Thinking About Quitting EMS......

Two and a half weeks ago, I was going to quit EMS, seriously.

I just completed my 15th year in the industry, I gave it a good 'ole try, right? In the middle of feeling like a complete failure because the operational efficiencies we work so hard to maintain were ineffective due to several circumstances, I had this amazing opportunity.

This wickedly evil virus-like thing, not our well-known friend COVID-19, took over our management team the two weeks prior. Why we were surprised that it hit the field providers, I'm still unable to tell you. 

So, there I was.... sounds like a good joke intro... feeling sad that the enormous amount of call offs had diminished our EMS unit count to below what we knew we needed. It is what it is, right? These things happen, I thought. We tried; we had tried very hard and moved mountains that week. I just couldn't go on with my day without thinking we should handle it differently. If I go in, will that even make a difference? It will make me look like I failed, will 5 or 6 more calls in a timelier manner prevent the wrath of concerned callers about our now not so-on time-performance? Why would the COO go in and run calls? If that's what is going to make or break this, I’m clearly not doing my job well... I couldn't let it go. I hemmed, hawed in fact, and said, “I’m going in, this is what we trained for”, in that loud voice that we use poking fun at that statement. I messaged the Shift Supervisor and said, “Meet me at Headquarters, we’re going out”. I knew this was not my best decision.

The week prior, of course during Heart Health Month, we rolled out a companywide survey, a Pulse Check, we called it. Soliciting honest, anonymous, and hopefully meaningful feedback about what matters most, how our team members feel. Now maybe that doesn't matter most to some COOs, maybe the bottom line, or the reimbursement matters most, after all, it is great to get paid for our organizational roles, right? 

Back to the Pulse Check. I believe there should be no surprises, if there are, we have a bigger problem than the actual problems. I could predict the top 5 things that would be brought up. I was hoping, just hoping, someone would bring a solution to the table, something I hadn't yet thought of, or maybe never would have. I figured; I can justify this bad decision in so many ways. I’m going on the road to engage with team members. No, no. I’m going on the road to support the team members leading from the front. No, no, no. I’m standing in front of the mirror, buttoning my Class B like I was practicing for some big speech, where in the end, they may not know I was ever on the road, and they may not care. Never let a good crisis go to waste, so maybe I should tell them? Maybe they'll feel supported. Then the truth, the stroke of genius hit me. I’m going on the road to get a Pulse Check. That’s the truth, and that actually makes sense.

I "grew up" in EMS in an amazing agency. We used to call it a member of the top 2%, where you did calls and then did your (management) other job around that, but the patient always came first. That's ingrained in me and probably to my detriment, but I grabbed my collar pins and headed to the car. I then went back to grab snacks because I knew how this was going to go. 

I arrived at our headquarters and the Communications dept. team members, were pleasantly surprised and thanked me for the help, "Of course" I said, wishing I had just said something more elegant or inspirational about our amazing team. But I didn't and felt a hint of “do I remember how to do this”, come over me. I did, I teach this, noooo problem. I met my partner in the vehicle which was less than ideally ready for me to do the pop in. A whole host of crumbs, some unidentified particles, and garbage from, only what I assume to be, previous crews. I looked at the schedule. The crew got off late the shift before, that’s a problem. I’ll just take a different truck- Nope, so I cleaned and gagged into a bliss of regret that was this day. 

I’m still new to California and had not yet been to the hospital on our first call. I depended heavily on my partner and the GPS which, as the driver, I couldn't see because it was mounted and facing completely straight. I could feel my left latissimus dorsi smiling at me like a mean girl at lunch, when you're dining for the first time at your new schools’ cafeteria. I took out my phone and programmed Google maps, now my neck was smirking, waiting for the muscle pull from looking down. Now multitasking while driving, I call it multitasking not being distracted, I was committing some crime against the state as you can't operate a phone while driving, and for good reason. I quickly put it down and again, depended on my partner and some soon to be Advil. My partner was the Supervisor on Duty, running the shift, I drove so he could answer calls without breaking the law, like I may have....but he was jamming, so very busy. The phone didn't stop ringing and the requests for him to manage were hefty. He was also multi-tasking with the best of us. So let me jump you to the end of the story with a brief recap of the middle.

Here's the middle:

On our first call, we waited 35 minutes at the hospital as the RN was busy. Short staffed they said. Our average on scene times have grown from 26 minutes to greater than 50 minutes.

Our patient was bariatric, the hospital said they didn't know. Should we have had other resources, it’s ok, we will muscle through.

The patient was non ambulatory and returning to an "assisted living" situation. I’m still wondering where the assisted part comes in. We saw zero signs of this.

She pooped. On me. She had no one, just us.

We were cleared from the call during the poop incident, where I was very much so still on the call. Problem 56 of the day.

The iPad wouldn't stop beeping at me. Problem 57.

The Stretcher mount wall anchor stud wouldn't engage, we had to fix it. 

The second call didn't run. The facility wouldn't accept the patient as they were "slightly hypertensive" with a history of hypertension, not medicated. What was the expectation here, we were on scene for 47 minutes.

The third call, the wait and return was to an MRI trailer, yes, a trailer, with an MRI. We had to wait; they may not ever get a unit back if this one clears? We are doing something wrong here.

The fourth call was remarkably less memorable because while that was occurring, every piece of technology we had, had to be trouble shot, the traffic was gross, the patient was sick, and the ambulance was hot. I couldn't hear the radio, the address wasn't clearly marked, we couldn't get a report from the staff and in that moment, I thought, everyone gets a raise! But how? So, I was just going to quit. Is this a failure of me or a failure of this system?

Here we are 17,18 days later, I'm still here. 

This is the point, If I had just said it at the beginning of my tale, you could have had 7 minutes of your life back, but I didn't. I didn't say at this beginning of the article because you needed context. Readers need to understand that if you run an Ambulance Service and have not done a shift on the road in the last year or EVER, that you need to run, not walk, run. Pass go, do not collect your $200, get out there and experience what is happening. 

My less than ideal shift allowed for us to solve Nine issues experienced by crews on a daily if not minute-by-minute base. Nine. 

Nine fixes, that were not easy, that we kept pushing to the side. 

When I returned and drafted my lengthy email to the management team, I was met with a couple of responses that a few of these points of enlightenment were new, but a few weren't. 

A few weren't? Wait, what? We knew that the crews were experiencing issues and didn't care to fix them? Chose not to fix them?  Why?

We could peel back the layers of the proverbial onions and ask why not. "Why not?" I said. Now, we are cooking with gas. 

The barriers that stand in the way of our new supervisors and middle managers or even seasoned directors, prevented us from fixing the actual issues. Not the perceived issues but the actual ones that reduce productivity and efficiency and cause our people to QUIT. That's right, half of your retention problem is most likely fixable. 

Hear me now and hear me loudly. 

Executives, go into the field. 

Go. Run. The. Calls. Just a few.

If you are not credentialed to do so or gave up your certificate because you thought you wouldn’t need it in the future, hold on to your hats. Get recerted, reinstated, or have a trusted credentialed leader run them for you, because you may be the only ones doing calls on a sunny Saturday afternoon if you don't fix it.

I could have easily put the day in the rear-view mirror. Shook it off as too difficult. Continue to push the A priorities down and complete the B and C priorities because they are easier. Now, we use the side view mirrors. They give us a wider and more detailed view, to reflect on what we learn daily and allow for course correction.

I pride myself and my leadership style on getting the next ready. The Ready Next mentality will allow leadership development to take priority. While concentrating so much on developing the team, I should have used my side mirrors to guide and direct my next move. As clinicians, we always want to predict the next move, have the next intervention planned if the airway fails, as Operators, we need contingency plans. 

If your agency runs over 100,000 EMS calls a year, I guarantee you, there are kinks in the armor. Check that, if your EMS agency runs calls at all, you need to go out and ride or do those calls. Experience the issues so you can use your brain for good, the best kind of good. The good that retains the humans that are the most important to the patients we care for.

So, did I fail? Or did we succeed in learning something new, and created solutions that rectified the issues? What do you think?