GAmedic1506

It is a cut and dry legal issue, not an EMS/FIRE issue. It is just that we in Fire and EMS seem to be the last to catch on to what the courts are saying. I guess you are assuming that our employees are too immature to have a fact-based debate without a war, so I will honor your request and remove any reference to Fire. We will just discuss this issue as an EMS station issue.

No, this is a serious subject that is currently getting lots of departments in trouble. Many may not be aware of recent sexual harrassment cases where far less provacative activities have cost employers big money. If you wish to debate the issue, please indicate where i am wrong, with facts and not emotion or personal attacks. I am very interested as to how you will defend your right to watch porn while on-duty.

Thank you all. The purpose of this post was to spark conversation and make you think about the care you deliver, I appreciate all that responded, even those who personally attacked me. If you will go to the Admin side, (Personnel growth and development) you will find a new post regarding Rated R and X TV programs viewed in the EMS or Fire Station. As always, I welcome your comments, as I think we all learn something through a healthy debate. But lets try to have the next debate without any personal attacks, stick to the issues and facts.

How many ems stations have the paid cable TV channels that show rated R or worse movies after hours (which means full frontal female nudity and profanity) ? If your station still has these channels, you should remove them. And before you get all enraged about what I am saying, ask yourself, "Would I sit with a county commissioner, the department Chaplain, or my daughter, and watch these programs ?" Or better yet, how would I feel if my daughter had to sit in the room with five men and watch these programs every day she came to work ? Sexual Harassment is one of the few issues where the victim gets to determine what is harassment. But it is not only the sex issue, the language in most of these programs would be horribly offensive to any one that is remotely religious. Can you imagine the employees in any corporate office sitting around watching soft-porn while at work ? This practice should have died in the last century, talk to your boss about changing your station to a professional work-environment. Lets see what your thoughts are:

Contact Dekalb County Public Safety in Decatur GA or Emory University (which is located in Dekalb Co). Emory started a first responder program years ago, my guess is around 1990-1992. Since it has been in operation for a long time, I imagine they can give you good advice on the problems that have occured since day one. The program had two great benefits, in that medical students got experience, and they were able to cut the number of responses that ground 911 ambulances had to respond for typical college low-actuity 911 calls. So both the university and the county 911 service benefited. Sorry that I do not have a phone number, but i am sure they can be found fairly easy with a google search.

You are quite welcome, and I should also tell you that this is a topic that i have researched thoroughly, it is not so off-the-hip comments of someone who has been in the business a couple of years. I would recommend that you buy/check-out a book that I believe is entitled "Keeping Good People" by Herman. It is a very good, in-depth look, at why companies lose employees. Something else to consider, that is unique to EMS, is that our managers are often very undertrained. Imagine trying to be a great paramedic without ever taking a PALS, ACLS, or a BTLS/PHTLS course; it would be very difficult. Yet most EMS managers have not taken a single management course before becomming a supervisor. This means that they often just model the supervisors that they have had over the years, which could be a good or bad thing. The para-military style of management (Fire and PD) is most often used, and may be the worst to employ for our current work-force. The absolute best advice that I can give you is: 1. Manage individuals. Most supervisors manage crews, trucks, or shifts, but not the individual. You should be able to go down your employee list and tell me what motivates and demotivates every individual employee on your list. If you dont know, then find out. Then you should be able to tell me how each employee is connected to the company, if you took away EMS calls (what other job functions do they have). The employees that are "unconnected" are the ones who will be the first to leave. Even the malcontent that no one can work with, can be turned around if you make an effort to get him connected. 2. Require management training for your supervisors -- if they do not model the ethic of wanting to learn and be better, how can you ask your paramedics to pick-up a book. 3. Find someway to be noticeable different in your EMS community. Start with your mission statement -- Are you living it; -- probably not as fully as you could. You might need to rewrite it, but every activity you perform should be linked to that mission statement. I gave you several examples of how to be different earlier. Dont fall into the trap of catch-phrases, committees, and empty promises. Start small, fix the easy potholes first, and work then work your way up to the most difficult. Be principled, and stick to your guns. Your employees will be skeptical at first, but as results begin to occur, they will come around. Please feel free to ask any specific question that you have, and I will answer as best I can.

It is the trained response. It is the American way. Its just like when you are in an exit interview and the boss asks why you are leaving, you dont want to burn the bridge, so you dont say its because you are an incompetent manager, you say its because of money and benefits. Here is another test for you, of all the people who left your organization in the past year for "better pay", how many of them would have stayed if you matched or beat the higher pay offer ? Some would, but the fact of the matter is that most had quit months before the day they put in their resignation. They searched for something better, but in most states, there isnt much of a difference, so they went with highest pay out of default. The trick is not to lose them to the point that they start looking; once they disengage, the battle is lost. And at no time did I advise that you should be non-competitive with your wages/benefits. But the truth of the matter is, that in every state, there is a service that is the top payor, with the top benefits, and the usually have the worst retention percentage (throwing money alone at the problem isnt enough, although it will attract more applicants initially). With that being said, todays applicant has seen corporations that were disloyal to their employees during the 80s-90s (maybe saw their dad being downsized), so they are less loyal to the company And to ramen noodle man --- I got into EMS 22 years ago, for $12,000/year working 24 on and 24 off (with alternating wkends off -- thats right 24/24, not 24/48). I didnt have a retirment, and the health insurance was a joke. I am not trying to minimize your sacrifice, but at what-ever pay rate you earn you today, 99% of EMS employees atleast have paid time off, health insurance, and a retirement plan. So you might not want to be so quick to judge the next time. Actually it is common among mine and your generation to blame the company for our plight instead of looking in the mirror. Our generations choose not to live within our means, with one or two $400.00/month car payments, boats, 4-wheelers, a huge house/apartment, and credit-card balances out the wazoo. Your parents probably didnt own a home or a new car until they were in their 30s, but we have to have it now. When ever I hear someone gripe about EMS pay, I have to ask, what would you be making (at your current education level) if it werent for EMS. Think of it this way, if you were a starting accountant, you might make in the high 20s low 30s to start, and would work a mon-fri schedule, with the weekend off. If you worked a part-time job, you might make $40k. Most medics are earning 40-80k with two days off per week. Which isnt to say we shouldnt strive for more, but I would hardly say that the current pay and benefits of most employers are slave or sweat-shop wages. Finally, I would ask, if its all about high pay, how do the many volunteer organizations that still operate in the US get employees ? But you can learn something from the high payors, as stated in my first post, they chose to set themselves out, away from the pack (they just did it with cash). The organizations that set high standards, have fair pay, good management, dedicated employees (employees and managment both live the mission statement) will not have retention problems. But in most organizations, you cant find an employee or a supervisor that can even recite the mission statement -- so you have to ask, what mission are they following ?

OK, this doesnt apply to flightmedics or services that do not carry AC. Let's play "courtroom": Plaintiff Attorney: Mr. medic, did you respond to a 14 year old female who had overdosed on "abc" pills approximately 20 minutes prior to you arrival on the date of 07/14/05 ? Mr. Medic: Yes Plaintiff Attorney: You arrived on the scene at 14:31, and recorded phone records indicate that you called poison control at 14:35.You were told that Activated Charcoal was the treatment of choice, is that true. Mr. Medic: Yes Plaintiff Attorney: You then transported this patient to the nearest emergency room, is that correct ? Mr. Medic : Yes Plaintiff Attorney: Records show that you left the scene at 14:54, why was there a delay. Mr. Medic: We had to assess her, load her on the stretcher and move her down some steps. Plaintiff Attorney: So when you left the scene, the pills had been in her system for approximately 30-40 minutes. Mr. Medic: I do not know for sure, thats what the patient told us, I wasnt there when she took the pills Plaintiff Attorney: Did you start an IV Mr. Medic : yes, while enroute to the hospital Plaintiff Attorney: Why Mr. Medic: In case we needed to administer some emergency medications. Plaintiff Attorney; So you thought there was a chance that her condition would deteriorate Mr. Medic: Well, she had overdosed on "abc". Plaintiff Attorney: So, as her body absorbed these meds, there was a chance for her life to be endangered. Mr. Medic : Uuuuhhhhhhhhh, yes Plaintiff Attorney: Mr. Medic do you carry Activated Charcoal on your ambulance Mr. Medic: yes Plaintiff Attorney: Is Activated Charcoal difficult to administer, I mean does it require special equipment, or special training, does it take hours to mix Mr. Medic: Well the prefered method is to administer it via an NG tube, but it can be drank from a cup. Plaintiff Attorney: So then I guess someone who was totally untrained could adminster it, if you only have to pour it in a cup. As a matter of fact, I believe this is sold over the counter at drug stores to the public. Is that right Mr. Medic: Yes Plaintiff Attorney: So if it is sold to the public, over the counter, it must be a pretty safe drug, am i missing something? Could this medicine have killed her if you gave it to her Mr. Medic: Well if she lost consciousness, it could cause airway problems. Plaintiff Attorney: Why would she lose consciousness Mr. Medic: Well as the body absorbed the medicines ........................ ddoooppppeeee Plaintiff Attorney: We now know that our plaintiff has kidney and liver damage because these medicines were allowed to be absorbed in her body. You could have stopped this absorbtion within 5-10 minutes after you arrived on scene, and you knew it was needed, because poison control told you it was the treatment of choice, why didnt you administer it ? Mr. medic: Uuuuuuuhhhhhhhhhhhhhhhh Plaintiff Attorney: You knew the patient needed treatment, You knew that her condition was likely to worsen, You had Activated Charcoal in the drug-box, but YOU chose not to give the medicine that would save her life. Her life-expectancy has been tremendously reduced, she is now on dialysis for the rest of her life. I ask you again Mr Medic, why did you choose not to save this patient's life: Mr. Medic: Uuuhhhhhhhhhh, the hospital was just 20 minutes away. Uuuhhhhhhhhhh, we dont have a protocol for that Uuuhhhhhhhhhh, no one in my state gives it Uuuhhhhhhhhhh, if she vomited, I would have trouble intubating her Better yet, you'all write the excuse that gets you out of writing a big check.

I never got on a high-horse, and i never said that I was better than anyone else. Yes, I was just as guilty as everyone else, until I began to work in the emergency room. I realized that I was wrong, and that our system was failing these patients. I educated my coworkers to the issue, and they agreed that we needed to change. We now administer it quite frequently. I felt that this would be a good topic to discuss, despite how defensive it might make people feel, because I know that this issue occurs in every community. How many over-dose patients die or suffer long-term consequences because we fail to treat them appropriately in the first few minutes of an overdose ? How many ICU-stays could be avoided if we treated these patients as aggressively as we treat stroke or heart disease ? None of us can say that we have done all that we could do when it comes to AC and overdose patients. But that doesnt mean we can't fix it moving forward. I am not suggesting that we treat every medication OD patient with AC --- I am just asking everyone to start treating the apporpriate ones. If I were a medic that refused to give Morphine to symptomatic Chest Pain patients that fit the protocol for its use, because I was afraid they might puke on me, you would want my license pulled. Every day there are overdose patients who need and should receive Activated Charcoal, but are not getting it, because we might have to clean up a mess. The vast majority of chest pain patients are not diagnosed with a cardiac event, yet EMS treats them because it could be life-threatening, and the treatment is rarely life threatening. When you have a patient who has just taken a toxic dose of medicine, and you continue to let the drugs be absorbed, even though you have the mechanism to stop it, I think that is just wrong. Maybe the rest of the EMS world sees it differently.

i got roaches in my liver (cirrhosis of the liver).

I am sorry, I just can not agree with the statement that it is no more underused than any other drug. I tell you what, I will make you a deal. I will pay you $5.00 for every AC administration that occured at your service in 2005, if you will pay me $1.00 for every case where it was indicated, needed, but not done. . DEAL OR NO DEAL ?

I would be very careful about the planning that goes into this. The person who is running this program has to be beyond reproach; any allegation (true or false) about sexual impropriety (consentual or forced/coeerced) and teens will ruin your service's reputation forever. It's sad to have to think this way, but you have to. For instance: Will they be allowed in the station at night, if so, with who -- what if the guys want to watch soft-porn on a cable station while they are there ? What happens when one of the 17 year old explorers flirts with one of your 20 year old rookies ? What happens when the explorers show up at your station in non-professional dress ? What will be your disciplinary process for bad explorers ? What happens when your terminate a poor-performing explorer, and then they threaten you with sex allegations (this happens with teachers all of the time) ? Will you have an orientation for them to explain HIPPA and confidentiallity (what do you do when they violate it) ? And then you have to ask yourself if it is worth that chance. It is admirable to try to get more people in the profession, but maybe there is another way to accomplish it. Then you may have insurance requirements that would not let you hire an 18-21 year old anyways, so recruiting them doesnt help you (most have moved to a minimum age of 23). I am in no way saying it is a bad idea, just saying Proceed With Caution.

dropping off pizza, candy, and donuts still works the best. I always used the approach of -- I know you like your current service, we would just like to be put in-line behind them for the times they are not available. The main thing is making connections with the people who pickup the phone.

I do not believe you are that far out of whack, but I would need to have some more numbers. But the problem is that those who control the purse-strings arent happy, and if you want to keep your job, you need to fix that. First and foremost, you have to ask yourself if you are running too many trucks, or are you heavily laden in administrative positions that you do not need. Can you justify what you are spending ? If you can justify it, and you are not wasting any money, then ask your bosses what target they would like to see you hit ? Then come back to the office, and see what it would take to do that: 1. Lay-off employees / supervisors 2. Shut-down some trucks 3. Change your schedule, are you running a traditional 24/48 ? Maybe you could shut down a truck at night, or run peak-hour trucks instead of 24s 4. How are you covering sick-outs and vacations (part-timers or full-timers on OT) 5. How much are you spending on OT 6. What % of billables are being collected, are your bills processed next day, or weeks/months after the call Ask yourself, If the commissioners asked a private service to come do it for a cheaper subsidy, what would that service do differently to run the company and make a profit. Then present the bosses with what it will take to get to their target, they probably wont have the stomach to make the changes, but you will have done your job.

Look at your needs first, and look at what you have expertice in or a passion for. If you cant find anything, how about improving community CPR training, and the purchase/placement of AEDs.

That last post is dead wrong. Money is the solution when, and only when you have failed to build the best service you can. If you look to whoever is the highest paying service in your state, you will see that they also have retention issues. What you need to do actually costs very little. Ask yourself, if i could create the perfect EMS system, what characteristics would it have ? Then incorporate as many of those improvements as you can at your service. Employees want to work for the best service, regardless of pay. But look around, the only difference between most services is the color of the truck and the uniform. Here are ten suggestions, I have several more: 1. Your employees need to have a meaningful voice in the daily operations. The more an employee is involved in the service, the happier they will be. I have found that committees dont work, so I assign meaningful tasks to individual employees, and try to balance so that all get to play. I have yet to be able to present a problem or task that they couldnt handle (although you will have to be a facilitator when you first start, because employees are not use to being trusted with the responsibility). If you have happy employees they will recruit for you. 2. Have cutting-edge protocols -- medics are type-A, and want to work where they can use their skills. There should be no reason to call for orders. 3. Let employees try equipment out prior to purchase, and let them choose what is purchased. 4. Have a real training program, not pencil-whipped paperwork that is a waste of time. Employees want to improve their skills. Also have management training for those who might want to pursue a management career. If people feel they can grow, they will stay. When you stagnate, they get bored, and look for the first service that will pay one penny above what you are paying. 5. Say thank you to alteast one employee every day. We forget to do that as supervisors. 6. Enforce the rules fairly. have some rules. 7. Dont hire warm-bodies, hire only the best. No one wants to work at a place that will employ anyone, and will not have standards that get-rid of problem employees. It means the white shirts have to work on the truck alot, but it is worth it. 8. Dont shuffle your problem employees around to whoever will work with them, solve the problem, or fire the employee. 9. You will get what you reward. Brag on the medic with the cleanest truck, you will see others start cleaning their truck. 10. Spend time with your superstar and reward him/her. Every service has a superstar, but do they get treated like one ? Give them the truck, station, schedule, that they want -- reward them.

My guess is that the lack of confidence isnt the only or primary problem. If you were my employee I would do the following: 1. Advise you to concentrate on one career, and to put all of your energy into it, whether that is music or ems. Also, you need to do what you want to do, not what your parents want. All parents want their children to be doctors or lawyers, they may not realize that on average technical school graduate makes more than a traditional college graduate. Regardless of pay, you need to do what makes you happy. By "concentrate", I mean you should really focus on improving your skills, not just sit around the station waiting on a call. a) study books take classes c)ride-third on off days d)pick the brains of those around you 2. I would ask to be put with the best medic possible, who likes to teach (if the schedule doesnt allow it, come ride third on your free time). 3. I would arrange for some clincal time at your local ER, you will see more in one day at the ER, than you will in a month at a slow service. 4. Email me through this venue, I will be happy to provide a phone number where you can call me to discuss the issue further.

I am sorry if I made you look in the mirror to see something you didnt like. I see a bunch of excuses and reasons for dancing around the issue, but you know that we (as an industry) are failing our patients. Yes there are cases where charcoal should not be administered, or administered first, but it isnt 100% of the cases. And since we are not administering it to anyone, either 100 % of the patients meet exclusion criteria, or we have a bunch of lazy medics in our workforce. When you go back to work, look at your monthly report and see how many overdoses your service ran last month, and then check to see how many times charcoal was administered -- ZERO -- you will have a hard time convincing me that 100% of your patients met exclusion criteria. You know, as well as I, that the majority of those patients received charcoal in the ER ! As far as it being an issue of protocols --- Good medics are patient advocates first, and your protocols shoud be reflective of those values (Currently your protocols are reflective: since you do not value treating an OD patient as highly as you do a chest pain patient, you do not have a protocol). If you didnt have a protocol for cardioversion you would be jumping up and down on your medical director's desk. I imagine that you run ten times the number of overdose patients, than you do cardioversion, pediatric arrests, OB, or burns (whether your service is urban or rural). The fact is that we do not administer it because we are scared of a mess, and it is time for us to wake up and right a wrong. PS to the city medic who is 5 minutes from the hospital --- i would buy that arguement if you didnt treat any other patients as well -- but my guess is you are providing the required treatment for all of the asthmatics and chest pain patients that are also only 5 minutes away. And its not 5 minutes: Lets say it takes you 8 minutes to get on scene, you spend 10 minutes on scene, 5 minutes to the hospital, 10 minutes to transfer triage and give report -- the drugs have now been on-board 33 minutes and the Physician hasn't even seen the patient, called poison control, or wrote an order. You know it will be atleast another 10-30 minutes before charcoal is in that patient's system.

It is time for the EMS community to improve in an area where we are substandard, nation-wide. Ask a Paramedic how many overdose calls he/she ran last year -- then ask how many times they administered activated charcoal ? To continue to let the body absorb toxins, when the medication for treating this disorder is sitting less than 3 feet from the patient in inexcusable. And dont give me that crap about "airway concerns", we know why we don'd do it, and it has nothing to do with the airway. Today's charcoal is easier to swallow from a cup, it is not as gritty or chunky as it once was. Most patients will drink it once they know an NG tube is coming if they don't. ***** PLEASE READ FOLLOW-UP COMMENT BELOW -- MAKES THE ISSUE MORE CLEAR !!! ** Thank you to the person who noted that I typed "antidote", that was an error that i corrected.

Has anyone had experience with purchasing refurbished monitors through PMI ? Is it a great savings, or a horrible headache ?