Monday, February 29

To the Intern Who Froze

You were standing there like a dear in headlights, staring at me crouching near the lump of a body.  I was most of the way through my primary assessment and your EMT and Medic crew kicked into gear taking up positions yet to be filled.

You stood silently, about 4 feet back, eyes fixed on the skull fracture, unable to look away.

I could have yelled at you.

We could have screamed for you to suck it up and get your head out of your ass.

We didn't because we know you needed that moment.  That moment when all your schooling, training, testing and evaluation combine to offer what your proctors never could: Actual life threatening trauma.

We've all been there and had that moment, believe me.  The same self doubt, confusion and sense of awe has raced through the mind of even the most confident provider you know (yes, even them) and shook their core.

They got over it, and so did you.

After a few moments of your Medic calling your name you let your training kick in and did a bad ass secondary assessment on a complicated patient.  Your skills were evident, your soul just needed a reality check.

 

Oh, and it WILL happen again.  When it does, take a deep breath and remember how it felt when you got down there with us and started doing everything you know how to do.  Keep that feeling close.

-HM

Sunday, February 28

the Crossover Show - Episode 44 - Day of Remembrance

crossoverlogo300In this week’s episode, HM and MC talk about a recent decision by the San Francisco Board of Supervisors to have a “day or remembrance” for Mario Woods. Don’t know who he is? Listen to the show or, you know, hit up Google.


Anywho, both MC and HM take umbrage with the Board of Supervisors in the city of San Francisco. HM, being the gentlemen lays some of the responsibility on himself as a member of the community; MC, on the other hand, takes a different road and extrapolates the Board’s decision to be endemic of the culture at large.


What’s your take?



HAVE A LISTEN

Thursday, February 25

New at Uniform Stories - Raising Revenue

[caption id="" align="aligncenter" width="900"] UniformStories.com[/caption]

One of my first posts here at HMHQ was about 10 New Responsibilities of the Fire Department in light of decreasing fire calls.  For my newest column at Uniform Stories I've added 5 more.  Have a look and see if maybe you already do some of these!

 

10 New Responsibilities of the Fire Department

5 More Ways the Fire Department can Increase Revenue

 

Want to stay up to date on posts here, columns at Uniform Stories and conferences?  Sign up for updates from HMHQ in the sidebar!

 

Thanks for reading!

-HM

Sunday, February 21

BLS Fire Officer or Paramedic - Who Makes Scene Decisions?

The answer to this is quite simple, really, so long as you are on the 99 of 100 EMS runs being tended to by a BLS Engine (That's for stopping the clock and bringing an AED to an asthma call) and an ALS ambulance.  In those unrare and remarkably common cases the Paramedic, the highest license there, is responsible for assessment, treatment, reassessment and the decision to transport or seek alternate methods of conclusion.

 

All too often, as you and I know, the BLS Fire Officer likes to get involved and use their rank at the scene to try to force a conclusion.  This is usually in the case of a patient who the BLS team thinks needs a hospital (They are most notably horrible at this determination) yet the ALS team seems to be leaning towards a referral or refusal.

In the BLS team's defense, the ALS team is not very good at determining patients who will be ADMITTED to hospital, but as the responsibility of care falls onto the shoulders of the Paramedic at the scene, it should be no surprise when said Paramedic chooses to defend the patient from the BLS Fire Officer.

This is when voices get raised and patient care suffers.

 

I was asked by an EMT in my system if any patient care scenarios or MCI questions were on the Fire Officer exam in our Department.  After I wiped the tears from my eyes and stopped laughing hysterically, I had to wonder:

If 80% of what they do isn't even considered a skill to be tested for promotion, where do our priorities lie?

Perhaps that is part of the reason for the rift?  We train our officers to be managers of engine companies, then forget to train them up on EMS runs, I guess assuming that their experience watching Paramedics make decisions will serve well enough.

Well, friends, we all know that sure isn't happening.

So what's the solution?  We can't shout "Third Service" in the living room of Mrs Fishbuscuit when the BLS team is telling her to goto the ER "to get checked out, it could be a stroke" because a scary dream woke her up.

We need to bring these events to the attention of the administration.  Not as a "write up" or "complaint" but as a concern.  If the BLS team makes a mistake and I try to tell the state "But the Fire Officer out ranks me, HE made the decision!" they'll take my license just as quickly.

 

Ask the training folks what training officers receive regarding EMS or MCI response.  Ask that they offer a course and, if they hesitate, offer to teach it.  Be part of the solution or get used to dealing with the problem.

And the best way to handle a BLS team not co-operating?  Cancel them on the radio.  While they're in the room.

Friday, February 19

the Crossover Show - Episode 43 - Viewer Questions

crossoverlogo300In this week's episode, MC and HM let the viewers on Periscope offer up some questions. Viewer TMChancellor asks the guys about a 10-13.

After much googling (to no avail), TMChancellor let the guys know a 10-13 in his jurisdiction is a medical doctor ordering a patient restrained and transported.

After marveling at the odd violation of any number of rights, HM and MC talk back and forth about protocols, crazy people, and lazy cops, EMTs and Firefighters who deplore paperwork and look to screw the other guys instead of doing the right thing.

 

LISTEN NOW

Friday, February 12

Why Budgeting Matters - Our Plumbing Nightmare

You have heard me, MC and Sean Eddy go on and on about budgeting.  You've heard us beat that horse dead a number of times.  Trouble is, the horse keeps getting back up and more and more of our brothers and sisters in the 3 disciplines are sinking into debt.

MC and his bride paid off a shit ton of debt, $77,000 if I recall, all while on a cop salary and raising 2, then 3 kids. They took that experience and turned it into a venture to help others in their situation, GPS Financial Coaching. Mrs HM and I watched from the sidelines as they put their noses to the grindstone and sold anything not bolted down (A Dave Ramsey quote).  We never went full Ramsey, we weren't very deep and had paid off the credit cards a few years before they started.  The big thing was the budgeting.

Let me start off with why, then I'll tell you the how.

We live in a house built in the 1950s.  It has charm and character.  It also has 60 year old pipes.  The other day the wife calls me at work (first day of a 48) and informs me that water is backing up into the sink in the garage.  It shares a drain with the washing machine so I walk her through some basic drain cleaning steps and a few hours later she calls to tell me the water has gone.  Cool.

I get home 2 days later and crawl under the house to see what I can see.

What I see is standing water in my crawlspace and the drain line from the front of the house completely broken free from the sewer system.  Sewer gas and water from the garage, laundry and kitchen has been flowing into our crawlspace the entire time.

I believe my initial response after crawling down there was something along the lines of, "This is bad!  Holy Shit this is bad!" because when I came back up, covered in stench, the 9 year old was in tears.  Later I would find out it was because she knows that if daddy panics there is trouble.

We got a plumber to solve that problem very quickly.

PlumbersWhat we didn't know was that the pipe didn't just fall out because of poor strapping and support, like we thought.  This was a symptom of a larger, more ominous problem.  A problem that would become an emergency later that night when the drains began to back up into our brand new shower.

After cleaning it out and waiting, it eventually drained but the plumbing company sent a crew out to assess the problem today.

Here's where the budget kicks in.

Do you have $5000?  Right now?  Because they just spent 5 hours trying to unclog the lines and can't get more than 5 feet before finding broken pipes.  And that only covers what we can see.  They have to break up asphault and concrete, dig down and make repairs.  Repairs on pipes that haven't moved in 60 years.  Oh, and there's still another 50 feet of pipe to inspect.  Sure you could "put it on the card" and hope you get hired for a few dozen overtimes, but because we followed MC's example and looked months ahead we have an Emergency reserve.  Add to that we've been saving for a new roof and this disaster goes from a "We're ruined" to a "We need to fix the budget to reflect these new expenditures" while not cancelling our Disneyland trip while repairs are made.  That, my friends, is piece of mind.

There are a number of large holes in my back yard, broken sewer lines in multiple locations, we can't wash dishes or shower.  Toilets are only for emergencies.

And it is a mere inconvenience.

All because we thought ahead and paid attention to where our money goes.  Each and every dollar.

MC is not only a friend and a brother, he is an example of how to truly provide for your family.  I used balk at some of the extremes they went to but we learned from their example and are better off for it.

 

Get on a written budget.  I can not stress that enough.  Manage your money or let it manage you, your choice, but if I hadn't changed my ways I'd have no way to get the water flowing in my house again, let alone be able to pay it off later at 18% interest.

the Crossover Show - Episode 42 - Protesting a Rally with a March

crossoverlogo300On this week's episode, HM and MC talk about a recent incident on the Bay Bridge leading into San Francisco. (Check out the resources below.)

They dig a bit into the minutiae of the subtle differences between a protest, a march, and a rally. Not all of these are created equally, friends!

Listen to the guys talk about the life lessons HM Jr. Sr. learned at the hands of dilettantes and how she has now been armed with the knowledge required to bring about actual change instead of simply yelling to be heard.

Also, #BringBackRollerGames.

Please help support the show by visiting Patreon.com/TCS
Resources:

MC's piece on BLM
BOLO:

Skip Hail, Caesar. Rewatch Clue or go see Deadpool.

 

EPISODE 42

 

Don't forget to pop on over to itunes and give us a rating!  Unless that rating is PG.  We try way harder than that.

Wednesday, February 10

DC FEMS MD Quits, calls FD Leadership "Toxic"

Jullette Saussy, the most recent Medical Director to try to turn around our Capitol’s failing EMS service, resigned with a scathing indictment of the DC FEMS Leadership on Tuesday, Feb 9th.

DC FEMS, for those of you wondering what a FEMS is, was an attempt by DC Metro Fire to rebrand themselves from a Fire Department to a Fire and EMS Department. Turns out you have to do a little bit more than just change the logo on the side of the trucks.

 

Saussy is not the first Director (Assistant Chief) to quit, but is the first to do so with such blatant honesty I find it odd that there is so much uproar about it.

DC FEMS is broken. Has been for a long time. In the past we have all known why, but it was easier to blame the revolving door of EMS Directors for the short comings and move along.

DC FEMS changed Medical Directors and EMS Directors more often than most systems change the oil in their ambulances, Saussy lasting only 7 months before throwing in the towel.

At what point do you stop wondering why all your girlfriends leave you and look in the mirror?

According to DC FIRE…never. “It isn’t me, it’s them.”

 

This needs to be an awakening; a wake up call to all fire based EMS services. A disturbance in the Force so strong that it rattles the crossed bugles into realizing that the bulk of their business needs to be the bulk of their business. They need to hire and retain people who know what a healthy EMS system needs to survive and focus their energy entirely on that. Whatever other time we have we can devote to fire. You know, kind of the inverse of what you do now.

Full disclosure, I work in a fire based system. I work in one and go in everyday trying to make it better than it was yesterday and we’re seeing improvements.

Jullette Saussy tried to make DC FEMS better and was met with lies, distortions and outright negativity when trying to even assess the system. She states in her detailed resignation letter that she was not even allowed access to basic intervention information, provider charts or run time data. These are the nuts and bolts of the system that need to be adjusted to dial in the right levels of service. Without access to the true data and information, how can one propose changes to the system?

How can a Doctor treat a patient if they are never shown the patient?

Let’s call this what it is: DC FIRE is alive and well within the folds of DCFEMS while blaming EMS crews for long response times and not giving anyone in the tiny EMS Supervisory positions any ability to assess the system, let alone change it.

DCFEMS has failed. Again.

I call on the leadership of DC FEMS to admit that they are wrong, that their interior attack against EMS has failed and become a life safety threat to their citizens, their visitors and each other. It is time for DC FIRE to call a MAYDAY, evacuate and go defensive. The building is a loss, guys, get out before anyone else gets hurt. Get out of EMS.

If you won’t let people who know what they’re talking about do what they need to do, then you might as well hire a librarian as your next Fire Chief. Why hire someone who knows what they’re doing if you’re already decided on what you think might, possibly work based on a dream you had.

More ambulances does not mean shorter response times.

Shorter response times does not mean better patient outcomes.

More fire engines going to medical calls to “stop an imaginary clock” as Saussy says, isn’t working, never has, yet you are ready to double down on failure.

DC FEMS should be renamed DC EMS and the governing body devote the lion’s share of the operating budget to addressing the services provided. Then let DC FIRE fight for the scraps and figure out how to be revenue neutral while being managed by a Paramedic or Physician.

Insane?

Is it dangerous to manage a fire department if they have no idea how to do so?

 

Now you sound like us. You sound like the Paramedics, EMTs, Physicians and anyone with eyes who see what you are doing isn’t working. Your management is non-existent and when you had the brain cells fire to hire Saussy you forgot to do the one thing a true leader does:

Trust their people to do their jobs.

 

I recommend Dr Saussy be immediately instated as Chief of DCEMS and get this thing turned around. And if you need some more help, Doc, give me a call. Resume on request.

Sunday, February 7

the Crossover Show - Episode 41 - America Ball

crossoverlogo300Sports!


It’s SuperBowl Weekend! The irony of the timing is, well, ironic. MC and HM recorded this show a few weeks back and the subject is America Ball (that’s football for you not in the know).

Well, really, it’s about the use of resources at football games. Do there need to be ambulances at every high school football team in the nation? There are typically officers present…do they need to be there?

Listen in as MC and HM hash it out Crossover-style.

As a special treat, find out if the rumors of the origin of MC’s wrist injury is accurate!

 

Go LISTEN NOW

Friday, February 5

The more things change...

The more they seem to, well, change.

 

Oh, look at the new theme.  He seems to change it every few months like a balding man in his 50s trying to choose a new trophy wife.

Well friends (all 3 of you, plus mom.  Hi mom) I was finally forced to take this therapy experiment of mine into my own hands.  Since she first launched in 2009 on blogger, then moved to FireEMSBlogs, then to First Responders Network, someone else has been managing the framework of this internet thing for me.

That's just how the cookie crumbled and I found myself looking at an odd screen this morning saying my content did not exist.  I emailed Ted Setla to ask what happened and as I hit send my heart jumped into my throat.  A year ago he told me I would have to manage this site on my own.  I agreed.  Then I flaked.

Consistency.

So, the theme has changed and some of your familiar stuff may be gone, but the content is still all me.  Better or worse, there you go.

So please excuse the dust as I likely tinker with the site like I did in the early days when we discussed NHS with Mark, argued with Montera and Rogue about Medics on engines and roomed with Randy, Kaiser and Saling (Not together mind you, that party would collapse the universe as we know it) at conferences.

Maybe the content will improve to the level it was back then?  I wish...

Speaking of conferences, catch me at FDIC again this year in Indianapolis speaking on MCI response.  I am honored to be selected for the second year in a row and hope to see you all there!

 

See you at the big one,

HM