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


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.


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.