Q&A: Thom Dick on what it takes to be a caregiver and lifesaver

Thom Dick started in EMS as a student at San Diego State University in 1970 when he answered a “live at work” ad for an ambulance attendant. He was paid $1.25 an hour, a portion of which went to pay rent to live at the station. His first call was for an auto accident that left five seriously injured in San Diego County’s backcountry.

“I was scared to death. But the next call was for a naked old lady. I had never seen a naked old lady before, and that scared me even more,” Dick says. “But I loved my days on the ambulance and I couldn’t wait to get out of school to do it more.”

In 2011 “Best Practices”, before it became Paramedic Chief, spoke with Dick, when he was the quality care coordinator for Platte Valley Ambulance Service, a hospital-based nonprofit in Brighton, Colo., Dick worked to improve the care provided by the organization’s 25 paramedics and five EMTs to the area’s 50,000 or so residents. Dick was a longtime columnist for EMS World magazine and JEMS, the author of “People Care” now in its third edition, and a nationally recognized advocate for respecting the dignity of patients and EMS responders alike. Dick served in EMS for more than 40 years before his retirement.

Much has changed since he started as an ambulance attendant. San Diego County’s first EMS medical director was a podiatrist. They had one oxygen regulator in their high-top Chevy ambulance, which patients had to share. And to access a typical community hospital’s emergency room, they’d bring injured and ill patients to the reception desk, where nurses would check to see if there was a “doctor in the house.”

Paramedic Chief: Is quality care coordinator a unique position among EMS organizations?

Thom Dick: Many organizations have a supervisor-level person who’s in charge of quality assurance or improvement. But I have my own way of managing quality: I call it “people care.” It’s about how to take care of people in crisis. It’s not about medicine; it’s about human interaction. It affects everything from recruiting people, educating them and cleaning up their mistakes to safety, management and turnover … the whole nine yards.

My personal view of quality management is if you select and educate the right kind of people, you don’t have to clean up so many mistakes. We run 5,000 calls a year and I get maybe six complaints. When I was at another organization, I had 12 complaints a week and they were angry. But the workforce was angry, too. That makes a big difference.

What does it take to be a good EMT or paramedic?

There are many things.

• Good eyes and ears.
• A quick mind.
• Manual dexterity.
• A sense of humor.
• A natural liking for people and a natural inclination to tell the truth.
• And past personal suffering.

I’ve learned from nurses that what makes you better at dealing with someone who is really suffering is if you know how it feels. It gives you understanding instead of just knowledge. It changes the way you touch people. The way you use their names. The way you look into their eyes. How careful you are to relay their personal information. How smooth of a ride you give them.

A good paramedic is somebody who has the gifts of a caregiver. When you are looking into somebody’s eyes and they are sitting there fixing to die on you, you better be wired right to deal with that. It’s not a medical problem—it’s somebody’s life.

Or when you get a call from a lady in the middle of the night who is complaining of shortness of breath and she seems to be breathing just fine, then you realize her husband just died and all of the relatives who had come for the funeral just left, you can brew her a pot of coffee and sit and talk with her. That’s what this job is really about. A lot of people don’t get that unless they’ve been doing it for a while.

You do need an ego to do this. But some paramedics are so mean to people. They use a bigger needle than they have to. They intubate when they don’t have to. One of the things we have to struggle with is people’s fear. Fear is a component of all suffering. But you don’t learn that at age 19. It takes some life experience.

What makes a good EMS leader?

You have to understand your people. You have to like them. You have to like what they laugh about. I think you have to love them. They’ll know if you do, and they’ll know if you don’t.

They get lied to for a living. There are so many people who will say, “I didn’t have anything to drink” and they’re flammable. Or, “I’m not having chest pain” because they’re scared of going to the hospital.

There’s a concept called “servant leadership,” which is the idea that if what you do for a living is serve people, then your boss should serve you. It makes perfect sense. If you think about all the good leaders you’ve known, most didn’t graduate from Yale. Their daddies didn’t help them to avoid military service. They are humble people. The Buddha was that way. Gandhi was that way. Jesus was that way. They serve people.

With the recession, the battles for turf between fire departments and private companies seem to be re-emerging in some places. How have you avoided that in your area?

In a healthy department, it should be the most natural thing in the world to serve people and to help each other serve people. Nobody is perfect and no organizations are perfect. But Brighton is a good example of a place where it works, and that is due to the fire chief (Mark Bodane) and to my chief (Carl Craigle). Both of them have enough humility to remember who we all work for, which is the public, especially the poor public, and they don’t let their egos get out of control.

There is also no war here between us and the fire department and the police department. We are very tight. We have a really amicable relationship between EMS and the other public services, and we do a lot of training together. That has not existed in a lot of other places where I’ve been. The fire department goes on all medical calls; we take responsibility for the medicine. The firefighters are all nationally registered EMTs, and they know where everything is on our ambulances. In addition, a lot of the EMS equipment in their engines came from us. And it wasn’t hand-me-downs; it was new equipment.

You speak highly of your organization. What else makes it special?

Our paramedics are very experienced, and we don’t have a lot of turnover. Our average tenure here for employees is 10 years.

One thing that also helps is being affiliated with a hospital. We get hospital benefits as far as health insurance, retirement and pretty much everything. We get two bonuses a year. And we get great support from them. We use the hospital human resources department. We are invited to their parties, and we invite them to ours. We are closely affiliated with other hospital employees and serve on hospital employee teams, including their safety committee and quality committee. Our hospital [Platte Valley Medical Center], for example, subscribes to Planetree, a customer service strategy that emphasizes caregiving.

You have often stood up for the rights of the EMT and paramedic, and the need for each to be regarded as true professionals. What kind of progress has EMS made in this regard?

It’s been slow. In a lot of ways we are not regarded as professionals. And a lot of that has to do with the fact that people who make the best EMTs and paramedics are not political thinkers. They don’t go to political meetings.

You’ve been a columnist for EMS Magazine and JEMS for decades. What was your favorite column?

My favorite column was “People Care,” published in JEMS. It was about how to be nice to people who are in crisis. Sometimes when people are having the worst day of their life, they are so nasty. A lot of paramedics don’t put up with it. But you have to. If you have the talent to do this job, it’s the most comfortable and easy thing in the world to be a good caregiver.

To be a paramedic, you have to have quick hands, quick eyes and a quick mind. But that is not enough. There are many people who can graduate from paramedic school but who can never be paramedics.

Early on, you often referred to medics as “life-savers” in your writing. Some thought that term reinforced only a small part of what a field provider really does for patients. Do you think that term is still relevant?

If you can keep somebody from falling and breaking their hip, you have saved their life.

If you can keep somebody connected to the medical community, you have saved their life.

If you can keep somebody using their diabetic medications, you have saved their life.

You don’t have to be resuscitating people’s hearts to help people. There are lots of ways to save a person’s life and preserve the quality of their life.

You’ve received many awards and accolades over the course of your career. Is there one particular point of recognition that stands out for you?

I would say my graduation from paramedic school. At the time, if you were in a fire department, it was pretty easy to get into paramedic school. If you were working for a hospital ambulance service or private service, it was almost impossible. I think our graduation class was the first one that graduated any hospital-based paramedics in California.

How has EMS evolved over the past four decades? Where do you see it going in the future?

It’s also been slow. However, there have been some big strides made because of the involvement of medical directors who are past paramedics. They include Art Kanowitz in Colorado. Richard Alcorta in Maryland. Doug Kupas in Pennsylvania. Ed Racht, now the medical director for AMR. Keith Wesley from Minnesota. Dave Ross in Colorado. It was people like them who founded NAEMSP and NASEMSO, organizations that are committed to the practice of good medicine in the field. It’s taken a long time for physicians to exert influence over what goes on in the field.

A lot of people think EMS is public safety, but it’s not. It’s medicine, and medicine comes from physicians.

What advice would you give a young person interested in pursuing a job as an EMT or paramedic?

Have fun. This really is a lot of fun. Remember that everybody you meet in the back of an ambulance is somebody who is not as lucky as you are. You get reminded of that again and again and again. And the kind of people you end up working with tend to be very nice. Also, know that not everything is serious; you see some pretty funny stuff.

You sometimes get the most beautiful letters from people. Certainly, they don’t all appreciate what you do for them. So you keep a scrapbook. When somebody fails to appreciate you, you pull out some of those letters and you readjust your balance.

Some of us refer to that as our TY/FY ratio; the TY stands for “thank you.”

You are known as being a champion for improving patient care. How can EMS do this?

There are many ways; one is to prevent people’s emergencies in the first place. For instance, when we go on a medical call, our crews look in the refrigerator for the absence of fruits and vegetables, for bad milk and things like that. We are looking to see if this person is eating a healthy diet. A lot of elderly people can’t get to the grocery store as often as they want to. So they live on canned or preserved foods, which often contains a lot of salt. If they have chronic heart failure, a preserved-food diet can be the cause of acute heart failure. And that can kill them.

We also look to see if they have a system for managing their trash, paying their bills, managing their medicines. We look to see how aware they are of what their medications are and when to take them. We look at their bathroom to see if there are grab rails or trip hazards. We look to see if they have an animal.

A lot of the elderly live alone, and that animal is their family. A cat can live for a week without food but not water. Dogs and birds have to be fed.

We try to find info about the next of kin, who drives them to the store. A good source of information is the calendar hanging by the phone, so we take that to the hospital with us. These are things you don’t learn from paramedic school or a textbook. These are things you learn from being a good paramedic for a while.

We use a physical environment assessment tool, PEAT, invented by Chris Hendricks, one of our paramedics. It’s a quick form that medics fill out. A low score triggers a return visit from us (a Re-PEAT) to check on their welfare. We spend a lot of our own money putting up handrails and taking them to the store and fixing toilets.

What do you think of the potential for community paramedicine?

I think that it’s absolutely our job, but that “paramedicine” is a bad word. It says medicine is different in the field than it is in the hospital. It shouldn’t be.

Jim Page was an important influence in your career. What leadership lessons did you learn from him that you can pass on to others?

There are at least two, but a whole bunch more. Jim was a very humble man. He knew he was leading the whole country in this new thing called EMS, yet he would sit down and have dinner with any old body and he could remember people’s names for years.

Another lesson was when I was one of the first four staff members at JEMS. Jim always left his door open. I could overhear all of his phone conversations. There were no secrets. I thought, What a healthy way to run an organization.