South Fulton Firefighters Let House Burn Again – Why Can’t EMS Do The Same?

Remember last year when the South Fulton Fire Department allowed a house to burn down because the owner hadn’t paid their $75 subscription fee? Rogue Medic defended the inaction quite eloquently but it raised the question about amoral policies leading to immoral actions.

Vicky Bell's Home After Fire

Well, they did it again. When Vicky Bell‘s mobile home caught fire she called 911. The South Fulton Fire Department responded and watched the home burn to the ground because she had not paid her $75 subscription fee. This policy is controversial to say the least, but more importantly raises a question most people would undoubtedly find objectionable and appalling.

What if EMS did the same thing?

What if EMS turned away from the reimbursement for service model that many feel is attributing to holding us back professionally and went to a subscription model? If you are a subscriber and you need us, we’ll take care of you. If you’re not a subscriber and you need us, we’re going to stand there and watch you writhe in pain and suffer.

EMS will no longer accept the abysmal rates from insurance companies or the government, but will set the rate according to the actual cost of service and the cost of improving that service, including adequate pay for its personnel. This is just the kind of solution to our financial issues that we’re looking for, right?

If it works for fire departments, then why not EMS? I know my reasons why I don’t think it would work (and will post about that later) but I’m curious to hear yours…


7 Things To Do When Attending An EMS Gala

This past weekend was the 40th Anniversary Gala of the Forest Hills VAC. Celebrating 40 years of service is quite a milestone for any service. This is the third such type of event I’ve attended for the FHVAC, but probably about the 12th I’ve attended over time.

Here are 7 tips for attending these type of events or your departmental holiday party:

    Kevin Chiaramonte, myself, and Kenny Ash

  • Events are a marathon, not a sprint - these type of events last awhile so be sure to pace yourself in both food and drink
  • Wear comfortable shoes - while you may have a seat, there’s not a lot of time spent in it
  • Be photo ready - cellphone cameras, point and shoots, and DSLRs will all be in use at these types of events so be sure you’re ready to smile at a moments notice… and remember that what gets photographed will most likely end up on Facebook
  • Bring spare batteries - your batteries for your phone/camera/hearing aid will die at the most inopportune moment so be sure to carry some extras
  • Bring a bag - most of these events will have coat checks where you can stow the bag during the event, and then afterwards if you didn’t take my advice about the shoes you can change into a comfy pair that are in the bag you checked before departing
  • Avoid getting into drinking games - while it may be tempting to take a shot every time a siren sounds, its going to be a lot less appealing when YOU’RE the intox taken out via ambulance… oh, and remember all those cameras? They’ll be snapping and posting as they wheel you out…

And finally…

  • Remember the defibrillator is not a jump pack - It doesn’t work trying to jump start a cab. Really

On The 40th Anniversary Of The Forest Hills VAC

This past weekend the Forest Hills VAC celebrated 40 years of service to the community. This is the letter I wrote to the attendees of the 40th Anniversary that appears in the Forest Hills 40th Anniversary Journal:

Dearest Members, Friends, and Honored Guests,

First, I would like to thank you for joining us in celebrating 40 years of service to the community by the members of the Forest Hills Volunteer Ambulance Corps. It is always gratifying when these events roll around to be able to look back and see all the good work that we have done. I also greatly enjoy the fact that while I may feel old, the Corps will always be older.

When the Corps is referred to in conversation, it usually conjures up the image of our headquarters building on Metropolitan Avenue. While the FHVAC is powered by the selfless hours donated by our members, the coordination and focal point of these efforts originates from our headquarters. The building owes its existence to the hard work and efforts of Former Captain, President, and Treasurer Judy Elliot. She worked tirelessly obtaining the property, having the building designed, and seeing its construction through to completion. Without her herculean efforts we would not be in the position of calling Metropolitan Avenue home as we do now.

Another member with a long legacy will also be honored tonight. Former Captain and President Bryce Friedman was responsible for a number of initiatives that ensured the continued financial survival of the FHVAC as we saw a shift in the community, an economic decline, and increased costs to EMS providers nationwide. One of these initiatives was the institution of our third-party billing system of reimbursement. Although Bryce faced ferocious opposition that cited tradition and being community-based, he persevered to prove his argument with fact and by doing so has without question ensured our existence for the last dozen or so years.

One of Bryce’s less known initiatives, but just as noteworthy, is holding the record for the Officer who disciplined the most members for infractions to the Corps policies. Believe it or not, Alan Wolfe is not the record holder in that area! I would be remiss if I failed to mention that the vast majority of those disciplines were issued against myself and my partner Daniel Exler. While at the time it may have seemed “unfair” or as if he were “targeting” us for prosecution, which is why we were sure he was heading to becoming a District Attorney. In hindsight, I am probably a better person but by far a better Crew Chief for it. I’m sure Danny would agree with me… or perhaps not.

As we gather together to celebrate the 40th Anniversary of the Forest Hills Volunteer Ambulance Corps providing service to the community it is important to note that the way EMS worked in 1971 is not the same way EMS works today. There are rising challenges to healthcare nationwide with a shift beginning to take place away from emergent treatment for acuities to a more preventive managed care model of service that is community based. We, as a community based EMS organization, are in a unique position to take this mission changing challenge on.

We will be successful at this because of the future Judy Elliots who will see daunting projects through from start to finish. We will be successful at this because of the future Bryce Friedmans who will have the vision to embrace change early and often contrary to the mindset of the mob. They may very well be sitting next to you, so be sure to make a note of who they are on your phone, piece of paper, or cocktail napkin. Be sure to bring that back with you and we’ll find out at the 50th Anniversary!

Remember – BSI, Scene Safety
Dave Konig
Captain


A Photo Essay: 9 Lessons Learned From #IRENE

Whenever there is an event such as Hurricane Irene we can always look and find a number of lessons that we learn from the experience to make the next time better. Rather than write diatribe after diatribe about the failures of both local and out of state mutual aid, the ineffectiveness of REMSCO, the dangers of over hyping worst case scenarios, and the double standards that exist between the public service sectors, I have decided instead to present the most important lessons to you in photographs:


Conversation: The Missing Key To Success

Problems and complaints about how an organization functions is a relatively universal occurrence. It doesn’t matter whether your agency is paid or volunteer, there is always room for improvement, and usually the first people to point this out will be your own members.

One of the biggest challenges in volunteer organizations is in getting those with the claims of inefficiency and system problems to realize that they are part of the solution. While paid organizations have the resources to place experts on the problem or dedicate time to the issue, volunteer organizations are usually more limited. The true key to resolving these types of issues, for both types of organizations, is through conversation.

Unfortunately, the leadership of volunteer organizations don’t necessarily understand the necessity of this key ingredient. Often they will hear the complaint, but not actually listen to identify the actual problem. They will view this as an attack on their performance instead of the constructive criticism it actually is will usually respond with a diatribe citing perceived accomplishments, reinforcing the fact that it is the leaderships issue to deal with, and promise some sort of resolution they have absolutely no ability to keep.

Instead of the aforementioned diatribe, volunteer leaders should take the time to actually listen to what the problem is. Engage the members in a conversation to verify that is the actual issue and harvest ideas for a solution. Then the leaders should have a conversation themselves about what the solution should be and begin implementation.

Conversation. It is too often the missing key to unlocking the solution to problems and issues.

What about your organization? Do you have conversations about the problems or are promises of magical solutions made? Do those every get delivered on? Inquiring minds want to know…


On Agency Decision Making

The vast majority if not all local volunteer agencies grew from a grass roots civic movement to provide a service for the improvement of the community. Agencies will fly the American flag and will open meetings and functions with ceremonies pledging allegiance to that flag

I am proud to live in the United States and to be able to have my voice heard in a democratic fashion. It provides me with both a sense of duty and makes me personally invested in the success of the country. I am a yearly voter for those who will represent me in the government and I am not afraid to let them know through correspondence or phone calls what I think of a topic or issue. Having the same abilities is what keeps me invested in the volunteer organizations I belong to. I think its essential, in order to have a successful volunteer agency, to maintain those same feelings and that sense of personal investment in all the members.

Unfortunately leaders of volunteer agencies who are democratically elected will often quickly forget this. They become enchanted by their new titles and unintentionally transform the mantle of responsibility that has been entrusted to them into a lust for what they perceive as power. Authoritative decision making, also commonly referred to as Executive decisions or Chief orders, are only effective when the person making such a decision possesses all the necessary information, has the required expertise, and the decision needs to be made quickly. Sadly, many times volunteer leaders lack that skill set but make these types of decisions in order to manifest their fictional authority.

It’s important as someone who volunteers to be invested in the success of the organization as a whole. In doing so it is each volunteers responsibility to select the leaders who will share that level of investment, who have the ability to learn the necessary skills, and are humble enough to understand that their election to a position is not so they can be served but so that they themselves can serve.

By electing the most popular, or the person who you are the friendliest with instead of those who are best suited is not only problematic for the organization but most importantly for the community the organization has been founded to serve. Therefore, ultimately, the mantle of responsibility for the success of the organization does not rest on the leaders but rather on the members.

With that in mind, be sure to choose wisely…


The Biblical Days Of EMS

While those of us within EMS wrestle with the relative youth and immaturity of our industry (being barely 40 years old in the grand scheme of the universe is truly not a long time), it is important to remember that the actual concept of providing medical care for an acute condition has been around since biblical times. The Parable of the Good Samaritan is an example of care being rendered to someone who was acutely injured, and then transported to a place where they can continue receiving treatment and to convalesce.

“A man was going down from Jerusalem to Jericho, when he fell into the hands of robbers. They stripped him of his clothes, beat him and went away, leaving him half dead with no clothes. A priest happened to be going down the same road, and when he saw the man, and he passed by on the other side. So too, a Levite, when he came to the place and saw him, he too passed by on the other side. But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and looked after him.”
-10 Luke 29-35

There is no mention of the Samaritan having completed an accredited course, passing a standardized test, or receiving a certification. The standard of acute care for that time was in fact wine and oil while the best mode of transportation was indeed a donkey. The actual basic concepts of what EMS is about are still all there. It is safe to say that The Good Samaritan was in fact, the world’s first Emergency Medical Technician… and he also just happened to be a volunteer.


…And The Afflicted Thou Wilt Save…


-2 Samuel 22:28

On Making An Impact

I want to help people.”

I constantly get that answer to the question of “Why do you want to work in EMS?” It is mundane, boring, predictable, and the absolute wrong reason. Anyone who knows me understands that answer is usually the death toll for a prospective new member or new hire.

Why?

Because I can stand on the corner and help people all day. I can help people cross the street. I can help people carry packages. I can help people with directions. I can help people all day standing on the corner and having absolutely nothing to do with EMS.

EMS is so much more. It is about creating an environmental or emotional change in someone’s life for the better at a moment where they are at their worse. It is about improving their quality of life regardless if they suffer from an acute or a chronic condition. EMS is about making an impact.

impact: [n. im-pakt;] a forceful consequence; a strong effect

This concept seems to be lost on the newest round of EMTs and Paramedics, more so than the last large group that came in 7 or 8 years ago. Not everyone coming out of school is willing to make the necessary sacrifices needed to make an impact on another person’s life. I freely admit that I myself did not understand what those sacrifices would be prior to making them. I made them to “make it happen” for others, and to make a positive impact on their lives. I learned about those sacrifices, and the need to make them, from volunteering.

Those who do volunteer potentially have both a true interest and a passion for at least learning what EMS is about. It says something about their character and their intentions. Those who volunteer often are teachable about both the sacrifices that will need to be made as well as the power of the impact they are being given the opportunity to put into effect.

Still, volunteer agencies are far from perfect. Besides having service dependability issues, their memberships are often peppered with those who are more interested in satisfying an internal inferiority complex desiring to be considered heroic with impatient adrenaline addict antics. The energies of these members needs to be refocused. For that matter, an agency that serves as a tertiary provider needs to refocus their mission to offer their community value and create a need for their existence.

Some simple ways to make a positive impact in a community:

  1. Provide public education
  2. Offer non-conventional but needed services
  3. Prepare to move from a tertiary provider to a primary service when the need arises

This is a necessary move for volunteer agencies, especially tertiary services, in order to continue being able to make a positive impact in their communities. Failing to refocus in both mission and operational scale makes them no better than those who just want to simply “help” people.

Ultimately, it is up to the leadership to set the tone for the mission, properly screen new members, and refocus the organization to serve the community in a way that can make a positive impact.


On Common Sense… Or The Lack Thereof

The apparent acute lack of “common sense” exhibited by members of a volunteer organization during certain situations that perhaps professional providers/leaders deal with on a more frequent basis can be terribly frustrating, especially when that member is considered to be a leader. Experienced members will often blame this on the inexperience of others and the inexperienced will often blame this on a lack of training or on the absence of a physical guide. While there is quite possibly truth in both of those assessments, they are also not entirely correct.

Building A Knowledge Base

How To Cross The Street

The first step in building a knowledge base for any person about an organization is providing a clear set of guidelines whether they be in the form of a Policy Manual or a Standard Operating Guide. What will often happen is that these guidelines get added to every time there is an issue or a problem, and they eventually become a muddied mess. It is essential that they guidelines be simple to understand, clear in their instructions, and properly titled for reference.

In order to develop “common sense” people need to be exposed to situations on a somewhat regular basis in order. This exposure helps a person to build a more in-depth knowledge base of the situation and from there develop what can be considered an acceptable response to it in accordance with the guidelines already provided.

My Solution

As my own personal guideline here is how I try to find resolution in these types of matters:

  1. Resolve the issue at hand
  2. Identify any system problems that may have contributed to the issue
  3. Identify personnel deficiencies
  4. Correct system problems as needed
  5. Educate and train personnel to operate under this situation and similar situations proficiently

I often find that a system problem will lead to a personnel deficiency. By providing a clearer explanation of the process (without making it into a book by itself) that should be followed under such a circumstance with an appropriate title as a reference it will hopefully help to build a knowledge base in the personnel.

While it would be great to be able to “write and forget” clearer guidelines, it’s important to help develop critical thinking skills and associations as well. Of course the first step to help develop critical thinking skills is to be able and identify what they actually are:

  • Utilize guidelines with similar variables as the presenting problem
  • Utilize your personal past knowledge base
  • Identify desired results
  • Identify factual information and data
  • Identify available options from similar situations
  • Make the decision and see the process through

Scenarios and role playing are two tools I’ll use to reinforce these concepts in actual practice. While verbal scenarios are usually the easiest, I find that in depth role playing can be not only more effective but also more fun.

It’s important to remember that “common sense” is something that is gained, not given.

How do you try to resolve instances where there seems to be a lack of “common sense”?


On Contributions And Consequences

I am a strong believer that everyone has something to contribute to an organization. It may be something others view as small, but to the person contributing its huge. It may be something the person contributing views as small, but to others it may be huge. This is especially important in volunteer organizations when the value of a contribution is magnified by what is often a greater need than the available supply.

Rules and Regulations of the Joint Library of the Ohio University ca. 1878 by Ohio University Libraries via Flickr

Still, there are rules and regulations that must be followed. Just because you are a volunteer organization does not excuse you from being any less professional than a paid organization. For that matter the standards should be higher for such an organization because in theory their members desire to be there. For some reason though there is a perception that because it is a volunteer organization the consequences for ill actions should be lessened because of the contributions one makes freely.

If you break a rule or regulation in a school, what happens? Depending on the severity it could mean detention, a loss of a recess period, a suspension or even an expulsion. If you break a rule or regulation at work, what happens? Depending on the severity it could mean being kept later to fix whatever mess was created, a loss of pay, a suspension or even a termination.

While there are laws that require school attendance, once you are of legal age it is no longer required but voluntary. While it may be great to not go to work, going to work is currently the only way in order for you to be economically independent other than winning the lottery. Ultimately, going to work (whether you actually like what you do is irrelevant for the purpose of this) is also a voluntary action. So why do people continue to think that just because you are a volunteer organization when you break the rules the same level of consequences should not be applied?

Of course I ask this because a situation has arisen that, were we a paid organization or a school the punishment would be clear. The fact is that we are not, but in the mind of the offender these levels of consequences never occurred to them because of the contributions they bring to the organization.

While a volunteer organization may have different levels of consequences for infractions and violations of the rules and regulations, its important to remember that our contributions do not justify bad and unsafe behavior nor does it excuse us from those same consequences we would face if we were paid.