You’re not that special. Really.

Posted on September 23, 2013 Written by

So, you think that your EMS system is broken?  Maybe even that EMS is broken?   And you’ve got the solutions: enhanced education, independent practice of paramedicine, an expanded scope of practice, getting rid of the deadwood, and definitely increasing the pay.

Well, la-di-da.  Welcome to the party.  You’re by no means the first and won’t be the last either.  Plenty of smart people have tried to do the same things.  The state of Texas initially was going to create a new level of paramedic to do just that.  In the legislative process, it got watered down to be the same level of paramedic, but with an associate’s degree or higher.  (See “licensed paramedic” in Texas.)   Several bloggers have pushed for EMS 2.0.   Mark Glencourse and Justin Schorr in particular.   Big name EMS educators like Kelly Grayson, too.   And the EMS Agenda for the Future started out with pretty lofty educational standards that were lowered to meet the needs of certain providers.

Plenty of people as smart as you (or even smarter) have said the same things.  Just as many of them have been like shooting stars — burning brightly, then fizzling out (or even crashing) rapidly.   Heck, I’ve even been in that fight myself.  (See my formerly ongoing pointless battle with a large third service EMS system about credentialing first responders as advanced providers.)

So what to do?  Simple.  Find the best EMS system that you can practice in.  One that works for you.  Make it the best place to be a medic that you can make it.  And the bad stuff?  The parts you don’t like?  Roll with it a little.   Things can be a lot  worse.

In the words of Kenny Rogers, “You got to know when to hold ’em, know when to fold ’em,
Know when to walk away and know when to run.”

Filed Under: EMS, EMS 2.0, EMS Politics

Don Quixote, Perfection, Mentoring, and EMS

Posted on September 22, 2013 Written by

Whew, that’s a mouthful.  And my apologies if this blog post comes across as a stream of consciousness rambling.  I’ve got a lot on my mind about some recent observations on some of the EMS Facebook groups.

A few weeks ago, I got “added” or invited to an EMS Facebook group that’s obviously populated by some pretty smart, perceptive medics.  As I’ve already shared my opinion of Facebook EMS groups and the “low information medic” demographic they skew towards, I was happy and excited to join such a group.  However, it’s pained me to watch the Don Quixote habit of tilting at windmills pop up.

Many of the best and brightest in EMS have tilted at EMS windmills over the years.  Bryan Bledsoe has done a great job at pointing out many of the flaws in EMS.  He does it with science, logic, reason, a dash of humor, and an incredibly likeable personality.  Unfortunately, so many of the super smart people in EMS who choose to tilt at the windmills fail in two aspects.  First, they have an incredibly poor sense of timing and perception.  Second, they tend to come across like Sheldon from The Big Bang Theory or The Comic Book Shop Guy from The Simpsons — socially awkward, judgmental, and more than a bit smug.  (Think about it, politics and music aside, socially, would you prefer to hang out with Ted Nugent or Moby?)

Pick our battles.  Yes, there are some low information Facebook groups out there that prey on the lowest common denominator of EMS.  Are we going to be able to change them?  Probably not.  However, those are not the people who are going to advance EMS.  If we pick our battles and learn how to work within the system, in future years, those same low information EMS types will still be on the transfer truck while the smart ones will be in management and clinical development positions.

Find like-minded individuals.  Associate with them, whether formally or informally.  Our national EMS association may have its issues, many of which I’ve blogged about before, but it will still be easier to fix EMS and our EMS association from within rather than merely complaining from the sidelines.  There are plenty of us who are still passionate about making EMS a profession.  Imagine what we could do if even 10% of us decided to run a slate of candidates for our EMS association.   Remember, politics is the art of the possible.  It takes compromise and deal-making to get things done.  These aren’t dirty words — just reality.

Until then, here’s some advice.  First, don’t argue with a moron.  They drag you down to their level and then beat you with experience.  Second, don’t let perfection be the enemy of the good.  I’ve had more than one instance in my EMS career where I wanted perfection instead of what worked.  In the process, I left more than one good place in EMS — and possibly burned some bridges in the process.  Finally, seek out a mentor.  I’ve been blessed to have several mentors in my EMS life.  They’ve given me sage counsel, especially from two perspectives. Number one, the “I wouldn’t do that if I were you” reminder.  Number two, the “Been there, done that” reminder.  If you don’t have a mentor in your vocation or avocation, you’re not setting yourself up to be a complete success.   Many thanks to the mentors I’ve had along the way of my EMS (and legal) career.  I shudder to think how many more mistakes I could’ve made.

Filed Under: EMS, EMS 2.0, EMS Legal, EMS Politics, Law

More on EMS Advocacy

Posted on September 19, 2013 Written by

One thing that really irks me about the so-called “Field EMS Bill” is how people think that creating a single Federal agency for EMS issues will solve the neglect that some perceive that EMS receives from the Federal government.  Of course, the limited government advocate in me says that being ignored by the Feds helps EMS overall.

Having said that, though, let me throw more cold water on the idea of a Federal EMS office, whether it’s in the Department of Homeland Security, Department of Health and Human Services, or even back in the Department of Transportation.   Such an office means that we’d have some sort of voice at the table, yes.  However, it wouldn’t necessarily be a true advocate for EMS.   Rather, it’d probably end up as some symbolic gesture where, at best, the bureaucrats could say that, “Yes, before we cut the Medicare ambulance rate again, we showed it to the Federal Office of EMS.”

To truly advocate for EMS, we need to step up and do what the other professions do.  Namely, we have to involve ourselves in the political process.   We need to donate to candidates, fight bad policies, and campaign like heck for those that do support EMS.  And we need lawyers and lobbyists too — to help draft legislation, to monitor legislation, and to monitor the bureaucracy’s actions and proposed regulations.

There’s no Federal Office of Physicians or Attorneys.  Why?  Because a real profession advocates for itself.

Filed Under: EMS, EMS 2.0, EMS Legal, EMS Politics, Law, Politics

Why the fire service succeeds and why EMS is in a rut

Posted on September 16, 2013 Written by

This past weekend, I had the opportunity to ride with the North Las Vegas Fire Department while at EMS Expo.  In addition to learning how they operate, my experience with Station 54 A Shift highlighted something that’s been in the back of my mind for a while.  We keep asking ourselves why EMS continues to flounder and why the fire service is seen as full of heroes.

From years of observing both the fire service and non-fire based EMS, I’ve observed a general rule.  Of course, as a lawyer, I realize there are exceptions to every rule.  Generally speaking though, the fire service sees themselves in the problem solving business. EMS sees itself in the transport business.

And if you’re only in one business, pretty soon that’s your solution to every problem given to you.

Lets become problem solvers.  Community paramedicine may be a first step along that path.

Filed Under: EMS, EMS 2.0

Welcome a new blogger

Posted on September 16, 2013 Written by

My friend, LadyMedic, is a new blogger.  She’s not new to EMS, though.  She’s an EMT with a large urban third-service EMS system in the southern half of the United States.  She’s also worked for transfer services, fire departments, and in hospital settings.   She’s pretty well educated and she’s a stickler for writing well.  All of those things make her a good blogger, an insightful mind on EMS, and a heck of a friend.    Without further ado, I give you the link to my friend LadyMedic.

Oh, she’s just started paramedic school too.   God help us all.

Filed Under: EMS, EMS 2.0

A time for reflection

Posted on September 11, 2013 Written by

Well, it is the 12th anniversary of 9/11 and I can think of no better way to dishonor terrorism than to spend time with my EMS friends and family, continue to be an infidel (bacon, anyone?), and get some EMS continuing education in the American testament to hedonism that is Las Vegas.

Part of vacation is a chance to renew and reflect and this vacation has been an excellent opportunity to do just that.  I’ve had the opportunity to renew and refresh my relationships with several of my fellow EMS providers and to finally meet some EMS leaders who I greatly respect, in particular, Pat Songer and Dr. Brent Myers.  I was fortunate to renew my friendship and clear any misunderstandings between Dr. Paul Hinchey and Dr. Ed Racht.   Yep,  I haven’t always been the fairest critic, but we are all on the path of wanting to do the best we can for our patients.   And when you start out the week helping in the cadaver lab alongside your mentor Bryan Bledsoe and your medical director Larry Miller, it’s going to be a great week.

More to come from Las Vegas, assuming I can pull myself away from the steak houses and buffets.

And as a personal request to EMS Expo attendees, please don’t wear the “Pass the Field EMS Bill” buttons unless you think that all that ails EMS is more Federal involvement and “free government money.”  We’re moving towards evidence based medicine.  It’s time that we move towards evidence based public policy as well.  And the history shows that more Federal involvement and throwing money at an issue is no solution.

Filed Under: EMS, EMS 2.0, EMS Politics

Food for thought

Posted on September 3, 2013 Written by

In law, you never hear “Legal assistants save attorneys.”

In nursing, you never hear “CNAs save RNs.”

Yet, in EMS, so many pride themselves on being the lowest level of certification by repeating “Paramedics save lives. EMTs save paramedics.”

To me, taking a sense of perverse pride in having only 120-180 clock hours of education, is but an example of the anti-education mentality that continues to hold EMS back from being even roughly equivalent to nursing.

And one final thought.  In EMS, you have to get an EMT certification before you can become a paramedic.   RNs don’t have to be LVNs first.  Doctors don’t have to be a physician’s assistant first.  And attorneys don’t have to spend time as paralegals first.

EMS still has a long ways to go.  I hope to see it get there.

Filed Under: EMS, EMS 2.0, EMS Politics

The truth hurts.

Posted on September 3, 2013 Written by

Fortunately, in most cases, my good friend the Ambulance Driver usually has a way of making painful truths funny as with his recent EMS 1 article entitled EMS: The Low Information Voters of Healthcare.

Kelly (oops, Ambulance Driver) nails it right on the head when he talks about so many EMS types immediately making decisions on emotion and superficial knowledge.  He’s also right when he talks about certain posts/stories becoming viral among EMS Facebook groups.  I observed the same thing in August when a years old article from JEMS about a jury verdict from a court in Florida turned into an opportunity for the average EMS social media user to show that they could never pass the bar exam.

I’m going to go one step further, and this is coming from someone who is a borderline addict to Facebook for socializing.  The growth of Facebook EMS groups is going to end up harming EMS professionally.  I’m not old enough to be an EMS dinosaur, but I vividly remember when clinically relevant discussions and professional networking were exceptionally common online, especially in the heyday of Yahoo Groups.

Now, we’ve devolved into a Jerry Springer/lowest common denominator of EMS networking online.  Facebook groups like “Paramedics on Facebook” and “The Most Interesting Ambulance Crew in the World” end up becoming little more than an opportunity to air our dirtiest laundry for the world to see.  Whether it’s active promotion of ignorance (e.g. “My buddy’s third cousin’s EMT instructor once said that someone got sued because they didn’t stop at a car wreck when they had an EMS sticker on their truck.”) or just willful ignorance (e.g. “I never was gud in skool and I can’t pass NREMT-B?  Can ne1 tell me how to get thru it so I kin git hired and start paramedik skool? THX –And don’t use my name.), these groups are showing the underbelly of EMS — the uneducated, the inarticulate, the buffoons, and the lazy medics (of all certifications). Additionally, factor in the “anonymous” questions that these groups post about medical-legal issues and employment issues where anyone with an internet connection or smart phone can share their ignorance and actually make a situation worse. In short, the denizens of these Facebook groups are little more than the online equivalent of the people at the EMS conferences with the “Big Johnson EMS” t-shirts.  And when your posts are full of misspellings and feeble attempts at mastering basic rules of grammar, I’m not surprised when you post about being unable to pass the National Registry and/or find a job in EMS.

In my other career, I’m a practicing attorney (and not completely incompetent, despite what a few state purchasing agents may say…).   I’ve yet to find Facebook groups like “The Most Interesting Law Office in the World” for attorneys.  And I’m pretty sure that, jokes aside, most attorneys consider what we do to be professional work and take it seriously.  Having said that, the best attorney jokes usually do come from attorneys.  It is possible to take the work seriously, yet still have fun with it.

Sadly, the majority of what passes for EMS social networking these days proves why EMS isn’t considered a profession.  It may well prove why so many places pay their EMTs and paramedics what they do, though.

 

Filed Under: EMS, EMS 2.0, EMS Politics, Rants

Uncomfortable EMS Truths

Posted on August 23, 2013 Written by

1) The Eagles represent the medical directors of the 50 largest EMS systems, not the 50 best EMS systems.

2) JEMS may have “Journal” in its name, but it is not a peer reviewed academic journal.

3) Calling yourself an EMS professional doesn’t make you a professional.

4) Despite their claims to be the voice of the field EMS provider, the overwhelming majority of the board of directors of the National Association of EMTs are actually EMS managers.

5) Good EMS systems aren’t good solely because of response time or cardiac arrest survival rates.

6) Anytime the committee is an EMS and Trauma Committee, be assured the nurses will take over and set the agenda.

7) EMTs and paramedics diagnose patients.  And if you aren’t making a diagnosis, you probably don’t have any business treating the patient.

8) Yes, Page, Wolfberg, and Wirth is a law firm for EMS, but it’s even more so a consulting company for Medicare/Medicaid billing.

9) Anytime you hear the term “high performance EMS,” expect to see ambulances parked in parking lots, not based in stations.

10) The only difference between EMTs and Paramedics is that Paramedics have more ways to kill a patient.  Good assessment skills are something that ANY certification level can master.

11) Malpractice insurance doesn’t make you “more attractive” to plaintiffs.  It’s merely self-protection in light of the reality that your EMS employer may not have your best interests at heart in the event of a malpractice claim.

12) As long as the same people are involved in the upper echelons of EMS management and education, EMS 2.0 is gonna look a lot like EMS 1.0.

13) And another uncomfortable truth, albeit not EMS….  The Dallas Cowboys will never again go past the first round of the playoffs until Tony Romo goes away.

Filed Under: EMS, EMS 2.0

We’ve found what’s holding EMS back.

Posted on August 20, 2013 Written by

It’s us. Or rather, I should say it’s what my high school history teacher called “the dirty unwashed masses.”

These are the people who hold EMS back. These are the people who want the shortest, quickest course they can find. These are the people who say “just teach me the skills.” These are the people who are the “cannon fodder” who are willing to work at minimum wage for a fly-by-night transfer company. These are the people who can’t follow the simple instructions to obtain their National Registry certification or obtain a state certification. These are the people who can’t string together a comprehensible sentence.

I’ve heard before that physicians write EMS protocols to the lowest common denominator. Having seen some of the posts on several EMS sites, I’m inclined to understand why.

And until we set higher standards to be a medic of any level and to remain a medic, we have only to look in the mirror at why RSI is a rarely granted privilege, why endotracheal intubation is going away, and why community paramedicine will most likely remain mental masturbation.

In other words, this is why we can’t have nice things to play with.

Sorry to rant. I’ll go back to my legal work now.

Filed Under: EMS, EMS 2.0, Rants
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