The Desk

Please be advised that the video does contain some language which might not be suitable for all viewers. In case anyone hadn’t realized it by now I am a huge fan of the HBO series The Wire.  I think it was one of the best directed, written, and acted shows I have ever seen.  I own every season on DVD, and I think I’ve been through every episode two or three times.  This is one of my favorite scenes, and I feel like it presents an interesting metaphor. Think of the desk as the current state of EMS today.  Everyone has an agenda for it, and has the intention of moving it in the direction that they feel it should go, whether that is where it belongs or not.  The one person who has the knowledge for the desk’s proper destination fails to speak up simply assuming that everyone else around him is already in the know, which they aren’t.  So he starts pushing.  From the opposite side, they start pushing.  More people arrive and decide that they know what is best, they take up their positions and start pushing as well.  What are you left with?  One big stalemate.  No progress. So what’s the answer?  In the video it is simple: everyone needs to shut up and decide as a group what needs to be done, and how to do it the right way.  In real life it is a bit more complicated.  We need a unified direction, and we lack that.  The NFPA sets one standard while evidence based medicine suggests another.  Some preach prevention and proactive medicine while others still insist on code 3 responses by multiple agencies to nearly every request for assistance.  Which is it going to be?  Do we want a fast, timely response or one more gauged towards what is medically efficient? Let’s pick one and stick with...

The Right Stuff

For the past two semesters, I have had the pleasure of doing the opening lecture to an EMT class at a local college.  This means I get to stand in front of a lecture hall of enthusiastic and often terrified EMT students who have no idea what to expect.  My lecture is called “So, You Want to be an EMT?”  Its purpose is to give the students an idea of what to expect out of EMS both as a career and as a provider.  I do not talk about patient care all that much, the lecture is more about stress management, the qualities that an EMT needs, what calls are really like, and also a generalized 50,000 foot view of EMS. In addition to all of that, I also talk about finding the right fit.  I explain to them that one of the beauties of EMS is if you don’t like the system that you are in, all you need to do is drive down the road and you can find someplace else to start over that might work a little better for you.  In the recent months that has been something that I have had to tackle as well, and it has left me asking myself a simple question: “what is the perfect EMS system for me?”  What I have tried to do is sum it up into five qualities.  Here is what I came up with: 1.  EMS centered – I want a system that is dedicated to EMS.  They need to be focused on patient care and encouraging the growth of their providers.  The focus cannot be on profit, justifying call volume or fire surpression.  It needs to be all EMS all the time. 2.  Horizontal career opportunities – This was a term that I heard Skip Kirkwood use a couple of years ago during a lecture at EMS Today.  The career path in EMS cannot and should not be solely vertical.  There needs to be opportunities for the street level providers to contribute to the organization with steering committees, study groups and assignments beyond the street.  This creates an environment where paramedics are encouraged to be involved with the growth...

The Big Payoff

Nothing seems more satisfying than when hard work pays off.  I set the bar high for July.  I knew I had some work to do, and I had to make sure everything was done, and everything was in order.  That meant getting my PHTLS recertified, taking PALS again, updating my ACLS, and obtaining my National Registry certification.  While that just seems like four classes, it is a lot harder than one might think. The first thing that I realized was PHTLS classes are very hard to come by.  I did, however, luck out and find one class down in Connecticut at the end of the month.  That would be the last piece of the puzzle, but it was scheduled.  PALS was the easiest of the group.  I found a class pretty quickly and got that squared away.  ACLS?  They’re a dime a dozen.  Scheduled, and done.  No problem. Then there was my National Registry paramedic certification.  That’s right: the Quest for the Disco Patch.  This was the one that terrified me the most.  Being twelve years out from any EMS related exam that I had taken, and eleven years since I took any standardized test, I was a touch nervous.  Add to that the fact that I felt the pressure of actually being a provider, and I was then really nervous.  I scheduled the written first, followed by the practical more towards the end of the month. I studied almost every day for three weeks.  I would take practice exams, then study what I got wrong, and then take another one trying to absorb as much of that supressed information as I could.  When the test day came, I was a wreck.  I sat down on a Thursday afternoon and fired up the computer that I was put in front of and cranked through 87 questions.  Yes, that’s right, just 87.  I got there, and it shut me down.  “You have completed this exam, and will get the results in two to three business days.” Headache number one was gone by Friday afternoon.  NREMT was quick to get me my results, and I knew my written was all set.  Then it was on to...