EMS 2.0 | The Social Medic

Yet Another (Other) Reason Why EMS Is Not Taken Seriously By [INSERT OTHER PROFESSION HERE]

September 30, 2014 by Dave Konig

So The Ambulance Chaser has (Another) reason why EMS isn’t taken seriously. For the record, I happen to agree with him to a certain extent.

I would agree that one of our weak points is understanding the science behind what we do. However, I disagree that it’s only the EMTs and Paramedics who lack this understanding. I would venture to say that there are a large number of nurses and doctors, both in and out of EMS, who don’t fully understand the science behind what we do.

I would also agree that often times in our rush to change practice we’ll grab hold of only one piece of scientifically processed theorem and hold it aloft as the new testament to the standard of care. Hypothermia resuscitation is the most recent one that comes to my mind. The problem is that I think there is real value in the treatment, but I think that it is only one piece of the bigger puzzle. Putting hypothermia into a system without increasing the communities capacity to perform bystander CPR, having an aggressive public access defibrillation program, communicating these events through technology such as the Pulse Point app, and keeping response times down will be overall ineffective.

Too often we approach our challenges thinking there is a single solution instead of looking at it as the integrated system it is, requiring multiple tweaks and changes for an overall positive effect. There is no magic pill to solve it all, but for some reason we keep thinking we’re going to find it.

The part where I really (and when I say really I mean REALLY) disagree is the part where he says, “But EMS is medical practice. And medical practice is supposed to based upon science.”

Yeeeaaaaaaah… no.

Medicine, even when based on science, is an art.

EMS medicine is no different and we’re kidding ourselves if we think otherwise. Our seeming inability to be flexible and dynamic in the care of the patient as an individual is what other professions will point to and argue that really all we’re doing is reading the manual, the cookbook, following the instructions or whatever other metaphor you want to insert highlighting our failure to think critically in such situations that require it. What’s worse is when we have providers who do just that, we look to scold, berate, and punish them for their decisions.

To be good at your art, you need to practice. Ask any artist… whether it be a writer, a painter, a piano player, or a dancer what the secret to their success is and they will most often point to two things. Sacrifice and practice.

We already sacrifice a lot for our art. Our bodies. Our minds. Our souls. We sacrifice for our art the same as the other artists do. We already practice heartily. We practice in a variety of settings. With a variety of subjects. We practice at all times of the day and night.

Yet we continue to measure our successes and failures by the highest standard of ROSC and very little else. This high standard gives us the false impression that we are failing… and when you are failing you can start floundering looking for anything and everything that may be able to turn that failure around. This creates the environment when every journal article that has just a whiff of scientific process, because science to most is infallible, should become the new standard because it’s “based on science”.

It’s a vicious cycle.

Now, don’t get all in a tizzy and think that I am against evidence-based medicine, because that is far from the truth. I will still hold the Cultists of Mechanism and their infernal Ceremony Of C-Spine Immobilization to task each and every time they try to torture those poor innocent vertebrae on that hard flat surface as if they were witches in Salem during the Salem Witch Trials.

My disagreement is that EMS, and medicine in general, is not easily defined by just one aspect. It is not just about the science, but also about the art. There is no one magic solution to our issues. It is going to take discoveries in the science, practice of the art, and change in the culture to bring us where we want to be.

Educate yourself on the science. Practice your art. Be open to change in both. Success will be ours. It’s a systematic solution to the systematic problem.

#EMSWorldExpo: Paramédico Documentary Receives A Standing Ovation At United States Premiere

September 16, 2013 by Dave Konig

Get Paramédico Today!

On Wednesday September 11 the documentary film Paramédico made its United States Premiere at EMS World Expo. The film by Benjamin Gilmour, based on a book by the same title that he authored, follows four different crews at Emergency Medical Services Agencies from around the globe. The film features these four locales:

Pakistan’s Rescue 1122, Pakistan
Mexico City’s Red Cross, Mexico
Venice EMS, Italy
Hawaii EMS, United States

Absent the collar brass and polished speeches of chiefs and directors that seem so prevalent in other films of this subject matter, Gilmour‘s film provides a unique look at each of these agencies from a very front line ground pounding perspective that is refreshing to the genre equally revealing the good and the bad. While I greatly enjoyed Paramedic Kip from Hawaii EMS (a system I have decided I could retire to) and found the idea of responding via watercraft in Venice a novel concept, I was truly intrigued by the Mexico City and Pakistan stories.

Pakistan’s Rescue 1122 was founded in 2006 to serve the Punjab Province. They are providers of emergency medical services, fire suppression services, search and rescue services, disaster management, and water rescue services. The Emergency Services Academy provides a para-military training regimen for its providers. Although Rescue 1122 provides a variety of services, they appear focused on fulfilling the Emergency Medical Service first and foremost, making them the only EMS-based fire service that I know of.

Interestingly, it seems that Rescue 1122 crews are four man teams. The majority of their calls are traumatic in nature, either from roadway accidents or from explosions and bomb blasts. The film depicts a typical drill that the agency runs in locales where the building occupants are not informed of the nature of the event prior to its occurrence. In stark contrast to this, recently Boston’s Logan Airport had to apologize for a drill it ran even though it had announced it. The priority on preparedness and practice over the personal discomfort of the citizenry gave me a newfound respect for the work that they are doing at Rescue 1122.

Mexico City’s Red Cross ambulance crew was far more typical of what an American crew would consist of. With both a driver and a technician they respond to a variety of calls among the 8 million + population of Mexico City. Foreshadowing the plight of the crew, it is revealed that the ambulance has a broken fuel gauge which is too expensive to replace. When responding up hills to calls and the ambulance stalls out provides a moment of tension, quickly broken into comedic relief when the ambulance restarts after reaching level ground. The fuel issue repeats itself a few times during the film highlighting the challenges of all kinds that the Mexico City crews face.

Mitix Garcia Rodriguez, Mexico — Mitix Garcia Rodriguez

One of the technicians featured in the film from Mexico City is Mitix Garcia Rodriguez. While there are the light hearted moments of her applying makeup while awaiting her partner to return with a can full of gas, a few round of spin the bottle at the station, and her being water boarded (EMS style, not CIA style) for her birthday, the film also explores a bit of the emotional toll it takes on her. Shootings and stabbings where upon their arrival it is more of a crime scene than a potential transport are prevalent in the area. The repetition of responding and being helpless wears on her physically, mentally, and emotionally. While the film notes that as an experienced provider she knows when she needs a break, I begin to wonder how many others out there are not as self aware, continue to be worn down, and are on the edge of running out of gas the same way the ambulance had numerous times previously.

Overall I absolutely loved the film Paramédico, and so did the packed room at EMS World Expo who gave it and its creator a standing ovation. The film brings a key aspect of EMS 2.0 into focus, learning from the experience of others. I highly recommend it for yourself, your partner, your station, and your chief to watch.

Check out this brief trailer for Paramédico:

Paramedico Trailer from PARAMEDICO on Vimeo.

I think it is imperative to help support the efforts of others who persistently present the world with an authentic perspective of the Emergency Medical Services in their work. Here is how you can get to all things Paramédico:

Visit the website: Paramédico
See the film: Paramédico via VIMEO On Demand
Get the book: Paramédico via Amazon
Tweet the author: @BenjaminGilmour

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What EMS Can Learn From MTVs 30 Years

August 1, 2011 by Dave Konig

Today Music Television (MTV) turns 30 years old. It hasn’t been any easy life for the channel, born out of revolution and angst, growing into the teen prom queen that was the envy of the ball, and then descending into it’s current seemingly mid-life crisis and dramatic antics of “real” life.

As with most things, there are a few lessons we can learn from the storied lifespan of MTV thus far:

Making big promises means taking big risks: MTV promised a revolution and, while some might argue differently, delivered just that when it comes to cable television. That promise came at a significant risk to both investors and on air talent. For that matter MTV may very well have failed had their talent, such as Adam Curry (responsible for MTV.com) and Kurt Loder (responsible for building MTV News), not taken the proverbial bull by the horns and dragged it against the grain. It was a risk to trust their talent in such dramatic ways, and ultimately it paid off for them
Arrogance of dominance leads to mediocrity: In the 90’s MTV was relatively arrogant about their status in the national culture. This lead to mediocre programming (with one or two true revolutionary for the time ideas) and forgetting that their audience was what made them what they were. We see that same type of arrogance reaping the rewards of reduced budgets and service cuts today for agencies that forgot it is their community that ultimately held them aloft. While I’m all for agency and professional pride, it’s important not to be arrogant about it, especially when it comes to dealing with the members of the community in which we serve
Never forget the base of your business: One of the sharpest criticisms of MTV is that they no longer play music videos, opting instead for a constant stream of Maury Povilch type programming. They have essentially forgotten the core of their business, and movements in EMS threaten to do the same. At our core, our job is to provide transportation to the sick and injured, which we also need to remember while promoting additional services we want to see but that the public may have no interest in

Unlike most people, I have a certain amount of faith that MTV will turn it around in their 30s. Hopefully when they do, we’ll be able to take some lessons from that as well.

Until then… Happy Birthday MTV… we await the return of the revolution!

Which Type Of Paramedic Does Your Patient Want?

April 18, 2011 by Dave Konig

I recently read an article over at EMS World titled Which Paramedic Type Are You? The author, Hidekatsu Kajitani, lays out a very simple method of measurement for type specifying Paramedics with both Paramedic Skills and Social Skills rated as either Good or Poor. It’s a simple enough method, and as a proponent of the KISS methodology I appreciate the ease of comprehension.

However, later in the article he makes this statement:

There is no doubt our patients will prefer Type II paramedics because of their good skill as paramedics.

Yeah… not so fast. I doubt the validity of that statement very much. The author defines a Type II Paramedic as one with Poor Social Skills and Good Paramedic Skills. Perhaps doubt isn’t a strong enough word… I challenge the validity of that statement.

The patient, unless they are trained in the medical field themselves, does not know good patient treatments from bad patient treatments. They know nice and not nice. They don’t know whether the paramedic was skilled in his assessment, proficient in reading the results of an ECG, and provided treatment according to protocol. They know whether the paramedic was respectful, helpful, compassionate, and kind. The patient isn’t going to know whether or not the Paramedic missed the tube, because in all likelihood they’d be unconscious. In order to understand what a patient wants, we need to view it from their perspective which I think the original author completely missed.

To verify my hunch I looked back over the last 100 actual patient complaints I had access to, excluding QA/QI issues that were not generated from the patient’s perspective. Out of that 100 there were 87 of them (or 87%) that focused on rudeness, unhelpfulness, or a perceived lack of compassion. There were another 10 that were driving related and the final 3 had to do with lateness.

Therefore I would dare say that the patient would prefer to be treated by what the author classifies as a Type III Paramedic (Good Social Skills, Poor Paramedic Skills). The author also makes a note that it is this type of Paramedic that EMTs prefer to work with, and that we should not be confusing Good Paramedic Skills with Good Social Skills.

I’m also going to challenge that assessment. If we are going to classify the ability to assess and provide treatment as the only skills needed to become a Paramedic, then we are severely handicapping ourselves into a worse corner than we already are. We need to view good social skills, critical thinking, and decision making skills to the same level as the ability to assess and provide treatment. They are ALL Paramedic Skills. Therefore, a Paramedic with Poor Social Skills also has Poor Paramedic Skills according to the original author’s typing system.

The challenge we have is being able to provide our Paramedics with that full scope of abilities. Our educational standards focus on assessment and treatment, but these other areas are just as important especially if we are going to look to advancing the profession beyond where we are now into an EMS 2.0 world.

So, which type of Paramedic do you think your patient wants?

The People Say: We Don’t Need No Stinkin’ EMS

November 16, 2010 by Dave Konig

Two weeks ago was the now infamous mid-term elections that saw the dethroning of Nancy Pelosi as House Speaker and claims of a public referendum against the health care reforms enacted by the administration. I’m generally not one to buy into political propaganda without some hard data because we all know politicians and their parties will say practically anything to get to power. In the days after there were two stories that appeared in JEMS that seemed to indicate that there was possibly truth in that claim.

The first story is about a PA Volunteer Corps that was voted out of fiscal existence. You can read the story from JEMS here. Now truthfully there have been long standing allegations of corruption and mismanagement with the leadership, so the agency leadership does not have a glowing reputation. What I found most disturbing was this quote from the article with my own added emphasis:

A township board member said he’s disappointed with the voter results. “People didn’t realize how important saving lives is. And having service locally to make it more effective and less time,” said Township Secretary Michael Stirr.
–Election Results Shut Down Pennsylvannia Ambulance, JEMS, 11/04/2010

So if the people (who’s lives are actually the ones we are talking about possibly saving) don’t realize how important it is to save lives than who’s fault is that? Is it their fault for not realizing the value an EMS system represents or is it our fault for not effectively communicating it to them? No matter who’s fault it is, the outcome is disturbing for those of us who anticipate a future for EMS.

The second story is about a MD County Ambulance Fee denied by voters that will probably result in a reduction of services. You can read the story from JEMS here and there is an associated video report here. What’s striking about this story is that the ambulance fee was directed at insurance companies, not the individual patients in the form of a charge or the residents in the form of an additional fee or tax.

There was definitely some opposition that seemed to be led by volunteers who claimed that the ambulance fee would increase insurance rates. Now this may have caused a fiscal concern, but when faced with the prospect of a reduction in services that were currently in place doesn’t it seem that should take precedence? In short what the community did, in my mind and probably those of fellow EMS professionals, was vote to take a step backward. In their minds they probably just saved themselves some money with no understanding of the actual effect the change will have.

I think both these stories are illustrations that those who we need to educate about the changes we want to see in EMS are the stakeholding public. Without their support we will not be able to effect true change in EMS.

Do you think these two stories indicative of the nature of the rest of the country when it comes to EMS? How would you communicate to the public the changes we need to have happen in EMS?