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.