101 Things the Fire Department wishes you knew



Wednesday, September 30

Social Media in EMS - A Tip of the Helmet

A Tip of the Helmet to online EMS educator Greg Friese and his extensive research into how EMS agencies need to embrace social media before it gets past them and starts to cause problems. In his September 2009 article, he mentions our efforts here at HMHQ to use this media for positive change in our profession.

Not sure what social networking can do for EMS? Have you ever used a tip you learned online, on twitter or even done a google search for something related to your role as an emergency care giver?

Then you are using social media to advance our Profession. Learn more in the article here,and at the EMS Expo in Atlanta Georgia, where it looks like Greg will be expanding on his article in person. I would attend, but will be recovering from my CO-Op Refresher in New Mexico and preparing for the Project, which starts in less than 6 weeks.

A Tip of the Helmet to Greg Friese. On twitter and facebook and everything. I'm sure he'd have it no other way.

Facebook updates now rolling

Hey Facebook friends and followers, it's your cartoon fireman friend the Happy Medic here, now linking directly to Facebook. Used to be I'd have to log out, log back in as Steph Frolin, navigate over to HM's fan page, grab a link...you get the idea.

And since we have been auto piping posts into twitter, and getting a good response, we decided to follow Fire Critic's lead and use an application called Networked Blogs in Facebook to crawl the blog and feed you updates without me having to do it all he time. This means you can follow the blog from the comfort of your Facebook status and make comments, like it or share it.

If you click on the image in the Facebook post you will be magically transported to HMHQ here at thehappymedic.com and have a chance to scroll through the 2nd alarm and mutual aid boards for the best fire and EMS bloggers on the interwebs machine, not to mention click an ad or two.

All this is in anticipation of making it easier for you to follow the Project, my and Medicblog999's adventures trading places and riding along to experience patient care across the pond.

Now you can hear about it on twitter, facebook and the blog readers, since the BBC will likely not be making our adventures into a program. We'll just have to change the world from right here on our computers.

For those of you not on facebook, who still have something called "free time," I'll try not to mention it much more after this, but I make no guarantees.

Tuesday, September 29

EMS FAIL or Client FAIL?

Our Pal CK had a rough night recently, not just with some hellish weather and unsound sleep, but encountered one of the glaring issues of modern Emergency Care, the frequent flier.

For those of you not in the industry, frequent flier refers to clients who activate 911 for non-emergent conditions or situations that the normal responsible person would simply take some tylenol or decongestant. These persons call 911 when they run out or lose their albuterol inhaler, have their seizure medication "stolen" or didn't listen when the pharmacist told them not to drink alcohol when ingesting these medications.

Another kind of frequent flier is the basic care seeker. These clients call 911 and use code words like "chest pain" and "seizure" and "difficulty breathing" to get their response bumped up to a priority dispatch. Then, when the crews arrive and find no life threat, they know the law and demand a transport to the ER, which they know we can not refuse.

You see, the laws were written back when companies would refuse to take those who could not pay, or, for whatever reason, the attendants didn't want to take in. That was back when we were a trade.

Now those laws tie the hands of professional care givers who care not only about the patient at the scene, but the next patient who may actually need that ambulance, instead of the client demanding care they do not need.

These folks are not responsible citizens. They demand others care for them, even when there is no care needed. It goes without saying that we treat those who need it, right? So why can't we be honest with those who don't need it? If she calls 911 3 times in 24 hours and got transported, seen, released and brought home twice, why the hell are we there a third time? This issue needs to be solved at EVERY level of the health care ladder, from the patient all the way up to the CEO of the insurance company she may or may not have. So let's break down where the system fails our friend CK, respecting that I don't know the specifics of his system model, so I'll try to be generic in my solutions.

The "patient," or client as I like to call them, is the single biggest share holder in their own health care decision making. The patient needs to seek out information about their medical history, health care options and basic interventions. This can be as simple as listening to the tylenol ads on TV in between episodes of Walker: Texas Ranger and as complex as making an appointment to see their doctor to discuss different interventions. Most folks can't take the time out of their busy schedule of sitting to be bothered with caring for themselves, besides, "Isn't that your job?" No, Ma'am, that's your job as a responsible citizen and proactive member of your community. Not every person can step back and see how their personal life effects their community, we are in the middle of the most selfish generation of people who don't care what happens to their neighbor, only to them.
In CK's example, the client was the first part of the system to fail. She refused to listen to the care takers already put in her path from the prior transports and thinks the ambulance is her personal taxi. PATIENT FAIL.

The family needs to be informed decision makers and understand the conditions which their family suffers from, if at all. Don't tell me she has seizures but you don't know how often, or why, or if she takes meds for them, or if it's just "DTs" (Which I am observing less and less, I think even the alcohol abusers are getting too lazy to fake seizures). If you care for your family, then CARE for them. If they fall and hurt their elbow, maybe take them to a clinic or their doctor's office. Don't call 911, demand a transport, then follow in your car. Tell you what, you get in with her and I'll drive your car, how's that? The family needs to also recognize abuse and nip it in the bud. Huh, third ambulance ride today? Maybe nothing is wrong if they keep sending her home. FAMILY FAIL

The General Practitioner who was called and defaulted to a 911 response is playing CYA with local resources. I am not your insurance policy Doctor, I am a Paramedic. My profession is not your car service and can not respond to cover you should you decide to actually see your patient. I know you are overbooked and understaffed, but that nice Audi I saw in the parking lot is coming from somewhere. Get off the phone and get in the Audi and tend to YOUR patients. House calls are a thing of the past? How about a thing of the future? If there was a component of your practice that allowed this patient to access you or your staff at all hours, she would not be calling 911 3 times in 24 hours and bothering you at all hours. If she is healthy she doesn't need to call you and you actually have more free time for cruising in the Audi. And if you think that simply activating us gets you off the hook and we can do a better job, then let's see you put your credentials where your mouth is and step up as a Medical Director and give your Paramedics authority to refuse care to folks who don't need it. DOCTOR FAIL

The 911 EMS system. You fall, they call, we haul is funny, yet true. Why can't our friend CK take in all the facts, do a professional assessment, determine no need for the ambulance transport and call the doctor back, informing them of the situation? Why? Lawsuits. Our services are afraid someone will actually be refused a transport because of their nationality, sexual orientation or ability to pay, but they ignore the fact that if I wanted to stick it to people I didn't like I would simply not treat them properly. Well, I think it's obvious we're past that part of EMS history, let's get up and actually move past it. Medical Directors need to be proactive in giving their systems tools to guide people out of the water slide that is defaulting to ALS to a hospital. Why was an entire town's EMS system activated 3 times for this client? EMS RESPONSE FAIL.

Does this woman have medical insurance? Is she on disability or perhaps in the VA system? If she is in a private system, has she called the nurse advice line and if we reached that far, did the dial-a-nurse default to telling her to call 911? In my experience with the dial-a-nurse lines, they should be replaced with a recording that says, "Hang up and call 911." In the rare instances where the information is valuable and followed, the clients calling are honest about their symptoms and are clearly responsible citizens, proactively trying to stay healthy. In this situation, again assuming she has some sort of policy, the company must now reimburse the ambulance service, the ER docs and whatever specialists may be activated, instead of spending $100 to get this person into the office sooner. INSURANCE FAIL

The emergency room is the most expensive form of preventative care. I once transported a woman who demanded a pregnancy test. When I offered her the $12 to buy one she refused and told me to do my job and take her in to get the test. "That's what my insurance is for." she told me. No, Ma'am, it's not. And even worse, I know for a fact that the Docs that night gave her that test and anything else she wanted simply to avoid the possibility of legal action should our client decide she didn't get what she wanted. We give these Physicians powers to save lives and end them but tie their hands when it comes to rationing (ooooh buzz word) treatments they know, from being doctors, clients do not require. Let Doctors practice medicine, not constantly defend themselves from what could, possibly, maybe, one day, be a law suit. ER FAIL

So there we have it, CK's situation broken down and the failure found. That's the easy part, unfortunately. The difficult part is finding the solution that fits to make sure our client, remember her, is healthy. That is what this whole giant medicine thing is about, healthy people.

So do we ditch the whole for profit thing and go single payer socialized medicine? It might change a few aspects fo the system, but it will not make our client responsible for her own care. It will give doctors and paramedics more options for diverting her away from the ER, but in he end, CK is still right there in the middle of the night for the third time.

Can we tweak the way insurance companies bill, maybe have everyone pay a little? Still not changing our client's desire to be proactive and there is CK, sleepy and at her home.

Tort reform will surely change the way physicians treat, right? Maybe, but how can solving the problems in the penthouse fix the problems in the foundations? Insurance for the Docs will cost less, but will they pass along the savings back into the system or will there be His and Hers Audis? Not to mention our client is still calling the first time, even if we can convince her no to call the second and third times.

Advanced Care Paramedics and ability to refuse transport could help, right HM? That's only part of the picture and we're still going out there for the initial call and, likely having to return multiple times if they don't get what they want. How many times have you had someone wave you down demand meds and when you refuse they call 911 thinking someone else will return for them. Refusing transport only works if there is a framework we can plug people into instead of the ER.

The solution has to be wide ranging, sweeping and take into account every single aspect of health care from inoculations and birth control to advanced surgery and experimental treatments for advanced conditions.
There is no solution that solves all our troubles, but there is one solution that goes the farthest towards helping to take the pressure off the rest of the system.

Personal Responsibility. Taking control of our own lives and inspiring others to do the same. Get in the faces of your clients and impress upon them how they impact the system. Follow your protocols, do what is right, but point out to your clients the truth about what they are doing and remind them of ways they can access healthcare that isn't running red lights, putting lives on the line for a hurt foot. Be honest about the cost of your response, that if someone nearby is actually sick or actually hurt, they will suffer as a result of this abuse of the system. Nothing in the laws says you can't tell the truth. When people say "Sorry to bother you with this, but I didn't know who to call" take the extra 5 minutes, grab a phone book and show them who to call, where to go and how to get help. Then do what the law requires. Be nice, be supportive, but be honest.

Next time, if we can get people proactive about their care and encourage them to do the same for their neighbors, maybe our call volume starts to go down.

Lofty dreams of an overly optimistic Paramedic, sure. Ramblings of an EMS blogger, certainly. A simple first step towards positive changes in our profession...if no one else will, then I will.

Will you?

Hope you have a better night CK, and if it gets to busy, I'll bring 99 over and we'll cover in. I'd love to have a little chat with your client.
This post started as a simple response...sorry I got long winded. And Medic999 and my UK friends, I'd love to get your responses to CK's situation.

Monday, September 28

Are you already intubating TRAUMA?

The Crew of Medic 77 - Kevin Rankin as Tyler, Derek Luke as Boone in NBC's TRAUMA

The buzz is alive! NBC's "new hit" TRAUMA premieres tonight, as I'm sure anyone who visits these pages and others already knows.

Thing is I'm already hearing from my co-workers and others that the show is doomed to fail.
"Looks so fake." I was told by a fellow watching The Terminator.
"It isn't like that at all, that's not an accurate picture of what we do." Said the woman who adores CSI:Las Vegas.

My point here is that this is not a documentary about EMS, that Project got knocked down, this is TV. A TV show not unlike the one with the yellow family that hasn't aged in 20 years, or the genius doctor and his merry group of physicians treating the exotic, or perhaps my favorite show about spaceships and people that talk funny.

It's TV. This is not the Emergency! of our generation, we know that, so lower the bar of expectations a bit my friends.

TV Paramedics never seem to do well for two main reasons.
1. No one wants to watch a show about what we ACTUALLY do. There is no good TV value in watching me help a 45 year old man claiming to have an asthma attack scream about how much I abuse him every week, without a single wheeze. Boring. Funny in the moment, but boring. The magic we on occasion create, when a patient actually responds to a complex treatment is rare and over quickly, mainly because we tend to move quickly to definitive care.

2. They follow the characters home. In my exhaustive 10 minute research on the subject of TV Paramedics, I've found that each had a really good chance of succeeding until the story followed them home.

Case in point:
Paramedic Wyatt Cole from TNT's Saved was a great example of a Paramedic of the 21st Century. Apart from the whole "I graduated Medical School but I hate my father so I work on an ambulance" story line, he was a true caregiver who they showed actually caring. The show was clearly written by someone who worked in the field, since they had smelly regulars and a rival ambulance company pushing unwanted vagrants into their roll area. It was a fun medical show, but the home lives of the characters began to take up more of the show and before you knew it it was less of a Paramedic show and more of a show about a guy who happens to work in EMS.

Law & Order does so well because you know exactly what is going to happen every week. 30 minutes of Police doing amazing police things, a twist, an arrest, and then 30 minutes of lawyering. No homelife BS, no diversions, plain and simple. In the rare cases they do wander home, it's part of the case.

TV isn't meant to be real, guys and gals, it is meant to be entertaining. Tonight, when you're angry that someone did something WAY outside their scope of practice, or says something like, "Don't you die on me now!" take a deep breath and imagine Motorcop watching reruns of Chips, or Firegeezer watching Rescue Me, don't get upset if it's not an accurate portrayal of EMS in the US, heck from what I can tell it's not even an accurate portrayal of EMS in San Francisco.

TRAUMA is a TV show about Paramedics, not FOR Paramedics. If it was, it would be on the BBC or Discovery Channel and actually ride along with Paramedics. Wait a minute, I swear I've seen such a program...

I will be watching it here at the Angry Captain's place with an open mind and a hope for entertaining television. And even if it fails to make me cheer, I'll keep watching it because it has helicopters and explosions, which are never a bad thing.

112

One Hundred and Twelve degrees farenheit. 112. Last I checked cell walls break down around 107, but our caller swears her son's temperature has broken the land heat record. At 1 AM, of course.

THE EMERGENCY

A mother states her son is lethargic with a temperature of 112.

THE ACTION

The bells are loud at this station and I seem to have chosen a bunk directly under the speaker. I wander into my turnout pants and down the slide pole before I completely comprehend the dispatch information.

"Did they say 112?" the Officer asks as we climb in the $450,000 fire engine staffed by 1 highly trained firefighter, 1 highly trained driver, 1 new Officer and yours truly.

"Impossible," I say clicking my seat belt, "107 is as high as you go while alive. Maybe she's reading it upside down?"

Enroute dispatch advises the child is unconscious and they add a Paramedic Supervisor to the run. This town panics when kids are involved. As we arrive at the address we see the standard teenage girl flailing her arms in the street as if the houses weren't numbered in ascending order. Off the engine and bags in hand we're led to the third floor, past a woman screaming a foreign language into the phone and into a back bedroom where I see our young fire child.

Awake. And dressed, shoes and all.

"Is this the boy with the fever?" I asked as the firefighter checked the boy's skin.
"His fever is 112, I had to call you, I don't know what else to do!" Mom is crying to us as young "Danny" is curled up at the edge of the bed asking why my pants look funny.
"These are my fire pants. We brought our fire engine, want to see it?" simply wanting to see if he comprehends the facts in front of him, kind of a level of consciousness test.

"YEAH!" He shouts and is off to the races and down the stairs nearly knocking down the ambulance crew running up the stairs, Pedi bags in hand.
"How much Tylenol have you given him?" was the last question I heard as the ambulance crew pushed us out the door and back in service.
"None" was mom's response.

Danny was excited to see the engine, lights flashing in the early morning hours, even though he should have been fast asleep, tylenol doing its thing on his mild fever.

You Make the Call...Smoke Showing...What Happened

Seems every time we put a fresh pot of coffee on, something comes in.

In this scenario I was actually the eager young fellow out in front of the station reading the smoke in the early morning hours. I was beside myself when the boss looked over to me and told me we were out of service and there are other companies to cover it. But, the red stuff, it's...red and burning and hot and stuff. Huff.

My jaw was on the floor. I wanted to throw the radios back in our coats and head over there. I don't need my ALS kits at a working fire, that's what ambulances are for.

If you said hang back, you made his call.
However,
If I was in the seat that morning we'd be right back in service on the air and responding if we were due. I think most of us work in a place where if you can see the smoke, chances are you're due.

If you said get off your butt, there's a fire, you made my call.



A quick note on our You Make the Call series. There are often comments about not knowing my situation or my SOPs, etc, etc. The point of these situations is to get us thinking about what WE would do in our own districts with our own SOPs, staffing, equipment, etc. Don't wonder what I did, tell me what YOU would do. Hence the "YOU" Make the Call.

Sunday, September 27

Saturday, September 26

Rules for Covering-In

Different places might call it different things, but here when one company is called to respond for another, it is called Covering-In. Our dispatch system already knows who will cover for who depending on the severity of the incident. Most commonly used when greater alarm fires are transmitted, this system puts companies into the effected area to maintain basic coverage.

We are dispatched as follows: "This is a directed cover for Engine 99 to the quarters of Engine 77, Engine 99 you are now first due in place of Engine 77." And we head over to Station 77.

There are rules you should follow when covering-in.

1. Get the map book from the office and put it on your rig, after looking it over. Maybe you're lucky enough to come from a nearby area and know the neighborhood you're covering, but if not, become best friends with that book if you're the driver.

2. Cover the food. If they were in the middle of a meal when the bells rang, cover their plates and tend to the food left out. Do not eat the food, they're expecting it to be there when they return, so go out and get your own food.

3. Make up a hose pack. If your department has a standard strapped hose load, make a new one so the company can go back in service faster when they return. Make it up or ensure there is enough line to restock their pre-connects and get it ready.

4. Don't sleep in their beds. If you're stuck there overnight, you get to sleep in a chair. Do you want some stranger sleeping in your bunk? Didn't think so.

5. Secure the house and the yard. Make sure all the doors are closed and locked (and that you can get back in) and cars in the lot are secure. Goodness only knows what they were doing when the call came in.

6. Make a fresh pot of coffee. Also check for bottled water and put some in the fridge.

7. Post a night watch. This person will be pre-selected to answer the phone, front door and monitor the radio to wake the crew when the home company is returning. That way they return to lights on, fresh coffee and extra hands to help get back in service.

8. Check the washing machine and dishwasher. Do basic chores to make less work for your co-workers when they return, likely exhausted.

9. Keep a log of any supplies you use while gone, from coffee to medical supplies.

10. Before leaving, make sure there is nothing else you can do for that company including chores, dishes, cooking, anything. Pay it forward. Do onto others, etc etc.

Friday, September 25

A Tip of the Helmet - HIPPA Mad Libs

A tip of the helmet to Mack505 at Notes From Mosquito Hill.

The recent post joking about how a HIPPA approved EMS blog entry would look sparked a nifty idea over at his home blog.

Mack505 copied the [bracketed] items and sent them to friends as an actual EMS Mad Lib.

The first one came back and it is indeed funny. Give it a shot, here is the list of brackets.

[a location]
[medical condition]
[possible relative]
[partaking in a household task]
[he and/or she]
[mechanism of injury]
[an injury and/or illness]
[municipal service]
[a/an approved medical device]
[conveyance]
[patient care procedure]
[medical device]
[medical device]
[an approved setting]
[the appropriate button]
[a body part]
[patient care procedure]
[approved pharmacological interventions]
[Physician and/or Physician's Group]
[a secular receiving medical facility]
[an approved pharmacological intervention]

Replace your words into the text of the original post and send it to Mack505. Neat idea Mack, I like it and we might just do this again some time.

You Make the Call...Smoke Showing

Congratulations on making it through your first shift as the Engine Boss. Yesterday went well and here you are at 6 AM stripping the radios and whatnot from the engine as she is due at the yard for an oil change.

Just as you finish removing the ALS bags, defib, radios and headsets, a call comes over the radio for a reported working fire in the next district over. You are out of service for the yard, made the call not 5 minutes ago.

Not thinking much of it at first you go back to your morning paper. The first engine to go enroute on the air reports heavy smoke showing as they pull out of quarters. One of your firefighters has come running back in as you take your first sip of coffee and tells you it looks to be on the border of your two jurisdictions, maybe even closer to you.

"Are we going on this or what?" He has his pants and coat on.

You make the call.

Thursday, September 24

the Handover - 8th Edition

The Handover is alive! And for the next 12 hours my link bar will likely have all links to this edition, hosted over at Life Under the Lights.

CK has put together the funniest. calls. ever. and did a fantastic job. Anything with a one armed fisherman joke, sign offering a free cat and stories about human urination can't go wrong. Right?

Attention all Companies

In case you were unaware, you can also access the Happy Medic blog from thehappymedic.com, or happymedic.com.

If you currently access HMHQ from a bookmark in your browser, please take a moment to update the exhausting yourhappymedic.blogspot.com with a quick happymedic.com.

This will make it easy for you to follow along seamlessly should I finally decide to expand the blog into a full fledged site. Yes, that was a threat.

Also, keep watching for details on the England Paramedic Exchange "the Project" and dates for EMS and Fire Bloggers meetups both in the UK and the US. They will be in November, exact dates and locations TBD. Want to join us? Drop me an email at thehappymedic@gmail.com and I'll update you personally. Or at least my secretary will, if Mrs HM will let me hire Scarlett. *sigh*

In addition, HMHQ was linked by a publication for our advice on Disaster Planning recently, so that will continue early next week with tips on how to plan for an evacuation. Remember, this is all adding to our binder we started after agreeing to finally get that living will sorted out, so just keep adding to that binder and before long you'll be prepared for anything.

That is all.

Wednesday, September 23

A HIPPA Friendly Post

I was joking with a friend that instead of changing facts in these posts to make them safe and legal and such, I could just omit the information. I joked it would look like a horrible MAD LIBS. Sounded like a challenge. So here is a HIPPA approved EMS Blogger Post:

THE EMERGENCY

[There is no way to confirm or deny the existence of a medical emergency]

THE ACTION

We arrived at [a location] for a reported [medical condition]. The reporting party said their [possible relative] was [partaking in a household task] when [he and/or she] lost their balance, resulting in a [mechanism of injury] that caused [an injury and/or illness].

The [municipal service] moved quickly to apply [a/an approved medical device] and extricated the patient to the awaiting [conveyance]. In the back I started a [patient care procedure] and rapidly shifted gears to the [medical device]. I charged the [medical device] to [an approved setting] and pressed [the appropriate button]. The smell was intense. [a body part] had caught fire, literally, as a result of the [patient care procedure] despite my use of [approved pharmacological interventions].

Needless to say the accepting [Physician and/or Physician's Group] at [a secular receiving medical facility] was not at all amused at our predicament and immediately started [an approved pharmacological intervention].

Two Houses

Two households, both alike in dignity,
In fair Verona, where we lay our scene,
From ancient grudge break to new mutiny,
Where civil blood makes civil hands unclean.
From forth the fatal loins of these two foes
A pair of star-cross'd lovers take their life;
Whose misadventur'd piteous overthrows
Doth with their death bury their parents' strife.
The fearful passage of their death-mark'd love,
And the continuance of their parents' rage,
Which, but their children's end, naught could remove,
Is now the two hours' traffic of our stage;
The which if you with patient ears attend,
What here shall miss, our toil shall strive to mend.
Shakespeare's Romeo & Juliet, Prologue

Two Houses.
EpiJunky

Capt. Schmoe


I do believe an ancient grudge is boiling to a head.
A grudge born from a time when what we do was still a mystery, a trade, an idea whose time was overdue. The fact that this new idea took root in a large municipal agency has led to many today misunderstanding why it was put there. Some have seen the big red machine have little effect on their company's ability to provide excellent service to their community over decades.

There is a battle raging in some systems between these two houses that has no winner, no finish line and no perfect solution.

We are the children of a time of confusion and reaction. The machine struggled to defend their size and mission. In no way am I suggesting that the children of the two systems will unite and die to finally get the parents to stop quarreling, as Shakespeare tells, but I now believe that my current role may in fact be that relationship. A combination of the two houses that was not properly vetted or thought through and was doomed from the beginning.

The meeting of fire and EMS for me is a natural fit. I don't see things in the contrast of Montague and Capulet but shades of Verona Citizenry. Fire based EMS makes sense to a point, but I've seen it taken so far past that point in some places, we're starting to finally turn on one another.
To quote James Andrews from PCU - "It used to be the Administration's job to make the rules. It used to be us against them, now its us against us."

The cousins of both families are at war because we take the least of each and apply it as the rule.

We're better than that. Those we make example of may not be "us", but the folks that take the time to even type EMS in the google search bar are miles ahead of those bringing the meaning of what we do into the gutter.

Fire engine, ambulance, squad, pick-up truck, volunteer, whatever capacity you provide you service, we should all be striving towards the same goal of providing the best possible service to our clients and patients, leaving all the political BS, name calling and ancient grudges outside. It doesn't belong at the scene, it belongs here, in the channels of communication we have opened when others failed.

It is here, in this new medium, we can have an International discussion about what to do next, instead of raising our voices in front of the people who call for help, not caring what color uniform walks in the door, or who pays the salary, just that help comes.

So vent my friends, get it out. Write a post out of frustration, erase it and start over again. Each version calming your anger and settling your frustrations.

Share your experiences so that those new in the business can learn what a true caregiver looks like and those who may be slipping can catch themselves before they fall.

Tuesday, September 22

Losing Independence

Not a political post, I assure you. This is about a section of the population that needs to come to terms with their limited abilities. And to remind PAs that I am in charge of patient care at a scene.

THE EMERGENCY

Caller states there has been a car accident and one person appears shaken up.

THE ACTION

Shaken up. OK. Out the doors and a few blocks down we see a large SUV into a light pole, newspaper machines and trash cans in the sidewalk, 2 parking meters down for the count and a little old lady seated behind the wheel of a little hatchback behind the SUV.

Blink. Blink.

The SUV was empty and parked, our little friend is alert and oriented, sitting behind the wheel, clearly upset at what has happened. I think she would likely get out of the car and be fine if it weren't for the half dozen samaritans encouraging her to go and get "checked out."

I introduce myself to the group and they all start to tell the story, each pointing different directions and saying different things. Quickly, I duck down and make contact, she is not injured and has no complaints. She describes not having parallel parked in years, let alone on a hill like this, and hit the gas a little to hard backing up (she points over her shoulder to the uphill parking meter). Then she gunned the gas a little too much instead of letting the car roll forward. (She points forward towards the mess down the hill). When she realized what was happening, she tried to hit the brakes, but her foot was still on the gas. She pushed that SUV right up off the street and onto what is usually a crowded sidewalk.

As I completed my assessment and she blushingly refuses an ambulance, a man approaches to ask me if she had a TIA.
"I don't think it appropriate to discuss her condition with strangers, do you know this man?" I asked her seeing her shaking her head.
"I'm a PA," he advises, removing his sun glasses, "Are you OK Dear?" He asked her as if talking to a three year old.
"Sir, I have this scene under control, and she has a name if you'd care to ask." Was my smart ass response that got his attention off of her and onto me, as planned.

"You guys sure have a lot of attitude," he observed looking me up and down, perhaps looking for my Registry Certificate, State and County Licenses, 48 hours of continuing education, Bachelor's Degree, instructor's certificate and years of assessments. I keep them in my other pants.

"I would have her checked out if I was you." And away he went, placing his sunglasses back on as if nothing was wrong.

"Who was that man?" my client asked looking up at me from the seat of the car, holding her insurance information and license.
It was then that all the BS around that man faded away and I saw what was going to happen to my friend. There is no way her insurance rates will stay affordable, likely resulting in her losing the car. The freedom she has known for close to 70 years of driving will be gone. Then she'll have to walk to the market, that is until her knees give out. Then she'll be stuck at home. And the PA so concerned for 80 seconds will never stop by to lend a hand.

Monday, September 21

Milk dripping from my nose

We added a new CE source awhile back and they recently earned a permanent spot in the CE group.

Take a big sip of milk and click on this link to the most recent post at Ugly Things for Sale entitled, "There is nothing about this post I don't like"

I haven't laughed like that since they tried to convince me the King tube is better than the combitube.

This is good for 48 CEs for the author of that blog.

LATE EDIT -

Speaking of CEs, I've added Rogue Medic to the Mutual Aid Board, but will also give CEs for his insightful posts and unyielding desire to CITE HIS SOURCES when making an argument. I find people who make claims they can back up fun to read and great to learn from.

By the way, your CEs are only good for your Happy Medic refresher, so no more emails asking for the certificate provider number for your National Registry. Even though I'm sure they were a joke, I just wanted to set some ground rules for you new folks. Both of you.

Last call for the Handover

CK at Life Under the Lights has sent out the last call for submissions to the Handover. This month's theme is "Funniest. Call. Ever." Grab a link to your funniest call and send it to him for inclusion, but hurry, today is the deadline.

You Make the Call...Advertising...What Happened

Well, well, well, your flirting has finally caught up with you, eh? (Thrown in for Little Girl)

This situation called for either disregard and hiding or coming out into the open. Or blaming someone else... Where is MC when you need him?

I chose to come forward and tell the brass about the situation, in person. When I walked into headquarters and into the Chief's office I was met by a familiar coffee cup on the desk and knew everything was cool. We talked about how parking in front of the shops we frequent can send the wrong signal and that we were of course allowed to patronize appropriate businesses.

In the end it could have gone either way with the same result, I think there was some pressure from City Hall as to why one of "their" rigs was in an ad without their permission.

There was no such outcry when a local insurance group used a shot of one of our rigs in their ads proclaiming quality care by their services.

If you said be honest and get out in front of this thing, you made the right call.

Sunday, September 20

Sunday Fun - Dinner, dinner, dinner

Three of my favorite words in the firehouse are:

Jumped - You are relieved, I'll jump a call if you get one.
Box - A reported fire.
Dinner - No explanation needed.

Stuck for a recipe for tonight? Try this site, FireHouse Chef dot com. Each recipe gives the member who submitted it and there are a large number.

Even something for my bacon loving friends:

Border Bullets - For Those Who Like it "HOT"

  • 12 large jalapenos or how ever many you want to make.
  • Cut the tip or small end off of the jalapenos leaving the stem on the other end.
  • hollow the jalapenos. ( we use a potato peeler )
  • Fill jalapenos with cream cheese.
  • wrap jalapenos with bacon holding bacon in place with toothpicks.
  • Broil in oven until bacon is to your liking.
  • remove, let cool and eat.

Recipe by Firefighter: Phil Burrow - Alva Fire Department, Alva Oklahoma

Do you have a favorite recipe? Post it in the comments and you'll have another place to look for recipes.
And don't forget to stop by our friend Mrs Fuzz over on Fuzz Food for other ideas.

Saturday, September 19

Onstar?

I was asked by a client recently if this Onstar really works. The idea is that the sensors in the car send signals to the company who calls 911 in the area and relays the information.




I was wondering if anyone out there has responded to one of these automated calls and how it came in. Was the information accurate? Did it make a difference?

Friday, September 18

You Make the Call...Advertising

A couple weeks ago you were at one of your local coffee spots enjoying a fresh, brewed just for you, cup of caffeine when you commented to the clerk, whom you fancy, how much you love the coffee there.

"These keep me awake to save lives" you half joked, half hoped she was single.

The bells rang over the radio and away you went on a call, not giving it a second thought. You've been back every shift, so has half the fleet.

Yesterday morning the newspaper has a new ad running showing your ambulance parked in front of the coffee shop with your quote in large block letters. Medic 99 clearly visible on the side.

This morning a memo is out asking those responsible to come forward. Your Department's policy on endorsing products in uniform is clear: No.

After sipping the last of your coffee, your partner asks why you turned red. You make the call.

Wednesday, September 16

No one wins

The dispatch is for an unknown medical aid.

I press the button for the rickety elevator, wondering how long the trip up to the fifth floor will be.

"Mid 40s female...overdose," the Fireman says.

I pause

"Early 60s male, respiratory issues," is my reply.

"Lunch and dinner?" He asks, hand outstretched.
"Lunch and dinner," and we shake hands as the elevator opens and we pile in.
The ride is shorter than we expected, and we made it all the way up.

As the door rumbles open there is a distinct odor of urine and an open door just down the hall.
"In here!" a tired male voice calls. I turn to enter the little room and see, on the bed, a man in his 60s having trouble breathing, holding onto a woman in her 40s with an altered mental status.

"Well that was anti-climactic" the boss says and we go to work.

Later that night we bought each other's meals just to keep the spirit of the game going.

Tuesday, September 15

Holy anhydrous ammonia Batman!

You need to stop what you are doing right now and click over to Life Under the Lights.

This is not a drill.

Disaster Plan - Supplies

I've gotten a couple of supportive emails about the Family Disaster Plan we've been slowly building, so I'll try to add a section or two every couple of weeks.

This new section is about supplies. Not necessarily MREs and climbing gear, but re-purposing some basic household items to be used in case of a disaster.

We'll need some bins. Buy your supplies first, stack the items together, then buy bins that will fit your stuff. Don't try to cram stuff into bins after the fact.

First, let's talk water. You will need one gallon of water per person, per day. That means at least 12 gallons for my family. When you get the water home look at howe much space it take up not only in the house, but in the parking lot at the store. Keep this space usage in mind since if you need to evacuate you'll need to bring it along. (Water does not go in the bins)

Next, let's talk food. I recommend one can of food per person, per meal. This means a family of four could share 2 cans of chili a vegetable and a fruit as an evening meal. Include canned foods, nothing that needs to be refrigerated, and things your family will actually eat. The side of the road in the middle of the night is a bad place to try to introduce spaghetti Os to a finicky 3 year old. Check the expiration date on the cans and make sure they'll make it to next year around Christmastime. When they near expiration, replace them and donate them to one of the many canned food drives. Instant karma.

In addition to the cans, we'll need some variety. Add in a box of unsalted crackers, a package of juice popsicles unfrozen (Like OtterPop Brand) and a handful of candies. This will keep the sugar level up and add some yummy flavor for the kiddos. At the store, find some 12oz V8 cans and add 3 per person. This is your breakfast and is also a great source of vitamins.

Avoid pasta, ramen, anything that requires water to cook. You need that water for drinking.

Now, onto the cooking of the food and the sheltering while away. We'll cover how and when to evacuate later, let's get our supplies together first.
Do you go camping? Do you have a tent, camp stove, flashlights, candles and a decent little stockpile of utensils and the like? Then great, you have a disaster kit almost ready to go. Move all you camping things together and into a place that can be easily accessed in a hurry. This will be your home if you need to evacuate. Especially if you are leaving with your pets since many shelters will not accept persons with animals, camping allows you to chose who you bunk with. Re-read the instructions and cautions on your cooking stove to ensure you always use it in an open area.

Just a few more things for our bins. Each bin now gets a can opener, 2 large trash bags, a small box of ziplock bags, a roll of duct tape, a package of baby wipes and an emergency radio/flashlight. You can find a variety of models to choose from, but I recommend one that can run on batteries, solar and dynamo power. It should include a flashlight and radio and some even offer adapters to charge a cell phone. Each bin gets one along with an old cell phone with charger cable. As long as you can transfer your card into the old phone, you're good to go.

If you have really little ones, add formula and a bottle set up to each bin and remember to update the food choices according to age.

There, the basic bins are ready to go. Whether it fits in 2 or 3 or 4 bins, be sure that the supply can be split if needed, one group taking enough for them while leaving enough for others. Store the bins so they are easily accessible, maybe with the camping gear and you'll have everything you need in the same place.

Write down what items are in each bin with their expiration dates and place it in the binder in the back. Update it every year before the holidays along with the photos on the front page.
Not sure what I'm talking about? See where this all started at our first adventure into Disaster Planning HERE, ans follow up HERE to learn even more.

Next time we'll talk about when and why to evacuate. Until then, be prepared.

Monday, September 14

It's a funny squeaky sound

You need only watch the first 20-30 seconds of this for the following dispatch to make sense.



Aunt Bethany from National Lampoon's Christmas Vacation is a favorite at HMHQ. It isn't Christmas until Clark W. Griswald and family go through their annual disaster. I was temped to hold this post until the Christmas season approaches but I had to share this remarkably appropriate use of resources.

THE EMERGENCY

The caller states she hears a "Loud squeaking sound" from her basement.

THE ACTION

Did I mention that I am so creative I have imagined every single one of these posts? None of them is rooted in any reality whatsoever, I'm that good.
Oh I wish I made this up.

The engine and truck companies arrive on the scene, code 3 I might add, to the large apartment complex where we are led to the unit of the reporting party.
"It's a loud squeaking sound" she tells us, causing me to smile recalling Aunt Bethany.

We head to the basement where we find a hot water circulator pump with what sounds like fried bearings. We explain that we can turn it off, but folks up on the upper floors may have to wait a while for hot water.

"I can't sleep with that sound, turn it off." she tells us and turn it off we did.

It was back on the sidewalk out front as the ladder came down (why not have a quick drill?) when a passerby asked me what the trouble was. When I told him what we had found he stopped dead in his tracks.
"Are you [expletive, deleted] kidding me? They called 911 for a noise? Are they retarded?"
"Sir I can make no statements as to the mental well being of our clients, what with privacy concerns and all."

He smiled and went along his way. I, unfortunately, had 14 more calls to run before that shift was over.

Sunday, September 13

Sunday Fun - For the Firegeezer

When I got my phone I didn't care if it had a camera. When I bought my camera I didn't want it to have a phone. Now that I've found myself in a few places wishing I had my camera only to have my phone, I will pay more attention.

While sitting fire watch on a large industrial fire from a few days earlier, our engine company was doing the obligatory orientation to entrance, egress and safety issues when I peaked into one of the warehouses and saw a sad sight. The sight captured by my sad little camera phone.

In the middle of the picture is a kitchenette with a two pot Bunn-o-Matic which completely melted down the front of the cabinets. The unit itself survived, but the bottom pot seems to now be stuck to the lower cabinet. The excessive light is from a section of collapsed roof, hence my inability to get closer for a better shot.

But I saw this and thought of Firegeezer's nice clean 4 pot Bunn on his Facebook avatar and I shed a tiny tear for this coffee maker.

Poor thing never had a chance.

Saturday, September 12

My Healing Hands

I'm working a 48 at a decently busy house when, early on day two we start to notice something extraordinary. Everyone I've touched has been cured on the spot. Call them miracles, call it a practitioner's energy, what have you, but don't burst my bubble by saying they weren't sick in the first place. That's just cruel.

PATIENT 1

A middle aged man at the local gym. The staff heard him singing one minute, then passed out cold on the floor the next. We arrived and found him supine, the water off, his skin still warm. I reached down to check his pulse when his eyes opened and he came to life. "What happened?" he asked me, standing and covering himself with the towel nearby. "You tell me," I tell him and he does. He's been up for two days straight and just finished a basketball game with friends. He remembers the water being so warm and inviting...then found himself on the floor. He awoke to my touch. Miracle.

PATIENT 2

Activated to a street corner for the severe asthma attack. The address is well known for drug traffic and asthmatics who rarely refill THAT prescription. the Police officers at the corner are waving frantically as we turn the engine down the last block. They run to my door, not the lieutenant's door, but mine. This must be serious. "She's barely breathing, hurry!" I'm told so I grab the bag and hustle over to where they pointed. A woman is leaning over the bed of a pickup truck with her head down. I quickly reach for her chin to assess her breathing when she slaps my hand away. Effective motor control for someone in distress. "Can you breathe?" I ask. "No, I can't. I have asthma real bad." Is her response. the stethoscope is out and under her intentional grunting is clear air movement, even way down in the lower lobes.
I can hear a bit of the conversation in the background between my lieutenant and the police.
"She wants into the apartment, hubby won't let her in, she told us she needs her asthma machine and to call you."
"I don't think this is asthma," reaching down to check her pulse rate, "is there anything-"
"Fine, thank you." She interrupted standing, straightening her shirt and walking over to the officers. "Will you let me in now or not?"
As the ambulance crew arrived I told them the situation and they agreed I had the magic touch. For sure.


PATIENT 3

An elderly man was seen being escorted from the commuter train, pale and sweating, by two adult males. In this time of increased security, the guard decided to give 911 a ring. When I arrive in the bathroom, the man turns out to have been escorted to the train by his two adult sons, who were concerned he wouldn't make it to the toilet in time. They reluctantly open the stall door and there he is, pale, cool skin covered in sweat, and a look of embarrassed discomfort on his face. "I'll be fine as soon as I can go." I'm thinking the same thing you are so I reach for his pulse rate when he groans. Honestly, the moment I touched him, he pooped and instantly felt better. "My medication makes me constipated." He says. And my supernatural powers do the opposite my friend.


PATIENT 4

Sometimes you really can talk sense into your regulars, especially when they try playing your game. This time our friend in the lobby of the motel tells us of an elaborate cardiac procedure performed earlier that day that should have meant a scar and a few more days of observation, but hey, at least he's trying. I explain the details of the procedure and how long I spent in school to learn that as he fidgets with 3 of his 4 extremeties. As my EMT is taking vitals and holding one arm still, the other begins to fidget around. This man's nervous system is clearly in massive overdrive and the blisters on his lips give me a good idea what's happening. When I place my hand on his shoulder to get his attention he straightens up, looks at me and says, "If you think nothing is wrong then I don't care, I'm going back to sleep." And wandered back up the stairs.
The lieutenant walked up and asked if I'd be willing to touch his throat, he's had a cough as of late. I told him he should wait until I wash my hands. My miracle hands.

PATIENT 5

Anxiety impacts a large portion of our population and our friend called today because he refilled his prescription for anti-anxiety pills, but sold them for heroin instead. We've all been there, right? He walks out of the hallway alert, oriented and breathing fine, all the while telling me he can't breathe. I talk him through some breathing exercises, slowly calming him and he feels better. As the ambulance pulls up he waves them off. I haven't touched him yet and am wondering if it's a fluke. As the ambulance turns the corner he starts to breathe quickly again telling me he needs the pills or he won't get better.
"Look at me," I say taking his arm to focus him, "You don't need those. We didn't use them today, it's all about controlling your breathing." He smiled, turned around and walked away. I turned to the crew, each with a different variation of "WTF" on their face and thought to myself, "This is totally going in the blog."

What is that smell?

Some folks, when given instructions by 911 dispatchers, follow those instructions. Others follow them to the extreme and have a negative impact.

THE EMERGENCY

Security is reporting an employee with burns from the fryer.

THE ACTION

Racing down the freeway towards the casino at the northernmost exit, ours is the ALS ambulance and my driver has decided he can't let the BLS unit responding behind us to beat us to the scene. To anyone coming the other way, it must have looked like an ambulance race instead of an emergency response. All I could think of was the scene from Mother, Juggs and Speed.

We arrive at the casino and are led into the tiny security office off the main lobby to a most peculiar smell. In the corner is the cook (They make nachos and chicken wings so Chef doesn't cut it) we always make a nod to when we pick up dinner on some nights. The look on his face is one I would later learn is true excruciating pain.

He was emptying the grease from the deep fryer when it spilled out and splashed on his lower leg, which is still smoking ever so slightly. As we made quick movements to do the first important thing when treating burns, removing the source of the burn, the security supervisor explained he was told by the dispatcher not to put anything on the burn.

Um...yeah...about that. That excludes removing the oil with a towel or perhaps cool water, right?

Soon after the 2% area was cleared and wrapped the Manager burst into the office asking why the kitchen (snack bar) was closed. She actually asked if he could finish the last 4 hours of his shift before getting treated. The guy could barely stand up the pain was so bad so there was not even a hint of a possibility of letting him stay.

Enroute to the hospital, a 40 minute haul, we talked about the Manager's plans to expand the kitchen (snack bar) into a real restaurant and hire him a staff. Then he could make one of them empty the fryer.

Friday, September 11

Battalion 1 to Manhattan

Radioed by FDNY Battalion Chief Matthew Ryan at 8:46 AM local time:

"A plane has crashed into the trade center. Transmit a second alarm and start sending additional companies into the area."

Less than 20 minutes later, FDNY Chaplain Mychal Judge, bottle of holy water in hand, entered the debris to tend to firefighter Danny Suhr, who had been killed by a body falling from the tower. When Father Judge removed his helmet to administer to the fallen firefighter, he was struck and killed by falling debris.

He was found by five men who carried the fallen Father 2 city blocks, placing his body in front of the altar of St Peter's Church. He was covered with a white sheet and his priest's stole, then his helmet and badge were placed on his chest.


This is an image that will remain with me for the rest of my days. The respect shown by these 5 men who took a fallen brother home stops me in my tracks every time I imagine myself seeking solace in that church on Barclay street. The doors bursting open and these five men carrying a lifeless body to the alter, showing their respects, then returning to help others. I was not there, but I can imagine the raw emotion.

Father Judge was later moved to Engine 1, where his car was housed.

Hidden in all the "Never Forget" and "343" stickers and T-shirts are thousands of tales of heroism and bravery, brotherhood and citizenship. Learn one. Pass it along to others.

Father Mychal Judge was later declared official fatality #00001.








Mychal Judge

Chaplain, FDNY

May 11, 1933 - September 11, 2001

Thursday, September 10

Video from NBC about 911 abusers

I almost missed this thanks to the football game tonight, but was able to get it online. the previews for this story were completely different than the story they tell in the video.



I think this is a foot in the door to address the abuses of the 911 system and possibly reach out to our communities about what an emergency is.

I think the most interesting part of this video was the dispatch in the beginning sending 2 engines and an ambulance to a trouble breathing call. 2 engines...10 people...1 patient...

"How can they do both?"

Just saw an ad for the NBC Nightly news tonight that talked about how "Our nation's bravest" (Showing pictures of fires) are being taken out of the firehouse to care for the nation's poor.

And this is news now?

Seems to me the article mentioned all over from DC E10 has made it to the airwaves. The problem is the public still has no idea what the mission of the modern fire service is. Is it fires? Is it EMS? Is it code inspection?

I'm sure there are many an IAFF local that would like nothing more than to stop providing EMS services from their fire apparatus, but have they looked at the ink those calls bring? When I run the numbers in my department, there would be no way to justify half the resources we have deployed if they no longer responded to EMS runs. Plus, who will wait on scene 40 minutes for a private ambulance to arrive?

Are we at the crossroads where EMS can be lifted out of the fire service and if so where do we put it? Our pal CK mentions an EMS based EMS system, but my area doesn't have the resources to deploy EMS without the pre-existing resources staffed by the fire service.

Believe me friends when I say that if there is a more efficient way of providing our services, let's get to it. But to my readers who are "hardcore firemen" and dislike providing EMS in between your increasingly infrequent fires, just remember it's your job to provide that service. When that service is no longer part of the expectations of the community you will have serious trouble justifying all those big red trucks when the bells no longer ring.

Without EMS runs our 3 busiest engines and one of the nation's busiest ladder companies will drop off the list completely. But it's not all about how busy we are, but are we providing a valuable service to the community in the most efficient manner possible?

I'll be tuning into NBC News tonight to see the story, curious to see what they report. The timing of the story is also very interesting, considering tomorrow.

Wednesday, September 9

Politics

Not in that sense, I steer clear of that here, you all know that.

I mean the politics of EMS. I mentioned a while back that I sought out and was appointed to a seat on the local EMS Committee in my community. At my first meeting I was a nervous wreck thinking I was way out of my league amongst industry reps and MDs with years and years of experience. I sat in the corner and said nothing.

This most recent meeting, I pitched the Project and they loved it. Everywhere I mention this opportunity, folks are interested in our differences and our similarities to our friends across the pond.

I had the opportunity to have a few words with the Medical Director who empowers the Paramedics who will treat my family and I had to smile. His thoughts on the Project were great and where he wants the system to go are progressive and treatment based. He showed interest in the Advanced Practice Paramedic concept as well as expanding the State's Paramedic training. Champion.

They also want to hear about what I learned from the Project when I return.

So now the pressure is on to gather as much information as I can on this exchange. I'm not looking to adopt a socialized response system, that won't work here. I'm looking for ideas that can reduce our requirements to default to transport to the emergency room. I'm looking to see if the rapid response model might work in my department to ease the burden on some of the nation's busiest ALS engines.

And on top of all that, I'm looking forward to finally meeting my friend Mark.

If you're also interested in meeting Mark and will be in the Northern California area around November 12th, let me know and we'll get together and talk shop.

And even though anyone paying attention knows exactly where I am I still need a bit longer to "come out" to you. It's a big deal, you know, but will be revealed as we promote the Project. Baby steps, hence the new banner.

Tuesday, September 8

Chasing the past - New Blog to follow

I'm adding a unique blog to the Continuing Education Board here at Happy Medic Head Quarters.

The Engine 17 Project chimed in on a recent post and I'm intrigued. The author is finding the original Engine from his childhood neighborhood and restoring it to it's prior glory.

The updates are coming slowly, but that is understandable with such a project. Click over and catch up, won't take more than 20 minutes and counts as a full hour of CE's for your refresher.

Plus she's an ALF 900 series. Happy is in the market for this Engine's cousin, the ALF 100' tractor tiller.

Monday, September 7

They Make the Call...What Happened

Well, what did happen when you told the family about this? As indestructible as we feel from time to time, planning for your death is the right thing to do.

Having the papers drawn up is not the end of your task, however, more must be done to make the tragedy easier to handle. That is where your Family Disaster Plan comes into play.

We all have 72 hours of supplies, right? Food, water, medications, flashlights and radios. Not just in hurricaine, tornado and earthquake country, but all of us should be ready to ride out 3 days on our own. We've all seen how help can take a few days to arrive in a disaster.

But just putting the food in a corner of the garage isn't enough either. The whole concept of surviving and recovering from a disaster should be at the forefront of your mind BEFORE you need it. Put the time in now and in an emergency you can simply follow your prepared plan. And, since the plan is written down, the family can follow the plan should it occur while you're stuck helping others.

So, for the first time ever I am assigning homework to all my readers. I know you understand computers, so click open a new word processing document and list the following things:
Members of your family with names, dates of birth, eye and hair color, you can add a photo later.
Next page lists contact numbers. Home, cells, work, doctor, pediatrician, local animal shelter, non emergency dispatch, family friend in walking distance.
You're doing great, now on another page, give simple instructions on where and how to shut off the electricity and gas in your home.

Now, print it out and place it in a large 3-ring binder and put it on the shelf. When you get all your living will documents together, place the originals here.

There. You're well on your way to completing a Family Disaster Plan.

If you're rolling your eyes or think I'm taking this thing way too far, there might be a Cop Rock rerun on that would be more worth your time.

More details to follow, including the Evacuation Ordered section and the previously mentioned LODD envelope. You can find that post under the label Disaster Plan under the Topics Tab.

Sunday, September 6

Sunday Fun - Your first

They say you always remember your first.

No matter how many came after, regardless of shape, size or ability, that first one will always have a special place in your heart.

My first was this 1976 International 10 speed double clutch 1000 gallon water tender. We shared some great experiences together and at times was my only friend out in the middle of nowhere on an abandoned car fire or running as fast as we could (mid 40s) to a freeway accident.

I learned from her that if you take care of your equipment, there is still no assurance it will work when you arrive on scene.
Aside from the water, she carried 8 pieces of assorted cribbing, 50 feet of supply line, two preconnects and a shovel. That was it.
Every time we went to the gas station on the other side of town she would backfire...loud enough to make folks duck. She had no primer motor and the light bar gave out from time to time, but it was experiences like that that taught me to expect the unexpected and adapt to ever changing situations.

Do you remember your first?

Friday, September 4

They Make the Call...You're dead

I'm wondering how many of you were motivated by my post a little bit ago about living wills and talking with your family about what should happen if/when you die.

So, congratulations, you're dead.

If your loved one is near you right now, tell them the following scenario:

On the way to work this morning another driver ran a red light broadsiding you and you died. Your body has been taken to the medical examiner.

Does your loved one know what to do next? All the account numbers, access codes, insurance, who to call at your work, what kind of service you want, if at all. What to do about income, the bills etc etc.

Now let's take that a step further and imagine the following scenario:

You and your loved one are out for a movie when the same thing happens, only both of you are dead. Who cares for your children? Who can legally come and care for them? How will your family access your accounts, your matters and deal with your estate?

If you or your loved one said "I don't know" to any part of the above scenarios stop reading this and look into a living will. At least talk about what you want to have happen to you after you die. As soon as you have the aftermath figured out, now get into the details of your wishes should you be unable to make medical decisions for yourself. Who makes them? Do you trust your loved one more than your mother, brother or local legislature? Put it in writing and get it notarized because simply saying "He told me he wanted to die/live" is not legally binding. Terry Schiavo ring a bell?

Get your living will and all other important documents and make 3 copies. Put the originals in a binder in a common area of your home labeled Family Disaster Plan (Details on that soon). Send another copy to whoever you chose to care for your children should you die. Then send the third set to a trusted friend or family member away from you who is not likely to be involved in the same disaster should one occur. Seal it in an envelope labeled (FOR EMERGENCY ONLY) and ask them to file it away.

Now, tell each other person about the 3 copies and where you keep the binder. Should something happen to you someone need only open the binder and follow the instructions, having all the necessary legal documents in hand should any question arise.

This, my friends, is how you take care of your family when you are dead. We'll cover more about the Family Disaster Plan later, especially the sealed folder in the back labeled LODD.

Get things straightened out before the unthinkable happens.

Thursday, September 3

Priceless


Plane tickets to England: $1000

New laptop for trip to England: $399

Seeing the fast response model first hand with a new friend to show the way: Priceless.


Clear your blog calendars in November friends, Mark and I are on a mission.

the Project is a go.

Wednesday, September 2

The PD to FD Translation book

No offense to my BIBs (Boys in Blue) but some of the CYA stuff we get called on is starting to wear thin. Every time you chuckle when we ask you to clear a scene evens out when you call me for a "red cheek" from a slap that "just needs to be cleared."

We all do it to ensure everything necessary has been done for our clients. That being said, let's see what we really mean when we communicate.

When the PD says:
"Send an ambulance code 3, this guy is out cold."

What they really mean:
"I have actual police work awaiting me, get someone here to get this drunk off the street before they call back."

When the PD Says:
"We need a psych hold."

What they really mean:
"I am not putting this bag of nuts and bolts in my car."

When the PD says(When I've barely started my assessment):
"Is this a transport?"

What they really mean:
"I'm not taking her to jail, so..."

When the PD says:
"We just need an eval, he says he got hit."

What they really mean:
"This guy can sue us and me if I don't offer to get him help for what is clearly a non emergent injury. Sorry."

And when the PD says:
"I'm releasing you so you can go to the hospital and get checked out, OK?"

What they really mean:
"Your hospital is nowhere my beat. Get out of my hair, there is way less paperwork. For me."

Before all my BIB readers get upset, the reverse is just as true, just as retarded, and will be posted soon.

Tuesday, September 1

Your sister is not my Medical Director

Each time I sit down and try to share this tale, I sigh and tell myself to calm down and try again another time. Being able to calm myself down is truly a fantastic sanity maintenance device. The young lady I met this night needs to learn it. Fast.

THE EMERGENCY

Two vehicles have collided in an intersection, PD states one occupant seems to be "panicing."

THE ACTION

We're sent code 2, or no lights no sirens to the nearby intersection where PD has already been able to close the intersection, set flares and even one wrecker has already arrived.
The passenger of one of the cars is in full hysteria mode, not unlike my three year old when you ask her to go wash her hands. She is crying, mumbling about making it to work in 2 days with no car and reaching out grabbing onto anyone who walks by.
Noting no injury and little mechanism from the crash to indicate such a thing, I move into dealing with hysterical clients.
"Hi there, I'm Happy and I'm here to see if you need some help. Are you hurt in anyway?"
She breaks down and just screams and cries. The boyfriend, who was driving and is also uninjured, tells me she started crying when the first police car arrived. She has trouble calming down he tells me.

Really?

I pretended she was my daughter and coached her through taking some deep breaths and trying to get her to laugh. Laughter is kind of like the synchronized cardioversion of emotional responses. You can go from balling your guts out, have a giggle and go back to normal in seconds. Works almost every time.

She calms after my patented one armed fisherman joke and agrees to climb into my office for a quick once over, but mainly to remove her from the stressful situation and into more of a comfortable space.

Now calm and settled, she has only a vague discomfort to her sternum below where the seatbelt kept her safely in her seat. I explain that is not unusual and everything else looks just fine. We offer her a ride to the ER, which she declines, the boyfriend will keep an eye on her and call an MD should anything change. After the usual legal disclaimer and autograph, we're back in service and heading back to dinner.

Suddenly the radio blows up with tones.
"Engine 99, Medic 99, Captain 99 and Rescue Squad 1 for the chest pain following MVA, possibly trapped..." to the same intersection we were just at. We told dispatch to hold the cavalry and turn around.

We pull up to the same two cars, same police cars, same everything except one officer shaking his head and looking down.
"I tried to tell her, but she won't listen" he tells me as I get out and there, on the side of the road in full hysterics, is the woman I just left calm and collected.
I open the side door and motion for her to get in. "I know I told you you could call us back for any reason, what changed?"
"I...called..." and the water works continue.
I gave the "WTF" look to the boyfriend who told me, "Her sister wants her to get checked out."

"What do you think I just did? I did check her out, she's fine. Do you want a ride to the hospital?" I ask her and she nods.

No treatment is indicated so I simply modify the report I had yet to complete on the way to the hospital. I spoke by telephone to the patient's mother explaining that I had performed a complete physical examination finding nothing of concern.
"Does she have whiplash? Her sister thinks she has whiplash. She should get checked out." I just handed the phone back.
"Is your sister a doctor?" I ask her to which she shakes her head, "She doesn't have a job right now."

"When you get the bill for this," I tell my uninsured friend, "Send it to your sister. All of this was her idea, let her pay for it."