Thursday, December 28

Patient - Defined. Wrong, but defined.

I nearly had a stroke the other morning.

As I came into work I was notified that our local EMS Agency, the agency tasked with telling me what I can and can't do as a Paramedic, has added a new sentence into a policy that makes it nearly impossible to believe they know what they are doing anymore.

I've been to the meetings where these policy changes are discussed and most are suggested by an ED doc upset something happened once out of 115,000 calls for service.

 

In our policy that defines what is required to document a patient contact, there were 2 bullet points that gave guidance as to who was a patient, since if you have a patient you must complete a primary and secondary assessment (including ECG and BGL), identify illness or injury, treat said illness or injury and offer transport.

Those two bullet points were:

  1. Anyone who requests medical evaluation. That makes perfect sense to me.  They want us here, we're here.

  2. Anyone who, based on practitioner impression, requires assessment or intervention.  Makes sense again, altered consciousness, folks who need us but can't ask for us by name.


That's all we really needed.  Either they want us or, if they were able to ask for us, they would.

 

Nope, now nestled inbetween sanity is insanity.  A new bullet point is included...

  1. Remains unchanged

  2. Any person for who assistance was summoned by a third party.

  3. Remains unchanged.


Do not adjust your TV sets.  Yes, the new policy states that a patient exists if a third party believes they are in need of assistance.   This means that, LEGALLY, there is a "patient" at every single 911 call regardless of the condition of the person in question.  If you sneeze and someone in a passing Lexus calls 911, I'm required to assess you and get a refusal signature.

We've fallen down more than a few rungs on this one and, so far, I can't get anyone in the agency to reply as to why this was changed.  All I can figure is that they're gearing up to start charging a response fee (Which is almost as stupid as the new definition of patient) and now delays units clearing calls where the caller was wrong (more often than right) which impacts the system.

And all for what?  So we can stay out of service longer to document how the 911 caller is not on scene and the man who sneezed is not giving consent for an unnecessary medical procedure and refuses to sign my form?

 

It's almost 2018 too.

Thursday, December 21

Merry Christmas from #TCS!

The Crossover Show - 136

In this episode, MC and HM celebrate some Christmas. The guys wax philosophic about holiday plans, traditions, and whine about their busy schedules (as they are wont to do) and let you down easy with announcement that episode 136 will be the last of 2017!


This episode is in no way brought to you by Alexa or her human sycophants at MCPD. In related news, MC got him an Alexa and he’s diggin’ it.


Not to worry, friends! HM and MC will be back and stronger than ever in 2018!


BOLO


Get MC’s book, Badges & Budgets, for FREE!


Support the Show over at Patreon.com/TCS


Rate the Show!






The post Merry Christmas from #TCS! appeared first on .


Source: the Crossover Show

Friday, December 15

Three Discipline Sponsors – Kosher or Corruption?

The Crossover Show - 135

In this episode, HM and MC discuss Mesa, Arizona, and their plan to advertise on the side of Fire Engines. MC is against it, HM is for it but they uncover a mine field of problems they hope Mesa has thought of ahead of time.


But why stop there? Why not an ad for a tow service on a traffic cop bike?


See? Problems…







The post Three Discipline Sponsors – Kosher or Corruption? appeared first on .


Source: the Crossover Show

Thursday, December 7

Has Video Killed the Radio Star?!

The Crossover Show - 134

They say that video killed the radio star but as far as the guys can tell…it ain’t helping all that much. In this episode of a cop and fireman having a beer and solving the worlds problems they discuss exactly what all the video is supposed to be doing for us. Everyone is taking video…what is it for?


The guys discuss MC showing video of a traffic violation in court, to a judge.

They also discuss a video from Statter 911 where a citizen live streams a fire response (and hilarity ensues)!


Is video even worth it if it isn’t being used properly?


BOLO


The Enemy of the State by Kyle Mills


Artemis by Andy Weir






SaveSave


The post Has Video Killed the Radio Star?! appeared first on .


Source: the Crossover Show

Sunday, December 3

Dispatch centers tracking the wrong things?

I was contacted recently by one of us internet EMS folks about their new role as supervisor of their dispatch center.  A qualified care giver with a thirst for knowledge from the old CoEMS days, they jumped into the role with both feet and, as too many of us learn in EMS, the admin pool is a lot shallower than we had hoped.

"Hey HM, I was wondering if you had a minute for some feedback on a project. I got the comm center job this week and am shadowing the current supervisor. So far I'm learning the basics OK, but we seem to be focusing on some random stats I would be curious to hear what you think about the stats?"

They go on to list the top 3 focuses of this center:

-Code 2 dispatches that result in code 3 returns

-Call taker processing between 5 minutes and 15 minutes

-Ambulance at hospital times "Wall time"

 

I can't make too much of a stink about those, except that I will.  Some centers look the other way, at least we have our eyes open.

Code 2 calls in this system have a response target of 22 minutes 90% of the time.  Code 3 calls, 12 minutes 90% of the time.  While no one can cite WHY these random numbers are pulled out of thin air (Why does the ambulance in this area have 2 minutes longer to arrive on scene than where I live? - easy answer is the contract they signed) at first glance this is a metric you'd want to take a look at.

Why did a non-emergency call become an emergency transport?

Our friend asked what the outcome was of the dozen calls they were looking at for the month and he was met by blank stares.  Apparently no one thought to find out if the emergency transport was warranted, justified or had an impact on patient condition.  While new research is leaning away from code 3 transports having an impact at all, we still need to take a look.

In 8 of the 13 returns, it involved an elderly fall.  The PCR's didn't have any time sensitive interventions, including pain control.  There was no discernible reason the crews used lights and sirens to transport these non emergent falls, until he interviewed the crews.  They stated feeling compassion for the patients who were found down after an extended period of time and wanted to minimize that discomfort.  When asked why no interventions were performed the crews (mostly) said they were not indicated.

So here we have a dispatch center about to upgrade certain fall calls based simply on the fact that crews chose to use the lights and sirens based on their observations of discomfort, without treating them or showing benefit.

I'd argue they're doing great but need to shift focus to a more concerning population in your data:

Code 3 calls that result in a non transport.

Why was an emergency call generated for a non-emergency situation?  Is it a call taker issue?  A call classification issue?  Could it be similar to the reason crews are transporting certain patients lights and sirens?  Sending crews out fast does not decrease system liability, it increases it.

Could it be a response metric issue?  Simply sending crews out code 3 on short runs to pad the numbers?  Sounds crazy but I've actually heard dispatchers discussing this, in multiple systems in more than 1 country.

 

Issue 2 - call taker processing between 5 and 15 minutes

WHAT?!  Unless there is a language barrier I can't imagine why it would take between 5 and 15 minutes to classify a call.  Look into that!

Issue 3 - Ambulance wall times

Ah, yes.  The hospital problem tracked by EMS.  We hear often that EMS can't truly ease ER workload simply by diverting patients, but oh hells yes we can.  When we have to transport every person who wants it, we seem to stack up at the ER.  Often times we are diverted to the triage desk in the waiting room with the minor injuries and chronic ailments but still have to wait for hospital staff to make space.  In my system we give a radio report with an ETA but they still act surprised when 5 minutes later we arrive and there's no bed.  One hospital in NM long ago had the bed assignment board next to the EMS radio.  As we made our radio report, they'd note it on the board and have a bed waiting.  When we arrived we'd check the board, goto that room and begin patient transfer.  After a few minutes the RN would arrive to take report.  Easy Peasy.  Nowadays we seem to be stuck with a triage nurse at a tiny little assessment computer more interested in the patient's billables than their condition.

Wall times are a hospital problem.  Their inefficiency slows EMS which then has an impact on response times, which then leads to non-compliance which leads to more cars on the road, you see where this is going.

 

So, Mr new dispatch supervisor, my advice to you is to look at everything, from all angles.  Look outside EMS for concepts and solutions.  Read Dan Khaneman, Dan Pink, Freakonomics, become a student of efficiency, productivity and truly strive to understand all the working parts of your system and how they interact with each other.  Sometimes a simple fix far upstream can steer the river.

 

Good luck!

-HM

Friday, December 1

Does your confidence exceed your abilities around the homestead?

The Crossover Show - 133

In this episode, MC and HM discuss how first responder personas and their inherent confidence/arrogance may land them in some proverbial (or possibly literal if we’re talking plumbing) hot water around the house.


What about you? Do any of your work experiences and your relative confidence surrounding them translate into possible problems for you at home?


On a side note, apologies for the lack of show last week! HM was traveling for the holiday and MCPD was rife with the flu. All of them. It was terrible.


BOLO


Sense Home Energy Monitor


Support the Show over at Patreon.com/TCS


Rate the Show!





The post Does your confidence exceed your abilities around the homestead? appeared first on .


Source: the Crossover Show

Wednesday, November 22

This post is about fentanyl so you shouldn't read it, you'll OD

The newest EMS urban legend is first responders ODing on fentanyl.  The tales start usually with a cop on a drug bust or a traffic stop who suddenly falls ill, fentanyl being the culprit.  That cop didn't have symptoms of opiod use, but the legend doesn't need facts to spread.  The anchors talk about their day when it was all over the place and the new guys are freaking out about how dangerous this job is.

The rest of us are just shaking our heads and wondering how they all manage to dress themselves in the morning.

Let's start with the obvious: Fentanyl is an opiod.  It's basically legal heroin for treating severe pain, or so say the little cards used to sell the pills to your Doctor.  Totally legal with a prescription there's a good chance that within 20 feet of you right now is enough fentanyl to put down a horse.

Yet you're still alive.

 

Then there are those less than reputable folks using fentanyl as a replacement for heroin.  They add a little fentanyl and a lot less heroin and can still give their customers that same high (or low, if you prefer).  More concentrated dosing can pose a threat to rescuers except for one thing:

It's outside your blood stream.

No rescuer is going to OD on fentanyl, carfentanyl or any other opiod or substance on the scene of an incident.  If medics respond to a CO poisoning, go in with no masks, then get sick, did they OD on CO?  Of course not.

 

Exposure is the word you're looking for.  Same as exposure to blood, feces or anything else on scene we have all the tools we need to not let something on the outside get inside.

Trouble is, when there isn't blood or something else nasty readily visible many in our ranks seem to let their guard down.  Using gloves with the clipboard, not having a drop pen, even driving with gloves on shows a lack of understanding of how things can transfer.  I've been seen touching patients without gloves on while they're poking out of my back pocket!  The horror!  But when I don't know everything, the gloves are on.  I even carry an N95 in that back pocket at all times, because you never really know.


We all need to take a deep breath and remember that while fentanyl is a white powder, we don't need to activate the HazMat team every time we think we see it.

Step 1:  Don't touch it.

Step 2: If you do touch it, rinse your gloves off.

Step 3: Don't rub your eyes, use your pen from your shirt, handle everything in the rig, then get surprised when you start to feel drowsy.

 

The urban legends came to life when an ambulance operator fell ill when driving to the hospital.  A quick thinking partner in the back was able to give him some Narcan and he improved, but that's a sign of accidental exposure, not an OD as was reported and shared online.  I don't have the details, but I understand how this powder works and how the skin and mucous membranes work and I can guarantee you there was a lapse in good isolation technique.

 

At a nasty choking recently, the intern got his gloves dirty and went to change them.  He took them off wrong, got vomit on his hands, then wiped his pant leg before learning the hard lesson that gloves don't go on wet hands.  His preceptor never taught him to double glove or to simply add a layer.  It's that kind of lack of basics that leads to an exposure.

 

Get back to basics before the fentanyl monster jumps up from across the room and dives down your throat and makes you OD.

Saturday, November 18

Off-duty: Intervene or Be a Witness?

The Crossover Show - 132

In this episode, HM and MC discuss off-duty actions. What are their (and more importantly, your) requirements/policies/moral obligations for acting during a given scenario.


Also…what about Worker’s Comp should you decide to take action and sustain some kind of injury? Are you in your jurisdiction? Are you considered on-duty?


*Disclaimer: As per usual, review and adhere to your department policies. Take the things these two knuckleheads say with a grain of salt.


BOLO


#MICC is #Done!!


The Slow Fix by Carl Honoré


Support the Show!


Rate the Show!





The post Off-duty: Intervene or Be a Witness? appeared first on .


Source: the Crossover Show

Friday, November 10

Mass Shootings in a Small Town: What are Your Resources?

The Crossover Show - 131

In this episode, MC and HM talk about the shooting in Texas that left over 2 dozen dead and as many more wounded.


The guys dive into what little is known about the Three Disciplines in the area and compare that to the Las Vegas shooting in October.


As always the conversation evolves (or devolves) and they’re back talking about what they’re reading and planning for the week.

BOLO


Sonoma Pride


Building a StoryBrand by Donald Miller


The Slow Fix by Carl Honoré


Support the Show!


Rate the Show!




SaveSave



SaveSaveSaveSaveSaveSave


The post Mass Shootings in a Small Town: What are Your Resources? appeared first on .


Source: the Crossover Show

Sunday, November 5

#TapTapTime: The Latest Trending Topic

The Crossover Show - 130

In this episode, MC and HM create a new hashtag:


#TapTapTime


Sure, there’s other things they talk about, but to be honest…#TapTapTime is the best part of the whole damn show.


They’re overly proud of it.


The guys talk about trying to get out of jury duty, shooting at actors, and getting FM transmissions over your phone.


They’re all connected. Promise(-ish).


BOLO


Secret drinks at CA Adventure’s Cove Bar


Support the Show!


Rate the Show!




SaveSave


The post #TapTapTime: The Latest Trending Topic appeared first on .


Source: the Crossover Show

Friday, November 3

Police Responsible for Ambulance Bills on College Campus?

Boy should they be.

Here's the story we're talking about and I can tell you this is a topic too often visited upon those who find themselves looking from a Police Officer to an Ambulance and wondering why either of them is there.

University Police at GW seem to think a policy they have overrides the rights of a Student and the authority of a duly licensed ET or Paramedic.

Adorable, I know.

 

Students have come forward challenging ambulance charges when they were found to have been suspected to have ingested alcohol and UPD forced them to the hospital, citing their policy.  Even students who passed field sobriety tests and gave breathalyzer readings below those required to operate a motor vehicle were still forced, using authority, to be taken somewhere they did not wish to go.

There's a word for that.  We've discussed it before and how so many EMS agencies don't understand it.

If the students are violating policy and are speaking clearly, able to walk and understand the risks of not seeking a physician evaluation (which pretty much consists of "you OK?") law enforcement can not coerce or force them to hospital unless they are taken into custody.

Otherwise this is cut and dry...

 

kidnapping by force.

Don't think so?  Local laws are usually vague, and even though the Officers may not be seeking ransom, guess who operates the Ambulance?  The University.  The policy is written to increase billable transports of the parent organization.  I'd argue that's enough, but include that the ambulance takes the person to a place where they may be harmed and I'd say we have a decent argument.  Far better then the policy to transport anyone who had a couple Bud Ice at a dorm party.  You can't force them to the hospital!  Give them a stern lecture?  Fine them at tuition time?

Or cite them.  Or arrest them, but you can't force them into the hospital.

So there's a simple bow on the UPD policy.  Took me 2 minutes.  Each and every student should file charges and demand UPD cover all ambulance and hospital charges relating to the forced relocation.  If campus drinking is such a problem, why not try some police work and prevent the drinking, or perhaps focus on those who over-imbibe and might actually need an ambulance?

Too much effort and paperwork?  I know.  Imagine the paperwork and effort you just forced all those healthcare professionals to waste, not to mention taking an ambulance out of service and clogging a hospital bed for 15 minutes.

 

You are liable for the events you created and you created one hell of a mess.  Drop the policy and pay the bills.

 

To any students seeking to challenge UPD or the university policy, I'm available as an Emergency Medical Services Subject Matter Expert for deposition in your case.  No fee.

 

 

Saturday, October 28

The Spooktacular Episode

The Crossover Show - 129

In this episode, MC and HM relive their childhood memories of the spookiest of days, All Hallows Eve.


Halloween, if you like.


Here’s a brief glimpse:


MC is ambivalent and HM actually makes his front yard a graveyard.


Also, they guys go deep intho their beliefs about the most underrated holiday in existence: Arbor Day.


You read that right.


Come join the guys as they wax all reminiscent.


No BOLO this episode.


Support the Show!


Rate the Show!





The post The Spooktacular Episode appeared first on .


Source: the Crossover Show

Thursday, October 19

"I'm out of ideas" Advanced Airway Seminar

Every time I try to dream up a clever title for a conference class I get stuck trying to not be too cute.  We all know the offenders who come up with something cute and clever as a class title, followed by a clinical description of the class.

Kind of like "Kids are suckers for a good joke - The Implications of Vaso Vagal Instructions using Humor on Children during Acute Asthma."  I still don't want to take the class but now I'm fascinated on how this is an hour long CE.

 

Not too long ago we had a call that could easily fill a 90 minute CE and we even accidentally named the seminar: "I'm out of ideas."

 

Called for the "possible heart attack," units are responding to a tough to reach location.  The last "possible heart attack" we were sent on was a man coughing so we're literally rolling into the unknown.  About 3 minutes into the response the first due rig asks dispatch "Can we determine if the nearby AED has been pulled (they're all alarmed) or if PD is on scene doing CPR?"

"Yes" is the only response.

Great.

 

PD, as always, is doing textbook CPR that puts the AHA video to shame.  They know our script and as we approach we hear one officer call out "15 minute down time, 1 shock delivered!"  Yes, you're jealous. No, you can't have them.

BVM, OPA and IV are almost  done in the background and an EPI is onboard as we prep for a tube.  I'm a big fan of keeping the BVM but considering the size of the patient and our trouble getting good chest rise we decide to go old school.

That would be the theme for the next 30 minutes.  Old School.

"Chords!  Passing!  End Tidal!" the medic calls out as if listing off his 3 favorite books, the blade snaps closed on the handle and is placed on the cold concrete as I begin to bag.

Nothing.

No sign of emesis, no stained clothing, evidence on mustache or chin...uh oh.  We have no sounds over the belly and zero compliance, confirmed with a big fat ZERO on the ETCO2. "Pull it and get the mask" I mention as the EMT draws the 10cc syringe out from the tube.

Mother. Of. God.

A solid 5 inches of rice, noodles and what appears to be either spinach or seaweed is clogging the tube and now filling the oropharynx.  Not in a wet, suctionable, as seen in Medic school fashion, but in an oddly dry, cakelike consistency.

"5 CALL!" is heard behind us as the local Ambulance arrives with a new hire student, ETT and camera scope in hand.

"Phew" I think.  This will be so much easier with a camera.

Wrong.  Remember our theme?  Old School.

The camera is constantly being obstructed by the food, the yank tip can't get the rice and noodle and the intern is wondering why we don't "just tube the bubbles?" Dude...that never works.

Suddenly the combined 75 years of experience begins to speak up,

"V-Vac!" Nope.

"Pull the yank tip off and just use the suction tubing!" Nope.

"Let's turn him to recovery and do some abdominal thrusts!" Oh yeah! Nope.

No matter of technology or mechanical maneuver was clearing the trachea.  19 year old me would have performed a surgical cric on him already but, alas, this is 2017 in California.  Besides, all we'd have is a new hole to clear.

"Options?" I ask the assembled crowd, CPR still in progress and a BVM standing by incase we get anything.  Before we knew what had happened 30 minutes had elapsed on the scene.  The BLS member keeping times on the Epi confirmed it.  Management of the scene was mine and time got away.  Dammit.

"We are leaving or we are done" and we began to load him up.  Quick thinking had the medic from the ambulance calling ahead to the nearby facility to warn them of this critical airway.

As we began the 5 minute walk from where he lay to as close as the ambulance could get we ran down the list of interventions attempted ending with...

"I'm out of ideas."

So was the ED.

Our preferred, dream intervention would have been an even bigger mess lying in the poorly lit garage.  We know that now from the absolute chaos the ED created.

 

It is important to remember that many of our interventions can take place enroute and others can not. Half of what we tried would have been impossible in the back of a rig and the other half just as useless but the major take away from this call was time.  Do what we can't do later now and do what we can do now, later.  While the old days of intubating with the long spine board on my knees in the back of the rig is over, we can't forget that, sometimes, that's what needs to be done.

You have a scope on your blade?  Do you know how to use it?  Do you know when it has exceeded its few limitations?

Do you know when to quit?

Do you have anymore ideas?  Because, if not, I'm calling it.

Tuesday, October 17

HM on Medic 2 Medic Podcast

Where are my manners?

Posting here has been irregular.  Sorry about that.  We've been doing this for just over 9 years now, so cut me some slack?

 

I had the honor of being a guest on the Medic2Medic Podcast not long ago and got to chat about this therapy space as well as what drives me as a caregiver. You can click over to the site HERE to have a listen and make sure you subscribe and leave a review over on itunes!

Wednesday, October 11

Respond to the Rollover - Tales from the Interwebs

In response to a recent post, a reader has requested I share a tale from their history.  I offer this service from time to time since it can help vent frustration for what it is we in the 3 disciplines do day in and day out.  You can hit me up in a DM on Twitter or FB or drop me an email.  If I like your story I make it my own and forget you ever lived.

This tale comes from a person calling themselves "Double Dispatcher."  Is it true?  I wish it wasn't.  Some details have been changed to protect the innocent, you'll see who they are in the end.  I have also made their 2 sentence story far more dramatic.  It's what I do.

 

THE EMERGENCY

"Rollover with injuries, at the Target Store, 32500 Center St.  Units due Engine 23, Truck 16, Medic 201, EMS Car 2, Rescue 3."

 

THE ACTION

We've been to a few decent wrecks at this intersection so the ears are up, the gloves are on and the beedoo beedoo is doing its thing.  Arriving at the intersection in front of the the Target we are met with frantic people in red polo shirts and khaki pants weaving between parked cars and waving us into the parking lot.

OK...

Into the lot we see no cars in odd places, on their sides, roof, in trees, or even crashed into the building.

"She's inside, cut up bad!" an employee shouts, then disappears apparently to put the Christmas Tree displays up. It is August after all.

Transmitting this new information we can think of no scenarios that led to a call for a rollover with injuries that could happen inside this large, two story Target...ohh well there you go.

At the base of the escalator, which has been shut down, is a small army of red polo shirts holding paper towel bandages to the arms and legs of an elderly woman who looks like she was attacked by a tiger.  Deep lacerations from the escalator look painful and we get to work.  Nearby is her Medicaid Scooter, shiny and new, on its side.

 

She rolled the scooter trying to ride it up the escalator.  In the apparent chaos and hearing the words "rolled over" "bleeding" and the address, radio did the only common sense thing and tapped it out as a rollover MVC.

 

The Truck was devastated they didn't have anything to cut.

 

Monday, October 9

Hazards we can most certainly remove

Code 3 for the fall!

Code 3 for the fall!

Code 3 for the...wait...you fell over what?

 

Escalator falls are serious business.  Not only do they hurt because of all the saw tooth edges, but they are designed to mash anything even slightly pliable without stopping until someone remembers where the shut down button is.

I am currently researching new ways to encourage people to remain still on escalators, more on that later.

 

First, the life or death emergency at the escalator. Well, kind of.  Well, there is one not far away.

I arrive on the scene to find a woman in her 50s on the ground near a suitcase on a tile floor.  It's a bit crowded and often folks will hurry around not realizing there are all kinds of obstacles when folks are dragging bags and such.  She is rubbing her ankle in a fashion that makes me wonder how much it can hurt if pressing it so hard.  One of the Administrative Managers has arrived and is already speaking to her.  These Managers are great.  They have the power to flex ANY resource to our needs.  In this kind of case I ask for the cameras to scroll back and see if we can figure out what happened.

Two reasons I do this:  First so that I can find out what kind of fall, if they struck their head, broke their fall etc.  Second, so that we may learn how to avoid another fall.  Was it a ridge where the tile meets the carpet?  Some other obstruction we can remove or better mark?

Most times we learn from it.  This time was only slightly different.

According to the security office, the video shows the patient place her bag on the ground, step away briefly, then walk right into it, falling to the ground.

 

No amount of signage will remove that obstacle I'm afraid.

Friday, September 29

Witty Banter with the Unaware - Volume 3324

One of the things I love...LOVE...about being a Paramedic is the ability to spot Trouble from across the room.  That's a capital T in Trouble, saved for those who need me to put a spring in my step and toss by bag and monitor strategically as I approach a person in need of immediate intervention.

That was last week.  haven't seen an IVR with pulses that slow in years...but that's another story.

This story is almost a call up from the past, back in the days of Medic 38, running 20+ calls in a shift.

3 calls are already running when a crew calls in that a person has collapsed not far away and are requesting an additional response.  Out the door I go knowing the local ambulance company will be flexed or delayed considering how many of their rigs are already on the property.

Usually it is the chronically inebriated who participate in my witty banter, not so this time.

Sitting in a chair, brand new T shirt for an out of town walk a thon, brand new simple black pants and brand new simple plastic flip flops.  This is the Shelter starter pack.  When folks goto some shelters, they get the dignity of a shower and some clean clothes.  For some it is enough to get through a rough patch, while for others it is simply a revolving door, similar to the ones very close by.

She sees me approach from behind the Policemen and her body language changes immediately.  Because I entered from behind the seating area I saw someone maintaining posture, moving hands and arms in concert with head movements and adjusting eyeglasses.  In short - everything is close to just fine.

As I approach she is suddenly slouching to one side, breathing at over 30 a minute and shaking her hands in the way only seen in TV shows and right there right then.

Our back and forth was swift because we have both had ample chance to practice.  Her chief complaint is severe, but vague, knowing what I can and can not assess.

My questions seem distracting and catching her off guard a few times, making eye contact, her frustration breaking the tachnypnea, just as I hoped.

When offered options suddenly a family was waiting for her, but she can't keep straight witch family members it is.  Mom, a son, a sick son (yes a different one) then a sister.

In the end she finally caved and admitted she felt fine but simply had no place to stay, to eat or the get help.  My feelings of victory were met equally with my compassion to help.  We don't always push a medication to help someone recover, sometimes we have to grease the wheels of the system to make sure someone who wants a chance to break the cycle can do so.

She ended up going to the hospital, simply because there was no other way to ensure she arrived at step one of her healing process, but she gave me a run for my money alright.

Thursday, September 28

the Crossover Ep 125 - Who Gives Two Sh*ts

Episode 124 is dedicated to SFFD Battalion Chief Terry Smerdel who died in the line of duty September 10th assigned to Battalion 1.



Episode 124 is dark in his memory.

On to #125...


In this episode, the boys are quick back to work, as Terry would have liked, talking about a comment on HM’s FB page. A rigid c-collar was placed on a suspect and HM wondered why. In jumps an LEO account who asked “who gives two shits about this guy?!”


What do a cop and fireman think of that comment?


What could it mean for the relationships of rescuers and officers at a scene where lives were put at risk?


BOLO






Support the Show!

Rate the Show!

 

LISTEN NOW!

Thursday, September 21

Why Giving Two Shits About a Patient is Not a Bad Thing

Those of you following me on FB probably already saw this comment and you can go there to find it, I want to summarize some thoughts here.

You may be wondering why on Earth the title of this post even has to be a thing.  A recent incident near my home led to law enforcement taking a man into custody following a motor vehicle collision.  A local media outlet was on scene and snapped a few pics.  One of them showed a man being assisted out of the back of a Police SUV, apparently with handcuffs on, and also wearing a cervical collar.

Being the keyboard commando I am I commented about the uselessness of the collar being applied, then the spinal movement of the patient seen in the photo.  My comment was about the application of the collar possibly not being part of the local SMR protocols and how I questioned the application.

In pops another keyboard commando, this time from the LEO side who said the following:

" Who gives 2 shits about this guy? He's a violent resister who put everyone at risk by running from the cops. He didn't care about our safety. Besides, he's walking fine. Pick another c collar "victim" as an example."

I responded that I give two shits about this guy.  Not only as a Paramedic but as a human being.  Did he hurt someone?  Are they being tended to appropriately?  The comment above is a perfect example of why some people can't tell the difference from "good cops" and "bad cops."  I'm not passing any judgement on the officers at the scene, just my fellow keyboard commando.

You're better than this.  At least I'd like to think you are.  Regardless of how someone gets injured, we need to help them.

He resisted?  I don't give two shits.

He put other people at risk? I don't give two shits.

You think we should let him suffer?  Now I give many shits.

He is uninjured?  I'll be the judge of that.

 

Your attitude wreaks of burnout and I hope it was just blowing off steam.  If this is how you truly, really, honestly feel you may not be far from making a career ending mistake.  I've seen it before, we all have.

Whether it's a comment taken out of context, an utterance in front of the wrong audience or negligence, it could happen very easily.

 

I too am sick and tired of people doing bad things to bad people and seeming to get away with it.  Perhaps that is where you should focus your anger and energies instead of getting upset that I'm curious as to how he is being treated.

 

Quick story:

Long ago I was called to the scene of an assault, 2 victims, PD on scene.  First patient was being tended to by the first in unit and they were already intubating her and getting ready to head to the landing zone on the nearby roadway.  Significant head trauma from a baseball bat.

My patient had bruising to his face and abrasions to his neck and chest from Police restraining him.  He was intoxicated and kept shouting some of the worst profanity I have heard in my life towards the young woman on the ground.  What sticks in my mind is how he kept describing the sounds of the bat on her head and how she "finally shut up."

Did I leave him there?  Did I ignore him?

No.  I did my fucking job and treated his wounds, assessing him for masking injuries, then driving him an hour to the hospital, thinking over and over how I hope he rots in prison, then in hell, then in hell again...all the while doing what I can to treat his wounds.

She died, he lived.  As far as I know he's still rotting.

Caring for the injured is not a choice we in EMS get to make.  I can't imagine withholding treatment based on someone's actions, especially someone accused of actions like so many cases we roll on day in and day out.

 

I will not mention the author of the comment on FB in case they take my original advice and delete the comment but just remember...what we say in public forums is only the tip of the iceberg of our true beliefs, feelings and ideas.

-HM

Thursday, September 7

the Crossover Episode 122 - Annual Kilted Show!

In this episode, MC and HM discuss their favorite charity: Their own!


September is here and that means one thing: no pants!



MC and HM are back to tell you why Kilted to Kick Cancer is the only charity you need to know about for the next 30 days.

Learn about how it started, why it seems quieter this year and how you can get a kilt and a t shirt for less than $100.


Visit Kilted to Kick Cancer to join!


Find your favorite Kilted Gear at the Kilted Army! We’ve got shirts, hoodies and other swag for you to pick up and get out there!


Get Kilted! Get Checked!

BOLO



 

LISTEN NOW!

Wednesday, September 6

Things keep getting worse for Cop who likes arresting Nurses

The initial story broke while Motorcop and I were at the Highland Games and facts were sketchy, but the body camera footage and subsequent facts told us most of what we already knew:

Detective Jeff Payne is a jerk.

Long story short, Detective Payne wanted blood from an unconscious person not under arrest or in custody.  In the ED, in full view of the staff, and with body camera rolling, he argued with charge nurse Alex Wubbles about whether or not he was going to "get my blood or not."

This happened a lot in rural New Mexico.  State Police would demand we draw blood, we would tell them to go pack sand.  If they wanted blood they need to get it from the hospital and with a warrant.

There are a boat load of comments being fired back and forth between medics and cops about this story, from "Why doesn't she just do it and be done" to "Why didn't he arrest her sooner?"

The specifics of the situation, at first report, were that the patient was conscious and not a suspect in the collision under investigation.  That's easy, he doesn't give consent, no blood draw.

Then we found out he was unconscious and the term "implied consent" started getting thrown around.  We in EMS used implied consent to treat the unconscious assuming that, if they were conscious, they'd want help.  We can't assume the patient would consent to the search of his body, which is what Utah considers a blood draw according to various sources, so that's out.

Detective Payne, we then learn, is also a phlebotomist.  OK, so he went to a few weeks of night school to draw blood.  Still can't take it without consent or placing him under arrest.

THEN we find out he's a PRN Paramedic?!  So, he's on both sides of the fence and still goes the extra mile to not only demand something he can try to obtain with a little Police work, but decides to physically restrain and arrest the charge nurse reminding him of his limitations?  And not just that, but he tries to go the bully route first and threaten to "bring all the transients here" to Wubbles' ED.  Smooth move, dick.  Who says that?  Honestly?  You're the kind of medic that would slam 2mg of Narcan at the doors of the ED and laugh when the patient vomits all over the staff I'd wager.

The charge nurse was holding the agreement that stated what you had to do.  She was on the phone with Hospital Admin reminding you of the policy and you chose the "macho" way to handle it.  Exert force and ask questions later.  Well, now he has lost his PRN Medic job and, thanks to the internet, his name will forever be associated with this event.

How hard would it be to work within the rules to get what you think you need?  Not hard at all.  It just takes not being a jerk.  Wubbles did the right thing being an advocate for her patients despite how easy it would be to let Payne in to violate that trust.

I hope the greater LEO community stops spinning the "He talked to his Lieutenant who ordered she be arrested" and pushes this guy out.  If this is what he does to a medical professional who pisses him off in public, on tape, imagine what he's doing when the cameras aren't rolling.

Payne isn't welcome in EMS after this toddler style melt down either as far as I'm concerned.  Forget a letter in your file, you're out.

 

Saturday, August 19

My Beautiful Blue Eyes

You may not know this about me, but I am remarkably humble.  As far as humble goes, I'm the best.  So it should be no surprise that when I get a compliment poolside in Las Vegas about my stunning physique, the wife's constant comments about my rugged handsomeness or even random comments from strangers in airports about my sparkling blue eyes, I always take it for what it is:

 

The alcohol talking.

 

Sure the young lady who commented on my "Dad bod" in Vegas probably meant it in a mocking fashion, based simply on tone and the giggles of her friends, but I was carrying 3 full Fat Tuesday frozen drinks just over a mile.  So yeah, I looked swole.

And, now that I think about it, the wife is under contractual obligation to support me, so there's that.

But the middle aged crisis 3 martini crowd must be honest, right?

In the middle of an assessment recently I was having a wonderful conversation with yet another passenger who seems to think that just because they aren't driving somewhere they can hit the bar no worries.  They hit the bar indeed, then the door of the plane and the floor...the entire time slurring "I'm...Ok...you guyzzzzzz..."

 

As we're discussing that there is no need to contact their lawyer prior to obtaining a blood pressure the patient suddenly stops talking, gazing at me, slightly tilting their head...

"You have sparkling blue eyes...did you know that?"

"Sir, thank you, but we really need you to help us out..."

 

That compliment is totally legit.

Monday, July 24

The Seizure Patient 500 - An EMS Race

Welcome back to the track, we have an exciting race lined up for you today!

In lane 1, returning despite multiple losses in recent hours, we have the Paramedics!  Trained to handle a number of emergencies, routine medical queries and even known to fight a fire here and there, they are armed to the hilt with just about anything to keep you alive for 30 minutes!

 

In lane 2, new to the race, is our caller.  Not entirely sure what's going on, he is quick to the phone and that easy to dial number has been ingrained into his brain since birth. "Police, Fire, Medical, DIAL 911!"

 

And in lane 3, also a new comer to the race, the seizure patient.

 

AND THEY'RE OFF!

 

Lane 3 is out into the lead quickly, having not slept last night and skipped breakfast to make this 6am flight.  She appears, well, no one knows for sure since everyone is half awake and not exactly sure what is happening.  No, wait...YES! Lane 3 is shaking nervous she is going to miss the flight suddenly seeing the time!

Lane 2 is close behind, grabbing the nearest phone and dialing that 3 digit number he knows so well.

Lane 1 is still in the starting blocks, they're going to have a lot of catching up to do.

Lane 3 has begun to cry, sobbing something about missing a dear friend!  What are we to do?!

Lane 2 has contacted the 911 dispatcher and is describing the shaking, sobbing person infront of them.

The dispatcher starts to collect more information NO WAIT! Lane 1 is finally on the go!  Instead of questioning the caller, we have already sent the Paramedics screaming out of the gate to a reported seizure!  They are gaining fast!

Lane 2 hangs up the phone and pulls ahead slightly, but the seizure patient has, YES! has been given a boarding pass and directed to pass through security!

The Paramedics are making amazing time rounding the 3rd corner in lane 1 and are about to catch up with the caller in lane 2!  This is exciting!

Seeing the caller stopped, the Paramedics stop as well, assuming as one would, that the person having the seizure would be at least within ear shot.

No!  It's a distraction!  Lane 3 has pulled so far ahead she can be seen running to her gate!

 

LANE 3 IS THE CHAMPION!!!

 

Second place is Lane 2, our caller, and the Paramedics appear confused but, hey, thanks for playing!

Saturday, July 22

Crossover Podcast - Ep 116 - That's Not Why we Have Cameras, Gary

In this episode, HM and MC talk about the Baltimore Cop and his alleged recording of planting dope.


Damn it Gary…
Officer Gary in Baltimore (not his real name…but probably is) didn’t listen to our last show about body cameras and filmed himself “allegedly” planting evidence at a scene.


Seriously.




The boys rake Gary over the coals as well as the other 2 officers watching this disaster in the making.


What would you do if one of your coworkers was about to pull a Gary? Is the camera the problem? Is it Gary? Is it the stellar alleys in Baltimore?

BOLO


Medic2MedicPodcast.com

Red Rising by Pierce Brown

The Warded Man by Peter Brett

Sean Eddy and Scott Kier…Troll Masters

Support the Show!

Rate the Show!

 

LISTEN NOW!

Wednesday, July 19

...for the head injury, PD on scene

Back into the "You called 911...for this?" format thanks to a recent interaction with the BIB (Boys in Blue).

 

Awoken by the tones at just past 130 in the morning.  Dispatch gives us the location and the chief complaint of "Head injury, PD on scene."  Shoot.  This could be a medium deal, I better head on over there and help my crews out.  After all, if the cops called in a head injury it could be serious.

Stop laughing, it's not nice.

On scene PD have awoken one of our regulars found asleep in public view, not unlike the dozen or so others trying to rest until their early morning flights.  None of those folks have been awoken and had an ambulance summoned for them though.

Being at the end of a public transit line, often folks wander out in search of food and shelter, not realizing where they are.

The officer talking to the person we are to assess is well known to us as a trouble maker.  This is the officer who always uses the "You can goto the hospital or goto jail!" argument just as we arrive onscene to most calls.  However, when a patient gets combative he's suddenly a few yards off sipping coffee.

Back to this call and I'm not seeing any blood on the floor and the person is sitting up in a chair.  I'm thinking the same thing you are...where's the head injury?

"She needs to goto the ER, she's got stitches."

Sure enough she turns her head towards me and I see a very nice, tight set of 4 stitches over a brow, maybe a day old.

"Looks to me like she's already been to the ER, Officer, but let's take a look."

"She can't stay here like that, she HAS to goto the hospital."

I pass the assessment off to the ALS crew and ask the Officer to step away with me.  Of course he does not.

"She doesn't HAVE to go to an ER if she doesn't want to.  And why did you call us?  This is a pre-existing injury.  It's like me calling PD for an armed robbery and you arrive to find Starbucks shorted me 15 cents on my coffee."

"She's got an open wound, can't stay here."

"I look over at the ALS crew fighting for a BP and wave them off. "Would you like a bandage for your stitches?" I ask her and she nods.  I reach in and pull out a standard size band aid and the Officer let's out a "Oh, hell, no.  She's going."

As he shifts his weight trying to figure out what to say next I obtain a refusal of transport and cancel the ambulance responding.  I then remind our regular that this isn't the best place to grab a nap and turn to leave.  That's when I see this call is about to get interesting.  Standing behind the officer is his Lieutenant, who calls him over ever so subtly.

"Officer (Jones)...a word please."

 

Sunday, July 2

Crossover Podcast ep 113 - Middletown Ohio or Deathville USA?

Yes, I'm back on this topic again.


MC and HM, our heroes, decide to dive headfirst into the Middletown, Ohio idea of no longer responding to overdose calls.


It goes very well and we actually see a glimmer of humanity in the soul crushing Motorcop.


Why stop at overdoses?


Why not stop responding to all the other repeat calls we get?



BOLO


Red Rising by Pierce Brown


The Warded Man by Peter Brett

 

LISTEN NOW!

Sunday, June 25

the Crossover Ep 112 - Are you a good hair boss or a bad hair boss?

The world's first and best Fire/EMS/Police Podcast keeps on keeping on with a show about hair.  And management.  In this episode, HM and MC discuss different leadership styles. From the Good Beat Partner to the Condescending Prick, leadership styles are as varied as the people that fill those roles.


What makes a supervisor good (besides the hair)? How can those of us being supervised offer constructive criticism/encouragement to a newer boss versus taking whatever is thrown at us from a supervisor that is “feeling his new stripes”?

Recently, EMScapades published a very telling cartoon (see below) that struck a chord with the guys and they spend this episode discussing it.

Here’s the cartoon from the fine folks over at EMScapades:


Support The Crossover Show!


Rate us on iTunes!


 

LISTEN NOW!

Stop Responding for Overdoses? Sign Me Up!

Middletown, Ohio.  Population 48,000 and change.  About 1/3 the number of people who pass through my service area in a day, has an opiod problem.  As the noted thespian Robin Williams stated in the motion picture Good Morning Vietnam "There isn't a marijuana problem in Vietnam...it's everywhere."

Middletown Ohio Councilman Dan Picard (No relation to the Starfleet Captain) is frustrated according to this story where he asked if EMS can just stop responding to overdose calls.  He applied the ever so American baseball "Three Strikes" correlation and asked if EMS could just not respond after a third ODcall to the same address.

Sign me up dude!

There's nothing I hate more than going to the same address and dealing with the same people for the same conditions.  Trouble is, your hamlet has done an incredibly poor job at dealing with the opiod problem and this is the fallout.  OH, and how do we differentiate between a foul and a strike?  After all the first 2 count but if they keep hitting it back and into the bleachers what do we do?

In the story Mr Picard notes that most of the OD patients are transients and not even residents of Middletown.  Well, shoot, Dan.  There goes your entire argument.

You see, when the call comes in it rarely mentions an "OD" or "Overdose" and since you said most of the overdoses are transients there is no consistent address to apply to them and deny the services.

But you know who we CAN start scaling back on?

Diabetics.  They are usually at home and the medications we give them are on par cost wise with narcan.

Seizure patients.  Again, usually at home or wearing a medic alert bracelet, the medications we give these folks are actually narcotics.  Imagine the cost savings if we stopped responding to their home after the third time we have to stop their seizure and get them breathing again.

I get it.  You're frustrated that people come into your little corner of the world, do drugs in the open, then have to be revived by your EMS system.  Costs are skyrocketing and you may not be able to have fireworks at this year's 4th of July party.  I get it.

Here's what you need to get, Mr Picard:

An understanding of addiction and a plan to prevent it.

The story points out that a new addiction center just opened and is starting to make a dent, but just a quick search has Middletown as a hot bed of illegal drug trafficking.  Maybe you should hire some more cops to intercept all of the fentanyl laced heroin and crystal meth rolling through town before holding back on the narcan?  After all, does that double in OD cases reported include home prescription ODs?  You know, of the people who you might actually give 2 cents about?

Oh, and one last thing before I go...you are quoted as saying

“I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life,” Picard said. “We need to put a fear about overdosing in Middletown.”

If withholding care is how you handle things I don't think many people want to goto Middletown in the first place.  Except to get drugs, which appears to be remarkably easy.

Saturday, June 24

Yup. Still Barfing

Somewhere along the lines the term "Emergency" has morphed.  I have argued in this forum and others that it is the patient's definition of "Emergency" that drives the system these days, not ours.  After all, what do we know?

But there has been a third party lurking in the shadows of EMS that has only been empowered by technology.  I am speaking, of course, about the third party caller.

Walking past a man sleeping in a doorway?  Whip out that cell phone and tell 911 that no, you can't see if he's breathing and no, you aren't going to go wake him up. Eww.

Now we're rolling lights and sirens to a "Man down, unconscious, breathing status unknown" when all you had to do was either keep walking or gently shake them.

Cell phones now allow a person to call 911 from across a crowded room without even making contact and asking a person if the want, or need help.

Case # 14,338,265 in point:  Last night.

Code 3 for the man vomiting.

Seriously.

Crews arrive to find a man vomiting into a trash bag, embarrassed, and waving off rescuers. "I feel horrible, but I'm fine."

30 minutes later crews are dispatched again for the "recall for the man vomiting."  As a supervisor I always like to roll on "rekindles" just to make sure everything is on the up and up.  After all, if the man changes his mind and now wants an assessment I need to make sure everything on the first contact was on the up and up.  Part of the way to this call I heard my crew on the radio, "This is the same person who refused assessment earlier, a third party called this in again."

So a special thanks to the person in the area who called 911 for something that happens all the time without approaching the person to ask if they need help, seeing him refuse Paramedics, THEN CALLING AGAIN.

 

What should have happened was this:

"911 what's the location of the life or death emergency?"

"Hi, there's a guy puking into a bag. I think he needs help."

"OK, walk over and ask him...I'll wait."

 

That would be so much easier, cheaper and better for all involved.  Instead, my medics hit the doorway and muttered "Yup, still barfing."

Wednesday, June 21

I Heard You, She Heard You, the Baby Heard You

This post is a vent of frustration that this therapy experiment was created for.  We bring you into the action where a full ALS assignment is standing by for an international overseas flight requesting Paramedics for a woman in labor.

Most of the time this is no big deal since airlines won't allow you to fly if you appear to be so pregnant that you'll deliver enroute to your final destination.  As the door opened the look on the face of the crew told us this would be the rare exception.

"Did you have a live birth on board?" I ask, formally as possible.

"Yes, it's a girl!" says the excited Purser.  He clearly has a great story to tell and I'll hear it after I get some APGAR and vitals from mom and the baby.

As has been happening far longer than we know, mom and baby did this all on their own.  A quick thinking passenger with kids of his own inspected the placenta and put it in a bag.  Our observation matched his and we're quickly giving mom a wipe down so she and baby can leave the plane with dignity, not covered in afterbirth.

Baby is about 4 hours old and doing just fine, we fashion a quick diaper and swaddle, making sure the EMTs without kids at home watch and learn.

When we later discussed the call and what happened immediately afterwards, everyone of the responders expected applause for mom and baby as we left the plane.

Dead. Silence.

It was Mom's long, billowy black gown, headscarf and olive toned skin, we would soon learn, that was causing the passengers to begin to draw conclusions and assumptions about what has transpired.

Out of the plane into fresh air and mom and baby are still doing fine.  The ambulance crew arrives with a fresh, green intern and we set him loose on the patients and close the thin curtain between the customs inspection/patient care room and the jetway where the passengers are about to leave.  It's a small area and there are a lot of us.

"Do you have a name picked out?" I ask mom soon after asking Dad for their travel documents and Passports to hand over to the Customs agent just outside.

Her answer was not Sally or Jane or anything else I recognized so I offered my congratulations and handed the documents outside.

"Enjoy your anchor baby" is heard more than once through the thin curtain as passengers begin to disembark the plane. "Good planning, enjoy free everything" is also heard and I begin to tense up.  Other disparaging comments are heard through the curtain but we can't leave the little room just yet.

They would not have said those things if they had the facts.  Or maybe they would?

Mom has a USA Passport.  Born and raised in the midwest.  Studied overseas, fell in love, got married and is returning home to have her baby near her parents.  Baby is 4 weeks early.

Baby isn't a citizen because Mom and Dad cheated.  Baby is a citizen because Mom is a citizen.

 

Have we really let things get so ugly that grown ass men will raise their voices to speak out against a woman and her newborn child simply because of her dress and complexion?

Yes.

The new parents planned on renting a car and driving out to the parent's place anyways, but first a trip to the hospital for a full exam for both and care and supplies for the drive. "Where do we even get a Car Seat?" Dad is asking, clearly still in shock of his new status in life. "Don't worry, the hospital will give you a list of everything you need before you make the drive home."

The drive home.

Is there a Doctor on board?

Or should the more accurate question on board an aircraft with a passenger feeling ill be "Is there anyone who has assessed a patient in person in the last, say 3-5 years?"

THE EMERGENCY

Tower reports an aircraft returning to the gate due to an unknown medical emergency, man unconscious.

THE ACTION

Units are racing over since a plane returning to the gate means delays and considerable cost to the airline and a loss of possible connections for those onboard.  It also means that the rest of that day for that plane and crew are now delayed.  They don't make this decision lightly.

The cabin doors open to a nervous looking flight attendant pointing us towards the rear of the fully packed 737, all 150 people wondering why they aren't in the air.

On the floor near the rear galley is a few vacant seats and no less than half a dozen people blocking our access.

"Hi folks, Paramedics, can I have all but one of you step out please?"

The man closest to me and still not at the patient's side simply breathes over his shoulder "I'm a nurse, we're going to get an IV going."

"I'd really wish you didn't until we have a look see.  What happened?"

"I told you," he says turning around so I can see the silly quote on his T-shirt, "We'll give a report once he's stabilized."

"Nope" comes out of my mouth as I direct him to be seated along with 4 more onlookers who have opened the MD kit on board and are slapping the AC of a man lying supine, shirt off, covered in vomit.

"Airway?" I ask so that my crews behind me can hear.  I step over the patient and pull the tourniquet on the far forearm and wipe vomit from the patient's mouth.

"He's dehydrated!" the woman calls to me from over her reading glasses. "I see it all the time in the office."

"He's unconscious and his airway isn't clear.  Folks thank you but please let us work." I said to the patient, who was slowly beginning to open his eyes.

A few moments later we have him breathing nice and deep, his color improving and we extricate him quickly down the aisle only now seeing the mound of vomit on the floor in front of one of the seats as well as partially on a young woman, clearly concerned for his well being.

 

Off the plane we are able to make a full assessment and place a line for some fluid.  Part of me wanted to go back on the plane and ask them what they were thinking trying so hard to start an IV on a patient with a mouth full of vomit, but I knew I'd be dismissed as an EMT who probably doesn't understand what it's like to treat patients on the mean streets of General Practice USA.

These folks are the minority but not the exception to the rule.  Luckily we are met with "Thank goodness you're here and a brief puff of dust as the person who helped until we got there gets out of the way.

Friday, June 16

the Crossover Podcast - Ep 111 - Paramedic Perv

Not me, you freak.

In this episode, HM and MC discuss pervy paramedics. Well, technically, just one medic. 


Here’s the link to the article to which the guys refer in this episode.


Not interested in listening to the guys wax philosophic about the appropriate time/place to get you a handful of patient breast? Here’s the Cliff’s Notes version:

FRIGGIN’ DON’T.

This Cliff’s Notes version of the show is brought to you by the fine people over at Patreon.com/TCS where you can go to support this very show!

BOLO


Wool by Hugh Howey

Orphan Black (Amazon Prime)

The Leftovers (HBO)

Support The Crossover Show!


Rate us on iTunes!


LISTEN NOW!

Thursday, June 15

Reporter Unclear of Aircraft EMS Operations

Our old pal the Social Medic, Dave Konig, has a new post up about a report from the Business Insider that inferred that EMTs were "under fire" for the way they removed a patient from an aircraft.

Dave's story is here.  Dave's story also has the link to the local news story of the event. I will not link to the Business Insider Article.  He doesn't deserve the traffic.

The author's name however, is Benjamin Zhang, and if he has a google search for his name running...Hi Ben, sit down and let's have a chat about patient care onboard an aircraft.

Just you and me.

You a transportation reporter and me a Rescue Paramedic Captain at one of the busiest airports in the world.  You know, expert to expert.

For those of you following along with Ben and I, one of the passengers on a flight had an issue with the manner in which an "EMT" removed a "dying woman" from the aircraft.  Mostly the issue was modesty, claiming the woman had no pants on as she was dragged off the plane.  She was found unconscious in the lavatory.  Happens quite often.

One passenger made comments about the situation.  Likely the same passenger who remained in their seat during the medical emergency onboard.  Likely the same passenger who sighs heavily when I board telling everyone that we'll be out of their way as soon as we can.

You see, Ben, the FAA requires that when a pilot requests medical assistance, that all passengers remain seated onboard the aircraft until the nature of the emergency can be determined and addressed.  This is most commonly Paramedics boarding the aircraft, assessing and treating the ill or injured and working closely with the cabin and flight crews to deboard as swiftly and as safely as possible.

In  my experience doing this exact thing we usually find someone low on sleep, food and water and high on exhaustion, booze and anxiety.  We walk them off or use a device called an aisle chair to remove them.  However, it sure is easier to wheel someone out of the upper deck of an Airbus A380 than it is a small commuter aircraft.  This being a 737 we can use the chair (props for getting the right aircraft in your thumbnail) but her being unconscious, the chair is not an option.

In those cases we use a drag or over seat board carry method.  If I have a patient in extremis and I can't intervene in the cramped quarters of the aircraft, we are extricating with all speed.  Ever stood in the rear galley of a 737 waiting for the restroom?  Exactly.

This may mean a slide board, blanket drag or a simple under arm carry/drag.  While we do try to retain modesty when possible, I'm sure you'll accept my condolences in the passing of your loved one because we took the extra time to put their pants back on before extricating them and doing our jobs.  I know you're simply rewording the local press version of events quoting 1 of the 150 some odd passengers on board which was disputed by multiple other passengers, the airline and the local EMS agency, but hey, headlines get clicks, right?

So do us all a favor, Ben, stick to writing about airplanes leaking fuel (which happens all the time you must know) or the newest mileage card offers but leave the commentary about Aircraft EMS to us, the experts.  Heck, I'll even offer to serve as a resource to you for your next headline about "Peanuts: Danger or Delicious."

 

-HM

The new rigs are here!

And we're wondering what happened to what we asked for.

In true municipal fashion we asked for a small, lightweight vehicle with a maximum height of 6'6" (this is a Paramedic first response unit, not an ambulance).  We needed some extra seats in the back and enough room for what we carry.

The folks who would have to work on it if it breaks down were in the loop and approved.  Everyone was onboard.

Then the bids came in and somewhere along the line the entire design had been changed.

The unit is too long, too tall and has none of the features needed to serve its primary goal.

In additional to all that is missing we have tons of space you can't access, features and extras we'll never use and the chassis and motor far exceed our needs.

Yet no one will step forward and explain what happened, where the disconnect was, where the requests of the line personnel who will use the unit were disregarded for this...this...THING.

But here it is.  It's ours now.  Brand new and that isn't nothing.

We'll rearrange the extra shelves someone thinks were a good idea and hopefully send them back for a credit.  We can use flashlights to light up a scene that isn't directly in front or to the side.  We can use the extra features to help out around town, towing forklifts or pulling cars out of ditches.

We're going to take these new rigs and love them because that's what we got.

It isn't anything close to what we need, but it's what we've got.

So we'll make it work.

No photos here, but watch the Facebook and Twitter feeds in the weeks to come as we put them in service.

-HM

Wednesday, June 14

the Crossover Show - Ep 110 - Do You Poop Where You Eat?

In this aptly titled episode, HM and MC  have a simple question for you: What would you do as a Paramedic, Cop or Fireman if your municipality offered you money to buy a home in your district?  What would HM do?  What would MC do?


Would you like to live where you work?  Work where you live?  MC brings up a difficult situation HM never considered as a fireman and both of your hosts get nostalgic about their Firefighter dads and having them both first due at home.


HM’s district offered just such a program and he doesn’t live anywhere near it.  Find out why.


BOLO is pushed aside this week for a long overdue edition of “Ask MC” where HM finds 3 stories from the disciplines and does his best to earn MC 1/8 of 1 Doubloon.


He actually doesn’t do as horribly as usual if you can believe it.


Support The Crossover Show!


Rate us on iTunes!


 

GO LISTEN NOW!

Monday, June 12

What to do for an allergic reaction...or not

Below was a situation I overheard from one of those crews who's rig you pass half parked, half landed in the ED, doors still open, engine still running and the back looks like a tornado hit.  I put a spring in my step inside thinking I could help transfer the patient to the cot or perhaps at the very least help the EMT get the cot out of the way.

The crew offered the following order of events as to their need to get into the ED as swiftly and as safely as they did.

Imagine yourself in these shoes:  You are driving with a friend and they begin to experience a scratchy throat and a hoarse cough soon after leaving the Thai restaurant you've both been wanting to try.  Here's what this person did...

  1. Keep driving

  2. Pull over at the corner market and get them some allergy medicine

  3. Drive some more

  4. When the coughing is too much for them to handle, pull off at a coffee shop and get them some hot chocolate

  5. Pull them out of the car, barely breathing and call your son, the Doctor

  6. After your son, the Doctor, screams for you to call 911 try giving him some of your seasonal allergy prescription medicine

  7. Call 911

  8. Get upset when Paramedics appear to be concerned about the severity of the allergic reaction

  9. Push cell phone into face of Paramedics with your son, the Doctor, on the line for instructions

  10. Call everyone you know and tell them you'll be late to the meeting because the Paramedics won't let you go


Elapsed time from onset of symptoms to 911 call estimated at 25 minutes.

 

Yeesh is right.

 

Call us first, folks.  There's no harm in us getting there, finding nothing wrong and letting you go about your day.  This person was put at significant risk for no reason other than a desire to get to where they had to be.

 

 

 

 

Monday, June 5

The Last Shift of the Lost Cause

...and I missed it.

 

While taking a few arguably well deserved days off no one even thought to call or even send a text when they found out Lost Cause, a Medic I keep butting heads with on calls, is no longer answering them for his employer.

I want to stop by and ask if anyone knows what happened, if it was the constant calls from me and other Captains or maybe the stress of the job or maybe even something completely unrelated...

 

I'd like to picture Lost Cause performing a job he understands in a field he can appreciate and getting satisfaction from it because we sure as hell weren't getting that in the old spot.

 

So here's to you, Lost Cause, mostly sure you know about my little therapy experiment here.  May your days be long upon the earth and never again be burdened with patient care decisions.

 

-HM

Sunday, June 4

The Crossover Show - ep 109 - Is that Cocaine or Anthrax?

In this episode, MC and HM talk about an old saying in the Fire Service: Cops suck at HazMat calls.


HM shares a story from el airopuerto about a cop who broke out in a sweat after incorrectly identifying the unknown substance found near a gate.


We discuss the importance of cops letting firemen be firemen and how jumping to conclusions could get someone hurt.


The boys also discuss the Willamette Writers Conference and how they’re presenting August 5th about how to to podcast for fun and profit.



BOLO






GO LISTEN NOW!

Thursday, June 1

How to respond when your spouse tells you to be safe at work

Each morning I roll out of bed, still mostly asleep, and get dressed in the dark and wife will wake up just enough to notice I'm leaving.  Somewhere in the back of her mind is the remote chance this is the last time we'll speak to one another, but in the front of her mind is the hope that I'll reset the coffee maker before I leave.

 

She has always offered some kind of goodbye usually including the natural "I love you" which was, is and always will be followed by an immediate reply, but I noticed a few years ago my response to her next sentence has changed.

"I love you. Be safe," is what her sleepy lips send my way and I used to respond "I love you, I will."

No more.

 

I can't remember when I stopped telling my wife I would be safe at work, but for the last few years I just haven't.  It has been replaced with "I'll do my best."

Maybe it was the few times I was nearly hit responding to a call, while wrestling a combative patient or arranging for quarantine for a known communicable disease from overseas, but it changed.

No one will come to my funeral and tell the wife "You know he told you he'd be safe, he lied!" but it just no longer feels right to tell her I'll be safe.  The best I can do is remind her that I'll be thinking of my family first as I go through my day of dealing with the unknown and should something happen, I did my best.

 

Do you have a ritual goodbye before your shift?  Has it changed over the years?

 

Thursday, May 25

Always, In Service - EMS Week 2017

EMS Week seems to be plugging right along, as usual, with a few nice things here and there.  New York Buildings lit up in Orange, Blue and White for example, or a day when ambulances are on display infront of City Hall like in San Francisco.

Coast to coast EMS Week reminds us that we remain an afterthought.

National EMS Organizations are only now catching up with 5-6 year old concepts while we on the rigs struggle to keep going day to day.  Happy with table scraps we seem content to uphold the status quo while listening to the same presenters at the same conferences speak on the same topics.  I'm not immune, but I do try to change things up.

This year's EMS Week slogan is "Always in Service" and I hated it just as much as the last ones.  It brings a connotation that we are always there to answer the call...Always ready to jump into danger.

The modern state of EMS is anything but.

A better, more honest slogan would have been EMS Week 2017: Any unit available to take a code 2 fall?

I decided to add a comma to this year's slogan, let me explain why.

Friend of the blog Scott Kier penned an article earlier this week that had me sitting in my chair for a good 15 minutes trying to figure out how he so clearly stated what I have been trying to say for years.  Read it HERE and come back.

You are not this job.

You are not this Calling.

You are a person with dreams and desires and hopes and fears and whatever else you cram into your waking hours.  If EMS falls in there somewhere...cool.  If you're here for the guts and the glory I still have the same bad news for you: There is divorce, depression and substance abuse in your future.

If you're here because one time, early on in all this thing we call EMS you made someone smile and that ignited a fire inside your soul...cool.

We are not always in service.  When heading home and I see a car on it's side in the trees, people pulling over and I have no gear...I keep driving.  What am I going to do without my gear?  Get hurt?  Maybe make a difference?  I've pulled up to too many scenes when on duty to see how folks like that can cause more harm than good.  Sure I stop sometimes but not always.

MC and I discussed this topic on a recent Crossover Podcast after he pulled over simply because no one else was.

 

I want to add a comma to this year's EMS Week slogan because I see it being embodied by so many for all the wrong reasons.  I want you to have a life outside EMS, just like Scott encourages and I want to take his theme and expand on it.

I want you to be a different person when you are at home.  I want you to be that big Baseball fan, gourmet chef or scrap booking king.  I need you as a little league coach, PTA board member and fund raiser.

When we hit AOR on the rig, I need you Always, in Service.

In Service to your partner, crew and company.

In Service to the community we protect.

In Service to make someone's bad day better, whether it be getting your ass handed to you with 15 runs in 12 hours or 5 take homes on the BLS car.

In Service to those who pick up the phone because they don't know who else to call.

In Service to those who need us just as much as those who don't, whether they know it or not.

 

Always.  Every call for service.

 

When we log off and get back to the yard, decompress and go back to being you.

Volunteer?  I need the same.  From the time you pager drops that tone to the time you're back home, back at work and back with the family I need 100%. Always.

 

It is easy to throw a slogan on a bumper sticker or a T-shirt but not until we start to live our lives without EMS will we realize just how important quality service is for our communities.

 

Always, in Service,

 

-HM

Friday, May 5

Lost Cause gets cocky

I do love a good medical call.  Don't get me wrong, I don't wish illness upon people, I just get really excited when I encounter someone suffering from something I can help with.  I don't mind the minor injuries and sickness that comes with not being prepared for your day but there is something about a person with an as yet unknown illness presenting in unique ways we must detect that makes me glad I paid attention in Paramedic School.

To be able to assess, combine a detailed history and list of meds, obtain an ECG and a BP then apply my diagnosis with interventions and reassessments is just...poetry.

But you all know where this is going if Lost Cause is involved.

 

Male, late 60s, over dressed for the weather, over weight for anything, pale cool and diaphoretic.  Dude read the textbook.

I'm onscene early getting an irregular pulse rate, maybe 6:1 early.  Chest Pain is a 7, down from a 10 after his nitro tab.

Ah ha.

I begin taking a BP as I prep the nitro spray.  as soon as I hear a "lub" at 160 I give him a spray.

"What do you need?" I hear from over my shoulder.

Lost Cause.  The Paramedic unsure of the use of 12 lead ECG and stead fast in their belief that Paramedics can not diagnose.  If Tor Eckman was on this rig they'd be a perfect matched set.

"Symptomatic chest pain with history, first nitro brought pain from 10-7, hypertensive, let's get him on the monitor."

"Do you want to goto the hospital today Sir?"  Oh hell no.  You did not just ask that of the clearly emergent cardiac patient infront of you.  Did you?

"No, I think I'll be OK" the patient says through gritted teeth giving a Levine's sign visible from the space station.

"ECG please. Prep for a 12 lead and let's get ready to move."

Lead II tells me most of what we need to know but the lab will want to see what we found.

12 Lead, after coaching Lost Cause on lead placement, shows infarct in Lead I, II, V2, V3, V4 and V5, ischemia in V1 and V6 and Lead I is somewhere in between the 2.

All criteria are met, everything indicates PCI facility without delay and nitro until I'm out. (you know what I mean)

Lost Cause looks up from the monitor only after the interpretation has printed, "Well, Sir, we can't," slowly he turns his head towards me and lets out a small smile, "diagnose you here.  We're not Doctors.  Do you want to go to the hospital?"

I stepped in.

"Sir, our assessment has led us to find your heart is under a massive amount of strain and needs immediate relief.  We are going to treat your symptoms based on our diagnosis and get you to definitive care without delay."

He agreed, Lost Cause let out a sigh.  The same sigh he had later during a retraining session I'm told.

 

The next day, on an overtime, I ducked into St Closest and asked in on our patient.  90% occlusions in 2 arteries and he's been stented.  The 2 arteries we saw on the 12 lead which guided our diagnosis, treatment and reassessment.

 

Friday, April 21

FDIC 2017 - Structural Response to Aviation Incidents: Engine Company Operations

I am honored to be invited back to FDIC for my third year, this time speaking on the expectations of the Engine Company when responding to aviation incidents.  I had been considering this course for last year's FDIC but wasn't sure exactly how to phrase some of the issues.

I gave it another year and tested some of the content on other audiences and here we are.

Attendees of the 0830 class on Friday (you can sleep in tomorrow) will be given the opportunity to learn about aviation incidents both on the airfield and off, as well as how to handle an aircraft on the wheels and off.  We won't go deep into ARFF tactics since we're focusing on the Engine Company response but we will cover the differences in responding with and without an ARFF element.

I'm not going to kill you with powerpoint or try to replace the 40 hour Basic ARFF class, just offer advice on how to handle a situation that is more common than active shootings and has the potential to cause massive disruption in your community.  However, don't think massive disaster, think more of a 70 passenger commuter jet making an emergency landing at a local airstrip used just for general aviation.  Probably no ARFF there...what will you do?



Come by Wabash Room 2 and get a FREE planespotting guide as well as a code for a FREE ebook.  There is literally nothing to lose except sleep.  See you there!