the queen

Social Suicide

This blog post is a part of  the second “What If We’re Wrong Blog-a-thon.” You can find the other posts here. The premise of this event is to play the devil’s advocate and argue the opposite view on a topic we normally cover.

In my lecture, “Selfie Sabotage” I discuss how to use social media to your advantage as a tool to promote your EMS career and increase your professional prospects. My personal experience using social media as an EMS provider has been a positive one; I have been able to advance my exposure in the industry over the past three years promoting my writing and making key connections with other EMS leaders using social media applications. Most others with an eye on improving their career prospects and the inclination or appropriate training have minimal issues with using these applications professionally or difficulty keeping their personal life out of their professional one… but we all know at least one story about a professional meltdown with social media as the weapon of choice.

AngryTwitter

Social media use is not a right. Unfortunately, most use it with abandon and no method of policing themselves or ability to pause before posting something controversial. There are reasons agencies place restrictions on their employees use of these applications; yes, you may “say” what you like, but there are always repercussions in real and virtual life.

 

  • “It’s on the internet, so it must be true.” I am a fan of curation in addition to producing content, however many social media users do not check the sources behind information, whether articles or photographs, that they share with their followers. The next people don’t check their sources and share and so on until a lie becomes the “truth.” Obviously, there are entertainment spoof sites like The Onion and Gomerblog, which most understand are tongue in cheek and not real news. Outside that, what do you look like to other providers and prospective employers when you share inaccurate information on a clinical level? What if you take a “clinical” article as gospel and it’s wrong? Could that be detrimental to patients in your care? It’s up to the reader to vet their sources and sadly most don’t.

 

  • Misrepresentation is rampant on the internet – and not just for online dating. It’s easy to slip past embellishment in a virtual environment; the virtual nature implies privacy and anonymity, but could not be further from the truth. I have been a witness to many conversations in chat groups or comment threads where one provider knows another and calls them to the carpet on the fib related to their stated experience or certification. I have also witnessed others researching a provider purporting to be someone their not and revealing the true status or level of their certification or employment. Not exactly the best way to be noticed.

 

  • It’s much easier to put your foot in your mouth with the insulation of the internet. That ranges from outlandish tweets to insensitive memes to inadvertent missteps. The results are wide ranging: insulting patients, offending your coworkers or peers, breaking agency protocols leading to your dismissal (and possible blackballing from emergency services), to causing safety concerns for yourself, your partners, and other emergency agencies in your area.

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Many EMS providers, and people at large, place too much faith in the content they find online. Just yesterday a friend posted an article that was an absolute lie, many people knew it was inaccurate and informed him; others commented and took it blindly as the truth. Posting on any social media site requires the same mindset as face to face interaction. If you are not willing to invest the time to pause before you post when you are unsure or ranting then you should limit your social media use. These missteps makes EMS look foolish as a whole.  If you don’t have anything nice to say – just don’t say anything at all.

Like No One is Watching

Sometimes you don’t even notice the people watching.

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I mean, we’re all busy right? So many tasks to complete in a certain number of hours and only a certain number of hours in a day, can leave everything in a little bit of a blur. Constant working and feeling like you never get anywhere can leave you really frustrated and focused on all the bad things going on; even like your work was worth it.

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I recently left an agency where I had a leadership role. The past year or so, I felt stagnant and voiceless; a few months ago, I decided as soon as I finished my agreed upon term, I was going to resign. I felt it was better not to “waste” any more of my time. So, for the last few weeks I have been prepping my replacements, giving them information, who to ask for what, how to avoid regular road bumps of people’s personalities. Yesterday, I turned over my keys to my replacement and punched out for the last time. Just before I did, something unexpected happened.

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People came up to me one at a time in the last few hours and said: Thank you. Thank you for doing a good job, working hard, helping out. Finally, my partner came up, I could see on his face he was about to say something mushy. He went on to wish me good luck and that we’d probably see each other at the hospitals and then…

“…thank you for teaching me.”

Wow. Just wow. I am so humbled on so many levels; mostly that someone thinks anything I had to say helped them become a better healer, to use their hands, head, and heart to take care of others. This whole time I didn’t think anyone was watching, using the work I was putting in. I thought maybe the whole thing was a waste of time.

It was me looking in the wrong place.

I was looking for acknowledgment from those who would never be moved. I was so zeroed in on their obstinance that I couldn’t see the people who did matter: the people I was leading and teaching by example.

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Some days I am so mad with EMS and all our shenanigans and tantrums and prima donna antics that I could just spit. I wonder if anything will ever change with just the minority of forward thinkers ready to depart from the ideas of yesteryear. But then, every so often, you find out someone WAS watching. What will you be teaching them?

It seems appropriate at this time to say thank you to all the people I watched when I was a new guy and watch today to learn how to be a better provider, leader, and human being. Every day I realize there are even more than I thought, when I remember an appropriate story or anecdote related to a present situation. Yes, that even includes folks I don’t care for very much because they left a sour taste in my mouth. I thank all of you, thank you for letting me watch and learn, thank you for sharing that part of yourself.

Have You Had “The Conversation”?

My plan was to watch some “mindless” television and lay on the bed and more than likely take a little nap to enjoy the afternoon during my mini vacation. The last channel watched was HLN and Dr. Drew was on with a panel discussing Bobbi Christina starting hospice care. Dr. Drew did not mince words when he described how the human body reacts to existing in a comatose state for any length of time. Many of the other panelists were very upset by the description he gave, yet medically it was accurate. How many of our patients have we seen well past the ability to make health care choices for themselves either without family members or with family members that don’t know the reality of the end of life trying to do the best they can?

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It is difficult to have influence over a total plan of care that true end of life care should be as prehospital providers with limited interaction time with the patient and their family, often in high stress situations that are not ideal for such a conversation. Yet, there are things we CAN do:

  • We CAN be aware of what services are offered in our response areas either for in patient or out patient and mention them to the patient and or family to follow up on later during an appropriately timed conversation.

  • We CAN also be aware of these services so we can be a part of the end of life health care team when patients have a plan in place

  • We CAN communicate our concerns with Emergency Department staff so they can discuss options with patient and family at a later time.

  • We CAN be aware of our state statutes regarding advance directives and our role in honoring them.

  • We CAN consider end of life care as important as other clinical issues when pursuing continuing education opportunities.

  • We CAN treat (ALL) patients and their families with dignity and care at all times.

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We also need to have this conversation with our families and loved ones and have end of life plans in place for both financial and health care concerns. In our line of work we are always aware that we could possibly be gravely injured or killed in the field, yet many of us don’t have a contingency plan to provide for our families’ well being and peace of mind in the horrible event that something should happen to us. This conversation is not just about what we would like to happen in the event we are unable to make medical or other decisions, but what kind of quality of life we expect and how that should happen. Will you expect your family to be your caregiver? Are they able to play that role? What do they expect if such an incident was to occur? Some things to consider:

  • Preparing a Living Will. This communicates to healthcare providers what kind of treatment you would like and in what situations.

  • Preparing a Healthcare Power of Attorney or appointing a Healthcare Proxy. This person is should be aware of what your preferences are for your healthcare and acts on your behalf in healthcare matter when you are unable to communicate.

  • Would you like to donate your organs? Some states require a registry, others allow you to note it on your drivers license, but you should prepare your family before an incident so they are aware of your choice.

  • Obtain Life Insurance. Health insurance is a hot topic in the United States today, but not much mention is made of life insurance which provides for our families financial well being after we are gone and unable to provide for them anymore.

    To be sure, no one wants to die, much less think and talk about it. We are hardwired as humans to love life and do whatever it takes to keep it. Yet, as unfortunate as it is, death will come for all of us and is an important event in our loved ones lives as well. Our demeanor will decide if it is a destructive event or one filled with the love and care of our loved ones celebrating a life well lived. Part of preparing for that celebration is being open to the conversation of end of life planning and bringing our loved ones into the fold with care and compassion.

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Is Too Much Starch A Bad Thing?

This blog is part of a larger “What-If-We’re-Wrong-a-Thon” by several EMS bloggers where we attempt to view the opposite point of view on a topic we have previously taken a stand on. You can find the other articles here.

This weekend I had the opportunity to attend the Connecticut State EMS Conference (more on that in another post). One of the sessions was about professionalism by Dr. David Powers. Honestly, I wasn’t sure how much more there was to say on the topic, it seems pretty straight forward. However, after attending I came away wondering is there such a thing as being too professional?

Google defines professionalism as: the competence or skill expected of a professional; the practicing of an activity, especially a sport, by professional rather than amateur players. This leaves quite a wide berth for perception of what is professional in terms of being an EMS provider. Please note it does not say “volunteer” or “paid”, but rather “professional” or “amateur”. I think we can all imagine some folks on both sides regardless of their compensation status.

Of course, there are some issues related to being “professional” that are non-negotiable:

-personal hygiene
-general cleanliness (people and equipment)
-using some sort of identifier that you are a responder and not just a bystander
-using any clothing or items related to safety (ANSI vests and the like)

Now that we have laid a foundation to be able to assess what it means at a base level to be a professional, how can individuals in various roles perceive professionalism differently? Is your Chief’s perception of what it means to be professional different from yours?  What do our patients think a professional looks like?

Cast from Nightwatch
Cast from Nightwatch

The cast from Nightwatch was one of the examples brought up in the lecture I attended, specifically about some of the cast members visible tattoos. In the past visible tattoos have been a hot button depending on your location and agency. Some providers were required to cover visible tattoos or wear long sleeves all year to keep them hidden. However, tattoos are now readily accepted in most of society and they could be used as a tool to related to certain patients.  To be sure, all patients are different, and some may take offense, particularly if the art in question is garish or overtly sexual, though that doesn’t seem to be common. Do they look professional to you? They look clean, their uniforms are neat and shirts are tucked in, pants held up with a belt, the tattoos are noticeable, but not the first thing you notice. If their community members and agency accepts it, they look like good providers to me (note we didn’t even discuss their clinical skills yet… perception is everything).

EMS Provider or Police Officer?
EMS Provider or Police Officer?

 

Could we look neat, clean, and in uniform, but be perceived by patients and family as “professionals” other than EMS providers? In the appropriate circumstance this uniform is appropriate and necessary for personal safety, but what about everyday use? If you were not involved in our service would you know if the man above was an EMT or paramedic or a police officer? Could looking militaristic be averse to excellent patient care?  Could our uniforms cause more anxiety for patients and exacerbate their already compromised health? Could a uniform like this lead to safety and security issues for crews while they are on duty due to mistaken identity or intent?

 

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Another part of the conversation in class was looking “too” professional. Funerals and special events do require an extra degree of attention to your uniform, but on a daily basis is your uniform so perfect you look like you didn’t work at work? If you are a white shirt, could your subordinates feel distanced from you because they feel you don’t relate to the “workers” and forgot what the “street” is like? Of course, this is not an excuse to roll out of bed and into the ambulance looking rumpled and bedraggled, but could looking too perfect be intimidating; like the proverbial beautiful woman who can’t get a date because men feel she is unapproachable?

While we shouldn’t throw away the idea of becoming professionals and being at the top of our game, particularly in our industry where life and safety are at the top or our responsibilities, we should take a step back and imagine the situation and perception that may be applied when we arrive on scene. Being presentable and clean are still important, but is a creased patch an absolute requirement to do the best CPR or be kind to a scared patient? Perhaps, less starch could be used in application to the topic of uniforms and appearance by staunch advocates, such as myself, when reviewing everyday EMS scenarios.

EMS Compass: The Missing Link in EMS

Hardly a week goes by without hearing about providers feeling left out in the planning of the futures of their agencies and the future of EMS in general. It’s true, some providers will never be happy, that is the nature of humans at large and it is present in any profession. Yet, not everyone is jaded, and many do have a point of not having had a voice in the coming change and development of EMS as we grow up. That is, until now.

The EMS Compass initiative is being led by The National Association of EMS Officials (NASEMSO) and financed by The National Highway Traffic Safety Administration (NHTSA) to develop EMS performance measures over the next few years. Part of their plan is to invite all stakeholders (providers, managers, agencies, government) to participate via direct suggestion during the Call for Measures this month, informational and public meetings, and transparent communication via direct access to key players.

Leaders don't necessarily need a title.
Leaders don’t necessarily need a title.

What is a performance measure?

Performance measures are common in other industries and have been used in medical practice, but not traditionally in EMS. Performance measures enable providers, management, and government agencies to track and improve performance to benefit patients and communities. Some of these measures will be clinical in nature, but operations, safety, and business/ financial aspects are also included as all of these are needed for well rounded agencies and further development of a well rounded industry.

Performance measures don’t have to be complex or convoluted. In actuality they are quite succinct. For example it is widely accepted that patients with cardiac chest pain should take an aspirin. The performance measure for that event would read: All patients who have chest pain of a cardiac nature should receive aspirin. This would then be documented via charting we already complete and reviewed later for quantification. Many things we already do such as standards for STEMI, TXA for Stroke patients, or even trauma protocols were founded in related medical professions performance measures.

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Why bother?

-We will be contributing to the development of these standards for our profession, who better to do so? Historically, government at large has not been the best at recognizing what we do and our level of importance (please see “Ambulance Extenders”)

-We already contribute data via NEMSIS for data collection in the EMS industry, this process contributes to data collection and provides information for where we currently stand so we can continue to improve and move forward

-The measures are evidence based. We are Emergency MEDICAL Services and should be practicing medicine in the way that other medical professions do, with evidence not today’s whimsical idea on how to get “cool toys”.

-Provides means of measuring long term performance in our industry so when the next generation of providers arrive, they can build on the foundation we have laid.

-Currently, if your agency bills, you are paid for service whether the patient is treated well clinically and will have an improved outcome or pleased with how they were treated, Medicare will pay for the transport. In the future, in conjunction with The Affordable Care Act (ACA or Obamacare) we will be paid for the outcome: clinically accurate care, patient satisfaction, etc. Hospitals have been preparing for this for the past few years, we should not be naive to think the government will not try to limit our payments.

-Medicare is encouraging other insurance companies to follow suit on requiring a higher standard of care for payment for EMS services.

-Can lead to better provider compensation, improved provider safety and health, and better recognition of the job we do and love.

Obviously, the above is a very simplified over view of what EMS Compass is and will achieve. I have included links below for your information. There is a great webinar you can access on demand that explains how the process works and the history of data collection in EMS. I also included links to the Call for Measures that is live until the end of May, so get your measures in. I also included links to some other blogs and podcasts that have been talking about EMS Compass recently.

Until a standard is set industry wide, EMS as an profession will flounder. EMS needs to define acceptable standards of care on an industry wide level, the lowest common denominator can no longer be our standard if we are to grow into the industry we desire. Much of what is described above are things we already do, we are just organizing and tracking it now. We must to take ownership of our profession before someone else, who has no idea what we really do, tells us how to do it. You can be a part of the future of EMS on a larger level than you ever imagined by contributing to the call for measures by May 31, 2015.

The EMS Compass Site (you can access the Call for Measures and informational webinar here)

The EMS Garage – The EMS Compass

Inside EMS Podcast – How the EMS Compass Initiative will create industry standards

Medic SBK- EMS In The New Decade – The EMS Compass

Magic Is Not Just For Harry Potter

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The pulse at his jugular notch was racing. I could count it’s beats visibly without palpation. I wondered at the intricate systems that worked to keep a heart beating and continue the magic that is life.

Then I solemnly remembered that one day that pulse would be stilled and the magic of the soul would disappear. I wasn’t sad or even angry, rather encouraged to use up my magic before it is spirited away suddenly. I was reminded of a conversation I had earlier in the day.

“Let the thing you regret be not working enough EMS shifts. Not, not spending enough time with your family.”

Many of us, including me, get caught up in the to do lists of life and miss small moments of wonderment that present themselves unexpectedly. We all need to work and have daily obligations for our day to day to function, but one day there will be no more “tomorrow” to fritter away. We need to be mindful of both large goals and small moments of wonder for the fuel to keep going and feel fulfilled.

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Love those who are precious to you. You never know when you, or they, will be gone.

Gripes Go Up

I recently had the opportunity to attend a lecture called “Why Just Manage When You Can Lead?” by Ray Barishansky. There were many little leadership morsels and treats to delve into a little deeper in future blogs, but today I’d like to focus on one in particular that keeps rearing it’s head in my life.

Leaders complain up, not down.

I am a member of the leadership at my agency. I was having an impromptu conversation about my frustration with some of the actions of the other leaders with a peer in the leadership group. We really got going about what got us heated. At one point I suddenly remembered the three or four other employees that were in the room watching TV… and probably listening to our bitchfest. The class immediately came to mind and I felt like an idiot.

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What did our conversation do to influence the other employees’ view of our agency?

How did our conversation affect their trust in the leadership?

Who do you think they will go tell now?

The clip above from Saving Private Ryan really illustrates this idea. Complaints should go up the chain of command where they can be addressed. Otherwise, complaints just stagnate your agency and bring morale down, particularly when an agent of change is doing the complaining. That is no good for anyone.

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Whether you are already in a position of leadership or aspire to be, be aware of what you say and where you are saying it. Words are power with both good and bad outcomes. Mom’s advice still stands, “If you don’t have anything nice to say… don’t say anything at all.”

Linus Knows Best

 

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Lucy & Linus of Peanuts

Folks, I have something important to say. I’m going to keep the flowery language and gentle guiding you are used to from me to a minimum because what I have to talk about is so obvious and yet so overlooked that perhaps keeping it simple will help.

It’s winter.

It’s cold.

Put a blanket on your patient and make sure they are warm.

Yes, that obvious. Yet attendants (not providers because provision indicates you care for your patient) don’t wrap up their already ill or injured patients.

Anybody chilly?
Anybody chilly?

Earlier in the week at work I already dropped off my patient in the emergency room and I was walking out to meet my partner and help clean the truck when I saw two EMTs bundled in job shirts, hats, and winter coats standing with a patient waiting on for the charge nurse to acknowledge them. Their patient appeared moist and febrile, fresh from the nursing home. All this patient was wearing was a hospital gown, hospital socks, and a stretchy sheet wrapped around his legs. No blanket or other covering, nothing covering his head, totally exposed to the arctic chill. I bet his attendants weren’t very cold under all their layers of clothing they wore to stay warm while outside with him.

When I was a new EMT I was fortunate to have excellent providers as examples who showed me what caring for a sick person requires. That includes using what some might perceive as “creature comfort” such as a blanket or head covering. It’s not just a modesty issue or about keeping warm, there are physiological repercussions to exposing an already compromised patient to the cold. For example, heart failure patients with pulmonary edema can “flash” when they inhale the cold air making a bad situation worse. Asthmatic and other respiratory patients may also have their symptoms exacerbated from cold exposure. Nursing home and other patients used to being indoors in a high heat environment can suffer hypothermic shock and agitate any medical issues they may be having at the time.

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Blankets are great for preserving patient’s modesty.

Some simple things to remember:

  • If you are cold, so are they.
  • Prep your carrying devices and stretcher with extra blankets and towels for patient use in frigid weather.
  • Have respiratory patients cover their nose and mouth before going out into the cold, coach them if they feel they cannot breathe because of the extra layers.
  • You can also use a patient’s own hat, scarf, and coat. Most families are more than happy to find it for you to use in addition to blankets you have provided.

This is one basic thing all providers can do to make their patient feel comfortable and have an improved patient outcome in the long run. It’s not something that requires a new certification, extra training hours, or extra money in the budget, but it does reflect what kind of provider you are and the level of care you provide.

What’s On Your Batbelt?

We pulled up to the desolate truck stop, our headlights shining on the sole person in the lot. Presumably she was our “sick” patient. She wore a pink head rag, dingy t-shirt and jeans, with even dingier keds carrying a bag full of her only possessions in the world. Her face showed a perpetual weariness that sleep would never cure. Not exactly how prostitutes are pictured on TV.

images (2)Richard Gere and Julia Roberts in Pretty Woman

My partner called out the driver’s window as she walked toward our ambulance, “Hey, you called 9-1-1?”

“Yeah, I called.” she replied as she stopped in the bright glare of the lights with her hand popped up on her hip.

“Well, what you want?” he shot at her.

“Just got back from Boston and I have a rash. I wanna see the doctor.” she explained.

“How long you had the rash?” my partner asked with a sneer.

“’Bout a week.” our patient responded with a head bop, her voice starting to show her impatience with his questions.

“A week! Why ain’t you go to the hospital in Boston?”

The interaction took a decidedly nasty turn and would have continued for a while as she was not going to “just leave” as my partner had hoped. I noted my partner’s exasperated sigh as I stepped out of the front and asked her to come to the side door so we could start the trip to the hospital and end this shouting match.

After much consolation and introducing myself and asking what hospital she would like to go to this evening, she relaxed and started to explain her complaint of a rash and boils in her vaginal area and previous related history. I didn’t do much for her other than take her vital signs and ask questions. But, by the end of our trip she was so grateful that I was NICE to her. That I didn’t judge her for her life and previous choices and related to her as a human being.

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Honestly, I was only extra “friendly” at first because I didn’t want to have to argue the whole way to the hospital. By the end of the ten minute trip I was sad that she had to deal with these issues and the life associated with them. She affected me in a greater capacity than I could ever have hoped to help her.

I am still thinking about her ten years later.

We are privy to peoples stories every time we are dispatched. How often do we see these “stories” in a one dimensional light? How does this skew how we react to patients and how can it affect our patient care in terms of clinical treatment? Could we be harming our patients by viewing them from a preconceived ideal rather than as unique, three dimensional, human beings? Could sharing our humanity be a better prescription than any medication we carry or any protocol we develop?

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There are situations where it is not safe or permissible to share a part of ourselves with our patients. But, there are some opportunities where it is okay for us to be humans and relate on a different level with our patients. You don’t have to always know the right words to say, sometimes a genuine smile and your presence is enough. Holding a frightened patient’s hand is not passe.

batman_vs_superman-batman-vs-superman-insider-scoop-on-batfleck-e2346155-2caf-4986-86be-1363bf2bb097

I recently had a discussion about what makes Batman a hero and Superman lame; my counterpart’s theory is that Batman is a regular guy saving people and Superman has special powers allowing him to save others. While he has awesome tools and a cool outfit, Batman’s superpower is his empathy and humanity. I submit that is our superpower as well. We don’t always have to wear the cape and tactical belt to be a “super” EMT or paramedic.

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Be Contagious

We spend our days complaining about how life what isn’t what we expected or how we haven’t reached our expected timeline instead of accepting that, letting it go, and focusing on our dreams.

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I’m too old.

I can’t afford it.

I’m not that smart.

I’m (insert any excuse here).

Life is hard. No one warns you about getting kicked while you’re down or what reality is like when you are young and idealistic. What makes an individual remarkable is that they prevail despite every unfair and awful thing that tries to intervene. If you were dying today, what would you want to leave as your legacy?

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We are all dying right now.  Put aside what you “think” you should be doing and live your passion. Don’t make excuses, just start to do it. Share it  and yourself with others. That is what builds a legacy.

Three responders from my area died in the line of duty this week, all cut down in their prime.  Their lives were electric and touched many people because they loved and were passionate about life. They pursued their dreams and impacted many people on the journey. Their legacies live on in our hearts via their examples of how to live life contagiously well.

If God graces me with another day tomorrow, I hope I can do those legacies justice and celebrate the lives of those individuals by starting to live my life contagiously and stop letting excuses steal my legacy.

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