EMS Culture, What Changes Us And Why?

As we move into 2017 I think about the way EMS was, and how it is today. I find myself wondering what has changed and why? Our culture has evolved. In some ways good and in some ways not so good. This career takes it's toll on all of us. It is an inevitable fact that the things we see have an impact on us, both physically and emotionally. I was recently in a training course that has been established to help front line first responders recognize and respond to psychological injuries within ourselves and our peers. This training is a valuable addition to our arsenal in self care.

My question, and this question was imposed to me recently,  is why is it inevitable? Why are we changed by this career? I only had the old school answer of well this is just how it is. When I began my career in EMS there was very little talk of psychological injury or mental health in first responders at all. Many first responders suffered silently, and alone for many years. Some of those people moved on into other fields, and some continued in EMS, untreated, and this untreated psychological injury has manifested in some to make them bitter practitioners that as a defense don't let people close or treat new staff and students disrespectfully. This was not their fault, and when we think about or meet these "grumpy ass medics" we should ask ourselves why are they this way. Is this a years long coping mechanism to protect them from some of the horrifying things they have seen? On the flip side of that some people had many great supports and took care of themselves when no one else would and are still happy and love doing what they do. Does that mean the person who is "grumpy" or suffering silently did something wrong or deserves to be treated differently? Absolutely not. The driving factor behind change is recognizing the way something was done is not necessarily the right way and that evolution is necessary.

When you continue to do things the way you always have, you will continue to get things you have always gotten. It is time for change in 2017, and it is time to understand that those people suffering from psychological injury are just that. They are injured, no different than a physical injury it's just that you can't see it. I have been more cognitive of this as of late and realized that it is important for us to acknowledge mental health awareness and not let the way we did things ruin it.

I was excited for this training that we had and I look forward to having more training down the road as the drive to end the stigma of mental illness in first responders continues to evolve. To all of those people involved in bringing forward these initiatives I want to salute you and thank you for your hard work. Change is slow, and is often resisted, but keep up the effort. If our methods don't change our profession won't evolve. This evolution in our profession is a giant step forward to creating longevity for all of the talented professionals who put their psychological and physical health on the line every day to protect the public at large.

Thank you for reading, hope you will like and share this article with your family and friends if you enjoyed it.

The Inspiration Of True Compassion

Yesterday I was inspired. I got to work with someone that I knew by name and reputation only. I listened intently as he spoke with one of the many vulnerable people within our city. There was something in his voice that went beyond the words that were being spoken. They came from a place that on occasion, we as Paramedics and EMT's forget about. I was in awe as he spoke quite directly, and plainly with our patient about their situation. This place that we sometimes close up and protect, so that we can protect ourselves, is called compassion, real, genuine compassion.

It goes beyond empathy, it goes deeper than just helping. Compassion is and was the driving factor that brought most of us into this business. Many of us, myself included, let that compassion slip away and it takes something special to remind us that helping people and compassion are the fundamental values of medicine. It is true that because of problems within the system and the tragedy we see we allow ourselves to become hard. We often let the people that abuse the system cause bitterness and then our compassion gets left out when we go to people that just need our help. This career changes us, and not always for the better.

I felt privileged to work with Dan yesterday and as I got to know him I learned another fact that increased my respect for him even greater. Many of you know this, but I had not put it together at this point. Dan is one of the founding members of The Sheepdog Lodge. The Sheepdog lodge is a not for profit organization that allows military veterans, as well as emergency first responders to come and stay there for free with their families. They offer a peer supported weekend away from everything that allows these people, suffering from PTSD, or other Occupational Stress Injuries, to focus on themselves, their family, and their recovery. This has been a tremendous undertaking. Dan and the other members of their steering committee have a true passion to help veterans and first responders recover from occupational stress and PTSD, and their role is an important one. A place that is safe, disconnected from the world. The lodge is heated by wood burning stove, there is no wifi, no television, and is your home for the 3 days you are there. Visit the website to learn more, and to offer help if you are able, http://www.sheepdoglodge.com.

Military veterans and emergency first responders choose to protect the public by offering their services, and in doing so are forced to see things that no person was ever meant to see. These events build up and take a toll on people mentally and physically. The Sheepdog Lodge is completely volunteer based, and the people are paired with a volunteer of the same discipline, someone that speaks the same language and can offer real support and understands their situation. Dan shared with me that The Lodge could use many more volunteers, his colleagues and himself offer up a short training program to help volunteers host families in the cabin for a weekend. The host is there to help, listen, cook and clean, while the person that is there focuses on why they are there. If you have a desire to help you can contact them through their website and they can help you from there.

The Sheepdog Lodge envisions a time when there is a nationwide community of veterans and first responders that are available to mentor and support other veterans and first responders. This statement copied directly from their website states it quite plainly. The vision for The Sheepdog Lodge is simple. Help each other to remain strong, healthy, compassionate and recover from the stresses that we face every day in our careers helping others. We help others because it is what we were built to do. The Sheepdog Lodge is finally a place that we can go when we are the ones that need help.

I would personally like to thank all of the staff and volunteers at the Sheepdog Lodge for their strong dedication to helping others. Please visit their site at The Sheepdog Lodge, read more about what they do there, and watch their story that appeared on CTV news  earlier this year. Please share this post with your friends and families to spread the word about the Lodge.

I Always Have Your Back, Except When.....

I know it's been a long time since I have written, so without adieu, here is today's post. An anecdote if you will. It was a warm shift that day, and my partner and I had been having a fun shift. No different than any other day. We had been doing some calls, and had had some down time. The day was a fairly typical shift and we didn't expect anything out of the ordinary.

The tones go off for a call to an older home in an older neighborhood for a lady in distress. The details were non specific and as we responded to the call it seemed like a normal type of call with no unusual expectations. As we arrived on scene the house was quite dark, and there was no light on on the outside. We approached the home and knocked on the door, a faint voice inside said to come in. As we opened the door we were greeted with no one. No one was in the foyer, but there was some piles of papers, and random junk. The house itself was not unkempt, just the entry way.

We called into the home to see where our patient was, and she stated she was upstairs, so I had asked if we needed to come up there or if she would come down to us. Immediately we got an uneasy feeling in the home when she insisted we stay down stairs. As we looked around the home was definitely older and had some unusual statues in it. There was nothing specifically odd about the home, but we had that uneasy feeling. As we patiently waited for our patient, she appeared after some time, crawling from one room across the floor towards another room... Now if you have ever seen the movie The Ring and remember the way the girl crawls out of the well...... Well that's what the patient looked like, crawling across the floor in a choppy almost animated state. The uneasy feeling intensified at this point, but we continued to wait at her request.

When she did finally allow us to come upstairs, we learned that she had an ankle injury and this is why she had been crawling. So we assisted her down the stairs and onto our stretcher, and made our way out to the ambulance. This is where things got weird. As we are assessing the patient and determining her history she looks me dead in the eye, and with the most serious voice I have heard, she says to me, "My sister is a satanist and I think she is trying to kill me!" To which my partner responded by slamming shut our tough book, and literally bolting straight out of the side of the ambulance, leaving me alone with this patient in the back. Now the humor to this story is of course my partners reaction to the patient's words. There was of course nothing to fear, it was just something that the patient needed help with.

When we got to the hospital and had dropped off our patient I had asked my partner, "what was with that reaction?" I was laughing when I asked him, and we both had a good laugh over his reaction. I know some people might read this, and not see the humor the same way I did,  but in our career it's little things like this that keep us going. The patient was cared for appropriately and brought to the hospital for the help she needed. I just had to laugh at my partners reaction to her words, and to this day it sticks in my mind as one of the more memorable calls in my career as a Paramedic.

EMS Credibility A Fragile Commodity

When paramedics arrive at the hospital with their patients and report to triage it's important to have our ducks lined up. The credibility of a paramedic is fragile when dealing with triage nurses and physicians in hospital. They often don't understand the conditions in which we work so it is vital that we are ready to give a solid triage report. When things go wrong on a call that's OK, that happens. This can sometimes look bad when we roll into the ED, which is why our credibility and out report is so important.

If things go wrong on a call, it's not a time to panic, it's just important to be organized in your report to triage. If we are running bush league and don't have that solid report, then we are presumed to be bush league. Don't forget our world is usually quick and dirty, they call us ditch doctors for a reason. To our nursing colleagues, it is important to remember that as practitioners we do our utmost best for our patients, just as you do. When you aren't there it is important to hear the story before you pass judgment.

In someone's home, or the back of an ambulance we potentially deal with poor lighting conditions, cramped spaces, and  limited help. These are not excuses, because this is also where we are specialists.  I once heard it said, 

"There will always be someone better at intubation than you, there always be someone better at IV's than you, there will always be some one better at assessments and differentials than you, BUT nobody can do it like you can with the wheels moving." 

This quote had always stuck with me, because it's true. We specialize in these environments and that is what sets our world apart from the world of the ER. To that end though, not every call goes perfectly. That in and of itself is not the end of the world. To maintain our credibility it is important to be honest when things go wrong, not make excuses, just be honest. Communication of what has went well and what has not gone well will go a long way to maintain the respect of your colleagues. Some might say our colleagues shouldn't judge our performance, and for the most part they don't. They do, however, know when we aren't honest with them. 

At the end of the day as paramedics and EMT's you work very hard for your patients, and the vast majority of the time you provide excellent care. That is why when a call goes sideways and your bringing them into the ER it's OK to tell them that call went poorly, these things happen  for various reasons. Your credibility will remain much higher with your colleagues if your straight up about what happened, and then as a larger team of professionals everything still gets taken care of! 

Let's continue to progress the profession and build relationships within our professional medical community. Doctors, Nurses, paramedics, RT'S, and the list goes on, all work hard to provide excellent care for our patients. Remember we are all a team and cohesiveness translates into effectiveness. 

Please like and share this post with your friends and loved ones!! Join the discussion and leave your comments below!! 

Through My Eyes

When I began my journey to become a paramedic in 1998 and stepped into a world much larger than myself, I had some misguided conceptions of what this job would be. As time has gone on I have seen the world through different eyes. When we come into this career we are all fresh and eager and feel like we are bullet proof ready to take on the world, save lives and run on water! The reality of this job hits pretty hard, and pretty fast. Not to say that the career is not worth it, because it is. There are just things that no amount of training can prepare you for.

When I was in school they told me I would see things. They told me I would see things that would stick with me, forever. During training they prepare you for the dead, they try to desensitize you to the ugly things you might see. The smells you might face. The horrible things that people will do to themselves or to others. They try to get us ready to handle the things that no one else should see. Through my eyes though, I was never prepared for the hurt, the pain, the turmoil or the agony I would see in the faces of families and loved ones of the people we were trying to help.






Those are the images that have stuck with me, and have burned themselves into my soul. Arriving at a home for a person who has just gone into cardiac arrest. The only words I hear as I approach the daughter doing CPR are the words of his wife, "He can't die, He is my life!" Uttered with such desperation that a lump forms in my throat as I kneel beside him to start treatment. The questions from a gentleman in a car accident asking about his young daughter whom I know is passed away, but now is not the time to tell him. The friends of a young girl asking about her condition. She was the one doing things right, wearing her seat belt, had a designated driver. Her life lost as a drunk driver smashed into their vehicle right where she was sitting. Their faces burned into my memory with the tears, and the pain they feel. The agonizing cry of a father who has just witnessed his daughter go into cardiac arrest. The sound rings in my ear even now as I write this. The training we receive is exceptional, the care we provide is second to none, and the people we help are truly the reward that make this career worth getting in the truck every day. These memories are the thing that I was unprepared for and I believe that sentiment is shared with many of my colleagues.

I don't tell you these things to discourage your career path, or even to invoke sympathy. I tell you these things so that you can prepare. Psychological safety and well being is a big deal in emergency services, and if you are not prepared for the things you will see, or the families of the people you are helping, it can take a toll on you. This glimpse into the world through my eyes is my way of trying to help you understand what we go through and also to prepare you as you enter this field. This is the most rewarding career I could have ever found for myself, and I truly love what I do. I encourage others that feel drawn to this career to pursue it. This career takes a little extra something as does any emergency service. Those people that find a passion for this career will be the people that continue to move it forward in a positive direction. They will continue to make pre hospital care a dynamic and ever evolving industry.

When you are doing your schooling take time to learn about work life balance. Find things to do that you love outside of this career. If this career becomes your whole focus you will lose appreciation for the beautiful things that are out there. My career went full circle and I am hoping that these anecdotes and stories can help prepare you for your journey. I hope you enjoyed the read, and encourage you to share it and like it so others can see it too.

Lights And Sirens. Riding The Line Between Safety And Patient Care.

What is the priority for Emergency Medical Services? Is it patient care, or is it rapid transport? This has become a hot button topic of late, and I want to try to address it, carefully. For many years Paramedics and EMT's have driven as they drive, with the only generalized label put on it was to be safe, and to drive as you feel comfortable. This was always considered to be quite vague. According to the highway traffic act an ambulance can contravene the act in a safe manner not exceeding 25 percent of the posted speed limit. No specific policies had been in place with many agencies, and unfortunately due to some unsafe driving practices, limited training and also due to other people not yielding to emergency vehicles, collisions happened, and people got hurt.






That last line is what is important.. People. GOT. HURT! This, in my opinion, is unacceptable. THIS flies directly in the face of what we do as a profession. I am not laying blame, that is not what this is about. This is about what exactly it is that we do. We are health care professionals. We conduct health care in a moving box, usually on bad roads, with unpredictable situations, and drivers. These are all things that need to be considered before we start to wonder how fast we can drive. It's not a matter of how fast CAN we drive, it boils down to how fast SHOULD we drive.

I'm not going to put numbers on things, we are professionals and at the end of the day we should make professional decisions. The reality is that there are now policies in place. Whether we agree or not is kind of irrelevant. I don't say that to be harsh, it is just the reality. As health care professionals it is important to refocus on what it is we do. We take care of the sick and injured, and we transport them to health care facilities. In these facilities there are many people who can start IV's better than you, many people who can read 12 leads better than you, and a few people who can intubate better than you, BUT NO ONE can do it like you can with the wheels moving. None of those skills,however, can be performed in the back of an over sized, over weight box at mach 1 on bad roads.

There needs to be a change in our mind set. We used to, many years ago, show up, throw people on a stretcher, and drive like hell to the hospital. That is not how we do things anymore. With the advancements of treatments that can be conducted in the field we have the opportunity to initiate many therapies and effect positive change in our patients prior to arriving at the ER. Does this mean that it's OK to drive slow? Of course not! We should still be diligent and ensure that scene times are minimized while treatments are maximized. When we are responding to a scene, it is important that we arrive as quickly and as safely as possible. Bare in mind that our role as Paramedics and EMT's is constantly evolving, and we need to evolve with that role. At the end of the day focus on what is important. What is it that's important? Your patient, and YOUR safety.

Reflections. How Leadership Affects The Streets

Poor morale and the degradation of paramedical services are a double edged sword that every individual should pay special attention to. It is a fact that paramedics and EMT's are good at adapting and overcoming a lot of adversity to ensure that patients receive excellent care. There comes, in time though, a negative feedback loop if the leadership of an industry becomes complacent and appears unsupportive of its staff. This is true in any industry but today we will focus on paramedicine. When leaders become disconnected from the street they can sometimes start to make decisions that in their eyes appear beneficial. This is not always the case, and if there is poor communication from the leadership it leaves the people on the street confused, and angry. This then causes a decrease in the general morale of the people on the floor. The people on the floor are the reason an EMS system works and degrading morale can directly affect their ability to do their job. It's the street staff that are going into people's homes to help them. The leadership team has a part to play in taking care of the business side of things, but if there is no back and forth communication and no acceptance of input from the people on the street the problems become worse.


The problem though is that the leadership are not the only people at fault. Sometimes street level staff are not the best at finding ways to communicate ideas to the upper management teams. I spoke the other day about how it is important to let ideas surface and find practical ways to implement them. That being said, it is evident sometimes that there is a complete disconnect from upper leadership and the street. When a leadership team has issues with implementing good ideas, and spend a lot of time arguing about things, and on occasion fail to get along themselves it will reflect directly to the street. The street level is a direct reflection of their leadership. We have all heard the phrase lead by example, and if the example being portrayed is disconnected, confrontational, and apathetic these attributes will show up at the street level as well. This is a known and studied fact. There is good news though!

There is room for improvement and fortunately it only takes one or two good leaders to at least affect positive change for morale. When a leader steps up and listens to the street level staff there can be a drastic increase in morale. When that happens there is a good chance that the staff will be able to let their good ideas surface. The people at the street level are the people that are going to give you the best ideas for improvement. Necessity is the mother of invention, and when someone sees something that can improve patient outcomes, or safety or any number of other things that person should be able to send that idea up the chain of command. When leadership teams can't even accept ideas from one another though, the staff becomes complacent, and reflects the actions of their leaders.

This double edged sword can freeze an industry in apathy, and complacency. When this happens, morale crumbles, leadership fails, and the industry can fall apart. Good communication is one of the biggest factors that can drive change within an industry. It is known that not all ideas can be implemented, but if ideas are at least heard, and discussed openly, that alone can boost morale. It can show that ideas are being considered. This will make a huge impact at the street level. Leadership is important, there is a vast difference between running an organization and leading one. At the street level it is important to remain positive and let good ideas surface and find the right channels of communication to implement or at least have good ideas looked at!