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