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CoEMS – A Double Edged Sword

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Also posted over at Paramedicine 101 & Chronicles of EMS

DoubleEdgedSwordI’ve been struggling lately.

Struggling with all of the information I am absorbing from all of the professionals I get to communicate with on a daily basis these days.

I am suddenly exposed to a wealth of EMS knowledge and experience which would, I assume, be seen as a gold mine of information to many people. Indeed, that is how I see it also, and I have gained so much from that, that sometimes my head hurts from the combined thoughts of hundreds of people’s experience.

The Chronicles of EMS has given me so much more than I would have ever thought possible, but there is a flip side to it also, and this is what is affecting my day to day work life.

I have had a post in the back of my mind for a number of months, one which constantly sits there and sometimes raises its head asking to take up its place in the archives of this blog.

It was going to question whether EMS 2.0 is a purely American thing. Does the UK need EMS 2.0 or are we already there?

I mean look at what I can do? I can tell people that they don’t need to go to hospital, I can organise for alternative care providers to come and see the patient at home instead of transporting them to the hospital. I can make autonomous decisions about what is best for my patients and have them agree with that treatment plan. Surely that is already EMS 2.0, right?

Well yes, I would say that that part of my role is definitely part and parcel of what Justin, Chris Kaiser and I hope to see develop from the Chronicles of EMS and EMS 2.0. However, what I am learning and what I am finding more and more difficult to accept is the fact that in other ways, the UK ambulance services are far behind our brothers and sisters in EMS across the great pond.

Before all of this crazy show started, I lived and practiced in my own little bubble. I used to naively think that we were the best at what we can do. If a patient needed emergency care, then they would get the best the world has to offer. In some cases I still believe that, but not in all.

Now, I can say this because I am not criticising my service here, I am looking at the NHS ambulance service as a whole and recognising that what has happened for years and years still happens now and will continue to happen. That is that we follow US developments in the field of medicine, usually anywhere from 2-5 years after the new development has been tried and tested in the USA.

That’s never been a problems for me before because I have never had the awareness that I have now from spending so much time in the US and talking so much to operational staff, managers, Chiefs and industry professionals.

Now, it is becoming a huge frustration for me because I can see what I should be doing and I can see what will be coming, but until that happens I feel angry that we are lagging behind.

Let’s take one example.

Out of hospital cardiac arrest.

I used to think that we were as good as this as anyone else. But now I know that there is so much more that could be done, like:

More hands on scene – that has always been a role I would like to see our colleagues in the UK fire service take on. If not, then even getting more ambulance responses on scene would be a benefit. One crew, 2 members of staff, no matter how well trained cannot perform continuous compression CPR on a patient from arrival on scene until handover at hospital, it is impossibility. As much as I can see flaws in a Fire Based EMS model at times, the one thing I saw which has obvious benefits is the amount of hands on a patient when necessary. There is no point in me looking for someone to swap in for some compressions when I am in the back of an ambulance alone, and if we can’t have extra hands then why not look at equipment that can help us.

Compression assist devices such as the Zoll Autopulse and the Physio-Control Lucas device could take the place of the extra pair of hands needed for a UK paramedic crew on scene. This will come, without doubt, but it will be a couple of years down the line.

What about the apparent holy Grail of prehospital induced therapeutic hypothermia? How long before that hits the UK shore.

Please don’t get me wrong, I’m not saying that all of these things will bring real benefit to patient care (well, actually I guess I am), but why does it take so long for them to make their way over here?

Why should I have to go to some of my patients knowing that there may be better ways of caring for them, which I may well not have access to for a number of years?

Uk pre-hospital care isn’t the yard stick for all other EMS systems to be judged against, far from it, but maybe this just goes to show the value that The Chronicles of EMS and the EMS 2.0 movement can have…..bringing new thoughts and ideas to services which feel that they may be doing things the best way they can already.

I have had my eyes opened and I can see the future of prehospital care, and it includes every bit of knowledge and experience that I can gather, and more importantly share, with services throughout the world.

Until that day comes though, I will remain hopeful and proud to work in my system, but also frustrated waiting for best practices to make their way over here as well as some of ours making their way over the the States.

To finish off, just read this article from the Richmond Ambulance Service in Virginia. This is what I want to be doing for my patients!

Richmond Ambulance Authority nearly doubled prehospital ROSC rate because of the ARCTIC program

Posted by Mark Glencorse on April 26, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS, EMS 2.0 • Tagged: , ,

CoEMS at the Zoll Summit – Part 2

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If you haven’t read part one, the link is here, or just scroll down the page two posts.

…….

The discussion that followed the session, proved to be both interesting and stimulating. Comments and questions came in from operational staff, systems managers, and Chiefs and unlike most of the other appearances that Justin and I have done, there was only a couple of questions about the show and the differences that we observed in each others service.

This time we achieved what we had hoped and had a great back and forth about the merits and dangers of using social media in an EMS system. We received questions from members of services that have a blanket ban on anyone using any social media platforms whilst at work; we discussed the impact of the now notorious medic/doctor animated video; we talked about how the responsible use of social media and embracing this ever growing community can bring real change and benefit to patients and medics alike.

Then, one of the attendees of our session came up with a great idea. Frankly, its one that we should have thought of long ago, but it never really occurred to us. He suggested that maybe it would be a good idea for the Chronicles of EMS to come up with a guidance document to assist services in writing and enforcing a social media policy that will allow employees to use social media without fear of recrimination from their employers and which could also serve as a means to allay some of the fears that management have over the use of social media.

It is something that both Justin and I intend to look at and produce within the not to distant future to make available for free on the Chronicles of EMS website.

The question and answers took us over our allotted time which was great, but the meant that I had to dash off to see if anyone had turned up at the ballroom for the showing of the pilot of Chronicles of EMS.

As I left the conference room, I noticed the electronic display on the wall next to the door into the room, and being the geek I am, I had to take a photo for prosperity. The first formal guest speaking invitation for CoEMS :

coems denver1

I left our conference area and headed to the ballroom, but as I turned the corner my heart dropped as I looked in and saw that it was empty. Now, in all honesty, I didn’t expect many as it was the end of the day and everyone would be going back to hotel rooms for the evening function starting at 6pm, but I thought there may be a few.

A few minutes later, Justin turned up and we had a quick conversation about if we should just pack it up for the day. We decided to give it one more shot of the microphones on full volume in the ballroom to try and get some interest in from the people walking past outside, on their way to their rooms.

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Justin drumming up some business using the P.A System of the Ballroom

Sure enough, after Justin worked his magic on the microphone and we spent 5 minutes dragging people into the ballroom, we had a small group waiting to see what the fuss was about.

We started the show and sat back to watch it yet again, this time in the most grand setting yet. Justin and I now have small parts of the show and private jokes about little things that most people may not see or be aware of, however, if you have watched it as many times as we have, the little things start to jump out.

The episode finished, we got a round of applause from the group watching then again, we got a good selection of questions about where we are planning to go next and when the next episode would be out. We had a great little discussion, and then said our goodbyes to the group.

I went around the back of the stage to turn off both of the massive projectors then made my way back to the control desk where I found Justin talking to an enthusiastic tall gentleman who seemed to be very interested in what we were doing.

I introduced myself and said hello, to which he replied

“Hi, I’m Rick Packer, CEO of Zoll”

Gulp!

What surprised me more than anything though was that he seemed like just a genuine, interested guy, wanting to know more about what we were doing and sharing his excitement. I actually asked Charlotte afterwards if he used to be a medic in a previous working life as he seemed to have that natural interest and personality of a medic.

coems denver3

Another successful partnership for CoEMS & Zoll

What a way to finish off the Summit though!

We packed up our things and spent a few minutes reflecting on what we had done and how we had gotten here. It still amazes me, that this all came from sitting in front of a laptop and wanting to share some of my stories.

Who knows how much farther this will go? I know what I am hoping for, and I sincerely wish that all of my hopes come true, because I truly believe in what the CoEMS team is trying to achieve. What I have also learned is that there is a huge appetite for EMS 2.0, in every form possible. The ground swell is growing month on month. Maybe we can actually make a change at some point.

Zoll Summit 2010, ended for me that night, although the conference itself carried on. Justin had to leave before me so I had another day to prepare to go home and say my goodbyes to so many other new friends.

Little did I know that I didn’t have to hurry to pack my bags after all………

Posted by Mark Glencorse on April 24, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS, EMS 2.0, Zoll, Zoll Sumitt • Tagged: , , , ,

CoEMS at the Zoll Summit – Part 1

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Well, Ive heard today that flights to Heathrow are planned to start tomorrow, so fingers crossed I may get on the plane tomorrow night. Now that my hopes are getting up a bit, I figured I should try and get back to normal blogging, so without further ado – here is part one of the fun part of the Denver trip.

The Chronicles of EMS team (or rather most of it) used the opportunity to have a 2 day office meeting to discuss company matters and look at the structure of the business. I struggled to decide if I needed to be at this meeting as I thought that it was all really above the level that concerns me (and Justin wasn’t coming in until Monday).

However a mixture of loyalty to the team, curiosity and wanting to represent Justin in his absence saw me arriving at The Curtis Hotel on Sunday morning. I won’t bore you with the details but suffice to say that I am really glad that I went, and feel that it was ultimately important for me to be there (although I wish it was Justin as he has a far better business head than me)

Justin arrived on Monday evening after a delayed flight (bless him!) and we were due to go to a Zoll meet up to meet some of the other guys involved in the Summit and the Zoll team who is working so hard to make our partnership so successful. A last minute call from ‘our girl in Zoll’, Charlotte put pay to that idea.

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Charlotte and me

Charlotte wanted to do dinner, and what Charlotte says, I do! (Plus Zoll were responsible for us being there due to Charlottes input and we wanted to spend some time with her)

One lovely steak later and a number of drinks afterwards, we decided that being the consummate professionals that we are, we better head back and get ready for our big day on Tuesday.

The whole reason for our visit was to present our vision of EMS 2.0, The Chronicles of EMS and how using social media responsibly can effect real change in EMS systems worldwide. This was both Justin’s and mine first ever Speaker role, and to be asked to speak at such a prestigious event was both exciting and a little scary.

We went down to see the room we would be in and immediately started to worry if anyone would turn up. If you don’t know what the Summit is, it is a conference that attendees pay for to attend to enjoy a multitude of different presentations in a number of different ‘tracks’. Each 50 minutes throughout the day there would be up to 10 different sessions going on simultaneously with the guests able to choose which one they want to go and see. We were part of the Clinical track and ours time slot was the last session of the day, so who knew if anyone would turn up?

Justin and I went back to Justin’s room to run through the presentation and do some tweaking. We had never been through it together and we needed to make sure that there would be enough time for a good discussion at the end.

As we were sitting together, the CoEMS wheels began to turn and what Justin and I are becoming known for at Zoll sprang into action.

Me: “You know, there are alot of people milling around outside of the rooms and in the reception area. Why don’t we see if we can get a monitor or a projector and go and show Episode 1 on a loop and try to get talking to some people and drum up some interest for our session this afternoon?

Justin: “Yeah, you think?”

Me: “Yup!, go on matey, off you go!”

I know where my strengths lie, and I know where Justin’s do to. I can come up with some great ideas at times, but Justin is the one to set loose to make them happen.

Justin: “Ok, be back soon”

I carried on working with the presentation and after about 20mins Justin returns.

Justin: “Nope, can’t get a monitor anywhere, so can’t show it on that”

Me: “Oh well, it was a good idea anyway”

Justin: “Yeah it was. So anyway, we can’t have it on a monitor in reception but we can put it on the 2x20ft screens in the Ballroom!!”

See…I told you he was the one to make things happen.

Next thing we noticed was that there was no signage for us. Fast forward 15 minutes and Justin had 2 flipchart holders and had drawn a couple of signs with the EMS 2.0 symbol on it and announcing a Q&A session with us over lunch time.

Now in all honesty, we didn’t get many people coming in, but we certainly let people know that we were there, and those that did come over became very interested very quickly with what we were trying to do.

Charlotte and her boss Blake walked past with grins on their faces, shaking their heads (I honestly think they look at us like proud parents sometimes! This project is Charlottes baby and it gives us a real pleasure when people show interest us, as it shows Charlotte that we are worth spending time on)

Before we knew it, it was time for our session, and to our relief, it turned out that we had the busiest session of the clinical track for that day. The room was over ¾ full and they remained engaged for the whole time that we were talking. Justin of course, took advantage of comedy moments and made as much fun of my accent as possible whenever possible, which always brought a giggle.

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Room filling up before we start.

I kept on looking to the back of the room at Charlotte and then to the front row where Blake was sitting. They laughed along with everyone else and nodded approval when we hoped the audience would. The bit that I was really looking forward to though, was after our presentation.

As soon as we asked if there were any questions, they started to come in. There were the usual questions about differences between US and UK pre-hospital care and where we are going next, but what really got us interested was when the questions started to come in regarding social media and how it could be used for good in EMS……..

But that is something for the next post…..

Posted by Mark Glencorse on April 19, 2010 • Filed under: Ambulance, CoEMS, EMS 2.0, Zoll, Zoll Sumitt • Tagged: , , , ,

Off across the Pond Again

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DenverColorado

Well, its that time again. Terminal 5 at Heathrow Airport no longer holds any fascination for me. I just sit here looking longingly at the BA Lounge which I will never be allowed in. However, I do realise how fortunate I am to be in the position I am in and have the experiences that this year is bringing.

So where am I off to this time?

Back across the pond to Denver, Colorado, to join Justin who will arrive on Monday. We will then be talking at the Zoll Summit event at the Denver Downtown Sheraton Hotel on Tuesday 13th and sharing what EMS 2.0 is and how using social media and the Chronicles of EMS, we can all have a say in effecting change in Emergency Medical Services around the world.

Yes, it’s a lofty goal, but I guess you know that the Chronicles team don’t like to settle for any less!

Before the summit though, its two days of meetings in a room at a hotel with the rest of the wider Chronicles of EMS team. We hope to be working together to form some sort of cohesive business plan on how to keep moving things forward and how to engage more and more of the EMS world and get them to come along with us.

There will be brainstorming and business talk (which will be more than a little above MY head im sure), but I am most looking forward to getting back together with the people who I really do think have become integral and important in both my life and career!

It would be great if there wasn’t such a wide expanse of water in between us though!

There is of course the chance to come and say hello if you are in, or around Denver. A last minute meet up has been arranged for Sunday night at the Rock Bottom Brewery at 1001 16th Street Mall. If you are there it would be great to meet some more of you in person.

zoll_logo1However, I cant finish this short post without giving kudos and thanks yet again, to the team at Zoll Rescue Net (@zoll_rescunet on twitter) and Zoll EMS/Fire (@zollemsfire on twitter) for bringing the Chronicles team to Summit. Their continued support really is showing them to be the leader in using social media to engage the EMS community.

Posted by Mark Glencorse on April 10, 2010 • Filed under: Chronicles of EMS, CoEMS, Zoll, Zoll Sumitt • Tagged: , , ,

Update from The Happy Medic and Ted Setla

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Just a quick update from The Happy Medic and Ted Setla on where we are with the Chronicles of EMS and what is coming up for EMS 2.0 :

CoEMS – Update from Thaddeus Setla on Vimeo.

Posted by Mark Glencorse on April 9, 2010 • Filed under: Chronicles of EMS, CoEMS, Videos • Tagged: ,

When is a refusal really a refusal?

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Also posted at Chronicles of EMS and Paramedicine 101

just-say-noOne of my fellow EMS Bloggers, MedicSK from `EMS in the new Decade’ recently put a post up which has initially struck my ‘getting on a soap box’ bone, then has made the grey matter work a little over the last day. I initially commented on his post, but decided that the follow up was going to be too long and deserved a post all to itself.

In his post, MedicSK asked questions about patients refusing treatment and looked at two things in particular.

  1. The need for the ability to deal with non transport decisions
  2. The fact that determining that someone being conscious, alert and orientated is the be all and end all of ‘accepting’ a patient’s refusal of treatment.

Go and read his post first, then come back and let’s talk about this further.

All done?

Great, right then off we go.

In my first comment, I questioned the statistics that he stated. Specifically:

“Nationally, on average, approximately 20-25% of all 911 Ambulance calls result in a non-transport, so refusal scenarios are encountered frequently”

I stated that the true amount of refusals are significantly less, probably somewhere in the region of <5%.

In general people phone 999 or 911 because they want our help. The refusals are usually from people who did not make the call themselves but instead it came from a ‘3rd party caller’ who thought they were doing the right thing.

MedicSK clarified his point by stating that:

“That also includes cancelations, unfounded calls, lift assists etc”

That’s all fine and good, but my soap box moment comes with the proportion of ‘refusals’ that are actually nothing of the sort.

These can be split into two sorts.

The first is one that MedicSK gives an example of:

The transport offer is always said to be there, and many Medics are taught to make three attempts to get someone to go to the hospital. It will usually go like this:

Medic: “Do you want to go to the hospital?”
Patient: “No, I do not.”
Medic: “That’s some pretty good damage to the front end of your car there. You could be hurt a lot worse than you realize. Are you sure?”
Patient: “Yes, I’m sure I do not want to go to the hospital.”
Medic: “Okay, well if you aren’t going to go I need you to sign this piece of paper. Before I leave, are you sure you don’t want to go?”
Patient: “No, I don’t want to go.” *Signs Paper*

There is some room for a Medic to give advice to a patient, but that door does not open up until after the PATIENT decides that they do not want to go to the hospital.

Is this a refusal of treatment?

I would argue that it is not. This is a conversation that will be repeated all around the world, numerous times a day and it is usually in relation to a minor injury or illness. I know this because if you were truly worried about someone’s health, the discussion would not start with “Do you want to go to hospital”

For someone to consent to treatment, there needs to be an informed decision. Likewise, if someone is refusing treatment, there needs to be an informed refusal. They need to be made aware of the risks of refusal in no uncertain terms, and in many cases this can be done fairly bluntly if you really want someone to go to hospital.

I have been heard to say to certain patients:

“You have a significant swelling to your head and there is a chance that with this type of injury you may develop a bleed into the brain. I am strongly advising you to come with me in the ambulance to hospital and get assessed fully by the doctors there. If you still choose to not come with me then you will have to sign a form stating that if you die tonight whilst you are asleep, it is all down to you, and has nothing to do with me as I am telling you that you need to go to hospital”

Now obviously, the language used depends on the person you are talking too. I wouldn’t dream of speaking like this to a sweet elderly lady who is afraid of going to hospital In case she doesn’t get back home; but as you all know, there are times that you need to speak to patients in a manner that they will understand and respond too.

Unfortunately, if we cannot prove that someone has lost the capacity to make an informed decision then we cannot do anything about it.

We can only act in the best interests of the patient if we can show that they do not have capacity anymore. This brings its very own moral and ethical dilemma which I will discuss at another time. Suffice to say though, just because we disagree with a patients choice doesn’t mean that we can force them into going to hospital.

If however, we can show a lack of capacity, then there are options open to ‘force’ them into receiving medical help.

But, for example, where does this leave us with a patient who has not taken any alcohol. Is alert and orientated and her partner is concerned that she has taken an overdose (and she admits it) but she absolutely refuses to go to hospital?

Between a rock and a hard place, that’s where.

If she is in her own house, we cannot get the police to remove her to a place of safety, as she has to be in a public area for that, and we have no authority to remove her either. The only option is for her to sign the refusal form and for us to leave and inform the GP that she has refused and we remain concerned for her. It is then down to the GP to try and persuade her to go, or go down the route of sectioning her under the Mental Health Act.

I have been in this situation a number of times and as frustrating as it is, sometimes we just have to go.

The second kind of ‘refusal’ that isn’t a refusal, is one that goes like this

Crew: “You know, we can take to you to hospital to get you seen, but it’s going to be really busy and you may have to wait hours to be seen, and the likelihood is that they will just send you home anyway”

Patient: “Oh, Ok then, I think I will just stay at home then”

Crew: “That’s fine, I just need you to sign this form for me, and then we can be on our way”

The patient then signs the form, not knowing what they are signing and thinking that they are just signing something to say that they aren’t going to hospital.

Is this a refusal of treatment?

Absolutely not, and these are the ones that open medics up to complaints and litigation.

I have issues with medics doing this, but I can understand why they do it. They do it because they can see that there is no real need for the patient to go to the hospital but they do not have any system in place or any support that will allow them to make that decision and advise the patient of what is the correct form of treatment for them to seek.

If you only have two options, either transport or refusal, then there is no pathway open for the medic to do legitimately what they want to do i.e. the best for their patient.

And here is the link to the ever present EMS 2.0 argument. As I have been speaking to my American colleagues, they all say how they would love to be able to tell patients that they don’t need to go to the ER or that there complaint or concern did not require an ambulance or any emergency response. However, they have been doing this for years already, only it has been just like I used to do before we were trained to ‘Respond not Convey’. I too used to use the old gem of telling the patient how long they would have to wait if they went to the hospital then getting them to sign the form, and to be honest some still do that now, even though we have better options and more transparent and honest options to take.

Some still think that a patient signature on the refusal of treatment form is a ‘get out of jail free’ card, when in reality it is so much more risky than that, unless, the real discussion is documented and agreed upon.

Here are the options I can get a patient to sign to agree to:

I have seen/examined/treated the patient and have reached the following conclusion:

  1. The patient’s condition is such that medical assessment is strongly advised and that the patient should be transferred to hospital by ambulance, but the patient has refused transfer and has the capacity to make that decision.
  2. The patient’s condition is such that medical assessment is strongly advised. However the patient has refused to undergo any such medical assessment.
  3. The patient’s condition is such that medical or social assessment is advisable and that a visit from the patients G.P or other appropriate healthcare professional should e sought.
  4. The patient requires some medical attention at a hospital or other treatment centre, but is able and willing to make their own way there.
  5. The patient requires assistance only and does not require medical attention.

Agreed Referral Pathways:

  • G.P
  • Minor Injury Unit
  • Urgent Care Team
  • Emergency Care Practitioner
  • Mental Health
  • Falls Team
  • Social Services
  • Pharmacy
  • Police
  • NHS Direct
  • Out of Hours Service
  • A&E
  • Walk in Centre
  • Other……………

The patient then signs the form at the end which is worded:

“I agree to the course of treatment described on this form and I am fully aware and understand the advice that I have received from the Ambulance Service. I have been made fully aware that should symptoms persist or a new symptom arise, I should seek medical attention without delay/or dial 999″

Before I get the form signed I also tell the patient that this is not a refusal of treatment form (unless they sign the top option), but instead it is based on my clinical decision and rests on my shoulders.

Yes, it would be a lot easier to get them to sign the old version refusal of treatment box on the patient report form, but in the vast majority of cases, that would be manipulating the patient into making me feel better about persuading them not to go to hospital.

So in answer to the question in the title, when is a refusal really a refusal? Unfortunately not that often at all.

Or do you disagree?

Let me know your thoughts……

P.S Told you it was too long for a comment.

Posted by Mark Glencorse on April 5, 2010 • Filed under: EMS 2.0, refusal of treatment • Tagged: ,

The Future of Paramedics – Assessment or Treatment?

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stethoscopeI have just finished reading a fascinating short article over on EMS1.com by Brian Bledsoe, entitled ‘Speed and Time in prehospital trauma care’.

I figured that I should read it as I am due on the EMS garage podcast in 20 mins and we will be discussing it!

However, it has left me with more questions that I expected.

I am already aware of the recent move to disprove the concept of the Golden Hour, and when I have been talking to colleagues at work about it, I have basically said that all it proves is that if your injuries are going to kill you, then it doesn’t matter if you are on scene for 10 minutes or 30 minutes (or so the current thinking is telling us), and likewise if you are going to survive, then you will unless you are kept out of the hospital for a significantly prolonged period of time.

I know that this goes against all of our training and is pretty much against the core values of how we look after our trauma patients.

But….

It has also got me thinking about other things.

Mrs999 and I have just had a conversation about it, and I came to a conclusion that I want to put out there and I would love to hear your thoughts on it.

There has and always will be the need for an ALS component to pre-hospital care. However, in the future (very near future in the UK already) will an ALS provider be defined by his or her ‘intervention capability’ or will a true ALS provider be defined by their assessment and diagnosis ability.

More and more in the UK, we have more varied options open to us for our patients. If I have a patient who is having a CVA, they go to a certain hospital or unit. An M.I will go to a different unit. Potentially significant head injuries go to one hospital whilst ‘less’ serious head injuries can go to a normal A&E unit. The list goes on and on, but shows that it is becoming more and more the paramedic’s responsibility to actually provide a provisional diagnosis to base their transport decision on.

If you get it wrong, then you can place your patient at risk by taking them to a hospital that may not be equipped to look after their needs at that time.

It also moves into the realms of minor injury and illness. Our experienced paramedics can ‘treat and refer’ or’ respond not convey’, which is completely reliant on a sound and thorough clinical assessment and a professional and eloquent patient care record.

Just take a look at  how often you pull out the magic box of ALS tricks and be honest and see how often they actually make a real and significant difference.

Now, don’t get me wrong, I am not saying that we should lose these skills and interventions. I have seen the benefit of them, and they are the times where we really, really feel good about what we can do and the differences that we make. All I am saying is, as we move forward with EMS 2.0, what really is the most important tool in our repertoire?

Is it our ‘awesome’ intubation, cannulation and drug therapies?

Or, is it our ability to make a clinical diagnosis, based on highly developed assessment skills and move our patient to the correct place for them to receive definitive care?

I would love to hear your thoughts.

Posted by Mark Glencorse on March 16, 2010 • Filed under: Ambulance, Assessment, EMT, paramedic • Tagged: , , , ,

In Response to “5 hard Questions”

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the-thinker4I have just been reading a very interesting post over at ‘The EMT Spot’ which is entitled ‘5 Hard Questions EMS 2.0 Needs to Address’.

It got me thinking, then had me commenting, then had me realising that the comment was getting really rather long, so I thought I should post it here instead!

So, in response to some of Steves questions :

“How do you influence standardization and still allow for the tremendous leeway required for EMS agencies to be optimized for the communities that they serve? Can EMS agencies be different in geography, financial resources, administrative structure, culture, call volume, compensation and certification/education level and still find enough unity to advance the profession together?”

Yes, absolutely!

In my humble opinion, we have already realised that there is no need, and in fact no possibility for unity and standardisation across somewhere as huge and diverse in systems as America. It works to a point in the Uk, but we are just an iddy biddy country compared to you guys over the pond.

Instead of striving to create unity and standardisation, we should be trying our best to focus on best practices and use them as a template to adapt current and new systems to encompass the good that has been learned and put in place else where – that is where the Chronicles can come in and help out a little, by sharing systems with other agencies to show what has worked else where.

“Mother Teresa once said that she would never attend an anti-war rally, but if you ever organized a peace rally, she’d be there. Will we gain more by rallying against the things that are wrong with EMS or supporting and expanding on the things that are right?”

As far as where the rally cry should lie, it is somewhere square in the middle of the two opposing camps.If we all go to one extreme or the other we will be seen as radically either for or against one point of view. To embrace the community, administrators and managers, we need to be able to show that we responsibly can challenge both sides of the argument. We can share best practice but we can also try to improve and comment on areas which may be ready for improvement and development. It`s all about how it is approached and the manner in which we share information.

For CoEMS and our community to be respected, it is essential that we blog and film with integrity and understanding of our primary committment, that of the patients that we care for.

“How do you encourage unity without creating conformity and stifling creativity and innovation?”

Again, we can all encourage unity towards the common goal of a new and improved, more responsive, better patient focused pre-hospital health care system, whilst still allowing individual systems to meet the unique needs of their patient population, service provision and specific geographical challenges. It is the goal that we all want to see achieved, there may be many different ways to actually get there. In fact, that is what makes this whole thing so exciting, it gets individuals thinking, groups of people discussing and whole systems to share ideas. In that respect, the unity behind one banner can actually encourage creativity and innovation, not stifle it!

“Today’s EMS systems are run by local agencies. A collective of public, private and third party agencies, guided by medical directors who maintain autonomous control over the care given in their system. People in positions of power and influence are reluctant to sacrifice control to larger concerns. How do you convince local power brokers to relinquish control over standards that they currently establish and oversee as they see fit?”

See above. Embracing EMS 2.0 doesnt mean losing control. It encourages each and every individual system to adapt and develop to rise to their own potential, to meet the needs of their patients and their staff. EMS 2.0 is a concept, not a text book which is prescriptive in how to deliver emergency and urgent care. EMS 2.0 is something to aspire to. Something to be embraced and shared with the medics in the system. To move forward will raise moral of the medics in the system, improve care and patient satisfaction and will elevate the term Paramedic, to a true health care profession standing. It is something that EMS has been waiting for and needing and now is the time to take it forward, whilst we gather the attention of the EMS world.

“Emergency room physicians and hospital administrators have a tremendous amount of influence over how EMS is conducted. They also profit from the current inefficiencies in the U.S. EMS system. How should we encourage hospitals and physicians to support the idea of alternate transport destinations when they are the ones who profit from patients being delivered to the E.R. Why would U.S. ER Physicians support paramedics making doctor’s appointments, transporting to urgent care facilities and leaving patients at home when it takes revenue from their pockets?”

Now this is something that goes beyond my reach, I have ideas, but how they would ever happen in the US maybe an impossibility. The glaringly obvious solution is that instead of hospitals benefiting from pre-hospital care, then it is just shared amongst those other health care providers that have responded to the new needs created by the new and improved EMS service. If an ‘urgent care clinic’ suddenly sees a business potential in opening its doors to direct ambulance referrals for minor injury and illness patients instead of transporting to an out of area ER, then kudos to them and allow them to make some profit from providing  service that is needed and appreicated in their own community. If an ambulance service historically gets its funding from transport to the hospital, then surely some of that revenue can just be transferred to the clinic that has just opened that will now take ambulance patients, and they will then pay the cost of the transport to their facility.

Dont get me wrong, this is an almost impossible task to comprehend, never mind to put into place, but I am hopeful that someone far more intelligent than me can maybe think of a wat to change the funding system to encourage EMS services to be innovative in the way that they approach patient care.

So, what do you guys think? Are we asking for the impossible? Is this all going to be for nothing?

I would love to hear your thoughts…….

Posted by Mark Glencorse on March 9, 2010 • Filed under: Chronicles of EMS, CoEMS, EMS 2.0, EMS Systems, EMT, paramedic • Tagged: , , , , , ,

EMS Today 2010, Baltimore Roundup!

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(This post was wrote 12 hours ago whilst sitting waiting for my plane from Baltimore. I post it now while waiting at Heathrow for my plane home!)

This seems to be becoming a bit of a habit for me. Sitting in an airport lounge reflecting on the latest developments in the Chronicles of EMS Story.

This weekend is going to take a while to sink in. There has been so much happen, so many new meetings of like minded people and so many friendships solidified once face to face.

Things couldn’t have gone better with Zoll. To have a partner like them and with someone like Charlotte charging ahead after recognising the possibilities for using social media for a greater good, we really do seem as though we are on a roll.

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Charlotte from Zoll and the Chronicles Team (minus Chris Eldridge)

My Baltimore EMS Today experience ended by being invited to the Zoll Summit in Denver Colorado in 5 weeks time to give a talk along with Justin on EMS 2.0. We have tentatively titled it

“EMS 2.0. What that means and how we can achieve it through the use of social media”

Would you come and see a presentation at a conference on that?

It also looks likely that the Chronicles team will be making an appearance at EMS Expo in Dallas, Texas in September too, and after reading my emails just now, it appears that Justin and Ted had a very productive journey home on the plane to San Francisco yesterday, and they have come up with some fantastic ideas for our next conference, but more on that once things are confirmed.

For the first time in my life, I have also lost my voice!

I have never talked so much and I am now paying for it. If it didn’t hurt so much it would actually be quite funny.

So, what have the Chronicles achieved at EMS Today?

That is what we need to ask ourselves and that is what I need to know so that I can justify being away from my wife and children so much. After all, if we haven’t moved forward, then it has just been a bit of a jolly for me and the boys (and girls, sorry Carissa!)

What we can be certain of after this weekend, is that we know there is a strong market for what we are doing. It has been made abundantly clear, that there is a passionate desire for the everyday medic to have their story told. It doesn’t need to be a dramatic or traumatic story, just real.

After a few hours of being on the conference floor, it became noticeable that our conversations with those who hadn’t heard of the Chronicles followed exactly the same path, and it went something like this:

Someone walks past the stall and sees the fantastic T-Shirts that Zoll got for us. There was a quick double take and a quick scan around our makeshift stall.

“Hi there, have you heard of the Chronicles of EMS?”

“Err, no.”

“Okay, can I quickly tell you a little about it, so you can let me know what you think about it”

There follows a brief description of how Justin and I met, and what the Chronicles of EMS is and what we are hoping to do with it. This is universally met with the same response….

“Really????,   Really????……..That’s awesome!”

Then comes their story.

As soon as they know that someone wants to hear their story, they jump at the chance to tell me about their system, their hopes and their frustrations, and the really exciting thing for me was that this was from an EMT-B right the way up to some EMS Chiefs.

There wasn’t a single Chief of EMS who stopped by to say hello, who didn’t leave without saying that they would love to have the team come and see what they do in their system.

This brings me to the second achievement of the weekend.

As well as the previous plans for Germany, Austria, Switzerland and Ireland, we know have permissions either granted or promised from a Chief for Richmond Virginia, Las Vegas, Florida, Washington D.C, the South of France, and various other smaller agencies throughout the States.

The only problem we have now is to find the time to actually go and visit these systems!

Then there were the networking opportunities.

Not just with Chiefs of EMS and manufacturers, but with our colleagues across the world. Thorsten Hagel from MAS Aeromed in Germany stopped off on the first day to say hello then returned on the second day with presents for Justin and I just to say thank you for what we are trying to do. Then there was the multitude of EMS professionals (and I use that term to use all people working in EMS who think and act like a professional – In my opinion it doesn’t matter if you are an ECSW, EMT-B, Paramedic, Advanced Paramedic or Chief of EMS, you are only a professional if you portray yourself as such) who I had the honour of spending some time with.

Discussions are well underway with a uniform manufacturer after I pushed Justin in the direction of some hi-vis jackets that I liked the look of (Hey, I know my place in things and I know Justin is better at schmoozing the folks who need to be schmoozed!), and believe me when I say that they are going to be something really rather cool!.

Then there were the personal highlights, away from being directly involved in the Chronicles of EMS. I got to meet soooooo many of my blogger and Twitter friends that it was just mind blowing.

There are some who I work with who think that my “internet friends” are not real friends, after all how could they be? Maybe I am just a saddo who has no friends and has to use the internet to meet people to be friends with?

I answer that by being honest and saying I have more real friends in the States and around the world than I have ever had in my close vicinity in the UK, and it makes it so much more special that I have had the chance to hang out with so many of you over the past few days.

In the words of a famous Greek philosopher:

“I love you guys!!!”

I won’t even attempt to list everyone here for the fear of missing someone out, but suffice to say that if we met, and I shook your hand, gave you a hug or just spent some time chatting, then I am talking about you!

A special mention has to go out to some people who made my last night so enjoyable.

Seb Wong, Chris Kaiser, Kevin (@NJDiveMedic) and Mike, who took me out to Hooters for dinner on Saturday night, I had one of the most enjoyable evenings out with friends for a very long time. And that had nothing to do with the Hooters girls (honest Mrs999!)

From making the mistake and thinking I could handle the 911 sauce on the chicken wings to seeing Mike drinking the hottest sauce they had, THROUGH A STRAW!, to hearing about Mikes childhood exploits, seeing Chris trying to get into his oysters with a blunt knife and nearly lopping a finger or two off, to just spending time in Seb`s company and seeing his face light up when his Mike turned up who he hasn’t seen for many a year was just brilliant.

The real downer of the night though was when it was arranged for the Brit to have his photo taken with the hooters girls.

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It’s a hard life being a blogger isn’t it?

But most important of all, is that I now get to go home and see my beautiful family again.

And yes, I have got Mrs999 a present this time, although I don’t know how it will go down? Guess I will soon see though.

Anyway, time to go and board the plane again. 9 hours and I will be back in Heathrow for a 3 hours stop over before the short jaunt home!

Speak again soon chaps, it’s been a blast!

Posted by Mark Glencorse on March 8, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS, EMS Today, EMT, paramedic • Tagged: , , , , ,

Is EMS 2.0 as big as we think?

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TOTWTYTR has again, wrote a very thought provoking post on his blog. This time the subject is our very own EMS 2.0 and indirectly ‘The Chronicles of EMS’

He has some very valid and interesting points to make, and this could be the starting point for a great discussion on how to move forward. Just don’t be getting all defensive when you read it ;-)

Head on over to Thoughts about EMS 2.0, have a read then join the discussion in the comments section.

Posted by Mark Glencorse on March 1, 2010 • Filed under: Chronicles of EMS, CoEMS, EMS 2.0 • Tagged: ,

A HUGE step forward!

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****Also posted over at Chronicles of EMS****

blogging

I may be over egging this a bit, but this morning has shown exactly what the Chronicles of EMS is about!

One of our main goals was to get everyone talking, to get everyone discussing issues that are hindering EMS moving forward, and to provide answers and plans to change what we do into a truly recognised health care profession.

This was always going to be a grass roots, ground up movement. That is where its strength and status comes from. It is the people who are at the sharp edge on the ambulances and fire engines who see the problems first hand, and know the solutions, but yet they always come up against a brick wall of red tape and bureaucracy.

Social media has given us all a platform to voice our opinions, ideas and suggestions. Used properly social media is going to move EMS onto much greater and better things.

But…..

We still have to convince the decision makers and policy writers, and sometimes, they are all more than a little scared of social media and the lack of control that they have regarding the content that is shared.

We have moved a long way to allaying those fears through our own self regulation and professional and ethical responsibilities that we take into account when blogging or using facebook or Twitter, and hopefully we will be able to engage the real movers and shakers in our profession on these very same platforms.

Which brings me to my point..

Imagine my surprise this morning, when I have a look on Twitter to see a tweet from Sebastian Wong announcing a blog post on his new blog.

In case you don’t remember, I mentioned Chief Wong when I was writing about my time in San Francisco. If not, you can read that post here.

Personally I find this HUGE!

An Acting Section of EMS Operations of the San Francisco Fire Department has started his own blog to share and discuss his thoughts and musings. Even in his very first post he mentions that they did things wrong during the merger of the Ambulance and Fire Service, and talks about losing some ‘good people’ as a result of this.

We need to show our support to Chief Wong, and we need to encourage other senior management figures to come and join us in this new era of communication and openness.

Seb Wong has started something here that he needs to be commended. From the first time that we spoke over that beautiful steak in San Francisco, I knew that he was the type of man to work with to make things better. Now I know that I was right.

Before I completed this post, I sent him a message to verify that it was ok to mention his full title in this post. He said that was fine, but I also want to include some of the email that he sent back. It shows the kind of man he is, and I am going to use his presence in our community to hopefully dis spell some of the fears about blogging and social media to some of my own senior managers and other influential people in our rapidly growing community :

“One of the reasons why I did this was because and employee told me that he wished there was a greater flow of information from the Administration to the paramedic on the ambulances. You and Justin taught me that information was more important shared that withheld.
As a young supervisor, a person I respected greatly sat me down and told me that my job title may be changed but my duties and responsibilities didn’t. Except they were expanded. He explained to me the concept that is now known as servant leadership. (maybe that’s what I will blog next about.)”

Seriously chaps, go and visit his blog, Really?….Why?…..OK! Leave a comment, subscribe to his RSS Feed and let him know how important it is to have voices like his to help move us forward and embrace EMS 2.0

I for one am excited to hear what he has to say.

Posted by Mark Glencorse on February 27, 2010 • Filed under: Chronicles of EMS, CoEMS, blogs • Tagged: , ,

Biggest EVER EMS Blogger Meet up?

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emst_logo

I had a great post planned to tell you all about what is going to be a monumental day for EMS blogging and bloggers next week at EMS Expo.

However, my dear friend Mr Happy Medic beat me to the post with a whole lot more wittier and amusing post that I could have dreamt up given my constant state of knackeredness (is that even a word??) at the moment.

Anyway, If you are EMS expo in Baltimore next week, add an entry for the March 5th, 8pm, then click on this link to go and read all about it over on Justins Blog.

A special mention has to go to Mr Chris Kaiser though. He may have biceps that look like cheese strings, and probably couldnt beat my 3 yr old in an arm wrestle, but he is making amazing forward movement for EMS 2.0, and has managed to get this meet up sponsored by non other than the George Washington University. Who knows, maybe they will lead the way for the educational changes that are a must to see EMS develop into what we all hope and know it can be!

See you all next week!!

Posted by Mark Glencorse on February 25, 2010 • Filed under: Blooger meet up, EMS Today • Tagged: ,

A seat at the Table – Episode 2

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CoEMS

Hi all,

Just a quick link this morning…

Episode two of our ground breaking discussion series is now live and available to view.

In this episode, Chris Kaiser, Justin and I continue to discuss the importance of EMS 2.0, the difficulty in Health Care Reform and what it means to be a professional.

Spread the word and dont be afraid to leave your feedback in the comments. We want to know what you think!!

Posted by Mark Glencorse on February 17, 2010 • Filed under: A seat at the table, Chronicles of EMS, CoEMS, Videos • Tagged: , ,

“A Seat at the Table”

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File1-SeatatthetableSo have you watched episode one of ‘A Seat at the table’ yet?

This is a sister program to our Chronicles of EMS show, that you have all been raving about!

Episode one was a discussion that Justin, Chris Kaiser and I had about EMS 2.0 and where the profession of pre-hospital care needs to go. However, what makes this series so unique is that you get to be part of it too.

Every time we film another set of episodes, which will be every time we travel to a new location to learn from another type of EMS system, there will also be an opportunity to discuss things further with professionals and leaders of the area that we are in.

And that includes you guys!

This is taking the social media concept side of the Chronicles of EMS and maximising its potential. How many other opportunities do you have to get your voice heard and your thoughts, concerns and aspirations out there to a wider audience?

So sit, back and enjoy episode 1…..We have another 5 coming your way over the next few weeks and months, then look out for details on when you can be involved in the future.

It would be great to have you take a seat at our table!

Posted by Mark Glencorse on February 16, 2010 • Filed under: Ambulance, Chronicles of EMS, CoEMS • Tagged: ,

Lets get this show started!!!

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CoEMS

Its come round so quickly!!

Im now sitting in Newcastle Airport waiting for my flight to Paris to start boarding so that I can start my journey back to San Francisco and the world premiere of the Chronicles of EMS.

In 15hrs time or (9.30pm today UK time) I will be arriving in San Francisco to meet up with Justin again. Kim and Justin have been gracious to allow me to stay with them for this weekend which I am looking forward to just as much as the launch party itself.

Last time I was over there, I hardly had any time to spend with Kim and Justins children. In fact, it had just got to the point that they would not run away and hide when I was in the room, when I had to leave to come back to the UK!

Then comes tomorrow night……

There are going to be so many people there that I feel as though I already know, but have never actually met yet.

Im really glad that Ted organised the event to be from 4pm till 7pm (11pm – 2am UK time), so that it gives us all a chance to socialise after the show too.

I know that there are many bloggers writing about what this means to the profession of EMS and the potential of what the CoEMS may bring. but the amazing thing is that, it may actually happen.

There are so many important and influential people going to be there on Friday night, that this will be a real opportunity to kick start the concept of the EMS 2.0 movement. Taking EMS to the next level of its development and letting it stand in its rightful place alongside other health professions.

Here is some of the things people are saying about it :

Life under the Lights :

“With their efforts come Hope… Hope that one day soon EMS will take its rightful place as a true profession; Hope that our profession will get the paid the attention that it deserves; Hope that our educational standards, resource needs, and compensation will finally be improved; and Hope that we will be able to improve our total service to our patients and our community through shedding a new light on our profession”

Fire Daily :

“What started out as two guys blogging has morphed into what just might be the second coming of EMS around the world.  Seriously!”

The Happy Medic :

“Various committees and organizations sprung up with a spot for us, among dozens of others, making sure we had no chance to be heard.  EMTs and Paramedics were never given a seat at the table. So we made our own”

David Konig :

“I briefly mentioned the existence of The Chronicles of EMS (Twitter hashtag #CoEMS) yesterday, but the truth is that it is an initiative that deserves its own post (or a dozen or so).”

Richmond EMS Examiner.com :

“If you are part of the fire and EMS community on Twitter or Facebook then you certainly have heard about “The Chronicles of EMS” reality series (Twitter hashtag #CoEMS).  If you are not, and do not know about it then you have been missing out on a truly unique project”

EMS Responder.com

“Chronicles of EMS was created as a form of ‘edutainment’ in an effort to inspire dialogue, raise awareness and generate a change of impression the EMS industry has about adopting social media.”

Believe me when I tell you that this is a drop in the oceon of what people are saying. There is such a buzz about what Ted Setla has created!!

So, thats it. If by some chance you havent seen the trailer, you can view it here

And if you want to be there for the premiere, but cant actually be there, you can still come along to the live premiere by the wonders of the web right here.

Whoops, time to board…..See you all on Friday night!!

Posted by Mark Glencorse on February 11, 2010 • Filed under: Ambulance, Chronicles of EMS, San Francisco Fire Dept • Tagged: , , ,

Zoll, EMS Today and The Chronicles of EMS!

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CoEMS

It really is amazing what can happen when like minded professionals share a common goal and seem to capture a level of enthusiasm in the masses of a particular group of people.

The Chronicles of EMS continues to grow, and with that comes opportunities that either present themselves, or are developed from small ideas into, frankly huge ones.

As you all know, if you have been following The Chronicles, Zoll, our main corporate sponsor has already stepped up to the plate as an early supporter for Ted Setla`s vision of where Justins and my initial project idea could develop into. Never in my wildest dreams could I have imagined such a change in my professional  (and social) life could have happened in the space of 3 short months. You can visit what Ted is up to at his site and hub for the Chronicles by clicking here.

I have already been to San Francisco, to work alongside Justin in the San Francisco Fire Department, and had the honour and privaledge of working with Ted and Chris Eldridge on the first episode of ‘The Chronicles of EMS’

I now get to go back to San Francisco in 6 days time for the live premiere of the pilot episode, thanks to donations from some of our supporters as well as financial support from some of the Chronicles team themselves. All of which I am extremely grateful for. Next Friday night looks to be one of the best nights I will likely have for quite a number of years and I cant wait to meet so many of the people that I have been communicating with through the wonders of social media, in person.

But, it doesnt stop there…

zoll_logo1Thanks to the hard work and negotiations of  Carissa O’Brian (www.reboxcommunications.com) and the forward thinking team at Zoll, Justin and I will now be at our very own Chronicles of EMS stall at the EMS Today Conference and Exibition in Baltimore from the 4th to the 6th of March.

Zoll have much planned for us including regular Q&A Sessions as well as the potential to have some pretty cool CoEMS/Zoll Merchandise to hand out for a minimal donation. We will be at Stand 3707 along with the rest of the Zoll team, so if you are coming out, make sure you pop along and say hello to the funny talking British guy!

But most of all, it is our opportunity to reach out to more people to spread the word of The Chronicles of EMS and the concept of EMS 2.0.

It is an added bonus to move over the east side of the country as well, as I know there are many supporters and followers who would love to come to the premiere in San Francisco, but the distance is just too great. (I keep forgetting just how big the USA actually is!). Hopefully this way, Justin and I can get to know even more of you and ask where you would like us to go next and what you want us to see?

Its going to be a hectic 4 weeks, and one hell of a Jetlag experience, but it is something not to be missed.

Zoll – Thank you for taking the step and embracing the opportunities that Social Media can bring to EMS.

Ted Setla –  Thank you for your vision and your continued unbounded enthusiasm.

Carrisa O`Brian –  Thank you for helping to make this opportunity a reality

Mr Happy Medic – Thank you for being ruggedly handsome and attracting the female audience!

Oh, and dont forget, you can help raise funding for further episodes of CoEMS just by clicking on this link and filling in the form, for which Zoll will donate 5$ to CoEMS

See you all in the USA soon!

Posted by Mark Glencorse on February 5, 2010 • Filed under: CoEMS • Tagged: ,

A Flaw in EMS 2.0?

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star_of_lifeSomething occurred to me last night whilst at work.

I was getting some comments in on my last post, all of which were very positive and flattering. I was expecting a couple of people to ‘bring me back to reality’ but that hasn’t happened yet.

So, I got to thinking.

Almost by definition, if you write and EMS blog, you are going to be passionate about the work that you do. You have to be, or else you are just plain mad to put so much time in above and beyond what you ‘have’ to do for your day job.

Equally, if you are in the profession already and you choose to read various musings and thoughts from colleagues around the world, then you too have a certain love for the job also.

Even those that comment or blog in a negative way, must still have a passion about what they do, otherwise they wouldn’t take the time to put opposing views forward all of the time.

One of the major forced behind EMS 2.0 is the use of social networking and new media to join together so many like minded individuals to create a group force for change. However, are we all just preaching to the converted?

No matter how much we like to think our movement is gaining momentum (which it definitely is), we will always be a minority in our services. There will always be more people who are not quite as passionate, and are maybe quite happy to come to work, do what they have to, get their pay check and go home without a care in the world.

As Ambulance Driver states, it is the views of the idealistic dreaming few that can create change, however, we need to bring the majority along with us.

Therefore the question is how we get the message out, in a meaningful way, which will start the change process. How do we reach the EMS staff that don’t read blogs, pick up trade journals, go to EMS Expo, or even want to think more deeply than just dealing with the patient in front of them?

Surely that is going to be one of the biggest challenges that we face.

Or am I wrong?

Posted by Mark Glencorse on October 29, 2009 • Filed under: Administration & Leadership, Ambulance, EMS 2.0, EMS Topics, EMT, emergency, paramedic, prehospital care • Tagged: , , , , ,

My thoughts on EMS 2.0

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Future NHS Design Ambulance

Future NHS Design Ambulance

Chris Kaiser, over at Life Under the Lights, has posted a fascinating piece today on the future of EMS, or as he likes to call it, EMS 2.0.

In his post, he ponders the questions that come from looking at where the profession may go clinically, in the future. If you have a proactive and forward thinking medical director who wants to implement loads of new procedures, medications and other advances into the pre-hospital arena which were historically held in the realms of in hospital physicians, where could it lead…..?

Click here to read Chris`s post, then come back to get my response.

Ok then, so what if I turned up to work tomorrow and all of my dreams came true (to do with how I would like to treat my patients!!)

Chris makes a valid point and one that has reared its head on many occasions in the past in my service. That of payment for the skills that we use. In the UK we are on par with the pay that a brand newly qualified nurse gets when they leave nursing school, who has far less direct responsibility for patient care than we have. To get the same sort of level of responsibility, the nurse will be on a significantly higher salary bracket than the paramedic.

When we first began to use Morphine, the payment question came up, and there was talk of an additional payment for Paramedics willing to use it. In the end it just became part of our protocols and we all ended up using it. Then came autonomous administration of Tenectaplase for STEMI (clot busters for Heart Attacks). We did not need permission to do this; we did not need someone to look at the ECG and say, Yup..OK….go ahead and administer the thrombolysis. It was down to the paramedic in the back of the ambulance, making a clinical diagnosis and implementing a treatment pathway that included the administration of a potential dangerous drug for the patient (albeit one which has much greater benefits than risks).

Again, there was talk about additional payments, but again, it just became part of our standard treatment guidelines.

There seems to be a pattern forming here, yes?

The Ambulance service is constantly moving forward. Medicine and treatments are constantly being developed and trialled in hospitals. Shortly after something is proven in the emergency medicine field, someone somewhere thinks about if it would improve patient outcome if given earlier in the prehospital setting. Inevitably it comes to us and we jump at the chance of having the opportunity to make a difference for some more of our patients.

I am one of the ones who have always said I would be happy to do these extra things, as I want to be able to give my patients the best possible treatment. I am not in this job for the money, that is blatantly clear, but I am in this job to move forward and develop the practice of myself, my colleagues and my profession where ever possible.

I wonder though, are paramedics like me doing my profession harm?

It shouldn’t come down to money, but surely there needs to be some recognition for the extra skills, assessments, diagnostic abilities and most importantly, ultimate responsibility that we as Paramedics and EMS providers hold.

As far as I can tell there are still many, many people wanting to be a paramedic. Recently, my service has just put out an advert for Student Paramedics and we had over 700 people apply for 25 positions.

These will come out of training school keen and eager to do what they can for their patients and in the mean time, they will come out with all of the extra skills and abilities that some of the current operational staff will not have had the opportunity to be trained on, or want to be trained on.

But what about Chris`s vision of the future….Paramedics performing thoracostomy and thoracotomy on the road side, giving drugs which would never have even been imagined to be given in the prehospital setting and generally taking the FULL ER/A&E department to the patient. (Just as a point of interest, one of our A&E consultants is actively recruiting paramedics to train to do Fast Ultrasound scans in the field to assist in treatment decisions).

In a previous post, I have talked about the analogy of a Paramedic Lego man. One little fella who is constantly having extra little bricks (skills) added onto him at least once a year. He keeps on getting more, and more, and more bricks until one day the base cannot hold him any further and he topples to the ground.

There are already some paramedics who are finding it hard to keep up with the ever changing guidelines and the ever more ‘diagnostic’ and assessment side of what we do.

I can’t think of any other medical professionals on the same pay grade as us who have the responsibility to go out to see someone who has dialled 999 for help, assess them, then have the ability to tell them that they do not need to get any further help and can stay at home.

Paramedicine needs to move forward, but for that we need to be seen as a profession in itself, a medical speciality that can attract the type of people who will thrive in this environment and bring it forward into the exciting and ever evolving animal that is EMS in the 21st Century (or should I just say EMS 2.0?)

However, I think we are getting ahead of ourselves by looking at all of the wonderful interventions that we may be able to do in the near future. My particular priority in taking EMS to a true profession starts at a much lower stage than advanced practice.

What I really want to see is a dedicated group of health care professionals who strive to keep up to date with the latest developments in their field. Who have been trained by highly skilled clinicians and experts in their fields. Who have maybe even had to re-sit a couple of modules as they weren’t quite up to scratch first time round, and the organisation said “Sorry you’re not quite ready yet, but we will help you get to where you want to be”

I want to see Paramedics be proud of what they do, but more importantly take pride in how they deliver care to their patients.

Once we start to act professional in the proper sense of the word, then we can move forward as ‘professionals’ and take control of our own future as a large and significant group of clinicians.

Too many paramedics are still ‘Ambulance Drivers’, which isn’t a derogatory term by any stretch of the imagination, but we need to move to be clinicians, and embrace all that comes with that:

  • Responsibility for your own development
  • Continuous professional development
  • Respect for the rest of the Multi Disciplinary team
  • An understanding of the ‘bigger picture’ in Emergency Care.
  • An awareness of where we fit into the overall health care provision for our patients.
  • A desire to develop our role
  • Embracing research
  • Being an ‘Ambassador’ for our Profession

EMS 2.0 should not just be a U.S model for the advancement in Pre-Hospital Emergency Care. It is just as relevant in the U.K today as it is in the USA.

I’m completely behind what you are trying to achieve Chris, and I hope that you get your concept to where you want us all to be.

Posted by Mark Glencorse on October 19, 2009 • Filed under: Administration & Leadership, Ambulance, EMS Topics, EMT, Training & Development, paramedic, prehospital care • Tagged: , , , ,