My email to Senator Exum

Senator Exum,

I am a paramedic and former Maryland resident. I am writing to tell you that the comments you made in reference to paramedics and firefighters in The Capital are insulting and inappropriate. In the event you don't recall the comments, I'll copy them here:

"But we aren't even able to talk about it," Mr. Exum said of the intense lobbying pressure. "They (state police and the Maryland Institute for Emergency Medical Services) call all the little people back home, the firefighters and the paramedics, and tell them we are trying to dismantle the system, and they come running." Mr. Exum said.

Maryland has a long tradition of proud service in both firefighting and EMS. The firefighters and emergency medical services personnel, both paid and volunteer, deserve better than to be referred to as "little people back home."

Perhaps these comments come from an over-inflated sense of self worth on your part. In my opinion, most people appreciate their local heroes much more than their politicians. Your behavior simply reinforces that belief.

I recommend an immediate public retraction and apology for your offensive comments.

Sincerely,
Daniel Limmer, EMT-P
Kennebunk, Maine

Senator Exum, please remove the foot from your mouth

I search the web every day for interesting articles to post. I find so many heroic and exceptional providers I can't list them all. I find systems losing volunteers, systems needing funding and systems with call volumes skyrocketing.

I also find politicians who don't give us the respect we deserve. Enter Maryland Senator Nathaniel Exum, D-Prince George's. While discussing whether the Maryland State Police helicopter program should be privatized he told The Capital:

"We have some concerns about the system, and the public needs to know," said Sen. Nathaniel Exum, D-Prince George's, who sponsored a bill four years ago to establish a medevac privatization pilot program.

"But we aren't even able to talk about it," Mr. Exum said of the intense lobbying pressure. "They (state police and the Maryland Institute for Emergency Medical Services) call all the little people back home, the firefighters and the paramedics, and tell them we are trying to dismantle the system, and they come running."

Little people? Regardless of your opinion on the helicopter system please let Senator Exum know what you think of this comment. Maryland has a quality EMS system with proud, talented people. They deserve better.

As a service to those reading this blog, here is the contact information for Senator Exum:

James Senate Office Building, Room 303
11 Bladen St., Annapolis, MD 21401
(410) 841-3148, (301) 858-3148
1-800-492-7122, ext. 3148 (toll free)
email Senator Exum

Even if you aren't from Maryland, Sen. Exum should know EMS won't stand for being treated like this.

Everyone loses on a call like this

Calls like this cause hearts to sink--for both the family and the EMS providers.

Family: Rescuers Questioned Need To Transport Baby Who Later Died

It is important to note that no details have been disclosed and it is not the intent of this blog post to second guess or make any opinions for or against anyone in the call.

One thing is certain, a family is grieving and an EMS crew is under investigation and will likely have some deep emotions about the call as well. The call does reinforce some other commonly taught themes:

1. Patient refusals are a leading cause of liability in EMS
2. Sometimes patient perceptions are their realities--especially in times of deep stress and emotion
3. Incidents that cause EMS providers stress aren't just bad trauma calls--or even kid calls. Stress comes from bad outcomes regardless of perception of fault. The perceptions and whisperings of colleagues can be very painful in the social microcosm of EMS or fire stations.

I will keep an eye out for updates. My thoughts go out to both the family and the providers in this tragic situation.

New drug hitting the streets

Just off the wire:

Dexaflox5 gets users high

Cutting edge information such as this is why EMSers in the know read my blog...

EMS Education Standards update

Last month I attended the National EMS Education Standards Stakeholder's Meeting in Washington, DC. Representatives from national EMS, fire, medical and government organizations were present to provide input to the project team.

The meeting was run by a professional facilitator. This resulted in meeting speak such as placing agenda items in the "parking lot" and requesting comments be "robust and succinct." While the inner child in me giggled when these phrases were used, the end result was a worthwhile meeting which I am happy to have attended.

I do have concerns from the meeting. The first is that controversial items such as accreditation of paramedic programs weren't the hot button I expected. I am afraid this means some stakeholders avoided the topic at the meeting but plan to oppose this in other arenas (e.g through political or other pressures on NHTSA).

The second area of concern is the instructional guidelines (IGs). The educational standards are broad stroke and conceptual. Instructional guidelines were initially proposed to help clarify the standards without being prescriptive as to content.

The instructional guidelines haven't been updated since the first draft of the standards. As we prepare to move to the third and final draft of the standards it looks like the IGs need to be trashed and begun again.

The primary issue noted by the project team is that the IGs are unfunded. They have been a bit of an albatross for the team--but a necessary one.

As an educator and textbook author I an deeply concerned about the process if the educational standards aren't accompanied by IGs. Interpretation of the standards without some clarification could be tragic for EMS education.

An example is patient assessment. The standards describe a primary and secondary assessment process but no further details are included. Now imagine authors such as myself and Mike O'Keefe, Joe Mistovich, and Walt Stoy and Tom Platt working separately writing a book and defining the steps of the assessment process. Everyone's would be different. Perhaps dramatically different. Every textbook/publisher could have a different assessment process. How would this be tested nationally?

IGs level the playing field. Without them there isn't a playing field at all.

I believe the education standards project is a step forward for EMS education. The less prescriptive process should make this more of a living document. IGs are a necessary item to assure some level of uniformity--at least until EMS practice and education matures and becomes less region- and state-centric similar to other medical disciplines.

Nebraska EMS Association

I just returned from the Nebraska EMS Association conference in Columbus, Nebraska. There I met about 400 of the most enthused EMSers one can find. I would recommend the conference to anyone. I would caution anyone venturing to the conference to be wary, however, of evenings at the bar and annual dinner. They know how to have a good time in Nebraska.

The attendees also know how to learn--even after nights in the bar. It is refreshing to speak to attendees who are eager to learn and stretch their knowledge and practice. I had the good fortune to speak there with Heather Davis and Chris Nolette. It was the first time I met the knowledgeable Dr. Nolette, a Texan who now lives in California. This combination leads to some very funny stories.

I also had the opportunity to ride with Omaha Fire Rescue Medic 21 and Columbus Fire Rescue and was able to observe and photograph quality EMS in action in America's heartland.

A friendly tip 'o the hat to my new friends in Nebraska. I hope to see you again soon.

Real Life EMS 2008

Here is the first issue of Real Life EMS for 2008. Click on the cover to enlarge it.

In case you don't get my not-so-subtle point, the professionalism we want must be earned. The respect we crave is earned. The aggressive protocols we want--you guessed it--earned.

Be a clinician. Dig into some research and make an educated stand to your medical director or regional authority. Don't whine about your protocols not being as good as the next region or state.

Change begins within. You'll be surprised what can happen.