It’s Time for a Paradigm Shift in Education!

I came across an article written by Dr. Bryan Bledsoe that really got me thinking recently. In it he suggested that we adopt a different model of pre-hospital education that is based upon competencies rather than simply hours.

Over the years, all education has moved toward counting hours. We have really taken an industrial/work model. . . Do your 9-5 job and keep coming back. We graduate our students based upon their date of manufacture rather than competency. Every year many high school students are given a diploma, despite the fact that they cannot read or do simple math.

Political forces try to address this by creating standards that are so obtuse that nobody can really understand their outcomes and create methods to teach these standards that add so many useless steps that students are frustrated and confused prior to achieving an answer.  Testing is created as a method to grade a school and teacher, yet the student still moves on.

Just over a year ago, many of the members of the Midwest Ski Area Association (MSAA) have requested a major re-write of the National Ski Patrol’s training methods. EMS agencies are having difficulty bringing in new qualified medics. Some that excel in the training have little ability to deal with the chaos that they will encounter in the field.

We need to make a change, not only to EMS training but all education. Education should be based upon competency. If it takes one student longer than another, then so-be-it. If another accelerates, Great! All levels of Bloom’s Taxonomy need to be considered, not simply the lowest levels addressed by hours and tests.

The world is calling for better educated youth and entry level providers. . . it’s time that all educators listen!

Please read Dr. Bledsoe’s article at 

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Can Young Adults Care for Others?

I realize that this blog has become neglected over the last number of weeks. It’s really amazing how one’s volunteering can get in the way of volunteering. I’ve been very busy doing leadership training for the Boy Scouts and teaching for the Ski Patrol and EMS. Even as I write this, I’m sitting on a picnic table at a scout camp, connected via cellular. The boys are still quiet and I’m taking a moment to write.

When many look at the youth of today, we seem to think that they are not as capable as they really are. We say things like “They’re too young,” or “It’s just easier to do it myself,” or “They just can’t seem to get organized.” We are doing them a great disservice.

The youth of today lack the ability to be great leaders, mostly because we don’t give them the opportunity to learn. This summer I’ve had the opportunity to watch some great young men and women age 13-15 really step up to the plate and lead. Are they the most proficient, No! Youth leadership is often a messy process and sometimes we need to let them be uncomfortable to force them to make a move. Why should they do anything if they can just let us provide for them?

In EMS we are often trying to protect them from some of the horrors that we see, but is this reality? These young men and women will be leaving the nest and heading out to the world, without a clue. Providing opportunities for them to grow; to see some of life’s horrors and learn how to mitigate a situation, while we still provide them some guidance and the safety that we’ve learned from experience is they only way they can learn.

EMS has always had issues with recruiting, but there are avenues available to help us entice the young to a life of service. The Boy Scouts have a program called Explorers that allow  youth 14-21 the opportunity to explore various career paths. Police have done programs, fire, but very few EMS agencies provide this learning opportunity. Perhaps we could use this to teach them to make safe decisions, prevent illness or injury and maybe even consider helping others in a career in pre-hospital medicine.

The National Ski Patrol also has a great program, the Young Adult Patroller program or YAP. These young men and women, ages 15 until completion of high school are taught the exact same programs, both EMR level first aid and toboggan transportation as the adults. They learn side by side with the adults and have mentors there to provide experience. Make no mistake, the YAP program doesn’t develop junior patrollers! They develop fully qualified and capable patrollers, who happen to be young.

Think about the benefits to these youth. They learn lifesaving skills that they may be able to use to save a loved one throughout their lives. They learn responsibility. They learn that caring for others provides self-benefit. They learn that being responsible adults sometimes means putting others first.

They also learn a skill that can help them land a college job. Working in EMS can bring in a meager income, and can allow them time to do homework between calls. The NSP’s YAP program can also provide them a place to enjoy skiing during a time that many cannot afford the sport. After all, beer is more important at that age. These two programs give them an opporunity to sober up and help others.

Consider becoming involved with today’s youth to help develop them into the responsible adults of the future to ensure that there are people there to provide care for us during our old age.

Posted in Education, Young Adult | 2 Comments

Honoring our Brave Through Medicine


Yes, I know it’s Tuesday. I hope that everyone had a wonderful day with their families and friends celebrating the brave who have given their lives to provide us with a safe, free lifestyle.

Yesterday we celebrated the freedom that was earned on the backs of these brave soldiers, today we discuss the advances in medicine that were gained in an effort to save the mortally wounded. Their sacrifice helped our country and helped many others through advances in medicine.

According to Webster, Ambulance descends from the French “hôpital ambulant” meaning Moving Hospital. The word was first recognized in 1809 during the Napoleonic wars. These carts were used to bring the war injured to the back to receive limited medical care. |It was this origin in war that has helped us gain much of the knowledge that we use to help everyone.

Even the National Ski Patrol has strong ties to war with the NSP used to recruit members for the 10th Mountain Division during WWII. These soldiers would use skis to traverse through the mountains, but were also taught first aid to help others. Upon their return many became innovators in the skiing industry.

For all of the atrocities that were done during WWII, the Nazi’s conducted many medical experiments on prisoners. While much of the research was ignored due to it’s disgusting method of research, some of the data has helped us move into more human efforts at research. The book “Was God on Vacation” was written by Jack Van Der Geest and described some of the experiments conducted on him. I had the opportunity to meet Mr. Van Der Geest and his views and book led to a whole new view of medicine.

Most of our routine prehospital care has its foundations in wartime care. Splinting, direct pressure to bleeding, IV fluid administration, even some of the foundations of CPR all were discovered as we tried to save our brave soldiers. Unfortunately war seems to be a time that we see a lot of trauma and can experiment with ways to try to save more lives.

Today we are still making advances in medicine to help our war injured and many of these advances are helping others.

A Tourniquet was considered for many years as the absolutely last resort to control bleeding. I was originally taught in Boy Scouts that the application of a tourniquet had as the only consequence the amputation of the receiving limb. Today we know that applying a tourniquet can save many lives. We’ve learned that a wide constricting band doesn’t necessarily demand an amputation. Today tourniquets are issued to soldier and have been commonly used in pre-hosptial medicine.

I have also read that the Army is now issuing a Junctional Tourniquet to provide stabilization for severe bilateral bleeding.

Abdominal injuries have often caused issues to rescuers. The inability to compress and control bleeding has been an issues and our care is generally limited to “Diesel Therapy.” The more Diesel that we put through the engine, the faster it goes. A study that’s currently being done involves Stasis foam which is injected into the abdomen and will harden to help tamponade off injuries. This has not moved to general use, but may someday help us control abdominal bleeding from traumatic injuries.


The Xstat has received some positive press, but still seems to be very difficult to get to do more experimentation. A large syringe containing hemostatically coated sponges can be injected into the site of a large penetrating injury and as the sponges expand will control bleeding. The Xstat has recently received FDA approval.

Yesterday we remembered those who lost their lives to provide our freedoms. Many of us vowed that they “will never be forgotten.” But their lives, and injuries helped us learn ways that we can help save many others. Hopefully some day we will be able to learn much more from peace than war.

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Time for a Tune Up?

As many of you know, these articles are intended for Ski Patrollers as well as EMS personnel. The ski season has pretty much wound down for most of us, although there are a still very late season options for those that are still looking.

For the rest of us, it’s time to start storing equipment and ensuring their peak performance for next season. I have been told a while ago to start by reducing your DIN settings on all bindings to take the pressure off the springs during the offseason. This helps them maintain their “springiness” longer. Take a fine Sharpie and mark your current settings and unwind the pressure.

Now is also the time to ensure that there’s no rust or burrs on your edges. I found a great set of videos to help you better tune your equipment. If you continue to watch, this multiple part series will continue one after the next.

Invest time now to ensure that your equipment is prepared for peak performance next year. While you’re working, remember all of the great times skiing with friends this past year.

Posted in Downhill Skiing, Uncategorized | Leave a comment

Happy EMS Week!

Congratulations for your decision to help others! Each of us has taken the step to become educated and increase our service to others. The world is a better place because you selflessly help others.

The theme for this year is “EMS Strong!”

Because we will often put others before ourselves, we sometimes don’t take the best care of our own body. We have to pick up many larger patients and carry them around corners, down narrow halls and up or down stairs. All of this takes a strain on the one body that we’ve been given.

Ours is a short career or avocation. Often cut short because of some of the things that we see, but increasingly cut short because our patients are not getting lighter and we end up with injuries.

Let’s take this EMS Week and work on getting stronger; starting with the core.


Thank you for all that you do to help others! You really are making a difference in other’s lives!

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The (Often) Forgotten: EMS in America

Occasionally I come across blog posts by others that so accurately describe medical care that I begin to do research to add to the topic. This article was so well thought out that I am doing something new. . . Posting the link so that you may read the entire article yourself.

The (Often) Forgotten: EMS in America

EMS personnel dedicate themselves to helping strangers, often with detrimental results to their own personal health and families. Let’s give them respect during the month of May. . . National EMS Appreciation month.

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Will You Be Successful?

Years ago I had watched a presentation on success in business and life. The crux of the presentation came to success is determined by who you know more than what you know. Being smart, working hard and reliability are very important but who you know can help bring your intelligence and diligence to greater success.

We have heard many who have complained that the world is out to get them; that it just isn’t giving them what they want. We have all met people that we just don’t want to be around. These people have already failed! Nobody wants to get to know them; those that do want to separate themselves.

With very few outliers, who you know is not determined by a relationship with a single person but rather the masses of people who consider you a person to be with.

Are you the person that everyone wants to associate? Do you make others feel important? Are you the one that makes everyone happy? Do strangers want to get to know you? These characteristics will lead to your success more than most others.

This last weekend we had our regional National Ski Patrol banquet. The room was filled with so many people that draw others because of who they are in addition to what they know. I want to take a moment to point out one young woman that that exemplifies what future success looks like. I had the opportunity to work with Elizabeth this season as I tried to obtain Senior qualification. In many ways I envy her. She is intelligent, dedicated and talented, but more than anything a wonderful person to be around; someone that others want to help succeed. She seems to be always happy, always caring and always willing to help others succeed.She will graduate from college this Saturday and move onto her career. I have no doubt that she will be successful because of who she is, in addition to what she knows.

I bring this one example, but the National Ski Patrol is filled with people like her. People that are very intelligent and dedicated, and who draw others to themselves because of their wonderful personalities and caring nature. I feel honored to be part of this group, which is why I continually work to help it succeed.

Many received well-deserved awards at the banquet. Without exception, the recipients have spent years drawing others to themselves because of how they made these same others feel better about themselves.

Why do I write this tribute on a medical blog? Because these same characteristics will lead to your success with patients, your career, ambulance, and patrol. Be the person that everyone wants to be with; be the one that everyone wants as a partner, as a friend. We’ve all had healthcare providers that have made us feel like a number, or a malady rather than a real person. Be the person that others want to be near because you make them feel important and needed.  If you can not only care for a person’s injuries but demonstrate true caring, your patients will benefit . . . and so will you.

Posted in Customer Service, National Ski Patrol, Well Being | Leave a comment

What’s Your Problem?

One of the more difficult problems in pre-hospital medicine is to determine what the problem exactly is without high-priced diagnostic equipment or labs.

I had written in the past of the methods that a doctor uses to create a diagnosis (Diagnose like a Doctor), but want to make things a bit easier for those of us without many years of medical school and internships.

Almost every problem in the body comes down to a few systems and their interactions. Rather than going into these systems using big medical words I want you to remember:

  • Lungs
  • Pump
  • Fluid
  • Pipes
  • Sticks

Shock, Cardiac arrest, hypoxia, acidosis and many others come down to improving the functions of the Lungs (allowing air to come in and out of the system), Pump (Move the O2 around the system), Fluid (to carry O2 and nutrients to the cells) and Pipes (ensuring that the fluid isn’t leaking). Maximizing the functionality of each of these will improve patient outcomes.

As you begin working on these, I want you to think about “What could be the problem with X?” American Heart association uses a mnemonic called H’s and T’s to help people remember the reversible causes of cardiac arrest, but with a bit of a broad stroked brush you will see that they cover just about everything that patients seek treatment

  • Hypoxia                                                                           Coronary Thrombosis
  • Hypovolemia                                                                 Pulmonary Thrombosis
  • Hydrogen Ion (Acidosis)                                            Tension Pneumothorax
  • Hyper/Hypo Kalemia (electrolyte imbalance)    Tampanade
  • Hypothermia                                                                 Toxins
  • Hypoglycemia                                                               Trauma

This is a very comprehesive list, but difficult to remember. I would suggest that if we still consider Lungs, Pump, Fluid, Pipes that these items become much easier to remember. To clarify, you need all of these working at optimum efficiency to ensure O2 delivery throughout the body (think of trying to get it all the way down to the toes) and remove acid from the system. Please consider this image as a more comprehensive list. Lungs Pump Fluid Pipes.jpg

Earlier, I brought up “Sticks” as well as an addition to this infographic. Sticks include all Muscles, bones and nerve impulses that are needed for the movement of the body. In Pre-hospital medicine, spinal injuries,  fractures, sprains & bruises cover a significant portion of our calls. While splinting is an easy practice, we still must remember the Lungs, Pump, Fluid and Pipes to ensure that circulation extends beyond the break in the sticks.

While there are other systems that play an important role in our day to day life, these fall much more into the purvue of other specialists and we simply can stabilize and quickly transport (In’s and Out’s (digestive system) and Future (reproductive system).

In medicine, the best that we can do is to help the body return to normal functioning as soon as possible. By supporting, increasing, and determining the underlying malfunction of the Lungs, Pump, Fluid, Pipes and Sticks we can help the body return to normal function much faster and provide better outcomes for our patients.

Posted in Airway, Assessment, Cardiac, Patient Care, Respiratory, Shock, Trauma | Leave a comment

Who’s the Most Important Person at a Scene?

As we began our medical training, we were taught that scene safety was paramount. Protecting ourselves and our partners from harm superseded the importance of care for our patient. The premise is valid; if we become injured, we cannot properly care for our patient.

Do we really heed this lesson? Not really. Yes, we try to check as we enter a scene, we try to prevent from being cornered into a bad situation but protecting ourselves goes much further than what we do when we are on the scene.

Many of us have a “Hero” mentality and want to do whatever it takes to help our patients. We try to do superhuman feats of lifting; drive faster than is prudently safe in inclement weather and deprive ourselves of needed recuperation time.
Studies have shown that there is no way to properly and safely lift another person. We must move into untenable positions to be able to move our patients. Additional help would be very beneficial, but in an effort to cut overhead services generally send our too few medics for the task at hand. Even lifting a light patient of 100 pounds (45 Kg) can twist us into positions that cause undue strain on our back or joints. Learning to rely on bystanders and ask for needed help will definitely help increase your longevity in the career.

We all like to drive like our hair’s on fire; that’s one of the things that new medics list as a draw to the field. . . Driving Fast. But speed is not needed in most cases and we are putting ourselves at undue risk. We face a double-edged sword; we are told that we may exceed the speed limits, travel on the wrong side of the road and proceed through traffic controlled intersections, but if anything goes wrong are held criminally responsible. There has been a number of Paramedics and responders that have served jail terms because they were rushing to help someone else.

Add to this the weather. We cannot control when someone becomes ill or injured, but need to take a higher regard as we head out into conditions not fit for man or beast. We take undue risks to transfer patients from one hospital to another during some of the worst weather. Yes, the patient needs the higher level of care, but is this outweighed by the much higher risk placed on the patient and the caregivers to transport during severe weather. . . I would suggest no!

We put ourselves into danger every shift, but there’s an even uglier monster that is often ignored. All of the recent studies have shown a huge negative effect on sleep deprivation. Why they needed to spend money to tell you something that everyone knows is another topic, but we all know that we are not thinking clearly or acting properly when we do not sleep. I guess the studies are trying to quantify the dangers.

Going without sleep for more than 24 hours is more impairing than 0.10 blood-alcohol on our reacting times, our higher reasoning, and physical abilities. Would anyone find it acceptable for their staff to be drunk on duty? Absolutely not. But 24 hours of work is considered the norm among many departments and residency programs.

While it is stated that we can relax between calls, how realistic is this expectation? Medics will not normally sleep between calls during the day, and some companies expect this time to do station maintenance and training. Calls may be continuous, preventing downtime and paperwork has a higher priority than the well-being of the crew. Even when the time is available, do we really achieve a relaxing sleep as we are always on alert for the next call?

There is no standard as exists for pilots or transportation careers that require a prescribed amount of downtime between working hours. Many leave their EMS jobs to work someplace else to make ends meet, missing the requisite relaxation and sleep. Sometimes people will trade work shifts to accommodate family functions and can work 48 or 72 hours. How do you think their mental facilities handle these hours.

At what point does it make sense to switch to an 8 hour or 12 hour day? A department that averages 10 calls per day per staffed unit? 20 calls? Where do we draw that line?

Some compensation packages require working 48-72 hours per week to be able to make a livable wage. This model may need to be adjusted.

On our very first night of class we were taught our safety was paramount, but after that, we’ve only ever paid lip service.


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He has Risen

When I teach classes, I often ask students “What does CPR Stand for?” the common answer (and in reality the correct one) is Cardio-Pulmonary Resuscitation. I continue to tell them that it really stands for Cardio-Pulmonary Resurrection.

The heart is not designed to take vacation. It begins beating before we’re born and continues until our death.

We have experimented and worked very hard to try to reverse this arrest, but it’s very important for everyone to remember that when a heart stops the patient is DEAD. we are trying to reverse death.

When an arrest doesn’t result in Return Of Spontaneous Circulation (ROSC) it is human nature to internalize the failure and blame yourself. “Of course they didn’t survive, in the 4th set I only did 27 compressions, not the recommended 30.” The patient was dead before we started and we are trying to resurrect them.

Over the years I’ve learned that EMS is a very stressful job, with a typical career span of 5 years. To continue to my 23 years of involvement I’ve always kept in mind that “I’ve done nothing to cause this, I’m try to make it better. Sometimes it just can’t be made better.”

When we are working a cardiac arrest patient, we are trying to reverse death and given our best science to date we are nowhere close to perfection. Given advances in compressions (CCR, Heads up CPR, High Efficiency CPR) we are still less than 50% effective. We are fighting a losing battle.

In the history of the universe, there’s only been one person who was pretty good at the resurrecting thing, and we celebrated that yesterday. Happy Easter!

Posted in Cardiac, Well Being | Leave a comment