Improving Operations in Crisis

Our practice of EMS is facing significant challenges right now. Although many traditional aspects must still continue, we have a few more obstacles to overcome in a crisis. This “pilot podcast” highlights some practical modifications to consider for operational improvements, especially for MARVLIS users.

Notes:

Demand for EMS services is disproportionate across America and outside of normal patterns, but some changes to our practice are helpful across any service right now. If you haven’t begun seeing longer times yet, you can expect it to be coming as we face longer dispatch delays for extended EMD, longer on-scene times for re-triaging patients using a “1-in and 1-out” scouting method, longer decontamination times for ambulances possibly infected with COVID-19, and fewer professional human resources collectively making operational efficiency and crew management even more important than ever. At the same that time we are still dealing with our regular calls, mass quarantines and stay-at-home orders are likely to increase calls for domestic violence, drug abuse, acute mental illnesses, and even suicide as people socially distance.

1. Consider modifying queries in Demand Monitor to include longer general timeframes when forecasting dynamic demand:

• Extend the period of weeks, e.g. 56-60 days both Before and After the current date.
• Extend the period of minutes, e.g. 90-120 minutes both Before and After now.
• Enable hotspot accuracy reports to quantify the value of different queries.

2. Create new posting plans with Deployment Planner that balance the weight of geography and demand to limit post move recommendations.

3. Implement a Leapfrog in Deployment Monitor value to penalize moving stationary ambulances by preferring to move units already in transit.

4. Call BCS Support for any help you need to configuring MARVLIS to your operational challenges beyond simple mindless efficiency.

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tl;dr but commenting anyway

I’ll try to be brief. As an EMS blogger, I have always believed in the potential that social media possesses to change the dynamics of how we interact and grow professionally. The promise of the democratization of information and the timely access to news and research on-demand should only be making us better at our prehospital jobs. It is my experience, though, that we have simply become more efficient at sharing opinions than we are at actually communicating useful information. Worse yet, many individuals continue to abuse social media resulting in a stifling of their own professional development. Dave Statter terms this phenomenon as “Social Media Assisted Career Suicide Syndrome” (with plenty of examples.) But probably most disturbing is that we, as healthcare professionals, are hardly any more progressive in our knowledge or use of social media than the general public.

As author Stephen Covey has aptly pointed out, “the biggest communication problem is we do not listen to understand. We listen to reply.� Like the responder who keys the microphone before thinking through the data that needs to be transmitted, many of us share a stream of thought from our beliefs in place of observing facts that may serve to lift the conversation. What becomes all too apparent in the rush to comment is the lack of depth in our training instead of the width of our understanding. It amazes me how many readers of an article will post comments based on the title of the piece without reading the text itself. The acronym “tl;dr” sums up the very problem at its heart because the person writing the comment is admitting the post was “too long; didn’t read.” 

To prove that this is not simply an opinion letter, I’ll submit a Pew Research Center study from earlier this year that demonstrates how differently various age groups receive their news. Hardly anyone younger than a Baby Boomer will dirty their fingers by thumbing through an actual newspaper any longer as social media finally edges out this traditional printed news in popularity. Even digital newspaper websites are declining in readership while television manages to retain its lead as the most popular medium (also propped up in large part by older generations.)  It is apparent that, independent of its source, more Americans prefer watching stories to actually reading the news. In fact, the most interesting insight from the survey is that the top two platforms for news among the college-aged crowd is Facebook and Snapchat.

My greatest fear has now become the “democratization of information” because of how much of the internet is fake. Not just “fake news,” but fake businesses, fake metrics, and even fake people. Artist Donny Miller, known as much for his typographic-based prints as his politically astute comments, noted that �We don’t communicate anymore. We just talk.� He is also the one who popularized the quote: �In the age of information, ignorance is a choice.� However, the internet has become much less than we thought it could be. And even using it becomes more of a challenge to mine information than simply find information.

As a sign of the decline of printed news in the prehospital arena, PennWell Corporation discontinued printing the Journal of EMS earlier this year and has opted for a digital approach to disseminating news. Whether JEMS, or its competitors at EMS1 and EMSWorld, can navigate the new reality of news is still to be seen. But it is clear that “readers” are demanding more interactive content that includes engaging visual infographics and flashy videos. One of the bright spots on the web to me as a professional has been the appearance of FOAM (the Free, Open Access Medical educational resources.) But this collective has many challenges as well. Some of the ethical issues that need to be analyzed and resolved are outlined in this article which also posted this handy summary graphic.

 

A few years ago, someone posted a question to a Reddit forum pondering, “If someone arrived from 50 years in the past, what thing would you have the hardest time explaining?” George Takei shared the reply of a very astute observer of society who answered, “I possess a device, in my pocket, that is capable of accessing the entirety of information known to man. I use it to look at pictures of cats and get in arguments with strangers.”

Although I am not fan of New Year’s resolutions, my personal plan for this coming year is to continue to educate myself (going beyond the bare minimums of ConEd classes) by actually reading more research and commenting my opinions on the news less often. We will have to see what happens to this blog as well as my Facebook and Twitter pages as a result. Happy New Year. 

Consumer Apps in EMS

The tools used in EMS are constantly changing, but one of the most powerful devices available to nearly every ambulance is the smartphone. However, the vast majority of these devices are owned personally by the crew assigned to any rig. While this may be acceptable to the employee who retains control over the personalization of their own device, it can lead to many potential problems for the organization. The advantage for the agency, however, is not having to purchase or support these devices. A trade that many services are apparently more than willing to take as my own non-scientific Twitter poll failed to discover any services that specifically ban the possession of personal phones while on duty. What did surprise me was that only 15% of respondents stated specific policies were already in place regarding their use.

 

 

Over the last few years, the number of medics with personal smartphones has only increased. This is due, at least in part, to an evolving workforce integrating the millennial generation that never knew a world without personal communication devices. Over those same years there have been several good articles that describe the potential of using them at work including “10 Apps Every Paramedic Should Have” or “EMS Apps Make Life Easier“. Many of these apps are focused on patient interactions such as drug identification or calculations, language translators, or a digital version of your protocols. Some, like the Northwest MedStar Alert app, are actually designed for operational improvement at the system level. This particular app allows a GPS coordinate from the phone to be sent directly to the flight communications center and even sets up a secure dialog between responders and hospital staff. (One of the best features to that app may be having an accurate ETA for the helicopter!)

Other authors are more excited about the near future, such as in “How EMS will benefit from smartphones and connected vehicles“. There are multiple studies currently going on regarding the potential of  bringing a virtual physician presence to the scene in order to evaluate a patient. The article “Mobile Devices Speed and Streamline Pre-hospital Care” identifies one of these telemedicine projects targeting stroke. The evolving mobile eco-system has also given birth to some new private businesses. Medlert is just one example of an app built specifically to optimize patient transport schedules using smartphones.  As EMS agencies become increasingly comfortable with leveraging more cloud-based services, there will be more development in the market.

Use of any of these apps (and the personal devices they depend upon) comes with certain caveats and risks. Many apps commonly state disclaimers about their use, particularly in emergency services, so it is worth reading the fine print.

 

 

According to a recent Pew Research Center study, 74% of adults use a smartphone for directions based on location. Another Twitter poll that I’ve conducted shows that using a smartphone app is fairly common for “ambulance drivers” as well. But how good are these routes when we are in an ambulance, especially one that is driving “emergency traffic”? If an agency can provide its own web service based on road data that it controls, the routing can be very good. With MARVLIS Impedance Monitor, an agency’s data can be automatically modified to reflect the travel times common to a fleet during specific timeframes and on certain days and for different seasons learned from actual emergency traffic experience.

There is less control when a commercial routing service is used through a consumer app. Google Maps has an option to show real-time traffic and Waze boasts being the world’s largest community-based traffic and navigation app where drivers share real-time traffic and road information. Waze is interesting in that it was created as a social navigation tool for passenger cars. So, if you plan to use it on an ambulance trip, it would be best not to “share your route” with friends or other contacts. For that, there is a “Go Invisible” option you must choose in order to keep any potential identifying data private.

Is simply “outsmarting traffic” really what we need to be doing, though? Apps like Waze are great to help you avoid the congestion created by an accident that is tying up traffic. But when the traffic accident IS your destination, avoiding it is not a recommended route for you to take. For most vehicles, commercial routing and real-time traffic is hugely valuable. But for an ambulance, not so much. Routing normal cars and trucks is relatively simple because there is a set of rules they must abide by in motion that can be easily modeled. Emergency vehicles, including ambulances or fire apparatus, often break those rules by traveling along the road shoulder or even crossing a median into the oncoming lane of travel. The normal direction of one-way streets can also be ignored at times.  No regular commercial app takes these routing options into account. It requires you to track your own vehicles and learn patterns from those operations only. A final consideration is how you may, inadvertently, influence the decision-making on a social routing app for others by including your behavior with all of the other vehicles on the roadway.

There is no question that you will be using, or allowing the use of, smartphones for a wide variety of purposes. What you need to do is be sure your staff are using the right apps for the right applications. We often like to think we are different, and in many ways we are very different indeed from most “consumers.”

We are interested in keeping this conversation going with your experience and ask that you share what apps have you found to be useful on the ambulance, or cautions about them, in the comment section below.

What If We're Wrong About Response Times?

Anyone who follows my posts here, or on Twitter, will recognize that I consistently argue for the value of prompt responses by emergency vehicles to nearly all incidents. However, this post will be different thanks to an inventive challenge through EMS Basics asking bloggers to consider an opposing view to their favorite topic. You can read about the challenge and link to other participating blog posts in The Second Great EMS What-If-We’re-Wrong-a-Thon.

There actually are some valid arguments against rapid responses, so let me begin with pointing out the lack of a recognized national standard. If a short response was really an evidence-based practice, there should be some agreement on exactly what a “short response” means. The NFPA and NIST standards suggest response times for all hazards, but are really focused on requirements for structure fires and have more to do with the central placement of stations than the speed of fire spread in a structure. The nature of this fixed deployment strategy becomes even more problematic for medical responses as there tends to be far fewer ambulances in comparison to fire suppression apparatus.

A shortage of resources is therefore, a compounding problem. Ambulance response time goals often vary tremendously by locality and type of service. Response time goals become a result of compromise matching community expectations with financing – not the science of resuscitation. Often contracts with private services are drafted to simply improve on the current response times rather than meet an objective goal with a defined clinical outcome.

The clock is an easy measurement device that is more easily understood than many other proxy measures of the quality of our service. And pushing for more (faster) response makes a contract negotiator look like a winner. Unfortunately, there is a heavy cost to pay to chase these ever increasing goals. And for services who cannot meet these objectives, there is either embarrassment, financial ruin or the flexibility built in to the start and end times for the clock. In other cases, there are rules for simply ignoring exceptions to the goal as outliers. Without standards on measurement, why do it?

Trends are showing a higher demand for services which translates to an increased demand in resources which in turn raises system costs unnecessarily. Recent studies have also shown that response times do not improve clinical care in the vast majority of cases. In fact, there are a significant number of responses that don’t even require an ambulance at all. Proper emergency medical dispatching through improved triage at the call taking phase can reduce the effective number of emergent calls that demand immediate responses.

Finally, there is also a growing awareness lately to the safety of providers. Studies show that the use of lights and sirens are risking the lives of responders and even the public. Ambulances driving at excessive speeds for most calls is just illogical and unsafe.

I would like to thank Brandon Oto for issuing this writing challenge. Viewing a problem from a new perspective is quite a liberating opportunity. I believe that in this case, there clearly is still a good reason to debate the need for rapid responses. However, I will continue that debate in a follow-up article from my own perspective.

EMS Today 2016 Review

It was my privilege to have been selected as the Official Blogger of the EMS Today conference for 2016. Like my predecessor, Tom Bouthillet at the EMS 12-Lead blog, I took that role very seriously and visited as many of the sessions, vendor exhibits, and even socials (they are definitely part of the experience) as I possibly could. Throughout the conference I posted my impressions live on Twitter through my @hp_ems account using the hashtag #EMSToday2016. But I know many people either couldn’t, or simply didn’t, watch that whole feed over the four days that I was tweeting live, so I felt a summary blog of the highlights was definitely in order. If you were there, I hope I saw you and that my remarks will echo your own experience. But I would also like to ask that you include your own impressions as comments at the end of this post. If you weren’t there, you missed a lot. And hopefully for you, this article can provide justification for you to make the trip to Salt Lake City next year for EMS Today 2017.

The very first time I attended an EMS Today conference, I arrived on the first day of the show only to discover that I was actually more than 24 hours late. By not arriving early, I had missed tons of great content presented during the pre-conference sessions the day before. While they definitely add an expense to attending the meeting, they also add anywhere from 4 to 8 hours of detailed content (as well as CEH) that you just won’t get in the faster paced 60-minute sessions of the rest of the conference. This year, I opted to attend an afternoon cadaver lab hosted by Teleflex. Training with manikins and simulators is great, but it can only take your skills so far. But flushing a proximal humerus IO access with the chest cavity open, allowed me to witness first-hand the short vascular distance from the infusion point to the heart compared with femoral access. In addition, we had plenty of time to practice ETI with various devices on many different patients. I also had the chance for my very first surgical cricothyroidotomy. While the practice of these skills was highly valuable, the opportunity to simply hold the lungs while they were ventilated and explore the chambers of the heart with my finger were enlightening beyond imagination. Nearby, was another very popular choice for a pre-conference class in the Active Shooter Simulation. It was unfortunate, but just the evening before this shooter simulation class was a vivid reminder of its importance to us in the form of a gunman who killed 3 and wounded 14 more in Hesston, Kansas. Violence leading to an MCI can clearly happen anywhere and we must all know how to respond. Thanks to this timely offering, many more EMS providers are now better prepared.

Moving quickly from the lab to change my clothes, I headed for the formal EMS10 awards ceremony. This invitation-only event hosted by Physio-Control was an opportunity to rub elbows will the people marking their mark to improve the level of care in EMS today. You can always read about the 2015 EMS10 recipients and their innovations, but by being here I was able to run into them several times throughout the conference and even had the chance to speak with some of them to learn their detailed stories.

The next day (which officially began the conference) started early with sessions beginning promptly at 8AM. I was given reasons to consider “Point of Care Testing” by Kevin Collopy who helped me better understand what we can, and cannot, do today based on federal CLIA regulations and why to consider accreditation. Next was Jonathan Washko discussing the success of community paramedicine at North Shore LIJ EMS. The best part of being at a conference with such notables is hearing comments that challenge your work. Jonathan asked “if you can’t manage yourself, or control your own emotions, how can you manage others” and reminded us that it is “the strongest leaders who ask for help.” Then from my virtual visit to NYC, it was on to a global view of self-regulation in paramedicine with Michael Nolan, Gary Wingrove, Becky Donelon, and Peter O’Meara. A couple of great lines prompted a shift in professional thinking, like when being told that “as paramedics it is time to ‘move out of mom and dad’s basement'” and as we argue over the universal meaning of “paramedic” (or “ambulance driver”), “the patient, the media, and your mother should all know what to call you!” Over in the room where Ray Barishansky spoke on “proactive professionalism,” it was crowed as he said “we as a profession have let ourselves down with our behaviors, low pay, and attitudes.” Ray also reminded us that it is “professional EMS providers who own their mistakes, are respectful, and are always advocates for the patient” and asked us to give further thought to the idea that “93% of how you’re judged is based on non-verbal data.”

Plenty of more data was presented at the Prehospital Care Research Forum session hosted by David Page where I am proud to say North Carolina was nicely represented. We also learned interesting tidbits in these lightning talks such as “volunteer EMS services are 27% more likely not to transport (also to accept refusals, or do ‘treat and release’) than paid services” and that the gender differences in the use of restraint (chemical or physical) is not about the sex of the patient, but more likely to happen with male providers even though female providers are the ones statistically more likely to be assaulted. Matt Zavadsky along with Rob Lawrence (filling in for Nick Nudell) also presented plenty of facts in their session on the Data Dichotomy of the current EMS payer landscape. All of these sessions were going on as the JEMS Games preliminary competitions were being held to see who could brag about being the best of the best in EMS. If you want to see how challenging these “games” can be, here is a quick view of the obstacles that participants face to prove they can handle the job.

It was the mid afternoon that the official opening of the conference was held with all of the pomp and circumstance (including fifes, drums, and bagpipes) that you expect at any public safety conference. There was a somber recognition of our brothers and sisters in EMS who have answered their last call due to LODD along with multiple awards and a stirring multi-media presentation by alpinist Brian O’Malley. The prestigious James O. Page award went to NEMSMA for this ground-breaking whitepaper aimed at preventing EMS provider suicide. There was also a brief visit from Maurice Davis to promote his tribute designed to raise awareness and remove the stigmatism that keeps EMS providers, the military, and many others silent and leading all to often to “The Wrong Goodbye“. The video depicting the impact of suicide is something we should all be sharing with our friends.

It is after the keynote presentation that the exhibit hall opens for a brief reception. If you didn’t get to see it, follow along with a bodycam highlight video of the exhibit hall from my friend Jeffery Armstrong. I must also recognize the generosity of Limmer Creative who donated several of their LCReady classes for me to give away during the conference for people who were able to find me and even opportunities for followers who retweeted my post about the contest. Being social is beneficial!

As my friend Bob Holloway put it, “Day 2 was packed with sessions on EMS innovation, MIH (Mobile Integrated Healthcare), and creating value.” And what better way to kick that off than with a cup of coffee and a lightning round called “Ask the Eagles”? If you aren’t similar with the Gathering of Eagles, it is also known less colloquially as the EMS State of the Sciences Conference. This year’s conference was held the previous week in Dallas and consequently the session at EMS Today (always a favorite of mine) is packed with the latest EMS Pearls that will hopefully one day make it into your local protocols. This is where you can hear progressive medical directors from around the country like Bryan Bledsoe busting dogma with comments like “less spinal movement with self extrication compared to backboard extrication.” Unfortunately, I missed it this year to interview Ferno in a video on their innovative iNTraxx system to promote safety, flexible modular design, and increased efficiency. Watch for the interview made in conjunction with my friends from EMTLife later this week.

Over lunch on Friday, I heard Dr. Keith Lurie, CTO of ZOLL Medical, discuss the changing perceptions of resuscitation through “active compression decompression” during CPR and his ResQPOD impedance threshold device that together can increase one-year survival after cardiac arrest by 49%. There was also discussion of heads-up CPR which can significantly decrease ICP during CPR ad many other tips to help us improve CPR survival rates. This discussion was followed up by another visit to the cadaver lab for some hands-on with real human patients. Practice such as this really makes the charts and figures come alive! But what had to be my favorite session of the whole conference had to be the experience of behavioral medicine with David Glendenning and Benjamin Currie. Far from a traditional PowerPoint presentation, we were invited to take a very different look at patients with behavioral issues by experimenting as a group with schizophrenia and delving into the taboo topic of viewing ourselves as potential patients. David suggested that “dealing with PTSD is NOT a rite of passage in EMS and we need to acknowledge it is a real physical condition and begin to talk openly about it.” The session closed with a thought-provoking David Foster Wallace video from a commencement speech explaining how “sometimes the hardest things to see are all around us.” I hope you will take about 9 minutes and watch it. I would also like to recognize the fine efforts of The Code Green Campaign in this same area (as JEMS/Penwell also did.)

Another awesome session well worth mentioning was early on Saturday morning, it was called “Creating a Social EMS Culture” with Carissa O’Brien and Steve Wirth. While there were several good quotes, it is most important to note that “your EMS agency has a legal interest in your use of social media just as you have a professional one.” There are several legal considerations that include the US Constitution, National Labor Relations, defamation laws, HIPAA, harassment laws, and more; but the end game is not “big brother” watching your networking. It must be understood that your agency has a responsibility in “building a culture that breeds responsible digital citizens.” Just as we develop our clinical skills, “we need to train EMS providers in social media just as we would with any other skill.” This discussion is one that can continue even after the conference by participating with the #socialEMS hashtag in your favorite forum.

For those who attended, you can access the conference proceedings with the username and password you received at registration. I also hope you will add your favorite memories below to give others a more accurate record of the whole conference.

I could go on about meeting the paramedics from Nightwatch, my childhood hero Johnny Gage (Randolph Mantooth), being able to sit in Squad 51, or see the original Heartmobile that played a significant role in the development of EMS in America, but I really think it would be best if you just went ahead and registered for your own journey and plan to attend the conference next year.

What You Need to Know for EMS Today

I know that some of you will be in Baltimore this week for EMS Today, while still others cannot join us. Regardless of which category you may fall into, I have some advice to help you make the most of this week.

First, if you are travelling, hopefully all your arrangements are complete. But even so, you still have an opportunity to save money during this trip. There are many transportation, parking, eating, drinking and shopping opportunities in the Baltimore area that are offering discounts to conference attendees. All you need to do is “Show Your Badge” for discounts at these participating merchants. To help you keep track of all the sessions (and any last minute changes) or just find your way through the exhibit hall, you should download the EMS Today app for your smart phone or mobile device. It is free for your Android phone from Google Play or for your Apple device from iTunes.

Whether you are physically at the conference or not, networking is what any conference experience is all about. And you can do it while you are here, at home, or even between calls. The key is to “be social” during the conference whether you are physically there in person or you can join us only in the virtual sense. Many attendees, including myself, will be active on social networks allowing you to connect with your peers and gain some insight of what is happening through the eyes and ears of others. If you are on Twitter use the #EMSToday2016 hashtag and follow the official @EMSTODAY account or join me, @hp_ems, for the latest updates, comments, and feedback on what is going on at, or even beyond, the sessions. Check out the latest posts on Facebook at the official EMS Today Conference & Expo page or join the conversations on various topics throughout the year at the High Performance EMS page. You can also learn from my own perspectives and the opinions of attendees that I talk with by reading my posts as this years official blogger of EMS Today 2016 at HighPerformanceEMS.com.

Being social can also win you prizes. There will be giveaways for visiting exhibitors in the Expo Hall, but also opportunities to find me at sessions where you can tell me about your favorite experience this week for an opportunity to win a prize from Limmer Creative who can not only help you pass the test, but retain the knowledge you need to succeed at the job. Just look for me, Dale Loberger, or find me by my backpack pictured here, and tell me what you love about this conference. I’ll make it easier to know where I will be by posting the sessions I will attend to my Twitter account at @hp_ems. If you won’t be at the conference, you can still have an opportunity to win by simply retweeting my contest post starting on Wednesday. Reposts of the full tweet will be counted through noon on Saturday in the drawing. Watch my account for more details!

Another EMS Today Winner

It may be Groundhog Day, but this is not a repeat post. We really do have another winner in the EMS Today Conference blogger promotion contest. Once again, it is my privilege to announce a winner who used the HPEMS promo code. PennWell Corporation, the sponsor of the Fire EMS Blogs network, has been kind enough to allow their bloggers to provide a promotional code offering discounts on Gold and Silver registrations for the EMS Today conference later this month. Using the code from any of the bloggers, gave the registrant an instant discount along with an opportunity to be entered in a monthly drawing. I announced the first winner here last month and now I have the privilege to congratulate Katherine Rodriguez as the final winner of an Apple iPad Mini that she can pick up at the PennWell booth during the conference. I have tried to contact her without any reply yet. So, if you know her, please extend the announcement to her.

There was another part to this contest, however, that I can now disclose and it was to choose the official EMS Today Conference Blogger. The email notification came yesterday, and I am excited to have been chosen to fill that position following in the footsteps of my friend Tom Bouthillet of EMS 12-Lead who performed that role last year. My plans are to attend the conference starting on Wednesday and I will post a blog each day highlighting the events that happened. Whether you attend the conference or not, I hope you will share this experience with me and check back each day in order to learn about what is happening there and how it may impact our industry. If you are in attendance, please watch for me. I typically sport the HP-EMS logo and I would love to meet you and hear about your impressions of the conference.

Travel safe (whether you will be in Baltimore or not), Dale

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. 

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!

The Last Word

You know that feeling you get when you have your partner laughing so hard it hurts? Sure, it helps that you both have been stuck at a remote street corner post since 0300, but you know what I’m talking about. Its that moment when the idea of being a stand-up comedian flashes through your mind and you can imagine the lucrative pay increase of working similar hours but in a late night bar instead of a moving box. There you would make patrons hold their sides with laughter instead of holding their sides for them while they try to stumble toward the back of your ambulance.

Well, we can’t make that dream come true, but JEMS has teamed up with illustrator Paul Combs to bring you a contest that allows you to show the creative side of your wit by captioning a cartoon destined to be plastered on the chests of EMS Today attendees as the feature image of the official conference t-shirt. Here is that cartoon image, and all it needs is your suggestion of what it should say. 

Submit your clever caption for the illustration in a direct message to EMS Today on Facebook, Twitter, or Instagram by December 31, 2015.  After this deadline, the top 3 to 5 captions will be selected and placed online for a public voting process.  Voting will be held in early January 2016 and the winner will be selected by popular vote. Watch the comment section below for links and updates.

That winning caption will then be added to the illustration by Paul Combs and will become the image that is printed on the “Official EMS Today 2016 T-shirt�? sold onsite. This is a most unique opportunity to get “the last word” in print!

If you haven’t registered for the conference yet, it is not too late to save $100 on your application through the end of this month when you apply the promo code HPEMS to your registration. One random name will even be selected from all those using a promotional code who will win a mini iPad tablet from JEMS. This is definitely the event you need to attend just for it’s educational and networking value. However, now you might just include these extra benefits as a result of your wits and luck.

So, send your last words to fill this bubble as a direct message to any of the following sites:

https://www.facebook.com/emstoday

https://twitter.com/EMSToday

https://www.instagram.com/emstoday/

I hope to see you there in the official t-shirt bearing your wisdom!

Looking Back to See Ahead: 2014 in Review

The end of the year is a great time to take stock in what has already passed and to make plans for the future. The vision I had when I started this blog four years ago was summarized in my first blog post, Hello World. Welcome to HP_EMS!  I’m glad to say that today, while many other things have changed about the business, that vision hasn’t strayed from the original intention of sharing news and trying to build community around the efficient and effective delivery of emergency medical care outside of the hospital environment.

Now, as I look back over this past year, I find it interesting to review which articles have generated the most interest. Topping that list was Rob Lawrences’ list on “11 of the Top 10 Tips for High Performing EMS.” I was so convinced it would generate some conversation that I “trickled” it out one point each day on the EMS Deployment Community of Practice to allow reader comments to be directed at each point. And I hope those comments continue to build. The second most active post was “Is ‘SSM’ Still a ‘Bad Idea’?” I hope it wasn’t just the way I phrased the title, but it may have been helped by timing it with the recognition of the lifetime accomplishments of Jack Stout at the Pinnacle conference or the release of a book I co-authored with John Brophy on “Dynamic Deployment: A Primer for EMS“. As any previous reader of my blog will know, I have a desire to improve the poor implementations of SSM and promote the successful ones.

We hear a lot lately about “Evidence-Based Medicince” (EBM) or “evidence-based practice” as it applies more directly to EMS. But we must sometimes learn how to interpret and apply these “best practices” as I tried to challenge readers in the next most popular post, “Could Busier be Better?” which showed evidence that “busier” services generally gave “better” care to patients. I also hear many comments about how the public is abusing EMS by not using our services “appropriately”. Just today, I posted the question on the High Performance EMS Facebook page “do we provide the emergency medical services that the public wants, or are we trying to train the public to use the EMS services that we can provide?” It was gratifying to see so much activity on the corresponding post from October asking “Is our success a sign of our failure?” and an honorable mention to the later post “We Need Some New Stories” on the same theme.

I am also heartened to see that the fifth most popular post was about deeper engagement with peers on other social media outlets, specifically Twitter, from the post “Influencing Paramedics on Twitter.” It has never been my desire to create the most popular blog, have the most “Likes” on Facebook, or even the greatest number of Twitter “Followers”, but to simply spark meaningful conversation. It doesn’t immediately need to ignite significant changes either. I want to help people think differently about their job and gradually see new perspectives. I plan to remain in this field for the long haul. The business of EMS does not change quickly, but still change is coming nonetheless. I want everyone concerned to participate in that change and make intelligent decisions for themselves and their service to help us all deliver the best EMS care – whatever that might eventually mean.

The title I chose for that first post four years ago included the phrase “Hello World” as an acknowledgment that my background was in programming and business optimization consulting prior to becoming an EMT late in life and really starting to focus my work specifically in public safety. As I saw the emergence of social networking and its potential to affect change in industries, my hope was to leverage it to build an effective community around change in EMS. As I look back over the years, I find that while my intentions have remained resolute, the results have been skewed toward sharing news rather than building community. That is the reason I brought the idea of a “Community of Practice” to this page centered around EMS Deployment. I hope you will check it out and become part of the discussions on the future direction of EMS (or whatever it becomes.) My hope is still to build that forum of respectful community where both providers and administrators have a voice. Even though I am a relative newcomer to this field, I am a field provider like many of you. I am not an administrator, but my work also brings me closely into their world as an adviser. I hope this unique perspective not only gives me different insight, but that it inspires others in “mobile healthcare” to see things things differently in the coming year. So, here is to the prospect of a prosperous new year for all of us!