The Mask

Patients;

Managers;

Ego;

Publicity;

Public education;

Anonymity;

Pride.

Go balance that lot!

I sent out a challenge, and dozens answered it, in comments on the blog, on Facebook, on twitter, in person. I have received suggestions, thoughts, ideas, humbling compliments, and on the whole, a strong recommendation not to reveal the face hidden behind the Insomniac's mask.

The main reason, although not the only one - an anti-management stance of mistrust. That in itself, is a sad reflection of the way social media is still perceived as foe rather than friend by the establishment. There is, of course, the potential to bite the hand that feeds you by blogging, but that was never one of the reasons for writing this blog. I'd like to take on the challenge of changing their view, but I'm not sure I'm up to that task.

Patients and their right to anonymity and confidentiality are clearly king. They are the reason we do what we do, they are the people who allow total strangers into their homes, their lives, and their vulnerabilities, with the promise that we don't then divulge their most intimate details to the world. To this end, as you all know by now, I change everything. Locations, ages, genders. I combine different calls to make one story, or divide one event into several different, unrelated posts. The tales I tell are effectively that - tales. Fiction based on real-life events. No patient has had their identity compromised.

And then there's the challenge of public education. Ideas such as the Chronicles of EMS, groups of visionary paramedics looking to advance their profession via open social networking and public media, could never work if we all hid behind masks. I'd love to get more involved, but at the moment, as an anonymous blogger, that's impossible. I could get involved in podcasts, as my face is probably more suited to radio anyway, but the options for exposing this to the public are limited, and therefore flawed as a plan for mass education.

Personally, my anonymity used to mean everything to me. It's still important to a certain degree, but every time someone guesses or knows outright that I'm the author of this blog, the pride I feel when they tell me they enjoy reading it, outweighs the shadows of anonymity that I crave. There's a voice that says I should be proud of what I have achieved, and that I should have no reason to hide, but then there's the other voice.

The voice that continuously asks "What if?".

What if there were repercussions from management? (Maybe one of them is reading this, and will have the courage or foresight to contact me? The email address is in the profile...).

What if I slipped up and did reveal a patient's identity?

What if I had to give the blog up all together?

For now, and I stress for now because this whole decision is finely balanced and on the brink of collapse, I'm staying hidden. It might well be the worst kept secret in the Ambulance Service, but for now, it stays a secret.

One day, hopefully, common sense, mutual trust, and pure, unadulterated ego will prevail.

When that happens, I'll lose the mask.

Change is Coming

I've just mentored a student. Four weeks of trying to improve their skills, teach them all I know, and introduce them to the world of ambulancing. And whilst I'm at it, enthuse them about this job of ours. And therein lies the problem.

I love my job. I love everything about it. Everything, except:

The politics.

The lack of decent vehicles.

The lack of equipment.

The lack of training possibilities.

The lack of pay.

The lack of respect from other medical professionals.

And most importantly -

When people, including me, complain about everything that's lacking. Yes, including me.

I'm overly, sickeningly positive about EMS. I can be, because I try my damnedest not to let the things all around me decide how I'm going to treat the people I meet. After all, they're what this job is all about.

There are always frustrations. The recent plethora of them has made me write this post in the first place.

It's wrong that I have to provide some of my own equipment because there are those who are dishonest enough at best to lose the kit and not report it, or at worst, steal it.

It's wrong that we're driving around in some vehicles that are nearly a decade old.

It's wrong that some of the calls we are asked to attend don't even come close to qualifying for something that needs an ambulance.

It's wrong that there is such a strong anti-management culture.

Equally, it's wrong that it seems as though that feeling is mutual.

A recent tweet from someone I follow, someone relatively new to EMS, mentioned that 90% of our calls could be attended by a horse and cart. I don't think that that's even close to being true, but it does show that this negativity is reaching and emanating from all corners, old and new.

Not all our calls are life-threatening emergencies. Not even the majority. From personal experience, and being one who tends to attract trouble when it's around, I'd say that the number of these calls is lower than 15%. But that's not all that our job is about.

There are loud mutterings in the ambulance service that this job isn't what it used to be.

I'm pleased to hear it.

I don't want to go back to the days of being just an ambulance man.

A recent shift with a different student showed me why. Their regular mentor was having a day off, so I was filling the gap. This student was enthusiastic, hungry for knowledge and experience, yet being mentored by someone who repeatedly claimed to be "just an ambulance man". This mentor started this job whilst I was still at school, when ambulances did nothing but pick people up, take them to hospital, and let the doctors there decide what was wrong and how they would treat them. The student, despite their enthusiasm, was being drawn into a world that I just don't want to be a part of. A world of pessimism, of negativity, of apathy.

I was trained by someone who said that our job isn't to diagnose, merely to take a history, treat only what we see, and transport. The Happy Medic has a post about paramedics diagnosing. I'm with him on this one.

We are so much more than we used to be. And we can be so much more.

Change is coming to the ambulance service. There's going to be much more of that stuff we're told that we don't do. You know - diagnosing. There are going to be paramedics trained to a higher level so that they can assess, treat, and refer to a much higher standard, all as necessary. And not necessarily transport. Some of the calls we'll be attending in future, are those that were traditionally seen and treated by GPs. The truth is, we're already attending them. We just don't yet have the system in place to do anything but transport them to hospital. That's changing too.

There are those who see these changes reflect an admission of defeat by the ambulance service. Rather than educate the public about who we are and what our role is in the health-care system, we are adapting to what we think the public would like to use us for.

Personally, I'd like the two ideas to meet in the middle.

I'd like to see more education for the staff, more training, more ability to treat at home and refer if necessary. Who hasn't thought about simply gluing the little kid's head wound back together, or the 90-year-old for that matter. Then they can stay in the comfort of their own home, rather than endure the trauma of several hours of an A&E visit for a ten-minute consultation and treatment.

I'd like to see more back-up from the system when we do leave patients at home, whether it's our decision or theirs.

I'd like to see that ambulances are waiting for calls, not calls waiting for ambulances. Why?

Because I'd love to see that we have time and the resources, like the fire-brigade for example, to go into schools, summer schemes, mother-and-toddler groups, anywhere, to educate the masses. Both about what we do, and about what they can do to help themselves and their loved ones.

I'd love to have all the latest vehicles, fully kitted with the best equipment, and attending calls that truly require our knowledge, our expertise, and our passion.

Until all that happens, I'll work with what I've got, to the best of my ability. And strive for more.

I'll keep enthusing about my work to anyone who'll listen, especially students.

However...

Change is coming.

So are we going to fight it, or are we going to take the lead and steer it in the right direction?

Change is coming.

The question is, are we afraid of it, or are we willing to embrace it, pioneer it, and grow with it?

Hilltop Hospital and CoEMS

Look out for the line starting at about 0:55 seconds. Kinda says it all. This is what Chronicles of EMS is all about! This is sort of the thing I was aiming for with the last post, but more EMS based. That comment said it all. There's a lot of work to be done to change the image of the ambulance service in the public's eyes, and to change the image of social media in the eyes of the management and the system as a whole. Some great people have started doing it. If you haven't seen their website, now is a good time to start getting involved.

Stay safe this weekend!

999medic

What a sad time. Due to various reasons listed on his blog, Mark's had to shut his blog down. He of 999medic and Chronicles of EMS, a voice of courage and conviction, has decided that he has to put his job and his family first. Understandable it may be, but the reasons behind it are worrying.

Read his final blogpost, along with all the comments below. They pay tribute much better than I could to his ability and vision to make the world of EMS what it has the strong potential to be.

And for the meantime, this blog remains anonymous (although possibly one of the world's worst kept secrets), for exactly the reasons that Mark has had to walk away.

It's a sad indictment of the lack of vision of others that holds us back, as a service, as EMS providers, and especially as bloggers. It's all the more upsetting that one of the trailblazers in the field, is the one to get caught up in the fear. A fear of the unknown shouldn't mean instant disapproval. It should be a challenge to those who hold on to that fear to come and face it. Come and see that those who blog do so, at least in the vast majority, because they love their jobs. Because they want to cast it in a better light. Because they want to improve both themselves and their environment.

Hopefully, some day, the vision will overpower the fear, and not, like today, the other way round.

Fishmedic

Blogsphere is an amazing place.

First, I started reading blogs.

Then I started following them.

Then, twice, I started writing them.

After a while I made contact with some other writers.

Whilst some of these writers decided to meet each other on opposite sides of the Atlantic.

Finally, this week, I had my own meeting with an overseas blogger/paramedic.

Fishmedic, AKA Sam, a paramedic and blogger from Germany, decided that on his short visit to London, he'd like to see a little of the whats, whys, wherefores and hows of the London Ambulance Service, at least as I see and experience them.

Through the wonders of social media and other forms of communication, a meeting at station was arranged.

So he came, he saw, he took photos (thankfully not with me in them), we talked.

And we drank coffee. When he asked for cream with his coffee, (in English that is better than most English people I know) I muttered something about this being the NHS, and that we can only afford milk.

Anyway, we compared notes and systems and were each shocked about things we see as lacking, and inspired by ideas we liked. It was entertaining, educational, eye-opening, and lots of other things beginning with the letter 'E'.

Chronicles of EMS - see what trouble you've caused!

Hmmmm, maybe that's an idea for the byline competition...

The Name Game

The story so far:

You know all about 999Medic and his journey to San Francisco.

You know all about HappyMedic and his return journey to the UK.

And you know all about the Chronicles of EMS and their efforts to bring this (ad)venture to the masses.

Well, now that you know all about it, how about becoming part of it?

Become part of the evolving world of EMS.

Join one of the productions.

Anywhere in the world.

The Reality Series at Chronicle of EMS needs a new by-line. Something catchy. Something exciting. Something that will tell the world all about it. And you could be the one to choose it. If you do, you'll win a MASSIVE prize. All you need to do, is join the Chronicles site, and follow the instructions from there.

Trust me, it's worth a look, and definitely worth having a go.

I will be.

The Curse

The curse is well known. You can be busy as anything for days before, then on the day itself, nothing happens. Closely followed by something happening, but it'll be very mundane, dull, even boring. It is the Curse of the Observer. I've had many observers out with me over the past few years, some on a Vanbulance, and some on the Carbulance, but the vast majority have been the same. Cursed. Not every shift with an observer is so, but it does seem to be more often than not.

In fact, just as an illustration, I once had a very eager young lady join me for a shift. She worked for one of the big medical supplies companies, and had travelled from overseas, sent by her bosses, to see first hand how one of their new pieces of kit worked out on the front line. I was one of six people in London trialling it. She spent eight of the twelve hours of my shift hours with me and we did nothing. I mean nothing. We didn't see a single patient for the whole eight hours. Later that afternoon she had a flight to catch, so I dropped her off at a train station, and off she went. Moments later I was called to a hanging, and she missed exactly what it was she had come to see. I also had another few calls before the end of the shift, all of which requiring proper intervention. She missed them all. See what I mean? Cursed.

Having an observer has its positives too. It gives me the chance to learn from these people. Often they are medical students, nurses, or doctors. All cleverer than me, and will instantly fall into the trap of being asked a million questions about one of the many things I don't know or understand.

More importantly, however, is that it gives me the chance to show off. Not necessarily my skills per se, but to show off the world of Prehospital Emergency Medicine. To show how far the Ambulance Service has come in the last few years. To show how we are able to deal with situations that even the best doctor would find challenging. To show off what happens before the patient arrives in the hospital and is presented packaged, 4 foot high, and horizontal. And I love doing it.

Now, whereas I do my little bit in this promotion of EMS to the non-ambulance world, there are those out there who have gone above and beyond the call of duty, and have started a small revolution. This weekend coming, is the premiere of a production called the "Chronicles of EMS". What started as a trans-Atlantic, glorified shift swap between two of my fellow bloggers, 999Medic from England, and HappyMedic in San Francisco, has turned into a huge project that promises to try to change the Ambulance world forever. The initial idea of sharing and swapping thoughts and working practises between two people, has now got thousands involved through all sorts of media, social and otherwise.

The whole concept has taken off in ways that no-one had envisaged. It'll give us all a chance to pool ideas and ideals, to highlight what separates us and, more importantly what we share, and to make us all think about how we can go about improving what we do, as well as how we do it.

So as I go on entertaining observers and their curse, really and truly, I should count myself lucky. More than that. I'm not really cursed at all. In fact, I'm anything but.