Turn it around

It has been quite a while since I have been able to sit down and do some solid writing. I have been busy between work, training, and still trying to keep up a social life. Naturally a hobby such as blogging takes a back seat when it doesn’t bring checks to the bank. Sigh….

Anyway, the reason I am writing today is to share a quote that came across my Facebook feed. As you may, or may not know I have started doing Crossfit. Its a no non-sense style to exercising and has really caught on with the masses it seems. As a result of that I spend a lot of time online doing research on techniques, nutritional plans, and connecting to other CF’ers out there. The quote came from Crossfit City Line, on Adams St in Newton MA.

““Was it you or I who stumbled first? It does not matter. The one of us who finds the strength to get up first, must help the other.” Author Unkown

The purpose behind this quote is to talk about how it is never too late to work on your own personal shape. It doesn’t matter what has happened in the past, all you can do is work on the present and future. One of the great things about Crossfit, is the sense of community. I am still getting to know people in the box I go to, but they are still there cheering me on as I work to achieve my goals.

Now, you are probably wondering why the hell are we talking about Crossfit again? This is an EMS blog isn’t it?

Well yes, it is. Thank you for noticing! Take the idea of physical fitness out of the equation here. Take that quote, and apply it to EMS.

It doesn’t matter who fell first people, It doesn’t matter who made the first mistake. It is no one else’s responsibility than our own to advance our profession. It is very easy for us to sit here, and talk about how the job could be better. If you don’t want to take the job seriously, or take the time to know your protocols by heart…then don’t complain to me about how nurses don’t respect you. Don’t complain to me when your medical control will not give you permission for certain procedures or medications.

Stand up, be the motivator for your profession. Be the model that everyone should follow behind. Do not become the person that people talk about, the person that has lost touch with the profession. Keep it exciting, one way or another.

It is never too late to turn it around, remember that. Until next time folks, take care…and most importantly stay safe!

Step up!

It has been quite a while since I have been able to sit down and do some solid writing. I have been busy between work, training, and still trying to keep up a social life. Naturally a hobby such as blogging takes a back seat when it doesn’t bring checks to the bank. Sigh….

Anyway, the reason I am writing today is to share a quote that came across my Facebook feed. As you may, or may not know I have started doing Crossfit. Its a no non-sense style to exercising and has really caught on with the masses it seems. As a result of that I spend a lot of time online doing research on techniques, nutritional plans, and connecting to other CF’ers out there. The quote came from Crossfit City Line, on Adams St in Newton MA. 

““Was it you or I who stumbled first? It does not matter. The one of us who finds the strength to get up first, must help the other.”

The purpose behind this quote is to talk about how it is never too late to work on your own personal shape. It doesn’t matter what has happened in the past, all you can do is work on the present and future. One of the great things about Crossfit, is the sense of community. I am still getting to know people in the box I go to, but they are still there cheering me on as I work to achieve my goals.

Now, you are probably wondering why the hell are we talking about Crossfit again? This is an EMS blog isn’t it?

Well yes, it is. Thank you for noticing! Take the idea of physical fitness out of the equation here. Take that quote, and apply it to EMS.

It doesn’t matter who fell first people, we owe it to each other to pick up the pieces and work towards a stronger profession. Keep that in mind next time you are out there and about to speak with a newbie, or a student rider. We all are human, situations happen. Be the bigger person, stand up, and take pride in the job that you are doing. People will notice a lot quicker than you may think!

Enough is Enough

This blog post is going to start off with a little self-assessment. When you get called out to a call, do you dread carrying someone down from the 3rd floor? Do you constantly break a sweat, to the point some of your partners may be inclined to put you on the cardiac monitor instead of your patient? Does your diet consist of anything that actually grows from the ground, and not some processed food plant in the middle of nowhere USA?

This was me at the end of last summer (2010). We would get called out to calls, that would require extrication assistance (stair chair, long board, scoop stretcher) and I found myself getting so winded after the carry that I would need to sit down in the ambulance before I could continue with my assessment and treatment. In addition to that, I would sweat…the need a towel kind of sweat.

It was embarrassing.

Around September I decided to take matters into my own hands. I will admit that I didn’t start trying to get in shape because of my job. It was because of the job that I wanted. I was looking to join Law Enforcement in some capacity, and as many of you out there know it requires a good amount of physical fitness to really succeed in that profession. Well, I went out and I tried. I did work outs at the gym, and I ran on the treadmill. I thought I was doing great. I was energetic, lost 10 pounds. Then it came time to actually go and test. 3 departments, 3 failed physical agility exams. At first, I was willing to accept that this was not my fate. I was not meant to work in Law Enforcement. It was a lazy way to avoid the harder task here, ACTUALLY getting in shape.

Finally, at the recommendation of many friends and coworkers. I started my initiation into the CrossFit world. I’ve only done one class so far, and it was the baseline workout to gauge how you are doing physically. Let’s just say it was a wake up call for me :).

I’m not on here to promote the CrossFit product, although I will personally recommend it. The reason I am here writing tonight is to talk about the overall picture of fitness. While I was doing some online research, I found an interesting article on the US National Library of Medicine, it was a study from the Carolina’s Medical Center: The Center for Prehospital Medicine, in Charlotte North Carolina. Let me give you some figures from the abstract:

  • Survey’s were sent to 58,435 providers who recertified in 2007. 30,560 (52%) returned questionnaires. Individuals missing data were removed, leaving 19,960 individual records.
  • 23.5% or 4,681 individuals who reported at least one existing health condition.
  • The mean BMI for the study participants was 27.69 kg/m(2). A normal BMI is 18.5-24.9
  • 75.3% or 15,022 individuals did not meet the Centers for Disease Control and Preventions minimum standards for physical fitness.
  • 3,394 classified themselves as current smokers.

Those are some alarming numbers! These are the best statistics published, that I could find in recent history. Let me put it to you this way, you know those frequent fliers that we all complain about. Yeah, you know…the ones with the HTN or the Hyperlipidemia, diabetes, 2 pack a day smokers, and the ones that also happen to be having the inferior wall myocardial infarction on your stretcher?

Based on these statistics, You are not any better than they are at taking care of yourself!!!

I am not here today to point fingers at anyone. Lord knows, I am not perfect (despite being a Paramedic). All I am asking you to do, as a responsible healthcare provider…is to take care of yourself first. It is a concept that we tend to forget about, usually it is overridden by our need to help people. Simply putting a few changes in our daily routine can make a huge difference. We are a tightly knit group in Public Safety, we get bent out of shape when one of our own dies. My question to you is, why are we not getting bent out of shape for something that will put you in the grave much sooner than a line of duty death?

Take this as food for thought, like I said I am not here to point fingers. Merely inspire a little motivation for a better you. I hope it helps, feel free to leave comments with your changes that you may have made to improve your overall health below. I look forward to reading them!

Stay safe my friends!

 

Social Media – Damned if you do, damned if you don’t.

We all have them, Facebook, Twitter, Flickr, etc. These accounts keep us in touch with each other. I myself have Facebook, Twitter, and Google Plus. Each of these accounts stand on their own merits, each offer different angles to the basic principle of social networking – a means to stay connected electronically across the globe. However, it also can create quite the headache for not only EMS, but Public Safety as a whole. Personally, I do not have much of an opinion about the restrictions that should be placed on an employee and their right, or privilege to access social media during work hours. That being said, social media can be used for a lot of good during an emergency, or massive public event. The majority of this post will be spent looking over the good, bad, and ugly sides of the social media world.

Since I try and keep a slight optimistic side to my life, lets talk about the good sides of social media first. Social media allows for almost instantaneous connections across the globe. It is probably the most rapid form of information deployment out there to date. I would even say it is more reliable than its predecessor “The Emergency Alert System,” that we see overtake our airwaves and televisions every once and a while. An example I like to use is a Tweet from Twitter after the Super Bowl this past weekend. Twitter announced that in the last three minutes of the game, they were seeing an average of 10,000 tweets per second. That is an insane number of tweets if you actually do the math out (1.8 Million in total to be exact). If you look at those numbers in an emergency situation, you could have collected 1.8 million different potential leads in a case. Conversely, you can very easily get as much information out there to the public through your followers and re-tweets. Twitter allows for rapid deployment in 140 characters, this requires you to keep your information relevant and brief. I think that is an absolutely amazing tool, that we would be foolish not to capitalize on.

Let’s talk about the bad portion of Social Media. I have a personal Facebook account, the account is locked down tighter than Fort Knox. However, I still operate under the idea of “Don’t post anything that you wouldn’t want to explain later.” Overall, that is a good way to look at social media. Facebook tends to draw the idea of “look at what I am doing.” This attracts people to post pictures for people to like, allows you to check into locations, and post statuses about what it is you are doing. Now, that is all well and good if used properly. We all know the type of person out there, commonly described as a ‘whacker’ or a ‘buff.’ They are out there looking for that great picture of the incident. I have no problem with outside photographers taking pictures of incidents. I actually encourage it because it allows the public to get a real view of what it is we do. I do have a problem when those pictures come from the providers/responders themselves. The motives behind the pictures may be for glory purposes, the ability to gloat about the great call that they just did. Most of us keep the patients identity out of the picture for fear of reprimand for violation of patient’s privacy. There is sort of an ethical debate about whether or not responders on the scene should be posting pictures. To be honest, I am leaning towards shouldn’t. We should be focused on maintaining the safety of what we are doing, not posting updates to various social media websites about what we are doing. If you wanna post, or write about it later then that is different.

Then there is the ugly side of social media. The side that gets people in trouble. There have been several cases of discipline handed down, or at least attempted to be handed down, about people complaining about superiors on social media website. Like I said earlier, if you don’t wanna explain what you posted to an employer later on…then don’t post it. Facebook can often be construed as some place where your actions have no consequences. Just think before you post, if you couldn’t walk up to that supervisor and tell them face to face what your problem is, then you better not be posting it on a website. I would like to dive into the legal side of this argument but unfortunately I do not have the expertise on the laws to really display a proper argument. I am going to refer you to an article, written by David Konig, that talks about how to properly handle social media faux pas. You can find the link below, along with several other links to articles that are a good read on the subject.

Speaking of the side of social media that will get people in trouble, I bring you to YouTube. YouTube has increased in popularity exponentially in recent years. This is a story of a Fire Department in Macon, GA. It is a YouTube clip of an apparent attempted robbery. A masked gunman burst into the firehouse, forces everyone onto the ground, drags a “probie” off camera and then a gun-shot is heard. I am all for a little chop busting when it comes to the new guy, but this is down-right unacceptable. The problem with social media is that we are forced to deal with how things appear, and not how they are. The appearance of this video is that there is a possible shooting incident inside the firehouse. In actuality it is only a prank. According to the article (cited below) on EMS1.com, five out of the seven firefighters on the video were in on the prank, and the two rookies were not. Frankly, if any of the firefighters that were in this video walk away from this incident with still having a job it will be a miracle. There are so many what-if’s that can be raised in this situation it is scary. I’ll spare you the time of going through them.

With the exception of the last couple of examples, problems with social media are rarely ever bad intent issues. Usually people mean well, and don’t see the fall out from their actions. Hopefully, you will choose your posts wisely. Remember that just because it is online does not mean that it is protected. Also, some organizations do have social media policies. This governs use of social media while at work, as well as information that may be “corporately protected.” As long as you always use sound mind and judgement when posting information online, you should have no problems.

Feel free to browse some of the articles that I have linked here, it’s where I got my information, you may find some of it helpful too!

STUDY: Twitter helps boost EMS Response

Social Media and EMS

Discipline over Ga. Firehouse ‘prank’ video

EMS and social media: Don’t be a Weiner

If you’re reading this and have some legal expertise on the subject, feel free to comment or email me at anderson.ryanm@gmail.com. I would love to hear some examples on the subjects.

Patient Assesment – Practice What You Preach

If you think about our job, what is the MOST important part of EMS?

…Is it the ability to sink that uncooperative ET Tube in the impossibly anterior airway?

…maybe it’s the ability to analyze every bump, nook, and cranny of an EKG strip to come up with a life changing, working diagnosis.

Actually, it just ends up being a trick question. The most important part of our job, as EMS providers, is patient assessment. The assessment allows us to do both sides of our job properly and efficiently. Without it, we would truly be a bunch of “Mother Jugs and Speed” Ambulance Drivers.

In EMS we have two major aspects of our job. The first there is treatment, then transport. Treatment tends to be at the forefront of our minds. We go into calls already running through treatment algorithms and protocols based solely on the dispatch complaint. This way, we are better prepared for the decisions we have to make, once we actually have made patient contact. I have two major problems with this train of thought. First and foremost, it causes tunnel vision. It only allows you to see the signs and symptoms that point towards your diagnosis that you have thought about in your head. This is very similar to when police officers only see the evidence that fits their theory of the crime, or the evidence that points to a particular suspect.

The second major aspect of our job is transport. Gone are the days of “scoop and screw,” to the closest hospital. We actually have to base our transport decisions based off of clinical evidence that supports why the patient needs the resources available at that facility. For example, why a patient with left sided facial droop, left sided weakness, and slurred speech needs to go to a stroke center as opposed to a standard community hospital emergency room. We also need to know our resources in our area. I am lucky enough to work within reasonable distance to some of the best medical facilities in the world. I know that I am taking my patients to some of the best facilities, and I know that I am doing them a true service.

If we take away our ability, or better yet, if we flat out neglect the ability to asses our patients then we loose the main attribute of our job that makes us clinicians. We wouldn’t ignore our assessments of our patients. So let me ask you this, why are we ignoring the assessment of our profession?

…yeah that’s right. I just slammed on the brakes, cut the wheel, and turned the bus around!

Being a Paramedic is quite possibly one of the most interesting, and exciting jobs I have had to date. For the record, I have worked as a Lifeguard, Police Dispatcher, Membership Service Rep, Camp Counselor, Maintenance Director, Maintenance worker, and last but not least a Pizza server. I truly come to work each day (despite what my evil, sleep deprived twin might say) looking forward to the challenges that will face me in the back of my 8’ by 5’ by 8’ office.

Why do we, as a profession, constantly accept the “mediocre” as good enough? When is the last time you looked at your paycheck and actually enjoyed seeing the hours to dollars ratio? When is the last time you have noticed how appropriately Paramedic and BLS resources are utilized? How about the last time that you complemented a patient for properly using EMS in the event of their acute misfortune?

Yeah, I can’t remember either.

That being said, lets talk about some ways to make this happen. The next time you debate taking the easy way out vs. the right way, choose the right way. That fight you just started with a nurse because she was too busy to take a report, or gave your some attitude because the needle gauge of your IV angio was too small, that set your profession back a bit. Make your decisions while on duty in the best interest of the job. Patient care comes first, image comes second, and attitude third.

Finally, in order to make the profession recognize and respected we need to get on the same level. The Federal Inter-agency Emergency Medical Services Commission published quite the extensive document showing how varied we are as a service, across the nation. It brings up all the vital statistics to show where we need to beef up, and where we need to scale back. It is important that we take the information in this document and use it wisely. The Fed’s have given us the material, brushing it aside and not following thru will be detrimental to our profession as a whole.

I hope these words gave you a little inspiration on this cold Sunday morning. Take care everyone, talk to ya soon!

National EMS Assessment: A series of posts, and soapbox moments. (Part 1)

First and foremost, many thanks to The Social Medic. I was reading his post on “Why Basics are More Important Than You Think.” Thru this blog post, my attention was brought to the Federal Inter-agency Committee for Emergency Medical Service’s Report on the “2011 National EMS Assessment Report” [CAUTION: It is a large PDF]. I got 7 pages into the 550 page report before I felt the need to hop on the good ol’ soap box. Be advised, statistically speaking…If I only made it 7 pages before I found something to talk about, I can assure you that it is safe to expect at least 78 more posts regarding this report. Maybe I’ll condense some of ‘em for ya.

This specific bullet point talks about data collection, as it relates to EMS Workplace Health and Safety. Anyone who has read more than one of my posts knows I am a hard ass for scene safety. Not in the sense of over bearing cowardliness, but more a self-awareness while on emergency scenes. According to this report that was published, the following points were made:

  • 12 (24%) of states have a formal recommended Wellness and Prevention Program for EMS Professionals.
    • How often are you complaining about the 350lbs patient in the 3rd floor walk up that you now have to carry down to the truck? Me…every time. The idea that we don’t actually recommend a fitness program for our employees is absolutely crazy. Does our hiring standards actually indicate any picture of physical health, or is it just a screening to see if we can do the tasks of the job? Most agencies it is the latter. Why are we not requiring our employees to maintain some sort of physical fitness standard?
  • Only one state currently monitors EMS on the job injury data.
    • THIS IS CRAZY! The idea that no one pays attention to job related injury is a little hard to believe. First and foremost I know it is done on a national level, because the Bureau of Labor statistics has information about, on average, how many providers go out on back injuries alone per year. My feeling is this report is designated to EMS specifically, and EMS Injuries usually get lumped into the same reporting system as all other work related injuries. It works but there really should be a separate reporting system. Having a separate reporting system will allow for easier monitoring of work environment’s and allow for faster developments of products and tools to protect us on a daily basis.
  • 18 (36%) states monitor EMS on the job fatalities.
    • Again, this blows my mind that there isn’t an entity responsible for monitoring such events. In all fairness, I can’t find information if this is the same case for all First Response agencies, or if it is just limited to EMS. Why wouldn’t we want someone monitoring this? After all we are all about QA/QI right? Then why are we letting this slip by?
  • 11 (22%) states monitor EMS Vehicle crash data.
  • 7 (14%( states monitor EMS blood-borne pathogen exposure data.

Again, this is the 7th point in the beginning of a VERY long document. My initial feelings after reading the first few pages of this expansive document are varied. I am very concerned that so little agencies monitor the statistics of the job. I am concerned that so much potential data for improvement is just going by the wayside and isn’t being analyzed. However, I am extremely optimistic that the document is released. It’s a grouping of ideas that show where we need to improve, and where we are excelling in the every day function of our jobs.

If you have a division of your states Office of EMS that is responsible for data collection and professional standards, that person can collect all this data that is being reported. That data is made public, available for all to scrutinize it. People realize that the number one cause of work related injury in EMS providers is back injuries. According to a study done by the American Journal of Industrial Medicine showed that about 10% of EMS providers are out because of back injury with lost time at work at any time in the country. The national average for the same statistic overall is only one percent.

This problem does not get solved on a national level. This needs to start from the ground up. First, we need to be sure we are using proper lifting techniques. Next, we need to make sure that we are physically fit enough to use said proper lifting techniques. In the event of an unfortunate work place injury, it needs to be documented. It needs to be sent to the states Dept of Labor, but also OEMS should start collecting such data. Then on a local level, we look at ways that we can prevent this from happening. We look at statistics and compare them to response patterns. What I would look for in response patterns are:

1) How many responders were on scene? Fire, PD, EMS etc.

2) How many of the responders aided with lifting the patient?

3) How many of the responders were not active in patient care?

  1. Why? Were they carrying equipment? Were they monitoring scene safety?

4) What is your opinion on how this can be corrected?

The most important part of that questionnaire, in my mind, is the fifth question. It is easy as supervisors, managers, and directors to “Monday Morning QB” a call, and judges the provider. It is a good way to provide some sort of self-evaluation to see if the employee truly sees the error of their ways. It could provide a great opportunity for them to voice their opinions and let them feel like they are needed. This information can also be passed up the chain of command and brought to EMS meetings to ensure proper safety is met with all the different entities responding to a scene.

I am looking forward to working through the National EMS assessment over the next few months (its 550 pages people, I don’t have THAT much free time). I hope it provides the powers that be on Capital Hill as much insight as it has for me thus far.

Tactical Emergency Medical Services – a preview

As you may, or may not know…there is a little hidden underground of EMS professionals known as Tactical Medics (The term “medics” in this case is not strictly for Paramedics. It is a generalized term for all EMS providers trained at the tactical level.)

Tactical EMS came about after a series of tragedies in our nation such as Waco, TX,  the North Hollywood incident, and most recently the Burbank CA shooting. It has changed the way Law Enforcement has responded to such incidents but yet EMS still responds relatively the same way…Stand on the side lines, until L.E.O.’s secure the scene, and then we begin triage. It is a safe way to do business and we usually just clean up the mess that’s left afterwards.  Tactical EMS works on both sides of this fence of scene safety. If you picture the Police Officers in harm’s way, and then EMS is back behind cover in a “safe location” waiting for the action to end. It allows Officers to have the knowledge to provide front line emergency care, and it allows EMS to assist in retreat to cover in the event that there is an officer down.

Why have we not evolved with Law Enforcement on this purpose? There are several big city agencies, usually urban environments who have members that are designated as tactical members who will assist in SWAT callouts. This is a concept that is very much in its infancy, much like the profession in a whole. I think it is imperative that each and every organization have some sort of “Special Ops” division that has a few specially trained members for these purposes. Yes, the cost can be a hindrance up front. There are several grants and such available from the Department of Homeland Security that you can use to train members regionally.

I did my training back in 2009 with STS Consultants, (click on the link for more information about the company, and the TEMS program) at a Western Massachusetts training facility. I learned a lot about scene safety, mostly scene survey. I learned how to asses a situation before I had even walked into the house. I learned how to asses for rapid routes of egress under stressful situations with low visibility. Overall, I couldn’t recommend this program more to anyone who wants to take it. I can think a dozen times where I noticed something on scene because I have had this training that could have potentially harmed myself, my coworker, or the other first responders on the scene.

In closing, the TEMS program is an innovative solution to help save an injured member of public safety. The primary purposes of TEMS is (according to STS Consulting):

  • Recognize a life threatening injury.
  • Provide treatment under hostile conditions
  • Conduct remote assessments and treatments
  • Plan and execute a rapid rescue to hard cover or safety.
  • Concepts of “Self-Aid” and improvised bandaging will be applied.

T.E.M.S. programs are offered all throughout the country. I only highlighted STS Consultants in this blog, because it was where I was personally trained. A simple Google search can guide you to various T.E.M.S. programs throughout the country, with various intensities in training, and various student dynamics. I hope this got you thinking about your agency, and the need for implementing or improving your T.E.M.S. program.

Take care everyone, until next time.