If you've been watching the EMS 2.0 discussion in the US, UK, etc -- you've probably seen some great ideas of how our EMS services can transform to be better. Hopefully we'll get a good post about that together soon.
However, a video came to my attention (thanks Jeff) about EMS in South Africa, which I wanted to share. This is a very well done documentary about some of the issues with under-resourced and mismanaged EMS resources there, with EMTs and Medics doing their best to provide quality care. Take a look at "Tell Me And I Will Forget".
I'm sure there are many other stories and documentaries from other locations. I welcome your posting of them here, to help us keep EMS in a world view.
Tuesday, October 11, 2011
Wednesday, June 15, 2011
Being the "New Guy"
When I was first invited to contribute to this blog, the purpose was to provide the perspective of someone who was new to the field of EMS...at this point, I hope that I am no longer labeled as the new guy, but I still remember what it was like to enter this field that has its own language, its own hierarchy (sorry everyone, as much as equality is stressed, it still exists), its own unique skill set, and its own place in college life.
I never thought I would end up in a college EMS squad, so when I attended the first informational meeting for Dartmouth EMS in the Fall of 2009, I didn't really know what to expect. I was handed a "New Member Checklist" but I noticed that the mass of 100ish prospective new members who were also handed the checklist stuck out among the handful of those who were obviously experienced EMS members, with embroidered jackets and all, sitting in one corner of the room. Also, as a side note, when one of the first sentences you hear at an information meeting reads something along the lines of: "D-EMS is a college-based BLS-QRS that works with DOSS and Dick's House IPD to provide fast squad style response to the campus. We also require all members to possess at a minimum BLS HCP CPR w/AED and HS FA" you tend to get a little shell-shocked. (Note: The sentence above may have been slightly tailored to make my point...the concept stands however). EMS is obviously different than a standard college club, there is a learning curve along with certain state-imposed requirements that must be fulfilled before one may take shifts. That is understandable, and little can be done to reduce that portion of the burden of attaining initial membership in the squad. What can be reduced however, are the barriers to entry into the "EMS culture." D-EMS has taken several steps to achieve this, from simply encouraging old members to sit among new ones during the first few meetings, to encouraging group dinners after the meeting, to the creation of a social email list that is used to coordinate events outside of official EMS trainings and shifts. For anyone familiar with D-EMS, I think you will agree in stating that we have become a more social organization over the past few years, and with that has come a reduction in the separation (for lack of a better term) that occurred in past terms between new members and the "old guns." If you have suggestions or experiences with this in your squad, please comment!
So, what if you aren't a brand new member. You passed "AHA BLS HCP CPR w/AED" and HS FA and have taken a few shifts as a FR or "tertiary" as we call them. Do you feel that you are completely a part of your squad? The answer for me was yes, partly because I made the effort to talk with my crew members, meet with other squad members outside of official activities, and in general had already developed an affinity for the structure and purpose of D-EMS by this time in the academic year. However, there were many people that still felt like an outsider, and that ultimately left the program because of this feeling. I cannot pinpoint exactly what remedy there may be for this problem, but I can only stress that new members are often the most important to the squad! After all, the seniors won't be around forever (ironic that the 2 other contributors to this blog are involved in D-EMS after graduation) and the new members are vital to the continuation of the organization. I hope this post can find some commonalities among other squads. If you have experiences like this, and definitely if you have found a solution, please let me know!
Tuesday, June 14, 2011
Late to the Party
Ok, so maybe my title isn't really reflective of what I am posting, but it is meant as an apology. I was originally invited to contribute to this blog almost a year ago, and for some reason, I just never got around to it. So, now that I am substantially "late to the party," I thought I would briefly introduce myself. I'm Nick, a member of the Class of 2013 at Dartmouth College. I am currently the Interim Director of Dartmouth EMS and Operations Officer for the regular academic year. I started in EMS as a freshmen at Dartmouth 2 years ago. At that time, I was a "tertiary," basically a First Responder with a few campus-specific trainings added in. Anyway, I was originally certified as an EMT-B in MA during the summer after my freshman year, transferring up to NH (a painful, time-consuming process that I hope to discuss in a later entry) that Fall. As an EMT, I work primarily with Dartmouth EMS and also join Ryan on the NH Medical Task Force of the Northern New England MMRS. I do consider myself an "EMS Nerd" in the sense that it has become a huge part of my college career, not just professionally with the squad, but also socially as well, allowing the opportunity for networking with other squads across the country as well as a strong group of friends and colleagues at Dartmouth. I hope to use this blog in the future as a forum to discuss topics such as Being the "New Guy" in EMS, Reciprocity and its effects on a College Population, Inter-Collegiate EMS communication, and anything else that I may find interesting our relevant. While I may not have as much experience as Ryan or Rob (true EMS nerds in my opinion), I think I have a unique perspective on this discipline and I look forward to contributing to this discussion in the future!
Monday, November 1, 2010
CQI
Continuous Quality Improvement (CQI, also called Quality Assurance / Quality Improvement, or QA/QI) is an integral part of any EMS system. It helps to ensure that patients receive quality care and, if any deficiencies exist, provides a mechanism for gently correcting providers who need it. Most commercial services have some sort of CQI infrastructure in place, either through the medical director or through personnel tasked to the job, and this is an area in which college EMS services should not be complacent either.
When selecting a CQI coordinator, your service's medical director is the first person to ask. It's possible, though, that he may not be willing to take on the additional responsibility of regular CQI work. And in the small college setting, there may not be many other physicians on campus whom you can approach (the student health service would be your best bet here). If that's the case for your service, it's time to start thinking creatively.
Is there a local ambulance service that might be willing to take on CQI responsibilities for your squad? What about alumni of your service that are still in the area? If worst comes to worst, you can appoint a senior, experienced active member of your squad to do the job. When picking your CQI coordinator, keep in mind that you want someone with EMS experience who is familiar with your system. (This may rule out your medical director in some instances, but he's still a physician, and you're practicing under his license, so he gets first crack. But that doesn't mean you can't enlist someone who is active in EMS as well.)
Lastly, keep in mind that CQI is never supposed to be punitive. The purpose of the program is to make sure that your providers are delivering quality care. When deficiencies are exposed, the goal is to remediate the provider(s) in question, not punish them. For this reason, the effective CQI coordinator always remembers that he and the providers under his watch are on the same team and working toward the same goal.
When selecting a CQI coordinator, your service's medical director is the first person to ask. It's possible, though, that he may not be willing to take on the additional responsibility of regular CQI work. And in the small college setting, there may not be many other physicians on campus whom you can approach (the student health service would be your best bet here). If that's the case for your service, it's time to start thinking creatively.
Is there a local ambulance service that might be willing to take on CQI responsibilities for your squad? What about alumni of your service that are still in the area? If worst comes to worst, you can appoint a senior, experienced active member of your squad to do the job. When picking your CQI coordinator, keep in mind that you want someone with EMS experience who is familiar with your system. (This may rule out your medical director in some instances, but he's still a physician, and you're practicing under his license, so he gets first crack. But that doesn't mean you can't enlist someone who is active in EMS as well.)
Lastly, keep in mind that CQI is never supposed to be punitive. The purpose of the program is to make sure that your providers are delivering quality care. When deficiencies are exposed, the goal is to remediate the provider(s) in question, not punish them. For this reason, the effective CQI coordinator always remembers that he and the providers under his watch are on the same team and working toward the same goal.
Monday, September 20, 2010
Expanding Your EMS Horizons
On a college squad, you've either worked as a quick response service, or perhaps as a transporting service. Maybe you also have worked with a local fire department or a commercial ambulance company back home or as an internship. These are all great ways to use your EMS training and learn and meet people.
But there are more places to turn that offer different types of EMS experiences and training, along with providing great networking opportunities. In this post, I'll focus on disaster medicine. Disasters call for large numbers of EMS resources, but also additional training and often using a different model of care.
There are many organizations that you can volunteer with (and/or work for) that provide disaster medical services. I won't try to list them all, but lets focus on the two that I work with (feel free to add more in the comments).
The Metropolitan Medical Response System (MMRS) has teams in most states which are funded by grants from Homeland Security (via FEMA). These teams are staffed by volunteers and are usually under the control of the state's emergency management office (or similar entity). They respond to mass casualty incidents mostly within their state. FEMA describes the goals as such (you can read a detailed document also):
The second organization is similar to MMRS, although with a different focus, and on a larger scale. The National Disaster Medical System has a variety of teams, such as the Disaster Medical Assistance Teams (DMAT). These teams are located nationwide and take turns being on call for a month per year to deploy to locations nationwide or internationally for two week deployments in support of medical operations. DMAT members are federal employees under the US Dept of Health and Human Services, so the approval and training takes a while and the teams require significant commitment. If you deploy, your regular job is protected and you are paid for deployment time. Most importantly, you are working with an extremely talented team of professionals responding to some of the worst natural disasters, etc.
But there are more places to turn that offer different types of EMS experiences and training, along with providing great networking opportunities. In this post, I'll focus on disaster medicine. Disasters call for large numbers of EMS resources, but also additional training and often using a different model of care.
There are many organizations that you can volunteer with (and/or work for) that provide disaster medical services. I won't try to list them all, but lets focus on the two that I work with (feel free to add more in the comments).
The Metropolitan Medical Response System (MMRS) has teams in most states which are funded by grants from Homeland Security (via FEMA). These teams are staffed by volunteers and are usually under the control of the state's emergency management office (or similar entity). They respond to mass casualty incidents mostly within their state. FEMA describes the goals as such (you can read a detailed document also):
The MMRS program supports the integration of emergency management, health, and medical systems into a coordinated response to mass casualty incidents caused by any hazard. Successful MMRS grantees reduce the consequences of a mass casualty incident during the initial period of a response by having augmented existing local operational response systems before the incident occurs. (FEMA HSGP)I have found my MMRS team to be a dynamic group of people (EMTs, nurses, doctors, non-medical administrators, communications experts, etc) that has provided great networking. Furthermore, each MMRS team has trainings that you otherwise don't have access to (at least easily or for free). Plus, the best part is that you are contributing your assistance in a meaningful way when an emergency occurs.
The second organization is similar to MMRS, although with a different focus, and on a larger scale. The National Disaster Medical System has a variety of teams, such as the Disaster Medical Assistance Teams (DMAT). These teams are located nationwide and take turns being on call for a month per year to deploy to locations nationwide or internationally for two week deployments in support of medical operations. DMAT members are federal employees under the US Dept of Health and Human Services, so the approval and training takes a while and the teams require significant commitment. If you deploy, your regular job is protected and you are paid for deployment time. Most importantly, you are working with an extremely talented team of professionals responding to some of the worst natural disasters, etc.
The National Response Framework utilizes the National Disaster Medical System (NDMS), as part of the Department of Health and Human Services, Office of Preparedness and Response, under Emergency Support Function #8 (ESF #8), Health and Medical Services, to support Federal agencies in the management and coordination of the Federal medical response to major emergencies and federally declared disasters including:
* Natural Disasters
* Major Transportation Accidents
* Technological Disasters
* Acts of Terrorism including Weapons of Mass Destruction Events
(NDMS)
College (EMS) Confidential
I was part of the team that designed and implemented the on-call EMS response program for my school, and one concern the administration voiced surprisingly frequently was that of privacy.
The Health Insurance Portability and Accountability Act (HIPAA) forbids, among other things, the unauthorized release of patients' protected health information. HIPAA applies to all on-duty EMS personnel, regardless of their age or unit affiliation. Many college administrators are not familiar with HIPAA--or at least with its application in the EMS setting--so their confusion is understandable.
The college EMS agency has the responsibility to educate the administration and assuage their privacy concerns. Seeing as college campuses are essentially small cities where word travels quickly, the consequences of a privacy violation could be devastating. The administration, and the student body, needs to know that confidential health information will be kept confidential.
For this reason, it's a good idea to conduct an annual or even semi-annual HIPAA training with your members. You may even wish to open the session to the campus community, so they can see what the EMS privacy guidelines are. (And it goes without saying that PCRs and other sensitive records should be kept securely.) Patient privacy is a priority for us, and the better the students and administration understand that, the easier it will be to earn their trust and confidence.
The Health Insurance Portability and Accountability Act (HIPAA) forbids, among other things, the unauthorized release of patients' protected health information. HIPAA applies to all on-duty EMS personnel, regardless of their age or unit affiliation. Many college administrators are not familiar with HIPAA--or at least with its application in the EMS setting--so their confusion is understandable.
The college EMS agency has the responsibility to educate the administration and assuage their privacy concerns. Seeing as college campuses are essentially small cities where word travels quickly, the consequences of a privacy violation could be devastating. The administration, and the student body, needs to know that confidential health information will be kept confidential.
For this reason, it's a good idea to conduct an annual or even semi-annual HIPAA training with your members. You may even wish to open the session to the campus community, so they can see what the EMS privacy guidelines are. (And it goes without saying that PCRs and other sensitive records should be kept securely.) Patient privacy is a priority for us, and the better the students and administration understand that, the easier it will be to earn their trust and confidence.
Saturday, September 18, 2010
EMS: College to Career
I arrived at college as a brand-new EMT-B. Throughout my undergraduate years I was active with the campus EMS squad during the term and with my hometown 911 transport agency during school breaks. Following my graduation, I worked for a private ambulance company for the summer and then moved to Buffalo for paramedic school. A year later, I have begun working as a paramedic. The lifeblood of my fledgling career may have been my time with urban and commercial services, but its backbone was definitely my four years of college EMS. That time was a jumping-off point that has greatly aided my transition to "real" EMS jobs.
For starters, experience is king. There is obviously a minimum level of training required to function in any EMS capacity, but beyond meeting "cognitive" and "psychomotor" certification standards, one of the chief distinguishing features between adequate, good and great EMS personnel is the experience they bring to the table. Collegiate EMS offers its members the opportunity to take calls, treat patients and practice skills. Any experience is good and more the better. Plus, college squads are often less complicated to join than private or municipal agencies.
Secondly, I learned a great deal about "behind-the-scenes" EMS while at college. In two years as Equipment Officer and two years as Operations Officer, I was closely involved with inventory, purchasing, communications, scheduling, training, personnel and inter-agency relations. This provided me with a more encompassing view of the industry that didn't end at the ambulance doors. College EMS is unique in that members can execute a wide variety of offices and responsibilities and do so much more quickly than could be expected in the commercial world. Any college student considering becoming an EMS professional would be well advised to seek office with his campus squad at some point during his (or her) time there.
Lastly, EMS isn't for everyone. Some people are born to do this job; most of us have to work at it. But there are also some people who are destined for greatness in other areas. If you are interested in EMS--in whatever capacity--the only way to know into which category you fall is to try the work. College EMS is the perfect way to do just that.
For starters, experience is king. There is obviously a minimum level of training required to function in any EMS capacity, but beyond meeting "cognitive" and "psychomotor" certification standards, one of the chief distinguishing features between adequate, good and great EMS personnel is the experience they bring to the table. Collegiate EMS offers its members the opportunity to take calls, treat patients and practice skills. Any experience is good and more the better. Plus, college squads are often less complicated to join than private or municipal agencies.
Secondly, I learned a great deal about "behind-the-scenes" EMS while at college. In two years as Equipment Officer and two years as Operations Officer, I was closely involved with inventory, purchasing, communications, scheduling, training, personnel and inter-agency relations. This provided me with a more encompassing view of the industry that didn't end at the ambulance doors. College EMS is unique in that members can execute a wide variety of offices and responsibilities and do so much more quickly than could be expected in the commercial world. Any college student considering becoming an EMS professional would be well advised to seek office with his campus squad at some point during his (or her) time there.
Lastly, EMS isn't for everyone. Some people are born to do this job; most of us have to work at it. But there are also some people who are destined for greatness in other areas. If you are interested in EMS--in whatever capacity--the only way to know into which category you fall is to try the work. College EMS is the perfect way to do just that.
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