Friday, April 1, 2011

Serving Since Tuesday!

A veteran firefighter in a neighboring "big city" recently referred to some of the EMS providers as having nameplates that say, "Serving Since Tuesday." In a metropolitan EMS system, that somtimes isn't a bad thing because the ambulance Paramedics and EMT's have backup from Advance Placement Paramedics (APPs), System Supervisors, Administrative Staff and they have the best, most experienced firefighters around on their worst calls. That approach works great in a large system - but in a smaller suburban EMS system, we cannot afford to have "Serving Since Tuesday" on our front-line ambulances responding to calls alone with a partner who has been "Serving Since Last Tuesday." Consolidation of EMS resources coupled with the demise of many of the traditional "Rescue Squad" EMS providers has led to the rapid growth of County-run EMS systems in our region of the state. Government-run EMS systems are initially very attractive to many EMS recruits. They have decent benefits, retirement, nice equipment and flashy uniforms. Often the County providers tout themselves as "the best" and often times contracted EMS agencies (the former Rescue Squads) are looked down upon because they don't have the funding or resources to have "the bling" and the "flashy" trucks. The government-run systems attract many new EMTs and Paramedics and often have mass-hirings to "put butts in seats" to ensure units stay in service. Thus, "Serving Since Tuesday" may be the front-line response to many EMS emergencies in a large system. I'm "ok" with that because they do have contingincies in place and veteran providers available just a radio call away. I do not agree with smaller, suburban government-run EMS systems hiring with the same philosophy. Often in our area, a single paramedic ambulance is the ONLY responding unit to some really bad calls (no first responders in some areas, no APPs or abundance of system supevisors). Thus, "Serving Since Tuesday" isn't the best that we can do. Our contracted EMS agencies recognize this and hire accordingly. The government-run system MUST adhere to the same standard. When a member of my family becomes ill, a "driver" and a "Serving Since Tuesday" are NOT who I want to come to my family member. You heard it correct - "Driver." It seems there is a trend lately to hire new EMT's who work as firefighters to fill the role of ambulance EMT. I have NO problem with this if they are proficient in ambulance operation. Often times, they are not. They have never filled out a PCR, never driven an ambulance (the operate differently from fire apparatus), and don't know what to say on "the call-in" or even what to do in the back of the truck by themselves. Folks, we need to be hiring CLINICIANS not TECHNICIANS. A technician can fill the seat, but a CLINICIAN can perform patient care adequately, complete the report and operate the unit with little help. Now, as for the government-run agencies touting themselves as "better" than contracted agencies, I agree and disagree. They may be better in that they have more employees, and often better benefits and retirement. I disagree with the notion that patient care is better provided by government-run providers. The contracted agencies in our system have the most experienced providers. If my dear friend Lisa and I work on an ambulance together - our patient receives 40 years of EMS experience caring for them. This is the "norm" for a lot of contracted providers rather than not. There are VERY few times that contracted agencies have less than 5 years of combined experience on a truck. Often it's 10+ years on almost every unit. "Serving Since Tuesday" and "Serving Since Last Tuesday" on a truck together have NO place in a suburban or rural EMS system that does not have the back-up contingency that our big cities have. Many days I see 20+ years of EMS experience on our contracted trucks and then see a 1 month paramedic and a 1 year EMT on a County-run EMS unit. Who would you rather have come to your mother? Contracted agencies may not have the size or the administrative overhead of a government-run system but they do have a lot to offer: 1. Excellent clinical care with years of experience on most units 2. Nice equipment (I work for an agency with 2 nice, new Horton ambulances). 3. Compassionate care - Contracted providers often interact with the same people/geographical area every day. They learn the area, know the people and become attached to the patients. I LOVE riding with new providers. I've been a preceptor in our county since the very first "preceptor class" was ever taught here by guest instructor Steve Gardner from Wake EMS. I enjoy riding with new people because I know my years of "street smarts" and their new "book smarts" even each other out. I can depend on them for quick drug calculations and they can depend on me to "figure out how it works" or how to get a person disentangled from a situation. In conclusion - -"Serving Since Tuesday" should be coupled with a veteran provider, not left alone with a new EMT. It's the right thing for the patient. -Hire Clinicians not TECHNICIANS. I want an EMT who can perform all of the EMT functions assisting the paramedic helping my family member - I don't want a steering wheel holder or clip-board holder coming to our aid. -Don't put down the contracted agencies. Often they have the most experienced clinicians that can be found, nice equipment and SPOTLESS units that you could eat off the floor of. Another thing they have is their customer service which generally far exceeds that of a government run organization that doesn't have to rely on those customers when it comes time for fundraising or making a capital purchase. I have NO problem with any government-run EMS provider in our area. I work for the government myself. I applaud Wake County's initiatives and the dilligence that has been given to their special programs, the APPs and keeping system supervisors responding to calls. Unfortunately, in a rural/suburban system that doesn't have the funding for "extra hands" we must place the most experienced providers available on every unit. We should support our contracted agencies and applaud their efforts serve their communities at a lesser cost.

Thursday, March 17, 2011

Updates and Ramblings

Well hello everyone! As most of you know, it's been over a year since I've blogged. It's not for lack of wanting to, it's just from plain laziness I guess. Well, what's new since last time?? A few things:

I stepped down from Clayton EMS as Operations Chief effective Jan 1, 2010. There were many factors involved in this decision, but overall it was time for me to look after ME! I also have the goal of pursuing higher education by completing a bachelors program. I remained part-time for about a year and ironically the last 2 calls I answered were a pediatric cardiac arrest and a ball-game standby. I say ironically because that is how I began my career as a cadet - ballgame standbys and a pediatric arrest.

I walked away completely this year, closing 20 years of some of the best and worst memories of my life. I had the blessing and privilege to save many lives in this 20 year span. I also helped carry many out of this world as well. I made many, many friends, and quite a few enemies during this time. I contributed to some community milestones:
-Supervising some of our first paid employees
-Hiring many wonderful employees
-Adding the county's first paid second duty crew
-Adding the county's first paid third duty crew
-Building a new station in 2004
-Advancing to the Paramedic level of care from Advanced Intermediate
-Adding a substation
-Purchasing quite a few Ambulances - some good ones and a couple of lemons!
-Seeing the retirement of our first volunteers with 20 years of service
-Seeing 911 implemented in our County
-Being a part of EMD implementation and one of the first EMD certified in our County

I think more than anything, becoming an instructor and seeing so many people that I taught far surpass me in their careers is one of the best feelings in the world! Clayton EMS will always be special in my heart, and I NEVER regret the 20 years of my life that I gave to it or that the organization gave to me. I feel like that chapter in my life has ended for a reason and now I am moving forward into a new chapter.

So what now? Well, I moved back into downtown last year. I moved right next door to my parents on the same block that I grew up on and am thrilled to be back within walking distance of everything again. I continue to serve our County government supervising at the 911 center, only now (with my arm twisted behind my back a little) I work dayshift! Yes guys, you heard it, Jason is working DAYSHIFT. What I have found from this adventure is that I actually have an opportunity to have a LIFE again. I don't get off work and go straight home to sleep anymore. Now I have time to do things that I want to do. So overall, I am happy with dayshift and glad I made that change.

I recently was voted into my third term as Vice President of the Johnston County EMS assocation and look forward to taking the Association in a new direction. We are going to make it less about chiefs and administration and more about the line-level staff and EMT's who make up the front line.

I continue to teach ALL OVER the southeast. I teach in Charleston, SC about once every couple of months which has been very nice. I also teach within the state quite often. I have made many friends and am SO thankful for the happiness given me, and the connections I have made teaching others.

I do continue to work on the ambulance some. I have THOROUGHLY enjoyed working at Four Oaks EMS a lot more lately. They have a GREAT organization and quality leadership. Their volunteers and paid employees are wonderful to work with. I have enjoyed each and every shift. I have also started working in Princeton some as well. I LOVE working in the smaller towns. The call volume isn't too bad, the citizens that call really need you and they are very appreciative of the care you give them. Smaller towns still appreciate their rescue squads and the contribution that is given by their personnel. It seems the bigger towns just expect you to show up and do a "job" whereas smaller communities realize that for many of these young rescuers they have literally given blood, sweat, and many tears to earn that EMT certification and to leave their families alone at night to come serve the citizens.

The last thing I have to add is that I could not keep moving forward if it weren't for having the best friends in the world and a wonderful family. When life seems to knock you down and the Devil tries to pull you under, I can always walk out and sit on the porch with my grandaddy or hop in the car and ride over to Four Oaks and sit with my dearest friend Lisa and things seem to stabilize. Everytime I feel like I'm about at the end, I can get in the back of an ambulance and talk to a war veteran who is a double amputee and provide him a great BLS transport for wound care, or help stabilize a small child whose reactive airway disease and respiratory infection have him lethargic and audibly wheezing when I walk in the room. The patients are the reason I continue serving others.

My hope is that all new EMS providers will keep that same focus. Make it about your patient, not about you. I have held many titles through the years from Sergeant to Captain to Chief, but the title I appeciate and am most proud of is that of EMT!! The paramedic part of my certification is secondary. Above everything else, I am an EMT and am proud to serve each and every patient.