Wednesday, August 31

Random Thoughts of Anniversaries and Expositions

Expo is alive and well here in Las Vegas and the FRNtv team is at full alert.

From Thaddeus Setla and Chris Eldridge shooting and editing video almost in real time to Random Ward and Sam Bradley preaching the good word at the ZOLL booth, we're operating at full speed and the response has been positive.

 

In our booth and in our hearts is the missing team member Mark Glencorse, who's name still gets recognition as Medic999.  But since he can't make it...I've had to recruit a new buddy.  My new partner in crime, noted blogger and dapper dresser Random Ward, has jumped into the deep end by not just attending his first conference but manning a booth at his first conference.  Having someone else who can explain the heart and soul behind FRNtv and CoEMS while Thaddeus and I film product videos is a huge stress reliever.

 

We started early this morning and didn't wander off the show floor for nearly 8 hours, a fair days' work.  Some quick blog catch up time here and we're heading for the pool to relax.

 

In the meantime, a quick Happy Anniversary to my little therapy experiment here as 3 years ago today I hit publish on my very first blog post.

 

And the rest...as they say...can be learned at the 1:15pm session "How a Blog Saved my Life" here at EMSWorldEXPO.

 

See you there!

 

Sunday, August 28

Surprise You Make the Call - Prank

I read this story over at Curt Varone's Fire law blog a few days ago but it's really had me thinking.  Where does your prank end and vandalism against my property begin?

We've all done something funny at someone's expense which they didn't think was too funny at the time, but what about the situation in Curt's story?  Comment here, there or both.

 

Was that example a prank or something else?

 

You make the call.

Friday, August 26

EMS World Expo Approaches!

As @ssgtjbroyles has been reminding me since the t-minus 90 days mark, EMS Expo in Las Vegas has snuck up and is making us all a bit giddy with excitement.

Not just because of the opportunity to raise awareness for a good cause, but for the reasons we all go to the conferences: CEs, BFFs and toys.

The show floor is not the only place to find me this year, but when on the floor, our friends at Zoll have once again rolled out the blue carpet for First Responders Network.  Come meet me, Thaddeus Setla and Random Ward, Scott Kier (creator of the EMS 2.0 star logo) and many other EMS bloggers who often wander in and have trouble wandering away when we all get talking.

Even though you've seen myself and the Setla roaming the floor of other shows with the cameras in tow, this year we are the OFFICIAL video provider, so don't be surprised if Thaddeus has to grab camera and split, just let him go.

This conference will of course be starting with the ZOLL Pre-Conference Blogger Bash taking place Tuesday Night at the Hard Rock Cafe on the third floor in the Iron Curtain Lounge.  8:30pm is the start and if the past has been any indication you'll have a chance to talk with your favorite bloggers, podcasters and twitter junkies live and awkwardly in person!  ZOLL started the Pre-Conference bash at a table in a bar and in Baltimore this year it brought industry reps, publishers and even the non-social media inclined to see just what all the buzz was about.  And those rumors about Kelly Grayson singing karaoke right before the duet by Scott Cravens and AJ Heightman...that was a different party all together.

Wednesday starts the show and we'll all be hustling to get as much knowledge crammed into our heads as possible between trips to the show floor to see what's new in gadgets, gear and garments.  Grab a seat for the keynote at 10am from FEMA Deputy Administrator Rich Serino, brought to you by ZOLL.

Speaking of gadgets, thanks to the folks at RipShears, I have a few to give away FREE, but have yet to devise a clever way to distribute them.  Watch for details.

Gear wise, Magnum Boots will be on site offering their particular wares and be sure to hit the booth for your chance to get one of 50 Kilted to Kick Cancer T-shirts.  Magnum will also have some great new garments, I'll be wearing them, come find me.

 

Thursday starts Kilted to Kick Cancer, the month long kilt extravaganza we hope will make men think about cancers specific to them before we get flooded with pink in October.  If you have a kilt, this is your day!  After a long day in classes and on the floor, grab some time by the pool and get ready for the big party- Hollywood Nights.  There's a cost of $30 per person, but try finding a night out in Vegas for less than that.  Get gussied up and be there 630-11, and by "there" I mean Planet Hollywood at the Caesar Forum Shops.  I will be kilted after all it's still September.

Friday will find me bright eyed and bushy tailed (in a kilt still) at 8AM presenting "Infiltrating Command to Effect Change" a little something I whipped up while going out as a PRN Supervisor this past year.  Grab a bite and some hair of the dog and come back for the 1:15 "How a Blog Saved my Life" when I'll expand on the tale I tell in the opening scenes of Beyond the Lights & Sirens and tell you how all this blog crap actually keeps me from crumbling.  Seriously.

 

And remember everyone - What happens in Vegas...will likely end up on Facebook.

 

 

Wednesday, August 24

After the Shaking

...is no time to think about disaster preparation.

 

Luckily you, the regular Happy Medic reader, have already stocked up and written a Family Disaster Plan.  Remember?

 

Let's revisit an older post.

 

You can see the rest of the Disaster Plan series by selecting Categories from the header menu bar and selecting, wait for it, Disaster Plan.

 

Be prepared!

Tuesday, August 23

Customer Service - A Lesson

Oh here he goes again, ranting about customer service in fire and EMS...

Well, kind of.

I was bamboozled!  Hoodwinked!  Can you believe it?! Someone mark your calendar, get Guinness on the phone (both of them actually) because, wait for it,

A salesman lied to me to make a sale.

*GASP!*

My 5 year old DVR is great and all, I enjoy the level of service from my TV provider but the bundling has gotten good.  TV phone and internet all for almost what we're paying for TV alone, no 12 month intro rate, no pesky plan changes.  That was all in writing from the provider, so I was good.

But I had some technical questions that this fellow had the perfect answers for:

"Can we transfer the shows on this DVR to the new one?" I asked, knowing the answer to be no.

"Until about a year or 8 months ago no, but now we can upload your DVR to a hard drive and the technician installs it with the new software on installation day, so 'transfer' no, but all your shows will be on the new DVR."  his statement was factually correct but completely misleading in context.  He told me there would be no transfer and that all the shows would be on the new DVR (just not saved, I can watch them when they're on), but he painted the picture with tech and terms I understood to answer my question in a manner that fit his end goal.

"Will they have to run new coaxial cable?"

"No, they can use your existing satellite." A flat out lie.  The installer removed his glasses and rubbed his eyes when I mentioned this.  "What else did they promise you I could magically do?" He asked.

I imagined an ER Doc listening to all the promises made by EMS in the field to talk someone into the ER in the first place.  "They said you'd give me a fancy scan" or perhaps "They promised pain medication."

The point being that if you buy into the customer service ideals you are a salesperson when it comes to talking someone into transport.  Not the folks that need to go in, those are an artform, but the ones who we choose to take in to keep them from calling back later, or because protocol says the rash she's had for weeks could be a reaction to meds.

If you make promises to your patients you had better be available to explain them and be held accountable if your statements were inaccurate.

I have an understanding installer who has heard all manner of tales promising this exotic install and that computer glitch repair, all so a salesman can chalk up another commission.  This is the modern model of customer service folks, this is the example being used to move ahead in these economic times.  The point of service man saves time by making the more valuable service provider work longer, costing the service more in the long run.

And if your service is hurting from lack of income from decreasing transports...what lies are you ready to tell to increase transport revenue?

Tuesday, August 16

Positive Dubowksi Reflex

I am blessed in my district with a large population of wealthy folk.   I say this because the well to do often can afford healthcare that looks past the immediate and takes the time to educate them on their conditions.   And when given this information, have the time and money to follow up with medications, referrals to specialists etc.   So when these folks dial 911 it is usually an actual emergency.

 

Oh, OK, not really.

 

THE EMERGENCY

Dispatchers are reporting an aneurism in an elderly woman.

 

THE ACTION

Odd how Erma knows the problem requires surgical intervention, but she knows more than me at the time of dispatch so I'm thinking ahead to possibly managing a tanking BP in a system with a hole in it.

Little did I know I'd be bumping into separation anxiety.

Ritchie, the home owner, is off traveling North Africa for business (Isn't that always the way?) and his lovely wife and kids are home alone in their 8-10 room likely 6000 sq foot home and not feeling well.

Through our assessment we've been able to assess diffuse abdominal discomfort in the lower quadrants without re-creation or increased intensity on palpation, and given her age (no where near the 86 we were told) we have to assume a certain condition until otherwise proven false.

As we're prepping for transport to St Cleanest a young woman comes down the stairs nearby and identifies herself as the live in maid/nanny who will watch the children after we all leave.

As I'm reassuring our new friend everything will be fine, we're listening on the radio to other calls going out without an ambulance the system is so busy.   We are 5th in line for an ambulance.

With time to spare I decide to complete a Dubowski Reflex Test.

You ARE doing Dubowskis in your system, right?   I often score a Dubowski in the following situations:

  • You're lying

  • I think you're lying

  • I have nothing else to do but go through the fridge looking for a snack


The Dubowski reflex is credited to my first Paramedic partner Bill, who's singular mission in life was to make you laugh on scene when it was inappropriate.

Bill would explain to the patient that he was going to perform a very sensitive examination using partial cerebral spinal fluid pressure.   The patient would get an explanation of the circulation of spinal fluid just enough for it to make sense to them and justify what he was about to do.

You see, when he administers the exam, the slight pressure on the occipital skull will create an increase of fluid pressure through the Foramen magnum, down the spine and into the abdomen.   This may cause brief pain but could help determine the problem.

I explained the procedure to our calm, seated, on the phone with North Africa patient and when I gently touched the back of her head she screamed in pain and covered her abdomen.   At first I thought she was genuinely in discomfort, but instead of having a recovery period she immediately went into telling the man on the phone that her injury was serious enough to require a "Dubewski" test.

I swear for a moment I saw Bill in the corner of the room laughing his ass off.

Positive Dubowski aside, the ambulance arrived to a stable patient, ECG normal, fluids running TKO, full history documented, meds in a bag and listed and requesting they talk to north Africa about how dangerous it is for her to stay home alone.

 

Engine 99 in service.

Sunday, August 14

Probie, probie, probie...

A brand new class of recruits has graduated from the Division of Training and are now settling into the firehouses throughout the City.  I applaud them for making it through and for giving it their all to be welcomed into their probie houses for the first 4 month rotation.

They will either spend those 4 months assigned to an engine or truck company, then another 4 months on the other prior to being retested and released into the wild known as "Unassigned."

Having a probie in the house is both a blessing and a curse.

  • First of all, no more toilets to clean when there's a probie about.  But chances are their last job didn't have them doing janitorial skills for 2 hours a morning, so usually it has to be redone.



  • They're behind on the cooking charts, so we get a break from cooking for a bit.  Again, unlikely they cooked for 9 at their last job, so the portions will be off for a few weeks.

  • We won't have to sit by the phone on the day watch anymore. Or will we?  When the probie answers the phone, then sheepishly looks around the room of people they just introduced themselves to and asks "Is there a Justin here today?" we might as well just keep on answering it.

  • Drills drills drills.  And not the regular go grab a hydrant and flow some water drills, but the go through it 50 times in 50 different ways drills since we'll be trusting the newbie with our lives as soon as 2 minutes from now if we catch a fire.

  • Speaking of fire, no nozzle time for a bit, probie needs the experience.  Fine by me, I'm a layout guy anyhow.

  • One less person to trade with in house.

  • More details to other houses since the probie needs to stay with a regular officer.  Pack your bags.


 

But in the end, they need to fit in with the company they're assigned to.  Too often in recent years probie classes have hit the floor on day 1 with a sigh of relief that they finally "made it."  Wrong attitude McFly.  Stepping foot into our house, our home, is not your destination.  You are a guest.  A regular guest, but a guest just the same.

That means full station uniform at all times, even in the morning before you get relieved.  You will offer to take the nightwatch and not take no for an answer.

It means that wen you are cleared to dress down for PT, you allow time to get clean and back into uniform prior to the meal.

Being a guest also means not lounging on the couch, no matter what the senior members may be doing.  Grab a manual or a couple fathoms of rope and make yourself busy.

This is your time to get up to speed, not downshift.  You may think you've got it made and have crested the plateau, but fortunately in this business, one accomplishment simply leads to another opportunity to improve, excel and advance.

 

Welcome probies, now get upstairs and clean the Rescue Captain's room!

Friday, August 12

Get Checked!

I'm thinking this image will get the conversation started with or without a kilt.  Well done Norm Quiros! And thank you Magnum Boots!



Don't forget to become a fan of Kilted to Kick Cancer on Facebook and visit kiltedtokickcancer.org for details on events and where you can make a donation.

Wednesday, August 10

Birds and Bees be Damned

In the film Parenthood, the master thespian Keanu Reeves utters one of my favorite lines of all time:
"You know, Mrs. Buckman, you need a license to buy a dog, to drive a car - hell, you even need a license to catch a fish. But they'll let any butt-reaming asshole be a father."

The same goes for mothers.

On a recent job I was reminded that if we don't teach people, kids, what sex and reproduction really are, they will no doubt deliver and raise even more clueless humans.

THE EMERGENCY
A woman is in pre-term labor.

THE ACTION
I know, I know, I always laugh when I hear this dispatch. Then I wipe my eyes, grab the OB kit and get to work. As with every single one of these kinds of calls, our client is in a public area, in no immediate (within 4 weeks) labor and has no clue what contractions are, let alone her term status.

I too was clueless as to most of the facts surrounding pregnancy when I was her age, but at least I had the basics of anatomy covered.

As she sat on the chair enduring our "many stupid questions" about her previous pregnancies as well as the one now clearly evident, she stated something I think even my 5 year old knows to be inaccurate.

"My baby had a diarrhea today." She tells me matter of factly, almost like I shouldn't be surprised.
I immediately shifted gears wondering if she had been advised there was meconium present and just couldn't recall the proper term. It was when I followed this new road that everything became frighteningly clear.

"How do you know the baby had a bowel movement? Have you been examined? Has anything passed from the birth canal?" I asked, hoping my words weren't too confusing.

"No, baby had a diarrhea, then it came out my butt. Can we just go now?" Was her response.

Repeated questioning while awaiting the ambulance led us to the discovery that our patient had no idea about the separate plumbing that exists for birthing and defecation, nor did she know how many weeks until she was full term, or what that meant.

It is my opinion that "the talk" was never had and it is clearly far too late to have it now, but I tried anyway, as we always should.

Saturday, August 6

the Crossover Episode 16 - Kilted to Kick Cancer

Motorcop and the Happy Medic spend the show discussing the upcoming Kilted to kick Cancer event to raise awareness about male specific cancers. Learn how you can be a part of the movement through sponsors MagnumbootsUSA and AltKilt. Need a kilt for the month of September? AltKilt is where you want to go. Mention KTKC and get 15% off your custom 100% made in the USA kilt. Visit kiltedtokickcancer.org for more links and to learn where you can donate!

 

Make sure you subscribe on itunes and note the Explicit Content tag.  I'm just sayin'.



 

EPISODE 16

Silence is golden. So is fire.

An automatic alarm call is not unlike getting the elderly disoriented call on the EMS side.  There's a lot of investigating involved and most times it's something simple.

But as we all know, other times, it's not.

THE EMERGENCY

An automatic alarm is ringing at an apartment building.

THE ACTION

Alarm bells in my agency are handled by a minimum of one engine, one truck and a Battalion Chief.  This allows us to do a pretty darn good investigation and get started working if the alarm turns out to be the real deal.

As we pull up we notice no one outside and no alarm ringing.  Odd.

Inside to the alarm panel and it has been silenced, but is still telling us trouble on the third floor.

As we begin to climb the stairs to the third floor a man emerges from the ground floor unit waving his arms and pushing us out of the building.  Well, he's trying to anyway.

"I was painting and set it off, no fire here! No fire here!"

As we get up to the third floor there is not only a smell of burnt food, but the faint ringing of a smoke detector.

"Control, balance this alarm to a full box" we hear over the air from the truck crew on the roof.

"We've got heavy smoke now from a skylight, third floor bravo side."

Entry is made into the unit and we find a woman standing in her living room, the only room in the house not banked with smoke.  The open window is allowing horizontal ventilation for the pot of oil in her kitchen that is now extending into her cabinets.

It's a quick and easy job removing the pot of oil and knocking down the fire with the pump can and we let the companies coming in behind us search for extension.

The woman is surprised it took us so long to get there, telling us the fire had been burning for over 10 minutes and the alarm bells only rang for a few moments, then were silenced.  She thought that meant we had arrived.  She was unharmed and we decided not to tell her about the man downstairs who silenced the alarm.

The Chief downstairs was taking care of that for us.

 

So many times we arrive to alarms silenced by occupants who don't like the noise or inconvenience of the alarm going off.  Tough.  When it rings, get out and wait for us to investigate.  When it's safe we'll let you back in.

Thursday, August 4

Overheard in the Ambulance Yard

EMT #1 "Congratulations!  Kid number 4 on the way! Wow.  Hey, wait a minute, didn't you get the big snip snip not long ago?"

 

EMT #2 "Sure did, tests looked fine.  I guess I not only snuck one past the goalie I didn't even know I was on the ice.  Doctor said it grew back fast too, (suddenly proud) faster than he's ever seen."

 

EMT #1 "Well maybe we can donate your vas deferens to Congress and they can grow a spine."

 

 

Monday, August 1

Public Service Announcement - Misconceptions

Inspired in part by Motorcop and his hatred for the confusion between jail and prison I too would like to clear a few things up for the general public.  Nearly everything you have ever seen on TV about fire, police and EMS is false, yet you assume it to be accurate.  Especially all the medical dramas...I get that you watched season 3 of Grey's last night and know what abdominal pain could be, but listen, it was probably the 4 packages of TGIFridays jalapeno poppers, not an AAA, so sit down before you hurt yourself and actually need an ambulance.

Misconception #1: You call for an ambulance.

When your kid cuts his finger, when your cough won't go away or when your neighbor seems to be walking funny and the Today Show says it could be a stroke, you do not call an ambulance.

 

You call for help.

 

The help that arrives is what you want, don't look at me funny when you report your kid's laceration won't stop bleeding and I arrive 4 minutes later in a big red truck.  Don't get testy when I tell you the ambulance is coming but that he doesn't need it.  I'm the expert, I'm going to talk for a few minutes and you're going to do what I say.

OK, not really, the law makes YOU in charge of this emergency, what was I thinking?

In your extensive medical wisdom you've decided junior's finger needs the ER, despite my assurances to the contrary and your ambulance has arrived.  We aren't doing anything for him because, aside from the self adhesive bandage I have already applied, there is nothing more we, or the ER, can do.  "But because we go in with you, we'll get seen quicker, right?"

Misconception #2: Arriving by ambulance will get you seen quicker.

No, no no my friend.  When you arrive by car and go inside and wait in line, then the person behind the desk asks you to fill out all the info and they let you see a nurse real quick, then sit and wait, that is called triage.

Triage is a word that means to sort.  We take the sickest people first.  Well, the ER does, I have to take every Tom Dick and Harry who asks, completely ruining what could be a proper working system, but that's another blog entirely.  Well...not really, but we're off track now.  See what you've done?

When we bring you in by ambulance, no lights and sirens, stopping for every red light, we're traveling no faster than you could be.  Then we arrive to a little nurse's station where they collect your info and the SAME NURSE checks you out real quick.  Now guess what happens.  If you're not sick enough to be seen right away, we take you off the cot and walk you to the chairs in the waiting room.  Then we make sure we have your billing address correct and say good day.

Misconception #3: The ER fills and refills prescriptions.

Cough been keeping you awake all night?  Too bad you never got that prescription filled.  You see, when a Doctor examines and diagnoses you, they may write a prescription for medication.  This little form lists your medication, dose and instructions and is the Doctor's way of healing you, but you have to go just a might further on your own.  Goto the local Walmart and go back to that cool little office in the back and hand them the piece of paper the Doctor gave you.  You're going to have to wait a few minutes, so go wander the tackle isle and wait for your name to be called.

Take the medicine home, read the instructions and follow them.  Oddly, your health will improve.  I know, weird.

Calling 911 at 4 in the morning and handing me the prescription will not help.  I do not dispense medications,  I administer them when indicated.  The ER does not have a pharmacy that dispenses medicines, just one that facilitates administration.  The ER will look at the prescription form and point you in the direction of the nearest 24 hour pharmacy.  I tried that, but you wouldn't listen to reason and do the right thing, you demanded transport.  When you get home in 45 minutes, don't call back.

Misconception #4: Your Doctor will be at the hospital.

Hate to break it to you Erma, but Dr Johnson is NOT at St Farthest today, it's Sunday and he's an endocrinologist.  He works for the same corporation as your hospital, cubbied into a group for billing purposes and is allowed access to your insurance corporation's network of specialists and tests, but he is not there.  He will not be there, nor will I call him to let him know you're going in again.  He will be notified should your condition warrant review by someone of his specialty.

Only once in my career have I seen a primary care race to the ER to meet a patient and she had more money than God, which gets you that kind of attention.  But still only gets her me in a City ambulance.  Figure that one out.

 

There it is, a quick list of some of the most common misconceptions in modern Emergency Medical Service.  If you ever wonder why it's taking so long for an ambulance, chances are we're taking care of someone who wants it, but doesn't need it.