EMS Day on the Hill 2014

1972281_10152289199047290_1229167034_nLast week I had the awesome experience of attending the 5th Annual EMS Day on the Hill sponsored by the National Association of Emergency Medical Technicians in Washington D.C. EMS Day on the Hill is an opportunity to educate our representatives at the federal level of government about EMS and the challenges we face on a daily basis as providers and managers. 190 EMS providers from various services and of all different certification levels attended and completed 242 meetings with federal legislators or their staff this year.

Before you get excited or think, “I don’t know anything about politics.” The NAEMT people have taken care of all of that. About a week before the event, they sent me an email with a basic schedule and information on the bills that are currently in progress. The evening before we went to Capitol Hill, they held a briefing reviewing information on the current bills, the atmosphere in Washington, and other recent events that might affect conversations the next day during our meetings. Along with our delegation meeting schedules, NAEMT provided us with briefing sheets on the bills at hand and any other pertinent information like phone numbers to people at the event if we needed help and a map to get around Capitol Hill. They also made packets for us to leave with representatives or their staff for their review after our scheduled meetings. We were seated by state delegations and after the briefing there was a networking event so we could get to know the other members of our delegations and discuss our plans for the next day. Everyone was friendly and happy to answer any questions.


Group Photo of 2014 Attendees

The next morning, my delegation met in the hotel lobby and migrated to our first meeting. Our delegation was a mix of veterans and novices to lobbying. Those that had participated before lead the way at the first few meetings until the rest of us were comfortable to take part as well. The staff that we met with were all attentive and interested in what we had to present. One staffer even let us know that she learned something new from us about EMS and how we provide service and the challenges we face in doing so. Many were aware of the changing climate of EMS and how the Affordable Care Act might affect us in the future. The bills NAEMT presented during these meetings were: The Field EMS Bill and Medical Preparedness Allowable Use Act. We also promoted The EMS Caucus.

While going to Capitol Hill and participating in our nation’s government and being able to walk through the halls of history that make our country great was exciting, meeting fellow providers that believe and continue to work toward the future of our profession was even more amazing. My hope for the future of EMS was renewed via these conversations and I gained new insights into possible solutions for recurring issues that affect our profession. There is momentum and direction at the top, the rest of EMS needs to unite and place the power of our voices and votes behind this movement if we are ever going to progress and become a true profession.

I learned many things in the few days I spent in Washington, chief among them that I still have much more to learn. EMS providers need to put aside certifications, department affiliations, and petty differences if we are going to advance as a whole profession. Others see our division and don’t take us seriously because of it. Lobbying for EMS is not just one day a year. Speak to and educate your local and state officials about what we do and what our needs are, the squeaky wheel gets the grease. If you have the opportunity to attend EMS Day on the Hill next year or at any time in the future, jump on it! You will be glad you did!


The Pit of Fear

The true terror began when I saw the room.

A friend sent me a photo of the room I was to be speaking in at my first national EMS conference just a few days before the event. As soon as I saw it the pit of mindless fear opened in my belly. Until that point, I almost felt as if I was preparing a program for someone else to present. That made it easier to quell the relentless voice in my head asking, “What if you mess up?” If you thought the world of EMS was small, I would call the circle of speakers at EMS conferences miniscule. Everyone truly knows everyone. If I blew it, this was the only chance I would ever get.


Previously, I had been encouraged to submit to other conferences, but I was not ready. Trepidation and doubt nailed my feet to the floor. Submission dates passed and the encouraging voices waned. I had no intention of applying to this conference either, but someone reminded me about the deadline the afternoon it was due: New Years Eve. I heard somewhere that what you do on New Years Eve is what you will do all year. I submitted, not thinking I would ever get accepted. Imagine my surprise when I received an acceptance letter.

Now was the time to put up or shut up. My chosen topic was The Silent Killer: EMS Suicide. I wondered why on earth I picked such a sensitive topic to talk about at my first event. I had previously had mixed reactions from different providers during discussions including quite a loud, angry discussion at what had originated as a fun outing.

painOf course, I had writer’s block for weeks while I was supposed to be updating my presentation. Intermittently, when I thought of me in front of the audience, all I could imagine was disaster. A good friend encouraged me to close my eyes and imagine every detail to the perfect performance: what I would wear, how my hair was styled, what the Power Point would look like behind me, how full the room was, and most importantly: the positive audience reaction. Thankfully, I also had an honest mentor that when I thought I was done (YES!), returned my slides back to me with more comments. His suggestions improved my presentation exponentially. If you intend on moving up in this business, clinical or otherwise, you need to find a mentor in the area you wish to excel in.


The day to present finally came. I woke up with my stomach tight and my attempt at breakfast was poorly received. I didn’t go on for another 6 hours! It was going to be a very long day indeed. I watched some other classes and found my mind wandering back to my subject matter while I wondered aimlessly around the host hotel and eventually decided to review one more time. It comforted me to run through the slides and make notes like someone with OCD arranges their desk over and over.

998572_10151784552212290_476214675_nAbout 20 minutes before I was scheduled to start, I went to find my assigned room and attempt to mentally prepare and put on the business face. I felt like an imposter when I walked to the front of the room to load my presentation. Everyone’s eyes felt like an accusation, “You don’t belong up there!”

The room started to get a little fuller and it was time to begin. I opened my mouth to introduce myself and the fear that had plagued me for weeks dissipated with every returned smile from the audience. I spoke and spoke, people nodding in agreement, smiling at anecdotes, silent when convicted. I shared secrets I only realized I had days before, the vulnerability uniting us, members of a secret club, no longer alone. I concluded and people came up to hug me and shake my hand. One young woman came up to me, speechless only able to utter, “ I just wanted to say thank you.” My friends surrounded me as I surrendered the lectern to the next speaker, the terror of just an hour ago growing into an indescribable high. And as I walked out of the room the joy and excitement bubbling from my heart I wondered, “When can I do it again?!?”

The Author Speaking

Maybe this is how you feel about public speaking. Maybe you think, “ I could NEVER do that.” Is there a topic you are passionate about? If you don’t talk about it, who will? I’m just a provider with an interest that stood up and said something.

What do you have to say?


The Courage to Write.

Initially, I thought I arrived here by “accident.

I can be a bit rambunctious and not everyone can appreciate that, so I ran into a little trouble at work and avoiding a long story that will bore you, I found myself looking for a new gig. A few weeks later, I went on an interview at a place I did not really like or want to work at and afterward found myself trolling Marshalls trying to feel better. New shoes, clothes, purses, or household crap for you to dust can do that for a girl.

thWhile strolling through the aisle of various pots and pans, a friend messaged me and asked if I could read something. We had talked about our individual school work and research demands previously and I thought highly of him (hes kind of a big deal), so I was SO excited to be included into this exclusive club to check out his writing! I read it right there next to the All-clad frying pans, the Stepford Wives shooting me dirty looks for blocking up the aisle and all. It was a management article, but he was speaking about my life! Specifically, the trouble at work situation and the type of manager I just encountered. I silently wished he had written it a few years earlier and saved me some agitation.

I began to wonder, “How can I write like that?” So I asked.

Hey, how did you get started writing for magazines?”

This gentleman was gracious enough to tell me a little bit about his journey and even offered to review anything that I wrote. WHAT!?! ME?!? I was honored, but didnt think anyone wanted to hear what I had to say, much less felt that I could influence someone positively. Didnt I just get into trouble for opening my big mouth?

Honestly, I was scared.


As time went on, this militant thought consistently reared its head, “Why not me?” I began to write a piece and shared it with a few people. To my surprise and pleasure, they liked it and were honest with me and told me how to improve it. Still I waited, unsure if I could really “do” this, I mean who was I to tell anyone anything? I had A LOT of “reasons.”

I don’t have a degree.

Im only an EMT.

I don’t have a fancy job as a platform.

I just ride on a truck.

Who would listen to anything I had to say anyway?

Another good friend with a flair for the literary and a silver tongue encouraged me to build a blog. I thought, “Uh, arent blogs for people with nothing going for them?” I received a quick education on EMS blogging and got lost in the internet for many hours finding amazing writing ranging from clinical topics to florid tales regaling the family that is EMS. More talking myself out of writing ensued after I read some of these authors who left me in stitches unable to breathe and others who made me shut the computer off heart broken and crying, knowing I could NEVER write like that.

c3d4fe411b27e8acd660c1509e0babc2I didn’t get here by accident. Life, destiny, the Universe, whatever you want to call it has been setting me up for years. As a little girl, I got busted sneaking books to bed and still I stub my toes on the stacks that don’t fit on the shelf. As a young hellion, I met a new friend whose mother was a writer and preacher and despite my alternative and undesirable appearance (which she still talks about in front of the congregation when I am in town at church) let me wait in the wings and watch. I learned how to speak to people in power. I learned how to write and speak and back up my position, so I did not just have an opinion. She let me learn how to serve others by imparting parts of myself via her example. She laid the foundation that others would build on during my creation as a writer. This was no accident. Neither is your journey.

speakingLike most FNGs in EMS I decided to fake it ’til I made it. With a lot of help from an accepting and encouraging EMS writing community, I built the blog and posted that first article. Then another and another and another and THEN I got my first piece of hate mail! That sealed it for me, people were listening!

I will tell you a secret. I am still terrified.

We do this every day. We speak to people and influence their healthcare decisions as a provider. We uplift our friends and family when we offer messages of encouragement or commiseration. We make strangers smile when we offer a pleasant word and smile of our own. Writing is just life via our fingers.

It is easy to listen to your inner critic knock you down and silence your voice. Its easier to turn a blind eye and keep your head down and get by, but what the hell will you have at the end of your life then? A bunch of “I should haves” and no time left.


There are many things that will try to slow you or distract you or stifle your voice. Dont let them. Your voice is important, what you have to say can only be said by you. You never know who your words will affect and improve or inspire or save.

Yes, the power of life is in your words. Use them.

How many A-holes work at your agency?

I was recently reading a piece by a gentleman named Olivier Blanchard called Brand Management: The Asshole Effect.  I was so excited while reading it because in a parallel life to my EMS career, I worked at a popular coffee emporium.  I was expected to and enjoyed providing awesome customer service (it’s possible that my caffeine addiction helped me fulfill that achievement).  About half way through the article, I had an “AHA!” moment. I realized that this is not just about business as we traditionally recognize it, but can also be applied to agency reputation and customer service within EMS.


Whether popular culture in our field regards EMS as a business or not, it is a business and we need to keep the money coming in to continue operations. We are a service provided to citizens.  Smiling at a patron while wearing my trademark green apron and handing them a paper cup filled with their caffeinated prescription is the same as smiling at a patient seated on my stretcher while wearing my clean and neat uniform bearing my agency patch.  I am representing my brand.  I am promoting my agency’s reputation.

 sbuxThe author in a parallel life

Mr. Blanchard posits that every “customer” facing agency with the least amount of a-holes wins.  Essentially, this means that people make a positive association with an agency for every positive experience they have with that agency.  Similarly, for every negative experience, people make a negative association with that agency.  Traditionally, if a customer has a great experience with a company they may tell 1 friend.  If a customer has a bad experience they will tell at least 10 friends. With the advent of the internet the 10 friends receiving bad information about your agency has increased exponentially. This theory does not only apply to customers we interact with directly, but everyone in the vicinity that might witness the event.  One glaring example involves modern technology. I am sure most of you have had some experience in the street with witnesses or family members with cell phone video cameras.  Some are just busybodies who want something cool for YouTube, but others have malicious intent and ambulance chasers on speed dial.  Civilians are not our only “customers.”  Our fellow responders such as police, fire, emergency management and hospital staff are our customers, too.  What if an asshole (I know you have one in mind) was on that scene representing your agency?


I used to work at an agency that was regarded as “elite” by some in our area.  We had expensive uniforms, nice ambulances with cool reflective lettering, and more toys than you could count in our garage.  Our positive reputation as an agency didn’t last long because no one checked the a-hole count.  One fine afternoon, my per diem partner and I responded to a little old lady with flu like symptoms at her home.  She had difficulty walking more than a few steps and lived on the second floor so we had to carry her down the stairs.  I set up the stair chair and assisted her to a seated position and secured her to the chair.  My partner and I move toward the stairs with our equipment and patient in tow.  I positioned myself on the stairs to carry the bottom of the chair and let my partner know I was ready.  I waited about 30 seconds and stated I was ready again.  30 more seconds passed, I leaned over and looked around the chair to find him texting away at the top of the chair.  He was totally checked out of reality. The police officer and the bystanders on scene saw it, too.  Our real “customers” now viewed our agency as a joke.


Customer Service at its Finest

Pride. Respect. Professionalism. Honestly, those are not adjectives I conjure immediately when I think about EMS. The adjectives that come to mind when I imagine describing my chosen profession are: lazy, slovenly, and unqualified.  Let me make a disclaimer: There are some shining examples of pride, respect, and professionalism among EMS agencies and individual providers, and looking disheveled does not make you unqualified for your job, it makes you LOOK unqualified for your job.  Being an a-hole is not limited to verbal communication. Visual communication speaks volumes.  Every time you wear your shirt wrinkled or untucked, every time your boots aren’t tied, every time your truck is dirty, every time you text while you are on a call indicates that you don’t care about the “customer’s” experience.  It indicates that you, and your agency by proxy, are a-holes.


Resolving this issue should be important to EMS agencies, although experience shows us this is not always the case.  (This is when people start to send me hate mail.)  The reputation of an agency is of the utmost importance because it influences all aspects of the organization.  The most obvious of these is related to securing funds.  If your agency uses fundraisers to secure operational funds for continuity of operation, you must have awesome “customer” service.  Who is going to GIVE their money to an organization they regard as a bunch of jerks?  The same goes for attracting new members or employees and retaining your current staff.  People volunteer or work for and agency for a variety of reasons, one of which is to belong to a group they believe in and identify with.  Even one a-hole can cause others to find new employment or volunteer at another agency or lead to a dedicated member resigning.  Now you don’t only have to find a new “body,” you have to pay for pre-employment checks such as a background check and a physical and new uniforms and training.  If you think the politicians in your town aren’t your customers, then you need to talk to agencies that have been cast aside, not by poor clinical performance or low response statistics, but because of poor customer relations.  Some politicians will reroute 911 service to the provider of their choice and then your agency is nothing more than a social club with fancy jackets.

 1781436_10202196788858772_1855065837_nThe best agency I ever worked for, felled by politics.

Mr. Blanchard proposes the awesome service you provided 10 years ago is soon forgotten, what is important to people is what you did WRONG last week.  We must provide awesome customer service continually! 20 years ago, before the widespread use of the internet and smart phones, it was easy to contain the fallout from the a-holes that afflict your organization, but now one small misstep can tarnish your agency exponentially.  Be aware of your behavior, and if you are part of the leadership structure, be cautious of who you hire or accept for membership in the first place.








“Your Face Will Freeze Like That!”

It’s funny how days have themes. Usually, a series of awful things happen to us during the day and they just seem to consistently work against us. On blessed occasion it’s a stunning, temperate day with perfect clouds and not a care in the world. It seems like you could drive forever and nothing could take your bliss away. Today, is something different. Today, there is an undercurrent surging … a “vibe” if you will.
“Granny” of Warner Brother’s Fame
I woke up to a message from my partner asking me to come in early for my shift because someone was sick. Yes, I already sense your collective heads nodding, “Oh yeah, I’ve had those days.” Believe me, I know no good deed goes unpunished and when you do something nice, you will usually get something you wanted no part in. Despite this knowledge, I happily agreed! I then had a stimulating, intellectual conversation with a good friend. All before coffee! I got to work and shortly after I was dispatched on a job to the nicest little old lady (very similar to “Granny” who owned Tweety Bird). She even called us before she was very sick! You know, the same day the symptoms started, not a week later. We took care of her, I got back to my primary and “Murphy” allowed me to wait in the seriously long Starbucks line AND get my coffee at the end. It was while I was waiting that I noticed the surreptitious undercurrent of joy I had been floating in all morning.
Some days it’s necessary.
Let me interject dear reader, your mother was not lying, your face WILL freeze like that. I found the woman who did not listen to her mother’s warning at the Starbucks counter. She was impatiently awaiting her latte. Bundled like the rest of us in an oversized, black, wool coat with an equally oversized hat atop her head, her eyes squinted and peered out from behind retro, cat lady eyeglasses just above her mouth which was drawn together in an aggressive, tight line. This lady was angry.
Disclaimer: Not Actual Angry Starbucks Lady
She really disturbed me. I could not help but stare at this woman. If this was Star Wars she would have altered my force. That is how angry she was.  It occurred to me that sometimes in EMS we act this way. It occurred to me that in many areas this is acceptable and even venerated. It occurred to me that some days at work I wear that same face.
Things happen in our job, terrible things. Patients or their family members project their fear of the unknown via angry or violent voices. We work hundreds of hours and ends still don’t meet while our loved ones rail in our ear about never being there. Not every moment will be a cacophony of angels trumpeting of our ecstasy. However, not every moment is agony and angst. How many situations could we prevent if we were pleasant from the beginning? How many angry letters to your Chief or supervisor and visits to their office could be avoided with a smile and friendly voice? How much could our patient’s outcome improve without the added stress of our grumpy attitude? How much could our lives improve without the stress of our grumpy attitude?
Just some food for thought. Not everything is that simple, but if the above sounds like you perhaps listen to this song before your shift…

The True Spirit of Christmas… Every Day.

You can tell a lot about a person by how they treat the disenfranchised. My grandmother used to start collecting socks, hats, and gloves in October and would store them until Christmas. During the week before Christmas she would cook a huge feast with all the traditional dishes and make individual meals for the homeless in her city. Christmas day she would pack it all in her car and my grandparents would go FIND the homeless and celebrate Christmas with them.
Grandma Thomas and The Author
Like many of us, she understood the love of serving others. Many of us think of our jobs as pre-hospital providers as technical and high minded, but the foundation of excellent care is service. We can provide all the latest techniques and gadgets, but if the practitioner is not in tune with the patient’s emotional well being the whole patient has not been treated.
So what happens to our “service” and compassion when we are called for the town drunk for the fifth time today or the homeless guy in layers and layers of clothes and excrement? How do we treat them? Honestly. How do we TREAT them?
Sometimes our role as providers is defined by the technical skills we possess, but not the social interventions that our patients might not have access to or may not know exist because they have been ignored for so long. It is our responsibility as providers to serve EVERYONE in our community, especially the unseen. Experienced providers should also note that the “new guy” is learning what is acceptable from us. If you treat people badly, that makes it “okay” for others to continue that cycle of neglect or abuse. 
This change in attitude starts with a change in our vocabulary. Like all our other patients, call them Mr or Mrs “Smith” not “Stinky Pete” or whatever nickname your service likes to use. While we are learning to speak to patients appropriately, we should not be doing all the talking. Listen to your patient. This has obvious technical elements such as obtaining an accurate history or acquiring one if your patient is a poor historian leading to better treatment. When there are no emergent matters, simply listening to your patient’s stories from their youth, military service or about their grandchildren relaxes the patient and provides a bond of trust. In my experience, I am the one who received the greatest benefit by hearing their tales and viewing history through their eyes. Be the person they remember because you showed them the greatest kindness by doing the unexpected, being nice.
Mark Bezos’ TED Talk on Heroism
Why do people become homeless or even stay homeless? Some of the usual factors that I discovered while talking with patients that are homeless include mental health issues or addiction problems. These are usually coupled with other chronic illnesses that are not addressed due to poor self-care or lack of access to regular healthcare. This is a multifaceted problem that even the brightest minds have not been able to fix and honestly, some people choose to continue to be homeless. We are not going to change it in 20 minutes to an hour. We can however improve their existence as humans, by sharing our humanity. That means: be nice and don’t dismiss them. Listen to what they have to say about how they got to this point and what their complaint is today. If someone is inebriated, their complaint might be in addition to intoxication. Complete a full assessment. This includes vital signs and exposing affected areas that need to be assessed based on the current complaint. I know, “That’s gross!” It is also our job to take care of all our patients, not just the ones who smell good. If we don’t fully assess the patient every time, we can miss injuries or indicators of chronic illness. The nurses and doctors at the emergency department do listen to our report and preconceived notions. If we say, “Oh, he’s just a drunk.” Chances are they are going to believe that, particularly with regulars, and let them sit and wait. If a patient is having a real emergency, that can obviously be a problem on many levels and the person who bears largest burden in that situation is the patient.
 Caring for the disenfranchised and invisible members of our population should be a daily occurrence, not just a special holiday season activity. This job is not just about all the “cool” stuff we get to use or skills we get to practice, it is largely about caring for others who don’t have anyone else to call. Maybe it’s time to think about why we put our boots on every day.
Merry Christmas!
I would like to thank two special individuals in particular for their inspiration/ assistance with this post.  A huge Thank you to Andrew Caruso and Larry Torrey for showing and reminding me that we are all human.

The Education Conundrum

I recently attended the EMS World Expo in Las Vegas and heard many ideas on how to improve EMS as a whole from responder to system. Surprisingly, one of the more controversial suggestions was higher education for EMS providers affiliated with current training. One side argues that providers will be no more than mere technicians without collegiate stature. The other side argues that continuing education is more than adequate since most providers across the nation are volunteer and time constraints would cause less volunteerism and more shifts to be covered. Of course, EMS is a tangled ball of interconnected arguments that have left us in an adolescent quagmire of how to proceed in our growing pains and the above discussion can lead in several different directions, none of which discuss the place of higher education in EMS.


Before you all get too excited, I am not going to trumpet the benefits of either side as it pertains to EMS. I would like to point out general benefits to attending college, even if you don’t graduate for several years and take the sloooooooooow road (like this author).  An important point to note is that your degree does not necessarily need to be EMS related, and it is probably a benefit if it is not.  Take a look at degrees related to business, public administration, government or anything that will assist in a management/ leadership role as an alternative to nursing or medical related degrees.
The Author hard at work.

 Higher Education provides critical thinking skills. These skills are well used throughout your entire life. In elementary school we are generally taught by reading, remembering and repeating. Not many kids question, “Why?” and the ones that do usually get branded as troublemakers. In college, they WANT you to ask why (to a point) and teach you to do the research to form your own opinion or understanding and not just ingest the information being fed to you.

EMS Provider Benefit: Critical thinking can help you understand the why behind treatment protocols and disease processes, how to best treat the patient and maybe even why your boss just doesn’t make any sense.

 Higher education improves your writing skills. At some point, especially since the advent of the internet, we will all be expected to correspond in the written word. Even an associate’s degree will provide the benefit of learning to write adequately if not well and how to perform research and present it professionally. Yes, people do judge you for text speak/ misspelling/ bad punctuation and construction. No, they don’t care that you don’t like it.

EMS Provider Benefit: Improved documentation skills beyond, “ Patient looked bad.  Took them to hospital.”


Higher education improves your speaking skills. At this point you are probably thinking, “Speaking!?! I got this!” This aspect is related to being well written and having critical thinking skills. Once you can form cohesive thoughts, they usually come out of your mouth well. However, being well spoken is even more than just spouting good ideas. Basic public speaking is part of most curriculum now and helps you appear more poised and prepared even when giving a personal speech (like at a wedding or party) even though you are shaking in your boots.

EMS Provider Benefit: Improves your ability to think on your feet while speaking with angry drunks and crazy family members.  Speaking well improves your credibility and level of respect with other providers instead of using slang and jargon.


Higher education provides exposure to new ideas and people. So many people put off going to school because, “I don’t know what I want to do.” Even going to school one class at a time not only starts the road to your completed degree, but can give you ideas on professional avenues or simply new interests you would like to pursue. People of all ages, nationalities, and stages of life attend college giving you access to their views and experiences.


EMS Provider Benefit: You gain a broader experience in your education enabling you to appreciate the vast differences between our patients and their cultures.


Higher education improves your self-confidence and maturity.Completing each class and interacting with other students and professors increases self-confidence and maturity of the student. Doing well and succeeding at school makes students feel accomplished and encourages them to move on and continue doing well both academically and professionally. Maturity is nurtured during the education process through team work and expectations from professors and fellow students. Self-confidence can help students reach for opportunities they never would have imagined being able to obtain prior to academic success.


EMS Provider Benefit: Occasionally there is a heavy gravity to situations providers must perform within. Even if the provider is not exactly sure what the best response is in a non-traditional situation, the maturity and confidence gained in college can assist in the “fake it til you make it” situation and make it seem like it’s what happens all the time.


Even completing some college credits can make you more marketable to ANY potential employer or supervisor. Let’s be real. No one wants to be “the fry guy” for life and even management at well-known establishments such as McDonald’s require some sort of post high school education or training. Even some college credits and evidence of current pursuit of a degree can help land a better position.
EMS Provider Benefit: Marketability can increase your value to get hired or promoted by your current employer opening new opportunities in the administration, education, or planning section of your department.


Eddie Murphy in Coming To America
Obviously, this list is not all inclusive. However in addition to the non-material benefits above, higher education can increase your net worth. Per the Census Bureau a high school graduate earns about $1,371,000 over a lifetime while a college graduate with a Bachelor’s degree earns about $2,422,000.  A million dollars more over a lifetime makes the monetary and time investment more than worth spending.
Show me the money!
If finances are an issue and loans are out of the question there are LOTS of scholarships out there if you dig for them. They are the only reason I can afford to go to school and eat at the present time. Check out your local IAFF, FMBA, PBA, FOP, VFW, EMS or OEM unions or support agencies for their scholarships. Most 2 year colleges have county or state wide academic scholarships or endowments and that information is usually available at student accounts or the financial aid office. If you do well and have good grades, PHI THETA KAPPA is a 2 year college academic fraternity that has access to international internships and opportunities and most importantly scholarships for when you want to transfer to a 4 year institution.
Whether you think higher education has a place in EMS or not, educating yourself will improve your life exponentially ($1 MILLION DOLLARS!). It will improve your family’s lives, your organizations and you might inspire your friends or brothers and sisters.




The Silent Killer

 There is a great hypocrisy in the world of Emergency Services.  Our job is to help people in any circumstance, at any time, at any place usually where unimaginable scenarios present themselves.  These are the worst days of peoples’ lives, but they shouldn’t affect responders…at least that is the popular conception within our circles.

This is why our coworkers, employees, partners, mentors, friends, brothers and sisters fall prey to treatable conditions unseen and unheard.  We look away at the worst time of their lives when they need the most help, but cannot ask for it.
“If ‘the job’ bothers you, then maybe it’s not for you.”
“I don’t know why you are so upset, you can’t save em’ all.”
“Man up!”
Maybe, there was no warning at all.  No complaint, no altered personality, no telltale sign of something amiss.  These people who we would protect and defend in the street are consigned to silence by the fear of our judgment in headquarters.  If you have been in this business for more than 5 years you have witnessed the phenomenon yourself.  Someone mentions that a particular call affected them or they seek treatment before the feelings progress and suddenly they are riding a desk or are forced out of the agency.  The typical line that is produced by the powers that be at the time is, “We have to know our people can make sound decisions under pressure.”  I admit this is a necessary component of our profession, but have you seen some of the people that get hired?  These providers are usually veterans who know to get help before the issues progress and were attempting to obtain help.  That is not good decision making?  What makes this whole situation worse is that we at the bottom then complete the abandonment by ignoring the person affected.  The person we used to be a brother or sister to is now treated like a leper because we “don’t want to deal with THAT.”
Some responders even commit suicide.  These are our friends!  We swim in each others pools and eat each others food.  We celebrate holidays together when we cannot be at home.  Our children play together and we tell each other secrets our loved ones wouldn’t begin to understand.  Yet we might as well show up to the funeral en masse in our dress blues and turn our backs for how some of their families are ostracized.  
Got cancer? We have a fundraiser.   
Got injured?  We come help around your house.  
 Have PTSD and kill yourself?  Oh, I’m sorry, do I know you?
There are no hard and fast statistics related to EMS or Fire related suicide.   Quite honestly, there are no statistics related to suicide by EMS providers. There are several reasons why: 70 percent of fire departments in the United States are volunteer departments and death certificates are completed with a profession noted, not volunteer activities.   Until recently the hero culture and machismo within Emergency Services had absolutely no room for discussion on first responder suicide, but like many things, the military attention on PTSD and responders with PTSD after 9/11 have shifted our attention to the topic.  The demographics within the EMS community are more varied than the Fire Service, but we are all exposed to some high risk factors for suicide.  We are all exposed to violence on a higher level than most citizens, whether via patient care or being assaulted during the incident ourselves.   Death is encountered by first responders in the normal course of duty and the loss of one’s life is accepted as an occupational risk.  A study, Occupational Fatalities in Emergency Medical Services: A Hidden Crisis, published in the December 2002 Annals of Emergency Medicine found that EMS providers are almost as likely to be killed at work as police officers and firefighters.  Between 1992 and 1997, 12.7 per 100,000 EMS Providers died at work compared to 14.2 per 100,000 police officers and 16.5 per 100,000 firefighters.  The national average for the working public is 5 death per 100,000 workers. We are also exposed to suicide or attempted suicide at higher levels than most citizens. This elevated exposure desensitizes providers to violence, death, and suicide and can lead to disinhibition and likely a more evolved capability for suicide than the general public.
Many non-demographic risk factors of suicide related to Emergency Services include alcohol abuse, mental illness, divorce or separation and the presence of a firearm in the home.  As you are well aware, we work long hours at multiple jobs, we don’t get paid very much, we deal with copious amounts of stress on a daily basis and this can lead to a myriad of difficulties in our personal lives without an outlet to release it all.  We all know someone, or maybe have had personal experience, with financial difficulties.  Having a strong work ethic is commendable, but 100 hour weeks dealing with everyone else’s problems is bound to lead to problems of your own. After working all those hours that’s just enough money to live in a tiny apartment eating butter noodles because that is all you could afford after paying your bills so you could get to work to do it all again next week.  We have all been cheated on or know someone who has or is currently involved in a love triangle (or square).  Everyone knows everyone else’s business in our world and in twenty years people will still remember.  And whisper.  If you are married or have a relationship with children involved this can lead to custody issues and likely a lawyer bill that your butter noodle budget cannot afford.  You know what happens when you don’t have a lawyer.  I’m sure we also know someone that lost their home because things got out of control and lived in their car and showered at the gym or work.  As if ALL that wasn’t bad enough add being ignored and told to “man up”  to the list.  The solution to the issues listed above is not simple or easily unraveled, some of it is the nature of the beast and some are personal choices.  These issues need a national forum for solution and voices from members of our community demanding change and improvement.  Some of these issues need better decision making skills in our personal lives as well.  It won’t solve the problem of suicide outright, but improved lives and life choices will contribute to stemming the tide.
FDNY EMT Daniel Stewart
While there aren’t many numbers to quantify first responder suicide what we do know about suicide in general is alarming. Of those who completed suicide, 70 to 80 percent suffered from alcohol abuse and a mood disorder, 40 to 60 percent were intoxicated at time of death and 56 percent used a firearm to carry out the suicide.  These are statistics for the general population, but closely resemble the majority of first responders.  In a study conducted by the International Association of Firefighters (IAFF) alcohol abuse was qualified as more than 2 alcoholic beverages a day for men and more than 1 alcoholic beverage a day for women.  The “two” beers and shots at the bar or party on your day off is qualified as binge drinking which is related to alcoholism as well.  Some other alarming numbers: various studies have cited PTSD rates, specifically related to firefighters, range from 16 to 24 percent while the average for American adults diagnosed with PTSD in their lifetime is 6.8 percent.
 Philadelphia Firefighter Jack Slivinski (left)
While suicide can be preceeded by a number of mental health issues, recent studies are linking PTSD and Suicide.  Per the Mayo Clinic, PTSD symptoms can include: flashbacks, upsetting dreams about the event, reliving the event, avoiding thinking or talking about the event, feeling emotionally numb, avoiding activities once enjoyed, hopelessness about the future, memory problems, trouble concentrating, difficulty maintaining close relationships, irritability, anger, overwhelming guilt or shame, self-destructive behavior, trouble sleeping, being easily startled or frightened, and seeing or hearing things that aren’t there.
Unfortunately, many of us, including our leadership are not educated on these warning signs.  Alternatively, the psychiatric and counseling communities are not usually well versed in our culture to understand the unique parameters that define our workplace.  Fire, Police and EMS units (unless aligned with a hospital) do not typically have Employee Assistance Programs (EAP) to call and speak with.  Those that do have programs in place still have providers with fear that their job will be affected.  These responders either pay out of pocket to go to a counselor of their own so the treatment does not show on their insurance or don’t do anything at all, letting the feelings grow in strength.
Chief Kyle Ienn of Ralson, NE Fire Department
There are many wonderful people advocating and researching PTSD and First Responder Suicide.  Peggy Sweeney of the Sweeney Alliance promotes educational programs for dealing with stress, trauma and grief and writes several newsletters including Grieving Behind the Badge.  Her colleague, Shannon Pennington is the founder of The North American Firefighter Veteran Network and together they have produced a training program for first responders called FIRST STEP HOPE: Not All Wounds are Visible.  Both have been first responders and understand the difficulties faced in our line of work.  Jeff Dill holds a Master’s degree and is a Licensed Counselor. He is also a Captain at Palatine Rural Fire Protection District in Inverness, Illinois and the founder of Counseling Services for FireFighters.  He educates leaders on the importance of counseling and awareness of PTSD and Suicide.  He is also compiling statistical data based on confidential reports of Firefighter and EMS provider suicides.
 Awareness, like many other topics in our profession is key to prevention.  Having an Employee Assistance Plan (EAP) and CISD Teams and leader education is a great first step, but until the change in our culture flows through the ranks, our brothers and sisters will continue to be cut down by this seemingly silent killer.  Ask about your workplace EAP Plan or why you don’t have one.  Educate yourself on issues that affect providers socially and emotionally and ask to have them addressed. Help each other when you notice a change.  Let your legislators know EMS needs funding for studies on these issues and ask what they plan to do about it. 

We strike for better pay and health benefits, we complain to get better couches or recliners to watch TV in, we gripe about not enough milk in the fridge for afternoon coffee.  Why don’t we speak up and stand in the gap for our friends and ourselves?  Who will pay attention if we don’t?  How will the culture change if we don’t change it?
If you are thinking about suicide or need help you can call the National Suicide Hotline.  It is open 24 hours a day, 7 days a week.  1-800-273-8255  1-800-273-TALK


Just Keepin’ It Real

A few nights ago I was relaxing and reflecting on how I got to this point in my life and reminiscing about the people and circumstances that helped mold me into the person I am today.  One person in particular came to mind, although we haven’t spoken in many years. I wondered what happened to them, how their life turned out and if they are still alive.  This person had a short tenure in my life, but left such an indelible mark on me that many others have not been able to affect in years. How can one person motivate such change in such a short time?  How can we leave that legacy when interacting with others?


I am sure there are several articles from big name magazines and Ivy League review magazines trending on LinkedIn and professional websites that address this topic.  They will have 5, 7 or 10 points or suggestions for you to implement in your professional or personal life to “make your mark” or “leave a legacy”.  I submit there is ONE thing you must do to change people’s lives and make your legacy in any area of your life.  It is the most difficult thing you will ever have to do.
Be authentic.
Yes, the one thing you have to do to change lives, both yours and others, is be yourself.  It might be the most terrifying thing, exposing the true you to the world.  There are a myriad of fearful questions that take flight in the mind when thinking of what taking off the layers of protection personality and ego afford.  When authenticity was first suggested to me I thought, “What if they don’t like me?  What if I fail?”  My initial solution was to stop writing.  If authentic was a quality then maybe this wasn’t for me because that kind of failure was just too much.  It took a while to realize that my fear was defeating me and I was failing by giving in to fear. 

People are waiting for something real!  We all look for it: the real deal, a real love, “I’m just keepin’ it real”.   Post Secret is immensely popular and addictive because it allows the poster and the reader to connect and share on a level that society does not subscribe to. The problem is when folks are face to face no one wants to take off their mask first.  No one wants to take the risk.

The Velveteen Rabbit
There is no simple fix to expedite the process of “being real”.  Protecting ourselves has been ingrained in us since we were first able to process thought.  You will have to apply yourself and look for opportunities to reveal the true you, choosing between putting up a front and being authentic.  Like a deep friendship or relationship, time will slowly strip away the layers and bonds will be formed based on these revelations.  These bonds can be within the workplace, friendships or with family.  The results are far reaching and beneficial.  Your personal and professional relationships will be improved because your colleagues, family and friends will feel valued.  You will get more accomplished because the roadblocks of ego and grandstanding will be washed away.  Your interactions will be more intense and people will be authentic with you because they know they can trust you. Take off your mask and see the difference it can make.

Post Secret Submission

Back in the Day

I recently returned from the Incident Response to Terrorist Bombings Course (IRTB) and learned many lessons, the most illuminating was the reverence for dangerous things and situations. Prior to witnessing some of the detonations at this class I thought, “Yeah, yeah, safety distances and recommendations. Blah, blah, blah.” After witnessing the devastation wrought by even a small device I am sobered by the realization of just how weak we really are and that any moment might be our last. Our strength is in knowledge and the USE of this knowledge for our safety and the safety of others in our daily operations.
The End of the Dinosaurs


Dinosaurs are extinct for a reason, they did not adapt to the changing atmosphere on Earth. In our case safety is the changing atmosphere and we have our own dinosaurs. A dinosaur is an individual or individuals within an organization that disregard or block new ideas or mechanisms to improve the organization or responses to events. Unfortunately, our dinosaurs can endanger all of our lives not just their own.
In our business we are exposed to a variety of possibly dangerous situations and have to be continually mindful of safety. This starts with planning via training, NFPA and OSHA codes, disaster and public health planning to name a few. Safety also includes the proper use of personal protective items like turnout gear, helmets, gloves and masks. We practice situational awareness and scan the scene and continually reassess for changing conditions. We do all this in the name of safety, but how often do we refresh our minds looking for innovative ways to improve our planning, response or gear?
Safety Steve at the Calgary Zoo
Life Safety is our mission and the most important life is your own. This is controversial to some although I don’t understand why, I really like my life. On a serious note, not only will response to the incident you are going to or arrived at be delayed if you are injured, but secondary units will likely be diverted to you and the initial call will be further delayed. In addition, there is a monetary and emotional cost to your family and organization if you are injured or killed. A small organization can be decimated if other responders leave the organization due to stress resulting from your injury or death. During initial training we are taught about situational awareness and protecting ourselves first. Yes, our job is dangerous but how many of us follow the lessons we learned to mitigate some of this danger?
It seems that the longer a responder serves, the less they value the safety lessons they learned initially. While this does not apply to everyone, we all know someone who always comments, “ Well, back in the day we…” and means it. We all have experience with this member or members stall tactics and nay saying when trying to implement proactive safety changes or any changes at all. They also usually use the secondary phrase, “It’s worked fine for this long…” Indeed, these dinosaurs have been the death knell of many organizations because they refuse to move into the modern era.
So what do we do about this culture of nostalgia to be respectful of our past yet embrace advances in responder safety? How can we convert these dinosaurs to change their views and not taint new responders with their example? Veteran responders should be an example of how to be safe, not an example of what not to do. Whether we like it or not veteran responders are an example to the new members of our agencies even if it is the wrong lesson taught.
Is this how your dinosaur treats you?
The following are some suggestions on how to deal with this phenomena in your agency. They are not all inclusive and may only be a part of your plan to implement improvements as there are several different types of agencies and models used in our region and nation.
Research what other reputable agencies are doing in your region and the nation. These plans are usually evidence based and with implementation the kinks have been ironed out already. If this is your agency’s first time updating your Standard Operating Guidelines (SOG’s) or Standard Operating Procedures (SOP’s) adapting a current plan will be easier than starting from scratch. Your dinosaurs will have a difficult time refuting these plans as they are already being used in similar agencies.

Make your members NEED to change. This depends on your responders, what is important to them? This could be new training, new improved gear, new gadgets. Show them how this one uncomfortable moment of modifying their behavior will benefit them in the long run.
Present the effects of non-action. This could be examples of exposure to lawsuits or Line of Duty Deaths (LODDs) that have occurred due to similar situations. Show how your organization could be held to account for their lack of planning.
Utilize current safety training programs. There are many training programs across the country focusing on safety. Everyone Goes Home is a fire based program, but has excellent potential in the EMS community. Contact your local representative and request a presentation! The Department of Transportation is also an excellent resource and most partner with state level fire and EMS organizations to present safety programs. Do some research, there are lots of free programs out there.
Reassure your dinosaurs and others that might not be ready for buy in. Much resistance to change is the belief that you are trying to usurp them or destroy the organization. Let them know that the entire unit needs to buy in for complete safety implementation and that your interest in in protecting the responders and organization. Unfortunately, in my experience those most averse to change are not the ones in the street. That may be another part of the problem your members need to address.
Like I said above, these recommendations are not exhaustive, only thoughts to get started. I practice EMS in New Jersey and we have been fractured for quite awhile, but the process for safety across the board and unity in our services has moved forward since I started. Though it is in small increments the safety at our organizations have improved. Developing, implementing and practicing safety standards is a team process. The standards are useless if even a few don’t follow them as we operate as a team. This may be something that you start and others finish; don’t be discouraged. Our business is to save others, we must keep ourselves safe to accomplish this task.

The author at The Museum of Natural History