Quite a few people have asked me to talk about my new job on my blog.  I have not done this yet for two reasons.  First, the nature of what I do is extremely sensitive.  The nature of EMS can be sensitive as well, but everything I do at my other job begins with someone dying.  So you will not find me spinning a lot of tales here.  Second, I am completely happy with this job.  And as I have stated before, the thing that usually gets me off my butt to write a rant is anger.  I simply do not feel anger at my other job, and so complacency is the death of art yet again.

I also have no idea what the rules about employee blogs are at my new job.  So rather than ask if I can write something and be told no, I will simply write something in very good taste and apologize if they find it and get mad.  But please do not think that this post will be boring or ‘clean’ for management.  Just wait.  I would like to compare and contrast this job with other EMS jobs I have had.  That’s where I might get creative with my analysis.

What is it that I do?  I am called a Donor Center Coordinator.  I sit in a very nice office where the phone rings every time someone dies.  Medicare and Joint Commission regulations require that hospitals participate in local donation programs.  This is interpreted in varying ways from state to state, but in this region every hospital must call us when a patient meets a set of criteria that we have set.

The easiest way for a patient to meet this criteria is to die.  And this makes up the vast majority of my phone calls.  Many people in healthcare are not aware that dead patients cannot donate organs such as their heart or their kidneys.  However, many things can still be recovered after death such as the eyes, skin, heart valves, various blood vessels and bones.  This is generally referred to a ‘tissue donation’ rather than organ donation.  In fact, there are really three divisions of organ procurement: organ, tissue, and eye.  They all have different criteria for acceptance and it is often the case that a patient is suitable for one kind of donation but not another.

When a nurse calls to inform us of a death that has occurred I take all the information and screen the case to see if the patient is suitable for tissue or eye donation.  If not, I wrap up the case and complete the paperwork.  If the case is suitable, I begin to set many things in motion.  I will question the caregivers at length to screen the case further.  This many include examining the chart, EMS records, and talking to the coroner and the medical examiner among other things.  Then I will approach the family to see if they will give consent for the donation.  If they consent then there is a lot of paperwork to complete with the family.  There is a legal consent form, and then a medical/social questionnaire.  The questionnaire can be quite jarring to families with certain beliefs or sensibilities.  There are a certain amount of questions that we have to ask based on requirements of the FDA who is one of the regulators of our industry.  So I wind up asking people about drug usage, jail time, tattoos, and sexual preferences.  Most families are understanding, but it does cause a bit of commotion sometimes.  Then I have to take all the information I have gathered and call tissue processors to try and find a home for the tissue once it is recovered.  Our agency only recovers tissue.  We do not process it or distribute it.  We actually sell it to another company who will put it into the hands of a surgeon for transplantation.  If I do find a home for the tissue, then I send a team to actually go recover it from the body.

That is the after-death tissue and eye side of things.  Organ procurement is quite different.  Many healthcare providers are unaware that in order to donate organs, the patient must still be alive and on a ventilator.  And this is where the general public has many misconceptions.  Yes, the patient is technically alive, however they have to be declared brain dead for organ recovery to take place.  To give you an example, let’s say someone has had a massive stroke.  The doctors have done all that can be done.  But despite all the efforts of the hospital, the patient is in a permanent comatose state and brain death is suspected or imminent.  The nurse calls us and informs us of the case.  We take just the basic information down for these cases and then pass it on to the ‘Organ Division’ for further screening.  In every state doctors are required to perform a battery of tests on such patients to confirm legal brain death.  If the family of one of these patients consents to organ donation then our team will go down there and prepare the brain dead patient for donation.  The body will be maintained and ventilated until an operating room can be prepared.  The patient will be terminally extubated and the team will wait for a short period to confirm complete clinical death.  When that occurs the organs are immediately recovered, packaged, and sent to their various recipients.  Often times tissue and eye recovery will occur directly after organ recovery.  This is known in the business as a ‘full donor’ and this can help anywhere from dozens to over 100 recipients.

The specific ‘Organ Procurement Organization’ (known as an OPO) that I work for is a very well established and very well respected non-profit corporation.  Being non-profit, there is no temptation to do anything other than obtain good tissue and organs for those in need.  There are OPO’s and various tissue processing centers around the country that are for profit, just like any other section of healthcare.  However, I enjoy our non-profit status because it keeps the motives pure and the politics to a minimum.  (I think the same way about EMS and hospitals, so please don’t take this as a criticism about other OPO’s.  I would not know enough to make those criticisms.) 

Since that motivation for profit has been taken out of the model, the leaders of this organization concentrate on the quality of the work and keeping the employees happy.  Consequently I am paid more than any job I have ever had in EMS.  The benefits package for any other EMS job I have ever had also pales in comparison.

But pay and benefits isn’t everything.  Well, yes it is.  But that’s not what I want to talk about.  I have learned things from every place that I have worked.  I have had many health care jobs outside of EMS, and I always look back on those experiences from the viewpoint of, “What can EMS learn from this section of heath care?”  And so I will try to answer that question from the organ procurement perspective.

First is charting.  There is more charting going on in organ procurement than EMS ever thought about doing.  And I am saying this as a person who has twice held the QA position at an ambulance service.  OPO charting isn’t just better than EMS charting, it obliterates it.  It vaporizes it.  There really is no way to compare it.  To be honest, when I first started working as a Donor Center Coordinator, so many people noticed mistakes that I had made on my charts that I became a bit paranoid.  I thought the Gestapo was after me.  But after the dust has settled and I am now used to the system I appreciate it for what it is.  Many people care about what I am doing, they regularly read charts, and the system is well regulated.  There are many EMS systems where only a sample of the charts are audited.  I have also worked for an EMS service that did not bother with a QA process unless a complaint was filed.  This is simply insane.

If I start a tissue or an eye case that goes to completion, it would not surprise me if a dozen people scrutinized the chart before it was filed away as completed.  And if you make a mistake (and I mean something as minor as “we can’t read the ‘i’ in the name ‘Smith’ on page 3 of this document”) it will be sent back to you for clarification and correction.  Everyone knows how things are to be charted, and everyone is on the same page about it.  I get very few conflicting statements from different managers about charting.  Oddly enough, I often find people bitching and complaining about the quality of the charting.  The complaints sometimes seem trivial to a person with an EMS background.  But I guess if you are employed somewhere, there will be bitching.  It’s just a given.

The second thing I would like to call attention to is attitude.  This is hard to describe.  All I can say is that many things that were bothering me about EMS are blissfully absent from this job.  And some of these things may be things that are enjoyed and defended by people who read this blog.  So I will try to describe what I am thinking in careful terms.  The EMS services I have worked for have a general undertone of transience.  There are so many people in EMS that simply don’t want to be in EMS.  There are people who want to be fire fighters who are just using their unwanted EMT cert as a stepping stone.  There are medical students looking to put something on a resume.  There are EMT’s who desperately want to be paramedics, and their heads swell when they get there to the point where there is no talking to them.  And then there are those really weird people who are just desperate to feel important and the EMT cert was the quickest path from zero to self perceived hero.  Now, not everyone who works in EMS is like this.  I work with many wonderful people at my current job.  But you know who I am talking about.  These annoying interlopers are a part of every service.

This is not true of the OPO that I work for.  Sure, there are people who come and go.  I work in the entry level department, so I see a bit of employee turnover.  But the organization as a whole has very good retention.  By and large, I work with a lot of very educated, well mannered, well organized people who know what they are doing and they act appropriately.  Since I have been working here I have not heard one racial slur, or seen anyone go off on an inappropriate tirade.  I wish I could say the same for any EMS service for which I have ever worked.

This is made evident by the amount of EMS personnel who work here.  This seems to be a place were EMT’s and paramedics who have had a career crisis wind up.  The conversations I have had with these people have been very enlightening.  In fact three of us were sitting around the other night when the question came up, “Would you ever go back?”  The consensus was, “What!?!?  Hell no!  What is wrong with you?  Why would I go back to longer hours, less pay, an angrier environment, and abusive patients who spit at me and cuss me out.  I think I’ll stay right here, thank you!”

There is one draw back to working for an OPO though.  There simply aren’t that many of these organizations.  In fact, there is only one agency to work for in this entire state.  Compared to other sections of the health care industry we are miniscule.  As a paramedic I could probably throw a dart at a map of the United States and say with certainty that anywhere that dart lands will have a job for me.  Nurses can say the same thing.  Pharmacists, doctors, x-ray technicians and other personnel have similar opportunities.  If I wanted to work for another OPO I would have to leave the state.  It’s as simple as that.  Consequently, someone who wants to make this their permanent career may find a great deal of frustration in the ability to move upwards or laterally.  If I had a falling out with management, I would have to move to find another job.

Do I hate EMS?  No.  Of course not.  But I have seen so many problems with the EMS industry in this country.  We have limited ourselves.  I listened to a piece of one of Chris Montera’s podcasts just a little while ago and the ‘blue collar’ nature of EMS in the US came up again.  He said that keeping ourselves bogged down in the ‘certification’ mindset in this country has caused a lot of problems.  Other countries require degrees to enter this field and the providers are treated more like a part of the health care system.  I whole heartedly agree.  We have unjustly categorized ourselves and sealed our fate.  How many people do you know who are over 40 and work solely in EMS if they haven’t been promoted to management?  Older, more mature people just get tired of it.  I can tell you that I am rapidly approaching 40 and I am tried of dealing with the attitudes of some providers.

So why have I written this?  Well, I would like to see the ‘maturity level’ of EMS be raised for lack of a better term.  It is a strange direction to look to, but EMS can learn a lot from looking at the organ procurement organizations.  This is evident from the amount of EMS personnel that are working in this industry as expatriates.  I would love to see some of the family interaction skills that I have learned here be used in the field.  I realize that I can use them, but these skills should really be taught to anyone that encounters a grieving family.  (This may be the subject of a future post.  Just like anything, specialization will reveal hidden secrets that folks in other professions may find useful.)  Also, if you are an EMS professional looking for a career change, you may be surprised to know how well suited your training and experiences have prepared you for a job in organ procurement.  My knowledge base is well suited to my position and I am surrounded by other paramedics and EMT’s who have thought the same thing.  If you feel like you have been stuck in a rut, this may be an option for you.

But is it possible for an overall maturity makeover to happen to an industry like EMS?  Give your employees good pay and benefits.  Give it to them in copious amounts.  Reward education.  Reward innovation.  Scrutinize charts.  Scrutinize them to a ridiculous degree.  If there is so much as an undotted ‘i’ send it back to be redone.  (See how well that goes over at your average EMS provider.)  And make those employees be professional.  I don’t mean clean uniforms, I mean well spoken educated providers who are always calm and have the family’s best interest at heart.  Make them be sensitive.  Make them be appropriate.

Well…that and pay with benefits.  That couldn’t hurt either.

Bookmark It

Hide Sites