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

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Stand-by plan activated for Pa. 911 system outage

Technicians were not sure what caused the equipment problem; the affected equipment is about 10 years old

NJ EMT who died of ALS remembered for compassion

Earl "Jim" Artle, 63, died after a long struggle with ALS; he served on the Hoboken Volunteer Ambulance Corp. for 20 years

14-year-old dies after truck hits horse-drawn buggy

Two siblings, ages 12 and 15, were also in the buggy; one suffered serious injuries and the other had minor injuries

Delays compound S.F.'s ambulance crisis

Delays are not spread around the city equally; neighborhoods on the city's southern rim were the most likely to suffer

Ky. fire capt. injured in ice bucket challenge dies

Tony Grider, 41, was the most seriously injured of the four firefighters when a high-voltage line arced the aerial set up for an ice-bucket challenge

Maine court dismisses do-not-resuscitate infant case

The baby suffered severe brain injuries when she was shaken by her father; the baby can't see or hear, must be fed through a tube and suffers severe ongoing health problems

Family, colleagues gather to mourn fallen Texas medic

Michael Howard, 46, was a paramedic for 22 years; he died of a heart attack while responding to a call

EMS official accused of stealing gas with company credit card

Stephen J. Wieland Sr., 61, has been charged with grand larceny and scheming to defraud; he stole $1,400 worth of gas

U.S. scientist: Ebola unlikely to become airborne

Researchers are monitoring for mutations in the virus, which has killed at least 2,400 people

94-year-old airplane passenger saved from heart failure

Two exercise physiologists on the plane had been at a heart-health conference; they noticed the man had no pulse and grabbed an AED to shock his heart
Top

EMS1 Topic Articles

Stand-by plan activated for Pa. 911 system outage

Technicians were not sure what caused the equipment problem; the affected equipment is about 10 years old

NJ EMT who died of ALS remembered for compassion

Earl "Jim" Artle, 63, died after a long struggle with ALS; he served on the Hoboken Volunteer Ambulance Corp. for 20 years

14-year-old dies after truck hits horse-drawn buggy

Two siblings, ages 12 and 15, were also in the buggy; one suffered serious injuries and the other had minor injuries

Delays compound S.F.'s ambulance crisis

Delays are not spread around the city equally; neighborhoods on the city's southern rim were the most likely to suffer

Ky. fire capt. injured in ice bucket challenge dies

Tony Grider, 41, was the most seriously injured of the four firefighters when a high-voltage line arced the aerial set up for an ice-bucket challenge

Maine court dismisses do-not-resuscitate infant case

The baby suffered severe brain injuries when she was shaken by her father; the baby can't see or hear, must be fed through a tube and suffers severe ongoing health problems

Family, colleagues gather to mourn fallen Texas medic

Michael Howard, 46, was a paramedic for 22 years; he died of a heart attack while responding to a call

EMS official accused of stealing gas with company credit card

Stephen J. Wieland Sr., 61, has been charged with grand larceny and scheming to defraud; he stole $1,400 worth of gas

U.S. scientist: Ebola unlikely to become airborne

Researchers are monitoring for mutations in the virus, which has killed at least 2,400 people

94-year-old airplane passenger saved from heart failure

Two exercise physiologists on the plane had been at a heart-health conference; they noticed the man had no pulse and grabbed an AED to shock his heart
Top

EMS1 Columnist Articles

Inside EMS Podcast: The secret to living on an EMS salary

Download this quick clip on iTunes, SoundCloud or via RSS feed

In this week’s Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson sit down with Sean Eddy, a Texas paramedic and financial coach who says he’s cracked the code on how to live on an EMS salary.

“What kind of witchcraft is this"” Grayson joked.

Like many EMS providers, Eddy was living paycheck to paycheck and struggling with overdue bills, collection agencies and debt.

“I started to realize this is problem with my behavior, not with the industry.”

He began taking control of his budget, got his finances in line, and made a conscious decision to stay in EMS rather than leave the field for a higher salary. The key, he said, is to eliminate debt.

Grayson, however, pointed out that’s easier said than done.

“When it comes to setting a budget, this is a hard process to get into when you don’t have two nickels to rub together at the end of a paycheck,” Grayson said.

Eddy said it starts with knowing exactly how much you own, and figuring out what to do to get caught up. Start opening those overdue bills, call creditors and banks, and work with them to come up with a plan. Then look at your monthly expenses, and start hacking away. Eddy said he made a list of all his expenses, listed them in order of priority, and began eliminating luxuries like cable and eventually fast food.

“One of the biggest things for me was overdraft fees,” Eddy said. “Once I stopped that, I was saving over $400 a month.”

Becoming a money-smart medic, he said, comes down to being disciplined with your finances, making decisions about what’s important in your life, and taking responsibility for your spending. The overwhelming majority of those who make between $30,000 - $70,000 per year and are financially happy at their jobs – whether they’re in EMS or not – don’t have debt, save for emergencies and have a retirement plan.

Cebollero and Grayson also discussed the news that DCFEMS medical director Dr. David Miramontes has left for a position in San Antonio. Grayson wished him well in his new position, saying it will hopefully be a chance for D.C. EMS to get a fresh start.

“I will say Dr. Miramontes joins a long and distinguished list that has left DC EMS and Fire,” Grayson said.

They also talked about a bus driver who was threw a 10-year-old out of the way of a rolling bus, and died after being caught underneath and dragged for 40 feet.

Cebollero said he’s always impressed by civilians that risk their lives for others.

“How brave people get where they just kind of put themselves in those dangerous situations,” Cebollero said, “it just amazes me that the good-hearted people that are out there that wind up giving their lives to save others – it’s probably situations where they don’t even think about it.”

It’s also something that EMS encounters every day, but most responders at least acknowledge that every day they put on their uniform could be their last.

“When you’re a bus driver and you give that act of selflessness, that’s not something you’re expecting,” Grayson said.

And they talk about having a zero tolerance when it comes to using cellphones while driving after an Ohio EMT admitted to she was looking at her mobile GPS in a fatal crash.

“We need to be vigilant at all times,” Grayson said.

Here are links to some of the articles and other items mentioned on the show:

Why EMS should put compassion before protocols

“No smoking. Oxygen in use.”

“No family in the back of the rig.”

“Food or drinks allowed in cab only.”

“No pets in the rig.”

Rules abound in EMS — algorithms, protocols, policies and procedures. As a profession, we put great stock in the rules.

They’re so prevalent in EMS and health care; the accreditation process intended to be the stamp of an agency’s legitimacy focuses primarily on how many rules and policies they have in place. Everywhere you look there’s a mechanism for addressing every conceivable situation.

But often we forget that it is impossible to conceive of every possible situation, and that the only unbreakable rule is that every rule has an exception.

The messiness of human grief

Real life has a way of throwing you curveballs. That’s because we’re people, caring for other people, and people are inherently fallible creatures. We’re complex, irrational, emotional, unpredictable beings, and most of our patients haven’t read our rulebook.

It’s easy to get bogged down in the minutiae of the protocol book, and ignore the mercies we are meant to bestow.

I’m sure your rig, like mine, is festooned with little decals that say, “No smoking, oxygen in use.”

But when your patient has just watched his 17-year-old daughter get taken away in another ambulance for the intentional overdose that may very well take her life, he doesn’t care about your safety regulations. And the bleeding from the cuts on his arms he sustained when he broke her apartment window is well-controlled, but his fear isn’t.

So when he pleads with you to let him smoke a cigarette just one, he begs – to settle his nerves before you put him in the rig, will you tell him no" How long will that cigarette take you out of service"

Is that extra couple of minutes going to cause your patient or the system to crash" Is the minutiae in the rulebook more important than the mercy"

There are plenty of reasons not to allow family members in the back of the rig. But when all your training and experience tells you the frail old man you’re transporting to another hospital two hours away isn’t likely to survive the trip, or the infant you’re doing CPR on probably won’t regain a pulse, will you deny the people who love them the chance to be by their side during their last moments"

A firm, “Sorry, no. Company policy,” is the expedient answer, the convenient lie that shields you from the messiness of human grief. But is it the merciful thing to do"

Yes, I know a hysterical family member can interfere with a resuscitation, even be a safety hazard in the back of the rig. But when the wife has signed a DNR for the trip, or the mother is emotionally devastated but still holding it together, is your comfort or the company’s policy worth their pain"

When the person on your stretcher isn’t likely to survive despite your best efforts, who is your real patient" What is best for them"

Is the rulebook more important than mercy"

OSHA has rules about food or drinks in the back of the rig, and for good reason. But when your patient has spent close to 12 hours in the ED with nothing but a limp turkey sandwich and a bag of chips to sustain him, and his wife brings him a burger before he is transferred out, do you deny him a simple meal, especially when he isn’t NPO"

Or do you delay the transport that has been holding for several hours just a few more minutes until he can wolf down his heart attack in a sack, or simply pretend you didn’t see it when he munches on it in the rig"

No doubt your agency has rules against animals in the rig. I know mine does. Maybe it includes exceptions for service animals, or maybe it doesn’t.

But all I know is that when I think my patient really needs to go to the hospital, I will pull out all stops to convince him to go. And if that requires me making friends with his psychotic little ankle biter, and detouring five blocks off my route to the hospital to drop off the dog with a friend, that’s what I do.

The cops were unsympathetic — “Not my job,” their body language quite clearly conveyed. And when the victim is a histrionic, HIV-positive gay man bleeding from multiple lacerations, they were quite happy to make him my job. The fear and revulsion were plain on their faces.

So I made friends with the dog, and I promised the man I’d see to his welfare. And I violated company policy to do it. I put the little critter in the front of my rig, where he cowered in the passenger floorboard until the man’s partner opened the door five minutes later.

But one man got to see that not everyone is like the homophobic thugs who beat him up for nothing more than their own amusement. That man saw that not all big, white rednecks are the same, and that not everyone he calls for help will treat him like a leper.

And when I told my supervisor about the encounter, he didn’t much care about my violation of company policy.

“Was the dog bloody, too"” he wanted to know.

“Yep.”

“Did you disinfect the rig thoroughly"”

“Yep, front and back.”

“Sounds like you did what was necessary, then,” he shrugged. “Good job.”

I’m not telling you to do anything that will get you fired. Don’t flaunt company policy just on my word. What I am saying is that most rules have some wiggle room, and a compassionate provider will exploit that wiggle room for the good of his patient.

If the letter or the law is more important to you than the intent, and you place more value on the minutiae than the mercy, then perhaps EMS isn’t the career for you. And if your employer puts the protocol book and the policy and procedure manual ahead of patient care, then perhaps you’re working for the wrong people.

There are a hundred little mercies we can bestow every shift we work, and believe me, those little things are more appreciated by our patients than any medical expertise we can muster.

Suicide in EMS: No shame in seeking help

EMS providers see a lot of things that few outside the business ever will.

Tragedy. Comedy. The macabre.

I’ve often said that we have the honor and privilege of watching life come into the world and leave it. From the routine to the sensational, our work experience runs the gamut of life itself.

Sometimes we make judgments on what we see. It’s not malevolent; it’s simply human nature. We take pity on the patient, make fun of the situation, or make harsh statements about why someone gets into a situation that seems so obviously wrong, and we think less of that person.

Suicide, or attempted suicide, is one of these situations.

Often we’re called to transport patients who have attempted suicide, or simply stated the ideation. We hope under our breath that the patient is cooperative, or that he is well enough to be transported by law enforcement.

Silently, some hope that the call will be over quickly, being a waste on the emergency medical response system. Surely there are more important calls to run. After all, suicide is a selfish, shameful act, isn’t it" It’s pretty easy to think that.

That is, until it’s one of us who commits suicide.

This happened yesterday to a colleague who, by all accounts, was a well-liked and well-respected EMS veteran who was well-known within the region. Only a few knew he was battling depression. Even they were taken aback by the news that their close friend had taken his own life.

He’s not the only one that I know; over the years, others have confided their worst fears and related episodes of nightmarish activity involving pills, guns or rope.

Somehow they reached out before the follow through. I thank them for doing so.

The recent death of Robin Williams brought the topic back to our national conscience, but it has faded just as quickly.

The fact is, the thought of suicide is not shameful. It is not selfish. It is a way for the mind to see a way out of a situation so bleak, so deep and so depressing that even sleeping provides no relief. Is it so selfish as to want to escape such pain"

Despite all of our “advances,” we continue to treat suicide as if it was a problem that was easy to solve: just don’t do it. People who have tried to commit suicide will tell you - it’s just not simple. It never was.

The mind is peculiar in how it operates, which is why psychiatric disorders are so difficult to diagnose and treat. Nevertheless, by attaching negative values to suicide we simply drive the issue underground, causing those afflicted to not reach out in the moment of truth.

So, please, if you are contemplating suicide, talk to someone, anyone — your colleague, your friend, your significant other, your parent, or your child. If you don’t know how, call a stranger — the National Suicide Prevention Lifeline number is 1-800-273-8255.

Before you go to that darkest of places, make one call and say, “I am thinking of committing suicide.” You might not want any help. But to hear someone respond to you with love and concern may help you step back from the brink, if even for a moment.

Trust me, it’ll be worth it.

Where to look for nongovernment EMS grants

Has your agency ever been denied from AFG or any other federal resource"

Have you been so frustrated by just missing a deadline or realizing at the last moment that your agency is ineligible for a government grant"

It might be time to start looking outside the box.

Private foundations often, if not always, have great funding opportunities for EMS agencies. Though this avenue takes some research, you will often find that they have more flexibility in allocating funds to your agency for a variety of projects.

Take a look at local trusts, companies, and charities in the area.

For instance, does your county have a railway or oil pipeline running through the district" BNSF Railway and Enbridge Inc. have a history of funding EMS projects in communities they service.

In 2014, Enbridge's Safe Community Grant funded four EMS and fire department agencies. Exxon-Mobil and BP are also some of the largest charitable contributors to communities they service.

Does your agency have a Bank of America or Wells Fargo in its area" In 2010, they respectively gave back $208 million and $315 million. Community foundations are another overlooked option. They are typically funded by a multitude of local trusts that are vested in the community; this includes a strong EMS system.

Large corporations are also great avenues to pursue for alternate funding. Pharmaceutical companies like Pfizer and AstraZeneca allocate funds toward health initiatives and contribute to organizations that help make a difference in the health and well-being of patients and communities — something that is foundation of an EMS agency

Do not let your agency get stuck in the government-resource bubble. There are plenty of alternative opportunities surrounding you — if you know where to look.

Clinical solution: A three-hour fall in the bathtub

In the previous scenario, you responded to a call for a 65-year-old obese woman who has been sitting in the bathtub for three hours and is unable to stand up. She denies any pain or other complaints, and says she simply wants help out of the tub.

Assessment

Calls to 911 for lift-assists are common but are also scenarios potentially filled with risk. Depending on state and local requirements, these patients may be entitled to a full medical assessment.

Regardless of those requirements, they should be accurately assessed prior to completing patient movements or treating and releasing them. For lift-assists particularly, any possible underlying causes should be evaluated. An important question to ask is: “Is this situation different than the baseline"”

For a patient who fell from his wheelchair while transferring to bed, ask whether he can normally transfer on his own. If the answer is yes, then the follow up question should be: “Why is today different"”

If the patient normally requires assistance to transfer and chose not to wait for his home health nurse, then it is possible that nothing is different from his baseline. The subsequent assessment and treatment of that patient depends on determining if today is consistent with his normal level of activity.

Also consider that potential underlying medical conditions for fall patients are numerous. At a minimum, EMS providers should be screening for cardiac, neurologic and diabetic symptoms.

Assessment tools like ECG (if available), stroke scale and blood glucose should all be performed. Vague complaints "like general weakness" or "just not feeling well" may be a presentation of an underlying infection or possibly sepsis.

Completing a patient history, physical exam and vital signs on fall patients can assist in ruling out some of these diseases. Particular emphasis should be paid to questions about infection, especially respiratory and urinary symptoms.

Treatment

Once a patient has been screened for medical and traumatic complaints, the focus of the call turns to moving her from her present location.

Before attempting to move a patient, it is important to ensure that there are enough resources on scene. For overweight and obese patients, it may be necessary to request additional units or agencies.

In most cases, it is far better for a patient to remain in the current situation for several extra minutes than to risk a career-ending injury by attempting a lift with an inadequate number of personnel.

Once you have adequate resources available, discuss a plan of attack. Think carefully about what devices (if any) will be used, and where each provider will be positioned.

Consider where the patient will wind up after the lift. Will it be on the gurney, a wheelchair or simply standing" Think about how each responder will need to move to get the patient to the final location. What is the abort plan if something goes wrong"

When preparing to actually lift the patient, one responder should communicate a count to the others. Make sure that directions are simple and clearly stated. Ask if anyone has a concern about the plan.

Be sure to explain the plan to the patient and ask if she has any questions. Caution the patient against reaching out or making any sudden movements; the patient shifting her weight during the lift could cause injury to one of the responders.

Above all, maintain sympathy and compassion for the patient; this is not an ideal situation for her either. There will be time after moving her to coach about prevention of future falls, but right before lifting her out of her bathtub is not an appropriate time to do so.

After moving the patient to the final location, reassess or perform any additional assessments which may be indicated. If appropriate, and consistent with your medical direction, perform any necessary paperwork or ready your patient for transport.

Outcome

While you continue to assess the patient, your partner calls dispatch and requests that an engine company respond to the residence for manpower.

The patient's assessment is normal and she does not appear to have any underlying medical conditions. She denies any dizziness or weakness before her fall and states that she "just got tired."

She acknowledges that she needs to purchase a shower chair but has been putting it off. Her daughter states that she will buy the chair today.

Once the engine company arrives, you discuss your plan with everyone present. The patient states that she thinks she will be able to support her own weight if she is assisted to a standing position. You ask her daughter to position her walker (which she normally uses to ambulate) in the hallway for her to use once she is standing.

Using a bed sheet under her arms, you determine that four responders should be able to lift the patient to a standing position. The patient confirms that she understands the plan and is comfortable with it. After she is standing, you assist the patient in stepping out of the tub and into a seated position on her walker.

After assisting her in getting a bathrobe on, you complete your assessment and find no complaints or apparent medical conditions. You and your partner thank the engine crew for responding and clear them from the scene.

You complete the refusal paperwork and contact online medical control for a consultation. After being thanked by the patient and her daughter you clear the scene and go available with dispatch.

How powerful EMS leaders can do more by delegating

By Jay Fitch, Ph.D.

It's hard to believe, but Sept. 4, 2014 marked the 10th anniversary of the death of James O. Page, who is often referenced as the father of modern EMS. In a more personal sense, he was my mentor, colleague and friend.

Jim served in many leadership roles throughout his career, including such diverse positions as EMS chief, fire chief, state EMS director, entrepreneur, and lawyer, which surprisingly doesn't even start to describe his unique characteristics as a leader.

Jim had many lessons for developing leaders; delegation was just one. This may seem pretty mundane, but it allowed Jim to accomplish so much more than if he had done everything himself.

"What do you think we should do""

One of the most debilitating characteristics of an underachieving leader is to be a micro manager, someone who constantly undermines his subordinates, questioning their choices while making decisions for them. It severely limits your ability to influence people beyond your direct sphere.

Jim was adept at hiring the right kind of people — in terms of ability, ambition, and values, and in spite of any job description — and figured he could train the rest.

So now, as you think about the efficiency of barking a command to your next-in-line, try this question instead, which may not be as efficient, but in the long term is more effective: “what do you think we should do"”

Jay Fitch is the founding partner at Fitch & Associates, which has provided leadership development and consulting for emergency services for more than three decades.

How EMS will benefit from smartphones and connected vehicles

Two-thirds of Americans now own a smartphone, and the number of cars in the U.S. exceeds the number of adults.

With mobile technology in the pockets of both patients and EMS providers, Dia Gainor, executive director of the National Association of State EMS Officials, sees a future that digitally connects roadways, infrastructures, emergency response systems and responders in new ways.

"This is happening already," Gainor said. "Especially in terms of the types of information a smartphone makes it possible to have and share."

Better, quicker information saves lives

Technology that moves information more quickly may help detect emergency events faster, she said. Whereas "situational blindness often compromises the patient," mobile tech will also allow emergency responders to be smarter about how help is deployed.

"I see changes in resource utilization and deployment being a big part of the future of EMS," Gainor said.

She envisions a role for "more computing to be devoted to assigning resources, without the limits that are now often placed by the invisible, geopolitical boundaries that define county lines or regions."

She also sees value in the rapid emergence of connected vehicles, which have garnered national attention and significant research funds.

Vehicle-to-responder communication: It's coming

Gainor points to the U.S. Department of Transportation's focus on the ability of smart cars to engage in vehicle-to-vehicle communication as well as vehicle-to-infrastructure communication. She also recognizes the importance of connected vehicles in encouraging collision avoidance.

But Gainor takes it one step further, saying her organization is pushing for what she calls vehicle-to-responder communication.

"A vehicle should be able to warn me about potential hazards," Gainor said, putting herself in the role of a first responder. "I would want to know, for example, about an un-deployed airbag that could suddenly deploy while my head is in front of it. Or if it's a hybrid vehicle, I want to know if I need to beware of an electrical system that is still charged."

Gainor envisions connected vehicles that even scan themselves for damages in a crash, locate passengers, and communicate to an emergency responder the best location for extrication tools to free a passenger.

"This is all very conceivable technology," Gainor said. "In fact, the technology already exists. It's just a question of connecting the dots, so the car can in fact talk to the rescuer in that kind of way."

When roads, cars, EMS and ER connect

In the future, Gainor envisions seamless and invisible connectivity between roadways and cars, including emergency response vehicles. Roads will detect, report, and warn oncoming vehicles about incidents they can't yet see. Emergency responders will be given real-time data on the best route to an incident and briefed automatically about a situation as they approach.

She also predicts a not-too-distant future where emergency responders will be able to connect back to the emergency room

"Emergency department staff can glance at one screen and see, real-time, the status of every ambulance," she said.

The staff, she said, will know information from any emergency responder that's been in contact with a patient. They'll also receive real-time updates on any patient being transported, including information from an EKG, a blood pressure monitor, blood glucose monitor, and essentially any device connected to the patient.

"All of that information will just move in real-time, ahead of the patient," she said, "so that the emergency department is prepared for any special need for which the hospital must bring special resources in advance."

For more on the conversation with Dia Gainor, go to the blog How Safe Are Ambulances"

Dia Gainor is the executive director and a past president of the National Association of State EMS Officials. She worked for two state EMS offices for 27 years, 19 of them as the bureau chief of Emergency Medical Services for the State of Idaho. In 2008, Gainor was appointed by the Secretary of the U.S. DOT to serve on the National EMS Advisory Council and was selected by the Administrator of the National Highway Traffic Safety Administration to be the Council's first chairman. Gainor is a member of the Transportation Safety Advancement Group, a public safety specific resource to the U.S. DOT Joint Programs Office.

Spotlight: Everyday Hero Housing Assistance Fund helps first responders achieve the American dream

Company Name: Everyday Hero Housing Assistance Fund
Headquarters: Denver, Colorado
Website: http://usehhaf.org/

Our mission is to help our heroes buy homes by expanding housing opportunities to EMS, law enforcement, fire, teachers, doctors and nurses; and to promote the value of home ownership as the foundation for building strong communities and financial security for men and women serving their communities.

Where did your company name originate from"
Back in 2005 when we first launched EHHAF, it was called Legacy Housing Fund. The idea behind the initial name was that the organization would be helping our first responders achieve the ‘American dream’ of home ownership and be able to start and leave a legacy for their children and grandchildren. As the economy turned, the founders were forced to close the doors to Legacy Housing Fund. They quickly seized the opportunity to re-launch several years later and renamed the company Everyday Hero Housing Assistance Fund. This new name, they felt, properly describes our clients and expresses how we see them as heroes as they go about their daily lives serving and protecting us all.

What was the inspiration behind starting your company"
The inspiration behind the foundation of EHHAF stems from the fact that our clients nurture and educate our future leaders, they preserve our health and put their lives on the line every day to uphold order and keep us safe, yet they are members of a workforce that is extremely underpaid and underappreciated. As many hours as they work and the preparation and effort they have to put in to be able to excel and do their jobs well, they are grossly underpaid and find it hard to save up the thousands of dollars it takes to be able to achieve the American dream of home ownership. Not enough is being done for them and EHHAF is proud to be leading the charge towards a higher level of appreciation as a grateful nation. This is the least we can do for them considering what they do for us on a daily basis.

Why do you believe your products are essential to the EMS community"
The services we provide are extremely essential to our everyday heroes because it is not an easy task to save thousands of dollars to put towards a home purchase, especially if they have a family to take care of. Closing costs can be as much as 3% of the purchase price of the property and the average everyday hero will most likely have a hard time putting that aside to help make their dream of home ownership a reality. Also, buying a house can be a challenging process and to have an organization like EHHAF in their corner to help make the process a lot less stressful is priceless. Our services are free and the gift funds never have to be repaid under any circumstance.

What has been the biggest challenge your company has faced"
Awareness within the first responder market has been the most challenging for us. Once the community learns about us they are thrilled beyond belief to have found us. Because we strive to operate as a lean company it allows us to push more benefits to our clients, but this means we do not have big marketing budgets to spend. We need to be very smart about each and every dollar we spend to create market awareness.

What makes your company unique"
EHHAF is unique because we are one of the very few organizations that offer this type of financial assistance. Other similar organizations place too many stipulations on the clients making it difficult to impossible for them to use and then benefit from their services. We have heard all too often that a client will be forced to stop during the process as the competitor places too many hurdles for them to overcome.

With EHHAF, there are no restrictions on the type of home you can purchase (foreclosure, resale or new construction). EHHAF does not limit our clients to a specific list of homes they must choose from. More importantly we do not place any restrictions on the length of time they choose to live in their new home. EHHAF gift funds are 100% free gifts that NEVER have to be repaid and EHHAF services are absolutely free. We are not aware of any other organization out there that provides this direct type of assistance.

The EHHAF Customer Service team is also very special and unique. We strive to make the process simple and easy by removing the stress that comes with trying to find agents they can trust to work hard for them and communicate well while putting them first at all times. EHHAF has developed a trusted network of agents that they have been carefully chosen, interviewed and trained to work with the EHHAF program across the entire U.S. Our clients can rest assured that these agents will leave no stone unturned to get them the best deal for their home.

What do your customers like best about you and your products"
Our clients appreciate the personalized attention we offer and impeccable service and assistance. They also are so relieved to learn that we stand behind our word and when we say we are offering FREE gift funds – we speak the truth. EHHAF gift funds are absolutely free and never have to be repaid under any circumstance!

What is the most rewarding part of serving the first responder community"
The most rewarding part of serving our Everyday Heroes is the feeling of fulfillment and pride our employees feel whenever we successfully help another community hero close on their home. They send us testimonials expressing their gratitude and pictures of them and their families in front their new homes. It is the most awesome feeling knowing that we played a part in their journey on their road to home ownership. We feel like we are giving back to a community that gives our nation so much! Also, when a client calls to say they heard about EHHAF through a colleague of theirs who we helped to purchase their home and they were so pleased that they passed on the word about EHHAF. That brings a huge smile to every EHHAF agent's face. I mean, they are our community heroes and we feel honored to be playing a role in their dream of home ownership. This is truly the least we can do considering how much they do for us. The founder's letter says it all… http://usehhaf.org/about-ehhaf/founder-letter/

Our mission for 2014 is to help 1,000 community heroes and their families achieve the American dream of home ownership. Please help pass on the word to your colleagues about the assistance we offer so that they can have our services as an option.

Do you support any charitable organizations within public safety"
Yes, we are partners with The Virtual Sports Academy (VSA) www.thevirtualsportsacademy.com. VSA, is a charitable organization that has joined the fight against childhood obesity. Their effort along with the EHHAF program helps support healthy communities through healthy living and home ownership thus healthy and happy families.

5 pros and cons of cameras in ambulances

The lowest of the low, in my opinion, are the lawsuits that arise from someone just doing his or her job; trying to be thorough and professional, only to be accused of wrongdoing for a quick buck.

Here's a real-life scenario

It’s a regular call on a regular shift on a regular day.

A unit is called to the report of a female in her 30s, with abdominal pain and vaginal bleeding for nearly a month. The male medic does his assessment, including vital signs, and a physical exam.

The somewhat large patient consents to a visual assessment of her vagina using no scopes or specula — just a visual, routine examination. Unfortunately, her girth and shorts make access difficult. The medic decides, with patient approval, to simply pull one leg of the shorts to the side to expose the area to be viewed, and provide a pad if necessary.

The exam lasts roughly four to seven seconds. There is no sign of injury or exsanguination. He documents his findings and the transport concludes without incident.

When the patient is turned over to the staff at the emergency department, however, she claims that she had been sexually assaulted by the medic in the ambulance.

“He touched my vagina,” she says.

The police are called, supervisors respond; it’s a big deal.

The medic directs all comers to his PCR and gives a full, honest account of the transport to the officials who question him.

“He violated me! I’m going to sue you,” she yells across the ER. “You’re going to pay!”

It’s his word against hers.

The EMSA and his LEMSA are investigating. As of yet, the police have not closed the investigation. Nevertheless, the medic was immediately placed on administrative leave without pay, and fired less than a week later — deemed guilty without so much as a completed investigation.

Cameras as the second set of eyes we can’t afford"

Have we really reached the point where EMS providers can no longer do what they are trained and expected to do for fear of being accused of and fired for something that didn’t happen"

Do we need to consider having two providers in the back of every ambulance on every call" Is it time to create the position of ‘Fair Witness’ that Robert Heinlein predicted in 1961" Probably not a bad idea, but I cannot think of a single system that can afford such a position.

If we can’t afford to further bloat EMS budgets with additional personnel, maybe it’s time for video cameras in ambulances. Maybe it’s time for the last corners of privacy in society to be stripped away in order to keep everyone honest. That would certainly help fulfill the prophecies of Kafka, Orwell, Heinlein, Bradbury, and Huxley.

As you can see, it makes me angry to think of it … but maybe it is time.

Police car dashboard cameras have proven guilt and confirmed innocence with near equal accuracy. Cellphone video, security video, and GoPro video have done wonders to keep police officers honest (or accountable) — and have helped convict the guilty

So, what would happen if the same technology was employed in EMS"

Pros and cons of cameras in EMS

PROS

  1. Every patient interaction would be chronicled
  2. Speech patterns, specific statements, patient complaints, skin color, and other environmental factors could all be confirmed and considered by the secondary and tertiary providers
  3. Specific treatments, techniques, and processes could be chronicled and used for future reference and training
  4. False accusations could be easily refuted and mistreatment or misconduct just as swiftly assuaged
  5. There would be accountability

CONS

  1. Every patient interaction would be chronicled
  2. The existence of information begets the disclosure of information
  3. Privacy could become compromised to the point of extinction
  4. The fear of disclosure could prevent some patients from sharing highly sensitive and medically essential facts
  5. Appropriate accountability could give way to unsupported judgment by unqualified armchair quarterbacks — and lawyers

On the whole, it’s not the worst idea I have ever heard, and it is an idea whose time has probably come.

But is the industry ready for it"

Are providers ready, willing, and able to be on top of their game, 100 percent of the time" Are agencies ready to assume liability they otherwise may have been able to avoid — by a preponderance of the evidence" Are the weak links ready to be called to task" And are agencies willing to call them to task"

Is EMS ready for the kind of accountability video cameras would foist upon it" Of course, I don’t know. There are just too many variables.

But, I do know this: ready or not, it’s coming.

Moving from a QA to QI program helps EMS managers focus on improvement, not blame

By Dr. Shana Nicholson and Joseph Heaton
InPublicSafety.com

As emergency medical services (EMS) managers, quality assurance (QA) can be a struggle when it comes to guiding our staff. It is imperative that we ensure staff is not only treating patients appropriately, but that we document this care within the appropriate guidelines and medical protocols. However, as we know, this effort can be a struggle.

Many times when we discuss the QA process of medical care review with emergency medical providers, the initial response is to become defensive or aggravated. Historically, the QA system has been used as a weapon in a sort of blame game for problems with a call. EMS providers have been judged by peers and medical directors as lacking in professionalism, skills, and providing bad patient care on an opinion-based system. However, there has been a shift in federal patient care guidelines toward the Quality Improvement (QI) method of review.

Medical professionals are transitioning to a QI for peer review of patient care records. The QI process of chart review looks for performance deficits over multiple care scenarios. The QI process sees a standardized level of care and utilizes a fair approach to evaluating the needs of the agency’s emergency providers. The QI process allows for self-reporting and sampling of run sheets. Data capture focuses on multiple areas of the run report for sampling as well. As the patient care sheets are evaluated, learning opportunities for the providers are identified as areas of improvement.

Read full story: Moving from a QA to QI Program Helps EMS Managers Focus on Improvement, Not Blame

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