Friday, July 31
Returning to your jurisdiction, and his, in the ambulance he is in the passenger seat in his uniform with weapon.
A convertible speeds by with a number of teenagers clearly not restrained and traveling well above the posted speed limit.
The officer radios in the plates but receives a radio message that no officers are available at this time to pursue.
He looks to you and says, "Light it up and catch that guy! I'll take the heat from your boss, just get him to slow down and stop!"
Do you turn your ambulance into a police cruiser? You make the call.
Thursday, July 30
A man is having difficulty breathing.
The middle aged man has called 911 reporting he can not breathe. We arrive at the house and are met by a girl in her late teens, telling us to hurry, her father can not breathe.
At the top of the stairs we hear him calling out to us, in full sentences and at quite a volume, that he can not reach his urinal.
"Hurry up already, I peed! I have to pee more!" He is shouting.
"Sir, do you have an emergency?" My partner asks as I take a moment to survey our surroundings. 50" HDTV with HD Satellite box, clean bedding, stacks and stacks of pirated DVDs, bed side commode and fridge (Not a combo unit).
"I need a ride to the doctor, I can't hold me pee!" He calls out as we hand him the urinal. "It's too late now. What took you so long?"
"..." I can't speak.
"..." Partner is at a loss for words as well.
The phone is placed back on the hook from where he called 911 and immediately rings. The son is calling asking what the problem is, he heard sirens. The son is 3 doors down. All this time the son is 3 doors down, alone, and can't come help dad pee. The girl is rubbing her forehead and taking notes of our assessment. When I ask why she tells me her mom will want to know exactly what happened and she wants to be accurate.
"You don't need an ambulance, Sir, but we'll call your Doctor's office to try to arrange a ride if you don't have one. I don't see a cane or walker, are you able to get around OK?" I ask, hoping he listens to reason.
"I want a ride and you are my ride. Let's go." He's up off the bed, slippers on and heading for the door, not even allowing a basic assessment until we're in the ambulance.
All the way downstairs and to the street without even a wince or groan, a wheeze or moan and he refuses to climb in, instead demanding we remove the cot and load him up. Realizing we are not in control, we've stopped trying to do the right thing. As soon as he sits down on the cot and I take the feet to load him up he cries out, "Hurry up I have to pee!"
"Can you hold your urine, I'll get you a urinal in..."
I love my job.
Wednesday, July 29
The call center has received a cell phone call requesting the FBI be sent immediately to a street corner.
Reading the text, which I'm sure the dispatch center was laughing about the whole time, I think back to every time I've had to wait for an ambulance to respond because others were tied up on clients instead of patients. Yes, I consider people who activate 911 for non-emergent, non-urgent, non-medical/police/fire/assistance clients, not patients.
Mr Universe is often seen at this corner, half in traffic, waving us along as if without him we will slow to a stop and not be able to continue. Mr Universe is homeless by choice and often tells us, at length, about how much easier it is to score with the ladies when you don't have to waste your assistance check on housing.
He wears a number of layers of clothing, each eclectic in its own right. An open front helmet is covered with a variety of old CDs and flashy nick knacks he has collected over the years and a beard that matches his dreadlocks perfectly. And yet, despite his appearance, is entirely sane.
Today Mr Universe found a cell phone in the street and, by golly, it turned on. There was no service to it, someone likely threw it out instead of recycling it, but when Mr Universe saw it ask him if he needed 911, he decided to get some things taken care of.
As we arrived and saw him waving, as usual, and on the phone we could only wonder what he was up to.
"When did Universe get a phone?" the driver wondered aloud.
"Probably nicer than mine" the officer grumbled.
As I approach Mr Universe is still online with radio telling them that there is a conspiracy to destroy the earth and some other nonsense, and he wants the FBI, not the Fire Department.
Yes, dispatch assumed this man was mentally unstable and instead of sending a law enforcement officer, as per the caller's request, they sent Fire/EMS. The catch all, end all of the system.
We informed Mr Universe we had no phone number for the FBI and the boss asked to see his phone. Out came the battery and Mr Universe was reminded that to seek fire or medical assistance he need simply use the street pull box located 6 feet away, but that false alarms are not tolerated.
He waited 6 hours to pull the hook in the box and ask for the FBI again.
Tuesday, July 28
Smoke Eater is a title that gets thrown around easily these days. With the proper use of airpacks and application of physics, no modern firefighter need be a smoke eater.
New on the job and still catching frequent big fire, our probie is assigned to the low rent district on the engine. This neighborhood is well known for the resident hotels and single room occupancies, often 5-7 floors each with 20 or so rooms scattered on a floor that has been remodeled who knows how many times in the 100 years the building has stood.
A fire in these buildings will get out of control and jump floors fast, not to mention catch unsuspecting occupants in the interior stairwell.
The bells ring late in the evening for a full box assignment, reported fire in a building.
On the engine, doors open and siren screaming, from their vantage point in the open cab they see the flames from blocks away. The south half of the 4th floor is blowing fire and catching the fifth fast. Luckily this building was recently updated with a standpipe system and, lucky still, it is not on the side on fire.
Off the engine with both bundles of 100', the officer has the wye and they're up the stairwell, pushing past folks running downstairs, most naked or nearly so.
Smoke is heavy on the second floor and our engine crew has been forced to their knees halfway to the third. On the third floor the heat is intense and the smoke thick. No hoods, no airpacks, just your guts and your experience to get you in and working. They hook into the standpipe and are leading the line upstairs when they are forced down to their stomachs. The heat is described as a giant elephant sitting on your neck and face, unrelenting, inescapable. To charge the line and shoot water now means a steam burn for sure. The body can take more heat dry than wet, so they push forward, a lunging crawl at a time, both members of the nozzle team wishing they could find the fire and get the hell out.
In all the confusion, they must have crawled into a closet because the team has encountered a pair of boots in their path. The smoke is thick and the low levels of oxygen could be playing tricks on their eyes.
The boots belong to the engine boss, crouching, but still walking, in a backwards duck like shuffle that outside of a burning building would indeed seem odd.
"Get off the floor you clowns, we're almost there!" He calls and the team rises and imitates the shuffle which, to their surprise, helps with the heat, but the smoke is more intense, piercing their eyes and making them burn as if on fire.
By the time they find the bulk of fire near the end of the fourth floor, they find the truck company passed them while crawling and has already ventilated and was pulling ceiling in anticipation of water.
After the fire, amidst all the coughing, snorting and wheezing, was a kid wondering if his boss went through the same learning experience he just did. It was there in the street he finally understood what they meant by "Trial by fire."
Monday, July 27
A mixture of emotions today, I was not working, but it really drives home that the Administration's plan, whatever it may be, is happening after all. As we all say, "I'll believe it when I see it," I'm seeing it. In 30 days time all Firefighter/Paramedics will be assigned to engine companies, not ambulances and all transports will be covered by single role Paramedics and EMTs. Some are rejoicing. Others are quiet. A handful of others have transferred over, grabbing sweet cars on nice hours (If your kids are grown).
I mentioned before, when I first told you of the plan to shut down van #99, that I will miss it. I took this job knowing the system was in a state of transition from day car to 24 hour car and I wanted a part of it. You read that right, I'm not mixed up. When I started here, we had just shifted from 10 hour to 24 hour cars. But the amount of abuse and waste in the dual medic 24 hour system sent the plan into disarray. Now we're 30 days from what I jokingly refer to as "Operation Full Circle." The ambulances out of the firehouses and back on the streets.
It's tough to make decisions about what is best for this system since so many high up play their cards very close. Accurate information is hard to come by and basing theories on my education gets me funny looks.
"May I see the 3 year plan?"
So raise a glass, lads. The never ending nights at 99 are now history.
Pedro the Paramedic recently caught my eye with a leaning towards the management aspect of what we do.
Writer Sean Fitzmorris has resurrected his Burning Tiger content at, where else, Burning Tiger Reborn! This link will take you back to the beginning of a great EMS story I'm still working through. Grab a drink and get yourself 30 minutes alone to get started and be able to appreciate it.
With all the talk in this economy about cutting back and spending wisely, a friend tried to get me to read some pretty crazy stuff. In a different category was this site Frugal Living at its Finest someone on Facebook recommended. I'm not familiar with the author they are basing their life changing economic adventure on, but I admire their honesty, even though it is an anonymous blog. If we could all be this honest about money, maybe this place would be running a little smoother.
Have a site I should be following? Drop a comment and I'll take a look in between playing Pirates on Facebook and watching the little ones.
When Mrs Happy came knocking on the door late that night, I had doubts initially about what I would do, whether it was making coffee or offering her a spot on the day room couch.
This station is one of the new fancy ones where the female bunk rooms and bathrooms have locks on the doors.
I made the decision to let her stay the night in the female bunk room and leave in the morning. I later told my supervisor the situation from that night and he nearly blew his top. It was against the rules, but was in the best interest of safety that night. I would do it again if I had to.
If you said let them stay, you made my call.
Sunday, July 26
No surprise then that the lost art of bar challenges rates high in our training here. We'll get into details of how to get a drink for a dollar and pick up a cherry without touching it in another post, but for today, we're playing with matches.
In most bars you can ask for a match book and, if properly prepared, entertain a group of friends for at least 2 rounds. For example: Can you make the fish in the picture here swim the other way moving only 3 matches?
Have fun with this link to Match Puzzles. I wanted to bring them over, but the folks did such a nice job, why ruin it? Each puzzle has a link to the solution so you can't accidentally cheat.
Friday, July 24
The wife (husband, significant other) recently got a job at a local restaurant. Your home is an hours drive away on a quiet dark highway.
At 11:30 PM the phone rings and your other feels too tired to make the drive home safely after working a double. You offer to meet at the gas station near the highway for a coffee and a pep talk when they tell you they are too tired even for that.
10 minutes later, they are at the door asking to lay down just for a little while.
Your Department's policy states no visitors after 8 PM. You make the Call.
Thursday, July 23
Tuesday, July 21
Lt Morse over at Rescuing Providence reminds us what professionalism is when he encountered another serious American EMS emergency.
Any call that has one of the following elements is a winner in Happy Medic's book:
Patient is smoking a cigarette on your arrival
The demand to "Be seen" or "Get checked out"
They refuse to answer questions
They are ambulatory and can see the hospital from where they are sitting
They call you an ambulance driver
They know "Their rights" and demand you do what they say
Lt Morse might have a Yahtzee. Go look and have a giggle, then a sigh, then cry because this is why you have to wait so long for an ambulance in the USA.
Monday, July 20
We got one of the firefighters to start driving back towards our district which was on the way towards the highway and the trauma center, at least an hour away.
In the back I was able to start IVs while he finished his assessment and prepared to intubate. Soon after the intubation, the head injury began to show and the seizures began. Had an experienced set of hands not been there to assist, I'm not sure what would have happened.
We pulled into the driveway of the station where a police officer/EMT was awaiting to jump in and take over driving to the trauma center. Our friend eventually got picked up a tthe firehouse and a viable poatient was delivered. All was well.
That is until administration found out. We were yelled at from all sides about the liability issues, what if he had been drinking, a suspended license, etc etc. After all the yelling was done my partenr looked at our Battalion Commander and simply told him, "It was a patient care decision and I was the highest ranking EMT on the scene. My decision was sound and proved to be in the patient's best interest."
If you said grab a driver and get moving, you made the right call.
Sunday, July 19
I will now jinx the Project by posting details before they are concrete.
Medicblog999 and the BBC will arrive the second week of November and I'll head out there after 6-7 days of filming and stay until the Thanksgiving holiday.
With that in mind, I am preparing to write up my official assignments request to the Chief describing what experiences I think Mark should have when he arrives.
Although what we do may differ from what you do, I want to give him a solid understanding of what it means to deliver EMS in a fire model.
So, I want you, my readers, to chime in on what you think Mark should see or do on his ride alongs with Happy. I have already worked out time on a lone engine company, an engine in a triple house downtown and scattered dynamically deployed ambulances. (Our 24 hour cars will all be closed by the time he arrives, including my beloved 99).
But what else should he see?
Here are some suggestions of what I would like to see, but can't fit it all into the time schedule we have:
Mark tillering downtown on the 100' ALF (With help and supervision of course)
A drill in the smoke house or at the tower
A ride with our heavy rescue squad
A cruise on the fire boat
A low angle rope rescue drill
A ride in the helicopter (Oh wait, we don't have those here)
A blogger meet up opportunity for folks in the area (You already know where I am, remember, I won't tell you) to come by and meet Mark while here.
What of these would you like to see Mark do? Do you have another suggestion? Remember, this is mainly to show him EMS delivered from a fire model, not a comprehensive evaluation and comparison of EMS from different regions. Maybe he'll head your way next year, but this year he's dropping by my neck of the woods.
First, let's shed some light on things.
It used to be we just carried a flashlight in our pocket, then folks started lashing them to the helmets, but they always seemed to get caught on something bolted to the side.
One of the brothers came in with this item on his helmet the other day:
This particular kind of light I like for 2 reasons. #1, it is low profile and can sit right along the front of my shield. #2 it is LED so it is bright and saves having to recharge it every shift.
This particular model is available from Foxfury Headlamps and will run you about $150 delivered. Not bad considering the size and specs. Maybe Santa will bring ol' Happy a new lamp.
I think we all now have a 90 degree coat lamp, like Ed here, by Pelican, this one from Police and Fire Supply dot com. I like Ed, he holds up well, but if you set your coat down wrong, you hear that "bang" and know the bulb is out. He can also be annoying when you're crawling along a smoke filled hallway and points at your face instead of the floor. I rigged up a little strap to solve this problem, which someone quickly "borrowed." The new strap has MEDIC written all over it and has yet to wander off.
The helmet camera is starting to get popular, have a look at firevideo if you don't believe me. At first I thought it was just another show off type gadget. A co-worker attached one to the bottom of his remote controlled plane and flew it around. If you ever need to get dizzy fast, watch something like that.
But recently I saw this video from the New Chapel Fire Department.
Find more videos like this on firevideo.net
What a great training video. And we don't have to worry about staffing a video unit to respond to fires either. We can hit record on the camera, film the evolution and have a first hand account on conditions inside. I think in the near future these will be linked to the command buggy to give the Chief in the street a better understanding of the fire conditions. Maybe he would have seen fire above this crew in two separate places and recognized an attic fire.
I don't have one and likely won't for awhile. I'd end up recording another burnt popcorn building alarm on the 18th floor and use up all the memory in the stairwell.
Personal escape tools are all the rage these days, from simply rope bags on belts to elaborate descent systems, there is indeed a variety on the market. My favorite it something that has versatility, that can expand as I need it. I like this product. I wish the video showed a few different things though, watch it first.
First, I'd like to see someone changing from belt to harness with gloves on and kneeling. Second, get that axe out of the passenger compartment. Take the time at the scene to put it in your belt while sizing up the fire. Heck, even get the SCBAs out of the cab. That 46 seconds of size up could make a big difference. And thirdly, I enjoyed the versatility of the strap that allows you to climb that nifty ladder to cut the hole, then you can climb off? Never leave your ladder when cutting the hole. Can't reach? Train more.
But all that aside, what a fantastic product from Fire Innovations. I'd like one.
The last item today isn't really a gadget, but a nice piece of tradition I think everyone should have. A leather shield from Paul Conway or the Fire Store. You can get them from a number of other places around the interwebs, but I like the Conway and Fire Store quality and sometimes the holes come pre-drilled, which is nice when trying to wrangle my own onto an old Cairns 5A with angled bolts. The quality is superb and there is a wide variety of customizable features. I like the gold leafed ones too, but we have a retired guy here who does them custom and by hand.
What will they think of next? Who knows. I know there are a lot of other gadgets out there, these are just some I've seen/have, that I like.
Do you have a gadget you like? Post a link in comments.
Friday, July 17
Caller states that her roommate is screaming for help from the bathroom floor.
Up and out of bed to bright lights and a piercing bell. A voice comes alive describing a person in need of life saving interventions. My Harry Potter book is knocked over as I throw open my sleeping bag and pull on my turnouts. Uniform jacket is zipped up and I see our driver is already sliding down the pole. I follow in safe time and we're away in less than a minute.
We arrive a the scene to our early 20's caller who responds to my opening question of "Did you report an emergency" with "I think so, we just need an ambulance. He's drunk."
Had I known that, I would have taken the stairs.
He is indeed in the bathroom vomiting as we approach. Our patient describes himself as "poisoned" to which I respond in the affirmative. Alcohol is indeed a kind of poison in any amount.
"This is not normal for me," he keeps repeating while I'm conducting my assessment and finding no life threats.
The private ambulance crew arrives and I give my report and then an odd thing happens. My client tries to correct my report.
"He never did a stroke scale on me, what if I'm having a stroke?" the client slurs and all the rescuers within ear shot turned their heads slowly his way.
"What?" The ambulance crew and I ask in unison.
"I'm an EMT student and I think it could be a stroke. Can you do the exam on me? The um...Cincin...Nat...Natti scale?" he slurs from infront of the toilet.
I was at a loss for words. Then, before I could think of something to say, our patient asked an interesting question:
"If I goto the hospital with you tonight, can it count towards my ride along time?"
Radio advises you they are receiving updates from a volunteer fire squad at the scene of a rollover MVA with ejection, one person still alive. You have asked for the helicopter to be launched, but it has just launched for a long trip and will not be available for some time.
Arriving on scene you find two volunteer firefighters standing near the man who is prone on the ground. They are not even EMTs in this area, just Firefighters for their small community.
The patient is unconscious and unresponsive. You do your best to get him immobilized and O2 on while instructing the firefighters what to do and how to help. Loading the patient your partner looks from you to the firefighter and says, "I'm going to need a lot of help back here," and turns to one of the firefighters, "can you drive us as far as our district so we can get another driver to intercept us?"
Seems like a logical decision this far out. It took you almost 40 minutes just to get here, calling for another driver to respond would take forever.
Do you allow a driver you've never met to operate your ambulance in order to assist the medic in the back?
You make the call.
Thursday, July 16
A man is having 10/10 non radiating chest pain.
As the address goes over the radio after the bells the crew is cheering, "There he is!"
They know his address by heart. I am infrequent in these areas so I keep my mind open to the possibility that the chief complaint stated to the operator is in fact the problem at the scene.
When will I ever learn?
We're into the tiny, dirty apartment and I'm performing my assessment on the overweight, dirty, 60ish year old who claims to be having "an extreme pressures all over my chests."
I am taking it seriously and, thankfully, so is the crew. They stopped cheering and commenting as soon as we were in drive. At the scene they have him on O2 in a flash and a BP cuff in my hand while I'm talking to him. I want to call out for a scalpul and see if he actually opens the OB kit, but I don't.
Our client's complaint shifts from his "extremes" chest pain to the swelling in his legs that his doctors won't fix. Every time I try to get him back on the chest pain subject, he brings up the legs.
I'm about to call BS on this guy, with inconsistent descriptions of a chief complaint, normal vital signs and no signs of distress whatsoever, when my EMS supervisor wanders in.
"What have you got?" He asks, thumbs in his belt like an old west gunslinger. White shirt, collar brass...striking. (Caddyshack reference #3) It's a slightly offensive posture and I can see what he's doing so, knowing I'm taller and in full turnouts from our recent building alarm, I rise to respond.
"Initial complaint of chest pain, but I'm looking at an activation for leg pain, non-traumatic. Still going the ASA route."
And I was, so I offer him 2 aspirin to chew and he brings up his hand to take them and begins shaking it wildly, dropping the little pink pills onto the floor.
"Look! I am seizuring! Help me! Help me!" he screams and I want to raise my voice and tell him I know he is faking, but my clinical supervisor is just outside the door.
I decided to do the right thing and call his bluff.
"Did you call us for leg pain and tell them your chest hurt so we'd get here faster?" I'm towering over him in the little room.
He looked at me like Puss in Boots from the Shrek movies, eyes big and just a hint of a pout. That white shirt in the hallway is now half in the doorway looking from me to the client, no expression on his face.
"My 3 year old knows that won't work on me, gave it up a year ago. Man to man, just tell me the truth. Did you call because of your legs or are you having chest pain?" I ask while loading another round of ASA into my hand.
"I need someone to fix my legs! I can no walk! Look!" and he does a half stand/half fall back into the chair.
I look to the EMS Supervisor who laughs to himself and asks if I need anything from him. I shake my head and take a deep breath.
Groan. Actually, it sounded more like Krusty the Clown from the Simpsons.
Our ambulance, a 24 hour car from 4 Battalions over, finally arrives and our client admits he called for leg pain. Leg pain he has been seen for 3 times this week. He made us carry him down 3 flights of stairs, even though last time he walked.
Last time he was intoxicated, I am informed as we're pulling away, and he wandered down the stairs just fine.
There are few things I hate more than lying. Especially when we crossed a few major intersections against traffic to what we thought was an emergency.
Wednesday, July 15
The Geezer states:
Firegeezer has five (5) complimentary passes for the last three days of the conference, July 23, 24 and 25. This complete package is worth $295, but it can be yours for FREE if you act now and rub your lucky rabbit’s foot.
Send us an email NOW to firstname.lastname@example.org with your name, address, phone #, and put “Expo” in the subject line. They must arrive at our Inbox by 10:30 am tomorrow - Thursday - and we will conduct a random drawing at 11:00 am tomorrow - Thursday.
Goto the original post for more details HERE and good luck.
Oh, and if you're around the second week of November I'm going to have a special guest at HMHQ, so maybe when the shoe drops we can have a Fire/EMS blogger meet up. Pencil in the 9th through the 15th for now, details to follow.
Police have found an intoxicated man.
Again, I have done extensive research on this subject, so trust me. Alcohol intoxication is not an emergency, nor is it necessarily against the law. But when you start stumbling down the street I guess concerned citizens call 911 instead of asking if you need help.
Between the citizen calling 911 (then driving away I might add) and our arrival, a police cruiser appears to have encountered our friend. He wasn't too excited to see the officers and made a move, we find him on the prone on the ground with an officer on his back.
"Gentlemen, can we be of assistance or is this a police matter?" I open with a leading question in these cases, sometimes it works.
"He's drunk and acting stupid" the officer keeping our man down says.
"Then a room full of sick people is exactly where he belongs! Can he stand by himself?"
They remind our man about keeping calm and that the ambulance will be taking him in, which he disagrees with at first.
"Is he in your custody?" I ask, receiving a chuckle and a negative answer.
"If you can walk away friend, you can do so at your leisure, unless you require medical assistance." I say and he just stares at me.
"You're ugly, you know that? Real ugly." He tells me, the common heavy odor of hour old liquor on his breath, "You're all ugly. A bunch of..."
You could tell he hesitated at his choice of words, carefully balancing the word with a possible outcome. Then the alcohol took over in his brain that said 'screw it who cares!'
"Give me a reason to drop you. Do it." The officer says shifting his stance. I was ready to watch the sidewalk rumble go down. I'm a lover, not a fighter, as you all well know, but I wanted to see this guy get owned.
Alas, he backed down and sat down cross legged on the sidewalk, clearly understanding he had already lost the fight that never happened.
"He's all yours," I'm told, wondering when being drunk and stupid became an emergency warranting an ambulance.
The basin made it into his lap just in time for the chunky stuff and I donned an N95 for the rest of the thankfully short drive to the waiting room of St Closest.
He was up and out the doors before I had given a report to triage.
And we wonder why ambulances are so busy these days?
Monday, July 13
On one of those drives, Capt Schmoe saw a water tanker like he hasn't seen in his area. Being an aviation junky in his spare time he exited the freeway and caught up with the UFO.
Go see what it takes to maintain and support a water tender that never touches dry land.
Photo credit Captain Schmoe (Not his real name...I hope.)
"It's not our emergency. I want a warm lunch, a warm dinner and to go home safe in the morning. and the first two are negotiable."
The situation I presented on friday is a common one where I am. We don't have the fancy opticom (sounds like a kind of transformer to me) since it would likely trigger lights for blocks. We beta tested a nifty satellite monitoring device that read our GPS location and the intent of the driver based on the turn signal to change the trafic lights, bt it was always too slow.
Easier to put the proper tools in the hands of the driver.
My department has no written policy about emergency driving, other than that the Officer is responsible and the driver is to use caution. Thanks.
In this situation I hang back and shut down. There is no need to blare the horn and siren trying to ge the driver in the left hand turn lane to pull out into cross traffic. When the light turns green the lights go back on, when the lane is clear the siren as well.
If we needed to make a right hand turn here I will also reach out and wave at folks to stop.
If you said shut down and wait, you made my call.
*Usually a disclaimer about following your Department's policies would be warranted but this is the safest thing to do, so how can it be wrong?
Sunday, July 12
Did I gain weight?
In the midst of the budget battles, somehow the "other side" has
Health services. I'm pretty sure I qualify there.
Human services. Debatable on some calls for service, but technically yes, my patients are humans.
How did I become a sacred cow? Politics.
In what is becoming more and more common around the US, EMS professionals are being marginalized as other services are expanding, mainly those dealing with substance abuse and low income services. But where do these folks turn for help when released from the fancy detox and housing unit? After buying cheap booze that is...
We gather them up and funnel them back into the system, all with a legally mandated smile on our tired faces. And I have it pretty good these days. A few years back some of our rigs ran the same person 2 or 3 times a day. We'd drop them off and they'd go right back into the streets.
A pioneering supervisor with a background in social work teamed up with the local homeless team, grabbed a surplus van from the yard and started making the rounds. They found regulars, got them off the streets and into rehab. Out of rehab and into housing. Out of housing and on their feet again. Or, which is becoming more common, a bus ticket back home.
The program was remarkably successful and I will expand on it when particulars are approved for posting here at HMHQ.
This program was recently cut due to budget concerns by the powers above the powers that be. Seems to me there is more profit in keeping some folks from getting better or out of town. There is a lot of
Maybe I'm exaggerating, maybe not. We'll never know why a successful money saving program was eliminated in favor of apathy. Here or anywhere, it all comes down to dollar signs.
Standing on a sidewalk earlier today I was told by a client, recently moved from 1200 miles away, that my salary could feed and house a dozen people and that my job was "eliminatable."
"But then who would come and pick you up for free, take you to free detox, free housing, free food just so you can get drunk and do it again? Without us you freeze to death in the street."
He had no answer, but no one passing out the budget money seems to understand that we are the first rung in the Health and Human Services matrix.
We're that square near the top that says 'Arrival into system.'
Apparently my submission was either not interesting or not well written, they passed.
I wrote this 4 years ago and never had a place to put it. I found it and wanted to share.
Submitted to newsweek Magazine, August 2005
Have you ever gone into work in the morning and it was closed for the day to save the company money? My employer is doing just such a thing. Now understand that I don’t get the day off, I have to gather all my things and go to another site to do my work. Everyday someone I work with is in this situation and not only is it inconvenient for me, it could cost you your life. You see, I’m a Firefighter / Paramedic.
Politicians and administrators across America are turning to a dangerous game that saves money on paper but can have disastrous results in real life. Instead of cutting costs by closing a fire station and moving the fire engines, ladder trucks and paramedic units to a nearby location, they close a different station everyday leaving the entire area without fire or paramedic services. Some cities “brownout” more than 10% of fire stations a day. You can see how the savings can add up quickly, that is until someone calls 911. Even with all the talk of Homeland Security, WMD response and terrorism threats, the very people who would come to our aid are gone.
The fire station nearest to my home is closed about 2 days a week. Is yours? How do you find out? I thought the best way would be to call the fire chief. Her office gave me a boiler plate answer about how the fancy computers they have will automatically dispatch the nearest unit in case of an emergency.
I asked, “Isn’t that why they built the fire station here in the first place? So that in case of an emergency they will be there?“ and was told, “…it will reopen tomorrow.“ Not satisfied, I called my elected district supervisor’s office who’s intern was unaware of the practice. His office had not heard the Chief had “closed” any stations at all, but that they would look into it. The intern called back 20 minutes later with the number to the fire chief’s office. Big help.
An official with the local firefighter’s union made an excellent example of this brownout policy that relates to every citizen. With a serial killer on the loose, leave one of your windows open every night. Not the same one all the time, but a different one, hoping the killer won’t notice.
This practice sounds unrealistic, I know, but your local fire department may have already made the decision for you by closing the closest fire station for the day.
Even if you do get out of the fire safely due to properly working smoke detectors and a well practiced escape plan, the nearest fire engine is 8 minutes away instead of 4. Keep in mind that a fire doubles in size every minute.
That extra 4 minutes could mean the difference between life and death should you experience a heart attack, stroke, get in a car accident, break your leg or any number of other conditions that warrant an emergency response.
The worst part of this practice is that it is being done quietly, so quietly in fact that many of my neighbors didn’t know it was happening until I told them. No politician will stand in front of TV cameras and volunteer the fire station near their home to be closed.
So go to your local fire station and find out if you really are as safe as you thought. Just don’t be surprised if there’s no one there to answer the door.
Friday, July 10
I give you Scroobius Pip vs Dan le Sac
And here are the lyrics, my favorite being, "Thou shall not pimp my ride. Thou shall not scream if you want to go faster."
Thou shalt not steal if there is direct victim.
Thou shalt not worship pop idols or follow lost prophets.
Thou shalt not take the names of Johnny Cash, Joe Strummer, Johnny Hartman, Desmond Decker, Jim Morrison, Jimmy Hendrix or Syd Barret in vain.
Thou shalt not think that any male over the age of 30 that plays with a child that is not their own is a pedophile. Some people are just nice.
Thou shalt not read NME.
Thou shalt not stop liking a band just because they've become popular.
Thou shalt not question Stephen Fry.
Thou shalt not judge a book by it's cover.
Thou shalt not judge Lethal Weapon by Danny Glover.
Thou shalt not buy Coca-Cola products.
Thou shalt not buy Nestle products.
Thou shalt not go into the woods with your boyfriend's best friend, take drugs and cheat on him.
Thou shalt not fall in love so easily.
Thou shalt not use poetry, art or music to get into girls' pants.
Use it to get into their heads.
Thou shalt not watch Holyoke’s.
Thou shalt not attend an open mic and leave before it's done just because you've finished your shitty little poem or song you self-righteous prick.
Thou shalt not return to the same club or bar week in, week out just 'cause you once saw a girl there that you fancied but you're never gonna fucking talk to.
Thou shalt not put musicians and recording artists on ridiculous pedestals no matter how great they are or were.
The Beatles? Were just a band.
Led Zeppelin? Just a band.
The Beach Boys? Just a band.
The Sex Pistols? Just a band.
The Clash? Just a band.
Crass? Just a band.
Minor Threat? Just a band.
The Cure? Just a band.
The Smiths? Just a band.
Nirvana? Just a band.
The Pixies? Just a band.
Oasis? Just a band.
Radiohead? Just a band.
Bloc Party? Just a band.
The Arctic Monkeys? Just a band.
The Next Big Thing.. JUST A BAND.
Thou shalt give equal worth to tragedies that occur in non-English speaking countries as to those that occur in English speaking countries.
Thou shalt remember that guns, bitches and bling were never part of the four elements and never will be.
Thou shalt not make repetitive generic music,
thou shalt not make repetitive generic music,
thou shalt not make repetitive generic music,
thou shalt not make repetitive generic music.
Thou shalt not pimp my ride.
Thou shalt not scream if you wanna go faster.
Thou shalt not move to the sound of the wickedness.
Thou shalt not make some noise for Detroit.
When I say 'Hey' thou shalt not say 'Ho'.
When I say 'Hip' thou shalt not say 'Hop'.
When I say, he say, she say, we say, make some noise kill me.
Thou shalt not quote me happy.
Thou shalt not shake it like a Polaroid picture.
Thou shalt not wish you girlfriend was a freak like me.
Thou shalt spell the word 'Pheonix' P-H-E-O-N-I-X not P-H-O-E-N-I-X, regardless of what the Oxford English Dictionary tells you.
Thou shalt not express your shock at the fact that Sharon got off with Bradley at the club last night by saying 'Is it'
Thou shalt think for yourselves.
And thou shalt always, Thou shalt always kill.
If you usually drive an ambulance, you are in one.
If you're in an engine, you are in one.
In a police vehicle, you get the picture.
This applies to your situation.
You have been dispatched to a multiple motor vehicle accident with report of victims trapped blocking all lanes of traffic 2 miles away.
You are responding lights and sirens, emergency traffic.
This is what you encounter:Do you force the turn lane through the red light?
Do you "hop" the curb to the left an oppose traffic?
Do you shut down and wait?
You make the call.
Include in your post what type of vehicle you are in.
Thursday, July 9
Who would have guessed.
Since you new followers may not be familiar with Calamity Jane, as she is called over ton APW's blog, head on over and start from the beginning, learning all you can about the disaster/entertainment that is Calamity Jane.
I, for one, will miss the CJ stories.
Perhaps a moment of silence is warranted. Just don't touch my gun.
I am not an "EMT Hater," I am not looking to pick a fight with the "Basic for lifers" out there who take their duties seriously. This is geared towards those who think ALS belongs on an ambulance only.
All good Paramedics must be accomplished EMTs. I know that. But on a call the other day, an EMT with clearly no understanding of the situation told me I was in the wrong for checking a blood sugar before a blood pressure. (Altered mental status with bounding radial pulse.) He told me later that I need to "...put that ALS shit aside. BLS before ALS saves lives."
It took me a minute to see what he meant to say, that BLS is better than nothing and ALS without BLS is clearly silly, but the underlying current is anti-ALS. Mainly because the ALS units here run more than their BLS counterparts.
Advanced Life Support begins when the bells ring and I combine my education and the information coming from radio. From that I can rule in and rule out possible beneficial treatments to conditions I may find. This way I'm not flying in the dark when we arrive.
I learned this business from an instructor who stressed "why." Your patient's pulse is 50 and irregular. You can treat it right away or you can find out "why" it is that way and treat the cause, not the symptom. Sure your patient is hypotensive, but "why." It is often the "why" that can steer ALS in one direction or the other.
BLS treats the what, ALS treats the why.
When I asked my co-worker why he thought a blood pressure was warranted right that moment, he replied that was what they do, he didn't have to care why. He asked if I knew the blood pressure by magic just by checking a pulse. I smiled.
Some communities are ditching Advanced Life Support in favor of a less expensive, but less effective, Basic Life Support system.
If you have ALS, fight to keep it. If you've lost ALS first response in your area, remember that the only rhythm BLS can treat is V-fib. By then it's too late.
Wednesday, July 8
A full ALS assignment has been dispatched to a local motel for a report of "multiple fainting."
The nonchalant way we were buzzed into the hallway should have been the first sign something was amiss.
We find our patient and the caller in a room labeled a non-smoking although the dozens of half smoked cigarettes on the floor tell us otherwise. The caller states his "friend" has not been answering her phone and knew she was here so called us in case he was unable to get in. Into the motel room. Near the front desk. Where they have keys.
Locksmith 99 responding.
Our patient is intoxicated to a point I rarely see anymore. Some people use paints, others fabric or sculpture, our new friend uses gin.
The bottles lined up against the window represent a years supply for me, maybe 10 months if family is in town. She's been here 1 week and both she and the room are showing it.
Vitals come back just fine and she is indeed altered, much in the way the label on the bottle tells her she will be.
The kicker here is that the family friend states her family pays for the room when she "goes into the blackness of another bender" and that they can often reach her by phone. The caller asks if we can get her "checked out" at the ER. When I asked what her doctor thinks of this activity, after we learned she has quite a bit of money at her disposal, the caller stated "Who are we to judge her lifestyle choice?"
"Um, you called me, so I'm the judge. This isn't an emergency, this is a chronic condition and she needs way more than the ER can handle."
As he's digesting my response a paramedic intern arrives with the day car to continue the assessment. The intern is gagging on the odor of feces, cigarettes and dirty sheets while trying to conduct the assessment. Must be in her first 200 hours. All the while the patient is slowly wavering from side to side as if I'm on the dock and she's on a boat. And she just might be.
Tuesday, July 7
Police have a woman for an involuntary psych eval.
I remember from the psych emergencies section of my pre-med classes that the...um...there was none as I recall. Call me crazy, but I'm no expert in crazy. I will tie her down and take her to an Emergency Room where a general practice physician will hold her for 72 hours. That's all I can do.
The ambulance pulls up in front of the most rundown house on the block and is the first hint at what we will find inside. On the steps outside are 3 police officers and a woman with a clipboard. She identifies herself as a representative from the local adult services organization and is the one who activated the police.
The agency is forcibly removing the woman from her home of 56 years. Not being one to stand in the way of personal rights I try to get more information.
"Just go inside, but be warned." She says.
I already knew it would be bad since everyone was outside talking, not inside. She isn't a physical threat we were told and upstairs into the house we go.
The odor is faint at first, but is almost like a curtain in the doorway. As we cross the threshold and enter the rundown house the floors are the first thing to catch our eyes. The old plank floor, likely installed when the house was built 70 some-odd years ago is visibly worn down in a small two lane pattern just wide enough for a small pair of legs to shuffle along in. Everywhere else is covered either in shredded paper, random trash or feces.
Movement in the back of the far room turns out to be a large swarm of flies of all sizes. They hover over the center of the room which appears to have been a chair at one time, but is covered in almost a glaze of feces and clothing, appearing almost like a mountain 5 feet tall. The swarm doesn't even scatter when we try to walk by.
The adjoining rooms are behind closed doors and the shuffle tracks don't lead there. It appears they haven't for some time. Maybe decades.
Our patient is in the room commonly used to prepare food. The items in the sink have a film on them, a fuzzy one, that seems to touch your skin from arms distance. the air is heavy and we're trying hard not to breathe too much. The stovetop has rotting bones of some kind and pots and pans with crusted leftovers from when I was in diapers.
The walls are caked with fly larva and their constant flying from feces to the wall has left certain areas with a brown tint. I see the refrigerator and am too frightened to look. If this is how she keeps the open areas, I honestly fear what that little area hides.
"Hello. Are you here to take me away in hand cuffs?"
She's standing in the corner in a clean nightgown, maybe in her late 70s, alert, oriented and...clean.
"We were told you needed some help getting this started. Are you in any pain or discomfort? Anything you would call an ambulance for?" I ask, wondering where she keeps the soap.
"Oh no. I called a friend who called the adult services. She came over and nearly cried. I know this place is a mess, has been for years, but there's just no way I can clean it on my own. I eat out a lot and dry clean all my clothes."
She's fine physically and mentally, as far as I can tell, but clearly can't thrive in this environment.
"This is going to sound insincere and I know we've only just met, but where do you use the facilities?" My partner asks.
"I go down to the deli on the corner for that. That's where I wash my hair too." That explains that.
"The toilet doesn't work, hasn't for awhile." she tells us looking at the sink.
We spend another 5 minutes letting her change into some clothes for the ride to the ER, she agrees to a 72 hour evaluation, if nothing else than for a proper shower and for the wheels to begin to turn to get her help in cleaning up.
When she's changed she moves a large sheet of plywood over a window to "lock it up" and walks with us, vigorously wiping her shoes on the welcome mat on the way...out.
I can only imagine what the house looked like before this happened and if there was a trigger of some kind, a death in the family, a job loss, something that caused this woman to simply stop tending to her home.
As we left and she went downstairs, I took one last scan of the house and something on the mantle caught my eye. It was a grouping of heavily dust covered christmas knick knacks and one of them appeared to have a date on it. I could barely lean over the pile of rotting trash and clothing to read it, our occupant would never have been able to reach it.
Merry Christmas, 1987.
Sunday, July 5
Throw a ladder, tie a knot, move a charged line around a parking lot. The basics. But then some of the articles go deeper into a concept of the "first due fire" or what your first alarm area holds in store for you. The emphasis is on pre-planning and identification of life hazards prior to a fire. I get that as well.
But it got me wondering. What is your bread and butter fire? What is the structure type most likely to get you working today? Ranch style residential detached? Multi-story type 1 multifamily dwelling?
I'm not sure how this will work, but I want to give it a try. Send me a picture, or link, to a picture of your bread and butter type structure. It doesn't HAVE to be in your jursidiction, but a fair and accurate representation of it. Include in the email what your first alarm assignment is if someone reported that structure to be "on fire."
I'm curious to see what kind of bread and butter is out there.
Hit me up at thehappymedic over at gmail. Maybe if I get enough response we'll do some virtual "burns" and see how Boston fights a Phoenix fire and a volunteer squad responds to a worker in Los Angeles. Could be fun.
Friday, July 3
My favorite BIB (Boy in Blue) got a great ad placement recently. Just like the ads here when they were for teeth whitening and hair straightening and more recently when Motorcop, Policewife and 2 Wheel Terror conspired to put a police education ad on my blog (They deny it, I know they did it), the ads google chooses to place can be hilarious.
We blog authors can block certain ads but with only 200 hits a day, I attract the low rent crowd.
But the positioning with a recent post of his was just too much to pass up.
Incase you missed it:And the page that made me laugh even harder:
As you arrive on scene, the local fire squads are cleaning up, all patients had been transported and they didn't know you were coming. As you exchange hellos, one of the pressurized hoses from the extrication equipment ruptures, spraying fluid on roughly 6 persons nearby, including fire and police personnel, even one state trooper.
The firefighter closest to the rupture has fluid in his eyes, the others were struck on the extremeties and protective gear, the trooper in the face, but he was wearing sunglasses which protected his eyes.
You agree most should be cleaned off and examined, the fluid could cause trouble, it was highly pressurized.
They all request transport for evaluation, but there are no ambulances except you available in the area considering the recent event.
A fluid rinse is helping our friend with the most severe trouble, you would take him code 2 if he was alone.
An appropriate hospital is 30 minutes away, the other ambulances are still enroute to the trauma center 45 minutes away.
Do you call for assistance or take them all in your rig?
You make the call.
Thursday, July 2
Dispatched just after 1 AM to a report of a person in the water, we are the first engine at the scene. Responding behind us are the truck company, ambulance, chief and paramedic supervisor as well as our heavy rescue units. The heavy rescue units are specially trained swimmers and divers but are at least 10 minutes behind us.
We spot her clinging to a thin cable, 15 feet below us along the dock about 10 feet from a large party boat.
Police have arrived and are moving a gang plank to the boat to gain access to the water level. We've deployed a flotation device but the victim is either too tired or too confused to grab onto it. Using ladders and hooks we are unable to reach the victim, despite multiple attempts. the water is cold and dangerous for those of us not properly trained or equipped.
We are able to arrange a staging area on the boat to remove the wet clothes and assess injury just as the heavy rescue team arrives, fully wetsuited and ready to work.
They are quick to the water and work safely and efficiently, attaching a rescue device and removing the victim from the water almost without visible effort. They made it look like nothing.
A tip of the helmet to those of you who were involved in the like clockwork water rescue. You delivered me a patient from a place I could not go.
And that's where the praise ends and your letter begins.
When you removed the victim from the water, you were directed to the awaiting backboard and blankets so I and the awaiting ambulance crew to begin our assessment.
The victim was placed on the board and the straps tightened despite our requests to the contrary. Everyone began shouting to get her off the boat quickly and into the awaiting ambulance.
We asked you to wait. Your part was down, it was time for us to do our thing.
But despite our requests there were more of you than us and away you carried the wet, dripping, cold victim to the ambulance where the wet clothes saturated the floor making working dangerous.
3 minutes it took to get her up the narrow stairs, gangplank and across the parking lot on the pier. All that time the medics are hustling to complete an airway assessment.
Luckily the victim's airway and major vitals are intact, but she is cold. We removed the clothes and try to contain the amount of water coming from the cot, but there is no stopping the flow from the many layers.
You are experts at what you do. I know that, you know that. You proved it putting yourself into a situation I would not.
Please let me do my job. I didn't tell you how to get into the water or what to do when you got there, please let me do what I am trained to do.
You get them, I treat them.
That is all.
Wednesday, July 1
The members of that company have been scattered to surrounding companies for now, wondering what the fate of the now 5 other Engines slated to be closed will be.
Interesting times in the City.
I wander into the house singing, "...something is dreadfully wrong for I feel..." and my girls laugh.
We ran a job the other night that I wanted to pass along based on the outcome but it needed context. In comes Marty and the song in my head.
So, with the greatest respect to Mr Robbins, I present the following lyrics to a song I wrote.
(Sung to the tune of El Paso by Marty Robbins)
Out in the west part of town that I work in,
We were dispatched to an emergency,
The caller has a girl who's tummy does hurt her,
She's feeling faint and she can't rightly breathe,
A young girl is ill and we can't stop to dawdle,
We have to hurry and get there real quick,
She could be suffering, painfully hurting,
So many reasons she could be so sick,
The night is cold as we pull out the door,
Siren and horn are so loud,
Weaving and turning,
Though nothing is burning,
Someone does need us,
And we aim to help.
So with patience I
Buckle my seat belt and put on the headset,
Hearing the screech of the brakes to my right.
The handsome young driver had stopped to let us pass,
The young lady behind him distracted by night.
Just for a moment we pause at the corner,
Making sure no one is injured or dead.
Would we have to leave the young girl unattended,
Just because somebody didn't see red?
I thought of the young girl you needed us then,
Somewhere alone in the dark.
Half way to her place,
I only the see the face,
Of the young driver
Who just broke to swerve,
Far away from
The bumper she torn off the car right infront of
Another that had stopped to yield to our cause.
Dispatch is calling, our patient is falling,
Out of her chair and she's now on the floor,
No one is injured down here at the corner,
I climb back in the engine and slam shut the door.
Lights again flashing away we do go,
Driving so fast in the dark.
The ride is a short one
And now we've arrived there.
I jump out just soon as the engines in park.
And at last here I
Am in the hallway of the teen girl's flop house,
Wondering which girl needs ALS care.
An angry adult has appeared from the back room.
I ask a question which evokes a glare.
"My name is Happy and I'm here to help you;
Did you report a life threat to a child?"
Shouting loud swear words a young girl appears,
I need to get this place a bit less wild.
Something is dreadfully wrong for I see
A teenager sitting just fine.
Though I am trying
To find out what happened,
The adult is screaming,
And starting to whine.
So I ask
The young girl just what is the bother,
Wondering what her response would entail.
She says that she's thrown up from a bad burrito,
"I must not have heard that , please give more detail."
All of this panic turns out to be nothing,
The adult who called us I desire to flog,
All of the damage they've done just for nothing
"This is gonna look great in my blog."