Thursday, December 29

the Crossover Show - Episode Eighty Eight

In this episode, brief though it may be, MC takes the helm because apparently HM was too busy “working” or some such nonsense.


At any rate, the winner(s) [spoiler alert] of the Be the 50th Reviewer on iTunes Challenge is announced and Surprise! more than one fits the bill. Give it a listen to find out who the lucky fools folks are.

From both HM and MC, have a safe and festive New Year’s Eve/Day and we’ll catch you in 2017!

 

LISTEN NOW

Wednesday, December 28

Eminence Based Medicine

Eminence Based Medicine is a phrase I heard on one of my favorite podcasts, Freakonomics, which was talking about "Bad Medicine" and the fact that the more we actually investigate what we're doing, the more we find out we don't know what we're doing.

The episode starts by investigating 98.6 and the methods used to determine the "normal temperature" of humans.  Fascinating story short, the methods were flawed, the tools were flawed and the conclusions shoddy at best.  Have a listen for the full story.

As they point out in the 3 part series, we think of medicine as being highly scientific but, it turns out, we have only really embraced evidence based treatments in the last 20 years.  Within my service time.

 

That should frighten everyone.

 

Dr Vinay Prasad, a Hematologist-Oncologist and Assistant Professor of Medicine at Oregon Health University was a guest on the show and uttered the phrase that titles this post.  He was comparing evidence based medicine to previous practice, demonstrating that until recently we went with what the oldest, most experienced person in the room did and assumed that was the thing to do.  Eminence Based Medicine.

 

We in EMS LOVE our war stories, our observations passed along as fact and the EMS Anchors who spin yarns about the old days when things used to work, long before all this new fangled BS came along.

EMS is an expert in Eminence Based Medicine.

How else can you explain most of the "treatments" we apply to patients, specifically trauma and cardiac arrest, arguably the places we can make the biggest difference in patient condition?  Or can we?  Have we become so entrenched in a skill set that we have forgotten to review what we do for effectiveness?

Or do we know, deep down inside, that most of what we do has no basis in fact?

 

If data was properly collected and reviewed that showed that cardiac arrest patients had better outcomes if a peanut butter sandwich to the chest was just as effective as a mechanical CPR machine, how quick would EMS implement it?

If no evidence existed for said intervention, say if it only mirrored the outcomes for patients without it, would we still be so quick to make sure it is on every rig?

Do you think I'm still talking about the peanut butter sandwich?

 

Evidence Based Medicine will drastically change the EMS landscape.  Yes, skills will be decreased in favor of more specific interventions and application of technique.  Some of our brothers and sisters will cling to their laryngoscopes so tightly, citing bad studies and flawed data, instead of hitting the airway lab to maybe get better.  Cardiac arrests filled with drugs and drips and cooling and tubes may be reduced to BLS calls, not because the ALS is hurting, but because we'll learn that most cardiac arrests did not start in the heart and can not be addressed with our narrow arsenal of cardio toxins.

 

"We've always done it that way" are he 6 most dangerous words in EMS and yet are the basis for most of what we do.  Don't believe me?  Look at the push back against eliminating long spine boards, the sudden reversal on pre-hospital cooling (although the data has always been the same) and the fact we are still transporting patients in cardiac arrest to the hospital.

If we demand evidence for new treatments we must also demand evidence for existing treatments.  All of them.  Perhaps it is not the poorly educated EMS masses we complain about that are leading to poor outcomes but instead our blind devotion to the comfortable, time honored tradition of looking to the oldest, most experienced person in the room and asking them what to do.

 

Demand Evidence.

Reject Eminence.

Otherwise, what are we even doing anymore?

Monday, December 19

If You Don't Give Him Insulin He's Going to Die

The title of this post was a statement made to me in a crowded airline terminal.  It was said by a bystander, sitting across the way from a family having a bad day.  The dispatcher called me on the phone about 10 minutes before this all began and asked me if we carry insulin on the rescue trucks.

"No, why do you ask?"

A woman was calling stating her son was insulin dependent, had been delayed many hours and he didn't have his insulin. "Put me on it," was my reply and out the door I went, hoping that all they needed was maybe a syringe or perhaps some lancets to check his sugar.

Holding his baby brother, this teenager is feeling fine, telling me how they had lunch not long ago but it didn't taste good because he didn't take his insulin.

His glucometer, insulin and supplies were all in the giant carry on they tried to get on the plane.  When it didn't fit in the little case near the jetway it was checked through and placed under the plane.  When the flight was cancelled due to weather at their destination (nasty storms on the east coast) the bag sat in the belly of the airplane while his sugar slowly crept higher and higher, no insulin to unlock it.

As I explained my lack of insulin and a number of options for obtaining some, the police officer left to get an airline agent to retrieve the bag from under the plane.  This is no easy task, especially since they were looking for a "black rolly carry on"  I grabbed my glucometer and tossed it to the boy after he passed baby brother back to mom.

"Show me how you check your sugar," I told him and he clearly had never been instructed on how to do so.  A quick inservice on location selection, lancette use and strips and he's a pro.  Probably had to be a quick learner when baby brother came along.

"If you don't give him insulin he's going to die" is suddenly said over me shoulder in a tone and volume to ensure most of the 250 people waiting in the 150 chair waiting area heard her.

"He'll go into a coma and you'll be liable.  Just give him the medicine already."

"Thank you for your concern for your fellow traveler, we'll be making sure he has a healthy plan before we leave."

"Do you even know what diabetes is?"

The boy smiled and tried not to laugh, understanding my role in the healthcare system, while the clearly inebriated woman sipping the iced coffee behind me just wanted to stir the pot.

As the glucometer came back with the ever concerning reading of "HI" meaning over 600, the officer emerged with a number of black carry ons to choose from.  The proper bag is found and I send the boy off to do his usual mid day dosing in the privacy of the rest room.  He has lost his glucometer so my extra has to fill in.

"I can't believe you refused to help him," she chimes in.  I grabbed one of my cards and handed it to her telling her that if she is as concerned she can feel free to lodge a formal complaint with the airport, Fire Department, County and State.

Just then mom chimes in, "I want one of those cards too please. If she's gonna get all bent out of shape by you helping us out I want to make sure all those people know what you really did for us today."

 

We'll see who's letters actually arrive.  Now, if I can only learn what diabetes actually is...

Sunday, December 11

Lost Cause Strikes Again

I spoke not long ago about a Medic that got under my skin for not wanting to complete a secondary assessment on a patient.

On a recent call he had me frustrated again, for almost the opposite reason.

 

55 year old male, chest pain, diaphoretic, history, pretty much every patient you got during your cardiology portion of Paramedic School.  Lead II and III look fine but of course we're placing the 12 lead and opening up the ASA as the wife gives us a better idea of his history.  Out of the corner of my eye as I check the BP I see Lost Cause (LC) approaching and his step slows as he sees me.

A report is given as I fish out the nitro and prep a spray.

"Does he want to go?" LC asks casually.

"Not exactly, but we haven't ruled out an acute MI here, so let's play it safe, shall we?" I respond as the 12 lead analyzes the pronounced ST elevations in V2 V3 and V4.  I know what the strip will say before it finishes printing.

As the O2 is transferred to the Ambulance the patient is beginning to calm and asks me what I saw on the ECG.  Before I could answer, LC jumps in and says one of my least favorite things.  If you've read anything here you know what he's about to say and you're proud of me for not screaming.

"Well, Sir, we don't diagnose, we're just Paramedics, you'll need a Doctor to diagnose your problem."

"Some parts of your heart are having trouble being their best.  It's the first sign of trouble, but we caught it in time." Was my swift response, pointing out that the medicine we had administered had cleared the pain, his color was back and he wasn't sweating through his shirt anymore.

"Thank you," the patient says and is loaded into the ambulance after being wheeled by silent LC and the ambulance EMT, me also silent nearby.

Sheesh.

Friday, December 9

the Crossover Podcast - Ep 85 - Florida Cry Baby

crossoverlogo300In this week's episode, MC and HM talk about a Florida man (because, of course it's Florida) having his picture sent out on the interwebs and the Florida agency taking some heat about it.


You can read the piece and, more importantly, see the photo here.

What do you think? Any issue posting this photo? Does the copy accompanying the photo matter?

Let the guys know in the comments!

BOLO


RIP Ron Glass

Motorcop's new YouTube Channel


LISTEN NOW!

Monday, December 5

"I Can't Breathe!" you keep using those words...

blog engineI don't think they mean what you think that they mean.

It has been a long time since I asked "You called 911...for this?" mainly because I moved on from that attitude and learned to embrace my inner adult.  No in a creepy way though.

 

Units dispatched for the 62 year old male, trouble breathing. 0510 hours.  Rescue and Ambulance are responding code 3, I add myself as the Captain just in case we have a serious case.  Hey, sometimes it is and I'm glad I'm there.

This was not one of those times.

We arrive and I grab the suction unit from the rescue and we all head in, still wiping the sleep from our eyes as we weave through the long line of people at the security checkpoint.  When we reach the front the TSA supervisor indicated that he has no idea who we're there for when I spot a man waving to us holding a tissue in his hand.

He sneezes.

"Ah, everytime I fly I get stuffed up, I can't breathe," he says, nose clearly clogged.  He looks like the exaggerated cold and flu commercial;  Red nose, slightly watery eyes, sad look on his face. "I need something for the pressure. I can't breathe."

"What medications are you taking right now?" I asked casually as we slowed the ambulance and set down all the gear nearby.

His answer will not surprise you: "Nutting, why?"  I smile as he is unable to pronounce certain syllables.

We impress upon him the need for common medicines for congestion as all assessments reveal a healthy 62 year old suffering from flu like symptoms.

"Is not da flu, I got my shot." Another wipe of the dry, red nose.  I cringe just thinking about it now.

"It doesn't work that way," my Medic tells him listening to his lungs and giving me a nod.  All clear.

Each time I walk past a shoppe in the airport, I note who carries what medicines, especially for the kiddos.  Out comes the notebook and I indicate shoppes nearby who sell medication that could help his symptoms.

"So you can gib me sumping?" he asks, wiping his dry, red nose...again.  "No," I reply, "how about we walk over and I'll help you choose the right medicine?"

He refused, citing the need to make his flight to avoid missing his connection.  Despite my warnings that the change in pressure while flying may lead to discomfort, pain and an increase in symptoms, he signed our form and went through the checkpoint.

I truly hope he stopped into the shoppe near his gate and got something, otherwise my counterpart at his destination is going to have the same conversation with him.

the Crossover Show - 84 - TN Bus Crash

crossoverlogo300 In this week’s episode, HM and MC talk about the recent tragedy in Chattanooga, TN, in which six children lost their lives in a fatal bus crash.


Please to keep in mind that this happened many hundreds of miles from CA, but has that ever stopped the guys from waxing philosophic and/or offering their insights into what could be at play?

Of course not!

As with many current events, the guys imagine themselves at the scene and they talk about what steps they would take if they were on scene/incident command.

And what about seat belts on buses. Some states require them and some don’t. What about your state? Are your children safe on their bus?

BOLO?


Nope! Enjoy another round of #AskMC!

 

GO LISTEN NOW!

Saturday, December 3

Happy 150th Anniversary San Francisco Fire Department!

On March 2nd, 1866, after the bustling gold rush port City of San Francisco had burned to the ground not once but twice, the California State Legislature approved "An Act to Establish a Paid Fire Department for the City and County of San Francisco."

Multiple volunteer companies were in place but had not been able to handle the increasing load of fires in the rapidly growing City.

According to the Department's Museum and Anniversary organizing group, April 1866 saw 6 Engines, a hose wagon and 2 ladder trailers ordered from back east, costing a jaw dropping $17,655.  17 horses were also purchased and a full time staff was hired.

When incorporated on this day, December 3rd 150 years ago, the apparatus were staffed as follows:

Chief Engineer Frankilin ER Whitney

First Assistant Chief HW Burkes

Second Assistant Chief Charles H Ackerson

Superintendent of Steamers Daniel Hayes

Corporation Yard Keeper Tom Sawyer (A writer friend of his you likely know)

Fire Marshal John L Durke

 

Each Engine Company was staffed as follows:

Foreman

Engineer

Driver

Fireman

8 extra call men

 

Each Truck was staffed as follows:

Foreman

Driver

Tillerman

12 extra call men

(No Fireman assigned to the Truck...hmmm)

 

The first 7 months of operation saw 159 working fires.

 

I always wanted to be part of an organization with a deep rooted history and I think this timing is perfect.

Happy Birthday, San Francisco Fire Department!

 

Wednesday, November 23

Thank You For Your Service?

This Thanksgiving it is important to reflect on what we are thankful for and what we take for granted.

"Thank you for your service." We hear this term a lot in recent years as we see more and more soldiers coming home from serving abroad.  It carries with it a sense of honor that someone would volunteer to stand where I choose not to.

Some use it as a quick excuse to get out of an awkward situation.  You see someone in full fatigues at the airport or grocery store and you respect them, then they head your way.  What can you do?  "Thank you for your service."

I haven't used the phrase myself, finding it as useless as the "Thanks for taking my call" that starts most radio caller diatribes.  It has almost become required without being required, if you catch my drift.

When I see a Soldier, Marine, Airman or other armed service member traveling through my airport I always stop and offer assistance, either with directions, a call to the USO center or even a cup of coffee.  I address them by name if I can see it and refer to them by rank if I can.  When I am nearby and someone casually says, "Thank you for your service" then continue on I can see the awkwardness in the service member's face and body language.  What do we expect?

"You're welcome?"

 

Recently I had an HVAC guy come out to the house to give the furnace a once over before winter rolls in.  As he approached the house he saw my car in the driveway and the Firefighter license plate.

"You a fireman?" He asked putting down his tools.

"Yup" I answered and took a sip of coffee.

This fellow in his mid 20s squared his shoulders, looked me in the eye and offered a handshake adding, "Thank you for your service."

I was frozen.  I had no idea how to react.  Not only did I not like that statement, it doesn't apply to me.  Sure I work for a service, provide a service and volunteered to do something few others do, but I'm not a soldier.  Why would he say that?  So I asked.

He told me that he admired firefighters but could never imagine himself going into a burning building or dealing with sick or dying people.  He saw firefighters as an integral part of the community and made a point of saying thank you to each one he saw.

It was that moment, standing in my garage sipping coffee that it occurred to me:  I don't get a say in what he wants to say.

Much like the imagined "War on Christmas" where anyone who says "Happy Holidays" is labeled an enemy of America, it shouldn't matter what was said, but that anything was said at all.  I shouldn't be upset that this person put me in a category I imagined, I should simply say "Thank you" and move on.

 

When I return to work I don't think my reaction to soldiers I see will change but I will certainly see folks passing by in a different light.  After all, they could have just kept walking, not saying anything at all.

 

It should only matter that they chose to say something, not necessarily how perfect their words may be.

Something to consider this Holiday Season.

Sunday, November 13

A Complete Secondary Assessment

That's what our policies require and it makes perfect sense.  A complete secondary assessment to rule out all known causes of illness or injury to allow providers to make a good faith report of condition to the patient to inform their decision.  We have tools and education to perform this task and it really isn't hard to put it all together.

 

Or so I thought.

 

On a call for the syncopal.  This is our bread and butter.  We find the patient pale, a bit moist with his shirt clearly previously soaked through (symptoms for 25 minutes now) but he is alert and oriented and refusing all care.  Being caring human beings we impressed upon him the need for an assessment.  After all, "what if we find something we can treat?  Wouldn't it feel nice for that dizziness to go away and your head to stop sweating?"

Strong radial, irregular, wife says he's got a history.  No chief complaint verbalized but his body is clearly telling me otherwise.  Meds and history paint the picture of an old a-fib but the ECG is showing PACs in II about 7:1.  Clearly something has changed.  The beats that should be irregular are regular...except that one little bugger.  He is calm and normotensive as we begin the chat that will convince him he should be seen by a physician sooner rather than later.  This conversation usually ends with them telling me they are going to hospital and there is nothing I can do to stop them.  Iceboxes to Eskimos.

The transport crew arrives and I ask them to set up the cot while we run a 12 lead and give a brief report.

"But he isn't having chest pain.  We don't need to run a 12 lead."

I was told later that the glare I shot him was visible from the space station.

"We need to get a better picture of what's going on as we have sudden onset syncope with an abrupt change in baseline ECG.  He is clearly no longer able to maintain homeostasis and we owe it to him to look for anything and everything we can to paint a clearer picture for his continuing care."

I didn't say that to the medic, I said it to the patient's wife who was standing nearby.  She seemed suddenly concerned and I was able to put her at ease.

 

Later, down at the ambulance I had a chance to speak to the transport medic.

"We don't run 12 leads on non chest pain patients, it isn't in the protocol.  Besides, he said before we got there he didn't even want to go."

 

I followed them to the hospital and assisted with the hand over, then helped the EMT reload the cot.  As the medic came out we discussed the importance of a complete secondary assessment when we can't reliably determine the cause of the chief complaint.

"He didn't have a chief complaint."

"His body sure as hell did.  Quit trying to pretend you're just here to push Epi and instead use your tools and education to find the cause of your patient's illnesses.  Assess, diagnose, intervene and reassess.  Just keep that wheel turning.  OK?"

"We don't diagnose."

Lost cause.

Friday, November 11

the Crossover Episode 81 - Let's Talk Politics!

crossover logoIn this week's episode, HM and MC talk politics! You know, that thing no one's supposed to talk about. (Stay tuned...because next week they're gonna talk religion!) #Sarcasm

Although, listen to the show and find out why that would not be as totally shocking as you hope it would be!

The guys discuss the outcome of the Presidential election and the amusing aftermath. SPOILER ALERT: Neither HM nor MC voted for Trump...or even the same candidate...and they're still friends!

The guys also touch on some of the most ridiculous propositions on the California ballot and MC goes on one of his epic rants about Prop. 57 and how it's a completely epic shit storm of stupidity.

Enjoy!

 

On a related note, we talk at the beginning of the show about "the third rail" and how the idea of the phrase is to not touch the electrified rail or you will be electrocuted.  Fair enough, but if we don't touch it together (You just read that in Ryan Reynold's voice as Deadpool didn't you) we can't get anywhere.  Unless the train touches the third rail it just sits still.

The start to a civilized, open discussion is to know where the other person is coming from and to respect their beliefs and viewpoints.  I don't mean accept it when your partner tells you they think the new McGuyver is the best TV ever, understand that you likely won't sway their opinion, but at least you know not to bash mullets.

 

Talk to your coworkers in a civil manner and everything will be fine.  MC and I differ on so many big topics, we talked about it early on, agreed to disagree and wouldn't you know it, everything went fine.

 

I'll leave you by paraphrasing our closing remarks and the Bible:

"Whatever, dude.  Just don't be a dick about it."

Friday, October 28

Aircraft skids off runway, rescue task force ill equipped

A recent conference guide arrived in my email inbox.

7 of 11 EMS courses listed were on active shooter.  That is not a Slushie joke.

As you know I have long believed that Law Enforcement Integration training should be standard for Fire and EMS.  We train on Hazardous Materials Awareness, Swift Water, confined space and maybe a half dozen other specific courses, but are we maybe running too quickly into the warm zone of active shooting?

 

A commuter aircraft crashed near my home last week.  A vice presidential candidate's plane skidded off the runway, and yet when I mention these things to my EMS friends I hear "That's just an airport thing, we don't need that training."

Let me get this straight...

 

We need training and gear for a situation that will be over before we arrive, but we ignore a situation that requires specific training because "it happens so rarely."

 

I have noticed that an intervention's usefulness has an inverse correlation compared to the rapidity with which EMS adopts it.  For example:  Cooling.  When post arrest cooling AKA Therapeutic hypothermia hit the scene it was adopted almost overnight by EMS.  Coolers were purchased, policies written and the most recently deceased were getting cold fluids and we were giving high fives.  At the same time those who were advocating for cooling were also defending long spine boards as the standard of care.  I know, stupid.

 

It took 2 full years of fighting to get long spine boards moved from "required" to "a tool."  The cold saline just showed up overnight.

Now what we've known from the start, that pre-hospital cooling has no benefit, has us no longer using the expensive coolers and nifty policies.  We were so fast to jump on board we never thought to look at the data first.

I can't help but see it happening again with vests and helmets for "active shooter" situations.  Don't get me wrong, TEMS has a place.  Medics need to be a part of tactical teams because when SWAT deploys EMS has nothing to do but standby nearby and wait.

We were to fast to throw vests and helmets at anyone who wanted to get trained did we ever stop to see if putting those people in the warm zone would make a difference?  San Bernadino?  No.  Orlando?  No.  LAX? No.  So where are all the active shooter incidents where a Rescue Task Force has been deployed successfully?  Where are all the post recus patients who got cooled walking out of the ED?

 

Or is it just a chance to finally get some new training, gear and something to do?  Were we too quick to adopt this new tactic or will it prove beneficial?  When a medic or firefighter gets shot in the warm zone will we be willing to re-examine this program or blame the provider for being in the wrong place at the wrong time?

 

I think you know as well as I do where the fault will be placed.

 

We seem to sprint towards the uncertain while ignoring the obvious.  How much longer will we just let it happen?

Crossover Show - Ep 79 - Do we need so much active shooter training?

In this episode, MC and HM talk about HM's recent trip to Nashville for Firehouse Expo and one of the presentations he attended. HM regales us all with what he learned about the need (or lack thereof) for tactical EMS in an active shooter scenario based upon the experiences of Florida responders during the Pulse Nightclub shooting.  Are we drawing a clear enough line between TEMS and active shooter preparadness or is it just too exciting to get a vest and helmet on and get in there?  Should LE Integration be as standard as hazmat awareness?

What do you think? Is tactical EMS just a fad? Should resources continue to be allocated to that training "just in case" or would time be better spent elsewhere?

BOLO


MC's New Budgeting 101 Course with Law Enforcement Learning - Yeah, MC said to use the coupon code "Crossover" during the show...but as it happens, unique codes won't be available until the end of November.  Not to worry, though! You can copy/paste this code:






e0e7225878fc29e33457

That code will get will get you 25% off!

 

GO LISTEN NOW!

Thursday, October 20

How to Ignore Everyone in the Room: Be an Intern

Just as my head was settling into the pillow after a Haz Mat call and much needed shower, the lights come on and the tones drop for the ever popular bystander diagnosis of "Possible heart attack."

As I move towards the buggy radio comes over the speaker in the large bays, "Control to units responding for the heart attack we have an AED activation nearby."

 

OK then.

 

Of course it isn't a cardiac arrest case, or even a heart attack as we piece together a story of exhaustion, stress at home and a few missed meals (replaced with some hard alcohol) and the assessment continues.

I'm gathering a history and the story from the witness while my medic team is preparing to run a 12 lead since we have reports of a near syncopal episode.  They're thorough...at least when I'm nearby.

As the ambulance crew arrives the familiar blue BDU pants, shirt and stethoscope of a Paramedic intern come into view and I prepare to give a report.  This is a good case for an intern. I'll give him the basic findings so far, vitals, then make contact with his preceptor to determine how much of a lead to give him on the rest.

I stand 6'2", am wearing turn out pants, a radio sling and a sweatshirt embroidered with my name and title.  I mention this because he approached me, saw the patient behind me about 10 feet and performed a careful side step saying only, "Excuse me, paramedics."

I had 2 initial reactions:

First was the reactionary side of my brain saying, "Oh no he di int!"

The second was the rational brain realizing he has tunnel vision, just like I used to, and wants to get in there and get a report from the folks performing an assessment in real time.  After all, I hear them telling him to sit still for the 12 lead.

Nope.

Not a word from the intern as he pulls out the stethoscope and begins to listen to lung sounds of our conscious, alert and speaking patient sitting up in a chair.

"12 lead compiling" my Medic states less than 12 inches from the intern.

"Hi Sir, turn towards me please" the intern asks as he is again reminded to remain still for the trace.  The leads on the screen look great, PsnTs where they should be, good R wave progression and I motion to my medic to let the assessment from the intern continue.

The preceptor is well known to us and he is at the doorway and flashes me a 1-5-0 on his fingers, letting me know the intern is at 150 hours on the ambulance so far.  We have a complex set of hand signals that would rival Motorcop and his tactical pals.  Without a word I express my displeasure with the sidestep, the lack of a primary exam or even a request for history of event or vital signs and interventions from the first crew to make contact.

He replies with a shrug and the clunky, random wandering assessment begins to draw to a close.  The stroke scale test (already administered and documented) looks good, and the patient shows the intern a band aid from the last blood sugar test when the intern tells him one will be completed.

"Would you like a report from fire?" the preceptor asks, clearly dealing with this situation...again.

"Not yet, I want an unbiased look first."

And....we're done.

 

 

Sunday, October 16

Your Meme is Bad and You're Not One of Us Anymore

Oh internet.  You let us grab onto a thought, find a somewhat fitting image, marry the two and throw it out for all to see.  Most times this happens so fast we don't stop to think about what it is that we're actually doing.  The idea started with cheesy motivational posters in office buildings showing jets and a quote about something vaguely business related.

Now we take that thought and add some snark, humor or unifying image and call it a meme.

Memes are great, they convey a sense of sarcasm the internet has not yet built a font for.  Goodguy Greg, winning fist pump baby and tea sipping Kermit call to mind certain feelings.  Then we add text and hope our point gets across.

I mention this because of a meme I saw shared by the Leatherhead Mafia on Facebook:

ff-meme

The image was first shared by "Firefighter Funnies" apparently a humor site.  Leatherhead Mafia shares my opinion regarding the image.

The image is not credited and the firefighters in the image I'm sure do not know about the words added by the keyboard commando.  It is a response to a Presidential candidate's comments about how he treats women.  No spin, no comment on what the candidate said, his words speak for themselves.  The broader implications, however, are that if this is how the person thinks and talks when people are listening, how do they think when people aren't listening.

As a son, husband, brother and father of 2 girls I find the comments repulsive and yet not at all surprising.  This candidate has repeatedly shown they are crude and sophomoric, especially when it comes to women who either refuse to accept his advances are are not the body type he prefers.

Enter the above image into my feed.

Fuck you whoever made this.

If I can't handle Trump's comments I'd never make it as a firefighter?  Let me guess...tough guy firefighter, big truck, sweet mustache, dirty leather helmet sitting on a pristine set of bunkers in a house that saw 3 fires last year?  No, that's too easy.

You're the asshole at morning muster bragging about this and that, be it women, hunting, your side job.  You're trying desperately to impress me when I couldn't care less.  You banged that "slut" from the bar last night?  Don't care.  Have you thought about what that makes you?  Your comments offend me and I tell you so to your face yet you tell me time and time again that I'm the problem with the Fire Department today:  "All talky touchy and feely...man up for once."

I don't need to grab women to man up.

I don't need to brag about grabbing women to man up.

I don't have to point out a ten year old in public and say I'll be dating her in 10 years to man up.

I set a good example for my daughters.  That is how I man up.

If I stumble in that mission, you'll be the last to notice though, won't you?

 

I am not at all surprised a person like Trump thinks and talks this way, having always assumed they can do what they want without repercussions.  Case in point look at the Brock Turner case and tell me if he was a student on loans if he's out in 3 months.  There is a type of male in our society who thinks they can take what they want when it comes to women.  Brock will be a Donald, bragging and trying anything he can to get what he thinks is his for the taking.

 

This quickly thrown together meme is not a reflection of the Fire Service as a whole.  Do we talk about some crazy stuff?  Yes.  Will being offended at a description of sexual assault make me less of a Firefighter?  Certainly not.  I argue that not calling this kind of shit out when you see it is the same as accepting it.

 

The next time someone like the maker of this meme sits down at the firehouse table or wanders into the ambulance yard and starts spreading the shit you have to shut. them. down.

The meme bothers me almost as much as the fact that this person believes so much in a political candidate they are willing to look away from the words of the candidate and dismiss it as "firehouse jargon" "locker room talk" or, my least favorite comment "Boys will be boys."

This is most commonly uttered by the mother of out of control boys hitting, screaming and ruining things for other kids.

No, boys will be men who act like boys unless you step in and set the example that hitting other kids randomly isn't OK, that using hateful terms to describe women who won't sleep with you isn't OK and supporting a person not by backing their statement but instead trying to say that if I don't agree I'm less of a man is not OK.

 



If you agree with the meme or the comments of the candidate, or dismiss it as "locker room talk" or "boys being boys" get out.  Get out of the modern fire service and go tell your mother how you really feel about women.  I fucking dare you.

Sunday, October 9

Goodbye tarps, I never loved you

MCIs can be stressful incidents.

During most of our preparation and planning we seem to focus on the basics, the parts of the plan that all come together as needed when a large incident strikes.

Vests, radio communication, incident structure...all these things gel into a well run scene.

 

Buried in the back of our minds, much like the desire to backboard everyone, is the idea that a colored tarp on the ground is a good idea.  "But Justin, how will be be able to distinguish the red area from the yellow and green?

Well, Sparky, first off, everyone is standing in the green area, so let's just leave them alone.  Until much, much later.  Send them into a general space out of the way and make a note to call them a bus.

Yellows are just greens who can't walk, so if they're 30-2-Can Do and can't move on their own we'll get to them later too.

 

Trick with the tarps is this: They're small, they can't be seen from the ground level and when they become covered in patients are impossible to distinguish.  Don't get me wrong, they work to a point and that point is when treatment begins.  Multiple solutions have been floated in recent decades including colored vests for the treatment team to match the area (Which I like) all the way to glow sticks!

At my assignment we have some recent experience with MCIs and have worked to address what did and did not work.  Instead of a colored rectangle on the ground that no one can see, we initially used our large Mass Casualty Units, giant Pierce Fire Engine chassis with extended roof cabinets, as landmarks for treatment areas.  Trouble is, for a person who doesn't know the difference between an engine, truck and MCU, they all look the same.  Big yellow trucks parked over someplace they need to go.

So we got some flags.

mci-flags

There no longer remains any question as to where the Immediate Treatment area is.  These flags are out on the airfield in a decent wind and held perfectly well.  Throw a sandbag intended to hold a tiny tarp down and we're golden.  This set up allows the treatment manager to arrange patients in a circle, or flower shape if you prefer, instead of the initial desire for rescuers to put a rectangle board on a rectangle tarp, forgetting that we need to get to them to treat them.  It allows the area to be seen from hundreds of meters away, from above and are just wide enough that, should you have the misfortune of approaching from upwind or directly downwind, they flap just enough to see the colors clearly.

They set up in about 30 seconds with one person and collapse into a tiny little case.  One person can deploy the entire set very quickly.

 

We still have our tarps, just like we still carry a backboard, in case we have a smaller incident with only 3-5 patients.  Sure they make bigger tarps with fancy outlines of patients, but are we simply taking something marginally useful and making it bigger instead of identifying a better solution?

I say ditch the tarps, plant the flags and get to work ordering resources instead of finding something to hold a tarp down.

Saturday, October 8

The Crossover Episode 76 - Flashback to the Beginning

crossoverlogo300While Hollywood is busy making this prequel and that prequel we here at the Crossover Show thought it would be only right to give you the only prequel you need.


6 years ago this week Motorcop and Happy Medic sat down at their respective interwebs machine interface devices and tried something Motorcop called “The Audio Crossover Show.”


Have a listen to the first ever episode we ever recorded.  Not much swearing, yet, and we seem to stay on topic.


This is from the original series, not the Youtube or our recent reboot.  This is over 130 episodes ago and here we are still not entirely sure what each other do or how we feel about everything.


A special thank you to you, our listener, for encouraging us to keep this exchange going!  Help us keep it going forward by supporting the show at http://patreon.com/TCS



ENJOY! LISTEN NOW!

Wednesday, October 5

You found me how?

This week's most interesting Google searches resulting in finding this website:

 

kelly grayson jokes

 

can emts drink alcohol

 

I think this may have been the same person.

Friday, September 23

Less CSI, More Columbo

Recently the TV company offered us a couple extra channels for being with them for 10 years.  I'd prefer a discount on the channels I don't watch instead, but whatever.  As the wife went through the new channels looking for movies to record she stumbled upon one of my favorite TV shows: Columbo.

Seeing the bumbling, confused Detective Lieutenant solve crime after crime using his observation skills was far more interesting than modern crime fighting shows like CSI.  They were all technology and little observation.  Columbo was all observation with a possible side dish of science when they could.

As I watched an episode of Peter Falk uttering his famous phrase, "Just one more question, Ma'am" I thought to myself, "Huh...how many Medics are Columbos and how many are CSIs?"

 

Let's break it down...

Columbo Medics:

Act on hunches based on experience,

Observe, observe and observe again,

Only ask questions they already know the answer to,

Rely on evidence rather than data suggesting an outcome

 

CSI Medics:

Run all tests possible and scan results,

Observe, but record for later review,

Collect all information,

Use data to influence outcome

 

 

Not sure where I fall or whether one is better than the other, but I will add this little tidbit:  While introducing HM JRSR to the program and explaining that there are no computers, cell phones or other advantages afforded modern detectives she said, "So he solves crimes by talking to people, collecting clues and putting them together?  I like that!"

 

Kind of the same...but kind of not the same.  I'd still rather be a Columbo than a CSI...

 

Me and Mrs Fishbiscuit...just one more question, ma'am...

Monday, September 19

EMS Festival Standby - You can't just park a car there

Expecting more than 50,000 people to attend an outdoor festival in your area?  Main street in town going to be shut down, other streets closed off and parking a nightmare?

Sure, we're prepared, we sent an ambulance to do a standby.

 

As an attendee of various festivals, events and gatherings in September for Kilted to Kick Cancer I have seen a wide variety of resources deployed.  On fairgrounds and larger venues we commonly see an ambulance at a first aid tent with a golf cart vehicle staffed to perform first response.  Works very well so long as the cart and first aid station can communicate with one another.

At a recent outdoor gathering on what was expected to be close to triple digit heat I witnessed how NOT to handle EMS at a venue.

Walking past the many vendors I noticed a small group of folks standing around a woman in a bar height chair and she was fanning herself rather quickly, but erratically.  It was clear that she was overheated and about to syncopal.  Judging by her girth it was imperative that that occur on the floor, not almost 3 feet off the ground.  I stepped in, grabbed her from behind, explained my actions and moved her to the ground.  I assigned the fanning to another person and poured some of the water she was unable to drink on her neck, arm pits and knees of her heavy pants.  It was a start at least.  Another person was sent into the nearby shop to call 911.  If this was a normal Saturday in this community we'd likely get a police car, an ALS Engine and a private ambulance.  Pretty standard.

The first uniform on scene was a foot patrol policeman assigned to the large festival.  We were midway down a closed street and it was packed with people.  He radioed an update and asked what I needed.  The next folks to wander up are the local Sheriff's Search and Rescue team, in full hiking gear carrying no equipment.  They radio their people an update and ask what I need.

A supervisor for the local ambulance company is next to find us and he too has no equipment and radios his people that I have her cooling down.  In all there are 6 people standing around me and the woman on the ground...still no one able to do more than I have already done.  Next the crowd is clearly parted by an ambulance crew with cot.  I give them a quick report and head back to my family waiting nearby.

She was taken away in shade and I assume did just fine.

About 15 minutes later a fire engine crew went pushing through the crowd to the spot where the chaos had cleared and looked around as if lost.  They made some radio communications and left, heading back through the crowd to their engine which must have been parked 2 blocks away.  This happened more than once that day.

 

Why was the engine even activated?  Why did the ambulance supervisor have no equipment?  Why is the search team on site if not to assist in aid?

This is a large annual event in this community and every year the manner in which EMS is handled never seems to improve despite clear complications and gaps in service capability.

 

But, the plan likely only called for an ambulance to be there...you know...just in case.  So park the car on the far side, order up a giant corn dog and enjoy the live music, if we do get a call it'll take so long to get there it may not even matter.

 

Sigh.

Sunday, September 11

the Crossover Show Ep 72 - Florida EMT photo game

crossoverlogo300Er mer gherd Florida Man strikes again.  In this episode of your Mom's favorite podcast, MC and I discuss the EMTs in Florida who were caught playing a stupid game of oneupsmanship using photos of patients.

 

Stupid is as stupid does I guess, but what do MC and HM think about the laws, guidelines and practices that each of their own disciplines must follow?  Find out now! LISTEN HERE

 

BOLO


Law Enforcement Learning

Come see HM LIVE at Firehouse Expo!

*This is sarcasm. If you're new, you may want to know that at the outset.

Wednesday, September 7

A&O vs able to make decisions

For as long as the nine magical letters on the side of the rig have existed there has always been a debate about when a person is "A&O" and when they are able to make decisions.

There are also stories, terrible stories from the Anchors (Those in EMS so long who refuse to evolve and help us move forward, instead holding us back) about so and so who got sued for kidnapping and were never to be seen again.  Those stories are always before your time.

There is a careful line we walk when discussing a person's ability to make good decisions.  My Aussie Medic Pal Nick once described it as follows:

Too many Medics are focused on whether or not the patient is sick enough to go to a hospital when instead they should be focused on whether or not the person is well enough to stay.

I have always been on the side of a patient proving to me they are well enough to stay but I always end up encountering the counter point.

For example:

Imagine a man in his mid thirties, appears healthy enough, clean clothes and an expensive watch is found by Police outside a local hotel and appears to be intoxicated.  You arrive to do your assessment and find him unable to stand on his own, slurring words and asking for detox.

Assessment finds no trauma, discoloration or signs of injury.  Vital signs do not indicate any urgent life threats.

He appears to be healthy, aside from the odor of wine and the dark purple tongue.

He knows his name, where he is and what day it is.

Is he A&O?  Sure

Can he refuse care or transport?  Does he understand the risks of refusal?  Now imagine that your ambulance crew arrives a short time later and utters may favorite phrase in EMS:

"If he's alert and refusing I'm not going to kidnap him."

Oh, he's alert, but not able to comprehend the risks of refusing care and/or transport to a hospital or appropriate facility.  He is also not able to walk away from danger or towards help.  Tell me all you want about the Anchor's tales or how you're too close to your OD time, but I threw my Aussie friend's challenge at this medic and he froze.

"Is he well enough to stay here alone?"

"No."

"Then there you go."

Not an hour later we found ourselves assigned to the same call in another part of town, this time at the train station.  Dude was in far better shape than the last one but still admitted to alcohol ingestion and was slurring words.

Through those slurred words he made a fair argument for not seeking treatment elsewhere and we were all convinced he was able to meet our County's refusal criteria comfortably.  Remember you can be intoxicated but still not under the influence.

The medic said to him, "I'm just not convinced you're well enough to stay here by yourself."

The man refused care, spoke to our MD on the phone and signed the form before wandering off with a steady gait.

 

We spoke later about the difference between calling someone "A&O" and making sure they are making an informed decision regarding care.

"What about kidnapping though?"

Some legends are hard to kill I guess.

Thursday, September 1

Kilted to Kick Cancer Cops vs Firemen

ktkcshield400whiteATTENTION FIREFIGHTERS!

Howdy readers!  I'm sure you were hoping for a quick word about how to fix EMS or a rant about long spine boards but, alas, it is September.

 

Remember years ago when we tossed about the idea of wearing kilts all month, then made it into a public awareness campaign, then into a real 501c3 having an impact on cancer?

Me too.

Point being that I am in a fight for bragging rights with my law enforcement counterpart and a good deal of other folks over in the fund raising competition at Kilted to Kick Cancer.

As co-founder I'm not eligible for any of the sweet prizes but you can help me win bragging rights over Ambo Driver and Motorcop at least by visiting THIS LINK and thumbing $10 or more to the cause of saving men from the second deadliest form of cancer facing men: Prostate Cancer.  As a sweet bonus you can be entered to win an AR15 (rules apply) for each $10 you donate to any participant.  Why not let that participant be me?  You win, I win, cancer loses...see, no downside.

PC will be diagnosed in 1 in 7 men and will kill...yes KILL...1 in 36.

Click the link above and choose Team Happy Medic at checkout (the last part of the process) and together we can rub it in Motorcop and Kelly's faces that firefighters are aware of their cancer risks and willing to do something about it.

 

Please support Kilted to Kick Cancer.  We're kilted all month long to raise awareness and anything you can send along helps us get the word a little bit farther.

 

-HM

Tuesday, August 30

Writer calls for Medics to risk more in shootings, misses the target

Kevin Hazzard (@NakedStrangers), is a writer and former Paramedic from Atlanta who wrote a piece for the Washington Post titled "Paramedics are taught not to risk their lives after mass shootings. They should."

 

You can imagine the uproar from the three disciplines.  Just reading the comments on the original piece sums up the range of emotions from one reader, "Hell yeah, get in there and save lives" to the other end of the spectrum calling Hazzard all sorts of names and questioning if 9 years in Atlanta makes him an EMS "expert."

First thing first: I wasn't with Hazzard those 9 years so I can't speak to his experiences.  However, based on this article and the recommendations, I would lean on the side of inexperience.

I'll also have to disagree with the title, which is not often written by the writer but instead an editor. "...risk their lives AFTER mass shootings" should read DURING.  After the shooting stops we re-evaluate the situation.

Here's why:

We in EMS and Fire are taught to stay back during violent events because we are not trained to be able to prevent the scene from devolving.  We are not trained to secure, scan for threats and protect a scene, be it shooting, stabbing or explosion.  We are trained to deal with the aftermath.

The article touches on the newest fad in EMS, TEMS, which will soon go the way of MAST pants and cooling.  The idea of giving an EMT a quick class on how to stand near an armed group of officers and issuing them a vest and helmet really only helps pay the mortgage of the guy selling the vests and helmets.

I'm all for PPE for our people.  I'm also for the core element of TEMS which is integration with PD when needed.  What we don't need is adrenaline junkies on almost minimum salary being given a vest and helmet and sent into chaos.  The team needs to be highly trained and fully equipped.

Will immediate intervention make a difference in some cases?  Perhaps.  Hazzard mentions that victims in Boston were treated immediately because EMS was already onsite.  True.  Hazzard also mentions that the Pulse Nightclub shooting held rescuers back and people were taken out in pick up trucks.  Also true.

 

As an EMS Captain for a large, busy EMS system I can relate to many of the challenges in staffing a TEMS team that can line up and be ready to go in with the second or third wave, the Rescue Task Force.  The training usually involves everyone arriving together at a safe location, donning their gear and going into an office building of some kind.  Neato!  Now imagine the real life call when the first 2 patrol officers report an active shooter and the ambulance beats everyone else in.

 

Hazzard, based on the article, wants the public to expect that ambulance crew to don their vests and helmets, grab their trauma gear and line up!  After all, isn't it worth my life to save another?

 

No.

No my life is not on the table to save another.  My skills are here to do the most good for the most people.  Getting shot to save a life while 3 others perish is not heroic, it is right out of Hollywood who has a horrible track record for accuracy of our profession.

Do we take risks?  Absolutely.

If trained and equipped will I enter a hazardous area to perform a rescue?  Absolutely.

If I am surf rescue qualified and see someone in distress in the water without my gear will I risk my life for theirs?  Absolutely not.

On a side note, I would imagine many folks who are pushing for TEMS gear and limited training were also against cops getting Narcan.  "They don't have the training to administer it and do a good enough job!"

Same as we don't yet have the training to TEMS everything.

A successful TEMS program deployed in the community is a great idea, throwing gear on the rig because it's the latest, greatest thing is going to get someone killed.  And chances are that someone was the only one who could have saved the rest of the injured at the scene.

 

Stick to writing TV for now Hazzard, your concepts will look better from my couch than the Command Post at an active incident when people are down.

Monday, August 22

What's with the French?

A few of you have sent messages about the weird post I put up completely in what Google Translate calls French.  It was an apology to a person I couldn't communicate with.  Emails to me said, "I can't understand what you're trying to say" and " Why not just tell us what you wanted to say in French?"

 

I wanted to see if, even using the tools we have, if I could convey myself and I kind of could.  Sort of.

 

Point of the post was to show that even when we think communication is happening, the meaning may not be getting through.

 

Thanks for reading,

HM

Friday, August 19

the Crossover - Ep 69 - Twelve Ninety




crossoverlogo300In this week's episode, MC and HM discuss Selma, Alabama, and their issues with pay. Two days in a row, officers called in "sick" (what is referred to as the "Blue Flu") to show solidarity and unity with regard to their abysmal pay.

The guys talk about solutions (some of which are likely to be unpopular) and what those officers may want to do to improve their financial well-being.  It won't be easy when they're paid $12.90 an hour.  No, that is not a typo. Twelve Ninety.  Below is the link to the article referenced on PoliceOne.com.

To our friends in Alabama: Keep the faith, fight the good fight, and remember why you took the job to begin with...because it sure as shit wasn't the pay.

And speaking of pay!

Don't forget to check out Patreon.com/TCS to show your support for the show! Believe it or not, this show takes a modicum of effort and planning...two things our heroes do not excel at. So, show them some love at Patreon!

And please hit iTunes and rate our show!

BOLO:


Dataclysm by Christian Rudder

The Millionaire Next Door by Thomas J. Stanley

Resource:


Blue Flu Article on PoliceOne

LISTEN NOW!


Thursday, August 18

Désolé

Votre mère était malade et ne pouvait pas parler.  Vous ne parlez pas ma langue.  J’ai essayé de mon mieux, mais je n’avais aucune idée que les hommes qui ressemblaient à moi ton père ont enlevé il y a une semaine et vous ai jamais revoyiez.  Vous étiez tellement peur que tu m’as fait peur.  Nous avons essayé des signaux à main, téléphone apps, mais même pas une voix familière d’un ami de la famille au téléphone pourrait vous calmer.  Vous criaient comme si votre vie avait été prise auprès de vous et, après avoir plus tard constaté sur la mort de ton père, j’ai compris pourquoi.  Désolé.  Je suis désolé, j’ai dû forcer la main de main de ta mère malade.  Je suis désolé, que je devais avoir un des pompiers maintenez vos bras dans une étreinte vous a crié et coups de pied.  J’ai dit à vous s’il vous plaît soyez calme, nous avons été aidée.

Vos cris s’est évanouie à un cri, le cri d’un gémissement et un gémissement d’une étincelle d’espoir que nous avons contribué à ta mère éveiller en face de vous. « MAMA ! » est tout ce j’ai compris que tous les deux de vous a éclaté en sanglots.  J’ai essayé de vous dire que j’étais Désolé d’utiliser une application idiote sur mon téléphone.  J’ai même essayé il prononcer, mais vous ri au lieu de cela.  Et c’est tout que j’ai eu besoin.

 

Je vous souhaite tout le meilleur, Capitaine Paramédic Schorr

Sunday, August 7

the Crossover Show - Ep 67 - Traffic Stops and Profiling

crossoverlogo300In this week's episode, HM and MC discuss Hamden, Connecticut's police chief and his request for his officers to conduct traffic stops based on moving violations instead of mechanical violations. You can read the piece for yourself here.

Why, you ask?

Seems the Hamden PD has been stopping a more significant amount of mechanical violations when the driver is off a non-caucasian persuasion.  As if you need to ask, Happy has data and numbers when it comes to this episode.

Tune in for our second FB live experience.

Don't forget to jump on iTunes and rate the show 6 stars (don't worry if you can't see that sixth star...it just means you haven't rated enough podcasts yet) and give the guys your feedback!

Also, you can support the show by visiting Patreon.com/TCS. Show the guys some love! The show is always free...but hosting it ain't. Thanks in advance for your consideration!

 

GO LISTEN NOW!

Saturday, August 6

Actually, Officer, No.

Officer Unclear on the Concept strikes again.

 

Dispatched to a diabetic male, unable to walk.  On arrival witnesses state a man seemed tired and has now walked over 100 meters.

When they finally caught up with the tired looking man he was accompanied by a police officer.

"What seems to be the trouble tonight Sir?" Rescuers ask.

"Nothing, why?  Why all the attention?" He asks.

"Maybe this isn't the right patient?" One medic asks themselves out loud, trying to figure out why they are chasing this man.

"Hold on, Pal," says the Officer, "I'm not letting you go anywhere until you sign their refusal."

 

Officer, that decision does not have you in it.  You can not require it, request it or use it as leverage.  If the person in question is being detained for law enforcement reasons we are more than happy to perform an evaluation.  However, if the person is not being detained, held, or in any other way involved with law enforcement, there is no point where your badge can require a patient refusal document for a person to continue on.

That decision is between us and them and has zero impact on their ability to continue on where they want to go unless you have another reason.

Please feel free to stand nearby and see your concerns melt away, but please don't use your authority on my behalf when I'm not there.

 

Respectfully,

The Medics you called

 

Sunday, July 31

It Really isn't that hard to try

A little bit of effort goes a long way.

I recently had the opportunity of tending to a fellow who tripped over a suitcase being pulled by someone in a hurry.  He took a tumble and broke a finger.  It hurt like hell and we did our best to get him comfortable, recommending a trip to the urgent care, local ED or even our onsite clinic.  After all, if it doesn't begin to heal properly it can remain disfigured.  I have an old injury to prove it.

He refused and just wanted to get on the plane and go home.

The airline, however, had other concerns.

 

There are 2 distinct conversations that take place when you're hurt or ill at an airport:

First, the usual EMS conversation about assessment findings, treatment options and transport availability.

Then a separate conversation takes place between the passenger and the carrier.

 

If the carrier wants you to go to the hospital, you are allowed to tell them to go pack sand.  They can deny you travel.

If I tell them to let you on the plane, they can tell me to go pack sand.  And then deny you travel.

 

When the airline supervisor was concerned about the injury I simply explained why I was comfortable letting the patient refuse transport and reminded them that if there was any real concern we would recommend to the airline that they restrict travel.  When we suggest that, they listen.

 

When an airline representative is nervous I do my best to calm them.

Sometimes it works, other times it doesn't, but I've been noticing in recent weeks I am met by first name by the representatives and soon after we discuss the patient's options with the patient, the rep asks what I think they should do.

 

I could have gotten upset, raised my voice or tried to assert some kind of authority early on but I'm fairly confident this would not be the end result.  A little effort now will go a long way later.

 

Try it.

 

 

 

Thursday, July 28

When Patients Don't Play by the Old Rules

You had a simple job, Mr patient.  All you had to do was follow the script.  I am highly trained and very experienced in the interventions you needed.  I have done countless thousands of chest compressions, delivered many score of shocks and can interpret dozens of heart rhythms.

You collapsed to the ground.

I specialize in that.

You weren't breathing.

I carry tools to help oxygen get back into your lungs.

All you had to do was play along.

Our training has included intubation during compression for years and we are quite proficient.  The IV fluid meant to flow into your vein and into your heart can carry chemicals they give me to get your heart beating again.

The state of the art monitor I carry can let me see every aspect of your heart's activity and deliver therapy accordingly.

Our tools can determine your oxygen saturation, blood pressure, mean arterial pressure and many, many other metrics.

All ready for you in case you need it.

You didn't need it.  You aren't playing by the old rules, are you Mr patient?

 

You collapsed in a crowded public space.

You hit the ground at the feet of two persons trained in bystander CPR.

They began compressions almost immediately, which drew the attention of a nearby Police officer.

The Police officer pulled the Public Access AED not 30 feet away and attached the pads.

 

By the time the dispatcher sent the call out you had already been defibrillated and the second round of CPR was just starting.  By the time I made it to the far side of the bay to respond the same dispatcher told me you were awake.

And you were.

Joking, telling me your ribs hurt because someone just did CPR on you, I tried to apply all the tools I had, all the training, education and experience...but you needed none of it.

What used to be a shot in the dark is turning into people walking out of the ED the next day.

That's where I saw you, climbing into a car, telling me all about how cool it was to die and come back.

 

They didn't prepare me for that.  Score another one for the good guys...the bystanders.

Saturday, July 23

Letters in the File - Oklaloosa Selfies

blog fileMan is this typewriter dusty!  I haven't written anyone up in a long time!  When this story first came across the feed I thought to myself, "No one is that stupid."

I can be funny sometimes.  People are indeed that stupid.

Kayla Dubois and Christopher Wimmer (Not winner) have been arrested for taking self portrait photos with patients.  Seems harmless enough, right?  A contest between practitioners bored silly from interfacility transfers and take homes is in poor taste, violates privacy and is, well, stupid is harmless enough I guess.

Oh, not all the patients gave consent and you touched them too?  Yeah, you are a special brand of stupid aren't you?

According to reports these idiots posed with patients who were unconscious, intubated or otherwise impaired and not able to give consent for your stupid game.  Jayne Cobb, noted philosopher, once noted when seeing a Reaver, "Cutting on your own face?  When does that get fun?"

Mr Wimmer, when does it get fun to expose an elderly woman's breast and photograph it?

Are you fucking kidding me right now?  If I was in your chain of command you'd be gone so fast the contents of your locker would be curbside before you finished reading your termination letter.

And Ms Dubois...I...I can't even.

 

The more I think about what you did to ruin the trust the public gives us makes me physically sick.  I read the story, then again and literally my joints hurt.

You didn't screw up by taking the photos or even sharing them, you screwed up by even thinking this was a good idea in the first place.  "When does that get fun?"  Never.  It never gets fun to violate a patient's trust especially when that violation involves touching, exposing and ridiculing.

 

You're both out of here.  Your stuff is at the curb.

Friday, July 15

the Crossover Podcast - Ep 64 - Turning Passion into Retirement

crossoverlogo300In this week's episode, HM and MC welcome back their last guest (because he wasn't allowed to leave after finishing the prior week's recording), Keith Graves with Graves and Associates.

Keith and the guys talk about something that should be on every first responder's three-discipliner's mind: What in the world to do after retirement?

Most cops try and double-dip with other department's, but HM wants to know what plans Keith and MC are working on to avoid going back to that trough.

Resources for this episode


Keith Graves' Butane Hash Oil Investigations: A Guide for Law Enforcement

Pat Flynn's Will It Fly

Alan Weiss' Million Dollar Consulting

Udemy

Teachable

Think you're ready to turn a passion into a post three disciplines hobby or new career?  GO LISTEN NOW!

Wednesday, July 13

Why Pokemon GO is so much like EMS

Like many of the man children in the world I too downloaded Pokemon GO to see what all the fuss was about.  The idea seems OK, you go around trying to pick up creatures from random places, then try to find large arenas where you can compare yours to others.

My, God...we already play this game!  It's called EMS!

From the front seat of the ambulance we receive a notification of a patient nearby, not unlike when my phone buzzes to tell me there is a two headed Doduo on my neighbor's lawn.  Sometimes they can be stealthy.  A little Bulbasaur with a stubbed toe seems to be common, or a Pidgey with a cough and a sniffle.  The more rare catches are few and far between.

We collect these patients and take them to the local arena, or hospital to see who has the larger CP (Care Points) meaning they'll be seen first.  They don't fight one another, mind you, but seeing the look of defeat on another EMS crew's face as you stride past their Caterpie with the rash with your nauseous Pinsir is an epic win!

Pokemon GO has people walking into traffic, congregating in random parking lots and, in general, just acting strangely.  When a rare Pokemon shows up on their feed they immediately race to the location and try to grab it to take it to the arena.  EMS does the same thing when a rare case pops up.  We race to the location and do our best to catch them and take them in.

When I showed the game to my 8 year old, she saw that there was a creature standing about a half block away. "Daddy, let's go for a walk and go get him!"

That is a nice change of pace for a game:  Get out and do something.  Just watch your surroundings or else you'll end up in our EMS version.

Pokemon EMS!

COLLECT THEM ALL!

 

 

Thursday, July 7

Us Against Us

I heard the news today...oh boy.

The live stream out of Dallas has me avoiding eye contact with my best friend for the last few hours.  Shooting pool at my buddy Motorcop's place is in my top 10 all time best things.  So what does it say when I'm so distracted by the news that I can't have fun?

Al Queda.

ISIS.

Iran.

We spend so much time and effort hating the other, the enemy, the infidel, we forgot about each other.

Terrorism is harder and harder to define anymore.  Even in the midst of preparing a "Response to Terrorism" for my agency I see Dallas and think, "Who is the bad guy?"

In the movie PCU the lead character "Draws" brings a crowd of college kids sick of being force fed political correctness to action by telling them, "It used to be us against them, now it's us against us."

Us against us.

We don't need ISIS or ISIL or Daesh or whatever the hell their brand of hate is called anymore coming around and ruing the American dream for us.  We did that to ourselves.  A long time ago.  This is nothing brought on by this President or congress or the last few even.  This has been boiling in the background for scores of years waiting to explode right here, literally in our own FRONT yards.

Sadly, there are those watching the chaos unfolding and rubbing their hands, glad to see it finally happening.  Fuck them.

The rest of us are in fear for the future we hope to leave our children.  A world where I can shoot pool with my friend and try not to let on that half a dozen of his brothers lay injured or dead because we as a nation can't seem to get our shit together.  Black Lives Matter, All Lives Matter...both sides sound like siblings upset over who gets the last slice of cake while others starve.  No shit lives matter.  I'm a Paramedic I could have told you that a long time ago and saved you all this strife, but it was already generations too late.

I pray, which is a big deal for me you know, that tomorrow the aliens will attack and we can come together as a species and see past our differences and just live alongside one another in some reasonable form of peace after kicking ET's ass, as the noted thespian Will Smith once said.

 

If that doesn't happen tomorrow I'm not sure what I'll do.  Probably go to work and hear about how ISIS is the biggest threat to America.

As far as I can tell, America is the biggest threat to America.  Our nation has lost sight of the first word of the document we just celebrated.  All we talk about is emails, scandal, oligarchy, TV channels, celebrities and when the next season of Naked and Afraid starts.  When we do pay attention to our founding documents it is with a selective tone and seeks to support our argument rather than to inform it.  The focus is on the amendments as if they are the end all be all and yet we so often forget the first word:

We.

We the people.  We are responsible for this chaos.  We.

It isn't us against them.  It's us against us.

And it sucks.

 

Tuesday, July 5

Apathy is worse than absence

One of the things I hate most about EMS is apathy.  A provider who has checked out mentally and simply no longer cares is far, far worse than one who simply doesn't show up.

 

I recall having a driver on the ambulance back in the day who simply didn't care.  Slamming doors, mumbling under his breath about how this band aid wagon crap wasn't his job.  His mentality radiated not unlike a hazardous material I couldn't escape.  Every call was a waste of his time, every turn a chance to slam on the brakes and treat the ambulance like a stolen sedan driven by an adrenaline stoked 14 year old.

Despite my multiple suggestions for caution and calm he continued his drag racing, brake slamming and grumbling.

It was months later, after many discussions with him and the Company Officer that he finally broke enough dishes that he didn't have to wash them anymore.  The solution was not to reprimand him for not doing his job, but instead reward him with exactly what he wanted...off the ambulance.

I could have had a better day by myself instead of having to deal with the apathy which later led to disregard for due caution sand common sense.

If you encounter someone who just can't understand why they are being so mistreated as to actually have to do their job...welcome to EMS.  Fire based, third service or private we all have those folks who just can't bring themselves to care.

What can we do to change it?

Monday, July 4

So Now I'm Back!

From outer space!

I just walked in to find you here with that sad look upon your face,

I should have changed that stupid lock I should have ... what?

Are we not in a singing mood?

 

Fresh off a 2 week wandering of the coast of Alaska your Pal Happy is back in HMHQ exclusively to ramble on and on about this thing we still call EMS.

Ground rules remain the same:  My writings are my own opinion, I avoid talking about specific work related stories (Although sometimes I reaaaallly wish I could) and anything that offends you in here is your problem, not mine.

 

On that note a few ideas I've been tossing around for my Firehouse World Presentation, "That's why we're here, but that's not what we do," centered around culture and decision making in the Fire Service and EMS.

When someone tells me I'm crazy for running into burning buildings I used to respond, "No, I crawl in taking calculated risks."  I have always marveled how 2 people with similar backgrounds, training and experience can make 2 completely different risk assessments given a specific situation.

Of course it mostly comes down to experience and the number of times a person has encountered that exact situation.

For example, 2 Engines arrive head to head at an apartment fire.  Officer 1 has 25 years and has been to 4 apartment fires.  Officer 2 has 10 years experience and has been to 10 apartment fires.  One has had more opportunity for experience while the other has actually built up experiences that can impact the current situation.

In his book Thinking: Fast and Slow Daniel Kehneman addresses the way our brains process risk, which he states is simply the way we address randomness that can not be explained.  He goes on to say, "Biased reactions to risk are an important source of erratic and misplaced priorities. The availability cascade – easier to recall justification leads to misplaced weight on risk analysis."

What this means is that our Officer on Engine 1 with more years in, if unable to immediately recall his last apartment fire, will calculate risk based on the easiest to recall information that may, or more likely may not, be useful in that situation.  The Officer on Engine 2 may have more recent apartment fire experience to recall easier.  Both will use their experiences to assign risk based on the ability to recall the situations present.

This means that being to 100 fires on the Truck does not prepare you for a single fire on the engine and vice versa.  When you tell me you've been to 20 fires this month, how many were you first in?  How many on the first truck?  Supply?  2nd in on the 2nd?  What kind of experiences are you drawing on to make decisions at a fire and how long will it take your brain to process those experiences?

We talk in the fire service about decision paralysis, how newer officers can sometimes freeze at the scene and not know what to do.  That is because their brains are rifling through the rolodex looking for experiences to calculate the risk of certain actions.  It's the same way you process what to eat, where to go and what to say.

Separate from that action is the application of cause and effect of one's actions without considering the entire event.  For example, Engine 1 quickly knocks down a kitchen fire just before Truck 1 vents the roof.  The fire goes out and Truck 1 feels as though their actions had a positive impact.  At the next kitchen fire each member of that crew will recall cutting the hole and the fire going out and will apply the same intervention, regardless of whether or not it might work.

We try to limit this kind of application of risk with training based on the latest research.

I say try because so many Firefighters would rather apply their own experience based observations over those of a controlled experiment.

 

We only fool ourselves when we allow limited specific experience to dictate our actions, yet that is exactly how our brains work.  Only through continuous hands on training and exposure to other fires, usually via helmet or scene camera or discussions with those directly involved, can we collect observations to aid us in quickly recalling experiences to apply a risk calculation.

So what does all this mean in the end?  It means that, based on how the brain makes decisions, it may be more useful to watch an entry team from a helmet camera than it is to stand across the street at the actual incident.

In no way am I claiming that a "youtube firefighter" will gain the experience and ability to be a firefighter, I'm saying that standing across the street at that fire does not give any useful experience for later application.

Unless, of course, you sit down later and ask them, "What did you see?  Feel?  Hear?  What was your plan?  Did it work?  Why not?

These conversations seem to be happening less and less from what I hear, mainly because if an entire house goes on the same fire most members will apply the same level of experience, "1 fire" instead of standing back and asking, "What did I learn from this experience?"

 

More ramblings to follow...

It feels good to be back home.

Thursday, June 16

Changes are a-comin'

Hey gang,

 

This is one of those blogger break notifications we use from time to time to step away from the keyboard and gather our thoughts.

You may have noticed that over the last year or so my thoughts have been fewer and far between here at HMHQ and that was because I was focusing on other outlets.  Speaking, writing an ebook of scenarios and working on another ebook about the 101 Things Your Fire Department Wishes you Knew.

Most of you saw me contributing to UniformStories.com for the last 2 years with this article about that or that list about this.

I have decided to focus less on lists and deadlines and more on ranting and continuing to impact this thing we still call EMS.  I miss the days of picking fights with DiverMedic, TOTWTYTR, Kelly and Scott and Chris (Before he went and made CPP so successful) (and after).  I miss late night conversations with Ted and MArk about what huge project was next.  I miss when we were so excited to change things for the better we began to see it happen.  I lost sight of all that.

Time to regain focus.  But first, we cleanse the palette.

These next couple weeks I'll be taking the family to the Great White North for a few weeks to get our heads screwed back on.  Remember last year when I told you about the fallacy of the bucket list?  Places, not things.

So we're going some places.

 

The feeds will be quiet until July but with any luck I'll have a huge announcement about the future of this little therapy experiment and what could he an amazing opportunity for your ol' pal Happy to spread his wings and try something new.

 

Keep checking back, I've been known to take 4 day month long breaks in the past.

 

Stay safe and put your seat belt back on,

HM

Wednesday, June 15

The Sounds of Silence

I have written before about the senses in EMS, the things we see, smell and feel.  I was prepared to write about the worst things we hear when I read an article that stopped me in my tracks.  I had to sit down here in the house and collect my thoughts while fighting back tears and I am on the far end of the world compared to Orlando.

 

Paramedics, Firefighters and Police hear some of the worst things imaginable.  We hear vitriol spewed from the darkest souls imaginable, often geared towards us or our female relatives.  We hear families torn apart by violence cry to their Gods to bring their loved one back.  We hear the pleading of a husband for us to please help his wife to live again.  “Please.  Please do something!”

It may be cliché but the worst thing I thought I could ever hear was the silence of a dead child.

 

This morning has me thanking those same Gods that that is the worst thing I have heard because our Brothers and Sisters in Orlando are hearing far, far worse in the aftermath of the murderous rampage by a creature so twisted I will not refer to it by name or by species.

 

The teams searching the Pulse nightclub for survivors, treating the wounded they found and especially later, cataloguing and sorting the bloody mess that remained had to suffer a sound so simple, so common that you may need to take a moment to imagine it.

 

A phone ringing.

 

For years these rescuers will hear the echo of a phone ringing in their nightmares.

You see, as the event unfolded, friends and family frantically called their loved ones to find out if they were OK, hiding maybe in the bathroom or made it out and sought refuge in an alley.

50 bodies in the building.  Likely all with phones.  Likely all of them ringing.

Ringing nonstop as multiple people tried to call.  Ringing nonstop as more and more phones began to call out to their deceased owner and no answer would come.  Ringing nonstop as rescuers sort through the chaos in the hopes that one of the phones could soon be answered by someone who can say to the caller, “I’m OK, they found me!”

Another 53 were wounded in the small club, I don’t know how many were pulled out by other club goers or rescuers, but their phones were likely ringing as well.  Some too injured to answer while those that could answer were likely unable to speak after seeing the tragedy unfold before them.

 

The ringing.

Songs and tones, sounds and voice clips, each one as original as the person lying in the blood, unable to answer.

That is a sound that chills my spine just to imagine it, but our Brothers and Sisters will never be able to unhear it.  That sound will echo in their minds and their hearts the rest of their lives.

 

Of all the things we hear, I thought silence was the worst.  I hope it remains that way for me, and for you too.

Tuesday, June 14

I know that feel, Bro

My new article at Uniform Stories talks about the worst things I've felt as a Paramedic.  Mainly it focuses on tactile feeling instead of emotional feeling but of course when things are bad the two intertwine.

 

In the wake of the Orlando mass murder, many folks are sharing how hard it would be to walk through the night club and hear all the phones ringing.  Powerful indeed.

 

Then a friend of mine at work posted the following status update:

"Went on a fatal shooting last night.  Nothing new, I was just trying to imagine 50 of them in one room."

 

Take a minute and digest that.  Put aside all your pro-gun, anti-gun, tolerance and anti-muslim back and forth and just take a moment to think about that.  50 of them.  In one room.

I hope I never have to feel that.

Friday, June 10

TCS - Ep 59 - SHOOT HIM!

crossoverlogo300In this week’s episode, HM and MC jump directly into the topic with little folderol and even less brouhaha.


On May 28, 2016, Flagstaff officers shot and killed an attempted carjacker who was armed at the time of the incident. Whilst that may seem par for the course, that really isn’t the bigger story.

The bigger story was the ferocity with which the guys watched the video and yelled, “Shoot him!” repeatedly.

That’s right. A fire guy with zero police experience and a cop both had similar opinions about when it was legal, legit, and damn near a moral imperative to shoot the carjacker.

Thing is, though, they didn’t. At least not soon enough to satisfy your hosts. Thankfully, officers were uninjured, the bad guy is in the ground and no civilians were harmed. Tune in and hear all about it!

 

YOU LISTEN NOW!

Sunday, May 29

CISD with OK GO part VI

CISD - Critical Incident Stress Debriefing

OK GO - A band

 

This is another in what I thought was a complete series of dealing with PTSD using the music of OK GO.  For over 4 years I've been seeing parts of my recovery in the lyrics of their songs and the images of their accompanying videos.  What started as a 2 song idea has clearly expanded as my recovery does.

We’ve covered the initial reaction – Don’t Ask Me How I Feel Part I, The Invincible stage of recovery Part II, then ask ourselves “WTF is Happening” Part III.

Then we realized the healing process is almost complete in Part IV – This Too Shall Pass.

When we think everything is OK we see the boys on their treadmills and realize Here it Goes Again.  We were done.  Or were we?

 

Recently OK GO released the video for their song Upside Down and Inside Out, filmed on a zero G training plane.  A number of the lyrics from this song struck chords with me in relationship to my continuing recovery.

"So when you met the new you, were you scared? Were you cold? Were you kind?  So when you met the new you, did someone die inside?"


I was stopped in my tracks by that line, it hit me like, well like the song says immediately following that line and in an aggressive tone, "DON'T STOP! CAN'T STOP! IT'S LIKE A FREIGHT TRAIN!"

Coming out of my injury period and trying to get back my mental footing was a challenge I look back on often when I wonder what we all do, "Am I the best person I can be?"

When I met the new me I did feel like someone died inside.  Was it the old me?  The questioning me?  The scared me?  It wasn't until almost 2 years after the injury that I came to complete terms with it, or so I thought.  Hearing these lyrics got me thinking about not just trying to move on but dealing with this nagging feeling:  If that had ceiling had never knocked me down, would I be the same person today?

The song goes on to tell us...

"Looks like it's time to decide.  Are you here? Are you now is this it?  All of those selves that you tried...wasn't one of them good enough?"

Well, damn guys, here I am again wondering how you can read my thoughts, this line had me confused I admit.  You go on to tell me "Because you're upside down and inside out and you can feel it. Inside down and upside out and you can feel it. Feel it."

Right as I contemplated this line, that when things are upside down and inside out, arguably completely messed up and you can feel something good, that must be a good thing, right?  Then we mix it up and create more chaos by telling me I'm inside down and upside out and I can still feel it?  That must be good, right?

Uh oh, here comes the freight train!

All the chaos, all the confusion, all the crap they had going on in this video, and I'm seeing my recovery.  Up is out, in is down and I can't shake the feeling that I'm supposed to be someone else sometimes, some other person.

Of all the selves that I tried...is this one good enough?