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.