Monday, April 30

Denver!

I'm on my way to ZOLL Summit to speak about CQI, but mainly to learn more about the systems I am charged with monitoring. 
When I took my new job my predecessor had been gone for weeks and I had to learn as I went.  It will be nice to learn how it actually works.
In the past Thaddeus and I have done videos but I never had a reason to sit in on a 2 hour lecture about server queries. Now I can think of little else.

Kind of sad...

Anyhoozle, I hope to be sending out updates mainly so Mark Glencorse (I see you have a Google alert) can think back to the exciting week he spent in Denver when the volcano exploded, trapping him.

Sorry, that's still kind of funny.

Updates as they come,
HM

Saturday, April 28

The Complaint Box

...is my email inbox at work.  Or my voicemail...whichever...

I knew our CQI position handled citizen complaints, but I had no idea how many there were.

"It's a thankless job" they told me when I took it.  Like being a Paramedic in the City was a thankful job?

Almost like clock work most mornings I get a call from a person I'll call "Bob."

Bob doesn't like the Fire Department, or my mother, or my race, or the fact that I am his employee since he pays taxes.  Bob was taken to an ER for a complaint and was shocked and appalled we were directed to place him in the triage waiting area after a nurse assessed him.  In other words Bob is 99% of our business.

Bob and I have a 30-45 second conversation about his most recent abduction by the Paramedics and how they assaulted him, robbed him and left him to die...at the hospital.  When I pull up Bob's run history the computer returns "Seriously?"

Some may say Bob's calls are a hindrance or a distraction, but Bob keeps me on my toes.  Bob is my window into the mind of someone who does not know our lingo, our policies or our commitment to his overall health and safety.  Others may say I should report Bob, but that's what he wants, a reaction, and all I do is listen, explain and then he hangs up.  then I get a coffee.  It's a routine we have.

 

Other  complaints vary from legitimate clinical concerns from local hospitals, to regulators who question charting, to folks who simply want to vent.

But my favorite calls of all are the ones I can tell in an instant are without merit.  Bob helps he spot them easier.  How do I know?  They don't know our lingo.

 

For example, if you tell me the ambulance people told you they would "throw you out of the truck" you're lying.  How do I know?  Because a "truck" to us is a giant 5 man device with a 100 foot ladder on the back and is big and red.  We do not call it a truck...only you people do.  And by you people I mean the ungrateful masses who demand our services in 4 minutes or less only to complain that we took you to the wrong ER, since they "kicked me out" earlier today.

Kicked you out did they?  How do I know you're lying?  Because they don't kick people out.

When people get bored waiting 4 hours for a refill of Plavix (which they were never going to do in the first place, we told you that) they leave or are told to go to the pharmacy, but they are not kicked out.

We stole your wallet you say?  (Keep in mind folks, I am required to investigate these complaints no matter what they are)

Doubtful since I recognize your name from my days on the ambulance and we keep track of these things.  2 years ago you claimed we stole $500 from your wallet, then 8 months ago another $700 and today the total is up to $900 and we somehow walked off with your brother's bass guitar.  I'll investigate this but I should warn you, the No Merit letter is on my desktop I use it so often. (The Further Investigation by Investigative Services Bureau Recommended is there too FYI).

But just for once think about what you are about to say to me in your complaint.  If the crew kicked you out of the truck how again did you get to the hospital for the nurse to sign our form that they accepted you?

If we stole your grandmother's $2000 necklace, why can you not describe it to me?

I'll take your call, I'll treat it as true until I complete my queries, but put some effort into it first folks.  If you're unhappy and make something up you're just wasting my time and yours.  If you have a legitimate concern I want to know about it.

 

Think twice about questioning the professionalism of the folks who took care of you when you didn't need it, only wanted it, and how they did everything you needed up to and including taking you to an ER you did not need for a reason you could have handled yourself.

But if they weren't professional, if they didn't do what you needed, I'll be the first one to tell you so.

 

Talk to you again on Monday Bob.

Monday, April 23

The Blogfather asked, I answered. I am the 75%

The Blogfather has issued a challenge of sorts.

 
"Nobody in EMS is paid what they're worth. 25% are paid far less than what they're worth, and 75% are paid far more than what they're worth."

~ Kelly Grayson

...discuss...

 

I'm not 100% with you on this one KG.  I'd add a sliver of 10% in the middle who are right where they should be.  But I'm not there.

I am most certainly in that 75% and have been for some time.  But I wasn't always that way.

<sepia toned early motion picture footage> Back when I got started in EMS (Angry Captain rolls eyes) I got on as a volunteer firefighter.  When I got my first paying gig I was jocking a 1,000 gallon water tender half an hour south of Albuquerque and making the king's ransom of $4.35 an hour.  For a 19 year old that meant turning on the long distance on the telephone, scaling back the second job to 5 days a week and moving out of the 2 bedroom apartment I shared with 3 other guys.

The point of memory lane was to set the starting point and how, if you are properly motivated, you can change what happens to you instead of standing still and complaining that everyone else gets to do fun stuff somewhere else.

I had been dissatisfied with the politics of my organization in New Mexico and sought other employment.  In Albuquerque you had 3 choices.  AFD, Bernalillo County or where I was.  That left 2 and I didn't want to work for either one.  Neither transported and that was a big deal breaker for me.  However, there was a growing need for secondary education to land some of the higher ranking jobs open around the country at the time and I was just finishing my Bachelor's in EMS when the 5 day window for the SFFD position opened up.  I had been a Paramedic less than 2 years and they wanted 5 years experience, but college credits would be considered.  Perfect.

The starting salary was $82,600.  Day1, walking in the door.  Was I overpaid?  Most surely, but I was so busy those first few years I barely noticed.  It was in this time frame I hit my personal best 32 calls for service in 24 hours, did a 48 on little sleep and also hit all 13 hospitals in the area in one shift.  We were run ragged and in the morning would get calls from the Assignment Office begging us to pick up an overtime.

We were Firefighter/Paramedics in name only, turnouts safely tucked into the side compartment of the ambulance.  And we were still expected to participate in all the engine and truck drills between calls for service and long drives back to district.

 

Overpaid?  Compared to West Corn Row Iowa, sure, but this was the salary they needed to get people in the door willing to work in that environment.  If they were paying $4.35 an hour the line would be around the block, with a high turnover and the phrase "They don't pay me enough to deal with this crap" more common than "Medic to follow."

 

Want a high paying EMS job?  They're out there, you just have to go find it.

At recent Firefighter seminars I've spoken at candidates approach me and ask what they can do to better their chances on getting hired with the SFFD.  My #1 response is "Get out of California."  They usually respond with a shocked look and wonder if my famous sarcasm is showing.  Nope.  Get out of your comfort zone.  Go somewhere new.  If a paycheck is all you want, go get it, it's waiting for you somewhere busier, louder, dirtier and likely smellier.

The old line that we need to raise our pay in EMS is a somewhat flawed argument.  Why should we pay you more when you seem fine making $4.35?  When we can't keep bodies in the seats, we'll offer $5, then $6.50 and so on and so on.

Imagine the kid that mows your lawn starts whining that he doesn't get paid enough.  Will you give him a raise or ask him what he's willing to do for it?  Now imagine your neighbor's yard is bigger, but he pays more.  What will the kid do?  Work more for more money or stay with you?

 

The real argument is whether paying a Firefighter/Paramedic $25/hr to sit around eating ice cream while the single role medic sits on post making $8 is a good idea.  I don't know for sure, but the only reason they make $8 is because the company knows they can keep you in the seat.  If enough of you left, they'd have to raise the salary to stay in business.

 

75% and fine about it,

HM

Sunday, April 22

Good Luck MC!

WikipediaTomorrow morning (Monday) our buddy Motorcop is taking the sarg...the seargean...the saarg...well, he's looking to promote.   In an effort to help him out I was able to pull some strings and get some of the exam questions.

I hope these help!

 

Vehicle 1 is parked facing south 22 feet from a stop sign in a 25MPH zone with hazard lights activated.  Vehicle 2 is traveling south at a speed of 35 MPH wit ha driver holding a cell phone to his head.  If vehicle 2 impacts vehicle 1 after applying the brake pedal for 20 feet, how far away is the Starbucks?

 

A male has been witnessed peeking into windows at the local yoga studio.  When you arrive on scene do you,

A) Detain the man in the london fog coat looking into the window.

B) Question the man in the london fog coat looking into the window.

C) Tazer the man in the london fog coat looking into the window.

D) Point out to the studio owner that their window faces a public street, the blinds are open and it's daylight.

 

One of your patrol officers fails to report for duty.  Phoning his residence there is no answer, but he answers his cell phone.  He states he is sick and notified the night Sergeant, but in the background you hear an airport announcement.  Do you,

A) Notify him he is in violation of Dept regulations and begin suspension paperwork.

B) Accept his statement and place him off sick, then call in a cover.

C) Call the night Sgt to confirm the story.

D)  WTF guys? Am I not invited on the camping trip again this year?

 

CVC 21100 addresses _______________________________

A) The size and location of mud flaps on commercial vehicles.

B) The allowable length of overhang of an object protruding from a vehicle before it needs to be flagged and lighted.

C) Electric vehicles on sidewalks

D) No one is ever going to look it up, just pick something random.

 

And the question weighted most heavily on the exam:

Responding to a reported man down you arrive to find the local town drunk an inebriated fellow.  Do you,

A) Dismount bike in manly fashion making sure all civilians see the stripes.

B) Assess the situation after growing a bad ass mustache.

C) Ensure the man down is breathing and if not, begin life saving efforts

D) Stand over him, hands on belt and shout "Stay down! The heroes are coming!" after calling for an ambulance.

 

Good luck MC, we're all rooting for you!

Monday, April 16

Big Brother or Caught in the Act? SF Buses to Issue Parking Tickets

Flick user Forty PhotographsParking in San Francisco is not a nightmare, but more of a craps shoot.  When Mrs HM and I lived in the City we only had one car and it was a small car at that.  When trying to find parking there was a rule:

3 blocks 6 times or 6 blocks 3 times.

This meant that if you went around the 3 nearest blocks in all directions 6 times you were not going to find a spot and should just find a shady spot maybe no one would see you.  But you had to be careful.  Handicap spots and the little ramps in the sidewalks were big tickets and I would never block a plug (hydrant).  Parking in a driveway or blocking a garage not your own was a guaranteed tow, so sneaking into a half spot was generally attempted, sometimes with success, other times that little white envelope would be waiting for you in the morning.

Unless of course you forgot which day of the week street cleaning was.  Then you've got another ticket for that too.

The Department of Parking and Traffic wanders the City in little 3 wheeled bikes and are almost like locusts swarming through the neighborhoods looking for places to earn revenue.  It's a thankless job and when I see their little trucks parked on a plug and they're no where in sight I call them in as illegally parked.

But I've gotten a bit off topic.

Point is, when you would be sitting at a sidewalk cafe and see a DPT bike go by, you suddenly sprang up and sprinted to the clearly expired meter and gave it another 25 cents for another 4 minutes without a $65 ticket.

But since 2008 the DPT officers aren't looking around as often.

Listen to KRON 4's Gabe Slate and Stanley Roberts Team up to look at how transit buses are issuing parking tickets just by driving down the street.

[yframe url='http://www.youtube.com/watch?feature=player_embedded&v=u3S2MVQW_qs']

Installed on select Municipal Transportation Buses (MUNI) are cameras that capture images of cars along the bus's route.  Those videos are then screened by a DPT officer and offending vehicles are sent tickets in the mail.

Unlike static red light cameras, they are able to see if a vehicle is moving, blocking traffic, occupied etc.  However, Happy is not a fan.

Reason being that buses are buses and parking enforcement is parking enforcement.  In addition, I seriously doubt the MUNI drivers are being cited for all their traffic violations, including blocking multiple lanes, stopping blocking intersections, illegal turns etc.  Or perhaps the drivers are safer now that the cameras are installed?

Either way, the City sees some value to the service since over the next 15 months cameras will be installed on all 819 buses.  At a cost of $800,000 in a City facing cuts in Fire, Police, EMS, library, even MUNI is hard to justify.  But in 2010 they recovered almost 1/4 of that cost on only 30 buses.

You do the math.

Some will scream "Big Brother!" and I see that argument and raise you a "it's breaking posted laws."

I only hope that the trucks that double park 2 and 3 wide directly next to a clearly identified loading zone get fined as much as the drivers who don't notice the 3 feet tall letters on the street "TAXI ONLY."

Perhaps MC could speak to the validity of mounting a camera on the ambulances to capture traffic violations?  I think we could up that 2102 citations in a year in just a few months the way folks seem to go insane around an ambulance.

Do you think this program is a good idea?  Think it goes too far?

Sunday, April 15

Sunday Fun - EMS Alley

60's Folks Music is one of my favorite genres of music.  I love the simplicity of some of the stories, but really that they tell a story about a specific group at a specific time.

From poor Charlie stuck on the MTA, Dom Dooley singing about his pending execution,  even a couple of brothers singing about a dead girl on the beach, Jenny Brown, they aren't just rhymes, but snapshots in history.

One of my favorite songs growing up was the Mammas and the Pappas Creeque Alley.  It's a fun song about a lot of their friends, but I didn't notice until recently that everyone in that song was influential in not only folk music, but in their becoming a group and landing success.  What I thought was a simple fun tune about their friends was really a giant "Thank You" to all the singers that laid the ground work for their success.

[yframe url='http://www.youtube.com/watch?v=_E3VqmyNgVU']

When I hear the opening notes to Creeque Alley now, there is one line I can't get out of my head that just wandered in one day driving home from work: "Mark and Justin, preconceptions they were bustin'..."

So I got up early this morning and played the song with the post editor open and the following is what filled my mind when I thought back to what inspired Mark Ted and me to get off our butts and do something.

 

EMS Alley

To the tune of Creeque Alley by the Mammas and the Poppas

Filmin' Level Zero, showin' lots of heroes
Setla lays down a big bet;
Down in Lou'siana, workin' for Acadian;
Kelly hasn't met Ron yet.
At a microphone Jamie sat,
The garage with Montera a great place to chat.
Mark and Justin preconceptions they were bustin' in S.F.,
You know the address.
But no one's seein' change in EMS.

Ron he said, "Kelly, you know there aren't many"
Who know patient care the way that you do, let's podcast"
Kelly said Ron don't you know it's not wrong,
Newbies need advice that will last.
Now Ron and Kelly friends they be
Every Friday morning recording the Newbie.
Mark says Justin, care for profit is disgustin in S.F.,
You know the address.
And no one's seein change in EMS.

In S.F. Ted planned, tried to get to England,
The NEAS said no way.
Ted quite discouraged, worked up the courage,
"Justin take video all day"
When Kaiser flew in to get the real scoop;
The CoEMS tweetup sure was a great group.
Mark and Justin couldn't get enough words in,
But that's what they're all tryin' to express.
That no one's seein' change in EMS.

Web logs, new jobs, No room for big slobs---
Don't you want your change right away.
Wake up, stand up, everything is made up;
HIPAA says it has to be that way.
Chris, Dave and JEMS they formed a network;
Dave, Rogue and Too Old also gathered their work.
Mark and Justin getting some attention in S.F.,
At the Premiere of Chronicles with their guests.
This might just have a chance to change EMS.

Chiefs, Captains and critics, so many cynics,
Don't understand the change that we seek.
Dridge and Setla tryin' to keep us in the hoopla---
More bloggers each day and each week.
Uphill climb feels like we're in the Andes;
Gaining recognition and respect from MDs.
All these good vibrations and our imaginations
Can't go on indefinitely.
And change in EMS is becomin' a reality...

Friday, April 13

Hopatitus B Label Concept - What say you?

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Monday, April 9

We Never Looked at the Son of a Bitch

[caption id="attachment_4942" align="alignleft" width="300" caption="Josh Kennedy Photography"][/caption]

"Oh Happy! How could you use such foul language on your blog?"

How could you use such foul language in your run report?

Two of the most misunderstood yet widely used abbreviations in EMS today are WNL and SOB.

They drove me nuts as a basic, troubled me as an intermediate, frustrated me as a medic and now that I'm in charge of reading all these charts, I'm simply disappointed.  And it's not just my guys and gals either.

How many of you out there are noting 'WNL" for a vital sign or in a narrative describing a patient's range of motion, bruising, etc?  Yes you have, don't deny it.

WNL - What does it mean?  It has multiple entries in the medical lexicon, including We Need Lawyer, We Never Looked and, down at the bottom, Within Normal Limits.  But even then WNL needs a qualifier to be accepted.  For example "WNL 79" for a blood glucose level.  WNLX is an accepted medical abbreviation but only when the value (X) being measured is mentioned.  Simply writing WNL in the abdominal section does not count.

What gives me the most frustration, however, is that many folks apply THEIR OWN normal limits in this assessment, not those of the patient.  If the blood pressure is 210/100 and they state that is their normal, can we mention "WNL 210/100 per patient"?  Absolutely!  Please do, because that will guide me as to why you didn't treat for acute hypertension.  A simple WNL for BP is shoddy documentation and makes me wonder if you even assessed the value and applied it to the entire patient presentation.

So, WNL can be used, but only if qualified.  Got it?  Good.

SOB- Commonly referred to in EMS circles as Shortness of Breath, but that's about it.  outside of EMS, most notably in legal circles, it can mean something else entirely.  Officially SOB refers to See Order Blank unless, wait for it, it is given a qualifier.  For example, SOBOE is official for Shortness of Breath on Exertion, but a simple SOB is not enough to describe the patient's condition.  When looking at the Chief Complaint drop down you may find a fancy word dyspnea.  Dyspnea is defined as the perception of respiratory discomfort, so someone can't technically be complaining of a perception of difficulty breathing, can they?  Sure we could apply this term to a number of our asthma related complaints that have no idea what true breathing difficulty looks like and seem to have no trouble lighting up a cigarette during our assessment, but does it apply to our large population of unknown respiratory difficulty patients?

How do we describe shortness of breath without using SOB? Describe the signs and symptoms of course.

"Pt c/c SOB" tells me nothing. "Pt c/c difficulty breathing on inspiration" now there we go, and it didn't take all that much longer to type.

It is also a good idea every now and again to define your abbreviations long hand in the chart. "Patient presents SOBOE (Short of Breath on Exertion)..." to allow for review and as a defense in case your abbreviations are ever called into question.  Your QI or a lawyer will pull your charts and see you are consistent in your use of the terms and abbreviations.

Now I hope your O2 sat reading doesn't say WNL...

 

Saturday, April 7

Patient Questionnaires - DiverMedic has a question

Diver Medic over at A Look at EMS from 120 Feet Below has a question about patient questionnaires.

Are you using them? Are they useful?  Do they tell us anything we didn't already know?

I left my comment.

Take a minute and have a look.

Wednesday, April 4

Hopatitus B

The B is for beer.

A few weeks back I mentioned preparations were under way to cook another batch of beer and asked on facebook if anyone had an idea of what I should cook next.

Noted ornithologist and man about town @ChicagoMedic suggested a hop forward pale ale, perhaps called "Hopatitus B."

 

Well, today I cooked that beer, here's the recipe.

1.5 lb Crystal 15L

8 lbs light malt extract (yes, I'm still cooking with extract)

30 mins  1 oz Chinook hops

5 mins 1oz Amarillo hops

5 mins 1oz Centennial hops

5 mins 1oz Cascade hops

14 days 1oz Cascade hops

14 days 1oz Amarillo hops

14 days 1oz Chinook hops

14 days 1oz Centennial hops

Pacific Ale Yeast WLP041 (to keep it from being too chewy)

Original Gravity 1.050 - target 1.056, estimated ABV 5.8%.

 

To say this is going to be a hoppy IPA is an understatement.  For you non beer types, my last batch had 1.5oz hops total.  This batch is 8oz.  It already smells delicious and hasn't even started fermenting yet.

 

It'll need a label...any ideas?

Due to Popular Demand...

...we will be making a limited edition of the Tactical Duty Kilt.


 

What started as a great April Fool's Day prank has turned into a lesson in the power of social media.

 

Late on the evening of March 31st 5.11 Tactical sent out a bulk email touting the addition of the Tactical Duty Kilt, including a link to the following you tube video.

[yframe url='http://www.youtube.com/watch?v=XoX7ZqaNPOQ']

 

Noting the date I thought little of it...at first.  Then I started getting emails and messages from the Kilted to Kick Cancer gang asking if I had seen the TDK.  When I looked at the site, sure enough, there it was listed for sale.

Could this be real?  Being the social media whore aficionado I am, I placed links on facebook and twitter only to find I was not the first to do so.  The response from the community was overwhelming.  We all wanted a 5.11 Tactical Duty Kilt.  The video is great, the pockets, d-rings...all the features are great, but if it was just a joke, how could they be so cruel?

On the product page there was a notice that they were "Out of Stock" but I could enter my email to be notified when the item becomes available.  I bet they forgot to disable that function because yesterday I got an email from 5.11 CEO Tom Davin letting me know that they're going to make the TDK.  It will be a limited run and online only, but you have to get your email into them ASAP to be included!

There are 3 colors to begin with, Black, Khaki and OD Green, with a multicam option coming later at a slightly higher price.  Each of these kilts will go perfectly with my Magnum Boots and Kilted to Kick Cancer Shirts, polos and T-shirts Magnum sponsored for the inaugural KTKC.

I got an email from a friend asking why Kilted to Kick Cancer had "abandoned" one vendor for another.  KTKC has done no such thing my friends (Oh God that sounds like something Mitt Romney would say).  We are looking for any and every way to spread the word about the importance of men getting the information they need to live healthy lifestyles.  We can only dream that future sponsors embrace KTKC the way Magnum Boots did, and they even did it site unseen.

We are not exclusive, never will be.

Alt Kilt jumped to the front of the line last year because they are awesome, but we will not ignore a chance to spread the word about what is now the second most lethal cancer known to humans with other kilt makers.  More voices can only mean more ears hearing the message (reading the message?  I get confused) and that's what we're about at KTKC, I'm sure Motorcop, Alex and Kelly and the now 13 state reps of the KTKC Kilted Army would agree.

If Magnum Boots made a kilt, I'd probably want one.  If Alt Kilt made boots, I'd probably want them too.  Actually, that would be an interesting combination...but I digress.

Still need a kilt for September?  Then get your email in for the TDK ASAP, then visit Alt Kilt to get your order in, because you'll need at least 3 for the month.

Sunday, April 1

New AED plan draws criticism

At the SXSW conference, a company called BBH equipped homeless employees with wireless devices to allow internet access.  They wore T-shirts that stated 'I'm a Wifi hotspot" and were paid between $20 and $50 a day, plus asking for a suggested $2-$15 tip for each person requesting the password to their internet access device.

The idea was niche, drew massive attention, and was a huge flop.  Human rights organizations made claims of exploitation, doctors shouted that carrying a cell phone constantly streaming to multiple devices could be harmful and some groups simply stated the move was in bad taste.

Building off that experience, the local Austin Travis County EMS service is preparing a bold new program that I am stealing right out from under them.  Sorry guys, you shouldn't let your research Captain chat with me on skype.

 

The San Francisco Fire Department has received a federal grant to deploy a fleet of state of the art automatic external defibrillators using our large homeless population in the City.

The homeless will be paid a stipend of $100 a week to carry the device so long as they wear the issued parka with the phrase "I'm an AED, I can save your life."  Should the AED be deployed successfully a reward of $5000 is to be paid if the victim survives.

With the homeless population in San Francisco hovering around 10,000 and most of them in the downtown corridors, we could see an AED on scene within seconds, not minutes.

Homeless outreach programs are against the plan, claiming that the homeless will simply not carry the AEDs or try to sell them in exchange for food or shelter, but if we focus on the 500-1000 that refuse shelter, I think we can be successful.  Sudden out of Hospital Cardiac Arrest is a big deal these days and I've been told we need to flex every resource in the community to make a bigger impact on the survival rate, so I am.

Next time you're in the City and see a homeless person begging for change, ask them if they're an AED, they just might save your life.

 
April fools