First Responder

I like Twitter.

I stress the word like because I find it useful for some things, but not so useful for many others. This doesn’t mean that I don’t believe in it’s power or it’s influence, just that I recognize the limitations the tool has and my expectations don’t exceed it. It’s important to remember that as you read on.

So in the same vain of answering Greg’s question, I am now going to answer a question most recently asked by Steve Whitehead on Twitter that deserves more than 140 characters will allow:

Can The Real Protocol Please Step Forward?

There is a reason why medicine is still considered an art.

You can have two patients with the same complaint, but because of having vastly different histories the same treatment applied to both may help one but harm the other.

This is one of the reasons why you will find some vastly different protocols across the country. What works well for some areas may not work well for others, and what works well for some patients may also not work well for others.

In My Experience

It’s important to understand that I am New York State Certified, so my experiences are limited to working within NYS Protocols. On the fifth page of those protocols under the Introduction heading appears this paragraph:

God bless the New York State Department Of Health Bureau of EMS.

The Continuing Problem

Unfortunately, even with that paragraph there, it still leads to problems. EMT recruitment is as easy as checking the ABCs. If you’ve got a pulse and can breathe you can become an EMT. The current education is centered around the protocols and complying with them as opposed to independent thinking with good clinical judgement, because by not following them you run the risk of being held liable if anything goes wrong with the patient.

Why is that 90 year old patient with osteoporosis strapped to a backboard after falling out of bed? Protocol.

Why is that hyper-ventilating patient suffering from an anxiety attack wearing a non-rebreather set to 15 liters per minute? Protocol.

Why is that patient sitting on a roadside construction sign (next to the car he was in when rear ended ever so slightly and obviously got out of) being strapped into a soft Spinal Immobilization Vest? Protocol.

Burn The Protocol Book, Care For Them All, Let The Triage Nurse Sort It Out

I once had a paramedic who would always refer back to the protocol book. If you were turning cyanotic and gasping for breathe in the tripod position in front of him, he would take a minute to look it up in the protocol book before giving you some much needed oxygen. This over reliance on protocol is a bad indicator that our education model needs to be revamped, our recruitment methods are not working, and that we are more concerned with the potential lawsuit down the road than we are the patient in front of us.

If that paragraph didn’t exist in the NYS Protocols, I probably wouldn’t be in EMS anymore today. Heck, I probably wouldn’t have made it out of my first year because strapping down 90 year old patients with osteoporosis is just not something I think I could actually do with or without legal “justification”.

Which is another thing I blame protocol for. EMTs and Paramedics use protocols as justification for providing treatment that doesn’t benefit the patient, but benefits them. Such as taking the patient to the nearest hospital as opposed to the hospital the patient has a doctor at. Sure in a perfect world hospitals would be able to share records, test results, and other information… but right now they can’t. It’s a major shortfall of the healthcare system that we won’t be able to solve, but for that specific patient we may be able to alleviate that issue as well as some anxiety by simply taking them the extra mile (or five) to where they already have received treatment.

Finally, I hate protocol because so many people think that providing patient care is a black and white issue when it is far more complicated than that. Sure protocol can provide you guidance on the basic treatment a patient should receive, but it doesn’t provide you with a methodology or the tools to provide exceptional patient care. As I said before, there is a difference between treating and caring for your patients. Which one would you rather do? Which one would you rather be on the receiving end of?

I say burn the protocol book, care for them all, and let the triage nurse sort it out.

This post is solely representative of my own opinion and using my local protocols as an example. It’s important to educate yourself on your own local protocols and adhere to them as required. I am in no way advocating violating protocols just for the sake of it.

One of the things I found myself talking to John Mitchell about last week in Baltimore was the fact that the blogosphere is actually comprised of alot of different spheres filled with all types of blogs. There are the obvious Techie Blogs, the Foodie Blogs, the Craft Blogs, the Political Blogs, the Humor Blogs, the Personal Blogs, the Photo Blogs, and of course the Mommy Blogs… and that is really only just scratching the surface of the blogosphere as a whole. We, as public safety and public health professionals, are a very small percentage of the greater blogosphere and it’s important that we recognize great contributions of content and share it. So here are some really great posts from the EMS Blogosphere that appeared over the previous week:

• Rogue Medic continued to provide a clearer picture of the Pittsburgh EMS situation by responding to anonymous comments from those who don’t do the job. Additionally TOTWTYTR hits the nail on the head by pointing out that Public Safety Director Michael Huss continues to throw around blame instead of accepting responsibility. I can think of no other bloggers I’d want backing my social media less department at such a time, and maybe someday one of the trade magazines or publications will take a stand for a department and write an original story instead of just reposting the Associated Press drivel. Chief McCaughan, my offer still stands
• Sean Eddy from Medic Madness asks a very important question… who do YOU work for? The answer may surprise some of you… and it may just make you rethink how you care for your patients
• Ms Paramedic has an inspirational post about making thunder as opposed to stealing it. I can relate to that post on a number of levels. Everytime I think I may have pushed the boundaries or have backed a lost cause, I am reminded of a saying my mother once told me: Every mighty oak was once a nut that stood its ground. Nuts make thunder, just in case you didn’t know…

And finally…

• I would be remiss not to mention Steve Whitehead’s fabulous monthly February Roundup in case you missed anything during that month…

Have a safe week!

This past Friday I got my large French Vanilla ice coffee light with cream and with four Splendas, set my iPod to listen to podcasts, and hit the road to Baltimore for the EMS Today Conference in Baltimore. The trip was pretty uneventful, making one stop at the Walt Whitman rest area for… well… rest, and arrived in Baltimore around 12:15.

I parked by the M&T Bank Stadium (where parking for conference attendees was free) and walked the 4 or so blocks over to the convention center. Once there I checked in to get my conference badge from Lauren who was extremely helpful and answered all my important questions… namely where I could find the restroom. Did I mention I drink large coffees? So of course right after that break, I got an ice coffee from the lobby Starbucks, where I was glad to see that the decline in customer service at Starbucks was not just a New York City phenomenon.

Once done there, I descended to where the exposition hall was. Going down the escalator was what looked to be an 8-10 foot tall banner from Zoll touting some of their exhibits… including a panel for The Chronicles of EMS. I have to say that it is great when innovators support innovators, and that was just one of many examples of that I saw while there.

Entering into the exhibit hall I went left and began going up and down the aisles checking out vendors and their products. I’ve gotten pretty used to doing exhibitions, so I walk in the middle of the aisle unless I see something I’m interested in. If a vendor throws a hook my way in an attempt to real me in, I’ll generally start off by asking, “What’s the price point?” which usually makes them wince. I’m not a fluff kind of guy, I’m all about the bottom line. This is kind of my way of really saying “I’m not interested in your product which is probably overpriced, but thanks anyway,” and most of them back off. I was pleasantly surprised that there weren’t very many of those at all.

Finally I reached the Zoll booth which was actually right by the entrance only in the complete opposite direction from where I had headed when I first walked in. As I looped around the booth grabbing some literature and checking out the latest Zoll innovations, I found myself looking at none other than Ted Setla (@Setla).

So I approached him and said, “Hey, I know you!”

He looked at me with a slight look of fear before there was that spark of recognition… and thus began the rush of meeting face to face those who I’ve been conversing with over the past 11 months or so. Ted and I talked briefly about his set-up and what was going on so far at the show. He explained that Justin and Mark were down the aisle at the live podcast for EMS Garage (@emsgarage), and then I was able to turn an old partner of mine who spotted me there onto Ted and the Chronicles of EMS.

Leaving Ted to continue to swoon the passerbys at the Chronicles of EMS Booth, I wandered down to where the EMS Garage was doing a live podcast. It was a standing room only crowd, so I stood off to one side in order to get a good view. Then I worried that I might be violating fire code by blocking a fire lane because it was pretty crowded for the podcast, and I moved closer to a a beautiful tall redhead who I completely accidentally bumped into. She turned to me, turned away, and then quickly turned back and said, “Oh my god. I know you.” I had literally just bumped into soon to be Paramedic Epi_Junky of Pink Warm and Dry. Imagine that coincidence!

The live podcast was featuring Justin Schorr (@thehappymedic) and Mark Glencourse (@ukmedic999) who had to depart mid-stream for their presentation back at the booth Ted was holding down. The host Chris Montera (@geekymedic) then called up Jamie Davis (@podmedic) and… of all people… me to come up and join him!!!

You can watch the video that was live streamed of the podcast by clicking on the picture above

After extolling the virtues of Social Media for EMS Agencies and soliciting fertilization for my farm in Farmville, I finally had the opportunity to actually meet Jamie and Chris who are incredibly passionate about EMS and Social Media. There can be no better advocates for that marriage than those who are turning out high quality content… and those two are definitely at the top of the list.

While basking in the afterglow of the live podcast I also was finally able to meet the fabulous Chris Kaiser (@ckemtp) who I constantly find myself nodding in agreement to his blog posts and I found myself doing the same thing in his presence as well. I was also afforded the opportunity to finally meet Rhett Fleitz (@firecritic) who I’ve corresponded with numeorus times about all sorts of issues and his podcast partner John Mitchell (firedaily). This was closely followed by meeting Justin Schorr and having a nice conversation with him about the going ons and how word about #CoEMS is spreading. At this point, pretty much everyone went their own way with plans to meet up later that night at the big Blogger/Tweeter Meetup… and I once again found a restroom. Did I mention the Starbucks Coffee was large too?

After using the fine facilities in the exhibit hall, I still had about an hour before me lecture to kill, so I found a nice comfy spot on the second (third?) floor. While I was there checking Twitter and some e-mail, I was approached by none other than the EMS Blogfather Kelly Grayson (@ambodriver) and his friend. I don’t remember exactly what was said, because I was in shock that THE Kelly Grayson had felt the need to come over and introduce himself to me. It was a shocker moment which I shared on Twitter:

My girlfriend was concerned by that tweet, and called me. That conversation went something like this:

Her: Is everything okay?
Me: I just met Kelly Grayson!
Her: Kelly who?
Me: The EMS Blogfather, Kelly Grayson!
Her: I have no idea who that is.
Me: You know the book that sits ontop of my computer? He’s the one who wrote it!
Her: Oh. Cool!

Now I’m not always the sharpest tack in the box, because after that conversation with her I realized that I also potentially met another iconic EMS Blogger who prefers to preserve his anonymity. I happen to have alot of respect for anonymous bloggers because I think others undervalue or overlook their contributions simply because they don’t use their real name. It’s not the blogger’s identity that matters, but the content that they produce. Anonymous bloggers usually have to build a bridge of trust from the ground up by providing solid reliable information instead of the trust that gets afforded to you when you disclose your name and service. So a hat tip to that gentleman for remaining fiercely independent.

So after my session, which ironically (or not) was about Social Media, I headed over to where the big EMS Blogger Meetup was at the Pizzeria Uno. There I got to continue chatting with those I had met earlier as well as finally actually meet Mark Glencourse, and we even shared a Kodak moment that you can see somewhere out there on the internet. I have to be honest, the excitment that Ted, Justin, and Mark have for the Chronicles of EMS is not only off the charts but damn near contagious, and that can be a strong catalyst for the change we need.

I also had the opportunity to meet Mike Ward (@fossilmedic), Chris Eldridge (@thedridge), Sebastian Wong (@sebwong) and Carissa O’Brien (@carissao) who insists that I trademark my eyebrow. The conversation was interesting, the gossip about who else was going to join the “FireEMSBlogs.com” lineup was entertaining, the experience enlightening, and the food was delish.

Unfortunately, the clock struck 10 and it was time for me to make my departure since I still had a 4 hour drive ahead of me after my 1.7 kilometer walk back to my truck. Leaving such fine company was a bit sorrowful. There were conversations that had started online concluded, and in their place new ones arose in person that undoubtedly will be continued online. It served as an important illustration of what effective communication among passionate people can accomplish, and the power that Social Media has in helping that along.

As you’re reading this I’m down in Baltimore, Maryland for the EMS Today Conference. I’m just doing a one day run but I still have a list of things to do:

• Get a large French Vanilla ice coffee with four Splendas and light with cream at Dunkin’ Donuts for the road… because afterall, I am the mayor
• Stop by the Zoll both to meet the Chronicles of EMS team… and hopefully price out one of those credit card accepting monitors
• Stop by the Demers booth so I can drool over the new Mirage EX Sprinter
• Do some serious schwag shopping
• Finally, attend the Blogger Meetup/Tweetup at the Pizzeria Uno sponsored by FireEMSBlogs.com to meet all the fine bloggers I’ve been reading and conversing with for the last year or so

Since I am me, I also have a list of things NOT to do while I’m there:

• DON’T get defensive when the Maryland State Trooper that pulls me over for speeding refers to it as “an Ambo meeting”
• DON’T offer myself as a testing dummy for the newest barriatric equipment without insisting on a helmet
• DON’T admit to being the one sending Aimee Garcia of Trauma flowers wrapped in multi-trauma dressings and band-aid boxed candy while signing the 4×4 cards General Morphine
• DON’T get upset when all the schwag shirts are size Large… because you know, it’s not like obesity is an epidemic that is afflicting more and more Americans or anything
• DON’T criticize the people from FireEMSBlogs.com for putting Fire before EMS in the URL even though EMS comes first in not only call volume but also alphabetically… at least not until AFTER I eat their food…

Wanna see how I do? You can follow me on Twitter @DavidKonig for updates as they happen!

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• Fire/EMS blogosphere meet-up at EMS Today (ems12lead.blogspot.com)

It’s been another pretty busy week in the blogosphere in general. The buzz hasn’t been so much about Google Buzz, but more about aftermaths of buzz worthy events. So here are a few posts that I found about the future of EMS, rightfully defending those unable to defend themselves, and the truth about the emotional toll we as EMS providers pay…

• The really big story over the course of last week was the premiere of The Chronicles of EMS. All the heavy weight bloggers had their own take including Steve Whitehead, Greg Friese, and Chris Kaiser. Of course Mark Glencourse and Justin Schorr explained the experience from a uniquely universal perspective. The CoEMS event was also blogged by some relative newcomers to ye old EMS blogosphere Jeramedic, Ms. Paramedic, and Ronnie Grubb. Gotta love how this is spreading…
• Chris Kaiser has a fantastic post about the negative emotions in EMS. If I were an instructor, I’d make it a mandatory must read for any of my classes
• Rogue Medic has taken on the defense for Pittsburgh EMS Paramedics and has asked Where was Public Safety Director Michael Huss as his EMS crews became virtually inundated and overrun with call volume? I’m really glad Rogue took this on because it seemed no one was going to be able to do it promptly enough. I had a post drafted that was similar to his (albeit without his specific sources), but he did a far better job than I could. Depending on the correspondence from a certain trade magazine that I am still waiting for, that post may be turning into a rage against the machine… again

And finally…

• KevinMD has a great post on why Doctors and Hospitals need to pay attention to word of mouth. I would dare to say that EMS Agencies need to heed the same advice for the exact same reasons

On a completely unrelated note, I’ll be attending the EMS Today Conference in Baltimore on Friday March 5. I’m only there for the day, but the two presentations I have scheduled have a 3 hour break in between… so if anyone’s going and wants to go drool over a new Mirage in the afternoon, let me know.

Have a safe week!

This past weekend was the premiere of the Chronicles of EMS first episode. It premiered both at a live event in San Francisco and on the internet through a UStream live feed. If you missed it live don’t worry. The entire episode is viewable here:

Powerful stuff isn’t it? Way better than NBC’s Trauma, more engrossing than Paramedic: Life on the Streets, and most importantly in my opinion is that it is heralding things still to come.

I see CoEMS as the industry’s Paul Revere… alerting it’s citizens and the world that there is a revolution taking shape. It’s a grassroots movement that has been seeded beneath our very feet and has the potential to grow and effect real change in the systems so many people, both providers and patients, find complaints with.

5 Things You Can Do To Help The #CoEMS Movement

Just like any grassroots movement looking to effect real change, the CoEMS movement depends on the passion of those who support it to spread it’s message. Here are some really easy things that YOU can do to help the cause:

• Share the video on Facebook
• Tweet about the video on Twitter
• Sign-up for the CoEMS Newsletter
• Join the CoEMS Social Network!
• Write your own blog post and link to the Chronicles of EMS Premiere Episode!

Real change doesn’t start at some agency in a land far far away.

It can start right where your sitting.

It can start with you.

Dear Midwest Ambulance Service,

I am writing this in response to the appearance of your ambulance and staff on the 2/15/10 episode of Monday Night RAW.

First, allow me to congratulate you on the appearance of your crew (both in neat and tidy uniforms) and the cleanliness of your ambulance (including the floor which, from experience, is not an easy thing to keep clean). They were a perfect representation for the industry of professionalism. Having previously worked with the Superstars of the WWE, I am sure they provided a great experience and atmosphere for your employees as they have for myself and my co-workers.

I do however have a gripe, because what would an open letter be without one? I fully understand that the removal of Brett Hart from the limousine (in fact the entire crash itself for that matter) was a staged event. While your employees were undoubtedly under the direction of the WWE producers and medical staff, I think it is important that we accept the responsibility of how we are portrayed on television even while under contract for entertainment purposes.

The fact that Brett was loaded into the back of the ambulance without any safety restraints engaged on the stretcher and then driven off does not send a good message to either the public or your fellow EMS providers. I understand your responders probably felt that to a certain extent they were “under the gun of the clock” by the WWE Producers, but having worked with them first hand I know that while they are indeed time conscious they are also mindful of delivering as authentic an experience to their audience as possible.

How long does it take to fasten a seatbelt? Roughly 1.6 seconds. As a collective we have a responsibility to both provide the highest quality of patient care and to represent that quality to the public accurately. Brett Hart should at least have been strapped in with the safety restraints.

I’d like to thank you for your forthcoming attention to the details that will represent us accurately as the professional and safe healthcare providers we all are.

Keepin’ It Real,

Dave

While most people in the Northeast today are focused on the descending Snowpocalypse, I’m more about looking to the future and what could potentially be an industry changer for EMS that has nothing to do with outside forces, but for a change is coming from within…

I’m looking to the very close future and this Friday’s world premiere of The Chronicles of EMS. That’s right, this Friday if you’re like myself and can’t make it to San Francisco, you can be like me even more and watch the premiere live online here. I have a lot of belief in the goal that The Chronicles of EMS is striving for, a better understanding of EMS systems world-wide and portraying them realistically so that public perception isn’t skewered.

I’m also looking to the future spawned by the day after the premiere, when The Chronicles of EMS does their Seat At The Table Series. I think this is a great opportunity to jump start the discussions industry wide. While I have a personal interest in hearing what Episode 3: Blogging/Social Media in EMS produces (and I have high hopes I may be able to get home from my new kitty vet appointment in time to hear it live) I think the very idea of bringing people together from different systems and regions is a valuable one to highlight not the differences, but the similarities and the challenges we all face.

Chris Kaiser already explained why he is passionate about Chronicles of EMS, and I find myself feeling the same way for many of the same reasons, most particularly the part about how EMS needs a unified message. The fact is though that there are many challenges on the way to achieve that goal.

EMS has a variety of systems and organizational types, each with their own set of concerns that they will view as being more important than someone else’s. While I think it is natural to champion yourself and your cause, often times we do it to the detriment of someone else and their cause whether we realize it or not. I’m not going to feign innocence here, because there have been plenty of times when I have been guilty of the exact same thing when trying to champion the causes of my agencies and their goals over others… which of course calls to mind Steve Whitehead’s book The Non-Conformist’s Guide to EMS Success… and I remember that doing that is indeed conforming to the current culture and really it gets all of us nowhere.

The Chronicles of EMS can be the game changer for EMS Providers. It can start the discussion about where we are, what differences and similarities we share, where we want to be, and ultimately how we get there. That collective discussion being held between EMTs, Paramedics, Supervisors, Chiefs, Directors, and Patients can lead us to a road map for industry wide success. Or it could be just another passing phase, a failed attempt at changing the service industry that Americans are depending upon more and more.

The difference between success and failure?

You.

Don’t be a conforming sheep.

Get involved.

Let’s make it happen… together.

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• #CoEMS Trailer Now Available (davidkonig.com)
• Conforming Is For The Weak Of Soul (davidkonig.com)
• Facebook Fan Pages for PIOs and Responders (piosocialmediatraining.com)

Ever since the New York Post’s half-truth article about FDNY and the NYC Vollies, I have been approached by people who know that I am involved with them asking me when they were in fact closing. The fact is, that unless they are already in dire financial stress (which quite a few are), the NYC Vollies are not closing.

Apparently I am not the only one. Here is a Letter to the Editor of the Queens Chronicle who ran a much better story although the tone was similar as the Post article:

Dear Editor:
We write with interest in response to your front-page article featuring Queens volunteer ambulance corps in peril (“FDNY shuts out ambulance corps,” Jan. 21). Since this publication many of our members have been personally stopped on the street numerous times by residents with great concern over the perception of the potential closure of our ambulance service, the Woodhaven-Richmond Hill Volunteer Ambulance Corps. We would like to go on record in assuring all our residents that WRHVAC in the foreseeable future is not closing.
Actually, quite to the contrary, our ambulance service within the past year has seen a marked increase in call volume and the amount of tours which we have been putting out on the street to better service our communities. WRHVAC has a good and professional relationship with both the FDNY and hospital-based units which we interact with on an everyday basis. We are committed to providing the best, most professional service possible to the communities of Woodhaven, Richmond Hill and Kew Gardens.
This is not to deny that presently or in the past there have been issues between the volunteer and municipal (FDNY) sector. This being said, we hope that any issues which the volunteers have with FDNY will come to an immediate resolution reached professionally and tactfully on the party of both parties. WRHVAC hopes that recent articles in papers will not affect the ongoing relationship which most ambulance corps have with these units.
The WRHVAC is an all-volunteer ambulance service. To maintain our service we depend on committed communities members like you! If you are interested in getting involved please call us at (718) 296-7918.
The officers of the
Woodhaven-Richmond Hill VAC
Woodhaven
Editor’s note: Nothing in the article or an editorial supporting the ambulance corps implied that any might close. If you missed either item, find it in the archives at queenschronicle.com.

I wonder if this is the reaction those involved with the articles expected.

I highly doubt it.

Full Disclosure: I am a member of the Forest Hills Volunteer Ambulance Corps in Forest Hills, Queens and have been a member of that Corps since 1994

Anyone who has spent significant time with me would probably tell you that I rarely conform with either the establishment or the culture built around it. Although the years in this business have (for lack of a better term) mellowed me out quite a bit, I still maintain my independence with only an occasional eccentric outburst.

Last week Steve Whitehead released an e-book entitled The Non-Conformists’ Guide To EMS Success. For those of you who don’t know Steve, he is the author of The EMT Spot Blog. While I agree with the VAST majority of what he says there, there have been times when I do indeed disagree.

This is not one of those times.

Steve really lays out success in EMS, or any job for that matter, in a plain english conversational tone. The very basis of this is a formula that appears deceivingly simple:

I believe there are three requirements or qualifications to be truly successful in EMS. I’ll call it my three step success formula.
Step 1.) Finding fulfillment in our work.
Step 2.) Creating a healthy relationship with our employers.
Step 3.) Making meaningful connections with the people in our lives
-Steve Whitehead, The Non-Conformists’ Guide To EMS Success

Too many times I read e-books (or real paper books) where the author lays out a formula but doesn’t provide you with the solution. Steve is not one of those authors. He provides not only guidance and hints to the answer, but solid actionable items to help you achieve the vision you will undoubtedly find yourself sharing in.

I know I did.

My head was bopping up and down after each paragraph so much that it gave me a neck cramp the likes of which I haven’t seen since coming out of the Summer Sanitarium show (part of the Tattoo The Earth festival series) featuring Metallica at Giants Stadium in 2000. I’m going to recommend that you read this book if you want to be successful in EMS even though I’m not a big fan of the three column layout. Actually, I am going to INSIST that you read this book whether or not you consider yourself successful in EMS already. Everyone can use a little refresher.

Even if it’s really for your soul as opposed to your skill.

You can download The Non-Conformists’ Guide To EMS Success by signing up for the Splatter Newsletter over at the EMT Spot