To Think

What does it mean to be an innovative thinker? What does it mean to think outside of the box? What is the box?

I'll get back to those in a second

I recently interviewed for a position within my department. The position was new, something that was needed and was definitely missing in our department. It was an opportunity of a lifetime (maybe). It was an opportunity to create something from nothing. I believed and still believe that it is a position that requires a creative mind, innovative thinking and the ability to see things for what they really are. To look below the surface and find the true problems and the true heartfelt needs.

I did not succeed.....

I don't think at the time of the interview that I was able to, or didn't have a quick enough mind to answer the questions in a way that truly displays my heart and passion for EMS and the department that I have lived in for the last 29 years.

I didn't understand what they wanted. There were many things that I wanted to say, but didn't, I don't really know why. Maybe I thought that I needed to try to give them what "they" needed, not showcasing myself but rather conforming my passion to the questions they were asking. Either way it has taken me time to formulate my thoughts and ideas concerning the questions that were asked me. And a few of them I want to address here.....

To the question of creating or establishing a paramedic skills maintenance or criterion. First I believe to truly answer that question, one needs to truly understand what the real problem is. Is it that we have a skills maintenance problem, I don't think so (at least not that I have seen). The problem is that for the last 10-15 years the school that we have used to teach paramedicine has been grossly substandard. Substandard teaching, administration, follow-up, basically everything. The root of the problem is not that we have a skills problem, it's that most paramedics were never really taught those skills in the first place. Most students that came into the field came into the preceptor phase at a deficit. Most would have been better prepared if they had done online training and not sat under the teaching of individuals who had no idea what they were talking about. That is the true root of the problem. Do we have medics in the field that need help? Yes, I believe that. But it is a case by case and not the whole. Would the department and paramedics benefit from an organized skills maintenance program... I believe yes. But if we fix the true problem then we are not starting out at a deficit.

EMS state mandated CORE training. I have no idea what the heck that is. I have been a medic for 25 years, recerted every 2 years, been to countless EMS TAG sessions, both mandatory and not mandatory, RPACs and I still don't know the difference. Do a majority of the paramedics in the field know? Do they even care? We are required to have 48 hours of continuing education every 2 years, most of the time we barely get that. Are we supposed to be getting it from the nurse educators. Most people just struggle to get the 48 hours. We don't care the difference between CORE mandated classes and online Target Solution classes, we just need the hours. And how do we evaluate that......very poorly, if at all. If someone who has been a medic for 25 years can't tell the difference and frankly doesn't care because it is merely a time based criterion, then apparently someone is totally missing the mark.

How would I interact with a "non-sworn" person if there was a conflict? Really??? I would like to think that that was the stupidest question asked, but I supposed that it needed to be asked because there are people out there who don't know how to be adults. You treat each other with respect. Each idea is valid and there is always common ground when you are trying to reach a common goal. The stupid person is the one who throws his badge on the table and plays the "I'm the Captain game". That's the person I personally don't want to work with. I want to find the commonality, the areas that complement each other. Just because I am sworn and someone else is not does not in any way negate the validity of their idea. That is called being an adult.

Rehab. Do we have a policy? Then institute it!!! How hard is that. Does it need to be tweaked. I don't know. I've only seen wet towels on an incident one time....and I didn't even get one!!! Do we need to have a study of what replacement drink we need or what is the best way to cool someone off? We have rehab units, are they not doing their job? Maybe the answer to that question is maybe we need a Captain in the service center in charge of rehab. I personally don't think it is an EMS problem. There are so many other pertinent problems that face EMS today. Stock the rehab units, assign them to every 2nd alarm or greater, train the guys who man it to take blood pressures and on what is the best method to cool guys down and then document it.

Could I recall a project that I worked on that was EMS related and what did I think of it or rather self-evaluation? I chose the first ePCR. It was a piece of crap.... It still is.... But we were told this is what we are getting, there was no opportunity for input to change it. In essence we were told that this is what we are getting, this is what you ARE using..... Like it!!! So did I have to sell it? Totally did, and I did it well. The guys in my battalion were some of the first to go live with it. It was not that I liked it or didn't like it, we didn't have a choice, so I had to make it work, because that is what we do. You give a firemen a fire engine and he will put a fire out with it, you give him a problem and he will come up with a solution, you give him a crappy computer and call it an ePCR and he will learn to document patient care with it....... It is just what we do!

There was a question on how we evaluate training, feedback. We don't. Or at least not well enough for me to recognize any benefit from it. Like I said in the interview, we are very quick to criticize but incredibly slow to applaud. That needs to change and it needs to start in the Captain rank. They are the leaders. When things are good they need to say they are good and give positive feedback to the people who are teaching. And if things are bad, then they need to be at the forefront in fixing the problem.

I don't know if that was all the questions that were asked, but I wanted to share answers that I should have given. I think I didn't respond the way I wanted to was because I was too afraid to stray to far outside of the box, outside of the norm, to not step on toes, to try to give the answers that I thought were closest to the questions and still be able to interject some of my passion for EMS. I struggle with bureaucracy, that is my box. It is what hems in creativity. I cannot form committees or do studies. I talk to people, create lines of communication to firemen, other Captain's, Paramedic school, Chiefs, other departments, people who have answers and ideas to the problems we face. I then bring those solutions and ideas to my department and mold them and use them in a way that benefits the OCFA and Orange County as a whole.

Lastly, I think that the EMS Captain needs to have the skill and foresight to aim and the"true" problems facing EMS. Paramedic school, Community based Paramedicine, OCFA and OCSD helicopter debacle (not specifically the helicopter portion but the OCSDs desire to get into the EMS business), the OCFA Fire Academies, Nurse educators and field personnel and specifically the lack of adequate communication that exists in every one of these areas.

That is my passion, and that is what I envisioned for the position of EMS Captain. Sadly I was not able to communicate that in the interview setting, and honestly I don't know if it would have helped. I don't think that our department is ready and willing to move outside of the box. Our department is reactionary, not innovative. We were slow to get the first ePCR (and the one we got was a mistake). Slow to go to the iPAD, haven't embraced Community based paramedicine, are pressured by OSHA to institute a rehab procedure (which should have been done way back when we did the studies), and have not taken an active role in assuring that Saddleback puts out at least a competent paramedic student. Creative thinking and innovation are not the characteristics of our department, but they need to be and I felt that the EMS Captain position could be the beginning of that




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