Great conversation on the EMSEduCast

Recently, Greg Friese of the EMSEduCast sent out a call for topics to fill an open slot on their podcast.  A few of us answered the call and came together for a great conversation about continuous learning for the experienced provider.

Check it out here:


New Hire’s Perspective

For the last five years of my EMS career, I’ve been studying best practices for EMS Field Training and Evaluation Programs (FTEP) from a management perspective.  I’ve looked at everything I could find about hiring and training EMS providers… from the interview to the FTO teaching in the field up to the manager organizing schedules and budgets.  I had studied it from every perspective.

At least I believed I had.

This month I’m seeing EMS FTEP from a perspective that I thought I understood; the new hire.  My family has relocated and I’m starting all over as a new hire in a new system.  A lot of the “truths” I believed are being challenged.  The changes I’m having to make now, both personally and professionally, are huge.

My fellow new hires have taught me most of what I’ve learned over the last two weeks about the new hire’s perspective.  Over lunch breaks and side conversations they have shared with me the spectrum of emotions a new hire may have during an EMS FTEP.  I’d like to share some of the most interesting ones.

“The ink is still wet on my state license.”  I’m not talking about someone who is simply new to your service.  This is someone who is completely new to EMS.  FTO’s and managers with any more than a year on the job have a few newbie horror stories.  There is always a learning curve for the newbie, some curves are steeper than others.  Often, these horror stories come from new employees who had character flaws on top of inexperience.  To be clear, I don’t believe any of my current peers are unmotivated or immoral.  There are just a few who (despite their EMT-B training) have never touched a cot, a monitor, or the steering wheel of an ambulance.  As an instructor or manager, are you ready and willing to spend the extra time that they will require in the skills stations or in post-run debriefs?  Does your FTEP have structured, non-punitive remediation plans built in?

“This is my dream job.”  Someone, somewhere has looked at your agency and thought it was the best thing since bacon.  If you’re in the position to be instructing or managing within your EMS agency, then you’ve probably been there a while.  The “new” has worn off many moons ago, and there are some things you’ve started taking for granted.  You also know all about your agency’s ugly side, so the thought of it being someone’s utopia is beyond bizarre.  But for someone coming from a much worse previous situation (and there is always at least one that is worse), your agency is the bomb.  Do you and your FTO’s promote the positive aspects that first attracted this new hire, or will they see more of the negative?

“Been there, done that.”  Occasionally a new hire will come into your service ready to go to the streets with little training or supervision needed.  There are still certain activities they’ll need to complete for the sake of organizational compliance, but for the most part they are ready to rock.  How does your FTEP engage and challenge the veteran adult learner?  Are your newer FTO’s prepared to work with a new hire who is more experienced than they are?

“There is no Plan B.”  This is the situation that always stops me in my tracks.  Either by poor choices or simple bad luck, the job you’ve given them is their only lifeline.  As weird as this may sound, entry-level EMT pay may make this person “rich” in the eyes of their family and peers.  Most of these people aren’t going to advertise their financial hardship, either.  They may share their concerns with you if you’re able to create an emotionally safe environment for them, but then again they may not.  Does your orientation sufficiently explain pay and benefits to new hires?  Do you have an employee assistance program with resources for those who would rather disclose problems to a third party professional?  Would you be willing to help someone find other employment if you had to terminate them from your FTEP?

There are endless variations and additions to the list above.  These are just a few that I’ve recently observed.  I’d love to read your thoughts, as well.

Risky Driving Behaviors

Yesterday I had a great time working with several of our local agencies to stage a mock wreck for some high school students.  We changed our focus from intoxicated driving to distracted driving this year, and I hope the message will hit home for the yesterday’s audience.  Everyone involved did a fantastic job, and I look forward to doing more of these next school year.

What types of outreach education does your agency provide to address risky driving behaviors?

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Vehicle Extrication Safety Course Online

I recently had the pleasure of working with the great people of CentreLearn and Western Taney County Fire Protection District on a special project.  We staged a two-car collision with entrapment and photographed the progression of activities occurring on an extrication, with a safety emphasis.  As an amateur EMS photographer, it was an exciting opportunity to work with both local responders and a national leader in EMS & Fire Education.  Click on over to the CentreLearn course announcement and check it out!

Photo Response to “Bad Recipe”

“You genuinely scared children for your amusement.”  
Tim Noonan, aka Rogue Medic
Blog Comment on May 5, 2013.

“…he seems to be entertaining his crews and only scaring the children.”  
Tim Noonan, aka Rogue Medic
Blog Post on May 7, 2013.

Apparently me and my “recipe” post are the flavor of the week for Rogue Medic.  He’s posted at length over at his blog in criticism of me and compared my thought process to the cruel humor of a fictional, post-apocalyptic warlord.

In my youth, unprofessional insinuations like this would have bothered me.  Now I just don’t see the point to engaging in it.  For my readers, it’s my sincere hope that each of you can also find enough joy and fulfillment in your careers to keep doing what you love in the face of criticism.  I thought I’d share with readers some photos, both old and new, of me scaring children educating and entertaining children in my time as a paramedic, firefighter, and community volunteer.  Enjoy!

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Photo Phriday: Recipe for PR Event Laughter



Recipe for PR Event Laughter

Serves: 6 – 8 children and accompanying adults

Ingredients:  Cardiac monitor/defibrillator, defibrillation load tester, small group of children, sense of humor, melodramatic EMS provider

1.  Gather together a group of children and display your cardiac monitor while asking, “Has anyone seen a medical show where they used one of these to shock a person in cardiac arrest?”

2.  Wait for responses and colorful explanations while turning on the monitor, unwinding limb leads, and plugging defibrillation cable into defibrillation load tester.

3.  Ask group of children, “Who would like to get shocked?!”  Savor the looks of slack-jaw disbelief on the faces of the children and adults.

4.  As the bravest children begin to volunteer, hand out three ECG limb leads, one for each of the first three volunteers.  Instruct them to put their thumbs on the end of the electrode.  Keep one for yourself.

5.  Explain to the children that each shock is delivered through a single limb lead, while the other three leads act as ground wires and will not receive a shock.  Further explain this is a randomly generated circuit that changes every time the monitor charges.  Claim you have no idea which single person is about to get shocked, but you’re willing to take the chance of being shocked if they are.

6.  With great fear and trepidation, charge the monitor for defibrillation.  Increase the distress of your expression as the monitor reaches full charge.

7.  Prior to pushing shock button give a, “Guess this is goodbye” expression to your partner.  One or more child volunteers may throw the limb lead down in fear.  Allow them to retreat and assign another brave child to the open limb lead(s).

8.  Push the shock button to defibrillate your defibrillation load tester.

9.  Immediately scream in agony, drop your limb lead, and run/jump/cry as you feel is appropriate to convey that you were “shocked.”

10.  After catching your breath, thank them for being brave and invite them to bring their friends back for additional demonstrations on the half-hour for the duration of the event.  With their full attention at your disposal, it is also the ideal time to discuss relevant public safety messages for your organization.

11.  Repeat procedure for the rest of the day, or as long as you can keep a straight face.

Mini EMSEduCast at the Missouri ICE Conference

Last year I thoroughly enjoyed the Missouri ICE Spring Break conference, and was excited to return for the 2013 event.  This year was even better, and I quickly realized that there was no way I could blog about all the cool things I picked up from this conference in a single post.

So over the next few weeks, I’ll be doing a series of posts on the topics and presenters from this year’s conference.  To kick things off, let’s take a listen to a podcast we made there.  One of the best experiences was putting together this Mini EMSEduCast of all the show alumni who were presenting.  Head on over the the EMSEduCast site and check it out!

Your Work Matters

Do you remember your first career aspiration?  That’s right, I’m talking about the bigger than life dream you had as a kid.  Are you living it now as an adult?

If your answer is “yes,” then stop reading now.  Go back to being an astronaut… or a supermodel… or whatever childhood dream you’re now living.

But if you’re not living the dream, then welcome to the party.  Most of us in EMS aren’t enamored with the monotony of our careers.  It’s no big secret.  The drudgery of oxygen, monitor, IV, transport to the Nth degree will wear on anyone.  Does that equal unhappiness?  No, it just means many will accept monotony as an excuse to be average, i.e. unawesomeness.

This week I witnessed… no, that’s not the right word.  I endured the handling of a healthcare team that had succumbed to mediocrity.  Long story short;  I had an outpatient surgery, and it was unpleasant.  Had my wonderful wife not been there to support me, the day would have been unbearable.  The whole experience got me thinking of a passage from Steve Whitehead’s e-book, “The Non-Conformist’s Guide to EMS Success.”

Yes, our work matters. The work of the EMT is vital and worth doing. 

If it doesn’t matter and we choose to do it anyway, we are fools. Since it does matter, it’s worth committing ourselves fully. 

When we do, we are free to support our workplace as a place for meaningful work. Sure, that all sounds good right? It is. But it comes with a bitter pill. A pill that not too many of us are willing to swallow. 

To recreate our workplace as a place of meaningful work, we need to take accountability for creating it. Not the future, the now. We need to accept that we have created our working environment, and we continue to create it each day. 

So don’t mistake this post as a pity party.  No, I want to tell you about the positive aspects of my care.  Let’s talk about the two things performed by healthcare workers that made me smile; warm blankets and a joke.

During the pre-operative procedures and interviews, I quickly became cold in my paper-thin patient gown and grabbed the standard white blanket provided on my bed.  Not much better.  My wife began piling our winter coats on me, and when my nurse saw this she went to grab several blankets from the blanket warmer.  Not from the cabinet in my room where more cold blankets were stored… the blanket warmer.  That doesn’t sound like much of a feat, but if you’ve spent much time in hospitals, then you know the logistics of blanket warming technology.  Though we’ve put astronauts on the moon, we can’t seem to install more than one blanket warmer per floor of a hospital.  Hospital-based healthcare workers will also agree that the patients requesting warm blankets are always placed in the rooms furthest from the sole blanket warmer.  Go figure.  My nurse could have easily grabbed some cold blankets from the nearby cabinet, but she didn’t.  So for the trip to and from the far-flung blanket warmer, I thank you, Nurse Cammie.  You made me smile.

After several other interactions with employees who appeared to be on autopilot, my warm blankets and I were wheeled to the operating room.  A young surgery tech helped clear the hallway of wandering family members and unattended beds.  She smiled at us and joked about racing me to the operating room as she jogged ahead to clear obstacles.  At O’dark-thirty in the morning, no one would have blamed her for being just as uninspired as her co-workers.  But she wasn’t.  She chose to be awesome.  Thank you, happy surgery tech chick, you made me smile.

My experience as a patient reminded me how easily healthcare workers can fall into ruts and stop caring about the little things.  Perhaps they feel like the little things don’t matter because they aren’t part of that bigger than life childhood dream.  But the little things do matter, and they weren’t given to me by the surgeon, the anesthesiologist, or the hospital administrator whose shiny car we passed in the parking lot.  They were given by people whose healthcare roles are very similar to ours in EMS; brief parts in the grand scheme of a patient’s care that can be easily forgotten or greatly appreciated.


Reply to “For EMS’ers, Is PA School Just the Next Thing to Do?”

Bob Sullivan at EMS Patient Perspective posted on one of my favorite topics today; brain drain in EMS.  What happens to great paramedics who get bored doing “vitals, oxygen, monitor, IV, transport” to the Nth degree for a few years?  They leave EMS!

If you haven’t read the original post, go check out “For EMS’ers, Is PA School Just the Next Thing to Do?”  Leave a comment or “Recommend” the post, then hurry on back here.  I’ll leave the light on for you.

Already back?  Good!

First, I agree that PA is a great goal for EMS providers, but it might be a pipe dream for the average paramedic with 5 years of street experience at McAmbulance. Here’s where I see obstacles for most:

1. Many will get tripped-up with the PA school entrance requirement of having a 4-year degree. It’s a damn costly endeavor. I’m still paying off mine, and will be for a while. Few McAmbulance operations are giving tuition reimbursement for employees to pursue a degree beyond the Associate’s degree they probably already earned with their paramedic courses.

2. Even if your employer pays for your 4-year degree, it will be a benefit to full-time employment only.  Ever try keeping your full-time job, family, and personal health together for several years while maintaining an “A” or “B” in Organic Chemistry and a handful of other prerequisite courses?  It’s something I’ve seen done, but only by a few high performers.  And I mean truly gifted people.

All that being said…
Going from paramedic to PA is entirely possible.
I’ve watched others do it.
They are very happy now.
You can do it, but it will be very challenging.
Here are a few tips. 

Second, there’s a bigger issue that needs to be addressed here.  That issue is our collective lack of career development.  As Skip Kirkwood so often points out in his writing, our law enforcement and fire/rescue peers have a dozen different career paths to take within their departments.  Since 2008, he’s been preaching that we need to develop career breadth for medics whose aspirations may not involve supervision.

Too many talented people leave EMS because we give them a job (something to do for a while) but fail to offer them a profession (something to pursue for decades).  As Bob Sullivan suggests, maybe they leave to become PA’s. Perhaps they depart to become RN’s or MD’s.  Regardless, they’re leaving and we need to address that.

EMS Book Review: “Silent Siren: Memoirs of a Life-saving Mortician” by Matthew Sias

My EMS Book Review for December is Silent Siren: Memoirs of a Life-saving Mortician by Matthew Sias. The book is a chronological progression along his unique career in emergency services.

 Sias’ story is uncommon with respect to his career development.  It’s normal for some new EMT’s to follow a non-EMS trajectory and eventually become career law enforcement, firefighters, nurses, PA’s, or doctors.  Less common are the EMT’s who become coroners or morticians.  Out of my hundreds of emergency service friends, I know of only two who pursued that path.

Going into the book, I had the preconceived notion of it being a collection of morbid stories that would depress even seasoned EMS providers. Despite the darkness of the cover and title, this isn’t the case.  Sias weaves together several dozen short memoirs with a light and humorous writing style that engages readers to follow him through his pursuit of providing for a patient or family’s needs.

 I enjoyed reading this book and even had the opportunity to talk with Sias on Medical Author Chat with Greg Friese.  Be sure to check out that interview and pick up the book!