The role of the first arriving ambulance at a MCI: Part Two – The Triage Unit Leader

MCI Course Oct 2013 2 car MVC A

Now that we have discussed the importance of defining exactly what a MCI is in comparison to your available resources, let’s get to work!
The passenger of the first arriving ambulance takes triage:
As we mentioned in the previous article, having seat assignments can help to eliminate confusion, reduce time-to-task and improve overall communication. Building scene momentum is something we want to achieve early in the MCI. Remember, the actions we take in the first 5 minutes will often dictate how smoothly things go for us throughout the rest of the event. Don’t get hung up on level of training – triage responsibilities can be more than adequately handled by any level of EMS certification. The reason why we chose to assign this important role to the ambulance instead of the fire apparatus is to account for the likelihood that the first arriving engine or truck will be faced with multiple competing demands (fire, smoke, extrication, haz-mat, technical rescue needs, etc.).

By “choreographing” the process of our first arriving resources, the incident commander can be assured that the ambulance crew will automatically assume responsibilities for Triage and Transportation, leaving the engine or truck free to address all of the other scene related challenges. This procedure also assures that a formal triage process will actually be performed on every MCI, avoiding the common MCI pitfalls of no triage being performed, competing methods of triage being performed or no tags being distributed.
Realizing that there are now multiple methods of triage being talked about in the trade journals and at national conferences, this article will focus on the use of the START Triage method. START is what we decided to use in our system. Ultimately, it doesn’t matter which method you use – just pick one, train everyone to it and use only that method on scene!

 

Getting your arms around the incident:
Imagine showing up to a motor vehicle collision on the highway, it is larger than you expected. Carnage everywhere you look! Broken glass, jagged metal, people ejected & bleeding on the ground, people trapped in their vehicles, others wandering around the incident yelling for help, or on their cell phones. One of the vehicles is on fire. Where the hell are you supposed to begin? How are you and your partner supposed to make any sense of this mess? The first principle of the Simple Triage and Rapid Treatment (START) process is that you START where you stand! (Cute huh?). Calling out, you ask all those that can walk to come to the sound of your voice (or to a location of your choice). Congratulations, you just effectively triaged all of the “Green” patients. With START, patients categorized as “Green” are the lowest priority. Disaster research tells us that low priority or “walking wounded” patients can typically go for many hours if not days before receiving medical attention and not have any negative outcomes as a result of delayed care. From a triage standpoint, those that cannot get up and walk to you are either “Yellow”, “Red” or Dead (“Black”).

The START method has a rapid assessment trick to help the Triage Unit Leader rapidly categorize the patients that remain – it’s called RPM;
Respirations:
– Is the patient breathing? (Yes or No)
No? – Open their airway, if the patient begins to breathe stuff a basic airway adjunct in them and tag them “RED”. You don’t need to do anything else, move on to the next patient! If they do not begin to breathe after opening their airway, then they will likely not survive – tag them “BLACK”(dead or expectant) and move on to the next patient!
Yes? – How fast are they breathing? If they are breathing greater than 30 breaths per minute, tag them “RED” and move on to the next patient! If they are breathing less than 30 breaths per minute, then move on to the next level of assessment…
A word of caution: This early part of the assessment contains the hardest decision we may be faced with making during an MCI, “Red” or Dead. Don’t fall into the trap of committing resources that are already overwhelmed to attempting to resuscitate someone found not breathing. You are there to help as many people as possible and committing resources to someone that will not survive may lead to preventable deaths due to delayed care… Trust the process, make the decision quickly and move on to the next person that really might benefit from your care.

When using the RPM format, the very first assessment contains the most difficult decision – whether or not the person is “Red”…or dead. If the patient is still not breathing after their airway has been opened, it is highly unlikely that they will survive the event. Do not commit your limited resources to a futile resuscitation effort, when so many others may benefit from your care (or die waiting for you)!

Perfusion:
NOTE: This portion of the assessment allows for checking either capillary refill (2 seconds or less is considered normal) or a distal pulse. There are many factors that can alter cap refill, making this method not as reliable or accurate as feeling for a pulse. Since the Triage Unit Leader is medically trained, our system recommends using the distal pulse as the deciding factor.
– Does the patient have a distal pulse? (Yes or No)
No? – Tag them “Red”, perform a quick scan for any signs of profuse bleeding – if present, stop the bleed or have the patient or a bystander control the bleeding and move on to the next patient!
Yes? – Move on to the next level of assessment.
Wait, if the patient is found without a distal pulse, aren’t they dead? Shouldn’t we be tagging them “Black” and moving on? Remember, you’ve already checked their respirations and you found that they were breathing within normal limits. The fact that the patient does not have a distal pulse is telling you that their perfusion is poor and their blood pressure is likely very low – making them a “Red” or priority patient.

Mentation:
– Can the patient answer simple questions or follow your commands? (Yes or No)
No? – Tag them “Red” and move on to the next patient!
Yes? – Tag them “Yellow” and move on to the next patient!
Hold on. If they’re respirations are within normal limits, they have a distal pulse and they have a normal mental status – why aren’t they “Green”? The simple answer is that you’ve already triaged the green patients – this patient was unable to get up and walk to you. Using START, the best category they will receive is “Yellow” or delayed.
Most of us were introduced to the START triage algorhythm at least once during our career. The RPM process is meant to be completed in 30 seconds or less. Much like our primary survey (ABC’s), in fact, just like our primary survey! RPM is ABC- just a different way of packaging it.

 

Using the tags:
There are also multiple styles of triage tag to choose from. For your MCI to run smoothly, it is important that only one style of tag is used. Multiple kinds of tags will certainly lead to confusion. Once you have chosen the style of triage tag for your system. It is important that all of your people (including hospital ED & trauma staff) know how to navigate and interpret the tag. For the purpose of this series of articles, we will be talking about the “MET-TAG” triage tag.
Suffice it to say that the triage unit leader only has to tear the color coded tabs at the bottom of each tag to the category they chose and affix the tag to the patient. They don’t have to write anything on it and they don’t have to tear anything else off! We’ll talk in greater detail about using all of the tag features in part three of this series.
NOTE: a trick of the trade is to make sure you save the tags that you tear off. Don’t throw them away. You’ll need them later. (Part three).

The “MET-TAG” triage tag is a two sided pseudo-laminated form created by the US Coast Guard – designed to provide a visual cue to medical personnel as to the patient’s priorty. It also has space for medical information & patient demographics. The medic performing triage only has to tear the perforated strips on the bottom to the appropriate color and affix the tag to the patient.

An important choice for the Triage Unit leader to make upon their arrival:
In order for the process of triage to be fast and effective, the triage unit leader must immediately decide how they will perform triage upon their arrival at the incident. Will they move to each patient and triage them on the go, or will they create a “triage funnel”? A triage funnel implies that the triage unit leader will pick a stationary location and others will bring the patients to them to be triaged. For the triage funnel to be useful it requires stretcher bearers (or shuttle teams) to move the patients to the funnel and there should be a casualty collection point established directly behind the funnel. As the patients are triaged, they are then gathered in areas based on their category (color coded tarps, flags, cones or tents can be used to mark the areas). It is important to understand that the triage funnel and the CCP rely upon each-other. They are NOT mutually exclusive. If you think you need one, you will need the other as well in order to adequately manage the incident.

So, it seems like the triage funnel is complicated and may serve to slow forward progress. I would actually suggest the opposite! If you are faced with a large number of patients covering either a geographical stretch or packed into a confined area (like a school bus), trying to go mobile and attempt to make contact with every individual will ultimately slow things down and in some cases, we may never find you again! While it will seem painfully slow initially, the triage funnel is a much more efficient way to organize the incident. It breeds consistency, reduces unnecessary duplication of effort and speeds the gathering of patients by their category. It also minimizes the likelihood that patients will be missed.

 

Triage Funnel Diagram

A quick note on stretcher bearers or shuttle teams:
Initially, you will not have enough people or equipment to do all of the things you want to do. Gathering teams of people for moving patients from the scene to the triage funnel is essential to creating the scene momentum that I keep mentioning. As with everything else we do in our profession, we are only limited by our creativity. Think about who could serve in that role until additional resources arrive. By the way, two-person teams are not safe or effective, think three or four person teams. More on this topic as well in part three.

 Common triage mistakes:
The START method has been criticized by others for being very subjective. In other words, two medics using START may categorize the same patients differently. I believe that this subjective tendency is partially due to lack of practice. If your people don’t train regularly and practice the process, when suddenly placed under time pressure and other situational stressors, they will fall back onto old habits or simply make their own rules for triaging patients.
– Don’t base your triage decisions on “mechanism of injury”. Thankfully, we’ve changed how we consider mechanism in our day to day assessments. While mechanism is a piece of the pie, it is NOT the whole pie and it has nothing to do with how we initially categorize our patients in a MCI.
– Don’t base your triage decisions on how “ugly” their injuries are. Bad looking wounds are distractors NOT indicators of priority.
– Don’t base your triage decisions on the location of their injuries. It is natural or intuitive to consider injuries to the core of the body more serious than injuries to the extremities. That is a consideration for the treatment unit leader, NOT the triage unit leader.
– Just because they’re really young or really old doesn’t automatically make them a “Red” patient. Yes, it is true that the pediatric or elderly patient can be at a higher risk of severity due to their age. Leave that for the treatment unit leader to worry about. Age is NOT a factor during initial triage.
Triaging patients is about their physiological condition in the moment, NOT what it might be in the future. You are trying to build forward progress and get things moving. Trying to consider too many what-ifs or potentials is crystal ball nonsense that you can’t afford when the number of patients overwhelms your resources. Triage does not have to be perfect. It does have to be fast. Also remember that triage is not static, it is dynamic. Triage should occur throughout the event, not just once. Re-triaging patients during each step of an MCI will account for changes in their physical condition and the potential need to adjust their priority.
– Avoid the temptation to assign triage responsibilities to multiple responders. I’m not saying that this should NEVER be a consideration. However, in most circumstances multiple people doing triage on one incident usually breeds confusion and opens the door to subjectivity. If it makes sense to assign multiple people, it should be done under the direct supervision of the single Triage Unit Leader (unity of command).
– Avoid the temptation of creating more than one triage funnel or more than one casualty collection point (CCP). In our line of work, we never say never. In circumstances that cover a large amount of geography (AKA, the world trade center, etc.) you may have no choice but to create more than one place to gather patients. Keep in mind that multiple triage funnels & CCPs will require exponentially more people and resources to successfully manage. If the decision is made to create more than one CCP or triage funnel, you may want to consider managing it as an “area command” – essentially like an incident within an incident. Review your ICS-300 & ICS-400 materials for a refresher on “area commands”.

 

Necessary Materials for the Triage Unit Leader:
– Our system uses a small “triage bag” that contains triage tags, basic oral and nasal airway adjuncts, tourniquets and basic first aid materials for bleeding control – that’s it, you don’t need anything else!
– Triage Unit Leader vest. Remember that a common MCI pitfall is confusion created by not knowing who has been assigned key positions in the event. Wearing the vest is critical in visibly marking the person responsible for this important role in MCI management. Our system utilizes vests that are also ANSI rated for roadway safety.
– There is no shame in using quick reference materials. Position specific quick reference cards are located in all of our MCI vests. A quick reference card specific to the triage unit leader is also placed inside the triage bag. It is not uncommon to lose your train of thought during a complex incident. When you realize that you have gone “off the reservation”– take a peek at the quick reference card and right your course!

As the first ambulance arrives, the passenger assumes the role of triage unit leader, grabs the triage bag and puts on the triage vest. If you develop seat assignments and place the necessary equipment close to the passenger, the triage unit leader could be ready for action in just a matter of seconds!

In Summary:
1. The passenger of the first arriving ambulance assumes the role of triage unit leader, grabs the “triage bag”, puts on the vest and goes to work!
2. The triage unit leader should use the pre- approved method of triage as well as the pre-approved triage tags. Do NOT allow multiple methods of triage or multiple styles of triage tags on your MCI.
3. The triage unit leader should choose whether or not to triage every patient one-by-one while on the go, or to set up a triage funnel and have shuttle teams bring the patients to them for triage. Remember that the triage funnel and the casualty collection point go together like peas and carrots. (ref. Forest Gump)
4. Don’t be afraid or ashamed to use quick reference materials. Checklists are used with great success in many industries that utilize high risk / low frequency procedures.

 

This quick reference card can be found in a pocket of the triage vest. It is also placed inside the triage bag. Many industries that work in high risk environments have had huge success using checklists. There is no shame in using reference materials!
Side 2 of the quick reference card for the triage unit leader is an algorhythm for the RPM process for adults & children.

NOTE: The next article (Part Three) will discuss the role of the Transportation Unit Leader and how Triage and Transport units work together to bring the situation to a safe and positive conclusion.

The role of the first arriving ambulance at a MCI: Defining what a MCI means in your organization and then planning for it. (Part One)

MCI Montage

For many of us, the thought of working an MCI is daunting and scary. The term “Mass Casualty” conjures up thoughts of plane crashes, train derailments, tornados, active shooter situations and other large scale, acts of nature, man-made or terrorist events. Certainly any of the above mentioned situations would challenge an EMS agency of any size and resource capability. A key point to bring up is that MCIs can be deceptive in that they really don’t have to be large scale. Often times, we can find ourselves knee deep in the middle of one before it occurs to us that we are actually dealing with an MCI – and that we are now behind the eight ball.

Do the math…the right math:

If you were to do a risk assessment for the communities I work in, you would find that we sit in the flight path of an international airport, we have active commuter and commercial train routes & two major interstates/ highways that run through our service area. We serve geography widely considered to be part of the tornado capital of our State. We also have a large and diverse school district surrounded by other religious and private/specialty schools, a movie theater, event centers and a hospital. The city in which our service was born is also the seat of government for our county – containing the jail, the coroner’s office, the sheriff’s office, other government facilities and the county fairgrounds. All of this makes us a target rich environment for homegrown and foreign extremists wishing to do a lot of damage or make some kind of statement.

A train derailed mangling many rail cars loaded with coal right next to our major interstate early last year. Fortunately, there were no major injuries. This incident served as a reminder to all of us that situations like this actually do happen – and they can happen to us!

Of course, this is reason enough to plan and prepare for an MCI. But is the “big one” really the only thing we should be gearing up for? Although we cannot predict when or how often a large scale disaster could happen, history tells us that, for most of us, the “big one” may only occur once or twice in our career. So, typically we plan for these large scale disasters, we may even have a drill once a year – otherwise, our plans sit on a shelf waiting to be dusted off if we even remember they existed in the first place.

The definition of an MCI is more about the number of your available resources than it is about the number of patients…

I propose that a true MCI exists when the number of patients overwhelms the number of resources in a particular community. So, if I am being honest, my service can tolerate a situation involving approximately 5-6 patients. Anything more than that constitutes an MCI for us! Just 5 or 6 patients? Really? How did I come up with that assertion? My organization operates 3 ALS ambulances on a 24 hour basis (We have the ability to double our fleet, but it requires calling people in for staffing).  Considering the safe transport of two patients per ambulance gives me the number we can adequately handle without having to ask for help (and that is assuming that one or more of our ambulances aren’t tied up on other calls when the situation occurs). I know what you’re thinking. Of course we could transport more than two per ambulance, especially in a “disaster” situation. However, transporting more than two patients at a time means that our providers will likely be unrestrained and perhaps even standing up in the patient compartment during transport and we want to avoid that at all costs. It may also mean that we are not adequately organizing the incident or using all of our resources appropriately. Being conservative with your calculations is also a good way to build your plan.

This everyday, “bread & butter”, two-car motor vehicle collision ultimately required ground transport units from two different agencies (coming from two different counties via two different dispatch centers) and a medical helicopter. Patients had to be prioritized, resources had to be managed, patients had to be tracked… This was an MCI for us.

The 3 T’s:

When building our plan, we don’t have to kill ourselves reinventing the wheel. MCI management falls neatly into the incident command system (ICS) structure. So, we already have a list of common terms and a model blueprint for organizing, tracking and ordering resources, creating and communicating a common plan and an orderly method of delegating responsibilities and maintaining a manageable span of control & authority. When creating the Incident Action Plan (IAP), we talk about using common “tactical benchmarks” to help us make sure we are making progress and working towards bringing the situation to a safe conclusion. In essence, these common benchmarks can also serve as the quick & dirty action plan for first arriving resources, until we have time to gather further information and create a more detailed plan as the incident continues.

As an example, if a house is on fire the fire service has a set of common tactical benchmarks that they would use to rescue trapped occupants and put the fire out – a checklist of sorts that can be used to track progress and assure safety;

– Primary Search
– Control Utilities
– Ventilation
– Extinguishment
– Overhaul

Law enforcement may also use a set of common tactical benchmarks to help track forward progress;

– Life Safety
– Perimeter Control
– Evidence Preservation
– Investigation

As EMS providers we also have a short list of common tactical benchmarks. If you think about it, these simple benchmarks apply to every call we respond to – not just an MCI;

– Triage
– Treatment
– Transport

However, I want to suggest one simple, yet extremely important adjustment to the order of these EMS benchmarks. When working an MCI it is no longer Triage, Treatment and Transport – It should become Triage, TRANSPORT, then Treatment. After 3 decades spent as a student of MCI management, it wasn’t until a few short years ago that this concept was posed to me – and I have since come to strongly believe that it is a major key to success! (I owe credit to mentors Bob Marlin and John Putt for not just enlightening me – but proving to me through demonstration that it works).

This concept can be a bitter pill to swallow when we’ve spent our entire careers showing up and immediately taking care of people who are sick or injured. Please consider that we are NOT ignoring treatment in an MCI. Treatment WILL occur naturally and throughout the incident, we are simply making the responsibilities of the “Transportation Unit Leader” an early priority. When we begin to discuss the responsibilities associated with the “Transportation Unit Leader” and how delaying or ignoring those responsibilities can really derail the forward progress of your MCI, I am confident everyone will understand why I am recommending this change in paradigm.

Common Pitfalls:

An interesting phenomenon related to our performance at MCIs and major disasters is that we seem to be doomed to make the same mistakes over and over again. A review of after action reports for widely publicized incidents all over the Country for the last 30 years reveals a list of common pitfalls;

– Inability to communicate with one another (Even with today’s capabilities and technology)
– Lack of a common plan amongst emergency service disciplines (Earlier incidents pre-date the use of ICS – now, even with NIMS and ICS, we are seeing multiple, discipline specific command posts or an overall lack of unified command)
– Difficulties with access and egress of ambulances and other emergency vehicles
– Confusion with who is responsible for what (No visual indicators used to identify key positions)
– No triage performed (now, we are starting to see multiple, conflicting methods of triage being used by different agencies causing confusion and duplication of effort)
– In some cases, triage was actually performed initially, but no tags were used (again with the confusion and wasteful duplication of effort!)
– Failure to notify and communicate with area hospitals throughout the incident
– Poor distribution of patients to surrounding hospitals – Some hospitals get all – Some get none (It does not help the patients to transpose the disaster from the scene to the hospital)
– Patient tracking was incomplete or not performed at all

So, how do we avoid making these same mistakes at our next MCI? We need to plan and train for the “small stuff” first and then practice MCI principles more than once a year! In fact, what I am really saying is that we have to find a way to practice these principles DAILY… (More on that later)

Getting Started:

A technique used with great success in the American fire service is the use of “seat assignments”. The concept is that the initial duties for each person on the apparatus are pre-defined based on where they sit. With seat assignments, the fire truck arrives and everyone jumps off and goes to work on achieving the common tactical benchmarks (certainly an over-simplification of the process). My point is that ride assignments limit confusion, reduce time to task and improve efficiency. In relation to MCI management, I think this concept works very well for the first arriving ambulance (regardless of the name on the side of it).

Front Seat Passenger: “Triage Unit Leader”. It does not matter what level of EMS certification they have. Grab the triage vest (actually wear it!), grab the triage tags and go to work.

Driver: “Transportation Unit Leader”. It does not matter what level of EMS certification they have. Grab the transport vest (actually wear it!), grab the transportation/tracking worksheet and go to work.

Hold on! Don’t give up on me yet. I realize that there are many different service delivery models in our Country and there is more than one way to skin a cat. We adopted this methodology for several reasons. Our service is “small” so are the surrounding first response agencies. We all have finite resources. Considering that many MCIs will present with multiple obstacles (IE: patients, fire, smoke, haz-mat, need for extrication or some sort of technical rescue requirement, etc.) it is also likely that the first arriving company officer or fire service battalion chief will be initially overwhelmed with competing priorities. We want our initial incident commander to be able to rely on the knowledge that the first arriving ambulance will come prepared to organize the 3 Ts, leaving them available to focus on all of the other problems the scene is posing at the time. We will talk in more detail as to how this concept fits within the traditional ICS model.

By having your first arriving ambulance crew automatically assume the TRIAGE and TRANSPORT responsibilities – you will significantly reduce the likelihood of missing the key elements we spoke of earlier in the common pitfalls section. You will also build scene momentum and increase the probability of a successful outcome through reduced confusion and improved communication. You have essentially given your team a reliable starting point to help them get their arms around the incident.

In Summary:

1. In order to adequately plan for MCIs, we need to do the right math. A quick and dirty way to identify what dictates an MCI in your community is to consider 2 patients per each ambulance you have in-service.

2. In an MCI, think – Triage, TRANSPORT, then Treatment.

3. Because we are human, when suddenly faced with difficult circumstances, in order to RISE to the occasion, we will FALL back on our training! We have to find a way to train on MCI concepts daily.

4. Consider using seat assignments to reduce confusion/frustration, increase confidence, gain momentum and work more efficiently to get our arms around the MCI. What we do in the first 5 minutes will dictate the next 5 hours of the incident.

NOTE: Please stay tuned. My next installments will cover the triage and transport concepts in greater detail!

PS: I also realize that some of this article may not fit entirely with active shooter/killer incidents. They are different animals. We will talk about how to apply MCI concepts to active shooter/killer situations later on…

Red, White and Blue

In this family nobody fights alone

Lately, I’ve been seeing a lot of social media posts from my friends and others about their concerns that our Country is in jeopardy. Senseless violence, death and hatred…Kids are no longer taught the essentials of manners, respect for their elders or the virtues of saying please & thank you…We’ve turned into a society that runs on entitlement, expecting something for nothing and shoving responsibility onto others instead of taking it ourselves…We don’t hold doors open for others anymore, we can’t be bothered to look up from our phones to say hello, good morning or thank you…

As I write this, we are only a few days beyond the horrible tragedy in Dallas, and still reeling from the ongoing shock waves of Orlando, San Bernardino, Charleston, Ferguson and the list goes on & on. Situations fueled by race baiters, homophobes, irresponsible politicians & media personnel among other causes – perhaps some of the examples listed above…

As a result of this madness and hate, law enforcement officers (LEOs) and those aligned with them have become targets.

Police Purge Poster July 2016

Slogans and symbols are abound! In the eyes of our society, professing one means you’re against another and more anger and hate follow in its wake. #Blacklivesmatter, #Bluelivesmatter, #Alllivesmatter. I was raised to believe that all 3 are true.

I am putting my thoughts in writing to serve as a source of encouragement for all of my friends and family that work in the emergency services. I am also posing a cautionary tale of sorts. Because of the unique attributes of our corresponding professions, we often feel a sense of separation from those who do not work in the emergency services – AKA “normal people”. Normal people don’t understand our dark sense of humor. Normal people don’t agree with our view points on – fill in the blank…

If we are not careful, this habit of thinking “us and them” can work against us. Instead of “us serving them”, it can easily be interpreted as “us versus them”! Sometimes this public perception develops because of some douche bag wearing our uniform making bad decisions and ultimately, making the rest of us look bad (every profession, every family, every organization has one or two idiots that waste space and cause problems). However, I believe it also happens unintentionally through symbolism that we intend to be positive and encouraging. For instance, the “Thin Blue Line” has long been used as a symbol to honor police officers injured or killed in the line of duty. It has also been used as a symbol of support & solidarity for LEOs. On the flip side, some citizens (law abiding, tax paying, contributing citizens) view the “Thin Blue Line” as a symbol of exclusivity (look at me, I’m better than you) and protection of corrupt cops. In other words, a bad cop can hide behind the “thin blue line” because his fellow cops won’t rat him out. I have heard that expression used in that manner since I was a kid.

How we communicate to our citizens is very important, especially now. On the coat tails of all this recent hatred, I am seeing and hearing fear and anger. I’m seeing “lines” drawn in the sand – by the people we serve as well as from some people in the emergency services and our loved ones. Our friends and family are fearful for us and angry that there are people that would take steps to harm us. On social media and in our daily lives, communications with others are strained, ultimatums are being given… Back my thought process, or else. Believe what I believe, or you’re no longer a friend, you’re an enemy. Diversity and differences of opinion are supposed to be supported and acceptable in our Country. We are unintentionally alienating others because of fear and anger. This is how the terrorists win.

Anyone who knows me knows that I am into symbolism. The emergency services are embodied by stories, relics, colors and shapes, each one explaining to the new recruit and reminding the seasoned veteran why we do what we do. Our uniforms, badges, mission statements and some of the tools of our respective trades contain symbolism. They help us find stability in our constant search for meaning.

As an example, the public recognizes each one of the emergency services by a series of shapes; Law Enforcement – the shield, Fire Service – the Maltese Cross (most people don’t know the name of it, but they recognize the shape), EMS – the Star of Life. Each shape has a history and a story behind it that supports the mission of its respective profession. Similarly, the general public also associates certain colors with the emergency services; Law Enforcement- Blue “The Boys in Blue”, “True Blue” and the “Thin Blue Line”. Fire Service- Red : The “Thin Red Line” was originally a military figure of speech to refer to a thinly manned unit of soldiers holding fast against a much larger opposing force, eventually, the term also became a symbol of courage and solidarity for firefighters. EMS – White: Being born with a direct connection to the medical profession, the color white was often associated with physicians & nurses, the “Angels in White”. Not to be caught without a “line” of our own… Many EMS professionals have recently adopted the ”Thin White Line” as a symbol of solidarity and support for the EMS trade. I think you might be getting the idea that I don’t buy into “lines” – I don’t think they serve us well. I don’t think they convey the message we intend to send. A line is also a symbol. It forces people to choose a side. By its nature, a line divides things (or people). It can have the same stigma as being born or living on the “wrong side of the tracks”.

Police EMS Fire Logo

There is also a psychology to colors. Colors hold significance to people, they influence emotion and they are deeply rooted in our culture. Think about it, what do the colors of our traffic lights mean? The meanings can spill over into other aspects of our lives… “Did you get the green light to move forward with that project?” What colors do you think of during Christmas? How about Halloween? Easter maybe? You can see by some of my examples that I was raised as a Christian. What about the colors associated with Jewish holidays? How about other religious holidays or cultural events? My point is that colors have meaning…

Here is what our colors mean to people in our western culture;
Blue: Integrity, Peace, Calm, Unity, Trust, Truth, Loyalty
Red: Heat, Fire, Danger, Intensity, Courage, Strength, Love
White: Purity, Cleanliness, Reverence, Peace, Goodness, Precision, Humility

These colors were given to our individual professions by the people we serve. This is what they think of when they think about what it means to be a cop, a firefighter or a medic (at my job, we use the term “medic” in its definition as a “Medical Aid Person” – to describe any level of EMS provider). In our Country, the colors Red, White and Blue combined (or said together) represent unity, courage and reverence, they instill a sense of patriotism. Is it a coincidence that the colors of the emergency services are also the colors that symbolize what our Country stands for?

Red lines, blue lines, & white lines all serve to set us apart from one another. On one hand, I understand and appreciate that concept. Each of our professions has parallels & similarities, but they are also unique and important unto themselves and deserve to be recognized individually. However, like I said earlier – these individual lines are often perceived by the public AND members of our individual professions as “lines in the sand” and as “us versus them” (Check out the websites & social media feeds for each “line” and see some of the disparaging remarks we make towards one another in the name or defense of another “line”) What would it be like if we combined our lines? Red, White and blue…. United, we are stronger. Together, our colors deeply connect with the people we serve and remind them that the vast majority of cops, firefighters and medics are patriots. Citizens serving citizens without prejudice or judgment. “You call…We come”

Just so you know, I am totally sober and lucid as I write this. I’m not floating on a cloud, farting unicorns and lollipops. There are seriously misguided individuals out there, being influenced & encouraged by crazy extremists, zealots & idiots, hell bent on killing cops and anyone affiliated with them (IE: firefighters & medics). United, we can all do a better job watching out for each other and taking care of one-another than any one of us could alone. However, I also think it is important for all of us to remember that these domestic and foreign terrorists that have made us all targets represent only 1% of society. For every ill-informed, hate-crazed, ass-hat we encounter, there are 100 people that actually appreciate and support what we do. As patriots, fellow citizens and uniformed public servants, we cannot let fear and anger rule our professional or personal lives. We must be ever vigilant and cautious – but we also have to find a way to continue to model the virtues that our colors represent.

As human beings, we naturally seek out praise, confirmation and support from others. We want it in writing. We want people to say it to our faces. As emergency service pros, we must constantly remind ourselves that we are the “silent professionals” – doing a thankless job because serving others is what we signed up for. We, above all others, are expected to do the right thing, even when no one is looking. Continuing to suit up and show up with a smile on our face is how we give the bird (or in our case, the bald eagle) to the 1%ers and it is also part of how we communicate to ALL of our citizens, not just our supporters, that we still have their backs 24/7/365. We are NOT fearful, we are cautious, and yes, we ARE angry, but not at you. Our supporters will understand this. I think the 1%ers will too.

In summary;

– Members of emergency services have to stop drawing “lines”. Either intentionally or unintentionally, it breeds an us vs. them perception and perpetuates hate and mistrust in the communities we serve. There are many other ways we can show support for each other.
– As natural as it may be to take a defensive stance and turn a suspicious eye to others, we must endeavor to wrap our arms around our citizens and our communities. The message from all of us needs to be one of integrity, loyalty, truth, courage, love, peace, reverence & humility. Sound silly? I don’t think so. I didn’t say this would be easy. This is work I’m talking about here. When we’re on-duty, we’re at work.
– Keep suiting up, showing up and running calls. No thank you required. By doing this, we pay our respects to those that served and sacrificed before us and we show our support for our colleagues (both inter-discipline and cross-discipline). Our message to the good guys AND the bad guys couldn’t be more clear.

I don’t just “back the blue”, I support and believe in the “Red, White and Blue” all together. I will continue to put on my “white” EMS uniform shirt and show up to serve people (even the 1%ers) in the darkest moments of their lives, in their most personal spaces, when they are at their worst (sick, hurt, angry, scared, lonely, drunk, high, broken, naked, covered in vomit, urine or excrement) because I know that my brothers and sisters in “blue” and my brothers & sisters showing up on “big red” will have my back and do their complex and thankless jobs right next to me.

NOTE: Of course, this diatribe is just my personal opinion. It is rooted in love & respect for all of my law enforcement, fire service and EMS colleagues. Take it for what it is worth.

PS: To my friends working as dispatchers – I didn’t forget about you. I must admit that I am ignorant to any symbols and colors that are associated with your profession. I am NOT ignorant to the role that all of you play in keeping the rest of us safe. It is comforting to know that the people on the other end of the mic are always looking out for us.

Don’t disqualify your patients or their loved ones with your qualifications!

EMTs & paramedics are a special group of people. Not just anyone can do our job. Our profession was created to put people in the streets who could effectively be the eyes, ears and hands of the emergency room physician. As such, our fast paced, short term education model has traditionally shoved 200 pounds of medical knowledge into a 10 pound bag (not everybody successfully navigates the required training & testing).

We are trained to perform high risk procedures that could potentially reverse the course of death (or expedite death of performed incorrectly)

We are permitted to administer medications that directly effect the respiratory, cardiovascular & nervous systems and alter people’s vital signs…

Wow, that’s some pretty impressive stuff…

So, it’s three o’clock in the morning and you and your partner find yourselves staring at a remotely human form that appears to have been squirted out of some alien’s anus into a random alley within the borders of your response district…

Every time this person speaks, crusts of dried vomit wiggle on the tip of his nose and from the gaps of his scruffy beard. His breath wreaks of alcohol- maybe gin, because “gin makes a man mean”. His angry, slurring diatribe is creatively inserting “fuck” into the middle of words at the rate of several words per sentence. As a cruel, defiant cherry on top, this person has freshly urinated on himself, creating a darker stain on top of the older, lighter stains on the crotch of his ill fitting pants.

Why are you here? You didn’t sign up for this! This guy is a hot mess and now your ambulance is going to stink like piss and boozy vomit! All of your training for this?  What a waste of of your time and talent!

….Don’t do it! Don’t fall into this trap! Time for a reality check…

What EMS really means;

1. True Emergencies are extremely rare. We must constantly train and prepare for true emergencies because we are the ones responsible for mitigating them. Also, keep in mind that we don’t get to define what an emergency is- the people we serve do that.

2. Medicine is occasional. Only a fraction of the calls we respond to actually require us to perform any of those fancy procedures -in fact,  sometimes we would be hard pressed to refer to the person we showed up to help as a “patient” – which is an important point… Those we serve are “people” before they are “patients”

All of the people we meet have a past or a history unto themselves. They were raised by someone, they’ve loved people, they’ve probably lost people. They’ve learned from others (good & bad things). They are creatures of habit (some good, some bad), They are fallible, they’ve made lots of choices (good & bad), they’ve made mistakes, they have experienced a broad  range of emotions, etc.

We must remember that there is a lot more to a person’s history than medical problems, medications and allergies… We couldn’t possibly learn all there is to know about a person in the 30 seconds it takes us to formulate a “general impression” – which leads me to the last & most important part of our profession…

3. Service! Emergency (rare) Medical (occasional) Service (always). Every single call we respond to is a call for service. At its most basic level, our job is about people helping people. We are public SERVANTS. It’s not about our comfort, our convenience or our ego.

We call it ” job security”… the knack that humans have for doing stupid things. In the course of our duties, we often find ourselves caring for people that have made bad choices. Let’s face it, people don’t call 911 when they’re having an awesome day. When we see them they’re sick or injured. They’re angry, sad, confused, scared, in pain, nauseated, altered…and so on.

We’re human too! We’ve had bad days, we’ve made poor choices, we’ve said and done things that we would be embarrassed to have other people know about..Get it? people helping people.

So, let’s go back to our 3-AM call. Does our 30 second general impression reveal a drunk, bearded, vulgar d-bag abusing the 911 system and wasting the time and talent of two of the worlds most gifted medics???

His name is Jim. He is 55. He spent 25  years in the US military and is a decorated war veteran. He raised three children, all of whom are well adjusted, law abiding citizens. Jim is also a grandfather. He works a blue collar job, volunteers in the community through his church and spends his spare time doing repairs to the home he raised his family in. In the last 10 months, he lost his wife of 30 years to cancer. Yesterday would have been her 54th birthday.

Your assessment is correct in that he is absolutely hammered! He is being nasty and borderline violent as he lashes out at you and the law enforcement officers standing with you. – but for years leading up to this moment he was a husband, father, grandfather and contributing community member. Aside from being human and heartbroken, he is hypoglycemic and mildly hypothermic and he could use two gifted caregivers like you and your partner to help him out…

it is not our job to judge. It IS our job to help ” people” whether they are “patients” or not.

– it is morally and ethically problematic to disqualify others with our qualifications

– it could be medically or even legally problematic to disqualify others with our qualifications

– every time we disqualify someone, we discredit ourselves and every person that wears our uniform.

– disqualifying others with your qualifications is an ignorant, arrogant,  rookie move that you will end up regretting (who is the real d- bag?)

It is not my intention to come off as all-knowing and self righteous. I am far from perfect. My 30 years of “experience” comes from 30 years of making “mistakes”. I have learned this one the hard way – more than once.

 

We don’t need no stinking badges!…..or do we?

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Why do some EMS providers wear badges? isn’t that a cop thing? Are we asking for trouble wearing badges? couldn’t we be mistaken for law enforcement? Are we creating a personal safety issue by wearing a badge?

All valid questions and concerns…

Now here is my take on the issue of wearing badges;

I got my first paid EMS position working for a small private ambulance service in Springfield, Pennsylvania in the mid-80’s. They had a fleet of very ordinary looking van ambulances with a single orange stripe down the center of the van. Much to my disappointment, my uniform consisted of JC Penny grey slacks and a maroon polo shirt with the agency’s initials on the left breast. Of course, as a 16 year old with “stars of life in my eyes”, I wanted to wear something that looked more like a public safety “uniform” NOT something worn by a delivery guy for A&W rootbeer. (I think that may have actually been the goal of the owner – generic ambulances, generic uniforms = no complaints traced back to his ambulance service).

Over time it began to occur to me that even though I showed up in a van that said “Ambulance” on the side of it and I was wearing very ordinary work clothing, people would ask me for directions by stating something like ” Officer, would you mind telling me how to get to….” or “Officer, I am only parked there for a couple of minutes… that’s okay right?” or my absolute favorite – a mother declaring to her child who is acting out in public “…If you don’t start behaving, those cops over there are going to arrest you!!” How on earth would a 16 year old kid, wearing a rootbeer shirt, driving a van ambulance ever be mistaken for a police officer?

As I continued my career, I can say that I have worn every conceivable “uniform” ever made….Maroon, Bright Red, White, Navy and Light Blue Polo shirts, An orange jump suit (Yes, prison orange!), a navy flight suit (I never worked as a flight medic – long story), White scrub shirt, French Grey, Powder Blue, Navy & White traditional uniform shirts, Pants with a stripe down the side, black and blue “Dickie” work pants, black and blue military BDU style pants, etc. etc, Some of my uniforms included badges and some did not – but ALL OF THEM got me mistaken for law enforcement at least once.

How could that be? I don’t really know the answer. My guess is that because we respond to many of the same calls and work along side or in conjuction with law enforcement officers – we are “guilty by association”. (???) I and my colleagues are often mistaken for secuirty guards and firefighters as well – probably for the same reasons.

Respectfully, I don’t think the badge is to blame for our mistaken identity. Like it or not, law enforcement and the fire service have been around for centuries – EMS is only in its late 40’s. Our profession is young and very fragmented in how it is provided across the country. EMS does not have a particular look or identity – it can be utterly different from community to community.

Here is what I think the badge offers us….real or perceived authority.

It has been my experience that the presence of a badge (it doesn’t even have to be a real badge – it can be a patch or an embroidered symbol that looks like a badge!) sends the message that the wearer of that badge must have some kind of authority. I have seen it over and over in my career, Put a group of first responders in a room… & even though it is understood that that group belongs to the emergency services – the person wearing the badge ends up being the go to person for civilians – even though that person may not be the ranking individual in that group! I also think that the color White is also recognized as a symbol of “leadership” – but thats for another discussion…

In my humble opinion, we are all uniformed public servants – regardless of our delivery model. Who do you think the general public perceives as a leader or a professional – the person wearing a faded t-shirt, the person wearing an embroidered polo shirt or the person in a pressed uniform shirt displaying a badge? If you had all three of these people suddenly show up in your home during an emergency, who would you choose to trust to solve your problem? Who would you go to for answers?

I realize that everyone reading this might answer differently based on their personal and past experiences. The point I am trying to make is that my goal as the leader of my organization is to create a culture and identity that garners respect and instills trust in the communities we serve. We have a difficult job trying to create a lasting, positive first impression with our patients when often times, our first time meeting them is during one of the worst times in their life. When they’re in the middle of their crisis, I want the people we serve to know at first glance that we are the medical “authority”, we are the pros and we’re going to take good care of them.

You might have guessed that I have chosen to have badges be a part of our uniform. You would be correct. We made that move in my organization 10 years ago. However, I don’t take the concern of being mistaken for law enforcement lightly. As I have explained, I think it is likely to happen to all of us regardless or whether or not a badge is part of our uniform. Our personal safety is upheld by having a sense of situational awareness at all times, by being conscientious of how we speak to people and their loved ones and how we carry ourselves in public (our body language, facial expressions and tone of voice). Simply put, being nice, smiling and being approachable to others are the traits that make it possible for all of us to go home at the end of our shifts.

Of course, there are always people in society that don’t care who you are, what you do or how you do it – they are going to pick a fight or look for ways to impose their poorly conceived agendas. They’re going to say horrible things to provoke a response or use violence towards you for no good reason. Having situational awareness, a committment to professional demeanor and posessing the skills to defend yourself from violence is a must in our line of work. Again, I think that these issues will exist and occur whether or not we wear a badge on our uniform.

With “authority” comes “responsibility”…

The concept of wearing a badge has a long and interesting history. The badge is a symbol of fidelity and committment to a cause, it represents a promise that was made by the wearer (which is why it is worn on the left side – over their heart). A close look at a badge reveals many elements. Loaded with symbolism, a common badge will indicate the Country, State or Province it is representing. It is also common for a badge to identify the agency, the profession (because it is not always law enforcement) and many times, the actual individual wearing it!

Over the last decade, it has become popular for agencies to stray away from traditional badge designs to more custom apearances that include landmarks or ornate logos, etc. The badge my organization wears looks very plain or generic – but closer inspection reveals the symbolism within…

1. The American Eagle is perched on the top of our badge. A proud symbol that we are American patriots and public servants. The eagle is ever vigilant over the promise we have made to our families and to the people we serve.
2. In the center of the badge is a garden of Columbines – the state flower of Colorado. We are proud to be a part of our profession in Colorado. We strive to become role models for the delivery of EMS in our State.
3. The name of our agency in stamped on the upper portion of our badge.
4. The symbol of our profession, the “Star of Life” is the center piece highlighted by the rays of the sun – a symbol of warmth & healing,
5. Our title that we are responsible for is also stamped on our badge.
6. Each full time team member is given an idividual badge number – which is stamped on the bottom of the badge. No one else will ever be issued this badge as it represents the promise made by that individual.
7. The outer edges of the badge are lined with olive branches – a symbol of peace, comfort and healing. The symbols of our agency, our profession and our promise are held within the principles of providing peace, warmth, comfort and healing to those we serve.

In most cases, a family member or loved one is the person who pins the badge to their chest for the very first time. in performing our duties, our family makes many sacrifices as well. This is why we ask them to particpate in the process of pinning the “promise” to their loved one’s chest. As a reminder to the wearer that they’ve made a promise to serve the community but also to come home to their loved ones at the end of every shift.

Not just anyone gets to wear our badge. It has to be earned (every day). It is a symbol of authority, trust and dedication – worn over the warm and caring heart of each of our providers….

Intro to Principle #7

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This has been a very positive process for me. Once again, thanks to all those that have participated in this with me and have sent their words of encouragement and suggestions for improvement…

The final principle that has been useful to me over many years is this… Principle #7: “Earn it”. What is “it”? Respect, Trust, Friendship, Money, etc., etc.

Coming up in this profession, I have come into contact with many “leaders” who were promoted due to proximity, NOT qualification, because they’re a buddy, NOT because they’re prepared, Because they’ve “been around a long time”, NOT because they have any aptitude or enthusiasm for the added responsibilities of leadership.

Because of this tendency, many of us have met the “bosses” that follow the “do as I say, not as I do” school of thought. They lead by fear and they think they are above any responsibility for explaining their actions, supporting their subordinates or pitching in when their crews need help.

Don’t get me wrong…as I’ve said, I have veered from these principles more than I want to admit. And in fairness, I was promoted to my level of incompetence more than once in my career – and if it wasn’t for certain people in my life (superiors, colleagues AND subordinates) that were willing to be patient with me, give me multiple chances to improve and show me better ways to do things, I wouldn’t be in my current position today.

The previous 6 principles that we’ve mentioned (1. Catch people doing things right, 2. Remember your way home, 3. Assist others in need, 4. Insist on Excellence, 5. Give love unconditionally, 6. Listen) have helped me to earn respect and trust as a leader. My people know that I am far from perfect, but they know that I am constantly trying to get better as a “boss” and in return, they take really good care of me.

I am thankful for all of my bosses, good and bad, because I have learned from all of them and I use my previous experiences as a sounding board for the actions I take and the decisions I make as a leader today.

Some suggestions for living this principle day to day;
1. Be willing to follow the same guidelines that you set for your people. Eventually, you will forget something or screw something up…thats okay – just own it, don’t try to hide it or explain it away.
2. So, it is no secret that you are human and you will make mistakes. You’re people will greatly appreciate you owning up to mistakes and apologizing when things don’t go according to plan.
3. As the leader, you are ultimately responsible…for EVERYTHING! When things go right, you get the glory – when things go wrong you get to take it on the chin. Remember that your people had a lot to do with things going right – and you get to take the credit for their hard work. When things go wrong it is rare that it is your people’s fault – look inward before swinging the finger of blame. What you do and how you act when things go wrong will have a huge impact on your leadership reputation moving forward.
4. Be willing to take the time to explain why. Let people know what your thought process is behind the decisions you make. They don’t have to agree with your thought process, but they do still have to comply with your expectations. If your people know the why behind it, it is much easier to buy into the decision.

Like the other principles, there are a lot of things we can talk about as we move on.
Please let me know what you think of this project, give your thoughts, suggestions, and case studies….We’ll talk again soon!

Intro to Principle #6

 

 

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Principle #6: “Listen” Yep, thats it…just listen. This principle is no different than the others I have mentioned so far – I continue to struggle with this one too!

The good thing is that “Active Listening” is a skill that can be practiced and developed over time – you can get better at it! But it takes focus and commitment.

Your boss wants to be heard, your patients and their family members want to be heard, your constituents and stakeholders want to be heard, your family unit and loved ones want to be heard and of course, your colleagues, co-workers and teammates want to be heard. It is not good enough to be heard – they want to be understood!

So, stop talking and trying to get your point across first – there will be time for that. As a leader, your priority should be to listen to your people. Not just listen when they are talking – but “listen between the lines”….

Developing your skills as an “active listener” is a great way to send the message that you actually care about the person that is speaking. Listening builds trust, improves relationships and saves time – yes, taking the time to listen and understand on the front end will reduce time spent on costly mistakes, frustrating misunderstandings and unnecessary duplication of effort on the tail end.

Great concept…NOT easy for a motivated leader with lots of responsibilities and time commitments. When working with people, it does you no good to try to be efficient. You can be efficient with things NOT with people. With people you can only be patient. Trying to be efficient with people means that you are not listening – You may look like you’re listening, but really you are rushing and thinking of the next ten things on your list. People…especially your people who are trained assessors and astute problem solvers will see through the act and know that you’re not really listening – which is disrespectful.

We can get into some specifics about how to become a better listener later – for now, get started on the path by stopping what you are doing and making eye contact with the person who is trying to communicate with you….

and then remember two things;
1. Seek first to understand – then to be understood
2. You have two ears and one mouth – use them proportionately!

 

 

Intro to Principle #5

 

I want extend my sincere appreciation for all of the folks that have sent their encouragement and support for this leadership imageproject I have started. I have taken your suggestion about starting a blog to heart & I am in the process of creating a blog site now! Any ideas on what name I should give it??

Principle # 5: “Give Love Unconditionally”… That is correct, I said “LOVE”. In our modern society, love has become a buzz-word. It is over used and misunderstood. In the workplace, “love” is unwelcome and essentially synonymous with harassment!

I contend that as leaders, we must love the folks we serve unconditionally. The Greeks did a much better job at defining the nuances of what we call love… AGAPE is the kind of love I am referring to. This concept means that we give selflessly as leaders without expecting anything in return. Don’t misunderstand my intent. You should expect professionalism, timeliness and adherence to job expectations and SOGs. An example of AGAPE leadership would be; you will spend a great deal of your time thanking and recognizing your staff for their accomplishments and contributions, yet it will be rare that someone steps up to thank you or recognize your efforts. Leadership can be a lonely, thankless venture… If you have become a leader for the limelight, accolades and fan fair, you have made a serious mistake.

To be effective as a leader, you must focus your efforts, actions and decisions for the good of the entire organization – not for your benefit or any one individual. Because you care deeply and give selflessly, a common pitfall of servant leadership is that the leader takes things personally. It is important to constantly seek perspective in your day to day activities as a leader. Your folks often don’t see what you go through behind the scenes on their behalf, nor do they have a concept on time & effort spent on getting equipment purchased or projects ready before they come to their fruition. Don’t hold that against them! It can seem like don’t care about stuff or appreciate the situation they’re in. Many times that really is not the case at all.

Resiliency and longevity as a leader requires that you remember two things;
1. Servant Leadership requires Selfless, unconditional service without expectation of something in return
2. Don’t get run down, depressed and stressed out by taking things personally. Your people do care very much and they will be engaged if you let them. They’re the ones that need your encouragement and support. If you need constant affection and affirmation… Get a dog. :-)

We will talk more about other “love” concepts around PHILOS & STORGE and what they have to do with leadership as we move forward

Intro to Principle #4

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Principle #4: “Insist on Excellence” Wow, a lot of stuff we can talk about here. I guess the best place to start with this principle is sitting down with your crews and defining what excellence means to your organization… what does excellence look like? How do you measure it? How do you know when you’ve achieved it? Once you’ve answered these questions – the next question will be How do you maintain/sustain excellence?

As the leader of my organization I have recently realized that it is time to sit down again with my colleagues and define Excellence. I believe it is a dynamic concept and can change along with your organization as it grows and improves. Some of the faces of our organization have changed since we first sat down together and asked these questions. Our organization is a different animal now…time to put our heads together and decide how we want to move into the future, how we want to remain relevant to our community, how we want to grow personally and as an organization.

A good sign that you are moving in the right direction is seeing signs of pride and ownership in your teammates. When your people feel like they have a say in the organization, like they can be involved and make meaningful decisions, like they are cared for by their leadership and not just a number…. they will begin to take the wheel, and communicate the organization’s culture and expectations to new team members. Uniforms are squared away, rigs are shiny and equipment is always ready to go. I think this is a message that you’re achieving excellence…

Any of us that have worked in any emergency service discipline (Law, Fire, S&R, EMS) know that politics and other operational frustrations can periodically distract and detract from all of the good things we are doing as individual professionals and as an organization. Maybe we haven’t achieved excellence yet – but if you take the pulse of your people and find folks that are willing to jump on board – you’ve got a fighting chance!

Catch your folks doing things right (even the little things), help them achieve a healthy balance between home and work, look for ways to be helpful and supportive of your co-workers – and build an environment where everyone is holding each other accountable for common goals – and EXCELLENCE is just around the corner.

Nobody ever said leadership would be easy – don’t give up

 

 

Intro to Principle #3

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Okay, it’s the beginning of a new week – time for principle #3: “Assist others in Need”. This may seem like an unnecessary topic for a group of people that joined emergency services for the purposes of helping others…However, as leaders, many of us are gradually removed from the day to day activities that we started out doing and become immersed in paperwork, meetings, budget, data acquisition, meetings, planning, meetings, inventory, trouble shooting, meetings, fleet maintenance, training, scheduling…and did I mention meetings!

Like most of the principles I have mentioned, this is a pretty broad topic – and there are many ways that we can assist others in need as leaders – lets talk about a few examples;
1. Make it a point to ask your co-workers “What can I do to help you today?” Most of the time, they won’t take you up on your offer – but when they do, it will be something small and very doable. It won’t mess up your busy schedule – but it will help them immensely!
2. Don’t fall into the trap of being chained to your desk! Make it a point to get out of your office and spend a little time with the people doing the real work. visit them at their stations, show up on calls or check in at shift change. Be attentive, look for opportunities to help out. It could also be that you assist by actually working a shift for one of your people – or washing the rig or doing the station chores. We talked about the importance of remembering where you came from..
3. I want to draw your attention to the attached photo. Notice that their vest tag says “Mentor”. Both of the guys in the photo have been in EMS for > 30 years and have encouraged others to enter EMS, helped others as they went through their EMT and Paramedic training and have also mentored folks as they ventured into leadership roles. Mentoring is an essential aspect for the continued growth and success of our chosen profession. You can seek people out that you feel are worth the effort – or you can be open minded when someone approaches you for help or for your opinion on something. It can be a subtle request – don’t miss the opportunity! You won’t regret it!

We can talk about other ways to assist others in need as we move forward with this process