Tuesday, June 30

Modern Blood Letters

It is my personal opinion that in 200 years our descendants will laugh out loud at the concept of dialysis. Not unlike the scene in Star Trek IV when Dr McCoy says, "Dialysis? What is this, the Dark Ages?"
It is an interesting life extending service, but lately, more and more, I'm encountering folks on double borrowed time. And others who are happy to get them in and get them out.


A man has an altered level of consciousness at the dialysis clinic.


Leaving personal feelings at the house, we arrive to find a man sitting in the dialysis chair, one of the more alert of the 3 dozen folks in this giant blood filtering factory. Half are asleep, most of the rest are about to doze off and the remainder are watching us with suspicious eyes.

Our client is seated in the chair, shunt freshly clamped, and a nasal cannula hanging from one ear.
"His sugar is too high," says the heavily gowned dialysis technician.
"How high is too high?" I asked thinking it was a fair question. 200 high or "Hi" on the glucometer high.
"His reading is high, our machine said high." She responds handing us the folder clearly prepared long before we were activated.

The next question I have never thought to ask until this morning and the reason I want to pass it along.
"What was his sugar before he got filtered?"
She froze, pointed at the folder and stormed off.
Inside the folder are barely legible copies of his record and results of this mornings filtering. In the space for the blood sugar reading pre-treatment someone has scribbled initials, not a number.

Our client is a bit confused and tired, we get a reading of 501 and everything else looks OK so until the ambulance arrives, I'm off to speak to the staff.

"Did you filter an insulin dependent diabetic without checking their blood sugar?" she's trying to avoid me and run off.
"No, I told you it was high."
"So you filtered a hyper-glycemic insulin dependent diabetic on purpose?"

"Can you move him please, we have people waiting," another technician chimes in.

I look around and realize that we are bothering the flow of cash into the center. These folks have to get them in and get them out as fast as possible.

When the ambulance arrived, I was impressed the medic immediately asked for the pre-treatment blood sugar reading. when I advised her of the situation she cleared us and took a deep breath.

One day we will look back at this practice and ask, "Did they really think that helped?"

Train explosion in Italy

My first read each morning, Fire Geezer is following closely the train explosion that has so far killed dozens of people in Italy.
The excellent coverage includes press, video reports and youtube video of the scene.

This is information gathering at it's best and the reason I follow Fire Geezer.

Keep an eye out for updates as the event progresses.

Monday, June 29

909 - Blogger Error

Blogger.com seems to be having a variety of problems at the moment. From problems posting comments on some sites to now most of my java script elements not working, I apologize if the blog is hard to read or navigate (more than usual anyway). I'll get to it sometime between the 72 of 96 coming up or the birthday party or...well, I'll get to it as soon as I can.

With any luck the Gasda folks will come riding to my rescue...




On this, the 300th post, I wanted to get a little political on everyone. No doubt some have figured out where I am and said, "It figures" or "I knew it!" but this is a different politics.

The politics of labeling and marketing.

Quick pop quiz - Why do American's set off fireworks on the fourth of July? Is it to reenact the battle for independence? Perhaps to recreate what Francis Scott Key saw out the window of the ship when he wrote the star spangled banner? We may never know, because now it is all about making noise and starting fires.

Fireworks are responsible for thousands of injuries and scores of thousands of dollars in property damage, mainly because most folk who handle them are inexperienced with explosives.

Yes, "fireworks" are explosives. Flammable compounds, gun powder, magnesium and a fuse. Explosives. The truck that delivers your explosives to the local Wal-Mart is placarded by DOT as carrying dangerous materials. Explosives.

Possibly millions of children and even more adults will run to the local store or, in some places, the giant local fireworks shop for a selection of bottle rockets (fire relocation devices), M80s (finger relocation devices) and countless other bright paper covered, shiny, nifty named explosive charges with the intent of setting them off on the Fourth of July.

I say leave it to the professionals. My local town has an impressive display launched from a barge on the river. As the fireworks go, the barge floats slowly downstream so you have a good view all the time.

"Oh Happy, lighten up, its the 4th! What are you? A commie?" For not giving my children explosives to celebrate signing a paper? If we were celebrating the invention of dynamite, maybe I could buy it, but setting off explosives is a dangerous way to show how proud you are of your independence.

You Make the Call...Round 3...What Happened

I'm writing this 2 days after my encounter with Bubba and I'm still a touch sore in the shoulders, but we also only got 3.5 hours of sleep that night, so which is the cause we may never know.

Remember friends, Bubba is drunk after a fight with his landlord which caused him to run with knives and stab himself pretty good. He might be an OK guy sober, we'll never know.
After we got him enroute, we had to re-bandage his leg as the wound had opened. I say we... I WAS THE DRIVER ON THIS RUN. From the start to the finish this was my partner's job, I just happened to be the one helping him down the stairs with the computer. Our drivers often start the chart while the other is doing their assessment.

Bubba's leg is messed up. Not as bad as it could have been if he had gotten even drunker before playing Benny Hanna, but the lac looked ugly and bled through our sheets and into a buckle. I hate that.

We made Mom and girlfriend take a cab to the ER, even after the mother slapped the empty passenger seat and in broken english told me, "But I he mutha!"

"He's an adult Ma'am and with an injury like his you can't come with us." OK, so technically I was using the unwitnessed violent trauma rule and assuming there is an Unsub (Criminal Minds anyone?) on the loose, so we don't take riders.

In the end, I think I'm going to let this bit of foolishness slide. I think the earfuls he has no doubt been getting from mom and the girlfriend will make him think twice in the future. Not to mention the bill for us and the ER. AND the nice 1-2 inch scar he'll see everyday he goes swimming. Or takes a shower. Or tries to get his groove on.

He'll look at that scar and think, "I never should have made Happy angry. I don't like him when he's angry."

If you said let him go, you made my call.

Sunday, June 28

Burning through cash

In these times of budget crisis, our City agency is making sweeping cuts to award the savings to other agencies. But we helped one City agency today that is literally burning through cash.


A bus driver reports smoke coming from the fare taker.


On scene to nothing showing and about 2 dozen folk on the sidewalk, clearly upset their bus has stopped, smoking or not. The driver does not carry a key to the cash box, understandably, and we're wondering whether or not to force it open. The smell of the smoke is a mixture of paper and electrical components and has mostly dissipated. There is no way to access the power for the unit so we have the driver power down on one of the hottest days of the year so far.

The supervisor arrives only to tell us, "I don't have a key, we'll have to get someone from the main office out here," and he is on the phone and walks away.

The box is cool to touch and the smell from 5 minutes ago is mostly gone, so the boss made them promise to not restart the bus until after the box was opened.

"2 hours fellas," the supervisor says and our boss audibly grunts.

If it starts again, call us back.

A few hours later we drove past on the way to another run and saw the driver still sitting on the sidewalk in a thin bit of shade from a nearby tree. I wonder how much was in there.

Sunday Fun - Bugles

One of the lasting symbols of the modern American fire service is the use of bugles to signify one's rank as an officer. But where did it start and why? I always wondered this and luckily my current department has a rich history to draw from.

Bugles, or speaking trumpets, were used on early fire grounds by the foreman of the hand pump teams to keep the large numbers of men working together to keep the pump working.
The foreman would often have to shout louder than other companies arriving, the fire and the crowds.

As hand pumps were replaced by steamers, the foreman became the leader of the fire fight and no longer dragged the bugle with him. The volunteer companies of the late 19th century and early 20th century used the bugles as a sign of their long history of service.

The bugle then became a kind of ornament at the fire halls, to be polished by prospective members and displayed proudly on parade day and in photographs. Similar to the ornate belts and helmet shields worn by the more experienced members.

But that explains why the bugle is used as a sign of rank, but why do we wear them on our collar instead of on our epaulets or our sleeves, as does the military?

The answer is in our professionalism. Note this photo from Hose Company No 1 in Nebraska. Each member is wearing their dress uniform, which was common at the time. Each coat has one row of buttons. The officer, in the center seat, holds the bugle, signifying him as the leader.

Without the bugle, he is difficult to identify as the Officer of the company, yes?

As departments became consolidated and fell under the supervision of the local governments, there became a need to have additional ranks between the bugle of the Officer and the white helmet of the Chief Engineer or Volunteer President. Enter the double breasted coat. This coat had two rows of buttons, making the new Officers easy to spot and gave them more formality than the original company Officers. In most departments a single bugle signifies a lieutenant, or Company Officer. Two bugles signifies a Captain, or multi company Officer. The two bugles noted that he controlled more than one company, usually a hose and ladder team in the same house or hall.

Often, the collar of the coat would button down to the coat. This became the symbol of the lead Officer. Try as I might, I can't find a reference to who was the first to inscribe or order buttons with bugles for their coats, but the insignia appears in many photographs beginning in the late 1910s.

This photo from the LA Fire Department shows the two Captains on the right, double breasted coats, two rows of buttons and additional insignia on their collar.

As departments became more relaxed and dress coats were no longer worn, the insignia stayed on the uniform shirt. Right in the same place the original officers found proper to place it 100 years ago.

Now it sometimes appears on the collars of polo shirts. Sometimes I wish we would get back to the formality that existed in those days, but the last vomiting patient I had would have ruined my dress uniform. We change with the times I guess.

a note. This history is gathered from my experiences and photographs from my and other departments. Your department may have it's own traditions and history, but this is the story I keep hearing.

Friday, June 26

Down but not out

Even though Bubba done roughed me up a spell, this post is about my little pal who goes nearly everywhere with me. Not quite an obituary, yet, I wanted to make her feel special in hopes she will not crap out completely.

The hinges on the 2002 eMachines laptop where Happy Medic first wrote finally gave out completely a few days ago. The screen has been tempermentel, at best, and getting it to function properly meant opening, closing, opening, closing and then holding extremely still so you could read the screen.

The second hinge died and, alas, I had no way of using her until I got a brilliant idea. I would try using a picture frame stand to keep the screen up. Not so brilliant after all.

In the end I tave taped a piece of string to the sceen to keep it from falling and spilling the glass of Talisker Isle of Skye Scotch my girls got me for Father's Day. As the author of I love my job says, "Daddy drinks because you cry."

So this old keyboard has at least a few weeks left to go. But I'm going to get every keystroke I can out of the 512 MB cache, 60 Gig hard drive and, wait for it, x2 speed DVD burner.

She was top of the line back then and still is in my eyes.

And I'm saving the replacement cost! Woo-Hoo!

Be safe out there friends,

your Happy Medic

You Make the Call...Round 3

Catch up on Round 1 and 2 to get up to speed on this to put it in context.

After getting this feisty fellow into restraints and as the boys in blue are climbing back out of the ambulance, my partner sees me stretching and asks, "Did he get you?"

"I'm not sure, still too much adrenaline to tell. I feel OK though." I respond, wondering how sore I'll be in the morning.

I turn to the officer to get his badge number and thank them again when he asks, "Do you want to press charges?"

You make the call.

Thursday, June 25

Round 2 - the Struggle

Round 1 seemed normal enough, at least as normal as things get in the big scary City some nights.

Round 2 begins as I'm assisting Bubba down the stairs and he decides an elbow to my face would make his night better.
Luckily, I watch a lot of movies. Not fighting movies or martial arts movies, Happy is a lover, not a fighter, but I enjoy a good strategy and tactics film when I can.

I had 3 options as Bubba took his first of many swings.
Option 1 - Let him hit me. Um, no.
Option 2 - Try to duck or dodge out of the way. I'm not one for choosing the direction of an assault and I figured I had a 1 in 3 chance of moving the correct way.
Option 3 - Close the range to target.

What came to my mind in a flash was the Hunt for Red October. When he turns into the path of the torpedo before it can arm itself. My reasoning after the fact seems perfect, in the moment I just needed him to chill.

The bottom of the stairs had along it's side a large wrought iron ornamental security gate, the kind we have to force open most days.

As Bubba moved with the elbow, I forced my shoulder into his, jamming him into the gate. My right leg got up under him to throw him off balance while my left hand dropped the computer and squeezed Bubba against that gate. I knew if he got me off balance and I went to the ground I was going to get hurt.

My partner was already on the radio screaming for police assistance. She had to scream to be heard over the screaming of, in ascending order of volume, Me, Bubba, the girlfriend...and mom, who's voice had found new heights.

Bubba was my height and had at least 20 pounds on me. I was tired and sober, he was drunk and rested. My only hope was to keep him against that gate until the cavalry arrived. All I wanted to hear was the screaming of the police sirens.

I was able to get his right hand into mine and forced behind his back, now near my waist. His left arm, the one that swung the first time was pinned between him and the gate, not moving for now.

The scene from Pulp Fiction when Julius is telling Honey Bunny to be cool was playing over and over in my head and I'm sure lines from the scene were coming out of my mouth. All I remember is wanting to keep his 230 pound frame off balance and against the gate which was almost more than my one leg could do.

After what seemed like hours of holding him he began to calm and still no sirens filling the night air, only screaming. He promised he was "OK," and I reminded him that I had no problem keeping him there all night if I had to, a thought my leg would most certainly disagree with.

I decided, possibly foolishly, to let him back down to the ground, partly for a rest and partly because he had indeed calmed. I kept his right hand behind him and made a reach for the left wrist, controlling both rather well considering the circumstances, I thought, and we slowly made the drunken, angry stumble towards the ambulance, feeling him squirming and trying to get free the whole time.

There in the middle of the street, mother still screaming and us now screaming at her to go back inside, Bubba sees an opportunity to try knocking me down again. He's got one leg up on the rear step of the ambulance and one hand on the rail to climb in when, I'm told later by my partner, Bubba takes a swing. All I recall was seeing him shift his weight and losing my cheerful disposition.

He quickly found himself flat on the cot as I tackled him into the ambulance, landing one leg on his hip and one arm on his chest. I'm not entirely sure it was one maneuver but I would have loved to see the video.

As we're struggling now in the ambulance, as if by stealth, a sea of blue rushes the back and there are no less than 3 boys in blue saying and doing things that I can not. They have him four pointed and are able to clearly shout over the rest of the commotion outside where I can make out at lest 2 more officers dealing with mom and the girlfriend.

I look at my partner and share a look of, "Holy s*it, did that just happen?"

I took off my duty jacket and took a deep breath throwing it to the bench seat in frustration, suddenly feeling the strain in my shoulders and legs from holding him for what turned out to be 4 minutes against that gate.

The officer looked to me and told me he was impressed I didn't fight back. What I had taken as staggering towards the ambulance, they had seen from afar as him struggling and swinging elbows, all while I'm walking behind him.

The final part of our tale, Round 3, will be covered tomorrow morning, Friday as a perfect You Make the Call.

Round 1 - the Dispatch

The next 3 posts will cover 3 distinct parts of a rather interesting job.

Round 1 - The Dispatch

1:15 AM and the MDT tells me you've cut your hand. It also tells me you're in your twenties. It doesn't tell me if you're seriously calling 911 for this. I assume you know more than I do about who needs an ambulance and away we go.


A man has accidentally cut his hand.


This was a perfect storm of mystery, intrigue, alcohol and lies. The building is older and has a large partial S staircase leading from the street level to the first floor door. So when we start our trek up the dark staircase, the front door is out of our sight above us and to the right. I stood there at the bottom of the stairs, tired already from the first 16 hours of the shift, waving my arms at the motion sensor light that, apparently, has yet to be installed. Warning flag #1.

The door is open and I hear high pitched voices speaking, nay shouting, in a language I do not understand. As is habit I scanned the floor for blood. I see none. In the next room is Bubba. (See Glossary of Terms)

Bubba has his pants half way down and has a towel tied to his thigh with twine.

"Hi there." I say, hesitant to put anything down quite yet.
He mumbles in response. Even just this slight mumble sends a waft of alcohol breath my way that would have caused me to fail the brethalyzer right then and there.

He's telling a story about opening a can of oysters and missing, hitting his leg. Then, after a few questions he tells a different story about how he got cut. All the while I'm telling him I know he is lying. And all the while the mother and the girlfriend are shouting and won't leave the room until my associate for the day finally convinces them to give us peace and quiet.

His leg is cut, not his hand...warning flag #2.

Using my Happy Medic skills we've convinced Bubba to come to the hospital to have the 5cm wide 2-3 cm deep wound from the chef's knife examined.
Oh, did I skip that part? After arguing with the landlord Bubba thought it would be a good idea to get wasted drunk, grab a couple of knives from the kitchen and wave them around like a child demaning more dinner. Darn it if those things are sharp when you get a little too animated.

His mother and his girlfriend, who hovered over my discussion with Bubba in the room are still shrieking in their native tongue and Bubba is trying to shout back at them as I'm guiding him towards the front door and down the stairs.
Quick aside, the wound is wrapped, not bleeding and he flat out got angry when we tried the chair. Warning flag #3.

Halfway down the dark stairs I have my hand under his arm to help him balance, as I offer to everyone I treat. I have Bubba in my right hand, one step ahead of him and the electronic PCR in my left. I looked away to check the bottom steps. When I looked back up...warning flag #4, a swinging elbow coming my way.

Coming soon - Round 2 - the Struggle

Wednesday, June 24

the Whine De Jour

I have spoken before about the strange days one can have on the ambulance. Sometimes everyone has the stomach bug, other days everyone is having trouble standing up. Other days you're on your 3rd intubation wondering "Really? Again?"

I call this the Whine de Jour, the one common thing going through the day. Either they're whining or we are. Well, today is kind of similar, except everyone has been sick. Legitimately, actually, needing a Doctor, sick. Not Sick, dying, Sick but sick none the less.

We're getting the calls as code 2 falls, sick evals and even a code 3 diarrhea. I think we've all been there for that.

But most days the folks are not nearly as sick as they think they are, or as sick as they try to convince us they are.
"You said your fever is 104.5 and yet you're not hot...explain that to me."

Today is the day from the Twilight Zone.

Our complaint of vertigo actually had vertigo. Most folks we get who self diagnose think a headache is vertigo. We arrive and they're on the phone, watching TV in a brightly lit room and walking around. This guy was seated in the kitchen, holding the tupper ware of vomit loosely in his hands as we entered, eyes closed wincing each time I spoke and unable to lay down the dizzyness was so bad.

Our clogged catheter call turned out to be the beginning of quite the bleed. I'll spare the details, but It's a good thing the live in 24 hour care nurse waited 96 HOURS to call for help when the cather was clogged, then suddenly started bleeding. 4 days of bleeding through your...well...we hurried him in.

And wouldn't you know it, the altered consciousness was actually altered for a medically unknown reason. Every assessment tool came back normal except for the part where he wouldn't wake up all the way.

No quick one liners, no discussions about the importance of the ambulance, no critical interventions, just some good old fashioned, "You look sick, let's get you cared for." But we're only 6 hours in, maybe things will go back to normal.

Today's Whine de Jour, "I'm actually sick."

Go figure.

Tuesday, June 23

Locked out of common sense

One of the services our emergency agency provides is breaking into your house if you're locked out. But there are caveats to this service, just be careful what you ask for.


A caller states she is locked out of her house and candles are burning inside.


We arrive to a calm citizen who left her apartment to fetch the daily paper only to hear the door close behind her. She has no keys in her robe but, curiously, did take her cell phone with her this morning.

She told the dispatchers she was locked out and the dispatchers told her we only responded if there was food on the stove, candles burning or another hazard. Contemplating the cost of a locksmith she made the mistake of telling the fire department there was open flame in her multi-story type 5 heavy timber residence.

After trying the usual techniques such as finding another key, turning the knob and reaching the windows we decide force will be needed.
We grabbed the universal lock set (axe) and made towards the door.
"No, don't do that! I wanted you to pick the lock or climb in a window or something!"
"You said your windows are locked. Do you think they're unlocked now?" The other firefighter asked.
"No, I just can't afford a broken door. Why can't you just pick the lock?" She is insisting we do something we never do. Ever. I wonder where she got the idea we pick locks.

The officer looked at her and asked the question we all wanted to.
"Is there really a burning candle in there? Honestly? Because if we do this and there isn't you're in big trouble."

She shifted her weight from one side to the other looking up at the 4th floor window.

Deep breath in, "No." Long sigh.

"Just, can you call someone for me? I don't know what to do."
Without missing a beat the firefighter reaches over to the mailboxes where a dozen or so phone books lay waiting for their new owners to claim them.

"I'd try Locksmiths." And handed her the book.

We clearly explained that if there was a hazard, we need to get in and remove it and she took the book and dragged herself up the stairs and out of sight.

"No merit, Engine 99 in service with a phone book referral." Was the report to the Comm Division.

Monday, June 22

The Handover, June Edition

BasicsDoc has published the latest version of The Handover Blog Carnival for Pre-Hospital and Emergency Hospital providers. This month's theme was "Communication" and I am honored to be included.

You Make the Call...Electrical room...What Happened

Funniest thing about this whole experience was the shoppers. Every time we're in this store shopping, in our uniforms, people ask jokingly "Is there a fire?" The one time we're in there in full PPE, airpacks and tools, not to mention smoke and sparks, people are pushing past us and moving the obstacles in place to keep them safe. "But I just need..."

In the back we are imagining the tongue lashing this manager is going to get not only from us, the Battalion Chief and the Bureau but corporate when they find out I cut the power during the evening rush.

Then it occurred to me, we only need to move enough to get in. I told the truckman to get ready, we were starting a soda case brigade line. I started grabbing cases and throwing them to my right, while he grabbed them from the floor and started another pile. It was a great workout. 5 minutes later we had a nice access corridor through the soda and I removed my airpack and crawled in.

I simply threw the pallets over the fence and finally gained access to the panels when I found that the remodel cut a few corners, like labeling the breakers.

There were more than a dozen labeled "Produce case." So I shut them all down.
During the renovation they had a few months prior, the shutoffs for the water jets were built into a display case. Conveniently, the one sparking. Dang you Murphy and your stupid law.

We were able to remove all the vegetables and gain access to the shutoff, turned off the water and found the culprit. A non GFCI plug from the old layout was simply covered over in the remodel and the water apparently finally made it down to the floor and the wood was smoldering, possibly for hours or days before it got this bad.

Why it was sparking so high in the display we never discovered, but when the Manager came running over demanding the power be restored, the Chief just advised they await the Fire Inspectors, who were enroute.

We didn't stay for the fireworks between people, we had enough enough from the vegetables.

If you said mitigate the hazard as safely and as quickly as possible, you made the right call.

Sunday, June 21

Sunday Fun - Dad

I wrote a bit about the history of the bugle in the fire service and intended to post it here today when the tradition led me back to why I am where I am today.

When my father made Captain, I recall being surprised and honored when he asked his teenage son to pin his badge on at the ceremony.
Two bugles.

Over the years that followed we had our differences, but those bugles always followed me. They were on the collar of the officer who led my volunteer fire academy. Two bugles adorned the badge of the woman who failed me out of the exam in Seattle. The bugles greeted me on my first day in my current Department.

Seems like a simple symbol, but looking back that had to be one of the most shaping moments in my learning years. A little piece of metal with twin shapes.

Why we do what we do can be a difficult question to answer. There are those who might show you a paycheck or a retirement calculation. Then there are others who look at you blankly as if there were no other profession in the world.

I particularly enjoyed Nicholas Cage's character in Bringing out the Dead when he answered, "Father was a bus driver, mother was a nurse, I was kind of born into it."

I am a fireman because of my father. I know, on Father's Day of all days to chime in about it.
Dad made sure I went to my Explorer meetings instead of being an idiot.
Dad sent me a pair of good structural gloves when my volunteer department's gloves didn't feel right.
He has always been there, even if it was shouting at one another that first summer back from college. Shouting which inspired me to pass the volunteer test and get on with the local dept.
Dad gave me support when I made Lieutenant at my first paid spot. Then even more support when I got demoted.
Dad did his best to keep me on task with school, despite my efforts to the contrary.
Dad made my Paramedic graduation and got me my own clipboard, which I used.
He led by example, still does.

Mal Reynolds would say the Angry Captain ain't got much need for words. His actions speak for him.

He likely disapproves of this kind of talk in a public arena, but I want my readers to know why I do what I do.

Because of Dad.
Sappy for sure, but 100% true. His example of unconditional support taught me that I can do anything I want, and I did.

The more I think about it, it was standing in front of Station 22 as the Truck pulled out on a job that got me into this profession. You can't show a 10 year old boy a 100' Crown Tiller rolling code to a job and not expect him to go into the business. Forget what I said up there, go with the truck explanation.

Thanks, Dad.
Thank you, Captain.
Appreciate it, Pop.

Saturday, June 20

Video of derailment

ProEMS has posted some video of the tanker derailment in Rockford, Ill yesterday.

His connection to the incident is, as I understand, his Department sent units to this incident, while he was assigned elsewhere. Isn't that always the case.

He CK, if you get a chance, I'd like to hear your Co-Member's impressions of the scene and operations. Maybe a followup post soon?

EDIT - I've got him in the Mutual Aid Board now so we can monitor for the follow-up interview with members on the scene of the tanker explosion.

Friday, June 19

You Make the Call...Electrical room

You are assigned to a single resource Engine company responding to a report of smoke in a large grocery store. You arrive to nothing showing and what appears to be business as usual at the bustling market.

Inside you are led to the produce section where one of the open fresh vegetable cases is sparking and smoking. Then the water jets turn on causing an impressive sparking display. The produce manager, standing next to you, says they have no way to turn the jets off.

You know better. Your officer sends you and a member of the truck company now at the scene to find the panel for that display and disconnect the power.

Recalling your days as a stock boy in a similar market you were expecting clutter, but what you find amazes you.

The panels are behind a locked gate which is blocked by pallets of cola cans in multiple packages. Each pallet stacks at least 4 feet high, one on another, and they're completely blocking access to the individual panels, which you can see through small gaps. Also through those gaps you see piles and piles of discarded boxes and plastic pallets directly blocking the panels, clearly in violation of the word and the spirit of the fire code.

As you are assessing how to get in there and what to do when you do get there you see on a different wall the main breaker for the store. Often together, the store was recently remodeled and the main shutoff is accessible and requires only a cut of a lock and the throw of a switch.

You estimate it would take at least 20 minutes to ladder the pallets or find a hand truck that can move them ("Only the drivers have those" you were told) or you can shut down the entire market, including registers, freezers, lighting. Everything.

You radio the officer of the situation and she fires back, "You make the call."

Wednesday, June 17

Of sprinklers and fog nozzles

A special welcome to a newcomer on the Mutual Aid Board, a new site I caught on day 1 following along on Twitter. Firecritic.com has some great stuff so far, with just enough angst between the lines to have your old pal Happy grinning and giggling.

Giggling aside, attached to a good piece about the Mexico daycare fire is this great video about residential sprinklers. This should be required viewing for every municipality considering requiring the installation of the little life savers.

As I was watching it and marveling at the effort someone went through to build the prop only to light it off, the nozzle team comes in and makes me pause the video and rewind.
Are they still teaching this "cool down the ceiling with fog" stuff in fire college? Watch the video:

I posted a comment over at Fire Critic and wanted to expand on it here. I was taught more than a few years ago about cooling the ceiling with fog, then I had a chance to try it in a residential fire. When the darn thing kept burning I chose to aim the wet at the red and, wouldn't you know it, the air stopped burning too.

Perhaps fire works differently where you are, maybe I'm in a vortex, but watching the amount of steam that escapes this prop when hey "cool" the air takes me back to how hot that hallway got when I tried it for the last time 10 plus years ago.

Yes, yes, I know, the fire went out. My point being, has anyone else noticed that a smooth bore from a distance works better and removes this need to "fog above?"

I am curious to especially hear from Nottrainedbutwetryhard, Lt Morse and the Road Dr on this one, mainly because I think they show a nice cross section of both readers and departments. (I only know one of them, that'll do.)

To fog or not to fog, that is my question.

Tuesday, June 16

Job Security

care of the fail blog. Please to enjoy:

Sneaking narcotics into prison

Mr Murphy and I have an understanding of sorts. If I bring full C-spine equipment to the 7th floor, I won't need it after all. If I get my full PPE on for the trash can fire, it will be just that. And if I bring the valium all the way into the jail, I won't need it when I arrive.


Jailers report a man actively seizing


Gosh darn it if there isn't a maze of doors, gates and guarded elevators in this jail. I guess it's to keep folks in, but since it often takes 4-5 minutes just to get confirmation we're supposed to be there, I decide to bring along the good stuff so I can stop this life threatening seizure. Besides, like I said, if I bring it, I won't need it.

We're led by the jailers to the medical ward where no less than 3 RNs and an MD are standing over a man sitting up on a stretcher, talking with him.

"Hi, did you report an active seizure?" I try not to sound accusatory, but I was told later I sounded upset.
We were informed that this man has had 3 seizures today and policy requires that he be transported for evaluation and observation.
He has no history of seizures. No one witnessed his seizures. He told his guard he had a seizure and came to the medical ward. Then he was released.
Then two more times and here he is. Never postictal, according to my explanation of what that meant to the guard who responded, "Not in the slightest."

The MD and the RNs are asking if I'm going to be sedating him for transport, since he is a violent offender.
"That's what these guys are for," I said pointing at 2 jailers salivating to rig this fellow up to our ambulance gurney.

Enroute the patient told me about how he was innocent and no one will listen to him, so he has to find ways to get them to listen.
"Like faking seizures?" I ask casually.
"Yeah, whatever it takes."

Sigh. At triage I passed everything along and the nurse was familiar with our friend who began to tell the entire ER how he didn't do anything wrong.
"What did he do?" I asked the jailer later.
"According to him, nothing." He replied, then smiled, "but according to the state, a whole lot of bad stuff."

It was then I finally remembered the valium was still just sitting in my jacket pocket, likely visible from more than 1 angle, and I can cross of another of my List of stuff I always wanted to do:
#32 Sneak narcotics into prison.

Monday, June 15

the Project

You heard it on the EMS Garage podcast, didn't you?

That's what sent you linking over here to confirm the seemingly impossible.

Two Paramedics, worlds apart, who ask each other never ending questions, will indeed meet to not only discuss their differences, but find common ground, all the while being filmed for the world to see.

Medic999 and myself have been comparing our systems for almost 10 months now, each finding the strengths and weaknesses in our own and comparing them to what we can learn of the other. With ambulances able to redirect patients and supported with rapid response cars, I am curious to see this system in action.
Hearing that I serve as a Paramedic from a Fire Engine, Medic999 is curious to see how a 4 man resource can multi-task from fire to EMS and back.

Wouldn't you know it, the BBC has taken interest in our mutual curiosity and will be recording each of us showing the other how our own system works, then switching places. Mark will ride with me, then I with him, all on camera.

I hope to learn from this project how to better serve the clients in my area, both with EMS care and fire protection, without overlapping services and making one rely on the other. I will be blogging, twittering, facebooking and sending smoke signals from here until the project is completed, letting you all in on what I am learning and what I like and don't think will work in the current "for profit" American systems.

Some who read these pages may think Happy is all about a solicalized, government run system. Reading some of my more political posts, I can see how someone would reach that conclusion, but I'm simply searching for something that can help a unique system like mine do more with less. If I get there and don't think it will work in my system, count on me to give it to you straight. Clearly they like it, I want to find out why.

I hope you all will come along with us, both online and possibly in person, depending on where you are. And of course be sure to watch the finished program when it airs. When that is, I will let you know.
As they say over the radio: Details to follow. Stay tuned.

I told you we were going to change the world. What did you think I meant?

You Make the Call...Running Late...What Happened

HERE was the situation from friday.

I had stood by for this person more than once in the past and he never showed when he said he would and it was always a different reason. From sick kids to alarm clocks, it was always something.

I made the decision to try to lead by example and agreed to stand by for an hour. That was at 7:45 AM.
At 11:30 he arrived at the station, making as if this was the agreed upon arrangement. I was furious, but tried to brush it off by offering for him to come in early for me the next rotation where that worked out. He said that wouldn't work for him and pulled a twenty dollar bill from his pocket.
"Thanks, man." He said.
"No thanks," I replied and told the officer I had been relieved.
The officer looked at Mr Late and frowned.

I no longer stand by or work trades with this person for obvious reasons.

If you said do the right thing, one last time, you made the right call.

Sunday, June 14

Sunday Fun - the Google

"the Google" it is called in my house. The search engine of choice for most.
As a part of tracking what you visitors are reading, google analytics lets me see any search engine queries that lead to someone clicking on the blog. At first I thought it was silly and useless, then I started to see posts over at AD's place about strange search queries that hit his popular site.

So I decided to look deeper into it and that is how I discovered Happy Medic is the number one google result for "cocaine and strippers" and all combinations of c-spine precautions.

But how did these folks find me?

  • "that'll do pig" - OK I do have a post that has that phrase
  • "confident paramedic" - I'll take that
  • "carter country mp3" - You got me
  • "Happy memory bomber" - That's me alright
  • "Her limp legs" - I admit this is in a post
  • "alcohol" - There is a lot of that here
  • "i threw up from food poisoning and nearly passed why did someone called the paramedics" - If I could figure that out, friend, I could retire happy
  • "how do you escape a building with heavy smoke" - Get low and go
  • "koiler theory" - A t-shirt mentioned on a linked site
  • "scout with a medic head" - Huh?
  • "why does fdny wear radio strap right side" - I don't really care why, but do they? Now I care
  • "who is emt in charge of paramedic at car crash scene in vermont" - I would certainly know that, right?

Was one of these you?

Friday, June 12

The Ancient Ones

Expecting a long post about geriatrics? As our friend MC says, "Wrong f'ing blog." On this call I was glad to hear that NorthCentral Positronics, a division of LeMerk, was still around. If that makes no sense, I beg ya' cry pardon.
Or read how something from my favorite books found me at work.


Transit authorities have a woman who has fallen.


Often our first question is "How far?" In this case, very far indeed, but she has yet to land. Our patient is sitting on a chair in the lobby of the transit area with two LEOs (Law Enforcement Officers). Sorry, that always makes me think of Dr Evil talking to Mini Me about Leonardo DiCaprio. You boys in blue need a new...I've got it! BIBs (Boys in Blue) ((girls in blue represented, just not present on this call)).

Let's start over.

Our patient is seated in a chair with two Officers (dang, BIBs) near the entrance. She's tracking us as we approach and we see no trauma, so into question mode we go.
The following, as usual, is the back and forth that followed.

HM - "Hi there. What's your name?"
A1 - "I am an ancient one."
HM - "Do you have names?"
A1 - "I have a machine inside me," she speaks softly in a noisy transit lobby.
Quick aside, I thought the same thing you did, that is, why does a seemingly healthy 30 something woman need a pacemaker?
HM - "Does the machine help you survive?"
A1 - "Not lately, no."
HM - "Well, I'm not trained to repair the machine, but can I examine your organic systems?" I said with a straight face and with all honesty. This is no place to challenge what may be a serious mental health issue. Let's just roll with the punches.
We do our thing and find nothing of interest, so onward with the questions awaiting the ambulance arrival.
HM - "Tell me more about the machine."
A1 - "It was placed within me by the ancient ones and will last until the end of the world. I believe that time to be near. The universe is collapsing."
HM - "Too true indeed. Do you take medicine for anything or does the machine need fuel or oil or anything?" I was trying to find out if the 'machine' maybe was a metaphore for something else. Turns out I was looking WAY too far into the possible meaning of machine.

The ambulance arrived and there was a nervous looking Paramedic intern with them who didn't believe my initial report. When he leaned in to confirm what I had told him, the patient told the same tale.

So when the world moves on, remember, you heard it here first.

You Make the Call...Running late

15 minutes to shift change and the name on the call sheet is a person you know to always be the last one in and the first one out.
You've got stuff to get done today after you get off duty, but nothing that can't wait an hour or two when the phone rings.
Your relief says he forgot to set his alarm and needs you to stay as a favor until he can make the one hour drive to the station.

You know from your previous run ins it will likely be twice as long and they haven't paid you back for previous stand bys yet.

The boss wants to know if you're standing by for your relief or if he will officially be absent in 15 minutes.

You make the call.

Thursday, June 11

The Brass is about

Tuck in your shirts and zip up your boots everyone, Happy Medic's bosses have been made aware of our little therapy experiment in anticipation of a major announcement.

I hope they find Happy Medic Head Quarters to be a place where a tired Medic found friends who understand and a chance to make things better.

For their benefit I would like to remind all of you that the dispatches shared here are from all over my career and every detail that can pinpoint a person has been changed or removed, but never "imagined" or "created."

Since they are just now finding out in an official capacity it goes without saying (but I'm saying it anyway?) that they do not endorse, support, officially sanction, reimburse or supply any means for me to keep this thing going. Aside from letting me work. This is my forum, not theirs.

I am simply letting them in on the blog so that when the project happens, it is no surprise.

Welcome Chief, I hope you find a smile. Feel free to leave a comment, if you like. That goes for everyone.
Here's a crash course on what the Happy Medic is all about:
The beginning, getting noticed, frustration, You make the call, memories and the man in the green jumpsuit discussions begin.

So look alive! Polish that diamond plate! Mop those floors! Study!

Your Happy Medic

Tuesday, June 9

Do you ever...

A few things I did the other day made my partner ask, more than once, "Do you always do that?"
So I was wondering...

Do you ever...

Wipe your feet before walking into a person's house?
Always wear a collared shirt, jacket or sweater in public on duty, not just a t-shirt?
Learn and repeat your patient's name?
Always check to see which preconnect is 150' and 200' even if you were 99% sure?
Tie an extra tourniquet to the hand rail, just in case?
Clean the stethoscope after each use?
Write the expiration date on the drug boxes and place them all right side up?
Keep spare goggles on your helmet and actually deploy them?
Wander out on the app floor and practice ropes and knots?
Apologize to the hospital clerk for misspelling the unconscious patient's name?
Honk the horn and teach people to pull RIGHT and stop, not LEFT and stop?
Offer to help the elderly woman to the toilet before the transport?
Let the new guy try for the tube first?
Clean the Officer's bathroom first?
Treat fake asthma with 0.9% saline, nebulized *wink*?
Make sure to buckle the waist strap on the SCBA?
Comment on filthy turnout pants in the kitchen?
Correct a false statement when not amongst friends?

No? Just me?

Monday, June 8

You Make the Call...Drafting...What Happened

Catch up HERE first.

Sorry everyone, but I failed this exam when I took it.

You see, when I was advised the primer motor failed, I simply opened the tank to pump, backfilled the hard suction and pump and began to throttle up. As I slowly opened the line I slowly closed the tank to pump, which caused the pump to draw water from the hard suction.

I failed the test with water flowing.

I was supposed to alert the IC my motor was dead and could not draft. So I told them that I would tell the IC that my motor was dead and I would continue to flow water as long as possible.

I still failed. The next time I stood there and said, "Tell the IC the motor is dead." and I passed.

If you said flow water another way, you made the right call.

Sunday, June 7


Some political stuff here at work had Happy in a mood. I get this way from time to time, too often Mrs Happy tells me, but I'm an emotional fellow, I love my chosen career. Now imagine my surprise when Jesus found me when I was down in the dumps.


A woman is experiencing dizzyness.


We meet the woman in her apartment and she's wandering up and down the stairs, mumbling. When we ask her name, she replies that she is Jesus.

Not "Hay-Zus," but the second coming of the Christian savior, Jesus Christ. I'm not one to be overly religious, or even beginingly religious for that matter, so I didn't think too much of it at the time. I don't pass judgement on my clients, that's not my job. I assess, I treat and I transport. Sometimes I take some liberties on claims and statements, but when it comes to religion, each person is entitled to their own beliefs.
These days you never know, right?

Despite the many depictions, this savior returned as a 5 foot tall 200 lb woman with mental health issues.

All that aside, we took her in because she wanted to go in, and I had a chance just to talk to her. She made me smile when I needed it most, so it doesn't matter who she is, was or will be. The more we talked the more I realized that my troubles were minor compared to my new friend.

Many people try to find Jesus. With all the stress I gave myself about the politics of what we do, it was the unlikely event of Jesus finding me that made all the difference this day.

Incase you're looking, Jesus was last seen in triage at Saint Farthest.

Sunday Fun - Behind the Curtain at HMHQ

Not wasting enough time online?

Well now you can waste more! With the Happy Medic list of addictive distracting sites. Here's a shot of my shortcuts bar in the firefox browser:
The Super T Icon - First stop, try out Tanga a daily purchase site with a twist. Not only can you get a great deal on a board game, Tshirt or other neat stuff, but see lower on their page, that area for the puzzles? Those are user submitted and are updated every evening at 10 PM Eastern. Try one out and, if you like it, click on the links to submit your own. (Warning, highly addictive.)

The Blue square and white f are for facebook, or f'book or crackbook. (also highly addictive.) I'm there by the way, just look for my mug under, you guessed it, the Happy Medic. Become a fan!

The next 4 exclamation marks are for woot! wine.woot! shirt.woot! and sellout.woot! The best of the deal a day sites, woot has great products and hilarious product descriptions, not to mention $5 shipping on every order, except the $10 shirts, which ship free. There's also a weekly shirt design contest at shirt.woot and if you purchase the wine.woot in the first few hours you could get your order overnighted for free to act as a "lab rat" for others. You taste teh free wine and post comments. How cool is that?

The google.

Next up is digg, the little guy with the shovel. More specifically, digg labs, this engine tracks what is hot online in real time and shows you all the top stories and how popular they are. then you set it as your screen saver and watch all the gold just drip from the screen.

ebay, self explanatory.

Pogo.com is a free games site that often does a free preview week where you can play all manner of games. The wife LOVES this one.

costco are good to have at the ready

as are
Craigslist, the peace symbol
the little red and blue dot are for Flickr, the photo sharing site.

The Tf in between is for Thingfling, another deal a day sight, with slightly lower quality than woot, but still fun stuff.
That annoying page symbol is because T-mobile won't make a cool icon, so no link for you.
Photobucket is a great image hosting site while vector magic used to be free. Boo-hoo.

Youtube and wikipedia are good for time wasting, so is netflix. Have to make sure the wife doesn't push my movies down the queue.

Gotta have my MSNBC fix (stop grumbling) and the next 3 help me solve the Tanga puzzles,(cheat really, don't tell anyone).

The k is for a neat game called k-dice.
Mr Smiley faced man leads to a tower defense game at Funnylishus that haunts my nightmares. You try it, tell me it's not addictive.
The blue house lets me keep tabs on the rental property and the next annoying boring icon is to 1800diapers.com. Yeah, I have that bookmarked. You want to make something of it?

The knot work logo leads to a really neat celtic knotwork program Square Knots that lets you make a neat knot, then capture it for use elsewhere.

The next f'book logo is for Happy's page, that first one was for my page.

The familiar orange b, for blogger, leads to the family blog, notice no link.

The graph looking icon is to google analytics which may be, quite possibly, the third coolest thing on the interwebs behind pron and Happy. It lets you track everything about your site's visitors. Their location, screen resolution, I can tell what you guys are reading and what you're not. Not you specifically, but I get an overview of how many folks went where. Really cool.

There's me, Happy, looking quite nice 16px x 16px. That took me over a week to draw you know.
On the other side is the link to my massive bankroll at google's adsense from all the ads you guys click. In a year of doing this, I have yet to get anything to invest back into this place.

The circled Z is to the zazzle store where you can get your Happy Medic T-shirts, hats, bibs, children's wear, etc. It started as an idea to raise money to go out on my own, away from blogger, but after selling 50% of my sales to date to my mother, maybe I should try something else.

Another photobucket is followed by everyone's favorite 140 character mini-blog site Twitter. Click the link at the top of this page to follow me.

Ah gmail, you know you can reach me there, thehapymedic at gmail dot com.
EMS united, JEMS Connect and Firefighter Nation round up the professional stuff, all great visits.

The ones you won't see up there are over in the mutual aid bar, most notably Mark Glencourse and Firegeezer.

Now go waste some time!

Saturday, June 6

How do you feel?

Anyone else feel like this some days?

We're in the midst of our department wide clean-up and luckily we've been slow so far today so we can participate in cleaning.
Highest paid janitors in the area.

Better that than running all day and cleaning all night, right?

See you at the big one,

Friday, June 5

You Make the Call...Drafting

This scenario was part of the basic pump operations proficiency exam in my current Department.

As apparatus operator at the scene of a fire the Incident Commander orders you to draft from a static source of water. Your hard suction line is in place and all valves are closed properly.

As you activate the primer motor, it fails.

Your engine is still in pump, 500 gallons of water, no mechanical issues other than the primer motor.
The IC is calling for water.
What do you do? You make the call.

Thursday, June 4


Sometimes the obvious is difficult to comprehend.
Why can't my system make common sense choices like this from Medic999:

"Its obvious that something is bothering her sufficiently to call 999, and in all likeliness, a further GP would just send her to the hospital anyway. I told her that I would run her up to the hospital myself, in the car, to get her checked out further. "

He can cancel the ambulance and transport appropriate patients in his car.

Am I the only one stateside thinking this is the right way to do it? A scaling system that can adapt to the changing call as it develops?
The American model is locked into a BLS before ALS mentality and it is hurting the system.

Benchmarks set to reach BLS patients faster than ALS patients simply because more of your resources are BLS is just silly. Yes, I said silly. We should be striving to reach the ALS patients within 6 minutes or less and let the scratched fingers and sick evals wait a little longer. They waited all day to call anyway.

My system has these same benchmarks and they were set in place when a BLS system was augmented with a smaller than curent day ALS force.

But now the volume is catching up and demand for ALS resources by BLS units is overwhelming the system everyday.

What is the solution, though? Adding ambulances is just like parking tow trucks near a problem intersection and waiting for the accidents to happen. We know what is causing the increase in call volume, why not nip it in the bud, where it starts?

The "patient."

Patient is defined by Webster's as both a noun and an adjective. But today, the two couldn't be more opposite.

As an adjective, patient means enduring difficult situations with an even temper; Capable of calmly awaiting an outcome or result; not hasty or impulsive.
That is most certainly not the modern clientel of EMS services. They call demanding a level of service they do not need or understand, only so they can seek attention from an advanced system, the hospital, which they may or may not need. And all of it has to happen right now, no question, no delay, let's go.

But the noun, patient, means one who receives medical attention, care, or treatment. "Receives," not requests, or identifies with, but "receives."

Does that mean I have not made patient contact until they receive care? Is calling 911 legally, technically, recieving care? Yes, unfortunately.

Why can't I rely on my training and ability to assess people for illness and/or injury and define them as something other than a patient? Could that cut down on our call volume?
Absolutely. Would it spark a tidal wave of legal questions? Most certainly.

So where does it leave the average American EMS professional? En route to the hospital, that's where.

WAKE UP friends! Our systems are about to be swamped with baby boomers hitting retirement and expecting the level of service they had to maintain for 40 years. If you thought we're busy now, just wait 10 years.

Reading Medic999's stories and then reading mine, I keep seeing distinct differences in the level of care provided by the systems. Medic999 is able to cancel an ambulance and refer the patient directly to the appropriate service, based on his professional assessment. That's what we're already doing, except the hospitals hold the keys to the services our clients need. We just move them from A to B, sometimes intervening.

If appropriate, again based on a professional assessment, they just need a ride, Medic999 can put them in the car and take them, leaving the ambulance available for a more serious call.

It makes so much sense it hurts to think about it.

So what is standing in the way? Profit. I can't refer patient #1 to the rehab unit at St Farthest because they have a different insurance, who needs to have a referral from the patient's primary care, who isn't at St Closest either, but in a completely different HMO. And I can't refer patient #2 to their general practitioner because, surprise, they don't have one. Their only access to medicine at all is me, as a ride to a doctor, who is legally required to listen to them, clogging up a bed in an EMERGENCY room.

There needs to be a complete re-thinking of the way EMS is delivered in the US if any of it is going to survive the rapid increase in volume that is coming.
We can't keep adding ambulances, we need to look for other ways to address the issues we face.

Help. We need help. We need a solution that can deal with the expectations of our clients, while still providing a competent, professional service that meets the needs, not the desires, of that client.
The UK system isn't the answer, it can't be so long as insurance companies can restrict access to services. But what about the fast car model?
Wake County EMS is having success with a variation of the FRU with their Advanced Practice Paramedic role, a design that interets me a great deal.

But in the end it really comes down to liability and cost. 2 things a Paramedic and EMT in the field have no control over. Sure if I can tell someone who doesn't need an ambulance to take the bus I can save money, but increase liability. We can take everyone who summons us, regardless of the reason, which eliminates liability, but increases cost.

Enough. The fire based model won't last long if it relies on an ever shrinking fire system and can't survive in the private sector with the increase in volume and decrease in benefits.

Enough. We are no longer a group of certificate wielding drivers, we are licensed professional Care Givers.

Enough. The EMS systems can't be governed by organizations that refuse to adapt to the changing landscape that is the modern patient, or citizen with a medical complaint.

Enough. We need those ambulances to stay in service for when the call comes in, the rare call, where we can actually use our advanced skills to make a difference.

"I'm sorry," I had to tell the woman lying on the floor of the grocery store after fainting, "We don't have anymore anbulances to take you in right now."
After not 10 minutes prior being forced to summon an ambulance for a man who skinned his finger, who demanded transport.

We're better than that. Now let's get out there and do somethign about it, before it's too late.

Humbly submitted,
Your Happy Medic

Wednesday, June 3

Epi_Junky has been deconned

Just got word from Epi_Junky over at pinkwarmdry.com/blog that the malicious code that was looking for a new home has been removed and new security in place. I wandered over not 3 minutes ago and lo and behold, No Norton warnings and no system melt down.

Good to have you back up Epi.

Tuesday, June 2

Epi_Junky Quarantine

When doing my usual evening check of sites, pink warm and dry by EpiJunky, a virus attacked my computer. Norton Anti-virus stopped it, but I'm running scans looking for anything else. I would recommend avoiding her new site and following along on twitter for now.

I'll pas more along when I know more.


I am not deaf, nor do I carry antibiotics

The whine de jour was "My tummy hurts." A stomach bug was going through town, even my own child was sick. At home. Taking medicine. not everyone stays home and takes medicine.


A mother reports her 5 year old child has food poisoning.


The report of a child in distress always ruffles feathers. What we learned part way there was that the 5 year old was vomiting, nothing more. What was odd to me was that this call came in at 5 in the morning. Had it been something she ate I would have expected this call sooner, closer to dinner time.

Here is the conversation. I will play the part of HM and she will be Mom.

HM - "Did you report an emergency?"
Mom - "Yeah she's been throwing up for like an hour."
HM - Noticed a 5 year old, fully dressed skip across the room. "That one there?"
Mom - "Yeah she has food poisoning, she needs antibiotics."
HM - "Well, I'll give her a once over, but I doubt it's food poisoning or that she needs antibiotics."
Mom - "Well, I want her checked out anyway."

So we do. She's fine. "I threw up, it was yucky," the little girl tells me.
HM - "Does your tummy hurt now?"
Mom - "I told you, she's sick. Can we please go now?"
HM - "Go where? The hospital? Listen, Mom, she may have vomited, it happens all the time, my own daughter is at home now with a fever and vomiting, but we're giving her medicine for it. What medicine have you given your daughter?"
Mom - "They told me not to give her anything."
HM - "Who? 911? No, before that."
Mom - "I don't have antibiotics to give her! Are you deaf? I want her to goto St Farthest and get checked out."

I did the calculation in my head. The time it would take to sit down and explain to her the workings of bacteria, the intestinal tract and the theory behind unit usage, I could be done, so away we went to St Farthest.
On arrival I gave a professional report to the triage nurse who looked at Mom over her reading glasses and said, "She threw up once? Go home and come back if it starts changing colors."


Monday, June 1

A note on strippers and cocaine

Print this list out and follow it next time you decide to call 911 when the stripper you brought home freaks out on the cocaine you gave her.

1. Get her dressed. The last thing you want to do is explain why the girl in your expensive room has no pants on.

2. Put the drugs away. If I can't convince you not to do them, at least hide them before I get there.

3. Remember her name. Awkward when I ask you what her name is and you blank. Good thing she's higher than the Hubble or else you'd be in trouble.

And now a list for strippers who do cocaine with strangers.

1. Keep your pants on. If it's consensual, who am I to judge? But in your condition, you'd consent to synchronized cardioversion.

2. Stay off the drugs. If you absolutely, positively, gosh darn HAVE to do drugs, pick one. Don't do cocaine, decide you don't like it and get drunk, then take ecstacy and smoke a joint.

3. Be honest with me when I get there. If I ask you what you do, if you goto school or work, don't say you're a "dancer." When I ask what show you dance in, don't say "12:30 to 5 AM."

4. Don't ask me if you "OD'd," no, there is no "dose" of this stuff, everything is over what your body needs to survive. Your heart is beating out of your chest because that is what cocaine does.

And finally, a note to the other rescuers I encountered at the scene.
(edit-Apparently blogger.com didn't like what I said.)
Thank you to my colleagues for not making this into what it could have been. You got her calmed, got her pants on and relayed a great report in a strange situation. Well done.

In case you're tuning in late

The breath of fresh air that is Beerphoto had one of their middle of the night updates and is quickly being buried in the Continuing Education section quickly. Make sure you stop by and take a look.

Wishing the bells would stop,


You Make the Call...Expired Meds...What Happened

We've got to stay focused during morning check from now on. Firegeezer is always reminding us to get the equipment checked out. Let's pay more attention.

Watching this woman slowly suffocating there was, of course, only one option. Give the medications.
The expiration dates on medications are put there for a reason, but the effectiveness remains long after that date, varying by medication. Happy does not endorse using expired meds on a regular basis, but in a situation like this, we have to deal with reality, not a discussion on the reliability of 2 month expired drugs.

As I gave the epinephrine I played out my defense in my mind, "Your honor, she's filing this law suit against me for using expired medications to save her life. Please note she is still alive. The defense rests."

When the ambulance arrived I explained the situation to the transport medic and she smiled and told me she will document that the medication was administered and the conditions under which I chose to give it.

If you said give the medications, you made the right call.