College

First, watch this video:

Credit to my friend Frank Piscitello (http://twitter.com/#!/fpiscite) for sharing

What, exactly, is one SUPPOSED to learn on a college campus these days? What DOES one learn? As a college senior myself, I am continually amazed at how many students have no concept of basic life functions. I find there are many students can’t do ANYTHING in moderation. Administrators can’t make up their minds – on the one hand, they acknowledge that almost all the campus community are legally adults, yet they enact rules to “protect” the students from perceived evils of society. While the campus does have walls… by design, access is almost unrestricted, for convenience if nothing else.
As the video points out, the current educational concept relies on the student accepting everything the teacher presents as face value – even when the instruction is blatantly biased. And the student that would seek to challenge bias is seen as a troublemaker.
When did our society change that a college degree is a requirement to enter the “real” workforce? What miracle happens at a college campus that makes a person with a B.A. or B.S. a good manager? Or qualifies them for a 9-5 job, where overtime is uncommon, and things like vacation time and holidays are expected?
I work 12 hour shifts, sometimes 2 or more consecutively. My “office” is a box on wheels with about 300-400 cubic feet of workspace. In that, I have enough tools at my disposal to at least attempt to “fix people”. EMS is the only part of the medical system that routinely makes house calls anymore. EMS, on average, has 30 TIMES the chance of being injured in an assault than the “average” worker. I work outside in extreme cold, extreme heat, and sunlight, darkness, rain and snow are all “normal” things that I’m expected to work through. If I call in sick, it means that someone else is called in or held over… or that the community isn’t as well protected as it would have been, and my co-workers have to make do with fewer resources.
In many cases, my peers and I are paid much less than a nurse… even though the actual responsibility and delegated practice model under which I perform makes me more of a Physician Assistant Lite. But because I have 3-4 years less schooling, I make a small fraction of what a PA makes. Why? Because the only letters after my name are NREMT-P…. not B.S. Even adding additional competencies such as FP-C or CCP-C doesn’t win me much of an increase, if any.

September 11th Reflections:

I know I'm a few days late.

This is where I was last year on 9/11, working a West Chester University of PA home football game with WCU EMS. It was 9/11/10, exactly 9 years after the attacks that changed America. One thing I hadn't known until then was that the First Officer of Flight 175 (2^nd flight to be hijacked and flown into the Trade Center Towers) was a graduate of my school, West Chester University. Not only that, he was the quarterback during two impressive seasons for WCU Football. These days, the prime benefit of a home football game is a chance to see the WCU Marching Band play. If you actually want to watch a football game, you might as well go somewhere else.

Anyway, Michael Horrocks was a noted graduate of WCU. A year ago, they unveiled a statue of him throwing a football. The statue is larger than life, at 7 feet tall, apparently just like Mr. Horrocks. His statue sits along the path that all athletes walking to and from the locker rooms will walk down.

Anyway, the video above is a well-done student production. At 8:20 in the video was a C-130 flyover. The video doesn't do it justice. The planes seemed to fill the sky, and the sound was deafening. As the game went on, I was following Twitter on my phone, and noticed a tweet from 22EMT22, retweeted by TheHappyMedic, mentioning Michael Horrocks by name. Turns out, William, an EMT from Sacremento, CA, knew members of the Horrocks family, and he seemed to appreciate knowing what WCU was doing on that day.

It's been 10 long years since that day... yet I can still remember it like it was yesterday.

Michael Horrocks
3/24/63-9/11/01

And the motto on the plaque:
Honor Him
Never Quit
Love the Game
WIN

And here's the actual text.

\

Up In Smoke, and why is EMS treated different then other employees?

Nicotine Tests Could Cost Fla. Medics Their Jobs

http://www.emsworld.com/article/article.jsp?id=17983&siteSection=1

The above article is the top news story on www.EMSWorld.com right now. Long story short, it appears that the county is now in the EMS buisness, so the EMS employees are now County Employees. The policy change doesn't go into effect until October of this year.

I've never been able to understand why so many people in EMS, the fire service, and LEO's smoke. We've all seen people dying of tobacco-related cancers. My favorite irony is seeing a firefighter come outside from a fire, and take off his mask on his way to rehab... and light up a smoke. If you really want to inhale smoke and carcinogens, why bother wearing a pack?

To be honest, I'm of mixed opinions. While I personally, don't smoke, and can't understand why people do (it's disgusting and harmful to your health). I don't see that my employer (especially a government employer) has any right to tell me what I can and can't do when I'm NOT at work/in uniform.

My biggest concern of the whole article, though, is this line:

“The nicotine test only applies to uniformed workers, like law enforcement. Paramedics and ambulance crew members will be required to take a nicotine test starting on Oct. 1.”

Why does it only apply to uniformed workers? Is there a different policy that applies to the rest of the county employees? The ones that sit behind desks all day, and get real lunch breaks? The article isn't clear, and I can't find anything else quickly online – If someone can enlighten me, I'd appreciate it. If there is no policy for the “office dwellers” - than this policy is out of line.

EMS 2.0 Primer

Ok... blogging again. First post is an EMS 2.0 primer I wrote to a collegiate EMS educator I met at the NCEMSF Conference this year, after attending a very good presentation discussing that EMS will only grow as much as we, as providers, want it to. She'd never heard of EMS 2.0, though. Great minds think alike.

~~~~~~~~~~~~~~

Professor ___,

It was great to see the enthusiasm you have for moving EMS forward... as I said in the session, you are not the only person with similar thoughts. I've been involved in EMS for 10 years, and active in various online forms for much of that time. There are several great web fourms dedicated to EMS, and one of the recurring discussions is the difference in training, professional recognition, and compensation between EMS in the USA, and other countries.

There are MANY EMTs and Paramedics that are active with online blogs, as well as being on web forums and other new social media (Twitter, Facebook, etc). It's amazing that there are many voices in unison saying the same thing – we, as providers, are responsible for helping shape our profession.

A few things I truly think are worth your time online:

EMS 2.0 – Written by a Paramedic from Wisconsin named Chris Kaiser, who writes a blog titled Life Under The Lights (http://lifeunderthelights.com/).

EMS 2.0 seeks to address the issues blocking EMTs and Paramedics from moving forward as a Profession. Built upon the concepts of Technology, Training and Trust, the movement seeks to improve all aspects of emergency services, including community care, disease and injury prevention and opening new avenues for patient care rather than simple transport to an ER.

Chronicles of EMS / Beyond the Lights and Sirens – a ~20 minute short film looking at a fire based urban EMS system from the point of view of both a medic within the system looking for the same change you want, and a English NHS paramedic. The project was instigated by social media, and exchanges between Justin Schorr, who blogs as The Happy Medic (http://happymedic.com/) and Mark Glencorse, who just retired from blogging after several years as 999Medic (http://999medic.com/).

The show is here: http://chroniclesofems.com/reality-series.htm (If you only look at one link, look at this one!).

Lastly, the Chronicles of EMS website has more to say on EMS 2.0:

http://chroniclesofems.com/ems-20.htm

Professor – I actually was able to meet all of the above at EMS Today last year. All are truly great people. There are many providers with a similar vision, united under the concept of EMS 2.0. We are self motivated, and while each of us is a small voice within our respective agencies, we constantly talk online and are able to be self-motivated and help each other. I follow a number of blogs on a daily basis (I am able to read/skim new posts through an application on my phone that syncs from the blog feeds). These blogs help entertain me on my downtime, and engage me in discussion when needed. There is also a great motivation in the knowledge that I am not alone.

If you have ANY questions or there is anything I can do, please feel free to ask.

Jonathan Blatman

Paramedic, West Chester, Pensylvania.

Fraud vs. Government Waste

The other day, I was talking with @WmRandomWard (www.twitter.com/wmrandomward), in regards to his latest blog post (http://randomparamedicine.firstrespondersnetwork.tv/?p=123). Our discussion was about Medicare/Medicaid billing, waste, and fraud.

Further, over on www.EMTLife.com there have been a few discussions lately that allude to EMS "buffing" charts so Medicare will pay.

Take a call from the other night for example. I was held over 5 hours late to deal with transfering a ventilator patient discharge from a Pennsylvania long-term acute care facility to a long term vent unit in New Jersey.

Pennsylvania and New Jersey have very different EMS rules. With Pennsylvania, I can manage a list of IV drugs on pumps, Monitor Cardiac rhythms, and manage advanced airways and ventilator settings. All by protocol and/or written orders. I need a nurse to manage drugs not on my list, TPN, continuous tube feedings, and transport blood.

In New Jersey, there is no provision for a private service to operate ALS interfacility, so all interfacility transports are SCT nurse runs, with a crew that contains at least 2 people who are EMT's as well as an RN (the nurse can also count as an EMT).

So this guy is going from PA into NJ, so I would be covered under PA protocols and rules for the whole transport. It's a simple ALS call - Vent only, not even on telemetry at the sending facility.

Yet I'm told that this run can't just go ALS, and must go with a RN. So now a nurse is coming to meet me and I'm going to jump in with her and do the run, with an EMT to drive us. Why am I there? Because this nurse isn't qualified as a PA ALS provider. So I have to be there, because this call is technically NOT needing a nurse.

So, why is this a nurse call? Punchline: Because NJ Medicaid is the payor, and they don't seem able to pay for ALS interfacility transports. Because they aren't done in NJ. So instead of running the call with myself and an EMT, there are now 2 advanced providers and an EMT, and a significant increase in cost. And guess who's eating the cost?

http://www.courierpostonline.com/article/20110609/NEWS01/106090338/Coalition-criticizes-Medicaid-cuts-N-J-

Yup. NJ Medicaid. The program that is facing huge budget cuts to help NJ's deficit.

We talk about EMS providers and services that commit fraud by billing for services that aren't indicated, but what of the government mandating services that aren't needed?

Jon

My own letter to Howard Cain

Mr. Cain,

I've been seeing you name in the media recently, and as a conservative, I'm enthusiastic about a conservative living at 1600 Pennsylvania Ave again. As we are in the beginning of the process for 2012, I am nowhere near certain who to support at this point.

I was recently reading a post by David Cordera: http://www.examiner.com/gun-rights-in-national/open-letter-to-herman-cain-on-the-right-to-keep-and-bear-arms
The post discusses your recent quote to Wolf Blitzer regarding your personal beliefs on the subject of "gun control.".

I'd like to see your response to Mr. Cordera's survey, so that as we enter primary season, I can see if I'm comfortable supporting you here in Pennsylvania.

Jon B.
Member: College Republicans, Firearm Owners Against Crime. Life Member, NRA.

EMS on the Hill – My Thoughts:

Two weeks ago, I had the opportunity to travel to Washington DC for the NAEMT's (National Association of Emergency Medical Technicians) EMS on the Hill Day (http://www.naemt.org/advocacy/emsonthehillday/EMSontheHillDay.aspx) I was lucky enough to get a scholarship from NAEMT to cover my costs of attending... as a part time student, this was really the only way I could afford to go.

While I've been involved in political lobbying events at the State level before, I've never done anything at the Federal level. This event was VERY well orchestrated, and went very smoothly.

Arriving the evening before the activism day, we met in a meeting room at the host hotel and went over the 3 main issues we were discussing.

Issue #1 was the expansion of the current PSOB (Public Safety Officer's benefit) death benefit to include EMS providers from third-service non-profit agencies. Currently Firefighters, EMS Providers, and Police Officers employed by a municipal, state, or federal government agency are covered by the PSOB death benefit. House Bill 1668, the Danny McIntosh Emergency Medical Service Providers Protection Act (http://thomas.loc.gov/cgi-bin/bdquery/D?d112:2:./temp/~bdfldE::), sponsored by Rep. Mike Fitzpatrick from Bucks County, PA.

HB 1668 bears the name of Daniel McIntosh, a Paramedic from Bucks County who died in the line of duty last year on a call in Bucks County. Because he was working for a non-profit community EMS agency, he didn't qualify for the PSOB funds. Rep. Fitzpatrick's bill aims to close that loophole and give more emergency medical providers that coverage.

A photo of my group from the event with Rep. Fitzpatrick
(Rep. Fitzpatrick is 2nd from the left, I'm on the right)

We also discussed the Medicare Ambulance Access Preservation Act with our elected representatives, pushing for a mild increase in Medicare reimbursement. In these trying economic times, EMS agencies large and small rely on Medicare reimbursement more and more. For us in Pennsylvania, faced with loosing the Emergency Medical Services Operating Fund from the state... we need to be able to make up that money somehow. The Government Accounting Office (GAO) has acknowledged that EMS is reimbursed below cost by Medicare. This act would increase EMS reimbursement for 5 years, hopefully giving the Government time to actually fix the Medicare reimbursement model to something MORE than just a transport model... we might actually get paid for the care we provide... not just as a transport service.

Finally, we were asking for an expansion of the currently approved 700mhz radio spectrum for Emergency Services to a 20mzh bandwidth with the addition of the D-Block 700mhz airspace. This will allow a national build-out of a broadband data network for Emergency Services across the US. Getting us off of aircards and national cell networks, and letting us have our own network where we can't interfere with other services. The downside to this is that the D-block airspace could go for 2.75 Billion at auction to a cell phone service. That's “real money” as the government attempts to balance the budget.

At the end of the day, we met back at the hotel for a reception where we got to compare notes and discuss our good and bad encounters. Then it was dinner with the EMS 2.0 crowd... that was a fun time.

I spent the next day touring DC – seeing the Capitol Visitor's center, and walking around the city on my own. Then I drove home. I really enjoyed the event... it was great seeing my good EMS 2.0 friends from Twitter: @MsParamedic, @Medic61, @WmRandomWard, @MedicSBK, and @TheHappyMedic. Further, I have applied for the NAEMT's new State Advocacy coordinator position... Looking to see where this goes from here.

The EMS 2.0 Bloggers present:

@MsParamedic: http://msparamedic.com
@Medic61: http://samtheemt.com/
@WmRandomWard: http://randomparamedicine.firstrespondersnetwork.tv/
@MedicSBK: http://medicsbk.com/
@TheHappyMedic: http://thehappymedic.com/

Anyway – It was a blast. Now I need to find an excuse to see them all again at EMS Expo in Vegas.

Monday, and a good mood!

Happy Monday! It’s 73 degrees, going up to 80+ today. I’m wearing shorts for the first time this year, and sitting in the office at the University. I’m supposed to be catching up on paperwork – my owed charts, and QA in general. The office door is open, and I can’t seem to focus. This weekend was nice overall. Worked as a Medic Saturday daytime – did 2 less than acute calls, including my first legitimate ALS release (never had a reason to before). Saturday night on the BLS squad, doing a “rent” shift, with the GF riding with me (she’s a member, too). It was miserable… 2 more patients that I like trying to throw up on me, and no real sleep. Slept in Sunday AM, then took the GF to the range for the first time ever… She tried my pistols (need to find something that better fits her hands), and I dropped the .22 conversion into the AR… she loved that. Then I had a meeting for Alpha Phi Omega at school… a late dinner with her, and she headed home. So, I’m in a good mood this week. School is over in a few weeks – that will be my first priority, to make sure I finish my class obligations. I’m trying to balance school, work, volunteer, and personal obligations, and I think I’m doing a better job than I have been. EMS on the Hill is in less than a month, and I can’t wait to see all my EMS 2.0 friends again. On the State side, House Bill 40 (Castle Doctrine) is supposed to go for its final vote in the State House today… then on to the Senate for their approval. We are getting there. Anyway – That’s all I’ve got for today!

Pins and Needles

I'm in a dark room, with a one-armed man. I'm trying to find an IV so I can give Nitro and Morphine for his chest pain... I search and search for a vein. I've got one, but it's resting on fatty tissue, with nothing to put tension against to hold it in place. I swing... and a miss. Clean the site and try the other side of the AC. Swing and a miss. Again... back at the first site. I get flash, but can't advance the catheter. I try to float it in. It blows. I swear in my head.

We load the patient up, and once in the truck, I find one more vein on the arm that I think I can get. I pray. I miss. I look at my partner and say “Just go”. I talk to the patient on the way to the hospital. Trying to keep his mind off things. It doesn't really work.

At the ER, we place the patient in bed. I explain that I can't get a line. The nurse looks at me and incredulously says “Are you a paramedic?” I doubt myself. I think I stole the patch and don't deserve to wear it. I say Yes, but inside I wonder.

After registering the patient, I peek in on my way out the door. The nurses are on try 4 or 5 themselves, with no more luck than I had. I walk out with my head just a little bit higher, recognizing that it wasn't JUST me.

~~~~~~~~~~~~~~~

I hate IV's in my own arms... it hurts. I cringe when I stick my patients. I don't dig for the vein, because that trick never works. I hate turning my patients into pincushions, but sometimes they have NOTHING for veins, and I'm desperate to get a line so I can push drugs to make them feel better.

EMS Today Recap

Life’s gotten very interesting this past month, and there have been some changes – mostly positive.

I’m still playing catch-up from EMS Today – Be it in my college class, sleep, or getting back into the saddle with work. I promised myself I’d blog more… and so I am trying.

EMS Today was amazing – I got to meet and/or re-connect with some great folks. And I actually added a blogroll of some of the best.

In addition to the core #CoEMS crew - @Setla, @SamBradley11, and @TheHappyMedic (http://happymedic.com/), I got to
A quick run-down:

Russell Stine / @HybridMedic, A firefighter/Paramedic and allaround good guy from Memphis: http://hybridmedic.com/

Scott Kier / @MedicSBK, a Paramedic Supervisor from Mass. We met in May 2010, and he was one of my first contacts into the wide world of #CoEMS on Twitter: http://2010ems.blogspot.com/

EpiJunky / @GingerMedic – A paramedic and great gal http://pinkwarmdry.com/

Kelly Grayson / @AmboDriver – A medic and author from Down South – Wish I’d had a chance to talk with him more: http://ambulancedriverfiles.com/

@MsParamedic – Because she’s awesome: http://msparamedic.com/

Chris Kaiser / @CKemtp – Some Guy That Writes Some really good Stuff: http://lifeunderthelights.com/

@Medic61 – http://samtheemt.com/

@MedicTrommashere – http://lookingthroughapairofpinkhandledtraumashears.com/

Kevin / @NJDiveMedic - http://njdivemedic.blogspot.com/

And if I missed you – My apologies – I met so many folks, and I’m sure I’m missing a few!

Conferences 101

In the next month, I have the privilege of attending two national EMS conferences The first is the NCEMSF Conference (National Collegiate EMS Foundation http://www.ncemsf.org/), in my backyard, Philadelphia, PA. The other will be the JEMS Conference, EMS Today (http://www.emstoday.com). I'm getting to be an old hand at JEMS, especially in Baltimore, but I've never been to the NCEMSF Conference before, so that will be a new experience.

On Twitter, I've seen some folks comment that they've never been to an EMS Conference before – so I figured I'd write a bit of a guide for new folks going.

First – What to wear:

Comfortable shoes are key. Between wandering the exhibit floor, walking between spread-out classrooms, and walking to lunch and evening activities, you'll spend a LOT of time on your feet. If you don't wear comfortable shoes, you'll be looking for the on-site EMS coverage folks for band-aids and moleskin for your blisters. Oh – and make sure the shoes are broken in... or you'll have the same issues with blisters.

Every year, I see a wide range of attire, from suits and ties to ripped T-shirts and torn blue jeans. There are also more than a few wearing “Absolute EMT” t-shirts and squad uniforms. I tend to try to appear professional – collared shirts and khakis or nice jeans.

As for uniforms: I may wear a jobshirt or sweatshirt with a department logo, and that's as far as I'll go. I never understand the folks wandering around in full duty uniforms (excluding the ones there staffing a booth for their department), and why do folks insist on wearing their pagers or turnout coats?

What to do:

The reason I get to go to the conference is education. That means that I try to pick topics that are interesting, and that I'll get something out of. Networking is a great benefit to an event of that scale, and I'm looking forward to seeing folks I met last year, and meeting new folks, too. Some folks go to these events looking for new employment possibilities, and there are a host of companies there recruiting.

As for sessions – Go to ones that interest you. Just because you signed up for one session doesn't mean you can't change your mind and go to a different one. Be aware of the continuing education restrictions, though. For example, even though I'm a medic, as a condition of me going last year, my sessions had to be approved for BLS con-ed. Be aware if you have similar restrictions. Steve Berry happens to be my favorite lecturer, and his sessions are ALWAYS standing-room-only. Get their early to get good seats. Bring a notepad and be able to take notes. I'm not a huge note-taker, but there will always be something of benefit to research more later.

Networking is great, and sometimes occurs in the exhibit halls and corridors of the convention center. More often than not, though, it occurs over food and drink at lunch and in the evenings. There are sales reps from many companies present, and some of them will offer to buy you dinner or drinks. Remember, they are trying to sell you something, and accepting free meals from them may violate an anti-kickback or ethics policy at your work place. Be careful, and remember, there is no such thing as a free lunch. That being said – meeting with sales reps is a natural occurrence at a conference like EMS Today – just be careful that you don't jam yourself up.

Additionally, if you are of legal age and partake in adult beverages, use caution. First, you are representing your service(s) and the profession as a whole, so don't make the rest of us look bad. For those of you that are perhaps networking for better employment, everything is an interview! Then again, it is natural to let your hair down a little bit with friends new and old, and some of the best education occurs when talking to folks with different experiences over a glass of good beer. Just remember to drink in moderation. If you do drink too much, you'll feel like SH*T the next morning, and perhaps sleep though sessions. I need to demonstrate that I attend the sessions so my conference fee gets paid for, but even if you are paying your own way – it's a shame to miss good sessions because you can't control your behavior.

Philadelphia and Baltimore are both big cities. They make an effort to make the downtown area “safe”, but bad stuff still happens. I KNOW Philly, and I'm comfortable with the Inner Harbor of Baltimore. When traveling, if possible, travel in groups. Don't go exploring areas off the beaten path, and don't be afraid to ask a Police Officer for assistance. Use some common sense, and recognize that even though it's the safe part of the city – it's still the big city.

Anyway – Have fun, and if you're at either conference, I'd love to meet you.