Wednesday, November 12, 2008

EMS Longevity

Work EMS for any length of time and you're bound to eventually question whether you've got the stamina to make a career of it.
We all know the challenges.
It was refreshing, therefore, to read this article by a guy who's been doing EMS for 24 years in North Carolina.
I hope when I've been doing it that long that I'll be half as optimistic as the column's author, Robert Powers.
I don't see why not.
I look at the ways EMS has improved since I worked my first shift as a Basic at MedTrans in 1995.
The field is dramatically better in almost every respect, and I have no reason to expect that this won't continue.
Like I tell myself whenever I respond to the wet shelter in The Big City for the fourth or fifth time in a shift -- this job may be hard, but it still beats working for a living...

Wednesday, November 5, 2008

An Easy Change

Change is hard.

I had an official from the Boston headquarters of the DCR tell me that once when I complained about a parking lot he was putting in my front yard.

This official was the worst kind of government hack, and I hope they move the PIP to his backyard.

But he had a good point.

Change is hard or, rather, can be hard, if you're not prepared for it.

I've written here before about the changes at Spencer Rescue, which under the guidance of its leadership has transformed itself almost overnight (at least in glacial EMS terms) into one of central Massachusetts' best EMS agencies and a place where good medics want to work.

Most of that change took place under the watchful eye of Keith Ventimiglia, the service's former clinical supervisor.

Keith has since moved on to tackle a very interesting project that I look forward to writing about here in the future.

Hired to continue the progress made under Ventimiglia's watch is Dominic Singh, who recently took over Keith's position at Spencer Rescue.

Dom, 31, is an immensely likable and talented paramedic, and in the interest of full disclosure I should admit that Dom and I worked together for several years in The Big City and he is a friend of mine, so objectivity is out the window on this one. Personal feelings aside, Dom has earned his reputation the way all good medics do it -- one shift at a time, year in and year out.

A native of the Merrimack Valley, Dom graduated from Andover High School in 1995 and received a B.A. in Chemistry from The College of the Holy Cross in Worcester. It was during his studies there in 1997 that Dom got his EMT card and went to work for both Patriot Ambulance and the Stow Fire Department. After graduating Dom attended the Quinsigamond Community College Paramedic Program.

In addition to Spencer Rescue, Dom is a career Firefighter/Paramedic with the Amherst (Mass.) Fire Department and was until recently a Paramedic for UMassMemorial/Worcester EMS.

Dom lives in Amherst with his wife and three kids: Matthew, 4; Eden, 2; Ezekiel, 1.

In an email exchange with CMM, Dom was kind enough to talk a little about his new position, Spencer Rescue, and EMS in general.

CMM: EMS is a challenging field, particularly for those working to improve the product, so to speak. What do you see as the main challenge facing QA/QI programs in general, and at Spencer Rescue specifically?

DS: The main challenge that any QA/QI program faces is learning to cater the feedback to your crews, so as to promote growth, learning and better patient care without creating a feeling of alienation or condemnation.
A lot of places start out with the best of intentions, but end up creating an adversarial relationship with the crews, or review so infrequently that too much is missed.
The challenge in Spencer is to cater the program to the wide range of experience and certification levels.
The personnel here range from 20-year medics to basics just out of school. The initiation of the new employe during his or her formative years is just as important as making sure a senior member is current on the latest advanced modalities.
As long as the employee can be encouraged to buy into the program and the administrator keeps the reviews honest and level, it should succeed.

CMM: Spencer Rescue has undergone a remarkable transformation in a relatively short period of time. What has allowed the service to make such strides, and do you think such progress is sustainable?

Spencer EMS has undergone some rather radical advancement over the last several years which were primarily the result of Keith Ventimiglia's leadership. He had a vision of where the agency should be headed, and facilitated that by bringing in a few reliable and reputable providers, as well as updating equipment, policies, and introducing some leading-edge therapies (e.g., CPAP).
I believe this type of change is sustainable as long as each small step on the way is planned, carefully executed, and has the buy-in of the crew members. While administration can choose a course, it will never be properly received without the backing of the providers.

CMM: Spencer Rescue is a third-service, non-profit agency that serves the Town of Spencer. What advantages do you see to this model, particularly in the western part of central Mass, where there aren't necessarily the resources in money and personnel you might find closer to Boston? Any disadvantages?

DS: Unlike some other third-services or fire-based EMS, we don't receive any funding from the town. All the monies collected from transports go entirely back into the agency.
I believe it does truly change the attitude of the crews if they think that their skills and hard work are being used to line the pockets of a distant owner, or all the money is being thrown into a town budget and distributed to other agencies.
Each dollar we make is in some way being used to assist people. I personally find this motivating, and it was a major in my decision to accept this current position. I'm truly working to heolp people and maintain a healthy environment for providers of a like mind.
We even allow the citizens of our service area the opportunity to buy-in to the agency with our subscription drive. It pays for itself in one transport, and offers a little bit of ownership in our end goal. [Residents] know that those dollars are going directly to this specific agency, unlike your taxes.
Our only disadvantage with this system comes from some people's view that, because we are not a "town department," we don't have their best interests in mind. Nothing could be further from the truth.

What's on the horizon for Spencer Rescue? Any new initiatives or changes you can talk about?

We're currently accepting sketches for a new patch design, possibly a couple changes to the uniform.
We're also investing in new outerwear and PPE for all department members.
My plan is to invest in our crews as much as they invest in us. There are definitely other plans in the works, but nothing I want to roll out in this forum. Sorry!

What was it about Spencer Rescue that first appealed to you, and what advice would you have to leaders of similar services about setting and achieving clinical goals?

DS: Spencer actually came to me. Keith contacted me to come in and fill some shifts. After checking it out for a while, I saw the unique model Spencer operates under and how this is truly the core structure I had been searching for. I also saw the potential this place had and wanted to be a part of its rise to that potential.
The only advice that I hve is to keep your crews involved.
If the crews don't buy-in then you're doomed to fail.

Saturday, November 1, 2008

Another podcast

Just wanted a quick note to plug
It's another site with a collection of awesome lectures, most less than an hour long, touching on some current topics in critical care medicine.
The site has some great information that is applicable to all venues of EMS, not just critical care.
Recent topics have included lectures on crush injuries and rhabdomyolysis, a two-part overview of MIs and their management (particularly thrombolytics and PCI centers), abdominal compartment syndrome (that one's for you Dr. Restuccia; I'll never forget sweating my way through the compartment sydrome question on your infamous written exam), and the philosophy and methodology of pain control.
The lectures can be downloaded to an mp3 device, or simply audio-streamed directly from the Web site.

Urban Inspiration

As you all know, one of my favorite blogs out there is Rescuing Providence, written by Mike Morse, a lieutenant on the Providence (RI) Fire Department, where he works on one of the country's busiest ambulances.

I especially liked his latest post, which I've linked here.

It made me think of all the times where an extra moment to take a closer look at my patient as a person has reaped amazing rewards.

I've been blessed to serve Holocaust survivors and war heroes, Gold Glove boxers and a novelist or two, General Patton's driver from WWII, long-forgotten celebrities and, once, a woman who was raised in the Philippines practically as a member of General Douglas "I Shall Return" MacArthur's family, and who went to elementary school with the children of Dwight Eisenhower, one of the most important figures in U.S. history.

These were interesting people and I am a better person for having met them.

They are proof positive that beneath the surface of some of these silly EMS calls we go on there occasionally lies gold.