Robert Vroman, M.Ed., BS NREMT-P

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EMS1 Daily News

REACH Air Medical acquires Summit Air Ambulance

Acquisition expands REACH to 570 employees operating a fleet of 18 medical helicopters, 9 airplanes, and 9 ground ambulances

Minn. man celebrates 36 years as an EMT

Buckwheat Johnson continues as an EMT because of his compassion for friends and neighbors

Mo. agency adds ambulance bus to its fleet

The new vehicle is a faster and easier way to get multiple patients to the hospital

Ohio considers law allowing EMTs to treat injured pets at emergency scenes

The bill would give responders authority to provide stabilizing treatment to hurt animals before they are transported to a veterinarian

Medics pronounce man dead; an hour later he moves

The paramedics documented the unresponsive man was "cold to the touch and in rigor" and did not attempt resuscitation; man taken to hospital instead of morgue

Dr. Oz helps helps woman who fainted at the mall

The television host and physician rushed to help a woman when she collapsed during a promotional event at a Fla. mall

Medics drive mental health patients hundreds of miles for care

Psychiatric patient transfers take ambulance crews out of the communities they are supposed to serve for hours at a time

EMS personnel hear from Navy SEAL who killed bin Laden

Robert O’Neill shared lessons from combat at an awards and EMS Week luncheon for Acadian Ambulance personnel

Ind. medics prepare for new fitness evaluation

The EMS-specific fitness test takes into account moving equipment, lifting people, and other mechanics of the job

Minn. man rescued after 2 hours in grain bin

The 65-year-old sank into the corn up to his neck after the crust-layered corn he was standing on collapsed

EMS1 Topic Articles

REACH Air Medical acquires Summit Air Ambulance

Acquisition expands REACH to 570 employees operating a fleet of 18 medical helicopters, 9 airplanes, and 9 ground ambulances

Minn. man celebrates 36 years as an EMT

Buckwheat Johnson continues as an EMT because of his compassion for friends and neighbors

Mo. agency adds ambulance bus to its fleet

The new vehicle is a faster and easier way to get multiple patients to the hospital

Ohio considers law allowing EMTs to treat injured pets at emergency scenes

The bill would give responders authority to provide stabilizing treatment to hurt animals before they are transported to a veterinarian

Medics pronounce man dead; an hour later he moves

The paramedics documented the unresponsive man was "cold to the touch and in rigor" and did not attempt resuscitation; man taken to hospital instead of morgue

Dr. Oz helps helps woman who fainted at the mall

The television host and physician rushed to help a woman when she collapsed during a promotional event at a Fla. mall

Medics drive mental health patients hundreds of miles for care

Psychiatric patient transfers take ambulance crews out of the communities they are supposed to serve for hours at a time

EMS personnel hear from Navy SEAL who killed bin Laden

Robert O’Neill shared lessons from combat at an awards and EMS Week luncheon for Acadian Ambulance personnel

Ind. medics prepare for new fitness evaluation

The EMS-specific fitness test takes into account moving equipment, lifting people, and other mechanics of the job

Minn. man rescued after 2 hours in grain bin

The 65-year-old sank into the corn up to his neck after the crust-layered corn he was standing on collapsed

EMS1 Columnist Articles

Inside EMS Podcast: Debunking the myth that volunteer EMS is dying

Download this week's episode on iTunes, SoundCloud or via RSS feed

In this week’s episode of Inside EMS, hosts Chris Cebollero and Kelly Grayson welcome new EMS1 columnist and volunteerism expert Nancy Magee. Her debut column, “ Why volunteers are critical to the future of EMS” explains why volunteers provide the foundation of EMS in the U.S.

Cebollero and Grayson force “the myth” that volunteerism is dead in today’s culture of EMS, and Magee’s answer may surprise you.

Cebollero and Grayson also highlight a news story about a man who sneezed out part of a toy dart after it was lodged in his nose for more than 40 years.

They also discuss what they consider to be inappropriate responses to a news story about a female EMT who was referred to as the “community bicycle” over an open mic.

The EMT has not returned to work after the comments were broadcast by a male lieutenant with Aurora Fire Engine 1, who is set to retire.

Cebollero and Kelly are very critical of Facebook comments from EMS1 readers telling the EMT to “toughen up.”

Quiz: What type of EMT are you?

This fun quiz is meant to help determine what type of EMT you are.

Remember this quiz and its results are merely for entertainment purposes. Everyday EMS providers get to care for patients and engage with their community to the best of their abilities. If you enjoyed this quiz, test your wits and knowledge of shock pathophysiology. And thanks to the National EMS Museum to the contributed photo.

Signs of a toxic leader

  • You don’t trust the words coming out of their mouths
  • You don’t have faith in their basic competence to do the job
  • You wonder what mood they’re in today
  • You wonder whether they changed their mind since you spoke to them yesterday
  • You wonder whether they are working to make the organization better, or make themselves look better
  • You come to work without knowing where your organization is headed

Mantooth discusses overcoming EMS career burnout

Randolph Mantooth, famous for his portrayal of firefighter/paramedic Johnny Gage on the television show Emergency! is a decades-long advocate for EMTs and paramedics as an actor, writer and speaker. In this Paramedic Chief video Mantooth discusses a loss of enthusiasm for the profession after a few years in the service. He comments on the importance of sharing those feelings of burnout with a peer or mentor.

Memorable quote from Mantooth

“If and when that day comes, they can’t just bottle it up [stress] and think they are the only ones that are feeling burnout.”

Questions about burnout

As you listen to Mantooth ask these questions about your own level of burnout:

1. When you are feeling frustration with patient care how do you work through those feelings of disillusionment"

2. What sparked your passion for a career in EMS"

3. If you have overcome a period of burnout, how did you work through it"

We welcome your response in the comments. Share what you have experienced and learned about overcoming burnout during your career in EMS.

Give your support to a National EMS Memorial

It’s National EMS Week. I’m proud to be an EMS provider; I hope that you are as well.

For decades we have struggled to emerge from the big brother/big sister shadows of our fellow public safety providers in the fire and law enforcement services. While many of us wear dual hats, just as many identify with the Star of Life rather than the Maltese Cross. Not better, not worse, just different orientation and purpose. In the public safety sandbox, we generally get along well, each branch providing niche services that combined, protects the health and welfare of the communities we serve.

In the pursuit of that mission to protect and serve, many providers have paid the ultimate price of losing their lives in the service of others. We commemorate their sacrifice through permanent memorial sites. Police services have the National Law Enforcement Officers Memorial. The fire service has the National Fallen Firefighters Memorial. These edifices were built to allow people to pay tribute and respect.

Sadly, no EMS memorial exists. But there is an opportunity to change that.

U.S. Rep. Stephen Lynch (D-Mass.) is sponsoring a bill to create a permanent National EMS Memorial in Washington D.C. A memorial would provide EMS providers a place of respect to call their own, and recognize the efforts of the 850,000 EMS providers across the country in providing care, comfort and compassion to the communities they serve. It would be amazing, and humbling, to see an EMS memorial come to life.

What is needed now is YOU. Contact your U.S. Representative and tell them you support H.R. 2274, A Bill to establish a National EMS Memorial. Tell them that you hope they will support it too. It’s only fitting that all of those who protect the health and safety of U.S. citizens be paid equal respect for the work they do. This would be the best gift we can give ourselves for EMS Week 2015.

5 surefire ways to ruin an EMS field supervisor

When Jan came to our leadership academy three years ago she was enthused, motivated and feisty. She had just become a field supervisor and passionately wanted to learn and do good things. She was fun to be around and full of energy and hope. When we talked about employee engagement and the unique challenges of leading EMS people, she got it. Jan was one of those supervisors any employer would be proud to have.

I ran into Jan recently at an EMS gathering in her state and found her burnt out, unmotivated and planning a return to street work. Sadly, her story is not unusual. Field supervisors perform one of the most important jobs in EMS, but they often do so without executive leaders understanding and valuing the role. Instead, many organizations ruin field supervisors. Here’s how.

1. Fail to see supervisors as key engagement leaders

The secret sauce of great EMS workplaces is engagement – employees who are excited, enthused, committed, loyal and willing to do more than required. Field supervisors are the kingpins of engagement. They are closest to field staff and the prime relationship builders with field staff. Their actions and behaviors tell the troops what the organization cares about, and what they do or don’t do has a big impact on engagement

Jan’s executive didn’t get this. He failed to see supervisors as leaders of engagement and treated them as low-level operations coordinators and structured the job as such. The result was engagement was poor, both field supervisors and field staff became frustrated, and the organization and its mission suffered.

When executives really believe supervisors are key engagement leaders it changes how they view, value, hire, develop, reward and support this important team member.

2. Overload supervisors

“I come to work feeling like I start my day behind,” Jan told me. Supervisors are often the task delegation dumping ground. Paperwork, daily operational tasks, supplies, shifts filling, responding to calls, special events, employee evaluations, big reporting ratios, and special projects all pile up on the supervisor

When supervisors are overloaded and priorities are not clear, they will often give attention to the operational tasks – the stuff that is urgent and time sensitive (paperwork, filling shifts, supplies). What gets dropped is the relational interaction with the frontline. There is no time to listen, encourage and support. Eventually this creates a disconnect between the supervisors and the frontline, leaving everyone without a key ingredient to great workplaces – connection.

3. Don't arm supervisors with great people skills

Sending a medic into the field without the right clinical skills would be unthinkable, but we often do it with field supervisors.

Field supervisors need the best people skills in the organization. Here’s why. Supervisors are stuck between management and field staff. We want them to be good listeners and great storytellers. We want them to hold the staff accountable and at the same time love and care for them. We expect them to absorb the frustration from the street and still build support for the organization’s mission. We expect them to encourage the timid and rein in the cowboys. And, we demand they do all of this while keeping the lid on the chaotic world of emergency operations.

While great people skills are often innate they can also be developed. In our EMS Supervisor Academy we devote more time to developing people skills than any other topic.

4. Leave supervisors out of key decisions

Jan’s greatest frustration was being left out of decisions that impacted the troops. “Why won’t they ask us"” she wondered. “I get stuck explaining bad decisions. All they had to do was ask.” When supervisors are left out of the decision process their loyalties become divided and their job becomes impossible.

When a decision impacts the field staff, bring in supervisors ahead of time. Let them inform the decisions and be part of the process. Doing so gives them an understanding of the “why” and helps them buy in.

5. Fail to provide executive leadership

Frontline people have questions: Where are we going" Why are we doing this" How does this connect with our primary mission of taking good care of patients" These are leadership questions. When executives fail to provide clear and inspiring answers to these questions the supervisor is stuck trying to figure out the answer. “I have not idea where we’re headed,” Jan confessed.

Most EMS executives are good at managing the business of EMS. But truly leading is rare. When executives actually lead, supervisors can then connect the dots.

At its core, leading is about building enthusiasm for doing something or going somewhere. When supervisors understand the “where” and the “why” they have a powerful story to tell the troops.

At the end of our conversation I encouraged Jan to find another employer – one who valued the role of supervisor and designed the role for success.

Why EMS agencies need to check the List of Excluded Individuals and Entities

A section of the Social Security Act authorizes the Office of the Inspector General (OIG) to exclude from participating in federal health care programs, such as Medicare, Medicaid, and TRICARE, individuals and entities (hereafter “persons”) who engage in conduct described in that statute, including various types of convictions, licensure actions, and several other types of misconduct.

For example, consider the case of an EMS agency that hired an individual with a nursing license to bill ambulance trips for reimbursement. That license was later revoked. The OIG acted months later to exclude the individual from participating in federal health care programs and listed the exclusion on its List of Excluded Individuals and Entities (LEIE).

After listing, the individual continued to bill ambulance service claims for the EMS agency, including claims for reimbursement from federal health care programs. Notwithstanding that the individual did not perform any nursing services for the EMS agency, the agency will be subject to a civil money penalty calculated from the date the individual’s name appeared in the LEIE.

Civil money penalties may be imposed against an EMS agency that employs or contracts with an excluded person

More troublesome for an EMS agency, another federal statute, commonly referred to as the Civil Monetary Penalties Law (CMPL), provides for civil money penalties to be assessed against a provider (government agencies included) who employs or contracts with an excluded person who the provider knew or should have known was excluded from participation. Those penalties may be imposed on the provider if that excluded person performs work for it that is linked to services for which the provider receives federal health care program reimbursement.

Under the CMPL an EMS agency may incur a civil money penalty not only if it employs or contracts with an excluded person who furnishes for it a service for which the agency receives federal health care program reimbursement, but also if it employs or contracts with an excluded person who performs work for it that is in some other manner connected to that service. This was spelled out in the Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs published by the OIG in May 2013.

The OIG states that if a provider is reimbursed for services by a federal health care program, a civil money penalty may be imposed against the provider if the excluded person serves it in an executive or leadership role. The OIG further advises that a civil money penalty may be imposed against the provider if an excluded person performs administrative or management services for it unless those services are completely unrelated to services paid by a federal health care program.

Health information technology services, strategic planning, billing and accounting, staff training, and human resources services are listed as examples of services that would subject the provider to civil money penalties if provided by an excluded person unless that work was isolated from the service for which the provider receives federal health care program payment. Achieving that separation is a hard thing to do when Medicare patients are such a high percentage of EMS patients.

The OIG’s position is that if a person is listed on the LEIE a provider should know that the person is excluded

The LEIE contains OIG federal health care program exclusion information and can be found on the OIG website.

There is no legal requirement that an EMS agency check the LEIE before employing or contracting with a person, or that it routinely check the LEIE for exclusions of its employees and contractors. However, an EMS agency that does not do so has made an unwise decision, because if the person is listed on the LEIE the agency will be subject to civil money penalties if the person performs work for it directly or indirectly reimbursed with federal health care program money. In some cases the EMS agency will also need to deal with overpayments made to the agency.

Federal health care program payment is prohibited for any service an excluded person participates in furnishing

EMS agencies should know that federal health care program payment is prohibited for services furnished for a provider by an excluded person. This is because, by virtue of the exclusion, that person is not “qualified” to provide that service. So, if an EMS agency employs an excluded individual as an EMT, paramedic or ambulance driver, and it receives payment from a federal health care program for ambulance transports in which that individual participates, the EMS agency must treat each of those payments as an overpayment.

The pros and cons of using the OIG Self-Disclosure Protocol to report the CMPL violation

If an EMS agency determines that it has employed or contracted with an excluded person in a manner that may violate the CMPL, it should immediately contact legal counsel knowledgeable about this law. One option available to the EMS agency, which should only be taken after consulting legal counsel, is to self-report the violation to the OIG using the OIG’s Provider Self-Disclosure Protocol (SDP). There are pros and cons to doing so.

The first con is reporting through the SDP does not guarantee that the EMS agency will be accepted into the SDP Program. The OIG has the discretion to accept or reject the applicant into the program.

If it accepts the agency, and is satisfied with the information the agency has provided, including the agency’s calculation of damages, the OIG will offer a settlement to the agency which will require the agency to pay to the U.S. Department of Health and Human Services the damages times a multiplier. Except in extraordinary cases, the multiplier is 1.5.

Of course another con is that the EMS agency is reporting to the OIG that it believes it has violated the CMPL. This is an SDP requirement. The OIG will evaluate the reported information and, if it believes the information presents a potential civil or criminal matter, it will coordinate with the Department of Justice.

On the other hand, there are also significant pros or benefits to using the SDP. One upside is that if the exclusion resulted in the EMS agency receiving overpayments, the 60-day time period for refunding overpayments is tolled when the OIG acknowledges receipt of the self-disclosure. If the EMS agency is accepted into the program and a settlement is reached, upon payment of the agreed upon amount the OIG will release the agency from liability under the CMPL and from its overpayment refund obligations.

Of course, those overpayments will be included in the calculation of damages. Additionally, reporting of the exclusion and associated overpayments through the SDP may, in some cases, provide protection from qui tam (whistleblower) suits filed thereafter.

Another benefit if a settlement is reached is that the EMS agency will likely not be required to admit wrongdoing in the settlement agreement. Still another likely benefit is that the OIG will release the EMS agency from any right the OIG may otherwise have to permissively exclude the agency from participating in federal health care programs for conduct covered by the agreement, and do so without requiring the agency to agree to a corporate integrity agreement.

One additional possible benefit to using the SDP is that if the EMS agency asserts and establishes that it does not have the financial ability to pay the damages times the multiplier, the OIG may agree to payment of a reduced amount, or terms of payment that are more lenient than that customarily accepted by the OIG.

Steps to avoid employing or contracting with excluded persons

The choice of dealing with a violation of the CMPL by using the SDP or by handling the violation in another manner is not a choice an EMS agency wants to be forced to make. An EMS agency needs to do its utmost to avoid employing or contracting with an excluded person to perform work for it that would expose it to civil money penalties and possible other adverse consequences.

So, the most prudent course of action for an EMS agency to take is to check the LEIE before making a decision to employ or contract with a person, and to routinely check its employees and contractors against the LEIE, perhaps monthly, as the LEIE is updated monthly. Doing so will maximize the EMS agency’s ability to prevent its impermissible use of excluded persons and the costly consequences of such use.

In-custody death video makes the case for a medically trained safety officer

It seems that more and more in-custody deaths are being caught on camera. It’s hard to determine if the frequency of in-custody death is actually increasing, or if we are more aware of the incidents because of the increase in recording equipment that is present all around us.

In this recent case from Texas, a prisoner dies after fighting with corrections officers. In the video we can see the prisoner being given a sedative, which I applaud. Early and appropriate sedation is important in the management of acute psychotic episodes, especially if they involve the abuse of a stimulant.

Obvious airway distress

As the video progresses, we can see the prisoner lose consciousness and begin breathing in a manner that is inconsistent with life. At no point in the video do we see any lifesaving interventions being performed.

As with the Eric Garner case, in all likelihood early airway positioning and BVM assistance could have resulted in a different outcome. Of course we don’t know that the end result would have been a positive one, but in any case, it is obvious to me that the prisoner is dying.

We have an opportunity for improvement. Let’s not let it go to waste.

Safety officer for high-risk activities

I think it’s time we take a page from the fire department manual and incorporate a safety officer for high-risk activities. This safety officer’s job would be to oversee the safety of activities for which there is a high risk of injury or death.

In this case, officers entered the cell of a prisoner for an extraction. This type of action is planned and practiced repeatedly. I recommend the addition of a safety officer who is trained and experienced in medical care and law enforcement operations. Had such a safety officer been present, they would surely have called for an intervention at the point we see sustained agonal respirations.

A safety officer needs to have the authority to observe and intervene in any activity for which they see unacceptable risk to the patient or caregivers. Potential activities to assign a safety officer include physical or chemical patient restraint or certain medical procedures like RSI or conscious sedation.

I’m sure there are other activities for which quality improvement should include implementation of a safety officer.

A fire department safety officer’s job is to keep a big picture view and make certain that firefighters are not being put at unnecessary risk. They work alongside the incident commander and function as a “check” on the orders of that commander. In many departments the safety officer has the authority to call a “time out” or for the immediate cessation of activities. In this case, when the prisoner’s breathing became inadequate, a safety officer could have called for an immediate intervention and for the prisoner’s respirations to be assisted.

Ideally, the safety officer role would be filled by a member of the team who is knowledgeable about all activities the team is performing. He or she should also have the knowledge and authority to intervene with any interventions necessary should the subject being restrained become a patient.

5 essential components for strategic change in EMS

When it comes to EMS leadership, there is a dirty little word that no one likes, but is essential to the success of any organization. That word is change. When change rears its head, people feel uncomfortable for all sorts of reasons. When your personnel have those negative feelings about change, they will normally resist, and oppose change.

In the present day EMS is full of change, transformation, and uncertainty. As a leader it is paramount that we are able to move change, motivate change and minimize the negative impact to the organization. Change management is the cornerstone to ensuring your organization grows and continues on a path towards success.

In October 2015, another change hits the streets; the new 2015 AHA Guidelines will be released. In an EMS1 interview, Dr. Michael Sayre talked about some of the changes in the 2015 AHA Guidelines.

Currently the AHA guidelines are published every five years, which really puts the EMS provider at a disadvantage as the science of resuscitation changes much faster. In the video Dr. Sayre states that the future AHA guidelines will be released every six to 12 months. This means an EMS provider will be able to take a CPR class with new information every time they recertify.

With the new standards due out in a few months, it is now time to prepare for this change and implementation.

Ineffective management forces change

Regardless of the organization, change is one of the words that brings a slew of emotions, feelings and uneasiness. One of the main reasons this occurs is the approach you and your organization takes to managing change. Instead of showing the ability to effectively sell change to the workforce, we usually just wrap it in a nice little bow and roll it out without input from field personnel. This is one of the most common ways to stoke the fire of resentment, and cause your workforce to hide from change rather than embrace it.

5 essential components for strategic change

Your organization is in a great position right now to prepare for the AHA changes. Do you have a plan"

You can prepare now, or get caught behind the 8-ball later. Being able to effectively sell change demands a strategy, let’s discuss five essential components to act as your foundation for a successful change progression:

1. Responsiveness to known and unknown

A component of being a great EMS leader is the ability to be responsive to the current changes in our career field. Being able to look into the future and predict what is coming is an essential skill for any successful leader. While working at MedStar, we were discussing the mobile integrated healthcare transformation. Matt Zavadsky said to me “we are standing on a hill with a pair of binoculars, what do you see"”

This was a great lesson, as it challenged me to look for what was coming. Knowing the AHA guidelines for CPR are going to change, have you prepared to address this change now" Waiting until the eleventh hour is never a way to lead. Be responsive to what the future is telling you and have a plan to address what’s to come.

2. Effective change equals effective timing

Now that we know change is coming, how do you effectively plan for this change to occur" If the AHA guidelines are released in October, as scheduled, you will need some time to learn the changes, determine how the guidelines will impact your protocols, rewrite the protocols, train personnel on the updated protocols, and finally implement the new protocols. Depending on your organization this could take weeks to months to achieve. You could wait until the last minute, or develop a schedule of implementation now.

3. Sell your ability and experience to manage change

There are many feelings and emotions that come from implementing something new; these may include:

  • Fear
  • Anxiety
  • Frustration
  • Anger
  • Sense of Uncertainty

Here is a secret to a successful change process: Being able to sell change really comes down to being able to sell your ability and experience to manage that change, more than the change itself. There are folks in your organizations that have a mentality of ‘if it’s not broken, don’t fix it.’ Being respected as a leader, and the workforce knowing you can manage this change, softens the blow that change is coming. Instill confidence in your workforce, and let them know you can navigate change with your ability and experience.

4. Create trust with the workforce

We trust our workforce to deliver the highest quality of patient care possible. We trust them to go into a dark house at three in the morning. Trust them to help them lead the organization!

Getting your workforce to that table and outlining the change you see coming is a win-win for all. From the very beginning, you are getting ideas, input, and buy-in because you are valuing their opinions and experience. Never implement change without input from your workforce.

There is an old saying, “Rules without relationships result in rebellion.”

Grow your trust in your workforce, ask for input, and develop relationships that get results.

When I was in the U.S. Air Force a middle manager came to the workforce and said, “I developed this new process, I think it will work better for you, start using it right away.”

There was no forewarning, no opinions asked for, and no one was happy. This process did not make things better one bit. In fact it was more time consuming, cumbersome and not very practical. As a team, we complained to the chief who said, “come with me.”

We entered the middle manager's office and the chief told us to totally rearrange the office. When he finally came in, the chief told him “we thought this configuration would work better for you.”

Do not change a process just because you think it will work better. Get the feedback of the people who do the actual work.

5. Be dynamic and fluid

You have reached the point where change is outlined, you and your team have developed a great strategy, and the workforce is on board. The next important step to realize is that things will go wrong, not work as planned, and at times it will seem like you are traveling down the wrong road.

This is just a normal day in the dynamic and fluid process of everyday business. Since we do not have a crystal ball, when we begin the process of walking into the future we have no idea what is happening around each corner. Be prepared, accepting, and be fluid. Reconstruct, analyze and adapt your plan as necessary.Like water, move around the challenge.

Change is coming; are you ready"

This time, the stroke victim will recover

This time, I’m going to make a difference.

Everything is working; the family called 911 five minutes after the symptoms began, Engine Company 11 arrived three minutes after that, oxygen was administered immediately, vital signs and neurological function assessed and a report transmitted to me.

This time, everything is going my way. The family has her medications ready, the stair chair is assembled, the patient lays in bed, unable to speak, eyes fixed to the right, facial droop, nothing on the left side. I’m not waiting; I don’t care about my back. I’m closest, I reach into her bed and pick her up and place her in the chair.

She’s 55, a year younger than my mother was on her last day as a functioning person.

This time, this patient will get to the hospital quickly, and this time the medications that will restore her functions will be effective, and she will regain her mobility and ability to communicate. This time, she won’t spend the last nine years of her life in a nursing home, half alive, her mind sharp but body unable - days and years of steady decline as family members watch her waste away until eventually the feeding tube goes in, the light in her eyes goes out, and she dies slowly, a week before Christmas.

Use FAST to access stroke victims

May is National Stroke Recognition Month. Annually, stroke's affect roughly 795,000 Americans. Do you know the signs...

Posted by American Medical Response on Thursday, May 14, 2015

Not this time.

We used what I call my fast and rosier response, FAST, a simple way to assess potential stroke victims.

F - Face: Does the face droop on one side when the person smiles"

A - Arm: After raising both arms, does one of the arms drift downwards"

S - Speech: After repeating a simple phrase, does the person’s speech sound slurred or strange"

T - Time: If any or all of the above are observed call 911nd ask for medical assistance.

Rosier is more often used in the emergency room to recognize the signs of a stroke. In my telephoned report to the triage team while enroute, I was concise and clear, the staff at the ER was ready, and there was no time wasted on neurological examinations.

Time is of the essence

This time we are in the trauma room, the stroke is team assembling, and only half an hour has passed since the onset of symptoms. Of all the doctors who could have been working, this time it’s the one I like more than all of the others; she listens, and she just happens to speak fluent Russian, the same language as the lady having the massive stroke.

The doctor is able to communicate with the patient, calm her a little, and figure out what is wrong. She calls her mother from her cell phone, and finds the Russian word for “stroke.” A mother-daughter connection happens in the trauma room, and the power of the moment is not lost on me. This time everything is going to work out well.

This time I sit and watch, a front row spectator as the 55-year-old lady gets a second chance. She’s a candidate for TPA, which I have seen work miracles, and she is on her way to the CT scanner before my freshly washed hands have a chance to dry.

This time I don’t forget about the patient as soon as the triage nurse signs my report. This time, every time I return to the ER with a different patient I check on her, and watch, and talk with the family, and offer encouragement.

Every time I’m able to have an effective intervention with a stroke patient I take a moment to remember my mother, whose active life ended at 56-years-old. Then I think of the families that will not have to endure the next nine years that mine did.

Medics on the street are not supposed to take things personally, but I’m only human. I May is Stroke Awareness month, but it’s not the only month I’m aware of the damage a stroke can have on a person who suffers one, and those they leave behind.


EMS1 Tips

7 ways to best use, or avoid, capnography in the field

EMS1 readers shared their suggestions on how to get the most out of the method

Active-shooter response: Are you physically ready?

Normally, I am strong believer that paramedics are at their best when they saunter into a scene, slowly walking and looking for clues and risks. But an active-shooter incident is going to require repetitive bursts of significant physical activity.

3 energy-saving tips for your EMS station

Earth Day, or any day, is a good time to see what you can do at your agency and home to save both resources and money.

How this video can "Keep Yourself Safe"

Consider using this PPE safety video in your EMT Basic or Refresher Class.

CPR class instruction tips: 5 ways to make it great

My most recent healthcare provider recertification was memorable for all of the things the instructors did well.

Patient assessments: How to avoid free-for-alls

Substantial cajoling and adult guidance from mom in a Santa hat was required to initiate an orderly process of taking turns, appreciating a gift after it was opened, and taking occasional pauses for a meal or to welcome additional relatives.

Patient assessment is a non-linear process

On a skill sheet, patient assessment is presented as a linear process: First size up the scene, then complete the primary assessment followed by the secondary assessment.

Blood pressure reading tips and tricks for EMS

One of the things I'm most often asked by students and rookie EMTs is, "Kelly, how am I supposed to hear a blood pressure in the back of the rig?"

How to use Slideshare for EMS education and training

Slideshare is an online community and tool for sharing presentations.

How to get optimal battery life from your devices

The batteries in your wireless cell phone, tablet or laptop are probably not the same old Duracells you used in your childhood walky-talkies.

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