Wednesday, December 18

Shared Narrative vs Personal Narrative in Apple Ad and why you should care

I speak on a number of topics, one of them being technology pros and cons for potential Fire Service Candidates through Fire Alumni.
It goes beyond the usual talks about the dangers of the evil social media and gives candidates tools they can use to better use the medium for their benefit.
In the presentation I discuss personal vs shared narrative as a way of addressing their desire to use the medium to communicate.  It's not much use to tell you not to do something if I can't explain WHY it is not a good idea.


Personal narrative is like a first person recollection of an event.
Shared narrative is including others in the event while simultaneously removing oneself from the event in order to do so.


I give 2 examples.


One is where a couple witnesses a romantic sunset and decides to photograph themselves with the sunset behind them. While they did experience the sunset, they also had to interrupt their personal narrative to arrange the photo, in which they are no longer enjoying the very thing they are hoping to share.


The second example is when I finally talked my young daughters into wanting to watch Star Wars.


We got bundled up on the couch, drinks and snacks at the ready and I started the DVD. The Lucas Film logo appeared and I suddenly wanted to share this personal narrative with friends, family and the girls when they got older. I crouched down in front of them and snapped a pic.
However, while I was doing that my eldest said, "Daddy, what do those words say?"


I had missed the opening scroll. Forever. I will never have that moment back.
My desire to share interrupted my experience of the moment.


According to the candidates that approach me following the presentation, this message is well received.


In order to keep errors on social media at bay, focus on personal narrative.


Today this Apple ad was circulating the interwebs machine and I think it perfectly encapsulates the importance of personal narrative.
Have a look:


The kid in the ad is ALWAYS on his phone.  Like I am most days I'll admit, but we assume from most of the ad he is texting or playing a game (Like I likely am, remember, I've fallen victim to the allure of the shared narrative) but we later learn he is making a clever little video.


We see the family becoming emotional at certain parts of the video, not because of what they see, but because of the emotions they associate with the memory of the events being shown.  They are being shown events they took part in.  The kid who made the video did not take part, he filmed them.  Each of the images has him removed from the event in an effort to later share it with the people in the image.  For the family it is a reminder of personal narrative, for the kid it is only shared narrative.


The exact same error I made with my daughters and Star Wars Apple wants us to believe is a good reason to use their products.


I love the idea of collecting and editing video on a handheld device.


I don't love the assumption that ignoring the present to revisit in the future should be our priority.  Our priority should be to live in the now, be with the people we are with and in the place we are in, not to post a clever status or photo to include others, but truly experience life while it happens.  If that later leads to a sharing of events, so be it, but just wait.


 


Imagine the family Christmas celebration this family could have had if the kid on the phone had taken part instead of filming.  We'd have no clever little video, but we would have the same memories and perhaps even more to talk about instead of looking to technology to share every moment at the expense of the moment itself.  Just as powerful to me would have been if the child was constantly reading a book the whole time, then stood and recounted all the fun times he witnessed.  he still would have missed the events themselves while reading.  It's not the phone that is to blame here, it is the desire to share the experience before the experience has been...well...experienced.


 


I tell Fire Service Candidates that social media is not dangerous, it's how you use it that is.  Technology has made it so easy to share anything with anyone at anytime the urge to transfer personal narrative to shared narrative can be difficult to overcome, but the only way to be truly successful and enjoy life is to do just that: Live Now.  Post Later.

Tuesday, December 17

Mixed Signals at Youth Detention - NOMA

I was asked to accompany my supervisor to the local Youth Detention Center where they're running a couple weeks of a modified almost career day program. They're bringing in trades and professions from TV makeup to EMS and showing the kids that they don't have to give up the hopes of moving on with their lives when they get out.

I think it's a great idea since simply putting someone in a room and waving a finger at them seldom produces change in behavior. My 7 year old could have told you that.

We had a presentation prepared about the history of EMS, local and State requirements to achieve licensure and what to expect on the job. We had pros, cons, salary expectations and, most importantly to them, what your background needed to look like.
They were very interested in learning about the sliding scale of background infractions that will still yield a job taking care of people on their worst days. This many years without a conviction in this, that many years without 2 or more convictions in that...they were riveted and you could see them doing the math in their heads. "If I get out this year and don't re-offend I can be an EMT in 4 years!"

The Company Man in me was on board with the message of inspiring these youths to look beyond their transgressions and wipe the slate clean. An opportunity awaits them to possibly get a job with me helping people.
Everyone deserves a second chance in life, especially the young.

Not on my ambulance (NOMA).

That's what the EMS 2.0 inside me said. During the presentation I did my best to explain to the class just how easy it is to get an EMT cert.
"Only 120 hours of class needed guys!"
"2 days a week for 1 semester at the community college and you'll be able to take the test. Pass it and you can apply to work on an ambulance!"

The conflict within me was well hidden I assure you.

While I agree that these kids need this message of how easy it is to get into EMS, I don't want it to be so easy.

Taking care of people takes blind trust on their part assuming that the agency responding has done something to make sure you are a trustworthy person and are trained to take care of them. We extend our message of EMS with the promise of lights and sirens, driving on the wrong side of the road and try to temper that with tales of 911 abuse, vomit, urine, blood and guts. All this group seemed to be interested in was why my stripes were silver and my boss's gold.

They're kids.

We need to take this message to EVERY school and get kids excited about helping people and being selfish about it.

Yes, I said selfish. I don't do this job to help people, I do it because the feeling I get from helping people is addictive and better than anything I know. I help people because if I don't I don't feel right. Trying to convey that message to a group of young men already 2 strikes down and out of their league doesn't translate as well as one may hope.

One of them asked how we handle dealing with sick people and I told them it's easy. It's taking care of the people you shouldn't want to that is hard.

I told the story of the child abuser that was confronted by a neighbor. The child had been transported by another crew and I was called to deal with the abuser and his mild injuries. That man got the exact same high level of assessment, care and transport as my mother would have received. Not because it was the law, or policy or the right thing to do, but that's what I was there for. My sole purpose was to help those who asked and I did it with a smile on my face. Maybe not the biggest smile, but I helped and I felt better.

I wanted to share more about the realities of EMS with those kids but we ran out of time.

We didn't talk about burnout, divorce, poor dietary habits, the sedentary lifestyle of 12 hour system status cars or the fact that in most communities you'll need a second job to make ends meet.

In the end I don't think it will matter.

The Company Man in me will apply whatever standards my employer sets forth when considering candidates, regardless of personal belief or Professional discretion. But if I was the boss, even if you carried the same license and all other things being equal, I'm hiring the kid that WANTS to be here, not one who took the easy road and wants to give it a shot because it took less hours than welding at the local college to get qualified.

Am I wrong? Maybe, but at least then I'll know and can move forward.

What are your thoughts on reaching out to troubled youth about jobs in EMS?

Friday, December 13

Ambulance Response Time Resolution Theater

A Paramedic I work with in CQI and I were having a conversation that was originally aimed at discovering the best way to handle complaints that had no merit.
You know the complaint:
"your paramedics stole $8000 from my wheelchair when they took me in for a swolen toe"
or
"I was almost late for my podiatry appointment..."
We also discussed how to respond when someone mentions a minor issue and follows it up with "I don't want to get anyone fired or anything but..."
Apparently telling them "Oh, no one is getting fired. Not for using the siren on your street when you told the call taker your husband couldn't breathe."
But our conversation yielded a brilliant idea I don't think anyone has tried before:
Ambulance Response Time Resolution Theater.
Here is how it works:
Someone calls in complaining about the time it took to get an ambulance for a minor issue, that they were taken to the wrong ED even though transport was not indicated etc etc. In other words, most of our clients.
When they call in, tell them to come by at 4:30 on Friday for a formal apology. If 4:30 isn't when your cardiac arrest survivor comes in to meet the crew that saved them, then adjust as necessary. Tell the complainant they can sit in if they like but you'll need to address the heart attack first.
They may not connect the dots but it sure will make you feel better.

Tuesday, November 19

Tribal Road 2

Deep in the southern end of the Res over on the other side of the river is TR2.  None of the old roads had names, they were just  numbered as they were cut.  Not paved mind you, cut.  I can clearly recall the giant tree at the corner of TR22 and TR2 where we'd make the right hand turn and start heading south towards whatever the dispatcher told us was waiting.


I've been thinking of that turn more and more lately and I'm not sure why.


I haven't made that sharp right in almost 20 years but I can almost smell it when I close my eyes.  At night the road was almost impossible to see unless you knew where it was.  Most of the roads weren't marked and those that were were easy enough to see.


TR2 was a tricky turn.


In those days I was 19 and riding alone in a 1976 International 10 speed double clutch 1000 gallon water tender (Yes, we called her Tanker 1).  I didn't run medical calls but did have to head down there for ditch fires, car fires and other various things a water truck can be used for.


I recall one night heading for a report of a gas leak on TR2.  Funny thing about house numbers down there back then, if you moved you took it with you, mail box and all.  It was not uncommon to go from house 1,2, 56, 4423, 8, 16...it got confusing.  We knew where the regulars were but I remember feeling lost.


And not just lost in location but completely unsure how I was going to handle a gas leak alone.  The cab of the tender had the radio, lightbar control unit and siren all mounted to the plastic dash.  It was clear from the large array of holes around it that it has been remounted time and time again.  I never wondered why, but on this night I found out.


As I was moving down TR22 the entire mounted set came crashing down to the floor of the cab.  My lights were still on, but I had no siren control, no radio and no way to turn the lights off.  And now I can't remember which house I'm looking for.  Just as I reach for the radio mic to test it I see the familiar giant tree just in reach of the headlights on the 1976 International.


I'm not going to make the turn.


My 19 year old brain was accessing all former driving experience for options.  Either I can slam the brakes and all 1000 gallons on this gravel road will go sliding Gods know where, or I can slow down, look for a turn out farther down TR22 and make my way back.


Of course I slammed on the brakes, I was 19 and had no idea how that vehicle would react.


Not well.


I lost control turning right and then into the slide like I was in a car commercial except the fine print at the bottom of the screen didn't read 'professional driver, closed course' it said 'A fireman was killed last night...'


The left rear duals left the gravel and I'm headed towards the ditch sideways, red and blue lights flashing out in the middle of nowhere New Mexico.


I never came to a full stop, but did somehow manage to get the front tires back on to TR2 enough to avoid the ditch.  My pulse was over 140 for what seemed like hours after that but I still had the gas leak to find, the radio to fix and this damned siren shut off.   The radio and siren control are on the floor, nothing but wires sticking through the swiss cheese dashboard, but the lightbar continues to turn.


I never did find the house that night.  I drove up and down TR2 waiting for someone to come running out to meet me, I wasn't easy to miss.


When I returned from my response I backed into the old mechanic's shop that passed for a fire station and made some repairs to get the radio working.  Turns out it was a false alarm, no problem after all.


From that night forward I think about Murphy and his law riding shotgun on Tanker 1 that night doing his darndest to get me in trouble.  I got distracted and it nearly cost me.


My thoughts go back to TR2 and that night often recently and I wonder if I'm about to make a big turn and am so distracted I haven't noticed a familiar landmark that can point me in the right direction.

Friday, November 15

San Francisco becomes Gotham City for 5 year old Bat Kid!

San Francisco has been transformed into Gotham City as part of a Make-A-Wish Foundation wish granting for 5 year old Miles.



Learn more HERE and follow the LIVE feed HERE.


 


Bat Kid is being escorted by the caped crusader himself and has already matched wits with a fellow called the Puzzler, who tied a helpless woman to the tracks in front of a run away cable car.  It is rumored that another fellow called Penguin has been spotted near AT&T Park and famous SF Giant's mascot Lou Seal is missing.


It appears by the names being used that perhaps there is a legal issue with saying he's with Batman, but the almost 10,000 people expected to take part in this boy's adventure don't seem to care.  They're lining the streets to catch a shot of the Batkid in his Batcar fighting crime while fighting Leukemia.


Proud of San Francisco coming together like this to turn what could have been handled with a simple guy in a suit into a truly memorable and inspiring morning.


Your move New York.

Tuesday, November 12

Toronto Mayor Rob Ford's perfectly thought out excuse for smoking crack

If your homepage news feed is anything like mine you'll know that Emma Thompson forgave Kenneth Branagh's affair, there was a storm where brown people live and Toronto's Mayor, Rob Ford, was filmed smoking crack.

There is a kind of whirlwind around the accusations, which he avoided for months, until a court battle surrounding the release of a video of him smoking crack surfaced.

 

Look at the surprise on my face.

 

I would, however, like everyone to dial back on the uproar surrounding crack cocaine use by Toronto's Mayor which he claims was only once and that he is "...not an addict."  Somehow he assumes we would see one instance of a behavior and apply it to the extremes of addiction.

"Did you see Justin drinking a Dr Pepper on the drive home today?"

"Yeah, but he's not an addict."

I thought nothing of this story and wanted it to go away until I read a quote that had me more worried about other aspects of Ford's life.  Aspects that should disqualify him as Mayor, but you likely didn't even notice.

Mr Ford, according to Mr Ford, has a drinking problem.

He is an alcohol addict.  Far worse in my opinion than being a crack addict, but we only apply the stigma to the "illegal" mind altering substances here.  Don't believe me?

When he finally came forward and admitted to smoking crack, he had a totally justifiable and well thought out answer:

"There's been times when I've been a drunken stupor. That's why I want to see the tape. I want everyone in the city to see this tape. I'd like to see this tape. I don't even recall there being a tape and a video and I know that. I want to see the state that I was in," Ford said. -CNN.com

Let me translate:

"Hi, I'm Mayor Ford.  I get so sloppy drunk on a regular basis it's my go to excuse whenever I get caught doing something stupid.  Obviously I wouldn't do that sober, I want to see the tape and prove to people I would never take part in the manufacturing, sales or use of an illicit substance.  I was so fall down drunk I can't even remember what you're talking about.  Did it even happen?  Who knows?  I was sooooo drunk." - Douchebag->English.com

He also added:

"Probably in one of my drunken stupors, probably approximately about a year ago," he said about the cocaine use. -CNN.com

Stupors. Plural.  Dude is Mayor and has a regular habit of becoming so intoxicated he does things he would never do sober.

Riiiiiiiiight.

As if that wasn't enough to disqualify him from cat sitting, let alone Mayor, he decided to say a few words about the camera man.  When asked to comment on his crude words, he responded with a safe "Obviously I was extremely, extremely inebriated. That's all I have to say."  Oh, well nevermind then, go back to Administrating the City and I'll meet you at the pub at 5.

Thanks, Mr Ford.  I thought you were a worthless human being up until it was the alcohol talking.  Now I think that title is an insult to the greater worthless human being community.  Working on an ambulance for 18 years I learned a very valuable lesson: Alcohol amplifies one's inner asshole and you, Mr Ford, go up to 11.

 

 

 

Sunday, November 10

Fear and Wussification

The world isn't fair.


Children are told this from day 1.  Today people like to use helicopter parenting as an excuse for kids who are different, sensitive or don't meet some imaginary standard set by "the good old days" of when they were kids or some book written 1400 years ago regardless of denomination.


Some call it the 'wussification' of America, a belief that being less violent somehow equates with weakness or lack of character.  I know many of you buy into the 'wussification' of America and point to millenials who "expect something for nothing" or come out of college with useless degrees  while working nights at the Burger King only to get upset when they can't find a job in the economy destroyed by the same people who told them they HAD to go to college or else they'll be flipping burgers the rest of their lives.  Ironic when you think about it.


In all the baseless arguments about guns, gun control, 'wussification' and Liberal vs Conservative is an underlying torrent of violence that few are willing to talk about.  We're afraid to admit how afraid we are of being seen as 'not tough enough.'


When someone walks into a school and commits mass murder we blame the shooter, the gun, the gun maker, the mental health system, the President, video games, violence on TV and just about anything but each other.  It is true that it takes a village to raise a child and somewhere along the way a wedge was driven between our kids.


It became us vs them.  There have been cliques since the first caveman hit another one on the head and a third smiled.  there will always be cliques when more than 2 people come together.  But what about when 2 believe the third to be lesser?


The 'other' was made to be lesser, the 'different' to be worse, the 'unusual' to be worthless.


Some kids address their fear with words, calling others fat, nerdy, stupid or worse.


Some kids choose physical violence, picking fights, tripping and pushing the others, the different, the unusual.


Some use knives, guns and other weapons to inflict harm on those they fear.


Yes, fear.


Fear of what they've been told is the lesser, the worse, the worthless.  Fear that they will not be seen as tough enough by their peers, parents and the greater community.  Trouble is that for every person who believes that is another of their peers who feels the same way, yet thinks they are alone.  In other words, a lie told enough times becomes truth in a vacuum of information.


Fear is a powerful motivator and kids today are so afraid to be seen as 'wussified' they'll take their fear to extremes using any means they can.  Words become pushes, pushes become punches, punches become a lighter/knife/gun/bat/car.


Take the recent attempted murder of Sasha Fleischman in California.  Sasha could easily be labeled by outsiders as an other, different and certainly unusual.  Sasha did not self identify as male or female, preferring to be called agender.  Many of you would point to this person's beliefs as a classic case of 'wussification.'  "What parent would raise a boy and allow them to think of themselves as anything different?  It's their own fault."  Nice knee jerk.  Blame the parents for their son being set on fire?


Yes, set on fire.  You see, 18 year old Sasha was comfortable wearing skirts to school and some kids there didn't like that.  I'm positive Sasha was called names, pushed, the usual incidents from every kid's childhood when seen as different.  I got picked on and hit growing up and all I did was join the computer club.


On November 4th Sasha was on a City bus asleep heading home from school when a 16 year lit Sasha on fire.


A coward who's name I will not mention thought Sasha a threat to his masculinity.  That's not my opinion, that's what this 16 year old attacker told police was the reason for this act.  He was afraid Sasha was a gay man.


So afraid of being seen as a 'wuss' by his peers, so afraid that talking to Sasha might influence his own opinions, so afraid Shasha might grow up to get one of those disastrous gay marriages, this 16 year old child reached for the only solution he thought would secure his masculinity: violence.


I'm sure that had this kid had access to an axe, knife or gun those likely would have been used but a quick click of the lighter and, fwoosh, he's more of a man in his mind.  The threat of the other, the different, the unusual has been removed.


This is what goes through the minds of children like this 16 year old.  Children not told by their parents to think of other people as equals.  Children who's parents are either a constant negative influence or an absent positive influence.  Parents who allow their children to do whatever they want and parents that smother children with rules so strict prison would be a vacation.


My point is that the 16 year old attacker must be seen as the weird, the different, the unusual and it must be addressed on a large scale.  Not by telling everyone to come to Town Square and sing Give Peace a Chance, but perhaps encourage parents to be mindful of the hate they share with their children.  While we can remove the threat of certain violent acts in some cases the emotion, hatred and misguided belief that the other is the enemy will eventually boil over and violence will ensue.


I'm less afraid of the boys at my daughters' school pointing their fingers like a gun and going "pew" while on the playground as I am of one of those kids one day thinking my daughter as so weird because she wears different colored socks, so different because she loves to read or so unusual for some reason I don't even know about that he feels so fearful of her the solution is to set her on fire.


That is the 'wussification' of America I'm afraid of.  Shasha Fleischman was a threat to no one yet will likely be blamed for being lit on fire by a coward.  Figure that one out.

Saturday, November 9

Talk about tough luck

I actually got to do some patient care this morning.  Calm yourselves.


 


A car locked up their brakes on the Bay Bridge and the following motorcycle did his best not to hit it.  In the process he got hurt a touch.


It happened just ahead of me around a turn near a tunnel (Yes we have a tunnel in the middle of our bridge) so when the lane stopped and a person ahead got out and ran ahead, I knew I had to help.  That's just what we do, right?  I carry no kit, so as cars go around I pull forward, hit the hazard lights, change out of my driving slippers (Yes, I wear slippers when I make my 3 hour daily roundtrip) and approach the bike.


 


Secondary assessment is being completed when over my shoulder I hear "Justin!  What do you need!?"


"Wow" I think to myself, "48's got here freaking fast!"


I turn to look and who's coming up to help?


My CQI counterpart from one of our competitors/partners.


2 CQIs alone in a tunnel on a bridge.  Sounds like a bitchin romance novel, but no, it was all this person had for a few minutes until the engine and medic units arrived and were able to complete a full assessment and render care.


 


As the patient was loaded in the ambulance I gave him my info and told the medic "I'm reading this chart later."


He shook his hands in the "Ohhhh, I'm soooo scared" fashion and smiled, then got right back to patient care.


 


 

Tuesday, October 29

Halloween and Christmas rolled into one

In all the EMS debates over BLS vs ALS, evidence based vs anecdotal, public vs private is the real reason we do what we do.  I like to say that we make bad days better.  More often than not we ride the bench.  Sometimes we get the grand slam in the bottom of the ninth to win the game.


I got a facebook message from a reader who was looking for a spark to get out of a rut and gave the best advice I could.  My response included examples where we find joy in this work: The smile from the woman who's hand we hold when nothing is wrong, the man who half smiles at his wife when he sees her as we unload him at hospital having a massive stroke.  There are so many small victories in this world sometimes we miss them.  If you are looking for medals or public recognition in EMS I have bad news for you: It will be a long, lonely wait.


 


But sometimes that wait pays off.  I had no idea that the best motivation to be a good Paramedic or EMT would come in my email inbox early this morning.


8 months ago today a man died.  Dead.  Asystole.


Then some of my co-workers showed up.


This morning we got an email with a photo.  The photo showed our patient dressed up for Halloween with his young daughter.  He was Obi Wan Kenobi and she was Princess Leia.


His smile made me smile.


Her smile made me forget all the bullshit.


Although I keep a running tally of cardiac arrest saves on a white board in my office, this is my first photo of a smiling child.  And hopefully not the last.

Friday, October 18

Righty tighty...

Being back in the field is a wonderful thing.  The smell of week old urine on a regular, the thrill of getting the line on the recus patient and even just sitting in the buggy at a street corner catching up on QA.  But I was not prepared for what happened today.

THE EMREGENCY

A local clinic has called in a code 3 transfer for an asthmatic patient.

THE ACTION

Well, this sounds like a good one.  With at least one MD and a scattering of RNs in the office for them to call 911 before 5PM means it must be something serious.

Stop giggling.

I add myself to the run and head over the few blocks to the well known clinic as the engine company pulls up.  We head inside and are led, rather swiftly, to an exam room where our patient is working on sucking a non-rebreather bag back through the tiny hole in the mask.

"Hi there, what seems to be the trouble today?" I ask seeing a look of panic on the patient's face.

"His sats are dropping and the albuterol isn't helping!" a pajama clad medical office worker is telling me as she's fumbling with the tiny O2 sat monitor on his finger.

"Well, let's switch this to one of ours to start" the Engine Medic and EMT have prepared a mask on 15 liters with a well filled bag and the patient drinks in the fresh air, the look of panic quickly receding and relief taking it's place.

"Thanks guys, the albutrol must have finally kicked in" the pajamas tell the room, hoping it will cover up the look on her face that she is still completely dumbfounded as to what happened.

"Here's your trouble" the Engine officer says as if noticing an oddly shaped cloud, "Yer tank ain't on." And as soon as I can turn around to see the EMT still holding the clinic's mask the officer turns the key on the top of the clinic's O2 tank and air begins to flow.

"Beginner's mistake I guess" he says as he shuts it off and looks to me barely holding my professional pose. "Unless you need us Cap, we'll be on our way."

I cleared the Engine and comforted the patient who's "low sat" of 94% had risen to a comfortable 96%.  The ambulance arrived to take him in to Saint Farthest, per his request, and I relayed the situation.  The pajama clad person had left just after the engine and now came in with what was clearly an experienced RN.

"I think the tank is faulty." She told the older RN.

"I don't think it's the tank, Dear.  Thanks, guys." And down the hall they went.

"What was all that about?" the ambulance EMT asked as we wheeled the now calm patient to the elevator.

"She didn't know how those tanks worked.  Can you believe that?" the patient chimed in with not a hint of distress.

And to their credit the crew kept a straight face as the doors closed.

Saturday, October 12

Hate Firefighters that complain about EMS? You might be one. I was.

It is no surprise that anyone working in the Fire Department who hates EMS is in for a rough career.


I have met many a "Basic for Life" who groans everytime the bells ring and it is not a fire.  Some even groan at building alarms.


I was talking with a colleague recently and we stumbled into the problem most in EMS struggle with and one I built this platform on:  BS calls.


You might be thinking "Justin, calling them BS calls isn't respectful.  It's that kind of attitude that encourages less than Professional actions by our low information voter EMS types."


But they are BS calls.  The scraped knees, the MVCs without injury some passerby called in, the headaches after slurpees and stomach aches after a seafood dinner, all BS calls.


And if you agree then you still have a lot to learn about modern, and I'll argue future, EMS.


If you argue that you only exist for emergencies and the other calls waste your time, your argument is no different than the firefighter claiming they are there to fight fire, not wipe asses.


So let's rename BS calls as Basic Service Calls.  Not EMT Basic, but Basic care.


You exist to assess.  So many in EMS list their abilities to treat as their claim to fame when we have all known for a long time that treatments are useless without a complete assessment.  That headache, stomach ache, every call you go on deserves a complete assessment to determine possible solutions to you patient's chief complaint.  If your main reason for assessing is simply whether this will be a transport or not, perhaps we should get you an application at Dairy Queen.  I can say that, I used to work there.  If all you d is check your boxes on the ePCR and exclude the patient from your box of tricks are you even addressing their concerns?


Every single call you are sent to is someone who didn't know what else to do.  What an amazing opportunity to help them.  Not with a 12-lead most times, or albuterol even, but listening to their concerns and reacting to them.


If the guy on 3rd street keeps calling every time he runs out of meds, can we possibly help him figure out why instead of getting upset he called again?  In case you haven't noticed, getting mad and yelling at him only makes him call and complain in between calls for 911 to refill his meds.


Getting upset isn't working.  So instead, get involved.  It will take just as long to complete a transport or refusal helping him or ignoring him so why not make the time you have with him useful?


You don't need Advanced Practice, Community Paramedicine or (I can' believe I'm about to type this) Integrated Mobile Healthcare (ewww) to make a positive impact while still acting within your scope of practice.  There is no law that keeps you from being a patient advocate.  Since he called you for medical care you are now able to access his medical record (as much as he gives permission for) to determine what may be the trouble.  Call his Doctor's office and mention to the clerk who answers that you are on a 911 call and need to speak to his Doctor.  Dude will be on the phone in a heartbeat.  If the van service from the managed care service is always late or keeps skipping the house, make a call.  If the home care nurse isn't doing what they are supposed to be doing, ask for their agency's contact information and follow up with your concerns.


All of this can be done in the same time frame as your frustrated conversation with your regular that will end the same way it always does unless you change your perception.


He IS the reason you are here.


Like the Fire Service before us we are doing a great job at preventing major medical issues and because everyone seems so intent on getting to any scene as fast as possible, we see many conditions far earlier than before, meaning they're not as dire as our 20 year veteran colleagues remember.


We are the safety net these people need when their insurance company fails them.  We are the number they call when Medicare can't cover everything.  We can make a difference if we try and we don't even need to try very hard.


These calls will frustrate you.  They frustrated me so much I wrote about them.  As I did I realized I was getting frustrated for no reason at all and that I alone had the power to help these people.  That's where EMS 2.0 became a reality for me.  That's when Chronicles jumped off and my perceptions changed forever.  Had I kept stewing in my frustrations there is no telling where my sanity would be.


If you disagree with me and believe the first word in EMS is more important than the last word in EMS give up ever becoming a Professional.  You'll burn out in a few years and I hope you don't hurt anyone between now and then.


It's time to take the extra step so many think is not their job, not their responsibility or not in their power:  Help people.


 

Tuesday, October 8

Being a Fireman, as imagined by children

I'm going to need 4 minutes of your time for this training video.


 


I think I worked with this guy down in District 4 20 years ago.

Thursday, October 3

Kelly Grayson belly flops with cliches, proves he's a Noob

"Ambulance Driver" Kelly Grayson proved his ignurences (aside from keeping us down by repeatedly refusing to stop calling himself an ambulance driver) in a recent column from EMS1.com where he "debunked" some EMS cliches.

This article proved to me that this Kelly person is not fit to write for any magazine or website.  Anyone who's been in EMS as long as me and worked as many calls as me HAS to see just how wrong Kelly is.  I've taken his 10 cliches and written my responses:

10. “Paramedics save lives, EMTs save paramedics.” This is the #1 truth in EMS.  I can't tell you how many times I get on scene and start an ALS assessment on a patient and an EMT swoops in and places the patient on 15 liters of high flow.  I forget all the time that O2 should be applied for anything.  My EMTs also remind me to recheck blood pressures and check my splinting.  EMTs DO save Paramedics Kelly, if you give them a chance!

9. “Here to save your ass, not kiss it.” We are being misused at an alarming rate.  I had a call just yesterday where a woman wanted us to refill her prescription.  "You call, we haul."  I wish they'd stop calling us and wasting our time.  What does she expect me to do? Explain the basics on healthcare?  I don't have time for that, we're a 911 service.

8. “We cheat death.”  We do, daily!  I have a T-shirt with the Grim Reaper being slapped in the face by a bad ass medic with sunglasses and everything.  You are so narrow minded you can't see how we bring the dead back everyday.  Epi works Kelly!

7. “Seconds count.” Try holding your breath for 3 minutes and see what happens.  I can't stand it when some washed up middle manager tries to tell me that we drove too fast or opposed traffic to the IFT.  We are en emergency service and I took a 3 hour driving course.

6. “I don’t have X-ray eyes.” If they think it's broken, what do they want us to do Kelly? Huh?  Guess what happened?  If I did have an X-ray machine would that change my treatment? I didn't think so.

5. “They should have gone to medical school if they wanted to be a doctor.” I spent 6 months in EMT school and another 11 in Paramedic School.  If there was something else I needed to know to treat from my Protocols, I'd know it.  Protocols are laws written by Doctors.  If I step outside those protocols, no matter the outcome, I will get stepped on and fired, no questions asked.  If they wanted me to learn more, why are the renewal credits where they are?  You can't answer that one can you?  If 24 hours is enough to keep doing what I'm doing, I'll keep taking the same 5 classes and cheating death on a daily basis.

4. “Zero to hero.” Classroom and book learning is a start, but you need true street experience to be a real EMT or Paramedic.  Only in the truck, getting puked on and standing in blood everyday can you truly realize and understand what it is we go through.  When you see death first hand it changes you.  It hardens you.  That's why I can't stand all the BS PC talk on facebook.  If you can't take a joke, get out of EMS!  What we see every day would leave regular people in a puddle of piss, so yeah, the street is the only place to learn what it is we do.  You could take a doctor and put them out here and they'd shit their britches.

3. “If it saves one life, it’s worth it.” What if it was your Mom?  What then?  The cost of 1 human life can't be calculated, I looked it up on wikidepia.

2. “I save lives for a living.” Damn right!  I suit up against Death, kick the Grim Reaper in the ass and take names later.  That's what we're there for Kelly, not all this BS moving people around because they are entitled whiny losers.  I don't remember the whiny brat portion of Paramedic School.

1. “Treat the patient, not the monitor.” All your fancy ALS machines don't tell you squat if you're not looking at the patient!  Get them on O2 and watch them change in front of your eyes.  Sat monitors are useless.  Just give them some O2 already!  EKG?  Not so fast!  Basic before Advanced!  Take a pulse, count respirations, give O2, check a blood sugar, get a BP.  Then and ONLY then should you be applying the monitor.

 

Kelly, your cliche list proves to me one of 3 things:  Either you are a Noob in EMS, have never done any time on the streets, or you're burnt out.  Either way I'm not going to listen to you, whoever you are.  I just saw an update on a facebook group I follow that belittles patients, makes off color comments about death and shares other updates that I agree with.  Keep your fancy learning to yourself, NOOB!

 

</satire>

Sunday, September 22

Custom Made Alt Kilt Fireman's Kilt up for Charity Auction

KTKC Alt KiltktkcshieldSeptember is Prostate Cancer Awareness Month and the Kilted to Kick Cancer Kilted Army has been without undergarments for most of the month.

For those of you not familiar with our efforts, we lovers of kilts banded together to support kicking squarely in the crotch the second leading cause of cancer death in men, Prostate Cancer.  We are not content simply sending money away to guys in white lab coats to find a cure, but would rather focus on preventing cancer and spreading information regarding the risk factors and disease process.

Every time a man in a kilt walks into a room people look.  When you pick up your kids from school in a kilt, people point and whisper.  We see it every time.  I have never asked a man why he is growing a mustache, or if he really is tough enough to wear  certain color, but the kilt gets people talking to us.  Then we abruptly change the subject to prostates and during a good laugh they are educated about the 1 in 6 chance of being diagnosed with prostate cancer in their lifetime and that it's a blood test at first, and that it's not an old man's disease.  If they seem turned off by the topic, we simply ask them to talk to their fathers, brothers, uncles cousins (thanks MC) and then politely wish them a good day and wander off, knowing full well it'll come up later. "I met a guy in a kilt today and you'll never guess what he wanted to talk about!"

Boom!

Along the way Wisconsin based Alt Kilt jumped on board with both feet offering discounts, gift certificates and other donations to help get Kilted of the ground.  And now we are ready to soar!

altkiltlogoIn their latest installment of support, Alt Kilt has donated a CUSTOM made Fireman's Kilt to be auctioned off online to raise money for the new charity Kilted to Kick Cancer.

The kilt is cotton, with tri-reflective striping on the front apron and Alt Kilt's unique pockets on the side.  Included in this one of a kind auction is custom embroidery on one of the panels!  See the lower image above for an example and the auction site for a full description of the kilt, but imagine this at YOUR next Department event, conference, or simply in September when you get Kilted to Kick Cancer!

Please support our cause and get a sweet kilt at the same time!

BID NOW!


If you are a blogger, on Facebook, Twitter etc, please help us spread the word to your followers!

Wednesday, September 18

Are you ready for Evidence Based EMS?

Bad news for those finally jumping on the Evidence Based bandwagon, most of the things you love about EMS are going out the door.

Don't get me wrong, I'm new on this Evidence Based roller coaster, but we used to call it common sense.  How can EMS take ourselves seriously when we demand research for a new toy while defending high dose Epi and backboards as witchcraft Standard of Care?  If something works once it does not guarantee a repeat occurrence.  Ask any married man with kids.

Where was I.  Ah yes...

Things you have to give up if you truly are "Evidence Based":

Lights and sirens

Backboards

Refusal forms

Amiodarone

Epinepherine 1:10,000

Dopamine

Most of the rest of your drugs except benadryl, albuterol, epi 1:1000, Adenosine and Dextrose

ET tubes

Combitubes

Automatic CPR devices

ACLS recertification

PALS recertification

National Registry

Attitude

ED triage

System Status Management

UhU

The pre-packaged occlusive dressing

MAST (oh, wait...I forgot, are we in a 10 year MAST is good or 10 year MAST is bad time period)

The idea that transporting is the solution

Fee for service

Community Paramedicine (They're calling it Mobile Integrated Healthcare now...you know...to make sure the word Paramedic isn't in there and so nurses can do it and bill more)

The idea that "seconds count" (See no more lights and sirens)

The idea that putting a cardiac monitor on a trauma patient does anything at all (Thanks Ambulance Chaser for the reminder)

The idea that CQI is out to get you (Maybe yours is, but I'm not.  Unless you fracked up, then it's on like Donkey Kong)

The idea that your manager was promoted for no reason but when you get the gig it's earned.

The concept that being more like Seattle will save more lives

The idea that a new Medical Director, Chief, Manager or boss will change things for the better

The idea that you are too good for where you are

The idea that EMTs save paramedics

"BLS before ALS saves lives"

The idea that making anything that is red and costs over $200,000 ALS will save lives

The idea that thinking only ambulances can help people

 

 

Need I go on?

Monday, September 16

Kilted to Kick Cancer Spotlight - Kelly Grayson

When the BlogFather tells you to start a contest, you start a contest.

Not content with simply raising awareness to Kilted to Kick Cancer, Kelly Grayson from Ambulance Driver Files .com decided to spearhead raising money for causes we all can get behind.  It was Kelly who started the blog contest.  It was Kelly who insisted we solicit prizes for fund raisers.  It was Kelly who waxed his...um...junk.  For charity.  Right...charity.

He has posted images of himself in drag.  For charity.

He even dressed up in a Star Trek shirt in response to a challenge and a donation.

He may have no shame, but he has a love of the kilt and a desire to raise money for worthy cancer kicking organizations.

 

So three cheers for the reason we have a contest at all, Kelly Grayson, who is indeed Kilted to Kick Cancer.

Donate to his team HERE.

Get Kilted!

Get Checked!

Monday, September 9

Learning new things with old friends

I'm winging my way to EMSExpo today and am slated to speak on Wednesday afternoon on some CQI topics.















CQI Swapmeet

Session 711
Wednesday, Sep 11 2013 3:00PM - 4:15PM
Room: 252
Track: Admin/Manager
Justin Schorr, FF/EMT-P

Since assuming the quality manager position with the San Francisco Fire Department, Captain Schorr has developed tools to track his system both clinically and operationally and looks to share those with other quality managers. Each one of us has a solution to a problem another system is trying to solve, so let's share. This will be a guided discussion covering a wide range of topics including core performance indicators, dashboard design, operations and deployment tracking, GPS integration and much more. It will be an open forum and attendees are encouraged to bring printouts, thumbdrives and CDs to the session for all to share.


Each conference I go to it seemed the conversations at the end were almost as good as the original content, so I thought, why not have a session of discussion?

Then stay in your chairs for he next session about how I turned some basic data and a spread sheet into a tool to determine workload, peak staffing and design a new EMS system to address a mandated increase in market share.















How Busy Are We? Developing Benchmarks to Measure Workload

Session 811
Wednesday, Sep 11 2013 4:30PM - 5:45PM
Room: 252
Track: Admin/Manager
Justin Schorr, FF/EMT-P

Possibly the most complicated metric to track in modern EMS aside from patient outcome is system workload. In late 2011, the presenter was asked by the administration of the San Francisco Fire Department how busy the ambulance fleet was. With no definitive answer, a year-long project began to establish benchmarks to measure system workload and optimize deployment, all while a regulator-mandated increase in market share was looming. Topics include basic system measurements, deployment models, presenting and trending data and how to beg, borrow and steal ideas from other EMS managers.

Aside from that I plan on stopping in on a few sessions Wednesday and Thursday and want to see every inch of the show floor. I won't have my usual homebase at the ZOLL booth this year, so look for me on the move, #kilted of course.

Oh, and you'll have a chance to meet the wife! Mrs HM is attending her first EMS conference this year and has no idea what to expect.

Let's all make it a memorable one! See you at EXPO!

Tuesday, September 3

Kilted to Kick Cancer's September Fund Drive has Begun!

Welcome to a pantless 30 days again this year my friends and thank you for helping make the last 2 years an overwhelming success!

You can donate to #TeamHM HERE and in the sidebar

This year Kilted to Kick Cancer is moving forward, not content with the measly $20,000 ish we raised last year.  Some of our bloggers and participants raised money by channeling their inner Trekkie or waxing parts of their body.

Others posted a link on Facebook and raised a few dollars from friends.  Every little bit helps, but it appears some of you need motivation.  A reason to take the 10 seconds to share the links or a few minutes to send in a few bucks so let me start off the month with the following blanket challenge to ALL the fund raisers out there:

If we can raise $50,000 in the month of September through the KTKC contest, I will let Motocop Tazer me.  Yup, I will ride the lightening for charity.

Are you telling me cops wouldn't want to donate 25 bucks to live vicariously through Motorcop as he tazes one of those lazy firemen?  Come on! You Law Enforcement types need to share this info and get fundraising!

Oh, you want more?  OK.

If we raise $60,000 I'll record it on cell phone and post the video on facebook.

Still not enough?

If we can break $75,000 I'll talk filmmaker Thaddeus Setla into filming  it in HD, edit it, slow mo the smile on MC's face and post it for all the world to see.

These may seem like unrealistic goals, but if you went back to 2010 and told me the late night idea to wear kilts all month would eventually turn into a world wide cancer awareness campaign I'd have laughed and laughed.

 

So take the first step in getting me tazered by clicking on the link in the sidebar and click off a couple bucks.  Then go find a law enforcement blog, facebook page etc and share this link.  Let's get some funds raised for Prostate Caner Foundation, Livestrong and BlueCure!

If I can wear a kilt for a month and get tazered by a cop to get just one man to talk to his doctor, change his diet and avoid/lessen his risk of cancer, shouldn't I?  If I can do all that, can you spare a few bucks to help?

 

Get Kilted!

Get Checked!

 

 

 

Saturday, August 31

Let the Contest Begin!

The Kilted to Kick Cancer fund raising challenge has begun!

 

Please support my team HERE and please give what you can!

 

To motivate you, we hope to be on track to yet again double the previous year's totals and raise $50,000 towards one of the 3 selected charities.

The goal of all of this is to raise awareness of male specific cancers during the month of September.  We are not exclusively against prostate cancer, we hate all cancers equally.  Trouble is, some cancers are sexier than others and get pro athletes to wear their color, products turn colors and the bulk of the nation sees commercials about walk a thon this and for a cure that.

I support them 100%.

What I don't support is that it wasn't until my mid 30s, after learning I had this risk for that cancer and this risk for that one, that TOTWTYTR warned me about my 1 in 36 chance of being killed by something called Prostate Cancer.

"It's an old man's disease" we'd been told.  Turns out they only tested old guys.  Now that they moved the test to a lower age range, turns out it's a young man's disease as well.

Instead of debating the validity of a PSA test (No one seems to challenge other cancer screenings) I want you to stop for a moment and think about your risk factors for cancer.  Any cancer.  All cancer.

#1 - If you have cancer in the family your risk of having a form of cancer go WAY up.

#2 - If you smoke you will likely develop Lung Cancer, the #1 deadliest and, oddly, most preventable cancer known to human kind.

#3 - Stay out of the sunshine.  Skin cancers are the #3 killer behind lung and prostate (for men and breast cancer for women).

#4 - Your diet.  Chances are you're like me and don't have the guts to go full vegan, studied to be the healthiest diet and the most likely diet to reverse and prevent cancer from forming in the first place.  If you don't want to do that, watch Forks Over Knives to get inspired about adding more fruits and vegetables to your diet.  And I don't mean a salad with bacon bits and a 1/4 cup or ranch dressing.

 

Kilted to Kick Cancer would love to find a cure.  But finding a cure means more men are going to be diagnosed and I'm not OK with that.  Last year we learned that over 95% of prostate cancer cases can be treated into remission if found early enough.

So let's do that.

Talk to your Doctor about screenings, your lifestyle and other things you can do to reduce the risk of cancer.

Talk to your father, uncles, brothers, friends about their cancer risks and spread the word.

Get Kilted!

Get Checked!

 

5 years? Yup, 5 years

Happy Birthday to this black hole of time and space called "the blog."

Were you to go back to August 31 2008 and see the look of brief relief I felt putting up that first post you'd understand why i keep it going, in lean times and in leaner times.

The last year of the ol' HMHQ has been pretty quiet but me and my Brother from another Mother Motorcop and I have been busy with Kilted to Kick Caner and our Crossover Show.

 

So thanks for coming by again and hope you see you here next year!

 

-HM

Thursday, August 8

Ying and Yang

The Universe, God, Spaghetti Monster, whatever, always seeks to maintain balance.  For every good thing there is a bad.  For every night there is a day.  To everything...turn turn, turn, there is a season...


Sorry about that.  I have a form of Tourette's where I suddenly break out in 60's folks music.


There is no cure.


Recently at work we've been going through what can only be described to folks outside the industry as upgrading from Grandma's black and white furniture TV set to a 75" 3D LED.


The programming still sucks, but WOW the picture looks amazing!


This week has been long in retrospect and not because of the hours.  It feels long because every minute was filled with activity that required problem solving, multi-tasking and co-ordination of multiple people of multiple disciplines in multiple places.


Tuesday some call it.


I'm usually sitting in a corner room with no windows reading about patients my folks take care of.  It was a shock to my system to say the least.  When the dust began to settle late yesterday afternoon (well after my off duty time) I saw my old nemesis turned ally with a huge smile on his face.  I used to lock horns with this person on a daily basis and here we were sharing a huge sigh of relief that the project was working after all.


All was right in the world.  I felt good.  We got a sitter for date night.  What could go wrong?


Stupid question.


My boss's boss wandered in this morning and reminded me how the (insert deity here) seeks to maintain balance and order.  What once was elation was gone and in it's place was a half empty cup of mediocre coffee and 6 days of PCRs to review.  We only do about 200 runs a day so it shouldn't take more than a decade to get caught up.


 



Wednesday, July 31

CA SB556 - The "He looked like them" Law

Special thanks to Mr Herrera for bringing this back to the front burner for me.

Just a quick reminder: The views on this website are mine and mine alone and not endorsed, reviewed or supported by my employer, co-workers, mother or hair dresser.

That being said,

SB 556 s a giant load of Gou shi.

"Oh my Happy...language..."

It is Gou shi.

Somehow the legislature is concerned that Erma Fishbiscuit is going to be confused when the nice men from the fire department arrive to take care of her, but then a completely different group of men arrive to take her into the hospital.  The uniforms may seem similar, but if she puts on her glasses she'll see the patch on the sleeve does not say Fire Department, nor does the ambulance, nor does the bill she'll get in a few weeks.

 

Apparently the law makers want to make sure Erma is aware that her local Fire Department has no interest in taking care of her by making sure the Fire Department employees wear a patch that clearly states "Government Employee."

Oh, wait.

Scratch that.  Reverse it.

This bill would require uniforms that are similar, but only those not a government agency, to read "Not a Government Agency."

Are we that stupid?

Don't answer that.

 

This bill had obvious beginnings, that being to make sure the guy AT&T sub contracted my install to can be held liable when he screws up, but it was clearly hijacked by someone, likely a Fire Department Union or 2 unhappy with the ambulance contracts in their area.

Disclosure, I'm a union thug myself.

Requiring private contractors to wear a patch or insignia that states "Not a Government Agency" is just as stupid (and would be shot down in a heartbeat) as asking all municipal fire, police and EMS agencies to wear a large orange hat, designating them Government Agencies.

It's good to know we solved the homeless problem and all the children can go to college free since we're passing legislation to make contractors wear patches to tell the public what it already says on the side of their trucks.

 

This kind of crap makes me want to run for office just to slap them with the patch that says "Government Agency" and make them pay for it.

"That's not fair, Happy" Yeah...I know...get it?

 

If you are for SB 556, I welcome your comments and ask that everyone commenting be respectful to one another, whether they be union thug or for profit people mover.

Tuesday, July 30

EMS Flashmob

Eli Beer formed an all volunteer First Aid/EMS group when he was 17.  In the process of developing the program he volunteered on an ambulance and was always upset when they would get stuck in traffic.

Eli attributed his dying patients' demise on the extended response time and wanted to do more for them in the time between when they needed help and when help arrived.

This video goes directly to the core of the Response Time argument and it is important to make a clear distinction between first response and ambulance response times.

We can all agree that getting someone in the door quickly can help guide the rest of the system's response.  This can be a fire department engine, an EMT Police Officer or perhaps a third service handling first response.  What we don't need is to send a reclined cot van on every call, nor does it need to get there in 4 minutes most of the time to make a difference.

In this TEDMED talk, Eli talks about how he came to found United Hatzalah and send motorcycles he calls "Ambucycles" to the scene of an emergency to help until an ambulance can arrive.  He touts a 3 minute response time to over 207,000 incidents last year and is using mobile technology to achieve it.



The phone app broadcasts the medical incident to the 5 closest volunteers in the same way CPR needed apps do so in the states.  When he mentioned it was kind of like an EMS flash mob he had my attention.  We're locked into some old ideas and this one breaks the mold.

 

Why aren't we as communities encouraging this kind of organization?  Sure there are volunteer First Aid Squads all over, but this is far far simpler than that.  And don't wave the liability flag here, those folks would have to be trained to get access to the app and with the right kind of basic QA program built in you're golden.

What do you think of the various things mentioned in this video?

  • Motorcycle first response

  • Volunteers

  • Phone App dispatching


 

Monday, July 29

Bridget Red Ale

First was Saffron, then Yolanda, now Bridget Red Ale completes the 3 known aliases of Malcolm's mystery bride.

image

All 3 have been the same More Beer American Red Ale extract kit and very similar in flavor.

1,000

This is my 1,000th post here on what I now call HMHQ.  One fracking thousand.  Gorram, that's a lot.


I have been putting a lot of thought into what this forum means to me and even considered shutting it down or at least no longer adding to it.


 


This therapy experiment worked.  I was able to overcome the PTSD I was experiencing and the little blog took on a life of it's own.  Many a night was spent ignoring my young family and fussing over every little pixel and post, word and emotion, trying to get out on the keyboard all the frustration I was feeling.  I'm not sure how it looks or feels on that side, but it worked great on this side.


 


Since getting my new gig here at work I've realized that what I used to post about just isn't me anymore.  It feels forced to try to put up a post that fits with what I've done in the past.  Gone are the days of the funny calls, silly patients and unbelievable dispatcher antics.  Here are the days of data analysis, chart reading and the occasional day in the field to remind me what this is all about.


 


My initial intention was to make post #1000 my last, I even told Motorcop I was going to convert the homepage and just walk away.  A large part of me still thinks that is the best idea.


However, not being one to go with the flow, I've decided to give this forum a rebirth of sorts.


August 31st 2013 is Happy Medic's 5th birthday.  But he's just that logo up in the corner.  What used to consume my life is now just a part of it.


But this site was never really his and his alone, it's mine too and I have hobbies and interests that extend past trying to make my day job better.  At some point I came to realize that work is one thing that I do to make home better.


In recent months the Mrs and I have gotten serious about our finances (mostly inspired by GPS Financial Coaching), my eldest is getting way more fun to talk to and the younger one's personality is beginning to show through the tantrums and crying.  Kind of.


This forum needs to spread it's base for me to once again blow off some steam and get some things out onto the virtual paper so they don't drive me insane.  Not that being insane is a bad thing, it's just a touch inconvenient at the present juncture.


In the weeks ahead the blog is going to split into three main categories.  Don't worry, all the posts you've seen will still be here, but will be organized slightly different.


I'm splitting the blog into "Fire/EMS" "Home Brew" and "Life" to accommodate my new interests while keeping the old ones close.  You can choose to read only 1 or all three together depending on whether or not you like the new topics.  I figured this way when I talk about brewing or the family and all you want is EMS, you don't need to see it and vice-a-versa.


 


So please excuse the virtual dust as I eek out a few minutes here and there to fiddle with the layout, categories and the like.  There is no set date on this project, just something I've been putting off.


 


A special thank you to all of you who participated in the Happy Medic and helped me overcome a rough spot, then inspired me to do better.


Thank You!


-Justin "HM" Schorr



Monday, July 22

Response Time or Patient Outcomes - How do you measure your EMS system?

I know it's been quite around these parts lately but a recent article caught my attention this morning.

High Performance EMS posted "Does Response Time Matter?" and it got me thinking.

The author states an example of a patient being "treated" by fellow citizens at an airport and having to wait 20 minutes for an ambulance to arrive.  The author goes on to describe how we need to arrive quickly to save the public from themselves.  After 30 years of telling them to call 911 for anything and convincing them that "seconds count!" what did we expect?  While I agree that a delayed response to certain patient presentations could result in an adverse outcome, that points out a glaring omission from the story.  Missing from the story is the patient outcome.  The outcome will allow us to marry all the data from the response to determine the answer to the author's question in the headline.

The short answer is no, response times don't matter.  And no, I don't have to pee.  I have data that does not have any correlation between quality of treatment, outcome and response time.  From my perch here at the data hub of a quite busy EMS system we have been trying to determine the quality of our EMS system and we rarely look at response times.

Don't get me wrong, we look and our Department statistician collects, quantifies, qualifies and reports to regulators the 90th percentile of all code 2 and code 3 calls to meet their requirements.  We report it, they receive it.  The document says nothing about the quality of care or patient outcome.  The reason being that we can not guarantee a positive patient outcome, but can measure when we left and when we arrived.  Imagine if we had to treat 90% of symptomatic asthmatics with oxygen within 5 minutes of arrival and document an improvement in condition.  Can your system guarantee that?  Why aren't EMS systems measured by the quality of their care instead of the quality of their response?

Apply this metric to any other industry and it fails.  Industry is measured by their quality and efficiency, not the speed in which they complete their tasks.  So long as we only look at one metric with any regularity we will continue to shuffle ambulances 2 blocks at 5 minute intervals to meet an average instead of realizing just leaving them still would bring the same outcome.

That's where I come in.  My Medical Director and I, unhappy with the lack of actual patient care quality metrics, created our own in an effort to determine the quality of care being provided.  We learned very quickly that our ambulances do not respond in a vacuum.  Each patient receives a call taker, dispatcher, first response, ambulance response, assessment, treatment and some get transported.  Once at hospital they receive a whole new level of care and review until they are finally sent home.  It is hard to argue that the time it took to get an ambulance from point A to B has an impact on this outcome without any review of the call taker's coding of the call, the dispatcher's assignment of the ambulance all the way to the destination hospital capabilities and location.

We can all sit at the Pratt Street Ale House in Baltimore and discuss short times that had a bad outcome and long times that had a good outcome, but the worst part of all of this discussion is that so few systems measure anything more than response time.

If you consider response time your metric of success you have already failed.  You have failed the patient who improves when you arrive "late" and discounting that response as a failure, yet trading high 5s when a 2 minute response yields a call to the Medical Examiner's Office.

We all know the stories of companies staffing ghost cars near the end of the month to bring down the monthly response metric to meet guidelines.  It happens.  But I also wonder if that flood of ambulances to help more people had any other impact.

The complication in tracking outcomes is the relationship your agency has with local hospitals.  We may never have a seamless transfer of data but what we can do is pull data from the PCR to determine if the patient received the indicated treatments for the recorded chief complaint and observed complications.  By reviewing your policies and protocols as well as your patient demographics you can quickly spot your core performance indicators and design tools to track them.

It may be nice to know that we make our 90th percentile in 8 of 10 districts on a regular basis, but what if those 2 districts happen to have the highest number of cardiac arrest survivals to discharge?  Are they still a failure?

Widen your view to include more than how quick you can put the ambulance in park.  This goes far beyond the lights and sirens System Status Management debate and speaks to the core of the reason we're out there to begin with:

To make someone's bad day better

Delays can hurt, but not unless you look deeper into your system to find out if that is the case...or not.
999

Tuesday, July 2

Paramedics say the Darndest Things

Mutual Aid company Captain Chair Confessions has a new post up that made me laugh, smile, snicker, exhale, then almost cry.

I miss it.

I miss the witty banter between rescuer and patient, between rescuer and pseudo-patient and above all else I miss the banter between rescuer and liar.  Gods I miss that.

I miss the basic interaction of assessment.  I miss Erma Fishbiscuit and her 23 meds prescribed by 24 doctors.  I miss her son Bubba and his drunken insults, the relief on the face of a CHFer on CPAP and the chill you get from hearing the EMT say "I think I feel a pulse you guys" after 35 minutes of CPR.

I miss it.

From my ivory tower at Headquarters I read most of the charts, checking my check boxes that the crews checked all of their check boxes and fielding calls from angry nurses that the crews didn't check the check boxes.

I turn off the light, close the door and head home, fire up the computer and live vicariously through you all.

Didn't that used to be the other way around?

The post today seemed like something from 2009, 4 years ago, when I was at the height of my posting, fired up and ready to change the world!  It seems so long ago.

Turns out the world wasn't in the mood to change.  They never got the memo, so I hand delivered it.

This therapy experiment we've been working on together has seen some incredible ups and some devastating downs.  We've shared war stories, ideas, concepts and solutions.  We've laughed together, mourned together and still cling to this one tiny thing we believe in above all else: EMS.

From PTSD to stress relief, from Chronicles to Seat at the Table, from Baltimore to Houston to Vegas this blog has not only opened doors but kicked them in guns blazing kickin' ass and takin' names.  Clinically speaking of course.

And now I wonder what it's place is anymore.  Most of my frustrations about the system not working come out in written form to Chiefs, Medical Directors and regulators who take them seriously and many are being considered or have already been implemented.  Motorcop and I spar on our weekly video show and I get great satisfaction from that interaction.  I can't tell even HIPAA cleansed stories because for each one I filter another pops up that fits that description.

Everything that made this forum what I wanted has found another outlet.

 

This forum, this community, you, helped me through a dark time and I came out shiny on the other end.



What's next?

 

Monday, June 10

Official Fire Service Ice Cream Rule

To finally dispel the myths, rumors and falsehoods regarding the Fire Service Ice Cream Rule (AKA Steaks, Cigars, etc) I offer the following definitive ruling on the matter:

Official Fire Service Ice Cream Rule:


1.  Purpose

To establish when a Member of a Company owes Ice Cream to the other members of said company.

2.  Scope

This rule applies to all Fire Service personnel, both paid, paid call and volunteer regardless of rank, station or assignment.

3.  Definitions

Company - A unit or similar single resource.  This can be defined as an Engine Company, Station House or Volunteer Post.

Member - Any person in official capacity at the time of the incident in question.

Ice Cream - While an abomination in the eyes of the Lord your God, something with a crap load of ingredients.

4.  Enough with the bullet points!  Onto the rule!

Ice Cream is owed only if a member of a company is portrayed in the media, be it television, print, online or otherwise (social media not affiliated with a media outlet excluded (see rule 8))  portrays the member in activities not associated with the assignment they are recorded at.  Being filmed fighting fire, cutting a car, rendering aid or performing regular assigned tasks on the scene of an emergency response DOES NOT entitle the members of the company to ice cream from the member involved. Also, for rules on double parenthesis, see rule 9.

5.  Who gets Ice Cream

Only other Members of the offending Member's Company are required to be appeased with the cold Ice Cream goodness.  Depending on Agency or Department, this may include all units assigned to a house or all shifts on that unit.  It DOES NOT apply to other Companies, units, houses or personnel who wander in to mention being "owed" Ice Cream.

6.  Who doesn't get Ice Cream

Officers above the rank of front line supervisor (Lieutenant/Captain/Sergeant) unless they were at the scene and may have to answer to the activities of the member caught not performing duties relevant to the scene in question.  All other houses, members and companies not assigned to the offending Member's HOME Company.

7.  Oh yeah, that reminds me, HOME Company

Ice Cream is only owed to a Member's HOME Company, not the Company where they were assigned when said incident took place.

8.  Social Media not involving media outlet

That doesn't get Ice Cream but instead a pat on the head for the person trying, because that wreaks of desperation.

9.  Multiple Parenthesis

Nah, looks weird...or like math, which is WAY worse.

 

Tuesday, May 28

You got WHAT stuck in a bowling ball?

In my memoirs of EMS (Working title - My Life in CQI: Kill me now, just document it properly) some calls will stand above all others.  This, sadly, is not one of mine, but from a friend overseas.

No, not Mark.

I got an email about a curious rescue his agency was called to and was wondering what I would have done.

So, here is the scenario:

 

A 19 year old male has gotten his finger stuck in a bowling ball.  He somehow wedged it in there so far, it up against the webbing of his hand with very little wiggle room.  Rotating the ball is out of the question as he seems to have the finger next to it wedged in almost just as bad.

25 minutes into the call you've tried gel, ice, lubricants of questionable origin (who carries that stuff into a bowling alley?) and brute force.  Prayer is taking place and all options seem exhausted when the decision is made to simply move him, and the 16 pound bowling ball, to the hospital.  What will they do there?  Dunno.

 

What would you do?

Saturday, May 18

Show me the Money

Friend of the blog Bill Carey posted on Facebook wondering why so many in EMS think that salary is the one thing holding us back.
Curious, question for EMS folks on FB: It appears, based on comments to various news stories in the past, that the greatest solution to all that ills EMS is greater pay. Respect is restored, working conditions and staffing improve and the general idea of professionalism is better. Fire-based, hospital-based, third service, doesn't matter, just pay us more and the service will get better.
Really?

No, not really.

The same issues I had when I got the paid gig for $4.35/hr are here at my current gig where medics average $65,000 to start (according to indeed.com).

EMS in general is paid what the market allows and what we are worth.  Keep in mind that EMS does not require a degree and Paramedics can get licensed in as little as 1 year in some places.  If some kid walked into my office and told me he went to school for something for a year my first question would be "When are you going back to finish?"

Pay is a result of our goals, not our goal.

Increasing our education standards and proving our worth to the industry is step number one.  But of course the stumbling block to education is how to pay for it.

If you think the reason you are not treated like a Professional is the size of your paycheck I think I know where your priorities are.  If your first concern is that you don't have access to enough education I'll ask where you live and why you're still there.

There are high paying EMS jobs out there, folks, I've had one for 10 years, but you have to be willing to put the effort into it.  No one is going to wander into the station or yard one day and say "You guys are great, here's a raise."  Your employer has no incentive to increase your compensation unless they desire a particular set of skills that bring that kind of salary.

EMTs are entry level and their compensation reflects it.

Paramedics have more responsibility and therefore more compensation.

A flight medic has even more responsibility, so more compensation.

A Firefighter/Paramedic has a different skills set, different compensation.

 

You get the salary you're getting because that's what you're worth to your employer.  If you started off at $10 an hour, got your degree, teach on the side, and are still making $10 you need to talk to your employer about the increased value you can bring to the organization.  Maybe you're in line for a promotion or reassignment with your increased education and experience.

It all comes back to education.  If you learn more, not only can you increase the care you can give to your patients, but you become a more responsible care giver and show your manager that you're not just in the seat for a thrill, but to make a difference.  Folks like that make less errors, collect less complaints and are more likely to collect extensive billing and demographic information.

That makes you a keeper and worth more to them.  You increased your value.  That is the only way you will increase your compensation.

 

Let's imagine that I'm wrong and simply snapping our fingers and giving you more money is the solution.

Now you make twice what you did yesterday.  Now what?  Now will you go back to school?  Teach?  Where is the added value we're paying for?

The patients are the same, your rig is the same, your protocols haven't changed and you haven't changed.  There isn't much we as EMTs and Paramedics can directly control but our own attitude and education are the easiest to improve in a short amount of time.

Just raising your pay won't improve your attitude or the attitude of your co-workers.  It won't help your manager see the worker bees from the cling ons and it surely won't help your patients.

If you think you're worth more to your organization than you're being compensated, tell them, and get ready to pack.  The high paying jobs are out there, but you'll likely be in a busier system and competing against higher education and higher motivated applicants for the extra money.

 

Case in point: me.

When I left my last job I was a Firefighter/Paramedic serving a suburban area working on both the Engine and Ambulance.  I was making just under $10 an hour on a 24 hour schedule.

When I got my degree in EMS and began teaching I knew I could reach out an look around for something better and have a good chance of landing it.

When I got hired in San Francisco as a Firefighter/Paramedic assigned to a 24 hour Ambulance I had tripled my salary.  Tripled.  But the cost of living was double and my old shifts of sleeping most nights turned into 32 run paramedic pinball sessions that I loved, but took their toll.

I moved 800 miles to get that gig and I have the broken down UHaul story to prove it.

You can get a high paying EMS job.  They exist, but you have to work for it.

What are you willing to do to prove your worth to EMS?

Saturday, May 11

Why can't the waitress bring me my food?

I can not wrap my head around what is happening in restaurants these days.

 

We are seated by the hostess and she makes sure we have our menus and place settings.  Well, at least she's supposed to.

Then an either overly friendly or clearly distracted waiter will come over and offer us an appetizer and to get us started with drinks.  OK, sure, I'll have a water.  And have you ever introduced yourself back when they tell you their name?  It's like they're confused.

Then the server gets deflated thinking I'm only drinking water when in reality I'm ordering it now because if I ask for a water AND a beer, they'll forget the water all together.

 

We finally order and are awaiting the food.  No surprise there.  If the food comes out too fast you have to wonder, right?

 

Then the oddest thing happens.

Someone, not our waitress, brings out the food.

Not only do they have no idea who ordered what, but it's never how we ordered it.  Why? Because if the waitress had picked it up she would have noticed the salad never made it out, that the wrong kind of meat is in the tacos and that the sauce with the chicken only rhymes with what I asked for, specifically.

"But your food gets out quicker this way."

No, I never got MY food, I got what they brought, but it was wrong.

Then as soon as it hits the table the waitress magically appears asking if we got everything OK.

No, no we didn't, where were you?

Why does any Tom, Dick or Harry wandering past the pass think it's OK to grab my order and bring it out?  If there's a mistake that is where you want to find it, not when Johnny the under waiter brings me the tray and has to ask about each and every dish.  Sally is serving Table 5, let Sally check on the food.

Each and every argument for the speed or so called efficiency of this system is countered by the fact that your speed is costing quality.

And it's not just where I ate tonight, but most establishments today.  Waiting for food that is as ordered is OK, rushing me something close and thinking I won't notice is no way to run a service based industry.  If the servers need help, let the under waiters handle all the drinks and refilling the waters and all the crap that seems to be "bothering" the waitress and distracting her from making sure the orders come out as...well...ordered.

And another thing, while I'm at it, waitresses, please look at the table you're about to talk to and gauge if it's the right time to ask if everything is OK.  I once ate at a restaurant where the waiter seemed to be just out of visual range...ALL THE TIME.  As soon as the water was low, he happened to be nearby with the pitcher.  Never once asked how we were or how the food was.  He just knew that since we were there and he was there that if we had something to say we'd say it.

I never waited tables and I'm not ragging on the waitresses, I'm asking this to the managers.  The ones who sometimes bring out said food or are idle in the corner in their tie staring out into the dining room.  The ones who awkwardly go from table to table every hour asking the same lame question: "Everything good here?"

For the third time and while I'm wrangling a kid with my mouth full of food, "mmmphmmdp"

And he's gone.

</rant>

Friday, May 10

Why it's "48's job" and not "A job for Engine 48"

In a recent post where I bragged that the Mrs can speak Fireman, BGMiller posted the following comment:

Okay HM, time for a question that’s been floating around my noggin for a while and this seems like as good a time as any to ask…
It’ll be a little convoluted but such is the nature of my brain.
Is it just a California thing to refer to a station’s companies by the possessive of the station number? (ie; 48′s caught a run for a structure fire…)
Does this come from it being more common in the West for multiple company stations to share numbers while departments in the MidWest and on the East coast tend to mix numbers in a station? (ie: LA County Station 51 was home to Squad 51 and Engine 51 or 127′s was Engine and Ladder 127 while here in Iowa my first due is Station 4 and houses Engine 4 and Truck 2.)
Just a little detail that’s been kicking around in my head.
 

Well BGM, I haven't the foggiest.  I only know that where I'm working it has been like that since, oh, the late 1840s.


Tradition is an easy answer, but most of the nomenclature stems from when the Companies were Volunteer.  The wagon, engine etc actually belonged to the Company, as did the response area.  When asking about who was at a fire, you could say, "Oh that was at 4th and Brannan" or "It was in district 5, Battalion 3, Division 1" similar to Companies in the military.


However, everyone knew where the engine companies were.  Before they were rolled into the municipal fire service and numbered in the order they joined they had names like Liberty Hose, Knickerbocker and Valiant.  It's was Valiant's fire, it was Knickerbocker's fire.


When Knickerbocker joined the municipal and took on the number 5, it became Knickerbocker 5's fire.  Then 5's fire.  And here we are.




SFFD Gorter Tower

Ladders and Trucks came later when they were also rolled into the municipal service, joining in different order than the engines they would be housed with.  That's why in some places Engine 4 is housed with Truck 1 etc.  In the early and mid 70's when computers were added some Departments (including mine) changed the truck numbers to match the engine number to avoid confusion.


But when I was growing up in a suburban Department that was roughly the same age as me I heard my father and his buddies refer to other stations by their numbers as well.


"Are we drilling with 19's this afternoon?"  It referred to the crew being a part of the company, part of the house.  The men and women assigned there belonged to it, not the other way around.



Does that answer your question?


Oh and BTW a tanker has wings.  ;)



Tuesday, May 7

Overheard at HMHQ

Over lunch one Saturday...

HM looking at phone news feed - "Oh look, 48's had a 2 alarm fire this morning."

MrsHM - "48's?  Which Companies are due on a second to the Island?"

HM, startled, -"What did you just say?"

MrsHM - "Didn't I say that right?"

HM, proud, -"Yes, you did..."

 

 

Monday, April 29

Morpheus is fighting Neo!

In 1999 we were introduced the concept of the Matrix.  An electronic dreamland wherein machines of the future have enslaved human kind and keep us around as power sources.  Since the body can not survive without the mind, the machines have created an elaborate computer world that we all live in, oblivious to the truth.

A select few humans have discovered this fact and escaped, creating an underground resistance to fight the machines in the future and free human kind.

Spoiler Alert: I kind of doesn't work.

Every time I hear someone in EMS complain about kidnapping, or having their chart blown up in court for all to see or some other urban legend of our Profession, I have to wonder what they would do if Morpheus arrived to show them the truth:

I picture Kelly Grayson sitting in a leather chair in some sweet shades and a fancy coat, holding out 2 pills to new EMTs.

You can take the blue pill, go along pretending this is all there is.  Backboards for everyone and NRBs at 15 liters per minute,  partners who torture with 14g catheters and refuse to tuck in their shirts, merit badge refreshers that rehash what we think we know and another conference class on how things used to be.

OR

You can take the red pill, and see the truth.

We are keeping you poorly educated and poorly paid because we need a steady stream of adrenaline junkies to replace you when you get burned out in 6 months.  You're living in a dream world, new EMT, a dream world where the bare minimum is acceptable, even encouraged, and we make sure you're just happy enough to accept it.

You go to work, collect billing information, treat from the cookbook, follow your patient's every demand no matter how outrageous and it bothers you.

But what to do about it?

You're here because you know something is wrong, but you can't seem to put your finger on it.  No matter how many conferences you attend, magazines you read or managers you talk to, the answer seems to be the same:

"The future is now!"

But you don't see it.  How can the future be here if it looks just like the last 30 years of guessing at science and pretending that taking them all and letting the MDs sort it out has ever worked?  When will you realize that "that's the way we've always done it" is the last excuse of the desperate?

Take the blue pill and you'll wake up tomorrow thinking your desire to improve was misguided, a waste, a dream.  You'll strap up your boots and go to work, still wondering what is bothering you about what you do.

Take the red pill, stay with me, and see just how far we have to go.  Learn more about why, expand your horizons and seek out solutions.  I can show you the truth behind the lies, but you have to forget everything you know and trust me.

I offer only the truth.  Nothing more.

Morpheus: I imagine that right now you're feeling a bit like Alice. Tumbling down the rabbit hole?
Neo: You could say that.
Morpheus: I can see it in your eyes. You have the look of a man who accepts what he sees because he's expecting to wake up. Ironically, this is not far from the truth. Do you believe in fate, Neo?
Neo: No.
Morpheus: Why not?
Neo: 'Cause I don't like the idea that I'm not in control of my life.
Morpheus: I know exactly what you mean. Let me tell you why you're here. You're here because you know something. What you know, you can't explain. But you feel it. You felt it your entire life. That there's something wrong with the world. You don't know what it is, but it's there. Like a splinter in your mind -- driving you mad. It is this feeling that has brought you to me. Do you know what I'm talking about?
Neo: The Matrix?
Morpheus: Do you want to know what it is?
(Neo nods his head.)
Morpheus: The Matrix is everywhere, it is all around us. Even now, in this very room. You can see it when you look out your window, or when you turn on your television. You can feel it when you go to work, or when go to church or when you pay your taxes. It is the world that has been pulled over your eyes to blind you from the truth.
Neo: What truth?
Morpheus: That you are a slave, Neo. Like everyone else, you were born into bondage, born inside a prison that you cannot smell, taste, or touch. A prison for your mind. (long pause, sighs) Unfortunately, no one can be told what the Matrix is. You have to see it for yourself. This is your last chance. After this, there is no turning back.
(In his left hand, Morpheus shows a blue pill.)
Morpheus: You take the blue pill and the story ends. You wake in your bed and believe whatever you want to believe. (a red pill is shown in his other hand) You take the red pill and you stay in Wonderland and I show you how deep the rabbit-hole goes.

 

It should be noted that many Matrix fans believe that the "real world" and Zion are also parts of the Matrix used to control the radical element and that the machines have anticipated their desire to rebel.

EMS doesn't need a Neo to come and save us, or even a Morpheus to show us the way to the Oracle to hear what we need to hear.  But what we do need to do is wake up, look around and stop taking half truths and scare tactics as solutions for our patients.

Which will it be?  The red?  Or the blue?