If You Like Your 24 Hour Shift, You Can Keep Your 24 Hour Shift

Yes, I shamelessly lured you into the this article using the Obamacare promise……

I’m going to preface this post by saying that I currently work 24 hour shifts, and I enjoy them. Throughout my career I have been assigned to 10’s, 12’s, 24’s, 48’s and even 72’s. I even pushed the envelope a few times and did a couple 7-day stretches (Disclaimer: It’s a bad idea. Don’t do it). For the most part, long-hour shifts are all I’ve known for the majority of my adult life. I don’t want to see them go away, but realistically I know they will.

Every time I bring this topic up, it is usually hit with some pretty fierce opposition. 24 hour shifts have been a staple in our industry since it’s creation and like many other things we enjoy, we hold on for dear life. Working 10 days a month on the right shift rotation allows us to do a lot of things that most people on traditional 8-5 schedules couldn’t dream of.

Here’s the problem….

Too many employers (and employees) don’t take the issue of fatigue and safety seriously. Virtually every branch of commercial or public transportation has very strict rules on hours that their employees can operate, except EMS. I can literally be on the tail end of a 48 hour shift with absolutely no sleep and legally operate an ambulance or fire engine. I’m fortunate enough to work for a service that takes work hours and safety seriously, but I wasn’t always so lucky. Many services subscribe to the “suck it up” mentality and actually punish employees for “tapping out” or blowing the whistle when they’re too tired to take a long distance transfer or run a call.

The “on your feet from 8-5″ policies are also going killing the 24 hour shifts. I completely support station duty and equipment maintenance requirements. However, once the requirements are met, I feel that it’s very foolish not to allow your employees to lay down and get some rest during the day to reduce fatigue in the night hours. Setting “break hours” only works when the pieces fall into place and no calls go out during that time. If you’re dead set on “not paying your employees to sleep”, then switch to 12-hour shifts. Quit putting your employees and your patients at risk.

I have never understood the practice of discouraging employees from requesting down time to rest. Yes, I understand that needs of the service and community have to be met, but at what cost? We don’t encourage our employees to enter unsafe scenes – regardless of how critical the patient is – so why aren’t we doing the same when it comes to fatigue? If a loved one called me and told me that they were exhausted while making a long drive, I would tell them to immediately pull over and sleep. If it isn’t good enough for ourselves or our loved ones, then why is it good enough for our employees? Nothing is worth a human life…not even staffing requirements.

My wake up call happened several years back when I was working as an EMT-Basic. I was working a 48 hour shift in a rural community and we were up running back-to-back calls for the majority of this particular rotation. I was driving to a hospital in a town that was an hour away from the scene location. Shortly after hitting the interstate, I started feeling the affects of fatigue and I started fighting to stay awake. I wanted to say something, but I was afraid that I would be sent home without pay if I tapped out. I tried rolling down the window, cranking on the air conditioner, listening to the radio, and even attempting to engage my partner in conversation. I had a brief period where I blacked out and the next thing I remember was waking up 3 lanes over from where I remembered and nearly striking a guard rail. I played it off like I was moving out of the way of an animal that ran out on the road. Thankfully, nothing else happened and we made to our destination safely. Yes, I showed up to work with plenty of rest that shift, but that didn’t do me a lot of good at hour 37 with no sleep.

Yes, I still work 24 hour shifts and I enjoy them. The difference is, I work for an employer that is serious about how many hours we work consecutively and encourages us to rest whenever we can. If I’m working a 48-hour shift, I’m not required to be awake at a specific time to perform a pointless “log-on”. I’m typically able to catch a decent nap during the day, and I know that if the time came where I couldn’t safely operate the ambulance, I could notify my supervisor without fear of punishment. In other words, they’re doing it right.

As far the title goes, yes we can keep the 24-hour shifts, but we are going to have to be serious about the risks from fatigue. If employers continue dangerous practices then it will just be a matter of time before we start to see legislation that restricts our work hours. I don’t want to see that, but my confidence in the industry to do the right thing is nearly non-existent when it comes to this issue.

I would love to hear what you have to say on the subject. Comment below to let us know your thoughts on 24 hour shifts.

Money Smart Medics Part 3: Starting the budget

If you’re anything like me, you probably cringed a little when you read the title. If you’ve never lived on a written budget, it can seem kind of scary. I used to think that budgeting meant that I would lose control of my finances. What I wound up discovering is that budgeting is the only way to take control of your finances. The truth is, we all live on a budget. It’s just a matter of how many categories we chose to setup.

Trust me when I say that setting up a budget is one of the most liberating feelings when it comes to managing money. My version of budgeting used to be swiping my debit card until it stopped working. I used to get anxious every time I paid for something because I was never 100% sure that the transaction was going to be approved. That’s no way to live. Once I took control of my spending, all of that stopped. My stress level became nearly non-existent.

I remember hearing Dave Ramsey say that I will feel like I got a pay raise once I start budgeting. I wasn’t sure what he meant by that until I actually started doing it myself. Within a month of living on a written budget, I quit both of my part-time jobs. I had previously believed that these jobs were absolutely essential to my survival. Budgeting and being intentional with my money actually allowed me to start focusing on balancing my home life with my work schedule.

List Out Your Monthly Bills

Before we can even start writing our first budget, we have to figure out exactly what we are bringing home and how much we are spending. Grab a note pad and add up your average monthly household income WITHOUT overtime. Now add up all of your monthly bills. This doesn’t include food, fuel, etc. We’ll get to that later. I’m talking about anything that requires a monthly payment like your rent / mortgage, cable TV, car payment, etc. Ideally, your income without overtime should be more than your monthly bills. If it’s not, don’t panic. We’ll be OK.

If your bills exceed your income without overtime, then you are living beyond your means and something has to change. We have 2 choices: We can either reduce the money going out or increase the money coming in. I strongly recommend taking a serious look at what’s going out every month and start eliminating non-essential items using the process I described in Part 2 of the #MoneySmartMedics series. Our goal is going to get all of our monthly expenses below our income amount without overtime. I understand that everyone’s situation is unique and you may not be able to accomplish this depending on your financial obligations. However, do your absolute best to get this as low as your possibly can.

Once you list everything out, grab a calendar and mark all of your due dates with the amount of money owed. This will be extremely useful when it comes time to creating your budget.

Figure Out What You’re Spending

Unless you make a habbit of writing down every dollar you spend, this step is going to take some time. Before you begin, try your best to figure out your basic categories of spending. You don’t have to be extremely detailed, but try to separate things like fast food from groceries. Try using the following as a starting guide:

Food
-Groceries
-Fast Food
Fuel
Entertainment
Household items
Clothing

Once you have your basic categories laid out, start pulling up your bank statements and add up the numbers. I would recommend doing a 3 month average in all of the categories, but using only the previous month will also suffice. This part is painful and eye opening, but it’s the only way you’re going to get a grasp on what your spending.

Side Note: The first time I did this, I found that my biggest expense was overdraft fees. Don’t be ashamed or discouraged. Knowledge is power. 

Building Our First Budget

Now that we have all the information we need, we can start putting it all together. We are going to start assigning categories to dollars until our “available funds” hits zero. This is going to take practice. Actually, it’s probably going to take a few months to really get it right. That’s OK! Don’t give up.

We need to lay out our categories, just like we did in the previous step. Only now, we are going to add in our monthly bills as well. You can use the following example to help get you started:

Rent / Mortgage
Utilities
-Electric
-Gas-
-Water
-Phone
-Internet
Car Insurance
Debt
-Car Payment
-Credit Cards
-Student Loans
Fuel
Food
-Groceries
-Fast Food
Entertainment
Spending Money
Clothing
Household Items
Emergency Fund

Now imagine that each of these categories is an envelope and your monthly income is a pile of cash (we’ll use real envelopes in a later step). Now we just have to fill in the envelopes until there’s no more cash on the table. This part is a bit tricky and it’s going to take practice, but trust me when I say that it gets easier with each time you do it.

We have to place priorities when we budget to make sure that our essential needs are met. If you wind up with a short paycheck, you may not be able to fill all of your envelopes, but that shouldn’t mean that you don’t eat. Here are my top 3 priorities that I make sure are met every paycheck:

Life Sustaining Items: Food, Water, Medicine
Shelter: Rent / Mortage, Essential utilities
Transportation: Fuel, Car Payment, Vehicle Insurance, Public Transit Costs

I used to make the mistake of placing debt collectors, cell phone providers and even the trash company above my essential survival needs. Yes, ideally you will pay everything on time. However, if you get into a pinch, your credit score shouldn’t take priority over feeding yourself and your family. Remember, Experian isn’t going to keep your lights on or take your kids to school.

Once your top 3 priorities are met, you can then decide what gets taken care of next. This part shouldn’t be too difficult to figure out.

Making Your Budget Work For Your Pay Cycle

Writing a monthly budget can be tricky when you’re on a bi-weekly pay schedule. It gets even more tricky when you work 24 hour shifts and have “short” and “long” pay periods. This is where your calendar that you created is going to come in handy. Take the time and mark out every pay period with the hours you are going to work. I use Google Calendars to do this automatically, but anything you have will work just fine.

By looking at your calendar, you should be able to determine which bills will be paid with each pay check. When it comes to larger bills like rent, mortgage or your car payment, you have 2 choices: You can either use one paycheck to cover the large expenses, or fill up half of your “envelope” with each check. Either way, it’s going to be easier to budget on a bi-weekly basis. Here’s an example of how you can set up categories to work with your pay cycle:

Rent:
-
Pay Period 1
-Pay Period 2
Groceries
-Pay Period 1
-Pay Period 2
Car Insurance
Utilities
-Electric
-Water

…you get the point

Start Stuffing Envelopes

I’m a huge fan of the cash envelope system. Just like we discussed when setting up your budget, you can use real envelopes to separate the cash for your spending categories. Once the envelope runs out, you’ve reached your budget.

This isn’t going to be practical for things that are typically paid out of your checking account like utilities, insurance, etc. But for all of your everyday expenses, this will work wonders. Keep your envelopes somewhere safe and only carry with you what you need.

I highly recommend checking out Dave Ramsey’s article explaining how the envelope system works: http://www.daveramsey.com/blog/envelope-system-explained 

Factoring In Overtime

Hopefully we have made it this far without having to factor in overtime shifts. But like I said, it’s not the end of world either way. I like to put a price tag on my overtime shifts so that I know exactly what I’m going to be bringing in. I accomplish this by doing the math to figure out exactly what my gross income is for a regular shift vs an overtime shift. Using Paycheck City’s online payroll calculator, I figure out exactly what my take home pay would be with no overtime, 12 hours extra, 24 hours extra, etc. I have a chart in my notebook that looks something like this:

No Overtime: $1,400
12 Hours:
$1,750
24 Hours:
$2,100
36 Hours: $2,600
48 Hours: $3,000
(These are made up numbers for the example)

Like I said before, knowledge is power. By placing a price on every shift, you can work towards balancing your work and personal lives and take complete control of your finances.

Make It Easy

All of the things I mentioned in this article can be done with nothing more than a pencil and a piece of paper. However, if you’re willing and able to spend a small amount of money, you can purchase a program called YNAB (You Need A Budget) that does the bulk of your budgeting work for you. Actually, YNAB is the only true “virtual envelope system” that I could find. I’ve never been a huge fan of carrying cash so YNAB really allowed me to continue using my debit card while holding myself accountable. If you’re going to use something like this, you need to make sure that you can discipline yourself to stick to your budget and keep YNAB up-to-date. If you think using your debit card is going to cause problems, stick to cash and real envelopes.

There are some free alternatives as well like Mint.com, however nothing I have found actually holds you accountable like YNAB does. While many people entering the the budget world seek full automation, YNAB forces you to manually enter all of your transactions. This is a good thing because learning how to budget is about developing good habits. Having a program “nag” at you in your e-mail when you have reached your budget isn’t going to accomplish that. I’ll be posting video tutorials on how to use YNAB in the coming weeks.

Fortunately, I was able to work out a deal with the folks at YNAB to give you a $6.00 off discount if you purchase it through the link on this article. Yes, I will receive a small commission on your purchase as well (just trying to be honest!). You can download their program and use a 34-day free trial if you just want to check it out.

YNAB

Click here to download YNAB and receive your $6.00 off discount.

Conclusion

If there is one thing to take away from this week’s article, it’s that being intentional with your money is the only way to gain control of your finances. Cut the credit cards and start paying with cash or debit. If you don’t have the money on hand, you can’t afford it. Breaking the credit card cycle can be tough and trust me, we’ll cover that in detail in a later article.

Don’t be afraid to budget. It’s the only way to take complete control of your spending, and taking control is the only way to achieve financial peace.

Money Smart Medics Part 2: Where Do We Go From Here?

In Part 1 of the Money Smart Medics series, I explained my back story and how I went from completely broke to actually getting ahead financially and planning for my future. If you read the article, you can clearly see that my life was a giant struggle. I used to believe that it was impossible to survive on an EMS salary and that my only way out was to find another line of work or to “move up” within the healthcare industry. I blamed my problems on the industry, taxes, child support, the economy, and even those pesky politicians. It wasn’t until I accepted complete responsibility for my situation that I started to make traction.

We can say what we want about EMS pay, but we have got to stop blaming the industry for our financial woes. Nobody made us promises of riches and a life of ease when we joined. Actually, we were all warned that it would be quite the contrary. As adults, we are responsible for our own lives. We have to quit blaming our employers

Yes, there are plenty of jobs that come with a higher hourly pay and much less responsibility. If you think that you can make a better life for yourself doing something else, then by all means, do it. But if you really enjoy what you do and don’t want to leave, this series is for you. Like I said in Part 1, money problems made me forget how much I love being a paramedic. I was so stuck on the “need” for more money that I simply couldn’t focus on doing what I truly love. Once I realized that I could live a comfortable life and secure a comfortable future – all while working in EMS – I knew that I would never have to leave. And you know what? If the day comes where I don’t want to do this job anymore, I can make that decision, because I won’t be tied down to a pension plan, and I won’t be dependent on the overtime cycle to support a paycheck-to-paycheck lifestyle.

First Things First

Before we can move forward, we have to accept responsibility. I know I’m repeating myself, but I simply can’t emphasize this enough. Control and responsibility go hand in hand. You can’t have one without the other. From this point forward, the only thing that matters about our current situation, is that we got ourselves here and only WE can get ourselves out.

When my financial situation was at it’s worst, I wouldn’t listen to the advice of others. They just “didn’t understand”. I used to say things like “they haven’t seen my paycheck” or “they don’t know what it’s like to live on an EMS salary”. What I didn’t do is ask myself if what I was doing was working. It may be extremely hard to do, but there’s nothing wrong with admitting that what you’re doing isn’t working.

Allow me to present to you, the definition of insanity:

Doing the same thing over and over again and expecting different results.

If you’re going to get ahead financially, you will have to admit when your wrong and be willing to listen to people that are doing it right. Now, having said that, we have to be very careful when we try to determine if someone is “doing it right”. Debt and income can cover up irresponsibility. Just because all of your Facebook friends are taking trips, driving nice cars and buying big houses, doesn’t mean they are in a good financial place. Actually, I’ll take it step further and say that most of them are not. Most of them will be tied down to loan payments for the rest of their lives and will continue to be one lost job away from losing everything. It’s just like Warren Buffett said: “Only when the tide goes out do you discover who’s been swimming naked”.

Getting Caught Up

For the longest time, getting caught up was something I could only dream about. If I was only 1 month behind on my car payment, it was a good month. Hell, I would get excited if I saw my account reach over $200 in the black on payday. Of course, this was because I was living in the negative. Yep, I was that guy.

When I hit my breaking point, I was $600 in the negative. My car was nearing the point of repossession and the county was 2 days away from issuing an arrest warrant for a traffic ticket that I kept putting off paying. Now, if you’re like me, you get resourceful when your broke. I always managed to scrounge together something to eat and I could always manage to dig up another $5.00 to put enough fuel in my car to get back and forth from work. When I got serious about fixing my situation, I got really resourceful. I needed money and I needed it now and nothing was off the table. My first line of business was to call everyone I immediately owed money to. I explained my situation and more importantly, my plan with 100% honesty to my bank, cell phone provider and the courts. Verizon worked out a deal where I would pay the normal bill with an extra $50 tacked on each month to pay off my past-due balance over time. The court actually gave me a week extension and even reduced the amount owed. The bank that held my car loan agreed to accept a post-dated check for the amount of a payment and a half. My personal bank actually agreed to reverse enough overdraft fees to bring my account into the black. It was the first time I actually had a plan, and nothing was going to stop me from following it.

Now that I knew exactly how much money was going out on the next check, I had to make sure I actually had the money in the bank to make good on my promises and to survive for the next 2 weeks. I knew that I was either going to work enough hours to make the money or sell enough items until I had everything covered. I took a long hard look at my bank statement and asked myself what I would be willing to give to never see the color red on my statement again. In that instant, price tags suddenly appeared on all my possessions. I stayed up all night and did an inventory of everything I owned and looked up how much I could sell each item for. I made a spreadsheet showing all my possessions valuing largest to smallest and started crossing off things I didn’t need or use. The next day I started putting items up for sale and the cash just started rolling in.

Getting caught up wound up being much easier than I had anticipated. Once I let go of my attachment to my possessions, I started making some serious progress. My guns were the hardest part. I told myself that I would NEVER sell any of my guns. However, once I added up the amount of money I was paying every month towards loan payments, overdraft fees and unneeded expenses, I realized that I could afford to buy 3 new guns a month with the cash that was going to be left over once my debts were paid off. Talk about motivation!

Figuring Out What’s Important

Figuring out what’s important wasn’t limited to just material possessions. Actually, they were a very small percentage of things that I needed to get rid of in order to get ahead. I had to take a hard look at all my monthly expenses and figure out what was important to me. The small stuff was easy. The Pandora subscription, XM Radio, and the Hulu Plus account were easy cuts and they actually saved me a substantial amount of money. But I didn’t stop there. I had to look at things that I actually did use and enjoy, like cable TV. Once again, I had to look at each item and ask myself if it was really worth the negative account balance that I saw every month. I wound up cutting out the majority of my luxury items and saving nearly $400 a month. That’s a car payment.

Balancing wants versus needs isn’t an easy task. The lines can get blurry when it comes time to make cuts. When it comes to monthly expenses, I recommend writing down everything that is absolutely essential. For example; food, rent / mortgage, utilities, transportation, and insurance. These are things that you know you absolutely must have. From there, start to list all of your other expenses and try to prioritize them. How I did this was simple: I made a hypothetical situation where I could only keep one of those monthly expenses. For me, that was internet. I use it for work, school, blogging, continuing education and entertainment. It isn’t essential for survival, but it’s extremely valuable, so clearly that was going to be my number 1 on the priority list. Once I established that, I then did the same with the remaining items of the list. Next up was my cell phone. Do you see where I’m going with this? Once you force yourself to place a level of importance on each item, you’ll start to realize what you can live without. Trim it down as much as you can with the understanding that once you get your financial situation under control, you can look at the luxury items to see if there’s something that’s worth the money.

I could write an entire book on everyday expenses, but the basic principles are simple. Look at where you’re spending your money and do your best to see what you can cut out. For me, the biggest expense was Starbucks and fast food. They were tough to cut out, but the results were immediate. Once I started to set limits on fast food consumption, I easily saved over $200 a month. Do you see a pattern here?

Get The Facts Straight

One of my biggest issues when it came to my finances was organization (or lack thereof). I had no clue what I owed, or what was going in and out. I would go days, and sometimes weeks without checking the mail because I knew it was just bills. I tried to pretend the problem didn’t exist, but deep down, it ate away at me every single day.

When I setup the appointment to meet with a financial counselor, he asked for 2 things: all of my monthly expenses and a list of debts owed. The sad part was, I didn’t have an answer for either. I really had no idea. I didn’t want to know.

I knew I had to get organized. I put my fear aside and opened every piece of mail I could find. I started stacking the papers from the smallest amount owed, to largest. I then entered them in the same order on a spreadsheet and added the total. It wasn’t a number that I was proud of, but I knew what it was, and now I could come up with a plan. In a way it felt very empowering. I had to do the same with my monthly expenses. I wrote down all of my monthly expense due dates with the amount on a calendar so that I knew exactly how much I owed and when it was due. For the first time, I was organized.

Moving Forward

Once I was caught up on my past due balances (on essential items), I had to devise a plan moving forward. I knew I had to setup a budget and I had to start paying down my debts. The problem was, I had no idea how. My financial coach really helped me with this and I also learned a ton from resources like Dave Ramsey’s book. Getting adjusted to living on a written budget wasn’t easy, but it was very liberating. For once, I was truly in complete control, and that felt amazing.

Budgeting, saving and preparing are all going to be essential to our success. Paying off debt is going to be a must. Accepting responsibility for our actions will allow all of this to work. If your situation looks anything like mine did, then I have a pretty good idea of what you’re going through. It sucks, it’s scary and it’s painful, but it doesn’t have to be permanent.

I’ve heard many people say that financial peace happens when you pay off your debt, save up money for emergencies and start to enjoy a debt-free life. I say it starts the second you take control. I lived the steps and stories that I laid out in this article. I struggled and I felt hopeless. Once I took control and accepted responsibility, it felt like a giant load had been taken off my shoulder. I started to love my job as a Paramedic again and realized that I don’t want to go anywhere. I’m happy doing the work that I love and even happier living the life I have.

In the coming articles, I’ll be talking a lot about budgeting, saving money, preparing for emergencies and even retirement and investing. The cool thing is, I’ll be doing it right along side everyone. I’m still building my ideal financial situation and I have a long way to go. I’m going to continue to make mistakes along the way, but I’ll never give up. My hope is that by sharing my experiences and knowledge, that somebody’s life will be changed.

I see good people leave EMS every day, many of which that don’t want to leave but feel they have to in order to get ahead. I want to show people that once we get our finances in line, the world is ours to take. We can do the work we love and not have to chase a pension or a dollar sign. We can build a legacy for our children and be the change that our industry so desperately needs.

I really hope that you enjoy this series as much as I will. If you have questions or need help, please e-mail me. I will gladly respond to all e-mails and help anyone get setup with the resources that they need to succeed.

Money Smart Medics Part 1: How I Got Here

The Excuses

For those of you that have been following my blog, the title probably shocked you a little bit. I have never written about money management, and for a very good reason: I sucked at it. Until about a year ago, my version of budgeting included swiping my debit card until it quit working, which usually indicated that my account had gone so far negative that the bank decided it wasn’t worth the risk to continue trying to profit off my stupidity.

But it wasn’t my fault….

God, no. It couldn’t be. It was the economy, the child support, the ridiculously low EMS salary, the taxes, the gas prices, the “unexpected”, etc. You name it, I had an excuse. (Roll the Blues Brothers scene where Jake is giving his ex fiance all the reasons he didn’t make the wedding….)

I was always behind on my bills, and my checking account became very accustomed to the color red. When I would get paid, looking at my account  balance made me feel like the swimmer in the ocean getting pulled down by the current, struggling to get his head above the water for a breath, only to get pulled right back down moments after getting a sweet taste of that precious oxygen. The cycle continued every 2 weeks.

It didn’t matter how much overtime I worked, I never got ahead.

Ahead…..what was that? To me, “ahead” was something that I would never accomplish. Hell, the word “current” even seemed like a pipe dream. Unless I somehow stumbled into a huge pile of money, my situation was never going to improve. Well, so I thought.

My breakthrough moment was the day I showed up to work with no money, no food and not even enough gas to get home. It was still a week from payday and I had no idea what I was going to do. This wasn’t the first time I had been faced with these circumstances, but over the following 24 hours I would be hit with the biggest reality sledge hammer that I had ever seen.

The Worst Financial Day Of My Life

Having no money or food wasn’t always the end of the world for me. After all, the local hospital fed us lunch and breakfast for free and many of the hospitals in the neighboring city provided all kinds of snacks and meals. You can say I was quite the connoisseur of the free EMS handouts. However, forces much stronger than my resourceful skills made sure that I never came anywhere near any of the hospitals. By 2 pm I was starving. My partner sensed that something was wrong and offered to buy me lunch. I lied and told him that I wasn’t hungry.

At one point in the late afternoon, I arrived at the station just in time to see a tow truck pulling into the employee parking lot. My heart sank. I knew for sure he was there to take my car. After all, I had been ignoring the bank’s calls for weeks. My spirits were lifted a little bit when I realized he was just using the driveway to turn around. Still, I knew it was coming and seeing that truck gave me a level of self-disgust that I had never felt before.

2 hours later, my phone shut off. Fortunately I was able to sweet talk Verizon into giving me 3 more days of service with an empty promise to pay off the entire balance by the weekend. Of course, I did this while hiding in the back of one of the ambulances in fear of one of my coworkers hearing me.

The final straw was getting a call from the local courthouse to inform me that if I didn’t pay my traffic ticket off within 48 hours, a warrant would be issued for my arrest.

I lost it.

I cried, I prayed, I begged, I did everything I could hoping that God would snap his fingers and make this horrible situation go away. What I didn’t realize, is that he was doing just that.

I Never Looked Back

As I left the station in my car (that was running on fumes), I took a long, deep look at my situation and wondered why I was where I was. Then it dawned on me. It’s my fault. While this may seem so simple, it was the epiphany that drove me to change. I suddenly felt empowered. I was going to beat this and I was never going to look back.

A couple weeks prior to this particular incident, I heard a fellow blogger and friend mention Dave Ramsey on a podcast. He talked about how he had struggled to make ends meet and he was making over $100,000 a year! He talked about how he completely turned his life around just by modifying his behavior. I kept playing his story over and over in my head on that drive home. It was my story. I wasn’t alone. I reached out to him and asked for help. As it turns out, he had just started a financial coaching business. I immediately signed up.

As I sat down to meet with him for the first time, I was a nervous wreck. Finances were NOT something I felt comfortable talking about, and you can probably imagine why. I expected to see him fall out of his chair in disgust as he looked over all my finances. I felt like my 10-year-old self, crouched down, bracing for impact the moments before my father ran that leather belt across my backside for something stupid I had done. I was surprised to hear him say “This isn’t so bad. You’re just unorganized”. I pulled my arms off my head, sat up straight, slowly raised my head, opened one eye and quietly uttered the words “really?”

Really.

We sat there well beyond my allotted hour and hashed out a written budget. It all made sense. I was going to do this. The next morning I immediately got on the phone with my bank, my cell phone company, my car insurance agency, and the courthouse. I didn’t make excuses and I didn’t make false promises. I told them the truth. I worked out deals with them to get on plan to get caught up. A plan I could work with. And I did it. My bank actually reversed enough overdraft fees to put me a couple hundred dollars in the black. I carefully budgeted the small amount of money I had on hand to make sure I could get by until payday and I stuck to it.

A month later I had $300 saved up for emergencies and I was caught up on all my bills. Caught up! The next few months were spent building up my emergency fund and then tackling my debt. My budgets weren’t perfect, but they worked. I just wish I could tell you how amazing it felt to lift that weight off my shoulders. I was a new man.

Here I Am

Over the last year I have made amazing strides towards learning how to manage money. Am I perfect? No. Do I still make mistakes? Absolutely! But one thing is for sure, I’m never going back where I came from.

Once I got my financial situation in line, I realized something that I had long forgot. I love being a paramedic. I guess when you’re over your head in personal disaster, it’s hard to see past your own problems, and it’s nearly impossible to help others with theirs. I also realized that I don’t have to leave EMS to be financially secure. I can do the work I love and plan for a healthy lifestyle with a comfortable retirement. And THAT, my friends, is exactly what this series is going to be about.

Learning how to manage money has turned my life around. I have developed a strong passion for personal finance and I have been extremely eager to share what I have learned with everyone. That’s why I started the Money Smart Medics campaign. I know there are plenty of people out there just like me and I want to help. Every Monday I will be posting personal finance articles on this blog. They will be mainly geared towards EMS professionals, but I’m sure anyone will be able to find use in them. I’ll be talking about saving, budgeting, insurance, investments, bargain shopping and a whole lot about preparing for retirement.

I really hope you enjoy this series. I’m really going to be looking for feedback, so please e-mail me or find me on social media to let me know what you think.

Thank you so much and stay tuned!

If Eric Holder Was A Paramedic

Eric HolderOur Celebrity Medic this week has certainly seen his ups and downs throughout his career. From botched gun running operations to investigations of high-ranking political officials, he has certainly experienced his share of stress on the job. With his career surely coming to an end in 2016, it leaves many of us to wonder if he will enjoy retirement or seek employment outside of the justice department? Perhaps a career change to EMS would be in order? That leaves us with no choice but to ask the famous question of the week:

What kind of paramedic would Eric Holder be?

Mr. Holder wouldn’t go though the standard hiring process that many services utilize. Instead, he would be appointed by the sitting director and most likely remain until new management took over. This of course, could mean lighter restrictions and less accountability while at work if he had helped the director promote to his current position.

Standard protocols would prove to be ineffective for Mr. Holder being that he doesn’t work well with stringent rules. Instead, he would adopt a new “patient care constitution” that would be interpreted differently by different groups of people. Of course, only the sections that the director deemed relevant or important would be followed. Any changes made to the treatment guidelines would require a two-thirds majority vote from the paramedics employed at the ambulance service.

While traditional paramedics hand off thorough written and verbal reports at the hospital, Mr. Holder would require a subpoena to appear at the bedside before he provided any information. Of course, only information that he felt was pertinent would be delivered.

Patient privacy would never be an issue for Mr. Holder. In fact, it would be nearly impossible to obtain patient care records. Even in cases where court orders demand the release of such documents, the director would declare executive privilege, preventing their release.

Working the streets as a paramedic would allow him to implement a drug-running operation aimed at tracking pain medications to high-level dealers. This would be very similar to the infamous “Fast and Furious” operation. Only this time, his operation would most likely be called “Quick an Painless”. Given his previous experiences, he would have to take careful steps to ensure his narcotics didn’t turn up at the scenes of any drug overdoses.

In conclusion, Mr. Holder’s ability to maintain privacy, strong political backing, flexibility and willingness to try outside-of-the-box projects all make him a perfect candidate for a job in EMS.

Have an idea for next week’s Celebrity Medic? E-Mail me at sean@medicmadness.com  

 

How Writing May Have Saved My Career

There’s a new post up at Uniform Stories featuring yours truly. I’m really excited to announce that I’ll be writing for them on a bi-weekly basis. This is really a huge blessing for me as I try to take my writing to the next level. None of this would even be remotely possible if it wasn’t for everyone that continues to come back and support this blog every day. Ya’ll (I can say that now that I’m in Texas) are freaking awesome!

In this article I talk about an incident I had a number of years back when I tried to pronounce a patient dead on scene after failed resucitation attempts and was overruled by the ER physician. The ER doc’s decision saved the patient’s life. Go check out the article to see what kind of emotional toll that had on me and how blogging may have been the one thing that kept me in EMS.

Check it out: How Writing May Have Saved My Career

If Al Sharpton Was a Paramedic

Our Celebrity Medic this week is no stranger to tragedy. With all the violent crime in the streets, he has no problem keeping his travel schedule full. Chances are, he will never find himself in a position to need a new line of work. But what if he got tired of his life in the spotlight? What if he decided to seek a more hands-on approach to responding to tragic events? Sure, he might need some training, but a transition to EMS would be right up his alley. So without any further delay, let’s ask ourselves the big question of the week:

What kind of Paramedic would Al Sharpton be?

Training for Al Sharpton would be tricky as most people wouldn’t be sure exactly what his qualifications were. While most paramedics train to thoroughly examine every patient before developing a clinical impression, Rev Sharpton would instead train to find only specific clinical signs to support a pre-determined diagnosis. It should also be noted that his patients would be screened before hand for these specific clinical signs before he would agree to respond.

Traditionally, paramedics responds to all calls for assistance. These might include – but are certainly not limited to – heart attacks, strokes, asthma attacks, pregnancy emergencies, trauma and even minor viral illnesses. Rev Sharpton would be unique as he would most likely specialize in trauma, more specifically, acts of violence. He would also stray from the long-standing belief in EMS that everyone is to be treated regardless of race, sex, religious beliefs or sexual orientation. Instead, his patient qualification criteria would exclude the Hispanic population, Caucasians, and people of Asian descent. African Americans would be his primary focus, however they could be disqualified for service if harmed by a member of the same race. Given the scarcity of patients that meet his criteria, he would have to expand his response area to include the entire United States.

Rev Sharpton would not have a need for the traditional lights and sirens that traditional emergency vehicles have. Members of the communities that he was responding to would be notified ahead of time via press-releases and therefore would have plenty of time to yield the right-of-way for his arrival.

Radio reports and patient-care documentation would be a thing of the past. Rev Sharpton would instead utilize press-conferences, FM radio monologue and speech rallies to deliver patient information to the receiving hospital. The ER staff would certainly know of his arrival as he would tend to make a large entrance. However, they would be surprised to find that he would quickly and quietly leave the facility without saying a word to anyone.

Joining Rev Sharpton at his new ambulance service would be none-other than the famous Jesse Jackson and possibly Michael Bloomberg. Dispatch would be handled by Barack Obama and Eric Holder. Together they would start the first official Racial Tension Task Force (RTTF). While many would speculate that this group would work well together, people might be surprised to find that Rev Sharpton typically works better alone.

In conclusion, we can clearly see that Al Sharpton’s experience dealing with tragedies, background in communication, and ability to quickly assess situations without clear facts or evidence would make him a perfect fit for a job in EMS.

Have an idea for the next Celebrity Medic? Comment below or e-mail me at: sean@medicmadness.com

Why Paramedics are Going to Lose Intubation

I’m sure the headline of this article will have many people lighting up their torches and sharpening their pitchforks, but hear me out before you burn my village down. Most of us have heard and most likely participated in the heated debate about whether or not paramedics should be intubating in the field. If you’ve been reading my blog for any amount of time, you know that I’m no exception. Do I think our industry falls short when it comes to airway management training? You bet. Do I think the solution is to eliminate intubation from the standard scope of practice? No, I don’t. However, we are going to be left with little choice unless we get over ourselves and make the necessary changes to improve our competency in airway management.

I recently read an article by Dr. Minh Le Cong on the Prehospital and Retrieval Medicine blog asking what the “gold standard” of airway management is for paramedics 1. Had I read this article 10 years ago, I would have been painting my face, soaking my torch in kerosene and rallying the villagers to start the witch-hunt.  Now after a decade of involvement in management, Q.A. and EMS education, I simply nod my head in agreement. Let’s face it guys, we have some serious work to do. Our educational systems, clinical sites, monitoring procedures, and most importantly, attitudes are all killing us when it comes to airway management.

Allow me to elaborate….

Initial advanced airway management training for paramedic students is highly inadequate. Studies have shown that it takes ER physicians anywhere from 18-35 successful monitored intubations to be considered “competent” and somewhere around 47 to be “good” 2. Anesthesia residents obviously require much more. Paramedic students? Well, the National Standard Paramedic Curriculum recommends 5. Mind you, paramedics traditionally perform the skill with much less frequency and in much less desirable environments, yet we are expected to be “competent” in the skill. Do you see a problem with that? This is unacceptable and we have to find a way to change this. Having said that, I have to point out some serious obstacles that we face in gaining more monitored experience. 

Hospitals and anesthesiologists aren’t exactly making this easy for us. We already have to compete against medical students for intubations during O.R. rotations and fewer and fewer anesthesiologists are allowing paramedics to perform the skill under their supervision. That’s a huge problem and I could write several blog posts on that topic alone. We are also missing out on opportunities as alternative airway devices are taking the place of ET tubes in many procedures. Clearly, getting over this hurdle isn’t going to be easy but something will have to change if we are going to increase our educational standards.

Another issue we have is continuing education and monitoring. Once our paramedics clear their initial training, many of our systems just cut them loose and hope for the best. A few years back, I worked for an EMS service that has a very unique coverage area. Depending on your assignment, you could find yourself working in a busy metropolitan area, or an extremely rural area with a very small call-volume. I knew a few paramedics in the rural stations that went nearly 2 years without attempting intubation. Nothing personal against those paramedics, but do you honestly think they possess the competence and / or confidence to handle a difficult intubation? More importantly, do you think anyone was watching over them to make sure they were practicing the skill enough to maintain competency? The system I mentioned only deploys one paramedic to every call. Imagine a fire-based system that deploys several paramedics to every call. We’ve already established that our paramedics aren’t intubating enough when they are the only advanced provider on scene, imagine having to split that skill between 4 paramedics.

We need to be monitoring our paramedics to make sure they are performing the skill enough to maintain competency. If they aren’t, we need to bring them in for monitored practice and refreshing. We also need to be doing quarterly airway training. The Law Enforcement community figured out a long time ago that most of their officers will go their entire career without firing a shot. They also recognized that if that time came, they had better be able to react appropriately and hit their target. That’s why they have to qualify with their firearms quarterly. We need to be doing the same.

One of the biggest things we need to change is our attitudes towards airway management. Back in 2010, there was a panel discussion on JEMS.com about the issue. I think William Gandy hit the nail on the head when he said: “Paramedics should be thoroughly schooled in airway evaluation and should have a variety of airway adjuncts, such as bougies, video laryngoscopy and supraglottic airways, available and be willing to use them3. The 4 words to take away from that sentence are “WILLING TO USE THEM”. I’m going to come right out and plead guilty to previously possessing the mindset that airway management revolved around direct laryngoscopy and that the use of any additional tools somehow made me less of a paramedic. Many of us in EMS still possess that mindset and it is killing patients.

If police officers approached every aggressive subject thinking “should I shoot him?” as opposed to “how can I stop the threat?” we would have a lot more officer-involved shootings. The same goes for airway management. We think we are doing our patients good by intubating everyone that presents with anything above a moderate level of distress. The truth is, we aren’t. In the cases where intubation is actually indicated, we have a huge potential to save a life. However, using the tool prematurely or inappropriately can be extremely detrimental and often fatal. For example; the bad CHF or COPD cases. These people often can’t come off the ventilators and therefore wind up dying in the ICU. In those specific cases, we need to be trying everything from medications to CPAP before even considering intubation. Just like the law enforcement analogy, we can’t approach every patient thinking: “Should I tube them?” Or even worse: “Can I tube them?” We need to be thinking about how we can improve ventilation and oxygenation. 

When it comes to intubating, we have this terrible habit of making it as difficult as we possibly can. Every time I hear the “we intubate in ditches while it’s raining” BS, I wan’t to choke someone. Why on Earth would anyone elect to intubate anyone in anything but the most convenient and practical location possible? I’ll tell you why: Because we don’t take it seriously. While there are those select few times that we will find ourselves forced to intubate in difficult environments, they are extremely rare and should be avoided at all costs. With every time that we place a blade we are causing damage, pain and potentially negative neurological effects such as increased ICP. We need to be approaching every case with the intention to intubate on the first try. That means having suction ready, having different size blades nearby, properly positioning the patient and using apneic oxygenation. It also means getting off our high-horse and using every available tool to make the intubation as easy and safe as possible. Got a bougie? Use it! Got a video laryngoscope? Then why in God’s name are you using a regular laryngoscope? The “I don’t need it” attitude is dangerous and it kills patients.

If you’re a paramedic working in the field, don’t wait for your employer to hold your hand and force you to practice. You can be the change we need. Stay up to date on your skills. Take 30 minutes each month and go practice on the airway manikins. Talk to your medical director and ER docs and see what you can learn. Whatever you do, don’t just sit around and complain that “The Man” is trying to take away your ability save lives and stamp out disease. If you read the previously mentioned JEMS panel, you will see that nobody is out to abolish prehospital intubation…..yet. That can and will change if we continue down this path.

Notes:

  1. Prehospital Airway Management – What is the Gold Standard? | Prehospital and Retrieval Medicine
    -http://prehospitalmed.com/2014/07/18/prehospital-airway-management-what-is-the-gold-standard/
  2. Laryngoscopic Intubation: Learning and Performance | PubMed
    -http://www.ncbi.nlm.nih.gov/pubmed/12502974
  3. Experts Debate Paramedic Intubation | JEMS
    -http://www.jems.com/article/patient-care/experts-debate-paramedic-intub

If Willie Nelson Was A Paramedic

This week’s Celebrity Medic has certainly seen his share of rough times, but will most likely never have to seek employment again. That is, unless he gives the finger to the IRS forgets to pay his taxes again. With Willie’s extensive knowledge in herbal remedies, experience working on a bus and ability to work with old, broken equipment, a job in EMS should be right up his alley. So without further delay, it’s time that we ask ourselves the almighty question of the week:

What kind of Paramedic would Willie Nelson be?

Even though his heroes have always been cowboys, his mamma certainly didn’t want him to grow up to be one. The truth is, a career of helping people has always been on his mind. All this highwayman really needs is an old bus and a good hearted woman to work with.

While most paramedics often seek an easy day shift, this midnight rider would most likely prefer the night life. Many people would call him crazy for working those kinds of hours, he’ll gladly pound the pavement until the the party’s over and the blue skies bring him sunshine. At that point he’ll be clocking out and headed home for a Bloody Mary morning in the city of New Orleans.

Willie’s coverage area certainly wouldn’t be limited to a single city or county. From the Mendocino County Line, to Luckenbach, Texas and even the seashores of old Mexico, this desperado would be on the road again at the first sign of trouble. Of course, with Georgia on his mind, expansion into new territories would always be a possibility. There would be no need to build stations when he could just stay at the Heartbreak Hotel.

Medical billing is no easy task, and Willie’s ambulance service is no exception. However, with Medicaid and insurance reimbursement at an all time low it would be safe to say that his bucket’s got a hole in it. To address this cash-flow problem, Willie would stop accepting forms of insurance and government aid. Instead, he would operate on a simple cash-pay system where if they had the money, he’d have the time.

At the end of the day, he’d clock out, travel down the lost highway and roll right into his sweet baby’s arms to help him make it through the night once again.

Have an idea for next week’s Celebrity Medic? Comment below or e-mail me!