Wednesday, December 17

Bag Baggage

I am not a fan of all the crap we have to carry around.

We carry the worst case scenario into every single call mainly because the manner in which we are assigned calls for service, by first come first served.  Add to that the impossibly broken categorization of calls into little boxes that has never, ever, EVER, been accurate or efficient.

Because of all that I have to carry my cardiac monitor/defibrillator, Oxygen, clipboard and ALS bag on every. single. call.

Why?

Because you never know what is waiting for you.  The 62 year old male with a headache you were dispatched on?  That's a 34 year old woman in active labor.

The unconscious man in Apartment 4H is actually the 5pm dialysis transfer wanting to get in early.

 

Since my attempts to change the way we dispatch failed in the design phases, perhaps there is a short term solution to all the gear we carry.  Here at my current assignment I oversee between 2 and 5 ALS first response units depending on staffing.  It seems each crew has their own way of stocking the bags.  We do a lot of hiking with or bags since our call may be to Gate 67 but the patient is now closer to gate 82.

This means all our stuff needs to be carefully stocked and easy to carry long distances.

The roller bag version was suggested, but the size and need to carry it up sometimes very steep jetway stairs made that solution unfeasible.  I know everyone seems to run a different bag in a different set up, but that's only because we all have different priorities and specialties when on scene.

For example, all my assessment gear is in the top compartment of my bag along with my oral glucose.  That's my "This part gets opened on all calls" part.  Then inside is my IV bag, meds and intubation kit on the bottom.

I'm not looking to wake the sleeping dinosaur of EMS opinion on bags and bag set ups, just wondering if I'm the only one frustrated that we carry everything everywhere.

On the engine I don't take a ladder inside every fire, I can go back out and get it, but for EMS, we carry cardiac arrest meds to stubbed toes.

0.5% of my call volume gets in my way the other 99.5% of the time.

"But if it saves one life...?"

But what if it negatively impacts another?

Am I over reacting, whining, or should we try something new?

Saturday, December 13

Police Fail?

I recently completed a patient care report that came about as a result of...let's just say our boys in blue were involved.  I have to complete a number of codes specific to the situation including the nature of injury, factors affecting care etc.

I never noticed that the code for Factors Affecting Care with Law Enforcement is...

 

wait for it

 

 

FALE.

 

I giggled just a little bit.

Thursday, December 11

The little plane that wouldn't go to Chicago

A children's tale.

 

Once upon a time there was a little plane named 757.

757 was told by the pilots that she was supposed to go to Chicago, but 757 did not want to go to Chicago.

She tried to shut down boarding by fidgeting with the gate controls, but passengers continued to board.  Soon after they were all in and she was steered towards the runway she reached out with her magic and made one of the passengers ill.

The Paramedics were there when she pulled back into the gate, pleased that she had stopped the dreaded trip to Chicago.

But what is this?  The passenger is swiftly removed and her crew is given permission to pull back out and into flow for takeoff?!

757 tried and tried everything she could imagine but a few minutes later found herself on the runway given clearance to take off.  If she didn't do something quickly, she'd be forced to fly to Chicago.

She didn't want to harm the passengers, but something had to be done!

That's when little 757 got the perfect idea!

"Flight 554 you are clear for takeoff runway 99 Right, have a good trip."

"Copy, thanks, 554."

"Uh, 554 this is Southwest 221 directly behind you, you have an APU fire, you'll want to pull off the runway. Tower can you send someone out here, 554 is on fire."

Little 757 had held her breath so long and suddenly blew it out so forcefully that the Auxiliary Power Unit (APU) on the rear of the plane erupted in flames.

Perfect!  The fire would mean being towed back to the maintenance facility and certainly no trip to Chicago!  Little 757 had...wait a minute, what's that tickling?

Rescue 10 had arrived swiftly and put the fire out.  So swiftly it seems that the pilot is now comfortable returning to the gate under her own power and having the mechanics evaluate any damage.

And there almost ends the tale of little 757 and her almost trip to Chicago.

Sunday, November 23

Working on the Holiday - A poem

So you've got to work the holidays, or your boss will get real mad?

You work in a big box store in town, and your schedule makes you sad?

Well let me tell you another story, of some folks who just like you,

are working on the holiday, so that others do not have to.

We are your firefighters, your medics, your cops,

your nurses and doctors ready to assist,

just like every other day, not just December 25th.

We'd like to teach you something you'll eventually figure out,

a holiday is just a number, there's no need to pout.

Turkey tastes delicious on November 29th,

and sometimes we celebrate Christmas on the 26th, at night.

Your place was open last year and the year before,

on the day so suddenly special you want to blame the store.

So for those of you who complain about working this holiday,

remember the others who are always working regardless of the day.

You won't have to work the holiday when you get a better gig,

but if you're lucky, you will, cause you'll be with us in the rig.

 

-HM

Monday, November 17

Community Paramedicine doesn't belong in EMS

Community Paramedicine, or what some would rather call Integrated Healthcare, is a fantastic concept.  Why not take basic medicine and evaluation skills to the patient recently recovering from a procedure instead of making them visit the MD's office?

Why not follow up with Mrs Jones on how her medications are doing?

Why not have a Paramedic check in on Mr Thompson and his blood sugar levels?

My first paying gig in EMS was for a system that did just this.  We visited our list of clients based on the schedule and checked their blood sugar, blood pressure, medications and checked the fridge for food.  I hated it.  I hated it because it wasn't what 18 year old me wanted to be doing.  I didn't see the value in the program until I was about to finish my employ there and noticed we never ran a 911 call on any of our home visit regulars.  We weren't providing Emergency Medical Services (EMS), we were doing something completely different.  Call it by any name you like, but don't call it EMS.

Today I'm a huge supporter of decreasing the demand on 911 by focusing on reducing the number of people who call.  One of the proven tools used to combat 911 calls is making people healthier before they need 911.

Community Paramedicine is just the thing each and every community in America can use to reach out to a niche that needs to be addressed.

When I was in England all those years ago Paramedics with only 1 year experience were out on their own making recommendations, referrals and taking people directly to what they needed, not just a 2 person cot van to an ER (Or AE for those who favourite that term.)

The concepts have been proven over and over again and some systems are even carving out revenue streams to make it profitable or, at least, not at cost.

I applaud their efforts and if the opportunity ever comes along for me to get involved...

...I'll pass.

In my opinion Community Paramedicine is too important to be trusted to the 911 crowd.  We need folks more interested in sitting and talking than squeezing a few home visits in between calls for service.  Some systems have adapted schedules and providers to respond only on the Community cars and that's great, but a greater separation is needed.

Yes, I'm advocating splitting EMS even further than we are now.  A split that will allow this new sub specialty to thrive.

Community Paramedicine needs to be a specialty, a half brother, not a spin off hoping to get picked up for a second season.

It will not succeed if it is tied to the chaos that is 911 for profit and must succeed if 911 for profit has any chance of surviving another 10 years.  We're approaching a cross roads to possibly finally squeeze our little patient care machine into the main stream of medical professionals.  Do we want to squander that opportunity by having Community Paramedicine as a side project of EMS or as a full fledged community service independent of the lights and sirens?

I know 18 year old me had a different reason for having this opinion, but the opinion remains:  911 and community care shouldn't mix.  They should each focus on their strengths and excel at the service they provide the community instead of stretching us so thin only our merit badge classes hold us above water.

Sunday, November 16

Taylor Swift inspires new EMS billing model

I've been reading in the papers lately that Taylor Swift and Spotify have been going back and forth about royalties for her songs playing on the streaming music site.

According to sources, she was paid less than $500,000 for 12 months of her songs playing on the site.

My first two words were Boo and Hoo.

Then I looked at the feed of a friend of mine who is a musician.  They have a fair argument in that the way the industry is arranged you get a small amount for creating the music (writers, musicians, performers) then more the more the piece is performed.  It makes sense on a certain level, but the model is clearly outdated.  Before it can be changed, the industry should realize that fewer and fewer of us listen to terrestrial radio (where their songs are actually placed at cost, not at profit) and more of us are streaming music using spotify and Pandora like apps.

I start with a band I like, then it introduces me to other bands I may like as well.  Then I buy their albums, but not in a store (that used to take as much as 30% of the 19.99 for the long box), I pay 99 cents per song on itunes at no cost to the production company.

This line of thought brought me back to EMS.  Let's apply the music industry reimbursement model to what we do:

First off, you'll be required to create unique treatment models and protocols.  Then you'll be paid a small amount for actually providing the care requested. (no real change there, right?)

Now here's the BIG difference:

You get 1% of your patient's income.  For life.

Are you motivated to provide quality care now?  Will you go to any level to ensure high quality care in any location in the world?

How quickly will our industry adapt to this new model?  Suddenly the more calls we run the more we can possibly make.  Will we focus on younger patients?  Will we ignore certain neighborhoods unlikely to yield incomes worth our efforts?  I think you know the answer to that.

 

While I still don't feel bad for Taylor Swift only making half a million a year on 1 web site for something she did long ago I also know she wasn't in there alone and the folks who were aren't necessarily the ones out on tour or behind her on SNL making money.  They were brought in for a day to play saxophone, record a piano solo or sing backup with the promise of a cut of the plays in the future.

Although I think billing EMS based on future income would see a HUGE shift in our comfort with pediatric patients.  Don't you?

Thursday, November 6

The 3 Real Reasons EMS isn't Ready to Refuse Care

Sean Eddy from Medic Madness, and fellow Uniform Stories contributor, has a new post up titled "3 Reasons EMS isn't ready to refuse care."

Go have a read, then come back for my comments.

Well, you're either ready to storm Sean's gates with your sharpened pitchfork or ready to defend him from what I've got to say on the subject.

Sean brings up some great issues that have been bouncing around EMS circles for decades.  With the recent introduction of Community Paramedicine and the concept that we can, gasp, leave people at home in certain situations, EMS providers are looking to build on the outdated "Transport them all and let the ED sort it out" mentality of the 1970s.

Sean's 3 reasons are certainly worth discussion but I think he was very careful to sidestep the elephants in the room.

l'll address Sean's reasons 1 by 1, then give you the 3 real reasons we're not refusing care.

Sean's Reason #1 We're not trained for it.

I'll agree with Sean here on a handful of cases.  I would argue that leaving a hyperventilating patient at home simply telling them "It's just anxiety" without addressing the symptoms we aren't ready for, nor should we be ready for.  However, this skips over the other 99% of our calls.  When a person has an injury or illness (or nothing assessed) and asks us "Do you think I need to go?" we should not be bullied into transporting by a management who only gets paid if the wheels turn and a nurse signs the chart.  Honestly answering that patient's question and giving them the information they need to seek the care the need should be job #1.  We are trained for that.

Sean's Reason #2 No Legal Protection

This is one of the urban legends of respond not convey, that somehow, somewhere, we're simply going to pull up, roll down the window, tell the person to just go to the ED and drive away.

There is not added liability in obtaining a refusal for a stubbed toe after telling the person that they don't need to go in an ambulance than there is in obtaining a refusal after telling them they should.  Zero.  It is simply changing the amount of accurate information available for the patient to make an informed decision regarding their are.

Sean's Reason #3 - We aren't designed to be the end point in care

Sean brings up an interesting point that we are not meant to be the definitive treatment for patients, that that is only done by MDs.  Then I would call into question each and every refusal of service ever collected in the history of EMS.  We should be, and currently are, the end point when necessary.  Again, we're not talking about chest pain, stroke, abdominal pain of unknown etiology, those patients are all obviously in need of evaluation and we are not their end point.  For the finger smashed in the door of the car we are also not the end point in care but that is no reason to REQUIRE ambulance transport to an Emergency Department.  I can't fix the finger, surely we can agree, but there is nothing I can do beyond splinting and supportive care.  In addition now we're sending an urgent care level patient to an ED, grossly over triaging "just to be safe."

 

Sean is a friend and don't take my comments about his concepts as disagreeing with him.  He and I have discussed this topic repeatedly, as many of us have, and it is of course far easier to comment on ideas than come up with them.  But we all need to be realistic about the REAL reasons EMS is not ready to refuse care.

Real Reason #1 - There's no profit in it

Oh, there's reduced cost in it, but no profit.  Spending 30 minutes on scene for a refusal is not nearly as lucrative as a 30 minute transport.  There is no increased liability, no increased training required, no fancy advanced classes or licenses, we just have to do what is right and allow the patient to make good decisions and seek out appropriate care in the community.  But so long as insurance only covers transport, it won't happen.

Real Reason #2 - We don't understand liability

Leaving Erma Fishbiscuit at home isn't the problem, it's transporting her for no reason to an ED for no reason "Just to be safe" that is the liability.  We remove needed resources from the system to satisfy decades of urban legends from the anchors about so and so who broke the rules and left someone home to die, but never about how no rigs were available for Mr Johnson yesterday.  If the rules were broken and something bad happened, it isn't the rule that is the problem.  We shouldn't be scared about letting patients make decisions.  We inform, they decide, we do our best to get them what they need, we complete a chart and go away.  Just like we do now.

Real Reason #3 - Adrenaline and turnover

No EMT wants to sit in Erma's house for 30 minutes making sure she knows where her medications are and when they should be taken.  No Paramedic wants to sit with Mr and Mrs Jones and explain how their daughter's nebulizer works.  They'd rather hit the lights and sirens, break hearts, save lives and take'em all and let the Doctor's sort them out, after all "We don't diagnose."

 

EMS is having a real problem taking itself seriously recently.  I applaud Sean for making his list and putting it out in the public.  We have a decision to make in the very near future and that relates to the future of EMS and I see it will divide us even further and I think it's a good thing.

Yes, I said dividing EMS is a good thing.  More to follow.

-HM

Monday, November 3

Tinglings of Inadequacy

In Paramedic School there were three know-it-alls in the back row.  Every Paramedic class had them.

They asked questions with 3 minutes left in class, always challenged the instructors for more challenging scenarios and seemed to always hit the airway lab right when everyone else broke for lunch.

They challenged test questions, the sequencing of interventions in answers and were eventually separated for testing, you know, "Just in case they're cheating."

They had their own study group, volunteered to teach the EMT and EMT-I classes when instructors needed a break.  All 3 of them stood together and graduated with their Bachelor's of Science in EMS on the same day.

Then they drifted apart.

Weddings, kids, careers.

Then one of them got into Medical School.  He sat to my right and is now a full fledged MD.

The kid to my left we called Doogie because he was young and smart.  I just found out today he will be completing Nurse Practitioner school in December.

My 2 best friends throughout Paramedic School and our clinical rotations, the guys I laughed with, cried with, broke bread with and, come to think of it, literally bled with, have achieved so much and I couldn't be prouder of either of them.

Dr Ian Medoro and soon to be NP Josh Kinnunen were my best friends for many years.  And even though life pulled us in different directions I am beside myself in admiration to the both of you.  We all had the same start, the same passion for quality patient care and have landed in three drastically different places.  The 2 of you seeking out more education and fitting into another form of care while I'm still in the field with my name on my shirt.

Those days listening to Larry and Kyle inspire us to do better, the anatomy lectures that seemed never ending, the waitress at the Applebees on bottomless chicken strip basket Fridays (I think we put her through grad school) will always be some of my best memories.

 

So congrats Doogie on making NP and congrats Ian on making MD!  The guy in the middle is happy where his is and proud of where he's been.

Sunday, November 2

Add Aiden Riebel to your Duty Roster

Young Aiden Reibel was brought to my attention through the Facebook.  He is a fan of the fire service in New Jersey and suffering from health issues that keep him from his dream: Riding Along at the local Fire Department.

Amidst the patch grabbers and beggars across facebook, Aiden's supporters caught my eye when they simply asked me to add Aiden to the roster for the day.

It wasn't a request for me to be with Aiden, but for Aiden to see he was with me.

I was moved.

I erased my name off the board at House 3 and added his name as the Rescue Captain (RC) for the Airport and sent the picture into the facebook page.  There he was with me as well as with a handful of other Departments from across the nation.

Each and every post was a photo of Aiden's name on the roster board, gear, helmet or rig.  Aiden was riding along at FDNY Battalion 9, with me in San Francisco, and a host of other agencies even an ambulance in Spain and a wildland crew in Australia.  Each post included a phrase along the lines of "You're with us" instead of the usual "We're with you" you see so often.

While Aiden is indeed accepting patches, the more powerful message is that even though he is too sick to ride along like he wants, his name is being spoken across the world in firehouses, ambulance yards and volunteer musters.

And to me that is far more powerful than any patch.

Aiden was with me for 2 days last week and thinking about having him along made me think about my own health and that of my family.

Your drill for today is to put Aiden's name on your roster, rig or gear and let him ride along in spirit for the day.  Then shoot a pic and share it with Aiden's page on FB.

 

It is literally the least you can do and will mean the world for a sick kid and will do wonders for your soul.

Trust me.

-HM

Tuesday, October 14

The EMS Ebola Checklist

Since it seems the nationwide panic known as Ebola has overflowed into the EMS sphere I thought it a good time to step in and calm everyone down for a moment.

We're experts at dealing with interventions based on a thorough assessment.  Hemorrhagic Fever can't be ruled out via ECG, stroke exam or any of our other tools.

To successfully deal with a patient exhibiting signs and symptoms of hemorrhagic fever in the pre-hospital environment, preparation is going to need to be solid.

  • Contact your local Department of Public Health for an updated copy of their response policy and local resource deployment.  Test the phone numbers in the plan and make sure they work now and that you know what information they want when you call in the possibility of an infected patient.

  • Train and retrain on your PPE.  This is not  race for speed, but a checklist for proper donning and, more importantly, doffing.  Improper removal of the best PPE negates all precautions.

  • Ask direct questions when still at a fair distance.  Monitor CDC bulletins for updated travel alerts at the beginning of each shift and ask questions that can rule out travel and contact with infected persons.

  • Treat the scene like a Hazardous Materials scene.  Isolate, identify, deny entry.  Limit exposure using pre-existing structures like walls, doors, airplane lavatories, car interiors, etc.

  • Ebola is still only in fluids, so limit contact with fluids using approved PPE barriers.  This includes gloves, gown, goggles, booties and cap.  It seems like an extreme measure, but think of all the things we touch with our gloves on.  Push hair out of our face, adjust pants, replace goggles...all these movements could introduce a small bit of vomit on a glove to another portion of the body and eventually we rub our eye or nose and...poof...infected.

  • Avoid unnecessary movement prior to Health Department assessment of the scene.

  • We are the eyes and ears of the local Health Department and CDC.  There is no treatment, no rapid transport, no EMS tool or technique that can help your patient more than making sure the system is in place and responding to what you see and hear.


The trick on a call you suspect to be Ebola (It's likely not) is to treat it as such until you can reasonably determine the likelihood that I'm right.  That means being a PPE expert, doffing properly and knowing who to call and how to keep people calm in the face of a perceived zombie apocalypse.

As the world panics, we will remain calm, gown up and get the job done.

 

Thursday, October 9

If a photo is never shared, but a photo of it being taken is, did it ever exist?

A few of you have emailed me asking what I think about Sacramento Kings basketball player Nik Stauskas photographing his per diem money.  Well, not exactly THAT, but the fact that teammate DeMarcus Cousins photographed the per diem photo shoot and shared it.

For those of you who haven't seen the picture, have a gander:



We'll save why a pro player needs that much money a day when clearly being taken very well care of when traveling and focus on why this photo even exists.

Who is responsible for this image?

Who is responsible for it being shared?

Is there a difference?

These are questions many public safety agencies skip past when writing short sighted social media policies.  Even though it feels like Facebook and Twitter are here to stay, there are already rumors of the "Next Myspace" with invites to the exclusive Ello drawing hundreds of dollars on ebay.

Departments are encouraged to apply existing rules to new technology by focusing on WHY their members share and how to break the impulse.

CBS reports that the image of the per diem has not been posted to Nik's public accounts on social media, but he still took the photo.  We can't say why.  Perhaps bragging to a friend?

Tough part here is that it isn't the initial photo that caught the attention (although I'm sure it would have) it was another player that thought the situation needed to be shared.

And likely without Nik's permission, which is where this situation will start getting complicated should the Sacramento Kings organization decide to take action against DeMarcus Cousins.

I'm not saying they should, but what if they did?

What would he be in violation of?  Does your agency have rules about sharing photos, quotes or speaking to the media?  If so, that will apply to in person interviews, emails, texts, posts...all possible methods of sharing media.

Now let's go back a few decades and pretend someone photographed this and had it developed, then hit the xerox machine and posted it all over the office?  Would the same rules apply?

They should.

"But Justin, it's the internet!  It'll be there forever!"

A: Not true

and

B: Who cares, it's there, let's try to prevent the next one.

I found this image funny but I've been there.  I remember being the new guy who showed off that first paycheck that had a comma in it.

The trouble is, Mr Cousins, maybe it didn't need to be shared.

Mr Nik Stauskas didn't feel the need to share his photo publicly.  Mr Stauskas gets it.

Thursday, October 2

From Trade to Profession - Thoughts from a Reader

Here on the blog I've had a favorite photo of Johnny and Roy in the Squad and Johnny looks like someone took a steamer in his cereal. (Chet most likely)



Under it I imagine Roy saying "Don't worry Johnny, one day we'll be a profession rather than a trade, just you wait."

Well, he's still waiting.

The folks over at Webster's say a profession is:

A field in which one is in a paid occupation, especially requiring prolonged training and qualification.

We can argue the merits of 2000 hours, but that is certainly prolonged and we do require a state license and there is even a list of folks who passed a special test and get "registered."  It would appear that, technically, we're there.  You can relax, Johnny.

 

However, ask any EMT struggling to get by if they feel part of a larger Profession and they'll likely tell you no.

Reader Garrett Kajmowicz shot an email to me asking the following question in regards to being considered a profession:


"How many professions exist where you aren't allowed to buy your own tools?


As it stands, as a paramedic, can you go online and buy your own supply of medications? How about diagnostic equipment like a heart monitor? I think that some form of legal independence is going to have to exist as a part of the trade to profession shift, though I don't know when, where, or how.

Thoughts?"


Interesting question there, but I'll have to go with no. Being able to purchase our own tools won't steer us one way or the other.  Case in point, no one would argue that being a pilot is not a profession because the pilots do not own the planes.


By the way, now that I work at the airport most of my bad analogies will be aircraft related.  Sorry for the inconvenience.


Being recognized as a profession takes time.  A long time.  Some will argue that we need an over arching Federal office to oversee licenses, skills and practices.  I agree and disagree at the same time.  While many similarities can be drawn looking to our close cousins the fire service (started as slaves chained to street corners) and nursing (started as prostitutes) who both have National level organizations, cabinet positions and offices in DC, we still have no idea what we are so where would our federal agency live?


Are we in the public safety business or the public health business?


Both need to be filled but with drastically different professionals in drastically different fields of specialization.


Our trouble is that we still sit on the fence and cry that the other kids won't let us play when both teams are a player short.  Do you want 911 or Community Paramedicine?  Can't do both.  Those who say you can are the same who say you can't be both a firefighter and a competent Paramedic.



In the past I've caught flack for suggesting I was competent in both, but have since specialized.  As my position required more focus on EMS I had to pick a side.  And did.


I say pick one and run with it.  A community can certainly offer (and would be doing a dis-service not offering) both services, but not using the same person.


You want to run 911?  I need you also swim certified, low angle rescue certified and in haz mat and active shooter training.  I need to put you in harm's way.


You want to do Community Paramedicine?  I need you back in school. Advanced A&P, pharmacology, psych, social work, community planning, administration and education and none of this community college stuff, I need you in the cadaver lab with the pre meds.


Two distinct professions can emerge from our little trade house if we want it enough but back to the original comment from Garrett, no, I don't think buying my own LifePack 30 (Are we up to the 30 yet?) will make me part of a Profession.


Only I can do that by lifting up my co-workers, my agency and my passion for patient care.  I would hope we are all doing the same.



What do you think of Garret's thought?  Will being able to order a monitor, ambulance and medications, the tools of our trade, allow us to become a profession?  If so, how? If not, why not?


Tell me in the comments.

Sunday, September 21

A House Divided...

Not a political post, just thinking about firing up the EMS 2.0 machine again here in my home system.  This speech keeps coming to mind.

An excerpt from Senator Lincoln's Speech to the Illinois Legislature in 1853:

"

If we could first know where we are, and whither we are tending, we could then better judge what to do, and how to do it.

We are now far into the fifth year, since a policy was initiated, with the avowed object, and confident promise, of putting an end to slavery agitation.

Under the operation of that policy, that agitation has not only, not ceased, but has constantly augmented.

In my opinion, it will not cease, until a crisis shall have been reached, and passed.

"A house divided against itself cannot stand."

I believe this government cannot endure, permanently half slave and half free.

I do not expect the Union to be dissolved -- I do not expect the house to fall -- but I do expect it will cease to be divided.

It will become all one thing or all the other."

 

Monday, September 8

Coast HP7R Rechargeable Flashlight Review

A few months back the kind folks at Coast Portland asked if I'd be willing to test out one of their flashlights at the firehouse.  Sadly I was still in an office and had little to no need for a flashlight.  Hoping things would change I told them my situation and they asked me to give them a shot as flashlights, not necessarily as firefighting flashlights.

Done.

I looked at their website and the HP7R immediately caught my eye.  Compact, LED and capable of being recharged from the wall, not just from a mount in the Captain's buggy, meant versatility.

This flashlight is heavy duty.  She'll put out 201 lumens for 7 hours 45 minutes on high and last almost 2 full days at 22 lumens.

For those of you that don't speak flashlight, that means if you accidentally leave it on it'll last a long time.  As someone who has eaten through more AAs than I'd care to share this was a big feature for me.

Even bigger was the ability to recharge the flashlight's 2 Lithium Ion batteries as well as back them up with a standard alkaline battery cartridge that'll take the AAAs.  Being able to quick change a battery for such a powerful flashlight is awesome.

Even more awesome is that I already have the charger.  The Lithium Ion batteries can be recharged with a micro USB connection, the same one I use to charge my phone and a number of other gadgets around the house.  This means no shortage of cables and cords, both AC and DC, but just in case you are an iPhone house, both adapters are included in the box. (as are the AAA batteries BTW)

And now the bad news:

This is not a good flashlight for being a Paramedic.

First, to cycle through the low and high light output modes, you have to cycle through a strobe feature that would make some emergency scenes downright dangerous.

Secondly, the beam focus is a slide in and out feature, not a twist to focus.  The slide focuses the beam and a slight twist "locks" it into place.  However, the lock is so weak it constantly gives way, especially when deploying it from the belt holster (also included).

However, I didn't give up on this flashlight.

I took it camping.

IMG_20140903_141527003This is the ultimate camping flashlight.  It is compact and lightweight, fitting on our hiking pack no problem, taking up almost as much space as the multi-tool.  the extra batteries can charge off the 12v system in the van on the way to camp and off the 12v trailer system if we somehow go through all 3 batteries.

The low light setting is perfect for night trips to the bathroom and the high feature makes scanning camp for bears easy.  No, seriously, I can actually say I tested this light looking for bears.  There were none, but that's beside the point.

And if we ever get lost on a hike that strobe feature will no doubt be seen for 306 meters, just like the box says.

 

In conclusion, this is a versatile light for non-emergency situations (except for bears and getting lost of course.)  The ability to have extra batteries ready to go, as well as plug the light itself into adapters I already have means I'll always be able to get light when I truly need it.

At $147.49 it may seem pricy but the features I've mentioned mean that added to the ruggedness of the construction I may never need another flashlight or batteries for a flashlight.  Like, ever.

 

Here are the specs from Coast Portland

  • Long Range Focusing Optic

  • Slide Focus

  • 201 lumen light output

  • 7 hour 45 minute runtime

  • 306 meter (1003 ft) beam distance

  • Battery type: Lithium Ion (2 included) or 4 x AAA (included)

  • Can be charged using AC, DC or USB power sources

  • Aluminum casing; rear switch

  • Impact and water resistant

  • Includes wall mount, speed clip, and heavy-duty sheath

  • Length: 5.58 in. / 14.2 cm

  • Weight: 7.2 oz. / 204 g

  • Diameter: Body - 1.18 in / 3.00 cm; Bezel - 1.47 in / 3.74 cm


 

Friday, September 5

Would I make a good Cop? Find out what Motorcop thinks

Get over to Uniform Stories to see if my buddy Motorcop thinks I'd make a decent cop.

 

Spoiler alert:  You know I'd get lost on day 1.

29,000 deaths vs 6,000. Which should get more attention?

The Ice Bucket challenge raised over $50 Million for ALSA, which is going to be diagnosed in about 5600 people this year.  ALS is responsible for 2 deaths for every 100,000 people.  That's 2 too many.

Let's cruise the math.  300 million folks in the US, let's say half are dudes.  1 in 36 men will be killed by Prostate Cancer so let's round that number down from 4.1 million to 4 million.  4 Million men currently in the US will be killed by Prostate Cancer in their lifetimes.  29,000 this year alone.

ALS will kill (since it also impacts women we'll say out of 300 million folks and ALSA states 2 in 100,000 will be killed...carry the 6, divided by pi...) 6000.

 

29,000 vs 6,000


Prostate Cancer will kill almost 5 times as many human beings as ALS this year.

I'm not anti-ALSA, in fact I'm against most things that kill people (stupidity sometimes gets a pass) but are our priorities in the right place?

I don't know.

So here's what we're going to do:

#1 QUIT USING TOBACCO


No one firing up a cigarette or pinching dip can even start to claim they believe in a healthy lifestyle.  There is no sense in literally GUARANTEEING your death by lung cancer (The #1 deadliest and most preventable cancer)

#2 CUT WAY WAY BACK ON THE SODA


Avoid diet soda like the plague, don't kid yourself that those 250 calories are making that big a difference in your overall diet.  The sweeteners are linked to a number of health related problems including, wait for it, cancer.  In addition, the caramel coloring added also increases risk of cancers.  I suggest Sierra Mist, natural sugar and no coloring, but in moderation!

#3 TALK TO YOUR FAMILY


Find out who is healthy and who is not and why.  If all your male relatives had prostate cancer, guess what?  If your mother and grandmother have cancer, guess what?

#4 TALK TO YOUR DOCTOR


Ask about your risk factors since you talked to all your relatives.  "Doc, all my female relatives have been diagnosed with ovarian cancer, should I be worried?"  "Doc, my uncle had his prostate removed at 55, should I be worried?"

#5 GET INVOLVED


Join Kilted to Kick Cancer in spreading the word about the risk of Prostate Cancer, hell all cancer, and don't just sit back and jump on the first cause that wanders by on Facebook.  If your family is impacted by a certain ailment, get involved locally!  Donate money, time, food, rides anything and everything to help in your own community.

 

The white coats far away working on a cure need to be put out of work by us PREVENTING and LESSENING THE IMPACT of cancer.

Cancer is a lot easier to cure when no one gets it anymore.

 

Get Kilted! Get Checked!

 

Monday, September 1

Kilted to Kick Cancer 2014 now in full swing!

It's that time of year my Kilted friends!



Time to kilt up for a great cause!

1 in 7 men will be diagnosed with Prostate Cancer in their Lifetime, 1 in 36 men will be killed by the disease.

September is Prostate Cancer Awareness Month and we need to start a conversation with men that they don't want to have: "How's your prostate?"

In addition, we challenge our Kilted Army to #DunkYourJunk.  Put the ice buckets down everyone and have a seat.  In the ice.  In your kilt.

WATCH OUR PSA VIDEO

We start this conversation by wearing kilts everywhere we go during the Month of September when not on duty.

 

I am part of the fundraising competition again this year and encourage you to join "Team Happy Medic" when donating to Kilted to Kick Cancer using this LINK.

The fundraising contest has some incredible prizes and near the end of the month bloggers around the internet will start to make crazy dares to win.

100% of the funds go towards the cause of raising awareness about male specific cancers, helping those already diagnosed and, of course research.

Get over to Alt Kilt for amazing deals on custom kilts and accessories, including this exclusive KTKC pouch! 

A portion of the proceeds benefit KTKC!

Help us get the word out about this dangerous disease and

Get Kilted! Get Checked!

Monday, August 25

Set down the Ice Buckets, this is the last video you'll need to see

Kilted to Kick Cancer decided to wade into the Ice Bucket arena.

 

And shut.it.down.


Visit Kilted to Kick Cancer for more information!

Don't forget to #DunkYourJunk!

 

Get Kilted! Get Checked!

Friday, August 22

Frequent Flyers

In my new spot serving as the EMS Supervisor for a busy International Airport I have had to learn a new normal.  For example, we get toned out on medical calls for both the approximately 5k-15k people in the terminal at any given time as well as the almost 140k people that circulate through the airport every 24 hours.

Gone are the days of the homeless man asleep in the bus shelter getting a 911 call for being unconscious (Who doesn't want to be unconscious at 3am?) and here are the new unconscious calls, called in by a flight crew on final approach.

The thing I'm still getting used to, however, is that there will be an ETA included in our dispatch, often 10-15 minutes, which eliminates the need to rush out the door on every bell.  That indeed takes getting used to.  No point rushing out the door and to the gate in 4 minutes when the flight has yet to even land, let alone taxi to the gate.

We'll grab our gear and access the jetway from the outside and wait for the flight to arrive, often having little to go on regarding the patient's condition.  The flight crew often calls in "ill passenger" or "vomiting" but the all too common chief complaint is "lost consciousness, now awake."

You can agree, that could be gosh darn anything.

The rules at our airport say if you call for us we get on the aircraft before anyone stands up, assess the patient and determine the best course of action.  Most often this is finding someone very embarrassed who isn't handling the flight as well as they hoped.

We do our best for them and handle the encounter like any other EMS system.

The most interesting part of waiting for a flight is when it is an International flight.  Now not only do we have the local police, ambulance company (and their airfield safety escort) but now a whole alphabet soup of customs agents.  If the patient and family needs to be transported they will get quick access to customs and be dealt with first, right there.  They even carry the stamp on their belts.  Very interesting indeed.

 

More to follow from the Airport soon,

HM

Monday, August 18

Japanese Technical Rescue Competition - Awesome Video!

Have you seen this amazing video from Japan?

Sure the US has musters with drag racers, but the efficiency and purpose movement of these men is admirable.  Have a look!

Thursday, August 14

The last letters are back

Looking through the traffic for this little blog I came across an old post getting more views than usual so I thought I'd put it back up here on the top for a little while.

 

Originally posted March 30, 2010.

The last letters you'll ever write

"...

Today’s step is an important one, but in no way, shape or form should it be your first.

Tonight you are going to write a Line of Duty Death instructions sheet to your spouse and loved ones to read and follow only in the event of your death, at work.

This is different than your living will, which you all have now, right?

This is also different than any funeral arrangements you may have made or hope to make.

In the back of the Family Disaster Plan are two important sets of instructions.  The first is the Line of Duty Injury instructions sheet.

This gives my wife a list of phone numbers at Headquarters as well as who to ask for at the firehouse, “the Captain” and “Daywatch” to get someone who can tell her more about what may have happened to me if she is indeed notified that I am injured on the job.

The last time I got hurt no one called her because I was treated and released so quickly.  But if it happens again and she gets a phone call in the middle of the night, she knows to take a deep breath and relax.  I know because that is how the instructions start.

Here is just a snippet to get you thinking about what to write in yours-

“Well, you got the phone call you’ve been dreading.  I understand you are upset.  If I got hurt I was in the wrong place at the wrong time.  We’ll worry about all that later, I need you to start thinking three hours ahead.  Each decision you make between now and this time tomorrow will set the pace for the coming week.  Take a deep breath and calm down.

I’ll wait.

Good.

Goto the closet and get one of my work T-Shirts or sweatshirts and wear it when you come to see me.  Be honest if folks ask if you need anything.  Take their help.  They need to help as much as you need it.”

It will get emotional when you prepare them for what they might see when a firefighter is injured in the line of duty.  Be honest.  If you dance around topics now it will only create confusion at the most improper time.  End the letter by reminding them that even though you are hurt, it could be worse.

Now, while an emotional wreck, excuse yourself and be alone for a bit and HAND WRITE the next letter – Line of Duty Death Instructions.

This letter is the one they will keep and read over and over and over after you are gone.  Tell them about why you did what you did or chose this job, profession, occupation, place to volunteer.  Sign it, seal it in an envelope and put it in the back of the Disaster Plan.

On the same day, make plans to open the letter the day after your retirement.  Perhaps someplace tropical.

Do it now or regret it later, your choice.

HM"

 

Wednesday, August 13

#EveryDayReview - Republic Wireless

#EveryDayReview


 

From time to time you've likely noticed I try to chat you up about a new product that was sent to me for review.  Maybe you took my advice and grabbed some gear for work or ignore the blog when I post a product review.  I hope it's the former.

Today I'm introducing a new feature, #EveryDayReview.  This will be an exciting product or service I use in my personal life that I just want to share.  I'm not getting the product to test, I've already tested it and endorsed it the best way I know how: I bought one/use it/ subscribe!

 

Let's jump into a common topic: Cellular service.

I recommend Republic Wireless.

Republic Wireless is my mobile phone provider and I could not be happier with their concept, products or service.

Long ago, in a galaxy far, far away, I was a T-Mobile customer hacking an iphone from ebay to get better use of the data service we were paying through the nose for.

A few years later wandering Costco and about to lose support for my hacked iphone we saw a great deal on Verizon Droid phones.

FREE phone with 2 year contract!

It wasn't until years later we realized the cost of the phone is rolled into the ridiculous cost of service.

Republic Wireless also takes advantage of a secret your wireless carrier doesn't want you to know:

They know most of your time is within wireless internet range, yet still charge you upwards of $75 a month for access to 4g internet.  Why?  Half the time I'm at home on wireless I already pay for or at work connected, why pay so much for my phone plan only to spend most of my time on wireless internet?  We did the math.  Only when commuting to and from work was I not on wireless, a total of 40 hours a month give or take.  40 hours / $75 4g plan:

Verizon was effectively charging me $1.87 an hour.  The rest of the time I was on wifi I already paid for.  Are you the same?  Want to drastically reduce your bill without losing service?

Republic Wireless is the answer.

Phone plans start at $5 a month.  Yes, $5 a month gets you calls and data over wireless networks only.

Want a little more?  How about $10 for cellular calls and data over wireless only?

I'm at the $25 plan which gives me unlimited* 3g data and cell calls over the Sprint network.

For $40 you get 4g coverage so you can stream Netflix without a wireless connection.
*Go over 5g in a month twice in 6 months and you might get throttled, but no fees. Go 6 months without going over and you get a pass next time.

How do they do it so cheap?  Your phone prefers to make calls over the wireless instead of the cell network.  Anytime you're connected to wifi, BOOM, you can make calls.

Republic Wireless MotoXWe got the MotoX and it's a great handset.  We paid upfront for the phones, but considering the cost savings month to month we were ahead of the game in 5 short months.  Not to mention our grandfathered Verizon unlimited data plans were worth a few hundred bucks on ebay!

The service still has a few glitches switching a call from wireless to the cell network, but I rarely keep talking when leaving the house so only noticed this problem when testing the system early on.

Below is a screenshot from my MotoX.  See the little green arch near the green llama?  That's the Republic Wireless happy green arch letting me know I'm completely on wifi. The llama is unrelated, I swear.

Republic Wireless PlansAnother neat option: you can change plans twice a billing cycle.  When we were going out of the country and not expecting cell service, we bumped the plans down to the $5 plan and made and received calls off the wifi in the beach house in Belize (when the router worked).

When we hit the states, we simply told the phone to update the plan.  A few minutes later and a restart on the phone and it was done.

No sense paying full price for a service you're not using full time.

In addition to a killer concept and competitive pricing, Republic Wireless thrives on the community the users have created.  Never before have I had a company engage on social media so swiftly and accurately.

Downside?  3g means less streaming of Pandora though some service areas (it is the Sprint network after all) and that's about it, really.  They can port most numbers and now even allow porting of Google Voice numbers.

The next time you're looking at your budget and wondering how to get that cell phone bill down to a reasonable level, take a look at Republic Wireless.  You'll pay for the phone, but far less than a free phone and inflated monthly fee from the other guys.

 

I use Republic Wireless and love it!

Friday, August 8

New news from the Kilted front!

Kilted to Kick Cancer is now an official 501(c)(3) according to the IRS!

 

That's right, everyone's favorite kilt wearing fund raisers can now offer you a receipt for Uncle Sam in exchange for your donation to help us spread the word about male specific cancers in September and all other cancers all the time.

I think it's a fair trade off, don't you?

Read more at the new post up at KTKC:

Achievement Unlocked: Official Charity Status!

Monday, August 4

Horseplay or Violence in the Workplace? Lebanon, TN Firefighters suspended for choke hold after fart

Firehouse.com is sharing a report from the Lebanon Democrat paper in Lebanon, TN, about an incident that has led to at least 2 suspensions of firefighters.

Initial reports indicated that one firefighter, also a mixed martial arts enthusiast, choked another firefighter.  I was on board with the suspensions based on that information.  However, as I learned in my short 2.5 years in Risk Management, the first version is never what really happened.

So here's what did happen:

Shenanigans.

Let me explain.

One firefighter had a habit of breaking wind near people and walking away.  Reports indicate he is older than 12 regardless of this form of entertainment.

One firefighter was sitting at the computer when the wind breaker attacked, sending fumes towards his coworker and scurrying into the other room.  Witnesses later stated the co-worker, smelling the offensive gift, gave chase, caught the squeaker and put him in a choke hold.  Words were exchanged and at least 1 person took cell phone video of the event.

The attacker was released by his attacker and suffered no injury but did lose consciousness briefly.

Shenanigans.

This is no different than what happens in countless firehouses across the Nation.

However, your personnel manager may see it differently.  Acting Personnel Director Lee Ann Crosslin disagreed with the finding of the Department that this event was horseplay.  She classified it as workplace violence.

Take a deep breath everyone.

The firefighter who got choked stated he was not humiliated, he suffers no health effects as a result and that the action against him was not malicious.

None of that matters to the third party after the fact.

Much like how sexual harassment now includes bystanders who are uncomfortable with something 2 others actually participating are comfortable with, what passes as hore play, or bonding, by one group of people appears violent to another.

And that other has considerable political power in this case.

We don't have the full story, not until the video is released by someone that is, so my comments below are based on the article linked above.

Lighten the Fuck up.

All of you.

Someone farts in your direction?  Fart back.

Think farting in someone's direction is funny? Grow up.

If someone says nothing happened we don't need to assume they're suffering from some kind of battered wife-like syndrome, protecting their attacker.

It's the firehouse.  If what happened in this story is to truly be interpreted as workplace violence I need to be arrested and locked up for life.

There is a fine line here, let's not forget.  What can start as fun can turn dangerous when the recipient calls Uncle or safety gear or equipment is involved.

Don't put potatoes in their boots, short sheet the bed.  Run a bag of fluid in the ceiling tiles to drip on their pillow all night.  Send them to get the hose stretcher or to spend the night stirring the tanks, but be careful because someone outside our community may think you're being mean and, well, suspend you. Or worse.

Regardless of my feelings on this case, or yours, you need to read, understand and follow your local rules and regulations regarding horseplay, pranks and personal interactions.

I'm not sure what bothers me more: That this all started with a fart or that so many political offices got involved.

 

Wednesday, July 23

Everything you need to know about EMS management...

you'll learn in a bar.

Or at least while at a bar.

It sounds cliche, but let me explain.

Hrs HM and I had a chance to escape for a lunch date today and headed for our favorite local watering hole that hosts Buzztime Trivia.  Over some buffalo style wild wings many a taunt is heard about who will win and our bartender is welcoming, as usual, offering this special and that while fetching the Mrs a water and me a tall IPA that looks new.

As we exchanged heated discussions about how I was right, just not how the game people thought, the bartender and the manager got into a discussion about the beer coolers.

This discussion has been had between bartender and manager, Paramedic and manager since the dawn of their respective professions.  Yes, bartenders are still considered a profession over paramedics, more on that soon.

They were discussing the location of the beers on display in the 2 large coolers flanking the bar.  Being a beer snob, I never drink bottled beer when the same on draft is available.  Drinking a bottle when the same beer is on draft is like choosing to skype with your girlfriend instead of have a face to face conversation.

It suddenly occurs to me some of you will miss that...let's move on...

The discussion was about how the beers should be displayed, the order and location compared to the other cooler.  One said they should be mirrored, the other claiming they are to be the same.

My OCD kicked in and despite the Mrs' frequent requests to stop, I was searching for a pattern to the location of the beers.  Alphabetical by name? No. Light to dark? No. Sorted by type? No. Size of bottle? No.  There was no discernible reason for the beers being in the order they were until I happened to mention a random joke: " I bet it's corporate's idea!"

Yup.

Someone in the home office was deciding what goes where and why.

Sound familiar?

I had the exact same conversation with an EMT from the medic unit just 24 hours prior and asked her to look at 3 spare bags we had, speak to her co-workers and their partners and figure out what works best when providing patient care, then get back to me.

Problem solved.  The EMTs get what they need and the medics get what they need and, as a nifty side effect, the patients get what they need.

Back at the place of wild wings the bartender joked about how the night shift will just change the coolers back to what they were before, all the while the manager was referencing an inventory sheet that clearly stated where the beers should be in each cooler.  The day manager conflicting with night. Perhaps there's a contract with beer X that says they have to be front and center?  I'd buy that but why not hand that decision over to the folks who have to pull the product day in and day out instead of mandating it from on high without reason other than "That's how it's always been?

 

And yes, achieving status as a fully fledged bartender takes up to 10 months...about the time as the average Paramedic program.

Happy Feet - the Blauer 6" Clash Boot Review

Blauer has been making boots longer than I've been wearing them and the Clash Waterproof line shows they're still improving on the concept.

In my career I've worn all manner of boot from slip ons (yuck) to steel toed zip ups (Big City fireman boots!) to whatever was cheap at the uniform

store.

I've reviewed Magnum Boots in the past and enjoyed their fit and specs and the Blauer Clash did not disappoint.

Often I give the boots I review a thorough testing period through random Engine Company duties such as footing ladders in drills, PT, footing gurneys etc but my new gig doesn't have much of that but it does have one thing most jobs don't:

Walking.

I do a lot of walking where I am and having a comfortable boot to do it in is essential.  The Clash 6" is far more flexible out of the box than I expected and it fit my foot well in my regular duty socks.  No extra thick hiking socks needed here to fill gaps.  There is no safety toe which may exclude it from some EMS and Fire duty, but as a supervisor I can get by without it, especially since I have the option at work of wearing a dress shoe instead of my boots.

The Clash has a number of features that set it aside and the first one that caught my attention before putting it on was the goofy looking disc on the front.  I say goofy looking because, well, this boot has no laces, zipper, or other discernible method of applying pressure to snug the boot.  They reminded me of Marty McFly Jr's shoes from October 2015...wait a minute...that's next year!

That disc is part of the new BOA system, a steel cable that is tightened by spinning the disc and loosened by pulling the disc forward.  I'll admit I was skeptical at first but the disc does what they say and I am able to quickly don the boots and tighten as well as release and don turn out boots (in case I need a safety toe...see?)

The BOA system does take some getting used to but as soon as you learn your comfort level, the boots begin to give support to the ankle and above right away.

However, once the boots are on and you begin to walk, and remember I do a lot of walking now, the real clever feature of this boot is revealed.  In the rear of the 6" Clash boot is a notch about an inch deep, padded, that allows an almost full range of motion with your ankle when walking.  Where my usual boots catch and have to bend, this boot remains supportive laterally and my achilles tendon never feels stressed.

The toe takes polish like a champ but did scuff easily before I got a coat of polish on.

Another feature of the Blauer 6" Clash Boot I didn't expect is the almost velcro grip on the sole of the boot.  Your pal Happy is a lover, not a fighter, and I am known to wipe my feet, dirty or not, on door mats.  When I did so in my Blaur 6" Clash boots they did not move.  The honeycomb pattern somehow grabs the flooring and won't let me wipe my feet naturally.  Perhaps my old boots are old and worn, but this was a pleasant surprise.

 

In conclusion, the Blaur 6" Clash Waterproof boot is a safe investment for anyone who needs a reliable boot to do a fair amount of walking.  If your agency requires a steel or safety toe sadly this won't fit the bill, but those in law enforcement, security and some EMS agencies should certainly find them at your local shop and give them a try.  If you are doing special events or are on your feet most of the day this is the boot you've been looking for.

I recommend the Blauer 6" Clash and give it a 446 out of 654 based on math I won't bore you with (but the spreadsheet looks amazing!)

 

On a sidenote to boot manufacturers:  Stop putting your logo on the inside of the boot.  It never lasts more than a day and I've had that with every boot I've ever tried.  It makes me feel dirty when I wear them for 9 hours, then see your logo mostly gone.  That is all.

Wednesday, July 16

Still Here. Still Sharing.

30 days away from you guys was tough, but I did OK.  I know there's a hole in your heart from missing my rambling therapy experiment, but fear not fair reader, I'm back.

For reasons I can't discuss I left the content of this site unchanged for 30 days, at my own request.

Now I can get back to venting, wishing, dreaming and sharing.

Speaking of sharing, those of you who subscribe to Fire Engineering Magazine should keep an eye out for your August 2014 issue which should contain an article about the way to enforce rules and regulations when it comes to sharing media.

"What the frack is sharing media?" you ask?

Sharing Media refers to the ever growing methods and, more importantly reasons, for sharing traditional (photo, paper, magazine, TV) and electronic (facebook, tweet, instagram, video) media.  Social media seems to focus on the facebook and the twitter and the instagram, which all require a set audience or group of friends.  I use Sharing Media to refer to any and all instances where an idea, sentence, paper, image, concept or anything else is shared with another in any format.  This covers internet sites, phone apps, newspaper and magazine articles, even the cork board at the local coffee shop.  The reason for this new definition is not only to expand the definition of media out of the pixels you see here but remind folks that it is the reason to share, not the method, that we should focus on.

In other words, focus on WHY, not HOW.

Most Fire Departments have rules covering the HOW that already cover the non pixelated methods of being foolish.  Simply expand that already existing net and, -boom-

 

You don't need a social media policy.  You already have a Sharing Media Policy.  Use it.

More on that topic, why WHY is so important and what you as a line firefighter, emt, manager, company or chief officer can do TODAY to get out of the digital swamp of social media restriction in the upcoming (I've been told) issue.

As always I welcome you feedback on that and any other ramblings you find on these pixels, in other articles, forums or sites, in the interwebs or magazines.  I stand behind all my shared media and always consider the WHY before I share.  There's a lot I want to share but have chosen not to.

Thanks for coming back and keep coming back as lots of product reviews are in the works including the flashlight I wish they sent me 2 of and a pair of boots without laces.  No, they're not the Nikes from Back to the Future.

Above all be safe!

-HM

Tuesday, June 10

18 year old woman dead after chasing cop with knife. Family wanted ambulance instead.

Yes, you read that correctly. What you will also read correctly is this cobbled together "news" story written to inflame your hatred of the po-po:

Worried family calls 911 hoping for ambulance, cops show up instead and KILL HER

Great work on the headline there Eric Owens, Education Editor. I guess there's no need to think this call through as far as my 3rd grade daughter could, but let's give it a try shall we?

1.  The family should have intervened long ago.  Years ago.  Waiting until someone with known mental health issues starts grabbing the cutlery is not the time to reach out for help.

2.  Ambulances can not make people take psych medications.  Again, see #1 "Family."  So far we've identified people far more responsible for the death of this girl than the police, but let's keep going.

3.  They called 911 "hoping" for an ambulance.  No one calls 911 and requests resources, that's not how it works.  People call and state what is happening, the dispatcher assigns the appropriate resource for the situation described.  Speaking of which...

4.  Paramedics can not safely deal with persons who have stated their desire to harm others or who may have weapons.  Paramedics are trained to assess and treat medical and traumatic conditions.  The reason the dispatcher sent a Police officer is because what happened happens far more often than people realize: People who want to hurt others pick up stuff that hurts others.

5.  Even the 12 year old kid saw the knife.  Let's put you in the Officer's shows for a moment.  A woman chases you with a knife.  A woman with known psychological issues.  A woman who is not taking her medications.  Now what do you do?  There can be all sorts of outcry about tazers and tackles and other such nonsense but when it comes down to it the Officer did what they had to do to remove the threat.

6.  To all of you about to comment that I don't know what I'm talking about, I wasn't there, I don't have the full story, go over to Eric's story and comment there first.

 

Eric, here are some headlines I think better fit the story:

"Woman killed by police after chasing them with knife off psych meds"

"Officers forced to kill knife wielding woman after family fails to assure she is healthy"

"Family unable to help 18 year old prior to her chasing police with a knife and being shot"

"Ambulances do not help people take medicine"

"Education Editor writes inflammatory headline oblivious to how 911 works"

 

Motorcop has a post up that should shut up all the "Why didn't they just taze her" folks.  Go have a read and see this situation through an Officer's eyes.

A human being is dead because someone waited too long to help her.  Blame the family, the system, the Doctors, Obama, Bush, God, heck blame me, pick your enemy, but don't turn this into a situation where the evil police are to blame. They were just there at her worst hour and did what they are trained to do when people attack them with knives.

 

 

Monday, May 26

Off Duty EMT and been drinking? Guess what?

You're not an EMT.

This may seem like it's coming from left field, and it kind of is.  One of the perks of having a website is that I get to see all the terms people type into search engines to find the site.  Until the Hangover movie I was the #1 google result for "strippers and cocaine."  True Story.

However a google search today troubled me a touch.  Especially since they hit me 6 times with it:

"if im an off duty emt and ive been drinking" (sp)

Well, Tiger, I think you might be a few into your day already so if you were the one doing this search put the drink down and let's have a chat.

Your search cut off a bit early didn't it?  Was there something else there like "should I help people?" or "will I get fired?" or "do I have to use apostrophes?"

Here's the short answer to all your possible questions:

No.  Except the apostrophes part.

As soon as you take a drink, smoke, snort, shoot, heck even if you pop an ambien or a flexoril you're not an EMT, you're just you.  While I have been known to break that rule, it was because one of my close friends had been badly cut in a fight.  I didn't go running into a situation inebriated simply because I just got signed off on splinting.

Take off the star off duty and have a responsible time doing what it is you do, but remember that anything you do while using that title or wearing that star reflects not only on you but the tens of thousands of us who know the difference between Professionalism and irresponsibility.

"if im an off duty emt and ive been drinking" yields far more relevant discussions on this topic and I hope you read them.

A Comment on Typical Idiot EMS Managers by Burned Out Medic.

Burned Out Medic had a post up recently I thought I commented on, but apparently you have to hit 'submit.'  Who knew?

The post is in reference to a Call the Cops story about an ambulance crew being reprimanded for going 90 MPH even though the vehicles govern out at 70.

Have a read and come back for my comments.

Well let me start by saying I agree 100% and that I'm going to have to disagree 100%.  Typical EMS Manager, right?

 

The trouble with the situation mentioned in the Call the Cops story is that there are no facts.  There does not appear to be any investigation policy or framework, nor is there any documentation confirming the speed of the vehicle, the exact location, time of day, etc.

Most field crews believe EMS Managers are sitting in the office hoping beyond hope that someone calls in a complaint so we can puff up our chests and assert the hair's width of authority we have.

Let me confirm that that is not the case at all.  In between phone calls from hospitals, regulators, our own managers, chart reading, report filing and other mundane tasks involved with making sure you can still practice, citizen complaints are taken very seriously.

I used to get weekly calls from a fellow who swore up one side and down the other that a crew raped him*.  Same crew, every week. Seriously.  For over a year we were on casual conversation terms each time he called.  Heck one week he didn't call and I was actually worried.  But the first time he called it was taken very, very seriously.

The conversation was recorded, run data was pulled, AVL signals gathered and only after confirming details from the caller was I able to conclude his complaint to be without merit.

The crew accused wasn't even working that night but had transported this individual a number of times.  That same crew had recently been accused of other things by other members of the public and medical system.  Each time he called I'd pull the AVL map as we spoke to confirm the crew in question was in the clear.

You see my friends, complaints do not happen in a vacuum.  They are most often the result of someone getting a bill for service or just plain not liking EMS in general.

The example given by Call the Cops that Burned-Out references is hilarious because it can be easily disputed:

  • Obtain complaint in writing or verbally recorded.



  • Pull the unit history for the ambulance in question.



  • Pull AVL data for location.



  • Access maintenance data to ensure governing device installed and properly working.

  • Access previous violations for pattern behavior.


That'll take maybe an hour.  The thing most field crews don't realize is that good people can still do bad things.  If you're a 5 star crew and get a complaint I handle it the same as a complaint about the crew that was in my office yesterday for what ever other frivolous thing the rumor mill says they were in for.

The tough call comes when the AVL data shows the unit traveling on the roadway in question, at the time in question, at the speed limit, but 3 hours earlier data show the vehicle traveling above the speed of the governor.

Now what do you do?  The crew has been proven to not be guilty of the accused offense, yet we now have data that show their defense is faulty.

It's easy to sit in the rig and gossip about how the managers are out to get you after what happened to so-and-so but just remember it's a lot of work to get you in trouble, and you know how we pencil pushing EMS Managers hate work.

If your managers are so bad at what they do, promote.  Nothing in EMS is easy, even sitting in a little room with a tie on reading charts and going to meetings.  The ultimate answer to bad leadership is to become a leader yourself.  Show me you can do it better than they can and your service will be the better for it and, as a result, your patients will have a better experience, which is all that matters in the end.

 

EDIT - *Forgot to mention, not the real reason he called, but just as unusual and hard to believe.

Wednesday, May 21

Deposition time and a friendly face appears

As a middle manager I get pushed forward as the "expert" at certain ways my agency handles things.  For example, since I am the only one that reads through all the charts I am the default "expert" on how to read through charts.  You get the idea.

This is important when a court case comes along that a chart was written for.  This happens often since many assaults, vehicle collisions and the like end up going to the lawyers.  I won't say going to court since it appears the system is rigged to favor them handling this all before we get to a judge.

I've been brought in to explain how ePCRs are created, stored and retrieved more times than I care to recall since each and every time the questions are exactly the same as are my answers.  I get a City Attorney to sit next to me and make sure I only answer the questions I'm supposed to and they often greet me in the hallway with a "The usual today" as if ordering an egg salad on whole wheat.

Every time it was exactly the same, until I suddenly sat down across the table from a familiar face.

This lawyer did his homework.

As I sat down, poured my water and readied my notebook I saw a 3 inch tall pile of clearly well handled papers, some stapled, some not, but in just enough disarray to show they had been reviewed, not simply all printed at once.  Right on top I saw a familiar face: Happy.

This lawyer had printed out at least 100 of my blog posts, news stories about the Chronicles of EMS, had photo copies of articles I wrote for magazines, photos of vendor events at conferences...you name it, it was there.

I suddenly felt a wave of panic flow over me and my wool dress coat was heavy.  He had achieved his initial purpose of setting me off my game and I did my best to recover as he launched into personal questions about my experience as a Paramedic and blogger.  The City Attorney was surprised to see all this material and at that point I wish I had mentioned the blog in our preparation.

Luckily, when we got to the vendor photos I was able to mention they are the same vendor as the medical charting system we use and my familiarity with the product is a result of those interactions.  The City Attorney made a very complex legal statement that I believe translates to, "Move along."

The rest of the interview went as always, I describe the manner in which crews enter data, that the final report can not be edited, that anyone viewing the chart afterwards is in the log, blah, blah, blah.  The clinical interviews are far more interesting but are very far between.

After the interview the City Attorney pulled me aside and mentioned that I should have told him about the blog and I apologized.  He laughed it off and said, "At least this time you had something new to say!"

Wednesday, May 14

Fresh perspective

Can you really ever see something from a fresh perspective?

If you are in the middle of a storm, how can you step back and see anything BUT a storm?  Much like looking at a cloud, as soon as it looks like one thing, you'll constantly see it as that until it's gone from site or morphed into something new.

 

Listen to an old song and sing the wrong words?  Even though you know for a fact there's a bad moon on the rise, not a bathroom on the right?  How can we clear out the mental cobwebs that keep us seeing what we see and hearing what we hear?

Do we seek out new clouds and new music or are we simply exchanging one set of perspectives for another?  How can one truly CHANGE perspective?

It begins with challenging your comfort zone, your home base.

Why do you feel the way you do?

What motivates you to feel that way?

What influences are in place to maintain those feelings?

Do the people around you support your perspective or do they challenge it?

Do your activities allow you to challenge your perspective or do you find comfort in the status quo?

All these questions are important when evaluating change of any kind but are essential when evaluating change that impacts more than simply your own little world.  Imagine that seeing that cloud as a dinosaur instead of a tea pot meant lost jobs, revenue, market share or something else important to your agency?  What if the old lyrics meant a low paying, poor working conditions job but the proper lyrics meant a better opportunity for you and your family?

Would you still stick with the dinosaur or would you ask others what they see and possibly be tainted by their perspectives?

Would you sing the old lyrics and shuffle along or will you challenge your perspective, your ideas, your beliefs?

Changing course on major decisions isn't easy and should not be undertaken without serious consideration of the impacts of your perspective.

After all, what if you're wrong but won't challenge your pre-conceptions enough to find out before it's too late?

Tuesday, April 29

Paramedics Make the Worst Patients

We're experts at assessment, treatment and disposition of life threatening emergencies.  We're also good at that stuff for all the other reasons people call 911, but when it comes to more complex medical issues we are lousy at assessment and can muddy the waters for the rest of the medical community.

But don't worry fellow medics, there is a solution I have discovered after almost 2 decades of falling into this trap:

Play dumb.

Luckily it's a skill I know for sure you possess.  Use simple lay person terms when speaking to the doctor.  "Adverse Lung Sounds" becomes "Funny breathing noises" for example.  Leave your education at the door and use the simplest terms to describe your condition.  Over simplify it if you have to.  At a recent visit I told my MD that I thought I heard a kind of clicking or bubbling in my throat at night and it always happened if I didn't use both pillows and even then I could still hear it.  Had I tried to describe to him that I was sure I was experiencing pneumonia symptoms all he would have heard was "Hi, Antibiotics please."

Instead he explained the difference between a bacteria and a virus and I let him.  I pointed out that I only had 2 of the 5 signs of a viral infection and 4 of the 5 for bacterial bronchitis or pneumonia.  I then mentioned my daughter was recently given (Not prescribed) medicine for her pneumonia and she got better almost overnight.

He pondered my statement and I looked at him and said "Doc, drugs or no I just need to be able to sleep so I can get back to work."

Prescription in hand and meds on board I can tell you that right now (18 hrs post loading dose) I awoke after almost 4 hours uninterrupted sleep after having done about the same time at least once more in the night.  HUGE improvement.

Had I gone in as a medic and explained my self assessment I keep him from doing his full assessment and he may not reach the same conclusions we do.  Had my kid not been sick with the same thing last week I'd be in the weeds.

After all, isn't your least favorite patient the one that calls you and then proceeds to tell you their assessment findings?

Play dumb!

 

Monday, April 14

Celebrating the Voices

I hear voices.

At least I used to hear voices, before I took this desk job at Headquarters, but before that, in the field, I heard voices.

The voices woke me from my sleep and interrupted meals more often than not and always seemed to know someone was ill or injured.  Most of the time anyway.

For all my griping about MPDS, dispatchers and call takers, they still show up everyday to do a job I would fake a seizure to not have to do.

They take the confused, rambling mumblings of someone, code it, send it and away I go to deal with the problem.  So what if it's not always what they say it is, all they're doing is telling us what someone told them.

And many times, after listening to some of these calls for QA purposes, "told" isn't exactly the right word.

A man is shouting to please hurry! please hurry! but won't say why or what is wrong.  He simply says please hurry.

The woman holding the lifeless baby can't get a word through her screaming but the voice still tries to talk her through CPR.

The whispers of the young boy hiding in the closet while someone assaults his older brother in another room are barely discernible because the call taker next to them is dealing with the screaming mother from before.

The voices belong to a group of folks who aim to bring a few moments of sanity to an insane world, and all over the phone and the radio.

Call them dispatchers, broadcasters, call takers, whatever, they still always answer the phone and will always answer the radio when you need them to.



So call up your local dispatch center and see if they have an event planned.  If not, step up and put something together.

Sunday, April 13

Now at Uniform Stories

Your pal Happy is proud to be included as a guest blogger over at Uniform Stories.



Uniform Stories allows you to upload a video about your experiences in uniform, no matter the type, and you know I'll tell you that is a powerful medium.

Head on over and take a look at the site and watch a few videos and I invite you to upload your own.

If your uniform could tell 1 story, what would it be?

See you there.

Thursday, April 10

Suicide: Know when to ask for help

Pussy.  Wimp.  Lightweight.

 

All things you think people will call you when you ask for help.

They went to the same call you did, they're fine.  They're not.

They went through a divorce just like you did and they're fine.  They're not.

I failed and they didn't because they're better than me.  They're not.

 

"They" are going through the exact same mental roller coaster you are.  I've been there to a certain extent.  When I got hurt I went through every emotion I've ever known from thrilling excitement getting back on the Engine to crushing depression that I was one call away from being killed in a fire.  I've been confused, conflicted, felt like screaming.  Screamed (it helps) and even cried like a baby.

Dealing with depression can be hard, is hard, will be hard.  Regardless of what people want to tell you, things aren't always going to be better.  One day you'll look back on today and be willing to swap feelings for anything.  The trick is going to be what you do about it today.

 

No one controls you but you.  The feelings you feel, the things you think, the situations you run out over and over and over in your head until they get so loud it feels like they're going to come bursting out of your forehead will only get worse unless you let them out.  Only you have the power to release them.

Start a journal, write your feelings on a single piece of paper.  Get out all the negativity, anger, hate and everything else Yoda warns us about the dark side and look at it.  It's outside your head and nothing is wrong with that.  Now destroy it.  Destroy all the hurt.  It feels good.  Then take a deep breath and feel the emptiness the hate has left.

 

What will you do with it?

This is the part no one tells you about PTSD, that you can address and overcome your fears rather easily, but even scarier is what might take their place.  If your thoughts were that dark before, what will happen now?  Now there is room for worse!

And for better.

Some fill that void with faith, companionship, adventure, music or art.

Others fill the void with solitude, smoke and the bottle.

 

What you do with the space you make is up to you, but I can tell you from experience that looking for a new challenge every day will lead you to places your old self never imagined.

Some departments offer Critical Incident Stress Debriefing (CISD) but others do not.  It is important to have an understanding of what to expect from your healing process.

I did a brief series on CISD using the band OKGO:

Part I   Part II  Part III  Part IV  Part V

The hardest part is knowing when to ask for help and realizing that anyone and everyone that tells you some bullshit line about having to have thick skin in this business is falling apart inside just like you and may actually want YOU to help THEM, but they're afraid to ask.

They're afraid you'll call them a pussy or wimp or lightweight, laugh at their sorrow because they can't take it while you're fine.

Asking for help early can break the cycle of depression not only for you, but for your coworkers, friends and family.

 

I don't understand suicide and I never will.  It's a coward's move and no one can convince me otherwise.  Besides, why not ask for help and avoid the whole mess to begin with?

There are a number of ways to find help, one of which is by following the Code Green Campaign on Facebook.  Click the green star and follow, talk, heal.

Sunday, April 6

Open, Pending

As the default Risk Management guy for my agency (until the new gig kicks in that is) I get routed all manner of citizen complaint that has anything to do with the Ambulances.

As a result I often have the opportunity to do some public relations work right there on the phone.

Did the mean Paramedics stab you with a needle?  Let me just take a look at your chart here...oh.  It says here you're a known diabetic and had a blood sugar of 21.  Yes, Sir.  Yes I understand you have trouble remembering to take you medicine.  Yes I do think they should have woken you up first before stabbing you with the needle.  But here's the thing...

Problem solved.

Most complaints seem to come in about 2-4 weeks following the date of service.

Our billing turn around is about 2-4 weeks.

Total coincidence I'm sure, but every now and again I get a phone call that brightens my day.  Often it has to do with someone most certainly under the influence of a central nervous system depressant and their attempt to recover said intoxicant from the Paramedics that took it.

Take Eddie Dean(Not his real name, but think of Eddie from the Dark Tower series).  Eddie called me doing his best Tommy Chong impression, right down to forgetting to answer some of my questions until after I ask "are you still there Eddie?" "Wha?"

Boils down to this:  Eddie is refusing to pay the ambulance bill because the Paramedics stole his marijuana.  Tough part on this one is that Eddie seriously needed some aggressive ALS care a few weeks back and I've got a gold star chart to prove it.  He mixed up a few prescriptions for a few diagnosed ailments and...BAM...altered, parastesias, the whole 9.  Most complaints revolve around fizzled attempts at a Lawsuit Chart, which still has to be paid prior to their surely losing case being heard.

Eddie is worried the Paramedics thought he was high at the time, which he claims he was not and I believe him...until he starts to try to explain how high he is right now.  While on the phone with me.  "Like...like right now, I'm able to smoke some and feel good, but I didn't smoke a lot that night."

He swears his girlfriend can corroborate that the Paramedics took his weed so I ask for her number to call her.  Eddie didn't think that all the way through and is asking that I not call her right away, that he needs to call her first to tell her what to say.

Smooth move, Eddie.

On the answering machine at my office is a message that ends with "If this is a pressing clinical matter, please call (my cell phone number)."

Eddie left me three messages yesterday (Saturday) moderately sober and begging me to call him immediately so I can talk to his girlfriend who "can tell you more about what happened because I talked to her already."

So now I get to hang onto an open file about how while in the midst of a code 3 scene time of less than 11 minutes  at an 8th floor apartment, my crew somehow had time to grab a few little green bags.

Marked:Open, Pending

 

Friday, April 4

C-Spine Policy Rooted in Science

Friend of the blog Nick Williams sent this on from a Reddit feed.

VMtHUmF

The future is here folks. Long spine boards are no longer the standard of care.

Speaking of the future, I posted all this from my phone. In my pajamas. While drinking wine. #micdrop

Wednesday, April 2

Overheard in the CQI Office

*Department issued cell phone ringing with hip electronic themed tone*

HM (Our hero): "Good afternoon, EMS CQI, Captain Schorr"

SM (Southern Ma'am-Caller with an almost comical southern accent): "This is Janine from General Freight we have a driver trying to deliver and your gates are locked. Can you send someone to the North Field gates?"

HM: "I'm sorry, I think you have the wrong number.  Who are you trying to reach?"

SM: "Sweetie, I doubt it, just get someone out to the gate for me...m'kay?"

HM: "Ma'am you called the San Francisco Fire Department.  Is your driver in San Francisco?"

SM: "Sweetie if he is he sure is lost.  How 'bout you just get someone out to the north gate and let us in OK?"

HM: "I believe someone gave you the wrong number Ma'am, I'm in a little office in San Francisco.  Can you read the number back to me?"

SM: "I need to speak to your supervisor unless you get someone to...oh...oh my...sorrybye"*click

Yup...never a dull moment in CQI.

 

Monday, March 31

A Big Move

I've been cryptic about things recently, and for good reason.

Those of you following on Facebook noted last week that I was preparing for an interview, but never explained for what.  Yesterday I got word that it went well.

Starting July 1st I will be assuming the role of EMS Director for the newly formed Detroit Unified Healthcare Service which will rebuild Detroit's EMS service from the ground up.

Plagued with difficulties for decades the DUHS will erase the problems of the past and build on an EMS 2.0 platform of prevention, home visits and has already connected with a vast network of secondary transport facilities.

Upgrading salary, training and service levels are just the beginning!

More details are to follow as the official announcement will be made on Friday at a joint press conference, we're still working on getting the house sold here, didn't expect this to happen so quickly.

This is an exciting time to say the least and I'll miss the SFFD but this is an opportunity not to be missed!

 

Interested in coming along?  We're hiring! Detroit United Healthcare Service info