EMS` Dirty Secret

People who make EMS happen are big-time givers who too often don't take what they need out of life. They tend to care for others at the expense of those who love them most.

We got that message again and again from EMS providers who either contacted us in response to Nancy Perry's From the Editor column in the October 2007 issue or answered our calls since that article appeared.

Nancy's column was entitled EMS' Dirty Secret: Are You Paying the Price for Being In EMS? The editorial congratulated EMS Magazine's 2007 award winners, but noted that many of the nominees seemed to be volunteering in addition to working two or three jobs. It speculated about how difficult that must be for families and significant others. And it asked whether we should continue to congratulate ourselves for what appears to be an unhealthy lack of balance. The question was good, and the observation sound enough. Unfortunately, the answers are anything but simple.

HEARTACHE IN THE HEARTLAND
Let's say you're a shift supervisor for a small emergency service in a large geographic area, and tomorrow morning one of your people calls in sick for a shift. You have no way to anticipate the call-in until it occurs--an hour before shift change. You and the offgoing crews are exhausted, and nobody wants to come in on short notice. But we're not talking about building somebody a deck, here--that could wait a day or two. Ambulances need to be staffed, period. What can you do?

No matter how well run they are, small services simply don't have the flexibility of their larger counterparts--especially when it's reduced to the finite whole numbers that make up every schedule. With a little luck, somebody will fill in for at least part of the shift. But when that doesn't happen, supervisors routinely subordinate the rest of their lives and run calls.

That would be bad enough, but there's much more. How do you stay balanced when, despite your limited (or nonexistent) clerical support, you are expected to cope with the endless meetings, public expectations, organizational priorities, inspections, recert deadlines, license renewals, safety issues, customer concerns and personnel matters that are all part of providing EMS? In a small agency, you have two options. You can blow off some of those obligations. Or, you can borrow even more time from the people who share your personal life and free up more time for work. (Of course, if you choose the latter option, you may still fail to meet some obligations.)

Now, imagine a complaint comes in. Or maybe one of your crews has a vehicle failure, collision or injury. Those are all surprise events that demand an immediate response and consume 100% of your attention until they're resolved. If you're blessed with great people, you don't get many surprises. But even the best people make some mistakes.

If you don't have great people, and you can't find or attract them, here's some really bad news: Protecting your own balance may mean relocating your family--or getting out of EMS altogether. The June 2006 Institute of Medicine Crossroads report on EMS acknowledged officially what American EMS practitioners and their leaders have been saying for years: This problem is much bigger than we are.¹ The role of EMS in the United States is underfunded, under-supported and underappreciated--at least until an incident occurs. According to that report, EMS has received precious little of the billions of WMD dollars allocated for our emergency responders since 9/11.² It's like we don't even exist. And there does not seem to be a great likelihood of increasing attention to EMS if we do not force the issue.

This is a time of opportunity for us to do precisely that. As this article is published, a political process is unfolding to elect a new president and impact the makeup of Congress. Considering their historical lack of participation in NAEMT or any political processes, EMTs have never been an active political force. That needs to change immediately.

This article will illustrate a general lack of support for EMS in the United States. It will offer advice from seasoned EMS providers who somehow manage to keep their balance in an unbalanced world. And finally, it will advocate convincing our government's leaders to finally take us seriously--at least as seriously as we take our own responsibilities. It's time they realize that our responsibilities are their responsibilities. That we're serious about taking care of the public. That we're not the fire service's junior varsity, and that it's ludicrous to expect good, professional people to provide good, professional emergency medicine for free.

TROUBLE IN VOLUNTEER-LAND
Jon Montano is furious as he composes a letter to one of his state's legislators. Montano is one of Colorado's 11 regional state trauma coordinators. He's also a working EMT-I in his area, surrounded by 14,000-foot mountains that form the San Luis Valley. It's the highest alpine valley in the world, and its 8,200 square miles of summertime beauty will take your breath away. But during the winter, it's no place for a pileup. Montano's region is home to 48,000 people in six counties, three of which he ranks as the second-, third- and fifth-poorest in the state. Its ambulance coverage comes from 10 agencies, nine of which are all-volunteer. Montano is frustrated over a delayed response to a collision this morning. The winter is mild so far, but the injured occupants of the vehicles still had to wait 44 minutes for help in 19°F temperatures prior to a 30-minute trip over icy roads to a Level 4 trauma center. A 9-1-1 dispatcher tried five times to page the ambulance responsible for this scene before a neighboring unit finally responded.

That would never happen in Beverly Hills or Laguna Beach, but Montano says it happens all the time here. And the truth is, it happens to plenty of ordinary working people all the time in places that aren't wealthy or famous. Nobody keeps national statistics, although the National EMS Information System may facilitate that in the future. But ask EMS providers anywhere in the United States, and they'll nod before you finish your question. The volunteer model is failing. And in rural America, that's the EMS system's lumbar spine. It needs to be fixed, and now.

There are probably no greater citizens than EMS volunteers. In large and small towns all over the world, they willingly set their lives aside and offer their hands and hearts to the folks in their communities anytime, day or night. Challenging the notion of volunteers in EMS is like saying bad things about somebody's mom--it's one of those things you just don't do.

But maybe it's time to ask whether America's volunteers are hurting themselves in their efforts to help others. Maybe they're hurting their own families. Maybe they're hurting others. Maybe...maybe they're even hurting us.

Let's say you're one of those volunteers. That means you depend on some form of income outside of EMS. How would you feel if the government came along one day and asked you to do your regular job for free? That would be a brief conversation. Now, imagine somebody from the government offered to pay you $10 an hour for all the time you've served as a volunteer during the past 10 years. Would you turn them down? Probably not.

Longtime paramedic, author and consultant Mike Taigman has another supposition. Imagine you're the only CPA in your little town. You don't get rich financially, but you do a good job for people and you have enough business to support your family. Now imagine somebody moves into a home across the street from you and puts up a sign that says CPA: Accounting Services, Free. Would that hurt you? Of course it would. It would put you right out of business.

Think about it. Diesel mechanics don't do what they do for free. Architects don't, and neither do plumbers or airline pilots. Nor do the people who drive those truckloads of oranges from Florida to Minnesota. Members of Congress wouldn't even dream of it. Why do we? The answer: because we always have. The basic emergency medicine in our rural communities we leave to volunteers. We haven't itched, so Congress hasn't scratched.

Long before Americans conceived the Internet, telephone, automobile or even a national identity, volunteers routinely stepped in to address the needs of their evolving communities. Even the fledgling Continental Army depended heavily on local volunteer militias. The option of using volunteers was a natural one in the early days of EMS. But EMS evolved in a time of relative prosperity, when most homes subsisted on single incomes. You resorted to a second income when you wanted to buy a boat or build an addition on your house or put your kids through college.

Those days are past. Having two incomes has become a necessity for most families, and multiple-occupancy homes have become a widespread phenomenon. Rank-and-file wage-earners lead a fragile existence today, one illness away from bankruptcy and insulated from life on the street by a scant couple of paychecks. For many of us, the American dream of earning our own permanent address in some nice little town is just a sweet notion from a time gone by.

It shouldn't be surprising that EMS agencies are having much more difficulty finding volunteers than they once did, despite many today providing their volunteers with some remuneration. Even those that do are having to settle for some people they'd rather not have.

Colorado EMS Director Randy Kuykendall has a systemic assessment of the problem of volunteerism. "From my perspective," he says, "EMS is without question the most pervasive healthcare system in America, with trained EMTs living and working in almost every community. However, as our culture and the demands on our personal time commitments change, it's highly questionable whether our rural and frontier communities will be able to maintain their volunteer EMS systems.

"It's incumbent on state, county and local leaders to identify priority solutions and resources to support their implementation. This is a national problem, and the National Association of State EMS Officials, the state EMS offices and the professional EMS community must be committed to working toward appropriate solutions."

It makes sense that in areas like the one Montano serves, if volunteer agencies were to pool their resources and share their infrastructure, they might be able to justify paid staffs using smaller numbers of people overall. Consolidating a number of small departments, each with chief administrators, billing departments, dispatch centers, human-resources workers, supervisors, fleet managers and supply departments, might save a lot of overhead.

But plenty of those folks refuse to play nice. Maj. Jon Friesen, a paramedic instructor/coordinator and training manager for the Wichita-Sedgwick County EMS system in south-central Kansas, offers the following observation:

"I think we're a territorial lot. We say 'This is my jurisdiction, so don't come in here and run my calls. I'm going to run my calls.' And out of that, we fail to imagine the possibilities of working together. (We) can't envision what working collectively would look like, because (we) assume that would be a county service, and we don't want a county service."

Carl Craigle, chief paramedic at Platte Valley Ambulance Service in Brighton, Colo., and himself a 20-year paramedic from Philadelphia, sees tradition as a major source of contention. That's especially true in the East, he says, where volunteerism in some departments spans several generations of families. "It's a proud, longstanding tradition," he says, "and it would be a smack in the face to the volunteers today to say, 'We don't need you anymore. Thanks, but good-bye.'"

Knute Mlott, a full-time paramedic with Onslow County EMS in Jacksonville, NC, agrees with Craigle. Both say they think combining services might be the answer, although people from different agencies could be expected to fight over details like their preferences for vacuum splints vs. air splints. And those could be big fights.

Craigle identifies another barrier in administrators who might lose their roles to consolidation, even if it were clearly better for the public and crews. But that barrier could manifest in more than just our administrators.

Longtime Utah EMS Director Don Wood, MD, says that despite the difficulties it causes, some volunteer agencies paradoxically embrace their own understaffing. "Sometimes it's tough to get new people to join a service, because some of the existing ones don't want that new blood coming in," Wood says. "As much as they're overworked and underappreciated and undercompensated, it's their life. It's their whole being. That's what they're recognized as: volunteers for their communities. But I think the bigger question is, why aren't these rural people able to make full-time careers out of EMS?"

Wood agrees with Friesen about people not wanting to share their agency identities, even for the benefit of the public. "These people have status in their communities," he says. "They don't want to give that up."

No one we talked to advocated simply replacing the volunteers. Several thought they should receive more support, including salaries that would enable them to continue their involvement in EMS full-time. EMS pioneer Eugene Nagel, MD, notes that all of the early system designs (and textbooks) came from people with big-city perspectives. Those were the seeds from which EMS evolved. But plenty of people don't live in big cities. Five of the cities named in a major EMS journal's survey of EMS in America's 200 largest cities have populations of less than 100,000.³

CRACKS IN THE MIRROR
Who are we? Are we a transportation industry? Are we public safety? Or are we part of medicine? Nagel says he considers us a blend of the three, but in fact EMS today is a hodgepodge of community-based agencies, each with its own identity.

Maybe it's time we make up our minds about who we are and what we're here for. Private providers commonly conceptualize themselves as a medical transportation industry (witness the term ambulance service). Police and fire agencies tend to think of EMS as a form of public safety. Third services, especially hospital-based ones, are probably most answerable to medical direction and identify themselves most closely with medicine.

That kind of confusion probably isn't inspiring to a U.S. Senator when you're asking for support. It certainly hasn't helped us coerce the insurance industry into paying our bills. And using the analogy of oil and water, it may be the biggest reason why some of us can't seem to consolidate with other agencies for the public good.

According to EMS safety expert Nadine Levick, MD, it takes 3--5 years to become an EMT in Australia, and 5--7 years to become a paramedic. The reason? Our friends Down Under realize that the M in EMS stands for medicine. Some CEOs think of medicine as a fuzzy budgeting tool they can use to staff ladder trucks or build corporate offices. That's a mistake. When your whole job is to serve the public, you'd better serve the public. Cheat them, even a little, and sooner or later you shame yourself.

There is no hidden money here, and no latitude for voodoo medicine. When people get sick, they deserve the knowledge and expertise of full-time professionals who live and breathe their medicine, who know what the hell they're doing and who answer to physician medical directors (not just "advisors"). Those kinds of people deserve to be paid for what they do, regardless of what kind of agency sponsors them or which areas they serve.

Maybe there's a very good reason you never hear about dual-role surgeons.

Shift work is another weak spot in our identity. Twenty-four-hour shifts have been standard in the fire service for many years. And they're good firefighting shifts. For years, they've worked fine for people who don't fight a lot of fires. But in fire-based EMS systems, firefighters and ambulance crews are very active by comparison. And despite their off-duty appeal to firefighters and EMTs alike, nothing about 24-hour shifts is good for the safety of a crew. Not one thing about them is good for the medical well-being of a patient. So why do we adhere to them?

It seems completely reasonable for us to employ work schedules that preserve our own safety and address what the public needs and deserves instead of what we want to do on our days off.

Is our commitment to EMS more than just a balance issue? Is it a compulsion for some of us? Worse than that, is it an addiction? An addiction is a recurring compulsion to engage in some specific activity, despite harmful consequences to an individual's health, mental state or social life.⁴ Now think about what an addict does. An addict becomes obsessed with a thing (obsession), develops a constant urge to engage in it, even to his/her own detriment (compulsion), and becomes irritable, disoriented and possibly physically ill without it (withdrawal).⁵ Does that sound familiar?

The compulsion is certainly real. We see it everywhere in EMS. "We struggle to cover our areas," Friesen says, "and in some cases families fall apart because providers are so dedicated to covering responses. I view that as a bit of a dependency issue. People live in a town and never leave it unless they're in an ambulance."

Twink Dalton, a renowned EMS educator/author and clinical coordinator for the Mountain View Fire Protection District in north-central Colorado, was not quite so diagnostic. "I think anyone who has a true passion for something tends to forfeit their personal life in favor of their passion," she says. "Why? Because it's easy to do, and our personal life seems to be expendable--it's easy to put off. Unfortunately, we (as EMS providers) need to develop a passion for living, not just a passion for a small part of what we do. Perhaps our identity ends up being tied to whatever our passion is, and therefore our devotion to our passion helps make us who we are. Who we are is bigger than what we do, but not to everyone. And that's the issue at heart.

"I think our personality (as a whole) also factors in. We tend to be perfectionists. We want to do a great job, not just a good one. We want that instant feedback, that gratification we get from a patient who smiles and thanks us. We certainly don't do it for the reception we get at the ED. We also like the camaraderie--it's really fun! So we tend to neglect our family and its mundane-ness for the excitement of the working family.

"At some level, those of us who are in EMS because we love it see ourselves as servants for the public in need. That is always a dicey place to be when there is little to no support, either in terms of money or people; little collective focus on the end goal; and little support for gaining or maintaining a healthy self-esteem. What support there is tends to be inconsistent, temporary or downright destructive.

"Are EMS providers paying a price? Of course we are!" Dalton concludes. "Why do you think so many EMTs and paramedics from the private sector seek out fire departments? There is decent pay, security in the job and retirement, regular schedules with days off, planned vacations and other choices within the job when you get tired."

"You have to strike that balance," says Gary Wiemokly, EMS section chief for the Connecticut Department of Health, "and it can be really hard to do. It doesn't matter if you're in EMS or the local librarian."

KEEPING YOUR BALANCE
What do you think? Are you having a tough time balancing the demands of EMS against your needs as a family member? Whether you're a leader or a street provider, the following are some practical suggestions from people who do what you do.

1. Shower the people you love with love. That pertains to the people at work as well as the people at home. You need them both, and they both need you. But juggle them carefully. Remember, the ones at home are the ones to whom you made your lifelong commitments.
2. Accept responsibility for your own situation and happiness. If you're not happy, make a change. If you don't make a change, fergoshsakes don't whine. Reserve the power to determine your circumstances, regardless of the actions of others.
3. Taking time away from EMS is key to healthy EMS and finding a balance. You may love EMS, but it cannot love you back. Only your family and friends can do that, and it's imperative that you allow them to love you. This is essential in keeping a healthy perspective and recharging your batteries. We are not Energizer bunnies, and we need to be renewed. (Gary Wiemokly)
4. Discipline yourself to think of every patient you meet as someone who's not as lucky as you are. Then, when you go home at the end of each shift, sit down over a cup of coffee with someone you love deeply and tell them about the people you met and the things you saw during your shift. Count your blessings. You'll never need to worry about burning out or growing to hate that ambulance.
5. Everybody in EMS needs to do an assessment on themselves, just the same as we do needs assessments on our systems. You need to stand back and look at whether you're doing harm to your family or yourself by being so dedicated and motivated. (Don Wood)
6. Take advantage of your situational awareness--the skill you use when you walk into a strange place full of people you don't know and quickly notice everything that's important. At work, it's what keeps you alive. Throughout the rest of your life, it's what connects you to the beauty all around you. And it gets better and better with experience. (Les Federoff)
7. Look around you. Are all of your organization's leaders emergaholics? If so, that will eventually become the organization's norm. Are they all divorced? If so, expect them to consider your marriage expendable as well. A life of serving others does not have to be a life of imbalance or unhappiness. Make no mistake, organizations where that's the norm are sick organizations. You don't have to work there.
8. Especially if you're a leader, tell your family what to expect as soon as you know about it: parades, added commitments, extra shifts and so on. Discipline yourself to compensate for those events with added family time, planned in advance. (Make sure the two are about equal.) (Carl Craigle)
9. As far as balance is concerned, it takes a singular focus on taking care of the "living" part of life. There's time I build in for me, away from EMS. Time for hobbies that have nothing to do with EMS--quilting, reading, writing (OK, so that's related to EMS), vacations with family, etc. It's more time than some take and less time than others. (Twink Dalton)
10. Am I balanced? Well, I think the gold standard is, can I enter into a conversation with friends and not bring up work? I can do that. Can I enjoy an evening at home and not do EMS stuff? I just started to do that--I have to plan it, but I'm doing it. I must say, on occasion it wreaks havoc with stuff that needs to get done. But I'm at a point where I can tell my chief "No time." Bottom line: I've finally reached a point of being comfortable placing boundaries and sticking to them. It's taken 30 years. (Twink Dalton)
11. When you do spend time with family, discipline yourself to listen--don't just await your turn to interrupt. Encourage them to tell you what each of them is doing, what's happening while you're apart, and every single thing that's important to them.
12. When you leave home for work, be sure to kiss each member of your family good-bye. Former paramedic and California Highway Patrol officer Mark Mayo, who was permanently disabled by a drunk driver after he stopped another drunk, has said repeatedly how much he regretted not telling each of his family members on the day of his incident how much he loved them. Mark was unconscious for several weeks afterward, and very nearly died without regaining consciousness.>
13. Next time you feel overwhelmed by the problems of EMS, take a sabbatical. Travel to a place where people are really poor and their medicine is primitive, and experience some real problems. San Diego County paramedic Devin Price has been going to El Salvador for years. You can reach Devin at dtprice@cox.net.
14. If you must pursue a second job, do it anywhere but in EMS. Do something completely unrelated to healthcare, so you don't come on duty already tired of hearing about other people's problems.
15. Whether you read, go to museums, browse the Web or just watch TV, don't stop learning about the world around you. Your life really is so much bigger than EMS.

A Guide to Practical Politics for EMS Beginners
By Sue Hecks

In Alaska, EMS has a strong voice. Services and providers have proven themselves through identifying important issues and stepping up to contact their legislators and policymakers. One of the great things about Alaska is that our regional EMS directors and subarea coordinators regularly meet and work collectively on issues. We strive to keep our services and personnel in the loop so when help on an issue is really needed, the legislature receives a lot of input and hears a unified statewide voice.

Here are some thoughts on how EMS providers can become more politically informed and active.

• If you're not knowledgeable or comfortable entering the political arena, take it slow. Choose a place to start and proceed one step at a time.
• Find out whom and where your local elected officials are, whether they're municipal, borough/county or state-level. Don't forget your U.S. Representatives and Senators. With multiple levels and layers, it can be overwhelming, but knowledge is power.
• Your opinion is important and they really do want to hear what you think.
• To begin, pick one level that will have the most pertinent impact to you and your situation.
• Keep informed. Contact your local and state offices of legislative information/legislative services, where they exist, and ask to be notified of any legislation or issues that come up in your areas of interest (e.g., EMS, fire, public-safety communications, insurance, Medicare/Medicaid, etc.). Ask your legislators to add you to their mailing lists.
• Get to know the legislative aides in your lawmakers' offices. They can be very helpful, and sometimes more important to your cause than talking with the actual elected official. They can answer your questions and keep you in the loop. They also have the direct attention of the elected official. Have them explain how the legislative process works in your area. Ask them to walk you through how a bill gets introduced and passed.
• If you aren't comfortable jumping in and testifying on an issue, listen while others do. Send letters, e-mails or public opinion messages to start. I've been told that a handwritten letter gets more attention than a form letter or e-mail because someone really took time to write about the issue.
• Take opportunities to meet elected officials while they're in their home districts. You don't need to have an issue to talk about--just get introduced and let them become familiar with you as a constituent. Let them know you're an EMS provider. Ask them where they stand on EMS issues.
• Most of the time, people only contact lawmakers when they need help or disagree on an issue. If you can get to know them and their staff when there's not an issue at stake, you can become a recognized entity. This can make a difference when you need to get a point across.
• Contact your regional or state EMS office to find out what political issues or legislation are significant to them. You can help educate legislators and public officials on these issues.
• Check with your own EMS/fire department to find out what issues and legislation are important. Coordinate your message so it conforms with local protocols and circumstances. You want to work with your agency, not against it.

Case Study of a Successful Effort
In Alaska, we believed a property tax exemption for fire and EMS providers could aid our recruitment and retention efforts. I started working on this in the Kenai Peninsula. We partnered with the fire service, found a sponsor and were moving forward at our borough (county) level when we found out such a local exemption was not allowed under state statutes. We had to move our efforts up to the state level.

Again partnering with the fire service, we found a sponsor and got legislation introduced that would make available a $10,000 property tax exemption for the primary residence of certified volunteer EMTs and firefighters. The statute provides for up to two exemptions per property--if husband and wife are both qualifying volunteers, they are each eligible for exemptions.

It was a process, but by enlisting the help of fire and EMS providers around the state--who contacted legislators, sent letters and e-mails of support--we successfully got it passed in the same year it was introduced.

The next hurdle was to go to the borough (county) and local governments to get them to embrace the idea and pass local-level ordinances to put the exemption into effect. Many communities took advantage of this, and it has meant a lot to our volunteers.

If anyone is interested in pursuing similar projects, I'd be happy to provide information to help them.

Sue Hecks, EMT-3, is a regional EMS director for the state of Alaska, based in Anchorage. Contact her at 907/562-6449.

CONCLUSION
Some people simply get things done. That's a price you pay for a choice you make, say, to get through medical school or raise a child. But hampered by a pathetic lack of political support, especially in rural America, today's EMS appears to be breaking the backs of its providers. We need to do a better job of balancing our needs, and those of our families, against those of the public. We clearly need to consolidate our smaller services and share our resources. And we need to bring EMS to the attention of our local, state and federal governments as an essential public service, no less important than law enforcement or fire protection. Our nation is in the midst of choosing its leaders. Late or not, we'd better get started now.

The author would like to thank the following people, without whose help this article would not have been possible: Scott Alexander, EMT-I, Saguache, CO; Kevin Binnall, EMT-P, Mansfield, MA; Capt. Harry Burch, Webster, NY; Steven L. Chait, BA, MICP, CCEMT-P, Newark, NJ; Chief Carl Craigle, NREMT-P, Brighton, CO; Chief Twink Dalton, MSN, NREMT-P, Longmont, CO; Chief Mark Edenfield, EMT-P, Bradenton, FL; Les Federoff, MICP, Santee, CA; Chief Jeff Forster, NREMT-P, Lafayette, CO; Jon Friesen, NREMT-P, Wichita, KS; Mary Greuel, EMT-I, Seymour, WI; Pam Gripp, NREMT-P, Crestone, CO; George Grover, EMT, Med, Cincinnati, OH; Sue Hecks, Anchorage, AK; Randy Kuykendall, NREMT-P, Denver, CO; Knute Mlott, NREMT-P, Jacksonville, NC; Jon Montano, NREMT-I, Alamosa, CO; Eugene Nagel, MD, Winter Haven, FL; Chris Olson, MICP, Escondido, CA; Mike Taigman, EMT-P, PhD, Santa Barbara, CA; Dudley Wait, Schertz, TX; Stanley Wardrip, EMT-P, DMT, AAS, Wilmington, NC; Gary Wiemokly, MPH, EMT-P, RN, Amherst, MA; Donald Wood, MD, Salt Lake City, Utah; and Ken Young, EMT-P.

References

1. Institute of Medicine Committee on the Future of Emergency Care in the United States Health System. Emergency Medical Services: At the Crossroads. National Academies Press, 2006, pp. 28--29.

2. Ibid, p. 46.

3. Williams DM. 200-City Survey: EMS From All Angles. JEMS, Feb 2007, p. 42.

4. https://en.wikipedia.org/wiki/Addiction.

5. https://www.indiana.edu/~engs/rbook/readabd.htm.

Thom Dick has been involved in EMS for 37 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.