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!



2012: What Will It Do For You

This post is going to be straying from the usual gun-ho EMS topics, and take it to a little bit more personal level. After all, if we don’t take care of ourselves first…how can we take care of others?

Well, its here. Its 2012. Another year, another chance, another fresh start. That being said, I’m here to offer a few personal & professional points to carry with you through 2012. They say a lot of New Years resolutions fail because they tend to be too broad, and nonspecific. In order for you to truly succeed with your resolution, make it smaller and quantifiable. Take the “I’m going to loose weight,” and make it “I’m going to be able to run five miles in 30 minutes.” Instead of saying your going to be nicer to people, actually open up your smartphone calender and block off time to go to a soup kitchen, or volunteer at a shelter. It will surprise you how quickly you will see your resolutions succeed.

Now that you have an idea on how to write your resolutions, lets think about where to direct your time and energy. This is when I tell you to analyze your professional, and personal lives.

Are they in unison?

……..Are you content?

……………….Are you HAPPY?

We work in a profession of selflessness. Day in and day out, we are asked to give up time. Time spent with our Husbands and Wives. Time spent with our children, and time spent with our friends. We miss meals, holidays, long weekends, vacations, and most importantly sleep.

I want you to think about a couple of questions:

1) Do you still see the joy out of being able to help someone in their time of need?

2) Do you feel like you are trapped, and are generally uninterested in your career any more?

If you answered no to question number one, or yes to question number 2 then it is time for you to move on. You don’t have to leave EMS, just get some sort of change to happen that will renew your love for your job. See about opportunities in training, (speaking from experience) it can be a great renewal to work with people who are excited about the career. You’d be surprised how quickly you will “get the wind back in your sails.” If Education isn’t your thing, then try a change of scenery. Bid on another station, see about cross-training so you can work in dispatch. These are just a few things that you can see about changing at work before you loose all faith in your specific Public Safety profession.

Most importantly, remember those family members, friends, and other various loved ones I talked about earlier? See them. I recently had a 2 week stretch where I didn’t work ANY overtime above my 48 hour schedule. I felt like I had weeks off. I was used to having “hours” off here and there to make it seem like days, but after resting and stuff it really was just hours. I spent time with my girlfriend, friends from college, family members, and people that really do make life seem enjoyable. That happiness is something that your patients, and your coworkers will notice, because no matter how hard you try it is not something that you can hide.

A sense of contentment is what will bring this profession into the next level. If you are contsantly talking about how being a Paramedic isn’t good enough, or is “just a stepping stone,” then that is all it will ever be. If you can’t find the enthusiasm in your job, then why even do it at all?

What ever holiday it is that you celebrate, I hope it was one filled with happiness.

Stay safe in 2012, we lost enough brothers and sisters last year.

Stop, and Remember…..

A Time to Remember

Today, I am writing this post as my girlfriend and I are currently 34,000 feet in the air somewhere over the “fly-over states” of the Midwest. We are heading to Vegas for a quick weekend vacation with another couple. It has me thinking of all that I am lucky enough to be able to do in this country. We owe that to a very certain group of people. The service men and women of this country fight day in and day out to maintain our freedoms and protect the life we lead, and all to often, take for granted.

I am writing today to memorialize an EMS ally that many of you may not know. Major John Pryor, was a combat surgeon with a forward surgical unit in the United States Army. December 25th 2008 Major Pryor was killed when his surgical unit went under attack while providing life saving care for our troops in Baghdad.

While attending college in Massachusetts I had the pleasure of leading a campus based EMS organization. That organization, every year, would travel to a national conference held by the Nation Collegiate EMS Foundation. This foundation provided professional networking and training for the colleges around the country that ran their own Emergency Medical Service. Services varied from First Response to full blown ALS transporting services at some of the bigger universities. If there was ever an underground EMS 2.0 Movement, it was here. People here are enthusiastic, creative, and motivated. They are motivated to go out and change the world.

Dr. Pryor was a practicing Trauma Surgeon at the University of Pennsylvania. He would always bring a wealth of knowledge to the NCEMSF Conference. He would show how battlefield trauma care is actively shaping the way that Civilian EMS provides trauma care. He would bring pictures to show the work that was being done overseas, but most importantly he would motivate you to go out there and change the world. Dr. George Koenig (President of NCEMSF Board of Directors at the time of his death) described it perfectly in a letter to the membership:

“He is best remembered by his favorite quote by Albert Schweitzer. “Seek always to do some good, somewhere. Every man has to seek in his own way to realize his true worth. You must give some time to your fellow man. Even if it’s a little thing, do something for those who need help, something for which you get no pay but the privilege of doing it. For remember, you don’t lie in a world all your own. Your brothers are here, too.”

The EMS community lost an amazing ally and advocate that Christmas. He was a humble man, that truly had the power to motivate many.

I had the pleasure of attending a few different lectures of his while at the conference. Once was a Key Note, and the other was a optional lecture. Both times I walked out of there with a wealth of knowledge pertaining to a world I have never seen. Battlefield medicine is a very interesting topic, and something that I have never personally had the pleasure of experiencing.

To all the men, and women who are serving overseas, and their families forced to spend the holidays without them…My prayers are with you that you can find a peace in knowing that you are doing this country a great service. One that I will never be able to pay you back, except with overwhelming amounts of gratitude and support.

Thank You. If you would like to read a little more about Major John Pryor, MD please click here.

Merry Christmas everyone.

The Most Dangerous Job in Public Safety?

Part of the EMS 2.0 mission is to improve the standard of our profession in clinical practice, knowlege base, technology, and safety. These combined makes what I am about to share with you pretty scary. Studies are finally starting to show the REAL danger that is out there from working in EMS. I was cruising the EMS Information sites today and looking at some of the articles that were published in JEMS during the November 2011 issue, by David Page, MS, EMT-P  Titled: “Studies Show Dangers of Working in EMS.”

Studies are showing EMS to be one of the most dangerous professions. Data was examined from 2003 to 2007 found that there were 65 EMS Fatalities, or 13 per year.

“Forty-five percent (29) of EMS worker deaths resulted from highway incidents, mostly due to vehicle collisions, and an additional 12% (8) involved personnel being struck by vehicles. Thirty-one percent (20) of EMS fatalities involved air transportation incidents. It’s important to note that these statistics don’t take into account any civilian or patient deaths that may have occurred as a result of EMS crashes or other incidents.” David Page MS, EMT-P

That is insane!!

We are in a field that is based soley in transportation. We answer a 911 call, we respond to said 911 call, and we transport the patient to the hospital. We haven’t gotten our profession to a treat and release basis yet (frankly I don’t think I want it to get there). So a majority of our mission is transporting a patient, and that is what is killing us the most? WHATS WRONG WITH THIS PICTURE?

Let me give you some examples:

Fire – they figured out that fire will burn you, and smoke will destroy your lungs. Solution? Better bunker gear, and better SCBA to improve respiratory function during interior operations .

Police – They realized…oh hey…bullets? Yeah they’re dangerous…lets put something protect us from that!

EMS – 45% of worker fatalities between 2003 and 2007 were related to 99% of our job function? Oh, but the R&D is too much to come up with a solution?

Give me a break.

I’d love to see our vehicles get to a point where we have a 5 star crash rating for both crew and patient compartments. I realize that isn’t going to happen overnight. This is a two way street where we need to be vigilant as much as management needs to be willing to provide proper equipment and training to make our job safer.

I hope the numbers have decreased since the last data set was collected (2003-2007), because these numbers are just too outrageous to ignore. The official study can be found in Prehospital Emergency Care Fatal and nonfatal injuries among emergency medical technicians & paramedics. Prehosp Emerg Care. 2011;15(4):511–517. A simple Google version will bring you to it.

Until then please remember to come to a complete stop at a red light, and don’t just “roll through it,” Look four times instead of two, and wear a safety vest or some sort of  high visibility uniform attire.

Stay Safe out there everyone, I don’t want to have to stop to give YOU a moment of silence.

Here’s a little collection of Ambulance crashes I have found through Google searches, just in case you were feeling safe and secure in your rig….

From Stepping Stone to Landing Pad

It is a tough choice, to pick something worth fighting for and to stay with it. Unfortunately, I am almost at a lost of what to do from here on out. So I am going to propose my idea of what EMS 2.0 should look like. The Emergency Medical Service should be a profession that lives up to the standards of excellence that we all expect of it. There are a few things that I want to see happen in order for this to happen.

First, take the idea of “for-profit healthcare” completely out of the equation. We all (at one point or another) got into this job to help people. Our motivations for business models should be based off of smart business decisions which provide fiscal responsibility, while keeping our main motivator being clinical excellence and patient satisfaction. If you make the majority of business models “non-profit” then that will turn a lot more cash flow over to the organization as a whole for advancement in many areas such as operations, or fleet. By investing more money in gadgets, newer fleet, or bonuses to employees (not sure of the legality of bonuses with non profits) this will show to your employees that they are a valuable part of your organization instead of just a line item on the payroll budget.

Next I would like to see us get away from certifications. Relax, I am not advocating for the total deregulation of EMS. I am saying lets elevate the responsibility of the care on the employees. Lets make Paramedics, maybe even EMT’s, licensed. Licensing will allow for more personal responsibility on behalf of the provider. The National Registry of EMT’s defines these hallmarks of certification:

  • Voluntary Process
  • By a private organization
  • for the purpose of providing the public information on those individuals who have successfully completed the certification process (usually entailing successful completion of educational and testing requirements) and demonstrated their ability to perform their profession competently.

On the contrary, the NREMT’s defines the licensing process:

“the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice. Under the licensure system, states define, by statute, the tasks and function or scope of practice of a profession and provide that these tasks may be legally performed only by those who are licensed. As such, licensure prohibits anyone from practicing the profession who is not licensed, regardless of whether or not the individual has been certified by a private organization.”

Certification and Licensure are often used interchangeably and they cannot be. For example, the American Heart Association is the private entity that certifies you in BCLS, ACLS, PALS, and so on. Whereas your State OEMS is the government agency that allows you to function as either an EMT or Paramedic. I hope this clears up the misconceptions that are out there with certification vs licensure. It did for me believe it or not.

Whats next on the list? Let’s take the idea of patient disposition out of the protocols and lets put it in the hands of the on scene Paramedic or EMT. Right now, in Massachusetts our protocols are riddled with phrases such as “transport to the closest appropriate facility,” or “follow appropriate Point of Entry protocol.” I laugh every time I read it because it seems like they feel we won’t transport to the closest hospital, or transport to a location other than what would be in the best interest of the patient.

Also, if you want us to act like professionals, pay us like professionals. While money certainly is not everything in this life, I would like to make more money than the manager at my local McDonald’s restaurant. In order for us to get more money, reimbursement from insurance agencies and medicare also need to increase. Lord knows that isn’t going to happen any time soon, but hey…A guy can dream right?

Finally, give us a future. The biggest reason that Medics, or EMT’s move onto other jobs is because of retirement options. Often times municipal departments offer some form of gaurnteed benefit retirement plan instead of some 401(k) plan offered by a private company. The other option to consider is promotional path or special team options (critical care, tactical EMS, Disaster Response, etc). Having more defined options allow for employees to feel less trapped and more secure with their career path instead of always looking for that greener grass on the other side of the fence.

This is clearly not the entire picture to solve how to bring the EMS industry into the next generation, but it is a start. Lets get it together, are you working towards the EMS 2.0?

Keeping it Together, a Discussion About Unity.

So I have taken a couple weeks off from blogging. It’s been a busy end of August.

As usual, I was browsing the typical social media outlets and I saw a post from a fellow paramedic. He was mentioning how there was a showing of different agencies from around New England for (what I believe) was an EMS LODD Funeral. He was in shock that there was less than 300 people there for a LODD Funeral. To be honest, I can’t say that I blame him.

I look at the displays of unity from across the area, PD and Fire always have a strong showing at a funeral for one of their own. Thankfully, I have yet to experience a first hand EMS LODD Funeral. I have had colleauges sadly pass away due to accidents or illnesses. They are just as sad, just as tragic, but there isn’t that sense of sacrafice because it obviously was a tragic passing.

When will EMS providers get the picture about unity?

I sit around work and listen to people who do nothing, but complain, about doing work. If something goes wrong, there’s 10 people in line to throw some one under the bus, and 2 standing next to him. It is sad really. These attitudes are our biggest downfall. I would love nothing more than to see the EMS Profession grow into something that people want to make careers out of…but day after day we are sabotaging our own advancement.

My suggestion? Get involved. Get involved with National Associations, such as NAEMT (Please forgive my shameless plug). They are really making a substantial effort thru political channels to give EMS Providers the legislation necessary to bring our profession to the next level. I applaud them for doing that.

Next, share you’re ideas. We are not going to get anywhere if we don’t even try. Maybe using blogging websites, or other forms of social media opens doors I, personally, never thought of walking through.

Finally…When push comes to shove, be there. Don’t back down, don’t run away, and fight for yourself (collectively, not individually) EMS is a profession that I love very much. However the majority of EMS Systems are built on the never ending “revolving door.” Meaning there is always a constant turn over of employees and experience levels. If we ever solve these fairly substantial issues, then we will see EMS rocket into version 2.0

MCI Triage – When $h*t Hits the Fan

Let’s talk about going from “0 to 60mph.”  We often hold these MCI drills (usually at the expense of Uncle Sam and his glorious grants). Does this training prove fruitful? I think so. While during the event it may seem like a cluster, afterwards it can be very easy to critique the event and usually you will find very little that needs to be fixed in this post 9-11 era.

For a case study I am going to use an example from Western Massachusetts. A few months ago, something happened in Massachusetts that hasn’t happened for almost a hundred years. Two tornadoes touched down in the Greater Springfield Area. This then launched the Greater Springfield into a disaster response mode , the likes of which hasn’t been seen since I started my career almost 7 years ago.

I spent some time talking with a former supervisor of mine, and fellow EMS 2.0 blogger, Scott Kier about the events that unfolded that day. He talked about the staging plans on the north and south sides of the tornadoes path. He praised staff for their dual command centers, and the communications staff for keeping everything in check. Luckily there were little casualties as a result of the storm. Most of the transports they did were all secondary injuries or normal medical jobs. Triaging casualties can be very difficult, especially if people aren’t on the same page. Thankfully two things happened that day to make it flow pretty easily. First, excellent crews that rose to the occasion of helping people at their time of need. They put their personal wants and needs behind and answered the call. I feel like this is a reflex reaction and no matter how burnt our or “crispy” you may be, its often hard to deny it. Second, there was a low casualty rate as a result of the storm, which didn’t bog down resources.

Scott spoke of “crews going door to door checking on the residents, making sure that everyone was okay.” I was proud to hear that such a large service still had the caring of a small town service. Scott also talked about how even at one point “crews had to take shelter in a resident’s basement because the second tornado was touching down.” The “Big-City” that everyone always talks about suddenly appeared as if to be a tiny “one horse town.”

It is very hard to keep your cool when mother natures is reigning down her wrath. I have to say from the stories that Scott told me, I am very proud to call you guys colleagues. I brought attention to this story because I feel it truly emulates the EMS 2.0 Mission. These providers were methodically searching the city looking for sick and injured. They were on the same page, and gained a lot of attention from local, state, and even some federal agencies.

Thank you to the Greater Springfield EMS providers for helping bring EMS 2.0 to your city. Keep up the great work, and most of all stay safe!