Monday, October 29

My EMS Expo Schedule

I've been getting messages on Twitter, Facebook and in the old fashioned email inbox (who uses email anymore?) about when to wear the kilts at Expo, will I be at the ZOLL booth as usual and how much are autographs going to be this year?

(Always free for you Dave Konig)


To answer all your questions would take more than 30 seconds and I don't have that kind of time, so I'll answer them all right here, right now.


Sadly I am unable to attend this year's drunken romp through another City EMS EXPO.  This would have been 1 too many trips far, far away this year and with the new gig at work, time off gets complicated.


However, Mr Grayson has arranged for the 30th (tomorrow) to be kilted day at EXPO, possibly creating a tradition born last year in Vegas when we kicked off KTKC.  I will be kilted in solidarity here at HMHQ.

Learn bunches, network bunches more and let your liver know just what you think of it.  I would humbly ask that all my blogging peeps stop by the ZOLL booth to say hello and check out the Z series monitor, it fits in your pocket and updates the patient's social media accounts as to their condition.  No, really, go take a look!


In all seriousness I'm going to miss all of you this year and hope I can make Baltimore (oops, DC) in the spring for EMS Today.

Lift a pint for me!

2012 World Series Champion San Francisco Giants

Great series Giants!  See you on Wednesday for the parade!

Saturday, October 27

If chest pain was treated like C-spine

Johnny is 72.

His brother and father both died of cardiac related issues.  He is currently feeling fine, no complaints, but was found near an energy drink, rare steak and a little blue pill.  The man sitting next to him has similar history and is experiencing an Anteriolateral STEMI.

Everything around Johnny is screaming that he COULD be having a cardiac event that we can't see, that he can't feel, and that we'll be liable for if we don't "treat him."


"Absurd" you say?

"We'd assess him and only treat him if he had signs or symptoms."



If you are required to strap a curved spine to a flat board based on how a person was found, then you should be required to treat Johnny for the MI he is surely experiencing based on his history, current situation and the fact that someone right next to him doing the same things is having an MI.

We seem content to compartmentalize our treatment based on the little boxes in the protocols.

As practitioners we must strive to use our assessment skills and tools to determine a patient's condition and need for treatment or transport.  Focus less on the looming lawyer myth you've been sold by the anchors and do what your patient needs.

In this situation, we don't even need to bother Johnny unless he asks.  Based on his history and environment he deserves a "You OK?" and his friend deserves your attention.

Evidence based medicine has slowly begun to trickle into EMS and we have to wait for it to make it all the way to the bottom where that cold, flat board that hurts our patients sits because of everyone's fear of the "one" that might get away.

Is Johnny on the track to an MI?  Surely, but that's no reason to make him worse now.

Saturday, October 20

That is not a late run

A trend has spread through EMS that is causing a bit of a ruffling of panties in my neck of the woods. If the term ruffling of panties is upsetting to you relax, it's accurate.

I hear a lot of "We got a late call" both in the yard and online as a reason folks dislike their shifts. Every shift seems to claim they are always held over because of a late call, that the next shift never has to hold over, it's not fair, IT'S NOT FAIR! Then they jump up and down from foot to foot in a tantrum which causes the bunching panties mentioned earlier.

Complaining in EMS is remarkably easy. We apply anecdotal observations skewed by our own bias and apply it to everyday. Suddenly getting a call 35 minutes before the end of your shift is a late call and being sent to it is an affront to all things holy.

In response to just such a statement recently I was sucked into a common EMS Manager response that had me actually catching my words just before they left my mouth.

"Back in my day..." was how the sentence was going to start, but I was just able to catch it before I lost all credibility.

But then I stopped. It likely looked like a stroke, but the phrase was easy to say, yet lacked the true meaning I wanted to get across.

"You were closest, you got the job. You are assigned to the ambulance until 0300, not until 0230." I went on to describe methods they could use to check the ambulance and plan their off duty chores in the 106 minutes they were on post prior to the "late call."

I then told a war story about the call at 825, 25 minutes AFTER my sift was over and when I had been ordered by the Battalion Chief that I was not to leave my post until relieved. That the call ended up being a transport to Saint Farthest and that I didn't return to the firehouse until close to 10 AM. They were unimpressed and still held on to the belief that they should get some wiggle room at the end of the shift to "wind down and restock."

The film version of me delivers the speech far better than I do but the point gets across that we are on duty to answer calls for service and make bad days better. Sometimes that means we're a little late getting home.

Sometimes we have to spend a few extra minutes doing this work that we have chosen, taking the time to do it right instead of half assing it just to race back and disappear, upset that we asked you for a little something extra. Especially when we're paying you extra to do it.

A late call is a call that comes in AFTER your shift has ended folks, plain and simple. if you are due off duty at 0300 and dispatch gives you a code 3 call guess what? You have another chance to do something for someone who might need it. Be thankful it's not the other way around.

Wednesday, October 17

Pre-Requisites for the Chicago Rescue Squad?

Many Fire Departments have strenuous and extensive requirements to make their rescue squad.

In NBC's new show Chicago Fire, apparently all you have to do is have worked as an EMT in San Francisco.

Taylor Kinney as SFFD EMS EMT Probie Glenn Morris in Trauma




Taylor Kinney as Lieutenant Kelly Severide on NBC's new show Chicago Fire


Not bad, SFFD EMT to CFD Lieutenant in 3 short years.

Also interesting that both Departments seem to have such lax rules regarding rugged facial hair.


After this show is cancelled what do you think Kelly will return as?

Tuesday, October 16

Of Blankets and Discipline

A very eye catching story has been circulating for a few days involving everyone's favorite EMS system to hate, Detroit and a Paramedic who claims to have been reprimanded for giving a blanket to a person who was cold after a fire.

I was waiting to comment until the Detroit EMS Administration commented.  Let's just say I'm glad I wasn't holding my breath.

As a Quality Manager I see this differently than most line medics might.  On the surface a medic was doing the right thing giving a blanket to a cold person.  It's what we do most: Make bad days better.  We all know most of the attaboy letters don't involve medicine but instead note demeanor and comfort measures.

Seems like a non starter.

However, it seems there were some policies in place, whether you agree with them or not, regarding dispensing agency property.

Take a deep breath...I'm getting to my point.

Most Vice Principles have a list of trouble makers who are just under the disciplinary surface and are watching them like a hawk waiting for a reason, any reason, to bust them on a black and white policy violation.

I don't know enough of the facts to pass a decision regarding the blanket, but I can tell you that if this was brought to my desk I'd ask how we solved all the other problems to be able to spend time on this.  If there had been a decision to reprimand based on the Rules and Regulations, in my experience, there is more going on than meets the eye.

I wander the halls looking for my borderline crews to screw up on something so I can have a chat with them, sure, but more often I'm wandering looking for any chance to talk with them about how things are going.

This could have been a policy enforcement or the straw that broke the camel's back.

Let's just hope the camel doesn't need a blanket.

Friday, October 5

A quiet weekend in the City

Some boats in the bay...

America's World Cup

More boats...
Fleet Week

Air traffic ticks up a smidge...

Blue Angels


Hardly Strictly Bluegrass

A bit of sport...
Cincinatti Reds at SF Giants MLB Playoff Game

Buffalo Bills at SF 49ers NFL Game


Should only triple to population for a few days, all 33,000+ hotel rooms are booked, and I wish my weekend cars luck.

Tuesday, October 2

You Make the Call - Handcuffed

Man it sure has been awhile since we fired up the ol' You Make the Call Machine here at HMHQ, but I thought it's finally time to get back on the posting circuit.


For you new people, I post a situation, you answer it based on your local policies.


Dispatched in the first response vehicle of choice for your agency, the local PD has detained a man who assaulted another person.  The other person is receiving care from your partner and is stable, bleeding controlled and has agreed to transport.  PD presents you to the window of the patrol car where you can see a superficial laceration to the forearm just distal to the left elbow.  There was a small drip of blood that appears to be dry, no other injuries are obvious through the window.

After repeated pleas the officer agrees to open the door and remove the patient but warns that he became violent when they took him into custody.  He stands and allows a brief primary and secondary exam and you note no other deformity or injury.  He is refusing vital signs, treatment and transport in colorful language, but denies alcohol or drug use.  When asked if he understands the risks of refusing assessment and treatment he replies in the affirmative and states his reason for assaulting the man and the police is his business, not yours.


Is he able to refuse service?  If so, who signs the form when PD tells you there's no chance of him removing the cuffs to allow for a signature?


You Make the Call.