Tuesday, July 31, 2007

Chief Justice gets ride from volunteer EMS

Summer in Maine is very busy. The influx of tourists--and U.S. Supreme Court Chief Justices--certainly stirs things up a bit.

This article in the Boston Globe is a wonderful story about a dying breed in EMS: the community volunteer.

This isn't about pros and cons of volunteer EMS. Sometimes it is nice to see good news about EMS. Community involvement and the old fashioned concept of neighbors helping (famous) neighbors is certainly good news. It might be more nostalgic than commonplace today--especially for us old-timers.

And continuing the good news: AMR has not gone on strike.

I hope your summer is great. Thank you for stopping by.

Thursday, July 26, 2007

Five articles you should read today...

I peruse the Internet for interesting EMS stories. Here are five I think you should read:

Another opinion on the AMR strike in New England.

Hospice cat predicts patient deaths with amazing accuracy.

The St. Petersburg Florida Times calls death a tragedy. A man codes at a VA hospital but is transported to another hospital 10 minutes away. Tampa Bay Online posted a follow-up

This article is about an EMS conference in India. While you check out this article see if an ad for dating in India comes up on the page. It is a fascinating cultural perspective. It doesn't say "man seeking woman." You look for a "bride" or a "groom." If you go in to the site looking for women you will see that many of the personals were written by the girl's parents--not her.

Some days people really do appreciate what we do.

Wednesday, July 25, 2007

EMS workers to strike Monday

Foster's Daily Democrat (New Hampshire) is one of many media outlets reporting a pending strike against American Medical Response (AMR) in Massachusetts, New Hampshire and Maine.

This will have an impact on EMS--both emergency response and non-emergency transports--throughout the northeast.

The news article contained the expected positioning quotes from both sides. In this case, I think the union has some valid points--and AMR's pockets seem deep enough to share a wee bit of wealth with its employees.

In addition to a prior post in this blog in reference to AMR, Reuters listed this report on AMR's parent company first quarter earnings:

May 3 (Reuters) - Emergency Medical Services Corp. (EMS) on Thursday reported first-quarter results that topped Wall Street estimates, and raised full-year profit forecast as it continued to win new contracts and renew agreements.

Shares of the company were up almost 10 percent at $36.76 in late morning trade on the New York Stock Exchange. They had hit an all-time high of $40.90 earlier in the day.

Strong performance from the EmCare segment combined with overall cost reductions led to the performance, J.P. Morgan Securities analyst Andreas Dirnagl said in a research note.

EmCare Holdings Inc., the company's emergency department and hospital-based management services segment, recorded a 23.8 percent higher net revenue for the quarter.

American Medical Response, the other segment that operates medical transportation services, saw a 4.3 percent increase in net revenue during the period.
"We continue to look for impressive growth out of EmCare as more hospitals realize the advantages of outsourcing the emergency department to such an efficient operator," Dirnagl added.

AMR can't be the fall guy for the lack of pay and professionalism in EMS. However, I do know several AMR employees in this little corner of the world...and none are getting rich.

To be fair, striking should never be done lightly. In the EMS biz lives are on the line. Both sides need to come to the table in good faith right to the end.

In a recent filing with the Securities and Exchange Commission, AMR was described like this:

About American Medical Response
American Medical Response Inc. ( www.amr.net ), America's leading provider of medical transportation, is locally operated in 36 states and the District of Columbia. More than 18,000 AMR paramedics, EMTs and other professionals transport nearly four million patients nationwide each year in critical, emergency and non-emergency situations. Operating a fleet of approximately 4,400 vehicles, AMR is headquartered in Greenwood Village, CO.

It is time for AMR to show how important their professionals truly are.

Monday, July 23, 2007

More on Ohio EMS fatalities

The Toledo Blade ran a follow-up story to the Ohio EMS fatalities mentioned on this blog yesterday.

With most emergency vehicle crashes, speculation develops about one or two things: was lights and siren transport necessary? and Who had right-of-way? In this crash there was speculation about whether lights and siren were necessary:

Because it appeared the Wellses’ injuries were not life-threatening, “There was no emergency that would warrant running lights and sirens in most people’s eyes,” the sergeant said.

But Sergeant Haas also said something may have happened medically to the couple along the way, causing the ambulance driver to want to get to the hospital more quickly.

“We’re never going to know,” he said. “The people that have that information didn’t make it.”

At least in this case the quote from the police sergeant was balanced.

The right-of-way issue is more complicated. Years ago, ambulances were involved in accidents. "Fault" was the term used to describe the cause of the accident.

Things have changed. Now we call these events crashes or collisions because many are preventable. Fault is important but not the gold standard. An emergency vehicle operator can find themselves not at fault but still in trouble at the agency level because the crash was preventable.

The days of police officers confirming that the lights and sirens were on then automatically giving the other driver a ticket are over. And the results are tragic. This document from the Centers for Disease Control (CDC) looks at ambulance crashes from 1991 - 2002.

In this case the police suspect the driver of the ambulance may not have seen the tractor trailer because of its position in the intersection. The ambulance had the stop sign.

The crash here in Maine is still under investigation. In this case the ambulance was on the main road and the truck that struck the ambulance had a stop sign. I'll post details on both crashes as they develop.

The take-home point: July isn't over and we have already lost 4 EMS personnel to motor vehicle crashes. These crashes kill more EMS providers each year than violence and rescues combined.

We must now mourn and pay our respect to those who died doing the job we do every day. It is about healing. About supporting each other in the small towns of Maine and Ohio where we have lost comrades. Details on the crashes can wait.

But today it must also be about safety. About caution. About rethinking the decisions we make every day. And about re-engineering vehicles and practices to provide the safety and piece of mind we deserve as we care for our patients.

Leading cellist becomes paramedic

Occasionally we forget the low pay and long hours involved in EMS and are reminded of the passion that brought us here.

Leading US cellist Nancy Donaruma, 59, followed this passion and is now a paramedic. Quoting an AP article:

After 31 years in the top-tier orchestra, playing with conductors including Leonard Bernstein, Zubin Mehta and Lorin Maazel, the 59-year-old cellist will go from a hefty six-figure annual income to a "low five-figure" salary.

People of all ages and all backgrounds come to EMS for reasons ranging from interest in medicine, a desire to help, or for those brave enough to admit it, the thrill. Some things are certain, though. The money isn't there. The thrill is fleeting (ask anyone who has transported the patient with a dislodged catheter at 3:00 am). And the work is less than glamorous most of the time.

As cellist Nancy Donaruma said,

"I've always had an interest in how the human body works — and doesn't," she said. "And I do like taking care of people."

I believe you have read similar words here before. EMS is about taking care of people. Those who embrace this thrive, those who don't move on.

If you work at Alamo EMS in New York there is now one additional reason to stay in EMS: free cello concerts.

Saturday, July 21, 2007

3 EMS providers die in Ohio crash

An article in the Toledo Blade reports three EMTs and two patients in their ambulance were killed last night after their ambulance was struck by a tractor-trailer and burst into flames. A fourth EMT and the driver of the truck are in the hospital.

These providers were volunteers from a small town. Please remember them in your thoughts and prayers.

More details as they become available.

Friday, July 20, 2007

The business of EMS

In my daily research on EMS I have seen several articles about Emergency Medical Services Corporation. EMSC describes itself on its web site as

...the leading provider of emergency medical services in the United States.

They operate two companies you my be familiar with: American Medical Response ambulance service and EmCare emergency medicine.

This article describes a recent acquisition of Abbott ambulance in the St. Louis area as well as Mission Care ambulance of Illinois, a company called Access2Care (a managed transport comany) and IHM Health Studies Center (a paramedic training program).

The usual quotes about opportunity, synergism and expansion followed:

"This acquisition provides EMS entry into a new market in two business lines," said William A. Sanger, EMSC chairman and chief executive officer, "A strong and well-managed company, Abbott will serve as an excellent platform for expansion of our ambulance services in the Missouri and Illinois markets.
"Abbott's managed transportation business, Access2Care, offers us opportunities to expand our managed transportation services into the commercial market. Abbott's IHM Health Studies Center is a strong addition to AMR's National College of Technical Instruction (NCTI), the largest paramedic training school in the nation."

Those happy, work together, pre-merger quotes are sometimes fleeting. I'd love to hear from some EMS providers in the area to get your perspective.

One thing is for certain, EMS (AMR) is a huge corporation--and getting bigger. And not only in the ambulance biz but training as well. The stock market seems to be taking notice. On August 1, 2006 EMS stock closed at $11.75. As of this writing (just short of a year later) it is selling at $42.90.

Should have bought some of that last year.

Thursday, July 19, 2007

Fire service first response--sort of

The Times Herald Record in Middletown, NY reports a story in which a local fire department was asked to cease first response to medical emergencies because they had minimal training and weren't registered as a first response agency.

Interestingly, the fire department wasn't asked to stop by the local ambulance service. It was one of the department's own commissioners who brought this up. According to the paper,

"The members say we should go anyway," said Commissioner Bill Lothrop Jr. He wants only qualified people running those calls, and only when the ambulance is delayed. "Of course we're worried about liability. In today's day and age, isn't everybody lawsuit-happy?"

The Mamakating First Aid Squad which serves Wurtsboro takes a mature, well stated, community-oriented stand:

"Having them there, the patient will feel more at ease," said Peter Goodman, Mamakating's captain. "You're not going to hurt someone by giving them oxygen."

Yes, the fire department should try to get more members trained as first responders. They should file the state paperwork. But in a world where it is more and more difficult to find volunteers, and at a time when people seem less neighborly in general, here is a group of people who want to help. And help they should.

This is also a lesson to advanced life support students and providers. Even without a lot of training I am sure that the efforts of the members of the Wurtsboro Fire Department are deeply appreciated by the citizens. I'd even feel confident saying that citizens of Wurtsboro will remember that bit of oxygen, hand holding and concern much more than they'll remember any skill performed on an ambulance.

Because when it all comes down to it, EMS is about taking care of people.

Wednesday, July 18, 2007

NAEMT moving in the right direction

Two things recently caught my eye about the National Association of EMTs. They are moving to online elections in which all members can participate and they are hiring an executive director.

While the organization has been in existence for years, many in the EMS community consider NAEMT a club rather than a membership organization with any muscle in EMS. I have largely fallen into that belief over the years.

The previous structure in which a Board of Governors elected officers created the appearance--and in some cases a reality--of a good old boys club was ineffective and incestuous. In the past when I advocated for general elections the concern was that votes off the floor would be stacked for local candidates in the state/region the conference was held. The Internet made this argument moot.

There is also a move afoot to reevaluate the societies within NAEMT. Another good move.

Now that NAEMT has made some significant changes I would say this:

These steps are a beginning to becoming a powerful national organization.

You will need to choose your executive director carefully. Then you will need to create a job description and not micromanage him or her. The goal of this person should be to increase three things: voice in EMS, credibility and true members (not numbers inflated by freebies).

You will need to invest in meaningful leadership development for NAEMT officers and board members. We could easily elect popular people. This does not equal vision or leadership. Over the years I have seen highs and lows in this area.

You will need to get the membership to vote--and then be active in the organization. This will be the true measure of credibility and success. He who harnesses the passion of EMS wins.

Every year at the annual conference Ken Bouvier, Paul Maniscalco, Ed Sawicki and Gregg Lord pull me aside and lobby for NAEMT. They told me things could improve. There was potential. I was skeptical, but respected their dedication.

You now have my attention. I'm going to pay my dues and vote.

Plus, I like to point out good things on my blog from time to time...

Saturday, July 14, 2007

Allan Parsons' last ride

A Maine paramedic was killed when the ambulance he was riding in collided with a pick-up truck in the early morning hours of July 7th. Paramedic Allan Parsons was treating a patient in the back and was pronounced dead at the scene.

I am a photojournalist and requested the assignment to shoot his funeral. I included two images in this post. The photo of the paramedic's young son kissing his father's casket ran on the front page of the Sun Journal in Lewiston, Maine.

I included the second photo because it had a profound impact on me. I didn't know Allan Parsons. From the wide variety of passionate speakers I heard at his funeral it was easy to see that he was a dedicated, funny, caring, passionate family man and paramedic.

At the end of the service I pulled the funeral director aside to make sure it was OK to get into the cab of the ambulance as the casket was loaded. This is how I got the image of Parsons' sons at the casket.

I watched Allan Parsons' co-workers load the casket, stand there silently for a moment, then close the doors. I clicked the camera shutter as the back door of the ambulance closed.

I never met Allan Parsons. But from a vantage point no one else had, I saw--no, I felt--the ambulance doors close for the last time.

It was fortunate I had to quickly exit the ambulance so Allan's co-workers could get in to drive him past the hundreds of saluting emergency services personnel in dress uniforms standing by dozens of gleaming ambulances. Because at that moment my skin tingled, my eyes welled with tears and I realized this was the start of Allan Parsons' last ride.

As I write this, 48 hours later, I can still feel the door close. My skin still reacts with a similar chill--even though as a paramedic I have heard ambulance doors close thousands of times before.

Friday, July 13, 2007

David versus Goliath

When I was a police officer there was a noteworthy homicide trial. The top prosecutor went up against a poor, minority defendant who acted in his own defense. The prosecutor lost. Not because of anything he did, it was because the jury felt sorry for the defendant. A classic David vs. Goliath scenario.

David vs. Goliath is a classic story--only now it seems to involve Bryan Bledsoe and NAEMSE. And Bryan Bledsoe is no ordinary David.

Previous posts on this blog have discussed the NAEMSE/Bledsoe situation. It continues. I received the following email from Bryan last night:

To all:

I have received a letter from the NAEMSE attorney in regard to this email I sent in anger. Thus, I must respond:

1. I am not involved in planning or developing another EMS organization nor have I been although it has been suggested by others. I will remain a member of NAEMSE for now.

2. The former NAEMSE webmaster who contacted me and offered material about elections and defamatory emails about me evidently came about these illegally and thus I must retract the statement that an affidavit would be submitted.

3. I would not compromise any contractual relationships between anybody and NAEMSE. First, I do not have that power and do not have that interest. The NAEMSE attorney has accused me of that but has not submitted any evidence to that effect. I have not contacted any vendors or sponsors, never intended to, and have no plans to.

I have attached a copy of the attorney letter if anybody is interested. I will attend the NAEMSE meeting in Hollywood to staff the Brady booth and attend meetings. I will evaluate my need to attend future NAEMSE meetings on a case by case basis. This will end anything I will say in writing or orally about NAEMSE henceforth.


Bryan Bledsoe

The email also contained a copy of the letter from NAEMSE's attorney, Pantelis T. Papazekos. Click on the letter to read it.

Disclosure time. I know Bryan Bledsoe. I write for the same publisher. I also realize that by posting this letter I am potentially furthering Bryan's stand.

So what. I think NAEMSE flubbed this one. They threw gasoline on the fire rather than letting it smolder out. They could have taken a high ground. Weathered the storm. Stood on their good intentions. Instead they moved themselves into a defensive position. And it isn't becoming.

More and more people are questioning the intentions of the organization. Why are my dues paying $400/hour to consult attorneys and write letters when NAEMSE should be concentrating on fixing what is broken?

I believe there are many people telling NAEMSE what is broken. Is NAEMSE listening? I guess I'll find out if I get a letter from Pantelis T. Papazekos.

Wednesday, July 11, 2007

Fire Service and EMS...again!

A document which has been referred to as the "Fire Service EMS White Paper" recently entered my email box.

My first observation from this paper is that 4 well known and talented fire service docs got together and published this paper. The fire service (IAFF, NFPA) quickly flew the white paper "flag" yet there are no logos or indications of endorsement on the paper itself.

It isn't really news that the fire service wants to do more EMS, and in some cases--but clearly not all cases--should. I guess I'm left wondering how a history lesson, a few examples and some muscle flexing gets billing as a white paper. I'm not sure it does the fire service justice and may even sell it a bit short.

John Becknell authored an opinion piece published on the Missouri EMS Association web site in response to the white paper. He brings up some good points.

For EMS to thrive in the fire service deep cultural changes will be required. These changes are the most difficult to make. Many city fire departments have merged fire and EMS and have stumbled (in some cases fallen flat) over these cultural differences. I have blogged about this previously.

In my small part of the world, firefighters are "stuck" on the rescue until they can bid off to a secondary, lower-volume rescue and eventually an engine. Why? Engine companies have a dramatically smaller call volume than the rescue. The least experienced people are always on the rescue. Don't get me wrong, they have the right to bid off. It just isn't good for the system.

In many cases there are no organizational benefits to working more as far as pay or promotion and in many cases it is cultural and career suicide to be a band-aid in a nozzle-head world.

With this paper the fire service has essentially lifted its leg and "marked" EMS as its own. The true test will be whether they have the commitment and institutional flexibility to be the EMS that patients need.

Monday, July 9, 2007

Active Shooter Training

I still do a bit of police work. Having done it so long it gets in your blood and stays there. Like bacteria.

Seriously, I attended a training session focused on how to respond to a call for an active shooter (e.g. Virginia Tech). I find it amazing how philosophies have come full circle over the years.

Long ago, old-time cops just went in and handled whatever came along. Then tactical teams were developed. First arriving officers secured a perimeter and waited for the team. Guess what? We're back to the first officers taking action.

While I am prohibited from talking specific details, the newest thinking is when the first arriving officers hear gunfire, they form a team and combine some tactical training with the need for immediate action to save lives and go in.

Thursday, July 5, 2007

Catching up

While taking some time off over the 4th of July I had this feeling I was forgetting something. The blog. Frequent posts grow a blog. Comments make a blog better (hint, hint). So, catching up with the world of EMS:

Jems.com reports another defibrillator save. This time by an ED physician at a church with a defibrillator.

In London, two car bombs were found--fortunately before they detonated. The second bomb is believed to have been planned as a secondary attack to injure rescue personnel and police. The story, if by chance you haven't seen it. Here is the medic's account from the BBC. Be careful out there.

Last weekend I put on my photojournalist hat and shot the protest in Kennebunkport. Three presidents (41, 43, Putin) and 2,000 protesters made for quite a day. There were even counter-protesters. It is always interesting.

You can also see an audio slideshow I produced.

Thats it for catching up. Until next time.

Line of Duty Death - Maine

It has been quiet on the blog this week. I've been in vacation mode. I'll begin posting again with some sad news.

Allan Parsons, a paramedic with MedCare ambulance, was killed this morning in a motor vehicle collision. Allan was in the passenger compartment and was pronounced at the scene.

The driver of the ambulance, Arlene Greenleaf, remains in ICU after surgery. Arlene is 68 and has had a long and strong presence in EMS. Even after receiving a lifetime achievement award she remained in the business. Arlene was driving at 3:00 am when many people with as much seniority have retired and almost all are asleep.

The patient in the back of the ambulance and the driver of the truck that collided with the ambulance are also in serious condition as of this writing.

Maine is a large state with a small EMS community. This loss has been acutely felt throughout this community.

Each year about 20 or 30 EMS providers lose their lives in the line of duty. Please take a moment to reflect or pray for the providers in this horrible crash. And be careful out there.