College

First, watch this video:

Credit to my friend Frank Piscitello (http://twitter.com/#!/fpiscite) for sharing

What, exactly, is one SUPPOSED to learn on a college campus these days? What DOES one learn? As a college senior myself, I am continually amazed at how many students have no concept of basic life functions. I find there are many students can’t do ANYTHING in moderation. Administrators can’t make up their minds – on the one hand, they acknowledge that almost all the campus community are legally adults, yet they enact rules to “protect” the students from perceived evils of society. While the campus does have walls… by design, access is almost unrestricted, for convenience if nothing else.
As the video points out, the current educational concept relies on the student accepting everything the teacher presents as face value – even when the instruction is blatantly biased. And the student that would seek to challenge bias is seen as a troublemaker.
When did our society change that a college degree is a requirement to enter the “real” workforce? What miracle happens at a college campus that makes a person with a B.A. or B.S. a good manager? Or qualifies them for a 9-5 job, where overtime is uncommon, and things like vacation time and holidays are expected?
I work 12 hour shifts, sometimes 2 or more consecutively. My “office” is a box on wheels with about 300-400 cubic feet of workspace. In that, I have enough tools at my disposal to at least attempt to “fix people”. EMS is the only part of the medical system that routinely makes house calls anymore. EMS, on average, has 30 TIMES the chance of being injured in an assault than the “average” worker. I work outside in extreme cold, extreme heat, and sunlight, darkness, rain and snow are all “normal” things that I’m expected to work through. If I call in sick, it means that someone else is called in or held over… or that the community isn’t as well protected as it would have been, and my co-workers have to make do with fewer resources.
In many cases, my peers and I are paid much less than a nurse… even though the actual responsibility and delegated practice model under which I perform makes me more of a Physician Assistant Lite. But because I have 3-4 years less schooling, I make a small fraction of what a PA makes. Why? Because the only letters after my name are NREMT-P…. not B.S. Even adding additional competencies such as FP-C or CCP-C doesn’t win me much of an increase, if any.

September 11th Reflections:

I know I'm a few days late.

This is where I was last year on 9/11, working a West Chester University of PA home football game with WCU EMS. It was 9/11/10, exactly 9 years after the attacks that changed America. One thing I hadn't known until then was that the First Officer of Flight 175 (2^nd flight to be hijacked and flown into the Trade Center Towers) was a graduate of my school, West Chester University. Not only that, he was the quarterback during two impressive seasons for WCU Football. These days, the prime benefit of a home football game is a chance to see the WCU Marching Band play. If you actually want to watch a football game, you might as well go somewhere else.

Anyway, Michael Horrocks was a noted graduate of WCU. A year ago, they unveiled a statue of him throwing a football. The statue is larger than life, at 7 feet tall, apparently just like Mr. Horrocks. His statue sits along the path that all athletes walking to and from the locker rooms will walk down.

Anyway, the video above is a well-done student production. At 8:20 in the video was a C-130 flyover. The video doesn't do it justice. The planes seemed to fill the sky, and the sound was deafening. As the game went on, I was following Twitter on my phone, and noticed a tweet from 22EMT22, retweeted by TheHappyMedic, mentioning Michael Horrocks by name. Turns out, William, an EMT from Sacremento, CA, knew members of the Horrocks family, and he seemed to appreciate knowing what WCU was doing on that day.

It's been 10 long years since that day... yet I can still remember it like it was yesterday.

Michael Horrocks
3/24/63-9/11/01

And the motto on the plaque:
Honor Him
Never Quit
Love the Game
WIN

And here's the actual text.

\

Up In Smoke, and why is EMS treated different then other employees?

Nicotine Tests Could Cost Fla. Medics Their Jobs

http://www.emsworld.com/article/article.jsp?id=17983&siteSection=1

The above article is the top news story on www.EMSWorld.com right now. Long story short, it appears that the county is now in the EMS buisness, so the EMS employees are now County Employees. The policy change doesn't go into effect until October of this year.

I've never been able to understand why so many people in EMS, the fire service, and LEO's smoke. We've all seen people dying of tobacco-related cancers. My favorite irony is seeing a firefighter come outside from a fire, and take off his mask on his way to rehab... and light up a smoke. If you really want to inhale smoke and carcinogens, why bother wearing a pack?

To be honest, I'm of mixed opinions. While I personally, don't smoke, and can't understand why people do (it's disgusting and harmful to your health). I don't see that my employer (especially a government employer) has any right to tell me what I can and can't do when I'm NOT at work/in uniform.

My biggest concern of the whole article, though, is this line:

“The nicotine test only applies to uniformed workers, like law enforcement. Paramedics and ambulance crew members will be required to take a nicotine test starting on Oct. 1.”

Why does it only apply to uniformed workers? Is there a different policy that applies to the rest of the county employees? The ones that sit behind desks all day, and get real lunch breaks? The article isn't clear, and I can't find anything else quickly online – If someone can enlighten me, I'd appreciate it. If there is no policy for the “office dwellers” - than this policy is out of line.

EMS 2.0 Primer

Ok... blogging again. First post is an EMS 2.0 primer I wrote to a collegiate EMS educator I met at the NCEMSF Conference this year, after attending a very good presentation discussing that EMS will only grow as much as we, as providers, want it to. She'd never heard of EMS 2.0, though. Great minds think alike.

~~~~~~~~~~~~~~

Professor ___,

It was great to see the enthusiasm you have for moving EMS forward... as I said in the session, you are not the only person with similar thoughts. I've been involved in EMS for 10 years, and active in various online forms for much of that time. There are several great web fourms dedicated to EMS, and one of the recurring discussions is the difference in training, professional recognition, and compensation between EMS in the USA, and other countries.

There are MANY EMTs and Paramedics that are active with online blogs, as well as being on web forums and other new social media (Twitter, Facebook, etc). It's amazing that there are many voices in unison saying the same thing – we, as providers, are responsible for helping shape our profession.

A few things I truly think are worth your time online:

EMS 2.0 – Written by a Paramedic from Wisconsin named Chris Kaiser, who writes a blog titled Life Under The Lights (http://lifeunderthelights.com/).

EMS 2.0 seeks to address the issues blocking EMTs and Paramedics from moving forward as a Profession. Built upon the concepts of Technology, Training and Trust, the movement seeks to improve all aspects of emergency services, including community care, disease and injury prevention and opening new avenues for patient care rather than simple transport to an ER.

Chronicles of EMS / Beyond the Lights and Sirens – a ~20 minute short film looking at a fire based urban EMS system from the point of view of both a medic within the system looking for the same change you want, and a English NHS paramedic. The project was instigated by social media, and exchanges between Justin Schorr, who blogs as The Happy Medic (http://happymedic.com/) and Mark Glencorse, who just retired from blogging after several years as 999Medic (http://999medic.com/).

The show is here: http://chroniclesofems.com/reality-series.htm (If you only look at one link, look at this one!).

Lastly, the Chronicles of EMS website has more to say on EMS 2.0:

http://chroniclesofems.com/ems-20.htm

Professor – I actually was able to meet all of the above at EMS Today last year. All are truly great people. There are many providers with a similar vision, united under the concept of EMS 2.0. We are self motivated, and while each of us is a small voice within our respective agencies, we constantly talk online and are able to be self-motivated and help each other. I follow a number of blogs on a daily basis (I am able to read/skim new posts through an application on my phone that syncs from the blog feeds). These blogs help entertain me on my downtime, and engage me in discussion when needed. There is also a great motivation in the knowledge that I am not alone.

If you have ANY questions or there is anything I can do, please feel free to ask.

Jonathan Blatman

Paramedic, West Chester, Pensylvania.

Fraud vs. Government Waste

The other day, I was talking with @WmRandomWard (www.twitter.com/wmrandomward), in regards to his latest blog post (http://randomparamedicine.firstrespondersnetwork.tv/?p=123). Our discussion was about Medicare/Medicaid billing, waste, and fraud.

Further, over on www.EMTLife.com there have been a few discussions lately that allude to EMS "buffing" charts so Medicare will pay.

Take a call from the other night for example. I was held over 5 hours late to deal with transfering a ventilator patient discharge from a Pennsylvania long-term acute care facility to a long term vent unit in New Jersey.

Pennsylvania and New Jersey have very different EMS rules. With Pennsylvania, I can manage a list of IV drugs on pumps, Monitor Cardiac rhythms, and manage advanced airways and ventilator settings. All by protocol and/or written orders. I need a nurse to manage drugs not on my list, TPN, continuous tube feedings, and transport blood.

In New Jersey, there is no provision for a private service to operate ALS interfacility, so all interfacility transports are SCT nurse runs, with a crew that contains at least 2 people who are EMT's as well as an RN (the nurse can also count as an EMT).

So this guy is going from PA into NJ, so I would be covered under PA protocols and rules for the whole transport. It's a simple ALS call - Vent only, not even on telemetry at the sending facility.

Yet I'm told that this run can't just go ALS, and must go with a RN. So now a nurse is coming to meet me and I'm going to jump in with her and do the run, with an EMT to drive us. Why am I there? Because this nurse isn't qualified as a PA ALS provider. So I have to be there, because this call is technically NOT needing a nurse.

So, why is this a nurse call? Punchline: Because NJ Medicaid is the payor, and they don't seem able to pay for ALS interfacility transports. Because they aren't done in NJ. So instead of running the call with myself and an EMT, there are now 2 advanced providers and an EMT, and a significant increase in cost. And guess who's eating the cost?

http://www.courierpostonline.com/article/20110609/NEWS01/106090338/Coalition-criticizes-Medicaid-cuts-N-J-

Yup. NJ Medicaid. The program that is facing huge budget cuts to help NJ's deficit.

We talk about EMS providers and services that commit fraud by billing for services that aren't indicated, but what of the government mandating services that aren't needed?

Jon