Monday, February 28

Mentioned on the cover too

There's a new article in your March EMS World Magazine.  Something about starting IVs or some such nonsense.

And special props to anyone who can identify where I am in the accompanying photo.

A Beautiful Morning

When the tops of the towers of the Golden Gate Bridge are a brilliant bright orange, it signals another day is about to begin.  The sun slowly rises over the City and that bright orange color slowly drips down to the rest of the bridge.  If you ever visit San Francisco the best place to see a sun rise is just at the base of the bridge at Fort Point.

Many mornings the bridge is fogged in, a pea soup so thick you can't tell you're on a bridge.  From below, at the fort, you can only tell where the bridge is by the fog horn.

On this particular morning it was crisp and clear. The temperature is in the low 40s and the sky is bright blue while the orange begins to drip down, coating the towers.  The water is eerily calm, only the beginning of the flood tide, but the surface is almost glass.  The only interruptions are the occasional dolphin, random bird or rescue jet ski.

Both skis are making their way towards the flare that was dropped in the water at the location the jumper was last seen.  The flare sparkles a bright red and the smoke it gives off is almost motionless as the source slowly drifts with the tide.

The coast guard ship makes the jet skis seem like ants at our range, and the rescue and fire boats are now approaching to aid in the search.

As the remaining units arrive at our location under the bridge the sun crests over the City and bathes us in warmth, the whole bridge now bright International Orange.

We stood there for nearly an hour.  Taking deep breaths of the crisp clean air, watching the City awake and listening to the traffic pick up on the bridge above.

It was a beautiful morning.

Friday, February 25

Baltimore Checklist

Alright ramblers, let's get ramblin'!

EMSToday promises to be another huge success and the folks at JEMS are working hard to make the conference their best ever.

Aside from world class presentations for every level of practitioner, manager and owner/Chief, a giant exhibit floor and the popular JEMS games on Friday night, there are a number of things I'm hoping to see in Baltimore this year.

First for me is the reaction to the brand new Brady/San Francisco Paramedic Association curriculum being debuted pre-conference.  Partnering with Chronicles of EMS producer Thaddeus Setla, the folks that brought you high quality video production for Beyond the lights & Sirens and A Seat at the Table have raised the bar in education media.  Gone are the days of a camera pointed at a lectern passing for multi-media in EMS education.  The team is signed on to complete the entire tract and you'll likely see it in a classroom near you soon.

While on the exhibit floor, I'm going to check in with the folks at AllMed and see what's new in uniforms and equipment.  AllMed is the supplier of the dress uniforms for Beyond the Lights & Sirens and they always have something new and exciting in the booth.  And they're the only vendor I recall that brings a seamstress to hem those new pants right there on the show floor!

A big topic at EMSWorld was ambulance safety and I'll be asking some tough questions of the manufacturers this year, mostly why they keep putting a little box on the back of a pickup truck and call it an ambulance.

Home this year is exactly that, our little corner of the Zoll booth #3707.  Last year we were added at the last minute and had to carve out a section in front of the closet.  Those who visited remember the crowded feeling and we ended up just standing in the isleway.  Zoll saw the crowds we were bringing in and have actually engineered a separate section of their new floor show just for us.  Come see it, meet Ted Setla and record your own "I am EMS 2.0" video.  While there, get a free CoEMS T-shirt and find out how you can be a part of the new First Responders Network TV channel.  Oops, I've said too much.

The show is going to be great and the folks at JEMS will no doubt outdo themselves again.

But what to do when the classes are over and the hall closed?  That leaves the out of conference activities to us!

Here's your cheat sheet:

Wednesday night-

Pratt Street Ale House - Directly across from the convention center, second floor, the Zoll Pre-Conference Blogger Bash, beginning at 8pm - 11pm.  A non-formal, smaller gathering to get fired up for the opening of the conference.

Thursday night-

Uno's Chicago Grill - Farther up Pratt street in the Harbor, THIS is the meetup everyone is talking about.  Hosted by FireEMSBlogs this is the gathering that last year garnered the attention of most EMS bloggers, most fire bloggers and a handful of Chiefs who were curious what we were up to.  I know everyone last year just came to meet Mark Glencorse, but this year promises to be another amazing success.  The guys from GoForward Media know how to throw a party and have spent a year planning this event to blow all previous events out of the water.  And considering their events in Indy and Houston last year, the bar is set pretty high.  You'll need the Zoll Pre-Conference party just to condition yourself for this one I promise you!

Did I miss anything?

Wednesday, February 23

Medic999 - RTB and signoff

I'm not sure how a standing ovation works online, but I'll give it a shot.

Mr Glencorse,

You changed my life for the better and I will never be able to thank you enough for that.  On a lark you wrote me to ask if I was interested in hosting you in my service for a week, then me in yours.  Our online back and forth was furious, each trying to learn more from the other and our audience was appreciative for it.

Then we made a show.

But while we were doing that we became family.

All the jokes about a bromance, two medics in love in San Francisco, really boiled down to two brothers, each searching for the same thing: A better tomorrow for themselves and their service.

Your writings have brought me to tears both in sadness and hysterical laughter, 12 leads I couldn't fathom were made clear and understandable.  The first social media save is because you recognized the importance of seeking out information wherever it can be found, not just in the classroom.

Mark and his family have sacrificed so much to give so much to the online EMS community, and eventhough he's not dead and gone, his constant stories about what it means to be a Paramedic in modern times have come to an end.

I think I'll go back and re-read it from the start and relive some of the best years of my life.

You and yours are always welcome with me and mine.

Your friend,

Justin

Tuesday, February 22

HMjr is home and why I shouldn't leave you alone anymore

Geez you guys.  I leave for a week and you can't even keep things in line?

Egypt, Tunisia, Lybia...Wisconsin...

I need to think twice about ducking out from now on.

My youngest was stricken by a severe case of RSV that landed us in the pediatrician's office on Valentine's Day. Less than an hour later, satting 88% on high flow O2 and decompensating before our eyes, we were wheeled to the ER.

After repeated interventions and evaluations hospital admission was necessary.  All this was happening while Mrs HM is on a plane home from a family funeral and the elder HMjr has no ride home.

Oh, and then my phone died.

You may have seen a cryptic message on facebook asking someone to check their facebook status ASAP.

I was able to "hack" my way into the computer in the ER that they use to record treatements and sent out a simple message to my out of state emergency contact.

You have one of those, right?  Someone who has a copy of your family's disaster and evacuation plan?

You have one of those, right? I sent a message that jr was getting admitted, I had jrsr with me and to activate the plan.

A few minutes later the unit clerk came knocking on the door labeled "DROPLET PRECAUTIONS" and handed me a phone. On the other line was my emergency contact, reading from the plan, gathering the information he would relay to other family members. He reassured me everything would be OK, that we were in good hands and that he would take care of everything.  And he did.

Less than an hour later, all parties who needed to know what was going on were notified, jrsr had a ride to a friend's house and I was clear to spend the next few hours listening to my 2 year old beg to go home in between her 60 breaths per minute.

The pediatrician came in and told me we had 2 options. I told him to make the best decision because my mind was clouded. He responded, "I already called the ambulance, they're on the way."

I will elaborate on the state of care available to those who can afford it (or who's collective bargaining forgoes huge raises in exchange for healthcare benefits) but I want to mention 3 people in particular who I was most afraid of but who did more for that little girl than the rest of the assorted health care team over the next week:

Sonoma AMR's Critical Care Transfer Unit.

Unfortunately, I recall only Tim's name. (and that PCR that we are always told the MDs look at was thrown out the night we arrived at the peds unit, the docs I spoke to never saw it.)

The only 2 people to warm their stethoscopes prior to placing them on my daughter were...the Paramedic and the nurse in the CCT ambulance.  I do it all the time without thinking and it almost passed unnoticed until the unit nurse in the hospital did it without warming it and my daughter arched her back and screamed.

The EMT driver slowed the cot and lifted ever so slightly as we crossed thresh holds and the Medic at her head holding the O2 blowby did the same.  With one hand on the mask and the other gently caressing her temple to calm her I'm unsure how he did it.

When we still couldn't reach Mrs HM on her phone even though she should have landed (my phone was charging in the back) the medic took a moment and checked an app on his phone he reserves for when staffing the aeromedical unit and checked the weather for me.  Then checked her flight status.  All the while the nurse was intently looking at HMjr's marked retractions and, in his mind I'm sure, already thinking of what to do with me should he decide intubation was necessary.

There is a saying in EMS Education, something along the lines of "You won't leave this class until I'm comfortable with you treating my own family."

Well, now these three men are part of my family and are welcome in my home any day for any reason.  They didn't just give us a ride, they did what they could for a sick kid and her distraught father and it made all the difference in the world.  The little things. Not their mighty tools, their big machines and gadgets, I didn't even notice their uniforms other than they were in blue. I noticed their tone of voice, their caring looks at my daughter and their absolute dedication to the task at hand.

I'll be back in the banner soon enough, we're home now and she's still weak, so I'll be back when I'm back, but I'll see you in Baltimore for sure.

HM

Tuesday, February 15

Life Called

I had to answer.

I'll be back later...if then...

Baltimore is a maybe go.

Sunday, February 13

The Crossover - Episode 9

Sure, we taped the show two weeks ago. It took MC two weeks to limp his way through editing. But Huzzah! He finally got the job done. In this episode, HM and I talk about freeway lane closures, who's in charge, and what happens when PD and Fire disagree.

We also take a couple more listener questions...remember, you can call with your question(s) at 313-451-HMMC. Want to know who figured out what 451 means? Listen to the show!

EPISODE 9

Saturday, February 12

Beyond the Lights & Sirens turns 1

A year ago we were gathered in the ballroom at the Hotel Frank in San Francisco waiting for Thaddeus Setla to press the play button.

The time finally came to show the audience what we had filmed the previous November in the engines and ambulances of an American EMS system while UK Paramedic Mark Glencorse followed along.  A hush fell over the crowd of EMTs, Paramedics, friend, industry leaders and family when Thaddeus raised his hands and said, "Our online audience is watching it right now, can we dim the lights please?"



Chronicles of EMS - The Reality Series (Season 1 Episode 1) from Thaddeus Setla on Vimeo.

25 minutes later, after a few good laughs and plenty of smiles the show finished and I found Mark in the crowd.  We were near tears seeing what Setla had done to capture the emotion we had experienced months before.  It was like reliving all we had learned in our trans-Atlantic exchange.

The evening was a great success and the following morning found us in Setla's studio filming the first 3 episodes of A Seat at the Table.

1 year later we've released 23 episodes and have plenty more planned as well as in post production.

The reality series got a new name, thanks to our audience and network TV executives are curious to see what else we have in mind.

If they only knew.

In recent weeks you've seen A LOT of activity at the Chronicles site because we are gaining partners and growing rapidly.  No longer is "Chronicles" (#CoEMS on the twitter) simply about Justin Mark and Ted in San Francisco.  Chronicles of EMS is now only part of the content planned for he new First Responders Network TV.  We've partnered with fire centered production houses to create new original training and entertaining content similar to the EMS side.

And we're not stopping there.

If Tak Response taught us anything, it's that cross training outside your discipline is exciting, new and long over due.  For that reason law enforcement will also be included in FRN.TV, focusing on how we can all learn from each other before the incident instead of during it.

We never landed in prime time on Discovery Health traveling the world exploring EMS systems, but we have time to do better.

Keep an eye on the Chronicles of EMS site for details about our new partnership with the SFPA and Brady and how EMTs all over the country will soon be familiar with what we're doing.

In addition, Seat at the Table has expanded into new territory, sitting down with the International Association of EMS Chiefs as well as sign language expert Louise Sattler to discuss communicating with unique patients.

We're charging forward in every direction, working on both reality shows, training series, CE content (coming soon) and a host of scripted dramas, comedies and features that will bring EMS into the home of Americans in a way they have never seen before: Accurate and entertaining.

Thanks for all your support over the last 365 days, and I hope we can count on it in the future.

-Justin

RIC - You Spin me (Right Round)

One of our Division Chiefs has seen more fire than a line cook at Outback Steakhouse and loves to ask odd questions in the heat of a situation.  Some think he's just picking on people while others see it as a way to really think about the situation we're in.

On other occasions this Chief likes to play with the RIC or Rapid Intervention Company.  This is the 4th due engine at a working fire and is tasked with standing by to rescue firefighters should the need arise.  Many Departments staff this position differently, but most will tell you they don't like standing in the street while everyone else gets to work.

The RIC is responsible to size up the building, soften the exterior by removing hazards before they are an issue and knowing what operations are going on in and around the fire building.

It seems like a no brainer, but as the RIC team gets itchy to freelance, the Chief will turn to them and make them turn around to face him in the street at the command post.

From here he asks a very simple question:

"Describe the fire building."

Each of the 4 members often have a slightly different interpretation of the building, from number of floors, to color, to where ladders are placed.

Ever since I saw him do it, I've always paid closer attention to the building as the RIC team.  And that was his intention.

Thursday, February 10

You Make the Call - 2 Year Old or 911 Caller

In the midst of potty training our youngest I've found myself saying some interesting things that, taken out of context, would sound disgusting.  Then I went to work and found myself saying some of the exact same things to grown adults in the midst of an "emergency."

So let's have a little challenge here and see if you can correctly guess which of the following statements were uttered by me to my 2 and 4 year olds or to a grown adult, or which was said by a 2 or 4 year old or grown adult.  Results soon!

[poll id="5"]

[poll id="6"]

[poll id="7"]

[poll id="8"]

[poll id="9"]

[poll id="10"]

[poll id="11"]

Why I'm no good at CHFers

More than one "experienced" EMT and Paramedic emailed me after my post about EMS Anchors, each one reminding me that I am but a child in this thing called EMS and have no idea what it's all about.

One email told me "Until you've been up to your ankles in pink frothy puke on a crashing CHFer don't tell me how to handle my career."

Well buddy, I have bad news for you...I don't let my patients get that bad anymore.

The reason so few Paramedics are experienced in the truly crashing complex patient is because there are less of them.  I can't even remember the last crashing CHF patient I had and since we adopted CPAP I barely even check the nasal ETT kit anymore other than to make sure it is there.

Treatments have advanced and, more importantly, EMS has become more recognized as an important public service.  More responders are in the community and able to respond quicker.  Education standards may be lower than we'd like (OK, ARE lower) but are still above where they were even just 15 years ago.

The grizzled old medic who rumbles on about how the kids today have never really seen it "go to hell" on a rough call actually are a dying breed.  They too see less and less truly critical patients because of the advancements in medical care, access to EMS and what passes for public outreach these days.  As annoying as all those medication ads are on TV, they at least tell people to call their doctors and ask questions, which is a plus in my book.

Does a Paramedic HAVE to be experienced at watching a patient far past therapeutic intervention die in their arms to be a good practitioner?  Certainly not, but it gets you the street cred doesn't it?

Stories about patients crashing, infrequently used procedures having no effect and blood and guts still seem to be the metric by which many in EMS try to measure themselves.  It used to be how much blood was on your crisp white shirt, then how messy your boots were, and now we're on to describing how our care and tools were inadequate.

Think about that for a minute.

Most folks in EMS are BRAGGING about how they failed their patients.  Nice.

Education is a wonderful thing and can never replace experience, but don't forget that experience is also useless without education.  While that new kid on Medic 88 may know 100 different ways a 12-lead can go wrong, you give him crap because he hasn't "been there" and "done that" the way you did.  He's thinking the same thing watching you, only wondering when the last time you took a class that wasn't a merit badge update was.

Things have changed.  Patients have changed.  I'd venture to say that the only thing that really hasn't changed is trauma, and that's easy enough to deal with regardless of your level of education or time on the streets.

I guess what I'm trying to say is this:

New People: Slow down and watch the folks who have been here awhile.  You think they're avoiding taking a BP when really they're reaching for the emesis basin just in time or anticipating what will come next based on experience.  If they're not up to the second on the newest toys and techniques, give them time, learn from them.

Not so New People: Take it easy on the new kid and think back to your early days on the street.  The new kid isn't being a jerk when they mention 100 different ways to read the 12 lead, just doing what he's been taught.  Teach him.  Make him better without all the BS about the old days.  Teach him how to learn the instinct you now possess.

Everyone: Climb down off your ivory towers of years on the job and step out from behind the curtain of education and talk to each other about the call you just went on.  Exchange impressions, ideas and explain why you did what you did.  We can all learn from one another if we just try.

Sunday, February 6

Hello, Fire Chief? I want to complain...

No, not me, but a recent client of mine.

THE EMERGENCY

Units were sent to a reported fire in a building.  The caller is describing flames coming from a room and he must evacuate.  This being in a residential hotel in an older part of town, a fire here will engulf the building quickly and our crews know it.

THE ACTION

The first engine reports nothing showing on arrival to the multi-story type 5 building, but the trucks aren't waiting to get the sticks up and supply lines are being stretched by second and third due engines.  All this happening within 4 minutes of the report of fire.

The reporting party is in the lobby, stating that there is no fire, but that he had been shot, and didn't want the police to come.  Telling a first due working company that their chance at getting some fire turned into a medical is like telling a 5 year old Santa took the year off on Christmas morning.

As the ladders came down and lines are drained the medic unit assigned to the first alarm is brought in to assess the patient.  Not surprisingly he is uninjured and well known to our crews for calling in a variety of ailments, not a one of them actually happening to him.

Since I was in the area (poaching really, Captains are dispatched on reports of working fires) I decided to swing in and see what they had going.

When the medic unit advised the patient they saw no evidence of a GSW and asked him to remove his shirt for a better assessment they were barraged with a string of profanity and threats that caught the attention of a nearby police officer.  I waved him over and said to our patient, "Tell him what you told us."  The story changed from being shot to being in a car that had been shot AT a few days ago.

And then he asked for us to be arrested.  Arrested for not taking him to the hospital.  Seriously.  Then the officer did something that, if I did it, I would be an insensitive care giver and subject to losing my license:  He broke out in hysterical laughter and walked away.   As the medics gathered their smirks and giggles I asked what our patient wanted us to do if he was unharmed and uninjured.

"I want to speak to your supervisor." he says

"I am the supervisor," is my reply and he gives me a once over.

"I want your badge number, I'm calling the Fire Chief and reporting this whole ordeal."

blink. blink.

My hand instinctively went for my phone and I pulled it out. "I'll call her office right now. I want to hear you tell her about calling in a fire, lying about that, then lying to us, TWICE, then asking to have us arrested.  You tell her I'm here, S-C-H-O-R-R.  Here."  I didn't dial the office, which would have been awesome, but it had the intended effect.

"I don't want to get you in trouble, you'll get fired and it will be my fault." He's scrambling to his feet, eyes darting around the lobby as if looking for the exit, which is squarely behind me and my ambulance crew.

"So now you don't want to go?" the medic asks and our patient asks to sign the form.  He's seen it so often he can likely fill in his own ePCR.

Calling his bluff and ending his BS is not in my job description, as a medic or as a temporary Captain, nor is it listed in my protocols, but it was the right thing to do.  Many will say we open ourselves to liability in having such conversations but I will gladly stand in court and defend my actions against his words any day.

Thursday, February 3

Firecritic! I'ma let you finish but Rescuing Providence is the greatest blog of all time!

The voting is over and the fire and EMS blogs of the year have been announced at Firecritic.com.  But before 2 deserving bloggers, Iron Firemen and AmboDriver accept their Black Diamond X2 Boots I'm jumping to the mic Kanye West style.

"Ambo, Iron, I'm real happy for you and I'ma let you finish, but Rescuing Providence is the greatest blog of all time!"

Rescuing Providence is the winner of the first ever "Blogs that made me Happy" Competition which brings with it no awards, no prizes, no sponsorships, no speeches, no nudity and no pesky voting.



Even though each blog nominated on Firecritic's list is an almost daily read for me, only one is in my reader for instant notification.

Thank you Michael!


And just to round out my Kanye:

"Rhett Fleitz hates tall people."

Wednesday, February 2

Scrub a dub dub

While washing the HM Mobile this morning (which recently crested the 100,000 mile mark TYVM!) I was amazed at how dirty it had gotten over the holiday season.  All the trash from the kids' snack wrappers, pretzel crumbs, paperwork from work, scattered uniform bits and other such regalia were taken out so I could vacuum and clean.

At one point I told myself, jokingly, "You wash your gear more often than this car."

And it's true.  I wash my turnouts once a month and after every fire.  I clean out and wash my car far less frequently.  But then again, there are few chances my dirty car will lead to my premature death.

The reason we wear our SCBAs into fires is because of the smoke, right?  What is smoke if not particles of non-complete combustion?  Where does that smoke land while our lungs are protected by fresh air?  On our gear.  We get back from a worker and clean our hose, hooks, axes and engine so that they are ready for the next alarm.  We shower and change into a fresh uniform, or at least a new pair of shorts and a T-shirt.

But how often are you cleaning your turnouts?

They likely sit neglected on the floor of the bay, covered in soot, drywall, insulation and whatever else was in that fire, signaling to the next crew that you are the man.  You caught a fire and you are one bad ass.  Your jacket is just as filthy, as is your helmet, but I bring up the boots for a special reason.  Would you sleep in that fire building that night after the fire is out?

Then why do you but your dirty, dangerous boots RIGHT NEXT to your bed later that night up in the dorm?

Fires are still killing us and that is disturbing all on it's own, but what is more disturbing is the growing list of firefighters contracting rare, and not so rare, forms of cancer.  Bladder, kidney, lung... all cancers we open ourselves to when we fail to clean our protective gear after a fire.

The glory days of the Fire Service of Old are long gone fellas.  Smoke Eaters did this job when houses were made of wood and cloth.  Now there are metals, chemical carpet stain blockers, plastics and a host of other things that we recognize as dangerous and mask up.

But remember that along for the ride was your coat.  And your helmet.  And your boots.

Don't have time to clean them?  Find another excuse.

It's not that bad? Find another excuse.

Or keep doing what you're doing but don't be surprised when the doctor tells you you won't be able to enjoy that retirement you earned.