Why is it never discussed that EMS take over fire?

Did I get your attention yet?

This quote from Collier County, FL Medical Director Bob Tober (in reference to fire absorbing EMS) sure got my attention:

“Somehow, providing BLS and the initial ALS (which is all they are really trained to do) is not enough for them because of 1) control, 2) power, 3) influence, 4) some revenue from transport, 5) justification of their existence,” Tober wrote. “Do not forget that 90 percent of what fire (rescue) does is medical. Since EMS is the medical specialist job description in our county, why is it never discussed that EMS take over fire?”

Wow.

Read the rest here.

Crashes and clashes...both too often in EMS

The Burlington Free Press reported yesterday on a crash that killed a patient and seriously injured the EMT in the patient compartment.

The article, Crash spotlights ambulance risks, is a good review of the issues facing EMTs in the patient compartment. With winter squarely upon us we must all be careful out there.


In the clashes category, the Naples Daily News reports on a county system in transition: Power, politics and money beneath fire merger talks. And EMS is squarely in the middle of the clash. While the devil is in the details when negotiating any merger, success is measured years later by how well a central culture of quality and respect is created from several different agencies.

My best wishes to the patients and providers in Collier County for a successful merger.

Allan Parsons slide show

It is difficult to believe that almost 4 months have passed since Allan Parsons was killed in an ambulance collision. I shot the funeral for the Sun Journal and also recorded audio.

I recently created an audio slideshow of the funeral which I am releasing so it will be available on the 6 month anniversary of his death. The ceremony was profoundly sad, yet remarkable in the number of providers present and the depth of the respect paid to Allan.

Alan Parsons' funeral slide show

Please feel free to place the link on your web site and forward this to anyone you wish.

Please take a moment to remember Allan and all those in the emergency services who made the ultimate sacrifice.

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.

You can lead a horse to water...

Millstone, NJ is having emergency service problems.

Millstone, NJ has a first aid squad. They also have a fire department. According to an article in the Examiner of Allentown, NJ, they don't work together.

It appears that first aid squad members respond from home some of the time. Firefighters sit in the station, able to respond, but can't.

Even more absurdly, it appears that when the Millstone First Aid Squad is on a call, another Monmouth County, NJ mutual aid squad responds to Millstone...while the firefighters still sit in the station.

Here are some killer quotes from the article:

Millstone Committeeman Ramin Dilfanian in reference to the First Aid Squad and Fire Department:

"I can lead the horse to water, but I can't make it drink," he said. "I can get the groups together, but I can't make them cooperate and work together."

and in the "I'm glad its not my heart category.."

First aid squad member Tina Mitchell said the first aid squad currently does not need the help of the firefighters and that the squad's response times are in line with the mutual aid system in Monmouth County.

So, Tina, what you are saying is that it could be faster if the FD responded but since we're in line with the county, the extra minutes a loved one spends in cardiac arrest is OK.

No, wait! The First Aid Squad has now decided the fire department can respond to cardiac arrests and unresponsive people.

At the fire commissioners' monthly board meeting June 11, first aid squad Capt. Bob Trifiro attended to discuss the first-responder issue. Trifiro told the firefighters that they could respond to emergency medical calls involving unconscious victims and to calls during which cardiopulmonary resuscitation (CPR) is already in progress.

I'm sorry if that doesn't leave me teary-eyed with the spirit of cooperation. Its not enough.

But what about the breathing difficulty patients, the patients with anaphylaxis, those with chest pain that haven't yet died? At least death finally invokes the First Aid Squad's blessing for the FD to respond.

There is a fable about a dog walking over a bridge with flesh in his mouth. He looks into the water and sees another dog with a bigger piece of flesh. He opens his mouth to grab the other dog's meat and loses his into the water--his greed costs him everything.

If I lived in Millstone, NJ and I had to wait even two extra minutes when EMT trained firefighters were there to respond sooner--or if an out of town squad had to respond in while firefighters were there to respond much sooner I'd be livid. Litigiously livid.

Like the dog with the flesh, some squads turn down help when they need it out of a sense of pride, threat--or greed. This leads to the demise of a squad faster than if they took the help and built the team that best served the citizens.

Plus--it is never wrong to do what is best for the patient.

Backboard Bubbles

During a conversation with my friend, Jon Politis, I learned of a solution to the pain and discomfort caused by spine boards.

It is well acknowledged that immobilization is uncomfortable. Prolonged immobilization causes pain and can make it challenging for hospital personnel to determine if spinal pain is from an injury or from the immobilization.


Two EMS Asst. Chiefs at Colonie EMS, Paul Fink and Ray Hughes III (both of whom I had the pleasure of learning from in my early EMS days), came up with a practical and inexpensive way to reduce this pain--bubble wrap!

This solution is cheap (bought in a large roll it works out to about 10 cents/patient) and effective. I'm guessing if patients were stressed they could calm themselves by popping the bubbles along the edge of the backboard on the way to the hospital.

I wonder why more squads don't do this? I'll bet a manufacturer will come out with a "medical-grade, hypoallergenic, OSHA approved, association-endorsed" product--which will still essentially be 10 cent bubble wrap...and cost $25.00 per disposable piece.

I'll stick with Paul and Ray's bubble wrap. It just makes sense.

Glad he's not my boss - part 2

This one goes into the category of "if you think your city administration is bad, you could always work in Ridgeley, WV."

While cruising the Internet for something of interest I hit the jackpot.

I saw an article in the online edition of the Cumberland (MD) Times-News about how the fire department ambulance is in its thirtieth year. Call volume continues to increase but the paper reports the FD is handling it well. The chief was one of the original EMTs. Good for them. This is nice--but not mother of all stories for a blogger.

While looking at the related story links I saw an article that reported the police chief and town clerk of Ridgeley, WV were fired by the mayor--who called in from jail! Hard to believe, but true. The mayor, Mitchell Reeves, was arrested for fraud one month after being arrested for driving without a license.

It could always be worse. You could be in the public safety biz in Ridgeley, West Virginia.

Conversation anyone?

This blog has been in existence for about 6 weeks. I have made 24--now 25--posts. Since May 21st (about three weeks) there have been 205 visitors to this site from around the world. These visitors have looked at 379 pages and spent an average of 2:29 minutes on the site. I know this because I put a cool tool called Google Analytics on the site. This can tell me what city people view from, what they look at and how long they stay on the site. And it is free.

Wow.

The purpose of this site is to talk about EMS. News, opinions, insights, practice, learning and education. The good, the bad and the ugly in the world of EMS.

At this point I ask you, in addition to reading my posts, to please post a comment. I can't believe that no one has had a thought about news I have found or thoughts I have written. I am actually quite good at controversy (stay tuned for more of this)...although some may even agree with things I have written.

The measure of a blog is not only that it is looked at, but that people interact and comment.

Thanks for coming by (again). Now hit that "comment" link...

While I tread on dangerous ground...how about the fire - EMS issue?

This thread began with a post about Senator Allard's really bad day, then lurched into some of the political issues and how EMS is lagging behind its public safety counterparts. Might just as well bring up the whole fire/EMS issue: just where does EMS belong?

It seems the city of Pittsburgh is asking the same question as evidenced in this article in the Pittsburgh Tribune Review.

The EMS union actually has it in their contract that they can't merge with fire unless there is a renegotiation of the contract terms (a smart bargaining team when that contract was negotiated). The fire union president wants EMS and blames the EMS union for holding up a merger.

Dropping back to a local example, the Kennebunk, Maine Police have been talking about merging with other local police forces. The issues, whether in the smaller police merger or the large Pittsburgh situation, generally aren't equipment or stations or budgets--people and cultures will make or break the merger. Issues like seniority, working environment and perception of equality within the ranks are the big issues.

There are a few big cities out there that may be wishing they could turn the clock back pre-merger for just these reasons.

The leaders who will institute the mergers also make a significant difference. How the merger is introduced, instituted and fed to the rank and file sets a foundation. Early, equitable decisions on controversial issues combined with a consistent message and expectation are vital.

I have seen spectacular fire medics that could treat my family any day. I've also seen fire medics treat people like shit because they got pulled from an engine company to work the rescue. Likewise there are some medics in third service agencies who are true clinicians and others who are many years past their prime.

To me, the issue isn't a blanket decision whether fire or EMS is better. It is about the agency which considers it its mission to provide high quality, clinically competent, patient-centered care to the people it serves--be it fire or EMS.

Wouldn't it be a wonderful world if we had two agencies in one municipality whose true mission it was to provide that type of care...but if that were the case mergers wouldn't be an issue after all, would they?

More on politics and EMS

Sleeping on yesterday's post (Senator Allard's press release) brought me to a bigger picture thought this morning: Why does something as important as EMS have near zip (nada, nothing) in the political power and support category?

There are many answers to this, some which are not our fault and some which are clearly our fault.

In the first (and easiest category) we are relatively new compared to the fire service, nursing, medicine, and the cops. As such it would logically take time to become rooted in the power (and money) structure of politics.

In the second, and more difficult, category we don't advocate for ourselves, we have 50 islands rather than a unified front, have many delivery models with different needs/interests, don't value education as much as we should and don't have anyone speaking for us politically--at least efficiently.

The National Association of EMTs has a legislative agenda which includes information for anyone from a leader to an individual on how to have a voice which is nicely done--but it isn't enough.

NAEMT has begun to lobby more aggressively in recent years. A good start. But to become a contender we need more muscle. If a senator wants to be re-elected they would like endorsements from the International Association of Firefighters (IAFF), International Association of Fire Chiefs (IAFC), International Association of Chiefs of Police (IACP) and the Fraternal Order of Police (FOP). The nursing associations (e.g. ENA) and physician's groups on the health care side of things (e.g. ACEP) have a strong voice. If one of these groups endorses a candidate it has meaning. People seek out these endorsements. We don't have that in EMS.

We also have the "who is better in providing EMS" argument which splits us down the middle. The NAEMT posted a position paper about this. It is written in that politically-correct-I-hope-people-get-the-meaning-of-this-
but-we-can't-say-it-and-offend-anyone language inherent in position papers.

The meaning: Get along. Be professional. Be smart. People won't take us seriously until we do.

Open mouth, insert foot...

Thanks to Paul Maniscalco for calling our attention to the press release from U.S. Senator Wayne Allard (R-Colorado) as posted on the web site Colorado Confidential.

The portion of the press release where the senator's aide Steve Wymer got a healthy taste of foot:

"First responders in Colorado have recently provided critical services in the face of blizzards and tornados," added Allard. "Since I don't think first responders have really done anything significant in comparison to their counterparts who have dealt with real natural disasters, I have no idea what else to say here..."

19 minutes later the corrected press release was issued.

Wymer called this a "typo" although it clearly wasn't. It was an attempt at humor and filler. Possibly something typed as a whim at a moment of mental block. Unfortunately it appears to have given a glimpse at what Wymer really feels about the first responders in the press release. Since senators don't write their own releases we don't know what the senator actually thinks.

It looks like Senator Allard isn't running for another term. Good thing. It will limit the damage control and meaningless groveling he would have been forced to do. While I think calling for a resignation from Wymer is a bit vindictive and harsh, I do think that Wymer should spend a few shifts (NOT day shifts) with some of the first responders he has disparaged.

Volunteers to host the ride-along?

National EMS Week

This week is National EMS Week. I feel obliged to post something about this. Plus my wife (quite blog savvy) said she would kick my ass if I didn't. Despite the appeal of that threat...here goes:

May 20 - 26 is National EMS Week.

There. I did it.

But did you know that May 20 - 26 is also:

National Public Works Week
National Hurricane Awareness Week
National Epilepsy Week
National Safe Boating Week
Schizophrenia Awareness Week
Tinnitus Awareness Week
National Medical Transcriptionists Week
Waterfall Week at Whiskeytown National Recreation Area.

So, when the public works employee is injured and when the hurricanes hit and epileptics have seizures and people aren't safe in their boats and schizophrenics need help and people have ringing in their ears we'll bring them all to the hospital giving the transcriptionists something to do. Then we'll all go to Whiskeytown National Recreation Area. We'll need it.

Happy EMS Week!

Dan

First draft of EMS education standards released

The long-awaited first draft of the EMS education standards has been released. These standards--both the content and the format of the standards themselves--will have a profound influence on EMS and EMS education.

EMS Education Standards

There are several questions with links to submit comments online. I like that. Some of the questions and issues:

Can EMS education be competency-based (rather than based strictly on hours)?

Is an EMT class that is estimated to run 166 - 198 hours too much (as proposed it includes NIMS, CPR and HazMat orientation)?

Should EMTs have a greater knowledge of anatomy, physiology and pathophysiology in order to better understand assessment, disease processes and traumatic conditions?

Are the education standards and brief outline of content enough (as opposed to providing a detailed lesson plan)? Will publishers fill this in? (I believe we do that now anyway.)

And more...

Check it out. Offer comments.

More to follow on this important topic...

National EMS Memorial Service Lists 2007 Honorees

Between EMS week and the transition between spring and summer, May holds one other very important event for EMS: the National EMS Memorial Service.

This year 17 EMS providers who died in the line of duty will be remembered and added to the National EMS Memorial which, sadly, is without a home.

Of the 17 people honored this year, 9 died in medical aviation accidents. Three were killed in motor vehicle collisions, one died from complications from rescue work at the 9-11 site in New York City. One died from cardiac arrest, one from a fall and the last during a flood rescue.

An increasing number of EMS providers are participating in bike rides (as long as 600 miles) to show support for the National EMS Memorial Service and to bring attention to the cause. The National Moment of Silence is scheduled for Saturday, May 26th at 20:00 hours.

Let's show our support for the museum and those who died in the line of duty. Participate in the moment of silence and support a permanent, meaningful home for the heroes who are no longer with us.

Medication Errors Hit Home

My 18 month old daughter had an ear infection. After a brief office visit with the pediatrician we left with a scrip for Omnicef. Off to the pharmacy. In this case I won't mention the pharmacy chain--I'll refer to the pharmacy as "Wrong Aid" to protect their identity.

After dropping the scrip off we did the obligatory 10 - 15 minutes of shopping with the unhappy child until the antibiotic was ready. When I got the bill it was twice what it normally was. The first alarm went off: this is different that the same scrip last month.

I asked a pharmacist who happened to be standing near the register (looking disinterested) about the difference in price. I was still working on the issue in my head. The dialogue (with unspoken thoughts):

Me: This is twice the cost it was last time. (I think something is wrong!)

Pharmacist: The co-pay is set by the insurance company. We have no control over that. (I got a Pharm.D to deal with these whiners?)

Me: But isn't that a big change? Has the concentration changed or something? (I still think there is something wrong.)

Pharmacist: (sigh) Let me look at it. No, it is right. Twice a day. There is enough in there for 6 days. (It is amazing that I don't dip into the Percocets because of these stupid customers.)

Me: 6 days? Isn't that a bit odd?

Pharmacist: That is what the doctor prescribed. There is enough in the bottle for that. 60ml. (Vicodin, Oxycontin...these needy parents of sick babies are driving me crazy.)

At this point I realized that the pharmacist was disinterested--and likely wrong. I decided to cut my losses and do what any self-respecting parent would do in this case: go to the Internet.

Sure enough it was more than double the manufacturer's recommended dose. The pharmacist who filled the prescription entered "twice" instead of "once per day." Interestingly that was a simple mistake and one which doesn't anger me nearly as much as the disinterested slug who could have caught the error. How?

1. When a flag is raised investigate why. My questions raised the flag--even though it was about cost--not dose.
2. The flag should have uncovered two points 1) Why treat an ear infection for 6 days? He obviously didn't pay attention during therapeutics class in pharmacy school and 2) 60ml is the EXACT amount for 10 ml/day for 6 days. Most liquid medications provide a bit extra since the dose pouring into a cup or oral syringe isn't the most exact. The correct dose (5ml/day for 10 days) would have left 10 ml extra.

"Wrong" Aid still calls me to apologize. Their risk management company called. I tell them all the same thing. The original pharmacist made a mistake. That happens. The second pharmacist blew me off and didn't care. That is unconscionable.