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:






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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.