Author: Scott McConnell

Scott McConnell, RN, CEN, PHRN, NRP, is the co-founder of Distance CME by OnCourse Learning and an EMS instructor.

4 Tips: Add Empathy to EMS Care

Empathy is about trying to understand, as best we can, someone else’s situation or experience. The question is, do we in EMS truly understand the word? Are we empathetical to ourselves and to the people we work with?

While some say that empathy comes from proper upbringing, today’s decline in civility means we see less and less of it displayed. A major contributing factor is the “tough” exterior we favor in each other: how often have you heard comments like “come on, just suck it up buttercup,” “you need to be tougher than that to be a medic,” or “we’re EMS, we eat our young.” Why are we like this, and why can’t we reinforce the empathy that naturally resides in all of us?

Empathy is a big part of our jobs, and we need to teach it to our students, our employees and each other. People need to feel that it’s OK to be empathetic and that it’s a natural part of the whole EMS picture.

One of the best techniques to foster empathy is active listening — not only to our patients but also to staff and co-workers. When you actively listen, you H.E.A.R. …

 Halt: Stop whatever else you are doing, end your internal dialogue on other thoughts, and free your mind to give the speaker your attention.

 Engage: Focus on the speaker. We suggest a physical component, such as turning your head slightly so that your right ear is toward the speaker as a reminder to be engaged solely in listening.

Anticipate: By looking forward to what the speaker has to say, you are acknowledging that you will likely learn something new and interesting, which will enhance your motivation to listen.

Replay: Think about what the speaker is saying. Analyze and paraphrase it in your mind or in discussion with the speaker and other classmates. Replaying and dialoguing the information you have heard will aid in understanding what the speaker is attempting to convey.”1

So always look at the other’s point of view and try to understand what he or she is facing. It just might change your attitude and make you a better provider.

References:
1  Wilson, Donna & Conyers, Marcus, “4 Proven Strategies for Teaching Empathy”. Edutopia, January 4, 2017.

Your EMS Reputation Depends on Three Cs

Your EMS Reputation Depends on Three Cs—Credentials, Courtesy, Community In EMS, your reputation is critical. Your character moves with you from provider to provider and from squad to squad; EMS is a small world where people know about you before you even step foot in the door. People react to you based on judgments from…

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Make a Difference: EMS and Human Trafficking

When we think of trafficking, we generally think of drugs or weapons, not human beings. Yet the problem exists in numerous communities where EMS responders deliver care.

Human trafficking is defined by the United Nations as “the recruitment, transportation, transfer, harboring, or receipt of persons by improper means for an improper purpose.” (End Slavery Now, 2018, para. 1) A more succinct definition comes from Kathryn Brinsfield, MD, MPH, Assistant Secretary for Health Affairs and Chief Medical Officer for the Department of Homeland Security: “Human trafficking is modern-day slavery.” (DHS, 2017, para. 3)

Why is this so important in today’s EMS field? We are the first on scene, we are the ones invited inside where others are not and we are the ones who see an injured person’s environment.  Our interactions with others can help us spot some of the tell-tale indicators.

Unfortunately, there are many reasons people are trafficked:

  • Domestic Slavery: People are brought into private homes to work as slave labor, with no options to leave.
  • Sex Trafficking: Children, men and women are forced into the commercial sex industry
  • Forced and Bonded Labor: People are forced to work under the threat of violence for no pay — often to repay a debt — without the ability to leave
  • Forced Marriage: Women and children are forced to marry another against their will and without their consent.

As an industry, there is much that EMS can do. We must keep our ears and eyes open, and report things that raise red flags in our minds. Some of the most common indicators we will see as emergency responders are:

  • Signs of abuse, wounds or bruising in various stages of healing or malnutrition
  • Scars or mutilations, including tattoos showing ownership
  • Language or cultural barriers preventing injured persons from communicating with you
  • Submissive or nervous appearances
  • Security measures like overly hardened doors or windows preventing movement of people

DHS has a great educational sheet with additional indicators to look for: click here for a printable copy. While a particular situation may turn out not to be what you suspect, report your suspicions regardless so trained law enforcement experts can evaluate the situation. Your hunch may save a life or multiple lives. Call Immigration and Customs Enforcement at 1-866-DHS-2-ICE (1-866-347-2423) or online here. You can also receive additional training here.

References

Slavery Today (2018). Retrieved from   http://www.endslaverynow.org/learn/slavery-today

EMS’s Role in the Effort to End Human Trafficking (2017). Retrieved from https://www.ems.gov/newsletter/marapr2016/end-human-trafficking.html

Changing the Face of EMS for the New Century

EMS has always been the forefront of medicine, delivering care to the sick and injured in various roles dating as far back as the Civil War. It has come a long way from the days of horse and buggy. Yet, where are we going now?

One look at the trajectory of Nursing indicates where we are headed. When Nursing first started, the profession was comprised of caring women who were viewed and treated as indentured servants, subservient to the male dominated physicians. Nursing evolved when the “servant” became educated. What followed were thousands of women beginning to diagnose, conduct research and improve outcomes in the healthcare field. Soon thereafter, they broke free of the care assistant model they were in. I see EMS following the same path.

The ambulance industry started out as transporters, with a curriculum that was adopted and funded by the Department of Transportation (DOT). The industry has roots in DOT, Police Departments, Fire Departments and the military, but are truly physician extenders that should be firmly rooted in Health Departments. EMS is now developing a language, doing research, obtaining national accreditation for our schools, even supporting continuing education with CAPCE. But we need to do more.

Outreach will help accomplish what many have started.  We need to consider the picture the public has of EMS, especially when we have overlooked self-promotion for decades.

Let’s be the ones who show the public what EMS is and is capable of.  I look forward to EMS education mirroring, “The Georgia Trauma Commission,” which collaborated with the Georgia Society of the American College of Surgeons and the Georgia Committee on Trauma to create the “Stop the Bleed” campaign. This inspiring crusade is designed to train school teachers, nurses and staff across the state on how to render immediate and potentially life-saving medical aid to injured students and co-workers while waiting for professional responders to arrive.” (2018, para. 4)  This type of training gives us face time with the public so they can learn what we do and what we do not.

One of the other important outreach programs to help us in this endeavor is the Community Paramedic Program. We are seeing this education transform EMS into new and exciting roles in the community. “First responders frequently respond to calls for social services. So, the emergency responders may know of people who need some sort of services or resources,” (Todd) Babbitt, a former fire chief, said. “This team could help connect those people with the services they need. It’s about getting everybody to work together and communicate.” (2018, para. 4)

What we can do is start to get EMS in front of the public. Teach. And open our historically closed doors to the folks that make it easier to do our jobs. Educate others and learn together how our roles are changing modern day healthcare while embracing the change. Otherwise we risk being left in the dust by our progressive healthcare brethren.

References

(2018, Feb 1st, 2018). Ga. School Nurses Train to Stop the Bleed. The Brunswick News. Retrieved from https://www.emsworld.com/news/219782/ga-school-nurses-train-stop-bleed

(Ed.). (2018, January 30th, 2018). Conn. Fire Chiefs to Form Community Action Team. Norwich Bulletin. Retrieved from https://www.emsworld.com/news/219757/conn-fire-chiefs-form-community-action-team

Is Narcan the Answer?

There has been a lot of talk recently in social media and the news about leaving Narcan behind after a reversal of an opioid overdose. A new voluntary program in Pittsburgh, PA allows the state to pay for Narcan atomizers that EMS can leave with friends and family of OD patients. The media buzz revolves around the idea that we are enabling this cycle of addiction; “There is some pushback that maybe you’re enabling the problem a little bit, but at least in the short term, reduce the chances that person is going to die and you create more opportunities to get them into treatment,” said Mark Pinchalk, patient care coordinator for Pittsburgh EMS.” (Media, 2018, para. 3) I agree with Mr. Pinchalk that as an EMS Provider we are not there to judge, we are there to render aid.

One of my early instructors said, “Scott, your purpose is to leave the patient better than the way you found them.” I have taken that long ago statement to heart ever since, trying to leave the patient better than the way I found them whether that is medically as in a Diabetic whose blood glucose I raise from 20mg/dl to 130mg/dl or the person who receives a ride to the hospital to be  checked out. EMS is about providing care. When we use our own judgements or opinions on our patients, it impedes or influences the care we provide.

These particular cases seem to bring out strong opinions surrounding a delicate issue. Thousands of people die every year from Opioid overdoses. A healthy percentage of them get their start on prescription pain killers. So where do we help? How do we not judge going to the same address three or four times a week to treat the same person in the same situation? These are just some of the tough questions providers and services face every day in America. Although we are trying to hold back the tide with a broom, it is up to us to provide the same level of care each and every time, regardless of the person or situation.

Will leaving Narcan at the scene save lives? Yes, I believe so. Will it encourage more drug use? I can’t be sure. Time will tell.

In comparison, studies show making birth control available to teens actually reduces sexual activity and reported pregnancies. Consider 2017 data that shows “Among adolescent females aged 15 to 19, 42 percent report having sex at least once. For males, that number was 44 percent. The numbers have gradually dropped since 1988, when 51 percent of female and 60 percent of male teens reported having had sex.” (Welch, 2017, para. 4)

So for now, I encourage the opportunity, as the law allows, to provide Narcan, knowing it doesn’t make the problem go away. And I look forward to EMS impacting this youthful epidemic. How? Community Paramedicine are the resource to embrace. Just like any other frequent patient, community paramedics will help those get the services they need including the much-needed follow up care.


Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME, which recently launched a new learning platform. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References

Media, C. (Ed.). (2018, Jan, 26th, 2018). Local EMS starts program to leave Naloxone with OD victims. WPXI.com. Retrieved from http://www.wpxi.com/news/top-stories/local-ems-starts-program-to-leave-naloxone-with-od-victims/689842523

Welch, A. (2017, June 22nd, 2017). Are today’s teens more responsible about sex? CBS News. Retrieved from https://www.cbsnews.com/news/teen-sex-trends-birth-control-cdc-report/

Reaching Millennials Through Virtual Gamification

When I mention EMS Games. What comes to mind? Do you picture yourself in the late 1980s playing ambulance driving games where you scored points by transporting patients to the hospital? Or do you think about games such as Emergency: The Paramedic Simulator, which was very much an animated comic book where you would choose a skill then turn to page 73 to see if it worked?

Today I think about millennial paramedic students and how they learn. The digital age has created a learning environment where people feel more comfortable multitasking, are tired of voiced over PowerPoint presentations and reading articles followed by a competency test. How many times have you skipped to the end of a self-directed learning module to take the test knowing you will pass? Did you stop to consider what you actually learned from doing that? Were there tidbits of information in the course that you may have picked up if you had followed along but since you already felt confident you knew the information you skipped to “prove competence or to just get your certification?”

The American Psychological Association article references a “study by Dalton State College psychology professor Christy Price, EdD, which suggests that millennials want more variety in class (August/September 2009 The Teaching Professor). “This is a culture that has been inundated with multimedia and they’re all huge multitaskers, so to just sit and listen to a talking head is often not engaging enough for them,” (Novotney, 2010, para. 4).

What can we, as educators, do to engage the millennial learners under our domain? I believe we must adapt to the types of learners we are teaching, not to the type of learner we are.

We all know the VARK model, Visual, Auditory, Read/write, Kinesthetic. In a perfect world students would learn using one mode. But this isn’t a perfect world and the way the next generation learns and retains the information differently. “Research shows that millennial students prefer a less formal learning environment that allows them to interact informally with the professor and fellow students.” (Novotney, 2010, para. 8). So, how can we become less formal when we are stuck with a brick and mortar classroom setting with ridged times and dates?

The answer: live online learning in small blocks of time with gaming styled learning activities to engage more, enhance retention, and provide the learner the opportunity to discuss and interact in a protected environment.

“Active learning approaches — such as the use of student response systems and collaborative learning — are associated with greater academic achievement, though this isn’t necessarily millennial-specific, Meyers says. For example, a 2007 study examined the use of an electronic audience response system, in which students use handheld “iclickers” to respond to questions during a class lecture or discussion.” (Novotney, 2010, para. 12).

What this tells me is more engaged learners not only share information, but also are more active participants, resulting in improved learning. Consider then Virtual Patient Care Scenarios created in a gamer format with reality-based dispatching, treatment, post call round ups that let staff not only see what, when, how the student performs, but also proof of competency for certain call types. As technology continues to double every 18 months, we will see more learning move towards virtual online, which we, as educators, need to embrace now to engage our learners.

Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References
Novotney, A. (2010, March 2010). Engaging the millennial learner.

Time to handle 911 call demands with Paramedics

When discussing this new and growing field of pre-hospital care, there seems to be two unique paths that services are following. The first is the hospital-owned or contracted service, where community providers seek ways to decrease readmission rates for CHF, COPD, Pneumonia, Sepsis, MI and other chronic illnesses.

When a patient discharged with one of these targeted conditions is readmitted within a 30 day window, “hospitals face penalties of up to 3 percent of Medicare payments in 2018” (Gluck, 2017, para. 10). That is a lot of money. Consider, “Lee Health, Southwest Florida’s largest hospital operator, which is expected to lose $3.4 million in payments” (Gluck, 2017, para. 2). This model represents the if, or, and type of service, meaning if we can do it for less and there are providers willing to do this type of medicine, then we can save the expensive penalties from CMC.

The other model of community paramedicine is 911 abuse reduction. For years EMS has conditioned the public to call 911 for any emergency. But today, what we consider an emergency is far from the public’s perception of an emergency. “EMS has experienced a 37% increase in 911 calls since 2008.” (White, 2016, para. 6) Yet have we increased staffing proportionally to meet the demand? Afraid not since “only 50% of EMS services in 2008 were fully staffed, and more than 63% had a volunteer component as part of their staffing level” (“Critical Staffing Shortages,” 2015, para. 2).

The article references increasing wages to help compensate for the decrease in trained providers by attracting more professionals to the field. With the CMC limiting payments and the major insurance companies following suit, doubtful this will be an option in the near future.

To reduce calls and increase levels of service, we can try to reeducate the public to what is a true emergency, but that is a long and slow process. For example, Philadelphia has started the trend and placed several billboards up around neighborhoods that contribute an ordinarily high amount of non-emergent 911 calls. Will this work? Time will tell but I would believe not enough to affect the volume of calls.

What about enlisting Community Paramedics in these situations? I believe this is a viable solution with nurses triaging the low acuity calls in the 911 center. Dispatching Community Paramedics armed with not only the usual equipment, but also the knowledge base to connect these patients with primary care physicians, social workers, and the programs that are available to them. This will help people receive the long-term care they deserve.

Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References
* Critical Staffing Shortages (2015)
* Gluck, F. (2017, February 7th, 2017). Lee Health will lose $3.4 million in Medicare payments because of readmission rates. USA Today
* White, D. (2016, February 16th, 2016). Community paramedic? program intended to reduce 911 calls. Manatee Technical College

Protecting EMS and What That Means

I have been seeing a lot of chatter on social media and reading quite a bit about ambulance services issuing ballistic vests and providers being allowed to arm themselves. Looking at the available data, consider the following:

  • 67% (95% CI = 63.7%–69.5%) of respondents reported that either they or their partner had been cursed at or threatened by a patient;
  • 45% (95% CI = 42.4%–48.3%) had been punched, slapped, or scratched and 41% (95% CI = 37.9%–43.7%) were spat upon;
  • Four percent (95% CI = 2.8%–5.0%) of the respondents reported that they or their partner had even been stabbed or involved in an attempted stabbing; and
  • 4% (95% CI = 2.5%–4.8%) reported being shot or involved in a shooting attempt by a patient.” (Oliver & Levine, 2014, para. 22).

When looking at the survey results, specifically the low percentages of violent activities, it would appear that such protections are not needed. However, I cannot support the notion that a provider feels that where they work this protection is essential to them. I think a closer, more current look with a larger sample will create a better perspective. This study is relatively small and would be better served if the questions were more focused.

When it comes to “arming EMS Providers” I do think we are far from that. To arm EMS Providers would certainly require specific training, educational classes, and buy in from legislators.

Consider what happens if I defend myself. Am I now obligated to treat the person I’ve harmed? Would I, should I, be held to the same standard of trying to deescalate a situation as the police? With the absence of training and ambiguity of the legal system, I do not think arming EMS providers at this point is the answer.

To me, we need better education, better perceptions from the general public, and most of all a unified EMS front at the national level that is tasked with moving our industry toward the 22nd century.

______

Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References

Oliver, A., & Levine, R. (2014). Workplace Violence: A Survey of Nationally Registered Emergency Medical Services Professionals

 

EMS Education – A Look Forward

I have always believed EMS parallels the career trajectory of nursing. This is especially true when you look at the infancy of nursing—1750 to 1893—in what was a subservient apprenticeship with no didactic education. “Most nurses working in the States received on-the-job training in hospital diploma schools. Nursing students initially were unpaid, giving hospitals a…

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Discovering the Meaning of EMS Week

Being in EMS since 1990 I can certainly tell you I have seen numerous EMS Week celebrations come and go. Did you know EMS week owes its founding to the American College of Emergency Physicians? In 1974, ACEP asked former President Gerald R. Ford to declare November 3-10 as National Emergency Medical Services Week. Since then, ACEP has moved the annual observance numerous times, finally landing on the third week in May. This move provided a distinction between EMS and Fire Prevention week.

EMS has always been a part of my life, from the EMT-M class I took in January 1990 to becoming an RN in 2008.  I have done almost everything in EMS a person could do, volunteer EMT, Paramedic, Critical Care Education, ED RN and now vice president of EMS Education at OnCourse Learning.

Let’s discuss ideally what EMS providers actually want most for EMS Week. This year, let’s dismiss all of the usual tchotchkes, mugs, t-shirts, hot dogs, pens and flash lights. I can honestly say after 25+ years, I’ve gotten it all and am a bit tired of it. The ED sponsored pizza, while a very kind gesture, always seems to go uneaten for a variety of reasons.

Let’s face it, we know we are under paid and over worked. Although I am always grateful for the sentiment people have for us as a profession during EMS week I’d prefer recognition more frequently, even every day. Don’t get me wrong, I’m not being ungrateful, the hot dogs and pens are appreciated. But let’s focus on what matters most for pre-hospital professionals – better pay, working conditions, and meaningful education.

Which brings me to the area I can influence most. Not the everyday education, you know card certs PHTLS, ITLS, APLS, PEPP, and EVDT etc. I want something more. I want continuing education that excites me. That embraces my desire to improve EMS and helps us all to change and improve the care we deliver to our patients. To change the protocols that guide us in the care we provide. Basically, what I am asking for is a seat at the table, minus the pens and hots dogs. Let’s start with a better educational foundation, a voice in the care we provide and deliver better care to those who rely on us to care for their loved ones.

About the Author
Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME.  Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

How to Stand Out Using Low-Cost Recruitment, Retention Strategies

Scrolling through Facebook, I regularly notice EMS providers seeking feedback from friends and colleagues. Someone will post, “Hey, I’m moving to this city. Does anybody know some good ambulance services that are hiring?” Plenty of people will respond, “This is a pretty good place.” Others share warnings such as, “Don’t work for Provider X.” Word…

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Maintaining Compliance Within an EMS Service

Maintaining compliance within an EMS service can be a daunting task, especially given the number of regulations that we must follow. One way to look at EMS is if a trucking company married a hospital. There are rules and regulations to abide by for an entire fleet of vehicles, from safe operation guidelines all the…

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