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

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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.

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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.

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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Normal vs Abnormal

 

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This week was a week of firsts. My first infant code and consequently my first Critical Incident Stress Debriefing (CISD).

For 18 years I was able to dodge the bullet of having to respond to dead or severely sick or injured babies. One time, there were too many new EMTs that just graduated so I gave my spot to one of them. Another time, I had just fallen asleep in my bunk between two long shifts. Another, I was blessed that the mother wrapped the newborn she left in a park bathroom well enough to survive the elements until we arrived. I have a myriad of tales like those related to bad pediatric jobs. This time when I heard the dispatch come over, “…7 month old CPR in progress.” I knew I would not be spared.

I expected to feel agitated, excited, or frustrated that everything was going too slowly, but while responding to the job a strange calm settled on me and remained throughout the call. The tick in my knee that I get on hot jobs was absent. The scenery rushed past as our caravan of emergency vehicles hurtled to the scene like a strange slow motion montage in an IMAX movie. Even the other first responders on scene were calm. No one yelled, “Rush the bus!”

Everyone worked together as a team even though many of us had never met before this moment. Police, Fire, and EMS all integrated and focused on the task at hand: caring for our patient and the family on the most awful day of their lives. This teamwork extended to post call care for all responders on scene; the fire chief invited all the agencies involved to the CISD event he arranged for his firefighters.

My partner mentioned the invitation to me and immediately a strange, fearful voice piped up in my mind, “Oh no, those folks will think there is something wrong with you.”

Tony and Dr. Melfi in The Sopranos
Tony and Dr. Melfi in The Sopranos

I was appalled at myself! I frequently talk about CISD and the importance of talking to each other and having an open mind when others need to talk about incidents and changing the culture of machismo we have been a slave to for so long. Yet, here I was thinking I couldn’t talk freely because I might get sent to a head shrinker. My partner sensed my hesitation and offered me an out that I happily agreed to so we didn’t have to go.

Then the Chief called our building personally. I am so happy he did.

It wasn’t as bad as I thought and based on body language I wasn’t the only one who was initially hesitant. There were no couches or straight jackets present. The gentleman who lead the debriefing promoted a relaxing atmosphere and assured us that the discussions during the meeting would not be shared, and accordingly I will not share them here. I do want to share some of the important things he told us that can be applied to any incident, although they are not a replacement for a proper CISD if you or your department need one.

 

  • You are having a normal reaction to an abnormal situation. The things we see are not normal by any means. We don’t normally imagine babies as dead or heads being detached from bodies or people being assaulted violently. Feeling upset about any of these or any other abnormal events is normal.
  • Don’t over or under indulge in caffeine, food, alcohol, etc. for the next 48 hours. If you normally drink 3 cups of coffee, don’t increase or decrease that amount as it will change how your body normally operates and can mask your feelings.
  • Don’t go home and not communicate what happened or pick a fight because you feel stressed. The family dog is not extra bad today, you are just more sensitive. That is normal! If you feel yourself getting upset, take a moment and relax.
  • Give yourself about 48 hours for your body to start to return to normal. Stress, like physical injuries, can have physiological effects. Your body needs time to heal.
  • If you are not starting to feel better and note you are starting to feel increasingly stressed, talk to someone. You can call the CISD staff for references, call your EAP plan, or talk to your agency leadership.

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These are all very sensible recommendations and you might be wondering what the benefit to actually going to a CISD meeting is when you could just google the information above and finish your lunch instead of pouring your heart out. There is something cathartic about being in a room with the men and women you shared a heartbreaking experience with. Something only the few of you will understand without words and can gain comfort just from each others’ presence. There is something healing in knowing you are not the only one who felt a rupture in their being from having a human reaction to a horrible circumstance that no one should have to experience, let alone think about.

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I am glad I went and allowed my heart to begin to knit itself back together again and to find out that I am human and how I felt, how all of us felt, is a normal reaction to an abnormal situation.

 

A Day in the Life of EMS

Ah, EMS Week, full of granola bars, bat-belt chachkis, and music videos.

No, not a typo, my EMS Week 2014 included the great opportunity to be involved in Lt. Farooq Muhammad’s latest and much awaited EMS rap video: A Day in the Life of EMS!

Everyone involved in the making of this video embodied the true spirit of EMS. Even though some of us (patients) were not a part of their agency, we were welcomed and we all worked together to get the job done. Farooq’s videos resonate with EMS responders because under all the lights, sirens, and cool uniforms, the real qualities of EMS: teamwork, professionalism, and family, are illuminated. I was reminded of why this job is the best in the world while watching some of the other scenes being filmed. I became inspired to continue to learn and become a better provider in spite of the daily struggles with EMS nonsense that weigh most of us down.

IMG_4616The Author and some of the cast

FDNY EMS Lt. Farooq Muhammad is one of the EMS 10 Innovator Awardees for 2013 for his work on videos promoting high quality EMS. You can see his other videos on his YouTube channel.

Dedicated For Life

“Not everyone wants a medal for their uniform, but everybody likes to hear ‘Thank You’.”

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Once again it is EMS Week – a week to recognize EMS providers, get free food, and maybe educate the public about EMS and what we do. I recently had the opportunity to be part of a podcast about EMS Week hosted by Medic SBK. One of the questions he posed in the interview was, “What part of EMS Week is something we should be doing ALL year?” There were many great ideas that came up in our conversation that I was going to highlight here, but this morning when I was thinking about this blog post, I saw the photo below.

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We, as providers, don’t appreciate each other ALL year. We pick at each other, catch attitude, stab each other in the back at the drop of a hat, but hardly anyone says, “Hey man, you’ve been doing great job. Thank you for giving your all.” How can we expect other healthcare professionals, our bosses, and the general public to appreciate what we do, when we don’t expect it of ourselves?

Being dedicated for life is more than a tag line for a campaign. The things we see and experience take residence within us and resonate far beyond retirement. Most of us are so busy keeping on our game face on and pushing down anything that looks like emotion, that we can’t begin to recognize the lack of general wellness in EMS as a whole. Sometimes, I wonder if we forget that we are human.

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I challenge you all to say “Thank you” at least once a week to a fellow EMS provider. Really appreciate them and let them know you mean it. If you need to write a note because you get tongue-tied or shy then do it! Let them know you are thankful for ALL their sacrifice: the holidays, the birthday parties, the vacations, the lost sleep, the cold food, the fights with family, and even their mental sacrifice.

I want to thank you all for your service and every sacrifice, no matter how small, to care for other people, most of which are strangers. You truly give your ALL, every part of you, and I am grateful that there are strong men and women out there to help us when we fall ill or are injured. Not everyone can do this job. You are a rare breed, and are to be treasured. I am honored to get to work with you and be a part of your life.

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What Are You “Saying”

While getting my nails done a few weeks ago my manicurist had CNN on the television, Donald Rumsfeld was talking about the United States response to one of the many violent events occurring in the world today. It struck me how eloquent this man was under pressure. I wondered how could this translate into my own deportment and why don’t EMS providers sound like this?

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Merriam Webster’s dictionary defines eloquence as: discourse marked by force and persuasiveness; the art or power of using such discourse, or the quality of forceful or persuasive expressiveness. These are all requisite to be even moderately successful health care providers and advocates for our patients. How can we convince a truly sick patient that they NEED to be in the hospital to curtail serious or deadly consequences if we don’t have the method to communicate this to them? How do we demonstrate our professionalism and passion to other related professions, healthcare providers, and politicians that also play a hand in advancing or restraining the future of EMS if we are not able to communicate well? Presentation is as important in EMS as it is in the business or entertainment setting. Good presentation is not just about tucking your shirt in and wearing new boots if you open your mouth ruin the illusion.

 Public Speaking

It’s not as difficult as it seems to “sound smart.” There are a few ways we can all start to improve our vocabulary.

  1. Stop using profanity. Cursing does not illustrate your point, shock, make you seem important, or benefit you in any way. It really just agitates people and that doesn’t really work positively most times.
  2. Be aware of your tone and volume. How you speak may be more important than what you are actually saying. I used to work in an area with an excellent provider, but the care he gave was often missed by everyone on scene because his tone was harsh and the volume of his voice was much too loud. Many patients were disturbed and several asked for him to “stop yelling at me.” It doesn’t matter if you are the best provider in the department if your care is marred by your tongue.
  3. Use appropriate (and correct) terminology. If you want to be treated like a medical professional, you should sound like one. Honestly, you should also write your documentation like one. If you don’t remember medical terms from your days of EMT school, bust out your book and study or take a course on medical terminology. This small investment of time and money will go a long way in increasing your stature with other medical providers.
  4. Think before you speak. Many times our vocabulary faux pas is not related to the words we misuse, but because we don’t police our tongues and end up offending people. This can lead to more than disciplinary action, inciting violence on scene and placing you and your partner in danger.
  5. Listen to understand, not to respond. When you are speaking with patients or their families listen to what they have to say so you can understand what the true problem is, not just your perception. Then you can respond appropriately and sound professional. Sometimes people speak to us because we are the only ones they trust to listen without passing judgment. We in turn are often entrusted with their life experiences and they end up imparting a gift to us.
  6. Read. Reading might seem incongruous with improving your speaking abilities yet how do you learn new words and ideas without reading? Read things you wouldn’t normally read. Read from all topics, not just related to EMS although you should try to keep up with current events within our field.
  7. Look the part. I attended a seminar at a prestigious university where a speaking coach was discussing how to have your message heard. The very first thing she talked about was visual presentation. People make their decision about whether or not you are worth listening to within milliseconds. That may not seem “fair”, but it is what we have to work with when attempting to deliver our message and treat our patients.

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The list above is not exhaustive, but it’s a good place to start. It won’t be easy, but changing your vocabulary and way of speaking is possible with mindfulness and persistence. Don’t give up if it feels like the change is long in coming, it takes 3 weeks to make a habit. Changing how you speak won’t only improve your professional life, but can transform your entire life for the better.