Thursday, April 29

Where there's smoke...

blog engineI hate that saying "Where there's smoke, there's fire" because we all know it to be false.  Don't believe me?  Light a candle.  No smoke.  Now blow it out. Poof...smoke.  Where there's smoke there are byproducts of combustion.

Now where did they put that darned combustion?

THE EMERGENCY

11 PM and things are winding down at the firehouse when the radio teases us the way they love to do, "Standby for the box" the voice calmly states as if settling on a choice of new carpet.

Most times the alarms hit somewhere else and we get to listen to the response, but when that tease is followed by the automatics firing on and the bells ringing, we get moving.  And fast.

"Engine 99, Engine 66, Engine 88, Truck 4, Truck 21, Battalion 5, Battalion 12, Rescue 3, Division 4 and Medic 99 respond to 123 Maple for a reported smoke in a building, alarm sounding.  Repeating..."

She went on but I was already heading for the engine, turnout pants buckling as I went, weaving in and out of the paths of the firemen descending the poles.

THE ACTION

There are folks outside of the 4 story type 3 with similar buildings on each exposure-attached and we see nothing showing.  Alarm bells are ringing and folks tell us of smoke on the third floor.

Grabbing the can and a tool I'm right behind the officer as we make entry to the lobby to an old alarm panel that simply has a light flashing next to "trouble."  Trouble indeed, no zone, no detector, we'll have to do the walk.

The walk, as we call it, is the systematic check of all doors by opening them to check for fire conditions.  If they can not be opened we gently break the seal at the top of the door feeling for heat and looking for smoke.

As we continue our walk there is indeed a scent of burning paper on the third floor, but no visible sign of smoke.  the truck has made the roof and done a 360 of the building, (yes we do that part of the sizeup from the roof) and are now searching top down.

Minutes pass as we investigate the source of the smell of smoke.  None of the units have fireplaces, the garbage chute is clear, the grills are clean and cool, but darn it if we can't find the source.

After making another walk through each unit I was resigned to take the apartment hose pack back downstairs when the firefighter emerged from the hallway and said, "Come take a look at this, will ya?"

Inside one of the kitchens he has a headlamp I admired at FDIC pointed towards the ceiling and said, "Do you see smoke up there or am I crazy?"

"Command Engine 99, we have smoke in unit 4." was my traffic and we set out to discover the source.  As more bodies came into the tiny unit and the even tinier kitchen, all in full gear, I stuck my head out the kitchen windows and looked outside.  I could smell the burning paper, but where was it?

As I turned to leave the spot near the window behind a table, my axe handle rubbed against a large paper bag and the bottom fell right out of it.  The burnt bottom.  And all the trash in it was burnt.  We dug through looking for a match or a cigarette or some other source but found nothing but trash.

Where there was smoke, there had been an early stage of combustion.  but had it not been for the smoke detectors, the occupants likely would have gone to bed, not knowing they would be awoken by fire cutting off their only means of egress.

A 9v battery saves the day again.

Tuesday, April 27

2nd Alarm Addition

Traveling the interwebs machine on a study break I found a blog post that was titled The SFFD is Stalking me.

So of course I had to.

Kent Firefighter Gary Lane runs the blog Coffee Talk Around the Tailboard and it contains a great mix of personal thoughts (He's anti-triple load), embarrassing co-worker photos, and a fair bit of tips and tricks at the company level.  Take this video for example:



Not a bad company drill, right?

Now go over to the blog and dig back to the first day he started building that prop and you too can have these kinds of drills.

So welcome to the 2nd Alarm Board Mr Lane, I'm a follower.

Monday, April 26

The Thelma and Louise of EMS

OK, I would be Geena Davis, which is a whole other round of therapy, but here is one of the better stories from FDIC.

[caption id="" align="aligncenter" width="420" caption="Happy and CK in Indianapolis"]Happy and CK in Indianapolis[/caption]

Mr Chris Kaiser and I had an arrangement.  I had a room, he had a car.  He stays with me and gives me rides.  We've all done this kind of thing with friends, and it usually goes just fine, but when you get 2 medics in a car late at night, funny things can happen.

Chris can tell this story better than me since I was nodding off on a regular basis.

It was after 1 AM and we had just left dinner with the FireEMSBlogs guys and were headed out the I-70 to my hotel, the closest I could get in my last minute decision to travel to Indy for the conference.

When our exit wasn't getting closer, we decided to go for the iphone GPS feature and discovered we were on the wrong highway.  Turning around isn't something that was considered when they built these concrete roadways back in the day and it was miles and miles until we were able to get going in the right direction.

Or so we thought.

Every time I dozed off (I had left home at 3:30 that morning is my excuse, too excited most likely) I would awake to CK asking to see the map on the iphone which showed us in the opposite direction.

It seems each time CK asked for advise on which way to go, I was asleep and he would make his best assumption, then try to wake me.

50 miles and an hour later we finally found our hotel and checked in, making the room right at 3 AM.

Thank goodness the beds were so comfortable, as you already know I was exhausted tired or knackered as Mark Glencorse would say.

The next morning rolled around and we were impressed by a midwest breakfast spread including biscuits and sausage gravy...mmm,mmm...or CK told me, I don't eat breakfast.  But their coffee was pretty good.

Then we jumped in the convertible, held hands and drove...wait...TMI.

That's my version of what happened, minus the country music and the blue light, but maybe Chris can expand on those when he tells his side of the first night at FDIC story.

Saturday, April 24

Flashing, Booth Babes and dirty hotel rooms

It sounds like a dirty post and I'm glad I have your attention because I have a hidden tip of the helmet and letter in the file from FDIC2010 in Indianapolis.

Unfortunately, the one part of this post you are craving I do not have, the booth babes.  Try as I might I seemed to be swamped with folks over at the Zoll booth interested in learning more about the Chronicles of EMS and I never had a change to witness that which was the greatest booth concept of all time.

I won't mention which manufacturer did it, but throughout the day, passers by mentioned gorgeous women in skimpy clothing nearby but just out of my visual range.  It was later I learned that the person who earns the Tip of the Helmet for FDIC2010 is the one who dressed these women in high fashion made from the fabrics of turnout gear.

Many many booths have put a bikini clad angel in a pair of baggy reflective pants and called that fashion, but this booth, who had a 4' high catwalk, gathered a crowd of drooling fireman the likes of which I have never seen.  They remained long after the lovely young ladies had departed, likely wondering if they had seen what they had just seen.

There was indeed a lot of flashing at FDIC, none of it from the booth babes though, it is a family show.  I'm referring to the large amount of lighting displays on the floors of FDIC.

Mostly LED, many manufacturers are pushing the capabilities of these diodes and making them rotate, shake, bounce and most other actions that make them more than a flashing light.  Everywhere you turn a new fancy light is flashing you, whether on a brand new ladder truck, a giant ambulance, boat (yes there were boats) or simply in a 50 light array that likely caused seizures in the vendors next door.

The flashing was so intense from one rig, a friend commented she was having eye trouble minutes later.  Now that's what I call a warning device.

Sadly, the amazing weekend was punctuated with a great example of modern customer service theory not being put into practice.

A hotel chain I will not name, other than to tell you it rhymes with El Binta not only set the bar so low success was assured, but dropped the ball completely and was the definition of a hotel FAIL.

When checking in one of the hand towels had clearly been used to dry dirty hands.  It being so early in the morning, since getting lost on the way TO the hotel (another story entirely) I dismissed it as an oversight and sought out a pillow and a mattress to sleep.  Out early the next morning, we later returned after the meetup to find the room a mess, it had not been cleaned.

Down to the manager and all I get is the kid who works the hotel desk at 2AM on a friday night.  No help.

The next morning, when checking out, the "manager" tells me there is nothing he can do since I used travelocity to book the room.  All the while not noticing the "Satisfaction 100% guaranteed or your stay is free" sign proudly displayed over his shoulder.

"So is that just for decoration?" I asked him pointing at the sign."

"Oh that, yeah, that's more of a corporate thing."

Oh really?  Well, at least I can imagine the booth babes, wandering that stage in small amounts of thermal barrier while knowing I made at least 400 people more interested in the Chronicles.

Don't forget, fair reader, I will be on leave to study for the Captain's exam and plan to post many of your I'll make the call leadership scenarios when I am out of the country beginning on the 10th of May.

I plan a few more FDIC related posts, some about fire and others about EMS and EMS 2.0, but bear with me, I'm trying to do as much writing as I can to keep you all up to date, but finding time lately has been a nightmare.

Be safe,

HM

Thursday, April 22

Dr one and Dr Two

ACT IV: SCENE I


Indoor Doctor Office, Day.


The waiting room is full and the temperature is hot.


A nurse appears from behind a door.



NURSE: (early 20s, slightly overweight, pink scrubs)


Mr Frolin?



MR FROLIN: (early/mid 30s, fit, seems unsick)


Here.


He raises a hand and they walk back to a waiting room.



NURSE: Sorry about the wait, we're swamped lately.



MR FROLIN: I just need a referral to a


dermatologist to get this spot checked out.


Insurance says they won't let me do it unless I


get permission from you guys.



NURSE: Whatever, the Doctors will


be by in a minute.



She leaves before Mr Frolin can respond,


clearly he had something to say.



An hour passes.


Finally two men in their mid 40s and in white


coats enter the room and introduce themselves.



DR ONE: Hi, I'm Dr One, this is Dr Two.  And you're...


(shuffling through papers)


MR FROLIN: I'm Steph Frolin, I hate to have to be here clogging


your office, but I have this skin spot


and want a dermatologist to check it,


my family has a history of skin


cancers.



DR TWO: Easy, buddy, we'll decide what you need.



MR FROLIN: I'm sorry, but why are there two of you in here


right now?



DR ONE: Dr Two is here for me to bounce ideas


off of and to help me if something goes


wrong.  And if it gets really busy we take


turns doing patient care.



DR TWO:  That's just how we do it.



MR FROLIN: But I've been in your office for over 3 hours now,


after waiting two weeks for an


appointment and now this?  Aren't


you both tired from having to see the same


patients?  Why not split up?  You could


see twice as many patients in the same time.



DR TWO:  That would leave each of us alone and


that's not safe for you.  We work better as a pair.



DR ONE: Besides, the nurse was here to make sure


everything was fine before we got here, right?



MR FROLIN: Sure, an hour ago.  If you guys saw


patients separately, my wait would have been cut in half.



DR ONE: Well this is how we've always done it,


so why change now?



MR FROLIN: Are there Doctor's offices that send one


Doctor to see a patient at a time?  I mean, both


of you are still getting paid and doing the same


thing, so there is no additional cost...



DR TWO: Look, sometimes we have a lot of patients and


having Dr One here to check on me is in


your best interest.



MR FROLIN: But my insurance is overcharging me


to pay you to know what you're doing.  Can't he go


help someone else right now, then you'll


be able to accomplish twice as much?


Better yet, if you had separate offices it would


go even smoother.



DR TWO: We just like it better this way.



DR ONE: Yeah, we're a team.



MR FROLIN: But only one of you is actually going to be


doing the work and the other is just watching.  Surely


you see this is a waste of resources?  Can't you?



SCENE.

Monday, April 19

Whining in Wine Country or legitimate tax payer concerns?

A well known vintner in California's famed Napa Valley has gotten a bit of attention as of late for a letter he wrote to his local paper, the St. Helena Star.

In the letter (Read the full version HERE) he called out the salaries and benefits of his local firefighters in a manner very common recently.

"Had I had any real brains I would have become a firefighter. What a racket they have.

While I respect the work they do and the inherent dangers, they are greatly overpaid, work only two days a week (a third of which they sleep) and get to retire at 50 years old at 90 percent of their pay after working 30 years.

But maybe getting paid 90 percent of one's maximum pay for another 25-30 years for doing nothing isn't so unjust, as they received high salaries for working very little before they retired."

The common misconception that firefighters are lounged back in recliners watching Judge Judy, all the while collecting outrageous salaries is supported by this man, Mr Sattui, and uses claims of salary and benefits, hours and activities as examples or firefighters wasting tax payer money.

Yet I still imagine the life of a winery owner as all relaxation and sipping fine wine with the social elite.  Clearly I have no clue as to the winery business, so I'll leave my assumptions there.  Writing to my local paper about the excesses of the industry when I have no experience in it would indeed be foolish.

But my interest is not necessarily as a firefighter, or amateur wine snob.  You see, I didn't read this in the St Helena Star, or on their website.  Not in the newspaper here at home or on the evening news, but it was on the dreaded facebook I first read these words and became angry.

It is his right and choice to write a letter of this nature, fact or fiction.  But something stuck with me, understandably. "How dare this man attack me!" was my first reaction, and that of a great many fans of the Anti-Sattui winery facebook group that sprouted almost out of nowhere.  Comments calling for his  resignation, and worse, were littered with persons names, department affiliations and very colorful opinions.

Opinions that could land one in hot water.

So then I began to wonder what Mr Sattui really meant when he wrote his letter to the editor.  Sure he makes sure not to blame the firefighters directly for being lazy holy cash cows (my words, not his) he blames the new bad guy, the career politician.

After all, the union contract that awards such salaries and benefits was agreed to by elected officials, so why not be upset at them?

As I was reading through the rants and raves in the facebook group, the membership continued to grow and suddenly, a response was posted by Mr Sattui "clarifying" his remarks.

Ted Appel at Watch Sonoma County reports that Mr Sattui wished to address the negative comments swirling through the interwebs machine (my words, not his).  Read the complete report at the above link.

"Napa cannot fix the roads, has chronically underfunded schools, has in some instances let sewage water that is not sufficiently treated spill out causing environmental damage because the county is so underfunded in its infrastructure needs that it cannot afford to fix it. Yet we have firefighters whose jobs are, according to them, identical in 90% of their duties to paramedics. But these Napa County paramedics make only about $50,000 a year with much lower benefits. The firefighters in Napa make about 140K on average and many make much more than that."

He has a point that I think Mr Kaiser from Life Under the Lights has covered many a time over.  Not the part where firefighter's benefits are constantly added to their salaries, as if the $26,000 healthcare tab is something I'm paid, or my vision plan, or my retirement contribution, etc etc, but the lack of competitive salaries for EMS providers.

It is comments from the public like this that inspire me more and more to redouble our efforts at public education into just what it is fire and EMS personnel do on a daily basis.

And to remind all of us that there is a section of the population that doesn't like what you do, no matter what that is.

I went to the Watch Sonoma site and left my personal opinion and if this is a topic that inspires you to action, in either direction, please do so civilly and respectfully.

And another interesting thought as I leave you,

Without someone monitoring social media, would Mr Sattui have posted a response so quickly?

Clearly he will be watching the forums a bit more closely from now on.

Sunday, April 18

Rule of threes

I have another list of 3 lists of three things.  Took awhile, I know.

Movies I will stop my day to watch the last 3 minutes of:

1.  Shawshank redemption

2.  Master & Commander

3.  That Thing You Do

Three websites taking up too much of my time:

1. Twitter

2. Facebook

3. Google wave

Three most mis-understood phrases in EMS:

1. "Avoid the liability."

2. "Practice good customer service."

3. "I know my rights."

Until another three of three strikes, be safe.

HM

Thursday, April 15

Discovery Channel

Please go over to the facebook page for Discovery Channel and let them know what you think about Chronicles of EMS.

Ted officially submitted the show and we're hoping to get their attention in the way we know how.

Thanks for your continuing support, see you all next week.

Back to the books.

HM

Wednesday, April 14

Denver and My EMS 2.0

Also posted at Chronicles of EMS

ems2point0pinMark and I are in Denver at the Zoll Summit, but wanted to give you a little better idea about what this conference is all about.

There are a number of different learning tracks in administrative, clinical and data fields, all with dynamite speakers bringing up topics that we need addressed in modern EMS.  Many of the presentations mentioned Zoll products, that makes sense, but the way it was presented was great for us field guys to understand.

Mark and I had the opportunity to present the merits of the EMS 2.0 concept and some of the basics behind where we got the term, what it could mean and how to go about getting us there.  But even before we did that I had an educational table top discussion with fellow EMS enthusiasts Chris Montera and Steve Whitehead.  In this discussion the merits of 2.0 were challenged, the ability of firefighters to be paramedics and surgeons to be mechanics, but also the nuts and bolts of an exciting emerging concept of community paramedicine.

This concept, in every example I have been able to find, fits very nicely into MY 2.0 vision.

I'll explain a bit more why I said MY and not THE in a moment.

The evening with Jamie Davis, Mark Glencorse, Chris Montera and Steve Whitehead, not to mention Charlotte from Zoll, ended on a more than positive note giving Mark and I fuel and insight into the ever evolving concept of EMS 2.0.

When we presented to a 3/4 full room in the clinical track, with only 2 or 3 people in the room even having a slight idea who we were or what we were to speak about, began nodding in the affirmative when I touched on the main points of EMS 2.0.

Thought I'd share.

  • Trust Clinical Judgment


For a system to operate efficiently and in the patient's best interest we need to be trusting well educated and highly trained paramedics to make the right decisions in the field.  We have even recently seen that without a strong education paramedics make life ending mistakes.  Education is a big part of the future of EMS.

  • Alternate Transport Destinations


Does everyone need an Emergency Room? No. Then why do we take everyone there?  Still can't get an answer from anyone on that one that doesn't include more that 'We've just always done it that way."  Urgent Care, MD Office, Home etc.  This destination can be based on clinical impression, destination matrix and, of course, trusting our people to do the right thing.

  • Alternate Transport Methods


Break away from the outdated concept that people that goto the hospital need to be reclined on a bed in a 2 person ambulance.  BLS or ALS you are wasting a resource, an expensive one, on someone who does not need it.  Liability, as I've covered previously, does not enter the equation when the patient's presentation is appropriate to be taken in by car.  A van to pick up the folks who mistakenly call for a colonoscopy is far less expensive than the ambulance twice a month.

  • Refusal of Transport


Not everyone needs to even go in to the hospital, but a mistaken definition and impression of liability hass clouded our ability to do what is right, not what they want.  Sometimes it is appropriate to leave someone at home, on the street, or at the store, who has no medical component to their chief complaint, but activated 911 because they know we'll take them in.  Capture an accurate assessment, create a clinical decision and act on it.

But how can you enact the above concepts?  It will take time and it will be expensive...at first.  But if you realize you can cut your costs by putting Paramedics into a single unit resource instead of a dual, you cut your costs by half.  Transport to the urgent care and you don't have to rely on the $600 payout on the $1500 transport, but the $130 payout on the $50 transport.

Three main concepts must be adopted in order for the concept to come together, I'll cover those in a few days.  But when I presented these concepts here in Denver to the folks who make the kind of changes I'm hoping for, they nodded in agreement and sought us out afterwards to ask about specifics.  Something is happening here, there is a buzz around this crazy notion that improving EMS might just work this time around since the ground folks seem to have a voice in the discussion.

Our voice will only get louder.  But please keep in mind, Mark and I still have full time jobs and families and are still flying around the country (Mark the world) telling anyone who will listen about our desires to learn more and share what we learn with you all in real time.  But this sharing takes time to filter into the pre-conceived notions about social media and it's power to unite a community.  Rome wasn't built in a day, neither was the system we have today, it will take time to gather enough evidence to support these concepts and traveling to systems that have enacted portions of it is the only way I see that happening.

Stay safe,

HM

Tuesday, April 13

Mile High Opportunity

Right smack dab in the middle of my crazy 30 days was an opportunity to come here to Zoll Summit and present the first position argument for EMS 2.0.

As much as it has been pulled apart, scrutinized and criticized, the core message of looking at why we do what we do was very well accepted by the audience here in Denver.  Supervisors, Chiefs, practitioners, designers and marketers all sat down and listened to that crazy blog guy and his UK buddy explain what EMS 2.0 means and why it has a chance to work this time.

Mark did a great job relating social media to the mission of improving EMS and the discussion that followed ended with one of the attendees asking where they could find a "user guide" on how to approach social media policies for departments.  Mark and I shared a "Well, duh...that's a great idea!" moment and went on.

Soon after our session and the discussion we commandeered the main ballroom and it's twin 25' screens to fire up the first episode of the Chronicles.  It was after the last session so not too many folks turned out, but many times it isn't the quantity, but the quality.

Soon after the show and a quick look at A Seat at the Table (thanks for the reminder Mic Gunderson) we found ourselves face to face with CEO of Zoll Rick Packer, our sponsor.  Fearing a "I never approved this" moment, we were welcomed with a warm smile and a hand shake, followed by a long discussion of the concepts we discussed in the show.

Zoll has been more than gracious in helping us spread the word of EMS 2.0 and Chronicles, even if I should be back in the room studying for the promotional exam.

This week has seen us debating EMS systems allocation with friends, Chris Montera and Steve Witehead to name a few, and sharing the idea of improving EMS.

Later today Mark and I will be attending a networking event where we hope to share the message even more.  Sorry for so few updates, we're working on it!

HM

Sunday, April 11

I'll Make the Call

I've decided to try to improve myself and my career track by putting in for the Paramedic Supervisor position at my agency.

In past examinations, information gathered from outside the agency has not proven very helpful in the specifics of the exams, but I'm all for increasing critical thinking skills, as you know.

So I am going to be calling on my most valued resource, you the reader, to help me do just that.

Over the next month, posting here will nearly grind to a halt with so much happening for Chronicles in Denver and Indianapolis, as I have mentioned, but the exam packet will be out soon and I want to study it as much as I can.

And since I know I'll be finding myself in front of this laptop more often than I should, give me something I need to see.

In the next 3 weeks I'm asking my friends in EMS, especially those of you who serve as supervisors, or have filled that role in the past, to send in problems, situations or questions for me to ponder or consider.  Include your name, or what you want to be called and some basics about your system.  And if you are not a supervisor, but have a situation you think could help, please send it along as well.

As they arrive in the inbox at thehappymedic@gmail.com, I'll put them up.

That way I can work on critical thinking skills and the rest of you have a month long You Make the Call right along with me.

Whether I comment or not will depend on my free time and whether my answer to your situation will confuse my answer to my agency's specific requirements for the test.

In a recent suppression promotional exam, agency specifics trumped nationwide practices, so I have to be careful about answering.

After the exam, regular posting should return, but my eldest asked me this morning,

"Daddy, do you have to go see Mark tomorrow or can Happy go instead?"

So get those questions in text and send them over, you are all my study buddies now, like it or not.  I have access to your experience and I plan to take full advantage of it.

Friday, April 9

A lot to do in 30 days

Happy Medic and the Chronicles of EMS message are headed to Indianapolis for FDIC April 22nd-24th. I was hoping to make some of the H.O.T. Classes earlier in the week, but Mrs HM is already tapping her foot about my Denver trip this week.
This full time work, full time web site thing is tough to balance.

But so long as I have the chance, I'm off to meet the other side at FDIC.



There is a meetup on Friday night at Rock Bottom Restaurant and Brewery just blocks away from the Convention Center at 10 West Washington Street, beginning at 8 PM.

I will be on the convention floor, meeting as many folks as I can to talk about Chronicles, FireEMSBlogs.com and social media in general. I'll be the one in the CoEMS T-Shirt.
If you find me on the floor at FDIC and tell me "Mark Glencorse is ruggedly handsome" I'll give you a free #CoEMS phone sticker (while supplies last or until I'm tired of hearing about the Brit.)

Thaddeus, Mark and the rest of the Chronicles gang will be recovering from the first EMS 2.0 position presentation at Zoll Summit in Denver. That presentation is on Tuesday and the gang will be meeting this weekend to put together something I think you guys are going to love. We hope to premiere something at EMSExpo later in the year that will take Social Media in public safety to a whole new level.
But I'll let them tell you more about it when they iron it out.

So Denver, then Indy, and all with my SCUBA certification in between, followed by the surf rescue course, and then some time off.

Heh, time off.

During National EMS Week, while Thaddeus and the team are here in the states working, I will be off the grid for a few weeks getting some time away with the wife. I think that's why she was OK with my booking Indy, she knew this trip was coming. We've been planning it for years.

And then this news that just dropped today.

My service is administering the Paramedic Supervisor's exam the week after I return from our trip away. Now my escape will be turned into a study trip.

That means it's time for one of those blogger breaks that we usually take for a few days, then wander back when the urge strikes, but I may need to force myself to focus on the exam prep when the materials are published.

Hell yes I'm taking the test!

But I'll still be your Happy Medic if I get the job, and just as happy if I end up right back where I am now.

More to follow,
HM

Thursday, April 8

Burned Out?

Ying, meet Yang.

New Mutual Aid Company: Burned Out Medic.

He dropped a comment on a recent post and I just spent an hour reading through some great posts of his.  Have a look and imagine the voice of Charlie Brown reading the stories of EMS we all tell.

*Good Grief*

The greatest firehouse story ever told

...can not be told online or in print because you have to know three specific things:

  1. The angle of the 100' articulated aerial ladder truck.

  2. The personality of the person on the end of the ladder with the net.

  3. The look on the face of the raccoon when he jumped.


I have not laughed like that in a long, long time.

And like all firehouse stories, it is 100% true.

Tuesday, April 6

Liability - Part I

A few months back I mentioned how I HATE the term "customer" in fire and EMS because it brings to mind the wrong impression on the delivery side.

Sure we can pound into the heads of our line personnel that they need to be more "customer service oriented" but what does that mean to them?  To me it means ignoring people and putting out a tip jar, getting their order wrong, then refusing to notice.

Let's all agree that reminding our crews that in many cases the person who they anger in the field can vote your salaries down, or to block your company's contract renewal.  Besides, they have been told they are customers to you and what is the one thing we know about customers?

"The customer is always right."

Well that's just a poor way to run an emergency service, catering to the needs of people who have no idea what service you offer or how it should be administered.

So let's slowly back away from the customer service model for a moment and take a deep breath.  Let's assume what we already know, that the general public has no idea what so ever the difference between an emergency and an inconvenience.  So why let these folks determine how the millions of dollars of equipment, staff and vehicles are utilized?

Because we are so afraid of a lawsuit we'll take anyone in for anything so long as they get the result they wanted.

But what about their neighbor five minutes later?

Imagine I take Erma Fishbiscuit in because her dial a nurse told her to call 911 to arrange her colonoscopy.  Erma demands transport and I am bound by law to oblige her, regardless of her lack of need of an ALS ambulance.  We take her because of a perceived liability, that if we don't take her and she sues us we will not like it one bit.

5 minutes after getting Erma loaded up a code 3 CPR in progress comes in next door to Erma and a 6 month old child dies before ALS can arrive on scene.  Are we liable for not having more ambulances?  Which liability is greater?  Which liability makes national headlines?

Liability, like patient, has two completely different yet totally accurate definitions.

Liability: ...being liable. A responsibility or obligation...

Liability: Something that holds one back. A disability, disadvantage or hindrance.

Well no wonder we use that word.

When we speak of liability in the pre-hospital arena our minds automatically shift to defending our actions in court, right?  We don't want to be held liable in court do we?

Here's a shocker: I do want to be held responsible as I have an obligation to both the people who do call me and those who are about to call.

But I am surely in the minority.

It is this fear of court, retribution, lawsuits and bad press that clouds our minds and won't let us see the real liability, the next call.

Our current liability, taking Erma in for no medical reason, acts as a hindrance, a disadvantage to the EMS system by taking highly trained resources to do the job of a taxi driver.  So why do we not have that resource in most places?

Liability.

There it is again!  That word gets thrown around so easily it's starting to give me a headache.

I argue that by taking Erma in we increase the threat of actual violation of responsibility should someone who actually needs EMS intervention is required to wait for it.  How long is an appropriate wait time you ask?  How long was Erma willing to wait?

We, as providers, are indeed locked into rigid 35 year old concepts of when to take people and why.

"Does he want to go?' the supervisor asked me as I was discussing the finer points of prescription refills with a client on a street corner at 3 AM.

"Yes, but I think we can get him to the pharmacy two blocks over if he just walks." I answer as the ambulance pulls up.

"We don't want that liability, take him in." She answers and the protocols once again trade the actual responsibility liability for the hindrance liability.

So who is liable when the 6 month old dies because the ALS resource was transporting Erma for no medical reason?  What if the child's parents find out you took her in non emergency for no medical reason?  Can they sue the City, Company, Town, Agency?  You bet they can, and publicly.  All because we are afraid of that word that no one bothered to explain in depth to us.  Even in my semester long Pre-Hospital Medical Legal class liability boiled down to just transport and let the next license up deal with it.

I say we need to rethink liability, both definitions, if we're going to enact change in this Profession.

Get Erma the ride she needs from someone who can actually help her and be there for the 6 month old neighbor.  That is your obligation.  That is your responsibility.  That is the liability.  And that is exactly why your system will never do it.

Keep in mind that even though I make grand assumptions, I still follow all local protocols and standards, no matter how outdated, wrong or misguided.  So should you.

Monday, April 5

20g-18g - 30%

The numbers may seem confusing but I've always wondered something and when I found a few expired saline bags in the storage closet I decided to do a completely scientific and infallible test.

Now that Rogue Medic is sitting up in his chair I will confess this is in no way an "accurate" demonstration, but all elements were equal so I can only assume that the same thing would happen proportionately under different situations.

Like, say, actually starting lines on people.

In the past I have made the in field decision, like many of us do, to get the 18g when others may try for the 16g.  But if I know I can get the 20g, but maybe get the 18g, shouldn't I err on the side of some access is better than no access?

Maybe, maybe not.

So I went out to the workbench, hooked up a 20g angiocath and opened the line wide open.

How long do you think it took to empty a 1000ml bag?  More on that later.

Taking into account the widespread myth that D50 can't fit through a 20g needle (then where does it go?) what is the difference between a 20g and an 18g?

"Large bore."

In my wonderfully arranged protocol manual there is an entry under abdominal pain and multi-systems trauma that mentions starting "2 large bore IVs..." but does that mean a 16g? 18g?  Certainly not a 20g, right?

But it seems like such a small difference to step from the 18g to the 20g and slamming fluid into these kinds of patients can be debated all year long, but I have to follow my protocols.  So what is the difference in fluid flow between those two catheters?

30%

The 20g drained in 18:08.

The 18g drained in 12:31.

That's a considerable difference and far more than I would have expected.  Maybe a few minutes, but 6?  So now wondering how fast a 16g can go, alas, I am out of expired bags.  But if the trend continues I would expect to be able to drain that 1000ml bag in 6 minutes or so.

6 minutes to run in a liter of fluid or 18 minutes just from going 16g to 20g?  That's huge.

We all know that in a bumpy rig with other concerns that line can get away from us sometimes and you look up at what you thought was a slow bolus and see an empty bag, so I used to err on the side of time instead of volume, just in case.

But that was back when I had 45 minute transport times.  Now that I'm just a few minutes out should I change my way of thinking of getting access?

We'll see, but I just wanted to pass along my experiment.

Stay safe,

HM

Sunday, April 4

Sunday Fun - Cruising Market Street

The Angry Captain's mother sent me this link and I've been keeping it to myself long enough.  Sit back, relax and enjoy a ride on the Market Street Railway in 1905, just before this was all destroyed by the great earthquake and fire in '06.

[youtube]http://www.youtube.com/watch?v=NINOxRxze9k[/youtube]

And now how that same ride looks today.

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

Did you see the guy in the cape come back around near the end?

Friday, April 2

He's Here.

Happy-Medic-colorLadies & Gentlemen, children of most ages, please welcome our new mascot, the Happy Medic.

He comes to us from well known artist Paul Combs of Art Studio Seven, Fire Engineering Magazine and a post not long ago about how moving his political cartoons are.

When I commissioned the new guy I gave Paul some basic requirements, but asked him to look through the website and watch #CoEMS to get what Happy is all about.

When the proofs came back I knew I had contacted the right guy.

Happy wears his helmet, of course, which bears the number 5, a tribute to the Engine Company I was assigned to on that day back in 2007 when I got hurt, the injury that started me blogging.

His badge shows the star of life encircled by the maltese cross, very fitting indeed, and he's wearing a smart uniform.

And, of course, that smile.

Happy did very well learning the ropes and will be taking his place in the banner very soon.  But for now, we here at Happy medic Head Quarters welcome him, and you to the site.

Stick around, we've got a lot of fun stuff coming up in April.

Thursday, April 1

Happy Medic Orientation

hmbootThis new guy is picking things up quick.

Now that we have the basics of the site narrowed down, let's deal with some of the other stuff that comes up day to day here at HMHQ.

This is the link to the Glossary of Terms, soon to become it's own page, which will explain why every old woman in this place is named Erma and why we have so many medic units that there even is a Medic 99.

Over on the side bar are a few modules we need to cover real quick in case folks want to click through.

Gasda Software are the guys who will program your shift schedule into your blackberry phone.  Rumor has it they have over 3 dozen custom schedules plugged in so you can follow your friend's shifts as well.

We also contribute to some other forums, the Handover and First Due blog carnivals are fun and are less a carnival and more a reader's digest of EMS and Fire blogs respectively.  You'll be expected to submit articles to both, so stay up to date on when the next host presents the topic.  The last guy missed a deadline and we weren't mentioned this month.

The Chronicles of EMS...oh man, you did know we need you to travel the world exploring EMS right?  Did we mention that?  Well, if not, too late, we're doing it, very soon in fact.  We have permissions from departments and services in England, Ireland, Sweden, Germany, South Africa and all over the US from volunteer rural to paid urban, we're going to see it all.

Paramedicine 101 is a forum we just got invited to contribute to, only post over there when what you're writing can match the quality of the other contributors.  From you, Mr probie, no time soon.

And another thing, here we earn our numbers.  I saw on an earlier post you already have a 5 on your helmet shield.  I've been here since the start and barely earned my number, yet you walk in with a number already there?  Are your dues paid through the end of the year?  Name on a locker yet?  Got a bunk all picked out do ya?

BUNKER DRILL! BOOT! BUNKER DRILL!

Then I'm going to have you do dopamine drip calculations while on air in the dark.

rookies...

Happy's Training Continues

happyhelmetFor those of you catching up, our old mascot is retiring and we're training the probie.  When he's ready he'll take over, but until then, we train!

With our daily chores completed, let's talk about how things run around here.

Most posts surround the author's years in a variety of different systems and stories he collects from around the world.

It's important that when we share these stories we follow a law called HIPAA, which could stand for Hilariously Inconsistent Patient Anonymizing Actions, but doesn't.  It's a fancy law designed to stop billers from selling sensitive information, but now has people looking over their shoulders before thinking of sharing life saving information and techniques.  It boils down to this: Never mention names, dates of birth, or other identifying information and change enough of the details that even that patient reading it might say, "Nah, that wasn't me."  Respect their privacy.  Many times the best information has to be changed so much it is unusable.  Such is modern internet story telling.

When we tell the stories, we break it down into two sections.  THE EMERGENCY will tell the reader what we got activated for and THE ACTION will summarize our, well, actions.  It doesn't imply there was 'action!' since there rarely is.

Not only dispatches are covered, you'll need to look out for the You Make the Call segments.  They used to be every Friday morning with the follow up Monday mornings, but a couple of them hit a little too close to home, so now they could be any time.  When a You Make the Call goes live, we'll see the Chief in a referee's shirt and the COMMAND vest.  Watch the comments to see a variety of different ways to handle fire, rescue and EMS cases and check back 48-72 hours later for what we did in that situation.  It can really get the discussion started on a number of issues.

And the weekend is no time to sit back and relax, probie, we've got a regular Sunday feature called Sunday Fun when we'll try to change gears away from dispatches and EMS chatter with some fun stuff from around the interwebs machine.

You really need to watch out for this EMS 2.0 thing.  It comes running in here and takes over for days at a time.  Changing the way EMS is delivered isn't an overnight solution or project so when the topic comes up it tends to linger.  If it's not your cup of tea, keep checking back, another fun call will come along soon.

Trauma.  A lot of folks are going to email and ask if the NBC hit drama TRAUMA is a realistic representation of EMS in San Francisco.  Just tell them to check out the TRAUMA FAQ tab at the top of the page and let them find out.  Trying to explain it just takes too long.

We've got you set up on Twitter as @theHappyMedic and on facebook at the Happy Medic Fan Page, so check those feeds often and remember, never post sensitive information there either.

Alright, that's enough for now, probie, get in there and make some lunch and let's see what kind of KP skills you've got.  More training after the meal.

New Happy's First Day

happybadgeToday is the new Happy Medic mascot's first day so we're showing him the ropes.  Only when he's ready will we let him up in the banner.

All right, kid, here's how it goes:

Shift change is at 8 am, but I expect you here at 7 to offer an early relief to one of the more senior members.

You'll be on the floor on time and in your issued uniform.

First thing is to check the logbook to see what has happened since your last visit.  Click on the current month and have a look at the title of articles, looking for anything you may have missed.  If unsure, ask around.

From there we'll refresh the page and make sure the blog rolls open up properly.  The 2nd Alarm Blogroll covers fire based sites, while the Mutual Aid board covers rescue and EMS.  Make sure the newest material is at the top and goes down chronologically.

The PD Evals blogroll covers the latest from our Law Enforcement friends, make sure they don't have any calls pending, then ensure the Training tab is live as well.

When all the elements are in place, make sure the banner ads are relevant and click through  to those of interest.

Now we need to get up to date on all the happenings out there.  Firegeezer gave me my start, so we'll start there.

Read the Morning Lineup, only then can we break for some coffee, but only when he says so and only after getting the equipment checked out.

After that it's housework probie, toilets, floors and kitchen.

The day has only just begun, but the basics are covered.  A little later we'll talk about what to expect from articles and updates here on the site.