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Dedication to Customer Service

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How dedicated to serving your public are you? We seem to pay a certain amount of lip service to “serving the public, 24/7, 365″ in our mission statements. I always hear how proud we are to “serve”, but do we draw the line at putting out fires? Carting them to a medical facility? Or are you in an organization who will put someone back in bed or stop a leak until a plumber can get there?

I hear about all-hazards response all the time, but do we draw the line at “hazards”, or do we raise the bar a little? While I don’t advocate anyone in our jurisdiction calling 9-1-1 because they need help completing their tax return, if a situation really does affect our customer that they had to dial that number, aren’t we charged with understanding how this is perceived as an emergency before saying we won’t help?

My wife owns a flooring company. While a floor product delivery may not constitute an emergency issue to you, to her company, when a customer needs a product someplace at sometime, if it isn’t there, it creates issues that may effectively stop the completion of the project, be it a remodel or new construction.  This week, a delivery had to go from the manufacturer directly to the project location in another state.  To the trucking company, excellent customer service was a non-issue: After neglecting to send the materials in a truck with a lift gate, they decided, “Oh well, you’ll just have to wait until we can get a truck to do that later.”  Later being three days later.

They had a pretty blase attitude about the whole thing, despite the fact that they were contracted to deliver something, they had an obligation to deliver it at a certain time and place, and being the subject matter experts on shipping, should have probably realized that they weren’t going to just hand-carry 3900 pounds of product off the truck (especially since they had to use a fork-lift to get it on there). Then to compound the issue, they weren’t very careful about how the product was loaded and they damaged some of the pieces. Again, “Oh, well…”

Dedication to customer service requires a “can do” attitude; it might seem to be outside your scope of practice, but depending on what your marketing strategy happens to be – and make no mistake about it, your mission statement and vision is your marketing strategy when you are fighting for ever-dwindling tax funds or donations – your organization will be faced with very specific situations in which you will have to stretch your resources to “make it happen”.  In our case, we rented a truck, picked up the material from the trucking company and delivered it ourselves.  The customer was completely thrilled.

In my wife’s company, we hope our efforts will be recognized in customer loyalty and a willingness to pass the word on. In emergency services, we hope that the care we take with each challenge is shared loudly when budget time or the annual fundraiser comes around.  You can draw the line where you choose, but in these times of limited funds, can you afford to ignore the added value of extraordinary customer service? It is extra effort that will distance you from the rest of the pack.  When a decision must be made between funding an analysis of the migratory path of earthworms in your community and cutting firefighters, that’s ammo you can’t afford to ignore. The next time you are drooling over your wish list and realizing you can’t afford things, remember the choices you made as to where you drew that customer service line.

Posted by truck6alpha on July 18, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS Topics, Fire Rescue Topics, Firefighter Nation, Firefighting Operations, Funding & Staffing, General, Media Relations, Patient Management, change, customer service, education, fire service, government, leadership, motivation, planning, politics, professionalism, revolution • Tagged: , , , , , , , , , , , , , , , , , , , ,

Risk vs. Reward and Patient Advocacy

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An OLD shot of Savannah's LifeStar landing for a Hilton Head Island F/R medevac.

The SC-TF1 Director copied an article to our command staff that I found interesting.  It ran in Popular Mechanics titled Unacceptable Risk (I couldn’t find a direct URL for it, so here’s the pdf: HelicopterCrash).

Our organization allows paramedics on scene to request a medical helicopter evacuation with a minimum amount of oversight by the medical control physician.  Being a paramedic myself, I know when to call for a flight and when not to.  I am not about to call for a chopper to take a patient to a hospital for a broken foot, and likewise, I am intelligent enough to be able to assess a patient and opt to fly them to a hospital that has the resources to help my critically injured victim.  I am appalled at some of the case histories where someone was flown out for a routine (very routine) injury and consequently, I know of agencies who simply won’t call for a flight, regardless of the need for it.

How bad of a medic must you be that you can’t tell the difference between a potentially life-threatening injury and one that can be transported by ground to a hospital?  If I’ve got an altered patient with a potential head injury, I know they need to go to a trauma center.  So what if I have to go on an out-of-jurisdiction transport to the trauma center- it’s what we do.

Regardless of whether or not the aeromedical evacuation of a patient is risky and may or may not have tangible benefit, the decision must come to this: What do I need to do for the best interest of the patient? I don’t care if you don’t like the way they look, or they stink, or you are tired.  When you became a medical response professional, you probably took an oath that involved a statement like “Above All, Do No Harm”.  Our jobs involve making sure our patients not only get care, but that it is the right care, it is not care that is provided at a huge cost because we were too lazy to do our jobs, and that the patient’s rights are maintained in their treatment and transport to a medical facility (or not).

Just as I wouldn’t make you take a treatment that could possibly kill you in order to cover my ass, ordering a helovac for a finger amputation isn’t in my first line of thought.  And I know I curse and fuss when I DO call for a chopper and a spot of rain on the pilot’s windshield causes them to scrub the mission, but you know what? I’m a big boy- I’d MUCH rather you err on the side of keeping your crew and my patient safe and I’ll deal with the fallout otherwise.  But to just say, “All patients go by air” or much worse, “No patients go by air” is ridiculous.

Maybe like everything else, we need to stop applying a broad brush to a situation and do our jobs, by appropriately assessing our patient, determining their logical needs based on mechanism of injury, observable findings, and our experience, and make a good call as to what to do with them.  If we ca’t do this much, it’s no wonder we continue to have to convince people we aren’t just “ambulance drivers” but real, live, medical professionals.

Posted by truck6alpha on June 28, 2010 • Filed under: "accident prevention", Command & Leadership, EMS Health & Safety, EMS Topics, Fire Rescue Topics, News, Patient Management, Vehicle Operation & Ambulances, customer service, education, leadership, professionalism, rescue, safety • Tagged: , , , , , , , ,

Mixing EMS and The Fire Service

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Two of Hilton Head Island Fire & Rescue's ten advanced life support medic units.

Two of Hilton Head Island Fire & Rescue's ten advanced life support medic units.

When I hear anyone suggest that the merger of fire and EMS is a mistake because “firefighters lack the skills to provide paramedic care”, I am highly insulted.

When I hear the ex-chief of a metropolitan department regretting decisions to bring medical providers and fire services together, I wonder aloud how he can continue to stomach the fact that it isn’t the inmiscible nature of these professions that caused the problem but the culture that the “leaders” of these organizations permitted to continue and encourage.

I admit that I know people with what could be termed the “fire” mentality and those with the “EMS” mentality.  But these individuals seem to be the minority now, rather than the majority.  Fortunately, I work with a lot of people who have the “Fire & EMS” mentality; people who are open to the belief we can do both well, we can exceed at the skills, we can meet our customers’ needs, and we can enjoy the diversity that having two “jobs” rolled into one provides on a daily basis.

I happen to work in an organization that merged fire and EMS together in 1993.  Prior to that, the two fire departments provided first responder service to our community to supplement the response of our local rescue squad.  Ultimately, with the merger, we took all three of these agencies and combined them into an outstanding example of emergency medical service delivery.  EVERY line employee is required to be at the MINIMUM a nationally registered EMT-Basic and of those personnel, over 40 of them are National Registry Paramedics as well.  This doesn’t count each of our chief and administrative officers who were all certified EMTs as well, and also doesn’t count our Training Division officers, who are both NREMT Paramedics as well.  Our organization provides a highly-recognized service to this world-class resort community and has incorporated 12-lead ECG monitoring and interpretation along with telemetry to reinforce our STEMI recognition program, among other programs like Island-wide AED promotion and education, public CPR and First Aid programs, car seat installation, and many, many other efforts.  I honestly work with some of the most outstanding EMS personnel in the nation and I’d be honored to let them work on anyone in my family, which is good, because I live in this community as well.

I have had it with anyone who suggests that EMS should be the exclusive domain of the third-party providers, especially since, with rare exception, a good number of these “non-fire service” providers don’t seem to provide any better of a service than the fire department EMS providers.  In fact, I know that our agency is an excellent EMS provider and is right now striving to be more than just excellent, but to be “state-of-the-art”.  With leaders like Lt. Tom over at the EMS 12-Lead ECG Blog, and Pete at the Star of Life EMS legal blog, we have a very good chance of putting ourselves in the position of being innovators and setters of the gold standard.

I would never suggest that fire-based EMS is the ONLY solution, but there are a few dinosaurs out there who continue to insist that EMS can only be effectively provided by non-fire department providers.  Apparently, stuffing themselves in their too-tight BDUs and hanging out at the local donut shop has occluded some sort of cerebral perfusion.  I hope they are watching carefully as the rest of us, the people who desire to have community-based EMS delivered by competent and caring providers, regardless of agency affiliation, kick them to the curb.

Your agency can only be as good as the personnel you retain; if you continue to recruit people who can’t do the job, the community shouldn’t be surprised if the situation won’t work.  Volunteer or career, you get what you pay for, and if the community doesn’t invest in good training, good equipment, good leadership, and good methods of keeping personnel, they shouldn’t be surprised if all they get is a crappy EMS system.

Posted by truck6alpha on March 20, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS Topics, Fire Rescue Topics, Firefighter Nation, Media Relations, News, Patient Management, change, customer service, fire service, government, leadership, motivation, officership, politics, professionalism, revolution • Tagged: , , , , , , , , , , , ,

Get Your Facts Straight

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DSC00043As usual, Dave Statter is hard at work getting us News from the Beltway, where there always seems like something is going on (it’s a happening place).  In this case, crews were on scene preparing to extricate a patient declared deceased when it was determined that the victim was in fact, alive.  While I was not there, nor are all the facts out there for examination yet, it makes for a very graphic illustration of today’s discussion: What facts may seem to be in evidence right now may not always be accurate, thus the need for continual re-evaluation of your situation.

I’m not advocating continual monitoring of the “pre-hospital dead”, although I would hope that this is a good case for the medically affiliated that we need to insure pulslessness and apnea, and confirm asystole in three leads (and print it).  That is called triangulating your facts and documenting them in the hopes things don’t change later (like the person is actually alive).

No, what I want to discuss is that in all kinds of places where we need to make a decision, even though something appears to be true right now, it might not be in a few minutes, a few hours, or a few days.  Conditions change and regardless of the origin of the facts you hold dear, they might not always be accurate facts.  The response to this ever-changing environment isn’t to throw up your hands in frustration (like my children and firefighters seem to do sometimes), but to re-evaluate your situation and to flex with the new conditions.  There’s a quote attributed to Whitey Ford I heard years ago (and of course, I can’t find my source now) and I have to paraphrase it because I don’t remember it exactly: “Don’t make up your mind about something until the moment you absolutely have to; it may be that by the time for coming to a conclusion occurs, the conditions may have changed.”

People who worked with me closely before I made Chief probably recall my frustration with schedule changes, personnel changes, equipment and apparatus changes that occurred over the course of a shift, often with no warning.  Now as a Chief Officer, I have a different perspective on the situation because I now have to step back and look at “the whole forest”.  I now understand how and why some of those “course changes” have come about and I also see why frustration with those changes is counterproductive.

As firefighters, we deal with changing conditions on scene without too much drama.  We know Murphy is a constant companion and if anything, we are surprised if everything goes RIGHT on a scene.  No incident is “textbook”.  But because we are good at our jobs, we flex with the new situation, understand it, and make whatever we have work.  Why we can’t do that in our daily operations, I guess, is my question.

If there’s anything I know about myself, it’s that I know I am not a patient man.  In fact, I’m probably one of the least patient people I know.  I also know I don’t have a lot of tolerance for less-than-excellent performance.  But part of maturing and growing involves experience, and experience shows us that there are many changing elements that occur over the course of a day, and a life, and reacting to them rather than soaking them in and understanding them (and then solving the problem) isn’t productive.  In fact, it is stressful and irritating to those who we have to live with.

I have a lot of personal growth and understanding to continue working toward and I wish some of this stuff would have been shared with me when I was a firefighter and a young officer, but it wasn’t.  I now have that benefit of experience, though, and it is my responsibility to share it with you all.  Take the time to understand the situation and instead of criticizing, find benefit in the lessons we learn and resolve not to let mistakes happen again, or at least in the environment we personally control.

Get facts before making critical decisions and don’t dwell on them too long, because in many cases, the facts will change before you even get a chance to decide on them.  Take decisive action when necessary, and when not, take considered action, and always, always, continue to re-evaluate the situation. By understanding your surroundings, you will be safer and your life richer for it.

Posted by truck6alpha on January 28, 2010 • Filed under: Command & Leadership, Firefighter Nation, News, Patient Management, Rescues, change, customer service, leadership, officership, planning, professionalism, revolution, safety, training-fire-rescue-topics • Tagged: , , , , , , , , , , , , , , ,