Sunday, March 6, 2011

The 5/20 and 20/5 Rule

We've all heard the old nomenclature given to the newbie cohorts that have been riding a rig for about 26 seconds, yet seem to have seen it all. These young bucks have done it all and saved 'em all. Just ask them. They're always willing to tell you all about their awesome exploits and war stories.... all three of them.

As a profession, we commonly refer to this collectively as the "5/20 Rule".  5 years in service, 20 years experience.

Now, I'm not going to bore everyone with examples of these heroes amongst us because we all know who they are and we all know their stories. Chances are, some of us were these guys and girls at one time or another. ....then we grew up.

Instead, I'm going to present to you another group of cohorts we all know and love. I refer to them as "...abiding by the 20/5 rule..." and once you smell what The Grinder is cookin', you'll follow along.

How many of you know a Paramedic or EMT who has been around since the beginning of time who just doesn't want to learn anything new? They've been doing the same old thing for 20 odd years and, dang it, it's worked just fine for this long. Why change? I know that personally I encounter 20/5'ers on a near daily basis. Actually, one of them asked me where we keep the Bretylium in the stock room.

I replied with " the coffin next to your Paramedic book...".

Thus, the "20/5 rule" is born. Paramedic Moses has been working shifts for 20 plus years and still operates out of the same 5 page Paramedic book they gave him in 1827. They've been doing the same thing for so long, their practices have went out of standard and have been re-adopted. (see: tourniquet application).

Both schools of practice are detrimental to morale and professionalism within their respective services. You can't be a true professional if you're not up to date on the newest skills and studies. Co-workers eventually get tired of the new guy with the big britches. Something has to give....

So, which one of these is worse for the cause? ...the old dog who refuses to learn new tricks or the new kid on the block with a dose of reality headed their way? What are some ways that you can help quell the effect that these negative schools of practice?

ADD Side note: As I write this, I'm sitting in a suburban firehouse with 3 of the whitest guys in the history of white guys watching Katt Williams on Netflix. One of these things is not like the other!

Wednesday, March 2, 2011

My Beef With Fire-Based EMS or "This ain't 1976 anymore!"

If you've been following me on Twitter or have known me long enough, you know I'm a fairly opinionated dude. I know that sometimes my opinion may seem wrong, far-fetched or biased in some way. Well, all three of those observations may be fitting for this next subject.

Shortly after the submittal and released of the new EMS White Paper, one of the first entities to pipe up and respond with ideas was...... Yep..... You guessed it.... The IAFF and IAFC. Wait... what?!

Yes, the International Association of FIRE FIGHTERS and the International Association of FIRE CHIEFS. NEMSA woke up, scratched it's ass, had a cup of coffee, smoked two Pall Malls and retorted in an untimely manner, as usual.

Let me make this clear before we go any further - I have NO beef with Firefighters, Chiefs, Recruits, Training Officers, Fire Prevention Officers, Hydrant Testers, Extinguisher-refiller-guys or anyone else even loosely affiliated with fire suppression.


Emergency Medical Services has been in need of a makeover professionally for a LOOOONG time, and this White Paper may be just the thing to light the proverbial fire under some asses. We need to develop an identity for ourselves, whether it be "Public Safety" or "Allied Health" or "Not Just a Meatwagon Anymore", something has to give. The IAFF and IAFC are doing the smart thing... They jumped right in and showed everyone how awesome fire-based EMS can be. Let me translate some of their lines for you, baby birds.

They say: "It's cost effective!"

- Translates to "We need EMS's revenue!"

They say: "We have a large base of EMTs and Paramedics to pull from within our fire departments!"

- Translates to "We have a whole bunch of guys who want to be firemen first and medical providers second for the extra cash."

They say: "Our fire trucks usually beat the ambulances on scene and render first response care anyways!"

- Translates to "Our fire engines don't get used enough to justify their being, so we make medical runs to boost our numbers." (and OBVIOUSLY your city needs more ambulances!)

I'm sure there are plenty of well-organized and medically driven fire-based EMS services around the nation, and I mean no discredit to any of them by saying all of these things. However, it's time for EMS to have a voice for itself. Do I blame the IAFF and IAFC for jumping into the discussion quickly to state their case? Absolutely not. It's the smart thing for THEIR organizations who would be hit the hardest should EMS break out of it's shell.

NEMSA has very little lobbying clout when it comes to big wig politicians in comparison to IAFF. The problem is, the soft-spoken and oft drowned out voice that EMS does have from time to time is so broken up, divided and unorganized that no one voice can be heard. That's why the time to organize and SCREAM "EMS IS..........." is NOW!

Pre-hospital medical care is at a dire and dangerous crossroad right now... Which way do you think we should go?

First Grind - "EMS Anchors"

Recently, there has been much discussion in the EMS Twitter and blog landscape on the idea of colleagues who are holding EMS back from evolving as a profession, or as Mr. Ted Setla so affectionately refers to them as "EMS Anchors". We all know these folks and if you've worked in an EMS service for longer than a few minutes, you have a pretty good idea as to who they are. They can be the old warhorses that have been around since Jesus cardioverted Lazarus or even someone who is new to the profession but is all about complacency. These are the people who are holding us back from moving forward, and they must be destoyed.

Ok, not really. That's a bit much.

Bitter and careless, these monkeys on the proverbial back of progress are keeping all of us from bringing EMS to the forefront and allowing us to develop and sense of individuality as a profession. They come to work disshelved, unshaved and unprofessional looking. They complain about everything possible. They just don't care. In this line of work, it's not the way to be.

These are the people who are undoubtably going to be the 'anchor' (ah ha!) that slows, if not completely hinders EMS to move forward. So, what can we do?

Comment away and let's discuss!

Thursday, February 24, 2011

Upcoming Posts

I've been working on a few posts that I'll (hopefully) be finishing up and putting up over the next few days.

Some of these include topics like the prevalence of EMS Anchors, professional obstacles created by fire-based EMS services and "The Grinder's 5/20 and 20/5 Rule of Attitude".

It should be fun. Stay tuned.

Sunday, February 13, 2011


Hi kids. Did you miss me? Yeah, didn't think so.

Anyways, over the past few weeks, I've been thinking about the blog. Everyday, I read many excellent posts from so many amazing writers and it makes me almost feel guilty for some of the things that I have written and have been working on posting.

Alot of the stuff I read is very informative, well thought out and well-researched.

My blog and it's drafts have been me writing knee-jerk reactions to situations I've been in or issues that I've encountered without much thought into how it would be perceived. When I first started this thing, I told a friend of mine (@MsParamedic) that I wanted it to be fun, sarcastic and mildly educational. I wanted people to find what I posted to be somewhat relevant and something that they could relate to.

Guess what? It kinda worked.

The bad part of me accomplishing this is simple... Some people took me the wrong way.

The whole "Apathetic Medic" thing immediately labeled the blog as a "I don't give a damn about my job, my career, my profession or my patients" kind of deal. This is 110% whole-heartedly NOT the case and is also 110% TOTALLY my fault for presenting it to you folks, the readers, as such.


I've beat my head into the wall for a few hours and a not so bad idea fell out. How about "The EMS Grind"? Not so much the "What Really Grinds My Gears" short stint segment that Peter Griffin had on Family Guy, but more of 'post and discuss' kind of forum, speaking about all kinds of different topics that concerns the modern EMS provider.

Hey... I kind of like it.

Regardless, with this kind of style and thinking process, I believe it will enable me to be more open as a writer on subjects and not appear to be so much of a bitter burn-out.

In closing, look for more medically related posts coming in the near future. Don't give up on me just yet.

- Grinder

Tuesday, November 30, 2010

Burnout : It's Real and It Hurts

When thinking about a worthy subject for my next post, I found that is fitting that I talk about something that not only I've been through (more than once), but something that the blog itself helps me with. Just another coping mechanism, I reckon.

For those of you who haven't known me for long, or at all, I am an absolute workaholic. On average, I pull 40-50 hours of overtime per bi-weekly pay period and sometimes way more (upwards to 80-90 hours). Working in a high run volume 911 service, those kind of hours can take it's toll on you very quickly and when you'd least expect it.

My first REAL run of being burnt came in 2008. I was making $17/hr at my current employer and was working 16 hour days for sometimes 14-15 days straight without an off day. If my memory serves me correctly, this was the year that I grossed well over $90,000. Yeah.... I was killing myself and I didn't even know it.

I would have long strings of bad runs, but I'd shrug them off like most of us do. I'd have nights of making 16-18 runs a night, getting off late and having to be back at work 6 hours later. I felt like I was superhuman at times. Boy was I wrong.

After 7 months and some change of relentless professional self-mutilation, I became bitter. I was angry at the world and had I been the owner of a puppy at the time, I wouldn't have wanted to be him. Anger turned into depression. Depression led to alcohol. Alcohol led to more and more pain and self-pity.

After bad break ups, more drinking, less caring about my work and my own well-being, I decided to make a change. Something I had never done before and like many other stubborn ass guys that I know, never dreamed of doing. I talked about my problems. Turning to the only person that I knew would understand, my preceptor, mentor and friend throughout my career, Joe, probably saved my career. Not to mention with the self-destructive behavior I was throwing down, maybe my life.

He suggested a few things that had helped him get through tough times in EMS. Working out, finding a hobby, read a book, build a model airplane... the usual stuff that normal folks do in that thing that we EMS folks have little of, "spare time".

"You need to stop working so much fuckin' overtime, dude. That's your issue." he said.

No shit, Sherlock. Like I didn't already know that.

Sad thing was, it was the truth. It was that simple. Stop working so much, have some time for yourself and relax. I hadn't had 2 days off in a row to sit on my couch in my boxers, watch TV and do absolutely nothing but chill out, collect my thoughts and catch up on sleep.

I know this sounds elementary, and it really was for me, but sometimes that's all it takes. Drop back five yards and punt.

Soon after this conversation, I found another thing that still to this day helps keep me sane. Social media and networking.

Twitter has helped me make so many connections all over the world, make great friends and assimilate a TON of knowledge from so many great pre-hospital providers from every edge of the globe. It really helps to see people being so passionate about the profession that deep down you love and want to succeed in. The folks on there that write blogs (most of which blow this heap of crap out of the water) are UNBELIEVABLY intelligent, articulate and passionate about the career and it shows in their writing. The Chronicles of EMS and EMS 2.0 movement has inspired me to want to be more involved with my career path and be a contributor to the future of OUR profession.

For me, it comes down to not working myself into a zombie-esque state and putting my time, thoughts and energy into making things better for the future of EMS. Simple? Yes. Does that mean I don't have my moments of anger, depression, etc? No. Everyone has that. But, knowing that I'm doing the right thing for myself and my chosen career helps keep things on a manageable platform.

That's how I've kept myself sane during the hard times. How about you?


Sunday, October 31, 2010

Common Paramedic Student Mistakes

As a fairly seasoned Paramedic in my service, I get the opportunity to teach new Paramedics and Paramedic graduates on a regular basis. I really enjoy helping the future heroes of our profession and every now and then, I get to make fun of them a little bit. This is about one of those times.

Before I get to the story, understand that I did like any good instructor or educator would. I complimented them, told them everything they did right and then verbally kicked them in the nuts. After making them see what they did wrong and how 'WE' were going to fix it, I complimented them again and away we went. This particular person went on to become a great Paramedic with our service and I'm proud to have a little part in their education.

However, I see ALOT of Paramedic graduates and even fairly new Paramedics make this same mistake. If you're reading this and fall into this category, read carefully and understand the story I'm about to tell. It'll help. Scouts honor.

We were dispatched to a 'shortness of breath' on a 74 year old female. Upon arrival, the patient is in very mild respiratory distress. She is cool and diaphoretic and says 'I just can't get a good, deep breath!'. My newb jumped in, placed her on oxygen, obtained baseline vitals and placed her on the EKG monitor.

"INFERIOR MI", he exclaimed.

"Ok, you want to explain that to everyone who didn't hear you in a 5 block radius who doesn't know what you just said? I would suggest speaking a little softer while doing that."

"Sorry." he murmured before rattling off what he had said meant to the patient, who looked like she had shat herself after his outburst.

We loaded her up onto the cot, moved her to the med unit and whisked her away to the closest STEMI center. On the way, I could tell he was fairly nervous. It was his first anginal equivalent MI and you could see he was scared. His hands were shaking and looked like someone had filled his gloves with water before he put them on from the sweat. He had given asprin in the house, got a BP and was working on an IV. She was a tad hypotensive so, luckily, he didn't go slamming NTG at her face immediately.

But the IV, he couldn't get it. Once.... missed. Twice....missed. After the third miss, I offered my services and quickly secured an 18g in her right forearm. He looked crushed. He looked as if I had kicked his little paramedical puppy. His face turned red and he started slamming things around as he was cleaning up his mess. Luckily, we weren't far from the hospital and quickly rushed the patient into the ED bed, gave our report and went back outside of a tobacco conference.

"So... How do you think you did?" I asked.

"Fucked up. I'm a moron. I never should have said that on scene and should have gotten that IV!".

"Listen, stop right there. Come down off the cross and stop pouting. You adapt, you overcome. So what you couldn't get an IV? It happens. Some of the best Paramedics in the world miss IV's. This one isn't your first miss and it won't even be close to your last. All you can do is learn from every run you make and better yourself in every way possible."

See... I can be diplomatic :)

He kept on with the pouting and the 'I fuckin' suck' comments for about the next hour until we secured for shift. Afterward, we sat around the table and had a man to man talk. I packed a dip and gave him the best advice I had ever gotten.

"Brother, let me tell you this. 20% of Paramedicine is getting to do Paramedical cool stuff. The tubes, the IVs, the drugs....all of that is a fifth of what it takes to be a Paramedic. The rest of the job is using your brain, knowing when to do what, and making the best possible decision for your patient. Using your brain is much more important than hitting every IV."

He nodded his head in agreement.

"But, she needed an IV. I was so nervous, I couldn't get it. What if you weren't there?" he came back.

"You would have done the best you could with what you had. That falls into the 'other 80%' too, hoss. Adapt and overcome. Don't let something like that frustrate you to the point that you can't function. Then, you're no good to anyone."

He smiled and shook his head.

"Speaking of being nervous, have I ever told you my 'Duck On a Pond' analogy?" I asked.

"No... But I'm sure I'm going to hear it after that, eh?"

"Damn right. It's applicable here. Let's say you're at a pond and you spot a duck chilling on the water. As you watch it, it's looks as if nothing could phase it. It's just floating along without a care in the world beyond 'I wonder if this fat kid is going to give me some bread'. But that's on the surface....."

"What in the Sam Hell are you getting at, dude? I'm like a duck?"

"No." I said. "On the surface, the duck looks cool, collected and relaxed. It's just floating around the pond. But, under the surface, that damn thing is kicking it's legs 200mph to get to where it's going. It's all over the place and it's moving a mile a minute. THAT is how you need to be! When you're in front of a patient, you should be calm and cool. Like Fonzie, if you will. At the same time, your mind needs to be going at light-speed. You have to think 10 steps ahead of yourself. You have to take in alot of information quickly, assimilate it and interpret what it means for your patient. Your brains needs to be working like the ducks legs....under the surface."

His face went from anger and frustration to the look of someone who'd just had an epiphany. "I see what you're saying. Honestly, it would probably make everything a little be easier too, eh? If I don't freak the patient out, I'd be able to develop a better rapport, they'd have more faith in my decisions and the whole run will go smoother."

"Nailed it." I was stoked. Now if he could actually pull it off, I'd hang my hat on the analogy.

The moral of the story is, to all of you young Paramedics and aspiring hero graduates, chill out. You're not going to be perfect. All you can do is use every mistake or negative situation as a learning experience. Missing an IV here and there doesn't make you a horrible Paramedic. Missing a vital piece of the assessment puzzle that results in a poor patient outcome does.

Be a duck on a pond.