Monday, December 28

Good Morning America skims over Fatigue in EMS

I was asked by my cousin Debbie, also a Fire Medic (Yes, it is a family business), what I thought about fatigue in EMS and the Good Morning America story about it that has been circling the EMS interwebs.

While any publicity on EMS is good these days, GMA simply told us about 3 private ambulance company employees who had a collision while being sleepy.  It reported the problem, and the symptoms, but did not look into the causes.

We know that EMS can be tiring.  I've been there.  I've been on my 40th call in 48 hours wondering what color the sky was.  Never made a medical error, never crashed an ambulance.

So why are others falling asleep and crashing?  GMA mentions long hours and the need to work other jobs.  These two symptoms can be placed solely on the shoulders of for profit healthcare.  Companies are required to turn a profit so they put a warm body in the seat, pay them poorly and send them out on 8,10 or 12 hour shifts with no facilities, restrooms or even a place to sit down besides the cramped cab of a van.  Ever been on a 12 hour road trip and needed rest stops to stretch your legs, hit the bathroom and grab a bite to eat?  Now what if I told you to make that road trip but stay in the cab.

Exactly.  Most of you who read this forum know this as System Status Management or "How to deploy an EMS fleet without investing in infrastructure."

If the posting locations are good, put up a station with a heater and a rest room.  Simply moving the fleet at random without an area for refuge is a recipe for disaster, as we can see.

 

The studies also mention employees in "Sleep deprived states."  I have been tired at the beginning of a shift and dreaded the rest of it, but without any sick or vacation time back then I was at risk of losing my job if I didn't show up.  Again, I'll put that on the shoulders of for profit healthcare.

 

What I won't do is buy into the nonsense that mistakes happen at the end of long shifts.  I won't because I have seen data that show more medical errors and collisions occurred in the first half of shifts in a large service, rather than near the end or even in the second half.  I would be curious to know at what point in their shift our friends in the GMA story we at.  I also won't be surprised if we find out it was not near the end of a long shift.

 

No, fatigue is the result of inefficient rest.  You can power through a 24 without sleep provided you can have at least 24 hours to recover, preferably 48. Running someone ragged for 12 hours in a shift, knowing that they will have time before and after shift awake, then asking them to come back in less than 12 is insane and is leading to fatigue, plain and simple.

"But Justin, that's how we've always done it."  Yes, I know, that's part of the problem.

GMA ends the story with the statement that, in the end, it is "Up to the employers to take care of their workers."

 

Good luck with that, EMS.  So long as profit reigns over quality of care (Some companies can make it work, I've seen them) we will continue to see ambulance operators tired, hungry and having to work additional hours to earn a living wage.

Fatigue in EMS is solvable but it costs money, something pre-hospital care is sorely lacking.

Wednesday, December 23

Police-24,336,756 EMS-4

"You can go to the hospital or go to jail!"

 

Often, dear Officer, there are far more options than those, and your threat of incarceration usually frightens people into a completely unnecessary ambulance ride to an even more unnecessary hospital, all to avoid whatever it is you don't want to do.

Usually.

Tonight, not so much.

"I'm not going to the hospital, I don't need it."

"I agree Officer, our assessment finds this man able to make his own decisions and we're going to let him refuse."

"You can go to the hospital or go to jail!"

"Then take me to jail!"

On go the cuffs while the officers debate what the charge is.

Well played, citizen, well played.

Police-24,336,756 EMS-4

 

 

 

Sunday, December 20

EMS Bike Program from the ground up

My ramblings in this forum have been quiet lately, mainly because my therapy is finding new forms.  Whether those forms be advanced ARFF training in Dallas, assisting in large MCI drills, writing SOGs, the list goes on and on.  My position here allows me the opportunity to try out some new ideas and gosh darn it if they aren't working more often than not!

Many of you following along on the Facebook machines may have noticed that my service is gearing up to host a large sporting event and since they still request I do not mention them in this forum, I can't be too much more specific.

Now that that is out of the way...

Like many jurisdictions we can get quickly overwhelmed when large events occur.  Be it a concert, sporting event or even public disturbance, the need to respond, assess, treat and possible transport exists, but the methods to do so are limited.

Large public gatherings can allow for a satellite system to be set up with more mobile units on foot or on bikes or in a small golf cart or Gator.  These resources are invaluable in reaching patients quickly and evacuating them to care when needed.

When facing a similar situation we looked for a solution already in place in many similar communities: Bicycles.

Law Enforcement here uses bikes with great success and we reached out to them for training.  A one day class put us through our paces and we were sore for days.

Policy was needed to not only determine when and where to deploy the bike, but what role it needed to play.  Many jurisdictions staff Medics or EMTs with an AED on the bikes.  This makes sense for the extreme calls, but in order to cancel our other units and complete an assessment the local EMS Authorities require ECG tracing when indicated as part of a secondary assessment.  If the bike unit can't complete an assessment and obtain a refusal when appropriate, all we're doing is stopping the clock.  I don't need the clock stopped, I need more resources.  I need a trained set of eyes on the "Man down unconscious" to determine it is only a minor slip and fall requiring and requesting no additional services.  Cancel the ALS first response and the ALS Transport unit, complete an assessment and cut a chart.

But how can I get an ECG on a bike?

In step our vendors and for the sporting event they're loaning us a lightweight 12 lead ECG machine that we can carry on the bike!  This is in addition to what we are calling, and many agencies already deploy, a "First 10 minutes kit" meaning we can perform all the interventions an ambulance can in the first 10 minutes.  Since that is when we expect our other units to arrive (unless delayed) it should cover just about everything we can bump into.

 

sfo bikeLess than 48 hours after completing our training the target designed to activate the team was met and away I went for a 10 hour shift on the bike.

We didn't even receive the bike unit polo shirts yet so there I was in my uniform shirt and some workout pants.

This photo is from one of the area employees who saw me pedaling by and said, "Alright Captain Schorr!  You got the bike!"

This program is more than 6 months in the making, heck I only convinced the local Police Bike Team to donate a beat up bike in July.  And there we were on December 18th in service and jumping calls.

 

If you had come to me in the CQI office 3 years ago, my nose buried in a spreadsheet, and told me I would be pedaling my way from EMS call to EMS call I would have laughed.  "The bike is not efficient logistically," I would have told you, "You'll need to ride in pairs for safety" would have been the next excuse.

Now that I understand the way this system can be deployed to fit this community's specific needs and access to services, it makes perfect sense.  There are 5 of us trained and ready for the large sporting event when our activation target is projected to be met for 10 days in a row.

Next project?

Dunno.  Until then keep an eye out, I'm still learning to ride again!

Monday, December 7

Become a Patron of the Arts - Support the Crossover Show!

My posts may be few and far between these days, but that is only because Motorcop and I have been covering a lot of great topics over on the Crossover Show, the internet's first, best and only Fire, Police, EMS podcast.

Now you can help us keep the show going by becoming a patron of the show, pledging your support.

We've had an enormous response to the relaunch of the show and want to make sure we have the capabilities to make your listening experience as good, if not better, than our recording experience.

 

You can pledge as little as $1 a month, or choose an amount that coincides with a reward from us to you.

Please help us keep the show going!  Visit Patreon.com/TCS to see what rewards we have available!

Oh, and watch our video about it for more details and a peek at MC's perfect 'do.

Wednesday, December 2

Engine Company First Strike MCI in San Bernardino

A still unfolding situation in San Bernadino, California, has resulted in at least 14 fatalities and as many as 14 more injured.

The first images were seen on the news from uncited facebook and twitter images from bystanders.  In these brief photos we can see firefighters, clearly in their yellow brush coats and helmets, working in a triage area near the incident.

I am currently working on an MCI presentation and I tried to put myself in the shoes of the first company officer on scene.

Are we in a safe area depending on the threat?

Are there victims within sight?

Where will our Immediate Treatment area be set up?

What is the most important information to transmit as my initial report?

 

These are all things you need to be able to do as the situation unfolds.  Before the vests go on and the tarps come out, the Engine Company will begin to find, sort and move victims as efficiently and safely s possible.

Tuesday, December 1

Video Shows Woman Banging on Ambulance Accusing Them of Organ Harvesting

The video below was posted on YouTube by user "Batter Up" and is painful to watch for a number of reasons but shows the wild perspectives of some in the community.  Watch with discretion, tin foil hat optional.


According to the videographer, she is a "Military and CIA Family" and "I see things you don't."

The folks at Albuquerque Ambulance show impressive, professional conduct at the scene when the sister of their patient begins to bang on the ambulance doors and disrupt patient care.  Full disclosure, I did my internship at AAS and still communicate with a number of folks in ABQ.

She mentions her name on the video and posted it in the public sphere so let me address her directly:

Jennifer (Audi perhaps?)

You need to quit drinking.  Or you need a Snickers bar.

The Paramedics could have taken care of your brother if you had just shut up and let them do their jobs.  You clearly have issues with authority and don't understand how the internet works so let me educate you on a few things:

  1. Ambulances registered and licensed to operate emergency lights and sirens can indeed park on the street when indicated.  Judging by your video the traffic is backed up for miles there on Central Avenue.  I know, I attended UNM and worked at the Frontier for a year.  Your claim at the end that they're blocking a hydrant is the only accurate thing you said in this 9 minutes of word vomit.

  2. Officer Daniel Webster deserves respect, not to be used as an example in your drunken tirade.  He was a soldier and police officer and was murdered by a felon at a traffic stop.  According to your credentials as a military police daughter you should know better.  But, judging by your reaction to APD coming by you have no connection to Law Enforcement whatsoever.  No Cop's daughter I know would even raise her voice to a seven point star, let alone puff up and be as rude as you were.  Officer Webster is above your little misconceptions.  You leave him out of this from now on.

  3. "APD Homicide Detective, best Dick I ever had."  Clever.  How is that working out for you?

  4. Organ harvesting happens when people are already dead, incase that CIA Military police family of yours is misinformed.  If we were harvesting organs, we'd be rich and probably try to hide it better than parking a giant van on the street at night with bright flashing lights.

  5. You are a special kind of crazy, do you know that?


Banging on the side of an ambulance to make them go away rarely works.  The reason they weren't getting out was because of your actions.  Had you shut up and let them do their jobs perhaps your opinion of their actions would change.  Oh, who am I fooling.

 

The only possible thing I can even try to give you credit for is the possible belief that organ donation after death somehow impacts the soul of the inhabitant, a notion I had heard more than once in my 8 years in your community, including on a Reservation.

 

But, I think I'm giving you far too much credit.  If this is what you choose to do in public and share in public I shudder to think of what you might say and do in private.

 

Leave the Paramedics alone, Jennifer.  What if one day you need them and someone else gets in their way?

Yup, that's what I thought.

Share this video.  This is too precious not to spread.

EDIT:



Oh my.  This isn't an isolated occurrence.  Jennifer, just sit down before someone else gets hurt.

 

Friday, November 20

The Crossover Talks Trouble Kids and Empathy

crossoverlogo300What could possibly go wrong, right?

 

This week on the world's first, best and only Police, Fire and EMS podcast Motorcop and Happy Medic welcome Mrs Motorcop for a much needed discussion.

MClet #3 is giving them trouble.  Nothing they do seems to help, but some careful research and a lot of time and effort seem to be making a difference.  I take that conversation and try to stretch it into police dealing with a trouble neighborhood or police leadership dealing with trouble employees.

We also discuss empathy and where it fits in for the three disciplines as well as for our families.

She certainly classed up the joint for this show and we hope you enjoy it.

GO LISTEN

If you have a topic you want the guys to discuss drop us a line at thehappymedic@gmail.com and make sure to rate us on itunes or your feedburner.  We welcome your feedback, unless you don't like the show, then tell us why.  Otherwise we will continue to drink beer and babble on.

Sunday, November 15

Am I Qualified for the Fire Department? - Reader Question

An email came in on the internets machine from a fellow reader of yours asking to remain anonymous.  It reads:

"In your expertise, have candidates with no experience been able to be hired as a firefighter, or emt, or police officer?"  He goes on to mention that his only previous experience is a CPR card that has expired.

Signed, Wondering.

 

Well, Wondering, how about this for an answer:  It depends.

If I was sitting across the desk from you at SmallTown FD your resume would find its way onto the floor.  Chances are I need someone who can hit the ground running, who I simply need to train to the basic differences of how we do things.  I'll need you EMT at the minimum and with at least a few years experience.

 

Now, If I'm at BigCity FD I have the time and resources to train you from the ground up including CPR and EMT.  Although many Departments have chosen to let you get that sorted out ahead of time and make it a requirement for application.  Larger departments often discourage experienced or lateral hires because it is harder to change the way you do things than it is to teach you from the beginning.

 

That's on the fire side but really does carry over into EMS and I think it is safe to say law enforcement.  Smaller agencies can't afford to train you and prefer someone who has already proven themselves elsewhere.

You may have a chance, Wondering, but if it comes down to you and someone with even a valid CPR card I have to wonder how much you really want the job if you let the easiest thing lapse.

So here is your ToDo list in the next 6 months, Wondering:

  1. Retake CPR.

  2. Sign up for an EMT class at the local college.

  3. Go do a ride along at your local ambulance company/service and fire department.


With these things accomplished I can look across the table at you as a fresh face and see that you were willing to do what you can to get your feet in the door.  Not to mention you know some names and have a better understanding of the system.

 

Good luck Wondering!  See you at the big one!

Friday, November 6

New Crossover Podcast and Uniform Stories Link!

Hello internets machine!

This Friday, like most, I want to share a few links with you.

 

crossoverlogo300First,  Episode 28 of the Crossover Show is up and ready for your favorite podcast reader to feed into your earholes.  This week HM and our law enforcement expert MC discuss technology used in police training, the possibility of MC wearing a body camera (and what one of his co-workers thinks of it), we touch on the South Carolina cell phone video making the rounds and of course end up going WAY off topic.

Have a listen HERE

 

 

 

While that plays in the background, get some work done or hit the treadmill. When done head over to Uniform Stories for my latest article: "5 Things Urban Firefighters Take for Granted" and let me know if I missed any.  Coming in a few weeks, what I learned about how good I have things when on a recent trip and seeing this firehouse:

http://uniformstories.com/articles/lists-category/5-things-urban-firefighters-take-for-granted

Saturday, October 24

The Crossover talks arrogance vs confidence

MC and HM con­fi­dently present episode 26 of The Crossover Show. They arro­gantly feel it is the internet’s best, first, and only Police/Fire/EMS pod­cast fea­tur­ing con­fi­dence vs arro­gance you’ll lis­ten to today.

In the world of Police, Fire, and EMS there is no short­age of con­fi­dent men and women. Often, how­ever, there are accu­sa­tions of “arrogance”.

The guys take a shot at crack­ing the code of when one can morph into the other, who decides, and they even break open the Google machine to get some actual, real-life definitions.

Also, there’s beer.

If you haven’t rated the show, please visit iTunes and rate the show six stars! If you have sug­ges­tions for improve­ment, please send the guys an email and let them know what they can do to bet­ter the show!

LINK TO SHOW

Wednesday, October 21

October 21st, 2015

We've been having some technical difficulties here at FireEMSblogs.com pertaining to the ability to schedule posts.  Believe it or not gentle reader, when a post goes up at 6 AM, chances are I'm not hitting publish right that minute.

We have (had) the ability to schedule things out so that my 10 posts I write when fired up don't all come tumbling out at the same time.

So to test a few ideas on how to trick the system into doing what it is supposed to do, you may see this post from time to time go up, then come back down.

I have chosen to schedule this post for October 21st, 2015, the day in the future Doc Brown takes Marty in back to the Future.



So if it not October 21st, 2015, just ignore this post, it'll be gone soon enough.

Thursday, October 15

An Inconvenient Truth - The Chicago Study is Right

EMS has our collective panties in a wad about yet another study showing that BLS has a better survival rate than ALS.  This time some researchers from the University of Chicago, including Prachi Sanghavi PhD a medical policy researcher from Harvard, looked back at patient outcomes at 90 days and how they arrived at the ED.

Fair enough.  More data that we caregivers ever get.

They then went through and controlled for all sorts of variables that can impact care and found what we all already know:  Patients who arrive BLS do better than patients who arrive by ALS.

You can not dispute this data.

You also can not dispute Prachi Sanghavi PhD's comment in a related video that "Our ambulance system is in serious trouble."

Just not for any of the reasons she wants to put forward.  Have a look:


Put down your pitchforks and let's wander through a few comments she pulls from the larger data set.  The first one I'll take issue with/agree on is when she alludes to EMS's inability to properly perform an endotracheal intubation.  Data on this skill ranges from incomplete to confusing.  For example, am I a success if I have a 100% first pass rate but do so on patients who did not need the procedure?  What if I have zero attempts, but a higher ROSC and discharge in tact  rate?  What if my last 3 misses were on the same crashing CHF patient?

"Delivery quality problems with intubation" as mentioned in the video is a stab while the ref isn't looking.  The research may not differentiate ALS or BLS placement of esophogeal airways.

 

In addition, let's start addressing all the post ROSC care required by many systems.  I'm talking about cooling, serial 12 lead ECG, fluid management...all things that take time to establish in the field to meet a pre-determined level of care the local regulatory agency thinks will work.

 

We have all known that the ambulance system is broken far longer than Prachi Sanghavi PhD has been studying it.  We also know that placing blame for a patient's death solely on the time between the scene and the hospital is foolish to say the least.

Response times generally don't impact patient outcomes.  Most cardiac arrest survivors had interventions prior to EMS arrival.  Many patients who die in hospital are still dying from hospital acquired infection.  If a patient dies of a GSW to the chest, that's one thing.  No amount of BLS or ALS can save them and I'd argue that a thoracic surgeon gowned up and standing in the street as it happened won't make a difference either, but let's not let that get in the way of the true drive behind this research:

Hospitals save lives, not Paramedics.

Can't argue that.  It is hard to argue that a person alive in a hospital for 56 days following cardiac arrest, then dies, is the fault of 14 of the first 21 minutes of that person's insult.

We can control for variables and I don't doubt that the researchers did just that, but we must also remember that focusing on the blood and guts and CPR alone will not give an accurate picture of an EMS system.

ALS exists to assess and treat at a level far above what the Chicago folks want you to understand.  "Scoop and Run" and "Stay and Play" haven't been uttered since the early 90's as far as I can tell and we've learned our lesson about pausing compressions for intubation and pulse checks (In the middle of this research no less).  ALS exists to intervene in respiratory cases, allergic reactions, tachycardias, bradycardias, mental disorders, minor infections and illnesses and a whole host of other cases that are treated and redirected away from an ED when appropriate.

If the researchers follow their conclusions to a logical end, their data will support only BLS ambulances and a universal "Scoop and Run" policy for each and every 911 call.

Did they miss where we only transport about 60% of our patient contacts?  Think the EDs are overcrowded now?  Wait until each and every patient hits the doors lights and sirens (shortening arrival to ED time) with an incomplete assessment, no interventions prehospital and an increase in volume of nearly 50%.

 

The numbers are nothing new.  Don't get upset because this data contradicts your 3 years observations on an ALS truck.  This is a wake up call for EMS.

The data say ALS isn't helping, heck it is hurting.  Methodology aside, would you rather address this study or make sure the next one has different results?

 

If all we do is reclined cot transport to the ED, I'm 100% behind the Chicago study.  Load'em all up, staff the ambulance with a driver and EMT-Basic and haul ass to the ED.

If we want to make a positive impact in the community, agree that ALS patients are more often sicker, more complicated and require more assessment and intervention skills to be delivered viable to the ED.

Agree that the ED CAN NOT be the only destination for all patients.

Agree that BLS and ALS CAN NOT be the only services provided in your community.

Agree that regardless of response times and scene times, good care sometimes takes time to get right.

Agree that endotracheal intubation is not the gold standard in airway management.

Agree that most of what we do is based on anecdotal observation, past practice and, in some cases, voodoo (LSB, epi, Bicarb).

Agree that the American ambulance system is broken and that all the bells and whistles we want to add to the prehospital area need to be researched and proven successful before being widely implemented.

 

Only then can you challenge the research.  Only then can you try to stand up to defend what you do, what I do, what we do.

 

 

Sunday, October 11

You Make the Call - Chef in Distress

ymtkIt happens.  Sometimes dinner at the firehouse is delayed by calls for service, drills, details you name it.  However, sometimes a newer member of the company, who's turn it is to cook, is having trouble with a new recipe.

I've already told you all about the dangers of trying a new recipe at the firehouse (try it at home first), but this member never got that advice.

As folks mingled into the kitchen to help, the member confidently told them that everything was prepped, he was just waiting to get started.  Lettuce had been cut, washed and is in the fridge, dressing made and chilling. "Just timing the chicken," he told everyone.

So we all wandered off.

At 15 minutes before 1900 hours, dinner time, I enter the kitchen to see the cook browning some chicken in a pot.  "What do you need?" is the question I ask.  The answer and how you respond to it will define what kind of Firefighter you are.

His answer was "I need to brown this chicken, then it goes in the oven for an hour."

There were half a dozen other firefighters at a nearby table commenting on how dinner would be late.

What would you do?

 

You Make the Call.

Friday, October 2

The Crossover Podcast - Is the Grass Really Greener?

Your first, best and only Police Fire and EMS pod­cast returns to talk about what it would take for our experts to leave their cur­rent ser­vices for another.


Is it pay?  Could it be oppor­tu­nity?  Do you feel a sense of loy­alty to your cur­rent organization?

All ques­tions that come up when a Fire­man and a Cop sit down for a beer (or 3) and talk about why it seems like every­one is always look­ing for another job.

 

LISTEN HERE

Thursday, October 1

That's Why We're Here, But That's Not What We Do

I got in a spirited discussion with a co-worker recently about the need for Paramedics in the modern Fire Service.  They railed on and on about how there is no EMS in the Fire Service, that we are here to put out fires, make rescues and do other fire related tasks and that EMS should be left to someone else.  When pressed for who exactly that should be they had no solutions, only a request that they personally not have to do "all that medic type stuff."

Bad news folks, EMS is going to be in the Fire Service for a long time, regardless of how much that third service idea gains traction.  The reason is because not every community can afford to pay 2 people to do 2 jobs when often 1 person can do both.

Simple math.

The key to recognizing the mission of the modern Fire Service is first coming to terms with the title of this post.  We are here to fight fires, but that is not what we do.  Increasingly the fire service has had to absorb other duties in the community for a number of reasons from shrinking budgets in other agencies to decreasing fire calls and a need to justify staffing.

Trouble is, when the reason a fire engine is in the community arises, we need it staffed by enough trained professionals to handle the problem.  Try telling Mrs Jones that the reason her house is now a parking lot is because budget cuts didn't allow a third person on the engine.  Sorry, that isn't going to cut it.

In between fires we need to be seeking out other ways to have a positive impact on the community.  For many that means running EMS calls.  Some will complain that those resources are needed on the EMS side and we should just move those jobs from the engine to the ambulance and solve all the problems.

Math is hard for these people.

Imagine the roles reversed for a moment.  Fire Engines are slow to respond because there are too few, but a large group of Ambulances seem to respond to fires and make a difference in the early stages.  Why not move those employees to the engines so you don't have to do that anymore?

Math.

We can do both from a single platform and that doesn't mean making every big red truck ALS or putting airpacks on every big box patient mover.  What it does mean is that those in the fire service need to recognize that the engine is there for a specific purpose and when not in use needs to be used for something else whenever possible.

EMS is not why the Fire Department is here.

BLS is not why the ambulances are here.

But that is what we do.

Day in and day out our preconceptions become misconceptions and your desire to get off the ambulance and onto the engine has simply changed when you arrive.  Same patient, same problems.

Too many today speak of the ambulance as if it is a disease that makes them less of a firefighter.  I've heard it here and many other places.  "I'm not on the box today, I was on it yesterday.  Today is my engine day."  So?

Why are you here?  What are you going to do today?  How many fires will you catch?  How many medical aids?

We spend so much time touting "Expect Fire" and throwing ladders that in the rare instances those actions apply they are second nature.  In the same shift we will make an arguably equal impact on far more people because of what we do in between fires.

 

Ask yourself, "What am I here for?"

Tuesday, September 22

Chronicles of EMS T-Shirts! For Charity!

We're getting close to the end of September and Motorcop (Team Soul Crusher) is mobilizing his army of readers so now I must bleg as well.

PLEASE donate to Kilted to Kick Cancer through Team Happy Medic!  Go to this link and click the amount you can donate (If you want an amount you don't see you can change the multiples before checkout) and after clicking contribute you will select Team Happy Medic.

 

To encourage you I have offered rare patches and sent some as far as England!  But we need more support!

I am making the following offer:

IMG_20150922_151443741[1]This is a Chronicles of EMS T-Shirt.  The original T-Shirt from EMS Today, Baltimore 2010.  This was the only place they were available.

Until now.

Sponsor ZOLL Medical made a few more of these than we thought and recently sent them back to EMS Jedi Master Filmmaker Thaddeus Setla.

Since he is moving to Michigan he has given me the rest of them.

I have sizes Medium through XL, each individually wrapped and ready to ship.

How about $10?

 

Donate $10 to KTKC through Team Happy Medic and I'll ship out a brand new CoEMS T-shirt.  Just enter the size in the notes section on the right of the checkout screen.

Don't let MC and the cops beat us!

 

Donate to KTKC and Team Happy Medic!

 

What is Chronicles of EMS you ask?

 

 

 

 

Homeless Showering in Firehouses? Why Not!

I'll tell you why not and it isn't as simple as "That's a stupid idea."

This story hit my feed awhile back and I ignored it, mainly because I was convinced it was satire.

Nope.

On his blog, self described community activist, and clearly tax payer, Michael Petrelis learned that the San Francisco Fire Department was budgeting to repair bathroom and shower facilities at most of the firehouses around the City.  He then goes on to make the following suggestion:

"I am proposing that the city consider making those taxpayer-funded facilities available to the homeless on a limited basis, for use to urinate and defecate and also regain or maintain good hygiene."

I see where you're going with this...but no.

Mr Petrelis was also striving very hard to demand that Fire houses open the ground floor restroom to anyone who asks during business hours.  Unfortunately for him, this was policy prior to his efforts.  What he seems to be missing is that not all those restrooms are serviceable, usable or safe for the public...hence the need for all the repairs.

While I have been witness to more than a few "sidewalk steamers" in broad daylight, the bulk of the public urination and defecation happens outside of the hours Mr Petrelis suggests.  Add to this the fact that the firehouse will likely be vacant and the idea falls apart.  More on why the station is vacant in a moment.

According to their website, the SFFD has some firehouses that were built in the 1930s and 1940s and have been repaired, re-repaired and updated slowly but are still in disrepair.  Mr Petrelis would like to add a few homeless folks dropping by to shower to the mix.

So let's dissect why his plan will not only not work but is a recipe for disaster and avoids the true problem.

Firstly, the homeless population is not spread out equally over the San Francisco area.  Anyone who visits can see the bulk of the almost 10,000 Urban Outdoorsmen are in the downtown corridor, specifically South of Market, along 6th Street and in the Tenderloin neighborhood.  For grins and giggles, let's use Mr Petrelis's estimate of 6,500 homeless in SF.  In those three neighborhoods I just mentioned there are 3 Firehouses.

3.

Two of them are among the busiest in the country and overlap calls for service on a regular basis.  If we line up all 6,500 homeless and let them take a 5 minute shower, we are in a drought after all, and taking into account 5 minutes to strip down and redress after the shower (We'll make them hurry) That is 65,000 minutes of showering.

A day.

That equates to 45 days worth of showering, non stop.  15 if we can somehow organize them to walk to another fire house.

Now, before I go any farther, I am pro shower for the homeless.  They are human beings and deserve respect and the chance to get out of the situation they are in.  A shower is not what they need long term, but let's stay on topic here.

Mr Petrelis would like to open the facilities during "reasonable hours" likely the same business hours the restrooms are already available.  This limits access even more, meaning that the 45 days around the clock to shower everyone just became 90 days.

Should we make people wait 90 days to take a shower at a firehouse?

Now on to the part of the equation that is often overlooked: Station security. When 2 of the busiest fire houses in the country go on over 30 calls for service in a day (A good deal of them dealing with this same population), the station is often vacant and locked closed.  This restricts access even further than 90 days and now we are likely pushing 120-200 days to get everyone showered.

 

Just because tax payer dollars fund something does not mean that it is free for public consumption.  If I walked up to a Police Officer and asked to use his car, or even gun, by claiming that it is tax payer funded I would be laughed at and ignored.

Mr Petrelis, I admire your efforts to help these people, but opening firehouse showers isn't the solution these folks need.  Having been ankle deep in human waste more times than I would like to ever recall helping people in that situation, the decades of mental strife, substance abuse and neglect (Not to mention easily half of the population we're discussing are not natives to their location instead bused in or come looking for a wealth of free services) many don't want to change.  It is an embarrassing reality.  For every person wishing to escape the streets I'll find 3 more that want nothing to do with shelter or aid.  It is a sad state that is almost too late to impact but some local programs have a chance.

Showers are a great idea, but hopefully Mr Petrelis now sees that only if he personally drives people to far flung firehouses can we realistically get all the homeless showered inside a week.

But now when do the firefighters shower?

 

 
As with all articles here these views are mine and mine alone and do not reflect the opinions or policy of my employer(s), mother in law nor ice dancing partner.

 

 

Sunday, September 13

Patch Collectors Rejoice! Another Kilted to Kick Cancer Patch Challenge!

I received a number of emails from you reader folk letting me in on a secret regarding my Chronicles of EMS Patch offer.  I'll let Bill N. from Kentucky give you the low down:

Mr Happy,

While we support your cause, you're asking quite a bit for what looks like a half finished proof patch. Rare, maybe but you are asking too, too much man.  That's a $25 patch easy.  Will you take $25?

 

Well Bill, I just might have to take you up on that, but not just yet.  I've decided to raid my patch collection for KTKC and offer the following deal first:

ktkc happy patchesIf you donate to Kilted to Kick Cancer, from now until the end of the month in the above amounts I will send you the noted patch (While supplies last).  For $10 it is the limited edition (200 run, about 20 remaining) EMS 2.0 patch.  For $20 it is the limited (100 run, about 10 remaining) final Chronicles of EMS patch.

Visit this link:

http://www.kiltedtokickcancer.org/product/ktkc-donation-2015/

And click on $10, then contribute.  On the next page you can select to increase your EMS 2.0 patch donation of $10 to 2, totaling $20 for the Chronicles of EMS patch.  From there you will be required to select a team, choose Team Happy Medic and note in the area on the right if you want 2 EMS 2.0 patches or 1 Chronicles of EMS patch.

These are from my private stash and I will keep only 1 of each.  When supplies get low I will post it here.

When these patches are gone, Bill, we can revisit your offer of $25 for the proof Chronicle patch.

Deal?

Please donate to KTKC and help me at least beat Motorcop in fundraising!

 

Get Kilted! Get Checked!

-Justin

Crossover Podcast -20 - Sorting Out Your Priorities






With fam­ily life, work, exchange stu­dents, gui­tar lessons, soc­cer prac­tice and Irish dance class, your heroes Motor­cop and the Happy Medic couldn’t find time to record this week.  And you can imag­ine the chaos when we add in the children’s activities!

With a break between chores while MC was at work, since HM couldn’t find time in the evening to get to MC, he fired up the mic and recorded a solo show.




The topic?


Time man­age­ment of course.  With our ever busier lives we as pub­lic safety pro­fes­sion­als have to take the time to iden­tify our pri­or­i­ties (Yes, you should only have 1 but we’ll dis­cuss that in another show), set real­is­tic expec­ta­tions and bud­get our time like we bud­get our money.


HM and MC usu­ally find time for 2 or 3 or, if there is enough beer, 4 shows but this last week was so crazy this is the best we can offer and we think you’ll enjoy it.


Oh, and did we men­tion the char­ity we founded and are run­ning all month-long?  No?  More on that soon.


Enjoy Episode 20!  next episode we’re old enough to drink…again.

GO HAVE A LISTEN

 

 

Thursday, September 10

Kilted to Kick Cancer Patch Giveaway!

ktkcshield400whiteTo help raise money for Kilted to Kick Cancer I am offering 2 RARE patches.

These were made to adorn the uniform shirts of myself and Mark Glencorse as we traveled the world learning about EMS on the reality show Beyond the Lights and Sirens (Previously the Chronicles of EMS).

A different patch was later made but these 2 samples stayed in my drawer as mementos of the show that never was.

And now I'm offering them as a prize for a donation to a worthy cause.

September is Prostate Cancer Awareness month and me and a few friends in 41 states are raising money for research and awareness and this morning I was behind Motorcop in the fundraising competition.

Boo, I know.

So I've decided to donate these patches, both of them, to the cause.

Any of you patch collectors out there are going to want to get one of these, there are only 2 in the known universe.

The first person to donate $100 to Kilted to Kick Cancer and select Team Happy Medic at THIS LINK will win the first patch.  The second the second.  The third person to donate gets my sincere thanks and a special runner up prize.

 



Here is the patch we're talking about.  Standard 3" design with the full moon rising over San Francisco's skyline as the US and UK flags wave above.

So who will step up and donate?

Your donation is tax deductible AND you get a 2 of a kind patch AND your donation could help cure cancer.

 

Give Early and give often!

#TeamHappyMedic

Tuesday, September 8

2 Completely Missed Milestones

In the preparation for Kilted to Kick Cancer and our Highland Games kick off weekend I completely missed 2 pretty big milestones.

First, on August 31st this little therapy experiment of mine has reached 7 years of age.  I remember when Firegeezer, my first "Follower," noted my 1 year anniversary as a great achievement.  I may not post as much as I did then but luckily the reason is because a lot of my frustrations are being addressed.  It turns out that if you get involved and try to make things better they can sometimes get better.

Second, this August marked my 20th year in the fire service.

I mentioned in February at a presentation that I had 20 years in the fire service and was kind of fudging the numbers based on my volunteer experience.  I can't say I feel old, but hitting this milestone reminds me that we are all responsible to pass along what we know, be it at the dinner table, on the drill ground or the fire ground.  Or even across the table at a review.

 

Thank you for being a part of this experiment, even you Chinese and Russian hackers spiking my traffic.

 

-Your Happy Medic

Justin

Tuesday, September 1

Team Happy Medic - Kilted to Kick Cancer

ktkcshield400whiteHere we go again my friends, another September to kick off our pants  to raise awareness, and some research money, for Prostate Cancer Awareness Month.

 

The annual fund raising contest is now in full swing and I need your help.

Visit THIS LINK to make a donation and after clicking "Contribute" choose Team Happy Medic from the dropdown.

If nothing else at least let me beat Motorcop!  If I have to listen to him brag all year about cops raising more money than firemen I might barf.

GET KILTED! GET CHECKED!

Saturday, August 29

Ontario Reader and Questions about Fire Based EMS

I got an email a few days ago from a fellow EMSer from the Great White North, I'll call him Edmond.  It would appear that Edmond's local Fire service is considering branching out into EMS and he had a few questions for me after watching Beyond the Lights and Sirens, my adventure with a British Paramedic from 2009.

He has given me permission to reply to his questions in a post, so here we go!
How are the hours for paramedics working on the ambulances?

In my agency we have 2 different types of Paramedics: Firefighter/Paramedic and Single Role Paramedic.  The former assigned to Fire Engines and the latter assigned to ambulances.  It wasn't always like that, however.  When I was brought on the ambulances were staffed on 24 on/48 off by Firefighter/EMTs and Firefighter/Paramedics.  Now the Paramedics work a 10 or 12 hour shift.


Are the paramedics and firefighters salary the same ? or does one make more than the other? or being cross certified?

Firefighter/Paramedics do make more than Firefighter EMTs, yes.  Maintaining both disciplines is not complicated.


What kind of training did you do to get to your position now as a paramedic-firefighter who also works for the fire department ?



I trained as a firefighter long, long ago, completing my EMT and EMT-Intermediate while a volunteer firefighter and later a paid firefighter.  I completed Paramedic School and my degree program while working as a Firefighter/EMT.  To qualify as a lateral Firefighter/Paramedic at my current location I had to have my training and 5 years as a firefighter as well as 3 years experience as a Paramedic.

Are the firefighters trained in medical calls to what I believe is EMT-B level ? If so are they allowed to administer symptom relief medications to patients while working on the fire engine as a firefighter without cross certification as a paramedic?


Yes, EMTs on the Fire Engine carry basic level medical training and are registered with the County and State.  They can perform assessments, administer Oxygen, deploy an AED and other basic splinting, bandaging etc.  In other areas, EMT-Bs can also administer Albuterol and glucose orally.  It really is "Basic."  Mark and I discuss it in a video from England that might make sense to you when he discusses ECSWs.





 Are the ambulances deployed and stay in the joint fire-ems stations or are they posted on the streets?

Ambulances here are dynamically deployed to pre-determined posting locations and dispatched based on their location.  They move all over the City throughout the shift.

Could you preform your ALS skills while scheduled to work on the Fire engine? If you are required to attend initially as a firefighter but later on the call as a medic?

Yes, I would hope so!  If not able to treat as a Paramedic on the fire engine there would be no need for me there.  We have Duty to Act legislation that requires a person to act to the level of their license whenever working for the agency and able to do so.  Placing a Paramedic on an Engine and not equipping them or allowing them to use their training is most wasteful and inefficient.

Many times we as Paramedics are deployed as Firefighters until the need arises.  Most often there are other Paramedics not directly involved in the firefighting effort that can tend to the injured.



Would the pension and age of retirement be the same for both EMS and firefighters?

Depending on the negotiated contract of course, but for our Firefighter/EMT and Firefighter/Paramedic personnel the retirement calculations are equal based on length of service.


He includes a link to explain his interest in my answers and I have to say a 20 hour self study course isn't even good enough for basic skills let alone "symptom relief."

If the Ontario Fire Service is truly interested in providing an increased level of care they shouldn't ignore the 10% of their staff that can deploy as Paramedics.


20 hour self study for "symptom relief..." I wouldn't trust a 20 hour self study learn to knit class.  Heck I took a 50 hour ICS self study class that wasn't enough.

Ontario Firefighters do appear to be trying to expand on a poor solution instead of deploying a reasonable one.  If ambulances are slow, making fire engines faster does not solve the slow ambulance problem.


Then again Edmond...I'm no expert.

Tuesday, August 25

Blast From the Past - August 2009

Coming up on HM's Anniversary I thought I'd share a post from long, long ago.  For you new folks, that little fire engine means I was on the engine when we had the call (clever, I know.)  We used to divide our calls into the Emergency (Why they called) and The Action (What really happened).

Enjoy "20 Years of Drunkenness" - OK, not really, that's just the title of the post.

 

20 Years of Drunkenness

I'm not referring to myself in the title, but to two women I met hours apart who may actually be the same person in some strange time twisting episode of the Twilight Zone. At any moment Rod Serling could have popped out and I would have accepted his version of events as truth.

THE EMERGENCY Part TWO

A caller reports a woman unconscious on the street corner.

THE ACTION Part TWO

This call comes in hours after Part ONE, but we'll be going in age order, not chronological order. The engine is waved down in a nice part of town just after closing time at the bars and we see a well dressed young lady in the usual too drunk for consciousness pose. A quick assessment rules out the usual alcohol look alikes of stroke, hypoglycemia and trauma, so we get more back story.

Our callers, a middle aged couple out walking a restless new puppy, saw the woman staggering and having trouble walking from a half block away. As they followed her, mildly concerned, they saw a car pull up next to her and a young man try to help her. "How nice," they thought until they noticed her try to walk away ever so clumbsy-like. As they approached, calling out to the young man that they could help, he let her down and made a run for it, speeding off before they had their wits to get the license plate.

The ambulance has no choice but to take her sobbing vodka laden body to the local non-ER resource for observation.
The young woman will awake in the local sobering center amongst some of the most odorous persons in existence and hopefully understand how lucky she was and to control her drinking. Otherwise, she might end up like our patient in Part ONE.

THE EMERGENCY Part ONE

The front desk of a hotel is describing a woman who has fallen and hit her head.

THE ACTION Part ONE

This call came in a good 6-7 hours before our friend above.
One of our dynamically deployed ambulances was switching posts and happened to be nearby, beating us to the scene. As I approach the front door, the EMT comes running past me offering only a quick "Hey."

Ahead of us in the lobby, I see a pair of legs flailing from around a corner and a string of expletives that would get this blog an X rating for sure. I'm a fan of using quotations in my reports when folks get verbally abusive, not only to better recall the event, but to paint the picture accurately should the case go to court. I would have hesitated to use half this language.

The flailing legs belong to a woman in her late 40s who took a swing at a stranger exiting an elevator, fell and struck her head on the marble floor, leaving a puddle of blood and quite a large bloody mess in the general area. I found this out as I rounded the corner to see the Paramedic partner of the EMT wrestling with the woman who was throwing blood covered fists and arms in all directions.

As we jumped onto the legs to help our friend, the EMT returned with restraints, a board and a collar. It is truly laughable that we are required to C-spine these types of people. All the while we were restraining her limbs she would make eye contact with one of us and say something so remarkably vile that even the cast of the Jackass movies would ask her to tone it down a bit.

Finally bandaged, tied and boarded we carry her to the awaiting cot while the husband and a few friends try to tell us she is normally a perfectly nice person, but she has been drinking too much. I firmly believe that enough alcohol will let the real you out of your skin and we met the real her.

The excitement has left the little lobby and only the bloody mess remains. Then Rod Serling steps out, lit cigarette in hand.
"Picture a woman who has no control over her emotions and allows excessive intoxication to control her life. Had she only recognized the destructive forces of alcohol 20 years earlier, regardless of how legal it might be, she may not have fallen and been hurt. Then none of the emergency workers would have heard language that should be reserved...for the Twilight Zone."

Saturday, August 15

Crossover Podcast Episode 16 - PC 148 A Medic's Dream Come True

In the lat­est episode, our intre­pid hosts ful­fill a life­long dream held by Happy Medic…kinda.

See, it all involves CA Penal Code Sec­tion 148 and the designees therein. In The Crossover Show 015, we talked about Penn­syl­va­nia v Mimms and the case of San­dra Bland. We briefly dis­cusses 148 and what it means from the per­spec­tive of Johnny Law. Keep in mind 148 is the CA sec­tion, but there are sec­tions just like it all over this great land of ours.  PC 148 is the code MC uses to arrest you for not signing a ticket.

Towards the end of the show, Happy is a wee bit morose about his lack of abil­ity to take part in hold­ing folks account­able for delay­ing him. But is that really the case?

Here’s the skinny:

148. (a) (1) Every person who willfully resists, delays, or obstructs any public officer, peace officer, or an emergency medical technician, as defined in Division 2.5 (commencing with Section 1797) of the Health and Safety Code, in the discharge or attempt to discharge any duty of his or her office or employment, when no other punishment is prescribed, shall be punished by a fine not exceeding one thousand dollars ($1,000), or by imprisonment in a county jail not to exceed one year, or by both that fine and imprisonment.

Did you catch that bold bit, there?

Yeah…it’s got Happy quite a bit hap­pier than usual.

After that encounter with glory, we devolved fairly rapidly into a level of shenani­ganry even we rarely achieve. Not to men­tion, it would appear that the entire EMS sys­tem is noth­ing more than a Ponzi scheme.
BOLO

Arthur Vines. Lis­ten very care­fully to this warn­ing. The man drops more f-bombs than nearly any man should…but it is hilar­i­ous. Plus, he’s British, so it’s cute, too.

Also, HM believes in ancient aliens while MC doesn't know the Ancient Aliens meme.

Listen carefully for the difference between MC's opinion on enforcing the penal code when it is him being delayed vs the medics.  Here's a hint:  He'll arrest you for delaying one of the people listed in PC 148, but not all.

GO LISTEN AT MC's PLACE

Sunday, August 9

A Message for Those E-Cig Cool Kids

You look like a fracking idiot.

Let me step past the obvious to at least acknowledge the fact that you are not smoking a traditional tobacco filtered cigarette. This is a step in the right direction my vaping friend.  Of course you put down one cancer causing death enhancing device simply to pick up another, so one step forward one step back, but at least you're moving, right?

I see you over on the curb outside the designated smoking area, clearly far too cool to be included with those smelly jerks.  We all see you.  We can't not see you with that thunderstorm you exhale after sucking on your little metal device.

Apparently some of you need to be reminded not to use your electronic cancer devices, sorry e-cigs, on airplanes, in restaurants and in other places you think are somehow restricting your right to kill yourself slowly.

Seriously?

You do remember the second half of the term e-cigarette, right?

The device heats a liquid into vapor form to be inhaled into the lungs.  It isn't some fancy replacement for rolled leafs, it is simply an easier way to preserve the contaminants in order for you to "vape" them.

And another thing about vaping...

STOP USING THAT WORD!

Vaporizing carcinogens for inhalation is called smoking.  The term "Vape" was introduced in 2009 with the wider distribution of the little magic wands you hold so near and dear.  It's likely that if you had to call it "smoking" you wouldn't buy one, right?  Dosing varies wildly by manufacturer, as does ingredients but, luckily for you, manufacturer's aren't required to tell you what you're smoking.  They'll throw in a bit about it being vegetable based then throw in the term "and flavoring."

I can think of at least 2 other things you could smoke that would be far healthier for you.  I'll let you use your imagination on what they are.

If you think using an electronic tobacco delivery system somehow reduces or removes the health impact of the ingredients and still makes you look like that 8th grade kid you admired long ago perhaps we should just put you in a corner and let the cloud of smoke and steam obscure you until you fall over dead.

Or you can quit.

You know, your call.

Friday, August 7

The Crossover Show 15 - Get out of the car

crossoverlogo300This week's episode was inspired by Sandra Bland who was stopped for not signaling a lane change, was asked to step out of the car and did not.  Tempers flared and what should have ended in a warning or infraction ended with Bland dead in Jail 2 days later.

The boys use that as a jumping off point for the ultimate question:

"Do I have to get out of the car on a traffic stop?"

 

This week, MC and HM talk about your rights, the Supreme Court's decision, and the recent case of Sandra Bland.

We understand this has been a topic about which MC has already posted, but HM isn't an officer and voices some opinions from a civilian perspective that have not yet been broached on #TheCrossoverShow.

 

HAVE A LISTEN

Wednesday, August 5

Acute Incarceritis - International Flavour

See what I did there?

We all know the story of the person who, when faced with impending jail time, suddenly remembers their out of control Type 3 Diabetes and severe asthma and requests an ambulance.  Well, they don't really, but PD sees a chance to dodge an arrest and gives us a call.

But what happens when the Acute Incarceritis occurs outside the United States?

THE EMERGENCY

A man is feeling ill in the customs line

THE ACTION

I would too if I just spent 16 hours on a plane and got the news he did.

Traveling for a job interview and banking his entire life savings on a one way ticket and landing the gig, our patient has discovered that he will not be allowed entry into the United States.

Ever see that movie with Tom Hanks "The Terminal" where the guy gets stuck in between the USA and his (spoilers) war torn nation that ceases to exist?  Same kind of thing going on here only this fellow's home country is still open for business.

Customs has no choice but to send him back home on the next flight.

Not that he has a home in that country anymore, but you get the idea.

Faced with the prospect of returning on another 16 hour flight without the sweet new job, wouldn't you know it, he is now sick.

A full assessment doesn't find the outward measurable signs of any illness we can treat or identify.  His vital signs and body could be used for  the textbook one could say.

And this next part is the part I always love.

When he asked if there was anything we could do for him, I honestly answered in the negative and asked him what he wanted to do.

"If you think I'm OK then I guess I'll stay here.  Well, not really.  You know what I mean."

He didn't demand transport.  He didn't spout some version of "I know my rights as a patient!"

He took my professional opinion and respected it.  It caught me off guard.

 

Always does.

Monday, August 3

A Letter to George Redner III - "Reds"

Reds,

I know we just met, may I call you Reds?  Do you prefer George?

I'm sorry that this letter comes 2 days too late.

I felt for you, your family and your Departments.

I won't feed you some bullshit line about knowing how you feel, or that everything will be better tomorrow after a hug and a song.  That's not how this works.  The touchy feely stigma attached to sharing feelings in EMS and the Fire Service has been blown out of control.  Those who you think have it together are just one small step behind you.

So instead of trying to convince you to call and talk to someone you trust about how you're feeling, I want you to call me. (602) MED-IC99.  That's my google voice and it rings to my cell phone.  Call me and let's just talk.  Get it off your chest to a total stranger, no names required.  I won't judge you and I won't pretend to know what you're feeling.  What I will do is try to talk you out of going down to the tracks.

We see a lot of sick shit in this job.  There's no sugar coating that.  The trick is to let out what you're feeling under your terms before it rips itself out through your heart and makes you feel...well...like you did 2 days ago.

Whatever it is, was or was going to be that guided you to the tracks I wish I could have been there for you if for no other reason than  to give you an outlet.  We can't talk to just anyone.  Family may judge, family doesn't stop caring, the wife doesn't understand, or understands all too well, the rent is late, the house is paid off, failed the exam, aced the final, got the dream job, didn't get the new job...pick one, or all, right?

But maybe, just maybe a stranger's ear could have made a difference.  It may sound cold, George, but I wish I didn't know your name, or the names of the others in our ranks that chose your option out.

It must seem like the only option there is.

 

I'm sorry I didn't meet you in time,

Justin

 

To anyone who might feel like George did I offer my number again (602)MED-IC99.  Call me.  If you don't call me, please call someone.  Anyone.  Talk about it.  You'll be glad you did.  I promise.

Don't want to talk? How about type? Get online.  There are 21,000 strangers HERE at Code Green you can vent to.  I've been venting for 6 years and am healthier for it.

Friday, July 31

the Crossover Episode 14 - S&M Tactics

Tee and a hee.
The guys are back with a new episode! In today’s episode, MC and HM talk about trans­port­ing com­bat­ive suspects/victims/patients.

Should they be in soft restraints? Hand­cuffs? Dri­ving the ambu­lance (to be fair, we didn’t cover this…because, c’mon…).

We also take about the dif­fer­ent options when it comes to restraints in the field…everything from sim­ple rope (not to hogtie, peo­ple) to the Wrap.

In the BOLO, MC let’s you know what he’s read­ing these days.

When it’s time to head back 7S/AIQ, they talk about whether or not dis­cussing your day/incidents with loved ones is a good idea and why.

BOLO


Robert Galbraith’s The Cuckoo’s Calling

LISTEN NOW

Thursday, July 30

In Bizarro World, Firemen Issue Tickets

An article got my pal MotorCop all fired up recently and for good reason.  The author, Tom Mullen, imagines what it would be like if Police Officers responded like firefighters.

My response initially was similar to most of you online (including CalltheCops who did this story already...AS SATIRE!) "You're talking gibberish."

But then I had two remarkably different thoughts at the same time.  Yes, I have those powers.

FIRST:

Why don't the cops respond like the Fire Department?

It makes perfect sense that since Officers are apparently most at risk at traffic stops, just stop doing traffic stops.  Stop patrolling, looking for bad guys, just wait for the bad guys to do stupid stuff and roll out!  Before you grab your pitch fork and storm HMHQ, follow me on this for a few more sentences.

PD has done very little in the form of crime prevention compared to the Fire Service.  They can't.  Criminals have intent to cause chaos.  That is difficult to prevent.  The reason Fire doesn't patrol the streets on a regular basis is because they have lobbied for over 100 years to make the main cause of fires preventable or at least detectable early on.  They ensure sprinklers are installed in public places and hopefully soon, private spaces.  I can't stand people who think a fire sprinkler system will leak while they ignore the maser bath upstairs (thanks Hollywood.)  I wish PD could respond only when needed, but that overlooks the main reason we need PD out and about:

Bad guys are out and about.

Put your resources near your need.

SECOND:

Why doesn't Fire have the same authority to reduce fire and injury risk that PD has?

Imagine a Fire Engine cruising Main street.  They turn on their lights and pull over a car with a driver smoking a cigarette.  They issue a Public Health fine citing research that shows the habit is not only unhealthy but a fire risk.  The driver refuses to sign the complaint and is arrested on site.

"Justin!  You're out of your mind!  That's not a crime!"

Prevention, folks...prevention.

 

EMS could do the same thing: Issuing citations to the obese, folks ordering cheese fries or those taking the escalator when stairs are readily available, but we prefer to only be warned and cited when folks are doing bad things like driving without license plates (which got a man shot and also nabbed Timothy McVeigh).

PD needs to be out there preventing crime the same way Fire and EMS need to be out there preventing fire, illness and injury.  Perhaps your agency has a robust smoke detector program or asthma outreach program.  GOOD!  Keep those going, you are making a difference!  Just don't get lazy and sit back waiting for something to happen.  Your goal should be to make yourself completely obsolete.

Look how well it is working for Fire.

They spent so much time and effort making the world safer we almost don't need them.

 

What do you think about Tom Mullen's suggestion to put PD in a station house like Fire?  What do you think about my idea to allow Fire and EMS to patrol and issue citations to those who are harming themselves instead of others?

Wednesday, July 29

Dealing With Stress - The Boat on the Ocean

There is a long standing metaphor for those who are seemingly overwhelmed by life.  It involves being a boat in a turbulent ocean, waves crashing from all directions, a fear of drowning under all the chaos.  Then the feeling of being anchored to one solitary thought that seems to make everything worse makes one wonder if they should just cut the anchor line and allow the current to sweep them away.  After all, a ship afloat with the ocean fares better than one which fights against it.



Right?

On my morning commute recently I was listening to Radio Lab (which you should be listening to by the way).  The episode Gray's Donation chronicles the story of a mother who traces down the donated organs of her dead newborn baby a year later.

During the story she encounters the researchers who are advancing therapies and research thanks to her son, Thomas, who died at 6 days old.  In a way, Thomas lives on because of the amazing resilience of newborn cells.  The mother now sees her dead son as a colleague, a co-worker, of the researchers after seeing his photo in a break room with a note reminding researchers of who gave the donation they use to investigate diseases in the young and old alike.

During her search for Thomas's organs she says she felt overwhelmed by the process, as if it was consuming her.

What she said next almost made me stop the car on the side of the road.

"I felt like I was a ship on an ocean that was rocky and choppy with waves.  Then I had this feeling that I'm not the boat, I'm the ocean. Like, the decisions I make are changing other people as opposed to I'm just a boat getting slapped with waves all the time.  And it has made me feel...powerful." - Sarah Gray

That hit me like a tidal wave.

"I'm not the boat, I'm the ocean."

How many of us are struggling with work, home, hobbies, sports, finances, you name it, fighting tooth and nail just to get 5 minutes alone to take a break yet find no relief?

How many of us are bringing this all on ourselves?

EMS is stressful but it doesn't have to consume you.  Not everyone burns out in this job, not everyone gives up.  Even though things seem impossible and like your little boat is going to capsize in this giant stormy ocean step back and ask yourself...

Am I the boat, or am I the ocean?

I think you'll be surprised at the answer.

Sunday, July 26

Airport Operations FAQ - Driving on the AOA

I get a lot of questions from folks about driving at the Airport.

Driving lights and sirens on roadways is dangerous, but at least the basic rules apply.  Cars drive on the right and are encouraged to yield to the red light and siren.  We are allowed to speed along and go around folks as needed.

Not so on the Airfield Operating Area (AOA).

At my Airport we are given the rare privilege of being allowed to operate not only in the marked cart road area you see all the baggage trucks driving in, but we can wander almost anywhere we need to.  This is an enormous responsibility and requires extreme caution when moving around giant airplanes.

And it isn't just a safety issue, we need to ensure no aircraft are delayed or even made to slow down.

If you do make a plane slow down you lose your airport access badge.  Can't work without a badge.

So what is it like driving around with all those airplanes?

Imagine you are driving your kid's powerwheels car through a parking lot.  As you are, cars and trucks are pulling into and out of parking spots and cruising the lanes.  There is a radio channel where they all talk to each other and you have to monitor it while driving along.  Add to that the control channel and watching for stray bags in the roadway and it is very easy to get distracted and find yourself suddenly unsure of what may be coming around the next turn.

As you cruise the parking lot keep in mind that if any of the cars have to slow down you're reassigned.

 

The longer you are on the airfield the easier it is to predict where the planes are coming from and going to.  Pulling onto taxiway Alpha from spot 1, for example, I know that the United 757 coming towards me is headed to Runway 1 left and won't turn in front of me suddenly, but the Jet Blue behind them will.  I need to either punch it across or wait.  Then I hear on the ground channel "Jetblue, go around the United 75 at hotel, bravo, alpha to the ramp"  Now I know the Jet Blue is going around the United 75, but why is the United stopping?  Ah, there is a ground crew at the Southwest flight pulling out of gate 31 onto Alpha infront of the United.  I'll have to wait.

 

And that's what it is like driving at the Airport.

When a call is street side and we get to do the old fashioned red light and siren it is a nice change of pace.

Friday, July 24

the Crossover Show - Shots Fired in Hayward

MC and HM recorded a special edition of the Crossover Show this week in honor of Hayward PD Sgt. Scott Lunger.

Sgt. Lunger was shot and killed in the line of duty during an early morning traffic stop on July 22, 2015. At the time of the recording, very little information was available regarding the incident. MC and HM don't talk specifically about the incident in which Sgt. Lunger was involved. Instead, HM takes the lead in asking MC about the dangers of traffic stops and if they should ever be considered "routine".

MC and HM appreciate your listening to a difficult episode. The guys have left the usual frivolity, patches, and BOLO for another show.

This episode opens with radio traffic from Sgt. Lunger's partner (and an incredibly professional and cool-headed dispatcher) and ends emotionally as well.

If you appreciate our show and this episode in particular, please share it.

LISTEN HERE

RIP, Sgt. Lunger.

We have the watch.

Wednesday, July 22

A Patient Bet I wouldn't know an obscure 90s song. And lost.

Airplanes have an interesting effect on people.

As Louis CK says, they're about to sit in a magical chair in the sky that takes you places!  As a result of this magical chair in the sky, apparently downing a few overpriced cocktails and skipping a few meals is in order as well.

Folks, do me and yourself a favor.  Drink lots of water, leave time to eat and please, please, use caution when imbibing.  You know me, I'm all for a few beers, but in moderation.

Onto our tale!

THE EMERGENCY

A passerby states a man is intoxicated.

THE ACTION

Still unsure if intoxication is a crime or a medical emergency, our dispatchers clearly spun a wheel and it landed on emergency.  Since my other 2 crews are on jobs, I'm next up to field a call and away I go.

Arriving at the scene in the boarding area, familiar watering hole not far away, our patient is sitting in a chair sipping a glass of water.  Introductions are made and I can quickly tell he has been drinking but is not under the influence as he understands why I am there, consents to an assessment and clearly weighs his options regarding transport.

Our friend has spent so much time arguing the finer points of electronic music with patrons of the watering hole he has missed his flight.  No longer holding a valid boarding coupon his options post security are limited.  Some of the boys in blue had arrived at this point but were circling a few yards back purposefully avoiding eye contact.  I was sure to use the terms "You missed your flight and haven't rebooked?" loud enough to make sure they knew what was coming:

Dude has to leave the boarding area.

I know that my encounter with him is coming to an end as no metrics are found that exclude him from refusing transport, which he does repeatedly in clear sentences while pacing with a steady gait.

When informed that he'll need to leave the boarding area and go to the ticket counter to be rebooked (his airline won't do it at the gate) he decides to disagree.

We go back and forth for a minute or two when finally the following transpires.  Spoiler alert: Ever see That Thing You Do when Guy asks Lamar if there are any good Jazz clubs nearby?  Yeah, this was my "SCotty McDonald" moment!

Dude (the tatted music fan mentioned earlier): I don't have to go anywhere, I know my rights.

HM (our hero): This is a classic 'You don't have to go home but you can't stay here' moment my friend, here let me show you to the exit and I'll walk you to the counter.

Dude: I'm not going anywhere and nothing you do can convince me otherwise.

HM: Nothing?

Dude: (thinking for a moment...then a smug smile.) I'll leave if you can answer one question.

Here I am knowing 2 things for sure.  One, if I answer correctly he'll leave.  Second, whether or not I answer correctly, PD behind me will MAKE him leave, so I'm golden to give it a shot.

HM: Deal.  Ask away Alex Trebek.

Dude's smile is so confident I'm starting to sweat through my T-shirt.  Could this be science?  History?  Geography?

Dude: Who took the last train to Transcentral?

Had he crossed his arms or stood and dropped a mic it would have better fit the look of confidence on his face.  You'd think he just asked me to state Boyle's law or determine the distance to Saturn on the 3rd of July 1867.

However, I was a fan of some very eclectic music back in the 90s.

HM: The Justified Ancients of Mumu.

 

His jaw didn't drop.

His smile didn't fade.

His eyes, however, lost focus and gazed over my shoulder, then slowly panned around the terminal as if to say 'Where did he pull that from?'

I grabbed his backpack from the chair next to him and he rose and began to walk as I escorted him.  He was silent the entire walk to the ticket counter.

When I returned to the officers nearby one of them rightly asked "What the fuck was that?"

"An obscure 90s song by KLF, I think from the White Room album.  Haven't heard that song in years."

 

I almost recounted this tale in the PCR, but decided "Patient ambulatory from scene with steady gait.  Signed refusal." was enough.

Saturday, July 18

Airport Life - 1 Year Later

It was a little over 400 days ago that I was transferred to our Department's Airport Division.

As a result my posts went from being QI centric to almost non-existent.

 

You're welcome.

 

However, a recent spike in visits to a few old topics, specifically HERE and HERE has gotten me thinking about why this little therapy experiment was started late that August night in 2008.

With that in mind I thought I'd share some of the more interesting things about life as the paramedic supervisor at a busy international port:

First you will get to know the CDC and customs officials really, really well.  Every time someone barfs on an International flight it could be the next ebola so everyone needs to be on their A game.

Second, you carry a lot of triage tags.  I mean, a lot.  I likely carry more in my buggy than your entire Department.  Keep in mind some of the aircraft landing here are configured to carry just under 600 passengers.  Add to that we get as many as 5 of them in house at a time and you can imagine the amount of tags we stock.

Third, it looks like there is a lot of downtime but dang FAA, can we get any more training?  11 distinct disciplines must be covered annually, PLUS a live burn certification requirement that can't be met locally (environmental issues and drought an all... burning all that oil and fuel, then spraying water on it) so it's off to Dallas at 0'dearlord in the Morning once a month for the 4 hour flight, 20 minute drill and 4 hour flight.  And all of that is on top of the structural and medical training. Groan...learning...

Fourth, we have a remarkably robust Public Access Defibrillator program with 96 units deployed throughout the campus.

Fifth, I volunteered to run that program before realizing how far a walk it is to all 96 (There were only 92 back then, but still).  Let's just say I don't need a treadmill.

Sixth, alerts can be scary.  We have three levels of alert ranging from Alert 1 (a condition with the aircraft that, if left unchecked, will not likely impact the aircraft or passengers) to Alert 2 (a condition with the aircraft that, if left unchecked, will likely impact the aircraft or passengers) and an Alert 3 (It is already happening).

I have had only 2 Alert 3s so far, one was a false alarm and the other a helicopter crash.

 

 

There is a lot more admin stuff here than was in the brochure.  We're teaching this to those folks and that to these folks, meeting with them about other stuff and over and again, but at the end of the day being back in the firehouse was the right decision for my family.  It was tough stepping away from the QA desk and I lost some chances at other spots in the process, but we're doing good things here.

 

I'll leave you with how I describe work when people ask me,

"How are things at the Airport?"

Planes go up, planes come down, IN A CONTROLLED FASHION.

 

Do you have a question about EMS in an International Airport?  Drop me a comment here or on Facebook and I'll answer it if I can.

Friday, July 17

Crossover Episode 12

Egads!  Another show?!

I know, you didn't think we'd make it this far...again, but here we are.

 
MC and HM talk about the con­cept of par­ents call­ing the police (be it sin­cerely or as a ploy) and ask­ing for help mak­ing their kids behave.


You may find this hard to believe, but the guys finds it not only stu­pid but patently offensive!

You’ll also learn about not only how the guys were raised them­selves, but how the lessons they learned helped shape the men they’ve become and the par­ents they are to their own kids.

 

GO HAVE A LISTEN!

Friday, July 10

the Crossover Show - Episode 11 - Guns and Kangaroos

Well, maybe not in that order, but the guys are back with the internet's only fire, EMS and police podcast.

This week's show is brought to you by the letters A and R and the number 15.

MC and HM welcome their buddy from Down Under, Nick Williams! Sure, they start with talking about the craziness of the metric system, Celsius, and Australian medic's insane vacation policies, but they quickly take a left turn to bring up one of everyone's favorite topics:

Gun Control!

Come listen in to hear the differences between our two countries' responses after large massacres (specifically the Port Arthur Massacre in Australia and Sandy Hook in the United States).

The only BOLO this week is a 15-minute bit on gun control by Australian comic Jim Jeffries:



Thanks again to Nick Williams for taking a week to spend with us! Safe travels home, Nicholas Cage!

GO LISTEN NOW!

Thursday, July 9

Are you well enough to stay home?

The title of this post was mumbled to me by good friend of the blog Nick Williams, a Paramedic in South Australia.  We were discussing refusal myths, the lie that is patient kidnapping and other similarities between our vastly different systems when Nick mentioned something that has been simmering in my brain ever since:

"It used to be we asked 'Are you well enough to stay home?' Now it seems we're too busy checking to see if they're sick enough to go."

 

Nick mentions a co-worker of his using a similar line to discuss the way EMS seems to have shifted focus over the years.  We discussed the changes in our systems and went on to talk about beer, family, TV, the usual, but more than a few sleepless nights have me convinced that he's onto something.

When you are dispatched to a call, what is the first thing that pops into your head?  Is it "I hope they're OK" or "This better be good?"

Why "This better be good" took over

I have written in the past that we're finally having an impact on public health.  The most serious, sick patients of the past are farther and farther in between.  We're nowhere close to where we could be but we're on the way.  Along that way we became more and more upset at the BS calls.  If you'll recall we renamed those Basic Service calls.  These are the calls that seem to be below your disco patch and Mac 3 blade skills.  I'm sure you're ready to apply every single medication and tool in your LED plastered rolling ED on wheels and your Racin the Reaper T-shirt, but your patients need those things less and less these days.

It is easier to walk in the door and cover the big stuff "Scene Safety, BSI!" quickly removing reasons for your skills to be applied than it is to sit down with Erma and figure out why you're there in the first place.

Why "I hope they're OK" needs to come back

Instead of working so hard to prove to Erma she doesn't have to go, why not follow Nick's advice and make her convince us she's well enough to stay?  Too many Paramedics jump to the "Do you want to go or not?" question, often combined with a comment along the lines of "There's nothing more I can do for you in the Ambulance..."

Nothing more?

You're not trying hard enough.

Erma has a problem.  She's having a bad day and you need to do everything you can to make it better.  All better? Maybe not, but you can't solve a problem if all you do is apply a narrow list of questions designed to get you back in service faster.

If Erma is OK staying at home, she can stay.  If she's not OK staying at home but still wants to it is your job as a clinician to explain to her the benefits and risks so that she can make an informed decision regarding her health.  No EMS anchor is going to convince me that hand cuffing Erma to the cot and transporting is the right thing to do.  Their consideration of that option already tells me they're lost to the process of transport rather than embracing the opportunity of assessment.

There is no law forbidding you from informing your patient of your opinion based on your assessment.  If Erma doesn't want to go she needs to convince me she is well enough to stay home with her complaint/symptoms/concerns.  That is all.  If she wants to go, she goes.  If she doesn't, well, do your best to convince her while being honest and helpful.

Not everyone who isn't sick enough for the ambulance is well enough to stay home.

It is your responsibility to make the decision WITH your patient, not for them.

 

When the bells ring tonight for the 30 year old male with chest pain at the police station, will you groan and start the assessment looking to exclude him from transport or will you assess him and help him make a good decision regarding his complaint?

I hope he's OK.

Sunday, July 5

Shared Narrative Ruins the 4th of July

I have written quite a bit about how personal narrative and shared narrative are in competition for our attention.  I have also spoken on this topic that Renny Gleeson turned me onto in his 2009 TED talk at Fire and EMS conferences.  For those of you unclear on what on Earth I am talking about, here's a quick refresher:

Personal narrative is your story, as it happens.

Shared Narrative is your story, including ensuring I am able to see it later, as it happens.

That doesn't mean I was there.

Go see an example I found in an Apple ad.

Imagine you are going to a dance recital.  One of your family members is unable to attend and asks you to film the performance so they may enjoy it later.  As you film the recital, you are forced to alter your personal narrative (simply viewing and enjoying the recital) to include this later sharing of the event (shared narrative).  This essentially means that you will be watching the recital through the camera, just like the person who didn't go.

In that case what's the point?

There comes a time when our desire to share an event, or even capture it for later enjoyment, alters the moment completely.  This is the core of why we in fire, police and EMS need to rethink WHY we wish to capture a moment, not blame the HOW (cell phone).

This was true last night at our community 4th of July fireworks show.

With my family on the smooth grass of the local high school was MC and his clan as well as our Aussie guest KablammoNick Williams (celebrating his first American Independence Day).  I could very easily have gotten my little one off my lap, fumbled for my phone, blocked his and other people's view of the fireworks and gotten a great picture of him to remember the moment.

Only we don't need that photo, do we?  I'll always remember that night.

As I looked around our little corner of a huge crowd I suddenly became aware of how bright it was behind us.  Dozens of people had their phones and cameras out and were video recording the fireworks.  Many of the devices were in AUTO mode so the spotlights were on.

It was distracting,  it was unnecessary, and I can not fathom who on Earth gets excited when someone says "Want to see a fireworks show I took a video of?"  That video caused the person taking it to miss some amazing things.

The greens were dazzling, the wafts of smoke illuminated by the sizzling ones made unreal shapes and the gasp of my daughter in my lap as a loud concussion and brilliant light engulfed us will not show up in those videos, nor would I have been able to actually experience the event with my camera in my hand the whole time.

I have a personal narrative, a first person account of the event that I can share afterwards.

I didn't need to add you to it in the moment to be able to share it.

That would have ruined it for both of us.

 

Don't blame the camera, blame the person so excited to share their life they forget to live it first.

Live now. Share later.

Friday, July 3

Do I Hate the Term First Responder?

I'd say "Hate" is a good start.

In Episode 10 of the Internet's only Fire, Police and EMS Show (Notice it is not a First Responder Show) MC finally lets me get off my chest why I mildly dislike the term "First Responder."

It is overly used mainly by those who don't understand the three disciplines or who simply didn't look closely enough at who actually showed up at the scene.

Special apologies to my fellow "First Responders Network" bloggers, but in the end it really does encompass everything from CPR trained soccer mom to powerline repair man to advanced critical care flight team, so why not just keep it?

BECAUSE I HATE IT!

Have a listen.

MotorCop and the Happy Medic bandy about the term “First Responder”.


Don’t mis­un­der­stand the sub­head­ing above. HM doesn’t hate first responders…he hates the term.

MC? Not so much.

The guys go ’round and ’round, give each other a mer­ci­less hard time and even­tu­ally agree to dis­agree while agreeing.

It’s like find­ing four-leaf clover in a wormhole.

Boy, we get angst-y at the end of batch record­ings after many beers…we also earn our explicit tag.  You have been warned.