Stand up to bad behavior in EMS.

Yes, you are your brother and sister’s keeper.

 

HumanRemainsFoundinPark

A year after Paramedic/ Firefighter Mittendorf’s tragic death at her own hand, the toxic culture of public safety continues to be an issue. On multiple social media forums open and closed, the commentary continues to be disgusting, unprofessional, immature and even suggestive of violence towards those women who dare to enter the predominantly male field of public safety.

While this continues to showcase a massive failure of leadership at its most basic function, the fact remains that this behavior is not born in or perpetrated in a vacuum.

It is time for every single decent human being in law enforcement, the fire service, and emergency medical services to take personal responsibility and

STOP THIS  SHIT RIGHT NOW.

https://www.statter911.com/2017/05/12/dc-firefighter-investigated-for-sexual-comments-on-facebook-about-va-firefighter-who-committed-suicide/ 

No excuses, no BS, no stupid jokes or crap about defending  “tradition” or the “brotherhood” (sic).

It’s 2017 folks.

We own this. I don’t care if you sucked it up and dealt with it as a newbie.

It’s a load of crap. I don’t care if you think hazing and humiliating people builds character or fellowship. Frankly, if you actually believe that to be the case you have no business in any profession that involves interaction with humans.

Go find a widget factory to haunt.

There is zero evidence supporting that idiocy, and basic humanity and common sense should tell you that.

There is no honor in bullying your colleagues.

People die because of this shit.moral compass questions

If you have a partner, agency manager, or company leader with an underdeveloped moral compass that fails to address this garbage, or you are afraid to speak up for fear of retribution, don’t keep your head in the sand. There is an army of people who will back you up. Reach out.

We can put you in touch with someone nearby.

If you are suffering at the hands of these cretins, reach out. Nobody in this family should fight alone.quote-i-am-my-brother-s-keeper-and-he-s-sleeping-pretty-rough-these-days-archbishop-derek-worlock-355510

You can reach me at nancy@medicsolutions.org, or Kelly Grayson at kelly@medicsolutions.org. if you need help.

We have your back.

If you want to add your name to the fight put your contact info in the comments.

Change begins with you.EMS_week_blog

 

 

 

 

Advertisements

Have EMS Acronyms outlived their usefulness?

2009-10-15-acronym-of-dignity

 I teach a class for EMS ‘Dinosaurs’ working with Gen X and Millennials in the EMS workplace.Because the focus is mostly towards understanding the value of long-term providers, there is typically a large contingent of ‘Dinosaurs’ among the attendees.

Jurassic EMS

Some version of this complaint comes up every time.

“These new EMT’s don’t want to talk to patients. They keep their nose in the computer and expect machines to tell them what they need to know.

 Can you teach compassion? Because they don’t seem to care about people.

They just want to * do stuff *.”

Take away the computer, and you have the what used to be called “clipboard” EMT’s back in the day.

A clipboard EMT would awkwardly approach a patient, stand at a safe distance and rattle off a series of interrogation style questions while scribbling the answers down on the ubiquitous metal clipboard/runform box found on all ambulances.

“What is your chief complaint? Past pertinent medical history? What was your last oral intake?”

This verbiage does nothing to create a connection between EMT and patient, and often fails to even elicit a meaningful response. Because normal people don’t talk that way.

For years, EMT students have been taught to memorize acronyms.

 SAMPLE, OPQRST, FAST, SMART, AVPU, DCAPBTLS, ABC, CPR, BSI.

I used to keep a book of them. EMS love their abbreviations, acronyms, and slang terms.

They are the Pig Latin of the profession, something EMS insiders understand.

dumb EMS acronyms

But are acronyms helpful? Or do they encourage rote memorization and parroting instead of critical thinking?  Even worse, do they discourage compassionate, meaningful conversation with patients?

The first thing every victim wants to hear from a rescuer is reassurance.

In his book “People Care”, Thom Dick reminds us :

“Patients don’t care how much you know until they know how much you care.”

 PDCHMYKUTKHMYC is not an acronym for a reason.

Acronyms have no heart, no soul, no passion. They are simply tools of task management.

epic-fail-photos-acronym-fail

Is it time to stop teaching them and focus on substance, and understanding?

My partner Kelly Grayson admonishes students who gripe about studying medical terminology, explaining the importance of understanding and using the language of their professional correctly, for a multitude of reasons. Continuum of care when turning over patients to other healthcare professionals. Clarity in documentation. Representing EMS as more than “ambulance drivers”.

He is correct of course, and without question, every EMS provider should be capable of identifying body parts and systems using medical terminology, appropriately characterize and describe injuries and illness, and even know the correct names of relevant equipment and associated parts.

Turn the thingy on” doesn’t fly when you need to direct someone helping with suction or oxygen administration.

But when it comes to direct patient care, we need to rethink how we teach assessment and history taking, and focus on the fact that we deal with anxious, frightened human beings, not simply disease processes and victims of bodily of injury.

In the past, most ‘clipboard’ EMT’s eventually became comfortable with talking to patients as the newness of the job wore off, and everyday life experience chatting with strangers meshed with the patient assessment process. Increasingly this is no longer the case. We are well into the second generation of Americans raised in a culture stressing stranger danger”,good touch-bad touch”, and the importance of respect for “personal space”.

personal-space-dilbert

The internet, smart phones, and artificial intelligence have also created a society where some young people are as uncomfortable with making eye contact, starting a conversation and laying a comforting hand on a stranger as the older generation is with texting and technology.

personal space clipart

In today’s society, in a world stressing cognitive offloading, is the emphasis on memorization tools such as acronyms obsolete?

Or should we be focusing instead on just providing a script without them, and practicing the kind of role playing that will achieve the result we want: A calm, reassuring, focused interview which results in extracting the answers needed to provide the best possible patient care.

Something like this:

“ Hi, I’m Nancy with XYZ small town ambulance, and I’m here to help you.

Can you tell me your full name? Do you prefer Susan, or Mrs. Smith?

(If not obvious) How can I help? What happened that caused you to call 911?

How are you feeling right now? Can you describe it?

 Is anything else bothering you, or hurting? Is your stomach upset?

 Does anything make it worse, or better? When did this start?

 What were you doing when this happened?

 Has this ever happened before? What happened then?

 Did you see a doctor? Were you prescribed medication? Have you been taking it as prescribed?

Do you take any other medicine, or vitamins, or supplements? What do you take them for?

 Have you ever had a bad reaction to medicine? What happened?

Do you have any allergies? What kind of reaction do you have when you (eat, touch ,or are exposed) to it?

 What have you been able to eat or drink today? When?

Mrs. Smith, my partner and I are going to do our best to take care of you and make you as comfortable as possible today.

 I think we should take you to St Something hospital. Is that what you want?

 Can we call anyone for you?

Here is what will happen next. “

Learning to effectively converse makes more sense than memorizing a bunch of letters and trying to remember what they mean. And when the answers to these questions are entered into check boxes in today’s ePCRs, the language is easily converted to standard healthcare terminology.  Most programs even have a 3-dimensional rotating diagram of the human body. All that is necessary is to point and click and your ‘broken ankle’ easily becomes a “deformity/swelling of the right medial malleolus”.

epcr body pic

Compounding the communication problem is the chapter in EMT textbooks which stresses formality, and strongly discourages any language that may be considered disrespectful or condescending to a patient. While there is no question that the message contained in this section is important, the interpretation has become entirely too rigid in a world that has become increasingly casual.

For some EMTs, it might seem safer to say as little as possible rather than make a mistake. But the ability to build trust and provide comfort depends greatly on the perceived sincerity of the caregiver. This is where education, mentoring and careful observation of various cultures, ethnicities, and generational differences become a critical part of the patient experience.

 

Here is how I would rewrite that section:

 When addressing a patient, and depending on the circumstances and nature of the call – Sir, Ma’am, Hun, Baby, Sweetie, Mr., Mrs, Miss, Doctor, Professor, brother, Bro, sister, dude, kiddo, and maybe even dumbass can all be appropriate ways to address a patient.

A good example of this is watching the interaction between EMS and the people of New Orleans in the A&E series ‘Nightwatch’.

 Patients generally do not know or care whether you are an ambulance driver, EMT, Paramedic, firefighter, volunteer or career provider. If they refer to your rank or position inaccurately -get over it.

ambulance driver meme

Kindness and respect are universally understood. Make sure you always sincerely demonstrate both.

Be yourself, with this caveat: Your sexual preference, religious persuasion -or lack thereof- or political opinion has zero place in the conversation. If the patient chooses to share his thoughts on any of these, your response is simply neutral or supportive.

 If you cannot practice EMS without being kind, or openly expressing or passing judgment, find a different career. EMS is not a good fit for you.

 We need to think about softening our teaching and mentoring style to put the humanity back in patient care.

Developing empathetic and confident EMT’s requires a mentor to personally demonstrate, and acknowledge proficiency of soft skills in others.

Soft skills are indicative of emotional intelligence, one of the characteristics that separate a good technician from a great healthcare provider. Very few people who enter the field of EMS  actually lack empathy or compassion. But fear or discomfort with doing or saying the wrong thing can cause those lacking confidences to retreat to their comfort zone, and in today’s world that is often technology.

epcr writing

I have seen students, new graduates, and volunteers who don’t run a lot of calls struggle to go down that imaginary checklist in their head, trying not to miss a letter from an acronym, meanwhile losing focus on the person in front of them. And so their eye goes to the pulse oximeter, and their hands go to the Toughbook. Because that is their comfort zone.

So to answer my Dinosaur’s question-

No, I don’t think you can teach compassion. But you should expect that most people, including young EMTs, have it until proven otherwise. Teach them how to be comfortable in a stranger’s personal space.   Confidence and soft skills are an inherent part of the knowledge capital owned by most of you tribal elders.Pass it on.

 Be patient. Demonstrate how a kind word and a soft touch provide reassurance and point out how Mrs. Smith responds. Because she is nothing like Rescue Annie or Sim Man.

And maybe, after you have said ‘Goodbye, feel better soon ma’am” to Mrs. Smith, your partner will help you figure out how to navigate that damn ePCR.

good dinosaur

 

Oh Sh*t, Bullsh*t, and… Pinball?

Anyone who has been in EMS for more than 5 minutes has heard it.

EMS is 10%  Oh SHIT!!, and 90% bullshit.” 

There are lots of derogatory names for certain populations notorious for “bullshit” calls. Some are funny, some are mean, and some are just plain stupid, but most should never be repeated  in the presence of non-EMS’ers. Maybe not at all, to be honest.

I don’t need to go down the list. I’ve said them, you’ve said them, and mostly they are spoken lightheartedly. But at the end of the day we need to remember that we are adults-   who whine  all the time about not being treated as professionals.

Words Matter.

But- Where does pinball fit in?

Kelly Grayson pretty accurately characterized me as an idea person crossed with a Lorax. Pinball is what happens to all those ideas as they  spring loose and bounce around in my head.

(Yes, I compared my thought process to an arcade game.”Attack from Mars,” specifically.)

In my pinball game, some balls ideas go nowhere. Some, on the other hand, get a bounce or two. Some get lots of bounce, and score decent points.

Now and then, you pull hard, get a lot of bounce and just when you think that ball idea has finished its part in the game, you catch it again… and it’s back in play.

https://upload.wikimedia.org/wikipedia/en/f/fc/Attack_From_Mars_Pinball_Flyer.png

**********************************************************************

During the past two years, I’ve spent a lot of time talking to EMS and Fire Department volunteers about recruitment, retention, cultural changes and leadership. A common complaint  is regarding volunteers who cherry pick calls, or are unreliable. Everybody  shows up for the *good calls*; structure fires, motor vehicle accidents, anything that might be perceived as a requiring a bona-fide  DO YOU HAVE WHAT IT TAKES! hero response.

My standard answer has for the most part been: “You’re attracting the wrong people, the wrong way.” Which is still true. Almost all marketing for EMS, be it PSA’s, recruitment videos, billboards, or television dramas send the same message about nonstop excitement, lifesaving, screaming sirens, flashing lights, and slow motion sexy guys and gals saving the day.

Nobody talks about the calls where Granny cant poop ,or Grandpa fell out of bed.

When a friend I saw at a conference introduced me to a volunteer chief who reads my column, I was not surprised at this comment.

“I actually have a lot of members on the roster. But nobody wants to show up for the bullshit calls.”

PING!  disengaged volunteers for 10,000 points.

Words. Matter.

When the experienced providers and leadership in EMS refer to everyday, routine calls as “bullshit calls,” why do we expect volunteers to be committed to responding?

Because it’s the job” may be factual, but it is absolutely the wrong approach.

Why do people get into EMS? Maybe the lights and sirens and superhero lifesaving mad skills they will get to use. Maybe because they want to make a difference. Maybe both.

Just because someone gets into EMS for the wrong reasons, doesn’t mean they won’t end up staying for the right reasons. That is where leadership comes in. And leadership doesn’t always mean having a title. Leadership means setting the example every day.

There are no bullshit calls.

Someone who believed they needed help called, and you answered the call.

You made a difference. Thank you.

That is what your members need to hear.

You may never know just how much of a difference just showing up for another human being in need made. Being there, prepared and ready to help is a gift you give to every person who calls 911.

Thank you. You make a difference. Every day.

This is the message that needs to be sent. Let’s keep volunteers in EMS for the right reasons ,who may have been sold on it for the wrong reasons.

Now I have to re-evaluate my  R&R  lecture. And that’s okay.

I want to  constantly be evolving in my thought process so that I can best serve those who would seek my advice.

PING.

Safe Spaces

The girl looked about 12, but her father said she had just turned 16. He had returned home from work unexpectedly, and found her vomiting into the kitchen sink.

We had been dispatched for a “Sick child- vomiting, possibly flu.”

 
The empty 100 count bottles of Tylenol and the almost empty bottle of blackberry brandy told a different story.

 
“How many pills did you take, honey?” I asked her quietly as my partner gently helped her onto the stretcher. He placed a plastic emesis basin on her lap. She turned her head away, not answering. Her freckled baby face was streaked with tears and melted mascara. Strings of chalky- looking vomit clung to her hair, and had begun to dry on her shirt. Pulling her arms across her chest, she looked down. Tears and snot slowly dribbled down her cheeks and slipped off her chin. The room was cold, and her pale, almost translucent skin felt even colder. There was no way of knowing how many 325 mg pills had been in the bottles. Or how much of the fifth of booze she got down. She looked to weigh about 85 pounds.

“Let’s get a blanket on her and get going. I’ll get vitals in the truck if she’ll let me. Ask dispatch to get a medic started our way for an accidental poisoning” I quietly said to my partner.

No need for everyone in town with a scanner to hear about an overdose, or possible suicide attempt at that address. The poor kid has enough problems.

**************************************************************
The medic had given me attitude since he got on board. He clearly felt I was wasting his time. I told him what little I knew. Our young patient became increasingly agitated when he attempted to start an IV and place her on his cardiac monitor. He didn’t bother to introduce himself, or ask her name. He simply shrugged, moved to the captain’s chair and said nothing until we were backing in to the ambulance bay at the hospital. And then he leaned over and got up close to her face.

“This is a really stupid way to try and kill yourself. Next time, get it right. Find some better drugs, or drive into a bridge embankment at 100 miles an hour. Blowing out your liver with acetaminophen is a nasty way to die. It could take days. Or you might just live and end up with brain damage and a transplant.”

I can still hear the echo of those words from a call from that happened 10 years ago.

Because it should never have happened that way.

Because despite the care and compassion my partner and I provided, I knew that little girl would never forget the words of a paramedic who in that moment failed his patient, his profession, and any litmus test that might determine what embodies a decent human being.

These kinds of interactions have been some of the most disturbing things that I have experienced in the back of an ambulance. And far from being isolated incidents, they seem to be proliferating. What chills me to the core is this: in our increasingly angry, “Mean is the New Cool” society, I could post this story in a variety of EMS forums and a significant number of commenters would come to the defense of the medic. And probably provoke a frenzied, rabid posting of memes and EMS platitudes disparaging a patient who today would no doubt be deemed “one of those special snowflakes.”

You know, the ones that just can’t cope, and need blankies and coloring books. Boo-hoo. The ones that create burn out and compassion fatigue, like those other skels- drunks, addicts, the homeless and the lonely frequent flyers. The ones who are undeserving of the time and effort that Highly-Skilled, Infinitely Well-Educated, Super-Excellent Health Care Professionals could be spending on *real*, deserving patients.

The patients the “HSIWESEHCP” crowd talk about incessantly, that need incredibly complex assessments and treatments.

The ones that make up less than 10 percent of all 911 calls.

The EMS community needs to be unified and vigilant about excising those individuals who display a lack of empathy, compassion or respect for any victim they have been tasked to care for. As healthcare professionals and trusted members of society, the responsibility to provide kind, appropriate and non- judgmental care cannot be compromised.

As I watched the inaugural ceremonies take place in Washington, there is no doubt that our nation remains bitterly divided. Promises of change and feelings of triumph give some Americans hope for a better future. But for thousands of others, it is clear they share a collective trauma. Fear, anxiety and despair have displaced any sense of normalcy in their daily lives. Violent protests have erupted in some areas as emotions run high and sometimes out of control. Non- violent protests are somehow seen as undermining the new-found hopefulness of others.

For everyone, there is increasing uncertainty about what the future will hold.

Nobody is “getting over it” anytime soon.

What is certain is this:

“Reassurance” is more than a check box on a patient care report.

All EMS providers need to understand and appreciate more than ever how important a commitment to providing reassurance is not only to the public, but also to their peers. Many are struggling to manage the responsibility, and physical and mental demands of this work while they find themselves emotionally exhausted by the polarized atmosphere and inescapable and hateful rhetoric that has somehow become the new normal.

There should never be a doubt that the EMS workplace, and the back of an ambulance, are safe spaces.

“The World is indeed full of peril, and in it there are many dark places. But still there is much that is fair.And though in all lands, love is now mingled with grief, it still grows, perhaps the greater.”  ~ J.R.R. Tolkien, The Fellowship of the Ring

 

* A Safe Space is a place where anyone can relax and be able to fully express concerns, without fear of being made to feel uncomfortable, unwelcome, or unsafe because of biological sex, race/ethnicity, sexual orientation, gender identity or expression, cultural background, religious affiliation, age, or physical or mental ability.

http://safespacenetwork.tumblr.com/Safespace