May 18, 2012

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Privatizing Detroit EMS

February 10, 2012 By 29 Comments

The City of Detroit has been facing some serious financial issues over recent years, and now they are faced with running out of cash before their fiscal year is over. It’s a pretty big deal. I’m not exactly sure how they got into this situation, but if I had to make a guess, I would say they spent more money than they took in (as if there’s any other way?). One of the major side effects from their financial woes is a horribly broken EMS system. Ambulances sitting idle because they can’t afford to fix them, response times to critical calls exceeding an hour in some cases, poor employee morale, and a bad working environment are just a few problems that the public can see.

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With the state jumping in to fix the problem, city officials now have some serious changes to make. Privatizing the EMS system is now on the table as a big possibility. Personally, I think it should have been on the table a long time ago, but that’s neither here nor there at this point. The talking heads at City Hall say it will save money while the union heads say it will cost the city money. So which is it?

There are a lot of details I don’t know about Detroit’s EMS system so I can only speculate based on some assumptions, so if I’m wrong about something, please feel free to correct me.

It’s pretty obvious at this point that Detroit EMS operates at a loss. This isn’t much of a surprise to me given the unemployment rate in Detroit and the fact that 911 simply isn’t a money-making enterprise. It’s very rare to find an EMS system that actually makes money on 911 calls alone. Where the money is usually made is event standbys and inter-facility transfers. Most private ambulance services use both to offset their losses from the 911 calls.

I’m not sure if Detroit EMS runs inter-facility or just 911, but I’m going to assume they only run 911. If I’m correct, then it is going to be virtually impossible for any service – whether it be public or private – to operate without a subsidy. So what can they do? Well 2 viable options exist. They can either pay a private service a fixed subsidy to run the 911 calls, or they can pay them no subsidy and give them exclusive rights to the inter-facility transfers and 911 calls. Personally, I think the second option is better at this point.

They can set performance requirements as a condition of the contract. These might include response times, minimum staffing, complaint resolution, etc. The service that wins the bid is required to operate within their budget and meet the requirements of the contract. I have seen this type of exclusive operating contract work very well in several areas, including a few that I have personally worked in. Where things usually go wrong, is when the city decides to start over-regulating the ambulance service to the point that they can’t afford to operate without a subsidy. At that point your right back to square one.

If the City of Detroit goes through with this decision, then my advice to the city is this:

Pick a good company with a good reputation. There are plenty of them out there. Give that company exclusive rights to all emergency and non-emergency responses within the city limits. Set reasonable requirements and hold them to it. After you do all that, stay the hell out of their way. Don’t start trying to fix something that isn’t broke.

I’m sure plenty people will disagree with me on privatization, but we do know that the public system isn’t working for them. The city has proven itself incapable of keeping a balanced budget, so why not wash their hands of it and allow someone else to manage the EMS operations? I really hope the best for the EMT’s and Paramedics working in Detroit. We’ll see what happens in the next couple months.


Filed Under: Featured, News, Opinion Tagged With: , , , , , ,

And That’s Why We Lock Our Ambulances

February 2, 2012 By 3 Comments

MT. JULIET, Tenn.–A man hopped into a Wilson County ambulance that was blocking his car and tried to move it while paramedics were loading a patient.

http://www.jems.com/article/news/blocked-tenn-man-tries-move-ambulance

Ambulances get stolen all the time, and yet many of us still think it’s OK to leave them unlocked. If someone truly wants inside your ambulance – or any vehicle for that matter – they will get inside. What locks do, is keep the honest people honest.

Locking your vehicles doesn’t just stop people from joy-riding, it also keeps idiots like the one mentioned above from damaging your equipment. Take for example, my story:

We were on scene of a 2-vehicle collision in the middle of the highway. I had parked my ambulance on the pavement as it had just finished raining and the shoulder was muddy and most likely too unstable to drive a large vehicle on. We were caring for 4 patients, 3 of which were critical.

We had a total of 2 ambulances, and 2 fire engines on scene. All vehicles were parked on the pavement (there’s really no coincidence here). Everything was going fine until a battalion chief rolled up on our scene and decided that the spot where my ambulance sat would be a perfect parking location for his bat-mobile. Never mind the fact that it was intentionally parked in it’s current location for quick and easy access.

So, Mr. Bat Chief (AKA Batman) decides that he is going to hop inside my ambulance and pull it over on the shoulder to make room for the bat-mobile. The ambulance did exactly what I was afraid of, and it slid about 5 feet into the mud and got stuck. So now we had the pleasure of sitting on scene with a critical patient for 35 minutes while we waited for another ambulance to arrive. And I got the pleasure of sitting on the side of the road for the next hour waiting for a tow-truck while I came up a good story to explain to my boss why I hadn’t locked the doors.

Obviously the morons in both stories weren’t trying to steal the ambulances, but I guarantee a locked door would have stopped them in their tracks.


Filed Under: Featured, News, Opinion

You Idiot

January 10, 2012 By 5 Comments

You probably read yesterday’s post about the paramedic that was accused of raping a patient. I was very upset with the media’s one-sided reporting of the story as they can easily destroy someone’s reputation if they turn out to be innocent. Well as it turns out, the paramedic in question tarnished his own reputation.

The warrant says Powell at first denied any inappropriate contact but then said he touched the woman’s breasts and genitals “to elicit a response from or awake the female.” The warrant says he expressed remorse to police.

Sorry dude, that’s never appropriate and you just made yourself and your peers look that much worse to the general public. I still stand by my dislike for one-sided journalism, they just happened to get lucky this time.

It’s always hard for me to imagine that my peers would consider doing things like this, which generally causes me to assume the best in cases like these. I hold EMS professionals to a high standard and I have a lot of respect for what we all do on a daily basis. Crap like this just reminds me that there are bad eggs everywhere.

For more details on the confession check out the local article:
http://www.newhavenregister.com/articles/2012/01/09/news/metro/doc4f0b325a4180c238579975.txt?viewmode=default

You can also download and read the arrest warrant that has details of the accusation and the statements from the paramedic admitting the allegations. Just be warned, it contains some potentially offensive material.

Download: 77689916-Powell-Warrant


Filed Under: Featured, News, Opinion Tagged With: , ,

Guilty Until Proven Innocent

January 9, 2012 By 9 Comments

 A paramedic raped a woman as she lay unconscious and strapped to a stretcher in the back of an ambulance on the way to a hospital, police said Friday.

If you haven’t read the story of a Conn. Paramedic Accused of Sexual Assault you should. The article published by the Associated Press leaves a bit to be desired, but the article found on a local news source paints a little bit of a better picture and has video of the interview with police officials.

I’m not particularly pleased with the reporting of this story as pretty much every news outlet involved has tried and found this paramedic to be guilty. But then again, objective reporting is rarity these days so I shouldn’t be all that surprised.  What’s more upsetting, is the comments provided by the local police department and his own employer:

“The allegations in this case represent outrageous and horrifying conduct by an emergency medical professional,” Wydra said. “Our society places the greatest level of trust and confidence in its public safety providers, and the circumstances in this case reflect a tremendous breach of that faith.

This quote from the police chief is something that I would expect AFTER a guilty verdict. In the event that new evidence clears this medics name or if he is found to be not-guilty, will the police chief issue an apology? Probably not. The problem with this kind of reporting is that it essentially destroys his reputation, whether or not he is guilty. He may very well be innocent and have his charges dropped, but these articles will remain and will ultimately cause trouble for him when he applies for jobs, school, etc.

Having worked as a supervisor for a rather large ambulance service, I fielded more complaints than I can count. Some of them were legitimate and many were bogus. On several occasions, I had employees accused of assault, battery, theft, and even sexual assault. In fact, I even know of one paramedic that was arrested due to allegations of sexual assault on a minor. His name was dragged around through the mud until the charges were dropped due to several inconsistencies in the “victim’s” stories. He was cleared back to work, but the allegations haunted him for years later.

I try to look at cases like this with an open mind. I know that while the over-whelming majority of EMS professionals are honest people, we still have a few bad eggs circulating out there. However, I can’t ignore the fact that we often transport less-than-honest individuals. I’m not saying the accuser in this situation isn’t honest. For all I know, she may be telling to truth. From my personal experience, allegations of illegal activity are more often than not found to be bogus. I’m very curious as to what evidence was sufficient enough to issue an arrest warrant.

There are several questions that aren’t being answered, and probably won’t be until the case reaches trial. Allegations alone aren’t enough for me to formulate an opinion on what happened.

A few things I want know:

  • What was the transport time?
    -Was there enough time for this to actually take place?
  • Did the partner witness anything?
    -    I can’t imagine that a woman waking up to being raped would go unnoticed by the paramedic’s partner.
  • Was the patient under the influence of alcohol or drugs?
    -This alone doesn’t prove innocence or guilt, but it’s an important thing to evaluate when investigating these cases.
  • Does the paramedic in question have any prior complaints or reprimands for similar incidents?
    -When things like this come to light (assuming it’s true), it’s rarely the first time.
There are a few things mentioned in the article that raise an eyebrow. For example:
“While being transported to the hospital, she awoke in the ambulance to find an AMR employee sexually assaulting her,” Smith said. Because the woman was strapped to the stretcher, she could neither move nor speak, he said. “She was helpless at the time of the assault,” he said.
Strapped to the stretcher? The article claimed that she was transported for a head injury, so was she in c-spine or actual restraints? If she was in restraints, was there an indication for it like combativeness? Were the restraints placed on scene or in the ambulance?
Unable to move or speak? I’m not exactly sure how this would be possible. Was she chemically restrained? Is it even possible to perform said acts with someone who is in c-spine and / or placed in 4-point restraints on an ambulance gurney? These are all things that I can only hope the prosecution looks at.
I certainly hope that these accusations are false, and if the paramedic in question is actually guilty, then I hope justice is served. Likewise, I hope the accuser faces serious consequences if it turns out that the allegations are false. What’s most important here is that we don’t jump to conclusions before we know all the facts.

Filed Under: Featured, News, Opinion Tagged With: , , ,

Who needs experts when you have lawyers?

September 27, 2011 By 2 Comments

Illinois Boy Dies in Ambulance during Hospital Transfers

Seven-year-old Aaron Pointer spoke his last words from the back of an ambulance.

“I . . . am . . . tired . . . of . . . breathing,” the asthmatic boy gasped, taking breaths between each word, according to a nurse’s report.

This is certainly a tragic story, and a terrible way to do die. It’s also a very important lesson for us EMS folks that regularly do inter-facility transfers. Incidents like this are why it’s important to determine if a patient is stable for transport and stand your ground if you don’t feel comfortable. While I don’t know any details outside of the media’s report (and you know how much I trust the media), I do know a situation like this would have probably required a specialized transport team, or better yet, air transport. This is of course assuming that said resources were available at the time. Once again, information that the media fails to provide.

When investigating cases like this, we always have the luxury of spending all the time we need to gather the facts and determine if the treatment was appropriate. It’s an unfair advantage that lawyers and administrative folks have, but that’s life. And that’s why we do the job that we do. We train to be able to make these decisions within minutes, if not seconds. Unfortunately, like this article points out, things don’t always go the way we want them to and we find ourselves in this position.

By no means am I criticizing the work of the paramedics on this call. I have been there, and I would be lying if I told you that I have never taken a chance with transports like this. Sometimes your only choices are to take the patient, or let them die at the facility they are at. It’s a bad position that none of us want to be in. As the article mentioned, the hospitals both transported the patient out because the treatment they had available wasn’t enough for his condition. I think the real questions we need to ask are: Why 3 hospitals? Did the kid present better at the first hospital, not necessarily raising any flags that warranted a 45-minute trip? Was there a specialty transport team available? What interventions did the hospitals and EMS attempt before the kid deteriorated?

Like I said before, it’s important to evaluate these cases carefully before initiating long transports. In a situation where the hospital simply can’t provide the treatment the patient needs, then “standing your ground” might mean to demand that a nurse or RT accompany you. If the patient is that bad, talk to the doctor about placing an advanced airway prior to leaving the hospital. These are all things that might have have been done, but we will probably never know for sure.

“Intubating a 7-year-old is difficult in the best of circumstances, much less in an ambulance,” during a long ride, said the family’s lawyer, Joseph Miroballi. “It’s a disaster waiting to happen. It’s a formula for death.”

This is where I typically start getting irritated when reading stories like this. Lawyers acting as medical experts. If intubating a 7-year-old is really “difficult at best”, then I must be the king of pediatric airways. Then again, a lawyer attempting to intubate a child WOULD be very difficult, so maybe his statement had some truth to it.

“They send him even though he’s not stable,” he said. “Why they didn’t put a doctor in that ambulance with him, or an anesthesioloist or someone who would manage his condition during that long transfer, we don’t know.”

I don’t even know where to begin with this one. Has anyone ever had a doctor, much less, an anestesiologist ride in with you during a transport? Yes, it sounds like the level of care available on the ambulance wasn’t sufficient, but sometimes I think the expectations placed on us are a bit unreasonable. Many ER’s, especially rural ones, only have 1 physician. So what do we do? Close down the ER so the doc can ride in?

There are so many factors not addressed in this story that it’s pretty much impossible to determine if anyone really did anything wrong. But hey, why let facts get in the way of a good story?


Filed Under: Featured, News, Opinion Tagged With: ,

Big Changes

August 24, 2011 By 2 Comments

As you all have probably noticed, I haven’t been very active on this blog for a couple weeks now. I have been tied up preparing for a big move that’s set to take place on September 1st. After some serious thought and several back-and-forth trips, my wife and I decided to leave the “Golden State” and move to Texas. This wasn’t an easy decision as we are leaving our family, friends and jobs behind, but it’s for the best.

I’ll still be involved in EMS, but not in the setting that I am now. I’m leaving my job at the large metropolitan ambulance service to work for a Children’s hospital part-time and a rural ambulance service part-time. I’m really excited about the change and I think I have a lot to gain from changing settings. I recently had the opportunity to meet the staff that I’ll be working with at both facilities and I am just blown away at how friendly and welcoming everybody is.

My wife and I plan on going back to school to further our careers in the health care field. This is one of the big reasons why we decided to make the move. The opportunities for higher education are much greater in the town that we are moving to than what we currently have here.

Like I mentioned before, leaving isn’t easy. We are going to miss all of our good friends and the family that live in California. We had a going-away party at one of my favorite “honky tonks” here in town, and it was an absolute blast. It was awesome to have the opportunity to get all of our friends together and just have a good time before we hit the road. Of course, it was also sad knowing that we will be 1500 miles away from these people soon and will only see them a few times a year.

The bar we hung out at was perfect. It has 2 stages, 2 dance floors, and cheap beer. There’s karaoke on one side, and a country band on the other. The only thing that could have made it better was a mechanical bull……

….and they pulled through!

So not only do I get to leave with the memories of my good friends gathering together, but I also get to take some back pain with me to remind me of being thrown off that bull 4 times.

As far as the blog goes, not much is changing. I still plan on actively writing once I get settled in. Until then, the posts may be a little scarce. I’ll be making a drive to Texas with my sister in a large rental truck, so stay tuned for pictures and stories of the road trip.

If any of you reside in the Dallas-Forth Worth area, hit me up!


Filed Under: Featured, Misc, News

Tour De Medic Madness [Video]

March 30, 2011 By Leave a Comment

This is a screen cast I created to take you on a tour of the new blog layout.

As most of you know, I recently moved my blog over to the EMSBlogs network. This has been a very enjoyable experience and I’m really excited about some of the changes that I have made and the changes yet to come. If you have any questions, comments or suggestions for the new layout, please let me know!


Filed Under: Featured, News

A bullet a day keeps the bad guys away

January 24, 2011 By Leave a Comment

image

A couple months back, I wrote about my newly acquired concealed weapons permit. Well, I recently decided to pony up some cash and get a membership to the local indoor range by my house. Before now, I would have to drive an hour to some public land and find a nice quiet place to participate in lead therapy. I tried to make this happen about once a month, in order to stay sharp on my accuracy and to have some fun. I still make it out to my spot as often as possible, being that the indoor range is only for handguns and .22 caliber rifles. But now I have the opportunity to have a blast (literally) on my way home from work, to work, to the gym, from the gym…..you get the point.

I learned 3 important things these past couple weeks:

  1. Zombies don’t stand a chance.
  2. EMS Professionals get a substantial discount on range memberships, ammo and accessories.
  3. I’m fairly certain that I can now hit a pimple on a gnats ass with my .357 revolver. (not that I’m bragging or anything)

Going from shooting with my buddies once a month, to seriously shooting at least once a week has done absolute wonders for my accuracy. The money spent on the annual membership is well worth it. If I actually keep up this routine, I might consider doing some competitions. If for nothing else, to get put back in my place.


Filed Under: Featured, News

Good to be back

January 18, 2011 By Leave a Comment

I made some pretty drastic changes to my career over the past couple weeks, and in a good way. For the last 3 1/2 years, I had been working as a field supervisor in a busy 911 system. I worked 48 hour shifts and was active for the better part of those hours. I responded to calls as a first-responder most of the time and sometimes staffed an ambulance. I participated in several community events, performed scheduling tasks, maintained inventory of controlled substances, investigated calls, handled customer concerns and completed several other jobs as prescribed. It was a great job and I took away some invaluable experience during my time.

This last week, I turned in my supervisor gear and headed back to work as a field paramedic. It’s been 3 shifts now since I started in the field and surprisingly, it has been quite the challenge. I did run calls and get patient contact during my time as a supervisor, but not nearly to the extent that I did as a paramedic. I’m quickly learning that I am a little rusty in several areas and that I have some cobwebs to kick out of my head. Now don’t get me wrong, I’m not doing a bad job, but I certainly have some work ahead of me.

It almost seems like I was on auto-pilot when I ran calls as a supervisor. I ran my calls, followed my protocols, treated my patients with respect and didn’t kill anyone. But it’s just not the same as it was when running calls was my only responsibility. I used to spend a lot of time researching diseases, learning about home medications and doing a lot of follow-up with the ER docs. As a supervisor, I simply didn’t have enough time.

Over the past few days I have set a few goals for myself. I want to spend more time participating in quality education like base station meetings, CE classes and on-line discussions. I also want to get back into precepting EMT and Paramedic interns. I’m going to spend the next few months learning everything I can and working hard to sharpen my skills and assessments before I take on that responsibility. And finally I want to get more involved with EMS education around my town. I already teach CPR classes and I recently got hired as a skills instructor with the local paramedic training program. I want to expand on this and start teaching classes like ACLS, PHTLS and PALS.

This change has been both positive and stressful at the same time, but overall I think this is the best move for me and my family. I’m taking this opportunity to really get back to what I became a paramedic to do. Patient care. My time with this blog will have to be rationed as I have also been committed to spending more quality time with my family. But fear not, I still plan on writing plenty of quality posts. I’m hoping to start up a video cast in the next couple months as I think that will be a fun and easy way to keep everyone up-to-date. I’ll start writing more educational posts along with the opinionated and humorous stuff that I have been writing.

I’m really looking forward to achieving my goals and moving forward with future plans. Like I said, it’s good to be back.


Filed Under: Featured, News

An update from the Droid Medic

November 23, 2010 By Leave a Comment

I recently released a new blog “DroidMedic.com“. In case you didn’t already know, the site is designed to be a one-stop Android resource for EMS professionals. Well so far it’s turning out to be just that. The site is picking up faster than I anticipated and there still tons of great content to come.

So far I have posted several medical app reviews, some Android news and a couple handy tutorials. I have received some great feedback and some good ideas that I am looking into.

The site is hosted over at the new “EMS Blogs” blogging network. With a lot of help and support from my good friend, Dave Konig, I have been able to get the blog up and running faster than I every expected. He is really doing some great work over at the blogging network. If you haven’t checked it out, you should do so now!

I have some exciting things planned in the near future for the blog. I’ll be starting a new YouTube channel for all of my tutorials and demonstrations. I’ll also be starting a video-cast that will feature tech news, site updates, tips, etc. While I wish I could promise a weekly release on that, I’m just not sure that I can pull it off while still working a full-time job. But who knows. I will also be improving the newsletter and gearing that towards a weekly release with some handy information.

The blog is still in it’s infancy so I’m open to any comments or suggestions. It’s a work in progress, but it looks like it has a bright future. Thank you all for your continued support.


Filed Under: News Tagged With: , ,
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