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Are you a good Medic? How do you know???

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This is going to be a short one but I am hoping for many comments so that I can form a follow up post.

I have just received some really nice compliments from some A&E (ER) nurses about what a good paramedic I am.  I was of course flattered and its always nice to get positive feedback, but as is the norm for me, it got me thinking…..

Am I actually a good medic?

I think so, but how can I justify that opinion of myself?

So here is my request. Think about yourself and the way you practice then complete this sentance and leave a comment:

” I am a good medic because…… ”

Dont be shy, lets see if we can come up with some sort of universal definition of what makes some stand out from others. Oh, and in this case, medic means anyone in prehospital care, EMTs, First responders, paramedics etc etc.

Posted by Mark Glencorse on September 2, 2010 • Filed under: Ambulance, EMT, paramedic • Tagged: , ,

A Blogoversary for my Blogger BFF !

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I dont even know why I am writing this because I am sure that if you read my blog, you will also be reading Justins blog over at www.happymedic.com right?

Because you read his blog, as well as mine, you will already be aware that he has just celebrated the second anniversary of the start of his blog, right??

If by some strange reason you havent wished him many congratulations or if by some freak of interdimensional freakishness you have yet to read ‘The Happy Medic’, I would strongly encourage you to click here and go and say hi and send a lovely big cake over there!

I also know that this also marks the second anniversary of a particularly harrowing time for both Justin and his family after his close call in a building collapse, but sometimes good comes out of bad circumstances, right???

Well, it has been an amazing journey for Justin, and I feel so very privaledged to have been more than a tiny part of that journey, and to have spent time as part of his own family.

Congratualtions buddy!

Can you just imagine what the next two years is going to bring????

YOUR GOING TO CHANGE THE WORLD!!!! (Ted Setla, Nov, 2009)

Posted by Mark Glencorse on September 1, 2010 • Filed under: Ambulance, Happy Medic, San Francisco Fire Dept, bloggers, blogging, paramedic • Tagged: , , ,

Do we really need paramedics on Ambulances?

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Well, since I am back, I thought I might cause a little controversy discussion.

Or maybe not, who knows….

It appears that one of the constants in the EMS world wide is the question of what is the best skill set for responders to a 999/911 call? Along with this comes the whole ALS/BLS discussion, and as far as I can tell there has never been a definitive answer either way, although many of us have our own thoughts.

When I started in the Ambulance service in 2000, there had been a particularily long drought as far as paramedic training in my service area. It was far more common to have an advanced technician crew (EMT – I) than have a paramedic crew. In fact, it got to the point that the wording on the side of the Ambulances changed from ‘Paramedic Ambulance’ to ‘Emergency Ambulance’ as when a ‘Paramedic Ambulance’ turned up on scene, the patient and their family quite rightly expected a paramedic.

Times have moved on however, and skill sets and grades of staff have also changed. We no longer train ‘Advanced Technicians’. We still have some on front line duties, but that rank of staff has now been changed to our ‘Emergency Care Support Worker’ colleagues who are as far as I can tell are the equivalent of an EMT Basic.

When the role was first developed, there was alot of opposition to it. So much so that I would have hated to have been one of the poor souls that were in the first few cohorts of training. There were shouts of the role not being fit for purpose and there were objections from many paramedics that this new role would result in them having to be in the back with the patient for every job instead of doing ‘job and job about’ with their advanced technician or paramedic partner.

There were other, more legitimate concerns though, and these are the ones that I also agreed with, but over time (the last 2-3 years), the role has become imbedded in the service and the amount of experience our ECSWs have now had, makes them more than capable of providing great support to the paramedic that they are working with.

There are moves afoot, to increase their level of training to have them almost at the level of what the advanced technician used to be, and we are all waiting with baited breath to see what the outcome of all the consultations are on that one.

But all of this is just a pre-amble and a bit of history before I get to the main question that I want to ask….

Does every ambulance need a paramedic on it?

I would suggest no, and here is my rationale:

I don’t think that every patient needs a paramedic staffed ambulance. I do, however believe that every patient deserves an assessment from a paramedic.

That may sound a bit of a contradiction but there is a suggestion that the UK ambulance services could adopt a formula of response which could actually achieve this.

Think of this scenario:

If you are a paramedic, then you will be working on a car, by yourself. The ambulances will be staffed by a double ECSW crew, or an ECSW and a ‘new grade technician (if that rule becomes a reality). The paramedics on the car will be sent to all 999 calls, and depending on the severity of the patient’s condition at telephone triage, a crew will also be sent, or will be allocated once the paramedic has arrived on scene and has assessed the patient and determined the most appropriate response. That may be no response, travel by own car, travel in the Rapid Response Car, travel in Ambulance or refer onto an alternative pathway of care. If the patient then requires medical interventions or a level of care higher than that of the responding BLS ambulance crew, then the paramedic will travel with the patient to hospital whilst one of the other members of the team drives the RR car.

I do this already, and it works.

If I am sent to a patient who requires transport to A&E but does not require a paramedic level of care, then I will ask for an ‘urgent crew’ to transport the patient. If however, I am with a poorly patient and the only backup available to me is an urgent crew or a double ECSW crew, then I will just jump in the back. Im sure there are many others around the country and world who also already do this too.

Then there is the question of the amount of ‘emergencies’ that we actually attend which require the advanced skills of a paramedic. As we all know, these are by far the rarest of the incidents that we attend, and the most common are the ones which don’t require an emergency response and usually don’t even really need a trip to hospital.

If that’s the case, then why not keep the paramedics for the jobs that they are really needed for?

This is where the understanding and the change in focus for modern day paramedics comes in. I have written previously about if intervention or assessment is the most important skill set for a paramedic to work with. (here and here) Both are essential, but in the every decreasing percentage volume of genuine medical emergencies, our primary route for assisting the patient is rapidly becoming the appropriate assessment/advice and referral onwards.

It then follows, that this is the reason that paramedics need to attend ALL categories of emergencies. A service would be leaving its litigation doors wide open if it allowed its lesser trained members of the healthcare team to assess and advise the public about their minor illnesses or ailments. The only alternative would be the default position of all patients who are seen by a member of ambulance staff who isn’t a paramedic, get transported to hospital, which is precisely what we are trying to avoid.

I give you this picture, as I want to have a bit of a discussion. This is only one suggestion of many that seems to be doing the rounds of the rumour mill.

In this time of cost efficiency savings and having to really pull in the purse strings, could we not take it as an opportunity to become both more cost effective and provide a better service for our patients. That may sound like an oxymoron, but I can see the potential. What about you??

Posted by Mark Glencorse on August 31, 2010 • Filed under: Ambulance, EMS Topics, EMT, paramedic, patient assessment • Tagged: , ,

A twinkle of an eye tinged with sadness..

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I was working on the rapid response car a little while ago when I was dispatched to an elderly gentleman who had fallen whilst at a day care centre and had possibly injured his hip.

Once I had arrived on scene, I was shown through to the dining area where my patient, Jim, was sitting propped up against the wall. He appeared in good spirits and not in too much discomfort. I on the other hand could not help but wonder how we were going to get him off the floor.

Let’s just say that he was a very large gentleman.

After doing my initial assessment, I examined his hip. There didn’t seem to be any shortening or external rotation and there was no apparent deformity to the leg, although this was very difficult to assess due to the sheer size of his legs.

What was obvious however was that any movement resulted in considerable pain. One cannula and a substantial dose of Morphine later, Jim was feeling far more comfortable.

Luckily, the day care centre had access to various hoists and lifting devices and once the crew arrived, he was gently lifted onto our trolley.

The crew that had backed me up were not a paramedic crew which meant that I was going for a ride in the ambulance whilst one of the crew drove my car up.

It was a 25 minute transfer, so shortly after I had finished my paper work we started chatting about this and that.

Jim was a navy veteran from the Second World War. He started off with the Atlantic convoys, and then ended up in the pacific towards the end of the war.

” So did you end up in the water then Jim? ”
” No, not me. They never sunk me!!……….Mind you, my mates Jonesy and Tommy both got sunk 3 times”

He giggled like a child, obviously recounting numerous episodes of ripping into his friends for always ending up in the Ocean after their ships had been sunk.

“Maybe I was a lucky omen. We had a fair amount of trouble, we had people killed, but we never went down”

We proceeded to have a great chat about the war years. I could listen to these men and women for hours. I feel privileged to be in their presence. It saddens me that it won’t be long before their voices are lost forever, but until that time I will always have time to listen and appreciate what they did for the world.

It wasn’t long before we got on to other stories from his past.

“So did you have a war bride then Jim?”

“You’re joking aren’t you…Im not one for being tied down son. Never got married”

A wink followed with a sparkle in his eyes which went against the many years he has lived…

“But…… I was never short of a lady, if you know what I mean”

We both laughed loudly, and then giggled as he reeled off an impressive list of names of his ‘lady friends’ around the world.

“It was a different time back then. You never knew if you were going to be alive the next week, or even just the next day. I took every opportunity I could to enjoy myself”

“I don’t blame you Jim, not at all mate!”

By now, we were almost at the hospital, and I was trying to string out just a little more conversation, but before I knew it the door opened and we wheeled Jim into the department.

As I handed over to the nursing staff, I was hoping that he had just pulled a muscle rather than any breaks. He was an elderly man, and I wanted him up and mobile as soon as possible to stop him getting any complications.

I said my goodbyes, and did what I always do when I get the chance to look after any veteran. I took his hand and thanked him for all he did for me, my family and our country.

Later in the day, I managed to get back to the hospital and thought I would ask how he got on. The Consultant informed me that he had actually had a mid shaft femur fracture and was listed for surgery the following morning. What concerned me most though was the doctors leaving comment :

“It’s not a good injury for him to have. If he was fit and well, for his age, it has a mortality rate of 50-60%, add in his size and co-morbidities, he will be lucky to get out of hospital”

I hope he is in the minority, I really do. It seems more than a little unfair to survive a life like Jims, only to be taken by a relatively minor fall and all of the complications that go along with it.

Posted by Mark Glencorse on August 29, 2010 • Filed under: Ambulance, elderly care

Im Back!!

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It’s been a strange week.

Things have happened.

Some very important people in my work life appear to have had a change of heart and some others have absolutely astounded me with comments like

“There is a real opportunity to communicate like we never have been able to……we need to learn to let go of some of the control we have always maintained over what we say and do”

and

“This is just the way it is now, this is how people communicate. If we don’t adapt, we will be left behind”

These were a few of the comments that were made after I presented a review of the past 20 months of my life in social media, my blog and the Chronicles of EMS, to all of the most senior managers, and directors of my service. This was a meeting that I had been trying to get into for a number of months; maybe fate had a hand in it finally coming around when I needed it most, and so soon after events which caused me to question my ongoing blogging.

I went into the meeting hoping that maybe I could alleviate even a little bit of the fear that surrounds social media and blogging. What I  came away with though, was the impression that a door has opened ever so slightly into the possibility of my service taking very tentative baby steps into communicating with, and even engaging our staff, our associated professionals and most importantly the community that we serve using all of this new fangled technology that is available to us.

But what about those who I felt were ‘anti’ my blog and social media, or rather those that had reservations about the safety and use of social media and the potential for harm to the service?

Well, they still remain, but they remain silent….for now.

What I am left with however, is a feeling different than that a couple of months ago. I still don’t have a seal of approval from my employers but I now know that those who really and truly need to know and understand what I am trying to do both on this blog and with the Chronicles of EMS have heard from my own mouth how safe and professional I am with my on line activities. I have had the opportunity to stand in front of all of them and have my say about how I feel about utilising all means of communication to take my own service and all other Ambulance services into a new era of communication. That gives me the confidence to come back.

Then there are my personal reasons for leaving the blog, how it affected my family, and the amount of time I spent sitting in front of the computer rather than with my wife and children. This is where my self imposed ground rules come in:

1) I will only blog when at home when Mrs999 is at work
2) If Mrs999 and I are off together, I wont even log onto my blog
3) Mrs999 will soon tell me if I am getting carried away with blogging again and will beat me around the head with a metal spoon until I get the message.

Dont worry though, as since we almost always seem to be on opposite shifts, I will still have plenty of opportunities to write and share my thoughts and musings!

I have missed being part of the EMS Blogosphere; it’s not the same to be a reader as it is to be a blogger. Although I have continued to read everyone’s blogs, I just didn’t feel as engaged in the community as before. Im excited to rectify that and be part of my group of friends again.

An enormous and heart felt thank you is needed for all of you who took the time to post a message following my ‘closing down’ post. I know for a fact that your words also made a difference in changing some opinions about the effect that positive and real blogging can have on readers.

A big thank you to all of you who have been popping in to see what is going on and if I was back on line again, I hope you are happy to see me back!

And finally, a thank you to Fire & EMS blogs for keeping 999Medic.com live.

Anyway….let’s get this show back on the road shall we??

Normal blogging will resume in the next couple of days.

Posted by Mark Glencorse on August 28, 2010 • Filed under: Ambulance • Tagged:

There is a chance…..

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Bet you didnt think that you would hear from me again???

Well, maybe some of you knew that I wouldnt be able to keep away for ever….

This isnt a return….Not yet anyway.

I just wanted to say that there have been some developments along with a potential olive branch being offered. It may amount to nothing and I may well stay away from the blog, but I have a very very very very very important meeting next Thursday which may turn the tide for me and my ability to blog.

I just wanted you to know that I am still trying to make this thing work but one thing is for sure. IF it does work out and I come back, there wont be the usually 7-8 posts per week. During the last 6 weeks, I have realised just how much time was going into the blog, to the detriment of my family, and I wont be letting that happen again. Maybe 2-3 per week will be better??

Anyway, its good to say hi again, please keep your fingers crossed for me next Thursday. Its going to be a pivotal presentation I am giving and I sincerely hope it provides me a way back.

After all, I really miss you all.

Posted by Mark Glencorse on August 18, 2010 • Filed under: Ambulance

My farewell to blogging……..

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I can’t believe I am actually at the point where I have to write this but this is my note to all of you that Medic999 is closing down and this will be the last post. 

I have had a truly amazing experience over the past 18months. I have made friends, travelled, shared experiences and have learned more from my peers than I could have ever imagined. 

I hope you have gotten something out of reading my posts too! 

A lot has happened in the past few weeks but the clincher has been the knowledge that there are some out to prove just how ‘dangerous’ blogging can be for those who write blogs. 

More and more has been happening recently that has made me more nervous than I have been in the past about what I write. I know, 100%, that I have not broken any patient’s confidence, I have not brought my service into disrepute and that I have acted as a professional throughout the whole time I have been blogging. 

I have written and published 483 posts. There have been over 3000 comments and I have had over 250,000 hits. I created ‘The Handover’ EMS Blog carnival which is still going strong as the only EMS related carnival That’s no mean feat! 

As you know, I am a family man, and that is my prime responsibility. I cannot risk my livelihood and my ability to financially support my wife and children. That has been the final nail in the coffin of my blog. 

I find it a shame that the reason for this blog ending is the general lack of understanding of blogging and social media. I feel that I have promoted best practice, shared my passion for the job that I do, and hopefully have shown all readers what it is that makes EMS and those that devote their lives to it so special. However, there still remains this general unease about social media and blogging in the Health Service. Some of the bloggers out here may want to continue the fight, and maybe I am being a coward, but I dont want to risk getting into a position where I cannot provide for my family and can no longer do the job that I love so much. 

Maybe this is a bit of over reacting on my side, but I have never been wrong about my gut feelings in the past, so I am going with this one too. 

I hope you have enjoyed my writing. As a final request, I would love it if you could leave a quick comment if this blog has touched you, made you think about your practice or how you do your job. I plan on sending all comments from this post to those who need to be persuaded that blogging can be a positive thing, in the hope that one day I can come back again, with more support and confidence in what I do. 

If you have never commented, then this is your last chance. Let everyone know why blogging should be here to stay! 

So with the blog gone, what about The Chronicles of EMS? 

CoEMS continues to go from strength to strength. Ted and Justin are hatching bigger and better ideas all the time. I have decided to take an intentional back seat for a while. I have spent so much time away from my family that I have had to make the decision to put family first and step back from all the transatlantic travel for a while. 

I am not leaving CoEMS; I will still be part of it, like all of you who follow it. I remain passionate about our goals and visions for the future of worldwide EMS and I am sure that you will see me again in some of the future episodes (they don’t get rid of me that easily) 

I will remain active on Twitter as @UKMedic999, so hopefully we can still keep in touch there, and you know you can all drop me an email whenever you want at mglencorse@yahoo.co.uk. 

I will also obviously still be reading everyone else’s blogs and commenting when the urge takes me and I will be downloading all of my posts and all of your comments from the past 18months  so that when the time is right I can bring them all back. 

One thing hasn’t changed though…….. 

I still work in the best profession in the world and I still feel lucky and privileged every time I step on my ambulance. 

I hope that I have shared some of that passion with you and I really hope that you all realise how much you have helped me at times also. 

Before I go, I want to commit once last thing to the interwebs. 

There have been two men, with two families that have come to be so close in the last year that I truly feel as though they are an extension of my family. 

Justin, you have become another brother to me over these last 10 months. Who would have thought that we would have clicked so well? You, Kim and the girls have opened your home to me and made me feel so welcome that it was that little bit easier being away from Sandra and my boys. We have shared some amazing times together and I will not forget them for as long as I live. From the ride on the ladder engine in San Francisco, to seeing your face as you stood on Hadrian’s Wall remembering your Grandma. The time that we stood together watching the pilot episode of The Chronicles in the Hotel Frank realising what we had achieved to bluffing our way into showing the Chronicles in the Ballroom of the Denver Downtown Sheraton. There are so many moments that I will cherish, but this isn’t the end my friend. There will be more memories to make and more goals to work towards. Plus, the families still need to meet. You have been Awesome, my partner in Bromance!!!!! 

Ted, you took Justin’s and my little project and turned it into something that still continues to make people reassess what EMS can achieve. Your passion and commitment to your art of film making is truly awe inspiring. Many times, all Justin and I had to do was to just be ourselves whilst you made our everyday actions look far more. I don’t know how I will be able to cope without listening to you tell me how we are going to ‘change the world!!!’ Two of the many things I will never forget….. One – sitting outside of the Irish Bar on my first trip out, Justin doing his pitch to the camera “You can buy the whole seat….But your only gonna need the edge”, and you nearly falling of your chair as you were crying with laughter so much; and two, Coyote Ugly in Denver and your Kid rock dancing!! Dude, you ROCK!!!! 

I have been blessed to work with Justin, Ted and so many more people than I could ever list. You know who you all are, and I hope you know how much you mean to me. 

TEAM CoEMS!!!! 

So that’s it guys. 

See ya! 

So long and thanks for all the fish! 

(hitchhikers guide to the galaxy reference for those that don’t know)”

Posted by Mark Glencorse on June 23, 2010 • Filed under: Ambulance

A Message

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I know I have people in my own service who read my blog and learn from and appreciate my writing.

I know I have people in my own service who read my blog and wait for me to trip up.

I know I have people in my own service who actively look for things to get me into trouble.

I now know I have people in my own service who have tried to cause trouble for me and this blog.

So, here again is the disclaimer that has sat in the side bar, since day one:

“I respect my patients and colleagues confidentiality. What you read here is essentially a work of fiction based on real life events. The stories will be changed in many ways to ensure anonymity of all involved, except me!

But rest assured, the essence of the tale will remain. I will be honest with my feelings my thoughts and my emotions, that much I can promise you!”

As it states, these stories are a work of fiction. Yes they are based on real patients, but you will not know who they are, Okay.

This means that I dont gain consent, because I am not sharing any of their personal details, ok?????

As I said in my last post, I need time to think.

I cant decide if this blog should continue or not, I dont know if it is worth the risk.

I have already made other decisions, and those I will share with you soon, but thatpost will be the only post for a while.

I will still be around. I will still be tweeting and twittering with you all, and rest assured that I will also be reading all of your blogs and chucking in the odd comment or two.

Until then my friends……


Posted by Mark Glencorse on June 18, 2010 • Filed under: Ambulance

Im not here..

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I need some time to think a few things through chaps……

I may be a little while, but Ill let you know how I get on.

Posted by Mark Glencorse on June 17, 2010 • Filed under: Ambulance

A fascinating day in the Studio

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I am sitting in the San Francisco airport waiting for my flight home and reflecting on this last trip to the US (But there is a whole other story which I will share in the next post!!)

The whole purpose was to come and film a few more episodes of the Seat at the table show, but this time it was going to be a little different. We werent going to be in Ted Setla’s Garage (and yes, as hard as it is to believe, those first 7 episodes of SATT where filmed in Ted Setlas garage), but instead in a proper TV studio in San Jose.

The other difference was that it was the first time that Justin and I had to film with guests who were not already our friends and colleagues.

But before they all arrived, we had to get set up :

Mr Ted Setla, in his element!

Once we were ready our first guest arrived, Jon Clotier from Zoll Medical.

As you know, Zoll has been our main sponsor and strongest industry supporter since we started this crazy journey, so it was great to have Jon on to share his views on where the industry and profession is heading as far as technology and equipment go. What pleased me most of all about this session was that it wasn’t an advert for Zoll products, more like a discussion between three paramedics, with the added benefit that one knows ALOT about the technology side of things.

Next up we have the President elect of the International Association of EMS Chiefs, and Chief of EMS for Oakland Fire Department, Bill Sugiama; and Mike Taigman, the General Manager for AMR, Alameda County. This discussion was fascinating for me. Mike shared with us the experiences that he is having leading the way in setting up a community health program utilising his Medics and the support services in his area. He seems to be making significant strides forward for US EMS, however, looking in from a UK perspective brought about some interesting points to further delve into.

Chief Sugiama, helped us to understand how his fledgling organisation (IAEMSC) is working hard on a national level, to try and raise the level of awareness of EMS within the political spectrum and give EMS its own unique standing in the US political spectrum. (Oh and I did ask why it is called the ‘International’ association when it appears to be just America!

The final program saw Justin and I talking with Carl Kustin, Fire Captain, City of San Mateo (President of Lee & Associates), Gerry Kohlmann, Fire Chief (Retired), Conference Chairman for TAK – Response ; and last but not least Jason Hoschouer, Motor Police Officer and Contributing Author to American Cop Magazine. The discussion was intended to look into the reason that the inaugural TAK Response conference is actually needed. Why is it that agencies still seem to have a difficulty working together in times of extreme stress and how can this be made better?. Gerry has some amazing ideas about it all, and he really was a fascinating man to listen to and to question. The same goes for Carl Kustin, who brought in some real life examples of when things go right and when things go wrong. Jason brought the operational police viewpoint to the table which balanced the conversation between senior managers and operational staff. Personally, I would like to see an episode dedicated to law enforcement and EMS working together and would love to have Jason back on at a later date.

And a HUGE thank you goes out to those that were in the chatroom at various times throughout the afternoon. We tried to get as many points in as possible, but it wasnt so easy this time. Rest assured though, either Justin or I were always looking and reading what you guys were up to and that helped us mold the conversation into something that we hope speaks to you guys too.

The one thing that blew my mind though, was after all of the filming, Justin, Ted and I are standing around the table just chatting to Carl and Gerry, and they start telling us about how they handled the task of co-ordinating the recovery and search of part of the pile after the 9/11 attacks.

I just stood back and listened in awe at these two men.

It really is amazing the people I have met thanks to this little ol blog and the things I write.

I hope you enjoy the episodes as much as we enjoyed making them. The first one should be due out next week, and will also be broadcast to resident of San Jose on the Public Access Channel.

I will post the link whenever Mr Setla puts out an episode.

Posted by Mark Glencorse on June 16, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS, Seat at the Table • Tagged: , , , , ,