Every year, I return to the USA at least once to attend an EMS conference. In 2013, I attended EMSToday in Washington, DC. As I usually do, I make time to meet up with some of my friends and blogging associates. This year, I got a chance to sit down with my friend Tom Bouthillet. My intention was to interview him as I have with other bloggers. We sat down in the lobby of his hotel, I clicked on the recorder and we started talking.
Tom is one of the most genuine people you can ever meet. He invests himself completely in every conversation and when Tom talks with you, you feel like you are the most important person he’s ever encountered. It’s a fantastic feeling. I am fortunate to count him as one of my good friends. Our conversation started as an interview but quickly turned into just a pair of friends catching up, drinking some good wine and talking about things that each of us found important. We covered subjects ranging from his work as a paramedic, my life in the Middle East, the importance of discipline, the connectedness of all humans, the Dalai Lama and electrical pathways in the heart.
If you haven’t been to the EMS12lead.com, go there now. Bookmark it and visit every day. It’s a master-class in 12-lead EKGs and a fantastic resource for paramedics, nurses, doctors and anyone else. Go ahead. I’ll wait …
Another project Tom has been working on is the CodeSTEMI web series. He and Ted Setla have been visiting with EMS systems that are putting passion, effort and money into improving outcomes of patient who suffer an S-T elevation myocardial infarction (STEMI for you EMS types or "heart attack" for non-EMS folks).
Click on that link up there. Watch the episodes. I’ll still be here … Go ahead! It’s worth watching.
Tom Bouthillet is one of those people who does the extraordinary as an ordinary chore. He commits himself completely to what has to be done and brings compassion and drive to the effort. Much of his work involves connecting people, from the collaborative nature of 12-lead EKG interpretation on his blog to the human stories that he tells in the CodeSTEMI series. What Tom and Ted did was exactly the sort of thing that ResqEllie was talking about in her interview with me. They tell a compelling narrative that EMS needs.
I did ask Tom a few questions about his work with the latest CodeSTEMI episode in the London Ambulance Service (LAS). He and Ted traveled to London and were given access to the LAS, one of the busiest EMS system in the world.
How did you feel about your access to the "real" LAS? Did you feel you were placed with the "cream of the crop?"
On one hand, I feel the sample size was small and hand-picked but on the other hand, and this is critical: in doing this web series, Ted and I have never hesitated to say, "That sounds amazing! Show me the data."
So, when we were at one health system in the USA being told, "Oh yeah. Our door to balloon times are 35 minutes." our reply was, "Extraordinary claims require extraordinary evidence. Show us." In the end, they couldn’t. The best the could show us was that 98% of the time, their door to balloon time was less than 90 minutes. In other words, I do believe they’ve had some door-to-balloon times of 35 minutes. I do not believe that their routine door-to-balloon time is 35 minutes. I think that’s something for the six o’clock evening news when so-and-so and his cameraman show up and they don’t know a thing.
We crunched these numbers for our system. We understand what an extraordinary claim that was. I was putting my credibility on the line, Physio-Control’s credibility on the line and First Responders Network’s credibility on the line for an educated, sophisticated audience. I’m not going to accept that without proof.
So it did not make it to production. You have to back it up if you’re going to make that claim. I’m not going to be your mouthpiece in a web series for something you can’t back up.
The CodeSTEMI web series is not a six o’clock evening news fluff piece nor is it a no-holds-barred documentary. It is a balance between documentary filmmaking, marketing and storytelling that is scientifically compelling. It is its own unique animal. It has to navigate a slender path to avoid bumpers that, on one hand, can cause it to lose credibility and, on the other, cause it to damage relationships.
Tell me a little bit about where you went in London, from the perspective of the patient care continuum. A patient with chest pain calls 999 in London, who does this patient reach?
That patient reaches a call taker in what is called their "control room."
And you were there?
Yeah. The control room, which holds the call handlers and is separate from the area holding the dispatchers. It’s a giant area. The 999 call comes into the call-handlers. They confirm your address and they confirm your phone number, the location and the call-back number. They use EMS ProQA, just like my fire department does, just like Seattle does. It’s a type of emergency medical dispatch program where, depending on what your complaint is, they have very specific directions and pre-arrival instructions. It’s highly regimented. They determine your emergency and then it’s coded. They then determine the appropriate response and it goes to the appropriate dispatcher.
It sounds like a whole lot is happening before the call gets passed off to a dispatcher. People who call 999 or 911 don’t see that. What did you observe when you were in the control room while these calls were coming in?
What I observed were some astoundingly competent call-handlers because of what they’re put through before they are ever allowed to be in that position in the first place. They have been carefully selected and carefully trained before they can sit there.
There was a woman named Jules Lockett, one of their head trainers that I sat down with and had a brilliant hour long interview. In my opinion, everyone should watch that interview just to understand how profound the process is to train a dispatcher. It was fascinating for me to hear her talk about the process. She’s involved in the hiring and selection as well as training of the call takers. This isn’t a process where they ask, "Do you have a pulse? Ok. Let’s put you in the chair, train you for two shifts and you’re on your own." No, it’s an exhaustive process for you to be qualified to sit down in that chair. They take time with you to make sure you’re competent to handle this responsibility.
Jules trains them to immerse themselves in the EMS call, just as she does in her work. In the CodeSTEMI episode she says:
"I tell people about an actual cardiac arrest that I dealt with personally on a phone call … I could picture the whole scene. I could tell you what kind of flooring they had in this kitchen. I could tell you what was cooking in the kitchen. I could tell you what the son and the daughter was wearing. I could tell you absolutely everything around that scene. And I think if you can’t picture the scene, if you can’t almost step into that call or that situation, then it’s very difficult to, probably, handle that call in the most appropriate way.
So, I actually have the best job, probably I would say, than even the chief executive. I get that opportunity to deliver exactly what the chief executive instructs and what the [National Health] Trust wants. We get to teach that and I get to mentor my staff into being able to deliver that and to make sure the staff in the control room do the very best job for patient care."
Wow! What is it about Jules that impressed you so much?
I think it’s a 100% commitment to doing whatever has to be done to help this patient on this 999 call. The last call doesn’t count and the next one doesn’t matter. In a nutshell, that was it. This call is the most important call of your career, each and every time.
Did you feel different walking away from your experience with the LAS?
I felt validated in a way, by the LAS. They showed me that it is possible for there to be an EMS system that is guided by impeccable integrity and caring for patients. There are probably a thousand paramedics from the LAS who would cringe to hear this. I don’t share their baggage with their supervisor and their battles between labor and management or whatever daily concerns get in the way of comprehending what they have over there, which is something they need to cherish. What I saw, in each and every aspect of their operations, from call-handling to dispatch to operations to the street-level ‘medic to the nurses to the people inside the cath lab: caring competence, caring competence caring competence. It was overwhelming! I saw it everywhere I went: caring and competence!
After days of it, I was like, "Ok, this must be a veneer." I thought I was in a "Potemkin Village" or something. We had a handler from their PR department but Ted and I weren’t born yesterday. We got to ride around with these ‘medic by ourselves.
From talking with you and Ted, it sounds like you both used your professionalism and "street cred," to borrow an American term, to quickly pierce the veil and talk to people in the LAS honestly. How quickly did that happen?
It happened by the end of the first day.
Did you feel like you could run any call any time with any of the ‘medics you met in the LAS?
Absolutely. In a heartbeat. Suzy Fish and Craig Birkin were the crew we were placed with. Top notch crew. They way they handled their business was not just competent and caring but street-wise. And you would be as a full-time ‘medic in London. 60,000 calls for chest pain last year! 5,000 active resuscitations in one of the busiest metropolitan areas!
One hundred percent commitment. Reading over my notes and editing this entry, I remember how I felt after talking with Tom. I was fired up about what I do. I was (and am) reminded about how much I really feel for my profession and the value of my work. As such, I’m driven again to look at each patient interaction and each encounter anew.
This call is the most important call of your career, each and every time.
Thanks, Tom Bouthillet. It’s always a pleasure to talk to you.