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The System Is Broken Not the People — Graham Judd · Dispatched & Dysfunctional

• speaker-0: 911, what's your emergency? following content is graphic emotional includes dark humor that may not be suitable for all listeners discretion is advised these stories are based on real life EMS military and health care experiences calls are real providers are real names and details have been changed to protect privacy they may be disturbing to some and are definitely inappropriate for HR department any medical or mental health discussion is personal experience not protocol use your damn brain follow your local guidelines and what a doubt called make control if you're struggling don't do it alone Talk to someone, a coworker, a friend, a therapist, or hell. Reach out to me, I'll answer. Need help right now? Text or call 988 or visit 988lifeline.org. All right, you're listening to Dispatch Disfunctional Podcast about what this job does to people after the call clears. This show isn't about hero stories. It's not about being tough, resilient, or pushing through all the costs. It's about the things this work quietly takes from us and what happens when the job doesn't stay at work. My guest today is Graham Judd. We connected online like a lot of people in this profession do through shared experiences, shared frustrations and shared understanding for this job. How it changes you in ways nobody realizes it changes you. Rather than me trying to introduce Graham, I'll let him do that himself. Graham, for listeners meeting you for the first time or finding out who you are, tell us who you are, what your background is and what you want people to understand about you before we get into this conversation. speaker-1: Hey Chris, my name is Graham Judd. I have been in EMS since 2007 when I took my first EMR course, my only EMR course, I did pass the first time. I went on to take my EMT course in 2008, got my first EMT job right after I finished school, finished paramedic in 2009 and I have been full-time employed in EMS now for 18 years, 19 years involved in the profession. I realized very early on that we worked in a very dysfunctional job field. And I'm not talking about people. I'm talking about the management, the leadership, the organization, the structure, the design. It is hideously, hideously, hideously dysfunctional in the sense that we are regulated by, ⁓ NHTSA. We're considered transportation. We're regulated by the same organization that regulates city buses, limousines, and rickshaw drivers. I noticed that we don't report to Health and Human Services. We are not considered a mandatory service in 41 out of 50 states. We're considered an optional service in many of those states. We have ⁓ private ambulance services like AMR and Falk and ⁓ Acadia. We have public agencies that run us and that's either city or county. We have fire departments that run our services. We have volunteer services. We have rule. We have urban. We have suburban. We have absolutely no unified structure in EMS. So very early on, I've always been highly motivated, always been enthusiastic, always been optimistic. I decided I was going to go to college and I was going to get an education to help improve emergency medical services. I went on and got, when I graduated from ⁓ paramedic school, it just so happened I had enough prerequisites that I had a two year degree. I thought, well, shoot, I've got a two year degree in EMS. I might as well go ahead and get a bachelor's degree. So I went ahead and in 2015, I graduated with a bachelor of science in organizational leadership. I thought, well, I've got a bachelor's degree, one out of masters. I went on and got a master of business administration with a focus in healthcare administration. And when I finished my master's degree, thought, ⁓ a doctorate's only four more years, let's do that too. So here I am, ⁓ hideous amount of student loan debt behind. And this semester I am actually going to be Dr. Graham Judd and my doctorate is in student, excuse me, strategic leadership. And the focus of all of my research throughout the entirety of my educational career, which started in 2006, is EMS. That is 100 % of what I focused on. Now, I thought when I get my bachelor's degree, I'm going to move up into a leadership position. No, that is not the way it worked. I did not have the right last name. I did not have the right connections. I did not kiss the bosses behind. So I didn't move up. Well, I thought for sure when I have a master's degree, people will look at me and think, he's got a master's degree. He's educated. He's intelligent. No, I intimidated people. I scared them. They didn't like the changes that I wanted to make. They didn't like the ideas that I had. We never did it that way. That's not how we do things here. This will never work. And so I found myself actually at one point in time being told you need to leave this job or we're going to fire you because the administrator was intimidated by the changes and strategies and ideas that I wanted to implement. even had her one time and maybe this is why I lost that particular gig. I even had her tell me we've tried that before and it didn't work. And I looked at her and said, then you didn't do it right. Because it works. I couldn't even tell you what the idea was. I could just tell you the look on her face. So I've learned that EMS today is about 50 years behind where it should be, right? And we're only a 60 year old profession, but we started, we advanced 10 years and then we stayed there. The problem is we have a bunch of paramedics running businesses, okay? Paramedics are good at patient care. Paramedics are good at starting IVs. Paramedics are good at intubating patients. Paramedics are good at doing drug calculations at 60 miles an hour at 3 a.m. on five minutes of sleep. Guess what they don't teach you in paramedic school. They don't teach you budgeting. They don't teach you payroll. They don't teach you scheduling. They don't teach you human resources. They don't teach you finance. They don't teach you accounting. They don't teach you procurement. They don't teach you manufacturing. They don't teach you distribution. They don't teach you any of the things that you need to know to successfully run an organization. So we have a bunch of paramedics running organizations and when they get into those positions, they're quickly overwhelmed. They know they don't know what they're doing, but rather than allowing people with the knowledge, the education skills and the ability to advance the profession, they get intimidated and push those people to the side and elevate people who are good clinicians. The problem is, is being a good clinician does not necessarily translate into being a good administrator. And so that's where the key, the focus of my research has been is leadership in EMS. speaker-0: Right. So on that note, I know you said when you started school, you started it. Were you always a research guy or is this just something that clicked when you got into EMS? speaker-1: So I'm really more of an intuitive guy. ⁓ Things just make sense to me, right? ⁓ Now, I don't mean with my hands. I'm not a mechanic. I fix people, not stuff. But intuitively, I have always understood that if you make certain adjustments within an organization, you will have certain outcomes, right? Certain input results in certain outcome. It just does. And I knew that like before I got into EMS, I was in retail management. And at 18 years old, was a district technical service representative for 36 retail outlets. Wow. Because just intuitively I knew that if I did these things, this would be the result. At one point I was a multi-location manager. had five stores that I managed that I directly managed while being the technical service rep, while being the regional training representative. my My background in retail actually really prepared me for what I was going to be doing in EMS. Now working on cash registers, running cash registers, making sales, all of that sort of stuff. Isn't what I'm talking about. What I'm talking about is when you start managing your organization as a, as a retail manager, you've got to control your inventory. You've got to control your, ⁓ your volumes, you've got to control your sales, you've got to control your employees, you've, and I don't like the term control, but you've got to manage your employee. And all of that translates very well into EMS. People are people regardless of the career field. know, I don't care what kind of business you work in. The way you take care of your people translates from industry to industry to industry. All of the research translates. back to one thing and that is how your people are treated. speaker-0: Gotcha. So, I'm to figure out a phrase that's the right way. So what started in your head when you got into EMS to make you say that, you know, this culture itself needs to be studied, this needs to be changed? What was that that broke you into that mentality? speaker-1: You know, I think it was noticing the problems. It was probably more along the lines of 2015, 2016, when I really started, when I graduated college, when I started thinking about the master's program. What it was is I was noticing similarities in the challenges that people had nationwide. It was around this time I started my Facebook page. I haven't been active on my Facebook page for quite some time and we can talk about that later. But I ended up with a following of 20 something thousand people on my Facebook page and just listening to these people and talking to these people. at one point I was a college program director and dealing with the agencies that I worked in. I noticed that there were similarities nationwide. between the challenges that EMS agencies were facing. And we're talking 10 years ago. The same challenges we're facing today are the same challenges we were facing 10 years ago. There were some things that occurred around 2009, 2010 that made it worse. But when I realized that these are the same challenges, you know, over and over and over, that makes the problem systemic. And if there's a systemic problem, then there is a systemic solution. and I wanted to find out what those solutions were. speaker-0: Gotcha. So what would be a solution to, guess, I know nothing is rapid to be fixed, especially in our realm of world. ⁓ What would, I guess, top priority be from your research? speaker-1: So I don't agree with the fact that it can't be rapid. Okay. think that can be. And I think that it starts with leadership. Now, there were several themes that I anticipated emerging ⁓ in my research. One theme that I didn't anticipate emerging was pay. Now, I know that pay is always an issue in EMS and people are always complaining about how much money we make and how much money nurses make and how we can do more in an ambulance than a nurse can do in a hospital and why aren't we treated as medical professionals and yada, yada, yada. We can get to that too, but pay emerged as the top issue. Now, I still don't think pay is the top issue and I'll explain that. But I was talking to someone the other day and this really... makes my point for me. This person said that pay wouldn't be such a big issue if leadership was better at what they do. And I fully agree with that. Now, here's the other problem. EMS personnel. ⁓ While we can do drug calculations, we suck at math. And I'll explain that. When I did this research, I got a lot of people saying better pay, better pay, better pay, better pay. Nobody said what better pay means, right? Nobody said it's, this is the dollar amount that we need to start at. Right. Okay. And I think that there needs to be a pay scale, right? I think that years of experience should count. think that education should count. I think that EMTs should make one level of pay advance, should make another paramedic, should make another critical care as a made up level. ⁓ So. I don't agree with that. I'll go to the mat on that one. We had critical care when I was an AMR and critical care basically meant that they could run the vent. But because I worked for AMR, my station was closest to the hospital. So guess who got all the vent transfers? did. Not the critical care guy. Not the guy making $2 more an hour. speaker-0: ⁓ I love it. I was an offshore medic for five years. And I actually had a critical care medic when I came on shore every now and then he'd be like ⁓ you know I have bigger scope than you I can do more than you. Really I'm just a medic and I can suture. So right sorry buddy. speaker-1: Right. No, no, no, no, you don't. You took you got a certificate and you know, whatever. ⁓ But so we suck at math. So if you're saying I need I need twenty dollars an hour, twenty five dollars an hour, thirty dollars an hour, that means nothing. Right. Any of this? Absolutely nothing. And I'll give you, for example, I think that now let's let's also understand that there's a difference between living in New York City. Living in Washington state, living in California versus living in Oklahoma, right? There's a big difference in you. You can leave California, excuse me. You can leave California and move to Mississippi, Alabama, Florida, Georgia, Tennessee, Oklahoma, Missouri. And just if you're paid the exact same amount in Oklahoma that you're paid in. California, it's like a 23 % pay increase just in taxes alone, right? Because Oklahoma doesn't have state unemployment tax. Oklahoma doesn't have state unemployment tax. Oklahoma's ⁓ state income tax is eight and a half percent less. Our sales tax is three percent less. So there are nuances based on where you live. Also, if you live in California, New York, Washington state, any of those places, quit voting the way you do and your taxes will come down. But when we talk money, $25 an hour doesn't necessarily mean you're going to make a lot of money, right? So EMS agencies play games with money. All right. I'm a 24 hour shift guy. love 24 hour shifts. I'll never work anything other than 12 hour shifts. When I worked 12 hour shifts, I worked a three on two or three on two off two on three off rotation. One week, didn't see my kids three days a week because they were in bed when I left. They were in bed when I got home three days a week. And when I worked my four days, I didn't see my kids four days a week because they were in bed when I left for work and they were in bed when I got home. what's the point in working a 12 hour shift if I'm not even going to get to see my kids or my family, right? I'd come home, grab something to eat, talk to my wife, go to bed, get six hours sleep and I'm back. I'd rather go to bed, get six hours sleep and get paid for it. Just, just me. I know a lot of people feel differently. I'm a 24 hour shift guy, but there are agencies that run, try to run. And you see this a lot with hospital based agencies. try to run it like they do their nursing schedule. Yep. So they want to give you a 36 hour week. And then they come out and they're like, we're paying $30 an hour. And all the paramedics are like, yeah, $30 an hour. But you're only working three days a week. Yep. Like. And you get zero over time. So you're not getting rich. Nope. So if you make $25 an hour, and I did $25 an hour for easy math, if you work, make $25 an hour and you work a 36 hour week, you make $46,800 a year. If you work 40 hours a week, that's $52,000 a year. If you work a 12 hour shift and you're working a three on, two off, two on, three off type of rotation. you're gonna make $55,900 a year. If you work a 48 hour schedule, two fixed days, you make $67,600 a year. And if you work 24 48 or a 48 96, you're gonna make $72,800 a year. So $25 an hour could be $46,000 or $25 an hour could be $72,000. Now, let's talk about the staffing issue. If you run a 24 48 or 48 96, you need six people to man one truck. But if you run a two on three off three on two off type of rotation, you need eight people. If you you run a 36 hour work week, you need 10 people. Yeah. speaker-0: Okay. speaker-1: So what happened and, and, here's the, here's where I say the administrators don't know what they're doing. You can pay, you can pay insurance benefits, retirement, healthcare on six people, or you can pay that on eight, or you can pay that on 10. Here's what a lot of people don't know. The employee, whatever you pay in taxes, let's say you pay $400 in taxes on every paycheck. Your employer pays $400 in taxes on every paycheck. Right. They have to match that. So it's more expensive for an agency to run a two on three off rotation or F or, or a 36 hour work week, because they've still got to pay you a salary good enough to at least get you in the door. Right. Or they've got to pay you more per hour to get you in the door. And then when they get short staffed because they require more people, now they're paying overtime on that. It's not the 24 48 or 48 96 or even two 24s a week with, you know, an overtime shift is how paramedics make money. It's how they make a living. And it's a way for EMS agencies are always, Oh, we're underfunded. We're underfunded. We're underfunded. I saw once somebody say, Oh, we haven't had a Medicare Medicaid reimbursement since 2006. then why was I making $8 an hour in 2009? Right. If they counted EMTs, $15 or $16 an hour now, they could have done it then, they just didn't. speaker-0: Exactly. And on that note real quick before – I forget this question. So how would you defend the old it's not safe to work 2448s compared to 12s? speaker-1: It is safe in a properly managed system. And I've heard a lot of people go, Oh, you couldn't do that here. You couldn't do that here. Yeah, you can. You need more trucks, you know, in a properly managed system. I'll give you a, for example, and, um, I love Austin Travis EMS. Um, I don't necessarily agree with how they do a lot of their things, but they do a lot of things very, very, very right. True. One of those things. And this is what got AMR in trouble in California. Austin Travis EMS monitors your uptime, the time that you're in the truck. And if they see you trending in a 24 hour shift where you're not going to get four hours, four consecutive hours of downtime throughout the shift, they shut your truck down. ⁓ wow. And you, and you get downtime. So if they see you trending in a particular direction, these guys aren't going to get enough sleep. They shut that truck down and you get sleep. California got in trouble AMR in California got in trouble because they considered it downtime when you were going from one post to the next. That's not downtime. If you're in the truck and your wheels are turning, it's not downtime. You may not be on a, on a call, but there's more to taking care of your employees than there is unit, unit hour utilization. Right. So AMR was calculating UHU, which is unit hour utilization. That's the number, that's the, the amount of time that the employee is on the truck and the amount of time that they're with a patient and out at the hospital. Anytime outside of patient contact time was not considered unit hour utilization. So they were calling that downtime. That got them in trouble because the folks in California weren't getting lunch breaks or anything like that. And sometimes that happens, right? That's the nature of Right. I mean, Sometimes we go on a call and, know, 15 minutes later, we're clear. Sometimes we go on a call and 15 hours later, we're clear. Right. If we have a traffic accident and we've got to shut down the interstate and drop helicopters and all this sort of stuff, it's a mess. We're going to be there a while. Sorry, go pee in the woods. You know, that's, that's the nature of our job. But when, AMR, so here's, let me tell you a little secret about AMR. AMR says we want to provide the best care and the best coverage and we're going to serve our communities and we'll make, we'll make it on scene in 10 minutes or less, 90 % of the time. Okay. That sounds great. Here's a dirty little secret about AMR. They don't really care about taking care of the community because as soon as you start responding to 93, 94, 95 % of the calls in 10 minutes or less. They take a truck off the road. because they can, because they can reduce the payroll and still meet their contractual obligations of 90 % or more. They don't, they don't really want 90. They don't want a hundred percent of the calls answered in 10 minutes or less. Right. Only 90%. They'll keep it at 91, 92 to give them a little bit of a buffer so that they don't incur the fees and things like that. But once they start hitting those benchmarks, And that's why in areas that use system status or areas that run 12 hour shifts, you're going to have 30 trucks during the day and six overnight. Right. So, ⁓ we couldn't do 24 hour shifts. You could, you got to leave all 30 trucks up though. Yep. You know, and then instead of two trucks running, instead of six trucks running five calls a piece, you've got 30 trucks running One call a piece overnight. Right. ⁓ speaker-0: mentally and physically. Overall, that would be a lot better for all of us. And like you said about the pay earlier, as I know a company around me that I know the owners and ⁓ me and him were one of the owners were talking the other day. They've paid raise their pay. They've done all this. And a lot of people, I'm sure you understand because of your research, but a lot of people don't realize how much it also cost to run an ambulance company. He was telling me just his insurance alone is a million dollars a year. speaker-1: That's cheap. speaker-0: Yeah, that's what he was telling me. He said it's cheap, but I'm like, that's still, it's a mom and pop shop. It's not a, it's not like AMR and I'm like that, but you know, still it's like, they're, starting their basics out at I think 20 something an hour and they work 24s. speaker-1: And the thing is, EMS leaders don't do anything to build the confidence in their employees. Right. We do. We do a ton of dumb stuff. Right. ⁓ When I first started in EMS, we didn't even collect face sheets. You know, we didn't. But then I started working for organizations and it's like, ⁓ we collect face sheets. And then they're like, ⁓ but now we've got these tablets. You need to take pictures of the face sheet. So started taking pictures of face sheet and Toss in the face sheet and they're like, no, no, no, we need that too. Okay. Collecting face sheet, take a picture of the face sheet, turn the face sheet in. Oh, you didn't put a cover sheet on the face sheet. Collect the face sheet, take a picture of the face sheet, put a cover sheet on the face sheet, put the face sheet in the box. What information do you need on the cover sheet? Everything that's on the face sheet. Yeah. You turned in that you took a picture of like when When EMS agencies start making all the paramedics do billing and finances job, it's like, why? Why are we making this piece of paper? Like I understand it's got billing information, it's got insurance information, we need to get paid and stuff like that. But we do things three, four, five times. When I started in EMS, I actually worked for a really good county agency. It was really good until it merged with the fire service, but I worked with a really good county agency. And we had mobile data terminals that pinpointed locations that drove us, We didn't have, I mean, we had cell phones, but we didn't have GPS cell phones right then, right? We had the little night, ⁓ the little Nokia bar phones, ⁓ the brakes that they're on playing snake and, ⁓ speaker-0: love doing that, man. Come on now. speaker-1: Okay, great. But, but we didn't have GPS, you know, Garmin's and Tom Toms and things like that were popular then, but we used a MacBook still. Right. And then they, they integrated this mobile data terminal. And I mean, you could see all the law enforcement notes and you could see fire department's notes and you could see EMS notes and it was, you know, 20 years later, and there's still a lot of agencies out there that don't even have a mobile data terminal. True. Why? Why are we, why are we running into call? I've been dispatched to a call where it said, we need you to respond to such and such location. Okay. Why? You know, we've got, we we've got to just, there are systems and processes and all sorts of things that we can do. You know, let, let's stop. Let's, let's remove all the duplicity, you know, We need to quit doing things three, four or five times. Like I said, I understand face sheets. I understand billing. I understand that we all have to get paid. That's why we exist. That's why we have jobs, but let's stop doing things two, three, four times. Let's bring in technology. And like I'm not saying bring in, know, newfangled technical, know, chat, GPT, AI, whatever stuff. I'm saying let's just bring technology into these agencies that we had 20 years ago. Right. There's still agencies out there using manual stretchers. speaker-0: Yeah. ⁓ yeah. speaker-1: Because guess what? You can get a manual stretcher for $50 on marketplace, or you can get an auto loader. Yeah, that costs, you know, $45,000. But there are many, many different things. And in fact, this falls into one of the categories of what I researched. The second most prevalent theme was management of daily tasks. Management can make EMS a better place, but They manage the daily task poorly. They beat the brakes off of their employees. The employees get burnout. Burnout leads to turnover intention. Turnover intention leads to turnover. So why are we running a psych transfer at three o'clock in the morning? Homeboy is going to be crazy at shift change too. Yep. Right. Medicaid them, let them sleep and then we'll take them in the morning. There's no reason on a 24 hour truck you're running a 3 a.m. psych transfer. Why are we doing a general surgical consult? at three o'clock in the morning when the surgeon dang sure ain't going to be there. Right. Give them some medication. Keep him comfortable. Let's put them in. Now you've got a STEMI, you've got a trauma, you've got a stroke. Absolutely. Dispatch me. Happy to run that call or better yet, put them on a helicopter, get them there in 15 minutes instead of an hour and a half. speaker-0: Well, and the problem with that I've seen too is thank God I work for different service now, but I've worked for services that – hospital discharge, 3 o'clock in the morning. Why can this not wait? ⁓ speaker-1: They can. The management doesn't have the cojones to stand up to the hospital and say, no. Right. And they need to, they need to say, no, we're not going to do that. No, we're not going to send units to post at midnight. One, two, three o'clock in the morning. No, we're going to let our employees get some sleep. No, we're not going to whatever they've got to stand up. to the cities and counties and say, we've got to protect our employees because as soon as they acquiesce to the city commission or when they acquiesce to the county commission or when they acquiesce to the hospital's demands, suddenly it's not EMS supervisors who are in charge of the operation anymore. It's the hospital, it's the city commission, it's the county commission who guess what? Those people are all in bed while we're out running calls. They're all in bed. while we're doing a two, three, four o'clock in the morning posting assignment when statistics show there's not even going to be a 911 call, right? Geographic profiling, knowing where to put your trucks, what times to put your trucks there, the hours of the day. ⁓ You know, that's important stuff. Arbitrarily sending them to the opposite end of the county or into the dead center of the county at three o'clock in the morning just because you have an extra truck doesn't necessarily make sense. It might make sense. But it doesn't necessarily make sense. And that's what managers have to figure out. When are we going to run this transfer? When are we going to dialysis transports? If we're doing dialysis transports as an EMS agency, there needs to be a dedicated unit to run those types of types of calls. I'll be honest. I didn't go and get all of this, you know, fancy paramedical training. speaker-0: to do a dialysis transport. speaker-1: to do a dialysis transport or, or transfer for that matter. Right. Like I didn't, I didn't get into this career field to move people from one hospital to the next, or from the hospital to the nursing home or for the nursing home to a doctor's appointment. I got in this career field to make a difference in people's lives in their immediate time of need. Right. And I realized that transfers and dialysis transports and stuff like that, they make money. Great. There are people who want to do that. There are people who want to do that for a living. There are people who go, you know what? It's great that I have this knowledge. I don't want to be responsible for that. I don't want to be the one shutting down a major interstate system in both ways. I don't want to be the first person that responds to, you know, a warehouse explosion and 30 people are hurt. don't, that's, let me do the inner facilities. Let me practice medicine. But let me practice it in an environment that's a little bit more low key. I'm not that guy. I want the chaos. Send me in the middle. I'll fix it. Promise. I'm taking command. I'm running the scene. We'll get this fixed. Everybody else needs to chill out. That's what I like. when, and that's what a lot of people like, a lot of people want to be the one that runs into the middle and brings the calm to the chaos. However, when you speaker-0: Right there. speaker-1: When you absolutely wear out your employees, when you take these people who have been trained to intubate, who have been trained to cardiovert, who have trained in cardiac rhythm interpretation, who know how to do IOs, who know how to do surgical crates, who know how to do all of these fancy things, and you're like, we've got a dialysis transport. That's burnout. That automatically says to your employee and managers may not understand this. Managers listen to me. When you tell your highly trained paramedic to go and do a dialysis transport, you're telling them that their value is that of someone who could basically be transported in a taxi cab. Yeah. You're not, you're not, we don't want you running emergency calls. We want you in the back of this ambulance. It's not an overt statement. It's a business decision. I understand that you understand that, but when you run these dialysis transports day after day, after day, after day, that's the, that's the message that is being sent to your highly trained paramedic. And that's going to lead to burnout. Then your paramedics going to go, you know what? I want to go somewhere. I can actually use my skills. your paramedic is going to want to go to that critical access hospital where the doctor runs a family practice Monday through Friday and wants you to do all of the intubations. That's where your paramedic is going to go. speaker-0: And then that also correct me if I'm wrong, but that also creates a bunch of compassion and fatigue in the end as well on the paramedic's part or whoever is in the back of the truck, EMT, advanced paramedic. speaker-1: It can, it can. And I don't want to speak to the causes of compassion fatigue so much. That's not an area that I've researched a ton. Right. But I will tell you that there are many, many different causes of compassion fatigue. If all you ever run all day, every day are a bunch of overweight diabetics who failed to control their blood sugar and now require renal dialysis, yet you're probably not going to be very compassionate towards a bunch of overweight diabetic, you know, renal dialysis patients. You're just not. Um, I'll give you a, for example, and this is just kind of a personal story. Um, my wife was diagnosed with cancer back in, um, October of 2023. Uh, we actually, we thought we had it beat. were told in September of 2023, you have absolutely no trace of cancer in your body. And then we started noticing my wife having different signs and symptoms, none that you would consider neurologic. individually, right? ⁓ She would knock things off of her table. Well, they said you've got neuropathy because you had the, the lymphectomy. ⁓ We were, we were canning some food one time and, and she couldn't use the canner thing. There were times where she felt dizzy. There were, she fell a couple of times and it wasn't like all of this happened in the same day or even in the same week. was just Well, you've got the neuropathy, you just had the surgery, you're getting chemo, you're weak, know, all of these types of things going on. And finally, my wife said to me one day, you know, I feel like a bobblehead. And she started driving down the road and she's like, I can't see, I can't see to drive. like, it looks like I'm driving underwater. So we took her to the hospital and as it turned out, ⁓ she had a tumor in her brain. The cancer had metastasized into her brain. And so for the next 11 months, we managed this brain cancer. went through surgery. She went through chemotherapy. She went through radiation. She went through, you know, appointment after appointment. And I'm, I'm pretty rural here. So we had to drive an hour and a half to the hospital and an hour and a half back, sometimes three and four days a week. And, ⁓ ultimately my wife passed away last August. And so I took time off. I've got three daughters at home that I have to take care of. ⁓ and you know, if you see my hat, I started my own business. ⁓ it's a Judd's quail. It's a quail farm. That's cool. Because I decided I wanted to farm. I didn't want to, is that me or you? Me. Okay. Making sure I'm not spanking over here. speaker-0: I'm sorry. Sorry, got a daughter of mine texting me trying to come home from school. speaker-1: But I decided that, ⁓ you know, I would rather be at home and take care of my kids. Then go to work and take care of other people because I took care of my wife for 23 months with cancer. Well, obviously, you know, when you start a new business, when you start a new company, when you start a new organization, it takes time to grow. But my very first day back on shift, I ran six calls and five of the six people were. terminal cancer patients. know, ⁓ I've worked really, really hard on my research. I've worked really hard on my education. ⁓ I've watched EMS stay the exact same despite the fact there's a preponderance of evidence out there. I interviewed for a supervisor position one time and the supervisor says, Well, what are you going to do about this or this or this? And I said, Well, I'm going to do these things. She's like, she says, Well, I've been doing this for 25 years and That won't work. No, the problem is lady, you don't- speaker-0: You don't want to change. speaker-1: You don't want to change it. It'll all work. I've got 250 research papers on my computer right now. I can show it with you, but I thought this was an interview, not a debate. Right. Like if you've tried those things and they didn't work, then you did it wrong. That's, that's the long and short of it. And after that interview with that superior, I decided, you know what? I don't, I don't care if I advance in this career field anymore. I've done the research. I've got the degree I've got. I can run any organization in this country. EMS and I can make it better. I don't want to. I've had enough. You know, I've been doing this for 20 years. ⁓ I've discovered that I enjoy farming a lot more. I don't want to deal with the administration. I don't want to deal with the city commission. I don't want to deal with, you know, annual or five-year contractor rules. I don't want to deal with national registry. I don't want to deal with a CAS accreditation. I don't want to deal with any of that stuff anymore. ⁓ And a lot of that I think has to do with, with for me, the compassion fatigue is a couple of different things. ⁓ quite frankly, I'm tired of having a front row seat to everyone else's tragedy. I want to sit here on my farm and I want to pretend like none of that's happening and I want to enjoy myself and I want to have a good time. And I don't have PTSD. don't have like administration has given me far more nightmares than any call ever has. So it's not like. I don't have any trouble sleeping. don't second guess my decision-making. don't, know, if I would have done this, this would have happened. If I would have done that, they would have lived. don't, none of that people die. It happens at, whatever. ⁓ That, that's not, that's not me. In fairness, I've seen people develop PTSD by running one call as a student. I've seen people blow their brains out at three years. But I think when you reach that point that the compassion fatigue is, and don't get me wrong, I still treat. I still treat every little old lady like my grandma. I still treat every little old man like my grandpa. ⁓ You know, I treat people, you know, my parents age like my parents. ⁓ I treat them very, very well. We don't have a dysfunctional family. So I do treat them very well. ⁓ You know, if you come from a dysfunctional family, maybe don't treat them the way you treat your parents. Yeah. So, you know, I still love this job. speaker-0: Yeah, that'd be a better one. speaker-1: I still love providing care. Anybody can call me any hour, any day. I'll answer the phone. I'll help you if there's any way humanly possible that I can, but to see us still, you know, garbling on about pay 20 years later, to see us utilizing, ⁓ you know, relics of equipment in EMS, to see us failing to advance is, it's just, it's just flipping absurd. And despite the fact that I know that I could impact all of these major changes, I mean, I've been able to make these changes for a long time. Like it's not the degrees that did it. It's young common sense. And the fact that we're not using common sense in this career field, 20 years after I started, 60 years after the career itself started, you know, I just don't want to do it. speaker-0: Well, like we were talking about before the show is, you know, the whole realm of nurses versus medics type deal thing. And, and like you said earlier, you know, we are pretty much a taxi service in the end. We do fall under NTHSA. ⁓ So what, what, in my opinion, I'm sure you could probably correct me on this, but in my opinion, what needs to happen is there needs to be a federal mandate that says, You update your equipment every so often. You stay with this, this and this. And that might help in the end. speaker-1: The very first thing that needs to happen is EMS needs to fall under the Department of Health and Human Services. ⁓ yeah. Bar none. National registry needs to go away. ⁓ National registry and CoA are a monopoly. ⁓ They are feeding each other. The implementation of programmatic accreditation, ⁓ while I certainly agree with accreditation, but the implementation of programmatic accreditation ⁓ through CoA. speaker-0: Yeah, 100%. speaker-1: eliminated almost one third of all training programs in the United States. There's been a little bit of a rebound. They all like to say that the the the co a and National Registry all like to say that, you know, 80 % of Americans live within, you know, I think 60 miles of an accredited DMS program. That's fantastic. That means almost 100 million people don't live within an hour of an accredited program. It's a money grab. If you want an accredited program, there's only one accreditation agency you can go for, which means they can charge however much money they want. They can make the process as complex as they want. They can ⁓ do it however they want to do it. States need to get back to regulating their own EMS agencies. Those EMS agencies need to fall under the healthcare wing of the government. And ⁓ there needs to be reciprocity among EMS nationwide, it needs to work. your, your paramedic license needs to be a driver's license. Right. should be able to take your, yeah. don't even know what state you're in. ⁓ Alabama. All right. You should be able to pack up, come to Oklahoma and get a job without having to go through the national registry. You should be able to pack up, come to Oklahoma and get a job without having to recertify through the state. What you need to do is when your, when your license expires, you need to submit your CEUs to the state with your Alabama license. Oklahoma needs to go. speaker-0: Alabama. speaker-1: Great. They were licensed in Alabama. They've got all their CEUs. You're now an Oklahoma paramedic. ⁓ It's not a complicated thing, but the problem is at the federal level to get EMS moved out from under NHTSA over to HHS takes a literal act of Congress. And if you watch the State of the Union address, we couldn't get 50 % of Congress to stand up and say that taking care of American citizens is more important than taking care of illegal aliens. If you can't get half of Congress to stand up and support American citizens, getting them to agree on whether or not EMS should be under a different wing of the government, ⁓ it's just not going to happen. And that's a problem. Moreover, just in quite frankly, at the federal level, we've got our military veterans in the Middle East right now preparing potentially for war. Congress has bigger issues to deal with. speaker-0: Right. Yeah, that's true. speaker-1: ⁓ So that's one of those things that's probably not going to happen and is just going to sit on the back burner. But that doesn't mean that at the local level, we can't manage our task better. We can't increase our public relations. We can't allow community members to do ride-alongs. We can't attend job fairs. We can't increase pay for EMTs and paramedics. But we got to find out what that pay is, right? What's a good starting pay for a high school graduate with a trade certificate? to chew on that for a minute. Y'all want more money. Don't want to go to college. And like a two year degree, I think a two year degree should be a minimum requirement for a paramedic. Okay. You know, by the time you finish paramedic school, you've got 42 credit hours in college, more or less. So what are the classes that you need to get that degree? You need a humanities degree, which teaches abstract thought. Good thing to have as a paramedic. You need a science class. Cool. How about anatomy and physiology? You need a government class. Not bad for people who work so closely and intertwined with the government or even for a government run agency. You need a math class. Not bad for people who do drug calculations. You need an English class. I've read some of your reports guys. You could use the English class. Then you take one elective. You got a two year degree. You want more money? Get a degree. You know what all those nurses have that you don't? A degree. You tell me what's a fair wage for a high school student with a trade certificate. You know what a welder has? A trade certificate. You know what HVAC has? Trade certificate. You know what a plumber has? Maybe a trade certificate. But those people don't start making real money as entry level. Right now we're entry level healthcare. We're always going to be entry level healthcare until the community says, well, maybe we should have higher education. And then I hear people say things like, well, if they paid me more, I would go to college. Really? Give your kid the candy before they do the dishes and see if they do the dishes. speaker-0: Exactly. And ⁓ I've done the same thing is I've, I've worked with both. I've worked with people that have education, people that don't. I've worked with leadership that has education, leadership that don't. In the end, it's just a piece of paper, but that piece of paper says that you were structured enough and had the integrity enough to go to school and speaker-1: They don't. speaker-0: Keep going that you don't give up. speaker-1: It does. It does. It shows that you have the ability to start a task and see it through to the end. And I'll be honest, I mean, with the emergence of AI and things like that, I think we're going to have a lot dumber paramedics because they're going to be popping everything in a chat GPT, spitting the answers back out on paper. They're not going to be reading their books. They're not going to be doing their workbooks. They're not going, you know. They're going to be popping things into chat GPT and they're going to be thrown back on a paper. They're not really going to learn, but they are going to have a passing grade. Right. So there's, there's, there's a lot of issues and, but from an education standpoint, no ma'am, thank you. ⁓ from an education standpoint, there are things that college does teach you. For example, if you take a college English class, you're necessarily going to write better because you have to write well. to pass that English class. I don't care if you get a C, you know, that doesn't matter. You you passed. ⁓ You're necessarily going to be better with computation if you take a math class. Doesn't have to be college algebra. Algebra's stupid, guess what? I'll have a doctorate in May, never pass college algebra. You know? ⁓ I don't think like that because A plus B equals C and unless you know what A and B are, you still have a problem. You don't know what C is either. algebra doesn't make any sense to me. Don't like it, don't wanna like it. Interestingly, I am good at statistics and economics though, so. speaker-0: That's kind of weird, but yeah. speaker-1: Right. I've graduated, I've passed master's level finance, accounting and statistics, but never college algebra, which is a freshman level class. you know, but, but any college math class is going to help you any, ⁓ like for your history, you take a government class and you have a better understanding of the way, you know, government operates. Then, then that helps you understand why your system does what your system does and why things take as long as they do and the checks and balances that they have in place. Like college education. can be a good thing. I don't want people going and just, you know, I don't want you to go to college and get a degree in communications and think I'm going to be a great paramedic. No, you're not. But you can make, you can go to paramedic school and become a great paramedic. And you speaker-0: So. Right. So one thing I learned from going to college myself is you pretty much just spoke about it yourself is I went back to college because I through a paramedic class. I was supposed to get associates. Didn't get associates. Got screwed out of that. Got my paramedical course, but not my associates. So I wound up going to a community college, taking psychology, loving psychology and finding out from all of the instances and incidents that I've had, actually did come have PTSD in the end and realize some of the traits out of the gate after taking that class. And it's like, wait, why is this something that we don't try to teach more of just like you said on English? You know, why do we not try to better ourselves as providers? Why do we not try to better ourselves on the entire field of emergency medicine? If we were able to study subjects such as psychology, A &P better, ⁓ We could be better clinicians. could be, as everyone wants to complain and gripe about, we could be on the same level as nurses. But you have to be able to want to improve. And a lot of the people in this field are so stuck in the old times that they don't think that that's what needs to happen. They believe that the wayside should just be the way it is. speaker-1: I think that starts with the leadership, right? Right. I truly, I truly think it starts with the leadership. You've, you've got a staff of 50 people, right. And all 50 people have a paramedic certificate. They don't, they don't have a college degree, local community colleges. You can go for like a hundred dollars a credit hour. Right. Okay. 18 credits, 1800 bucks. So to the people who are going to have to pay for themselves, quick complaint. it's 1800 bucks. It's a hundred bucks, a hundred bucks a month for a year and a half. It's, you know, you can afford that. Delete your, delete your Roku and you can afford it. promise. Um, but why don't we have EMS agencies going, we want the best and we'll pay that $1,800. You got a staff of 50 people. It's $1,800 each for them to go to school and graduate. It's less than a hundred thousand dollars. You know, I like, and I know a hundred thousand dollars is a lot of money, but when you're charging $1,500 a transport and you're doing 25 transports a day as an agency, you got a lot of money, you know, or when your transfers are creating, you know, $4,500 a piece, it's not, it's not a ton of money, but the signal that shows your team, your employees is we as an organization are willing to invest in your success. speaker-0: dropping that. And that's a big thing. speaker-1: creates organizational commitment. And when you start having these training classes once a month, people are going to show up. And I don't mean these silly training classes where you come in, they do one skill and you sign off. Have a good solid four hour training class. Bring in a cardiologist, bring in a nephrologist, bring in an endocrinologist, bring in all of these specialists ⁓ from the healthcare field that are more than willing and able and happy to help you. do a training class on diabetes, do a training class on stroke. When I went through school and you can't even find this anymore, ⁓ really, we used to do a Miami 12 lead class, absolutely phenomenal class. Miami stroke, look it up, great, great class. I haven't seen one in years. PHTLS, it's hard to get because it's almost impossible to get your cert and then the people that do get the certs are like a bunch of gatekeepers because they wanna charge you $100 a person to take the class. What, you know, we need to do more Miami 12 lead. need to do more Ph TLS. We need to do, ⁓ what, ⁓ we used to do advanced stroke life support, right. But, but now everybody's like, I've got my CPR card and ACLS. I would like to be a paramedic. Invest in your employees leaders, invest in them. They will invest in you. You've got to train them. You've got to teach them. You've got to pay them fairly. speaker-0: That's cool. speaker-1: That's going to vary from county to county, city to city, state to state. But talk to your people. And people, you can't say I need $25 an hour because like I discussed at the very beginning of this pod, $25 an hour, 36 hours a week is very, very different from $25 an hour on a 24 48 rotation. It's almost a $30,000 a year difference. We need to figure out what's a good starting wage. But again, If all you are is a high school graduate with a trade certificate, what's fair? speaker-0: And the another thing I want to bring up too is like you're saying a minute ago, why I have it on the, sorry, I have it on focus. But anyway, thing I wanted to bring up on that is just like you were saying, the leaderships, I've worked for an agency that took very good care of me when I had a traumatic call that caused me to second guess myself, caused me to, you know, have some of the PTSD and The doctor literally called me at two o'clock in the morning. My top, my med control doctor called me at two in the morning and like, Hey Chris, how you doing? How's everything holding up? You know, it's not hard for management to be human. It's not, it's not like a lot of us are asking for a million dollars or anything like that. If management would, as you said, take care of their people, even in the smallest ways, just a simple phone call like that. Doctor called me. That makes such a difference in the minds of the parabetics and the minds of the entire company that, hey, look, leadership standing behind me, leadership cares. And that creates that whole, let me go improve myself, let me go to college, let me make this company better because this company cares about me, I care about this company. speaker-1: The challenge, the challenges you're 100 % right. The challenge is that most leaders don't know what they're doing. they're running scared of the hospital. They're running scared of their supervision. They're running scared of county commission. They're running scared of... So rather than making decisions and advocating for the employee, they just do what they're told by their higher ups without ever second guessing what they're told to do. It can be the worst decision in the world. And I've seen some pretty bad decisions, but run with it just because that's what they were told to do. They don't have the ability. And this is where college comes into play. They don't have the ability to critically analyze this initiative that they're being told to implement and look at what impact it's going to have on the employee. What impact it's going to have on turnover, what impact it's going to have on cost, what impact it's going to have on the organization, what impact it's going to have on. the system because college teaches you how to go through and analyze those systems and those processes and teaches you to look at what the outcomes are going to potentially be. And that's one of the biggest problems is that, these initiatives get implemented, but they're never measured in any way. So we just do what we're told to do without analyzing what the outcome is. You know, there are going to be times where as a leader, you've got to implement something because you've pushed back and they've said, you're going to do this or we're going to fire you. Okay. So you do it, but you come to this understanding of let's do it for three months or six months or a year. And then let's come back and analyze what the outcome of this, you know, initiative is going to be. Because if this initiative isn't producing the desired results, why are we going to keep doing it? We need to stop doing stuff that's stupid. And we need to start doing more of the things that work. speaker-0: Right. And that's key is, like you said, we need to stop the BS in the end is my best way to say it. Because there is no need for second guessing your people. There's no need for, I'm trying to think of the proper way to say this, there's no need to belittle your people that are under you in front of everyone else or berate them. mentality, you kind of spoke on it minute ago, the whole mentality of correcting people because they don't want to do it a certain way, it should not be a public event. It should be in private, in my opinion. speaker-1: And there's no, there's no reason to be a little or berate anybody anytime ever. But you, that's not the way that you treat people. Right. ⁓ but the, fact of the matter is, is, you know, I'll give you a good, for example, and anybody who's worked in EMS can understand this. I've worked with EMTs who come and say, Hey, this paramedic ran this call this way. How would you have done it? Well, based on what you're telling me, I probably would have done things a little bit differently. However, I'm not in a position to say this paramedic was wrong because the decisions that that person made on that call were made with the best information available at that time. So you and I may run a call totally differently. I may tube somebody, you may not. Maybe that's because I think they need it and you don't. Maybe that's because I'm more confident and you're not. Who knows? It doesn't matter. As long as we both got to the patient to the hospital alive, that's what matters. That's the key. And when When we start nitpicking each other, one of the respondents in the ⁓ research that I did said paramedics are offering QAs on each other. And what's happening is if you like me, I get a good QA. If I don't like you, you get a bad QA. We gotta cut that crap out, man. We gotta stop eating our young. You go into these Facebook groups and stuff like that. I avoid them. I don't go in them. I don't read EMS-1. I don't read GEMS. EMS-1 is... They cycle the same five articles all the time. You asked about 24 hour shifts. They posted an article one time and they're like, does 24 hour shifts lead to fatigue? Well, duh, we know that, right? But the problem was they listed five different accidents that occurred. three of the five accidents occurred during the daytime and four of five occurred on trucks that worked 12 hour shifts. So you're trying to jam on 24 hour shifts and you did a very poor job because 80 % of the traffic accidents occurred during 12 hour shifts. Should we stop running lights and sirens? Well, by and large, yeah. mean, you know, there's no read. speaker-0: That's no correlation there. speaker-1: There's no reason on a lift assist we're running lights and sirens. Well, what if there are cardiac arrest? They're not they told you they felt right? Like, if we don't know what's going on, if it's a chest pain, if it's weakness on one side, if it's a traumatic event, if it's a pediatric, if it's a you know, we even an unknown, hey, we don't know we can just hear him breathing in the background. Heck yeah, light that sucker up and get there as quick as you can. That's when 45 seconds. 60 seconds, a minute and a half. That's when it does make a difference, right? ⁓ But, you know, even with lights and sirens, when seconds count, we'll be there in a few minutes. so he but running lights and sirens to lift assist just to meet, you know, some type of ⁓ arbitrary contractual agreement, you're putting your people in danger and you're putting the people on the road in danger. But he but but EMS one cycles through should we run lights and sirens? Should we stop giving epi and cardiac arrest? Should we do this? Should we do this? Should we do that? And it's like, yeah, y'all don't even know how to read research guys. There was, should we stop using epi and a cardiac arrest? Well, neurological outcome isn't improved any. You're right. It's not, but you know what? You get rosk a lot more with epi. so let's do a little bit of math. You get a hundred people and you get rosk because you used epi and you get 5 % come out with, you know, positive neurological results, that's five people you just saved. You get 10 people and cardiac arrest. or you get 100 people in cardiac arrest and you don't give epi only 10 of those get rosk. So guess what? You killed people. Yep. So a lot of the a lot of the things that are even on on these these trade websites, these journals and stuff like that I changed the way that I did cardiac arrests. ⁓ Back in 2014 or 2015, I read a piece of research that came out that said, if you get epi before an advanced airway, you're more likely to survive. than if you get airway before ⁓ EPI. speaker-0: Makes sense, actually. speaker-1: That made sense to me. And I grew up in a system where it was airway, airway, airway, airway. We tube everybody, right? ⁓ And I still tube cardiac arrest. They took out tubes. No, you need to get an eye gel. That's great. If you're in advanced, that's great. If you're on a basic truck, if you're a paramedic, you need to isolate the airway because it doesn't do any good to get them back and kill them because of aspiration pneumonia, isolate the airway, intubate that patient. So I'm a big fan of intubation, but get that EPI on board first. You can use OPA BBM, hit the IO, administer the medication. That's another big argument. Well, should we do IV or should we do IO? IO is quicker, do the IO. Because even though people respond to EPI quicker, if you start an IV, you're doing an IV on a person with no blood pressure. You're doing an IV on someone who's sick anyway. You're doing an IV on somebody with poor vasculature. By the time you actually find a vein and are able to establish an IO, and that's if a firefighter hadn't kicked your IV bag in the process, right? By the time you're able to find this IV, you could have already had the IO and the EPI on board. Yep. So. You get on scene, you start CPR immediately, you put the pads on, you drill the IO, you pop them with the first epi, you analyze the rhythm. You need to shock them, shock them, pop them with amiodarone, go to your next epi, move over to the airway. Yeah. It's like, but, but even the people who are running these major EMS organizations and that are speaking at these national EMS conferences don't have a freaking clue. They don't know how to read research, you know? ⁓ I've got a master's degree in marketing. Great. We'll let you handle the advertising for the event. Let someone else speak. speaker-0: I love it. So about to wrap this all up. But before we wrap up, I want to make sure people know where to find you just so, you know, this case, I'm going to reach out to you. ⁓ speaker-1: You Well, ⁓ my email address is medic judd. ⁓ E D I C J U D D at gmail.com. ⁓ I mentioned earlier that I don't use my paramedic Facebook page anymore. ⁓ let me rephrase that much. I still use it. ⁓ but that's paramedic Judd. ⁓ or if you want quail, cause remember I'm trying to get out of this thing. It's on Facebook and, I'm to help you out, but I am seriously. Chris, I'm available anytime. speaker-0: Do you ship your quail nationwide? speaker-1: I ship hatching eggs nationwide. I ship hatching eggs nationwide. started a poultry swap. run a town of 300 people on Saturdays. The population of the town more than doubles. ⁓ So we've got a small poultry swap in town. I raise quail for meat and eggs. ⁓ I ship hatching eggs nationwide. It's a lot of fun. any of you guys who are like... ⁓ Doomsday prepper, zombie apocalypse types. If you want a renewable food source, highly recommend quail. You can process a quail in about two minutes, throw it in the crock pot, three hours later you got supper. ⁓ It's fantastic thing. speaker-0: I don't know they're that quick to slaughter. speaker-1: ⁓ yeah. ⁓ yeah. Easy. Easy. It's great. So, ⁓ but if you don't like meat for food, then probably not, probably not going to be your jam. ⁓ I had some vegans slip into my Facebook page the other day, which was fantastic because it increased monetization. ⁓ but, and I don't even argue with the vegans. I let all my followers handle that visibility and then I make a lot of money. But, anyway, yeah, if anybody ever wants to reach out, I'm always available. ⁓ my phone number is published on my, on my, ⁓ Judd's Quail Facebook page, email. You can reach out Facebook. You can reach out, you know, all the time. ⁓ and, and this, this also applies Chris to anybody who is struggling. ⁓ I know your focus, ⁓ very heavily on PTSD, ⁓ and things like that. Again, I haven't gone through PTSD. I've never experienced PTSD, but I was married to a wife that had PTSD. ⁓ so I am very familiar with it. ⁓ I'd rather, I would rather sit with you and speak to you in your darkness than see you at your funeral. ⁓ So, ⁓ you know, if anybody's ever having a rough go of things, they need someone to talk to. I'm a paramedic. I'm not the most sympathetic person in the world. ⁓ But like I said, I've seen people who develop PTSD in school. I've seen people blow their brains out after a year. There's no sense in that, right? We get in this field to help each other, but we can't help ourselves. ⁓ It's unfortunate. I don't think we're prepared for the things that we're going to see. I know what a three year old in the grill of a Buick looks like. ⁓ You know, I know what a child that's laid in a crib and been eaten by roaches looks like. ⁓ I know what it looks like when you ⁓ commit suicide by running your ⁓ car into the back of a citrus tractor. know, it like this is this is a career field where you just can't be prepared for the things that you see until you see it. Right. ⁓ It's normal people don't see decapitated bodies. Normal people don't see dead babies. ⁓ and we're hideously unprepared for that. So I am always ready to help somebody in a time of need. ⁓ it's a tough job. ⁓ but you know, and reaching out isn't weakness and any conversation ever had with me at any time and is 100 % completely confidential. ⁓ I'm not going to tell anyone that we ever spoke, you know, but I am more than happy to sit down and talk to somebody if they ever need help. That brings speaker-0: Maybe one more point, but I forgot to bring up earlier. ⁓ As you said, lot of earlier ⁓ leadership issues, one I see a lot is the reaching out for help and the scarcity, I would say, people losing their jobs to reach out. the scarcity of reaching out and, hey, I do need help. Hey, I have… issues ⁓ with my brain or my mind or my thoughts or emotions, how or why would you tell a leadership to fix that? speaker-1: First thing I'm gonna tell leaders is your supervisors need to be off the ambulance. If you run an EMS agency and your supervisors are on a truck, that is the absolute most ridiculous thing ever. They cannot run 911 calls and supervise your agency, period. Number two, there needs to be a 24 hour supervisor at every single ambulance station in the country. They need to have a Sprinter truck and they need to be able to respond to emergencies. That may be different in some of the Uber rule areas, but generally speaking, If you're in a county agency or a fire agency or something like that, you need to have somebody ⁓ who's got an SUV or a pickup truck and they're able to help respond to calls. They need to be able to go out. You know, a lot of these, a lot of these issues with PTSD and, anxiety and depression and things like that could be mitigated at the very, very beginning. If Graham felt like he held had help on scene, if Chris felt like he had help on scene, if we weren't in it completely alone. If we had people to bounce ideas off of, if we ⁓ were able to expedite the extrication process, if we were able to make better ⁓ transport decisions, things like that. And that's what supervisors need to be available for. We could limit a lot of the PTSD just by having a supervisor available to help us. Excuse me, respond to these critical calls. Second, some counties are very, very big. especially out West, you've got massive counties. There's no way they could make it to the call on time, but they can make it to the hospital. They can make it to the landing zone and there needs to be an immediate debriefing. an hour later, not a week later, not a day later, not in between calls. Shut that truck down, debrief your employees. then follow up with them a week later, then follow them up with a month later, then follow up with them six months later and keep an eye on that person, right? Do you have a star employee who's never missed a single day and suddenly they're calling out every other month, every other week? Do you have someone who comes in, they're always rosy, chippy, happy, and the next thing you know, they're coming in and they haven't combed their hair and they haven't taken a shower and they smell like last night's ⁓ kegger? know, we've got... We've got to have supervisors who available for that. then organizations, county agencies, private agencies need to have an EAP and employee assistance program and encourage people to reach out. If not mandate that your employees reach out. And I'm not talking about running a cardiac arrest at a nursing home, right? Like old people diets, what they do. But when we run that pediatric, when we run that, you know, speaker-0: Right. speaker-1: ⁓ vehicle versus bicycle. When we run that vehicle versus motorcycle, when we run our own family, when we run our own friends, right? ⁓ Those are the things that we need to ⁓ have that EAP for. And we need to make sure that, know, drownings, know, incinerations, things like that. Those are calls that we don't get every day and they have the ability to really, really, really impact ⁓ the paramedic and the EMT running that call mandate that those people are reaching out mandate that those people see, you know, a lot of, a lot of the counties that you've got county health departments, you've got psychiatrists, psychologists, you know, things like that, make your employees go. They, you know, they, need to, and don't get me wrong. There's a lot of calls in my career where they, would have made me go and quite frankly, I didn't want to, didn't need to, right. You know, I, I, Firmly recognize that I am a totally different breed of person. grew up in a law enforcement household. I've seen the worst of the worst, you know, ⁓ growing up, remember my, my dad used to teach a college class in law enforcement. And I remember at six, seven, eight years old, I found a book called gunshot wounds. And I thumbed through that sucker, you know, looking at all the different types of guns and the different types of wounds and the burn marks and all of this and, you know, busted open heads and stuff. But I mean. If you walk into a scene and somebody's blown their face off with a shotgun and their mustache is stuck on the wall behind them, that's not something that we're supposed to see. But there's a reason why EMS has the highest rate of suicide of all public safety careers. And it's because we're poorly managed. all falls. Everything falls back in leadership. You know, and, like you said, some of these issues are complicated. Some of these issues do take a long time. speaker-0: Yep. speaker-1: But contracting with an EAP program, contracting with a community psychiatrist, contracting with a community psychologist, that shouldn't be a difficult thing. You know, and, and we've got to do a better job. Educators, we've got to do a better job preparing ⁓ our students for what they're going to see. When I was teaching, I ran a college program. was college program director in Nebraska. When I taught every single class started. with a video and it's an old video. It was put out on Vimeo, but it's called The Things We See. And I played that video at the beginning of every class because I wanted to remind people that, you know, even though most of our calls are, you know, hadn't pooped in three days, been sick for five days, don't feel goods, we do run these vehicle explosions. We run warehouse explosions. We run... ⁓ complicated pregnancies, we run surgical cryothyrotomy, we run plural decompressions, we train really, really, really heavy on that, but we don't see it a lot. Right. And the first time that, you know, the first time I ever did a plural decompression, man, I was, I was messing my pants, because I'm like, are his lung sounds really decreased? I mean, it kind of sounds like it, but what if, what if they're not? speaker-0: right. speaker-1: Oh, well, stuck him anyway, because I thought his lung sounds were decreased, you know, but so, and I'll be honest, I didn't do my first plural decompression until I'd been in the career field 11 years. It took me 17 years as a paramedic before I ever completed every single skill on that checklist, right? Before I ever did a surgical crank, before I ever delivered a baby, before. Weird thing was I delivered my first baby and ended up doing three within six months. But before I delivered a baby, ⁓ before I ever did a cry, before I ever did a plural decompression, before I ever did a cardioversion, before I ever did a transcutaneous pacing, like, and the problem is, is we don't focus enough on these low frequency skills. And we should, you know, and then, you know, how many times in people listening, I'm sure they've been through this experience where speaker-0: Right. speaker-1: the company changes equipment. learned how to do ⁓ femur fractures on a ⁓ traction splint, hair traction splint. Then I went to work for an agency. They threw me on the truck. We got a femur fracture and guess what they have? A Sager splint. Well, I'll be darned. Then I go to work for another agency and they've got some tent pole thing that you use. speaker-0: I hate that one. speaker-1: It works really good though. I I it out, but it does work really good. speaker-0: No, it works good. Just the first time you use it, it's like, wait, what is this thing? How do I use it? What is this? Where does this go? What is this? What? speaker-1: Right. But the point is, you know, we've got to train, we've got to practice, we've got to, ⁓ we've got to focus more as leaders. And I say, I'm not even a leader right now. Right now I'm tucked away in the corner of the county doing my own thing and ignoring everybody else. But what leaders have to do is they have to make an effort to increase the amount of training. And I understand this takes money. I get it. but you're going to get back what you invest. And I don't remember the exact statistic, but it's something like 300 % more expensive to hire a person than it is to keep somebody. And my agency at one point in time had a 300 % turnover on supervisors. Nevermind the frontline staff. So, you know, there's work to be done. But the research is out there. The data is out there. Let me differentiate between research and Google, right? Google is not research. People are like, I did my own research. No, you did a Google search. Vastly different, right? And I know we know that because we've picked up patients who have done their own research, right? I'm talking peer-reviewed academic literature that has gone through the rigor of the academic process. And the reason is, is this research does things that like a Google search doesn't like controls for variables, right? Does statistical regression. speaker-0: of MD. speaker-1: takes this ⁓ data and applies it to different situations and different scenarios to achieve different outcomes. We've got to do real research to determine the best way to pay our employees to give benefits, to provide psychological care, to provide ⁓ physical care, healthcare, rehabilitation for back injuries, things like that. You have to have people in leadership positions who are capable of doing it. Right. Because if you're going off the headline on the EMS one article, you're, already getting bad information, you know, so there's, there's a lot of things and I've been doing this a long time. They pulled lidocaine out of the 2010 AHA recommendations through an amiodarone and guess what's coming back lidocaine. Yep. Why? Cause it works. Always did. we've gone to hands on only CPR, which don't get me wrong. I think for the general public, that's a good thing. ⁓ But we're talking about pulling intubation out of the field. We don't need to pull intubation, we need to train our paramedics better. The requirement right now to graduate from a paramedic program is five innovations on a dummy. Wow. Or at least that's what it was when I was teaching. Five intubations on a dummy. speaker-0: I think when I did it, we weren't allowed to it on a, we were allowed to do it on the dummy for I think five or six times. And we had to have I think 15 or 20 on a live person or not live, but on a person. speaker-1: Right. Partner with your local hospital, send employees into the OR, let them work with anesthesia, let them do innovations in there. You know, let them see the difference between a MAC, let them see the difference between a Miller. Moreover, why don't we send our paramedics who are already in the field to the OR once a year and have them do some innovations? know, when you administer a paramedic, when you drop ROC, when you drop SUX, when you drop VEC, any of those things, you have 100 % assumed control for those airways. I love superglottics. think they're great. I love an eye gel. It's a fantastic tool. I combi tubes. I love an eye gel. ⁓ But we've also got to be cognizant of the fact that when you use an eye gel, when you use an air cue, when you use a combi tube, you're not isolating the trachea. there's still the opportunity for aspiration pneumonia. If you're a paramedic and you're not comfortable intubating, you need to get some training. You need to, you need to be able to drop that tube on any patient at any time. And if you can't, you need to do a surgical crank. And if you're not confident doing a surgical crank, go find you a set of pig lungs. know, true hog farm, give you the trachea, the lungs and everything. And you can practice your surgical cranks, sit there, palpate on yourself, reach over to your partner. Poke on their throat. Maybe not when they're driving, but you know, reach over, poke on their throat, feel those landmarks, you know, check it out on, on. You know, people that are bigger than you, people that are smaller than you, women are a little bit different because they don't have the, you know, pronounced hyoid bones. So, you know, it's, it's the solutions are out there. Need leaders with the fortitude to implement those solutions as opposed to leaders who simply acquiesce to the demands of the hospital or the county commission. Or acquiesce to the demands of upper management. speaker-0: very true. speaker-1: You know, there becomes a time where you get so distanced from ⁓ the field that the problems in the field are not your problems, right? Leaders only address problems when they become their problems. And then you end up writing an incident report and peeing in a cup. Leaders need to start addressing problems before they become problems. There needs to be a proactive approach to solving problems within the EMS community and the data is out there. And there's not a ton of data related to EMS. but there is an absolute ton of data related to nursing and a ton of data related to ⁓ emergency rooms and things like that. For now, we need to extrapolate what we can from the research on nursing in emergency rooms. Moreover, we need dedicated academics who are committed to researching problems that are specific to EMS. speaker-0: Very true. it's again, there's that whole debacle between nurses versus medics and all that. We are on the same field. We all deal with the same things in the end. ⁓ So we can learn from the doctors. We can learn from the nurses and their rates are just like ours. You know, they have PTSD. They have all the symptoms we have, all the diseases that we get. They are just like us. They just have a more controlled environment. speaker-1: I think what they fail to understand though is, know, on a 911 call, I am the emergency room doctor. I am the neurologist. am the cardiologist. I am the respiratory therapist. I am the nurse. I am the tech, you know? And so, you know, working a code in a hospital is vastly, vastly different than working a code on the floor of a single wide trailer covered in dog crap with no lights. In the bathroom. Yeah, in the bathroom. So I think that, you know, it's, very different than working a cardiac arrest and you discover their firearms sitting all over the room or there are knives or swords or whatever the case. And you've got 17 people who are watching you perform this cardiac arrest. ⁓ you know, it's, it's just a vastly different scenario. And, know, the, the, the debate between nurses and EMS is not a matter of you know, who's a better clinician or who's better educated or who makes more money. Look, there's stuff nurses know that I don't, don't know crap about most of the lab values. You know, I don't do ABGs. I don't do CBCs. don't do, you know, I don't know how those things interrelate. mean, I took an anatomy and physiology class and I took paramedic, ⁓ a paramedic course in high school chemistry. But I mean, I don't know how all of those things ⁓ correlate and, how those ⁓ I don't understand how those necessarily matter in the continuum of care. On the other hand, nurses don't understand the situations that we're faced with, right? Nurses don't understand what it's like trying to manage the airway on a person who's got a blood pressure of 50 over 30, and I have no protocols for a push dose presser. know, so, you know, in a hospital, ⁓ that's 50 over 30 push dose presser, RSI, they've got a tube. Great. I could do that in the field. I don't have the protocols for right? I could accidentally leave the Lima Fed running, you know, but again, I don't I don't have unlimited in what I can do not necessarily my scope of practice, but my protocol. There's a lot of people listening to this going man, I wish I had RSI. I wish you did too. It's a great, great tool. need more traumatic head injuries, you need it for respiratory distress, you need it for ⁓ quite frankly, sometimes you need it for combative patients, right? ⁓ Sometimes there is absolutely no way to control a person who is in danger of harming themselves and others, but to take that airway. And so, you know, it needs to be in the field. Versed, sometimes it's a good drug, but let's face it, you're not knocking somebody out to innovate with Versed. No. You know, you're just not. When my wife had her wisdom teeth removed, they gave her 11 milligrams of Versed to sedate her. walked in the room. She looked up and said, Hey baby. Yep. So, you know, the, verse head's not going to cut it. You know, we've got to have. I prefer a Tom it's what I started with is what I grew up with. I also like sucks because I do like the short half-life on the sucks downside to sucks is the short half-life, right? Upside to sucks is if it is a complicated airway, they're going to get their airway back in a few minutes, but you know, let's do, let's do a Tom it eight. Let's do rock. Let's do VEC. Let's do sucks. Let's do. um, continuing sedation either with fentanyl or with a propofol or whatever we have available to us, but telling us, give them 50 a fentanyl and five a verset. Really? It's not going to work. I worked in an agency that didn't have RSI one time. My partner's like, Oh man, should we go? I'm like, nah, give them a They passed out. I'm like, all right, now let's tube them. I didn't have any option. They wouldn't keep a mask on. You know, they were, they were frantic. They were diaphoretic. They were, couldn't see pap. couldn't non-rebreather. couldn't nothing because they, they, they were so anxious about the respiratory distress. I didn't have RSI. The option was blow by oxygen until they passed out. Then I do them. So, you know, the, the, doesn't need to be a fight. Right. We don't have the same jobs, just like firefighters in the EMTs don't have the same job. Sorry, guys. If you fight fire, you're a firefighter. Right. speaker-0: True. speaker-1: Your job now exists because you run medical calls. ⁓ Firefighting in EMS is not the same job, just like firefighting in law enforcement in the same job, right? Firefighters, fire departments shouldn't oversee EMS agencies, just like fire departments shouldn't oversee law enforcement agencies, right? You can't just strap a gun on a fireman and be like, hey, look, it's a cop. can't give them a little laryngoscope and be like, hey, look, it's an EMT. That's not how it works. We have different jobs, we have different functions, but we all work together. I love my firefighters. I do. I enjoy working with the fire departments. ⁓ I enjoy working with law enforcement. I enjoy working with the hospital. We don't do the same jobs. that's, and this intermingling or co-mingling or whatever that they've tried to do, it's not based in the public interest of the community. It's all based on public safety. They swore up and down one agency I worked for that if we merged with the fire department, it would be more efficient. We merged with the fire department, they cut two ambulances. The time on scene increased, the time at the hospital increased, the total out of service time for the ambulance has increased. Why? Because firemen didn't want to be on the ambulance. You know, I mean, that was just the bottom line. Firemen want to work on the engine and they want to fight fire. That's great. We should do that. But you shouldn't have a fire station with more apparatus than firemen either. You know? When a fire department controls EMS, if they've got an option to buy a new ladder truck or a new ambulance, guess what they're getting. Yeah. So, you know, there's a lot of things that need to be corrected. There's nobody with the fortitude to attempt to correct those issues. I'm not going to be the person to do it on my own. I'm going to sell quail. speaker-0: Later. Alright man, well I appreciate it. It was a very good episode today. If you think it's too heavy to say, say it anyway. It beats a eulogy. You don't have to apologize for surviving however you can. You're not the reason things are heavy. You're the reason they're still moving. Need support right now? Reach out to me. Reach out to somebody. Text or call 988 or visit 988lifeline.org. You're not alone. Not in this job. Not in this fight. Want to share your story or connect? Visit critical-run.com or message the Facebook page, Dispatched and Dysfunctional. We're building this for you, for them, for all of us.