Time to Make Some Changes?

Years ago we enacted legislation to protect our patients, improve professionalism, and improve the standards of care. I’m old enough to remember the shoddy ambulance practices that existed here in Portland. We had the best of intentions – we wanted to get rid of those funeral home operators who were only trying to squeeze a little more profit out of their vehicles. We wanted people to get the best of care. We wanted to stop the crazy madness of call jumping, fist fights over patients, and scoop and run transport – without any standards.

[Note: This post is inspired by This Post, by The Happy Medic.]

Credit: Flickr

Interestingly, in those days, we, the paramedics, could refuse to transport someone who didn’t need an ambulance – it wasn’t in the protocols, but it was easy to do. Also, most of us really, really cared about being professionals, and we didn’t really need these regulations.Now, 35 years later, those laws are cast in stone. Most, if not all of the shoddy ambulance operators have sold out and moved to warmer climates, and the profession has changed – substantially. Now, those concrete laws are like shackles around our feet. Eight minute response time requirements are only needed for a small percentage of our calls. Eight responders on every call – the same.

There needs to be changes, but it feels very daunting to even begin that process.

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Killing Us Softly

It’s no secret that sleep deprivation is a killer. Too little sleep is linked with depression, obesity, diabetes, and heart disease. We are lifesavers, but we are killing ourselves while we save others. Whether working in a system that requires overtime, working overtime to make up for low pay, or working in a busy system that requires 24, 48, or longer shifts – your life is ebbing away.

Is it worth it?

I see older coworkers who are barely able to put one foot in front of the other. They are depressed, broken, sick, and tired. Back issues, arthritis, obesity, and other burnout symptoms are rampant. It saddens me to see this.

What good does it do for us to save the whole world, but lose the lives of ourselves and our families?

When we were young we had visions of saving the world. We didn’t care about long hours and poor working conditions, we were pioneers in the exciting world of EMS and we were willing to do whatever it took to save people. My first full-time EMS job paid $4.10/hr. I worked 48/48s, and we ran 32 calls a shift. We learned to sleep and eat whenever – fortunately, most of the hospitals fed us well, and we ran our tails off. I was 21 years old and literally, living the dream! That first year, I made $6000 total.

That first EMS job cost me my marriage. I was either working or sleeping – that didn’t work well.

For the next 15 years, I got one of those elusive fire-medic positions. My pay tripled, my hours were cut by a third, and our call volume was only 10% of the big city ambulance gig. At first I was bored, but I now see how that saved my life.

I left EMS 16 years ago and completed by degree and began to work on post-graduate education. I got remarried, found a new career, and we have a couple of kids. Unfortunately, when the economy tanked, I lost my job – along with about 40 million other people. I figured that the best way to keep my house and feed my family, was to go back into EMS. So, I got re-licensed and found a job as an ambulance jockey.

It was fun to come back. I really never wanted to leave – and I always missed the challenges of transport – something many fire medics don’t get to do.

But a month ago, I had to take a medical leave. I didn’t hurt myself. I don’t have a medical condition. I am just exhausted. Because I have no seniority, I’ve been working nights. Because we had a house in the country, I’ve been commuting three hours – round-trip. It was killing me, killing my family, and destroying our quality of life.

We decided long ago that we had to move, but because we were now upside down on our mortgage, we couldn’t sell the house. Because our income is 30% less than my previous career, we were barely surviving. We drive very old cars, rarely eat out, and don’t take vacations – other than an occasional camping trip. Although we are not in debt, financially, we are in debt emotionally, physically, and medically.

Many of my younger colleagues are so eager to get the adrenaline rush they don’t see the path they’re on.

For the past few years we avoided house repairs, car maintenance, and medical/dental check ups. The co-pays are too expensive and we didn’t want to go into debt. Our lives are literally falling apart around us.

Being older, wiser, and with a few more trips around the infield, I can see this happening. The sad thing is, many of my coworkers didn’t see the job changing around them. And now they’re trapped. Many of my younger colleagues are so eager to get the adrenaline rush we all used to live on, they don’t see the path they’re on.

Something has to change – at least in the for-profit EMS world.

But even the non-profit sector has some self examination to do. Recently, I applied for a management position at a non-profit, hospital-based system. The crews work 48/96s – and apparently, this is causing some big issues. Safety and crew health are being negatively affected, but without hiring additional personnel, they can’t really change the system.

As a profession, we need to look at the issues, address the problems, and create positive solutions. What good does it do for us to save the whole world, but lose the lives of ourselves and our families?

Ductus Exemplo!

Image by lumaxart via Flickr

It’s easy to complain about stuff.  In fact, without trying to hard, you can find something wrong with almost everything.  So, when one stops to think about it, complaining doesn’t take much skill, art, or imagination.  And yet, everyone seems to want to outdo everyone else in their powers of complaint.  Why is this?  What is it about our culture that makes complaining so ubiquitous?  What is it about our lives that make us unable to appreciate the good and instead focus on the negative?

If you are reading this, most likely you live in the United States – the most prosperous and richest nation in the world.  According to some researchers, even the poorest Americans are richer than 99% of the world’s population.  Yet, we still grumble, bitch, and moan.

We attribute our lack of happiness to our employers, our spouses, or our government. We seem to think that if we made more money, had a better job, or had lower taxes, our lives would suddenly become pristine journey’s of joy.  I don’t believe this is true however.  I don’t think higher wages, a better boss, or the perfect government is going to solve your problems.  Indeed, the issues of happiness probably go much deeper than this – and I’m not going to try to address them here.  However, I would like to propose one simple idea that we can all employ to better our home, work, and social lives.

How to Deal with a Grumpy Partner

Image via Wikipedia

In the old days, we would have quarters to retreat to and many distractions from one-on-one interaction. Whether it be chores, fire inspections, drills and training, or just TV – at least one wasn’t forced to interact with their partner all day.  Times have changed and employers are getting more calls out of their medics through that great invention of System Status Management.  Consequently, we spend our entire shift locked in a cage and chained at the hip to our partners.  Depending on the situation, this can be a good thing, or a bad thing.

Assuming you draw a good partner, a friendship usually unfolds and going to work can  be quite pleasant.  However, given the opposite situation, this doesn’t always work out so well.  How does one deal with endless minutes, hours, and shifts with the partner from Hell?  Dismiss the fact that we all have bad days, and overlooking some minor personality defects – which we all possess, what do we do with people who are just plain hard to be around?

The Next Step: EMS 2.0

We can’t keep doing things the way we’ve always done them, or we’ll keep getting the same results over and over again.  That’s called insanity.  We have to keep moving forward.

I ran my first EMS call in the early 70s.  I’ve been involved in this profession since I was a teenage, snot-nosed, kid.  Those early days of EMS were incredible.  CPR, Hurst Tools, Advanced Life Support, and even the 9-1-1 system brought radical life-saving to the prehospital setting.  But now I have to ask, what have you done for me lately?

CPR Doesn’t Work on Dead People

Photo by: Michael Ferrari - http://www.flickr.com/people/bunshee/

Time stood still as I stood motionless in the stranger’s apartment.  It was beautifully furnished.  There was a baby grand piano across the room with a silver tea set carefully placed on an expensive table-cloth.  Exquisite furniture, expensive carpets, and decoration only found in the most expensive homes.  Yet, here on the floor, lay an elderly woman in her night-clothes.  She looked very peaceful.

I was a young, eager, and very inexperienced EMT. Not yet a paramedic, that would come several years into the future.  Now, on this quiet Sunday morning in, I stood in a luxury, retirement, high-rise building in the 16th floor suite of a very unconscious, peaceful elderly woman.  My senses sought desperately to keep up with the scene unfolding around me, but my body remained motionless.

My partner on the ambulance that day was one of the first paramedics in the country, yet he was only a few years older than me.  His certification number was three – as in the third in the nation.  Bob carried himself with the nonchalance of the streetwise, the coolness of the experienced, and the cynicism of someone who has seen the darkest of the human soul.  I wasn’t his regular partner, in fact, I normally worked transporting people in wheelchairs.  This was just a fill-in shift – to prepare me for my future as a street medic.