Mikey’s list includes the low volume of true medical emergencies, poor CPR outcomes and our inability to say we improve outcomes over private vehicle transport. I know, it’s all stuff you’ve heard before. Mikey poses the question, “Can we justify the expense of EMS?”

Then the real fun begins. The forum users begin suggesting what needs to happen to fix EMS. The suggestions include:

• Creating national committees filled with street level providers to brainstorm and then dispense their wisdom for national adoption.
• Better pay.
• Improved education.
• Community paramedics providing expanded models of care.
• Higher standards of hiring.
• Paramedic initiated refusal.
• Government funded standards development.

Some of the ideas are great. There’s always plenty of insightful, well thought out input. But there are also a lot of EMS solution myths that rise to the surface when these discussions get rolling. Many of our ideas for how to fix all that ails us are shrouded in false beliefs and oversimplified analogies.

Here are six EMS fit-it myths that find their way into so many of our EMS rants. How many do you fall for?

1)      The myth of solution by committee.

In this delusion, we convince ourselves that even the most complex and pressing problems could be solved if only we just got the people closest to the issues to come together and talk. If that were to happen, we believe that the right solution would emerge from the dialogue and then we would ll agree and implement those solutions.

This idea is flawed on many fronts. First it places its faith on the myth of the single solution. (See below) It also disregards how difficult true dialogue becomes in these situations. Committees are notoriously awful at producing worthwhile solutions. The old axiom that a mule is a thoroughbred designed by committee is true.

When we elevate groups of individuals to the level of “problem solvers” we interject ego, turf wars, personality conflict, competing interests, inter agency politics and the interloping of millions of stakeholders all looking for a piece of the influence.

If you think problem solving within your organization is difficult, doing the same thing at the national level is monumental. (Literally…if it were to work, we would build a monument.)

2)      The Myth of the single solution.

This one is endemic to conversations about the woes of our EMS nation. It’s the belief that a single solution could be applied to EMS systems across America and they would work universally. Our EMS systems are unfathomably diverse. We have fire based EMS systems, private EMS industry, public service EMS delivery, hospital based EMS providers and combination systems.

Add to this the fact that we serve diverse populations from rural areas where EMS response can take hours (or longer) and call volumes are measured in calls per week to busy urban systems over-run with system abuse, overtaxed hospitals and annual declining budgets.

Don’t forget that over half of us are volunteers and most of us are under-trained and the idea that a single panacea idea or movement could solve the issue of modern EMS becomes extremely unlikely.

3)      The Myth that nothing is being done.

Here’s a shocker that most of the arm-chair EMS quarterbacks will have a hard time wrapping their brains around. Most every problem endemic to EMS in America and around the world is already being addressed and worked on by some organization or group of people.  And here’s the really sad thing. Most of them are begging for your support and you don’t even know they exist.

That’s right. While you’re angry about the lack of national representation of EMS, the NAEMT is working hard every day to fix that. (And you’re still not a member.) Movements like EMS on the Hill Day are taking place every year and you aren’t present. Upset about other jobs having strong national union representation? Check out NEMSA.

Worried about EMS education NREMT is fighting for a minimum national standard of EMS education as well with one of the most advanced testing processes available to anyone ever. (Even though you bash the test every time you take it.) And online education groups like CenterLearn and The EMS Web Summit are striving to bring real, cutting edge EMS education to your desktop.

Upset about system abuse? Agencies like West Eagle County EMS and Colorado Springs Fire are experimenting with community paramedic models to try to head off the call before it comes. Progressive EMS organizations are partnering with community service agencies to identify repeated 911 abusers to find more long term solutions to their ongoing problems. And that idea of a national committee? Groups like FRN-TV are working on creative ways to create that national dialogue you’re talking about. You should watch…and comment.

Instead of trying to launch a movement, find where the movement is and join it. Champion the EMS champions who are already working hard to solve the problems of EMS.

4)      The myth of EMS ineffectiveness.

For folks who subscribe to the myth of ineffectiveness, EMS doesn’t do any good because so few of our interventions or actions are truly lifesaving.  It’s as if providing medical care that falls short of life-or-death interventions is beneath us.

By this same logic, urgent care clinics should close their doors. I mean really, how many of their interventions are lifesaving? If someone has a true emergency they have to call 911. They should feel so ineffective.

Of course, that’s ridiculous. They practice medicine. So do we. We listen, we question, we evaluate and then we give people advice. We also apply medical treatments and, yes, we take people to the hospital. We make a difference. We make a difference to the people we serve. If you need someone’s life to hang in the balance before you can feel like your work is important, you may want to switch jobs.

5)      The myth that only field EMS providers know the real answers to the problems.

This myth rears its ugly head with a rant that sounds something like this, “The problem with EMS is that the people implementing changes have been riding a desk for the last 20 years and don’t know a thing about real EMS. These jokers would be more likely to find Jesus in their morning toast than find a real solution to a real EMS problem.”

We’re convinced that real system solutions are only found behind the windshield of an ambulance. Anyone outside of direct patient contact is an idiot. Here’s the thing…I only hear this opinion from people who don’t spend any time with nationally recognized EMS leadership.

Sit in a room for a while with creative EMS managers and consultants like Chris Montera, Mike Taigman and Skip Kirkwood and your head will swim. You may find yourself overwhelmed with their creativity and the depth of their understanding of EMS operational challenges. (With all things truly considered.)

Let them give you an eye opening perspective of what EMS looks like from 30,000 feet in the air. Suddenly, your ground level, overly simplistic EMS solutions might seem a little naive.  If you spent less than 30 minutes trying to solve our nations EMS woes you may leave feeling a little foolish (or enlightened).

6)      The myth of instant results.

While the myth of instant results is present in every industry, it is particularly endemic to EMS. We don’t just want solutions; we want solutions that present themselves fast. We are results oriented people. If an idea works, then it should work now. If it hasn’t created results in six months scrap it and do something else.

Here’s the thing we so often forget. Today’s problems are the result of yesterday’s solutions. Emergency services are in-and-of-themselves solutions to yesterday’s problems. Fifty years ago, getting sick people to life saving interventions in a timely manner was a real problem. It isn’t much of a problem anymore. We created a system where anyone call a simple number and get bedside delivery of our most time-sensitive medical interventions. But the way we designed the system created a bunch of new problems today. Those problems are what we’re talking about now. Yesterday’s solution = todays new problem.

The better we design our solutions today, the fewer problems they will create for the next generation. But slow implementation solutions don’t win managers awards. Creative solutions that solve problems ten years from now aren’t that popular in an immediate gratification society.

We want sloppy, fast answers that show immediate results. With any luck, but the time the new problems emerge, we’ll be on to our next promotion and some other poor sap will have to solve the new problems we created.

7) The myth of the perfect solution.

We are also deeply intolerant of answers that only partially solve the problem we are trying to address. Even when the problem is death itself, we demand changes that produce dramatic results. If our cardiac arrest save rate is 4% before the implementation of continuous compressions CPR and it’s 7% after, we deem the intervention a failure.

Death happens to be a remarkably difficult process to reverse, and yet a 3% decrease in this troublesome disorder is apparently nothing worth celebrating. We are apparently in search of an intervention that will definitively reverse death. Nothing else will do.

It seems ridiculous, but this is how we measure positive change in emergency services. Unfortunately, this isn’t how positive change tends to happen. It happens slowly over many years, backed by the hard work of a whole bunch of really smart people.

And yet, when new EMTs enter the field they find that people don’t always call 911 for appropriate reasons and more often than not, the people who die stay dead. In a few short years (or less) they are frustrated and angry. They write angry blogs dedicated to EMS rants and adopt the affect of the burned out old-timer. (Not realizing that we’ve seen this all before.)

There’s a much better way to go about all this.

If you’d like to work towards positive change in EMS, instead of adding one more angry rant to the pile, here are a few possibilities that would be far more productive.

A.)   Embrace the imperfection.  Life isn’t perfect. Neither is any job…anywhere. Life is about solving problems. When we’re done solving these problems, we get more. That’s the way it works.

B.)    Join the fight. You don’t need to start a movement. (There are already several.) You need to look into the long list of groups and organizations already working to advance the cause of improving EMS. They could all use your support.

C.)    Champion the people who are doing good work.  There are a bunch of them. EMS doesn’t need another rant. Rants are easy. Use your voice to talk about everything that’s right with EMS. If you can’t see it, you aren’t looking hard enough. When you do see it, help other people see it.

D.)   Be patient. Do the right things because they are the right things to do. If you don’t see immediate results, be patient. EMS isn’t going to change overnight, but it will change. It’s been slowly improving for the past 50 years and it will continue to improve. You could be a part of it.

E.)    Respect the folks who have invested their lifetimes working in EMS. Just because you don’t understand why they are moving in the direction they are moving doesn’t mean they are wrong. Ask them. You may learn something.

F.)    Keep your eyes open. The next brilliant idea is around the corner, but you’re going to miss it if you’re too caught up in your “everything sucks” mentality. People who explain what’s wrong are a dime a dozen. People who see what’s going to happen next and move in anticipation are rare and valuable. Be valuable.

Now it’s your turn: What other EMS solution myths do you encounter? What else can we do to be a part of a better solution? Leave a comment and let us know.

Now it’s my turn to be the older, more experienced prehospital provider. It’s time for me to take my stab at the longevity subject. Yes, I know that giving you this advice makes me sound old. It’s a price I’m willing to pay.

Your future is coming. You will, with almost certainty, arrive at your future. As improbable as it seems right now, one day, you will be 30 and then 40 and then 50. Your older years are coming. And they are closer than you might imagine. I was fortunate to heed just enough good advice in my youth to enjoy good health and comfortable finances as my career passes it’s half-way point.

Here’s some of the best advice I received in my EMS youth:

1) Protect your back.

I don’t mean that in the colloquial sense. I mean literally…protect your back. While you are at it, take care of your knees as well. I’ve seen too many good EMS careers cut short because of a single, nagging back injury. Knee injuries may be a little more hit and miss, but back injuries are preventable.

The proliferation of back injuries in EMS are not entirely due to the work environment. For certain, carrying a limp, heavy patient down their staircase at 2:00 AM is a high risk task. But most back injuries begin long before the actual day or moment of injury. Protecting your back starts with weight control, strength and fitness. Being fit for duty is the single best thing you can do to protect your spinal column.

The second best thing you can do is use discretion when lifting. Wait for appropriate resources. Use lifting aids when available and asking for help even when the lift is within your ability. Save the big lifts for controlled environments like the gym. When it’s time to tackle the patients narrow, rickety staircase, ask for help.

2) Contribute the maximum to your 401K.

It’s a no-brainer. Yet, so few of us actually do it when we are young. Your younger years are a financial boon for your 401K. Did you know that if you contributed $2,000 to your 401K when you were 19, 20 and 21 years old respectively and then never put in another penny, you’d have more money at 65 than if you contributed $2,000 every year from 22 years old onward? (Source: Your Money or Your Life? By: Joe Domingez)

It doesn’t seem possible until you understand the concept of compounding interest. When you’re young, you can truly get the power of compounding interest on your side. The problem is, most of us never take advantage of this concept. Because, really, who’s ever going to be fifty anyway?

Another huge advantage to using your 401K plan is that you can take advantage of your employers matching plan. (If they have one.) If your employer has a 401K matching plan and you’re not taking advantage of it, you are literally walking away from free money every month. Not just the money that is being offered each month, the money that could be accumulated over the next 20, 30 or 40 years. You are giving away thousands of dollars.

3) Complete your college education.

It isn’t as hard as you think. And the older you get, the more difficult it is to find the time to make it happen. If you think that a college education takes to much time, money and energy, I can tell you this is a certainty. Marriage, children and increasing work responsibilities will not make a college education any easier in the coming years.

You might be surprised by how simple and inexpensive it is to convert your current EMS education and experience into an online degree. You can go to The College Network right now, give them your contact info, and a representative will consult with you on your personal online education needs. It’s simple, it’s free and you’ll never know how easy it really is to start pursuing your college degree until you do it.

Your college education is a mouse click away. That time you’ve been spending playing World of Warcraft online could be time spend earning an EMS management degree, or even converting your EMT or paramedic education into an RN (ADN) or BS in fire science. Go do it.

4) Get some quality life insurance.

I’m sad to say that I’ve seen a few careers cut short by unexpected death. Last year, just before Christmas, I received the sad news that my partner, whom I was expecting to work with the next morning, wasn’t coming back to work. He fell from a moving vehicle and died that previous night. He was a great father and husband and he had a lot of good living left to do.

You never know when you’re going to run your last call. Get some quality life insurance. There are a lot of companies out there willing to help you with this type of financial security. Each time someone I know dies unexpectedly, there is a question that weighs heavily on all of our minds. What can we do to relieve the financial burdens from their family? Golf tournaments and memorial bike rides only go so far. You can help answer the question yourself. It isn’t that hard.

5) Work less overtime.

While were talking about the capricious nature of life. If you’re young and working in EMS, you’re probably working too much overtime. We all do it. Especially when we’re younger. Your time is more valuable than you think.

When you’re in your 20′s and an employer asks you to trade a day of down time for time and a half, it seems like a great deal. There’s always time to ski, hike and hang out with friends later right. Your friends and the great outdoors will always be there right? The truth is, the great outdoors will be there, your friends might not…and you might not be either.

You’re only young once. Go enjoy your life. Your EMS career will be longer if you learn how to keep your work and your life in balance now. The overtime will always be there. Your work is not your life. Go live your life.

Now it’s your turn: What did I miss? What other advice do you wish you had when you were a little younger in your EMS career? What should we do to protect our EMS longevity and our relationships with our loved ones? Leave a comment and let us know.

If you liked this, you should also read:

17 Ways to Become an Awesome EMT

What Makes a Good EMT?

What Makes a Good EMT (Part 2)

Unconventional Thoughts on Emergency Services

EMT Basic Skills Are Not Basic

If you’ve been in EMS for more than a few months, you’ve undoubtedly been asked this question by now, probably more than once. The question comes in many forms and in countless forums but the intention is usually the same. The hidden request behind the question is, “entertain me.”

Sometimes the questions comes in the form of a subtle prompt, “So…have you had any good calls lately?” or a more direct request for the morbid and graphic like, “Have you seen any really bad trauma?” Often the inquirer will be subtle. “Boy, working in EMS…I bet you see some stuff!” But they can also be very specific, “Have you ever seen a gunshot wound to the head?”

If you make it public that you work on an ambulance, there is no question that you will be taped for the occasional morbid story. The only real question is – how will you choose to respond?

Over my career, I’ve developed a multitude of strategies for fielding the inappropriate request for a gratuitous gory tale. Some are quick and to the point, others can sting a little.

For a long time, my favorite technique was the witty reply.

“What’s the worst thing I’ve ever seen? It’s got to be Star Trek Five: The Final Frontier. Horrible, absolutely horrible.”

“Have I seen a gunshot wound to the head? Of course. Didn’t you ever see Saving Private Ryan? There were heads exploding everywhere. You can even rewind on the good ones and watch again.”

“Have I had any good calls? I did have one pretty good stomach churner. The Republican National Convention folks called and wanted to talk about the benefits of supply side economics. It was pretty nauseating.” (Please insert preferred political ideology to suit your tastes.)

The witty reply is a conversational dodge and parry. It side-steps the question gracefully and leaves the questioner completely unsatisfied. It can also be used repeatedly to exhaust even the most persistent gore hunter. “No…I’m serious too. The fifth Star Trek installment was the absolute worst thing I have ever seen. How they could get away with charging money for that stink-bomb is beyond me.”

Sometimes, if I feel that there is more to the request than the simple seeking of entertainment, I’ll probe a little further into the questioner’s intentions. I’ll simple look them in the eye and say, “Interesting question, why do you want to know?” If the individual posing the question has a good enough answer, I’ll tell them a story.

Another technique is to turn the tables on the individual and make them really think about their own intentions. I do this by asking them what kind of story they were looking for from me. “You want a story about one of my calls? Well, sure. I have lots of stories. What kind of story were you looking for? Would you like a sad story? If you’d like, I can make you feel sad. Or perhaps you wanted a gross story? If you want to feel nauseous I’m certain I can make you not want to finish your hamburger.”

The question, “What kind of story do you want?” often makes the asker feel a little uncomfortable. It’s a very direct way of asking their honest intentions. Some folks will hedge their bets and say they were looking for something funny or interesting. Nobody ever really comes clean and says they wanted to be entertained by a true story of someone else’s grief, pain and tragedy.

In the world of reality TV it seems that no grief is too great to become entertainment fodder and no tragedy is too private for a bar-side story. Us folks who go to work in the EMS industry are known for our stories. We make people laugh and amaze them with how truly strange and often absurd the reality of EMS really can be.

You’ll have to decide for yourself how far you’re willing to go to entertain the crowds when they come looking for a story.

Now it’s your turn. What do you do when people ask the question, “What’s the worst thing you’ve ever seen?”

An Excerpt from The Non-Conformists Guide To EMS Success

The allure of conformity is powerful for all it offers. On the other side of the conformity dance floor is security, approval, and all the benefits of eventual success. Why wouldn’t we waltz? Doesn’t everybody?

Perhaps that desire within us to do something that matters can be fulfilled after we’ve gained the promotions, the love and admiration of our peers, and the power of authority. Then we can start being an advocate for the patient. Then we can start taking good care of the folks who call 911.

We can bone up on our skills, attend the conference, and develop the competencies we were putting off until we got the official nod. We’ll work hard to improve basic proficiencies, overhaul the broken training and orientation systems, and advocate for safer work conditions.

This is all a broken promise the minute we make it. Once we’ve achieved some degree of success by walking the path of conformity the expectations will only continue to grow.

Your leaders, whoever they are, have even less power to step outside the boundaries than you. If there is pressure on you to conform, you can bet there’s twice as much pressure on the poor guy or gal above you. Poor saps.

Non-conformity is stepping back from the speed and thoughtlessness that we tend to operate under. We manage emergencies. Most of our leaders have grown out of this industry that specializes in the fast fix approach. In our business, speed is king, and time is the devil. This creates an environment that doesn’t value thoughtfulness or introspection.

Asking larger questions about the greater purpose of our industry is frowned upon. Those who follow this path get labeled as pie-in-the-sky dreamers.

Non-conformity means being willing to take the time and effort to evaluate ourselves, our performance, and our purpose. It means being willing to stand for something and being willing to stand against something, especially when we stand against the mediocre status-quo that pervades our industry.

Are you getting a vision of what I’m talking about here? Let me be even more specific.

EMS Non-conformists:

• Think for themselves. They know their protocols and rules but are guided primarily by their own sense of what is right. Non-conformists speak with their own voice and hold on to their own values and judgment. They do not choose to be defined by what they do (as our culture would prefer) but choose what they do as an expression of their identity.

• Expect to have their values expressed in their work. They don’t check their values and guiding principles at the door when they show up for their shift. On the contrary, they have an expectation that their greatest self can be expressed through their chosen work.

• Believe that their lives and work should stand for something. In this regard, they refuse to be bartered like a commodity. The idea of punching the clock for a day’s pay is taboo to non-conformists. They work because the work is meaningful to them. In doing so, they maintain their power and are accountable for their actions.

• Desire to be a part of a community and a team and seek meaningful connections with others. Our industry is a human industry and non-conformists seek to humanize and personalize their work. They pay attention to the details of their lives and the lives of those with whom they interact each day. In refusing to conform to the sterile, impersonal world of clinical medicine, they dive deep into the tragedy and triumph of medical care and fight to humanize their connections with their patients.

• Hold themselves to a higher standard than the status quo and rally against mediocrity and incompetence. Non-conformists see that their work is worth doing well and refuse to be swayed by the tide of mediocrity that constantly pulls at us to accept what is just good enough as our standard. They always seek to raise the bar.

• Don’t expect their leaders to have the solutions to their problems, embody their values, provide their motivation or direct their career path. They don’t look for parental nurturing and constant direction from their leaders, and they don’t whine and complain about operational minutia like memos and policy changes. Non-conformists seek grown-up partnerships with authority figures and seek common ground and mutually acceptable goals.

• Fearlessly seek performance feedback and relish intelligent coaching and criticism. Non-conformists know who to hear and who to ignore. They consider themselves in a constant state of growth and don’t fear failure or mistakes. They look for opportunities to push their boundaries and acknowledge their own imperfections and mistakes without shame or anxiety. Non-conformists know that if they are not making errors, they are not living at the edge of their potential.

If you would like the full 48 page manifesto, The Non-Conformists Guide To EMS Success, click on the green mail button at the top of the sidebar and sign up for the newsletter. Or just click here.

Now it’s your turn: Have you read the manifesto? What do you think?

Read More EMT Madness:

The Ultimate Guide To EMT Vital Signs

Patients Define Their Emergencies

The EMT Code of Ethics

Are You The Opening Act or Are You The Rock Star?

Unconventional Thoughts on Emergency Services

So here is our latest collection of crowed sourced wisdom. This time, the topic is great EMS care. I asked the readers to finish this sentence:

“The secret to great EMS care is…”

I have to wait until I can read all of the answers before I can decide how to split them all up. This time, I divided the majority of the responses into what I called, “provider focused answers” and “patient focused answers.” (Though the two are strikingly similar.) I also added in the short and the sweet and, of course, the funny. It is EMS after all.

Here are your responses:

The Provider Focused Answers

The secret to great EMS care is…

leaving your ego at the door when you walk in. – @PenguinEMT via Twitter

compassion, experience and listening power. – Dee (@Old_Hen) via Twitter

appropriate care. – Jeremiah Bush via Facebook (See follow up next.)

…And the secret to the secret is determining, and agreeing on what appropriate means. – Jeremiah Bush via Facebook

a genuine desire to care. – Florian Breitenbach via Facebook

truly caring, experience certainly helps too. – Joseph Shankland via Facebook

still being able to do a great assessment without all the new technology. – Anne Dorchak via Facebook

Compassion and understanding…also some patience. – Brad Buck via Facebook

Staying current, and having compassion, no matter what time of day or night. – Jon Gubernick via Facebook

a mix of compassion for your patients and job, confidence in yourself, good skills, and being able to adapt and overcome. – VWMedicgirl via The Blog

remaining focused on care, while protecting the health and safety of your patient. – Marcus via The Blog

The Patient Focused Answers

The secret to great EMS care is…

The greatest secret to great EMS care is passionate patient advocacy–social, clinical, educational–in all pursuits. – William Pitt (@wepitt) -via Twitter

always remembering that the patient always comes first. – Kevin Reiter (@DiverMedic) via Twitter

treat your patients how you’d want a member of your family to be treated. – @MadMedic via Twitter

to remember that you are a servant. Leave them better than you found them. – Brian McCoy via Facebook

to always advocate for your patient’s best interests. – Adders via The Blog

to advocate and provide the best care possible (under your protocols and skill level) for our patients. – Fern via The Blog

to treat your patients exactly as you would want to be treated if the roles were reversed. – Collin via The Blog

The Short and Sweet

The secret to great EMS care is…

that you care shouldn’t be a secret. – Rob Walker via Facebook

that there are no secrets. Learn, teach, correct and do no harm. – Craig Spader via Facebook

you! – Steve via The Blog

humility. – Bryan DeWolfe via Facebook

empathy. – Greg Friese via The Blog

caring. – Jameson via The Blog

not a secret. – Andrew Przepioski via The Blog

The Funny

The secret to great EMS care is…

to get them to the friggin’ hospital if they need it. …Yesterday. – Joe Sims via Facebook

a paramedic initiated refusal. I usually start with, “Is there anything you WANT to go to the hospital for?” and follow up with, “I can’t take you against your will, so it’s your choice.” – Mike DeBoer via Facebook

Smoke and mirrors. – Dennis K. Baker via Facebook

Convincing the patient that you are smarter then they are. – Kourtney Hartford via Facebook
That just about sums it up doesn’t it? Thank you all for your thoughtful answers. And what about you? If you have a contribution that didn’t make it in time, feel free to add it to the comments list below.

Over the next 45 minutes the morning travelers were treated to six classical masterpieces. But this was no ordinary street performance. This performer happened to be Joshua Bell, the Grammy Award winning violinist who had recently played to a full house at the Met. Less than 48 hours before his impromptu subway appearance, music lovers had shelled out just over a hundred bucks a seat to hear the artist.

Mr. Bell’s performance on that chilly August morning was inspired by a question. Would people recognize the beauty and remarkable talent of a world class violinist, playing a 3 million dollar violin out of context? Could a master violinist and his music penetrate the early morning rush of a busy subway?

The answer was a resounding no. Few people stopped to listen for more than a few seconds. (With the exception of a single small child and one woman who recognized him.) A few more contributed a dollar or two in passing.

If you’d like to see Joshua’s performance, you can see it here.

So why do I bring up Joshua Bell and the subway performance here? I bring it up because in EMS we do this all the time. We are busy. We are rushed. We are focused on the task at hand. And, in the midst of our call, we miss some truly remarkable people and we pass by some extraordinary possibilities for human interaction and connection.

Just as the busy subway travelers rushed passed, seeing only the struggling musician trying to make a few extra bucks, we often only see our patients for their medical complaints. We see their skin color and their vital signs and we evaluate their potential to decompensate. We question, we palpate and we evaluate. And we often miss the simple fact that the person before us is extraordinary.

Humans, by their very nature, are remarkable. If you’re willing to recognize that essential element of their nature, your job will be immeasurably more fulfilling. Medical complaints become boring over time, but humans are incredibly interesting. If you spend your career treating chest pain and fall victims you will quickly become tired of your job. Spend your career treating humans. They are immensely more interesting. Start right now.

1) Start Checking Out Your Rig Each Morning

Most organizations have a policy in place that states that oncoming EMS crews should complete a thorough checkout process. The reality is that very few of us check out our rig at the beginning of each shift with the proper attention that the task deserves. We know we should, but we get caught up. The signs of an incomplete rig checker are subtle but recognizable. If you open your cabinet or kit on a call and note (for the first time) that you are low or absent a needed supply, you’re not checking out your rig well enough. If you need to look in two or three paces to find what you are looking for, you aren’t checking out your rig well enough.

When you complete a detailed rig inventory, you aren’t just confirming that everything that is supposed to be there is still there. You are hard-wiring into your brain the exact location of everything that you might need. Once you’ve done this over and over again, you’ll find that you are able to collect necessary equipment in a fraction of the time. When you can grab equipment without even looking, your patient care efficiency will go way up. You’ll become a better caregiver. So grab that list and open those cabinets.

2) Look -Up Every Prescription Medication That You Don’t Recognize

The patient’s medication list is a wealth of information about their medical history. It contains vital information about possible causes of the their current condition. It hides details about how the patient will respond to acute medical conditions and it gives clues to how they will respond to your subsequent treatments. If you don’t understand what those medicines are and what they do…you’ll miss all of it.

If you’re caring for folks and you don’t understand the medications on their med list, you might as well wear a blindfold. You’re missing that much.

In today’s information age, there’s no excuse to not have some sort of medication reference in your phone or in your pocket or in your work bag. Carry it and use it. Every time you sit down to write a trip report and you write a medication down that you aren’t completely familiar with, look it up…right then. Don’t wait till later. Just pull out your reference and learn the medication. Google it if you need to. Once you start this habit, you’ll be surprised by how quickly you start to understand these lists in a much more detailed way.

3) Stand Up and Claim Your Mistakes

This can be one of the hardest new habits to learn. Partly because we’re all so afraid of admitting that we made an error. Winston Churchill once said that success was the ability to go from mistake to mistake without losing our enthusiasm. It’s absolutely true in medicine. We can’t grow as patient care providers without making errors. In 2012 commit to avoiding errors whenever possible and owning every error that you make. Be brave. Be fearless. (But don’t be reckless.)

4) Learn Every Patients Name and Use It for the Duration of Your Care

In all but a few rare exceptions, asking your patient’s name is an excellent first step in your patient assessment. Airway, breathing, circulation and a large majority of the cranial nerves can be assessed by simply taking your patient by the wrist and asking their name.

Once they say their name, the next step is a little harder. Remember their name. This takes a conscious effort at first. Once you get in the habit, it’s easier. Now that you remember their name, use it. I think you’ll find that your patient rapport increases dramatically (almost effortlessly) once you stop calling your patient honey, sweetie, dear, sirs, ma’am, pal, friend or partner, and start calling them by their name.

5) Learn Your Protocols

I mean better than you already do. When I was an EMT-Basic, I all but ignored my county protocols. I figured protocols were things that paramedics needed to worry about. Once I became a paramedic and started reading my protocols I realized that I should have read most of them back when I was an EMT.

Your protocols are the rule book. I’m not an advocate of always following the rules, but before you can break the rules properly, you need to know the rules. Learn them. Know them. Then you can start refining your care around them.

6) Pay Attention to Research

I already mentioned that this was the information age. There’s really no excuse to be ignorant of current research in EMS. If you don’t know where to start, start with the research section of EMS World. Then check out the news and features at EMS1. Keep an eye on podcasts like The EMS Educast and The Research Podcast. When you’re ready for the big leagues, check out Rogue Medic’s blog. (Wear your seatbelt.)

Half a dozen things you’re doing right now will change in the next five years. Want to know which six things are going to be obsolete? Start paying attention to research.

7) Develop a Specialty

Think of the most talented, well respected EMS practitioner you know. I’ll bet I know something about them, even though I’ve never met them. I’ll bet that they’ve taken their knowledge in at least one area of medicine far beyond the expectations of their job.  Think I’m wrong? Ask them.

Sooner or later, every EMS caregiver who’s eager to learn and improve will find some area of medicine that interests them to a degree that they seek out more information. Once they tap into the subject they’re compelled to keep going. They become specialists.

It could be cardiology and it could be limb splinting. It could be airway management and it could be extrication. The subject isn’t that important, the idea that your knowledge does not need to be limited by your scope of practice is critical. Find an area of medicine that fascinates you and dive in. Don’t worry about whether or not the information is applicable to your patient care. Learn for the sake of learning.

Before you know it, you’ll be a specialist.

8.) Use the Information in This Blog (Or Stop Reading It)

Yes, you read that correctly. This might be the only time you’ve ever heard a blogger tell you to stop reading his or her blog, but I’m serious. If you’ve been reading my blog for a while and you still haven’t encountered anything that you can take to work and use to your benefit, stop reading.

I’m not writing this stuff for my own information. I’m writing it for you. If you don’t actually use any of it in practice, then it’s worthless. You can stop reading…I won’t take it personally.

If you aren’t using and applying the information you see here your wasting our time. Find those useful little gems that resonate with you and go to work and actually try to be a better EMT. Or find someone else’s blog to read who might be more useful to you.

9) Listen to (At Least) One Podcast in Your Rig While Posting (Or On Duty)

There are so many awesome podcasts out there in our field. If you have an iPod or an MP3 player or any other device that plays digital audio, you have no excuse to not listen. Download a few and see what you like. Make that down time useful.

You can hear some of the most lucid thinkers in EMS talk about the latest issues that affect you and your industry if you simply tune in. I recommend The EMS Garage, The EMS Educast, The EMS Leadership Podcast, EMS Office Hours, and Confessions of An EMS Newbie. They’re all awesome.

You can learn a bunch from regularly listening to any one of them. In the age of MP3 Players, Ipods and smart phones, there are no longer any excuses for wasting your time in your car listening to commercials on the radio. Pick a podcast you like and start listening. You won’t believe how much good information you’ll have packed into your brain by next year.

10) Start Teaching Something

It’s time. If you already teach a class, such as Red Cross First Aid or AHA CPR, great. You can skip this one. But if you haven’t taken the time to give back to the community by teaching the EMS information you already know, 2012 is your year.

It’s hard to describe how much teaching can expand your knowledge and experience. Once you know that other people are going to learn vital skills based on your knowledge you will feel compelled, like you never have been before, to dial in your own knowledge.

Teaching opportunities are everywhere. Hopefully you can find a way to teach your specialty to other people. Educators like Mike Smith and Tom Dick have built their careers on finding something they are passionate about, becoming the leading authority on the topic and then teaching it to other people.

Maybe in 2013 I’ll see you on the speakers list for EMS World or EMS Today.

11) Bring Yourself to Work

You might be thinking, “Steve, I’m required to show up at work.” True. That’s not what I mean. I mean that this year is the year for you to find that unique contribution that only you can make to the world of EMS. When you begin your career, you mostly copy the styles and techniques of your preferred instructors. You do what you can to be like them.

Now it’s time to break that mold and ask yourself what your style is going to be. What are your techniques? How can you make this job uniquely your own. What can you do to make the people you work with think to themselves, “Wow, I’ve never seen anyone do it like that before.”

There is a unique something that you were meant to bring to the world of prehospital emergency care. No one can tell you what it is. You have to figure it out on your own. When you find it, don’t tell anyone…just show them.

12) Start Doing Full Head-to-Toe Patient Assessments

I know you’ve been faking it. I know this because most EMT’s fake it. Regardless of how good or talented they are, most EMTs don’t have a good, smooth, thorough head-to-toe assessment that they can perform with confidence in front of other people.

And the really sad thing is that it isn’t that hard to do. You just have to start doing it. Do it and then do it again and then do it again. As you practice detailed head-to-toe assessments again and again you will quickly reach a level of proficiency that far exceeds that of the vast majority of your colleagues.

More importantly, you’ll become a better caregiver to your patients. Commit right now to making 2012 the year when you quit faking it and start doing solid patient assessments

13) Learn a Thorough Neurological Assessment And Do It Whenever It’s Appropriate

You can add this one to your new-found head-to-toe assessment when the need arises. A neurological assessment is how we figure out if the patient’s body is talking to the patient’s brain correctly. Just like a physical assessment, it starts and the head and ends at the feet. A good neurological assessment includes motor, sensory and cognitive assessments. If your assessment includes questions like, “Can you feel me touching here?” or “Squeeze my hand.” or “Where are you right now?”, you’re already doing some neurological assessments.

Once you have a systematic, head-to-toe, neurological assessment, do it on every potential spinal injury, stroke, overdose, poisoning and head injury patient. (That’s a good start.) I’ve never seen two caregivers who use the exact same neurological assessment. Develop your own. It will get better over time. Do it often. It will help define you as a quality caregiver in 2012.

14) Find One Glaring Mistake or Outdated Treatment in Your Protocols and Vow to Violate It

I know this one is going to be a little controversial. I’m not telling you to give inappropriate care to your patient. I’m also not giving you a license to not know your protocols. (See number five.) But I can guarantee, beyond doubt, that there are some things in your protocols that are out of date, useless and possibly harmful to your patients. Find one of those things and commit to not doing it in 2012. Make sure to write a variance report when you’re done.

15) Stop Eating Roadside Junk Food

It’s killing you. Just stop. This year, start bringing your food in a little cooler. As an industry tasked with protecting the health and safety of others, we are ridiculously fat and out of shape. Don’t be the next post-difficult-call-cardiac-arrest story in the national news. Drop the trans-fat and eat an apple.

16) Stop Having Tantrums On Your Way To Calls

Yes, you do. We all do it. The dispatch happens and we immediately start rationalizing why this shouldn’t be our call. “Isn’t Medic 36 closer to this? Are they still out at the hospital. Those guys spend way too long at the hospital. This nursing home calls for the dumbest reasons. Why can’t PD transport their own drunks?” When we’d rather be doing something else, there’s always a reason why we shouldn’t have to run the call we’ve been assigned.

Just decide to commit yourself to the call from the moment that you are dispatched. You can’t feel good about the job you do if every time you get assigned a call you go into angry / frustrated mode. You’d be surprised how much energy you can expend with these habitual negative tantrums. Let go of it. Shrug it off like a heavy weight. If the job is worth doing then decide to just do it. You’ll be amazed at how much better you feel.

So that’s it. There’s your recipe for how to have an awesome 2012. We’re just far enough into 2012 to have abandoned all of those ridiculous resolutions that we committed to on January 1st. Now you can make some real worthwhile commitments. Pick a few and get started.

“Wait!” you say… “You promised us 17 ways to become awesome.” Indeed I did. You’ll have to wait until next time to get the 17th tidbit. It’s just good enough to warrant its own post. …And you can find it right here.

]]> http://theemtspot.com/2012/02/26/17-ways-to-become-an-awesome-emt-in-2011/feed/ 22 http://theemtspot.com/2012/02/06/no-one-can-care-for-you/ http://theemtspot.com/2012/02/06/no-one-can-care-for-you/#comments Mon, 06 Feb 2012 22:46:40 +0000 Steve Whitehead http://theemtspot.com/?p=4778 Someone else can be committed to training you to an acceptable standard.

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/ 7 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

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.

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See other videos:

Remember Two Things: Saying Goodbye

Passion: How Sam Able Makes a Photograph

Remember Two Things: Sepsis

What Motivates Us Really?