Teaching Gently

[chbare]

Set a standard and make sure the details are spelled out clearly along with expectations and consequences, Have specific goals and benchmarks set and ensure you have your medical director back you up. Also, you will have to take the lead by setting a good example. After you set the standard and begin changing the underlying culture of the service I would also suggenst the following:

1) You should look at having a mandatory monthly meeting, perhaps two different dates to catch all your employees. This meeting should be several hours long and would cover a refresher topic. Airway, paeds, toxicology and so on could be covered.

2) you should implement a good QI/QA process and mandate 100% compliance. In addition, at least one chart review should be performed at the monthly meeting along with frank discussion that should be preferably facilitated by your medical director.

3) Look at contracting with a larger, high volume service and mandate that your employees get a day of ride time under a qualified preceptor every quarter. In addition, implement a quarterly skills verification session and if you guys do invasive procedures, quarterly clinical verification such as spending a day in the theatre for airway management is highly recommended.

4) Mandate that your employees spend some time rotating through hospital specialty clinical areas such as ICU and Labour and Delivery every six months to a year.

5) Recognise and respect the crew members and have a mechanism in place for identifying and rewarding people. Let them know that they are valued and integral components of the team.

Take care,

chbare.

Edited January 30, 2011 by chbare

[Timmy]

Unfortunately I see myself in a similar situation to yourself. Im a manager of a volunteer BLS EMS event standby division which is run on a national level, Australia wide I think we have around 5000 volunteers. Unfortunately the organisation has taken a more corporate focus and is more concerned about bums on seats and brining in the bacon than good clinical care and solid training and education.

Time and time again I see volunteers who are completely incompetent and clueless, bordering negligence. The majority of the volunteers are made up of less than desirable people who are worthless, wanker, chauvinists. I audit the patient reports, provide re education, we do weekly training, we do yearly re accreditation, I work hard to provide good education but get nothing back expect complaints that the material was to complicated and not relevant, if its not relevant then why are you still completely miss managing patients who present with chest pain after weve spent hours and hours going of the theory and practical aspects, how is it possible that you still havent learnt this, are you that intellectually challenged you cant remember what Ive told you 70 times over? You still cant even explain to me basic patient assessment. Is it because you left school when you were 12 to smoke pot and live off welfare payments?

I submit incident reports time and time again to our line mangers and clinical coordinators but get no feedback or action what so ever. Im sure there all silenced from the executive team because if we cracked down on training and education theyd lose a good 80% of the volunteers which means no income. Im told theres nothing I can do about problem volunteers because it would be classed as defamation, bullying and harassment and all that crap, if people want to volunteer than apparently they can, Im powerless to stop them…

Were often referred to as the band aid patrol which is quiet true if you look at the calliper of our volunteers. Over the past 4 months Ive managed 2 patients who required rapid sequence intubation, one of which required pre hospital emergency bur holes to relieve intracranial pressure then emergency surgery to have a craniotomy as soon as the helicopter touched down on the pad at the hospital, Ive had a patient who needed needle chest decompression, a patient who needed thrombolysing, a patient who had a metal pole impaled through his foot, many cervical injury patients, a patient suffering from sever asthma who needed steroids and non invasive ventilation… All of which I can only perform BSL interventions while I wait over 30mins for ALS to arrive.

I may as well attend some of the events by my self because even though I may have 6 other first responders with me they panic and carry on more than the patients family. I had no idea how hard it was trying to manage an unconscious 17 year old with a respiration rate of 8, I was managing his airway, ventilating, trying to coach a first year student paramedic on how take a blood pressure and BGL, trying to calm the family and mange my first responders excessive anxiety. I cant even rely on a first responder to scribe for me without having to tell them word by word what to write on the form. Dont get me wrong, we have some very competent first responders and quiet a number of doctors, paramedics and nurses who volunteer on there weekends off to help out but they never seem to have as much time as the ferals on welfare payments, so Im often forced to send these lovely people on duty praying to god they dont crash our new ambulance because there barley confident to drive…

Im at the stage were Im ready to throw in the towel and walk away, Ive done my best to improve things but theres no point in fighting a losing battle. Some days it really gets me down, Im only 21, Im dealing with these people and the situations they put themselves in, I generally let me social life lack because Im so scared the first responder will kill someone, I make myself available to attend all these events from the pure fear of if I wasnt there and something goes wrong… What if? I do get tired, I attend university full time, I work as much as I can and in between this Im flicking through books and material trying to make basic care presentations to teach these people something. Some nights I only get an hour or so sleep before I have to drive to uni or be at work.

I really do enjoy the work and the demand on our services are in ever increasing demand, I have some great friends in the service and I work along side some really well known and knowledgably health care professionals but at the minute the negatives seem to out weight the positives. I love pre hospital care and once I complete my nursing degree (not even a year left!!) Im hoping to go into the paramedic degree. The problem I have is living in the country there are no other EMS services (unless I travel nearly 4 hours to Melbourne) apart from the state ambulance service so if I throw in this gig Ive got no pre hospital contact.

I completely understand why the paramedics roll there eyes at us every time we drive past but our service covers most of the biggest events in Australia so you need people who are competent and eager to learn. I sometimes get angry at the government, they spend money on such ridicules things but they cant even spare a couple of thousand of dollars to support our service, were still classified as a charity even though the government are the first to call us to respond to staging areas of flooding, bushfires and major incidents to provide 24 hour standby for weeks on end.

I really dont know how to answer your questions because I cant even answer my own. I guess I really dont agree with EMS being volunteer, if we were a paid service then maybe I could enforce clinical competents and some form of quality standard in our ranks but as a volunteer service there really isnt a great deal you can do to manage trouble makers.

Edited January 30, 2011 by Timmy

[Richard B the EMT]

Timmy, are you referring to those 2 rodeos you mentioned, a bit more than a year ago, on a different string?

[kbrozenick]

A lot of really good posts! Especially "tcripp", I really appreciate your perspectives. Keep doing what your doing!

All I can say is you want quality not quantity! If they are good providers and you give them the tools to improve the ones that care will . The ones that don't will leave. It will be better in the long run.

[Emtpbill]

I remember my first paid 911 job was a volunteer based squad. The one thing they told me when I started was that just like paid employees, volunteers can be fired.

I know that is drastic and last option, but if those who are there refuse to give the quality service your customers deserve, get rid of EM.