Dr. Emma Jones is a hospice and palliative care physician, also worked as a pediatric oncologist and pediatrician. She’s been in the field for over 10 years and is active in helping healthcare professionals with burnout in the modern medical system. She is the author of The Phoenix Blueprint, Emerging Stronger from the Blaze of Healthcare

https://www.emmajonesmd.com

Sometimes you need to realize you may be part of someone else’s plan and get onto your own plan

Dr. Jones talks about the difficulties with working with pediatrics but also the amazing resiliency of kids and their parents

We are told that medicine is a calling and a privilege, and we should sacrifice everything in service of the patient – this is an unrealistic expectation 

We talk about burnout and moral injury

Burnout a helpful term because it’s something we can all feel and understand and use to seek help

Moral distress or injury is something that occurs regularly - when there is discordance between what you want to do and what you are able to do - whereas burnout is more at the end of a line of moral injuries

Burnout triad: emotional exhaustion, cynicism, lack of fulfillment

If we can get the frontline healthcare workers out of burnout and the day-to-day strife, we can help them be part of the solutions to the problems we face

Dr. Jones talks about the philosophy of yoga and how it can help us flourish

Sleep is vital to healing from burnout. It allows the brain to clean itself; you are smarter after getting adequate sleep

A lot of us are not even giving ourselves the opportunity to get enough sleep

Lack of sleep makes it difficult to put things in their proper context and map solutions

We talk about core values and the importance of knowing what yours are and how they correspond to your actions

Emma shows the actions she takes to correspond with her core values

Joy and humor are a huge part of our humanity 

Questioning your thoughts is key. All thoughts are lies. We recreate memories. Our memories are fallible and tend to degenerate the more we recall an event

Learn to let go of thoughts that do not serve you. Choose the ones that are helpful. You get to control them. You cannot believe every thought that comes into your head

Steven Covey describes 3 types of circles in our lives in The Seven Habits of Highly Effective People. You have the circle of control you have direct control over but the circle of influence and circle of concern you have less control over. The point is to recognize what is worth focusing on and what is not worth your focus. For exampl

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Bryan Jepson MD and CFP, author of The Physician's Path to True Wealth: 12 steps to gaining control over your money and your time – you can find it on Amazon and at this website for free Bryan Jepson MD, CFP® | physician finance

Disclaimers:

This is not specific financial advice, this is general education. Talk with your own advisor or schedule with Bryan to get specific advice 

The easiest, most straightforward way to start creating assets is to invest in your 401k

Debt to fund a liability is bad debt, it takes money out of your pocket

Debt that leads to more money in your pocket is good debt, but this requires wisdom in choosing your degree and education path

There are a couple of methodologies to pay off debt, the snowball method vs the avalanche method. Snowball goes smallest debt to largest. Avalanche goes from highest interest to lowest interest. Use the one that will actually work for YOU and will make you be consistent

The 4% rule: generally, when you can live off 4% of your investments per year, you have enough for retirement

So, if you need 100K to live off in retirement, you need 2.5 million in investments

Why does everyone need a will? If you have kids, it allows you to designate a guardian should you die. It also allows you to allocate where your assets go

What is the importance of giving away money?

Giving can be looked at through a couple different lenes. When you give, you are blessed in return. Or maybe you can view it as good karma

Bryan talks about how relationships are an important aspect of life and giving allows for meaningful relationships with something you value. Donate money but also your time

When you are rich, you don’t have the cushion to give. When you are wealthy, you have the ability to give to others

Finance is simple but not easy because you need discipline. You don’t have to get far into the weeds to be successful

Bryans book has the foundation you need to understand finance

Bryan talks about the difference between a financial advisor and a certified financial planner

 Bryan gives his opinion on whole life insurance vs term insurance

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Bryan Jepson MD and CFP, author of The Physician's Path to True Wealth: 12 steps to gaining control over your money and your time – you can find it on Amazon and at this website for free Bryan Jepson MD, CFP® | physician finance

Disclaimers:

This is not specific financial advice, this is general education. Talk with your own advisor or schedule with Bryan to get specific advice 

The earlier you can get financially literate and work on a plan the better

Bryan is an emergency medicine physician, along his journey in medicine he also spent 5 years working in Autism before coming back to EM full time

The covid pandemic and a feeling of stagnation and desire to keep learning prompted Bryan to pursue a master’s degree in finance 

Bryan finds familiarity in his role as a physician to his role as a financial planner. You listen to the client and come up with a plan that fits their needs

Bryan talks about the difference between riches and wealth; discretionary income is the income above your mandatory expenses – and what you do with that extra income is how you become wealthy or rich

Riches are the material things you may spend that money on, car, house, toys

Wealth is the money you could spend but instead save or invest instead

The goal is to create assets so that your income is no longer needed. Buying back your time

When you have true wealth, you can make decisions with your time

Working towards being financially independent prevents burnout

Choosing to work vs working because you have to is easier, and makes you a better provider

Key attributes to develop to be financially successful: Be patient – assets grow slowly. Be consistent in investing. It is boring. Be honest with what you know and what you don’t know so you can spend some time educating yourself. Courage, because it does take some risk taking to invest instead of just saving

If you keep all your money in cash, you are guaranteed to lose purchasing power

The longer your time frame the better the stock market will perform for you

Creating discretionary income is difficult at lower incomes levels. But I do still believe you can retire from EMS. One way that I was able to save and invest as a paramedic was working overtime

Having higher incomes does speed things along but it is not the cure for financial problems because we all have a tendency to spend what we make – fundamentally it’s the same problem

We talk about the vehicles we drive and how we have utilized them to save more money

But spend money on

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

We need to remember that paramedic and EMT’s are solely focused on emergency medicine vs RN’s or even PA’s who are trained in general medicine then learn how to do EM later on

Learning sick vs not sick is a skill that develops with time, it’s not always easy

Gestalt can be an important factor in your assessment but don’t trust it all the time, it can lead you astray

A negative work-up does not always mean there isn’t something dangerous going on

Recognizing your biases will help protect you from making a mistake or overlooking something

Advice for the newbies:

Have humility when you are new, be willing to be taught

Never stop learning

Be proud when you do perform well

Don’t trust your gestalt when you are new. Take every patient seriously

Keep a journal

Be honest, do what you document and document what you do, admit your mistakes quickly

Taking ownership over mistakes helps you learn and gives you more respect than passing the buck

The call you are going to is the call you are supposed to go to. That is where you are meant to go. No patient is a waste of time. That patient deserves your undivided attention

 Too many people hear the other exciting calls dropping nearby and they become distracted from what they are currently doing

People are put in your path for a reason

Alex talks about a night he ran 3 GSW’s and had to use good coping skills to recover

Sometimes the lower acuity patients can rejuvenate you

Running only high acuity will burn you out too, take some joy in the less stressful calls

Appreciate the highs and lows

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

How do we have long careers and avoid burnout?

Micah talks about burnout and how we have the advantage in emergency medicine that we can leave work at work and step back

Have time off and don’t work overtime every time an opportunity arises, don’t only discuss work with your spouse, have other interests that you can engage in

Emergency medicine is a fun job to identify with because we get to save lives, but you should not make it your whole personality

Find an identity outside of work, you may not have work at some point and life changes

Audrianna talks about taking care of yourself. As we spend so much time being empathetic for others, we can lose that empathy for family or even ourselves

We talk about the lower acuity patients we care for and infrastructure to take care of their complaint quickly from the ED, patients have poor access to primary care, and we can be that solution

We can’t use low acuity calls as something that burns us out or allows us to get frustrated, it will always be part of the job and we should view it as us being the solution

We can be educators, we are trained to recognize emergencies, the layperson shouldn’t be expected to know this

We have the privilege of taking care of everyone regardless of complaint, ability to pay, social status

Burnout begets burnout

Take the time off when you need it, overtime takes more from you than it may be worth

Certain seasons of life may necessitate working more but you have to understand the cost benefit

Just making it through COVID is a victory, it burned a lot of providers out, even those with experience

We recount some of our COVID war stories

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

How do we handle the sensitive hand-off reports from EMS to the ED?

Different aspects, like potentially violent family members, unsafe scenes, are often a critical details that need to be conveyed to the ED but don’t have to be announced to everyone in the hand-off report in front of the patient

Micah works as a field and ER paramedic. He talks about this situation and how it’s going for him. He enjoys the number of resources he has access to in the ED

Being able to see the whole workup and outcome of the patient is a big benefit as well, working in the ED

I love it when the EMS crews come back and follow up on their patients, it’s a big way to help them improve and learn

We talk about interpersonal conflict on scenes

Casey tries to be as friendly as he can and learn everyone’s names

It’s easy for all of us to allow our egos to get too out of hand, but we need to treat everyone how we would want to be treated

I talk about some issues I’ve had with the fire department in the past – sometimes it is all about how you are doing something as opposed to what you are doing in your interactions with other agencies

At the end of the day, the patient can be affected when we have confrontational scenes so we should always be seeking to avoid this

Alex talks about working 48 hours with his fire crew and responding on scenes with the same crew and how this differs from private ambulance responding with other agencies he may not know very well

Casey talks about how, years ago, the EMS crews had more time to stop by the fire stations and become more familiar with the fire crews

Casey talks about the power of edifying others in our field

Audrianna talks about a fire crew going above and beyond in the ED as well

We talk about small things we can all do to go above and beyond our regular tasks, helping families navigate the ED, getting a blanket for someone, cleaning a room

Little things like this also help you feel better about your job too; they help you remember why you got into medicine in the first place

It does require you to look beyond yourself to see those opportunities

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

New panel with Audrianna (RN), Alex (paramedic), Casey (paramedic) and Micah (paramedic)

What do the ER nurses like to get in the hand-off report from EMS?

Audrianna likes to hear clear, concise reports. How ambulatory was the patient on scene? 

Casey recalls from years ago how the ER nurses didn’t understand enough about what EMS did, that always made giving reports more difficult and how that has improved over the years

I always try and give new EMT’s the freedom to struggle through giving reports so they can practice and improve without cutting them off or making them feel rushed

Giving report is a difficult aspect of the job, especially when it’s a critical trauma patient and you are giving report to a room full of people

It’s easy to get in a rush to move the patient over, but we need to give EMS the time to give report - It’s a big part of our day that allows us to build the team rapport between EMS and the ED

Alex talks about the perspective going from a busy private ambulance to a slower county system 

We talk about differences in nurse workload vs paramedic in the field

Sometimes EMS doesn’t fully understand some of the nuances of how and what we use their IV’s for in the ED

Audrianna talks about how ER nurses are trying to maximize their time while getting report from EMS

ED charting is a lot more complicated than the field

I talk about how seeing ambulances when they arrive should be the highest priority for a provider

Micah talks about the limits of our ability to obtain accurate information in the field many times

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Some ambulance crews may not have the best understanding of how a fire crew is going to run a call, with everyone assigned specific roles – often the fire department will be allowing a new crew member to lead the call

I always struggled with arriving first on scene on the ambulance because that role is more work and more pressure 

What does fire like from the ambulance crews when they arrive first?

First on scene should be allowed to lead the call and ask for help where needed, second on scene should not be pushing their way in and trying to take over the call

Sometimes the providers that take over lack experience or are not yet comfortable enough with their own skills to allow someone else to lead

If you have another provider on scene constantly trying to interrupt, give them something to do - often this applies to a disruptive family member

Does the ambulance paramedic have to attend in the back if the fire paramedic rides in?

As a previous ambulance paramedic, I viewed the ambulance as my space, meaning I always appreciated it when the fire paramedic had the respect to treat it as such, asking to ride into the hospital as opposed to telling me they were riding in. 

As a general rule, if the fire paramedic believes they need to ride in due to acuity, the ambulance paramedic should also attend

Kash, as a medical director, gives his opinion on this situation

I really appreciated it when the fire crews respected our ambulance because the front is truly our office

EMT’s can ride in too on low acuity where more hands, not ALS treatment, is needed

I’ve talked before that a paradigm shift is needed for the paramedics at times, where they are more likely to have to attend more calls then their EMT partners -  easy for me to say from outside the field now – but transporting the patient is almost always the safest, lowest liability option, we shouldn’t be trying to get out of transports just because it’s less work

Always treat the patient like they are a family member

We are looking for proof that the patient is not sick, as opposed to assuming they are not sick from the outset, our approach is different in emergency medicine

We have, historically, reversed hypoglycemia or opiate OD, and the patient has refused when maybe transport to the hospital is warranted despite the fact that we have temporarily fixed a major problem

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

How do we have successful, long careers in EMS?

John recommends living away from where you work, doing unrelated activities outside of work so your life doesn’t revolve around work things

Taking care of someone you know is an odd position to be in, it can mess with your ability to be objective

Jason says we need to have an awareness of how we are feeling and how those around us are feeling, therapy is always a great option, get outside

Those of us in EMS/fire do deal with a level of PTSD

Terry talks about this in his own life, when he broke down and started crying without an obvious reason

PTSD is not a lack of desire to cope nor is it a sign of weakness

Kash talks about burnout vs moral injury

Burnout tends to blame the individual vs moral injury blames the system we work in

I don’t disagree that the systems we work in are imperfect and moral injury exists, but I still like the term burnout because, no one is coming to save us, the responsibility is on the individual to overcome

Burnout can slowly occur to the degree that you don’t even realize right away what is happening

Is burnout inevitable?

Kash says that moral injury is inevitable in some form or another - the important thing is to recognize it and deciding what to do about it, take action

Acute vs chronic burnout requires different solutions as well

Kash recounts the Covid effects on EMS

Terry talks about the ability to acknowledge your struggles and continue to move on and live your life, in spite of them

I asked Jason about his decision to stay a fire paramedic instead of promoting up the chain, he didn’t want to promote just for the money, he would rather have passion for it. He is still very passionate about practicing medicine as a paramedic and enjoys his career as it is

How do we get along on scene when responding with multiple agencies, fire vs private ambulance

Jason talks about how beneficial it has been to see both sides, you can have more compassion for the other side when you see their struggles

Have the right attitude approaching a scene, work to get along with others as best you can despite the strong personalities we all tend to have

Sometimes a short conversation goes a long way. Having ambulance crews stop by the fire station for some food or short hang-out can also dramatically improve your relationship

We tend to assign ill-intent when we don’t know someone, vs good intent when we do know them

It is difficult to fully understand each other’s roles, when you aren’t doing that job on a daily basis, trauma bonding calls can be helpful when you get into th

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Our system has made access to EMS trained medical directors much easier, which is a huge benefit to the crews

The EMS fellowship for MD’s tends to attract those that are interested in helping EMS because they are passionate about it and not in it for the money

We are always trying to give EMS the amount of time they deserve when giving reports from the ER side

Kash talks about his technique in getting a good report from EMS on the higher acuity side

Every provider has slightly different preferences on how much information they like to get from EMS, Kash talks about his ideal EMS report

I really like the crews to lead with the chief complaint so I can understand how pertinent the rest of the report is

We talked about the previous culture on contacting medical control and how this has changed over time

What does retirement from EMS/fire look like?

Terry’s retirement came suddenly after an injury, which made it difficult as he wasn’t expecting it

Terry still remembers the calls he has run around town, the intersections, he says the bad memories have tended to get better over time. 

He recommends finding something else to do in retirement, keeping busy. Don’t get stuck in the past recounting call after call. It can be difficult to give up the comradery you have at the fire department

We talk about the terrible question “What is the worst thing you’ve ever seen?” that we frequently get

It forces us to recount those horrific calls

The person asking the question is not mentally prepared to hear the answer

I talk about the difference dealing with tragedy in the ER vs the field

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.