Saturday, February 16

Not Lost in Translation

I'm not one to name drop on this blog, just ask my good friend Kelly Grayson.


That being said I had an interesting conversation with someone who shall not be named who stopped by my Medical Director's office on Friday.  In from out of town he was curious about or current ramp up to pick up another 10-15% of the response market share and how we were planning on doing it.

Phrases like workload, UhU, time on task, staggered starts, logistics gap and dozens of others were immediately understood by all 3 parties and the conversation was inspiring.  What we have been trying to explain to regulators, the field crews and the bean counters was immediately understood, digested and we got an honest review of our efforts so far.

Just as interesting was when this expert made suggestions on where to go next that we had already put in motion.

The entire conversation lasted about 2 hours and solidified a lot of our methods and decisions in a field that has 1000 different solutions for a half a dozen problems.  The great part about sharing ideas is that we all learn what works for some and not for others and can apply the successes while avoiding the mistakes.

He asked what our start times were, we answered.  We were doing it right.

He asked what our deployment plan was, we answered.  We were doing it right.

We talked about the difficulties ahead in justifying the plan that calls for more hires, more units and more equipment and he shared some ideas.  Now we can do it right.

I don't expect every CFO to understand how UhU alone is a waste of time and that the return on investment is useless if we don't directly collect our receipts.  Sometimes a chance to talk to someone who "gets it" can inspire you to keep fighting.

So what did I do?  I went on vacation.

See you in a week Internets.


Friday, February 15

I've seen it all, we're done here

I thought I had seen it all until today.

Every manner of injury, illness, presentation and patient seen, noted and documented.

Oh universe, I love it when you mess with my mind.



A bicyclist has been hit by a car



Well, not exactly "hit" and not exactly "by a car" but at least there's a bicycle involved.  Units are approaching from all directions downtown and traffic is thick as it is almost 330 on a Friday afternoon.  The bicycle messenger rider is standing, rather clamly, on the sidewalk near a stretch of street with cars inching forward, but none of them stopped.  At least not stopped as much as you'd expect for someone who just hit a bicyclist.

As we approach he's holding his right arm with what appears to be a napkin, likely from the Chinese take out place behind him.

The assessment begins and we're hard pressed to find any injuries consistant with a vehicle versus pedestrian.  We are allowed to get so deep into the assessment before discovering what happened because, as always, our question of "what happened?" is met with a 25 minute slide presentation about how he was following all laws, riding this direction from this place as he always does, blah, blah blah.  I used my patented "skip to the part where it's an emergency" more than once and finally he explained the napkin on the arm.

He got bit.

By a dog.

While on his bike.

I did a quick double take.  On the bike, even crouched over his shoulder is a good 5 feet off the ground.  How did a dog-

And that's when the delivery truck in the far left lane, the one right in front of us hit a pothole, tilted and gently scraped a no parking sign.  Judging by the sign and the scratches on the truck, not to mention the truck not stopping, happens all the time.

The dog was in a car.

It was hard not to stifle the giggles and my partner is a pro at getting the giggles out, so my next question was tough.

"Did you get a look at the dog?"

He suddenly had somewhere to be and rode away before we got his signature on the form, but I imagined him on his hipster bike, riding along in traffic and some dog out for a joyride just sniffing the air decided to see what the City tasted like.


That was a first.  And it reminded me that as soon as you think you've seen it all-BAM-sumpin' new.


Monday, February 11

Paramedic - A look back at the first 100 years - Part III

Now that the solar flares have passed and we're all back topside we can continue on our jaunt through the history books looking back at the first 100 years since Paramedics were born of necessity and grew into the most valued public service since the Post Office was reinstated.

Today we look at the early use of the pre-cortex for Paramedics of yesteryear to check their work with Physicians.


Online Medical Control

Before the Cortex people accessed a maze of sites with conflicting information, often having to enter queries using digit tabs called "keyboards" which allowed them to access information.  From my research I have discovered that early Paramedics were rarely trusted to make decisions on their own and would access online medical control.

Since the Paramedic's searches were based on their own impressions of what was happening, it was very easy for them to access the information they needed for the proper treatment of their patients.  It was not the same as today, where Paramedics are trained to act in all situations, but instead was a way for our lesser educated predecessors to ask for help on difficult cases.

This was also referred to as "WebMD" and was accessible from any screen in any community.  Before screens contact was made via telephone line or by radio.  I know it seems odd to call a WebMD for Online Medical Control without them being able to see the patient but apparently it was done quite often.  Some systems were very strict and even required Online Control for some medications.

You see, before Paramedicine was recognized as a specialization it was often relegated to those who could not afford to attend Medical School but still wanted to make a difference.  This WebMD allowed them to be trained quickly and work for far less than their skills were worth to the greater medical community.

After the influenza their value was recognized but up until then Paramedics still accessed the world web when needed, not unlike a wave consult for surgical consults of decades past.

It was a good tool for the time but seems to have held Paramedicine back in some communities for reasons I can't discover.


Next time we'll answer one of the biggest mysteries of early Paramedicine:  Was it really done by the Firemen?

Tuesday, February 5

A new kind of intern

For the last two Tuesdays I have had an intern.

I can hear you now, "That silly Happy, he has a desk job, how can he have an intern?"

Well, a local High School has expanded and offered an EMS Intern position.  One of the local Rescue Captains has assisted in designing the program which will give this student an inside look at not just field time, but supervisor time, administration time, radio time and even a few days with the regulators (Remind me to ask her to ask about proof spine boards are a good idea.)

I am proud to announce she was officially bored out of her skull in the CQI office.  What we do can be distilled down to the high school level, but the finer points of QA (stop laughing already) can be lost.

"We apply the rules, regulations, policies and protocols to each chart and determine if variations warrant review, coaching, counseling or reprimand.  And after completing those reviews we analyze the results to determine trends and act on them."

She was unimpressed (Seriously? Stop laughing.)

So we read a narrative I was reviewing.  It went a little something like this:

"Police activated EMS for man defecating on sidewalk.  Male present alert and oriented, steady gait near pile of human feces.  Male has no chief complaint and has no signs of traumatic injury.  Male states "Just cite me and go away" without slurred speech.  Male does not give consent to treat or to assess vital signs, threatens to pick up and forcibly relocate feces, EMS agrees male may leave area under own power."

"Why did the cops call if he wasn't hurt?" She asked.

"We're working on that, but I expect your generation to get that sorted out for good."


She had a chance to meet the Chief of EMS and talk to him a bit about what it means to be a Paramedic these days and looking forward.  He is of the same mindset as me, that we make bad days better and go home safe to our families who will never know the truth of what we've been through.

I told her that the gauge of a good EMS leader is someone who, when asked if they would go back to an ambulance answers "yes" without the slightest of hesitation.  You can be away from the ambulance for only so long I have learned and the farther away, the more you miss it.


Next Tuesday is her last day in the Administration track and we'll stop by the fleet yard and let her observe a World Class System deploy to chaos.


Saturday, February 2

Go home apparatus doors, you're drunk

Caught this video from Sydney from youtube superuser www911rescuede.

Dig the apparatus doors.  First the side opening ones...then'll see.