Many things have changed throughout my journey. My work setting has changed dramatically several times, but what has remained consistent is me. Sure, I have certainly grown and matured throughout my career, but my work ethic, professionalism and level of care has pretty much stayed the same.

In every setting I have seen exceptional care-givers and I have seen exceptionally bad care-givers. Every place I worked at had their strengths and weaknesses. Sometimes I agreed with their practices, and other times I didn’t. Over the years I have developed an opinion on what I feel is the “best” way to run an EMS system, and I know that there are plenty of people out there that disagree and most likely have equal – if not better – ideas than I do. I know that I’m never going to be 100% right, and neither will anyone else. What remains the same, is that we both care enough about the profession to share ideas and try to improve the industry.

One thing that has really stuck with me, was something my boss said to me before leaving my job at the metropolitan ambulance service: “No matter where you end up, don’t ever lower your standards”. I didn’t fully grasp what he was saying until I started both of my new jobs recently. During classroom orientation at the hospital, I quickly learned that the management practices are much different than what I’m used to. Not in a good or bad way, just different. Once I got onto the floor and started training, the human factor set in. Both places offer plenty of training resources, good protocols, and top-of-the-line equipment. And just like both places, there are those who choose to take advantage of it, and those that don’t. Most people care about the quality of care that they provide, but unfortunately, some people just do enough to stay out of trouble and bring home a check.

Now let’s look at the other side of the coin. The small, rural ambulance service I work for reminds me a lot of my first EMS job. Both companies don’t have the resources of the large hospitals or the metropolitan EMS systems. They may not have bleeding-edge technology, but their equipment is good, functions well and serves it’s purpose when caring for patients. Most of the EMT’s and Paramedics working on the trucks (a new term I picked up working out here in Texas) use the long transport times and limited resources as an opportunity to improve their skills and actually do some real hands-on patient care. And of course, there are the few that choose to use the setting as an excuse for “not being able to do their job”. Once again, completely different settings, essentially the same people working.

I guess where I’m going with this, is that it doesn’t matter what setting you work in. Whether it be fire-based, private-based, non-profit, 3rd-service, or volunteer, the decision to provide quality patient care is up to you.

Good patient care isn’t measured by your protocols or resources. It’s measured by compassion, competence, and the willingness to do what’s right for the patient. It doesn’t matter if you show up in a brand-new ambulance with all the latest equipment and aggressive protocols, or if your on the side of the road in your private vehicle with nothing but a first-aid kit. You can still provide quality care to the best of your abilities.

So, back to the previous statement about “not lowering your standards”. It doesn’t matter what system you work in, the decision to provide quality care is yours. Just because a service doesn’t require you to attend airway training doesn’t mean you shouldn’t practice on a dummy frequently. Your service might be very conservative on the amount of medications and procedures that are allowed in your protocols, but that doesn’t mean you can’t do a thorough assessment and treat your patients to the best of your ability. The same goes for appearance. You should always present yourself in a professional manner, regardless of the mandatory dress code or lack thereof. You may be able to get away with wearing a worn-out, faded uniform – hell, it may be all that’s available to you – but that shouldn’t stop you from ironing it every day and at least looking like you give a damn about your job.

If there is one thing that I have learned throughout my years in healthcare, it’s that management simply cannot force good or bad patient care. They can certainly influence it one way or the other, but the final decision rests with the provider on the ground.

What kind of paramedic would John Wayne be? 

Shifts

While Mr. Wayne would be available day and night, it wouldn’t be very wise to require his services during the night when he is sleeping. He also wouldn’t cover a specific area as he is constantly on the move during the day.

Response

John Wayne wouldn’t need to respond to calls for medical aid as disease processes know better than to mess with “The Duke”. Chances are, any patients of his would be people that he shot or beat up. This of course wouldn’t leave much for Mr. Wayne to do as most of the people that found themselves in that position would either be dead or incapacitated.

Scene Safety

The Duke laughs at the possibility of an “unsafe scene”. As a matter of fact, any person wishing to cause harm to John Wayne would have to stage and wait for clearance for their own safety.

Protocols

Being that The Duke is more “old school” his protocols would be rather simple and could be summarized into the following categories:

• Pain Management – Consists of breaking a finger or limb to take the pain away from the original injury.

• Trauma Care – The walking wounded would be told to “walk it off”, the severely injured would be shot.

• Medical Emergencies – Refer back to “trauma care” and “pain management”.

Equipment

Trauma shears, cardiac monitors, stethoscopes and IV catheters are great for urban EMS providers, but are over-kill for The Duke’s service. He would need a rather simple and light set of tools that he could easily carry on a horse. Given the simple nature of his protocols, all he would really need is the following:

• Whiskey – The only thing carried in his “medicine bag”. Used for infection control and to either get his patients or himself drunk.

• Rope – Used to tie his patients behind his horse to bring into town for definitive care.

• Gun – Utilized for putting severely ill and injured patients “out of their misery”.

Conclusion

In paramedic school we often teach the “KISS” (keep it simple, stupid) method of patient care. John Wayne would be a great example of how that can be effective. He would operate a cost-effective service as he wouldn’t need to transport very many people (see trauma and medical protocols) and he wouldn’t require first responders or law enforcement to assist him. His resourcefulness, ability to adapt, simplicity of care and ability to kick some serious ass would make him a perfect candidate for a job in EMS.

Do you have an idea for next week’s “Celebrity Medic”? Feel free to comment below or e-mail me at sean@medicmadness.com.

Week 2 of “The Office” month is better than ever with one of my favorite characters. We all know Creed for his strange comments, terrible memory and resourcefulness. Despite his foggy memory and shady behavior, he has shown us that he is quite crafty and thinks well on his feet. This is why I feel that he would be a perfect fit for a job in the pre-hospital setting. So let’s ask ourselves the big question of the week:

What kind of paramedic would Creed be?

Shifts

24 or 48 hour shifts wouldn’t be something that Creed could do for very long. His old age and bad work ethic would land him in a job that required no more than 8 hours of work at a time.

Response

Being that Creed operates under the radar, he probably wouldn’t utilize the typical radio or quick-call system to be notified of calls for help. Instead he would be slipped notes with the names and addresses of people requesting his services. It should also be known that he would most likely run his own “under the table” ambulance service while working for a real ambulance service.  He would use company equipment and vehicles and respond without notifying dispatch. This would allow him to operate with no overhead and therefore could steal the patient load by under-cutting his employer with much cheaper rates.

Vehicle

Given Creed’s old age, bad vision and memory loss, he would most likely hire a “wheel-man” to assist him in operating his service. As previously mentioned, he would utilize whatever ambulance is assigned to him by his employer. He would also utilize their company gas card and take it in to their shop for regular maintenance.

Protocols

Creed probably wouldn’t remember anything that was written in his protocols, so he would have to treat each patient differently and use his own judgement. My guess is that he would most likely document that he treated his patients, but would really be stealing the drugs either for his own use or to sell on the black market.

Uniform

Creed would most likely need 1 uniform with 2 sets of identification. He would wear his standard ID with his name and credentials when reporting for work, and then switch out his ID to match his alter-ego “William Charles Schneider”. This would allow him to run his black-market calls without being identified.

Documentation

Creed’s poor memory would do little for him in a court a law, should he find himself on the wrong end of a law suit. Although rather than use the traditional PCR, he would document his findings and interventions on his blog: www.creedthoughts.gov.www/creedthoughts.

Conclusion

Creed’s ability to adapt, street smarts, and connections in the black market would give him an upper hand with his new business. While he may be taking a pay cut at his regular job, he would certainly make up for it by running his side-business. He may not be turn out to be the best paramedic in the world, but he would real interesting to work with. Check in next Friday to find out which “Office” character gets to take on a new career in pre-hospital care!

March is here, and what better way to kick off “The Office” month then a Celebrity Medic write up on Dwight K. Schrute? With his boss leaving the cast, it is uncertain where Mr. Schrute will find himself. Some speculate that he will take over as office manager, while others think that perhaps he too will look for other forms of employment. Personally, I think Dwight and the rest of the office staff should turn their business around and start an ambulance service. So let’s kick off “The Office” month with the question we have all been waiting to answer:

What kind of paramedic would Dwight Schrute be?

Shifts

While it would appear that Dwight prefers the 9-5 schedule, he would actually be on duty 24 hours a day, 7 days a week. You wouldn’t know this because he would be an under-cover paramedic.

Response

Dwight isn’t one for relying on other people to call-take and dispatch his calls for help. Instead he would have his calls routed to his work phone at Dunder Mifflin. Being that Dwight takes a more investigative approach to patient care, his patients would not be calling him directly for help. Instead, random people would call into his anonymous tip line to alert him of ill and injured people in the public. He would then set out to find them and take appropriate action.

Vehicle

Being that Dwight works under-cover, the traditional ambulance or first-responder vehicle wouldn’t be sufficient. Instead he would continue to drive his red 1987 Pontiac Firebird and utilize his police detective light to operate code-3 when necessary. His vehicle would also be equipped with archives of Mötley Crüe albums to get him pumped up in the back seat before entering the scene of a call.

Scene Safety

With Dwight’s experience as a volunteer sheriffs deputy, his large arsenal of weapons, and his training in Goju Ryu, I think it’s safe to say that he would not have to be cleared into a potentially dangerous scene. However, it would still be a good idea to respond the authorities to make sure that no unnecessary force was used.

Treatment

Dwight doesn’t like doing on-scene work, and transporting to the hospital isn’t quite his style either. Instead Mr. Schrute would transport the ill and injured to his 9 bedroom house on his beet farm, where they would be sheltered and medically evaluated by his partner Moses. Dwight would keep emergency medications hidden around the house in places like ceiling panels, the toaster, under the bed and inside the light fixtures. This would allow for quick and easy access in the event of a medical emergency. Trauma care would consist of old-fashioned techniques like “walk it off” or “suck it up”.

In the wild, there is no healthcare. In the wild, healthcare is “ow, I hurt my leg, I can’t run, a lion eats me, and I’m dead.” Well, I’m not dead. I’m the lion………your dead.

-Dwight K Schrute

Uniform

For Dwight’s under-cover job as a paramedic, the traditional EMS uniform wouldn’t cut it. Instead he would continue to wear his mustard-colored shirt and tie with a badge on his belt labeled “DMEMS”, which stands for “Dunder Mifflin Emergency Medical Services”.

Specialties

While Dwight is fairly well versed in all forms of medical care, he is especially educated in treatment of bear attacks, and organ harvesting.

Conclusion

Almost all of Dwights talents would give him an upper hand when it comes to pre-hospital care. His experience in sales would give him the ability to talk patients into going to the hospital while his training in investigations would allow him to complete a thorough assessment. In addition, his knowledge of trauma, experience as a sheriff’s deputy, ability to adapt and knowledge of the outdoors would make him a perfect candidate for a job in EMS.

Stay tuned for next weeks “Celebrity Medic” to find out which Office character will be the next to take up a job in EMS.

Running for Vice President of the United States didn’t work out for her and she recently quit her job as Governor of Alaska. So now everyone is wondering if she will continue to be in the campaign spotlight for other candidates, or will she take the leap of faith and run for President? What if she chooses neither? Then perhaps a new career in EMS would be right up her alley.

So naturally lets ask ourselves the question of the century: What kind of paramedic would Sarah Palin be?

Shifts

Unlike other EMS jobs, Sarah would have to be voted into her position by a group of her peers that work in the EMS industry. Once elected, she would typically work Monday through Friday, 8am to 5pm. All holidays would be paid vacation and she could typically take time off as she pleased. However, about half-way through her expected time in her career she would most likely resign and move on to marketing products related to the EMS industry.

Response

Rather than utilize the traditional “quick call” system to alert her to emergency traffic, she would respond to negative press and campaign ads against her patients. Response times would typically take 24 to 48 hours as she would need time to come up with a treatment plan and consult with her advisors.

Service Area

While I’m guessing that Mrs. Palin would base her service in the Alaska area, I’m sure that whatever area she chose would have to be visible from her house.

Scene Safety

Are you kidding me? Mess with Sarah and you would have thousands of gun-toting, right-wingers on your ass faster that you could say “change”.

Radio Reports

Radios are outdated. Instead, Mrs. Palin would deliver patient care reports in the form of campaign speeches, televised debates and smear-campaign ads.

Service Name

Tea Party Medical Services….duh!

Equipment

Sarah would require some specialized medical equipment to help perform her job as a paramedic. Some examples would include:

• Zoll “Election Series” ECG monitor / defibrillator – Comes with all of the handy features of the standard “E-Series” with the addition of a built in teleprompter for giving radio reports.
• Folding Backboards – These would be used to treat patients with potential spinal trauma, and could be folded into a make-shift podium. This would be needed for when she delivered reports to nursing staff.
• Portable Ventilator / Hair Dryer – This handy device wouldn’t just be for positive pressure ventilation. By attaching a small accessory and hitting the heat switch, this could easily be used to keep up “the do”.
• Pencil Skirts – These aren’t just for fashion. When Sarah isn’t dressing up for campaign speeches these tight articles of clothing can be used to stabilize hip-fractures or to shunt blood towards vital organs.

As you can see, Sarah Palin would make a perfect candidate for a job in the pre-hospital field. Her popularity, financial backing and handy equipment all make her a perfect fit for the job!

Have a suggestion for next weeks “Celebrity Medic”? E-mail me at sean@medicmadness.com

We all know him from hit movies such as “The Patriot”, “Lethal Weapon” and “Braveheart”. I don’t believe that there is a doubt in anyone’s mind that he is an exceptional actor. However, bad press in the recent years has left many people wondering if the end of his acting career is near. What would he do if he left the big screen for good? This would be the perfect opportunity for Mel to seek a career in pre-hospital care.

So the question is, what kind of paramedic would Mel Gibson be?

Shifts

A 2pm to 10pm shift would probably benefit Mel. This would allow him plenty of time to partake in late night outings and give him plenty of time to recover in the morning before reporting to work.

Response Vehicle

Many things came to mind when determining the vehicle that Mel would respond in. I think the best choice would be Danny Glover’s station wagon from the early Lethal Weapon movies. The vehicle is already equipped with emergency lights and sirens and it could easily be retrofitted for use as a transport vehicle.

Partner

I think it’s obvious that Danny Glover would make the ideal partner for Mel. In addition to using his car, Danny could be utilized to drive for Mr. Gibson. This would be necessary as his recent traffic violations involving alcohol would most likely prohibit him from operating an emergency vehicle.

Protocols

You could write protocols for Mel’s ambulance service but we all know he wouldn’t follow them. He will just have to use Danny as his voice of reason.

Radio Reports

Rather than utilize the traditional form of radio communication, Mel would hand off patient information in the form of conspicuous voice mail messages. He would utilize heavy breathing patterns to mimic the patient’s respiratory status and give the ER staff a clear picture of how the patient is breathing.

Uniform

I would personally like to see him adopt the outfit from “The Patriot”. Especially the hat. The only addition required would be a patch labeled “TP-EMS”, an acronym for “The Passion of EMS”.

Scene Safety

Pretty much every movie Mel has starred in has showed us that he isn’t afraid of danger. I would imagine that a staging policy would not be necessary. Besides, if all else fails, he can send Danny out in his underwear as a distraction while he treats the patient.

Conclusion

Mel’s good working relationship with his partner, ability to kick some ass, means to quickly respond and ability to defend himself in high-risk areas make him the perfect candidate for a job in EMS. You can assured that he wouldn’t take any crap from patients, bystanders, triage nurses, supervisors and doctors. All exceptional qualities in a paramedic.

Have a suggestion for next weeks “Celebrity Medic”? Comment below or e-mail me at sean@medicmadness.com.

Now I don’t typically make a habit out of hassling ”The Hoff”, but I think this weeks post will be an exception. The timing is perfect. David Hasselhoff’s career has certainly seen better days. Bad press and embarrassing roasts have left the man to wonder what comes next in his career? Well why not take that life guarding experience and put it to good use the field of Emergency Medical Services? So lets ask ourselves the big question of the week…

What kind of Paramedic would David Hasselhoff be?

Shifts

I’m not so sure that “The Hoff” could pick a permanent shift that would work for him. Between “Bay Watch” and “Night Rider”, he has shown us that he can do either just as well.

Partner

The 2 obvious choices would be a hot blond lifeguard and a talking car. I don’t know about you but I think the first option would be a preferred choice.

Vehicle

This one should be a no-brainer. A 1982 Pontiac Trans-am would be the obvious choice for “The Hoff’s” response vehicle. It comes equipped with a voice-guided GPS, pre-installed light bar, and the ability to drive itself should Mr. Hasselhoff’s blood-alcohol level prohibit him from safely operating the vehicle.

Uniform

I’m going to have to stay away from the lifeguard outfit, only because it’s difficult to properly identify yourself when you are only wearing a pair of shorts. I really think the jacket and black speedos would be more appropriate and more awesome. A back patch labeled “HMS” for “Hoff Medical Services” would be used as well.

Radio Reports

David Hasselhoff wouldn’t utilize the traditional 2-way radio to hand off patient information. Instead he would deliver his reports in the form of bad singing and “AA” speeches.

Conclusion

Between his lifeguard training, awesome driving abilities and ability to adapt and overcome bad press, I think that he would a perfect fit for a job in the pre-hospital setting.

As always, I welcome any comments. Have a great week and stay tuned for the next “Celebrity Medic”.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The last “celebrity medic” featured a popular scientist that had the ability to travel through time. Well this week I want to step it up a notch and feature 2 totally awesome time traveling dudes that I feel would be a perfect fit for a job in EMS. Whether they are running excellent adventures to calls for critical trauma, or bogus journeys to the local nursing homes, Bill and Ted would most definitely lead the EMS industry.

So as always, we must ask the ever important question. What kind of paramedics would Bill and Ted be?

Shifts

As mentioned before, time travel makes shifts a thing of the past.

Vehicle

I’m going to have to stick with the original time-traveling phone booth. This is for the simple reason that it is just to awesome to modify. Multiple patients can be transported in this vehicle, however they would be have to be placed in a standing position.

Scene Safety

Being cleared to scenes would not be necessary for Bill and Ted’s ambulance service. Their safety would be ensured by bringing along “Billy the Kid” and “Genghis Khan”. I can assure you that the team would be left unharmed.

Supervision

Bill and Ted may make good medics, but would require some oversight. And what better person to fill the roll of “Totally Excellent Paramedic Supervisor” than the one and only Rufus? He’s smart, experienced and comes complete with his own phone booth.

Medical Direction

Finding a medical director would not be a problem for team. Dr. Sigmund Freud may be old-school, but he would be a great fit. The “Freud Dude” could also be utilized for critical incident stress debriefing.

Fitness Programs

As we all know, physical health is something that is commonly overlooked in EMS. Bill and Ted would have the benefit of utilizing “Joan of Arch” to start their first aerobics class.

Service Name

Wild Stallions Ambulance Service dude!

Equipment

What would Bill and Ted’s ambulance service be without some totally awesome equipment? Below is a list of some essential tools:

• Fender American Stratocaster / traction splint.
• Guitar Tuner – Could double as an Sp02 monitor.
• Marshall 150watt guitar amp with external port for attaching defibrillator paddles.
• Hollowed out drum – To be used as a c-collar.
• Yamaha Keyboard – Can be used to make siren noises or as a backboard.
• Guitar Cables – Can be used as restraints.

As always, I welcome any comments or suggestions. I hope you all have a great week!

So as usual, we must ask the big question. What kind of Paramedic would Doc Brown be?

Shifts

Being that Dr. Brown has the ability to travel through time, shift work be a thing of the past (time travel joke).

Response

Doc Brown wouldn’t respond to calls in the present time. Instead, he would find sick people and travel back in time before they became ill and warn them to either take care of themselves or seek treatment to prevent whatever caused their health issues. He certainly wouldn’t have any issues finding patients and he would have the luxury of taking all the time he needs.

Vehicle

The Delorean wouldn’t exactly be good for transporting patients, but perhaps it wouldn’t matter if he’s confronting them before they become sick…..

Uniform

I think it’s obvious that he would continue to wear his white hazmat jumpsuit. The only difference would be a star of life instead of the radiation symbol on the back. Also included would be a patch that read “GSEMS” which stands for “Great Scotts Emergency Medical Services”.

Protocols

Protocols? Where he’s going they don’t need protocols……

Radio Reports

Doc Brown wouldn’t need to give radio reports as he could travel forward in time to give the ER staff a decent heads-up that he’s bringing in a patient before returning back in time to the scene of incident.

Partner

This one is no-brainer. The only people qualified to work for Dr. Brown’s time-travel GCEMS service would be 2 individuals that are already experienced in the field. Bill and Ted! (More on that to come)

Equipment

Doc Brown is no stranger to handy gadgets. This is one of the many reasons that I feel he would be a perfect fit for the pre-hospital emergency medical field.

• Delorean – Modified for use as time machine / first-responder vehicle.
• Heart Monitor / Defibrillator – Powered by used soda cans and other household trash.
• Plutonium powered Pulse Oximeter – What else would he power it with?
• Brain Wave Monitor – Could be used to detect strokes and bleeds.

As always, I welcome any comments or suggestions. Have a great week!