Sunday, May 29

Jumping off bridges

[caption id="attachment_3572" align="alignleft" width="180" caption="Jump - Aza Raskin"][/caption]

No, this isn't a post about the Golden Gate Bridge.

Although it could be.

More a comment a bout blind allegiance without question.

I think everyone's mother at one time uttered the phrase "If all your friends were jumping off a bridge would you do that too?" when our defense of a choice was "But all my friends are doing it!"

I was wondering recently why so many systems are running full speed towards certain treatments that have a great effect, but not necessarily pre-hospital.  If the beneficial time of application is within 3 hours of illness or injury and my average time from patient contact to hospital is 30 minutes, is that worth the investment for the system?

What if the time of application is 6 hours?

If studies show that applying treatments within 6 hours is beneficial, is that a good investment for my system?

So many systems are running towards therapeutic htpothermia and judging by the studies it is a beneficial treatment.  But do we need to be starting it immediately?  From what I can tell systems with prolonged transport times, only Intermediate Life Support, most rural areas, could see a great improvement in patient outcomes.

But in the urban settings, when even the ER could wait to apply it, is it something we need on the rigs, in our continuing education, and yes I'll go there, additional opportunity for misapplication (liability)?

When does the risk/cost outweigh the benefit?

I think it is similar to the decisions I make in starting an IV pre-hospital.  We have nifty little saline locks attached to tubing for "gaining access."  With the risk of infection in the back of my rig, or worse yet in the street, I will only take that risk if the benefit is there.  Why am I breaking the skin simply to attach tubing?  If I am not anticipating the administration of life saving fluid or medication, then why even do it?

When these pricey little guys arrived in our bags there was a training session and now 4 saline tubes and tubing are in my overflowing 40 pound bag.  In the early days someone (I don't know who...) put a little paper in the baggie with the saline lock that read:  "Peripheral venous puncture is not a benign procedure.  If you do not anticipate the administration of life saving fluid or medication, does the benefit of administration outweigh the risk of infection?"

I still don't use them and am quite within policy, protocol and the one that should be first on the list, the patient's best interests.

BUT, on the other side of the bridge jumping argument, I like to think I surround myself with people who are like minded, forward thinking individuals.  If Ted Setla, Radom Ward, Chris Montera and Jeremiah Bush jumped off a bridge I would have to ask some serious questions as to why.  Or trust my friends.

I have made some blind leaps in the past that I now find foolish, probably still a few left in my future, but a blind allegiance is the thing I want to bring to your attention.  It is said that the most dangerous person is the true believer and someone who will blindly jump off that bridge with their friends no questions asked is the same in my mind.  However, a constant doubter, someone who refuses to jump or stay, but wants to see what the majority of folks do first is equally as foolish.

So when Mom asks  "If all your friends jumped off a bridge, would you jump too?"

I'll answer:

"Well...is there a train coming?"

Tuesday, May 24

Alert for the Haz Mat Incident

Our engine boss is cramming for the Captain's exam when the bells ring for a call at the golf course.  A HazMat at the golf course.  This could be interesting...

THE EMERGENCY

Multiple calls for multiple sick persons, unknown cause.

 

THE ACTION

There are a few things we look for on the way to these types of calls, right?  There was no smoke, or cloud, and we approach from upwind, despite the requests from local law enforcement to pull up to the main entrance with him.  However, his skin remained intact and he was conscious, so our trusty litmus officer was helping in an odd way.

There were, however, 2 things that had me curious on our approach.  First, the ambulance had arrived before us and was staged across the street.  Second, there was a line of cars exiting the parking lot in a hurry.

Something was up.

 

We parked upwind at a hydrant so we could hook in and mass decon if needed.  Airpacks went on and the triage kit came out of the side compartment.  I was having trouble resetting my mind from being the EMS supervisor the day before, to being part of the engine company today.  Part of me wanted to establish the warm zone and set up the decon corridor while also designing ambulance ingress and egress.

Instead I had to find out what on earth spooked an entire golf course to run like hell on a beautiful California afternoon.

The remaining people near the clubhouse are pointing and giggling at the firemen approaching taking full precautions as we're shouting for them to remain still and tell us wha on earth is going on.

As with most emergencies of this nature, their first action was to come towards us.  Great.

"In the kitchen," a man with a name tag tells us, "Pepper spray."

Huh?

Around the side of the building is a person with a wet towel on their face and a group of white shirt, checkered pants clad folks, clearly the kitchen staff.

Someone thought it would be funny to release some pepper spray into the kitchen during the lunch rush.

When the entire staff ran out of the kitchen screaming and rubbing heir eyes, the patrons thought the worst and did the exact wrong thing.

They dispersed themselves across the City and the region before we had identified what had happened.  Perhaps they understood it was pepper spray, but none of the non-kitchen staffers were able to tell us what had happened, so I doubt that.

Now imagine it was somehow something more sinister and all 300 people escaped without being decontaminated.  There you are in your district running a general sick call.  She mentions being in San Francisco a few hours ago on a golf weekend that went sour.  Then the husband vomits and passes out.

Worst case scenario sure, but we deal in those sometimes.

Any ideas on how to stop those evacuating?  And don't say PD, because remember, he's already in the hot zone.

Sunday, May 22

Bryan Stow Attacker in Custody

The LA Times is reporting that one of Paramedic Bryan Stow's attackers is in custody.

 

One down, one to go.



Keep up your support!

Friday, May 20

Missed Connections

YOU - Screaming about how we were fighting you, no shirt, significant head injury and intoxicated.  The things you said made my heart sing.  And by sing, I mean one of those heavy metal screaming songs no one listens to unless they have to.

ME - Dressed in yellow, kneeling on your shoulder dodging bloody spit.  In all the yelling I never got your name.  You only said you'd see us in court where you would, "Sue your ass for everything you'll ever be!"

 

Let's meet in court, I'd love to connect again, just let me know where and when.

Thursday, May 19

EMS Day on the Hill - Part 2

Needed to focus on Denver this past week but still want to share more from EMS on the Hill day.

My morning started the night before when I got on the airplane and after finally getting into DC from Dulles Airport (an hour in traffic and $70 cab ride later) I grabbed my packet at the front desk. The packet was handed out the night before at the informational dinner where folks got a primer on when their appointments had been made. Additional information about how to act and what to expect from lawmakers and their staffers was also covered. I missed it all but thankfully the California delegation brought me up to speed, and fast. If you've never done advocacy, the NAEMT gives you a crash course.

Just before meeting with the California delegation I ran into the hotel restaurant for a quick breakfast and saw a group of friends walk in the door.
EMS 2.0 pins were proudly worn by Scott, Random, Natalie and Meris as we shared a long overdue greeting and smile.
In between bites of egg and sips of coffee I was rifling through my schedule for the day. What I thought would be only 3 meetings (My Congressman and the 2 Senators) was suddenly 8. I had no idea where I was going or half the names I was going to be meeting with. My research into Garamendi, my Rep, had me excited because he was paramount in establishing California's EMS Agency in the 1970s and has supported EMS bills state wide since.

Our first meeting took us into one of the three large buildings, past offices from many of our 50 states to the last one at the end of the hall with the US and California flags aside the doors.

Our first meeting was with the staffer from Henry Waxman's office,Congressman from Los Angeles.  We took a seat at the table and went into our topics.

There is a strict format we were supposed to follow.  Introductions, "asks" and thanks.

Yeah...no.

We offered literature from the NAEMT that explained our positions on legislation and a few pages about what an EMT is, how many of us there are etc etc, but I wanted our visits to be memorable and make an impact.  It is likely everyone tries this, but I had to give it a shot.

Into the folders, somehow, a Chronicles of EMS patch and card fell and each person we met with immediately felt it  and smiled.

"That's cool!" our first staffer proclaimed when we concluded the meeting.  He had to tell at least one other person, right?

There were 3 main pieces of legislation we focused on (the descriptions are from my thank you letters):

HR 1668 extends federal death benefits to private paramedics and EMTS who die in the line of duty. The same benefits awarded to their governmental counterparts. It shouldn't matter who employs us, but the job we do for our communities. The CBO reports the costs are completely offset by DOJ forfeiture. There is a similar bill in the Senate and it appears to be part of the FAA bill.

 

HR 607 supports expanding the D-Block Broadband for Public Safety. Imagine if your entire office had to share a dial up modem. That is what public safety is forced to do using the narrow band of traffic available to us at the present time. Most recently as the San Bruno gas explosion, fire and rescue radio systems were overwhelmed and unable to function. Commanders resorted to cell phone and messenger. We deserve better and if a large earthquake strikes, the Third District deserves fire and rescue who can communicate to help them.

 

HR 1005 supports increasing medicare payments to ambulance companies. Currently ambulances are reimbursed BELOW the cost of service causing many private companies to close and many municipal agencies to restrict services to the community. HR 1005 seeks to increase the funding 6% per the GAO report.

 

When speaking to a Senator's staff we had other bills to reference and each office we met with, save one, was receptive and sent staffers who already knew details about the bills we mentioned.  We even learned about recent developments and were able to share it with the larger group later in the day.

Speaking of larger group, check out this photo!

EMS on the Hill 2011I'm the tall guy WAY in the back.

More on how to tell which staffers think you are a waste of time and why missing this event next year is a mistake soon.

Monday, May 16

Bryan Stow one big step closer to home

I got the email yesterday while cooking dinner. It was the usual daily email about overtime available on the ambulances the next day, but the subject line caught my eye immediately:

"Escort Bryan Stow to SFGH - Need volunteers."

The phone flew into my hand.

Representatives from Santa Clara American Medical Response (AMR), San Francisco AMR and the San Francisco Fire Department EMS Division came together to give Bryan a proper ride to his new temporary residence at San Francisco General Hospital today, May 16th.

The plane left Los Angeles and touched down at San Francisco International Airport just after 1pm and the AMR Critical Care Transport Team was ready, as were Bryan's ex-wife and his cousin, both of whom have been visiting Bryan since the incident at Dodger Stadium in April when he was attacked for wearing a San Francisco Giant's jersey.

Due to the short notice we were unable to get the FRN cameras to join us, but it was an amazing experience. When the plane landed and the CCT unit was allowed through security we all stood a little taller. When the airplane door opened you could have heard a pin drop (if you filtered out the 747's departing close by for exotic locales unknown) and when Bryan was lifted out and onto the cot on solid ground I heard more than one person whisper "Welcome home."

From there the CCT unit, Bryan's regular ambulance from Santa Clara and the supervisor's unit pulled out of the airport parking lot and the SFFD led the way.
Members from Station 49, the SFFD EMS Division, all off duty, lit up Medic 54 and cleared the way for what one local TV station called a "mini caravan." Closely following were Bryan's family, the San Francisco AMR rig, and my unit Medic 94. Following up in the end was on-duty EMS Supervisor Rescue Captain 3, whose first due area includes the Airport.

We have seen a motorcade and escort in gloomier times, when friends are no longer with us and to be part of a positive escort was uplifting. Seeing cars yield to a long line of EMS vehicles was striking.

Not one fire engine.
Not one police cruiser or bike.
Just EMS folks helping a brother home.

There were numerous helicopters filming us on the freeway, but I have yet to see any of that footage. I would like to see it from the air, I think Bryan would love it. And one day I hope to meet him.

Don't forget you can still donate to support Bryan and his family by visiting Support4Stow.

 

Video from KIONtv reporter Azenith Smith:

 

the Crossover Episode 13 - Gordon Graham

My partner in crime Motorcop has taken the cassette recorder from the Crossover Show locker and scored an interview with Law Enforcement expert and San Francisco native Gordon Graham.
Mr Graham served as a Motor Officer in Los Angeles for 10 years, my guess why the interview goes so well. Those motor guys stick together.

They discuss social media, the use of smart phones on the job and the risks that come with it. This is a no nonsense interview and my helmet is tipped to our Boy in Blue for a job well done. just make sure you rewind the tape and put the recorder back.



Episode 13

Saturday, May 14

Bad Customer Service - Sometimes it's our own fault

Grandpa would pull into the service station and three young men would jog up to the car.  Check the oil, fill 'er up and wash the wind screen.  Life was good.  Service with a smile.

My how times have changed.

We can blame it on personal responsibility, say that we get crappy service because those providing it don't care, but what happens when it is company policy to be a jerk?

I think we can all agree you think I'm some Liberal out here in SF, ranting against the corporations and against free market capitalism, and you'd be partially right.  I have seen a number of examples where a superior product or service is pushed out of the market by another.

Starbucks coffee was never very good, but it was hot (burnt most days) and easy to find.  That green logo seems to be everywhere and on a recent rough morning my preferred coffee shop was across town so I gave up quality in favor of convenience.

When I travel to and from work I use a travel mug from my favorite coffee shop.  I've had it for years.  Then I left it at Ted Setla's house a few weeks back.

This morning I wandered into the coffee shop and into line with a paper cup from the day before that I had rinsed out yesterday.  I'm no environmental nut, but one less cup is one less cup and my mug is gone.

Up to the counter and I hand him my cup, as I have done dozens of times in other coffee shops, and asked for a fill up of coffee.

He took the cup, began to turn and then looked at the competitor's logo on the side.

"Um, we can't use your cup, it has to be one of ours...for...for quality control."

I turned to my right to the line-up of travel mugs awaiting 600 calorie milkshakes we convince ourselves are "coffees" and asked the obvious question.

"But those are not yours.  You guys do it all the time, pretend I was here 20 minutes ago and refill it."

Now the other cashier is involved and spinning a yarn about the health code.  I point out the more than one person in line with a dog on a leash and they have no response.

In the end I settled for getting a new cup, I'm no militant and I wanted more coffee, but I realized that it was my own fault for sacrificing what I knew to be a superior product with superior service just to shave 20 minutes off my commute time.

This is why places like this are successful.  We're too lazy to do the right thing and support what we actually like.  I just wonder when I'll stop doing the same thing and expecting a different result.

And yes, the coffee was burnt.

Wednesday, May 11

Funny you should ask...

I like it here in Dever at Zoll Summit.

I like talking to the rep that handles my Department's monitors and ePCRs.  I like talking to the sales people about what's new and improved in the line of products.  I like listening to presentations from speakers about the future of EMS technology and how, as one twitter follower asked, it's getting smaller, smarter and cheaper.

I sent out a message yesterday morning asking you what you would change on your monitors if you could.  The responses were what we all expect, smaller, lighter, less cumbersome, better cables, but the one thing that was mentioned most was the ability to wirelessly transmit 12 lead ECGs to any destination regardless of proprietary tech on the receiving side.

When I read that I nearly shouted out loud in the presentation room.  Reason being that the speaker was discussing the launch today of ZOLL RescueNet 12-Lead, an open architecture, browser based transmission system that allows any person with log on credentials to view a transmitted 12-Lead anywhere they have an internet signal.

Sunday, May 8

Zoll Summit in Denver

No better time to get back on the road than 2 days after getting home, right?



It has now been a full year since EMS 2.0 was given a chance to be heard at a conference when ZOLL brought me and Mark Glencorse out to Denver to pitch the idea of improving EMS from the ground up.  It was very well received at the time, but some in the crowd told us it was the same ideas they've always heard but with a new title.  I can kind of agree with that.  Nothing I or many others associated with the movement are suggesting is new, but we're sharing information in a new way letting us make informed decisions on policy instead of stabs in the dark.  Borrowing wheels instead of re-inventing them, if you will.

ZOLL Summit is a chance for EMS Leaders, Q/I Staff and others to come together and discuss technology and leading trends as they pertain to EMS.

It was at last year's ZOLL Summit we heard speakers call for smaller batteries, lighter defib units and perhaps...gasp...remove the defib completely.  Leaders from many systems, Medical Directors and yes a few medics and EMTs met in the hallways to discuss parts they love and parts they don't in their data systems, ePCRs and monitors and folks from ZOLL were always there to listen.

 

On Monday the 9th Thaddeus Setla joins me to head out to Denver in Mark's place to bring the Summit to you!

 

Instead of having to find the words to describe the networking and chance to give input to the industry, we're firing up the FRNtv cameras for updates conference style.  We've been the ones to bring you same day coverage of both major EMS conferences and ZOLL, our oldest and biggest supporter, is looking for the same kind  of coverage so we're enroute.

Updates will come fast and furious with that Ted Setla flair so keep your browsers pointed to FirstRespondersNetwork.com for updates almost as soon as we land.

Something you want to ask ZOLL Medical, ZOLL Data or any of the ZOLL divisions?  Leave a comment and look for a video reply from the folks in the know at ZOLL Summit in Denver this week.

Friday, May 6

EMS Day on the Hill Part 1

I wasn't sure if the trip would be possible this year and trying to sleep on an airplane for the second time in 16 hours on the way home I almost regretted it.
EMS Day on the Hill was organized by our friends at the NAEMT and had an attendance this year of almost 200 EMTs, Paramedics, Chiefs, Managers and Medical Directors.

My first Washington DC visit began just before 11pm when I got on the plane in San Francisco with no bags, no change of clothes, just me and my coat, tie, iPad, phone and Random Ward's camera.

A restless 4 hours of tossing and squirming in the fully sold out airplane led to a beautiful sunrise at 20,000 feet as we began to descend and everyone rubbed their eyes and readied for the day.

Just before 8 o'clock I made it to the Park Hotel and collected the packet from the NAEMT. Inside was my badge for the events and a number of pre-made folders to hand to lawmakers. Inside were info sheets on three important pieces of legislation we were presenting to the aides on our visits which had been prearranged based on our home state. After all, why would the Congressman from Maine care what a Paramedic from California thought?

Expectations? None. Like being dispatched to an "unknown problem" I would be relying on my brief research into etiquette and the tips mentioned in the packet to guide my actions. Luckily the California group was large enough to divide and conquer. Three of us set out on a schedule and the other 2 would cover the remaining appointments.  5 of us would handle 8 meetings and 2 photo ops.

We were not scheduled to meet any congressional leaders, but instead one of their aides. It would become clear how important they thought our meeting was based on the aide who was chosen to meet with us. For example, one lawmaker sent us their lead council, another their Healthcare expert while yet another had us meet in a hallway with whoever drew the short straw.

If you've ever worked a trade show or as a salesperson you understand how your presentation becomes more streamlined as you go and this is no different.  as soon as you say goodbye and walk out a better phrase pops into your head or a different example becomes clearer.

My group included NAEMT Secretary Charlene Donahue and Dr Kevin Mackey, who serves rural and suburban areas of Northern California. He was very interested in my EMS 2.0 pin and is already curious enough about improving EMS to travel to other systems to learn more. More on that later.

Congress keeps their offices in a group of 3 large buildings interconnected by a series if tunnels and even an actual subway train in the basement.
Mixed in with we lobbyists were hundreds of young staffers running from office to office doing goodness only knows what. The cavernous hallways upstairs in the office area were full of folks running to 5-10 minute meetings with staffers who scrambled to find meeting space.
Downstairs in the basement moving between buildings is quite different. Cramped, slightly damp and shoulder to shoulder are all the same folks from upstairs looking for the cafeteria or restroom, but now you begin to see well dressed people moving with purpose in small packs. Each of them is wearing the Congressional Pin on their left lapel which denotes them as members of congress. Here in the basement, just walking around. I was constantly scanning the groups for any of the Californai law makers we were hoping to meet with, perhaps even walk with them and pass along our concerns. Alas, I never saw them in the basement, but each time we stopped into an office and looked at the live feed on TV we would see one of them speaking on a topic. It was surreal to look up at Rep Waxman on TV, then down at his office, then up at him, then down at his office and wonder how busy his day must be.

 

It is said that seeing laws made is much like seeing sausage made in that after seeing it one may not wish to partake in the experience of the final product.  But seeing the sheer volume of topics presented by lobbyists just in the short time we were present, everything from coal to cancer, eyelashes to budget slashes, it can't be easy to choose where to vote on some of these issues.

 

In coming posts I'll describe the three pieces of legislation we were trumpeting, the names of the folks we met with and how the meetings went and a brief wrap up of how I think we can inform law makers better next year.

Sunday, May 1

Well done boys.



 

Now get home.