KCM1 Video

[RocketMedic]

Lets see...I saw plenty of ineffective manual compressions, gastric distension, questionable invasive venous access, old equipment lacking power cots and autopulses, a tiered system discussing how low-priority calls are turfed with no further discussion of them and an educational system that seems to be first-rate until you realize that it boils down to thirty-five years of tradition unimpeded by progress.

Why would I move there?

 

[Ecgg]

Lets see...I saw plenty of ineffective manual compressions, gastric distension, questionable invasive venous access, old equipment lacking power cots and autopulses, a tiered system discussing how low-priority calls are turfed with no further discussion of them and an educational system that seems to be first-rate until you realize that it boils down to thirty-five years of tradition unimpeded by progress.

Why would I move there?

To do all that while wearing a cool tactical bullet proof vest that has MEDIC 1 in big bold letters!

 

[Summit]

Did their medical director see this crap before they showed the world?

 

[KingCountyMedic]

Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs.

We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest.

I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.

I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.

 

[Christopher]

Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs.

Is the rate of CLABSI tracked explicitly?

We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest.

Any chance you could find out why your rigs don't have them? I've never seen one without one (besides old Cadillac ambulances) and I'm intrigued that they are left out.

Human performance issues are a big deal in my day job, and it seems like this is a useful omission in some respects.

I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.

I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.

The responses have certainly been off-putting.

I find KCM1 to be top tier mostly due to how rigorously performance is tracked. If you're not measuring your system, it is hard to know just how well it is performing. I can't say I necessarily agree with all of the system implementation details, but I can certainly say you work at one of the few services which actually seems to know, "how it is doing."

If you could address the cameras bit I'd be very interested to know if they were there simply for filming, or if they exist for QA/QI in the long run.

 

[medicdan]

Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs.

We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest.

I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.

I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.

We thank you for sharing this video, but with all due respect, I think the "rude" comments shared were all productive, raising legitimate questions about how you operate, not primarily to question your actions, but wonder aloud why they haven't been implemented elsewhere (or are performed differently elsewhere), and whether they are actually associated with any improved outcomes (central lines, for example). We are all aware of the impressive public relations and statistics related to cardiac arrest survival, but wonder about the effectiveness of the service in other measures.
I think some legitimate questions were asked, and while you may not be able to answer them, we'll keep searching for explinations.

Again, thanks for the video, and I hope you don't confuse productive questioning with rudeness.

 

[chaz90]

Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs.

We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest.

I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.

I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.

I think we really are trying to be measured in our response to the video and not completely tear apart your system. Like I said before, I think there are some things KCM1 does extremely well. As far as "cool stuff" goes though, shouldn't we be trying to recruit people based on EMS realities rather than myths? Our average day doesn't involve a surgical cric, cardiac arrest save, or incredible rescue with multiple patients involved and good outcomes all around. Let's make recruitment videos that find people that want to start this profession for the right reasons. We can do plenty of which we can be proud, even if we don't save lives everyday. I think this is the reason some on here have had these reactions to your video.

Our focus should be more on the service aspects of our job that can make a difference in one person's life. Let's say Grandma fell and broke her hip. She would probably survive being rolled on a background and transported emergently with high flow oxygen, but paramedic promotional videos could focus on how much better that transport and cara can be by initially managing her pain with IN Fentanyl prior to movement, quality stabilization of the affected limb, and comfortable transport with repeated dosing of pain management as needed.

Most comments have brought up legitimate concerns with aspects of your system. You can be proud of your place of employment but still able to recognize flaws and ways you can improve.

 

[Summit]

Don't confuse critical analysis instead of compulsary bowing towards "Mecca" as rudeness.

 

[NomadicMedic]

I don't think it's particularly rude, I think some of the content of this video is questionable, and you may be a little close to it. Nobody wants to hear that their baby is ugly. I also think that the mystique of King County medic one supersedes the reality. There's no such thing as a perfect service, where I work is far from perfect… We have a lot of issues and I'm sure if King County medics came and rode with my system, they would say "what the hell is this mess!"

However, bragging about the fact that you can push paralytics and perform central lines is really not what I would hang my hat on. I know that all of the other counties surrounding King County can do the same thing. Snohomish County? RSI. Jefferson County? RSI. Pierce County? RSI. Grays Harbor County? RSI. Thurston County? RSI.
And most of those services, if not all, have removed central lines in favor of the IO.

But King County medic one paramedics go through all that schooling! Great point, I think that most paramedics should have the exposure to the patients that King County paramedics get while in the program. I don't think anybody would ever question the amount of education that King County paramedics are exposed to. However, making all new hires go to the paramedic program seems ludicrous. A six-week refresher/review? Maybe.

But bragging about the fact you get to "talk to the doc on the radio and present your case?" Come on man. Unless we're calling for orders for RSI or something off the page… Our docs don't want to be bothered.

Amazing cardiac arrest survival rates? Utstein for Sussex County is 52%. Utstien with bystander CPR is 54%. I think that's pretty comparable to most of the "progressive" EMS agencies. So maybe Seattle isn't the best place to have a heart attack anymore?

If you really want to recruit great medics, talk to me about the pay. Talk about the retirement. Talk about the equipment. Talk about the Continuing education. Talk about the research opportunities.

If it's just a flash piece to get Sparky new paramedics to apply at Public Safety testing, then you did a great job. If you really want to recruit paramedics from other systems, tell us about the salary versus cost-of-living, the availability of affordable real estate, the green community that makes up King County… There's a lot of great things about the Pacific Northwest. The fact that you guys do RSI and central lines isn't the biggest one. Talk about the things that would make me want to move (back) to King County.

 

[VFlutter]

Is the rate of CLABSI tracked explicitly?

I would assume not since they are all pulled in the ER.

After seeing that video I would be very interested to see line cultures after they removed them.

I totally understand you can not be 100% sterile in emergent situations but it does not take that much time to throw on a mask and a pair of sterile gloves.

 

[RocketMedic]

I should hope that they are only being done in extremis...precautionary central lines sound like the start of a nightmare.

Wheres your power cots? What about your c-spine? Exactly what do you have to call in for, as opposed to standing orders? Can you medicate falls, or do you never see them?

 

[46Young]

This is a recruitment video. Its purpose is to highlight the most desirable attributes of the organization to a prospective employee. What do medics typically complain about? They complain about pay, working conditions, scope of practice, not seeing enough sick patients wither due to being in an all-ALS system, or a rural area, lack of training, and turnover.

In the video, a medic stated that he's paid well. It was stated that their medics typically stay 20+ years (I don't remember the exact number). A medic said that he used to run five cardiac arrests a year, and that he had at least that many in his first month at KCMO (this is a reversal of me leaving NYC for Charleston and later NOVA BTW), it was stated that the work environment was desirable, some features of their scope of practice, such as RSI and central lines, were selected to imply that they do everything else up to those relatively rare interventions.

The recruitment video was basically a hiring commercial. Certain aspects are highlighted, and others are purposefully omitted. It was effective to that end, IMO. What's the problem?

 

[46Young]

That's one of the idiosyncrasies of this forum. In much of the EMS community, Medic One is seen as the Mecca for US ALS care. On EMTLife however, we seem to have gone the complete opposite direction and sometimes seem to criticize them overly harshly. No system is perfect, and I think we react to the perception that they are by some providers. In truth, I think they do some things really well and fall short in others, just like all of us. I like their emphasis on education, can understand their desire to have some consistency in background, and think they do the best job of effective PR of any EMS system. At the same time, I agree (from an outside perspective) that they seem to put too much emphasis on a narrow subset of cardiac arrests and may have a system bias towards BLSing less than glamorous calls that should be ALS.

Envy is probably to blame. When talking about desirable EMS employers, very few places are mentioned. KCMO is consistently one of them. If the worst they can get dinged for is gloves and cardiac arrest save criteria, then they're doing better than pretty much everyone else. Just sayin'

The EMS workplace can be a cut throat, back stabbing place. I'm seeing some of the same behavior patterns when people try to nit pick and deride (as said previously, there's a more proper way to question the video's content) a system that's probably #1 single role EMS employer in the country to work for, if not at least in the top 5.

 

[Aidey]

I don't think it is envy. If you look at the people who are critical of the system they tend to be people with first hand knowledge of it, or who know people with first hand knowledge.

I don't think very many people are disagreeing that it is good to be employed by KCM1. But that doesn't mean the system doesn't have major issues. People can work for an agency with a good schedule, good wage, and good benefits that still delivers questionable medical care. I think they do some things right, but I would never ever work there.

 

[46Young]

I don't think it is envy. If you look at the people who are critical of the system they tend to be people with first hand knowledge of it, or who know people with first hand knowledge.

I don't think very many people are disagreeing that it is good to be employed by KCM1. But that doesn't mean the system doesn't have major issues. People can work for an agency with a good schedule, good wage, and good benefits that still delivers questionable medical care. I think they do some things right, but I would never ever work there.

I can agree with you. I just think that it's a strong response to a top-of-the-line department's recruitment video, which is basically an advertisement. Advertising is basically smoke and mirrors. The video is not an accurate depiction of the department's operations, just a sales pitch with certain aspects cherry picked to dazzle the intended audience.

If I were looking for a desirable place to work, this video would make a fairly strong impression on me. The Medical Director talked about the medics taking criticism well, not getting offended, etc. I took it as their medics don't have egos, and are interested in QI. The lengthy educational period isn't a turn off, since I'm on the payroll. I'll shadow doctors all day and pick their brains. The main sells for me are the lack of turnover (implying favorable working conditions), the pay, and the frequent high acuity patients. Bragging about interventions such as RSI and Central lines is a little tacky IMO. Progressive guidelines that facilitate independent thinking (which was addressed in the video) are a solid selling point, not what skills and interventions are available.

I wouldn't want to be busy for 25+ years, though. 15 years then a promotion to supervisor, or placement in a slower station (retirement house).

 

[Aidey]

I took it as their medics don't have egos, and are interested in QI.

Not having an ego with your very involved medical director is smart, but if you want to judge the presence of an ego, don't talk to their superiors, talk to other medics and people they view as inferiors. We're talking about a group that is notorious for blowing off the input and concerns of the EMTs from the private agencies.

 

[46Young]

Not having an ego with your very involved medical director is smart, but if you want to judge the presence of an ego, don't talk to their superiors, talk to other medics and people they view as inferiors. We're talking about a group that is notorious for blowing off the input and concerns of the EMTs from the private agencies.

A quick way to alienate me is to exhibit an elitist attitude. What input and concerns are the KCM1 medics blowing off?

 

[Sublime]

I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.

I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.

The reason your system is getting so much criticism is because of its reputation. King County is world renowned for its cardiac arrest survival rate. This and the fact that you guys are supposed to be one of the most "progressive" systems opens you up for being criticized when posting a video like this.

If you worked for some unheard of system in the middle of nowhere then nobody would be so quick to make judgements or be so curious. It is only natural to question the ones who claim to be the best.

I do believe some legitimate questions were asked, and you really only addressed central line placement. Not that you owe anyone here answers, but when you post something like this I'm sure you expected people to ask questions.

I for one wonder why you guys use central line placement at all, especially in a cardiac arrest. An IO is so much simpler, faster, and involves less risks. Also the hospital pulls it anyway so why even bother!? What are the benefits over an IO?

And can you confirm for me that you guys use CPAP or not? I've heard you don't but that could be a rumor.

 

[Aidey]

A quick way to alienate me is to exhibit an elitist attitude. What input and concerns are the KCM1 medics blowing off?

In an effort to not derail this thread too much, I suggest you read through some of the past threads on KCM1, because I know a lot of examples have been given. The short of it is, they have a history of turfing patients to BLS crews even after the BLS crew says they aren't comfortable with the patient. This includes patients that have been treated, and then had lines yanked so they could be sent in BLS.

 

[RocketMedic]

In an effort to not derail this thread too much, I suggest you read through some of the past threads on KCM1, because I know a lot of examples have been given. The short of it is, they have a history of turfing patients to BLS crews even after the BLS crew says they aren't comfortable with the patient. This includes patients that have been treated, and then had lines yanked so they could be sent in BLS.

Theres been some excellent threads about it. Also, on the video itself, I didnt see anything really earth-shaking and quite a bit thats antiquated (Ferno manual cot).