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.