Do Something!

Late Sunday night, a madman killed people in Las Vegas.  Predictably, both sides have drawn their lines in the sand and demand that politicians “DO SOMETHING!”  Those on the left demand that politicians enact gun control and hector, cajole, shame, and belittle those who don’t believe as they do.  Conservatives argue that gun control doesn’t work and that the solution doesn’t include disarming the public.

In the spirit of full disclosure, I tend more toward the conservative view of things. I also have a Texas license to carry a firearm and do carry.  But I’m also a realist.  I doubt that a person carrying a handgun can stop a situation like in Las Vegas where a rifle is being shot from a high place at a large crowd.  Individual street crimes may be a different situation, but even in those cases, a “good guy with a gun” can only do so much.

So, we all want to “DO SOMETHING.” Here’s my opinion.  You can absolutely do something above and beyond “thoughts and prayers,” changing your profile picture on Facebook, or contacting your politicians for or against guns.  First things first. Learn some basic life-saving skills.  Learn CPR.  Learn basic first aid.  Learn bleeding control — including how to use a tourniquet.  And make sure you have current supplies at your home and/or in your car.  Some basic gauze, gloves, and a tourniquet can go a long way to make sure that a violent assault doesn’t become a homicide.  As an added bonus, your knowledge of CPR and first aid is valuable in other situations above and beyond shootings.  Car wrecks and sudden cardiac arrest kill just like a shooting — and a concealed firearm isn’t as useful in those situations. There are plenty of first aid and CPR classes out there.  If you can’t find one or have questions, feel free to ask me — or ask your local EMS organization.  You do know who your local EMS organization is, right?

Next.  You do need to contact your politicians.  But not necessarily about guns.  Ensure that your community has a well-funded EMS system and trauma facilities. Too many communities rely on the “low bidder” to provide 911 response.  Too many communities are holding bake sales so that their volunteer fire and EMS organizations can have the bare minimum equipment.  We can always have a debate about the role and scope of government and taxes.  However, all but the most radical anarchists or extreme libertarians would agree that a fundamental role of government is to send help when you call 911.  A high-quality EMS system is not a luxury.  Whether a car wreck, a mass shooting, or chest pain, the fact remains that early access to definitive care saves lives.  An Emergency Medical Services system does exactly that. For all of the comments on social media about so-called “First World Problems,” Americans should demand a quality EMS system that ensures access to clinically current, professionally delivered, compassionate medical care 24/7.

And if you still want to “DO SOMETHING,” consider getting training and volunteering.  The reality is that you might be near a volunteer fire or EMS department that needs people and just might even train you.  A basic first responder course is often less than 80 hours.

These are the steps you can take to “DO SOMETHING.”  Or you can keep changing your profile picture on Facebook.  The choice is yours.  Choose wisely.

Longhorn Student EMS

The University of Texas has decided not to provide insurance or legal protection to a student EMS group on campus.  Since this is my alma mater, I felt compelled to share my $0.02 with University of Texas President Gregory Fenves.  If you feel compelled to reach out, do so (and keep it polite).  He can be emailed at [email protected]

Dear President Fenves:

It’s rare that I find myself writing an email that hits multiple areas of who I am – a Texan, a Longhorn (BA 1996), an attorney, and a paramedic.  But the decision of the University to deny funding for Longhorn EMS’s liability insurance and/or assumption of liability hits home for me.

The University of Texas and the University of Texas System are blessed with many outstanding attorneys, both of counsel to the University and the System and throughout the faculty.  I would never take away from their counsel or guidance, but I would note to you that the liability for the provision of emergency medical services in Texas, especially by a governmental entity, is exceptionally limited. Texas Civil Practices and Remedies Codes §§74.151-74.154 and Texas Health and Safety Code §773.009 provide broad protection and multiple Texas appellate court decisions have broadened said liability protection.  As such, I would assert that the legal liability for the provision of emergency medical services, particularly at the EMT/basic life support level, is exceptionally limited and that the costs of any liability insurance would reflect such limited exposure. In short, this concern about legal liability on behalf of the University is a red herring at best.

University spokesperson Bird’s statements that the University wants students to be students and not to take on potentially dangerous professional responsibilities is, at best, ignorant of many students who are already certified as EMS personnel or might even be in the armed services.  Wanting students to be students first ignores that many students already are working including as employees of the University. Several UT students already work as emergency medical services providers in other venues even including as employees of the organizations that provide EMS coverage for University athletic events.  Additionally, many students of the University already volunteer in many campus organizations, several of which provide direct services for the University. And finally, there’s the eight hundred pound gorilla in the room that shatters the illusion that students should be only students – namely, men’s and women’s intercollegiate athletics. I am pretty certain that the time involved to become an emergency medical technician and remain active with a student EMS organization is a small commitment in comparison to the time that student athletes spend in service to the University.

From a public safety standpoint, having an on campus EMS system makes sense.  Even on an urban campus like the University, EMS response time takes time. The closest Austin Fire Department stations to campus, Station 2 on Martin Luther King, Jr. Boulevard and Station 3 on West 30th Street do not have ambulances.  The closest ambulance, if available for assignment, is Medic 3, located in the parking garage of the old Brackenridge Hospital.  At best, there is a delay in getting emergency care to campus.  Having responded to the University campus as an EMS provider, I can tell you that calls on campus are a challenge, especially in getting emergency resources to the right location because of the combination of obstacles in terms of vehicle access, determining the right location, and getting access/entry into University buildings, many of which are secured.  In a critical emergency such as cardiac arrest, severe allergic reaction, or uncontrolled bleeding, having a trained set of hands on scene sooner can, will, and does regularly make a significant difference in patient outcome.  In some cases, that difference in patient outcome is life as opposed to death.  Waiting for City of Austin resources and also waiting for someone from the University to provide access to a building just doesn’t make sense. And in case of a severe emergency or disaster, having “all hands on deck” and a force multiplier in the form of a University recognized and accredited group of EMS providers can and does make a difference.

The University has always encouraged public service.

As an undergraduate government major, my spirit of public service and engagement was encouraged and nourished by Dr. Janice May’s classes on state government and her public service internship program which gave me a foundation and prepared me for a career in state government. Especially as the University develops its own medical school and expands its involvement in all aspects of healthcare, encouraging a student volunteer EMS program is a no-brainer decision.  Encouraging students to volunteer and to become engaged in healthcare is, plain and simple, an outgrowth of the University’s mission to educate.  Such a program should be encouraged, not stopped. Many notable physicians and healthcare leaders got their first exposure to EMS, medicine, and volunteerism through campus EMS programs.

Texas A&M University has long had a student-run EMS.  In fact, Texas A&M University has student-run EMS for university events as well as a separate EMS program that provides paramedic-level ambulance coverage for the university campus as well as providing mutual aid backup coverage to the cities of Bryan and College Station.  Rice University has a student-run EMS program operating under the supervision and guidance of their campus police department. Rice’s EMS program operates as a campus first response organization, providing advanced EMT level care until the arrival of the Houston Fire Department’s ambulances. Colleges and universities throughout the United States have campus EMS organizations.  In fact, there’s even a National Collegiate Emergency Medical Services Foundation that exists to guide and promote campus EMS programs.  At the University of Texas, we are a “University of the first class,” as described by Article 7, Section 10 of the Texas Constitution.  More bluntly, to quote our former athletic director, DeLoss Dodds, “We are the Joneses.”  The University of Texas shouldn’t take a back seat to anyone. And that includes providing emergency medical services to the University community and its visitors.

Bluntly, the idea of a student EMS on the Forty Acres has grown in fits and starts.  Good intentions alone are nowhere near enough. And some of the attempts to provide this service have been, at times, amateurish. That is why it’s even more imperative for the University to recognize, fund, and support this effort, if for no other reason than to provide the resources of the University to supervise these students and ensure that what goes on with this organization is a credit to and not a harm to the University.

If I may offer my services to you, the University, or these students, I stand ready to do so – as a volunteer.  I am a Texas licensed attorney, a Texas licensed (and nationally registered) paramedic, a Texas EMS instructor, and a proud Texas Ex.

I encourage you to reconsider the University’s decision and strongly commend you to take steps to help this fledgling EMS program get the right start it needs.

Respectfully submitted (and Hook Em Horns!).

 

Part of being a clinician

Today, I heard from a good friend of mine who happens to be a good paramedic out of state.  They were telling me about issues with a family member who’s in the hospital and in poor condition.  Part of this involved the communication from the hospitalist who asked if the family member had a do not resuscitate order because the family member in question is “very sick” and without a DNR order, the patient’s ribs would be broken during CPR and “her insides would be messed up.”

I’ve dealt with similar conversations before both as a medical provider and as a family member.  Without going into my rant against hospitalists (who don’t know the patient outside of the hospital, rarely have an idea as to the patient’s baseline, and are often the bottom of barrel clinically and academically), this is completely unacceptable.

However, I will say that this is how people in medicine get sued. Not because their medicine hurt or helped. But because they have zero idea how to communicate with people. There are way too many physicians who have a pure science background and see patients as lab values on paper. They see patients and their families as a distraction. Likewise, there are way too many in EMS who are bitter because they were promised a chance to race the reaper and save lives and taking care of sick people isn’t “what they signed up for.” I am far from religious and definitely not Christian, but the verse from the Gospel of Matthew says it all. “I was sick and you visited me.” Ultimately, that’s what being a clinician is about. Taking care of sick people. Not flashing lights or even geeking out over lab values. And caring (and dare I say ministering) for the sick means caring for their family too.

I see way too many physicians who have a gift for the sciences and not a gift for communication.  I see way too many in EMS who can improvise a solution to make MacGyver proud but who make Chuck Norris look sensitive and compassionate. Medicine is not a pure science, no matter what anyone says.  It’s a profession.  Whether you’re a brand new EMT or a tenured medical school professor with subspecialty certification, you’re a professional using your scientific knowledge to solve human problems.  And human problems require interacting with humans.  Part of that interaction means communicating with other people, not all of whom you may like or who you may think are as smart as you are or even worth your time.

And the human factor in any profession, especially including medicine, is why professions aren’t mere sciences.  Yes, there’s a ton of science in medicine.  It is the foundation for much of what we do.  But we apply this knowledge to help others.  And helping others goes significantly beyond acid-base balances, covalent bonds, thermodynamics, or gas laws. It’s about demonstrating a bit of compassion and empathy.

You don’t necessarily learn those things in a science lab.  You learn them from interacting with others.  You learn these things in a liberal arts classroom where your views about the world are challenged, where you learn to defend your views, where you learn to maybe change your views, and most importantly, where you learn to communicate and get along with others.

Medicine — at any level — is ultimately a people profession.  If you’re not comfortable with people, you’re not likely to succeed.  It’s why EMS clinical evaluations are supposed to include an “affective domain” aspect.  And this is why I think that the constant drumbeat for more “science” classes in EMS also needs to be tempered with more classes in English, psychology, sociology, history, geography, and management.  In other words, being a solid clinician requires understanding people as much as it does the science.

And to add in my legal advice, people rarely know if you’re good at what you do.  They do know whether or not you’re nice to them.  And many of these cases of being “not nice” often involve poor or failed communications with the patient and/or their family.  Learning how to talk to others, whether to get information or to persuade, was a significant part of my education as a legal professional.  It needs to be a significant part of our EMS education as well — and that means more than rapidly brushing through the mnemonics of “SAMPLE” and “OPQRST.”  It means active listening and then incorporating that information with your scientific knowledge to actually care for your patient.

That’s what being a professional is about. That’s what being a clinician is about.  It’s not about the flashing lights.  It’s not about the lab values.  It’s not about an obscure EKG finding.  It is about caring for others.  Period.

Why The Advice Is Rarely Free

Anyone who knows me (especially on Facebook) knows how much I rant about giving free legal advice.  To be more exact, I rant at the expectation that some in EMS have that they are entitled to ask me for free legal advice.  (But Wes, it’s just a quick question!)  That would be the same as asking an EMT who does transfers to give my dad a free ride to a doctor’s appointment, because, after all, it’s just a quick ride over to that clinic on the other side of town. As I’ve said more than once, I’m a volunteer paramedic, not a volunteer lawyer.

Kidding and ranting aside, I do get it, at least somewhat.  For a lot of us who are attorneys, we may be the only attorney that our friends know.  And I think that may be even more the case in EMS.

Law pays my bills and EMS keeps me sane. (Think on that one for a while.) Having said that, I need a law license to pay my bills and those things that could potentially jeopardize my license are things I typically try to avoid. Just like in EMS or any other licensed profession, as a lawyer, I’m subject to certain legal and ethical obligations. In my case, as a Texas attorney, my ground rules are largely set by what our State Bar refers to as the Texas Disciplinary Rules of Professional Conduct.

Generally speaking, my obligations to you start once an attorney-client relationship is established. I would refer you to Part 10 of the Preamble of the Texas Disciplinary Rules of Professional Conduct which states, in part, “Most of the duties flowing from the client-lawyer relationship attach only after the client has requested the lawyer to render legal services and the lawyer has agreed to do so.” In other words, if I’m providing you legal advice, the attorney-client relationship may well exist and I’m under all of those professional, ethical, and legal obligations.  Even if it’s “just a quick question,” please understand and respect me when I say that you need to seek legal counsel. After all, “legal services” constitutes what I do.  I’ve heard a few folks say, “Well, I’m just asking your opinion since you’re also a medic.”  If that’s the case, why was I picked out of every EMS provider you know to provide guidance on a legal question?

Please understand that another one of my obligations as an attorney is to only provide representation on matters that I’m competent in. Rule 1.01 states, again, in part, “A lawyer shall not accept or continue employment in a legal matter which the lawyer knows or should know is beyond the lawyer’s competence…”  I primarily do administrative law and government contracts.  I know about EMS law because it’s a field that’s near and dear to my heart personally.  That doesn’t mean that I know anything about your child custody, your speeding ticket, or your Aunt Erma’s will.  It’s the same as expecting your orthopedic surgeon to read an EKG.  Sure, they’re licensed and permitted to do such, but would you really trust their opinion?  More importantly, would you trust an orthopedic surgeon who’s actually willing to read and interpret an EKG?

As I’ve said more than once when discussing legal issues, both the underlying facts of the case as well as the laws of the jurisdiction make a huge difference in providing legal advice or in answering a question.  That’s why most of us who are lawyers have a favorite answer — it depends. Also, because lawyers need all of the facts and to find out the relevant law, it’s rarely just a short answer that we can give quickly. When you combine this with the duties that attach to an attorney-client relationship, you can hopefully understand why I’m loathe to wade into a social media debate about the law.  These debates often become a debate about what the law should be rather than what the law is.  If you want to change what the law is to your version of what the law should be, the political process exists for that very reason.

Also, just like I wouldn’t ask or expect my EMS friends and colleagues in Vegas to come to Texas and immediately start practicing as medics, please understand that my law license is issued by Texas.  I can provide legal advice in Texas — and no other state until or unless I apply to become licensed in another state.  As there’s no National Registry of Lawyers, the reciprocity process for attorneys (if it’s even granted in other states) tends to be a bit more complex and expensive. Otherwise, I end up taking another state’s bar exam to get admitted.  For reference, the Texas Bar Exam is offered twice a year and is a two and a half day exam.  That explains, at least in part, why the Registry exam didn’t seem like too much of a hurdle in comparison.

When I get tagged into or dragged into these debates online, it creates a dilemma for me and my fellow medic-lawyers. One colleague of mine recently noted to me that replying to “Facebook lawyers” puts us in an awkward position because even replying to or arguing with their positions, even when clearly and blatantly wrong, could be construed as providing legal advice. And when it’s about a specific instance, that’s even more likely to be considered providing legal advice — which is the practice of law.

Hopefully, these thoughts give you a better understanding of my mindset about not wanting to give legal advice, even if it’s “just a quick question;” why I like to say “it depends;” and why I recommend you get legal counsel of your own if you do have a question.  In Texas, our State Bar offers a lawyer referral service to find legal counsel.  For EMS issues affecting your liability or license, insurance coverage is available which may include legal representation.

I love our EMS community (ok,  most of the time) and I am always in favor of EMS providers being better educated on the laws and regulations that affect our practice.  However, please understand that while I am a lawyer, I am not your lawyer.  And for those of you who I’ve actually given “free” advice to, I hope you might understand and appreciate what exactly is involved when I do that. Being a lawyer is as much a part of my identity as being a medic — and both are a form of public trust that I sincerely value and hope to maintain.

 

What’s Wrong

This morning, I received a long email from a long-time mentor of mine who’s also a paramedic and attorney.  He was pretty upset about the lack of involvement from physicians in improving the state of EMS.  As I replied, I realized that I needed to adapt my reply to share with my three or four devoted followers.

I blame the docs too, but only tangentially.  They write protocols for the lowest common denominator.  They are risk averse and rightfully so.  There’s a lot of good paramedics out there, but there’s even more who shouldn’t even be trusted with a BVM (which I still think is the most dangerous and under-respected tool on the ambulance).  It goes back some to education.  We have way too many people teaching EMS education whose only expertise is that they hold an EMS certification. Law school and medical school aren’t taught the entire way through by the same someone with a JD or MD.  There are multiple classes, each taught by subject matter experts.  One of the things I hear from some of the EMS dinosaur types is how some of their classes were taught by physicians (including specialists) and nurses.  We don’t have that anymore and I think the education has suffered as a result.  CoAEMSP doesn’t care. They care that you’re using FISDAP or “Platinum Planner” to track your students and develop more metrics. They don’t care about the quality of the content.  NAEMSE doesn’t care.  They are too busy promoting “flipped classrooms,” “learning styles,” or whatever other trendy topics are out there.  The NAEMT doesn’t care.  They’re too busy promoting new card courses to cover things that should’ve been covered in initial education.  The American Heart Association doesn’t care.  They’re too busy promoting ACLS, BLS, and PALS to care.  And the NREMT?  They should care, but they don’t.  They will get the usual professional EMS committee members in a room and issue high and mighty statements about the EMS Agenda Version Whatever.  And the item writing committees for the exams will give a de facto veto to the state with the worst EMS standards because the exam “has to reflect the entire country.”  And the publishers of EMS texts don’t care.  They know their market.  Truth be told, there’s more people reading at a tenth grade reading level who are getting their paramedic because their fire department requires it than there are students (or teachers) who really want to understand the whys of prehospital medicine.  And the students and educators that do want to know how to practice prehospital medicine are supplementing their texts with medical and nursing texts as well as online material. The state health bureaucracies don’t care.  EMS is a small part of their mission.  They see their mission as public health and welfare — and to the average bureaucrat with a RN and a MPH degree, EMS is best seen and not heard — and then, only seen during EMS Week.  The Feds?  Well, truth be told, EMS really isn’t a Federal responsibility and making it such will ensure that the same people who brought us the VA will be in charge of prehospital medicine as well.
And don’t even get me started about the usual gang of idiots.  In short, every EMS committee is tasked to solve the ongoing problems of EMS but is full of the same EMS celebrities who created the problem in the first place.
EMS as a whole is beyond repair.  But virtually no single EMS system (except maybe perhaps some of the large urban systems) is beyond salvage.  Fix each system and fix the individual EMS education programs and eventually, the rising tide will lift all boats.
Until then, rant globally, fix locally.

Things You Need To Know

As an EMS provider, there are a lot of things you need to know. Many of them are clinical things about the practice of medicine that a lot of people who are a lot smarter than me can teach.  But for your reading pleasure and hopefully, for your education, here are some other things I’ve learned.

1) Most of your patients have no idea if you know what you’re doing.  They do know if you’re nice.

2) I spent a great deal of my time in EMS looking for the perfect EMS system.  I found out more than once that such a system doesn’t exist. Find the system that works for you (or that you can make work for you).  You’ll be infinitely happier in the long run.

3) It’s important to be current and correct on the practice of EMS.  It’s less important letting others know you’re correct. Corollary to this axiom: If you do need to coach or correct others, there’s an art to doing it.

4) EMS as it exists now in the USA has only been a thing for 45 years or so.  It’s still growing. And I think most of us are impatient. I know I am. But one thing I continually have to remind me myself is that EMS is still growing and maturing. Whether its your EMS system or another, it isn’t going to magically improve overnight or reach the level we know it can overnight. Continual gradual improvement is a thing. And in some systems, that improvement is showing. It’s just not going to happen immediately.

5) Your mentors will change. As we grow and mature in our practice, we find that some of the people we idolized aren’t as smart as we first thought.  And that’s ok too.

6) Knowing what to do is easy.  Knowing when to do it or not do it is the hard part of being a clinician.

7) Taking a patient to a hospital incapable of managing their condition is a disservice to the patient.  Part of being an EMS provider is that we are supposed to know where to take our patients.

8) This is actually supposed to be fun. When it’s no longer consistently fun, it’s time.

9) A significant portion of our time in EMS is spent dealing with emergencies.  The patient defines emergency.  We don’t.  And our education fails to recognize what patients consider emergencies.

10) A preceptor once told me that the paramedic’s job is to bring order to chaos.  If you can combine that skill with the passion and zest that most rookies and volunteers have along with being current on medicine and slaying dogma, you’re on your way.

Bread And Butter

Today’s blog post (and sorry for the delay to my Mom and the two others who read the blog) was going to be about continuing education.  I was going to write about the seeming inability to get the majority of EMS providers to engage in continuing education above and beyond the usual “required” card courses and/or the state-mandated refresher course material.  (Parenthetical.  I’m very glad to practice prehospital medicine in the Lone Star State where the state mandates very little as far as specific content and leaves it up to the provider as to what continuing education to seek out, subject to a few broad categories.)

I was going to complain about people not attending high quality continuing education, even when it’s offered for free.  I was going to mention the challenge of bringing the knowledge from international and national conferences like SMACC and EMSWorldExpo back to one’s home EMS system.  I was going to mention what I call the “Goldilocks” challenge of EMS continuing education — ensuring that the material isn’t so introductory to be a rehash of EMT classes but isn’t so complex as to require a PhD in pharmacology and physiology to understand the material, let alone apply it. I could even mention the whole volunteer versus paid debate, not even mentioning how so many volunteers manage to attend outside continuing education and conferences on their own dime, but you’ll rarely see a large EMS system (let alone a fire-based EMS system) sending people to a conference, let alone their members attending on their own. (See also: If I need to know it, they’ll do it in-house and pay me overtime for it.)

These are all worth mentioning.  And they deserve mentioning.  But here’s what really struck me. We can have all of the high-speed providers going to courses like these.  And there’s also going to be a lot of people going to “cool” sounding continuing education courses in tactical medicine, hazmat, or some sort of technical rescue. (Please, please tell me why an EMT working interfacility transfers needs to know how to be an “operator” in the hot zone.) But we rarely have good, consistent, clinically current, relevant continuing education on the topics that are the bread and butter of prehospital medicine. Think about your last shift on the ambulance.  Chest pain, respiratory difficulty, sepsis, ground level falls, abdominal pain, routine MVCs.  How much continuing education have you received on these matters? If you did receive continuing education on these topics, was it merely a repeat of what you’ve been told every recertification cycle you’ve been in EMS? From the amount of providers who think that any heart rate above 120 must be some form of arrhythmia that requires treatment and who think that EMS administration of diuretics for CHF patients is a good idea, clearly, we’re not getting the bread and butter of EMS down, much less mastering it.

What we see with continuing education is but a symptom of what’s wrong with EMS.  We want to do all the new cool things of the moment, whether it’s community paramedicine, technical rescue, tactical medicine, or critical care medicine.  We don’t want to do the bread and butter of medicine (see also: every EMS social media forum complaining about system abuse, drug abusers, or “frequent flyers”) and when we do the bread and butter, we aren’t always current.  If we can’t get the routine right, why should we be trusted with thinking outside the box?

A Time To NOT Volunteer

If you know me or you’ve come by this blog a few times, you know I’m very passionate about the role of volunteers in the world of emergency services, particularly in the fire and EMS world.  Today marks a change.  One, I’m about to give some very broad, generic “free” legal advice.  Two, I’m about to tell you NOT to volunteer.

Event medical standbys. At least in Texas, those fall into a massive loophole where they’re not subject to any regulation from the state. In Texas, transport providers (officially called “EMS Providers”) and “first responder organizations” are subject to state regulatory requirements.  Because event medical standbys don’t fit into Texas’s definition of EMS Provider or First Responder Organization, they’re completely outside the purview of our state EMS regulatory system.

These events always say “BLS only” or “CPR/first aid” but seem to recruit heavily from the ranks of EMS providers. If they truly only want “BLS” or layperson aid, why are they recruiting so heavily from EMS?  Simple.  They want EMS providers on site, but they’ve gotten some legal or risk management advice to not call it an “EMS standby.”  They think that by saying it’s only first aid that their liability will somehow be limited.  Truth be told, I’m not sure if it would or wouldn’t be limited.  But I know this much from law school — anyone that can be sued will be sued, both collectively and individually.  While you may not end up being found liable, I can guarantee that will not protect you from either a suit or the lawyer’s bills to represent you.  (Speaking of which, you do have your own EMS liability insurance to protect you and provide for legal representation, don’t you?)

This is the closest you’ll ever get to free legal advice from me. Just say no. You’re unlikely covered by any medical direction or protocols, which begs the question of what you’re doing there and whether you’re practicing “medicine” or delivering EMS care. And if all they want is “BLS” or first aid, why are they asking you to be there by virtue of you holding an EMS certification? I’ve helped at these events before and it feels very odd to be there without the ability to function at your certification level, assuming they’ve even verified your certification.

In the very best case, you’re probably going to be poorly equipped.  You’re even more likely to be expected to supply your own gear. And I will virtually guarantee that if something bad happens, you will be on your own. The worst part? Many of these events are for profit. Those that aren’t are usually run by nonprofits that have plenty of money for everything besides real EMS coverage. Many of these so-called event medicine companies have a business model based on you being an “independent contractor,” meaning that they’ll throw you to the sharks and claim that they had no oversight of you.  In other words, helping some of these events out for free as a “volunteer” isn’t much better than offering to drive Lyft or Uber for free.

If you truly want to “feel good” by volunteering, get a t-shirt, and/or be thanked for your service, there’s probably a volunteer service within an hour’s drive of you that would actually benefit from your volunteer hours. To me, it’s really ironic is how many paid firefighters/EMTs jump at the chance to work at these events and then say how volunteering “holds back the profession” and artificially lowers salaries.  If that’s the case, then it’s high time that we tell each and every one of these large public events that they need to provide EMS coverage just like they have porta-potties, trash collection, food service, and security on site.

Want to Volunteer?

Anyone who knows me knows that I’m pretty passionate about my volunteer work in EMS.  To me, it’s a wonderful way to give back and it’s a wonderful change of pace from my workday of moving contracts through the bureaucracy.

Those of us in the fire and EMS world hear a lot about the supposed shortage of volunteers.  Last week, I saw the irony of a state volunteer fire association doing a media outreach at the state capitol using trucks from a department that is primarily paid and doesn’t even have information on its webpage about volunteer recruitment.

So, in the spirit of an intervention filled with tough love, I offer you the following advice.

Want to join a volunteer fire or EMS department? Let’s talk about what happens.
1) Good luck finding the department online. If you do find them online, good luck finding an application.

2) If you do apply, you can expect some sort of committee process to see if you “fit in” with the prevailing culture of the department, which is probably dysfunctional.

3) If you have no interest in 80% of the fire department’s calls being medical, no worries. You don’t have to even get your first responder. But even if you already have your EMT or Paramedic, we will demand that you be a firefighter.

4) Training? What’s that? We’ll do training when we feel like it, on topics that only interest us, conducted by people with no qualifications. If you need additional training to maintain your certifications, that’s probably going to be on your own, with your own money.  But if the training sounds “cool,” you can fully expect that the connected members of the department will be travelling to it — on the department’s dime.

5) Equipment?  Yeah…. Here’s a t-shirt or two. We’ll issue you a radio, pager, safety apparel, and EMS equipment sometime, maybe — if we like you and/or you still keep coming around after putting up with us.

6) Leadership?  What’s that?  We’re likely run by a self-perpetuating group of insiders who are completely insular in our thinking and definitely don’t wear how anyplace else does things, especially from you, the new guy.

7) You’ll be on some sort of probationary process for a while, which will be a form of institutionalized hazing until we “check you off.”  Good luck getting one or two of the very specific training classes that you need to be released from probation.  We only offer those every few months at best.

8) We will continue the same things we’ve been doing for 40+ years, then wonder why we can’t find volunteers.

9) If we have paid guys, they’ll unionize and then claim that they can’t work with volunteers.

10) We will beg and plead everywhere for volunteers, show zero flexibility, and use that as political cover to put in another tax levy to pay for more unionized firefighters. Once we do that, we’ll then try to become an “all-hazards” department and get ambulances staffed by 18-25 year old firefighter/medics who want to do suppression only.

If you find a department where the majority of these thing don’t apply, stay there.  You’ve found a gem.

Brotherhood and Family

Everyone talks about the fire/EMS “brotherhood.”  Everyone says that we’re “family.”  Today, a few of my close online fire/EMS “family” were talking about how the term “brother” bothers them for some reason.

In the most abstract sense, I can get that.  “Brother” sounds like something you’d call someone in a religious order, a cult, or maybe the Moose lodge.  For some reason, I immediately picture Fred Flintstone and Barney Rubble in the Loyal Order of the Water Buffaloes.

But seriously, let’s assume that we want to be “brothers,” or to be politically correct and diverse, “brothers, sisters, and the pronoun you choose to identify with.” Well then, let’s really talk about what brotherhood and family mean in the fire/EMS world.

Brotherhood and family isn’t a t-shirt.  It’s not a cute slogan.  It’s not something we should do when it’s convenient.  It’s taking care of each other, watching out for each other, and yeah, it means we hold each other accountable too.

Brotherhood and family is checking on a partner after a rough call.

Brotherhood and family means taking the extra time to see a sick person in the hospital.

Brotherhood and family means that when you have a “brother” visiting from out of town, you spend a bit of time with them and maybe take them someplace local to get the feel of your home.

Brotherhood and family means that you take the time to mentor and train your station mates, even if both of you take time away from work to master the trade, because doing the job right matters.  Period.

One of my favorite incidents of brotherhood and family came when I did a ride at Station 11 in Clark County on the south end of the Las Vegas Strip.  As I was leaving, one of the firefighters gave me the station phone number.  I asked why.  He told me to call the station if I needed anything while I was in town because I’m “family.”

Brotherhood and family isn’t about hazing the rookies.  It’s not about creating a ridiculous paramilitary boot camp atmosphere.  And it’s sure as heck not about abusing the public trust or treating the public or our so-called “brothers” with anything less than respect.  And an IAFF sticker or a paid/volunteer status doesn’t mean a hill of beans about “brotherhood” or “family” either. It is always supposed to be about taking care of the public who implicitly trusts us to walk in their door at any hour and take care of them, hopefully like we’d take care of our family.

In other words, you can have all the slogans you want, wear all the t-shirts, say “brother” to everyone at the station, and eat all of your meals at the station’s dinner table as a “family,” but if you still have a toxic environment, inadequate leadership, a bunch of youngsters playing at being firefighters and medics, and a tolerance for inadequate service – then, no, you’re not my “brother” and you’re not my “family.”