Spare Some Change?

This post can also be found at

With EMS Today right around the corner, I got thinking the other day about the past conferences that I have been to.  This year’s gathering in Washington, DC marks my ninth consecutive major conference that I have attended.  I’ve been to Baltimore three times, this will be my second appearance in DC, Las Vegas twice, New Orleans, and the first conference that I attended back in 2010 in Dallas.

That year in Dallas, Had quite the opportunity drop in my lap.  One morning, I had the chance to sit down and interview a person who I very quickly came to admire because of his involvement in the National EMS Management Association, Skip Kirkwood, who at the time was the chief of Wake County EMS.  Even before I had a chance to meet Skip the words “Well, in Wake County. . . ” were a constantly used phrase in my vocabulary.  I admired the changes and strides that they had made in their quest to provide the best possible patient care for the residents of Wake County.

More than that though, I admired Skip’s approaches to problem solving.  For years to follow, presentations that I have given have involved little pearls of wisdom that I have obtained at the hands (and fingers) of skip over the years from e-mails and posts that I have received from him, so while I had a long standing admiration for Skip, having the chance to sit down with him as a captive audience and pick his brain was quite the opportunity for me.

One thing that stood out to me was how he approached change and progression in Wake County.  As I read about his service it was clear that things always seemed to progress quickly there.  Skip’s answer to me was that he always promotes an environment that is comfortable and welcoming to change.  He wanted his people to be ready to walk in one day and find a new piece of equipment, or a new policy change.  By doing this, when major changes were rolled out his staff was more welcoming and willing to adapt.

I cannot tell you how much that stuck with me.  Far too often, I have seen paramedics, EMTs and even services becoming complacent with the “norm.”  They get themselves into a rut, and allow life to just carry on day to day in their same routine.  Response becomes automatic, treatment becomes automatic, and then when someone suggests doing something differently there is significant pushback.  I have seen it through my own experiences as a supervisor, I have seen it as a street medic both from myself and from my peers, and I have seen it through my friends in other services.  It is a consistent trend.

It goes without saying, and has been stated repeatedly in the virtual pages of my blog that we are at a major crossroads in EMS.  The care that we provide is slowly moving away from simply providing emergency care, and we are evolving into what MedStar and Matt Zavadsky are calling “Mobile Healthcare.”  We are being asked to relearn the EMS alphabet, and but “C” before “A” and “B” all in the name of saving more lives.  It’s change, and for most people who have adapted their own way of doing things and their own rhythm, it’s is terrifying.

Every service and every manager has their own challenges for how to promote and allow their people to become comfortable with change.  For example, one of the major ones that I dealt with at my former employer was having a diverse work force that was around 40% part-time and per-diem employees.  Getting the word out to these people and getting them proficient to the point where they could just seamlessly transition into the workforce was difficult.  Dispatchers had to be convinced that no, that crew is not dogging it at the hospital, they’re learning our new computer system.  Managers had to learn that we might have to put an extra truck or two on to let our people adapt, and give them a chance to apply what they learned in a classroom (or on a memo) hands on.

The important thing to remember though is that while fresh ideas can be born at any level from the newest EMT right on up to the medical director, the key to how that new treatment or policy is received is up to the leadership team.  Implementations need to be methodical.  No one should ever say, “Just do it, make the change.”  Memos should not be rushed out.  Rollouts on major changes need timelines.  With every new policy fails, is not followed, or is simply imposed with an iron fist on a work force, you can expect the next one to be that much more difficult.  While I am certainly guilty of contributing to the problem as well as the solution, all that I can do is learn from my mistakes, and more importantly, embrace Chief Kirkwood’s ideas and values.

Promote the change, embrace the change, and be a champion of the evolution of EMS.

To read my full interview with Chief Skip Kirkwood, check out Part 1 and Part 2 at

Extending the Career Ladder

I remember the first time that I watched Mother, Juggs, and Speed and saw Larry Hagman walk into F&B Ambulance for the first time, and put his resume on the table.  After barely even looking at his resume, Mr. Fishbine hired him, with barely an interview.  No selection process, no nothing.  A guy with a card, getting a job.  Many might see that as a Hollywood shortcut, but sadly in my experience in many places, especially the private industry, the vetting of prospective employees is far too brief.  You then are introduced to the rest of the “team” at F&B ambulance which includes the veteran, Mother.  The guy who is really in charge, seemingly because he is the guy who has been there the longest.

I point out this great 70’s movie because it was actually the first exposure to EMS that many people who are my age had.  Sure, I’m 35, and this movie came out the same year that i was born, but even nineteen years later when I was a freshman in college we watched it as part of one of our EMS management classes.  Although my two full time jobs have been with pretty large, put together organizations I have plenty of friends who have and do work in the smaller mom and pop sized section of the industry.  I have heard plenty of stories about people being sent out on the street as fast as they come in the door.  It is time for EMS to take a good look at their career ladder and hiring processes.   First though, we need, as an industry, to decide who we want and decide what a career ladder really entails.  Should the evolution of BLS to ALS really be considered part of that ladder, or is it possible to move “up” the chain in EMS without having a paramedic patch on your sleeve?

Can a BLS provider be qualified to be a section leader on a major incident?  Can they receive and utilize the training necessary to deal with day to day personnel and scheduling issues that always seem to pop up?  Far too often, we associate a person’s ability to manage people with their ability to provide care to people and those two do not intersect as much as we think they do.

Think of an example of workers on a production line.  The worker who can do their job fastest and most efficiently might not be the most qualified to step off of the line and manage the company’s books.  The same rings true for EMS.  The best paramedics are not always the best managers, and the best managers are not always the best paramedics.

This provides quite the conundrum for anyone who is seeking to take their opportunity to get off the streets as many of us have done throughout our career.  Sometimes it is quite the challenge to have to wear two thinking caps: one that helps us with drug dosages and extrication techniques, and another that gives us the ability to manage a UHU, or know not what is going on with one patient but what is going on with six, seven, or twenty units you are responsible for.  Twice the learning, twice the responsibility, and twice the headache.

Sounds great, doesn’t it?

Now, here is where the employer comes into play.  The employee, regardless of level, shows an interest.  We cannot as an industry expect them to figure everything out on their own.  They must be let in on whatever trade secrets that a department has, because personally, I feel that there are NO trade secrets.  No secret sauce.  We just choose to lie to ourselves and say that there is.

Giving someone the opportunity to see what goes on behind the scenes and on a more macroscopic level can change their impression of the entire business.  I remember one day I had an employee riding with me on my supervisor unit for a few hours, and when I dropped him back off for his shift, he said “man,  I did not realize how much you actually had to deal with.”  That impression was after just a couple of hours of driving from one end of the city to the other, and a phone ringing off the hook.  Emails were answered, and a complaint or two was handled.  In the time that he was with me, we only made it to one call, and during that time, I did not pick up the radio mic.  I am sure that at least one of my 20 or so units on the street probably thought that I was tucked away hiding somewhere, but in reality I was working my butt off, and frankly, I would come home more tired from a 12 hour supervisor shift than I would a 16 hour ambulance shift.

The moral of this post is we need to remember that when we have that position open up and we are ready to move someone up the chain, whoever throws their hat into the ring might be walking into a position blind.  They can read the job description and requirements all they want but there is so much more to learn and understand, and it is the leader and the manager’s requirement to prepare them for what is to come.

This post can also be found at EMS in the New Decade