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

Thursday, March 27

Comments on 'a flickering flame' by Captain Chair Confessions OR How to confine burnout to the area of origin

Fellow EMS Blogger Captain Chair Confessions (CCC) has a post up that will likely sound familiar to anyone who has spent more than 10 days in EMS.

CCC is experiencing the first smoldering effects of burn out.

The reason CCC is going to recover and grow from this experience is their ability to come out and talk about it.  Granted, it's more of a 1 way conversation considering the way the interwebs works, but it's enough.

Simply recognizing something is happening is the first sign of recovery believe it or not.

I know CCC is feeling more than they are writing, and that's OK, because everything will come out in the end.  Every emotion, every angry thought hidden by a forced smile with teeth clenched on a transport everyone knows is unnecessary, everything will see the light of day.

That flickering flame CCC is feeling is easy to ignore and is often missed because of pride.  Misplaced pride, but pride just the same.  We tell ourselves that we need to toughen up, grin and bear it, grow a pair or some other lie we tell ourselves and ignore the growing flickering flame.

Worst part is, at this small stage the flame is easy to extinguish.  Even the softest of breezes causes it to waver.  Believe it or not, simply saying your frustrations out loud can be enough to knock down the tiny flame.  Of course the fuel still remains and needs to be dealt with, but try taking a candle apart while it's burning and you're going to get hurt, spread a fire and be in worse condition than you are now.

The amount of fuel in EMS is staggering and I've seen shovels on both sides adding more.  Admin needs more transports to meet payroll, response times need to be faster, posting moves aren't efficient know the complaints.  At the same time patients are getting less and less emergent and are calling more often looking for the quick service we've spent 40 years convincing them they needed.

Somewhere between a missed lunch and an angry call from the QI Captain you run a call like the one CCC had and the flame is back, flickering away in the back of your mind, ready to grow unchecked as soon as it can.

Don't ignore that flickering, fluttering light.  Talk to someone, anyone, write a letter and throw it away, get the frustration out of your system.  Ever heard of screaming?  Go for it.  Find a local supermarket and ask them if you can borrow their walk in fridge for a minute.  Shut the door and scream.  Go ahead, I speak from experience when I tell you that the sky is a little brighter when you emerge.

From there attack the problem.  Get involved, get active and if things can't change, then you have to.  Staying in a broken system that refuses to change isn't healthy for you or your patients.  Move.

Again, from experience, it helps.  I got up, got out and landed somewhere where I eventually, just this last week, had a chance to rewrite our C-spine precautions policy.  And it might just pass.

It took a long time to get where I am, but the flickering flame I spotted when I got hurt was doused when I first stepped into this little room on the internet and began to scream.

And CCC is doing the same thing.

Keep strong Brother (or Sister)!


If you feel that flickering of burn out and want to vent, drop me an email, I'll read it, or not, whatever, just talk to someone, anyone.

You'll be glad you did.

Tuesday, March 25

Proper use of Long Spine Board pre-hospital

Friend of the blog Nick Williams sent a photo to me about Monday's commuter train derailment in Chicago that left over 30 injured.  It was upon closer inspection of the photo by KyeCommuteNBC that I almost spit beer onto the screen tonight.

Take a look at this photo for proof that long spine boards are an important tool in the pre-hospital setting.


[caption id="attachment_5778" align="aligncenter" width="474"]@KYECOMMUTENBC @KYECOMMUTENBC[/caption]

Without that long board, someone could have been injured...

Saturday, March 22

Spring Cleaning - Empty Your Pockets

For some of you, the seasons have shifted due to an unexplained miracle (or the axis of the earth rotating, your call) and Spring Cleaning is in the air.  Your desire to open up the windows and drag a mop around the house is a good thing, not OCD.


But I want to focus on something a little more specific to you fire types:  Cleaning out your gear.

[caption id="" align="alignleft" width="300"][/caption]

Since you're already washing your turnouts once a month and after every fire (or else cancer is your own fault) I want to get down to the nitty gritty of what's in your pockets.

Personal preference and jurisdiction is going to determine what you carry so don't worry if someone tells you to carry something you'll never use.  Figure out what you need and add it but perhaps you need some guidance on what to wear and why.

Here's the Happy Medic's advice on spring cleaning your turnout pockets:


You need to have a common theme between pants and jacket to start.  I like to use a Right for Fight Left for Life system so that I instinctively know what is where when I need it most.

  • Pants Left (LIFE) Hip Pocket

    • Bail out kit.  You can buy a fancy harness and lifeline if you like, but I keep a 50 foot section of 3/8" with carabiners on a fig 8 follow through on both ends.  One end is through the bottom of the bag and is for me, the other end deploys out the top of the bag and can be quickly latched around an axe or halligan in a window sill for quick evac.  This is not a descent bag, this is a life or death hang from the window and possibly get rescued bag.

  • Pants Right (Fight) Hip Pocket

    • Cut up bleach bottle "key" for forcing metal gates and latch doors. (If you don't know what this is let me know and I'll post how to make and use one!)  Hydrant spanner/gas key tucked into leather work gloves.  Medical gloves.

  • Jacket Left (LIFE) Pocket

    • Flash Hood, Gloves.  Don't store your gloves on some dinky velcro clip outside your coat, keep them safe inside a pocket.

  • Jacket Right (FIGHT) Pocket

    • Multitool Clippers, medical gloves, 2 wooden door chocks.


Anything else wandering through your gear or anything you haven't trained on in 30 days needs to go bye bye.

I also have on my gear: A firehouse key on pants and jacket, scissor pouch on pants with pens, shears and light.  Flashlight on helmet.  On shift I always add the radio, axe on the SCBA waist strap (You don't need a Truckman's belt if you have an SCBA) and box box flashlight from the Engine.

Sadly, now as an RC, I still carry all the same things in my pockets, but instead of an axe I have a reflective vest.  :(


Do you carry something I didn't mention?  Think I should?  Mention it in the comments!

Take this warming feeling to clean and apply it to your gear.  Train on the location until you can deploy anything from your pockets without having to think of where stuff is.


Thursday, March 20

Missing the Grind of the Lightbar

I was doing some math and realized my career in EMS has reached past middle aged.  I have 18 years in and 17 to go.

It made me think of how I am still perceived as a new guy by some and an out of touch almost dinosaur by others.

Thinking back to the early days of when I realized this was what I wanted to do brought back some memories many in this field will never experience.


For example:

Manual transmission water tender.  My first paid unit was a 1970s 10 speed double clutch 1000 gallon water Tender.  I learned to drive code 3, work the siren and shift, all while reaching a top speed somewhere in the high 40s.

But as memories went through my head of that beast of a unit a certain sound crept into my head and has stuck for a few days:


The grinding of the rotators in the lightbar.

While some of you might still have an "old" rotating lightbar, most of you are likely used to all manner of flashing light bulbs and diodes.

Back in the olden days we had lights that turned on and spun around in circles.  Our old rescue truck on the Reservation had 3 bright white lights mounted on a 12" diameter spinning disk covered with a sun bleached almost still reddish pink cover.  When you turned it on and pulled out of the station is spun slowly.  When you pressed the button for the old Federal Q siren mounted on the front bumper it would slow and almost stop.  It was not uncommon to reach the scene and go to work only to see the beacon slowly begin to dim as the alternator on the ford pickup could no longer keep it shining and turning.  It was later upgraded to a strobe light and we thought that was the neatest thing ever.

On the ambulance was the Code3 standard lightbar of the time, 2 rotating lights and a series of reflectors as well as intersection lights that swept back and forth on each side, apparently designed to get the attention of drivers coming from the sides.  Those rotators were noisy!

That grinding was constant, loud and almost annoying.  And they were especially annoying if one of the reflectors got dislodged and stuck while on a run at night.  Or in the snow.  Or in the rain.  Or at all.  A single beam of bright red or white light trying desperately to distract you from looking at the road.  And Gods help you if it was an intersection light that got stuck!  That was worse than driving code 3 with your alley lights on.


Nowadays the kids have these LEDs that blink in ever impressive patterns.  For those noobs unsure of exactly what I'm talking about when I mention the grinding of the old rotators, imagine how much nicer your drive would be without the high beam flasher motor clicking away under the dash.  You'll be glad when it's gone, then 15 years later remember when things were bigger, clunkier and less efficient and miss it ever so slightly.


Friday, March 14

Rogue! Madness! Rogue!

All ahead 1/3.

For reasons I was asked not to mention (cue mysterious music and an odd closeup on a surprised face) I was asked to not "do anything online for awhile."

Well, I think this is long enough.

What brought me out of mandated hiding?

Blog on blog action of course!

Rogue Medic was on one of his usual data driven rants about mechanical CPR devices and how study after study reveal results of, well, nothing.  Read more here.  Personally I'm not a fan of the mechanical CPR devices.  I'd rather spend that money removing the stigma of mouth to mouth from our communities and introducing "Push hard, push fast, call 911" at the 7th grade level.

And wouldn't you know it, another blogger and old friend Sean over at Medic Madness jumped on Rogue's conclusions (well not exactly) in support of mechanical CPR.  More at this underlined word here.

When I read Sean's article I immediately went over to Rogue Medic for his inevitable reply.

BAM (Complete with surprised Scarecrow image.)

For those of you not clicking on the links (How on Earth are you going to understand why this is so important) here's the Reader's Digest version:

Rogue reminds us that the mechanical CPR devices have not increased survival in any location they have been deployed.  ROSC is through the roof, but if ROSC was our only goal the Epinephrine would be gone.  Survival to discharge with no neurological deficit is the goal and the mechanical devices are not helping despite their claims to the contrary.  I can't say my product does something it does not and not expect to get called out on it when someone with a 10th grade education reviews the data.

But Sean at Medic Madness fires back a sortie of examples of devices his agency deploys that do not impact survival.  Cots, power loaders (what a waste, another topic) and 12 lead monitors are discussed.  He also mentions that in rural systems all the fancy new pit crew compressions centric CPR doesn't work with only 2 rescuers at the scene.  On the surface Sean is right, that none of those things can be directly linked to survival, but the overwhelming point I read between the lines is that if we're going to hang survivability as the most important thing what are we doing about it?

We're talking about it.  Like adults.  No one is challenging Rogue's license, training or the color of his ambulance.  No one cares if Sean truly is mad, jocks a box for the here privates or rides backwards on a BRT.

The merits of the methods are being discussed for all to see and I count that as a win.  A win important enough to climb up from the depths to share with my remaining readership (Hi mom, Hi Linda).

A lot has changed in EMS since I joined this blogging thing in 2008.  Can you believe we're finally getting traction on spine boards?  With discussions like Sean and Rogue actually getting to the root of most of the conversations in the ambulance yards and bench seats Nationwide it can't hurt and I'm pretty sure it'll get the ol' brain pans fired up for the crowd gathering who no doubt smell blood in the water.

So a Tip of the Helmet to Medic Madness and Rogue Medic for having the conversation in public and keeping it Professional.

Well done, Gentlemen.

All ahead full!