Thursday, October 4, 2007

Professional and Personal

Yesterday was not a good day. I have found that blogging is about as good a way to work through and consider a problem as any other. So, dear readers, please allow me to ramble a bit.

About seven months ago I took my departments test to try to promote to Lieutenant. For the several months preceding that, I was studying. Hard studying. Like not spending time with family. Not going to events so I could stay home and read and try to memorize 9 books. I worked hard, I gave up a lot during that time. My family gave up a bunch more during that time.
I made it onto the list. I actually did pretty well.

Yesterday, I was "unofficially" asked if I would take a promotion to EMS Lieutenant.
And that is the problem.

Stay with me here.

I love EMS. I really do. I like having the knowledge and ability. I love being able to make a difference in someones life. I love helping others. Some of you folks in EMS/Fire/LEO jobs know what I mean. What I don't like about EMS is the administration. The paperwork. The justification of why I did something just outside protocol. The total BS.

When I started in EMS in the late '80s/early 90's as an EMT then Paramedic, we could only start an IV as standing orders. We then had to get on the radio (pre cell phone days) and actually talk to a doctor in order to give nitro. CPR? One round of Epi and Atropine and get on the radio for anything else.

As time went on, we got more and more standing orders. When I was promoted to Driver, and stopped riding the MICU,(about '03) I could work a full code and then call and tell them what I had done. I had standing orders for everything from D50 to Morphine.

What we got in return for those standing orders was over site. More and more we had to justify what we had decided to do. More paperwork, more headaches. And then, we got EMS Lieutenants. Several drivers were promoted to Lt., and then went to paramedic school to be the EMS shift supervisors. For those who might not understand let me say again. The sent guys to paramedic school, who were not then, or had been paramedics, and made them 'supervisors' over guys who had been paramedics for as long as 20 years in some cases.

The EMS Lt.'s job was (is) to find errors. To second guess veteran paramedics on runs they were not on. To do "QC" which means to analyze the run reports and try to spot ways the run could have been done better/different. To go over paperwork and find charting 'problems' such as not having a patients social security number, or not having the trauma score filled in for a med call patient.

That was the reason I studied and made driver. The truth was that I could have gone out on a call, done everything possible and correctly for the patient, and saved a live or at least made a major difference in the patients outcome. But if the paperwork was out of order, or messy, or whatever, I would catch holy hell. I know, I lived that more than once.
By contrast, I could also go out on a call, do shoddy work, barely follow protocol, and just be an inch short of unfit. But if my paperwork was OK, all was well with the world. I never did that, but I saw it more than once.

The EMS Lt. was the one who caused those scenarios. It was his job.

And now, they want me to do that to others.

I had hoped, and expected, that the promotion would be in Fire Operations. I would still be a paramedic, riding a paramedic staffed and equipped engine. I would have a crew of "my guys" to work with. I would have been an officer, leading men that I respect. I would have guys (or possibly girls) to work with, train with, lead, protect. We would have our differences, but we would be a team, looking out for each other.

The EMS Lt. drives a car, alone. He has no "guys". He has no team. He has no one to look after, no one to lead, no one to protect.

My current job is as a "Chief's Driver". I drive our shift battalion chief. I answer to him, not the Lt. or Capt. at the station we work out of. My job now is to drive, help the Chief with administration duties as needed, and mainly to help him on the fire scene to keep up with everyone. I listen to radio traffic to help him understand what is happening at a scene. I help make sure that all the crews are safe and accounted for. That's what he does, I help him do that. I answer to him, no one answers to me. But, I "give orders" in the name of the Chief at scenes.

My job now is to help take care of everyone on duty on our shift. If I can't have my own team to take care of, I may just stay where I am and take care of everyone as I am now.

I don't know if I could do the EMS Lt. job. I don't think I would do it very well. But that might mean not making Lt., having to go through and put my family through all that study again in a few months.

I just don't know.

Mr Fixit


Who is..... Carteach0? said...

And what service will you do your family by coming home each day unhappy..... and empty?

Do what is right... let the chips then fall.

Brandon said...

I think we all know what your decision is going to be. You're not going to take the EMS Lt. position because you know that it wouldn't be fair to you, your family, or your department for you to take a position that you already know that you will hate.

As much as your family had to sacrifice during your preparation for the test, I'm sure that they'd be willing to go through it all again so that you could get the engine spot that you truly want.

Medic3 said...

Well, let me speak for the idea of accepting the EMS Lt position. Consider the truism that "if you're not part of the solution, you're part of the problem".

You mentioned that DFD has more than a few EMS Lts who were sent to medic school to supervise the paramedics without actually serving in that role themselves. They are jerks to the medics that they manage, enforcing policy blindly and without discretion. Essentially, they practice Zero Tolerance with their subordinates because they have no personal experience to allow them discretion.

You can fill their shoes and do it better. You have been a medic. You can be a field supervisor who has actually done the job that you are overseeing. You can focus on QA/QIing the actual field care by dropping by the real calls that your medics are running; "fun" runs and "non-urgent" alike. See the work that they are really getting gone.

While many are good medics (I dare hope "most") there are undoubtedly a few that were scraped from the bottem of the barrel. The good medics benefit from the occasional "attaboy" just like anyone else. I know that it's a fairly foreign concept in the fire service, but people really do respond to positive feedback much better than they do negative. I would guess that like most fire departments, EMS is given short shrift in terms of accolades despite being the meal ticket of the fire side of the service. Mine is like that, and I've seen very few that aren't. The poor or marginal medics will also benefit from low key "suggestions" on how they can improve their quality of service; be it adherence to protocol, public interaction, or even the dreaded documentation. Keep a record of the people you make these "suggestions" to and as long as they improve, there's no need to hamstring their careers by adding it to their personnel records.

I suspect that overseeing field care is not a hardship for you, but documentation sounds like it is. The mantra "if you didn't write it, it didn't happen" from most people's EMS training is quite true. I have never had to take the defendant's table in malpractice (knock on wood) but a well documented run of mine has made it into the record of court proceedings several times. Had they not been well documented, I expect that I would have had to make a personal appearance and attempt to prove that my medical skills were not as sloppy as my writing. Most EMS providers underappreciate the value of documentation. So you have the opportunity to address this in your department. In your supervisory area. On your shift. But change has to happen somewhere.

As to not having your "guys" anymore, that is often the consequence of promotion. The EMS side of fire service does not have as much station-level/small-unit supervision as does the fire side. Junior officers are placed in the equivalent of battalion/district positions on the fire side. That being said, you can have your "guys" if you try. Make the rounds of your stations. Meet your medic crews. Spend some time at your receiving hospital(s) and schmooze with the staff there. While your guys won't be concentrated in a single house, you can still have your buddies--just spread out a bit.

I went the EMS supervisor route (EMS Chief, now) and there are times that I regret it. Especially, I miss riding the medic unit and making an immediate, direct difference in a citizen's or firefighter's life. But when I think about what we do as a department, I suspect that I have made more difference overall by improving the quality of our other providers. I would be happier with more departmental support when I try to change things. There are times that it is like trying to nail Jello to a wall. But such is the price of advancement. EMS and rescue are my preferred fields within the fire service, and I took that path many years ago, turning my back on suppression. As such, this was the route to advance. If you prefer suppression, then by all means hold out for it. I don't know if DFD allows lateral moves from EMS to suppression Lts, but that may also be an option for you.

Good luck, and make the choice that feels best to you, your family, and your department.

Medic 3

Gerald said...

I whole-heartedly agree with medic-3-take the EMS Lt. position and handle it like it should be run and not like it has been in the past. Don't be afraid to make a difference.

Anonymous said...

Taking the job really depends on the supervison YOU would receive. A by the books paper pusher would make improving the situation impossible.

Chris in SE TX said...

Bottom line is, you have to get up everymorning and look at the man in the mirror while you shave. You have to like what you see.....

My advice (I know you didnt' ask for one), is to do what's right for you. I've worked at a company where I hated the work.... It was miserable.... It's not worth it. Extra money means nothing if you're dreading to go to work....

Do what's right for you and don't look back...

Good luck!

GeorgeH said...

You are the beginning of the solution to the problem if you will take the job.

I remember going through the exact same scenario in computers in the '70s. Companies data processing grew to have millions of dollars in equipment and hundreds of employees. Boards of Directors decided they needed company officers, vice presidents, to run the divisions. They didn't see anyone in the department who looked old enough to shave, and certainly not ready to be one of them, so they took 20 year guys from sales and planning and gave them a quick computer course and made them VPs of Computer Services. Of course all they could do was see that the paper clips were counted and the forms all filled out properly, after all they didn't really know anything about the operations they were running. Eventually enough people came up through the ranks to replace them with mostly competent people. There will always be some incompetent chickenshit supervisors.

You have the opportunity to begin to establish the correct way to manage EMS in your department. By giving the writeups for performance that are deserved, and explaining to subordinates that the stupid writeups are gonna end as soon as you can get some policy changes. You can nudge the good people under you to take the Lt. exam in the future.

You have a better chance than anyone else will of reforming the system, because you know what needs to be done, and because of your prior relationship with the chief it will be harder for the other Lt.s to sabotage you.

Ambulance Driver said...

I'm of two minds...

First, it sounds like they desperately need an EMS Lieutenant who has the experience and judgment to handle the job of QA fairly. You'd have a lot of built-in credibility with the people you're supervising. You're one of them, not some zero-to-hero rookie.

It's an important job, Fixit. You know that. EMS needs solid oversight and QA. But you mentioned the sticking point - the EMS Lieutenant is the paperwork Nazi, and you don't want to be that. I can't blame you.

On the other hand, what better position to change the system than from within? Your EMS Lieutenants need to approach QA from a patient care standpoint, not paperwork nitpicking. Seems to me that the best people to bring about that change in philosophy are...the EMS Lieutenants.

OTOH, I read your blog posts, brother. Don't take this the wrong way, but you're not a paramedic at heart. You're a firefighter who runs paramedic calls. You're probably not going to be happy in a pure EMS role, and the job deserves someone with their heart in it.

I'd say stick with your brother firefighters where you'd be happiest.

Ray said...

My opinion is worth exactly what you paid for it. That said, here it is: I have had two full time jobs in my life. The United States Navy and where i am at now. I am lucky to have loved both jobs. I can not imagine what it would be like to work in a job where i wasn't happy. Now in my current company i have moved 6 times. Each time i relocated it gave me the opportunity to put my Stamp on the location. This may be your chance to make the program right and put your Stamp on it. I would question them and see what lattitude they planned on giving you and then if you really want it, go for it.