“In Germany they first came for the communists, and I didn’t speak up because I wasn’t a communist. Then they came for the Jews, and I didn’t speak up because I wasn’t a Jew. Then they came for the trade unionists, and I didn’t speak up because I wasn’t a trade unionist. Then they came for the Catholics, and I didn’t speak up because I was a Protestant. Then they came for me – and by that time no one was left to speak up.”

- Rev. Martin Niemoller

Yesterday an Action Care ambulance covered my station while I was at a training. Action Care is the local private ambulance service. I know, the name always seemed a little silly to me. If a super hero ever created an ambulance service, he would most certainly call it Action Care. I joke about the name, but they’re the real deal.

I’m glad we have Action Care. They help cover our district when we are low on resources. They are always professional and polite on scene. They give good care.

Sometimes, working with a private ambulance service on scene can be challenging. There are conflicts. There always are. Occasionally a private ambulance service medic will assume that I’m an idiot because I’m wearing fire gear. Sometimes, that can be amusing and sometimes it can be frustrating. Sometimes a fire medic will assume that the private ambulance medic needs her hand held because, well, she works for a private company after all. I’m sure that’s frustrating for them as well.

I know that most of these biases are made up. When I was in the private ambulance service, I advocated for the advantages of private ambulance service and denounced the fire service as bad for EMS. When I became a fire fighter I suddenly saw things differently and the flaws of private, for profit medicine became more evident.

I’ve certainly seen both sides of the equation. Which, recently made me consider an interesting question. While driving back to my station, thinking about how much I appreciated having our local private service available for our district, an interesting thought occurred to me.

What would happen if we advocated for each other?

I know, it’s a crazy thought. The very idea of a fire fighter / paramedic extolling the virtues of private ambulance service medicine and a private service medic understanding and advocating for the benefits of fire based EMS seems insane. But consider it. Go crazy with me and ask yourself, “What if..?”

What if firefighters saw private EMS as good for our industry and supported the efforts of their private ambulance brothers and sisters?

What if private services recognized the important contributions of fire based EMS systems?

What if, instead of being threatened by each other, our service were public advocates for the others needs?

What if I told members of the community that our local private service was an essential part of our response plan and an excellent example of everything private services can be?

What if my private ambulance counterparts explained why my fire based service was the right design for the community and a good model of what fire based EMS can be?

What if we spoke up for each other?

What would happen next?

You tell me.

You may be able to guess the results. If there were no pieces of litter on the ground, or only one piece, the subjects were unlikely to throw the unwanted piece of paper on the ground. After that, the likelihood of the person discarding the paper on the ground was exactly proportional to the number of pieces of paper already on the ground. The more litter already present on the ground, the more likely that the next person would also throw their piece of paper on the ground. It’s the law of social conformity.

Litter begets litter.

This isn’t new news. The 1990 research (Cialdini, Reno and Kalgren) was a repeat of similar research done in 1973 (Finnie), 1977 (Geller, Witmer and Tuso) and 1978 (Krause, Freedmen and Whitcup.)

How does this apply to you?

The law of social conformity affects everything. If you leave trash in the bottom of the trash can in the back of your rig, the next guy is likely to leave trash in it at the end of his shift too. If the floor is dirty it’s likely to get dirtier. If there’s blood splatter on the ceiling, the next medic is more likely to not wipe the compartment down either.

It’s not just a cleanliness issue. If you attend a C.E. class and twelve of your coworkers are there, you’re more likely to attend the next one than if there are only four. If two-hundred of your coworkers forge their C.E. documentation, you’re more likely to do it than you would be if only five committed the offense. If you don’t call the patient by their name it’s more likely that the next caregiver won’t either.

Of course, the inverse is also true. Your personal patient greeting, clean ambulance and impeccable C.E. record are just as likely to influence the culture for the better as your negative behavior is to influence it for the worst. Sometimes we talk about the culture as if we are only visiting. We are the culture. What did you beget today?

Now it’s your turn: What else have you noticed that begets more of itself? The possibilities are endless.

Read More Posts:

Ten Reasons I Work In EMS

Passion Counts

6 Reasons Why You Should Be A Better EMT

4 Sloppy IV mistakes You Should Avoid

EMT Burn Management

“In June, as many as a dozen species may burst their buds on a single day. No man can heed all of these anniversaries; no man can ignore all of them.”

-Aldo Leopold

So many anniversaries. So many happenings in the EMS world. Regardless of how many of them you attempted to heed, you were bound to miss a few. Here’s to the stuff you may have inadvertently ignored.

I started the month with a webinar on how to pass the national registry cognitive exam and quickly moved on to the name the chronicles contest and part three of the very popular ultimate guide to EMT vital signs. I asked you two telling questions with “Where do you put the fear?” and “Are you an EMS nonconformist?” before asking you to consider what will happen on the day that your career clock strikes midnight. Then we talked about what really motivates us and wrapped up with ten reasons why I work in EMS.

Elsewhere around our EMS online neighborhood, one happening that deserves its own paragraph is the sad departure of UK medic Mark Glencorse from the blogging world. Mark made a huge impact on EMS blogging with the Medic999 blog and his influence will continue to be felt for years to come. I’ll deeply miss his musings on the EMS around the world. Fair thee well Mark. Thanks for all the fish.

In the other rings of the perpetual EMS blogging circus, David Konig showed a few creative billboards aimed at getting people to call 911 only for appropriate emergencies. Greg Friese posted a fathers day memory. Peter Canning discussed the use of a magical question, “Would you like more pain medicine?” Jeramedic launched a post series reviewing shock. (Psst: It’s off to a great start.) EpiJunki gave a heartwarming hallelujah for second chances that made me want to send her a silent amen from the choir. Chris Kaiser went all Jeff Foxworthy with “You know you work rural EMS when.” (Chris, I’m still waiting for my deer meat.) Never one to shy away from a fight, Rogue Medic sunk his teeth into a recent podcast and Justin “Happy Medic” Schorr threw down with some hilarious EMS based motivational posters.

And what about EMS news? Plenty of EMTs behaving badly. The Massachusetts dispatcher who canceled critical 911 resources on a medical alert has been fired. The NYC EMS Lieutenant who took a picture of his MDT screen with patient information visible and posted it on facebook will also likely lose his job. Some of the 207 Massachusetts EMTs who falsely claimed they took re-certification courses feel that their suspensions are unfair. A couple of UK medics are in hot water for walking a man having a full blown MI to the ambulance. A lawsuit is claiming that Dallas Fire-Rescue incorrectly billed every call at the ALS rate and may owe the government somewhere around 40 million dollars. Police apparently aren’t done filing charges against the Port-Orange Firefighter Paramedic who was sneaking back into patient’s homes to steal their medications.

Then there were the podcasts. The Medicast interviewed Natalie Quibodeaux. The EMS Educast talked about training EMTs in high school. The GenMedShow discussed the new film Firestorm and The EMS Garage round-tabled over EMS system abuse in the episode Fava Beans. All well worth a listen.

So there you have it. The month in a nut shell. What do you think will happen next?

Read More Roundups:

The May EMS Roundup

The April EMS Roundup

The March EMS Roundup

The February EMS Roundup

The January EMS Roundup

It’s strange. In a line of work as interesting, diverse and unique as ours, you’d think our blogs would read like a fan page for a band called EMS, but that’s just not the case. How to survive in EMS, how to scrape by and how to “fix” EMS seem to be the relevant topics of the day. I thought this readers question was a great opportunity to go on the record and say that there are a lot of good reasons to work in EMS. Here are ten.

It’s different.

I’ve learned that I don’t do well with routine. I couldn’t spend my work life in a cubicle. I’d rather chew tinfoil than show up each day and do the same thing. EMS is infinitely variable. Just when you think you’ve seen it all someone will pick up the phone, dial 911 and prove you wrong.

It’s human.

Unlike so many jobs and careers, medicine is profoundly human. We interact with people and see the full spectrum of the human condition. Few people clean the house or put on their Sunday best before they dial 911. We see a very real slice of humanity in EMS. Being a patient is a, “come as you are.” experience.

It’s huge.

I mean, it’s everywhere. You can go anywhere on the planet and practice medicine. The opportunities are truly endless. I practice EMS in a major urban center but I’ve also practiced it in the middle of the Mojave Desert. Early next year I’ll go out into the jungles of northern Panama and practice EMS there too. I mean really, it’s huge.

It’s challenging.

You will never master emergency medicine. The vast well of knowledge that is medicine grows far faster than you can learn and absorb it. You can dedicate a lifetime to the understanding of this one small facet of medicine and you’ll still only scratch the surface.

It’s fun.

The people are fun and the work is fun. This can actually take some folks a long time to learn. We get so caught up in the seriousness of EMS that we don’t really enjoy the process of running calls together. One of the benefits to sticking with the job long enough to achieve a level of comfortable competence is that you can really start to relax and have fun.

It’s variable.

Two weeks ago, I spent two full days riding a bike around a senior PGA tour event. I was on the medical response team. Last week I was backstage at the Iron Maiden concert. I was on fire watch duty. After 20 years in EMS the job is still filled with first time experiences. I’ve lost count of the seemingly endless parade of lifetime firsts that I’ve logged on the job.

It’s timeless.

People always had medical emergencies and people will always have medical emergencies. When they do, they’re going to want someone like you around. That’s kinda nice when you think about it.

It’s fulfilling.

I don’t get people who don’t feel fulfilled in this line of work. Well, OK, maybe I do get them. So let me clarify. If you do your job to gratify yourself and your ego, EMS isn’t very fulfilling. If you do your job to be of service to others, EMS is very fulfilling.

It matters.

Sure most everyone’s job matters. But some folks have to reach farther than others to explain how their job matters to others and to their community. In EMS it reaches out and smacks you in the face. To every single person who calls for your service you matter. The job you do, the service you provide and how well you provide it all matter.

It enlightens.

This job gives us a unique and privileged perspective on the human condition. One that is hard for people in other lines of work to understand. You just can’t do CPR on someone’s husband and then go home and be angry about the coffee stain on your rug. You can’t take someone’s child to the emergency room for a rare respiratory condition and then go home and yell at your kid for not cleaning his room.

EMS gives us an amazing perspective on what’s really important in life. It’s a perspective that few people have. It’s a perspective that’s reserved for those who experience great tragedy and those who help. We get the perspective without the grief. It’s a gift. It’s a gift than many EMS caregivers leave unopened. That’s a shame.

If you need any evidence of the unopened gifts, just take a look around the EMS blogsphere.

Now it’s your turn: Why do you work in EMS? Leave us a comment and let everyone know.

Or Just Read More Stuff:

Where Do You Put The Fear?

Six Reasons Why You Should Be A Better EMT

The Ultimate EMS Protocol

You Can’t Give Away What You Don’t Have

EMT Basic Skills Are Not Basic

]]> http://theemtspot.com/2010/06/26/ten-reasons-i-work-in-ems/feed/ 10 http://theemtspot.com/2010/06/23/what-motivates-us-really/ http://theemtspot.com/2010/06/23/what-motivates-us-really/#comments Wed, 23 Jun 2010 17:36:14 +0000 administrator http://theemtspot.com/?p=3327 The Surprising Truth About Personal Motivation

For years as an EMS supervisor I sat in operations meetings discussing the timeless business question, “How do we motivate people to be high performers?” Since most everyone in the room was a current or former field paramedic, you’d think we’d have an edge in answering the question. We didn’t.

It’s worth considering while your sitting around with your partner, hashing out the latest management blunders and explaining how you’d fix everything. If it was you sitting in the agonizingly long staff meeting throwing around ideas, chances are, you wouldn’t do much better.

I do know that the one opportunity I had to work on a true high-performance EMS team, these were the basic ingredients.

• We were a relatively small group
• We weren’t highly paid
• We were on a mission
• We respected our leader
• We had a lot of freedom
• We all felt accountable to the team
• We all felt like our role was important

It was fun while it lasted. And then we were successful. And we got big and corporate. And the team got bigger and the rule book got thicker and the memos got longer (I wrote many of them.) and the motivation dropped.

One interesting dynamic I noticed. When I was being paid the highest by the organization, my motivation was the lowest. No amount of money could make up for the sense of loss I felt. The loss of freedom, autonomy and contribution. Getting paid well to be a cog just sucked the life out of me and every other high performer in the group. So I left.

Based on that experience, this video made a lot of sense. I wish I had seen it 10 years ago. I don’t know if it would have helped, but at least I would have understood what was happening better.

Now it’s your turn: Do you still feel like more money would help motivate you to be better at what you do? Leave a comment and let me know.

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, type your name and e-mail address in the sidebar box to your left. I’ll mail you copy.

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

Read More EMT Spotage:

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

Turn me loose! If you were there for my Conquer the National Registry Skills Boot Camp you know that I’m pretty fired up about getting people through this exam with the right tools and the right information in their heads. Now I’m ready to take on the cognitive exam.

This has been a fun series and on Monday June 7th at 8:00PM EST / 6:00PM MST I’m goin to wrap it all up with what just might be the most anticipated, most requested, most highly attended EMS Boot Camp of all time.

With Conquer The National Registry Cognitive Exam, I’ll be dissecting the making of a computer based test. I’ll share with you the knowledge I’ve gained from the very people who write and conduct the exam. We’re going to talk about:

• Why you’re going to fail. (Don’t worry, everyone does.)
• Why the percentage of questions you answer correctly doesn’t matter.
• How you can detect weaknesses in the distractors and sometimes find the correct answer even if you do know the information.
• What the questions are really going to be about.
• What to study when time is short.
• How to pass the very first time.

I’m excited to bring you this free lecture and if you’re planning on taking the national registry test, I hope you’ll plan on attending. I’d love to see you there.

Click this link to register.

But you can hear me talk about it tonight, online, for free. I hope you’ll come and be a part of the chat room. This is a subject that every EMS caregiver can benefit from sharing and exploring. I’m always seeking more information on how to better connect with our patients. This webinar will be one more step in that process. I’d love for you to be a part of it. See you there.

Steve

This guy wasn’t looking for an easy 200 bucks. This guy was looking to implode his life. Pure and simple. I say this because I know people who’ve done it. Folks who just wake up one morning and decide to push the self destruct button on their life. When we work in EMS it isn’t that hard to do. One minute we’re buying a cup of coffee, the next minute we’re on CNN. 

Ray decided to steal the narcotics from the units parked down at the shop. Mark went home and put a .44 in his mouth. Matt just put his bike helmet on, walked out the front door and never came back. And each time it happens I think, “Next time…next time, I’ll see it coming.”

But that never quite works.

This coming Monday. May 10th at 8:00PM EST (6:00PM Mountain) I’m going to be putting on an EMS Boot Camp to teach anyone who wants to learn how to pass the dreaded National Registry skills exam. I finally got the green light to put on a few EMS Boot Camp’s and this was the first topic I knew I wanted to bring to the table.

I’ve been proctoring National Registry skills exams and teaching EMT students to pass this test for over a decade. Now, Greg Friese and Jim Hoffman, the masterminds behind EMS Boot Camp, are going to let me teach you.

Would you like to learn:

• The attitude that almost guarantees success?
• How the test is conducted and scored?
• How to avoid common pitfalls?
• Proper station etiquette?
• The real skills that will help you learn and remember the stations?

If you’re planning on taking the national registry test in the future, I’d like to teach you these skills. My instruction has been tremendously helpful to my students and I’m excited by the prospect of being able to being these skills to you.

On average, 66% of EMT and paramedic students pass the National Registry on their first try. Only 86% are able to successfully complete it after three attempts. 92% of my EMT students pass the test on the first try. 100% pass within three attempts. Yes, you read that right. I’ve never had a student ultimately fail the registry.

Would you like to know how I do it? Come to the EMS Boot Camp and find out. I look forward to seeing you there.

Update: This webinar was a whole bunch of fun. I’m going to do more of these in the future. If you missed it, I hope you still go check out the archives. I’m proud of the way the session turned out.