Friday, July 29

Alt Kilt steps up and we're Kilted!

Kilted to Kick Cancer, our effort to raise awareness about male specific cancers throughout the month of September, has received extraordinary news!

Not only has Magnum Boots USA stepped forward in a big way, but we now have an official kilt sponsor: Altkilt



Someone on Motorcop's facebook page suggested we take a look at their products and not only are they hand made in the USA, there was a link in their sidebar that caught my attention.  Kilted for kids' cancerGo read their story, I'll wait.

 

This match could not be more perfect.  The folks at Alt Kilts have a wide variety of products, even kid's kilts for all sizes, shapes, needs and budgets.  From the basic grey to the elaborate welder's kilt, each one is available custom designed for your lifestyle.  And for those of you conceal carry folks, I think they might just have something you're looking for.

 

Follow them on facebook HERE and on the twitter machine HERE and tell them #kiltedtokickcancer sent you.  If you need a kilt, these are the folks we want you to call.  They may even be offering specials for folks who mention KTKC, more details soon.  This is a small company with a big heart and we're excited to see where we can take this partnership!

Thursday, July 28

EMS Transport vs PD Incarceration

[caption id="attachment_3579" align="alignleft" width="240" caption="Drunk Girl - Crossfirecw"][/caption]

When people call 911 for an intoxicated person, which amazes me to begin with, I have to wonder why the badges start to bump into each other.

"Code 3 for the PD request" is a call classification I hate hearing because it means the call taker has not completed a triage of the call.  There is a glitch (yes, I'll call it a glitch because if this is done purposely I need to fix it) that allows PD to bypass call triage and get an amulance immediately.

There is no reverse for this system.  When I request PD code 3 I get barraged with questions.  And when I'm fighting someone no less.  When I get on scene to the PD request, they are most often standing, looking at someone.  Not providing care (which they usually don't need to and are not trained to do), so why not take the time to classify their call too?

Who knows.

The reason this is fresh in my mind is because on a recent run with our boys in blue I was told "We're not arresting him, it's too much paper work and too expensive for the department to hold him until he sobers up."

I stood up and cocked my head aside.

I responded that our paperwork is just as burdensome and the cost was exponentially more to the same city for what he was requesting.

Drunk is not an emergency, nor is it necessarily an arrestable offense, so what do we do?  If a person is unable to refuse transport (meaning unable to sign, not that they don't need an ambulance, which they don't) we're trapped in a way.  We HAVE to take them and the ER HAS to accept them, meaning the actaul patient we bring in later has no room and has to be diverted.  This is not an argument to have on scene. When on a run THAT patient is your concern, not the next one.  Let me worry about the next one.

This is an opportunity for a third service to step in and handle intoxicated individuals.  We do have "sobering centers" although I'd reclassify them as ambulance drop-in and pick-up zones with a 2 hour waiting period.  We take people there in an ALS ambulance, then when they awake and vomit, the center calls us back code 3 for the "unconscious."

Public intoxication is more common in my area than sudden cardiac arrest, yet there is no tool in my kit or on my radio to help.  The van service for shelter and detox requires a person to be ambulatory and climb in the van unassisted.  Most folks that meet that metric wander away when they hear us coming.

So why not let them sleep it off in the holding cell at the local PD?  I'm sure there's a person there to monitor them and it is remarkably less expensive than an ALS transport and hospitalization.

But that's not where they belong.  That is not the right place for them.

But the hospital is the more inappropriate place for them.  Why not check them out in the field, clear them of life threats (which the triage nurse will do from 100 yards) and let them sleep it off somewhere less expensive than an ER?

Motorcop?  Trauma Pig?

Turfing them to me is easy for you, but not for us, nor for the citizen.

Fodder for a Crossover indeed!

Monday, July 25

A Letter in the File - "Bystanders"

For you new people, it's been awhile since I've fired up the typewriter here at HMHQ to issue a formal reprimand, but this really got under my skin.

 

I was out as the supervisor when dispatched to a reported fainting on the sidewalk.  We get these calls all the time from out of town visitors not used to seeing the homeless sleeping off a bottle of $5 vodka in a puddle of their own urine.  I guess wherever they come from that's abnormal.  This is not the reason for your letter.

Still lights and sirens because you never really know, I realize I am the only unit responding since there is a second alarm fire a few blocks away and all the local engines are at it.  Dispatch advises they are "out of medics" and will send one when it is available.  They call it "medic to follow."  This is not the reason for your letter.

On scene there is a large line on the sidewalk for a concert at a venue a block away.  It appears a teen sensation is performing tonight (it's only 1pm) and the line is already easily 10,000 deep.  Hidden within this throng of people both young and not so is a hand waving for my attention.  The crowd seems unwilling to part from their place in the 10 person wide line that wraps around the sidewalk and I have to literally push people aside.  This is not the reason for your letter.

A security guard from a block away sees my little buggy (that's what we call our Chief and Captain cars) nearby and comes to help.  He removes the large gate the police have set up so that I can more easily access my patient, an elderly man who is unconscious in the arms of his maybe 14 year old grandson.  Of the HUNDREDS of able bodied men nearby, none step forward as, with ALS bag, O2 and Zoll M Series, I grab my patient (breathing with pulses) and carry him into a shady area out of the 90 plus degree heat about 40 feet away.  This is not the reason for your letter.

After my primary and secondary survey and the removal of some heavy clothing my patient is opening his eyes and talking about how hot it is.  A bit of cool water on a towel to the back of the neck and a 250cc bolus has him cracking jokes about the young pop star performing this evening.  As the ambulance arrives and takes a report I have a chance to stand up and take a better look around.  No one is looking at what is happening just outside the line to the show of the year.  This is not the reason for your letter.

Then you speak up.

You.

You and your "girlfriend" sitting in the cafe not 10 feet from me the entire time.  Watching me call for an ambulance, check for pulses, apply the NRB, the monitor, start the line, have the crying 14 year old hold the bag so I could help his grand father...you.

Close to 12 minutes you watched this man in distress, the grandson too, not to mention a lone paramedic who could use one more set of hands...any hands.

You are an "Off duty paramedic" and she's an "ER nurse" and NOW you ask if I need a hand?

A letter in the file for both of you.  Not for leaving me to help my patient alone, but for not coming over and offering your assistance to HIM or his grandson.  I was fine, but the kid needed someone to take the bag, hold his hand, anything, but you sat there within earshot the entire time, then jump in when the ambulance arrived?

If it was up to me you'd both be getting days off, but since you were both "off duty" and "drinking" I guess it was too far out of the question to help out doing something other than patient care.  Next time, just blend in with the crowd.

Friday, July 22

Complaint Department

For someone called the Happy Medic I do seem to complain a lot.  A recent discussion with a trusted Fire Service friend who introduces himself as " A Basic for life" circled back to why EMS folks are always complaining.

 

We complain about money, hours, crappy bosses, Medical Directors who don't get it, patients who don't need it and other agencies who aren't doing exactly what we want them to be doing.

 

When he rattled off that list I couldn't help but stifle a chuckle and agree, "Yup, that's EMS in a nutshell."

 

We in EMS love to be abused and have had plenty of chances to jump off this roller coaster but never do.  We come back over and over again not to complain and bitch and moan about it, which we love to do, but because we love to do this thing called EMS.  For every crappy call I make a difference on 2 others.  For every MD who has no clue what we do another steps forward and smiles when they see the compassion and care we give our patients.

 

The positives are out there and we see them, we even secretly think back to the times we were instrumental in making someone's bad day just a hint better even if it was just for bringing them a blanket or putting their little dog in the back room before we left for the hospital.

EMS bloggers are notoriously negative because sharing the good moments isn't as therapeutic as letting the bad ones out.  Griping about how much I hate little rat dogs (Nothing but love, MsP) relieves far more stress than a post about how nice it is that the elderly can keep pets better these days.  See, rat dog tirade beats observation about Granny any day.

 

From the outside my blog is a collection of complaints, gripes, wishes and dreams with very few shimmers of hope.  Well, that's how it is on the inside as well, but if I came to this little wordpress screen and began to tell you all the good things about my chosen profession I would spend 22 hours on it instead of just the 2 I do complaining.

 

This is still my therapy experiment, shouting into this room of mine that used to be empty, but somewhere you and I connected on something, be it good or bad, inspiring or deplorable and each of you reading this likely has a different reason for stopping by again and again.

The Google tells me most of you like a good misuse of 911 story or a letter in the file of some EMT or Paramedic doing something stupid and I can see that, but keep in mind I have a smile on my face most days because this therapy experiment lets me get those emotions out here and not on scene.

And when we can side step burnout simply by venting, we extend a job into a career, and that's what I'm here for.

Thanks for reading,

HM

 

 

Wednesday, July 20

Thank You OCFA Engine 26

10 hours cramped into a fire engine.

450 miles.

14 minutes and 40 seconds that made me cry.



Thank You.

Tuesday, July 19

I never would have guessed

Reports of shootings and stabbings just blocks from where Washington DC "Public Safety Officials" chose to deploy firefighters in an effort to deter crime?

You mean it's not working? Who would have guessed?  I'll need a minute to compose myself.  Discuss amongst yourselves, I'll give you a topic:

"Police and Fire are never expected to cover expenses, why is EMS?"

Ah, I'm better now, thanks.

 

The cartoon Statter911 links to says it all.

 

It's not working DC, pull those fire and EMS crews off the street corners and let the police deal with law enforcement.

You've been watching too many movies. Before trying anything else sit down for a minute and really think it through.  It seems cardboard cutouts of police cars and fake cameras would have a bigger impact, and be safer.  Don't forget that your firefighters and paramedics are "public" too and fall into your "Public Safety" arena.

 

Good grief.

Saturday, July 16

the Crossover Episode 15 - DC Needs their heads examined

The Happy Medic and Motorcop are back with a look into the Washington DC idea of preventing crime using unarmed firefighters, then some tips on how to answer the dreaded oral boards question "Why do you want this job" and we finish with an exciting announcement about cancer and the month of September.



EPISODE 15

Friday, July 15

You Make the Call - Stove Fire

You are assigned to a three person engine company dispatched to a reported kitchen fire in a restaurant.  On arrival you have light smoke showing and a manager advises you a cutting board is on fire on the stove top and that all employees and patrons have exited and are accounted for.

The building is 3 story type 5 with the top 2 floors residential.

Conditions inside are smoky but the kitchen area is visible from outside and only 20 feet inside the front door. It is open to the dining area, only a half wall separates the kitchen from the rest of the area.  You observe flame across 8 burners climbing 2-3 feet towards the vent.

 

All utilities, ventilation, search and other concerns are being handled by other responders.

 

Your selection of suppression devices is as follows:

1)Water extinguisher

2)CO2 extinguisher

3)150' 1 3/4" preconnect

4)1" booster reel

 

Which do you choose and why?  You Make the Call.

Wednesday, July 13

Giving up social media

A recent article in a major EMS publication has me second guessing how I communicate.  Regular readers may want to sit down before reading this.

 

Imagine that instead of thinking through a thought, concept or comment a person could simply spout it out, anonymously, for anyone who wanted to listen?  And not in a public arena, but from the comfort of their own home.

Gone are the days of decorum and civilized discussion when a person took out a pen and paper and wrote a letter to the editor.  Replacing that honorable tradition is this new technology promising to let us communicate instantly with anyone in the world, at a moment's notice, to say anything about anything, not knowing who may be party to the conversation.

Privacy is gone.

When I speak my mind, where does it go? Into the ether to be collected on the other side, surely, but what of the intermediate?  Where is it before it gets to it's destination?  We'll never know who or what is there, listening in, watching for us, taking notes just in case.

No longer can correspondence be between two people when a third party could be a part of it at any moment, without notice.

This is unprecedented in world history and I can not be blind to it any more.  Where is our honor?  Where is our respect for our fellow man?  When did we decide that communicating instantly was more important than communicating well?

I imagine next we will stop referring to one another by our names but instead use the letters and numbers that define where we are in relation to this so called "new frontier" of social interaction.

Well, I'm out.  I have seen the dangers, read actual accounts of persons who have fallen out of good public standing because of someone reporting what was recorded and I am not going to take the chance that this technology comes between me and a meaningful relationship with my friends and colleagues.

 

I am giving up the telephone.

-HM

Monday, July 11

You Make the Call - Kid in the Street - What Happened

This call was fabricated to see what different kinds of treatment options and requirements exist amongst my 4.75 readers.

 

The kid seems fine, but the language barrier puts us in a gray area and learning that he fell to the hood of the car with mom on top, then to the ground adds to the dreaded M word.

 

But in this situation, unfortunately, many systems' hands are tied.  In some areas a new category has emerged called the "High Risk" population, commonly those under the age of 5 and over the age of 65.  Some protocols are requiring MANDATORY precautions for patients who meet criteria regardless of physical assessment or paramedic judgment.

I am against blanket policies that take my clinical judgment out of a decision matrix.  If this is the future of EMS, let me off the train, we need to rebuild the track.

 

My system has this group but luckily we are still clinging to a "paramedic judgment" line in our policy to let me use my skills to evaluate the patient, not the protocol.

There is always a debate as whether to "immobilize" this child or not, mainly because we all know attempting just such an intervention will cause more range of motion and trauma than letting him stand still.  I don't need research to tell me that.

Spinal Immobilization is useless at restricting cervical movement,  a nice splint for other things, but until an agency is willing to admit the truth, we're afraid some lawyer will bring up a 30 year paramedic who will testify that they used the board for 30 years and never had a problem.  Groan.  Defensive medicine.

Instead, they would rather us pull out the pediatric LSB, wrestle the kid into submission, twisting and contorting his little body far worse than anything he's experienced already, then, because he doesn't understand our requests to stop ripping the tape off his head, we have to restrain him.  Restrain a 2 year old based on someone's warped definition of a "high risk" group.

In the end I have 2 options for this kid, neither of them appropriate for the situation.

First, full C-spine immobilization and trauma activation based on the "High Risk" matrix or convincing mom that further evaluation is warranted and she and the kiddo should come calmly in the ambulance, no lights, no sirens.

A refusal on this kid is going to be tricky and a tough sell to the Medical Control MD on the other end of the line.  If you tell the story wrong they might launch a helicopter (or 2).

 

This tale began as a near drowning in a pool to see who would board him, but after running a guy hit outside a crosswalk I decided to change it.

As always, regardless of how archaic our protocols may seem, follow yours.  If you don't like them, get them changed. On scene is no place to challenge established policy.

Sunday, July 10

Sunday Fun - Close your doors

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On a recent family trip we drove past a sub-urban/rural firehouse quite a few times. Each time we passed by, all three rigs were in quarters, sometimes bay doors open, sometimes closed, but I made an important observation I'd like you to confirm for me:

How busy your rig is is inversely noted by how many rig doors are open and how many boots sit outside said doors.

Each time we drove by all 4 doors of the ladder truck were open with boots on the ground and on some passes, even a coat could be seen hanging from the door. This tells me you aren't running many calls.

When running a large number of calls it is important to keep all your gear safely inside the rig so as not to forget it or have it placed aside when the driver does something without you.

My system has 2 of the Nation's busiest engine companies and one of the busiest truck companies and they don't sit with their doors open, gear on the floor because they have become efficient in donning due to their call volume.

I thought back to my early rural days and we almost always put our gear out with the doors open in hopes of a call. Even the other night at the five-one I spotted a door open and we had had a slow day to that point.

Close your doors and put your gear back in the rig. All that "preparation" only telegraphs that you don't get dressed all that often. Unless of course that's the only time you get to touch your fire gear aside from the locker.

Saturday, July 9

Job Opening - Paramedics needed

Michael Morse is hiring for The EMS.

 

I don't swear often, but when I do, I say:

"Michael, Hells yeah I'm in!"

Friday, July 8

You Make the Call - The Kid in the Street

Oh, I caught you off guard didn't I?

For you new people, this is a situation I completely made up.  This did not happen.  Today I give you a situation, on Monday we discuss what I would have done.  Now that that is out of the way, let us begin the call.

 

You are dispatched to a reported motor vehicle versus pedestrian incident at an intersection well known for trouble.  You and your EMT partner arrive on scene before anyone else to find a car stopped BEFORE the crosswalk and a woman and a toddler nearby on the sidewalk.

As you approach the child, later you discover he is 2, he begins to do the usual "I'm afraid of the new people" dance behind mom's legs.  He does it steadily, never off balance and if he's hurt he isn't showing it.

Mom is giving you the same impressions as you complete your primary assessment, finding nothing of note, except she does not speak English.  They're from out of town but your partner speaks their native language, but the kiddo seems uninterested in answering questions.

No trauma, no pain, no complaint.  All she wants is the police to come and cite the driver.

 

A BLS crew arrives as you begin to head for the driver, just to be sure, when they wave you off.  They're a strong crew and you trust their judgment.

That's why you believe them when they tell you what the driver tells them:

"I came around the corner and the lady was in the street already.  I couldn't have been doing much more than 10, when I hit her, she was carrying the kid and she flopped onto the hood.  Well, onto the kid on the hood at least.  They seemed fine, the kid didn't cry or anything, but they hit the ground and got up no problem.  I backed up just to make sure they were OK."

Per your own protocols and policies in your area, what do you do next?

You make the call.

Wednesday, July 6

Well Geez Honey...

Hybrid Medic asks his nurse wife an honest question and she assaults him?

 

Hehehehehe