Thursday, October 15
Wednesday, October 14
On October 7th DC Fire & EMS put on a demonstration of the effectiveness of fire sprinklers. It also ended up showing the ineffectiveness of modern firefighting.
One of our brothers was hurt in this exercise and I hope he makes a full recovery. I've been hurt at fires and I've been burned, neither experience do I wish to repeat. Our thoughts are with our injured brother.
This is not a Monday Morning Quarterbacking of the event, but instead some great video that will show you what happens when you are unfamiliar with how to use your equipment to its full potential.
This first video is from farther back than the second and is a better opportunity to read the smoke and see possible flashes. As you watch it, imagine you are in the hallway of a dorm approaching this room. Heavy smoke in the hallway, intense heat and that flame dancing out of the top of the prop will be spreading in all directions along the hallway ceiling. Now, as it flashes, imagine where you will place your team and where you will shoot first.
This is another video from head on that better shows the incipient, free burning and flash periods of this particular fire, as well as our brothers placing their line. I can't help but notice the fog nozzle.
A smooth bore at 60 psi could have knocked the seat of this fire from the imagined hallway in my earlier example, even banking it off the wall if the heat was too much. Many news outlets talk about the lack of a backup line. Huh? Don't need one. Smooth bore from 20 feet makes short work of this fire without even having to go on air.
Putting ourselves in a dangerous situation in public only makes me wonder what we're doing in the dark hallways at working fires. Let's use our equipment to our advantage. Take that fog nozzle and put it in your pocket, get smooth bore nozzles on your pre-connects so you can put the fires out. HMHQ is a firm believer in the power of water applied from a safe distance in order to make a safer environment for extinguishment.
Another quick word on the Culture of Extinguishment. Lt McCormack, in his "controversial" remarks before the FDIC in April 2009, fought for the idea that "If you put out the fire, safety is accomplished for everyone on the fireground." I agree with that 100%. Unfortunately, I don't think Lt McCormack's message is getting to firefighters as intended. The Lt wants you to safely put out the fire, not go running in without using your tools and training to your advantage.
I speak with many firefighters in my service who heard about the speech, but never read excerpts. They make it into a call for safety to be thrown out the window when there is a fire or a rescue. Not at all, friends, not at all.
WAKE UP! Pay less attention to which Chief or Union Leader blames who and look at what gets our people hurt and don't do that. Don't go somewhere your water can go instead.
Placing a hoseline is not a simple task and I, on the nozzle, have been dragged by my airpack to a different location by my officer who had a better view of the situation. Each and every time I have them walk me through where I was, where they moved me to and why. Then I apply that next time.
Are we all perfect first try? No. But this first try got someone hurt.
Tuesday, October 13
Welcome back Motor Cop, we missed you and your matter of fact style. We always enjoy reading from our Law Enforcement friends, but you are after all our brother from another mother here in blogger land.
Stay Safe MC and see you in the report room for cocktails.
(Oh yeah I did)
It got me thinking though, that many of you not in the business may think us 24 hour guys have it pretty good. I'm the first to tell you we do, but not because of the reasons you may think. When I stopped to think about it, I really do have a weekend everyday I go home. But I also work 5 distinct "days" within my 24 hour shift. Since I try to arrive an hour early, this makes my day 25 hours. Allow me to explain.
Monday - 7 AM to noon
Back to work, just like you folks on your Mondays. Getting into the swing of things, seeing your work friends, and remembering what working is like. Check all the gear, clean the house and get the shopping done. It's all routine on Monday.
Tuesday - Noon to 5 PM
The week drags on, but the morning is finished. After lunch it's usually a drill and a class, then maybe a workout before getting ready to fix dinner. This is by far my favorite part of the day.
Wednesday - 5 PM to 10 PM
Hump day. Making dinner, eating dinner and the wind down following the meal can be good, but you're reminded that your shift is only half way finished. Sometimes you have time for a full movie, other times you're lucky if you get dinner on Wednesday.
Thursday - 10 PM to 3 AM
Isn't it Friday yet? On my Thursday I'm up in the dorm looking for a good place to sleep, wondering how many more times I will have to climb the three flights of stairs before Friday is over. When busy it goes fast, but when the calls are spaced about an hour apart and bells ring just as you enter REM sleep it can exhaust you just thinking about it. I HATE THURSDAYS.
Friday - 3 AM to 8 AM
But those who know my writings here know I'm a fan of my Friday. When I awake and see we're heading out and it's after three I relax and realize it is officially morning instead of night. then it's a downhill slide to the sunrise and end of shift at 8 AM, my Friday night.
So there you have it my 9-5 friends, my 5 day week within a day. Then I get a weekend, just like you, except mine can't start until I get home after the shift.
Monday, October 12
Another example of the need to restart this trade as a Profession and lift ourselves out of this "patch and tan box" mentality so many of us are still stuck in. Reboot the entire system. EMS 2.0.
The Sergeant stuck his head in the back door a few moments later laughing, apologizing for the seriousness of the request, they expected him to smile and laugh instead of actually ask us about the line up. The superiors had intentionally waited until both men were on the boards before telling the rookie about the suspect in custody.
Seems they realized our clients were far to inebriated to make a reliable ID.
If you said "You're kidding right?" You made the right call.
Sunday, October 11
"The locker room is too small!"
"This kitchen sucks"
"Can't we have a toilet on the ground floor?"
The usual complaints.
So this Sunday we're heading out of HMHQ and over to the architect's office with a copy of Gerry Souder's book and the following demands.
#1 - Humidor Cabinet
The guys are having an occasional cigar, but why have the engine parked infront of the smoke shop every weekend? With this cabinet, each member can purchase and store quality cigars to enjoy 50 feet from the closest door, per policy. If your organization prohibits the use of tobacco products while on duty, install this in the basement. Cigars.com has a lovely selection.
#2 - Commercial Dishwasher
At a busy triple company house, feeding and cleaning up after 14 people can be a chore. But if you use a commercial strength dishwasher, you can wash an entire load of dishes in 90 seconds. That is not a typo. 90 seconds. I work at a big house that has one of these and it is awesome. Pile in the silverware, press on, wait a minute and a half and POW, clean forks.
It takes a few more cycles since there is only one tray, but the water heats up to 170 degrees and cleans those things like no one's business. The folks at ArchiExpo can tell you more.
#3 - 3 Burner Bunn-o-Matic Coffee Maker
Forget those fancy fru-fru drinks for $3 a pop at the local coffee shop. Save those for heading home. That's your reward for staying safe and going home again. Until then, we need 3 piping hot supplies of delicious coffee. Some may tell you the 4 burner is the way to go, maybe if you're having a lot of meetings at your house, but if you're all career, 3 should do fine. And while you're at it, stop buying the crappy coffee at the warehouse store and spend the extra $2 a pound for some quality coffee from a local vendor. Chances are he'll be glad to brag that you buy his coffee to drink in your house. No gifts, buy the coffee.
#4 - Wireless
Do I even need to include this in our dream house? What house these days doesn't have wireless yet? Get a private phone line installed and collect the $5 a month from the members and get a network set up. You'll likely want two routers, one on each side or end of the house so that the computer up front gets as strong of a signal as the dorms. We'll also need a communal computer for research and checking for updates on firegeezer. That brings up another thing, networking the network. That fancy TV you spent all the money on last year you currently use to watch Dancing With the Stars has a video input on the back. Run a cable from the computer to the TV and watch training videos, fireground close calls, and post important information. We recently had a boss do this to the giant TV to give a ventilation drill. he fired up the video on the communal computer and everyone actually wanted to try it and was involved. We watched, we learned, then we went and did it. And add in the free printer, make it wireless so all the laptop guys can use it too.
#5 Truck Turntable
Too many folks are getting hurt and some have even died while the apparatus is backing up. Why? Why are we even "spotting" these things, only putting ourselves in danger to protect someone's investment. Let's install a truck turntable. Pull in, press the button and just like Batman did, we're turned around and ready for the next attack from the Riddler. I can hear some of you groaning about how elaborate, expensive, problem prone this might be but it can never fail. It simply becomes a floor if it stops rotating. Not sure how the tillers will do with this, we'll look into something. And for those of you singing the praises of drive through bays...I don't want to hear your bragging anymore.
No slide. Slide Pole.
Friday, October 9
A couple of guys from out of town got mugged and attacked with a knife. Nothing major, but the report in your mind already has the phrase "copious ETOH odor" so both are getting full c-spine precautions with various bruises forming on their faces and some superficial lacerations to their faces, necks and torsos.
Nothing worth screaming towards the trauma center for, but certainly taking your time for a full secondary assessment.
As you're completing C-spine precautions on the man on the bench seat and indicate your driver to go, a police officer jumps in the back and begins asking the men questions. Completely understandable, so you get a head start on your charting in the few moments he takes to finish up getting different descriptions from your patients, who are clearly intoxicated beyond remembering.
You exchange your professional courtesies and the officer climbs out and closes the door. As you begin to pull away from the curb, he opens the door and asks you to divert over 4 blocks for a lineup, they think they have the suspect in custody.
Both men are in full C-spine precautions.
Divert oven and have your patients ID the suspect or not?
You make the call.
Thursday, October 8
I recently discovered that just saying that phrase, "Oh no. Not again" means your night is about to get interesting.
THE FIRST EMERGENCY
Automatic fire alarm activation
THE FIRST ACTION
The engine arrives on the scene just before 3 AM to find no alarm bell ringing and no strobes flashing. The building is secure and we prepare to pack up as a small man dragging a shopping cart makes a mad dash across four lanes of decently busy road to reach us.
He waves and waves and I lean out the window to ask him his trouble.
"I am out of medication." he tells me, not even a hint of a wheeze or shortness of breath. There he is, no distress whatsoever, apparently he thinks we have a pharmacist behind the hydrant jumper lead in the hose bed.
"We don't have medication refills here, do you have an emergency Sir?" I ask wondering if I;m really having this conversation.
"I need more medicine, I need 911." He tells me, refusing to get onto the sidewalk, preferring to stand in the street.
"Do you want an ambulance, Sir, you seem OK."
"No ambulance, no hospital, I need medication from 911." He tells us, looking from my jump seat to the ladders on the side of the engine, still waiting for the pharmacist to pop out.
"We have no medicine refills on the fire engine, so if you don't have an emergency and don't want an ambulance, we're going to go, OK?"
"OK, but where is 911?" And he grabs the dirty cart and scurries (Yes, he altered route and speed at random) back across the street and around the corner.
"We're going to see him again, I can feel it" I said into the headset as we pulled away and back to the house.
Just as I got my turnout pants unbuttoned, the lights are on and the bells are ringing.
Oh no. Not again.
THE SECOND EMERGENCY
A cell phone caller reports a man short of breath at the doughnut shop.
THE SECOND ACTION
The doughnut shop in question is not the high quality place mentioned in other posts, but the 24 hour place on the other end of town.
Off the engine I can see only two customers in the shop. One on the phone and drinking coffee, the other remarkably familiar and scurrying again, this time out the door towards me, not away.
"No, no" He's waving, "I no need firemans, I need 911 for medications,"
"What medicine do you need Sir? I have medicines for sick people...are you...sick?" I ask trying to chase him through the parking lot.
"My brain pills are gone. GONE! I am needing more." he tells me over his shoulder, zig-zagging through the lot. There's no way I'm letting him get away just to call us back all night long, so I'm in pursuit.
The only thing that slows him down is the sound of the approaching ambulance from at least 5 blocks away.
"My medicine is coming!" He tells me.
The ambulance crew gets my "Don't kill the messenger speech" to which they sigh and wave us off. I pay careful attention to the radio traffic when I hear the ambulance report that their patient has disappeared down an alley and they are going back in service.
Not ten minutes later, we're backing into the barn when the bells ring.
Oh no. Not again.
Wednesday, October 7
Cell phone caller reports flames in the window of a residential building.
4:30 AM. We should have had 3-4 calls since I crawled into my sleeping bag and am rather well rested when the dorm came to life for a full box alarm. The Engine, Truck and Chief are all first due and only blocks away.
We're barely dressed when we pull up to the intersection and see flames in a window box outside a window on the fourth floor.
Airpacks go on as we see the truck get set to head for the roof and to the window in question when I see my boss do that head movement that can only be described as the RCA Dog tilt. His body language changed right then to a relaxed stance as he motioned for us to come to his side with one hand and began waving down the rising aerial ladder with the other.
As we looked, I mean really read the flames, we noticed...no smoke and the flames are neither growing nor receding, meaning the fire is not growing, moving or giving off gasses. Hmmm...
Then we looked closer at the window, noting not only no discoloration, but there are multiple paper Halloween decorations on the outside, slowly waving in the soft breeze of the early morning.
By this time the entire first alarm compliment had arrived and we can now see it is a small electric cauldron. A small fan is blowing fabric above a light, causing the appearance of fire.
Outside. In a planter box. At night. We get planter box fires often, what with discarded cigarettes and all. I just never expected someone so excited about modern Halloween celebration to put such an element outside a wooden frame building.
Monday, October 5
So imagine my surprise when we responded to our Headquarters on a medical call and I found myself without my button-up shirt.
Not really listening to the guys calling out jokingly "Grab your shirts!" I donned my navy blue, collared job shirt, zipped it up and climbed into the fire engine to respond.
20 minutes later I was doing a walk of shame.
Lessons I've learned from this event:
1. Always have your shirt at the ready. Whether you are anywhere near HQ or not, if you're not wearing it, put it on the engine anyways.
2. If you find yourself without it and out in public, don your safety coat instead of wearing just your shirtsleeves. You shouldn't be wearing your shirtsleeves out anyways.
3. When you see your engine mates donning their safety coats OVER their uniform shirts, follow suite and do the same, even if the call is a possible cardiac.
4. While assessing the patient and the Chief walks in, focus on patient care, there is time for chit chat later.
5. When the Chief says "Nice Sweatshirt" in the same tone one might say "Hey you cut me off in traffic," do not say "Thank you, Sir" while taking the blood pressure.
6. And by all means, when important papers still have to pass through that Chief's office for certain blog related issues, avoid this situation entirely.
I parked my car in the first metered spot, fed it some coins and was walking to the corner when a man sleeping in a doorway peeked out from behind a number of dirty blankets to see who was passing.
I paused at the corner, empty mug in hand, and glanced back to the eyes in the doorway. He was visibly startled when he recognized my uniform and he began to gather his things.
"I don't want to go to the shelter! I don't want a hospital! Leave me alone! Leave me alone!" And he began to run down the street.
I was amazed. Every time I pull up in an ambulance, they never run. And now this man is fearful of my uniform, so much so he'll abandon a clean, warm doorway to get away from me.
That cup of coffee was extra delicious.
Sunday, October 4
Kids Firefighter Blog was started by a family who had trouble finding a single site as a resource for kid friendly toys, information and activities related to the fire service. They cover coloring books, regional activities, lego, you name it, if it relates to kids and fire trucks, chances are it's in there.
I especially enjoyed this photo series of classic fire apparatus built with Legos. So close to my 900 series, I had to post a pic.
With so much going on around the Project, I've been neglecting my traditional Sunday Fun stories of the tradition of our Profession. Until I get my piece on red lights finished, visit our new 2nd Alarm Company firedaily.com.
Saturday, October 3
It seems that the powers that be on both sides of the pond are still nervous about the reality of patient confidentiality laws, and rightly so. It is understandable to be worried about litigation if one of your people is blogging, facebooking/Myspacing or tweeting the address of a patient, a patient's name, history, likeness or scene photo, but what about those of us trying to make an impact on the Profession of EMS?
These same supervisors who are nervous about Mark's blog being perceived as NHS driven and my supervisors to even allow me to tell you my name, surely sit down with other professionals and share tales of "the big one" or "the call that went wrong." Are those violations of privacy rights?
What about ACLS scenarios? Each time we enter the classroom we are encouraged to share stories of patient outcomes and interventions. Are those violations of privacy rights?
Many of you may be shaking your heads and saying, "That's different, it's not in the public realm," I say sure it is. I go home, tell the wife about a rough call or scenario in class, she tells a friend, etc etc.
We share information all the time, and mostly even more details than have even been shared in this arena. Privacy is so private that people will scream for help on a busy sidewalk, then refuse to give their name because they don't want a bill. Will rail on and on about their medical history, in front of dozens of strangers, then I have to get a form signed saying I promise not to share their information with anyone outside of our billing system. That's makes sense, right?
I took this opportunity to re-read the Health Insurance Privacy and Portability Act (HIPPA) and find out once and for all if what I've been doing is allowed. Here's a shocker...yes.
From the text of HIPPA:
What Information is Protected
Protected Health Information. The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."12
“Individually identifiable health information” is information, including demographic data, that relates to:
- the individual’s past, present or future physical or mental health or condition,
- the provision of health care to the individual, or
- the past, present, or future payment for the provision of health care to the individual,
and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).
The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. §1232g.De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15
Take note of the "and" following the bullet points under Protected Health Information. If I post about someone who, even if I change all the information, can still be identified by someone not there at the time, it becomes questionable.
I understand the reason for privacy rights, believe me, but I also understand how sharing information of a non-sensitive manner can help move our understanding of this Profession forward by leaps and bounds.
I don't know what privacy laws are relevant in the UK, but I'm sure Mark is well aware of his limitations, as evidenced in his post.
Blogging can do harm Mark, when done recklessly and without respect to our patients, clients, employers and co-workers.
But when done following the intent AND letter of the law, it can only help.
I'll explain more when you pick me up from the airport in Newcastle during our blog born EMS exchange to advance patient care. But keep that private, OK?
Friday, October 2
You are assigned to your regular response unit and dispatched just after 10 am for a reported altered mental status. You response time is 6 minutes and you are the first care giver on scene.
Family states the late 60s male in the hospital bed in the family living room has an extensive cancer history and has been having difficulty getting up and walking around in recent weeks. This morning he awoke around 530 and had his linens changed, at which time he used a walker to move around the room.
Just a few minutes ago family returned to awake him from his nap and find him unresponsive, left extremeties in a state of contraction and a noted facial droop with drooling, also left sided.
You complete a full assessment finding him actually responding to painful stimuli with a grimace from the non drooping side, no voluntary movement from the contracted left extremeties and faint squeezing on command on the right. Blood sugar is in normal range, EKG and secondary exam all come back normal, previous notations excluded.
Pupils are equal and tracking together, no fixed gaze.
There is no past history of stroke or CVA.
The nearest hospital is 10 minutes away. Another 10 minutes is the regional trauma center, with scanner.
What is your agency's policy for this patient? Is he in the window for stroke center care in your jurisdiction? Does your system offer any in field treatments for this patient? You Make the Call.