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A Better Place to work

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There’s a great post up at on the culture at some of the “Top Places to Work” and how they differ from the norm and the worst.

In particular, the authors mention that “many organizations are bastions of dysfunction, where overwork and stress fuel negative and aggressive behaviors.” This rang true to me as the norm at least half the places I have worked in EMS.

We all talk about the need to show people respect and keep people motivated but I think many of us are at a loss as to how to do this day to day. There are some good pointers in the post, check it out.

Written by ben

December 14th, 2009 at 8:44 am

Posted in leadership,links

Get involved: Advocates for EMS

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AEMS’ mission is to promote EMS, educate elected and appointed officials and the public on issues of importance to EMS, monitor and influence EMS legislation and regulatory activity, and raise awareness among decision-makers on issues of importance to EMS.”

Among issues they bat for are increased NHTSA funding for EMS, increased funding for the NEMSIS database, along with other EMS related funding from the Dept. of Homeland Security, Department of Health and Human Services, FEMA, and others.

They also offer, with NAEMT, an excellent website called the “AES & NAEMT Legislative Action Center” detailing current issues in EMS, and highlighting how your state representatives have voted on them. Information is available to write your representatives and urge them to vote yes in support of EMS, along with their past voting record in these areas.

To my knowledge, there is no other group in Washington dedicated specifically to advocate for the EMS industry. I suggest becoming a member if you are able.

Thanks to Chris and Episode 6 of the EMSGarage for drawing me to this excellent organization.

Written by ben

October 21st, 2008 at 12:35 pm

Posted in leadership,links


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I am at the Colorado Advanced Life Suport ConferenceMike Taigman was speaking yesterday, and he mentioned TED!  I was so excited that someone else had heard about it I laughed out loud.  Then I realized I should share this gem here.

TED stands for Technolgy, Entertainment, Design.  It is an annual conference held in Monerey, CA that “brings together the world’s most fascinating thinkers and doers, who are challenged to give the talk of their lives (in 18 minutes).”  The best part is that they make the best talks available online for free.

I’ve watched several of these through the years, and I have never been dissapointed.  The talks range from serious to hilarious.

I relate this here because I believe very strongly that ideas from anywhere can be incorporated into your practice.  The example used yesterday was this TED talk from author Malcom Gladwell about the history of Spaghetti Sauce.  The point of the video was that the food industry discovered about 25 years ago that there is no one perfect Spaghetti Sauce, there are hundreds; everyone has slightly different preferences and tases.  The point for our purposes: no one learns the same, and no group of people are is looking for exactly the same information.  By injecting variety into your teaching practice, you can reach more people more effectively.

Browse through the available videos and watch one that piques your interest.  I don’t think you’ll be dissapointed.

Written by ben

October 17th, 2008 at 6:57 am

Posted in ideas,leadership,links

Debreifing difficult calls

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You have a huge opportunity to learn from critical calls during your turn-around time at the hospital.

After a critical call, while still at the hospital, take 5 minutes to debrief the call and review any lessons learned. This might include cardiac arrest, critical trauma, severe illness, and any call that requires lots of work and critical thinking.

In my experience, most EMS systems offer the ability to take a third rider into the hospital with the ambulance to assist with care of a critical patient.  Typically this will be a firefighter or two from the fire crew you ran the call with.  This results in everyone with whom you ran the call being at the hospital afterward (the fire engine often follows the ambulance to the hospital to pick up their missing crew member)  This means you have a great opportunity to sit down with everyone who ran the call for a few minutes and go over it.

We can learn things from any call.  Critical patients offer not only the best chance to make errors (I’ve made plenty), but also the best chances to learn from them.  Research has shown [sorry, no link] that the best time to review and retain information is one to two days after first introduction of new information.  Typically, if I review these calls at all with anyone besides my partner, it is in one of two settings (outside the call to my training guy with a stream of questions): M&M review or a call into a CQI meeting.  These trainings usually occur 1-2 months after the call: far too long to retain anything important.

So when it is possible, take an extra 5 minutes at the hospital to go over things with everyone involved.  Get permission from your supervisor or from dispatch if necessary.  Everyone will have ideas about what went wrong and right.  Some will have misconceptions about what happened that can be cleared up right then – offering understanding all around and maybe the opportunity to stop a call to your quality manager.  Everyone will have a chance to learn more about that patient and their condition.

It can be difficult to create an environment in these situations where everyone feels comfortable speaking frankly.  I’ll offer some guidelines gleaned from my organizations M&M review own guidelines(themselves taken from the Massachusetts Medical Society and an article from the Journal of Academic Internal Medicine).  All are aimed at creating a comfortable environment.

  1. Make sure that everyone understands that all questions will be respected.
  2. Limit who can participate only to those who were there.  This Any other ambulance crews or hospital staff who are interested in participating should be asked to leave.
  3. Be sure that everyone is comfortable having this discussion.
  4. Most M&M reviews also involve the understanding by participants that nothing leaves the meeting.  Since this is not an official, sanctioned type of meeting involving medical directors and other higher-ups, I really don’t think this is advisable here.  Any significant clinical issues should be brought to the attention of the appropriate people immediately.

Also, if you are the one organizing the discussion, you have the role as moderator.  In addition to creating a comfortable environment for everyone involved,you should strive to:

  1. Keep the discussion limited to he call.
  2. Start with what went right and give credit to everyone involved for their role.
  3. Identify problems without assigning blame to specific individuals.  For example, failure to give a medication in the appropriate amount of time is not solely the fault of the person giving the medication.  Blame lies with the person running the call, the person holding the drug kit, the person giving the medication, the person starting the IV, and the atmosphere of communication among the group in general: EMS calls are a team effort.  Caveat: don’t let this become the excuse for poor performance.

Learning from your calls does not have to be limited to that provided by the clinical education staff months later.  It can happen in just a few minutes following the call.   Whether it was run-of-the-mill, or the best/worst call you have ever run, you can learn things here. Give it a try.

Written by ben

October 16th, 2008 at 4:22 pm

Posted in ideas,leadership