Monday, August 30

Engine 51 taking shape

Today was my second day helping to set up the newest Engine Company in the SFFD, Engine 51 in the Presidio. Today was day 4 of the new services provided and the contractors working at the old firehouse are flying. Last I saw the house it was still dirty and disorganized. Today the painters were touching up while the flooring folks were starting on the final rooms.
I'm collecting photos to put together in a before and after post, so keep an eye out for that.
My next scheduled day on the Engine is after we are all moved in, so that will be interesting for sure!

New paint, new flooring, clean cabinets and bed frames.

The rest is up to us.

Not "us" the SFFD, but "us" the 15 Firefighters, Paramedics and Officers staffing the Company.

This morning we heard word that some of the other firehouses around the City have pledged to donate extra pots, pans and some plates and cups to us to help get us going.

It really is like one big family out here.

And in related news, some of the firefighters previously employed by the Park Service started an abbreviated SFFD Academy this morning.

HM

Saturday, June 19

Tie one on

Yup, I'm adding a new icon for a new class of response: Water Rescue

In my firehouse we staff an ALS Engine, Truck, a rescue boat and rescue water craft, meaning most of the folks here are certified rescue swimmers and take their roles very seriously.  Most of the dispatches for these highly specialized units are in the news and easily identifiable, so if a person is rescued, chances are you will not read about it here due to privacy concerns.

But what if there is no victim?  Then there is no privacy.

Been tied up all day?  So were we.  Then, when I read the screen on this call I had to scratch my head.  Not only had the caller actually called for this, but it made it through the system as a code 3 water rescue.

THE EMERGENCY

A caller has reported, "A neck tie can be seen in a pond and there could be a body attached to it."

THE ACTION

I just completed my class so my role on this job would be dock side and assist the boat in...wait a sec...did they say...pond?

The engine officer wisely chooses to respond to the reported location in the fire engine instead of deploying the rescue boat and we arrive to a very large tourist crowd at a very popular tourist attraction.  Lights and sirens.

Because of some of the key words in the caller's statement, we also have a heavy rescue unit, ambulance, Chiefs and a truck responding as well.  Lights and sirens.  To the pond.  For the neck tie.

As we arrive our swimmer is ready to deploy if necessary and I grab a ceiling hook because I always like to have a tool when I leave the engine.

In slightly dirty 2 foot deep water we can see the bottom of a neck tie floating and the remainder of it resting, very much without a neck, on the shallow bottom.

It was in easy reach with the hook so I grabbed it and pulled it in.

"Anything else down there?" The Chief asks.

"No, Sir," I reply, "I can see the bottom and there's nothing there."

"Drag it around just to be sure." He tells me and I oblige.

The caller is understandably embarrassed and tells us something we are starting to hear more and more, "Better safe than sorry, right?"

"Absolutely, Sir.  That's why we're here."  In that moment I was part of the problem of mis-information of the public as to the purpose and abilities of the modern fire service and EMS resources.

But then again there is no other resource in my community that deals with dead bodies in shallow ponds.

Or is there?

Friday, June 18

You Make the Call - A fall or not a fall?

When we hear a person has had a fall, there are a series of questions to be asked to find out more about the fall.  Most of these establish mechanism, or the likelihood an injury has resulted.  Most of the time there are factors in play that remove all of our normal indicators and put us back at square one.  Other times it is obvious what we need to be concerned about.

But what about when the story evolves into a grey area?

A cable TV installer was working on a rooftop when he stepped through a plastic skylight.  The opening is approx 3 foot by 3 foot and he was brought down to the street by residents of the apartment building.

As units arrive you hear he has fallen through a skylight 20 feet over a staircase and is bleeding from the legs, arms and face.  C-Spine precautions are taken as you learn he caught himself on the edges of the skylight and was raised back up through the opening by residents.

Is it a fall?  From how high?  Do we need to maintain C-spine precautions?

You make the call.

Thursday, June 17

Overheard on the Fire Engine

Dispatched to a person who fell off a bicycle, just 15 minutes after being canceled for a similar call at the same location.  The MDT even adds the info "confirmed not same incident as previous call" which more or less guarantees it is.

Officer over control channel: "Control we're on scene do you have any additional information on this call, there is no one here."

Control: "Standby 99."  Then she comes back on and reads, word for word, the MDT information, as if we didn't have it already.

Officer:"Yeah, there's no one here wagging us down.  Um, flagging us down."

Wednesday, June 16

Well, that was stupid

It can be confirmed with the Mrs that I have a problem keeping on task at times.  I often get distracted today about tomorrow, neglect this week because I'm worried about next week.  You get the idea.

This morning I was my usual self and it put a lot in jeopardy.

It is also widely known that Mark's and my families sacrifice a whole lot to do what we have sought out to accomplish.  Sandra and the boys more so than Kim and my girls.  This was Mark's FIFTH trip to the USA for Chronicles business and you remember what happened last time, right?

Well, this morning when we left to take him to the airport, I wasn't concentrating on the task at hand and he agreed to be dropped off at the BART station instead of me driving him all the way in, which I should have done.

While off with my girls I got a call from Mark, "I'm gonna miss my flight!"

And he did, because of my and my inattention to the task at hand.

Luckily, using his British charm he was able to arrange an alternate itinerary that puts him back home only an hour and a half later than anticipated...provided he isn't delayed further.

To Mark and his family I apologize.

Monday, June 14

Meeting the NEAS Executive Team - My UK EMS Conclusion

It all comes down to this meeting doesn't it.  The entire project, everything I hoped to learn comes down to sitting with Mark's supervisors and policy makers in the UK and making a solid impression that American EMS is not awash in profit driven patient care.

But then again, we kind of are.

I started the meeting starving hungry from my hours in the dispatch center downstairs and was told this would be a kind of working lunch meeting.

Sandwiches and various appetizer type dishes were brought in and my personal favorite, fresh coffee.  The conference room at the NEAS appeared to have been recently remodeled or redecorated as there were literally dozens of legal sized computer generated signs reminding those reading not to place cups directly on the table.

So what do I do?

Yes, and luckily I had Peter right behind me to place a saucer beneath the cup and shoot me a "Hey stupid" look.  It was in this framework that the rest of the administrative team made their way in and began a presentation on the stats of the NEAS.  Population, call volume, etc.

It was made clear to me ahead of time that Fiona, the Chief Executive's aide, had prepared the presentation and Simon Featherstone gave credit where credit is due.

Mr Featherstone, the aforementioned Chief Executive of the NEAS, seemed like any other person I had met on my travels so far and that made it very easy to listen to him discuss his system.

A few slides in he turned to the dozen or so folks in the room and suggested we do more interacting.  This was, after all, common knowledge to all but one person in the room, me, and they wanted to hear from me, not their Chief Executive.

I went into a brief overview of my system in the SFFD and also explained other systems around the country.  Much time was spent, and not surprisingly, with their fascination with the idea of for profit ambulance services.

Each member present asked a number of questions about billing and a person's ability to pay and I had to remind them many a time that that doesn't come into play until well after the call, but does drive policy decisions in the end, therefore changing our field care decisions.

Each time I snuck a bite to eat another question would have me or Mark discussing his observations of the system as well as his tales of life in a San Francisco Firehouse.

When it came to Mr Featherstone asking what differences we have observed patient care wise, I brought up CPAP and cardioversion and that those are widely used skills in the US.  Pacing and cardioversion along with adenosine surely more common than CPAP, but it is such a wonderful tool more services should invest in it.

In true executive fashion Mr Featherstone turned to his clinical care person and said, "How soon can we look into doing these things?"

Bang.

Right then and there, slightly leaned back in his chair, the Chief Executive might be moving forward on something that can directly benefit the patients Mark encounters as well as giving him tools to help more people.

The meeting ended with handshakes and wishes of luck, but very little was said regarding the lack of Ted Setla and the Chronicles of EMS team in the room to record all of this fantastic learning and sharing of best practices.

But I understand that.  England is a far less litigious society than the US, but they still have to concern themselves with the appearance of the service and those who function in it.

Everyone reading this post knows Mark and his blog are a source of incredible knowledge and a commitment to improving himself through new pathways.  If Mark wrote a book about EMS I would buy it.  If he had a radio show I would listen to it, but until those things happen (If he had a TV show I'd watch it) I will follow the media he uses to become a better Paramedic.  Right now that is his blog http://999medic.com, twitter @ukmedic999 and on facebook.  All media that is growing not only in popularity but usability and relevance to what we're trying to do in the pre-hospital care fields.

I don't expect every service in the world to be open to bloggers sharing patient care and contact stories, regardless of permissions, and the few that value the following some EMS bloggers have are doing so very carefully.

One of the things Mark and I hope to work on in the years to come is acceptance of new media and new ways to share information that still respects a patient's privacy while allowing those doing the care to share insight and best practices in real time.

A unique airway solution is discovered in Australia, blogged about, read by an ECSW in England who passes it along to their Paramedic who posts a link to twitter where I read it. Suddenly a technique that 5 years ago would wait months to get considered for a trade journal has been seen by thousands of caregivers who are about to share it with their friends and co-workers, and all in minutes, not months.

After a morning of listening to the Pathways system work in the dispatch center, then seeing the openness of the Executives to concepts and treatments, I think Mark is in a good place with the North East Ambulance Service.

In Conclusion-

The NEAS provides a high quality service in a straightforward manner to a well informed population.  Powers rest with the Paramedic at the scene to determine transport, not the patient ahead of time like in my system.  Front loading and getting eyes on a patient is a reliable way to handle system resources and gauge response.

The service is not reliant on insurance companies reimbursing for the services rendered nor are their paramedics passing perfectly capable ERs to reach a certain carrier's preferred spot.

Mark Glencorse was a gracious host and everyone I met from A&E tech to Chief Executive was welcoming and asked great questions about American systems and I did my best to represent all of us in a professional and knowledgeable fashion.

The food was great, the coffee we can work on in future visits.

Will the NEAS model work in San Francisco?  I won't know until tomorrow when I get a tour of the Tyne and Wear Fire and Rescue Service by Station Manager Peter Mudie.  Fire readers, this is the post you've been waiting for.  But like most of what we do, EMS comes first and accounts for 80-90% of what we do.  Why should my UK story be any different?

Sunday, June 13

"RTB for a cuppa" I'm allocating in the UK

chroniclesblogRTB means Return to Base.  A cuppa is slang for a cup of tea.  Allocating is something I very much wanted to see first hand.

On this morning in Newcastle, my second to last, Mark has arranged for me to meet with the executive staff of the NEAS at their headquarters.

Before meeting with them, however, I'm downstairs in the bullpens.  I've got 2 hours to sit in the dispatch center and do a "Sit-along."

When you tell a guy who loves talking theory on systems allocation he gets to see the system work from the nerve center, he gets a touch giddy.

My first chair was at a call taker's desk and I got plugged in.

BANG, less than 10 seconds, not even a chance to introduce myself to the call taker I'm with the first tone is in my right ear.

Before she can answer the call a timer has popped up on her screen 8:00, 7:59... the clock is running.

"Ambulance Service" she answers and begins reading from the screen the pre-ordained triage system called Pathways.  As I've mentioned before, this dispatch system makes no attempt to diagnose the problem, but the physician designed questions can dial up or down the response in real time as the call taker asks the questions.

While she is asking and answering, a small red circle has appeared on the screen, then, a bit away, a purple one.  Later I would learn that one is the location of the caller and the other the closest vehicle assigned to the call.  When that vehicle arrives on scene, the timer now passing 6:15 will stop.  This is their target and they take it very seriously.  As I'm listening to the call, it is a very straight forward sick call and the caller is honest about it.  It is then I see the benefits of the flexible front loaded system.  The rapid response car, the closest resource to the caller, has been stood down since there is not an emergency at the caller's location.

The vehicle, or cot transport capable ambulance, is continuing, however, and the target is no longer 8 minutes, but now 16 from the time the call was answered.

As more questions are answered and the system confirms the lack of life threats, a simple screen gives instructions for the caller until the crew arrives.  The call taker then scrolls around her GPS monitor and finds the vehicle, then advises the caller about how far out they are.  The caller thanked her and the call was terminated.  Less than 3 minutes passed from the answering of the call to the triaging and confirmation of appropriate response.

At no time did a supervisor step in to augment the call taker's classification, nor did the system err on the side of caution by upgrading the response, putting rescuers' lives at risk, "Just in case."

In the hour we were together I learned more about the desk I was at and the number of calls she answers in an average shift.  We took mostly non-emergent calls, details of which would obviously violate privacy, but I can share with you the CALLERS.

When I explained how folks abuse our service by calling from a cell phone miles away about a person they think might have been either unconscious or sleeping, she smiled.  Then, I went on, our criteria based dispatch system considers the caller's inability to confirm consciousness to be unconscious and their inability to confirm breathing to be apnea, and 7 people are now responding code 3 for nothing.

It was just when the call taker was explaining some of the loop holes used that a care facility called to request an ambulance.

They were not with the patient so unable to observe their mental status, efficiency of breathing or if there was any bleeding.  The system took this information and kept the RRC responding.  Each time the call taker asked a question, the caller was already answering, knowing exactly which question comes next.

She later explained that folks have learned that if they take a cordless phone around the corner and call an ambulance, the crew arrives faster than if they honestly answer the triage questions.

"Same callers, different country."

It was later in the morning across the room with the allocators that I saw the strength and weakness of the NEAS.

Mark and I spoke at great length about being honest but respectful when offering our observations and suggestions to improve each other's systems.  Mark was an example of this when he met with SFFD Chief of EMS Pete Howes for a kind of exit interview before leaving.  I hope I can meet that example with the following paragraphs, but each time I write it it comes off preachy, so here goes.

Sitting between the allocators I watched them constantly on the radio with numerous vehicles and cars in various states of service.  Each color on their screens meant something different, from enroute, on scene, RRC, vehicle, on post etc, but it was the clipboard they were passing back and forth that caused them the most frustration and, more than once, delayed allocation.

Not by a definitive amount, we're talking 3-5 seconds, but it was the constant flipping of pages and radio traffic related to the one thing that I think the NEAS needs to change for the betterment of the system.

No more breaks.

I can hear the UK medics now "Hell no."

Let me elaborate for my work straight through the shift American friends.

The NEAS, as a portion of their labor agreement, provides their crews with certain breaks depending on their daily activities.  When they have been on post for an hour away from station, they get rotated back to the station.  This was commonly referred to on the radio as "Return for a cuppa."  The basic premise is simple enough, really.  People need clean bathrooms and a chance to eat since eating is not allowed in the cars or vehicles, nor are they allowed to sit down and eat in an establishment while on duty.  This was evident when Mark was nervous enjoying some Pho in San Francisco.

In the car and vehicle this didn't seem to be a big deal, we'd get a message to return to base, or that we were clear for meal break.  The meal break can be interrupted, should the allocators need the resources, but they avoid it since the crew interrupted gets paid quite a bit for it and the allocators, although they wouldn't elaborate, appear to be held accountable.

Sitting between the two allocators on the desk that morning, 50%-75% of their time was arranging rotation station breaks or ensuring crews got their meal breaks.  These variables also added more color codes to the dispatch screen.  This car is on dinner, this vehicle is on base rotation...etc, etc.

When a call came in they shot a quick look to the clipboard showing who gets a break when and dispatch decisions are based off of that.  I did not witness it make a difference in response times, since that information is streaming in real time on giant monitors overhead, but these folks are scrambling to keep everything running smoothly.

With my limited dispatch experience it seemed like a simple change, since on the days I was on rotation in Newcastle we never had a point in the day where we were unable to reach a bathroom or food.

My head was trying to process all the information these women were basing their allocations on and one of them turned to ask me, inbetween moving a car back to base "for a cuppa," "How do your dispatchers handle your breaks?"

When I explained we (listen to me, like I'm still in a rig), THEY are gone for 10 hours, no breaks, they froze.

It was passing the clipboard back and forth that I saw the only 2 seconds they both held still: glaring at me.  It was clear I was not to repeat that statement for the rest of my time with them.

"That would make, 'Go ahead 405' this so much 'thanks and to base if you please' easier."

Yeah, 2 conversations at once.  I have trouble typing and listening to music or TV at the same time.

Mark had some family business to attend to while I was meeting the voice on the other end of the radio and he returned just before dinner time to collect me.  It was an eye and ear opening experience to see the chaos that a simple concept like breaks caused the folks moving units around.

Something I completely neglected to mention over lunch with the executive team.

Told you I couldn't screw that up.  My conversation with the folks hopefully getting Mark cardioversion and CPAP, and where to put your coffee when the table is literally covered in signs that say "DO NOT PUT CUPS ON TABLE, USE SAUCER" soon.

Yeah I did.

Saturday, June 12

Informed Pocket Guide iphone app Review

I was approached by Infomed to review their iphone app Emergency & Critical Care ACLS Pocket Guide Version.

It is safe to say I was skeptical about using a phone app for patient care advice, but after having a look through this thorough guide I recommend it highly.

I do not recommend using this or any other guide during actual patient care.  Using it in the back of the ambulance or on scene requires both hands and both eyes off of the patient, something I do not practice.  However, the list of medications and common poisons could help you down the proper path while others are tending to the patient.

I have had this app on my phone for a week and a half now and moved it from page 4 to page 1 during my testing for the Captain's exam.  I used it when I had only a few minutes to review some basic protocols and it was far nicer than lugging around the large binder or even a flip guide that does not fit in my uniform pants or shorts at home.

Even a quick visit to my "office" meant a few moments to review things like Pediatric Glascow Coma scales, APGAR scores, ACLS for symptomatic bradycardia, dosages and even common poisons.

The app is well designed, in my mind, and lacks a lot of the bells and whistles I think could trap field providers into over relying on it.

For example, a really neat feature would be a digital braselow tape that brings up the color coded info for that child.  As neat as that would be, it would become a crutch and if forgotten at home, but relied upon, it could negatively impact patient care.

Three menus at the bottom offer the topic home page, a smart calculator and bookmarks you can add to or arrange.  It is a clean and easy to use design and the information is excellent to review.  Any time you pull out your phone to play a game you could be reviewing the included Spanish translations guide, complete with pronunciation key, or reviewing just what Acebutolol does.

There is one downside, the cost.  Personally I don't like paying for apps on my phone.  But, considering the paper version of this guide is $21.95, the app is a steal at half the price.

Had I a scoring system in place it would do very well.  Perhaps I should get one.

You can find out more at Informed's website, as well as links to other valuable guides in the EMS, nursing, fire and law enforcement arenas.

Halfway Done in Newcastle

chroniclesblogThe morning of Day 4 started much like the first morning, with me confused and disoriented up on the fifth floor looking at an alarm clock that said 5:15 AM and a body that said "No."  I was dragging and the project induced exhaustion was starting to wear through.  Downstairs in the lobby waiting for Mark to pick me up, I sipped my coffee and wondered if I would make it all the way through the day.  When at work and I feel this tired, I can just zone out in a corner after chores and I feel better.

Being a guest and having to be on top of my game meant today was going to be rough.  And rough is just how I came across according to Mark.

At the Fire and Ambulance station I made another cup of coffee and settled into a green chair.  Mark would later tell me I looked Knackered.  If that meant anything like destroyed, he was right.  I was tired.

About an hour later, out on post, Mark must have seen me nod off in the back seat.  It was still dark, the light rain misting around the car, the bright green hills and warm brown houses passing by outside the tinted windows...zzz...roundabout...zzz...

It was embarrassing to say the least.  9000 miles from home and I fall asleep.  Mark steered the car back to my hotel in between postings and dropped me off for a proper nap.  We agreed on a time to collect me and I melted into that bed for a power nap unlike any I had had before.

And while I slept Mark did what I wanted to see him do - Refuse transport to someone who didn't need it.  One of the 2 benefits to the front loaded model and I missed it.  My foot still makes contact with my back side for that.

Mark arrived at the hotel to collect a refreshed and appreciative American and we finished the shift with a few calls I have mentioned already.  This afternoon showed the flexibility of the RRC  and we transported more than 1 person in the car.  As I think back about that experience from here in the future, I get frustrated.  We just this morning were activated for a difficulty breathing that turned out to be someone looking for a ride across town.  6 people responded lights and sirens at 7 in the morning for that and the patient knew we could not tell them "No."  They described all the insurance plans they were a part of and refused to understand just how badly they were abusing an emergency service, let alone the lives they put at risk by flat out deceiving the dispatchers.

From what I have seen to this point from Mark and the NEAS, Mark could stand down the ambulance and either re-direct the person to an appropriate clinic or GP, or, if he still insists or has something else bothering him, Mark can put him in the car.  1 man and a station wagon saving the day for an overloaded system.  In the end, Mark isn't coming in that car, nor is he going to cancel me when it is realized this complaint is not worthy of a lights and sirens response.

At the end of our car shift I was a bit bummed it was over.  We still had a day on the vehicle ambulance coming up and I was indeed looking forward to that, but I've done ambulance work, I wanted more RRC time.  I wanted to jump in the car and drive it home to show my system that we don't need a $50,000 4 wheel drive SUV to deliver care.  But alas, the wheel is on the wrong side and there is a touch of water between there and home.

As we pulled away from the station and back to the house I thanked Mark for letting me rest that morning and I apologized for my lack of professionalism.  He smiled and said something about he really wanted to go with me, but was able to rest on his rotations back to the station.  No nap, but a chance to sit still and recover.

The evening activities were to include a nice dinner in a town called Heddon-on-the-Wall at a wonderful restaurant called the Swan.  In attendance were some of the NEAS executives and my chance to ask about where the service has been and where they are going.  In between questions about response times and clinical interventions we enjoyed a wonderful evening meal.

Peter Stoddart, Operations Manager and the arranger of most of my experiences in Newcastle, was in attendance as was his lovely wife.  We spoke at length about event EMS at the Sunderland match the day before and I had to bend his ear about disaster and event related topics later as well.  What can I say, I'm a systems and resource allocation nerd.

Paul Liversidge, one of the executive team from the NEAS, was also there to talk to me and I took advantage.  I made sure to sit next to him and over a few drinks we got to talking about the future of the NEAS and the possible new role of the Fire and Rescue Services (Fire Brigade) in providing EMS.  He was curious to hear of the troubles many American services experienced, are experiencing, and will soon experience.  Only there it will be a blue shirt green shirt battle, instead of a blue shirt white shirt battle like in the states.

Mr Stoddart's Left hand man, a lovely woman named Fiona in this case, was back with us after a wonderful night the night before and she is always all smiles.

Mark and Sandra somehow muscled their way into the arrangement, Mark trying to get a word in edgewise whenever I took a breath or a bite and Sandra was constantly checking to see if I was wearing white socks again.  And, not surprisingly, she is happy and in the only one in focus in this photo taken by Mark.

This must have been how Mark felt when we were treated to a wonderful dinner and frank conversation with SFFD EMS Section Chief Seb Wong.  He and Mark talked about ideas the SFFD had for the near future and Chief Wong listened.  It was amazing to see the way he trusted Mark's opinions and suggestions.  I can only hope I made a similar impression on the NEAS team.  After all, in 2 days time I was to meet with the ENTIRE administrative staff to tell them about San Francisco and the fire based model.

And I couldn't screw that up if I tried right?  Right?

And don't worry fire buffs, that kick ass training center is coming up, here's a photo to wet your whistle.

And those are just the appliances assigned to the training yard.  The first row.  Of the first yard.

Friday, June 11

On the Ambo in the UK

Subtitle for this post: Can you reach that for me?

Coming off a superb time on the Rapid Response Car, nappy time aside, we're on the vehicle today.  The vehicle is what you and I would call an ambulance, but since anything that can take people to the hospital is an ambulance, it needs to be narrowed down a bit.

The car is certified as an ambulance since it can take people.

The vehicle can, as that is the main purpose of it.

But hiding around town, and just out of camera range as we drove by were swarms of non emergency ambulances, almost buses in their capacity.  When asked their function, Mark and our ECSW Becky (more on her later) informed me they take folks to their appointments, get tests and from one facility to another.

Collecting my jaw from the floor I explained to them and reminded Mark how many times we activated 6 people to do just that.  Becky shot me a look from the driver's seat of the vehicle and asked a great question I still can't answer.

"Why not just give them a ride in a van or bus?  Why send the ambulance?'

Why indeed Becky, why indeed.

I could try to explain to her how, in America, people have become so expectant of lights and sirens whenever they want them that they're willing to sue if they don't get them.  Regardless of the condition, reason or outcome, folks will threaten a lawsuit and managers will blink and change protocol. Why inconvenience the few when we can just take them and inconvenience the many, right?

That was the start of my shift on the vehicle.  I'd love to tell you that life on a UK ambulance is so much different than in the US.  But when it finally gets to comparing apples to apples in these systems, having someone in the back is it.

Previous posts have covered my impressions of the ambulance layout and ways I think they can be improved to benefit patient care and provider comfort and safety.

Mark had difficulty accessing most of his equipment from the cabinets.  Everything he needed he got to, but not without ducking around the patient, around the family member, then leaning over.  The trash was also oddly placed, lying directly behind the family member so that to dispose of bloody mess you have to ask them to lean aside.

But that being said, with the current layout based on "safety" there is no other place to put these things.

Mark described to me the regulations in place to protect the persons traveling in the back of the vehicles and it makes perfect sense.  Until we have to actually do patient care.

After my description of the ambulances in a previous post I was contacted by an ambulance manufacturer who wishes to remain anonymous, I'll call them Box inc.  Box inc wanted my thoughts on what makes the perfect ambulance and I told them I have yet to see it.  But, Box inc had some new ideas about making your ambulance more versatile when on post, more on that another day.  But Box inc will still take a van or pickup truck, rip off the back, slap on a place for a cot and make it flash, there really isn't another option at this point.

But back to Newcastle and the McDonald's parking lot.

Yes, we've found our way to the parking lot at the McDonald's, on post if you can believe that, so I snuck in for a coffee.  It's an addiction, I know.  We had a chance to talk on camera about Becky's role in the NHS and what an ECSW is.  But as we talk about it, a few points to look for first.

I am sitting on the cot and Mark in the chair for family members.  The pass through to the cab behind him has a small door on the top that leads to the trash bin behind that seat he's in.

The cabinets behind us and between as as we talk contain all of Mark's equipment.  Just from the layout you can see how challenging it could be to access them with a poorly patient in the back.

[youtube]http://www.youtube.com/watch?v=ACSEs70OKv4[/youtube]

When I said that Becky was above an EMT, the comments section at youtube went insane.  What I meant was that she can give pain relief without medical direction.  She can do something I can't do, mainly because I'm told I need more education and training to deliver pain gas to those in need.  Becky is proof I do not.  So when I said she is above an EMT, I was referring to her ability to medicate them in that manner.  An EMT can transport, Becky can not.  Apples and Oranges folks.

Our jobs on the vehicle were similar to what Mark and I saw on Medic 99 in the City, moving folks with this complaint over there and that complaint over here.

It was on the vehicle that we encountered the only person, out of dozens, who demanded transport.

As you all plainly know, my clients demand transport 90% of the time and need it 5% of the time.  Newcastle respects their Paramedic's opinions, likely because they can get in and get seen outside the A&E in a reasonable amount of time compared to here in the US.

This person activated 999 to report an assault and we entered the house cautiously.  It was quite a bit reassuring knowing that the occupant was most likely not carrying a weapon that could mow us down from 40 feet away.  I'm no ninja but I'll take a clipboard to a knife fight over a knife to a gun fight any day.

The local police were close on our heels, again, without firearms (hard to get used to) and the scene was more than secure.  Very secure the police confirmed, poking holes in our patient's story.  Then there was the recounting and description of the event given and none of that matched what we were looking at.

Clearly there were behavioral issues in play and the decision was made to transport based on the inability to confirm normal mental status.  We've all been there and trying to communicate with eye movements and physical gestures must have appeared as though Becky and I were flirting.

My eyes said "Look at the door, the things piled in front of it, it opens inward, no one broke in there."

Her eyes said "What?"

My body, arms crossed, said 'Over there, look, the door!"

Her body, arms raised to the side and shoulders up said, "Huh?"

Mark's eyes said "Stop it!"

Mark does not ring down, or pre-alert, the hospital himself, but relays it through his control center.  When I saw what the control center did the next day, I decided that was unnecessary.  If your service relays patient reports trough a third person you are introducing another player in the telephone game and just another chance for pertinent information to get lost.  I would love to be able to forward my report to that point to the hospital and they can move that information to a bed and await our arrival.

Oh, did I nod off?

Right now my service gives audio radio reports to whichever nurse lost the coin toss that day and has to answer the radio.  I tell them what I have and why, vitals and hang up.

 

Many Americans may shudder at the idea of waiting 2 hours for an ambulance but I met a woman who disagrees.


Mary, I'll call her, fell down on a friday afternoon and injured her hip. Being of a stoic generation, she didn't want to bother anyone with her trouble, so she hobbles through the weekend until her doctor's office opened monday morning. She called the office and spoke to her doctor who advised her to go into the A&E to be evaluated since his office had no x-ray capabilities.


The doctor called the ambulance and the call was classified as an €œurgent€ meaning there was no life threat, but still a need for a transport. This call is then put in hold in the system with a maximum wait time and an ambulance is assigned as soon as the system has the available resources.


Mary met us at the front door and walked us in with a slight limp, dressed and ready for her trip to the A&E like many of my lights and sirens patients. We took our time making sure her medications were gathered and the stove turned off, then into the chair and down to the ambulance.


Because this trip was arranged her medical records were waiting at the hospital, as was a bed reserved for her and she was seen as soon as she arrived. I asked her if the 2 hour wait was too long and she looked at me as if I asked her what color the sky was.


€œI waited all weekend to call, another few hours wasn't going to kill me, son.€


I wanted to hug Mary right then and there.


After a day of back and forths on the vehicle and torturing Becky with the American and the camera duties, we were close to finishing our shift when that dreaded job came in.


The late job.


We were planning on meeting some of the rank and file for a social evening and this job would put us over our shift and we'd be late.


We screamed through the streets of Newcastle, pushing old women off the road and opposing traffic wherever we could.  OK, not really, we were sent on a common case that would later bring out our common response "Same patient, different country."


With the patient on board and her friend safely secured we made our way through the evening traffic to St Farthest, all the while talking and keeping our patient in good spirits.


The day went fast in retrospect.  Traffic still doesn't get out of the way when you're rolling lights and sirens, you still have to go hunting for the extra blanket at the hospital and the nursing staff is still often glad to see you when it counts.


The evening was a night out with some of Mark and Sandra's co-workers, we were fashionably late after some creative dropping off and ride sharing.  I got to talk to them about Mark without him listening and their opinions were high and genuine.  Mark is a respected and admired Team Leader in his station and his system.


[youtube]http://www.youtube.com/watch?v=AiE_FcuNkic[/youtube]

Thursday, June 10

Artists donate talents for Boston Firehouse

A Firehouse in Boston, Engine 37 and Ladder 26, has quite the unique new conversation piece.

See what happened when the members put an ad on Craigslist for a portrait of their fallen members and the artistic community came to answer the call.  The Huntington Avenue station is first due to Fenway and what they got from the local artistic community is amazing.  Watch the video, then head over and read the story HERE

The Car, The Wall and The Game - Day 3

chroniclesblog

England recap, Day 3.

The alarm seemed to be timed better this morning and I was bright eyed and bushy tailed for my second day on Mark Glencorse's Rapid response Car in Newcastle.  The coffee was ready when I got out of the shower and I watched a bit of news while getting ready.  When I was in England a frightening wave of flooding was literally washing away parts of the western side of the country and numerous Fire and Rescue resources had been mobilized.   It was a topic of conversation in passing throughout the morning with the Vehicle (ambulance) crews we saw and hospital staff we talked to.

The check out on the car was much quicker since my first day orientation and away we went to our first post.  On the way Mark asked if I was hungry and I had to remind him I don't often eat breakfast.  In the back of my mind was another McDonald's run but in the front of Mark's was taking my for a proper Geordie breakfast.  The term Geordie refers to the people or speech from the Tyneside region of England, which is where Mark is from and where we were.  Similar to referring to someone as a Lonestar or Southerner here in the US, a dialect of speech and set of stereotypes is set into your mind.

The car weaved through the light morning traffic to a take away trailer in a light industrial park.  The aroma from this man's trailer was like heaven.  The odor of bacon, along with other smells, changed my long standing no breakfast clause and my mouth was watering.

As with many of our other adventures this day, Mark in the car had folks wondering where the emergency was.  No one thought he was the Police coming to get him...until they saw me in my navy blue.  When Mark ordered my meal and the fellows standing nearby read the back of my jacket, which said "Firefighter/Paramedic SFFD" they were curious to ask all the questions we've been asking each other for months.

"Is it true you have to pay to go to the Doctor?" "yes."

"If you can't pay do they send you away?" "No, you get a bill later."

"What about an ambulance? Is it true you'll leave me to die if I can't pay?" "No, we'll help you out no matter."

It was a great conversation with locals about their neighborhood and town.  Keep in mind this town has been here more or less FOREVER.  It's not like some guy wandered through 200 years ago and started a farm.  There are castles and churches still standing despite centuries of wars.

It was in the middle of a talk about a nearby castle that my breakfast was ready.  Mark's smile widened as he handed me what can only be described as heaven with a side of LAD.


Bun, mushrooms, brown sauce, black pudding, eggs, sausage, bacon and it was glorious!  Along with a true cup of coffee and some good conversation it was a wonderful way to start the morning.


But like so many things on this job, wouldn't you know it a motor vehicle accident has been reported just a few blocks away.  Chomp, gulp, a thanks and away we go to the 2 car accident.  There was an initial need for extrication so Mark called in the Brigade.


The ambulance arrived quickly, as did the brigade and everyone went to work doing their pre-determined roles.  It was refreshing to see firefighters not distracted by assisting with patient care, but simply having a task and seeing to it that it was done.  This scene was more what I was used to.  Ambulance, fire engines, police, a proper job.  Although the injuries minor and the damage to match, the resources in the community worked seamlessly together to get the job done.  After the patient was transported I had a quick talk with the firefighters about their roles and responsibilities on this assignment, since there was not the usual bickering or fighting for the glory of the jaws that I have seen all throughout my career.  The firefighter assigned to cribbing was working just as carefully and quickly as the two sets, yes I said two sets, of hydrolics that were being prepared.  We discussed my role as dual trained and they gave a polite smile.  I think just below that was two distinct thoughts.  First, "That'll never happen here" and the competing, "Oh God, what if they do that here?"


My photographer for the day obliged for a photo of the brigade that responded drawing my caption, "One of these fireman is not like the other..."




After a couple more jobs we were released from our roll area and directed north to the Arsenal/Sunderland football match.  The trip started as a chance to show a lifelong soccer fan a proper football match in his adopted country, but it would turn out to be an EMS learning experience.



But first, Mark had something special planned for me.  We grabbed our sack dinner, lovingly prepared by Mrs999, and hit the road to see the proper section of the old Roman Wall I was so interested in.  The drive through the countryside was amazing.  Rolling green hills hiding in the fog, unchanged since ancient times, save for the occasional 200 year old farmhouse with it's trailing smoke from the chimney proving someone still inside.  The park rangers (or the UK equivalent) came out of their warm office to meet us when the RRC pulled up and we got out.  They wondered if a hiker had been hurt on the wall, why else would the ambulance be there on a foggy, rainy afternoon?


After a climb and a brief hike I was able to take some video and one of my favorite pictures from this adventure.  smallerThen I got to do what my Grandmother never did, stand on Hadrian's Wall, where her hero Arthur may once have stood.  There was a connection with that place I can't really describe.  I have the book she was reading when she died, Stories of King Arthur, a book she received as a child from her grandmother and I display it proudly in my living room, bookmark still in place and soon a photo of this part of the wall will accompany it.


It was an experience I hope to share with my young girls when they are old enough to appreciate what the wall means to the family.  Folks have been known to walk the whole length, camping as they go, and I plan to do the same in good time.



And now for something completely different.  If you've made it this far, I thank you.  Like Mark has said, so much happened on this trip, so many interesting and exciting things we shared with each other and with all of you, these day by day accounts are long winded.  If you skipped this far to read about Event EMS you are truly a Fire and EMS nerd and I salute you for that.



The Sunderland stadium can hold, at capacity for a football match, 45,000 impassioned fans.  The perception of many of you in the US may be "Soccer Hooligan" and the stereotpye is fitting in many cases when it comes to premier league football.  I was treated to not only the game, but a tour of the medical facilities made available for players and fans alike.


The stadium has an impressive command center encompassing the EMS team co-ordinator, Fire safety specialist, CCTV team and the police commander, all in two large rooms.  From this unified command center a response can be co-ordinated and a plan followed by radio.  The CCTV cameras also allow the leader to call in extra security if it appears an EMS fly team has unrest around them.  Help can be on the way before they even notice what is happening.  There were 4 teams on staff, dispersed around the stadium with assigned seats and radios, ready to respond as well as 2 pitch or field teams ready to respond to an injured player or person on the ground level.


Behind the scenes are two levels of care.  The teams have physicians on staff to deal with injuries to their people and outside the stadium, tucked in with the snacks and beverages are a number of doors marked First Aid.  Behind these doors are the service I know little about from my travels there, St John Ambulance.  (Not St John'S ambulance, St John.  I learned that one real quick.)  In these almost clinic areas are basic care givers, EMT's, Paramedics, RNs and an entire medical community, all volunteering to help out.  While Mark and I sought refuge there to eat our dinner before the game, a woman came in, was assessed, treated, medicated and released, all in the span of 10 minutes, all by the St John staff.  It all happened before I could finish my Dr Pepper.


Upstairs in the control center I had a chance to peek at the emergency response plan and these guys have it all figured out.  I learned later that a number of previous events led to a mandate that each stadium have an action plan and the resources in place to react to those emergencies.  We also talked about rotating the teams if more than 1 fly team was mobilized, the extent of the St John involvement, their ability to staff a team and a number of other things most laymen would have fallen asleep thinking about.


The match was brilliant.  We stood just outside the command center, which was near the visitor's seats.  Arsenal fans are passionate fans.  When I applauded a good play, which is common in this sport, Mark grabbed my hands just as one of the visiting supporters turned to see who was clapping.  Just what I need 4,000 pissed off drunk football fans chasing the American who clapped because the home team goal keeper made a nice save.  Tragedy averted.  And good too, because we were heading out on the town later.




We're meeting Mrs999 and Fiona for a night on the local scene to give me an idea what Geordies do when the sun goes down.  Well, a while after the sun goes down.  OK, late at night.  I was treated to some local color and had a chance to talk to Mrs999 and Fiona about the person I was shadowing this week.  We talked, danced, twittered and had a wonderful time.  Mark loved his new iphone, since the old one died in San Francisco and at one point he fell asleep updating all the Chronicles of EMS followers.  OK, not really, but it made for a fun twitter update.


As the evening continued on the famous Millennium bridge over the river Tyne, I had a chance to reflect on where I was and why.  It was a big deal to be where I was, with Mark and the NEAS, learning how to deliver care in the front loaded model.  We should have called it a night there, but we had one more stop.


Bachelor and bachelorette parties in Geordie country take themed dressing to the extreme.  In Las Vegas, the girls may dress in pink shirts with the bride to be in some kind of white head dress and veil, letting all the single guys know exactly what she is celebrating.  But here, the entire group dressed to match.  There was a group of guys dressed as 20's gangsters, pinstriped suits and fedoras.  Why? Stag party.  Groups of girls wearing matching tight shirts all wishing their engaged friend luck in cleverly worded phrases on the front. Why? Bachelorette party.  In came a group of girls wearing black and their names on he back of their shirts.  One of them we know.  Steph Frolin is the name my co-workers use to alert me to a scene that is not what it seems.  Imagine we are investigating a person who says they just came in from a terrible car crash.  As I'm assessing them my partner discovers witnesses in the next room who can confirm no such thing ever happened.  They will refer to me by my BS name: Steph (Pronounced Steve) Frolin.  as in "hey Steph, can you have her describe the car again?" Now I know something has changed and that I need to speak to the partner ASAP.


So Mark turned on his ambulance charm and talked the poor girl into standing with the only guy wearing a jacket for some reason involving an American and a blog.  No doubt she has erased this moment from her own memory.


As I mentioned earlier, we should have cut the evening short at the bridge.  The jet lag, the drink, Mark's dancing, a long day and an early alarm clock would spell disaster early the next morning for our last day on the car.

Taking it easy on the drink is a suggestion that carries through all situations and this one is no different.  Not that I went to excess this night, no where close, but the combination of the time change, new diet and excitement of the Project would lead Mark to getting me off the streets the next morning.  And I'm glad he did.  Details on my nap next time.

Wednesday, June 9

Reflections on Day 2 - the Project



Originally posted on November 20th, 2010

Today was my second day in Newcastle, UK but the first on the streets with Mark.  It is indeed a different world here.  the video from the end of today is linked at the end of this post.

We started early this morning and grabbed a coffee at the McDonald's, then off to standby in a local neighborhood where we pulled out the laptops and discussed the day.

I was able to have a quick interaction with some of the Firefighters assigned to the station with Mark and the Ambulance crews, nothing more than a quick introduction between calls, but it was later in the morning when I learned I don't have it nearly as good as I thought.

While heading out to the pouring rain, I bumped into the station cleaning crew mopping the floors.  The fireman don't do the big housework.  No wonder mark was so surprised when I gloved up and cleaned toilets back home.

Later in the morning still, I met the Station's French Chef.  They don't cook their own food either.  These are two things I think identify the firehouse as a home.  It seemed more like a school than a fire house.

But, I have yet to see it through the eyes of one of the firefighters, that comes next week.

As far as impressions on the ambulance, I can say that some of my expectations were met while others missed completely.

For example, Mark can honestly tell people when they don't need to go, then leave them at home to recover.  He can not only let them drink water, but take pain meds.  He can cancel the ambulance and drive patients into the clinic.

He also has to wait in the middle of the highway for a second ambulance when he has 2 patients in C-spine precautions.  You see, the European style ambulance is abundant on space on the inside, but so much of it is unused.  There are two chairs and a cot in the back of these rigs, no room for a second patient.  When we had 2, almost 3 patients to board, we had to wait, when most US services have the bench seat that can be used for that second patient.

He also gets to watch the fire brigade going the other way on that highway just looking.  They did not respond to the traffic collision.  Had I not been there he would have been alone, but I'm sure done fine.  The police and highway department arrived and had a cool hand with the traffic, no safety issues or requests to reopen the highway sooner.  In fact, where some of the agencies I have worked with would open the lane next to the accident, these folks kept it closed since we were close to it.

It is hard to draw any conclusions from a 12 hour shift in one station, but at first glance I want to have Mark's training and options when encountering patients who don't need an ambulance and I think he needs my ambulances to offer a better service to his community.

Deploying rapid response cars within the SFFD may not work after all without the clinical routing options he has at his disposal, not to mention an ENTIRELY different view of what it means to call an ambulance.  Each and every person I encountered today listened to Mark explain their situation, condition and options whereas most of my clients demand transport regardless of their condition.

The internet here in my hotel is not included, like their website would like you to believe so I am using Mark's mobile USB adapter which uploads a single photo in 8 minutes, so the updates from here will be mostly in text, but I'll film my video and give it to mark to upload at home each night.

And for those of you who think I'm in the bag for socialized care, I favor it because it makes more sense but I will be honest about what I see here.  Believe that.

The Day 2 Roundup Video

The Good and the Bad - Continuing Day 2

I left off soon after our first job on the car which had me wanting to see the versatility of Swalwell 405, our Rapid Response Car.   I was beginning to wonder if I had built it up into more than it was when the universe stepped in and answered my questions, as always.

A school child was ill with a unique condition that was familiar to the child's brother at the school as well as the mother who had arrived on the scene before us in the car.   When Mark had determined the non-emergent condition of the 10-18 year old (not a little one is the point) the ambulance was canceled.   There it was, the front loaded model in action.   A trained set of eyes able to determine no need for a two person gurney transport, so the unit is canceled ASAP.   Should transport be needed or requested (which it never was, save once over there) the patient was appropriate to sit in a car, seat belted, and driven to the A&E or clinic.

Through the course of the evaluation Mark and I both asked a variety of questions trying to get to the center of what the unique condition was doing to our patient.   In the end, Mom decided she would follow up with their Doctor later that day and she will let the child rest at home, something that usually helps when the child feels this way.   Mark offered to follow Mom back to their house just 5 minutes away just in case something happened.   Not sure exactly what that might be I was even more excited when he said, "Or I can just take her in the car and follow you home.   Would that make you feel better?"

The mother smiled, blushed and sighed. "Would you?"   Mark smiled and assured her it was no problem at all and we escorted our patient to the car and drove her home.   There was never a point where this patient needed a hospital, let alone an ambulance based on the mother's description of the unique condition and other factors revealed at the scene.   In San Francisco I would have had to transport the child or send them home with Mom.   In my experience both parents are often working and unavailable to respond to the school, and that's IF they even answer the phone number given on the emergency contact card.

5 minutes and a car made a huge difference for resources in the area.   I was sold on it right there and then and a number of other calls re-enforced the benefits of the RRC.   The old man with the hurt wrist who we gave a ride to the clinic, leaving the ambulance available.   The baby with a cough who we gave a ride, strapped in her seat with Mom along for the ride.   None of them needed an ambulance but had no other way of getting evaluated for their chief complaint.   In San Francisco a 4 person ALS engine and 2 person ALS ambulance, 6 people and$600,000 worth of apparatus to do the job of 1 man and a ford station wagon.   It was reading through the real estate section looking for a house to buy that a call came in that would change my mind about the current NEAS system.   A certain resource issue that is.

This is the section Mark has been waiting for.   All through our experiences he has been wondering what my real opinions were/are/will be and I kept telling him, "I already told you."   But I have to share with all of you or else this is all for nothing, right?

The ambulances currently used by the NEAS are inefficient when it comes to treating a patient enroute or dealing with more than 1 patient.   I use the term carefully since when a rider is placed in Mark's ambulance and a patient is in the cot, half of his kit is inaccessible.   The large gurneys load into the open space in the rear of the ambulance and latch into a sliding platform that can move the gurney from the wall to the center of the floor for the simple reason of accessing the patient's left side.   This removes space for a bench seat and moves the patient a good deal away from a practitioner in the back.   I had difficulty imagining Mark working a proper patient, rolling blues to the hospital and being able to access anything quickly and safely.   This photo is from Swalwell Vehicle 214, which we worked on later in the week, but show the head of the cot and the fold down seat for a family member or rider.   the cabinets slide out of the wall so when they are closed they are secure and not accessible.   More on that when I discuss working in these Vehicles.

That being said, I did like being able to almost stand up completely and have all the light and vent controls in an overhead consul instead of buried back in the corner near the shelf near the captain's chair like in many type IIIs here in the US.

Working a motor vehicle collision with more than one patient opened my eyes to the benefit of multiple hands on the scene.   We arrived soon after the police and began assessment.   An ambulance had already been dispatched and when they arrived I had my first glance into one.   Whoa.

The crew opened the doors and a large lift was raised and the gurney loaded onto it.   Then it was lowered to the ground and removed to our location.   In all less than 2 minutes, but still seemed like a long time.   I'm an immediate satisfaction type of guy.

When the first patient had been boarded and was being loaded I saw Mark reach to his radio and request another ambulance.   I stopped, looked around the crew loading the first patient in and that is when I saw there is no bench.   No place to put a second patient on a board.   Neither of the patients needed critical care interventions, just C-spine precaution, routine medical care and assessment, something I've done to 2 LSB folks often.

It was an awkward wait in the middle of the highway for that second ambulance.   During that wait, on the other side of the highway went a fire engine.   In service, staffed, yet not dispatched to the motor vehicle accident on the highway.   The first emotion was confusion as in, "Why can't they respond to assist?" which gave way to frustration, "Lazy brigade won't even hang a u-turn and check on us?" then reality sank in, "They couldn't help right now if they wanted to."   No fluid leaks, no fire hazard, the road was already safely blocked by the highway department and all we needed was a place to put a patient on a backboard.

My plans to move over were put on hold.   For all the benefits there were indeed drawbacks.   Of course there would be.   But so far, the only thing missing was that ability to take a second backboarded patient and have access to all the equipment in case of a proper patient.   Especially since Mark spoke of having to do CPR and push drugs alone in some cases.

But what is the answer?   The NEAS used a Chevy type III years ago and it didn't work out.   From what I've been told I think it was a combination of politics and underpowered motors, not necessarily the patient care compartment.   That conclusion is drawn from a number of conversations with a number of NEAS folks.

It was made clear to me when I brought up my observations to Mark that the governing bodies mandate the secured nature of all the equipment in the ambulance and that repositioning it would not only take a completely new vehicle, but changes in rules and regulations country wide.   So the work is cut out there. However, to be fair, Mark took one look into the back of medic 99 and nearly passed out.   Nothing secured, supplies behind flimsy plastic doors, no cot lift, it was a recipe for injury in his mind and the mind of his regulators.

Is there a middle ground?   Wheeled Coach, Medstar, there are so many different manufacturers just here in the US, what are they using as the basis for their designs?   And what about Mark's ambulance manufacturer?   Are they deciding what is best for us or are we?   I have yet to work in an ambulance where I thought to myself, "This is perfect!"

See Mark, all things I told you when I was there.   We even discussed it in a video report later in the trip.

A few more jobs and we were back to the station for end of shift.

[youtube]http://www.youtube.com/watch?v=UjdvG9MR3-A[/youtube]

The spot on swooning British nurse impression Mark does was not actually spoken, but he was told repeatedly that I looked "nice" in my station uniform.   Funniest thing was, I was cold and wearing my coat most of the time and he had me remove it before going in.   I think he's angling for a different style of uniform.

The end of my first day on the RRC brought smiles from me and from Mark and a look forward to another wonderful evening with my extended UK family.   Tea with Margaret, Sandra and the Boys was my family time.   Had I had the time to bring Mark the hour home with me each night here in SF, I think he would have had a much better experience and I now regret not being able to share that time with him.

Back to the hotel and a warm shower and inviting bed.   Tomorrow would be another big day on the car and an afternoon of local heritage, discussing Event EMS and an explanation of this photo:

Steph Frolin? Is that you?

Swalwell 405 - Day 2 in Newcastle

 

This is a continued retelling of my adventures on Part 2 of the Chronicles of EMS, the one we weren't allowed to film.

Day 2 in Newcastle, Day 1 on the car.

The iphone rang so early I thought I was still dreaming.  Sure it said 5:15 AM and Mark would be along to pick me up in 30 minutes time, but I felt destroyed.  My body still thought it was 10 PM and was gearing down for night.

NO! I yelled to myself and turned the lights on.

This was going to suck.

I got cleaned up and dressed, then went to make a cup of coffee.  Coffee in England is different than in America.  In America you get a nice drip brewed cup of joe from perhaps a Peet's, or even a Starbucks or gas station.  In room 501 of the hotel, my HMHQ for the week, there was a water kettle and a baggie of freeze dried coffee.  A taste I choked down at first and then missed as soon as I was on the plane ride home.  I had come prepared for the coffee situation, however, as you may recall from this video I posted later in the day:

[youtube]http://www.youtube.com/watch?v=6vcDwv0C_7s[/youtube]

Mark took me over to his station, the sun yet to rise.  Inside I met a few of the night shift going off duty in the ambulance room of the Fire and Ambulance Station.  It immediately took me back to microwaving 25 cent burritos and drinking tap water during my internships.  There was a TV in the corner, 4 very nice green chairs (green is the color for EMS there) a couple of side tables, small kitchenette with sink and a microwave.  We really are the same.

Craving more coffee I went to fire up the kettle and prepared another cup of the freeze dried goodness as Mark took me out to the floor and to Swalwell 405, our Rapid Response Car for the day.

It was exactly as I had imagined.  A ford station wagon, appointed with safety markings, emergency lights and the ever important aspect to the RRC, the label "Ambulance."

[caption id="attachment_1456" align="aligncenter" width="500" caption="The RRC with the Appliances at Swalwell Station"]The RRC with the Appliances at Swalwell Station[/caption]

Mark led me on a quick overview of the equipment kept inside and what I could carry on a job and what I should stay away from.  We talked about interventions I could perform, such as assisting persons to stand or to walk, the basic stuff we all do, but at no time was I to use his giant Lifepack 12 to cardiovert someone in unstable SVT.

As soon as we were checked out we were sent on a system status post in a nearby neighborhood.  Not to get Mark in trouble, but I needed more coffee (some have cocaine, others a hobby or "life", I have coffee, let it go) and the only place that pours a cup is a place I hadn't been in over two decades, the McDonald's.

We were on post for an hour when we were called back to the station.  You see, Mark and his co-workers are given a rotation back to the station each hour for bathroom trips, food and what not.  When we left our area, another vehicle or car would fill in.  This seemed simple enough at first, but a few days later, while watching the allocators try to juggle all the breaks and rotations, I wondered just how important that 1 hour mark was.

At the station Mark's point to point radio came alive.  I had trouble understanding the accents at first to decipher our assignment and there was no station alarm or alert system.  Perhaps it would have awakened the firefighters upstairs?  We climbed in the car and away we went, blue lights flashing to a reported fall victim.  Specifics aside this was the perfect first call for me to see the NHS in action.

I in my station duty uniform with badge of office and Mark in his now famous green jumpsuit made our way in and found a run we EMT and Paramedics handle all the time, a minor muscular injury.  Mark went into his comfort zone, patient care, and I handed him the BP cuff and placed the stethoscope across his shoulders to have it in reach.  That got me a look I often saw as a small child when I would break something expensive.  No one over there stores their stethoscope around their neck.  I only do it on scene, mainly so I don't lose it, but throughout my trip I never saw one 'scope around one neck.

As I recovered from that faux pas a walking Saturday Night Live memory came through the door.  The patient's neighbor was a Scotsman, a true Scotsman, and when he found out I was American he began to tell me a story about an American he knew back in the 60s.  I know this because Mark translated for me later.  I could only make out a few words here and there, no unlike watching TV in a foreign country.

The Scotsman was ignored when I heard Mark tell the woman she should take some Peracetamol and the ambulance will be along in a moment.  He is allowed to let his patients medicate themselves for new conditions.  Now, I can create a gray area and make it work, but imagine telling the receiving facility that you let your patient dose up on Tylenol (paracetamol) for a new injury.  The ambulance crew arrived and away the patient went and we were back in service.  Nothing extraordinary, a simple run of the mill job we both encounter all the time.  The only difference was arriving at the scene in a car, and alone (without me) would be challenging at first, but some days, with some crews, I am kind of am responding alone.

In my next post I'll describe the odd moment when we were waiting in the middle of the highway for a second ambulance as a fire engine drove by, not assigned to the accident and something I think the NEAS needs to change immediately to better serve their citizens.

Tuesday, June 8

My first day in Newcastle

After following Mark's day by day adventures, I'm dragging you right along on the second week, the one not covered by the Chronicles of EMS cameras.

But why is this going up at 11PM your time Happy? Because that is 7 AM Newcastle time.  Wrap your head around that one and let's get started.
Mark's San Francisco adventure covered 10 days in total and he was clearly as exhausted as I and likely more. I last saw him at the BART station on the way back to the City and then to the airport.

I wouldn't see him again for 48 hours.

In that time I let my girls crawl all over me, literally and figuratively, all the while packing and preparing for my England trip. When the time came to board the plane emotions were high. The littlest one giggled when I gave her a kiss, the older one asked me to say hi to Mark in England. She seemed to be taking this experiment remarkably well considering the enormity of it and her comparatively small understanding of the world. The Mrs was understandably emotional and supportive, something she does very well. I had already given 10 days to this project rarely seeing the girls awake, if at all, and was about to give 10 more.

Into the airport I saw the car drive away and took a deep breath. This was not going to be easy.

The plane was packed. I had one of the window seats, but they neglected to tell me the foot room is severely restricted thanks to the new video on demand units. I had been to Seat Guru, but it seemed every seat sad that.  In exchange for a place to put my feet I had dozens of movies to watch to take my mind off the tingling in my lower extremeties.

The time difference was 8 hours ahead. To help deflect the impact of the time change I knew I would have to get on the plane, eat and get to sleep as soon as possible, then sleep most of the flight. The last time we flew across the Atlantic I fell asleep during the safety video, then not a wink the rest of the flight, I was exhausted 20 hours later.
Imagine my surprise and pride when I finished dinner, put on my headphones and fell asleep. Then again we medics have been known to fall asleep in odd places at odd times.

I was awoken an unknown time later (6 hours I discovered) to the following conversation:
(This was an Air France flight)
"Keep heir on ze oxee-jin and we can moove heir to zee floors."

Oxygen? Moving someone to the floor? This sounds like a job for...
...the flight crew.

Watch this video from my layover in Paris to find out what happened next:

[youtube]http://www.youtube.com/watch?v=cRkmeWTVcJY[/youtube]

After a quick commuter flight from Paris, we landed in cloudy, rainy, windy Newcastle, met by a somewhat rested Mark Glencorse.

I was whisked away to mark's home and welcomed as family. It was nice after a long flight to sit down on a couch surrounded by familiar names and voices. We enjoyed a wonderful dinner (Tea, I was told to call it, the evening meal if you prefer) and the perfect start to what would become an exhausting week.

Even though my family was far away, I had a new one just a few minutes down the road.

I had shared a family story that my late Grandmother was fascinated by the King Arthur legends and that recent research believes Arthur to have been a Roman General defending Hadrian's Wall from Northern Invasions.  I had mentioned this in passing on an episode of EMS Garage and Mark and Fiona had heard me.  Fiona scheduled a dinner meeting at the Swan Inn in a town called Heddon-on-the-Wall who's cathedral was built with stone from the wall.

I was hoping for a brief time during the trip to go out to see the wall my Grandmother spoke of, but didn't expect much at all.  Little did I know that, on the drive back to the hotel, we passed by part of the wall there in the middle of town.  Mark made it a nice surprise and swung the car around, parked and said, "There's your wall, Mate."

I froze.  I had trouble moving for a moment. It was kind of like meeting someone you admired.  I climbed out of the car into the cold night air and took a deep breath.  I could hear my Grandmother's voice as if she was right there with me.  "He stood here.  He garrisoned here.  This is history."

It was a small section, only 6 feet wide, maybe 30 feet long and a few feet tall, in a protected grass area near homes, but it was the wall she spoke of.

I took a few photos and a quick one of me on the wall before heading back to the hotel to rest.  As is now a Chronicles of EMS custom, the internet was pay as you go, so uploads were going to be difficult.

Mark dropped me at the hotel and I went straight past the pints in the lobby and straight to bed. The first day on the Rapid Response Car was waiting for us early the next morning and I wanted to be ready for it.

That story, and video of what I look like before coffee, next time.

Look out Newcastle!

For you new people who are following Chronicles of EMS, did you know I went to England too?  For reasons I could tell you, but then have to cardiovert you, the cameras weren't allowed.  However, I did document the heck out of my experiences in Mark's system and wanted to share that with you again.

Over the next week, in the lead up to the next installments of Chronicles of EMS: A Seat at the Table, I'll be "re-releasing" my England experiences to give the new followers a chance to see what this series could really do for us all.

I have posts in 2 parts.  Posts from in the moment will be out each day at 8 AM pacific, 4 pm GMT and my later recap post of that day after reflection and checking notes will go live at 8pm pacific or the ever inconvenient 4 am GMT.  Enjoy.

Originally published November 19th, 2009:

I arrived in Newcastle earlier this afternoon and am eager to get out with Mark and see what he has to show me.

Tonight I was welcomed in his home and felt at peace there.  The more time mark and I spend together, the more we feel like old friends, and we mostly are.

Tomorrow starts at 530 AM, 8 hours ahead of Pacific time by the way, and then it's 12 hours on the car.  We're having the worst luck with internet connections, with the signal in the hotel here an additional charge, even though the hotel site says Wi-fi.  I guess they forgot the "for an additional fee" part.

I am a bit nervous to see the response times here, with Mark often waiting a bit for an ambulance to back him up.  But we'll see.  On a lighter note...

On the way back from Mark's house tonight, he made a quick turn not 3 minutes from the hotel and pulled the car over.

"There's Hadrian's Wall there Mate."

newcastle day 1 009And here's me standing on the ancient Roman Wall just blocks from the hotel.

Sunday, June 6

You Make the Call - Document THIS

Ah, you all have gotten used to not having a weekly challenge, so let's get back to basics.  How about the different ways to describe skin?  Instead of being crazy like some of my lab proctors in college finding the most exotic and disgusting photos, I'll send along one of my own.

I know I have already turned a few stomachs with the photos of my burns, but that was about pain control and had to be done to make a point.

There is no point in this.  Unless of course, you have no idea how to describe this wound in writing.  Yes, that was a challenge.

You may ask questions as to specifics not clear in the photo, but having the wrist and hand in the picture gives all the info you need for size, color and location.

I have been known to add a little of my college education to a PCR narrative or two, but only when sure.  So when I awoke this morning with the following mark on my forearm and my daughter asked what it was I told her and she wrinkled her face.

So my question to you is, how would you document this mark on my forearm?You make the call.

Friday, June 4

I'm a better Paramedic than you

You sat on the tailboard of the rescue truck and told her she was wrong, you didn't need any more schooling.  You had a job as an EMT and liked it where you were.  You didn't want to leave your friends and you didn't.

I wouldn't be surprised if you are still there.

Still making $4.35 an hour?  Oh, got a little bit of a raise did you?

It's not that you are a bad practitioner, just not as good as you could be.  I may not be the best there is, but I'm better than you. You settle for the status quo, a nice shift on a mediocre rig because it's easier.  Screw that.  Your patients, your system and you deserve better than that.  When the water pipes leak, I don't want someone who thinks plumbing is neat, I want someone who is at the top of their game, well versed in the art and passionate about what they are doing.

You are none of those things.

This may come as a shock, but you landed where you are by chance, not by skill.  Big deal you put out a grass fire when they couldn't, they needed someone anyway.  You had a rare opportunity to take a chance and turn it into something fantastic but instead chose a life of low call volume, low pay and low expectations.

What are you hiding from?

Ridicule?

Failure?

The possibility you'll like it too much?

News flash, jerk, you DO like it too much.  You love it.  Stop fooling yourself thinking opportunity will find you in the little corner of the world you've chosen to hide in.  Stop whining about why things are so screwed up and find out how to make them better.  The only solution you'll find on the Playstation is how to get the Tombraider out of level 4.

WAKE UP, JUSTIN!

You're sleeping all night and all day, running 2-3 calls in a 24 hour cycle and thinking this is enough to satisfy that desire instilled in you as a child?

What would your father say?  Your mother?  Or worse yet, that girl who saw your potential but not even the slight possibility you would pass on her suggestion you could do better.

I took the chance.  I listened and I learned.

Those extra classes you were afraid of made me think differently.  I am anticipating patients responses instead of trying to react to them.  You could be 2 steps ahead, instead you are 2 steps behind.

I'm better than you in more ways than I can count and I wake up every morning glad I'm not you.

Respectfully,

the Other You.

Thursday, June 3

What's in a name?

Well, let's find out.


As Mark mentioned over on the Chronicles home page moments ago, many of the media big wigs are interested in what we are trying to do, but the name turns them off.

"OK," said Chronicles Producer Thaddeus Setla.

And this being a first of it's kind social television project, it's up to you, the audience, to come up with the name.

Find details over at Chronicles of EMS

Wednesday, June 2

Dangly Bits

Got your attention?  Good.  I witnessed something we all do our best to avoid and need to pass it along.

It is said that police officers should not wear neck ties so that if a suspect gets rough they don't automatically have something to grab onto.  Makes perfect sense to me.  We don't wear ties day to day so I never gave it much thought until today.

When encountering a person having an undisclosed medical complaint got disagreeable, we did our best to stay at safe distance, then make sure the person didn't hurt themselves.  When that plan didn't work we did our best to control the erratic movements using our brute strength.

Again, not working.  When we made the last ditch decision to use force to protect the person and ourselves, not to mention the growing crowd not listening to our commands to step back, we had a plan and stuck to it.

The next thing I know we have one arm down, the hips more or less still, the legs are rough but under control and one of the persons in charge of the other arm is fumbling with his coat.

We all have the neat radio mics that have fancy, easy to grab cables running from the radio to the mic.  Many folks even go so far as to put it on their epaulettes.  I clip mine to the inside of my collar so I can hear it.  Clipping it to my shoulder or to my chest as some new shirts are doing doesn't help me hear the radio, but it sure makes it easy for a combative person to grab.  And this person has his radio mic.

It's keyed open and the whole Department is listening to our struggle when she finally lets go of the mic.  only to grab onto something else.

This image is a perfect representation of the item she grabbed onto.  The item is great to pull the mic to your mouth to speak but still doesn't solve the problem of the speaker being nowhere near your ear when you need to hear it.

The person's hand is wrapped tightly around the clip that is attached to the retractable cord.  They pull it out, then swing.  It is now a weapon.  Not just the fist, but now this narrow cable flying through our treatment area.

I thought maybe this was just fire folks that this may happen to, but if you wear those kinds of radios with the mics on a rope, it needs to be behind your back, not infront.

It took 3 people to break the person's grip on this equipment, there was too much tension to get it off his coat.

In the end, it is still a neat piece of equipment.  Not one I'll use on the fireground, but sure as heck want one for my SCUBA gear.

Just a reminder to be mindful of what is on your person and how it may be grabbed if things get crazy.

Sunday, May 30

New Salary List is Out

One of the things I love about Mother's Day here in the US is that story they run every year about "If mom got paid for what she did, she'd make $150,000 a year" because they include cook, maid, teacher, etc.  Yet Father's Day rolls around and no one adds on handy man, gardener, mechanic, roofer etc.

But wait, what if I took an average day in my firehouse and log what I did, then made a similar chart?  Oh dear Gods am I underpaid.

Line Cook - $25,000/year - First thing in the morning is firing up breakfast and it's never just for yourself.

Housekeeper - $21,000/year - Kitchen, dorm, bahrooms, floors and laundry all need to be done by 9 AM.

Bus Driver - $30,000 - Pre-trip inspection, maintain higher standards and drivers' license.  Not to mention the part about taking people where they want to go.  This will cover Taxi Driver.

Event Planner - $43,000 - We need to shop for and feed 9 meaning a menu, cooking the meal, then offering entertainment for after.

Personal Trainer - $54,000 - Keeping the troops motivated to stay in shape takes effort.  Not to mention climbing the 14 floors for the burnt popcorn.

Social Worker - $60,000 - Trying to help people who think they have no other options can be stressful.

Nurse - $69,000 - I am rendering advanced care without direct supervision from a physician, and this is the closest comparable field.

Lifeguard - $25,000 - Surf rescue dispatch.

Nanny - $23,000 - A school tour comes by.

Teacher - $57,000 - Gave a drill on the ALS bag to the companies.

Building Inspector - $33,000 - School exit drills and fire inspections fill out the afternoon.

Sleep therapist - $54,000 - Studying why I am still awake at 2:30 AM is taking longer than it should.

So add it up and it's, well, a lot.  But we're not always doing all those things are we?  We do a bit of this here and a bit of that there, so it all makes sense in the end.

EMT - $40,000

Paramedic - $60,000

Firefighter - $43,000

Firefighter/Paramedic - $59,000 (Someone explain that to me)

*All these figures are from Free Salary Search.com which bases the numbers by your IP address so these are all numbers where I am.  Yours may vary, but they'll likely vary all together.

Saturday, May 29

Test time - Can you help me?

Rogue Medic could tear the science apart on this one, but I can attest it is true:

I learn and recall memories linked to music.

You can play me a song and I can tell you things I was doing, sometimes in odd detail, when that song was playing.

Some folks have dabbled into the science on this but it stands that it works for me.  So with that in mind I have been studying listening to a certain kind of music that gets easily stuck in my head and is easy to hum over and over in my head during the exam.

I was wondering if you might sing along to this and send the good vibes my way.

[youtube]http://www.youtube.com/watch?v=vxBjKa8KcW0&feature=related[/youtube]

My study buddy and I had the mock test earlier this week and both chose the same two scenarios to challenge each other with, a botched refusal form and a complaint about an esophogeal ET placement, let's see how well we guessed.

I'll be recovering later this afternoon and spending tomorrow gathering the call sheet for our next round of A Seat at the Table episodes to be filmed in San Jose, CA in June.  We're bringing in some industry folks this time to talk about equipment, upcoming conferences and the like, so stay tuned for details on that.

And does anyone else know what on earth Mark and Ted have planned for June 4th in relation to Chronicles?  This image seems to leave a lot of questions unanswered.