The legacy of a man, Rest in Peace Dave Kaye.

                Friend, colleague, soldier, teacher, paramedic, convicted murderer, it would seem that one of these terms didn’t belong with the other. Well, allow me to tell you about a man named Dave Kaye. Dave was a flawed individual. A boisterous man who knew of the mistakes he made and never tried to hide from them. He instead chose to take another path and in the process proved that a man can change his destiny.

                When I first met this man, I never expected that he would influence as many people as he did. First impressions would tell you that he was nothing more than an arrogant, loud, and abrasive person. Till he got to know you, he was a bit standoffish. But if you wanted to learn, and he knew something, he was always willing to teach. From advice to a laugh he gave what he could and we all remembered this today.   

        

                Allow me to explain something here. Illinois used to have a program that allowed prison inmates to become E. M. T.’s. It was a successful program that lead to many people turning their life around. This program is no longer active for many reasons, but it was a success. I am a firm believer that we need to find ways to help those who are convicted of crimes reintegrate into society. This is what Dave did.    

                      

                Too many people found out about the bad part of who he had been and failed to recognize who he became. Dave owned his past, never making excuses or acting like someone else was to blame. Instead he chose to become better than that. I mention his past because unlike most paramedics, his legacy isn’t the lives saved or the families he comforted. His legacy is something greater, hope.

                Hope is what he embodied. Hope that a man doesn’t have to be defined by a horrible mistake. Hope that choosing to be different can lead to a better place. Hope that redemption is possible. Dave lived the statement, YOU CAN BECAUSE I DID.

                I come here saying this because on April 3, 2015, this man passed on to his eternal reward. In the back of the ambulance today taking him on his final trip, we laughed telling stories of this man. We all realized how he influenced us all. Too often we forget that the most important part of the journey is those who we teach and those we inspire. The end is that we are not ruled by the mistakes we made and we can all change.  Dave my friend, rest easy brother and enjoy your rest, we have it from here.

As always thank you for reading,

Roger Morgan

NRP

An Open Letter to Holly Monteleone

Dear Holly,

     I am writing this to express both gratitude and disappointment. For what it is worth, allow me to state that you are a good representative of EMS overall. You present yourself as a compassionate caregiver and professional Paramedic. You do EMS a great service and as a father and husband of EMT's I am glad to a strong, intelligent, positive female being put forth as a provider. Thank you for this above all else.

     EMS has needed someone like you to be highlighted. Your performance makes us look good while showing that being a burnt out miserable individual is not what we should aspire to be. Your demonstration that good patient care and being positive are needed. Personally, your being inked shows that those of us with tattoos are capable of being professional and courteous. Add in your being well spoken, intelligent, and attractive and we have a rock star paramedic.

    This is why I was disappointed in what you having a negative attitude about Dr. Bledsoe and his criticism of the PAF t-shirt. While overall I consider PAF to be a positive group, as in they tend to not attack science and are great in supporting needed EMS ideals such as the Code Green Campaign. But the T-Shirt that was pointed out is something that while it might seem fun, has a negative impact on the profession. I will go even further if PAF was private I would consider it to be a necessary page.

    Gallows humor and venting frustration is healthy, but I tend to be critical of these things in a public forum. The public can't understand it, and often sees it as being uncaring. I am a small time blogger and this is part of my personal way to relax and blow off steam. But I saw this and felt I should point out that you are now the face of EMS. No individuals like Kelly Grayson, Chris Cebellero, or other provider. You are on television and highly visible. There are those out there that would tear you down. There is a likelihood that you will wind up interviewed on EMS issues. In short you represent us all, and we could do a lot worse. Thank you for reading this if you do, have a great shift, and stay safe my sister.


Roger Morgan

Lone Medic

Depression, Change, Friends, and Recovery.

It has been a while. During this time I have changed jobs, had some family problems, and I fell back into the an old enemy, depression. We in EMS are big on hiding from our pain and acting like it doesn't affect us. We often hide through substance or self abuse. I personally became aware of it when I snapped on my wife and made an inappropriate statement in front of a patient. These are out of character for me, and this showed me that I was having a problem. My old pal depression was back.

Depression is an affliction that strikes many in EMS. We are told to get tough. If it shakes you, then you are in the wrong job. You should not allow yourself to become that close. Just put it behind you, you can't do anything about it. But that doesn't work, because to be good at what we do, we have to be able to empathize with our patients. Empathy requires that we feel. It cannot be faked or compensated for.

So on to my story, when I was shocked into action, I started reaching out. Many of those that listened to my private rants and offered help are members of the Code Green Campaign. I was also offered assistance from my employer, which was welcome. My employer has a plan in place to assist employees in trouble that is available from day one.

So far, I have been able to avoid medication, but I was forced to do some serious introspection and evaluation. I am doing better, but I am still considering medication. I am going to share some of the things that helped me. The most important thing was to admit that I was depressed. You cannot beat this or even fight it without admitting it. I know people that have ruined their lives trying to drink, use drugs, or sleep around till they feel better. This does not work. It will make things worse, causing often irreparable damage to you relationships, the very ones you will need to ensure you make it through this.

I took a step back and examined what I wanted to do with my life and was EMS part of it still. I recently changed jobs, and increased my commute for slightly less money, but it was improved by the increase in benefits. I also had a truly private problem, that I will not discuss here. But in changing jobs I left the state I started in. I was not happy working under the system I was in. Even though the system was systemically broken, I felt as though I had given up. That was part of the problem. I had also labored under that system with the goal of changing it. I had to leave.

So I took I reached out to those who were on my side. I talked to people who had been through it. I also read some articles that allowed me accept that my emotional involvement was a good thing, something I should have remembered. Also I was reminded that leaving is sometimes necessary for perspective and growth. But it made me feel like I was a failure. See in leaving Illinois, I realized I had to abandon that fight from the frontlines. It was like a divorce. Probably for the best, but still feels like a failure. So I am winning the struggle. It isn't over yet, but I am happier now.

The following blogs are part of what helped me.

http://www.ambulancedriverfiles.com/2007/07/27/perspectives/

http://www.ambulancedriverfiles.com/2007/06/23/grief-sponge/

http://www.ambulancedriverfiles.com/2007/07/24/seeking-words-of-balm/

http://thehappymedic.com/2014/04/suicide-know-when-to-ask-for-help/

http://www.lifeunderthelights.com/2009/10/28/dear-state-of-illinois-emshellip/#sthash.uyFvxhfj.dpbs

These are but a small amount of the EMS blogs out there that I read. They allowed me to accept that I was ok. Changing jobs, feeling pain, these things are ok. Asking for help when it hits is ok as well. Sometimes, you have to understand that you can't change the world alone. If you are a provider that is in this place. Message me on here. Ask your friends Ifand employer for help. Talk to someone. You are not alone. EMS Suicide it a disease we inflict on our own. I refuse to be in that statistic. I hope you agree.

To those who helped me, actively or passively thank you. To those who are in trouble, you are not alone. Please visit and donate. These folks do good work.

http://codegreencampaign.org/

Thank you for your time,

Lone Medic

A simple concept that is often forgot.

First and foremost, I would like to recommend that any EMS professionals reading this take your time to listen to the Inside EMS podcast. Kelly Grayson and Chris Cebollero. Follow the attached link and enjoy. The EMS news, clinical information, and guests provide insight into the future of EMS. Please follow the attached link. http://www.ems1.com/columnists/inside-ems/

                Now on to the new post. You sit around any EMS squadroom and you hear people talking about the calls they had and amazing skills they performed. From catching a STEMI early to quickly managing an airway. I know I am guilty of this myself. We have a lot of bravado in this professional. But we are often missing what makes people remember you in a positive way.

                Taking time to do little things often improves the patient’s opinion of you. There was recent discussion online about whether or not you should allow a patient take a selfie with you after appropriately managing their pain. Really, a patient wants to brag on how you helped them in an extremely modern way and you think it is a bad idea.

                I have saw and helped other EMS personnel take a few extra minutes with a patient ensuring their dog was fed or their lights were off. These might seem like small things but they relieve anxiety. These acts of kindness also help providers reconnect with the humanity we often try to leave behind. They are a form of compassion that should be encouraged.

                Compassion, that is often considered a word of weakness. In a world where providers grab up t-shirts that say things like here to save your ass not kiss it or drive safe or I get to see you naked. We celebrate the burnouts and listen to people who actively encourage negative attitudes about the profession. I know those dialysis appointments are a total waste of your time, even though you are providing an actual lifesaving service at the time. Yet being nice and compassionate is often the most effective way to have a real impact on your patient.

                I was recently called to a patient where I had transported a member of the patient’s family. The patient was a pediatric and was apprehensive until they were told by the family member how I treated them. One seemingly unrelated act allowed me to effectively manage a situation. Learn to be proud of getting the hugs from your elderly patients. When you are getting these responses you know that you are providing compassionate care.  They won’t remember you starting an IV or rapidly intubating them to save their life. They will remember you treated them with respect and care. In the end that can make the difference between being able to appropriately intervene and not.

 

                                                                                                                                Until we meet again,

                                                                                                             Lone Medic

Listen to the cry for help.

                I recently read Kelly Grayson’s new article on EMS1. Now most people who know me, know that Kelly is on my required reading list, and that I am occasionally fortunate enough to speak with him. So the linked article was a final push that lead me to posting this particular post.

                In 2006, I was clinically depressed. My marriage was on the rocks, I hated EMS. I had no prospects for improving things. I was near the end of my rope. I had a continuous stream of bad calls, which sooner or later gets to you. But I was fortunate. I found a job that allowed me to use my talents, knowledge, and experience while lowering my overall stress level. I jumped at it, and will forever be grateful.

                I was lucky. Many are not. We need to look for the signs of depression and burnout in our fellow EMS types. We often hide our problems from fellow EMS personnel, as well as friends and family. We have to look out for one another. Please help your brother and sister EMS personnel. If you’re in trouble, please get help. Use whatever recourses you have immediately. We lose to many to despair and depression.

 

Kelly Grayson's Article. http://www.ems1.com/ems-advocacy/articles/1679642-Why-we-should-always-look-out-for-each-other/

Thank you Kelly, We need more like you,

 

Lone Medic

Mentorship and professional development.

   

              I had an encounter with a decent young EMT who was leaving the field. This young man had a strong sense compassion, the ability to think, and truly wanted to help people. He was not helped grow as an EMT. He was not taught the things he should have been. His partner was quick to blame him for any failures. He seemed to think that he should take responsibility for things that went wrong. I happened to be driving while he was finishing a PCR when we were dispatched to an emergency call. It took us an inordinate amount of time due to confusion on my part. He was willing to take the blame for this as he was quitting, and thought it was ok. That’s when I started seething.

                When I started in this business, I had several Paramedics and senior EMTs who took time to ensure that my questions were answered. They reassured me when I thought I did something wrong. I was corrected when I actually was wrong, but at no point was I belittled. I was mentored. We didn’t call it that, it was just how things were done. If someone wanted to be an EMT and was willing to listen we helped them. Now to be honest, we often eased or tried to force people out who we noticed were dangerous.

                Everyone was given a chance because you never knew who was going to have the ability to do the job. We took time to cover skills that were often neglected in class. We listened and took time to help them deal when that bad call came. We had a lot of people turn out to be good EMT’s and some of them became Paramedics with the talent and understanding. It seems silly but it worked.

                This seems to be gone these days. People make mistakes, and new people are unsure of themselves. Someone’s inexperience should not be an excuse to shift blame to them. These people need your guidance. When you make a mistake, own that mistake. Show the new person that mistakes should be a chance to improve. Learn from your errors and grow from them. Teach these things to new EMTs.

                I mentioned a bad response time earlier. I went to the Supervisor on duty and took my concerns to him. I readily admitted that I was the one in error. I also took my concerns to him. As an employee I felt it was my job to pass on my concerns. I also explained to the young man that he did not want to burn his bridges. He might want to come back one day. I hope that he returns to EMS, as we need people who have the passion to help others.

                A blogger who I respect has stated the good judgment comes from experience and that experience comes with bad judgment. Bad judgment seems to cause a lot more situations like this. If we refuse to mentor people EMS will continue to be a job and not a profession. EMS will not be a destination, but a stop towards something else. We often discuss better treatment modalities, appropriate response types, and bases vs. SSM. But we never discuss how to improve the profession from the inside. You are the first person that young EMT gets to work with. You are the one that will influence their mentality. Don’t treat them like they should be perfect. Remember someone took the time to help you.  Good mentorship will give you that partner that you want. The one that can anticipate your moves and sees patients as a human beings.

 

Thank you for your time,

Lone Medic

EMS, John Henry, and Providing Care

Another blogger has pointed out the useless ness of the Glascow Coma Scale outside of trauma and the under 8 intubate idea, and I hope you take time to read this, http://theambulancechaser.com/2013/12/01/i-broke-an-ems-rule/.

But what about where it applies, trauma, RSI is known to improve a patient’s outcome in traumatic head injuries, unless it is performed by EMS. The cause of this is often EMS providers freaking and hyperventilating a patient. Folks, oxygen can hurt, and over oxygenation has a negative consequence involving morbidity and mortality.

So what am I getting at here. RSI is a very important tool that should be in every Paramedics tool bag, as long as they can ensure it is done properly. So what do we need to do this properly, two things, End Tidal CO2 Capnography and a ventilator. This is going to hurt some peoples feelings, but a ventilator does the job better than you because it doesn’t have adrenaline. You set the rate, tidal volume, and voila perfect controlled respirations.

This is something no one wants to admit, machines can do things better. I am an advocate of taking CPR out of people’s hands as well. These things involve a level of control that humans are not capable of. IV access is an art, but EZIO makes IO access better, easier, and safer so we can use it in the most critical of situations.

The idea here is to ensure that we are doing the best thing for our patients. We need to accept that our egos are not more important than our patients. As a Paramedic, we are expected to make proper decisions in high stress environments. So why not push to make our lives simpler. We all know that we need to ventilate the patient 8 times a minute after the intubating. We know a patient needs 100 compressions a minute with minimal interuptions. So why not seet it and forget it.

I know, I am probably giving up my title as a Paragod by saying this, but we need to perform better. We need to learn to cheat. From Video Laryngoscopes to Thumpers, there are tools out there that can help us perform better. Agencies need to determine which ones will cover their deficits and budget appropriately. Providers, you need to be honest. Admit your faults. This is how we get better, and remember that when John Henry said he was better than the machine, he died beating it.

 

                As always I value your input and comments,

                Lone Medic.