Is your fitness a liability?

What if there was something that could lead to your personnel being injured or even killed on the job? What if that same thing also caused you and your fellow EMTs/Medics to be more stressed than they needed to be in an already stressful job? Am I talking about some new communicable disease you should be on the look-out for? Not exactly. I'm talking about your health and physical fitness.

If you work for/with a combination Fire/EMS department, you most likely had to go through some form of Candidate Physical Ability Test (CPAT) in order to be considered for your position, but the majority of volunteers in this country don't have to meet any sort of physical fitness requirements to be able to join an EMS agency. This shocks me in some ways but is predictable nonetheless. We're often in a position where we struggle to recruit and retain a sufficient number of volunteers to staff our agencies and be able to respond to calls. We likely set some standards (can't be a felon, should generally have a pulse, etc), but let's be honest - we're not really picky.

Still, I see it every day: I'm driving home and see an ambulance pull up to the scene of a car accident and two (or 5, if you're from that kind of department) providers slide out of the truck with a thud as they slowly lumber around to the back of the ambulance, already panting from this exertion. As they approach their patients, I suddenly lose track of who needs treatment - the car accident victim or the possible heart attack patient in the blue uniform.

The people who trained me when I got started in EMS used to say, "We don't run on the scene. If people see us running," the logic goes, "they'll panic because we looked panicked." Sound advice, I think. I don't recommend charging up to your next elderly patient with a broken ankle like an NFL running back, but what if you needed to move quickly. I've dodged more than one speeding car driven by an inattentive motorist on the side of the interstate or found myself wedged into a position to hold C-spine that would make an contortionist cringe. How then do we allow ourselves and our fellow EMS providers to go out there every day to save our fellow citizens from peril when they, themselves, are on the brink of the same fate?

Let me be clear, I'm no gym rat. I do not hide six pack abs under my uniform shirt. I do have confidence that if I was in danger, however, or my fellow provider was 100yds away and in need of emergent assistance, I could close that gap or get to safety without an attack of acute angina. We spend countless hours in training to learn how to park the ambulance on the road to create a "zone of safety" to work in, learning to lift with the legs and not with the back, and that the fold down step on the back of the truck can (and will) bruise your shins if you try to leap into the truck like a gazelle. Somehow, though, we don't hold our agencies to the same standard when it comes to our fitness for duty - a factor that has a great deal to do with how safe we are while doing our job.

Should every new applicant be able to bench 300 pounds and do 75 pushups in under a minute? Probably not, but there is a such thing as functional fitness. That is, does a person possess the necessary strength and agility to perform tasks that they will likely be called upon to accomplish in the course of their daily duties. Can they lift a patient of "large carriage" into the truck without the assistance of the battery operated cot you got that grant for? Can they maneuver their way to the top of a ladder on the construction site when someone has fallen? Can they run as they would if they were in danger? Can they defend themselves from a patient that suddenly becomes violent and the police are still minutes away (when seconds count)?

Sadly, the answer is undoubtedly "no" in the case of the larger than life EMS providers I see huffing and puffing behind the cot as they come and go from the ER. You don't have to be as fit as the SEALS to be an EMT, but you should be able to have a baseline level of fitness that prepares you for the job. Collegiate agencies have the benefit of a pool of young, generally fit applicants but setting standards for fitness now serves the agency's immediate need to protect its people and also provides a valuable life skill for your members as they graduate and move on. I don't know about you, but the next time a drunk starts taking swings at me and my partner is a football field away, I hope they're coming quickly, even if they're not going to qualify for the Olympics in the process. Fitness = Preparedness.

Turning $8 into $80,000: Part I

First, let me say how excited I am to join the team here at EMSonCampus. You can read all about my background and what I'm up to now in the Big Apple here. So how is my experience going to help you better manage your organization? Hopefully, the answer is through a number of posts on relationship management, fundraising (what I prefer to call development), and a few other topic areas.

So let's get started. What's with the title? The goal is that if you read closely you will learn how to turn an $8 coffee tab into an $80,000 response vehicle. This is the first- and some might argue most important- step in relationship management, building the relationship. Who holds the purse strings for your organization? Does that person have autonomy over their budget, or do they seek approval from someone higher up? These are both important questions you should know the answer to before you book your Starbucks date. Get the answers to those questions and then proceed.

So now that you know who your date will be with you need to reach out to them, yeah? Here's a novel idea. DO NOT send an email. Yes, I know, it's 2011 and we're all walking around with iPhone4s, iPad2s, and the likes attached to our flesh. However, one of the most important things I have learned when it comes to networking and relationship management is something that stands out [positively] will make a lasting impact and get you noticed. Thus, the 2-minute Drill. No, I'm not talking football, but rather email vs. phone. This should apply to your everyday life, but most certainly to your relationship management toolbox. If what you're about to ask, say, etc. could be accomplished in two minutes or less... you should call. Why? Here's the thing you may not know about decision makers yet, they're extremely busy and hate to be annoyed. What's the easiest way to annoy someone who is really busy? Send them an email about something that then turns into a ten email long chain of back and forth questions and answers. All of that could have been avoided had you just picked the phone up and called them, where you could talk through things. This is some of the best advice I ever received from a very senior level decision maker and what was the inspiration for my 2-minute Drill. He told me, "If what you're trying to ask or tell me is going to take up 2-minutes of my time on the phone, or fill up my inbox with a ten email long chain and require 15-minutes of me reading and replying, and you want me to react favorably for you... you best pick up the phone and call." At first this seemed counterintuitive to everything I had thought appropriate. "Busy, important person: I should email so they can read at their convenience, not just call and interrupt." Turns out that busy person would rather you interrupt them for 2-minutes than 15-minutes, go figure. Alright, so pick up the phone and call your decision maker (or their assistant) and get on their calendar. Use the logical approach to context the meeting. Have you never met them? [I would love to meet you] Do they know of you, but not really what you (your organization) does? [I would love to discuss further with you the goals of our organization and how we operate] Do you know them fairly well as they do you? [It would be great to talk about our goal for xxx] Have your pitch ready to go, but don't make it sound to pitchy. This isn't a business proposition. The decision maker must know you're genuinely interested in them, not their ability to make a decision.

Your coffee date is rapidly approaching, how do you prepare? Well, to be honest, there isn't much preparation necessary. Remember, this is supposed to be informal and more of a social occasion. You're not there to walk away with a promise for a new $80,000 response vehicle. You're there to build the foundation of a relationship, which if nurtured and managed properly will blossom that tricked out tahoe/suburban you've been wanting all on its own. This is true even if you're in the last scenario case where the decision maker knows you and your organization pretty well. Don't walk in to the Starbucks with a flushed out three page, colorful proposal on why you need LED lights 360 degrees around the vehicle and and ALS drug/IV warming cabinet, oh and don't forget the wood paneling inside and the leather seats. WRONG. Even in this case you should only casually mention the sweet new soon to be featured on YouTube response vehicle [more to come in a later post on that]. Do your research. Know the decision maker's background, a bit about what their job description entails. Use that as your launching pad if necessary in conversation, but again show genuine interest in the decision maker. Don't make it too scripted and robotic or they'll see right through that charade.

The day has come. First, don't use the gift card your grandmother sent you. Pony up and pay in cash/debit/credit and buy the decision maker's drink as well. Insist upon it, you called the meeting after all. Just hope they don't order a Grande Skim Raspberry White Chocolate Mocha with Whipped Cream... err I certainly would never drink such a thing *cough*. Sit down, engage, and impress.

Follow up with a handwritten thank you card delivered in the mail (inner office or USPS) it doesn't matter. Sit back, relax, and watch as the relationship will soon start to bud with just a little watering every now and then and some sun exposure. More to come on the next step in relationship management and how to turn the bulb you just planted into a springtime shoot.

Agree? Disagree? Let us know below.

Continuous Improvement - Closing the Training Loop in EMS

Let's talk training. Before I get to my main point, I want to clarify what I mean when I say training. We use this word to encompass a lot of things - classroom sessions, certification courses, hands-on "drills," or even required reading. One of the things I've had to get used to since I've been designing training and exercises under the DHS model known as HSEEP - Homeland Security Exercise Evaluation Program - is that there are, in fact, industry-standard definitions for each of these things. Training is something we do to learn a new skill and exercises are what we do to practice those skills and identify where we have strengths and where we have room for improvement. Beyond that, there are many different types of exercises, each with a specific purpose, but that's an entirely different post for another day.

For the purposes of this post, when I say training I'm referring to the entire spectrum of educational (hands on or off) activities we undertake to better prepare for our jobs in EMS. Ready for my point? Here it is: most of us are actually not very good at training. "Wait just a second," you're saying, "we train hard and we train often and it shows in our performance." I'm sure you do, so take a deep breath and read on.

Effective training is a cyclical process - we learn a skill, we practice that skill (maybe even within a scenario), then we determine where we need to do better and we train more and practice more. Most EMS agencies I've worked on exercises with (to include collegiate EMS agencies) are very good at being ahead of the curve on training - we have to be. This is a trade where people's lives depend on our readiness - whether its knowing your ACLS protocols to save that one patient or having a plan for "the big one" that could save hundreds or thousands. We all understand this responsibility and we train to meet it.

Where a lot of agencies fail in this process is closing the loop. Remember, training is cyclical. Just because we trained everyone on the new plan for a mass casualty incident at the stadium/auditorium/lecture hall/etc. doesn't mean we're done. We have to close the loop - that's called continuous improvement. In order to achieve a standard of continuous improvement, we have to train, test, refine, train, test, refine, train, test.... until we get it right.

Key to this cycle is having a training plan - training and exercises have to fit into an overall plan that lays out the objectives we're trying to reach, how we plan to reach them and finally (but most importantly) how we know we've reached them or not. After each hands-on training (or exercise, if you please) we have to review those things we were good at and which we could do better. Those improvement items need to be written down and corrective actions determined for each of them. Answer the question: what do we need to do to improve our performance in doing ___________? Then write that action down and record who is responsible, what they need to do, and by what deadline should they do it. After we've acted on our improvement items, we're done - right?

No! This is the single point of failure in most agency training programs. Once corrective actions have been taken, we have to test ourselves again. We have to validate that the actions we took resulted in improvement. You will likely identify even more improvement items in your second round - and we do the same thing with those items.

This is the burden we carry by accepting responsibility for the lives of the people we serve - each time we improve we uncover new areas we can further improve. The cycle is easy, but maintaining momentum is difficult. Remember this, continuous improvement is the keystone of this structure and without it, the rest isn't worth much because you'll always be limited by the same challenges you encountered in your first round of training.

Think about it - are you continuously improving according to your training plan?

Peer Leadership, Easier Spelled than Done

Those wondering about the title can ask anyone who has read my hand written reports at the hospital, good spelling is not on my list of qualifications, but fortunately we are now in the age of tough books and spell check. I hope you all enjoy my first of hopefully many blogs on EMSonCampus.com. I will be writing a little about leadership, eventually some integration with other agencies, training and whatever else I am feeling inclined to write about at the moment. Let’s get to it…

The fact that peer leadership is the hardest type of leadership was etched in my brain through my ROTC classes and was shown true through my leadership role on the Virginia Tech Rescue Squad. Organizing college students in general is a difficult task alone, whether you are a more senior individual in the university or a volunteer student member of an agency, it is tough. It is hardest, however, when the people you lead are your peers. Through my experiences, I have seen a few main reasons for why peer leadership is so difficult. First of all, EMS at the college level (and most levels) is full of people with type-A personalities, where everyone wants to be the one in charge and believes they have the best idea. This alone can cause drama amongst the members and cause headaches for the leaders. College students are typically very driven and motivated, but at the same time, they’re visionaries. When harnessed appropriately these are great traits. It is important for the leaders to sit back and figure out the best way to do the harnessing, while still maintaining a chain of command. A good way to do this is to listen to your members. While you might think that you have an open relationship with the agency, it is good to have a more structured place and time to listen to ideas. In the military, we call this a “commanders call,” which is when the commanding officer will call the company, squadron, ship (military group of your choosing) together and give them a chance to ask questions, make requests and give their input. While this is not always a mandatory event it is always publically advertised to the entire group. This will not only give the members with ideas a chance to voice them, but at the same time let the members know that they have a pivotal role in the group.

Still, at times a leader must draw the line and as a peer leader this can be very difficult. It is hard for someone being disciplined or critiqued to understand or respect the punishment when it is coming from someone of his or her own peer group. This is due to the simple fact that peer leaders often are friends with their followers before they are placed in a leadership role. A good way to avoid this situation all together is to lead by example. If you, as the leader, consistently do the right thing and ensure that your followers are observing you doing the right thing then they are more than likely to follow your example. Unfortunately, this does not always work. So when it comes to disciplinary actions it is important to have a face to face conversation in a private place. In middle school everyone always laughed at the kid who was publically called to the principal’s office. Avoid that situation by contacting the individual in a private manner. Once a meeting is established, be sure to fully explain the problem that has occurred, what the outcome is and, most importantly, ensure that it is a two-way conversation. Let the person being disciplined explain themselves and ask questions. If they’re resistant, you might even ask them to explain the consequences back to you so that you can ensure they have a complete understanding. Throughout this process, the most important thing is to document. Documenting what happened and what decisions were made holds your peers accountable and allows them to hold you to the same standard.

Another complication of leadership is no less common in peer leadership: as a leader you will often be blamed for poor outcomes. As well you should be, because you hold the ultimate responsibility, but it is important that your followers understand the situation and that you hold yourself responsible and articulate what should have happened. On the other hand, when it’s praise coming your way, it is important to praise your followers and let them know that it was their hard work that aided in mission accomplishment. This is the best part of leadership, praising your subordinates. Ensure that they understand the big picture, which they often do not see. If your agency was involved in a multi-agency response and there is a de-brief that they are invited to, encourage them to go. If they are unable to go, make sure to take notes and make those available, this will not only aid in professional development, but also let them see what role they played in completing the mission.

I hope this might help some with those difficult peer leadership situations out there. Does anyone else have any questions, life experiences or words of advice?

A Great Read: "On Teaching, Mentoring and Stewardship" at AbmulanceDriverFiles.com

There's a great blog post over on AmbulanceDriverFiles.com today about precepting and it got me thinking about my experience as a preceptor and also as the coordinator in charge of laying out the rules for preceptorship.

When I served as a Training Lieutenant, I revamped the agency's training program for clearing new crew team leaders and attendants in charge (AICs). It was something I undertook because I felt that there was too little focus on skills and too much focus on the subjective impression of a field training officer (FTO) - sometimes called a preceptor.

It became clear (quickly, in fact) that the total loss of that subjective view that only the trainer can have when working with a new provider is inherently valuable. It's that gut instinct about whether someone is ready to do this on their own (preferably without leaving a trail of lawsuits and complaints) that can't be put into words. We ultimately decided to mix the two systems (old and new) to ensure we were monitoring candidates both objectively and subjectively. I think what came out of that was a very clear understanding for preceptors that the goal was to help the new provider develop their own understanding and approach to EMS - not to pass or fail someone or simply check a box. When I read the article on AmbulanceDriverFiles.com, it really hit a note for me as something I think we all need to remind ourselves about. Here's the link: On Teaching, Mentoring and Stewardship

What are your training and strategy questions?

I'm putting the finishing touches on some presentations on Designing Effective Training and Exercises and Strategic Planning for the Virginia Fire Chiefs Association Conference next weekend.

What are your biggest questions or challenges in these areas? I'd like to try and include some answers in these presentations and, of course, would post them here as well.

We're working on it...

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