Team Profile: Chris DiBona, Director of Clinical Quality

Chris DiBona

Q: People interested in EMS careers often ask you, "How do you do what you do; how do you get where you are?" when they meet you. Can you tell the story of your journey to where you are now in your career?

CD: It's about relationships, working hard and doing things that you may not be comfortable doing at the time, so it's all about taking risks. When I was in high school I had a job asphalt paving, but I also had an ambition for automotive. So I worked for a tow truck company that was next to my fathers's shop, a company called Blue Hills Towing, which is a business we still use at Brewster.

  Randolph on Route 24 1991, the wreck that inspired the career

Randolph on Route 24 1991, the wreck that inspired the career

While doing the towing, you go to different accidents and that sort of thing, and there was one accident that really stuck in my head and was a career motivator. There was an overturned truck that incorporated police, fire, the ambulance—they actually landed a helicopter there—and I saw the whole dynamic that was going down. So I said to myself as we were waiting to hook up the truck, "I want to be up there and not on the sidelines doing the cleanup work." I later talked to my folks about it and they said, "We have family business, but whatever you want to do, we'll support you." So the last day of high school was my first night of EMT school at Quincy Hospital (at the time they were teaching an EMT program.) I did a course with them and after I completed my course, I got a job at Fallon Ambulance. The reason I went over there was because my parents had a friend who knew the owners and they thought it was a good place to cut my teeth.

I quickly learned at Fallon that I was in my niche. I really liked it, I enjoyed it and was craving more of it. I reached out to two mentors, who are historically the pinnacle of where I am in my career today. Bill Doherty and Chris Grazioso, who were both paramedics at Fallon Ambulance, were both very open people. At that time when I talked with them, it was unorthodox to do so because there was this stigma around paramedics that you should let them do their thing, because we're just kind of the little guys [EMTs]. But they were guys who were open to showing you stuff and that piqued my interest even more.


I reached out to two mentors, who are historically the pinnacle of where I am in my career today.

So I approached them one day and said, "Hey listen, I'm looking to learn more. I will volunteer my time after work, so can I just come and ride along with you guys? I'll carry your bags, I'll clean the truck, I'll sweep the floors—whatever you need me to do, I just want to get exposed to a different element that we're not getting at the BLS transport level." And at that time, paramedics were very new in the state and these guys were the elite few out there and I wanted to fall into that category at some point. So after working a full shift at Fallon, I went along with Chris and Billy and got more comfortable with stressful conditions by exposure.

  MedFlight 2, in flight

MedFlight 2, in flight

I got to that point in my career where I had about a year or so as an EMT, and I thought now's the time to take that educational approach to paramedic. I was nineteen years old, and it was unheard of because they thought I was too young and inexperienced. I thought, "If I don't do it now, I may never do it." I wanted the challenge. Academically, I'm engaged, the passion is there, the drive is there, so I ended up enrolling into Northeastern University, and by a long shot, based on my age because part of the interview questions were, "Hey you're only nineteen years old, we've never had folks your age in here," but I met all of their requirements to do so, I had a year's experience, I was over the age of eighteen, I met all of the requirements for the school.

At the same point, I was getting indications from my friends that Brewster Ambulance was the place to go. This was back a while ago when they had services up and running initially. I switched over my EMT job to Brewster before I went to paramedic school and went to school full time during the day and worked nights at Brewster full time as an EMT. To help pay for school, I got a loan from my parents because the school was very expensive at that time, so I went through the program.

  Brewster Ambulance Dedham Police Station, circa 1993

Brewster Ambulance Dedham Police Station, circa 1993

After graduating the program, I got a job with Brewster as a paramedic, working in the areas between Boston and Plymouth and the system started to specialize a bit. By then they started putting up non-transport trucks, which were like a two-man Bronco SUV and we'd go out and run these calls with the BLS guys. There were more EMTs than paramedics, and we were a limited resource and were trying to make ourselves available as much as we could to impact the community.

Brewster Ambulance had dedicated a non-transport truck to the Jordan Hospital in Plymouth. I met with the hospital staff for an interview and was awarded a position for the hospital as a paramedic. We serviced twelve towns in and around the Plymouth area with that Jordan Hospital truck, so we were running all over and it was a good time. I found that I was getting good at that, and then South Shore Hospital got two trucks. So I applied at South Shore Hospital as well, and then I was working for both Brewster Ambulance and South Shore Hospital on basically three dedicated SUVs that were doing the paramedic work. I was getting high acuity patients a lot and it was busy, so I was getting a lot better.

  MedFlight Team, circa 2004

MedFlight Team, circa 2004

I was doing that for five years or so, I was right around 25 years old, and I thought, "Alright, what's my next step?" I had a fair amount of interaction with Boston MedFlight, either giving them patients or watching those guys work in Boston when they landed. There was a gentleman named Joe Murray, who was the top flight paramedic for Boston MedFlight at the time. Joe was one of those guys like Billy and Chris. As soon as you met him, he was very engaging. He'd show you everything, tell you everything he knew, he was a wealth of knowledge and information. I recall being in Boston Medical Center one day and Joe came in with a very sick trauma patient. A lot of us read notes off of paper because it's so difficult to absorb all of the information and work and try to regurgitate it after the call to the surgeons and medical staff. Joe came in and gave this tremendous detailed report without ever looking at a note. I walked out of there and I said to myself, "At some point, I'm gonna get to that comfort level."

  MedFlight 2

MedFlight 2

I applied to Boston MedFlight. I was concerned because I thought, "I'm young, I might not be good enough, if I fail and don't get in, I don't want my peers to know, because it'd be like, 'Yeah, well, if they're not taking you, then they won't take me,'" so I kept it hush hush. By the luck of the draw I got an interview. The process took about a year after I put in my application. I kept checking in with them because there were limited positions and they only had one open at the time. I really didn't think I had a shot at it. I had a couple of friends who were working over there that I had worked with in systems previously, so I networked with them a bit, checking in, and then they called me in for an interview.

I sat down with Dr. Suzanne Wedel, who was in charge of the MedFlight program, for my interview. I'd already met with the crew chiefs. She said, "Listen, I'm gonna start it off with this: you're twenty five years old, why should I hire you?" I said, "I'm not sure I understand your question," and she said, "I have people in their thirties and forties applying for this position, what makes you their caliber of individual?" I said, "No disrespect, but what have they been doing for the last ten, twenty years? This is an amazing organization."

It’s about relationships, working hard and doing things that you may not be comfortable doing at the time, so it’s all about taking risks.

She said, "Okay, let's keep going." She started asking me the typical stuff, strengths, weaknesses, etc. I made the mistake of saying that my strengths were pediatrics, for whatever reason I thought was valid at the time. She said, "Really? Pediatrics? Why do you say that?" I said, "I think it's because I don't have children, and I have this ability to focus on the task at hand and not be wrapped up in the emotional piece. I don't know if that's an ability or a curse, but I can turn the switch off." She said, "Okay, let's talk about pediatrics," and she asked me a ton of questions. I talked to her later on and she shared that her goal during that process was to show me how much I didn't know. She put me in an environment of being uncomfortable where I thought I was comfortable. I thought after that interview that I had bombed and that they'd never call me back.

Two weeks later, Charley Blathras called me up and offered me a position with MedFlight. It was one of those feelings of, "Did they mistake?" Because Charlie was the kind of guy to joke around. That was the next career leap for me. I was very proud to be part of a high performance, dedicated team with a real specific mission that was foreign to a lot of people. Not a lot of people get to fly, never mind doing it in what some refer to as the medical capital of the world. 

  Jim Ahlstead and Chris DiBona with their daughters Genevieve and Tia

Jim Ahlstead and Chris DiBona with their daughters Genevieve and Tia

In between when I was working for Brewster Ambulance Service and had just gotten out of paramedic school and was working, I was in a major motorcycle accident. I ended up breaking my back, had a near amputation of my leg, and was out of play for about a year between surgeries and rehab and all that stuff that goes along with a major trauma patient. I was in Mass General for a number of weeks and pretty much out of work for a year, but my goal was to get back into the work force. When I got back to Brewster for a bit, I took a break and moved to Colorado and worked for the City of Denver, spent a year out there and then came back to Boston. It was good experience and good to get into a different environment for a bit. 

  2010 SWAT FBI Boston Division

2010 SWAT FBI Boston Division

I returned to working at MedFlight, plus still worked the non- transport trucks on the street, and then concentrated most of my work at MedFlight. I worked a total of ten years at MedFlight, progressed to senior paramedic, and was doing a lot of public relations, outreach, demonstrations, and things like that. I kind of missed working the street, so Fallon Ambulance Service, at that time (Brewster was in their hiatus), so I went to work for Fallon again in Quincy and loved it. So I was full time on the helicopter, part time in the city. That's about the time that this tactical medicine thing ramped up, and so as things come full circle, I reached out to Chris Grazioso and said, "This is something I want to do, can I build this with you?"

  MetroLEC SWAT Team

MetroLEC SWAT Team

As a result, I ended up spending ten years working for Metro SWAT and in the middle of that we took on the FBI work for FBI Boston doing tactical work with the SWAT teams. The reason I was able to embed myself into these special operations groups was, it wasn't anything as far as being a good shooter or athlete, it was our niche in medicine because these teams needed medical to support them and support people that were injured or involved or whatever it may be. We were using our niche in medicine to progress into all areas that were foreign to medical personnel. It was a good ten year pinch there where I was flying, working SWAT, working marine units doing the operational medicine type stuff. So that was a pretty good stint there and we did a lot of good work.

  MetroLEC SWAT Team after the 2007 World Series

MetroLEC SWAT Team after the 2007 World Series

  Chris DiBona and Steve Wallace

Chris DiBona and Steve Wallace

Now in 2010, Mark Brewster got back in business and he said, "Listen. We're back in business, I'm talking to people in the industry, as I'm making these phone calls, we're looking to fill these positions and a lot of folks told me, 'Have you talked to Chris? That's who you need over there.'" So Mark reached out to me and initially I respectfully declined, because I really was loving what I was doing: flying, working in Quincy and the tactical stuff. I felt that I was not ready for an administration position. I was very active with work and, the typical Mark, he kept calling. He said, "Listen, just sit down and have a cup of coffee with me." He added, "Everybody I've called is telling me, 'you're the guy I need,' and if I can't get the guy I need, I'm not gonna stop until it happens," and he didn't. So, I sat down and I listened to his mission and where he was looking to grow his company, and I said, "I'm sold."

I'd done ten years at MedFlight. Between MedFlight and SWAT,—which is more of a lifestyle than a job—I felt it was good with the growing company and the mission of what they were looking to accomplish that for me, the timing was finally right. So I resigned my position at Fallon and MedFlight and took a full time job with Brewster. It was one of those things that was somewhat difficult because when you're not entirely ready to make a change—you know, a lot of people make a change because they're not happy—but I was making the change for longevity and I didn't want to miss an opportunity that I knew that would get filled and it was a unique opportunity.

  SWAT team coverage for 2007 World Series at Fenway Park

SWAT team coverage for 2007 World Series at Fenway Park

So with that, we progressed to building these systems. What I felt was different about Brewster Ambulance was, the first conversation I had with Mark he said, "I want you to build a clinical product for my patients and we will figure out a way to pay for it." That's unheard of in the industry. Usually it's, "Here's $20K, don't spend a dollar more, and you're never getting any more." So that was a different philosophy than I was used to. And he was 100% honest with that. We sat down and we went through a checklist. We were frugal, we stayed away from a lot of stuff that would have been a waste of money, but we focused on the important stuff that would be good for the patients and customers, and also safe and useful for the workforce.

It was great being on the ground level of the system and watching the success of Brewster and the acquisition of highly qualified clinicians and now we get to the point where the tables were turning and people were banging on our door to work for Brewster Ambulance. It was an interesting evolution that came into play. Like any small company, as you grow with a small company, your roles get packed on. Not only are you a field guy, you're a clinical guy, you're a policy writer, you're a call taker and a dispatcher and a maintenance person and you take on a lot of roles until that infrastructure is underneath you.

 

  Bridgewater rollover

Bridgewater rollover

Q: What was it about your conversation with Mark Brewster and what he was proposing to you that inspired you to make the switch and support what he was trying to create?

CD: There's a level of excitement when you see the ambition and the energy that's delivered by somebody with a passion, and I felt that with Mark. I feel like in the industry, for a number of years, you tend to lose that drive because a corporate feel tends to squash out that drive for patient care. When you see that rejuvenation, when you see that energy, and when it was about going back to the basics, and it was going to be about the patients and about the cleanliness, and about the things we'd strived for over the years that just fell by the wayside because it turned into watching the numbers and watching money and the spending, and, "Yeah, don't wash the truck today we don't need more water bills." That's what I was used to in some of these other programs. That wears on you when you've got a dirty truck, missing hub caps that haven't been replaced in X amount of years and you look at the company and say, "Yeah, you don't care about your equipment and the company, why should I?"

When you see that energy and you see that drive and ambition, it becomes contagious. Still to this day, if I could bottle Mark's energy I'd be a millionaire. I saw that there was a very significant balance that was happening in the company. You had Mark's energy of business and you had George's drive and passion for technology and equipment and then you rope into it the advice of a different generation of their dad. I remember sitting in meetings and George Sr. was like, "Put down your smart phones, your emails your voice mails and everything like that, and get out there and network with people—you have to build relationships." It was a combination of new age and old school that was a dramatic clash of success. Those three individuals are the perfect storm of EMS. There's no other way to describe it. So you start to like a pyramid scheme. Get two people on board. Gets those two people energized and the energy just got contagious throughout the company.

  Chris DiBona flying the Brewster drone (Image courtesy Duxbury Fire Department)

Chris DiBona flying the Brewster drone (Image courtesy Duxbury Fire Department)

It was unbelievable growth. We were working on project after project. For success of the company with aggressive time frames, it was just amazing to watch the progress of 9-1-1 municipality acquisitions and big health system acquisitions, new hires, more new trucks, we'd never seen growth like that in the industry. We have to make this next leap and we have to get into this county. Okay now we're going into Rhode Island. It was like a motorcycle with an unlimited throttle. There was no governor on it. It was have at it. So it was very successful. It was mostly the energy and drive that roped me in from a very comfortable, financially stable place, because I was very happy with all of the positions I was holding at MedFlight and with the tactical units and it was very difficult to leave because I was in a capacity of building those positions. 

 

Q: So was one of the keys to your success how you valued mentorship and put yourself in a position to learn by shadowing more seasoned medics?

CD: I never had a problem dedicating or offering my time for no pay to advance myself. Even coming in at the ground level. Do you need me to sweep? Do you need me to clean up stuff? I felt that if you kept busy, people would recognize that. When you keep busy, it shows initiative. For me, it was all about timing. The non-transport trucks were perfect timing and the MedFlight piece was also timing, maybe it was my demeanor, my attitude, my skill, but I use the excuse that it was the right time.

It was also the fact that paramedics were young in their career at the time. When I started there were only 1,200 of us in the state, and now there are 20-25,000 or so now. We were a limited resource, there weren't a lot of schools that were teaching the course; they were kind of just colleges that were hosting it it was an up and coming career.

I took the approach early, which was unorthodox in my advancement, in my career, to basically train myself to work for the workforce.

Q: What is it about being very focused on the customer, relationships and communication that you feel is an important component of your success?

CD: I took the approach early, which was unorthodox in my advancement, in my career, to basically train myself to work for the workforce. As people progress to supervisor or different positions that may be elite or highly sought after, I looked at it as an opportunity to work harder for my peers. as an opportunity to train them, to help them. I flipped it around and took a totally different approach and said, "What can I do? How can I help you out? What can I get you better at? What do we need to do here?" whatever it might be, and that was a driving success for me to get through navigating the difficult waters of EMS.

  Beth Israel Deaconess Plymouth medical simulation

Beth Israel Deaconess Plymouth medical simulation

I understood that for the general public, EMS was a mystery, so the more they could interact, talk and ask questions and get folks that weren't standoffish and trying to intimidate, the more successful you were not only with the community, but with your coworkers, with municipalities, with patient's families and things like that. So in my dramatically different approach to it, I was trying to break down borders. Some of the borders in EMS were, "Alright I'm gonna hoard information, I'm gonna look better than the next guy, and I'm gonna show them how much they don't know." What I did was a different approach. I was, "Hey come on over here I want to show you this thing." I wanted to share information to make the group stronger, and we did that successfully at Brewster Ambulance. We broke down barriers so that our interpersonal skills within the company allowed people to succeed. It's not to stifle them, it's to watch them thrive. That different approach of  "I work for you," has been one of the biggest successors with getting met through.

With that being said, too, when you get to certain levels in an organization, is you can't stop caring about people. Especially your coworkers. If there's something important to them, you need to make it important to you. They're still people. They may be people that work with you or for you or whatever it may be. They have good days, they have bad days, they have strengths and they have weaknesses and you have to learn how to navigate those waters to watch them thrive.

  Opening day in Quincy

Opening day in Quincy

The other thing I wanted to do was I wanted to get myself into a position where I could always support someone I was with. I never wanted to be the individual without the answers, not that I have all the answers, but I wanted to be the person they could be candid with. Someone who was approachable. If you have an aggressive posture and you dismiss people like, "I can't believe you don't know that!" A lot of people will do that because they don't know the answer themselves, but I have no problem saying, "Man, I have no idea what you're talking about, but let's look it up together," or, "Let me find out what you're talking about and get back to you," whatever.

I think that people appreciate honesty. I wanted to expose people to more stuff and take that opportunity to say, "Hey, come over here let's do this together," I'd never put any of my folks here in a position that I wouldn't put myself in, whether it's a new piece of equipment or new protocol. If there's some new equipment, I'll be the first one to train on it, let's do it together. If there's something I'm good at, let's get a bunch of people up to speed, let's share the wealth with this thing. It's only going to make us all look better in the long run.

 

  Adam Shanahan and Chris DiBona Tactical Paramedics on protection detail with Congressional Medal of Honor recipient James C. McCloughan

Adam Shanahan and Chris DiBona Tactical Paramedics on protection detail with Congressional Medal of Honor recipient James C. McCloughan

Q: Where did you learn that approach?

CD: I realized early that the empty barrel makes the most noise. The people who were humble and worked behind the scenes were actually your work horses and not your show horses. You can get a lot out of just listening to people and I could pick up who would and who wouldn't be able to help me in my career. One of the most important pieces that I have to reiterate is that you have to start and work your way up. You just can't jump into uncomfortable positions without a foundation to build off of, and that's what we want to do is give people the opportunity to experience different things to see what they like because there's a lot of good opportunities.

 

Q: any last thoughts?

CD: Pay it forward. If I'm the success story of a kid out of Quincy who accomplished this, there's another generation coming in who can tap into this. I approached four people over the last couple of years and told them, "I wouldn't be doing what I'm doing if it wasn't for you." I said that to Chris Grazioso. Had the same conversation with Billy Doherty. Dr. Wedel, who passed away two years ago from ovarian cancer, all of us from the MedFlight community went to her home town for the memorial services. I ran into Joe Murray there and said to him, "I just wanted to tell you that you are an inspiration for us when we were younger and cutting our teeth and as we watched you work, that job spilled over and I've accomplished what I've wanted to accomplish." It's important to embrace those opportunities because it's important for those folks to understand the impact they've had on the community growing up in the systems. It's important for them to know that they left a good legacy and promoted the next generation of Chris Graziosos and Joe Murrays and Bill Dohertys and Jim Ahlsteads.

  Tactical medical support for armed gunman in the woods, October 2017

Tactical medical support for armed gunman in the woods, October 2017

The most impactful bosses I've also had were attention-to-detail women. Dr. Wedel, Jane Stiles at Jordan Hospital, they were women leaders in their career—they weren't in the 'good ole boys club'—they were all about the business, the product and performance, and they were black and white—there was no gray. They had high standards and expectations and had no tolerance for the behavioral issues or tardiness. It keeps you on the straight an narrow.

Lastly, one thing I've noticed that's different is that today the young guys seem enthralled with technology. There's no limit with what we can do today. But back when I first started, we didn't have the tech they have today, the cell phones, laptops, internet. We were reading articles and literature and we were designing small pieces of equipment to make our jobs easier. We would pre-plan for things, lay out things and make devices out of different tubing for securing devices when we needed them hastily. So our days were spent designing, crafting and improving efficiency and learning medical where today's work environment is, "Hey, I'm gonna check out my stuff and then go on the internet," it's for entertainment. Ours was different; we were embedded in it. I'd like to see a change where we have more of an education-consistent environment as opposed to an entertainment environment. It will only add value to what these guys can do out in the field and in their careers as they advance in EMS.