Monthly Archives: January 2016

Intolerance is Not a Black and White Issue

Of course “Black Lives Matter.” Just like white ones, red ones, blue ones, and every other color that we place as a ‘label’ on a life. All. Lives. Matter. But that isn’t the end of the story.

KingisRightMartin Luther King, Jr’s vision was not just about ending racism, but about stopping every form of intolerance that denies the basic respect that all life deserves. With his transcending attitude of justice, I wonder just how long King would have made it as a paramedic. Facing people on their very worse; day after day, or night after night, has an affect on your mind. Watching people abusing a system that is intended to provide a literal “lifeline” to the sick and injured eats away at compassion. Seeing what people do to themselves as a result of their over-indulgence, arrogance, or addiction can layer a crust over the heart of tolerance.

I have heard first responders speak openly about those who “do not deserve my compassion.” This mindset justifies the segregation of our patients. It is a segregation not based on skin color, but on some invisible scale of worth. A scale that we try to teach others in order to make us feel better about how we fit upon it. This expression of attitude reminds me, however, to commit myself to practice compassion based on another popular saying instead: “Be kind, for everyone you meet is fighting a battle you know nothing about.? In my own past, I have easily given my compassion to a drug-seeker who fooled me with an insincere exhibition of pain. More regretfully, I have also withheld some measure of that compassion for a patient who was in real pain and that I had assumed was simply too lazy to drive himself to the hospital. I prefer now not to be a judge of the character of the heart of any patient I treat because I truly do not know their personal pain nor the extent of their real struggle. And most importantly, because the time that I have to make an impact on their lives is incredibly small. I have come to learn that in those times when I do not know what is the right thing to do, I can live easier with the choice of doing what is the best thing.

This morning, I read a story about an EMT in Minnesota who admitted to stealing $120 from the wallets of two teenage brothers killed in a car wreck. Like all of us, she had bills. Like all of us, she was not paid enough for the public service she rendered.  She simply found the wallets lying in the road when she arrived first on the scene. Not a penny of that money could do any good for those teens any longer. She made a bad choice. A very bad choice. I do not know her, or anything more about the situation, but I would prefer to believe the best about her. At least as the woman she was in the beginning of her career. None of us entered the field with illusions about becoming rich. Most of us have a genuine desire to do good for others. Unfortunately, we too often work in a corrosive environment for our souls. But, as Dr. King reminds us, “The time is always right to do what is right.” So today, challenge yourself to go back to the roots of your service. Instead of trying to toughen up the “FNG” who is just getting started in his journey, borrow some of his fire to rekindle your own passion and renew your spirit. I bet your career in EMS will last longer too.

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Filed under Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, News, Opinion, Patient Management, Training & Development

EMSToday Earlybird Winner

Planning ahead pays off. At least it did for Christopher Clarkin of OMFD! He didn’t win the billion dollar lottery, but having a brand new iPad Mini for the EMS Today conference in Baltimore later next month is pretty sweet. Christopher registered during December for the conference using the promo code HPEMS which earned him $100 off his Gold or Silver registration along with the winning entry for an iPad Mini. emstodayipadmini

If you haven’t registered for the conference yet, its not too late. You can still register today using the HPEMS promo code to receive a discount and your own entry for this month’s drawing of another iPad Mini. Not everyone will win the next drawing (however, your odds are much better than this past lottery drawing) but you will benefit from unparalleled networking and learning opportunities at the premier EMS conference of the year. Highlights include Leadership tracks, clinical tracks, JEMS games, Dynamic & Active Threats training, Expo hall, and so much more.

You can also still vote on the winning caption for the Paul Combs “Drawn by Fire” official 2016 conference t-shirt design at this special link through January 22.

Christopher, you can pick up your prize at the PennWell Booth any time at EMS Today conference in Baltimore. I hope to see you there!

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Improving EMS Clinical Preceptorships

A guest article by Caitlyn Armisteadparamedic-preceptor

Clinicals are a critical component of EMS education. These dynamic educational environments can be complicated to manage in order to ensure a complete education for each student. Consider these points as you structure your program and develop guidelines for the coming year.

1) Support Strong Mentorships

Formal preceptorship relationships are effective in transferring procedures and protocols to a student; however, the informal dynamics of a solid mentorship are even more effective at conveying not only clinical concepts but positive culture as well. The primary ingredients are time and empathy. A strong teaching environment is built over time in hundreds of small interactions. A student needs time to warm up and build trust; the preceptor needs time to identify strengths, weaknesses, and academic needs. The worst possible way to schedule clinical mentoring is to randomly place students with whomever is available on shift that day.

It is also critical to be selective in whom you choose as mentors. New employees look for role models, and their preceptor is an obvious choice. If mentors are chosen simply from the employees with the most time at your service, there is the risk of jaded viewpoints and out-of-date practices. Mentors should be chosen from among the seasoned employees that you want to replicate within your organization, not simply the one who has managed to hold the same position for the longest time.

2) Reduce Power Symbols

Rules concerning student conduct should be well defined in policy manuals and reviewed with students. However, these rules should be reasonable for the conduction of clinicals and not exist solely to create a false appearance of discipline while demeaning and belittling the student. Even when not written in overt policy, many times these mandates exist de facto at a clinical site. These sometimes include:

-students must only sit at a table and study, with no other permissible activity, for an undefined or

  unreasonable amount of time

-students must never sit in comfortable chairs

-students must never eat at the same table

-students must never ride in the cab, never observe driving operations

-students must only ride to calls in the box, in the dark, without air conditioning and/or

  radio contact

-students must never have radio access (at times, this may be a safety issue on scene)

-students must never be allowed the same safety equipment as the personnel

Rules such as these, whether explicit or implicit, send a very strong message to students. The usual response when rules are questioned is that they create discipline in the student and that “students need to know their place.?

The result of such power symbols varies depending on the student. To some, it is merely annoyance with little gain. Others may be reluctant to engage with a mentor and ask necessary questions. Students motivated by affiliation, however, can be demoralized. This can result in a student losing academic momentum or being more likely to choose inappropriate behavior.

3) Teaching techniques are important

New skills and activities should be introduced, modeled, guided, and supported, just as they are in the classroom. Checking off supplies in the truck is a great activity for a student, but when a student is given a paper and expected to go on a scavenger hunt alone, the benefit is minimal and the teaching opportunity–identifying equipment, telling what it’s used for and why it’s in the location that it is–is lost. If a student is expected to learn efficiently, a teacher needs to be present. If a student is expected to ask questions, the preceptor must be available to provide an answer.

4) Use objective evaluations and rubrics

Evaluations should be clear, precise, and as specific as possible. Students are quick to notice when a critique is based more on their football team preference than their skills in the field, but that can be difficult to prove if the guidelines are vaguely written: “gets along well with EMS staff.? When critiques are unreliable and yet used determine a student’s grade, students driven by achievement and autonomy, in particular, are demotivated. These students want to earn their grade on their own merit and want concise goals and boxes to check off. This requires not only well-designed evaluations, but also well-trained preceptors.

5) Avoid turf wars

When two or more students are assigned to the same station, truck, or even the same calls, learning opportunities per student are reduced. This can also lead to the student focusing on jumping calls instead of gaining knowledge and building the mentoring relationship. “Nice? students, who defer calls to others, may end up with sub-par clinical experiences. When setting schedules, attempt to ensure adequate call resources for all students and enforce these guidelines.

6) Choose healthy clinical sites

EMS services with toxic work environments easily infect students with poor work ethic, bad habits, and out-of-date dogma. This becomes critical if laws and standards of care are broken, and huge problems can result if a student is caught in the middle or is forced to become a whistleblower. When all possible, avoid such sites and use other services and hospitals for clinicals.

7) Ensure respect

Female, minority, and older EMS students, participating in FISDAP, reported significantly lower preceptor performance ratings compared to Caucasian males (Page, 2013). While this issue needs further study, in the meantime, it is important that all students be treated with respect and empathy. If uniforms are required, make sure there are options designed for females. Harassment and hazing policies should be easily understood and enforced. Student concerns should be welcomed and anonymous reporting available.

Conclusion

Clinical rotations and field training are expensive for a service; they divert time from the best field personnel to a student or new employee. It only makes sense to make the most of these opportunities. Preceptors must embrace the concept of being a mentor. And the training staff, with the support of administration, needs to provide a healthy environment where both formal and informal education can occur. By constructing thoughtful policies and implementing solid practice, clinicals become a valuable dynamic education experience that pays long-term dividends.

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Filed under Administration & Leadership, EMS Health & Safety, Opinion, Patient Management, Training & Development