Other people can require you to hold the proper certifications and minimal requirements to do the job.

Field instructors can demand that you demonstrate a minimum level of competence before you are allowed to work autonomously.

Quality assurance managers can confirm that you document acceptable treatment plans.

Administrators can monitor your adherence to policies and procedures.

Governments and institutions can demand your attendance at continuing education classes.

Almost everything about your performance can be demanded and confirmed, except for your compassion.

Nobody can force you to care.

Nobody can demand your heart-felt effort or your empathy or your genuine kindness. If you choose to have it, it is your prerogative. The industry can demand that you perform a service, but nobody can command you to serve. You can’t be ordered to bring your passion, your spirit and your individual, unique contribution to your job each day.

You have to choose to do that on your own.

That’s what makes it so valuable. …That’s what makes it priceless.

I’d like to know what you think about that.

]]> http://theemtspot.com/2012/02/06/no-one-can-care-for-you/feed/ 4 http://theemtspot.com/2012/01/22/objectivity-and-patient-care/ http://theemtspot.com/2012/01/22/objectivity-and-patient-care/#comments Sun, 22 Jan 2012 23:58:35 +0000 Steve Whitehead http://theemtspot.com/?p=4736 A Guest Post by Sean Fontaine

I love posting articles controversial enough to warrant a disclaimer. Today I have the pleasure of bringing you another post by guest author Sean Fontaine. Sean is a graduate of Regis University and a Firefighter / Paramedic for The South Metro Fire Rescue Authority. He lives in Denver, Colorado with his lovely wife Oz and their two sons Jonas and Axel.

Today, Sean throws down the gauntlet on an issue that must be addressed by every emergency caregiver; the delicate balance between delivering objective, impartial medical care and the urge to interject our emotions into the often emotional drama that is emergency medicine. Can you make real emotional connections in the process of administering medical care, or does the emotional aspect of the job directly impact the effectiveness of your care? Some of us may address this dilemma only in our own private thoughts. Others may wish to publicly declare their position. To that end, here’s Sean…

Let me preface this post with the explanation that this topic comes straight from my discussions with paramedic school students and co-workers and the differing/agreeing viewpoints that resulted from those discussions.  These are my opinions (not Steve’s) and I know full well that there are many of you out there that will disagree and some that will think I’m an insensitive ass. So be it, we’re here to listen to different viewpoints and think through them for ourselves, deciding in the process what our own thoughts truly are on a given subject.

The Argument: Your level of objectivity effects the quality of your patient care.

I contend that when we emotionally care about our patients we become subjective caregivers and as such render subjective care, transitioning to reactive rather than proactive medicine.

This topic has come up with co-workers when discussing my history of sick and dying pediatric patients, traumatic or precipitous delivery OB calls, and violent sexual assault calls over the past 10 years. (In comparison to the rest of my calls.)  In addition, this topic inevitably came up when I spoke with last year’s paramedic school class at a local teaching institution. (I was speaking on the subject of pediatric death and dying, prior to their PALS scenarios.)

During those instances, I stated with no intended malice, that a sick, dying or dead pediatric patient demands the same mental cognizance as a sick, dying or dead adult patient.  As such, I see no reason to change my treatment or mindset because the pediatric patient is viewed as “innocent” or deemed “more worthy” of our efforts by some caregivers who then become emotionally involved with the patient.  All patients are “worthy” of our full and complete efforts and treatment. That’s our job.

Once we take that step and become emotionally involved with our patient, I believe we cease to observe and treat to the fullest extent of our ability. Hence the previous statement regarding the rendering of subjective and reactive medicine, rather than focused, proactive medicine. I believe that we are paid to think through patient’s current signs and symptoms and consider differential diagnoses, treatment options, appropriate destinations and the most appropriate continued course of treatment. Then, through the course of these actions…we care for our patient by acting in their better interest. We act as their “advocate” if you will.

As you can tell by my verbiage the line as I see it is, “Caring for your patient equals proactive/objective care, whereas caring about your patient equals reactive/subjective care.

Don’t think that I don’t appreciate the weight of this argument. I have had numerous sick, dying and dead pediatric patients with a myriad of outcomes, some of these patients have been carried in my arms to the ambulance, as I have likely carried my own children at some point. However, in acting as our patient’s advocate, we need to operate without our emotions. It’s part of the cost of doing business for us as caregivers.  That’s not to say that I don’t think about the potential gravity of the call, I just do it later.

Thinking through the call later is good for multiple reasons, such as addressing learning points, emotionally dealing with the gravity of the call, and ensuring that the crew are dealing with all associated issues in a positive manner. There is an agreement made when choosing this profession and this unspoken agreement is what defines that “mental cognizance” we are asked to bring on each call. This “mental cognizance” doesn’t recognize age, sex, color, religion, level of income, level of education or attitude. Every patient is deserving of our best and most objective efforts. The great part about this agreement though is that it’s nonbinding. We can opt out at any point and move on with our lives.

As I said earlier, I appreciate the weight of this topic. I do not intend to come across as callous in my stated opinion. I also don’t tread through unfamiliar territory. Quite the opposite, this is territory I’m quite familiar with and fully appreciate after some time running these calls. Additionally, I have come to a personal understanding about how to best work through these emotional issues, both during and after the call, to render the best possible objective patient care.

Now it’s your turn:

Thanks Sean. Now I’d love to hear what you think. Can emotions and objectivity be separated during the course of patient care or do they inevitably affect your care? Leave a comment and let us know.

Related EMS Awesomeness:

Five Tips for New Paramedic Students

Overcoming EMS Burnout

Connections

Coping With Grief and Tragedy

One EMT Can Make A Difference

]]> http://theemtspot.com/2012/01/22/objectivity-and-patient-care/feed/ 9 http://theemtspot.com/2012/01/04/its-a-calling/ http://theemtspot.com/2012/01/04/its-a-calling/#comments Wed, 04 Jan 2012 21:26:12 +0000 Steve Whitehead http://theemtspot.com/?p=4721 I really enjoyed this video that was uploaded today over at EMS1‘s ParamedicTV. I’ve seen a few of these videos come and go over the years and I’ve even contemplated putting one together myself.

What I appreciated about this video was the focus on the commitment and compassion of EMS providers as well as the multicultural scope of the photos. Some of these videos get a bit over the top with the “hero”aspect of the job…a characterization that I’ve never been entirely comfortable with.

I think this video gets it right and I’d like to share it with you.

ParamedicTV is powered by EMS1.com

See other videos:

Remember Two Things: Saying Goodbye

Passion: How Sam Able Makes a Photograph

Remember Two Things: Sepsis

What Motivates Us Really?

“There can be no real freedom without the freedom to fail.”

-Eric Hoffer (American Social Writer)

But can we really? I mean, really fail. In the course of delivering emergency care can we completely fail?

I imagine that somewhere at the core of each and every one of us is a secret fear that the next call, the next major incident, the next patient contact might be the one where we fail. I think we all carry around with us the fear of a massive, public, ugly failure in the course of our care.

I say that because it’s entirely plausible that we will experience one of these failures in our careers. They happen all the time. They happen more frequently than we want to admit. And I would like to assert that we are better caregivers when we can put that fear aside.

What does your organization do to help resolve that fear? What does it do to feed it?

What your organization does to respond to critical failures in patient care will determine a lot about how free their personnel we feel to go out and practice good medicine. It’s worth thinking about.

“The opposite of love is not hate, it is indifference. The opposite of art is not ugliness, it is indifference. The opposite of faith is not heresy, it is indifference. And the opposite of life is not death, it is indifference.”  -Eli Wiesel (Holocaust survivor and author of the book Night.)

Sometimes we equate behaviors like anger and frustration to burnout. I often disagree. It isn’t the angry EMS worker or the frustrated employee that concerns me, it’s the indifferent one.

Anger is OK. Don’t be afraid of your anger or the anger of others. Anger means that we sense injustice and we care enough about it to want to take action. Angry people have done some great things. As long as we find respectful and appropriate outlets for our anger, it can be a very powerful emotion.

The same goes for frustration. Frustration is the birthplace of innovation. Frustration is often what we experience right before our breakthroughs. Frustration tells us that we are still ingarged and we haven’t given up.

Neither of these are burnout.

Burnout is the point when we no longer care. Burned out individuals may still see the injustice. They may still sense the need for a breakthrough. They may even be able to define it. The difference is that they no longer care.

Indifferent caregivers  are dangerous. Avoid them like the plague. You have permission to feel angry. You have permission to feel frustrated. You never have permission to be indifferent.

If you find yourself at a point of indifference, it’s time to move on.

What do you think?

It’s an important moment because it’s an opportunity to make a very real, human connection with our patient and leave them with a positive impression of their experience with us and our service organization.

ParamedicTV is powered by EMS1.com

There’s an interesting little bit of behind-the-scenes information about how I started the tradition of saying these two things before I left a patients room. I picked up the idea of always saying that I was glad to be of service to the patient early on while working at Pridemark Paramedic Services.

Jeff Forster, the organization’s CEO, was the first EMS leader I encountered who really challenged his people to take their service level up a notch and maintain a patient-needs-first focus.

Years later I had a partner named Will Dunn. Will went on to be a popular EMS instructor in the mid-west region as well as a paramedic supervisor and education coordinator for Eagle County Ambulance District.

Years after our partnership, Will and I were having lunch together when he brought up how he’d picked up on my habit of leaving each patient with a hand-shake and warm goodbye. He told me that he had been doing it ever sense our partnership. I respected Will as an excellent paramedic and I was proud to know that I had influenced his care in that way.

Then he told me about how he always asked if there was anything he could do for the patient. I really liked the idea and started trying it out immediately. I’ve been doing it ever since.

I was influenced by Jeff, then Will learned something from me and then I learned something from Will and now, perhaps, you can learn something from all of us. It’s amazing the way we influence each other, isn’t it? I hope you’ll try this out and I hope you enjoy the video.

Leave a comment and let me know how it goes. It’s been a pleasure being of service to you today.

If your current EMS employer doesn’t value and respect you, there are plenty of organizations out there that will. If you are in a toxic work environment, it may be hard to imagine that there are places out there where respect, dignity and good patient care are the norm. Good organizations are out there and, as you might imagine, there are many common elements to their success.

Are you wondering if your being treated the way you should be? Let me help you answer the question of whether you’re working in a top-notch company or scraping the bottom of the EMS-service barrel. Here’s a list of some of the positive attributes of well run EMS organizations.

Best in class EMS organizations:

1. Value 2-way performance evaluation and are open to employee feedback.

Some EMS organizations prefer to give no feedback what-so-ever to their employees. (Unless someone screws up.) There are no scheduled performance reviews and supervisors say very little about job performance on a day-to-day basis. Most companies provide some sort of formalized performance review, though they may do it out of the misguided perception that it protects them from liability. (It doesn’t.)

The very best EMS organizations give generous real-time feedback to their workforce, both good and bad. Feedback is received in a timely manner, when it is most relevant and appropriate. But they don’t stop there. They also seek out feedback and create channels for employees to evaluate their leaders and their workplace. They encourage feedback and then they do something amazing with it, they listen and respond.

2. Hold personal respect as an essential ingredient in all human interaction.

It should have been made clear at some point in your employee orientation that disrespect is not tolerated in the workplace. High performance workplaces understand that when employees are given the latitude to express themselves and give honest feedback, there will be conflict. It’s OK to disagree with each other in the workplace and have honest discussions about what’s working and what isn’t. The only way this can happen consistently is if all communication is based mutual respect. It’s essential. It makes all the other good stuff possible. That’s why good employers value it so much.

3. Support their employees personal and professional goals.

Sure, the company has a mission statement and they may even have some goals that they came up with at a leadership retreat somewhere, but what about your goals? If you want to know if your employer really values your personal goals, watch how they respond when an employee announces that they have a personal goal that may not fit with the organizations agenda. (i.e. I want to become a nurse, or a PA or be a firefighter or go to medical school.)

Notice if those employees are supported in their personal goals or ignored…or worse, hindered and discouraged. If an organization doesn’t value their employees personal goals, they don’t value their employees. And that means, beyond the hours of labor that you provide, they don’t value you either.

4. Provide clearly defined expectations.

Expectations don’t need to be complicated. They don’t need to come in a 400 page employee manual with chapter after chapter of rules and minutia. Expectations can be simple. (The best ones usually are.) Provide competent, compassionate care to our customers. Treat people with dignity and respect. Work hard.

The very best EMS shops out there have clearly defined, simple expectations and they make them well known. When expectations are simple and clear you don’t need to spend hours wading through employee manuals to figure out what you need to wear to work or how you are expected to act or what you are expected to do. It should be obvious when you walk around. that everyone is on the same page and everyone knows what is and is not allowed.

5. Value learning and maintain an opportunity focus.

The best in class workplaces are future oriented and are willing to try new things and innovate. Regardless of whether or not the organization is growing in size (Bigger isn’t always better.) they are always growing in performance. Management is open to new ideas and advancements in prehospital care that might be implemented to better serve the end customer. There is an expectation that employees will attend continuing education to keep on top of the most current information.

Working in a high performance EMS system can be exhausting because of the pace of change and the expectation that employees will keep abreast of current research. The pace of change can be stressful for some folks. The leadership team may decide to try something new this week and then decide to change it back the next week. New equipment and protocols seem to appear monthly. Some last, some don’t, but just about everything that looks useful is given a try.

6. Pay attention to breaks and down time.

As a rule, EMS employees will work themselves to death if you let them. It’s considered a badge of honor to run the most calls, put the most miles on the rig or work the longest shift. The best EMS organizations value down time and rest as an essential component of a long term, healthy workforce.

It’s easy (and tempting) for some EMS workplaces to take advantage of the work ethic of the average EMT. Some design “system status response” deployment models to strip the workforce to its bare minimum and keep every rig running nonstop for 12, 16 and 24 hours at a go. They run their people into the ground and call their system efficient. Morning checkout times, mid-day breaks, meals and off times become lesser priorities to running the most possible calls with the fewest possible resources.

Once an organization has given in to the temptation and bitten into this type of profit model, it’s very difficult to get them to turn back. You may be better off starting over somewhere else.

7. Practice fair compensation and provide a living wage.

The EMS workforce doesn’t expect to get rich running EMS calls. They know about the modest pay when they sign on to do their job. That’s OK. In fact, once peoples basic life needs are met, more money doesn’t really motivate them anyway. But people do need to be paid fairly. Great EMS organizations strive to compensate their people fairly and provide the highest standard of living that is reasonably possible.

8. Give employees a stake in organizational goals and celebrate combined success.

Great EMS employers also work to create profit sharing systems and mutual goals, tying increased compensation to reducing workplace injuries, eliminating avoidable accidents and increasing call volume.

One of my favorite EMS bosses used to take a big chunk of money and offer it to the employees at the beginning of the year. “This is your money.” he’d tell us. At the end of the year we’d all be able to split it. Here was the catch. Every avoidable workplace accident or injury was paid for out of the fund throughout the year. If an employee got an exposure, the pot was reduced. If a vehicle backed into a pole, the pot was reduced. Suddenly, management wasn’t spending company money on these avoidable expenses, they were spending OUR money! Once it was our money, it was amazing how hard we all tried to stay safe and not be responsible for pulling money from the pot. The peer pressure was very effective. The idea was brilliant.

9. Demand competence and quality care.

Employees want to know that they are doing good work. The best EMS organizations aren’t afraid to demand competence. Demanding competence doesn’t reduce morale, it increases it. People want to feel like they are part of a high performance team. Allow team members to demonstrate sub-standard performance and you demoralize the rest of the team. People will work extraordinarily hard to become and remain a membere of a highly respected team. If they weren’t, special operations groups like the Navy SEAL’s wouldn’t be able to exist. Great employers aren’t afraid to set the bar high and they have confidence that their people will rise to the challenge.

10. Give employees the opportunity to practice meaningful service.

Service doesn’t end at the ambulance emergency room door and it doesn’t stop with the folks who call 911 in our district. The best EMS workplaces understand that and they value service in all of its forms everywhere. That means they support the mission of caring for the sick and injured everywhere.

Once an employer truly embraces the mission of emergency service they seek out opportunities to servie the community and the world. They support employees in fund raising efforts and community wellness initiatives. They might participate in local health fare clinics, not for the promotional aspect, but because it’s part of their mission. They encourage employees to travel and perform medical missionary work and participate in disaster relief and clean water initatives.

The good organizations don’t do it for the good press and they don’t need the public information officer to explain why it might be a good return on investment. They do it because that’s what we do. We are a service industry. That means we are of service to all communities, everywhere. Best-in-class EMS companies understand that the people who want to do those things are the people they want running calls for their company and caring for their patients. Those are the people that embrace the mission because it’s part of who they are.

Now it’s your turn: What do you think? Do you work for a best-in-class EMS organization? What does your workplace do well and what could it do better? Leave a comment below and let us know.

He has passion.

In this video Sam describes the year long process of taking a single photograph of a bison skull on the American plains. Watch the video and listen to Sam’s story, then I’d like to make a few observations.

While listening to this interview, I had several ideas about what makes Sam Abell a great photojournalist. As he relates his experience, he gives us clues into what it takes to be really good at what you do. Here’s what I got from his story:

Be Patient With Yourself

You are on a journey. Let it take as long as it takes to become what you want to be. That doesn’t mean you get to slack off. Just be a little bit better tomorrow than you were today. Don’t get to frustrated with yourself. I’m sure Sam had some frustration when he returned with that first group of photographs and saw that they weren’t the quality that he expected.

You don’t have to be a great EMT tomorrow. Just be a little bit better than you are today. And enjoy the process.

Care About Your Subject

I like the way Sam talks about his subject. Oh, by the way, his subject wasn’t photography, it was the artist Charles Marion Russell. When Sam talks about the subject of his photography piece, you can see his interest in the subject. He understands the essence of Charles Russell’s work and he’s excited to deliver a photo journal that really honors the work of his subject. There’s no question that Sam respects C.M. Russell. If he didn’t, he would never put such energy into his work. That’s worth considering.

Do you care about the people you serve? When you are dispatched on a call, are you interested in your patient? Do you want to know more about their particular problem and how you might help them? You aren’t the subject of the call, neither are your skills or experience. The patient is the subject. If you care about them, you’ll spend years striving to be great at what you do.

Have a Vision

Sam knew exactly what he wanted in his photograph a year before he took the first picture. He had an intense vision of the image that he needed. When we’re trying to do something great, it helps to have a detailed vision of what it’s going to look like.

What are you trying to become? If you were the EMT or the paramedic you wanted to be, what would it look like? What would you know? What would your journey look like to get from here to there? Isn’t it time to get started?

Don’t Accept Almost Good Enough

How easy would it have been for Sam to have looked at his first photographs of the bison skulls and decide that they were good enough? He had conducted a nationwide search for the skulls. He had traveled across the country and gone to great lengths to find exactly what he was looking for. He found every element he was looking for and in the end, he came up with something that was certainly good enough. Let’s be honest, wouldn’t most of us have stopped right there? He could have submitted those photographs and nobody would have questioned his dedication. He met every expectation, except his own.

When Sam looked at his good-enough product he wasn’t satisfied. He keep pushing for something that met his expectations. And when he did, something magical happened. He gave himself the opportunity to create something great. Do you create opportunities for greatness for yourself, or do you stop at good enough? If you’re always satisfied with just good enough then you’ll probably always be just good enough.

Share Your Gifts

Sam tells a great story at the end of the interview about seeing a man on a plane looking through the magazine at his articles and making a choice to engage the man and share his experience. You can see that it’s important to him to share his gifts with the world.

Are you willing to bring your gifts to the masses? What are you waiting for? Your talent can’t live inside you. Go out and do something remarkable.

When the local nursing home calls for a patient who’s been feeling ill, do you lean in or do you lean back?

When the monthly continuing education lecture starts, do you lean in or do you lean back?

When the E.R. doctor wants to talk to you about the care you just gave her patient, do you lean in or do you lean back?

When you are scheduled to work with the partner who’s has the social skills of warm Bisquick, do you lean in or do you lean back?

When it’s near the end of your shift and there are inter-facility transfers pending, do you lean in or do you lean back?

Today you’ll be presented with countless opportunities. There will be opportunities for growth, connection, effort and fulfillment. There will be opportunities to bring quality to your job. There will be opportunities to learn from your colleagues and coworkers. Most of those opportunities come dressed up like work.

When they do come, do you lean in, ready to hear what the next person has to say. Are you looking for the connection with your next patient, the new home medication you haven’t heard of yet, the next piece of advice from your Q.A. person that might refine your skills? Or do you lean back, scared of what it all might mean, upset about the missed off-time, frustrated by the weaknesses and failings of others?

Lean in or lean back. It’s a decision we all have to make each day.

What do you think about that?

If you’ve ever heard anyone say, “I know this is right because that’s the way we’ve always done it.” You’ve heard the appeal to common practice, the argumentum ad antiquitatem in action.

In EMS, the appeal to common practice is everywhere. So much of what we do, from c-spine immobilization to intubation to oxygen administration, is based on the idea that we’ve just always done it that way.

Any time new research suggests that we we may have been doing it wrong all along, the appeal to common practice rears it’s ugly head. The longer we’ve been in EMS, the harder it can be to admit that, perhaps, we were doing it wrong all along. So, instead, we fight it. The appeal to common practice works its way into our language in sneaky ways.

“We can’t just show up tomorrow and deice that we aren’t going to do that anymore can we?”

“Patient’s don’t really change that much over time.”

“This flies in the face of three decades of tradition.”

“Maybe you should get a little more experience under your belt before you start talking about changing everything.”

“There’s a standard of care that we have to think about here.”

“Our citizens demand this level of treatment.”

The truth of the matter is that the appeal to common practice is a fallacy. It was identified as an argumentative fallacy in the time of Socrates and it remains a fallacy today. Just because our behaviors or actions correlate with some past or present tradition doesn’t mean that they are correct. It only means that they way we are doing it happens to be the way everyone else has already done it.

Sometimes that’s a good thing. Sometimes it’s not. We have to decide for ourselves.

When decisions get complicated, the appeal to common practice is a powerful thing to overcome. It’s always helpful to remember that the old way of thinking may have been flat out incorrect in the first place. It may have been based on a faulty premiss or an old assumption that has already been proven untrue.

If we’re doing something for the right reasons, no appeal to common practice is necessary.

I’d like to hear what you think about that.