Insights on Trauma and Technology

Small Businesses Leading Nation’s Economic Recovery

2013. According to a recent U.S. Small Business Administration (SBA) Office of Advocacy report out of Washington, the economic environment is “turning around” for America’s small businesses despite “some lingering challenges” from the recession. As a small business owner, I have tremendously mixed feelings about the report. I thought I would share some alternative views.

First, I love my job. I just think sometimes the other side of the story is worth stating. Secondly, I am comfortable with being wrong. So if I am please correct me. I would love your thoughts.

The article recounts that 2011 represented the second full year of economic expansion since the peak of the recession, with small businesses representing half of this; manifested as output, business income and profits rising, and bankruptcies and unemployment declining. Well, I don’t know about all the other small businesses in the US but I have been extremely busy since 2009 simply surviving. To survive I had to make unpopular decisions, let good people go, adjust, cancel expenditures, go without vacations, change our focus, ask my employees to take pay cuts/deferrals, and fund much of this on my own nickel. I cannot honestly say that I am unaware of any help from the SBA. In fact the issues I had, like so many other small business owners, were probably caused by the government reducing or eliminating funding opportunities, or making applying for aid so complex and consuming it had little ROI. With the drastic changes in governmental support, I would suggest almost all surviving small businesses had to change, cut expenses drastically, or fold. That said, many good small businesses folded; and now with many of them gone the statistics without a doubt must look “better”? The damage is done. We are not stronger, just “here”, continuing to try to survive the policies and behaviors in place. Perhaps we were lucky. As a small business without the government bailouts and seeing huge declines in support in this same time period, and with very little real political leverage to change things, perhaps I can offer an alternative explanation to some of the SBA claims.

For example, this SBA report included the following:

  • Manufacturing sales are up. Maybe this is true, but R&D is drastically down, and a lot harder to get, meaning we are not investing or even able to invest in our future. But we continue to ship jobs overseas and push employees into retirement or layoffs. Even Apple products play in this as recently I noted that “Made in America” has been replaced with “Designed in America” and “Made in China” on the back label of my new iPod.
  • Corporate profits, which declined in 2005-2009, now show increases by 7.9 percent. True. Part of this is point one above. For us, to secure loans and lines of credit I had to show better P/L’s. It was highly competitive and a high risk pursuit to gain revenues so cuts were needed. This means lower investment in new innovations, decrease expenditures (I had to let people go and spend less and look at off-shore manufacturing). Rest assured there were US funds available to us to expand but these required extensive application processes, and a 10 to 1 match which I did not have. So although my profit looks better we are a shell of the company we once were.
  • Startups hit a new high of 680,716 in 2009, declining to 593,347 in 2010. True. When people lose their businesses or their jobs they either go to work for someone else (if they can find a job) or they try/start again. In my mind this is a misleading statistic. The SBA report should look at startup survival at 3, 5 or 10 years and changes in survival rates and job growth for small businesses in the last decade. It might also look at why the statistics look the way they do.
  • Small businesses consistently outperform large firms in job creation. True. And I think this is a key point. If the government invested solely in small businesses, and didn’t offer bailouts, it would go more readily into solid job creation. We are not talking tax breaks here; we are talking about funds to hire and perform; not funds to try to fix what was broken without changing anything. I would gladly pay the taxes if I had funds to hire. To me, funds to hire to a small business are greater than a large company’s coffee budget or executive travel perks and bonuses. If you take away my funding, a “tax break” if I hire someone is an empty promise that only sounds good. Somewhere in the statistics we lose the idea that every single person I had to let go felt like letting go a family member.
  • Total business lending continues to increase and the rate of decline slowed. True. However, we might suggest that those that survived are better risks now. Additionally the amount of work we do and the forms we fill out to apply are more than I have ever seen in my forty-plus years of business.
  • VC funding and disbursements increased. True. But this is also quite troublesome. First of all people are vulnerable and it has been exceedingly hard to survive as a small business owner the last four years. Although VC serves a purpose it also preys on vulnerability. When I hear about some of my partners in small businesses selling out we have to ask why. Is this money real and is it US money or “selling out” our ideas, our jobs and our national future?

Technology marches on! Why are we trudging??

I’ve been a dork for pretty much my entire life. I mean, really, really dorky. Girls refused to speak to me for years, unless I was going to help with homework, I wore sweatpants for most of middle school, I have been described as “a really nice guy” too often to count.

So, believe me when I tell you that technology is moving forward at an incredible pace! These are exciting times we live in Lifesaver… So, riddle me this, why are we taking our time adopting and moving forward with the advancement of technology?

Having spent a few years working in pre-hospital medicine and many more years working in various IT capacities (often in hospitals), I can tell you that we are reluctant to embrace new technology.

To a certain degree, I completely understand our caution. Pushing the limits is that last thing we want to do when it relates to our ability to perform our duties. Patient, provider and public safety should always be of utmost concern.

Sadly, I believe we use the excuse of “it may sacrifice patient safety” far too often for our own good. So many different technologies have come about that could allow for us to provide a higher level of care for our patients. But somehow much of this gets poo-pooed for risking patient safety.

Again, I’m not saying we should use technology for technology’s sake. In fact, I tend to believe technology should be getting out of our way, not interfering in our lives (another post for another time). However, I believe that we’re dragging our feet on things that we’re just being a little too curmudgeonly and stodgy to embrace and move forward.

Today, specifically, I’m thinking about wireless technology.

First and foremost, we need to understand that not all wireless is the same. There’s Bluetooth, Zigbee, 802.11 standards and so many other different methodologies for delivering information wirelessly. In the end, each of these have many different positives an negatives. If you ever find yourself evaluating new tech, take a moment to get familiar with this stuff. We won’t talk about it here, but there really is some cool stuff out there.

I’m sure we’ve all had the experience of being told to shut off our wireless devices before the plane takes off. Or our CD player (it’s not wireless!!), or Nook (but sir, the wireless is off), or iPod or whatever… Now, I’m in no position to pick a fight with the FCC or FAA and I trust that they really are working for our overall benefit; however I still believe that we need to take a good hard look at the way we use (or don’t) wireless in the medical field.

Data exchange has become such an important part of our world, let alone our medical practice. We transmit 12-leads, we call on cellular phones to provide private information and receive orders from specialists, demographic information is sent to our laptops in the truck to give us more information on what type of response we are headed to. These are incredible leaps of technology.

Imagine if we lived in a world where we could wireless transmit more patient data. Vital signs, 12-leads, demographic information, pill shapes and on and on. Rather than having to paint a picture for the specialist that you’re consulting with, they see what you see. Your data is their data. And you can actually consult! You both are working with all the same information and treatment modalities become a much more fluid and patient-centric practice of medicine!!

Even on a completely mundane and practical level, imagine not having to disentangle your patient from 400 feet of pulse ox, ecg, end-tidal and blood pressure wires and tubing!

“But Matt,” you say, “wireless isn’t safe!” Isn’t it? I’ve heard this from the military too… They’re reluctant to allow wireless on the battlefield, even… Haven’t we been using wireless technologies on the battlefield since World War II? Which wireless are we talking about? How long has it been since we really evaluated the way this technology worked?? Wireless enables capability. Who among us doesn’t have a cell phone now? They’re putting wireless on planes now… Maybe we need to take a good hard look at what we are and are not doing with wireless. I think the technology is right here in front of us and we need to embrace it. Maybe now is the time to critically evaluate the role technology can play in the treatment and transport of our patients…

We live in exciting times, Lifesaver. Let us not fear the unknown. Let us forge bravely ahead and make good choices. For the sake of ourselves and our patients.

Traitors and Patriots: Keeping perspective over time in Emergency Services

Some call it jaded. Some call it experience. Regardless of the label you place on it, over time, opinions form and perspective can change. Maintaining objectivity and perspective in any given situation can make all the difference in the world.

“To the victor belong the spoils.” –Senator William Learned Marcy

One of the most interesting (and I think overlooked) aspects of this quote is the fact that history tends to be written by whoever wins the contest. Whomever has the most power, clout, wherewithal or what have you gets to offer their perspective of what “really” happened.

In EMS, we providers are often the victors. We swoop in, prepared to be the best thing about the worst day of that patients life. Ultimately, our version of the story has the ability to follow that patient through the rest of their spectrum of care. We report to the facility where we deliver them. If, heaven forbid, the call ends up in court for any reason, our story follows the patient there. Here I use the word “story” somewhat loosely. Truthfully, it’s not our story, but our perspective that has the potential to follow this patient.

Was the patient drunk? Acting irrationally? How do you know?

Situational bias plays an incredible role in our approach to anything. As human beings we’re trained to follow our gut instinct. Is that person a good mate? Are they a threat to our tribe? Our babies? Being able to read a situation (Scene Size Up) is a crucial part of being in Emergency Services. Is the scene safe? Should we proceed? What equipment do we need? What additional resources do we expect to need?

This “instinct” plays a pivotal role in what we do on every call. But is it really an instinct? Sure, some people may be more natural at assessing the scenario as they walk in, but ultimately this is an issue of experience. We take all of the things we have seen before, process them in to patterns and react accordingly when presented with similar patterns later. Valuable? Absolutely. But it sometimes comes at a price.

Situational bias is something that is an incredibly useful tool, but is a double edged sword. Is every house in a low income neighborhood dirty inside? Do the people take worse care of themselves? Is every morbidly obese patient “just lazy?” Of course not. Every patient is a different scenario. Every patient has a different story. This is the beauty of pre-hospital emergency care.

When confronted with scenarios like this on the other side of a computer screen it’s easy to shout out the “right” answer. When walking in to a house that you’ve never been in before it becomes a little more difficult. Compound that with it being o’dark thirty at the end of a 12 hour shift you picked up to cover after already doing a 24 hour shift and things get a little more blurred.

Shamefully, I was recently confronted with my own bias (and I was completely unaware that I had developed it)… We were dispatched to pick up a patient from home being taken to hospice care. At this point, total mixed bag, you really never know what you might get on a hospice trip (it’s a fact, at some point, everyone dies). Given the address information I was aware that it was, arguably, a lower income part of the city. When we arrived at the house there were cars parked everywhere, in the yard, halfway on the street, everywhere. There was a large group of people outside, milling about.

As we drew closer I distinctly remember thinking “great, this place is going to be a mess and these people are going to be in my way. They knew we were coming, couldn’t they have moved the cars at least!”

Closer still, I noticed something, though the car parking seemed erratic, they were actually all parked in such a way as to make it easier for us to know where to park and to give us perfect access to the front door. We opened the front door and I entered, possibly, the cleanest house I’ve ever been in. The furniture had all been moved to allow us better access to the patient and to make it easy for us to load her up and get out of the house. This woman had become suddenly sick not long ago, but this family had done everything to prepare. Had taken better care of her and the logistics of the whole scenario better than I could have imagined. Likely better than I have when in similar situations…

In that moment, I was confronted with my own bias so obviously that I had to step aside (metaphorically) and scold myself a bit. What a clear reminder of how important objectivity and perspective are…

Situational bias is an important tool to have in our toolkit, Lifesaver. But we need to know as much as we can about every tool we have. Know your bias and stay on your toes. Stay safe, but also remember that every patient’s story is a little different. Keep your mind open and give them a chance.

History is filled with traitors and patriots, depending on the perspective (and the “winner”), they might even be the same person. Ever patient, every healthcare provider, every person has likely been on both sides of this coin. Our goal, maybe even our purpose, is to enter the situation and provide the highest level of care we can to every patient. To remain objective and tell the story of the patient, to impart information and assist care, not to perpetuate misunderstanding and bias.

You each do great things. Keep it up. Alexander Pope probably summed it up best… “Act well your part, there all the honor lies.”

About: Me (My path to paramedic)

My trip to becoming a paramedic has been a bit of a wild ride.

I’ve posted a few times here, I suppose it only makes sense to tell you a little about myself before we get too far in to this relationship…

Seems reasonable to start at the beginning and go on until the end, doesn’t it??

I was born in a little town East of the metro area several (well, many) moons ago. My father was a lawyer, my mother a second grade teacher. They were often supportive of my hair-brained schemes. I lived a life somewhat typical of a small town Midwesterner (this is an exaggeration, I probably have not lived a standard life– I’ll leave that up to someone else to decide). Believe me, there are loads of stories that come from that, but we’ll save those for another time. Regardless, early on, I discovered that I had an affinity and an interest in medicine.

I grew up with a very sick mother. Really, really sick. And sick in incredibly weird ways. This fostered an early affinity for medicine and a comfort with illness and medical community at a very early age.

My interest continued passively until I was living in Tanzania. Normal stuff happened. Malaria. Giardia. Then, through a pretty terrible accident my roommate lost his hand. We were spending our last day in the field at a place called Simba Kopje. Truly an accident, he slipped while climbing when a rock shifted. The rock fell, bounced off his head and landed on his wrist. Nearly completely severing his hand. I recall being very impressed by the man that would later be my other roommate at how cool he was under pressure and how much he knew about what to do.

I don’t like not knowing what to do.

So, I started a Wilderness First Aid course through SOLO. I learned a lot, but it only whet my appetite. I continued having more adventures. I found my way to the jungles of Belize. I graduated with a degree in biology from Grinnell College. Continuing my travels ultimately led me to McMurdo Station in Antarctica. I became a member of the Joint Antarctic Search and Rescue Team. I took a Wilderness First Responder Course from Wilderness Medical Associates and continued traveling the world having all sorts of misadventures… My interest in medicine, particularly in austere conditions, grew and grew. I took my EMT-Basic course from the University of Iowa and was completely hooked.

I returned to Antarctica twice more, traveling in between and being confronted with the continued illness and deaths of family and friends. Moving back to Iowa, I went to work for a private ambulance company as an EMT. Frustrated by how little I was actually allowed to do, I found my way in to paramedic school. In case you’re wondering, 2 jobs and paramedic school is a little much. 4 jobs at once, also a little much. After I finished paramedic school I worked part time for a few different services around the metro area. Mostly at the same time.  There’s a lot to learn once you get out of paramedic school, so I still spend most of my free time trying to absorb as much as I can…

– To be continued –

Heroes In The Heartland

First of all, readers, let me thank all of you for what you do.  Many of you are current EMS personnel.  Others are family, who truly have no less sacrifice than those who respond.  Still more of you may be active or reserve military.  Regardless of your status, thank you for what you do.

Recently, a couple of us from Athena had the opportunity to respond to a potential Multiple Casualty Incident.  The midwest is often known as tornado alley for those of you in parts unknown.  In the springtime we get a curious mix of cold air from the north and warm air from the south and WHAM, tornados.  Last Saturday was one of those moments.  120 tornados were reported throughout the midwest that night.

It’s a curious feeling when you’re called to something like that.  Those of us in EMS are often self-described “adrenaline junkies,” though I have a hard time taking anyone who can actually say that out loud seriously…  Regardless, there is definitely a sense of excitement.  Followed closely behind by a sense of dread.  But most importantly, I think we all are called by a sense of duty.  To respond.  To act.  To help.

When our radios squawked to life letting us know that all available flight and ground crews were being called to respond to a small rural hospital that had sustained a direct hit from an EF-2 tornado, all of those feelings and emotions came rushing forward.

In the metro area we are blessed with a very high level of care.  You can’t swing a dead cat without hitting a full time, very professional service around here. On the way down to the scene (approximately 80 miles away), we were joined by services I recognized.  Other metro area services all responding emergently, ready to do what was necessary to support the town and evacuate the hospital and a few other facilities that had been damaged.

It was a little eery as we careened through the night.  Passing through heavy rain, the sky alternately ominous, pitch black and lit up with such spectacular lightning that you were struck by both awe and a slight sense of terror at what mother nature might be capable of.  As you get further into rural areas, it gets dark fast.  Occasionally you might pass another car or see the flashing lights of another emergency vehicle, but largely, this is a very alienating place to be…

As we got closer to the scene we started seeing more emergency vehicles.  Some racing the other direction, delivering patients to facilities around the area.  Providing care and transport through the harrowing weather.  Some were helping to direct traffic and response efforts.  Tornados, felled trees, flooding…  Logistics is taken to a whole new level when complicating factors such as these are introduced.

We passed through the southern part of town, things seemed almost normal.  Street lights, stop lights, convenience stores.  Everything seemed to be functioning relatively normally for this sleepy little Iowa town.  As we pressed northward, we started to see more fallen trees, downed power lines, the damage started to become far more evident.

We turned a corner and crested a hill and I was taken by a truly incredible sight.  In this moment of need, there had been an incredible response.  Scene lights from the tens of fire apparatus illuminated the scene before us.  The flashing lights of emergency vehicles lit up the sky and bathed the whole scene in alternating blue, white, red and yellow.  The call had been made.  And that call had been answered with speed, alacrity and the vigor that we all bring to our profession.  It was truly a sight to behold.

I work for two ambulance services in the metro area.  Between the two services we responded with 6 ambulances, an MCI vehicle, a gator and approximately 21 people (including specialty pediatric and flight teams).  While impressive, and what the news chose to focus on, this was not what I saw as the most impressive aspect of this response.

I’ve been an Iowan my entire life.  I’ve spent a great deal of time wandering the rural parts of this great land and pride myself and having passed through or near most of the wee towns of rural Iowa.  What impressed me most about this scene was not the full time paid staff that responded.  Was not the folks that came in to help out with the full time crews that they worked with normally (though still an impressive and selfless act).  What I remarked on to myself and out loud, was the number of responders that showed up from tiny little towns in the surrounding area.  Fully volunteer services that were ready to drop everything, pile in to whatever vehicles they possessed and drive through the night, the harrowing weather, and respond when the need arose.  Half of these services were from towns I had never heard of, let alone considered what their EMS, Fire or Police presence might be like.  But here they were.  Here we all were, side by side in the middle of the night.  Prepared to be the best part of a horrible scenario.

So, to all of you, whether you be volunteer or paid.  Full time, part time, paid on call or volunteer.  Civilian, military, reserve or whatever.  Thank you for showing up.  Thank you for all that you do when a stranger calls and is in need of assistance.  Your service is admirable and people notice.


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