May 21, 2013

The Scene Is Not Safe

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The phrase “scene safety” is hammered into our brains all throughout our training. Dispatchers try their best to make sure the scene of an emergency is safe before “clearing” us to make entry, we assess for hazards before making patient contact, and we watch each other’s backs at all times. We wear gloves to prevent the spread of disease, seat belts to protect us in the event of a collision and safety vests to lessen the chance of being struck by a motorist on the side of the road. We drive at safe speeds to reduce the chance of vehicle collisions, we lift with our knees instead of our backs to prevent back injuries and if somethings smells or looks funny, we leave it alone so we don’t get sick. Our biggest job is going home at the end of the day. We try our best to stay out of harms way and make it home to our families every shift.

But how do we protect ourselves from this?

Brown called 911 and said he was suffering from chest pains, and five Gwinnett County firefighters arrived at 3:48, believing it was a routine call, said Police Chief Charles Walters. Brown was lying in bed and appeared to be suffering from a condition that left him unable to move. But when they approached the bed to help him, he pulled out a handgun, Walters said.

Source: http://www.ems1.com/fire-ems/articles/1430652-Firefighter-hostage-gunman-planned-kidnapping-for-weeks/

A man calls 911 complaining of chest pain. A Routine call, right? He acts like any other patient when he speaks to dispatchers. There are no obvious dangers in front of, or inside of the residence. He is calm and presents like many of our patients do. No danger here, just a routine medical call. I can only imagine that the responders involved with this incident didn’t expect to become hostages when they reached the bedside.

I have often feared incidents like this. The fact is, we are never safe. We are easy targets and we carry what many people want. I’m not the slightest bit surprised that this happened. What does surprise me, is that this doesn’t happen more often.  It should be no surprise that a deranged individual would pick a target such as a paramedic or firefighter. They know we aren’t armed and they know we will come inside their home to any room they choose.

Fortunately, this guy had motives other than immediately killing the responders. The 4 firefighters who were shot while responding to a structure fire last December, weren’t so lucky:

WEBSTER, N.Y. — A gunman ambushed four volunteer firefighters responding to an intense pre-dawn house fire Monday morning outside Rochester, N.Y., killing two before ending up dead himself, authorities said. Police used an armored vehicle to evacuate more than 30 nearby residents.

Source: http://www.ems1.com/safety/articles/1384752-4-firefighters-shot-2-fatally-in-western-NY/

Nobody anticipates getting shot at a structure fire, and we shouldn’t have to, but that is the world we live in. There are a lot of bad people out there that wish to cause harm and we must prepare ourselves so that we can respond appropriately. There is simply no way to prevent incidents like this. There aren’t enough cops to secure every scene before we enter and we haven’t developed a way to read minds. That leaves us with 2 choices. We either continue to do business as usual and place ourselves at the mercy of people that wish to cause harm, or we prepare ourselves so that we don’t become victims. I make no secret about the fact that I support concealed carry for EMS providers, and this is exactly why. We run into the same neighborhoods and deal with the same people that the cops do, only we have no way to defend ourselves.

Any time I bring up the argument about concealed carry in EMS, I get the “we’re not cops” and “we shouldn’t be entering unsafe scenes” response. Guess what, guys? There are no safe scenes. Another popular argument is that we use “Verbal Kung Fu” to talk our way out of situations. That doesn’t do much to stop a 9mm round. We take every precaution possible to avoid placing ourselves in harm’s way, but we simply can’t stop these things from happening. In both of the cases mentioned, the responders did what any of our peers would have done. They didn’t try to be a hero or engage in conflict. They just showed up to a call for service and found themselves becoming victims.

I’m not asking anyone to “issue” guns or mandate that paramedics or firefighters carry firearms. All I’m asking is that I not have to check my right to self-defense at the time clock. If I have a legal right to carry a concealed firearm – whether it be via carry license or state law – then why can’t I continue to do so at work?

I often hear people argue that if tighter gun laws and further restrictions on private ownership could save one life, then it would be worth it. Well, let me ask you the same thing. If allowing our responders to carry a firearm could save one life, wouldn’t IT be worth it?

The Crossover Show Episode 22

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Last night (02-28-13) I had the chance to participate in the Crossover show with Justin Schorr from Happymedic.com and Motorcop of motorcopblog.com. The show was recorded live using “Hangouts” on Google+. I had a blast and I think the G+ platform is an excellent tool for podcasting. If you’re interested in seeing how the show went, feel free to watch the video below.

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If Mitt Romney Was A Paramedic

With election season around the corner, 2 people are going to be faced with some major career changes. One of them is going to lead this country, and the other is going to become unemployed. With Mitt Romney’s poll numbers starting to slide, it’s uncertain if he’s going to have a job come November. Sure, he could probably stand to not work for the rest of his life, but at the risk of becoming one of the 47%, I would imagine that he would immediately start to look for some form of employment. This would be a huge opportunity for him to make a difference in healthcare by taking up a job in the pre-hospital setting.

So without further delay, we must ask ourselves the big question of the week:

What kind of paramedic would Mitt Romney be?

Mr. Romney’s job would start sometime around January and wouldn’t be secure forever. He would have to re-apply and go through the employment screening and hiring process every 4 years.

Once employed, Mitt’s first item on his agenda would be to immediately work towards repealing whatever set of protocols are in place. These would most likely be replaced by new guidelines that many would argue withhold or limit care for women and retired seniors. Others might argue that the new protocols would save the service money by limiting supplies and care to only those that pay their bills.

Funding for Mr. Romney’s ambulance service would be obtained similar to that of a campaign contribution. These donations would primarily be made by large drug companies. While this method would be effective in maintaining more than adequate funds, it would require protocols to be written that regularly include the use of said drug company’s products.

Staffing for Mitt’s ambulance service could be kept to a minimum as 47% of the population in his response area would never use his services. Instead, those residents would utilize a government-run EMS service that is funded by 100% tax dollars.

Performance for Mr. Romney’s service would not be evaluated based on response times. Instead, agencies would be hired to conduct scientific polls in his response area to determine the approval rating. This method would also be used heavily during contract bids.

Documentation would not require the use of paper or electronic patient care reports. Instead, all interventions during his call would be recorded secretly using cell phone cameras or tape recorders. He would only be require to maintain these medical records for 2 years.

Mitt’s radio reports would be unique as the information provided would be different than that of a traditional report. He wouldn’t provide the basic information about the chief complaint, vitals, or response to treatment. Instead, he would explain how the last paramedic to run the patient didn’t do a good enough job and how they will be better off not repeating their last pre-hospital experience.

In the end, his care would differ very little from the last few paramedics to hold his job. Treatment would continue to consist mostly of promises to start feeling better and blaming of previous forms of treatment. Most patients would complain that the service is inadequate, however they would continue to utilize and support it.

Have a suggestion for the next “Celebrity Medic”? Send me an e-mail at sean@medicmadness.com

 

Privatizing Detroit EMS

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.

Define Discrimination….

The jobs of three EVAC employees with more than 30 years of combined experience are up in smoke after they were found in violation of the county’s nicotine policy, a county spokesman confirmed Saturday.

If you haven’t read the article, read it here: http://www.news-journalonline.com/news/local/west-volusia/2011/12/18/volusia-paramedics-fired-for-smoking.html

I’ll start off by saying that legally, the terminations are valid and will most likely not be overturned. Whether you agree with the policy or not, it’s still written policy with clear language for what happens if you violate said policy. So yes, I think it’s sad that these experienced paramedics lost their jobs, but you can’t knowingly violate the rules and not expect to suffer the consequences.

Now, having said that, I must say that I think the policy is 100% BS.

“I was terminated for something I do at home and is perfectly legal,” said Mike Stone, who had worked as a paramedic for EVAC for 5 1/2 years.

I completely agree. As of right now, smoking is still legal and it doesn’t impair your ability to think rationally or function in the workplace. If they don’t want their employees smoking while on duty, then that’s OK. They have that right. But to try and dictate what their employees do in their personal lives is plain wrong.

For many of us, a nicotine-free policy wouldn’t have any affect, but what’s important is that the employer has already demonstrated that they are willing to tell you what you can and can’t do in your own time. Sure, it might not affect me now, but what happens when they decide that they don’t want to hire anyone that consumes caffeine or alcohol on their days off?

Smokers may not be a “protected classification” but I still view policies like this as discriminatory. Regardless of how much they spin this as an attempt to improve the health and well-being of their employees, it still comes down to them determining employment eligibility based on lifestyle choices. Of course, they won’t put people with high cholesterol on the chopping block, because that would most likely eliminate all of management. Eliminating people because they have bad habits seems fine and well until it’s THEIR bad habit that makes the hit list.

Maybe I’m just old-school, but I would think they would be better off addressing things like work performance or attendance. Then again, I’m just a dumb-ass paramedic, what do I know?

At least it sounded like a good idea….

http://www.jems.com/article/news/california-city-becomes-first

As I was doing my daily read of the most recent EMS-related news headlines, I stumbled across this interesting article. To be honest I was taken back at first, because I have always wondered why all of the cities around the OC / LA area insist on responding so many paramedics to every call. The fact that they run ALS engines isn’t what gets me, it’s the fact they use private ambulances for transport and FORBID them from providing any ALS care. This of course requires a fire-medic to ride in to the hospital and have the engine or squad follow them to pick them up at the ER. Maybe I’m just ignorant, but it seems like they are doubling their work.

To me it seems that it would make more sense for the fire department to just provide the ambulance transport themselves. Staff a paramedic who doesn’t split his/her role with any other function on the ambulance and an EMT to drive. I will never be convinced that having 4 paramedics treating 1 patient is a good idea.

This particular article is intriguing because for the first time (that I have seen), they actually want to get away from their current system and let a private ambulance staffed with a single paramedic and EMT handle the patient care. While I typically endorse this kind of change, I think the city and county need to be fair to the tax-payers. Chances are, the citizens pay some form of tax to pay for the paramedic service that is currently in place. While such a move will certainly save money, it kinda screws the tax payers. If they go ahead with a switch to private-level service, then they either need to remove that tax, or reduce it accordingly. The whole purpose of contracting to a private pay-for-service model, is the savings in tax dollars to the public, not the general fund.

I thought that this was actually a viable option until I read that the city doesn’t attempt to collect on uninsured parties, and they would expect the private service to do the same. I can say with 100% certainty that this kind of policy WILL NOT WORK without government subsidies. If they are expecting that some private company is going to come in and willingly operate at a loss, then they have another thing coming.

I personally don’t think that such a change is going to happen without some fierce resistance. I applaud their ability to think outside of the box, but I have my doubts that they will actually make this happen.

Don't ignore the big HIPAA in the room

The Detroit EMS Saga continues to get more interesting as we watch the system fall to pieces before our very eyes. Most of you probably heard about the infamous 20 minute response that possibly resulted in the death of a patient, and as it turns out, the blame is being shifted on to the crew. Their termination from employment has sparked quite the up-roar amongst fellow EMS professionals and citizens from that community. But that’s not the reason for this article. I’m not going to voice an opinion on the matter because I don’t know all the details surrounding the situation. What I do know is that the EMT made a huge mistake going on camera to talk about that call.

After watching the video I turned on my stop watch to count the amount of time it takes for a privacy law suite to be filled for an obvious HIPAA violation. By going on national TV and talking about details surrounding the call, he not only put himself but the entire Detroit EMS service in harms way. That was a HUGE, HUGE, HUGE, no no. Being that the call itself made national headlines makes it extremely easy to reference the call, and the individual involved with his comments. I get the frustration, and I understand why he did it, but it was a bad move.

As medical professionals, we really have to watch ourselves when it comes to talking in front of a camera. This is why services like the one I work for prohibit us from speaking to the media at all. Just because he isn’t employed anymore, doesn’t mean he won’t get nailed with a hefty fine. If nothing else, he now has less protection then he did before the termination.

I’m keeping my fingers crossed that nothing happens to this EMT as a result of his statements, but I’m not exactly holding my breath.

My Thoughts on Social Media in the Workplace

There has been a ton of press about employees getting fired or punished for “misconduct” on popular social media sites. So naturally comes the debate on:

  • Whether an employer has the right to terminate you for something you did off-duty.
  • Whether or not they should get aggressive on social media policies or embrace this as a new form of communication.
  • How we should conduct ourselves when posting on the internet.

In recent news, an EMT was fired for criticizing her boss on Facebook. While the feds ruled that the firing was illegal, I still think she could have used better judgement. This wasn’t a matter of silencing social media in EMS, it was a matter of someone trash talking their boss on Facebook and facing the consequences.

I have had many bosses over the years and I could probably write a book trash talking all of them. We all have bad things that we can say about the lovely folks in management, however it’s usually best to confine that talk to friends and family. Biting the hand that feeds you typically ends up with results like this EMT faced. In her case, a trip to federal court and a large amount of lawyers fees might just get her job back, but it’s probably not going to be a job she wants.

Working for someone that you don’t like is one thing. Working for someone that doesn’t like you is quite another. Even if she goes back to AMR, at the very least the awkwardness will be enough to make her hate her job. Regardless of what a federal judge says, she will never win that battle.

Employers and employees have a reputation to hold. We as employees don’t want the general public looking at us as being childish or immature, and employers don’t want the actions of their employees to damage their company image. It’s really not rocket science. When you work in any avenue of healthcare or public safety, you have agreed to take on a new level of responsibility, both on and off duty. Posting derogatory comments about coworkers, patients, bosses or establishments does absolutely nothing to lighten the beating that we already take in EMS.

Social media is a giant that wont be stopped, but that’s not a bad thing. It has allowed me to easily keep in touch with family and friends from across the country. It has also allowed EMS professionals like you and me to meet and share ideas with our peers around the globe. It’s a new form of communication that is literally changing the world as we know it.

I am firm believer that we should embrace it and use it to our advantage. I think that EMS and public safety professionals being able to reach out to each other and the general public is a wonderful thing. Unfortunately, as easy as it is to build relationships through social media, it’s just as easy to destroy them. Like I have said over and over, “with great power comes great responsibility”.

No Room for Dead Heroes

It is of my strong opinion that safety is our #1 priority. As EMS professionals, our jobs are to treat and transport the ill and injured to the closest most appropriate facility, not enforce the law. Every time I hit the streets I have 1 major goal in mind – to make it home safe to my family.

Taking stupid risks to gain some sort of “hero status” not only puts yourself in danger, but does nothing for your patients. The risks I’m talking about range anywhere from not wearing a seatbelt to entering an unsafe scene. We aren’t cops and we certainly aren’t invincible.

I like to think of us as a starting quarterback. We are extremely valuable, in short supply, and our employers cant afford for us to get hurt or killed. Cops, hazmat teams, and rescue squads are our linemen. They run defense to make sure that we can effectively do our jobs without getting harmed. Let them do their job.

One of my pet peeves is bad driving. Everyone hates being called “ambulance drivers” even though driving the ambulance is arguably the most important job on the rig. Getting to the calls safely, getting the patients to the hospital safely are high on the priority list. Going home at night is the highest. This is a huge responsibility and yet we treat driving like it’s no big deal. The “it wont happen to me” mentality is what causes articles like this one: http://www.ems1.com/ambulances-emergency-vehicles/articles/900736-5-injured-in-Calif-ambulance-crash/ While I wasn’t at that accident scene, I can’t accurately be a judge of who was at fault. But I can say that if you are hit while running a red light, then you probably didn’t pay close enough attention and weren’t driving with due regard.

Another no-no is trying to play the roll of a police officer. While being a good Samaritan is always appreciated, putting yourself in danger for no good reason is foolish. In this article 2 EMT’s did a good service by chasing down a criminal that stole a ladies cell phone. While I’m sure it was much appreciated, it put them in a terrible position as the man could have easily been armed and caused great harm to them. http://www.jems.com/article/news/fdny-emts-chase-down-cell-phon

This next article tells a story of 2 EMT’s that were recognized for stopping a mentally ill patient from gaining access to a police officers firearm and potentially causing harm to a lot of people. This is one of the few scenarios where I agree with the crews decision to step in harms way. I only say this because they acted in an effort to prevent someone from gaining access to a lethal weapon. While I could go into a rant about retention holsters and officer safety, I’ll stick to my playing field. In this scenario, their chances of sustaining extensive injury or even death would have been much greater if the person was actually successful in grabbing the firearm. http://www.ems1.com/ems-oddities/articles/903134-NY-EMTs-disarm-ER-gunman/

The message behind this article is simple. Rather than “drive it like you stole it”, I say “drive it like your life depends on it”. Don’t put yourself in harms way over stupid things like a cell phone and for god’s sake, let the cops be cops. You work on treating and transporting the ill and injured to the closest most appropriate facility.

November 2nd, 2010

November 2nd is going to be a day that we as EMS providers and as American citizens need to have our voice heard. Many of us are unhappy with our elected officals – both Democrat and Republican – and the only way to change this is to elect people that represent you the best.

Politicians use various forms of media to bash their opponents with the hopes of winning your vote. They never offer up any plans or discuss real issues. It isn’t until they are in office that we find out what kind of representative they really are. It’s very important that we ignore the negative ads and ridiculous allegations. Do a little research on the candidates and find out who really represents your best interest. You can do this by looking at their campaign contributors, voting records, and debates.

Don’t be afraid to cross party lines or vote for 3rd party candidates. Many people argue that voting for a 3rd party is a “wasted vote”, but this couldn’t be further from the truth. Every time you vote against someone, as opposed to for someone, you have wasted your vote. The truth is, if everyone actually did the research and picked the best candidate, then all of this campaign spending would be worthless. This would also be the end of the 2-party system. Remember, the lesser of the 2 evils is still evil.

As EMS professionals, we need to pick candidates that will represent our industry. If you work in public safety, then you might want to find out what the candidates plan to do with pensions, benefits, and funding for your organization. If you work in private EMS, or even public-based EMS, then find out where the candidate stands on Medicare and Medicaid reimbursement. Everyone claims to want to “cut spending”, so find out exactly what they plan to cut. Are they planning to cut back on beautification projects or public safety jobs?

While it is extremely important that you get out to vote, it is just as important you know what you are voting for. Don’t be fooled by rhetoric, negative ads and smear campaigns. Remember that voting is your way to have your voice heard.