Sunday, May 31

Sunday Fun - More Posters

Some EMS Motivational posters I'd like to see.

Saturday, May 30

Dear Happy, this one time...

I've been getting emails from some regular readers with their tales of 911 calls that made them smile, laugh or question the way their service works.

I'd like to share some of them with the rest of you as well as ask you to send in your tales.

Many of you have your own blogs and outlets, but others may not. If you need a place to vent, here it is. Send your tale to thehappymedic at gmail dot com and I'll sort through and pick a few here and there to send along.

The rules are simple: No names, no locations, no pictures. Include what kind of service you work for and a little bit about the system. (BLS third tier rescue motorcycle in the Midwest.)

We all know the same silliness exists all over the world, send me your favorites and let's all smile together!

Friday, May 29

You Make the Call...Expired Meds

You are assigned to an ALS engine dispatched to a reported asthma attack.

On your arrival a middle aged woman is in severe respiratory distress, tripoding and you see a rash on her neck. Her husband tells you she has allergies to shellfish and may have been exposed at the restaurant they just left.

You reach for your Epi and Benadryl only to find that what you thought was a 12/2009 during this morning's checks is actually a 2/2009. Kicking yourself and swearing to look closer next time you hold them both to your face to make sure.

Both your life saving meds are clearly expired. Her condition is worsening as your officer looks to you and says, "No ambulance assigned yet, something wrong with your drugs?"

Give the expired meds or no? You Make the Call.

Thursday, May 28

Blue collar vs White collar?

At the ever entertaining dinner table discussion a little while back, between false building alarms and rides to the ER for a cough, one of the quieter members made the following comment.

"Paramedics don't belong in the Fire Service because blue collar and white collar never mix well."

I smiled and shrugged it off as the regurgitated ramblings of a medic hater, but it stuck in my mind.
Are paramedics white collar? Does that mean anything?
Of course many systems are looking for ways to cut costs and downgrading fire response from ALS to BLS does save money. The same way stopping your car insurance policy saves you money, but all anyone cares about these days is the bottom line, not the value in a service.

The rift between BLS and ALS is bigger in some places than others, I recognize that, but the more I thought about this guy's comment, the more it started to eat away at me.

Was it good or bad that he thought of me as white collar? I pulled out the entire supply side to test hose too. I geared up and checked the second floor for extension, same as him, but my special ability to handle the 85%+ of our call volume makes me different in his mind.

And I realized this morning, it should.

He should be worried that I can do my job AND his job. He can only do his.

We tried to be one big family over the last 40 years and in most palces it's working OK so far, but I think it will be these budget woes that will drive a giant spike into our systems and have those who fear being eliminated nervous.
We are emerging as a profession trapped within a trade. Can we, as medical providers, remain in this pre-existing delivery model, or will we all be system status before long?

White collar paramedics and blue collar firefighters? I want us all to be successful professionals who go home safe in the morning. I'm not here for glory, or attention or to break stuff with a big tool. I want to make things better from the bottom up.
"What a waste of time, they'll never change anything" I was told this morning while typing up one of the many changes I propose.
"You miss 100% of the shots you don't take," I responded.
"Whatever. Fuckin' Medics, acting all smart."

What do you think? Is this perceived divide alive where you are?

Heavy smoke showing

Get the adrenaline flowing by telling the 911 dispatcher that the 6 story apartment building across the street has "heavy, thick" smoke coming from a window. First engine on the scene reports nothing showing.
"Look harder!" we're shouting to ourselves and laughing.

Just as we're pulling up we see the first in truck is already laddering the fire escape and the first in engine is securing a supply.

Maybe they have something.

We're geared up and see no smoke, smell no smoke, but head to the front door to check in with the chief...

...who is leaving, laughing, waving us off.

It seems a CO2 extinguisher fell off the wall and broke on the floor. The occupant went running to the window and opened it, causing the gas to escape, looking like a cloud of smoke.

All dressed up and nowhere to go.

Wednesday, May 27

...for the sick eval/REALLY sick eval

Here we are rolling out the door to evaluate grandma's cough. We all go on these calls all day long. Many times we wonder why they call, how the call made it through the call center, and how in the world a cough became a 6E1 (Cardiac unconscious).

But then there are the 26A1s(minor fall) that catch your eye. Like this one we met this morning. Well, we met her, she's still unconscious in ICU.


Caller states her charge is sick and would like her transported.


Not one private health care care giver, but two, answer the door. One was there with her little rat dog (No offense dog people, but it was a yip yip rat dog) and the other was in her sweater and all ready to go home for the rest of the day.

Then they led us to the chair in the corner where their employer's customer was propped up.
"She needs to go to Saint Farthest, she's been feeling sick."

No radial pulses.
Shallow breathing.
Eyes are open, but she's not responding.

"How long has she been like this?" I ask, instructing my crew to move her to the floor.
"Since yesterday. Her doctor was here, then left."
"Her Doctor saw her like this and left?" I ask wondering what kind of medical doctor would...wait a minute.
"What KIND of doctor saw her?"
Wonderful. I have 8 years of college, I think I'll start calling myself Doctor as well.

In the movie version of this call I (Matt Damon or Edward Norton) reach up, grab her by the neck and scream how completely useless she and her friend are and they should give back every penny they take for what it is they "do."
In reality I moved on to assessment and upgraded the ambulance to code 3.

This woman was indeed sick. Tachycardic, distended abdomen, skin hot to touch. Another few hours and she would be much worse off.
I still can't figure out what kind of qualifications these folks have to do what they do. I know it's thankless work and few will do it, but this woman has (had) money and had 2 people on staff. If anyone is going to get the cream of the crop, it's her.

And, I'll expand on this more soon, I think we need to leave the term "Doctor" for the actual Medical Doctors, not anyone with a PhD.

Monday, May 25

...for the man down/ ICE saves the day again...

I told you awhile back about the girl who's phone had the entry ICE (In Case of Emergency) that led to her sister being able to help her out.

There were discussions about how much info to enter into the phones, privacy issues, etc. Even Fossil Medic over at Firegeezer weighed in on the topic. (I just hate that old picture of me)

Not long ago I bumped into another ICE situation and knew I had to pass it along.


A caller states a man is on her doorstep, altered and incoherent.


Expecting one of our regulars we roll up to the address ready to pry a pickled retiree off the steps of the house. Shocked we were to find a young man, possibly in his early twenties, semi-conscious leaning up against a handrail.
We assist him to sit and begin our assessment. He is one of the kind of patients I love. You have to apply everything you learned in school to figure out what is pertinent and what isn't. My EMT partner gets a finger stick glucose of 69, looks up at me and says, "There you go."

I am not so easily fooled. We're finding no life threats, other than the brain's inability to control the body, so we get him into my office and on some O2 to start.

Monitor shows Normal Sinus Rhythm at 90.
BP was unremarkable, in the 130's if I recall with a good diastolic to match.
Pupils were at 3 and reactive.
No evidence of ingestion or injection.
Physical exam finds skin is warm, not hot, no trauma noted.
He's trying to speak, slurring really, seems postictal to me but something just isn't right. He's ABOVE the level he should be post seizure. You know the patient, semi-conscious, altered, then you administer O2, maybe a little glucose paste as they perk up and viola, they tell you they have seizures.

But this kid bothered me. Something was off.

We performed a field surgical walletectomy and found he lived in another part of town completely. To even get to where he was was at least 2 or 3 bus transfers and it's not like we're in the drug neighborhood either.

Then I find his cell phone.ICE is the first entry and I hit send.

A woman answers and I explain my situation and she is near hysterics.
"Where is he?! We've been looking everywhere!"
Turns out our friend is autistic.
I looked over at him again and it clicked clear as day.

What we perceived as an altered state was a tired, lost and confused low functioning autism sufferer. Not the autism label they give to kids who read slow so schools can get more funding, closer to Dustin Hoffman counting tooth picks autism. Only exhausted and afraid.

We bundled him up and turned the radio to his favorite music station while Mom made the 20 minute drive to get him. When she arrived and climbed in his face changed and turned towards her, reaching for a long hug.

Had he lost his phone or not had an easy to find entry, he might have had to wait in the ER for hours while someone tried to figure out what was "wrong" with him when all he needed was mom.

Sunday, May 24

The Handover - Volume 4

The ever growing blog round up known as The Handover is live over at Rescuing Providence.

Many thanks to Lt Morse for hosting and including one of my posts in this edition. The photos of partners throughout media are hilarious, I'm just wondering which member of the team I am in this accompanying photo.

Great posts all!

Sunday Fun - Hitting the Bricks

I've had enough.

I'm leaving my current Department and moving on. Thinking I could just rebuild my system from the ground up like some giant Lego set, I was out of my mind.

So I'm moving to Lego Township which, I recently found out, has quite the fire department.

Folks of a certain age grew up with the little interlocking bricks, I need not give you the history, or how much fun it can be to see all those little pieces and imagine what they could become.

I was looking for some images for a different post and came across this one by chance. My first thought was "Are those Lego?" and my next thought was "I have got to get a real hobby."

I then began to research the LTFD (Lego Township Fire Department) and found them to be quite organized. There are 3 Battalions commanding 9 stations, each station complete with company rosters, apparatus photos and, as the image above suggests, RECENT INCIDENTS.

I remembered when I would piece together quite the impressive fire truck with my Lego bricks but, um, yeah, I never did anything this elaborate. It is amazing what these folks do with the same materials.

The operator of the site, Robert A. Karpowicz, runs a tight ship and his Department includes EMS, fire prevention, heck even a retired firehouses section. My favorite part is reading all the back story that goes with each picture, as if it was real.

But, when you think about it, it is real. Someone took the time and effort to make these kits look real. Took the time to make the rigs look real, not the funny looking rigs in the kits. Someone put a lot of love and appreciation into these kits.

I looked just at the pictures at first, that was 2 hours ago. You can get lost over there on his site, be careful. But do go and take a look around, it is more than worth it. Take special note that the engines actually connect to the hydrants. Too cool.

So, Chief Karpowicz, I officially submit my application for the position of Chief of EMS of the Lego Township Fire Department. I have references.

Friday, May 22

You Make the Call...Rescue

This has no right answer, so no followup on Monday morning, but just think about the "why" of your answer. I was asked this by a co-worker and it had me stumped. I'll post his response in the comments in a little bit.

You are searching the fire floor of a residential building when you come into a smoke filled room halfway down the hallway.
You are halfway in, and conditions are worsening, when you encounter two victims on the floor.
They are of similar build to you and to one another. When you turn to ask your search partner to help, he is gone.

One is caucasian and the other is african american.

Who do you rescue first?

You make the call.

Wednesday, May 20

Breaking Mutual Aid News

From the site:

"EMS1 invited all EMS providers from across the nation to submit a short, original story for the second annual Excellence in EMS Award contest – and we're delighted to announce the winner.

Michael Morse, an 18-year veteran, is a Firefighter-EMT in Providence, Rhode Island.

His article, 'Here,' was chosen by judges as the 2009 winner from the many entries submitted. We'd like to thank everyone who submitted articles, and you can see a selection of some of the best entries on our special Excellence in EMS Award page. "

Congratulations Mike!
Now the Handover is indeed in good hands. (No pressure)

2 Letters, one for the EMT and one for the MD

Dear Medical Doctor,

You went to college a full 4 years longer than I and I can only assume in that 4 extra years you got wicked smart.

Test question, then.

An admitted child murderer should or should not be eligible to serve as an EMT on an ambulance?

Should? You fail.

Firegeezer reported recently about one of the cracks in the EMS system, the complete reliance on Medical Directors to do everything. Policy, protocols, certifications, perhaps they even decide when to mop the floors at their agency buildings.

But first, the true evil.

First letter is to Jessie Thrush who until recently, was just an ex-Sheriffs Deputy trying to make his way as an EMT. When Mr Thrush filled out his EMT certification application in San Diego, CA, he checked the box next to "Have you been convicted of a misdermeanor or felony in this state or any other..." YES.

You see, Mr Thrush admittedly shook his girlfriends daughter to death. A felony. He KILLED another human being. A letter in your file for three reasons.

1. Killing

2. You have uncontrolled temper

3. Thinking you can hide on an ambulance "doing good" to make up for what you did.

But really, the man who signed off on Mr Thrush's certification has a HELL of a lot of explaining to do.

As the Medical Director for San Diego County, Dr Bruce Haynes is the one who's name is on each County certification card, advising prospective employers that the candidate does in fact meet the qualifications to serve as an EMT.

Did this one "slip through the cracks" Doc? Busy out there in San Diego? Too busy to see if any of your "EMT"s are child killers?

I get nervous wondering if a traffic stop will delay my license and you're rubber stamping whoever wanders in the door?

Here's the problem everyone. Medical Directors who look out over their ivory walls and put their hands in everything. You have an MD, I do not. I respect the levels of education you have received and the skills you posess, but unless you served in the field or maintain a valid National Registry Paramedic License (more common thank God) I believe you have no business as an EMS Medical Director in any agency.

I'm sure Dr Haynes doesn't see every single application that comes across his desk, but at what point does that application fee to the county EMS agency kick in?

Each County in California appears to have it's own EMS accredidation process, staff and fees. Why?

So each little feifdom can pretend they're doing something special.

We've arrived at the point where experienced Paramedics have more patient care time than the physicians "overseeing" the system.

So why are MD's even still in the loop? The law still requires we act under a Physician's license. Because back when this whole thing started, the MD's knew more about field care than we did.

We need to move away from the "Base Hospital" system folks, many states already have and they have progressive, adaptive systems.

So long as any ol' MD can wander in and certify admitted child killers as OK to enter your home and treat your child, we have a problem. An isolated one? I seriously doubt it.

A letter in your file, Dr Haynes. That degree on your wall says you're smarter than this.

Tuesday, May 19

The Handover is in Providence

Last chance reminder, friends, to get your submissions into Lt. Morse over at Rescuing Providence for this month's blog carnival. Deadline is tomorrow, the 20th.

This month's theme is "Partners."

So if you're a pre-hospital blogger, in the ER or A&E or even just have a tale to tell about partners and want to submit one of your own posts, or suggest one you've found, send it along.

You can find submission info under this underlined segment here.

Monday, May 18

You Make the Call...Level Zero...What Happened

Do I really need to tell you how I felt at THIS run?

Wandering through town with a man I've taken before, simply because the lawyers who tell the doctors what to do won't hire someone to actually help him, let the civil servants handle it, I was upset. Why should his private insurance company spend the money to treat him? We'll do it at a discount.

He is not injured, he is not sick. But he is a human being and "pushing him aside" for any reason is not the right thing to do.

So I asked him what to do. Boiling it down, it's his decision what hospital to goto and when, so I let him decide. I told him of the situation and the option we kind of had, but not really, but I wanted to be open and honest.

He tried to get off the cot by himself. He told me if he could help someone else, he wanted to.

We redirected to the trauma patient and were at the scene in minutes.

They indeed needed us. A woman had a seizure, fell forward and struck her head, then fell backwards down a flight of stairs, tangling with the bike she had been carrying. It was a mess, the suction unit almost full, the airway a gurgling nightmare. It was a tough tube we eventually got. (The King tube would have failed miserably on this airway.)

The EMT driver and the fire officer assisted our initial patient onto a scoop stretcher and onto the bench, which is designed to carry another stretcher if necessary and the engine medic and I went to work, now code 3 to the trauma center.

I kept asking our original patient how he was doing and if he was OK and he just stared at us. I don't think he had ever considered that we actually provided a service other than moving people from A to B.

We were starting lines, jumping like monkeys over one another from equipment to patient, the emesis was everywhere.

On arrival at the hospital I looked over to tell our original patient the EMT would stay with him and we'd be right back with the stretcher to get him checked in. Before I could tell him that he told me,

"Take her first."

In the end we got a stern lecture about the billing nightmare legality of transporting two patients from two different scenes, all the while waiting for the part where they actually show us the law, rule or order that states we were wrong in doing what we did.

Still haven't seen it. Nor have they written one because of us.

If you said care for both within your abilities, you made the right call.

Sunday, May 17

Sunday Fun - Dinner Table

I've noticed, over my extensive career (Angry Captain rolls eyes), the dinner table at the firehouse tells a lot about the folks working that day.

For example, I can tell you how long you've been on the job based on where in line you are to get your salad. If you're standing back waving others ahead, you have 1-5 years or 20-30 years. Accepting the wave and grabbing yours first gives away that you have 5-10 years of service and just a hint of smugness. If you push ahead and get yours without using a bowl, stuffing it in your mouth, grabbing bread on the way out, you're a Medic and just caught a job.

As we sit down, I can tell your family status by how you prepare to enjoy your meal. Sitting slowly, carefully buttering your bread and pouring a glass of water, you're divorced. No need to hurry along with food, you've always got time. A quick dash of salt, water with one hand and bread with the other, you've got kids, younger ones who always cause trouble. Talking with another guy while ignoring your plate pegs you as a single. Why eat when you can chat, possibly creating a connection?

And the biggest tell tale at the dinner table? I can go to any firehouse in America and sit down at the table and tell you exactly what unit each person is assigned to as the meal progresses. Don't believe me? Try this on your next shift:

The folks grazing their salad, taking slow bites while telling stories, are on the truck. They take their time since they rarely get interrupted and will talk at length about recent fires, rescues etc.

The folks listening to the stories and finishing their salads are assigned to the engine. They need to get a little food in while they can, but are in no real hurry. After all, they got the salad down and can wait on dinner should they get a run.

The empty plates on the other end of the table belong to the medic van crew, still out on a run. If, by some miracle, they were to get a warm meal, they eat like prisoners, hunched over, arms guarding their plates as if someone is going to take their food away. And, more often than not at Medic 99, the voices who know where the sick people are do indeed steal the food.

So there you have it. Sideshow psychology Firehouse style. For all of you Truckmen rolling your eyes and upset I made such a stereotype, the next time you're at the dinner table and the bells ring, do you even stop chewing?

Friday, May 15

You Make the Call...Level Zero

Ambulances are busy tonight, more so than usual, and for the last few hours you've been running back to back runs. Dispatch is on you as soon as you radio at hospital to turn around as fast as you can. Calls are pending.

As you're on the way to yet another call you hear calls going out over the air:
"Engine 99 and an ambulance when available respond to..."
"Truck 99 copy, we're out of ambulances we'll put you in line..."

And so on and so on.

You arrive at a call and pick up one of your regulars who has, once again, fallen out of bed and the home health care staff can't, or won't, pick him up, so here we are. We'll discuss the politics of this dispatch another time.

While transporting the stable patient you are very familiar with you hear an engine not far away calling frantically for an ambulance.
They report a traumatic injury, fall from a bicycle, unconscious and an unstable airway. You recall the medic on that engine is a good practitioner and know that if they're calling for help, they need it.

Your driver leans back and says, "They're between us and the trauma center. Wanna go for it?"
You're on the way to the same hospital already. Your patient looks at you and says, "Go for what?"

You make the call.

Thursday, May 14

...for the shooting, again...

By all means, call 911 if you have been shot, or if you believe you have been shot.

Disclaimer aside, I think I had been watching too many movies over the last few years and reading into things.

A couple years ago I responded to a unique shooting. A man states there was a knock at the door, he opened it and a man he had never seen before shot him in the genitals.

I didn't buy the "I don't know who it was" excuse, but he had indeed been shot in the genitals. Treatment went smoothly and after transferring him to the ER staff, I started to wonder why someone would shoot someone else in the genitals.
"A message" was the decision I came to. Maybe too many mob movies or shows about the "Honor among thieves."
Perhaps there had been an affair and the shooting party wanted to send the message that the affair was over. It made perfect sense at the time and we moved on.

Fast forward to a few weeks ago when I encountered the same kind of call. Different fellow this time, but the story was the same. Knock at the door, open, bang, ouch in the sensitive place.

I commented to one of the officers at the scene that I had seen this before and he laughed. He explained to me that the injury is likely self inflicted. It seems folks who shove guns into their waste bands rarely understand basic safety measures to take with a firearm. Then the friend who was nearby takes the likely illegal weapon away before we arrive. (Rarely do folks who have legal weapons remove them before police arrive.)

It seems folks are shooting themselves in the personal place while trying to carry a gun without a holster.

Go figure.

Wednesday, May 13

Woot Off!

One of my favorite sites w00t! is going through their warehouse clearing sale-a-thon. The sale will take place around the clock with neat items going for ridiculous prices. as soon as one sells out, another will come up.

This is the event set up on my laptop to ring the Emergency! tones when a new item is for sale.

Thanks for the birthday gift, w00t! No, not that laptop, just the woot off.

Overheard over the radio today

My head hung low after hearing the following radio traffic:

"Control, this is Engine 99, we need a code 3 ambulance at our location."

"Copy that 99, do you have a patient report?"

"Yeah, this guy wants a ride to a shelter, refuses to stand up."

"99, can you confirm you need the ambulance code 3?"

"Yeah, we can't wait here all day, send them code 3."

It hurt. It hurt to hear that. But luckily an ambulance was around the corner and cleared a few minutes later with a final classification of "No medical merit."

Monday, May 11

Signs you're going to have a good shift...or not.

What keeps Happy smiling?

A parking space at work. In the big city, parking is a premium, so when I get to a house and find a nice spot, my day has started well.

Fresh coffee in the pot and not that Costco crap. Sure it's cheap, but you get what you paid for.

A well respected and thorough medic is going off duty. I know my morning check will not have any surprises.

I finish the newspaper in one sitting.

Chores are completed by the new guy.

First job out the door actually needs us.

Lunch is on the table on time and finished before the next bells.

The chairs are comfortable enough to cross your legs while on the laptop.

Dinner is delicious and, like lunch, warm.

The night is quiet as we finish Shawshank Redemption and goto sleep.

Awake at 6:30 without a night run, shower and get downstairs to see your relief has already arrived.


Arrived earlier than anyone else by 45 minutes.

I have to park across the street in the red zone.

The kit is a disaster, some meds over 60 days expired, and where is the BP Cuff? Really?

My engine driver's nickname is "The Disaster."

Shopping is interrupted twice for cell phone callers calling in an old accident.

The lunch is leftovers.

First job after lunch is a bike accident with a Paramedic intern on the ambulance who likes to make his decisions about whether or not to C-spine outloud.

With a start like this do I really need to tell you the rest?

You Make the Call...Testing Time...What Happened

Browsing through the study materials in mid 2001 you saw what appeared to be a National Registry Test. Read this first, then read up on what happened below.

I waited until the class returned and asked them all to turn to the back of their binders and show me any test prep supplies they had. Only a hand full of students looked through the binders, clearly wondering what they had missed, while the one I peeked into and a half dozen others never made a move towards their binders. This spoke volumes.

Changing the subject we went on to clinical stations, pulling the 6 or so students into the head instructor's office one by one to inquire about what appeared to be the written exam from the last testing. You better bet I brought it to the attention of the instructors.

Where I was at the time had only one testing in the state per year so only a handful of people had access to the exams.

In the end the validity of the materials was never decided upon, they were assumed to be study materials, but not returned to the students. The instructor decided the materials had no value other than a study aid, a poorly chosen one, but a study aid just the same.

I recall meeting up with one of them a few years later and they insisted it was a sample test made up by a friend. I still have my doubts.

Some people getting into this business don't realize that this isn't about passing a test, but about learning and understanding what we do. Properly assessing and treating a life threat is the real exam.

If you said speak up and find out what the materials really are, you made the right call.

Sunday, May 10

Medic 99 to stay open

My love/hate relationship with the animal that is Fire based ALS transport will continue for a short while longer it seems.

I never believe word that comes from Headquarters, or even the Division level, but when you visit the fleet center and there are not enough people to staff the rigs they need, I kind of knew the word of 99 closing was premature.

I told all of you mainly so I could explain away a decrease in crazy and wacky nonsense calls since it comes in waves on the ambulance. But now, snuck out in an auto email on Mother's Day Sunday, word that the *new* "plan" is to close Medic 99 and her sister cars by the end of the year. No, the calendar year.

I hear what you're saying, "Don't believe it, Happy! Look away from the sparkling brass, look away." But I can feel their pain. It takes money to do the things they told us they were doing and money is one thing in short supply lately. So instead of getting rid of all my Medic unit hours, like many of my co-workers are praying for, I'll get about 2 shifts a month with ol' 99 or one of her sisters.

And, like I said when I got news they were closing, I can deal with that.

Are we all ready for another 6 months of Medic 99 tales? I am. And hopefully she'll stay open into the spring and early summer.

See you at the big one. I'll be across the street in the triage area.

Your Happy Medic

Sunday Fun - The Maltese Cross

Last week we had a bit about Saint Florian, Catholic Saint of Fire Fighters. This week a look into the history of another overused and often misunderstood symbol, the Maltese Cross.

Most firefighters, if they even know what the cross might symbolize, tell a tale of crusading knights in ancient times putting down their weapons to fight fires. Oddly, only firefighters seem to tell this tale, while the historical community tells a different, much wider story about the symbol and those who wore it on their tunics, shields and later stamped it on their coins.

First a bit about the cross itself. The cross is eight-pointed and has the form of four "V"-shaped arms joined together at their tips, so that each arm has two points.This was originally the cross of Amalfi, a province in Italy, but was adopted by the Island of Malta's future rulers in the 11th Century. It is said that the points of the star represent:
  • Loyalty
  • Bravery
  • Generosity
  • Piety
  • Contempt of death
  • Glory and honor
  • Helpfulness towards the poor and the sick
  • Respect for the church
This original cross was worn by a group of crusading knights called the Knights Hospitaller and was so named from a hospital built in Jerusalem around 1080 to care for those traveling to the Holy Land. This hospital was built on the site of the monastery of Saint John the Baptist which is why the Knights Hospitaller were also known as the Knights of Saint John.

In 1129 they were charged to not only care for the wounded but to also provide armed escort to crusaders and pilgrims. To bolster their numbers they were paired with the newly endorsed Knights Templar, some of the best fighters the western world had seen.

As these groups attacked the Saracens, or followers of the Muslim faith, they encountered many new weapons, most notably a pitch oil later called naphtha. This was catapulted into the ranks or stronghold, then lit from afar by arrow or flaming bale of straw. The fire would be fast and intense. The Knights of Saint John, charged by the Pope to protect and care for pilgrims, treated the victims of these attacks as well as other injuries at their field hospitals.

It was written later, by other orders, that while the Knights Templar were fearless in the face of attack, the Knights of Saint John were fearless in the face of the flames.

This may be where modern firefighters saw a history to build on. A group of dedicated men who helped others and were fearless in the face of fire. Sounds perfect to me.

The modern cross, most often a four sided cross with rounded sides, resembles a Teutonic Cross rather than a Maltese Cross.

Perhaps geography is to blame.

The Knights Hospitaller did not come from Malta, they were given the island by Charles the 5th of Spain, also the King of Sicily, after seven years of moving around Europe. It was here they transformed what they originally called a bare rock of sand into a thriving Mediterranean port which would repel a Turkish attack in the 1500s.

And of course some of the first structures built were hospitals.

So where did the 8 point cross of Saint John become the modern Maltese cross available for free embroidery on suitcases? Probably the same way Santa Claus became part of Christmas.(No I'm not saying Coca Cola made the cross) We could figure it out but would that ruin it? Perhaps.

But looking back at what those eight points of the cross stood for, I think it is still there in our modern cross, just a little softer and more subtle.

But I imagine if a Knight Templar and a Knight of Saint John were transported into modern day America, they would see a Maltese Cross on a firehouse and know they would be welcomed, cared for and amongst family.

Saturday, May 9

You're not listening to me, are you?

We're together on this.

You're supposed to be my partner in this little task of ours today.
Since we started all you do is ignore me. Not a word of encouragement, as if you don't even want to be here today. Fine by me, I can get along alright on my own.

In Paramedic school I was told you would help me, be there when I had questions, and be ready to give your opinion when it mattered. You aren't even listening to me now, are you?

You were no help with the backboard, fumbled with the straps, as if you'd never seen one before. You dropped the NPA on the floor and made me get another one out. What kind of partner are you?

I've been where you are now, I understand how frustrating it can be when driving lights and sirens to the hospital. It's hard to communicate with all that noise and all the commotion in the back of the ambulance. But even when I raise my voice, you won't listen.

Our day started so well. Me in the passenger seat and you in the driver's seat. Coffee as usual for me, you had nothing. A few hours later, here we are.

We're supposed to be in this together. Partners of a sort. You talk I listen, I talk you listen, a two way road. But instead I feel like you're ignoring me. I ask you question after question and you're not even looking at me, you're looking past me.

The textbook said I could rely on you in an emergency and they were wrong.

Maybe you're not talking because I had to intubate you. 15 minutes ago the rescue squad pulled you from the driver's seat of that mangled sedan you were driving and now you won't answer any of my questions. We've been here for 10 minutes and I feel ignored. You haven't even acknowledged my existence.
"Can you hear me?" Nothing. It's like I'm talking to a fence.
"Squeeze my fingers if you can hear me!" Why do I even try, you're not listening.
"Come on! Get that blood pressure back up!" As if you would if you were even paying attention to me.

You're my partner in all this mess. You and me, me and you. No one else is here, no one else cares. It's just you and me. I'm doing all the talking and if you do make it out of this alive you won't even know my name. The surgeon will be your hero, the nurse your angel, our time together will be but a footnote in your file. "Arrived by ambulance" it will say in the back of that giant file you're about to start.

But we started this together. You and me in the middle of the intersection. You were in blue, I was in my best turnout coat. I'll never forget it.

You already have.

Friday, May 8

Congratulations Hot Fuzz

Follower Mrs Hot Fuzz has been chronicling her adventures as a soon to be police wife at the appropriately named a police wife blog.

She's been in the list of PD blogs I follow for some time and following along has indeed been fun and informative for those of us on this end of the interwebs.

But starting today, according to the counter on her blog, Hot Fuzz has graduated from the Police Academy, making her truly, a police wife.

Congratulations Hot Fuzz on successful completion of your Po-Po studies and stay safe out there, especially from Calamity Jane (oh I do love a good CJ tale!).

Welcome to the high paid, easy life of civil service,

All your friends at HMHQ

You Make the Call...Testing time

Testing time in the Fire Department.

A number of folks have finished their Paramedic studies and are preparing for the National Registry exam in a week's time.

You have offered to serve as a tutor for some of the struggling students for the exams and practicals. During a break for students, you notice the large binders each student has at their seat and admire the way ot appears to be well organized, giving the student a great resource when they complete their training.
Opening one of the binders you note extensive A&P notes, 12-lead diagrams and drug calculation worksheets, all fantastic resources for later in their careers.

Also amongst their study materials is what you believe to be a copy of the exam. It is formatted differently than the other study materials and is clearly not part of the Department's materials.

Some of these students are on shaky ground as it is and would likely be discharged should your suspicions serve true.

What do you do? You make the call.

Thursday, May 7

...for the smoker in the building...

We take a report of smoke in a building seriously here. We don't send an engine to check things out, we send the cavalry to keep folks safe and keep stuff from burning down. When you call and report a smoker in a hallway, we try to get ahead of the...wait...what? Did you say 'smoker?'


Campus Police report smoke in a hallway of the sciences building.


Oh the possibilities that are racing through my mind as to what could be causing smoke in the sciences building. Just trying to remember the chemicals I used in my pre-med classes, let alone what else was in there had me thinking ICS and Haz-Mat.

I was geared up quickly and turned in my seat to take a look at the screen in the Engine and get an idea of where we were in the response pattern and what our likely goals will be when we arrive.

I'm reading through the text of the 911 call as we're racing through heavy traffic on a rainy afternoon, a dangerous time to be on the road.

It's then that I see the entry, "Caller states a smoker was caught in the hallway."

I can only assume that the sirens are playing with my eyes somehow and we arrive second.
The first engine is at the alarm panel and sends us to the third floor to investigate. All the way in and up the stairs there is no alarm and students are everywhere.
On the third floor is campus security with a young woman crying.
"She was smoking and there's no smoking here. I told her it was dangerous and she told me to just call you, so I did."

I can only imagine the conversation as we turned around and went back downstairs.
"You can't smoke here."
"Why don't you just call the fire department then!"
"Fine, I will."
"Here I go, calling them."
"I don't care, go ahead."
"I'm calling..."

In these situations I find it best to let the white helmets do all the talking. The Chief looked like a baseball manager arguing at home plate, in her face and voice raised. As we were pulling away he was laying in to the security supervisor as well pointing at us and then at her, then at the building.

If you're going to bluff and get called on it, don't put my life on the line to make a point.

Wednesday, May 6


"You should handle it like CNN and the Weather Channel...constant updates."
If you know the film, the character and the topic, then you know I'm in a good mood.

Plans will soon be put into motion (Cue muh hahaha evil laugh and hand rubbing) starting my long and lofty project of changing the way EMS is delivered in my system.

A few weeks ago I mention in our You Make the Call section the possibility of ending the blog to further the project and many of you mentioned doing both.

OK, both.

I'm working on a "re-launch," date TBD, that will allow me to still yell into this little room and maybe make changes that will require less need to yell into a little room.

I've already changed the way we're dispatching calls here at Happy Medic Head Quarters (HMHQ). Previously I gave you the dispatch info only, and even I am having trouble searching the 225+ posts to date for past runs. So now I'm giving you a little more than the dispatch info to make the post memorable from the archives.

We'll also be steering way from dispatches or possibly inviting our readers to submit their dispatches from across the US and the world to share in the hilarity that is modern emergency services.

I'll keep you, my three loyal readers, updated on changes as they happen, but feel free to stop by whenever you like. If the red light is on out front, we're in quarters.

Stay safe all!

Your Happy Medic

A Letter in the File of the Attending Physician

A Letter in the file of the Attending Physician at the Riverbend Urgent Care in Springfield, Oregon.

Firegeezer, my first read every morning, brings a tale of a Doctor who sent a man from the clinic in one corner of the hospital to the ER in the same complex. LINK over to Firegeezer for the report and video, then come back.

The gentleman in the story was informed by the clinic staff he should be seen in the ER and when he asked if he should walk or get taken over in a wheelchair the Doctor tells him, "We'll call you an ambulance."

Put yourselves in the shoes of the crew that arrives. If the layout is as described,(remember the video) would you load the man in your rig? Would you wheelchair him to the ER? Would you laugh out loud and tell the Doctor he's part of the problem? Or would the private ambulance crew be reprimanded for not putting the patient in the ambulance to generate a bill for transport?

This Doctor was clearly so afraid of being liable should something happen in the moments between locations, it clouded his judgment as to what was best for the patient.

Best for the patient is a calm transfer from location A to location B.

Time after time our service gets called to the office side of a hospital campus to transfer folks to the ER, often from a 911 activation. When we arrive we find a stable patient who needs "tests and x-rays." Unfortunately this building has no physical attachment to the ER, so away we go. It's so close that I have to give my 1 minute ETA radio call prior to loading the patient. It gets especially awkward when the patient's condition calls for cannulation and I have to delay transport or transfer to do the Doctor's job before I hand the patient off to another Doctor.

This is all hindsight, I understand that, but you can't tell me there was no staff available in the clinic to wheel this particular man to the ER, within the same building complex.

Isn't that what they keep raising our premiums for? For patient care? Or is it for all that advertising at the local baseball park?

Doctor, you screwed up on this one, and every other one you've sent from urgent care to ER by ambulance. You clearly have no understanding of the abilities of the modern ambulance compared to the advancements in wheelchairs.
And another thing, the hospital complex looks fairly new. Perhaps they might have considered putting the urgent care near the emergency care. If I can figure that one out what are all you high paid folks doing all day long?
At my local medical complex the elderly and pediatrics have to walk all the way around the building to get in, but the dental offices are front and center. Way to think that one through giant insurance company.

Doc, I can only hope you're getting a financial kickback from the ambulance company because if this was your idea of a working system, we're in trouble. If it was up to me you'd be assigned to an ambulance for 48 hours to see exactly the impact your little calls are having on your community and just how little the ambulance crew can do in a minute and a half crossing a parking lot.
But you've designed the system in such a way that all I can do is yell at the clouds.

Monday, May 4

...for the swine flu panic...

We all know this thing has been blown way out of proportion, but the kind of hysteria it is causing didn't sink in until last night.
We were having a great day. One of those days where both folks on the rig wanted to be there, had similar opinions about the problems we face and same great taste in coffee.

We also found out we had the same sense of humor at the absolute strangest time.


Started out as a code 2 sick eval, now the caller has called in again stating he has overdosed.


More like overdosed on aporkolyptic (Thanks FireGeezer) nonsense. We arrive to find an ALS engine company standing in a half circle in front of a man in his early thirties who has a look on his face like he needs to get something off his chest.
"I'm embarrassed" He tells us, exhaling deeply into his folded fingers.
"Don't be, just tell us what's wrong," my partner asks.
Our patient stands and begins to pace. "Can I tell you without them here?" He's pointing at his parents, standing in the hallway.
"Of course, man, whatever you need." I said and the parents silently oblige.
Another deep exhalation into his hands and the hands quickly through the hair on his head. He's got something gnawing at him that he doesn't want to tell us.

Later on we compared thoughts as to what he might have told us. Some included: Swallowing a live fish, sex with a household item, illegal drug use, pregnant girlfriend and leprosy.

"I'm sick. I just know I'm sick," he's repeating as he paces.
"Just take a deep breath, think of the words and just let them out. I guarantee we've heard it before. We're not here to judge, just to help." I said, guiding him to sit back on the couch. The engine has gone so it's just two happy medics and a stressed out, nervous thirty something.

"I was cleaning my fishtank (swallowed a live fish idea) and smoking a cigarette (post sex with household item idea) when I started to feel sick (drug use)." He's up and pacing again. "What am I going to do?(pregnant girlfriend idea), I'm going to die (leprosy is as good as anything else now), I just know it."

"Let it out, just let it go, you'll feel so much better." I encouraged, feeling like Maury Povich on one of those cheating spouse shows.

"I think I have that flu from cleaning my fish tank." He said, clearly relieved.
Before I realized where it would lead I asked the natural followup question, "What flu?"

Oh my. That flu.

Well. Clearly there are mental issues, which are explained by the eaves dropping parents who remain remarkably calm when they hear this explanation for all the pacing and heavy breathing.
I proceeded to hide my smile, as did my partner, as I went into my Influenza Like Illness Assessment Tools routine. No really, we have a training sheet and everything.

Of course everything is clean, but he clearly needs to get into the mental health system and we're happy to help.

My partner, however, decides he'll go into advanced questioning about possible infection vectors.
"Have you recently been to Mexico?" he asks, getting a faint head shake.
I couldn't resist getting one in, now just to see if I can get my partner to break character.
"What about China Town, any pork products?" again, a head shake.
Then the pies de resistance:
"Perhaps your fish had a fever. Was the water warm when you emptied it?"
I nearly chuckled. Time to go.

At the hospital, the staff was less than thrilled they were the only option for our new friend getting into the mental health system, but luckily it was clinical night and a dozen nursing and paramedic students were asking him how he felt and what was wrong.

With any luck they medicated him, he clamed down and was not infected by his fish tank after all. 'Cause if you can get it from fish tanks, we're all going to die.

You Make the Call...Restaurant...What Happened

Needless to say THIS situation was a first and has not repeated itself.

I asked for the oxygen bag and told the officer I'd radio if I needed anything.

I was led into quite the posh seating area and scanned for famous faces, not seeing any. My patient was sitting up in his chair but pale and diaphoretic which clicked this from a courtesy to a necessity. I grabbed the mic on the radio and called in an active chest pain, which where I work gives me authority to do darn near anything.

The officer and engine crew were inside in a flash, not causing trouble, but indeed helping me treat the patient.

When the ambulance arrived the owner again tried to stop them and make the patient walk outside. At that point the ambulance Paramedic let out a little laugh and pushed right by.

Outside, after the ambulance had gone, the officer asked me what I was thinking and how I decided on going in there alone. I recall telling him I knew they had my back if I called for help and I did so I saw no issue with it. If I had gotten inside and not needed assistance I would have worked it out, all the while the owner nervous about the giant fire engine parked infront of the restaurant.

If you said get in and make an assessment as soon as possible, you made the right call.

Sunday, May 3

Sunday Fun - Saint Florian

Those who know me know I'm not terribly religious, but I do admire the Catholic faith in their variety of Patroned Saints.

Saint Florian, as many of you know, is the Patroned Saint of those in Danger of Fire as well as chimney sweeps and brewers. I always thought that was odd. One saint for brewers and firefighters, it just fits.

On the job these days folks seem to not have an understanding of the history of Saint Florian or the Maltese Cross they wear on their T-shirts.
Few seem to recognize the tradition and lessons that can be learned from these 2 symbols of what we do.

This week, a bit of a reminder about that figure with the armor, bucket and flag, Saint Florian.

At the time of Florian, circa 250-300 AD, Emperor Decius continued in the tradition put in place before him of assigning night watchmen to patrol the streets of Rome. This nightwatch arrested drunks, broke up fights and watched for untended or out of control fires. In the event of a fire the mostly slave brigade didn't seem to try too hard to stop the fires destroying the homes of their masters.

The actual fire fighters were members of the Equestrian Order (Ordo Equesto). They were the lower of the highest two classes in Rome, below only the Senatorial Class. These men were charged with ensuring buckets and hooks were available and that slaves turned out to fight the fires.
By the time Florian joined up, the slaves were nearly out of the picture and the first professionally organized fire service was being formed from these trained and respected men.

There were an estimated 7000 men assigned to such tasks around the time of Florian, all military men. They were distinguished from active duty soldiers by their tunics and capes. Soldiers wore red, the ancient firefighters wore green. That is why Florian appears in paintings in a green tunic instead of the more commonly seen Roman red.

Legend states that Florian doused an entire village on fire with only one bucket of water. Possibly the first firefighter to use my mantra, "Big fire, smart water."

Since they were in the military, they had the opportunity to advance through the ranks and Florian did just that, making the rank of General and being assigned his own Governorship in the region of Noricum on the Austrian border.

It was here his religious views and those of Rome clashed and events occurred ending in Florian's arrest and torture before being burned to death. It is said that Florian told the Roman soldiers to make his funeral pyre bigger so the smoke would take him directly to Heaven.

His body was later found in a river, guarded by an eagle, and given a Christian burial.

In the end, Florian's image adorns T-shirts, medallions, plaques and other trinkets, but what does it really represent?
To me it represents professionalism and dedication to task. These men were the upper crust of society who chose to take part in a difficult and dangerous task, fighting fire in ancient times.
And although I am not a religious person, I take the image of Saint Florian with me both scribed on my turnout coat and behind my helmet shield.

And just in time, Saint Florian is celebrated with a feast day each year on May 4th. So lift a glass of your chosen libation and toast to those who came before us, to their sacrifices and their service, repeating the rhyme:

Heiliger Sankt Florian
Verschon mein Haus
Z√ľnd andre an!

Oh Saint Florian,
save my home,
kinkle someone elses!

Friday, May 1

You Make the Call...Restaurant

You are the Paramedic assigned to an ALS engine.
Dispatched to a swanky new restaurant for a reported chest pain, you are met at the door by a man who states he is the owner.

He tells you his customers wouldn't appreciate a bunch of blue collar civil servants firefighters wandering through the restaurant and he'll let one person in to attend to the patient.

You have on your shoulder the ALS kit and monitor, the EMT is carrying the oxygen bag which would be easy enough to get through any restaurant without hitting people in the head. You also have a portable radio with you.

The boss looks to you and says, "You make the call."