Saturday, January 31

Ricky Rescue gets hitched

Each Department has a Ricky Rescue. The guy who reads ALL the magazines, has every tool in their truck, maybe even has an old Hurst set in their pick-up, because "You never know..."

These are the folks that buy anything and everything with a fire helmet or a Maltese Cross on it. Their vehicle is covered in stickers and there is probably a switch in there that makes lights flash.
They wear their Department shirts, in their response area, off duty. You get the idea.

As a second generation Fireman, when I was married, I had Maltese Cross cuff links. A simple, understated, nod to those I served with and that came before me.

But who is supporting the market for these items at Firefighter Weddings?
Colorado Carla, who I can only assume is the creator of these items, has quite an imagination.
Here are some of the items I think are hilarious: (All pics credited to




Not only is she dragging him by the collar, but look at his fingernails! And the scratches he's leaving! Awesome.


Nothing says "I want to spend the rest of my life with you,"
like a hatchet with a cake beneath it.

There is a fantastic variety of items to make your wedding personalized and most of the items are very nice. There are basic cake toppers, napkins, matchbooks, the usual stuff all emblazoned with your name and date and a neat logo.

But in all reality, is anyone going to use this?
Aside from Ricky? On the whole, great concepts, but this ring pillow officially goes too far.

Thursday, January 29

...for the code 3 transfer...

In our system, like many, the private ambulance companies in the area handle most transfers, but when they are out of rigs, they can reclassify a dialysis patient as a critical care cardiac patient to get out of their contractual requirement. Or there could be an actual legitimate medical emer...Oh who am I fooling.

A local private ambulance company (I'll call them F&B) has called in a request for a transfer, stating the patient meets code 3 priority status, which requires 911 activation.

I can get you to the ER. I can get you to Pediatrics. I can get you to L&D in a hurry using the big elevator, should you need the extra room. I know where that hidden door button is to get into the cath lab. I can find most places in most hospitals, but when our instructions were to the Critical Care unit, I got curious.

We made our way up to the unit and got the usual hospital staff response. We were ignored. Often when ignored in the ER, we park the gurney so nurses have to find a new way out of the nurses station. So far no one has jumped the counter, but I've seen a few consider it.

Ignored and feeling lonely, I ask if anyone called for an ambulance. Nothing.

A physician approaches us doing a strange walk looking from us, then back over her shoulder down the hall, then back to us.
"Are you here for Mr Johnson?"
"We're here for a medical emergency. Did anyone request a private ambulance recently?" I offer to the entire room.
"I called for a transport for Mr Jones, but he just left for CT. He won't be back for 30 minutes." says a Doc barely looking up from a computer monitor.
"Did you request the ambulance code 3, lights and sirens?" Asking as I approach him.
"Yes, critical abdominal injury, we're going to operate tomorrow morning at Saint Farthest." Checks his watch, "I need to get a move on. The nurses can fill you in when he gets back, thanks."
And away he went. Not believing we had the correct patient I called the ambulance company mentioned on our data screen and, sure enough, the guy we were sent lights and sirens for is in the CT scanner.
Not to waste time, we notified dispatch of our situation, then filled out all the paperwork we could from the gentleman's face sheet.
35 minutes later, and ambulance still parked blocking the main entrance to the hospital, the nurse returned with Mr Jones who looked at us and frowned.
"You guys aren't from F&B, where's my crew from F&B?" he asks.
"They're a bit busy today, decided to upgrade you to 911 status."
"You aren't scheduled to pick him up for another hour, he still has to give labs," the nurse tells us.
"Maybe someone missed something here. We're here to get him right now, we've already waited too long. If he's not urgent or even ready to go, I'm going to have to leave and put him back in line."
"Fine, sorry to bother you." She snipped from behind the hastily drawn curtain.
I wish I had my own to slam shut as we push the gurney back out.
We left and never had to come back. Found out later an MVA happened near our station and a unit had to come from across town.

Wednesday, January 28

Chuck Norris doesn't call 911, 911 calls Chuck Norris

I always got a roundhouse kick to the face out of these Norrisisms, but never realized there would be a definitive collection of the best.
Then I stumbled on Chuck Norris Facts

My favorites:
Chuck Norris can kill two stones with one bird.
At the end of a long night of drinking Chuck Norris doesn't throw up, he throws down.

Have a favorite not mentioned on the list? Drop it in the comments section.

Happy Norrising, have a chuckle,

Your Happy Medic

...for the fall...

I was back in a house I haven't worked in for a while and saw a memento from the old days and wanted to share.

Imagine you're on vacation, sound asleep in your crisp white sheeted bed in a luxury hotel. Then, while you're dreaming of never going back to work, you are awakened by a revving chainsaw at 3 AM. Then you hear the blades ripping through a door and a woman screaming. Scary? No, all in a days work.

A local hotel reports a woman has fallen in her room.

Escorted up and into the quiet hallways we're met at the door by a clearly tired middle aged man and his teenage children. They explain that their mother has not been feeling well and has possibly fallen in the bathroom.
We make verbal contact and she is alert and uninjured as far as we can understand, but she tells us her back is in so much pain she can not move. As we begin to open the bathroom door she screams in pain and begs us to stop moving the door.
We take a step back and rethink the situation. The door opens inward and we have no access to the pins and there is no other access to the room.
Then one of the firefighters gets a smile on his face. Not a word passes between us as I smile back. The boss asks what we have in mind and I tell him.

"We're going to chainsaw the top half of the door and climb in to extricate."
The hotel manager turned the same color white as the walls.
"You can't damage our property like that." he whispers, confused.
"You called us, my guys will do whatever they need to do." the boss shoots back.

The saw is upstairs after a few minutes and we tell the patient what she is going to hear and feel. We're cutting the door just above the middle hinge so we can open the top without anything falling on her.
"NOOOO!" she is screaming, "Just let me lay here!"
We tell her if she can simply move a bit we could figure out how to get in, otherwise our solution.
The boss made the decision for her. "We're coming in!"

The look on the manager's face will never leave my mind. His jaw slacked as the firefighter began to throttle up and make the cut. It was a hollow core door, but made a big mess. Less than 30 seconds of cutting yielded a space just big enough for me to climb in and into the bathroom.

Our patient was screaming that she'll move now and we smiled. Now she can move. We got her out and off to a physician for a checkup. No drama there and no injuries, just an old back injury kicking in while she was resting in the john.

After we got off shift I decided to return to the scene of the crime and see if we could get the door. It now hangs in the firehouse with our autographs on it and a brief description of the incident.

Tuesday, January 27

...for the alcohol intoxication...

Somewhere along the line "drunk" became an emergency. I guess someone let someone else sleep it off and they sued. Can't think of any other reason. Fortunately it gave me the opportunity to gauge when you've had too many.

The PD are on the scene of a woman who is screaming at the top of her lungs, "It's going to kill me! Get it off! Get it off!"

I have to hand it to the boys in blue. Either they can keep a straight face better than I can, or they stopped laughing before we arrived.
Our "patient" is indeed well under the influence of the fire water, lying supine on the floor of her little apartment. We down shift seeing there is no immediate life threat.

When I ask what the trouble is, the officers tell me, "Just wait until her arm starts moving."

So we waited nearly 2 minutes when her arm began to slowly rotate, her nervous system clearly experimenting with proprioception. As it began to noticeably move along her chest, where it had rested until only recently, she began to take note.
The look on her face was similar to those movies you see from the 40s where they tell the actress, "look horrified." Her eyes grew so large and she tried to wiggle away on her back, but ended up simply making her own arm move more. As she writhed in horror to escape this threat she began to scream what made her neighbors call the police in the first place.

"Help! It's going to kill me! Get it off! Get it off of me!"
I reached down and gently moved her hand away from her chest and smiled.
"Thank you," I remember her saying. I wanted to say something about the fact that if this was the hand that poured all that liquor down your throat, it is killing you, but I didn't.

I did, however, learn the cut off between drunk and DRUNK. When you think your own body is trying to kill you, you are DRUNK.

Monday, January 26

Grab your mower, let's party!

It seems that not only are the folks responding to the calls blogging, so is the Dispatch Center.
Smooth Operator has just started out and so far the posts are short and sweet, but he (she?) posted some collected video that is good for a chuckle.

It seems this fellow has been in trouble a few times, but his mode of transportation is just hilarious.

Take a look: Are you serious?

Sunday, January 25

...for the vehicle fire...

So many dangers these days with flammable bumpers, exploding pistons and a full load of cardboard...wait...say that again?

A passerby has noticed a pickup truck on fire on a residential street

It's late at night and we arrive to find a large pick up truck built up in the back to transport large amounts of cardboard for recycling, rolling pretty good. As the officer calls for the bumper line I look over to the firefighter on the other side of the engine and see an empty seat and an open door as the engine rolls to a slow stop. As usual, I don't move until I hear the brake. It's a habit.

He's out in front struggling to free the bumper line so I decide to check the cab of the truck, more out of curiosity than anything else when I see a head, connected to a body, resting on the open window edge of the door.
"Hey!" I call to him with no response. I realized later that if the siren didn't wake him, my voice won't.
I open the door and pull him out into the quiet street where the boss watches over him.
The other firefighter is just beginning to stretch the line as I return to help with the layout. Looking over the driver is fine, rubbing his eyes, clearly tired, but uninjured.

It took almost an hour to pull all the cardboard out and soak it down. The fire was intense and burned a lot of cardboard but, amazingly, the truck was rather unscathed, aside from a little discoloration.
"Why so fast out of the engine?" I asked later as we were loading up.
"Wanted to beat you to the nozzle." Was his smiling response.
"You can have it if you promise to wait until the engine stops to get out."

He never replied and I'm sure still jumps out first chance.

Saturday, January 24

...for the code 3 transfer...

Ever walk in a room, recognize a patient and wish you had taken that job at the car wash? Erma has been visited by her home health care physical therapist and...well...that's when things got interesting.

A care taker has called 911 requesting a code 3 transfer for a not alert patient.

Usually this call is for a doctor's office at closing time when they need to clear out the waiting room without rescheduling everyone. But this house is familiar as we pull up in the fire engine after running red lights and opposing traffic after being told this was a life or death emergency. We arrive to Erma on the couch, no distress, and her very vocal middle aged daughter.

"You reported an emergency?"
My standard opening is met with a symphony of responses.

Symphony is the wrong word, that implies order and beauty. A barrage of noises attack me before I can put my bag on the ground.

"I called you," says the woman with the cell phone to her ear and a stethoscope around her neck, "I'm her nurse and she seems to be neglected."
The daughter takes issue with this and begins to scream that the nurse is crazy and Erma is fine where she is, she just needs her exercises.
"Are you the physical therapist?" I ask relaxing with hands into pockets while the EMT confirms Erma is not in distress.
"Yes, this is my first visit and she is clearly altered and look at her mouth, its dry."
"Hello!" I hear Erma behind me "Are you with the Fire Squad?" she seems appropriate to me and that's when the room begins to look familiar. I've been here before.
"Did your mom fall out of bed last week, early in the morning?"
"Yeah those men took my mom in and were so nice to were took her in, you look different rested." I smiled.

The physical therapist is on the phone to someone and I need more information. She hangs up and looks at me like as if she's in charge.
"You called this into your agency and they called us or how did this evolve into what we have now?"
"I called you directly because I need her to get evaluated. She's clearly being neglected."

Again the daughter erupts. My engine officer is able to pull her into the other room and I have a chat with the therapist who strangely has left all her business cards at her office. I explain to her that we are not a contract van service and that her agency can arrange for non-emergency transport to a physician. Then she lays out the truth:

"I can't wait here for a van, I have other patients to visit today."
"So do I."

In the background I hear, "I want to go get checked and make sure everything is alright." Erma speaks and breaks the tension.

The ambulance arrives and packages her for the trip to the busy ER, the one we heard on the radio was only recently turning patients away due to overcrowding, but is now forced to accept ambulance patients.
As we loaded Erma, the daughter followed the therapist to her car and demanded her contact information.
I'm sure I'll see them again. All 3 of them.

Friday, January 23

We have a plane in the water!

US Airways flight 1549 averted disaster in January of 2009.

Amidst all the news coverage of this event was little about the nuts and bolts of the emergency response and understandably so.
I was glad to get this dialogue emailed to me earlier today and it opened my eyes to the difficulties of an evolving, and moving, major incident. This is long, but is a great learning tool for anyone taking ICS 400 or above.

I tried to confirm this information and came across some great pics and account of the rescues at the Bravest including the above pic.
A number of audio versions of this information are on youtube.

Location: Hudson River @ W50 st

15:34 hours
Phone Box 868 - Report of a plane in the water
Engs. 54, 34, 65
TL21, L4
Battalions 9
Rescue 1
Squad 18
Tactical Support 1
Marine 1 Alpha

15:35 hours
Also receiving reports of plane in the water @ Hudson River @ W83 st.
Multiple calls received in the Bronx reporting a plane with engine fire.
Queens in contact with LGA tower reporting a plane with a bird into the
E76, TL22 assigned to W83 st

15:36 hours
Rescue 1 to Manhattan, urgent! Plane in the water with people out, we're
launching our boat!
E23 available assigned in

15:37 hours
Rescue Battalion: Start a second rescue.
Rescue 4 S/C

15:37 hours
Battalion 9: Have all units respond to the Intrepid, that's where Rescue 1

10-60-868 - 15:38 hours
Battalion 9 to Manhattan, Urgent! According to PD we have a major airl
iner in the water, possibly a 707, give me a 10-60!


10-60 Major emergency (Bldg collapse, train wreck, Etc.) 8 Engines,
5 Ladders (one being the FAST Unit), 6 Battalion Chiefs (3rd due
chief is Safety Officer; 6th due chief is Resource Unit Leader), 2
Deputy Chiefs, 2 Rescue Companies, 2 Collapse Units, 2 SOC Support
Trucks, SOC logistics van, Squad 1 with is Technical Response
Vehicle, 1 additional Squad, Rescue Battalion, Haz-Mat Battalion,
Safety Battalion, Field Communications Unit, Satellite Unit with its
associated Engine, RAC Unit, and a Mobile Command Center). Also, a
Battalion responds and meets NYPD Aviation to provide Air Recon.

Engs. 8, 21, 40, 16
E9 w/ Satellite 1
E93 w/ Mobile Command Center 2
L2, L16
TL35 is the FAST truck
L25 w/ Collapse Rescue 1
Collapse Rescue 4
TL7 (SOC Support Truck)
TL1 (SOC Support Truck)
Battalions 10. 11
Battalion 6 (Safety Officer)
Battalion 8 (Resource Unit Leader)
Battalion 4 (Planning Sections Chief)
Battalion 58 (Air-Recon Chief)
HazMat, Safety, Marine Battalions
Squad 1 w/ TRV
HazMat 1
SOC Logistics
SOC Compressor
Divisions 1, 3
Marines 1, 6
Command Tactical Unit

15:38 hours
TL21 to Manhattan, Urgent! The location of the plane is 43 and West Side!

15:39 hours
Marine 1 to Manhattan, this is confirmed! You have a commercial airliner
in the water, 2 ferries alongside, Marine 1A is pulling up alongside,
Marine 1 is responding as well.

15:40 hours
BC9 to Manhattan, Urgent! We have a commercial airliner down, ha ve all
units respond to Circle Line Piers, we have people on the wings, we have a
Circle Line Boat pushing it to the pier.

15:42 hours
BC9: We're going to use the Command Post at the end of Pier 83

15:43 hours
Division 1: Have All-Units respond into 42 st, Pier 81.

15:44 hours
Marine 1: Tide is moving downtown.

15:46 hours
DC1: At this time, we have an FD command post set up at Pier 81 opposite
41 and 12th. We have a US Airway Jet, approximately 60 passenger Jet, we
have Circle Line ferries circling the plane, it is drifting south at this
time, right now south of 41st and 12th.

15:46 hours
DC1 to Manhattan, Urgent! I want all the Marine Units responding on this
incident! At this time we have numerous people on the wings on the plane,
we have numerous Circle Line ferries surrounding the plane, FD units are
jumping on additional ferries.
Marine 9 w/ Rescue 5, E153, TL77, Battalion 21 S/C

15:47 hours
DC1: Have Division 3 s et up a secondary command post at the tip of Pier
76 (W36 st)

15:48 hours
Car 4A (AC Robert Sweeney, Assistant Chief of Operations) is responding.

15:49 hours
DC1: We want FD units to respond to Pier 76, all command units respond to
Pier 81

15:50 hours
Battalion 6 is 10-84, already designated the Resource Unit Leader,
Battalion 8 re-designated the Safety Officer.

15:51 hours
DC1: We want a Major EMS response to both Piers. First boat loaded with
passengers is heading to Pier 81. We have reports of 146 passengers on the

15:52 hours
Coast Gaurd reports 4 ferries and 1 cutter en-route

15:53 hours
Car 4A: Notify Division 1 as per FDOC there are 146 Passengers and 5 crew,
total of 151.

15:54 hours
E14: Notify Division 1 we're at the 33st Heliport, they're directly
opposite us now, it's a perfect place to land boats.
E14 assigned

15:56 hours
Car 9 (DAC John Sudnik, Queens Borough Commander) is respo nding to DC3
command post
Car 11(DAC William Siegel, Chief of SOC) is responding

15:59 hours
L10 acting 24, as per Division 3, we'll be operating at W33 at the
Battalion 1 acting 9 S/C to the 30th street Heliport
E1 S/C to 30th street Heliport

16:00 hours
Rescue 3 is relocating to Rescue 1

16:03 hours
L25 w/ Collapse Rescue 1 is responding to 41 and 12th
L116 w/ Collapse Rescue 4 is responding to Pier 76

16:03 hours
DC1: Have all Chief officers switch over to command channel 2.

16:03 hours
FDOC reports plane took off with 21800 Gallons of Fuel

16:04 hours
Marine 9 has a 30 minute ETA responding with Rescue 5

16:05 hours
Car 9: Have TL35 respond to with their water gear 41st and 12th, also
special call another FAST truck to 36th and 12th.
Marine 6A is responding
TL22 acting 12 S/C as an additional FAST Truck

16:06 hours
Car 11A (DC William Seelig, Chief of Rescue Operations): W e're responding
to your 10-60, advise the Chief of Rescue Services the Scuba Support Van
is responding from Fort Totten.

16:09 hours
E9: We're at 40 and 12th, pier 79, we have approximately 30 people here no
one seriously injured, if we can get some blankets over, everyone's
soaking wet.

16:10 hours
Car 12 (BC Stephen Raynis (Acting), Chief of Safety and Inspectional
Services) is responding

16:11 hours
The staging area is W42 st and 11 ave

16:13 hours
Marine Battalion: Marine 1 and Marine 6 have lashed the plane to ensure
the remaining fuel and engine do not break away, notify Coast Guard.

16:13 hours
Car 12A (Executive Officer of Safety and Inspectional Services) is 10-84

16:15 hours
Car 11A: Have the SOC Scuba Van respond to 42 and 12th

16:15 hours
SOC Scuba Support Van: Be advised we have 5 confirmed divers on board at
this moment.

16:18 hours
BC1 acting 9: We're at the Chelsea Pier. We're with Divis ion 1, we're at
the end of the Chelsea Pier at the Command Post at Pier 61

16:20 hours
FieldCom: As per DC1, the pilot stated he got all the people off the plane
onto the wings, and the pilot was dropped off at Pier 76. At this time we
are attempting to ascertain the number of people and injuries. As per the
pilot there is noone left on the plane.
BC1/9: There is noone operating at the heliport, the plane has drifted
south of that area.

16:21 hours
FC: Have the Planning Unit respond to W41 st and 12th
IMT Planning Vehicle is responding
L116 (Rescue Collapse 4 support) is responding.

16:23 hours
Battalion 58 is airborne with a 5 minute ETA

16L23 hours
DC1: Be advised Division 1's command post is now at Pier 61 (23 st @ West
Side Highway)

16:24 hours
Division 6 is relocating to Division 3

16:27 hours
Manhattan requesting a rundown of which company is at which location

16:26 hours
DC3: At this time at Pier 76, I have TL22, he'll be appointed contact at
this time.

16:27 hours
DC1: I need an EMS supervisor to assist me at Pier 61

16:28 hours
Rundown for Pier 76: W36th st and 12th ave
Collapse Rescue 4

16:28 hours
Marine 9 gives a 20 minute ETA.

16:35 hours
DC1: We are still waiting for an EMS Supervisor at Pier 61.

16:40 hours
E9 is at the Waterway Building (W48 st) with approximately 54 passengers,
2 were taken to the hospital.

16:43 hours
Marine 9 is 10-84.

16:45 hours
Nassau PD and Jersey City PD reports each has a helicopter at the 30th st

16:49 hours
PD is requesting a representative at W34 and 12th ave

16:49 hours
FC: Assign another battalion chief, we're moving our command post, it's
heading south.
Battalion 46 acting 7 S/C as "PD Liaison"
Battalion 14 acting 8 S/C as Staging Manager

16:57 hours
E1 is 10-8

16:59 hours
BC1/9: We're being directe d with TL1 to respond to Pier A.

17:10 hours
As per news report from US Airways:
Latest reports are that US Airways Flight 1549, an Airbus A320, flew into
a bird or flock of birds and lost both engines shortly after takeoff from
LaGuardia Aiport over the Bronx while en-route to Charlotte, NC. The pilot
was unable to return to the airfield and instead managed to successfully
crash-land in the river. All passengers are reportedly accounted for.
Majority of injuries are hypothermia-related.

17:14 hours
DC3: Get in contact with Mobile Command, have them respond to Battery Park
Pier, we have the plane tied off now. Can we also get 2 engine companies
down here, we need them to stretch 2 foam lines, we're at north of Murray
St, right at the pier.
Engs. 205 acting 10, 7 S/C

17:17 hours
DC1: At Pier 81, we have Battalion 8 and 2 engines committed there. We
have no units left at Pier 76, have Collapse Rescue 4 take up from there
and head down to Battery Pa rk City.

17:19 hours
L25/Collapse Rescue 1 are 10-8.
Battalion 58 is returning to Brooklyn.

17:24 hours
Battalion 8: We have 14 passengers remaining at this location (Pier 81)
that require transportation back to LaGuardia. We had 20 passengers, 6
transported by EMS.

17:26 hours
Car 9: Have E205 go to Battery Park City and just go to the water, they'll
see us there.

17:28 hours
Car 9: The aircraft has been secured, it's being secured to the sea wall
opposite Battery Park City, 2 precautionary handlines are being stretched.
Division 3 will be radio contact, Car 11 will be Incident Commander

10-86-868 - 17:33 hours
DC3: Transmit a 10-86 (Fleuroprotein Foam Operation), we're going to need
some more foam units down here.
E5 w/ Foam 5
E95 w/ Foam 95
E238 w/ Foam Tender 1
Battalion 31 (Foam Coordinator)

17:33 hours
DC1: I want all agencies to respond to River Terrace off of Warren St on
the water.

17:44 hour s
The NTSB advises that no FD members are to enter the plane.

17:49 hours
FC: Have an EMS Supervisor respond to Murray and River View Terrace.

17:52 hours
E9: Advise all units coming in on the 10-86 to come in on Warren as close
as they can to the water.

17:52 hours
At this time, as per news conference with the mayor, victim tracking is
still in progress. It is believed that all passengers got out and were
picked up by a variety of Circle Line, FD, PD, USCG, and civilian vessels.
It is believe that most were recovered to Manhattan, with some to New

18:04 hours
Battalion 10: Could you 10-10 (get location of) L16, I have one of their

18:08 hours
E238: Have an ambulance respond to Murray and West St, we have an injured

Currently Operating @ Battery Park City:
Engs. 7, 205 acting 10
E9 w/ Satellite 1
E5 w/ Foam 5
E95 w/ Foam 95
E238 w/ Foam Tender 1
Battalions 9, 10
Battalion 31 (F oam Coordinator)
Divisions 1, 3
Rescues 1, 4
Squad 1
Marines 1, 6, 9
Tactical Support 1
Mobile Command Center 2

Currently Operating elsewhere:
Battalion 8

How did we get here?

What are we doing anymore?

Not an entirely rhetorical question, but looking back over the last few dispatches I've been on, it's a fair question.

What is the role of Emergency Medical Services in the 21st Century?

We were born of the traumatic injuries of the 50s and 60s, adapted from the battlefield surgeons of old. We were given basic skills, then basic tools.
Then the emergence of advanced cardiac care. We became the first link in the Chain of Survival and evolved from ventilators and thumpers to vasopressors and antiarrythmics. We can create artificial, clinical life and, in some cases, perfuse tissue until advanced care can take over.
We started as funeral home drivers, then ambulance attendants, then technicians and are now on the verge of being recognized as a legitimate profession, not just a trade school certificate.
We have evolved by setting training standards, publishing journals and lobbying politically for this new profession, the one we chose to advance by doing it to the best of our ability.

And then something happened. Something slowly, so as not to alarm us or give us a chance to object.

EMS became the catch all for everything lacking in the Health Care system. We're the hospice nurse after hours, the 2 AM taxi driver. We're the solution when the question defies reason. It used to be "I don't know what to do, call 911" now it's "I want to goto the hospital, call an ambulance."

Ambulances and by extension, those resources that respond with them, are being called to extend aid to the homeless, the elderly, the disadvantaged, not the sick or injured. When I took this job I knew that people of all races, creeds and economic status would need our services and I treat each one with the respect I would want to receive.

The car accident, the allergic reaction, the choking, these are our patients.
The hungry, the tired, the alone, they are our fellow citizens, but not our patients.

But what about those who don't need us? Those who simply have no other recourse or way to receive assistance, whatever their issue may be? The woman who can't stand up when she sits down too far from her walker? The man out of breath at the top of the flight of stairs not because of his asthma, but because of his obesity and poor exercise habits?

They call us knowing full well it is against the law for us to deny them care. I have been told to my face by persons who requested our services (not patients by definition) that my job is simply to drive them to a doctor. I take a deep breath smile and do it, knowing they'll never listen to reason or wait in line like everyone else to get an appointment.

Many may wish to blame immigrants. People not paying into the system who are perceived in the news as clogging the system. I happen to work in a municipality that is very lenient when it comes to enforcing immigration and I see few of them.

It is those who believe they are entitled to a level of care they do not need that are clogging the system and it is, I fear, too late to change the mindset they have adopted.
I see their children watching, learning that no matter how you mismanage your affairs or ignore your health, no one will tell you otherwise.

I'm really happy to be where I am. I worked very hard to get this job and chose it specifically because it is still a Fire based transporting agency. I love my carreer and am proud to work with other professionals on a daily basis, bad apples aside.

At the rate our responses are growing and the impending retirement of the baby boomers, when will Emergency Medical Services be reclassified as such? If there was a Routine Medical Technician position, I would not put in for it.

If we don't get a handle on what the public expects from their emergency responders, I fear in 10 years time we will be giving psych evals and family counciling in the back of the ambulance instead on focusing on the reason we exist in the first place.

We are the insurance policy. We are the only ones who can do what we do and are asked more each day to pick up the slack of other agencies while seeing our own budget cut.

I don't have the answer. We may never have an answer, but when will we begin to speak up against the blanket policies that require us to act when our action is not needed or being blatantly abused?

Call this a rant, a complaint, call it the random ramblings of a misguided almost burnt out medic, but I'll still be at work next shift, an hour early with a smile on my face because I know as bad as it gets, it can always get worse.

I could be back making tortillas for $4.35 an hour.

Your still Happy Medic

Thursday, January 22

How could this accident have been prevented?

First off, I have a new source for amazing fire photos, First Due Fire Photos
, which is where I saw the following image taken at the scene of quite a fire in Ansonia, CT.
The image is part from a series taken by the gentleman noted in the photo, which includes a dramatic bailout from a third floor amidst heavy smoke.

No doubt this was a tense situation and the life of a brother was at risk, but while looking through the photos, this one grabbed me right away:

See the whole series HERE

Even though from the comfort of my laptop and having plenty of time to guess that is a cable TV line I'm not going to touch it. I don't care if the utility guy himself is touching it and not dead, any wire overhead is there for a reason.

Now before everyone starts posting that I'm wrong or overly cautious, look again at the other wire nearby that they already passed or are about to pass. Think they'll grab that one too? No one was injured as a result of this, at least not reported, but is this a habit to get into?

Helmet off to the folks who thought fast to get a ladder to the white helmet bailing out and control the fire to the best of their ability, but this is an accident waiting to happen.

Wednesday, January 21

Your vehicle is unsafe to operate

We just wanted an oil change.
Turns out the reason Medic Van 99 has felt rough recently was only visible from below. Part of the frame was cracked. We look for the obvious stuff, sure, but mechanics we are not. What do you think this is Boston?

So the oil change guy at the City yard tells us the vehicle has been "Red tagged" and is not safe to operate. Then he gives us instructions to drive the red tagged ambulance to the mechanic's yard a few blocks away. OK.

When we arrive at the mechanic's yard, they have no spare ambulance for us. "You'll need to drive over to the ambulance storage yard and get a relief piece, then bring it back." We're told.

This is too priceless. So I had my buddy in the seat snap a pic. It's not the clearest and I still have my helmet on, but you can just make out the tag as we're driving along.

...for the unknown medical...9:13

The ever exciting Unknown Medical Aid. We just cleared a very unhappy bicyclist and were on our way to an "unknown bleed, getting interpreter." Great.

There may be blood.

Not getting any information about people shouting or blood from, say, a bullet passing through living tissue, we proceed into the basement unit in an older part of town. As we enter we see the religious artifacts that tell us our patients are from south east asia and looking at my partner, who is whiter than white bread, I know we'll have trouble communicating.

The little old woman meets us first, pushing past without so much as a glance, simply shouting something about "tongs" and "has." We continue back through the hallways of the unit to find a computer room inhabited by 12 year olds playing games.
"Who wants to be a hero today?"
Not even a glance. They're not even playing a game I recognize. No Halo, no Super Mario Brothers, not even a Circus Atari.
"Who's the oldest here?" Hoping I can get someone to rat out someone else.
A hand rises and we grab him as an interpreter.
Turns out grandpa has had a nose bleed for a few days and grandma wants him to go to the hospital to get checked out.

Thing about nose bleeds is, they tend to bleed either from trauma or hypertension and keep bleeding as a result of...trauma or hypertension. Blood thinners aside, and since he gets all his medications at the local pharmacy, labeled in Chinese, I'll assume both to be true as we enter the bedroom and find him.

And no blood.

No bloody towels or tissues, even his nostrils are clean. His shirt is clean, his pillowcase is clean. I ask the kid to tell me when it stopped bleeding and he relays the patient's answer.


"Why am I here today?" I'm interrogating a 12 year old about a 70 year old. Only in EMS, right?
"He needs to get it checked and no one here can drive him to hospital."
It dawns on me then that we've been activated for a ride. Taxi 99 responding...
Not in the mood to argue the merits of the situation through a 12 year old, we grab grandpa and get moving. I was staring at the strange shapes on his medication bottles and wondered what they were, homeopathic or engineered.

Didn't lose a drop on the way in.

Tuesday, January 20

Pedestrians are funny

Usually its my patients that bring me the greatest thrills, but so far today (I'm again here at Medic 99) our best chuckle was from a pedestrian.

While returning from an actual legitimate run (I know, Oh my god!) we went through a trendy part of town to girl watch, um, check for road closures, when we noticed a car in the middle of an intersection. In this area there is a large above ground trnsit system and the car is almost blocking the tracks, but the train operators seem to get by just fine.

As we approach, curious, we see the man standing in the crosswalk, facing the car, mere inches from the bumper, jaw clinched and shaking, just slightly, holding a grocery bag.

We are able to see the car is occupied and appears to be in the park gear since it is stopped and the brake lights are out.

We light up ol' 99 and block the fellow in the crosswalk so folks turning don't make him into a customer. The following is too crazy not to be true.

HM - "Hi there? Are you OK here in the street?"
Baldy - "I want this woman detained, I want the police, she almost hit me. She's not from around here and she refuses to back up and go the other way."
HM - "Do me a favor and just step over to the sidewalk before you get hurt."
Baldy - "I'm tired of this!" the shaking gets more noticable. Not a seizure, but years of frustration coming to a head. In anticipation my driver undoes his seatbelt and cracks the driver's door. If this guy charges us he can kick the door at him, buying me time to run like a coward.
"This is a NICE NEIGHBORHOOD!" and there goes the top. He screams into the sky. In a movie, birds would have flown away and the shot would have widened out.
HM Driver - "Why not just bang on the hood of the car, take down her license number and go about your day?"
Baldy - "You're not from here either. I'm not moving."
HM - "What do you want to do? You can't stay in the street all night."
Baldy - "I'm not moving until the police make me move."
Looking around, a crowd is beginningto gather. A woman offers her cell phone to the man, "Here call 911 from my phone" she tells him.
HM - "HELLO? We're already here." I grab the mic knowing this will get them giggling at the dispatch center. "Fire control this is Medic 99. I need PD at [our location] for a man standing in the street, causing a hazard."
"99 can we get a description?"
I couldn't resist replying: "He's standing and in the middle of the street, approximately 10 feet northwest of our van."
A few more minutes of trying to talk this man to the curb and no result.
The blue lights pull up and an officer I recognize gets out and immediately our friend Baldy is moving.
"Get out of the street you idiot!" calls the officer and Baldy jumps onto the curb and the car begins to pull away.
"Oh no you don't" says the other officer who steps infront of her car, "You're getting onto the curb too, this is stupid."
He said it. He gets to say what I want to say. Unfair.
And we're still laughing 2 hours later. I imaging the officer ended their meeting with, "Now shake hands and say you're sorry."

#44 has arrived

Congratulations President Barack Hussein Obama

You Make the call...Electric Wheelchair...What Happened

Catch up on the situation and comments HERE

Before we get to the meat and potatoes on this, a little salad.
These wheel chairs need to be given only to those who need them, not anyone who wants them. I meet dozens of folks who were GIVEN a chair by some doctor's group or manufacturer, likely at the expense of medicare, without a medical need. Even met a woman who had 2 of the exact same chairs in her living room, never using them. Called the local news station about that one.

Our friend Bob in the chair doesn't have a disability, he is "simply" obese. He uses the chair, "to keep from walking," since he gets winded if he tries to walk. With the chair he is able to get to the market, the corner, anywhere that sells the fattening crap he eats that put him in the situation he's in. The chairs are a great resource, but there's an elderly person somewhere who was told 'no' to a chair but this Bob got one.

So what did I do in this particular situation?

The chair has a standard three prong plug, but the battery is dead. "How long does it take to charge?" I ask, looking at the collection of snacks in the bag attached to the back of the chair. I'm convinced that each package alone was easily 500 calories and there are dozens of them. And a 2 liter bottle of generic cola.
"Overnight is best" he mumbles.
We've exhausted our official list of taxis, vans and wreckers (seems the tow company on call will take the man, but not the chair) and are down to head scratching.
We're at an intersection of three roads and a bus access lane, making a kind of makeshift 4 way super intersection. Across 2 of the streets is a small strip mall type area where a number of shops and restaurants are closing for the night.
I see our solution in the hands of a waitress in a pizza parlor.
"Will this thing move if we plug it in?"
"Yeah, but why?" He adjusts his over sized, thick eyeglasses.
"I have an idea, Ricardo (My partner's BS name) block traffic when I come back out will 'ya?"
Into the pizza parlor to borrow the extension cord the waitress is using to vacuum the floor. I explain the situation to the manager and he's soon back from the stock room with 2 more cords.
We got traffic stopped (it was light), got him plugged in and moved him over to the pizza parlor. The man was embarrassed, but for all the wrong reasons, and we pleaded the manager to let him recharge for awhile.
As we left he was sitting in front of the local pizza joint, battery light flashing yellow, wolfing down a slice of something greasy.

If you said keep the man and chair together, just not in a hospital, you made the right call.

Monday, January 19

Now I can say 'colour' and 'favourite'

The Happy Medic has gone International. I love reading about other pre-hospital providers from all over the country but never really realized (realised) they have the internets machine in other countries until I started following Medicblog999. But I'm being followed as well.

Reading the posts is like looking in a mirror. They have the same BS over there. It makes me feel better that no matter whether the system is for profit or Nationalized (Nationalised), the crazies still call 911 (999) to get help to the toilet (loo) or just for a ride.
(trying to help my new UK friends follow along with translations in parenthesis)

So I call out to my EMS buddy across the pond to tell it like it is. Here in the states we hear a lot about NHS and the troubles they're having with dispatch errors, long response times, etc. I plan to take these stories to the folks who can tell us what is really happening, the Medics on the streets.


EDIT - forgot to put them on the other side of the "road" up there.

...for the altered mental status...8:13

Finally getting to the good stuff on our busy day from long ago.

Nothing pleases your pal Happy Medic more than a family member who has been to Medical School at the scene of a call that has no emergency component. I wonder if they're forgetting all that expensive schooling or if they just get confused when it's Mommy who wants help.

A man has called saying his mother is complaining of general weakness.

We have a code on our forms I know by heart. No Not PDAL - Alcohol Intoxication. It's the other catch all - GMWD General Medical Weak/Dizzy.
I'd say a third of my clients fall into this giant hole of a classification including my new friend 'Erma.'

A quick aside for those following along at home. When I use the name 'Erma' its more about describing her and her situation than just keeping her name private, if I could even recall it. No, Erma is an old teaching tool my Paramedic mentor Beemer used to describe my now favorite kind of patient: The elderly female with numerous general complaints that don't seem to add up to much, but none of the signs explain the symptoms and vice versa. You need to put on your Sherlock Holmes hat and get to work asking all sorts of questions just to figure out what makes sense and what is Alzheimer's poking through.

So back to the Erma I met today. Erma's son, the Doctor, is concerned his Mother has been neglecting herself and her health and requests we take her to the not so local ER for an eval. I love it when an Doctor tries to tell us what is going to happen at the scene. They are welcome to make recommendations and offer guidance but the minute they stop asking for things and start ordering things is when HM let's the lawyers in.

"May I see your Physician's ID, Doctor?" I ask when he tells use we should be starting an IV on the patient who is now wandering the house looking for her coat.
"Why do you need that?" he asks taking half a step back.
"I'm required by law to confirm you are indeed a Physician, then I must radio to my Physician at the hospital that you are taking over care at the scene. Only then can I work as a Paramedic under your license."
He looks from me to my partner, who looks up with a blank look and simply nods.
"Do your job, she needs care."
"From what we've been able to record when she's not evading us, Doctor, is that our services may not be needed in the capacity you expected. I'm more than happy to take her in to be seen, but please understand we have strict protocols in place for a reason and I'm simply following them."
"Then what protocol are you following now?" Ah, the point where we have to classify her into a pre-determined square has arrived. If I answer "Altered Mental Status", protocol calls for meds. If I answer "Stroke" I need to start a line and leave quickly.
Without missing a beat I tell him, "Assist a Citizen." The back door left open by those who have come before me which allows us to wiggle when needed.

"That's unprofessional, I want to talk to your supervisor." He points to me as if a referee will jump out and declare him the winner of our little confrontation.
"Fire Control, this is Medic Van 99, I need a Paramedic Captain at this location."
He can't believe I did it. I called his bluff. I know I have all the cards on this one and he was hoping I'd take the easy way out and just throw Mom in the van and go.

The Captain arrives and pulls me outside to get my situation first. Just inside the door the son tries to push the Captain around.
"I'll have you know your people here need to learn to follow instructions."
The Captain stands tall. "May I see your ID card please, Doctor?" and I smile.
"I don't see what the deal is here. Take her to the ER. I'm a doctor." He's starting to pace, a clear sign of frustration.
"Until you can ID yourself as a physician and speak with our online Medical Control Physician and assume licensure of my Paramedics, they operate under standing orders and from what I can see we don't have what your mother needs."
"And what's that?" The son asks.
"A family to help her through a rough patch. Medic 99, you're in service." He says over his shoulder and we await confirmation of the order. I want to jump out from behind the Captain screaming, "Take that Doctor Boy!" doing some king of victory dance, but i don't.
"Control this is Captain 99," he speaks into the mic," Medic 99 is in service on a No Medical Merit, I'll be on scene for a few moments assisting a citizen."

We cleared and monitored the radio waiting for the recall of an ambulance so we could jump the call, saving another crew a lot of frustration. We ran into the supervisor the next shift and he informed us the son wasn't actually a Medical Doctor, but just a PhD in mental health.
A good thing for his mother if he ever takes the time to help her out.

Sunday, January 18

Advice for a new Paramedic

Over the years I've been asked by students, interns and other Paramedics for tips, tricks or advice that can either smooth things out or help the new folks adjust to this rough and tumble world we work in.
I can never stress enough the first and most important tip I have:

It's not your emergency

No matter the incident, injury, illness or situation, you did not create it. It is not yours. There is no need to speed to the scene, run, shout, get upset or angry.

You will never know enough

There is a Paramedic you work with who seems to know everything, and not in that smug way, but leads by example and is a confident care giver. That person will never know everything about medicine and neither will you. They read, they listen, they learn. Do the same.

Don't tune your patients out

Many folks don't know what is wrong and when they think they do, 50% are wrong. Listen to what they say but note how they walk, look at their living conditions, check the date on the milk in the fridge. Does she wince when she stands? Is the cough productive? How long? Don't get stuck in the SAMPLE questions, but use them as a starting point.

The most important person in the room is you

Scene safety is paramount. It's not as easy as simply saying, "We'll wait for PD" like it was in P School. On the streets, the friends come running up to the ambulance screaming for help, the parents cry for you to hurry. Keep yourself safe, then your crew, then your patient, then the rest. Dead Paramedics have a horrible cardiac save rate.

Don't leave the hospital so fast

Just like you and your partner had a little palaver about the patient at the scene, the doctors at the ER will do the same. Listen in on their conversation. Learn from it. Are they asking questions you did not? Make a note of it and ask those questions next time it's pertinent. Wait for the 12-lead EKG and see not only what it says, but what the Doc thinks. You'd be amazed how many times I've seen a Doc spot something the machine misses.

Buy Dubin's

Dubin's Rapid Interpretation of EKGs is THE best resource for learning EKG rhythms. Without knowing what you have, it can be hard to formulate an action plan. Dubins will teach you the simple questions to ask yourself while staring at that 6 second print out.
Fast or slow? Regular or irregular? Does every P have a QRS? Does every QRS have a P? DONE. From those simple questions you can treat most arythmias.

Find your comfort zone and avoid it

If trauma is your strong suit, focus on cardiology. If you enjoy intubation, focus on IOs. Expand your comfort zone until everything is only slightly unfomfortable. That means grabbing for the pediatric bag feels the same as grabbing the BP cuff. That means reading, drilling and asking questions you don't know the answer to.

Practice humility

People will thank you profusely for what they believe was a life changing moment in their lives. Accept their thanks and tell them it was your pleasure to help them. Then learn more about what ailed them so the next person doesn't suffer as much. When you do an exceptional job, reward yourself by passing on the experience to another care provider. Not as a "war story" but as an addition to a lecture, lesson or discussion.

Warm lunch, warm dinner, go home safe

Those are my only 3 requirements for each day. The first two are negotiable and the rest doesn't matter.

Saturday, January 17

A blog to follow

I've been following it for only a short while, but the new post recently made me want to pass this along.

A Day in the Life of an Ambulance Driver follows a Medic in "Somewhere:Louisiana" on his adventures in real life EMS. If you ever wished Happy Medic could write better, this is the guy to read. As I read it I can only picture Steve Berry's Characters from the "I'm not an Ambulance Driver" cartoons seen in JEMS and online.
Hope the author doesn't mind the comparison.
The posts are longer than mine, but when you add the details and more emotion, that tends to happen.

Happy Reading,

Friday, January 16

...for the transfer... 7:13

One of my favorite calls is to the local dialysis clinic. These folks are having their blood removed, filtered, and put back in, all while sitting in a giant chair either watching TV, knitting or sleeping. But what happens when they don't want to wake up?

The RN at the dialysis clinic has called stating the MD on the other line, wants a person transported.

We're familiar with the facility and the staff and most of the customers are familiar. Today's customer is sitting in the chair, asleep.
"Have you filtered her yet?" I ask the technician, getting the standard answer: "I don't know."
She's standing there, in her paper gown, gloves, mask and goggles, but has to retrieve the file to see if she's been filtered yet.
"How long has she been here?"
"Not long, maybe 15 minutes." she tells me flipping through the file.
"So is it safe to assume she has not been filtered yet?" I ask, getting no response. "So what's the emergency?"
"She won't wake up."
I reach down and gently shake her arm calling her name no louder than I've been speaking to the nurse. Her eyes open and she looks at me, confused.
"Is it time?" and she begins to remove her jacket.
"Won't wake up? Did you even try to wake her?"
"I am not permitted to do anything but connect her."
"So you can stick the needles in her shunt, but not shake her to wake her?"
"Get me your RN supervisor now." I point to the nurse's station where she retrieved the file. A clearly overworked nurse walked over with the weight of folks above who ask too much and folks below that do too little.
"I didn't even know she called you guys again. I'll handle this."
We made sure the woman in the chair didn't want or need us and we left. I've been back since and the nurse is gone, but the technicians still call us to wake the sick early in the morning. Hopefully that RN has moved on to greener pastures.

...for the explosion...

OK, here we go right? An explosion! The possibility for major fire, major injuries and major mayhem. This could be quite the incident. Then again...

A caller states their babysitter notified them the stove top exploded, they are out of town and want it checked out.

On a quick side note: I always wonder if the dispatchers are learning some kind of perverted shorthand, or if they don't type well do they make it up as they go? Looking at the dispatch information for this run it reads, "Stove Explored, Glass Lab...Cooktop explorer, ADV'G babysiter alone...possible gas leak"
I don't even know what to make of that.

We arrive to a calm house and the odor of beer.

Ever try a recipe for beer can chicken? The technique, in a nutshell, has the chef preparing a whole chicken propped on top of a can of beer, soaking the flavor, I guess.
Apparently the instructions neglected to note OPENING the can of beer, since our homeowners didn't do so. They also didn't notice that their stove is electric and, hence, there is no gas leak. The babysitter is beet red and the glass cooktop (Glass Lab - Glass Slab?) is cracked from the pressure of the can BLEVEing.

I hope they add opening the can to the instructions real soon. Either that or allow us to smack these people in the head ala the V8 commercials. Maybe the $1000+ to replace the stove will teach them to pay more attention to their $6 chicken and $0.80 beer.

Thursday, January 15

You Make the Call...Electric Wheelchair

I am dispatched code 2 for a public assist at a local corner known for drunks since that is where the buses turn around. Everyone has to get off.
It is a cool, breezy evening, around 10 PM. We arrive to find a man, alone, in his electric wheelchair. The battery is dead and he is wondering how to get home.
The bus driver called us since he didn't want the man all by himself over night. A quick call to dispatch states there are no wheelchair capable taxis on their approved list (explain that one to me) and they'll call the city van. 10 minutes later we hear the city van driver is out sick today, so no van.
The 300 pound chair won't fit in the ambulance, even if you tried, and the 300 pound patient is unable to walk unassisted.

Any ideas?
You make the call.

Brave or Crazy?

Fireman Bobby Lehman is coated with ice after fighting a fire at a multi-family home in Lynn, Mass., Wednesday, Jan. 14, 2009. A cold wave expanded into the Northeast, bringing cold temperatures and biting winds .(AP Photo/John Cetrino)

Yeah, Crazy brave.

Wednesday, January 14

...for the bicycle down... 6:13

Still catching up with the busy day of old, we now encounter a man on a bicycle. At least he used to be. He was cut off in traffic and...well...just read.

The way its dispatched you'd think this is a major incident like from EMT class: "You're responding to the OB case, hang gliding accident into a bus load of hemopheliacs and the chainsaw is still running...GO"

But its not. On the ambulance Happy Medic uses what I call BS names. These are the names we refer to each other as if we think the other person is missing something and taking a call too far. For example, I'm told by the bike rider that he went over the handlebars and smashed into the hood of the car, then into the windshield, breaking it. So I'm taking this call as very seriously and I've shifted from my complacent mode into Trauma Mode. My partner, meanwhile, is triaging the rest of the folks around and sees the car involved as well as the bike and calls to me using my BS name "Steph."(Pronounced Steve)
I perk up. "Yeah Fred? (Fred Garvin, male prostitute from Saturday Night Live, his BS name) You may want to ask the rider again about the mechanism here" and he's pointing at the bike, kickstand out, not a scratch on it.
"Explain to me again what happened?" Which is the best way to gauge a person's intent. He goes into a long speech about how he was traveling this way, doing that, minding his business when this car pulled in front of him.
When asked to skip to the part where its an emergency, it comes out, "I want a report taken and I want to make a Citizen's arrest on this man!"
Glorious. He thinks we're going to call PD for him. I confirm the biker is uninjured and the driver of the car just smiles and shakes his head when I ask if he'd like to be evaluated. "I cut him off sure, but he never even touched my car."
"You're lying!" The biker calls out and I decide its time for us to go.
"Where's my copy of your report?" He asks. I give him the standard version of "I haven't written it yet and he can get a copy at HQ in 7-10 business days" and he is irate.
I'm never sure why people want that report. If anything he wants me not to report there was no complaint, no physical evidence of an injury and that the driver states the bike never touched the car.
He demands it so I called on the radio that we were extended at the scene writing a report for a citizen. I wrote up everything he said and that I saw, as per usual, and he signed the refusal form, generating an assessment fee, and asked for a copy. I told him it had to be filed first and that HIPPA laws allow him to ask me to make changes but it must be processed before he can have a copy. I handed him the hard copy of the HIPPA form with our HQ address on it and he quickly pulled it to his face and began to read.
Fire control called us and requested we go back in service, they were out of ambulances and had code 3 calls pending.
He may have said more as we drove away but darn it if the siren going to our next run didn't drown him out.

Tuesday, January 13

Hey medics,you've got mail.

Of all the people we encounter on a daily basis, you never realize the impact you can have on another human being just by being nice. Case in point:
Of all the calls for service I've been to and all the hard work on the patients that really needed us, why is it always the ones who didn't need much that write the letters.

Our friend from earlier, whom I assumed would never see another person outside of her house, is still going as strong as ever and wanted to let us know it. She sent an "Atta Boy" letter to the station addressed simply "The Firemen who saved my life." Inside the card was written how we took her from the jaws of death and brought her back to the life she remembers. We of course simply gave her a little sugar, gave the daughter some tips on helping mom adjust to hospice and watched her eat for almost an hour. Any 15 year old could have done what we did. As upset as we were at the time and as understanding as we were later, now we felt odd. We did the simplest thing that took an hour, 1/24th of my day, and it changed what is left of her life completely. We work accidents and major medicals that never make comments like this woman was giving.
Keep a smile on your face everyone. If you get too stressed and feel the smile beginning to crack, start a blog. It helps.

Monday, January 12

...for the MVA versus pedestrian...

I never had any idea that trauma was contagious. I met a family in an intersection today that proved that just because you aren't hurt doesn't mean you don't get to go to the hospital.

A young boy was rubbed by a vehicle's mirror as it pulled from a stop.

The boy is fine, simply nudged, but then it gets good. The aunt walking with him attempted to effect a rescue by yanking the 12 year old by the arm. As she did, the boy's head struck her in the face. She wasn't hurt, but there was no telling her that. As the rest of the extended family begins to arrive at the scene, the drama sets in and the local police is overwhelmed. We arrive to the boy doing fine, the Aunt forgot she was hurt and Grandma is just watching, for now.
Out of nowhere, the mother arrives and goes into hysterics, screaming in a language I do not speak. Suddenly the boy has developed a limp, the aunt is grabbing at her neck and Grandma is staring at us. The mother demands we take the boy to the ER, and take the aunt too. We're told her neck hurts from trying to save the boy. Then grandma walks up holding her neck in the same way as a teenage family member tries to help her into the back of the crowded ambulance.
"OK, this needs to stop right now. Tell her this is fraud and she really doesn't want me to write down that she was fine, unhurt, then suddenly had a complaint, it looks bad in court."
"Oh I can't wait to testify on this one" My partner says while putting the aunt in C-Spine.
"What do you mean?" asks mom from the tailboard.
"You see, when you try to sue him, he'll subpoena your medical records and see you weren't hurt. If only the boy was touched by the car, only the boy's injuries are valid."
"But my poor mother turned her head so quickly when it happened, she is now hurt." she tells me.
My partner, a veteran street medic with less than 3 years to retirement let out such a laugh, I was almost embarrassed. The woman took mother back to the sidewalk and took the hand away from the neck, speaking to her in their native language.
"Why the laugh?" I asked him later.
"I speak their language and was following along the whole time. The woman told the grandmother to be sure to moan and tell them it hurts badly at the hospital before walking her over holding her neck."

Sunday, January 11 evaluate the pneumonia...5:13

Pneumonia seems to strike the elderly easily, especially those smoking 2 packs a day.

A woman insists she is developing pneumonia and demands an ambulance to take her to a doctor.

She meets us as so many do these days, fully dressed first thing in the morning, as if she awoke, looked at her iphone and saw that the first thing on today's agenda was to call 911. Thankfully she extinguishes the cigarette as we approach and insists later that, no, her smoking has no effect on her 'pneumonia.'
Darn it if I can't find any clinical signs of an illness other than the likely 60% of her lungs that no longer function after a life of tobacco poisoning. And since the lawyers won't let me tell her the truth and make her call for an appointment, away we go. The nurse at triage gives a sigh and knows the patient by name. "Pneumonia again 'Erma'?" I feel like Charlie Brown, *good grief*

Every Simpsons Couch Gag


Did you see the fire pole?

...for the pain in the neck... 4:13

Remember that day I told you about awhile back? I've been so busy dealing with so many other life or death legitimate emergencies, I've neglected to catch you up on that glorious day. Especially my favorite dispatch priority of all time: 26A1 - "Pain in the neck"
What I saw on this call not only reinforced my views on autism in this country but showed me what Courage and Family really mean.

A woman has called stating a 26 year old man is having a pain in his neck.

What she fails to tell the dispatchers is that this man has autism. Not the BS autism floating around these days where the kids simply have behavioral issues, but THE autism. He is deaf, mute, has no ears, has problems purposely moving his extremeties, his skull is elongated and his fingers and toes are elongated as well. This man is autistic.
He lives with his mother and his father is with him when we arrive. The patient appears to be having a type of seizure, but the father tells us this is his normal presentation. The pain in the neck comment came from a visible rash that has appeared recently on his neck.
The real reason for our dispatch shows what it means to be Family.
When our patient visits a place he has been before, he is able to navigate furniture, people and stairs no problem. Without speaking and while being mostly blind he is able to notice when pictures are moved at his aunt's house. Today he has been bumping into furniture. At home. They noticed something so simple and identified it as a serious problem.
In the ambulance he is afraid of me in my blue clothes and blue exam gloves so a sit away from him, near the end of the bench. His father is next to him on the bench, holding his hand, allowing his son to smell it and rub his hair. The look on the son's face is one of comfort and calm from then on.

It was relayed to me that the son has been this way since birth and that when he was 2 they visited a local park, then went a block away for ice cream. At the time he was deaf, mostly blind and no one could explain his condition other than, "retarded." The father then tells me, with tears in his eyes, that 3 years later they took him to the same park for the first time since his first trip. When they got there the son walked slowly to each swing, pausing for only a few seconds as if gathering his bearings, then began to walk away. The parents gave chase and were amazed when their son walked a block in one direction, waited to cross the street, them walked another half block and stopped in front of the ice cream parlor.

I know adults that can't do that.

He was fine all the way to the ER and had some issues with the triage nurse insisting that his temperature be taken BEFORE a bed was assigned.
Later that night while dropping another patient off we passed by his door and he saw us standing there. He reached out and felt my hands, where my gloves were, and smiled. "He knows you now, by your hands, the blue." the father said as we left and I wondered if he was trapped in there like a pilot at the stick of a big broken plane or if his brain is firing like a fireworks show on the fourth of July.
But for 26 years a family has cared for their son who has never improved and likely never will and I saw true Courage in that father's actions. I would crumble under those kind of responsibilities.

Saturday, January 10

Thank You Gasda Software

A much over due tip of the helmet to the folks over at Gasda Software, makers of the BlackBerry Firefighter Shift Calendar thing. I've mentioned them before, simply because of their neat product and the "crackberry" addicts I know are needing something like that.
Imagine my surprise when the guy from Gasda emails me and tells me how I can fix a problem I've been having here on the blog. Seems these programmer folks are savvy at finding the glitches.
For a few weeks I've been tinkering with my "101 Things the Fire Department Wishes You Knew" widget and it wasn't working despite both my valiant tries to make it so. I can either learn synchronized cardioversion or Javascript and one of them pays much better right now.

I made the suggested changes and sure enough, it's working like a charm. Crazy, huh?

So a Tip of the Helmet to Gasda Software(Which means excellent in Gaelic according to wiktionary) for helping a blogger get along. As a thank you I added a link to their product on the main page a few days back and hope for a decent kick back, although I'll likely just get kicked.

...for the fire in a chimney...

This one also goes under the topic of, "Yes, call 911 when you think your house is on fire," but is listed amongst my other stories for the comments we receive during cleanup. It's a classic.

A family has called reporting their chimney has embers coming out of it and the fire has been out for a few hours.

Thank goodness for the thermal imaging camera. First companies are able to pinpoint the area of involvement and quickly act to water down the proper chimney vent. As we're due in after all the excitement, we assist the first folks in reloading hose while the neighbors are out in their robes pointing and commenting. One woman approaches and this is what transpires:
Fire Expert -"Excuse me, but is the fire out?"
Fireman -"Yes Ma'am it was a small bit of build up in the chimney, not entirely uncommon."
Fire Expert -"But look, there's still smoke up there" Pointing to the roof, still populated by firemen.
Fireman-"No ma'am that's steam. See how it dissipates instead of rising in a plume? That's how you tell the difference."
Fire Expert-"I know steam and that is not steam. Do those men up there know...can they see...will you tell them I can still see smoke?"
Fireman-"We'll pass that along but I think they have a good view from there."
Fire Expert-"I think someone should call and report that it's still smoking, just to be sure." She says as she's walking away.

I was steaming for sure, the boss who was talking with her almost climbed down from the hose bed and started some trouble.

Friday, January 9

...for the code 3 medic...

I've spoken many times about the horrible policy many departments are following where they forgo coding calls for assistance in an effort to get the call out quicker. For whatever reason the bean counters think heading out the door with no information is a great idea. Imagine being sent "shopping" with no list and arrive at the grocery store to find you should be shopping for clothes. All that time saved so more time can be wasted where there is no record or performance goal: On scene. I just heard an exchange over the radio that made my skin crawl.

Who knows? No one asked, aparently, and an engine and ambulance have been dispatched to an unknown medical aid call.


Engine 99 and Medic 99 are responding and asking for updates, receiving none.
This is what I hear over the radio while sipping my coffee:

"Fire Control to Engine 99 and Medic 99 responding, the call has now been coded psych, violent, stand by for PD."
30 seconds pass.
"Control to Engine 99 did you copy, stand by for PD?"
"Control this is Medic 99, we're on scene already, unable to make contact with Engine 99."
Another 30 seconds pass as everyone in the house is around the radio waiting to hear what happened.
"Engine 99, what is your status? We're sending PD now."
"Control this is Engine 99, we have made patient contact, are you sending PD to this location?"
"If you need them 99."
"There is no need for PD here, do you have additional information on this run finally?" A hint of sarcasm noted. I smiled.
"Afirm 99, we have a report of a psych patient, possibly armed at your location."
"We'll make a note of that control, cancel PD there is no danger here."

A collective sigh of relief went through the entire building and I'm sure the entire com center as well. Had they simply waited another 60 seconds to code the call like they're trained to do, this could have been avoided.

Or do we wait until Engine 99 is shot to death while responding to the 'unknown medical , more to follow' before letting the dispatchers do the job they're trained to do?

At least the stats will look good in the paper next to the obituaries. I feel sick.

Thursday, January 8

...for the not alert...

2 to 4 AM is usually when I meet my favorite customers, but sometimes we meet someone who got lucky in an unlucky place. No, not like that. Just read.

A cab driver reports a female unconscious in the back of his cab.

We're not far from the address and I'm barely awake as we roll up on the cab in a relatively swanky part of town. You know, Mercedes parked on the street because the nice car is the one in the garage. The cabby tells us she requested this intersection but passed out halfway here. Instead of pulling over right away, he continued to the destination. He was hoping someone might be waiting.
Her ID is from out of state so there's no just getting her home and she has plenty of cash to cover the fare when we got an idea. Let's start calling people on her cell phone.
It was relayed to me everyone should have an entry in their phone labeled ICE-In Case of Emergency. Sure enough in her phone book is a number, a local number, marked ICE. When we call a female answers and says she is just up the block and will be down in a few minutes.
Turns out sister from out of town went out ON the town and had forgotten the address, only remembering the street names.
Had she been 10 blocks south she would have been robbed and left on the street. The sister tipped the cabby quite well and then helped her sister upstairs. Lucky girl.

Wednesday, January 7

Combining 2 great hobbies

While wandering the internets looking for new pics to put up I stumbled across a blog that my viewers might enjoy.

Beerphoto is a simple little blog that combines the great hobby of photography with the timeless joy of beer. Some of the pics might be considered risque, but Happy Medic likes that kind of stuff, I mean art.

So next time you're looking for still pics from a motion picture about firemen called Backdraft you will find the following pic from a new favorite blog.

This image is available for purchase from, contact beerphoto at gmail dot com for details.
EDIT - Just noticed that all profits go towards, "Equipment or subject material" HA!

Tuesday, January 6

...for the burn...

You can not make this stuff up. Not even if the best writers in Hollywood all sat down and brainstormed for 50 years could they create these situations. But somehow random citizens think this stuff seems perfectly legitimate. Case in point: My new bro 'Bob.'

A man has called 911 stating he has been burned and needs an ambulance.

Checking the status of the local trauma burn center, we are ready to treat any kind of burn. Except the kind we find. This man is a light shade of pink around the cheeks, eyes are white, looks a bit like he's been skiing and forgot to...oh he didn't.

Yes, he did.

911 was activated for a light sunburn from a ski vacation. He's asking for a ride to the local ER while thumbing his blackberry, possibly clearing his schedule for the rest of the day, thinking he'll be at the hospital all day. We sit down and explain how minor his situation is and that the ER can not help him.
"Oh it's OK," he tells us, "I have insurance so you guys are covered."
"We're covered? You think we get a percentage or something? No, sir we treat life threatening emergencies and transport those needing further treatment to the appropriate hospital. Looking at your injury I can't seem to think of an appropriate facility."
He is set on the idea of getting a ride to the local ER and won't answer our questions about whether he has aloe in the house or a bus pass, or maybe the keys to the fancy car outside that can likely be driven to the hospital.
Then he shocks me with the question that Hollywood could never write:
"What if they give me morphine for my burns, I can't drive while on narcotics now can I Mr Smartypants."
"I'll give you $1,000,000 if they do that." I shoot back and he just looks at me, almost glaring.
Of course I lost this one since we're REQUIRED BY LAW to take anyone who asks. But when we arrived at the triage desk and the nurse got the story, she flagged a passing Doc who looked at the sunburn and said, "Seriously? Go home. Do you have aloe?"

Monday, January 5

That was fun, and addictive!

I usually hate these sites but Future Game follows indexes in real time and all you have to do is guess where the index will be in 30 seconds, higher or lower. Seems easy, but the payoff is in the streaks. They give awards for the longest streaks of the day and the month. Little things like iPods and laptops.

I thought I was hot stuff at 5 in a row, but today's high score is 10. If you get 30 in a row correct you win $10,000.

It's free to sign up and fun to play, if for nothing else than a distraction.
Give it a shot!

You Make the Call...Building Alarm...What Happened

First, get up to speed on the situation and comments HERE.

So what did I do in this particular situation?

The engine driver and I agreed that the combination of building alarm and a man screaming about water everywhere likely meant a sprinkler has discharged, but was it broken off or putting out a fire?

I grabbed a portable radio, pump can and hose bundle and went in search of the man from earlier. One of the guys from the Ladder came with me and brought his standard gear as well. Wandering around the walkways between the shops we began to notice water pooling in some areas. As we came around a corner into an interior courtyard, we found the source. An upscale restaurant had a steady stream of water coming out the double doors and there is the screaming man and half a dozen employees running around inside.
The Ladderman retreats to gather the rest of the crew and the sprinkler kit while I investigate the source. A curiously placed sprinkler is very close to the large open fire pit they use to cook and is discharging water not only into the kitchen, but is flowing onto the beautiful wood floors. Random employees are taking turns trying to use napkins to redirect the water away from the tables and back into the tiled kitchen. I sigh, drop my gear and grab a table cloth from a nearby pile and enlist another tall fellow to help. We create a decent wall/water chute that stops the water from escaping the kitchen and hold it long enough for the ladder crew to get the sprinkler kit and cap the head.
Turns out the new kitchen staff, after 2 AM closing, decided to burn off the grill instead of simply cleaning it. They stoked the fire so hot it broke the sprinkler, as designed, but it was so close to the fire pit I think the pit was added without a reinspection.

As the ladder was cleaning up the water the Chief and engine officer walked in stating they found the alarm panel in the basement behind a number of locked doors and it indicated a water flow in a different part of the building, but they've been around and found nothing else.

Splitting the team and going "rogue" is never suggested at a fire scene and can even get folks hurt. In this situation, with nothing showing and no cell phone calls as to a fire, I thought it best to at least see where the water was coming from. Had we waited for the officer and Chief to return to the access point instead of investigating there could have been 1000's of gallons of additional water spilling into the fancy restaurant. Look what happened at this event in Northern CA.
It was the report at FireGeezer that got my memory turning on this one.

If you said investigate the source of water, safely, you made the right call.

Sunday, January 4

...for the fall, unconscious...

Falls can be dangerous, sure, but most times are exaggerated either by the caller or the call taker. You know that saying "I went to a boxing match and a hockey game broke out?"
Well how about, "I went to an emergency scene and another episode of drunk wrestling broke out?"

A caller states a man has fallen and is now unconscious

En route we hear an out of breath firefighter calling for police assistance, code 3, combative patient. We are sent since the first in engine has only basic life support capabilities and arrive soon after the ambulance, but before police.
As I approach the incident address I notice no one is there, but I hear shouting from a nearby corner. Curious, I look and see a half dozen emergency workers struggling to subdue a man in the middle of the street. It appears our unconscious patient has improved. The odor of alcohol is evident at 20 paces and I take over the head and shoulders from the out of breath fire officer. The patient is shouting profanity even MotorCop would cringe at. His accent is thick and a stereotypical accent for this man's condition, which causes everyone to giggle just a bit.
As we're attaching the restraints he is screaming and fighting causing everyone to almost sit on his extremeties, not just hold them down. We've managed to get a c-collar on him (To maintain his C-spine while wrestling us) and he is adamant about not going to the hospital. When I ask his name, this is the banter we have:
"Calm down man, just tell me your name,"
"Odd name, are you hurt at all?"
"OK, we're told you fell, is that true?"
"Ah, an improvement. Tell me Mr. Off, have you been drinking tonight?"
"Actually we do. You see, when you start drinking, your ability to make decisions no longer rests with you, but with me."
Just then the police arrive and assist in corralling his arms into restrainable positions. The Sergeant leans over and shouts, "Calm down! Either go to the hospital or we're taking you to jail!"
As if someone hit a pause button, he's calm and we all stop, look at the Sergeant, and smile.
"Dang, called my bluff. Well, you can't go to jail."
I lean back over him, constantly having to keep my knee on his shoulders and a hand over his opposite scapula to keep his neck on the ground and we go back and forth until we flip him over onto the backboard and his fight is renewed.
"We can actually, in fact there was a warning about this on the liquor bottle."
"The little white box on the side that speaks about a General and impaired judgment? Sound familiar?"
The ambulance crew finally gets him loaded up and we begin to wander away when the caller steps forward and says, "He fell from over there" and points to a porch easily 12 feet above the street level.
"Hey guys?" I lean my head into the ambulance to tell them about the height of the fall, "Good thing he's 'medicated' or that fall might have hurt."