Saturday, January 30

One of those nights

I've been busy preparing for the premiere of the Chronicles of EMS and haven't been sleeping well.  When I do sleep, it is shallow, poor sleep, at least at work.  At home Mrs HM tells me I sleep like a baby rock log.

But a few days ago at the table after a long night at work I had to ask the firefighter on the engine, "Did I get in trouble last night?"

As I remember it, we were running back and forth on our usual compliment of folks unclear on the concept of an emergency.  The engine was dispatched to a reported motor vehicle versus pedestrian.  At 4 AM it could be bad, so we were ready to work when we arrived at the intersection to find a man laying on his back between 2 parked cars.

A quick approach shows no damage to the vehicles around him and no fluid on the ground.  As we approach we see his feet crossed and he wipes his chin with a dirty hand.

"Sir!" I call out as we arrive at his side.

"Ah, you made it.  Man, I need a place to sleep, this is killing me." He replies as he rises looking past me to the engine. "Where's the ambulance? I asked for an ambulance."  No distress, no problems.

I assessed his clean clothes and unstained shoelaces, a clear sign he has not been on the streets long.  He told us all about how he was a local and grew up in the neighborhood, but couldn't name the school he went to or what street he lived on.

We get a lot of folks coming to town thinking it's all wine and roses on the streets of the big City.  Many other cities appear to be using us as their dropping point for folks they choose not to help.

This guy clearly expects an ambulance to take him in.  As we confirm he is not injured, I spot a $20 in his pocket.

"You have cab fare, just call a cab if you want shelter." I tell him as the boss code 2s the ambulance.

"You can't tell me what to do, now call me an ambulance and go away." He said laying back down between the cars.

I lost control for the briefest of moments and threw the BP cuff at him from a short distance.  I was fuming, rage kept deep for so long bubbling up to the surface and I know I have to leave.  Across the street I walk and sit down.

"What the hell are you doing?" The boss calls out to me.

"I'm done with him.  Call the EMS Supervisor and the BC, I'm not coming back over there, I might do something more stupid than I just did."

Hours later I'm sitting at the kitchen table, sipping coffee, still angry.  The firefighter is pondering my earlier question, clearly thinking about it.

"No, I don't think so.  Did you kill someone while I wasn't looking?" He answers, looking back to the metro section.

"Did I throw a BP cuff at that guy in the street?"

His head looks up and he smiles. "Threw a WHAT? Are you feeling alright?  Have you thrown anything, like, ever?  No you didn't get in trouble last night.  We didn't  run a guy in the street."

The boss has heard the tail end of the conversation and chimes in, "Bad dreams huh?" and he offers to fill my coffee.

Bad dreams indeed.

the Handover turns 1

The Handover, blog carnival roundup brain child of my UK alter ego Medic999 turns a year old this month.

Buckman at Gomerville.com asked for submissions around the theme of an EMS Portrait and the submissions did not disappoint.

Hard to believe it was a year ago Mark emailed me about this idea and I had no idea what he was talking about.  Now it's a great way to find new blogs and share posts about a theme.

Be sure to read up on next month's topic and host while there and drop a post in.

Thursday, January 28

Two Important Lessons

I've been saving this a little while so as not to give away too much.

Lesson #1

Don't leave your iphone alarm set to a ringtone in the dorm of a double company house with a Battalion Chief.  If you do, make sure to either turn it off immediately or, should you get a job near alarm time, take it with you so it doesn't disturb the others.

Lesson #2

Don't take a picture of yourself with said phone if the owner has hundreds of hits a day on his blog.  He might just post the pic.

IMG_0196

Sorry about the alarm.

Tuesday, January 26

Chronicles of EMS Caption Contest

All right all you twitter folk, I heard your call for the contest and I'm stepping up.

We're having ourselves a little caption contest.

Mr Setla, my producer, and ninja trainer, over at the Chronicles of EMS posted some teaser photos of a brand new series in the works called Chronicles of EMS: A Seat at the Table.  This new web series is an exciting project we're working on to open up the dialogue in our profession in a way that's never been done before.

As a result, we've been testing and experimenting with topics, light and film and this photo is a screen shot of one of those tests.frumpydumples

So you're wondering what I'm saying?  Let's hear it.  Caption this photo.

CONTEST RULES

  • You can comment as many times as you like and offer as many entries as you like.

  • All entries must be here at the Happy Medic blog in the comments of this post.

  • I am the judge and will choose the one that makes me the happiest.

  • Entries must be made before 10 PM pacific time February 11th

  • The winning caption will be announced immediately after the premiere of the Chronicles of EMS pilot episode which airs at 5 PM Pacific on February 12th.

  • The winner will receive a Chronicles of EMS T-shirt to be supplied by me.

  • You MUST be present at the premiere or in the chat room during the premiere to claim your prize.

  • This contest is void where prohibited by law or llama, whichever comes first.

  • Foul language will not get you eliminated, but may be difficult to explain to your mother when the shirt arrives in the mail.

  • There is no cost to enter, but if you must, donate to the CoEMS cause.

  • The winner will also be invited to be a special guest on the new Chronicles of EMS:A Seat at the Table series in Northern California.  I'll invite you, you just have to get here.

Monday, January 25

Shapes and Colors

I often joke with folks outside the Profession that things need to be made "Firefighter Proof."  This denotes the fact that my mother was right, I ended up with a job where they put my name on my shirt.  Another variation is that this job is all about shapes and colors.  Why else are the drugs in different color boxes, catheters as well, and we color code hydrants based on flow in some places?

But buried in all the jokes about how simple things need to be are some basic shapes and colors that are out in plain sight in the community that help us do our jobs better.

We visited a local cell phone company's transfer station to train on a new system shutdown procedure.  it seems that if there is a fire in the server and transfer room, the system will handle it but there will be a need to shut down sections of the system, not the entire system.

Inside we saw reflective taping on the floor leading us to the breaker panel.  The tape said "FIRE DEPT SHUTOFF - THIS WAY --->" and it continued all the way to the panel.  At the panel, each switch had a colored reflective tape.  Each area served by that breaker was marked on the floor in front of it by the corresponding tape.  no more wondering which breaker to hit, just remember the color.

Loved it.

Shapes and colors really does work.

If you're not really concerned about the switching station in your response area, let's start with the simple ones found in elevators.

SOL_elevator Here is a shot I took at a local shopping mall.  Many places I go have these markings and few rescuers know what it means when a Star of Life is in the elevator well.  And why does this one have it but the one next to it does not?



Think you know?  Do you know?  Formulate your answer, then CLICK HERE to find out what makes this elevator so special.

star floor



Now that we're in the elevator, we need to know how to get out at the ground level.  In the City, many buildings are on hills so they have more than one exit to street level.  In this elevator, which floor is the ground floor? This panel is pretty straight forward, being in a smaller building, CLICK HERE for a neat collection of photos of panels from around the world. Be glad we have a uniform building and elevator code. That star will get you out on the street level of the marked address. If the building is 123 Main street, that star will get you out on Main street.

All right, how about this reflective sticker on the electric meter at the street level?

What about the house next door with this sticker?



Find out from an article on FFN from Christopher J Naum.



Keep your eyes open out there.


HM

Saturday, January 23

Hey, Box Jockeys!

This hose monkey has some questions for you.  Please answer honestly, anonymously if you like, but some things have been bothering Happy as of late.

Question #1

Does your employer discourage you from being honest with your patients when it comes to transport decisions?

Question #2

Has your employer asked you to omit information on your reports that would prevent billing a patient a certain way?

Question #3

If a patient asked your opinion, you told the truth and they refused care, would you be in fear for your job?

Question #4

Does your service encourage starting an IV or EKG monitoring for BLS patients to upgrade the billing?

Question #5

Are you aware that the above situations could constitute fraud?

If you are trying to decide whether to do what is right by your patient or keep your job, email me.  Your employer, municipal or private, paid or volunteer, is wrong and we need help changing their practices.

If you are comfortable and supported by your service when being honest with your patients about their conditions and transport options, please list your service in the comments section, they deserve praise.

ems2point0

HM

Friday, January 22

Get it out now

I have decided too many in this field use the phrase
"You call, we haul, that's all."
So I have declared that today, January 22, 2010 is the last day we are allowed to say that, unless you have a side job in the refuse industry or possibly driving a tow truck.

Your new slogan is
"You hurt, we flirt. You lyin', someone might be dyin'."
It is not against the law, nor outside of your responsibilities to inform persons when their injuries or illnesses are untreatable by you and your staff.  Nor is it against the law or outside your responsibilities to tell the truth when they ask if they should have called you.

I have been known to remind clients that a baby could be choking nearby but they will die because their paramedic resource is here putting your swollen wrist in a towel from your kitchen and frozen vegetables from your freezer while all your college buddies watch from the couch.

"I didn't know what to do so I called you guys, is that wrong?"

"Yes."  Odd look.  "An emergency and an injury are two remarkably different things.  Sometimes they overlap, but not as much as you might think.  Your ambulance will be here shortly, they're coming from far away, busy night tonight."

"A lot of sick people huh?"

"No."

"Do you think I need an ambulance?"

"No."

"What should I do?"

"Goto a doctor.  But as you can see I've taken the pain away and reduced the swelling in your wrist using common household items.  I learned this in the cub scouts.  This is as much pre-hospital care as we can give, so from this point on everything is else is just a ride. A very expensive ride."

"Can my friends take me instead?  I mean I thought you guys could get me in quicker."

"Sure your friends can take you, let me help you to the car.  Sign this release form first and assume liability for the bill."

"What bill?'

"The bill from us coming here to help you.  As much as your politicians would like you not to know, this tax payer funded service is not fully funded to the point we can provide service for everyone calling 911, so we bill for our service."

"Oh."

OMG happy, what are you doing?  If he's insured that's an easy ALS billing transport, we need that money!

No, I just freed up one of your precious ambulances to run an actual emergency call and performed vital public education, something our profession fears among all other things.

A well informed and healthy populace generates few billable transports.

Stop lying to your patients by telling them they should always call you when they stub their toe or that there is no fee when there is one.  Lying to them IS against the law and outside your responsibilities.  Telling the truth and refusing transport are two completely different things.

Telling the truth can never get you in trouble.

Carry on.

Thursday, January 21

What do you know?

blog medicWell, Ma'am, a great deal more than you.  Especially when it comes to emergency response protocols, anatomy and physiology, the effects of alcohol on the clotting factor of blood and what my job is.

THE EMERGENCY

A woman in a wheel chair has rolled herself into a hotel lobby, bleeding from the nose, asking for an ambulance.

THE ACTION

The engine has advised us to slow to a code 2 response and we are happy to do so.  As we arrive on scene I see the engine crew on the sidewalk having an animated discussion with a very alert and oriented woman with cotton balls stuffed up her nose.

As the door to the ambulance opens I now have the audio to match the pointing and head shaking.

Engine Medic: "Have you called your doctor, any doctor, about your nose bleed?"

Hell on Wheels (Could have been Helen, I can't recall): "I'm not saying anything to you.  You are not a doctor."

HM: "He sure isn't.  Anything remarkable?" Is my question and the head shake my answer.

HM: "Then thank you Sir, we can take it from here."

I introduce myself to our client and ask her to define a chief complaint.  Most times the person who called us has a singular issue they wish our assistance with.  My dad can't breathe, for example, or I cut off my foot.  But this client goes into a laundry list of complaints ranging from before I was alive finally ending with what got us involved today.

"My nose is bleedin'."

And it was.  At least it had been.  Hard to tell with her constantly moving around telling me to get her to St Farthest before she dies from it.

HM: "How long has it been like this?'

HOW: "Since 1 AM, I haven't slept! Why all the stupid questions, let's just go."

A quick glance at the time, 6 PM.

HM: "Have you made any attempt to seek an evaluation without calling 911?  A clinic or an urgent care?"

HOW: "Honey I just got here and don't have time for all your 20 questions.  I need a doctor, I need my pills."

As my partner is confirming the vitals we got from the engine, I begin my social worker intake interview.

HM: "You mean you need a pharmacy.  The doctors don't dispense medicine, they write prescriptions.  Is your prescription empty?"

She shoots me a look I get often wen I bring reality into these conversations.  The head snaps around on the thick neck to me while leaning back slightly, eyes wide and a look of anger around the mouth.  Then it comes out.

HOW: "What do you know?  The paramedics where I'm from never disrespect me like this."

HM: "What do you mean disrespect you?  I'm trying to establish if an ambulance ride to the hospital is the best option for you right now."

I feel my tired arms leaning onto my knees as I stand bent over trying to stay in her line of sight as she realizes I'm not the pushover medics she left behind in whatever town she sailed in from.  A quick stretch and I ask her the magic question.

HM: "Do you want to do the right thing or would you like an ambulance ride to the hospital?"

HOW: "Do your job and take me to the hospital.  But somewhere where I can get seen fast, and get something to eat."

My hands are back on my knees and I'm as in her face as I can be without losing my cheerful disposition.

HM: "Are you looking for a ride to food?  Because if you are we actually have that resource here.  You'll have to wait a little while, but I can get you a free ride to a shelter and a warm meal."

HOW: "I don't have time for that, I need my pills now.  I have chest pain."

Had I been a TV detective, this is the part where I bang on the interview table and go into a well prepared speech about the abuses of 911 and how the best thing she can do for everyone is go back where she came from.  Where she came from easily has a lower cost of living, but that has not entered into her equation.

But I am not a TV detective so she steered the power wheel chair over to the ambulance and told us how she has so many leg problems she is on disability.  Then she stands, climbs in the ambulance and sits on the cot with a familiarity some folks on the job don't show.

We sigh.

HM: "Chest pain you say?"

HOW Now with arms and legs crossed: "Yup, let's go."

HM: "That means an IV, and I'm not all that good at them."

HOW: "Oh no you don't, you ain't touchin' me with no needles." Her head is shaking almost to a point I think she's going to hit it on the cabinet doors and then need an ambulance.

HM: "Yup, let's go."

On our short trip to St Closest she wanted to discuss the finer points of how I don't know what I'm talking about and only Doctors understand what she is going through.  My lips were sealed, only asking my billing and pertinent negative questions and completing my report.  She refused a line, a trace and everything else except another BP.

When we made it inside she commented that the ER had an odd odor to it and she wanted to know the name of the hospital.

HM: "St Closest, why?"

HOW: "Tomorrow they'll take me somewhere better."

Report finished I left, smile on my face, almost wanting to work the next day just to see if she does it.

Tuesday, January 19

That's twice

blog engineI'm walking through a busy shopping center looking for someone, not sure who, and it's stressing me out.  Panic, confusion, anticipation.  Then a loud tone strikes me from my sleep, the shopping center nothing but a dream.  The lights are bright in the dorm of the firehouse, the time is just before 2 AM and the tones finish just as I sit up to the corner of the bed awaiting the inevitable magic voice telling me where the sick people are.

"Units standby for the box!" the voice says with a tone of excitement.

A fire.

The dorm springs to life, sleepy firemen now scrambling into their turnouts and heading for the pole hole as the dispatcher rattles off the companies due.  Downstairs we dress, the doors are coming up and the rainy night awaits our response.  The dispatcher finishes reading the first alarm assignment by telling us this is a report of smoke in a building and we take that very seriously.

The engine beats the truck out the door, as we should, but not by much and I can see them following from my rear facing jump seat.  The green light on the front gives away they are a truck company, letting our driver know to let them take the block ahead of us if we're second due.  The MDT tells me that we are first due and by the address, we're less than 3 blocks away.  I might just be ready by the time we get there.

Hands still tingling from waking suddenly we are on scene to the large apartment building with nothing showing but an audible alarm sounding and young people milling about in the lobby.

My walk around the engine to my airpack gives me a chance to size up the building.  If we're going above the ground floor, we'll need a bundle to extend a pre-connect.  The first door on the first floor (first above the garage level) has a smoke detector alarm sounding and an odor of burnt food.  Deadbolt secured, we'll need to force the door, damaging it completely, to make entry to investigate.

The truck is laddering the fire escape when they see a haze through the window of the unit in question and the decision is quickly made to enter through the window.

From our position in the hallway outside the door, the haligan tool is just being placed in the door jamb when we hear the truck make entry through the window.  The old thick windows break loudly and we now hear our brother pushing the mini blinds aside.  Boots thunder to the floor and footsteps get louder as the lock on the door clicks and the smoke wafts out as he opens the door.

"I gave at the office," he says as I grab the pump can and go in search of the source of the smoke.  As we converge in the kitchen we hear shouting from the back room.  Shouting about waking up.  Shouting only from our people.  Being the Paramedic, I peel away from the burning pizza making all the smoke and meet the truck in the back room with a man curled up on the couch, completely passed out asleep.

They're shaking his feet, being polite as can be in an effort to let him know we're there and his apartment is filled with smoke.  It's amazing that the breaking window didn't wake him.  The tillerman and I exchange a look and the politeness is gone as he shakes the man's shoulders shouting "Wake up! Fire! Fire! Wake up!"

Nothing.

Down in his face. "WAKE UP!"

"Whoa! What?" He sits up defensive, most of the first alarm compliment standing in his living room.  Escorted to the hallway, he is still confused about what is happening and I make my way back to the kitchen to help remove the source of the smoke.  The pick end of the haligan has a number of uses, one of them being removing small pizzas from ovens, so out it comes onto a baking tray and it is carried outside into the rain.

Back upstairs one of the firemen from another company looked around, saw the man we awoke and cried out,

"Let me guess, pizza in the oven?"  He went to the man and held up two fingers, "That's twice!"

Sunday, January 17

Dose That Kid! Results

Some of you may have known the age of the child in this post from experience, others may have had no clue.

In the comments there was a wide range of values, and it is indeed difficult to guess the weight of a child if you aren't with them.  But the point of the post was to get us thinking about why we base our peds doses on weight and how we arrive at that weight.  There were comments about carrying a backup broselow tape (I spelled it right this time), but is that really the answer?

I understand the usefulness of a field guide and having a broselow tape in my peds bag is one of the first things I look for in that kit.

But I am also confident in knowing that if it is lost, stolen, damaged or suddenly switched for a BeeGees Best of Compilation that I can take a deep breath and do my job without it.

I am not better than anyone else because I feel comfortable with peds calls.  I can't handle dislocated fingers.  That's my Achilles heel, or finger, if you prefer.

Again, the goal of this You Make the Call game was to get you to remember what you are trained to do when all the fancy tools, bells and whistles are gone.  Anyone claiming "BLS before ALS" needs to start with the simple deduction of size, age and weight of the patient.

We do it for Dopamine on adults, but don't carry large cheat sheets to lay next to them.  Why do we rely on one for kids?





The young lady in the photo was 4 weeks old and weighed 9 pounds.

If you were way off, no big deal, keep that tape handy.  But next time you have a peds patient ASK the parents how much they weigh and remember it for reference.  We also learned a quick reference rhyme in P school, hopefully you did too.  It's the 1-5-10, 10-20-30 ratio.  Meaning a 1 year old should weigh in around 10 kilos.  A 5 year old at 20, and a 10 year old at 30.  These are guidelines to establish if a suspected weight is within reason.  Don't grab a one year old and start dosing at 10 kilos without a proper assessment.  Also keep in mind that a child's diet, heredity and, believe it or not, race could be a factor as well.

A wonderfully designed system being adopted by hospitals can be found here, along with photos of children to represent their sizes and color coded dosages of medications.  But keep in mind your concentrations of those medications may be different and if you don't know what the value should be, there is no way the guide can help you.

Take a few minutes to wander the Color Coding Kids site, a lot of common sense stuff there.

See you next week when our patients get bigger.  Much bigger.

Saturday, January 16

Are you for Coco?



Tell the chin he had his chance. He screwed it up and now he wants his old house back? I don't think so Jay. Stay at 10 or retire.

NBC, I have a show in mind that could replace Jay at 10 and be of interest to millions of viewers you lost to the other networks.

My name is Justin Schorr and I'm with Coco.

Pass the candle.

Friday, January 15

the Angry Captain, Film Maker

The popularity of the Fireman Mike video I linked to has spawned quite the collection of tributes.  Through that link I have found dozens of hospital and firefighter related videos that have me rolling.

Then I get a message from the Angry Captain to check my facebook page for an update.  I found this.


I can't wait until retirement.
And I can't wait until I can dance like that cartoon.

Posted with permission of the Blog Master of the Universe and is all in good fun.

Talk about Tactical Pants and they talk about you

Those multi-pocket pants loving folks over at Tactical Pants have featured your favorite cartoon fireman (No not Fireman Mike, me silly) in a very well researched Q&A session.  And they finally reveal why cartoon Happy has such a prominent probiscus.



I enjoyed answering questions about my pants, as most guys do, but also about the Chronicles of EMS, my time on the Reservation and even a bit about how I got the name the Happy Medic.

And make sure you're a follower of all things tactical on their blog, I have a feeling some of my favorite bloggers have also answered similar questions and I'm curious to learn what kind of pants RogueMedic and TOTWTYTR wear.  Wait, that came out wrong.

Wearing my wool 5 pockets,

HM

Thursday, January 14

You Make the Call - Dose That Kid!

Welcome back to every Paramedic's worst nightmare-

DOSE THAT KID!


The wildly entertaining game show that makes you actually learn what kids weigh by looking at them without being given their specs on a written exam.


So there can be no cheating, despite your best efforts to find someone who knows the age/history of the child, none can be found.  Your Braslow tape was left on the bed in the ER last night.  Also, for you out there in the know, all of the clothing tags have been removed, so no excuses.  Now let's play DOSE THAT KID!


elizaOur first contestant has been found in a child care center in a woman's garage.  They state the girl is new to the group and they have no information on her whatsoever.  She was having a bottle when she choked,turned blue and is now unconscious, unresponsive and in vfib.  Your partner is managing the airway and has IV access. DOSE THAT KID!







Chronicles of EMS Episode leaked!

Despite his best efforts, Producer/Director/Paramedic/Nice Guy Ted Setla was not minding the store when our friend Ms Paramedic hacked his iphone and downloaded the pilot episode of the Chronicles of EMS.

I don't know how long I can keep this up before he knows it's gone and demands I take it down.

But you all deserve to see the show before the big premiere next month on the 12th.

Sorry, Ted, I had to.  Here you go:


And for those who love Fireman Mike, no I did not make him, only embedded his video.  You can watch more of Fireman Mike HERE and leave comments for the creator.

These little movies are getting popular.  I tried making one and apparently have no knack for it.  Thanks for the laughs MsP.  See you at the real premiere on February 12th.

Wednesday, January 13

Questions in Haiti

We're all following the updates from the 7.0 earthquake that struck Haiti just 48 hours ago.  Our brothers and sisters have been mobilized to assist and there is a pouring out of support in the form of food drives and monetary donations all over the internets.  Before I get into my points to think about, please remember to donate to established organizations.  The American Red Cross is just such an organization that can use the money well, as opposed to your local corner Girl Scout Troop who may have to pay to have things sent over, and even then it may not arrive in time.

In time for what Happy?  Oh I think you know.

Our brothers and sisters mobilized for the search and rescue effort are facing a task they may not be ready for.  They are trained professionals in search, rescue, recovery, everything first response, but there is, by all accounts so far, no framework to support their efforts.  I don't just mean a place to land, restock and camp, I'm talking about basic disaster concerns.  These folks can get in and get setup, do their thing like no other.

Let's think this through for a moment.  Estimates show 9 million people in Haiti and at least 1/3 of the country may be injured.  3 million injuries.  From scratches and scrapes to fractures to crush syndrome and major systems trauma.  Many may not survive the night because of their injuries, but let's look past that.

When the USAR teams use their tech, tools and smarts to rescue the injured, where will they go?  Who will come to transport them to the hospital?  Where are the hospitals?  In rubble.  Each and every resource that can assist in this event will need to be brought in from without.  How long will it take to set up triage and treatment centers to help the ambulatory?  Then the injured but invalid? And finally to the traumatic injuries.  The hospital does not just need electricity, or staff, or supplies, they need everything, including walls.

On all 4 networks I have seen different footage, all of one ambulance traveling the rubble strewn roads.

The honest answer is that definitive care for most of those injured will not arrive within 72 hours of their injury.

Do we remember what happens to internal injuries that go untreated?
I had an image of three survivors still trapped in the rubble set for this post, but have deleted it.  You can see it here, it's photo number 2.  When these folks are rescued...then what?



What is the plan for when the almost 100,000 estimated dead are still in the streets in 96 hours?  Will they have an adverse effect on what little sanitation remains, what little clean water there may be?  What will happen to those sleeping in the open near the bodies?

I do not  envy the person who must choose how to deploy resources, but it makes me think about my own City when, not if, but when our big one hits.  We will have plans, resources from afar.  We have volunteers trained to help, we have disaster supplies ready to go.  We have folks with phones that can make calls without cell towers, buildings that can generate electricity when the sun shines.

Those things are not common in Haiti.  Cell phones, the ones that still have a signal, will have dead batteries soon.  Gasoline for generators will be running low.  People will become desperate for help.

What do we do then?

I don't have an answer, nor am I posing these questions in a political framework, just trying to get us all thinking ahead.

If it looks bad now, just be ready for when decomp begins and things get worse.  And each person rescued is another that will need advanced care, food, water, medicine.  Each reporter that arrives needs water, food and shelter that could be used at a temporary hospital.

I challenge each and every news network to pull your crew out of the disaster area and donate what you would have used on your people to the relief effort.

If anyone has a link to updates directly from teams at the site, let me know.

HM

Tuesday, January 12

Breaking News

Mark McGuire did steroids.  Also new tonight, the earth is round.  But for more about what is really on our minds, here is your Anchorman Fireman Mike:

[youtube]http://www.youtube.com/watch?v=zNVscJ5AkK4[/youtube]

I'm not sure what's worse, that everything he said is true or that we would all get fired if we said it on camera.  Fireman Mike has a youtube channel and I'll be watching for updates.  And now back to your regularly scheduled blog.

Check for updates about the premiere of the pilot episode of Chronicles of EMS, the new reality EMS series HERE.chroniclesblog

Small fire, small water. Big fire...

Well, did you finish the statement?

Did you finish it the same way most do? "Big fire big water"?

Is that really the right answer?

I think it is the wrong answer.

Pumping high volumes of water into the 7th floor office complex isn't going to help us if we haven't trained with the tools used to knock that fire down. Yes having larger amounts of water on the fire floor will help us, but we must remember the layout of our commercial sites. They are commonly open with organized furnishings, and heavy on false walls and highly flammable file cabinets, records etc.

Training needs to include coordinating multiple lines, finding the seat of the fire, and knocking it down. Sounds simple and straight forward, but when all you hear is, big fire, big water, then train residential and not commercial, things can get tricky.  But even in a multi-residential situation, we need to get our water to the fire, otherwise it will ricochet off the ceiling, fall to the floor and run into the street.  All that big water right down the drain and the fire is still burning.
I prefer to say "Big fire, SMART water."

Get in there with the large line but use it appropriately. Get your fog nozzle off and gain the distance from a smooth bore nozzle. That will give you a chance to get closer to the seat of the fire, find it and effect a knockdown to facilitate a search.  Defensive fires are no different.  Shooting a line from the street and aiming for the ridge line will direct all that water up and over the fire, not into it.  If you don't have fire to hit, why are you training a line there?  Use that water to your advantage.  Collapse an issue?  Then get the lines up and out of the collapse zone with aerial pipes and platforms but don't just "surround and drown."  Aim for areas of heavy fire.  You won't be "pushing it" somewhere else, it's already going there, knock down the bulk of it's heat and support and it will slow it's advance.

When it is commercial and you're trying your best to get as many large lines as you can into the office building, what are we doing?  Each of those lines needs 2 persons on the nozzle, an officer and then a member at each corner feeding line.  That exceeds even the best staffing models I've seen.  Take that first line and make a difference with it.  Keep it dry until you absolutely need water, then your layout person and other companies can help you stretch as you go.  Charge that 2 1/2" line with 2 people at the door and all it will be good for is holding the front door open.You'll need help getting it where it needs to be, but once there and trained on the seat of the fire, conditions will improve and smaller lines can chase the fire back as you advance, knocking down a lot of fire.  All because of SMART application of water.

Think I'm wrong?  Know I'm wrong?  Show me.
These are my observations and do not reflect the standards and practices of my employer.  Nor is the Department in the image used being singled out, nor were they the inspiration for this post, just a nice shot of an outside defensive line and an officer who appears to REALLY love that tree.

Monday, January 11

A Tip of the Helmet - Cleveland says "No"

Social Media in EMS - A Tip of the HelmetIt was reported this morning in the Cleveland Paper the Plain Dealer that Cleveland EMS will start rejecting minor calls for service unless the system is able to handle it. Writer Mark Puente reports:

"This is a huge step for Cleveland," EMS Commissioner Ed Eckart said. "This is a step back from a long-standing culture in this city."

And indeed a long standing culture in America on whole.  I have a call into the Commissioner to get more details on the nuts and bolts of this move as I would love to know how we all can enact this kind of common sense in our own EMS systems.

Now before everyone starts wringing their hands about what is going to happen, take the time to read through the comments on the story, many of which claim to be written by local responders.

As you start to write your comment about the referred ankle pain that could be presenting as a silent MI, keep in mind that as you transport that "maybe" call, the actual crushing chest pain that IS an MI is waiting longer for a transport.  We need to stop worrying about what might be and focus on what is.

The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers.  We call it triage.  No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center?  If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.

For so long we as an industry have striven for an 8 minute goal only to see the nation expect that 8 minutes for everything.  Cleveland says no more.  Cleveland.  No offense to the system there, I'm learning more about it now, but if you went to a conference and asked which EMS system in the Nation is out ahead of the others, Cleveland is not in my top 3.  Until now.

A Tip of the Helmet to Commissioner Eckart and the Cleveland EMS system for breaking free and doing the right thing.  I hope to learn more about their research and system savings in the near future.  I will most certainly pass that along if I can get it.  Do you have a question you'd like me to ask the Commissioner?  Post it below and I'll ask him.

Sunday, January 10

Mutual Aid Updates

Attention all units in the field.

The Mutual Aid Bards are being updated with a couple of new blogs on the EMS radar.

Ambulance Amateur is a volunteer care giver in the UK who so far is quite opinionated by the clients he meets.  I'm adding them as a window into another version of what i saw with UKMedic999 on the Project.

Another new find is the Orange Taxi who I found wandering looking for other folks reactions to the discussion over at CK's place about EMS pay.  He's been in the business a bit and has something to say about it. I'll be listening.

I wish our new blog family good luck with their endeavors.  have a read and if you like them, follow them.

HM

Friday, January 8

20 Keys to a Positive Exchange

The 20 Keys to having a positive, productive exchange in Emergency Services.




1. Agree on your purposes upfront.  if you want to prove another system inferior, they may not be too cool with that.

2.  Observe, note, learn, apply, repeat.  Not everything will work in both places, politics will never allow it.

3.  Know why you're choosing that place.  It needs to be a balance between person and system.  If neither is 100% it will never work.

4.  Get the third rail conversation out of the way early.  Talk religion, politics, family.  Find your differences and common ground early.  If you see another persons religion or values as an issue you may not honestly see the system they want to show you.

5.  Be honest with yourself and your partner.  If they ask your opinion, give it, but be prepared to back it up.

6.  4 days observation is a fair amount.  8 days away from home yields travel, 4 days on the streets and meetings.

7. Plan to be exhausted.

8.  Plan time between visits of at least 1 week for family time.  Mark and I did 23 days total, too much.

9. Get the support of the local media to showcase your work.  This should draw the attention of the politicians who can enact some of the changes you may want.

10.  Every system has one Chief or Administrator who wants to be involved.  Let them be.  Keep them in the loop, it is handy to have someone upstairs if you need it.

11.  Avoid the unusual or extreme.  Give them an honest average day in your life.

12.  Be respectful if things turn out differently than you thought.  Above all else be honest.

13.  Find alone time during your trip to reflect on why you are there.  Whether it be a meal, evening or part of a day, you'll need a few hours to reflect on what you're doing.

14.  Avoid heavy drink.  It can not only impact your next day, but reflect poorly on your partner, you and your service.

15.  Make sure you have permission from your Department to appear in your uniform and make public comments about your system.

16.  Avoid questions that start with "How come you don't ..." like "How come you don't intubate kids?" The tone could be considered confrontational.  Try making it easier to answer. "What tools do you have to secure a pediatric airway?"

17. Eat the food.

18. Try to understand the culture, phrasing and customs.  Learn the local history.

19.  Remember not everyone has the same set of definitions you do. A rescue here may not be a rescue there.  When there, use their terms, not yours.

20.  Be Happy.  Smile.  Have fun.

Wednesday, January 6

My vote for Blog of the Year

There be another contest on the interwebs where my site has the honor (Sorry Mark, honour) of being included with some of my favorite sites.  So I clicked on a link to vote and was unsure who I should vote for.  I could vote for myself (and there is still time) but for today I wanted to share with you my decision process in voting for Fire Critic's 20009 Fire/EMS Blog of the Year.

In the voice of Jon Lovitz from SNL.

Fire Daily is not only half the mind behind the new Firefighter Netcast Show (debuting January 12th), but is a great fire service read with the 360 burn size up of the web feature and others.  He has a nice bit about how he has gotten this far and a great recap of why he likes each of the other contenders for the FC2009, but I heard he leaves his trash out all night, so I can't vote for him. Yeah, the trash.

Firegeezer is the site that gave me my big break.  Between Old Man Geezer on the fire side and that Fossil of a Medic Ward covering EMS they are your one stop shop for everything Fire and EMS.  Wait, that makes it sound like I should vote for them.  I take it back, they just sell mugs, pay them no attention.  No attention at all, that's it.

999Medic is a fraud.  A complete fraud.  The guy got all the way here and he isn't even a Paramedic.  True story.  I'm surprised he hasn't been disqualified already.  Just because he created the Handover Blog carnival...big whoop!  I met him and he isn't even the guy in his photos...or something...well I can't vote for him now anyway.

STATter911 isn't just Dave Statter you know.  It's a bot!  How else could one man post pictures and a news report from a fire that hasn't even started yet?  Whenever someone asks me something about the fire service, I check statter911 first to see if it's true, then claim the information as my own.  No way is STATter911 eligible, way too accurate.  Look over there now, I bet there's already a story about who won this contest and it's only the 6th!  Can't give you my vote. Yeah, that's the ticket.

Rescuing Providence is written by a Lieutenant with a bad back!  Ignore the whole published author, writing style and emotion on the blog, pay attention to the fact he is injured!  Just because he's making a movie from his wonderful writing doesn't make him the best, does it?  Sorry Lt Morse, if you were healthy I'd give you my vote. Yeah. Yeah, injured.

Firehouse Zen seems like a great choice for fire/EMS blog of the year, but look again.  Most of his posts are about responsible leadership and thinking through decisions on the fireground.  If I wanted to be responsible I'd work for UPS.  UPS, or maybe the TSA.  yeah, TSA, thet's the ticket.  Too much white helmet stuff, Mick, I can't give you my vote.

Everyday EMS Tips by Greg Friese?  That guy has 11 billiondy learning websites and has a huge impact on young paramedics and EMTs.  EMS Bootcamp?  Seriously?  If I was a smart guy I could do all that teaching stuff too Greg.  And all the twitter updates.  Shoot...um...well...you're too...um...teachy.  Yeah, too teachy, no vote.

The EMT Spot - "I'm Steve Whitehead and I write posts that make you really think about your job and those around you.  And I have the coolest banner on the interwebs."  He actually told that to me once, so no way am I voting for him.

</jon lovitz>

Engine 9 RFD.   A single engine blogs from all three shifts about life in Roanoke?  I know, but this video alone gets them my vote for Fire/EMS blog of the year.  If that isn't a firehouse video, I don't know what is.  This video gets my official 10th LOL on the interwebs machine.  Even the music was timed perfectly.

I am also very appreciative to the Fire Critic, the other mind behind the Firefighter netcast, for creating this contest and letting me be a part of it.  I hope to win and have hired a large group of alzheimers patients to vote for me every day.  So there.  Ha!

In all honesty, friends, this is an impossible field for me to choose from.  I will vote for everyone because I read them all regularly and respect their motives, content and intentions.  I chose everyone. Everyone, yeah.

HM

Monday, January 4

Is that tactical in your pants?

...No, I'm always Happy to see you.

As it is these days with blogs, websites, social media accounts, emails and every other conceivable way to link to these here pages of EMS and Fire fun, there always seems to be something new and interesting out there.  My analytics recently showed a site called tactical pants.

Enter tacticalpants.com.  Now before you get all Motorcop on me and discuss the merits on how many pockets your duty pants should have (Mark's jumpsuit has billions, I prefer a standard 5) take a look in the bottom right hand corner of their site and hidden rather carefully is a title labeled Tactical Pants Blog.

I know, right?  I thought the same thing.  Kind of like seeing that my toothpaste has a website, how interesting could it really be?

Well, I had a click and started to read not only posts about law enforcement, but links to some of my favorite blogs as well.  They even interviewed AD a little while ago, but not too much about his pants, more about being a Medic, blogger, author and role model.

So I'm trying to decide where to add Tactical Pants in my blogroll between PD Evals and Continuing Education.  For now they will reside in the PD Evals section just because of the hilarious Cop LOLCats feature they did.  Go on, take a look.  It's right near the AD piece.  Coincidence?  HMMMMM?

Waiting for the bells to ring,

HM

You Make the Call...Chili Cookoff...What Happened

You Make the CallAlas, Fireman88 from Buttasscold, Michigan (A false name I found out) never responded to my messages, nor in the comments, so what they did in this situation remains a mystery, but I know what I would have done.

First of all, I don't think this needs to even be mentioned to the Chief, unless this department is so small that the Chief is the front line supervisor.  Secondly, I have a responsibility to report unsafe conditions to appropriate municipal agencies, it's part of that whole swearing to support and defend the constitution part of what I do.

When I was faced with a similar situation I completed my preplan, as required, then returned to the station to INQUIRE about cleanliness standards in our area.  The agency responsible for enforcing food temperatures and the like was out of the office for the weekend but would follow up as soon as possible.  I didn't make a big deal about it, but since I had enjoyed eating there a number of times, I felt it my civic duty to pass along what I had seen to folks in the know.

The fact that this business owner was involved in the chili cookoff doesn't even enter into it in my opinion and it is not a Fire Department matter.  But I would also hope that should the Food Inspector see something that they believe is a fire hazard, they simply do their job and give us a call to make that determination.

If you said call someone who knows better, you made my call.  If you're ignoring me, you made Fireman88's call.

[caption id="" align="aligncenter" width="425" caption="Anyone for some tater tots or a lime slushy? Is it me or does this photo seem wildly out of place?"]Anyone for some tater tots or a lime slushy?  Is it me or does this photo seem wildly out of place?[/caption]

A bit of side business real quick, I've got a couple more You Make the Call situations in the pipeline, but a friend of mine is looking at forming a training specific program for them, so it may be a bit before I let them go.  Until then, you can read about my EMS exploits and other ramblings.