Friday...who loves Friday?

It's time we demand change.  No longer shall people get sick or injured from Friday at 1700 until Monday at 0600.  We have lives too you know!  Those that are on shift will appreciate the rest while the managers will scream about truck productivity.  Easy to solve this though:  If there are no sick or injured people from Friday at 1700 until Monday at 0600 there would be no need to staff any units, anywhere.  We all get the weekend off.

(Pipe Dream mode Off)

EMS sees Friday as just another day.  If you're on a rolling 24 Friday is nothing more to you than one of two days off or another 24 hour shift.  Supervisors don't ever get a day off, just a day out of the office.  Being on both side of the coin (truck and management) I can tell you that there is almost no difference at all.

I think I've worked about every job possible in the private EMS field.  As I sit and reflect on the last 16 years I'm happy that I always knew where I came from....even if I didn't know where I was going.  That's part of the magic and allure of EMS, each day is different yet very much the same.  You can know 100% of what you job entails but never 100% of what you will see that day.

So it's Friday and my week is blown.  I've had so much drama packed into a 50 hour work week that I couldn't possibly stand another day of it.  I've had meeting after meeting, conference call after conference call and run after run.  Some days I really miss the simplicity of the lights and sirens.  Some days I miss the purity of the sick and injured.  It sounds silly but at least I knew my place in the universe back then.  Now a days  I feel like a juggler with a show that no one finds entertaining.

Happy Friday to you all.

So you want to be an EMT?

I had this same thought about 18 years ago.  Light, sirens, rush,rush, rush SAVE A LIFE, BE A HERO!

Reality is very different than the musings of a young man bent on saving the world.  Reality is harsh and blunt and often a splash of cold water in the face of those who intended to make a difference.

Reality is Private EMS.

Out of ever 100 people who go to EMT school only 75% will complete it and pass.  Out of those 75 people only about 5 will end up on municipal departments, 40 will end up working in a volunteer setting only and the 30 remaining people will find themselves braving the wilds of Private EMS.  The above statistics are mine and mine alone.  I don't really care if you don't agree or have a differing opinion.  This is what I've observed in the last 18 years and as such I consider it fact.  Your facts my vary, so be it.

Bigger isn't always better.  You have the big ones like Rural Metro, AMR and Acadian then you have several THOUSAND smaller outfits.  Some are mom and pop squads and some are bigger players on the local or even State level.  They all deserve your attention and your scrutiny.

There are a few things you need to consider before jumping feet first into the acid pool that we know as private EMS.  I wouldn't be doing my readers any favors if I didn't try to educate you in even the smallest fashion before you made this huge decision.  Lets explore a few of these things:

1. Is the service for profit or non-profit?  Seems pretty straight forward but there are huge advantages and disadvantages to both.  Your personal politics may play a big role in deciding who to work for.  Remember if you have picked EMS as a career you have already put yourself behind the 8-ball by not finding a municipal job but you can still become very successful working in private EMS.  You just need to make your decision based on your personal preference.  I wont tell you which I work for, it would only skew your decision making process and you really have to do this one yourself.
2. Is there room for growth in both the company and yourself?  Another no-brainer for those of us who have been here for decades but a tough one for that 21 year old EMT that has trouble making ends meet.  Don't just jump at the first job that comes your way, remember at this time in the history of private EMS it's an employee market. Meaning more and more managers are competing for fewer and fewer "Good" EMTs.
3. Is the company financially sound? Do a little digging through the interwebs here.  Remember, if they can't pay their bills how will they pay you?  All BIG companies go through restructuring at some point or the other so be wary of "Old" information.  How is the company doing now?
4. What is the public perception of the service?  Nothing will grind you into the dust faster than going to work for a company that has a piss-poor reputation.  You won't save it, you won't make it better, you wont rise above it.  Unless the philosophy changes from the inside out it will only drag you down, kick the shit out of you and leave you feeling used.  The bright side of this is that when you walk into my office broken and beaten by crappy XYZ ambulance service you would have seen the worst and you'll appreciate what I have to offer you.
5. Pay and benefits?  This one catches new EMTs all the time. XYZ ambulance service is paying 2 dollars more per hour than ABC ambulance service and they have offered me a job!!  Hell ya, I'm going to be making bank!  WRONG young EMTling, master tells you to examine the facts. The is a finite amount of money being received from all ambulance runs.  Every service charges pretty much the same to remain competitive and the Fed and State sure as hell don't pay a lot on the Medicare / Medicaid calls.  XYZ is robbing from Paul to pay Peter most of the time.  You can be Peter or Paul but I assure you, you'll be one of them.  You want to find a nice median rate with an insurance premium you can live with.  Uniforms should be provided (not payroll deducted) and you shouldn't have to pay for any pre-employemnt "testing".

Enough of that for now.  When you have considered those 5 things it will be time for you to start filling out applications.  This is where the fun begins!

If your handwriting sucks your application goes immediately into my circular file, better known as the trash can.  After all if you can't neatly fill out an application how in the hell will you neatly fill our a PCR in the back of a moving ambulance?  You'd be surprised how many people are denied jobs at good services because they lack common sense.

If you are asked to take a personality or Turing test understand that it is important.  Give all the questions some thought and realize that some of the top minds in the nation KNOW you will try to tell the employer what they want to hear.  They expect it, here is where it gets tricky; if you answer all of those questions COMPLETELY honestly you'll probably get a low score.  Seeing as everyone from the beginning of time has lied on those or "fluffed" their answers the curve is horribly off.  "Have you ever stolen company property?"  You answer NO, even though you glance at your pocket and notice 3 pens and a stapler you swiped from your last job.  If you answer YES to this you're pretty much out of the running.  It's bullshit, I know it, but this is how it has to be.  Trust me on this one young EMTling, I've taken and failed more of those tests than I can count simply by answering honestly.

Piss test.  Yep, it will happen.  Nope we're not dum-dums.  You can't fake it, you can't skew the results.  I'll just make you re-take it.  There is no "cure all" on the market that will take it out of your system, no matter what Tommy Chong says.  I've seen it all, heard it all and ya, done it all.  You can't fool me.  Get clean, then come take your test.  Although I don't think what you do on your off-time is any of my business, someone does and unless you have a medical pot card don't even bother wasting your time taking the test.  Probably better you don't even fill out an application until you are clean because it's going to look awful strange when you postpone your interview and whizz quizz for 30 days after you're called in.

Training.  Suck it up butter-cup.  Do as much training as the company will offer you.  This is free money and in private EMS it don't come around often.  During this time someone will either be showing you how to do the work or they will observe you do the work. That safety net is awful nice for your first few weeks.  No matter how well you did in school, no matter how much of a god-damn genius you are when it comes to patient care you still got to remember that I haven't met a patient yet who has read the book and dies as prescribed.  Go into your training like a fresh chalk board (I'm dating myself) ready to gather and store as much information as you can.  Show respect to those who have walked before you and for the love of god keep your mouth closed unless you have something relevant to say.

Be on time, every time. I've seen many a competent EMT lose their job because they were chronologically challenged.  No one cares about you except your mother.  No one cares you don't have child care.  No one cares your vehicle broke down.  No one cares your alarm didn't go off.  No one cares about anything except you showing up on time, every time.

Dress the part.  You're expected to be a medical professional, dress like it.  Learn to use an iron, never forget an undershirt. Polish your boots, comb your hair.  Easiest way to make sure you look the part is do a little research on military dress, learn it, do it.  You should have a stethoscope, penlight, trauma sheers and a notepad with pen and a multi-tool never hurts either. Without these things you just look under-prepared.  The opposite also hold true though.  If you walk in looking like inspector gadget with every bit of crap under the sun attached to your belt you will likely be scoffed at and asked to lighten your load a little.  We joke saying that the newness of an EMTling is directly proportionate to the amount of shit that hangs from them.

Well my lunch break is over; 9 interviews, 3 reports and a termination to go before my day is over.  I wish you the best of luck and I hope to see you become a successful EMT.  EMS is a very small community, we will meet at some point.  I'll be expecting you to be prepared.

Z

I dislike Monday.........very much.

Coffee.....check
Payroll.....check
Incident reports....check
Maintenance log.....check


**YAWN**

Someone really needs to do something about Mondays.

So I sit here this morning wondering if I'm going to have to fire an employee that has been with me for 12 years.  It weighs heavy on my soul.  I've never had a problem cutting someone loose if they deserved it but when you got to make a decision based upon someone else's interpretation of the rules it kind of sucks.

Corporate policy often contradicts personal opinion.  How do you deal with it?

Easy.

You voice your opinion, you put that opinion in writing and you fire it up the chain.  You have done what you can do at this point.  I know it sounds harsh, but really, are you going to jeopardize the jobs of 35 other people for the sake of 1?

Still I wish they would come down and do it themselves.  I feel like a hatchet man.

OR...

Maybe my opinion will be taken into consideration and the ruling will be in their favor.  Although I can't completely discount that happening I still have to live through this Monday with the dread that I might have to replace an employee.  I'll never be able to replace the friend.

Monday Sucks.

The more things change...

Sitting here I got an email saying someone posted to my blog.  "I've got a blog?" I wondered.  Oh ya, the blog I started when I was ranting about life in EMS.  So I take a quick look and this is what greeted me.

Well after a stressful day in the field I see no problem coming home to smoke and relax, it beats becoming an alcoholic like half the people in the field. for some one to say your the lowest of snakes and a fucking idiot is some one who is very uneducated in the subject of weed. some of the best medics and emts smoke weed, your personal life and work are two different things, keep them apart and you should be fine. and as for Mr. "Hating on smokers"chill out seems like u could use a joint yourself with all that anger haha.. 

If some of the "best" medics and EMTs you know smoke weed you really need to  to find a new group of role models.  17 years in the field and I can say one thing with complete confidence:  "I don't drink to excess and I don't smoke weed."  All of the best EMTs and Medics I know also don't.  They are committed to their profession and taking care of the people in their charge.

You need a clear head for this job, it can't be addled with anything other than the mass amount of information you have to retain to do it to the best of your ability.  You're lying to yourself if you think that your recreational drug use is a "good" thing.  You can try to justify anything, drug use, alcohol use, abuse of prescription medications or even violence but in the end, you're still lying to yourself.  You are relying on a "crutch" to get through the evenings so you can do it all again the next day.

If EMS is to ever get the same respect as doctors and nurses we need to hold ourselves to a higher standard and demand that those around us to as well.  Snake shit, and fucking idiot was probably pretty harsh.  I apologize for that.  At that point in my life I was really feeling the pressure of the job.  It was before I learned healthy coping techniques and got myself into a stable home environment.  Now I'm just kind of sad for you. Until you are willing to let go of childhood vices you will never be able to take that next step to being a professional provider.

I'm no prude, I've smoked weed and gotten as drunk as the next guy but there is a time when you have to start looking at the bigger picture and thinking beyond your own vices.  Grow - Up.  Set an example for new EMTs.  Be the change that we all so desperately need.

Partners

It's been awhile. I'm not sure if I have returned to vent or to actually try and express some of the frustration I have been feeling lately. No matter I guess; I'm here now.

You ever stop to notice that it's not just the patients that you make a difference (or indifference) with in your day to day dealings? I mean, we like to think that we are in this job to preserve life but in the end we also leave a considerable mark on those around us. Some of them are patients, some are not.

Partners

One way or the other if you work with someone long enough there is a transference of both attitude and personality (not to mention skill level) between you and your partner. I have written many a blog post about grizzled old paramedics that I have learned a trick or two from. It wasn't until a few months ago that my wife pointed out to me that I WAS in fact a grizzled old paramedic now.

I guess it just crept up on me. I never saw it coming, then one day WHAMO....shit.... you've been doing this a long time. What stories are people telling about you? How did you affect the lives of the people around you? What did someone learn from you? What legacy are you leaving to the NEW group of practitioners?

One person comes to mind when I think about how I might have influenced a younger, less experienced EMT. You know me I never name names, just not polite.

I got this guy as a partner straight from his basic program, he was young, eager to learn and a cracker jack basic. Many times I had to reel him back in on things, but at the end of the day we saw pretty much eye-to-eye on most calls. He would ask questions when he needed answers and I'd do my best to answer them or at least point him in the right direction for answers. It wasn't long before he decided to go to intermediate school, it seemed almost effortless for him. He had a question or two from time to time but in the end he did very well and his experience on the truck gave him a good foundation to build upon his basic education.

After he got his intermediate card he immediately stepped up his game. There was very little coaching from me. He did very well under his scope and knew most of my scope as well. We were able to work seamlessly in the back of the truck. People would often comment about that fact that we would almost never speak to each other during a critical call. Talking to the patient was important to us, but getting the job done didn't require any delays. We had worked together for almost 2 years and we KNEW what each of us were going to do. Conversation with anyone but the patient was unnecessary.

I could see his mind growing past his scope though and it wasn't long before he was in medic school. This time around his training was more difficult for him, but he always asked questions when he didn't know and he pushed right along to graduation day. I was so proud of him when he walked in and passed registry. 3 years had passed and I watched this young EMT really refine his art. It almost like a father watching his son graduate college. I suppose I felt just as much a sense of accomplishment as he did. It wasn't just that HE made it... It felt more like WE made it.

A couple months later staffing changes forced us on to different trucks. A month after that he never showed up for work again. 30 days later he went to work for another company. I felt betrayed. I felt like I had invested so much to have him just walk away without even so much as saying goodbye (not to mention 2 weeks notice). The rumor mill was spreading that he didn't like the people he was reassigned with and he wanted his own truck. Well, I guess he got it.

So I fumed over this for 4 months. I was always polite when I saw him out with the other company but I never stopped to have much of a word with him. I don't know if I was more angry about the switch to another company or just the fact that he left at all.

I ran across his profile on Facebook. Just for old times sake I start poking through some of his pictures then I noticed his favorite quotation.... It was something I had told him over and over during his time riding with me.

I made an impact on him, and in the end I guess thats all that matters. We all move on in one way or the other, it sucks, but it's life.

Death a collection of scars.

It's a fact of life, that life ends. From the moment we are born we begin the process of dying, it's not a mystery and it is not avoidable. You are born, you live, and you die and along the way you give and get a few scars.

I can run on a DOA of a senior and not even batt an eyelash. It's so common place that you have to remember to be sullen and mournful while in the presence of the family. I guess my brain justifies it as "They had a good long life." To tell you the truth I'd be hard pressed to remember the name or even location of the call. I'd have to read my report to refresh my memory, but it leaves a small scar on me.

With that said, while you're all thinking I'm some cold heartless bastard, I can remember the name, age and face of every person I ever came across DOA or worked in vain that was under 70. I don't know why 70 is the magic number for me, it just seems to work out that way. It's not like someone dying at 71 is any less a tragedy, but my brain just doesn't process it the same way.

The others haunt me sometimes. I'll dream of them and wake up in a cold sweat. I'll close my eyes and vividly recall every single action I took on the scene. I'll hear and feel the screams and sorrow of the family. My heart will start racing again just as if it were that day. I can't escape them and honestly I don't think I want to. They keep me centered, oddly enough. The ones that we lose can teach us much more about ourselves than the ones we save. Can you remember the last 20 patients you "saved" (treated, etc..)? I can't, but I can remember all the ones I lost. I know what I did, how I felt, how the patient presented. I can recall all of my treatment and could probably tell you pretty close to 100 percent on how I wrote the report. The same goes for the DOA's. I can tell you how the house looked, how we determined death, who I called, who was there from the family and who arrived later and pretty much what time they got there. The scars from these calls run deeper.

Then there is my personal nemesis, the 30 somethings. I'm a 30something and when one of them buys the farm I can't shake it for months. Probably some sense of self preservation or something but it scares the hell out of me when someone my age punches their ticket. I have shit to do, I'm not ready to check out, but whenever a 30 something dies I always think "That could have been me". So then my brain goes into "justification mode". I try to find a reason that person died: drug use, poor driver, no seat-belt, alcohol, bad genetics, non-compliance with prescribed meds. Really, anything I can try to explain why this person died. It's all just a ploy though, when your number is up....your number is up. These scars are noticeable.

Kids are the worst. I imagine they are for everyone in this profession. Let me be clear, it's not the absence of life in the child that damages me the most. It's the sound of a parents weeping, like their soul is being ripped from their chest. There is no worse sound in the world than a mother or father crying over the loss of a child. It will burn it's self into your consciousness and sub-consciousness and you will never remove it. No amount of therapy or booze will help, don't bother with it. Maybe you would have to be a parent to understand. These are deep vicious scars that are ragged and ugly.

Death scars us all, no matter how tough you are.

Paramedics are a collection of scars. Cherish them all, they once were a life and will continue to live on through you.

Where to start...?

Sorry, it's been awhile since I have posted. Things have become crazy in my life and I was also introduced to facebook.

In June I got married to a wonderful gal and was promoted to station captain. Things took a bit to smooth out around the station but we are running like a well oiled machine now. Private EMS is still private EMS.. it has it's ups and downs, you just hold on for the ride and make the best of every situation and every call.

A few months ago they restructured the emergency room. They replaced all the ER technicians with paramedics and I picked up a part-time job there too. I must say that I find that very enjoyable. On the squad you get to be a paramedic 5-6 times a day; but in the ER you get to function as a paramedic for 12 hours in a row. It's a great way to keep your skills polished and learn a lot of new tricks from the ER docs.

I'm still teaching EMS too, so some weeks I work over 120 hours. I feel it's worth it. I'm trying to save as much money as I can now so I can relax later.

Balancing work time with family time is always challenging but I'm doing the best I can.

Stay safe out there guys!

It shouldn't be easy...

My next few comments may be a bit sensitive. I apologize in advance for them, but they are my true feelings and in the spirit of open discussion I will post them now. They are not pointing fingers at anyone. They are general remarks.

Do not be a "Bare Minimum" provider. Do not be a "Fast Food" provider. Do not be a "Good Enough EMT"
We have already dumbed the system down quite a bit from what it was 10 years ago. Many of my friends who have been medics much longer than I spoke of a text for Paramedics titled "You the ER Physician". We made it easier so more people would do it. I think that was a mistake.

We have cut too much already, we have made the system and the testing easier for people to pass and as a result of this we have some pretty crappy providers on the road. This is also one of the reasons we cant get better reimbursement as a health care profession. It's also a reason why we are not taken as seriously as we should be.

Not everyone should be an EMT. Volunteer or not, some people just do not have the aptitude for the work, they don't work well under pressure etc. All we accomplish by making the system easier is a type of EMT that you wouldn't want attending to your loved one. You can teach ANYONE to pass registry, but the cold hard truth of the matter is not everyone should. There is a big difference between book knowledge and actual working knowledge.

I don't care what your level is. A solid understanding of the human body and how it works is essential to being a good provider. Yes, there are areas you can stress and areas you can gloss over but all of these areas are very important to the rounded knowledge of a "Good" clinician. You can skate with "Just Enough" to pass the class and still get your card; but honestly, is that the type of EMT you want treating you?

*My Disclaimer*

The preceding post was not a reply to anyone. If you take offense to it your most likely one of the people I'm talking about. If you skin is actually that thin, find new work.

Ass Whoopin' Needed

YOU HAVE GOT TO SEE THIS http://www.youtube.com/watch?v=Gkaq9o_qe1M

By Carlos Miller
An Oklahoma State Trooper pulled over an ambulance on its way to the hospital Sunday, resulting in the police officer placing a chokehold on a paramedic as a patient lingered in the back.

It was all caught on video by the patient’s son, who was following in another car.
The officer was apparently upset that the ambulance did not yield for him.
However, it is evident that the ambulance had a real emergency on its hands, unlike the cop, who had been speeding towards some incident he was able to resolve in minutes, enabling him to refocus his attention on the ambulance.

The incident marks the second time this year that a police officer pulled a vehicle over as it was clearly on its way to a hospital for an emergency.
Paramedics say they were rushing a woman to the hospital who had suffered heat exhaustion when they noticed the trooper traveling at a high rate of speed behind them. They say the trooper had its emergency lights on but had its sirens off.
The driver of the ambulance did not notice the trooper until it got right behind him. He pulled over allowing it to pass. Through his microphone, the officer allegedly said, “You should consider checking your rearview mirrors.” The driver of the ambulance said he responded by lifting his hands in bewilderment.

Three blocks later, the trooper was seen pulling out of a side street - apparently having addressed his emergency or having picked up a female passenger - and pulled the ambulance over.

At first, paramedics thought the woman in the passenger side was having an emergency.
According to the paramedic’s transport incident report: The officer got out of his vehicle in a state of rage. He approached my partner and yelled, “Get your ass back here. I am giving you a ticket for failure to yield.” He also added, “What do you mean flipping me off?”

The trooper wanted to cite the driver of the ambulance but the other paramedic insisted on driving the patient to the hospital first, then allowing the driver to be cited.
The trooper then told the second paramedic that he was under arrest for obstruction and attempted to grab the paramedic’s arm. But the paramedic reminded him that it was a felony to assault a paramedic in the line of duty, especially when he needs to transport a patient to the hospital. They struggled briefly before the paramedic was able to hop in the back of the ambulance to tend to the patient.

By that time, another trooper had pulled up and started banging on the side of the ambulance, telling the paramedic that he was under arrest for assault. The paramedic stepped out of the vehicle and another struggle ensued - this one caught on tape - which resulted in a cop grabbing the paramedic in a vise-like-grip around his neck.

The officers finally allowed the paramedics to transport the patient to the hospital where they planned to arrest the paramedic. But then they finally got smart and contacted the district attorney, who insisted on reviewing the evidence before filing charges.
Police say they have their own version of the truth that was recorded by their dashboard cam. Of course they are refusing to release it.

At one point in the hospital, the trooper told the paramedic that he was so enraged about the perceived “flipping off” gesture that he considered pulling his gun out and using deadly force, according to the paramedic’s transport report.


Clearly this cop was WAAAAAYYYY over the line here and needs to evaluate his position within the scope of things. He would be better suited serveing fries at McDonalds.

I can tell you one thing for sure, he and I would be meeting off duty to "discuss" how he treated me.

If your in this business....

I started catching up on the comments of this blog today. Lots of people I never got a chance to respond to over the years. In the course of doing that I re-read a lot of my old posts and noticed that I used the phrase: "If your in this business any length of time" quite a few times. It struck me as odd at first that those were he only words repeated often. Then I came to the following conclusion. IT FITS.

If your in this business for any length of time you will...
notice that your call volume increases sharply and proportionately to the las time you took a piss.

If your in the business for any length of time you will...
get screamed at for taking too long to get there, even though no one moved out of your way.

If your in this business for any length of time you will...
know what it feels like to wear the same underwear for 48 or more hours.

If your in this business for any length of time you will...
know the pain of a complete stranger crying on your shoulder.

If your in this business for any length of time you will...
feel wracked with sadness over telling a parent their child is dead

If your in this business for any length of time you will...
eat from every single fast food restaurant in your area.

If your in this business for any length of time you will...
miss your children's plays and sporting events, not to mention special evenings with your spouse. You will cancel and re-schedule appoints almost monthly.

If your in this business for any length of time you will...
respond to find a friend or family member seriously injured or deceased and your the only truck available.

If your in this business for any length of time you will...
see a near complete turnover at your station, leaving you feeling alone and with strangers.

If your in this business for any length of time you will...
see new EMTs burn out and fade away even before their carrer starts, due to one bad run.

If your in this business for any length of time you will...
witness the miracle of life and the sadness of death all within 24 hours.

If your in this business for any length of time you will...
find your boots fit differently at the end of the day because your feet are swollen from all the walking.

If your in this business for any length of time you will...
learn to eat when you can and never miss a chance to take a leak.

If your in this business for any length of time you will...
know the difference between: mostly dead, almost dead and dead.

If your in this business for any length of time you will...
opt to work when your sick and save your PTO for "Important" things.

If your in this business for any length of time you will...
learn from someone everyday and teach others without knowing you did it.

If your in this business for any length of time you will...
be constantly reminded to lift correctly, but still lift incorrectly and suffer back bain almost 50% of the time.

If your in this business for any length of time you will...
ruin at least 2-3 perfectly good relationships, but replace them with stronger bonds than you ever thought possible.

If your in this business for any length of time you will...
notice that most nurses don't even listen to your report.

If your in this business for any length of time you will...
see at least 10 patients more than 10 times each per year. They will start calling you "friend"

If your in this business for any length of time you will...
stare blankly when someone approaches you in the mall rattling off a call you were on that helped them. You will struggle to remember the details.

If your in this business for any length of time you will...
measure your payment in the smiles you recieve from little old ladies, they know someone cares. (JS)

If your in this business for any length of time you will...
sit behind your computer and write lists of shit that occured to you...

There are literally hundreds more I think of day to day but forget to add here. Please leave a comment and I'll keep editing this post until we have covered as many as we can think of. I need to start carrying a tape recorder, lol.

Take care guys, stay safe out there.