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.