“I’m Only An EMT Basic”

I’m so sick of hearing this phrase. If I could banish any phrase from the EMS lexicon this would most certainly be the one. I heard it today when I posted a question on Twitter, “How much do you really know about ACE inhibitors?” I asked.  The first reader reply, “Not much since I’m only an EMT Basic.” Ouch. I get stomach pains when I hear that.

I want to make a bonfire out of all the worthless phrases in our vocabulary and throw, “I’m only a …” right on top.

Since when was an understanding of out patients medications an advanced skill? Since when is medical knowledge of any kind an advanced skill?

Somewhere along the way we started giving EMT Basics the idea that anything that isn’t contained in their EMT textbook is somehow beyond them. It’s patronizing. “Here you go little EMT dude, here’s the basics. Don’t move on to anything more complicated, you could hurt yourself.” That’s just ridiculous.

Continue Reading…

5 Hard Questions EMS 2.0 Will Need to Address

“Success is to be measured not so much by the position that one has reached in life… as by the obstacles which he has overcome while trying to succeed.”

- Booker T. Washington

With multiple premiers of The Chronicles of EMS and a wave of enthusiasm from the EMS Today conference in Baltimore, the future of EMS looks bright, blindingly-bright. I’m incredibly optimistic about where this crazy experiment in EMS is headed, but I also see some big hurdles in our path.

Put on your shades and let’s talk about what I feel are the five biggest challenges to EMS reform.

1.) We’ve been talking a lot about unity and standardization, but individual EMS systems are unique in every way. How do you influence standardization and still allow for the tremendous leeway required for EMS agencies to be optimized for the communities that they serve? Can EMS agencies be different in geography, financial resources, administrative structure, culture, call volume, compensation and certification/education level and still find enough unity to advance the profession together?

Continue Reading…

The February EMS Roundup

In the coldest February, as in every other month in every other year, the best thing to hold on to in this world is each other.

                    – Linda Ellerbee (American Journalist)

And what better way to bring the EMS world together than the Internet? February was full of news and fun at The Spot. I hid inside from the Colorado cold and wrote about how to set up an IV line firefighter style. I asked you if you knew what was in the last issue of Splatter. (If you subscribed you’d know!) We discussed tips for mastering the head-to-toe assessment and getting people to hang up their cell phones. The premier of The Chronicles of EMS was the coolest thing is the blogging world. And we explored credibility and redundancy before launching into two posts on hypothermia. (Specifically how to assess it and how to treat it.) Then we wrapped up with a few musings about what it means to be passionate and what it’s like to be a firefighter. My fingers bleed for you.

Continue Reading…

Mastering The Head-To-Toe Assessment

You probably practiced your head-to-toe assessment a bunch in your EMT class. Maybe more than any other skill in the EMT curriculum. If your class was or is anything like mine (as a student or a teacher) you performed the head-to-toe assessment again and again.

As much as we practice this skill in EMT class, I often wonder why so many EMT’s have such bad head-to-toe skills out on the street. It seems that, once we get out on the street, the systematic, thorough head-to-toe assessment falls out of favor and quickly gets replaced with the faster, more direct focused assessment.

That works just fine most of the time. If it didn’t, I figure it probably wouldn’t be such a universal phenomenon. (For the record, have you ever worked somewhere where this wasn’t the case? Neither have I.) The downside is that when the patient arrives who really needs a, honest-to-goodness, rapid, complete head-to-toe, we’re not up to the task.

I happen to believe that patient assessment skills are one of the defining qualities of a talented EMT. Here are seven tips to keep your head-to-toe in top form.

Continue Reading…

The E-Book is Coming!

OK, I can’t keep this to myself any longer. It’s time for the big announcement. With the final draft still in the mail from my editorial team and the final design still lacking a few details, it would probably be best to just keep this under wraps for a few more weeks, but I can’t wait.

My first E-book is scheduled for release on January 21st, one week from today. The e-book will be free and it will be available right here at The Spot.

The Book is called The Non-Conformists Guide to EMS Success. This book is the culmination of two decades of EMS experiences, mistakes, failures, trials, and errors that lead to my ultimate success. My goal was to write something that would be useful to EMTs at any stage in their career. And I didn’t hold anything back. This is my road map to finding true success and fulfilment in EMS work.

Continue Reading…

The Art of The Nasopharyngeal Airway

I would surely rank the nasopharyngeal airway (NPA) as one of the most under-rated / under-utilized pieces of equipment in the EMT bag of tricks. They’re useful, simple and versatile. As a group, we tend to do a pretty good job oxygenating our patients, but I think we drop the ball on BLS airway adjuncts.

Most of our unresponsive or semi-responsive patients should be arriving at the ER with an NPA in place. If you’re bagging a patient they should have one … maybe two NPAs in place.

They’re fast, they’re friendly, they work much better on the semi-conscious and they don’t stimulate the gag reflex quite like their cousin the oropharyngeal airway. They also stay in place better, leaving the mouth open for examination and advanced airway techniques.

I’ve often had EMTs explain that they didn’t drop a basic airway adjunct because they knew I was right around the corner and I’d be intubating. That’s a poor excuse. When I arrive on scene I’d like to see that the EMT at the head has managed the BLS airway aggressively.

So let’s bone up on our NPA skills. Once you’re comfortable with these little beauties, they only take a few seconds to drop. You don’t need to make it a big production. Grab the right size, squirt a clump of KY on the end and go.

So let’s break it down and make you an NPA, quick draw, master.

Continue Reading…

Staked Down With a Twig

Circus elephants present a containment problem. It’s hard to keep a big elephant cage around wherever you go. So when baby circus elephants are trained, they are staked down to a pole with a chain. The young elephants pull and struggle against the chain for a while and then learn the limitations of the situation.

Soon the elephant can be staked down with a wooden stick. The elephant could easily break the confinement but it doesn’t try. It’s already learned what it can and can’t do. To add further insult to the awesome, unrecognized power of the beast, by adulthood many of the elephants can be training to pull up their own stake and move it on command and then remain in the spot that they re-staked themselves too.

I think about the circus elephant staking itself down often. Mostly when I hear my colleagues and friends talk about the obstacles that prevent them from recognizing their goals. You know what I’m talking about. All that stuff we’re waiting for before we can start really moving toward our vision for our life.

When I look at the awesome human potential that we carry around within us and then I consider the little, insignificant things we chose to see as barriers, I think about the elephant.

Continue Reading…

The November EMS Roundup

“Whenever I find myself growing grim about the mouth; whenever it is a damp drizzly November in my soul … then, I account it high time to get me to the sea.”

Herman Melville

When the cold November finds me grim about the mouth I find myself drawn to a warm fireplace and the click of my laptop’s keyboard. Lucky you. In November we kicked off with the idea that details matter. We discussed the importance of determination and I reminded you to ask the patient. I also pointed out ten things you can’t learn about EMS sitting in front of your computer and I made the polite request; don’t be a jerk. Chris Framstead took a walk down memory lane and talked about how things were back in the day. I told you about the ultimate EMS protocol and the controversy over c-spine immobilization. And we even found time to explore podcasting and the sternal rub. (Insert deep breath here.)

Continue Reading…

The Podcast Conundrum

I’ll admit that I really like listening to podcasts and I certainly have a few favorites that I make an earnest attempt to keep up on. There is a collaborative element to a good podcast that you can’t get in other mediums. I like the idea of listening to different folks hash out ideas in audio cyberspace.

Having said that, there are some drawbacks. For one, you need to be organized to download your podcasts regularly and put them somewhere accessible. (ie. your ipod or preferred mp3 device.) This may be easy for you organized folks, but it’s not my strong point.

Also, they take a time commitment from the listener that can be challenging. I rather like the idea of being able to log on to a blog or rss feed, cruise through my choice of blog posts and then move on. I find it hard to devote an hour and twenty minutes to my favorite podcast regardless of how interesting it may be.

Perhaps this is my generation-X monkey mind at work.

But if you do have an hour and twenty minutes at your disposal, check out the latest episode of The EMS Garage, one of the very best shows in EMS podcasting. This episode is called “Spot The Crazy Guy” and if you just can’t wait to find out … it’s me.

This show was a bunch of fun and I hope you enjoy listening as much as I enjoyed being a part. I think I may try to crash the show tonight as well. That is … if they let me back on.

Back In The Day

A Guest Post By: Chris Framstead

If you’ve worked in EMS anywhere near the Denver Metro area in the last 20 years you’re probably going to really like today’s offering by EMT Spot guest author Chris Framstead. I’ve had the pleasure of knowing Chris for over a decade now and I’ve hounded him to put his fingers to the keys for The Spot. Chris is an uncomparable teacher and an insatiable student of all things EMS. Is his twenty year career he has been an EMT, a paramedic,  a firefighter, an EMS administrator, a chemical weapons and explosives specialist and a teacher at various colleges around the nation.

Today Chris is the International Training Coordinator for the famed Texas Engineering Extension Services, the worlds largest emergency responder training facility and a division of Texas A+M. If you happen to be one of the 80,000 responders who pass through the facility for one training or another, you might run in to Chris. Buy him a cup of coffee and ask how things were … back in the day.

Back in the Day

I’ve been in EMS and fire service for twenty years now, and have been a certified EMS provider for the past eighteen years. Over this time (which is not all that long compared to my other friends in the Denver system who have been playing the game a lot longer), I have seen a lot of change. Lately I’ve heard, what feels like, a lot of brand spanking new, right off the lot new Paramedics, and EMT-Basics, standing outside the EMS classroom, or outside the volunteer fire station, talking about “back in the day”. I have to laugh, not to belittle their stories, but because “back in the day” to a twenty year old EMT-Basic, was….well…..2007. So my mind started racing and memories started flowing, as I thought back to my wonderful career and the “back in the day” memories I have.

So as I was sitting in my kitchen this morning drinking my first (of many) cups of coffee….and I thought…what a cool article….”back in the day”. I am certain if I presented this article title to any one of my friends who have been around the Denver system for as long, or longer than myself, they we could easily write a book about “back in the day”. I simply had my memories flowing this morning and wanted to share them with you readers, in hopes of striking up your memories of “back in the day”.

Continue Reading…