practices and system management when making a return on your investment isn’t a priority. This is why you will commonly see fire services take on new procedures and protocols with open arms. They don’t typically have to worry about reimbursement.

So there you have it. My list of pros to fire-based EMS.

EMS 2.0 – Be careful what you wish for

I had a great conversation with a fellow EMS blogger last night over Skype. We discussed several ways to implement changes to our “broken” ems system and how EMS 2.0 could not only fix our industry, but improve healthcare as a whole. All was good as we were fixing the world and saving lives all through the wonders of internet phone calls. This was of course, until we came to a shocking realization of what EMS 2.0 could actually mean for us as an industry. I’ll get to that in a minute.

If you have worked in EMS for any period of time, you are no stranger to 911 abuse. People using 911 to seek routine, non-emergent medical care have tied up paramedic ambulances, increased costs and delayed response times. The “you call we haul” system that we have in place decreases liability as everyone is transported to an ER physician, but it doesn’t exactly use resources efficiently. As Justin Schorr mentioned on the Happy Hour, “putting more paramedic ambulances on the street is like putting more tow trucks at a dangerous intersection. We need to fix the intersection”.

Everyone has probably heard this rant from me or any of my fellow EMS bloggers at some point in time. Regardless of the specific solution we have in mind, we can all agree that we want patients to be routed to appropriate care. Not just the ER via paramedic ambulance. One thing me and @Jeramedic discussed was the possibility of using advice nurses in conjunction with EMS dispatch to properly route these people to appropriate care. A tactic that HMO’s have been doing for years. Here is a great article on a service that has already attempted to implement such a system.

So now for the scary part.

Let’s say that one day we woke up and our dreams came true. Patients are being routed to appropriate levels of care. Paramedics have the ability to refer non-emergent patients to urgent cares, clinics, etc. Now our ALS ambulances are only being used to transport the truly ill and injured patients to the ER. Sounds great right? We have successfully decreased the workload on our EMS system. There is only one problem. What are we going to do with all those paramedics that were once responding to 12+ calls a day? If we are only transporting truly emergent patients, wouldn’t that significantly decrease the demand for paramedics? Would this leave a bunch of paramedics looking for work?

I’ll use the fire service as an example. Over the years, fire prevention and regulations have worked so well that fire departments aren’t exactly putting out fires anymore. At least not very often. They damn near prevented themselves out of jobs. Is this what we are doing to EMS?

Fire departments did a great job of overcoming this problem by integrating fire suppression with EMS response. It has done wonders for fire services around the nation. This is actually a great example of how we as EMS professionals can use EMS 2.0 to our advantage and not only advance our career, but increase demand. Programs like community-based paramedics, and advanced-care paramedics would open up a whole new world of opportunity for EMS professionals to advance in the profession. This would also be an opportunity to increase educational standards, scope of practice and improve EMS salaries. You would see EMS turn from a stepping-stone job to a life-long career.

If you haven’t had a chance to listen to Episode 88 of the EMS Garage, you should do so now. We had some great discussion on this very topic. Hopefully Justin will hijack another show in the near future so we can get further into this discussion.

The death of pre-hospital intubation

No way Sean! Say it aint so!

Unfortunately this could be a reality in the near future. In California, there is a large push to pull intubation from the scope of paramedics. In L.A. County, they already removed pediatric intubation. Many of the “higher-ups” are starting to think that the skill is unnecessary in a pre-hospital setting.  Some actually believe that intubation is too risky to be performed by paramedics. Scary thought huh?

This all sparked from a couple EMS systems (I wont mention names) that have a big problem with intubation. Success rates averaging around 60% in these areas having raised quite a few eyebrows. Unfortunately these areas make up a large portion of the state. While it is clear that some areas have a problem, I think that this is the wrong way to go about fixing it.

This trend of “dumbing down” EMS really troubles me. I can’t think of any other profession that takes away responsibilities at the first sign of incompetence. I wouldn’t want cops to have their guns taken away for having a bad day at the range. I would expect that the areas of deficiency be addressed by training, refresher courses, skills labs, etc.

Intubation is an extremely valuable procedure that we do. I mean sure, secondary airways like Combitubes or King Airways WORK but they are counter productive when the receiving ER doc pulls them immediately upon arrival to place an ET tube. It is not a difficult skill and there is absolutely no reason why we can’t be proficient at it.

I know that a lot of this is just talk right now, but it scares me to think that our leaders are even considering it. I want to see EMS continue to move forward and advance. This is certainly not the way to do it.

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